121 research outputs found

    La Rosa custodiada. Participación ciudadana y gestión pública en Reus 1999-2003

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    El presente trabajo tiene como objetivo principal la exploración de un ámbito de interacción poco definido y acaso ambiguo, que es complejo y difuso, pero que sin duda resulta emergente y central para el actual ejercicio político: es el referido a la participación de los ciudadanos en la gestión pública local. Trata sobre todo, de relaciones, formas y canales, de actores y sectores que interactúan, y que, en el caso que nos ocupa, tiene como protagonistas principales a la clase política y sus brazos técnico-ejecutivos del Ajuntament, a las diversas entidades civiles y a la ciudadanía no organizada. Son estos los sectores o actores que inciden localmente en la vida pública de Reus, lugar donde se realizó este trabajo, una ciudad que concentra casi toda la población del municipio del mismo nombre, situado en la Cataluña meridional, y por lo tanto, dentro del ámbito político español y europeo, cuya influencia ha sido y sigue siendo muy relevante en la vida local. Un sitio donde el tema participativo mantiene una particular relevancia, motivada por sus nutridos antecedentes históricos de implicación de la población en la vida pública y política, incluso más allá de lo local; donde hasta hoy existe una intensa actividad participativa de variada raigambre que se canaliza por vías ciudadanas.La tesis comprende siete capítulos temáticos, más un octavo y final de conclusiones, seguido de bibliografía. El primero corresponde a la propuesta teórica y metodológica que fundamenta nuestro estudio, revisando primeramente las aportaciones que desde la antropología se han hecho para el estudio de los fenómenos políticos, para luego, en un segundo apartado, referir los aspectos metodológicos. El segundo contiene una necesaria reflexión teórica sobre el tema de la participación, repasando la evolución histórica de conceptos como el espacio de lo público, el carácter de la ciudadanía y los cambios en la concepción de la democracia, centrando la exposición en el contexto europeo. Revisa también sus implicaciones para un momento como el actual, caracterizado, entre otras cosas, por el surgimiento de lo "glocal", que alude a la forma en que influencias lejanas inciden en el nivel local. El tercero, abocado más específicamente a nuestro estudio de caso, explora las raíces históricas mediante las cuales en Reus se ha estructurado lo político, abarcando para tal objetivo tanto hechos históricos previos a su conformación como ciudad, como situaciones diferenciales derivadas de su condición catalana dentro del Estado Español. Las particularidades del sistema político español constituyen a su vez el tema del cuarto capítulo, que describe sus actuales bases enfatizando en torno a la repartición de competencias entre los distintos niveles que lo estructuran en el marco del Estado de las Autonomías.El quinto ("En nom de la Rosa"), ofrece una semblanza de la ciudad de Reus en sus aspectos etnográficos más generales, incluyendo, además de elementos impresionistas, una descripción de sus aspectos básicos como núcleo urbano y poblacional. El sexto ("Desde la Plaça del Mercadal") presenta un panorama de la forma en que la gestión pública es asumida a nivel local por el Ajuntament de Reus, presentando especial atención a aspectos que consideramos relevantes para el tema de la participación. Un séptimo intenta resumir posiciones rescatadas desde la ciudadanía organizada y no, describiendo el mundo asociativo ciudadano de Reus y las expectativas que los ciudadanos tienen sobre las posibilidades de participar en la gestión que se realiza desde el Ajuntament. Finalmente, el octavo y último capítulo presenta conclusiones derivadas de nuestro estudio, en plan de reflexiones y lineamiesntos para la implementación de experiencias participativas en el nivel local.The main purpose of the present work is to explore a field of interaction which, although poorly defined and perhaps ambiguous because of growing importance to current political praxis: citizen participation in local public government. The study deals specifically with relationships, means and channels, and links between interacting actors and sectors. The political class, the technical and administrative personnel of the Ajuntament or municipality, the variety of civil associations and the non-organized citizens are the protagonists of this study. They are the local actors that shape public life in Reus, a city that hosts almost the entire population of the municipality of the same name, located in the south of Catalonian and, therefore, within the political influence of Spain and the European Union, which remains strong over the local level. It is also a place where public participation still has special importance due to a very rich local history of commitment and participation of the people of Reus in political and public life beyond the local level.The thesis contains seven thematic chapters and a conclusion, followed by the bibliography. The first chapter discusses the theoretical and methodological issues related to our study, reviewing some contributions from anthropological visions to the study of the political, followed by the methodological aspects of our work in terms of time and ethnographic techniques. The second chapter consist of a necessary theoretical reflection on the subject of participation, the historical evolution of concepts and terms such as public space, the nature of citizenship, and changes in the idea of democracy, all within the European context and paying special attention to the implications that issues of participation have in actuality considering, among others, the emergence of the "glocal", which alludes to how far external influences act on local levels, including the political arena. The third chapter, which refers more directly to our case study, explores the historical roots of political power in Reus, from ancient times to the present, and explores the special situation of this city as a municipality within Spain and Catalonia. The particularities of the current Spanish political system are the topic of the fourth chapter, focusing on the repartition of competences between the different levels that compose it, in the model of the "Estado de las Autonomías".The fifth chapter ("En nom de la Rosa"), offers a general assessment of the city of Reus from an ethnographic perspective, it also includes an overviewof its basic urban and demographical issues, the economics of the city and the political behaviour of its habitants. The sixth chapter ("Desde la Plaga del Mercadal"), presents a panoramic review of the current organization within the public government at the local level in the Ajuntament de Reus, stressing aspects related to issues of participation. The seventh chapter summarizes the viewpoints of organized and non-organized citizens, describing the associative world of citizens in Reus, and their expectations regarding the possibilities of participating in the management of public interests from the municipal gooovernment. Finally, the eighth and final chapter presents some conclusions derived from our study, in the form of reflections and recommendations or considerations for the implementation of participative experiences at the local level

    Conocimiento de la inteligencia artificial en la auditoría financiera de las empresas manufactureras de Víctor Larco Herrera, Trujillo 2022

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    En la presente tesis titulada: “Conocimiento de la inteligencia artificial en la auditoría financiera de las empresas manufactureras de Víctor Larco Herrera, Trujillo 2022.” Su principal objetivo fue determinar la incidencia del conocimiento de la inteligencia artificial en la auditoría financiera de las empresas manufactureras de Víctor Larco Herrera, Trujillo 2022. La metodología fue del tipo básica, no experimental cuantitativa, la población estuvo conformada por las empresas manufactureras del distrito Víctor Larco Herrera en el año 2022 y la muestra fueron empresas de los principales rubros manufactureros del distrito. En los resultados se llegó determinar que existe una incidencia alta del 57% entre las variables conocimiento de la inteligencia artificial y la auditoría financiera, también existe una significativa correlación positiva moderada de 0.759 entre las variables. Concluyendo que ante la alta incidencia entre las variables de estudio es fundamental tener en cuenta que frente al uso e implementación de nuevas tecnologías es posible que se reduzcan las fallas y permitirá que el trabajo del contador sea más eficiente y eficaz

    Versatility of the estlander flap: upper lip, lower lip and comissure reconstruction due to a dog bite

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    Background: Dog bites continue to be a frequent cause for plastic and reconstructive services in the world. The grand majority of these cases affect the head and neck area; and more often than not they involve the commissure and the lips. The latter leading to an increased level of difficulty and a substantial decrease on the posibilities for a successful reconstruction. This case report focuses on the exploration of the Abbe-Estlander flap as an efficient alternative in most of these cases.Methods: We present two clinical cases involving dog bites where the affected area of both patients was estimated to be one third of the total volume of the lip. Both patients required emergency reconstructive surgery. An Estlander flap was successfully performed in both instances. The purpose of the article is to share the results and motivate the medical community to continue to use this method as a strong avenue for an effective recovery.Results: After two months of the surgery, the team followed up with both patients and they were satisfied with the results. Patient A presented adequate healing of the wound; a lack of alignment of the mucocutaneous rim and rounding of the commissure was observed. Phonation, oral continence without any leakage and complete closure of the lip were also part of the recovery assessment. Patient B presented adequate healing of the wound, phonation and medium oral continence with occasional leakage of liquids and incomplete closure.Conclusions: The Abbe-Estlander flap is still an excellent reconstructive alternative for upper and lower lip reconstruction where the affected area is up to one third of the total volume. As long as the commissure involvement represents minimum difficulty, both aesthetic and functional objectives can be successfully attained using this flap

    Bienestar de oro: Una propuesta para mejorar la calidad de vida del adulto mayor de Lima Metropolitana

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    Bienestar de Oro a través de su plataforma permitirá al adulto mayor mantenerse activo y saludable, con las actividades que ofrece a libre elección, con contenidos variados y renovados de forma permanente a propuesta del usuario. Además busca familiarizar al adulto mayor en tecnología mediante una capacitación gratuita en el uso de redes sociales y en las funciones básicas para el uso de su smartphone. Se resume el proceso mediante el cual se identificó, en las personas adultas mayores la necesidad de interactuar con nuevas personas y desarrollar actividades que le permitan salir de la rutina, en base a ello se planteó la solución con el uso de metodologías ágiles lo cual generó un modelo de negocio sostenible. La propuesta se llama Bienestar de Oro, solución innovadora, que ofrece a las personas adultos mayores una forma digital, fácil y sencilla de adquirir diferentes actividades desde el lugar donde se encuentre a través de su smartphone, cuyo propósito es impartir conocimientos y a su vez brindar la posibilidad al adulto mayor de generarse ingresos impartiendo conocimiento a otros adultos mayores. Nuestro público objetivo son personas mayores de 60 a 75 años de los niveles socioeconómicos alto, medio alto y medio que aún trabajan, buscan mantenerse activos, tienen interés por aprender, enseñar sus conocimientos y experiencias. El proyecto se desarrollará en Lima Metropolitana; iniciará con 1,954 usuarios en el año 1 y 45,474 usuarios al año 5, atracción de usuarios generada a través de una inversión publicitaria en marketing digital y medios publicitarios tradicionales. En cuanto al entorno competitivo, los servicios para el adulto mayor se presentan a través de la oferta pública y privada en el país, en donde las actividades que ofrece Bienestar de Oro en las entidades se ofrecen como actividades complementarias o como servicios principales. En ambos casos buscan mejorar la calidad de vida de las personas adultas mayores. En el proceso de diseño, se validó la hipótesis de deseabilidad realizando pruebas de uso del prototipo con el usuario, donde la aplicación tuvo aceptación, dado que es fácil de usar, es amigable y satisfacen las necesidades del usuario. Asimismo se validó la hipótesis de factibilidad, donde el plan de mercadeo generará un retorno de ingresos mayor a la inversión en publicidad para captar nuevos usuarios cada año. Por último, Bienestar de Oro es un proyecto financieramente viable ya que inicia con una inversión de S/2,049,373 soles, incrementa volumen de ventas con flujos financieros exponenciales en una proyección de cinco años, con una VAN de S/3,927,751 soles y una TIR del 39%; asimismo, un VAN Social de S/56,369,394 soles. Está alineado con alcanzar la meta 3.d de la ODS, promoviendo el bienestar mediante los talleres de yoga, baile, danzas y otras actividades físicas; 4.3 de la ODS número 4 brindando cursos sobre tecnología y emprendimiento para el adulto mayor; 8.3 de la ODS número 8 capacitándose en talleres para emprender un nuevo negocio y 10 .3 de la ODS número 10 eliminado la desigualdad y discriminación para empoderar al adulto mayor en sus capacidades y aportes a la sociedad.“Bienestar de Oro” through its platform will allow the elderly people to stay active and healthy, with activities offered a free choice. This offers varied and permanently renewed content at the user's suggestion. It also seeks to familiarize the elderly people with technology through free training in the use of social networks and the basic functions of their smartphone. In the process, it was identified that older adults need to interact with new people and develop activities that allow them to get out of the routine, based on this, the solution was proposed with the use of agile methodologies, which generated a sustainable business model. The proposal is called “Bienestar de Oro”, an innovative solution that offers elderly people a digital, easy and simple way to acquire different activities from the place where they are from their smartphone, whose purpose is to impart knowledge and in turn provide the possibility for the elderly to generate income by imparting knowledge to other elderly adults. Our target audience is people over 60 to 75 years old from high, medium-high and medium socioeconomic levels who still work, seek to stay active, have an interest in learning, teaching their knowledge and experiences. The project will be developed in Metropolitan Lima; it will start with 1,954 users in year 1 and 45,474 users in year 5. The attraction of users will be generated through an advertising investment in digital marketing and traditional advertising media. Regarding the competitive environment, services for the elderly people are presented through public and private offerings in the country, where the activities offered by “Bienestar de Oro” in the entities are offered as complementary activities or as main services. In both cases, they seek to improve the quality of life of the elderly. In the design process, the desirability hypothesis was validated by testing the use of the prototype with the user, where the application was accepted, given that it is easy to use, it is friendly and satisfies the needs of the user. Likewise, the feasibility hypothesis was validated, where the marketing plan will generate a higher return on income, which is greater than the investment in advertising to attract new users each year. Finally, “Bienestar de Oro” is a financially viable project since it begins with an investment of S/2,049,373 soles, increases sales volume with exponential financial flows in a five-year projection, with a NPV of S / 3,927,751 soles and an IRR of 39%: likewise, a social NPV of S/56,369,394 soles. It is aligned with achieving goal 3.d of SDG number 3 by promoting well-being through yoga, dance, and other physical activities workshops; 4.3 of SDG number 4, offering courses on technology and entrepreneurship for the elderly people; 8.3 of SDG number 8 by training in workshops to start a new business and 10.3 of SDG number 10 eliminated inequality and discrimination to empower the elderly people in their capacities and contributions to society

    Prediction of fatty acid composition in intact and minced fat of European autochthonous pigs breeds by near infrared spectroscopy

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    The fatty acids profile has been playing a decisive role in recent years, thanks to technological, sensory and health demands from producers and consumers. The application of NIRS technique on fat tissues, could lead to more efficient, practical, and economical in the quality control. The study aim was to assess the accuracy of Fourier Transformed Near Infrared Spectroscopy technique to determine fatty acids composition in fat of 12 European local pig breeds. A total of 439 spectra of backfat were collected both in intact and minced tissue and then were analyzed using gas chromatographic analysis. Predictive equations were developed using the 80% of samples for the calibration, followed by full cross validation, and the remaining 20% for the external validation test. NIRS analysis of minced samples allowed a better response for fatty acid families, n6 PUFA, it is promising both for n3 PUFA quantification and for the screening (high, low value) of the major fatty acids. Intact fat prediction, although with a lower predictive ability, seems suitable for PUFA and n6 PUFA while for other families allows only a discrimination between high and low values.info:eu-repo/semantics/publishedVersio

    Bipolar multiplex families have an increased burden of common risk variants for psychiatric disorders

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    Multiplex families with a high prevalence of a psychiatric disorder are often examined to identify rare genetic variants with large effect sizes. In the present study, we analysed whether the risk for bipolar disorder (BD) in BD multiplex families is influenced by common genetic variants. Furthermore, we investigated whether this risk is conferred mainly by BD-specific risk variants or by variants also associated with the susceptibility to schizophrenia or major depression. In total, 395 individuals from 33 Andalusian BD multiplex families (166 BD, 78 major depressive disorder, 151 unaffected) as well as 438 subjects from an independent, BD case/control cohort (161 unrelated BD, 277 unrelated controls) were analysed. Polygenic risk scores (PRS) for BD, schizophrenia (SCZ), and major depression were calculated and compared between the cohorts. Both the familial BD cases and unaffected family members had higher PRS for all three psychiatric disorders than the independent controls, with BD and SCZ being significant after correction for multiple testing, suggesting a high baseline risk for several psychiatric disorders in the families. Moreover, familial BD cases showed significantly higher BD PRS than unaffected family members and unrelated BD cases. A plausible hypothesis is that, in multiplex families with a general increase in risk for psychiatric disease, BD development is attributable to a high burden of common variants that confer a specific risk for BD. The present analyses demonstrated that common genetic risk variants for psychiatric disorders are likely to contribute to the high incidence of affective psychiatric disorders in the multiplex families. However, the PRS explained only part of the observed phenotypic variance, and rare variants might have also contributed to disease development

    Screening risk assessment tools for assessing the environmental impact in an abandoned pyritic mine in Spain

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    This is the author’s version of a work that was accepted for publication in Science of the Total Environment. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Science of the Total Environment 409.4 (2011): 692-703 http://dx.doi.org/10.1016/j.scitotenv.2010.10.056This paper describes a new methodology for assessing site-specific environmental impact of contaminants. The proposed method integrates traditional risk assessment approaches with real and variable environmental characteristics at a local scale. Environmental impact on selected receptors was classified for each environmental compartment into 5 categories derived from the whole (chronic and acute) risk assessment using 8 risk levels. Risk levels were established according to three hazard quotients (HQs) which represented the ratio of exposure to acute and chronic toxicity values. This tool allowed integrating in only one impact category all the elements involved in the standard risk assessment. The methodology was applied to an abandoned metal mine in Spain, where high levels of As, Cd, Zn and Cu were detected. Risk affecting potential receptors such as aquatic and soil organisms and terrestrial vertebrates were assessed. Whole results showed that impact to the ecosystem is likely high and further investigation or remedial actions are necessary. Some proposals to refine the risk assessment for a more realistic diagnostic are included.This work has been financed by Madrid Community through EIADES Project S-505/AMB/0296, and by Spanish MinistryfEducation and Science, project CTM-2007-66401-CO2/TECN

    Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic

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    [EN] Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May–September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October–December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0–4; odds ratio [OR] range = 1.23–1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0–4; OR range 1.30–1.32), and the perceived lack of healthcare center preparedness (scaled 0–4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3–57.6%. Other significant risk factors were financial stressors (OR range 1.26–1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.S

    Bacteria-inducing legume nodules involved in the improvement of plant growth, health and nutrition

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    Bacteria-inducing legume nodules are known as rhizobia and belong to the class Alphaproteobacteria and Betaproteobacteria. They promote the growth and nutrition of their respective legume hosts through atmospheric nitrogen fixation which takes place in the nodules induced in their roots or stems. In addition, rhizobia have other plant growth-promoting mechanisms, mainly solubilization of phosphate and production of indoleacetic acid, ACC deaminase and siderophores. Some of these mechanisms have been reported for strains of rhizobia which are also able to promote the growth of several nonlegumes, such as cereals, oilseeds and vegetables. Less studied are the mechanisms that have the rhizobia to promote the plant health; however, these bacteria are able to exert biocontrol of some phytopathogens and to induce the plant resistance. In this chapter, we revised the available data about the ability of the legume nodule-inducing bacteria for improving the plant growth, health and nutrition of both legumes and nonlegumes. These data showed that rhizobia meet all the requirements of sustainable agriculture to be used as bio-inoculants allowing the total or partial replacement of chemicals used for fertilization or protection of crops

    Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

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    Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations
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