954 resultados para Rawls, John, 1921-2002


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Eguíluz, Federico; Merino, Raquel; Olsen, Vickie; Pajares, Eterio; Santamaría, José Miguel (eds.)

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La Tuberculosis es una enfermedad cuya presencia ha sido constante en la historia de la humanidad. Como toda enfermedad infectocontagiosa no respeta fronteras, ni edades, ni sexos, ni razas, ni tampoco clases sociales. La tuberculosis que actualmente padecemos no es nueva; representa el final de una onda epidémica secular que alcanzó su máxima incidencia en Europa entre 1780 y 1880. Cien años marcados por el desplazamiento masivo de campesinos a las ciudades en busca de trabajo en las fábricas. Históricamente la epidemiología de la tuberculosis ha demostrado la existencia de un declive natural. Dicho declive se inició ya, incluso antes del descubrimiento de su agente causal, debido a la mejoría de las condiciones socio-económicas de la población. La aparición de la quimioterapia específica aceleró su ritmo de descenso anual. Hasta la aparición del SIDA, ningún otro factor ha modificado substancialmente su natural declinar. Tan importante son las condiciones socioeconómicas y sociopolíticas de la población en la expresión epidemiológica de ésta y otras muchas enfermedades, que en 1910, cuando no existían remedios para la tuberculosis, Holanda alcanzó el llamado punto de ruptura. Dicho punto es aquel en que se considera que la tuberculosis camina hacia su erradicación espontánea. Corresponde al momento en que cada enfermo bacilífero no puede infectar al número suficiente de personas para que se origine otro nuevo enfermo bacilífero. Evidentemente el SIDA ha supuesto una inyección de gasolina en la llama de la enfermedad tuberculosa que ha desbaratado los programas de prevención y control puestos en marcha en 1982 en nuestra Comunidad Autónoma. Como decía Napoleón Bonaparte, las batallas se ganan con organización y dinero. La batalla del SIDA aún continúa y con más ahínco en nuestro País Vasco donde esta enfermedad es especialmente prevalente. Afortunadamente los nuevos tratamientos han convertido una enfermedad mortal de necesidad en una enfermedad crónica con una mejora substancial en las expectativas de vida. Sin embargo, la gran secuela de la coinfección SIDA/Tuberculosis ha sido la aparición de multirresistencias a los fármacos por tratamientos incorrectos o falta de adherencia del paciente a los mismos. Parece que el devenir de la tuberculosis, al margen de los factores políticos, culturales y económicos, ligados a la globalización y al desarrollo sostenible dentro de un modelo neoliberal; de los movimientos de masas: inmigrantes y refugiados; del racismo; de las desigualdades de género; de la diferente accesibilidad, cobertura y eficacia en los Sistemas Públicos de Salud, etc., al margen de todo esto, la tuberculosis va a quedar condicionada a cuatro factores de índole biomédica: a) A la evolución de las multirresistencias. b) A la subordinación con la coinfección VIH. c) Al establecimiento de los denominados "nichos ecológicos", en donde la enfermedad alcanzará su máxima progresión (mayores de 65 años, sobre todo los de bajo nivel económico; inmigrantes procedentes de zonas de endemia elevada; personal sanitario y trabajadores expuestos; colectivos con adicción a drogas por vía parenteral (ADVP); alcohólicos; personas con padecimientos crónicos; pacientes en tratamientos prolongados con corticoides e inmunosupresores). En estos nichos ecológicos es donde hay que mantener un elevado índice de sospecha y establecer las estrategias adecuadas para la detección precoz de la enfermedad. d) Al éxito que se obtenga con la nueva vacuna terapéutica contra la TB creada por Joan Pere Cardona. La epidemiología de la tuberculosis estará próximamente ligada a la biología molecular y a la genética. En efecto, ya no bastará con identificar al bacilo de Koch en un paciente. Será imprescindible saber qué cepas están actuando en una determinada colectividad, así como su grado de sensibilidad frente a los tuberculostáticos. Acabó el siglo XX, hemos iniciado la segunda década del siglo XXI y la pelota aún sigue en el tejado. Estamos ante un problema de primera magnitud que hace mucho tiempo que dejó de seducir a los románticos. Como señala Bignall, comparando a la tuberculosis con lo que en su día supuso la viruela como problema de Salud Pública: La viruela se erradicó porque no sólo se disponía de una vacuna eficaz, sino además porque no requería habilidad en las relaciones humanas. Sin embargo, en la tuberculosis, la lucha ya no es contra el bacilo sino contra la mentalidad y las miserias humanas; por ello será larga, muy larga. Por todo esto y visto lo previamente descrito concluimos: 1. En la década 1993 a 2002 se diagnosticaron 847 casos de tuberculosis, 548 varones y 299 mujeres; 364 con SIDA y 483 sin demostración de VIH. 2. Si agrupamos las características medias de todos los casos recogidos, definiríamos al paciente tipo como a un varón con serología VIH negativa, una edad de 46,6 años y una afección tuberculosa de localización extrapulmonar, atendida en el Servicio de Enfermedades Infecciosas del Hospital. 3. Si el paciente tuberculoso que escogiéramos tuviera 31 años, la edad con más casos acumulados de la serie, al igual que los de 30 y 32 años, lo más frecuente que observaríamos, sería un paciente varón con SIDA y adicción a drogas por vía parenteral. 4. Aunque el sexo predominante es el varón entre los enfermos de tuberculosis, este predominio se atenúa al prescindir de los pacientes que asociaron SIDA. 5. El principal factor de riesgo para contraer el VIH en los tísicos con SIDA fue la ADVP. 6. El número de casos totales anuales viene descendiendo desde 1991, fundamentalmente a expensas del declive entre los casos que asociaron SIDA. 7. Es necesario disminuir el tiempo de demora 2 consistente en el número de días que transcurren desde que el paciente manifiesta sus primeros síntomas hasta que éste recibe el tratamiento. Puesto que el tiempo de demora 1 (que va desde que el paciente es visto en el hospital hasta que se instaura el tratamiento) cumple con los objetivos marcados en el Programa de control y prevención del Gobierno Vasco, deducimos que la Atención Primaria tiene la máxima importancia en acelerar este acortamiento del tiempo de demora disminuyendo así el periodo de riesgo de transmisión de la enfermedad. 8. La tuberculosis es una enfermedad que tiende a su natural declinar pero haciéndolo muy lentamente. Actualmente, la encontramos en zonas periféricas de la ciudad donde el VIH hace estragos en pacientes jóvenes con estilos de vida nada saludables. A estas zonas deprimidas se las denominan "nichos ecológicos". 9. La lucha contra esta enfermedad deberá ser enfocada hacia estos "nichos ecológicos". La condición necesaria para que consigamos acelerar la eliminación de la enfermedad consistirá en que diagnostiquemos y tratemos los casos afectados junto a la búsqueda de sus contactos. Pero en la tuberculosis, esto no es suficiente. Estamos luchando frente a un bacilo que se aprovecha de los más débiles, los inmunodeprimidos, edades extremas de la vida, drogodependientes, alcohólicos, zonas deprimidas económica y socialmente, que podemos delimitar en un plano y concentrar en él las medidas de control pertinentes. No olvidemos que estamos frente a un bacilo que se enclaustra en una caverna, que infecta a la tercera parte de la humanidad y espera. La tuberculosis desaparecerá en la medida en que la sociedad prospere.

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As a component of a three-year cooperative effort of the Washington State Department of Ecology and the National Oceanic and Atmospheric Administration, surficial sediment samples from 100 locations in southern Puget Sound were collected in 1999 to determine their relative quality based on measures of toxicity, chemical contamination, and benthic infaunal assemblage structure. The survey encompassed an area of approximately 858 km2, ranging from East and Colvos Passages south to Oakland Bay, and including Hood Canal. Toxic responses were most severe in some of the industrialized waterways of Tacoma’s Commencement Bay. Other industrialized harbors in which sediments induced toxic responses on smaller scales included the Port of Olympia, Oakland Bay at Shelton, Gig Harbor, Port Ludlow, and Port Gamble. Based on the methods selected for this survey, the spatial extent of toxicity for the southern Puget Sound survey area was 0% of the total survey area for amphipod survival, 5.7% for urchin fertilization, 0.2% for microbial bioluminescence, and 5- 38% with the cytochrome P450 HRGS assay. Measurements of trace metals, PAHs, PCBs, chlorinated pesticides, other organic chemicals, and other characteristics of the sediments, indicated that 20 of the 100 samples collected had one or more chemical concentrations that exceeded applicable, effects-based sediment guidelines and/or Washington State standards. Chemical contamination was highest in eight samples collected in or near the industrialized waterways of Commencement Bay. Samples from the Thea Foss and Middle Waterways were primarily contaminated with a mixture of PAHs and trace metals, whereas those from Hylebos Waterway were contaminated with chlorinated organic hydrocarbons. The remaining 12 samples with elevated chemical concentrations primarily had high levels of other chemicals, including bis(2-ethylhexyl) phthalate, benzoic acid, benzyl alcohol, and phenol. The characteristics of benthic infaunal assemblages in south Puget Sound differed considerably among locations and habitat types throughout the study area. In general, many of the small embayments and inlets throughout the study area had infaunal assemblages with relatively low total abundance, taxa richness, evenness, and dominance values, although total abundance values were very high in some cases, typically due to high abundance of one organism such as the polychaete Aphelochaeta sp. N1. The majority of the samples collected from passages, outer embayments, and larger bodies of water tended to have infaunal assemblages with higher total abundance, taxa richness, evenness, and dominance values. Two samples collected in the Port of Olympia near a superfund cleanup site had no living organisms in them. A weight-of-evidence approach used to simultaneously examine all three “sediment quality triad” parameters, identified 11 stations (representing 4.4 km2, 0.5% of the total study area) with sediment toxicity, chemical contamination, and altered benthos (i.e., degraded sediment quality), 36 stations (493.5 km2, 57.5% total study area) with no toxicity or chemical contamination (i.e., high sediment quality), 35 stations (274.1 km2, 32.0% total study area) with one impaired sediment triad parameter (i.e., intermediate/high sediment quality), and 18 stations (85.7km2, 10.0% total study area) with two impaired sediment parameters (i.e., intermediate/degraded quality sediments). Generally, upon comparison, the number of stations with degraded sediments based upon the sediment quality triad of data was slightly greater in the central Puget Sound than in the northern and southern Puget Sound study areas, with the percent of the total study area degraded in each region decreasing from central to north to south (2.8, 1.3 and 0.5%, respectively). Overall, the sediments collected in Puget Sound during the combined 1997-1999 surveys were among the least contaminated relative to other marine bays and estuaries studied by NOAA using equivalent methods. (PDF contains 351 pages)

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Forward: Looe Key National Marine Sanctuary (LKNMS) was designated in 1981 to protect and promote the study, teaching, and wise use of the resources of Looe Key Sanctuary (Plate A). In order to wisely manage this valuable resource, a quantitative resource inventory was funded by the Sanctuary Programs Division (SPD), Office of Ocean and Coastal Resource Management, National Oceanic and Atmospheric Administration (NOAA) in cooperation with the Southeast Fisheries Center, National Marine Fisheries Service, NOAA; the Cooperative Institute for Marine and Atmospheric Studies (CIMAS), University of Miami; the Fisher Island Laboratory, United States Geological Survey; and the St. Petersburg Laboratory, State of Florida Department of Natural Resources. This report is the result of this cooperative effort. The objective of this study was to quantitatively inventory selected resources of LKNMS in order to allow future monitoring of changes in the Sanctuary as a result of human or natural processes. This study, referred to as Phase I, gives a brief summary of past and present uses of the Sanctuary (Chapter 2); and describes general habitat types (Chapter 3), geology and sediment distribution (Chapter 4), coral abundance and distribution (Chapter 5), the growth history of the coral Montastraea annularis (Chapter 6), reef fish abundance and distribution (Chapter 7), and status of selected resources (Chapter 8). An interpretation of the results of the survey are provided for management consideration (Chapter 9). The results are expected to provide fundamental information for applied management, natural history interpretation, and scientific research. Numerous photographs and illustrations were used to supplement the report to make the material presented easier to comprehend (Plate B). We anticipate the information provided will be used by managers, naturalists, and the general public in addition to scientists. Unless otherwise indicated, all photographs were taken at Looe Key Reef by Dr. James A. Bohnsack. The top photograph in Plate 7.8 was taken by Michael C. Schmale. Illustrations were done by Jack Javech, NMFS. Field work was initiated in May 1983 and completed for the most part by October 1983 thanks to the cooperation of numerous people and organizations. In addition to the participating agencies and organizations we thank the Newfound Harbor Marine Institute and the Division of Parks and Recreation, State of Florida Department of Natural Resources for their logistical support. Special thanks goes to Billy Causey, the Sanctuary Manager, for his help, information, and comments. We thank in alphabetical order: Scott Bannerot, Margie Bastian, Bill Becker, Barbara Bohnsack, Grant Beardsley, John Halas, Raymond Hixon, Irene Hooper, Eric Lindblad, and Mike Schmale. We dedicate this effort to the memory of Ray Hixon who participated in the study and who loved Looe Key. (PDF contains 43 pages)

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Parte 1 - Atos do Poder Legislativo

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Executive Summary: Circulation and Exchange of Florida Bay and South Florida Coastal Waters The coastal ecosystem of South Florida is comprised of distinct marine environments. Circulation of surface waters and exchange processes, which respond to both local and regional forcings, interconnect different coastal environments. In addition, re-circulating current systems within the South Florida coastal ecosystem such as the Tortugas Gyre contribute to retention of locally spawned larvae. Variability in salinity, chlorophyll, and light transmittance occurs on a wide range of temporal and spatial scales, in response to both natural forcing, such as seasonal precipitation and evaporation and interannual “El Niño” climate signals, and anthropogenic forcing, such as water management practices in south Florida. The full time series of surface property maps are posted at www.aoml.noaa.gov/sfp. Regional surface circulation patterns, shown by satellite-tracked surface drifters, respond to large-scale forcing such as wind variability and sea level slopes. Recent patterns include slow flow from near the mouth of the Shark River to the Lower Keys, rapid flow from the Tortugas to the shelf of the Carolinas, and flow from the Tortugas around the Tortugas Gyre and out of the Florida Straits. The Southwest Florida Shelf and the Atlantic side of the Florida Keys coastal zone are directly connected by passages between the islands of the Middle and Lower Keys. Movement of water between these regions depends on a combination of local wind-forced currents and gravitydriven transports through the passages, produced by cross-Key sea level differences on time scales of several days to weeks, which arise because of differences in physical characteristics (shape, orientation, and depth) of the shelf on either side of the Keys. A southeastward mean flow transports water from western Florida Bay, which undergoes large variations in water quality, to the reef tract. Adequate sampling of oceanographic events requires both the capability of near real-time recognition of these events, and the flexibility to rapidly stage targeted field sampling. Capacity to respond to events is increasing, as demonstrated by investigations of the 2002 “blackwater” event and a 2003 entrainment of Mississippi River water to the Tortugas. (PDF contains 364 pages.)

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In September 2002, side scan sonar was used to image a portion of the sea floor in the northern OCNMS and was mosaiced at 1-meter pixel resolution using 100 kHz data collected at 300-meter range scale. Video from a remotely-operated vehicle (ROV), bathymetry data, sedimentary samples, and sonar mapping have been integrated to describe geological and biological aspects of habitat and polygon features have been created and attributed with a hierarchical deep-water marine benthic classification scheme (Greene et al. 1999). The data can be used with geographic information system (GIS) software for display, query, and analysis. Textural analysis of the sonar images provided a relatively automated method for delineating substrate into three broad classes representing soft, mixed sediment, and hard bottom. Microhabitat and presence of certain biologic attributes were also populated into the polygon features, but strictly limited to areas where video groundtruthing occurred. Further groundtruthing work in specific areas would improve confidence in the classified habitat map. (PDF contains 22 pages.)

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This report documents abundance and cover for selected elements of the benthic coral reef assemblage at the site of the 1984 grounding of the M/V Wellwood on Molasses Reef, Florida Keys. The purpose of the effort was to establish a pre-construction baseline before the installation of reef modules at the site. The installation process is intended to stabilize fractured substrates that were recently exposed by storm impacts, and to provide three-dimensional relief in order to enhance reef community recovery. It is hoped that the restoration effort will result in a biological assemblage with the character of the transition community that would exist there had the incident not occurred. To date, the assemblage has developed the character of a comparatively featureless hard ground similar in composition to hard ground areas and transition zones surrounding the grounding site. These data will allow scientists and resource managers to better track the trajectory of recovery following the installation of modules. Direct counts of scleractinian and gorgonian corals, hydrocorals of the genus Millepora, and zoanthids of the genus Palythoa were made in three areas within and around the grounding site. The site is poorly developed with respect to scleractinian colony size and cover compared to surrounding areas. Key scleractinian species necessary for the development of topographic relief in the area denuded by the grounding are not well represented in the current community. Though gorgonian cover and richness is similar in all study areas, gorgonian community recovery in the damaged area is not complete. Unlike surrounding areas, one species, Pseudopterogorgia americana, accounts for over half of all corals at the grounding site, over 80% of all gorgonians, and nearly all the coral cover. Based on these findings and other observations made in the 18 years since the grounding, recommendations are made that should be considered in the course of human intervention targeted at stabilizing and enhancing the site. (PDF contains 24 pages.)

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Santamaría, José Miguel; Pajares, Eterio; Olsen, Vickie; Merino, Raquel; Eguíluz, Federico (eds.)

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Since the STREAM Initiative’s official launch on 1 December 2001, this Regional Conference was the first opportunity for many colleagues directly involved in STREAM to come together. (PDF has 30 pages.)

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Sustainable Aquaculture for Poverty Alleviation (SAPA) is a strategy under the overall national program for hunger eradication and poverty reduction. This reflects high attention by the Ministry of Fisheries (MOFI) to the poor. Since the strategy was initiated, several actions have been taken. Recently, conferences and meetings were conducted in Hanoi, Thai Nguyen and Quang Tri. Consequently we also have workshops on a regional basis, and today we are pleased to conduct a workshop in Long An on livelihoods analysis. Now at the Ministry, there are more than 340 projects in aquaculture to attack poverty. The launch of SAPA has been given a high priority among support agencies. Recently Mr Gill of the World Bank and the Ministry agreed that they would act to strengthen aquaculture for poverty reduction. So today with the support of the Long An People’s Committee, NACA and STREAM we have a workshop to strengthen learning about livelihoods analysis. (PDF has 61 pages.)