RESUMEN Objetivo. Proporcionar una visión general de las actividades de evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe, en la que se incluyan las tecnologías evaluadas, los recursos utilizados, los métodos de evaluación aplicados y los desafíos enfrentados. Métodos. realizó una revisión exploratoria sobre la evaluación hospitalaria de tecnologías sanitarias en bases de datos y en la literatura gris, para lo cual se utilizaron los marcos de referencia del Instituto Joanna Briggs. Resultados. encontraron 17 estudios y se obtuvieron mediante una búsqueda manual otros dos documentos de un congreso, con lo que el total fue de 19 registros. Brasil se reveló como un actor clave en las actividades de evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe, y sus hospitales públicos universitarios son los que lideran los esfuerzos. Las unidades de evaluación hospitalaria de tecnologías sanitarias se centraron sobre todo en la evaluación de medicamentos, productos farmacéuticos y dispositivos médicos, para lo que empleaban análisis de impacto presupuestario y de costo-efectividad o costo-utilidad como principales herramientas de evaluación. La revisión también permitió detectar desafíos como la escasez de recursos humanos y económicos. Conclusiones. El estudio pone de manifiesto el creciente interés por la evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe impulsado, sobre todo, por las instituciones públicas. Los resultados subrayan la necesidad de adoptar enfoques individualizados para fortalecer la toma de decisiones basadas en la evidencia en el ámbito de la salud, y afrontar los desafíos que suponen las limitaciones de recursos y las restricciones económicas en la región.

ABSTRACT Objective. To provide an overview of hospital-based health technology assessment (HB-HTA) activities in Latin America and the Caribbean, including the technologies assessed, resources utilized, evaluation methods employed, and challenges encountered. Methods. A scoping review focused on HB-HTA using frameworks from the Joanna Briggs Institute was conducted across databases and gray literature. Results. Seventeen studies were identified, and another two documents were retrieved manually at a conference, totaling 19 files. Brazil emerged as a key player in HB-HTA activities in Latin America and the Caribbean, with public teaching hospitals leading the efforts. The primary focus of HB-HTA units was assessing medicines/pharmaceuticals and medical devices, using budget impact and cost-effectiveness/utility analyses as the main appraisal tools. The review also identified challenges such as limited human resources and financial support. Conclusions. The study highlights a growing interest in HB-HTA in Latin America and the Caribbean, driven primarily by public institutions. The findings underscore the need for tailored approaches to strengthen evidence-based decision-making in healthcare settings and address the challenges of the region’s limited resources and financial constraints.

Resumo Criado em 2003 a partir do Fome Zero, o Programa de Aquisição de Alimentos (PAA) é uma importante política pública estruturante de combate à fome e fortalecimento da agricultura familiar. O programa tem sofrido desmontes orçamentários e operacionais sistemáticos; concomitantemente, observa-se a ascensão da insegurança alimentar no Brasil. Trata-se de uma revisão integrativa de literatura acerca da relevância do PAA para a garantia da soberania alimentar e fortalecimento da agricultura familiar. A busca na literatura foi realizada em dezembro de 2022, nos idiomas português, espanhol e inglês, com recorte temporal de dez anos. Utilizaram-se as bases de dados SciELO e BVS, que incluem LILACS e MEDLINE. Foram identificadas 35 publicações, após análise dos estudos, oito artigos compuseram esta revisão. As experiências relatadas mostram que o PAA possui relevância no combate à fome e contribui para a promoção da segurança alimentar das famílias das cidades e do campo. Porém, o programa enfrenta desafios relacionados à diminuição orçamentária, descontinuidade das modalidades de operacionalização e falta de estruturação como política de Estado. Frente a isso, há urgência de rever as estruturas organizacionais do PAA e consolidar esse programa como uma importante política de Estado.

Abstract Established in 2003 as part of the "Zero Hunger" Program, the Food Purchase Program (PAA) is a crucial structural public policy to combat hunger and strengthen family farming. The program has suffered systematic budgetary and operational dismantling, concomitantly with Brazil’s rise in food insecurity. This integrative literature review examines the significance of PAA in ensuring food sovereignty and empowering family farming. The literature search was conducted in December 2022, encompassing Portuguese, Spanish, and English publications within a ten-year timeframe. The databases used were SciELO and BVS, which include LILACS and MEDLINE. Thirty-five publications were identified, and eight articles were included in this review after analysis. The documented experiences demonstrate the effectiveness of the PAA in combating hunger and contributing to the promotion of food security in rural families. Nevertheless, the program faces challenges related to budget cuts, the discontinuation of operational modalities and the lack of structure as a State policy. In light of this, there is an urgent need to revise the PAA's organizational structures and consolidate this program as a critical state policy, not only to ensure its resistance but also to regain its effectiveness.

Resumo: A produção de laticínios no Uruguai é essencial e está sob escrutínio devido aos impactos ambientais que pode causar. Os impactos resultam principalmente de práticas de gestão ineficientes, que levam ao uso excessivo de nutrientes, cujo excedente escoa para o meio ambiente, afetando o solo, as águas subterrâneas e os rios. Neste contexto, este artigo explica pesquisas que geraram novos conhecimentos para o setor lácteo do Uruguai alcançar uma produção mais sustentável, ao compreender quais práticas agrícolas maximizam a eficiência dos nutrientes e, ao mesmo tempo, reduzem os impactos ambientais. A pesquisa utilizou uma abordagem multimetodológica no caso de uma típica fazenda leiteira no Uruguai, aplicando o Método de Orçamento de Nutrientes e desenvolvendo um Modelo Baseado em Agentes (ABM) denominado Gestão de Nitrogênio e Fósforo (NPM). O balanço de nutrientes é um método valioso e simples para analisar dados e avaliar entradas e saídas de nutrientes, embora tenha limitações visuais e analíticas, que podem ser complementadas com modelagem adequada baseada em agentes, que permite analisar os agentes do modelo no tempo e no espaço, capturando a heterogeneidade do agroecossistema. Os resultados da pesquisa mostram que a utilização de práticas corretas melhora a eficiência nutricional, reduzindo a dependência de insumos externos. As principais conclusões indicam que a fixação biológica de azoto, as dietas pastoris, a taxa de lotação e a acumulação de fósforo no solo são variáveis-chave que afetam a eficiência e os impactos ambientais.

Abstract: In Uruguay, dairy production is essential for the country and is under scrutiny due to the environmental impacts it can cause. Impacts are primarily the result of inefficient management practices which lead to an excessive use of nutrients -mainly nitrogen (N) and phosphorus (P)- and their surplus flow into the environment, affecting soil, groundwater, and rivers. In this context, this paper explains research that has generated new knowledge for Uruguay's dairy sector to achieve more sustainable production by understanding which farm management practices maximize nutrient efficiency while reducing environmental damage. The research used a multi-methodology approach for the case study of a typical Uruguayan dairy farm by applying the Nutrient Budget Method and developing an Agent-Based Model (ABM) called Nitrogen Phosphorus Management (NPM). Nutrient budgeting is a valuable and straightforward method for analyzing farm data and evaluating all the nutrient inputs and outputs. However, it has some visual and research limitations that can be complemented with suitable agent-based modeling. The ABM modeling approach enables the analysis of the model’s agents in space and time, capturing the agroecosystem’s heterogeneity. Through their combined application, the research results demonstrate that, along with the use of correct management practices, it is possible to improve nutrient efficiency, and, in this way, dairy production systems can be less dependent on external nutrient inputs. The main findings indicate that nitrogen biological fixation, pastoral diets, cow stocking rates, and phosphorus accumulation in soils are key management variables that affect nutrient efficiency and environmental impacts.

Resumen: La producción lechera en Uruguay es fundamental y está bajo escrutinio debido a los impactos ambientales que puede causar. Dichos impactos son principalmente el resultado de prácticas de manejo ineficientes que conducen al uso excesivo de nutrientes cuyo excedente fluye hacia el medio ambiente, afectando el suelo, las aguas subterráneas y los ríos. En este contexto, este artículo explica una investigación que ha generado nuevos conocimientos para que el sector lechero de Uruguay logre una producción más sostenible mediante la comprensión de qué prácticas agropecuarias maximizan la eficiencia de los nutrientes a la vez que reducen los impactos ambientales. La investigación utilizó un enfoque multimetodológico en el caso de un predio lechero típico de Uruguay, aplicando el Método de Presupuesto de Nutrientes y desarrollando un Modelo Basado en Agentes (ABM) llamado Manejo de Nitrógeno y Fósforo (NPM). El balance de nutrientes es un método valioso y sencillo para analizar datos y evaluar las entradas y las salidas de nutrientes. Aunque tiene limitaciones visuales y de análisis, esto puede complementarse con un modelado adecuado basado en agentes, que permite analizar los agentes del modelo en tiempo y espacio, capturando la heterogeneidad del agroecosistema. Los resultados de la investigación muestran que el uso de prácticas correctas mejora la eficiencia de los nutrientes, reduciendo la dependencia de insumos externos. Los principales hallazgos indican que la fijación biológica de nitrógeno, las dietas pastoriles, la carga animal y la acumulación de fósforo en el suelo son variables clave que afectan la eficiencia y los impactos ambientales.

Met hierdie studie word daar gekyk na die rol van die Britse Military Intelligence Division en meer spesifiek sy onderafdeling, die Field Intelligence Department (FID) in Suid-Afrika, tydens die Anglo-Boereoorlog van 1899-1902. Daar word gewys op die goeie werk voor die oorlog. Die rol wat die FID in die Britse nederlae van "Black Week" (10 tot 15 Desember 1899) gespeel het, kry vervolgens aandag. Die nederlae van "Black Week" word hoofsaaklik toegeskryf aan die offisiere se gebrek aan waardering vir behoorlike intelligensie deur verkenners en hul ongegronde optimisme oor die vermoëns van hul eie troepe. Met lord Frederick Roberts se vervanging in Januarie 1900 van sir Redvers Buller as opperbevelhebber van die Britse troepe in Suid-Afrika het taktiese intelligensie dramaties verbeter. Die Boere se nuwe tipe oorlogvoering, naamlik 'n guerrillakryg, het nuwe eise aan die Britse oorlogspoging gestel. Lt.kol. David Henderson het as direkteur van die FID 'n groot bydrae tot die doeltreffendheid van die intelligensiestelsel gelewer. Inligting is veral verkry van Boere wat as spioene in die kommando's opgetree het en swart mense. Ten slotte word die waarde vir die Intelligensiediens bepaal van inligting uit enkele Boere-dagboeke wat in hulle hande geval en deur hulle vertaal is.

This study investigates the role played by the British Military Intelligence Division and more specifically, its subdivision, the Field Intelligence Department, in South Africa during the Anglo-Boer War of 1899-1902. It starts with a brief overview of the sound work done by this division prior to the war. In 1896, an important new dispensation dawned with the appointment of Maj.-Gen. Sir John Ardagh as Director of Military Intelligence. Despite a limited budget the Military Intelligence Division did excellent work. Between 1896 and 1899 it prepared twelve reports with a view to the possibility of war in South Africa. The highlight of this preparatory work was the publication of a guide, Military notes on the Dutch republics of South Africa. The role played by the Field Intelligence Department (South Africa) in the defeats suffered by the British during "Black Week" (10 to 15 December 1899) next receives attention, as does the heavy storm of criticism that erupted in Britain over "Black Week". This criticism of the Military Intelligence Division is largely unwarranted. Given its lack offunds and authority within the War Office it accomplished much, notably its accurate findings on the number of Boers liable for miltary service, the number and types of Boer armaments and the intentions of the Boer military leaders. There was indeed an initial lack of accurate mapping of the probable operational area. However, in the last eighteen months of the war the Topographical Section issued several maps, based on existing maps and reconnaissance, compiled for the most part by intelligence officers of the various columns. When Lord Roberts replaced Gen. Sir Redvers Buller as commander-in-chief of the British troops in South Africa in January 1900, intelligence improved dramatically. The Boers'guerrilla warfare from the mid-1900s forced Roberts to apply counter-guerrilla tactics and split his force into smaller mobile units to gain better intelligence about Boer assaults. Between February 1901 and the end of the war on 31 May 1902, Lt.-Col. David Henderson the Director of the Field Intelligence Department (South Africa) made an important contribution to the effectiveness of the intelligence system. He divided the operational area into four districts - the Transvaal, Orange River Colony, the Cape Colony south of the Orange River, and Kimberley. These districts were then subdivided into sub-districts. A staff officer was placed in charge of each and was given the responsibility of collecting information on the enemy in his sub-district. It was his duty to supply the columns with interpreters, guides, scouts and maps. He also had to pass on relevant information receivedfrom his own agents, from columns in adjoining districts, and from headquarters in Pretoria. The staff officer was also required to send a telegraph to Henderson on Sunday evenings, providing a weekly summary of the situation in his sub-district. Where did the Field Intelligence Department (South Africa) get its information other than from its own scouts? It is clear that some Boers acted as British spies and there is also evidence that black people provided the department with information. An important source on intelligence activity was the private diaries and other documents that were confiscated from Boer prisoners of war. The point also made is that even when scouts gained valuable intelligence, problems arose with communication and this caused operations to fail. During the guerrilla phase the number of people working for the Field Intelligence Department (South Africa) increased dramatically, largely because the independent units now had their own intelligence officers. The department did good work in South Africa, but the Boer intelligence system was so efficient that they were able to outmanoeuver the British troops, even when the Field Intelligence Department (South Africa) had accurate intelligence of their strength and disposition. In conclusion, two diaries taken from Boer prisoners of war that were translated by the Intelligence staff are analysed to determine their possible value for British intelligence.

Road contracts are not always delivered within time, on budget and to the required quality. Consequently, the aim of this study was to develop a Public Road Contract Management Framework for the Zambian Construction Industry (ZCI) to facilitate timely completion of roadworks, which are executed to the desired quality, and at the budgeted cost. The study adopted a sequential exploratory research design to identify and determine the associated challenges and critical success factors (CSFs), respectively, in the ZCI. This was achieved by initially conducting an extensive literature review. Ranking the data obtained from 92 respondents via a survey questionnaire revealed the following as some of the major challenges: viability of strategic plans being affected by political regime changes, failure to allocate the contract with the required funds, lengthy payment processes, and lack of reviews to document lessons learnt and best practices. Some of the top CSFs were the following: preparation of comprehensive feasibility studies, allocating the contract with the required funds in the budget, adequate funding during implementation, and enhanced record keeping. The developed framework was validated by seven experts through a Delphi technique. The Spearman correlation coefficient showed that there was a strong positive relationship of 0.776 between contract implementation and monitoring and control.

Resumen Introducción: Las bahías bioluminiscentes en Puerto Rico desempeñan un papel socioeconómico importante y disminuciones del dinoflagelado bioluminiscente dominante Pyrodinium bahamense son preocupantes. Los estudios muestran proliferaciones erráticas débilmente correlacionadas con factores ambientales locales. Objetivos: Cuantificar cambios en la densidad de dinoflagelados a largo plazo en la Laguna Grande de Fajardo (LGF), comprender cómo el ambiente marino modula esos cambios y determinar los impactos de eventos climáticos extremos en la densidad de dinoflagelados. Métodos: Se recolectaron muestras bimestrales del 2016-2021 en tres sitios de la LGF. La densidad se estimó mediante el conteo de células de Sedgewick Rafter. Condiciones ambientales se obtuvieron de la estación Río Fajardo 5007100 y de la boya NOAA 41056. El clima marino y los indicadores bióticos se obtuvieron por mediciones de teledetección. Se utilizaron correlaciones Kruskal Wallis, Spearman y las correlaciones cruzadas en los registros de campo corto y proxy largos para evaluar los controles ambientales en las proliferaciones de dinoflagelados LGF. Resultados: En seis años de monitoreo se encontraron densidades bajas entre el 2016-2017 y proliferaciones frecuentes e intensas en 2018-2021 marcadas por huracanes. Se registraron valores bajos a finales del invierno, en contraste con valores más altos a finales del verano (agosto-noviembre). Vientos ligeros y la respuesta de capas mixtas al calentamiento estacional en forma de mareas altas y baja salinidad, mantienen la reproducción de los dinoflagelados. Conclusiones: Los dinoflagelados bioluminiscentes son vitales para el turismo costero y requieren manejo de los recursos. En general: 1) los recuentos de dinoflagelados fluctúan ampliamente, 2) los dinoflagelados fluorescentes son sensibles a las condiciones ambientales debido a su estacionalidad limitada y estrecho rango fisiológico, 3) los huracanes juegan un rol de rastrillar y refrescar la laguna costera para su posterior reproducción, y 4) fluctuaciones intra-estacionales se relacionan con las condiciones termodinámicas aire-mar, el balance de salinidad y el nivel del mar.

Abstract Introduction: Bio bays in Puerto Rico play an important socio-economic role and declines in dominant bioluminescent dinoflagellate Pyrodinium bahamense are concerning. Studies show erratic blooms with is weak correlation to in situ environmental factors. Our study examines shorter field and longer proxy records on dinoflagellate density at Laguna Grande de Fajardo (LGF). Objectives: To quantify temporal changes in dinoflagellate density in a long-term monitoring study, understand how the marine environment modulates those changes, and determine the wider impacts of a fluctuating climate and extreme events on proxies for dinoflagellate density. Methods: Bimonthly samples were collected from 2016 to 2021 at three sampling sites in LGF. Dinoflagellates density was estimated by Sedgewick Rafter counting cells. Environmental conditions were obtained from Rio Fajardo 5007100 station and NOAA buoy 41056. Marine climate and biotic proxies were obtained from remote sensing measurements. Kruskal Wallis, Spearman correlations and cross-correlations in the shorter field and longer proxy records were used to evaluate environmental controls on LGF dinoflagellate blooms. Results: Six years of field monitoring densities found a low period in 2016-2017, frequent and intense blooms in 2018-2021 punctuated by hurricanes. Generally low values were recorded in late winter in contrast with higher values in late summer (Aug-Nov). Light winds and mixed layer response to seasonal warming in the form of high tides and low salinity, were found to sustain dinoflagellate reproduction. Conclusions: Bioluminescent dinoflagellates are vital to coastal tourism and require resource management. LGF results show that: 1) dinoflagellate counts fluctuate widely, 2) fluorescing dinoflagellates are sensitive to environmental conditions because of limited seasonality and narrow physiological range, 3) hurricanes play a role by ‘raking and refreshing’ the coastal lagoon for subsequent biotic reproduction, and 4) intra-seasonal fluctuations of density and proxies relate to air-sea thermodynamic conditions, the salinity budget and sea level.

Resumen La conservación preventiva se basa en evitar o minimizar el deterioro de bienes culturales mediante el control de riesgos. Se analizaron los métodos de conservación utilizados en proyectos arqueológicos y colecciones en Paraguay, enfocándose en los sistemas de almacenaje y exhibición del material. Se estudiaron casos en Santa Rosa de Lima (Misiones) y Asunción, junto con un proyecto de reorganización de una colección museística. En la selección de materiales, se consideraron criterios de conservación, compatibilidad, estabilidad y disponibilidad en el mercado local. Se identificaron patrones similares mejorables para futuros proyectos, como la necesidad de contemplar el almacenaje dentro del marco de excavación e incluir presupuesto para conservación con personal especializado, facilitando así la posterior inserción de estas colecciones en museos accesibles a la comunidad. Para la colección museística, se busca mejorar progresivamente el sistema de almacenaje y las condiciones de los espacios disponibles. La aplicación de estas estrategias podría tener un impacto positivo en la gestión de materiales arqueológicos, tanto en campo como en su depósito definitivo.

Abstract Preventive conservation focuses on avoiding or minimizing the deterioration of cultural assets through risk control. Conservation methods used in archaeological projects and collections in Paraguay were analyzed, focusing on storage and exhibition systems. Case studies were conducted in Santa Rosa de Lima (Misiones) and Asunción, along with a reorganization project of a museum collection. In the selection of materials, conservation criteria, compatibility, stability, and availability in the local market were considered. Similar patterns were identified that could be improved for future projects, such as the need to consider storage within the excavation framework and include budget for conservation with specialized personnel, thus facilitating the subsequent insertion of these collections in museums accessible to the community. For the museum collection, the aim is to progressively improve the storage system and the conditions of available spaces. The application of these strategies could have a positive impact on the management of archaeological materials, both in the field and in their final storage.

RESUMEN Paraguay ha aumentado la inversión en educación en la última década por medio del Fondo Nacional de Inversión Pública y Desarrollo (FONACIDE) cuya finalidad consiste en abordar las carencias que afectan a la educación paraguaya. Entonces, considerando la creciente preocupación por la gestión de los recursos públicos dada la escasa infraestructura y el deficiente servicio del almuerzo escolar, en este trabajo se pretende analizar la eficiencia de la gestión de los gastos públicos en educación del FONACIDE de los departamentos de Paraguay durante el período 2015 a 2017, a través de la aplicación de la técnica Data Envelopment Analysis (DEA) con análisis de ventana y retornos variables de escala con orientación producto. La técnica DEA con análisis de ventana consiste en medir el nivel de eficiencia de varias Decision Making Units (DMUs) en diferentes períodos de tiempo basado en el principio de promedios móviles. Los resultados muestran que la ineficiencia técnica pura media nacional es del 11,04%, por tanto, los departamentos en general podrían mejorar sus indicadores educativos utilizando los mismos niveles de financiamiento. Además, el mayor acceso a recursos no está vinculado a mejores rendimientos educativos. Por tanto, para potenciar el rendimiento educativo es necesario establecer otros criterios de redistribución presupuestaria del FONACIDE, considerando la necesidad de infraestructura y número de alumnos matriculados por departamento.

ABSTRACT Paraguay has increased investment in education over the past decade through the National Fund for Public Investment and Development (FONACIDE), whose goal is to address the deficiencies affecting Paraguayan education. Considering the growing concern over the management of public resources given the inadequate infrastructure and poor school lunch service, this paper aims to analyze the efficiency of public spending management in education by FONACIDE in the departments of Paraguay during the period 2015 to 2017. This is achieved through the application of the Data Envelopment Analysis (DEA) technique with window analysis and variable returns to scale with product orientation. The DEA technique with window analysis measures the efficiency level of several Decision-Making Units (DMUs) over different periods based on the moving averages principle. The results show that the average national pure technical inefficiency is 11.04%, meaning that the departments, in general, could improve their educational indicators using the same funding levels. Additionally, greater access to resources is not linked to better educational outcomes. Therefore, to enhance educational performance, it is necessary to establish other budget redistribution criteria for FONACIDE, considering the need for infrastructure and the number of enrolled students per department

This work seeks to highlight the increase in the cost of social housing due to new regulations and laws in the last 20 years. For this reason, norms and laws that have a significant percentage of the direct cost of construction were chosen. Subsequently, each law and regulation is studied by identifying in the general budget the items that are affected, modifying these items and comparing them with the original ones to see if the direct cost of construction increases. This increase is translated into percentages, which are then applied to the base cost of each housing complex to see how much the cost varies. This process is done on a budget of 228 houses that were built in the Bío Bío region and in a condominium of 5 buildings in the Ñuble region. This is evaluated and compared with the amount of the housing subsidy provided by SERVIU. Additionally, an analysis of the subsidies that have been provided to vulnerable families in Chile in the last 20 years is considered. Finally, the types of subsidies that are given to each region, what are the amounts given to each family and how many subsidies are given in the study regions are evaluated.

Este trabajo busca poner en evidencia el alza en el costo de viviendas sociales por nuevas normativas o leyes en los últimos 20 años. Es por ello que se eligen normas y leyes que tienen un porcentaje significativo de influencia sobre el costo directo de la construcción. Posteriormente, se estudia cada ley y norma identificando en el presupuesto general las partidas que son afectadas, se modifican estas partidas y se comparan con las originales para ver si aumenta el costo directo de la construcción. Este aumento se traduce a porcentajes, que luego son aplicados al costo base de cada conjunto de viviendas para saber cuánto es lo que varía dicho costo. Este proceso se hace en un presupuesto de 228 casas que se construyeron en la región del Bío Bío y en un condominio de 5 edificios de la región del Ñuble. Esto se evalúa y se compara a su vez con el monto del subsidio habitacional entregado por el SERVIU. Adicionalmente, se considera un análisis de los subsidios que han sido entregados a las familias vulnerables de Chile en los últimos 20 años. Evaluando los tipos de subsidios que se entregan a cada región, cuáles son los montos entregados a cada familia y cuantos subsidios se entregan en las regiones de estudio.

Resumen La nueva estructura de la migración internacional en el siglo XXI hace que los gobiernos locales se enfrenten a muchos desafíos. Las restricciones legales, las limitaciones presupuestarias y los determinantes sociales y estructurales juegan un papel en la respuesta de las ciudades a la migración internacional. Los municipios utilizan diferentes estrategias tanto para desarrollar respuestas a la inmigración como para hacer frente a las llamadas restricciones. Si bien la cooperación y la colaboración con organizaciones no gubernamentales son las vías preferidas por los municipios, en este estudio estas estrategias se analizan en el contexto de la búsqueda de foros. Se analiza el papel de la Asociación de Solidaridad con Inmigrantes (Göçmendd), apoyada por la Municipalidad de Şişli, y el de la Asociación de Asistencia y Solidaridad para Refugiados y Solicitantes de Asilo (Mülteciler), establecida por la Municipalidad de Sultanbeyli, ambas organizaciones representativas en los acuerdos de gobernanza migratoria de Estambul.

Abstract The new structure of international migration in the 21st century forces local governments to cope with a range of challenges. Legal restrictions, budget constraints, and social and structural determinants all play a role in cities’ response to international migration. Municipalities use an array of strategies to develop responses to immigration and cope with restrictions. While cooperation and collaboration with non-governmental organizations are the strategies of choice for municipalities, in this study, these strategies are analyzed within the context of venue shopping. The role of the Migrant Solidarity Association (Göçmendd), supported by Şişli Municipality, and the Refugee and Asylum Seekers Assistance and Solidarity Association (Mülteciler), established by Sultanbeyli Municipality, are analyzed. Both organizations are representatives in the Istanbul migration governance arrangements.

Abstract: The Chilean political-administrative organization, highly centralized and presidential, is undergoing significant transformations. In 2021, the first democratic elections for regional governors were held, and, at the same time the country embarked on a constituent debate that addressed the political-administrative structure, although, without positive results. This article analyzes the regulatory changes on the powers of the sub-national levels of government in Chile, including their budget structure, the main debates occurred in the constitutional proposals, and the opinion on these issues expressed by key social actors from the areas of Maule, Chiloe and Aysen. This analisys includes quantitative and qualitative data, processed through content and discourse analysis, for each of the three administrative levels of the country: region, province and commune. The results show that the commune is the first level of interaction between citizens and the Chilean institutions, although it has few resources and generates evident clientelist relationships that must be prevented. The province only performs administrative functions, with very few powers and resources. Finally, the region is consolidating its autonomy, although there is still significant confusion about its powers, operation, resource management, and oversight mechanisms, also showing significant tensions with the national government.

Resumen: La organización político-administrativa chilena, centralizada y presidencialista, se encuentra bajo transformaciones significativas. En 2021 se realizaron las primeras elecciones democráticas de gobernadores/as regionales, una larga demanda de las comunidades regionales y locales. Paralelamente, el país se embarcó en un proceso de discusión constituyente que debatió la estructura político-administrativa, pero que finalizó sin resultados positivos en 2023. El presente artículo analiza los cambios ocurridos en los niveles subnacionales de gobierno en Chile, incluyendo sus normativas, atribuciones, recursos, las principales ideas emergidas de los debates constituyentes y la opinión sobre el tema de actores sociales clave de las zonas de Maule, Chiloé y Aysén. Se incorporan datos cuantitativos y cualitativos procesados mediante análisis de contenido y de discurso para en cada uno de los niveles: región, provincia y comuna. Los resultados muestran que la comuna es el primer nivel de interacción entre los ciudadanos y la institucionalidad, aunque posee escasos recursos y genera relaciones clientelares que deben prevenirse. La provincia sólo cumple funciones administrativas, con muy pocas atribuciones y recursos. Finalmente, la región está consolidando su autonomía, aunque aún hay significativas confusiones sobre sus atribuciones, funcionamiento, manejo de recursos y mecanismos de fiscalización, mostrándose, además, tensiones significativas con el gobierno nacional.

Abstract Introduction: Heart failure (HF) is a global public health issue. Its economic impact in the Autonomous Region of Madeira (ARM) is unknown. Thus, profiling HF prevalence, healthcare utilization and related costs in the ARM is fundamental. We aimed to estimate the direct costs of HF in the ARM. Methods: Prevalence-based, cost-of-illness study based on 2014, from the health system perspective. Hospitaliza-tion and emergency department (ED) episodes were identified by the International Classification of Diseases 9th edition - Clinical Modification (ICD-9-CM). Patterns of visits, tests and medication consumption were derived from previous reported research. Costs were based on Disease Related Groups and from the official regional health system tariffs. Results: There was a 4.93% prevalence above the age of 25 (9201 patients). Out of these, 4140 were symptomatic and hence healthcare consumers. We identified 426 admissions with a primary diagnosis of HF, 17 305 primary care medical visits, 857 ED visits and 6707 medical hospital visits. Total direct costs were €4 089 540.10. Hospital-related care was responsible for the majority of costs (56%), followed by primary care costs (23%), medication (20%) and long-term care (2%). The average annual cost per patient was €987.81. Conclusion: Total annual direct costs amounted to 0.1% of the gross domestic product of the ARM and 1.2% of the healthcare budget of the ARM for 2014. This research adds information about the disease that was until now unknown and should lead to better disease management programs.

Resumo Introdução: A insuficiência cardíaca (IC) é um problema global de saúde pública. Desconhece-se o impacto económico da IC na Região Autónoma da Madeira (RAM) pelo que é fundamental caracterizar a sua prevalência, perfil de utilização de recursos e custos associados. O nosso objetivo foi estimar os custos diretos da insuficiência cardíaca na Região Autónoma da Madeira. Métodos: Estudo custo-doença, baseado em prevalência, relativo ao ano 2014, e analisado na perspetiva do sistema de saúde regional. Os internamentos e a utilização da urgência foram identificados pela International Classification of Diseases 9th edition Clinical Modification (ICD-9CM). O número de consultas, exames e medicação foi estimado a partir da literatura. Os custos foram baseados na tabela de preços dos Grupos de Diagnósticos Homogéneos e na tabela de preços do Sistema Regional de Saúde. Resultados: Estimou-se uma prevalência de 4,93% (9201 indivíduos) para uma população com idade superior a 25 anos. Destes, 4140 sintomáticos e, portanto, consumidores de recursos. Identificaram-se 426 internamentos por IC, 17 305 consultas médicas de cuidados de saúde primários, 857 episódios de urgência e 6707 consultas médicas hospitalares. O custo direto total foi €4 089 540,10. O custo em cuidados hospitalares (CH) foi a principal rubrica de custos (56%), seguido dos cuidados de saúde primários (23%) e consumo de medicamentos (20%). O custo médio anual por doente foi €987,81. Conclusão: O custo direto total corresponde a 0,1% do produto interno bruto da RAM e 1,2% da despesa da saúde da RAM para o ano de referência. Estes resultados fornecem informação até aqui desconhecida e poderão auxiliar na implementação de modelos e estruturas que promovam a redução das hospitalizações, principal motor de custos diretos.

RESUMEN El artículo examina la necesidad de introducir la presupuestación por programas, como parte de un proceso más amplio de modernización de las finanzas públicas en Cuba. Dentro de los factores que hacen necesaria su implementación están los nichos de eficiencia del gasto público y la desconexión entre el sistema presupuestario y el sistema de planificación. Esta metodología presupuestaria se orienta a la gestión basada en resultados, permitiendo analizar la productividad del gasto público durante el ejercicio fiscal. Asimismo, su introducción serviría al propósito de calzar financieramente la arquitectura establecida a través de macroprogramas, programas y proyectos, fortaleciendo la correspondecia entre planificación y presupuestación. Se concluye que el éxito en su implementación está condicionado por la existencia de problemas en el entorno macroeconómico, institucional y regulatorio.

ABSTRACT The article examines the need to introduce budgeting by programs, as part of a broader process of modernization of public finances in Cuba. Among the factors that make its implementation necessary are the niches of efficiency in public spending and the disconnection between the budget system and the planning system. This budgetary methodology is oriented towards results based management, making it possible to analyze the productivity of public spending during the fiscal year. Likewise, its introduction would serve the purpose of financially fitting the architecture established through Macroprograms, programs and projects, strengthening the correspondence between planning and budgeting. It is concluded that the success in its implementation is conditioned by the existence of problems in the macroeconomic, institutional and regulatory environment.

RESUMEN La industria del tabaco, como cualquier otra, es participe del producto interno bruto y la generación de empleo en cualquier país. No obstante, los gobiernos han establecido mecanismos fiscales para erradicar su consumo, debido a las enfermedades que ocasiona como cáncer pulmonar, bronquitis crónica; lo que puede llevar a la muerte. En este sentido, se propone una aplicación de un modelo de externalidades para la producción de tabaco en México. Se obtuvieron dos mecanismos para la erradicación del tabaco, uno de ellos implica que las empresas disminuyan salarios de los trabajadores por el aumento de impuestos; el segundo, aumentar precios del tabaco permitiendo que las empresas equilibren su presupuesto. Ambos mecanismos implican un desajuste presupuestal para los ciudadanos, pero el segundo es una solución socialmente optima, pues solo se ven afectados los consumidores de tabaco y no así los que dependen del empleo y salario de la empresa.

ABSTRACT The tobacco industry, like any other, is a participant in the gross domestic product and the generation of employment in any country. However, governments have established fiscal mechanisms to eradicate its consumption, due to the diseases it causes such as lung cancer, chronic bronchitis; what can lead to death. In this sense, an application of an externalities model for tobacco production in Mexico is proposed. Two mechanisms were obtained for the eradication of tobacco; one of them implies that companies reduce workers' wages due to the increase in taxes. A second is to increase tobacco prices allowing companies to balance their budget. Both mechanisms imply a budget imbalance for citizens, but the second is a socially optimal solution, since only tobacco users are affected and not those who depend on the company's employment and salary.

The Fourth Industrial Revolution (4IR) has ushered in a transformative era for industries worldwide, including the water sector. This paper investigates the difficulties that are encountered and the changes that are required in water sector supply chain management amid the 4IR. A comprehensive analysis of scholarly articles, research papers, and industry reports provides insights into the evolving dynamics of water supply chains. The review identifies challenges such as data integration complexities, cybersecurity vulnerabilities, budget constraints, regulatory intricacies, skills gaps, environmental sustainability concerns, infrastructure compatibility issues, data privacy dilemmas, resource limitations, socio-political factors, and geographical disparities. These are critically examined within their contextual frameworks, highlighting their significance for the water sector. This paper is valuable for researchers, policymakers, water utility professionals, and stakeholders seeking a comprehensive understanding of water sector supply chain management's intricate challenges and transformative changes during the 4IR. This paper could also assist in illuminating water-related problems and solutions.

Die Vierde Industriële Revolusie (4IR) het 'n transformerende era vir nywerhede wêreldwyd ingelui, insluitend die watersektor. Hierdie artikel delf in die uitdagings wat teëgekom word en die veranderinge wat nodig is in watersektor voorsieningskettingbestuur te midde van die 4IR. 'n Omvattende ontleding van vakkundige artikels, navorsingsartikels en bedryfsverslae bied insig in die ontwikkelende dinamika van watervoorsieningskettings. Die oorsig identifiseer uitdagings soos data integrasie kompleksiteit, kwesbaarheid met betrekking tot kuberveiligheid, begrotingsbeperkings, regulatoriese verwikkeldheid, vaardigheidsgapings, omgewingsvolhoubaarheidskwessies, infrastruktuurversoenbaarheidskwessies, data-privaatheidsdilemmas, hulpbronbeperkinge, sosio-politieke faktore en geografiese ongelykhede. Dit word krities ondersoek binne hul kontekstuele raamwerke, wat hul betekenis vir die watersektor beklemtoon. Hierdie artikel behoort waardevol te wees vir navorsers, beleidmakers, professionele mense in waternutsdienste en belanghebbendes wat 'n omvattende begrip soek van watersektorvoorsieningskettingbestuur se ingewikkelde uitdagings en transformerende veranderinge tydens die 4IR. Hierdie artikel kan ook help om waterverwante probleme en oplossings te belig.