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Background: Previous biomechanical studies of the meniscotibial ligament have determined that it contributes to meniscal stability. An injury to it can cause the meniscus to extrude, and reconstruction of that ligament significantly reduces extrusion. Purpose: To assess the biomechanical effects of sectioning the lateral meniscotibial ligament (LMTL) and the meniscofibular ligament (MFL) with respect to the radial mobility of the lateral meniscus and to evaluate the biomechanical effects of the capsulodesis and centralization techniques. Study Design: Controlled laboratory study. Methods: The lateral meniscus of 22 porcine knees was evaluated. They were mounted on a testing apparatus to apply muscle and ground-reaction forces. The meniscus was evaluated at 30° and 60° of knee flexion using 2 markers placed on the posterior cruciate ligament and the lateral meniscus after applying an axial compression of 200 N to the knee joint. Measurements were recorded under 5 conditions: intact lateral meniscus, injury of the LMTL, subsequent injury of the MFL, the use of the open capsulodesis technique, and the reconstruction of the LMTL and the MFL with the centralization technique. Results: The distance between the 2 markers was significantly greater in the extrusion group (combined lesion of the LMTL and MFL) than in the intact or reconstruction groups (capsulodesis and centralization techniques; P < .001 in all cases). In the cases of load application, no significant differences were observed between the control group (intact meniscus) and the groups on which the reconstruction techniques were performed. There were also no differences when comparing the results obtained between both reconstruction techniques. In all settings, the distance between the 2 markers increased with the increase in the knee flexion angle. Conclusion: In a porcine model, the LMTL and the MFL participated as restrictors of the radial mobility of the lateral meniscus during loading. Their injury caused a significant increase in lateral meniscal extrusion, and the centralization and the capsulodesis procedures were able to reduce extrusion. Clinical Relevance: This study demonstrates the capacity of the LMTL and the MFL to restrict the radial mobility of the lateral meniscus during loading and how it is affected when they are injured.

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Land-use generates multiple stress factors, and we need to understand their effects on plant-plant interactions to predict the consequences of land-use intensification. The stress-gradient hypothesis predicts that the relative strength of positive and negative interactions changes inversely under increasing environmental stress. However, the outcome of interactions also depends on stress factor's complexity, the scale of analysis, and the role of functional traits in structuring the community. We evaluated plant-plant co-occurrences in a temperate forest, aiming to identify changes in pairwise and network metrics under increasing silvopastoral use intensity. Proportionally, positive co-occurrences were more frequent under high than low use, while negative co-occurrences were more frequent under low than high. Networks of negative co-occurrences showed higher centralization under low use, while networks of positive co-occurrences showed lower modularity and higher centralization under high use. We found a partial relationship between co-occurrences and key functional traits expected to mediate facilitation and competition processes. Our results shows that the stress-gradient hypothesis predicts changes in spatial co-occurrences even when two stress factors interact in a complex way. Networks of negative co-occurrences showed a hierarchical effect of dominant species under low use intensity. But positive co-occurrence network structure partially presented the characteristics expected if the facilitation was an important mechanism characterizing the community under high disturbance intensity. The partial relationship between functional traits and co-occurrences may indicate that other factors besides biotic interactions may be structuring the observed negative spatial associations in temperate Patagonian forests.

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Wastewater pollution problems are associated with population growth and the concentration of population in large urban centers. According to United Nations projections for 2050, the world population will reach 9 billion people, increasing the pressures on water resources due to their demand and pollution. Based on UNICEF and World Health Organization estimates, 2.4 billion people worldwide currently lack access to improved sanitation facilities, with 946 million practicing open defecation. Decentralized wastewater treatment systems are a viable and necessary alternative for wastewater management, thus, minimizing environmental impacts, facilitating resource recovery, and providing rural and peri-urban inhabitants with access to basic sanitation. This literature review article uses the multicriteria analysis tool to present the key economic, institutional, social, environmental, and technological aspects, criteria, and indicators that must be considered for successful decentralized system implementation planning to strengthen basic sanitation service coverage in the rural and peri-urban areas where it does not exist.

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The centralization-decentralization dichotomy in wastewater treatment management has been a recurrent topic of discussion in the urban context. The escalation of environmental hazards linked to increasing mismanaged wastewater flows in emerging or developing cities has vivified this conundrum. It is argued that there is a wide range of parameters to identify the optimal level of centralization-decentralization that must be implemented. In many cases, this prevents decision-makers from having a clear picture of the most appropriate management choices that must be undertaken. Hence, the main objective of the current discussion consists of an in-depth comparison between centralized wastewater treatment systems and decentralized systems with source separation in urban environments of the Global South. Moreover, a set of actions that should be considered in order to upgrade wastewater treatment systems amidst the existence of numerous economic, social and environmental constraints are analyzed. Considering the constraints of megacentralization as a preferred option, we argue that decision-makers should restrain from entering a centralization-decentralization dichotomy, seeing the process as a gradient between the two concepts. In fact, we advocate combining the benefits of each of the two perspectives to generate an adaptive management, site-specific solution for urban environments. For this, the inclusion of quantitative management tools, such as life-cycle environmental or cost management methodologies, in multi-objective optimization models, constitutes an interesting path forward towards fostering comprehensive policy support.

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INTRODUCTION: Giant cell tumor of bone (GCTB) is a benign-aggressive tumor that has a high-rate of recurrence with curettage resection alone. Patients with GCTB in underserved regions of the world can have progression of the tumor with significant disability due to a lack of specialty care. We present a case of an en bloc resection of an aggressive, recurrent GCTB of the radius with excellent function and no evidence of tumor recurrence two years after surgery. PRESENTATION OF CASE: A 22-year-old right-hand dominant female in Haiti developed an aggressive recurrence of a giant cell tumor of bone (GCTB) of the distal radius. Treatment consisted of en bloc resection of the distal radius with the proximal row of the carpus and centralization of the ulna. At two-year follow-up, the patient maintained good functional capacity with no clinical or radiological evidence of recurrence. DISCUSSION: GCTB can cause significant destruction of the bone and articular surface if not treated adequately. Treatment options should be considered carefully in underserved regions of the world based on the resources available. This case exemplifies that complex limb-salvage surgery is possible when coordination of care between international and local surgeons is provided with an emphasis on continuity of care post-operatively. CONCLUSION: En bloc resection with centralization of the ulna remains a viable technique to address aggressive GCTB of the distal radius and can be appropriate in resource-limited settings.

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Radiocarbon summed probability distribution (SPD) methods promise to illuminate the role of demography in shaping prehistoric social processes, but theories linking population indices to social organization are still uncommon. Here, we develop Power Theory, a formal model of political centralization that casts population density and size as key variables modulating the interactive capacity of political agents to construct power over others. To evaluate this argument, we generated an SPD from 755 radiocarbon dates for 10 000-1000 BP from Central, North Central and North Coast Peru, a period when Peruvian political form developed from 'quasi-egalitarianism' to state levels of political centralization. These data are congruent with theoretical expectations of the model but also point to an artefactual distortion previously unremarked in SPD research. This article is part of the theme issue 'Cross-disciplinary approaches to prehistoric demography'.

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Introducción: la epidemia de covid-19 ha dejado en evidencia una serie de problemas de desigualdad en el acceso a la salud pública en Perú, especialmente en las provincias alejadas de la capital, donde se observa precariedad tanto en infraestructura como en personal sanitario. Este artículo analiza cómo el Gobierno y la población han hecho frente a epidemias en el sur de Perú, usando como casos de estudio el covid-19 y la peste bubónica ocurrida en 1903 y 1905, con el fin de entender continuidades en el manejo de la crisis epidémica y su respuesta a ellas. Desarrollo: se estudia la epidemia de la peste bubónica en las ciudades de Arequipa y Mollendo en 1903 y 1905 y el covid-19, con un enfoque en el funcionamiento del sistema de salud local y nacional, en la infraestructura sanitaria disponible para enfrentar epidemias y, finalmente, en las respuestas sociales de la población respecto al escepticismo de las medidas impuestas por las autoridades y al incremento de la automedicación. Conclusiones: la epidemia del covid-19 en el sur de Perú presenta importantes similitudes con la epidemia de peste bubónica que afectó a la región a inicios del siglo xx: desorden de responsabilidades, falta de previsión para hacer frente a enfermedades epidémicas, infraestructura precaria y una población con alto grado de desconfianza frente a las recomendaciones de las autoridades civiles y sanitarias

Introduction: The covid-19 epidemic has revealed a series of inequality problems in the access to public health services in Peru, especially in provinces far from the capital where precariousness in both infra-structure and sanitary personnel is observed. In this study, we analyzed how the population and author-ities in southern Peru faced epidemics, using covid-19 epidemic and bubonic plague in 1903 and 1905 as case studies to understand continuities in the management of epidemic crises and social response to them. Development: We studied the bubonic plague epidemic in the cities of Arequipa and Mollendo in 1903 and 1905 as well as the covid-19 epidemic, focusing on the functioning of local and national health systems, health infrastructure available to face epidemics, and finally, the social response of the population, paying particular attention to the skepticism of the population toward measures imposed by the authorities and increase in self-medication. Conclusions: The covid-19 epidemic in southern Peru pres-ents important similarities with the bubonic plague epidemic that affected the region at the beginning of the 20th century, including a disorder of responsibilities, lack of foresight to face epidemic diseases, insufficient infrastructure, and a population with a high degree of distrust in the recommendations given by the civil and health authorities

Introdução: a epidemia de covid-19 expôs uma série de problemas de desigualdade no acesso à saúde pública no Peru, especialmente nas províncias distantes da capital onde há precariedade tanto de infraestrutura quanto de pessoal de saúde. Este artigo analisa como o governo e a população têm enfren-tado epidemias no sul do Peru, utilizando o covid-19 e a peste bubônica ocorrida em 1903 e 1905 como estudos de caso, a fim de compreender as continuidades na gestão da crise epidêmica e suas respostas. Desenvolvimento: são estudadas as epidemias de peste bubônica nas cidades de Arequipa e Mollendo em 1903 e 1905 e a covid-19, enfocando no funcionamento do sistema de saúde local e nacional, a infraes-trutura de saúde disponível para enfrentar as epidemias e, por fim, as respostas da população, com particular atenção para o ceticismo em relação às medidas impostas pelas autoridades e ao aumento da automedicação. Conclusões: a epidemia de covid-19 no sul do Peru apresenta semelhanças importantes com a epidemia de peste bubônica que afetou a região no início do século XX: desordem de responsabili-dades, falta de previsão para enfrentar as doenças epidêmicas, infraestrutura precária e uma população com alto grau de desconfiança em relação às recomendações das autoridades civis e sanitárias

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O Programa Mais Médicos projeta abrir, até 2017, 11.400 vagas em graduac¸ão em medicina e 12.400 vagas em residência. O Brasil já conta com cerca de 400 mil médicos atuantes, correspondendo a 2,11 médicos a cada mil habitantes. Assim, o país supera a perspectiva da Organizac¸ão Mundial da Saúde, que recomenda um profissional a cada mil habitantes. Os números saltam aos olhos e pintam um cenário de prosperidade e sucesso no que tange à medicina e à assistência em saúde; mas não é bem assim. Há expressiva concentrac¸ão de generalistas e especialistas na Região Sudeste e falta destes no Norte. O Sudeste centraliza mais especialistas do que a soma dos médicos do Nordeste, Centro-Oeste e Norte. Neste trabalho, expomos estes números e analisamos o impacto deles na formac¸ão do egresso que se prepara para entrar no mercado de trabalho.

By 2017, the Mais Médicos Program plans to open 11,400 places in medical schools and 12,400 residency places. Brazil already has about 400,000 doctors in service, which makes up a ratio of 2.11 doctors per thousand inhabitants. Thus, the country clearly surpasses the standpoint of the World Health Organization, which recommends one professional per thousand inhabitants. The numbers jump out and depict a scenario of prosperity and success in medicine and health care, but it’s not quite like this. There is a significant concentration of generalists and specialists in the Southeast Region and a lack of them in the North. The Southeast concentrate more specialists than the sum of the doctors of the Northeast, Center-West and North. In this paper, we present these figures and analyze their impact on the number of graduates that are getting ready to enter the job market.

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The role and effect of glide path preparation in root canal treatment remain controversial. This systematic review aims to compare apical transportation and canal centring of different glide path preparation techniques, with or without subsequent engine-driven root canal preparation. A database search in PubMed, PubMed Central, Embase, Scopus, EBSCO Dentistry & Oral Sciences Source and Virtual Health Library was conducted, using appropriate key words to identify the effect of glide path preparation (or its absence) on apical transportation and canal centring. An assessment for the risk of bias in included studies was carried out. Amongst 2146 studies, 18 satisfied the inclusion criteria. Nine studies assessed glide path preparation per se, comparing apical transportation and canal centring of rotary systems and/or manual files; eleven further investigations examined the efficacy of the glide path prior to final canal preparation with different engine-driven systems. Risk of bias and other study design features with potential influence on study outcomes and clinical implications were assessed. Based on the available evidence, and within the limitation of the studies included, preparation of a glide path using rotary sequences performs similarly (in most of the component studies) or significantly better than manual preparation when assessing apical transportation or canal centring. When compared to the absence of a glide path, canal shaping following glide path preparation was of similar, or significantly better quality, in regard to apical transportation or canal centring.

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Radial longitudinal deficiency (RLD) is the most common congenital longitudinal deficiency at birth and represents a wide spectrum of upper extremity anomalies, from mild thumb hypoplasia to absent radius. Radial dysplasia may be isolated or associated with an array of systemic anomalies that should be familiar to pediatric hand surgeons. The management of RLD has evolved greatly since its inception in the late 19th century, largely due to decades of innovation that followed the thalidomide catastrophe of the 1960s. Yet controversy still exists regarding many aspects of RLD. Traditional treatments of radial dysplasia (ie, centralization) are unfortunately wrought with poor outcomes and high rates of recurrence, leading some authors to recommend alternative techniques for this condition. Reconstruction of the hypoplastic thumb, although less controversial, is just starting to see long-term outcomes. This article reviews the etiology, classification, and treatment options for RLD, highlighting recent developments and outcomes.

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INTRODUCTION: The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), transportation and centralization of different nickel-titanium (NiTi) rotary instruments. METHODS: One hundred and twenty eight mandibular premolars were selected and instrumented using the following brands of NiTi files: WaveOne, WaveOne Gold, Reciproc, ProTaper Next, ProTaper Gold, Mtwo, BioRaCe and RaCe. CBCT imaging was performed before and after root canal preparation to obtain measurements of mesial and distal dentin walls and calculations of root canal transportation and centralization. A normal distribution of data was confirmed by the Kolmogorov-Smirnov and Levene tests, and results were assessed using the Kruskal-Wallis test. Statistical significance was set at 5%. RESULTS: ProTaper Gold produced the lowest canal transportation values, and RaCe, the highest. ProTaper Gold files also showed the highest values for centering ability, whereas BioRaCe showed the lowest. No significant differences were found across the different instruments in terms of canal transportation and centering ability (P > 0.05). CONCLUSION: Based on the methodology employed, all instruments used for root canal preparation of mandibular premolars performed similarly with regard to canal transportation and centering ability.

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RESUMO O propósito deste artigo é analisar como a composição dos gabinetes afeta a criação de burocracias centralizadas na Presidência da República no Brasil. Argumento que quanto maior o custo de gerenciamento da coalizão, maior a probabilidade de centralização dos órgãos públicos na Presidência da República. No estudo, são analisados 172 órgãos criados na administração pública federal brasileira entre 1990 e 2009, tendo o órgão individual como unidade de análise do trabalho. A fim de captar a incidência de centralização na criação presidencial, assumo o órgão criado na hierarquia da Presidência ou realocado dos ministérios para a Presidência como variável dependente binária. Para avaliar os efeitos do grau de conflitos de preferências da coalizão sobre a probabilidade de centralização presidencial, foram estimados quatro modelos de regressão logística binária. As incidências da dispersão ideológica do gabinete; do grau de partidarização da coalizão; da fracionalização partidária do gabinete e do extremismo ideológico do presidente serão analisadas como fatores centrais da análise.

ABSTRACT The aim of the following article is to analyze how the composition of the cabinets affects the creation of centralized bureaucracies in the Presidency of the Republic of Brazil. I argue that the higher the cost of managing the coalition, the greater the likelihood of the centralization of public bodies in the Presidency. The study analyzes 172 bodies created by the Brazilian federal public administration from 1990 to 2009, with individual bodies serving as the unit of analysis. With the aim of gauging the extent to which centralization shapes the Presidency, my binary dependent variable is whether a body created within the hierarchy of the Presidency or reallocated from the ministries to the Presidency. In order to assess the effects of the degree of conflicts among the coalition's preferences on the probability of presidential centralization, four binary logistic regression models were estimated, with the degree of ideological dispersion in the cabinet; the degree of politicization in the coalition; the degree of party fractionalization in the cabinet, and the degree of ideological extremism analyzed as key factors to the study.

RÉSUMÉ L'objectif de cet article est d'analyser de quelle manière la composition des gouvernements affecte la création de bureaucraties centralisées au sein des services de la Présidence de la république au Brésil. Selon notre étude, plus le coût de gestion de la coalition est élevé, plus on a de chances d'assister à une centralisation des organismes publics au sein des services de la Présidence. Nous avons analysé 172 organismes créés par l'administration publique fédérale brésilienne entre 1990 et 2009, en prenant l'organisme lui-même comme unité d'analyse. Afin de comprendre l'incidence de la centralisation dans la création d'organismes par les services présidentiels, je prendrai comme variable dépendante binaire l'organisme créé au sein de la hiérarchie présidentielle ou déplacé des ministères à la Présidence. Pour évaluer les effets du degré de conflit des préférences de la coalition sur la probabilité de centralisation présidentielle, on a pris en compte quatre modèles de régression logistique binaire, dont les facteurs centraux d'analyse seront les incidences de la dispersion idéologique du gouvernement; du degré de concentration partisane de la coalition; de l'éclatement partisan du gouvernement; et de l'extrémisme idéologique du président.

RESUMEN El propósito de este artículo es analizar la forma en que la composición de los gabinetes influye en la creación de burocracias centralizadas en la Presidencia de la República de Brasil. Cuanto más altos son los costes administrativos de la coalición, mayor es la probabilidad de centralización de los órganos públicos en la Presidencia de la República. En este estudio, se analizan 172 órganos creados en el seno de la administración pública federal brasileña entre 1990 y 2009, y se toma el órgano individual como objeto de investigación. Con intención de captar la incidencia de la centralización en la creación de organismos de carácter presidencial, asumo como variable dependiente binaria el órgano conformado en la jerarquía de la Presidencia o reasignado de los ministerios a ella. Para evaluar los efectos del grado de conflictos de preferencias de la coalición en la probabilidad de centralización presidencial, se recurrió a cuatro modelos de regresión logística binaria. Las repercusiones de la dispersión ideológica del gabinete, del grado de partidismo de la coalición, del fraccionamiento partidario del gabinete y del extremismo ideológico del presidente serán analizadas como factores centrales del estudio.

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INTRODUCTION: The aim of this study was to evaluate through computed microtomography the transportation and centralization of root canals instrumented using the WaveOne system (Dentsply Maillefer, Ballaigues, Switzerland) associated or unassociated with previous apical and cervical enlargements. METHODS: Thirty-six mandibular molars were selected with independent mesial roots and curvatures and randomized into the following groups: PathFile (Dentsply Maillefer) before WaveOne Primary (the PFWO group), ProTaper Universal SX (Dentsply Maillefer) before WaveOne Primary (the SXWO group), and WaveOne Primary (the WO group). Computed microtomographic imaging was performed pre- and postpreparation to obtain measurements of mesial and distal dentin walls and calculations of root canal transportation (%) and centralization. One-way analysis of variance was performed to compare the different groups, repeated measures analysis of variance for comparison of the root thirds in each group, and the Student t test for comparisons between the mesiobuccal and mesiolingual canals. RESULTS: Transportation of the cervical and middle thirds to the danger zone was observed in both roots, whereas the apical thirds were transported to the outer face of the curvature. In the PFWO and SXWO groups, less transportation was observed in the middle thirds of the mesiobuccal canals compared with the WO group (P < .05). Centralization remained almost unchanged in the SXWO group (P < .05). CONCLUSIONS: In each group, transportation toward the danger zone was mostly observed in the cervical thirds of the mesiobuccal canals. Cervical or apical enlargement resulted in reduced transportation and improved centralization of the middle thirds compared with the exclusive use of the WaveOne system.

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El desplazamiento forzado afecta a más de 5 millones de personas en Colombia. El proceso de movilidad que experimentan los desplazados implica el debilitamiento de los vínculos con su entorno relacional y supone la privación del derecho de incidir a nivel sociopolítico. El sentido de comunidad, la participación y el empoderamiento sirven para comprender tanto el proceso de adaptación en la comunidad de destino, como el incremento de la participación comunitaria. Desde un enfoque estructural, el Análisis de Redes Sociales hace posible evaluar las redes de apoyo social de la población desplazada. Los objetivos de la investigación son (a) evaluar los tres procesos mencionados, (b) analizar las redes personales de los participantes y (c) examinar los posibles efectos que la estructura de las redes personales pueda ejercer sobre el desarrollo de los procesos comunitarios analizados. Los resultados indican que las propiedades estructurales de las redes inciden en el nivel de participación en actividades de desarrollo comunitario. Sin embargo, no se han detectado relaciones significativas entre los indicadores estructurales y los otros dos procesos comunitarios evaluados. Existen evidencias que indican que la densidad contribuye positivamente sobre la participación mientras que los parámetros de centralización afectan de forma negativa. Concluimos discutiendo el alcance de nuestros resultados para diseñar estrategias de intervención que promuevan la integración plena de los desplazados en la comunidad receptora.

Forced displacement affects over 5 million people in Colombia. The process of mobility experienced by displaced implies the weakening of the linkages with their relational environment and may involve the deprivation of the right to decide at socio-political level. The sense of community, the community engagement and the psychological empowerment display a strong potential to understand both the adaptation process in destination community, and the increase in community involvement. From a structural viewpoint, Social Network Analysis allows to evaluate the social support networks of the displaced population. The aims of this study are: (a) assess the three community processes; (b) analyze the personal networks structure of the displaced population; and (c) identify the potential effects that personal networks may exert on the development of community processes. Results suggest that structural properties of networks impact on the level of participation in community development activities. However, no significant relationships were identified between the structural measures and the other two community processes evaluated. Density contributes positively on community participation while centralization parameters affect in a negative way. We conclude discussing the applications of our results to design effective intervention strategies to promote the full integration of displaced population in the host community.

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En este artículo se presenta un análisis acerca de la forma como se configuran los Servicios Universitarios de Atención Psicológica (SUAP), para la formación académica y profesional de los psicólogos y para la atención psicológica de los consultantes. El estudio, fundamentado en la teoría orgánica contingente, se realizó aplicando un análisis factorial exploratorio por componentes principales y un análisis factorial confirmatorio mediante un modelo de ecuaciones estructurales. Los resultados muestran que los SUAP se caracterizan por tener una estructura organizacional de tipo mecanicista, fundamentada en las variables de formalización, centralización y complejidad, las cuales tienen una relación directa con su efectividad.

This article presents an analysis about how it is configured University Services of Psychological Attention (USPA), for academic and professional formation of psychologists and for the psychological attention of users. The study based on the organic contingent theory was carried out using an exploratory factor analysis by principal components and a confirmatory factor analysis through structural equation modeling. The results show that USPA are characterized by an organizational structure of type mechanistic, based on the variables of formalization, centralization and complexity which have a direct bearing over its effectiveness.

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The purpose of this study was to describe, using qualitative case study methods, and evaluate, using the ethical framework 'accountability for reasonableness', priority setting in a hospital in Chile. In policy making contexts that have historically been dominated by central authority, especially where there are limited resources, fair priority setting processes can empower people, foster social learning, improve the quality of the decisions, enhance compliance with policy decisions, and increase public confidence in the hospital.

El propósito de este estudio fue describir, a través del uso de métodos cualitativos en un estudio de caso, y evaluar, siguiendo la estructura ética de "Administración Razonable", el proceso de priorización en salud en un hospital de Chile. En el contexto de las políticas públicas ha dominado históricamente la centralización de la autoridad, especialmente cuando los recursos son limitados. Un proceso justo de priorización en salud puede empoderar a las personas, mejorar y aumentar el proceso de aprendizaje social, mejorar la calidad de las decisiones, aumentar el grado de adherencia y satisfacción de las políticas desarrolladas y aumentar la confianza pública en el hospital.

O propósito deste estudo foi descrever, por métodos qualitativos em um estudo de caso, e avaliar, seguindo a estrutura ética de "administração razoável", o processo de priorização em saúde em um hospital chileno. No contexto das políticas públicas onde tem dominado historicamente a centralização da autoridade, especialmente quando os recursos são limitados, um processo justo de priorização em saúde pode empoderar as pessoas, melhorar e aumentar o processo de aprendizagem social, melhorar a qualidade das decisões, aumentar o grau de aderência e satisfação das políticas desenvolvidas e a confiança pública no hospital.

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