The Magicians Land Epub 29
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An equitable distribution of land remains ever critical, especially in developing countries and in countries that have recently changed from systems based on collectivities or colonization[382]. In rural areas, the possibility of acquiring land through opportunities offered by labour and credit markets is a necessary condition for access to other goods and services. Besides constituting an effective means for safeguarding the environment, this possibility represents a system of social security that can be put in place also in those countries with a weak administrative structure.
471. The relationship of indigenous peoples to their lands and resources deserves particular attention, since it is a fundamental expression of their identity.[996] Due to powerful agro-industrial interests or the powerful processes of assimilation and urbanization, many of these peoples have already lost or risk losing the lands on which they live,[997] lands tied to the very meaning of their existence.[998] The rights of indigenous peoples must be appropriately protected.[999] These peoples offer an example of a life lived in harmony with the environment that they have come to know well and to preserve.[1000] Their extraordinary experience, which is an irreplaceable resource for all humanity, runs the risk of being lost together with the environment from which they originate.
482. The environmental crisis and poverty are connected by a complex and dramatic set of causes that can be resolved by the principle of the universal destination of goods, which offers a fundamental moral and cultural orientation. The present environmental crisis affects those who are poorest in a particular way, whether they live in those lands subject to erosion and desertification, are involved in armed conflicts or subject to forced immigration, or because they do not have the economic and technological means to protect themselves from other calamities.
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Although scoliosis is characterized by lateral deviation of the spine, a 3D deformation actually is responsible for geometric and morphologic changes in the trunk and rib cage. In a vast related medical literature, one can find quite a few scoliosis evaluation indices, which are based on back surface data and are generally measured along three planes. Regardless the large number of such indices, the literature is lacking a coherent presentation of the underlying metrics, the involved anatomic surface landmarks, the definition of planes and the definition of the related body axes. In addition, the long list of proposed scoliotic indices is rarely presented in cross-reference to each other. This creates a possibility of misunderstandings and sometimes irrational or even wrong use of these indices by the medical society.
Surface metrics have very little correlation to Cobb angle measurements. Indices measured on different planes do not correlate to each other. Different indices exhibit quite diverging characteristics in terms of observer-induced errors, accuracy, sensitivity and specificity. Complicated positioning of the patient and ambiguous anatomical landmarks are the major error sources, which cause observer variations. Principles that should be followed when an index is proposed are presented.
In a vast related medical literature, one can find quite a few scoliosis evaluation indices, which are based on back surface data and are generally measured along the three planes (coronal, transverse and sagittal). However, there exist no coherent presentation of the underlying metrics, the involved anatomic surface landmarks and the definition of the planes and the related body axes they refer to.
Any attempt to establish such a constant system through points on the background creates major technical problems and is cumbersome in use. The only vital solution is to use a "body specific" coordinate system, in which case stable anatomical landmarks are necessary. The SOSORT consensus shows 10 such points (see SOSORT conclusion No. 2), which are depicted in Fig. 4.
Anatomic landmarks used for back surface measurements as suggested by SOSORT. 2: Spinous process of C7, 8: Spinous process of L4, 0, 4: Acromial Angle of shoulders, 1, 3: Superior Angle of Scapulae, 5, 6: Inferior Angle of Scapulae, 7, 9: PSIS-Posterior Superior Iliac Spine.
The same anatomical landmarks have been used by many researchers, as for example [53, 54, 47] (Fig. 5, 6). The Integrated Shape Imaging System (ISIS) [30] uses also the C7/T1, the PSIS (Posterior Superior Iliac Spines) points and their point the sacrum, and a sufficient number of spinous processes.
Similar, but not exactly the same, landmarks have been used by other systems, eg. in QSIS (Fig. 7). The Quantec Spinal Image System (QSIS), is based on raster stereography [33, 55]. QSIS uses color markers of a diameter of 6.0 mm, which are attached to each spinous process from T1 to L5, including the two PSIS. The multiple fringes are projected onto the surface of the back above the natal cleft. A total of 12 metrics are produced from the 3D surface data.
Anatomic landmarks used in QSIS (after [55]). T1: Spinous process of T1, T12: Spinous process of T12, S1: Spinous process of S1m, NC: Natal Cleft, PSIS 1,2: PSIS-Posterior Superior Iliac Spine. Note: q1 and q2 angles can only be measured with the moiré fringes.
Anatomic landmarks used in POTSI index (after [56]). 1: Spinous process of C7, 2: Left Axilla fold, 3: Right Axilla fold, 4: Most intended point of the Left Trunk, 5: Most intended point of the Right Trunk, 6: Natal Cleft (NC). Note: All horizontal distances are measured from the Vertical line passing through the NC point.
Anatomic landmarks used in SHS index (after [56, 57, 68]). A: Spinous process of C7, B: the max. prominence of the angle of the scapula, C: the lowest indentation of the lumbar lordosis, h1L - h1R = Height difference of Left and Right low and high (anterior and posterior) point at Thoracic level, h3L - h3R = Height difference of Left and Right low and high point at Thoraco-Lumbar level, h5L - h5R = Height difference of Left and Right low and high point at Lumbar level.
Anatomic landmarks used in DAPI index (after [59]). 1: Spinous process of C7, 2: top of the intergluteal furrow, 9: most prominent point of the left scapula, 10: most prominent point of the right scapula, 11: least prominent point of the waist line, left, 12: least prominent point of the waist line, right, 10': symmetric point of 10 on line 10-9, 11': symmetric point of 11 on line 11-12. Note: Points 13 and 14 (most prominent point of the left and right gluteus) are used to correct, if necessary, the incorrect placement of the patient. Points 13 and 14 must have equal prominence if the patient is positioned correctly.
The coordinate system usually adopted is shown in Figure 11. Many researchers [53, 34, 54, 47] (Fig. 12, 13) prefer such a body system simply because it can be easily established, since it is based on sound body landmarks, which are easily traceable and marked by the physician.
On the other hand, the indices suggested by Nault et al. [3] (Fig. 16), [54] and [47] (Fig. 17) use the landmarks of shoulders and scapula to measure the body balance, following thus the SOSORT consensus conclusions.
It is clear that complicated positioning of the patient and ambiguous anatomical landmarks are the major error sources, which cause observer variations. For instance, moiré techniques generally suffer from errors due to malpositions of the patient and generally require strict and cumbersome protocols for positioning the patient. "A major drawback of moiré topography is that while the shape information is displayed, it is not in a form which can be unambiguously interpreted" [30]. POTSI index is reported [59] to introduce errors due to the difficulty in situating the points involved for calculating the index, as some of them are located in the shaded areas, while they are not anatomical points easily and uniquely identifiable. "The ISIS system lacked accuracy mainly because of the difficulty of distinguishing adequate landmarks due to shadowing effect" [67]. 1e1e36bf2d