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INTRODUCTIONAs cardiac arrest occurs in around 20% of the patients with severe erectile dysfunction treatment, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in erectile dysfunction treatment levitra has buy levitra online with prescription become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving for patients, appears as an aerosol-generating procedure risking lives of HCPs caring for patients with erectile dysfunction treatment. Protected code blue algorithm has been buy levitra online with prescription formulated to address both performer and patient safety.3POCUS-INTEGRATED CPR. WHY THE NEED IN erectile dysfunction treatment?.

Danilo Buonsenso and colleagues have described erectile dysfunction treatment era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility. This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation buy levitra online with prescription and thus HCP exposure. Bedside ultrasound could act as visual stethoscope in the described scenario. Sono-CPR in erectile dysfunction treatment can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts.

Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk of buy levitra online with prescription transmission. Various algorithms are described for sono-cardiopulmonary resuscitation (sono-CPR) during cardiac arrest, but none are discussed to address patients with erectile dysfunction treatment.5 It would hence be wise to integrate bedside point-of-care ultrasound (POCUS) in the code blue algorithm.HOW THE BEDSIDE TOOL HELPS?. Hypoxemia and respiratory failure attribute over 80% aetiology of cardiac arrest in patients with erectile dysfunction treatment.1 Prioritising oxygenation and ventilation using definitive airway and use of high-efficiency particulate air filters reduces airborne transmission, thereby making early intubation the dictum of resuscitation.3 Considering poor visualisation due to fogging with the goggles and face shield, inability to use stethoscope and lack of availability of end-tidal CO2 (EtCO2) in resource constraint settings, ultrasound-guided real-time intubation by trained HCP or endotracheal tube (ETT) placement confirmation post intubation could prove beneficial. Confirming ETT placement and direct visualisation of oesophagal buy levitra online with prescription lumen can be done using a linear ultrasound probe.6 In cases of oesophageal intubation, tissue-air hyperechoic lines are visualised in both trachea and oesophagus, referred to as ‘double-track sign’.State of hypercoagulability and myocardial dysfunction exist in patients with erectile dysfunction treatment, hence increasing the likelihood of myocardial infarction or pulmonary thromboembolism as aetiologies of cardiac arrest.7 Regional wall motion abnormality, dilated right atrium or right ventricle, plethoric inferior vena cava are easily identified by goal-directed echocardiography.

Pneumothorax has been reported in patients with erectile dysfunction treatment, and ultrasound can identify absence of lung sliding, helping in quick needle thoracocentesis in arrest and peri-arrest cases. Few cases of cardiac tamponade owing to myopericarditis have also been reported and bedside ultrasound can help diagnose and perform pericardiocentesis in such patients.Literature suggests that the chances of Return Of Spontaneous Circulation (ROSC) and survival to hospital buy levitra online with prescription admission at 24 hours is better in patients with baseline cardiac activity rather than no baseline cardiac activity. In patients with no baseline cardiac activity on arrival, one can withhold CPR, thereby protecting the HCP in this resource-intensive, aerosol-generating futile resuscitative effort.8 Asystole could be the disguised entity of fine ventricular fibrillation, which can be confirmed by fibrillatory cardiac activity on transthoracic echocardiography and can be defibrillated, thereby increasing the chances of earlier ROSC.9POCUS-INTEGRATED CPR. THE PROPOSED ALGORITHMCPR is a chaotic scenario, and to prevent added chaos, there is a need for a well-trained ultrasound performer placed in an appropriate area (figure 1).

Intubating room needs to consist of minimal necessary number buy levitra online with prescription of HCPs, and all of them should be equipped with full PPE. Ultrasound device could be a potential fomite facilitating cross-transmission and requires adequate protection of machine and its components with a transparent cover, sheet or bag. When unavailable, low-level disinfectant solution should be used between each patient.Proposed algorithm for integration of POCUS during CPR in patients with erectile dysfunction treatment with team dynamics. The illustration buy levitra online with prescription is original work of the authors Dr Brunda RL and colleagues.

CPR, cardiopulmonary resuscitation. HCP, healthcare professional. POCUS, point-of-care buy levitra online with prescription ultrasound. PPE, personal protective equipment.

RA, right buy levitra online with prescription atrium. RV, right ventricle. VF, ventricular fibrillation. USG, ultrasonography." data-icon-position data-hide-link-title="0">Figure 1 Proposed algorithm for integration of POCUS buy levitra online with prescription during CPR in patients with erectile dysfunction treatment with team dynamics.

The illustration is original work of the authors Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional buy levitra online with prescription. POCUS, point-of-care ultrasound.

PPE, personal protective equipment. RA, right buy levitra online with prescription atrium. RV, right ventricle. VF, ventricular fibrillation buy levitra online with prescription.

USG, ultrasonography.When a patient experiences cardiac arrest, there is a need for HCPs with full PPE to check pulse and begin CPR as per standard guidelines. After 2 min of CPR, if there is no ROSC, during the 10 second pause for rhythm assessment, a trained HCP can perform POCUS in a stepwise manner. Each step needs to be performed individually during 10 second pause without prolonging delay buy levitra online with prescription between chest compressions and compromising the quality of CPR. Any treatable aetiology identified during the algorithm requires immediate intervention.Step 1.

Assess cardiac activity—Sub-xiphoid view can be procured and cardiac activity assessed. If absent, consider buy levitra online with prescription termination of efforts, and if present, resuscitative efforts can be continued.After repeating 2 min cycle of CPR, if there has been no ROSC, consider hypoxic aetiology as the cause of arrest in patients with erectile dysfunction treatment and intubate without delay. Withholding chest compressions during intubation is recommended.3Step 2. Assess ETT placement—At the level of thyroid gland, above the suprasternal notch, place ultrasound probe transversely and visualise the oesophagus.10 If the posterior wall of oesophagus is obscured by a dark acoustic shadow or if there is ‘double-track’ sign, consider failed endotracheal intubation and perform immediate re-intubation.Step 3.

Assess lung for pneumothorax—Assess lung sliding, and if absent look for ‘stratosphere sign’ in M-mode of ultrasound.10 If buy levitra online with prescription detected, perform immediate needle thoracocentesis.Step 4. Assess for Cardiac etiology of arrest—Obtain sub-xiphoid window preferably, and look for the presence of cardiac tamponade, chamber dilatation or collapse, regional wall motion abnormality and cardiac contractility.Availability of trained personnel and smaller portable ultrasound devices makes its use during cardiac arrest plausible.CPR with the help of POCUS could thus prove to improve chances of ROSC and also reduced transmission to HCP by early identification, treatment of reversible causes and avoidance of prolonged efforts. Sono-CPR appears to be more HCP-friendly than prolonged blind CPR and necessitates its utility in the era of erectile dysfunction treatment addressing performer safety as well as patient safety..

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In a study of adults with normal kidney function, those who had frequent depressive symptoms were more likely levitra and premature ejaculation to later experience a rapid decline in kidney function. The study will appear in an upcoming issue of CJASN.Depression is a common condition in middle-aged and older adults, and it can contribute to a variety of mental and physical problems. Previous research has found a link between depressive symptoms and rapid levitra and premature ejaculation kidney function decline in patients with chronic kidney disease (CKD). To look for a potential link in adults with normal kidney function as well, a team led by Xianhui Qin, MD (Nanfang Hospital, Southern Medical University, in China) examined information on 4,763 individuals with healthy kidneys when they enrolled in the China Health and Retirement Longitudinal Study (CHARLS).At the start of the study, 39% of participants had high depressive symptoms, and during a median follow-up of 4 years, 260 (6%) participants experienced rapid kidney function decline. There was a significant association between depressive symptoms at the levitra and premature ejaculation start of the study and rapid decline in kidney function during follow-up.

Participants with frequent depressive symptoms were 1.4-times more likely to experience rapid kidney function decline than participants with infrequent depressive symptoms, after adjustments."CKD is a leading risk factor for cardiovascular disease, kidney failure, and mortality worldwide. Therefore, the identification of more modifiable risk factors may possibly reduce the huge burden of CKD and its related complications by leading to early detection and prevention," said Dr. Qin. "While our study does not show causality, it demonstrated that high depressive symptoms were significantly associated with rapid decline in kidney function among Chinese adults with normal kidney function. If further confirmed, our data provide some evidence for depressive symptom screening and effective psychosocial interventions to improve the prevention of CKD."An accompanying Pantiet Voice article provides the perspective of a two-time kidney transplant recipient with an American-Born Chinese background.

Story Source. Materials provided by American Society of Nephrology. Note. Content may be edited for style and length.About 36 million people have blindness including 1 million children. Additionally, 216 million people experience moderate to severe visual impairment.

However, STEM (science, technology, engineering and math) education maintains a reliance on three-dimensional imagery for education. Most of this imagery is inaccessible to students with blindness. A breakthrough study by Bryan Shaw, Ph.D., professor of chemistry and biochemistry at Baylor University, aims to make science more accessible to people who are blind or visually impaired through small, candy-like models.The Baylor-led study, published May 28 in the journal Science Advances, uses millimeter-scale gelatin models -- similar to gummy bears -- to improve visualization of protein molecules using oral stereognosis, or visualization of 3D shapes via the tongue and lips. The goal of the study was to create smaller, more practical tactile models of 3D imagery depicting protein molecules. The protein molecules were selected because their structures are some of the most numerous, complex and high-resolution 3D images presented throughout STEM education."Your tongue is your finest tactile sensor -- about twice as sensitive as the finger tips -- but it is also a hydrostat, similar to an octopus arm.

It can wiggle into grooves that your fingers won't touch, but nobody really uses the tongue or lips in tactile learning. We thought to make very small, high-resolution 3D models, and visualize them by mouth," Shaw said.The study included 396 participants in total -- 31 fourth- and fifth-graders as well as 365 college students. Mouth, hands and eyesight were tested at identifying specific structures. All students were blindfolded during the oral and manual tactile model testing.Each participant was given three minutes to assess or visualize the structure of a study protein with their fingertips, followed by one minute with a test protein. After the four minutes, they were asked whether the test protein was the same or a different model than the initial study protein.

The entire process was repeated using the mouth to discern shape instead of the fingers.Students recognized struc¬tures by mouth at 85.59% accuracy, similar to recognition by eyesight using computer animation. Testing involved identical edible gelatin models and nonedible 3D-printed models. Gelatin models were correctly identified at rates comparable to the nonedible models. advertisement "You can visualize the shapes of these tiny objects as accurately by mouth as by eyesight. That was actually surprising," Shaw said.The models, which can be used for students with or without visual impairment, offer a low-cost, portable and convenient way to make 3D imagery more accessible.

The methods of the study are not limited to molecular models of protein structures -- oral visualization could be done with any 3D model, Shaw said.Additionally, while gelatin models were the only edible models tested, Shaw's team created high-resolution models from other edible materials, including taffy and chocolate. Certain surface features of the models, like a proteins pattern of positive and negative surface charge, could be represented using different flavor patterns on the model."This methodology could be applied to images and models of anything, like cells, organelles, 3D surfaces in math or 3D pieces of art -- any 3D rendering. It's not limited to STEM, but useful for humanities too," said Katelyn Baumer, doctoral candidate and lead author of the study.Shaw's lab sees oral visualization through tiny models as a beneficial addition to the multisensory learning tools available for students, particularly those with extraordinary visual needs. Models like the ones in this study can make STEM more accessible to students with blindness or visual impairment."Students with blindness are systematically excluded from chemistry, and much of STEM. Just look around our labs and you can see why -- there is Braille on the elevator button up to the lab and Braille on the door of the lab.

That's where accessibility ends. Baylor is the perfect place to start making STEM more accessible. Baylor could become an oasis for people with disabilities to learn STEM," Shaw said.Shaw isn't new to high-profile research related to visual impairment. He has received recognition for his work on the White Eye Detector app. Shaw and Greg Hamerly, Ph.D., associate professor of computer science at Baylor, built the mobile app which serves as a tool for parents to screen for pediatric eye disease.

Shaw's inspiration for the app came after his son, Noah, was diagnosed with retinoblastoma at four months of age.A new study of dozens of wild fish species commonly consumed in the Peruvian Amazon says that people there could suffer major nutritional shortages if ongoing losses in fish biodiversity continue. Furthermore, the increasing use of aquaculture and other substitutes may not compensate. The research has implications far beyond the Amazon, since the diversity and abundance of wild-harvested foods is declining in rivers and lakes globally, as well as on land. Some 2 billion people globally depend on non-cultivated foods. Inland fisheries alone employ some 60 million people, and provide the primary source of protein for some 200 million.

The study appears this week in the journal Science Advances.The authors studied the vast, rural Loreto department of the Peruvian Amazon, where most of the 800,000 inhabitants eat fish at least once a day, or an average of about 52 kilograms (115 pounds) per year. This is their primary source not only of protein, but fatty acids and essential trace minerals including iron, zinc and calcium. Unfortunately, it is not enough. A quarter of all children are malnourished or stunted, and more than a fifth of women of child-bearing age are iron deficient.Threats to Amazon fisheries, long a mainstay for both indigenous people and modern development, are legion. New hydropower dams that pen in big migratory fish (some travel thousands of miles from Andes headwaters to the Atlantic estuary and back).

Soil erosion into rivers from deforestation. Toxic runoff from gold mines. And over-exploitation by fishermen themselves, who are struggling to feed fast-growing populations. In Loreto, catch tonnages are stagnating. Some large migratory species are already on the decline, and others may be on the way.

It is the same elsewhere. Globally, a third of freshwater fish species are threatened with extinction, and 80 are already known to be extinct, according to the World Wildlife Fund.Different species of animals and plants contain different ratios of nutrients, so biodiversity is key to adequate human nutrition, say the researchers. "If fish decline, the quality of the diet will decline," said the study's senior coauthor, Shahid Naeem, director of Columbia University's Earth Institute Center for Environmental Sustainability. "Things are definitely declining now, and they could be on the path to crashing eventually."To study the region's fish, the study's lead author, then-Columbia PhD. Student Sebastian Heilpern, made numerous shopping trips to the bustling Belén retail market in the provincial capital of Iquitos.

He also visited the city's Amazon River docks, where wholesale commerce begins at 3:30 in the morning. He and another student bought multiple specimens of as many different species as they could find, and ended up with 56 of the region's 60-some main food species. These included modest-size scale fish known locally as ractacara and yulilla. Saucer-shaped palometa (related to piranha). And giant catfish extending six feet or more.

(The researchers settled for chunks of the biggest ones.)The fish were flown on ice to a government lab in Lima, where each species was analyzed for protein, fatty acids and trace minerals. The researchers then plotted the nutritional value of each species against its probability of surviving various kinds of ongoing environmental degradation. From this, they drew up multiple scenarios of how people's future diet would be affected as various species dropped out of the mix. advertisement Overall, the biomass of fish caught has remained stable in recent years. However, large migratory species, the most vulnerable to human activities, comprise a shrinking portion, and as they disappear, they are being replaced by smaller local species.

Most fish contain about the same amount of protein, so this has not affected the protein supply. And, the researchers found, many smaller fish in fact contain higher levels of omega-3 fatty acids, so their takeover may actually increase those supplies. On the other hand, as species compositions lean more to smaller fish, supplies of iron, zinc are already going down, and will continue to decline, they say."Like any other complex system, you see a tradeoff," said Heilpern. "Some things are going up while other things are going down. But that only lasts up to a point." Exactly which species will fill the gaps left when others decline is difficult to predict -- but the researchers project that the overall nutritional value of the catch will nosedive around the point where 40 of the 60 food species become scarce or extinct.

"You have a tipping point, where the species that remain can be really lousy," said Heilpern.One potential solution. In many places around the world where wild foods including fish and bush meat (such as monkeys and lizards) are declining, people are turning increasingly to farm-raised chicken and aquaculture -- a trend encouraged by the World Bank and other powerful organizations. This is increasingly the case in Loreto. But in a separate study published in March, Heilpern, Naeem and their colleagues show that this, too, is undermining human nutrition.The researchers observed that chicken production in the region grew by about three quarters from 2010 to 2016, and aquaculture nearly doubled. But in analyzing the farmed animals' nutritional values, they found that they typically offer poorer nutrition than a diverse mix of wild fish.

In particular, the move to chicken and aquaculture will probably exacerbate the region's already serious iron deficiencies, and limit supplies of essential fatty acids, they say. "Because no single species can offer all key nutrients, a diversity of species is needed to sustain nutritionally adequate diets," they write.Besides this, chicken farming and aquaculture exert far more pressure on the environment than fishing. In addition to encouraging clearing of forests to produce feed for the animals, animal farming produces more more greenhouse gases, and introduces fertilizers and other pollutants into nearby waters, says Heilpern."Inland fish are fundamental for nutrition in many low-income and food-deficit countries, and of course landlocked countries," said John Valbo Jørgensen, a Rome-based expert on inland fisheries with the UN Food and Agriculture Organization. "Many significant inland fisheries, including those of Peru, take place in remote areas with poor infrastructure and limited inputs. It will not be feasible to replace those fisheries with farmed animals including fish."Heilpern is now working with the Wildlife Conservation Society to produce an illustrated guide to the region's fish, including their nutritional values, in hopes of promoting a better understanding of their value among both fishermen and consumers.The other authors of the new study are Ruth deFries and Maria Uriarte of the Earth Institute.

And Kathryn Fiorella, Alexander Flecker and Suresh Sethi of Cornell University..

In a study of adults with normal kidney function, buy levitra online with prescription those who had frequent depressive symptoms were more likely to later experience a rapid decline in kidney function. The study will appear in an upcoming issue of CJASN.Depression is a common condition in middle-aged and older adults, and it can contribute to a variety of mental and physical problems. Previous research buy levitra online with prescription has found a link between depressive symptoms and rapid kidney function decline in patients with chronic kidney disease (CKD).

To look for a potential link in adults with normal kidney function as well, a team led by Xianhui Qin, MD (Nanfang Hospital, Southern Medical University, in China) examined information on 4,763 individuals with healthy kidneys when they enrolled in the China Health and Retirement Longitudinal Study (CHARLS).At the start of the study, 39% of participants had high depressive symptoms, and during a median follow-up of 4 years, 260 (6%) participants experienced rapid kidney function decline. There was a significant buy levitra online with prescription association between depressive symptoms at the start of the study and rapid decline in kidney function during follow-up. Participants with frequent depressive symptoms were 1.4-times more likely to experience rapid kidney function decline than participants with infrequent depressive symptoms, after adjustments."CKD is a leading risk factor for cardiovascular disease, kidney failure, and mortality worldwide.

Therefore, the identification of more modifiable risk factors may possibly reduce the huge burden of CKD and its related complications by leading to early detection and prevention," said Dr. Qin. "While our study does not show causality, it demonstrated that high depressive symptoms were significantly associated with rapid decline in kidney function among Chinese adults with normal kidney function.

If further confirmed, our data provide some evidence for depressive symptom screening and effective psychosocial interventions to improve the prevention of CKD."An accompanying Pantiet Voice article provides the perspective of a two-time kidney transplant recipient with an American-Born Chinese background. Story Source. Materials provided by American Society of Nephrology.

Note. Content may be edited for style and length.About 36 million people have blindness including 1 million children. Additionally, 216 million people experience moderate to severe visual impairment.

However, STEM (science, technology, engineering and math) education maintains a reliance on three-dimensional imagery for education. Most of this imagery is inaccessible to students with blindness. A breakthrough study by Bryan Shaw, Ph.D., professor of chemistry and biochemistry at Baylor University, aims to make science more accessible to people who are blind or visually impaired through small, candy-like models.The Baylor-led study, published May 28 in the journal Science Advances, uses millimeter-scale gelatin models -- similar to gummy bears -- to improve visualization of protein molecules using oral stereognosis, or visualization of 3D shapes via the tongue and lips.

The goal of the study was to create smaller, more practical tactile models of 3D imagery depicting protein molecules. The protein molecules were selected because their structures are some of the most numerous, complex and high-resolution 3D images presented throughout STEM education."Your tongue is your finest tactile sensor -- about twice as sensitive as the finger tips -- but it is also a hydrostat, similar to an octopus arm. It can wiggle into grooves that your fingers won't touch, but nobody really uses the tongue or lips in tactile learning.

We thought to make very small, high-resolution 3D models, and visualize them by mouth," Shaw said.The study included 396 participants in total -- 31 fourth- and fifth-graders as well as 365 college students. Mouth, hands and eyesight were tested at identifying specific structures. All students were blindfolded during the oral and manual tactile model testing.Each participant was given three minutes to assess or visualize the structure of a study protein with their fingertips, followed by one minute with a test protein.

After the four minutes, they were asked whether the test protein was the same or a different model than the initial study protein. The entire process was repeated using the mouth to discern shape instead of the fingers.Students recognized struc¬tures by mouth at 85.59% accuracy, similar to recognition by eyesight using computer animation. Testing involved identical edible gelatin models and nonedible 3D-printed models.

Gelatin models were correctly identified at rates comparable to the nonedible models. advertisement "You can visualize the shapes of these tiny objects as accurately by mouth as by eyesight. That was actually surprising," Shaw said.The models, which can be used for students with or without visual impairment, offer a low-cost, portable and convenient way to make 3D imagery more accessible.

The methods of the study are not limited to molecular models of protein structures -- oral visualization could be done with any 3D model, Shaw said.Additionally, while gelatin models were the only edible models tested, Shaw's team created high-resolution models from other edible materials, including taffy and chocolate. Certain surface features of the models, like a proteins pattern of positive and negative surface charge, could be represented using different flavor patterns on the model."This methodology could be applied to images and models of anything, like cells, organelles, 3D surfaces in math or 3D pieces of art -- any 3D rendering. It's not limited to STEM, but useful for humanities too," said Katelyn Baumer, doctoral candidate and lead author of the study.Shaw's lab sees oral visualization through tiny models as a beneficial addition to the multisensory learning tools available for students, particularly those with extraordinary visual needs.

Models like the ones in this study can make STEM more accessible to students with blindness or visual impairment."Students with blindness are systematically excluded from chemistry, and much of STEM. Just look around our labs and you can see why -- there is Braille on the elevator button up to the lab and Braille on the door of the lab. That's where accessibility ends.

Baylor is the perfect place to start making STEM more accessible. Baylor could become an oasis for people with disabilities to learn STEM," Shaw said.Shaw isn't new to high-profile research related to visual impairment. He has received recognition for his work on the White Eye Detector app.

Shaw and Greg Hamerly, Ph.D., associate professor of computer science at Baylor, built the mobile app which serves as a tool for parents to screen for pediatric eye disease. Shaw's inspiration for the app came after his son, Noah, was diagnosed with retinoblastoma at four months of age.A new study of dozens of wild fish species commonly consumed in the Peruvian Amazon says that people there could suffer major nutritional shortages if ongoing losses in fish biodiversity continue. Furthermore, the increasing use of aquaculture and other substitutes may not compensate.

The research has implications far beyond the Amazon, since the diversity and abundance of wild-harvested foods is declining in rivers and lakes globally, as well as on land. Some 2 billion people globally depend on non-cultivated foods. Inland fisheries alone employ some 60 million people, and provide the primary source of protein for some 200 million.

The study appears this week in the journal Science Advances.The authors studied the vast, rural Loreto department of the Peruvian Amazon, where most of the 800,000 inhabitants eat fish at least once a day, or an average of about 52 kilograms (115 pounds) per year. This is their primary source not only of protein, but fatty acids and essential trace minerals including iron, zinc and calcium. Unfortunately, it is not enough.

A quarter of all children are malnourished or stunted, and more than a fifth of women of child-bearing age are iron deficient.Threats to Amazon fisheries, long a mainstay for both indigenous people and modern development, are legion. New hydropower dams that pen in big migratory fish (some travel thousands of miles from Andes headwaters to the Atlantic estuary and back). Soil erosion into rivers from deforestation.

Toxic runoff from gold mines. And over-exploitation by fishermen themselves, who are struggling to feed fast-growing populations. In Loreto, catch tonnages are stagnating.

Some large migratory species are already on the decline, and others may be on the way. It is the same elsewhere. Globally, a third of freshwater fish species are threatened with extinction, and 80 are already known to be extinct, according to the World Wildlife Fund.Different species of animals and plants contain different ratios of nutrients, so biodiversity is key to adequate human nutrition, say the researchers.

"If fish decline, the quality of the diet will decline," said the study's senior coauthor, Shahid Naeem, director of Columbia University's Earth Institute Center for Environmental Sustainability. "Things are definitely declining now, and they could be on the path to crashing eventually."To study the region's fish, the study's lead author, then-Columbia PhD. Student Sebastian Heilpern, made numerous shopping trips to the bustling Belén retail market in the provincial capital of Iquitos.

He also visited the city's Amazon River docks, where wholesale commerce begins at 3:30 in the morning. He and another student bought multiple specimens of as many different species as they could find, and ended up with 56 of the region's 60-some main food species. These included modest-size scale fish known locally as ractacara and yulilla.

Saucer-shaped palometa (related to piranha). And giant catfish extending six feet or more. (The researchers settled for chunks of the biggest ones.)The fish were flown on ice to a government lab in Lima, where each species was analyzed for protein, fatty acids and trace minerals.

The researchers then plotted the nutritional value of each species against its probability of surviving various kinds of ongoing environmental degradation. From this, they drew up multiple scenarios of how people's future diet would be affected as various species dropped out of the mix. advertisement Overall, the biomass of fish caught has remained stable in recent years.

However, large migratory species, the most vulnerable to human activities, comprise a shrinking portion, and as they disappear, they are being replaced by smaller local species. Most fish contain about the same amount of protein, so this has not affected the protein supply. And, the researchers found, many smaller fish in fact contain higher levels of omega-3 fatty acids, so their takeover may actually increase those supplies.

On the other hand, as species compositions lean more to smaller fish, supplies of iron, zinc are already going down, and will continue to decline, they say."Like any other complex system, you see a tradeoff," said Heilpern. "Some things are going up while other things are going down. But that only lasts up to a point." Exactly which species will fill the gaps left when others decline is difficult to predict -- but the researchers project that the overall nutritional value of the catch will nosedive around the point where 40 of the 60 food species become scarce or extinct.

"You have a tipping point, where the species that remain can be really lousy," said Heilpern.One potential solution. In many places around the world where wild foods including fish and bush meat (such as monkeys and lizards) are declining, people are turning increasingly to farm-raised chicken and aquaculture -- a trend encouraged by the World Bank and other powerful organizations. This is increasingly the case in Loreto.

But in a separate study published in March, Heilpern, Naeem and their colleagues show that this, too, is undermining human nutrition.The researchers observed that chicken production in the region grew by about three quarters from 2010 to 2016, and aquaculture nearly doubled. But in analyzing the farmed animals' nutritional values, they found that they typically offer poorer nutrition than a diverse mix of wild fish. In particular, the move to chicken and aquaculture will probably exacerbate the region's already serious iron deficiencies, and limit supplies of essential fatty acids, they say.

"Because no single species can offer all key nutrients, a diversity of species is needed to sustain nutritionally adequate diets," they write.Besides this, chicken farming and aquaculture exert far more pressure on the environment than fishing. In addition to encouraging clearing of forests to produce feed for the animals, animal farming produces more more greenhouse gases, and introduces fertilizers and other pollutants into nearby waters, says Heilpern."Inland fish are fundamental for nutrition in many low-income and food-deficit countries, and of course landlocked countries," said John Valbo Jørgensen, a Rome-based expert on inland fisheries with the UN Food and Agriculture Organization. "Many significant inland fisheries, including those of Peru, take place in remote areas with poor infrastructure and limited inputs.

It will not be feasible to replace those fisheries with farmed animals including fish."Heilpern is now working with the Wildlife Conservation Society to produce an illustrated guide to the region's fish, including their nutritional values, in hopes of promoting a better understanding of their value among both fishermen and consumers.The other authors of the new study are Ruth deFries and Maria Uriarte of the Earth Institute. And Kathryn Fiorella, Alexander Flecker and Suresh Sethi of Cornell University..

What side effects may I notice from Levitra?

Side effects that you should report to your prescriber or health care professional as soon as possible.

  • back pain
  • changes in hearing such as loss of hearing or ringing in ears
  • changes in vision such as loss of vision, blurred vision, eyes being more sensitive to light, or trouble telling the difference between blue and green objects or objects having a blue color tinge to them
  • chest pain or palpitations
  • difficulty breathing, shortness of breath
  • dizziness
  • eyelid swelling
  • muscle aches
  • prolonged erection (lasting longer than 4 hours)
  • skin rash, itching
  • seizures

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

  • flushing
  • headache
  • indigestion
  • nausea
  • stuffy nose

This list may not describe all possible side effects.

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