O princípio da Integralidade e o SAMU

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.

Human Dimensions of Marine Fisheries: Using GIS to Illustrate Land-Sea Connections in the Northeast U.S. Herring, Clupea harengus, Fishery

Geographic Information Systems can help improve ocean literacy and inform our understanding of the human dimensions of marine resource use. This paper describes a pilot project where GIS is used to illustrate the connections between fish stocks and the social, cultural, and economic components of the fishery on land. This method of presenting and merging qualitative and quantitative data represents a new approach to assist fishery managers, participants, policy-makers, and other stakeholders in visualizing an often confusing and poorly understood web of interactions. The Atlantic herring fishery serves as a case study and maps from this pilot project are presented and methods reviewed.

The Great Whales: History and Status of Six Species Listed as Endangered Under the U.S. Endangered Species Act of 1973

In the history of whaling from prehistoric to modern times, the large whales, sometimes called the “great whales,” were hunted most heavily owing in part to their corresponding value in oil, meat, and baleen. Regional populations of North Atlantic right whales, Eubalaena glacialis glacialis, were already decimated by 1700, and the North Atlantic gray whale, Eschrichtius robustus, was hunted to extinction by the early 1700’s (Mitchell and Mead1).

The Bowhead Whale, Balaena mysticetus: Its Historic and Current Status

The bowhead whale, Balaena mysticetus, is currently listed as endangered under the Endangered Species Act of 1973 and as depleted under the Marine Mammal Protection Act of 1972. Literature on the species is updated since 1984, and elements are reviewed that may contribute to the evaluation of the status of bowhead whale stocks.

The Threatened Status of Steller Sea Lions, Eumetopias jubatus, under the Endangered Species Act: Effects on Alaska Groundfish Fisheries Management

In April 1990, the Steller sea lion, Eumetopias jubatus, was listed as threatened under the U.S. Endangered Species Act by emergency action. Competitive interactions with the billion-dollar Alaska commercial groundfish fisheries have been suggested as one of the possible contributing factors to the Steller sea lion population decline. Since the listing, fisheries managers have attempted to address the potential impacts of the groundfish fisheries on Steller sea lion recovery. In this paper, we review pertinent Federal legislation, biological information on the Steller sea lion decline, changes in the Alaska trawl fishery for walleye pollock, Theragra chalcogramma, since the late 1970's, andpossible interactions between fisheries and sea lions. Using three cases, we illustrate how the listing of Steller sea lions has affected Alaska groundfish fisheries through: I) actions taken at the time of listing designed to limit the potential for directhuman-related sea lion mortality, 2) actions addressing spatial and temporal separation of fisheries from sea lions, and 3) introduction of risk-adverse stock assessment methodologies and Steller sea lion conservation considerations directly in the annual quota-setting process. This discussion shows some of the ways that North Pacific groundfish resource managers have begun to explicitly consider the conservation ofmarine mammal and other nontarget species.

Pacific Salmon, Oncorhynchus spp., and the Definition of "Species" Under the Endangered Species Act

For purposes ofthe Endangered Species Act (ESA), a "species" is defined to include "any distinct population segment of any species of vertebrate fish or wildlife which interbreeds when mature. "Federal agencies charged with carrying out the provisions of the ESA have struggled for over a decade to develop a consistent approach for interpreting the term "distinct population segment." This paper outlines such an approach and explains in some detail how it can be applied to ESA evaluations of anadromous Pacific salmonids. The following definition is proposed: A population (or group of populations) will be considered "distinct" (and hence a "species ")for purposes of the ESA if it represents an evolutionarily significant unit (ESU) of the biological species. A population must satisfy two criteria to be considered an ESU: 1) It must be substantially reproductively isolated from other conspecific population units, and 2) It must represent an important component in the evolutionary legacy of the species. Isolation does not have to be absolute, but it must be strong enough to permit evolutionarily important differences to accrue in different population units. The second criterion would be met if the population contributes substantially to the ecological/genetic diversity of the species as a whole. Insights into the extent of reproductive isolation can be provided by movements of tagged fish, natural recolonization rates observed in other populations, measurements of genetic differences between populations, and evaluations of the efficacy of natural barriers. Each of these methods has its limitations. Identification of physical barriers to genetic exchange can help define the geographic extent of distinct populations, but reliance on physical features alone can be misleading in the absence of supporting biological information. Physical tags provide information about the movements of individual fish but not the genetic consequences of migration. Furthermore, measurements ofc urrent straying or recolonization rates provide no direct information about the magnitude or consistency of such rates in the past. In this respect, data from protein electrophoresis or DNA analyses can be very useful because they reflect levels of gene flow that have occurred over evolutionary time scales. The best strategy is to use all available lines of evidence for or against reproductive isolation, recognizing the limitations of each and taking advantage of the often complementary nature of the different types of information. If available evidence indicates significant reproductive isolation, the next step is to determine whether the population in question is of substantial ecological/genetic importance to the species as a whole. In other words, if the population became extinct, would this event represent a significant loss to the ecological/genetic diversity of thes pecies? In making this determination, the following questions are relevant: 1) Is the population genetically distinct from other conspecific populations? 2) Does the population occupy unusual or distinctive habitat? 3) Does the population show evidence of unusual or distinctive adaptation to its environment? Several types of information are useful in addressing these questions. Again, the strengths and limitations of each should be kept in mind in making the evaluation. Phenotypic/life-history traits such as size, fecundity, and age and time of spawning may reflect local adaptations of evolutionary importance, but interpretation of these traits is complicated by their sensitivity to environmental conditions. Data from protein electrophoresis or DNA analyses provide valuable insight into theprocessofgenetic differentiation among populations but little direct information regarding the extent of adaptive genetic differences. Habitat differences suggest the possibility for local adaptations but do not prove that such adaptations exist. The framework suggested here provides a focal point for accomplishing the majorgoal of the Act-to conserve the genetic diversity of species and the ecosystems they inhabit. At the same time, it allows discretion in the listing of populations by requiring that they represent units of real evolutionary significance to the species. Further, this framework provides a means of addressing several issues of particular concern for Pacific salmon, including anadromous/nonanadromous population segments, differences in run-timing, groups of populations, introduced populations, and the role of hatchery fish.

Regional Fisheries Advisory Committee 25th April, 1983

This is the report from the Regional Fisheries Advisory Committee meeting, which was held on the 25th April 1983. The report contains the minutes of the Local Fisheries Advisory Committees and recommendations for these committees, fishing licence duties 1984, fyke nets and otters, whirling disease, Salmon and Freshwater Fisheries Act 1975, and Fisheries Statistics 1982 (National Water Council Publication). The Fisheries Advisory Committee was part of the Regional Water Authorities, in this case the North West Water Authority. This preceded the Environment Agency which came into existence in 1996.

Regional Fisheries Advisory Committee Meeting 30th January, 1984

This is the report from the Regional Fisheries Advisory Committee meeting, which was held on the 30th January, 1984. The report contains information on the use of fyke nets and an application to use Rotenone fish Toxicant. Also included is information on Dunsop Trout Farm and the establishment of migratory fish rearing facilities, the decline of salmon and sea trout catches in South Cumbria, and the decline of salmon stocks in the River Eden. The Fisheries Advisory Committee was part of the Regional Water Authorities, in this case the North West Water Authority. This preceded the Environment Agency which came into existence in 1996.

Regional Fisheries Advisory Committee Meeting 15th October, 1984

This is the report from the Regional Fisheries Advisory Committee meeting, which was held on the 15th October, 1984. The report contains sections on Grass Carp Field Trials in the Lancaster Canal, liaisons with Sea Fisheries Committees, Rivers Leven and Crake migratory fish stocking, and migratory fish stocking policy. The Fisheries Advisory Committee was part of the Regional Water Authorities, in this case the North West Water Authority. This preceded the Environment Agency which came into existence in 1996.