La planificaci\uf3n tributaria en la gerencia de recaudaci\uf3n de la Alcald\ueda del Municipio Iribarren del Estado Lara

El objeto de estudio del presente trabajo, es la planificaci\uf3n Tributaria en la Gerencia de Recaudaci\uf3n de la Alcald\ueda del Municipio Iribarren del Estado Lara. La metodolog\ueda utilizada se ubica dentro de la modalidad investigaci\uf3n de campo, de acuerdo con los objetivos de car\ue1cter descriptivo porque el inter\ue9s estuvo enfocado en las propiedades del objeto. La muestra qued\uf3 constituida por 12 funcionarios adscritos al departamento de Rentas del Municipio Iribarren en la ciudad de Barquisimeto, Divisi\uf3n de Rentas del Distrito Iribarren. La informaci\uf3n se recolect\uf3 a trav\ue9s de la observaci\uf3n directa del personal y posteriormente se aplic\uf3 un cuestionario tipo encuesta conformado por diez \uedtems con una escala dicot\uf3mica, con el objetivo de diagnosticar el cumplimiento de los objetivos de Recaudaci\uf3n y Fiscalizaci\uf3n que se utilizan. Para la validez se utiliz\uf3 el juicio de expertos en el \ue1rea tributaria. Se concluy\uf3 que la Direcci\uf3n de Hacienda necesita metodolog\ueda para mejorar la formulaci\uf3n de objetivos y la fijaci\uf3n de metas que puedan contribuir a optimizar el proceso de recaudaci\uf3n y fiscalizaci\uf3n, por lo que se sugirieron objetivos, estrategias y t\ue9cnicas de fiscalizaci\uf3n para determinar la Planificaci\uf3n Tributaria en la Gerencia de Recaudaci\uf3n de la Alcald\ueda del Municipio Iribarren del Estado Lara

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Diversidad de ma\uedz en la sierra sur de Oaxaca, M\ue9xico: conocimiento y manejo tradicional

The state of Oaxaca represents an important pool of maize in Mexico. Previous studies have indicated the presence of many local varieties and agronomic races, mainly at the Northern Sierra and Central Valleys. The Southern Sierra has not been studied, in spite of the presence of indigenous Zapotec communities, which cultivate maize, among other crops, and have preserved local varieties. The present study is focused on the following questions: Which is the maize diversity, in terms of traditional varieties and agronomic races, in the Zapotec region of Los Loxicha? Does Maize diversity follow a pattern of distribution along an altitudinal interval? Which practices promote, and maintain this diversity? To answer these questions, we conducted a study within five municipalities at the Southern part of Oaxaca. During 2007, structured interviews were applied to 930 farmers in order to obtain a descriptive process of seed management. Morphological characterization of agronomic races was based on ear specimens obtained from a sample of 375 "milpas", with 20 plants per "milpa". High levels of local maize diversity were recorder, with 36 traditional varieties belonging to 10 races. Races exhibited differences in terms of phenotypic variation, and altitudinal distribution, and some could indicate local adaptation. People practice some ancestral management of ear and seed selection, thus maintaining differentiation among varieties and agronomic races. Nevertheless, sowing many local varieties in the same field, promotes gene flow and introgression among them, maintaining, and promoting phenotypic and genetic diversity.El estado de Oaxaca representa un importante acervo de maíz en México. Estudios previos han indicado la presencia de muchas variedades locales y razas agronómicas en la Sierra Norte y Valles Centrales. La Sierra Sur ha sido poco estudiada a pesar de la presencia de comunidades indígenas zapotecas, las cuales cultivan maíz, entre otras especies, y han preservado las variedades locales. El presente estudio responde a las siguientes preguntas: ¿cuál es la diversidad de maíz en términos de variedades tradicionales y razas agronómicas en la región zapoteca de Los Loxicha?, ¿la diversidad de maíz sigue un patrón de distribución a lo largo de un gradiente altitudinal?, ¿cuáles prácticas promueven y mantienen esta diversidad? Para contestar estas preguntas se realizó un estudio en cinco municipios de la Sierra Sur de Oaxaca. Durante 2007 se aplicaron entrevistas estructuradas a 930 agricultores para describir el proceso de manejo de semilla. La caracterización morfológica de las razas agronómicas se basó en muestras de mazorcas obtenidas en 375 milpas, con 20 plantas por milpa. Se encontraron altos niveles de diversidad local de maíz, con 36 variedades tradicionales correspondientes a 10 razas agronómicas. Las razas exhibieron diferencias en términos de variación fenotípica, distribución altitudinal y algunas muestran adaptación local. Los agricultores practican algunas formas de manejo ancestral para la selección de mazorcas y semillas, manteniendo, así, ciertos niveles de diferenciación entre las variedades y las razas agronómicas. Sin embargo, al sembrar diferentes variedades dentro de la misma parcela, se promueve el flujo génico y la introgresión entre ellas, manteniendo y promoviendo la diversidad fenotípica y genética

International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis

Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population

La \uabmetaf\uedsica de la experiencia interior\ubb clave teor\ue9tica de la estructura relacional de la persona.

Riflessione sull'esperienza interiore come esperienza metafisica della relazionalit\ue0 accessibile all'essere uman

The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry

Background: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479

Architecture and performance of the KM3NeT front-end firmware

The KM3NeT infrastructure consists of two deep-sea neutrino telescopes being deployed in the Mediterranean Sea. The telescopes will detect extraterrestrial and atmospheric neutrinos by means of the incident photons induced by the passage of relativistic charged particles through the seawater as a consequence of a neutrino interaction. The telescopes are configured in a three-dimensional grid of digital optical modules, each hosting 31 photomultipliers. The photomultiplier signals produced by the incident Cherenkov photons are converted into digital information consisting of the integrated pulse duration and the time at which it surpasses a chosen threshold. The digitization is done by means of time to digital converters (TDCs) embedded in the field programmable gate array of the central logic board. Subsequently, a state machine formats the acquired data for its transmission to shore. We present the architecture and performance of the front-end firmware consisting of the TDCs and the state machine

State of the climate in 2015

In 2015, the dominant greenhouse gases released into Earth\u2019s atmosphere\u2014carbon dioxide, methane, and nitrous oxide\u2014all continued to reach new high levels. At Mauna Loa, Hawaii, the annual CO2 concentration increased by a record 3.1 ppm, exceeding 400 ppm for the first time on record. The 2015 global CO2 average neared this threshold, at 399.4 ppm. Additionally, one of the strongest El Ni\uf1o events since at least 1950 developed in spring 2015 and continued to evolve through the year. The phenomenon was far reaching, impacting many regions across the globe and affecting most aspects of the climate system. Owing to the combination of El Ni\uf1o and a long-term upward trend, Earth observed record warmth for the second consecutive year, with the 2015 annual global surface temperature surpassing the previous record by more than 0.1\ub0C and exceeding the average for the mid- to late 19th century\u2014commonly considered representative of preindustrial conditions\u2014by more than 1\ub0C for the first time. Above Earth\u2019s surface, lower troposphere temperatures were near-record high. Across land surfaces, record to near-record warmth was reported across every inhabited continent. Twelve countries, including Russia and China, reported record high annual temperatures. In June, one of the most severe heat waves since 1980 affected Karachi, Pakistan, claiming over 1000 lives. On 27 October, Vredendal, South Africa, reached 48.4\ub0C, a new global high temperature record for this month. In the Arctic, the 2015 land surface temperature was 1.2\ub0C above the 1981\u20132010 average, tying 2007 and 2011 for the highest annual temperature and representing a 2.8\ub0C increase since the record began in 1900. Increasing temperatures have led to decreasing Arctic sea ice extent and thickness. On 25 February 2015, the lowest maximum sea ice extent in the 37-year satellite record was observed, 7% below the 1981\u20132010 average. Mean sea surface temperatures across the Arctic Ocean during August in ice-free regions, representative of Arctic Ocean summer anomalies, ranged from ~0\ub0C to 8\ub0C above average. As a consequence of sea ice retreat and warming oceans, vast walrus herds in the Pacific Arctic are hauling out on land rather than on sea ice, raising concern about the energetics of females and young animals. Increasing temperatures in the Barents Sea are linked to a community-wide shift in fish populations: boreal communities are now farther north, and long-standing Arctic species have been almost pushed out of the area. Above average sea surface temperatures are not confined to the Arctic. Sea surface temperature for 2015 was record high at the global scale; however, the North Atlantic southeast of Greenland remained colder than average and colder than 2014. Global annual ocean heat content and mean sea level also reached new record highs. The Greenland Ice Sheet, with the capacity to contribute ~7 m to sea level rise, experienced melting over more than 50% of its surface for the first time since the record melt of 2012. Other aspects of the cryosphere were remarkable. Alpine glacier retreat continued, and preliminary data indicate that 2015 is the 36th consecutive year of negative annual mass balance. Across the Northern Hemisphere, late-spring snow cover extent continued its trend of decline, with June the second lowest in the 49-year satellite record. Below the surface, record high temperatures at 20-m depth were measured at all permafrost observatories on the North Slope of Alaska, increasing by up to 0.66\ub0C decade\u20131 since 2000. In the Antarctic, surface pressure and temperatures were lower than the 1981\u20132010 average for most of the year, consistent with the primarily positive southern annular mode, which saw a record high index value of +4.92 in February. Antarctic sea ice extent and area had large intra-annual variability, with a shift from record high levels in May to record low levels in August. Springtime ozone depletion resulted in one of the largest and most persistent Antarctic ozone holes observed since the 1990s. Closer to the equator, 101 named tropical storms were observed in 2015, well above the 1981\u20132010 average of 82. The eastern/central Pacific had 26 named storms, the most since 1992. The western north Pacific and north and south Indian Ocean basins also saw high activity. Globally, eight tropical cyclones reached the Saffir\u2013Simpson Category 5 intensity level. Overlaying a general increase in the hydrologic cycle, the strong El Ni\uf1o enhanced precipitation variability around the world. An above-normal rainy season led to major floods in Paraguay, Bolivia, and southern Brazil. In May, the United States recorded its all-time wettest month in its 121-year national record. Denmark and Norway reported their second and third wettest year on record, respectively, but globally soil moisture was below average, terrestrial groundwater storage was the lowest in the 14-year record, and areas in \u201csevere\u201d drought rose from 8% in 2014 to 14% in 2015. Drought conditions prevailed across many Caribbean island nations, Colombia, Venezuela, and northeast Brazil for most of the year. Several South Pacific countries also experienced drought. Lack of rainfall across Ethiopia led to its worst drought in decades and affected millions of people, while prolonged drought in South Africa severely affected agricultural production. Indian summer monsoon rainfall was just 86% of average. Extremely dry conditions in Indonesia resulted in intense and widespread fires during August\u2013November that produced abundant carbonaceous aerosols, carbon monoxide, and ozone. Overall, emissions from tropical Asian biomass burning in 2015 were almost three times the 2001\u201314 average