A partir de 2002 o Estado assume o esforço de normatizar a atenção às urgências com edição de Portarias e documentos. O SAMU foi o primeiro componente da política implantado. Ele opera com ambulâncias com ou sem médico e com recursos tecnológicos diversos. Este estudo teve como objetivo analisar o potencial de prática de integralidade no SAMU. Para tal, foram realizadas três etapas de trabalho. Analisou-se a política de urgência a partir dos documentos e Portarias que a compõem. No trabalho de campo foram entrevistados seis gestores dos três níveis de governo e avaliadas as práticas de regulação nos SAMU do Estado do Rio de Janeiro. A metodologia utilizou o referencial da análise da conduta estratégica da Teoria da Estruturação de Giddens (1984) relacionando as capacidades cognitivas dos agentes e suas estratégias de ação, com as dimensões estruturais. Para o campo, além da teoria de Giddens, busquei no referencial da avaliação, indicadores (incluindo os da política), dialogando com a análise d situação do serviço. A Política de Urgência tece como marcos os financiamento federal, a regionalização, a capacitação dos profissionais, a função do SAMU de observatório da rede; e a gestão por comitês de urgência. A integralidade é proposta como valor, na indicação de utilizar o conceito ampliado de urgência, através da regionalização e da comunicação entre os serviços. A capacitação não foi instituída no estado e os vínculos empregatícios eram precários. Foi constatada a inoperância do Comitê Gestor Nacional de Urgências e a ausência do Comitê Estadual. Não há assistência integrada tendo entre as causas a insuficiência estrutural da rede, representada pela ausência da atenção básica e pela precariedade nos hospitais de referência. Não há produção e utilização de informação e o SAMU não cumpre a função de observatório de saúde. Os três SAMUs têm estruturas diferenciadas. Foram analisados 206 atendimentos e sua categirazação destacou: o SAMU bem sucedido, com práticas de integralidade no seu componente individual e de acesso aos serviços; sua função de observatório de rede, que refletiu o vazio assistencial do PSF e média complexidade e a restrição do acesso hospitalar; a insuficiência de recursos, com uso inadequado de ambulâncias; e demandas não reconhecidas, onde casos de urgência não reconhecida foram recusados. Destaca-se a prevalência da urgência clínica. Conclusão: a legitimação da regulação esteve presente na atitude dos entrevistados e de alguns profissionais nos casos do SAMU bem sucedido. A densidade das propostas documentais foi a vertente facilitadora do recurso estrutural. A mobilização de recursos autoritativos e alocativos mostrou fragilidades. Não houve mudança significativa nas práticas tipicamente excludentes do SUS, mas acreditamos no efeito cumulativo dos pequenos desvios que têm na ética e na solidariedade a base da aplicação do conhecimento técnico. / The State, since 2002, has made an effort to normalize the assistance for urgencies/emergencies with documents and politics. The SAMU (Urgent Mobile Assistance Service) was the first political component to be established. It operates with two types of ambulance, with or without a doctor, and with more or less technological resources. This study aims at analyzing SAMUs integrality practice potential. The work was developed in three steps. The urgency politics was analyzed from documents and acts that form it. Field work comprised interviews with six managers from the three government levels, and evaluation of regulation practices in the three SAMU in Rio de Janeiro State. Methodology employed the Strategic Conduct Analysis (Giddens, 1984) studding knowledge and action related with network structures and dialoguing with the service situation analysis and with evaluation based on politics indicators. The urgency politics had the following marks: federal support; regionalization, professional capacitation; SAMUs function of health observatory system; and management by urgency committees in several levels. Integrality is proposed as a values, through regionalization and communication among services, and in the large sense of urgency. There was no capacitation and labor ties were precarious. We noticed the malfunction of the National Management Committee, and the absence of the State Committee. There is no integrated assistance, as a consequence of insufficient network structure and restrict hospital access. The three SAMU have different structures. We analyzed 206 assistances in the three SAMU. Categorization highlighted: the successful SAMU, with integrality practices and health system access; as network observatory, which reflects the lack of assistance of the Family Health Program average complexity, and restrict hospital access; insufficient resources, with inadequate use of resources; and unrecognized demands, where cases of unrecognized urgency were refused. The prevalence of clinical urgency stands out. Conclusion: legitimation of the regulating role was present in the work of professionals in the successful SAMU. The politics act as facilitator to network structure. There was insufficient mobilization of structure resource. There were no change in excluding practices in SUS but we hope in small changes in attendances compatibles with ethics and solidarity techniques application of knowledge.

A partir de 2002 o Estado assume o esforço de normatizar a atenção às urgências com edição de Portarias e documentos. O SAMU foi o primeiro componente da política implantado. Ele opera com ambulâncias com ou sem médico e com recursos tecnológicos diversos. Este estudo teve como objetivo analisar o potencial de prática de integralidade no SAMU. Para tal, foram realizadas três etapas de trabalho. Analisou-se a política de urgência a partir dos documentos e Portarias que a compõem. No trabalho de campo foram entrevistados seis gestores dos três níveis de governo e avaliadas as práticas de regulação nos SAMU do Estado do Rio de Janeiro. A metodologia utilizou o referencial da análise da conduta estratégica da Teoria da Estruturação de Giddens (1984) relacionando as capacidades cognitivas dos agentes e suas estratégias de ação, com as dimensões estruturais. Para o campo, além da teoria de Giddens, busquei no referencial da avaliação, indicadores (incluindo os da política), dialogando com a análise d situação do serviço. A Política de Urgência tece como marcos os financiamento federal, a regionalização, a capacitação dos profissionais, a função do SAMU de observatório da rede; e a gestão por comitês de urgência. A integralidade é proposta como valor, na indicação de utilizar o conceito ampliado de urgência, através da regionalização e da comunicação entre os serviços. A capacitação não foi instituída no estado e os vínculos empregatícios eram precários. Foi constatada a inoperância do Comitê Gestor Nacional de Urgências e a ausência do Comitê Estadual. Não há assistência integrada tendo entre as causas a insuficiência estrutural da rede, representada pela ausência da atenção básica e pela precariedade nos hospitais de referência. Não há produção e utilização de informação e o SAMU não cumpre a função de observatório de saúde. Os três SAMUs têm estruturas diferenciadas. Foram analisados 206 atendimentos e sua categirazação destacou: o SAMU bem sucedido, com práticas de integralidade no seu componente individual e de acesso aos serviços; sua função de observatório de rede, que refletiu o vazio assistencial do PSF e média complexidade e a restrição do acesso hospitalar; a insuficiência de recursos, com uso inadequado de ambulâncias; e demandas não reconhecidas, onde casos de urgência não reconhecida foram recusados. Destaca-se a prevalência da urgência clínica. Conclusão: a legitimação da regulação esteve presente na atitude dos entrevistados e de alguns profissionais nos casos do SAMU bem sucedido. A densidade das propostas documentais foi a vertente facilitadora do recurso estrutural. A mobilização de recursos autoritativos e alocativos mostrou fragilidades. Não houve mudança significativa nas práticas tipicamente excludentes do SUS, mas acreditamos no efeito cumulativo dos pequenos desvios que têm na ética e na solidariedade a base da aplicação do conhecimento técnico. / The State, since 2002, has made an effort to normalize the assistance for urgencies/emergencies with documents and politics. The SAMU (Urgent Mobile Assistance Service) was the first political component to be established. It operates with two types of ambulance, with or without a doctor, and with more or less technological resources. This study aims at analyzing SAMUs integrality practice potential. The work was developed in three steps. The urgency politics was analyzed from documents and acts that form it. Field work comprised interviews with six managers from the three government levels, and evaluation of regulation practices in the three SAMU in Rio de Janeiro State. Methodology employed the Strategic Conduct Analysis (Giddens, 1984) studding knowledge and action related with network structures and dialoguing with the service situation analysis and with evaluation based on politics indicators. The urgency politics had the following marks: federal support; regionalization, professional capacitation; SAMUs function of health observatory system; and management by urgency committees in several levels. Integrality is proposed as a values, through regionalization and communication among services, and in the large sense of urgency. There was no capacitation and labor ties were precarious. We noticed the malfunction of the National Management Committee, and the absence of the State Committee. There is no integrated assistance, as a consequence of insufficient network structure and restrict hospital access. The three SAMU have different structures. We analyzed 206 assistances in the three SAMU. Categorization highlighted: the successful SAMU, with integrality practices and health system access; as network observatory, which reflects the lack of assistance of the Family Health Program average complexity, and restrict hospital access; insufficient resources, with inadequate use of resources; and unrecognized demands, where cases of unrecognized urgency were refused. The prevalence of clinical urgency stands out. Conclusion: legitimation of the regulating role was present in the work of professionals in the successful SAMU. The politics act as facilitator to network structure. There was insufficient mobilization of structure resource. There were no change in excluding practices in SUS but we hope in small changes in attendances compatibles with ethics and solidarity techniques application of knowledge.

O Atendimento pré-hospitalar (APH) móvel é uma modalidade de assistência recente no Brasil e, em especial, no município de Ribeirão Preto-SP, tendo sido criada em 1996, com a finalidade de atendimento a toda e qualquer solicitação de ajuda, fora do âmbito hospitalar, visando a manutenção da vida e/ou a minimização das seqüelas, podendo ser oriunda do próprio cidadão ou ainda de instituições de saúde. Tendo em vista a recente implantação deste serviço, os objetivos do presente estudo são descrever a epidemiologia do atendimento pré-hospitalar móvel primário e secundário de urgência e emergência, o fluxo de atendimento pré-hospitalar móvel secundário e o fluxo do atendimento pré-hospitalar móvel da unidade de suporte avançado no município de Ribeirão Preto. Nossa pesquisa trata-se de um estudo de natureza descritiva, em que utilizamos dados de fonte secundária com transcrição de informações específicas do Serviço de APH do Município em Ribeirão Preto-SP, quando da solicitação de atendimento em situações de agravos à saúde. Os dados referentes ao objeto de estudo, foram coletados junto ao Programa de Assistência Médica Emergencial da Secretaria Municipal da Saúde. A base de dados analisada permitiu delinear a caracterização da atenção pré-hospitalar móvel da Secretaria Municipal da Saúde. Os resultados da pesquisa revelam o perfil das solicitações de atendimento das urgências e emergências com análises importantes que poderão subsidiar futuras reorganizações do serviço de APH móvel primário e secundário. O estudo poderá subsidiar ainda decisões dos atores sociais envolvidos na promoção, prevenção, recuperação e reabilitação aos agravos à saúde, tais como: conselhos de saúde, gestores de saúde, prestadores de serviços, usuários, conselhos de classes, órgãos de educação, promoção social, segurança social, transporte e outros. / The pre-hospital mobile attendant is a recent modality of assistance in Brazil, in special, at the District of Ribeirão Preto – SP, created since 1996, with the intention of attending any help of solicitation of care outside the hospital environment, looking for a life maintenance and/or a sequel minimization, and still looking to be accepted for the health institutions or the own patient. Because of the this new system implementation of service, the goals for the recent studies are to describe the pre-hospital assistance mobile of Epidemology for the first and second degrees of emergency and urgent care, the overflowing of the system now settle at this district of Ribeirão Preto for this type of help/ work with patients. Our research is about a descriptive nature where we can use secondary sources of database with transcription of specified information of the APH Service in the District of Ribeirão Preto-SP, when in need of care the solicitation of worst problems for health at own. The database collected for the goals of this research were taken at the Emergency Medical Assistance Program of the Health Minister of Care. The base studied let us create a line of attention in characterization of the pre-hospital mobile assistance from the Health Municipal Secretary . The results of the research reveals the profile of each assistance solicitations of emergencies and urgent cases with very important analyses which can create future reorganizations of the first and secondary mobile APH service. This study will subside many important decisions of the social actors involved at this promotion, prevention, recover, rehabilitation of the worst problems in health care such as: health counseling, health managers, services, utilitarian, class counseling, education organism, social promotion, social security, transportation and others.

On 1 November, 1954 an armed insurgency against French rule commenced with a large scale terrorist attack throughout various parts of Algeria. France responded by sending troops from the continent to Algeria and was soon involved in a full out counterinsurgency against the Front Liberé National (FLN), a revolutionary movement organised in a classical communist insurgent pattern. Many of the experiences the French gained conducting counterinsurgency in Algeria have been examined by writers of COIN literature. The conclusions have been incorporated into counterinsurgency doctrines of many countries, and the works of Galula, who experienced the war, is considered basic literature for many counterinsurgency courses. This has been inherited by modern COIN literature. The US FM 3.24 draws from the French experiences and theorists in its main body. This essay examines whether modern counterinsurgency literature derived from French experiences and theories gained, fighting FLN fails to address the question on how the insurgent organisation is structured. It provides a few arguments why we should know this, such as knowing your enemy’s structure will help you understand his vulnerabilities. To archive this and lay a foundation for the argumentation it first compares the Algerian FLN to modern day Taliban to establish if their organisational structures are different or similar.

The initiation of criminal prosecution The reason for my thesis, is to analyse the procedure of initiation of criminal prosecution and acts of preliminary hearing that are connected to it. The stress will be put on problematic details of current legislation and conceptions created during the procedure of recodification of criminal procedure in the Czech republic.The thesis is divided into seven chapters, which analyse the initiation of criminal prosecution from different points of view and as a result describe the initiation of criminal prosecution as one of the most important proceduralal acts of whole criminal procedure. The firs chapter is focused on historical development of the initiation of criminal prosecution between years 1962 - 20116, especially its form, organization and systhematical position. Following chapter desribes and analyses preceeding of urgent and non reproductible tasks placed in section 158a of criminal code as an exception from usual procedure of collecting pieces of evidence in criminal procedure and its relationship to the initiation of criminal prosecution with using the case-law of the European Court of Human Rights Chapter three desribes general principles of the initiation of criminal prosecution in relation to definition of legal term act which the person is accused...

Urgent and non-repeatable actions Abstract The graduation thesis focuses on the ambivalent institute of urgent and non-repeatable actions, which combines two contradictory requirements. On the one hand, a balance needs to be struck between the demand to protect the state, society and the legitimate interests of individuals and legal entities and to ensure a fair trial for the person against whom criminal proceedings are being conducted, on the other. The purpose of the urgent and non-repeatable actions is to enable the authorities involved in criminal proceedings to secure perishable evidence, even at the cost of infringing the rights of the defense. However, this distortion should be compensated to the defense by providing increased protection and furthermore, urgent and non-repeatable actions should be performed only when the legal conditions are fulfilled. The main goal of the thesis is a comprehensive analysis of urgent and non-repeatable actions in the sense of the Code of Criminal Procedure and higlihgting controversial issues and problems that arise in practice. The graduation thesis is composed of four chapters, each of them dealing with different aspect of urgent and non-repeatable actions. Chapter 1 is subdivided into two parts. Part 1 describes the historical development of urgent and...

1 Abstract Urgent and unrepeatable acts are an integral part of criminal proceedings and it would be difficult for law enforcement authorities to detect perpetrators of criminal offenses without them. Despite their characteristic of denying fundamental human rights, their implementation is in some cases essential for finding the material truth. This contradiction between the state's effort to maintain security on the one hand and the individual's right to a fair trial on the other poses a risk of possible misconduct for the entire criminal proceedings. The aim of this work was to point out that their implementation has a significant impact on the overall outcome of criminal proceedings considering their changing probative value, or even their absolute ineffectiveness. The individual acts were gradually incorporated into the Criminal Procedure Code from the most general legal boundaries to their present form. However, even today, it cannot be said with certainty that their legal regulation corresponds to the current needs. An analysis of the case law of individual urgent and / or unrepeatable acts shows that their completion by courts is necessary. From the available analysis, the following factors were found to affect the probative value: (i) insufficient reasoning of urgency or non-repeatability, but also...

Orientador: Daniela Ponce / Resumo: RESUMO: Diálise urgent start acontece em 60% dos pacientes incidentes no Brasil, o que implica em altas taxas de uso do cateter venoso central (CVC) e maior morbidade destes doentes. Poucos serviços oferecem a diálise peritoneal (DP) crônica com inicio urgente. Objetivo: Comparar os resultados de um programa de DP planejada versus não planejada quanto às complicações mecânicas e infecciosas associadas à DP, à sobrevida da técnica e dos pacientes, às taxas de hospitalização e descrever o impacto no crescimento do programa de DP. Método: Estudo prospectivo obsevacional que avaliou pacientes incidentes em DP planejada e não planejada em hospital universitário do interior de São Paulo, no período de julho/2014 a dezembro/2017. Foram incluídos no estudo pacientes com DRC estadio 5 que iniciaram tratamento dialítico peritoneal conforme indicação médica, divididos em dois grupos: Grupo 1 (G1): DP de início planejado – pacientes seguidos por nefrologista previamente à indicação de tratamento renal substitutivo (TRS) há mais de 90 dias e com início da DP após pelo menos 7 dias do implante do cateter peritoneal, com treinamento familiar prévio e adequação do domicílio. Grupo 2 (G2): DP de início não planejado – pacientes não seguidos por nefrologistas ou seguidos há menos de 90 dias previamente à indicação de TRS e/ou com início da DP antes de 7 dias após o implante do cateter peritoneal, sem treinamento familiar prévio em relação ao método ou adequação do domicílio. Resultados: Incluí... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: ABSTRACT: Urgent start dialysis occurs in 60% of patients in Brazil, which implies in high rates of central venous catheter (CVC) use and increased morbidity in these patients. Few services offer peritoneal dialysis (PD) as an urgent. Objective: To compare the results of a planned versus unplanned PD program for mechanical and infectious complications associated with PD, techinique and patients survival, hospitalization rates and describe the impact on the growth of the PD program. Method: This is a prospective observacional study that evaluated incident patients in planned and unplanned PD at an university hospital located in the southeasterm region of Brazil, of SP, from July 2014 to December 2017. We included patients with stage 5 CKD who started PD treatment according to medical indication, divided into two groups: Group 1 (G1): Planned PD - patients followed by a nephrologist prior to indication of renal replacement therapy (RRT) longer than 90 days and after at least 7 days of peritoneal catheter implantation, with previous family training and adequacy of the home. Group 2 (G2): Unplanned PD - patients not followed by nephrologists or followed lower than 90 days prior to RRT and within 7 days after peritoneal catheter implantation, without prior family training in relation to the method or adequacy of the home. Results: We included 58 patients in planned PD (G1) and 113 in unplanned PD (G2). There was no difference in the baseline characteristics between the two groups ... (Complete abstract click electronic access below) / Doutor

The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percent decrease in utilization of the emergency departments by self-pay patients was found. Non-parametric tests demonstrated significant differences in the population seen at the emergency departments and the clinics over the three-year study period. Regression analysis demonstrated a statistically significant decrease in non-urgent, self-pay visits at the emergency departments as a result of the increase in self-pay visits at the federally qualified health centers. Further analysis includes forecasting the impact of future federally qualified health centers on emergency department utilization. Recommendations for future research include evaluation of the increased numbers of non-urgent transports from the local emergency medical system by self-pay patients as well as the design of a pilot study to look at the effectiveness of transporting these patients to the federally qualified health centers for care instead of to the local emergency departments.

Yes / Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID-19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist's recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. A total of 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face-to-face consultation were 4.66 times more likely to be correctly managed [Exp (β) = 5.66], relative to those solely managed virtually. Optometrists' phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false-positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socioeconomic status. The present study found that a virtual assessment service providing optometrist tele-consultations was not effective at resolving patients' acute-onset eye problems. The range and number of pathologies missed by tele-consultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute-onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis.