Le imprese sociali sono caratterizzate dall'essere organizzazioni ibride, a causa delle due richieste concorrenti esistenti allo stesso tempo. Quelle richieste in competizione sono le richieste sociali e finanziarie. Le organizzazioni con richieste in competizione sperimentano una nuova serie di sfide diverse da quelle affrontate dalle organizzazioni tradizionali. Queste sfide non sono cosi chiare come appaiono nella pratica. Tuttavia, e stato sottolineato in letteratura che le nuove sfide richiederebbero un diverso insieme di competenze da abbracciare e gestire bene. La letteratura ha anche proposto due diversi modi per sviluppare quelle capacita manageriali per le organizzazioni ibride come le imprese sociali. Il primo modo e attraverso l'educazione all'imprenditorialita sociale presso la direzione e le scuole di business al fine di preparare i futuri manager a lavorare in imprese sociali ibride. Il secondo modo e quello di formare gruppi eterogenei in organizzazioni ibride sociali che idealmente funzionerebbero meglio di gruppi omogenei in tali organizzazioni.
Questa tesi mira a far progredire la nostra comprensione delle sfide specifiche che affrontano organizzazioni ibride sociali e il capitale umano in tali organizzazioni. Per fare cio, la tesi dapprima studia le sfide specifiche, come appaiono nella pratica presso le organizzazioni ibride sociali e quali abilita devono essere associate a tali sfide. In secondo luogo, valuta l'educazione all'imprenditorialita sociale per verificare se fornisce l'istruzione e la formazione necessarie per sviluppare le competenze richieste nelle organizzazioni ibride sociali. In terzo luogo, studia se un team eterogeneo avrebbe un impatto migliore sulle prestazioni dell'organizzazione rispetto a un team omogeneo.
Per raggiungere gli obiettivi di cui sopra, sono state condotte interviste, sondaggi e ricerche basate sul web.
Questa tesi contribuisce all'imprenditoria sociale, alle organizzazioni ibride e alle letterature sul capitale umano. Fornisce anche una serie di implicazioni gestionali che sono di beneficio per educatori, responsabili delle politiche e professionisti nel campo.
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Aim: To perform an update of liver resection as treatment of liver metastases of gynecological cancers, as well as an update on these metastases. Bibliographical search: PubMed Search 1990-2011 in English language. Authors reviewed only relevant articles. Results: No more than 20 relevant articles have been published on this topic, including case reports. We performed a classical review of the information published in the literature. Conclusions: Liver Metastases from Gynecological cancers, not peritoneal implants in the liver, usually appear in patients with disseminated disease, so it is uncommon to perform a liver resection. In some patients with limited extrahepatic disease or only liver disease, liver resection is a safe alternative and improves the oncological results. We try to emphasize which patients may benefit from liver resection and the importance of tailoring medical decisions.
Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. To present our experience in extrahepatic and extrapulmonary hydatidosis. Period: May 2007–December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. The mean age of the patients was 44.5 years, with a range of 33–80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography) + puncture, aspiration, injection and re-aspiration. The remaining 4 did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk. La hidatidosis es una zoonosis producida por las larvas del parásito Echinococcus, endémica en muchos países del Mediterráneo. Puede afectar a cualquier órgano. Las localizaciones más frecuentes son: el hígado (70%) y el pulmón (20%). La hidatidosis esplénica es la tercera localización más habitual. Otras localizaciones como la ósea, cutánea o renal son excepcionales. Presentar nuestra experiencia en hidatidosis extrahepática y extrapulmonar. El periodo de este estudio fue de mayo de 2007 a diciembre de 2014. En una población de 251,000 habitantes. En dicho periodo en la Unidad de Cirugía Hepatobiliopancreática fue evaluado un total de 136 pacientes con hidatidosis; 18 pacientes presentaron hidatidosis extrahepática y extrapulmonar (13%). Se revisaron retrospectivamente las historias clínicas, estudios de laboratorio (serologías) y gabinete, métodos diagnósticos y medidas terapéuticas, realizadas en todos los pacientes. Además, se realizó una ecografía y tomografía axial computada abdominal, y serología hidatídica. La edad media de los pacientes era de 44.5 años, rango: 33–80 años. La mitad de los pacientes (50%) presentaron hidatidosis hepática concomitante. De los 18 pacientes, 13 fueron intervenidos quirúrgicamente (12 con cirugía radical) y a uno se le realizó punción, aspiración, instilación y reaspiración + colangiopancreatografía retrógrada endoscópica; los 4 restantes no fueron operados por negativa del paciente (3) o neoplasia avanzada (1). No se observó ninguna recidiva. El tratamiento quirúrgico de elección es la quistectomía total cerrada, para evitar la recidiva, excepto en el bazo, que es la esplenectomía. Las técnicas conservadoras están indicadas en casos de hidatidosis múltiple y en pacientes con alto riesgo quirúrgico.
Liver hydatidosis is a zoonosis caused by Echinococcus that has worldwide distribution. There are three types of therapeutical options: surgery, medical treatment and PAIR. But surgery is the treatment that offers better long-term results. Usually surgery for liver hydatidosis is made as a scheduled procedure, but sometimes, severe symptoms provoked by liver cysts must be treated in emergency setting. We have made a review of every complication that could provoke liver hydatidosis: complications related to cysto-biliary communication, intraperitoneal rupture, vascular complications and rupture in surrounding organs. We have made a review of epidemiology, diagnosis and treatment of each complication, focusing when an emergency treatment is needed. We could conclude that only few patients require an emergency treatment due to liver hydatidosis, but morbidity and even mortality is high because diagnosis is difficult and sometimes delayed, and we have to face to severe medical situations (anaphylaxis, hypovolemic or septic shock, cholangitis, etc.).