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Summary and conclusion: One of the main challenges facing the Swiss health care system remains continued fragmentation as a consequence of the federal structure and the division of responsibilities. This constitutes a major barrier for the implementation of a nationwide public health strategy and a more rational organization of health care. Much of the health reform agenda during the past decade was driven by cost-containment efforts. Despite the absence of a national regulatory framework targeting prevention and care of chronic diseases, national strategies and programmes have been developed within a growing recognition of the need to address chronic disease in the health care system. In addition, several small-scale pilot and preliminary structured care programmes have been implemented in selected localities. The latter are however still too few and limited in scope to cover the needs of the majority of patients with chronic diseases residing in Switzerland. Given the continued high satisfaction with the system among health care users, of around 80%, pressure to actually initiate larger scale changes might not yet be sufficiently strong.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives.

BACKGROUND: In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country. METHODS: As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries. RESULTS: There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015). CONCLUSION: Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

Gobierno electrónico: diagnóstico de participación ciudadana en municipios del programa MuNet II – Caso Panamá

Este documento tiene el objetivo de presentar los resultados del diagnóstico de participación ciudadana realizado en 28 municipios de Panamá durante la implementación del Programa de Gobierno Electrónico de la Organización de los Estados Americanos –Oea– denominado Municipios Eficientes y Transparentes –MuNet–.

Escolhas estratégicas e guerra fiscal: competição ou cooperação no caso do Estado do Rio de Janeiro

Este estudo tem por objetivo analisar as tendências atuais para a cooperação ou competição entre os estados brasileiros, nos jogos predatórios para atração de investimentos privados. Investigamos o processo de construção de agendas, relacionado às opções do Estado, no momento em que se debate a reforma tributária e o fim da "guerra fiscal". A pesquisa apresenta as razões históricas da questão e enfoca as condições estratégicas nas quais o Governo do Estado do Rio de Janeiro pode se inserir nessa agenda política. Os resultados revelam que, sem a superação de um conjunto de fragilidades na estrutura federativa e no sistema tributário nacional, mesmo com fortes lideranças políticas e mecanismos regulatórios, o jogo competitivo entre os estados não alcançará, em curto ou médio prazo, um padrão salutar.

Modernization and new services of the Brazilian active control network

The Brazilian Network for Continuous Monitoring of GNSS - RBMC is a national network of continuously operating reference GNSS stations. Since its establishment in December of 1996, it has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country. In order to provide better services for RBMC, the Brazilian Institute of Geography and Statistics - IBGE and the National Institute of Colonization and Land Reform - INCRA are both partners involved in the National Geospatial Framework Project - PIGN. This paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. These steps involve the installation of new equipment, provide real time data from a group of core stations and compute real-time DGPS corrections, based on CDGPS (The real-time Canada-Wide DGPS Service) (The Real-Time Canada-Wide DGPS Service. http://www.cdgps.com/ 2009a). In addition to this, a post-mission Precise Point Positioning (PPP) service has been established based on the current Geodetic Survey Division of NRCan (CSRS-PPP) service. This service is operational since April 2009 and is in large use in the country. All activities mentioned before are based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project. This infrastructure of 66 GNSS stations, the real time, post processing services and the potentiality of providing Wide Area DGPS corrections in the future show that the RBMC system is comparable to those available in USA and Europe. © Springer-Verlag Berlin Heidelberg 2012.

Sacralità del testo costituzionale ed eresia interpretativa: la sentenza della corte suprema brasiliana sulle unioni civili omosessuali

The paper provides a close lecture of the arguments and methods of legal construction, employed in the extensive individual opinions written by the Justices of the Brazilian Supreme Court in the case which authorized the same sex civil union. After tracing an outline of the legal problem and his possible solutions, we analyze the individual opinions, showing their methodological syncretism, the use of legal methods and arguments in a contradictory way as well the defciencies in the reasoning. The Justices use legal arguments, but do not meet the requirements of rationality in the decision-making. We have a rhetorical attempt that aims to satisfy the public opinion rather than to ofer a comprehensive and coherent solution according the normative elements of the Brazilian Federal Constitution of 1988.

A variação e o preconceito linguístico na escola à luz sociolinguística e dos PCNs

Nowadays questions involving the use of social and cult language approach at the school has produced discussions between teachers, thus the use of the linguistics registers different of that considered correct aren’t accept or analyzed in the context of the classroom, although the national curriculum framework recommend it. So, there are many difficulties of socialization by the students principally that ones who come from the surrounding regions, if they use the linguistics approach differently of the accepted as a model. The objective of this paper is to analyze those questions, involving variation and prejudice in the classroom context, from the Sociolinguistics point of view how this science has been applied in the classroom context, considering the curriculum proposals of 1992 and the national curriculum .

Concessioni di servizio in ambito interportuale, portuale e demaniale marittimo ed esercizio delle relative attività: l'impatto della disciplina comunitaria in materia di libera prestazioni di servizi.

Come si evince dal titolo della tesi, la ricerca effettuata dal presente candidato nel corso del dottorato di ricerca ha avuto ad oggetto l’analisi delle competenze che, a diverso livello, comunitario, nazionale e regionale, sono attribuite agli enti in materia di rilascio di concessioni di servizi in abito interportuale, portuale e demaniale marittimo. L’attenzione, pertanto, ha dovuto innanzitutto essere rivolta ai compiti ed alle facoltà che, in forza del trattato che istituisce la Comunità Europea, sono attribuite alla Comunità stessa. Si è provveduto, pertanto, ad analizzare l’evoluzione della normativa per giungere all’attuale sistema giuridico. Gli aspetti della disciplina delle concessioni, oggetto di ricerca, hanno dovuto ripercorrere i vari procedimenti di infrazione comminati dalla Corte Europea, per i quali il sistema giuridico nazionale si è dovuto adattare con non poche difficoltà, soprattutto per la presenza di posizioni e prassi, negli anni, divenute consolidate.

Teoria e pratica dell'architettura solare - Morfologia, rendimento, strategia progettuale

La recente Direttiva 31/2010 dell’Unione Europea impone agli stati membri di riorganizzare il quadro legislativo nazionale in materia di prestazione energetica degli edifici, affinchè tutte le nuove costruzioni presentino dal 1° gennaio 2021 un bilancio energetico tendente allo zero; termine peraltro anticipato al 1° gennaio 2019 per gli edifici pubblici. La concezione di edifici a energia “quasi” zero (nZEB) parte dal presupposto di un involucro energeticamente di standard passivo per arrivare a compensare, attraverso la produzione preferibilmente in sito di energia da fonti rinnovabili, gli esigui consumi richiesti su base annuale. In quest’ottica la riconsiderazione delle potenzialità dell’architettura solare individua degli strumenti concreti e delle valide metodologie per supportare la progettazione di involucri sempre più performanti che sfruttino pienamente una risorsa inesauribile, diffusa e alla portata di tutti come quella solare. Tutto ciò in considerazione anche della non più procrastinabile necessità di ridurre il carico energetico imputabile agli edifici, responsabili come noto di oltre il 40% dei consumi mondiali e del 24% delle emissioni di gas climalteranti. Secondo queste premesse la ricerca pone come centrale il tema dell’integrazione dei sistemi di guadagno termico, cosiddetti passivi, e di produzione energetica, cosiddetti attivi, da fonte solare nell’involucro architettonico. Il percorso sia analitico che operativo effettuato si è posto la finalità di fornire degli strumenti metodologici e pratici al progetto dell’architettura, bisognoso di un nuovo approccio integrato mirato al raggiungimento degli obiettivi di risparmio energetico. Attraverso una ricognizione generale del concetto di architettura solare e dei presupposti teorici e terminologici che stanno alla base della stessa, la ricerca ha prefigurato tre tipologie di esito finale: una codificazione delle morfologie ricorrenti nelle realizzazioni solari, un’analisi comparata del rendimento solare nelle principali aggregazioni tipologiche edilizie e una parte importante di verifica progettuale dove sono stati applicati gli assunti delle categorie precedenti

Il riconoscimento della protezione internazionale: il ruolo dell'interprete nei colloqui con i richiedenti asilo e i rifugiati. Italia e Argentina a confronto.

L’obiettivo del presente elaborato è quello di analizzare diversi aspetti legati alla protezione internazionale e all’iter per il riconoscimento dello status di rifugiato in Italia e in Argentina. In primo luogo, viene effettuato un breve excursus della normativa vigente che viene analizzata su cinque livelli, ossia internazionale, europeo, italiano, latino-americano e argentino. In secondo luogo, vengono presentate le diverse fasi della procedura da seguire per richiedere asilo nei due Stati: la richiesta di protezione internazionale, la convocazione e l’audizione da parte degli organi competenti alla valutazione dell’istanza e, infine, la decisione. In seguito, viene approfondito nello specifico il ruolo dell’interprete nei colloqui con i richiedenti asilo e i rifugiati. In particolare, viene analizzata l’audizione per il riconoscimento della protezione internazionale, ossia la fase dell’iter in cui si decide la concessione o meno dello status di rifugiato, con il fine di scoprire se esistono delle peculiarità proprie di questo setting specifico rispetto ad altri ambiti giuridici. A tal proposito, vengono analizzati i fattori che la costituiscono, l’influenza che tali aspetti esercitano sull’interazione, nonché sull’interpretazione e le difficoltà di tipo linguistico-culturale e psicologico che l’interprete si può trovare ad affrontare. Infine, vengono presentate quattro interviste che raccontano l’esperienza concreta di interpreti e mediatori e che mostrano fino a che punto la teoria analizzata trova un riscontro nella pratica professionale quotidiana.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives

BACKGROUND In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country. METHODS As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries. RESULTS There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015). CONCLUSION Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.