967 resultados para state regulation


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ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

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The article analyzes the economic importance of the health activities in the developed countries in the last decades of the twentieth century. It takes into consideration the evolution of the weight of the employment in the health activities in European countries' and also in the United States' labour markets, which will be compared in an historical perspective. The evolution and the weight of the public expenditure in the health activities will also be taken into account so as to analyze the economic importance of the sector in the last decades of twentieth century. The role played by the political, economic and social context of the Post-Second World War in the construction of the system of social protection (Welfare State) and its effects over the health activities will be also considered.

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Diese Dissertation stellt eine Studie da, welche sich mit den Änderungen in der Governance der Hochschulbildung in Vietnam beschäftigt. Das zentrale Ziel dieser Forschungsarbeit ist die Untersuchung der Herkunft und Änderung in der Beziehung der Mächte zwischen dem vietnamesischen Staat und den Hochschulbildungsinstituten (HI), welche hauptsächlich aus der Interaktion dieser beiden Akteure resultiert. Die Macht dieser beiden Akteure wurde im sozialen Bereich konstruiert und ist hauptsächlich durch ihre Nützlichkeit und Beiträge für die Hochschulbildung bestimmt. Diese Arbeit beschäftigt sich dabei besonders mit dem Aspekt der Lehrqualität. Diese Studie nimmt dabei die Perspektive einer allgemeinen Governance ein, um die Beziehung zwischen Staat und HI zu erforschen. Zudem verwendet sie die „Resource Dependence Theory“ (RDT), um das Verhalten der HI in Bezug auf die sich verändernde Umgebung zu untersuchen, welche durch die Politik und eine abnehmende Finanzierung charakterisiert ist. Durch eine empirische Untersuchung der Regierungspolitik sowie der internen Steuerung und den Praktiken der vier führenden Universitäten kommt die Studie zu dem Schluss, dass unter Berücksichtigung des Drucks der Schaffung von Einkommen die vietnamesischen Universitäten sowohl Strategien als auch Taktiken entwickelt haben, um Ressourcenflüsse und Legitimität zu kontrollieren. Die Entscheidungs- und Zielfindung der Komitees, die aus einer Mehrheit von Akademikern bestehen, sind dabei mächtiger als die der Manager. Daher werden bei initiativen Handlungen der Universitäten größtenteils Akademiker mit einbezogen. Gestützt auf die sich entwickelnden Muster der Ressourcenbeiträge von Akademikern und Studierenden für die Hochschulbildung prognostiziert die Studie eine aufstrebende Governance Konfiguration, bei der die Dimensionen der akademischen Selbstverwaltung und des Wettbewerbsmarktes stärker werden und die Regulation des Staates rational zunimmt. Das derzeitige institutionelle Design und administrative System des Landes, die spezifische Gewichtung und die Koordinationsmechanismen, auch als sogenanntes effektives Aufsichtssystem zwischen den drei Schlüsselakteuren - der Staat, die HI/Akademiker und die Studierenden – bezeichnet, brauchen eine lange Zeit zur Detektion und Etablierung. In der aktuellen Phase der Suche nach einem solchen System sollte die Regierung Management-Tools stärken, wie zum Beispiel die Akkreditierung, belohnende und marktbasierte Instrumente und das Treffen informations-basierter Entscheidungen. Darüber hinaus ist es notwendig die Transparenz der Politik zu erhöhen und mehr Informationen offenzulegen.

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In recent decades there has been an ethical turn in expectations of how African mineral production and trade should be conducted. Good labour conditions, the absence of conflict and mining’s potential for securing economic, social and environmental benefits are being demanded in the jewellery trade. As a consequence the quality of precious and semi-precious metals and gemstones is now being judged on their ethical credentials in addition to their aesthetic and mineral qualities. Mineral production for industrial manufacture, particularly in the electronics industry, is also coming under scrutiny. Adding value through ethics is closely associated with the use of voluntary (non-state) regulation. This includes standards and associated certification and labels, which have been widely adopted by the minerals and metals sector in efforts to ensure improvements in the social and environmental conditions of production and to enable access to the profitable and expanding global ‘ethical market’. In this chapter, we focus on ethical trading schemes that incorporate voluntary regulation, by using artisanal gold mining in Tanzania and the sale of gold through international fair trade markets as an exemplar to consider the development dynamics that emerge from ethical schemes.

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Background. Retail clinics, also called convenience care clinics, have become a rapidly growing trend since their initial development in 2000. These clinics are coupled within a larger retail operation and are generally located in "big-box" discount stores such as Wal-mart or Target, grocery stores such as Publix or H-E-B, or in retail pharmacies such as CVS or Walgreen's (Deloitte Center for Health Solutions, 2008). Care is typically provided by nurse practitioners. Research indicates that this new health care delivery system reduces cost, raises quality, and provides a means of access to the uninsured population (e.g., Deloitte Center for Health Solutions, 2008; Convenient Care Association, 2008a, 2008b, 2008c; Hansen-Turton, Miller, Nash, Ryan, Counts, 2007; Salinsky, 2009; Scott, 2006; Ahmed & Fincham, 2010). Some healthcare analysts even suggest that retail clinics offer a feasible solution to the shortage of primary care physicians facing the nation (AHRQ Health Care Innovations Exchange, 2010). ^ The development and performance of retail clinics is heavily dependent upon individual state policies regulating NPs. Texas currently has one of the most highly regulated practice environments for NPs (Stout & Elton, 2007; Hammonds, 2008). In September 2009, Texas passed Senate Bill 532 addressing the scope of practice of nurse practitioners in the convenience care model. In comparison to other states, this law still heavily regulates nurse practitioners. However, little research has been conducted to evaluate the impact of state laws regulating nurse practitioners on the development and performance of retail clinics. ^ Objectives. (1). To describe the potential impact that SB 532 has on retail clinic performance. (2). To discuss the effectiveness, efficiency, and equity of the convenience care model. (3). To describe possible alternatives to Texas' nurse practitioner scope of practice guidelines as delineated in Texas Senate Bill 532. (4). To describe the type of nurse practitioner state regulation (i.e. independent, light, moderate, or heavy) that best promotes the convenience care model. ^ Methods. State regulations governing nurse practitioners can be characterized as independent, light, moderate, and heavy. Four state NP regulatory types and retail clinic performance were compared and contrasted to that of Texas regulations using Dunn and Aday's theoretical models for conducting policy analysis and evaluating healthcare systems. Criteria for measurement included effectiveness, efficiency, and equity. Comparison states were Arizona (Independent), Minnesota (Light), Massachusetts (Moderate), and Florida (Heavy). ^ Results. A comparative states analysis of Texas SB 532 and alternative NP scope of practice guidelines among the four states: Arizona, Florida, Massachusetts, and Minnesota, indicated that SB 532 has minimal potential to affect the shortage of primary care providers in the state. Although SB 532 may increase the number of NPs a physician may supervise, NPs are still heavily restricted in their scope of practice and limited in their ability to act as primary care providers. Arizona's example of independent NP practice provided the best alternative to affect the shortage of PCPs in Texas as evidenced by a lower uninsured rate and less ED visits per 1,000 population. A survey of comparison states suggests that retail clinics thrive in states that more heavily restrict NP scope of practice as opposed to those that are more permissive, with the exception of Arizona. An analysis of effectiveness, efficiency, and equity of the convenience care model indicates that retail clinics perform well in the areas of effectiveness and efficiency; but, fall short in the area of equity. ^ Conclusion. Texas Senate 532 represents an incremental step towards addressing the problem of a shortage of PCPs in the state. A comparative policy analysis of the other four states with varying degrees of NP scope of practice indicate that a more aggressive policy allowing for independent NP practice will be needed to achieve positive changes in health outcomes. Retail clinics pose a temporary solution to the shortage of PCPs and will need to expand their locations to poorer regions and incorporate some chronic care to obtain measurable health outcomes. ^

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Dissertação de Mestrado em Educação, especialidade em Administração e Organização Escolar.

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This thesis examines the interplay between state regulation and the way organisations define performance. Performance is generally understood to be a multidimensional concept, but the extent to which its different facets are shaped by regulation remains an understudied question. This thesis aims to address this question and provide at least a partial answer to it. To do so, it examines whether the level of regulation amplifies or abates the multidimensionality of regulated entities' performance definition, i.e. the way they define the concept of performance. The leading question is whether an organisation's performance definition can be associated with the regulatory intensity its environment confronts it with. Moreover, the study explores whether the type of ownership-public or private-plays a role in regard to how a regulated entity defines performance. In order to undertake this investigation, the thesis focuses on the performance definitions of organisations in six different sport betting and lottery regulations. Qualitative data is gathered from primary and secondary documents as well as through semi-structured interviews with chief executive officers (CEO), members of executive management and gambling experts in each of these countries. The thesis concludes that the performance definitions of the organisations under study are indeed multidimensional, as well as clearly influenced by their respective regulatory environments. However, not all performance dimensions identified in the literature are present, nor can they all be estimated to be part of the performance definition. In addition, the public-private difference in defining performance-as conceptualised in the literature- seems to be abated in a regulated environment. The central role played by regulation in regard to the multidimensionality of the performance definition partially outweighs the effect of the nature of ownership.

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Sustainability is the aim of forest management and forest regulation in many countries. Accordingly, forest management has been steered towards more environmentally friendly methods and new regulatory instruments have been introduced. At the same time, wood trade and forest industry have become a global business. Even if the importance of national forest legislation has not decreased, it has been widely acknowledged that national regulation of forest management is no longer sufficient. The movement of goods does not acknowledge boundaries, even though most negative environmental and social consequences stay in the country of origin of wood and other raw materials. As a partial solution to this dilemma, different kinds of regulations have been developed. Various forest certification schemes and wood trade regulation in the EU (995/2010) are examples of efforts to prevent illegal logging and unsustainable forestry. The Finland-based forest industry is to a varying extent dependent on wood trade from Russia. Especially in the 1990‟s, ethical questions concerning import of wood from Russian old growth forests near the Finnish border were widely discussed. Consequently, forest industry enterprises have developed systems to trace the origin of wood and to buy certified wood from Russia. The aim of the research has been to evaluate Finnish and Russian forest regulations in order to investigate what kind of forest management these regulations enhance, and to what extent ecologically sustainable forest management has been integrated into different forms of regulation. I have examined Finnish and Russian forest regulation in four separate articles based on the topics of the Russian Forest Code, forest certification and other voluntary forest protection measures in Russia, Finnish forest certification and Finnish forest legislation. One objective has been to analyse the roles voluntary forest certification plays in promoting sustainable forest management in different countries. In my research, I have mainly concentrated on ecological sustainability and protection of biodiversity, although other aspects of sustainable forest management have been touched upon in different articles. In the following I shall conclude the findings of my research. When the current Russian Forest Code (2006) was being adopted, the main emphasis was not on ecological issues, but on reorganizing forest governance. The role of ecological requirements was even slightly diminished during the legislative reform. There are, nevertheless, still stipulations aiming at ecological sustainability, such as the division of forests into different forest management categories and various protection zones. In 2000, FSC forest certification arrived in Russia, at present covering already 28 million hectares of forests. The PEFC scheme is now in use as well, but to a much lesser extent. If properly implemented, Russian forest certification schemes clearly improve the level of ecological and social sustainability of forestry in Russia. Certification criteria, however, are partly in conflict with the Russian forest legislation and certified enterprises have been forced to pay fines or to negotiate with forest authorities. This clearly indicates that even if Russian forest legislation has otherwise been liberalized to a certain extent, some significant paternalism still exists. Voluntary, hands-on biodiversity protection measures are not valued, and they are not part of the official protection policies as in many other countries. However, there have been some regional solutions to this dilemma. In the Republic of Karelia forest authorities have approved a set of forest biodiversity protection rules created by a local NGO and a forest industry enterprise. By following these local rules, an enterprise can avoid fines for protection measures. The current Finnish Forest Act was adopted in 1996. It brought forest legislation into a new era as some ecological aspects were integrated into forest legislation. The various soft-law forest management recommendations further increased the level of biodiversity protection. My evaluation of the overall legitimacy of the Finnish forest legislation and forest management paradigm revealed, however, several problematic issues. As part of this study I analysed the history of the current forest management paradigm. This analysis revealed the path dependency which still hinders the protection of biodiversity and clearly decreases the general legitimacy of forest management. Due to several historical reasons only even-structured forest management based on clear cuts has for decades been officially approved in Finland. Due to increasing demands of forest owners the legislation is finally being revised. Yet, the official approval of uneven-structured forest management would not be enough to fully improve ecological, social and cultural legitimacy. The latest ecological theories and knowledge of endangered species should be taken into account in the on-going reform of forest legislation as well as the modernisation. Forest legislation is one of the very few spheres of Finnish environmental legislation where openness and participation are still considered a threat. The first Finnish forest certification scheme, PEFC, was established in 2000. It now covers more than 20 million hectares, about 95% of the forests in Finland. PEFC Finland does not require a higher level of biodiversity protection than the recommendations by Tapio (the Development Centre for Forestry), but certification has unified forest management practices and requires more protection measures than mere forest legislation. The study suggests that in Finland PEFC has not functioned as an instrument which would substantially improve the level of forest management. Rather it has supported the status quo of the forest sector. While the ecological and social responsibility of Finland-based forest corporations was one impetus for this research, I want to conclude that there are problems related to forest legislation and non-state regulation in both Finland and Russia. If an enterprise buying wood from Russia buys only certified wood, and carefully avoids wood coming from high conservation value forests that are either ecologically or socially valuable, it can be claimed to be as sustainably produced as in Finland. However, there must be continuous scrutiny of the circumstances. In Russia, the level of the compliance of certification criteria varies considerably, and there are vast unprotected invaluable forest areas. The utilisation of these areas should not be based on short-sighted decisions or lack of consensus among stakeholders.

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Selon Max Weber, seul l’État (moderne) dispose de l’exercice légitime de la contrainte physique. Il est le seul qui puisse légitimement garantir des droits subjectifs qu’il énonce directement ou indirectement. Toutefois, avec l’arrivée du 21e siècle, caractérisée par le retour du pluralisme juridique et la multiplication des instances juridiques et politiques, le monopole étatique de la contrainte légitime devient menacé. Weber, reconnaissant la présence de multiples sphères de droit extra-étatique, affirme que l’ordre juridique existe partout où existe un certain type d’entité sociale destiné à l’exercice de la contrainte juridique. À ce propos, le droit interne de l’entreprise, qui est un droit appliqué par l’entrepreneur indépendamment du droit de l’État, exerce la contrainte la plus puissante. C'est à propos de ce droit que l’auteur se penche dans cette étude pour nous décrire un droit du travail qui est d’abord caractérisé par un quasi-absentéisme juridique et étatique et également par la prévalence du pluralisme juridique, mais où l’intervention de l’État reste un phénomène relativement récent.

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Dans son sens le plus courant, mais aussi le plus étroit, la résolution des conflits en ligne (RCL) réfère à la migration, vers Internet, des modes alternatifs de règlement des conflits. Notre mémoire se concentre sur la transposition, en ligne, des seuls modes amiables de règlement des différends, dont font notamment partie la négociation et la médiation. La question guidant notre étude consiste à savoir si la résolution en ligne permet d’accroître l’accès du consommateur québécois à la justice. La première partie répond par l’affirmative, en démontrant en quoi la RCL permet de surmonter plusieurs obstacles à la fois objectifs et subjectifs auxquels se heurte le consommateur québécois souhaitant obtenir justice. Nous y présentons également certaines critiques récurrentes en matière de RCL et y répondons. Si cette première partie aborde essentiellement la question du pourquoi il est opportun de recourir au règlement électronique des litiges de consommation dans une perspective d’accès à la justice, la seconde s’intéresse à celle du comment. Notre hypothèse est que si le recours à la RCL est souhaitable pour améliorer l’accès du consommateur québécois à la justice, ce mode de règlement ne pourra véritablement porter ses fruits que s’il est encadré par l’État. Nous démontrons ainsi l’opportunité d’une intervention étatique en matière de règlement en ligne des différends de consommation. Selon nous, seule l’institutionnalisation de la RCL permettra de lever, en partie du moins, les barrières qui ont freiné, jusqu’à maintenant, le déploiement à grande échelle de ce procédé de règlement novateur.

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El fenómeno de las revueltas urbanas apareció en Francia a finales de los años 1970, se arraigó en la década de los 80s y experimentó en 2005 una generalización inédita. Se desarrolla localmente desde esta fecha. Con algunas excepciones, se desata en la mayoría de los casos por la muerte de jóvenes en relación con una operación de policía. Este artículo propone una síntesis de las investigaciones llevadas a cabo en Francia en los últimos años y trata de desglosar un marco de interpretación global de este fenómeno al articular sus dimensiones económicas, sociales y políticas. Este trabajo pone énfasis en los procesos de creación de guetos, en las fallas de la regulación estatal y en la ausencia de representación política de los habitantes de los barrios pobres. Finalmente, se analizan las revueltas como una « forma elemental de protesta política».