The reported prevalence of centralization in patients with back pain ranges from 30.8% [15] to 87% [9] with a mean of 58% [17]. In a meta-analysis of 1,056 patients [17], centralization occurred in 64.5% (681 patients). The prevalence of centralization appears to be dependent on several factors: the more acute the pain, the more proximal the pain, the younger the patient, the higher the prevalence. The definition of centralization also affects the prevalence.
The reliability of any clinical test is a prerequisite to justifying its use. For classifying centralization, Fritz et al. reported an average agreement of 88% (Kappa 0.79) by 40 practicing and student physical therapists, who did not have any formal qualifications in the McKenzie system. They observed videotapes of a standardized examination of 12 patients and classified each patient according to his/her pain response to movement [16]. Kilpikoski et al. reported that two highly experienced physical therapists with credentials in mechanical diagnosis and therapy (MDT) examined 39 chronic LBP patients. Their agreement in identifying the patients who centralized was 95% (Kappa 0.7) [18]. In a literature review by Aina et al. [17], the authors concluded that agreement in identifying centralization ranged between 88% and 100% (Kappa 0.51 to 0.96, mean 0.75).
Decentralization Vs Centralization Pdf Free
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Decentralization or decentralisation is the process by which the activities of an organization, particularly those regarding planning and decision making, are distributed or delegated away from a central, authoritative location or group.[1]
Concepts of decentralization have been applied to group dynamics and management science in private businesses and organizations, political science, law and public administration, economics, money and technology.
The word "centralisation" came into use in France in 1794 as the post-Revolution French Directory leadership created a new government structure. The word "décentralisation" came into usage in the 1820s.[2] "Centralization" entered written English in the first third of the 1800s;[3] mentions of decentralization also first appear during those years. In the mid-1800s Tocqueville would write that the French Revolution began with "a push towards decentralization...[but became,] in the end, an extension of centralization."[4] In 1863, retired French bureaucrat Maurice Block wrote an article called "Decentralization" for a French journal that reviewed the dynamics of government and bureaucratic centralization and recent French efforts at decentralization of government functions.[5]
In the early 20th century, America's response to the centralization of economic wealth and political power was a decentralist movement. It blamed large-scale industrial production for destroying middle-class shop keepers and small manufacturers and promoted increased property ownership and a return to small scale living. The decentralist movement attracted Southern Agrarians like Robert Penn Warren, as well as journalist Herbert Agar.[10] New Left and libertarian individuals who identified with social, economic, and often political decentralism through the ensuing years included Ralph Borsodi, Wendell Berry, Paul Goodman, Carl Oglesby, Karl Hess, Donald Livingston, Kirkpatrick Sale (author of Human Scale),[11] Murray Bookchin,[12] Dorothy Day,[13] Senator Mark O. Hatfield,[14] Mildred J. Loomis[15] and Bill Kauffman.[16]
Daniel Bell's The Coming of Post-Industrial Society[4] discussed the need for decentralization and a "comprehensive overhaul of government structure to find the appropriate size and scope of units", as well as the need to detach functions from current state boundaries, creating regions based on functions like water, transport, education and economics which might have "different 'overlays' on the map."[19][20] Alvin Toffler published Future Shock (1970) and The Third Wave (1980). Discussing the books in a later interview, Toffler said that industrial-style, centralized, top-down bureaucratic planning would be replaced by a more open, democratic, decentralized style which he called "anticipatory democracy".[21] Futurist John Naisbitt's 1982 book "Megatrends" was on The New York Times Best Seller list for more than two years and sold 14 million copies.[22] Naisbitt's book outlines 10 "megatrends", the fifth of which is from centralization to decentralization.[23] In 1996 David Osborne and Ted Gaebler had a best selling book Reinventing Government proposing decentralist public administration theories which became labeled the "New Public Management".[24]
Stephen Cummings wrote that decentralization became a "revolutionary megatrend" in the 1980s.[25] In 1983 Diana Conyers asked if decentralization was the "latest fashion" in development administration.[26] Cornell University's project on Restructuring Local Government states that decentralization refers to the "global trend" of devolving responsibilities to regional or local governments.[27] Robert J. Bennett's Decentralization, Intergovernmental Relations and Markets: Towards a Post-Welfare Agenda describes how after World War II governments pursued a centralized "welfarist" policy of entitlements which now has become a "post-welfare" policy of intergovernmental and market-based decentralization.[27]
"... A large number of developing and transitional countries have embarked on some form of decentralization programmes. This trend is coupled with a growing interest in the role of civil society and the private sector as partners to governments in seeking new ways of service delivery...Decentralization of governance and the strengthening of local governing capacity is in part also a function of broader societal trends. These include, for example, the growing distrust of government generally, the spectacular demise of some of the most centralized regimes in the world (especially the Soviet Union) and the emerging separatist demands that seem to routinely pop up in one or another part of the world. The movement toward local accountability and greater control over one's destiny is, however, not solely the result of the negative attitude towards central government. Rather, these developments, as we have already noted, are principally being driven by a strong desire for greater participation of citizens and private sector organizations in governance."[28]
Those studying the goals and processes of implementing decentralization often use a systems theory approach, which according to the United Nations Development Programme report applies to the topic of decentralization "a whole systems perspective, including levels, spheres, sectors and functions and seeing the community level as the entry point at which holistic definitions of development goals arefrom the people themselves and where it is most practical to support them. It involves seeing multi-level frameworks and continuous, synergistic processes of interaction and iteration of cycles as critical for achieving wholeness in a decentralized system and for sustaining its development."[29]
University of California, Irvine's Institute for Software Research's "PACE" project is creating an "architectural style for trust management in decentralized applications." It adopted Rohit Khare's definition of decentralization: "A decentralized system is one which requires multiple parties to make their own independent decisions" and applies it to Peer-to-peer software creation, writing:
Decentralization in any area is a response to the problems of centralized systems. Decentralization in government, the topic most studied, has been seen as a solution to problems like economic decline, government inability to fund services and their general decline in performance of overloaded services, the demands of minorities for a greater say in local governance, the general weakening legitimacy of the public sector and global and international pressure on countries with inefficient, undemocratic, overly centralized systems.[32] The following four goals or objectives are frequently stated in various analyses of decentralization.
In decentralization, the principle of subsidiarity is often invoked. It holds that the lowest or least centralized authority that is capable of addressing an issue effectively should do so. According to one definition: "Decentralization, or decentralizing governance, refers to the restructuring or reorganization of authority so that there is a system of co-responsibility between institutions of governance at the central, regional and local levels according to the principle of subsidiarity, thus increasing the overall quality and effectiveness of the system of governance while increasing the authority and capacities of sub-national levels."[33]
Decentralization is often linked to concepts of participation in decision-making, democracy, equality and liberty from a higher authority.[34][35] Decentralization enhances the democratic voice.[27] Theorists believe that local representative authorities with actual discretionary powers are the basis of decentralization that can lead to local efficiency, equity and development."[36] Columbia University's Earth Institute identified one of three major trends relating to decentralization: "increased involvement of local jurisdictions and civil society in the management of their affairs, with new forms of participation, consultation, and partnerships."[6]
Decentralization has been described as a "counterpoint to globalization [which] removes decisions from the local and national stage to the global sphere of multi-national or non-national interests. Decentralization brings decision-making back to the sub-national levels". Decentralization strategies must account for the interrelations of global, regional, national, sub-national, and local levels.[37]
Norman L. Johnson writes that diversity plays an important role in decentralized systems like ecosystems, social groups, large organizations, political systems. "Diversity is defined to be unique properties of entities, agents, or individuals that are not shared by the larger group, population, structure. Decentralized is defined as a property of a system where the agents have some ability to operate "locally." Both decentralization and diversity are necessary attributes to achieve the self-organizing properties of interest."[30] 2ff7e9595c
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