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Despite striking global change, management to ensure healthy landscapes and sustained natural resources has tended to set objectives on the basis of the historical range of variability in stationary ecosystems. Many social–ecological systems are moving into novel conditions that can result in ecological transformation. We present four foundations to enable a transition to future-oriented conservation and management that increases capacity to manage change. The foundations are to identify plausible social–ecological trajectories, to apply upstream and deliberate engagement and decision-making with stakeholders, to formulate management pathways to desired futures, and to consider a portfolio approach to manage risk and account for multiple preferences across space and time. We use the Kenai National Wildlife Refuge in Alaska as a case study to illustrate how the four foundations address common land management challenges for navigating transformation and deciding when, where, and how to resist, accept, or direct social–ecological change.

Phytoplankton and accompanying environmental data (temperature, salinity, secchi depth, stratification, and inorganic nutrients) were analyzed from 672 surface water samples (0 to 1.5 m depth) collected from 95 stations located on the Louisiana shelf between April 1990 and August 2011. Phytoplankton were identified to the lowest practical taxonomic unit from glutaraldehyde-preserved samples using epifluorescent microscopy and reported as cells L-1. Twenty-six phytoplankton taxa (primarily diatoms) that were > 8 μm in size, identified to genus-level resolution and ranked in the top 20 in at least one of three separate categories (average abundance; frequency of occurrence; and bloom frequency) were used in subsequent analyses. Temperature, stratification, and secchi depth constituted the environmental variable combination best related to the phytoplankton community composition patterns across the 672 samples (r = 0.288; p

Catch share management was implemented in the bottom trawl sector of the West Coast Groundfish fishery in 2011 to address a range of issues including high bycatch and discard rates. The catch share...

A somewhat disparate, yet temporally cohesive, set of phytoplankton abundance, microphytobenthos, including the diatom Pseudo-nitzschia, benthic infauna, and sediment toxin data were used to develop a theory for the transfer of domoic acid (DA) from the toxic diatom to the benthos in the highly productive waters of the northern Gulf of Mexico near the Mississippi River plume. Archived samples and new data were used to test the theory that DA is likely to be incorporated into benthic consumers. High spring abundances of potentially toxic Pseudo-nitzschia diatoms were simultaneously present in the surface waters, bottom waters and on the seafloor. Examination of the gut contents of a typical deposit-feeding and suspension-feeding polychaete, Paraprionospio pinnata, during similar periods of high Pseudo-nitzschia abundance in surface water indicated consumption of the diatoms. Demersal fishes, particularly Atlantic croaker, are known to consume these polychaetes, with a potential for transfer of DA to even higher trophic levels. These findings warrant a theory to be tested with further studies about the trophic linkage of a phytoplankton toxin into the benthic food web.

This paper is intended to pose questions about the recording of Post-Medieval toys found during the course of archaeological excavations in Britain. We ask whether there is any useful purpose in recording the location and deposition of modern toys and toy fragments, and note the absence of any current forum for presenting data on toy recovery. Toys found during the course of excavation at Dorchester-on-Thames, Oxford, are used as a case study.

Microphytobenthos may influence benthic processes, such as the oxygen dynamics in the bottom-water of the hypoxic area of the northern Gulf of Mexico. We collected sediment along the Louisiana continental shelf ∼14–20 m isobath from the Mississippi River to Lake Calcasieu, LA, during periods of extensive bottom-water hypoxia in July 2006–2008 to estimate microphytobenthos biomass (chlorophyll a) and community composition. Typical sediment chlorophyll a concentrations were −1 , with the highest mean concentration at a sandier mid-shelf area, and the lowest mean concentration at a station near the Mississippi River. Microphytobenthos abundances in the size fraction >3 μm ranged from 0.7×10 1 to 1×10 5 cells g dry sed −1 . Benthic cells represented on average 67% of total cell abundance, varying from 1 to 99%, while pelagic and tychopelagic phytoplankton cells contributed to the remainder. Microphytobenthos were composed of diatoms ( Nitzschia , Gyrosigma , Pleurosigma and Bacillaria) and cyanobacteria (filamentous and colonial). Our results indicate that environmental variables, mainly seafloor PAR and bottom-water nutrient concentrations correlated the most with the spatial distribution of microphytobenthos biomass and composition. Microphytobenthos along the Louisiana continental shelf, in turn, could influence benthic processes, such as secondary production, nutrient fluxes and oxygen dynamics.

The RCN is calling for 'urgent' action over the failure of a strategic health authority (SHA) to keep its top nursing post after the retirement of its director of nursing.

Until recently, the only examples of inverted biomass pyramids have been in freshwater and marine planktonic communities. In 2002 and 2008 investigators documented inverted biomass pyramids for nearly pristine coral reef ecosystems within the NW Hawaiian islands and the Line Islands, where apex predator abundance comprises up to 85% of the fish biomass. We build a new refuge based predator-prey model to study the fish biomass structure at coral reefs and investigate the effect of fishing on biomass pyramids. Utilizing realistic life history parameters of coral reef fish, our model exhibits a stable inverted biomass pyramid. Since the predators and prey are not well mixed, our model does not incorporate homogeneous mixing and the inverted biomass pyramid is a consequence of the refuge. Understanding predator-prey dynamics in nearly pristine conditions provides a more realistic historical framework for comparison with fished reefs. Finally, we show that fishing transforms the inverted biomass pyramid to be bottom heavy., Comment: 24 pages, 4 figures

The presence of photosynthetic organisms on the seafloor may indicate whether oxy- gen evolution contributes to the bottom water oxygen pool in the hypoxic area of the northern Gulf of Mexico. We sampled 3 stations (depth: 14, 20 and 23 m) 100 km west of the mouth of the Mississippi River over 3 hypoxic annual cycles to determine whether microphytobenthos or settled phytoplankton existed on the sediment surface. Microscopy and high-performance liquid chro- matography were used to determine the presence and composition, and to estimate the biomass of microphytobenthos and phytoplankton in surface and bottom waters and sediments. The sedi- ment community (cells >3 µm) found during hypoxia differed from those in the water column and were primarily benthic (58 to 88%). Settled pelagic phytoplankton (1 to 36%) and tychopelagic phytoplankton (5 to 10%) were also present. The settled phytoplankton were mostly present on the sediment during fall and winter. The abundance of benthic cells was directly correlated with light levels on the seafloor and sediment chlorophyll a values. Picocyanobacteria, pennate diatoms and filamentous cyanobacteria dominated the sediment community (by density for all cells 0.2 to 8.0 µm in diameter) during summer. The presence of a viable community of microphytobenthos during hypoxia indicates that the potential for photosynthetic oxygen production exists and may influence the oxygen dynamics in the hypoxic zone.

The United States hosts one native and five non-native species of aquatic apple snails (Ampullariidae). All are currently found in or around the Everglades in Florida. Two of these introduced species have devastated wetlands in Southeast Asia, but little is known about how they may impact the Everglades. To evaluate potential impacts of introduced apple snails relative to the native species, we investigated plant species preference, consumption rates, growth rates, and growth efficiencies in five introduced and the single native species across eight native macrophytes common in the Everglades. Three of the non-native snails are invasive, one has shown no tendency to expand, and one appears to have minimal direct impact on macrophytes due to its diet. All snails exhibited similar feeding preferences, with Utricularia sp. being the most preferred, Bacopa caroliniana, Sagittaria latifolia, and Nymphaea odorata being of intermediate preference, and Eleocharis cellulosa, Pontederia cordata, Panicum hemitomon and Typha sp. being least preferred (avoided as foods). Consumption and growth was minimal for P. diffusa on all macrophytes. On Utricularia sp. and Bacopa caroliniana, the invasive species Pomacea insularum and P. canaliculata tended to eat more, grow more, and have higher conversion efficiencies than the native P. paludosa or the non-invasive P. haustrum. These contrasts were more often significant for P. insularum than for P. canaliculata. The greater rates of expansion by the invasive species may derive from their enhanced feeding and growth rates.

Toxin producing cyanobacteria commonly inhabit fresh waters and brackish estuaries, and blooms of these species may be escalating worldwide due to eutrophication. The most common cyanobacterial toxins occurring in fresh and brackish waters are microcystins (MC), which are known to accumulate in aquatic organisms. Prey preference for filter-feeding organisms, such as clams and mussels, make the blue crab, Callinectes sapidus, a candidate for microcystin contamination, therefore making this commercially important edible crab species a potential vector of these toxins to humans. The present study was conducted in a hyper-eutrophic freshwater lake, Lac des Allemands, located in the Barataria estuary system of southeastern Louisiana, and was aimed at documenting the presence and abundance of toxic cyanobacteria and assessing microcystin concentrations in surface water and blue crabs taken from this region. Microcystis sp. were the dominant cyanobacteria, with alternating blooms of Microcystis and Anabaena spp. occurring during the 8-month study. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate concentrations of microcystins from surface water and hepatopancreas, viscera, and muscle tissues of blue crabs. The highest concentration of microcystins found in surface water (1.42 μg MC l−1) was above the tolerable daily intake (TDI) guideline for microcystins in drinking water (1.0 μg MC l−1) set by the World Health Organization (WHO). Highest concentration of microcystins occurring in crab tissue were 820 μg MC kg−1 in hepatopancreas, 65 μg MC kg−1 in viscera, and 105 μg MC kg−1 in muscle, which were close to or exceeding the WHO-TDI guidelines for human consumption (0.04 μg MC kg−1 body weight day−1) based on human body weight and amount of crab tissue consumed. This study documents the presence of microcystins in both surface water and blue crab tissue and therefore, demonstrates the potential for Microcystis and Anabaena blooms to produce toxins that may be accumulated in the tissues of blue crabs and transferred to higher level consumers, including humans.

The Davis Pond Diversion (DPD) was constructed to divert Mississippi River (MR) water into the Barataria Basin to reduce the salinity in support of wetland restoration on the Louisiana coast. To assess the phytoplankton nutrient limitation in adjacent water systems and potential impacts of DPD, 12 seasonal nutrient-phytoplankton bioassay experiments were conducted from October 2003 to July 2004 using the natural phytoplankton assemblages from freshwater and brackish-water lakes, Cataouatche and Salvador, LA (USA), which receive Mississippi River water from the DPD, and from a nearby freshwater lake, Lac des Allemands, that does not. Dissolved inorganic nitrogen (N), phosphorus (P), and silicate (Si) were added with different combinations at Redfield ratios in 10-l microcosms. Nitrogen was found to be the sole or primary limiting nutrient in all 12 experiments. N and P colimitations were found in seven of 12 experiments, but N was always the stronger limiting factor. P limitation was never observed to be the sole limiting nutrient. The results showed that a low concentration of P and a relatively high concentration of N do not necessarily indicate only P limitation in these lakes. Lake Cataouatche and Lake Salvador were dominated by centric diatoms, and Anabaena spp. were detected at high levels, particularly in summer. Lac des Allemands was generally dominated by N-fixing Anabaena spp. and other cyanobacteria, and their biomass responded significantly to N addition but not to P addition, indicating that nitrogen fixation in Lac des Allemands may be inhibited by other factors such as iron. Our bioassay results demonstrate that whether a water body is N- or P-limited is the consequence of the nutrient status and not the salinity regime. The results suggest that the addition of nutrient-rich waters via diversions of Mississippi River water into these lakes might increase the frequency of algal blooms, including noxious and toxic freshwater cyanobacteria.

Although the existence of robust inverted biomass pyramids (IBPs) seems paradoxical, they are well known to exist in planktonic communities, and have recently been discovered in pristine coral reefs and in a reef off the North Carolina coast. Understanding the underlying mechanisms which produce inverted biomass pyramids provides new ecological insights. Some ecologists hypothesize that “the high growth rate of prey and low death rate of predators” causes IBPs. However, we show this is not always the case (see Sections 3.1 and 4). We devise predator–prey models to describe three mechanisms that can lead to IBPs: (1) well-mixed populations with large prey turn-over rate, (2) well-mixed populations with prey immigration, and (3) non-mixed populations where the prey can hide in refuges. The three models are motivated by the three ecosystems where IBPs have been observed. We also devise three refuge mediated models, with explicit refuge size, which incorporate different prey responses in the refuge, and we discuss how these lead to IBPs.

Using cross-sectional data, this paper estimates a national energy model of fuel choice by both households and firms. Consumers in warmer locations rely relatively more heavily on electricity rather than natural gas, oil, and other fuels. They also use more energy. Climate change will likely increase electricity consumption on cooling but reduce the use of other fuels for heating. On net, American energy expenditures will likely increase, resulting in welfare damages that increase as temperatures rise. For example, if the US warms by 5 °C by 2100, we predict annual welfare losses of $57 billion.

Using the fatigue algorithm described in the Clinical Practice Guidelines for Fatigue and Multiple Sclerosis (MS), this study aimed to determine the frequency of fatigue related directly to the MS disease process (primary fatigue) versus that related to disease symptoms such as depression (nonprimary fatigue), differentiate primary from nonprimary MS fatigue, and identify any characteristics unique to primary MS fatigue. Consecutive clinically definite MS patients from the University of British Columbia MS clinic were invited to participate. The screening assessment included standardized scales and questionnaires. In total, 50 patients completed the study. Nonprimary fatigue was present in 36 individuals (72%), of whom all but 2 had multiple factors contributing to fatigue. The most common factors contributing to nonprimary fatigue were sleep problems (58%), mobility limitations (52%), and depression (40%). Compared with patients with nonprimary fatigue, those with isolated primary fatigue had lower fatigue scores and reported fatigue onset at midday (P < .05). Any attempt to study or manage MS fatigue should be preceded by identification and amelioration of treatable nonprimary fatigue factors before focusing on primary fatigue in MS.

The Louisiana shelf is the largest zone of seasonally oxygen-depleted coastal bottom water in the U.S. This condition results from the high freshwater and nutrient input from the Mississippi River and the resulting high primary productivity in the river plume. The hypoxic zone has doubled in area since regular measurements began in 1985. Identification of the nutrient(s) limiting phytoplankton growth on the shelf and their sources is important for developing hypoxia-reduction strategies; nitrogen (N) has been considered the most important to date. In this study, we measured multiple parameters addressing nutrient limitation or stress (nutrient concentrations and ratios, alkaline phosphatase activity, phosphorus (P)turnover times, and changes in chlorophyll a concentrations in nutrient enrichment bioassays) in the Mississippi River plume in March, May, July, and September of 2001. All results indicate that phytoplankton growth on the Louisiana shelf was limited by P in May and July of 2001. P limitation was weakly evident in March, but N was limiting in September. The observed P limitation in spring and summer probably results from the historical increases in riverine N due to excessive N loading and has potential implications for developing hypoxia reduction strategies.

The first recorded bloom of Karenia spp., resulting in brevetoxin in oysters, in the low salinity waters of the Northern Gulf of Mexico (NGOMEX) occurred in November 1996. It raised questions about the salinity tolerance of Karenia spp., previously considered unlikely to occur at salinities

Salinity varies widely in coastal areas that often have a high abundance of Pseudo-nitzschia H. Peragallo. Pseudo-nitzschia is abundant in Louisiana waters, and high cellular domoic acid has been observed in natural samples but no human illness has been reported. To assess the threat of amnesic shellfish poisoning (ASP), we examined the effect of salinity on Pseudo-nitzschia occurrence in the field and growth in the laboratory with special emphasis on the salinity range where oysters are harvested (10-20 psu). In Louisiana coastal waters, Pseudo-nitzschia spp. occurred over a salinity range of 1 to >35 psu, but they occurred more frequently at higher rather than lower salinities. Seven species were identified, including toxigenic species occurring at low salinities. In culture studies, seven clones of three species grew over a salinity range of 15 to 40 psu, some grew at salinities down to 6.25 psu, and most grew at salinities up to 45 psu. Tolerance of low salinities decreased from Pseudo-nitzschia delicatissima (Cleve) Heiden to P. multiseries (Hasle) Hasle to P. pseudodelicatissima (Hasle) Hasle emend. Lundholm, Hasle et Moestrup. In conclusion, although Pseudo-nitzschia was more prevalent in the field and grew better in the laboratory at higher salinities, it grew and has been observed at low salinities. Therefore, the probability of ASP from consumption of oysters harvested from the low salinity estuaries of the northern Gulf of Mexico is low but not zero; animal mortality events from toxin vectors other than oysters at higher salinity on the shelf are more likely.

1. A necessary component of implementing a successful marine reserve is the quantification of the biological resources that fall under its protection. Without such an initial assessment, the future effects of the reserve on the local habitat and biotic community cannot be quantified and will remain the subject of debate. 2. This study provides such a baseline assessment of fish diversity and habitat types within a recently enlarged marine reserve. Buck Island Reef National Monument, US Virgin Islands, was recently enlarged from approximately 4 km2 to over 76 km2. Areas of sand, seagrass, and hard-bottom under protection were increased from 0.29 km2, 0.47 km2, and 1.96 km2 to 2.70 km2, 2.89 km2, and 18.30 km2 respectively when the Monument was expanded. A 53 km2 area of pelagic/deep-water habitat with unknown bottom type is now also protected by the Monument. 3. Visual counts of fish within 25×4 m2 transects conducted during the day were used to assess fish community structure and habitat utilization patterns. Species richness, diversity, assemblage structure, and fish density were evaluated and compared among sand, seagrass, and hard-bottom habitats. Hard-bottom sites had over twice the mean species richness and diversity as sand and seagrass sites, and several times greater mean fish density. 4. Quantification of the fish community in pelagic and deep-water habitats within the reserve is recommended to provide a more comprehensive assessment of the offshore areas of the reserve. Fish numbers, size, and diversity outside the reserve boundaries must also be evaluated to allow quantification of the effects of the marine reserve on the adjacent fish communities. Copyright © 2004 John Wiley & Sons, Ltd.

This article summarises the methodology we have applied to an intensively investigated part of the Upper Thames Valley. We discuss the potential of digital spatially referenced data to help bridge the gaps between the various commercial units who work side by side in the landscape, as well as between the various planning authorities. This article will be of interest to anyone working with digital data or with diverse datasets to understand wider landscapes, as well as anyone working with various funders, developers, and consultancies to plan for the best use of such 'big data' to improve heritage management and archaeological enquiry.

Often, both augmentation and mastopexy are necessary to solve the problems of breast ptosis with hypoplasia. These two procedures can be done simultaneously with no increased risks. Patients who have any degree of ptosis may benefit from some lifting of the nipple areola complex if the nipple is not in the central portion of the general contour of the breast mound when seen in the upright position. A simple crescent or eccentric excision in the upper quadrant may be sufficient to lift the nipple-areola complex 1-2 cm. If the nipple needs to be moved more than a couple of centimeters, or if the distance between the nipple and the inframammary crease is already excessive, an inframammary skin excision and redraping will be necessary. We have been using these combined techniques for 20 years with universal patient satisfaction.

Increased herbivory at lower latitudes is hypothesized to select for more effective plant defenses. Feeding assays with seaweeds and salt marsh plants support this hypothesis, with low-latitude plants experiencing greater damage in the field and being less palatable than higher-latitude plants. We tested this hypothesis for freshwater macrophytes because they offered an independent plant lineage and habitat type for testing this general hypothesis and because the patchiness of consumer occupancy across isolated water bodies might produce local variance in herbivory that would override geographic variance and produce different results for this habitat type. When we fed eight congeneric pairs of live plants from four sites in Indiana vs. four sites in South Florida (-215 and 0 frost days/yr respectively) to three species of crayfishes and one species of snail, three of the four herbivores significantly preferred high-latitude to low-latitude plants. For two crayfishes that differed in feeding on live plants (one favoring high-latitude plants and one not), we retested feeding using foods composed of freeze-dried and finely ground plants, thus removing structural characteristics while retaining most chemical/nutritional traits. In this assay, both herbivores strongly preferred high-latitude plants, suggesting that lower-latitude plants had been selected for more deterrent chemical traits. When we collected 22 pairs of congeneric plants from 9 sites throughout Indiana vs. 13 sites in Central Florida (-215 and -95 frost days/yr respectively) and tested these in feeding assays with three crayfishes using dried, ground, and reconstituted plant material, we found a significant effect of latitude for only one of three species of herbivore. Overall, our results suggest a preference for high-latitude plants, but the strength of this relationship varied considerably across small scales of latitude that differed considerably in numbers of frost-free days. The difference in results suggests that large changes in frost frequency over small spatial scales may affect selection for plant defenses, that local variance in herbivory overrode differential selection at geographic scales, or that these possibilities interact when durations of cold weather periodically exclude herbivores from shallower habitats, producing heterogeneous selection for defenses at small spatial scales.

Enemy release and biotic resistance are competing, but not mutually exclusive, hypotheses addressing the success or failure of non-native plants entering a new region. Enemy release predicts that exotic plants become invasive by escaping their co-adapted herbivores and by being unrecognized or unpalatable to native herbivores that have not been selected to consume them. In contrast, biotic resistance predicts that native generalist herbivores will suppress exotic plants that will not have been selected to deter these herbivores. We tested these hypotheses using five generalist herbivores from North or South America and nine confamilial pairs of native and exotic aquatic plants. Four of five herbivores showed 2.4–17.3 fold preferences for exotic over native plants. Three species of South American apple snails (Pomacea sp.) preferred North American over South American macrophytes, while a North American crayfish Procambarus spiculifer preferred South American, Asian, and Australian macrophytes over North American relatives. Apple snails have their center of diversity in South America, but a single species (Pomacea paludosa) occurs in North America. This species, with a South American lineage but a North American distribution, did not differentiate between South American and North American plants. Its preferences correlated with preferences of its South American relatives rather than with preferences of the North American crayfish, consistent with evolutionary inertia due to its South American lineage. Tests of plant traits indicated that the crayfish responded primarily to plant structure, the apple snails primarily to plant chemistry, and that plant protein concentration played no detectable role. Generalist herbivores preferred non-native plants, suggesting that intact guilds of native, generalist herbivores may provide biotic resistance to plant invasions. Past invasions may have been facilitated by removal of native herbivores, introduction of non-native herbivores (which commonly prefer native plants), or both.

The No Child Left Behind Act (NCLB) (2001) has led to widespread use of high-stakes assessment in determining graduation options for all students, including those with disabilities. In this chapter, we examine graduation trends in the state of Florida before and after the implementation of a high-stakes test used as a means to meet NCLB requirements and further examine specific trends in rates of graduation with a standard diploma attained by students with disabilities. As trends for students with disabilities reveal a reduction in standard diploma attainment, we discuss research related to the Individuals with Disabilities Education Improvement Act (IDEA) provisions for individualized education program (IEP) and transition planning for students with disabilities that are designed to improve students’ graduation and post-school outcomes. We discuss ways in which schools might improve student graduation rates within the context of both NCLB and IDEA. Specifically, we report findings from a study conducted in a school district in Florida that demonstrates a positive relationship between student perceptions of school's efforts to facilitate student involvement in planning (as outlined by IDEA requirements) and the likelihood of graduation with a standard diploma (based on “passing” a high-stakes test) for students both with and without disabilities. Implications for policy and practice are discussed.

Water resource scarcity around the world is driving the need for the development of simulation models that can assist in water resources management. Transboundary water resources are receiving special attention because of the potential for conflict over scarce shared water resources. The Rio Grande/Rio Bravo along the U.S./Mexican border is an example of a scarce, transboundary water resource over which conflict has already begun. The data collection and modeling effort described in this report aims at developing methods for international collaboration, data collection, data integration and modeling for simulating geographically large and diverse international watersheds, with a special focus on the Rio Grande/Rio Bravo. This report describes the basin, and the data collected. This data collection effort was spatially aggregated across five reaches consisting of Fort Quitman to Presidio, the Rio Conchos, Presidio to Amistad Dam, Amistad Dam to Falcon Dam, and Falcon Dam to the Gulf of Mexico. This report represents a nine-month effort made in FY04, during which time the model was not completed.

The introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the last 7 years has had a significant effect on the management of those living with this disease. Initially, the focus of improving treatment outcomes was on ensuring adherence to therapy by managing drug-related adverse events. However, treatment adherence is only one facet of ensuring optimal health outcomes for patients using DMTs. Therefore, a group of 80 nurses from Canada and the United States (The North American MS Nurses' Treatment Optimization Group) developed an evidence-based nursing approach to address the various factors involved in obtaining optimal patient outcomes. The goal of this nursing approach is to ensure the best possible clinical, subclinical, psychosocial, and quality-of-life outcomes for patients with MS using DMTs.

We have used blunt liposuction for removing excess fat from the neck and jowls since 1983 with generally good results and few complications. Under local anesthesia with Valium and ketamine sedation and the use of the super-wet technique, and by using special precautions to avoid the complications of prominent platysmal bands, wrinkling of the neck, and salivary gland prominence, carefully performed liposuction to the neck and jowls has been shown to be a safe and dependable procedure with good results, and may delay or obviate the need for a facelift.