Hybrid management of aortic arch trauma

El trauma aórtico es la segunda causa de muerte por trauma cerrado. Presentamos un paciente al que se le realizó un abordaje híbrido dadas las características, la localización y las particularidades anatómicas de la lesión, con excelentes resultados. Se trata de un paciente de 31 años que ingresó remitido con un cuadro de 15 días de evolución de un trauma contundente por caída de parapente (desde 15 metros de altura). En la atención inicial se evidenció fractura abierta del miembro inferior izquierdo manejada con tutor externo, hemotórax y neumotórax bilateral, manejados con toracostomía cerrada. Se tomaron imágenes según los protocolos de trauma que evidenciaron lesión aórtica de grado III. Se decidió reparación híbrida: debranching desde la aorta ascendente hacia el tronco braquiocefálico y la arteria carótida común izquierda, con posterior reparación endovascular con endoprótesis aórtica para cobertura desde la zona cero a la zona cuatro de Ishimaru con sistema endovascular Zenith Cook dissection (Cook Medical Inc., Bloomington, Indiana, Estados Unidos). La evolución posterior fue satisfactoria y sin complicaciones.Q4Q4Pacientes con trauma del arco aórticoAortic trauma is the second cause of death due to blund trauma. We present a patient who underwent a hybrid approach given the characteristics, location, and anatomical characteristics of the lesion, with excellent results. A 31-year-old male patient was admitted with a 15-day of blunt trauma due to a fall from a paraglider (15 meters). Initial care revealed an open fracture of the left lower limb managed with an external tutor, hemothorax and bilateral pneumothorax, managed with a closed thoracostomy. Images were taken according to trauma protocols, showing grade III aortic injury. Hybrid repair was decided, debranching from the ascending aorta towards the brachiocephalic trunk and the left common carotid artery, with subsequent endovascular repair aortic endoprosthesis for coverage from zone zero to zone four of Ishimaru with Zenith Cook dissection endovascular system (cook Medical INC., Bloomington, In, USA), uncomplicated procedures.https://orcid.org/0000-0001-5550-9144Revista Internacional - IndexadaCN

Plan de Responsabilidad Social Empresarial Empresa Estilo Ingeniería S.A.

El presente documento, consiste en la investigación, descripción y análisis de las condiciones, normas, principios, factores y grupos de interés a los que le apunta una empresa colombiana del sector de la construcción y la movilidad vertical para la ejecución de un Plan de Responsabilidad Social Empresarial en el cual pueda enfocar sus valores corporativos en su cadena de valor para atender los requerimientos de aquellas agrupaciones las cuales hacen parte fundamental en la definición de soluciones de la empresa a nivel corporativo y social para cumplir con sus objetivos organizacionales enfocados a la construcción de programas que beneficien a la organización y sus diferentes stakeholders. La investigación se basó en analizar tanto interna como externamente los factores principales que aportan a un proyecto de RSE, a través de la metodología de estudio de caso, en donde se evaluaron diferentes temas de la organización como código de conducta, RSE vs Marketing, evaluación y clasificación de stakeholders y elaboración y definición de indicadores y modelos de gestión de RSE, lo anterior enfocado en la información recolectada por medio de fuentes internas a la organización y externas. La anterior investigación permite de manera fácil, la evaluación y comprensión de la importancia de un programa de RSE, para ayudar a la organización a un crecimiento más sostenible y amigable con sus grupos de interés y a un reconocimiento más ameno en el mercado en el que se encuentra, además de los beneficios económicos que puede obtener mediante la implementación de programas sociales y ambientales.This document consists of the investigation, description and analysis of the conditions, norms, principles, factors and interest groups to which a Colombia company in the construction and vertical mobility sector points for the implementation of a responsibility plan corporate social in which you can focus your corporate values in your value chain to meet the requirements of those groups which are a fundamental part in the decision making of the company at the corporate and social level to meet its organizational objectives focused on construction of programs that benefit the organization and its different stakeholders. The research was based on analyzing both internally and externally the main factors which contribute to a corporate social responsibility plan, through the case study methodology, where different topics of the organization were evaluated as a code of conduct, CSR vs. Marketing, evaluation and classification of stakeholders and development and definition of indicators and models of CSR management, the above focused on the information collected through internal sources to the organization and external. The previous research allows in an easy way, the evaluation and understanding of the importance of CSR, to help the organization to a more sustainable and friendly growth with its stakeholders and to a more pleasant recognition in the market in which it is located, In addition to the economic benefits that can be obtained through the implementation of social and environmental programs

Propuesta Plan de Responsabilidad Social Empresarial para la Compañía Alimentos Comapan S.A.

Enlace E-Book Código de ética, Formato de diagnóstico para la Empresa Comapan.Las empresas enfrentan cambios en su funcionamiento y prioridades debido a la exigencia cada vez más alta por parte de los grupos de interés que intervienen en el proceso, es por ello por lo que por medio de la implementación un Plan de Responsabilidad Social Empresarial para una compañía como COMAPAN se busca integrar las acciones que se realizan dentro de la empresa con las necesidades ambientales y sociales de sus grupos de interés, esto combinado con las estrategias comerciales de la misma.The companies change in their operation and the needs due to the increasingly high demand on the part of the interest groups that intervene in the process, that is why through the implementation of a Corporate Social Responsibility Plan for a company like COMAPAN seeks to integrate the actions carried out within the company with the environmental and social needs of its stakeholders, this is combined with its commercial strategies

The highly surprising behaviour of diphosphine ligands in iron-catalysed Negishi cross-coupling

Iron-catalysed cross-coupling is undergoing explosive development, but mechanistic understanding lags far behind synthetic methodology. Here, we find that the activity of iron–diphosphine pre-catalysts in the Negishi coupling of benzyl halides is strongly dependent on the diphosphine, but the ligand does not appear to be coordinated to the iron during turnover. This was determined using time-resolved in operando X-ray absorption fine structure spectroscopy employing a custom-made flow cell and confirmed by 31P NMR spectroscopy. While the diphosphine ligands tested are all able to coordinate to iron(II), in the presence of excess zinc(II)—as in the catalytic reaction—they coordinate predominantly to the zinc. Furthermore, combined synthetic and kinetic investigations implicate the formation of a putative mixed Fe–Zn(dpbz) species before the rate-limiting step of catalysis. These unexpected findings may not only impact the field of iron-catalysed Negishi cross-coupling, but potentially beyond to reactions catalysed by other transition metal/diphosphine complexes

Naturaleza y cultura en Ámerica Latina

La concreción del XVIII Foro de Estudiantes Latinoamericanos de Antrología y Arqueología: Cultura y naturaleza en América Latina: escenarios para un modelo de desarrollo no civilizatorio, efectuado en Quito desde el 17 al 23 de julio del 2011, se constituyó en un acontecimiento sumamente significativo para la antropología latinoamericana debido a dos motivos. Primero porque coincidió con la emergencia del movimiento universitario estudiantil latinoamericano que expresaba sus tendencias, propuestas y exigencias de cambios tanto de las prácticas académicas como de los patrones civilizatorios que rigen las relaciones actuales. Segundo, porque se inscribía en un contexto de consolidación de las nuevas democracias de los países andinos, de carácter antineoliberal y basadas en los sujetos de derecho entre los cuales se incluye la naturaleza. Estos contextos determinaron que el Foro no ponga en escena certidumbres teóricas o metodológicas, ni se preste al exhibicionismo estéril de los avances disciplinares. Más bien, la convocatoria de la antropología y la arqueología fue apenas un pretexto para hablar, con su lenguaje, de nosotros mismos, de lo que somos, de lo que pensamos, de lo que aspiramos y sentimos sobre nuestra Latinoamérica. Lo que hemos visto, oído y compartido, en realidad, no han sido solamente ideas o conceptos sino opciones y toma de posiciones respecto a múltiples encrucijadas. Posición ante situaciones que amenazan la vida, la justicia y los derechos de todos, un desafío epistemológico todavía en ciernes y que no termina de cuajar aún en nuestras prácticas académicas

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals