Lilja Bjork Solnes, M.B.A., M.D.

• Program Director, Diagnostic Radiology Residency
• Assistant Professor of Radiology and Radiological Science

https://www.hopkinsmedicine.org/profiles/results/directory/profile/5251718/lilja-solnes

In previous years allergy medicine upset stomach buy 200 mcg rhinocort, orthotolidine reagent had also been used for total chlorine determinations in wastewater allergy doctor discount 100 mcg rhinocort otc. In addition allergy forecast dallas buy rhinocort 200 mcg lowest price, orthotolidine is a suspect carcinogen and therefore allergy shots side effects generic rhinocort 200mcg otc, on the basis of these two reasons, this method is no longer approved (111). The amperometric and starch-iodide forward titration methods for total chlorine residuals have been found to produce comparable results (122). For wastewaters, it is recommended that the total chlorine reverse titrations be used. In the forward methods, free iodine residuals are in contact with the wastewater for a period of time during the completion of the titration. Experimental studies comparing these methods, however, have tended to yield disparate results, which appear to vary with the quality of the wastewater being chlorinated. Recent data suggest that all of the methods used for total chlorine residual may produce false negative readings if sulfite or similar reducing agents are present(110). Two additional methods for the analysis of total residual chlorine in wastewater have been reported; however, neither of them has yet appeared in Standard Methods. Jenkins and Baird (130) utilized a polarographic iodine electrode to measure the iodine released following acid-iodide addition to wastewater. This method is essentially a forward titration procedure using a direct electrode analysis of iodine production. This test yielded a linear response to 10 mg/l total chlorine, and was found to be comparable to the forward amperometric method. In certain cases, particularly in breakpoint chlorination for nitrogen rElmoval, or the chlorination of nitrified effluents, it may be desirable to measure free chlorine apart from total chlorine. It should be noted that the determination of small concentrations of free chlorine in the presence of large amounts of total chlorine (as might be found immediately prior to the breakpoint itself) is an extremely difficult analytical problem (132). In particular, the effect of disinfectant concentration on the rate of this process will determine the most efficient combination of contact time (Le. The discussion that follows here is a practical and logical outgrowth of that theory. In the disinfection of a wastewater by halogens the concentration of disinfectant changes with time, and, particularly during the initial moments of contact with either chlorine or bromine, the chemical form of the halogen undergoes a rapid transformation from the free to the combined forms. Since C in Equation 4-6 would thus not be a constant, typically wastewater disinfection results obtained in batch systems exhibit "tailing," the degree of which may depend on the chlorine demand and the ammonia concentration of the system (135). Free or combined bromine can oxidize iodide to iodine, and any of the methods for total chlorine can be used to measure total bromine. If mixtures of chlorine and bromine residuals are present, it becomes impossible to distinguish between the two by iodoll)etric methods. However, it has been shown that organic solid materials present in actual wastewaters can render enmeshed microorganisms some protection from a measurable chlorine. Table 5-11,summarizes a number of values of the Chick-Watson parameters for microbial inactivation. In general, microbial inactivation increases with a decrease in pH for either free or combined chlorine residuals. At a given temperature and pH, free chlorine residuals are more effective than combined chlorine residuals. Reference 141 Chick-Watson Parameters for Microbial Inactivation by Chlorine Temp. Unfortunately, all of the data summarized in Table 5-11 are based upon the use of pure, laboratory strains of microorganisms. These may have different sensitivities as compared with indigenous wastewater organisms. Table 512 summarizes values for the a and b parameters in Equation 5-65 which have been determined for the inactivation of coliforms indigenous to wastewaters. For each of these elements, several possible options exist for the system designer to consider. By specifying the potential options, the many available halogenation disinfection systems may be enumerated. In the following section, the methodology for detailed sizing and specification of each option element will be discussed. The general block diagram of a halogen disinfection system, with optional dechlorination, is shown in Figure 5-7. In general, the disinfection system contains four elements and the dechlorination system contains three elements. Flows of information are depicted by dashed lines and flows of material are depicted by solid lines. The disinfection subsystem elements are chemical generation and/or supply, mixing, contacting and control. In the generation/supply element the disinfecting agent is maintained and fed continuously. In the contacting element, the blended wastewater is held for a sufficient period until the desired microbial inactivation has been attained. The mixing elements and the control elements have identical functions as in the case of the disinfection subsystem. In dechlorination, there is generally no substantial contacting element (other than, perhaps, the final outfall pipe). For the halogen generation/supply subsystem, a number of choices exist as to the option to be selected. In these systems, the chemical may be fed directly as a solid (proprietary tablet feed chlorinators) or may be prepared as a slurry/solution and fed in a similar manner as sodium hypochlorite. Solution feed of calcium hypochlorite has inherent disadvantages in that the addition of water to calcium hypochlorite will produce a calcium carbonate sludge that will foul surfaces and storage tanks. The choice among gaseous chlorine/sodium hypochlorite/calcium hypochlorite is governed primarily by economic considerations in conjunction with inherent safety and handling hazards with the use of gaseous chlorine. In wastewater treatment plants serving large municipalities, it may be advantageous to use sodium hypochlorite, despite higher unit costs, to minimize risks associated with the transport of liquid chlorine through populated urban areas. In chlorine dioxide systems, the primary design choice in the generation/ supply subsystem is the type ofthe generation process. As discussed above, the utilization of chlorite is greater in the chlorine/chlorite process than in the acid-chlorite process. However, in the former process, the possibility for the production of chlorine dioxide containing chlorine at low levels exists, and thus some of the deleterious aspects of chlorine residuals and byproduct reactions may exist. In the mixing subsystem, the primary design options are the use of devices (static mixers or hydraulic jumps) that dissipate hydraulic head and the use of mechanical mixers (jet mixers, impeller mixers, etc. In plants where there is little available head between the influent and effluent (such as may exist in wastewater treatment plants serving municipalities with relatively flat topography), the use of the former processes may be infeasible. The contacting subsystem may consist of a separate contact basin or the outfall pipe itself. The latter option reduces capital costs; however, it necessitates the existence of a sufficiently long outfall pipe, which may not exist at all plants. The control subsystem serves to produce an effluent in which a consistent effluent quality is attained at a minimum chemical dose. Method of G,eneration (a) ChlorinEt-chlorite process (b) Acid-chlorite process Bromine Chloridl3 B. For chlorine gas, the choic:e of gas or liquid withdrawal is dictated primarily by the size of the disinfection system to be designed. It is impractical to use gas withdrawal in very large systems due to limitations on safe withdrawal of galS from ton containers of chlorine. The use of calcium hypochlorite is confined primarily to smaller wastewater treatment plants due to 56 or "open-loop" control (relying upon operator intervention); simple flow-proportional feed-forward control, and true closed-loop feedback control (relying upon continuous sensing of halogen residual, usually in conjunction with feed-forward flow proportional control). The last option provides minimum chemical utilization, but is more capital intensive. In very small plants, where dechlorination is not practiced, manual, or feed-forward control is sufficient. However, in plants subject to effluent constraints on chlorine residual, or in very large plants where small decreases in chemical dosage result in large economic savings, the last option may be most desirable.

Within the host the mycelium gives rise to a subcuticular stroma from which arise numerous allergy medicine can i give my dog rhinocort 200 mcg for sale, short allergy testing louisville ky generic rhinocort 100 mcg overnight delivery, erumpent conidiophores ­ each bearing a single allergy shots vs. sinus surgery generic rhinocort 200mcg amex, terminal allergy forecast granbury tx purchase 100 mcg rhinocort otc, flask-shaped conidium. Conidia continue to be formed until early autumn when the ascocarps ­ individual pseudoperithecia ­ start to develop in stromata within the dead and dying leaves. Each pseudoperithecium contains a layer of asci and pseudoparaphyses, and it bears several setae around the rim of its ostiolar pore; the yellowish ascospores each have a septum which divides the spore into two cells of unequal sizes. A cultivar which is resistant to an existing race of a pathogen may become susceptible when a new race of the pathogen emerges, i. Cilia may cover the entire body or may be restricted to particular regions; oral ciliature is characteristically somatic in origin. Vi antigens Polysaccharide cell-surface (microcapsular) antigens which occur in some enterobacteria ­. Vi antigens may play a role in the virulence of a pathogen for a particular host(s). Vi antigens are detected in the serological characterization of certain enterobacteria (see. Before use, a vial is stoppered with a cotton wool plug and sterilized in a hot-air oven. Various sugars can be fermented, but lactose is usually not fermented (exceptions: strains of V. Vibrio spp are primarily aquatic, occurring in freshwater, estuarine and marine habitats and in association with aquatic organisms ­ including. Colonies on nutrient agar are round, entire, glossy and translucent, 1­2 mm in 24 hours. The O1 strains include two biotypes: (i) El Tor (also called Eltor, or eltor) and (ii) cholerae (= classical biotype); the El Tor biotype is more resistant than the classical biotype to adverse conditions. The original El Tor isolates were strongly haemolytic for sheep blood, but strains subsequently isolated were less strongly haemolytic, or even non-haemolytic. O1 strains can be subdivided into variants designated Ogawa, Inaba and Hikojima [Book ref. It is also associated with wound infection in swimmers and fish handlers, and with diseased shellfish. Growth can occur at 30° C and 40° C but not at 4° C, and not in peptone water containing 8% NaCl. Vibriocin production (by cells in the mid- or late-logarithmic phase) can be induced. A vibriocin is a tubular structure which resembles the tail section of certain phages; it has a contractile sheath. Vibrionaceae A family of Gram-negative, asporogenous, facultatively anaerobic bacteria. Most strains are motile with one or more polar flagella; lateral flagella may be formed on solid media. Species occur mainly in marine and freshwater habitats and in association with aquatic animals; some are pathogenic in man and/or animals. Symptoms: necrosis and reddening of seedling leaves, and later rotting of stem bases. In vivo, vidarabine is readily converted to the less active arabinosylhypoxanthine by adenosine deaminase (an enzyme widely distributed in host cells); its antiviral activity can be potentiated by the adenosine deaminase inhibitor pentostatin. A surface growth of Geotrichum candidum may be present; this organism lowers the acidity by utilizing some of the lactic acid. Vinca alkaloids (Cantharanthus alkaloids) A group of iridoid indole alkaloids obtained from the periwinkle Cantharanthus roseus (formerly Vinca rosea). The Vinca alkaloids can precipitate tubulin, in paracrystalline form, intracellularly. Slow processes of manufacture involve the bulk acetification of naturally fermented liquor on exposure to air. The Orleans process, still used in some regions, is a continuous slow process in which vinegar (serving as an inoculum) is mixed with the fermented liquor which is allowed to acetify in partially filled kegs; acetifying bacteria form a film on the liquid surface. The commonest, the Frings trickling generator, is packed with beechwood shavings; the liquor is pumped from a reservoir at the base to the top of the tank and allowed to trickle back to the reservoir through the coated shavings. Trickling generators can become blocked by growth of the slime-producing Acetobacter xylinum, especially if acidity levels are low. The commonest is the Frings Acetator: a fermenter with a high-speed rotor that distributes fine air-bubbles which rise through the agitated liquor. Vinegar produced by any of these processes may be aged prior to filtration, bottling and pasteurization. Onset is insidious, with chills and fever, myalgia, headache, conjunctivitis, anorexia and vomiting; exanthem and oedema of the face, neck and upper thorax may occur. After a few days, hypotension and haemorrhages develop, and death may follow uraemic coma or hypovolaemic shock. Transmission typically occurs mechanically, particularly by vegetative propagation. This secondary structure is highly conserved among the viroids and is apparently necessary for replication and possibly also for pathogenicity. A viroplasm generally consists of or contains accumulations of virions and/or virus components. Among effector Yops, YopH (a phosphatase) can inhibit phagocytosis by de-phosphorylating certain macrophage proteins. When cells of Yersinia are placed in a rich environment at 37° C, the Ysc secretion channel is installed. A stock of Yop proteins is synthesized, and some of them are capped with their specific Syc chaperone. As long as there is no contact with a eukaryotic cell, a stop-valve, possibly made of YopN, TyeA and LcrG, blocks the Ysc secretion channel. On contact with a eukaryotic target cell, the bacterium attaches tightly by interaction between its YadA and Inv adhesins and b-integrins, and the secretion channel opens. The Yops are then transported through the Ysc channel, and the Yop effectors are translocated across the plasma membrane, guided by the translocators YopB, YopD and LcrV. Cornelis, Christian de Duve Institute of Cellular Pathology ґ ґ ґ and Faculte de Medecine, Universite catholique de Louvain, Brussels. Infection of an organism by a virus may or may not result in disease, depending. Virions vary in structural complexity from relatively simple, with only one or a few types of major structural protein, to highly complex, with many components ­ including glycoproteins and various enzymes (see. The virus replication cycle begins with the attachment (adsorption) of the virion to a specific receptor on the host cell surface, followed by penetration of the cell by the virion or by part of the virion (including at least its genome). Release of the progeny virions from virus-associated haemophagocytic syndrome the host cell may occur. Current classification schemes are based on features such as the composition, morphology and anatomy of the virion, the nature of the genome, replication strategy, etc. Enveloped viruses (and some non-enveloped viruses) are generally inactivated by organic solvents. The disease occurs primarily in Africa, Asia and South America; in India the disease in man is called kalaazar. In man, the incubation period may be 3­6 months (range: weeks­years); typically, there is a recurrent low-grade fever, splenomegaly, hepatomegaly, leucopenia and cachexia ­ with high mortality rates in untreated cases. Janus green) are more toxic than others, neutral red being one of the least toxic; all vital dyes are used in low concentrations. In animals, intra vitam (= intravital) staining involves the Voges­Proskauer test injection or ingestion of a dye which is taken up by certain types of cell in the (living) animal; thus. The staining of living cells after their removal from the host has been referred to as supervital or supravital staining when the cells remain viable during the staining process. Some microorganisms are important natural and/or commercial sources of certain vitamins. In the cobalamins, 5,6-dimethylbenzimidazole forms a bridge between the cobalt atom and the a-1-position of the ribose residue; the sixth coordination position of the cobalt may be occupied by. Cobamide coenzymes (= coenzymes B12) typically consist of a cobalamin in which a 5 -deoxyadenosyl residue has been linked, through its 5 position, to the cobalt atom, forming 5 -deoxyadenosylcobalamin.

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Following a manual application allergy treatment kids generic 200mcg rhinocort visa, there may be unused sources that must be returned to an appropriate storage location allergy united rhinocort 200mcg low cost. There should be a procedure to ensure that this is achieved safely and efficiently allergy treatment xanthelasma generic 100mcg rhinocort with mastercard, independently checked allergy medicine hsa generic rhinocort 100mcg amex, and that the source locations log book is appropriately updated. Radiographs of the implant are then obtained for two purposes: 53 (1) (2) To check that the position and arrangement of the implant are correct; To determine the location of the sources (shown by the dummy sources) in order to calculate the dose distribution and to select the appropriate activity of the sources required to deliver the dose. At this time the clinician can make an immediate decision on whether to continue with the treatment as it is or to modify the application. The overall responsibility for these procedures lies with the radiation oncologist. Treatment planning the overall responsibility for calculation of dose and dose distribution to determine the duration of the implant will lie with the medical physicist. The planning procedures must be compatible with the chosen clinical practice and must include a method of independent verification. These procedures will define how the specific treatment parameters are passed to the person controlling treatment delivery. Treatment delivery the overall responsibility for treatment delivery and particularly for the termination of treatment will lie with the radiation oncologist. The main procedures will cover: (a) (b) (c) (d) (e) (f) Treatment startup (for afterloading treatments); Patient and/or applicator monitoring to ensure the continuing integrity of the application; Emergency procedures with clearly stated action criteria; Procedures for unplanned activity or treatment interruption. Further technical procedures will cover checking of the returned sources and updating of source location records. Periodic evaluation and follow-up Periodic follow-up examinations after treatment are critical, not only to evaluate the general condition of the patient and tumour response but also to detect recurrences early, should they occur, and to observe the effects of irradiation on the normal tissues. A maintenance strategy determined at the beginning of the project is essential to achieving and maintaining: (a) (b) (c) (d) (e) Acceptable out-of-service interruptions; High quality treatments; Planned treatment schedules (fractionation); Patient and staff safety; Accident prevention. Three lines of maintenance can be considered: (1) (2) (3) In-house service for routine small repairs; Local support by a specialized maintenance company, usually a representative of the supplier; Prompt support by the manufacturer for major repairs. The scope and limitations of each should be clearly established in writing, and the necessary training and certification by the manufacturer should be arranged. No option is inexpensive, but neglect of maintenance is even more expensive as it can have unacceptable and even dangerous consequences. Equipment containing large amounts of radioactive material (60Co units and remote afterloaders) may require a licensed source handler to carry out particular maintenance tasks. Overall, the medical physicist should provide management for the maintenance programme. When maintenance staff will be working around hazardous radioactive materials and potentially affecting basic safety mechanisms in the devices, the help and cooperation of the radiation protection officer should be sought. The programme should be developed with 55 the cooperation and assistance of the manufacturer of the equipment, and the level of on-site support will depend partially on the availability of timely support from the manufacturer. Each of the procedures developed as part of this programme should clearly establish who is authorized to perform the service, who must be notified before and after a service has been performed, and what records are to be kept. After each major repair or preventive maintenance has been carried out, a complete set of quality control measurements must be taken. Preventive maintenance Procedures should include provision of preventive maintenance services. A service contract including preventive maintenance may be preferred, since the manufacturer may provide both spare parts and expertise. Repairs Written procedures should establish who is authorized to work on various components of the system, recognizing the hazards and potential consequences associated with different subsystems and radioactive sources. Again, a service contract may be the preferred route, since in practice it is difficult for local staff to maintain the expertise required to repair the equipment when problems occur only infrequently. There should be a formal procedure for notifying the medical physicist every time there is a repair, regardless of its apparent importance. For safety reasons, the medical physicist will decide the extent of quality control required. Spare parts Funds must be allocated for the purchase of an adequate supply of spare parts to be maintained on-site. Particular attention should be paid to the possibility and advisability of substituting components obtained from local vendors. It may be cost effective to do so, but only if the substitutes are of sufficient quality and compatibility. Any equipment failure, accident, error, mishap, miscalculation or other unusual occurrence with the potential for causing a patient dose significantly different from that intended. In most cases the radiation physicist will be the most appropriate person to undertake such an investigation, which should include: (i) A calculation or estimation of the doses received and their distribution within the patient; (ii) Corrective measures required to prevent recurrence of such an accident; (iii) A method to implement any corrective measures. Depending upon national regulations, it may also be necessary to report to an external regulatory authority. Individuals performing these audits must not be directly responsible for the activities that are audited. Quality audits may be conducted by personnel within the institution (internal audits), as well as those from outside the institution (external audits). However, even at larger institutions, an external review by qualified experts is an important 57 aspect of any quality assurance programme. With regard to an external quality audit, the best results are achieved with site visits by outside, qualified, experts; however, this is an expensive process. This approach involves the outside review team forwarding a package of questions to which the reviewed organization responds. A radiotherapy department involves the construction of facilities, which are difficult to modify later. In some countries, regulatory authorities require a two stage process of authorization, i. A practical way to implement the two stage process is for the regulatory authority to receive the initial application containing information about the design of the facility and a description of its equipment [22, 23]. After authorization, substantial modifications to the radiotherapy facilities, sources and procedures may have safety implications, and regulatory 58 authorities may also require a specific application for any modifications. Radioactive sources and associated equipment for radiotherapy that have not been used for a long time while awaiting disposal have been involved in severe accidents when not properly secured or when security has lapsed over time [24­27]. A means of preventing such accidents may be a requirement to notify the regulatory authority of the planned date for resuming operation or of the decommissioning and disposal of the sources and the security conditions for interim storage. The longer the period, the higher the risk that the sources become orphaned, but too short a period may increase the bureaucracy involved without having a significant impact on safety. Management policy An overall policy on safety culture, defence in depth and accountability for sources relies primarily on the policy that management introduces and supports. In some serious accidents [28, 29]1, management allowed safety systems to degrade significantly and staff to improvise procedures or continue operations when a safety system failed, or to operate without sufficient training, quality assurance programme or documented and rehearsed procedures. Workers may have perceived that management encouraged deviation from procedures in order to perform the job more quickly. Other parties shall have subsidiary responsibilities for the application of the Standards. These parties may include, as appropriate: (a) (b) (c) (d) (e) (f) (g) (h) suppliers; workers; radiation protection officers; medical practitioners; health professionals; qualified experts; Ethical Review Committees; and any other party to whom a principal party has delegated specific responsibilities. For the programme to be effective the licensee needs to provide for its implementation, including the necessary resources to comply with this programme and the arrangements to facilitate cooperation between all relevant parties. Members of both committees may also be the same: an administrator representing the management, the chief radiation oncologist, a qualified expert (medical physicist), a radiotherapy technologist, and possibly a brachytherapy nurse and a maintenance engineer. Since a representative of the management is usually a member of the radiation protection committee, communication to this person may be the most appropriate. The members of the committee typically include an administrator representing the management, the chief radiation oncologist, a qualified expert in radiotherapy physics (medical physicist), the radiation protection officer, a radiotherapy technologist, possibly a brachytherapy nurse and a maintenance engineer. For the day-to-day oversight of the radiation protection programme, a radiation protection officer is necessary, who should report to the committee. The licensee should provide them with the time and resources required to supervise the programme, and with the authority to communicate not only periodically with the committee but in case of breaches of compliance that may compromise safety, they should have the authority to communicate directly with the licensee. Staffing and training A sufficient number of trained staff have to be assigned and their responsibilities clearly defined. With regard to medical exposure in radiotherapy, the overall responsibility for patient protection has to be assigned to medical practitioners [1], and calibration, dosimetry and quality assurance have to be conducted by or be done under the supervision of a qualified expert in radiotherapy physics (usually a medical physicist).

Finally allergy oil blend safe rhinocort 100mcg, the issue of perspective-"whose lens are we looking through"-is critical to welfare analysis allergy medicine not over the counter purchase rhinocort 100 mcg amex, particularly economic welfare allergy medicine 180 mg purchase 200mcg rhinocort fast delivery. In general allergy forecast history austin rhinocort 100 mcg without a prescription, the perspective of valuation focuses on the valuation of individuals who are directly affected, and who are living today. The perspectives of public decision makers may be somewhat different from those of individuals, since they will take into account social and community consequences, as well as individual consequences. For example, sea level rise puts much of the freshwater wetland that comprises Florida Everglades National Park at risk (Glick and Clough, 2006). Even relatively modest sea level rise projections could result in the conversion of much of this low-lying area to brackish or intertidal marine and mangrove habitats. Another such extreme example is alpine tundra habitat in mountain ranges in the contiguous states. This alpine national park, is located at elevations ranging from 7,000 to 14,000 feet above sea level. The first approach examined variations in monthly visitation in response to historic variations in temperature. All climate change scenarios were used with wildlife models to estimate the increase in elk populations and decrease in ptarmigan populations. As indicated in the table, applying visitor survey estimates of visitation change yields a 13. In the extreme heat scenario, however, visitations declines from current conditions. Transportation and communication infrastructure enable citizens to move around efficiently and communicate reliably. Governments are led by competent and responsive officials, who provide public services effectively and equitably, such as order and public safety; citizens are well-informed and participate in civic activities. Social institutions provide services to those in need, support philanthropy, volunteerism, patronage of arts and leisure activities, and social interactions characterized by equality of opportunity and social harmony. Air, water, and land pollution Recreational opportunities Water supply and quality Natural hazards and risks Ecosystem condition and services Biodiversity Direct climate amenity effects Mortality risks Morbidity and risk of illness Quality and accessibility of health care Health status of vulnerable populations Prenatal and childhood health Psychological and emotional health Affordable, and accessible public transit Adequate road, air, and rail infrastructure Reliable communication systems Waste management and sewerage Maintained and available public and private facilities Power generation Electoral participation Civic engagement Equity and opportunity Municipal budgets and finance Public safety Emergency services Volunteerism Culture, arts, entertainment, and leisure activities Education and human capital services Social harmony Family and friendship networks Human health Increased frequency of heat waves in a larger geographical area will directly affect health, resulting in higher incidence of heat-related mortality and illness. Melting permafrost due to warming in the arctic damages road transport, pipeline, and utility infrastructure, which in turn leads to disrupted product and personal movements, increased repair costs, and shorter time periods for capital replacement. Use of foregone earnings as a lower bound estimate to the value of premature mortality. Each of the assessment chapters have drawn on different literatures, with generally more available scientific knowledge on impacts and adaptations related to human health, somewhat less related to human settlements, and still somewhat less related to human welfare. Several themes recur across these chapters and point to advances in the science of climate impacts assessment and the development and deployment of adaptation responses. Extreme weather events will play a defining role, particularly in the near term, shaping climate-related impacts and adaptive capacity. Climate change will have a disproportionate impact on disadvantaged groups in communities across the U. However, for places already struggling to provide or maintain basic public amenities and services, the additional costs of adaptation will impose a potentially-insupportable burden (5. With such a complex scientific and policy landscape, an integrated multi-disciplinary framework is needed to enable climate change impacts to be measured in meaningful ways and for optimal mitigation and adaptation strategies to be identified, developed, and deployed (5. While this assessment focuses on how climate change could affect the future health, well-being, and settlements in the U. The effects of climate change very often spread from directly impacted areas and sectors to other areas and sectors through extensive and complex linkages. Their potential impacts on health, settlements, and welfare result in two broad categories of effects: changes in extreme weather events. Some changes in the average climate conditions have strong potential to impact human systems. For example, changes in the growing season or the timing and amount of spring runoff. Higher minimum temperatures are related to the spread of ticks as well as the increase in deaths associated with heat waves. The effects of other climate changes, such as the perceived relationship between people and their environment. Key vulnerabilities are often defined by climate phenomena that exceed thresholds for adaptation. Their severity is not only related to the rate and magnitude of climate change, particularly extreme weather events and/or abrupt climate change, but also by limited access to resources for coping across a range of social systems. Depending on the degree and speed of climate change and on the effectiveness of adaptation strategies, adverse human welfare outcomes may increase even as total burdens of climatesensitive outcomes decrease given infrastructure and technology improvements. Native American peoples in Alaska and other low socio-economic communities because of their decreased economic capacity to prepare for and respond to the impacts of climate change. Just as there are differences across populations, there are important differences in vulnerability across geographic regions, such as the exposure to extreme events along the Gulf Coast and water supply issues in the southeast, the southwest and the Inter-Mountain West. Biological sensitivity related to age (especially the very young and the very old), the presence of pre-existing chronic medical conditions (such as the sensitivity of people with chronic heart and pulmonary conditions to heat-related illness), developmental characteristics, acquired factors (such as immunity), those taking certain medications. Projections of increased frequencies of drought combined put the increasing populations of desert southwest cities at risk. Poor communities and households are already under stress from climate variability and climate-related extreme events such as heat waves, hurricanes, and tropical and riverine flooding. With scarce resources, communities should also choose adaptation options with co-benefits that help ameliorate other issues or where they can easily add climate concerns to existing response plans. Planting trees and green roofs to reduce urban heat islands has the added benefit of creating a more aesthetically pleasing location that increasing well-being and by decreasing energy use in these buildings. Resiliency ­ a central concept in assessing the vulnerability and adaptability of regions, communities, and individuals ­ will depend on both physical and social infrastructure. Each of these assets vary from community to community and from individual to individual. Collectively, non-economic capital provides both assets and buffers for communities and individuals. Human welfare is an emerging concept, similar in purpose to something like "sustainability. The focus on sustainability has evolved as an effort to curb individual consumption and to minimize the collective footprint of communities on natural resources, ecosystems, pollution, and anthropogenic emissions of greenhouse gases that contribute to climate change. The emphasis of sustainable development is on creating livable communities and promoting physical well-being and desirable lifestyles. Put slightly differently, sustainability is realized as resilience within communities. Resiliency, a central concept in measuring the vulnerability and adaptability of communities and individuals depends not only on physical infrastructure, but also on social infrastructure. Each of these assets varies from community to community and from individual to individual. These non-economic capital goods provide both assets and buffers for communities and individuals. Related to sustainable development is the concept of smart growth which has been described as an alternative to sprawl, traffic congestion, disconnected neighborhoods and inner city decay. It explicitly considers long-term costs and consequences of growth, not just near-term benefits. For instance, a focus on mass transit can improve quality of life and encourage a healthier pedestrian-based lifestyle with less pollution. Some communities of the 21st Century are moving away from suburban sprawl, long commutes, vehicle emissions, and sedentary lifestyles and adopting sustainable development practices that will cushion the impacts of climate change on these communities and enhance their overall resilience. The potential for utilizing human welfare as an integrating framework is not yet mature, and additional research will be needed, including, for example, deriving valuation methodologies. As an integrating concept, human welfare can provide insight into the determinants of human happiness. Just as health is an indicator of welfare, especially as physical health is closely tied to individual measures of happiness, contentment, and well-being, similarly determinants of wellbeing are derived from aspects of human settlements. Collectively, human welfare is a measure of what makes people, their families, and their communities satisfied. In order to more accurately portray the consequences of climate change and support better-informed adaptation strategies, research efforts should focus on: deriving socioeconomic scenarios that describe how the world may evolve in the future, including assumptions about changes in societal characteristics, governments and public policy, as well as economic and technological development.

References

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