#James M. Lupus
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Systemic Lupus Erythematosus Case Study Systemic Lupus Erythematosus Systemic lupus erythematosus (SLE) is a chronic, life-long autoimmune disease that affects multiple tissues and organs in the body (Madhok and Wu, 2009). The primary tissues and organs affected by immune system dysfunction are the joints, kidneys, vessel walls, and skin. SLE is believed to be due to an interaction between genetic factors and environmental triggers. The disease is also more prevalent among women, which is consistent with the possibility that hormones play some role in disease etiology. Of primary concern is lupus glomerulonephritis (Madhok and Wu, 2009). Other serious complications include cardiovascular and neuropsychiatric involvement. Most patients will experience arthritis or joint pain (84%), fever (52%), malar rash (58%), and photosensitivity (45%). Accordingly, a diagnosis of SLE will depend in part on a blood test for anti-nuclear antibodies (ANA) and presentation with rash, joint pain, fatigue, and/or low-grade fevers. The pain in Vicki's knees, shoulders, and elbows is the result of inflammation, which is caused by an autoimmune reaction to cartilaginous tissue in the joints (A.D.A.M., 2013). The fever is most likely low grade and due to systemic inflammation and the frequent infections is the result of immune dysfunction. Inflammation is also the cause of the prototypical butterfly rash. The anemia could be the result of iron deficiency, possibly due to frequent menstruation or gastrointestinal bleeding; however hemolytic anemia is another possibility. Hemolytic anemia has been associated with very high serum levels of cardiolipin auto-antibodies. The hardening of the skin over the fingers is not a symptom of SLE, but of scleroderma, another autoimmune disease. Scleroderma is caused by excessive collagen deposition reminiscent of what happens during wound repair. SLE and scleroderma can co-occur. Laboratory tests will probably reveal the following: 1. ANA titer above 1:40 (Gill, Quisell, Rocca, and Walters, 2003) 2. CBC revealing lower than normal RBC count, hemoglobin, and hematocrit indicating iron deficiency (Schrier, 2013) or a positive erythrocyte antibody screen consistent with a diagnosis of hemolytic anemia (ABSCM) (Mayo Medical Laboratories, 2013) 3. CBC with differential showing a low white blood cell count Renal inflammation due to progressive SLE can be devastating. Close to 50% of SLE sufferers will experience nephritis due to the deposition of cellular debris generated by the autoimmune process (A.D.A.M., 2013). The kidneys could also become a direct target of the immune system, resulting in destruction of the organ. In 30% of SLE patients kidney function will become seriously impaired or fail altogether. If lupus nephritis has not developed with 10 years of SLE onset, however, it is unlikely to ever occur. If Vicki is not already taking the anti-malarial drug hydroxychloroquine she should, to help with the joint pain and rash (Madhok and Hu, 2009). Corticosteroid use should be discontinued and methotrexate would not be advisable given the history of frequent infections. Limited use of NSAIDs is allowed. Iron supplementation could be beneficial if the anemia is due to iron deficiency. Madhok and Wu (2009) examined the research literature for studies investigating the efficacy of medications commonly used to treat SLE and found the number of high-quality randomized controlled trials was limited. Drug efficacy for treating SLE symptoms continues to be a central focus of lupus research, although there is growing interest in biological (Hedberg, Kanapathippillai, Rekviq, and Fenton, 2013) and alternative medical treatments (Zhong et al., 2013). References A.D.A.M. (2013, Mar. 14). Lupus in-depth report. Reviewed by H. Simon and D. Zieve. New York Times. Retrieved 7 Nov. 2013 from http://health.nytimes.com/health/guides/disease/systemic-lupus-erythematosus/print/html. Gill, James M., Quisell, Anna M., Rocca, Peter V., and Walters, Dene T. (2003). Diagnosis of systemic lupus erythematosus. American Family Physician, 68, 2179-2186. Hedberg, A., Kanapathippillai, P., Rekviq, O.P., and Fenton, K.A. (2013). SMW heparin prevents increased kidney expression of proinflammatory mediators in (NZBxNZW) F1 mice. Clinical & Developmental Immunology, published 17 Sep. 2013 online ahead of print. Available 9 Nov. 2013 from http://www.hindawi.com/journals/cdi/2013/791262/. Madhok, Rajan and Wu, Olivia. (2009). Systemic lupus erythematosus. Clinical Evidence, 7(1123), 1-29. Mayo Medical Laboratories. (2013). Test ID: ABSCM. Antibody screen, erythrocytes. Mayo Clinic. Retrieved 8 Nov. 2013 from http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8956. Schrier, Stanley L. (2013). Patient information: Anemia caused by low iron (beyond the basics). Wolters Kluwer Health. Retrieved 8 Nov. 2013 from http://www.uptodate.com/contents/anemia-caused-by-low-iron-beyond-the-basics. Zhong, L.L., Bian, Z.X., Gu, J.H., Zhou, X., Tian, Y., Mao, J.C. et al. (2013). Chinese herbal medicine (Zi Shen Qing) for mild-to-moderate systemic lupus erythematosus: A pilot prospective, single-blinded, randomized controlled study. Evidence-Based Complimentary and Alternative Medicine: eCAM, 2013, 327245. Read the full article
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I drew more about James
I LOVE MY HARE SOOOOO MUCH ;-;
I have to play Jonah's route soon
#march hare alice#march hare#oc#my art#my oc#ikemen revolition#ikerev#ikemen revolution march hare#i love my hare so much#WHY IKEREV DOESNOT HAD MARCH HARE???????#please dont steal james i forget write my name T_T#James M. Lúpus#James M. Lupus
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BLOGTOBER 10/17/2022: WOLFEN
WOLFEN is a fascinating thriller that is unflaggingly compelling in spite of its somewhat clunky social commentary. Its broad indictments of manifest destiny, and of the scourge of capitalism, are easily grasped in comparison with the collection of details and red herrings one has to chew through to get to the heart of this murder mystery about a series of apparent animal attacks plaguing New York City. Political aspirations aside, though, the visually stunning film is as much about the nature of perception as it is about anything else.

Adapted from a Whitley Strieber novel by director Michael Wadleigh (best known for the Oscar-winning documentary WOODSTOCK) and David M. Eyre, Jr., WOLFEN begins with the bizarre murder of an elite business mogul. The police have identified a revolutionary terrorist group as the guilty party, but the unusual killings continue with other, more innocent, less fortunate victims. Captain Dewey Wilson (Albert Finney) realizes that there is more to the story when he discovers that these specific acts of violence could only have been perpetuated by wolves—and further evidence ties these slayings to Eddie Holt (Edward James Olmos), a Native American who claims he can shape-shift into an animal form.

Wilson may be an enforcer for white, capitalist civilization, but he himself is only half-domesticated. He has been retrieved from an early retirement to work this case following an unspecified personal implosion, and his cagey demeanor suggests that whatever traumatized him then isn't done with him yet. When his reluctant partner, criminal psychologist Rebecca Neff (Diane Venora), asks why he became a cop, he replies, "I like to kill. It's a habit I picked up, and it's hard to shake." When she presses him, he first claims that he simply wounded a fellow officer while cleaning his gun; when she asks again if he's really killed before, he replies, "Why don't you ask how many?" We never find out exactly what is haunting Captain Wilson, but the film makes a sharp distinction between the importance of what we are told, versus what we perceive.

Coroner Whittington (Gregory Hines) introduces Wilson and Neff to a zoologist named Ferguson (Tom Noonan), who puts the team onto the idea that the murders most resemble wolf attacks. Ferguson is a classic wolf nerd, which is a whole Type in my personal experience: a usually-male fan of the species who jealously lauds Canis lupus's advanced form of society and perceived nobility, along with their hunting prowess. And, like many wolf nerds, Ferguson has a fetishistic attitude toward Native Americans, onto whom he transposes many of the qualities he so admires in his favorite animal. He seems to accept the notion of shape-shifters, too, as he excitedly declares, "The body is just a physical expression of the soul…reality is just a state of mind!"

In WOLFEN, reality is linked less to accumulated legal evidence, and more to the senses, which are extended in various ways. One of its more fantastical elements is the state of police surveillance, which involves a high tech command center that looks like something out of GHOST IN THE SHELL. In addition to the ability to monitor parts of the city, they are able to monitor the inside of a person, as Neff rakes various terrorist suspects over the coals in a chamber that is alive with finely tuned sensors. "The whole room is a lie detector!" its operator remarks, as he reviews thermographic readouts and voice analyses, looking for signs of stress and deception. These borderline sci-fi touches are unusual in the werewolf genre, which is usually rather earthy. However, the somewhat trippy aesthetic of these scenes is mirrored by the innovative, infrared-like photography (later used in PREDATOR) that represents the roving wolves' first-person point of view.

WOLFEN'S innovative ways of depicting sensory perception are complimented by the vision it offers of New York City, which is rarely accessible for most people. The wolves' hunting ground is the South Bronx, which in 1981 resembled the Berlin of 1945, utterly devastated and abandoned by all but the most desperate survivors. Even if you are aware of the state of such places and how they got that way, Gerry Fisher's extensive photography of this location from above and below is deeply shocking. In contrast, Fisher also gives us a stunning view of prosperous lower Manhattan from the very peak of the Brooklyn Bridge, from which Eddie Holt and other Native construction workers can see how the other half lives.

Late in the film, a battered and beleaguered Wilson wanders into the Wigwam Bar, a dive populated by Eddie's community. There, he hears about the Wolfen, semi-divine shapeshifters that the police cannot hope to defeat. "You've seen them, haven't you?" Eddie says, observing Wilson's fascinated acceptance of this story. The spell is suddenly broken by another man, who remarks dryly, "This is all just Indian jive. We've been watching too many cowboy movies!" Eddie sneers ironically at Wilson as he chimes in, "Don't even think about believing any of this shit. It's the 20th century. We got it all figured out." In this scene, the key point is about what Wilson has seen. His direct, sensory experience is elevated in importance above data, documentation, circumstantial evidence, and cultural prejudices about the nature of reality. Those other, indirect items that make up our perceptions, but that do not belong to us, are a part of how larger forces control the narrative of what happened to the Native population of America, and what still happens to places like the South Bronx.

#blogtober#blogtober 2022#wolfen#horror#supernatural#werewolf#shapeshifter#folk horror#native american#michael wadleigh#whitley strieber#adaptation#thriller#gerry fisher#albert finney#diane venora#david m. eyre jr#tom noonan#gregory hines#edward james olmos
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Tattoos I Think Sirius Had.
Canis Major, Lupus and Leo constellations going down his spine.
M W P P (Moony, Wormtail Padfoot and Prongs) on his right knuckles, after he broke out of Azkaban, he got the W removed and replaced it with an E for “Evans”
A crescent moon on his ring finger.
Four trails of the footprints from the Marauders Map that travel up his arm and turned into all their paw prints. He later had the one that turned into rat paws removed.
The moon phases across his forearm.
The Gryffindor lion across one side of his chest.
“Gay” on his inner lip.
Line-art of a stag head somewhere on his arm.
A pink triangle somewhere.
Post-POA, he got a pair of round glasses for James and Harry.
#wizarding world#marauders#marauders era#sirius black#remus lupin#regulus black#lily evans#peter pettigrew#james potter#harry potter#canis major#lupus constellation#leo#sirius#regulus#moony wormtail padfoot and prongs#moony#wormtail#padfoot#prongs#wolfstar#moon#moon phases#werewolf#lycanthrope#lycanthropy#animagus#gryffindor#gay#tattoo
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Living the Life
read it on the AO3 at https://ift.tt/3DgCwOD
by pineapplepnut
Regulus has type 1 and I want to write one-shots about his life, sue me.
Words: 1804, Chapters: 1/?, Language: English
Fandoms: Harry Potter - J. K. Rowling
Rating: Mature
Warnings: Creator Chose Not To Use Archive Warnings
Categories: F/F, F/M, M/M
Characters: Regulus Black, James Potter, Sirius Black, Remus Lupin, Lily Potter, Marlene McKinnon, Dorcas Meadows, Narcissa Malfoy, Lucius Malfoy, Draco Malfoy, Bellatrix Lestrange, Walburga Black, Orion Black, Euphemia Potter, Fleamont Potter, Barty Crouch Jr
Relationships: Sirius Black/Remus Lupin, James Potter/Lily Potter, Dorcas Meadows/Marlene McKinnon, Lucius Malfoy/Narcissa Malfoy
Additional Tags: Regulus had Type 1, Sirius is a nurse, sirius is overprotective, James is a motherhen, Muggle AU, Remus also has Lupus
read it on the AO3 at https://ift.tt/3DgCwOD
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canis lupus
read it on the AO3 at https://ift.tt/32dc4lD
by xniccky
Una storia Steve/Tony!omegaverse molto particolare e insolita, che vedrà i nostri protagonisti nelle sembianze di lupi sotto ogni aspetto. Tranne un piccolo particolare: è una storia ABO dopotutto.
Steve è un omega con un passato, seppur breve, molto tormentato e infelice, che sta cercando di lasciarsi alle spalle. Bucky è il suo unico appoggio ora che non ha più un branco, ma la convivenza nomade dei due è tutt'altro che facile specialmente quando l'omega è in calore. Tony è un alfa giovane e senza una preoccupazione al mondo. La fortuna si farà avversa nel momento in cui poserà lo sguardo su un omega dal manto argenteo che non avrà nessuna intenzione di approfondire la sua conoscenza. Nonostante le avversità l'alfa trova difficile prendere le distanze e voltarsi tutto alle spalle. Tutto andrà a rotoli, numerose volte e in situazioni tutt'altro che piacevoli che riporteranno alla luce vecchie ferite.
Alla fine di tutto ne sarà valsa la pena? Ai posteri l'ardua sentenza.
Words: 12, Chapters: 1/?, Language: Italiano
Fandoms: The Avengers (Marvel) - All Media Types, The Avengers (Marvel Movies), Iron Man (Movies), Captain America (Movies)
Rating: Explicit
Warnings: Creator Chose Not To Use Archive Warnings, Rape/Non-Con
Categories: M/M, Multi
Characters: Steve Rogers, Tony Stark, James "Bucky" Barnes, Avengers Team (MCU)
Relationships: Steve Rogers/Tony Stark
Additional Tags: Alpha Tony Stark, Omega Steve Rogers, Alpha Bucky Barnes, Alpha/Beta/Omega Dynamics, Implied Mpreg, Alternate Universe, Sex, Mating Cycles/In Heat, Mating Bond, Tony Stark Has A Heart, Bottom Steve Rogers, Top Tony Stark, Protective Avengers
read it on the AO3 at https://ift.tt/32dc4lD
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Top Festivals in Croatia
Single price ticket costs for these events vary between a hundred and 2330 kuna and with the exception of the festivals on the coast, one among them are going to be control in Slavonia, Croatia’s most japaneseregion. Based on the votes of the distinguished British DJ Magazine, the Croatian clubs may be terribly pleased with the inclusion on the list of the simplest clubs within the world. Six clubs square measure among the forty best within the world and also the voters have expressed their feelings regarding the atmosphere on the Croatian coast thus we {will|we are able to} expect that the organizers will do their best to form2018 even higher than the previous year. the amount of festivals grows once a year, a spread of genres at festivals throughout European country permit everybody to search out one thing for themselves and their friends to get pleasure from and have an honest time. Also, for a few of them, you'll still obtaintickets at the first bird value. The first event is that the echinoderm pageant http://www.seastarfestival.com/ (from twenty four to twenty seven May), that was control last year for the primary time in Umag, welcome quite fifty,000 guests from seventy completely different countries, exposes however huge this pageant extremely is. There square measure seven stages within the famed laguna of the Frank Stella Maris advanced and considering the various genres, we tend to square measure certain that everybody can realize their favorite stage. huge names are confirmed, like Dimitri Vegas & Like electro-acoustic transducer, the Belgian brothers WHO take second place on the list of the simplest DJs of nowadays. There square measure also: Hurts, Disciples, Robin Charles M. Schulz, Paul van Dyk, Detour, Dječaci, Krešo Bengalka … the value for the ocean Star pageant is 279 kunas. Big names are confirmed, like Dimitri Vegas & Like electro-acoustic transducer, the Belgian brothers WHOtake second place on the list of the simplest DJs of nowadays. There square measure also: Hurts, Disciples, Robin Charles M. Schulz, Paul van Dyk, Detour, Dječaci, Krešo Bengalka Events at Papaya https://papaya.com.hr/ begin at the top of could (May 31st) once the large Beach recessstarts. For now, there are confirmed performances by electro-acoustic transducer Candy, Rene Rodrigezz, David Puentez, Sheko, and Trevon. the value of a three-day pageant price ticket is 370 kunas. At the top of Gregorian calendar month (from twenty five to twenty seven June), the thirteenth edition of the foremost famed pageant in Zagreb, INMusic festivalhttps://www.inmusicfestival.com/ are going to becontrol at Jarun lake. free performers square measure Queens Of The period, Nick Cave & The dangerousSeeds, Interpol, Alice bound, David Byrne, St. Vincent, Portugal. The Man, The Kills, Bombino, Frank Carter & The Rattlesnakes, Forest, Reykjavíkurdætur, Tshegue, Super Besse and lots of others. Tickets may bepurchased at a value of 470 kunas, and there's a break of shopping for inhabitation price ticket for 265 kunas. A sixth day of remembrance, from Gregorian calendar month sixth to Gregorian calendar month eighth, are going to be celebrated by radical Europe https://ultraeurope.com/ , the eu edition of the radicalMusic pageant, the foremost famed electronic music pageant within the world. once the top of the third day, the complete story goes to Brač, wherever the fun can continue on the beach known as ‘Zlatni rat’. The second island to be visited by lovers of this pageant are going to be Hvar (July 10th), whereas the topis reserved for the island of Vis on Gregorian calendar month eleventh. Afrojack, Alesso, Arminius van Buuren, Axwell & Ingrosso, Carl Cox, David Guetta, DJ Snake, Hardwell, Steve Angello, The Chainsmokers are going to be performers within the Split, whereas Hvar is set-aside for Fedde lupus erythematosusGrand, Nicky Romero, Jonas Blue, Joseph Oliver Heldens and San Holo. price ticket value for the primary a part of the pageant is 1300 kunas. In time period (10 – twelve July) the contemporary Island pageant https://www.fresh-island.org/ (with hip-hop and R’n’B music) are going to be prevailed Zrće. within the past, this pageant brought hugenames like Sean Paul, wizard Khalifa, and Chris Brown whereas the leading name of this year’s list is that the seventeen-year-old Lil Pump. contemporary Island is additionally set-aside for Goldlink, J Hus, Stefflon Don, Tim Westeood, Statik Selektah, Cheese on Bread, Faded, Shorebitch, Shorty Bless, thuscontemporary thus Clean and Stamina. guests will be able to visit the Boat Party (ticket value is 240 kunas). An exception to the festivals on the Croatian coast are going to be Ferragosto JAM http://ferragostojam.com/, which is able to be control from August a pair of to five August on Orahovica lake. after you see the list of performers: TRAM eleven, pipschips & videoclips, Bolesna Braća, Mašinko, Bad Copy, Zdenka Kovačiček, J.R. August, Shank, No Smoking, High5, Space, Sass, Chui, and Killed A Fox, we are able to conclude that the organizers have created certain that each traveler enjoys their genre. Tickets may be purchased in pre-sale, at a price of a hundred kunas. For now, solely a price ticket package of 2330 kuna is offered, which has a pageant price ticket, accommodation, and a few drinks. When you see the list of performers: TRAM eleven, pipschips & videoclips, Bolesna Braća, Mašinko, Bad Copy, Zdenka Kovačiček, J.R. August, Shank, No Smoking, High5, Space, Sass, Chui, and Killed A Fox, we are able to conclude that the organizers have created certain that each traveler enjoys their genre. Papaya https://papaya.com.hr/ , Aquarius http://www.aquarius.hr/ , and Kalypso https://kalypso-zrce.com/ are going to be home of the Sonus pageant https://www.sonus-festival.com/ (from August nineteenth to 23rd). For now, solely a price ticket package of 2330 kuna is offered, which has a pageant price ticket, accommodation, and a few drinks. The performers can be: Adam Beyer, Adriatique, Agoria, Chris Liebing, D’julz, Dana Ruh, Dixon, Dorian Paic, Constantine, Luigi Madonna, Maceo Plex, Marco Carola, Rhadoo, David Ricardo Villalobos, Richie Hawtin, Seth Troxler, Solomun (Official), Sonja Moonear et al. The end of August and also the starting of Sept square measure reserved for the size pageant https://dimensionsfestival.com/line-up/ , which is able to be prevailed eleven stages, whereas the guestswill be able to party on the boats and beaches. The pageant can surface from the twenty ninth of August till the third of Sept at Fort Punta Christo in Botswana monetary unit. The price ticket value is four hundred kunas, and a few of the performers square measure Jon Hopkins, Bonobo, Lena Willikens, Amp Fiddler, Helena Hauff, urban center In impact, Semitic deity Kraviz, Batu, Peggy Gou, James Holden & The Animal Spirits, Azymuth & Marcos Valle Alfa Mist, Kraftwerk, Moodymann … The Outlook pageant https://outlookfestival.com/ are going to be control at constant location from Septfifth to Sept tenth, wherever fans of bass, d’n’b, dub, reggae, lurking, hip-hop, jungle, and dubstep canrealize their favorite stage. Jay, Commodore, Jodie, Jhus, X-Men, X-Men, Jie Hou, Stefflon Don, Kojey Radical, Mist, Madam X, kids of Zeus, AJ Tracey, David Rodigan, Channel One, Bonobo, Andy C, Noisia, Digital Mystikz, Gantz and Lamont, designer & Neek, Channel One, Icing Steppas, Confederate soldier Clarke, Digital Mystikz, Silkie, Truth, Kaiju, A / T / O / S, Sicaria Sound, India and Jack Sparrow square measure just a few of the performers WHO can perform at this pageant. the value for Outlook pageant is four hundredkunas.
https://zajed.no/
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Strongly Interacting Species:Conservation Policy,Management, and Ethics
MICHAEL E. SOULÉ, JAMES A. ESTES, BRIAN MILLER, AND DOUGLAS L. HONNOLD
Any legislation or other policy instrument based onempirical science is prone to senescence. Consider theUS Endangered Species Act (ESA) of 1973. This was the firstfederal statute to grant de facto existence rights to species ofplants and animals (Varner 1987) and to impose binding, en-forceable duties on government agencies and private citi-zens to protect imperiled species. The ESA was based on thebest science of the time (Bean and Rowland 1997), and it stillremains in the vanguard of worldwide species protection ef-forts. However, the ESA, like other environmental laws fromthe 1970s, was enacted before conservation biology existed asa discipline, before the field of population viability analysisexisted, before ecologists understood many of the ecosys-tem consequences of species interactions and community dy-namics (Terborgh et al. 1999), and before the spatial andtemporal scale–related complexities of effective protection ofvulnerable species were widely understood (Soulé et al. 2003).Although the ESA was revised and reauthorized in 1988, itdoes not reflect many advances in population biology andcommunity ecology.
Among the scientific anachronisms in this law is the absenceof specific reference to species interactions that contribute sub-stantially to the maintenance of ecological and species diversity.Not only has the understanding of interaction webs ad-vanced (Menge 1995), but it is now widely understood thatthe disappearance of a strongly interactive species can lead toprofound changes in ecosystem composition, structure, anddiversity (Soulé and Terborgh 1999, Terborgh et al. 1999,Oksanen and Oksanen 2000, Schmitz et al. 2000, Soulé et al.2003). For instance, decimation of great whales by industrialwhaling substantially altered krill-consumer dynamics in theSouthern Ocean, and whaling has been proposed as the maincause of a recent megafaunal collapse in the North PacificOcean (Springer et al. 2003). In addition, the disruption offruit dispersal and seed-set patterns following early Holocenemegafaunal extinctions fundamentally altered the speciescomposition of neotropical forests (Janzen and Martin 1982),and the functional dynamics of coastal marine ecosystemsworldwide have been grossly altered by overfishing of largeherbivores and predators (Jackson et al. 2001).The functional extinction of species interactions often oc-curs well before the species themselves have completely dis-appeared. In the oceans, many large, interactive species persistonly as rare adults, or as small or juvenile individuals that donot interact like large adults, qualitatively or quantitatively.
On land, many large animals and other strongly interactivespecies are completely missing from vast areas that they oc-cupied a century or two ago (Laliberte and Ripple 2004). Glob-ally, many, if not most, large-bodied, strongly interactingspecies are increasingly rare, even if they persist in parts of theirformer range. A reasonable hypothesis is that ecosystemsthat have lost one or more strongly interactive species are des-tined to undergo profound degradation and simplification over time.
Nevertheless, most conservation laws, including the ESA,fail to reflect the effects of widespread ecological disappear-ances of strongly interacting species and the resulting ecosys-tem perturbations. For example, the current criteria forrecovery of endangered mammal species under the ESA gen-erally ignore interspecies interactions altogether (Soulé et al.2003), emphasizing short-term, single-species, demographicviability in only a few circumscribed areas. Indeed, manycurrent recovery plans, at least for mammals, call for no in-crease in numbers of individuals, numbers of populations, orgeographic range (Tear et al. 1995; but see USFWS 1998,Jennings 1999). Here we propose that population densities of strongly in-teractive species must not be permitted to fall below thresh-olds for ecological effectiveness, and that the geographicranges of such species should be as large as possible (Conner1988, Soulé et al. 2003). Before this proposal can be imple-mented, however, two issues must be clarified: (1) the defi-nition of strongly interactive species and (2) the achievementof ecologically effective densities of such species.
What are strongly interactive species?
The idea that some species interact more strongly than oth-ers is not new. Paine (1969) first used the term “keystonespecies” for particularly strong interactors: those, for exam-ple, whose activities maintain species and habitat diversity andwhose effects are disproportionate to their abundance (Kotliaret al. 1999). It is worth noting that Paine’s idea, one of the mostinfluential in all of modern ecology, is fundamentally a the-ory of species diversity—that the presence or absence of oneor several key species influences the distribution and abun-dance of many other species. Ecologists recognize, however,that the keystone designation artificially dichotomizes speciesinto groups such as “strongly interactive” (or keystone) and“non-strongly interactive” (Mills et al. 1993). Though such du-alisms have limited utility in science, this particular one is help-ful in education and advocacy.
Species that are relatively interactive have been catego-rized according to the kind of ecological interaction that ismost evident. Among these interactions are habitat enrich-ment, mutualisms, predation,and competition.Species whoseactivities affect and enhance physical or biological habitatstructure have been referred to as “ecological engineers”(Jones et al. 1994). Ecological engineers significantly modifytheir habitat in ways that increase local species diversity.Beavers (Castor canadensis), for instance, create wetlands bybuilding dams in streams. Other examples of ecological en- gineering include mound building by termites, burrowing andgrazing by prairie dogs (Cynomysspp.), and habitat conver-sion by elephants (Loxodonta africana) and bison (Bison bi-son) (Naiman et al. 1988, Owen-Smith 1988, Detling 1998,Kotliar et al. 1999).Mutualist species, by virtue of their interactions, can alsomaintain species diversity. An example is the relationshipbetween the whitebark pine (Pinus albicaulus) and Clark’s nut-cracker (Nucifraga columbiana). Clark’s nutcracker is stronglydependent on the seeds of the whitebark pine, and the pinedepends on the nutcracker for the dispersal of its seeds intocaches. These seed caches are also a major food source for bothsmall vertebrates and grizzly bears (Ursus arctos) in theGreater Yellowstone ecosystem (Mattson et al. 1992). Terborgh and colleagues (1999) describe how the loss ofapex mammalian predators can precipitate ecological chainreactions that lead to profound degradation and species loss.Although top-down forcing through three or more trophiclevels has been demonstrated for nonvertebrate taxa (Stronget al. 1996, Terborgh et al. 2001), space constraints and im-mediate policy relevance preclude a detailed review here.Many predator-mediated chains of reaction have been de-scribed or postulated (Estes and Palmisano 1974, Pace et al.1999, Terborgh et al. 2001); some of these (ecological cascades)are summarized in figure 1 and further elaborated in figure2. Figure 2a illustrates the familiar case of gray wolves (Ca-nis lupus) in Yellowstone, representing the scenario in whichthe extirpation of a large carnivore leads to the ecological re-lease of large terrestrial ungulates and other herbivores, caus-ing changes in vegetation structure, species composition,and diversity.
Crooks and Soulé (1999) demonstrated the behavioral re-lease of mesopredators in patches of coastal sage scrub andchaparral in southern California, where the local absence ofcoyotes (Canis latrans) led to an increase in the activity of thehouse cat (Felis catus), in turn causing reductions of native,scrub-requiring bird species (figure 2b). An impressive caseof competitive release (Paine 1966) was described by Henkeand Bryant (1999) and is illustrated in figure 2c. They doc-umented a reduction of rodent diversity from 12 species tojust 1 as a result of coyote removal; the survivor was thecompetitively dominant kangaroo rat,Dipodomys ordii.Thefourth example (figure 2d)—the case of sea otters (Enhydralutris) and kelp forest—is described below.
The fifth example (figure 2e) of a predator-mediated eco-logical cascade is hypothesized to have begun with the deci-mation of the great whales by industrial whaling followingWorld War II. Springer and colleagues (2003) suggest that aseries of ecological extinction events affecting pinnipeds andsea otters in the northern Pacific Ocean and the Bering Seawas initiated when killer whales (Orcinus orca), followingthe effective disappearance of large baleen whales, expandedtheir diets. Though baleen whales are themselves carnivores,they are not considered to be apex predators because of therelatively small size of their prey and because they are preyedon by killer whales.
We know little about the distribution of interaction strengthamong species in most ecosystems. Nor do we know themorphological, physiological, behavioral, or ecological cor-relates of strong interactivity. Paine (1992) showed experi-mentally that the interaction strengths of seemingly similarspecies can vary substantially; he also argued that mammalsare especially strong interactors in many terrestrial ecosystems(Paine 2000). One of us (M. E. S.) surveyed all mammalspecies listed as threatened or endangered under the ESAfor which recovery plans are written (about 44 species orsubspecies). It appears that nearly half of these vulnerablemammals are relatively interactive, according to the criterialisted below, though this estimate may be low because the ques-tion is unstudied for many of the species (Soulé et al. 2003).Sala and Graham (2002) provide the most comprehensiveanalysis to date on species-specific variation in inter actionstrength. They estimate that roughly half of the macroinver-tebrate herbivore species in kelp forest ecosystems are stronginteractors. Based on limited information, therefore, it appearsthat a significant proportion of invertebrate and vertebratespecies are sufficiently interactive to warrant attention if re-covery criteria are an issue. Parenthetically, there are excep-tions to the view that strong interactors are universallybeneficial. Invasive exotic species and some native carnivores,particularly in highly perturbed ecosystems, can exacerbatemanagement problems. For example, coyotes can devastatesmaller, endangered predators such as captive-bred black-footed ferrets (Mustela nigripes), particularly if the coyotes areuncontrolled by wolves and if their prey occur in reduced, dis-turbed, or fragmented habitats (Miller et al. 1996).
The question of how interactivity is dis-tributed in ecosystems has yet another di-mension, namely variability within species.Like all ecological variables, interactionstrength is contingent on place, time, andhistory (Power et al. 1996). Just as it would befutile to assign species-wide, fixed values forage-specific fecundity, population growthrate, coefficients of competition, or othercontext-dependent variables, it would be un-reasonable to assign a fixed value for inter-activity to a widespread species.
Arguably, the related goals of (a) catego-rizing the kinds of interspecific interactionsand (b) assigning species to these categoriestrivialize the variability of species and envi-ronments in space and time. Interactivity isobviously a complex, context-dependent vari-able, and no species trait or feature is uni-versally associated with it across all taxonomicgroups and ecosystems. Nevertheless, the ESAcontains wording that justifies attending tospecies interactions: “The purposes of thisAct [the ESA] are to provide a means wherebythe ecosystems upon which threatened andendangered species depend may be con-served” (16 U.S.C. § 1531[b]). This leaves us with a practicalquestion: How can agencies and managers, in the face of thisuncertainty and variability, determine whether a vulnerablespecies in a particular locality or region is sufficiently inter-active to warrant special consideration with regard to recov-ery goals?
Guidelines for assessing interactivity
Operationally, a given species should receive special attentionfor recovery—beyond mere demographic viability—if itsabsence or unusual rarity causes cascading, dissipative trans-formations in ecosystems, including alterations or simplifi-cations in ecological structure, function, or composition.The following questions may assist in determining whetherthere are grounds to warrant the creation of appropriatemanagement prescriptions and actions that guarantee itsecological effectiveness.
Does the absence or decrease in abundance of the specieslead directly or indirectly to a reduction in local species di-versity? For example, the absence of coyotes from arid ecosys-tems can lead to a reduction in bird species diversity viamesopredator release (Crooks and Soulé 1999) or to a re-duction in rodent species diversity via competitive exclusion(Henke and Bryant 1999), as noted above.
Does the absence, decrease in abundance, or range con-traction of the species directly or indirectly reduce repro-duction or recruitment of other species? For example, thenumber of forest tree species that successfully reproduced on islands in a Venezuelan reservoir lacking large predatorsdropped from about 65 to about 10 because of a super-abundance of herbivores (Terborgh et al. 2001). Likewise, un-gulate herbivory prevented aspen (Populus tremuloides) clonesfrom recruiting sprouts into the overstory after extirpation ofwolves in the northern range of Yellowstone National Park(Romme et al. 1995, Ripple and Larsen 2000, Ripple andBeschta 2004).
Does the absence or decrease in abundance of the specieslead directly or indirectly to a change in habitat structureor composition of ecosystems? For example, excessive elk(Cervus elaphus) herbivory on willow (Salixspp.) in the ab-sence of wolves in Rocky Mountain National Park (Peinettiet al. 2002) and Yellowstone National Park (Ripple and Beschta2004) was apparently the major factor in the disappearanceof beaver and associated wetlands.
Does the absence or decrease in abundance of the specieslead directly or indirectly to a change in productivity or nu-trient dynamics in or between ecosystems? For example,prairie dog colonies shape nutrient cycling, soil chemistry, soilporosity, and the productivity and nutrient content of vege-tation through their burrowing and grazing activities (Whickerand Detling 1993, Kotliar et al. 1999, Miller et al. 2000), andsea otters strongly influence algal productivity (Duggins et al.1989) and food resource availability to herbivores (Konarand Estes 2003).
Does the absence or decrease in abundance of the specieschange an important ecological process in the system? For example, beavers have a profound effect on stream dy-namics, water tables, flooding, and the extent of wetlands(Naiman et al. 1988).
Does the absence or decrease in abundance of the speciesreduce the resilience of the system to disturbances such asfire, drought, flood, or exotic species? For example, the ex-tirpation of the dingo (Canis lupus dingo) in some regions ofAustralia indirectly degrades habitat quality because dingoesprey effectively on exotic rabbits (Oryctolagus cuniculus), redkangaroos (Macropus rufus), and other herbivores (New-some 2001). In addition, dingoes may benefit native fauna,including small, endangered marsupials, by reducing popu-lation densities of the introduced red fox (Vulpes vulpes)(Newsome 2001), a major predator of small animals (O’Neill2002).
These questions cannot eliminate the need for informedjudgment, because interactivity of species is a multidimen-sional continuum, not a simple dichotomy. In addition, theinteraction strength of species is usually not susceptible to rig-orous empirical tests, in part because many appropriate ex-periments would be manipulative (involving the removal ofspecies), long-term, and geographically extensive. With sucha small portion of nature protected, it is difficult to justify experimental removal of a putatively critical species to provea point. There are, however, a number of powerful approachesthat can often be used to make inferences about interactionstrengths. Recovery of ecosystems following the reappearanceof species is one such approach that has been used effec-tively to establish that predators such as gray wolves and seaotters are strongly interactive (see the cases described be-low). Interaction strength has been modeled on the basis ofdemographic and energetic parameters (Williams et al. 2004),even where data are limited. Ecological reconstructions basedon historical records (Jackson et al. 2001), in conjunction withthe comparative approach, provide yet another powerfulmeans of assessing the ecological importance of species.
The estimation of ecologically effective densities
If persistence of species diversity is a management objective,it is essential to consider the densities or population levels thatmaintain interaction effectiveness rather than mere persistenceat minimal numbers. Once it is determined that a species hasrelatively strong interspecies interactions, the proper man-agement of such a species may require the estimation of theminimum threshold of ecological effectiveness. We define anecologically effective density as the population level that pre-vents undesired changes in a defined ecological setting. Asstated above, however, the estimation of effective density isstrongly contextual, depending on locality, season, produc-tivity, and other variables that fluctuate spatially and tem-porally (Estes and Duggins 1995, Soulé et al. 2003). Althougha challenge, this problem may not be more intractable thanthe estimation of population viability. For example, many ofthe relevant parameters in population viability analysis, in-cluding age-specific fecundity and mortality, are similarlysensitive to local conditions. To illustrate some of the factorsthat must be considered in the estimation of ecologically ef-fective densities, we present three examples of strongly in-teractive genera or species: the sea otter, the gray wolf, and theprairie dog.
The sea otter. Abundant sea otter populations inhabitedcoastal waters of the North Pacific Ocean and southernBering Sea throughout most of the Pleistocene and Holocene,but were reduced to a few remnant colonies by the maritimefur trade of the 18th and 19th centuries. Recovery followingthe fur trade was spatially and temporally asynchronous,thus providing contrasts between otherwise similar habitatswith and without sea otters. These contrasts demonstrate astrong limiting influence of sea otters on their most impor-tant prey, kelp-consuming sea urchins (Strongylocentrotusspp.). Thus, lush kelp forests abound where sea otters are abun-dant; where sea otters are absent, the habitat is typically de-forested by hyperabundant sea urchins. Because kelp forestsare highly productive (Duggins et al. 1989), provide habitatfor other coastal species (Dayton 1985), and attenuate watermovements (Jackson and Winant 1983), sea otters exert far-reaching influences on many other species (Estes 1996).Without sea otters, some of these kelp-dependent species decline or disappear, while others, including urchins, eruptto high levels. The ecologically effective population for sea ot-ters, though regionally variable, is always much larger thanminimum viable population sizes based on demography,and in some instances is near the environmental carrying ca-pacity (Estes and Duggins 1995).Geographic variation in the behavior of predators, com-petitors, and prey will also affect the population densitythreshold for ecological effectiveness. For example, the den-sity of sea otters that is effective in suppressing sea urchins dif-fers between sites, because the demography and dispersal ofsea urchins vary geographically. In the Aleutian Islands, whereurchin recruitment is frequent and strong, a higher densityof otters is needed to suppress the urchins and prevent kelpdeforestation than in southeast Alaska, where urchin re-cruitment is weak and episodic, and where just a few ottersare enough to maintain the kelp ecosystem (Estes and Dug-gins 1995). In summary, the estimation of effective densities of sea ot-ters for preventing kelp deforestation depends, among otherthings, on whether the state of the system is kelp dominatedor deforested, on the recruitment dynamics of urchins tothe kelp beds, on whether the substrate is dominated byrocks or mud, and on the mortality rate of otters (see Souléet al. 2003). For these reasons, the ecologically effective den-sities of otters can vary by an order of magnitude, but in allsituations observed, otters eventually attain such densities ifthey are not harassed by human beings or preyed on by killerwhales.
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The gray wolf. Large areas of the United States, including mostof the East Coast and Midwest, now lack wolves and other largecarnivores, the result of a century of eradication on behalf oflivestock growers, hunters, and other interest groups thatbenefit from the absence of wolf predation on ungulates.Populations of white-tailed deer (Odocoileus virginianus),elk, and moose (Alces alces) have increased both in numbersand in per capita consumption (Soulé et al. 2003), and theseincreases are frequently attributed, at least in part, to the ab-sence of wolves (Messier 1994, Crête 1999). Among the manyharmful consequences of wolf eradication have been in-creased costs for agricultural producers in the Midwest andEast, the widespread degradation of forests and other ecosys-tems, and the decline of many species of plants favored by un-gulates (Rooney et al. 2004). As noted above, aspenrecruitment failed for 80 years in large parts of YellowstoneNational Park, reflecting numerical and behavioral release ofelk subsequent to wolf eradication. Excessive browsing by elkalso affected recruitment of riparian cottonwoods and willows(Beschta 2003), causing the local disappearance of beaverwetlands. These effects are being reversed in Yellowstone Na-tional Park since wolves were reintroduced (starting in 1995),and signs of ecological effectiveness were noted before wolvesreached their current abundance of about 200 (Ripple and Beschta 2004). A similar trend has been observed in GrandTeton National Park, where a decrease in Neotropical migrant bird diversity has been attributed to overbrowsing by moosein riparian willow communities in the absence of wolf pre-dation or sport hunting of moose (Berger et al. 2001). It isnoteworthy that the recovery of willows in northern Yellow-stone National Park is particularly striking in areas where thetopography facilitates capture of elk by wolves (Ripple andBeschta 2003). Several factors affect wolves’ ecologically ef-fective population density. It is lower where hunters can sup-press ungulate numbers; where wolves coexist with otherlarge carnivores, such as bears and cougars; or where deep win-ter snow or periodically severe storms facilitate capture ofprey—for example, El Niño versus La Niña years (Schmitz etal. 2003). We grant that predators do not always control largeherbivores, but given alternative prey, multiple carnivorespecies, or appropriate habitat, wolves can often control su-perabundant ungulates (Soulé et al. 2003).
The prairie dog. A century ago, five species of prairie dog livedin a shifting mosaic of colonies that covered more than40,000,000 hectares (ha) on the Great Plains. By 1960, prairiedog area had declined to about 600,000 ha (Marsh 1984),largely because of poisoning campaigns, land conversion,and the introduction of plague (Yersinia pestis). This is a de-cline of 98 percent, and the remaining colonies are smalland isolated. Prairie dogs are a valuable food for many speciesof predators. In addition, prairie dogs decrease densities ofwoody shrubs and increase densities of grasses and forbs, thuscreating conditions that large grazers prefer. Prairie dog ac-tivities also increase plant productivity, soil nitrogen, nutri-ent cycling, and digestibility of grasses and forbs (Whicker andDetling 1993, Detling 1998). Their burrowing activity changessoil chemistry; increases soil porosity, soil turnover, and the organic content of soil; and enhances the dimensionality ofthe habitat for many other species (Whicker and Detling1993, Outwater 1996). Some species of plants, invertebrates,and vertebrates benefit from prairie dog activities, whileother species benefit from the areas outside of the colony(Kotliar et al. 1999). These effects differ among prairie dogspecies. Furthermore, prairie dogs, unfenced bison, and fireinteracted closely on the midgrass prairies, although thattriad may not have been as tightly associated on the drought-driven shortgrass prairies or the semidesert grasslands andshrublands. Estimating ecologically effective densities of prairie dogsis complicated by the introduction of plague. Plague reducesnumbers and changes the temporal and spatial characteris-tics of the historic “shifting mosaic” between prairie dogcolonies and grasslands. Despite those ambiguities, it is clearthat ecologically effective densities of prairie dogs are farhigher than the densities required for population persistence(Miller et al. 2000). As an example, 762 prairie dogs may berequired to support each female black-footed ferret and heroffspring (Biggins et al. 1993). Thus, conservative recoverygoals that consider only population viability could maintainprairie dogs without providing sufficient resources for ferrets.
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Conclusions
Mitigating the current anthropogenic mass extinction will re-quire a scientifically rigorous and ecologically comprehensivegrasp of its drivers. Among these is the increasing rarity of in-teractive species, such as plants that provide critical resources(Terborgh 1986), insect pollinators (Dobson et al. 1999),habitat modifiers (Soulé et al. 2003), coral reef herbivores(Jackson et al. 2001), and carnivores, both marine and ter-restrial (Terborgh et al. 1999). The activities of relatively in-teractive species are disproportionately significant for thesurvival of native species and ecosystems.It is essential, therefore, that conservation practitioners,whether governmental or nongovernmental, adopt an eco-logical view that ensures the persistence of interactive speciesat ecologically effective population densities and maximalspatial occurrence (Soulé et al. 2003). In particular, we believethat natural-resource policymakers and wildlands managersshould determine whether the rarity or absence (Hughes etal. 2000) of a species in a region can be expected to trigger eco-logical degradation, including the disappearances of nativespecies and other elements of biodiversity. Even though interactivity is a quantitative variable, man-agers may be forced to make binary determinations, such aswhether to treat a particular species as strongly interactivewhen formulating recovery goals. Notwithstanding the arbi-trariness of such decisions, a commonsense approach will of-ten suffice. One should assume, for instance, that a substantialreduction of tree species that produce mast or invite cavity for-mation, or of apex predators and many large herbivores—suchas wolves, coyotes, sea otters, killer whales, sharks, predatoryfreshwater fish, and large, predatory or algae-eating reeffish—will trigger cascades of ecological degradation andspecies loss (Terborgh et al. 1999, Jackson et al. 2001, Souléet al. 2003, Springer et al. 2003). Other situations may requireliterature reviews or detailed research to ascertain whether aparticular species in a particular place fulfills any of the cri-teria for relatively strong interactivity given above.A conundrum for managers is that the ecological effec-tiveness of strongly interacting species is not specifically ad-dressed in current laws and policies dealing with biodiversityprotection and management. Until this perspective has beencodified in such laws, conservationists need to consider howbest to provide for such species and the processes they me-diate in accord with the intent of these laws. Population via-bility analyses and conservative recovery goals are aninadequate regulatory context for strongly interacting species.We now understand that the biodiversity of ecosystems willdegrade unless the interactions of species are maintained inas many regions as feasible, particularly those areas within thehistoric range. This more holistic, contemporary view re-quires that strongly interactive species receive special atten-tion to assure that they are well distributed and abundant, aposition consistent with an opinion of the US Ninth CircuitCourt of Appeals (Defenders of Wildlife v.Norton,258 F.3d1136 [2001]). Such a geographic criterion for recovery wouldrequire more than scattered or refugial representation ofsuch species. Ecological function and diversity cannot beconserved in a region by maintaining interactive species in onlya few protected areas. Rather, it is essential that strongly in-teractive species be distributed as broadly as possible and beprotected within well-distributed, secure areas. Applying thisguideline to the wolf in the United States, for example, wouldmean that effective populations should be restored and pro-tected in the Northeast, the Pacific Northwest, the GreatBasin, the Colorado Plateau, the Southwest, and the south-ern Rockies. Moreover, if the current trend of decreasingsport hunting and the spread of chronic wasting disease in deerand elk continue, the pressure to reinstitute natural controlmechanisms will surely increase.The critical roles of interspecies interactions are rarelyconsidered in recovery planning. For example, the US Fish andWildlife Service (USFWS) admits that its goals for wolf re-covery are “somewhat conservative...and should be consideredminimal” (68 Fed. Reg. 15817 [2003]). A recent decision byUSFWS (68 Fed. Reg. 15821 [2003]) states that USFWS is notrequired to restore a species across its available habitat. Thedecision would limit wolf protection to about 5 percent of itshistorical range in the lower 48 states. Similarly, the multistateconservation plan for black-tailed prairie dogs (Luce 2003) sets a 10-year recovery goal for black-tailed prairie dogs(Cynomys ludovicianus) at about 2.5 percent of their histor-ical area, essentially the status quo.
We believe that such conservative recommendations are notbased on current ecological knowledge about the signifi-cance of species interactions. Moreover, minimalist distrib-utional and temporal goals constitute a trivialization of theterm “recovery” as it is used in the ESA. In other words, “re-covery,” at least for mammals, is typically used to mean thepersistence of only a few populations in a limited area for afew generations.Notwithstanding current policies, most natural-resourceand environmental laws require that federal agencies considernew scientific knowledge. Indeed, the ESA’s own mandate isto use “the best scientific and commercial data available” (16U.S.C. § 1533[b][1][A]). Moreover, implementing regulationsfor the National Environmental Protection Act of 1969 requirethat federal agencies disclose and consider “cumulative im-pacts” and the anticipated environmental impacts of proposedfederal agency actions (40 C.F.R. § 1500 et seq. 1995). Any ar-tificially induced reduction in abundance of a strongly in-teractive species, therefore, must be considered in theseenvironmental analyses. In addition, regulations of the Na-tional Forest Management Act of 1976 require that nationalforest plans “provide for the diversity of plant and animal com-munities” and that “such diversity shall be considered through-out the process” (36 C.F.R. § 219.3).Since the recognition of conservation biology as a discipline(Soulé 1985), its practitioners have tacitly assumed that con-servation biologists are “physicians to nature.” Indeed, thereare many parallels between conservation biology and thefields of medicine and public health—disciplines infusedwith morality. Following the Hippocratic principle of doingthe least harm and the most good for patients and the pub-lic, physicians and public health officers are obligated, we think,to consider using new therapies and prophylaxes stemmingfrom peer-reviewed research, even before such practices aregenerally adopted in canonical documents such as textbooks.We propose, therefore, that conservation practitioners, whetherin a public or private (nongovernmental) employ, are simi-larly obligated to apply new biological knowledge in theirwork. Such a doctrine of “best conservation practices basedon the best science” is tantamount to an ethical obligation ofbiologists to adopt a higher standard for management thanis mandated by existing statutes and regulations, if the evidencewarrants it. Environmental codes build the legal and ethicalfoundation of conservation practice, but the best science ofthe day creates the walls and ceiling.In practice, policymakers and managers already haveenough flexibility to implement new knowledge while still ad-hering to relevant statutes and policies, though the exerciseof this doctrine may be inhibited by monetary and politicalconstraints. (Setting relatively stringent recovery objectives forstrongly interactive species, for example, will be opposed byindividuals and organizations who perceive negative conse-quences of such actions.) Even so, ignoring the interspecificinteractions of strongly interactive species will further impairthe diversity and resilience of ecosystems that are alreadyunraveling. In a nation and a world where increasing num-bers of species and ecosystems are shoved toward the brinkof annihilation, it is more important than ever that environ-mental policy and management be buttressed by the bestavailable science.
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Didi, Boone, Andujar, Kranepool to Receive Thurman Munson Awards Feb. 5

A star-studded lineup will be honored at the 39th Annual Thurman Munson Awards Dinner on Tuesday night, February 5, at the Grand Hyatt Hotel in New York City to benefit AHRC New York City Foundation which assists children and adults with intellectual and developmental disabilities. These are the award recipients: New York Yankees standout shortstop Didi Gregorius, Yankees manager and 2003 ALCS hero Aaron Boone, Yankees rookie sensation Miguel Andujar, 1969 New York Mets World Series champion Ed Kranepool (in celebration of the 50thAnniversary), and New York Football Giants two-time Super Bowl champion Zak DeOssie will each receive Thurman Munson Awards. The gala remembers the late great Yankees captain and catcher Thurman Munson and has raised more than $16 million for the AHRC NYC Foundation which supports programs that enable children and adults with intellectual and developmental disabilities to lead richer, more productive lives. Thurman’s widow Diana Munson will attend her 39th consecutive benefit, having been involved in the dinner since its inception. The Thurman Munson Awards are presented annually for success and inspiration on the fields of play, and community spirit off the field. Gary L. Green, Chief Executive Officer, Alliance Baseball LLC Alliance Building Services, will receive the M. Anthony Fisher Humanitarian Award. Former Yankees and Mets World champion Darryl Strawberry will present the award which recognizes leadership in business and philanthropy, and was named to honor the memory of M. Anthony Fisher, a partner in Fisher Brothers and Co-Founder of AHRC NYC Foundation's A Special Night for Special Children. Michael N. Rosen, Senior Counsel, Bryan Cave Leighton Paisner LLP, will receive AHRC NYC Foundation's Lifetime Achievement Award. Kranepool will be presented by his teammate and World Series hero Ron Swoboda. For tickets and information on the Munson Awards Dinner call 212-249-6188 or email [email protected]. Tickets may be purchased online atwww.ahrcNYCfoundation.org/events/munson. Michael Kay, the "Voice of the Yankees" on YES Network and host of The Michael Kay Show on ESPN New York Radio 98.7 FM, will serve as Master of Ceremonies. AHRC NEW YORK CITY - CELEBRATING 70 YEARS OF REALIZING POTENTIAL! AHRC New York City is a family governed organization committed to finding ways for people with intellectual and developmental disabilities to build full lives as defined by each person and supported by dedicated families, staff, and community partners. Each year, AHRC New York City touches the lives of over 15,000 individuals throughout the five boroughs. The organization that created the first schools, workshops, day treatment programs, and community residences continues to offer a wide range of programs, services, and supports tailored to meet specific needs. All of the five honorees are dedicated to community service. Aaron Boone will forever be remembered in Yankee lore for his Walk Off home run to eliminate the Boston Red Sox in the riveting Game 7 of the 2003 ALCS. The third generation Major Leaguer returned to the Bombers last season as manager to lead the Yankees to 100 wins and a second-round playoff appearance. After his 12 years as a player with 1,017 career hits and an All-Star appearance to his credit, Aaron transitioned to the broadcasting booth as a commentator for Sunday Night Baseball and a contributor for Baseball Tonight on ESPN. Off the field, Boone has been on the board for Chances for Children, and has traveled to Haiti with his wife to help out the hurricane-stricken island, which led to them meeting and adopting of two young boys. Bronx-born Ed Kranepool, an original Met in the 1962 season, was a major contributor in the Gil Hodges platoon at first base and spot-duty in the outfield on the memorable 1969 World Series Champion Mets. The James Monroe High School product signed with the Mets straight out of high school, and spent his entire 18-year career in blue and orange. Krane’s resume includes 1,418 hits, 118 home runs, an All-Star appearance in 1965, and a pair of .300 seasons. Later in his career, he became a pinch-hitter deluxe, and batting .486 (17-for-35) in the role in 1974 is still the major league single-season pinch hit batting average record. Enshrined in the Mets Hall of Fame in 1990, Kranepool works with the Diabetes Association and promotes organ donations. His well-document search for a kidney donor continues. Didi Gregorius has emerged as a bona fide star and key cog in the Yankees lineup after facing the unenviable task of replacing Derek Jeter as starting shortstop in 2015. Three consecutive 20+ home run seasons have thrust the Netherlands native into the middle of the potent Yankees lineup. The 2018 season was a career best with 27 home runs, breaking his own franchise record for a shortstop, 86 RBI, a .494 slugging percentage and .829 OPS. Gregorius won the Baseball World Cup with his native Netherlands in 2011, and following the victory, he and his teammates were knighted, resulting in the nickname Sir Didi. Gregorius has been involved with DidisDeeds, visiting children hospitals and handing out umbrellas and beanies in the streets of New York, and in the Yankees annual Hope Week reach out. Didi underwent Tommy John surgery this off season. Miguel Andujar enjoyed a sensational Rookie of the Year candidate campaign with the Yankees last season, adding a potent bat to the lineup. A member of the “Baby Bombers,” Andujar ranked among the top two on the Yankees with 27 home runs, 97 RBIs, 170 hits and a .297 batting average. He broke the Yankees rookie record, and tied the AL rookie record with 47 doubles in a season. Andujar’s superb performances throughout the year resulted in twice being honored as the AL Rookie of the Month in June and August. The Dominican third baseman is an active participant in the Yankees’ Hope Week community effort. Brown University product and current New York Giants long snapper Zak DeOssie earned two Super Bowl rings on the Big Blue championship squads in 2009 and 2012. Prior to winning his second Super Bowl, DeOssie was named special teams captain in 2012, and has been named to two Pro Bowls. Zak’s Super Bowl victory has put him and his father, former Giants linebacker Steve DeOssie, as the only father-son duo to have won a Super Bowl with the same franchise. Off the gridiron, Zak has been active in his community, where he has worked with the Newark Mentoring Movement, the Lupus Foundation of America, Muscular Dystrophy Association and with Punt, Pass and Kick Clinics with the Special Olympics of New Jersey.
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Lunes, 27 de agosto
Hoy me he levantado muy temprano. Cuando he bajado al perro, antes del amanecer, la luna —creo que llena; en cualquier caso, magnífica— aún no se había ocultado; reinaba en el cielo, a poniente, por encima de los arcos metálicos de la glorieta de las Reales Academias, y de las copas de los álamos, cipreses y negrillos que enmarcaban mi horizonte, recortada como un medallón de espuma desbravada, con manchas de azul prusia moteando su blanco redondel de cremosos penachos agrietados, sobre la líquida superficie de otro azul, más claro pero si cabe más intenso, que el fresco viento del alba erizaba… Era una estampa que te obligaba a pararte y clavar en ella la mirada, hipnotizado; y yo he pensado, como tan a menudo pienso cuando contemplo estos pasmosos cuadros lunares, en las dos palabras que marcan el final, perverso e inquietante, trágico y fatal, de la novela Pacto de sangre, de James M. Cain: The moon… Se le ponen a uno los pelos de punta, y si además es lobo —como su propio apellido indica, y las lunáticas mareas de sus humores confirman—, más todavía…
Lo cierto, a todo esto, y hablando tal vez un poco más en serio, es que yo la luna llena no tengo que verla para sentirla…; es como si algo, una presencia, un pálpito, un temblor, me la estuvieran anunciando…; y luego vuelvo los ojos al firmamento y ahí la diviso, redonda y callada, majestuosa en su indiferente esplendidez, mudo testigo de los perpetuos desatinos de los hombres… Como en aquel magnífico poema de Cernuda, «Noche de luna», al que yo a mi vez hago velada alusión en otra más modesta pieza mía, de Gran esperanza, titulada «Fin de mundo»:
En lo más alto del cielo, la luna que Cernuda contemplaba en Méjico resplandece, imperturbable.
Ha visto el fin del mundo muchas veces…
Tras dar la vuelta con el perro y subir de nuevo a casa, y hacerme un segundo café, me he puesto sin demora a laborar, en la alta madrugada… Y ha sido miel, con un divino punto ácido, sobre crujientes hojuelas… Y han rodado las palabras, las oraciones y los párrafos, como si ya estuvieran ahí, esperando a que yo les diera salida, esperando el pulso de mis yemas en las teclas, esperando el milagro de la luz, en todos sus sentidos (luz de iluminar; luz de ser dadas las palabras a la vida). Solo un goce iguala esta diaria taumaturgia del verbo…, y es el que consigo lleva esa otra manera de hacerse carne mística el anhelo —y carne bien real, de sudor y de lágrimas de dicha— en el dulce y desgarrado torbellino íntimo de la coyunda (hermoso vocablo donde los haya); en el combate deleitoso de las almas y los cuerpos, que se funden y separan y se vuelven luego a confundir; en el fragor de esas gongorinas batallas de amor que reclaman sus campos de pluma…
Después de la sesión matinal de escritura me he preparado para el siguiente round del día, lenta y cuidadosamente, mimando cada detalle del ritual que nos apresta para encarar nuestras obligaciones cotidianas, y he salido, aún muy de mañana, a hacerme cargo de lo que puede considerarse el primer trabajito alimenticio, fuera de casa, de la temporada, aunque la temporada propiamente dicha no haya comenzado todavía… Y todo ha ido insospechadamente bien. Todo ha ido sobre ruedas. Tanto es así que para rematar tan satisfactorio «primer tiempo» de la jornada me he metido en el cine, a ver una película que sin ser, quizá, como para lanzar las campanas furiosamente al vuelo, me ha gustado, y yo casi diría que mucho… Alpha, se titula el modesto estreno.
Alpha es la historia —¿una posible historia?— de cómo el hombre domesticó al lobo, y lo convirtió en canis lupus familiaris… Incluye una pequeña sorpresa final, que no desvelaré, y que por cierto proporcionó la respuesta a una pregunta que yo había estado haciéndome a medida que avanzaba el largometraje. No sé qué grado de fidelidad «paleohistórica» tendrá el argumento (que es, evidentemente, una «variación ficcional» entre las muchas posibles); pese a mi amor por los perros, nunca he investigado a fondo el origen más remoto del «mejor amigo del hombre», y no estoy por lo tanto en condiciones de hacer una evaluación rigurosa y «científica» de esta cinta… La película, no obstante, me ha parecido interesante, y hasta fascinante, y también —por momentos— conmovedora.
No me extrañaría que Alpha pasara sin pena ni gloria por las carteleras, porque no es ni mucho menos «superproducción», ni tampoco es «arte y ensayo» para escogidos esnobs intelectuales de los que luego difunden, mediante el «boca a oreja», las novedades supuestamente in por los circuitos de las «informadas minorías pensantes». Estos dos últimos factores, sin embargo, contribuyen precisamente en mi caso a la favorable impresión, y al buen sabor de boca —un poco agridulce, como el que dejan los poemas memorables— con los que he salido esta tarde del cine: ¡nada de estridencias millonarias! ¡Y nada de pretenciosos «mensajes» ni «analogías» elitistas! Una épica historia, sencillamente contada, cuyo asunto —dicho sea de paso; me acabo de dar cuenta— podría haber salido de las páginas de Jack London.
Alpha se localizó por lo visto en las heladas inmensidades de la provincia de Alberta, en Canadá, y no sé si incluirá también secuencias rodadas en los desérticos parajes de Nuevo México. Hay asimismo en ella mucho trabajo «digital», excelentemente realizado y resuelto. Todo el film tiene un aire de documental «no espectacular»...; y eso para mí, como ya he señalado, le añade considerable encanto.
Con la sesión de cine ha quedado vista para sentencia la jornada, que ahora viene lentamente a morir entre estas líneas… Y es curioso que antes haya dicho que mi opción cinematográfica de esta tarde probablemente vaya a pasar sin pena ni gloria...; porque eso mismo es lo que les sucede a la mayoría de los días. Pero no hay día que por ello deje de tener, a su manera, su sencilla pizca de épica grandeza. Sumemos el de hoy a nuestra íntima epopeya y continuemos con la gesta.
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Time May Change Me
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by Kaymardsa
Your favorite marauders (non magic AU) are working in a modern day shopping mall while they attend university or decide what they want to do with their lives. Various meet-cutes (and one or two not-so-cutes). Lots of sarcasm. Texting, cursing, and generally just trying not to drown under the weight of adulthood.
This is going to be a long one, so buckle up folks!
Words: 1105, Chapters: 1/?, Language: English
Fandoms: Harry Potter - J. K. Rowling
Rating: Not Rated
Warnings: Creator Chose Not To Use Archive Warnings
Categories: F/F, F/M, Gen, M/M, Multi, Other
Characters: Sirius Black, Remus Lupin, Marlene McKinnon, Dorcas Meadowes, Mary Macdonald, Peter Pettigrew, James Potter, Lily Evans Potter, Alice Longbottom, Frank Longbottom
Relationships: Sirius Black/Remus Lupin, James Potter/Lily Evans Potter, Marlene McKinnon/Dorcas Meadowes, Mary Macdonald/Peter Pettigrew, Minor or Background Relationship(s)
Additional Tags: Marauders, Marauders Friendship (Harry Potter), Modern Marauders (Harry Potter), Female Marauders (Harry Potter), Alternate Universe - Modern Setting, Alternate Universe - Non-Magical, Modern Era, Alternate Universe - Modern: No Powers, Texting, Drunk Texting, Gay, Gay Male Character, Bisexual Male Character, Demisexual Sirius Black, Gay Remus Lupin, Male-Female Friendship, Male Friendship, Bisexual Female Character, Female Character of Color, Female Friendship, Friendship/Love, Epic Friendship, Romantic Friendship, Developing Friendships, Queer Themes, Queer Character, Queerplatonic Relationships, Queer Youth, Queer Friendly, Alternate Universe - College/University, University, Childhood Friends, Childhood Memories, Childhood Trauma, Sick Remus Lupin, Police, Drunk Dancing, Dancing Lessons, Dancing and Singing, Theatre, Shopping Malls, Minor Alice Longbottom/Frank Longbottom, Nonbinary Character, they/them pronouns, Cussing, Inappropriate Humor, Inappropriate Behavior, Sarcasm, Humor, Fluff and Humor, Angst and Humor, Attempt at Humor, Sexual Humor, Bad Humor, Implied Sexual Content, Implied/Referenced Child Abuse, Lupus, Chronic Illness, Police Academy, Dance School, figuring out life, Adulting, Adulting is hard, Career Changes, Music, Guitars, Song Lyrics, Cooking, top model, Watch Parties, Roommates, Remus Lupin & Lily Evans Potter Friendship
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canis lupus
read it on the AO3 at https://ift.tt/32dc4lD
by xniccky
Una storia Steve/Tony!omegaverse molto particolare e insolita, che vedrà i nostri protagonisti nelle sembianze di lupi sotto ogni aspetto. Tranne un piccolo particolare: è una storia ABO dopotutto.
Steve è un omega con un passato, seppur breve, molto tormentato e infelice, che sta cercando di lasciarsi alle spalle. Bucky è il suo unico appoggio ora che non ha più un branco, ma la convivenza nomade dei due è tutt'altro che facile specialmente quando l'omega è in calore. Tony è un alfa giovane e senza una preoccupazione al mondo. La fortuna si farà avversa nel momento in cui poserà lo sguardo su un omega dal manto argenteo che non avrà nessuna intenzione di approfondire la sua conoscenza. Nonostante le avversità l'alfa trova difficile prendere le distanze e voltarsi tutto alle spalle. Tutto andrà a rotoli, numerose volte e in situazioni tutt'altro che piacevoli che riporteranno alla luce vecchie ferite.
Alla fine di tutto ne sarà valsa la pena? Ai posteri l'ardua sentenza.
Words: 12, Chapters: 1/?, Language: Italiano
Fandoms: The Avengers (Marvel) - All Media Types, The Avengers (Marvel Movies), Iron Man (Movies), Captain America (Movies)
Rating: Explicit
Warnings: Creator Chose Not To Use Archive Warnings, Rape/Non-Con
Categories: M/M, Multi
Characters: Steve Rogers, Tony Stark, James "Bucky" Barnes, Avengers Team (MCU)
Relationships: Steve Rogers/Tony Stark
Additional Tags: Alpha Tony Stark, Omega Steve Rogers, Alpha Bucky Barnes, Alpha/Beta/Omega Dynamics, Implied Mpreg, Alternate Universe, Sex, Mating Cycles/In Heat, Mating Bond, Tony Stark Has A Heart, Bottom Steve Rogers, Top Tony Stark, Protective Avengers
read it on the AO3 at https://ift.tt/32dc4lD
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canis lupus
read it on the AO3 at https://ift.tt/32dc4lD
by xniccky
Una storia Steve/Tony!omegaverse molto particolare e insolita, che vedrà i nostri protagonisti nelle sembianze di lupi sotto ogni aspetto. Tranne un piccolo particolare: è una storia ABO dopotutto.
Steve è un omega con un passato, seppur breve, molto tormentato e infelice, che sta cercando di lasciarsi alle spalle. Bucky è il suo unico appoggio ora che non ha più un branco, ma la convivenza nomade dei due è tutt'altro che facile specialmente quando l'omega è in calore. Tony è un alfa giovane e senza una preoccupazione al mondo. La fortuna si farà avversa nel momento in cui poserà lo sguardo su un omega dal manto argenteo che non avrà nessuna intenzione di approfondire la sua conoscenza. Nonostante le avversità l'alfa trova difficile prendere le distanze e voltarsi tutto alle spalle. Tutto andrà a rotoli, numerose volte e in situazioni tutt'altro che piacevoli che riporteranno alla luce vecchie ferite.
Alla fine di tutto ne sarà valsa la pena? Ai posteri l'ardua sentenza.
Words: 12, Chapters: 1/?, Language: Italiano
Fandoms: The Avengers (Marvel) - All Media Types, The Avengers (Marvel Movies), Iron Man (Movies), Captain America (Movies)
Rating: Explicit
Warnings: Creator Chose Not To Use Archive Warnings, Rape/Non-Con
Categories: M/M, Multi
Characters: Steve Rogers, Tony Stark, James "Bucky" Barnes, Avengers Team (MCU)
Relationships: Steve Rogers/Tony Stark
Additional Tags: Alpha Tony Stark, Omega Steve Rogers, Alpha Bucky Barnes, Alpha/Beta/Omega Dynamics, Implied Mpreg, Alternate Universe, Sex, Mating Cycles/In Heat, Mating Bond, Tony Stark Has A Heart, Bottom Steve Rogers, Top Tony Stark, Protective Avengers
read it on the AO3 at https://ift.tt/32dc4lD
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9 skin conditions that could signal a more serious problem, Defence Online
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Your outer layer could expose health and fitness situations taking place internally.
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Joe Raedel/Getty
Several interior well being circumstances can result in signs and symptoms in the skin.
INSIDER spoke with a dermatologist about some pores and skin indications of inner health issues.
Circumstances like lupus, inflammatory bowel sickness, diabetic issues, and over- or underactive thyroid can influence the skin in unique techniques.
The skin is your body’s premier organ, so it’s not as well stunning that quite a few interior health problems can cause alterations to the pores and skin, far too.
“In a way, you can believe of your skin as a window into the inside body,” Dr. Kathleen Suozzi, assistant professor of dermatology at Yale University of Drugs, advised INSIDER. “The wide the greater part of different medical situations can manifest with difficulties, reactions, or conclusions on the skin.”
Compiling a checklist of each and every pores and skin symptom of every single inside ailment would be difficult – Suozzi characterised this as a “huge” matter to which “whole textbooks” are dedicated – but there are some exclusive skin improvements that may possibly be early indicators of really serious systemic wellbeing disorders.
Browse on to study about some illustrations.
1. Itching
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Persistent itching may be a signal of Hodgkin lymphoma, Suozzi explained.
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9nong/Shutterstock
“Sometimes if a individual has intractable itch, we’ll examine …to make sure they don’t have Hodgkin lymphoma,” Suozzi said. “Rarely, that can be a presenting indication.”
Hodgkin lymphoma is a variety of cancer that impacts white blood cells named lymphocytes, and the most common symptom of the illness is an enlarged lymph node in the neck, the armpit or the groin, in accordance to the American Cancer Society.
It’s also critical to keep in mind that there are several, lots of other well being situations that aren’t most cancers that can also bring about itchy skin.
2. Thicker, darker skin on some components of the entire body
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Some people with diabetes may well have darker or thicker pores and skin in their skin folds.
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Jaral Lertjamekorn/Shutterstock
Suozzi stated that a condition called acanthosis nigricans (AN), in which the skin thickens and darkens in sure spots, can be a signal that a person has diabetic issues.
“It’s an region of hyperpigmentation, or darkening of the pores and skin, that takes place in the pores and skin folds,” she explained. “Classically [it happens] in the back again of the neck, or in the creases of the arms. Primarily in children, which is a indication that you may want to verify them for diabetes.”
The affliction can also occur in fully healthful people today or occur simply because of sure prescription drugs or other ailments, according to the American Academy of Dermatology (AAD).
3. Heat, sweaty pores and skin or chilly, dry pores and skin
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Heat, moist skin could be one indicator of an overactive thyroid.
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cliplab.professional/Shutterstock
An overactive or underactive thyroid can result in alterations in how your skin feels, Suozzi discussed.
The thyroid is a butterfly-shaped gland in the neck. It releases hormones that do the job to control fat burning capacity, coronary heart fee, system temperature, and far more. But in some folks, the thyroid can be overactive, generating a lot more thyroid hormones than the body demands (a.k.a. hyperthyroidism), or underactive, building far too small ( a.k.a. hypothyroidism). Both equally disorders guide to a wide array of attainable signs throughout the whole system, including the pores and skin.
Examine a lot more: 17 things you need to know about your thyroid – because it controls a good deal extra in your physique than you’d think
“In standard, with overactive thyroid, your pores and skin is warm and moist thanks to amplified sweating, vs . underactive thyroid, [when the skin] can be cold, pale, rough, and dry,” Suozzi reported.
4. Hair loss or thinning
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Thyroid illness could also have an impact on hair.
resource
srisakorn wonglakorn/Shutterstock
“Patients with thyroid illness can also get hair variations,” Suozzi mentioned. “So if a individual existing with hair loss, we will occasionally, dependent on the high-quality of the hair loss, examine their thyroid operate.”
She stated that men and women with an overactive thyroid can experience hair thinning, although people today with an underactive thyroid can drop hair in a quite certain location: The outer third of their eyebrows.
5. Darkening skin
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Folks with Addison condition may perhaps experience darkening of their skin that will make them seem tan, according to Suozzi.
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James Heilman, MD/Wikimedia Commons/Attribution–Share Alike
In Addison’s condition, the adrenal glands – which sit just on prime of the kidneys – don’t create adequate of the hormones cortisol and aldosterone.
The most widespread symptom of Addison’s disorder is fatigue, in accordance to the Countrywide Organization for Rare Conditions (NORD), but it can also lead to skin variations.
Suozzi described that hormonal adjustments in Addison’s disease individuals can make the pores and skin additional pigmented,
“These people search tan,” she claimed.
NORD provides that this darker, or hyperpigmented, skin can also occur in patches, often in the vicinity of scars or pores and skin creases like knuckles. In actuality, these pores and skin modifications can materialize yrs just before other symptoms of Addison’s ailment develop, in accordance to NORD.
6. Sensitivity to solar
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Sunshine sensitivity is one pores and skin symptom that can point out lupus.
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Trybex/Shutterstock
Solar sensitivity is 1 of quite a few distinctive pores and skin signals that could show lupus, a issue in which the body’s immune procedure assaults its very own organs and tissue.
In truth, Suozzi mentioned, specified pores and skin signs and symptoms are element of the standards physicians use to diagnose lupus.
“One factor would be photosensitivity – reacting much more than normal to sunshine exposure,” she explained. (About 50% of men and women with lupus practical experience this sensitivity, according to the Johns Hopkins Lupus Centre.)
She additional that selected rashes can also denote the condition. The to start with is a malar rash (also referred to as a “butterfly rash,” so named mainly because it spreads throughout both equally cheeks in a butterfly shape. The second is termed a discoid lupus rash, she mentioned.
Finally, mouth ulcers can also be a pores and skin indication of lupus – the mucous membrane within your mouth is regarded part of your pores and skin, Suozzi stated.
7. A hump amongst the shoulders
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Individuals with Cushing’s syndrome can have a lump concerning their shoulders.
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Rawpixel.com/Shutterstock
In Cushing’s syndrome, the adrenal glands generate an extra of the anxiety hormone cortisol. A person of the condition’s lots of indicators is a fatty hump located concerning the shoulders.
“We connect with it the buffalo hump,” Suozzi claimed. “It’s a roundness on the upper back under the neck.”
“[Cushing’s syndrome] individuals can also get stretch marks named striae that sometimes just erupt,” she added. “That can be a presenting indication of the disease.”
8. A type of tender bump under the pores and skin
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An illustration of erythema nodosum, which could be a indicator of inflammatory bowel illness.
resource
James Heilman, MD/Wikimedia Commons/Attribution–Share Alike
Suozzi reported that inflammatory bowel disorder (IBD), an umbrella expression that features Crohn’s ailment and ulcerative colitis, can manifest with precise pores and skin signs and symptoms.
“One is called pyoderma gangrenosum – it’s these eroded lesions that display up on the legs and they never heal,” she mentioned. “And if younger clients get that, we often glance to make guaranteed they do not have Crohn’s ailment or ulcerative colitis.” (You can see a photograph of pyoderma gangrenosum at the Mayo Clinic website, but be warned that it’s graphic.)
A further feasible pores and skin sign of IBD is erythema nodosum, she additional. This is when tender, purple bumps type under the skin, normally on the shins but from time to time in other places on the physique.
“It can present up in people for a assortment of reasons, but it does make us go glimpse [for IBD],” Suozzi stated.
9. A kind of rash on the backs of the palms
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Gottron’s papules, pictured listed here, could be a signal of a fewer widespread autoimmune condition.
resource
Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider/Wikimedia Commons/Attribution–Share Alike
Dermatomyositis is a condition that can result in the two muscle weak spot and distinctive skin concerns.
“[It’s a] less popular autoimmune dysfunction, but it has quite attribute pores and skin results,” Suozzi claimed.
A person is a rash termed Gottron’s papules that seems on the back of the hands, Suozzi stated.
A different is called the shawl indication. It is a pink rash that addresses the shoulders, arms, and upper again in a sample that resembles a scarf.
The post 9 skin conditions that could signal a more serious problem, Defence Online appeared first on Defence Online.
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2018 Nobel Prize in Physiology or Medicine: Cancer therapy: Inhibiting the brakes on the immune system
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2018 Nobel Prize in Physiology or Medicine: Cancer therapy: Inhibiting the brakes on the immune system
The Nobel Assembly at Karolinska Institutet has today decided to award the 2018 Nobel Prize in Physiology or Medicine jointly to James P. Allison and Tasuku Honjo for their discovery of cancer therapy by inhibition of negative immune regulation.
Cancer kills millions of people every year and is one of humanity’s greatest health challenges. By stimulating the inherent ability of our immune system to attack tumor cells this year’s Nobel Laureates have established an entirely new principle for cancer therapy.
James P. Allison studied a known protein that functions as a brake on the immune system. He realized the potential of releasing the brake and thereby unleashing our immune cells to attack tumors. He then developed this concept into a brand new approach for treating patients.
In parallel, Tasuku Honjo discovered a protein on immune cells and, after careful exploration of its function, eventually revealed that it also operates as a brake, but with a different mechanism of action. Therapies based on his discovery proved to be strikingly effective in the fight against cancer.
Allison and Honjo showed how different strategies for inhibiting the brakes on the immune system can be used in the treatment of cancer. The seminal discoveries by the two Laureates constitute a landmark in our fight against cancer.
Can our immune defense be engaged for cancer treatment?
Cancer comprises many different diseases, all characterized by uncontrolled proliferation of abnormal cells with capacity for spread to healthy organs and tissues. A number of therapeutic approaches are available for cancer treatment, including surgery, radiation, and other strategies, some of which have been awarded previous Nobel Prizes. These include methods for hormone treatment for prostate cancer (Huggins, 1966), chemotherapy (Elion and Hitchins, 1988), and bone marrow transplantation for leukemia (Thomas 1990). However, advanced cancer remains immensely difficult to treat, and novel therapeutic strategies are desperately needed.
In the late 19th century and beginning of the 20th century the concept emerged that activation of the immune system might be a strategy for attacking tumor cells. Attempts were made to infect patients with bacteria to activate the defense. These efforts only had modest effects, but a variant of this strategy is used today in the treatment of bladder cancer. It was realized that more knowledge was needed. Many scientists engaged in intense basic research and uncovered fundamental mechanisms regulating immunity and also showed how the immune system can recognize cancer cells. Despite remarkable scientific progress, attempts to develop generalizable new strategies against cancer proved difficult.
Accelerators and brakes in our immune system
The fundamental property of our immune system is the ability to discriminate “self” from “non-self” so that invading bacteria, viruses and other dangers can be attacked and eliminated. T cells, a type of white blood cell, are key players in this defense. T cells were shown to have receptors that bind to structures recognized as non-self and such interactions trigger the immune system to engage in defense. But additional proteins acting as T-cell accelerators are also required to trigger a full-blown immune response (see Figure). Many scientists contributed to this important basic research and identified other proteins that function as brakes on the T cells, inhibiting immune activation. This intricate balance between accelerators and brakes is essential for tight control. It ensures that the immune system is sufficiently engaged in attack against foreign microorganisms while avoiding the excessive activation that can lead to autoimmune destruction of healthy cells and tissues.
A new principle for immune therapy
During the 1990s, in his laboratory at the University of California, Berkeley, James P. Allison studied the T-cell protein CTLA-4. He was one of several scientists who had made the observation that CTLA-4 functions as a brake on T cells. Other research teams exploited the mechanism as a target in the treatment of autoimmune disease. Allison, however, had an entirely different idea. He had already developed an antibody that could bind to CTLA-4 and block its function (see Figure). He now set out to investigate if CTLA-4 blockade could disengage the T-cell brake and unleash the immune system to attack cancer cells. Allison and co-workers performed a first experiment at the end of 1994, and in their excitement it was immediately repeated over the Christmas break. The results were spectacular. Mice with cancer had been cured by treatment with the antibodies that inhibit the brake and unlock antitumor T-cell activity. Despite little interest from the pharmaceutical industry, Allison continued his intense efforts to develop the strategy into a therapy for humans. Promising results soon emerged from several groups, and in 2010 an important clinical study showed striking effects in patients with advanced melanoma, a type of skin cancer. In several patients signs of remaining cancer disappeared. Such remarkable results had never been seen before in this patient group.
Discovery of PD-1 and its importance for cancer therapy
In 1992, a few years before Allison’s discovery, Tasuku Honjo discovered PD-1, another protein expressed on the surface of T-cells. Determined to unravel its role, he meticulously explored its function in a series of elegant experiments performed over many years in his laboratory at Kyoto University. The results showed that PD-1, similar to CTLA-4, functions as a T-cell brake, but operates by a different mechanism (see Figure). In animal experiments, PD-1 blockade was also shown to be a promising strategy in the fight against cancer, as demonstrated by Honjo and other groups. This paved the way for utilizing PD-1 as a target in the treatment of patients. Clinical development ensued, and in 2012 a key study demonstrated clear efficacy in the treatment of patients with different types of cancer. Results were dramatic, leading to long-term remission and possible cure in several patients with metastatic cancer, a condition that had previously been considered essentially untreatable.
Immune checkpoint therapy for cancer today and in the future
After the initial studies showing the effects of CTLA-4 and PD-1 blockade, the clinical development has been dramatic. We now know that the treatment, often referred to as “immune checkpoint therapy,” has fundamentally changed the outcome for certain groups of patients with advanced cancer. Similar to other cancer therapies, adverse side effects are seen, which can be serious and even life threatening. They are caused by an overactive immune response leading to autoimmune reactions, but are usually manageable. Intense continuing research is focused on elucidating mechanisms of action, with the aim of improving therapies and reducing side effects.
Of the two treatment strategies, checkpoint therapy against PD-1 has proven more effective and positive results are being observed in several types of cancer, including lung cancer, renal cancer, lymphoma and melanoma. New clinical studies indicate that combination therapy, targeting both CTLA-4 and PD-1, can be even more effective, as demonstrated in patients with melanoma. Thus, Allison and Honjo have inspired efforts to combine different strategies to release the brakes on the immune system with the aim of eliminating tumor cells even more efficiently. A large number of checkpoint therapy trials are currently underway against most types of cancer, and new checkpoint proteins are being tested as targets.
For more than 100 years scientists attempted to engage the immune system in the fight against cancer. Until the seminal discoveries by the two laureates, progress into clinical development was modest. Checkpoint therapy has now revolutionized cancer treatment and has fundamentally changed the way we view how cancer can be managed.
Key publications
Ishida, Y., Agata, Y., Shibahara, K., & Honjo, T. (1992). Induced expression of PD-1, a novel member of the immunoglobulin gene superfamily, upon programmed cell death. EMBO J., 11(11), 3887-3895.
Leach, D. R., Krummel, M. F., & Allison, J. P. (1996). Enhancement of antitumor immunity by CTLA-4 blockade. Science, 271(5256), 1734-1736.
Kwon, E. D., Hurwitz, A. A., Foster, B. A., Madias, C., Feldhaus, A. L., Greenberg, N. M., Burg, M.B. & Allison, J.P. (1997). Manipulation of T cell costimulatory and inhibitory signals for immunotherapy of prostate cancer. Proc Natl Acad Sci USA, 94(15), 8099-8103.
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James P. Allison was born 1948 in Alice, Texas, USA. He received his PhD in 1973 at the University of Texas, Austin. From 1974-1977 he was a postdoctoral fellow at the Scripps Clinic and Research Foundation, La Jolla, California. From 1977-1984 he was a faculty member at University of Texas System Cancer Center, Smithville, Texas; from 1985-2004 at University of California, Berkeley and from 2004-2012 at Memorial Sloan-Kettering Cancer Center, New York. From 1997-2012 he was an Investigator at the Howard Hughes Medical Institute. Since 2012 he has been Professor at University of Texas MD Anderson Cancer Center, Houston, Texas and is affiliated with the Parker Institute for Cancer Immunotherapy.
Tasuku Honjo was born in 1942 in Kyoto, Japan. In 1966 he became an MD, and from 1971-1974 he was a research fellow in USA at Carnegie Institution of Washington, Baltimore and at the National Institutes of Health, Bethesda, Maryland. He received his PhD in 1975 at Kyoto University. From 1974-1979 he was a faculty member at Tokyo University and from 1979-1984 at Osaka University. Since 1984 he has been Professor at Kyoto University. He was a Faculty Dean from 1996-2000 and from 2002-2004 at Kyoto University.
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