Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Cohort profle: the consortium of health-orientated ro origins of childhood leukaemia cheap 10mg demadex with mastercard. The Editors are grateful to discount 20mg demadex otc the Charles Rodolphe Brupbacher Stiftung for facilitating inclusion in World Cancer Report 2014 of material based on some contributions to buy discount demadex 20mg line the 2013 Scientifc Symposium. It extends to the outer margin of the sternum medially and to the level of the anterior axillary line laterally. The breast itself consists of the mammary gland (glandula mammaria) and subcutaneous connective tissue. The nipple (papilla) and the areola are hyperpigmented and form areomamillary complex, which also contains smooth muscle cells that make nipple erection possible. Fibrous connective tissue encapsulates the lobes of the mammary gland and forms a supportive network of fibrous bands that projects between the lobes (ligamenta Cooperi, ligamentum suspensorium mammae, retinaculum cutis mammae). The network ends in the subcutaneous tissue ventrally and connects to the pectoralis fascia dorsally. Clearly, the breast is not a homogenous organ, and it is best described as a combination of glandular, adipose, and connective tissue, with the glandular tissue only accounting for about half of the total mass of the breast. The breast is subject to fluctuations in both mass and size, which can be influenced by age, phase of the menstrual cycle, lactation, and gravidity. In adulthood, the breast can take several shapes: mamma disciformis flat and shallow breast mamma hemispheroidea classic? hemispheroid shape mamma piriformis the shape of the pear, typical for middle-aged women mamma pendula saggy breast, typical for older women, caused by the loss of adipose tissue Arterial nutrition of the breast is made possible by the rr. The veins form an anastomotic circle around the base of the papilla (first described as the 4 circulus venosus by Haller), which converge towards the gland and drain into the internal and lateral thoracic vein. The main destinations of the lymphatic drainage are the axillary lymphatic nodes, although other systems have also been described. To this day, the full intricacy of the lymphatic drainage of the breast remains unknown. Modern anatomical methods using radioisotopes show that 97 percent of the lymph is drained by the axillary nodes and the rest by the lymph nodes proximate to the internal thoracic artery (a. One of the axillary nodes is the Sorgius lymph node often the sentinel node of the breast. Sensory innervation of the breast is through the fourth to sixth intercostal nerves. The mammary gland consists of 15 20 tubuloalveolar lobes that divide into smaller lobules. Every lobe of the mammary gland ends in a lactiferous duct (ductus lactiferus, width 2 4 mm). Close to the nipple, the lactiferous ducts dilate into sinuses (sinus lactiferus) and open on the nipple through constricted orifices (porus lactiferus, width 0. Tubuloalveolar mammary glands are modified apocrine sweat glands and lie in the subcutaneus tissue. The epithelial lining of the duct transitions gradually from keratinized squamous epithelium to stratified cuboidal epithelium in the lactiferous sinus and finally to simple cuboidal or simple columnar epithelium in the more proximal sections of the duct. Myoepithelial cells form a basket-like network in the secretory part of the ducts. Recent immunofluorescent studies have shown that the progenitor cells in the ductal epithelium give rise to both types of cells. The morphology of the secretory part of the gland changes with the menstrual cycle. In the inactive gland, the glandular parts of the breast are sparse and consist primarily of ductal elements. During the follicular phase of the cycle, the intralobular stroma is sparse and the terminal ducts look like rods of cuboidal epithelium without a well-defined lumen. During the luteal phase, the epithelial cells enlarge and lumens, as well as small amounts of secretory product, become visible. During the last few days of the cycle, an abrupt involution and apoptosis returns the gland to its inactive state. The mammary gland also goes through dramatic changes in preparation for lactation and during lactation itself (see Physiology of the Breast). For proper development of the mammary gland, several different classes of signal molecules are thought to be needed. Predictably, female sexual hormones play a major role in breast development, mainly estrogens (primarily responsible for duct proliferation), and progesterone, the main action of which is to promote cell differentiation within lobules. There is some experimental evidence that supports the role of prolactin in breast development. Unfortunately, this has only been proven in animal models the exact role of prolactin in humans is yet to be determined. It is known that levels of prolactin rise continuously throughout pregnancy and the action of prolactin is irreplaceable in the full development of terminal ducto-lobular units. Despite this, process is still strongly influenced by high levels of estrogens and progesterone produced by placenta. Development of the gland also seems to be influenced by human growth hormone, even though in people with growth hormone deficiency (nanism) fully functional breast development can be observed. In men, the mammary gland regresses due to the effects of testosterone, however, its tissue still maintains the ability to react to the same signal molecules and stimuli as in women. The growth and development of female mammary glands is influenced by the relatively high levels of estrogen and progesterone in women. In women stricken with gonadal dysgenesis, estrogen substitution therapy alone is often sufficient to stimulate full development of the mammary glands. Studies that are more recent have shown that glandular epithelium proliferates much more actively during the luteal (second) phase of the menstrual cycle, which indicates the importance of progesterone. It is known that the morphology of the mammary gland changes not only with age, but also relative to changes associated with the menstrual cycle.
We $nally begin to purchase 10mg demadex with amex understand the so important correlation and dependency between ourselves and the environment we are surrounded by 10 mg demadex fast delivery. We start realizing cheap 10 mg demadex overnight delivery, that we as human beings are just a tiny part of a perfectly designed natural ecosystem. And we also start believing in the fact, that our existence, our health and our diseases are inextricable linked to the space we live in. Every fundamental shift in our understanding, in our education and in our personal behavior requires time, interest, knowledge, motivation, ix evidence and most importantly action. Unfortunately human beings are educated in the fact, that one always needs evidence before something works! However, you can consult 10 specialists, read 100 books, study 1000 scienti$c publications unless you do not try and experience, you will never bene$t! All of this in a language, that everybody will easily understand and be able to follow eagerly riddled with numerous scienti$c evidence and yet plausible and easily comprehensible. Over the past 6 years I have dedicated myself full time to researching, testing, marketing, sharing, training, and personally helping hundreds of people with a research proven, natural, non-invasive form of energy medicine called Pulsed Electromagnetic Field! Oz Show aired a special broadcast on the pain-relieving e#ects of Pulsed Electromagnetic Field! Oz, for with this great exposure and sharing of knowledge, thousands of Americans now know of this amazing technology. In fact, I can almost guarantee it can help anyone to xii improve their quality of health. Of course I cannot make any claims for treating or curing any disease, but when you see not just one. Many of the initial studies have been carried out in Russia and Eastern Europe, but more and more research is now taking place in the United States. It has the natural ability to heal when given the proper energy and elements needed for sustaining life (more on the $ve essential elements in the next chapter). My love of physics stemmed from a deep yearning for understanding the big questions. I followed a very unorthodox career path and spiritual journey that led me to teaching physics for 5 years, living at a yoga retreat center for 4 years, and spending 6 months in India with a focus on mediation. I also worked 10 years part time for a health food store all while teaching the incredible bene$ts of natural healing, nutrition and energy medicine. I became a certi$ed nutritionist and helped hundreds of people with one on one nutritional counseling. I have an interest and passion that combines all of these disciplines in a branch of alternative healing and wellness called energy medicine. I currently have around 18 years experience in researching, testing, and trying over $500,000 worth of energy medicine devices. During my $nal year at Georgia Tech my senior research project was on radionics and healing with frequencies. Even though my audience left me with a lot of blank stares and some half hearted applause. It is the $rst and most important device I personally use every day, and something I highly recommend for you to invest in. When I say energy medicine?, I mean using natural energy rather than chemistry or surgery to help assist the body in healing itself. So the ability to heal our bodies with energy is becoming less science $ction and more scienti$c fact. Discussing all the di#erent modalities of energy medicine is beyond the scope of this book, but I want to give you a sample of the various types of machines on the market, and just how vast and fast this $eld of energy medicine is growing. Over the past 18 years I?ve personally invested in and owned over $500,000 worth of equipment, spent countless hours researching and talking directly to owners, inventors and experts. Here is a sample of some of the machines I have owned, tested, used and researched. It will not only give you the tools to radically improve your health and longevity, it will also open your mind to a new way of thinking about the human body and the universe we live in. Understanding the new physics? will provide the $rst foundation for understanding energy medicine, speci$cally pulsed electromagnetic $eld therapy. You?ll be amazed to see just how deeply connected you are to the earth and its natural geomagnetic and Schumann frequencies. Health should not be looked upon as the absence of disease, but instead a process of growing stronger and more energetic every day. I?ll also share what I feel are the best devices to invest in after trying and testing over $500,000 worth myself. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed. In the midst of this spiraling growth of our universe that began at speeds faster than light, a Goldilocks? planet (Earth) evolved with conditions and elements that are not too hot and not too cold, but just right? for life. Stargazing connects us to this vastness we call our universe, but as many stars that seemingly pop out on a clear night we are only seeing roughly 10,000 of them with our naked eye. On top of that, our nearest galaxy Andromeda is much larger then ours and yet appears as only a small fuzzy patch on a dark night sky. What man needs to create, maintain and sustain an ever-increasing level of health and energy. Modern physics is now shedding light on the great serendipity of life and the conditions needed to create it. Before we dive into the essential elements needed for the health of our body, lets take a brief journey into the amazing circumstances that were needed for life in the universe to exist at all.
Available at emissions: characterization of causative Occup Environ Med purchase demadex 20 mg otc, 69:619?627 order demadex 10mg mastercard. Association risk factors and risk factor clusters in 21 estimation of the global burden of dis between long-term exposure to buy cheap demadex outdoor air regions, 1990?2010: a systematic analy ease attributable to outdoor air pollu pollution and mortality in China: a cohort sis for the Global Burden of Disease Study tion. N Engl J Med, cer: systematic review and meta-analysis from groundwater and rice in Bengal Delta 360:376?386. Household stove improvement sure in Latin America: a review of history Methods for Accountability Research. Olsen Pharmaceutical drugs are chemi problematic in circumstances involv Summary cals that are developed and applied ing non-life-threatening conditions. A possible side-ef nantly include antineoplastic agents apparently cured; this is most as well as a diverse range of drugs fect is modifcation of the likelihood readily attributable to the geno not used as cancer therapy. Only a few drugs have been ap may involve either a risk-enhancing proved for cancer preventive thera-. Other carcino not established, as carcinogenic cancers in cancer patients who are genic drugs include antineoplastic to humans by limited epidemio apparently cured. Twelve such agents agents that particularly among logical data or by data restrict or combination therapies have been ed to the results of bioassay in those that are genotoxic cause classifed as carcinogenic to humans animals. Typically these agents therapy, and several others are research to reduce dosage or de cause acute myeloid leukaemia that being evaluated as preventive velop safer and more effective re often exhibits clonal loss of either agents, including aromatase placement products. In contrast, a chromosome 5 or 7, as distinct from inhibitors, aspirin, statins, and decision to prescribe and use drugs acute myeloid leukaemia induced metformin. Use of these agents may are monitored for possible carcino cause skin cancer and non-Hodgkin genic effects. Typically, the antineo lymphoma; relevant evidence comes plastic mechanisms of the replace primarily from studies of patients who ment drugs are similar to those of have undergone organ transplanta the traditional drugs, and much in tion (Table 2. Since individual Female sex hormones, including susceptibility is often a factor that estrogen-only and estrogen?pro emerges from relevant mechanistic gestogen agents, are used widely to analysis, this knowledge contributes achieve various outcomes, including to improved identifcation of patients contraception and the amelioration who may be susceptible to drug of menopausal symptoms, uterine induced cancer . In addition, these agents have been Immunosuppressive agents used widely for prevention of osteo Immunosuppressive agents, such as porosis and coronary heart disease azathioprine and ciclosporin (also among postmenopausal women, known as cyclosporin, cyclosporine, although the latter indication was 162 Table 2. Moreover, the increased risk of endometrial duction for coronary heart disease an increased risk of breast cancer cancer decreases with the number reported in many observational stud was also noted. For of carcinogenesis of female sex hor menopausal therapy was initially several other sites, including cancers mones include estrogen-receptor developed to avoid the excess oc of the thyroid, lung, stomach, liver, mediated responses and potentially currence of endometrial cancer as urinary tract, pancreas, ovary, and direct genotoxic effects of the estro sociated with estrogen-only therapy cervix, as well as lymphoma, leu genic hormones or their associated . Estrogen-only menopausal therapy trogen?progestogen agents among refers to the use of estrogen without women aged 50?79 years at baseline progestogen by perimenopausal and was associated with a hazard ratio Fig. Oral contraceptives are avail postmenopausal women, primar for coronary heart disease of 1. This study has affected the in the 1960s and early 1970s, the prescribing of combined estrogen? use declined after reports of a strong progestogen menopausal therapy association between estrogen-only substantially, resulting in rapidly de therapy and risk of endometrial clining use of these agents, restricted cancer. Since then, estrogen-only indications, and reduced duration of menopausal agents have been pre therapy. Variations in Although breast implants are very dence have been reported between development. In addition, one study their long-term effects on cancer found that women with subglandular 2. Int J Cancer, Concerns about the carcino cern about a possible link between 124:490?493. Toxicol Appl to specifc implant characteristics, no epidemiological cohort studies Pharmacol, 107:562?567. Anal Sci, dular), and implant envelope (with or implants may obscure the visuali 17:1369?1374. Int J Cancer, 118:998? ratory studies show that 2,4-toluene ability to identify breast cancer at 1003. Plast Reconstr Surg, the progression of already present recent epidemiological evidence 128:651?661. In addition, one has suggested that breast cancers epidemiological study showed an el are diagnosed at more advanced 10. Plast Reconstr evation in breast cancer incidence stages among women with cosmet Surg, 123:790?793. For other sites, including cancers this synthetic estrogen was frst man suffcient evidence that combined of the thyroid, lung, stomach, urinary ufactured in 1938 . Diethylstilbestrol estrogen?progestogen oral contra tract, gall bladder, and pancreas, as was widely used, especially from the ceptives cause cancers of the breast well as lymphoma, cutaneous mela 1940s to the 1970s, to prevent po (notably among young women), noma, and central nervous system tential miscarriages by stimulating 164 the synthesis of estrogen and pro Phenacetin been limited to traditional Chinese gesterone in the placenta. Subsequently, (Group 2A), since the available plastic agents and is associated with several adverse effects emerged evidence had not been able to dis nephropathy and an increased risk (Table 2. First, slightly in criminate between potential carci of cancers of the renal pelvis and creased risks of breast cancer and nogenic effects of phenacetin and ureter (Table 2. Genome-wide possibly of endometrial cancer were those attributable to other analge sequencing has established the observed among women exposed to sics or components of analgesics mutational signature of aristolochic diethylstilbestrol during pregnancy. Third, fetal exposure to di Since phenacetin was withdrawn conjunction with ultraviolet radiation ethylstilbestrol was associated with from the market in most countries in as phototherapy for various condi increased risks of squamous cell car about 1980, the pool of patients with tions, notably psoriasis. The drug cinoma of the cervix among female excess risk of cancers of the renal has been suspected to cause vari offspring and testicular cancer among pelvis or ureter due to phenacetin ous types of skin cancer, but there is male offspring. Currently, evidence is convincing evidence only for causa therapy is probably limited now, tion of squamous cell carcinoma .
The term fibrocystic breast disease (fibrocystic changes) includes a variety of changes in glandular and stromal tissue in response to buy demadex 20mg otc hormonal levels demadex 10mg visa, and often presents with cyclical breast pain (mastalgia) buy demadex 20 mg without prescription. Breast pain (mastalgia) and breast tenderness (mastodynia) are more common in younger premenopausal women, and perimenopausal women. Mastalgia affects up to two-thirds of women at some time during their reproductive lives. Difficulties may be cyclic (dependent on menstrual cycle phases), or non-cyclic, (either lasting or intermittent, but not related to the menstrual cycle). More often, cyclic difficulties are associated with physiological changes of the breast parenchyma, as opposed to the menstrual cycle (see Physiology of the breast). They primarily occur during reproductive age and, since the terminal duct lobular unit glands that are under the influence of progestogen in the second phase of the cycle, they are filled with secretions; additionally, the entire gland is well perfused and often voluminous. Mastodynia is frequently associated with premenstrual syndrome and spontaneously disappears. It is more common in women with fibrocystic mastopathy and duct ectasia; the volume of the mammary tissue itself is not crucial. Mastodynia deteriorates in circadian rhythm disorders, or during the use of certain drugs that lead to hyperprolactinemia. A clinical evaluation is required to assess the cause, and the majority of women can be reassured after a clinical evaluation. Breast imaging techniques can exclude an organic cause of the mastalgia/mastodynia. Well established treatments for mastalgia and mastodynia are Mastodynon? (an extract of Vitex agnus-castus, which is available in drops and tablets), or evening primrose oil. Evening primrose oil is extracted from seeds of the evening primrose plant (Oenothera biennis), which is a wildflower that grows in eastern and central North America. Evening primrose oil can also reduce the pains associated with premenstrual stress syndrome. Other treatment options include bromocriptine, lisuride, quinagolide, danazol, low dosed monophasic contraceptives, or non-steroidal anti-inflammatory drugs during the second phase of the menstrual cycle. Progestogen substitution during the second phase of the menstrual cycle is recommended in patients with luteal insufficiency. If the cause of 39 mastodynia is an increasing, solitary growing cyst, or fibroadenoma, then causal treatment is the treatment of the choice (aspiration of cyst contents and extirpation of fibroadenoma, respectively). It is usually difficult to find the real cause of non-cyclic mastalgia / mastodynia. Mastalgia is often the result of an improper lifestyle (stress, excessive intake of caffeine, methylxanthine, nicotine, etc. Transient mastalgia in peri and postmenopausal age can be caused by age-specific physiological involution and transformation of glandular tissue. It is also known that breast surgery scars can be painful, often associated with changes in atmospheric pressure. Misdiagnosis and postponing the start of effective treatment may lead to a breast abscess, which may in turn lead to even more serious health complications. Inflammatory diseases, therefore, should not be underestimated and they must be given due weight. It essentially expresses interactions across a series of putative causal factors that result in a wide range of clinical manifestations. In any case, it is assumed that a retention of thickened secretions in the extended terminal milk ducts (duct ectasia) plays an important role, and causes a mechanical obstruction of the lumen. Secondary bacterial infections that enter primarily through the nipple cause periductal inflammation. The following are microscopically visible: squamous metaplasia in dilated ducts, foam histiocytes around ductal epithelial cells, and signs of periductal lymphocytic infiltration. Staphylococcus can be detected in most cases as the primary source of infection, but mixed aerobic and anaerobic bacterial flora may be also present. Other etiological factors such as nicotine and relative hypovitaminosis A are also proposed in the literature. Congenital, or even acquired, inversion of the nipple (where the skin around the mammilla folds and creates an environment for dead epithelial cells, sebum and bacteria), is also a form of predisposition to this syndrome. In the early stage of the syndrome, one usually starts with conservative treatment, i. The problem lies with the chronic nature of this inflammation and its tendency to reoccur. This then results in periareolar fistulas in about 2 % of patients, for whom surgical treatment is then needed. An optical contrast agent (methylene blue) is instilled into the affected duct and excised (ductectomy) together with the eventual skin fistula. The material is then sent for histological evaluation, which might reveal intraductal papillomatosis. Unfortunately, in some cases circumstances (repeated inflammation with the formation of fistulas) force us to remove the entire areolo-mammillary complex along with the affected gland through a central quadrantectomy. The operation must be performed during an inactive stage of the inflammation and under antibiotic therapy. If not managed carefully, the infection may spread to the entire gland, which may lead to the formation of multiple abscesses in the breast and the eventual development of sepsis.
Purchase demadex 20mg with mastercard. Schizophrenia Simulation.
I propose a strategy discount demadex 10 mg with amex, which opposes the basic Web Art: bringing space into media approach of Le Corbusier and the modernists: destroy and Extension of screen-based applications by exploring three rebuild? but leave Modern space intact and undermine? dimensional (3D) space and navigation (using 3D it with digital media purchase 10mg demadex overnight delivery. In return buy demadex 20 mg online, the transformation of the connected by wires to each other, and light-emitting diodes space influences the sound level and panning. Modern space and media were Second prototype: Servo sculpture blended together to create smooth space and extend their In this phase I challenge the setup of the one-dimensional dimensions beyond the traditional perception. I translate the logic of the code into spatial Modern white cube? was stretched beyond its limited architectural qualities. Like a Moebius the fabric strips have two distinct sides: silver, smooth strip? (a single topological surface with only one side and and shiny front and a white, interwoven and matte back. D (Advanced proximity by changing the speed of the motors and the Architectural Design), Columbia University 2000; rotation patterns. For To-Morrow and Its Planning (1929), Dover Pubns, example, the partition can be 10% closed at the top while 1987. Its conclusions were published in the made up of disparate elements which maintain their controversial documents "The Athens Charter". We felt that this was a limiting view of how to improve the elevator Keywords experience, especially with the opportunities for interaction Social awkwardness, digital word modules, magnetic provided by digital technology. This project was originally conceived as a digital solution to the social awkwardness endemic to elevators. Thus, its Theoretical Parameters design parameters reflect the limitations of its original the first step in this project was to list a set of general location. However, since many public spaces share the design parameters that this project would have to follow to psychic and physical characteristics of elevators, it has the be successful. In our view, any elevator installation would potential to be useful in spaces far beyond its original have to be: context. Warmly inclusive, to encourage riders to interact with if it is more of a social fear than a physical one. The goal of this project was to Of course, elevators have their own specific, practical eliminate, or at least minimize, these emotions. Thus an installation should As noted, this has not been the first attempt at making the ideally be small and self-powered. We decided that elevator can also invite larceny or vandalism, the there have historically been three broad strategies that have installation would also ideally be self-contained and been used to engage elevator riders - that is to say, music inexpensive. Each module contains around 200 words in a the best inspiration for a digital installation that could given part of speech; there are noun modules, verb satisfy each of these parameters was found in the now modules, adjective modules, and so forth. Arranged famous magnetic poetry sets found stuck on refrigerators together, they form phrases that range from the cryptic to across the country. After all, an elevator is like a the profound to the entertaining to the baffling. Since the refrigerator - a cramped gateway to a more interesting words are pre-selected, what results is not necessarily destination. Magnetic poetry sets consist of hundreds of tiny magnets, each imprinted with a different word in various parts of speech. They can be arranged on an refrigerator in combinations from the ridiculous to the sublime, allowing for the entertainment of the "author" while providing a means for indirect communication of jokes, ideas, and various degrees of poetic thought to others visiting the space. Refrigerator poetry is often not "poetry" per se, but the limited wordset provided by the magnets does force approximate compositions that reflect many of the ambiguities of verse. Although it takes some thought to build a sentence that rises above nonsense, building meaningful sentences is possible. Many of the fragments created reside in the realm of the cheerfully cryptic, much like most of the proverbs found in fortune cookies or badly translated philosophical texts. Future prototypes would use either advanced microcontrollers or flash memory to store more the idea of poetry as a calming snapshot? is at the heart of words. You want just a little of-speech wordlist compiled by Grady Ward snapshot of an emotion or an experience. The modules are currently mounted using instance, the initial prototype of this installation used the strong suction cups. In network-enabled environments a connection Interactive Telecommunications Program, for his useful could be set up to dynamically update the lists in real-time. Thanks also to the Additionally, the words selected could be broadcast to a anonymous reviewers who provided helpful feedback on website to reflect the compositions presented in a given this project proposal after it was submitted to the 2003 place to the world at large. Thus, they are ideal for "transitory spaces," that is, public areas where people often pass by, allowing for virtual self expression and subtle, anonymous communication between strangers. In this sense they are best thought of as ephemeral graffiti, although while graffiti is used mainly by gangs to mark territory, these modules are used by everyday people to communicate, however cryptically. In that sense they are not objects of distraction but also true artifacts of interaction that hopefully can serve to relieve the social awkwardness of public spaces. Witness the recent furor over a way to introduce and distribute verse into everyday controversial poem written by New Jersey poet life. Just as the invention of the electronic calculator made relatively the Verse-O-Matic attepts to remedy this situation by complex mathematics accessible to the masses, a providing a convenient, accessible interface to classic poetry calculator elevates ordinary discourse by and modern poetry, requiring only a curiosity about making verse more easily accessible to all. This project is not the only effort to seep poetry to unexpected corners of everyday life. The selections were chosen from over solving mathematical equations was a time-consuming 18,000 submissions. This offers instead a metaphysical democratization of beautiful verse can add greater moment in the subway.
The ultimate causes of biodiversity impact are growth the latter is a paradox in that ecosystem services favour based economics order 20mg demadex with amex, excessive personal consumption and the rich and powerful when pristine cheap 20mg demadex with mastercard, and affict the poor associated waste buy 10mg demadex with amex, and excessive per capita energy use. However, a great deal of energy is expended in stopgap solutions to address proximate causes, winning a few Rising population levels weigh heavily upon the resources biodiversity battles, but losing the war. While non-native invasive species areas with a high percentage of impervious surface can force out more benefcial native marsh plants, high area. Sediments reduce water clarity, smother bottom levels of chemical pollutants can accumulate in wetlands organisms, and clog waterways; excessive nutrient input as pollutant carrying sediments are trapped in wetland causes eutrophication; and toxic chemicals affect plants vegetation. A change in the onset, continuity, of temperature and heat accumulation in ecological and withdrawal patterns of the southwest monsoon in systems, it also refects the reality that future climate recent years has also led to considerable spatial and change predictions related to temperature are the most temporal variations in rainwater availability. At least half certain, followed by those for precipitation and other of the severe failures of the Indian summer monsoon since climate variables. Changes in long-term climate patterns and climatic Fragmentation can result in reduced genetic diversity variability are likely to have signifcant effects on natural within populations, loss of species, and increases in ecosystems, and a particularly large impact on the undesirable, non-native, and weedy species. Forests are also threatened by change could work in concert with other stresses to further the invasion of non-native species. Pollution can also reduce populations of rare and endemic species, while stress forest trees, especially in urban, industrial, and increasing populations of already abundant, widespread heavily populated areas. Table 2 describes how climate variability and and insect pests can severely stress forests and cause change might impact on ecosystems already weakened the effective extinction of previously dominant trees and by other stresses. The most irreversible of human impacts on ecosystems will most likely be the loss of native Analytical Framework biodiversity. Climate change may manifest itself as a Stream fows are moderated in vegetated watersheds shift in mean conditions or as changes in the variance because rain is absorbed into the ground and slowly and frequency of extremes of climatic variables. An increase in the frequency or intensity of Range and abundance shifts, changes in phenology, storms could exacerbate existing problems. In heavily physiology, and behaviour, and evolutionary change paved urban areas, increases in peak fows during are the most often cited species-level responses. At the storms scour stream banks, which decreases reproductive ecosystem level, changes in structure, function, patterns success, while reduced stream fow during dry periods of disturbance, and the increased dominance of invasive reduces available habitats for fsh and aquatic insects. Fragmentation may hinder the migration of some species, and the loss of genetic diversity within fragments will reduce the potential for populations to respond to changing conditions through adaptive evolution. Habitat loss reduces the resilience of wetlands to the negative effects of storms, because wetlands play a role in moderating destructively high stream fows and pollution runoff. Pollution: nutrients, sediments, toxic substances Figure 4: Conceptual framework for the assessment of climate change impacts on biodiversity Climate change stressors Impact mechanisms Biodiversity Freshwater Terrestrial Range/ abundance shifts Ecosystem diversityEcosystem diversityEcosystem diversity Changes in Species diversitySpecies diversitySpecies diversity phenology/ Evolutionary physiology change Genetic diversityGenetic diversityGenetic diversity In this synthesis, the assessment of biodiversity impacts Limiting factors is structured using an Ecosystems/Species X Terrestrial/ One of the key diffculties in any attempt to understand Freshwater framework, i. In short, this involves making climate, the complexity of the physiographic environment, specifc linkages along the continuum from climate and the natural variations and cycles of the large-scale change stressors to impact mechanisms and biodiversity monsoonal circulation. Figure 4 presents an overview assessment challenges and major uncertainties, certain of the analytical framework of climate change impacts on conclusions are emerging. Of particular relevance to biodiversity that shape the structure of this synthesis. This climatic characteristics in the mountains than in the was the strongest conclusion to date, making it virtually plains. Existing knowledge of the climatic characteristics impossible to blame natural forces for global warming. Floods and droughts have also been of barriers on air fow and on orographic effects on observed to be increasing in frequency and intensity, and weather systems, rather than on conditions within the this trend is likely to continue. As much as climate shapes the mountain environment and determines its constituent Projections of temperature increases in the 21st Century characteristics, so do the mountains in turn infuence have been made on the basis of established and the climate and related environmental features through plausible scenarios of the future. The and the best estimate of temperature increase by the roles of these factors are summarised schematically in end of the 21st Century is placed at 1. These climatic extremes, heat waves, and heavy precipitation events will differences are expressed in vegetation type and cover, become more frequent, future tropical cyclones (typhoons and geomorphic and hydrological features. Increases in the amount of precipitation are and glaciers and ice caps show unequivocally that very likely at high-latitudes, while decreases are likely in the world is warming. There are several constraints and issues that need to be resolved at the policy, There have been investigations into climate trends and institutional, and feld levels to improve the observational characteristics in the Himalayan regions of southwest and and prediction basis for accurate and conclusive northwest China using time series data of varying lengths statements on climate variability and change. In the southwest a need to probe deeper into the dynamics of mountain region covering the counties of Deqin and Weixi of the climate systems in search of signs of climate change. The changes in have interpreted the existing observational and prediction precipitation, however, are very different and complex. Trends in air temperature were more signifcant in the dry season than in the rainy season, with precipitation For this vulnerability assessment, it was necessary to showing the opposite behaviour. Climate trends differed refect on climate trends and projections determined at the from climate element to climate element, region to region, country level from a large compilation of national reports. In this synthesis, climate variability refers to day-to-day, year-to-year, and decade-to-decade patterns of weather Signifcant warming has been observed on the Tibetan and climate; climate change refers to longer trends, Plateau (Liu and Chen 2000), with warming more usually measured by temperature and precipitation. The fndings confrm earlier observed in a similar study encompassing the whole studies that temperatures will continue to rise and rainfall physiographic region of Nepal using climatological patterns will be more variable, with both localised data from 1977 to 2000 (updated from Shrestha et al. Nonetheless, they reinforce the scientifc region recording the highest positive trend (Table 4). Unlike temperature, precipitation does not Trends show any consistent spatial trends. Annual precipitation changes are quite variable, decreasing at one site and Few studies provide an exclusive and comprehensive increasing at a site nearby.