Policy drift in ideologically heterogeneous governments: tax policy in Latin America / Policy drift en gobiernos ideológicamente heterogéneos: política tributaria en América Latina / Policy Drift em governos ideologicamente heterogêneos: política tributária na América Latina

Abstract The relation between taxation and partisanship is a widely studied topic in Political Science. However, previous works have provided conflicting findings without clarifying which parties are most prone to progressive taxation. These studies also did not consider one distinctive feature of Latin American politics: coalition governments. Using the level of direct tax collection as a proxy for progressive taxation and panel data of Latin American countries since 1990, we investigate how progressive taxes vary across a scale of ideology observed in the executive branch along with the ideological heterogeneity of its coalition. The results show that ideologically heterogeneous governments present a policy drift, as the policies being enacted depart from parties' original preferences. Homogeneous left-wing governments collect more direct taxes than ideologically heterogeneous coalitions led by governments with the same ideology. The same dynamic is observed with homogeneous right-wing governments, which collect more indirect taxes in ideologically homogeneous coalitions. These results create new paths of research highlighting the need to include the government's composition in the analysis to understand policy design and the need to unravel the mechanism through which policy drift occurs in ideologically heterogeneous governments.

Resumen La relación entre tributación y partidismo es un tema ampliamente estudiado en Ciencias Políticas. Sin embargo, trabajos previos han proporcionado hallazgos contradictorios sin aclarar qué partes son más propensas a la tributación progresiva. Estos estudios tampoco consideraron una característica distintiva de la política latinoamericana: los gobiernos de coalición. Utilizando el nivel de recaudación de impuestos directos como indicador de la tributación progresiva y datos de panel de los países de América Latina desde 1990, investigamos cómo varían los impuestos progresivos a lo largo de una escala de ideología observada en el poder ejecutivo junto con la heterogeneidad ideológica de su coalición. Los resultados muestran que los gobiernos ideológicamente heterogéneos presentan un policy drift, ya que las políticas que se promulgan se apartan de las preferencias originales de los partidos. Los gobiernos homogéneos de izquierda recaudan más impuestos directos que las coaliciones ideológicamente heterogéneas lideradas por gobiernos con la misma ideología. La misma dinámica se observa con gobiernos homogéneos de derecha, que recaudan más impuestos indirectos en coaliciones ideológicamente homogéneas. Estos resultados crean nuevos caminos de investigación que destacan la necesidad de incluir la composición del gobierno en el análisis para comprender el diseño de políticas y la necesidad de desentrañar el mecanismo a través del cual se produce policy drift de políticas en gobiernos ideológicamente heterogéneos.

Resumo A relação entre tributação e partidarismo é amplamente estudada na Ciência Política. Entretanto, trabalhos anteriores não só apresentaram resultados contraditórios - sem esclarecer quais partidos são mais propensos a instituir tributos progressivos - como nenhum considerou um elemento particular da política latino-americana: os governos de coalizão. Usando o nível de arrecadação com tributos diretos como uma proxy para tributação progressiva e adotando um banco de dados em painel, investiga-se a receita com tributos progressivos considerando uma escala da ideologia da liderança executiva e a heterogeneidade ideológica da coalizão que forma o governo. Os resultados indicam que governos ideologicamente heterogêneos apresentam policy drift, já que as políticas sendo implementadas se distanciam das preferências originais da liderança executiva. Governos homogêneos de esquerda têm receitas maiores com tributos diretos do que governos formados a partir de coalizão ideologicamente heterogênea sob as mesmas lideranças. A mesma dinâmica ocorre com governos homogêneos de direita, que têm receitas maiores com tributos indiretos. Os resultados indicam novos caminhos para pesquisa, destacando a necessidade de se incorporar a composição de um governo à análise de políticas públicas, como a importância de se compreender o mecanismo pelo qual policy drift ocorre em governos ideologicamente heterogêneos.

Practice of the construction of urban medical alliance in Huzhou city / 中华医院管理杂志

Promoting balanced distribution of medical resources and realizing high-quality sharing of basic medical services between urban and rural areas are an important part of common prosperity. Huzhou urban medical alliance was a new urban and rural of medical alliance mode based on level 4 vertical integration, which played an important role in the whole evolution process of the medical alliance. This medical alliance had not only broken through the " integration of counties" but also explored the " integration of cities" . It was a bridge connecting counties and cities, which was of great significance in narrowing the gap between urban and rural medical health services. The construction of urban medical alliance took digital transformation and systematic integration as two breakthroughs to comprehensively promote the upgrade of energy efficiency and benefit stacking of health governance. In 2021, the grass-roots medical utilization rate and county-level medical utilization rate were 72.7% and 90.6%. In 2020, the average hospitalization cost(8 726.7 yuan)and the average outpatient and emergency expenses(239.6 yuan)of public hospitals were 25.0% and 8.6% lower than the average level of Zhejiang Province, respectively. Although Huzhou city had broken through the restrictions of administrative divisions and actively promoted the construction of the medical alliance, and achieved phased results, there were still structural defects and institutional difficulties. In order to solve these problems, the author proposed to promote the improvement of governance structure and optimization of governance system through " three governance" and " three characteristics" , and then promote the high-quality development of urban medical alliances.

Endoscopic resection of symptomatic talocalcaneal coalition in adolescents using a posterior approach / 中华创伤骨科杂志

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

Segregar ou incluir? Coalizões de defesa, ideias e mudanças na educação especial do Brasil / ¿Segregar o incluir? Coaliciones de defensa, ideas y cambios en la educación especial en Brasil / Segregate or include? Advocacy coalitions, ideas, and changes in special education in Brazil

Resumo O artigo examina as mudanças na escolarização das pessoas com deficiência (PcD) no Brasil, advindas da difusão de ideias e ações governamentais que introduziram a perspectiva da inclusão na educação especial. Com base na teoria das coalizões de defesa, analisaram-se o subsistema nacional de educação especial (SEE), as coalizões de defesa que o integram e as crenças em disputa, além dos fatores elucidativos das modificações observadas no setor. Trata-se de um estudo de caso que abrangeu reconstrução histórica, análise documental, revisão bibliográfica e levantamento de dados secundários. Entre os resultados, identificaram-se duas coalizões no subsistema: a do atendimento exclusivo (coalizão 1) e a da educação inclusiva (coalizão 2). A primeira foi dominante entre 1973 e 2002, e a segunda surgiu na década de 2000, tornando-se hegemônica em 2008, com a promulgação da Política Nacional de Educação Especial na Perspectiva da Educação Inclusiva. Também se verificou que a coalizão 1 se pauta na separação dos estudantes conforme os tipos de deficiência e capacidades de aprendizagem, enfatizando a importância do atendimento clínico especializado e das escolas especiais. Em contrapartida, a coalizão 2 concebe que todos são capazes de aprender, sobretudo quando inseridos em classes comuns de escolas regulares, dentro de sistemas inclusivos. Como fatores explicativos das mudanças no SEE, sobressaíram as variáveis exógenas, principalmente a mudança do governo federal em 2003, a disseminação mundial e nos subsistemas de concepções sobre educação inclusiva, além do feedback de políticas públicas do SEE e de outros setores.

Resumen El artículo examina los cambios en la educación de las personas con discapacidad (PwD) en Brasil, derivados de la difusión de ideas y acciones gubernamentales que introdujeron la perspectiva de la inclusión en la educación especial. Con base en la teoría de coaliciones de defensa, se analizó el subsistema nacional de educación especial (SEE), las coaliciones de defensa que lo integran y las creencias en disputa, además de los factores que explican los cambios observados en el sector. Se trata de un estudio de caso que incluyó reconstrucción histórica, análisis documental, revisión de literatura y recolección de datos secundarios. Entre los resultados se identificó la existencia de dos coaliciones en el subsistema: atención exclusiva (coalición 1) y educación inclusiva (coalición 2). La primera fue dominante entre 1973 y 2002 y la segunda surgió en la década de 2000, volviéndose hegemónica en 2008, con la promulgación de la Política Nacional de Educación Especial desde la Perspectiva de la Educación Inclusiva. También se encontró que la coalición 1 se guía por la separación de los estudiantes según los tipos de discapacidad y habilidades de aprendizaje, enfatizando la importancia de la atención clínica especializada y de las escuelas especiales. Por otro lado, la coalición 2 concibe que todos son capaces de aprender, especialmente cuando se insertan en clases comunes de escuelas regulares, dentro de sistemas inclusivos. Como factores explicativos de los cambios en el SEE, se destacaron las variables exógenas, principalmente: el cambio en el gobierno federal en 2003, la difusión mundial y en los subsistemas de concepciones sobre educación inclusiva, además del feedback de las políticas públicas del SEE y de otros sectores.

Abstract This article examines the changes in education for people with disabilities (PwD) in Brazil, arising from the dissemination of ideas and government actions that introduced the perspective of inclusion. Based on the advocacy coalition framework, we analyzed the national special education subsystem (SES), the advocacy coalitions that integrate the SES, the beliefs in dispute, and the factors that explain the changes observed in the sector. This case study included historical reconstruction, document analysis, literature review and secondary data collection. The results identified the existence of two coalitions in the subsystem: specialized and exclusive care (coalition 1) and inclusive education (coalition 2). The first was dominant between 1973 and 2002, and the second emerged in the 2000s, becoming hegemonic in 2008 with the promulgation of the National Policy for Special Education from the Perspective of Inclusive Education. It was also found that coalition 1 is guided by the separation of students according to types of disability and learning abilities, emphasizing the importance of specialized clinical care and special schools. On the other hand, coalition 2 conceives that everyone is capable of learning, especially when inserted in standard classes of regular schools, within inclusive systems. As explanatory factors of the changes in the SES, exogenous variables stood out, particularly the changes in the Brazilian federal government in 2003, the worldwide dissemination of the inclusive education conceptions - reaching the education subsystems, and the feedback of public policies from the SES and other sectors.

Large-scale environmental policy change: analysis of the Brazilian reality / Cambio de gran escala en la política ambiental: análisis de la realidad brasileña / Mudança de larga escala na política ambiental: análise da realidade brasileira

Abstract The Brazilian presidential elections of 2018 brought large-scale changes in the Brazilian environmental policy subsystem. The purpose of this article is to analyze these changes through the lenses of the Advocacy Coalition Framework - ACF. First, we introduced some of the main characteristics of this subsystem, then we presented a hemerographic analysis to describe and analyze the effects of four recent shocks in this subsystem. Two of these shocks were external: (i) the election of a new political elite in power that brought a clear discourse of denial of the relevance of environmental policy and (ii) calamitous environmental events that occurred in Brazil in 2019. The other two shocks were internal: (i) the capture of key positions and resources by dominant coalition members and (ii) the rise of conflict and polarization among the coalitions in the subsystem. The results showed: (i) the rise of a hyper-adversarial environmental policy subsystem; (ii) a realignment between non-dominant coalitions in a cooperative direction; (iii) the imposition of clear barriers to negotiation; (iv) changes in the use of scientific information by more politicized discourses with a high degree of bias. The article contributes to the understanding of the processes of institutional change in environmental policy, especially in contexts of large-scale change generated by increasing electoral polarization and fierce political disputes. It also contributes to the analysis of the limits and possibilities of the ACF in the Brazilian environmental agenda.

Resumen Las elecciones presidenciales brasileñas de 2018 introdujeron cambios de gran escala en el subsistema de política ambiental del país. El propósito de este documento es analizar estos cambios a través de las lentes del Advocacy Coalition Framework - ACF. Para ello, exponemos algunas de las características principales de este subsistema y, luego, presentamos un análisis hemerográfico para describir y analizar los efectos de cuatro shocks recientes en este subsistema. Dos de estos shocks fueron externos: (i) el ascenso de una nueva élite política al poder, la cual ha traído un claro discurso de negación de la relevancia de la política ambiental y (ii) catastróficos eventos ambientales que ocurrieron en Brasil durante 2019. Otros dos shocks fueron internos: (i) la captura de posiciones y recursos claves por los miembros de la coalición dominante y (ii) el surgimiento de conflictos y polarizaciones entre las coaliciones del subsistema. Los resultados mostraron: (i) el ascenso de un subsistema de política ambiental hipercontradictorio; (ii) el realineamiento de las coaliciones no dominantes en una dirección cooperativa; (iii) la imposición de claras barreras en los procesos de negociación; y (iv) cambios en el uso de información científica por discursos más politizados con un alto grado de sesgo. Este artículo contribuye a la comprensión de los procesos de cambio institucional en la política ambiental, especialmente en contextos de cambios de gran escala generados por un aumento en la polarización electoral e intensas disputas políticas. También contribuye al análisis de los límites y posibilidades del ACF en la agenda ambiental brasileña.

Resumo As eleições presidenciais brasileiras de 2018 trouxeram mudanças em larga escala no subsistema de política ambiental do país. O objetivo deste artigo é analisar essas mudanças através do Advocacy Coalition Framework - ACF. Para isso, introduzimos algumas das principais características do subsistema de política ambiental e, a seguir, apresentamos uma análise hemerográfica para descrever e analisar os efeitos de quatro choques recentes no subsistema em análise. Dois desses choques foram externos: (i) a ascensão ao poder de uma nova elite política que trouxe um discurso claro de negação da relevância da política ambiental e (ii) eventos ambientais calamitosos que ocorreram no Brasil em 2019. Dois outros choques foram internos: (i) a captura de posições e recursos importantes pelos membros da coalizão dominante e (ii) o surgimento de conflitos e polarizações entre as coalizões no subsistema. Os resultados mostraram: (i) a ascensão de um subsistema hiper-contraditório; (ii) o realinhamento entre coalizões não dominantes em direção à cooperação; (iii) a imposição de barreiras claras à negociação; e (iv) mudanças no uso da informação científica por discursos mais politizados com alto grau de viés. O artigo contribui para a compreensão dos processos de mudança institucional na política ambiental, especialmente em contextos de mudança em larga escala gerados pelo aumento da polarização eleitoral e intensas disputas políticas. Contribui também para a análise dos limites e possibilidades do ACF na agenda ambiental brasileira.

Advocacy coalition formation and key actors within the policy / Formación de coaliciones de defensa y actores clave dentro de la política / Formação de coalizão de defesa e atores chaves da política

Abstract The article discusses advocacy coalition formation and the roles of key actors in science, technology and innovation (ST&I) policies for social inclusion in a subnational context. The policy subsystem category and concept of advocacy coalition are used in the context of the advocacy coalition framework and address the need to understand the influences of key actors (policy broker and policy entrepreneur) on it. The policy subsystem was outlined using case-oriented research and the discourse was analyzed in order to understand the policy actors' beliefs. The analysis of two cases of ST&I policy processes for social inclusion (assistive technology and social technology) highlighted policy broker and policy entrepreneur key roles in the emergence of policy subsystems, but had different effects on advocacy coalition formation. The policy entrepreneur had a closer relationship with advocacy coalition building when setting up regular mechanisms to share beliefs and policy-oriented learning, as well as taking initiatives to coordinate the collective action of members in the early advocacy coalition. Although relevant in agenda setting and maintaining a specific social inclusion agenda in the policy process, the policy broker did not achieve a positive relationship with advocacy coalition building. The article corroborates the possibility of incorporating the concept of policy entrepreneur in analyses of the advocacy coalition framework and highlights this actor's characteristics through this analytical model.

Resumen El artículo analiza la formación de coaliciones de defensa y los roles de los actores clave en las políticas de ciencia, tecnología e innovación (PCTI) para la inclusión social en un contexto subnacional. Considerando el modelo de coalición de defensa (MCD), se utilizaron como referencia las categorías analíticas del subsistema de la política y de la coalición de defensa, para comprender las influencias de los actores clave, específicamente del policy broker (intermediario) y del emprendedor de políticas. El subsistema de la política se delimitó mediante el método de investigación basado en casos y se usó el análisis del discurso para comprender las creencias de los actores en la política. El análisis de dos casos del proceso de la PCTI para la inclusión social (tecnología social y tecnología de la rehabilitación) resaltó los roles de los actores clave en la aparición de subsistemas de la política, sin embargo tuvieron diferentes efectos en la formación de coaliciones de defensa. El emprendedor de políticas tuvo una mayor relación con la formación de una coalición de defensa al establecer mecanismos regulares para comunicar sus posiciones y aprendizajes orientados a la política, así como al tomar iniciativas para coordinar la acción colectiva en la naciente coalición de defensa. El policy broker no logró una relación positiva con la formación de las coaliciones de defensa analizadas, pero sí fue relevante para el establecimiento de la agenda y la permanencia de la pauta de inclusión social en el proceso de la política. Este trabajo corrobora la posibilidad de incorporar el concepto de emprendedor de política en los análisis de MDC y señala las características de este actor clave en el modelo analítico estudiado.

Resumo O artigo discute a formação de coalizão de defesa e o papel de atores chaves em políticas de Ciência, Tecnologia e Inovação (CT&I) para inclusão social em um contexto subnacional. No âmbito do Modelo de Coalizão de Defesa (MCD), utilizou-se as categorias analíticas do subsistema da política e da coalizão de defesa como referência e buscou-se compreender as influências de atores chaves nestas, especificamente o policy broker (mediador) e o empreendedor de política. O subsistema de política foi delimitado pelo método de pesquisa baseada em caso e a análise de discurso foi mobilizada para compreender as crenças dos atores da política. A análise de dois casos do processo de política de CT&I para inclusão social (tecnologia social e tecnologia assistiva) realçou os papéis de atores chaves na emergência dos subsistemas de política, porém estes tiveram diferentes efeitos sobre a formação de coalizões de defesa. O empreendedor da política teve maior relação com a formação de coalizão de defesa ao estabelecer mecanismos regulares para compartilhamento de crenças e aprendizados orientados para a política, bem como ao tomar iniciativas de coordenação da ação coletiva na coalizão de defesa nascente. O policy broker não alcançou relação positiva substancial com a formação das coalizões de defesa analisadas, embora tenha sido relevante para o agenda-setting e a permanência da pauta de inclusão social no processo da política. O artigo corrobora com a possibilidade de incorporação do conceito de empreendedor de política em análises do MDC e aponta características deste ator chave iluminadas pelo modelo analítico.

Práticas de barganha política por meio da execução orçamentária federal / Prácticas de regateo político mediante la ejecución presupuestaria federal / Political bargaining practices through federal budget execution

Resumo O processo orçamentário brasileiro tem sido historicamente questionado pela suposta presença de barganha política na inclusão e na execução de emendas ao orçamento, fato que interfere nas premissas, nos critérios e nas práticas das escolhas alocativas. Este artigo, sustentado pela Teoria da Formação de Coalizões, investiga a existência de uma possível relação de barganha política entre os poderes Executivo e Legislativo no processo orçamentário na esfera federal. Tal pesquisa ocorre por meio da análise das execuções de emendas parlamentares singulares ao longo de cinco legislaturas (entre 2000 e 2017) e das decisões dos deputados na votação de projetos propostos pelo Executivo. Analisaram-se dados referentes à execução de emendas singulares, bem como aqueles concernentes à posição política do parlamentar com relação ao Executivo no instante da proposição das emendas. A metodologia envolveu técnicas econométricas que lidam com a correção do viés de seleção para avaliar a presença ou não da referida relação de barganha. Os resultados obtidos corroboram a hipótese de existência de barganha política entre os poderes Executivo e Legislativo, pois o parlamentar com maior aporte de execução de suas emendas singulares foi aquele que, além de ter exercido apoio ao Executivo através de votos favoráveis aos projetos enviados ao congresso nacional, era de fora da coligação de governo, alvo do Executivo na formação do quorum mínimo para a aprovação de seus projetos.

Resumen El proceso presupuestario brasileño ha sido históricamente cuestionado por la supuesta presencia de regateo político en la inclusión y ejecución de enmiendas al presupuesto, hecho que interfiere con las premisas, criterios y prácticas de las decisiones distributivas. Este artículo, apoyado en la Teoría de la Formación de Coaliciones, investiga la existencia de una posible relación de regateo político entre los poderes Ejecutivo y Legislativo en el proceso presupuestario a nivel federal. Dicha investigación se da a través del análisis de las ejecuciones de enmiendas parlamentarias singulares en cinco legislaturas (entre 2000 y 2017) y de las decisiones de los diputados en la votación de proyectos propuestos por el Ejecutivo. Se analizaron datos referentes a la ejecución de enmiendas singulares, así como los referentes a la posición política del parlamentario frente al Ejecutivo al momento de la proposición de las enmiendas. La metodología involucró técnicas econométricas que tratan la corrección del sesgo de selección para evaluar la presencia o ausencia de la referida relación de regateo. Los resultados obtenidos corroboran la hipótesis de existencia de regateo político entre los poderes Ejecutivo y Legislativo, ya que el parlamentario con mayor aporte de ejecución de sus enmiendas singulares fue quien, además de haber apoyado al Ejecutivo a través de votos a favor de los proyectos remitidos al Congreso Nacional, era ajeno a la coalición de gobierno, objetivo del Ejecutivo en la formación del quórum mínimo para la aprobación de sus proyectos.

Abstract The Brazilian budgetary process has historically been questioned based on the alleged use of political bargaining in the inclusion and implementation of amendments from deputies to the executive's budget, which affects the principles, criteria, and practices of allocative choices. Supported by the theory of coalition formation, this article examines a possible political bargaining relationship between the executive and legislative branches in the budgetary process at the federal level. The study analyzed the execution of amendments from deputies over five mandates (between 2000 and 2017) and the deputies' votes on projects proposed by the executive. Data regarding the execution of singular amendments were also analyzed, together with information concerning the deputies' political position toward the executive when proposing amendments. Econometric techniques were employed to correct selection bias, assessing the presence of political bargaining. The results corroborate the hypothesis that there is political bargaining in the relationship between the executive and legislative branches in Brazil. The deputy who had more of their amendments executed by the government was also the one that voted with the government in the bills sent from the executive to the legislative, even though they were not part of the governing coalition in the Congress. Therefore, the executive targeted deputies who were not part of the governing coalition to increase the number of votes in Congress.

The institutional origin of an international coalition in favor of the right to sport / A origem institucional de uma coalizão internacional em favor do direito ao esporte

ABSTRACT We aimed do analyze the configuration of the relationships established among intergovernmental/transnational organizations that have been ahead for institutionalizing the idea of the right to sport from 1968 to 1978. We used analysis of documents under the theoretical perspective of the Advocacy Coalition Framework. It was seen that the organizations started a coalition to defend a belief system regarding the idea of the right to sport. However, such a movement was not contrary to the elite sport. It can be concluded that the institutional construction process of the idea of the right to sport in an international context occurred in a nonconflicting way with a partnership of actions, despite a certain difference of beliefs.

RESUMO Objetivamos analisar a configuração das relações estabelecidas entre organizações intergovernamentais/transnacionais que estiveram à frente da institucionalização da ideia de direito ao esporte entre 1968 e 1978. Pautamo-nos na análise de documentos sob a perspectiva teórica do Advocacy Coalition Framework. Identificamos que as organizações formaram uma coalizão de defesa de um sistema de crenças relativo à ideia de direito ao esporte. Contudo, tal movimento não era contrário ao esporte de elite. Concluímos que o processo de construção institucional da ideia de direito ao esporte em âmbito internacional ocorreu de maneira pouco conflituosa, havendo parceria de ações, apesar de certa diferença de crenças.

Evans lateral lengthening calcaneal osteotomy for talocalcaneal coalitions with forefoot abduction deformity in the teenagers / 中华创伤骨科杂志

Objective To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT) in the treatment oftalocalcaneal coalitions (TCCs) with forefoot abduction deformity in the teenagers.Methods From February 2014 to August 2018,11 teenaged patients (14 feet) were treated at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity.They were 6 males (8 feet) and 5 females (6 feet),aged from 13 to 17 years (average,15 years).Their diseases involved bilateral feet in 3 cases and unilateral foot in 8,the left foot in 7 cases and the right in 7.All patients underwent TCCs resection followed by E-LLCOT.Their talonavicular coverage angles (TCA) and talar-second metatarsal angles (T2-MT) on the anteroposterior film and talar horizontal angles (TH) and talar-first metatarsal angles (T1-MT) on the lateral film were measured preoperatively and at the last follow-up.The foot functions were evaluated preoperatively and at the last follow-up using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS).Results All the 11 patients were followed up for 12 to 24 months (average,16.5 months).The mean preoperative TCA (22.3°,from 20° to 26°) was improved to 10.5° (from 8° to 13°) at the last follow-up;the mean T-2MT was improved from preoperative 17.6° (from 16° to 20°) to 6.5° (from 5° to 11°) at the last follow-up;the mean TH on the lateral view was improved from preoperative 35° (from 25° to 40°) to 17.5° (from 16° to 21°) at the last follow-up;the mean T-1MT was improved from preoperative 15.5° (from 10° to 22°) to 3.5° (from 2° to 6°) at the last follow-up;the mean AOFAS score was improved from 56.5 (from 50 to 62) preoperatively to 90.6 (from 75 to 95) at the last follow-up;the mean VAS score was improved from 6.0 (from 5 to 7) preoperatively to 2 (from 0 to 3) at the last follow-up.Conclusion For TCCs with severe forefoot abduction deformity in the geenagers,E-LLCOT after TCCs resection can effectively correct deformity,relieve pain and achieve significant functional and radiographic improvements.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Methods: Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. Results: The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. Conclusion: It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity / 中国修复重建外科杂志

Objective: To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity. Methods: Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation. Results: All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores ( t=-23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones ( P<0.05), and the CP was significantly higher than preoperative one ( P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot). Conclusion: For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.

Tibio-talar coalition - a case report and review of the literature

Background: A tarsal coalition is a bridging of two or more of the bones in the hindfoot. Multiple coalitions aredescribed in the literature. However, the presence of a tibio-talar coalition has not previously been reported.Results : Here, we describe the first reported case of tibio-talar and fibulo-talar coalition in the literature in a 31-year-old male. The patient had a 5-year history of bilateral hindfoot and ankle pain, with an established rightsided talo-calaneal coalition. Investigations and subsequent open chilectomy and debridement surgery confirmeda tibio-talar and fibulo-talar coalition. The patient was discharged at one-year following surgery as he was painfree and returned to work.Conclusions: We report the first case of failure of mesenchymal segmentation leading to tibio-talar fibrouscoalition and fibulo-talar coalition. In this case surgical debridement provided resolution of symptoms. Level ofClinical Evidence: 4

Marcha das Vadias de Porto Alegre: uma análise das políticas de aliança / Political Alliances of the SlutWalk in Porto Alegre / Política de alianzas a partir de la Marcha de las Putas de Porto Alegre / Politique d'alliances de la SlutWalk de Porto Alegre

Este artigo parte da análise da ruptura ocorrida na Marcha das Vadias de Porto Alegre no ano de 2014, para pensar como se negociaram as políticas de aliança e coalizões dentro de um campo de tensões dos feminismos contemporâneos. Trata-se de um recorte de uma pesquisa de mestrado que acompanhou o processo de organização da Marcha das Vadias em caráter etnográfico e entrevistou sete pessoas que fizeram parte desse momento político. Aqui, são apresentadas brevemente as personagens a fim de refletir como se compôs a pluralidade em um campo de disputa que parecia ser polarizado. Essa análise busca ainda trazer uma reflexão mais ampla em relação aos movimentos políticos contemporâneos, suas pluralidades e negociações em campo identitário. Conclui-se que para pensar as alianças nas pautas é necessário considerar os marcadores sociais que se atravessam nos diferentes modos de fazer política feminista.

Marcha das Vadias de Porto Alegre: uma análise das políticas de aliança. Psicologia Política, 19(45), p 216-228 The aim of this article is to apply the analysis of rupture that occurred in the SlutWalk, during 2014 in Porto Alegre, to explore how alliances and coalitions were negotiated in a contemporary feminism tension field. This is part of a master's research that followed the SlutWalk organization, in an ethnographic process, and interviewed seven people who were part of this political moment. Here, the characters are briefly introduced in order to reflect how the plurality was composed in a dispute field that seemed to be polarized. This analysis also seeks to bring a broader reflection on contemporary political movements, their pluralities and negotiations in the identity field. In conclusion, in order to think about the alliances in the feminist guidelines, it is necessary to consider social markers that are crossed in the different ways of doing of feministpolitics.

Este artículo parte del análisis de la ruptura ocurrida en la Marcha de las Putas de Porto Alegre en el ano 2014, para pensar cómo se negociaron las políticas de alianza y coaliciones dentro de un campo de tensiones de los feminismos contemporáneos. Se trata de un recorte de una investigación de maestría que acompanó el proceso de organización de la Marcha de las Putas en carácter etnográfico y entrevistó a siete personas que formaron parte de ese momento político. Aquí, se presentan brevemente los personajes para reflejar cómo se compuso la pluralidad en un campo de disputa que parecía ser binario. Este análisis busca aún traer una reflexión más amplia en relación a los movimientos políticos contemporáneos, sus pluralidades y negociaciones en campo identitario. Se concluye que para pensar las alianzas en las pautas feministas es necesario considerar marcadores sociales que se atravesan en las diferentes formas de feminismos.

Cet article commence par l'analyse de la rupture survenue lors de la SlutWalk de Porto Alegre en 2014, afm de réfléchir à la manière dont les politiques d'alliance et de coalitions ont été négociées dans un champ de tensions du féminisme contemporain. Il s 'agit d 'une partie de la recherche d 'un Master qui a accompagné le processus d 'organisation de la SlutWalk à caractère ethnographique et qui a interrogé sept personnes qui faisaient partie de ce moment politique. Ici, les personnages sont brièvement présentés afm de refléter la composition de la pluralité dans un champ de controverse qui semblait être polarisé. Cette analyse cherche également à apporter une réflexion plus large sur les mouvements politiques contemporains, leurs pluralités et leurs négociations dans le domaine de l'identité. Il est conclu que, pour penser les alliances dans les lignes directrices, il est nécessaire de considérer différents marqueurs sociaux croisés dans les différentes formes de féminisme.

Lunotriquetral coalition and ulnar impaction syndrome: a pictorial essay / Coalizão lunato-triquetral e síndrome da impactação ulnar: ensaio iconográfico

Abstract Lunotriquetral coalition and ulnar impaction syndrome are among the spectrum of pathology encountered at the medial wrist. The co-existence of these entities in the same wrist is rare. The purpose of this pictorial essay is to present the etiology, clinical course, imaging findings, and treatment of lunotriquetral coalition and ulnar impaction syndrome, and co-existing disease.

Resumo Coalizão lunatotriquetral e síndrome da impactação ulnar estão incluídas no espectro de doenças do punho medial. A coexistência dessas entidades no mesmo pulso é rara. O objetivo deste ensaio pictórico é apresentar a etiologia, o curso clínico, os achados de imagem e o tratamento da coalizão lunatotriquetral e da síndrome da impactação ulnar, e a coexistência dessas doenças.

The reform and faith regained:A study on the changes of medical and health policy under the framework of initiative alliance / 中国卫生政策研究

Based on the advocacy coalition framework,the game between policy alliances with different beliefs is regarded as a key factor contributing to the long-term policy changes. At the same time, the policy changes are seen as the product of the antagonism of the core faith of the alliance, the policy-oriented learning and the internal and external shocks of the coalitions. The change of China's health care policy has always been accompanied by the debate on whether fairness or efficiency should be given priority between"government-led"and"market-oriented"coalitions. Its evolving characteristics are consistent with the explanatory logic of the advocacy coalition framework. Based on the advocacy coalition framework this paper makes a comprehensive of review of the historical literature on Chinese medical and health policy,it founds out that advocacy coalitions with different beliefs are critical to the re-form and return of the health care policy, policy-oriented learning promotes the gradual change of the policy, while internal and external shocks provide opportunities for policy paradigm change. Besides,the more passive and lack of active initiatives of policy change,the government's bias of the public welfare feature of the medical business coupled with the underdevelopment of market economy are the main causes for lagging medical policy and frequent industry chaos. To this end,it is recommended to highlight the forward-looking policy,strengthen the internal drive,create a more liberal debate environment for the coalitions,promote the learning of policy orientation among coalitions to en-hance the scientific and effective medical and health policy change.

Non-osseous Coalition of the Third Metatarsal-Lateral Cuneiform Joint: A Case Report / 대한족부족관절학회지

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.

Isolated Symptomatic Scapho-Lunate Coalition without Accompanying Anomalies / 대한정형외과학회잡지

A carpal coalition that indicates the fusion of two carpal bones resulting from the failure of differentiation is a rare condition compared to the tarsal coalition. The most common carpal coalition is the luno-triquetral coalition, followed by the capitate-hamate coalition. Most of these coalitions are usually asymptomatic. Thus far, only a few cases of a coalition between the scaphoid and lunate with accompanied anomalies in the ipsilateral hand, such as accessory carpal bone or ray deficiency, have been reported. We present, for the first time, a case of a symptomatic isolated scapho-lunate coalition without any accompanying anomalies.

Pagando o preço de governar: custos de gerência de coalizão no presidencialismo brasileiro / Pagando el precio de gobernar: costos del manejo de coalición en el presidencialismo brasileño / The price of governing: coalition management costs in Brazil's presidential system

Resumo Este artigo analisa os efeitos das estratégias do presidente de como gerir sua coalizão sobre os custos de governar ao longo do seu mandato. Foi desenvolvido um Índice inédito de Custo de Governo (ICG) considerando as transferências políticas e monetárias feitas pelo presidente aos partidos da sua coalizão. O ICG foi calculado a partir de análise de componentes principais. As relações entre as variações de estratégias de gerência e seus custos foram estimadas por meio de um painel não balanceado em primeiras diferenças, tendo como variável dependente o ICG e como variáveis explicativas o tamanho da coalizão, a heterogeneidade ideológica e a alocação proporcional de poder entre parceiros. Os resultados indicam que coalizões grandes, ideologicamente heterogêneas e desproporcionais tendem a ser mais caras ao longo do tempo. As decisões presidenciais de como gerenciar suas coalizões influenciam os custos de governo, mesmo controlando por aspectos exógenos, como fragmentação partidária na Câmara dos Deputados e popularidade presidencial. Além disso, gastar mais recursos políticos e financeiros com os aliados da coalizão não significa necessariamente maior apoio político no Legislativo.

Resumen Este artículo analiza los efectos de las decisiones presidenciales del manejo de la coalición en los costos para gobernar. Se utiliza el análisis de componentes principales para crear el Índice de Costo de Gobierno (ICG) y se utiliza un panel de primeras diferencias para estimar la relación entre el índice y las variables de gestión de la coalición: el tamaño de la coalición, la heterogeneidad ideológica y proporcionalidad de poder con aliados. Los resultados indican que coaliciones demasiado grandes, desproporcionadas y ideológicamente heterogéneas tienden a ser más costosas a lo largo del tiempo. Los resultados también sugieren que las decisiones presidenciales sobre cómo manejar las coaliciones influyen en los costos, aún controlando por las limitaciones exógenas como fragmentación partidaria y popularidad presidencial. Además, gastar más recursos políticos y financieros con los aliados de la coalición no implica necesariamente un mayor apoyo político para el Presidente en el Congreso.

Abstract: This paper examines the effects of a president's coalition management decisions on the costs of governing. An innovative Governing Costs Index (GCI) was developed, taking into consideration political and financial transfers made by the president to coalition parties. GCI is calculated employing a principal component analysis. The relationship between the variations on the management strategies and the costs were estimated using a first-differences panel. GCI was considered as the dependent variable and the coalition size, ideological heterogeneity, and cabinet proportionality among partners as the explanatory variables. Results indicate that large, ideologically heterogeneous coalitions and disproportional cabinets tend to be more expensive over time. The results also suggest that presidential decisions about how to manage coalitions influence governing costs in important ways, even when controlling exogenous constraints like party fragmentation at the Congress and presidential popularity. In addition, spending more political and financial resources with coalition allies does not necessarily lead to greater political support for the president in the Congress.

Review on the Health Policy Research Based on the Advocacy Coaliton Framework / 中国卫生经济

Health policy research could provide prospecting and effective references and suggestions for top-level design of the new medical reform.Advocacy Coalition Framework was a very important model for the research policy change that synthesizes institutional economics,political science and other theories,which had strong explanatory power in many policy areas of high-income countries.However,China was still in its infancy.It introduced the main ideas of the framework,development,application status of health policy field at home and abroad,and put forward the future research direction in the field of health policy that in order to promote the application of the framework in health policy research in China.improve the theoretical and scientific levels of the policy research.

Osseous bridge resection for the treatment of adult talocalaneal coalitions without arthritis / 中国骨伤

<p><b>OBJECTIVE</b>To analyze clinical outcomes of osseous-bridge resection for the treatment of adult symptomatic talocalcaneal coalitions without arthritis.</p><p><b>METHODS</b>The clinical data of 12 patients (15 feet) with symptomatic talocalcaneal coalitions without arthtitis from January 2013 to June 2016 were respectively analyzed. All cases were secondary talocalcaneal coalition. There were 9 males (11 feet) and 3 females (4 feet) with a mean (26.6±3.3) years old (ranged, 18 to 33 years old). According to the Rozansky classification, there were 4 (6 feet) type I, 3 (3 feet) type II, 2 (2 feet) type III, 1 (1 feet) type IV, and 2 (3 feet) type V. All patients received coalition resection and interposition of fat graft. Complication, recurrence and range of motion was regularly recorded after operation. Clinical efficacy was evaluated according to the visual analogue scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale.</p><p><b>RESULTS</b>All patients were followed up for an average duration of (28.7±18.3) months (ranged, 12 to 48 months). All the incisions were primarily healed. There were no wound necrosis, infection, neurovascular or tendon injuries. Range of motion was improved in 13 feet. All patients returned back to work. Recurrence happened in 1 case 2 years after surgery, the patient received a secondary coalition resection. At the latest follow-up, VAS was 2.1±0.8 and AOFAS score was 82.7±7.2, were siginificantly improved when compared with the preoperative scores(8.2±0.7,=6.233,<0.01; 48.4±6.8,=5.747,<0.01).</p><p><b>CONCLUSIONS</b>For adult patients with symptomatic talocalcaneal coalitions without arthritis, simple coalition resection could provide good clinical outcomes with minimal complications.</p>