Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion

The absence of an adequate ileo-femoral access is usually considered an absolute contraindication to fenestrated and branched aortic repairs. Alternative routes and dedicated stent-graft designs have been advocated. Hereby, we describe the case of a 73-year-old man with a recurrent type IV thoracoabdominal aortic aneurysm and complete thrombotic pararenal aortic occlusion treated successfully with a tri-branch custom-made endograft deployed via a transaxillary access

\u3ci\u3eLeadership in Middle-Earth: Theories and Applications for Organizations - Exploring Effective Leadership Practices Through Popular Culture\u3c/i\u3e by Michael J. Urick

A review of Urick\u27s Leadership in Middle-Earth which considers both the appeal and limitations of utilising examples of leadership from Tolkien\u27s legendarium to illustrate academic theory

La comunicación organizada en la empresa y la reproducción de las estructuras de dominación

A través de nuestro trabajo y aplicando un análisis sistémico y el modelo de la mediación social, creemos haber confirmado fehacientemente nuestra hipótesis: la “comunicación organizada” reproduce las estructuras de dominación del sistema social y hemos podido establecer y corroborar el esquema que refleja el modelo que convierte a la empresa en emisora y receptora de sus propias comunicaciones y que supone a la fuerza de trabajo como canal. Al abordar el estudio y análisis de las prácticas sociales a través de la Teoría de la Comunicación hemos superado el divorcio existente entre trabajo teórico y trabajo metodológico en las prácticas sociales concretas.Through our work and by applying a systemic analysis and the social mediation model, we consider to have reliably confirmed our hypothesis: “organized communication” reproduces the domination structures of the social system. We have been able to establish and corroborate as well the diagram that reflects the model that makes the enterprise be both the source and receptor of their own communications, and also, that the work force is the channel. When going over the study and analysis of the social practices based on the Communication Theory, we have overcome the divorce between the theoretical and methodological work in specific social practices

Hemodynamic analysis based on biofluid models and MRI velocity measurements

Tesis para optar al grado de Doctor en Ciencias de la Ingeniería, Mención Fluidodinámica en cotutela con la Universidad de GroningenFor the diagnosis, treatment planning and post-surgical monitoring of cardiovascular disease (CVD), hemodynamic markers have proven to be of great utility. However, non-invasive assessment of the hemodynamics of a patient is still a challenge. Phase-contrast magnetic resonance imaging (PC-MRI) can measure the distribution of blood velocity along two-dimensional planes or in three-dimensional volumes and is limited in accuracy mainly by the image resolution and noise. The local variation in the blood pressure cannot be measured non-invasively, but is required in the clinical practice to evaluate CVD. Other hemodynamic quantities, such as the arterial wall stiffness or wall shear stress can also be relevant as diagnostic quantities and for understanding the onset of CVD, but are not observable with imaging techniques. This thesis approaches the topic of patient-specific hemodynamics on three different paths. In Chapter 2 of this thesis a method was presented to improve the accuracy of hemodynamic data recovery from partial 2D PC-MRI measurements by means of solving an inverse problem of the Navier–Stokes equations of fluid flow. Vessel geometries extracted from MRI or CT images are affected by errors due to noise, artifacts and limited image resolution. Small errors in the geometry propagate into the recovered data and lead to large errors in the solution when standard no-slip boundary conditions are used on inaccurately positioned walls. The core idea of this work was replacing no-slip boundary conditions at the arterial walls by slip/transpiration conditions with parameters which were estimated from velocity measurements. Numerical results of synthetic test cases showed an important improvement in accuracy of the estimated pressure differences and the reconstructed velocity fields. In Chapter 3 a comparison study of different direct pressure gradient estimation techniques was presented. These methods compute relative pressure fields directly from 3D PC-MRI data. The new Stokes estimation method (STE) by Švihlová et al. [Švi+16] was applied for the first time to real phantom and patient data. In comparison to the classical Poisson pressure estimation method (PPE), the STE method proved more accurate and more robust to noise and the image segmentation in most cases. Chapter 4 was dedicated to a numerical validation of the new MAPDD model [Ber+19] for a domain decomposition reduction of vascular networks. This approach considers the vessels as a network of thin pipes in which the flow has the shape of a Womersley flow, connected by arbitrary 3D junction domains where the flow is governed by the Navier–Stokes equations. In the MAPDD model, the thin pipes are replaced by coupling conditions on the junction domains. A strategy to easily implement the MAPDD model with the finite element method was presented and the theoretical results of Bertoglio et al. [Ber+19] were reproduced with numerical simulations in a simple test case. The method was shown to deliver accurate results even for moderately large Reynolds numbers, far from the regime where the theory is valid.Los indicadores hemodinámicos han demostrado gran utilidad para el diagnóstico, planificación y monitoreo post-operatorio de enfermedades cardiovasculares (CVD). Sin embargo, la evaluación hemodinámica en pacientes continúa siendo un desafío. La Resonancia Magnética de Contraste de Fase (PC-MRI) es capaz de medir la distribución de la velocidad sanguínea en planos 2D o volúmenes 3D, siendo mayormente limitada por la resolución de la imágen y el ruido. Por otro lado, las variaciónes locales en la presión sanguínea sólo pueden ser medidas invasivamente, siendo usualmente requeridas en clínica para la evaluación de las CVD. Otras cantidades hemodinámicas, tales como la rigidez arterial, pueden ser también relevantes para el diagnóstico y entendimiento del origen de las CVD, pero lamentablemente estas no son observables en las imágenes. Esta tesis aborda el tema de la hemodinámica en pacientes desde tres diferentes perspectivas. En el Capítulo 2, se presenta un método para mejorar la precisión en la reconstrucción de datos hemodinámicos, usando medidas 2D en PC-MRI. A partir de las ecuaciones de Navier-Stokes para un fluido, se plantea y resuelve un problema inverso. Además, las geometrías arteriales extraídas de imágenes MRI o CT, suelen ser afectadas por errores debidos al ruido, artefactos o propios de la limitación en la resolución espacial. Pequeños errores en la geometría son propagados en la reconstrucción, pudiendo generar mayores desviaciones en la solución, por ejemplo cuando condiciones de borde tipo no-slip son usadas en paredes mal mente posicionadas. La idea central de este trabajo es relajar las condiciones no-slip en las paredes por unas slip/transpiration, con parámetros a estimar de medidas de velocidad. Los resultados numéricos en casos sintéticos muestran mejoras en el cálculo de diferencias de presión y campo de velocidades. En el Capítulo 3 se presenta una comparación entre diferentes técnicas de estimación de presión. Estos métodos reconstruyen campos de presión directamente de medidas 3D en PC-MRI. Por primera vez el reciente estimador de Stokes (STE) Švihlová y col. [Švi+16] es aplicado en medidas a fantomas y pacientes. A diferencia del clásico estimador de Poisson (PPE), este estimador muestra, en la mayoría de los casos, menos error en la reconstrucción y ser más robusto al ruido y a la segmentación. El Capítulo 4 es dedicado a la validación numérica del nuevo modelo MAPDD Bertoglio y col. [Ber+19], para una descomposición reducida de redes vasculares. Este enfoque considera las venas como una red de delgadas tuberías, en donde el flujo tiene la forma de un flujo de Womersley, conectado por un dominio arbitrario 3D de uniones, en donde el flujo es gobernado por las ecuaciones de Navier-Stokes. En este modelo, las tuberías delgadas son reemplazadas acoplando distintas condiciones en el dominio de uniones. Aquí, se presenta una estrategia fácilmente de implementar usando elementos finitos. Se reproducen los resultados teóricos de Bertoglio y col. [Ber+19] además de simulaciones numéricas en un caso de prueba simple. El método muestra entregar buenos resultados incluso para números de Reynolds ligeramente grandes, excediendo los límites donde es válida la teória

Digital editions and the creative work of the performer

One of the aims of this article is to clarify and align more closely the respective priorities of researchers and practical musicians in using music notation. To that end, the first part surveys existing digital editions of music both in general and from the standpoints of different types of performer. Consideration is then given to a new ‘digital edition concept’ which might achieve more creative engagement with music on the parts of instrumentalists and singers alike. Two ostensibly conventional editions of nineteenth-century music serve as the basis of case studies that show how the notorious limitations of the printed page might be transcended more effectively and propitiously. The conclusion is that digital editions of music (DEMs) are unlikely to replace printed editions and that wholesale replacement should not be the goal in any case. Instead, in developing future DEMs for performers, the aim should be to take fuller advantage of the affordances of the digital medium so that musicians can engage with and make music all the more creatively. Only by moving conceptually beyond the stasis of ‘the material medium’ and harnessing the dynamic flux of the digital medium can the dynamic flux inherent in music itself best be captured. At the same time, it is important to recognize and respect musicians’ need for a fixed version of the score on given performance occasions, even if it is bound to be superseded thereafter.N/

Hybrid RANS/LES of plane impinging jets on a flat plate at small nozzle-plate distances

A k-ω based hybrid RANS/LES (Reynolds Averaged Navier Stokes/Large Eddy Simulation) model is tested for simulation of plane impinging jets at various nozzle-plate distances (H/B, where H is the distance and B is the slot width) and various Reynolds numbers (based on the slot width and the velocity in the symmetry plane). The studied combinations are H/B=2 for Re=10000, H/B=4 for Re=18000 and H/B=9.2 for Re=20000. The focus is on small distance of the nozzle exit to the plate. This means for impact of the jet onto the plate before complete mixing of the shear layers. The centre of the impact zone is then in laminar state and the developing boundary layer on the plate undergoes transition to turbulent state. The transitional flow cannot be correctly simulated with a RANS turbulence model, but we will demonstrate that a hybrid model is basically correct

Hybrid RANS/LES of plane jets impinging on a flat plate at small nozzle-plate distances

A k-omega BASED HYBRID RANS/LES (Reynolds-averaged Navier-Stokes/large eddy simulation) model is tested for simulation of plane impinging jets at various nozzle-plate distances (H/B), where H is the distance and B is the slot's width) and various Reynolds numbers (based on the slot's width and the velocity in the symmetry plane). The studied combinations are H/B = 2 for Re = 10000, H/B = 4 for Re = 18 000 and H/B = 9.2 for Re = 20000. The focus is on small distance of the nozzle exit to the plate. In LES mode, the hybrid RANS/LES model uses two definitions of the local grid size, one based on the maximum distance between the cell faces in the destruction term of the turbulent kinetic energy equation and one based on the cube root of the cell volume in the eddy-viscosity formula. This allows accounting for flow inhomogeneity on anisotropic grids. In RANS mode, the hybrid model turns into the newest version of the k-omega model by Wilcox

Calcium-phosphate glass-based bioresorbable fibre optics for light and drug delivery

Calcium-phosphate glasses (CPGs) are commonly used as scaffolds in tissue engineering. A novel formulation of optically transparent CPG has been recently developed to be used as an optical fibre for biomedical implantable devices. Its purpose is to combine the bioresorbability of CPGs with optical features, thus extending the applications of bioresorbable sensors for in-body monitoring or diagnostics. Modifications of the glass composition or post-treatments on the fibres can tailor the dissolution time and the interaction of the glass with different stimuli as well as with specific cells. The tested glasses both in bulk and fibre shapes showed good strength (from 200 to 350 MPa) with values that are lower than standard silica glass and much higher than common bioresorbable polymers. CPG fibres were also implanted in living rats for several weeks and no clinical signs of any adverse effect have been found. We will present our latest results on these subjects starting from the characterisation of the CPGs by means of dissolution tests, in-vitro, and ex-vivo experiments

Children's health care assistance according to their families: a comparison between models of Primary Care

OBJETIVO Comparar o modelo assistencial de Unidades Básicas Tradicionais (UBS) com as unidades Estratégia Saúde da Família (ESF) quanto à presença e extensão dos atributos da Atenção Primária de Saúde (APS), no atendimento de crianças. MÉTODO Estudo transversal, com abordagem quantitativa, com familiares de crianças atendidas no Serviço Público de Saúde de Colombo, Paraná. O Primary Care Assessment Tool (PCA-Tool) foi aplicado aos responsáveis de 482 crianças, 235 de unidades ESF e 247 de UBS, abrangendo todas as unidades de atenção primária do município, entre junho e julho de 2012. Os resultados foram analisados segundo o manual do PCA-Tool. RESULTADOS As unidades com ESF alcançaram escore geral limítrofe para APS. Porém, tiveram melhores resultados nos atributos Afiliação, Coordenação da integração dos cuidados, Integralidade, Orientação Familiar e Acessibilidade quanto à utilização, enquanto os atributos Orientação Comunitária, Coordenação dos sistemas de informações, Longitudinalidade e Acesso foram classificados como insuficientes para a APS. As UBS tiveram escores baixos em todos os atributos. CONCLUSÃO As unidades com ESF estão mais próximas dos princípios da APS, mas há necessidade de rever ações de assistência à criança, visando aos atributos da APS, em ambos os modelos de atenção, corroborando com estudos semelhantes em outras regiões do Brasil.OBJETIVO Comparar el modelo asistencial de Unidades Básicas Tradicionales (UBS) con las unidades Estrategia Salud de la Familia (ESF) en cuanto a la presencia y extensión de los atributos de la Atención Primaria de Salud (APS), en la atención a los niños. MÉTODO Estudio transversal, con abordaje cuantitativo, con familiares de niños atendidos en el Servicio Público de Salud de Colombo, Paraná. El Primary Care Assessment Tool (PCA-Tool) fue aplicado a los responsables de 482 niños, 235 de unidades ESF y 247 de UBS, abarcando todas las unidades de atención primaria del municipio, entre junio y julio de 2012. Los resultados fueron analizados según el manual del PCA-Tool. RESULTADOS Las unidades con ESF alcanzaron un puntaje general limítrofe para APS. Sin embargo, tuvieron mejores resultados en los atributos Afiliación, Coordinación de la integración de los cuidados, Integralidad, Orientación Familiar y Accesibilidad en cuanto a la utilización, mientras que los atributos Orientación Comunitaria, Coordinación de los sistemas de informaciones, Longitudinalidad y Acceso fueron clasificados como insuficientes para la APS. Las UBS tuvieron puntajes bajos en todos los atributos. CONCLUSIÓN Las unidades con ESF se acercan más a los principios de la APS, pero existe la necesidad de rever acciones de asistencia al niño, con vistas a los atributos de la APS, en ambos modelos de atención, corroborando con estudios semejantes en otras regiones de Brasil.OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS) with the Family Health Strategy (ESF) units for presence and extent of attributes of Primary Health Care (APS), specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool) was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care), but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil

Análisis de la administración de las pequeñas y medianas empresas del sector marroquinero en Colombia: una mirada desde los cambios constantes de la economía global

Trabajo de investigaciónCon la apertura de mercados en los diferentes países se crea una entrada de productos mucho más económicos que los producidos en las regiones donde entra estos nuevos artículos o materias primas, esto conlleva que las empresas idean formas de producción más económicas arriesgando la calidad de los productos o entre en un estado de banca rotaINTRODUCCION 1.GENERALIDADES 2.RESULTADOS Y ANALISIS DE RESULTADOS 3.CONCLUSIONES 4.RECOMERNDACIONES BIBLIOGRAFIA ANEXOSPregradoIngeniero Industria