Análisis general de sistemas productivos claves y sus indicadores a nivel nacional en el contexto de crecimiento verde

El concepto de crecimiento verde fue incluido en el Plan Nacional de Desarrollo 2014-2018 “Todos por un Nuevo País” con el objetivo de buscar el desarrollo económico sostenible, la competitividad y la reducción de vulnerabilidades al cambio climático. En este informe se busca dar a conocer el estado actual de los indicadores de crecimiento verde para diferentes sistemas productivos agropecuarios en Colombia e identificar las opciones tecnológicas que permitan mejorar dichos indicadores con el fin de incrementar la productividad de la tierra sin afectar los demás indicadores de crecimiento verde. Para lograr esto se han propuesto en este estudio cinco fases que van desde la fase de preparación, un análisis general a nivel nacional, un análisis detallado a nivel regional, un análisis de barreras para la implementación de medidas y recomendaciones. Este reporte corresponde a la fase dos del estudio sobre análisis general. La línea base de expansión en área proyectada para los cinco sistemas productivos, la construcción y estimación de los indicadores a nivel nacional para cada uno de los sistemas productivos y una lista de opciones tecnológicas que pueden contribuir al crecimiento verde en estos sistemas productivos. Posteriormente se estimará el potencial que tiene cada tecnología sobre los indicadores de crecimiento verde. En este estudio también se incluye la metodología y resultados sobre el proceso de priorización de los sistemas productivos. The concept of green growth was included in the National Development Plan 2014-2018 "All for a New Country" with the objective of seeking sustainable economic development, competitiveness and the reduction of vulnerabilities in climate change. This report seeks to publicize the current status of green growth indicators for different agricultural production systems in Colombia and identify the technological options that allow improving the indicators in order to increase the productivity of the land without affecting the other indicators of green growth To achieve this, five phases have been improved in this study, ranging from the preparation phase, a general analysis at the national level, detailed analysis at the regional level, an analysis of barriers to the implementation of measures and recommendations. This report corresponds to the phase of the study on general analysis. The baseline projected in this area for the five productive systems, the construction and the estimation of the indicators at national level for each one of the productive systems and a list of technological options that can contribute to the green growth in these productive systems. Subsequently, the potential of each technology on green growth indicators will be estimated. This study also includes the methodology and results on the process of prioritization of productive systems.The concept of green growth was included in the National Development Plan 2014-2018 "All for a New Country" with the objective of seeking sustainable economic development, competitiveness and the reduction of vulnerabilities in climate change. This report seeks to publicize the current status of green growth indicators for different agricultural production systems in Colombia and identify the technological options that allow improving the indicators in order to increase the productivity of the land without affecting the other indicators of green growth To achieve this, five phases have been improved in this study, ranging from the preparation phase, a general analysis at the national level, detailed analysis at the regional level, an analysis of barriers to the implementation of measures and recommendations. This report corresponds to the phase of the study on general analysis. The baseline projected in this area for the five productive systems, the construction and the estimation of the indicators at national level for each one of the productive systems and a list of technological options that can contribute to the green growth in these productive systems. Subsequently, the potential of each technology on green growth indicators will be estimated. This study also includes the methodology and results on the process of prioritization of productive systems

Precapillary Pulmonary Arterial Hypertension Despite Contrary Anchoring Bias

We present the case of a patient with risk factors and a noninvasive evaluation that suggested postcapillary pulmonary hypertension, but in fact had invasive hemodynamics consistent with precapillary pulmonary hypertension. A thorough hemodynamic evaluation of pulmonary hypertension must be performed, as treatment is linked to the underlying physiology. (Level of Difficulty: Advanced.

Percutaneous coronary intervention for ventricular fibrillation in the setting of an anomalous right coronary artery

Key Clinical Message We present a case of a quadriplegic male who developed ventricular fibrillation associated with an anomalous aortic origin of the right coronary artery. Successful revascularization was achieved with percutaneous coronary intervention. This case highlights the application of an unconventional approach to resolve ischemia in a patient with prohibitive surgical risk

Intracoronary Gene Transfer of Adenylyl Cyclase 6 in Patients With Heart Failure: A Randomized Clinical Trial.

ImportanceGene transfer has rarely been tested in randomized clinical trials.ObjectiveTo evaluate the safety and efficacy of intracoronary delivery of adenovirus 5 encoding adenylyl cyclase 6 (Ad5.hAC6) in heart failure.Design, setting, and participantsA randomized, double-blind, placebo-controlled, phase 2 clinical trial was conducted in US medical centers (randomization occurred from July 19, 2010, to October 30, 2014). Participants 18 to 80 years with symptomatic heart failure (ischemic and nonischemic) and an ejection fraction (EF) of 40% or less were screened; 86 individuals were enrolled, and 56 were randomized. Data analysis was of the intention-to-treat population. Participants underwent exercise testing and measurement of left ventricular EF (echocardiography) and then cardiac catheterization, where left ventricular pressure development (+dP/dt) and decline (-dP/dt) were recorded. Participants were randomized (3:1 ratio) to receive 1 of 5 doses of intracoronary Ad5.hAC6 or placebo. Participants underwent a second catheterization 4 weeks later for measurement of dP/dt. Exercise testing and EF were assessed 4 and 12 weeks after randomization.InterventionsIntracoronary administration of Ad5.hAC6 (3.2 × 109 to 1012 virus particles) or placebo.Main outcomes and measuresPrimary end points included exercise duration and EF before and 4 and 12 weeks after randomization and peak rates of +dP/dt and -dP/dt before and 4 weeks after randomization. Fourteen placebo participants were compared (intention to treat) with 24 Ad5.hAC6 participants receiving the highest 2 doses (D4 + 5).ResultsFifty-six individuals were randomized and monitored for up to 1 year. Forty-two participants (75%) received Ad5.hAC6 (mean [SE] age, 63 [1] years; EF, 30% [1%]), and 14 individuals (25%) received placebo (age, 62 [1] years; EF, 30% [2%]). Exercise duration showed no significant group differences (4 weeks, P = .27; 12 weeks, P = .47, respectively). The D4 + 5 participants had increased EF at 4 weeks (+6.0 [1.7] EF units; n = 21; P < .004), but not 12 weeks (+3.0 [2.4] EF units; n = 21; P = .16). Placebo participants showed no increase in EF at 4 weeks or 12 weeks. Exercise duration showed no between-group differences (4-week change from baseline: placebo, 27 [36] seconds; D4 + 5, 44 [25] seconds; P = .27; 12-week change from baseline: placebo, 44 [28] seconds; D4 + 5, 58 [29 seconds, P = .47). AC6 gene transfer increased basal left ventricular peak -dP/dt (4-week change from baseline: placebo, +93 [51] mm Hg/s; D4 + 5, -39 [33] mm Hg/s; placebo [n = 21]; P < .03); AC6 did not increase arrhythmias. The admission rate for patients with heart failure was 9.5% (4 of 42) in the AC6 group and 28.6% (4 of 14) in the placebo group (relative risk, 0.33 [95% CI, 0.08-1.36]; P = .10).Conclusions and relevanceAC6 gene transfer safely increased LV function beyond standard heart failure therapy, attainable with one-time administration. Larger trials are warranted.Trial registrationclinicaltrials.gov Identifier: NCT00787059