Tom McCall remember him? I thought it was great. Where the voters of Clackamas County have their place is in the next election. They elected the person, not the party. If they don't like his party switching, they can either recall him, or not renew his contract. Sowa should not resign because he switched parties.
People should resign because they appoint their college roomate to protect our country in cases of emergency. I disagree. I believe that "Democrat" and "Republican" are not meaningless labels. They are not the sports-team equivalent of red uniforms and blue uniforms. As anyone who has gone door-to-door for a candidate can attest, the only thing that many, many voters care about is "Is he a Democrat? Sure, Democrats disagree amongst themselves a lot - and so do Republicans.
Larry Sowa was certainly a very conservative Democrat. By changing parties, he's breaking faith with the voters who voted for him. He should resign immediately, and give them a chance to elect whomever they want. Including him, as a Republican. Steve, you're right. The voters voted for a person. But they elected that person because he made meaningful representations about his basic view of the world. Now, he's indicated that he no longer shares that basic view of the world. He's not the same person they thought they voted for.
How many Democrats in Clackamas County and Oregon as a whole voted for President Bush in and , and Senator Gordon Smith in ; for same reason or near that of what Cmmr Sowa stated: "I'm conservative, and I think Democrats tend to get more and more liberal all the time.
Loyalty to one's party can only go so far based on how other members of the party treat each other--and idealogy and methodology is part of treatment. I don't think it makes Steve's original point any less relevant, but I believe it was Wayne Morse, not Tom McCall, who switched from being a Republican to a Democrat during his political career.
Does Sowa's switching-of-parties have any meaningful impact in his work on the Commission and how he votes? It might also be worth noting that over the last decade the numbers of registered R voters in Clackamas Co. Maybe Sowa's philosophical shift has more to do with sensing where the political winds are shifting in his county than how he sees himself voting. No-one is the same in office as when campaigning. They "grow" once in office. They change and adapt to - shall we say - the rigors of governing.
That's why elective offices are not lifetime appointments, and that's why term limits make sense. Most everyone knows rule 1: power corrupts and absolute power corrupts absolutely.
If you are too naive for that you are miscast for a career in politics and public policy. Question: If larry were to die in office, resign or otherwise need to vacate prior to filling his term, what is the process for replacement.
I believe perhaps wrongly that in some cases the replacement in these instances in Oregon is chosen based on having the same party as the person leaving offices. If this is the case in Clack co, it would be a HUGE deal to have a person switch parties, and thus the method of replacement.
Anyone know the answer on this? Comment: In reading polls like on pollingreport. Check out some of those breakouts and then try to tell me that party affiliation is meaningless.
Thus in Sowa's case, though he is now a Republican should he vacate the office a Democrat would be appointed to replace him.
That's absurd. Should Wayne Morse have resigned from the U. Senate when he switched from Republican to independent to Democrat? Views change - parties change. Chris -- It's not about how Sowa "see himself voting". It's about how the voters assumed he would be voting. The voters elected him as a Democrat, not as a Republican. Those are not meaningless labels. The voters elected a Democrat. Now, there's a Republican in that office. Certainly, there can be a discussion about whether the Clackamas County Commission ought to be a nonpartisan office like Multnomah but the citizens of Clackamas County have decided long ago that their County Commission ought to be a partisan job - with party primaries and candidates labeled as one or the other.
Given that it is a partisan office, he should resign. He is no longer the elected official that the voters elected.
Oh, and you need look no further than his hero Kevin Mannix's environmental voting record helpfully posted on BlueOregon by Jonathan Poisner after he changed parties to see that the very act of changing sides often precipitates a shift in voting direction. Rorovitz writes: "Check out some of those breakouts and then try to tell me that party affiliation is meaningless.
But this "democrat" doesn't believe in those issues. So why does his party registration matter? He, I imagine, has voted in a manner inconsistent with D values all along. Now, before the election, he has chosen to identify as a Republican. Big Deal. If it was a month after his election I would cry foul. But he is probably going to announce his run for and its great that he makes this change before he runs. Resignation should not be part of this discussion. Whether either party has any integrity whatsoever is another discussion.
Fred - I think I was writing my comment at the same as yours. In Clackamas County, it is a partisan office. There are various types of party switch: 1 Fed up with current party for specified detailed reasons; 2 Truth in label Cong. Sonny Montgomery of the deep South should have changed to Republican because of his friendship with Bush 1 and his voting record, but because Democrats controlled the Congress back then he would have lost his committee chairmanship ; 3 Opportunistic.
I recall in the session where a member got fed up with Larry Campbell's bullying and had a press conference announcing he was leaving the caucus. That would be my model of 1. But I don't agree with what Kari said "Democrat" means something. Nonetheless, as a "Democrat", the voters assumed that he had certain basic views of the world.
While there is room within "Democrat" for lots of differing views and I've been among those arguing for an expansive definition , I do think that the phrase comes with meaning. It is not meaningless. In politics, we spend almost all of our timing trying to educate and motivate the swing. I was active in the Young Democrats of Oregon before I was old enough to vote and I've been a Democratic precinct commiteeperson in three Oregon counties.
I've never voted for a Republican in a partisan race. Unfortunately, money has replaced the party structure as the driving force in electoral politics.
Parties aren't as important as they used to be. Sex steroids are strongly implicated in the development and modulation of the immune system Schuurs and Verheul ; Mann et al. Estrogens have been demonstrated to enhance cellular proliferation and antibody secretion Cutolo et al. Hormonal contraceptives also suppress pituitary gonadotropins, which have a number of additional immunomodulatory effects Athreya, Rettig, and Williams Gonadotropin releasing hormone GnRH and its receptor are expressed in immune cell subsets and GnRH plays a role in programming the immune system Tanriverdi et al.
In addition, several autoimmune diseases have a marked sex predominance, with females much more susceptible to diseases such as systemic lupus erythematosus SLE , rheumatoid arthritis RA , autoimmune thyroid disease, and multiple sclerosis, while males are more susceptible to ankylosing spondylitis and reactive arthritis.
Thus, while a specific mechanism linking hormonal contraceptives to autoimmune disease pathogenesis has not been elucidated, it is reasonable to speculate that the administration of hormonal contraceptives, either combined estrogen-progestin contraceptives or progestin-only contraceptives, would modulate the immune system and may affect the predisposition of hormonal-contraceptive users to autoimmune diseases.
To evaluate the hypothesis that hormonal contraceptive use affects susceptibility to autoimmune diseases, a literature search was performed to capture studies that have evaluated this question. These studies were analyzed in terms of their size and quality to provide insights into the linkage between hormonal contraceptive use and the subsequent development of autoimmune diseases.
The objective of this literature survey was to determine if hormonal contraceptives alter the susceptibility for autoimmune diseases. The initial search returned references, and titles were scanned to find relevant papers. A total of papers were reviewed in depth, and an additional 70 papers were retrieved from the bibliographies of these papers. The search in October limited to —14 returned an additional 20 relevant papers not including case reports, reviews, and other papers that did not bear on the question at hand.
These papers were retrieved and reviewed, focusing on case-control and cohort studies. The search in May limited to —15 returned one additional relevant paper. The search for April limited to —16 returned an additional 5 relevant papers.
This included the following:. Eligibility criteria, and the sources and methods of selection of participants provided? Diagnostic criteria, outcomes, exposures, predictors, potential confounders, and effect modifiers provided? Numbers of individuals at each stage of the study provided and reasons for non-participation? Characteristics of study participants, information on exposures and potential confounders provided? Numbers in each exposure category, or summary measures of exposure reported case-control?
Limitations of the study discussed, including magnitude and direction of potential bias? Each item was assigned a maximum score of 1, and the result converted into a percentage. Also noted for each study were the odds ratio OR or relative risk RR and the 95 percent confidence interval.
Briefly, if the population under study is divided into those with and without exposure to a hormonal contraceptive, and is further divided into those who subsequently develop the disease or do not develop the disease, the relative risk is the percentage of those in the exposed group with the disease divided by the percentage of those in the unexposed group who develop the disease. The odds ratio is the proportion of those in the exposed group who did versus did not develop the disease divided by the proportion of those in the unexposed group who did versus did not develop the disease Altman ; Deeks and Higgins ; Pagano and Gauvreau ; Parshall The initial search showed no relevant literature for a number of the less frequent autoimmune diseases.
A number of less frequent autoimmune diseases did have literature supporting a link to hormonal contraceptives, and these will be briefly mentioned in the following section. Here, each disease with supporting data will be discussed in turn, starting with those with the most studies evaluated. Rheumatoid arthritis is a systemic inflammatory disease that affects multiple joints of the body, typically in a symmetrical fashion, often causing joint deformity and disability. The annual incidence of rheumatoid arthritis is reported to be about 40 per , Myasoedova et al.
Women are affected two to three times more often than men. Patients with rheumatoid arthritis are at increased risk for mortality, with the studies showing an over twofold increase in mortality compared with the general population Wolfe et al. It is a well-known clinical fact that pregnancy typically ameliorates the signs and symptoms of rheumatoid arthritis while the disease typically flares post-partum.
Breastfeeding also appears protective. Thus an effect of hormonal contraceptives, which produce many of the same hormonal effects as pregnancy, is of interest. The literature search produced 30 primary studies of rheumatoid arthritis and 3 meta-analyses.
These are summarized in Supplemental Tables 1A and 1B all tables are shown in descending order of quality scores. Of these 30 studies, four Doran et al. One study Pedersen et al. Meta-analysis of current use or past use did not show a significant reduction in risk. On analysis of these papers a few trends become apparent. Early studies, predominately case-control studies, suggested that hormonal contraceptives exert a protective effect against the development of rheumatoid arthritis.
However, the quality of these studies was poor, and some were funded by the pharmaceutical companies that sell oral contraceptives. The more recent studies, especially those published since , tended to show either no decrease in risk or an increased risk. The meta-analyses were all published before and therefore did not take into account these more recent data. Interestingly cohort studies, which typically evaluate many individuals for the development of disease over time, did not show a reduced risk of rheumatoid arthritis with the exception of one early study of relatively poor quality Wingrave and Kay Some have hypothesized that case-control studies tend to select patients with more severe disease, while the cohort studies select patients with milder disease.
The suggestion was that cHCs lessens the severity of rheumatoid arthritis and so those with mild disease may have been missed in the case-control studies.
In opposition to this is the data from Pedersen Pedersen et al. Others have hypothesized that the lower estrogen doses in the third and fourth generation cHCs are less protective against the development of rheumatoid arthritis and thus the early results have not been carried forward. Another observation is that the RR and OR for studies based in the United States have rarely shown a decreased risk, while those from the European Union EU have often shown a decreased risk.
Thus, geographic factors may be at play as well. But the overall trend is similar in the US and EU over time: both fail to show a protective effect in more recent studies which are also of higher quality and some analyses show an increased risk. The most recent study, from China, did not show an effect of cHCs on the risk of rheumatoid arthritis Adab et al.
Typical symptoms include fatigue, prolonged diarrhea with abdominal pain with or without gross bleeding, weight loss, and fever Mekhjian et al. The age of onset peaks between 15 and 25 years, suggesting a hormonal influence. None of the primary studies showed a significantly decreased risk. A meta-analysis published in showed a significantly increased risk for current use RR of 1. Recent studies have produced similar findings as older studies, with the highest OR published in 9.
Ulcerative colitis is an inflammatory disease of the colon large intestine. The combination of inflammation and ulceration can cause abdominal discomfort and diarrhea. In North America, incidence rates range from 2.
Ulcerative colitis is relatively equally distributed between men and women, with perhaps a slight increase in males Loftus The age of onset peaks between 15 and 30 years and again from 50 to 70, suggesting a hormonal influence. Approximately 20 percent of patients with UC will eventually require a colectomy Solberg et al.
Mortality is slightly increased in ulcerative colitis HR 1. Overall 14 primary studies and one meta-analysis were identified that evaluated the effect of cHCs on the later development of ulcerative colitis Supplemental Table 4.
Overall these studies suggest that use of cHCs conveys an increased risk of ulcerative colitis, especially current use. Systemic lupus erythematosus is a systemic autoimmune disease affecting multiple organ systems. More than 90 percent of cases of systemic lupus erythematosus occur in women, frequently starting at childbearing age.
The annual incidence of systemic lupus erythematosus estimated by the Centers for Disease Control ranges between 1. The reported prevalence ranges from 52 cases per , population Helmick et al. Mortality is clearly increased in SLE with mortality rates ranging from two to five times higher than that of the general population Borchers et al.
Crude death rates are increased with age, among women five times higher than in men , among blacks three times higher than in whites Sacks et al. Systemic lupus erythematosus has been observed by some Petri, Howard, and Repke ; Ruiz-Irastorza et al. Similarly, several studies have suggested that cHCs may induce flares of systemic lupus erythematosus disease activity Jungers et al.
It is, however, generally agreed that cHCs increase the risk of thrombosis particularly in the subset of systemic lupus erythematosus patients with concomitant antiphosphiolipid antibody syndrome a disorder that predisposes individuals to clotting ACOG Committee ; Urbanus et al.
Seven studies published evaluated the effect of hormonal contraceptives on susceptibility to systemic lupus erythematosus Supplemental Table 5. None of the studies showed a decreased risk. While no meta-analyses of these studies have been performed, the uniformity of the results implicate cHCs as an important risk factor for the subsequent development of systemic lupus erythematosus. Multiple sclerosis is an autoimmune inflammatory disease of the central nervous system with resultant nerve damage causing sensory loss numbness, tingling , spasticity, loss of bowel or bladder control, sexual dysfunction, imbalance walking, difficulty speaking, tremor, visual disturbances, muscle twitching and weakness, fatigue, dizziness, and difficulties with attention span, concentration, memory, and judgment Katz Sand and Lublin ; Polman et al.
The mean age of multiple sclerosis onset ranges from 28 to 31 years Goodin Women are afflicted with multiple sclerosis 1. Depending on the region and population evaluated male vs. Patients with multiple sclerosis have an increased risk of mortality of about 2. Six studies 3 cohort studies and 3 case-control studies were identified that evaluated the impact of cHCs on the subsequent development of multiple sclerosis Supplemental Table 6.
Overall these studies suggest that use of cHCs may convey an increased risk for the subsequent development of multiple sclerosis. Hyperthyroidism and hypothyroidism are both linked in many cases to autoimmune mechanisms. Hyperthyroidism is more common in women by a ratio with a prevalence estimated as 1.
Three studies one cohort and two case-control studies were identified which evaluated the impact of cHCs of the subsequent development of hyperthyroidism Supplemental Table 7. In one study with relatively few cases this was estimated at an RR of 0. In the other study, which focused on use of cHCs, the OR was 0. The cohort study evaluated current use and past use but did not report statistical significance. Overall these studies suggest that use of cHCs may be protective against the subsequent development of hyperthyroidism, although the small number of studies and their quality makes it difficult to develop a firm conclusion.
Hypothyroidism is five to eight times more common in women than men Aoki et al. The prevalence of clinical hypothyroidism varies from 0. The evidence for an impact of hypothyroidism on mortality is conflicting Thvilum et al. The same three studies that evaluated the effect of cHCs on the development of hyperthyroidism also looked at hypothyroidism Supplemental Table 7.
These studies show no evidence of any statistically significant effect of cHCs on the subsequent development of hypothyroidism. Current use was only evaluated in one study, and no effect was seen. Overall these studies do not suggest that use of cHCs conveys an increased or decreased risk on the subsequent development of hypothyroidism.
Five studies were identified which evaluated the effect of cHCs on various dermatologic conditions, including some with clear immune mediated mechanisms Supplemental Table 8.
Significant increases were seen for the effect on cHCs on the subsequent development of eczema current use and pemphigus and, in one of two studies, vulval lichen sclerosis. There was no significant impact noted on the development of scleroderma or psoriasis.
The OR for all OCs was infinity. One large cohort study in the developing world evaluated the risk of developing a number of diseases following the use of Norplant contraceptive implants Supplemental Table 9. This was a concurrent cohort study of women initiating use of Norplant implants compared with women initiating use of IUDs nonhormonal and sterilization in 8 developing countries. Women 20—40 years old were followed up six weeks after the initial visit and then biannually.
The study was designed to have 80 percent power to detect a doubling of event rates among implant users from a baseline incidence of 1 per 1, women. The study recruited 16, women, of whom used Norplant, IUDs and sterilization International Collaborative The study based diagnosis on the ICD9 codes, and their methodology lumped several diseases together.
Although it is beyond the scope of this article to review each of these conditions in depth, it should be noted that all of them carry significant morbidity, and many increase mortality in the affected individuals. In terms of dermatological conditions, the authors found significantly increased risks for eczema and contact dermatitis, pruritis and related conditions, alopecia, acne, and urticaria. This was supplemented by one study that specifically evaluated the effect of progesterone-only contraceptives on the subsequent development of vulval lichen sclerosis.
This showed a decrease risk with the use of progesterone-only contraceptives. Several other immune-related disorders have been studied. These include interstitial cystitis Konkle et al. Another case-control study showed that use of OCs markedly increased the risk of the disease whether past OR 4. Interstitial cystitis was associated with vulvodynia and sexual dysfunction in a high number of cases Gardella et al.
Another study showed that use of OCs in patients with interstitial cystitis was associated with a decrease in quality of life El Khoudary et al. Primary sclerosing cholangitis was the subject of one case-control study using a Norwegian PSC patient registry Andersen et al. They also noted a strong linear relationship between parity and age at primary sclerosing cholangitis diagnosis suggesting that pregnancy may delay primary sclerosing cholangitis onset.
In contrast, a recent, relatively small study in Iran of patients with ulcerative colitis found that oral contraceptives increased the risk of the development of sclerosing cholangitis, but there were relatively few women who developed this complication Khosravi Khorashad et al.
Primary biliary cirrhosis Gao, Qiao, and Wang ; Feld and Heathcote was the subject of a case-control study which showed that OC use was reported by fewer primary biliary cirrhosis patients compared with controls RR of 0. The authors note that due to the small number of cases and relatively low level of statistical significance these results should be interpreted with caution. Antiphospholipid antibody syndrome is a prothrombotic autoimmune disease Lackner et al. One recent study evaluated 1, women who were referred to an infertility clinic.
They found that hormonal contraceptives correlated with an increased risk to develop antiphospholipid antibodies, and the risk increased for increasing duration of use Ulcova-Gallova et al. The authors did not look at the occurrence of the clinical antiphospholipid antibody syndrome.
They suggest prolonged use of hormonal contraceptives may affect female autoimmunity through the induction of autoantibodies. One case-control study of complex regional pain syndrome showed no effect of the use of cHCs OR 1. Aplastic anemia, in one population-based case-control study in Thailand, was found not to be associated with the use of OCs with a multivariate RR of 0. A cohort study of black women in the United States did not show an effect of OCs on the development of sarcoidosis with an RR of 0.
In one uncontrolled case-series, condylar resorption of the jaw was associated with the use of OCs Gunson et al. Card Updates Genevieve Elmheart : health decreases from 5 to 4. Bastion : its mana cost increases from 3 to 4. Labs In the announcement of the Patch, Riot Games told us that they are experimenting with a quicker rotation for Labs.
Due to that, one week after the release of the expansion, we will have A Landmark Occasion: One week after, there will be a change, and the ARAM Lab will come back with a few changes, Riot says.
Personalization Boards : Haunted Grounds. Expeditions: New archetypes have been added with the expansion, featuring the new champions, Landmarks, and strategies. Monuments of Power archetypes will temporarily be three times as likely as they would otherwise be to appear in the initial Champion picks. Schindler C. Grim T. Stratification of Cannabinoid 1 Receptor CB1R agonist efficacy: Manipulation of CB1R density through use of transgenic mice reveals congruence between in vivo and in vitro assays.
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Koller V. Toxicological profiles of selected synthetic Cannabinoids showing high binding affinities to the cannabinoid receptor subtype CB1. Investigation of the in vitro toxicological properties of the synthetic cannabimimetic drug CP,C8. Funada M. Synthetic Cannabinoids enhanced ethanol-induced motor impairments through reduction of central glutamate neurotransmission. Chen X. Schoeder C. Banister S. The chemistry and pharmacology of synthetic Cannabinoid SDB and its regioisomeric fluorinated and methoxylated analogs.
ACS Chem. Haschimi B. Vigolo A. Novel halogenated derivates of JWH Behavioral and binding studies in mice. Ametovski A. Doi T. Post-mortem toxicology: A systematic review of death cases involving synthetic cannabinoid receptor agonists. Yun J. Maggo S. Effect of cannabinoid receptor agonists on isolated rat atria. Ozturk H. Synthetic cannabinoids and cardiac arrhythmia risk: Review of the literature. Pinson A. Metabolism, CB1 cannabinoid receptor binding and in vivo activity of synthetic cannabinoid 5f-akb Implications for toxicity.
Hutchison R. Longworth M. Rajasekaran M. Human metabolites of synthetic cannabinoids JWH and JWH bind with high affinity and act as potent agonists at cannabinoid type-2 receptors. Couceiro J. Robinson L. WIN55, induced deficits in spatial learning are mediated by cholinergic hypofunction. Ossato A.
Psychostimulant effect of the synthetic cannabinoid JWH and AKB Behavioral, neurochemical, and dopamine transporter scan imaging studies in mice. Irie T. MAM, a synthetic cannabinoid drug of abuse, suppresses the synaptic input to cerebellar purkinje cells via activation of presynaptic CB1 receptors. Grassin-Delyle S. Cannabinoids inhibit cholinergic contraction in human airways through prejunctional CB1 receptors. Pro-psychotic effects of synthetic cannabinoids: Interactions with central dopamine, serotonin, and glutamate systems.
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