Raymund R. Razonable, M.D.
- Associate Professor of Medicine
- Department of Medicine
- Mayo Clinic College of Medicine
- Consultant Staff
- Division of Infectious Diseases
- Mayo Clinic
- Rochester, Minnesota
Urbanization of watersheds with an accompanying decrease in permeable surface area can affect the hydrologic response of basins to precipitation events erectile dysfunction doctor nj buy aurogra 100 mg otc. As a result erectile dysfunction treatment centers in bangalore generic 100mg aurogra with amex, rainfall flows into streams at a much faster rate resulting in floodwaters that rise and peak very rapidly erectile dysfunction hypertension medications generic 100mg aurogra mastercard. Development or encroachment on floodplains and floodways may cause floodwaters to expand and rise above historical levels (Mid-Willamette Valley Council of Governments and Oregon Natural Hazards Workgroup 2005) impotence tcm cheap 100mg aurogra amex. Projected increases in flooding related to climate change may pose even greater risks to developed areas in floodplains, urban areas, roads, stormwater systems, and other infrastructure at water crossings such as pipelines, bridges, and culverts (Climate Impacts Group 2012). Extreme precipitation events have the potential to cause localized flooding due partly to inadequate capacity of storm drain systems. Extreme events may damage or cause failure of dam spillways (Oregon Department of Land Conservation and Development 2010). Heavy rainfall can also saturate soils and increase risk of landslides, particularly in areas with unstable slopes or disturbed vegetation, potentially damaging roadways and other infrastructure (Oregon Department of Land Conservation and Development 2010). Impacts on transportation systems can impose delays on the movement of goods and the traveling public (Walker et al. Flooding and erosion along forest road networks may damage culverts and generate increased sediment loads that can affect salmon and steelhead spawning, migration, and rearing habitat (Climate Impacts Group 2012). Future hydrologic conditions are projected to include warmer stream temperatures, lower summer flows, and more frequent extreme events that may damage or stress the reliability of the current water infrastructure. With lower summer flows, it is projected that diversification and development of water supplies, reducing water demand, improving water-use efficiency, initiating operational changes at reservoirs, increasing water transfers between users, and increasing drought preparedness would be required (Whitely Binder et al. The strategy recommends expanding and accelerating implementation of municipal water efficiency improvements to reduce the amount of water used per person or household and seeking more reliable funding mechanisms to help water providers implement climate-ready plans and practices. The reduced resilience in some of these ecosystems, resulting from other anthropogenic pressures (urbanization, logging, agriculture, etc. The response of aquatic and terrestrial species to future climate changes will be complex and may be mediated by a number of other factors, including land use changes and interactions with other species. As human populations respond to climate change and make changes to the wastewater, stormwater, and water supply infrastructure, these new projects are likely to have implications for aquatic ecosystems as well. These changes are likely to result in a wide range of consequences for natural systems and are expected to alter key habitat conditions for salmon and other anadromous fish that depend on specific conditions for spawning and migration (box 3. For example, increased winter and early-spring streamflows have the potential to scour eggs or wash away newly emerged fry from fall-spawning salmon and trout species (Isaak, Muhlfeld, et al. In addition, extreme low summer flows can limit the ability for some species to migrate upstream to spawn (Battin et al. In addition to altered hydrologic regimes, warming stream temperatures also pose significant threats to aquatic ecosystems. Increasing trends in water temperature of lakes and streams have been observed in recent historical data (Isaak et al. Such changes may affect the health of aquatic populations and the extent of suitable habitat for many species. The fish play an important role in ecosystems, including providing a critical food source for a plethora of wildlife, from tiny invertebrates to bald eagles, grizzly bears, and orcas. For the people who call the Northwest home, salmon are a fundamental part of their ecological, economic, and cultural heritage. The historic decline of wild salmon in the Northwest has galvanized the region and country around numerous efforts to restore and protect the populations that remain-a significant challenge that is all the more so given projected future climate change. The impacts of climate change will vary among different species and populations, and will depend on multiple and diverse factors. Indeed, the diverse habitat needs and behavior of Pacific salmon have been fundamental to their historic resilience. As different salmon species and populations within species evolved over time, they acquired diverse spawning and migratory behaviors to take advantage of variations in temperatures, streamflow, ocean conditions, and other habitat features (Mantua et al. The adults then return in the spring and summer, often taking several months to migrate upstream to high-elevation headwater streams to spawn (Mantua et al. For these populations, higher stream temperatures and altered streamflows due to climate change are likely to be significant limiting factors.
Minardi D erectile dysfunction natural foods order 100mg aurogra mastercard, Galosi A erectile dysfunction age range cheap aurogra 100mg visa, Recchioni A et al: Diagnostic accuracy of percent free prostate-specific antigen in prostatic pathology and its usefulness in monitoring prostatic cancer patients wellbutrin xl impotence order 100mg aurogra with amex. Gravas S erectile dysfunction at age 26 order aurogra 100 mg with amex, Laguna M, de la Rosette J: Efficacy and safety of intraprostatic temperature-controlled microwave thermotherapy in patients with benign prostatic hyperplasia: results of a prospective, open-label, single-center study with 1-year follow-up. Dahlstrand C, Walden M, Geirsson G: Transurethral microwave thermotherapy versus transurethral resection for symptomatic benign prostatic obstruction: a prospective randomized study with 2-year follow-up. Floratos D, Kiemeney L, Rossi C et al: Long-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study. Ohigashi T, Nakamura K, Nakashima J et al: Long-term results of three different minimally invasive therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: comparison at a single institute. Laguna M, Kiemeney L, Debruyne F et al: Baseline prostatic specific antigen does not predict the outcome of high energy transurethral microwave thermotherapy. Vesely S, Knutson T, Dicuio M et al: Transurethral microwave thermotherapy: clinical results after 11 years of use. Djavan B, Seitz C, Roehrborn C et al: Targeted transurethral microwave thermotherapy versus alpha-blockade in benign prostatic hyperplasia: outcomes at 18 months. Thalmann G, Mattei A, Treuthardt C et al: Transurethral microwave therapy in 200 patients with a minimum followup of 2 years: urodynamic and clinical results. Osman Y, Wadie B, El-Diasty T et al: High-energy transurethral microwave thermotherapy: symptomatic vs urodynamic success. Miller P, Kastner C, Ramsey E et al: Cooled thermotherapy for the treatment of benign prostatic hyperplasia: durability of results obtained with the Targis System. Bock D, Price D, Fay R: Prolieve transurethral microwave thermodilation versus finasteride: results of a multicenter, randomized trial in symptomatic patients with benign prostatic hyperplasia. Bach T, Herrmann T, Ganzer R et al: RevoLix vaporesection of the prostate: initial results of 54 patients with a 1-year follow-up. Hettiarachchi J, Samadi A, Konno S et al: Holmium laser enucleation for large (greater than 100 mL) prostate glands. Kuntz R, Lehrich K: Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm. Tan A, Gilling P, Kennett K et al: A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). Montorsi F, Naspro R, Salonia A et al: Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. Briganti A, Naspro R, Gallina A et al: Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. Kuntz R, Ahyai S, Lehrich K et al: Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. Aho T, Gilling P, Kennett K et al: Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial. Malek R, Kuntzman R, Barrett D: Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. Monoski M, Gonzalez R, Sandhu J et al: Urodynamic predictors of outcomes with photoselective laser vaporization prostatectomy in patients with benign prostatic hyperplasia and preoperative retention. The A, Malloy T, Stein B et al: Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: analysis and results of an ongoing prospective multicentre study at 3 years. Neill M, Gilling P, Kennett K et al: Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Elzayat E, Habib E, Elhilali M: Holmium laser enucleation of prostate for patients in urinary retention. Tan A, Gilling P, Kennett K et al: Long-term results of high-power holmium laser vaporization (ablation) of the prostate. Kuntz R, Lehrich K, Ahyai S: Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size Sandhu J, Ng C, Vanderbrink B et al: High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Volkan T, Ihsan T, Yilmaz O et al: Short term outcomes of high power (80 W) potassium-titanylphosphate laser vaporization of the prostate. The A, Malloy T, Stein B et al: Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial. Yuan J, Wang H, Wu G et al: High-power (80 W) potassium titanyl phosphate laser prostatectomy in 128 high-risk patients. Reich O, Bachmann A, Siebels M et al: High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients.
There are many different types of health erectile dysfunction new treatments aurogra 100 mg overnight delivery, environmental impotence herbs generic 100 mg aurogra, or housing inspectors who work in North Carolina homes and who could be cross-trained to identify and help mitigate multiple health erectile dysfunction shake cheap 100 mg aurogra visa, environmental impotence synonym purchase aurogra 100 mg overnight delivery, and safety risks while in a home. Nationally, about one-third of schools in the United States are believed to have significant environmental risk issues and are in need of extensive repair or renovation. Studies have shown that these school-based environmental risks are linked to decreased performance; students attending schools in poor condition. The plan should include statewide efforts to: promote active, walkable, livable communities; reduce environmental exposures and risks that negatively impact population health; promote clean, renewable energy, green technology, and local production of food, energy, goods, and services; and increase opportunities for mass transportation. Reduce Unintentional and Intentional Injuries Injury and violence are significant problems in North Carolina leading to death and disability for thousands of people each year. Unintentional injuries, which account for more than two-thirds of all injury deaths nationwide, are defined as injuries in which a harmful outcome was not sought. Because such injuries tend to occur among younger populations, they result in more years of life lost than any other leading cause of death. Prevention for the Health of North Carolina: Prevention Action Plan 31 Executive Summary Injury is a serious cause of disability, resulting in more than 148,000 hospitalizations, 819,000 emergency department visits, and an unknown number of outpatient visits and medically unattended injuries in North Carolina each year. It is estimated that in North Carolina in 2007, 37% of traffic fatalities involved someone who was speeding, 32% involved someone who was not wearing a seatbelt, 29% involved a driver with a blood alcohol level of at least 0. The Task Force did not examine every type of intentional injury, but chose to focus on family violence. Child maltreatment can take a number of forms, including neglect, physical violence, psychological violence, sexual assault, and witnessing partner violence, and typically occurs with other forms of family violence like domestic violence. Historically, the North Carolina General Assembly has not given the same priority to injury prevention as it has to other public health activities. Prevention of injury and violence is not listed as an essential public health service, although injury and violence are both major causes of death and disability in the state. North Carolina should make injury and violence prevention explicit in the list of essential public health services at the state level. Further, greater interagency leadership and coordination is needed across agencies involved with preventing injury and violence in the state. Good data are also important to establish targeted and effective injury prevention initiatives. In addition, evidence-based programs, which have been shown to be effective in reducing falls, child maltreatment, family violence, and motor vehicle injury, should be supported and disseminated in communities across the state. Reduce the Incidence of Vaccine Preventable Diseases and Foodborne Illnesses An infectious or communicable disease is an illness due to a specific infectious agent that is transmitted from a source to a susceptible host. Prevention for the Health of North Carolina: Prevention Action Plan 33 Executive Summary There are many different types of infectious or communicable diseases. Communicable diseases transmitted through sexual contact are covered elsewhere in the report. Infectious diseases, including pneumonia and influenza, were the 10th leading cause of death among North Carolinians, causing 1,644 deaths in 2007, and are major causes of disability as well. Vaccines are also effective in preventing other diseases including hepatitis A and B, rotavirus, diphtheria, tetanus, pertussis, measles, mumps, rubella, meningitis, human papillomavirus, polio, and varicella. Additional outreach is needed to ensure that children and adolescents receive all the recommended vaccines. Salmonella, listeria, and toxoplasma are the most common pathogens, causing more than 75% of those foodborne illnesses caused by known pathogens. The symptoms of foodborne illness range from mild gastrointestinal discomfort to life-threatening problems in the brain, liver, and kidneys. Unfortunately, the current food safety and defense system is very complex and varies by agency. Although oversight and enforcement of food safety standards are split between many different state agencies, our system could be strengthened by developing a single agency approach based on a proactive, scientifically-based strategy to prevent, detect, and respond to foodborne illnesses, and by ensuring that data about foodborne illnesses are shared among appropriate agencies. Eliminate Racial and Ethnic Disparities Racial and ethnic minorities have poorer health status and experience poorer health outcomes than non-minorities. This racial and ethnic disparity translates into lower life expectancies: minorities have, on average, a life expectancy of 72. Minority groups in North Carolina are also more likely to have risk factors for some of the underlying causes of poor health.
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