Planeamiento estratégico para la industria de la silvicultura

La industria de la silvicultura en los últimos años ha tomado gran relevancia en el mundo por el gran potencial que poseen los bosques que no es solo la producción de madera, sino también de la producción de flora de manera sostenible asegurando su perpetuación, los recursos de los bosques aportan grandes beneficios a la sociedad, estos son utilizados en diferentes rubros como la medicina, nutrición entre otros. Esta razón ha hecho que los países desarrollados demanden de estos productos y se vuelva una industria muy atractiva a nivel mundial, convirtiéndose en un elemento primordial en la economía mundial. El Perú es un país que posee extensas hectáreas de bosques con gran diversidad de ecosistemas, clima, especies. La región amazónica está cubierta de árboles madereros y abundante vegetación los cuales no están siendo aprovechados de manera sostenible. Actualmente el Perú no cuenta con una industria de la silvicultura, está orientada a la explotación indiscriminada de los recursos madereros generando empleos informales y deforestación sin protección sostenible del ecosistema. La presente tesis elabora el planeamiento estratégico de la industria de la silvicultura en el Perú, en ella se plasma un exhaustivo análisis de los factores externos e internos de la industria de la silvicultura identificando las oportunidades, fortalezas, debilidades y amenazas que están relacionadas directamente con el incremento de oferta de los productos de los bosques e incrementar la producción utilizando tecnología de punta y personal capacitado en técnicas silvícolas. Para lo cual se establecieron las estrategias principales con los cuales se llegará a cumplir con los objetivos a largo plazo para alcanzar la visión trazadaThe forestry industry in recent years has become very important in the world for the great potential that forests have not only the production of wood, but also the production of flora in a sustainable way, ensuring its perpetuation, the resources of the forests bring great benefits to society, these are used in different areas such as medicine, nutrition and others. This reason has made the developed countries demand these products and become a very attractive industry all around the world, becoming a key element in the world economy. Peru is a country that has extensive hectares of forests with great diversity of ecosystems, climate and species. The Amazon region is covered with timber trees and abundant vegetation which are not being used in a sustainable way. At present, Peru does not have a forestry industry, it is oriented to the indiscriminate exploitation of the wood resources generating informal jobs and deforestation without sustainable protection of the habitats. This thesis elaborates the Strategic planning of the silviculture industry in Peru, which provides an exhaustive analysis of the external and internal factors of the forestry industry, identifying the opportunities, strengths, weaknesses and threats that are directly related to increase the supply of forest products and aggressively increase production using state-of-theart technology and trained personnel in forestry techniques. For this, the main strategies were established focused on the long-term objectives to achieve the vision outlinedTesi

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030