text:
Wikipedia talk:Introduction (historical)

Default sandbox
Sandbox should be replaced with draft:sandbox, since the latter allows testing with VisualEditor, and so is more useful to new users (the group most likely to need to test out their editing). T.Shafee(Evo & Evo)talk 06:38, 26 April 2017 (UTC)

❌ for various reasons:

 * 1) This is not the talk of the sandbox
 * 2) Sandbox is not fully protected
 * 3) It's barely clear what you want done, I can imagine that you want WP:Sandbox to be redirected to Draft:sandbox; for such a thing, seek consensus on the right page Lil Johnny (talk) (contribs) 00:49, 7 May 2017 (UTC)

Protected edit request

 * to as per MediaWiki talk:Wikimedia-copyrightwarning--Moxy (talk) 13:20, 19 December 2017 (UTC)
 * Yes check.svg Done — Martin (MSGJ · talk) 12:10, 20 December 2017 (UTC)

Proposal to overhaul WP:I and WP:T
I've put up a proposal at the Village Pump to replace the old WP:I and WP:T with the superior Help:Intro. Any opinions welcomed there. T.Shafee(Evo & Evo)talk 02:41, 18 February 2018 (UTC)

The tutorial section looks like a tab, but clicking it brings you away from the introduction's folder layout entirely
Seems like that needs a redesign, it's an unexpected and inconsistent change in interface. -- occono (talk) 22:52, 16 June 2018 (UTC)

Proposal: Redirect this page and WP:Tutorial to Help:Introduction
Among tutorial-style introductions (so distinct from the main non-tutorial introduction, WP:Contributing to Wikipedia), it is clear that WP:Introduction and the associated WP:Tutorial are markedly inferior to Help:Introduction, the redesigned version put together from ~2015 to ~2018 and recently updated to be more mobile-friendly. They are less up-to-date, less comprehensive, less usable, etc. 's proposal to make this change two years ago may have reached consensus to proceed, but was archived before it could be closed. As I have argued before, we should be no less aggressive about merging duplicate content in WP-space than we are in mainspace — keeping it around confuses newcomers by creating a maze and wastes editors' time improving/maintaining duplicate resources.

In terms of technical implementation, since these pages have been so important in the past, I think a copy of them should be preserved. I propose that they be moved to WP:Old (original name) (e.g. WP:Old Introduction), given a historical tag with a note about the renaming, and then the original address redirected to Help:Introduction. Per the page protections, we'll need to get an admin to help perform the move.

As we've seen over the past few weeks, the Wikipedia Help Project has become pretty inactive lately, but if those of us remaining here (,, and anyone else who sees this and wants to chime in) are all on the same page, that might be sufficient to establish consensus and save us the trouble of having to post at the Village Pump and get everyone there up to speed on why this is necessary. Let's act boldly and get this done. Cheers, Sdkb (talk) 05:21, 5 March 2020 (UTC)
 * Think having only a few module style tutorials is more then enough as we know they are not effective as people dont complete them |Wikipedia:TWA/1/Start|Wikipedia:TWA/2/Start|Wikipedia:TWA/3/Start adventure stats show all gone by page 3....Nevertheless keep The_Wikipedia_Adventure (for fun)  and redirect WP:Tutorial  to Help:Introduction despite it being a navigational black hole it works better in mobile view and seems to |Help:Introduction_to_editing_with_VisualEditor/2|Help:Introduction_to_editing_with_VisualEditor/3|Help:Introduction_to_editing_with_VisualEditor/4|Help:Introduction_to_editing_with_VisualEditor/5|Help:Introduction_to_editing_with_VisualEditor/6retain retain  25% of its readers. WP:Introduction should be transformed into a normal page for easy of use with a TOC for section navigation over tab loading to a list of links....or  redirected to Help:Contents that cover topics not covered in most  how to "edit" tutorials (Report a problem - Find an article - Donating info - etc..).-- Moxy 🍁 06:27, 5 March 2020 (UTC)
 * Because WP:Introduction has been substituted a gazillion times in the standard welcome template and elsewhere, we're somewhat stuck with keeping it to its current use as a tutorial-style intro to WP for contributors, even though its name could also have fit with other uses, such as a redirect to WP:About or WP:Getting Started or Help:Contents. I'm hoping we can approach this as a somewhat unified front; anything else and we'll most likely end up stuck with the status quo. Sdkb (talk) 07:38, 5 March 2020 (UTC)
 * I'm obviously pretty biased on this, since when I came across the original 'introduction to references' by user:The wub, I was inspired to to create a wider set based on the same style! I've found in my outreach and editathons that I've had better feedback on them than for WP:I and WP:T. One thing to note is that even though there's a drop-off in multi-tabbed information pages, there's also a drop-off in scrolling down long pages, and WP:T already has quite a few tabs, which go into some detail (e.g on tables, or manually writing tags in markup). Overall, I'd put Help:contents as more useful than WP:Introduction, though I think in the context of people going to WP:Tutorial, Help:Introduction might be more useful. Might also be worth considering the left hand menu's "interaction" section (thgouh I suspect that more new editors come to the relevant pages via welcome templates than the left hand links). Perhaps a useful scoping question is "If starting with a clean slate today, what would the ideal system look like?". Perhaps we could define a couple of 'ideal scenarios' over at the Wikipedia Help Project? T.Shafee(Evo & Evo)talk 09:40, 5 March 2020 (UTC)
 * or another admin with experience in the help space, would you be willing to assist us with this? Sdkb (talk) 05:02, 7 March 2020 (UTC)
 * Comment Anyone here may also be interested in the proposal to get rid of Welcoming committee/Welcome to Wikipedia. Sdkb (talk) 18:40, 10 March 2020 (UTC)

RfC
Should we redirect WP:Introduction and WP:Tutorial to Help:Introduction? Sdkb (talk) 22:10, 12 March 2020 (UTC)
 * Support as proposer. Copying my comment from above:
 * Among tutorial-style introductions (so distinct from the main non-tutorial introduction, WP:Contributing to Wikipedia), it is clear that WP:Introduction and the associated WP:Tutorial are markedly inferior to Help:Introduction, the redesigned version put together from ~2015 to ~2018 and recently updated to be more mobile-friendly. They are less up-to-date, less comprehensive, less usable, etc. 's proposal to make this change two years ago may have reached consensus to proceed, but was archived before it could be closed. As I have argued before, we should be no less aggressive about merging duplicate content in WP-space than we are in mainspace — keeping it around confuses newcomers by creating a maze and wastes editors' time improving/maintaining duplicate resources. Sdkb (talk) 22:10, 12 March 2020 (UTC)
 * Support as main contributor of the  tutorial  up for redirect  Wikipedia:Tutorial.  |Wikipedia:TWA/1/Start|Wikipedia:TWA/2/Start|Wikipedia:TWA/3/Start Next style pages dont hold readers well so why have 4 of them (4th being the Wikipedia adventure).....best keep the one that has interested editors updating it. That said much cleanup will need to be done ...like section links to Tutorial/Editing will need to go to Help:Editing that covers both editing environments (WikiText and VE) or like Tutorial/Citing sources will need to go to Help:Referencing for beginners that again covers both editing environments because Help:Introduction divides  WikiText and VE over different pages.-- Moxy 🍁 01:37, 13 March 2020 (UTC)
 * Support. Though certainly not perfect, I think that Help:intro is overall the better option than WP:T, and even WP:I. I think the useful throught experiment is "how would we organise onboarding tutorials if designing from scratch". The main objections raised two years ago have all been addressed in the subsequent time. In particular, the and  templates have now been updated to use flexbox css to display well on phones and narrow desktop windows (thank you to  for the initial design, and  for css advice). Indeed, I beleive that they are now more mobile-friendly than the current WP:T page. In expanding the series, I've tried to follow UX guideslines where possible (<70 characters per line, <250 words per tab, <6 tabs per tutorial). They also allow users to choose whether they're getting info on markup or visualeditor rather than a mix (which can be confusing to very new users). Sidenote: this is also a problem with a lot of templates that aim to implement multilpe tabs (compare Tutorial vs WikiJournal_User_Group for a flexbox equivalent for tabs). T.Shafee(Evo & Evo)talk 09:27, 13 March 2020 (UTC)
 * Support streamlining the introduction and tutorial pages so that we can manage and improve them more efficiently. Introduction seems redundant to the modernized Help:Introduction to Wikipedia. Tutorial seems inferior to the pages linked from Help:Introduction for both Wikimarkup and the Visual Editor. Ajpolino (talk) 16:50, 13 March 2020 (UTC)
 * Support for the reasons cited above but with the proviso that even more attention should be given to adapting the page display for use by mobile contributors. Despite significant improvements, it currently still works best in full screen display on desktops and laptops. The various limitations of using mobile phones for editing could perhaps be stressed more strongly.--Ipigott (talk) 07:42, 19 March 2020 (UTC)
 * I added a note about mobile editing that appears when viewing the page on a mobile device. Thanks for the suggestion! {{u| Sdkb  }}  talk 02:32, 4 April 2020 (UTC)

 * Comment I've left a note announcing this discussion and RfC at Help_talk:Introduction and Wikipedia_talk:Tutorial, in case there's anyone watching those pages who isn't watching this one. Seems the obvious places. Pam  D  07:28, 20 March 2020 (UTC)
 * Lets close this up as snow move (no objections) and ask for help moving all!!-- Moxy 🍁 14:14, 7 April 2020 (UTC)
 * Yeah, with the RfC tag having just been removed, the consensus here seems very clear, so it doesn't look like it needs a formal close. Since some of the things this involves are move-protected, I'm going to add an admin help tag here. {{u| Sdkb  }}  talk 23:33, 11 April 2020 (UTC)

Implementation
We request help enacting the SNOW results of the above RfC. Could you turn WP:Introduction and WP:Tutorial into historical pages, with the original targets redirecting to Help:Introduction? Thanks! {{u| Sdkb  }}  talk 23:41, 11 April 2020 (UTC)
 * ( Non-administrator comment ) Listed at WP:RM/T. I see admins patrolling that page. In my experience, that page moves faster than the does.  I put your username instead of mine in the   parameter of the request templates. Stay well, Rotideypoc41352 (talk · contribs) 16:06, 12 April 2020 (UTC)
 * I would have made the move, but I think you need to get an admin to close the RfC, and mostly I think you should decide whether to redirect or to move to "(historical)". L293D (☎ • ✎) 01:59, 13 April 2020 (UTC)
 * To be honest a redirect would be fine....edit history remains intact at its original location to be viewed. A move is simply not needed as its a new page altogether being targeted....history of the evolution on the page is not needed since is a new page. We also have this talk page as a history of what happened. Would.be  confusing and complicated to merger two histories  and view them separately.-- Moxy 🍁 02:53, 13 April 2020 (UTC)
 * Okay, so this is somewhat messy currently. moved the page to Introduction (historical), so the page history is there, although they didn't move the associated header or this associated talk page. They then re-added the content to this page. I'm not sure how the redirect bots are handling it.  why do you think it's necessary to get an admin to close the RfC? There were no objections, and there was decent participation/wide enough advertising, so it seems a textbook  result. You're uninvolved, so you should feel free to close it yourself; there's no need to write out a long closing statement, since again, there's no one on the other side to object. I don't have a strong preference about whether or not to create a historical page, but I think, given how important a page this has been, it'd be nice to have a more accessible record of it. Either way, our focus should be just getting this implemented (it's long overdue), not ticking every bureaucratic box. {{u|  Sdkb  }}  talk 05:02, 13 April 2020 (UTC)

based on what Moxy said (beginning To be honest a redirect would be fine...) and the situation Anthony Appleyard's encountered (see above), should we just...copy the original page's contents, paste them to the "(historical)" pages, and attribute in the edit summary? I ask because this situation may be similar enough to archiving talk page conversations that we could use the same approach. Stay well, and thanks again! Rotideypoc41352 (talk · contribs) 17:19, 13 April 2020 (UTC)
 * For information, see Administrators' noticeboard. Anthony Appleyard (talk) 11:29, 13 April 2020 (UTC)
 * My message quoted:
 * "See in https://en.wikipedia.org/w/index.php?title=Wikipedia:Requested_moves/Technical_requests&oldid=950645337, the section "Moves needing help from someone with oversight". I tried to obey the first move, and it refused "took more than 3 seconds, ran out of time", and it asked me to move the page and its talk page and all its subpages one at a time. So, as a start, I moved Introduction by itself, and it worked, Then I moved Wikipedia talk:Introduction by itself and it refused "ran out of time" and system fault, several times. So, to restore to the starting setup, I tried to move Introduction (historical) back to Introduction by itself, and it refused "ran out of time" and system fault, several times. So, to make the page and its subpages work, I copied the current edit of Introduction (historical) back to Introduction by itself. It looks like it needs someone with oversight to obey these moves. " Anthony Appleyard (talk) 11:32, 13 April 2020 (UTC)
 * The original requested moves were:
 * - - - - - - - - - - - - Anthony Appleyard (talk) 11:33, 13 April 2020 (UTC)
 * - - - - - - - - - - - - Anthony Appleyard (talk) 11:33, 13 April 2020 (UTC)
 * - - - - - - - - - - - - Anthony Appleyard (talk) 11:33, 13 April 2020 (UTC)
 * - - - - - - - - - - - - Anthony Appleyard (talk) 11:33, 13 April 2020 (UTC)
 * Just now I tried again to move Introduction (historical) back to Introduction by itself, and it refused "Database error / To avoid creating high replication lag, this transaction was aborted because the write duration (4.107429265976) exceeded the 3 second limit. If you are changing many items at once, try doing multiple smaller operations instead. / [XpTIzwpAMOIAAnl9zXEAAACQ] 2020-04-13 20:17:26: Fatal exception of type "Wikimedia\Rdbms\DBTransactionSizeError". What is needed is some admin with the power to make such bulky page moves.Anthony Appleyard (talk) 20:19, 13 April 2020 (UTC)
 * Thanks for your efforts, . I'm not sure technically who that would need to be, but perhaps someone else does. {{u| Sdkb  }}  talk 20:29, 13 April 2020 (UTC)
 * can you unprotect the pages involved to a level a template editor can do this? (me). -- Moxy 🍁 22:52, 13 April 2020 (UTC)

 * ✅. Also, page Introduction (historical) has at least 15000 edits :: no wonder that trying to move it causes snags and system faults. Anthony Appleyard (talk) 03:35, 14 April 2020 (UTC)
 * I tried to move Wikipedia talk:Introduction to Wikipedia talk:Introduction (historical), and it failed with a system error, likeliest due to long edit history. Anthony Appleyard (talk) 11:38, 14 April 2020 (UTC)
 * Yup same problem...will write am email to someone see if they can breakup the page. I moved it to user page...cant move it back ...will try again when servers are less full.-- Moxy 🍁 22:23, 14 April 2020 (UTC)
 * Perhaps User:Ad Orientem could try....page locked up again before completed.-- Moxy 🍁 04:20, 15 April 2020 (UTC)

 * At 22:17, 14 April 2020 User:Moxy moved page Introduction (historical) to User:Moxy Introduction (historical) without leaving a redirect. Anthony Appleyard (talk) 20:08, 15 April 2020 (UTC)
 * Yup got locked up again before all completed.. oh well. Waiting on an email.-- Moxy 🍁 21:27, 15 April 2020 (UTC)
 * This is a complete mess right now. Who knows whether the redirects are now pointing to User:Moxy Introduction (historical), and whether they're being deleted as cross-namespace. And I'm noticing on my watchlist that stuff is happening at Wikidata that's probably messing things up further. This needed concerted and sustained attention to get completed in one go, and I understand there were unanticipated technical snags, but where do we go to escalate and get someone to fix them? VPT? AN? Do we need a bureaucrat or sysop or something? The problem is just going to get worse the longer it stays in this partially-completed state. {{u| Sdkb  }}  talk 18:30, 16 April 2020 (UTC)

 * So everything is exactly how it started off before anything happened.... except for an odd copy in a place  no one will ever see it. So back to the start....still waiting on reply to my email. But why not just redirect in the meantime....page history is the only thing not intact...but can be moved when possible if it's even needed. -- Moxy 🍁 01:40, 17 April 2020 (UTC)
 * Um, page history is not just disposable — it's pretty crucial. It seems to reside at User:Wikipedia:Introduction (historical) currently. And I'm not sure that the redirects and Wikidata pages are in fact intact. This is a massive mess at this point that someone is going to need to clean up. {{u| Sdkb  }}  talk 07:43, 17 April 2020 (UTC)
 * Here's how we can fix this. The current Introduction can be moved to Introduction (historical) (like requested), and then deleted. Then, the old version currently located somewhere in userspace can be moved there and deleted. Then, we can restore every single revision on the new page.  Anarchyte ( talk  |  work )  03:31, 18 April 2020 (UTC)
 * Whelp, I accidentally titled it Wikipedia:Wikipedia:Introduction (historical) but luckily in order to get it down to where it allows me to move it, this is the only related page with the wrong name. All subpages and talk pages have not been moved yet. I'll do those once the software stops yelling at me (0.5s too long).  Anarchyte ( talk  |  work )  03:37, 18 April 2020 (UTC)
 * Please see Administrators' noticeboard.  Anarchyte ( talk  |  work )  03:59, 18 April 2020 (UTC)

( Non-administrator comment ) Closing template as admins have escalated this issue to sysadmin. My move request led to Steward requests/Miscellaneous; a steward there has also pinged a sysadmin. System administrators reads if you need something to be done...file a ticket on phabricator.wikimedia.org. The discussions on AN led to. Rotideypoc41352 (talk · contribs) 02:28, 22 April 2020 (UTC)

✅. The page was redirected to Help:Introduction. I did not read the whole discussion above; but to have this page redirect the reader to some "user's" "historical" definitely doesn't make sense. If someone types in the search bar "Wikipedia:Introduction", then he or she is searching for the "introduction to Wikipedia". -- -- -- 04:42, 22 April 2020 (UTC)
 * ❌ this is not yet done. You jumping in and making changes, including opening a redirect discussion, without familiarizing yourself with what's going on is not helpful. {{u| Sdkb  }}  talk 07:08, 22 April 2020 (UTC)
 * I'm sorry. Please feel free to undo my changes if you feel that's better. -- -- -- 10:09, 22 April 2020 (UTC)
 * ✓ Done. Wikimedia sysadmin reply on Meta: I've ignored subpages and the like, if any of them is too big to handle, ping me and I'll try my best. Rotideypoc41352 (talk · contribs) 18:15, 22 April 2020 (UTC)
 * Okay! I'll try seeing if I can handle some of the subpages. {{u| Sdkb  }}  talk 18:50, 22 April 2020 (UTC)

Continued implementation
Okay, so taking stock of where we are, Introduction has now successfully been moved to Introduction (historical) with the history intact. Remaining tasks (feel free to cross these out as they're done): Whew, this is complex. Glad we're getting there, though. {{u| Sdkb  }}  talk 19:16, 22 April 2020 (UTC)
 * Move this talk page to Wikipedia talk:Introduction (historical) (requires admin access) ✅
 * Move the header from Introduction/Header to Introduction (historical)/Header (requires admin access) ✅
 * This may also involve moving constituent tabs of the header, I'm not sure ✅
 * Decide where to redirect to at Wikipedia:Introduction 2 (which currently redirects to the historical version, but we might want to redirect to Help:Introduction if anything links to it). ✅
 * Move Introduction 3 to Introduction (historical)/3, then decide where to redirect the original page to, since to WP:I2. ✅
 * Redirect constituent pages of the tutorial such as Tutorial/Citing sources to their new counterparts (e.g. Help:Introduction to referencing with Wiki Markup/1). The original pages could be preserved at a historical version if we want. ✅
 * I'm not sure if this is the right place to comment, but the tab subpages (e.g. Introduction/Tab2) have 150+ transclusions in multiple namespaces. They were recently modified, breaking every page in which they were transcluded. I reverted that change to unbreak the pages, and the pages have since been changed to have a bunch of red links on them, breaking their documentation. And now they are being substed by and maybe others. Since these pages are effectively templates, there should be a TfD or MfD to determine if they should be redirected, substed, or kept in place. – Jonesey95 (talk) 23:36, 23 April 2020 (UTC)
 * hello! Hope you're well. That's the only substitution I've done. AnotherBeliever's reverted it pending the discussion at Wikipedia talk:Introduction/TabsTop. Rotideypoc41352 (talk · contribs) 23:53, 23 April 2020 (UTC)
 * My intention with the above RfC was that redirecting WP:I and WP:T to Help:I included redirecting the subpages of WP:T to their counterparts in the Help:I series. Although looking at it now I realize I never stated that explicitly, Moxy did in the first support !vote, and my sense is that that is what has been agreed upon. The discussion was never formally closed since it was SNOWy, but since you're pretty uninvolved, if you'd like to do that it would be welcome. Overall, this is already hugely complicated as a technical matter, and I'd prefer not to reintroduce editorial hurdles as well unless it's really necessary. {{u| Sdkb  }}  talk 03:07, 24 April 2020 (UTC)
 * I'm flexible as long as there is no more breaking or substitution of working transclusions of subpages. That was pretty unpleasant. – Jonesey95 (talk) 03:29, 24 April 2020 (UTC)
 * (The third commented on my talk.) What do you think of moving the tab subpages to the "(historical)" titles and letting the redirects be? Rotideypoc41352 (talk · contribs) 00:50, 25 April 2020 (UTC)
 * Again, it's fine with me as long as it does not break transclusions. – Jonesey95 (talk) 14:16, 25 April 2020 (UTC)
 * I just went through the constituent pages of the tutorial and redirected the remaining ones to their new counterparts. So it looks like we're (hopefully) done here. Thanks everyone for all the work put into this! {{u| Sdkb  }}  talk 09:12, 30 April 2020 (UTC)
 * Not necessarily. So ... these move requests I posted on WP:RMTR ... some of them were performed without redirects being left behind. This may be a problem since the titles at the old "Wikipedia:Historical"/"Wikipedia:Tutorial" titles, as far as I last check, still have incoming links and/or transclusions. My understanding was that the redirects should remain until all incoming links and transclusions were bypassed, especially considering the issues that were brought up by other editors after the links to the old titles were changed over to the historical titles prior to the pages being moved. Steel1943  (talk) 15:39, 30 April 2020 (UTC)
 * Yeah, those links were the ones I went through. They had all been moved to the historical version with nothing left behind in most cases. I checked both the historical and original location for important links, and then redirected the original location to its successor page in the Help:Intro series in all but two cases, where I redirected to the historical version (for the summary page) or to WP:Why create an account? (for the registration page). {{u| Sdkb  }}  talk 16:52, 30 April 2020 (UTC)
 * The talk pages appear to have mostly gotten redirected to WP:Help:Introduction at some point, which seems good enough (hopefully the originals are at the historical version? Not 100% sure they all survived...). And I didn't pay attention to the sandboxes, but hopefully they don't have any important incoming links, and perhaps a bot will come through and take care of redirecting them at some point. It's not a huge loss if they just sit and fade into obscurity. {{u| Sdkb  }}  talk 17:02, 30 April 2020 (UTC)


text:
Winkler, Manitoba

Winkler is a city in Manitoba, Canada with a population of 13,745 (census agglomeration 32,655 ), making it the 4th largest city in Manitoba, as of the 2021 Canadian census. It is located in southern Manitoba, surrounded by the Rural Municipality of Stanley, about one hundred kilometres southwest of Winnipeg and 13 km east of its "twin city" Morden. As the largest city in the Pembina Valley, it serves as a regional hub for commerce, agriculture and industry. Winkler is the third-fastest growing city in the province after Morden and Steinbach.

Pre-European settlement
The land in southeast Manitoba upon which Winkler sits, was the traditional lands of the nomadic Ojibwe-speaking Anishinaabe people. They used their lands for hunting, fishing, and trapping. The Anishinaabe knew no borders at the time and their land ranged both north and south of the Canada–United States border, and both east and west of the Red River. On 3 August 1871 the Anishinaabe signed Treaty 1 and moved onto reserves.

Early history
European settlement in the Winkler area history dates back to 1876 when Plautdietsch-speaking Mennonites began settling in the area known as the West Reserve, which had been set aside exclusively for the Russian Mennonites. The West Reserve as established two years after an earlier Mennonite Reserve called the East Reserve was founded east of the Red River. Many of Winkler-area's first settlers moved from the East Reserve. The first official Mennonite Brethren congregation was founded in Burwalde, near Winkler in 1888.

In 1892, Valentine Winkler, a lumber entrepreneur and politician who owned and operated his own lumber business in nearby Morden founded the village of Winkler. Because Winkler's many customers from the Mennonite settlement wanted him to build a market in their vicinity, he persuaded the Canadian Pacific Railway to build a spur route on the northeastern edge of the settlement where Winkler had been established.

Incorporation as a village
Winkler was incorporated as a village on May 9, 1906. By that time, the flourishing village had become home to a number of German, Jewish and English merchants. The Mennonites began moving into the village soon after and by World War I, they outnumbered all other groups.

Winkler experienced significant floods in 1916, 1917, 1933 and 1966. On Tuesday, March 22, 1966, several merchants in Winkler closed down their shops for the day when they found the street flooded and water up to their doorsteps. Most of the business section was covered with two feet of water. Shopkeepers sandbagged their store front entrances while homeowners had flooded basements. A spokesman for the Emergency Measures Organization, said that about two-thirds of the town was under water. A tornado and accompanying cloudburst passed a mile west of Winkler on May 23, 1933, resulting in the worst flooding that locals could recall. The twister struck late in the afternoon, and on May 24, the whole town was flooded.

Incorporation as a town
During the early 1900s, a large number of Jewish and German merchants emigrated from Winkler, causing a decline in population. However, the village's population increased after World War II, and on April 7, 1954, Winkler was incorporated as a town.

In 1985, the Habitat for Humanity movement spread to Canada with the first Canadian build in Winkler.

Winkler becomes a city
Following a halt in growth during the 1960s, the town's rapid growth in population resumed and continued into the 1990s. On April 7, 2002, Winkler was officially granted city status. The city celebrated its centennial anniversary in the summer of 2006.

Geography and climate
Located on the western edge of the Red River Valley, Winkler is located at the corner of provincial highways 14 and 32. It is 70 km northwest of a 24-hour Canada–United States border crossing at Emerson, and about 20 km north of the Walhalla–Winkler Border Crossing with the United States at Walhalla, North Dakota.

Winkler is situated on the prehistoric beaches of Lake Agassiz. The lake's shores were formed over 10,000 years ago by the Pembina Escarpment, located a few kilometres west of Winkler. A secondary beach known as the Emerado Beach lies to the west of Winkler. This gentle rise in elevation was formed thousands of years ago when the draining of Lake Agassiz temporarily stalled.

The rich soils of the area are separated by the Emerado Beach. Coarser textured loamy sand soils, located to the west, are suitable for irrigation and produce potato, corn and bean crops. To the east, finer textured clay soils produce sugar beets, beans, canola, corn and small grains.

Winkler's climate is typically continental, resulting in dry cold winters and hot, frequently dry summers. Summer temperatures typically range from 20 to 30 C, while winter temperatures average between -15 and -25 C. The Winkler area obtains the most heat units for crop production in Manitoba. Winkler receives an annual average of 416 mm of precipitation (most of which falls during the spring and summer months) and 119.7 cm of snow. Winkler's average frost-free period is 125 days.

Economy
Winkler is the economic hub of southern Manitoba. The retail trading area serves an estimated 17,000 households. 4,380 people are employed in Winkler. Approximately 30% of the work force is employed in the industrial sector. The city's second-largest employer, employing 20% of the work force, is the health and education sector.

A number of industries have grown and developed in Winkler throughout the years. One of Winkler's largest employers is Triple E Recreational Vehicles, a recreational vehicle manufacturer. Other products manufactured in Winkler include mobile homes, houseboats, farm equipment, windows and doors. Two foundries, a straw fibre plant and a tire recycling plant are also located in Winkler.

Winkler's agricultural sector is one of the most productive and diversified in Manitoba. The area surrounding Winkler is home to rich, fertile soils which are especially suited to growing potatoes. However, many other crops are grown in the area, including wheat, canola, corn and beans. The area's livestock operations also continue to grow; hogs and cattle are raised, while dairy farms contribute to the making of cheese.

Business development in Winkler has boomed in the years since incorporation. On average, the city becomes home to 10-20 new businesses per year. In 2002, 55 new businesses were established in Winkler. The increase in new businesses can be attributed to low taxes, reasonably priced real estate and cooperation between the city and entrepreneurs. One example of this is the recently established Incubator Mall, a city-owned, five office facility that gives new businesses the opportunity to rent office space at moderate rates. Once those businesses outgrow the space, they relocate, making room for new startups.

A recent development is the rise of and competition in the technology industry in Winkler with startup internet service provider Valley Fiber and Bell MTS installing fiber optic cabling (fibre to the home) throughout the city.

Government and politics
Winkler is governed by a mayor and six councillors who are elected by residents. The current mayor of Winkler is Henry Siemens. The current Winkler city councillors are Marvin Plett, Peter Froese, Andrew Froese, Michael Grenier, Don Friesen and Don Fehr.

Winkler is represented in the Legislative Assembly of Manitoba (as part of the Morden-Winkler riding) by Progressive Conservative MLA, Carrie Hiebert, and in the House of Commons of Canada (as part of the Portage—Lisgar riding) by Conservative MP, Branden Leslie.

Transport
Winkler's chief transport connection to other communities is the highway system. Winnipeg is accessible from Winkler either via PTH 14 and PTH 3 or via PR 428 or PTH 23 and PTH 75 or PTH 14 and PTH 75. PTH 32 leads directly to the Winkler Port of Entry on the Canada–United States border. A 4-lane divided highway connects Winkler and the other major city of the region, Morden.

Winkler Airport (CKZ7, 49.16667°N, -97.91667°W) is located in the city's industrial park. It has two runways: an 2900 ft turf/paved runway (09/27), and a 1540 ft turf runway (17/35). Aircraft which need a longer runway are advised to use the Morden Regional Aerodrome which is located 9 km from Winkler.

The city has three taxi services, Pembina Valley Taxi, Winkler Taxi Service, and Green Taxi Service.

Canadian Pacific Railway has a spur line going into Winkler's industrial park that connects to the La Riviere subdivision, a secondary feeder line on the CPR network.

Demographics
In the 2021 Census of Population conducted by Statistics Canada, Winkler had a population of 13,745 living in 5,089 of its 5,239 total private dwellings, a change of NaN% from its 2016 population of 12,660. With a land area of 20.73 km2, it had a population density of in 2021.

There are 2,885 households, out of which 36.2% are married couples living together with children, 30.8% are married couples living together without children, 25.5% are one-person households and 7.6% are multiple-family households, single parent family households or non-family households other than one-person households. 90.2% of Winkler's 2,135 families are married couple families, while 1.4% are common-law couple families and 8.2% are single parent families. The average household size is 3.0 and the average family size is 3.3.

In the city the population is spread out, with 21.6% under the age of 15, 8.5% from 15 to 19, 8.1% from 20 to 24, 25.3% from 25 to 44, 12.1% from 45 to 54, 7.1% from 55 to 64 and 17.2% who are 65 years of age or older. The median age is 34.3 years. For every 100 females there are 94.8 males.

The average income for a family in the city is $44,227. The average income for all workers is $22,423, with males earning an average income of $27,787 and females earning an average income of $16,061. The average income for full-time, full-year workers is $30,779. Males who work full-time for a full year earn an average of $34,326 while females who work full-time for a full year earn an average of $23,546.

15.9% of Winkler's population is foreign-born. 1,832 immigrants settled in Winkler from 1999 to 2004, with 465 arriving in 2004 alone. Due to the city's cultural roots, most recent immigrants to Winkler are ethnic Germans from the former Soviet Union, Germans originating from Germany, or returning Low German Mennonites from Latin America.

According to Statistics Canada's 2006 census data for Winkler residents over the age of 25, 66% have high school diplomas, of which 9% also hold university certificates, diplomas or degrees.

Ethnicity
The most common ancestries in Winkler (as of 1996) are German (65.2%), Dutch (Netherlands) (24.7%), Canadian (23.0%), Russian (10.0%), Ukrainian (2.1%), French (1.5%), Aboriginal (1.2%), Scottish (1.0%), Irish (0.9%), Polish (0.8%) and Icelandic (0.2%). Most Winklerites are of Mennonite descent, which would most accurately be described as Dutch. The racial makeup of the city (as of 2001) is 98.8% White, 0.4% Chinese, 0.38% Aboriginal, 0.1% Black, 0.1% South Asian and 0.1% Southeast Asian.

Religion
According to the 2011 National Household Survey, 93.4% of the Winkler population report being of Christian faith, 6.3% report no religious affiliation, and 0.3% report being religious but of non-Christian faith.

Culture
The Pembina Thresherman's Museum is situated on Highway 3 between Winkler and Morden. It includes a number of historical buildings in a village setting and a collection of agricultural machinery, tools and household items, as well as a meeting hall.

Winkler's main festival is the Harvest Festival and Exhibition. Held at the Winkler Parkland in mid-August, it features a parade, midway, live stage entertainment, fireworks, rodeo and more. Canada Day celebrations are held at the Winkler Parkland on July 1. The Cripple Creek Music Festival takes place on the fourth Sunday in July.

Education

Winkler's public school system is the Garden Valley School Division, which consists of five elementary schools - Winkler Elementary School, Parkland Elementary School, J.R. Walkof School, Emerado Centennial School, Pine Ridge Elementary School and two high schools, Garden Valley Collegiate and Northlands Parkway Collegiate, which opened in September 2013. As of June 2023, Garden Valley School Division had a total enrollment of 4,180 students. There are no private schools operating within the city.

Garden Valley Technical School is the new vocational campus that has opened in Winkler.

Red River College also operates a regional campus in Winkler, serving 1,500 students each year.

Radio
Winkler is home to two radio stations, both of which are owned and operated by Altona-based Golden West Broadcasting. COUNTRY 88, a country music station, was established in 1980 on the AM dial at 1530 kHz, then moved to 1570 kHz in 1987, and since 2013, broadcasts on the FM dial at 88.9 MHz. CJEL-FM, an adult contemporary music station branded as The Eagle 93.5, launched in 2000.

Newspapers
The Winkler-Morden Voice is published weekly and distributed by mail to households in both Winkler and Morden and many surrounding smaller communities. A former paper, The Winkler Times newspaper ceased publication in 2020.

Sports
The Winkler Flyers compete in the Manitoba Junior Hockey League and play their home games at the Winkler Arena. Perhaps the best known alumnus of the team is Hockey Hall of Fame inductee Ed Belfour. There is also a minor league hockey in Winkler. The two local high schools have multiple sports teams under the names Zodiacs and Nighthawks. Winkler also has two men's soccer teams called the Winkler Storm, and the Riots. The women's soccer team is called the Hurricanes. Winkler was selected as host city for the 2008 edition of CBC Sports' day-long Hockey Day in Canada, which took place on February 9, 2008.

Notable people

 * Di Brandt, poet and literary critic
 * Arnold Brown, politician
 * Benjamin De Fehr, soldier executed during World War I
 * The Color, Christian band
 * Karen Doell, softball player
 * Howard Dyck, conductor and broadcaster
 * Jonathan Dyck, graphic novelist
 * Larry Dyck, hockey player
 * Peter Dyck, politician
 * David Elias, writer
 * Justin Falk, NHL player for the Buffalo Sabres
 * Eric Fehr, NHL player for the Washington Capitals
 * Byron Froese, NHL player for the Tampa Bay Lightning
 * Jacob Froese, politician
 * Peter J. Hooge, politician
 * Ray Neufeld, former NHL player for the Hartford Whalers
 * Jordan Peters, curler
 * Dustin Penner, former NHL player Anaheim Ducks
 * John Sawatsky, award-winning author and journalist
 * George Sawatzky, physicist, Fellow of the Royal Society of Canada
 * Cornelius Wiebe, physician and politician
 * Valentine Winkler, town founder

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Winkler, Manitoba


text: User talk:68.226.11.210

title: User talk:68.226.11.210


text:
Abdominoperineal resection

An abdomino perineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum is a surgery for rectal cancer or anal cancer. It is frequently abbreviated as AP resection, APR and APER.

Indication and description
See image on National Cancer Institute website The principal indication for AP resection is a rectal carcinoma situated in the distal (lower) one-third of the rectum. Other indications include recurrent or residual anal carcinoma (squamous cell carcinoma) following initial, usually definitive combination chemoradiotherapy.

APRs involves removal of the anus, the rectum and part of the sigmoid colon along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum. The end of the remaining sigmoid colon is brought out permanently as an opening, called a stoma, which is used by the patient in conjunction with a colostomy pouch, on the surface of the abdomen.

Centralisation of rectal surgery
This operation is one of the less commonly performed by general surgeons, although they are specifically trained to perform this operation. As low case volumes in rectal surgery have been found to be associated with higher complication rates, it is often centralised in larger centres, where case volumes are higher.

Laparoscopic approach
There are several advantages in terms of outcomes if the surgery can be performed laparoscopically

Relation to low anterior resection (LAR)
An APR, generally, results in a worse quality of life than the less invasive lower anterior resection (LAR). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible.

History
William Ernest Miles (1869–1947), an English surgeon first performed the surgery of removing the rectum in 1907. He assumed that the rectal cancer can spread in both upwards and downward directions, thus necessitating the removal of the entire rectum together with the anal sphincters, resulting in a permanent stoma by connecting the proximal end of the descending colon to the skin. Mile's operation became the gold standard for treating rectal cancer because his technique successfully reduced the rate of cancer recurrence.

To reduce the incidence of death and suffering of the patients associated with the APR procedure, Henri Albert Hartmann introduced the anterior resection of the rectum by preserving the distal rectum and anal sphincters, while producing end-sigmoid colostomy. There were attempts to restore bowel continuity by joining the proximal colon with the rectum, but the high incidence of leakage from the anastomotic site caused an increased risk of death to patients. It was only in 1948, Claude Dixon successfully connected the proximal bowel to the rectum, thus allowing patients to have a 64% 5-year survival rate.

title: Abdominoperineal resection


text:
Peter Dawkins

Peter Dawkins may refer to:

 * Pete Dawkins (born 1938), American college football player, military officer, business executive
 * Peter Dawkins (musician) (1946–2014), New Zealand musician and producer, based in Australia

title: Peter Dawkins


text:
Nanaimo bar

The Nanaimo bar is a bar dessert that requires no baking and is named after the Canadian city of Nanaimo in British Columbia. It consists of three layers: a wafer, nut (walnuts, almonds, or pecans), and coconut crumb base; custard icing in the middle; and a layer of chocolate ganache on top. Many varieties exist, consisting of various types of crumb, various flavours of icing (such as peanut butter or coconut, mocha), and various types of chocolate.

Origins
The earliest confirmed printed copy of the recipe using the name "Nanaimo bars" appears in the Edith Adams' prize cookbook (14th edition) from 1953. Following research into the origins of Nanaimo bars, Lenore Newman writes that the same recipe was published in the Vancouver Sun earlier that same year under the name "London Fog Bar". The recipe later also appears in the publication His/Her Favourite Recipes, Compiled by the Women's Association of the Brechin United Church (1957), with the recipe submitted by Joy Wilgress, a Baltimore, Maryland, native. (Brechin United Church is in Nanaimo.)

In 1954, the recipe "Mabel's Squares" was published in The Country Woman's Favourite by the Upper Gloucester Women's Institute (New Brunswick). The recipe was submitted by Mrs. Harold Payne, the daughter of Mabel (Knowles) Scott (1883–1957).

The first printing of recipes featuring Nanaimo bar ingredients is found in the 1952 Women's Auxiliary to the Nanaimo Hospital Cookbook, which features three nearly identical recipes that differ only slightly from the modern Nanaimo bar. They are referred to as the "chocolate square" or the "chocolate slice".

Other unconfirmed references date the bar back to the 1930s, when it was said to be known locally as "chocolate fridge cake". One modern reference mentions the bars' existence in 19th century Nanaimo.

Popularity
The popularity of the bar in Nanaimo led local residents to mobilise to have it voted "Canada's Favourite Confection" in a National Post reader survey. In 1985, Mayor Graeme Roberts initiated a contest to find the ultimate Nanaimo bar recipe. The recipe submitted by Joyce Hardcastle, a resident of Nanaimo, was unanimously selected by a panel of judges. The Nanaimo bar was popularized nationwide after being highlighted as a classic Canadian dessert at Expo 86.

Recipes for similar desserts are found in various places, under various names, in North America and Europe. The designation "Nanaimo bar" is Canadian, and appears in the Canadian Oxford Dictionary, but not in other language or dialect versions.

An episode from the first season of the competition television show MasterChef Canada features an elimination challenge where competitors made desserts inspired by Nanaimo bars, chosen among three Canadian desserts.

A 2016 US state dinner in honour of Canadian Prime Minister Justin Trudeau featured Nanaimo bars as the main dessert. The elaborate dinner, hosted by then-US President Barack Obama and his wife Michelle Obama, consisted of a blend of American and Canadian dishes. The Nanaimo bars were presented on a plate inspired by the Rocky Mountains.

In April 2019, Canada Post announced the release of a booklet of postage stamps dedicated to Canadian desserts and sweets. The booklet of 10 stamps features images of the Nanaimo bar, the butter tart, tarte au sucre (sugar pie), blueberry grunt, and Saskatoon berry pie. Canada Post described the stamps as "fun-shaped", and the booklet of stamps resembled a recipe card. The image of the Nanaimo bar on the stamp received some criticism for its ratio of "the crumbly base, the custard filling, and the chocolate ganache icing."

title: Nanaimo bar


text: User talk:67.166.193.46

title: User talk:67.166.193.46


text: User talk:172.130.215.85

title: User talk:172.130.215.85


text: User talk:66.169.66.218

title: User talk:66.169.66.218


text:
Royal College of Veterinary Surgeons

The Royal College of Veterinary Surgeons  (RCVS) is the regulatory body for veterinary surgeons in the United Kingdom, established in 1844 by royal charter. It is responsible for monitoring the educational, ethical and clinical standards of the veterinary profession. Anyone wishing to practice as a vet in the United Kingdom must be registered with the RCVS.

Role

 * To safeguard the health and welfare of animals committed to veterinary care through the regulation of the educational, ethical and clinical standards of the veterinary profession, thereby protecting the interests of those dependent on animals and assuring public health.
 * To act as an impartial source of informed opinion on animal health and welfare issues and their interaction with human health.

Anyone who wishes to practice as a vet in the United Kingdom must first register with the RCVS. Eligibility for registration is based either on having a recognised qualification or by passing the RCVS statutory membership examination. After registration, the vet is entitled to use the letters MRCVS (Member of the Royal College of Veterinary Surgeons) or FRCVS (Fellow of the Royal College of Veterinary Surgeons) after their name.

During the ceremony of admission to the RCVS, members make a declaration:

I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care.

The Royal Charter
The 1844 charter regulates particular aspects of the college's management of its affairs and gives it the power to award fellowships, diplomas and certificates to veterinary surgeons, veterinary nurses, and others engaged in "veterinary science and its auxiliary sciences".

The statutory duties of the RCVS are laid out in the Veterinary Surgeons Act 1966.

RCVS Practice Standards Scheme
The regulatory role of the RCVS has always meant that members of the public could rest assured that their individual vet is properly qualified and fit to practise, and now the same assurance can apply to practice premises. The RCVS Practice Standards Scheme is a voluntary initiative to accredit veterinary practices in the UK. Through setting standards and carrying out regular inspections, the Scheme aims to promote and maintain the highest standards of veterinary care.

RCVS Accredited practices are able to display the RCVS accredited practice logo, which indicates that the practice has undergone a rigorous, independent inspection and various minimum standards have been met.

The Disciplinary Committee of the Royal College of Veterinary Surgeons
The Disciplinary Committee of the Royal College of Veterinary Surgeons hears charges against veterinary surgeons accused of serious professional misconduct or being unfit to practice because of a criminal conviction.

Appeals from decisions of the Disciplinary Committee are heard by the Judicial Committee of the Privy Council.

Officials
In order to carry out its statutory duties a council of 33 members governs the RCVS and meets eight times a year. The President, vice-presidents (two), and Treasurer are elected by Council and together with the Chief Executive and Head of Legal Services/Registrar, form a team of officers who have the main responsibility for running the RCVS.

 * President: Melissa Donald
 * Vice President: Kate Richards
 * Vice President: Sue Patterson
 * Treasurer: Prof Susan Dawson
 * Chief Executive: Ms Lizzie Lockett
 * Registrar: Eleanor Ferguson

Publications

 * Colours and Markings of Horses (revised 2005 and distributed by Weatherbys Bookshop)
 * Directory of Veterinary Practices (annual, published in October)
 * RCVS Annual Report (annual, published in June)
 * RCVS Guide to Professional Conduct (revised 2006)
 * RCVS News (newsletter – March/June/November)
 * Register of Members (annual, published in November)
 * Veterinary Nurses List (annual, published in March)

Past-Presidents

 * James Beart Simonds (1862–3–?)
 * William Hunting (1894–1895)
 * Orlando Charnock Bradley (1920–1922)
 * John Share Jones (1928–1929)
 * Thomas Dalling (1949–51)
 * Olga Uvarov (1976–1977)
 * Judy MacArthur Clark (1992-1993)
 * Alasdair Steele-Bodger (1972–1973)
 * Richard Halliwell (2003–2004)
 * Alexander Trees, Baron Trees (2009–2010)

title: Royal College of Veterinary Surgeons


text:
User talk:Albinomonkey/F1 Aerodynamics

To Do:
 * Finish each section
 * History of aero (shark nose, fan car, ground effect, 2005 changes)
 * Get diagrams

Just do it
Why is this just sitting around in user space for years, rather than in an article Formula 1 racecar aerodynamics? Wikipedia articles aren't one-man shows; there's no reason to have it "perfect" in your judgment before creating it. Gene Nygaard 14:14, 7 November 2005 (UTC)

title: User talk:Albinomonkey/F1 Aerodynamics


text:
Acitretin

Acitretin, sold under the brand names Neotigason and Soriatane, is a second-generation retinoid. It is taken orally, and is typically used for psoriasis.

Acitretin is an oral retinoid used in the treatment of severe resistant psoriasis. Because of the potential for problems and severe side effects it is generally used in only very severe cases of psoriasis that have been unresponsive to other treatments. It binds to nuclear receptors that regulates gene transcription. They induce keratinocyte differentiation and reduce epidermal hyperplasia, leading to the slowing of cell reproduction. Acitretin is readily absorbed and widely distributed after oral administration. A therapeutic effect occurs after two to four weeks or longer.

Patients who have received the medication are advised against giving blood for at least three years due to the risk of birth defects.

Adverse effects
Acitretin is highly teratogenic and noted for the possibility of severe birth defects. It should not be used by pregnant women or women planning to get pregnant within 3 years following the use of acitretin. Sexually active women of childbearing age who use acitretin should also use at least two forms of birth control concurrently. Men and women who use it should not donate blood for three years after using it, because of the possibility that the blood might be used in a pregnant patient and cause birth defects. In addition, it may cause nausea, headache, itching, dry, red or flaky skin, dry or red eyes, dry or chapped lips, swollen lips, dry mouth, thirst, cystic acne or hair loss.

Pharmacokinetics
It is a metabolite of etretinate, which was used prior to the introduction of acitretin. Etretinate was discontinued because it had a narrow therapeutic index as well as a long elimination half-life (t1/2 = 120 days), making dosing difficult. In contrast, acitretin's half-life is approximately 2 days. However, because acitretin can be reverse metabolised into etretinate which has an extremely long half-life, women must avoid becoming pregnant for at least three years after discontinuing acitretin. Therefore, acitretin is generally not recommended for women of child-bearing age with a risk of becoming pregnant.

title: Acitretin


text:
Wikipedia:Articles for deletion/Larry Moneta

Larry Moneta
Copy/paste vanity page of a non-notable possibly notable person from .--Lucky13pjn 02:59, Dec 20, 2004 (UTC)
 * Does a vice-president of a very major university meet the professor test? Probably. On the other hand, it is a copy/paste. No inbound links. (No vote yet.) Samaritan 03:31, 20 Dec 2004 (UTC)
 * Is a vice president of student affairs an important post?--Lucky13pjn 03:55, Dec 20, 2004 (UTC)
 * More influential and more important in a job-based ranking, yes, but more encyclopedic and notable? On reflection, I'm not so sure he's more notable than the average professor. The Duke Conservative Union seems to hate him, in part for nonpartisan reason ("Larry Moneta and his lemmings at student affairs came under fire for not alerting the campus of the first rape incident until days later?indeed, after the media was informed." ) Expectedly glowing Duke magazine profile here. The rape disclosure controversy merits mention at Duke University, but I'm not convinced about Moneta. Samaritan 03:59, 20 Dec 2004 (UTC)
 * Copyvio should be tagged as such and listed on Copyright Problems. -- Cyrius|✎ 06:34, 20 Dec 2004 (UTC)
 * Keep - he's obviously notable - and sort out copyright issues. Dan100 08:10, Dec 20, 2004 (UTC)
 * Delete, not notable.  --fvw *  08:22, 2004 Dec 20 (UTC)
 * Weak Keep (although copyvio should certainly be rectified). I'm a recent grad of Duke (Class Of 2004), and Larry Moneta's arrival (I believe it was during my sophomore year?) could be likened to the coming of the Antichrist. I have no strong opinion one way or the other about the guy, but he's probably the most hated man at Duke, for the following reasons: 1) his unapologetic policy of "Harvardization", 2) helping to make Aramark the provider of Duke's food services, 3) new housing policies that favor freshmen and sophomores over upperclassmen, 4) enacting policies to marginalize selective groups, fraternities, and sororities (and emphasizing 'quad-based' living groups which don't change from enrollment to graduation), 5) the flurry of student rapes last year and the slow reaction of the entire administration, and 6) that whole monorail thing (yes, Duke wants to build a monorail to facilitate transportation - Simpsons much?). And probably some other things that I can't remember (there's more, I'm sure). So... there's some background for you. Hope that helped? AvestanHamster 06:59, 20 Dec 2004 (UTC)
 * Sounds like the makings of a far more interesting article than the one that is there (although much of this is of strictly local interest). Still, I would guess that using the school newspaper as a reference, one could do a duly cited article about some of these controversies that, if well written would be of genuine interest. Neutral for now, but if someone can turn this into an interesting profile, with decent citation, I'd keep it. -- Jmabel | Talk 09:03, Dec 20, 2004 (UTC)
 * Yeah, I think you hit the nail squarely on the head, Jmabel. I think he's notable for some of the trends he's perpetuating, especially when you consider how most other Southern universities of note (Emory and Rice, to name two more off the top of my head) are also currently "Harvardizing". But is he really important in the big scheme of things? *shrugs shoulders* Only time will tell, I guess... AvestanHamster 09:47, 20 Dec 2004 (UTC)
 * Delete: wrong side of the line. Every university has a bunch of vice presidents for this-n-that. Wile E. Heresiarch 00:17, 21 Dec 2004 (UTC)
 * Keep, current article is unhelpful, though. Wyss 00:29, 21 Dec 2004 (UTC)
 * Listed on Copyright problems. -- Cyrius|✎ 01:01, 21 Dec 2004 (UTC)
 * Even if the copyvio issues are resolved, I'm not seeing any evidence that puts him on the right side of the recommended criteria for inclusion of biographies. The controversies that Avestan describes above belong in the Duke University article, not isolated in the biography of a single administrator. Delete unless other evidence provided.  Rossami (talk) 04:38, 22 Dec 2004 (UTC)


text:
User talk:Gacoutts

Well, I got myself an account so all there seems to be left to do is be bold, huh?... Well, that and finding a topic to edit/start. This strikes me as a very cool, very useful project, I just hope I use it well and contribute something of worth. The Wikipedia is what the net should be, rather than an exercise in marketing that it has become!!

--Gacoutts 02:59, 2004 Dec 20 (UTC)

title: User talk:Gacoutts


text:
Wikipedia:Articles for deletion/Novafritz

Novafritz
Vanity. Non-notable—Trevor Caira 03:00, 20 Dec 2004 (UTC)


text:
Carson–Newman University

Carson-Newman University is a private university in Jefferson City, Tennessee, United States. Carson-Newman is affiliated with the Tennessee Baptist Mission Board. Founded in 1851, the university enrolls about 2,500 students. Studies are offered in approximately 90 different academic programs.

History
Following a ten-year effort of five early East Tennessee Baptists, the school was established and chartered with the state of Tennessee as Mossy Creek Missionary Baptist Seminary in 1851, and construction began that summer on the first building on the west bank of the creek. While this was ongoing, the school held classes in a local Baptist church located near the old zinc mine on the current Allen and Phyllis Morgan East Campus. Within a year the school occupied its own building between the current Silver Diamond Baseball Complex and the East Campus. The campus gradually grew to the west, and is now a mile wide stretching across the northern end of Jefferson City.

In 1880, the institution was named Carson College for James Harvey Carson, who left $15,000 of his estate to the school. For several years it existed alongside Newman College, a separate facility for the education of women named for William Cate Newman, who had donated money to the women's college. In 1889, the two colleges united as one of the first coeducational institutions in the South. The institution operated as Carson-Newman College until 2012 when the board of trustees voted to acknowledge recent organizational changes by changing the name to Carson-Newman University.

In 1919, Carson-Newman became officially affiliated with the Tennessee Baptist Convention. The college was admitted to membership in the Southern Association of Colleges and Schools in 1927 and the Association of American Colleges in 1928.

During World War II, Carson-Newman was one of 131 colleges and universities nationally that took part in the V-12 Navy College Training Program which offered students a path to a Navy commission.

In 2015 the school applied for and received a Title IX exemption so that it could maintain its status as a private Christian institution and also granting it the right to turn away "gay students, unwed mothers, women who've had an abortion and even students who may be pregnant" should it so choose to do so. Then-President Randall O'Brien stated that the decision was made based on the advice of legal counsel and that the school does not discriminate and does not plan to.

Through an alumni donation in 2007, the university acquired an overgrown wooded area of land along Mossy Creek, known as a dead creek. The property was turned into a park called Allen and Phyllis Morgan East Campus. In Fall 2017, the creek started showing fresh signs of life once again. In 2019, the university completed construction on a 250-seat open air amphitheater on the East Campus.

On June 7, 2019, the trustees appointed Charles A. Fowler as the 23rd president of the university. Fowler began his tenure July 1, 2019.

Presidents

 * Mossy Creek Missionary Baptist Seminary (1851–1859)
 * William Rogers (1851–1851)
 * R.R. Bryan (1851–1853)
 * Matthew Hillsman (1857–1859)
 * Mossy Creek Baptist College (1866–1881)
 * R. R. Bryan (1866–1868)
 * Jesse Baker (1869–1870)
 * N.B. Goforth (1870–1881)
 * Carson College and Newman College (1882-1889)
 * W.T. Russell (1882–1889)
 * W.A. Montgomery (1888–1892)
 * Carson and Newman College (1889-1941)
 * W.A. Montgomery (1888–1892)
 * John T. Henderson (1892–1903)
 * M. D. Jeffries (1903–1912)
 * J.M. Burnett (1912–1917)
 * W. L. Gentry (1917–1919)
 * Oscar L. Sams (1920–1927)
 * James T. Warren (1927–1948)
 * Carson-Newman College (1941-2012)
 * James T. Warren (1927–1948)
 * I.N. Carr (interim, 1948)
 * D. Harley Fite (1948–1968)
 * John A. Fincher (1968–1977)
 * J. Cordell Maddox (1977–2000)
 * James S. Netherton (2000–2007)
 * Joe Bill Sloan (interim, 2007–2008)
 * J. Randall O'Brien (2008–2012)
 * Carson-Newman University (2012–present)
 * J. Randall O'Brien (2012–2018)
 * Paul Percy (interim, 2019)
 * Charles A. Fowler (2019–present)

Athletics
Carson-Newman is a member of the South Atlantic Conference (SAC) and fields 21 varsity teams in National Collegiate Athletic Association (NCAA) Division II competition. Men's varsity sports at Carson-Newman are: baseball, basketball, cross country, football, golf, soccer, swimming, tennis, and track & field (indoor and outdoor). Women's sports are: basketball, beach volleyball, cross country, golf, soccer, softball, swimming, tennis, track & tield (indoor and outdoor), and volleyball.

title: Carson–Newman University


text:
User:Forteblast

If you were expecting a huge page with lots of pictures, infoboxes, and proselytizing, you're not going to find it here. I don't care that much about Wikipedia; I only tend to fix bad grammar and spelling, or glaring factual inaccuracies that don't require too much time on my part. If you do, and you're not being paid for it, you need a better hobby. You know what makes editing Wikipedia a pain in the ass? People like you.

title: User:Forteblast


text:
Actinic keratosis

Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder (-osis) of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure (actin-). These growths are more common in fair-skinned people and those who are frequently in the sun. They are believed to form when skin gets damaged by UV radiation from the sun or indoor tanning beds, usually over the course of decades. Given their pre-cancerous nature, if left untreated, they may turn into a type of skin cancer called squamous cell carcinoma. Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, so treatment by a dermatologist is recommended.

Actinic keratoses characteristically appear as thick, scaly, or crusty areas that often feel dry or rough. Size commonly ranges between 2 and 6 millimeters, but they can grow to be several centimeters in diameter. AKs are often felt before they are seen, and the texture is sometimes compared to sandpaper. They may be dark, light, tan, pink, red, a combination of all these, or have the same color as the surrounding skin.

Given the causal relationship between sun exposure and AK growth, they often appear on a background of sun-damaged skin and in areas that are commonly sun-exposed, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips. Because sun exposure is rarely limited to a small area, most people who have an AK have more than one.

If clinical examination findings are not typical of AK and the possibility of in situ or invasive squamous cell carcinoma (SCC) cannot be excluded based on clinical examination alone, a biopsy or excision can be considered for definitive diagnosis by histologic examination of the lesional tissue. Multiple treatment options for AK are available. Photodynamic therapy (PDT) is one option for the treatment of numerous AK lesions in a region of the skin, termed field cancerization. It involves the application of a photosensitizer to the skin followed by illumination with a strong light source. Topical creams, such as 5-fluorouracil or imiquimod, may require daily application to affected skin areas over a typical time course of weeks.

Cryotherapy is frequently used for few and well-defined lesions, but undesired skin lightening, or hypopigmentation, may occur at the treatment site. By following up with a dermatologist, AKs can be treated before they progress to skin cancer. If cancer does develop from an AK lesion, it can be caught early with close monitoring, at a time when treatment is likely to have a high cure rate.

Signs and symptoms
Actinic keratoses (AKs) most commonly present as a white, scaly plaque of variable thickness with surrounding redness; they have a sandpaper-like texture when felt with a gloved hand. Skin nearby the lesion often shows evidence of solar damage characterized by pigmentary alterations, being yellow or pale in color with areas of hyperpigmentation; deep wrinkles, coarse texture, purpura and ecchymoses, dry skin, and scattered telangiectasias are also characteristic.

Photoaging leads to an accumulation of oncogenic changes, resulting in a proliferation of mutated keratinocytes that can manifest as AKs or other neoplastic growths. With years of sun damage, it is possible to develop multiple AKs in a single area on the skin. This condition is termed field cancerization.

The lesions are usually asymptomatic, but can be tender, itch, bleed, or produce a stinging or burning sensation. AKs are typically graded in accordance with their clinical presentation: Grade I (easily visible, slightly palpable), Grade II (easily visible, palpable), and Grade III (frankly visible and hyperkeratotic).

Variants
Actinic keratoses can have various clinical presentations, often characterized as follows:

 * Classic (or common): Classic AKs present as white, scaly macules, papules or plaques of various thickness, often with surrounding erythema. They are usually 2–6mm in diameter but can sometimes reach several centimeters in diameter.
 * Hypertrophic (or hyperkeratotic): Hypertrophic AKs (HAKs) appears as a thicker scale or rough papule or plaque, often adherent to an erythematous base. Classic AKs can progress to become HAKs, and HAKs themselves can be difficult to distinguish from malignant lesions.
 * Atrophic: Atrophic AKs lack an overlying scale, and therefore appear as a nonpalpable change in color (or macule). They are often smooth and red and are less than 10mm in diameter.
 * AK with cutaneous horn: A cutaneous horn is a keratinic projection with its height at least one-half of its diameter, often conical in shape. They can be seen in the setting of actinic keratosis as a progression of an HAK, but are also present in other skin conditions. 38–40% of cutaneous horns represent AKs.
 * Pigmented AK: Pigmented AKs are rare variants that often present as macules or plaques that are tan to brown in color. They can be difficult to distinguish from a solar lentigo or lentigo maligna.
 * Actinic cheilitis: When an AK forms on the lip, it is called actinic cheilitis. This usually presents as a rough, scaly patch on the lip, often accompanied by the sensation of dry mouth and symptomatic splitting of the lips.
 * Bowenoid AK: Usually presents as a solitary, erythematous, scaly patch or plaque with well-defined borders. Bowenoid AKs are differentiated from Bowen's disease by degree of epithelial involvement as seen on histology.

The presence of ulceration, nodularity, or bleeding should raise concern for malignancy. Specifically, clinical findings suggesting an increased risk of progression to squamous cell carcinoma can be recognized as "IDRBEU": I (induration/inflammation), D (diameter > 1 cm), R (rapid enlargement), B (bleeding), E (erythema), and U (ulceration). AKs are usually diagnosed clinically, but because they are difficult to clinically differentiate from squamous cell carcinoma, any concerning features warrant biopsy for diagnostic confirmation.

Causes
The most important cause of AK formation is solar radiation, through a variety of mechanisms. Mutation of the p53 tumor suppressor gene, induced by UV radiation, has been identified as a crucial step in AK formation. This tumor suppressor gene, located on chromosome 17p132, allows for cell cycle arrest when DNA or RNA is damaged. Dysregulation of the p53 pathway can thus result in unchecked replication of dysplastic keratinocytes, thereby serving as a source of neoplastic growth and the development of AK, as well as possible progression from AK to skin cancer. Other molecular markers that have been associated with the development of AK include the expression of p16ink4, p14, the CD95 ligand, TNF-related apoptosis-inducing ligand (TRAIL) and TRAIL receptors, and loss of heterozygosity.

Evidence also suggests that the human papillomavirus (HPV) plays a role in the development of AKs. The HPV virus has been detected in AKs, with measurable HPV viral loads (one HPV-DNA copy per less than 50 cells) measured in 40% of AKs. Similar to UV radiation, higher levels of HPV found in AKs reflect enhanced viral DNA replication. This is suspected to be related to the abnormal keratinocyte proliferation and differentiation in AKs, which facilitate an environment for HPV replication. This in turn may further stimulate the abnormal proliferation that contributes to the development of AKs and carcinogenesis.

Ultraviolet radiation
It is thought that ultraviolet (UV) radiation induces mutations in the keratinocytes of the epidermis, promoting the survival and proliferation of these atypical cells. Both UV-A and UV-B radiation have been implicated as causes of AKs. UV-A radiation (wavelength 320–400 nm) reaches more deeply into the skin and can lead to the generation of reactive oxygen species, which in turn can damage cell membranes, signaling proteins, and nucleic acids. UV-B radiation (wavelength 290–320 nm) causes thymidine dimer formation in DNA and RNA, leading to significant cellular mutations. In particular, mutations in the p53 tumor suppressor gene have been found in 30–50% of AK lesion skin samples.

UV radiation has also been shown to cause elevated inflammatory markers such as arachidonic acid, as well as other molecules associated with inflammation. Eventually, over time these changes lead to the formation of AKs. Several predictors for increased AK risk from UV radiation have been identified:

 * Extent of sun exposure: Cumulative sun exposure leads to an increased risk for development of AKs. In one U.S. study, AKs were found in 55% of fair-skinned men with high cumulative sun exposure, and in only 19% of fair-skinned men with low cumulative sun exposure in an age-matched cohort (the percents for women in this same study were 37% and 12% respectively). Furthermore, the use of sunscreen (SPF 17 or higher) has been found to significantly reduce the development of AK lesions, and also promotes the regression of existing lesions.
 * History of sunburn: Studies show that even a single episode of painful sunburn as a child can increase an individual's risk of developing AK as an adult. Six or more painful sunburns over the course of a lifetime was found to be significantly associated with the likelihood of developing AK.

Skin pigmentation
Melanin is a pigment in the epidermis that functions to protect keratinocytes from the damage caused by UV radiation; it is found in higher concentrations in the epidermis of darker-skinned individuals, affording them protection against the development of AKs.

Fair-skinned individuals have a significantly increased risk of developing AKs when compared to olive-skinned individuals (odds ratios of 14.1 and 6.5, respectively), and AKs are uncommon in dark-skinned people of African descent. Other phenotypic features seen in fair-skinned individuals that are associated with an increased propensity to develop AKs include:

 * Freckling
 * Light hair and eye color
 * Propensity to sunburn
 * Inability to tan

Other risk factors

 * Immunosuppression: People with a compromised immune system from medical conditions (such as AIDS) or immunosuppressive therapy (such as chronic immunosuppression after organ transplantation, or chemotherapy for cancer) are at increased risk for developing AKs. They may develop AK at an earlier age or have an increased number of AK lesions compared to immunocompetent people.
 * Human papillomavirus (HPV): The role of HPV in the development of AK remains unclear, but evidence suggests that infection with the betapapillomavirus type of HPV may be associated with an increased likelihood of AK.
 * Genodermatoses: Certain genetic disorders interfere with DNA repair after sun exposure, thereby putting these individuals at higher risk for the development of AKs. Examples of such genetic disorders include xeroderma pigmentosum and Bloom syndrome.
 * Balding: AKs are commonly found on the scalps of balding men. The degree of baldness seems to be a risk factor for lesion development, as men with severe baldness were found to be seven times more likely to have 10 or more AKs when compared to men with minimal or no baldness. This observation can be explained by an absence of hair causing a larger proportion of scalp to be exposed to UV radiation if other sun protection measures are not taken.

Diagnosis
Physicians usually diagnose actinic keratosis by doing a thorough physical examination, through a combination of visual observation and touch. However a biopsy may be necessary when the keratosis is large in diameter, thick, or bleeding, in order to make sure that the lesion is not a skin cancer. Actinic keratosis may progress to invasive squamous cell carcinoma (SCC) but both diseases can present similarly upon physical exam and can be difficult to distinguish clinically. Histological examination of the lesion from a biopsy or excision may be necessary to definitively distinguish AK from in situ or invasive SCC. In addition to SCCs, AKs can be mistaken for other cutaneous lesions including seborrheic keratoses, basal cell carcinoma, lichenoid keratosis, porokeratosis, viral warts, erosive pustular dermatosis of the scalp, pemphigus foliaceus, inflammatory dermatoses like psoriasis, or melanoma.

Biopsy
A lesion biopsy is performed if the diagnosis remains uncertain after a clinical physical exam, or if there is suspicion that the AK might have progressed to squamous cell carcinoma. The most common tissue sampling techniques include shave or punch biopsy. When only a portion of the lesion can be removed due to its size or location, the biopsy should sample tissue from the thickest area of the lesion, as SCCs are most likely to be detected in that area.

If a shave biopsy is performed, it should extend through to the level of the dermis in order to provide sufficient tissue for diagnosis; ideally, it would extend to the mid-reticular dermis. Punch biopsy usually extends to the subcutaneous fat when the entire length of the punch blade is utilized.

Histopathology
On histologic examination, actinic keratoses usually show a collection of atypical keratinocytes with hyperpigmented or pleomorphic nuclei, extending to the basal layer of the epidermis. A "flag sign" is often described, referring to alternating areas of orthokeratosis and parakeratosis. Epidermal thickening and surrounding areas of sun-damaged skin are often seen. The normal ordered maturation of the keratinocytes is disordered to varying degrees: there may be widening of the intracellular spaces, cytologic atypia such as abnormally large nuclei, and a mild chronic inflammatory infiltrate.

Specific findings depend on the clinical variant and particular lesion characteristics. The seven major histopathologic variants are all characterized by atypical keratinocytic proliferation beginning in the basal layer and confined to the epidermis; they include:

 * Hypertrophic: Notable for marked hyperkeratosis, often with evident parakeratosis. Keratinocytes in the stratum malphigii may show a loss of polarity, pleomorphism, and anaplasia. Some irregular downward proliferation into the uppermost dermis may be observed, but does not represent frank invasion.
 * Atrophic: With slight hyperkeratosis and overall atrophic changes to the epidermis; the basal layer shows cells with large, hyperchromatic nuclei in close proximity to each other. These cells have been observed to proliferate into the dermis as buds and duct-like structures.
 * Lichenoid: Demonstrate a band-like lymphocytic infiltrate in the papillary dermis, directly beneath the dermal-epidermal junction.
 * Achantholytic: Intercellular clefts or lacunae in the lowermost epidermal layer that result from anaplastic changes; these produce dyskeratotic cells with disrupted intercellular bridges.
 * Bowenoid: This term is controversial and usually refers to full-thickness atypia, microscopically indistinguishable from Bowen's Disease. However most dermatologists and pathologists will use it in reference to tissue samples that are notable for small foci of atypia that involve the full thickness of the epidermis, in the background of a lesion that is otherwise consistent with an AK.
 * Epidermolytic: With granular degeneration.
 * Pigmented: Show pigmentation in the basal layer of the epidermis, similar to a solar lentigo.

Dermoscopy
Dermoscopy is a noninvasive technique utilizing a handheld magnifying device coupled with a transilluminating lift. It is often used in the evaluation of cutaneous lesions but lacks the definitive diagnostic ability of biopsy-based tissue diagnosis. Histopathologic exam remains the gold standard.

Polarized contact dermoscopy of AKs occasionally reveals a "rosette sign," described as four white points arranged in a clover pattern, often localized to within a follicular opening. It is hypothesized that the "rosette sign" corresponds histologically to the changes of orthokeratosis and parakeratosis known as the "flag sign."

 * Non-pigmented AKs: linear or wavy vascular patterning, or a "strawberry pattern," described as unfocused vessels between hair follicles, with white-haloed follicular openings.
 * Pigmented AKs: gray to brown dots or globules surrounding follicular openings, and annular-granular rhomboidal structures; often difficult to differentiate from lentigo maligna.

Prevention
Ultraviolet radiation is believed to contribute to the development of actinic keratoses by inducing mutations in epidermal keratinocytes, leading to proliferation of atypical cells. Therefore, preventive measures for AKs are targeted at limiting exposure to solar radiation, including:

 * Limiting extent of sun exposure
 * Avoid sun exposure during noontime hours between 10:00 AM and 2:00 PM when UV light is most powerful
 * Minimize all time in the sun, since UV exposure occurs even in the winter and on cloudy days
 * Using sun protection
 * Applying sunscreens with SPF ratings 30 or greater that also block both UVA and UVB light, at least every 2 hours and after swimming or sweating
 * Applying sunscreen at least 15 minutes before going outside, as this allows time for the sunscreen to be absorbed appropriately by the skin
 * Wearing sun protective clothing such as hats, sunglasses, long-sleeved shirts, long skirts, or trousers. “Consider taking 10 micrograms of vitamin D a day if you always cover up outdoors. This is because you may not get enough vitamin D from sunlight.”

Recent research implicating human papillomavirus (HPV) in the development of AKs suggests that HPV prevention might in turn help prevent development of AKs, as UV-induced mutations and oncogenic transformation are likely facilitated in cases of active HPV infection. A key component of HPV prevention includes vaccination, and the CDC currently recommends routine vaccination in all children at age 11 or 12.

There are some data that in individuals with a history of non-melanoma skin cancer, a low-fat diet can serve as a preventative measure against future actinic keratoses.

Management
There are a variety of treatment options for AK depending on the patient and the clinical characteristics of the lesion. AKs show a wide range of features, which guide decision-making in choosing treatment. As there are multiple effective treatments, patient preference and lifestyle are also factors that physicians consider when determining the management plan for actinic keratosis. Regular follow-up is advisable after any treatment to make sure no new lesions have developed and that old ones are not progressing. Adding topical treatment after a procedure may improve outcomes.

Medication
Topical medications are often recommended for areas where multiple or ill-defined AKs are present, as the medication can easily be used to treat a relatively large area.

Fluorouracil cream
Topical fluorouracil (5-FU) destroys AKs by blocking methylation of thymidylate synthetase, thereby interrupting DNA and RNA synthesis. This in turn prevents the proliferation of dysplastic cells in AK. Topical 5-FU is the most utilized treatment for AK, and often results in effective removal of the lesion. Overall, there is a 50% efficacy rate resulting in 100% clearance of AKs treated with topical 5-FU. 5-FU may be up to 90% effective in treating non-hyperkeratotic lesions. While topical 5-FU is a widely used and cost-effective treatment for AKs and is generally well tolerated, its potential side-effects can include: pain, crusting, redness, and local swelling. These adverse effects can be mitigated or minimized by reducing the frequency of application or taking breaks between uses. The most commonly used application regimen consists of applying a layer of topical cream to the lesion twice a day after washing; duration of treatment is typically 2–4 weeks to thinner skin like the cheeks and up to 8 weeks for the arms; treatment of up to 8 weeks has demonstrated a higher cure rate.

Imiquimod cream
Imiquimod is a topical immune-enhancing agent licensed for the treatment of genital warts. Imiquimod stimulates the immune system through the release and up-regulation of cytokines. Treatment with Imiquimod cream applied 2–3 times per week for 12 to 16 weeks was found to result in complete resolution of AKs in 50% of people, compared to 5% of controls. The Imiquimod 3.75% cream has been validated in a treatment regimen consisting of daily application to entire face and scalp for two 2-week treatment cycles, with a complete clearance rate of 36%.

While the clearance rate observed with the Imiquimod 3.75% cream was lower than that observed with the 5% cream (36 and 50 percent, respectively), there are lower reported rates of adverse reactions with the 3.75% cream: 19% of individuals using Imiquimod 3.75% cream reported adverse reactions including local erythema, scabbing, and flaking at the application site, while nearly a third of individuals using the 5% cream reported the same types of reactions with Imiquimod treatment. However, it is ultimately difficult to compare the efficacy of the different strength creams directly, as current study data varies in methodology (e.g. duration and frequency of treatment, and amount of skin surface area covered).

Ingenol mebutate gel
Ingenol mebutate is a newer treatment for AK used in Europe and the United States. It works in two ways, first by disrupting cell membranes and mitochondria resulting cell death, and then by inducing antibody-dependent cellular cytotoxicity to eliminate remaining tumor cells. A 3-day treatment course with the 0.015% gel is recommended for the scalp and face, while a 2-day treatment course with the 0.05% gel is recommended for the trunk and extremities. Treatment with the 0.015% gel was found to completely clear 57% of AK, while the 0.05% gel had a 34% clearance rate. Advantages of ingenol mebutate treatment include the short duration of therapy and a low recurrence rate. Local skin reactions including pain, itching and redness can be expected during treatment with ingenol mebutate. This treatment was derived from the petty spurge, Euphorbia peplus which has been used as a traditional remedy for keratosis.

Diclofenac sodium gel
Topical diclofenac sodium gel is a nonsteroidal anti-inflammatory drug that is thought to work in the treatment of AK through its inhibition of the arachidonic acid pathway, thereby limiting the production of prostaglandins which are thought to be involved in the development of UVB-induced skin cancers. Recommended duration of therapy is 60 to 90 days with twice daily application. Treatment of facial AK with diclofenac gel led to complete lesion resolution in 40% of cases. Common side effects include dryness, itching, redness, and rash at the site of application.

Retinoids
Topical retinoids have been studied in the treatment of AK with modest results, and the American Academy of Dermatology does not currently recommend this as first-line therapy. Treatment with adapalene gel daily for 4 weeks, and then twice daily thereafter for a total of nine months led to a significant but modest reduction in the number AKs compared to placebo; it demonstrated the additional advantage of improving the appearance of photodamaged skin.

Topical tretinoin is ineffective as treatment for reducing the number of AKs. For secondary prevention of AK, systemic, low-dose acitretin was found to be safe, well tolerated and moderately effective in chemoprophylaxis for skin cancers in kidney transplant patients. Acitretin is a viable treatment option for organ transplant patients according to expert opinion.

Tirbanibulin
Tirbanibulin (Klisyri) was approved for medical use in the United States in December 2020, for the treatment of actinic keratosis on the face or scalp.

Cryotherapy
Liquid nitrogen (−195.8 °C) is the most commonly used destructive therapy for the treatment of AK in the United States. It is a well-tolerated office procedure that does not require anesthesia.

Cryotherapy is particularly indicated for cases where there are fewer than 15 thin, well-demarcated lesions. Caution is encouraged for thicker, more hyperkeratotic lesions, as dysplastic cells may evade treatment. Treatment with both cryotherapy and field treatment can be considered for these more advanced lesions. Cryotherapy is generally performed using an open-spray technique, wherein the AK is sprayed for several seconds.

The process can be repeated multiple times in one office visit, as tolerated. Cure rates from 67 to 99 percent have been reported, depending on freeze time and lesion characteristics. Disadvantages include discomfort during and after the procedure; blistering, scarring and redness; hypo- or hyperpigmentation; and destruction of healthy tissue.

Photodynamic therapy
AKs are one of the most common dermatologic lesions for which photodynamic therapy, including topical methyl aminolevulinate (MAL) or 5-aminolevulinic acid (5-ALA), is indicated.

Treatment begins with preparation of the lesion, which includes scraping away scales and crusts using a dermal curette. A thick layer of topical MAL or 5-ALA cream is applied to the lesion and a small area surrounding the lesion, which is then covered with an occlusive dressing and left for a period of time. During this time the photosensitizer accumulates in the target cells within the AK lesion. The dressings are then removed and the lesion is treated with light at a specified wavelength.

Multiple treatment regimens using different photosensitizers, incubation times, light sources, and pretreatment regimens have been studied and suggest that longer incubation times lead to higher rates of lesion clearance. Photodynamic therapy is gaining in popularity. It has been found to have a 14% higher likelihood of achieving complete lesion clearance at 3 months compared to cryotherapy, and seems to result in superior cosmetic outcomes when compared to cryotherapy or 5-FU treatment. Photodynamic therapy can be particularly effective in treating areas with multiple AK lesions.

Surgical techniques

 * Surgical excision: Excision should be reserved for cases when the AK is a thick, horny papule, or when deeper invasion is suspected and histopathologic diagnosis is necessary. It is a rarely utilized technique for AK treatment.
 * Shave excision and curettage (sometimes followed by electrodesiccation when deemed appropriate by the physician ): This technique is often used for treatment of AKs, and particularly for lesions appearing more similar to squamous cell carcinoma, or those that are unresponsive to other treatments. The surface of the lesion can be scraped away using a scalpel, or the base can be removed with a curette. Tissue can be evaluated histopathologically under the microscope, but specimens acquired using this technique are not often adequate to determine whether a lesion is invasive or intraepidermal.
 * Dermabrasion: Dermabrasion is useful in the treatment of large areas with multiple AK lesions. The process involves using a hand-held instrument to "sand" the skin, removing the stratum corneum layer of the epidermis. Diamond fraises or wire brushes revolving at high speeds are used. The procedure can be quite painful and requires procedural sedation and anesthetic, necessitating a hospital stay. One-year clearance rates with dermabrasion treatment are as high as 96%, but diminish drastically to 54% at five years.

Laser therapy
Laser therapy using carbon dioxide or erbium:yttrium aluminum garnet (Er:YAG) lasers is a treatment approach being utilized with increased frequency, and sometimes in conjunction with computer scanning technology. Laser therapy has not been extensively studied, but current evidence suggests it may be effective in cases involving multiple AKs refractive to medical therapy, or AKs located in cosmetically sensitive locations such as the face. The laser has been recommended for extensive actinic cheilitis that has not responded to 5-FU.

Chemical peels
A chemical peel is a topically applied agent that wounds the outermost layer of the skin, promoting organized repair, exfoliation, and eventually the development of smooth and rejuvenated skin. Multiple therapies have been studied. A medium-depth peel may effectively treat multiple non-hyperkeratotic AKs. It can be achieved with 35% to 50% trichloroacetic acid (TCA) alone or at 35% in combination with Jessner's solution in a once-daily application for a minimum of 3 weeks; 70% glycolic acid (α-hydroxy acid); or solid. When compared to treatment with 5-FU, chemical peels have demonstrated similar efficacy and increased ease of use with similar morbidity. Chemical peels must be performed in a controlled clinic environment and are recommended only for individuals who are able to comply with follow-up precautions, including avoidance of sun exposure. Furthermore, they should be avoided in individuals with a history of HSV infection or keloids, and in those who are immunosuppressed or who are taking photosensitizing medications.

Prognosis
Untreated AKs follow one of three paths: they can either persist as AKs, regress, or progress to invasive skin cancer, as AK lesions are considered to be on the same continuum with squamous cell carcinoma (SCC). AK lesions that regress also have the potential to recur.

 * Progression: The overall risk of an AK turning into invasive cancer is low. In average-risk individuals, likelihood of an AK lesion progressing to SCC is less than 1% per year. Despite this low rate of progression, studies suggest that a full 60% of SCCs arise from pre-existing AKs, reinforcing the idea that these lesions are closely related.
 * Regression: Reported regression rates for single AK lesions have ranged between 15 and 63% after one year.
 * Recurrence: Recurrence rates after 1 year for single AK lesions that have regressed range between 15 and 53%.

Clinical course
Given the aforementioned differering clinical outcomes, it is difficult to predict the clinical course of any given actinic keratosis. AK lesions may also come and go—in a cycle of appearing on the skin, remaining for months, and then disappearing. Often they will reappear in a few weeks or months, particularly after unprotected sun exposure. Left untreated, there is a chance that the lesion will advance to become invasive. Although it is difficult to predict whether an AK will advance to become squamous cell carcinoma, it has been noted that squamous cell carcinomas originate in lesions formerly diagnosed as AKs with frequencies reported between 65 and 97%.

Epidemiology
Actinic keratosis is very common, with an estimated 14% of dermatology visits related to AKs. It is seen more often in fair-skinned individuals, and rates vary with geographical location and age. Other factors such as exposure to ultraviolet (UV) radiation, certain phenotypic features, and immunosuppression can also contribute to the development of AKs.

Men are more likely to develop AK than women, and the risk of developing AK lesions increases with age. These findings have been observed in multiple studies, with numbers from one study suggesting that approximately 5% of women ages 20–29 develop AK compared to 68% of women ages 60–69, and 10% of men ages 20–29 develop AK compared to 79% of men ages 60–69.

Geography seems to play a role in the sense that individuals living in locations where they are exposed to more UV radiation throughout their lifetime have a significantly higher risk of developing AK. Much of the literature on AK comes from Australia, where the prevalence of AK is estimated at 40–50% in adults over 40, as compared to the United States and Europe, where prevalence is estimated at under 11–38% in adults. One study found that those who immigrated to Australia after age 20 had fewer AKs than native Australians in all age groups.

Research
Diagnostically, researchers are investigating the role of novel biomarkers to assist in determining which AKs are more likely to develop into cutaneous or metastatic SCC. Upregulation of matrix metalloproteinases (MMP) is seen in many different types of cancers, and the expression and production of MMP-7 in particular has been found to be elevated in SCC specifically. The role of serin peptidase inhibitors (Serpins) is also being investigated. SerpinA1 was found to be elevated in the keratinocytes of SCC cell lines, and SerpinA1 upregulation was correlated with SCC tumor progression in vivo. Further investigation into specific biomarkers could help providers better assess prognosis and determine best treatment approaches for particular lesions.

In terms of treatment, a number of medications are being studied. Resiquimod is a TLR 7/8 agonist that works similarly to imiquimod, but is 10 to 100 times more potent; when used to treat AK lesions, complete response rates have range from 40 to 74%. Afamelanotide is a drug that induces the production of melanin by melanocytes to act as a protective factor against UVB radiation. It is being studied to determine its efficacy in preventing AKs in organ transplant patients who are on immunosuppressive therapy. Epidermal growth factor receptor (EGFR) inhibitors such as gefitinib, and anti-EGFR antibodies such as cetuximab are used in the treatment of various types of cancers, and are currently being investigated for potential use in the treatment and prevention of AKs.

title: Actinic keratosis


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I'm not gonna pretend the plot summary I reverted to was perfect, but the grammatical nightmare I was referring to read "Which he tries to kill the others, Them Franco gives Mcbride his revolver, But the gun was a fake, And He angry leaves the house." That was what I was referring to.  Corvoe  (speak to me)  18:14, 18 November 2013 (UTC)

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