O estudo tem por objetivos analisar a organização tecnológica do trabalho dos enfermeiros na produção do cuidado em Unidades de Pronto Atendimento, analisar as atividades dos enfermeiros, descrevendo a constituição da dimensão assistencial e gerencial no seu processo de trabalho; identificar o objeto do cuidado e a finalidade do trabalho dos enfermeiros e identificar os saberes tecnológicos e o conjunto de instrumentos utilizados pelos enfermeiros na produção de cuidados em Unidades de Pronto Atendimento (UPA). A estratégia de investigação foi à pesquisa de métodos mistos, do tipo explanatório sequencial. Na etapa quantitativa foi utilizado um questionário para a coleta de dados com 47 enfermeiros e, na etapa qualitativa, foi utilizada a técnica de observação por amostragem de eventos, referente às atividades dos enfermeiros em uma unidade de pronto atendimento selecionada. Os dados quantitativos foram analisados com o auxílio do Programa Statistical Package for the Social Sciences (SPSS), pela utilização de técnicas da estatística descritiva. Os dados qualitativos foram analisados pela técnica de Análise Temática de Conteúdo, contemplando os núcleos de sentido que compõem a comunicação e interpretação dos seus significados. O agrupamento dos dados quantitativos e qualitativos originou quatro núcleos de análise: trabalho dos enfermeiros, finalidade do trabalho dos enfermeiros, instrumentos de trabalho dos enfermeiros e os desafios e perspectivas do trabalho dos enfermeiros nos serviços de pronto atendimento. Na dimensão assistencial do trabalho destacaram-se as atividades de acolhimento com avaliação e classificação de risco e o registro dos dados clínicos em prontuários, caracterizados pelo atendimento partindo da queixa, com aprofundamento, enriquecendo a conduta, contudo as intervenções de enfermagem não extrapolaram seu caráter instrumental. Na dimensão gerencial do trabalho as atividades de distribuição de tarefas entre a equipe de enfermagem, o dimensionamento de pessoal da enfermagem, a organização de escalas de trabalho da enfermagem e o preenchimento de relatórios referentes ao seu trabalho são as práticas desenvolvidas com muita frequência pelos enfermeiros nessa realidade de trabalho. As ações de gerência do cuidado visam à previsão e provisão de recursos para produção do cuidado, por meio da organização e divisão do trabalho da equipe de enfermagem. O encaminhamento dos usuários a níveis adequados de assistência foi apontado pelos enfermeiros como a principal finalidade do seu trabalho nas unidades de pronto atendimento, seguido das finalidades de prestar o atendimento clínico ao usuário, prestar a assistência ao usuário em situação de urgência e de recuperar a saúde, tratando doenças e agravos. Os instrumentos mais utilizados pelos enfermeiros foram o julgamento e tomada de decisão clínica, a escuta, vínculo e acolhimento, os equipamentos para realização de procedimentos, o conhecimento clínico e o protocolo que orienta a classificação de risco. A resolução de problemas que não são de sua responsabilidade e o volume de atendimento da unidade são as principais dificuldades para o desenvolvimento do trabalho. As variáveis referentes à prática clínica foram identificadas como um potencial para a instrumentalização na tomada de decisão, colaborando para a produção de cuidados. / This study aims at analyzing the technological organization of nurses’ work, focusing on the production of health care in Emergency Units, as well as the activities performed by nurses. This research also aims at describing how the aid and management dimensions of nurses’ work are developed, with the goal of identifying the object of care and the purpose of nurses’ work, pointing out the technological knowledge and the instruments used by nurses to produce health care in Emergency Units. The investigation strategy was based on the Mixed Methods of Research, such as sequential explanatory. During the quantitative part of the research, a questionnaire was given to 47 nurses as a means of collecting data. During the qualitative part, the technique of sample rate events observation was used to follow nurses’ activities in an Emergency Unit previously selected. The quantitative data was analyzed by the Statistical Package for the Social Sciences (SPSS) program, using techniques from descriptive statistics. The qualitative data was analyzed by the technique of theme content analysis, prioritizing the meaning cells which compose the communication and interpretation of their meanings. The grouping of quantitative and qualitative data gave origin to four analysis cells: Nurses’ Work, the Objective of Nurses’ Work, Instruments of Nurses’ Work and Challenges and Perspectives of Nurses’ Work at Emergency Units. In the aid dimension of nurses’ work, activities of admission and rating of life risk and the registration of clinical data on patients’ charts stand out, characterized by the service performed from patient’s complain, making the process of admission more reliable. However, the nurses’ interventions do not go beyond its instrumental character. In the management dimension of nurses’ work, the activities of chores distribution among the team of nurses, the distribution of people in the Emergency Units, the organization of shifts and turns and the filling of reports concerning the work are very popular practices among nurses in the Emergency Units. The actions of managing the health care try to predict and provide resources to produce this care by organizing and dividing the work. The actions to analyze the patient’s situation and provide follow up medical procedures was pointed by nurses as being the main objective of their work in Emergency Units, followed by the objective of providing clinic care to patients, proving medical attention to patients in emergency and recovery situations, by treating illnesses and injuries. The most used instruments by nurses were clinic judgment and decision-making, listening, bonding and acceptance, procedure equipments, clinic knowledge and the protocol which guides the risk rating. The solution to problems which do not concern nurses’ work and the amount of patients in Emergency Units were mentioned as the main difficulties to develop their work. The variables referring to clinical practice were identified as a potential to provide instruments during decision-making moments, collaborating to produce health care. / El estudio tiene por objetivos analizar la organización tecnológica del trabajo de los enfermeros en la producción del cuidado en unidades de pronto atendimiento (urgencias), analizar las actividades de los enfermeros, describiendo la constitución de la dimensión asistencial y gerencial en su proceso de trabajo; identificar los saberes tecnológicos y el conjunto de instrumentos utilizados por los enfermeros en la producción de cuidados en las unidades de pronto atendimiento (urgencias). La estrategia de investigación fue por métodos mistos, del tipo explanatorio sequencial. En la etapa cuantitativa fue realizado el cuestionario como técnica de colecta de datos con 47 enfermeros y en la etapa cualitativa, fue realizada la técnica de observación por amostraje de eventos relacionados a las actividades de los enfermeros en una unidad de pronto atendimiento (urgencia) selecionada. Los datos cuantitativos fueron analizados en el programa Programa Statistical Package for the Social Sciences (SPSS), por la utilización de técnicas de estatística descriptiva. Los datos cualitativos fueron analizados por la técnica del análisis de conteúdo temático, contemplando los núcleos de sentido que componen la comunicación e interpretación de sus significados. El agrupamiento de los datos cuantitativos y cualitativos originó cuatro núcleos de análisis: trabajo de los enfermeros, finalidad del trabajo de los enfermeros, instrumentos de trabajo de los enfermeros y los desafíos y perspectivas del Trabajo de los Enfermeros en los servicios de Pronto Atendimiento (urgencias). En la dimensión asistencial del trabajo se destacan las actividades de acogida con evaluación y clasificación de riesgo y el registro de datos clínicos en prontuarios, caracterizados por el atendimiento partiendo de la queja, con aprofundación, enriqueciendo la conducta, sin embargo las intervenciones de enfermería no extrapolaron su carácter instrumental. En la dimensión gerencial del trabajo las actividades de distribución de tarefas entre el equipo de enfermeros, el dimensionamiento de personal de enfermería, la organización de escalas de trabajo de enfermería y el relleno de relatorios referentes a su trabajo son prácticas desarrolladas con mucha frecuencia por los enfermeros en el pronto atendimiento (urgencias). Las acciones de gerencia del cuidado visan la provisión de recursos para la producción del cuidado, por medio de la organización y división del trabajo de equipo de enfermeros. El encaminamiento de los usuários a los locales adecuados de asistencia fue apuntado por los enfermeros como la principal finalidad de su trabajo en las unidades de pronto atendimiento (urgencia), acompañado de las finalidades de prestar el atendimiento clínico ao usuario, prestar asistencia al usuario en situación de urgencia y de recuperar la salud, tratando las enfermedades y agravios. Los instrumentos más utilizados por los enfermeros fueron el juicio y la tomada de decisión clínica, la escucha, vínculo y acogida, los equipamientos para la realización de los procedimientos, el conocimiento clínico y el protocolo que orienta la Classificacíón de Riesgo. La resolución de problemas sin relación a su trabajo y el volumen de atendimiento de la unidad aparecen como las principales dificultades para el desarrollo del trabajo. Las variables referentes a la práctica clínica fueron identificándose como un potencial para la instrumentalización en las tomadas de decisión, colaborando en la producción de los cuidados.

Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.

There has been significant increase in the occurrence of earthquakes and other disasters around the world recently. With record-breaking storms and natural disasters destroying different parts of the world, many people have to deal with the repercussions of the aftermaths; and homelessness is one of the facts of such incidence. This master thesis is aimed at creating living solution for the victims of earthquakes and other kind of disasters; natural or human-made (war), providing accommodation for homeless people after an earthquake or a housing alternative for refugees. The design of the collapsible home is basically a new concept of emergency hut for accommodating people in emergency after the event of disaster with easy assembling and quick installation feature. Considering the situation of homeless people after catastrophic disasters who need to be accommodated, the design and creation of a quick, accommodating and low-cost emergency hut is advantageous.  This project also provides a living service for both refugees and homeless people. It is low cost, modular, and easy to use. More than that it is feasible and it makes it possible to accommodate people for a longer period of time, rather than a very short temporary housing solution such as tents. / Det har skett en signifikant ökning av jordbävningar och andra katastrofer i världen. Med rekordstora stormar och naturkatastrofer som förstör i delar av världen måste många människor nu hantera efterverkningar och återuppbyggande, och hemlöshet är en av de faktorer som uppstår och som påverkar människor mest. Det här examensarbetet syftar till att skapa en boendelösning för offer för jordbävning och andra naturkatastrofer och krig. Det hopfällbara hemmets design är ett koncept för krisboende med enkelt montage och installering. Om man betänker den situation som människor hamnar i som blir hemlösa vid en katastrof, kan en design av en snabb och billig boendelösning som krisboende ge enormt mycket. Projektet kan också vara en boendeservice till flyktingar och människor som är hemlösa av andra anledningar än katastrofer. Det tillverkas för en låg kostnad och är möjlig att använda som modul och enkel att sätta upp. Men viktigare än det är att den ger möjlighet att härbergera människor under en längre tid till skillnad från mer temporära lösningar som exempelvis tält. Det hopfällbara hemmet är gjort av hållbart material, den använder grön energi och lyser upp staden. Den är utrustad med vertikala trädgårdar för att användarna ska kunna odla egna grönsaker och den återvinner vatten från regn. Den innehåller basala hopfällbara möbler och rumsavdelare som ger känsla av hemtrevnad och bekvämlighet.

Foi realizado um survey transversal, descritivo e analítico em amostra não-probabilística, prontamente acessível, de tamanho 561, formada por pacientes que procuraram o Pronto-Socorro de Oftalmologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo numa semana considerada típica de atendimento.Os dados foram obtidos através da ficha administrativa e aplicação de questionário semi-estruturado, realizado por meio de entrevistas. O questionário também constava de entrevista com o médico que fez o atendimento. O estudo teve como objetivos, em relação a usuários do pronto-socorro: descrever características sócio-demográficas, razões da procura e da escolha de unidade hospitalar, verificar conhecimentos e condutas referentes a causas e tratamentos do agravo ocular; verificar a adoção de tratamentos oculares prévios ao atendimento, identificar fontes de orientação na adoção de tratamentos, verificar causas de demora na procura de tratamento, identificar percepções sobre diagnóstico e tratamento prescrito. Em relação à instituição: determinar a proporção de atendimentos oculares de urgência e não urgência; disponibilizar informações para subsidiar intervenções educativas e assistenciais de saúde ocular. A análise estatística foi realizada com o uso do programa Stata (versão 9.0). Entre os resultados, destacou-se: o período de maior procura por atendimento oftalmológico no Pronto-Socorro do Hospital das Clínicas foi matutino e nos dias da semana; não houve diferença significante entre os sexos; a média de idade foi 39,8 anos; o atendimento foi realizado pelo Sistema Único de Saúde para 91,1% dos pacientes. A maioria dos atendidos tinha baixa renda e escolaridade. Metade dos pacientes era de fora da área de cobertura do Hospital das Clínicas. Para 49,0% a escolha do Hospital das Clínicas ocorreu por confiança e competência; para 42,2% por não haver oftalmologista nos serviços que costumam freqüentar. O tempo para procurar o serviço foi de mais de 24 horas a uma semana para 40,8% dos pacientes. A demora em procurar atendimento ocorreu por não considerar que era urgente por 47,0% e 34,1% foram a outro serviço antes. Daqueles que foram a outros serviços previamente, 48,8% não tiveram alteração do quadro, 39,6% pioraram sintomas. A automedicação foi usada prévio a vinda ao Pronto-Socorro por 40,5% dos pacientes. Desses, 29,4% usaram produtos caseiros. Os produtos mais freqüentemente utilizados foram água boricada, soro fisiológico, água de torneira ou poço, chás, compressas, lavagem com ervas (alecrim, arruda). Não foram observadas diferenças significativas no uso de automedicação para tratar os sintomas oculares entre homens e mulheres (p = 0,95), nas diferentes faixas etárias (p = 0,14) ou nos diferentes níveis de escolaridade (p = 0,21). Também não foi observada diferença no padrão de uso de automedicação quanto à situação de trabalho dos pacientes (p = 0,15) ou quanto ao seu local de residência (p = 0,52).Pacientes com diagnóstico de inflamação/infecção ou trauma apresentaram as maiores proporções de uso de automedicação (49,5%). Relataram ter procurado auxílio religioso para tratar o problema 16,1% dos pacientes. Referiram ter entendido a informação sobre o que tinham 95,1%dos pacientes. Dos que receberam prescrição de medicamento, 95,0% entenderam como e porque usá-lo. Aproximadamente 50,0% dos pacientes deram nota máxima ao atendimento recebido. Segundo os oftalmologistas, 18,1% eram casos de urgência e 83,2% dos casos poderiam ter sido resolvidos em serviços de menor complexidade. Dos pacientes, 55,2% apresentavam diagnóstico de inflamação/infecção; 19,1% trauma. Conjuntivite viral foi o diagnóstico mais freqüente 24,6%, seguido por corpo estranho de córnea 7,5%, meibomite 6,4%. Entre os pacientes atendidos, os plantonistas classificaram 11,7% como retorno e 2,0% pós-operatório. Não houve diferença significativa no diagnóstico clínico entre os pacientes que vieram espontaneamente e os referenciados (p = 0,09). Em relação ao preenchimento das fichas administrativas, ressalta-se que 3,6% não constavam o nome do médico, 3,4% não constavam o CRM, 33,4% não foram preenchidos histórico ou observações clínicas; 6,3% só constavam o CID como diagnóstico. Concluiu-se que: a automedicação é muito difundida entre os pacientes e o uso de produtos caseiros se faz presente mesmo nos casos de urgência ocular. Os pacientes estão recebendo e entendendo explicações sobre o agravo ocular e sobre o tratamento prescrito. Os plantonistas vêm mantendo um bom relacionamento médico-paciente. O atendimento recebido pelo paciente foi considerado excelente. O Pronto-Socorro de Oftalmologia do Hospital das Clínicas é um hospital terciário que atende em sua maioria, casos primários e secundários; a maioria dos diagnósticos não foi considerada como urgência / We report a transversal, descriptive and analytical survey in a non-probabilistic promptly accessible sample, composed of 561 patients who looked for the Ophthalmology Emergency Room (E.R) of Clinics Hospital of the University of Sao Paulo School of Medicine during a regular week. Data were collected from administrative charts and from semi-structured questionnaire through interviews. The questionnaire also included an interview with the physician who assisted the patient. The study had the following purposes relative to the E.R patients: to describe social-demographic characteristics; reasons for search and choice of the hospital unit; to assess knowledge and conducts related to eye diseases and their causes and treatment; to assess previous ocular treatments; to identify the causes of compliance with treatment; to identify the reason for delayed search to medical treatment; to identify the knowledge about diagnosed diseases and prescribed treatment. Relative to the institution: to assess the rate of urgent and non-urgent ocular visits; to provide helpful data for ocular health assistance and educational interventions. Statistical analysis was performed using Stata software (version 9.0). The most important results were: most searches for the Emergency Room occurred during the day and on week-days; no statistically significant difference related to gender; average age was 39.8; and 91.1% of visits were assisted by the Public Health System. Most patients had low schooling and money income. Half of the patients did not belong to the area covered by Clinics Hospital. Forty-nine percent of the patients chose Clinics Hospital based to trust on the professionals and their competence; for 42.2% of the patients due to unavailability of ophthalmologists in the health units they are used to go to. The time taken to search assistance was between 24 hours and 1 (one) week for 40.8% of the patients. Such delay was due to the fact the 47% of the patients did not believe that their situation was urgent, and 34.1% searched another health unit before. Among those who searched another unit, 48.8% did not report worsening of health symptoms by the time they reached the E.R, while 39.6% did. Auto-medication was used previously to the E.R. visit by 40.5% of the patients, 29.4% of whom used home-made products. Most of these products were: boric water, physiologic saline solution, tap or well water, and herbs. No significant difference in auto-medication between man and women (p = 0.95), in different age levels (p= 0.14) or schooling levels (p= 0.21) was observed, neither in relation to work situation (p= 0.15) or place of residence (p= 0.52). Higher rates of auto-medication were observed among patients with ocular inflammation/ infection or trauma (49.5%), while 16.1% of the patients reported search for religious help to treat their disease. 95.1% of the patients reported having understood the information given about their condition. Among those patients to whom medication was prescribed, 95% understood how and why to use it. Approximately 50% of the patients graded with the maximum score the xxii xxiii assistance received. According to the ophthalmologists opinion, 18.1% of visits were real urgent cases, while 83.2% could have been attended at less complex health units. 52.2% of the patients were diagnosed with inflammation/infectious diseases; and 19.1% with trauma. Viral conjunctivitis was the most frequent diagnosis (24.6%), followed by corneal foreign bodies (7.5%), and meibomitis (6.4%). Considering assisted patients, physicians classified 11.7% as return visits and 2.0% as post-surgical visits. There was no significant difference on clinical diagnosis between patients on spontaneous or referred assistance (p= 0.09). As for the administration charts, it is important to emphasize that 3.6% of them did not contain the physicians name, 3.4% did not contain the professional registration number, 33.4% did not contain historical and clinical observations, and 6.3% only contained the International Classification of Diseases number. In conclusion, auto-medication is largely used among patients and the use of home-made products occurs even in urgent ocular situations. Patients are receiving and understanding the explanations about their ocular diseases and the prescribed treatment. E.R ophthalmologists have had a satisfactory physician-patient relationship. Medical assistance received by patients was considered excellent. Clinics Hospital Ophthalmologic E.R is a reference service which assists mostly primary and secondary cases, most of them being considered non-urgent

Made available in DSpace on 2016-04-26T20:23:40Z (GMT). No. of bitstreams: 1 Regiane Martins dos Santos.pdf: 1085712 bytes, checksum: c4fd27b8db162fc59d3bf9f0b258553e (MD5) Previous issue date: 2015-04-10 / The present task has the intention to present, analytically, the existing urgent measures in the Brazilian law, highlighting its use under appellate level. Begins with the conceptualization of the precautionary measure institutes, with the anticipation of the legal protection and the injunctions, going by the analysis of its peculiarities, distinctions and similarities. Then, the characteristics features of each guardianship analyzed in this study, highlighting its requirements and entering slowly in its peculiarities. Subsequently, the study addresses the filing of such measures on appellate headquarters, presenting the general theory of resources for, then, treat more specifically the use of the emergency measures also in this procedural sphere. Still, the peculiarities surrounding the new system of emergency measures under the new Code of Civil Procedure project are highlighted. Finally, the conclusions of the study are brought, presenting the corollary of the analysis and showing the most notable similarities and differences about the displayed topic / O presente trabalho tem o intuito de apresentar, de forma analítica, as medidas de urgência existentes no ordenamento jurídico brasileiro, destacando sua utilização no âmbito recursal. Inicia-se pela conceituação dos institutos da medida cautelar, da antecipação de tutela e das liminares, passando-se à análise de suas peculiaridades, distinções e semelhanças. Em seguida, são apresentados os traços característicos de cada uma das tutelas analisadas neste estudo, destacando seus requisitos e adentrando com mais vagar em suas particularidades. Posteriormente, o estudo aborda a interposição de tais medidas em sede recursal, apresentando a teoria geral dos recursos para, em seguida, tratar mais especificamente da utilização das medidas de urgência também nesta esfera processual. Ainda, são destacadas as peculiaridades que cercam a nova sistemática das medidas de urgência no âmbito do projeto do novo código de processo civil. Por fim, são trazidas as conclusões do estudo, apresentando o corolário da análise realizada e demonstrando as semelhanças e divergências mais notórias observadas a respeito do tema exibido

政府存在的目的，在維持人民基本的生活水準，在促使民眾能在自由、安和、樂利的平等的社會環境，並透過與運用法律、道德所允許的公權力手段，以促進社會的繁榮為最高之宗旨；但在目前政府處理危機緊急應變機制計有國土安全會報、災害防救會報及全民防衛動員準備業務會報(此即政府三大緊急應變體系)等，並自2005年起推動合併運作迄今，在中央政府之作法，似已達實際聯合運作與資源整合之效益，然在實際運作情形因需涉及中央與地方間權責分工關係？各公民營事業機構等體系能否協同運作之勾聯？等問題，現有運作並非如此順暢，究其原因係政府在面對新型態的危機發生時，三大應變體系聯合運作所能回應與處理的緊急應變處置作為，不僅未能有效的解決危機與事件所引發的問題，甚者更成為危機處置的亂源與礙手礙腳始作俑者；實有再予檢視與探討空間，以期建立一個權責相符且明確的緊急應變機制。 本文試圖以運用跨域治理為出發點，謹就政府目前積極推動之國土安全、災害防救及全民防衛動員準備業務(此即政府三大緊急應變體系)上聯合運作既存的困境，究其緣由乃此三應變體系皆屬危機管理範疇，各體系內所包含之工作項目與所涉單位甚多，任務屬性與編組成員重疊度極高，甚者尚可包含公(私)營事業機構，故亦應屬跨域治理之特徵，此三者之間關係應緊密運作且具關聯性。然從自2005年起政府積極推動情形下，縱然掌握最大的緊急應變資源與能量，但從歷次處理各項災後或危機應變等工作，卻往往是成為社會與民眾所責難焦點，何以如此呢？實因在於政府的緊急應變處置的機制紛亂不一所致，況且今日台灣面臨全球化所造成的衝擊，環境的變遷導致複合式災害所形成的危機出現層出不窮、社會科技上多元技術的需求以及民眾普遍要求全面的危機管理與跨域治理，故本文主要乃是以「跨域治理」與「危機管理理論」作為基礎論點，藉由文獻探討、焦點座談及問卷調查等方式，檢視三大應變體系聯合運作政府與民間的豐沛資源，運用網際網絡之功能與跨域治理的模式，才能達到凝聚總體資源，群策群力共同處理危機。 / The primary purpose of the government existence is maintaining the integrity of the people's basic living standard, encouraging people to have freedom, peace, and equality. Furthermore, under the law and morality, by means of public power to promote social prosperity. Since 2005, the Taiwan government has amalgamated and promoted the joint operation of three urgent strain response systems which includes homeland security council, disaster council, and national defense mobilization council (these three are the urgent strain response systems of Taiwan Government). The government's approach seems to have reached the joint operation of resources integration of benefits. However, in the actual operation, the problems were emerged from the conflict involved between Central and local authorities, the responsibilities between the public and private utilities, and how to implement the operation of the system of cooperative association. To trace the causes, the joint operation of three major urgent strain response systems is incapable to respond and handle emergency disposal when facing a new state crisis. Moreover, it might cause the crisis of the source of chaos and drag initiator. Definitely, there is a need for further review and assessment to establish a consistent and clear responsibilities among these three urgent strain response systems. This article attempts to use cross-domain governance as a starting point to assess the system. The government impetus the urgent strain of government presently, the three urgent strain response systems are the part of crisis management which includes lots of work and connections with other majority organizations. Because the association constitutes various members base on the different tasks, some members may belong to different divisions. Even the enterprises which run by the local people are the members of the “cross-boundary governance” which should be closely related each other. Since 2005, the government has actively promoting circumstances, even the government has enough information and resources of handling emergency situation, this government (administration) still censured by the public. The reason is that the emergency structure of our government is out of frame and inconsistence. In addition, Taiwan is facing the high pressure of becoming globalization. The impact of changes of the environment resulted in the formation of compound disaster crises emerged, the needs of diverse technologies and social science and people generally demand comprehensive crisis management along with cross-domain administration, so this paper is based on “cross-boundary governance” and “crisis management”, by using the literature reviews, seminars and workshops, questionnaires and surveys to assess the joint operation of three urgent strain systems of Taiwan Government, and the public use of the vast resources, to apply the internet functions and cross-domain governance model, will be able to reach the overall resources and effectively integrating the common crisis management of Taiwan Government.

Foi realizado um survey transversal, descritivo e analítico em amostra não-probabilística, prontamente acessível, de tamanho 561, formada por pacientes que procuraram o Pronto-Socorro de Oftalmologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo numa semana considerada típica de atendimento.Os dados foram obtidos através da ficha administrativa e aplicação de questionário semi-estruturado, realizado por meio de entrevistas. O questionário também constava de entrevista com o médico que fez o atendimento. O estudo teve como objetivos, em relação a usuários do pronto-socorro: descrever características sócio-demográficas, razões da procura e da escolha de unidade hospitalar, verificar conhecimentos e condutas referentes a causas e tratamentos do agravo ocular; verificar a adoção de tratamentos oculares prévios ao atendimento, identificar fontes de orientação na adoção de tratamentos, verificar causas de demora na procura de tratamento, identificar percepções sobre diagnóstico e tratamento prescrito. Em relação à instituição: determinar a proporção de atendimentos oculares de urgência e não urgência; disponibilizar informações para subsidiar intervenções educativas e assistenciais de saúde ocular. A análise estatística foi realizada com o uso do programa Stata (versão 9.0). Entre os resultados, destacou-se: o período de maior procura por atendimento oftalmológico no Pronto-Socorro do Hospital das Clínicas foi matutino e nos dias da semana; não houve diferença significante entre os sexos; a média de idade foi 39,8 anos; o atendimento foi realizado pelo Sistema Único de Saúde para 91,1% dos pacientes. A maioria dos atendidos tinha baixa renda e escolaridade. Metade dos pacientes era de fora da área de cobertura do Hospital das Clínicas. Para 49,0% a escolha do Hospital das Clínicas ocorreu por confiança e competência; para 42,2% por não haver oftalmologista nos serviços que costumam freqüentar. O tempo para procurar o serviço foi de mais de 24 horas a uma semana para 40,8% dos pacientes. A demora em procurar atendimento ocorreu por não considerar que era urgente por 47,0% e 34,1% foram a outro serviço antes. Daqueles que foram a outros serviços previamente, 48,8% não tiveram alteração do quadro, 39,6% pioraram sintomas. A automedicação foi usada prévio a vinda ao Pronto-Socorro por 40,5% dos pacientes. Desses, 29,4% usaram produtos caseiros. Os produtos mais freqüentemente utilizados foram água boricada, soro fisiológico, água de torneira ou poço, chás, compressas, lavagem com ervas (alecrim, arruda). Não foram observadas diferenças significativas no uso de automedicação para tratar os sintomas oculares entre homens e mulheres (p = 0,95), nas diferentes faixas etárias (p = 0,14) ou nos diferentes níveis de escolaridade (p = 0,21). Também não foi observada diferença no padrão de uso de automedicação quanto à situação de trabalho dos pacientes (p = 0,15) ou quanto ao seu local de residência (p = 0,52).Pacientes com diagnóstico de inflamação/infecção ou trauma apresentaram as maiores proporções de uso de automedicação (49,5%). Relataram ter procurado auxílio religioso para tratar o problema 16,1% dos pacientes. Referiram ter entendido a informação sobre o que tinham 95,1%dos pacientes. Dos que receberam prescrição de medicamento, 95,0% entenderam como e porque usá-lo. Aproximadamente 50,0% dos pacientes deram nota máxima ao atendimento recebido. Segundo os oftalmologistas, 18,1% eram casos de urgência e 83,2% dos casos poderiam ter sido resolvidos em serviços de menor complexidade. Dos pacientes, 55,2% apresentavam diagnóstico de inflamação/infecção; 19,1% trauma. Conjuntivite viral foi o diagnóstico mais freqüente 24,6%, seguido por corpo estranho de córnea 7,5%, meibomite 6,4%. Entre os pacientes atendidos, os plantonistas classificaram 11,7% como retorno e 2,0% pós-operatório. Não houve diferença significativa no diagnóstico clínico entre os pacientes que vieram espontaneamente e os referenciados (p = 0,09). Em relação ao preenchimento das fichas administrativas, ressalta-se que 3,6% não constavam o nome do médico, 3,4% não constavam o CRM, 33,4% não foram preenchidos histórico ou observações clínicas; 6,3% só constavam o CID como diagnóstico. Concluiu-se que: a automedicação é muito difundida entre os pacientes e o uso de produtos caseiros se faz presente mesmo nos casos de urgência ocular. Os pacientes estão recebendo e entendendo explicações sobre o agravo ocular e sobre o tratamento prescrito. Os plantonistas vêm mantendo um bom relacionamento médico-paciente. O atendimento recebido pelo paciente foi considerado excelente. O Pronto-Socorro de Oftalmologia do Hospital das Clínicas é um hospital terciário que atende em sua maioria, casos primários e secundários; a maioria dos diagnósticos não foi considerada como urgência / We report a transversal, descriptive and analytical survey in a non-probabilistic promptly accessible sample, composed of 561 patients who looked for the Ophthalmology Emergency Room (E.R) of Clinics Hospital of the University of Sao Paulo School of Medicine during a regular week. Data were collected from administrative charts and from semi-structured questionnaire through interviews. The questionnaire also included an interview with the physician who assisted the patient. The study had the following purposes relative to the E.R patients: to describe social-demographic characteristics; reasons for search and choice of the hospital unit; to assess knowledge and conducts related to eye diseases and their causes and treatment; to assess previous ocular treatments; to identify the causes of compliance with treatment; to identify the reason for delayed search to medical treatment; to identify the knowledge about diagnosed diseases and prescribed treatment. Relative to the institution: to assess the rate of urgent and non-urgent ocular visits; to provide helpful data for ocular health assistance and educational interventions. Statistical analysis was performed using Stata software (version 9.0). The most important results were: most searches for the Emergency Room occurred during the day and on week-days; no statistically significant difference related to gender; average age was 39.8; and 91.1% of visits were assisted by the Public Health System. Most patients had low schooling and money income. Half of the patients did not belong to the area covered by Clinics Hospital. Forty-nine percent of the patients chose Clinics Hospital based to trust on the professionals and their competence; for 42.2% of the patients due to unavailability of ophthalmologists in the health units they are used to go to. The time taken to search assistance was between 24 hours and 1 (one) week for 40.8% of the patients. Such delay was due to the fact the 47% of the patients did not believe that their situation was urgent, and 34.1% searched another health unit before. Among those who searched another unit, 48.8% did not report worsening of health symptoms by the time they reached the E.R, while 39.6% did. Auto-medication was used previously to the E.R. visit by 40.5% of the patients, 29.4% of whom used home-made products. Most of these products were: boric water, physiologic saline solution, tap or well water, and herbs. No significant difference in auto-medication between man and women (p = 0.95), in different age levels (p= 0.14) or schooling levels (p= 0.21) was observed, neither in relation to work situation (p= 0.15) or place of residence (p= 0.52). Higher rates of auto-medication were observed among patients with ocular inflammation/ infection or trauma (49.5%), while 16.1% of the patients reported search for religious help to treat their disease. 95.1% of the patients reported having understood the information given about their condition. Among those patients to whom medication was prescribed, 95% understood how and why to use it. Approximately 50% of the patients graded with the maximum score the xxii xxiii assistance received. According to the ophthalmologists opinion, 18.1% of visits were real urgent cases, while 83.2% could have been attended at less complex health units. 52.2% of the patients were diagnosed with inflammation/infectious diseases; and 19.1% with trauma. Viral conjunctivitis was the most frequent diagnosis (24.6%), followed by corneal foreign bodies (7.5%), and meibomitis (6.4%). Considering assisted patients, physicians classified 11.7% as return visits and 2.0% as post-surgical visits. There was no significant difference on clinical diagnosis between patients on spontaneous or referred assistance (p= 0.09). As for the administration charts, it is important to emphasize that 3.6% of them did not contain the physicians name, 3.4% did not contain the professional registration number, 33.4% did not contain historical and clinical observations, and 6.3% only contained the International Classification of Diseases number. In conclusion, auto-medication is largely used among patients and the use of home-made products occurs even in urgent ocular situations. Patients are receiving and understanding the explanations about their ocular diseases and the prescribed treatment. E.R ophthalmologists have had a satisfactory physician-patient relationship. Medical assistance received by patients was considered excellent. Clinics Hospital Ophthalmologic E.R is a reference service which assists mostly primary and secondary cases, most of them being considered non-urgent

Many people do not like thinking about the future. If they do, over 50% of Canadians think “our way of life” (p. 7) will end within 100 years and over 80% of Canadians think “we need to change our worldview and way of life if we are to create a better future for the world” (Randle & Eckersley, 2015, p. 9). There is a good reason for this. Alarms have sounded over global urgent complex problems with potential for catastrophic consequences such as the development of artificial intelligence, climate change, mass extinction, nuclear war and pandemics (Marien & Halal, 2011). Society is also increasingly fragmenting as imminent crises build on lack of understanding, the sense of incapacity to act, fear, distrust, blame and a lack of hope. This struggle for humanity’s survival is complicated by the turbulent global environment in which institutions continue to follow path-dependent trajectories set forth in a different time and context. Governments at various levels face a problem of “fit” between current structures and processes, that have not progressed sufficiently to meet changing needs of a global society mired in complexity and governance challenges. However, hope exists. Incremental progress on many fronts and a massive amount of efforts and resources are being engaged worldwide. There are emerging fields, lenses and tools that can potentially alleviate complex problems and address this emergency. The purpose of this dissertation is to understand and assess dialogue-based foresight practices being applied towards complex problems in Canada to provide insights into how these practices can assist society to alleviate global urgent complex problems and their impacts, within this backdrop of looming crises. Foresight, alternatively known as future studies or scenario-building, is a forward-looking practice recognized and used globally with over 100 research organizations focused on foresight, widespread usage by firms and over 18 countries involved in foresight activities (Berze, 2014b). Overall literature findings suggest foresight is widely and at least incrementally effective with a number of impacts in various areas (Calof, Miller, & Jackson, 2012; March, Therond, & Leenhardt, 2012; Meissner, Gokhberg, & Sokolov, 2013) but the extent of this effectiveness, the mechanisms involved, and the specific foresight benefits per type of project needs further research and evidence. For instance, limited literature exists on whether foresight can transform complex situations and if so, under what conditions. Thus, opportunities exist for assessing and increasing foresight’s impact. This dissertation is a contextualized, systematic empirical study that taps into transdisciplinary literature and practice, case studies of how foresight has been used to address specific types of complex problems in Canada, as well as surveys and interviews with foresight experts and participants. This dissertation uses a foresight community scan and a comparative case study approach to provide practical and theoretical benefits to foresight and complex problem area stakeholders. The research focuses on studying the broad interactions of foresight and identifying the impacts of dialogue-based foresight projects on people and the outcomes of complex problems. The dissertation concludes that dialogue-based foresight is a valuable and unique practice for ameliorating complex problems and their consequences. Insights are offered towards dialogue-based foresight’s potential contributions within the context of other efforts directed at humanity’s struggle for survival and global complex problems. These insights can then foster the further development and application of dialogue-based foresight on a global scale to alleviate complex problems and their effects. The dissertation outlines recommendations on key next steps to realize these potential contributions. / Graduate