Felly, yn gwybod, yw'r hyn yn sicr i ymgyrchau cyfnodau a'r ydydd yr ydydd yr ydydd ymgyrchau. Mae'n ffordd i chi i ddim yn ei wneud, rydyn ni'n zainad i'n gweithio. Rwy'n gyffredinol, rwy'n gyffredinol gyda'r llwyffrif o'r afrikanol, a'r gwneud am ddifrif i'r pethau arall. Rwy'n gyfreidio, rwy'n gyfreidio, roeddwn ni wedi ddweud i'r seisio cyffredinol ar y Cymraeg Unigol Ysgol, yng Nghaerffordd. Now we are a year on, and we are going to be discussing how to advance the global deal, what we've achieved in the final year, what the obstacles have been, and just whether we can chart a path for the future. As most of you know, of course the global deal looks to creating a dialogue, a social dialogue between governments, business and trades unions. And the idea is that it draws its inspiration, trying to achieve Goal 8 which is for decent work, decent jobs and inclusive growth, and also SDG 17 which is all about partnerships to achieve these goals. We've got lot of wonderful speakers so I'm going to keep quiet and say that our first speaker, Mr Prime Minister hello, Stefan Lovian. How did you like my Swedish? That was good enough. Many Swedes cannot pronounce it that well as you did. But your English is better than my Swedish and let's face it. Stefan, love you. We were together last year, weren't we? We had a very good time. Listening to your vision because it was very much your initiative. I know now it's broadened out and we've got so many more stakeholders. you like to do more, but you know you're trying to create this global deal for social dialogue for inclusive growth and decent work. It's a very difficult background. A lot of people are skeptical about globalization. The fact that it hasn't really brought benefits to everybody, you know, the Chinese saying a rising tide does not lift all boats. I think a lot of people feel that their boats have not been raised. So how can you advance the global dialogue against this difficult background? ac mae'n gweithio'r idea o'r ysgrifennu sydd wedi'i gweithio'r ysgrifennu i'r gyffredinol. Gweithio'r ysgrifennu. First, I'm very glad to be here and to meet all of you and to meet Angela and Guy also who we launched the globalty together a year ago. So, I'm very happy to be here and see how the progress that we have made. First, let us note that globalisation means also positive things. We have to bear that in our minds that of course we want this world to develop as a whole. We know that, not least for Sweden, being a small country, we're very export-oriented. We believe in the global economy in open and fair trade and so on. Technology is spreading all over the world and we know that we have reduced poverty. The worst forms of poverty, we have a growing middle class in the world. More and more boys and girls go to school every day, which is a progress that has been made. But at the same time we see these winding gaps. I said earlier in this hole that some years ago, just a few years ago, Oxfam told us that some 50, 60 people, the richest people in the world own as much as the poorest half of the population, meaning 3.5 billion people, so 50 people owning as much as 3.5 billion. That's not longer a fact because today you can count to 10 people. So, the 10 richest people in the world own as much as 3.5 billion of the poorest. And that's a sign that there's something wrong. We also have a refugee crisis, climate crisis, conflicts, very serious conflicts, not least in the Korean Peninsula right now. So, that's the other side of the coin and we have more and more people believing we are not controlling this development at all.  And I think that's the worst scenario that we can have because if people feel that they are out of control, that's really, really bad. And what happens, you know, extremists and populists and those are against globalization as an idea they gain terrain. And we can see that, not least in Europe right now with neo-Nazis and those who attract people that feel despair. When people feel despair they are attracted to extremists. And that is one of the reasons why we need to do something very fast. And then of course the reason is the basic that we want all human beings to have a good life. We want all human beings in the world to look forward to the future, not being afraid of the future. We want them to long for tomorrow. Now the social dialogue, the global deal is essential in that. Because if you have a dialogue, a constant dialogue on this change, this development, how are we going to cope with it? Not only cope, how are we going to make sure that everyone benefits from the global economy? And that means in my world, that is my whole work in life experience has shown me that you can do so much together. One plus one can be more than two, it can be three. So this is not about different stakeholders fighting against each other. This is about how we create a win-win-win situation. When workers have decent working conditions, yes, that's a benefit for workers. But I can say at the same time with decent working conditions, productivity will increase. You will have more engaged staff in your companies, employees in the companies, because I see, yes, I have a positive future in this connection. And the society will gain as well. Because if enterprises are more productive, the society will gain. And then you have to find out who is doing what in this cooperation. What is the responsibility for the trade union, the employees? What's the responsibility for the employers, the enterprises? And what's the responsibility for the society to make this happen? And that could be different from different parts of the world, different countries, because we have different backgrounds, different history. But we have to find a way to make sure that this development is good for everyone. And that's indeed what we're going to be trying to do, see if we can find a way. Prime Minister, thank you so much. Angiel Gurria, you are director general of the OECD. Also a former finance minister in your native Mexico. And you know how difficult it is to implement some of the things that the Prime Minister has been talking about.  So just how does the global deal really fit into all this as a tool to try to break down these issues, these problems? The social dialogue which is implicit in the global deal, what I would call the transformational, the functional element of the global deal, really has to look at all of society. And here it's obviously the governments, the trade unions, business, civil society. Now we're talking about a workforce which is less and less unionized. And we're talking about a workforce which is more individualized. As we move more and more into services, the more you, you know, the high percentages of unionization are basically having to do with more in the manufacturing sector.  And even in a country like China, services are now more than 50% of the worth of the economy. And so that's where the action is and that's where we should focus for the future. But it means also that you have to create different forms of the social dialogue, and of course even of social protection when you're talking about skilling, upskilling, reskilling the workforce in order to adapt it to a growing digitalization. In fact, it's not about the digital economy but about an economy that already went digital. How do you adapt the workforce? Because about 9% to 10% of the workforce today is, we have, you know, we've found out in our research, is basically in danger of being substituted by technology, by robotisation, et cetera. But there's another 25% of the workforce. One full fourth, which together with this 9-10%, you mean one full third of the workforce that will either be substituted or disrupted in their workplace. For that we really need to prepare not only the workforce but society at large. So basically what you're talking about here is a whole making the social dialogue a very deep, very profound leverage the social dialogue into effectively what is moving the whole of the economy, whole of the society into the 21st century. Thank you very much indeed, Angel Gwria. Guy Ryder, director general of the ILO, the International Labour Organization based there in Geneva. Interesting what Angel Gwria had to say that actually you're beginning to see fewer and fewer members of the workforce who are unionised. So when you're talking about that within the context of the social dialogue, does it really help advance the social dialogue if you're saying let's include the trades unions if they are representing an ever diminishing portion of the workforce? Yeah, I think there is a reality of reduced union density in many countries, the country where I come from. When I worked in the trade union movement we had 13 million members. I don't know what they've done since I left. They've only got 6 million now. I often wonder what my colleagues have done. You shouldn't have left. But it remains still the biggest voluntary body of people and representative structure in the country. So I think we have to relativise at that point. But let me start from the general and go a little bit more to the specific. I want to sort of suggest that dialogue, I use the word in the most generic sort of expression, is a public good. I think we live at a time when dialogue is becoming extremely difficult in all sorts of scenario, including international relations. Anybody coming to the General Assembly I think might bear that in mind. And I think we should be worried when we stop talking to each other. It's like a relationship when you stop talking to each other you have a problem generally speaking. So dialogue is a public good in my view because it is a problem-solving mechanism. And if you relate to the world of work, which is obviously where our focus is with the global deal, social dialogue is a public good in the sense that it helps society to deal with difficult questions in the world of work in a manner which is both fair. And I think as Prime Minister Löffan has indicated, people are looking for a greater degree of fairness, is inclusive. If people are listened to, they tend to buy into solutions more than they otherwise would. And it's a very good way of taking the sharp edges off inequality and exclusion, some of the things that worry us very much in our societies. And being here in New York and looking at the 2030 agenda, I think we see that social dialogue is very, very much in the spirit of the 2030 agenda, as you've indicated at the outset. Now, these are all very fine general sentiments and we could all agree that it's very good to talk to each other. But I think to take the global deal forward and to win more and more support for it, I think we have to make a much sort of sharper, I'm going to call it a business case for social dialogue. Why and how is it good for companies, not just for workers, but for enterprises, for our society and for our economies. And we produced a small pamphlet with seven interesting examples of how precisely this happens. And let me just sort of telegraphically signal some of the elements of the business case. You take our Tunisian colleagues where social dialogue has been perhaps the most important method through which democratic process has been preserved in that country, recognised in the Nobel Peace Prize for the social dialogue partners. You look at the impact of the 2008 crisis, which were the countries which navigated the crisis best in terms of employment and growth. It was those countries which had good and effective institutions and traditions of social dialogue. I don't want to spare the Prime Minister's blushes, but Sweden was one country which did that. But also we have very strong evidence that social dialogue rebounds very, very clearly and very, very positively to company productivity. Companies which have good avenues and channels of dialogue perform very, very well. And one can go on. Training mechanisms which have tripartite inputs, they're very, very good. They're efficient. These are problem-solving, efficient mechanisms of labour market governance. It's a very, very solid, very, very objective assessment. I think these are the issues that we need to bring to the fore as we push forward with the global dialogue. Just very quickly, is it a dialogue of equals that you're talking about? Not always. I mean, the rappel de force can vary enormously, I think, but it is generally a mistake to believe that you come out ahead if you take advantage of the weakness of the person on the other side of the table. They might be a short-term win, but you pay for it. And confidence and trust and reciprocity, I think, in the end is what pays out if you take the longer-term approach to life. You started off by saying... It's not a dialogue of equals in the following sense because everybody has a different role. You see that the employers, the employees, whether they're unionised or not, and then the government, but all of them are indispensable to make it work. Good. Final word to you there before I finish with this panel. No, I mean, there's two examples. There will always be new technology that we know. There will be restructuring. We know that as well. Now, the thing is, how do we make people feel at least more confident in this restructuring? And that's a social dialogue when you agree upon the conditions for this. And if you have people afraid... I mean, when I was a local trade union leader, the blue-collar workers in our company, we rationalised a part of that company. We made it 30% more efficient. 30%. How was that possible? Because I knew in this part of the production a third of the workers would need another job. It was possible because I could tell them in the other part of the company there's a job for you. And if you need retraining, a training to get that job will make sure you have that training. So they could say, OK, this is a change. It will not be easy. But of course I will be fine after this as well. Now, if you scale that to a national perspective, you have to do the same. How do you make sure in this restructuring that people feel well? I will not be unemployed for a long time. I will be helped with training. If I'm unemployed, I will have a financial situation that doesn't make me go under it. So these kind of issues we need to discuss. Thank you all very much indeed, gentlemen. If you would be so kind as to take your seat on the floor. To get out of here. And may I ask Sheikh Hasina, President Fasquez, Philip Winnie. I'm staying here. He didn't use it. Thank you. That was the three gentlemen there, kicking off the opening discussion. And I'm now going to welcome to the stage President Fasquez, who is sitting there, Sheikh Hasina. So President Fasquez, of course, you know the president of Uruguay and he will be speaking in Spanish. Sheikh Hasina, hello. Prime Minister of Bangladesh. Yes, good, good, good. I have my next group of guests. I have my next group of guests here. So we're going to start with you, Sheikh Hasina. Prime Minister of Bangladesh. And of course, I should say, just everybody wishes your country every success in trying to deal with this huge influx of refugees that you are having to cope with in your country. But we are talking here about the social dialogue and Bangladesh is one of the countries that has signed up to this idea of a dialogue. And really, I wanted to ask you, what are you doing at country level to try to implement some of these principles and also how you've been scaling up initiatives. So this is a chance for us to hear what countries have done. We're going to hear from Bangladesh and also from Uruguay. But Sheikh Hasina, if you'd be so kind. I see you have some, you've come prepared. Prime Minister, you've come prepared for your speech. Okay. Well, be my guest. See what I have to be prepared and then I can, will give you answer. Well, thank you very much. Thank you very much for giving me this opportunity. Well, ladies and gentlemen, I say, ladies and gentlemen, good evening. In the last nine years, we have been strengthening democracy in Bangladesh. As you know that we suffered from military dictatorship for a long time. So we have to struggle to establish democracy. Our relentless efforts have also been successful in achieving tremendous economic and social progress. We have brought pro-labor changes in labour relations. These advances have contributed to uplifting the work condition. As we embark upon promoting global deal in collaboration with Sweden, our commitment for the protection of human rights and labour rights remains steadfast. We look at the protection of labour rights as an integral part of our economy and society. We believe that if the overall socio-economic development is ensued, it will eventually enhance decent jobs and labour rights. Due to various pro-development actions taken by the government for capital income of our citizens has almost tripled over the last nine years and significant achievements in poverty alleviation has been made. The minimum wages of government's workers was increased threefold in the past five years. These have contributed in ensuring better life, livelihood and working environment and income stability of workers. The government of Bangladesh has started implementing the better work programme. We have undertaken massive training programmes under the social dialogue and harmonious industrial relations project. The Tepatite Consultative Council dedicated for addressing the RMG sector labour issues has been established. The aim of the Tepatite Council is to support social dialogue in the labour sector of Bangladesh for achieving harmonious industrial relations. The council is composed of members from government, labour leaders and business community and employers. In the RMG sector, as you know, most of the women are working. We have to make sure that also we are pursuing and also assisting the owner of the industry to develop a good environment for living conditions of our women labour force. We are building hostels or dormitories for them. We give money to the organisation with just two percent services from banks to build up hostels or dormitories for labour, especially for women and also for training. Training as well as for their establishments. We are trying our best to assist our labour force and also people. Are you finding business is helping? You are the government doing this. You talked about the labour force welcoming these initiatives, the minimum wage and the rest of it. You find that businesses in Bangladesh are also part of this dialogue? Yes, of course. Being head of the government, sometimes I discuss with the owner and then to increase the wages, definitely we pursue them, but of course we have to give some facilities for the owner also, otherwise they don't agree to increase the wages. You are going to make it worse there while. So in one hand you have to put pressure, side by side you have to give them some opportunity so that they can run their business easily and efficiently. The phrase is enlightened self-interest. You can appeal to business to do that. Within nine years, I can give you an example, in our taka money, it was only 1600 taka per month of wages, then I talked to them at first interest they increased it to 5000 and next 5500 within this period. That means they triple the wages, but definitely the owner of the industry always wants some facilities, extra facilities, so we provided that. But we must see the interest of the labour and also for the children of the women's labour who have established a centre for medical facilities for parents and for the labour who are working whole day so they are with the main facilities. Some other facilities they are providing. Thank you very much. It's not just in developing nations. I talked to our business community that look I am here. I am not only the Prime Minister of Bangladesh, but I am also working the job of the Prime Minister. I feel that it is for the labour, pharma and downtrodden people, especially for them I am here. So I want to assist our people so that they can get a better life. I was about to say it's not just in developing countries, in the United Kingdom there was a report that women are more likely to not earn the minimum wage because they don't. So it's a point well made. I'd like to go to Uruguay now, leave Asia and go to Latin America. President Vasquez, welcome to you. Thank you so much. So again, I know you are going to speak in Spanish, but we have the help of your delightful interpreter there. Again, what are you doing on the ground to make these principles come about and just how you are trying to scale up these initiatives in your country? Okay. Thank you. Firstly, thank you so much for minister for your invitation. And secondly, I will speak in Spanish, my mother language. Nwestro païs Uruguay a implementado i se a comprometido voluntariamente con el acuerdo global a traves de la siguiente medida concretas. Uruguay has implemented and has voluntarily pledged to the global deal through the following concrete measures. Primero, promoción de la cultura del trabajo como diretrice estratégica de gobierno nacional. First, encouragement of the culture of work as a strategic island of the national government. Segundo, implementación del primer programa tripartito de trabajo decente en nwestro païs. Second, deployment of the first three party program for teachers in our country. Teresero, ampliación de la cobertura de seguridad social i de salud a traves de un sistema nacional de cuidados que abarca a tres poblaciones fundamentalmente. El adulto mayor, la niñez y sobretodo la mujer embarasada. Third, enlargement of social and health insurance through national system of care that involves the main three groups, senior citizens, children and pregnant women. In 10 years, and in fourth place, there was an increase in employment rate founded in the growth of employment, especially in women, which went from 43.7% in 2006 to 50.1% in 2016. Number four, in ten years, there was an increase of employment rate based on the growth of employment of women at the workforce that was raised from 43.7% in 2006 to 50.1% in 2016. In fifth place, there was an increase in real wages between 2005, when we reached the government in 2016, in an increase of 55.1%. In sixth place, the real variation of the minimum wage national between 2015 that we reached a new government period, and 2017 was 137%. In seventh place, macroeconomic policies responsible for the economic growth of our country uninterrupted in the last 15 years, which resulted in an increase in direct foreign investment with a reinversion in the 61% environment. These growths are based fundamentally in a deep democratic state in a participation of all the actors and in the search for political and social balance. Thank you so much indeed, Mr President, especially your last comment on just reminding us how initiatives like the social dialogue are very much a cornerstone of democracy. Thank you very much indeed and also to your brilliant interpreter there. Thank you. Philip Jennings, you are Secretary General of the UNI Global Trade Union, which is a private sector services union based in Switzerland. What do you think about incentives for business to be part of the dialogue? I think it's a win-win case, as the Prime Minister said, for business in all respects. First of all, when you look at the question of productivity, when you look at dealing with transformational change, when you look at the demands that society are making on business in terms of their respect for human rights, when you look at what consumers are demanding of business in terms of where the goods are produced, how the goods are produced and what conditions goods are produced on, given the new pressures and dynamics on the business community, engaging with the workforce, recognising the trade union movement and working with them through the process of social dialogue and collective bargaining, I consider it a win-win. Unfortunately, we would like them to share this perspective, and I think we like the global deal in that regard. It is an invitation to the business community to discover some good business common sense about engaging with the workforce and engaging with your most important stakeholder. We take matters into our own hand and please don't accept the fact that we're not organising. We are organising in numbers in the services sector that we've never seen. But the dynamics, as Angel said, of the services economy is very different. I have unions signing up 100,000 members a year for a net gain of 2,000 to 3,000. We are signing people up, but to sign them up, we need to get access. We need to have an environment where the labour law helps us and where the framework for organising works. We have faced so much opposition, principally political, which means we can't have the oxygen to organise. We have two union officials here. Their union has grown by 150,000 in the last four years. We have more women in membership, more women leaders in membership. If you ask the millennials what they think about us, then we have the best kind of opinion poll numbers that we've seen. There is a case to deal with the shocks. There is a case to deal with an ethical supply chain. I'm very happy with the work that we've done in Bangladesh. With the Bangladesh Accord, we had a conversation today in Paris with the Bangladesh Government manufacturers about the continuation of the accord. It's a very good example of a strong message to the world that social dialogue works and it makes business sense to do this. If not, then 200 businesses wouldn't have signed up for the Bangladesh Accord when we started with zero. Philip, thank you so much for your very robust intervention. Power to you, great. Thank you. I'm just getting warmed up. I know, I'm just... I'd hate to see you when you're warmed up. He was just clearing his throat, ladies and gentlemen. But the passion is out there amongst our membership. The passion and the compassion is there. Great, I'm with you. Matt Granrid, you are director general of GSMA, which is the International Mobile Association, which is the kind of unbred organisation for the mobile operators. You've seen the gauntlets being thrown in your direction, business. Are you going to rise to the challenge? Absolutely, I'm equally passionate, but maybe not so vocal as my colleague to the writer. It was great sitting here listening to both directions. But I think if we take the mobile industry, now you might wonder why am I sitting? The mobile operators were competing like never before. It's a cutthroat market for us as an industry. But there's one thing that we do agree on and that is that the SDGs is something that is critically important for exactly the reasons you said. It is important for our customers. It is important to attract and retain top talent that we are thriving on. And it is so important that we have agreed on a common purpose, common vision. We are connecting everyone and everything to a better future. And that better future is the SDGs. We are also, mind you, connecting over five billion people. Five billion people. It is an awesome power and awesome platform to advocate and have an outreach on the betterment of mobile. Every year we launch a report called the impact report, and now I just gave it away to the Office of the Swedish Prime Minister, but you have one there, I hope. But what it says is that we're actually doing good progress on all 17 goals. When we started this work, we didn't think that we would do that, but we did. And I have so many great examples from our members, the mobile operators, what they are doing to achieve betterment and achieve SDG targets. One example is that the industry is growing tremendously. There is a huge amount of money being put in and investing into the fintech area. I just came from San Francisco last year, and I know that VC company, private equity groups are investing, for the first half of this year, half a trillion US dollars into media, telecom, and technology sector. Now if that stands to be the way that the second half of 2017 goes, it will be an all-time record high. So the momentum in the industry is tremendous. We are thriving on an increasing of digitisation and more automation. Internet of things is just around the corner. If 2G gave us mobility, remember 2G? Then we got 3G, which gave us a half-baked data usage, but a little bit better speed, and then we got 5G. Sorry, 4G, and 4G is what we are doing right now. Now it gave us better speed and lower latency, but the important thing is that we had one common technology globally. One common platform globally, which made that the platform economy, very much what you were alluding to, that the platform economy is creating a huge amount of energy and positivism in this energy. Now what will happen with 5G? Well, I think if 4G changed my life, 5G will change society, because it is a connected society that we are entering into, and 5G will play a super important role. So we are here for the long run, and we are united in the mobile industry to achieve these SDGs. Just for the record, I'm a 5G kind of girl. Good for you. Yes, fast. Winnie Bian Yma, executive director of Oxfam. You've listened to what your fellow panellists have to say.  Perhaps you might tell us social dialogue all very well, we like it, but where do you see the barriers and the challenges in achieving it? Did you want to answer that? Or I saw you taking notes, would you like to say something else? No, I'm happy to respond to that. First, we've signed on to the global deal, as Oxfam, and we are proud to, and we congratulate the Prime Minister of Sweden for his leadership on that. Social dialogue is the way forward. We have to talk business, governments and citizens and work our way out of a crisis of rising inequality, where we have a global economy that is funneling wealth to a few at the top and leaving so many behind. You know, the IMF recently released a report and said that one key driver of inequality has been the decline, guess what, of trade unions. This is the IMF. Now, if the IMF says that we need more trade unions and more collective bargaining, then you know there's a problem in the global economy. There has to be. Thank you very much. I mean, we, Oxfam, we are committed to exposing this rising extreme inequality and the dangers it has to society and to sustainable growth, and to fight for the rights of workers. Whether these are government workers in Bangladesh or hotel cleaners in Thailand, or even poultry workers here in the United States of America who are living on poverty wages, we fight for them. Some of them go to work in diapas because they are afraid of asking for a toilet break. That's how bad it is. Here in the richest country in the world, it's unacceptable. So we will fight for justice there. There has to be a way, there has to be businesses that will share value more equitably. You know, the chief economist of the Bank of England said this, it's not a statistic of Oxfam, that in 1970 companies in the UK gave their shareholders 10% of their profits. Today that percentage is 70%, and that's the trend across the rich countries and the emerging countries, that more and more of the profits are going to shareholders less and less to workers, less and less is invested back to grow the business and it also encourages tax dodging. We have to get out of those business morals. We have to think of different morals and there are there. And Oxfam, we have some experience in building different business morals and we are studying and trying to actually envisage more business morals that are fair. We have come to accept that business must channel wealth to the owners of capital and cheat the other stakeholders. That's wrong. Let me give you an example, Oxfam in 1991 with others formed a company called Café Direct. It's a cooperative. It gives a premium to coffee farmers. It invests 50% of the profits back into communities. Two of the board seats are for the farmers and the company publishes information about wage levels. No one, the top worker doesn't earn more than 4.4% more than the bottom worker or the amount the bottom worker gets. There is a fair wage differential. These are things that can happen. You can take it to scale. There's a company called Mondragon, a Spanish company owned by 74,000 workers, employees. They democratically manage their cooperative. It's in industry, it's in finance, it's in knowledge production. It does a lot of value addition. But it's owned by its employees. The top owner, the CEO, the top worker doesn't earn more than nine times more than the bottom. These are real businesses making $13 billion turnover. So we have to go away from exploitative businesses and it can happen through social dialogue. Thank you, Winnie. You've given us some good case studies there. Thank you very much indeed. You can stay relaxed. I'm going to go to the floor, though, because I think we've got a couple of interventions from the floor. I'd like to ask first of all the vice president of Costa Rica, Vice President Chacon. There's a microphone coming for you. Thank you very much indeed, Madam. Would you be so kind perhaps as to stand? Of course. It would just help so people at the back can understand. Okay, thank you. So just a brief response, please, in response to what you've heard. I've been grateful, you know, here and everybody. First of all, talking about justice, then talking about as women in the workforce. It's very important to give us different opportunities. And another thing that's very important that the Secretary has been talking about, it's equal pay for as women. That's another thing that we have to do. I love these words and I love these examples. You know, in Costa Rica we just finished a new law that really gives us another opportunities for being in the workforce as women, especially taking care of our kids. That's very important. If we don't have where to leave our kids, we can't be in the workforce. And if we are not in the workforce, we are losing half of the workforce of the whole world. So this is very important for us to do. Also it's very important to have an knowledge in sexual rights and reproductive rights. So it's very important to take little girls into education, quality education, and then growing up knowing that we deserve to have the amount of kids that we can really take care. That's another very important thing. And having this opportunity to talk in the World Economic Forum, it's a great opportunity to think that we can build a better world. A better world that's, you know, made from women and from men, and that we can work in this. Another very important issue that you have been talking is about technologies. You know everybody needs to have technologies so they can reach the information. And that's another very important thing we have been doing in Costa Rica. Now the gap between the people with technologies and the poorest that they didn't use to have technologies, it's really a very small gap because with the politics I have been doing in Costa Rica, we are getting all the whole country connected. So the kids will have the same opportunity to learn to learn another language. We are trying to teach English as a second language in all our children, but also it's very important to be a competitive country. So I'm very grateful for this opportunity. I'm very grateful to see and to share with you what we are doing in a little country called Costa Rica for 1.5 million people. We can have this as a laboratory, but we are doing good things. And as vice president of my country, I'm really proud that these gaps are really getting shorter, smaller, and we are finding out a better society. So thank you very much. Thank you very much indeed, vice president. And indeed you are very much a global laboratory because you have done so many good things in Costa Rica in setting an example of what could be done in so many ways, industrialisation and so on. But let's go to the Netherlands. Lilliann Plowman, you are the minister for foreign trade and development. A brief response from you. Thank you for watching. Thank you very much. Let me first thank the prime minister of Sweden for taking this initiative. And I think what makes the global deal, the global initiative special, is that it can bring together all kind of practical work that is being done. So now I'm not going to list what wonderful practical work the Netherlands is doing. I'm going to point out a bit more of a political issue that I think we need to address. You've been all talking about the social dialogue and we basically invented the social dialogue. You've been talking about the problem of people becoming or countries becoming less unionised. There is an other issue that we need to address that in too many countries people are afraid to unionise in themselves. They are afraid to organise themselves. They are in real time punished for organising themselves at the places where they work. And I think not only politicians have a responsibility to fix that, we should, but also businesses and of course NGOs. So now the World Economic Forum brings us together. We have this wonderful initiative. I do think that we need to get a little bit more political on this issue. You've set the ball rolling there on the political. Thank you. Just pass the microphone to your fellow minister there on the side. Thank you. Doctor Bekele from Ethiopia Minister for Water Irrigation and Electricity. You're a busy man. That's a big portfolio. All three. Yes, it is. It is. Thank you very much, Mr Prime Minister, for your continued leadership in this global deal. This is important partnership actually to bring together everyone to implement the 20th agenda for sustainable development. The inclusive growth and job creation is a very critical issue for discussion. My country is rapidly, one of rapidly growing economies in the world, about 8% even in the difficult year. This has been continuing for the last 12 years. Within this we see the importance of sectors like agriculture in African context to be productiveness. We have to really create job opportunities through looking into agroprocessing value addition of agriculture because right now 70% of African population is actually engaged as a patient in agriculture, but not productive enough in terms of productivity. Therefore it is critical to really think that agriculture productivity increases substantially. Africa should also revolutionise in terms of industrialisation manufacturing service sectors and so on. So in this also we need to invest significantly. My country is doing well recently in terms of industrialisation and manufacturing. Currently we are building 12 industrial parks that would really create a decent job for young people and women. The critical problem we have is unemployment. We are very successful in terms of education. For example, from 3 universities about 10 years ago we have now about 50 public universities. So one of the target area 86 says to mix employment as well as education and training. So we are doing very well in terms of education and training but the demographic dividend need to be set through what we have established as secondary and tertiary education where a lot of young people are graduating from universities but need to be employed through fast developing industry manufacturing and agroprocessing as I have said. So that's what happens. I said you were busy. You are certainly. Good luck. Yes, because huge population there in Ethiopia is about 90 million so yes the challenge is great. John Irons, your director for inclusive economies at the Ford Foundation and of course this is about inclusive growth and decent work. So just give us a quick rundown. Yes, so I'm here to think about the impressive presentations we've heard today and thinking about the global deal and the components of that which is just the questions why partner and then why dialogue. That's when what I'm trying to think about when thinking listening to the presentations. So in why partnership but we're trying to solve what in philanthropy we would call wicked problems but I apologize it probably does not translate well into many languages here but a wicked problem is a problem that has no easy solution, there's no one way to solve it and it really demands partnerships. It demands that people bring different skills to the table, different expertise and different perspectives and that's what we're talking about today. Finally why dialogue, why is that important? We heard about several what I would call the drivers of inequality the drivers of the problems we see today be it lack of unionization or others. At Ford we often talk about the five drivers of inequality being entranced cultural narratives, failure to invest in public goods, unfair rules of the economy, unequal access to government decision making and resources and persistent prejudice and discrimination. So I challenge you to deal with any one of those problems without dialogue, dialogue has to be a part of every one of those problems and more. But we also need I would call it directed dialogue, dialogue with a purpose. I think the SDGs as you've heard today in some sense provides that purpose, provides a framework for which we can not just talk about things in the abstract we can really aim them towards solutions so that we can create the more inclusive economies we'd all like to see. Thank you very much indeed John. And now for our closing remarks we are absolutely delighted to have in our midst and may I invite her to the lectern. Somebody of course who was absolutely instrumental in providing the framework of the SDGs the Deputy Secretary General of the United Nations Amina Mohamed also former cabinet minister in her native Nigeria amongst many other accolades you have which are far too numerous to mention but Amina thank you very much indeed. Thank you very much and excellent these ladies and friends and a lot of friends in this audience and I know that I'm standing between you and many receptions. This has been really enlightening for us and engaging and I think when we the temperature was raised it was also good for all of us just waking us up to what the deal was about and I do want to thank the Prime Minister of Sweden because I remember him bringing people on to the stage in 2015 and making a commitment and here we are today with the full room and really those commitments are beginning to be realised and it's not a long way to go but it's the partnerships and thank you World Economic Forum for doing that. I have this wonderful speech that my great team wrote so I'm going to put it to one side because it really doesn't capture anywhere near the kind of commitments and passion we're seeing in the room today. Leaders are here from different parts maybe not enough women but we are here around not enough young people. But speaking. The global deal and social dialogue are two different imperatives both and they have to be well and truly connected and it cannot be a sterile dialogue I think we've heard that from everyone that it's got to be meaningful and for us we believe that people at the centre of that dialogue is essential. People that are given respect, that are given dignity that are allowed to actualise justice in globalisation and to do it without fear and I think that this is what happens in the communities that we have the minute we talk about inclusive consultations and dialogues to get us into a place where we will have equal access to whatever it is that we have then the barriers start to come up and very very quickly we make we justify the barriers and so I think that this discussion brings us to what we already have which took us four years to get and that's the SDG framework it's an amazing framework and it is a consensus of 193 countries that didn't have to sign a legal document so it is one that we're all wedded to we don't need any more resolutions we don't have to go negotiate any more cross any T's or dot any I's we have it and that's what we can call leaders to that's what we should be saying the political space needs to be opened up for is implementation of those commitments that were made in 2015 not just the 2030 agenda but the climate Paris agreement as well and a numerous other resolutions that we added to that with the 2030 agenda we don't just have 17 goals and you pick one you have 17 entry points as a response to the context and challenges that we have in the world today and that's what's exciting about them is that there isn't any one goal that doesn't matter to our 7 billion and we have different levels of priorities that we would put them but as a whole they're all really important and I think that we can make them exciting we can find the solutions and certainly become much more fit for purpose to engage with implementation not in New York, yes I know we have some dire consequences in the United States we've left many people behind but really when you map the world we know and have the data to go where we need to go we know where those are really left behind in dire straits are and so I think that when we talk about the unions fit for purpose today is it the unions of today or the unions of yesterday and I think that we I'm not picking on you because I can tell you about the unions in my country but I am saying that because of that the UN has to think about whether it's fit for purpose with its over 30 odd organisations and institutions it's why we're doing the reform now and we ask the question do you think that you are implementing the SDGs 90% came back and said yes we're doing the SDGs and consultants came back experts came back and said no you're not you're doing MDGs plus I think we need to have an honest conversation look in the mirror and see across the globe what are we doing have we got the skill sets have we got the narrative have we got the mindset to really engage with this new agenda that took all of us a long time to agree to and very quickly we're finding people slipping back into the old ways to think that they could implement this new agenda it is absolutely not possible we really have to stretch it is painful, it is transitional in many cases it will take a long time for us to run with it, we will be crawling and walking but it's worth it it's worth it because those 7 billion people are no longer in a place that they can't reach you there are no borders in this world for the catastrophes and the problems that we have what happens in one country today can visit you in another country overnight across the internet, across borders we're seeing it today and I think this is where we need to look at the opportunity that these goals create for businesses and partnerships for businesses to put people at the centre to have that social dialogue that is genuine and continuous not a one off and that we can bring all sorts of stakeholders into the room and not have siloed dialogue either, there are many convenings that we have when we only put one sort of people in the room and then we have another dialogue and then someone has to put all those threads together and they very often don't interpret them the right way as if you were all in the same room so really defining the kind of dialogues that we have, political space we absolutely need the political space to bring in those that are on the outside and I do think that in many cases that political space isn't open for unions and it needs to be I think there's a huge opportunity in the labour force for what we can do and build on what has been successful but I think youth are missing youth are being spoken about and we're asking they're saying how important they are today not tomorrow they need to be at the table and then suddenly it's very difficult to bring them to the table very difficult to give them a position on the table what do we want them to talk about and I think that you know in creating the agenda for a conversation or a social dialogue and not just be asked in after the agenda has been created and there are examples of how this is happening really well but they are key and they need to be there the advent of the digital world and the frontier issues that we're all dealing with now can allow us to leapfrog today we heard about digital finance and how women and young people and entrepreneurs can have access to that and so that's exciting but it really needs to be thought through what the conditions are and how we need to get that on the road but I think that it also raises a number of other issues in terms of the opportunities that could be available to us today we speak about the 2030 agenda and we go off into another room and talk about climate change it's one and the same I can tell you in our countries that when we want to put a pipeline of projects together it is not NDCs and 2030 agenda it's the same thing the power project the transportation project the health project all of them are related to both and so having that alignment and using the opportunities of NDCs to say that we can attain the 2030 goal we've tried now to put in I want to go back just quickly to the digital finance piece what has that raised it's raised the issue of skills and education I hear us talking about education maybe I won't say this but as I mean a Mohammed I'll tell you that education is in crisis all over the world we have to rethink education what kind of skills are we saying that our young people need to have for these new frontiers that we have the new jobs, the new economies are we going to be left behind because we don't have those skills there's an opportunity now that we have millions of young people with the wrong set of skills with a bad quality education really bad I guess we'll tell us about it now is an opportunity to retool to re-skill to actually join up in a social dialogue with unions to say what should the labour force look like across the world in different places to engage these young people who can live their aspirations finally I just want to encourage everyone to continue what you're doing bigger and better if it's in line with a genuine social dialogue for the global deal and to use the secretary general's convening power his political capital to bring that together at the country level we're committed to making sure that we have a new generation of country teams with resident coordinators that can do just that coordinate a number of institutions with the capacities and the expertise that we have a symphony and not a cacophony as we often have these days but we promise you that we're up front there we're ready to lead on it and we really encourage all of you to come into this the SDGs really will deliver us to the promised land thank you Deputy Secretary General thank you thank you very much indeed Deputy Secretary General I think that has rounded off this discussion on advancing the global deal very very well I thank all my panellists and those of you who have contributed from the floor please those of you who spoke would you be so kind as to come onto the stage for a group photograph but it just remains from me Zane Abidari to say it's been my pleasure to be with all of you and I wish you a very successful and productive General Assembly 2017 thank you


Hello everyone. Thank you very much for having me again at the Toronto Perioperative Team Symposium. It's a honor to be with you. I'd like to be there in person. I hope we can meet each other again soon. And thanks Azad and congratulations for the excellent job that you've been doing and that you've done again with this conference. As you asked me, I'm now talking about structural heart disease and presenting a few cases where ecocardiography plays a significant role in the procedures and in the planning for the best patient care. I have no conflicts of interest in regards to the stock. I do have a few disclosures. I'm a member of the board for the National Board of Ecocardiography Basic Exam preparation. And at Herdcentrum Leipzig, we are a reference center for Philips. Therefore, we don't get any money from Philips. We get eco-machines and software and all of our images are Philips. And I've also received an honorarium from Hubbot to talk about some of the products and eco for some of the devices that are made by this company. So as just said, I'll be presenting two cases. We'll be having a case of Tavi. And here is again something relatively new. We've been moving away from T for Tavi. And now we get a T back in the back in the game and it's starting to play again an interesting role in some of these cases. And then we'll be talking presenting another case of transcatheter mitral valve implantation. Our first patient who presented to us about two months ago was an 84-year-old man who presented for Tavi. He had a previous aortic valve replacement in 2004 with a stentless bioprostesis that failed ten years later, was replaced by with a triflecta aortic valve prosthesis. And in between, he also had bypasses on the left coronary system. And all of the bypasses were patent but open. He had chronic renaly sufficiency. He had a permanent pacemaker peripheral vascular disease heart failure. And the indication for Tavi was severe aortic insufficiency. When we met the day before the procedure with our heart team, our radiologist presented the CT. And as you can see here, it's relatively easy to see how the coronary arteries, the osteo of the coronary arteries are just above the ring of these bioprostesis. And so you can clearly imagine, we draw here, they drew the casts of these prosthesis that as we and if we deploy a valve inside these prosthesis, the leaflet will certainly obstruct these coronary osteo because the coronary osteo are too long. Now, for the left coronary osteo, osteo is not much of a deal, a big deal because we have bypasses that are patent but for the right coronary osteo, obviously if we deploy a valve and we don't do anything that will most likely result into a complete obstruction of the right coronary osteo. Therefore, we talked about or was suggested to do a basilica procedure. What is a basilica procedure? Basilica has nothing to do with the famous basilica in Rome but it has to do with a complex acronym that means bioprostetic aortic valve scallop intentional at laceration to prevent iatrogenic coronary artery obstruction. And this is the first paper where the group from here from Leipzig led by Mohamed Abdelwaham described this technique. Here is going back to the to the CT scan on the left is the left coronary artery, on the right is the right coronary artery and here the radiologist showed how is the coronary artery osteo oriented in respect to the center of the leaflet in this patient. And you can see that in the right on the right coronary artery, the osteo is oriented seven degrees, seven degrees from the center of the of the of the leaflet towards the left side. And so if we want to cut this leaflet in half in order to prevent the leaflet to obstruct the osteo, then we want to cut the osteo right in front. We want to cut the leaflet right in front of the osteo. So this is for example a diagram that I made with like famous Mercedes Benz sign. This is the right coronary cast and we want to cut it right in front of the osteum towards the center of the valve. This is our patient at the baseline the baseline echo. You can see a long axis view with X plane there's an aortic insufficiency, which is in this case actually a good news because normally patient will have aortic insufficiency if we do a basillica and we cause more aortic insufficiency that's usually way better tolerated than patient who have no aortic insufficiency and then suddenly develop significant aortic insufficiency with the basillica procedure. Now we can now look at the left ventricle, right ventricle, there's no wall motion abnormalities and in the deep trans gastric view we can appreciate how this regurgitan jet is actually quite eccentric and flows against the interventricular septum on the right. So here is our short taxis view and from this view by small movement of the probin and out we want to try to identify the cusp of the mitral valve which we want to identify the osteum of the coronary artery which I think it's somewhere around here. And now what I did is I took our CT scan and I flipped it up and down and right and left to orient the cusp, to orient this picture the same way as the echo and here where I put my now my arrow is where probably where we can appreciate the right coronary osteum and that's where we would want to from there we want to start a cut towards the center of the of the leaflet. Echo cardiography plays an important role in the basillica procedure and no one has described it before and we were lucky and honored to be able to write about it and publish this paper last year on jays where we described the role of echo and what are the steps and what we need to look for with echo for this basillica procedure. Basillica procedure is made of a few steps so the first step is consists of putting a loop like over a catheter under the valve that we want to cut so that's the snare system positioning and you can see that there's this catheter that goes through the aortic valve here in the LVOT we don't see the loop here because of the orientation we cannot really see it with echo. Now we've positioned the loop now comes the second and most important catheter there's the catheter that's the transversal system so it's a catheter that needs to be positioned exactly where we want to pop the leaflet where do we want to pop the leaflet right against the annulus or the ring here and right where the osteum of the coronary artery is so in this case we have our catheter was positioned exactly there and now if we're once we're lucky when we're happy with the positioning of this catheter through the catheter we get a wire an electrified wire and as we apply cotter into this wire we go through the the the casps off the off these bioprostatic valves and we can see we've gone through that the wire goes through the valve and as we pull through the valve you see that generates a little bit of bubbles and now we want to fish this wire back up with the snare so you can see on fluoroscopy we've now caught this wire with the snare and now the snare like the wire it's on one hand comes out of this catheter here on at the ring at the annulus here at the ring yeah of the bioprostasis the wire goes through the the the the casps comes into the second wire up yeah so the snaring is complete yeah and we can see that there's two catheters one and two one is here at the ring at the annulus and the other one is in the sample and this catheter as we put tension on both they take sort of a V uh like they appear like a V this is also described as the flying V sign doesn't really mean much it's simply that once we apply tension on the catheter the two catheter are oriented and the tips are oriented like a V now we apply to the wire in the catheter electricity again so cottering with like a normal surgical cottery system and we pull the wire and now we've lacerated the leaflet we've lacerated the leaflet the patient tolerated it well we have a little bit more arctic insufficiency in this case we what we also appreciated that happens often is that we may not be able to see exactly where like where this new jet comes from unless there is no the unless there is no insufficiency before but in this case we definitely can see that the initial jet is different so the insufficiency is definitely as like the jet of the the backflow has a different morphology and here actually comes from the anterior or like the right or what was what corresponds to the most anterior casks that corresponds to the native right coronary cask done the procedure we decided don't need to do the right because the left coronary system is has the bypasses that are still open so then we proceed to deploy an evolutar procedure 23 millimeter that's deployed based on fluoroscopy on echo we can see how the valve is released the valve is released and now the valve push the new valve the core valve push the leaflet of this bioprostesis on the against the the arctic root and because one was lacerated that's the right was lacerated the flow in the right coronary ostium is preserved there's no wall motion abnormalities and there was a successful procedure without parabola early and with sort of acceptable gradient with this new prosthesis the second case is a younger patient who presented with severe mitral regurgitation severe tricuspid regurgitation after with so patient who had a mitral valve repair 2008 and multiple comorbidities atrial fibrillation chronic renal insufficiency anemia cerebral infarct hemiparesis tias epilepsy peripheral vascular disease given the the high risk for conventional surgery it was proposed to deal with the art mitral valve regurgitation with the tendine valve the tendine valve is a is a wire so relatively invasive not not minimally invasive because it's done through the apex of the heart but transapical valve system that's delivered through a catheter you can see here the catheter through the mitral valve leaflet this is the tendine valve the valve can be its position it sits on the native mitral valve annulus and can be re grasped and taken out if we're not happy with the positioning or reposition adjusted the position and once we're happy with it how it sits on the annulus then the valve has a string that comes outside of the heart through the apex and the pad holds the string in place and holds the valve so then the valve sits on the native annulus this is our patient giant atria as you can you can see the mitral valve ring there was a son on the previous procedure mitral valve insufficiency in the long axis you can appreciate even so even higher degree of mitral valve insufficiency the problem was here that when we thought about tendine valve now you look at these anterior mitral valve leaflet and you look at at the tendine valve out sits on the mitral valve and you can appreciate that the tendine valve is at least two centimeter high so if we deploy a tendine valve in this patient with this long anterior mitral valve leaflet that you see here then what's left for blood flow in the lbot is limited very limited and it's like extremely small yeah opening below where would the core the tendine valve end and the interventricular septum not only because this anterior mitral valve leaflet it's long but also because the angle between the interventricular septum and the ascending aorta is relatively acute yeah it's it's a it's a it's a short it's not it's it's there's there's quite an angle between the septum and the aorta the ascending aorta sentence yeah so what we decided to do is or what we consider to do is to do so-called lampoon procedure lampoon procedure is is basically the the use of the same technique that you see for the so for the aortic valve but applied to the mitral valve so we pork the anterior mitral valve leaflet with an electrified wire that's caught by a snare here is in this animation done through the aortic valve so from the aortic arch now we electrify this wire we pull and then we cut the anterior mitral valve leaflet and this is the difference between having deployed a valve inside the mitral valve with lampoon or without lampoon and with lampoon the valve the anterior leaflet is split in half and that's a core sapience valve as you can see that sits in the mitral valve position this is our patient we look at the ring here we look at on the right with color massive mitral regurgitation what's interesting though is that when we're looking at the unfast view here I would have expected to find the aortic valve right here at 12 o'clock in respect to my annulus but in this patient the aortic valve is actually not sitting at 12 o'clock in respect to the mitral valve ring here it's actually sitting at like 10 11 o'clock here so at the level of the lateral commissure of the mitral valve so what was interesting is okay so normally with the lampoon procedure we cut the anterior leaflet of the mitral valve in half where this arrow is here but in this case that's not exactly where the lbot is the lbot is more a little bit more lateral and at a slightly different angle so that's where we decided just based on 3d yeah where we would be poking the anterior mitral valve leaflets and where we're going to proceed with the lampoon procedure the first step though was the trans trans apical approach so before we started anything we wanted to be ready to then deploy the tendine valve so we first identify the apex of the heart which is a critical step you see with the finger of the surgeon is poking on the apex of the valve here and we're trying to yeah identify the apex yeah where the apex is we do a per string around the apex and then we start with the lampoon procedure in our case we did it through the inter atrial septum that's the trans the the transseptal puncture catheter that came down this is an indentation we poke right in the center of the fossil valleys and superior uh in um so sorry and posterior so center and posterior and here is the catheter through the inter atrial septum through the catheter we park a wire as for clips in the left upper pulmonary vein and then we advance the second catheter through the inter atrial septum because for for this procedure we'll need two catheters at the same time which we can appreciate them on 3d on the right which is something that normally we don't see when we do other procedure through the septum because we only have one catheter and one wire so now we proceed with the with the lampoon the lampoon starts with the um positioning of snare system similarly to what we saw for the basilica procedure this snare system is positioned under the mitral valve and you can see here that there's one catheter that's going through the mitral valve and it's like sitting in the left ventricle and now the second the second step is the positioning of the transverse system so the transverse system uh is this catheter that needs to be positioned where we want to poke the leaflet then you can see that now the position in 3d here it's exactly where we saw before where we want to poke we're not we don't want to poke right in the middle here we want to poke more towards the um towards the lateral commissure and here you can see that also the catheter in the this mitral commissure of you is a little bit not right in the center but a bit more lateral and here you can appreciate the angle of incidence of this catheter in respect to the leaflet and we want to poke and position this catheter as close as possible to the annulus of the mitral valve once we are happy once we were happy with the positioning then we electrify the wire inside the catheter we push the wire through and now the wire is through the anterior mitral valve leaflet as we poke through the through the leaflet we got a little bit of bubbles and now the wire has to be catch caught by the loop that's underneath and here we were lucky that playing around with the with the probe we managed to get a also short axis view with the loop with the wire inside and now the loop is pulled back and the the wire is near and then now we have uh something similar to what we saw before for the aortic valve with like sort of like a v or like a flying v where we have like one catheter goes in the second catheter that goes out the wire is in the middle we're sort of ready to electrify and pull back and um we electrify we pull back and now we've lacerated the anterior mitral valve leaflet on 3d this is how it looked with our mitral insufficiency that was there and now it's there's also obviously even more mitral insufficiency given the degree of mitral insufficiency to begin with in this case this laceration didn't make a big difference um to the amodynamics of the patient so patient was stable and now we can proceed with our tendine deployment we have a wire a needle that's passed through the apex where the bursting was made the needle is directed to the um mitral valve now a wire is inserted over the wire the delivery catheter is inserted and now through the delivery catheter we need to position our valve now let's go back one step and let's look at this tendine valve so the tendine valve the top of the valve is not flat is um has a saddle shape just like the native mitral valve venues and just to remember that the tendine valve is higher anteriorly and lower posteriorly so you can see here that this portion of the valve is is higher than than the portion at the back so then as we orient these valves how do we orient it so how do we orient the highest portion do we orient it in respect to the aortic valve here or do we orient it in respect to the mitral valve venues and what we decided to do is to orient it in respect to the mitral valve venues because that's exactly that's where this valve is going to sit so regardless of the fact that the aortic valve is here at 11 o'clock then we still orient our valve so then the highest portion is like oriented towards the anterior portion of this mitral valve ring we start to deploy the valve yeah and as we release the valve you see that this is the highest portion that comes here anteriorly this is the aortic valve is still here at like sort of 11 o'clock and there's a point where the valve is the top of the valve is deployed but the bottom of the valve is not completely released and there's basically no flow through the valve and no flow through the mitral valve and you can appreciate it by the smoke that you have here in the in the left atrium and now the valve is fully deployed we have normal flow through the valve and now if we look in the long axis unfortunately the valve is stable it's now the string is pulled to the pad at the apex of the ventricle there is no a here and anterior paravalval or leak the gradient across this new valve was four millimeters of mercury and there's no LVOT acceleration so the lampoon procedure was successful there's also no turbulent flow although it's not easy to assess the turbulent flow given the shadow from the valve itself here is in 3d the valve is fully deployed sits nicely opens nicely and you can see and you can appreciate the location of this paravalval or leak which is comes exactly from where we started cutting this anterior mitral valve we tried to adjust the tension on the valve by increasing the tension on the string to see if this paravalval leak would get better but unfortunately despite our attempts the paravalval leak stayed there so we sort of accepted it as sort of not perfect but still acceptable result for this patient so basillica procedure for tavi is now becoming more and more common we do here roughly more or less one one every two weeks obviously echo then as we come back into the tavi room as well as general anesthesia because whenever we do echo we also do general anesthesia for basillica our cardiologist and we believe that echo makes a big difference it decreases the amount of radiation increases the the precision in which we we do the procedure and it also allows us to promptly detect complications and manage them then consecutively in a more prompt way we need to know the steps of these procedures and we need to follow what the cardiologists are doing on fluoroscopy we're lucky that here we have a screen just over I have a screen just over my echo machine so I can I just by moving my eyes I can see the fluoroscopy on this on the second screen so which obviously increased our communication and so and also sometimes I asked the cardiologist to to just turn on the fluoroscopy to see where my probe is in respect to the structures and respect to the devices that we're using sometimes it helps to optimize the quality of my images Lampoon is now become an option for mitral valve valve valve and more than ever is important to appreciate and understand the three-dimensional anatomy of the mitral valve and the lbot and three the echocardiography plays and makes a huge difference here in guiding our colleagues to complete a successful procedure I need to thank the interventionalists with with with whom I've been working in the past two years and who would do all of this procedure in our hybrid oar and particularly Philip Lurz and Christian Bessler and Mohammed Abdel Wahab who have been very patient especially at the beginning when I couldn't speak to German to to work with me and from whom I've really learned a lot together with Professor Ender who's my chief who's mentored me and helped me learn and be integrated in this team and to whom I owe all I know in in this new and exciting field of interoperative echocardiography here is my email you're welcome to email me anytime you're welcome to visit us anytime it's it's if you come to europe is you pass by here we're not far from berlin we are in sort of former east germany not far from the polish border we're easy to reach and next year in june i'd like to take this opportunity to personally invite you to join our team masterclass which is going to be a three-days event with online transmission of real cases from our operating room not only cardiac room but also hybrid rooms there's lots of good names that are going to come as as the speakers to our conference the conference would be both in presence so you can come to Leipzig and see our center as well as online so you can also follow us from canada once again thank you for the invitation thank you for having me and i hope we will have the opportunity to meet in person so bye


One reason is that digital research is important to secure a successful green transition of society. Research in artificial intelligence, machine learning, digital twin technologies and knowledge representation are generally important, but particularly important in future energy systems for restoring nature and when developing digital solutions for everyone, everywhere. The most important research topics in AI are to make the algorithms both knowledge driven and energy efficient. Well, Europe should really invest in digital technology and AI topics because we see that developments in digital technology and also our transforming society. If we look over the past 20 years, we see that our daily lives have changed tremendously due to all these new techniques. And right now we are not in control of that or only partially in control of that. It's the big American and Japanese and Chinese companies who determine our lives. And I think that the European Union should ensure that we are in charge again of our own lives when it comes to digital technology. And one of the things that I think we should focus on and not just being reactive in trying to say, well, how can we find new applications of this technology, but also think ahead, like where are we in 10 years? What are the future developments in AI? Because I think that is the power of fundamental research that we can look forward, look into the future. What are the needs in 10 years and not just the needs of tomorrow because I think that is where research is powerful in and I think that is what we should aim for. Well, of course, in this period, I mean, AI is really pervasive. So it appears in every aspect of our life, in our lower market in health, in public services, so basically whatever. And the important thing is that this technology can be made human centric. And for doing that, the commission is also pursuing this aspect in destination 6 of cluster 4, where really the human part is central to the technology, instead of being the other way around. So the human that is just using the technology, so it's the technology that shapes on the human part. The ethical guidelines for trustworthy AI are a very important cornerstone for this human centric aspect of the technology. But now, starting from the very high level principles, we need really to ground them and to make them practical, meaning what all these dimensions imply in practical terms when we develop an AI system.