Resumo A reforma de 2005 dos cuidados de saúde primários (CSP) portugueses foi uma das mais bem-sucedidas feitas nos serviços públicos do país. O acontecimento mais relevante foi a constituição das Unidades de Saúde Familiar (USF): equipes multidisciplinares voluntárias e auto-organizadas, que prestam cuidados médicos e de enfermagem personalizados a um conjunto de pessoas. Num segundo momento reorganizaram-se as restantes dimensões dos CSP com a criação dos Agrupamentos de Centros de Saúde (ACeS). Apostou-se na governação clínica procurando-se obter ganhos em saúde pela melhoria da qualidade e da participação e responsabilização de todos. Este artigo tem por objetivo caracterizar a reforma de 2005 dos CSP Portugueses com a análise das suas dimensões sistêmica e local. Trata-se de um estudo de caso de uma reforma na área dos CSP de um sistema de saúde com análise documental e descrição de uma de suas unidades. Esta reforma foi portuguesa, moderna e inovadora. Portuguesa ao não quebrar completamente com o passado, moderna porque se aliou à tecnologia e ao trabalho em rede, e inovadora porque ultrapassou o modelo hierarquizado tradicional. Cumpriu o objetivo de uma reforma: conseguiu melhorias com maior satisfação de todos e ganhos em saúde.
Abstract-Obtaining synoptic observations of dynamic ocean phenomena such as fronts, eddies, oxygen minimum zones and blooms has been challenging primarily due to the large spatial scales involved. Traditional methods of observation with manned ships are expensive and, unless the vessel can survey at high-speed, unrealistic. Autonomous underwater vehicles (AUVs) are robotic platforms that have been making steady gains in sampling capabilities and impacting oceanographic observations especially in coastal areas. However, their reach is still limited by operating constraints related to their energy sources. Unmanned aerial vehicles (UAVs) recently introduced in coastal and polar oceanographic experiments have added to the mix in observation strategy and methods. They offer a tantalizing opportunity to bridge such scales in operational oceanography by coordinating with AUVs in the water-column to get in-situ measurements. In this paper, we articulate the principal challenges in operating UAVs with AUVs making synoptic observations for such targeted watercolumn sampling. We do so in the context of autonomous control and operation for networked robotics and describe novel experiments while articulating the key challenges and lessons learned.
Over the last decade, ocean sunfish movements have been monitored worldwide using various satellite tracking methods. This study reports the near-real time monitoring of fine-scale (< 10 m) behaviour of sunfish. The study was conducted in southern Portugal in May 2014 and involved satellite tags and underwater and surface robotic vehicles to measure both the movements and the contextual environment of the fish. A total of four individuals were tracked using custom-made GPS satellite tags providing geolocation estimates of fine-scale resolution. These accurate positions further informed sunfish areas of restricted search (ARS), which were directly correlated to steep thermal frontal zones. Simultaneously, and for two different occasions, an Autonomous Underwater Vehicle (AUV) video-recorded the path of the tracked fish and detected buoyant particles in the water column. Importantly, the densities of these particles were also directly correlated to steep thermal gradients. Thus, both sunfish foraging behaviour (ARS) and possibly prey densities, were found to be influenced by analogous environmental conditions. In addition, the dynamic structure of the water transited by the tracked individuals was described by a Lagrangian modelling approach. The model informed the distribution of zooplankton in the region, both horizontally and in the water column, and the resultant simulated densities positively correlated with sunfish ARS behaviour estimator (rs = 0.184, p<0.001). The model also revealed that tracked fish opportunistically displace with respect to subsurface current flow. Thus, we show how physical forcing and current structure provide a rationale for a predator’s fine-scale behaviour observed over a two weeks in May 2014.
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