Academic literature on the topic 'TAVI procedure'

The UK Transcatheter Aortic Valve Implantation (TAVI) registry has collected data about every TAVI procedure performed in the UK. The latest data are from 2016 when 3250 procedures (49.5 pmp) were performed. There has been no change in the mean age of patients but there has been a shift to lower risk with fall in mean Logistic Euroscore since 2012. The switch from general anaesthetic to conscious sedation has been rapid, and propensity-adjusted analysis has not shown a difference in outcomes. In-hospital mortality has fallen to 1.8% in 2016, and relative survival analysis has shown outcome the same as the matched general population to 3 years. The UK TAVI registry has provided valuable benchmarks, and a risk adjustment model that includes frailty measures has been successfully developed and is available online.

Abstract Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with severe symptomatic aortic stenosis who are not suitable for surgery. The procedure has become the preferred strategy in patients at intermediate/high surgical risk with favourable clinical and anatomical characteristics. The collected scientific evidences, as well as the technologic innovations shaping the newer devices, allowed for a progressive reduction of the procedure-related complications as a well as a simplification of the procedure itself, promoting the gradual expansion of the indication for TAVI with the consequent increase in the estimated number of procedures performed each year. There are significant geographic and socio-economic disparities in the use of TAVI around the world and in Italy as well, reflecting an application of the procedure directly related to the economic prosperity of the Health System of the Country examined. The Italian situation, similar to the worldwide reality, reveals an uneven application of the procedure, signalling a disparity in the socio-economic and organizational capabilities of each single region. Standardization of patient selection for treatment, and of the clinical pathway for TAVI are crucial for an homogeneous integration of this new technology in the current Health Care System.

Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.

Objective We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures. Methods Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay. Fourteen physicians used the tool to perform retrospective planning of TAVI procedures. Results of prosthesis sizing were compared with the prosthesis size used in the actually performed procedure, and the patients were accordingly divided into three groups: those with equal size (concordance with retrospective planning), oversizing (retrospective planning of a smaller prosthesis), and undersizing (retrospective planning of a larger prosthesis). Results In the oversizing group, 85% of the patients had new pacemaker implantation. In the undersizing group, in 66%, at least mild paravalvular leakage was observed (greater than grade 1 in one third of the cases). In 46% of the patients in the equal-size group, neither of these complications was observed. Conclusions Three-dimensional prosthesis overlay in MDCT-derived patient data for patient-specific planning of TAVI procedures is feasible. It may improve valve selection compared with two-dimensional MDCT planning and thus yield better outcomes.

Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.

Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.

The aim – to systematize information on key features of echocardiographic evaluation of transcatheter aortic valve implantation (TAVI) procedure stages and their effectiveness in cardiac surgery, in patients with severe aortic valve stenosis.Materials and methods. We initiated a single-center clinical study to evaluate the XPand device and initial analysis of the primary results was performed. Patients met the inclusion criteria underwent a full range of examinations and TAVI procedures using the XPand device. The key parameters for echocardiographic examination in TAVI, which influence the formation of further procedure strategy, have been determined for the cardiac surgeon.Results and discussion. Based on the determined echocardiographic parameters, we obtained the primary outcomes of TAVI XPand in patients (n=7), the result of implantation was good. Minimal paravalvular insufficiency absence was found in 71.5 % of patients and minimal insufficiency in 14,5 %. In one patient to moderate insufficiency was observed. There was a statistically significant improvement in the ejection fraction (p<0.05) and a decrease in the mean gradient at the aortic valve (p<0.01).Conclusions. Echocardiographic parameters at all TAVI stages in patients over 75 years allow to control the implementation of the procedure and to improve the immediate post procedural outcome. The first experience of using the novel device for transcatheter implantation of the XPand aortic valve prosthesis confirms its effectiveness and safety in elderly patients with severe aortic stenosis.

Aortic stenosis is the most common primary valve lesion requiring surgery or, especially for older patients, transcatheter intervention (TAVI). We showcase a successful transfemoral TAVI procedure in a very high-risk patient and an extremely tortuous S-shaped descending aorta, characterized by heavy calcifications and multiple strong resistance points. We demonstrated that transfemoral TAVI using the “buddy stiff guidewire” technique could be a feasible, simple, quick, and easy procedure able to straighten an extremely abdominal aorta tortuosity. With all techniques available and careful pre-procedural planning, and thanks to the flexibility of new generation TAVI delivery systems, it is possible to safely perform the procedure even in the most challenging patients.

The transcatheter aortic valve implantation (TAVI) treatment pathway is complex, leading to procedure-related delays. Dedicated TAVI coordinators can improve pathway efficiency. COORDINATE was a pilot observational prospective registry at three German centers that enrolled consecutive elective patients with severe aortic stenosis undergoing TAVI to investigate the impact a TAVI coordinator program. Pathway parameters and clinical outcomes were assessed before (control group) and after TAVI coordinator program implementation (intervention phase). The number of repeated diagnostics remained unchanged after implementation. Patients with separate hospitalizations for screening and TAVI had long delays, which increased after implementation (65 days pre- vs. 103 days post-implementation); hospitalizations combining these were more efficient. The mean time between TAVI and hospital discharge remained constant. Nurse (p = 0.001) and medical technician (p = 0.008) working hours decreased. Patient satisfaction increased, and more consistent/intensive contact between patients and staff was reported. TAVI coordinators provided more post-TAVI support, including discharge management. No adverse effects on post-procedure or 30-day outcomes were seen. This pilot suggests that TAVI coordinator programs may improve aspects of the TAVI pathway, including post-TAVI care and patient satisfaction, without compromising safety. These findings will be further investigated in the BENCHMARK registry.

The first TAVI implantation was performed in 2002 by Cribier and colleagues. From then, we have seen significant progress in technology, with the appearance of new generations &ndash; lower-profile, longer-lasting and more stable during positioning TAVI prostheses. The present publication presents single-center results and experience with TAVI procedures over an eight-year period. During the period 2013 &ndash; November 2022 a total of 354 TAVI procedures were performed in Acibadem City Clinical Cardiovascular Center. Two operating strategies are used &ndash; standard and minimalist approach. From the first procedure in 2013 until mid-2018 the standard approach (surgical vascular access, general anesthesia, direct valve implantation where possible) was mostly used. Then, the minimalist approach (percutaneous access, no intubation anesthesia, mandatory valve predilation and use of rapid pacing) was introduced as a standard approach in the center.

Transcatheter Aortic Valve Implantation (TAVI) is a procedure developed for replacing the defective aortic valve of a patient as an alternative to open heart Surgical Aortic Valve Replacement (SAVR). In the TAVI procedure a prosthetic valve, which is assembled on to a stent, is crimped and delivered to the patient's aortic root site through several available percutaneous means. The percutaneous nature of TAVI, which is its core advantage in comparison to other SAVR procedures, can however also be its main disadvantage. This is due to lack of direct access to the calcified leaflets, and hence reliance on the host tissue for the proper positioning and anchorage of the deployed prosthetic valve. Therefore, it is desired to have a preoperative quantitative understanding of patient-specific biomechanical interaction of the stent and the native valve to be able to maximise the chance of success of the procedure. The aim of this study was to develop a patient-specific Finite Element (FE) model of the Transcatheter Aortic Valve Implantation (TAVI) procedure for two patients, using a model of the 23 mm percutaneous prosthetic aortic valve developed by Strait Access Technologies (SAT), for the purpose of its post-operative performance. In this regard, the image processing software ScanIP was used to extract the 3D models of the patient-specific aortic roots and leaflets from the provided Multi-Slice Computer Tomography (MSCT) images of the patients. An anisotropic hyperelastic material model was implemented for the roots and leaflets, using two and one families of collagen fibres for their tissues respectively. The stent is made of a cobalt-chromium alloy and its mechanical response was modelled as an isotropic elastoplastic material, with a linear elastic initial response, followed by plastic behaviour with isotropic hardening. The prosthetic leaflets are made of polymer and were modelled as an isotropic hyperelastic material, using the provided experimental test data. The results for the first patient showed that the stent maintained its structural integrity after deployment, and successfully pushed the native leaflets back to keep the aortic root clear of all impediments. No obstruction of the coronary ostia was observed, and prosthetic leaflets were seen to function normally. The stent radial recoil was calculated to be between 2 to 4.28 % after deployments. Its foreshortening was calculated to be approximately 20%. The stent was observed to move back and forth by approximately 3 mm in the last simulation step in which cardiac cycle pressure were applied to the aortic root and prosthetic leaflets. Also, two openings were observed between the stent and aortic root wall during this simulation step, which indicates the possibility of paravalvular leakage. From the second patient simulation, it was observed that the 23 mm stent was not a good choice for this patient, and will cause severe damage or tissue tearing. The maximum principal stress in the aortic root and valve tissues were observed to follow approximately the defined collagen fibre directions.

La réparation valvulaire aortique percutanée a connu d’immense progrès depuis unevingtaine d’années permettant au patient atteint de rétrécissement aortique (RA) serré debénéficier d’un traitement curatif, le plus souvent avec une approche minimaliste sous anesthésielocale associée à une diminution des complications procédurales. Cependant la prise en charge decertaines situations cliniques d’urgence ou de certains patients à haut risque opératoire est encoremal définie et nécessite une évaluation précise des complications ischémiques et hémorragiquesde la procédure percutanée.Dans la première partie de la thèse nous avons confirmé que certaines situations cliniquescomplexes urgentes telles qu’un état de choc cardiogénique secondaire à un RA serré, ou lanécessité d’une chirurgie extracardiaque urgente constituent encore une zone grise où letraitement optimal du RA n'est pas clair et nécessite de plus amples investigations. Dans le choccardiogénique ou la chirurgie extracardiaque urgente, le risque de complications hémorragiqueset surtout ischémiques et la mortalité à court terme restent très élevés. En cas de choccardiogénique, les complications sont principalement reliées au timing de la valvuloplastieaortique (BAV). En cas de chirurgie extracardiaque urgente, la BAV systématique n’améliore pasle pronostic par rapport au traitement médical.Dans la deuxième partie de la thèse, chez des patients à risque intermédiaire ou élevécontre indiqué à l’accès transfémoral pour un TAVI, nous avons comparé les deux voiesalternatives extrathoraciques les plus utilisées : axillaire et carotidienne. Celles ci font jeu égal enterme de complications ischémiques et de mortalité mais l’accès carotidien semble avoir plus decomplications hémorragiques en particulier locales.La troisième et dernière partie de la thèse nous a permis d’apprécier l’incidenceimportante de microbleeds au cours de la procédure TAVI. Leur apparition semble être reliéeavec la durée de la procédure et l’absence de correction du déficit en facteur Willebrand acquislors du RA ; ces lésions n’ont pas de retentissement sur l’évolution neurologique à court terme(6mois). Des études sont en cours pour mieux préciser le lien entre risque hémorragique cérébral,anomalie du facteur vWF et dispositif cardiaque valvulaire ou d’assistance
Ischemic and haemorrhagic complications during percutaneous aortic valve interventionsPercutaneous aortic valve repair including balloon aortic valvuloplasty (BAV) and TAVI has experienced significant improvements over the past twenty years, allowing patients with severe aortic stenosis (SAS) to benefit from a curative treatment, mostly with a minimalist approach under local anesthesia associated with a drastic reduction of procedural complications.However, the management of specific clinical emergency situations or of high-risk patients is still poorly explored and requires an accurate assessment of the ischemic and hemorrhagic complications of percutaneous procedures.In the first part of this thesis, we confirmed that some urgent complex clinical situations such as cardiogenic shock secondary to SAS, or the need for urgent extracardiac surgery in SAS patients still constitute a grey zone where the optimal treatment is unclear and requires further investigations. During cardiogenic shock or urgent extracardiac surgery, the risk of hemorrhagic and especially ischemic complications and short-term mortality remain very high. During cardiogenic shock, complications are mainly related to the timing of the BAV. When urgent extracardiac surgery is required, routine BAV does not improve the prognosis of SAS patients compared to medical treatment.In the second part of this thesis, we compared the axillary and carotid access in intermediate or high-risk patients contraindicated to transfemoral route for TAVI. These accesses have similar rates of ischemic complications and mortality, but carotid artery has more local hemorrhagic complications.The third and final part of this thesis analyse the significant incidence of microbleeds during the TAVI procedure. Their appearance seems to be related to the duration of the procedure and the lack of correction of the von Willebrand factor deficiency acquired during SAS; these lesions have no impact on the neurological evolution in the short term.Studies are underway to better define the link between the risk of cerebral hemorrhage, the vWF factor and cardiac valvular or circulatory assist device

L'objectif de ce travail de these a consiste a qualifier et optimiser le depot des grilles des memoires eeprom en polycide de tungstene. Ces grilles sont destinees a remplacer les grilles en polycide de tantale. Les etudes realisees sur les structures de test ont permis d'etablir que les capacites mos avec une grille en ta-polycide presentent une meilleure resistance a l'injection d'electrons et que les cellules memoires presentent une meilleure endurance. Malgre ces avantages, il a ete decide d'introduire le siliciure de tungstene pour tenter d'ameliorer la fiabilite des memoires eeprom. Deux chimies de depot des couches de siliciure de tungstene ont ete comparees : la premiere utilise la reduction du monosilane (sih 4) par l'hexafluorure de tungstene (procede ms), la seconde utilise la reduction du dichlorosilane (sih 2cl 2) par l'hexafluorure de tungstene (procede dcs). La comparaison des deux procedes pour des dispositifs realises avec des oxydes de grille et tunnel sec a montre que ce dernier presente un certain nombre d'avantages en ce qui concerne les caracteristiques du depot obtenu. Par contre, les performances de la memoire n'ont pas ete suffisantes pour le retenir. Le procede ms a alors ete retenu. Les etudes precedentes pour determiner la chimie de depot optimale du siliciure de tungstene pour remplacer le siliciure de tantale ont fait apparaitre la necessite d'optimiser certaines etapes du procede de fabrication : croissance de l'oxyde tunnel, optimisation du depot de la couche de silicium dope, optimisation du rapport des epaisseurs des deux couches qui constituent le polycide de tungstene, gravure des espaceurs, recuit oxydant du siliciure les differentes etudes menees sur les etapes technologiques decrites auparavant ont permis de definir un procede de fabrication qui ameliore les performances des memoires non volatiles de type eeprom.

碩士
逢甲大學
土地管理所
102
Taxi pooling has existed in Taiwan since 1988, but is still not popular. The taxi market in Taiwan is currently facing vacancy rates that are too high. If current taxi use patterns can be changed in favor of taxi pooling, lower costs would encourage more people to use taxis, thus lowering vacancy rates and increasing industry revenue. This paper develops a two-phrase method of matching multiple passengers for one-to-many pooling, which includes only one departure and two or three destination for a trip. First phrase is called neighboring matching where all destinations in a matched group should be nearby each other, say in 1.5km, and thus each passenger can pay nearly the same amount of fares, providing the best case scenario for matching. For those passengers who are not matched in the first phrase, non-neighboring matching, also called lowest-deviation matching, will be applied as the second phrase, where destinations are not close but passengers can still receive decent fares due to pooling. A simulation is carried out using Taichung High Speed Rail Station as the departure and 81 convenient stores in the Xitun District of Taichung City as selectable destinations, which can help evaluate the feasibility of matching method developed by this research. Three independent cases of 50 passengers with randomly selected destinations were examined by applying the matching method. Results indicate that the matching method can reach satisfactory pooling rides where most passengers are matched with an minimal fare discount. In the research, the average discount is the best factor for the matching procedure to survey, and it had be proof by three independent cases, the average discount are 44.86%、43.27% and 45.71%, which are better than the acceptable range of value, in other words, the matching procedure can make the passengers save money. As a result, the matching process described in this paper and the results of the experiments can be a reference for further research on taxi pooling in Taiwan.

L’indagine prende in esame l’uso e la funzione politica della figura del martire nello spazio pubblico contemporaneo. La ricerca, pur nel riferimento consapevole alla consolidata letteratura ormai classica sull'argomento, ha tra i propri riferimenti filosofici specificatamente la teoria del discorso di Michel Foucault, con la sua metodologia dell’analisi discorsiva, e segue un approccio transdiscipli¬nare fra scienze culturali e filosofia. Essa ha come punto di partenza, come caso di studio, la rappresentazione mediale del politico e statista democristiano Aldo Moro quale martire di stato durante e dopo il suo assassinio per opera delle Brigate Rosse nel 1978. La ricerca si sviluppa sulla scorta dell’ipotesi di una connessione fra procedure di legittimazione dell’autorità politica e delle strutture di potere e l’emergere della figura del martire di Stato. Le rappresentazioni martirologiche sono considerate pratiche discorsive performanti, attraverso le quali la morte di Moro viene ad assumere il significato di un martirio per lo Stato, la Repubblica Italiana e i valori democratici. L’ipotesi di lavoro è che, attraverso l’allocazione dello statuto di martire, la morte di Moro acquisisca il significato di un atto (volontario) di testimonianza della verità assoluta e trascendentale dei diritti umani, garantiti dalla costituzione (in particolare articolo 2 della Costituzione Italiana), così come della necessità dello Stato come garante di tali diritti. Attraverso questa significazione, la figura di Moro assurge inoltre a corpo simbolico dello Stato-nazione, legittimando lo stesso e fungendo da simbolo d’identificazione collettiva con la nazione. Si tratta qui di mettere in luce il rapporto intrinseco fra la figura del martire e una narrazione mitologica dello Stato, dove mito sta a indicare un «assolutismo del reale» (Absolutismus der Wirklichkeit). La ricerca vuole altresì mettere in luce la dimensione strumentale delle rappresentazioni martirologiche di Aldo Moro, le quali hanno mantenuto e tuttora mantengono un’efficacia performativa nonostante il chiaro ed evidente rifiuto, espresso da Moro stesso, di essere sacrificato «in nome di un astratto principio di legalità.» La ricerca si propone di dimostrare la valenza di tale ipotesi di lavoro attraverso l’analisi dell’apparizione e diffusione delle rappresentazioni martirologiche di Aldo Moro in forme mediali differenti nell’intervallo temporale di quattro decenni. Il corpus delle fonti preso in esame include: articoli di giornali e riviste, i documenti prodotti da Moro e della Brigate Rosse durante i 55 giorni di sequestro, trasmissioni televisive (documentari e reportage), opere letterarie e cinematografiche. La teoria discorsiva e l’analisi archeologico-genealogica sviluppate da Michel Foucault fungono da base teorico-metodologica del lavoro. Il taglio transdisciplinare dell’indagine rende necessaria la distinzione di due diversi piani di ricerca. In primo luogo, ci si pone come obiettivo di individuare e analizzare le diverse rappresentazioni come elementi di una formazione discorsiva il cui tema comune è la morte di Aldo Moro. Si tratta di operare una ricognizione, attraverso il lavoro empirico, dei modi di rappresentare l’uccisione di Aldo Moro e di individuare le regole che determinano ciò che può essere detto e mostrato a tale riguardo. In secondo luogo, a partire da qui, ci si propone di fare un’analisi critica dell’uso e della funzione del linguaggio e della simbologia di matrice religiosa all’interno della forma¬zione discorsiva presa in esame. L'obiettivo è di mettere così in luce non solo il dispositivo di legittimazione politica che presiede alla costruzione della figura del martire, ma anche la sua polivalenza.

INTRODUZIONE: Il presente progetto di ricerca nasce all’interno di un Dottorato Eureka, sviluppato grazie al contributo della Regione Marche, dell’Università di Macerata e dell’azienda Jobmetoo by Jobdisabili srl, agenzia per il lavoro esclusivamente focalizzata sui lavoratori con disabilità o appartenenti alle categorie protette. Se trovare lavoro è già difficile per molti, per chi ha una disabilità diventa un percorso pieno di ostacoli. Nonostante, infatti, la legge 68/99 abbia una visione tra le più avanzate in Europa, l’Italia è stata ripresa dalla Corte Europea per non rispettare i propri doveri relativamente al collocamento mirato delle persone con disabilità. Tra chi ha una disabilità, la disoccupazione è fra il 50% e il 70% in Europa, con punte dell’80% in Italia. L’attuale strategia europea sulla disabilità 2010-2020 pone come obiettivi fondamentali la lotta alla discriminazione, le pari opportunità e l’inclusione attiva. Per la realizzazione di tali obiettivi assume un’importanza centrale l’orientamento permanente: esso si esercita in forme e modalità diverse a seconda dei bisogni, dei contesti e delle situazioni. La centralità di tutti gli interventi orientativi è il riconoscimento della capacità di autodeterminazione dell’essere umano, che va supportato nel trovare la massima possibilità di manifestarsi e realizzarsi. Ciò vale ancora di più per le persone con disabilità, in quanto risultano fondamentali tutte quelle azioni che consentono loro di raggiungere una consapevolezza delle proprie capacità/abilità accanto al riconoscimento delle caratteristiche della propria disabilità. L’orientamento assume così un valore permanente nella vita di ogni persona, garantendone lo sviluppo e il sostegno nei processi di scelta e di decisione con l’obiettivo di promuovere l’occupazione attiva, la crescita economica e l’inclusione sociale. Oggi giorno il frame work di riferimento concettuale nel campo della disabilità è l’International Classification of Functioning, Disability and Health (ICF), il quale ha portato a un vero e proprio rovesciamento del termine disabilità dal negativo al positivo: non si parla più di impedimenti, disabilità, handicap, ma di funzioni, strutture e attività. In quest’ottica, la disabilità non appare più come mera conseguenza delle condizioni fisiche dell’individuo, ma scaturisce dalla relazione fra l’individuo e le condizioni del mondo esterno. In termini di progetto di vita la sfida della persona con disabilità è quella di poter essere messa nelle condizioni di sperimentarsi come attore della propria esistenza, con il diritto di poter decidere e, quindi, di agire di conseguenza in funzione del proprio benessere e della qualità della propria vita, un una logica di autodeterminazione. OBIETTIVO: Sulla base del background e delle teorie di riferimento analizzate e delle necessità aziendali è stata elaborata la seguente domanda di ricerca: è possibile aumentare la consapevolezza negli/nelle studenti/esse e laureati/e con disabilità che si approcciano al mondo del lavoro, rispetto alle proprie abilità, competenze, risorse, oltre che alle limitazioni imposte dalla propria disabilità? L’obiettivo è quello di sostenere i processi di auto-riflessione sulla propria identità e di valorizzare il ruolo attivo della persona stessa nella sua autodeterminazione, con la finalità ultima di aumentare e migliorare il match tra le persone con disabilità e le imprese. L’auto-riflessione permetterà di facilitare il successivo contatto dialogico con esperti di orientamento e costituirà una competenza che il soggetto porterà comunque come valore aggiunto nel mondo del lavoro. METODI E ATTIVITÀ: Il paradigma teorico-metodologico adottato è un approccio costruttivista: peculiarità di questo metodo è che ciascuna componente della ricerca può essere riconsiderata o modificata nel corso della sua conduzione o come conseguenza di cambiamenti introdotti in qualche altra componente e pertanto il processo è caratterizzato da circolarità; la metodologia e gli strumenti non sono dunque assoggettati alla ricerca ma sono al servizio degli obiettivi di questa. Il primo passo del progetto di ricerca è stato quello di ricostruzione dello stato dell’arte, raccogliendo dati, attraverso la ricerca bibliografica e sitografica su: l’orientamento, la normativa vigente in tema di disabilità, i dati di occupazione/disoccupazione delle persone con disabilità e gli strumenti di accompagnamento al lavoro. A fronte di dati mancanti sul territorio italiano relativi alla carriera e ai fabbisogni lavorativi degli/delle studenti/esse e laureati/e con disabilità, nella prima fase del progetto di ricerca è stata avviata una raccolta dati su scala nazionale, relativa al monitoraggio di carriera degli studenti/laureati con disabilità e all’individuazione dei bisogni connessi al mondo del lavoro. Per la raccolta dati è stato sviluppato un questionario ed è stata richiesta la collaborazione a tutte le Università italiane. Sulla base dei dati ricavati dal questionario, della letteratura e delle indagini esistenti sulle professioni, nella fase successiva della ricerca si è proceduto alla strutturazione di un percorso di auto-orientamento, volto ad aumentare la consapevolezza nelle persone con disabilità delle proprie abilità e risorse, accanto a quella dei propri limiti. In particolare, il punto di partenza per la costruzione del percorso è stata l’Indagine Istat- Isfol sulle professioni (2012) e la teoria delle Intelligenze Multiple di H. Gardner (1983). Si è arrivati così alla strutturazione del percorso di auto-orientamento, composto da una serie di questionari attraverso i quali il candidato è chiamato ad auto-valutare le proprie conoscenze, le competenze, le condizioni di lavoro che gli richiedono più o meno sforzo e le intelligenze che lo caratterizzano, aggiungendo a questi anche una parte più narrativa dove il soggetto è invitato a raccontare i propri punti di forza, debolezza e le proprie aspirazioni in ambito professionale. Per sperimentare il percorso di auto-orientamento creato, nell’ultima fase della ricerca è stato predisposto uno studio pilota per la raccolta di alcuni primi dati qualitativi con target differenti, studenti/esse universitari/e e insegnanti di scuola superiore impegnati nel tema del sostegno e dell’orientamento, e utilizzando diversi strumenti (autopresentazioni, test multidimensionale autostima, focus group). CONCLUSIONI: I dati ottenuti dallo studio pilota, seppur non generalizzabili, in quanto provenienti da un campione esiguo, hanno evidenziato come il percorso di auto-orientamento attivi una riflessione sulla visione di sé nei diversi contesti e un cambiamento, in positivo o in negativo, nell’autostima e nella valutazione di sé in diverse aree, ad esempio nell’area delle relazioni interpersonali, del vissuto corporeo, dell’emotività ecc. Tali dati ci hanno permesso soprattutto di evidenziare punti di forza e debolezza del percorso creato e di apportare modifiche per una maggiore comprensione e adattabilità del prodotto stesso. Il valore del percorso orientativo è connesso al ruolo attivo di auto-valutatore giocato dal candidato con disabilità, affiancando a questa prima fase di autovalutazione un successivo confronto dialogico con un esperto, tale da permettere un ancoraggio alla realtà esterna, al contesto in cui il soggetto si trova a vivere. In questo senso, l’orientamento assume il valore di un processo continuo e articolato, che ha come scopo principale quello di sostenere la consapevolezza di sé e delle proprie potenzialità, agendo all’interno dell’area dello sviluppo prossimale della persona verso la realizzazione della propria identità personale, sociale e professionale.

mondo universitario ha subito un’ondata di cambiamenti che si possono ricondurre alla ricerca dell’eccellenza, declinata secondo le due dimensioni della valutazione e della rendicontazione. Tre sono quelli più evidenti: il primo, il passaggio da una ricerca curiosity driven a una ricerca funzionale al raggiungimento di risultati valutabili in tempi brevi; dalla ricerca pura a quella applicata, da un approccio problem-making a uno problem-solving, da una conoscenza come processo a una conoscenza come prodotto, da un modello disinteressato a uno utilitaristico (Barnett, 1994); il secondo, riguardante l’offerta formativa: dal momento che si è modificato il modo di concepire l’apprendimento; i curricula tendono a essere definiti in termini di risultati di apprendimento predefiniti (Blackmore, 2016); il terzo, peculiare della struttura amministrativa: dal momento in cui sono divenute essenziali una serie di nuove sovrastrutture (programmazione, valutazione, controlli, comunicazione) rispetto al mandato originario della struttura universitaria si registra un aumento consistente del personale delle strutture amministrative. Questi cambiamenti devono fare i conti con la perdita di prestigio della vita accademica, il cambiamento del ruolo dello studente, che è diventato sempre più importante e l’aumento delle procedure burocratiche che rischiano di ingessare un sistema un tempo caratterizzato da un’elevata autonomia. Per consentire alle strutture universitarie di affrontare le sfide culturali a partire dagli anni Settanta nelle università nord-americane si sono strutturate iniziative finalizzate allo sviluppo e alla promozione di una migliore offerta formativa. Tali iniziative vengono definite con l’espressione Faculty Development (FD), una policy accademica finalizzata a creare le condizioni per un miglioramento delle competenze di tutti coloro che sono coinvolti nelle attività svolte in un ateneo. Nella realtà italiana emerge la mancanza di una vera politica di formazione al teaching per i ricercatori e i docenti universitari, per non parlare dell’esigenza di superare il pregiudizio, di gentiliana memoria, secondo il quale non è necessario apprendere a insegnare, ma sia sufficiente avere successo nella ricerca, cui si aggiunge nell’ultimo decennio una continua e affannata richiesta al personale accademico di azioni organizzative, valutative e documentali, che assorbono tempo e energie senza il supporto di adeguati apparati gestionali e senza predisporre indagini valutative capaci di misurare l’effettivo esito di tutte queste azioni. L’effetto finale è un evidente declino (Capano et al., 2017) dell’istituzione universitaria. Si può ipotizzare che la cultura del organizzazione propria del Faculty Development possa contribuire nel contesto italiano a fornire azioni a supporto del cambiamento: è quanto mai essenziale dotare gli atenei di risorse funzionali a riqualificare la vita accademica, fornendo al personale accademico gli strumenti necessari per performare una buona scholarship, realizzare un’efficace offerta formativa e attuare adeguate forme di terza missione, capaci di incrementare la vita culturale della comunità. Il presente studio si propone come un’analisi sistematica della letteratura sul tema del Faculty Development, che persegue l’obiettivo di sviluppare una disamina estesa dell’oggetto, in modo che l’esplicitazione della datità raccolta fornisca un’analisi del fenomeno che possa essere di supporto a un’avveduta educational policy nel campo della formazione universitaria. Nel contesto italiano ad oggi non esiste una cultura di attenzione ai contesti di apprendimento universitario. L’offerta formativa è concepita come offerta di pacchetti curriculari e la predisposizione delle condizioni di apprendimento per il conseguimento del titolo universitario si risolve nella organizzazione di una serie di lezioni, frontali o laboratoriali, senza che tutto questo sia innervato da una specifica intenzionalità didattica. Questa immagine poco confortante non intende affatto trascurare tutti i casi di buone prassi sviluppati nei vari corsi di studio, ma il buono che emerge è demandato all’impegno del singolo, senza che l’istituzione universitaria si interroghi sul come predisporre le condizioni per il potenziamento della qualità dei processi di apprendimento. A fronte di questa situazione la necessità di migliorare la qualità dell’insegnamento non è mai stata così stringente e sfidante come lo è oggi, in un clima di continuo cambiamento della formazione superiore. Nuove tendenze definiscono la formazione superiore, attraversando confini istituzionali e nazionali. Essi influiscono sul modo in cui un insegnamento efficace viene concettualizzato, condotto e supportato, valutato, valorizzato e riconosciuto. È necessario affrontare temi quali l’inadeguata preparazione per il lavoro accademico nei corsi di studio magistrali, l’incapacità dei docenti a trasferire competenze, la crescente complessità degli ambienti accademici, le attese e le responsabilità istituzionali, la necessità di preparare meglio gli studenti con bisogni diversi, e la necessità di stare al passo con i balzi della conoscenza e i cambiamenti nelle professioni. Migliorare la qualità della didattica è inoltre essenziale perché consente di ridurre il numero degli abbandoni. È venuto il momento di transitare da un’offerta formativa di tipo episodico a una prospettiva di esperienze di apprendimento in continuità nel tempo, per accompagnare la formazione dei docenti in un modo strutturalmente organizzato (Webster-Wright, 2009). Sulla base della rilevazione fenomenica, sono emerse le seguenti domande di ricerca: che cosa è il FD? Cosa consente di fare? Come si mette in pratica? Quali sono le potenzialità? Quali sono i limiti? Il FD ha il compito di incentivare i docenti ad interessarsi ai processi di insegnamento e apprendimento e a procurare un ambiente sicuro e positivo nel quale fare ricerca, sperimentare, valutare e adottare nuovi metodi (Lancaster et al. 2014). È finalizzato a promuovere cambiamento sia a livello individuale sia a livello organizzativo. Occupa un posto centrale il miglioramento delle competenze di teaching (Steinert, 2014). Due importanti obiettivi sono rappresentati dalla promozione delle capacità di leadership e di gestione dei contesti (Steiner et al., 2012). Una volta definite le metodologie del teaching, che possono essere oggetto di apprendimento da parte del personale accademico, è risultato necessario identificare le principali modalità formative che un centro di Faculty Development (FDc) dovrebbe mettere in atto per favorire l’apprendimento delle competenze didattiche. Per comprenderne la funzione reale è stato utile prendere in esame le attività proposte dai più importanti centri del panorama accademico nordamericano, analizzandone la struttura organizzativa, le risorse disponibili ed identificandone le due figure principali: il responsabile dell’organizzazione dei processi formativi e il responsabile della struttura. L’analisi dei casi ha consentito di evidenziare i molteplici servizi che possono essere forniti da un FDc. Questa analisi di realtà è risultata molto utile poiché ha offerto indicazioni pragmatiche ai fini di una politica accademica innovativa anche in ambito italiano. Alla luce degli argomenti sviluppati è stato possibile ipotizzare anche per gli atenei italiani l’istituzione di “Centri per la professionalità accademica”, indicando possibili iniziative da essi realizzabili, che potrebbero trovare spazio nella realtà del nostro paese.

The analysis of the regulatory framework of environmental environment, wildlife, and environmental safety in Russia and abroad. Particular attention is paid to the presentation of the theory, methodology and practice cal techniques for geo-environmental study of economic activity level of a feasibility study, design, construction and operation, as well as designing principles tion and environmental protection facilities. The conceptual procedure environmental impact assessment (EIA), environmental risk analysis, assessment and auditing, which are the main tools Tami environmental support planned economic activity of Russia&#180;s (methods, tools, and environmental assessment criteria, methods Wild assess the intensity of anthropogenic load on the environment). Compliant with the Federal State of Education tional standard of the latest generation of higher education. Recommended for students and teachers of all technical eg boards and university education specialties. May be also used in the study courses &#34;Ecology&#34;, &#34;Ecology and nature dopolzovanie &#34;&#34; Environmental Protection &#34;,&#34; Harmful substances in the environ- environment &#34;,&#34; Ekozaschitnaya equipment and technology &#34;and aspiranta- E specialty &#34;Geoecology&#34;.

During the past decade, development of catheter-based techniques for treatment of thoracic aortic and aortic valve pathologies has required that interventionalists focus on the anatomic suitability of vascular access to allow safe introduction of large size devices. Both thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures require 20 French and larger sheaths and most of major complications during these procedures have been access related. This chapter reviews transcaval aortic access techniques for delivering large devices during TEVAR and TAVI. Alternative arterial access or adjunctive femoral access techniques that increase the safety of access and reduce the overall procedural risk for patients with challenging access are critically important for the success of TEVAR or TAVI. The procedure involves transcatheter puncture of the abdominal aorta from the inferior vena cava, with delivery of a large vascular sheath and tract closure post device delivery using a nitinol occlusion device.

The chapter contributes to the emerging understanding of expertise as social, relational, and material. The authors examine current views on expertise building in the study of an innovative medical procedure called Transcatheter Aortic Valve Implantation (TAVI). They find that expertise occurs in many locales concurrently—each with its own trajectory and history—and that expert activity feeds upon the connections established and maintained between locales. Accordingly, expertise is not so much distributed or relational as it is trans-situated. Being an expert implies not only being socialized and becoming versed in the local way of doing things, it also implies participating in, learning to navigate, and exploiting alternative potentially competing circuits of knowledge.

Il declino della legislazione di fonte statuale e la progressiva espansione della tendenza alla cosiddetta autonormazione hanno determinato un fenomeno per effetto del quale la disciplina di ampi settori delle attività sociali non è più rimessa all’originaria competenza statale, ma è, invece, affidata a quelli che sono i suoi più diretti destinatari, sì da dar luogo ad una sostanziale autodisciplina dei loro rapporti. Tali procedure di autoregolamentazione urtano, sul terreno del diritto penale, con il principio-cardine di questo ramo dell’ordinamento giuridico, che è rappresentato dal principio di [ii]riserva di legge . L’Autrice ritiene che questo contrasto possa essere superato in forza delle garanzie di democraticità interna che quelle procedure di autonormazione e di co-legislazione assicurano; e che, d’altra parte, le statuizioni, che ne sono il prodotto, paiono garantire un grado di effettività ben maggiore di quello associabile a quelle promananti da una legislazione statuale (che si vuole) esposta ad un alto grado di ineffettività. La materia sulla quale viene vagliata la tenuta complessiva di questi assunti è la disciplina penale della sicurezza sul lavoro. Si intraprende, in tal senso, un’ampia e articolata indagine comparata, che ha ad oggetto i paesi di common law e in particolare i modelli offerti dall’esperienza inglese e statunitense. Questa documentata disamina vale a confortare l’assunto per cui il ricorso all’autodisciplina, in sede di normazione avente ad oggetto la sicurezza sul lavoro nelle imprese, lungi dal condurre a riedizioni occulte del liberismo, garantisce il rispetto di tutti gli interessi in gioco; ciò in specie se e nella misura in cui alla stessa autodisciplina si abbina un sistema di controlli pubblici efficienti.

This chapter is a complement to Chapter 15, concentrating on the non-pharmacological approaches to chronic pain. It features a discussion on the utility of mind-body therapies, psychosocial treatments, and technology-based therapies in the context of recovery through 12-Step programs and other mutual support groups. Such settings are commonly poorly receptive to medication management of either pain or addiction; the availability of other approaches can bridge the gap, leading to effective management of both. The therapies discussed include “movement” therapies, such as internal qi gong, tai chi, yoga, and martial arts. Healing touch, reiki, external qi gong, and acupuncture are examples of “energy” therapies, requiring an intercessor. Among the psychosocial treatments are motivational interviewing, cognitive restructuring, cognitive behavioral therapy, acceptance-based cognitive therapy, operant training, hypnosis, relaxation training, and mindfulness/meditation. Addressed as procedures are massage, chiropractic and osteopathic manipulations, trans-epidermal nerve stimulation (TENS), and transcranial magnetic stimulation (TMS).

Ład korporacyjny (corporate governance)1, tworzący system wzajemnie powiązanych wewnętrznych oraz zewnętrznych mechanizmów organizacyjno- -kontrolnych, uznawany jest obecnie za jedną z kluczowych determinant sukce- su gospodarczego złożonych struktur korporacyjnych. Brak odpowiednich roz- wiązań w obszarze nadzoru korporacyjnego zwiększa prawdopodobieństwo materializacji ryzyka nadużyć i nieprawidłowości we wszystkich obszarach funkcjonowania spółki, a w konsekwencji potęguje ryzyko utraty zainwestowa- nego w niej kapitału. Zwiększa również ryzyko transakcyjne dla innych nieza- angażowanych kapitałowo interesariuszy. Jak ważne jest tworzenie odpowied- nich zabezpieczeń przed wymienionymi wyżej zagrożeniami, potwierdzają liczne badania prowadzone przez firmy audytorskie czy instytucje powołane w celu przeciwdziałania nadużyciom i oszustwom. Wykonywane przez nie ana- lizy o charakterze globalnym potwierdzają wysoki poziom zagrożenia defrauda- cją mienia, korupcją czy przestępstwami polegającymi na zniekształceniu infor- macji prezentowanych w sprawozdaniach. Mimo wprowadzanych rozwiązań organizacyjnych, których celem jest mitygowanie ryzyka, badania te często nie wskazują na istotną tendencję spadkową, a wręcz przeciwnie, potwierdzają wciąż znaczną liczbę ujawnionych nieprawidłowości. Pojawia się zatem pytanie, czy tendencja ta jest efektem zwiększonej świadomości i skuteczności mechani- zmów nadzoru, a co za tym idzie lepszej wykrywalności, czy też wraz ze wzro- stem nieprawidłowości zwiększa się również liczba ujawnień, a wprowadzane instrumenty nadzoru nie przynoszą oczekiwanych rezultatów. Aby odpowie- dzieć na to pytanie, niezbędne będzie przeprowadzenie złożonych badań uwzględniających między innymi turbulentność gospodarki, zmienność czynni- ka psychologicznego, rozwiązań prawnych i organizacyjnych, i na tym tle doko- nanie oceny jakości i skuteczności implementowanych w przedsiębiorstwach mechanizmów corporate governance. Sam nadzór korporacyjny jest bowiem pojęciem multidyscyplinarnym, które powinno być rozpatrywane przez pryzmat problemów rozważanych w ramach różnych dyscyplin naukowych. Przystąpienie do oceny skuteczności mechanizmów nadzoru ze względu na jego wielowymiarowość należy poprzedzić przeglądem podstaw teoretycznych, w tym zmian koncepcji zarządzania, a w szczególności zmiany perspektywy postrzegania celu przedsiębiorstwa. Cel ten formułowany jest bowiem w róż- nych ujęciach teoretycznych w zróżnicowany sposób. Z perspektywy rozwoju koncepcji nadzoru korporacyjnego kluczowe znaczenie ma akcentowane w teo- riach menedżerskich oddzielenie własności kapitału od procesu zarządzania nim oraz zróżnicowanie celów właściciela i zarządzającego kapitałem menedżera. W efekcie wyżej wskazanego podziału właściciel zostaje pozbawiony w znacz- nej mierze kontroli nad powierzonym spółce majątkiem. Negatywne skutki ograniczonego dostępu właściciela kapitału zainwesto- wanego w spółkach do rzetelnej informacji potwierdzają przypadki oszustw i nadużyć, które ujrzały światło dzienne dopiero po wieloletnim okresie manipu- lowania danymi sprawozdawczymi. Po ich wykryciu było już za późno na podej- mowanie jakichkolwiek działań naprawczych. Bezcelowa w tych przypadkach okazała się ocena spółki przez pryzmat jej sprawozdania. Pomimo nadzoru pro- wadzonego przez dedykowany do tego organ, jakim jest rada nadzorcza, w wielu przypadkach nie udało się uniknąć przykrych konsekwencji celowego działania nieuczciwych menedżerów. Co ciekawe, naruszenia zasady rzetelności sprawoz- dawczej nie dostrzegali również audytorzy. Sytuacje te ujawniły nie tylko niepra- widłowości sprawozdawcze, ale przede wszystkim przestępstwa niewykryte przez wprowadzone w tych spółkach mechanizmy kontrolne obejmujące rozwiązania organizacyjne, polityki, procedury działania, w tym kodeksy etyczne. Fakt ten dał asumpt do poszukiwania coraz sprawniejszych rozwiązań organizacyjnych ogra- niczających ryzyko nadużyć i fałszerstw. Przeprowadzając historyczną analizę przyczyn i konsekwencji przestępstw gospodarczych ukrywanych przed właścicielami wprowadzanymi w błąd poprzez nierzetelne informacje sprawozdawcze, autorzy licznych publikacji skupiają się głównie na zdarzeniach wykrytych w latach 90. XX w. oraz w pierwszej dekadzie XXI w. Jednak problematyka związana z naruszeniami prawa gospodarczego, a następnie celowego naruszania reguł sprawozdawczych (prawa bilansowego) i potrzeby budowania odpowiednich zabezpieczeń pozwalających ograniczyć ryzy- ko nieprawidłowości i nierzetelności stanowiła przedmiot rozważań autorów już zdecydowanie wcześniej. S. Latanowicz – zaprzysiężony i publicznie ustanowiony rewizor ksiąg, publikujący opracowania poruszające omawianą tematykę już od 1910 r. – twierdził, że: „Fałszowanie ksiąg i dowodów rozpoczęło się prawie rów- nocześnie z wynalezieniem księgowości w ogóle” [Latanowicz, 1934, s. 11]. W opublikowanym w 1549 r. dziele niemieckim pt. Zwifach Buchhalten, autorstwa B.W. Schweickera, znajdował się już opis fałszywych dowodów i złego prowadzenia księgowości. Jak podkreśla S. Latanowicz, „od tego czasu upłynęło blisko 400 lat, w którym to czasie fałszerstwa nie ustały” [Latanowicz, 1934, s. 11]. Zważywszy na fakt, że przywołana publikacja ukazała się już w 1934 r. czas dyskusji na temat manipulacji i fałszerstw księgowych, których celem jest ukrycie działalności przestępczej i „lukrowanie rzeczywistości”, a także czas poszukiwania remedium, pozwalającego na wyeliminowanie praw- dopodobieństwa naruszeń, jest zdecydowanie dłuższy. J. Jeżak podkreśla, że: „Problem kontroli nad zachowaniami menadżerów pojawił się [...] w dysku- sjach akademickich i badaniach już na początku lat 30-tych XX wieku” [Jeżak, 2006, s. 42]. Właśnie wtedy A. Berle i G. Means, publikując wyniki swoich badań, sformułowali tezę o oddzieleniu własności od kontroli nad korporacją oraz zaprezentowali związane z tym zagrożenia [Jeżak, 2006, s. 42]. Od lat stopniowo wprowadzane są mechanizmy prawne oraz organizacyjne pozwalające na minimalizację ryzyka wystąpienia opisanych wyżej naruszeń nie tylko na etapie raportowania, ale już wcześniej, bo w trakcie realizacji procesów operacyjnych. Szczególną rolę należy tu przypisać wewnętrznym narzędziom nadzoru korporacyjnego. Wewnętrzne mechanizmy corporate governance utoż- samiane są często z radą nadzorczą. I. Koładkiewicz do grupy mechanizmów wewnętrznych włącza również organy doradcze i organy opiniujące [Gad, 2011, s. 30]. Biorąc pod uwagę kontrolę nad sprawozdawczością finansową, J. Gad wymienia zdecydowanie szerszy katalog mechanizmów nadzoru. Do tej grupy autor zaliczył: radę nadzorczą oraz komitet audytu, audyt wewnętrzny działający na rzecz rady oraz samoregulację w postaci kodeksów etycznych czy procedur wewnętrznych [Gad, 2019, s. 85]. To właśnie te mechanizmy, mające na celu zwiększenie zakresu i skutecz- ności kontroli wewnętrznej oraz kontroli sprawowanej przez samego właściciela, tworzą kontekst tematyczny niniejszej publikacji. Celem prowadzonych w niej rozważań jest prezentacja interdyscyplinarności problematyki corporate governance, a w tym przedstawienie wybranych problemów dotyczących efektywności mechanizmów nadzoru, zwiększających szanse na wy- krywanie przestępstw oraz nadużyć wewnętrznych, a także oszustw, w tym tych dotyczących raportowania. Zrealizowanie tak sformułowanego celu umożliwiła realizacja określonych na wstępie celów cząstkowych, do których zaliczono: prezentację koncepcji nadzoru korporacyjnego oraz związanych z nią wybranych problemów prawnych i organizacyjnych, prezentację problemów raportowania i monitorowania procesu raportowania jako kluczowego narzędzia nadzoru korporacyjnego, prezentację problemów audytu wewnętrznego jako kluczowego mechanizmu wewnętrznego nadzoru korporacyjnego. Biorąc pod uwagę wyżej wskazany cel główny, uzasadnione jest skupienie uwagi czytelnika na mechanizmach wewnętrznych oraz wybranych mechanizmach regulacyjnych, zapewniających czy też mających zapewnić właścicielom odpo- wiednią jakość informacji na temat sytuacji ekonomicznej spółki. Skuteczny nadzór determinowany jest umiejętnością dostrzegania powiązań i przenikania się poszczególnych procesów, a także wykorzystywania zachodzącej pomiędzy nimi synergii. Niniejsza publikacja ma być wsparciem w kształtowaniu umiejętności spoglądania na problematykę nadzoru korporacyjnego w taki właśnie sposób. Ze względu na coraz większą świadomość potrzeby tworzenia skutecznych systemów nadzoru tematyka ta staje się coraz częściej przedmiotem dyskusji i roz- ważań zarówno wśród teoretyków, jak i praktyków przedmiotu. Rozdziały zawarte w monografii poruszają wybrane problemy uznane przez autorów za ważne dla zrozumienia istoty procesu rozwoju koncepcji corporate governance, którą utożsamia się tu z nadzorem korporacyjnym. Książka została podzielona na trzy części, w których przedstawiono kolejno kwestie podstawo- we, stanowiące bazę teoretyczną dla dalszych rozważań na temat corporate governance (część I), mechanizmy regulacyjne i wewnętrzne tworzące system nadzoru nad informacją udostępnianą właścicielowi (część II) i wreszcie audyt wewnętrzny oraz związane z nim problemy komunikacji prezentowane jako istotny element systemu kontroli wewnętrznej i jego środowiska (część III). W pierwszej części książki zostały omówione podstawowe problemy kon- cepcyjne obejmujące istotę oraz ogólny zarys modeli nadzoru korporacyjnego. Dokonany w niej przegląd definicji pojęcia corporate governance pozwolił na potwierdzenie niejednoznaczności pojęciowej. Umożliwił również wyodrębnienie atrybutów łączących wskazane definicje corporate governance. Poza prezentacją głównych założeń leżących u podstaw koncepcji zwrócono uwagę na kluczowe mierniki efektywności ładu korporacyjnego pozwalające na ocenę poziomu sku- teczności stosowanych w przedsiębiorstwie rozwiązań. Poruszono również pro- blematykę dotyczącą uprawnień i obowiązków zarządu spółki jako organu realizu- jącego obowiązki decyzyjne, odpowiedzialnego za jej funkcjonowanie. W drugiej części książki skupiono uwagę czytelnika na problematyce rapor- towania. Scharakteryzowano podstawowe problemy związane z implementacją odpowiednich mechanizmów regulacyjnych nakładających na zarządy spółek szerokie obowiązki sprawozdawcze. Zaakcentowano również fakt, iż zmieniają- ce się uwarunkowania gospodarcze oraz próba poszukiwania rozwiązań, których celem jest ograniczenie asymetrii informacyjnej pomiędzy zarządem a właści- cielem kapitału, wpływają na obserwowane wyraźne zmiany zakresu obowiąz- ków informacyjnych, mających na celu zapewnienie pełnej transparentności procesów zachodzących w spółce. Zgodnie z obowiązującym prawem bilanso-wym, pryncypał otrzymuje bowiem określony ustawowo minimalny zakres infor- macji o działalności przedsiębiorstwa. W przypadku dużych spółek, szczególnie tych notowanych na GPW, stopniowo zwiększa się zakres raportowanych infor- macji. Jako przykład można tutaj wymienić wprowadzenie omówionego w drugiej części książki obowiązku raportowania informacji niefinansowych czy też wpro- wadzenie nowych zasad raportowania realizacji dobrych praktyk spółek notowa- nych na GPW. Trafność oceny efektywności pracy zarządu dokonywanej przez „wypchniętego ze spółki” właściciela kapitału i możliwość reagowania w przy- padku zidentyfikowania ryzyka uzależnione są jednak od wiarygodności, a nie od ilości, informacji udostępnianej przez zarząd. Kluczowe znaczenie ma tutaj za- pewnienie odpowiednich mechanizmów corporate governance ograniczających ryzyko ewentualnych nieścisłości i zniekształceń. Istotną rolę odgrywa tu rada nadzorcza i działający w jej ramach komitet audytu. W drugiej części opracowania omówiono ich znaczenie w zapewnieniu skuteczności nadzoru korporacyjnego. Trzecia część książki zawiera rozważania dotyczące funkcjonowania i efek- tywności audytu wewnętrznego, prowadzone na tle wybranych aspektów obszaru komunikacji wewnętrznej w organizacji. Audyt stanowi jeden z kluczowych me- chanizmów wewnętrznych corporate governance. Jego szczególną rolę potwierdza fakt, iż to właśnie ta komórka zgodnie z DPSN 2021 odpowiedzialna jest za corocz- ną ocenę skuteczności systemu kontroli wewnętrznej spółki. Doświadczenie, przy- gotowanie merytoryczne oraz umiejętności komunikacyjne audytorów wewnętrz- nych są zatem istotnym czynnikiem zwiększającym szansę wykrycia ewentualnych słabości systemu zabezpieczającego przed nieprawidłowościami zarówno w obsza- rze raportowania, jak i w obszarze innych procesów realizowanych w przedsiębior- stwie. Co więcej, rekomendacje wydawane przez tą komórkę powinny wpływać na stałe doskonalenie skuteczności mechanizmów kontrolnych. Nie można zatem pominąć jej roli, prowadząc rozważania na temat skuteczności wewnętrznych me- chanizmów nadzoru korporacyjnego. Książka powstała głównie z myślą o czytelnikach, którzy chcą uczestniczyć w dyskusjach na temat roli mechanizmów corporate governance i potrzeby ich doskonalenia, a także tych, którzy chcą rozwijać swoje kompetencje praktyczne w tym obszarze. Budowanie potencjału praktycznego wymaga bowiem odpo- wiedniej podbudowy teoretycznej. Ważną grupę adresatów książki stanowią słuchacze kierunków podyplomowych studiów doskonalących kompetencje menadżerskie w obszarze corporate governance, a w szczególności kierunków Master of Corporate Governance i Master of Business Administration in Corpo- rate Governance. Autorzy, jako wykładowcy przedmiotów objętych programem wyżej wymienionych studiów podyplomowych, działają na rzecz zwiększania wśród kadry menadżerskiej świadomości roli mechanizmów nadzoru korpora- cyjnego zaimplementowanych w spółce oraz możliwości ich doskonalenia. Dziękuję recenzentowi niniejszej publikacji, Panu Prof. dr. hab. Janowi Jeża- kowi, za wszystkie cenne uwagi, które wpłynęły na proces doskonalenia opracowa- nia. Dziękuję również wszystkim uczestnikom projektu, którzy zechcieli wypowie- dzieć się w tak ważnej dla zarządzania jednostką gospodarczą kwestii i przygotowali materiał, który pozwolił na opracowanie niniejszej pracy. Mam nadzieję, że książka przekazana do rąk czytelników przyczyni się do zwiększenia zainteresowania pro- blematyką nadzoru korporacyjnego.

When performing transcatheter aortic valve implantation (TAVI), the access route of choice is transfemoral (TF) access since it is less invasive compared to other approaches and it is feasible in the majority of patients undergoing this procedure. Although new devices with smaller sheath sizes are available for TF-TAVI, a minority of patients still do not represent good candidates for this access route and, because of unfavourable iliofemoral arteries, need an alternative approach. Among the access site options are the transapical, direct aortic, transaxillary, or subclavian and, less frequently, transcarotid approaches. Moreover, when TF access is not feasible, the most common approaches are the transapical for the balloon-expandable Edwards SAPIEN XT valve, the subclavian for the Medtronic self-expandable CoreValve, and the transaortic for both prostheses. This chapter provides a detailed overview of all the access sites available for TAVI.

Transcatheter aortic valve implantation (TAVI) has evolved into a highly effective treatment option for inoperable patients or those with high and intermediate operative risk with symptomatic severe aortic stenosis. Several factors determine the success of a TAVI procedure, and patient and prosthesis selection are considered the most crucial among them. A plethora of TAVI devices is currently available for implantation, owing to the substantial design modifications and technological advancements of both prostheses and their delivery systems in the past decade. In this chapter, we provide a comprehensive overview of currently available devices, and discuss potential patient-related factors that may influence their selection for TAVI.

Transcatheter aortic valve implantation (TAVI) is re- garded as the option of preference minimally invasive intervention to treat high-risk patients with aortic steno- sis, which is a common heart valve disease charac- terized by the narrowing of the valve opening due to the thickening of the valve leaflets. During TAVI, a prosthetic aortic valve, replacing the diseased native valve with its function, is inserted and expanded by a balloon catheter if it is a balloon-expandable device. As a result, the correct size of the prosthetic device is vital due to its association with potential complications such as paravalvular regurgitation and aortic annulus rupture [1]. Pre-operative annulus size measurement based on imaging techniques is commonly applied be- fore TAVI procedure including transthoracic echocar- diography, transesophageal echocardiography and multi- detector computed tomography [2], [3]. However, these techniques face two major limitations: heavy dependence on the operator’s experience and the influence of the optimum instant in the cardiac cycle for evaluation. In addition, the potential changes in the annular geometry caused by balloon aortic valvuloplasty, which uses a balloon catheter to dilate the calcified aortic leaflets as a bridge treatment to TAVI, are not considered. There- fore, intraoperative assessments based on valvuloplasty balloon catheters were introduced, which measure the annulus size by the balloon when it is inflated for dilatation [4]. They do, however, only provide limited compatibility for a limited number of devices. This study proposes an intra-operative method for mea- suring the aortic annulus that account for compliance and elliptical geometries using balloon internal pressure and volume data. The valvuloplasty balloon catheter from a commercially available source was used to obtain the intra-balloon pressure-volume curves by an inflation device. A characterized analytical model and a numeri- cal model for balloon free-inflation were used to develop a sizing algorithm for estimating annulus dimensions.

Total cardiovascular disease (CVD) prevalence has risen dramatically from 271 million in 1990 to 523 million in 2019, and CVD fatalities rose gradually from 12.1 million in 1990 to 18.6 million in 2019. According to American Heart Association statistics, annual heart valve procedures in the United States were above 100,000 in 2013, with approximately 50,000 AV replacements. The ideal replacement valve should be durable, resistant to thrombosis, and have excellent hemodynamics features. Transcatheter aortic valve replacement (TAVR) has been introduced about two decades ago as an alternative for minimally invasive implantation of new generation bioprosthetic heart valves. Computational modeling can be used during therapy planning for the selection of appropriate replacement valves for TAVR. In this NPRP funded project, we are establishing a mechanical and FSI analysis path, for a detailed patient-specific hemodynamics analysis for TAVR, considering the most important parameters affecting TAV efficiency. This approach will enable the choice of the most suitable TAV type and deployment position for the treatment. TAV which is crimped and placed into the catheter by mechanical analysis is deployed in a patient-specific geometry in a virtual treatment then contact pressure and the stress are measured on the aortic root, stent, and aortic leaflets. TAV performance indicators are determined by FSI analysis using coupled ABAQUS and Flow-vision software. With this advanced analysis and simulation path, we expect to estimate accurately the clinical TAVR parameters such as contact pressure, contact area, principal stress, etc. before the operation during therapy planning. This approach will help clinicians in optimal valve selection for TAVR patients.

Abstract Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis (AS) patients who present a high risk for mortality should they receive a surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential complication with a high mortality rate, as CAO causes a deterioration of coronary perfusion, followed by cardiogenic shock and electrical instability. Due to this dangerous potential complication, bailout percutaneous coronary intervention (PCI) techniques, like the snorkel and chimney techniques, have been developed as an effective strategy for ensuring coronary perfusion is maintained following a TAVR procedure. Both snorkel and chimney techniques have been implemented in a reanimated swine and human heart respectively utilizing Visible Heart® methodologies. The procedures have been recorded utilizing endoscopic cameras, echocardiography, optical coherence tomography, and fluoroscopy. Post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. The reconstructions are then segmented and used to create 3D renderings of these complex procedures. These methodologies are repeatable and can be used in a variety of conditions to be used in subsequent educational uses.

In the past decade, Transcatheter Aortic Valve Replacement (TAVI) has been shown to be a feasible, less invasive option to open heart surgery for aortic valve replacement; however, TAVI is indicated only in patients with severe, symptomatic, aortic stenosis and who are considered at high or prohibitive risk for conventional surgery [1]. To date, two different TAVI devices are available on the market — the balloon-expandable Edwards-Sapien® Valve (Edwards Lifesciences, CA, USA) and the self-expandable CoreValve ReValving System® (Medtronic, MN, USA) — with many other devices currently under development and clinical trials. The procedural success rate has been >90% in all studies [1], but vascular complications, electrical conduction abnormalities and paravalvular leak — 65–89% of cases, the majority being trivial to mild, with 0 to 26% moderate and 0 to 10% severe — still remain major safety concerns. In particular, a negative influence of moderate to severe paravalvular leak on survival rates has recently been demonstrated [2].

<div class="section abstract"><div class="htmlview paragraph">Community noise at vertiports is one of the most important questions related to upcoming urban air mobility (UAM) operations. While fixed-wing and/or fixed-rotor aircraft can mainly be treated by their changing operational parameters, such as rotor or propeller rpm, tilt-wing or tilt-engine configurations are more difficult to simulate because of their constantly changing noise emission and spatial radiation characteristics. The work presented in this paper is providing an overview of the noise situation at a virtual vertiport which is being approached and departed by a tilt-wing air-taxi in different ways. Several different departure procedures are simulated with the same generic air-taxi. For the noise emission semi-empiric methods were used. During the air-taxi’s descent and climb, different tilt configurations are included, mainly defined by the time dependent engine’s tilt-angle, but also related to different approach paths. Each approach or departure procedure is generating individually time dependent changing noise emission characteristics which are used for noise footprint mapping around the touch-down or lift-off point. Different noise metrics are computed, including some which are representative to indicate noise annoyance among the vertiport’s neighborhood. It is expected that each procedure will generate its own specific community noise situation in the vicinity of the vertiport, and thus may provide an early recommenddation for later operations. The results are compared towards each other. Additionally, a simulated certification flyover according to ICAO Chapter 13 - which is about the noise certification of tilt-rotor aircraft - is set into relation to the vertiport’s community noise.</div></div>