ResearctotheCurrentSituationofSmallandMedium-SizedEnterprisesPublicServicePlatformofChina
2024北京朝阳高二(上)期末英语(教师版)
2024北京朝阳高二（上）期末英语(考试时间100分钟满分100分)第一部分知识运用(共三节，30分)第一节完形填空(共10小题；每小题1分，共10分)阅读下面短文，掌握其大意，从每题所给的A、B、C、D四个选项中，选出最佳选项，并在答题卡上将该项涂黑。
I was in my home office on a cold Sunday when I heard a quick knock on the door. I ___1___ downstairs, threw open the door and saw my dad ___2___ something. wrapped up in paper in his arms. Strangely, he had given no hint (暗示) of it when we spoke on the phone last night.“Open it.” he said.I opened it to find a yellow begonia (秋海棠) It occurred to me that it was Mother’s Day.“But···but I’m not a mother.” I said, ___3___.My dad smiled, “Well, some special people aren’t mothers. but I think they ___4___ to get flowers, too.” With that, he hugged me and drove off.Later, I called to thank him and we got to talking a lot. That’s when he let me in on his little ___5___. He had decided that he would challenge himself to do one act of ___6___ per day. It had started several weeks before when he accidentally knew a friend of his was having a rough day. He knew she loved ice cream, so he drove straight to her house with a huge tub of ice cream.“She laughed ___7___ when she saw it,” he said, “It really delighted me to know that I had ___8___ her day.”When asked why, he added, “I already know about the importance of being ___9___ in the moment. So, I try to be there with each person I am spending time with. I want them to feel important and believe in the goodness in people in that moment.”I realized my dad was making a difference in people’s lives. ___10___, I also want to be more like my dad, who goes out of his way to make people feel loved and cared for.1. A. fell B. waited C. raced D. looked2. A. shaking B. pulling C. holding D. collecting3. A. annoyed B. confused C. worried D. disappointed4. A. deserve B. decide C. promise D. pretend5. A. celebration B. joke C. secret D. excuse6. A. faith B. courage C. appreciation D. kindness7. A. coldly B. excitedly C. proudly D. nervously8. A. kept B. spent C. predicted D. brightened9. A. present B. healthy C. patient D. humorous10. A. Depressed B. Inspired C. Terrified D. Astonished第二节选词填空(共10小题；每小题1分，共10分)(请务必将第11至20题的答案写在答题卡指定区域内)阅读下面句子，根据句意，从方框中选择恰当的词或词组，并用其正确形式填空。
2021年12月大学英语CET四级预测押题卷一和答案解析
2021年12月四级考试预测押题卷（一）Part I Writing(30minutes)Directions:For this part,you are allowed30minutes to write a letter to offer your suggestions to your cousin who sought your advice on how to make his resume distinctive.You should write at least120words but no more than 180words.Part II Listening Comprehension(25minutes)Section ADirections:In this section,you will hear three news reports.At the end of each conversation,you will hear four questions.Both the news report and the questions will be spoken only once.After you hear a question,you must choose the best answer from the four choices marked A),B),C)and D).Then mark the corresponding letter on Answer Sheet1with a single line through the centre.Questions1and2are based on the news report you have just heard.1.A)Two.B)Three.C)Four.D)Five.2.A)He called the police after the accident.B)He broke his arm in the accident.C)He was caught taking drugs.D)He was arrested by the police.Questions3and4are based on the news report you have just heard.3.A)A cure to brain cancer.B)A new surgical instrument.C)A pen that can identify cancerous tissue.D)A new drug that can eliminate cancerous tissue.4.A)Finding the border between the cancerous and normal tissue.B)Identifying the accuracy rate of the new device.C)Improving their speed of removing a tumour.D)Using the new device in brain surgery.Questions5to7are based on the news report you have just heard.5.A)To collect scientific data on it.C)To take photos of the storm on it.B)To monitor the storm on it.D)To investigate its environment.6.A)It has lasted for nearly350years.B)It has lasted for more that350months.C)It seems to be getting smaller.D)It seems to be getting larger.7.A)What initially caused the storm.C)What is the impact of the storm.B)What is underneath the storm.D)What makes the storm last for so long.Section BDirections：In this section,you will hear two long conversations.At the end of each conversation,you will hear four questions.Both the conversation and the questions will be spoken only once.After you hear a question,you must choose the best answer from the four choices marked A),B),C),and D).Then mark the corresponding letter on Answer Sheet1with a single line through the centre.Questions8to11are based on the conversation you have just heard.8.A)It’s for disabled adults.B)It’s in a sports centre.C)It’s rewarding and challenging.D)It’s compulsive in her community.9.A)The skills they need.B)The products they have.C)The market they target.D)The language they require.10.A)Diversify markets and sales strategies.B)Reduce costs and jobs.C)Learn from other companies.D)Listen to the opinions of experts.11.A)The salary and the workload.B)The office hour and the penalty system.C)The welfare and the holiday system.D)The ethical policy and the carbon footprint.Questions12to15are based on the conversation you have just heard.12.A)Double-decker buses.B)The traffic in London.C)Bus routes.D)Travels in Britain.13.A)It has no windows.B)People get onto it at the front.C)It has two carriages.D)It is open at the back.14.A)Uncomfortable.B)Noisy.C)Dangerous.D)Shabby.15.A)Bendy buses can help reduce the traffic jam.B)Bendy buses are more environmentally friendly.C)Bendy buses are convenient for people in wheelchairs.D)Bendy buses are more popular among tourists.Section CDirections:In this section,you will hear three passages.At the end of each passage,you will hear some questions. Both the passage and the questions will be spoken only once.After you hear a question,you must choose the best answer from the four choices marked A),B),C)and D).Then mark the corresponding letter on Answer Sheet1 with a single line through the centre.Questions16to18are based on the passage you have just heard.16.A)They had four toes.B)They were not as big as dogs.C)They lived in South America.D)They lived in thick forests.17.A)They had long legs and a long tail.B)They were smaller and had front eyes.C)They began to eat grass as well as fruit.D)They were bigger and had long legs.18.A)They evolved into donkeys in Asia and Africa.B)They used their long legs to run south to South Africa.C)They began to eat apples on the North American plains.D)They preferred grass to fruit and vegetables.Questions19to21are based on the passage you have just heard.19.A)Being rejected by friends and teachers.B)Staying away from his native land.C)Adapting to new study expectations.D)Keeping a balance between study and job.20.A)Talking with older brothers or sisters.C)Starting a conversation with close friends.B)Having a casual talk with a college student.D)Playing with friends on the same sports team.21.A)Follow traditions of with a college student.C)Respect the customs of different colleges.B)Take part in as many activities as possible.D)Take others’advice as reference only.Questions22to25are based on the passage you have just heard.22.A)They tend to harm wildlife.C)They are thrown away everywhere.B)They are hardly recyclable.D)They are made from useless materials.23.A)It is fatal.B)It is weird.C)It is very serious.D)It is complicated.24.A)The sea creatures that have taken in then are consumed by humans.B)The ocean’s ecology has been polluted and affected humans.C)Humans eat the seabirds that have swallowed plastic particles.D)Humans consume the fish that have eaten sea creatures with them.25.A)Its use has been drastically reduced.C)Most products use natural materials.B)It is still an indispensable material.D)The use of plastic items will be charged.PartⅢReading Comprehension(40minutes)Section ADirections:In this section,there is a passage with ten blanks.You are required to select one word for each blank from a list of choices given in a word bank following the passage.Read the passage through carefully before making your choices.Each choice in the bank is identified by a letter.Please mark the corresponding letter for each item on Answer Sheet2with a single line through the centre.You may not use any of the words in the bank more than once.Questions26to35are based on the following passage.A third of the planet’s land is severely degraded and fertile soil is being lost at the rate of24bn tonnes a year, according to a new United Nations-backed study that calls for a shift away from destructively intensive agriculture, The alarming____26____,which is forecast to continue as demand for food and productive land increases,will ass to the risks of conflicts unless____27____actions are implemented,warns the institution behind the report.“As the ready supply of healthy and productive land dries up and the population grows,competition is ___28___for land within countries and globally,”said executive secretary of the UN Convention to Combat Desertification(UNCCD)at the launch of the Global Land Outlook.“To___29____the losses,the outlook suggests it is in all our interests to step back and rethink how we are managing the pressures and the competition.”The Global Land Outlook is____30____as the most comprehensive study of its type,mapping the interlinked impacts of urbanization,climate change,erosion and forest loss.But the biggest factor is the___31___of industrial farming.Heavy tilling,multiple harvests ans___32____use of agrochemicals have increased yields at the____33____of long-term sustainability.If the past20years,agricultural production has increased threefold and the amount of irrigated land has doubled,notes a paper in the outlook by the Joint Research Centre(JRC)of the European commission.Over time,however,this___34___fertility and can lead to abandonment of land and ___35___desertification.A)absorb I)limitedB)abundant J)minimizeC)billed K)occasionallyD)decline L)optimizesE)diminishes M)rateF)expansion N)remedialG)expense O)ultimatelyH)intensifyingSection BDirections:In this section,you are going to read a passage with ten statements attached to it.Each statement contains information given in one of the paragraphs.Identify the paragraph from which the information is derived. You may choose a paragraph more than once.Each paragraph is marked with a letter.Answer the questions by marking the corresponding letter on Answer Sheet2.Take Naps at Work.Apologize to No One[A]In the past two weeks I’ve taken three naps at work,a total of an hour or so of shut-eye while on the clock.And I have no shame or uncertainty about doing it.I couldn’t feel better about it,and my productivity reflects it,too.[B]Sleeping on the job is one of those workplace taboos-like leaving your desk for lunch or taking an afternoon walk-that we’re taught to look down on.If someone naps at2p.m.while the rest of us furiously write memos and respond to emails,surely it must mean they’re slacking off(偷懒).Or so the assumption goes.[C]Restfulness and recharging can take a back seat to the perception and appearance of productivity.It’s easier to stay on a virtual hamster(仓鼠)wheel of activity by immediately responding to every email than it is to measure aggregate productivity over a greater period of time.But a growing field of occupational and psychological research is building the case for restfulness in pursuit of greater productivity.[D]Companies are suffering from tremendous productivity problems because people are stressed out and not recovering from the workday,said Josh Bersin,Principal and Founder of Bersin by Deloitte.“They’re beginning to realize that this is their problem,and they can’t just say to people,‘Here’s a work-life balance course,go teach yourself how to manage your inbox,’”Mr.Bersin said.“It’s way more complicated than that.”[E]To be sure,the ability to nap at work is far from widespread,experts said.Few among us have the luxury of being able to step away for a half-hour snoozefest.But lunch hours and coffee breaks can be great times to duck out,and your increased productivity and alertness will be all the evidence you need to make your case to inquiring bosses.[F]In an ideal world,we’d all solve this problem by unplugging early and getting a good night’s sleep. Here’s our guide on how to do just that.But the next best thing is stealing away for a quick power nap when you’re dragging after lunch.[G]In a study published in Nature Neuroscience,researchers tested subjects on their perceptual performance four times throughout the day.Performance deteriorated with each test,but subjects who took a30-minute nap between tests stopped the deterioration in performance,and those who took a60-minute nap even reversed it.[H]“Naps had the same magnitude of benefits as full nights of sleep if they had a quality of nap.”said Sara Mednick,a co-author of the study and associate professor of psychology at the University of California,Riverside.[I]Dr.Mednick,a sleep researcher and the author of Take a Nap!Change Your Life,said daytime napping can have many of the benefits of overnight sleep,and different types of naps offer specific benefits.[J]For example,Dr.Mednick said a20-to60-minute nap might help with memorization and learning specific bits of information.It’s just long enough to enter stage-two sleep,or non-rapid eye movement(R.E.M.)sleep.[K]After60minutes,you start getting into R.E.M.sleep,most often associated with that deep,dreaming state we all enjoy at night R.E.M.sleep can improve creativity,perceptual processing and highly associativethinking,which allows you to make connections between disparate ideas,Dr.Mednick said.Beyond that,your best bet is a90-minute nap,which will give you a full sleep cycle.[L]Any nap,however,can help with alertness and perception and cut through the general fog that creeps in during the day,experts said.[M]So how did we even arrive at this point where aptitude is inextricably tied(紧密相连)to working long, concentrated hours?Blame technology,but think broader than smartphones and laptops;the real issue is that tech has enabled us to be available at all times.[N]“We went through a period where people were in denial and business leaders were ignoring it,”Mr. Bersin said.“They were assuming that if we give people more tools,more emails,more Slack,more chatter,and we’ll just assume they can figure out how to deal with it all.And I think they’ve woken up to the fact that this is a big problem,and it is affecting productivity,engagement,health,safety,wellness and all sorts of things.”[O]It isn’t just office workers who can benefit from an afternoon siesta(午睡).A2015study published in Current Biology looked at the at the sleeping habits of three hunter-gatherer preindustrial societies in Tanzania, Namibia and Bolivia.[P]“They’re active in the morning,then they get in the shade under the trees and have a sort of quiet time, but they’re not generally napping,”said Jerome Siegel,professor of psychiatry and biobehavioral sciences,and director of the U.C.L.A.Center for Sleep Research,a co-author of the study.“Then they do some work and go to sleep,and they sleep through the night.”[Q]Still,Mr.Siegel said,“the only genuine way to solve daytime sleepiness and fatigue starts the night before with a solid night’s sleep.”The real Holy Grail of restfulness is a regular sleep schedule with ideally seven or eight hours of sleep each night,which experts say is optimal.[R]“Daytime napping certainly does increase alertness,”Mr.Siegel said.“But it’s not as simple as going to the gas station and filling the tank.”[S]He also advises avoiding caffeine late in the day and waking around the same time every morning,even if you can’t get to sleep at the same time every night,This helps acclimate(使适应)your body to your regular wake-up time,regardless of how much sleep you got the night before.[T]So if you’ve made it this far and you’re interested in giving workday naps a try(or just starting to nod off),here’s a quick guide to the perfect nap;Find a quiet,unoccupied space where you won’t be disturbed.Try to make your area as dim as possible(or invest in a sleep mask you can keep in the office).Earplugs might help.too.Aim for around20minutes.Any longer than that and you’re likely to wake up with sleep inertia(睡眠惰性)，which will leave you even groggier(头脑昏沉的)than before.36.Participants’perceptual performance became better after sleeping one hour between tests in an article inNature Neuroscience.37.Jerome Siegel found that only by sleeping soundly through the previous night could people tackle theirweariness during the day.38.Our talent is closely bound to working with concentration for long periods of time because technologymakes us accessible24/7.39.Taking a nap at work is normally regarded as laziness that should be held in contempt and avoided inworkplace.40.Between20to60minutes,people can get into non-REM sleep which may improve memory and learningability according to Dr.Mednick.41.People can doze off at lunch and coffee breaks and defended themselves by saying their improvedproductivity and alertness when bosses investigated their whereabouts.42.The author’s tips on taking a perfect nap involve sleeping place,environment and duration.43.The author believes business leaders are aware that availability at any time due to technology has negativeeffects on every aspect of people’s life.44.The optimal length of a nap was an hour and a half so that people could go through a complete sleep cycle.45.Josh Bersin mentioned the cause of companies’big productivity problems and the solution which needsmore that just employees’efforts.Section CDirections:There are2passages in this section.Each passage is followed by some questions or unfinished statements.For each of them there are four choices marked A),B),C)and D).You should decide on the best choice and mark the corresponding letter on Answer Sheet2with a single line through the centre.Passage OneQuestions46to50are based on the following passage.Every office worker hates meetings.But it’s a strange sort of hate,similar to the hatred of Londoners for the Northern Line,or New Yorkers for tourists who walk too slowly:the dislike is real,yet if the despised thing were to vanish,it’d be like surrendering a piece of your soul.When researchers probed into why people put up with the strain that meetings place on their time and sanity, they found something-those who resent and dread meetings the moat also defend them as a“necessary evil”, sometimes with great passion.True,research suggests that meetings take up vastly more of the average manager’s time than they used to.True,done badly,they’re associated with lower levels of innovation and employee wellbeing(幸福).But that’s just office life,right?It’s not supposed to be fun.That’s why they call it work.Underlying(引起)this attitude is an assumption that’s drummed into us not just as workers but as children, parents and romantic partners;that more communication is always a good thing.So suggestions abound for(大量存在)communicating better in meetings-for example,hold them standing up,so speakers will come to the point more quickly.But even when some companies consider abolishing meetings entirely,the principle that more communication is better isn’t questioned.If anything,it’s reinforced when such firms introduce“flat”management structures,with bosses always available to everyone,plus plenty of electronic distraction.In fact,constant connectivity is disastrous for both job satisfaction and the bottom line.And anyway,once you give it three seconds’thought,isn’t it cleat that more communication frequently isn’t a good thing?Often,the difference between a successful marriage and a second-rate one consists of leaving about three or four things a day unsaid.At work,it’s surely many more than four,though for a different reason;office communication comes at the cost of precisely the kind of focus that’s essential to good work.Yet we’re so accustomed to seeing talking as a source of solutions-for resolving conflicts or finding new ideas-that it’s hard to see when it is the problem.46.What does the author say about meetings?A)Londoners hate them as well as the Northern Line.B)They can help to keep workers’physical and spiritual health.C)Workers might be reluctant to give up them completely.D)New Yorkers dislike meetings more than Londoners.47.What did researchers find about people’s attitude towards meeting?A.Their attitude and behavior are paradoxical.B)People who hate meetings the most are senior insane.C)Those who like meetings might be considered insane.D)More meetings are regarded as a sign of less innovation.48.Why do people think that more communication is always a good thing?A)Because the concept is firmly believed by workers.B)Because everyone loves to communicate with others.C)Because the idea has been instilled into people’s mind.D)Because communication is vital for building relationships.49.What does the author think of the“flat”management structure?A)It forces bosses to frequently contact their employees.B)It helps to soften employees’bottom line of work.C)It is definitely a disaster to employees’job satisfaction.D)It strengthens people’s deeply-rooted notion of communication.50.What is the author’s argument about office communication?A)It is an effective way to solve office conflicts.B)It affects work efficiency in a negative way.C)It should come to a halt at intervals.D)It is useful for workers to find new ideas.Passage TwoQuestions51to55are based on the following passage.The Internet has enabled the spread of information at lightning speed.This information revolution has created tremendous business opportunities for online publishers,but not all of them maintain proper quality-control mechanisms to ensure that only good information is being shared.Instead,many publishers aim simply to make money by whatever means possible,with no regard for the implications for society at large.When selfish publishers set up shops online,the primary goal is to publish as much as possible,often at the cost of quality.In this respect,many publishers start numerous online journals focused on overlapping(重叠的)disciplines—to increase their total number of published papers—and hire young business managers who do not have any experience in either science or publishing.In some cases,online publishers even give up peer review, while still presenting themselves as scientific journals—deception designed to take advantage of scientists who simply want to share their research.If publishers structure their business to make more revenue,it often does harm to their products.When publishers start journals with overlapping domains,in combination with the pressure to publish more studies,this could promote the publication of marginal or even questionable articles.Moreover,publishers with multiple overlapping journals and journals with very narrow specialties(专业)increase the demands on the time and efforts of willing reviewers.With the fact that reviewers are generally not compensated for their time and effort,journal editors are often unable to find enough reviewers to keep up with the increased publication rate.To improve the situation and increase the trust in scientific community,the pressure to publish must be reduced.Funding and promotion decisions should not be based on the number of publications,but on the quality of those publications and a researcher’s long-term productivity and instructions.And that’s just the start.We need additional mechanisms,such as Beall’s list of predatory(掠夺的)publishers, to alert scientists to fake journals and fake articles.In addition,the price for online publication must be controlled and a mechanism must be put in place to honor and reward hard-working reviewers.51.What does the author think of online publishers?A)A small proportion of them can guarantee their publishing quality.B)They have lots of opportunities to renovate their business models.C)Many of them tend to try every means to make a buck.D)Social impact is their first priority when publishing books.52.It can be inferred from the second paragraph that______.A)peer review generally is a criterion to identify academic journalsB)researchers focus their research on the combination of disciplinesC)scientists care about their publications rather than researchD)young business managers are willing to face new challenges53.Why can’t publishers find enough reviewers to review papers?A)Reviewers are pressed for time when reviewing articles.B)Reviewers’gains can’t make up for what they have done.C)Publishers may compel reviewers to accept marginal articles.D)Publishers urge reviewers to increase publication rate rapidly.54.What is the author’s suggestion for online publication?A)More weight should be put on the quantity of publications.B)It is worthwhile to reward diligent reviewers for their effort.C)Fake journals should be reported to a regulatory organization.D)The price of online publication should be lowered greatly.55.What is the main idea of this passage?A)Online publishers should take measures to fight against fake scientific journals.B)Online publishers are pursuing their work efficiency at the cost of quality.C)Online publishers business models are quite likely to harm their publications.D)Online publishers are sacrificing the quality of research articles to make money.PartⅣTranslation(30minutes)Directions:For this part,you are allowed30minutes to translate a passage from Chinese intoEnglish.You should write your answer on Answer Sheet2.春节是中国的传统节日，相当于美国的圣诞节。
上海市金山区上海交大南洋中学2022-2023学年高三英语第一学期期末检测试题含解析
2022-2023高三上英语期末模拟试卷注意事项：1．答卷前，考生务必将自己的姓名、准考证号、考场号和座位号填写在试题卷和答题卡上。
用2B铅笔将试卷类型（B）填涂在答题卡相应位置上。
将条形码粘贴在答题卡右上角"条形码粘贴处"。
2．作答选择题时，选出每小题答案后，用2B铅笔把答题卡上对应题目选项的答案信息点涂黑；如需改动，用橡皮擦干净后，再选涂其他答案。
答案不能答在试题卷上。
3．非选择题必须用黑色字迹的钢笔或签字笔作答，答案必须写在答题卡各题目指定区域内相应位置上；如需改动，先划掉原来的答案，然后再写上新答案；不准使用铅笔和涂改液。
不按以上要求作答无效。
4．考生必须保证答题卡的整洁。
考试结束后，请将本试卷和答题卡一并交回。
第一部分（共20小题，每小题1.5分，满分30分）1．—What's wrong with him? He seemed upset.—He had to give up his drawing, not because he wanted ________ that way but because he had to be.A．this B．oneC．it D．such2．—I keep on meeting with difficulties in the experiment. I can hardly go on. —Where there are difficulties, there are ways to get over them. ________A．Suit yourself. B．Good for youC．Pull yourself together! D．What’s the deal?3．To be an expert, a beginner needs to go through a series of _____ stages. A．intermediate B．liberalC．overall D．demanding4．But for your instruction, I ______ such great progress in so short a time. Thanks a lot. A．wouldn’t make B．hadn’t madeC．won’t make D．wouldn’t h ave made5．He is very tired，so he needs some time ________ duty for relaxation and rest. A．through B．onC．with D．off6．It is immediately clear ______ the financial crisis will soon be over.A．since B．whatC．when D．whether7．Many developing countries are unwilling to pursue their economic development______ destroying the environment despite there being several financial crises.A．at the risk of B．at the cost of C．at the end of D．at the mercy of8．—Is Peter coming?—No, he____ his mind after a phone call at the last minute.A．changes B．changedC．was changing D．had changed9．He wrote a letter ________ he explained what had happened in the accident. A．that B．whichC．where D．what10．We are committed to creating a world free from the homeless and the hopeless, a world _______ each and every corner is a true paradise.A．that B．whichC．of which D．from where11．The children wrote magical stories together, _____ imaginary worlds of romantic and military adventure.A．to spin B．spinningC．having spun D．to have spun12．The government spokesman has to ________ his words before responding to reporters.A．pass B．weigh C．cover D．express13．When I was small, my mom ________read me stories at night.A．could B．shouldC．might D．would14．When he was running after his brother, the boy lost his ___ and had a bad fall. A．balance B．chanceC．memory D．place15．After he was promoted to the present position, he is not so hardworking as he______.A．was used to B．used to be C．was used to being D．used to16．Why do you turn to me for help ______ you can easily work out the problem independently?A．until B．whenC．after D．unless17．The biggest problem for most plants, which ________just get up and run away when threatened, is that animals like to eat them.A．shall not B．can'tC．needn't D．mustn't18．It's said that the power plant is now large as what it was.A．twice as B．as twiceC．twice much D．much twice19．As to the long-term effects of global warming some believe that the damage has been done, ______________________.A．otherwise we take steps to make up nowB．now that we take steps to make upC．whether we take steps to make up now or notD．unless we take steps to make up now20．— I am gaining weight. I need to see a doctor.— But I think you eat too much. ___________.A．Neglect of health is doctor’s wealth B．Laugh at your ills, and save doctors’ billsC．Diet cures more than the doctor D．An apple a day keeps the doctor away第二部分阅读理解（满分40分）阅读下列短文，从每题所给的A、B、C、D四个选项中，选出最佳选项。
2023年考研英语二真题试卷+参考答案及解析【详细版】全
2023年全国硕士研究生招生考试（英语二）参考答案及解析Section Ⅰ Use of EnglishHere’s a common scenario that any number of entrepreneurs face today: you’re the CEO of a small business and though you're making a nice 1 , you need to find a way to take it to the next level. what you need to do is 2 growth by establishing a growth team. A growth team is made up of members from different departments within your company, and it harnesses the power of collaboration to focus 3 on finding ways to grow.Let's look at a real-world 4 . Prior to forming a growth team, the software company BitTorrent had 50 employees.Working in the 5 departments of engineering, marketing and product development. This brought them good results until 2012, when their growth plateaued. The 6 was that too many customers were using the basic, free version of their product. And 7 improvements to the premium, paid version, few people were making the upgrade.Things changed, 8 , when an innovative project marketing manager came aboard, 9 a growth team and sparked the kind of 10 perspective they needed. By looking at engineering issues from a marketing point of view, it became clear that the 11 of upgrades wasn't due to a quality issue. Most customers were simply unaware of the premium version and what it offered.Armed with this 12 , the marketing and engineering teams joined forces to raise awareness by prominently 13 the premium version to users of the free version. 14 ,upgrades skyrocketed, and revenue increased by 92 percent.But in order for your growth, team to succeed, it needs to a have a strong leader. It needs someone who can 15 the interdisciplinary team and keep them on course for improvement.This leader will 16 the target area, set clear goals and establish a time frame for the 17 of these goals. This growth leader is also 18 for keeping the team focus on moving forward and steer them clear of distractions. 19 attractive, new ideas can be distracting, the team leader must recognize when these ideas don’t 20 the current goal and need to be put on the back burner.1.A. purchase B. profit C. connection D. bet2.A. define B. predict C. prioritize D. appreciate3.A. exclusively B. temporarily C. potentially D. initially4.A. experiment B. proposal C. debate D. example5.A. identical B. marginal C. provisional D. traditional6.A. rumor B. secret C. myth D. problem7.A. despite B. unlike C. through D. besides8.A. moreover B. however C. therefore D. again9.A. inspected B. created C. expanded D. reformed10.A.cultural B. objective C. fresh D. personal11.A. end B. burden C. lack D. decrease12.A. policy B. suggestion C. purpose D. insight13.A. contributing B. allocating C. promoting D. transferring14.A. As a result B. At any rate C. By the way D. In a sense15.A. unite B. finance C. follow D. choose16.A. share B. identify C. divide D. broaden17.A. announcement B. assessment C. adjustment D. accomplishment18.A. famous B. responsible C. available D. respectable19.A. Before B. Once C. While D. Unless20.A. serve B. limit C. summarize D. alter【1】B. profit 原文提到“小公司的CEO也挣到了大钱”。
外文文献——精选推荐
外⽂⽂献外⽂资料New product launch strategy research for the market1. The problem definitionStandard marketing mode, most companies to market a standardized large-scale studies, and on the basis of market segmentation, and step by step into a different choice segment market, so the enterprise new product strategy are also aimed at a market segment, standardization to from concept to product (see new product development strategy) of the new product development process. So they selected for the crowd to market feature has detailed understanding, and in the form of official product before, its product planning, packaging and price plan, target user group of the definition, market promotion plan, and so should is very clear.Conventional marketing model: in some industries, its product development is hard to follow from concept to product model, such as medical products, some of IT products, they are more based on solving problems orientation, consumer is hard to understand. Some products are in another market such as the European market developed, directly transplant into the Chinese market, also do not need to experience from concept to product process. For these new products, they were in the market before, with no early market research support, should make a series of market research, in order to solve the listed strategy formulated faced problems.For such products, appear on the market with the marketing people often before the main problem is that target user group is what kind of person? How big a target market? Target users for price, packing opinion is what kind of? How to reach the promotion of such a target population? How many target user group of people will buy our product? Competitors are? They in the market condition? How to establish and competitor strategy?2. The research for the clients are often saying, "yes, that's to solve these problems, help us to do a market survey,". In fact, to solve the above problems need to more elaborate market research to complete.Market segmentation research-market segment, choose target marketThe market localization to target market, provide the diversity of the products or product characteristics of the products with differentiationBrand image research-aimed to brand market special personalityTest market analysis-selected effective test marketEarly market research-understanding buyers and track their products and overall evaluation of the marketing strategy3. Market segmentation of studiesMarket segmentation purpose: to segment the market, choose target market.Market segmentation research methods: user use and attitude research (U&A).Market segment of steps:Deep visit or forum. Help researchers clear target classification of respondents, competition the characteristics of the products, the consumer attention product attributes, etc., thus the large-scale quantitative research for then prepare design; Researchers U&A of questionnaire, and data collection, sorting data, do basic data analysis;Using the factor analysis and cluster analysis, AnswerTree technology do all kinds of analysis, from different Angle to provide different segments of the pattern.Evaluation of the subdivision MASA conditions: can be used to subdivision variables as many as dozens of, has a population of characteristic, the product use and buy characteristics and other natural features, also can be all kinds of psychological characteristics, such as creativity, etc. In a word, can from any Angle the market any subdivision, but really good market segment case required MASA conditions: market size measurement (measurement), target user can reach (accessibility), market is big enough (substantiality), the son is not insurmountable market access barriers (actionability). Choose target market five mode:Target centralization-manufacturing a product, only to select a target son market, focus on marketing. Suitable for theresource is limited, and less competitive situation.Product specialization-manufacturing a product, more than in the similar son market, focus on marketing. Suitable for company productivity is weak, the less competitive.Professional production more market-a kind of products to meet customers a variety of needs. For example, specifically for hotel produce different electric appliance.Selective specialization-choose several different son of market, and son different market production of different products. Full access to-for each child market production of different products.Choose target market of 3 kinds of marketing strategy:There is no difference marketing strategy-not segments of the market, the company launched a single product to the market, use the same marketing way;The differential marketing strategy-will be big market segments, according to the company's resources and ability choose some son market for different son market with different products, take different marketing plan;Focus on marketing-for several more homogeneous son market use the same marketing strategy.Selector market must consider three factors:A small molecule market a quantity to whether enough big, growth speed and whether enough growth, so as to ensure that the company in this business have improved;The son of market competition status? How many competitors? Strength? Will you draw new competitors? The buyer power strong or weak? Power supplier strong or weak? Etc.?Coincide with the company's strategic objectives? The company resources in support of these children in the market whether enough ability?4. The market localization company once chose a son market as a target market, also was made clear in the future of the customer service type, and competitors. Therefore, the next of the company to consider how to make their products look and the competitor's products are not the same, so that the user more choose their own products, achieve the purpose of from the competition. This is the market localization.The market localization four strategies:The first strategy-to the user to send a "we are the best," so suddenly bring yourself with other distinguish between products out;Old two philosophy-this is because the United States Avis rental company's famous advertising and of the formation of a strategy, the performance is a spirit striving to make progress;Uniqueness strategy-through the market research to find a unique aspects in the market, according to the basic points to dress. Such as haier quick service response, wave server experts, etc.;"Alongside pointed" strategy-just as its name implies, find a common accepted characteristics, their products and other people are the products of the said to be kind of. For example, when you don't know much about Singapore, Singapore and Hong Kong media claims as "Asian tigers", help people at the Singapore from numerous small countries in Asia indistinguishable, become a and unique countries. This is the power of the positioning.The market localization method: can from every Angle to position yourself of the product or brand. The concrete methods see "market positioning research".Market positioning of the three steps:Sure potential unique advantages through the market research symposium of the research, the scale of the quantitative questionnaire survey, clear alternative several unique advantages point;Determine the core advantage by taking into account of the market competition situation, the company's resources and so on, clear the core of the product competitive advantage;Promotion core advantage through a series of integrated marketing solutions, to the general user clear transfer the core of the product competitive advantage.5. Test market after segments of the market, select the target market, and made clear the son of product positioning, below is the product into the market to inspection. For each kind of product, it is always the orderly market. First of all, find a small range of market for some time, right amount promotion support, watching the market reaction. The market was to test the market.Test market is not only to test the product, the marketing plan, more important is to observe the user of the product characteristics and the early in their use of the reaction.6. Early market tracking study after test after test market, products will be in the parts of the market on the first, and with the corresponding marketing do support. When the product into to reach 2-3 months later, early users have accumulated to a certain amount, this is should be a right amount of quantitative research, the purpose is to study the user characteristics, users of the product, and the reaction to the market competition.7. The national promotion when products in the small scope market sustained, the next step is to the broader scope or nationwide market matures. Enter the national market, products face user features will each are not identical, the competition pattern will also extremely complicated, so the range of use and attitude research, and competition condition is very necessary. At the same time, because of the current is the big market, the power of the brand gradually become prominent, so do the brand research has also become more and more important.Case: the Chinese market in research (industry market research)The client's name: a European famous multinational companyBusiness areas: building materialsBusiness content:The next five years the market forecast analysis;Area market forecast analysis;Potential customer demand survey;Market segmentation and confirm the target market;Such products in price analysis;Supply and demand analysis;Main competitor analysis;Major media and publicity channels and related public price;The investment cost survey analysis;The main entry strategy development.The report time: 40 working daysNew product development strategy research for the market1. The definition of new products at least can have two kinds: first, it comes from some existing product line is outspread, such as business has launched ordinary washing powder, and then again the extension of fragrance, develop new products with apple the fragrance of washing powder. This new product is the extension of ordinary washing powder. Second, it is a brand new product.2. The basic steps of new product developmentStage of establishing a think tankConcept screening stageConcept test phaseProduct testing phase3. How to establish the idea is the think tank can form the text product idea, too many products in accordance with some ideas in the formation of the standard for the think tank. Generally speaking, the enterprise research and developmentdepartment (R&D) is responsible for establishing and maintaining the think tank products. For stores, it is very important to the establishment of the think tank product, because it is the enterprise continuously introducing new products the source.The think tank the source of the ideas include: (1) the past the market report, research and development report and other internal document; (2) the organization of the internal staff in different time mind about the result of the discussion echoes; (3) the user/customer complaints/complaint results; (4) research and development personnel according to a research and development regularity of the results is made; (5) market research company, U&A research using user forum user unmet needs analysis, etc.The think tank need to constantly update for every thought also need to define and then defined process, the only way to ensure that the think tank is a really useful products source library.4. How to screen for production technology has the concept of mature, or look might be a market for regulation of new ideas of the description, to give users to evaluate, purpose is to choose a high degree of acceptance, like the thought, after the composition of the marketing added, to promote the concept, product testing phase, test to the final push to the market.Concept is often a dozen screening stage concept to evaluate, only purpose is to select the higher the concept of acceptance, don't do other marketing components evaluation.5. How to test concept in the selection from ten several concept stage out of 2-5 a accept the concept of high degree of concept test, the purpose is to estimate of the concept of each target population quantity, the market, price acceptance, whether for product testing phase for support role.6. How to test the product through the concept of product for test, the businessman or a product product or product model of product testing. The aim of the test is to products of the concept of product and the attributes of the matching degree, product evaluation, etc.7. The new product development market research the problems should pay attention to the new product development is very sensitive market research technology, because it involves is a brand new product, the user basically see touch products, so the difficulty is very big. In the study, the company in a process control, target user definition, sampling design, the study design, data analysis, report writing until results explain every level of the demand is higher, and must have special analysis technology and experience. In addition, for different types of products, the research design are also different. Century blueprint set nearly 10 years of technology and experience accumulation, will try to customers for new product development design the most appropriate research plan and development strategy.中⽂译⽂新产品上市策略市场研究⽅案1. 问题定义标准营销模式下，⼤多数公司对市场都做过规范化的⼤规模研究，并在此基础上对市场进⾏了细分，从⽽有步骤地选择进⼊不同的细分市场，因此这些企业的新产品策略也都是针对某个细分市场，规范化地进⾏从概念到产品（详见新产品开发策略）的新产品开发步骤。
GMAT阅读真题解析(英吉GMAT每日一题)
400-638-5988
2
《GMAT 非官方指南》—阅读部分 指导教师：英吉
star's light rays, which would otherwise diverge, to bend together so that, as observed from Earth, the star would temporarily appear to brighten, a process known as microlensing. 这句话的大致 意思是 MACHO 重力飘移将会导致曾经分散的光聚集到一起，这样从地球上看起来，这些 星就会看起来更亮一些！我们来看看选项
问的是细节，我们根据 microlensing of a star in the Large Magellanic Cloud?来定位，但是这 个破词全篇都是，问题起不到作用了，怎么办？我们来看看选项！这些选项好像都和星星的 亮度和光被观测到有关系，如果选项存在一个共同点，那就证明你要读到的原文应该包含这 些共同点，我们来看看原文哪句话说得是这些亮度和光被观察，应该是 microlensing 这个词 出现的第一句：the gravity of a MACHO that had so drifted, astronomers agree, would cause the
《GMAT 非官方指南》—阅读部分 指导教师：英吉
GMAT 阅读每日一题详解（GMAT 非官方指南）
指导教师：博智英吉老师
说明: 1、此文档一共 28 篇阅读，把所有题目跟着做下来，您的逻辑正确率应该在 70%以上 了，加油哦！ 2、这个系列还有语法、逻辑，OG13 更多请关注人人网“英吉”老师公共主页！ 3、如果你看解析之前先把题目做做会更好的！
2023年考研英语试卷
1、The recent study on climate change emphasizes the urgent need for ________ in order to mitigate its severe impacts.A. sustainable development practicesB. increased consumption of fossil fuelsC. ignoring environmental regulationsD. prioritizing economic growth over ecology (答案：A)2、In the context of global trade, the term "tariff" refers to ________.A. a tax imposed on imported or exported goodsB. a subsidy provided to domestic producersC. an agreement to eliminate trade barriersD. the free flow of goods and services without restrictions (答案：A)3、Which of the following statements best describes the concept of "cultural relativism"?A. All cultures are equally advanced and should be judged by universal standards.B. Cultural practices should be evaluated within their own cultural context.C. Some cultures are inherently better than others.D. Cultural differences are irrelevant in today's globalized world. (答案：B)4、The author's primary purpose in writing the passage is to ________.A. argue against the use of technology in educationB. advocate for the integration of technology into classroomsC. describe the historical evolution of educational toolsD. analyze the negative effects of technology on student learning (答案：B)5、The phrase "the tipping point" in the passage refers to ________.A. the moment when a minor change leads to a significant effectB. the highest point of achievement in a particular fieldC. a gradual and steady process of improvementD. the initial stage of a project's development (答案：A)6、According to the article, which of the following is NOT a challenge faced by remote workers?A. Maintaining a healthy work-life balanceB. Limited opportunities for social interactionC. Increased productivity due to fewer distractionsD. Difficulties in separating work and personal spaces (答案：C)7、The research highlights the importance of ________ in enhancing team collaboration and innovation.A. strict hierarchical structuresB. open communication channelsC. individual competition within teamsD. minimizing face-to-face interactions (答案：B)8、In the field of artificial intelligence, "machine learning" involves ________.A. programming computers to perform specific tasks without adaptationB. enabling computers to learn and improve from data without being explicitly programmedC. using pre-determined algorithms for all problem-solving scenariosD. relying solely on human input for decision-making processes (答案：B)9、The main argument presented in the passage is that ________.A. renewable energy sources are not yet reliable enoughB. investing in renewable energy is crucial for sustainable developmentC. fossil fuels remain the most efficient energy sourceD. technological advancements have made traditional energy sources obsolete (答案：B)10、Which of the following best explains the concept of "digital footprint"?A. The physical space occupied by digital devicesB. The trail of data left behind by online activitiesC. The speed of internet connectionD. The amount of storage space on a digital device (答案：B)。
SAH治疗指南
REVIEWCritical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage:Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus ConferenceMichael N.Diringer•Thomas P.Bleck•J.Claude Hemphill III•David Menon•Lori Shutter•Paul Vespa•Nicolas Bruder•E.Sander Connolly Jr.•Giuseppe Citerio•Daryl Gress•Daniel Ha¨nggi•Brian L.Hoh•Giuseppe Lanzino•Peter Le Roux•Alejandro Rabinstein•Erich Schmutzhard•Nino Stocchetti•Jose I.Suarez•Miriam Treggiari•Ming-Yuan Tseng•Mervyn D.I.Vergouwen•Stefan Wolf•Gregory ZipfelPublished online:20July2011ÓSpringer Science+Business Media,LLC2011Abstract Subarachnoid hemorrhage(SAH)is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs.SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team.A lack of high quality data has led to numerous approaches to management and limited guidance on choos-ing among them.Existing guidelines emphasize risk factors, prevention,natural history,and prevention of rebleeding,but provide limited discussion of the complex critical care issues involved in the care of SAH patients.The Neurocritical Care Society organized an international,multidisciplinary con-sensus conference on the critical care management of SAH to address this need.Experts from neurocritical care,neuro-surgery,neurology,interventional neuroradiology,and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise.A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines.Recommendations were developed based on literature review using the GRADE system,dis-cussion integrating the literature with the collective experience of the participants and critical review by an impartial jury.Recommendations were developed using the GRADE system.Emphasis was placed on the principle thatDisclaimer This statement is provided as an educational service of the Neurocritical Care Society.It is based on an assessment of current literature and the consensus of the opinions of the attendees and jury of the conference.It is not intended to include all possible proper methods of care for SAH patients.Neither is it intended to exclude any reasonable alternative methodologies.The Neurocritical Care Society recognizes that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on all of the circumstances involved.No formal practice recommendations should be inferred.The Organizer,Members of the Jury,and Conference participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage are listed in Appendix.M.N.Diringer(&)Neurology/Neurosurgery Intensive Care Unit,Washington University,St.Louis,MO,USAe-mail:diringerm@T.P.BleckRush Medical College,Chicago,IL,USAJ.Claude Hemphill IIIUniversity of California at San Francisco,San Francisco, CA,USAD.MenonUniversity of Cambridge,Cambridge,UK L.ShutterUniversity of Cincinnati,Cincinnati,OH,USAP.VespaUniversity of California at Los Angeles,Los Angeles,CA,USA N.BruderUniversite´de la Me´diterrane´e,Marseille,FranceE.S.Connolly Jr.Columbia University,New York,NY,USANeurocrit Care(2011)15:211–240 DOI10.1007/s12028-011-9605-9recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily man-agement of SAH patients,even in the absence of high quality data.Keywords Subarachnoid hemorrhageÁCritical careÁAneurysmÁVasospasmÁAnticonvulsantsÁHyponatremiaÁEndovascularÁFeverIntroductionSubarachnoid hemorrhage(SAH)is an acute cerebrovas-cular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs.The course of the disease can be prolonged,with considerable secondary brain injury due to delayed cerebral ischemia(DCI).Systemic manifestations affecting cardiovascular,pulmonary,and renal function are common,and complicate the management of DCI.Due to the profound effects of the hemorrhage itself and the risk of early rebleeding and hydrocephalus,SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team including neurosur-geons,(neuro)intensivists,(neuro)anesthesiologists and interventional neuroradiologists.The ICU course of SAH patients ranges from a few days to a few weeks and is fre-quently accompanied by multiple medical complications.Despite considerable effort,only one intervention—the use of nimodipine—for this complex multifaceted disorder has been proven to improve outcome in prospective ran-domized controlled trials[1].This lack of high quality definitive data has led to numerous approaches to manage-ment and provides limited guidance on choosing among them.There have been relatively few guidelines developed for SAH management.They emphasize risk factors,preven-tion,natural history,and prevention of rebleeding,but provide limited discussion of the critical care issues involved in the care of SAH patients.In order to provide a comprehensive review of those issues the Neurocritical Care Society organized a multidisciplinary consensus conference on the critical care management of SAH. Topics were chosen based on their relevance to the critical care management of patients with aneurysmal SAH.Pro-cedures used to repair aneurysms were not addressed.Statement of PurposeThe purpose of the consensus conference was to develop recommendations for the critical care management of patients following acute SAH.The complex multi-organ pathophysiology of SAH presents a multitude of clinical challenges which demand attention.For each situation decisions must be made about if,when,and how to inter-vene.Ideally,each decision would be made based on high quality data;yet the reality is that such data rarely exist. Still,decisions about management must be made.Recom-mendations were developed based on the literature,a robust discussion regarding the interpretation of the liter-ature,the collective experience of the members of the group and review by an impartial jury.G.CiterioSan Gerardo Hospital,Monza,ItalyD.GressUniversity of Virginia,Charlottesville,VA,USAD.Ha¨nggiHeinrich-Heine University,Du¨sseldorf,GermanyB.L.HohUniversity of Florida,Gainesville,FL,USAnzinoÁA.RabinsteinMayo Clinic,Rochester,MN,USAP.Le RouxUniversity of Pennsylvania,Philadelphia,PA,USAE.SchmutzhardUniversity Hospital Innsbruck,Innsbruck,AustriaN.StocchettiFondazione IRCCS Ca`Granda–Ospedale Policlinico,Milan University,Milan,Italy J.I.SuarezBaylor College of Medicine,Houston,TX,USA M.TreggiariUniversity of Washington,St.Louis,MO,USA M.-Y.TsengNottingham University Hospitals,Nottingham,UK M.D.I.VergouwenUniversity of Utrecht,Utrecht,The Netherlands S.WolfFreie Universita¨t Berlin,Berlin,GermanyG.ZipfelWashington University,St.Louis,MO,USAProcessTopics were identified based on clinical decision points in the critical care management of SAH patients.Experts drawn from Europe and North America from thefields of neurosurgery, neurocritical care,neurology,interventional neuroradiology, and neuroanesthesiology were recruited based on their expertise related to each topic.A jury of four experienced neurointensivists was selected for their expertise in clinical investigation and development of practice guidelines.Each participant performed a critical literature review.The findings were summarized in tables and a summary was pre-pared which reviewed the data and provided specific management recommendations.These were submitted in draft form before the conference and distributed to all participants.The quality of the data was assessed and recommenda-tions developed using the GRADE system[2].The quality of the evidence was graded as:•High=Further research is very unlikely to change our confidence in the estimate of effect.•Moderate=Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.•Low=Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.•Very low=Any estimate of effect is very uncertain.The GRADE system classifies recommendations as strong or weak,according to the balance among benefits,risks, burden,and cost,and according to the quality of evidence. Keeping those components explicitly separate constitutes a crucial and defining feature of this grading system.An advantage of the GRADE system is that it allows for strong recommendations in the setting of lower quality evidence and thus it is well suited to this situation.Recommendations were either strong or weak and based on the following:•The trade-offs,taking into account the estimated size of the effect for the main outcomes,the confidence limits around those estimates,and the relative value placed on each outcome•The quality of the evidence•Translation of the evidence into practice in a specific setting,taking into consideration important factors that could be expected to modify the size of the expected effectsThe conference took place on October22–23,2010.Each participant presented a summary of the data and recom-mendations to the jury and other participants.Presentations were followed by discussion focused on refining the pro-posed management recommendations.Approximately1/3of the conference time was utilized for discussion.The jury met for2days after the conference and again at a subsequent2-day meeting and held several conference calls.They reviewed selected key studies,the recommen-dations made by the primary reviewers and the discussion that took place at the conference.Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.Medical Measures to Prevent RebleedingQuestions Addressed•Do any medical interventions reduce the incidence of rebleeding in patients awaiting definitive management of their ruptured aneurysm?•Do alterations in investigative approaches reduce the incidence of rebleeding in patients awaiting definitive management of their ruptured aneurysm?•Does stringent blood pressure reduction reduce the incidence of rebleeding in patients awaiting definitive management of their ruptured aneurysm?Summary of the LiteratureRebleeding following aneurysmal SAH is common.Its incidence is highest immediately following the initial hemorrhage(5–10%over thefirst72h)[3],is higher in patients with poor-grade SAH,larger aneurysms,sentinel bleeds,and those who undergo catheter angiography within 3h of the ictus.Immediate repair of the ruptured aneurysm by either coil embolization or microsurgical clip ligation markedly reduces the risk of rebleeding,with microsurgical exclusion being slightly more efficacious[4].Nevertheless, some patients are either too sick for immediate repair or require transport to a center where repair can be performed. Repair procedures have significant risks and require experienced teams to minimize the serious procedural side effects of repair.This fact can lead to further delay in repair,and increase the risk of rebleeding.We considered three interventions that might modulate this risk:antifi-brinolytic therapy,catheter vs.CT angiography,and blood pressure control.Nine studies of antifibrinolytic therapy prior to2002 involving1399patients showed no benefit on poor out-come or death despite a marked significant reduction in rebleeding,probably due to a significantly higher incidence of cerebral ischemia in the treated patients[5].It is note-worthy that all of these studies continued therapy for weeks (into the period when the risk of vasospasm was high),and at least one of these studies initiated therapy as late as 4days post-ictus,when the risk of rebleeding wassubstantially reduced.More recently,one randomized trial (involving505patients)[6]and two case control studies (involving428patients)[7,8]examined whether an early short course of antifibrinolytic therapy can reduce the risk of rebleeding while early,safe repair is being arranged.A third study also found a reduction in rebleeding but noted an increased incidence of DVTs[8].These studies suggest a uniform reduction in rebleeding rates from*11to *2.5%,but the studies were not adequately powered to determine the effect of antifibrinolytic therapy on overall patient outcome.Several case reports or case series report aneurysmal rebleeding when catheter angiography is undertaken very early(less than3–6h)following aneurysmal SAH.Specific rebleeding rates are difficult to compute,as many of these are individual case reports,and the denominator in case series (i.e.,the total number of patients undergoing early angiog-raphy)is poorly defined.However,rates as high as20–38.5% have been quoted[9–13].It seems unwarranted to conclude this is a specific risk attributable to DSA for several reasons. First,where a clear denominator is provided to assess the incidence of rebleeding,figures are much lower(*5%)[11]. Second,it is unclear whether these instances of rebleeding with DSA actually reflect a risk of the procedure,or are simply a manifestation of the high rebleeding rates known to occur after initial aneurysm rupture.Third,there is no sat-isfactory direct comparison of rebleeding with and without DSA or to CTA within thefirst6h post-SAH;the one case series that does report a twofold risk with DSA included only a small number of patients[12].Intriguingly,reports of contrast extravasation during ultra-early CTA[14,15]have heretofore been interpreted as the investigation being able to image the process of early rebleeding[13],rather than being a cause of such rebleeding.There are no systematic data that address blood pressure levels in patients with unsecured aneurysms in relation to the risk of rebleeding.Some early studies of hypervolemic–hypertensive therapy reported aneurysmal rebleeding or hemorrhagic transformation of hypodense lesions with ele-vation of systolic blood pressure to160–200mmHg. However,more recent series do not report rebleeding at systolic blood pressure in this range,and the clear consensus of the participants at the workshop was that modest blood pressure elevation(mean arterial pressure<110mmHg; systolic blood pressure<160mmHg)was not associated with rebleeding.DiscussionFurther definitive evidence of benefit from antifibrinolytic agents will require a trial with very early identification of patients and early administration of tranexamic acid or aminocaproic acid,a large sample size and sufficient power to detect an effect on functional outcome.Patients in good neurological condition with evidence of sentinel hemor-rhage,loss of consciousness at ictus and who harbor larger aneurysms on initial CTA are likely to be the best popu-lation for study.There appears to be sufficient equipoise in the USA for such a trial to be conducted,and we would underline the fact that our recommendations in this area would need to be revised when data from such a study were available.Given the less-than-definitive evidence on which we have based our recommendation for early antifibrino-lytic therapy,we have explicitly stated several cautionary recommendations that would mitigate against side effects of the intervention.We did not feel that the data available provided a clear basis for attributing an increased rebleeding risk to ultra-early DSA.Formal assessment of catheter vs.CT angiog-raphy in the hyperacute phase would require further collection of epidemiological data in thefirst instance,and a large trial comparing the two would be needed to provide definitive recommendations.Given that CTA is now well established,it seems unlikely that a large RCT comparing DSA and CTA will ever materialize.However,pending the continued collection of epidemiological data,it was felt that choosing CTA over DSA for ultra-early angiography was a reasonable option where both options are available, the technical quality of CTA was good,and an endovas-cular intervention was not planned at the time of angiography.However,in the setting of SAH,the over-whelming aim is to detect and secure a culprit aneurysm, and there is no case for delaying investigation(either CTA or DSA)to reduce any theoretical risk of rebleeding.There appears to be little concern that rebleeding with modest blood pressure elevation is a significant clinical issue,and there was no enthusiasm for a study addressing this issue.Recommendations•Early aneurysm repair should be undertaken,when possible and reasonable,to prevent rebleeding(High Quality Evidence;Strong Recommendation).•An early,short course of antifibrinolytic therapy prior to early aneurysm repair(begun at diagnosis;continued up to the point at which the aneurysm is secured or at72h post-ictus,whichever is shorter)should be considered (Low Quality Evidence;Weak Recommendation).•Delayed(>48h after the ictus)or prolonged(>3days) antifibrinolytic therapy exposes patients to side effects of therapy when the risk of rebleeding is sharply reduced and should be avoided(High Quality Evidence;Strong Recommendation).•Antifibrinolytic therapy is relatively contraindicated in patients with risk factors for thromboemboliccomplications(Moderate Quality Evidence;Strong Recommendation).•Patients treated with antifibrinolytic therapy should have close screening for deep venous thrombosis(Moderate Quality Evidence;Strong Recommendation).•Antifibrinolytic therapy should be discontinued2h before planned endovascular ablation of an aneurysm (Very Low Quality Evidence;Weak Recommendation).•When CTA and DSA are both available and CTA is of high technical quality,CTA should be performed preferentially if endovascular intervention is not planned at the time of angiography(Very Low Quality Evidence;Weak Recommendation).•Treat extreme hypertension in patients with an unse-cured,recently ruptured aneurysm.Modest elevations in blood pressure(mean blood pressure<110mmHg) do not require therapy.Pre-morbid baseline blood pressures should be used to refine targets;hypotension should be avoided(Low Quality Evidence;Strong Recommendation).Seizures and Prophylactic Anticonvulsant Use Questions Addressed•What is the incidence and impact of convulsive and non-convulsive seizures after SAH?•Does anticonvulsant prophylaxis influence this incidence?Summary of the LiteratureAbnormal movements that may appear seizure-like are common at the onset of SAH,but it is usually unclear whether this is a true seizure or represents posturing at the time of aneurysm rupture[16,17].Clinical seizures are uncommon after the initial aneurysm rupture(occurring in 1–7%of patients)and when they occur in patients with an unsecured aneurysm,they are often the manifestation of aneurysmal re-rupture[4,18].Risk factors for the development of seizures in SAH are surgical aneurysm repair in patients>65years of age,thick subarachnoid clot,and possibly intraparenchymal hematoma or infarc-tion[16,17].Prophylactic treatment with anticonvulsants in SAH patients without seizures has previously been commonplace,although no randomized trials specifically addressing this issue have been performed.Recent studies have suggested that anticonvulsant use is associated with worsened long-term outcome after SAH,although most of the patients in these studies were treated with phenytoin [19,20].Thus,prophylactic anticonvulsant therapy with phenytoin may worsen outcome,although the impact of other anticonvulsant medications is less clear.Also,in patients with no history of seizure,a short course(72h) of anticonvulsant prophylaxis seems as effective as a more prolonged course in preventing seizures[21].In comatose(poor-grade)SAH patients,non-convulsive sei-zures may be detected on continuous EEG(cEEG)in 10–20%of cases[22–24].While patients with non-con-vulsive seizures have a worsened outcome,the impact of successful treatment of these non-convulsive seizures has not been studied.Also,the influence of anticonvulsant prophylaxis on the occurrence of non-convulsive seizures has not been studied.DiscussionThere was general agreement among the participants that current evidence raises concern that anticonvulsants,spe-cifically phenytoin,may worsen outcome after SAH. Therefore,there was consensus that routine prophylactic phenytoin use should not be undertaken after SAH.There was,however,controversy regarding use of other anti-convulsant medications and the unknown potential for anticonvulsants to lessen the impact of non-convulsive seizures.Also,the possibility that certain subgroups,such as elderly patients undergoing craniotomy,may have a higher seizure risk led the group to consider that a short course(3–7days)of anticonvulsant prophylaxis might still be considered in certain situations,especially if an agent other than phenytoin was used.There was also agreement that patients who suffer a clear clinical seizure after the period of aneurysmal rupture should be treated with anti-convulsants,but that if seizures do not recur,these anticonvulsants should be discontinued after3–6months. There was disagreement about whether an EEG should be performed at that time and,if so,whether seizure-free patients with an epileptic focus should be continued on anticonvulsants.There was consensus that cEEG is prob-ably underutilized in poor-grade SAH patients and that non-convulsive seizures are common.However,there was concern regarding whether these non-convulsive seizures represented markers of disease severity or a target for treatment.Thus,there was modest disagreement on the aggressiveness with which to pursue treatment of non-convulsive seizures.There was a general agreement that one or perhaps two anticonvulsants should be used to attempt to treat non-convulsive seizures identified on cEEG,but disagreement about whether to pursue more aggressive means such as benzodiazepine or barbiturate infusions if initial measures were unsuccessful.Recommendations•Routine use of anticonvulsant prophylaxis with phe-nytoin is not recommended after SAH(low quality evidence—strong recommendation).•Routine use of other anticonvulsants for prophylaxis may be considered(very low quality evidence—weak recommendation).•If anticonvulsant prophylaxis is used,a short course (3–7days)is recommended(low quality evidence—weak recommendation).•In patients who suffer a seizure after presentation, anticonvulsants should be continued for a duration defined by local practice(low quality evidence—weak recommendation).•Continuous EEG monitoring should be considered in patients with poor-grade SAH who fail to improve or who have neurological deterioration of undetermined etiology(low quality evidence—strong recommendation).Cardiopulmonary ComplicationsQuestions Addressed•What monitoring should be utilized in SAH patients with cardiovascular instability?•Are there recommendations regarding managing car-diopulmonary complications in patients with SAH? Summary of the LiteratureMyocardial injury occurs following SAH and is thought to be related to sympathetic stimulation and catecholamine discharge.Elevations of troponin I levels occur in approximately35%[25,26],arrhythmias in35%[27],and wall motion abnormalities on echocardiography in about 25%of patients with SAH[28].Echocardiographic abnormalities are more frequent in patients with elevated troponin levels.The terms‘‘Neurogenic Stress Cardiomy-opathy’’and‘‘Stunned Myocardium’’have been applied to the clinical syndrome of chest pain;dyspnea;hypoxemia, and cardiogenic shock with pulmonary edema and elevated cardiac markers that occurs within hours of SAH.This syndrome has a wide spectrum of severity,and it may contribute to sudden death in12%of patients.The mani-festations are usually transient lasting1–3days after which myocardial function returns to normal.Management should focus on supportive care that balances cardiac needs with the neurological goals[29].In general,cardiac abnormalities are more common in patients who later develop DCI and have worse outcomes [30].Although several mechanisms have been proposed to explain the cardiac abnormalities,the evidence seems strongest for a catecholamine induced process[29].Mon-itoring of cardiac function may be beneficial in the setting of hemodynamic instability or myocardial dysfunction,but there is no evidence that it improves outcome.Manage-ment of cardiac complications is heterogeneous,and interventions should reflect current best medical practices.Symptomatic pulmonary complications occur in over 20%of patients after SAH[31,32],although evidence of impaired oxygenation occurs in up to80%[33].These complications are associated with worse clinical grade SAH and higher mortality[34–36].Patients may develop pulmonary edema(cardiac or neurogenic),acute lung injury or acute respiratory distress syndrome.The mecha-nism of pulmonary injury may also be related to sympathetic hyperactivity or cardiac failure.Management of pulmonary issues follows general principles of pul-monary management,however,with careful attention to avoid hypovolemia.DiscussionThe participants all agreed that cardiopulmonary compli-cations are common after SAH,and have a significant impact on clinical care.They frequently complicate management by increasing procedural risk and exacerbate brain oxygen delivery by lowering perfusion pressure and arterial oxygenation saturation.It was generally agreed that a baseline assessment of cardiac function with echocardiography may be beneficial,especially if there are any signs of myocardial dysfunction.Although there is limited evidence,the panel strongly felt that cardiac output should be monitored(invasively or non-invasively) in those patients with myocardial dysfunction or hemo-dynamic instability.The participants voiced the opinion that management of these complications may vary based on the patient’s clin-ical status and in the setting of vasospasm.There was strong agreement that cardiopulmonary issues are wors-ened in the event of hypervolemia,thus the goal of therapy should be euvolemia.The panel also strongly recom-mended that management of cardiopulmonary issues should reflect current best medical practice,while balanc-ing the needs of the underlying neurological condition. RecommendationsMonitoring•Baseline cardiac assessment with serial enzymes, electrocardiography,and echocardiography is recom-mended,especially in patients with evidence ofmyocardial dysfunction(Low quality evidence;Strong Recommendation).•Monitoring of cardiac output may be useful in patients with evidence of hemodynamic instability or myocar-dial dysfunction.(Low quality evidence;Strong Recommendation).Treatment•In case of pulmonary edema or evidence of lung injury,the goal of therapy should include avoiding excessivefluid intake and judicious use of diuretics targeting euvolemia (Moderate quality evidence;Strong recommendation).•Standard management of heart failure is indicated with the exception that CPP/MAP should be maintained as appropriate for the neurological condition.(Moderate quality evidence;Strong recommendation). Monitoring Intravascular Volume StatusQuestions Addressed•What is the role of monitoringfluid balance and central venous pressure(CVP)?•What measurements should be used to assess blood volume?•Is there a role for non-invasive hemodynamic monitoring?•Is there a role for pulmonary artery catheters(PACs)? Summary of the LiteratureSAH patients frequently develop hypovolemia and hypo-natremia.Retrospective studies have identified a relationship between hypovolemia and an increased inci-dence of cerebral infarcts and worse outcome[37,38]; especially whenfluid administration is restricted.For this reason,assessment of intravascular volume in patients after SAH is essential to daily management.Therefore,guidance is needed regarding the mechanism and impact of altera-tions influid balance,and the methods for monitoring volume status.Available literature describes multiple fac-tors that may contribute to changes in volume status [39,40].Fluid balance may not accurately reflect intravascular volume[41–44],therefore invasive and non-invasive methods have been used as possible alternatives to monitor volume status.Although all methods provide information to guide patient management,none have demonstrated superiority over vigilantfluid management[45–47].In fact,CVP appears to be an unreliable indicator of intravascular volume[45,46],and,although PACs may have a role in hemodynamically unstable patients,the complications associated with their routine use appear to outweigh any potential benefit[48–50].DiscussionThe participants generally agreed that volume status of patients should be monitored after SAH even though it may not accurately reflect intravascular volume,nor is there evidence that close monitoring has a beneficial impact on outcome.The panel discussed multiples methods to monitor vol-ume status,and weighed the evidence regarding potential risk versus benefit of each.It was generally felt that both physicalfindings and clinical data must be integrated into assessment of volume status.Although there was not a preferred method of monitoring volume status,a hierar-chical approach is often used.The primary assessment should be close monitoring offluid input and output.Other invasive and non-invasive modalities may be used to pro-vide supplemental information based on the clinical scenario,but no one tool should be used in isolation.The panel did voice strong agreement against the routine use of invasive PACs or dependence on CVP targets. Recommendations•Monitoring of volume status may be beneficial(Mod-erate quality evidence;weak recommendation).•Vigilantfluid balance management should be the foundation for monitoring intravascular volume status.While both non-invasive and invasive monitoring technologies are available,no specific modality can be recommended over clinical assessment(Moderate quality evidence;weak recommendation).•Central venous lines should not be placed solely to obtain CVP measures andfluid management based solely on CVP measurements is not recommended (Moderate quality evidence;strong recommendation).•Use of PACs incurs risk and lacks evidence of benefit.Routine use of PACs is not recommended(Moderate quality evidence;strong recommendation). Managing Intravascular Volume StatusQuestions Addressed•Should prophylactic hypervolemia be employed in the management of SAH patients?。