The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQF's Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process? / Ph. D.

<p dir="ltr">When diagnosed with cancer, it is not uncommon for patients to turn to narratives—both fiction and non—looking for comfort or a way to make sense of their situation. When it comes to cancer on screen, we often see a romanticized version of cancer diagnosis: young sick kids falling in love, messages of going on to do amazing things after treatment, or visuals of glamorized sickness. This is not reflective of the dark thoughts that often find homes in the minds of cancer patients. And yet, little media exists to resonate with these darker narratives. Netflix’s The Midnight Club, a horror show catered toward young adults, helps to twist the pre-existing narratives surrounding cancer by utilizing the conventions of the horror genre to explore the darker sides of cancer diagnosis through storytelling. Though often uncomfortable, the show’s ability to discuss thoughts of mortality, pain, and loss in wake of terminal diagnosis is one important of discussion, as is done in this paper.</p>

This project represents the search for an architecture within the physical, historical, and political situation that an existing city presents. Set within the physical bounds of Savannah, it builds upon an understanding of the city as a series of Utopian propositions existing subliminally and often incongruously. As such, the project concerns the making of public space--space to relieve the culturally disjointed condition of modern urban life by acting as a sort of stage for creative expression and collective improvisation. This also involves the making of characteristic places, which by energetically acknowledging, confronting, challenging, or amplifying the cityâ s conceptions of itself, have the potential to generate both physical and metaphysical transformations. Furthermore, in response to urban development paradigms that are either senselessly uncoordinated or mechanistically authoritarian, the project proposes an alternative: the structured interweaving of a â civic layerâ of these generative urban centers, each serving a different part of the city. The centers must function architecturally as the symbols and containers of civic life, providing space and programmatic flexibility to allow for open cultural engagement while aesthetically enlivening the urban fabric and serving collectively as an index to the city at large. / Master of Architecture

Dans un contexte où le recours au mécanisme des lois de police apparaît de plus en plus fréquent et facilité sur le plan des conflits de lois, la perte d’impérativité que connaissent ces dispositions du fait des solutions libérales retenues sur le plan des conflits de juridictions, conduit à s’interroger sur la possibilité d’apporter des correctifs. En droit positif, l’admission généralisée des clauses de prorogation de for, étatique et arbitral, malgré l’applicabilité d’une loi de police, associée à un système de reconnaissance pratiquement automatique des jugements étrangers et des sentences arbitrales au stade du contentieux de l’exequatur, conduit à rendre ces dispositions globalement semi-nécessaires dans les rapports internationaux. Alors que la mise en œuvre des lois de police devant un for étatique étranger ou arbitral apparaît très incertaine et que la violation de ces dispositions ne fait pas obstacle à la reconnaissance d’un jugement ou d’une sentence qui les aurait négligées, les clauses de prorogation de for apparaissent comme des instruments à la disposition des parties pour se livrer au forum shopping et contourner les impérativités étatiques. Cette solution, paradoxale et peu satisfaisante, compte tenu de l’importance et de la nature des intérêts par principe mis en cause à travers ces dispositions, incite à envisager une solution permettant de restaurer l’impérativité des lois de police dans les conflits de juridictions. Dès lors que ce résultat apparaît comme la conséquence du maintien du principe traditionnel de l’indépendance des compétences législative et juridictionnelle malgré le lien existant entre forum et jus en matière de lois de police, ce constat conduit à s’interroger sur la possibilité de déroger exceptionnellement à ce principe pour consacrer un forum legis impératif et exclusif, fondé sur l’applicabilité d’une telle disposition. Cette solution, restaurant efficacement l’impérativité des lois de police dans leur for d’origine, devrait néanmoins être associée à la mise en place d’un mécanisme de coordination des systèmes permettant de prolonger son efficacité devant les fors étrangers. Il pourrait trouver ses fondements dans certains procédés préexistants, susceptibles d’être adaptés à la réalisation de l’objectif de protection des impérativités étatiques poursuivis. La mise en place de différents mécanismes, apparentés à celui du forum non conveniens, fondés sur un système de coopération interjuridictionnelle ou inspirés de la méthode de référence à l’ordre juridique compétent envisagée par P. Picone, pourrait permettre d’assurer, à l’étranger, le respect des lois de police du for dans des hypothèses différentes. De manière transversale, la restauration de l’impérativité des lois de police pourrait être assurée grâce à un recours à la notion d’ordre juridique prépondérant. Désignant un ordre juridique dont une loi de police mettant directement en cause un intérêt étatique réellement fondamental serait applicable au fond du litige, elle devrait pouvoir fonder la reconnaissance de la vocation plus forte de celui-ci à faire valoir ses vues pour la résolution d’un litige. Elle pourrait fonder à la fois la revendication de compétence juridictionnelle prioritaire de celui-ci pour trancher le différend et un effacement des fors étrangers pour faire prévaloir le point de vue qu’il retient. Une telle solution, étroitement délimitée et justifiée au regard de l’importance des intérêts mis en cause, assurerait une solution satisfaisante permettant à la fois d’articuler harmonieusement la poursuite de la politique libérale qui s’impose dans les conflits de juridictions avec le respect des lois de police et de réconcilier la protection des impérativités étatiques avec la coordination des systèmes. / In times of mandatory provisions becoming more and more prevalent, based on conflict of law, the concept of mandatory enforcement appears to be somehow diluted regarding the liberal solutions found in conflicts of jurisdictions. In positive law, mandatory rules do not prevent the enforcement of a forum clause, no more than they are considered during the enforcement stage of decisions. While the application of these rules before foreign courts and arbitrators is very uncertain and does not raise obstacles to the recognition of foreign judgments or arbitral judgment which overlook them, choice of forum clauses has become an instrument of forum shopping in order to avoid mandatory regulations. This solution paradoxically induces a search for a solution to restore there international imperativity. This result has appeared as a consequence of the principle of separation of conflicts of law and conflicts of jurisdictions. That observation leads to ask questions about the possibility of an exemption to this general principle. Indeed, this encourages to consider the possibility to admit a correlation between forum and jus in order to establish imperative and exclusive competence, based on the applicability of such mandatory rules. This forum legis would require to maintain the litigation in its courts and could ensure their application in international relations. However, unilateralism that governs rules of judicial competence should involve the establishment of a mechanism of different legal systems coordination. Depending on the type of mandatory rules concerned, it could be based on an adapted form of forum non conveniens, on international judicial Co-operation processes, or be inspired by the method of reference to the competent legal order envisaged by P. Picone. The deployment of these solutions could be based on using preponderant state notion, that would be the one with the most widely public policy involved. It would lead to the recognition of the strong vocation of it to assert its views for the resolution of a dispute and would justify both the priority jurisdiction of its courts and circumspection of the other jurisdictional authorities to exercise their competence. Such a solution, tightly defined and justified in view of the importance of the interests involved, would provide a satisfactory solution to both harmoniously articulate the pursuit of liberal politics required in conflicts of jurisdictions with respect of public policy, and reconcile the protection of imperativities with the coordination of legal systems.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Cette thèse a pour objectif de convaincre de la nécessité d’introduire des règles applicables aux groupes de sociétés au sein du règlement, et d’analyser, au moyen du droit comparé, les résistances que cette position impliquent et d’en tirer les conséquences qui lui sont attachées au regard de la sécurité juridique au sein de l’Union européenne.Alors que le texte prohibe - implicitement - l’application du règlement au groupe de sociétés, le juge anglais, inspiré par un certain pragmatisme, a très vite considéré que le renversement de la présomption en faveur du siège social statutaire des filiales permettrait la centralisation des procédures principales au sein d’un seul État membre pour le traitement unitaire des difficultés des groupes de sociétés (« la jurisprudence Daisytek »). La Cour de justice de l’Union européenne a dans son célèbre arrêt Eurofood tenté de limiter les interprétations extensives des critères de compétence dont les juridictions nationales s’étaient vite accommodées. Les jurisprudences nationales se sont ensuite diversifiées. Si certains juges ont accordé un poids déterminant à la présence d’une activité dans l’État membre sur le territoire duquel est situé le siège social statutaire des sociétés membres d’un groupe, d’autres juges ont tout simplement résisté à l’arrêt Eurofood. Examinant ensuite les propositions des institutions européennes visant à modifier le règlement 1346/2000, cette thèse souligne la volonté des autorités européennes d’insérer des règles applicables aux groupes de sociétés pour la mise en oeuvre du règlement. Au terme de cette étude de droit comparé, des solutions sont proposées pour favoriser un traitement transfrontière efficace des difficultés au sein d’un groupe de société tout en garantissant la sécurité juridique des tiers au sein de l’Union européenne. / On 12 December 2012, the European Commission published its proposals for the revision of the Insolvency Regulation which were followed by a draft Legislative Resolution from the European Parliament (20th December 2013). While these proposals’ main objective is to create a specific legal framework for corporate group insolvencies, this thesis aims to demonstrate that they are unlikely to achieve their goal because of the requirement of legal certainty requirement within the EU.Adopted on 29 May 2000, the Council Regulation (EC) No 1346/2000 on insolvency proceedings (the « Insolvency Regulation ») aims at establishing a uniform set of private international law rules on insolvency proceedings having cross-border effects within the EU. Since its entry into force (31 May 2002), its application by national courts has created debate, in particular with regard to its application to corporate groups. In order to maximise the value of groups’ assets or to achieve a global restructuration of groups, the national courts broadened the scope of the Insolvency Regulation by an extensive interpretation of the centre of main interest (« COMI ») criterion. In such a context, the Court of Justice of the European Union (« CJEU ») reinforced the rule that each legal entity should be treated separately (in its 2006 Eurofood case).However, the CJEU’s ruling did not solve the legal issues that national courts were facing when applying the Insolvency Regulation in respect of corporate groups insolvencies.In spite of the fact that the creation of rules for groups of companies has always raised complex legal (and political) issues, the European’s proposals constitute surely a solid basis for discussion and a great opportunity for European academics and practitioners to make their voices heard as well as to propose further amendments to the current Insolvency Regulation. This thesis aims to demonstrate that several issues are unresolved with regard to the whole structure of the revised Insolvency Regulation (e.g. no specific definition of COMI with regard to corporate groups) as well as with regard to the special regime introduced for corporate groups (e.g. no clear choice on the coordination system to be favoured for insolvent groups of companies).

Detta kandidatarbete syftar till att utreda om Urban Forestry kan tillföra något till svensk planering. Urbanisering har skett under en lång tid och för att tillgodose det växande behovet av bostäder har förtätning av staden skett, vilket ofta har gjorts på bekostnad av städers grönska. För att hantera utmaningarna med att integrera grönska i täta städer har ett behov av nytänkande grönplanering uppkommit. Urban Forestry anses vara en lösning på denna problematik och fokuserar på att skapa gröna städer där det inte finns ytor kvar för traditionella parker. För att undersöka om Urban Forestry tillför något nytt till svensk planering utreds grönplaneringens utveckling genom tiderna samt företeelsen Urban Forestry genom en litteraturstudie. Urban Forestry visade sig vara ett vagt och svårdefinierat begrepp, dessutom är de vetenskapliga grunderna för dess positiva miljöeffekter bristande. Dock bidrar Urban Forestry med uppmärksammande av miljö- och hållbarhetsfrågor, och visar goda ambitioner och initiativ till att utveckla och förbättra grönplanering. När den svenska grönplaneringen sattes i relation till Urban Forestry visade det sig att de bärande idéerna redan är representerade inom existerande grönplanering i Sverige. / This bachelor thesis aims to investigate if the concept of Urban Forestry could bring new knowledge into Swedish urban planning. Urbanization has taken place for a long time and in order to meet the growing need for housing, densification of the city has taken place, which has often been done at the expense of urban greenery. In order to deal with the challenges of integrating greenery into dense cities, a need for innovative green planning has arisen. Urban Forestry as a concept is considered a solution to this problem and focuses on creating greenery in cities where limited areas for traditional parks are available. In order to investigate whether Urban Forestry adds something new to Swedish planning, the development of green planning over time and the concept of Urban Forestry is investigated. Urban Forestry turned out to be vague and difficult to define, and the scientific basis for the concept’s arguments are lacking. However, Urban Forestry contributes attention to environmental and sustainability issues, and shows good ambitions and initiatives to develop and improve green planning. When Swedish green planning was put in relation to Urban Forestry, the outcome was that the ideas in the concept were already represented within existing green planning.

Made available in DSpace on 2016-04-04T18:31:19Z (GMT). No. of bitstreams: 1 Alexandre David Medeiros-1.pdf: 2241104 bytes, checksum: 2474b0cdd4a080e937967b0552c2b175 (MD5) Previous issue date: 2007-06-23 / The telecommunications services quality, as well as several other products in the telecommunications area, is strongly linked to the suppliers services levels quality. These services levels can, however, be measured andevaluated by objective criteria and from a service level agreement between service supplier and customer, this agreement is called SLA. In this study a methodology is proposed for the elaboration of the SLA documentation model, that takes care the business model necessity.This methodology is structuralized in the politics and processes of service quality described by the international norms and standards like Management Forum, ITU, IETF and ITIL. The modeling of the SLA documentation was applied in a practical case of multi-service networks, based in IP networks, resulting in the system specification of the quality service level to be contracted with services supplier. The application of this methodology resulted in improvements for both sides, regarding the reduction in operational costs, the correction of processes and procedures, and a high reliability and transparency in the commercial relation. / A qualidade dos servi?os de telecomunica??es, assim como a de v?rios outros produtos da ?rea de telecomunica??es, est? fortemente ligada aos n?veis de qualidade de servi?os prestados pelos fornecedores. Esses n?veis de servi?os podem, no entanto, ser medidos e avaliados por meio de fatores e crit?rios objetivos, a partir de um N?vel de Servi?o acordado entre o provedor do servi?o e o cliente, chamado de SLA. Neste estudo ? proposta uma metodologia para elabora??o de modelo de documenta??o SLA. Essa metodologia est? estruturada na pol?tica e nos processos de qualidade de servi?o descritos nas normas e padr?es internacionais do TeleManagement Forum, ITU ,IETF e ITIL. A modelagem da documenta??o SLA foi aplicada em um caso pr?tico de rede de multiservi?os, baseada em redes IP, resultando na especifica??o do sistema de n?vel de qualidade de servi?o a ser contratado do provedor de servi?os. Na aplica??o dessa metodologia obteve-se ganhos para ambos os lados, com refer?ncia a redu??o de custo operacional, na corre??o de processos e procedimentos e uma alta confiabilidade e transpar?ncia na rela??o comercial.

Made available in DSpace on 2016-04-29T14:17:10Z (GMT). No. of bitstreams: 1 Maria Irene Gerassi.pdf: 933430 bytes, checksum: fdcec24e2aaab28d669eb1bece9b77fd (MD5) Previous issue date: 2007-10-26 / This dissertation aims to report the process of construction, in a socio-historical perspective of a experience of technic-political-social articulation, turned to the children and teenagers rights defense in Santo Amaro zone, a district in the south of São Paulo and of how this process permitted, in its bulge, the expansion of political conscience and the formation of political subjects that might constitute, lately, in a coletive political subject, the Santo Amaro DCA Forum. This research starts from life stories of three members of the Santo Amaro DCA Forum executive commission, focusing mainly in the facts that propitiated to these subjects, their formation or their sensibilization, to become political subjects, what, lately, enabled them, the own commitment in the Forum. This way, I seek to bring elements for a better analysis about the formation of political subjects and so the Santo Amaro DCA Forum as my universe of research, is understood here as a coletive political subject, that really acquitted fundamental part in this process, where I could conclude that there is some necessity of political spaces in order to political subjects can be formed. For basing this study, I worked from the philosophic perspective of Dialetic Historical Materialism, focusing in the central category "of totality". In this dissertation, I opted to work with qualitative research, understanding to be this the approach more consistent to acquire the aimed results / Esta dissertação visa relatar o processo de construção, numa perspectiva sócio-histórica, de uma experiência de articulação técnico-político-social, voltada para a defesa de direitos de crianças e adolescentes na região de Santo Amaro, bairro da zona Sul da cidade de São Paulo e de como este processo permitiu, em seu bojo, a expansão da consciência política e a formação de sujeitos políticos que puderam constituir-se, posteriormente, em um sujeito político coletivo, o Fórum DCA Sto. Amaro. Inicio esta pesquisa a partir das histórias de vida de três membros da comissão executiva do Fórum DCA Sto. Amaro, focando principalmente nos fatos que propiciaram a estes sujeitos sua formação, ou sua sensibilização, para se tornarem sujeitos políticos, o que, posteriormente, possibilitou-lhes, o próprio engajamento no Fórum. Busco assim, trazer elementos para uma melhor análise acerca da formação de sujeitos políticos e para tanto, o Fórum DCA Santo Amaro, enquanto meu universo de pesquisa, é entendido aqui como um sujeito político coletivo, que realmente desempenhou papel fundamental nesse processo, onde pude concluir que há necessidade de espaços políticos para que se formem sujeitos políticos. Para embasamento deste estudo, trabalhei a partir da perspectiva filosófica do Materialismo Histórico e Dialético, focando na categoria central da totalidade . Nesta dissertação, optei por trabalhar com a pesquisa qualitativa, entendendo ser esta a abordagem mais consistente para obtenção dos resultados pretendidos

[pt] As conferências por computador incorporam-se cada vez mais ao dia-a-dia acadêmico, através de programas de ensino a distância e de sua utilização como ferramenta auxiliar no processo de ensino e aprendizagem. Contudo, os estudos têm privilegiado as modalidades sincrônicas de comunicação. As poucas incursões pela assincronia detêm-se nas listas de discussão ou limitam-se a definições no que tange ao fórum. Preenchendo esta lacuna, o presente estudo trata de um fórum de discussão privado ocorrido simultaneamente às aulas presenciais de uma turma de engenharia elétrica da PUC-Rio. O objetivo é descrever e analisar qualitativa e quantitativamente o papel do fórum enquanto experiência discursiva, investigando como se dá a interação e a construção do conhecimento; a possível caracterização do fórum como gênero ou suporte; e o efeito da intervenção do professor no processo. Inspirada pelo sociointeracionismo, a análise focou a freqüência de participação e sua direcionalidade, o fluxo de tópico, a presença social e cognitiva via índices lingüísticos que indicassem afeto, atitude, metacognição, complexidade lexical e sintática. Os resultados sugerem que o fórum deveria ser investigado dentro de um arcabouço de estudos de gênero. Sugerem também que o fórum é um gênero e funciona como uma comunidade de prática, favorecendo a reflexão crítica através de práticas discursivas dialógicas, a aprendizagem de elos coesivos na produção textual, o processo de letramento e de desenvolvimento da inteligência coletiva. Aparentemente, o fórum de discussão contribui para a construção da identidade social e profissional dos participantes. / [en] Computer conferencing has been increasingly incorporated to academic routines, either in distance learning or in the regular classroom, as a support. Nevertheless, the literature has focused on synchronous CMC; its few incursions into asynchrony refer to discussion lists or limit themselves to defining the forum. To fill up such a gap, this study focuses on a private forum held simultaneously with classroom learning by undergrads in Electrical Engineering, at PUC-Rio. Its objective is to describe and analyze, quantitative and qualitatively, the role of the forum as a discursive experience, investigating how interaction and knowledge construction take place; the possibility of characterizing the forum as a genre; and the effect of teacher`s intervention in the process. Inspired by sociointeractionism, it analyzed participation and interactional direction, the topic framework, social and cognitive aspects signaled by linguistic devices that represent affect, attitude, metacognition, lexical and syntactic complexity. Results suggest that future studies need to address the forum within the paradigm of genre study. It also suggests that the forum is a genre and functions as a community of inquiry, leading to critical thinking by means of dialogical discursive and literacy practices, learning of coesive ties in writing, and the development of collective intelligence. Apparently, it contributes to the construction of the social and professional identities of the participants.