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Heart Of Courage (long Version) ((EXCLUSIVE))



Sedlis SP, Hartigan PM, Teo KK, et al., on behalf of the COURAGE Trial Investigators. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med 2015;373:1937-46.




Heart of Courage (long version)



One of the approaches the team looked at involved opening narrowed coronary arteries with percutaneous intervention (PCI), a non-surgical procedure that uses a catheter (a thin flexible tube) to mechanically widen their arteries. During PCIs, a small mesh structure called a stent is often placed to keep the arteries open. In the COURAGE trial, PCI was combined with aggressive medication for some study participants who had chronic, stable angina as a way to prevent heart attacks and deaths in Veterans who do not require emergency care. (Angina is a condition marked by severe pain in the chest and other locations caused by an inadequate blood supply to the heart.)


After following each patient for five years, the team found that the rates of death, non-fatal heart attacks, strokes and hospitalization were the same for those who underwent the PCI procedure as those who did not. Taking medicine as directed, exercising regularly, and successfully managing diet gives patients the opportunity to avoid angioplasty procedures and the risks associated with them.


Effect of PCI on long-term survival in patients with stable ischemic heart disease. Sedlis SP, Hartigan PM, Teo KK, Maron DJ, Spertus JA, Mancini GBJ, Kostuk W, Chaitman BR, Berman D, Lorin JD, Dada M, Weintraub WS, Boden WE, COURAGE Trial Investigators. N Engl J Med, 2015 Nov 12;373(20):1937-46.


Background: Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years.


Conclusions: During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA Cooperative Studies Program and others; COURAGE ClinicalTrials.gov number, NCT00007657.).


Youth means a temperamental predominance of courage over timidity of the appetite, for adventure over the love of ease. This often exists in a man of sixty more than a boy of twenty. Nobody grows old merely by a number of years. We grow old by deserting our ideals.


Whether sixty or sixteen, there is in every human being's heart the lure of wonder, the unfailing child-like appetite of what's next, and the joy of the game of living. In the center of your heart and my heart there is a wireless station; so long as it receives messages of beauty, hope, cheer, courage and power from men and from the infinite, so long are you young.


To help us identify the different types of leadership, we will explore the Heart, Head, and Courage model (GOSSELIN & BRUNELLE, 2016). We will focus on the three main characteristics that distinguish a leader: his intelligence (head), his ability to evoke emotion (heart) and his strength of character (courage) (GOSSELIN & BRUNELLE, 2016).


That said, your ability to analyse a context, reformulate issues and propose innovative solutions will not be enough to allow you to become an effective and impactful leader in the water and climate sector. You will also need the courage to take risks as the challenges ahead are complicated and can be overwhelming and you will need heart to understand the impact of your decisions on your team or the communities with whom you will be working. You will need to also take the time to explain your decision to your other team members and be careful not to be carried away by arrogance.


The effectiveness and impact of leaders who lead with their heart has been well demonstrated specially to lead change within an organisation or within society (ISSAH, 2018; RHEE & SIGLER, 2014). These leaders are impactful leaders. They can foster transformative impact. This type of leadership can be found in different types of organisations in the water and climate sector including the public, private and non-governmental sector. That said, a leader that leads with his heart, will also need to have a clear plan and strategy to reach its vision and to be assertive in his decisions to inspire confidence in his team. This is where we differentiate our best friend from someone we consider as a leader. He will also need courage to face the obstacles and difficulties that will arise. This is particularly true in the water and climate sector as the road ahead will certainly be a bumpy road that will require courageous leaders.


Your strengths and weaknesses will evolve over time and might change from one situation to another. As you go reflect on different situations in which you have shown leadership, you might realize that in some situations you have led more with heart and other more with your head or with courage. Being flexible and adapting your leadership styles to different contexts is also a sign of good leadership.


In 1976, Steve Jobs co-founded Apple (XUE, 2016). Over the years, Steve Jobs invented hundreds of innovative products such as the iPod, iPhone and MacBook and lead the development of a company which today has become a trillion-dollar company implemented in hundreds of countries around the world. Steve Jobs is known to have a very high cognitive ability, able to solve most of the problems which Apple faced (XUE, 2016). He had a clear vision and knew exactly the steps which he needed to take to achieve his goals. Steves Jobs led with his head. That said, many will say that Jobs lack the heart characteristic of the model which we presented in this module. Jobs rarely took time to consult his colleagues and is known for being rude and obnoxious preferring to go fast than to take the time to explain his thought process to his team and giving little attention to the well-being of his colleagues.


Mandela is a great example of what you can achieve if you lead with your heart above all. Even though Mandela was far from being a perfect leader, he taught us the importance of building trust by empathizing with others and have deep self-knowledge and humility. Even though Mandela led mostly with his heart, he also had a clear strategic vision and build powerful processes. He also had the courage to face his enemies and go against the mainstream thoughts. This importance of being well-balanced in the three main leadership characteristics can guide you as you embark in your leadership journey!


Why might we need the imaginative richness of C. S. Lewis to learn about courage? In their 2019 book, The Stressed Years of Their Lives: Helping Your Kid Survive and Thrive During Their College Years, Janet Hibbs and


Notice Lewis does not think our deepest challenges are strictly intellectual. Rather our challenges are those of the heart. Even when we know what is good and true, we may fail to act and feel accordingly in the midst of overwhelming feelings and emotions.


In another scene from one of The Chronicles of Narnia, Prince Caspian, we hear of Susan who refused to listen to her sister Lucy when Lucy had seen Aslan the great lion telling them to go in a different direction. Later, when Susan is finally able to see Aslan herself, she confesses to Lucy deep down, she knew it was Aslan leading them in a different direction but did not want to follow him, she just wanted to get out of the woods. In this instance, she did not lack knowledge of the right thing to do; she lacked the courage to do it, the willingness to bear the difficulty and associated fears.


Enduring suffering without giving into terror or despair, confronting evil without giving into panic or fear, all of these actions require the strength of courage. It is not enough to know the right thing to do since we must also be able to act in the midst of situations that occasion intense fears. Love alone cannot be the answer since, as Aquinas observed centuries earlier, fears rise in proportion to our loves, for the greater we love things, the more we fear to lose them.


"Be strong and courageous, do not be afraid or tremble at them, for the LORD your God is the one who goes with you He will not fail you or forsake you." Then Moses called to Joshua and said to him in the sight of all Israel, "Be strong and courageous, for you shall go with this people into the land which the LORD has sworn to their fathers to give them, and you shall give it to them as an inheritance. "The LORD is the one who goes ahead of you; He will be with you He will not fail you or forsake you. Do not fear or be dismayed."


"Be strong and courageous, for you shall give this people possession of the land which I swore to their fathers to give them. "Only be strong and very courageous; be careful to do according to all the law which Moses My servant commanded you; do not turn from it to the right or to the left, so that you may have success wherever you go. "This book of the law shall not depart from your mouth, but you shall meditate on it day and night, so that you may be careful to do according to all that is written in it; for then you will make your way prosperous, and then you will have success. read more. "Have I not commanded you? Be strong and courageous! Do not tremble or be dismayed, for the LORD your God is with you wherever you go."


"Be strong and courageous, do not fear or be dismayed because of the king of Assyria nor because of all the horde that is with him; for the one with us is greater than the one with him. "With him is only an arm of flesh, but with us is the LORD our God to help us and to fight our battles." And the people relied on the words of Hezekiah king of Judah. 041b061a72


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