Avaliação das ações de regulação em saúde: um estudo de caso do município de Rio Bonito RJ

O presente estudo aborda a introdução de ações de regulação na gestão de saúde de um município do interior do estado do Rio de Janeiro, de 2009 a 2012. Mais especificamente, são analisadas a responsabilização sanitária do ente municipal a partir da aquisição da gestão plena do sistema (Pacto de Gestão) e as ações desencadeadas pela implantação do Controle, Avaliação e Auditoria, e pela criação do Complexo Regulador, tendo como referência a Política Nacional de Regulação. A metodologia empregada envolveu análise documental e entrevistas com informantes-chave. Os resultados demonstram o desenvolvimento de ações em todas as dimensões da regulação e o amadurecimento da função reitora da secretaria municipal de saúde sobre o sistema, através do direcionamento qualitativo e quantitativo dos prestadores privados.

History of Molluscan Fishery Regulations and the Shellfish Officer Service in Massachusetts

Oysters, Crassostrea virginica, and softshell clams, Mya arenaria, along the Massachusetts coast were harvested by European colonists beginning in the 1600’s. By the 1700’s, official Commonwealth rules were established to regulate their harvests. In the final quarter of the 1800’s, commercial fishermen began harvesting northern quahogs, Mercenaria mercenaria, and northern bay scallops, Argopecten irradians irradians, and regulations established by the Massachusetts Legislature were applied to their harvests also. Constables (also termed wardens), whose salaries were paid by the local towns, enforced the regulations, which centered on restricting harvests to certain seasons, preventing seed from being taken, and personal daily limits on harvests. In 1933, the Massachusetts Legislature turned over shellfisheries management to individual towns. Local constables (wardens) enforced the rules. In the 1970’s, the Massachusetts Shellfish Officers Association was formed, and was officially incorporated in 2000, to help the constables deal with increasing environmental problems in estuaries where fishermen harvest mollusks. The constables’ stewardship of the molluscan resources and the estuarine environments and promotion of the fisheries has become increasingly complex.

Our living oceans: report on the status of U.S. living marine resources, 6th edition

The National Marine Fisheries Service (NMFS) is dedicated to the stewardship of living marine resources (LMR’s). This is accomplished through science-based conservation and management, and the promotion of healthy ecosystems. As a steward, NMFS has an obligation to conserve, protect, and manage these resources in a way that ensures their continuation as functioning components of healthy marine ecosystems, affords economic opportunities, and enhances the quality of life for the American public. In addition to its responsibilities within the U.S. Exclusive Economic Zone (EEZ), NMFS plays a supportive and advisory role in the management of LMR’s in the coastal areas under state jurisdiction and provides scientific and policy leadership in the international arena. NMFS also implements international measures for the conservation and management of LMR’s, as appropriate.NMFS receives its stewardship responsibilities under a number of Federal laws. These include the Nation’s primary fisheries law, the Magnuson Fishery Conservation and Management Act. This law was first passed in 1976, later reauthorized as the Magnuson-Stevens Fishery Conservation and Management Act in 1996, and reauthorized again on 12 January 2007 as the Magnuson-Stevens Fishery Conservation and Management Reauthorization Act (MSRA). The MSRA mandates strong action to conserve and manage fishery resources and requires NMFS to end overfishing by 2010 in all U.S. commercial and recreational fisheries, rebuild all overfished stocks, and conserve essential fish habitat.

A Biogeographic assessment off North/Central California: In support of the National Marine Sanctuaries of Cordell Bank, Gulf of the Farallones and Monterey Bay. Phase II - Environmental setting and update to marine birds and animals

NOAA’s National Centers for Coastal Ocean Science (NCCOS) conducts and supports research, monitoring, assessments, and technical assistance to meet NOAA’s coastal stewardship and management responsibilities. In 2001 the Biogeography Branch of NCCOS partnered with NOAA’s National Marine Sanctuary Program (NMSP) to conduct biogeographic assessments to support the management plan updates for the sanctuaries. The first biogeographic assessment conducted in this partnership focused on three sanctuaries off north/ central California: Cordell Bank, Gulf of the Farallones and Monterey Bay. Phase I of this assessment was conducted from 2001 to 2004, with the primary goal to identify and gather the best available data and information to characterize and identify important biological areas and time periods within the study area. The study area encompasses the three sanctuaries and extends along the coastal ocean off California from Pt. Arena to Pt. Sal (35°-39°N). This partnership project was lead by the NCCOS Biogeography Branch, but included over 90 contributors and 25 collaborating institutions. Phase I results include: 1) a report on the overall assessment that includes hundreds of maps, tables and analyses; 2) an ecological linkage report on the marine and estuarine ecosystems along the coast of north/central California, and 3) related geographic information system (GIS) data and other summary data files, which are available for viewing and download in several formats at the following website: http://ccma.nos.noaa.gov/products/biogeography/canms_cd/welcome.html Phase II (this report) was initiated in the Fall of 2004 to complete the analyses of marine mammals and update the marine bird colony information. Phase II resulted in significant updates to the bird and mammal chapters, as well as adding an environmental settings chapter, which contains new and existing data and maps on the study area. Specifically, the following Phase II topics and items were either revised or developed new for Phase II: •environmental, ecological settings – new maps on marine physiographic features, sea surface temperature and fronts, chlorophyll and productivity •all bird colony or roost maps, including a summary of marine bird colonies •updated at-sea data CDAS data set (1980-2003) •all mammal maps and descriptions •new overall density maps for eight mammal species •new summary pinniped rookery/haulout map •new maps on at-sea richness for cetaceans and pinnipeds •most text in the mammal chapter •new summary tables for mammals on population status and spatial and temporal patterns

Technical and mapping support for marine spatial planning: Final report

Washington depends on a healthy coastal and marine ecosystem to maintain a thriving economy and vibrant communities. These ecosystems support critical habitats for wildlife and a growing number of often competing ocean activities, such as fishing, transportation, aquaculture, recreation, and energy production. Planners, policy makers and resource managers are being challenged to sustainably balance ocean uses, and environmental conservation in a finite space and with limited information. This balancing act can be supported by spatial planning. Marine spatial planning (MSP) is a planning process that enables integrated, forward looking, and consistent decision making on the human uses of the oceans and coasts. It can improve marine resource management by planning for human uses in locations that reduce conflict, increase certainty, and support a balance among social, economic, and ecological benefits we receive from ocean resources. In March 2010, the Washington state legislature enacted a marine spatial planning law (RCW §43.372) to address resource use conflicts in Washington waters. In 2011, a report to the legislature and a workshop on human use data provided guidance for the marine spatial planning process. The report outlines a set of recommendations for the State to effectively undertake marine spatial planning and this work plan will support some of these recommendations, such as: federal integration, regional coordination, developing mechanisms to integrate scientific and technical expertise, developing data standards, and accessing and sharing spatial data. In 2012 the Governor amended the existing law to focus funding on mapping and ecosystem assessments for Washington’s Pacific coast and the legislature provided $2.1 million in funds to begin marine spatial planning off Washington’s coast. The funds are appropriated through the Washington Department of Natural Resources Marine Resources Stewardship Account with coordination among the State Ocean Caucus, the four Coastal Treaty Tribes, four coastal Marine Resource Committees and the newly formed stakeholder body, the Washington Coastal Marine Advisory Council.

Marine cage culture and the environment: twenty-first century science informing a sustainable industry

Technological innovation has made it possible to grow marine finfish in the coastal and open ocean. Along with this opportunity comes environmental risk. As a federal agency charged with stewardship of the nation’s marine resources, the National Oceanic and Atmospheric Administration (NOAA) requires tools to evaluate the benefits and risks that aquaculture poses in the marine environment, to implement policies and regulations which safeguard our marine and coastal ecosystems, and to inform production designs and operational procedures compatible with marine stewardship. There is an opportunity to apply the best available science and globally proven best management practices to regulate and guide a sustainable United States (U.S.) marine finfish farming aquaculture industry. There are strong economic incentives to develop this industry, and doing so in an environmentally responsible way is possible if stakeholders, the public and regulatory agencies have a clear understanding of the relative risks to the environment and the feasible solutions to minimize, manage or eliminate those risks. This report spans many of the environmental challenges that marine finfish aquaculture faces. We believe that it will serve as a useful tool to those interested in and responsible for the industry and safeguarding the health, productivity and resilience of our marine ecosystems. This report aims to provide a comprehensive review of some predominant environmental risks that marine fish cage culture aquaculture, as it is currently conducted, poses in the marine environment and designs and practices now in use to address these environmental risks in the U.S. and elsewhere. Today’s finfish aquaculture industry has learned, adapted and improved to lessen or eliminate impacts to the marine habitats in which it operates. What progress has been made? What has been learned? How have practices changed and what are the results in terms of water quality, benthic, and other environmental effects? To answer these questions we conducted a critical review of the large body of scientific work published since 2000 on the environmental impacts of marine finfish aquaculture around the world. Our report includes results, findings and recommendations from over 420 papers, primarily from peer-reviewed professional journals. This report provides a broad overview of the twenty-first century marine finfish aquaculture industry, with a targeted focus on potential impacts to water quality, sediment chemistry, benthic communities, marine life and sensitive habitats. Other environmental issues including fish health, genetic issues, and feed formulation were beyond the scope of this report and are being addressed in other initiatives and reports. Also absent is detailed information about complex computer simulations that are used to model discharge, assimilation and accumulation of nutrient waste from farms. These tools are instrumental for siting and managing farms, and a comparative analysis of these models is underway by NOAA.

Support for integrated ecosystem assessments of NOAA’s National Estuarine Research Reserve System (NERRS): assessment of ecological condition and stressor impacts in subtidal waters of the Sapelo Island National Estuarine Research Reserve

A study was conducted in June 2009 to assess the current status of ecological condition and potential human-health risks throughout subtidal estuarine waters of the Sapelo Island National Estuarine Research Reserve (SINERR) along the coast of Georgia. Samples were collected for multiple indicators of ecosystem condition, including water quality (dissolved oxygen, salinity, temperature, pH, nutrients and chlorophyll, suspended solids, fecal coliform bacteria and coliphages), sediment quality (granulometry, organic matter content, chemical contaminant concentrations), biological condition (diversity and abundance of benthic fauna, fish tissue contaminant levels and pathologies), and human dimensions (fish-tissue contaminant levels relative to human-health consumption limits, various aesthetic properties). Use of a probabilistic sampling design facilitated the calculation of statistics to estimate the spatial extent of the Reserve classified according to various categories (i.e., Good, Fair, Poor) of ecological condition relative to established thresholds of these indicators, where available. Overall, the majority of subtidal habitat in the SINERR appeared to be healthy, with over half (56.7 %) of the Reserve area having water quality, sediment quality, and benthic biological condition indicators rated in the healthy to intermediate range of corresponding guideline thresholds. None of the stations sampled had one or more indicators in all three categories rated as poor/degraded. While these results are encouraging, it should be noted that one or more indicators were rated as poor/degraded in at least one of the three categories over 40% of the Reserve study area, represented by 12 of the 30 stations sampled. Although measures of fish tissue chemical contamination were not included in any of the above estimates, a number of trace metals, pesticides, polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) were found at low yet detectable levels in some fish at stations where fish were caught. Levels of mercury and total PCBs in some fish specimens fell within EPA guideline values considered safe, given a consumption rate of no more than four fish meals per month. Moreover, PCB congener profiles in sediments and fish in the SINERR exhibit a relative abundance of higher-chlorinated homologs which are uniquely characteristic of Aroclor 1268. It has been well-documented that sediments and fish in the creeks and marshes near the LCP Chemicals Superfund site, near Brunswick, Georgia, also display this congener pattern associated with Aroclor 1268, a highly chlorinated mixture of PCBs used extensively at a chlor-alkali plant that was in operation at the LCP site from 1955-1994. This report provides results suggesting that the protected habitats lying within the boundaries of the SINERR may be experiencing the effects of a legacy of chemical contamination at a site over 40km away. These effects, as well as other potential stressors associated with increased development of nearby coastal areas, underscore the importance of establishing baseline ecological conditions that can be used to track potential changes in the future and to guide management and stewardship of the otherwise relatively unspoiled ecosystems of the SINERR.

A literature and practice review to develop sustainable business model archetypes

Eco-innovations, eco-efficiency and corporate social responsibility practices define much of the current industrial sustainability agenda. While important, they are insufficient in themselves to deliver the holistic changes necessary to achieve long-term social and environmental sustainability. How can we encourage corporate innovation that significantly changes the way companies operate to ensure greater sustainability? Sustainable business models (SBM) incorporate a triple bottom line approach and consider a wide range of stakeholder interests, including environment and society. They are important in driving and implementing corporate innovation for sustainability, can help embed sustainability into business purpose and processes, and serve as a key driver of competitive advantage. Many innovative approaches may contribute to delivering sustainability through business models, but have not been collated under a unifying theme of business model innovation. The literature and business practice review has identified a wide range of examples of mechanisms and solutions that can contribute to business model innovation for sustainability. The examples were collated and analysed to identify defining patterns and attributes that might facilitate categorisation. Sustainable business model archetypes are introduced to describe groupings of mechanisms and solutions that may contribute to building up the business model for sustainability. The aim of these archetypes is to develop a common language that can be used to accelerate the development of sustainable business models in research and practice. The archetypes are: Maximise material and energy efficiency; Create value from 'waste'; Substitute with renewables and natural processes; Deliver functionality rather than ownership; Adopt a stewardship role; Encourage sufficiency; Re-purpose the business for society/environment; and Develop scale-up solutions. © 2014 The Authors. Published by Elsevier Ltd. All rights reserved.

Methane contamination of drinking water accompanying gas-well drilling and hydraulic fracturing.

Directional drilling and hydraulic-fracturing technologies are dramatically increasing natural-gas extraction. In aquifers overlying the Marcellus and Utica shale formations of northeastern Pennsylvania and upstate New York, we document systematic evidence for methane contamination of drinking water associated with shale-gas extraction. In active gas-extraction areas (one or more gas wells within 1 km), average and maximum methane concentrations in drinking-water wells increased with proximity to the nearest gas well and were 19.2 and 64 mg CH(4) L(-1) (n = 26), a potential explosion hazard; in contrast, dissolved methane samples in neighboring nonextraction sites (no gas wells within 1 km) within similar geologic formations and hydrogeologic regimes averaged only 1.1 mg L(-1) (P < 0.05; n = 34). Average δ(13)C-CH(4) values of dissolved methane in shallow groundwater were significantly less negative for active than for nonactive sites (-37 ± 7‰ and -54 ± 11‰, respectively; P < 0.0001). These δ(13)C-CH(4) data, coupled with the ratios of methane-to-higher-chain hydrocarbons, and δ(2)H-CH(4) values, are consistent with deeper thermogenic methane sources such as the Marcellus and Utica shales at the active sites and matched gas geochemistry from gas wells nearby. In contrast, lower-concentration samples from shallow groundwater at nonactive sites had isotopic signatures reflecting a more biogenic or mixed biogenic/thermogenic methane source. We found no evidence for contamination of drinking-water samples with deep saline brines or fracturing fluids. We conclude that greater stewardship, data, and-possibly-regulation are needed to ensure the sustainable future of shale-gas extraction and to improve public confidence in its use.

Community-based Data Validation Practices in Citizen Science

Technology-supported citizen science has created huge volumes of data with increasing potential to facilitate scientific progress, however, verifying data quality is still a substantial hurdle due to the limitations of existing data quality mechanisms. In this study, we adopted a mixed methods approach to investigate community-based data validation practices and the characteristics of records of wildlife species observations that affected the outcomes of collaborative data quality management in an online community where people record what they see in the nature. The findings describe the processes that both relied upon and added to information provenance through information stewardship behaviors, which led to improved reliability and informativity. The likelihood of community-based validation interactions were predicted by several factors, including the types of organisms observed and whether the data were submitted from a mobile device. We conclude with implications for technology design, citizen science practices, and research.

Trust, leadership and economic necessity in post-compulsory education

Trust is a complex concept that has increasingly been debated in academic research (Kramer and Tyler, 1996). Research on 'trust and leadership' (Caldwell and Hayes, 2007) has suggested, unsurprisingly, that leadership behaviours influence 'follower' perceptions of leaders' trustworthiness. The development of 'ethical stewardship' amongst leaders may foster high trust situations (Caldwell, Hayes, Karri and Bernal, 2008), yet studies on the erosion of teacher professionalism in UK post-compulsory education have highlighted the distrust that arguably accompanies 'new managerialism', performativity and surveillance within a climate of economic rationalisation established by recent deterministic skills-focused government agendas for education (Avis, 2003; Codd, 1999, Deem, 2004, DFES, 2006). Given the shift from community to commercialism identified by Collinson and Collinson (2005) in a global economic environment characterised by uncertainty and rapid change, trust is, simultaneously, increasingly important and progressively both more fragile and limited in a post compulsory education sector dominated by skills-based targets and inspection demands. Building on such prior studies, this conference paper reports on the analysis of findings from a 2007-8 funded research study on 'trust and leadership' carried out in post-compulsory education. The research project collected and analysed case study interview and survey data from the lifelong learning sector, including selected tertiary, further and higher education (FE and HE) institutions. We interviewed 18 UK respondents from HE and FE, including principals, middle managers, first line managers, lecturers and researchers, supplementing and cross-checking this with a small number of survey responses (11) on 'trust and leadership' and a larger number (241) of survey responses on more generalised leadership issues in post-compulsory education. A range of facilitators and enablers of trust and their relationship to leadership were identified and investigated. The research analysed the ways in which interviewees defined the concept of 'trust' and the extent to which they identified that trust was a mediating factor affecting leadership and organisational performance. Prior literature indicates that trust involves a psychological state in which, despite dependency, risk and vulnerability, trustors have some degree of confident expectation that trustees will behave in benevolent rather than detrimental ways. The project confirmed the views of prior researchers (Mayer, Davis and Schoorman, 1995) that, since trust inevitably involves potential betrayal, estimations of leadership 'trustworthiness' are based on followers' cognitive and affective perceptions of the reliability, competence, benevolence and reputation of leaders. During the course of the interviews it also became clear that some interviewees were being managed in more or less transaction-focused, performative, audit-dominated cultures in which trust was not regarded as particularly important: while 'cautious trust' existed, collegiality flourished only marginally in small teams. Economic necessity and survival were key factors influencing leadership and employee behaviours, while an increasing distance was reported between senior managers and their staff. The paper reflects on the nature of the public sector leadership and management environment in post-compulsory education reported by interviewees and survey respondents. Leadership behaviours to build trust are recommended, including effective communication, honesty, integrity, authenticity, reliability and openness. It was generally felt that building trust was difficult in an educational environment largely determined by economic necessity and performativity. Yet, despite this, the researchers did identify a number of examples of high trust leadership situations that are worthy of emulation.

Recruitment in a changing environment: the 2000s North Sea herring recruitment failure

Environmentally induced change appears to be impacting the recruitment of North Sea herring (Clupea harengus). Despite simultaneously having a large adult population, historically low exploitation, and Marine Stewardship Council accreditation (implying sustainability), there have been an unprecedented 6 sequential years of poor juvenile production (recruitment). Analysis suggests that the poor recruitment arises during the larval overwintering phase, with recent survival rates greatly reduced. Contemporary warming of the North Sea has caused significant changes in the plankton community, and a recently identified regime shift around 2000 shows close temporal agreement with the reduced larval survival. It is, therefore, possible that we are observing the first consequences of this planktonic change for higher trophic levels. There is no indication of a recovery in recruitment in the short term. Fishing mortality is currently outside the agreed management plan, and forecasts show a high risk of the stock moving outside safe biological limits soon, potentially precipitating another collapse of the stock. However, bringing the realized fishing mortality back in line with the management plan would likely alleviate the problem. This illustrates again that recruitment is influenced by more than just spawning-stock biomass, and that changes in other factors can be of equal, or even greater, importance. In such dynamically changing environments, recent management success does not necessarily guarantee future sustainability.

Factores determinantes del uso de Internet en la comercialización del aceite de oliva. Análisis del sector en Cataluña

Las cooperativas son entidades con una gran presencia económica y social en España, y tienen una gran influencia en la economía rural de las zonas donde están ubicadas. El principal objetivo del presente trabajo es el análisis del uso de las nuevas tecnologías por parte de las cooperativas agroalimentarias, centrándose en las productoras de aceite de oliva para determinar los principales factores que condicionan su comportamiento en la Red. En el presente estudio se analizan sus sitios web y se determina qué tipo de información aporta, tanto datos generales como datos de comercialización. A partir de los resultados obtenidos, se busca la relación que pueda existir entre el tamaño de la cooperativa, su actividad exportadora o la actividad de comercio electrónico con la presencia online, mediante una regresión logística. De esta manera podremos conocer si realmente la implantación de nuevas tecnologías en las cooperativas permite desarrollar una óptima actividad económica.

Agricultura urbana, condición para el desarrollo sostenible y la mejora del paisaje

Este artículo resulta de investigaciones en torno al “enverdecimiento” de las ciudades y las oportunidades de la agricultura urbana para la alimentación de una población en constante aumento que no trabaja la tierra. También es fruto de actividades de mejora de ambientes urbanos realizadas con la Escuela de Ingenieros Agrónomos de la Universidad Politécnica de Madrid. A través de casos de agricultura urbana, entendiendo por ella el conjunto de prácticas para la producción de alimentos y plantas ornamentales dentro de las ciudades y en sus entornos, se analizan alternativas para la recuperación de espacios construidos e incremento de la calidad de vida de la población. Todo ello se traduce, además, en creación de riqueza y mejora del paisaje urbano, siempre desde criterios de sostenibilidad que favorecen el desarrollo local desde la Cumbre de la Tierra de Río de 1992 y la Conferencia sobre Desarrollo Sostenible Río+20 de 2013.

The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings

Aims: The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS: The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). Results: Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P <0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P <0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. Discussion: This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.