The Freedom SOLO bovine pericardial stentless valve: Single-center experience, outcome and long-term durability

Abstract Objectives We report our institutional experience and long-term results with the Sorin Freedom SOLO bovine pericardial stentless bioprosthesis. Methods Between January 2005 and November 2009, 149 patients (mean age 73.6±8.7 years, 68 [45.6%] female) underwent isolated (n=75) or combined (n=74) aortic valve replacement (AVR) using the SOLO in our institution. Follow-up was 100% complete with an average follow-up time of 5.9±2.6 years (maximum 9.6 years) and a total of 885.3 patient years. Results Operative (30-day) mortality was 2.7% (1.3% for isolated AVR [n=1] and 4.0% for combined procedures [n=3]). All causes of death were not valve-related. Preoperative peak (mean) gradients of 74.2±23.0 mmHg (48.6 ± 16.3 mmHg) decreased to 15.6±5.4 (8.8±3.0) after AVR, and remained low for up to 9 years. The postoperative effective orifice area (EOA) was 1.6 ±0.57 cm2, 1.90±0.45 cm2, 2.12±0.48 cm2 and 2.20±0.66 cm2 for the valve sizes 21, 23, 25 and 27, respectively; with absence of severe prosthesis-patient-mismatch (PPM) and 0.7% (n=1) moderate PPM. During follow-up, Twenty-six patients experienced structural valve deterioration (SVD) and 14 patients underwent explantation. Kaplan-Meier estimates for freedom from death, explantation and SVD at 9 years averaged 0.57 [0.47‒0.66], 0.82 [0.69‒0.90] and 0.70 [0.57‒0.79], respectively. Conclusions The Freedom SOLO stentless aortic valve is safe to implant and shows excellent early and mid-term hemodynamic performance. However, SVD was observed in a substantial number of patients after only 5 ̶ 6 years and the need for explantation increased markedly, suggesting low durability.

The main principles of the creed and ethics of the Jews : exhibited in selections from the Yad hachazakah of Maimonides ; with a literal English translation, copious illustrations from the Talmud, & c.

by Hermann Hedwig Bernard

Implications of Health Care Reform (Medical Ethics Series, 2011)

A video of a panel discussion on how Obama's Health Care Reform would affect Texas Medical Center institutions and health care in general.Speakers include Tom Cole (moderator), Roberta Schwartz (Methodist Hospital), Pauline Rosenau (UT-Houston School of Public Health), and Laurence McCullough (Baylor College of Medicine).

Leadership and project management competences in executive women: different styles from the agents' perceptions

The exercise of management and leadership are key aspects to achieve objectives, goals and relationships in the current knowledge society marked by increasingly competitive environments in which cognitive factors, creativity, knowledge and information determine the success of organizations. Both concepts have been historically associated with the male domain because of the underrepresentation of women in managerial positions. However, the increasing participation of women in the workplace has led to the development of an extensive literature on the possible existence of differences between the styles of male and female leadership, although it has not been addressed from the analysis of competences associated with each sex. Through a participatory process the abilities and skills related to women managers are analyzed and the differences in leadership styles. The results indicate that women particularly value the skills associated with human relationships, and that female leadership style tends to be transformational.

Naturaleza, ética, y arquitectura: Autenticidad y criterios éticos que integran el desarrollo de una arquitectura más sostenible = Nature, ethics and architecture: Authenticity and ethics criteria that integrate the development of a more sustainable architecture

La ecología no solamente ha puesto de manifiesto problemas ambientales, sino que ha confirmado la necesidad de una nueva armonía entre los propios seres humanos y de éstos con la naturaleza y con todos los seres que la habitan. Es necesario un nuevo contrato que determine nuestras relaciones con la Naturaleza (Serrs1), y una nueva Ética para nuestras vidas (Guattari2). La ética medioambiental nos ha dado una visión universal y supra-generacional de la gestión de la naturaleza y como consecuencia, una nueva forma de construir nuestra ‘segunda’ Naturaleza, que es la arquitectura. ¿Qué es lo esencial que esta nueva ética exige para la arquitectura? Este es un momento crucial para reconsiderar los objetivos de la arquitectura, porque lo ‘eco’ está produciendo grandes cambios. ¿Implica esta era post-ecológica una particular ética, es decir, referida a sus fines y medios? ¿Porqué, para qué, para quién, cómo debemos hacer la arquitectura de nuestro tiempo? Es momento de afrontar críticamente el discurso de la eco-arquitectura, e incluso de repensar los propios límites de la arquitectura. El desarrollo actual del conocimiento medioambiental es esencialmente técnico y utilitario, pero ¿es el reto solamente técnico?¿Es suficiente la suma de lo medioambiental-social-económico-cultural para definirla? ¿Hay claves que nos puedan dar la dimensión ética de esta aproximación técnica-empírica? ¿Sabemos lo que estamos haciendo cuando aplicamos este conocimiento? Y, sobre todo, ¿cuál es el sentido de lo que estamos haciendo? La tesis que se propone puede resumirse: De acuerdo con el actual conocimiento que tenemos de la Naturaleza, la Arquitectura de nuestro tiempo deber reconsiderar sus fines y medios, puesto que la ética medioambiental está definiendo nuevos objetivos. Para fundamentar y profundizar en esta afirmación la tesis analiza cómo son hoy día las relaciones entre Ética-Naturaleza-Arquitectura (Fig.1), lo que facilitará las claves de cuáles son los criterios éticos (en cuanto a fines y medios) que deben definir la arquitectura del tiempo de la ecología. ABSTRACT Ecology shows us not only environmental problems; it shows that we need a new balance and harmony between individuals, beings, communities and Nature. We need a new contract with Nature according to Serres576, and a new Ethics for our lives according to Guattari577. Environmental ethics have given us a universal and supra-generational vision of the management of our Nature and, as a consequence, a new way to construct our ‘second’ nature, which is architecture. What is essential for this new architecture that the new ethics demand? This is a critical moment to reconsider the object of architecture, because the ‘eco’ is making significant changes in it. Are there any specifically ethical concerns (ends and means) in the post-ecological era? Why, for what, for whom, how should we make architecture in our times? This is the time to approach the eco-architectural discourse critically and to question the current boundaries of architecture itself: Where is eco-architecture going? The current development of environmental knowledge is essentially technical and utilitarian, but it is its technical aspect the only challenge? Is the sum of environmental-social-economic aspects enough to define it? Are there any clues which can give an ethical sense to this technical-empirical approach? Do we know what we are doing when we apply this knowledge? And overall, what is the meaning of what we are doing? Exploring this subject, this thesis makes a statement: In accordance with the actual knowledge of Nature, Architecture of our time must reconsider its ends and means, since the environmental ethics is defining new objectives. To support that, the thesis analyzes what the relationships between Ethics –Nature- Architecture (Fig. 53) are like nowadays, this will provide the clues of which ethical criteria (ends and means) must architecture of an ecological era define.

Knowledge spirals, situational leadership and informal learning applied on b-learning methodology

The methodology “b-learning” is a new teaching scenario and it requires the creation, adaptation and application of new learning tools searching the assimilation of new collaborative competences. In this context, it is well known the knowledge spirals, the situational leadership and the informal learning. The knowledge spirals is a basic concept of the knowledge procedure and they are based on that the knowledge increases when a cycle of 4 phases is repeated successively.1) The knowledge is created (for instance, to have an idea); 2) The knowledge is decoded into a format to be easily transmitted; 3) The knowledge is modified to be easily comprehensive and it is used; 4) New knowledge is created. This new knowledge improves the previous one (step 1). Each cycle shows a step of a spiral staircase: by going up the staircase, more knowledge is created. On the other hand, the situational leadership is based on that each person has a maturity degree to develop a specific task and this maturity increases with the experience. Therefore, the teacher (leader) has to adapt the teaching style to the student (subordinate) requirements and in this way, the professional and personal development of the student will increase quickly by improving the results and satisfaction. This educational strategy, finally combined with the informal learning, and in particular the zone of proximal development, and using a learning content management system own in our University, gets a successful and well-evaluated learning activity in Master subjects focused on the collaborative activity of preparation and oral exhibition of short and specific topics affine to these subjects. Therefore, the teacher has a relevant and consultant role of the selected topic and his function is to guide and supervise the work, incorporating many times the previous works done in other courses, as a research tutor or more experienced student. Then, in this work, we show the academic results, grade of interactivity developed in these collaborative tasks, statistics and the satisfaction grade shown by our post-graduate students.

Rare breast cancer: adenoid cystic carcinoma treated in a cancer reference center between 2001 and 2013

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

European Union Leadership and Enlargement in 2014. Jean Monnet/Robert Schuman Paper Series Vol. 14 No. 14, July 2014

On July 15, 2014 the European Parliament confirmed the new European Commission President. An absolute majority was needed for this purpose, and the 422 votes “For” cleared the 376-vote threshold in the legislative body of 751 members. A Grand Coalition has been formed among the three largest political parties: the European People’s Party (EPP), the Progressive Alliances of Socialists Democrats (S&D), and the Alliance of Liberals and Democrats for Europe (ALDE). Considering policy decisions going forward, the European Union (EU) faces the pressing question: Will there be more, less, or similar power from the EU? There are a greater number voices from across the political spectrum contributing to the democratic plurality. European leaders may regain trust by acknowledging that future governance will not be “business as usual” as the reform agenda gets underway. 2014 has been an exciting and important year in European politics. “This time is different” was the motto for the European Parliament’s election campaign. This essay analyzes recent EU political trends with the new Commission leadership and the Parliamentary elections results. The Parliamentary elections, held in late May, and the new European Commission, planned to be in place in the autumn, influence the leadership direction of the 28-member bloc. Additionally, this year on July 1 Croatia celebrated the first anniversary of joining the EU in 2013. Leading the way for candidate countries, Croatia embraces the democratic politics and capitalist market economics embodied by the EU. The greater number of seats held by newer political parties in the European Parliament demonstrates increasing plurality in the EU democracy. The Parliamentary elections have taken place every 5 years since 1979. In this eighth legislative session, the EPP and the S&D remain the largest parties represented, with 221 and 191 seats respectively. As the EU has evolved, a greater number of voices influence politics. The ongoing point of contention on a host of policies is national sovereignty in relation to pooled sovereignty in the EU. The European Parliament is important for democracy in EU governance since it is the direct link from the national citizens to their elected leaders at the supranational level. The representatives of the European Commission are appointed by the national governments of Member States, and their heads of government are the representatives to the European Council. These three political institutions – the European Parliament, the European Commission, and the European Council – together with other important institutions, including the European Court of Justice Luxembourg, form the EU. The new European Commission President is Jean-Claude Juncker, former Prime Minister and Minister of Finance of Luxembourg (1995-2013). After being nominated by the European Council on June 27, his candidacy was voted on by the European Parliament on July 15, according to the guidelines of the Lisbon Treaty. The leadership for the President of the European Commission has been an important issue, considering Britain’s deliberations on whether or not to stay in the EU in the face of a future national referendum. Voting on June 27, among the European Council on the nomination of Commission President-Designate Juncker, was 26 in favor and 2 opposed. Only Viktor Orbán, the prime minister of Hungary, joined David Cameron, the prime minister of the United Kingdom (UK), with a negative vote (Spiegel and Parker 2014). The UK had not been supportive, being concerned that Juncker embraces the policies of a federalist, prioritizing an ever-closer union above the interests of individual Member States. Historically, since joining the predecessor institution of the European Economic Community in 1973, the UK has had a relatively independent attitude about participation in the EU.

National Center for Statistics and Analysis collected technical studies. Volume I: accident data analysis of vehicle crashworthiness - ten papers.

Mode of access: Internet.

National Center for Statistics and Analysis collected technical studies. Volume II: accident data analysis of occupant injuries and crash characteristics - eight papers.

Mode of access: Internet.

Tomb, excavated artifact, Rabbits, Birds, Bamboo and Flowers, center portion: birds and flowers; from the western interior wall of the outer (xiaozhang) coffin

Liaoning. Faku. Yemaotai; hanging scroll, ink and colors on silk

The moral leaders of Israel : studies in the development of Hebrew religion and ethics /

Mode of access: Internet.