Allan Pickens, MD
Use topical uorinated corticosteroids (betamethasone weight loss oils generic 60 caps shuddha guggulu with amex, ucinolone weight loss pills bodybuilding buy generic shuddha guggulu 60caps on-line, clobestasol) in an ointment base weight loss pills dollar tree buy shuddha guggulu 60caps with mastercard. Apply after soaking off the scale in a salt-water bath bid x 2 weeks (then move to non-uorinated steroid ointment) weight loss pills definition 60 caps shuddha guggulu visa. Never apply uorinated steroid to the face or in occluded areas like the groin or axilla Alternative: Triamcinalone ointment Symptomatic: Hydroxyzine (atarax) 25-75 mg po q4 hrs for pruritus. Empiric: Ultraviolet exposure (20 min exposure to noonday sun) will accelerate the resolution of the lesions. Follow-up Actions Reevaluation: If lesions do not start to thin in 2-3 weeks referral is needed Evacuation/Consultation Criteria: Referral is not usually indicated, unless unstable. It is caused by multiple factors and is more common in those with very curly beard hair. Affected persons may have a genetic predisposition due to abnormal formation of the hair follicle. Curly hair can then penetrate the side of the follicular unit and cause a mechanical irritation in the skin, or the curly hair may exit appropriately and then curl back into the surface of the face again, causing an irritation. Subjective: Symptoms Rapid development of papules and pustules in the beard area after shaving. Objective: Signs Using Basic Tools: Follicular-based papules and pustules below the jawline and on the anterior neck. Differential Diagnosis Acne lesions also in other areas Irritant contact dermatitis lesions also in other areas. Allow the hair to grow out onto the surface of the skin and then trim with a safety razor or clipper. Gently lift out remaining buried ingrown hair tips onto the surface and clip- do not pluck or pull. Empiric: Minocycline 100 mg po bid will help decrease the irritation and secondary infection. Patient Education General: Shave gently with bump ghter razor, without pulling the skin taut or repeating over the same area; shave with the grain of the hair. Close shaving promotes oblique penetration of the sharpened hairs into the skin and should be avoided whenever possible. Prevention and Hygiene: Apply moist heat after shaving, followed by a moisturizer (like razor bump ghter), and avoid strong astringents like alcohol that will only dry the face and cause more irritation. Early detection and treatment are paramount in order to avoid extensive tissue destruction, damage to adjacent structures, and complex surgery and reconstruction. The good news is that this cancer is virtually 100% curable if approached early and properly. Sun exposure and fair complexion, light-colored hair and eyes are the main risk factors for skin cancer. Unfortunately about 80% of all the ultraviolet radiation (sun) exposure comes before age 18 when most people think they are immortal and not affected by skin cancer. Subjective: Symptoms Very slow-growing, small, pearly or waxy papule, usually in a sun-exposed area. Objective: Signs Using Basic Tools: Waxy or pearly papule (2-3mm diameter) that can grow to several cm over time; peripheral telangiectasias (small, dilated blood vessels); supercial erosion; some lesions are at scars, usually without a history of trauma; sun-exposed areas are the most common sites: ears, periauricular skin, eyelids and periocular skin, nose, cheeks, temples, forehead, upper chest and back, and arms and forearms; can occur even in protected areas like the axilla, so skin exams should be thorough and complete. Assessment: Differential Diagnosis benign lichenoid keratosis, intradermal nevus, neurobroma, irritated seborrheic keratosis, amelanotic melanoma, tricholemmoma. Differentiating these conditions in the eld is nearly impos sible, since they require expert microscopic evaluation of a biopsy. Plan: Treatment: Defer treatment of team members until return from mission (tumors are very slow growing). For local nationals, if evacuation or referral cannot be accom plished within the coming 6 months, perform full thickness excision with 5mm margins all around the tumor. Follow-up Actions Evacuation/Consultant Criteria: Evacuate non-urgently (Routine status) if on long deployment. Sun-exposed skin is at highest risk, and people with fair complexions are at higher risk than are those who are darker-skinned. Differentiating some of these conditions in the eld is nearly impossible, requiring expert microscopic evaluation of a biopsy. Follow-up Actions Evacuation/Consultation Criteria: Evacuate non-urgently (Routine status) if less than 2 months before return from deployment. S citizens is currently 1 in 75 and rising, up from about 1in 250 twenty years ago. The 5-year survival rate is about 83% (double what it was 50 years ago), but since melanoma is becoming more common, the death rate is still rising (3 per 100,000/year). Severe sun damage is worrisome, and should lower your threshold for recognizing these lesions. The nail beds and nail matrix (which is just proximal to the cuticle and between the skin and the bone of the distal phalanx) are also at risk, so have a high index of suspicion for pigmentation changes in these areas. Amelanotic melanomas are difficult to diagnose because they do not have much pigment and can look nothing like the above description. Amelanotic melanomas can be flesh-colored or hypopigmented papules or plaques and are often thought to be some other entity when they are biopsied. Subjective: Symptoms High-risk history: family history of melanoma, childhood history of sunburns, personal history of many atypical nevi. Focused History: Have you had melanoma in your family/childhood sunburns/ unusual moles or freckles The earliest of these is probably color variegation, and the colors red, white or blue are most worrisome. Irregular areas which are very dark, or which become very light in color are also bad signs. Asymmetry and border irregularity come from uncontrolled growth of abnormal melanocytes at the edges of the lesion. Notched, grooved or scalloped borders are suspicious, and are usually apparent in a lesion of 6mm diameter or more. Early melanomas tend to be at with nodular components indicating that the cancer is progressing, and a higher risk for metastasis. Assessment: Differential Diagnosis: Seborrheic keratosis, pigmented basal cell carcinoma, atypical nevus, solar lentigo. Differentiating these conditions in the eld is nearly impossible, since it requires expert microscopic evaluation of a biopsy. Plan: Treatment: Evacuate immediately (aggressive tumor) for evaluation and biopsy, preferably by a dermatolo gist. If emergent evacuation is not possible, perform initial excisional biopsy with wide margins (5-10 mm) around the entire tumor. Subjective: Symptoms Strong hereditary predisposition; slightly more common in males; rarely pruritic or painful unless irritated or secondarily infected after trauma. Objective: Signs Using Basic Tools: Lesion: 1 mm to 3 cm, round to oval, slightly elevated, stuck-on appearing, papule or plaque with variable pigmentary change; surface of lesion commonly has warty (verrucoid) appearance as it matures and grows; face, trunk and extremities are common sites. Assessment: Diagnose based on clinical criteria Differential Diagnosis: Early lesions: actinic keratosis, nevus. Differentiating these conditions in the eld can be very difficult without expert microscopic evaluation of a biopsy. Plan: Treatment Primary: None is required for this benign lesion Patient Education General: this is a local benign proliferation of keratinocytes. The main difference is that an allergen will only cause problems such as dermatitis in those sensitized to it. Even a tiny amount of allergen can cause a reaction in an allergic person, whereas an irritant will irritate anyone, without previous sensitization, and the effects tend to be dose-related. Plants such as poison oak can leave linear streaks of itchy, red papules and vesicles, corresponding to the leafy contact made with the skin. Preservatives and fragrances in beauty and health care products are often a problem. Formaldehyde, present in dry-cleaned clothes and released by some preservatives, is also a common allergen. Others need education about some of the possibilities to allow them to figure out the problem later, particularly after keeping a journal to correlate symptoms and exposures. Yew. Shuddha Guggulu.
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Areas of anticipated significant growth that may extend into levee failure areas are identified in the Flagstaff and Tusayan (Coconino) weight loss pills us proven 60caps shuddha guggulu, Prescott Valley and Chino Valley (Yavapai) weight loss 33 order shuddha guggulu 60 caps line, Bullhead City and Lake Havasu City (Mohave) weight loss 6 months before and after discount shuddha guggulu 60 caps with visa, plus several populated areas within the unincorporated areas of Coconino weight loss pills uk 2015 purchase shuddha guggulu us, Mohave, and Yavapai Counties. None of the anticipated development is expected to alter any of the current dam hazard and safety ratings. The federal and local levees impacting Maricopa County have been actively studied and evaluated for failure inundation limits, with small pockets of the county being situated within an identified levee failure inundation zone. Development over the next five years will at least partially occur within these mapped areas, however the risk of failure for most of the levees impacting the area are low due to the high level of maintenance and mitigation of potential failure modes. Planned growth in Pinal County areas subject to levee failure inundation is low to moderate and anticipated in or near Apache Junction, Coolidge, Florence, Maricopa, areas along the Santa Cruz River, and portions of the San Tan Valley. South Region Pima and Yuma Counties have experienced moderate growth over the past five years in some locations and population declines in others. Moderate growth is expected to continue in Pima and Yuma Counties, primarily near or within the Tucson and Yuma Metropolitan areas, expanding the exposure to existing levee failure inundation zones. Future growth into levee failure zones within Cochise, Graham, Greenlee, and Santa Cruz Counties is not anticipated to be significant. The loss calculations assume that exposed structures are subject to a loss-to-exposure ratio of 0. Three of the 15 county multi-jurisdictional hazard mitigation plans included levee failure in their risk assessment. The facilities exposed to levee failure inundation represent a total exposed replacement value of $500,000, with an estimated $130,000 in potential losses. Specific Areas of Concernthe Winslow Levee and other levees along or near the Little Colorado River in Navajo County have a history of failure risk, and especially in and around the City of Winslow. An additional area of concern regarding levees located near or within North Region communities, is the possibility for significant post-wildfire flooding that could significantly overwhelm existing capacities. Alternately, the Central Region arguably has the greatest amount of resources for active dam and levee maintenance and repair, as well as modeling and mapping of hazard areas. The facilities exposed to levee failure inundation represent a total exposed replacement value of $800,000 with an estimated $200,000 in potential losses. State-owned and maintained roadways and infrastructure within the metropolitan Phoenix area are designed to meet local drainage requirements, and therefore are protected to 1% annual flood level. Typical impacts might include erosion of roadway embankments and pavements, culvert and bridge failures, and significant sedimentation. Exposure estimates for at-risk population groups like persons under 18 years of age, over 65-years of age, and those living at or below poverty level. Local Jurisdiction Vulnerability Local hazard mitigation plans for the Central Region identified a total of 113 assets with a total replacement value of $143. Specific Areas of Concern There are numerous non-accredited and unstudied levee embankments located in the Central Region that were constructed by various entities and are still in place today. The presence of those facilities can give residents a false sense of security, and a failure could result in significant damage to downstream properties. The facilities exposed to levee failure inundation represent a total exposed replacement value of $560,000, with an estimated $140,000 in potential losses. Local Jurisdiction Vulnerability Local hazard mitigation plans for the South Region identified a total of four assets with a total replacement value of $1 million. Specific Areas of Concern There are numerous non-accredited and unstudied levee embankments located in the South Region that were constructed by various entities and are still in place today. Another very disruptive effect is when this hazard leads to isolation or evacuation. The evacuation alone can cause considerable trauma and stress for those affected, not to mention those who must find shelter for their pets and livestock. Property/Facilities/Infrastructurethe flood-wave typically released by a levee failure can be very destructive both in force and flooding depths. Damage to most impacted, above ground property, structures, and infrastructure is likely to be catastrophic, with the worst impacts being closest to the breach or failure location and dissipating with distance. The potential for significant erosion and scour also threatens buried infrastructure. Responders to the Incident Much like the dangers of flooding, levee failure incident responders may experience injury due to debris, drowning, electrocution, cold stress and exposure to hazardous materials. Because flooded disaster sites are unstable, clean-up workers might also encounter sharp, jagged debris, biological hazards in the flood water, exposed electrical lines, blood or other body fluids, and animal and human feces and remains. Responders are prone to the same dangers as the general public is, only on a higher level as they may be putting themselves in harms way by performing rescue activities. Continuity of Operations/Delivery of Services Potential levee failures as currently mapped are not expected to have a significant effect on the states abilities to provide operations and services. Environment/Cultural Levee failures result in flooding with the addition of a flood-wave pulse that dissipates as it moves further into the leveed area. The impacts to environmental and cultural resources are a magnified version of what might occur with regular flooding. Economic/Financial Condition of Jurisdiction Levee failures result in flooding with the addition of a flood-wave pulse that dissipates as it moves further into the leveed areas. The impacts to the economic and financial condition of the state is a magnified version of what might occur with regular flooding. Effects on the publics confidence in the states governance are a magnified version of what might occur with regular flooding. Cascading/Secondary Impacts Levee failures result in flooding with the addition of a flood-wave pulse that dissipates as it moves further into the leveed areas. Development of cascading or secondary impacts is a magnified version of what might occur with regular flooding. Flood Control District of Maricopa County 1997, Storm Report, Tropical Storm Nora Sept 1997. National Committee on Levee Safety 2011,the Definition of a Levee under a National Levee Safety Program. For Arizona, severe winds typically result from either extreme pressure gradients that usually occur in the spring and early summer months, or from thunderstorms. Occasionally, tropical storm activity (remnant hurricanes) can be accompanied by severe winds, but the wind speeds usually dissipate by the time the tropical storm front approaches the state, with greater threat to the southern portions of the state. Thunderstorms can occur year-round and are usually associated with cold fronts in the winter, monsoon Dust Storm in Downtown Phoenix 2002 activity in the summer, and tropical storms in the late Source: Pinterest Patti Pettigrew summer or early fall. Three types of damaging wind-related features may accompany a typical Arizona thunderstorm; 1) downbursts, 2) straight-line winds, and infrequently, 3) tornadoes. When the air reaches the ground, it spreads out in all directions, creating horizontal wind gusts of 80 mph or higher. Some of the air curls back upward with the potential to generate a new thunderstorm cell. There can be either dry or wet downbursts, where the wet downburst contains precipitation that continues all the way down to the ground, while the precipitation in a dry downburst evaporates on the way to the ground, decreasing the air temperature and increasing the airspeed. In a microburst, the wind speeds are highest near the location where the downdraft reaches the surface, and are reduced as they move outward due to the friction of objects at the surface. Typical damage from downbursts includes uprooted trees, downed power lines, mobile homes knocked off their foundations, block walls and fences blown down, and porches and awnings blown off homes. Straight line winds are developed similar to downbursts, but are usually sustained for greater periods as a thunderstorm reaches the mature stage. Straight line winds travel (or are pushed), parallel to the ground surface on the leading edge of a thunderhead, reaching speeds of 75 mph or higher. These winds are frequently responsible for generating the large dust and sand storms seen moving across the desert regions of Central and Southern Arizona. The blowing dust can reduce visibility to near zero, creating hazardous driving conditions. Strong wind events not associated with thunderstorms can occur throughout the year, but are frequently strongest in the late winter to late spring months and can generate high-speed winds that last for hours and often include exceptionally strong gusts. A tornado is a rapidly rotating funnel (or vortex) of air that extends toward the ground from a cumulonimbus cloud. Most funnel clouds do not touch the ground, but when the lower tip of the 2018 173 2018 State of Arizona Hazard Mitigation Plan funnel cloud touches the earth, it becomes a tornado and can cause extensive damage. For Arizona, tornadoes are the least common severe wind to accompany a thunderstorm. Many of the trees fell on apartment buildings, houses, and vehicles and the roof of a church suffered severe wind damage. One person was electrocuted after coming in contact with a live downed wire but survived.
Do you notice any change in symptoms at home weight loss pills zoller order shuddha guggulu amex, work weight loss green smoothie recipes cheap 60caps shuddha guggulu overnight delivery, or in any environment in particular Challenge testing with moisture in the environment are allergic in methacholine or histamine is used to confirm nature and manifest themselves as asthma or asthma when spirometry fails to demonstrate allergic rhinitis weight loss pills zantrex 3 order shuddha guggulu 60caps amex. Delayed hypersensitivity is not uncommon and often less well recognized and reversible bronchospasm in a patient with symp manifests as chronic rhinitis weight loss workouts for women buy 60 caps shuddha guggulu with mastercard, sinusitis, or toms consistent with asthma. They may help Although toxic syndromes are not well defined to focus the diagnostic process but do not from inhalation exposure of mold or mold products in indoor environments, many assist in assessing causal relationships. Total patients and some physicians have attributed IgE can indicate atopic status. Acute idiopathic cognitive and other neurological syndromes to pulmonary hemorrhage is marked by the sud mold exposures. There is no consensus as to den onset of pulmonary hemorrhage in a the nature, pathophysiology, or etiology of these syndromes. Clinical Evaluation Relative to the Environment Often the most powerful diagnostic strategy is to evaluate the patient before and after exposure to the environment of concern. When the etiology of a condition is unknown and the individual is working or living in the environment of concern, judicious trials away from and back in the environment allow the physician and the patient to evaluate the likelihood that a job or home is playing a role in an illness. Such trials should be coupled with careful measurement of pertinent physical exam, laboratory, or physiologic parameters. Bracketed spirometry, for example, involves spirometry after at least 2 full days away from the environment and again after exposure (usually at the end of the same day or after the onset of symptoms). Serial peak flow measurements obtained at least 4 times a day for 2 consecutive weeks may assist in evaluating physiologic response to an environment. Because the late phase of asthma, hypersensitivity pneumonitis, and chronic rhinitis may take several weeks or even months to improve after removal from exposure, a longer duration may be required for adequate evaluation of pre and post-exposure. The diffusion capacity is a more sensitive indication of an interstitial process such as hypersensitivity pneumonitis and can be used over time to 36 monitor responses to changes in environment. This kind of trial best follows an environmental assess A Note on Discussing Mold and ment, which increases the suspicion that the Moisture with Your Patient medical condition is environmentally induced. Recurring leaks or continuous moisture are indicative of environments that support indoor Antibodies to specific antigens can be mea growth of mold. IgG antibody testing to in the patients home is contributing to the mold or other antigenic exposures may be used to patients illness. Suggested subjects include confirm a preliminary diagnosis of hypersensitivity air conditioners and dehumidifiers (and maintenance practices designed to control pneumonitis. IgE testing is used to confirm an accumulation of water and dirt in the system allergic mechanism (such as in asthma or rhinitis). The validity of either test depends on (especially in bathrooms and kitchen) that encourage condensation. Most reagents for mold consist of crude Appropriate conclusions drawn from this extracts of the substance; very few test reagents discussion may be counter-intuitive. Studies have shown that example, occasional mold spots on shower curtains that are appropriately cleaned are not there is a wide variation in the antigenic potency likely significant. Conversely, the presence of from one company that manufactures these an air conditioner or dehumidier that is not extracts to another. A more extensive discussion of approaches to testing for specific antibodies is provided in Appendix C because of the interest patients express in being tested for mold. The first one, Table C: Environmental Questionnaire, is designed for the patient to fill out independently in a few minutes. It consists of a set of questions that explore moisture and mold in the patients home, school, or work environment. Any positive response (except to questions on environmental tobacco smoke) may indicate uncontrolled moisture with a corresponding potential for biological growth. We recommend providing these patients (who presented with sentinel conditions or have temporal patterns of concern) with the list of suggested references in 37 Table C: Environmental Questionnaire (For Patients with Sentinel Conditions, Symptoms that Vary by Environment, or a History of Recurrent Moisture Incursion) About hour home Do you have a central humidifier or air conditioner V Yes V No Do you regularly see mold on tiles, ceilings, walls, or V Yes V No floors in your bathroom (other than occasionally on the shower curtain or tub enclosure) V Daily year Are there wet spots anywhere in your home, V Yes V No including your basement Environmental Tobacco Smoke* How many people who live in your home, or visit it Adults Children regularly, smoke on a daily basis For adult patients, please consider the locations and work environments where you spend most of your time outside your home to answer these questions. Do you usually smell a musty odor anywhere in this V Yes V No place or general work area Is there carpet in this place or classroom, or at your V Yes V No general work area We provided qualifying questions about air A Note on Humidifiers, Air conditioning, roof leaks, and plumbing leaks to Conditioners, and the Resource enable the clinician to explore the likelihood of List problem moisture. With concern over growth proliferating in drain pans, the presence of humidifiers and airthe second environmental evaluation tool, conditioners may be a reason to provide the Table D: Current Symptoms History and patient with the Resource List. Unless diligently maintained, these appliances hold Relationship to Home, Work, or School, is a grid substantial potential for supporting sources of the healthcare provider can use to guide an unhealthy bioaerosals. This is especially true exploration with the patient of his or her particular for central air conditioners. When a patient is symptoms and how he or she experiences them in experiencing illness or symptoms with even a suspicion of environmental association, it is specific home or work environments. This ques useful to provide the references on mold tionnaire can be completed either independently remediation. Once an asso ciation with a moist and/or moldy environment has been established for patients with either sentinel conditions (Table A) or common symptoms in temporal relationship with certain environments, especially wet or moldy ones (Table B), a discussion about the responses to Table D is helpful to more fully explore the patients potentially mold-related symptom(s). In addition, as stated earlier, we suggest this tool would be instructive with the third group of patients (those who are concerned generally over a potential mold exposure). A Public Health Model:the Sentinel Case Management and Remediation Once a building relationship is established, the healthcare provider is encouraged to exclude Medical Management and Follow-up a more general public health problem related Patient care for the treatment of building to the building. Without requesting names, the provider should ask whether other individuals related illnesses include (1) removal from the in the building have similar symptoms. In all states, if frequently, the first two are ignored and only multiple individuals are involved, the treating the underlying condition is emphasized. It is espe evaluate the building to identify the cause of cially important in conditions that may become the illness. Sources of water intrusion and irreversible, such as asthma and hypersensitivity mold amplification need to be identified and pneumonitis. Waking up first thing in the morning with a feeling of Y N Better Worse Same Better Worse Same tightness in your chest Waking up during the night Y N Better Worse Same Better Worse Same with shortness of breath Y N Better Worse Same Better Worse Same Extreme or unusual lethargy Y N Better Worse Same Better Worse Same and/or tiredness Y N Better Worse Same Better Worse Same Difficulty recalling names of Y N Better Worse Same Better Worse Same people you know This makes timely recognition of the condition and removal of the patient from expo A Note on the Use sure important. There is no support in the medical or scientific Environmental intervention could be a fix-it solution to elimi literature for this approach in the absence of documented nate moisture incursion and moldy materials by, for example, repair tissue invasion, and we do ing a leaky roof and replacing damaged materials, or it could involve not recommend the use of a program of improved maintenance. After remediation, clinical follow-up is critical in evaluating the success of the intervention. Fre quently, the offending mold can be decreased to a tolerable level, but once an individual is sensitized, this may not always be possible. Unfortunately, current methods of mold detection are not sensitive or quantitative enough to be able to determine if the exposure has been sufficiently decreased. The only assessment for someone very sensitized to mold is to allow the individual to return to the environment and monitor his or her condition carefully to determine if there is an exacerbation of symptoms. Once an individual has developed asthma, the asthma may not subside completely, even when exposure to the original agent has ceased (Chan-Yeung and Lam 1986, Chan-Yeung and Malo 1995). So, one must monitor the severity of asthmatic symptoms and the quantity and type of medications that are required for asthma control. At that point, the patient may be returned, on a trial basis and with careful oversight to detect exacerbation, to the remediated building. The medical management of allergic and irritant syndromes is no different for those related to mold exposure than for other types. Antihistamines, inhaled nasal corticosteroids, and inhaled pulmonary corticosteroids can be prescribed as needed.
Drought is a complex natural hazard and its impacts result from the interaction between the natural event (less precipitation than expected) and the demand people place on the water supply weight loss pills for teens buy cheapest shuddha guggulu, which may include agricultural weight loss pills names purchase shuddha guggulu 60 caps with visa, municipal weight loss journal discount 60 caps shuddha guggulu with visa, industrial weight loss patch purchase shuddha guggulu 60caps otc, and natural uses. First, the onset and end of a drought are difficult to determine due to the slow manifestation and lingering effects of an event after its apparent end. Second, the lack of an exact and universally accepted definition adds to the confusion of its existence and severity. Third, drought is not an event or incident-based hazard, but more of a long term condition with subtle, less obvious changes in 2018 36 2018 State of Arizona Hazard Mitigation Plan conditions that develop over a period of years and may be spread over large geographical areas. All economic activity within Arizona, including mining, irrigated agriculture, industry, tourism and urban and rural growth can occur only where dependable water supplies are available. As a result, Arizona places a high priority on managing its limited water to ensure that secure water 1 supplies are available now and well into the future. Sources for the water included the Colorado River (38%), groundwater (41%), in-state rivers (18%) and reclaimed water (3%). Throughout the last half-century, groundwater has been extracted more rapidly than it can be replenished, leading to a condition known as overdraft. In-state surface water from lakes, rivers, and streams is a major renewable resource for the state. Several storage reservoirs and delivery systems have been constructed throughout the state to make the best use of the surface water when and where it is needed, with the most notable being the systems located on the Salt, Verde, Gila, and Agua Fria rivers. Reclaimed water, or effluent, is the one water source in the state with potential for increase. As the population and water use grows, more treated wastewater will be available for use. Reclaimed water is treated to a quality that can be used for purposes such as agriculture, golf courses, parks, industrial cooling, or maintenance of wildlife areas. For 2017, La Paz and Yuma Counties were designated as primary disaster areas, with Maricopa, Mohave, Pima, and Yavapai Counties being named as contiguous disaster counties. Average annual precipitation 2 records dating from 1895 to present (121 years of record) provide a snapshot of past drought periods when evaluated on the basis of how the average annual precipitation for any given year varies from the normal of the whole data set. The period from 1979-1983 appears to have been anomalously wet, while the rest of the historical records shows that dry conditions are most likely the normal condition for Arizona. The four wetter than normal years within that period have brought some relief, but have not been enough to ameliorate the drought. The data suggests that extended drought is a normal condition in the southwest, and the wet decades of the 1970s and 1980s are uncharacteristic. A droughts severity depends on numerous factors, including duration, intensity, and geographic extent as well as regional water supply demands by humans, animals, and vegetation. Due to its multi-dimensional nature, drought is difficult to define in exact terms and also poses difficulties in terms of comprehensive risk assessments. This is due to the snapshot in time nature of drought severity and predictive tools. What is valid for today, will likely change in the next day, or week or month depending on the season, the amount of precipitation, or lack thereof, and user demand. The magnitude of drought is usually measured in time and the severity of the hydrologic deficit. The changing climate and continued population growth may increase the probability, extent, and severity of future drought events. Future potential for changes to a current drought cycle use meteorological modeling to develop predictions of near future temperature and precipitation levels, and then apply those data to assess future changes in drought severity. Publications and studies produced over the last 10-years generally agree on a potential warming trend over the past century that is st anticipated to continue into the 21 century. The same research is inconclusive on the amount of precipitation change expected, except that all tend to agree that a potential for reduction in snowpack and streamflow amounts are projected for parts of the Southwest, resulting in 1 National Weather Service, Climate Prediction Center. Given the current research, it is anticipated that drought cycles will continue and may worsen in the future when compared to the recent past. Even without reduced snowpack and precipitation, the warmer temperatures enhance evaporation leading to drier soil and vegetation. Changes in Development Increases in development that accompany the anticipated growth of Arizonas population and economy are all dependent upon reliable water sources. For each of the state regions, the water demands imposed by additional population and industry, and the ability to meet those demands, will be directly impacted by drought. Most of the growth anticipated over the next plan cycle is expected to concentrate around current population centers. Reduced yields from increasing temperatures and increasing competition for scarce water supplies may displace jobs in some 1 rural communities. North Regionthe majority of the anticipated growth in the North Region is expected to expand from existing cities and towns. The primary agricultural demand is livestock related water sources for range animals, which are not expected to grow significantly due to range management constraints. Drought impacts are less constraining in the Central Region due to the multiple sources of water available to Maricopa and Pinal Counties. In some areas, conversion of agriculture areas into residential and retail commercial development may change the water demand profile. South Regionthe most significant development in the South Region is expected to primarily occur in the Tucson Metropolitan Area. Drought is already causing development constraints where new development depends on access to a diminishing or highly regulated groundwater supply. Potential developments in Benson (Cochise County) have faced challenges in obtaining development rights, as the use of water might impact the health of 2 the San Pedro River. The severity and magnitude of the drought conditions, however, fluctuate in time and geography depending on the season, the amount of precipitation or lack thereof, and user demand. Drought generally is not a direct source of damage to state-owned facilities and no losses are estimated for this Plan. North Regionthe North Region is considered to be second-most vulnerable due to the multiple in-state surface water sources, higher precipitation rates, and lower average temperatures. The portions of Mohave and La Paz Counties that are generally situated along the Colorado River (Bullhead City, Lake Havasu City, Parker, etc. Range animals (both livestock and wildlife) are vulnerable to extended droughts as forage and water sources dry up. Vulnerable Population Groupsthe entire 2015 estimated population of 772,157 people are considered to be equally exposed to drought. Specific Areas of Concern Drought related declines in snowpack depths in the northern mountain areas will result in decreased surface water flows during the latter part of the summer and early fall, forcing a greater reliance on groundwater and reservoir storage. Depths to groundwater for many areas in the North Region make installing and operating wells very expensive. Increased 2018 41 2018 State of Arizona Hazard Mitigation Plan reliance on these groundwater resources during times of severe drought, or lowering of groundwater tables due to increased pumping rates, could become a significant problem. Long duration droughts will also dry forested areas, increasing the wildfire risk. The Fort Mojave Indian Reservation sits on the border of Arizona, California, and Nevada in the North Region. The reservation is experiencing extreme drought conditions that will impact their culture and traditional practices as it places greater stress on traditional fish, plant, and animal species. The Hualapai Tribe is also located in the North Region and also faces impacts from lack of water supply due to drought. The current water source for their population center of Grand Canyon West, is located 35 miles away and delivers only 45 gallons per minute. Central Regionthe Central Region is considered to be the least vulnerable to drought due to the availability of multiple water sources (Colorado River, Salt River Project, and groundwater). The only exception to this ranking would be if a severe drought were to persist or develop in the Colorado River Watershed since Colorado River water comprises a significant portion of the water currently used in the Central Region. Vulnerable Population Groupsthe entire 2015 estimated population of 4,604,414 people are considered to be equally exposed to drought. Reliance upon Colorado River water may result in a significant water shortage should the current drought cycle persist or worsen. Purchase on line shuddha guggulu. Weight Loss Surgery Across the Border: Bariatric Procedure in Mexico. |
