type: legislation

text:
 15.10.2011
 BG
 Официален вестник на Европейския съюз
 L 270/24
 РЕГЛАМЕНТ ЗА ИЗПЪЛНЕНИЕ (ЕС) No 1024/2011 НА КОМИСИЯТА
 от 14 октомври 2011 година
 за изменение за 159-ти път на Регламент (ЕО) No 881/2002 на Съвета за налагане на някои специфични ограничителни мерки, насочени срещу определени физически лица и образувания, свързани с мрежата на Ал Кайда
 ЕВРОПЕЙСКАТА КОМИСИЯ,
 като взе предвид Договора за функционирането на Европейския съюз,
 като взе предвид Регламент (ЕО) No 881/2002 на Съвета от 27 май 2002 г. за налагане на някои специфични ограничителни мерки, насочени срещу определени физически лица и образувания, свързани с мрежата на Ал Кайда (1), и по-специално член 7, параграф 1, буква а) и член 7а, параграф 1 от него,
 като има предвид, че:
 (1)
 В приложение I към Регламент (ЕО) No 881/2002 се посочват лицата, групите и образуванията, засегнати от замразяването на средства и икономически ресурси по този регламент.
 (2)
 На 5 октомври 2011 г. Комитетът по санкциите към Съвета за сигурност на Организацията на обединените нации реши да добави едно физическо лице към списъка на лицата, групите и образуванията, спрямо които следва да се прилага замразяването на средства и икономически ресурси.
 (3)
 Приложение I към Регламент (ЕО) No 881/2002 следва да бъде съответно актуализирано.
 (4)
 За да се гарантира, че предвидените в настоящия регламент мерки са ефективни, настоящият регламент следва да влезе в сила незабавно,
 ПРИЕ НАСТОЯЩИЯ РЕГЛАМЕНТ:
 Член 1
 Приложение I към Регламент (ЕО) No 881/2002 се изменя в съответствие с приложението към настоящия регламент.
 Член 2
 Настоящият регламент влиза в сила в деня на неговото публикуване в Официален вестник на Европейския съюз.
 Настоящият регламент е задължителен в своята цялост и се прилага пряко във всички държави-членки.
 Съставено в Брюксел на 14 октомври 2011 година.
 За Комисията, от името на председателя,
 Началникът на Службата за инструментите на външната политика
 (1) ОВ L 139, 29.5.2002 г., стр. 9.
 ПРИЛОЖЕНИЕ
 Приложение I към Регламент (ЕО) No 881/2002 се изменя, както следва:
 Под заглавието „Физически лица“ се добавя следното вписване:
 а)
 „Ibrahim Awwad Ibrahim Ali Al-Badri Al-Samarrai (известен още като: a) Dr. Ibrahim ‘Awwad Ibrahim ’Ali al-Badri al-Samarrai’, б) Ibrahim ‘Awad Ibrahim al-Badri al-Samarrai, в) Ibrahim ‘Awad Ibrahim al-Samarra’i, г) Dr. Ibrahim Awwad Ibrahim al-Samarra’i, д) Abu Du’a, (f) Abu Duaa’, ж) Dr. Ibrahim, з) Abu Bakr al-Baghdadi al-Husayni al-Quraishi, и) Abu Bakr al-Baghdadi. Титла: доктор. Адрес: Ирак. Дата на раждане: 1971 г. Място на раждане: Samarra, Ирак. Гражданство: иракско. Други сведения: а) ръководител на Ал Кайда в Ирак, б) понастояшем е базиран в Ирак, в) отговаря за управлението и ръководството на широкомащабните операции на Ал Кайда в Ирак, г) широко известен с военното си име (Abu Du’a, Abu Duaa’). Дата на определянето, посочено в член 2a, параграф 4, буква б): 5.10.2011 г.“


jurisdiction: EU

text:
 IL-KUMMISSJONI EWROPEA
 Brussell, 19.11.2018
 COM(2018) 753 final
 2018/0391(NLE)
 Proposta għal
 DEĊIŻJONI TAL-KUNSILL
 dwar il-pożizzjoni li trid tittieħed f’isem l-Unjoni Ewropea fil-Konferenza tal-Partijiet għall-Konvenzjoni ta’ Rotterdam rigward il-proċeduri ta’ konformità
 MEMORANDUM TA’ SPJEGAZZJONI
 1.Suġġett tal-proposta
 Din il-proposta tikkonċerna d-deċiżjoni li tistabbilixxi l-pożizzjoni li trid tittieħed f’isem l-Unjoni fil-Konferenza tal-Partijiet (CoP) għall-Konvenzjoni ta’ Rotterdam, b’konnessjoni mal-proposta prevista ta’ anness proċedurali dwar il-proċeduri u l-mekkaniżmi istituzzjonali għad-determinazzjoni tan-nuqqas ta’ konformità.
 2.Kuntest tal-proposta
 2.1.Il-Konvenzjoni ta’ Rotterdam
 Il-Konvenzjoni ta’ Rotterdam dwar il-Proċedura ta’ Kunsens Infurmat minn Qabel għal Ċerti Kimiċi u Pestiċidi Perikolużi fil-Kummerċ Internazzjonali (“il-Konvenzjoni”) għandha l-għan li tippromwovi responsabbiltà kondiviża u sforzi kooperattivi fost il-Partijiet fil-kummerċ internazzjonali ta’ kimiċi perikolużi, sabiex jiġu protetti s-saħħa tal-bniedem u l-ambjent, u biex isir kontribut għal użu tagħhom li jirrispetta l-ambjent. Il-Konvenzjoni toħloq obbligi vinkolanti għall-implimentazzjoni tal-proċedura għall-Kunsens Infurmat minn Qabel (PIC), u tipproteġi lill-pajjiżi, b’mod partikolari l-pajjiżi fil-fażi ta’ żvilupp, minn esportazzjonijiet mhux mixtieqa ta’ kimiċi minn pajjiżi produtturi billi timponi obbligi ta’ esportazzjoni fuq il-Partijiet esportaturi.
 Il-Ftehim daħal fis-seħħ fl-24 ta’ Frar 2004.
 L-Unjoni Ewropea hija firmatarju tal-Ftehim
 1
 .
 2.2.Il-Konferenza tal-Partijiet għall-Konvenzjoni ta’ Rotterdam
 Stabbilita skont l-Artikolu 18 tal-Konvenzjoni, is-CoP hija l-korp governattiv tal-Konvenzjoni ta’ Rotterdam. Il-korp normalment jiltaqa’ kull sentejn biex jimmonitorja l-implimentazzjoni tal-Konvenzjoni. Huwa jirrieżamina wkoll il-kimiċi ppreżentati mill-Kumitat ta’ Reviżjoni dwar Kimika għall-kunsiderazzjoni tiegħu.
 B’konformità mal-Artikoli 44 u 45 tar-Regoli ta’ Proċedura għas-CoP għall-Konvenzjoni ta’ Rotterdam, kull parti għandha vot wieħed. Madankollu, l-Organizzazzjonijiet Reġjonali għall-Integrazzjoni Ekonomika bħall-UE jeżerċitaw id-dritt tagħhom li jivvutaw b’għadd ta’ voti li jkun ugwali għall-għadd ta’ Stati Membri tagħhom li huma Firmatarji tal-Konvenzjoni.
 2.3.L-att previst tal-Konferenza tal-Partijiet
 Fid-9 laqgħa ordinarja tas-CoP, li se sseħħ bejn id-29 ta’ April u l-10 ta’ Mejju 2019, se titqies l-adozzjoni ta’ anness addizzjonali dwar il-proċeduri u l-mekkaniżmi istituzzjonali għad-determinazzjoni tan-nuqqas ta’ konformità (“l-att previst”). L-anness il-ġdid propost jinkludi mutatis mutandis l-istess test li ġie diskuss preċedentement fis-CoP7 u s-CoP8 li kellu l-appoġġ ta’ maġġoranza vasta tal-Partijiet.
 Dan l-anness ikun jaqa’ fi ħdan il-kamp ta’ applikazzjoni tal-Artikolu 22.2 tal-Konvenzjoni, li jipprevedi proċedura għall-adozzjoni ta’ annessi li jikkonċernaw “materji proċedurali, xjentifiċi, tekniċi jew amministrattivi”. L-att previst jimplika l-applikazzjoni ta’ ftehim eżistenti, li ma jibdilx il-kamp ta’ applikazzjoni jew il-kontenut tal-konvenzjoni.
 L-għan tal-att previst huwa li jrendi aktar effettiva l-implimentazzjoni tal-Konvenzjoni ta’ Rotterdam, billi jintroduċi mekkaniżmu ta’ nuqqas ta’ konformità kif meħtieġ mill-Artikolu 17 tal-Konvenzjoni. L-Artikolu 17 jipprevedi li “il-Konferenza tal-Partijiet għandha, malajr daqs kemm prattikabbli, tiżviluppa u tapprova proċeduri u mekkaniżmi istituzzjonali biex tiddetermina nuqqas ta’ osservanza tad-disposizzjonijiet ta’ din il-Konvenzjoni u għal trattament ta’ Partijiet li jinstabu f'nuqqas ta’ osservanza”.
 Id-determinazzjoni tan-nuqqas ta’ konformità hija deċiżiva fiż-żieda tat-trasparenza u t-tħejjija tal-Partijiet biex jikkonformaw mal-obbligi internazzjonali tagħhom. Il-proposta annessa tipprovdi mezz alternattiv biex jiġu appoġġati Partijiet li jkunu jixtiequ jistabbilixxu proċeduri ta’ konformità, bl-użu ta’ test imħejji minn qabel f’laqgħat preċedenti tas-CoP. L-intenzjoni hija li jibdew jinħasdu l-benefiċċji tal-istabbiliment ta’ mekkaniżmu ta’ konformità faċilitattiv, li se jgħin biex jiġu identifikati problemi u soluzzjonijiet relatati mal-konformità u, fl-aħħar mill-aħħar iwassal għal Konvenzjoni aktar effettiva.
 Għalkemm it-test tal-Konvenzjoni jindika b’mod ċar li l-proċeduri u l-mekkaniżmi biex jiġi indirizzat in-nuqqas ta’ konformità jridu jiġu żviluppati u approvati “kemm jista' jkun malajr prattikabbli”, 14-il sena wara d-dħul fis-seħħ tal-Konvenzjoni u n-negozjati matul it-tmien CoPs kollha li saru minn dak iż-żmien, il-Partijiet għadhom ma adottawx dawn il-proċeduri u mekkaniżmi.
 B’konformità mal-Artikolu 22.1 tal-Ftehim, l-anness addizzjonali propost għall-Konvenzjoni jkun jifforma “parti integrali minnha u, ħlief jekk espressament ipprovdut mod ieħor, referenza għal din il-Konvenzjoni tikkostitwixxi fl-istess ħin referenza għall-Annessi magħha”. L-adozzjoni tal-anness ma jeħtieġx ratifika mill-Partijiet sabiex jidħol fis-seħħ. Barra minn hekk, kwalunkwe Parti li topponi l-proposta tkun tista’ tagħżel li ma tapplikax l-anness il-ġdid, b’konformità mal-Artikolu 22.3(b), li joffri għażla lill-Istati li jivvutaw kontrih. Għalhekk, l-att previst ikun vinkolanti fuq il-Partijiet kollha li jkunu għażlu li japplikawh.
 3.Il-pożizzjoni li trid tittieħed f’isem l-Unjoni
 Bħala mexxej fit-tfassil tal-politika ambjentali, huwa kruċjali li l-UE terġa’ tafferma l-impenn globali tagħha għall-promozzjoni ta’ implimentazzjoni aħjar tal-ftehimiet u l-istandards ambjentali multilaterali. Fil-laqgħa tal-WPIEI dwar il-Kimiċi Internazzjonali fis-7 ta’ Ġunju 2018, id-delegazzjonijiet tal-Istati Membri diġà appoġġaw b’mod espliċitu, f’isem l-UE, l-inizjattiva ta’ proposta għall-istabbiliment ta’ mekkaniżmu ta’ konformità f’anness addizzjonali għall-konvenzjoni.
 Barra minn hekk, din l-inizjattiva hija konformi mal-prijorità ta’ Juncker biex l-UE ssir attur globali aktar b’saħħtu b’għanijiet għall-iżvilupp sostenibbli, b’mod partikolari s-saħħa (3) u l-konsum u l-produzzjoni responsabbli (12), kif ukoll mas-Seba’ Programm ta’ Azzjoni Ambjentali.
 Għalhekk, l-Unjoni jenħtieġ li tappoġġa l-Anness propost u tkun kosponser tiegħu fit-tħejjija għas-CoP9.
 Trid tiġi stabbilita l-pożizzjoni li trid tittieħed f’isem l-Unjoni fis-CoP, billi l-anness addizzjonali se jkun vinkolanti fuq l-Unjoni. Din il-pożizzjoni jenħtieġ li tiġi stabbilita kmieni kemm jista’ jkun, sabiex tiġi żgurata kosponserizzazzjoni tal-anness addizzjonali.
 4.Bażi ġuridika
 4.1.Bażi ġuridika proċedurali
 4.1.1.Prinċipji
 L-Artikolu 218(9) tat-Trattat dwar il-Funzjonament tal-Unjoni Ewropea (TFUE) jipprevedi l-proċeduri li jikkonċernaw deċiżjonijiet li jistabbilixxu “l-pożizzjonijiet li għandhom jiġu adottati f’isem l-Unjoni f’sede stabbilita fi ftehim, meta dik is-sede tintalab tadotta atti li jkollhom effetti legali, sakemm dawn ma jkunux atti li jissupplimentaw jew jemendaw il-qafas istituzzjonali tal-ftehim.”
 Il-kunċett ta’ “atti li jkollhom effetti legali” jinkludi atti li jkollhom effetti legali bis-saħħa tar-regoli tad-dritt internazzjonali li jirregolaw il-korp ikkonċernat. Dan jinkludi wkoll strumenti li ma għandhomx effett vinkolanti skont id-dritt internazzjonali, iżda li “jistgħu jinfluwenzaw b’mod determinanti l-kontenut tal-leġiżlazzjoni adottata mil-leġiżlatura tal-UE”
 2
 .
 4.1.2.Applikazzjoni għall-każ preżenti
 Is-CoP hija korp stabbilit permezz ta’ ftehim, jiġifieri l-Konvenzjoni ta’ Rotterdam dwar il-Proċedura ta’ Kunsens Infurmat minn Qabel għal Ċerti Kimiċi u Pestiċidi Perikolużi fil-Kummerċ Internazzjonali.
 L-att, li s-COP hija mitluba tadotta, jikkostitwixxi att li għandu effetti ġuridiċi. L-att previst se jkun vinkolanti skont id-dritt internazzjonali, b’konformità mal-Artikolu 22-1 tal-Konvenzjoni ta’ Rotterdam.
 L-att previst la jissupplimenta u lanqas jemenda l-qafas istituzzjonali tal-Ftehim. Lanqas ma se jkollu xi influwenza deċiżiva fuq il-kontenut tal-leġiżlazzjoni tal-UE.
 Għalhekk, il-bażi ġuridika proċedurali għad-deċiżjoni proposta hija l-Artikolu 218(9) tat-TFUE.
 4.2.Bażi ġuridika sostantiva
 4.2.1.Prinċipji
 Il-bażi ġuridika sostantiva għal deċiżjoni skont l-Artikolu 218(9) tat-TFUE tiddependi primarjament mill-objettiv u mill-kontenut tal-att previst li dwaru tittieħed pożizzjoni f’isem l-Unjoni. Jekk l-att previst ikollu żewġ għanijiet jew żewġ komponenti, u jekk wieħed minn dawn l-għanijiet jew komponenti jkun jista’ jiġi identifikat bħala dak prinċipali, filwaqt li l-ieħor ikun sempliċiment inċidentali, id-deċiżjoni skont l-Artikolu 218(9) tat-TFUE trid tissejjes fuq bażi ġuridika sostantiva waħda, jiġifieri dik li jeżiġi l-għan jew il-komponent prinċipali jew predominanti.
 4.2.2.Applikazzjoni għall-każ preżenti
 L-objettiv u l-kontenut prinċipali tal-att previst huma relatati mal-“ambjent”. Madankollu, il-miżuri miftiehma skont il-Konvenzjoni ta’ Rotterdam, filwaqt li jsegwu objettiv ambjentali, huma wkoll fil-biċċa l-kbira ta’ natura relatata mal-kummerċ.
 4.3.Konklużjoni
 Għalhekk, il-bażijiet ġuridiċi tad-deċiżjoni proposta jenħtieġ li jkunu l-Artikolu 207(3) u l-Artikolu 192(1) tat-TFUE, flimkien mal-Artikolu 218(9) tat-TFUE.
 5.Pubblikazzjoni tal-att previst
 Billi l-att tas-CoP se jimplimenta l-Konvenzjoni ta’ Rotterdam permezz ta’ anness proċedurali ġdid, huwa xieraq li dan jiġi ppubblikat f’Il-Ġurnal Uffiċjali tal-Unjoni Ewropea wara li jiġi adottat.
 2018/0391 (NLE)
 Proposta għal
 DEĊIŻJONI TAL-KUNSILL
 dwar il-pożizzjoni li trid tittieħed f’isem l-Unjoni Ewropea fil-Konferenza tal-Partijiet għall-Konvenzjoni ta’ Rotterdam rigward il-proċeduri ta’ konformità
 IL-KUNSILL TAL-UNJONI EWROPEA,
 Wara li kkunsidra t-Trattat dwar il-Funzjonament tal-Unjoni Ewropea, u b’mod partikolari l-Artikoli 192(1) u 207(3), flimkien mal-Artikolu 218(9) tiegħu,
 Wara li kkunsidra l-proposta tal-Kummissjoni Ewropea,
 Billi:
 (1)Il-Konvenzjoni ta’ Rotterdam dwar il-Proċedura ta’ Kunsens Infurmat minn Qabel għal Ċerti Kimiċi u Pestiċidi Perikolużi fil-Kummerċ Internazzjonali (“il-Konvenzjoni”) ġiet konkluża f’isem l-Unjoni bid-Deċiżjoni tal-Kunsill 2006/730/KE
 3
 u daħlet fis-seħħ fl-24 ta’ Frar 2004.
 (2)Skont l-Artikolu 22 tal-Konvenzjoni, il-Konferenza tal-Partijiet tista’ tadotta annessi addizzjonali għall-Konvenzjoni relatati ma’ “kwistjonijiet proċedurali, xjentifiċi, tekniċi jew amministrattivi”.
 (3)Fid-9 laqgħa ordinarja tal-Konferenza tal-Partijiet, li se sseħħ bejn id-29 ta’ April u l-10 ta’ Mejju 2019, il-Partijiet se jqisu l-adozzjoni ta’ anness proċedurali addizzjonali li jintroduċi mekkaniżmu ta’ konformità kif meħtieġ mill-Artikolu 17 tal-Konvenzjoni.
 (4)Huwa xieraq li tiġi stabbilita l-pożizzjoni li trid tittieħed f’isem l-Unjoni fil-Konferenza tal-Partijiet, billi l-anness addizzjonali se jkun vinkolanti fuq l-Unjoni.
 (5)L-Unjoni terġa’ tafferma li huwa kruċjali li tiġi promossa u li jkun hemm impenn globali fir-rigward ta’ implimentazzjoni aħjar tal-ftehimiet u l-istandards ambjentali multilaterali.
 ADOTTA DIN ID-DEĊIŻJONI
 Artikolu 1
 Il-pożizzjoni li trid tittieħed f’isem l-Unjoni fil-Konferenza tal-Partijiet li ġejja għall-Konvenzjoni ta’ Rotterdam għandha tkun li jrid jiġi appoġġat l-abbozz ta’ att (“l-att previst”) mehmuż ma’ din id-Deċiżjoni u/jew xi rfinar possibbli, li jirriżulta fl-adozzjoni ta’ proċeduri u mekkaniżmi istituzzjonali għad-determinazzjoni tan-nuqqas ta’ konformità, kif meħtieġ mill-Artikolu 17 tal-Konvenzjoni.
 Artikolu 2
 Din id-Deċiżjoni hija indirizzata lill-Kummissjoni.
 Artikolu 3
 L-att previst għandu jiġi ppubblikat f’Il-Ġurnal Uffiċjali tal-Unjoni Ewropea wara li jiġi adottat mill-Konferenza tal-Partijiet għall-Konvenzjoni ta’ Rotterdam.
 Magħmul fi Brussell,
 Għall-Kunsill
 Il-President
 (1)
 2006/730/KE: Id-Deċiżjoni tal-Kunsill tal-25 ta’ Settembru 2006 dwar il-konklużjoni, f’isem il-Komunità Ewropea, tal-Konvenzjoni ta’ Rotterdam dwar il-Proċedura għall-Kunsens Infurmat bil-Quddiem għal ċerti kimiċi u pestiċidi perikolużi fil-kummerċ internazzjonali; ĠU L 299, 28.10.2006, p. 23–25 (ES, CS, DA, DE, ET, EL, EN, FR, IT, LV, LT, HU, NL, PL, PT, SK, SL, FI, SV); ĠU L 335M, 13.12.2008, p. 514–519 (MT)
 (2)
 Is-Sentenza tal-Qorti tal-Ġustizzja tas-7 ta’ Ottubru 2014, Il-Ġermanja vs Il-Kunsill, C-399/12, ECLI:UE:C:2014:2258, il-paragrafi 61 sa 64.
 (3)
 ĠU L 299, 28.10.2006, p. 23–25.
 ---documentbreak---
 IL-KUMMISSJONI EWROPEA
 Brussell, 19.11.2018
 COM(2018) 753 final
 ANNESS
 tal-
 Proposta għal DEĊIŻJONI TAL-KUNSILL
 dwar il-pożizzjoni li trid tittieħed f’isem l-Unjoni Ewropea fil-Konferenza tal-Partijiet għall-Konvenzjoni ta’ Rotterdam rigward il-proċeduri ta’ konformità
 ANNESS
 Abbozz ta’ deċiżjoni RC-9/[ ]: Proċeduri u mekkaniżmi dwar il-konformità mal-Konvenzjoni ta’ Rotterdam
 Sottomissjoni minn ...
 Jiddeċiedi li jadotta l-Anness VII tal-Konvenzjoni, li jistipula proċeduri u mekkaniżmi rigward il-konformità mal-Konvenzjoni ta’ Rotterdam, kif inhu inkluż fl-anness għad-deċiżjoni preżenti.
 APPENDIĊI.
 Anness VII: Proċeduri u mekkaniżmi dwar il-konformità mal-Konvenzjoni ta’ Rotterdam
 (1)B’dan huwa stabbilit kumitat ta’ konformità (minn hawn ’il quddiem imsejjaħ “il-Kumitat”).
 Membri
 (2)Il-Kumitat għandu jikkonsisti minn 15-il membru. Il-membri għandhom jiġu nnominati mill-partijiet u jiġu eletti mill-Konferenza tal-Partijiet abbażi ta’ rappreżentanza ġeografika ekwa tal-ħames gruppi reġjonali tan-Nazzjonijiet Uniti.
 (3)Il-Membri għandu jkollhom l-għarfien espert u l-kwalifiki speċifiċi fis-suġġett kopert mill-Konvenzjoni. Huma għandhom jaqdu dmirijiethom b’mod oġġettiv u fl-aħjar interessi tal-Konvenzjoni.
 Elezzjoni tal-membri
 (4)Fl-ewwel laqgħa tagħha wara d-dħul fis-seħħ ta’ dan l-anness, il-Konferenza tal-Partijiet għandha teleġġi tmiem membri tal-Kumitat għal terminu wieħed, kif ukoll seba’ membri għal żewġ termini. F’kull laqgħa ordinarja sussegwenti, il-Konferenza tal-Partijiet għandha teleġġi, għal żewġ termini, membri ġodda biex jissostitwixxu lil dawk il-membri li l-perjodu tagħhom fil-kariga jkun skada jew ikun se jiskadi. Il-Membri ma għandhomx iżommu l-kariga għal aktar minn żewġ termini konsekuttivi. Għall-finijiet ta’ dan l-anness, “terminu” għandu jfisser il-perjodu li jibda fi tmiem laqgħa ordinarja waħda tal-Konferenza tal-Partijiet u li jintemm fi tmiem il-laqgħa ordinarja sussegwenti tal-Konferenza tal-Partijiet.
 (5)Jekk membru tal-Kumitat jirreżenja jew inkella ma jkunx jista’ jwettaq it-terminu jew il-funzjonijiet tiegħu b’xi mod ieħor, il-parti li tkun innominat dak il-membru għandha tinnomina sostitut biex iservi għall-bqija tat-terminu.
 Uffiċjali
 (6)Il-Kumitat għandu jeleġġi l-President tiegħu stess. Il-Kumitat għandu jeleġġi Viċi President u relatur, fuq bażi ta’ rotazzjoni, b’konformità mar-regola 30 tar-regoli ta’ proċedura tal-Konferenza tal-Partijiet.
 Laqgħat
 (7)Il-Kumitat għandu jospita laqgħat kif meħtieġ u kull meta jkun possibbli flimkien ma’ laqgħat tal-Konferenza tal-Partijiet jew korpi oħra tal-Konvenzjoni.
 (8)Suġġett għall-paragrafu 9 hawn taħt, il-laqgħat tal-Kumitat għandhom ikunu miftuħa għall-partijiet u għall-pubbliku, dment li l-Kumitat ma jiddeċidix mod ieħor.
 Meta l-Kumitat ikun qed jittratta xi sottomissjonijiet skont il-paragrafu 12 jew 13, il-laqgħat tal-Kumitat għandhom ikunu miftuħa għall-partijiet u magħluqa għall-pubbliku, dment li l-parti li l-konformità tagħha tkun f’dubju ma taqbilx mod ieħor.
 Il-partijiet jew l-osservaturi li għalihom tkun miftuħa l-laqgħa ma għandux ikollhom id-dritt li jipparteċipaw fil-laqgħa, dment li l-Kumitat u l-parti li l-konformità tagħha tkun f’dubju ma jaqblux mod ieħor.
 (9)Fejn issir sottomissjoni fir-rigward tan-nuqqas ta’ konformità possibbli ta’ xi parti, din għandha tiġi mistiedna tipparteċipa fil-kunsiderazzjoni tas-sottomissjoni mill-Kumitat. Madankollu, din il-parti ma tistax tipparteċipa fl-elaborazzjoni u fl-adozzjoni ta’ rakkomandazzjoni, jew fil-konklużjoni tal-Kumitat.
 (10)Il-Kumitat għandu jagħmel kull sforz biex jilħaq ftehim b’kunsens dwar kwalunkwe kwistjoni ta’ sustanza. Fejn dan ma jkunx possibbli, ir-rapport għandu jirrifletti l-fehmiet tal-membri tal-Kumitat kollha. Jekk ikunu ġew eżawriti l-isforzi kollha bex jinstab kunsens u jibqa’ ma jintlaħaqx ftehim, bħala l-aħħar rimedju, kull deċiżjoni għandha tittieħed b’maġġoranza ta’ 80 % tal-membri preżenti li jivvutaw, jew inkella bi tmien membri, skont liema waħda tkun l-ogħla. Il-kworum jintlaħaq b’għaxar membri tal-Kumitat.
 (11)Fir-rigward ta’ kwalunkwe kwistjoni li tittieħed inkunsiderazzjoni mill-Kumitat, kull membru tal-Kumitat għandu jevita kull kunflitt ta’ interessi dirett jew indirett. Meta membru jsib ruħu ffaċċjat minn kunflitt ta’ interessi dirett jew indirett, jew ikun ċittadin ta’ parti li l-konformità tagħha tkun f’dubju, dak il-membru għandu jiġbed l-attenzjoni tal-Kumitat għall-kwistjoni qabel din tiġi kkunsidrata. Il-membru kkonċernat ma għandux jipparteċipa fl-elaborazzjoni u fl-adozzjoni ta’ rakkomandazzjoni tal-Kumitat relatata ma’ dik il-kwistjoni.
 (12)Jistgħu jsiru sottomissjonijiet bil-miktub, permezz tas-Segretarjat fejn japplikaw is-subparagrafi (a) u (b), minn:
 (a)Parti li temmen li, minkejja l-aqwa sforzi tagħha, mhijiex jew mhijiex se tkun tista’ tikkonforma ma ċerti obbligi skont il-Konvenzjoni. Sottomissjoni bħal din għandha tinkludi dettalji dwar liema obbligi speċifiċi huma kkonċernati u valutazzjoni tar-raġuni għalfejn il-parti tista’ ma tkunx kapaċi tissodisfa dawk l-obbligi. Fejn possibbli, jistgħu jiġu pprodvuti informazzjoni ta’ sostenn jew parir dwar fejn tista’ tinstab informazzjoni ta’ sostenn bħal din. Is-sottomissjoni tista’ tinkludi suġġerimenti għal soluzzjonijiet li l-parti tqis li jistgħu jkunu l-aktar xierqa għall-ħtiġijiet partikolari tagħha.
 (b)Parti li hija affetwata direttament, jew li x’aktarx se tiġi affettwata direttament, min-nuqqas allegat ta’ parti oħra li tikkonforma mal-obbligi tal-Konvenzjoni. Parti li tkun beħsiebha tagħmel sottomissjoni skont dan is-subparagrafu jenħtieġ li tikkonsulta mal-parti li l-konformità tagħha tkun f’dubju qabel tagħmel dan. Is-sottomissjoni jenħtieġ li tinkludi dettalji dwar liema obbligi speċifiċi huma kkonċernati, kif ukoll informazzjoni li ssostni s-sottomissjoni, inkluż kif il-parti hija affettwata jew x’aktarx li tiġi affettwata.
 (13)Sabiex il-Kumitat jivvaluta xi diffikultajiet possibbli ffaċċjati mill-partijiet fl-issodisfar tal-obbligi tagħhom skont l-Artikoli 4(1), 5(1) u (2) u 10 tal-Konvenzjoni, malli jirċievi l-informazzjoni mis-Segretarjat ipprovduta minn dawn il-Partijiet skont dawk id-dispożizzjonijiet, għandu jinnotifika lill-parti bil-miktub rigward il-kwistjoni kkonċernata. Jekk il-kwistjoni ma tkunx ġiet riżolta fi żmien 90 jum permezz ta’ konsultazzjoni mal-parti kkonċernata mwettqa permezz tas-Segretarjat, u l-Kumitat ikompli jqis il-kwistjoni, huwa se jagħmel dan b’konformità mal-paragrafi 16 sa 24.
 (14)Fi żmien ġimagħtejn minn meta jirċievi dawn is-sottomissjonijiet, is-Segretarjat għandu jibgħat is-sottomissjonijiet li jkunu saru skont is-subparagrafu 12(a) hawn fuq lill-membri tal-Kumitat, biex jiġu kkunsidrati fil-laqgħa sussegwenti tal-Kumitat.
 (15)Fi żmien ġimagħtejn minn meta jirċievi xi sottomissjoni li tkun saret skont is-subparagrafu 12(b) jew skont il-paragrafu 13, is-Segretarjat għandu jibgħat kopja lill-parti li l-konformità tagħha mal-Konvenzjoni tkun f’dubju kif ukoll lill-membri tal-Kumitat, biex din tiġi kkunsidrata fil-laqgħa sussegwenti tal-Kumitat.
 (16)Partijiet li l-konformità tagħhom tkun f’dubju jistgħu jipreżentaw tweġibiet jew kummenti fi kwalunkwe stadju tal-proċedimenti deskritti fid-deċiżjoni preżenti.
 (17)Mingħajr preġudizzju għall-paragrafu 16 hawn fuq, informazzjoni addizzjonali pprovduta minn parti li l-konformità tagħha tkun f’dubju b’reazzjoni għal sottomissjoni, għandha tintbagħat lis-Segretarjat fi żmien tliet xhur mid-data li fiha tkun ġiet riċevuta s-sottomissjoni ta’ dik il-parti, dment li ċ-ċirkustanzi ta’ każ partikolari ma jkunux jeħtieġu perjodu ta’ żmien estiż. Din l-informazzjoni għandha tiġi trażmessa immedjatament lill-membri tal-Kumitat biex tiġi kkunsidrata fil-laqgħa sussegwenti tal-Kumitat. Fejn tkun saret sottomissjoni skont is-subparagrafu 12(b) hawn fuq, is-Segretarjat għandu jibgħat l-informazzjoni wkoll lill-parti li tkun għamlet is-sottomissjoni.
 (18)Il-Kumitat jista’ jiddeċiedi li ma jipproċedix b’sottomissjonijiet li huwa jqis bħala:
 (a)De minimis;
 (b)Evidentement ibbażati fuq informazzjoni żbaljata.
 Faċilitazzjoni
 (19)Il-Kumitat għandu jqis kull sottomissjoni li titressaq quddiemu b’konformità mal-paragrafu 12 jew b’sostenn għall-paragrafu 13 hawn fuq, bil-ħsieb li jistabbilixxi l-fatti u l-għeruq ta’ dak li jkun ikkawża t-tħassib, kif ukoll biex jgħin fir-riżoluzzjoni tagħha, filwaqt li jqis l-Artikolu 16 tal-Konvenzjoni. Għal dak il-għan, il-Kumitat jista’ jipprovdi lil parti b’:
 (a)Parir;
 (b)Rakkomandazzjonijiet mhux vinkolanti;
 (c)Kwalunkwe informazzjoni oħra meħtieġa biex il-parti tiġi megħjuna tiżviluppa pjan ta’ konformità, inklużi kronoloġiji u miri.
 Miżuri possibbli biex jiġu indirizzati problemi ta’ konformità
 (20)Jekk, wara li jwettaq il-proċedura ta’ faċilitazzjoni stipulata fil-paragrafu 19 hawn fuq u jieħu inkunsiderazzjoni l-kawża, it-tip, il-grad u l-frekwenza tad-diffikultajiet fil-konformità, inklużi l-kapaċitajiet finanzjarji u tekniċi tal-partijiet li l-konformità tagħhom tkun f’dubju, il-Kumitat iqis bħala meħtieġ li jipproponi miżuri ulterjuri biex jindirizza l-problemi bil-konformità ta’ parti partikolari, huwa jista’ jirrakkomanda lill-Konferenza tal-Partijiet, filwaqt li jżomm f’moħħu l-kapaċità tagħha skont l-Artikolu 18, il-paragrafu 5(c), tal-Konvenzjoni, biex hija tqis il-miżuri li ġejjin, li għandhom jittieħdu b’konformità mad-dritt internazzjonali biex tinkiseb il-konformità:
 (a)
 Aktar appoġġ taħt il-Konvenzjoni għall-parti kkonċernata, inkluża l-faċilitazzjoni, kif xieraq, tal-aċċess għal riżorsi finanzjarji, assistenza teknika u bini tal-kapaċità;
 (b)
 Tipprovdi parir rigward il-konformità fil-futur sabiex tgħin lill-partijiet jimplimentaw id-dispożizzjonijiet tal-Konvenzjoni, kif ukoll biex tippromwovi l-kooperazzjoni bejn il-partijiet kollha;
 (c)
 Titlob lill-Parti kkonċernata biex tagħti aġġornamenti dwar l-isforzi tagħha;
 (d)
 Toħroġ dikjarazzjoni ta’ tħassib rigward in-nuqqas ta’ konformità possibbli fil-futur;
 (e)
 Toħroġ dikjarazzjoni ta’ tħassib rigward in-nuqqas ta’ konformità attwali;
 (f)
 Titlob lis-Segretarju Eżekuttiv biex jippubblika l-każijiet ta’ nuqqas ta’ konformità;
 (g)
 Tirrakkomanda li s-sistwazzjoni ta’ nuqqas ta’ konformità tiġi indirizzata mill-parti mhux konformi, bl-għan li tiġi riżolta s-sitwazzjoni.
 Trattament tal-informazzjoni
 (21)(1) Il-Kumitat jista’ jirċievi informazzjoni rilevanti, permezz tas-Segretarjat:
 (a)Mill-partijiet;
 (b)Minn sorsi rilevanti li huwa jqis bħala neċessarji u xierqa, bil-kunsens minn qabel tal-parti kkonċernata jew kif dirett mill-Konferenza tal-Partijiet;
 (c)Mill-mekkaniżmu ta’ koordinament tal-Konvenzjoni u l-organizzazzjonijiet intergovernattivi rilevanti. Il-Kumitat għandu jipprovdi lill-Parti kkonċernata b’din l-informazzjoni u għandu jistedinha tippreżenta l-kummenti tagħha dwarha.
 (2) Il-Kumitat jista’ jitlob ukoll informazzjoni mis-Segretarjat, fejn xieraq, fl-għamla ta’ rapport dwar kwistjonijiet li jkunu qed jiġu kkunsidrati mill-Kumitat.
 (22)Għall-finijiet tal-eżaminar ta’ problemi sistemiċi ta’ konformità ġenerali skont il-paragrafu 25, il-Kumitat jista’:
 (a)Jitlob informazzjoni mill-partijiet kollha;
 (b)B’konformità mal-gwida rilevanti mill-Konferenza tal-Partijiet, jitlob informazzjoni rilevanti minn kwalunkwe sors affidabbli u esperti esterni; u
 (c)Jikkonsulta mas-Segretarjat u jagħmel użu mill-esperjenza u l-għarfien tiegħu.
 (23)Suġġett għall-Artikolu 14 tal-Konvenzjoni, il-Kumitat, kwalunkwe parti u kwalunkwe persuna involuta fid-deliberazzjonijiet tal-Kumitat għandhom jipproteġu l-kunfidenzjalità tal-informazzjoni riċevuta b’mod kunfidenzjali.
 Monitoraġġ
 (24)Il-Kumitat ta’ Konformità jenħtieġ li jimmonitorja l-konsegwenzi tal-azzjonijiet meħuda b’konformità mal-paragrafi 19 jew 20 hawn fuq.
 Problemi ġenerali ta’ konformità
 (25)Il-Kumitat ta’ Konformità jista’ jeżamina problemi sistemiċi ta’ konformità ġenerali li jinteressaw lill-partijiet kollha, fejn:
 (a)Il-Konferenza tal-Partijiet titlob dan;
 (b)Abbażi tal-informazzjoni mill-Partijiet li tingħadda lis-Segretarjat u tiġi ppreżentata lill-Kumitat, filwaqt li dak tal-ewwel jaġixxi skont il-funzjonijiet tiegħu taħt il-Konvenzjoni, il-Kumitat jiddeċiedi li hemm bżonn li problema ta’ nuqqas ta’ konformità ġenerali tiġi eżaminata u li jsir rapport dwarha lill-Konferenza tal-Partijiet.
 Rapporti lill-Konferenza tal-Partijiet
 (26)Il-Kumitat għandu jippreżenta rapport għal kull laqgħa ordinarja tal-Konferenza tal-Partijiet, li jirrifletti:
 (a)Ix-xogħol li l-Kumitat ikun wettaq;
 (b)Il-konklużjonijiet jew ir-rakkomandazzjonijiet tal-Kumitat;
 (c)Il-programm ta’ ħidma futur tal-Kumitat, inkluża l-iskeda tal-laqgħat mistennija li huwa jqis bħala neċessarji għall-issodisfar tal-programm ta’ ħidma tiegħu, għall-kunsiderazzjoni u l-approvazzjoni tal-Konferenza tal-Partijiet.
 Korpi sussidjarji oħra
 (27)Fejn l-attivitajiet tal-Kumitat fir-rigward ta’ kwistjonijiet partikolari jirkbu fuq ir-responsabbiltajiet ta’ korp ieħor tal-Konvenzjoni ta’ Rotterdam, il-Konferenza tal-Partijiet tista’ tidderieġi lill-Kumitat biex jikkonsulta ma’ dak il-korp.
 Kondiviżjoni ta’ informazzjoni ma’ ftehimiet ambjentai multilaterali oħra
 (28)Fejn rilevanti, il-Kumitat jista’ jitlob informazzjoni speċifika, fuq talba tal-Konferenza tal-Partijiet jew direttament, mill-kumitati ta’ konformità li jittrattaw sustanzi u skart perikolużi taħt l-awspiċji ta’ ftehimiet ambjentali multilaterali rilevanti oħra, u jirrapporta dwar dawn l-attivitajiet lill-Konferenza tal-Partijiet.
 Rieżami tal-mekkaniżmu ta’ konformità
 (29)Il-Konferenza tal-Partijiet għandha tirrieżamina regolarment l-implimentazzjoni tal-proċeduri u l-mekkaniżmi stipulati f’dan l-Anness.
 Relazzjoni mas-soluzzjoni ta’ tilwim
 (30)Dawn il-proċeduri u l-mekkaniżmi għandhom ikunu mingħajr preġudizzju għall-Artikolu 20 tal-Konvenzjoni.


type: wikipedia

text:
Ulrike Röseberg (* 15. Oktober 1978 in Berlin) ist eine deutsche Theater- und Fernsehschauspielerin.
 Leben
 Ulrike Röseberg absolvierte nach dem Abitur von 1999 bis 2003 ihr Schauspielstudium in der brandenburgischen Landeshauptstadt Potsdam an der staatlichen Hochschule für Film und Fernsehen „Konrad Wolf“ am Studio Babelsberg und machte dort ihren Abschluss mit Diplom. Sie spielte nach ihrem Festengagement am Salzburger Landestheater auf einigen Theaterbühnen, unter anderem am Bregenzer Landestheater und an der Klosterruine Boitzenburg. Die Rolle der Annette Bergmann in der Fernsehserie Alles was zählt, die sie von 2006 bis 2012 spielte, war ihre erste große Fernsehrolle; am 1. Juni 2012 starb sie in Folge 1445 den Serientod. Seitdem ist sie in diversen Fernsehformaten zu sehen, unter anderem in Heiter bis tödlich: Zwischen den Zeilen, SOKO Köln, SOKO Leipzig, Block B – Unter Arrest.
 Im August 2013 ist sie mit ihrer langjährigen Freundin Franzi eine eingetragene Lebenspartnerschaft eingegangen. Im Februar 2021 nahm sie an der Initiative #actout im SZ-Magazin mit 184 anderen lesbischen, schwulen, bisexuellen, queeren, nicht-binären und trans* Schauspielern teil. Neben ihrer Schauspielkarriere arbeitet sie auch als Videocoach.
 Filmografie (Auswahl)
 2006–2015: Alles was zählt (Fernsehserie, 203 Folgen)
 2008: Wechseljahr (Kurzfilm)
 2010: SOKO Köln (Fernsehserie, Folge Katz und Maus)
 2010: Stralsund – Außer Kontrolle (Fernsehreihe)
 2013: Eine verhängnisvolle Nacht
 2013: Heiter bis tödlich: Zwischen den Zeilen (Fernsehserie, Folge Zu viel Zukunft ist auch nicht gut)
 2013: SOKO Leipzig (Fernsehserie, Folge Klassenclown)
 2015: Block B – Unter Arrest (Fernsehserie, 10 Folgen)
 2017: Love Is in the Air
 2017: Kein Herz für Inder
 2020: Bettys Diagnose (Fernsehserie, Staffel 07, Folge 15: Der nächste Schritt)
 2021: Der Usedom-Krimi: Entführt
 2021: Die Heiland – Wir sind Anwalt (Fernsehserie, Folge: Der unsichtbare Feind)
 Weblinks
 Ulrike Röseberg Homepage
 Ulrike Röseberg Agenturprofil
 Einzelnachweise
 Filmschauspieler
 Theaterschauspieler
 Deutscher
 Geboren 1978
 Frau


type: other

jurisdiction: US

text: b"Department of Health and Human Services\n\n OFFICE OF\n INSPECTOR GENERAL\n\n\n\n\n Quality Oversight of\n Ambulatory Surgical Centers\n\n A System in Neglect\n\n\n\n\n JANET REHNQUIST\n Inspector General\n\n FEBRUARY 2002\n OEI-01-00-00450\n\x0c OFFICE OF INSPECTOR GENERAL\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to\nprotect the integrity of the Department of Health and Human Services programs as well as the health\nand welfare of beneficiaries served by them. This statutory mission is carried out through a nationwide\nprogram of audits, investigations, inspections, sanctions, and fraud alerts. The Inspector General\ninforms the Secretary of program and management problems and recommends legislative, regulatory,\nand operational approaches to correct them.\n\n Office of Evaluation and Inspections\n\nThe Office of Evaluation and Inspections (OEI) is one of several components of the Office of Inspector\nGeneral. It conducts short-term management and program evaluations (called inspections) that focus\non issues of concern to the Department, the Congress, and the public. The inspection reports provide\nfindings and recommendations on the efficiency, vulnerability, and effectiveness of departmental\nprograms.\n\nOEI's Boston Regional Office prepared this report under the direction of Mark R. Yessian, Ph.D.,\nRegional Inspector General and Joyce M. Greenleaf, MBA, Assistant Regional Inspector General.\nPrincipal OEI staff included:\n\nBOSTON HEADQUARTERS\n\nKenneth R. Price, Project Leader Linda Frisch, Program Specialist\n\nChristopher T. Gould, MS, Program Analyst\n\nMegan V. Smith, MPH, Program Analyst\n\n\n\n\n\n To obtain copies of this report, please call the Boston Regional Office at (617) 565-1050.\n Reports are also available on the World Wide Web at our home page address:\n\n http://oig.hhs.gov/oei\n\x0c EXECUTIVE SUMMARY\n\nPurpose and Background\n\n This inquiry assesses how State agencies and accreditors oversee ambulatory surgical centers\n (ASCs) and how the Centers for Medicare & Medicaid Services (CMS) holds them\n accountable. In addition to this report, this inquiry includes two supplemental reports:\n Supplemental Report 1: The Role of Certification and Accreditation and Supplemental\n Report 2: Holding the State Agencies and Accreditors Accountable.\n\n Medicare annually pays over $1.6 billion for procedures performed by over 3,000 ASCs.\n Quality oversight of ASCs revolves around the Conditions of Coverage, Medicare\xe2\x80\x99s set of\n minimum health and safety requirements. ASCs must become Medicare certified by a State\n survey and certification agency or privately accredited to show that they meet the Conditions.\n The overwhelming majority of ASCs choose to become certified by State agencies.\n\n While ambulatory surgery has been shown to have good outcomes, routine procedures can\n result in serious complications and death. For example, a patient undergoing a routine\n Medicare-covered gynecologic procedure died in an ASC from complications; a patient whose\n bladder was perforated during surgery in an ASC was transported while bleeding to the nearest\n emergency room; a patient undergoing one of the most common procedures in Medicare,\n cataract extraction, went into cardiac arrest and died on the operating table in an ASC.\n\nFindings\n\nOversight of ASCs is more important than ever\n Medicare ASCs are experiencing explosive growth\xe2\x80\x94more than doubling in number from 1990\n to 2000. Over the same period, the annual volume of major procedures they performed\n increased by 730 percent, from 12,000 to over 101,000 procedures.\n\nBut Medicare\xe2\x80\x99s system of quality oversight is not up to the task\n Nearly a third of ASCs certified by State agencies have not been recertified in 5 or more years.\n Accredited ASCs are surveyed at least every 3 years, but the survey process devotes less\n attention to verifying compliance.\n\nAnd it lacks accountability\n CMS does little to hold State certification agencies and accreditors accountable to the\n Medicare program and the public.\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 1 OEI-01-00-00450\n\x0cRecommendations\n\nCMS should determine an appropriate minimum cycle for surveying ASCs\ncertified by State agencies\n\nCMS should update the Medicare Conditions of Coverage for ASCs\n Add sections to address patient rights and continuous quality improvement. Make the\n conditions adjustable to match the levels of surgery performed by different ASCs.\n\nCMS should ensure that State agency certification and accreditation strike an\nappropriate balance between compliance and continuous quality improvement\n Monitor State agencies and accreditors to ensure that they protect the public from poor\n performing ASCs while encouraging the rest to go beyond minimal health and safety standards.\n\nCMS should hold State agencies and accreditors fully accountable to the\nMedicare program for their performance overseeing ASCs\n Use electronic data reporting, Federal oversight surveys, and formal, periodic evaluations to\n monitor and provide feedback to State agencies and accreditors.\n\nCMS should do more to hold State agencies and accreditors accountable to the\npublic for their performance overseeing ASCs\n Take steps to increase public information about State agency certified and accredited ASCs\n and the accessibility of State agencies\xe2\x80\x99 and accreditors\xe2\x80\x99 complaint processes. Publish\n performance information about State agencies and the accreditors.\n\nComments on the Draft Reports\n Within the Department, we received comments from CMS. We also solicited and received\n comments from the Accreditation Association for Ambulatory Health Care, the Joint\n Commission on Accreditation of Healthcare Organizations, and the American Association for\n Accreditation of Ambulatory Surgical Facilities. The full text is included in appendix A. In\n response, we made several clarifying and technical changes.\n\n The commenters expressed much general support for our recommendations. CMS elaborated\n on options it is considering that are in accord with many of our recommendations. However,\n citing resource constraints and other concerns, it did not fully commit itself to a number of our\n recommendations, particularly those calling for a minimum survey cycle and a more accessible\n complaint process. We urge CMS to devote a sense of urgency to the early warning signal we\n provide and to develop an action plan detailing the specific actions it will take to improve ASC\n oversight.\n\n Some commenters took issue with our concerns about the depth of accreditation surveys. We\n still conclude that accreditation surveys tend to pay more attention to education and\n improvement than to verifying compliance, but in the final reports did give more prominence to\n the need for balance between compliance and improvement.\n\n\nQuality Oversight of ASCs: A System in Neglect 2 OEI-01-00-00450\n\x0c TABLE OF CONTENTS\n\n PAGE\n\n\nEXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1\n\n\nINTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4\n\n\nFINDINGS\n\n\n Oversight of ASCs is more important than ever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6\n\n\n Medicare\xe2\x80\x99s system of quality oversight is not up to the task . . . . . . . . . . . . . . . . . . . . . . . . . . 6\n\n\n Medicare\xe2\x80\x99s system of quality oversight lacks accountability . . . . . . . . . . . . . . . . . . . . . . . . . . 7\n\n\nRECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10\n\n\nCOMMENTS on the DRAFT REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14\n\n\nAPPENDICES\n\n\n A: Comments on the Draft Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16\n\n B: Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34\n\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 3 OEI-01-00-00450\n\x0c INTRODUCTION\n\nPurpose\n\n To assess how State agencies and accreditors oversee ambulatory surgical centers (ASCs) and\n how the Centers for Medicare & Medicaid Services (CMS) holds them accountable.\n\nBackground\n\n ASCs in the Medicare Program\n In 2000, Medicare paid $1.6 billion for 4.3 million procedures performed in ambulatory\n surgical centers (ASCs). ASCs are generally free-standing facilities and may only bill Medicare\n for surgical procedures that the Centers for Medicare & Medicaid Services (CMS) has\n determined can be performed safely outside of the hospital. 1 Currently, over 3,000 ASCs\n participate in Medicare.\n\n While ambulatory surgery has been shown to have good surgical outcomes, even routine\n procedures can result in serious complications and death. 2 For example, a patient undergoing a\n routine Medicare-covered gynecologic procedure died in an ASC from complications during\n surgery; a patient whose bladder was perforated during surgery in an ASC was transported\n while bleeding to the nearest emergency room; a patient undergoing one of the most common\n procedures in Medicare, cataract extraction, went into cardiac arrest and died on the operating\n table in an ASC. While these adverse events could happen in any setting, the risk of such\n complications and the fact that more elderly patients with poorer health conditions are\n becoming candidates for ambulatory surgery illustrate the necessity for strong quality oversight\n of ASCs.3\n\n Quality Oversight of ASCs\n Quality oversight of ASCs revolves around the Conditions of Coverage, Medicare\xe2\x80\x99s set of\n minimum health and safety requirements. CMS requires that ASCs become Medicare-\n certified by a State survey and certification agency or privately accredited to show that they\n meet the Conditions. While ASCs are free to choose which route they take, over 90 percent\n elect to become certified by State agencies rather than through accreditation. Some ASCs that\n are certified by State agencies, however, are also accredited for reasons other than Medicare\n certification.\n\n The focus of certification by State agencies and accreditation is routine inspections of ASCs,\n called surveys. Generally, surveys are conducted to add new ASCs to Medicare, reevaluate\n those already in the program, and respond to complaints or adverse events. State agency\n surveys follow CMS\xe2\x80\x99 survey protocol, which is based on the Conditions. Accreditation\n surveys, however, are based on accreditors\xe2\x80\x99 own standards. Thus, only accreditors whose\n standards meet or exceed the Conditions may survey ASCs for Medicare.4 CMS has\n approved three accreditors: the American Association for Accreditation of Ambulatory Surgical\n\nQuality Oversight of ASCs: A System in Neglect 4 OEI-01-00-00450\n\x0c Facilities, the Accreditation Association for Ambulatory Health Care, and the Joint Commission\n on Accreditation of Healthcare Organizations.5\n\n Holding State Agencies and Accreditors Accountable\n CMS\xe2\x80\x99 tools for monitoring and holding State agencies and accreditors accountable to\n Medicare include: 1) electronic data reporting that, for each survey, identifies the provider,\n survey date, standards not met by the provider, and follow-up activity;\n 2) Federal oversight surveys during which CMS staff observe surveys unfold or evaluate\n recently surveyed facilities; and, 3) periodic evaluations whereby CMS conducts formal\n reviews of State agencies\xe2\x80\x99 and accreditors\xe2\x80\x99 performance.\n\n Tools for holding State agencies and accreditors accountable to the public include:\n 1) public release of data on the performance of ASCs; 2) complaint processes that investigate\n complaints about poor care received in ASCs; and 3) public release of data on the\n performance of State agencies and accreditors.\n\nThis Inquiry and This Report\n\n This inquiry focuses on the oversight of ASCs and is part of a larger plan to assess the quality\n oversight of ambulatory surgery in the Medicare program. We chose to evaluate the oversight\n of ASCs first because they are one of the fastest growing settings for ambulatory surgery in\n Medicare. In addition to this report, this inquiry includes two supplemental reports:\n Supplemental Report 1: The Role of Certification and Accreditation and Supplemental\n Report 2: Holding the State Agencies and Accreditors Accountable.\n\n We conducted this inspection in accordance with the Quality Standards for Inspections\n issued by the President\xe2\x80\x99s Council on Integrity and Efficiency.\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 5 OEI-01-00-00450\n\x0c FINDINGS\n\nOversight of ASCs is more important than ever\n\n Medicare ASCs are experiencing explosive growth\n From 1990 to 2000, the number of ASCs has increased by close to 200 facilities a year while\n during the same period the number of hospitals decreased slightly. In fact, over the past 5\n years, the growth rate of ASCs outpaces all other settings in Medicare except for\n comprehensive rehabilitation facilities and rural health clinics.\n\n As the number of ASCs has increased, so too has the number of surgical procedures that they\n perform. From 1990 to 2000, the annual volume of procedures performed by ASCs grew by\n over 220 percent, from 1.3 to 4.3 million procedures. This growth outpaces that of Medicare\xe2\x80\x99s\n two other main surgical settings, hospital outpatient departments and inpatient hospitals, which\n grew by 78 percent and 38 percent respectively.\n\n Scope and complexity of procedures are on the rise\n From 1990 to 2000, CMS approved over 800 new procedures for ASCs\xe2\x80\x94bringing the total\n number of approved procedures to nearly 2,300.6 Many of these new procedures are major\n procedures that involve high levels of anesthesia and invasiveness. In fact, CMS now allows\n ASCs to conduct over 600 major procedures that together represent over a quarter of all\n approved procedures. Recently CMS proposed expanding its list of approved procedures to\n over 2,500 procedures, 743 of which are major procedures.7\n\n These changes in the list of approved procedures have resulted in a dramatic increase in the\n volume of major procedures performed in ASCs. Between 1990 and 2000, the annual volume\n of major procedures taking place in ASCs increased by 730 percent, from 12,000 to over\n 101,000 procedures, while those in outpatient departments and hospitals grew by 392 percent\n and 57 percent respectively.\n\nBut Medicare\xe2\x80\x99s system of quality oversight is not up to the task\n\n State agencies\xe2\x80\x99 ability to adequately oversee ASCs is crumbling\n Nearly a third of ASCs certified by State agencies (872) have gone 5 or more years and 136\n facilities have gone 10 or more years without a recertification survey.8 From 1990 to 2000, the\n elapsed time between recertification surveys of ASCs already in the program more than\n doubled, from 1.8 years to 4.4 years. Elapsed time between surveys grew so dramatically\n during this period because the level of State agency surveys changed little while the number of\n ASCs certified by State agencies more than doubled.9 These numbers are significant because\n the overwhelming majority of ASCs\xe2\x80\x94over 90 percent \xe2\x80\x94are certified by State agencies.\n\n State agencies\xe2\x80\x99 oversight of ASCs is also weak in following through with complaints. In the\n past 5 years, State agencies responded to 141 complaints with a complaint survey.\n\nQuality Oversight of ASCs: A System in Neglect 6 OEI-01-00-00450\n\x0c Yet, as of 2001, 47 percent of these complaints remain unresolved\xe2\x80\x94in some cases for as many\n as 5 years. In fact, nearly a fifth of these complaints are against facilities that have deficiencies\n serious enough to warrant termination from Medicare.10\n\n In addition, the standards that drive State agency surveys, the Medicare Conditions of\n Coverage, have not been updated since the inception of the ASC program in 1982. Thus,\n State agency certification has failed to keep pace with important advances in quality oversight.\n For example, the Conditions do not address patient rights, such as handling patient complaints\n and safeguarding patient privacy. They also fail to address continuous quality improvement.11\n CMS has begun to address these issues in the Conditions for other provider types including\n nursing homes, home health agencies, and hospitals.12 We note that CMS attempted to update\n the Conditions in 1996, but its effort never reached conclusion.\n\n Finally, State agency surveys perform a focused review around the Conditions, but fail to\n encompass quality improvement. These surveys are characterized by a challenging, direct\n approach in which surveyors aim to enforce minimums, rather than educate toward quality\n improvement. This approach is reinforced by CMS\xe2\x80\x99 survey policy, which states that surveyors\n are not to educate, advise, or consult with the facility on ways to improve its quality of care.\n\n Accreditors offer routine surveys based on up-to-date standards, but pay\n less attention to verifying compliance\n Unlike State agencies, accreditors survey ASCs every 3 years. This gives them and their\n standards high visibility and allows them to keep abreast of changes in facilities. In addition, the\n accreditors update their standards far more often than CMS, in some cases annually. This\n allows them to keep pace with advances in technology and changes in the ASC industry. For\n example, each has developed standards concerning malignant hyperthermia, a recently\n recognized complication triggered by common general anesthetics. Finally, accreditors tailor\n their standards to reflect the varying risk and complexity of services offered by different ASCs.\n\n By their nature, accreditors focus on continuous quality improvement through peer-to-peer\n interaction during surveys.13 Yet, while on-site, accreditation surveyors must assess compliance\n with hundreds of standards, usually within surveys that last less than 2 days. This packed\n agenda and the accreditor\xe2\x80\x99s instructive approach result in less attention to verifying compliance\n with their standards. For example, we observed surveyors asking a series of questions about\n key standards, but not verifying the existence of supporting evidence. At times this approach\n can result in superficial review.\n\nMedicare\xe2\x80\x99s system of quality oversight lacks accountability\n\n CMS does little to hold State agencies and accreditors accountable to the\n Medicare program\n CMS does little to monitor the performance of State agencies and accreditors. It limits its use\n of electronic survey data to reviewing quarterly summaries of deficiencies, and does\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 7 OEI-01-00-00450\n\x0c not use it to monitor elapsed times between surveys, disciplinary actions, or other metrics of\n performance. It cannot obtain a unified picture of survey activity in the ASC program because\n State agency and accreditation data each contain different information and are stored in\n separate, incompatible systems.14 It rarely performs Federal oversight surveys to monitor State\n agencies\xe2\x80\x99 and accreditors\xe2\x80\x99 performance surveying ASCs. While State agencies and accreditors\n conducted over 3,400 surveys of ASCs from 1995 to 2001, CMS conducted just 15 Federal\n oversight surveys\xe2\x80\x9411 of which were in California. Finally, CMS\xe2\x80\x99 periodic, formal evaluations\n shed little light on performance. Evaluations of State agencies only address their performance\n surveying nursing homes and those for accreditors are largely removed from their performance\n surveying ASCs.\n\n With so little monitoring of their performance, CMS is hard-pressed to provide meaningful\n feedback to State agencies and accreditors. It provides virtually no feedback to the State\n agencies on their performance overseeing ASCs. Its feedback to the accreditors, which is\n comprised of a letter following formal evaluation, is limited since it focuses on their policies and\n procedures rather than the quality of surveys they conduct.\n\n Finally, CMS\xe2\x80\x99 routine, operational feedback to State agencies and accreditors is problematic.\n Officials from State agencies and accreditors cited lingering confusion over the permissibility of\n keeping Medicare patients for overnight stays, the required frequency of Life Safety Code\n surveys, and which accreditors were approved to survey ASCs.\n\n CMS does little to hold State agencies and accreditors accountable to the\n public\n State agency certification provides little public information on the performance of ASCs;\n accreditation provides slightly more. While CMS uses the Medicare web site, a telephone\n hotline, and postings within facilities to disseminate State agency survey reports for other\n provider types, it does not do so for ASCs.15 The Medicare handbook, which it sends to all\n Medicare beneficiaries, makes no mention of survey reports. Such reports are available\n through CMS offices or State agencies. However, these reports lack comparative information,\n leaving the public with no information on an ASC\xe2\x80\x99s performance relative to its past or its peers.\n\n The availability of accreditation survey reports is also limited; only the Joint Commission makes\n them available to the public. The Joint Commission makes survey results, called performance\n reports, available over the phone and on-line. These reports include accreditation decisions,\n dates of surveys, and comparative information to other ASCs. They also identify those areas\n requiring improvement and whether they were resolved.\n\n CMS does little to make State agencies\xe2\x80\x99 complaint process accessible to Medicare consumers.\n For example, it does not provide prominent, clear instructions for lodging complaints on the\n Medicare web site or over the Medicare telephone hotline, nor does it require ASCs to post\n complaint instructions.16, 17 In the Medicare handbook it instructs beneficiaries to bring\n complaints to peer review organizations, but recent OIG inquiries have found that they have\n flawed complaint processes.18 The complaint processes of the accreditors are slightly more\n accessible. Though not required by CMS, they include toll-\n\n\nQuality Oversight of ASCs: A System in Neglect 8 OEI-01-00-00450\n\x0c free numbers on certificates of accreditation, which ASCs generally post in their lobbies, and/or\n solicit complaints or feedback through their web sites.\n\n Finally, CMS makes no information available on how well State agencies and accreditors carry\n out their charge to the Medicare program. It does not publish the results of formal evaluations,\n summaries of complaint volumes against State agency certified/accredited ASCs, or other\n information that would allow comparison across State agencies and accreditors.\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 9 OEI-01-00-00450\n\x0c RECOMMENDATIONS\n\nCMS should determine an appropriate minimum cycle for\nsurveying ASCs certified by State agencies\n\n In determining a minimum survey cycle for ASCs, CMS should consider the nature and risks of\n care ASCs deliver.19 CMS should also consider a strategic approach that addresses survey\n cycles for ASCs within the overall context of adequately surveying all types of providers\n certified by State agencies. In addition, it should consider how its analysis of certain data could\n help it prioritize surveys across ASCs. For example, it could draw on volume of Medicare\n procedures, complaint history, and whether an ASC is accredited for reasons other than\n Medicare certification. CMS should also consider whether the financial demands presented by\n the rising number of Medicare-certified providers warrant establishing user fees, which would\n require a legislative change. Such steps might enable CMS to better manage and plan for\n growth in the number of certification surveys required to adequately oversee certified providers.\n\nCMS should update the Medicare Conditions of Coverage for ASCs\n\n At a minimum, add sections that deal with patient rights and continuous\n quality improvement\n CMS should add a section to the Conditions that addresses issues such as how ASCs will\n respect patients\xe2\x80\x99 dignity and resolve patient complaints. Such a step would reflect CMS\xe2\x80\x99\n renewed focus on beneficiaries within its strategic plan and goals aimed at strengthening\n beneficiary satisfaction and protections.\n\n CMS should ensure that the Conditions require ASCs to conduct continuous quality\n improvement efforts. Over the longer term, we urge CMS to explore developing a set of\n standardized performance measures for ASCs. CMS could also use such measures to monitor\n ASCs\xe2\x80\x99 performance and adjust the frequency and focus of surveys. CMS already has a similar\n initiative underway for nursing homes and home health agencies. Both the Medicare Payment\n Advisory Commission and Congress have recently called on CMS to explore the expanded use\n of quality indicators.20\n\n Make the Conditions adjustable to match the levels of surgery performed by\n different ASCs\n In updating the Conditions, CMS should move away from its current one-size-fits-all model and\n instead consider an adjustable approach that would enable surveyors to tailor them to individual\n ASCs.21 Such an approach might take into account anesthesia, invasiveness, and other factors\n that drive the risk and complexity of procedures done by a given ASC. This would improve the\n effectiveness and efficiency of State agency certification as well as minimize the regulatory\n burden by focusing the standards and the State agency survey around the level of services\n offered by each ASC.\n\n\nQuality Oversight of ASCs: A System in Neglect 10 OEI-01-00-00450\n\x0cCMS should ensure that State agency certification and\naccreditation strike an appropriate balance between compliance\nand continuous quality improvement\n\n While compliance typifies the regulatory approach taken by State agencies, continuous quality\n improvement is central to the collegial approach of accreditors. Both have important roles to\n play in quality oversight. In previous work, the OIG has highlighted work done by the National\n Roundtable on Health Care Quality and others that suggests both approaches have value, but\n not so much that one should dominate at the expense of the other.22 Balance between the\n approaches would protect the public from poorly performing ASCs while encouraging the rest\n to improve beyond minimal health and safety standards. Yet, quality oversight of ASCs\n provided by State agencies and accreditors engages almost exclusively in one approach or the\n other.\n\nCMS should hold State agencies and accreditors fully accountable\nto the Medicare program for their performance overseeing ASCs\n\n Use electronic data reporting to monitor basic metrics of performance\n CMS should use metrics such as elapsed time between surveys, follow-through with\n deficiencies and complaints, and trends in deficiency citations to continuously monitor State\n agencies\xe2\x80\x99 and accreditors\xe2\x80\x99 progress overseeing ASCs. This type of monitoring would allow\n CMS to detect problems within State agency certification and accreditation and take actions to\n correct them. In addition, it would enable CMS and State agencies to better manage survey\n resources, thus avoiding problems we found such as unresolved complaints and letting ASCs go\n 10 or more years without a survey.\n\n Yet, to make better use of survey data, CMS must address limitations in their structure. We\n note that CMS is in the process of designing a new system for survey data and, in fact, is\n already using it for nursing homes and home health agencies. Thus, as CMS plans to move\n ASCs onto its new system, we offer some specifics for it to consider. First, CMS should\n ensure that its approach captures both State agency and accreditation data and allows them to\n be aggregated. The data should support monitoring the performance of accreditors and State\n agencies. Second, CMS should ensure that its system captures data on termination tracks,\n plans of correction, and reduced accreditation periods. Third, if CMS implements standardized\n performance indicators for ASCs, its system should house such data and support their use for\n adjusting the frequency and focus of surveys\xe2\x80\x94as its new system does now for nursing homes\n and home health agencies.23\n\n Conduct periodic Federal oversight surveys to monitor the nature and\n extent of review done during State agency and accreditation surveys\n In conducting these surveys, CMS should use an approach that allows for consistency among\n Federal reviewers. CMS should also ensure that oversight surveys result in both routine and\n formal feedback to State agencies and accreditors. Without the benefit of Federal oversight\n surveys, it is nearly impossible for CMS to judge the quality of review conducted by State\n agencies and accreditors on Medicare\xe2\x80\x99s behalf.\n\nQuality Oversight of ASCs: A System in Neglect 11 OEI-01-00-00450\n\x0c Conduct formal, periodic evaluations of State agencies\xe2\x80\x99 and accreditors\xe2\x80\x99\n performance overseeing ASCs\n CMS\xe2\x80\x99 newest approach to evaluation of State agencies uses national thresholds that are based\n on measurable indicators of performance\xe2\x80\x94but thus far it focuses only on nursing homes. We\n urge CMS to broaden the scope of its evaluations of State agencies to incorporate other types\n of providers, including ASCs, and to use them to examine performance specific to each type of\n provider they survey. In addition, CMS should focus its evaluations of accreditors toward\n assessing their performance overseeing ASCs, in addition to assessing their organizational\n capacity and operating policies.\n\n Provide feedback to State agencies and accreditors on their performance\n CMS should use electronic survey data, Federal oversight surveys, and formal evaluations to\n inform routine and formal feedback to State agencies and accreditors. However, we note that\n for CMS to effectively monitor and provide feedback to State agencies and accreditors, it\n should first work with them to establish a common set of performance expectations for the\n oversight of ASCs.\n\n In addition, CMS should consider establishing a policy clearinghouse as a way of disseminating\n policy to State agencies and accreditors in a simultaneous and consistent manner. Such a\n clearinghouse would eliminate the confusion around CMS policy that we observed during our\n review. We note that CMS has already established a similar clearinghouse for nursing homes.\n\nCMS should hold State agencies and accreditors accountable to\nthe public for their performance overseeing ASCs\n\n As our health care system moves toward a consumer-oriented marketplace, public\n accountability takes on increasing importance. Public accountability leverages CMS\xe2\x80\x99 oversight\n by focusing the attention of the public, Medicare beneficiaries, and interest groups on the\n performance of ASCs and how well State agencies and accreditors ensure that ASCs provide\n quality care. Indeed, consumer orientation and its implications on CMS\xe2\x80\x99 programs comprise a\n major theme within CMS strategic plan.24 The CMS Administrator has recently reaffirmed\n CMS\xe2\x80\x99 commitment to enhancing the information available to the public on the Medicare\n program.25 However, at this time, the information available to Medicare beneficiaries about the\n performance of ASCs, their ability to complain about poor quality of care, and the performance\n of the quality oversight system itself is woefully inadequate.\n\n Take steps to increase the availability of performance information about\n ASCs certified by State agencies, including publishing it on the Medicare\n web site\n CMS should make full use of mechanisms it has available to disseminate performance\n information about ASCs. For example, with little effort, CMS could immediately place the\n results of State agency surveys on the Medicare web site, as it has done for nursing homes and\n dialysis facilities. In addition, CMS should make them available by request over the Medicare\n telephone hotline and provide instructions for obtaining them within\n\n\n\nQuality Oversight of ASCs: A System in Neglect 12 OEI-01-00-00450\n\x0c the Medicare Handbook. Finally, CMS should require ASCs to post survey results on-site for\n patients to see\xe2\x80\x94as it now does with nursing homes.\n\n CMS should improve the usefulness of survey results to Medicare consumers by adding\n comparative information such as the average number and types of deficiencies outstanding at all\n ASCs. In addition, CMS should seek to supplement them with other data that it already has\n available, such as the facility\xe2\x80\x99s survey and complaint history. Finally, if CMS were to implement\n performance indicators for ASCs, summaries and comparisons of these data should be made\n available to consumers as well.\n\n Increase the accessibility of State agencies\xe2\x80\x99 complaint process\n CMS should make full use of tools it has available to solicit complaints from Medicare\n consumers. Specifically, CMS should make clear, easy-to-find instructions for how to\n complain about ASCs available on the Medicare web site and over the Medicare telephone\n hotline. CMS should also require ASCs to post complaint instructions. These steps are in line\n with CMS\xe2\x80\x99 commitment to collecting and investigating complaints that it outlines in its strategic\n plan.\n\n Negotiate with the accreditors to increase public information about\n accredited ASCs and the accessibility of their complaint processes\n CMS should work with the accreditors to define a minimum amount of information that they will\n make available about the Medicare ASCs they accredit. Similarly, CMS should work with the\n accreditors to ensure that their complaint mechanisms are accessible to Medicare consumers.\n In both cases, each of the accreditors already has in place a web site and telephone number\n where they could make information available. Finally, CMS should require accredited ASCs to\n post survey results and complaint instructions.\n\n Publish information on the performance of State agencies and accreditors\n CMS should use the Medicare web site, the Medicare telephone hotline, and other resources\n to disclose performance reviews of State agencies and accreditors. Information it discloses\n could include comparative summaries of survey data reporting, results of Federal oversight\n surveys, and formal evaluations. Should CMS implement performance indicators for ASCs,\n information could also include comparative summaries of the performance of State agency\n certified and accredited ASCs. Such disclosure holds State agencies and accreditors\n accountable for how well they oversee ASCs and can be useful for Medicare beneficiaries who\n have a choice between State agency certified and accredited facilities.\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 13 OEI-01-00-00450\n\x0c COMMENTS ON THE\n DRAFT REPORT\n\n We received comments from CMS, the Accreditation Association for Ambulatory Health\n Care, the Joint Commission on Accreditation of Healthcare Organizations, and the American\n Association for Accreditation of Ambulatory Surgical Facilities. Below, we summarize their\n comments and offer our response to them in italics. Appendix A contains the full text of all the\n comments.\n\nCMS\n\n CMS expressed general concurrence with many of our recommendations and cited many\n options it is considering that are in accord with them. However, noting resource constraints and\n other concerns, it did not fully commit itself to our key recommendations calling for a minimum\n survey cycle, a more accessible complaint process, and the publication of survey results.\n\n We understand the constraints CMS faces and the complexity of the issues associated\n with ASC oversight. Yet, we urge CMS to view our report as an early warning signal and\n to devote a sense of urgency to our recommendations. As we note in the report,\n Medicare ASCs are experiencing explosive growth and increasingly are performing\n major procedures that involve high levels of anesthesia and invasiveness. We urge CMS\n to develop an action plan and timetable that set forth specific actions it will take to\n improve its oversight of ASCs.\n\nAccreditation Association for Ambulatory Health Care\n\n The Accreditation Association for Ambulatory Health Care generally agreed with our findings\n and recommendations. It asked that our reports include comparative data on safety across\n surgical settings and took issue with our concern about the depth of accreditation surveys. It\n noted that it has added a form to its website to solicit feedback, such as complaints, about its\n accredited centers. It also supported our call for a balance between compliance and\n continuous quality improvement efforts and noted its new policy for random, unannounced\n surveys, which will be effective in 2002.\n\n While our reports do reference literature on the safety of ambulatory surgery, presenting\n comparative data on safety across all settings was outside the scope of our inquiry, which\n focused on the oversight of ambulatory surgery centers. Future inquiries are planned\n that will examine the oversight of ambulatory surgery performed in hospital outpatient\n departments and physician offices. We still conclude that accreditation surveys pay more\n attention to education and improvement than to verifying compliance, and spell out the\n details for that conclusion in the supplemental report, \xe2\x80\x9cThe Role of Certification and\n Accreditation.\xe2\x80\x9d Furthermore, we give more prominence to the importance of balance\n\n\nQuality Oversight of ASCs: A System in Neglect 14 OEI-01-00-00450\n\x0c between compliance and improvement in the final reports. Finally, we made changes to\n the reports to clarify certain points and acknowledge the Association\xe2\x80\x99s feedback\n mechanism on its web site.\n\nJoint Commission on Accreditation of Healthcare Organizations\n\n The Joint Commission generally agreed with the findings in our reports. It pointed out that\n many accredited ASCs have not elected to use their accreditation for deemed status. The Joint\n Commission took issue with our concern about the depth of accreditation reviews and the\n helpfulness of the survey information it discloses.\n\n In the final reports, we clarified that some ASCs surveyed by State agencies for Medicare\n certification may also, in fact, be accredited without electing to use their accreditation\n for deemed status. We urge CMS to consider this information, along with volume of\n Medicare claims and complaints, in determining how to best use its limited resources and\n prioritize ASCs for State agency surveys. We still conclude that accreditation surveys\n pay more attention to education and improvement than to verifying compliance. We give\n more prominence to the importance of balance between compliance and improvement in\n the final reports. Finally, although we still contend that a scoring system that results in\n the great majority of ASCs falling into one broad category of accreditation\n (Accreditation with Type I Recommendations) does little to help consumers differentiate\n between an ASC with few or many recommendations for improvement, we did clarify the\n performance information available from the Joint Commission.\n\nAmerican Association for Accreditation of Ambulatory Surgery Facilities\n\n The American Association generally agreed with our conclusions. It noted that its certificates of\n accreditation include a toll-free number for complaints and that these certificates are generally\n displayed prominently by its accredited ASCs.\n\n In the final reports, we clarified that the certificates of accreditation include a toll-free\n number and address for filing complaints.\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 15 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\n Full Text of Comments on the Draft Report\n\n\n\n\n CMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17\n\n\n Accreditation Association for Ambulatory Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23\n\n\n Joint Commission on Accreditation of Healthcare Organizations . . . . . . . . . . . . . . . . . . . . . 27\n\n\n American Association for Accreditation of Ambulatory Surgical Facilities . . . . . . . . . . . . . . 31\n\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 16 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 17 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 18 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 19 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 20 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 21 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 22 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 23 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 24 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 25 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 26 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 27 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 28 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 29 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 30 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 31 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 32 OEI-01-00-00450\n\x0c APPENDIX A\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 33 OEI-01-00-00450\n\x0c APPENDIX B\n\n\n\n\n Endnotes\n\n\n1. 42 C.F.R., sec. 416.2.\n\n2. Mark A. Warner et al., \xe2\x80\x9cMajor Morbidity and Mortality Within 1 Month of Ambulatory Surgery and\nAnesthesia,\xe2\x80\x9d Journal of the American Medical Association 270 (September 22, 1993) 12: 1437-\n1441.\n\nG. Mezei & F. Chung, \xe2\x80\x9cReturn hospital visits and hospital readmissions after ambulatory surgery,\xe2\x80\x9d\nAnnals of Surgery 230 (November 1999) 5: 721-727.\n\nRebecca Twersky et al., \xe2\x80\x9cWhat happens after discharge? Return hospital visits after ambulatory\nsurgery,\xe2\x80\x9d Anesthesia & Analgesia 84 (February 1997) 2: 319-324.\n\n3. Margaret Jean Hall et al., \xe2\x80\x9cAmbulatory Surgery in the United States, 1996,\xe2\x80\x9d Advance Data: National\nCenter for Health Statistics, Centers for Disease Control 300 (August 12, 1998).\n\nMark A. Warner et al., \xe2\x80\x9cMajor Morbidity and Mortality Within 1 Month of Ambulatory Surgery and\nAnesthesia,\xe2\x80\x9d Journal of the American Medical Association 270 (September 22, 1993) 12: 1437-\n1441.\n\n4. Social Security Act, sec. 1865, 42 U.S.C. 1395bb.\n\n5. These are the accreditors approved as of August, 2001. CMS announced in the Federal Register\n(50 Fed. Reg. 66, 14906, March 14, 2001) that the American Osteopathic Association (AOA)\napplied for recognition as a national accreditation program for ASCs for the Medicare program. As of\nthe date this report was issued the AOA had not yet been approved to accredit Medicare ASCs. The\nJoint Commission on the Accreditation of Health Care Organizations and the Accreditation Association\nfor Ambulatory Health Care have been approved since December 19, 1996 ( 245 Fed. Reg. 61,\n67042, Dec. 19, 1996). The American Association for Accreditation of Ambulatory Surgical Facilities\nhas had approval since December 2, 1998 (231 Fed. Reg. 63, 66554, Dec. 2, 1998).\n\n6. CMS approves procedures to be performed in ASCs based on 42 C.F.R., sec. 416.65. These\nstandards limit ASC procedures to those that do not generally result in extensive blood loss, that do not\nrequire major or prolonged invasion of body cavities, that do not directly involve major blood vessels,\nor that are not generally emergency or life-threatening in nature.\n\n7. Section 1833(i)(1) of the Social Security Act requires that the ASC list be reviewed and updated at\nleast biennially. The current list of procedures approved for ASCs was last reviewed and updated in\n1995. CMS has not updated this list in over 6 years and has missed its last three scheduled update\ndeadlines.\n\n\nQuality Oversight of ASCs: A System in Neglect 34 OEI-01-00-00450\n\x0c APPENDIX B\n\n\n\n8. We count the number of ASCs that have not had a survey in 5 or more years in a given year using\nthe midyear, July 1, as the point of reference for each year.\n\n9. Year 2000 data is from December 2000. According to OSCAR, as of May 2001, 3,234 ASCs\nparticipate in the Medicare program, of those, 2, 966 are certified.\n\n10. OIG analysis of OSCAR data. Complaint files are considered to be unresolved if they are listed in\nOSCAR as \xe2\x80\x9cpending.\xe2\x80\x9d We obtained a total of 18 complaint files to check against OSCAR. We found\nthat the provider files marked pending in OSCAR have not had a follow-up survey or action against\nthem since the complaint survey was performed.\n\n11. CMS does speak to the importance of continuous quality improvement in its interpretive guidelines\nto ASC surveyors. However, because the Conditions themselves make no demand for ASCs to\nconduct continuous quality improvement, CMS cannot hold ASCs responsible for not engaging in such\nactivities.\n\n12. CMS has implemented the Minimum Data Set in nursing homes and the Outcome and Assessment\nInformation Set in home health agencies. In addition, CMS calls for quality indicators within its\nproposed update of the Conditions of participation for hospitals.\n\n13. For more on the nature of accreditation, see Office of Inspector General, The External Review of\nHospital Quality: A Call for Greater Accountability (July 1999).\n\n14. CMS stores State agency data in its Online Survey Certification and Reporting System (OSCAR),\nwhich resides on its mainframe computer. It stores accreditation data on a personal computer\nspreadsheet.\n\n15. For example, CMS provides nursing home surveys and comparative data on nursing homes on a\nspecial section of its web site called \xe2\x80\x9cMedicare Compare\xe2\x80\x9d. CMS also requires nursing homes to post\nrecent surveys for consumers to see. In addition, CMS requires State agencies maintain a hotline for\nbeneficiaries to obtain the results of home health surveys.\n\n16. As of July, 2001, the Medicare web site (www.medicare.gov) listed points of contact for quality of\ncare and complaints together in a section called \xe2\x80\x98Helpful Contacts,\xe2\x80\x99 placed two levels beneath the front\n(home) page . The list contained points of contact for a dozen entities including those for complaints\nabout nursing homes and end stage renal disease dialysis facilities. Peer Review Organizations appeared\nat the end of the list as a point of contact for complaints about quality of care. There were no\ninstructions about how the complaint process works, its time lines, or beneficiaries\xe2\x80\x99 rights within the\ncomplaint process.\n\n17. We called the Medicare telephone hotline (1-800-MEDICARE) twice in February, 2001 to find\ninstructions for complaining about poor care. One time the operator referred us to the Peer Review\nOrganization and the other to the State agency.\n\nQuality Oversight of ASCs: A System in Neglect 35 OEI-01-00-00450\n\x0c APPENDIX B\n\n\n\n18. See Office of Inspector General, The Beneficiary Complaint Process of the Medicare Peer\nReview Organization, OEI-01-93-00250, November 1995 and Office of Inspector General, The\nMedicare Beneficiary Complaint Process - A Rusty Safety Valve, OEI-01-00-00060, August\n2001.\n\n19. CMS could also consider whether particular ASCs are, in fact, treating Medicare beneficiaries.\nOur analysis revealed 515 certified ASCs that made no Medicare claims in 2000. Further analysis\nwould be needed to determine whether these 515 are newly certified and therefore unlikely to have\nclaims for the year 2000.\n\n20. In its 2000 Report to the Congress, Medpac recommended that CMS expand its indicator-driven\nsurvey process for nursing homes and home health agencies to other providers in the Medicare\nprogram. In the Benefits Improvement and Protection Act of 2000, Congress directed the Secretary to\nwork with Medpac and the Agency for Healthcare Research and Quality to examine and report on the\ndevelopment of standard instruments for patient assessment across settings.\n\n21. Such a change may require legislation.\n\n22. Department of Health and Human Services, Office of Inspector General, The External Review of\nHospital Quality, OEI-01-97-00050; Office of Inspector General, The External Quality Review of\nDialysis Facilities, OEI-01-99-00050; Mark R. Chasin et al, \xe2\x80\x9cThe Urgent Need to Improve Health\nCare Quality: Institute of Medicine National Roundtable on Health Care Quality,\xe2\x80\x9d Journal of the\nAmerican Medical Association 280 (September 16, 1998) 11: 1000-1005.\n\n23. CMS\xe2\x80\x99 new system, called the Quality Improvement and Evaluation System (QIES), uses the\nMinimum Data Set merged with OSCAR data to allow State agencies to monitor the performance of\nnursing homes. CMS also uses these data to monitor the performance of State agencies. CMS is now\nintegrating the Home Health Care Outcome and Assessment Information Set into QIES to allow for\nsimilar capability for overseeing home health agencies.\n\n24. CMS Strategic Plan, Publication HCFA-02135, September, 1998.\n\n25. Using Technology to Improve Medicare Before the Subcomm. on Science, Technology, and\nSpace of the Senate Comm. on Commerce, Science, and Transportation, 107th Cong., 1st Sess. 78\n(2001).\n\n\n\n\nQuality Oversight of ASCs: A System in Neglect 36 OEI-01-00-00450\n\x0c"


type: caselaw

text:
 28.4.2007
 EL
 Επίσημη Εφημερίδα της Ευρωπαϊκής Ένωσης
 C 96/39
 Απόφαση του Δικαστηρίου Δημόσιας Διοίκησης (τρίτο τμήμα) της 29ης Μαρτίου 2007 — Cwik κατά Επιτροπής
 (Υπόθεση F-31/05) (1)
 (Υπάλληλοι - Αξιολόγηση - Έκθεση εξελίξεως της σταδιοδρομίας - Έτος αξιολογήσεως 2003 - Προσφυγή ακυρώσεως - Ένσταση ελλείψεως νομιμότητας - Πρόδηλη πλάνη εκτιμήσεως)
 (2007/C 96/80)
 Γλώσσα διαδικασίας: η γαλλική
 Διάδικοι
 Προσφεύγων: Michael Cwik (Tervuren, Βέλγιο) (εκπρόσωπος: N. Lhoëst, δικηγόρος)
 Καθής: Επιτροπή tων Ευρωπαϊκών Κοινοτήτων (εκπρόσωποι: L. Lozano Palacios και J. Currall)
 Αντικείμενο της υποθέσεως
 Αφενός, ακύρωση της εκθέσεως εξελίξεως της σταδιοδρομίας του προσφεύγοντος για την περίοδο από 1ης Ιανουαρίου έως 31 Δεκεμβρίου 2003 και, εφόσον παρίσταται ανάγκη, της αποφάσεως της 24ης Ιανουαρίου 2005 περί απορρίψεως της διοικητικής του ενστάσεως κατά της ΕΕΣ 2003 και, αφετέρου, αίτημα να υποχρεωθεί η Επιτροπή των Ευρωπαϊκών Κοινοτήτων στην καταβολή αποζημιώσεως ενός συμβολικού ευρώ.
 Διατακτικό της αποφάσεως
 Το Δικαστήριο Δημόσιας Διοίκησης αποφασίζει:
 1.
 Απορρίπτει την προσφυγή.
 2.
 Κάθε διάδικος φέρει τα δικαστικά του έξοδα.
 (1) EE C 193 της 6.8.2005 (υπόθεση αρχικά πρωτοκολληθείσα ενώπιον του Πρωτοδικείου των Ευρωπαϊκών Κοινοτήτων με αριθμό υποθέσεως Τ-200/05 και μεταβιβασθείσα στο Δικαστήριο Δημόσιας Διοίκησης της Ευρωπαϊκής Ένωσης με διάταξη της 15.12.2005).


text:
La computer-generated imagery (termine mutuato dall'inglese che tradotto letteralmente in italiano significa "immagini generate al computer") più nota con la sigla CGI, è un'applicazione nel campo della computer grafica o, più specificatamente, nel campo della computer grafica 3D per la resa degli effetti speciali digitali nei film, in televisione, negli spot commerciali, nei videogiochi di simulazione e in tutte le applicazioni di grafica visiva.
 Quando vediamo un film in CGI ci sembra un film con attori e oggetti in carne ed ossa: solo che i personaggi hanno sempre un aspetto cartoonesco .
 Spesso il CGI viene usato anche per film con attori veri: spesso per mostri o personaggi fittizi per renderlo fedele al personaggio originale, come il fantasy e horror.
 Descrizione
 La vettorializzazione di un'immagine è il processo che consente ad un'immagine bidimensionale digitalizzata di essere gestita in ogni tipo di vista tridimensionale. Nell'ambito della animazione, sul finire degli anni ottanta questo processo ha portato una vera e propria rivoluzione nella realizzazione dei cartoni animati, principalmente per il fatto che l'animazione non doveva più avvenire attraverso il montaggio su pellicola dei vari fotogrammi, ma essendo proveniente da immagini già digitali, essa poteva essere gestita direttamente al computer.
 Immagini statiche e paesaggi
 Non solo le immagini animate fanno parte delle immagini generate al computer; I paesaggi dall'aspetto naturale (come i paesaggi frattali) vengono generati anche tramite algoritmi informatici. Un modo semplice per generare superfici frattali è usare un'estensione del metodo della mesh triangolare, basandosi sulla costruzione di qualche caso speciale di una curva di de Rham, ad esempio lo spostamento del punto medio. Ad esempio, l'algoritmo può iniziare con un triangolo grande, quindi ingrandire ricorsivamente dividendolo in quattro triangoli di Sierpinski più piccoli, quindi interpolare l'altezza di ogni punto dai suoi vicini più vicini. La creazione di una superficie browniana può essere ottenuto non solo aggiungendo rumore quando vengono creati nuovi nodi, ma aggiungendo ulteriore rumore a più livelli della mesh. Così una mappa topografica con diversi livelli di altezza può essere creata usando algoritmi frattali relativamente semplici. Alcuni frattali tipici e facili da programmare usati in CGI sono il frattale del plasma e il frattale di faglia più drammatico.
 Molte tecniche specifiche sono state ricercate e sviluppate per produrre effetti generati dal computer altamente focalizzati; ad esempio, l'uso di modelli specifici per rappresentare l'alterazione chimica delle pietre per modellare l'erosione e produrre un "aspetto invecchiato" per una data superficie a base di pietra.
 Scene architettoniche
 Gli architetti moderni utilizzano i servizi delle aziende di computer grafica per creare modelli tridimensionali sia per i clienti che per i costruttori. Questi modelli generati dal computer possono essere più accurati dei disegni tradizionali. L'animazione architettonica (che fornisce filmati animati degli edifici, piuttosto che immagini interattive) può essere utilizzata anche per vedere la possibile relazione che un edificio avrà in relazione all'ambiente e agli edifici circostanti. Il rendering di spazi architettonici senza l'uso di strumenti come matita e carta è oggi una pratica ampiamente accettata con una serie di sistemi di progettazione architettonica assistita da computer.
 Gli strumenti di modellazione architettonica consentono a un architetto di visualizzare uno spazio ed eseguire "walk-through" in modo interattivo, fornendo così "ambienti interattivi" sia a livello urbano che a livello di edificio. Applicazioni specifiche in architettura non includono solo le specifiche delle strutture edilizie (come muri e finestre) e passaggi pedonali, ma anche gli effetti della luce e il modo in cui la luce solare influenzerà un progetto specifico in diversi momenti della giornata.
 Gli strumenti di modellazione architettonica sono ora diventati sempre più basati su Internet. Tuttavia, la qualità dei sistemi basati su Internet è ancora inferiore a quella dei sofisticati sistemi di modellazione interni.
 In alcune applicazioni, le immagini generate al computer vengono utilizzate per "decodificare" edifici storici. Ad esempio, una ricostruzione generata dal computer del monastero di Georgenthal in Germania è stata ricavata dalle rovine del monastero, ma fornisce allo spettatore un "aspetto e una sensazione" di come sarebbe stato l'edificio ai suoi tempi.
 Modelli anatomici
 I modelli generati dal computer utilizzati nell'animazione scheletrica non sono sempre anatomicamente corretti. Tuttavia, organizzazioni come lo Scientific Computing and Imaging Institute hanno sviluppato modelli computerizzati anatomicamente corretti. I modelli anatomici generati dal computer possono essere utilizzati sia per scopi didattici che operativi. Ad oggi, un grande numero di immagini mediche prodotte dagli artisti continuano ad essere utilizzate dagli studenti di medicina, come le immagini di Frank H. Netter, ad esempio le immagini cardiache. Tuttavia, stanno diventando disponibili numerosi modelli anatomici online.
 Una radiografia di un singolo paziente non è un'immagine generata da computer, anche se digitalizzata. Tuttavia, nelle applicazioni che implicano scansioni TC, un modello tridimensionale viene automaticamente prodotto da molti raggi X a sezione singola, producendo "immagini generate al computer". Le applicazioni che coinvolgono la risonanza magnetica mettono insieme anche una serie di "istantanee" (in questo caso tramite impulsi magnetici) per produrre un'immagine interna composita.
 Nelle moderne applicazioni mediche, i modelli specifici del paziente sono costruiti in "chirurgia assistita da computer". Ad esempio, nella protesi totale del ginocchio, la costruzione di un modello dettagliato specifico per il paziente può essere utilizzata per pianificare attentamente l'intervento. Questi modelli tridimensionali vengono solitamente estratti da più scansioni TC delle parti appropriate dell'anatomia del paziente. Tali modelli possono essere utilizzati anche per la pianificazione degli impianti della valvola aortica, una delle procedure comuni per il trattamento delle malattie cardiache. Dato che la forma, il diametro e la posizione delle aperture coronariche possono variare notevolmente da paziente a paziente, l'estrazione (dalle scansioni TC) di un modello che assomiglia molto all'anatomia valvolare di un paziente può essere molto utile nella pianificazione della procedura.
 Immagini di stoffa e pelle
 I modelli di stoffa generalmente si dividono in tre gruppi:
 La struttura geometrico-meccanica all'incrocio del filo
 La meccanica dei fogli elastici continui
 I tratti geometrici macroscopici del tessuto.
 Ad oggi, far piegare automaticamente in modo naturale gli abiti di un personaggio digitale rimane una sfida per molti animatori.
 Oltre al loro utilizzo nei film, nella pubblicità e in altre modalità di visualizzazione pubblica, le immagini di abbigliamento generate al computer sono ora utilizzate di routine dalle migliori aziende di fashion design.
 La sfida nel rendere le immagini della pelle umana coinvolge tre livelli di realismo:
 Realismo fotografico che assomiglia a una pelle reale a livello statico
 Realismo fisico nell'assomigliare ai suoi movimenti
 Realismo funzionale nel somigliare alla sua risposta alle azioni.
 Le caratteristiche visibili più fini come rughe sottili e pori della pelle hanno una dimensione di circa 100 μm o 0,1 millimetri. La pelle può essere modellata come una funzione di trama bidirezionale a 7 dimensioni (BTF) o una raccolta di funzione di distribuzione della diffusione bidirezionale (BSDF) sulle superfici del bersaglio.
 Simulazione e visualizzazione interattive
 La visualizzazione interattiva è il rendering di dati che possono variare dinamicamente e che consente a un utente di visualizzare i dati da più prospettive. Le aree di applicazione possono variare in modo significativo, dalla visualizzazione dei modelli di flusso in fluidodinamica a specifiche applicazioni di progettazione assistita da computer. I dati resi possono corrispondere a scene visive specifiche che cambiano quando l'utente interagisce con il sistema - ad es. I simulatori, come i simulatori di volo, fanno ampio uso di tecniche CGI per rappresentare il mondo.
 A livello astratto, un processo di visualizzazione interattiva coinvolge una "pipeline di dati" in cui i dati grezzi vengono gestiti e filtrati in una forma che lo rende adatto per il rendering. Questo è spesso chiamato "dati di visualizzazione" . I dati di visualizzazione vengono quindi mappati in una "rappresentazione di visualizzazione" che può essere inviata a un sistema di rendering. Questa è solitamente chiamata "rappresentazione renderizzabile" . Questa rappresentazione viene quindi renderizzata come un'immagine visualizzabile. Quando l'utente interagisce con il sistema (ad esempio utilizzando i controlli del joystick per cambiare la propria posizione all'interno del mondo virtuale) i dati grezzi vengono inviati attraverso la pipeline per creare una nuova immagine renderizzata, spesso facendo dell'efficienza computazionale in tempo reale una considerazione chiave in tali applicazioni.
 Animazione al computer
 Mentre le immagini di paesaggi generate al computer possono essere statiche, l'animazione al computer si applica solo alle immagini dinamiche che assomigliano a un film. Tuttavia, in generale, il termine animazione al computer si riferisce a immagini dinamiche che non consentono l'interazione dell'utente e il termine mondo virtuale viene utilizzato per gli ambienti animati interattivi.
 L'animazione al computer è essenzialmente un successore digitale dell'arte dell'animazione in stop motion di modelli 3D e dell'animazione fotogramma per fotogramma delle illustrazioni 2D. Le animazioni generate al computer sono più controllabili rispetto ad altri processi più basati sulla fisica, come la costruzione di miniature per riprese con effetti o l'assunzione di extra per scene di folla, e perché consente la creazione di immagini che non sarebbero realizzabili utilizzando altre tecnologie. Può anche consentire a un singolo artista grafico di produrre tali contenuti senza l'uso di attori, scene costose o oggetti di scena.
 Per creare l'illusione del movimento, un'immagine viene visualizzata sullo schermo del computer e ripetutamente sostituita da una nuova immagine simile all'immagine precedente, ma leggermente avanzata nel dominio del tempo (solitamente a una velocità di 24 o 30 fotogrammi al secondo). Questa tecnica è identica a come si ottiene l'illusione del movimento con la televisione e il cinema.
 Mondi virtuali
 Un mondo virtuale è un ambiente simulato, che consente all'utente di interagire con personaggi animati chiamati npc o interagire con altri utenti attraverso l'uso di personaggi animati noti come avatar. I mondi virtuali sono destinati ai suoi utenti per abitare e interagire, e il termine oggi è diventato in gran parte sinonimo di ambienti virtuali 3D interattivi, in cui gli utenti assumono la forma di avatar visibili agli altri graficamente. Questi avatar sono solitamente rappresentati come rappresentazioni grafiche testuali, bidimensionali o tridimensionali, sebbene siano possibili altre forme (uditivo e sensazioni tattili per esempio). Alcuni, ma non tutti, i mondi virtuali consentono più utenti.
 Nelle aule di tribunale
 Le immagini generate al computer sono state utilizzate nelle aule giudiziarie, principalmente dall'inizio degli anni 2000. Tuttavia, alcuni esperti hanno affermato che è pregiudizievole. Sono usati per aiutare i giudici o la giuria a visualizzare meglio la sequenza di eventi, prove o ipotesi. Tuttavia, uno studio del 1997 ha mostrato che le persone sono fisici poco intuitivi e facilmente influenzabili dalle immagini generate al computer. Pertanto è importante che i giurati e gli altri responsabili delle decisioni legali siano consapevoli del fatto che tali mostre sono semplicemente una rappresentazione di una potenziale sequenza di eventi.
 Motion capture
 Le immagini generate al computer vengono spesso utilizzate insieme al motion capture per coprire meglio i difetti che derivano dalla CGI e dall'animazione. Le immagini generate al computer sono limitate nella loro applicazione pratica da quanto possono apparire realistiche. Immagini generate al computer non realistiche o mal gestite possono provocare l'effetto Uncanny Valley. Questo effetto si riferisce alla capacità umana di riconoscere cose che assomigliano stranamente agli umani, ma sono leggermente fuori posto. Tale capacità è un difetto delle normali immagini generate al computer che, a causa della complessa anatomia del corpo umano, spesso possono non riuscire a replicarle perfettamente. È qui che entra in gioco il motion capture. Gli artisti possono utilizzare un impianto di acquisizione del movimento per ottenere filmati di un essere umano che esegue un'azione e quindi replicarli perfettamente con immagini generate al computer in modo che appaia normale.
 La mancanza di modelli digitali anatomicamente corretti contribuisce alla necessità del motion capture poiché viene utilizzato con immagini generate al computer. Poiché le immagini generate al computer riflettono solo l'esterno, o la pelle, dell'oggetto da renderizzare, non riescono a catturare le interazioni infinitamente piccole tra i gruppi muscolari interconnessi utilizzati nel controllo motorio fine, come il parlare. Il movimento costante del viso mentre emette suoni con labbra sagomate e movimenti della lingua, insieme alle espressioni facciali che accompagnano il parlare sono difficili da replicare a mano. Il motion capture può catturare il movimento sottostante dei muscoli facciali e replicare meglio l'immagine che accompagna l'audio, come Thanos di Josh Brolin.
 Principali studi di produzione animazioni in CGI
 Dreamworks Animation
 Industrial Light & Magic
 Illumination Entertainment
 Blue Sky Studios
 Walt Disney Animation Studios
 Sony Pictures Animation
 ImageMovers Digital
 Gruppo Alcuni
 Vanguard Animation
 Lucasfilm Animation
 Rainbow CGI
 Aardman Animations
 Xilam
 Pixar Animation Studios
 Warner Bros. Animation
 Note
 Voci correlate
 Grafica computerizzata
 Computer grafica 3D
 Animazione al computer
 Effetti speciali digitali
 Attore virtuale
 Altri progetti
 Grafica 3D
 Arte digitale
 Computer grafica