title: Kwashiorkor

text: The low protein theory, which relies heavily upon Starling's theory for the movement of fluid in biological systems, provided a compelling rationale for the pathogenesis of edema in kwashiorkor. What it does not explain however, is the entire array of disturbances that define the kwashiorkor syndrome. These include, irritability, anorexia, skin desquamation, skin depigmentation, hair discoloration, reduced mitochondrial respiration, impaired lipid export from the liver without an accompanying reduction of lipoprotein synthesis, 'oxidative stress', glutathione depletions, transsulfuration disturbances, diffuse DNA hypomethylation, immune dysfunction, decreased transmethylation activity, and sulfated glycosaminoglycan deficiencies. It is now generally acknowledged that by itself, the low protein theory does not adequately account for the pathogenesis of kwashiorkor. More complex deficiencies are at work. These have still not been established.


title: Kwashiorkor

text: Social factors also matter. Ignorance of nutrition can be a cause. A case was described where parents who fed their child cassava failed to recognize malnutrition because of the edema caused by the syndrome and believed the child was well-nourished despite the lack of dietary protein.


title: Kwashiorkor

text: Recent studies have attempted to pinpoint a relationship between kwashiorkor and high levels of aflatoxins. Aflatoxins are naturally occurring toxins produced by the mold "Aspergillus flavus", a fungus found in areas with hot and humid climates. These toxins tend to grow and can be found in agricultural crops such as millet, maize, and rice. An analysis found that the presence of aflatoxins was found more frequently and in higher concentrations in individuals with kwashiorkor when compared to individuals with marasmus (another form of severe acute malnutrition). In particular, biological samples showed greater levels of aflatoxins in the brain, heart, kidney, liver, lungs, serum, stool, and urine. Aflatoxins were not found in liver samples of individuals with marasmus. It has been known that the liver organ is the main target of aflatoxins and chronic toxicity can result in immunosuppressive and carcinogenic effects. However, there is currently conflicting evidence to pinpoint a connection between kwashiorkor and aflatoxins. Studies have shown that not all children with kwashiorkor present with detectable aflatoxin levels. It has also been proposed that damage done by aflatoxins may be due to glutathione depletion (another proposed mechanism of the disease) in children with kwashiorkor.


title: Kwashiorkor

text: Kwashiorkor is a form of protein deficiency, which can result in both osmotic imbalances and irregularities in the lymphatic system.


title: Kwashiorkor

text: Kwashiorkor is most notable for peripheral edema. The presence of edema in kwashiorkor is correlated with very low albumin concentration (hypoalbuminemia). Edema results from a loss of fluid balance between the hydrostatic and oncotic pressures across the capillary blood vessel walls due to the lack of protein which affects the body's ability to draw fluid from the tissues into the bloodstream. Low albumin concentration influences negatively the strength of oncotic pressure. Failure leads to the fluid buildup in the abdomen, resulting in edema and belly distension.


title: Kwashiorkor

text: Furthermore, the release of antidiuretic hormone is stimulated by hypovolemia, also leading to the development of peripheral edema. Plasma renin is also stimulated, promoting sodium retention.


title: Kwashiorkor

text: It is important to distinguish the pathophysiology of marasmus and kwashiorkor when it comes to treating malnourished children who may have hypovolemic shock that is cause by an acute loss of salt and water. Children with severe albumin deficiency struggle physiologically to maintain their blood volume.


title: Kwashiorkor

text: Kwashiorkor is also marked by low glutathione levels. Glutathione is used in many of the body processes on a molecule level.


title: Kwashiorkor

text: It is believed to be related to high oxidant levels commonly seen in people who suffer from starvation and rarely in chronic inflammation. Glutathione serves vital functions including management of oxidative stress which is an imbalance that plays a key role in the pathogenesis of many diseases.


title: Kwashiorkor

text: Cysteine is an essential amino acid that acts as the limiting amino acid for glutathione synthesis in humans. Factors that stimulate cysteine uptake by cells will increase glutathione levels and prevent glutathione deficiency in humans under various conditions including protein malnutrition.


title: Kwashiorkor

text: Evidence indicates that dietary amino acids balance has an important effect on protein nutrition and therefore on glutathione homeostasis.


title: Kwashiorkor

text: A proposed experimental theory suggests that alterations in the microbiome/virone contributes to edematous malnutrition, but further studies are required to understand the mechanism.


title: Kwashiorkor

text: Kwashiorkor, or edematous malnutrition, like many other malnutrition diseases, is indirectly assessed using anthropometry. Kwashiorkor is a subtype of severe acute malnutrition (SAM) characterized by bilateral peripheral pitting edema. According to the World Health Organization, the SAM diagnosis parameters are a "mid-upper arm circumference (MUAC) of < 115 mm, weight-for-height/length Z-score (WHZ) of < -3Z and nutritional edema or any combination of these parameters." Additional clinical findings on physical exam include marked muscle atrophy, abdominal distension, dermatitis, and hepatomegaly.


title: Kwashiorkor

text: WHO criteria for clinical assessment of malnutrition are based on the degree of wasting (MUAC), stunting (weight-for-height Z-score), and the presence of edema (mild to severe).<ref name="WHO 10665/95584"></ref>


title: Kwashiorkor

text: Because it can be difficult to measure weight-for-height Z scores (WHZ) frequently, screening is performed by physical exam, with careful examination of the child's feet to detect the presence of bilateral pitting edema. Screening for edema is essential for the diagnosis of kwashiorkor, since nearly two thirds of kwashiorkor cases do not have evidence of acute wasting (i.e. mid-upper arm circumference (MUAC) < 125 mm, or WHZ < -2) when diagnosed with kwashiorkor.


title: Kwashiorkor

text: As for the prevention of childhood malnutrition, there needs to be public health changes such as improving agriculture and improving access to healthcare to effectively reduce the rates of malnutrition in children. By educating individuals of childbearing age on proper nutrition and health during and after pregnancy, they can provide their children with the appropriate nutrients from a young age. By ensuring they are equipped with the proper education and resources, caretakers and infants are in better health, ultimately preventing childhood malnutrition.


title: Kwashiorkor

text: Because edema can hide decreased muscle mass, it can be hard to diagnose kwashiorkor in young children; however, if cases are overlooked, children become more susceptible to infections and can ultimately lead to morbidity and mortality. To prevent this from happening, parents can be educated on proper nutrition and the importance of breastfeeding infants to ensure they receive all the nutrients they need.


title: Kwashiorkor

text: A diet rich in carbohydrates, fats that make up 10% of the total caloric needs, and proteins that make up 15% of the caloric needs can prevent kwashiorkor.


title: Kwashiorkor

text: WHO guidelines outline 10 general principles for the inpatient management of severely malnourished children.


title: Kwashiorkor

text: Both clinical subtypes of severe acute malnutrition (kwashiorkor and marasmus) are treated similarly. Upon initial treatment, children with kwashiorkor may experience weight loss as their edema resolves. Therefore, after concerns of refeeding syndrome have passed, children may require 120-140% of their estimated caloric needs in order to achieve catch-up growth.


title: Kwashiorkor

text: The cause, type, and severity of malnutrition determines what type of treatment would be most appropriate. For primary acute malnutrition, children with no complications are treated at home and are encouraged to either continue breastfeeding (for infants) or start using ready-to-use therapeutic foods (for children). For secondary acute malnutrition, the underlying cause needs to be identified to appropriately treat children. Only after the primary disease is determined can an appropriate dietary plan be made, as fluid, vitamins, and macronutrients may need to be considered to not exacerbate the cause of the malnutrition.


title: Kwashiorkor

text: Ready-to-use therapeutic foods (RUTFs) and F-75 and F-100 milks were created to provide appropriate nutrition and caloric intake to those experiencing malnutrition. F-75 milk would be ideal when trying to reintroduce food into a malnourished person, and F-100 milk would be used to aid in weight gain. While RUTFs and F-100 milk were made to have the same nutritional value, RUTFs are beneficial as they are dehydrated and do not require much preparation.


title: Kwashiorkor

text: Kwashiorkor is associated with a high risk of mortality and long-term complications. Treatment under the guidelines of the World Health Organization has proven to reduce this mortality risk and affected children tend to recover faster than children with other severe malnutrition diseases. However, physical and intellectual capabilities are not fully restored. Growth stunting and chronic disruption of microbiota are commonly observed after recovery.


title: Kwashiorkor

text: A high risk of death is identified by a brachial perimeter < 11 cm or by a weight-for-age threshold < −3 z-scores below the median of the WHO child growth standards. In practice, malnourished children with edema are suffering from potentially life-threatening severe malnutrition.


title: Kwashiorkor

text: Kwashiorkor is rare in high income countries. It is mostly observed in low-income and middle income nations and regions such as Southeast Asia, Central America, Congo, Ethiopia, Puerto Rico, Jamaica, South Africa, and Uganda, where poverty is prominent. Occurrences of severe malnutrition also tend to trend higher under conditions of food insecurity, higher prevalence of infectious diseases, lack of access to appropriate care, and poor living situations with inadequate sanitation. Communities experiencing famine are affected the most especially during the rainy season. Prevalence varies, but it affects children of either sex commonly under five years old. "Globally, kwashiorkor indirected accounted for 53% of deaths among children under five between 2000 and 2003 when associated with other common childhood diseases like acute respiratory infections, malaria, measles, HIV/AIDS and other causes of perinatal deaths."


title: Kwashiorkor

text: When compared to marasmus in developing countries, kwashiorkor typically has a lower prevalence, "0.2%-1.6% for kwashiorkor and 1.2%-6.8% for marasmus." Factors such as "diet, geographical locations, climate and aflatoxin exposure" have been invoked as potential causes for observed differences in the prevalence for kwashiorkor and marasmus.


title: Kwashiorkor

text: In general, in areas where Severe Acute Malnutrition (SAM) is prevalent, marasmus is more often the dominant SAM condition. However, in certain areas kwashiorkor may be more common than marasmus.


title: Kwashiorkor

text: Kwashiorkor was present in the world long before 1933, when Cecily Williams published research which took the Ga name for the disease. There were already many names for the illness which referenced the cessation of breastfeeding, or the consumption of monotonous diets high in starch. However, Williams was the first to suggest that this might be a deficiency of protein or an amino acid. Despite publishing in 1933, it was only in 1949 that the World Health Organization officially recognized kwashiorkor as a public health concern. This period also correlated with the promotion of infant formula, often by European colonial powers. The substitution of breastmilk for formula contributed significantly to the increasing visibility of kwashiorkor throughout the twentieth century. Cicely Williams later described the promotion of formula as "the most criminal form of sedition, and that those deaths should be regarded as murder." These arguments underpinned the 1970s Nestlé boycott.


title: Kwashiorkor

text: Those experiencing poverty-related infectious diseases (PRDs) such as malaria and tuberculosis are also likely to be malnourished. Malnutrition can affect the pharmacokinetics of various drugs used to treat PRDs by changing a drug's bioavailability, distribution, and elimination. To optimize treatment of those diseases, there needs to be more research into how severe malnutrition, specifically kwashiorkor, can affect treatment response.


title: Kwashiorkor

text: Current research and recommendations to manage severe acute malnutrition (SAM), such as kwashiorkor, in children are largely based on expert opinions. Only one-third of the WHO guidelines for management of SAM are based on epidemiological and clinical research. Further studies are needed in order to "improve treatment outcomes in the large number of children with SAM."


title: Anthony De La Torre

text: Anthony De La Torre (born November 24, 1993) is an American actor, singer, songwriter and guitarist, known for his roles as young Jack Sparrow in "" (2017) and Jan Axel Blomberg in "Lords of Chaos" (2018).


title: Anthony De La Torre

text: De La Torre was born in Bowling Green, Ohio, to Cuban parents. His mother, Esther Garcia, is a Spanish teacher at Bowling Green High School, and also owns a cleaning business. His parents divorced shortly after De La Torre's birth. He has one older brother, Nicolas, and one older sister, Angelica. De La Torre attended St. Aloysius Elementary and Junior High School in Bowling Green, before enrolling in online schooling via Ohio Virtual Academy.


title: Anthony De La Torre

text: As a teen, De La Torre performed as a Justin Bieber impersonator, for which he would make between $300 and $600 an hour, and also worked for his mother's cleaning business. In 2012, he moved to Nashville, Tennessee, to work on a music project with songwriter and producer Desmond Child. The following year, he moved to Los Angeles, California.


title: Anthony De La Torre

text: De La Torre began his acting career with a voice role in "Go, Diego, Go!" as Willie the Whistling Duck, for which he was credited as Antonio Cabrera. He also appeared in a print advertisement for Del Monte ketchup. He had a recurring role in two episodes of Nickelodeon's "100 Things to Do Before High School", portraying a Latino actor named Anthony Del Rey.


title: Anthony De La Torre

text: De La Torre starred as the young Jack Sparrow in the 2017 blockbuster fantasy film "", directed by Joachim Rønning and Espen Sandberg. His appearance as the character was merged with Johnny Depp's via CGI. In July 2017, he replaced Toby Rand as the frontman for The Fell, a rock band consisting of Mike Krompass, Randy Cooke, and Billy Sheehan.


title: Anthony De La Torre

text: He portrayed Jan Axel Blomberg / Hellhammer in Jonas Åkerlund's thriller "Lords of Chaos", alongside Rory Culkin, Emory Cohen and Jack Kilmer. De La Torre also appeared as Hellhammer in the music video for Metallica's "ManUNkind". The film premiered at the 2018 Sundance Film Festival. De La Torre is set to star in the title role in the low budget horror film "Johnny Gruesome", directed by Greg Lamberson.


title: Anthony De La Torre

text: Since August 2015, De La Torre has been in a relationship with Lana Condor. They became engaged on January 28, 2022.


title: Skin cancer

text: Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.


title: Skin cancer

text: More than 90% of cases are caused by exposure to ultraviolet radiation from the Sun. This exposure increases the risk of all three main types of skin cancer. Exposure has increased, partly due to a thinner ozone layer. Tanning beds are another common source of ultraviolet radiation. For melanomas and basal-cell cancers, exposure during childhood is particularly harmful. For squamous-cell skin cancers, total exposure, irrespective of when it occurs, is more important. Between 20% and 30% of melanomas develop from moles. People with lighter skin are at higher risk as are those with poor immune function such as from medications or HIV/AIDS. Diagnosis is by biopsy.


title: Skin cancer

text: Decreasing exposure to ultraviolet radiation and the use of sunscreen appear to be effective methods of preventing melanoma and squamous-cell skin cancer. It is not clear if sunscreen affects the risk of basal-cell cancer. Nonmelanoma skin cancer is usually curable. Treatment is generally by surgical removal but may, less commonly, involve radiation therapy or topical medications such as fluorouracil. Treatment of melanoma may involve some combination of surgery, chemotherapy, radiation therapy and targeted therapy. In those people whose disease has spread to other areas of the body, palliative care may be used to improve quality of life. Melanoma has one of the higher survival rates among cancers, with over 86% of people in the UK and more than 90% in the United States surviving more than 5 years.


title: Skin cancer

text: Skin cancer is the most common form of cancer, globally accounting for at least 40% of cancer cases. The most common type is nonmelanoma skin cancer, which occurs in at least 2–3 million people per year. This is a rough estimate, however, as good statistics are not kept. Of nonmelanoma skin cancers, about 80% are basal-cell cancers and 20% squamous-cell skin cancers. Basal-cell and squamous-cell skin cancers rarely result in death. In the United States, they were the cause of less than 0.1% of all cancer deaths. Globally in 2012, melanoma occurred in 232,000 people and resulted in 55,000 deaths. White people in Australia, New Zealand and South Africa have the highest rates of melanoma in the world. The three main types of skin cancer have become more common in the last 20 to 40 years, especially regions where the population is predominantly White.


title: Skin cancer

text: There are three main types of skin cancer: basal-cell skin cancer (basal-cell carcinoma) (BCC), squamous-cell skin cancer (squamous-cell carcinoma) (SCC) and malignant melanoma.


title: Skin cancer

text: Basal-cell carcinomas are most commonly present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous-cell skin cancers are also common, but much less common than basal-cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip, ear, and in people who are immunosuppressed. Melanoma are the least frequent of the three common skin cancers. They frequently metastasize, and potentially cause death once they spread.


title: Skin cancer

text: Less common skin cancers include: dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi's sarcoma, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, Paget's disease of the breast, atypical fibroxanthoma, leiomyosarcoma, and angiosarcoma, and porocarcinoma.


title: Skin cancer

text: BCC and SCC often carry a UV-signature mutation indicating that these cancers are caused by UVB radiation via direct DNA damage. However malignant melanoma is predominantly caused by UVA radiation via indirect DNA damage. The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin, if applied in too little quantity and too infrequently. However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add that frequent re-application reduces the risk of radical formation.


title: Skin cancer

text: There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole, enlargement of the mole, changes in color, the way it feels or if it bleeds. Other common signs of skin cancer can be painful lesion that itches or burns and large brownish spot with darker speckles.


title: Skin cancer

text: Basal-cell skin cancer (BCC) usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, torso or shoulders. Sometimes small blood vessels (called telangiectasia) can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly, and with proper treatment can be eliminated, often without significant scarring.


title: Skin cancer

text: Squamous-cell skin cancer (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like keratoacanthomas. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.


title: Skin cancer

text: Most melanoma consist of various colours from shades of brown to black. A small number of melanoma are pink, red or fleshy in colour; these are called amelanotic melanoma and tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for "borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm – the size of a pencil eraser) and E for "evolving."


title: Skin cancer

text: Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or another type of cancer.


title: Skin cancer

text: Ultraviolet radiation from sun exposure is the primary environmental cause of skin cancer. This can occur in professions such as farming. Other risk factors that play a role include:


title: Skin cancer

text: A malignant epithelial tumor that primarily originates in the epidermis, in squamous mucosa or in areas of squamous metaplasia is referred to as a squamous-cell carcinoma.


title: Skin cancer

text: Macroscopically, the tumor is often elevated, fungating, or may be ulcerated with irregular borders. Microscopically, tumor cells destroy the basement membrane and form sheets or compact masses which invade the subjacent connective tissue (dermis). In well differentiated carcinomas, tumor cells are pleomorphic/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant eosinophilic (pink) cytoplasm and central nucleus).


title: Skin cancer

text: Their disposal tends to be similar to that of normal epidermis: immature/basal cells at the periphery, becoming more mature to the centre of the tumor masses. Tumor cells transform into keratinized squamous cells and form round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes). Poorly differentiated squamous carcinomas contain more pleomorphic cells and no keratinization.


title: Skin cancer

text: A molecular factor involved in the disease process is mutation in gene PTCH1 that plays an important role in the Sonic hedgehog signaling pathway.


title: Skin cancer

text: Non-invasive skin cancer detection methods include photography, dermatoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis.


title: Skin cancer

text: There is insufficient evidence that optical coherence tomography (OCT) is useful in diagnosing melanoma or squamous cell carcinoma. OCT may have a role in diagnosing basal cell carcinoma but more data is needed to support this.


title: Skin cancer

text: Computer-assisted diagnosis devices have been developed that analyze images from a dermatoscope or spectroscopy and can be used by a diagnostician to aid in the detection of skin cancer. CAD systems have been found to be highly sensitive in the detection of melanoma, but have a high false-positive rate. There is not yet enough evidence to recommend CAD as compared to traditional diagnostic methods.


title: Skin cancer

text: High-frequency ultrasound (HFUS) is of unclear usefulness in the diagnosis of skin cancer. There is insufficient evidence for reflectance confocal microscopy to diagnose basal cell or squamous cell carcinoma or any other skin cancers.


title: Skin cancer

text: Sunscreen is effective and thus recommended to prevent melanoma and squamous-cell carcinoma. There is little evidence that it is effective in preventing basal-cell carcinoma. Other advice to reduce rates of skin cancer includes avoiding sunburn, wearing protective clothing, sunglasses and hats, and attempting to avoid sun exposure or periods of peak exposure. The U.S. Preventive Services Task Force recommends that people between 9 and 25 years of age be advised to avoid ultraviolet light.


title: Skin cancer

text: The risk of developing skin cancer can be reduced through a number of measures including decreasing indoor tanning and mid-day sun exposure, increasing the use of sunscreen, and avoiding the use of tobacco products.


title: Skin cancer

text: The reason it is important to limit sun exposure and to avoid tanning beds is because they both involve UV light. UV light is known to damage skin cells by mutating the DNA in it. The mutated DNA can cause tumors and other growths to form on the skin. Further, there are other risk factors beside just UV exposure. Fair skin, prolonged history of sunburns, moles, and family history of skin cancer are just a few.


title: Skin cancer

text: There is insufficient evidence either for or against screening for skin cancers. Vitamin supplements and antioxidant supplements have not been found to have an effect in prevention. Evidence for reducing melanoma risk from dietary measures is tentative, with some supportive epidemiological evidence, but no clinical trials.


title: Skin cancer

text: Zinc oxide and titanium oxide are often used in sunscreen to provide broad protection from UVA and UVB ranges.


title: Skin cancer

text: Eating certain foods may decrease the risk of sunburns but this is much less than the protection provided by sunscreen.


title: Skin cancer

text: A meta-analysis of skin cancer prevention in high risk individuals found evidence that topical application of T4N5 liposome lotion reduced the rate of appearance of basal cell carcinomas in people with xeroderma pigmentosum, and that acitretin taken by mouth may have a skin protective benefit in people following kidney transplant.


title: Skin cancer

text: A research published in January 2022 by the Oregon State University College of Pharmacy showed that a vaccine that stimulates the production of a protein critical to the skin's antioxidant network could reinforce people's defenses against skin cancer.


title: Skin cancer

text: Treatment is dependent on the specific type of cancer, location of the cancer, age of the person, and whether the cancer is primary or a recurrence. For a small basal-cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal-cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal-cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal-cell carcinoma or invasive squamous-cell carcinoma. In general, melanoma is poorly responsive to radiation or chemotherapy.


title: Skin cancer

text: For low-risk disease, radiation therapy (external beam radiotherapy or brachytherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; all of them, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, epidermal radioisotope therapy, topical chemotherapy, electrodesiccation and curettage can be found in the discussions of basal-cell carcinoma and squamous-cell carcinoma.


title: Skin cancer

text: Mohs' micrographic surgery (Mohs surgery) is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.


title: Skin cancer

text: In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.


title: Skin cancer

text: Treatments for metastatic melanoma include biologic immunotherapy agents ipilimumab, pembrolizumab, nivolumab, cemiplimab; BRAF inhibitors, such as vemurafenib and dabrafenib; and a MEK inhibitor trametinib.


title: Skin cancer

text: Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is the restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers are generally more challenging due to the presence of highly visible and functional anatomic structures in the face.


title: Skin cancer

text: When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.


title: Skin cancer

text: Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.


title: Skin cancer

text: Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.


title: Skin cancer

text: Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for the repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.


title: Skin cancer

text: The mortality rate of basal-cell and squamous-cell carcinoma is around 0.3%, causing 2000 deaths per year in the US. In comparison, the mortality rate of melanoma is 15–20% and it causes 6500 deaths per year. Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.


title: Skin cancer

text: The survival rate for people with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body. As of 2003 the overall five-year cure rate with Mohs' micrographic surgery was around 95 percent for recurrent basal cell carcinoma.


title: Skin cancer

text: Australia and New Zealand exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the most common type of cancer in people between 15 and 44 years in both countries. The incidence of skin cancer has been increasing. The incidence of melanoma among Auckland residents of European descent in 1995 was 77.7 cases per 100,000 people per year, and was predicted to increase in the 21st century because of "the effect of local stratospheric ozone depletion and the time lag from sun exposure to melanoma development."


title: Skin cancer

text: Skin cancers result in 80,000 deaths a year as of 2010, 49,000 of which are due to melanoma and 31,000 of which are due to non-melanoma skin cancers. This is up from 51,000 in 1990.


title: Skin cancer

text: More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. One in five Americans will develop skin cancer at some point of their lives. The most common form of skin cancer is basal-cell carcinoma, followed by squamous cell carcinoma. Unlike for other cancers, there exists no basal and squamous cell skin cancers registry in the United States.


title: Skin cancer

text: In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it. In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. Australia has the highest per capita incidence of melanoma in the world.


title: Skin cancer

text: Although the rates of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.


title: Skin cancer

text: Melanoma is the fifth most common cancer in the UK (around 13,300 people were diagnosed with melanoma in 2011), and the disease accounts for 1% all cancer deaths (around 2,100 people died in 2012).


title: Skin cancer

text: Approximately 2,000 people die from basal or squamous cell skin cancers (non-melanoma skin cancers) in the United States each year. The rate has dropped in recent years. Most of the deaths happen to people who are elderly and might not have seen a doctor until the cancer had spread; and people with immune system disorders.


title: Anne Gwynne

text: Anne Gwynne (born Marguerite Gwynne Trice; December 10, 1918 – March 31, 2003) was an American actress who was known as one of the first scream queens because of her numerous appearances in horror films. Gwynne was also one of the most popular pin-ups of World War II. She is the maternal grandmother of actor Chris Pine.


title: Anne Gwynne

text: Gwynne was born in Waco, Texas, the daughter of Pearl (née Guinn) and Jefferson Benjamin Trice, an apparel manufacturer. She had a brother Jefferson Jr. (b. 1914). After her family moved to St. Louis, Missouri, she attended Stephens College, where she studied drama.


title: Anne Gwynne

text: While accompanying her father to a convention in Los Angeles, Gwynne obtained a job modeling for Catalina Swimwear. She soon began acting in small theaters and appeared in a newsreel and a charity short. In June 1939, she signed a contract with Universal and was immediately put to work in "Unexpected Father".


title: Anne Gwynne

text: Universal cast her in a variety of genres including film noir and musical comedy. She co-starred with Buster Crabbe and Carol Hughes in "Flash Gordon Conquers The Universe", a 12 episode Universal serial (1940). Gwynne made a number of Westerns at the studio, including two she numbered among her favorite projects; "Men of Texas" with Robert Stack and Broderick Crawford and "Ride 'Em Cowboy" with Abbott and Costello (both 1942). She is remembered by fans of horror for her work in several pictures made in the 1940s. Her first horror film was "Black Friday" (1940) in which she played Boris Karloff's daughter. "House of Frankenstein" (1944) was the last horror picture she did at Universal.


title: Anne Gwynne

text: Gwynne was a television pioneer, appearing in TV's first filmed series, "Public Prosecutor" (1947–48); she was a member of the regular cast, playing Pat Kelly, the district attorney's secretary.


title: Anne Gwynne

text: Gwynne married Max M. Gilford in 1945. The couple had two children: Gregory, a recording artist on Dunhill Records; and Gwynne, an actress. Gwynne Gilford and her husband, actor Robert Pine, have two children, actress Katherine Pine and actor Chris Pine.


title: Anne Gwynne

text: Anne Gwynne died March 31, 2003, of a stroke following surgery at the Motion Picture Country Hospital in Woodland Hills, California. She was cremated, and her ashes were scattered at sea.


title: Extrapolations (TV series)

text: Extrapolations is an upcoming American anthology drama series created by Scott Z. Burns for Apple TV+.


title: Extrapolations (TV series)

text: An anthology series that depicts the effects of climate change on the planet through various different points of view through interconnected stories.


title: Celebrimbor

text: Celebrimbor () is a fictional character in J. R. R. Tolkien's legendarium. His name means "silver fist" or "hand of silver" in Tolkien's invented language of Sindarin. In Tolkien's stories, Celebrimbor was an elven-smith who was manipulated into forging the Rings of Power by the Dark Lord Sauron, in fair disguise and named "Annatar" ("Lord of Gifts"). Sauron then secretly made the One Ring to gain control over all the other Rings and dominate Middle-earth, setting in motion the events of "The Lord of the Rings".


title: Celebrimbor

text: Tolkien, as a professional philologist, had been asked to translate an inscription at the temple of Nodens at Lydney Park (Gloucester). There was a curse upon a ring; the place was named "Dwarf's Hill"; and he traced Nodens to an Irish hero whose name meant "silver hand". This may have inspired him to create Celebrimbor and other elements of "The Lord of the Rings".


title: Celebrimbor

text: Celebrimbor appears in the 2014 video game "" and its , where he is voiced by Alastair Duncan. In the 2022 television show "", he is played by Charles Edwards.


title: Celebrimbor

text: Celebrimbor was the son of Curufin, fifth son of Fëanor and Nerdanel, and Fëanor's only known grandchild. Fëanor was the most skilful craftsman of the First Age, forging the three Silmarils to capture some of the light of the Two Trees of Valinor. It is not stated where or when Celebrimbor was born. During the Second Age, Celebrimbor lived in the Elvish realm of Eregion and founded a brotherhood of jewel-smiths.


title: Celebrimbor

text: From the early days of Eregion, Celebrimbor fostered the relationship with Khazad-dûm (Moria), the neighbouring Dwarf-kingdom. He became friends with Narvi, a great Dwarf-craftsman, and together they made the West-gate of Khazad-dûm. Celebrimbor's special contribution was the inscriptions on the gateway.


title: Celebrimbor

text: Later, someone naming himself "Annatar" arrived in Eregion. He appeared to be an Elf, and claimed he has been sent by the Valar to share his wisdom and skills in ring-craft and jewelry for the benefit of all Middle-earth; but in fact he was the Dark Lord Sauron in disguise. Annatar provided valuable and seemingly benevolent guidance and instruction to Celebrimbor and the smiths of Eregion, and they began making the Rings of Power for the rulers of Middle-earth—seven for the Dwarf-lords and nine for Men. Secretly, without Sauron's knowledge, Celebrimbor also forged three Rings for the Elves, the greatest and fairest of the Rings of Power. The three Rings were thus free of Sauron's corrupting influence.


title: Celebrimbor

text: At the same time, Sauron secretly forged a ring: the One Ring which would enable him to rule Middle-earth. Later Sauron reassumed his role as the Dark Lord and placed the One Ring on his finger, claiming dominion over all the Rings of Power and their bearers. Before this, Celebrimbor believed Sauron to be what he had claimed to be, but realising the truth he and the Elves of Eregion defied Sauron by withholding the other rings from him. He had already sent the three Rings away for safekeeping.


title: Celebrimbor

text: With his scheme exposed to the elves, Sauron retaliated by attacking Eregion, initiating the War of the Elves and Sauron, and laying waste to the realm. Celebrimbor was captured in the sack of Eregion, and was forced under torture to disclose where the Nine and the Seven were held, but he would not reveal the whereabouts of the three Elvish Rings. Sauron captured the lesser rings and used them as instruments of evil in later years, particularly against Men. Celebrimbor died from his torment; his body, shot with arrows, was then hung upon a pole and used by Sauron's forces like a banner on the battlefield.


title: Celebrimbor

text: Like Galadriel and Gil-galad, Celebrimbor first appeared as a character in "The Lord of the Rings" and then had to be inserted into "The Silmarillion", leading to multiple changes to his descent. In a 1968 version of the story, Celebrimbor was not a Noldor but one of the Teleri of Aman, one of the three companions of Galadriel and Celeborn (here made into a Telerin prince "Teleporno" or "Telporno", grandson of Olwë). Christopher Tolkien noted that his father had mentioned Celebrimbor's descent from Fëanor in the appendices to "The Lord of the Rings", and had underlined it in one of his personal copies, writing in the margin a note stating that Celebrimbor was Curufin's son, and that if he had remembered this he would have felt bound to retain that version. A different version, in the late essay "Of Dwarves and Men", has Celebrimbor as a Sindar who claimed descent from Daeron, and at one point, Celebrimbor was also one of the Noldor of Gondolin.


title: Celebrimbor

text: Celebrimbor was of the royal line of Finwë, high king of the Noldor, the elves especially skilled in craftwork who migrated to Valinor and lived in the blessed realm.


title: Celebrimbor

text: In 1928, a 4th-century pagan cult temple was excavated at Lydney Park, Gloucestershire. Tolkien was asked to investigate a Latin inscription there: "For the god Nodens. Silvianus has lost a ring and has donated one-half [its worth] to Nodens. Among those who are called Senicianus do not allow health until he brings it to the temple of Nodens." An old name for the place was Dwarf's Hill, and in 1932 Tolkien, a professional philologist, traced Nodens to the Irish hero "Nuada Airgetlám", "Nuada of the Silver-Hand".


title: Celebrimbor

text: The Tolkien scholar Tom Shippey thought this "a pivotal influence" on Tolkien's Middle-earth, combining as it did a god-hero, a ring, dwarves, and a silver hand. "The J. R. R. Tolkien Encyclopedia" states that Mathew Lyons noted the "Hobbit-like appearance of [Dwarf's Hill]'s mine-shaft holes", and that Tolkien was, according to the Lydney curator Sylvia Jones, extremely interested in the hill's folklore on his stay there. It adds that Helen Armstrong commented that the place may have inspired "Celebrimbor and the fallen realms of Moria and Eregion". The scholar of English literature John M. Bowers notes that Celebrimbor is the Sindarin for "Silver Hand", and that "because the place was known locally as Dwarf's Hill and honeycombed with abandoned mines, it naturally suggested itself as background for the Lonely Mountain and the Mines of Moria."


title: Celebrimbor

text: Celebrimbor appears in the 2014 video game "" where he is voiced by Alastair Duncan. In order not simply to copy Peter Jackson's films, the game's makers Monolith Productions decided to combine a minor but significant Middle-earth character from "The Silmarillion", Celebrimbor, with an original character of their own invention, Talion. The game takes place sometime between the action of "The Hobbit" and "The Lord of the Rings" at which time Celebrimbor survives as an amnesiac wraith. After being bonded with Talion (a ranger of Gondor) the two become an immortal fighting team unable to leave Mordor. Over the game, Celebrimbor lends his abilities as a wraith to Talion, and the two recover Celebrimbor's lost memories of Sauron and the forging of the Rings of Power: Sauron comes to Celebrimbor to give him a powerful hammer to forge the rings, is betrayed by Sauron, is forced to inscribe the incantation in the One Ring but steals it, and is tortured and beaten to death by Sauron after an attempted coup. After the defeat of Sauron's captains, Celebrimbor describes defeating Sauron himself as futile and wishes to depart for Valinor, but is convinced to stay by Talion; he then mentions his desire to forge a new Ring of Power immune to Sauron's influence. This leads to the events of the 2017 sequel "", which reviewers described as "fun, inventive, exciting—and totally non-canonical". In "Shadow of War", Celebrimbor and Talion successfully forge a new Ring of Power that appears to be free of Sauron's influence and is stated to be equal in power to the nine Rings of the Nazgûl without their corrupting influence. They use their new Ring to take the fight to Sauron with an army of Uruks, with Talion noticing Celebrimbor becoming more aggressive and worn out. Eventually revealed to fully intend to overthrow Sauron rather than destroy him, Celebrimbor ends his bond with Talion and possesses Eltariel to use her to defeat Sauron. Talion survives by becoming a Nazgûl, and Celebrimbor is defeated when forced out of Eltariel and is quickly absorbed by Sauron trapping both of them in the form of a large flaming eye on top of Barad-dûr. Celebrimbor remains trapped as part of the Dark Lord until the One Ring is destroyed, freeing the spirit as Sauron dies.


title: Celebrimbor

text: "Celebrimbor's Secret" is the title of an expansion, part of "The Ring-maker Cycle" series, for "", a non-collectible customizable card game produced by Fantasy Flight Games.


title: Doctor Sleep (novel)

text: Doctor Sleep is a 2013 horror novel by American writer Stephen King and the sequel to his 1977 novel "The Shining". The book reached the first position on "The New York Times" Best Seller list for print and ebook fiction (combined), hardcover fiction, and ebook fiction. "Doctor Sleep" won the 2013 Bram Stoker Award for Best Novel.


title: Doctor Sleep (novel)

text: The novel was adapted into a film of the same name, which was released on November 8, 2019 in the United States.


title: Doctor Sleep (novel)

text: Following the events of "The Shining", after receiving a settlement from the owners of the Overlook Hotel, Danny Torrance remains psychologically traumatized as his mother Wendy slowly recovers from her injuries. The two are living in Florida, but angry ghosts from the Overlook, including Mrs. Massey, the woman from Room 217, still want to find Danny and eventually consume his phenomenal "shining" power. Dick Hallorann, the Overlook's former chef, teaches Danny to create mental lockboxes to contain the ghosts, including that of former Overlook owner Horace Derwent.


title: Doctor Sleep (novel)

text: As an adult, Danny (now going by Dan) takes up his father's legacy of anger and alcoholism. Dan spends years drifting across the United States, but he eventually makes his way to New Hampshire and decides to give up drinking. He settles in the small town of Frazier on a psychic hunch, working first for the Frazier municipal department and then at the local hospice, and attending Alcoholics Anonymous meetings. His psychic abilities, long suppressed by his drinking, re-emerge and allow him to provide comfort to dying patients. Aided by a cat, "Azzie", that can sense when someone is about to die, Dan acquires the nickname "Doctor Sleep".


title: Doctor Sleep (novel)

text: In the meantime, Abra Stone, a baby girl born in 2001, begins to manifest psychic powers of her own when she seemingly predicts the 9/11 attacks. She slowly and unintentionally establishes a telepathic bond with Dan through Tony, Dan's childhood "imaginary friend". As she grows, the contact becomes more conscious and voluntary, and her shining grows stronger than even his. One night, Abra psychically witnesses the ritual torture and murder of a young boy, Bradley Trevor, by the True Knot, a group of quasi-immortal nomads who possess their own psychic abilities. The True Knot members wander across the United States and periodically feed on "steam", a psychic essence produced when people who possess the shining die in pain. They refer to their victims as Rubes. The True Knot's leader, Rose the Hat, becomes aware of Abra's existence and formulates a plan to kidnap Abra and keep her alive, making her produce a limitless supply of steam.


title: Doctor Sleep (novel)

text: The True Knot begin to die off from measles contracted from Bradley Trevor; they believe that Abra's steam can cure them. Abra asks for Dan's help, and he reveals his connection with Abra to her father David and their family doctor, John Dalton. Though angry and skeptical, David agrees to go along with Dan's plan to save Abra. With the help of Billy Freeman, a friend of Dan, they foil and kill a raiding party led by Crow Daddy, Rose's second-in-command. However, Dan realizes that Rose will relentlessly hunt Abra for revenge. He visits Abra's great-grandmother Concetta, who is dying of cancer at the Frazier hospice, and telepathically learns from her that he and Abra's mother, Lucy, are half-siblings with the same father: Jack Torrance. As Concetta dies, Dan takes her diseased steam into himself. Meanwhile, dissension among the True Knot, along with Rose's obsession with Abra, leads to the group splitting up, leaving Rose with even fewer followers.


title: Doctor Sleep (novel)

text: Following another kidnapping attempt that Abra foils with Dan's telepathic help, she baits Rose into confronting her at the location where the Overlook Hotel once stood in the Rocky Mountains in Colorado, now home to a campsite owned by the True Knot. Dan and Billy travel to the site while Abra helps them by using her astral projection. Lying in wait, Dan releases the steam collected from Concetta to the remaining group of True Knot members, killing all of them. He also frees the ghost of Horace Derwent to kill the last member, Silent Sarey, waiting to ambush him and Abra, and the two fight Rose in a long psychic struggle. With help from Billy and the ghost of Dan's father, Jack Torrance, they push Rose off an observation platform so she falls to the ground, breaking her neck and dying. Before leaving the campsite, Dan sees his father wave goodbye, having finally found peace.


title: Doctor Sleep (novel)

text: In the epilogue, Dan celebrates 15 years of sobriety and attends Abra's 15th birthday party. He tells her about the patterns of alcoholism and violent behavior that run in his family and warns her not to repeat them by starting to drink or submitting to rage. Abra agrees that she will behave, but before they can finish the conversation, Dan is called back to his hospice, where he comforts a dying colleague who had antagonized him in the past.


title: Doctor Sleep (novel)

text: King described the idea for a sequel to his 1977 novel "The Shining" on November 19, 2009, during a promotional tour for his novel "Under the Dome". During a reading moderated by filmmaker David Cronenberg at the Canon Theatre, King said the sequel would follow a character from the original, Danny Torrance, now in his 40s, living in New Hampshire where he works as an orderly at a hospice and helps terminally ill patients die with the aid of extraordinary powers. Later, on December 1, 2009, King posted a poll on his official website, asking visitors to vote for which book he should write next, "Doctor Sleep" or :


title: Doctor Sleep (novel)

text: Voting ended on December 31, 2009. "Doctor Sleep" won the poll with 5,861 votes to "The Wind Through the Keyhole"s 5,812.


title: Doctor Sleep (novel)

text: On September 23, 2011, Stephen King received the Mason Award at the Fall for the Book event at the George Mason University in Fairfax, Virginia, during which he read an excerpt from "Doctor Sleep". King finished work on the first draft in early November 2011. On February 19, 2012, King read the beginning section of "Doctor Sleep" at the Savannah Book Festival, in Savannah, Georgia. The audiobook edition of King's 2012 novel "", released on April 24, 2012, contains the novel's prologue read by the author.


title: Doctor Sleep (novel)

text: In an interview with "Entertainment Weekly", King revealed that he had hired researcher Rocky Wood to work on the continuity between "The Shining" and "Doctor Sleep".


title: Doctor Sleep (novel)

text: The story was partly inspired by Oscar, a therapy cat who allegedly predicts the deaths of terminally ill patients. King said, "I thought to myself: 'I want to write a story about that.' And then I made the connection with Danny Torrance as an adult, working in a hospice. I thought: 'That's it. I'm gonna write this book.' The cat had to be there. It always takes two things for me to get going. It's like the cat was the transmission and Danny was the motor."


title: Doctor Sleep (novel)

text: On May 8, 2012, Stephen King's official website announced a tentative publication date of January 15, 2013, for "Doctor Sleep". The book was available for pre-order that same day, with the page count of 544 and . However, the exact date was removed the next day with the statement that a new release date was forthcoming, and the pre-order items were removed. Stephen King was not happy with the present draft of the novel and felt it needed a lot of editing. On September 18, 2012, a publication date of September 24, 2013 was announced. Cemetery Dance also published "Doctor Sleep" as a limited edition in three versions: Gift edition (limited to 1,750 copies), Limited edition (limited to 700 copies), and Lettered edition (limited to 52 copies), the latter two signed by Stephen King and the illustrators. On March 1, 2013, Stephen King's official site unveiled the book's cover.


title: Doctor Sleep (novel)

text: A collector's edition was announced in August 2013 by Hodder & Stoughton for publication in the United Kingdom, limited to 200 numbered copies, signed by Stephen King.


title: Doctor Sleep (novel)

text: The novel was extensively screened by critics. Steven Poole of "The Guardian" stated "..."Doctor Sleep" does not actually deliver the "good scare" of yore... What the novel lacks in brute fright, though, it makes up for with more subtle pleasures". Alan Cheuse of NPR wrote "A rather neatly designed plot has kicked in even before the book opens... Stephen King is still scaring the hell out of me." Margaret Atwood in "The New York Times" commented ""Doctor Sleep" is Stephen King's latest novel, and it's a very good specimen of the quintessential King blend... King's inventiveness and skill show no signs of slacking: "Doctor Sleep" has all the virtues of his best work." Kathryn Schulz of Vulture stated, "Much as "The Shining" was fundamentally about family violence, "Doctor Sleep" is fundamentally about alcoholism. King, a recovering addict himself, is excellent on addiction and its attendant dysfunctions: deception, self-justification, disregard of others, new-leaf fantasies and their near-instant collapse, the next fix as the North Star. And, conversely, he is excellent on deliberate sobriety. Some of the best parts of "Doctor Sleep" draw on the culture of Alcoholics Anonymous, which also provides this book's ethical core." James Kidd of "The Independent" stated "The novel's well-intentioned tale of redemption through sobriety, work and family seems to have profound personal significance for King, himself a recovering alcoholic. Perhaps it is too personal. "The Shining" had terrified by marrying a recognisable young family to claustrophobia and an unflinching portrayal of a loved one becoming a monster. "Doctor Sleep"s soupy, supernatural atmosphere reads like horror inspired by fantasy and salvation drawn from therapy. In this, the story doesn't escape its own contrivances." A reviewer of "Publishers Weekly" added "Less terrifying than its famous predecessor, perhaps because of the author's obvious affection for even the most repellant characters, King's latest is still a gripping, taut read that provides a satisfying conclusion to Danny Torrance's story."


title: Doctor Sleep (novel)

text: "The Washington Post"s Keith Donohue wrote, "King is a master of the paranormal thriller, cross-cutting among these three plotlines in short cinematic scenes that give "Doctor Sleep" its relentless narrative drive. His characters, particularly the baddies, are drawn with an economy that brings them briskly to life. Like some twisted bastard son of the Houses of Lovecraft and Dickens, he is as macabre and entertaining as ever... Despite its many horrors, "Doctor Sleep" is more assuredly a novel of redemption, well-earned in the end. It won't make you forget Jack Nicholson and his ax, but "Doctor Sleep" will give you a fresh case of the creeps." Roger Luckhurst of "Los Angeles Review of Books" stated, "Above all, "Doctor Sleep" is a novel about addiction and the fight to overcome it... King's vision of the supernatural is something that hovers numinously on the edges of the awareness, something that needs a cautious and respectful watching at all times. There will be skirmishes, minor battles, victories and losses, but no end to the long term war. Exactly like a recovering alcoholic thinks of booze." Colette Bancroft of "Tampa Bay Times" noted "At just over 500 pages, "Doctor Sleep" is a bit slimmer than most of King's recent novels, and it barrels along at an accelerating pace. Is it as bone-chillingly scary as "The Shining"? No, and few books are. But it's plenty creepy, and it's richer in the themes that have come to occupy King more, especially family relationships." A reviewer of "Kirkus Reviews" called it "satisfying at every level. King even leaves room for a follow-up, should he choose to write one—and with luck, sooner than three decades hence." Joshua Rothman of "The New Yorker" stated, ""The Shining" is introspective, austere, and unsettlingly plausible, which is why it comes to mind whenever you visit a creepy hotel, play croquet, or see an angry dad with his kid. But "Doctor Sleep", which feels less like a sequel and more like a spinoff, is unapologetically fun, free-wheeling, and bizarre."


title: Doctor Sleep (novel)

text: A film adaptation of the novel directed by Mike Flanagan and starring Ewan McGregor as Danny Torrance was released on November 8, 2019. The film is both an adaptation of the novel, and a sequel to the 1980 film adaptation of the first book. It therefore makes significant changes to the plot in order to preserve continuity with Kubrick's popular film.


title: Justin Tucker

text: Justin Paul Tucker (born November 21, 1989) is an American football placekicker for the Baltimore Ravens of the National Football League (NFL). He played college football at Texas and was signed by the Ravens as an undrafted free agent in 2012. Known for his near-perfect accuracy, Tucker is regarded as one of the greatest placekickers of all time. Tucker owns two major NFL records for kickers: career field goal percentage (minimum 100 attempts) with 91.0 percent and longest field goal at 66 yards.


title: Justin Tucker

text: Tucker graduated from Westlake High School in Austin, Texas. At Westlake, he was a teammate of future NFL quarterback Nick Foles. Tucker played wide receiver, safety, and placekicker on the Westlake Chaparrals. Tucker also played soccer from age 3-4 up until his sophomore year. He played in the 2008 U.S. Army All-American Bowl.


title: Justin Tucker

text: Tucker attended the University of Texas and played on the Texas Longhorns football team. In 2011, concluding a rivalry that saw Texas A&M University and the University of Texas square off 118 times over 117 years, he kicked the game-winning field goal as time expired. Texas, then ranked No. 25, won 27–25. While attending the University of Texas, Tucker graduated with a degree in Music.


title: Justin Tucker

text: Tucker was not selected in the 2012 NFL Draft. The Baltimore Ravens signed him on May 29, 2012, to begin workouts and camp for the Ravens alongside placekicker Billy Cundiff. After Tucker's impressive preseason performance, he was named the starter and Cundiff was released.


title: Justin Tucker

text: In his debut season, Tucker proved to be a very accurate kicker, making all 42 of his PAT attempts and missing only three out of his 33 field goals. During Week 3 against the New England Patriots, Tucker kicked a game-winning field goal with two seconds left, giving the Ravens a 31–30 victory and their first-ever regular season victory over the Patriots. In Week 12 against the San Diego Chargers, Tucker kicked the game-tying and game-winning field goal at the end of regulation and in overtime respectively in a 16–13 victory. On January 12, 2013, during the divisional playoff round game against the Denver Broncos, Tucker kicked a 47-yard field goal in double overtime to win the game (later known as the Mile High Miracle) and sent the Ravens to the AFC championship for the second consecutive year.


title: Justin Tucker

text: During the second quarter of Super Bowl XLVII against the San Francisco 49ers, Tucker failed in completing the first fake field goal attempt in Super Bowl history, coming up just one yard short of the nine needed for the first down. Nonetheless, his two fourth-quarter field goals secured a Ravens victory, earning Tucker his first Super Bowl ring.


title: Justin Tucker

text: Despite missing two field goals in Week 2 against the Cleveland Browns, Tucker continued his success as an accurate kicker for the Ravens. In Week 5 against the Miami Dolphins, he kicked the go-ahead 44-yard field goal late in the fourth quarter to give the Ravens a 26–23 victory. He also kicked the game-winning 46-yard field goal in overtime against the Cincinnati Bengals in Week 10, letting the Ravens win 20-17. He was named AFC Special Teams Player of the Month for November. On Thanksgiving, Tucker kicked five field goals en route to the Ravens' 22–20 win against the Pittsburgh Steelers. He was also selected as the player of the game along with Jacoby Jones by John Madden. He brought his holder, Sam Koch and long snapper, Morgan Cox, to accept the award on screen with him.


title: Justin Tucker

text: In 2013, Tucker kicked a franchise record-tying six field goals that were the Ravens' only points in an 18–16 win against the Detroit Lions at Ford Field in Detroit on December 16, including a 61-yard field goal in the last minute. During the game, Tucker became the first kicker in NFL history to kick a field goal in the 20s, 30s, 40s, 50s, and 60s in the same game. Tucker's 61-yard field goal also set the NFL record for longest field goal in a domed stadium. He would break his own record almost eight years later in the same stadium. Tucker would finish the year leading the league in field goal attempts and makes earning his first Pro Bowl selection as well as being voted 1st team All-Pro by AP voters.


title: Justin Tucker

text: In Week 3 against the Cleveland Browns, Tucker kicked a game-winning 32-yard field goal as time expired to give the Ravens a 23–21 victory. He would finish the year contributing 129 of the then-franchise-record 409 points scored by the Ravens that season.


title: Justin Tucker

text: Tucker had his worst year statistically, missing seven field goals despite leading the league in field goal attempts. However, he was also one of the lone bright spots in a season plagued by injuries. In Week 4 against the Pittsburgh Steelers he would kick the game-tying and game-winning field goals at the end of regulation and in overtime respectively in a 23–20 victory. The next week against the Cleveland Browns, he kicked the game-tying 25-yard field goal late in the fourth quarter, but the Ravens would lose in overtime 30–33. In Week 7 against the San Diego Chargers, Tucker made all five of his field goal attempts, including the game-winning 39-yard field goal as time expired as the Ravens won 29–26 for their second win of the year. In Week 11 against the St. Louis Rams, made the game-tying and game-winning field goal in the fourth quarter with the latter coming as time expired in the 16–13 victory for the Ravens' third win of the year. However, in Week 13 against the Miami Dolphins, Tucker missed a potential go-ahead 55-yard field goal late in the fourth quarter and the Ravens would lose 13–15.


title: Justin Tucker

text: On February 26, 2016, the Ravens placed the franchise tag on Tucker. Tucker signed the franchise tender on March 4, 2016, which would pay him $4.5 million.


title: Justin Tucker

text: Tucker would kick a go-ahead field goal in Week 2 against the Cleveland Browns in a 25–20 win before kicking a game-winning 53-yard field goal late in the fourth quarter of a 19–17 win over the Jacksonville Jaguars. In Week 12 against the Cincinnati Bengals, Tucker kicked four field goals, three from over 50 yards in a 19–14 win, earning him AFC Special Teams Player of the Week. In Week 15 against the Philadelphia Eagles, Tucker tied the NFL single-season record for 10 field goals of more than 50 yards in a 27–26 win. Tucker finished the year making all but one field goal, which was blocked in Week 14 against the New England Patriots, leading the league with 38 makes. He was named to his second Pro Bowl, his first since 2013, as a result of his successful 2016 season and was named First-team All-Pro for the second time in his career.


title: Justin Tucker

text: In 2017, Tucker completed 34 of 37 field goals and was a perfect 39-for-39 on extra points. He was named second-team All-Pro for the 2017 season.


title: Justin Tucker

text: In Week 3 of the 2018 season, Tucker made two 50+ yard field goals and three extra points in a 27-14 win over the Denver Broncos, earning him AFC Special Teams Player of the Week. He was later named the AFC Special Teams Player of the Month for September. However, on October 21, 2018, Tucker missed his first career extra point attempt against the New Orleans Saints with 24 seconds left in the game, resulting in a 23–24 loss in a game that would have otherwise likely gone to overtime. In Week 11 against the Cincinnati Bengals, Tucker kicked the go-ahead 24-yard field goal midway through the fourth quarter of a 24–21 win. In Week 17, Tucker converted all four field goals and two extra point attempts in a 26–24 win over the Cleveland Browns, earning him AFC Special Teams Player of the Week. Tucker became the first player in NFL history with six seasons of 30 or more made field goals.


title: Justin Tucker

text: In the third quarter of the wild card round against in the Los Angeles Chargers on January 6, 2019, Tucker missed a 50-yard field goal, his first career postseason miss. He would finish the game 1 of 2 as the Ravens lost 17–23.


title: Justin Tucker

text: On April 24, 2019, Tucker signed a four-year, $23.05 million contract extension with $12 million guaranteed, keeping him under contract through the 2023 season. In Week 5 against the Pittsburgh Steelers, Tucker hit all four field goals, including a game-tying 48-yarder and a 46-yard game-winner in overtime, earning him AFC Special Teams Player of the Week.


title: Justin Tucker

text: In the following week's game against the Cincinnati Bengals, Tucker made three field goals and two extra points en route to another AFC special teams player of the week. On November 3, in a game against the New England Patriots, Tucker missed his first kick of the season and his second extra point of his career. The Ravens still went on to win 37–20. On December 1, in a game against the San Francisco 49ers, he made a 49-yard game winning field goal in the 20–17 victory.


title: Justin Tucker

text: Tucker continued his accurate kicking in 2020, with his first miss not coming until Week 5, when he missed a 61-yard attempt in Week 5 against the Cincinnati Bengals. In Week 14 against the Cleveland Browns, Tucker kicked a game-winning 55-yard field goal with two seconds remaining as the Ravens won 47–42.


title: Justin Tucker

text: Amid difficult wind conditions, Tucker missed a pair of field goals in the first half that hit the left upright in the first attempt and the right upright in the second attempt in a 3–17 Divisional Round loss to the Buffalo Bills on January 16, 2021. He would finish the game going one for three.


title: Justin Tucker

text: On September 26, 2021, Tucker kicked an NFL record 66-yard game winning field goal as time expired in regulation in a 19–17 Week 3 win over the Detroit Lions. He also broke his own record for the longest field goal in a domed stadium. He finished the game with a performance reminiscent of his 2013 one in the same stadium, making four straight field goals after missing a 49-yard field goal in the first quarter. Tucker would also kick a game-winning 36-yard field goal in Week 9 34–31 overtime win over the Minnesota Vikings. Tucker was selected to his fifth Pro Bowl following the season. On the NFL Top 100 Players of 2022, Tucker was ranked number 94.


title: Justin Tucker

text: On August 8, 2022, Tucker signed a four-year extension with the Ravens worth $24 million, making him the highest-paid kicker in the league. He made the game-winning 43-yard field goal as time expired in a 19–17 win over the Cincinnati Bengals in Week 5. The kick was also his 61st consecutive field goal make in the fourth quarter or overtime, which is an NFL record. In a Week 12 28-27 loss against the Jacksonville Jaguars, Tucker attempted an NFL record 67-yard field goal with two seconds left in the fourth quarter, the attempt fell short. On December 11, Tucker became the Ravens all-time leading scorer with a 42-yard attempt versus the Pittsburgh Steelers.


title: Justin Tucker

text: ! colspan="2"| Career || 174 || 354 || 389 || style="background:#e0cef2;"| 91.0% || 6 || style="background:#e0cef2;"| 66 || 411 || 416 || 98.8% || 955 || 62.9 || 600 || 1,473


title: Justin Tucker

text: ! colspan="2"| Career || 10 || 14 || 18 || 77.8% || 0 || 52 || 27 || 27 || 100.0% || 46 || 65.2 || 22 || 69


title: Justin Tucker

text: Tucker is a devout Catholic and makes the sign of the cross before every kick. He is also a licensed real estate agent.


title: Justin Tucker

text: He is a classically trained bass-baritone who can sing opera in seven different languages. He has been asked by both the Baltimore Symphony Orchestra and Opera Orchestra of New York for performances in the past, although he was unable to participate. In 2015, Tucker was contracted by Royal Farms to sing for its line of commercials. During the year, he sang "Ave Maria" for a Catholic Charities benefit concert with the Concert Artists of Baltimore. Tucker's opera talents also led him through to the finals of the Most Valuable Performer, a talent show featuring talent performances of NFL players, where he won thanks to his rendition of "Ave Maria". As a result of his victory, he received a ring and won $50,000 for his charity through the Baltimore School for the Arts.


title: Justin Tucker

text: Tucker married Amanda Bass in March 2015. Their first child, Easton, was born on May 10, 2016 and they live in Maryland.


title: Snowy owl

text: The snowy owl (Bubo scandiacus), also known as the polar owl, the white owl and the Arctic owl, is a large, white owl of the true owl family. Snowy owls are native to the Arctic regions of both North America and the Palearctic, breeding mostly on the tundra. It has a number of unique adaptations to its habitat and lifestyle, which are quite distinct from other extant owls. One of the largest species of owl, it is the only owl with mainly white plumage. Males tend to be a purer white overall while females tend to more have more extensive flecks of dark brown. Juvenile male snowy owls have dark markings that may appear similar to females until maturity, at which point they typically turn whiter. The composition of brown markings about the wing, although not foolproof, is the most reliable technique to age and sex individual snowy owls.


title: Snowy owl

text: Most owls sleep during the day and hunt at night, but the snowy owl is often active during the day, especially in the summertime. The snowy owl is both a specialized and generalist hunter. Its breeding efforts and global population are closely tied to the availability of tundra-dwelling lemmings, but in the non-breeding season, and occasionally during breeding, the snowy owl can adapt to almost any available prey – most often other small mammals and northerly water birds, as well as, opportunistically, carrion. Snowy owls typically nest on a small rise on the ground of the tundra. The snowy owl lays a very large clutch of eggs, often from about 5 to 11, with the laying and hatching of eggs considerably staggered. Despite the short Arctic summer, the development of the young takes a relatively long time and independence is sought in autumn.


title: Snowy owl

text: The snowy owl is a nomadic bird, rarely breeding at the same locations or with the same mates on an annual basis and often not breeding at all if prey is unavailable. A largely migratory bird, snowy owls can wander almost anywhere close to the Arctic, sometimes unpredictably irrupting to the south in large numbers. Given the difficulty of surveying such an unpredictable bird, there was little in-depth knowledge historically about the snowy owl's status. However, recent data suggests the species is declining precipitously. Whereas the global population was once estimated at over 200,000 individuals, recent data suggests that there are probably fewer than 100,000 individuals globally and that the number of successful breeding pairs is 28,000 or even considerably less. While the causes are not well understood, numerous, complex environmental factors often correlated with global warming are probably at the forefront of the fragility of the snowy owl's existence.


title: Snowy owl

text: The snowy owl was one of the many bird species originally described by Carl Linnaeus in his landmark 1758 10th edition of "Systema Naturae", where it was given the binomial name "Strix scandiaca". The genus name "Bubo" is Latin for "an horned owl" and "scandiacus" is New Latin for "of Scandinavia". The former generic name "Nyctea" is derived from Greek meaning "night". Linnaeus originally described the different plumages of this owl as separate species, with the male specimens of snowy owls being considered "Strix scandiaca" and the likely females considered as "Strix nyctea". Until recently, the snowy owl was regarded as the sole member of a distinct genus, as "Nyctea scandiaca", but mtDNA cytochrome "b" sequence data shows that it is very closely related to the horned owls in the genus "Bubo" and the species is now thusly often considered inclusive with that genus. However, some authorities debate this classification, still preferring "Nyctea". Often authorities are motivated to retain the separate genus on the grounds of osteological distinctions.


title: Snowy owl

text: Genetic testing revealed a reasonably distinct genetic makeup for snowy owls, being about 8% genetically distinct from other "Bubo" owls, perhaps giving credence to those who count the species as separate under "Nyctea". However, a fairly recent shared origin in evolutionary history has been illustrated through a combination of genetic study and fossil review and there is little, other than osteology of the tarsometatarsus, to outright distinguish the snowy owl from other modern species like the Eurasian eagle-owl ("Bubo bubo"). Genetic testing has indicated that the snowy owl may have diverged from related species at around 4 million years ago. Furthermore, it has determined that the living species genetically most closely related to the snowy owl is the great horned owl ("Bubo virginianus"). On a broader scale, owls in general have, through genetic materials, been determined to be a highly distinct group, with outwardly similar groups such as Caprimulgiformes revealed to not be at all closely related. Within the owl order, typical owls are highly divergent from barn-owls. Furthermore, the "Bubo" genus likely clustered at some point during the evolutionary process with other largish owls, such as "Strix", "Pulsatrix" and "Ciccaba", based on broad similarities in their voice, reproductive behaviors (i.e. hooting postures) and a similar number and structure of chromosomes and autosomes. A number, but not all, of extant typical owls seem to have evolved from an ancient shared common ancestor with the "Bubo" owls. In addition to the question of relationship of the traditional "Bubo" owls to the snowy owls, ongoing ambiguity of the relationship of other similarly large-sized owls has been persistent. These have sometimes either been included in the genus or within separate genera, i.e. the "Ketupu" or fish owls and the "Scotopelia" or fishing owls. Despite the adaptive distinctions, the grouping of these large owls (i.e. "Bubo", snowy, fish and perhaps fishing owls) appears to be borne out via research of karyotypes.


title: Snowy owl

text: The fossil history of snowy owls is fairly well documented despite some early confusion on how to distinguish the skeletal structure of the snowy owls from eagle-owls. It was determined that the snowy owl once was distributed much more widely and far farther to the south during the Quaternary glaciation when much of the Northern Hemisphere was in the midst of an ice age. Fossil records shows that snowy owls once could be found in Austria, Azerbaijan, Czechoslovakia, England, France, Germany, Hungary, Italy, Poland, Sardinia and Spain as well as in the Americas in Cape Prince of Wales, Little Kiska Island, St. Lawrence Island, and in Illinois. In the Late Pleistocene the range expanded southward even more so to Bulgaria (80,000–16,000 years, Kozarnika Cave, W Bulgaria). and much of the Italian Peninsula. Pleistocene era fossils from France, i.e. "B. s. gallica", showed that the snowy owls of the time were somewhat bulkier (though still notably smaller than contemporary eagle-owls of the times, which were larger than the eagle-owls of today) and osteologically more sexually dimorphic in size than the modern form (9.9% dimorphism in favor of females in the fossils against 4.8% in the same features today). There are no subspecific or other geographical variations reported in the modern snowy owls, with individuals of vastly different origins breeding together readily due to their nomadic habits. Despite apparent variations in body size, environmental conditions are the likely variant rather than genetics. No evidence could be found of phylogeographic variation in snowy owls upon testing. Furthermore, the snowy owl appears to have a similar level of genetic diversity as other European owls.


title: Snowy owl

text: Snowy owls are not known to interbreed with other owl species in the wild, and accordingly, no hybrids of snowy owls and other owl species have yet been sighted in the wild. However, a hobby falconer in Kollnburg, Germany, bred hybrids from a male snowy owl and a female Eurasian eagle-owl ("Bubo bubo") in 2013. The two resulting male hybrid owls possessed the prominent ear-tufts (generally absent in snowy owls), general size, orange eyes, and the same pattern of black markings on their plumage from their Eurasian eagle-owl mother, while retaining the generally black-and-white plumage colours from their snowy owl father. The hybrids were dubbed ""Schnuhus"" from the German words for snowy owl and Eurasian eagle-owl ("Schnee-Eule" and "Uhu", respectively). As of 2014, the hybrids had grown to maturity and were healthy.


title: Snowy owl

text: The snowy owl is mostly white. They are purer white than predatory mammals like polar bears ("Ursus maritimus") and Arctic fox ("Vulpes lagopus"). Often when seen in the field, these owls can resemble a pale rock or a lump of snow on the ground. It usually appears to lack ear tufts but very short (and probably vestigial) tufts can be erected in some situations, perhaps most frequently by the female when she is sitting on the nest. The ear tufts measure about and consist of about 10 small feathers. The snowy owl has bright yellow eyes. The head is relatively small and, even for the relatively simply adapted hearing mechanism of a "Bubo" owl, the facial disc is shallow and the ear is uncomplicated. 1 male had ear slits of merely on left and on the right. Females are almost invariably more duskily patterned than like-age males. In mature males, the upper parts are plain white with usually a few dark spots on the miniature ear-tufts, about the head and the tips of some primaries and secondaries whilst the underside is often pure white. Despite their reputation for being purely white, only 3 out of 129 Russian museum specimens of adult males showed an almost complete absence of darker spots. The adult female is usually considerably more spotted and often slightly barred with dark brown on the crown and the underparts. Her flight and tail feathers are faintly barred brown while the underparts are white in base color with brown spotting and barring on the flanks and upper breast. In confusingly plumaged snowy owls, the sex can be determined by the shape of wing markings, which manifest as bars more so in females and spots in males. However, the very darkest males and the lightest females are nearly indistinguishable by plumage. On rare occasion, a female can appear almost pure white, as has been recorded in both the field and in captivity. There is some evidence that some of the species grow paler with age after maturity. One study's conclusions were that males were usually but not always lighter and that correctly aging is extremely difficult, sometimes individuals either get lighter, darker or do not change their appearance with age. On the other hand, with close study, it is possible to visually identify even individual snowy owls using the pattern of markings on the wing, which can be somewhat unique in each individual. After a fresh moult, some adult females that previously appeared relatively pale newly evidenced dark, heavy markings. On the contrary, some banded individuals over at least four years were observed to have been almost entirely unchanged in the extent of their markings. In another very pale owl, the barn owl ("Tyto alba"), the sexual dimorphism of spotting appears to be driven by genetics while, in snowy owls, environment may be the dictating factor instead.


title: Snowy owl

text: The chicks are initially grayish white but quickly transition to dark gray-brown in the mesoptile plumage. This type of plumage camouflages effectively against the variously colored lichens that dot the tundra ground. This is gradually replaced by plumage showing dark barring on white. At the point of fledging, the plumage often becomes irregularly mottled or blotched with dark and is mostly solidly dark gray-brown above with white eyebrows and other areas of the face white. Recently fledged young can already be sexed to a semi-reliable degree by the dark marking patterns about their wings. The juvenile plumage resembles that of adult females but averages slightly darker on average. By their second moult fewer or more broken bars are usually evidenced on the wing. The extent of white and composition of wing patterns become more dimorphic by sex with each juvenile moult, culminating in the 4th or 5th pre-basic moult, wherein the owls are hard to distinguish from mature adults. Moults usually occur from July and September, non-breeding birds moulting later and more extensively, and are never extensive enough to render the owls flightless. Evidence indicates that snowy owls may attain adult plumage at 3 to 4 years of age, but fragmentary information suggests that some males are not fully mature and/or as fully white in plumage that they can attain until the 9th or 10th year. Generally speaking, moults of snowy owls occur more quickly than do those of Eurasian eagle-owls.


title: Snowy owl

text: The toes of the snowy owl are extremely thickly feathered white, while the claws are black. The toe feathers are the longest known of any owl, averaging at , against the great horned owl which has the 2nd longest toe feathers at a mean of Occasionally, snowy owls may show a faint blackish edge to the eyes and have a dark gray cere, though this is often not visible from the feather coverage, and a black bill. Unlike many other whitish birds, the snowy owl does not possess black wingtips, which is theorized to minimize wear-and-tear on the wing feathers in the other whitish bird types. The conspicuously notched primaries of the snowy owl appear to give an advantage over similar owls in long-distance flight and more extensive flapping flight. The snowy owl does have some of the noise-canceling serrations and comb-like wing feathers that render the flight of most owls functionally silent, but they have fewer than most related "Bubo" owls. Therefore, in combination with its less soft feathers, the flight of a snowy owl can be somewhat audible at close range. The flight of snowy owls tends to be steady and direct and is reminiscent to some of the flight of a large, slow-flying falcon. Though capable of occasional gliding flight, there is no evidence that snowy owls will soar. It is said that the species seldom exceeds a flying height of around even during passage. While the feet are sometimes described as "enormous", the tarsus is in osteological terms relatively short at 68% the length of those of a Eurasian eagle-owl but the claws are nearly as large, at 89% of the size of those of the eagle-owl. Despite its relatively short length, the tarsus is of similar circumference as in other "Bubo" owls. Also compared to an eagle-owl, the snowy owl has a relatively short decurved rostrum, a proportionately greater length to the interorbital roof and a much longer sclerotic ring surrounding the eyes while the anterior opening are the greatest known in any owl. Owls have extremely large eyes which are nearly the same size in large species such as the snowy owl as those of humans. The snowy owl's eye, at about in diameter, is slightly smaller than those of great horned and Eurasian eagle-owls but is slightly larger than those of some other large owls. Snowy owls must be able to see from great distances and in highly variable conditions but probably possess less acute night vision than many other owls. Based on the study of dioptres in different owl species, the snowy owl was determined to have eyesight better suited to long-range perception than to close discrimination, while some related species such as great horned owls could probably more successful perceive closer objects. Despite their visual limits, snowy owls may have up to 1.5 times more visual acuity than humans. Like other owls, snowy owls can probably perceive all colors but cannot perceive ultraviolet visual pigments. Owls have the largest brains of any bird (increasing in sync with the size of the owl species), with the size of the brain and eye related less to intelligence than perhaps to increased nocturnality and predatory behavior.


title: Snowy owl

text: The snowy owl is a very large owl. They are the largest avian predator of the High Arctic and one of the largest owls in the world. Snowy owls are about the sixth or seventh heaviest living owl on average, around the fifth longest and perhaps the third longest winged. This species is the heaviest and longest winged owl (as well as the second longest) in North America, the second heaviest and longest winged owl in Europe (and third longest) but is outsized in bulk by about 3 to 4 other species in Asia. Despite being sometimes described as of similar size, the snowy owl is somewhat larger in all aspects of average size than the great horned owl while the similarly specialized taiga-dwelling great grey owl ("Strix nebulosa"), is longer in total length and of similar dimensions in standard measurements, but is shorter winged and much less heavy than the snowy owl. In Eurasia, the Eurasian eagle-owl is larger in all standards of measurements than the snowy owl not to mention two additional species each from Africa and Asia that are slightly to considerably heavier on average than the snowy owl. Like most birds of prey, the snowy owl shows reverse sexual dimorphism relative to most non-raptorial birds in that females are larger than males. Sexual dimorphism that favors the female may have some correlation with being able to more effectively withstand food shortages such as during brooding as well as the rigors associated with incubating and brooding. Females are sometimes described as “giant” whereas males appear relatively “neat and compact”. However, the sexual dimorphism is relatively less pronounced compared to some other "Bubo" species.


title: Snowy owl

text: Male snowy owls have been known to measure from in total length, with an average from four large samples of and a maximum length, perhaps in need of verification, of reportedly . In wingspan, males may range from , with a mean of . In females, total length has been known to range from , with a mean of and an unverified maximum length of perhaps (if so they would have the second longest maximum length of any living owl, after only the great grey owl). Female wingspans have reportedly measured from , with a mean of . Despite one study claiming that snowy owl had the highest wing loading (i.e. grams per square cm of wing area) of any of 15 well-known owl species, more extensive sampling demonstratively illustrated that the wing loading of snowy owls is notably lower than Eurasian eagle- and great horned owls. The conspicuously long-winged profile of a flying snowy owl compared to these related species may cause some to compare their flight profile to a bulkier version of an enormous "Buteo" or a large falcon. Body mass in males can average from , with a median of and a full weight range of from six sources. Body mass in females can average from , with a median of and a full weight range of . Larger than the aforementioned body mass studies, a massive pooled dataset at six wintering sites in North America showed that 995 males averaged at while 1,189 females were found to average . Reported weights of down to for males and of for females are probably in reference to owls in a state of starvation. Such emaciated individuals are known to highly impaired and starvation deaths are probably not infrequent in winters with poor food accesses.


title: Snowy owl

text: Standard measurements have been even more widely reported than length and wingspan. The wing chord of males can vary from , averaging from with a median of . The wing chord of females can vary from , averaging from with a median of . The tail length of males can vary on average from , with a full range of and a median of . The tail length of females can average from , with a full range of and a median of . Data indicates that slightly longer wing chord and tail lengths were reported on average in Russian data than in American research, however the weights were not significantly different in the two regions. Less widely taken measurements include the culmen, which can measure from with a median average of in males and in females, and the total bill length which is from , with an average in both sexes of . Tarsal length in males averages about , with a range of , and averages about , with a range of , in females.


title: Snowy owl

text: The snowy owl is certainly one of the most unmistakable owls (or perhaps even animals) in the world. No other species attains the signature white stippled sparsely with black-brown color of these birds, a coloring which renders their bright yellow eyes all the more detectable, nor possesses their obvious extremely long feathering. The only other owl to breed in the High Arctic is the short-eared owl ("Asio flammeus"). Both species inhabit open country, overlap in range and are often seen by day, but the short-eared is much smaller and more tan or straw-colored in coloration, with streaked brown on chest. Even the palest short-eared owls conspicuously differ and are darker than the snowy owl; additionally the short-eared most often hunts in extended flights. More similar owls such as the Eurasian eagle-owl and the great horned owl attain a fairly pale, sometimes white-washed look in their northernmost races. These species do not normally breed nearly as far north as snowy owls but overlaps certainly do occur when snowy owls when the latter owl sometimes comes south in winter. However, even the most pale great horned and Eurasian eagle-owls are still considerably more heavily marked with darker base colors than snowy owls (the whitest eagle-owls are paler than the whitest great horned owls), possess much larger and more conspicuous ear tufts and lack the bicolored appearance of the darkest snowy owls. While the great horned owl has yellow eyes like the snowy owl, the Eurasian eagle-owl tends to have bright orange eyes. The open terrain habitats normally used by wintering snowy owls are also distinct from the typical edge and rocky habitats usually favored by the great horned and Eurasian eagle-owls, respectively.


title: Snowy owl

text: The snowy owl differ in their calls from other "Bubo" owls, with a much more barking quality to their version of a hooting song. Perhaps as many as 15 different calls by mature snowy owls have been documented. The main vocalization is a monotonous sequence that normally contains 2–6 (but occasionally more), rough notes similar to the rhythm of a barking dog: "krooh krooh krooh krooh"... The call may end with an emphatic "aaoow", which is somewhat reminiscent of the deep alarm call of a great black-backed gull ("Larus marinus"). They will call mainly from a perch but also sometimes do so in flight. The "krooh" call of the male snowy owl may perform multiple functions such as competitive exclusion of other males and advertising to females. The calls of this species may carry exceptionally far in the thin air of Arctic, certainly over more than , and maybe even to as much away. The female has a similar call to male but can be higher-pitched and/or more guttural as well as single notes which are often disyllabic, "khuso". Female snowy owls have also been known to utter chirps and high screaming notes, similar to those of the nestlings. Both sexes may at times give a series of clucking, squeals, grunts, hisses and cackles, perhaps such as in circumstances when they are excited. The alarm call is a loud, grating, hoarse "keeea". Another raspier bark is recorded, sometimes called a "watchman's rattle" call, and may be transcribed as "rick, rick, rick", "ha, how, quack, quock" or "kre, kre, kre, kre, kre". A female attacking to protect her nest was recorded to let out a crowed "ca-ca-oh" call, whilst other owls attacking to protect the nest did a loud version of the typical call while circling before dropping down. They may also clap their beak in response to threats or annoyances. While called clapping, it is believed this sound may actually be a clicking of the tongue, not the beak. Though largely only vocal in the breeding season, leading to some erroneous older accounts describing the snowy owl as completely silent, some vocalizations have been recorded in winter in the northern United States. Initially, the young of the snowy owl have a high pitched and soft begging call which develops into a strong, wheezy scream at around 2 weeks. At the point when the young owls leave the nest around 3 weeks, the shrill squeals they emit may allow the mothers to locate them.