[CAP, understand, act and share: A toolbox made in Nouvelle Aquitaine to support healthcare establishments in their ecological transformation]. / CAP, comprendre, agir et partager : une boite à outils made in Nouvelle Aquitaine pour accompagner les établissements dans leur transformation écologique.

In the face of climate change, Health is mobilizing to find solutions and reduce its environmental impact. The CAP (understand, act and share) sustainable hospital toolbox cited in the roadmap for the Ecological Planning of the French Health System offers 3 original, operational and complementary tools to: (1) acculturate professionals in the sector (Plan Health Faire®), (2) build the establishment strategy (2030 Agenda), and (3) take action with healthcare professionals (The Sustainable Units program).

[Medical education in ecology and environmental health: A sustainable tool for action]. / La pédagogie médicale en écologie et santé environnementale : un levier d'action durable.

Global warming and the disruption in ecosystems have been identified as the greatest threats to human health in the 21st century. Today, the French healthcare system accounts for 6.6% to 10% of overall greenhouse gas emissions in France. This system is currently not resilient and totally dependent on fossil fuels. Therefore, a transformation of the current system is needed in order to reduce the deterioration of populations' health. Medical education and pedagogy have been identified as a major solution for the ecological transformation of the healthcare system. The introduction of early education on ecology and environmental health in the first and second cycles of medical studies is a major lever for action. From the third cycle of medical studies, and more specifically in pathology, it is essential to teach this topic to residents and experienced pathologists, whether in "theoretical teaching" or "applied to the medical specialty". The aim of this review is to identify the educational programs and training currently available in the medical courses and at the post-graduate level, regarding ecology/environmental health and the consequences on human health. Then, we will detail more specifically the pedagogical perspectives and training opportunities for pathology residents and pathologists.

[Recycled formalin: A new environmental mitigation tool in pathology?] / Le formol recyclé : un nouvel outil d'atténuation de l'impact environnemental de l'ACP ?

Formalin is the international gold-standard fixative in pathology laboratories. However it is not the ideal one considering its deleterious effects on individuals and the environment. Complete formalin removal or even substitution does not seem possible in the near future. In this update, we present various tools allowing to integrate the use of formalin into an ecocare approach. Among them, formalin recycling according to the protocol developed by the University Hospital of Bordeaux is simple to implement and delivers rapid and significant results, allowing pathology professionals to meet the sustainable development objectives included in the France 2030 agenda.

[Integrating environmental health into our nursing practices]. / Intégrer la santé environnementale dans les pratiques infirmières.

The healthcare sector accounts for 8% of the national carbon footprint in France. It is imperative to integrate climate and environmental issues into modern healthcare management. Many health professionals are advocating for more eco-responsible care. Each caregiver can reduce the environmental and health impact of their activity, while evolving in a healthy environment. Nurses have a particular responsibility to contribute to sustainable development.

[Ecology: The blind spot in pathology research]. / Écologie : l'angle mort de la recherche en ACP.

INTRODUCTION: The 2015 Paris Agreement has been the first restrictive agreement in the fight against climate change. The newer generations of pathologists, who feel more anxiety due to environmental problems than their predecessors, are asked to publish research works while they are harder and harder to and in a context of demographical tensions. We wanted to measure the rise of ecology research in pathology since the Paris Agreement. MATERIAL & METHODS: Over a ten years study period (2013-2022), we have identified via PubMed the number of articles in which forty-three terms taken from the sustainable development vocabulary appeared in ten renowned international pathology journals, selected for their SJR index from ScimagoJr and their impact factor, plus the Annales de pathologie, and compared their means of incidence between the 2013-2015 (m1) and 2016-2022 (m2) periods. The same process has been applied for "artificial intelligence", "deep learning" and "digital pathology". RESULTS: A total of 1336 articles have been identified. Only "digital pathology" (fromm1=8,33 to m2=23,29; p=0,010) and "deep learning" (fromm1=0 to m2=10,14; p=0,034) saw their incidence rise significantly. A significant decrease has been observed with "biological" (fromm1=70,00 to m2=56,86; p=0,020). DISCUSSION-CONCLUSIONS: Pathology reacts to trends but research in ecology has remained in the blind spot since 2015. However there seems to be an awakening as editorials, articles and communications in congress have blossomed the last two years.

[Reducing the environmental impact of inhalers dispensed in France. From diagnosis to sustainable action]. / Réduire l'impact environnemental des inhalateurs dispensés en ville et à l'hôpital en France. Du diagnostic à l'action durable.

OBJECTIVES: While inhaled drugs are mainly used to treat chronic respiratory diseases, they are also responsible for greenhouse gas (GHG) emission. To highlight this issue, a dispensed analysis and a carbon footprint evaluation of inhalers in France have been conducted. METHODS: A national qualitative and quantitative analysis of dispensed inhalers in community pharmacies (CP) and hospitals (H) was conducted in France for 2019. A data review from the literature led to the determination of the inhalers carbon footprint, expressed in carbon dioxide equivalent (CO2e) during the inhaler life cycle. RESULTS: Close to 40 million inhalers were dispensed by community pharmacies and one million by hospitals in 2019. It concerned three types of inhalers: metered-dose inhalers (MDI) [CP: 49%; H: 45%], dry powder inhalers (DPI) [CP: 47%; H: 51%], and soft mist inhalers (SMI) [CP: 4%; H: 4%]. According to the literature, MDI have the highest carbon footprint, ranging from 11 to 28 kgCO2e versus less than 1 kgCO2e for DPI/SMI. In 2019, the national carbon footprint of salbutamol (MDI), the most dispensed inhaler, was estimated to be over 310 million kgCO2e (CP+H) corresponding to more than 310,000 round-trip Paris-New York. CONCLUSIONS: This study shows the involvement of MDI in GHG emissions. Taking actions as part of a global and coordinated approach to limit their environmental impact is possible and thus is a priority.

[Engage health and medico-social institutions in a sustainable development or CSR approach]. / Engager les établissements dans une démarche de développement durable ou de RSE.

Health and medico-social establishments have every interest in embarking on corporate social responsibility for establishments: decarbonisation, compliance with regulations, attractiveness strategy, links with territorial partners, economic interest, etc. To support them, the Fédération hospitalière de France has put forward proposals to the presidential candidates, which are intended to be supported throughout Emmanuel Macron's new five-year term.

[French national overview of the inclusion of environmental criteria in the public purchasing of health products (drugs and sterile medical devices)]. / Prise en compte des critères environnementaux dans la commande publique des produits de santé.

OBJECTIVES: Healthcare products (HP) have a significant carbon footprint that must be included by regulation in the facility's purchasing policy. A national overview of the inclusion of environmental criteria (EC) in the public procurement (PP) of HP in hospitals has been carried out. METHODS: Thirty EC were identified in the literature. Two questionnaires were proposed: (i) for buyers that analyze the level of "importance" and "ease of application" for public tenders (PT), and (ii) for suppliers that declare their commitments and evidence. RESULTS: Six regional buyers and 28 suppliers participated. Buyers recognize the "importance" of sustainable development (SD) but are more reticent about the "applicability" of EC in PT. The environmental rating remains low: on average 4.38 (0.25-10.00) % of the total rating. Only 12 EC are integrated within some PT. Suppliers report a high and diversified commitment to SD: 18 suppliers sent 474 evidence. Buyers and suppliers converge on the optimization of primary packaging and the establishment of a minimum order or delivery group. CONCLUSIONS: Since the efficiency of PP is inevitable, EC that combines SD and savings should be prioritized. The integration of additional EC, simple and easily documented, allowing cost containment for both suppliers and buyers, is possible to promote sustainable purchasing.

[Reducing the exposure of patients and healthcare teams to cytotoxins]. / Réduire l'exposition des patients et des équipes soignantes aux cytotoxiques.

In order to prevent human and environmental risks related to the handling of cytotoxins and cytostatics, health care institutions are implementing precautionary measures. Information and training actions for health professionals, nurses, orderlies and pharmacy assistants are also part of the system. Example with a team in Lyon.

[Cats, a controlled species within the hospital]. / Les chats, une espèce maîtrisée au sein d'un hôpital.

Faced with the proliferation of stray cats in its park, the Barthélemy-Durand public health establishment in Étampes (91), in partnership with the Société protectrice des animaux, has managed to find the right balance between health safety and a pleasant animal presence for patients and caregivers. The regulated control of free and healthy cats on the hospital site also opens up possibilities for animal mediation. Sharing experience and commitment to the animal cause.

[Being aware of the ecological and societal footprint of care giving]. / Prendre conscience de l'empreinte écologique et sociétale des soins.

The Covid-19 pandemic strongly emphasizes the social and societal imperatives to be taken into account in terms of sustainable development and health. Various legal, political and methodological mechanisms exist and allow health workers to rely on a validated framework. If health care providers are being put to the test by the health crisis they have been facing for more than a year, they are also confident in their ability to act to reduce the ecological footprint of care giving.

[Sustainable development and daily care of the patient]. / Développement durable et prise en charge journalière du patient.

How can we actively participate in sustainable development when we are nurses, orderlies or health care agents? Are nurses simply executors, users of equipment and consumers of products or, on the contrary, major contributors to the evolution towards more eco-responsible care practices? A shared reflection and a commitment from all hospital staff could encourage active participation in health establishments.

[Integrating sustainable development into initial nursing education]. / Intégrer le développement durable dans la formation initiale infirmière.

The initial nursing training framework offers the opportunity to build a teaching program that will lay the foundations of an eco-citizen care giving practice. With evolving content, and in light of climatic contingencies and the need to adapt to emerging pathologies, these courses must make sustainable development, associated with hygiene and safety, a new professional imperative in the care giving system.

[Raising awareness of sustainable development and environmental health among caregivers]. / Sensibiliser les soignants au développement durable et à la santé environnementale.

In order to be more consistent with their care giving values, a growing number of health professionals are looking for more environmentally friendly care practices. The health crisis we are going through strongly questions the footprint of care in terms of sustainable development and environmental health. Changes are possible; training courses exist to assimilate eco-actions.

[Fighting global warming in the operating room]. / Lutter contre le réchauffement climatique au bloc opératoire.

At the Pitié-Salpêtrière hospital group (AP-HP, Paris), the central operating room teams embarked, in 2017, on a project to reduce the ecological impact of the procedures performed there. The results are convincing: reduction of the carbon footprint of anesthetic gases, reduction of waste and improvement of its sorting, recycling of metals. The project has spread to the other operating rooms in the hospital group, with strong support from professionals.

O eu e o mundo: por uma ética para o século XXI / The self and the world: for ethics in the 21st century / El yo y el mundo: por una ética para el siglo XXI / Le moi et le monde: pour une éthique pour le XXIe siècle

RESUMO O autor propõe tratar de uma ética para o século XXI. Ressalta a contradição entre as conquistas alcançadas nos últimos 100 anos - como o aumento da expectativa de vida, a diminuição da mortalidade infantil, o aumento da produção de riqueza e o desenvolvimento tecnológico - e a difusão dessas conquistas. Houve avanço na capacidade de gerar riqueza, mas não na capacidade de distribuí-la. Reconhece que avançamos em série, no desenvolvimento econômico, nas condições do trabalho e no cuidado com o ambiente, sem, no entanto, termos uma visão integrada na qual o modo de produção se torne sustentável. Destaca o impacto ambiental deletério causado por um modo de desenvolvimento que não se coloca limites. Propõe, por fim, rever o papel e o perfil das lideranças governamentais, de maneira a levar o homem a compreender a relação entre produção, preservação da natureza e distribuição de riqueza.

ABSTRACT This work aims at covering ethics for the 21st century. It highlights the contradiction between achievements in the last one hundred years, such as the increase of life expectancy, decrease of infant mortality rate, higher production of wealth and the technological development besides its distribution among people and population. There has been an improvement on the ability to create wealth, but not on the way it is distributed. It recognizes that we have progressed as a group, watching the economic development, work conditions and the environment. However, we haven't achieved an integrated vision on sustainable production. It also points out the detrimental impact on the environmental caused by the way development is happening, without limit control. It proposes that governmental leadership roles and profile are reviewed so that people understand the relation among production, nature preservation and wealth distribution.

RESUMEN El trabajo propone tratar de una ética para el siglo XXI. Destaca la contradicción entre las conquistas alcanzadas en los últimos cien años, tales como el aumento de la esperanza de vida, la disminución de la mortalidad infantil, el aumento de la producción de riqueza y del desarrollo tecnológico, y, su distribución entre las personas. Hubo un avance en la capacidad de generar riqueza, pero no en la capacidad de distribuirla. Reconoce que avanzamos en serie cuidando del desarrollo económico, de las condiciones de trabajo y con el cuidado del ambiente, no obstante, sin una visión integrada, en la que el modo de producción sea sostenible. Destaca el impacto ambiental negativo generado por el desarrollo sin límites. Propone finalmente revisar el papel y el perfil de los líderes gubernamentales de manera que faciliten al hombre a comprender la relación entre producción, preservación de la naturaleza y distribución de riqueza.

RÉSUMÉ L'auteur propose de discuter d'une éthique pour le XXIe siècle. Il souligne la contradiction entre les progrès atteints pendant les dernières cent ans - telles que l'augmentation de l'espérance de vie, la diminution de la mortalité infantile, l'augmentation de la production de richesses et le développement technologique - et la diffusion de ces réussites. Il y a eu des avancements dans la capacité de générer des richesses, mas pas dans la capacité de les distribuer. Il reconnaît que nous progressons en série, dans le développement économique, dans les conditions du travail et dans la protection de l'environnement, sans pourtant en avoir une vision intégrée dont le processus de production devienne durable. Il met en relief l'impact environnemental délétère provoqué par un mode de développement qui n'établit pas de limites. Pour finir, il propose de revoir le rôle et le profil des responsables gouvernementaux, de façon à mener l'homme à comprendre le rapport entre la production, la préservation de la nature et la répartition des richesses.

Diálogos entre psicanálise e comunidades tradicionais / Dialogues between psychoanalysis and traditional communities / Diálogos entre psicoanálisis y comunidades tradicionales / Dialogues entre la psychanalyse et les communautés traditionnelles

O autor pretende compartilhar sua experiência como psicanalista morador de Paraty (RJ), seu contato com as comunidades tradicionais existentes na cidade e como o conhecimento dessas comunidades transformou seu olhar sobre o adoecimento humano e ampliou seu conhecimento psicanalítico.

The author intends to share his experience as a psychoanalyst living in the city of Paraty, his contacts with the local traditional communities and how the knowledge of these communities transformed his view of human illness as well as increased his psychoanalytical knowledge.

El autor pretende compartir su experiencia como psicoanalista residente de Paraty, sus contactos con las comunidades tradicionales existentes en la ciudad y cómo el conocimiento de esas comunidades transformó su mirada sobre el padecimiento humano así también amplió su conocimiento psicoanalítico.

L'auteur a l'intention de partager son expérience en tant que psychanalyste habitant à Paraty, ses contacts avec les communautés traditionnelles qui existent dans cette ville et comment le fait de connaître ces communautés a modifié son regard concernant la souffrance humaine, aussi bien qui a élargi ses connaissances psychanalytiques.

Building a sustainable aquaculture industry in South Africa: the role of biosecurity.

Progress towards the South African Government's social upliftment targets on food security, equity, job creation and economic development can be made by diversification of fish production in the country's aquaculture sector. The risks associated with the diseases and parasitic infections that affect aquaculture production in South Africa are poorly understood. Substantial investment is currently being made to provide evidence of freedom from OIE-listed diseases to support an aquaculture industry that is largely reliant on access to foreign markets for high-value aquacultural products. The projected rapid expansion of the aquaculture sector in South Africa accentuates the associated need to prevent the spread of aquatic animal diseases. The primary constraint is that the current regulatory framework governing aquacultural activities is not centralised due to the diversity of aquaculture activities spanning marine, brackish and freshwater environments. An aquaculture development bill was drafted in 2018 to promote aquacultural development. The effective implementation of the provisions of the bill requires resources to ensure that suitable standards for aquatic animal health management are achieved in accordance with international standards and government policies and objectives.

L'Afrique du Sud peut progresser vers les objectifs gouvernementaux de redressement social spécifiquement axés sur la sécurité alimentaire, l'égalité, la création d'emplois et le développement économique en diversifiant la production de poissons au sein du secteur national de l'aquaculture. Les risques liés aux maladies et aux parasitoses affectant les productions aquacoles en Afrique du Sud sont mal appréhendés. Le pays mobilise actuellement d'importantes ressources pour démontrer sur son territoire l'absence de maladies listées par l'OIE afin de soutenir le secteur aquacole qui dépend fortement de l'accès aux marchés d'exportation pour écouler des productions aquacoles de grande valeur. L'expansion rapide que devrait connaître le secteur de l'aquaculture en Afrique du Sud accentue la nécessité concomitante de prévenir la propagation des maladies affectant les animaux aquatiques. La principale contrainte réside dans la structure non centralisée du cadre réglementaire régissant actuellement les activités aquacoles, principalement due à la diversité de ces activités, qui recouvrent les productions en milieu marin, en eau saumâtre et en eau douce. Un projet de loi sur le développement de l'aquaculture a été élaboré en 2018 pour promouvoir le secteur. La mise en œuvre effective des dispositions incluses dans ce projet exige que des ressources soient consacrées à assurer l'application des normes appropriées de gestion de la santé des animaux aquatiques, en conformité avec les normes internationales et avec les objectifs et la stratégie du gouvernement.

La diversificación de la producción piscícola en el sector de la acuicultura de Sudáfrica puede ser uno de los medios para avanzar hacia los objetivos de progreso social del Gobierno del país en materia de seguridad alimentaria, equidad, creación de empleo y desarrollo económico. No se sabe lo suficiente de los riesgos ligados a las enfermedades e infestaciones parasitarias que en Sudáfrica afectan a la producción acuícola. Actualmente se están haciendo cuantiosas inversiones para obtener datos que demuestren la ausencia de enfermedades inscritas en la lista de la OIE y ayudar así a una industria, la de la acuicultura, que depende en gran medida del acceso a los mercados extranjeros para vender productos acuícolas de elevado valor. La rápida expansión del sector que se tiene proyectada en Sudáfrica acrecienta la necesidad conexa de prevenir la propagación de enfermedades de los animales acuáticos. El principal escollo para lograrlo es la descentralización del ordenamiento normativo que rige actualmente las actividades de acuicultura, fruto de la propia diversidad del sector, que trabaja tanto en aguas marinas como en medios de agua dulce y salobre. En 2018 se redactó una ley de desarrollo de la acuicultura destinada a promover esta actividad, ley cuyas disposiciones, para ser aplicadas eficazmente, exigen recursos que permitan gestionar la sanidad de los animales acuáticos con criterios de exigencia acordes con la normativa internacional y con las políticas y objetivos del Gobierno.

Vulnerabilities in aquatic animal production.

The role of aquatic animals in global food and nutrition security is increasingly recognised. The global demand for fish is increasing, leading to a need to significantly increase its supply. Securing future fish supplies through sustainable production is a challenge as major resources such as fresh water and land are becoming limited worldwide. Aquaculture and capture fisheries face various threats from both human-mediated and natural environmental change, including climate change. Aquaculture systems and practices are vulnerable to such changes. Moreover, aquatic animal diseases are currently considered one of the most important constraints to sustainable global fish production. The need to increase global production, combined with climate change, may increase losses due to diseases. This paper examines key vulnerabilities, their impacts and management to achieve increased and sustainable global fish production. The authors focus on the need to apply international standards, and to develop biosecurity and capacity in aquatic animal health to improve global fish health. Research needed to underpin the development of improved detection and control of fish diseases is also discussed.

L'importance des animaux aquatiques pour la sécurité alimentaire et nutritionnelle mondiale est désormais reconnue. La demande mondiale en aliments issus d'animaux aquatiques ne cessant d'augmenter, il est devenu impératif de renforcer significativement l'offre du secteur. La sécurisation future de cette offre grâce à la mise en place d'une production durable constitue un défi de taille en raison de la raréfaction de certaines ressources cruciales, dont l'eau douce et les terres. L'aquaculture et la pêche de capture font face à plusieurs menaces induites par les transformations tant naturelles qu'anthropiques subies par l'environnement, y compris le changement climatique. Les systèmes et les pratiques de l'aquaculture présentent des vulnérabilités à ces changements. De plus, on considère aujourd'hui que les maladies des animaux aquatiques constituent l'une des principales entraves à une production aquacole durable au niveau mondial. Les pertes dues aux maladies vont probablement augmenter par l'effet conjoint du changement climatique et de la nécessité d'accroître les quantités produites dans le monde. Les auteurs examinent les principales vulnérabilités à l'œuvre ainsi que leur impact et les manières d'y faire face en vue d'une production aquacole mondiale accrue et durable. Ils mettent l'accent sur la nécessité de se conformer aux normes internationales et de renforcer la biosécurité et les capacités du secteur de la santé des animaux aquatiques afin d'améliorer le statut sanitaire de ces animaux à l'échelle mondiale. Ils font également le point sur les travaux de recherche qu'il convient de mener afin de mettre au point de meilleures méthodes de détection et de contrôle des maladies des animaux aquatiques.

Cada vez está más clara la función de los animales acuáticos en relación con la seguridad alimentaria y nutricional del mundo. La demanda planetaria de alimentos derivados de animales acuáticos va en aumento, lo que obliga a incrementar sustancialmente el suministro. El objetivo de asegurar el abastecimiento de animales acuáticos en el futuro gracias a una producción sostenible plantea no pocas dificultades, en la medida en que recursos importantes, como el agua dulce o las tierras, empiezan a escasear en todo el mundo. La acuicultura y la pesca de captura afrontan una serie de amenazas derivadas de los cambios ambientales, ya sean de origen natural o antrópico, en particular el cambio climático. Las praxis y los sistemas acuícolas son vulnerables a esos cambios. Están además las enfermedades de los animales acuáticos, consideradas actualmente uno de los principales frenos a la producción sostenible del sector en el mundo. La necesidad de elevar la producción mundial, combinada con el cambio climático, puede acrecentar el volumen de pérdidas debidas a enfermedades. Los autores examinan las principales fragilidades del sistema, sus consecuencias y la forma de gestionarlas para lograr una producción acuícola mundial más cuantiosa y sostenible, centrándose en la necesidad de aplicar normas internacionales y de desarrollar tanto la seguridad biológica como la capacidad en materia de sanidad de los animales acuáticos para mejorar el estado de salud de estos animales a escala mundial. También se refieren a las investigaciones necesarias para fundamentar sistemas más eficaces de detección y control de las enfermedades de los animales acuáticos.

The changing nature of aquatic animal production.

Aquaculture will continue to grow, but environmental constraints will interact with changing consumer profiles and regulatory frameworks such that future growth will look somewhat different from the trajectories of the past 30 years. Availability and price of land, fresh water, feeds and energy, and concerns about pollution and the introduction of non-native species will be major constraints to expansion. New technology will evolve in response to these concerns. This new technology will be based on the principle of sustainable intensification so as to reduce the environmental footprint per unit of production and limit volatility in markets precipitated by disease and other production system problems. Markets and consumer demand will be reflected in the economics of the industry under more sophisticated regulatory regimes. More sustainable sources of the proteins and oils in fish diets, improved genetic management, and better health and production systems will continue to underpin the expansion of aquaculture into the 21st century and beyond.

La croissance de l'aquaculture va se poursuivre mais les contraintes environnementales risquent d'interagir avec les mutations des profils des consommateurs et avec l'évolution des cadres réglementaires, de sorte que cette croissance empruntera à l'avenir des voies bien différentes de celles tracées au cours des 30 dernières années. Les principaux obstacles à la croissance concernent la disponibilité et le prix des terres, de l'eau douce, des aliments pour animaux et de l'énergie, les problèmes en lien avec la pollution et l'introduction d'espèces non natives. L'évolution des nouvelles technologies devrait apporter une réponse à ces préoccupations. Ces nouvelles technologies reposeront sur le principe d'une intensification durable de la production afin de réduire l'empreinte écologique par unité de production et de limiter la volatilité accélérée des marchés induite par les maladies ou par d'autres problèmes affectant les systèmes de production. Les exigences des marchés et des consommateurs se répercuteront dans la stratégie économique du secteur en vertu de dispositifs réglementaires plus sophistiqués. Grâce au recours à des sources plus durables de protéines et d'huiles pour l'alimentation des poissons, à une meilleure gestion des ressources génétiques et à des systèmes sanitaires et de production plus performants, l'expansion de l'aquaculture devrait se poursuivre tout au long du xxie siècle et au-delà.

Aunque en el futuro la acuicultura seguirá creciendo, las limitaciones ambientales interactuarán del tal modo con la evolución de las modalidades de consumo y los ordenamientos reglamentarios que este crecimiento se apartará en cierta medida de las trayectorias observadas en los últimos 30 años. La disponibilidad y el precio de terrenos, agua dulce, piensos y energía, junto con las inquietudes por la contaminación y la introducción de especies no autóctonas, limitarán considerablemente la expansión. En respuesta a esas inquietudes surgirá una nueva tecnología basada en el principio de la intensificación sostenible, que servirá para reducir la «huella¼ ecológica por unidad de producción y para poner coto a la volatilidad de los mercados causada por enfermedades u otros problemas del sistema productivo. La demanda de mercados y consumidores incidirá en la economía del sector en forma de ordenamientos reglamentarios más sofisticados. En los primeros compases del siglo XXI, y también más adelante, la expansión de la acuicultura seguirá reposando en el uso de fuentes más sostenibles de proteínas y aceites para alimentar a los peces, en el perfeccionamiento de los procesos de selección genética y en sistemas productivos y sanitarios más eficaces.