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IAAP-CPACC Certified Professional in Accessibility Core Competencies (CPACC) approach | http://babelouedstory.com/
IAAP-CPACC approach - Certified Professional in Accessibility Core Competencies (CPACC) Updated: 2024
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Difficulty with navigating, sensitivity to noise and visual stimuli, impaired ability to screen out background noise and/or movement, and sensations of overload are all psychomotor
perceptions mostly associated to which type of disability?
D. Learning Answer: D
Reference: https://usability.yale.edu/web-accessibility/articles/types-disabilities Question: 23
Products that are designed with the specific intent of standardization, ease of access, efficiency, and satisfaction are based on the principles of
A. accessible design
B. innovative design
C. functional design
D. usability design Answer: D
Reference: https://www.interaction-design.org/literature/topics/usability Question: 24
Color Contrast (Minimum) is associated to which Web Content Accessibility Guidelines (WCAG) 2.0 principle?
D. Understandable Answer: B
$13$10 Question: 25
Which is the biggest business benefit of designing an accessible website?
A. Data integrity
B. Information security
C. Search engine optimization
D. Web site availability Answer: C
The biggest business benefit of designing an accessible website is search engine optimization (SEO). Accessible websites tend to have better structure, more descriptive content, and
improved user experience, all of which contribute to higher search engine rankings and increased visibility in search results. Question: 26
When purchasing third-party software, a business will BEST mitigate the risk of buying inaccessible software by
A. including a contractual penalty for inaccessibility.
B. requesting an accessibility conformance claim in writing.
C. requiring accessible outcomes in contractual agreements.
D. verifying product accessibility. Answer: D
Reference: https://www.w3.org/WAI/ER/tools/ Question: 27
An individual is developing an upper extremity medical problem that is currently increasing pain and reducing movement in the elbows, while expected to eventually spread into the
wrists and hands.
Which group of accommodations should be recommended?
A. Adjustable keyboard/mouse tray, ergonomic keyboard, and adjustable monitor
B. Screen reader software, keyboard shortcuts, and adjustable keyboard/mouse tray
C. Voice recognition software, ergonomic mouse, and adjustable keyboard/mouse tray
D. Voice recognition software, screen reader software, and ergonomic mouse Answer: C
$13$10 Question: 28
In the Principles of Universal Design Version 2.0, which definition defines principle one:
A. design accommodates a wide range of individual preferences.
B. design communicates necessary information effectively to the user regardless of sensory abilities.
C. design is useful and marketable to people with diverse abilities.
D. of the design is easy to understand, regardless of the userâs experience. Answer: C
In the Principles of Universal Design Version 2.0, principle one, Equitable Use, is defined as: "design is useful and marketable to people with diverse abilities." This principle
emphasizes the importance of creating products and environments that can be used by people with a wide range of abilities, ensuring equal access and participation for all. Question: 29
Which statement BEST describes a way the U.N. Convention on the Rights of Persons with
Disabilities (CRPD) is being used to open opportunities for people with disabilities in information technology?
A. The CRPD defers to the W3C for policy guidance on website accessibility and how to best promote its adoption.
B. The CRPD relies on partnerships between the private and public sector to encourage better accessibility standards.
C. The CRPD requires member states to enact tough laws that adopt WCAG 2.0.
D. The CRPD urges member states to take appropriate measures to ensure people with disabilities are not excluded. Answer: D
Reference: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html Question: 30
What is a common first approach in website design that could assist a person with a working-memory deficit when accessing a multi-page website?
A. Embedded contrast /color controls
B. Embedded screen reader
C. Page magnification
D. Simplified and consistent navigation Answer: D
Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552350/ Question: 31
Which is the BEST example of the Principles of Universal Design Version 2.0 principle six:
Low Physical Effort?
A. Automatic soap dispensers
B. Lamp with round switch
C. Round door handles
D. Stationary escalator steps Answer: A Question: 32
Which syndrome is now widely recognized as being a specific learning disability of neurological origin?
B. Autism Spectrum
D. Dyslexia Answer: D
forces/coga/wiki/Gap_Analysis/Dyslexia#:~:text=The%20syndrome%20of%20dyslexia%20is,of%20race%20and%20social%20background Question: 33
When making accessible pre-recorded video content with audio for people with hearing impairments, the video needs to include
A. audio description.
B. captions and transcript.
C. high contrast mode.
D. keyboard accessible controls. Answer: B
When making accessible pre-recorded video content with audio for people with hearing impairments, the video needs to include captions and a transcript. Captions provide a text
version of the audio content, while a transcript offers a complete text description of the video, including dialogue, sound effects, and other relevant information.
$13$10 Question: 34
A company in Belgium that manufactures IT products is thinking about developing a hardware product for sale throughout Europe.
Which standards should the company be MOST concerned with in the design of its product?
A. BS 88.78
B. EN 301-549
C. ISO 9001
D. WCAG 2.0 A and AA Answer: B
Reference: https://www.deque.com/en-301-549-compliance/#:~:text=EN%20301%20549%20enables%20European,people%2C%20including%20those%20with%20disabilities Question: 35
A Web site designed for optimal use considers what factor that is NOT directly related to disability?
A. Age-related disease
B. Color blindness
D. Lack of computer skills Answer: D
CBC is committed to making its content available to as many people in Canada as possible. Our accessibility team's vision is to provide inclusive experiences that inform, enlighten and entertain audiences on all platforms. To send us a comment or a suggestion, please complete our form within the Accessibility FeedbackÂ page.
Consult with people with disabilitiesÂ
Our online platforms are constantly designed and developed in consultation with people using assistive technologies, particularly screen readers, screen magnifiers and alternate navigation tools (e.g. Voice Control on iOS). We deepen our understanding through direct feedback from our audience, CBC staff and community members. This helps change our view of disabilities, gives a voice to our diverse audience and enriches our collective knowledge.Â
Continuously Excellerate based on CRTC and WCAG guidelines
CBC is subject to conditions of licence from the Canadian Radio-television and Telecommunications Commission (CRTC). In addition to these responsibilities, CBC is committed to developing web and mobile platforms according to WCAG 2.2Â AA accessibility standards determined by the World Wide Web Consortium (W3C). Our teams use a combination of automated, manual and user testing to identify areas of improvement. Our team of accessibility specialists also provide feedback from early stages of development of our online platforms.
Create awareness and provide training to teams
Training is regularly offered to teams to understand digital and content accessibility considerations and use of different types of assistive technology. Additionally, our team of accessibility champions meet on a frequent basis to discuss innovation in accessibility and how we can Excellerate the experience for our audience.Â
Accessibility improvements with content and digital experiences
While we have many accessibility features available, we are also aware of some important areas to Excellerate on within our website and applications.
Increase closed captioning for videos, particularly live events
Increase transcripts, American Sign Language ("ASL") and described video
Expand research with users with invisible disabilities and other diverse needs
Improve font and visual accessibility of our content
Make our mobile applications compatible with keyboard navigation
Mon, 12 Jun 2023 02:28:00 -0500entext/htmlhttps://www.cbc.ca/accessibility/our-approach-to-improving-accessibility-1.5131502Accessibility: A guiding principle of the ConventionUN Enable - Accessibility
Accessibility is about giving equal access to everyone. Without being able to access the facilities and services found in the community, persons with disabilities will never be fully included. In most societies, however, there are innumerable obstacles and barriers that hinder persons with disabilities. These include such things as stairs, lack of information in accessible formats such as Braille and sign language, and community services provided in a form which persons with disabilities are not able to understand. Although some of the more costly accessibility provisions in the Convention can be implemented progressively, there are a number of low-cost, low-tech accessibility solutions that would have immediate benefits.
The principle of accessibility is relevant to all of the areas of implementation of the Convention. For example:
1. Physical environment
An accessible physical environment benefits everyone, not just persons with disabilities. The Convention states that measures should be undertaken to eliminate obstacles and barriers to indoor and outdoor facilities including schools, medical facilities and workplaces. These would include not only buildings, but also footpaths, curb cuts, and obstacles that block the flow of pedestrian traffic.
Transportation is a vital component for independent living, and like others in society persons with disabilities rely on transportation facilities to move from point A to point B. The term transportation covers a number of areas including air travel, buses, taxis, and trains. In many instances, these are inaccessible to persons with disabilities because either they cannot use them in the first instance (e.g. inaccessible buses, train stations), be more clear, use an actual example; relate to other rights: access to transportation provides access to other rights and vise versa.
Longer-term the Convention foresees that all transportation be accessible to everyone in society. Immediate steps should ensure that persons with disabilities using public transportation are not at a disadvantage to others. Measures could include ensuring that bus and train drivers make regular announcements at stops to inform individuals where they are, allowing the transportation of service animals, and providing signage in Braille.
Access to information creates opportunities for everyone in society. Access to information refers all information. In all societies, people use information in many forms to make decisions about their daily lives. Depending on the society, this can range from actions such as being able to read price tags, to physically enter a hall to participate in a gathering, to read a pamphlet with healthcare information, to understand a bus schedule or a note from a schoolteacher, or to view webpages. No longer should societal barriers of prejudice, infrastructure, and inaccessible formats stand in the way of obtaining and utilizing information in daily life. In most countries, there are no laws on providing information in accessible formats (e.g. Braille, audio formats, sign language), or to make websites accessible. Even where there is legislation, the actual provision of such services is lacking. Governments are asked by the Convention to introduce adequate legislation and means to ensure that persons with disabilities are able to access information that impinge on their daily lives. This includes providing information on emergency services.
4. Public facilities and services
The Convention asks States to develop guidelines to make public facilities and services accessible. Government should set example on ensuring the full participation in society. Governments need to think, for example, if a person with disabilities goes to a public health clinic, what services need to be provided in order to ensure that they receive the same level of treatment as others? This same accessibility analysis or audit needs to be considered for all public services. This may include the provision of ramps into buildings, signage in Braille, and sign language interpreters or closed captioning on public television. This should be conducted with involvement of persons with disabilities throughout the entire process.
Mon, 03 Dec 2018 15:06:00 -0600text/htmlhttps://www.un.org/esa/socdev/enable/disacc.htmAn In-Depth Look at Appleâs Approach to Accessibility
Mashable published a profile of Jordyn Castor, a 22-year-old Apple engineer on its accessibility design and quality team. Castor, who has been blind since birth, joined Apple full-time last year after interning there in college. As she explains to Mashable:
âI realized then I could code on the computer to have it fulfill the tasks I wanted it to,â says Castor, whose current work focuses on enhancing features like VoiceOver for blind Apple users. âI came to realize that with my knowledge of computers and technology, I could help change the world for people with disabilities.
In addition to speaking with Castor, Mashable interviewed Sarah Herrlinger, senior manager for global accessibility policy and initiatives, who explained Appleâs approach to accessibility:
a notable part of the companyâs steps toward accessibility is its dedication to making inclusivity features standard, not specialized. This allows those features to be dually accessible â both for getting the tech to more users, as well as keeping down costs.
Mashableâs piece is a must-read for Jordyn Castroâs inspiring personal story and its insight into the unique way Apple approaches accessibility. Instead of treating accessibility as a special, add-on feature that is purchased separately, itâs built into the operating system itself. That, combined with the work Apple has done to make accessibility features easy for developers to adopt, reveals a pragmatic approach designed to encourage broad-based adoption, making Appleâs accessibility innovations available to as many people who need them as possible.
Sun, 10 Jul 2016 03:26:00 -0500Linked By John Voorheesen-UStext/htmlhttps://www.macstories.net/linked/an-in-depth-look-at-apples-approach-to-accessibility/Building a Multi-layered Approach to Securing Access
No organization is immune to the sophisticated methods todayâs threat actors are using, from bypassing traditional authentication tools to hijacking usersâ web sessions. And no single tool on its own can protect against these attacks â especially at a time when:
Key initiatives, such as cloud migrations, are driven by an ecosystem of users, each tied to digital identities used for accessing what they need.
These identities often have far more access than needed to sensitive resources such as enterprise data and critical environments.
Often, the only thing standing between these variables and the attackers targeting them are poorly protected credentials.
Identity compromise may feel inevitable, but thankfully there are strategic moves organizations can make to greatly reduce risk. In this whitepaper, explore a multi-layered approach to securing usersâ access that:
Uncovers security gaps, layer by layer.
Identifies the security controls needed for protecting each layer.
Secures access for all users.
Reduces the attack surface and mitigates vulnerabilities.
Fri, 01 Dec 2023 08:45:00 -0600entext/htmlhttps://www.scmagazine.com/whitepaper/building-a-multi-layered-approach-to-securing-accessComic Contracts: A Novel Approach To Contract Clarity And Accessibility
Credit: Fruit Picker contract pages by Jincom
Beware the fine print is the oft-repeated expression heard in almost any deal or contract negotiation. Itâs good advice that too often is ignored in daily life and job situationsâespecially among those segments of the population that may not have excellent English language skills, or for that matter, anyone without experience with the often-impenetrable legalese featured in contracts.
Robert de Rooy is an attorney based in South Africa and the founder of Comic Contracts -- and this is no joke.
Comic contracts are documents that are:
â˘ Legally binding contracts in which parties are represented by characters
â˘ The agreement is captured in pictures
â˘ The parties sign the comic as the contract
âWe produce illustrated contracts for people who are illiterate, people who are not literate in the language of the contract, employers with multi-cultural workplaces or companies that wish to transact with people who suffer from memorizing or intellectual disabilities. We want to enable people to be able to independently understand the contracts they are expected to sign.â
Those who are fans of contracts that have transparency, visibility, simplicity and clarity should take note.
De Rooy laid out the comic contract idea in a exact presentation at an International Association for Contract and Commercial Management (IACCM) Americas Conference. He says the comic contract was inspired by, and builds on, the work of preventative law and proactive contractingâa âmovement in law that is being led by Professors Tom Barton (USA) and Helena Haapio (Finland), which promotes the use of visualization as a non-binding aid in understanding the text of an agreement, and thereby creates more âfit for purposeâ contracts designed for better relationships and better outcomes.â
Optimizing contract outcomes is the goal, no matter who the parties are, or their situation. Or, as de Rooy puts it: âWe want contracts to be useful in aligning expectations and to signal healthy relationships towards successful outcomes. We donât try to serve the interests of any party, we try to serve the relationships between them.â
Beyond Text-based Contracts: Examples Of Comic Contracts In Practice
Comic contracts step out of the âtextâ-based contract paradigm, de Rooy explains. Pictures can are not only useful to aid understanding of the text in a contract, pictures can actually âbeâ the contract.
This takes contracting to a new and exciting level by making the contract document accessible to everyone. This offers a proactive and workable solution to the challenge faced by vulnerable or illiterate people when they are expected to sign, and be legally bound by, text agreements that they are not able to understand.
De Rooy explained the genesis of comic contract. He had been working on the idea for some years, and entered a description of the idea into a legal innovation competition in 2014, but it received no notice. A kind introduction by Kim Wright, an American lawyer and the American Bar Associationâs Legal Rebel in 2009, to Professor Haapio, led to an invitation to present the idea at the Contract Simplification Conference in Switzerland in May 2016. âI could describe the idea, the theory of it and had some samples of illustrated clauses but I still did not have a complete field and signature ready agreement. This is where one of my practiceâs clients stepped up to the plate. Indigo Fruit Farming gave me some budget to work with a Cape Town company called Jincom to produce a complete and professional quality Fruit-picker contract for their citrus farms.â
So, when he presented his idea, this time, he had something to show: âI did not have to try to describe the idea, the audience could see it, and they loved it. Moreover, I could tell them that this contract was actually going to be implemented.â
Initially, de Rooy was âworried that the workers would perceive the contract as patronizing, and the farm managers were concerned about doing things differently. So, it was agreed that their comic contract would first be presented to a group of workers they knew are unlikely to cause a problem if they did not like it for any reason. When this went well, it was then presented to a general group of new workers.â
After the contracts were signed, and the feedback came from the workers, âIndigo felt so proud that they wanted their consumer brand âClemengoldâ˘â brand displayed on the contract.â
Robert has now partnered with Jincom to produce comic contracts for other companies who like this idea and want it for their people.
Apart from the Fruit-Picker agreement, other examples of comic contracts that have been or are being developed, include:
â˘ A Generic Farm Laborer contract for the South African Wine and Agricultural Ethical Trading Association (WIETA), a multi-stakeholder, non-profit voluntary organization, which promotes ethical trade in the wine industry value chain. Stakeholders include producers, retailers, trade unions, non-governmental organizations and the government.
â˘ Shop-floor Worker contract for a dairy business
â˘ Kitchen Staff contract for a hotel group
â˘ Codes of Conduct for sport clubs in Australia
â˘ Domestic worker contracts
â˘ Loan agreements
â˘ Funeral Insurance contracts
â˘ Rental contracts
We Are Defined By Our Ability To Understand Contracts
De Rooy observes that the law uses âa blunt instrument called age, and assumes that when you reached the age of 18, you can read and understand contracts. If you sign an agreement after age 17, itâs not binding without your parentâs signature. But when you sign it after age 18, itâs binding. âWhen one is well-educated, that's reasonable, but if you are vulnerable, illiterate or simply faced with a contract that is not in your native language, you are factually in the same position as a small child, except that the law offers you no protection.â
Tim Cummins, IACCM CEO, provides insight into the use of comic contracts. âOur long-held perspective is that today's contract design and structure is frequently a source of risk. Contracts contain important information that the typical user finds hard to understand, a belief confirmed by exact IACCM research where 88% of business people said that 'contracts are difficult or impossible to understand'.
âWe have supported new thinking in contract design for several years, introducing a design award in 2012. Therefore, we were delighted to discover the exciting innovation by Robert -- a remarkable example of social responsibility, inclusive thinking and effective risk management that has led to better economic results for both employer and workers.Â We continue to encourage new thinking and we are delighted by the steady recognition in major corporations that this is a path they should follow.â
Cummins noted IACCM members were so impressed with the comic contract concept that de Rooy was selected to receive the âProgram of Visionary Change Awardâ at the organizationâs Americas conference last year. He noted IACCM members were so impressed with the comic contract concept that de Rooy was selected to receive the âProgram of Visionary Change Awardâ at the organizationâs Americas conference last year.
Using comics as the contract might sound condescending, especially with respect to illiterate people. That is not the intent; itâs reality that illiterate people should sign contracts they understand. The purpose is to fill a serious need and a void in the âartâ of contracting.
Mon, 13 Feb 2017 22:00:00 -0600Kate Vitasekentext/htmlhttps://www.forbes.com/sites/katevitasek/2017/02/14/comic-contracts-a-novel-approach-to-contract-clarity-and-accessibility/Transcatheter Aortic Valve Implantation
The Aortic Annulus
Assessment of the anatomy of the aortic annulus is an important component of case selection. Both manufacturers currently have only two sizes of bioprosthesis in widespread use to treat a wide range of annuli. They have thresholds for sizing of their respective prostheses for the annular dimensions of a particular patient dictated by estimated need for oversizing. These are based on the in-vitro dimensions of the bioprosthesis stent frames, plus their expected, slightly smaller dimensions in vivo, given that in contrast to conventional SAVR, the native aortic valve leaflets are not removed, but rather pushed aside.
Evidence for the thresholds for sizing, as well as the optimal imaging modality for this sizing, remains elusive. It is clear that measured dimensions by various imaging modalities employed for this purpose vary significantly (Figure 2). While transthoracic echocardiography acts as a useful screening tool in this regard, transesophageal echocardiography, sometimes as an immediate pre-TAVI confirmatory evaluation, is regarded as the current standard of care. The methodology for echocardiographic measurement is important. Surgical valve sizing is often using a left ventricular outflow tract (LVOT) measurement, either by bougie measurement, or periprocedural TEE. By contrast, the preferred measure for TAVI by echocardiography is slightly higher, at the annulus, from hingepoint to hingepoint (generally that of the noncoronary leaflet and the right coronary leaflet). Measurement in systole or diastole may have implications for sizing but remains poorly elucidated.
Assessment of the aortic annulus by (A) TTE, (B) transesophageal echocardiography and (C) computed tomography in the same patient (measurement by each modality shown in bottom left corner), illustrating differences that may be observed in sizing depending on imaging modality. Many of the differences observed may be attributable not only to the varying imaging modality employed, but also due to measurement technique, with some measurements made too low in the left ventricular outflow tract (as seen in [A]), rather than at the level of the basal leaflet attachment, and others too short, measuring the internal edge of calcium at one or both margins (as seen in [B]), rather than a true hinge-point to hinge-point measurement.
Computed tomography may provide additional information regarding the noncircular nature of the aortic annulus, which is poorly appreciated by echocardiographic modalities. How we use such information, however, and the corresponding quantitative thresholds for each bioprosthesis size remain unclear. There is data to show that while the balloon expandable Edwards Sapien design 'forces' a circular morphology, the self expanding Medtronic CoreValve design tends to conform more to the ellipsoid configuration of the annulus. The relative benefits and disadvantages of each morphological outcome are unknown.
Despite the aforementioned uncertainties, each manufacturer has set clear boundaries for each of their respective bioprosthesis sizes. The Edwards Sapien device requires an annulus of 18â21 mm for its smaller 23-mm bioprosthesis and 22â25 mm for its larger 26-mm bioprosthesis, with 21â22 mm remaining a 'gray zone', at the operator's discretion. The 23-mm and 26-mm sizes specified for the Edwards Sapien bioprosthesis correspond to in vitro diameters of the fully expanded stent frame. A larger 29-mm Edwards Sapien device now has CE mark for the transapical route. The Medtronic CoreValve device requires an annulus of 20â23 mm for its smaller 26-mm bioprosthesis and 24â27 mm for its larger 29-mm bioprosthesis. Although 23â24 mm is an unspecified gray zone, the larger bioprosthesis is generally prescribed for these dimensions.
The 26-mm and 29-mm sizes specified for the Medtronic CoreValve bioprosthesis correspond to diameters of the inflow (proximal LVOT portion) of the fully expanded stent frame in vitro. The respective in-vitro dimensions at the level of the stent frame's higher most constrained portion is 22 mm for the smaller 26-mm inflow valve and 24 mm for the larger 29-mm inflow valve. The expected in vitro dimensions at the level of the annulus are hence somewhere in-between 22â26 mm for the smaller bioprosthesis and 24â29 mm for the larger device. The noncylindrical nature of this bioprosthesis means that the expected dimensions at the level of the aortic annulus will vary widely, depending on the final deployed position of the device. Moreover, the heavily calcified native leaflets also take up some space at the annulus. Thus, both device designs tend to 'oversize' their prostheses, compensating for the fact that obtained in-vivo dimensions are likely to be smaller than expected in vivo dimensions.
The are several potential implications of inappropriate sizing of a TAVI bioprosthesis. Undersizing may result in incomplete apposition/contact with the native aortic annulus and paravalvular aortic regurgitation (AR). In contrast, oversizing may result in the serious complication of annular rupture. One study has demonstrated that paravalvular AR is more common in Edwards Sapien TAVI in taller patients and in larger annuli, suggesting that undersizing may be an issue in such cases.
Iliofemoral Anatomic Assessment
Transfemoral TAVI represents the most commonly employed access approach overall. However, the safety of this approach depends heavily on careful iliofemoral assessment. Important aspects of relevance are sizing, assessment of tortuosity and calcification. Although fluoroscopy with a graduated pigtail for calibration is frequently employed, CT offers a plethora of invaluable additional precise information regarding all of these aspects. For this reason, it has become the standard of care for such assessment in our center and many others.
Minimum femoral dimension is specified by manufacturer guidelines, based on the French (Fr) size of required access sheaths and catheters. These are currently 6 mm (18 Fr) for the Medtronic CoreValve device and 7 mm (22 Fr) and 8 mm (24 Fr) for the transfemoral Edwards Sapien transfemoral delivery catheter. Recently, there has been a further iteration of the Edwards Sapien device, the XT, with a corresponding reduction in profile 18 Fr (minimum femoral dimension 6 mm) and 19 Fr (minimum femoral dimension 6.5 mm) respectively. However, these sheath sizes are based on internal dimensions of the access sheaths which have larger external dimensions and inevitably cause some arterial stretch.
Indeed, femoral access risk ratio, defined as sheath size (Fr)/minimal FA diameter (mm), with a threshold of 2.6, has recently been identified as an independent predictor of major vascular complications. This has important implications for femoral sizing. In contrast to the manufacturer supplied dimensions, this study suggests that to avoid major vascular complication, minimal femoral dimensions of 7.0 mm for 18Fr, 7.3 mm for 19Fr, 8.5 mm for 22Fr and 9.2 mm for 24Fr should be employed. This conforms more to external sheath dimensions rather than the internal dimensions used as a reference point for device profile by the manufacturers. exact evidence from the same study has also shown that excessive calcification at the site of femoral access is an independent risk factor for major vascular complication.
Additional Anatomic Considerations
There are several additional anatomic considerations for appropriate case selection in order to minimize post TAVI complications. Importantly, the Medtronic CoreValve device, as well as a subcoronary anchor point at the aortic annulus, has a supra-coronary anchor point at the outflow of the device. This means the proximal ascending aorta, around 35â50 mm from the aortic annulus, must be â¤40 mm in diameter for the smaller 26-mm device and â¤43 mm for the larger 29-mm device. The distal anchor point also allows the device to potentially be used in predominant aortic regurgitation, although this remains an off-label indication at present.
Aortic root angulation for the Medtronic CoreValve device has been shown to influence paravalvular AR. Severe septal hypertrophy has been correlated with a greater need for permanent pacemaker implantation with the Medtronic CoreValve device and TAVI may also influence the unmasking of a hypertrophic obstructive cardiomyopathy type physiology in its presence.
Low sinus of valsalva height and width are regarded as a concern for both device designs. This is because space is required to accommodate the excluded native aortic valve leaflets, which otherwise could compromise coronary arterial flow. Since the Medtronic CoreValve device is a much longer device, it requires stabilization by contact with the proximal ascending aorta. As such, criteria for selection for this device include a maximum ascending aorta dimension of 40 mm for the smaller device and 43 mm for the larger device. The Edwards Sapien device could potentially be used in cases where the aortic dimensions are too large.
For the Medtronic CoreValve device, criteria for selection are summarized in a selection 'matrix' (Figure 3). Although relevant, many such criteria are arbitrary and designed to avoid theoretical complications; they require further systematic testing. Given the widespread use of this technology, TAVI has been performed with incomplete adherence to these prespecified criteria and resultant off-label use is prevalent. Further elucidation and formation of a clear evidence base is needed, so that patients are not excluded from treatment inappropriately, but patients are not placed at excessive risk by TAVI due to the important anatomic factors described. Although the important clinical and anatomic factors require further elucidation with an evidence base, the appropriate selection of patients is undoubtedly the first step towards an uncomplicated TAVI procedure.
Medtronic CoreValveÂŽ patient evaluation criteria. CT: Computed tomography; LV: Left ventricle. Reproduced with permission ÂŠ 2010 Medtronic, Inc.
Sat, 30 Dec 2023 10:01:00 -0600entext/htmlhttps://www.medscape.com/viewarticle/747754_5Developing a Patient-Centered Approach to Vascular Access Device Selection
Abstract and Introduction
Physicians select vascular access devices (VADs) for patients based on the duration and/or type of therapy needed. However, there is insufficient research to unequivocally support the choice of one catheter over another. A shared-decision approach involving both the physician and the patient offers an alternative that may be more beneficial. Active patient involvement in device selection that integrates the healthcare provider's clinical priorities with patient preferences may enhance patient outcomes and quality of life. A collaborative selection process is therefore ideal for instituting a shared-decision model. Study findings reviewed in this article identify patient preferences that should be considered in a shared-decision approach to VAD selection.
The consumer movement in healthcare and the proliferation of consumer-directed information, including resources available through the Internet and mass media, support patient participation in healthcare decision making. Managed care plans continue to encourage participants to be actively involved in both understanding and managing their health needs. The ethical principle of patient autonomy and the legal requirement of informed consent also have fostered consumer participation in medical decision making.
Information and choice are essential components of patient empowerment. Patients who feel powerless are at a greater risk for disease, and powerlessness has also been associated with lower or noncompliance with treatment regimens. A variety of factors can influence a patient's perceived level of empowerment, including individual responses to pain, alterations in daily activities, disability, family problems, and body image. Unfortunately, the reliable assessment of how all these variables impact a patient's preferences and associated risks is one of the weakest links in the clinical decision-making process.
Many factors inherent in healthcare today hinder effective shared decision making. These factors include: providers' lack of understanding about what information patients need to make decisions; patients' lack of comprehensive, unbiased, and readily understandable information about treatment options; office visit time constraints; and patients' compromised ability to absorb information under stressful conditions. Placing a patient in the shared-decision-making role requires a deeper understanding of how treatment decisions are made and what elements impact patient preferences.
Vascular access has moved from the periphery of medical care to its very core. As vascular access professionals strive to Excellerate quality and control costs, the appropriate selection, care, and maintenance of VADs have become increasingly urgent and serious issues.
Consider these relevant facts about VADs and their use in American medicine:
One in 4 Americans dies of cancer, and chemotherapy usually requires some type of VAD.
Patients have little or no knowledge about VADs, yet their quality of life is significantly impacted by device placement. Routine, repeated, peripheral venipuncture is a major source of anxiety and pain for cancer patients.
Complications caused by VADs can be life threatening. About 10% to 25% of hospital admissions are related to VAD complications. As many as 50% of patients with VADs (2.5 million per year) experience complications. Patient morbidity is at least 10%.
These statistics help explain the safety concerns voiced by professional and consumer advocacy groups about the use of centrally placed VADS in hospitals.
The lack of comprehensive information about VAD selection, insertion, care, and maintenance may lead to serious consequences. These include the overuse of short-term peripheral vascular access catheters; inappropriate or delayed choices of intermediate or long-term VADs; immeasurable pain to the patient; permanent damage and/or loss of peripheral access; permanent disfigurement; life-threatening complications; poor device performance; emotional and psychosocial damage; and loss of healthcare dollars.
Tue, 16 Aug 2005 12:00:00 -0500entext/htmlhttps://www.medscape.com/viewarticle/508093AMA's Reimbursement Codes For Psychedelic-Assisted Therapies Take Effect: Here's What To Expect
The American Medical Associationâs new coverage and reimbursement codes for FDA-legalized psychedelic-assisted therapies, the current procedural terminology (CPT) III codes, have become active for physicians and other qualified healthcare providers to apply.
These are temporary codes assigned to emerging technologies, services and procedures, to facilitate reimbursement and support access to psychedelic therapies in the U.S.Â
The data collected through the use of the new CPT III codes could reflect sufficient usage, and eventually lead to them being converted to permanent CPT I codes, with a valuation assigned for widespread coverage and reimbursement.Â
First announced in July 2023, the codes have been jointly championed by the for-profit arm of the legendary Multidisciplinary Association for Psychedelic Studies, MAPS PBC, and biotechÂ COMPASS Pathways (NASDAQ:CMPS).Â
More specifically, AMA accepted the new CPT III codes applicationÂ in March 2023. Titled "Continuous In-Person Monitoring and Intervention during Psychedelic Medication Therapy," the first code (0820T) is for a healthcare professional to be reimbursed for monitoring and intervention during psychedelic-assisted therapy. Two additional modifiers (codes 0821 and 0822) are for reimbursement for a second qualified healthcare professional and for clinical staff.
Both companies have performed some of the most advanced research on MDMA therapy for PTSD treatment and psilocybin therapy for Treatment-Resistant Depression (TRD,) respectively.
MAPS PBCâs exact application to the FDA for MDMA administration paired with psychological intervention is, essentially, the step prior to having what would be the first federally legal psychedelic-assisted therapy. CEO Amy Emerson says "It is critical that there is a path to cover not only the MDMA but also the medication sessions should this novel investigational approach be approved."
With the Breakthrough Therapy designation given to MDMA in 2017, MAPS PBC has requested the FDA grant Priority Review of the new drug application. The FDA has 60 days to determine whether the NDA will be accepted for review and whether it will be a priority or standard review of six or ten months, respectively.Â
If approved by the FDA, the DEAÂ would be required to reschedule MDMA making it available for prescription medical use.
Wed, 03 Jan 2024 09:17:00 -0600entext/htmlhttps://markets.businessinsider.com/news/stocks/ama-s-reimbursement-codes-for-psychedelic-assisted-therapies-take-effect-here-s-what-to-expect-1032941362DE Ogbonnia Okoronkwo explains his approach to free agency on 'NFL Total Access'No result found, try new keyword!Cincinnati Bengals center Ted Karras joins 'NFL Total Access' ahead of his Week 15 game against the Minnesota Vikings in Week 15 of the 2023 NFL regular season. In a segment on 'NFL Total Access ...Fri, 10 Mar 2023 11:12:00 -0600en-UStext/htmlhttps://www.nfl.com/videos/de-ogbonnia-okoronkwo-explains-his-approach-to-free-agency-on-nfl-total-access