Planeamiento estratégico de la provincia de Alto Amazonas

La provincia de Alto Amazonas se encuentra en la región Loreto, en el norte del Perú. Se encuentra ubicada al Sur Oeste del departamento de Loreto, en las cuencas de los ríos Marañón, Huallaga, Nucuray y Paranapura, en un rango altitudinal entre 800 msnm en el occidente, en las montañas subandinas y 120 msnm en el llano aluvial. La provincia está conformada por seis distritos, los cuales son: (a) Yurimaguas, (b) Balsapuerto, (c) Jeberos, (d) Laguna, (e) Santa Cruz y (f) Teniente César López Rojas, siendo Yurimaguas la capital de la provincia, clave para el desarrollo de la misma, del departamento y de la región. En relación con el tema económico, la provincia de Alto Amazonas cuenta con una Población Económicamente Activa (PEA) de 33,372 habitantes y se desarrollan principalmente actividades primarias o extractivas como la agrícola, pecuaria, de caza y silvicultura, pesca y extracción de canteras, que sumado hace un total de 52.76% de la PEA. La segunda actividad de importancia en la provincia es la terciaria con un total de 40.24%, donde destaca el comercio con 11.73%, y, finalmente, con solo el 7% la actividad secundaria o industrial. El planeamiento estratégico desarrollado para la provincia de Alto Amazonas, en la región de Loreto, ha sido proyectado al 2030 y tiene como objetivo establecer las estrategias, basadas en el análisis del entorno interno de la provincia, y políticas que permitirán el crecimiento económico y social de Alto Amazonas. Actualmente su población se dedica al comercio y la producción agrícola, siendo sus principales productos: el camu camu, el cacao y la palma aceitera. La visión, misión y valores han sido definidos a partir de la estructura social de la provincia, la cual busca convertirse en una de las más competitivas del país a partir de su crecimiento económico, mediante el aprovechamiento de sus recursos, la explotación de su potencial comercial interoceánico, la expansión de su turismo, el desarrollo agropecuario y la mejora de la calidad de vida de su población. Para lograrlo se han formulado los siguientes objetivos de largo plazo: (a) incrementar el PBI del sector comercio en productos y servicios finales, a través del desarrollo del comercio interoceánico; (b) desarrollar el sector agropecuario, mediante la ejecución de políticas que fomenten la productividad y el intercambio comercial; (c) lograr la interconectividad de todos los distritos de Alto Amazonas en un 100%; (d) incrementar la esperanza de vida en la población a través de la reducción de la desnutrición crónica y la mejora de los servicios de salud; (e) disminuir la tasa estimada de analfabetismo de la población e (f) incrementar el número de turistas que visitan la provincia. Todo ello con el propósito de garantizar un desarrollo sostenible en el tiempo, en beneficio de los pobladores de la provincia, y alcanzar un nivel competitivo que contribuirá al desarrollo de la provincia, región y del paísThe province of Alto Amazonas is located in the Loreto region, in northern Peru. It is located to the South West of the department of Loreto, in the basins of the Marañón, Huallaga, Nucuray and Paranapura rivers, in an altitudinal range between 800 masl in the west, in the sub-Andean mountains and 120 masl in the alluvial plain. The province is made up of six districts, which are: (a) Yurimaguas, (b) Balsapuerto, (c) Jeberos, (d) Laguna, (e) Santa Cruz and (f) Lieutenant César López Rojas, being Yurimaguas the capital of the province, key to the development of the same, the department and the region. In relation to the economic issue, the province of Alto Amazonas has an Economically Active Population (EAP) of 33,372 inhabitants and mainly primary or extractive activities are developed, such as agriculture, livestock, hunting and forestry, fishing and quarrying, which added a total of 52.76% of the PEA. The second activity of importance in the province is tertiary with a total of 40.24%, where trade stands out with 11.73%, and, finally, with only 7% secondary or industrial activity. The strategic plan developed for the province of Alto Amazonas, in the Loreto region, has been projected to the year 2030, and aims to establish strategies, based on the analysis of the province's internal environment, and policies will allow economic and social growth of Alto Amazonas. Currently, its population is dedicated to the commerce and the agricultural production, being its main products: the camu camu, the cacao and the oil palm. Vision, mission and values have been defined from the social structure of the province, which seeks to become one of the most competitive in the country from its economic growth, through the use of its resources, the exploitation of its interoceanic commercial potential, the expansion of its tourism, agricultural development and the improvement of the quality of life of its population. To achieve this, the following longterm objectives have been formulated: (a) increase the PIB of the trade sector in final products and services, through the development of interoceanic trade; (b) develop the agricultural sector through the implementation of policies that promote productivity and commercial exchange; (c) achieve the interconnectivity of all the districts of Alto Amazonas by 100%; (d) increase the life expectancy in the population through the reduction of chronic malnutrition and the improvement of health services; (e) decrease the estimated illiteracy rate of the population and (f) increase the number of tourists visiting the province. All this with the purpose of guaranteeing a sustainable development over time, for the benefit of the inhabitants of the province, and reaching a competitive level that will contribute to the development of the province, region and countryTesi

Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: A multi-center randomized clinical trial

Introduction: Because of ongoing controversy, renal and vital outcomes are compared between systemically administered unfractionated heparin and regional anticoagulation with citrate-buffered replacement solution in predilution mode, during continuous venovenous hemofiltration (CVVH) in critically ill patients with acute kidney injury (AKI).Methods: In this multi-center randomized controlled trial, patients admitted to the intensive care unit requiring CVVH and meeting inclusion criteria, were randomly assigned to citrate or heparin. Primary endpoints were mortality and renal outcome in intention-to-treat analysis. Secondary endpoints were safety and efficacy. Safety was defined as absence of any adverse event necessitating discontinuation of the assigned anticoagulant. For efficacy, among other parameters, survival times of the first hemofilter were studied.Results: Of the 139 patients enrolled, 66 were randomized to citrate and 73 to heparin. Mortality rates at 28 and 90 days did not differ between groups: 22/66 (33%) of citrate-treated patients died versus 25/72 (35%) of heparin-treated patients at 28 days, and 27/65 (42%) of citrate-treated patients died versus 29/69 (42%) of heparin-treated patients at 90 days (P = 1.00 for both). Renal outcome, i.e. independency of renal replacement therapy 28 days after initiation of CVVH in surviving patients, did not differ between groups: 29/43 (67%) in the citrate-treated patients versus 33/47 (70%) in heparin-treated patients (P = 0.82). Heparin was discontinued in 24/73 (33%) of patients whereas citrate was discontinued in 5/66 (8%) of patients (P < 0.001). Filter survival times were superior for citrate (median 46 versus 32 hour

Optimized Acute Treatment of Migraine Is Associated With Greater Productivity in People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.

OBJECTIVE: This study aimed to ascertain whether level of optimization of acute treatment of migraine is related to work productivity across the spectrum of migraine. METHODS: Data were from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, an internet-based longitudinal survey. Respondents with migraine who reported full-time employment and use of ≥1 acute prescription medication for migraine were included. We determined relationships among lost productive time (LPT; measured with the Migraine Disability Assessment Scale), acute treatment optimization (Migraine Treatment Optimization Questionnaire- ), and monthly headache days (MHDs). RESULTS: There was a direct relationship between LPT and MHD category. Greater acute treatment optimization was associated with lower total LPT, less absenteeism, and less presenteeism within each MHD category. CONCLUSIONS: Optimizing acute treatment for migraine may reduce LPT in people with migraine and reduce indirect costs

Fluid balance-adjusted creatinine at initiation of continuous venovenous hemofiltration and mortality. A post-hoc analysis of a multicenter randomized controlled trial.

Introduction Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality. The creatinine-based stage of AKI is considered when deciding to start or delay RRT. However, creatinine is not only determined by renal function (excretion), but also by dilution (fluid balance) and creatinine generation (muscle mass). The aim of this study was to explore whether fluid balance-adjusted creatinine at initiation of RRT is rel

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations