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Free-Form Select (with synonyms) is a technique in printmaking, graphic design and image processing.
The effect is to erase background colors or elements from a motif to create stand-alone objects. Today, this is done with graphics software (computer graphics) and computers rather than by cutting away parts with scissors or scalpels.
Almost every modern graphics software includes this feature, such as CorelDRAW, Adobe Photoshop, GIMP, and Microsoft Paint. The motif which is to be cut-out freehanded is defined by a border path around the motif.
Free-Form Select is also understood in coloring parts of a black-and-white images and vice versa. Coloring a single object within a black-and-white environment is sometimes called Sin City effect.
See also
Chroma key
Computer-aided design
Cropping (image)
Vignetting (scene setting in photography)
References and footnotes
Imaging
Printmaking
Publishing
Photographic techniques
Composition in visual art | wiki |
A firefighter is a first responder trained in firefighting, primarily to control and extinguish fires that threaten life and property, as well as to rescue persons from confinement or dangerous situations. Male firefighters are sometimes referred to as firemen (and, less commonly, a female firefighter as firewoman).
The fire service, also known in some countries as the fire brigade or fire department, is one of the three main emergency services. From urban areas to aboard ships, firefighters have become ubiquitous around the world.
The skills required for safe operations are regularly practiced during training evaluations throughout a firefighter's career. Initial firefighting skills are normally taught through local, regional or state-approved fire academies or training courses. Depending on the requirements of a department, additional skills and certifications may also be acquired at this time.
Firefighters work closely with other emergency response agencies such as the police and emergency medical service. A firefighter's role may overlap with both. Fire investigators or fire marshals investigate the cause of a fire. If the fire was caused by arson or negligence, their work will overlap with law enforcement. Firefighters may also provide some degree of emergency medical service.
Duties
Fire suppression
A fire burns due to the presence of three elements: fuel, oxygen and heat. This is often referred to as the fire triangle. Sometimes it is known as the fire tetrahedron if a fourth element is added: a chemical chain reaction which can help sustain certain types of fire. The aim of firefighting is to deprive the fire of at least one of those elements. Most commonly this is done by dousing the fire with water, though some fires require other methods such as foam or dry agents. Firefighters are equipped with a wide variety of equipment for this purpose that include ladder trucks, pumper trucks, tanker trucks, fire hose, and fire extinguishers.
Structural firefighting
See also Fire suppression for other techniques.
While sometimes fires can be limited to small areas of a structure, wider collateral damage due to smoke, water and burning embers is common. Utility shutoff (such as gas and electricity) is typically an early priority for arriving fire crews. In addition, forcible entry may be required in order to gain access into the structure. Specific procedures and equipment are needed at a property where hazardous materials are being used or stored.
Structure fires may be attacked with either "interior" or "exterior" resources, or both. Interior crews, using the "two in, two out" rule, may extend fire hose lines inside the building, find the fire and cool it with water. Exterior crews may direct water into windows and other openings, or against any nearby fuels exposed to the initial fire. Hose streams directed into the interior through exterior wall apertures may conflict and jeopardize interior fire attack crews.
Buildings that are made of flammable materials such as wood are different from building materials such as concrete. Generally, a "fire-resistant" building is designed to limit fire to a small area or floor. Other floors can be safe by preventing smoke inhalation and damage. All buildings suspected or on fire must be evacuated, regardless of fire rating.
Some fire fighting tactics may appear to be destructive, but often serve specific needs. For example, during ventilation, firefighters are forced to either open holes in the roof or floors of a structure (called vertical ventilation), or open windows and walls (called horizontal ventilation) to remove smoke and heated gases from the interior of the structure. Such ventilation methods are also used to improve interior visibility to locate victims more quickly. Ventilation helps to preserve the life of trapped or unconscious individuals as it releases the poisonous gases from inside the structure. Vertical ventilation is vital to firefighter safety in the event of a flashover or backdraft scenario. Releasing the flammable gases through the roof eliminates the possibility of a backdraft, and the removal of heat can reduce the possibility of a flashover. Flashovers, due to their intense heat () and explosive temperaments, are commonly fatal to firefighter personnel. Precautionary methods, such as smashing a window, reveal backdraft situations before the firefighter enters the structure and is met with the circumstance head-on. Firefighter safety is the number one priority.
Whenever possible during a structure fire, property is moved into the middle of a room and covered with a salvage cover, a heavy cloth-like tarp. Various steps such as retrieving and protecting valuables found during suppression or overhaul, evacuating water, and boarding windows and roofs can divert or prevent post-fire runoff.
Wildland firefighting
Wildfires (known in Australia as bushfires) require a unique set of strategies and tactics. In many countries such as Australia and the United States, these duties are mostly carried out by local volunteer firefighters. Wildfires have some ecological role in allowing new plants to grow, therefore in some cases they will be left to burn. Priorities in fighting wildfires include preventing the loss of life and property as well as ecological damage.
Aircraft rescue and firefighting
Airports employ specialist firefighters to deal with potential ground emergencies. Due to the mass casualty potential of an aviation emergency, the speed with which emergency response equipment and personnel arrive at the scene of the emergency is of paramount importance. When dealing with an emergency, the airport firefighters are tasked with rapidly securing the aircraft, its crew and its passengers from all hazards, particularly fire. Airport firefighters have advanced training in the application of firefighting foams, dry chemical and clean agents used to extinguish burning aviation fuel.
Rescue
Firefighters rescue persons from confinement or dangerous situations such as burning buildings and crashed vehicles. Complex, infrequent situations requiring specialized training and equipment include rescues from collapsed buildings and confined spaces. Many fire departments, including most in the United Kingdom, refer to themselves as a fire and rescue service for this reason. Large fire departments, such as the New York City Fire Department and London Fire Brigade, have specialist teams for advanced technical rescue. As structure fires have been in decline for many years in developed countries such as the United States, rescues other than fires make up an increasing proportion of their firefighters' work.
Emergency medical services
Firefighters frequently provide some degree of emergency medical care. In some jurisdictions first aid is the only medical training that firefighters have, and medical calls are the sole responsibility of a separate emergency medical services (EMS) agency. Elsewhere, it is common for firefighters to respond to medical calls. The impetus for this is the growing demand in medical emergencies and the significant decline in fires.
In such departments, firefighters are often certified as emergency medical technicians in order to deliver basic life support, and more rarely as paramedics to deliver advanced life support. In the United Kingdom, where fire services and EMS are run separately, fire service co-responding has been introduced more recently. Another point of variation is whether the firefighters respond in a fire engine or a response car.
Hazardous materials
Fire departments are usually the lead agency that responds to hazardous materials incidents. Specialized firefighters, known as hazardous materials technicians, are trained in chemical identification, leak and spill control, and decontamination.
Fire prevention
Fire departments frequently provide advice to the public on how to prevent fires in the home and work-place environments. Fire inspectors or fire marshals will directly inspect businesses to ensure they are up to the current building fire codes, which are enforced so that a building can sufficiently resist fire spread, potential hazards are located, and to ensure that occupants can be safely evacuated, commensurate with the risks involved.
Fire suppression systems have a proven record for controlling and extinguishing unwanted fires. Many fire officials recommend that every building, including residences, have fire sprinkler systems. Correctly working sprinklers in a residence greatly reduce the risk of death from a fire. With the small rooms typical of a residence, one or two sprinklers can cover most rooms. In the United States, the housing industry trade groups have lobbied at the State level to prevent the requirement for Fire Sprinklers in one or two family homes.
Other methods of fire prevention are by directing efforts to reduce known hazardous conditions or by preventing dangerous acts before tragedy strikes. This is normally accomplished in many innovative ways such as conducting presentations, distributing safety brochures, providing news articles, writing public safety announcements (PSA) or establishing meaningful displays in well-visited areas. Ensuring that each household has working smoke alarms, is educated in the proper techniques of fire safety, has an evacuation route and rendezvous point is of top priority in public education for most fire prevention teams in almost all fire department localities.
Fire investigators, who are experienced firefighters trained in fire cause determinism, are dispatched to fire scenes, in order to investigate and determine whether the fire was a result of an accident or intentional. Some fire investigators have full law enforcement powers to investigate and arrest suspected arsonists.
Occupational health and safety
Direct risks
Fires
To allow protection from the inherent risks of fighting fires, firefighters wear and carry protective and self-rescue equipment at all times. A self-contained breathing apparatus (SCBA) delivers air to the firefighter through a full face mask and is worn to protect against smoke inhalation, toxic fumes, and super heated gases. A special device called a Personal Alert Safety System (PASS) is commonly worn independently or as a part of the SCBA to alert others when a firefighter stops moving for a specified period of time or manually operates the device. The PASS device sounds an alarm that can assist another firefighter (firefighter assist and search team (FAST), or rapid intervention team (RIT), in locating the firefighter in distress.
Firefighters often carry personal self-rescue ropes. The ropes are generally long and can provide a firefighter (that has enough time to deploy the rope) a partially controlled exit out of an elevated window. Lack of a personal rescue rope is cited in the deaths of two New York City Firefighters, Lt. John Bellew and Lt. Curtis Meyran, who died after they jumped from the fourth floor of a burning apartment building in the Bronx. Of the four firefighters who jumped and survived, only one of them had a self-rescue rope. Since the incident, the Fire Department of New York City has issued self-rescue ropes to their firefighters.
Heat injury is a major issue for firefighters as they wear insulated clothing and cannot shed the heat generated from physical exertion. Early detection of heat issues is critical to stop dehydration and heat stress becoming fatal. Early onset of heat stress affects cognitive function which combined with operating in dangerous environment makes heat stress and dehydration a critical issue to monitor. Firefighter physiological status monitoring is showing promise in alerting EMS and commanders to the status of their people on the fire ground. Devices such as PASS device alert 10–20 seconds after a firefighter has stopped moving in a structure. Physiological status monitors measure a firefighter's vital sign status, fatigue and exertion levels and transmit this information over their voice radio. This technology allows a degree of early warning to physiological stress. These devices are similar to technology developed for Future Force Warrior and give a measure of exertion and fatigue. They also tell the people outside a building when they have stopped moving or fallen. This allows a supervisor to call in additional engines before the crew get exhausted and also gives an early warning to firefighters before they run out of air, as they may not be able to make voice calls over their radio. Current OSHA tables exist for heat injury and the allowable amount of work in a given environment based on temperature, humidity and solar loading.
Firefighters are also at risk for developing rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue and has many causes including heat exposure, high core body temperature, and prolonged, intense exertion. Routine firefighter tasks, such as carrying extra weight of equipment and working in hot environments, can increase firefighters’ risk for rhabdomyolysis.
Structural collapses
Another leading cause of death during firefighting is structural collapse of a burning building (e.g. a wall, floor, ceiling, roof, or truss system). Structural collapse, which often occurs without warning, may crush or trap firefighters inside the structure. To avoid loss of life, all on-duty firefighters should maintain two-way communication with the incident commander and be equipped with a personal alert safety system device on all fire scenes and maintain radio communication on all incidents(PASS). Francis Brannigan was the founder and greatest contributor to this element of firefighter safety.
Traffic collisions
In the United States, 25% of fatalities of firefighters are caused by traffic collisions while responding to or returning from an incident. Other firefighters have been injured or killed by vehicles at the scene of a fire or emergency (Paulison 2005). A common measure fire departments have taken to prevent this is to require firefighters to wear a bright yellow reflective vest over their turnout coats if they have to work on a public road, to make them more visible to passing drivers.
Violence
Firefighters have sometimes been assaulted by members of the public while responding to calls. These kinds of attacks can cause firefighters to fear for their safety and may cause them to not have full focus on the situation which could result in injury to their selves or the patient.
During debris cleanup
Once extinguished, fire debris cleanup poses several safety and health risks for workers.
Many hazardous substances are commonly found in fire debris. Silica can be found in concrete, roofing tiles, or it may be a naturally occurring element. Occupational exposures to silica dust can cause silicosis, lung cancer, pulmonary tuberculosis, airway diseases, and some additional non-respiratory diseases. Inhalation of asbestos can result in various diseases including asbestosis, lung cancer, and mesothelioma. Sources of metals exposure include burnt or melted electronics, cars, refrigerators, stoves, etc. Fire debris cleanup workers may be exposed to these metals or their combustion products in the air or on their skin. These metals may include beryllium, cadmium, chromium, cobalt, lead, manganese, nickel, and many more. Polyaromatic hydrocarbons (PAHs), some of which are carcinogenic, come from the incomplete combustion of organic materials and are often found as a result of structural and wildland fires.
Safety hazards of fire cleanup include the risk of reignition of smoldering debris, electrocution from downed or exposed electrical lines or in instances where water has come into contact with electrical equipment. Structures that have been burned may be unstable and at risk of sudden collapse.
Standard personal protective equipment for fire cleanup include hard hats, goggles or safety glasses, heavy work gloves, earplugs or other hearing protection, steel-toe boots, and fall protection devices. Hazard controls for electrical injury include assuming all power lines are energized until confirmation they are de-energized, and grounding power lines to guard against electrical feedback, and using appropriate personal protective equipment. Proper respiratory protection can protect against hazardous substances. Proper ventilation of an area is an engineering control that can be used to avoid or minimize exposure to hazardous substances. When ventilation is insufficient or dust cannot be avoided, personal protective equipment such as N95 respirators can be used.
Long-term risks
Cardiovascular disease
Firefighting has long been associated with poor cardiovascular outcomes. In the United States, the most common cause of on-duty fatalities for firefighters is sudden cardiac death, accounting for approximately 45% of on duty US firefighter deaths. In addition to personal factors that may predispose an individual to coronary artery disease or other cardiovascular diseases, occupational exposures can significantly increase a firefighter's risk. Historically, the fire service blamed poor firefighter physical condition for being the primary cause of cardiovascular related deaths. However, over the last 20 years, studies and research has indicated the toxic gasses put fire service personnel at significantly higher risk for cardiovascular related conditions and death. For instance, carbon monoxide, present in nearly all fire environments, and hydrogen cyanide, formed during the combustion of paper, cotton, plastics, and other substances containing carbon and nitrogen. The substances inside of materials change during combustion, and their by-products can interfere with the transport of oxygen in the body. Hypoxia can then lead to heart injury. In addition, chronic exposure to particulate matter in smoke is associated with atherosclerosis. Noise exposures may contribute to hypertension and possibly ischemic heart disease. Other factors associated with firefighting, such as stress, heat stress, and heavy physical exertion, also increase the risk of cardiovascular events.
During fire suppression activities a firefighter can reach peak or near peak heart rates which can act as a trigger for a cardiac event. For example, tachycardia can cause plaque buildup to break loose and lodge itself is a small part of the heart causing myocardial infarction, also known as a heart attack. This along with unhealthy habits and lack of exercise can be very hazardous to firefighter health.
Cancer
Cancer risk in the U.S. fire service is a topic of growing concern. Recent studies suggest that due to their exposure on the fireground, firefighters may be at an increased risk for certain types of cancer and other chronic diseases. Additionally, large international studies generally support the finding from U.S. studies that firefighters have elevated rates of cancer, with some variation by cancer site.
A 2015 retrospective longitudinal study showed that firefighters are at higher risk for certain types of cancer. Firefighters had mesothelioma, which is caused by asbestos exposure, at twice the rate of the non-firefighting working population. Younger firefighters (under age 65) also developed bladder cancer and prostate cancer at higher rates than the general population. The risk of bladder cancer may be present in female firefighters, but research is inconclusive as of 2014. Preliminary research from 2015 on a large cohort of US firefighters showed a direct relationship between the number of hours spent fighting fires and lung cancer and leukemia mortality in firefighters. This link is a topic of continuing research in the medical community, as is cancer mortality in general among firefighters.
In addition to epidemiological studies, mechanistic studies have used biomarkers to investigate exposures' effects on biological changes that could be related to cancer development. Several of these studies have found evidence of DNA damage, oxidative stress, and epigenetic changes related to firefighters' exposures.
Firefighters regularly encounter carcinogenic materials and hazardous contaminants, which is thought to contribute to their excess cancer risk. Dozens of chemicals classified by the International Agency for Research on Cancer (IARC) as known or probable carcinogens have been identified on the fireground. Several studies have documented airborne and/or dermal exposures to carcinogenic compounds during firefighting, as well as contamination on turnout gear and other equipment worn by firefighters. Some of these compounds have been shown to absorb into firefighters’ bodies.
In addition to chemical exposures, firefighters often work 24-hr shifts or longer, and may respond to emergencies at night. Night shift work has been classified as a probable human carcinogen by IARC. Some firefighters also work with hazardous materials and trained to control and clean up these dangerous materials, such as oil spills and chemical accidents. As firefighters combat a fire and clean up hazardous materials, there is a risk of harmful chemicals coming in contact with their skin if it penetrates their personal protective equipment (PPE). In June 2022, IARC classified occupational exposure as a firefighter as “carcinogenic to humans.”
Firefighters are in addition to carcinogenic chemicals, firefighters can be exposed to radiation (alpha radiation, beta radiation, and gamma radiation).
There are many types of firefighters. Most research on firefighters’ cancer risk has involved structural or municipal career firefighters. Wildland firefighters are specially trained firefighters tasked with controlling forest fires. They frequently create fire lines, which are swathes of cut-down trees and dug-up grass placed in the path of the fire. This is designed to deprive the fire of fuel. Wildland firefighting is a physically demanding job with many acute hazards. Wildland firefighters may hike several miles while carrying heavy equipment during the wildfire season, which has increased in duration over time, especially in the western United States. Unlike structural firefighters, wildland firefighters typically do not wear respiratory protection, and may inhale particulate and other compounds emitted by the wildfires. They also use prescribed fires to burn potential fire fuel under controlled conditions. To examine cancer risk for wildland firefighters, a risk assessment was conducted using an exposure-response relationship for risk of lung cancer mortality and measured particulate matter exposure from smoke at wildfires. This study concluded that wildland firefighters could have an increased risk of lung cancer mortality. The research on cancer for other subspecialty groups of firefighters is limited, but a recent study of fire instructors in Australia found an exposure-response relationship between training exposures and cancer incidence.
Due to the lack of central and comprehensive sources of data, research on cancer rates amongst firefighters has been challenging. On July 7, 2018, Congress passed the Firefighter Cancer Registry Act of 2018 requiring the Centers for Disease Control and Prevention to create the National Firefighter Registry designed to collect data on cancer rates among U.S. firefighters.
Mental stress
As with other emergency workers, firefighters may witness traumatic scenes during their careers. They are thus more vulnerable than most people to certain mental health issues such as post-traumatic stress disorder and suicidal thoughts and behaviors. Among women in the US, the occupations with the highest suicide rates are police and firefighters, with a rate of 14.1 per 100 000, according to the National Center for Injury Prevention and Control, CDC. Chronic stress over time attributes to symptoms that affect first responders, such as anxiousness, irritability, nervousness, memory and concentration problems can occur overtime which can lead to anxiety and depression. Mental stress can have long lasting affects on the brain. A 2014 report from the National Fallen Firefighters Foundation found that a fire department is three times more likely to experience a suicide in a given year than a line-of-duty death. Mental stress of the job can lead to substance abuse and alcohol abuse as ways of coping with the stress. The mental stress of fire fighting has many different causes. There are those they see on duty and also what they miss by being on duty. Firefighters schedules fluctuate by district. There are stations where fire fighters work 48 hours on and 48 hours off, whereas some allow 24 hours on and 72 hours off. The mental impact of missing a child's first steps or a ballet recital can take a heavy impact on first responders. There is also the stress of being on opposite shifts as a spouse or being away from family.
When not on the scene of an emergency, firefighters remain on call at fire stations, where they eat, sleep, and perform other duties during their shifts. Hence, sleep disruption is another occupational hazard that they may encounter at their job.
Occupational hearing loss
Another long-term risk factor from firefighting is exposure to high levels of sound, which can cause noise-induced hearing loss (NIHL) and tinnitus. NIHL affects sound frequencies between 3,000 and 6,000 Hertz first, then with more frequent exposure, will spread to more frequencies. Many consonants will be more difficult to hear or inaudible with NIHL because of the higher frequencies effected, which results in poorer communication. NIHL is caused by exposure to sound levels at or above 85dBA according to NIOSH and at or above 90dBA according to OSHA. dBA represents A-weighted decibels. dBA is used for measuring sound levels relating to occupational sound exposure since it attempts to mimic the sensitivity of the human ear to different frequencies of sound. OSHA uses a 5-dBA exchange rate, which means that for every 5dBA increase in sound from 90dBA, the acceptable exposure time before a risk of permanent hearing loss occurs decreases by half (starting with 8 hours acceptable exposure time at 90dBA). NIOSH uses a 3-dBA exchange rate starting at 8 hours acceptable exposure time at 85dBA.
The time of exposure required to potentially cause damage depends on the level of sound exposed to. The most common causes of excessive sound exposure are sirens, transportation to and from fires, fire alarms, and work tools. Traveling in an emergency vehicle has shown to expose a person to between 103 and 114dBA of sound. According to OSHA, exposure at this level is acceptable for between 17 and 78 minutes and according to NIOSH is acceptable for between 35 seconds and 7.5 minutes over a 24-hour day before permanent hearing loss can occur. This time period considers that no other high level sound exposure occurs in that 24-hour time frame. Sirens often output about 120 dBA, which according to OSHA, 7.5 minutes of exposure is needed and according to NIOSH, 9 seconds of exposure is needed in a 24-hour time period before permanent hearing loss can occur. In addition to high sound levels, another risk factor for hearing disorders is the co-exposure to chemicals that are ototoxic.
The average day of work for a firefighter can often be under the sound exposure limit for both OSHA and NIOSH. While the average day of sound exposure as a firefighter is often under the limit, firefighters can be exposed to impulse noise, which has a very low acceptable time exposure before permanent hearing damage can occur due to the high intensity and short duration.
There are also high rates of hearing loss, often NIHL, in firefighters, which increases with age and number of years working as a firefighter. Hearing loss prevention programs have been implemented in multiple stations and have shown to help lower the rate of firefighters with NIHL. Other attempts have been made to lower sound exposures for firefighters, such as enclosing the cabs of the firetrucks to lower the siren exposure while driving. NFPA (National Fire Protection Association) is responsible for occupational health programs and standards in firefighters which discusses what hearing sensitivity is required to work as a firefighter, but also enforces baseline (initial) and annual hearing tests (based on OSHA hearing maintenance regulations). While NIHL can be a risk that occurs from working as a firefighter, NIHL can also be a safety concern for communicating while doing the job as communicating with coworkers and victims is essential for safety. Hearing protection devices have been used by firefighters in the United States. Earmuffs are the most commonly used hearing protection device (HPD) as they are the most easy to put on correctly in a quick manner. Multiple fire departments have used HPDs that have communication devices built in, allowing firefighters to speak with each other at safe, but audible sound levels, while lowering the hazardous sound levels around them.
Types of coverage and workload
In a country with a comprehensive fire service, fire departments must be able to send firefighters to emergencies at any hour of day or night, to arrive on the scene within minutes. In urban areas, this means that full-time paid firefighters usually have shift work, with some providing cover each night. On the other hand, it may not be practical to employ full-time firefighters in villages and isolated small towns, where their services may not be required for days at a time. For this reason, many fire departments have firefighters who spend long periods on call to respond to infrequent emergencies; they may have regular jobs outside of firefighting.
Whether they are paid or not varies by country. In the United States and Germany, volunteer fire departments provide most of the cover in rural areas. In the United Kingdom and Ireland, by contrast, actual volunteers are rare. Instead, "retained firefighters" are paid for responding to incidents, along with a small salary for spending long periods of time on call. The combined fire services of the United Kingdom retain around 18,000 retained firefighters alongside their wholetime colleagues. In both the UK and Ireland retained firefighters make up the majority of active firefighting personnel. Their training, qualifications, and range of possible deployments, are all comparable to wholetime firefighters. Retained firefighters are required to live or work within a set radius of their assigned fire station - in the United Kingdom this is usually , and in Ireland .
Firefighting around the world
A key difference between many countries' fire services is what the balance is between full-time and volunteer (or on-call) firefighters. In the United States and United Kingdom, large metropolitan fire departments are almost entirely made up of full-time firefighters. On the other hand, in Germany and Austria, volunteers play a substantial role even in the largest fire departments, including Berlin's, which serves a population of 3.6 million. Regardless of how this balance works, a common feature is that smaller urban areas have a mix of full-time and volunteer/on-call firefighters. This is known in the United States as a combination fire department. In Chile and Peru, all firefighters are volunteers.
Another point of variation is how the fire services are organized. Some countries like the Czech Republic, Israel and New Zealand have a single national fire service. Others like Australia, the United Kingdom and France organize fire services based on regions or sub-national states. In the United States, Austria, Germany and Canada, fire departments are run at a municipal level.
Atypically, Singapore and many parts of Switzerland have fire service conscription. In Germany, conscription can also be used if a village does not have a functioning fire service. Other unusual arrangements are seen in Denmark, where most fire services are run by private companies, and in France, where two of the country's fire services (the Paris Fire Brigade and the Marseille Naval Fire Battalion) are part of the armed forces; similarly, the national fire service of Monaco is part of the Military of Monaco and maintains an armoury of sidearms for use by firefighters during civil defence operations.
Another way in which a firefighter's work varies around the world is the nature of firefighting equipment and tactics. For example, American fire departments make heavier use of aerial appliances, and are often split between engine and ladder companies. In Europe, where the size and usefulness of aerial appliances are often limited by narrow streets, they are only used for rescues, and firefighters can rotate between working on an engine and an aerial appliance.
A final point in variation is how involved firefighters are in emergency medical services.
Communication and command structure
The expedient and accurate handling of fire alarms or calls are significant factors in the successful outcome of any incident. Fire department communications play a critical role in that successful outcome. Fire department communications include the methods by which the public can notify the communications center of an emergency, the methods by which the center can notify the proper fire fighting forces, and the methods by which information is exchanged at the scene. One method is to use a megaphone to communicate.
A telecommunicator (often referred to as a 000 Operator in Australia) has a role different from but just as important as other emergency personnel. The telecommunicator must process calls from unknown and unseen individuals, usually calling under stressful conditions. He/she must be able to obtain complete, reliable information from the caller and prioritize requests for assistance. It is the dispatcher's responsibility to bring order to chaos.
While some fire departments are large enough to utilize their own telecommunication dispatcher, most rural and small areas rely on a central dispatcher to provide handling of fire, rescue, and police services.
Firefighters are trained to use communications equipment to receive alarms, give and receive commands, request assistance, and report on conditions. Since firefighters from different agencies routinely provide mutual aid to each other, and routinely operate at incidents where other emergency services are present, it is essential to have structures in place to establish a unified chain of command, and share information between agencies. The U.S. Federal Emergency Management Agency (FEMA) has established a National Incident Management System. One component of this system is the Incident Command System.
All radio communication in the United States is under authorization from the Federal Communications Commission (FCC); as such, fire departments that operate radio equipment must have radio licenses from the FCC.
Ten codes were popular in the early days of radio equipment because of poor transmission and reception. Advances in modern radio technology have reduced the need for ten-codes and many departments have converted to simple English (clear text).
Ranks
Many firefighters are sworn members with command structures similar to the military or police. They do not usually have general police powers (although some firefighters in the United States have limited police powers, like fire police departments), though certain fire safety officials (such as fire marshals or fire safety inspectors) do possess extensive police powers in connection with their work of enforcement and control in regulatory and emergency situations. In some countries fire fighters carry, or have access to, firearms, including some US fire marshals, and the Corps des Sapeurs-Pompiers of Monaco which is a military unit providing civilian fire cover.
The nomenclature of firefighting varies from country to country. The basic unit of firefighters is known as a "company" in many countries, including the United States, with its members typically working on the same engine. A "crew" or "platoon" is a subdivision of a company who work on the same shift. In British and Commonwealth fire services the firefighters of each station are more typically organised around a "watch" pattern, with several watches (usually four) working on a shift basis, as a separate "crew" for each engine or specialist appliance at that station.
Firefighter equipment
A partial list of some equipment typically used by firefighters:
Hand tools, such as
Flat-head and pick-head axe
Pike pole
Halligan bar
Flashlight
Spanner wrench
Circular ("K-12"), Cutters Edge and chain saws
Hydraulic rescue tools such as spreaders, cutters, and rams
Personal protective equipment ("PPE") designed to withstand water and high temperatures, such as
Bunker gear, including turnout jacket and pants
Self-contained breathing apparatus (SCBA)
Helmet, face mask and visor; climbing helmets
Safety boots, gloves, and Nomex and Carbon flash hoods
Personal alert safety system (PASS) device
Handheld radio, pager, or other communication devices
Thermal imaging camera
Gas detector
History
Although people have fought fires since there have been valuable things to burn, the first instance of organized professionals combating structural fires occurred in
ancient Egypt. Likewise, fire fighters of the Roman Republic existed solely as privately organized and funded groups that operated more similarly to a business than a public service; however, during the Principate period, Augustus revolutionized firefighting by calling for the creation of a fire guard that was trained, paid, and equipped by the state, thereby commissioning the first truly public and professional firefighting service. Known as the Vigiles, they were organised into cohorts, serving as a night watch and city police force.
The earliest American fire departments were volunteers, including the volunteer fire company in New Amsterdam, now known as New York. Fire companies were composed of citizens who volunteered their time to help protect the community. As time progressed and new towns were established throughout the region, there was a sharp increase in the number of volunteer departments.
In 1853, the first career fire department in the United States was established in Cincinnati, Ohio, followed four years later by St. Louis Fire Department. Large cities began establishing paid, full-time staff in order to try to facilitate greater call volume.
City fire departments draw their funding directly from city taxes and share the same budget as other public works like the police department and trash services. The primary difference between municipality departments and city departments is the funding source. Municipal fire departments do not share their budget with any other service and are considered to be private entities within a jurisdiction. This means that they have their own taxes that feed into their budgeting needs. City fire departments report to the mayor, whereas municipal departments are accountable to elected board officials who help maintain and run the department along with the chief officer staff.
Fundraisers
Funds for firefighting equipment may be raised by the firefighters themselves, especially in the case of volunteer organizations. Events such as pancake breakfasts and chili feeds are common in the United States. Social events are used to raise money include dances, fairs, and car washes.
See also
USAF Firefighting
References
External links
Fact Sheet for Firefighters and EMS providers regarding risks for exposure to COVID-19, Centers for Disease Control and Prevention.
Occupational safety and health
Protective service occupations | wiki |
A fireman is a firefighter. It may also be used restrictively to refer only to male firefighters.
Fireman or Firemen may also refer to:
Basic meanings
Fireman (steam engine), an individual employed to tend the fire for running a steam engine, either on a stationary engine, a railway locomotive or a steamship
A United States Navy or United States Coast Guard rate for an enlisted seaman who works on ships' propulsion systems, even though steamships are no longer used
Sports
Fireman (baseball), a baseball player who enters the game after the starting pitcher is removed
Film
The Fireman (1916 film), a Charlie Chaplin film
The Fireman (1931 film), a short animated film distributed by Universal Pictures
Fireman (film), a 2015 Malayalam film
An individual employed to start fires to burn books in the novel and film Fahrenheit 451
Fireman (TV series), a Japanese TV series known as Magma Man in some markets
Fire Man (Mega Man), a Robot Master from the video game series Mega Man
Music
The Fireman, an alternative name used by Capleton, a Jamaican reggae artist
The Fireman (band), an electronic music duo consisting of English musicians Paul McCartney and Youth
Fireman (album), an album by hHead
Songs
"Fireman" (song), from Lil Wayne's 2005 studio album Tha Carter II
"Fireman", single by The Cravats 1982
"Fireman", single by Steve Kilbey 1987
"Fireman", single by Jawbreaker 1995
Other
Fireman (peyote), a role within ceremonies of the Native American Church
Fireman Sam
See also
Firefighter (disambiguation)
Fire Fighters (disambiguation) | wiki |
In telecommunication, a dial plan (or dialing plan) establishes the permitted sequences of digits dialed by telephone subscriber and the manner in which a telephone switch interprets these digits within the definitions of the prevailing telephone numbering plan. Dial plans in the public switched telephone network (PSTN) have traditionally been more commonly referred to as dialing procedures.
The collection of permissible digit patterns, so called digit-maps, for a private telephone system or for customer premise equipment, such as an analog telephone adapter (ATA) or an IP phone, is sometimes also called dial plan. A pattern may be as short as a single digit, e.g. for reaching an operator, or as long as a complete international telephone number, including trunk prefixes and international prefixes.
Public switched telephone network (USA)
Local numbers consist of seven digits within a numbering plan area with a single area code. For overlay numbering plans the area code must dialed before the local telephone number.
Long distance dialing requires the dialing of 1, the three-digit area code, and the seven-digit local number.
International numbers of any length are dialing starting with 011.
Similarly, telephony service operators may provide dialing sequences for special services, such as directory assistance and emergency services.
Private telephone systems
PBX equipment, carrier switching systems, or end-user telephones may specify a variable-length dial plan or a fixed-length dial plan.
In private branch exchanges in the U.S. a dialing plan may specify the addresses of internal extension, as numbers of two, three, or four digits.
Dialing telephone numbers of the PSTN often requires the dialing of 9 on PBX systems to reach an outside line.
Digit maps
Analog telephone adapters, IP phones, and many other VoIP media gateways have configuration options that establish the digit sequences that can be dialed with the equipment. The dial plan of these devices is established by a digit map.
The following syntax may be used for such dial plan, as adapted from RFC 2705,<ref>RFC 2705, Media Gateway Control Protocol (MGCP) Version 1.0, Arango et al. (1999)</ref> the specification for the Media Gateway Control Protocol.
Some dial plan'' examples using the above syntax look as follows:
References
Telephone numbers | wiki |
Soldan may refer to:
Soldan, ancient for Sultan
Mariano Felipe Paz Soldán
14190 Soldán
Soldan International Studies High School
Sandra Soldan
Aho & Soldan
Silvio Soldán
Mackenzie Soldan
Narciso Soldan
Michael Soldan
See also
Soldano (disambiguation) | wiki |
Classique may refer to:
Classique (fragrance), a women's fragrance created by Jacques Cavallier for Jean-Paul Gaultier in 1993
ATMA Classique, a Canadian record label
Canadian Classique, a soccer rivalry between Toronto FC and the Montreal Impact
Le Classique, a football match contested between French clubs Paris Saint-Germain and Olympique de Marseille
Musique classique, a French television channel
Orchestrette Classique, an American female chamber orchestra in New York
Radio Classique, a French classical music radio station | wiki |
The Hawthorne Place District is a historic district in Chicago, Illinois, United States. The district was built in the 1890s by various architects including the McConnell brothers, Burnham & Root, and Pond & Pond. It was designated a Chicago Landmark on March 26, 1996.
References
1890s architecture in the United States
Historic districts in Chicago
Chicago Landmarks | wiki |
Shibe may refer to:
Shibe Park, a former baseball stadium in Philadelphia, Pennsylvania, United States
Ben Shibe (1838–1922), American sporting goods and baseball executive
Sean Shibe (born 1992), Japanese-Scottish guitarist
Shiba Inu, a breed of dog with origins in Japan | wiki |
Pro X or Pro-X may refer to:
Television
Pro Arena, a Romanian TV channel formerly named Pro X
Pro X, a Kohavision TV show
Biology
Cytosol nonspecific dipeptidase, an enzyme also known as Pro-X dipeptidase
Lysosomal Pro-X carboxypeptidase, an enzyme
Membrane Pro-X carboxypeptidase, an enzyme
Prolyl aminopeptidase, an enzyme also known as Pro-X aminopeptidase
Software
Modbook Pro X, a type of tablet computer
Final Cut Pro X, a non-linear video editing application
Logic Pro X, a digital audio workstation
Samplitude Pro X, a version of the Magix Samplitude digital audio workstation
Video Pro X, a video editor by Magix
Snapz Pro X, a utility computer application
Xara Designer Pro X, a version of the Xara Photo & Graphic Designer image editing program
Technology
Korg Triton Pro X, a version of the Korg Triton music workstation synthesizer
Razor Pro X, a RazorUSA kick scooter model
Telstra Wi-Fi 4G Advanced Pro X, a mobile broadband device | wiki |
Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques. ACLS expands on Basic Life Support (BLS) by adding recommendations on additional medication and advanced procedure use to the CPR guidelines that are fundamental and efficacious in BLS. ACLS is practiced by advanced medical providers including physicians, some nurses and paramedics; these providers are usually required to hold certifications in ACLS care.
While "ACLS" is almost always semantically interchangeable with the term "Advanced Life Support" (ALS), when used distinctly, ACLS tends to refer to the immediate cardiac care, while ALS tends to refer to more specialized resuscitation care such as ECMO and PCI. In the EMS community, "ALS" may refer to the advanced care provided by paramedics while "BLS" may refer to the fundamental care provided by EMTs and EMRs; without these terms referring to cardiovascular-specific care.
Overview
Advanced cardiac life support refers to a set of guidelines used by medical providers to treat life-threatening cardiovascular conditions. These life-threatening conditions range from dangerous arrhythmias to cardiac arrest. ACLS algorithms frequently address at least five different aspects of peri-cardiac arrest care: Airway management, ventilation, CPR compressions (continued from BLS), defibrillation, and medications. Due to the seriousness of the diseases treated, the paucity of data known about most ACLS patients, and the need for multiple, rapid, simultaneous treatments, ACLS is executed as a standardized, algorithmic set of treatments. Successful ACLS treatment starts with diagnosis of the correct EKG rhythm causing the arrest. Common cardiac arrest rhythms covered by ACLS guidelines include: ventricular tachycardia, ventricular fibrillation, Pulseless Electrical Activity, and asystole. Dangerous, non-arrest rhythms typically covered includes: narrow- and wide-complex tachycardias, torsades de pointe, atrial fibrillation/flutter with rapid ventricular response, and bradycardia.
Successful ACLS treatment generally requires a team of trained individuals. Common team roles include: Leader, back-up leader, 2 CPR performers, an airway/respiratory specialist, an IV access and medication administration specialist, a monitor/ defibrillator attendant, a pharmacist, a lab member to send samples, and a recorder to document the treatment. For in-hospital events, these members are frequently physicians, mid-level providers, nurses and allied health providers; while for out-of-hospital events, these teams are usually composed of a small number of EMTs and paramedics.
Scope
ACLS algorithms include multiple, simultaneous treatment recommendations. Some ACLS providers may be required to strictly adhere to these guidelines, however physicians may generally deviate to pursue different evidence-based treatment, especially if they are addressing an underlying cause of the arrest and/or unique aspects of a patient's care. ACLS algorithms are complex but the table, below, demonstrates common aspects of ACLS care.
ACLS Certification
Due to the rapidity and complexity of ACLS care, as well as the recommendation that it be performed in a standardized fashion, providers must usually hold certifications in ACLS care. Certifications may be provided by a few different, generally national, organizations but their legitimacy is ultimately determined by hospital hiring and privileging boards; that is, ACLS certification is frequently a requirement for employment as a health care provider at most hospitals. ACLS certifications usually provide education on the aforementioned aspects of ACLS care except for specialized resuscitation techniques. Specialized resuscitation techniques are not covered by ACLS certifications and their use is restricted to further specialized providers. ACLS education is based on ILCOR recommendations which are then adapted to local practices by authoritative medical organizations such as the American Red Cross, the European Resuscitation Council, or the Resuscitation Council of Asia.
BLS proficiency is usually a prerequisite to ACLS training; however the initial portions of an ACLS class may cover CPR. Initial training usually takes around 15 hours and includes both classroom instruction and hands-on simulation experience; passing a test, with a practical component, at the end of the course is usually the final requirement to receive certification. After receiving initial certification, providers must usually recertify every two years in a class with similar content that lasts about seven hours. Widely accepted providers of ACLS certification include, non-exclusively: American Heart Association, American Red cross, European Resuscitation Council or the Australian Resuscitation Council.
Holding ACLS certification is a testament to a provider's education on ACLS guidelines. The certification does not superseded a provider's scope of practice as determined by state law or employer protocols; and does not, itself, provide any license to practice.
Efficacy of ACLS
Like a medical intervention, researchers have had to ask whether ACLS is effective. Data generally demonstrates that patients have better survival outcomes (increased ROSC, increased survival to hospital discharge and/or superior neurological outcomes) when they receive ACLS; however a large study of ROC patients showed that this effect may only be if ACLS is delivered in the first six minutes of arrest. This study also found that ACLS increases survival but does not produce superior neurological outcomes.
Some studies have raised concerns that ACLS education can be inconstantly or inadequately taught which can result in poor retention, leading to poor ACLS performance. One study from 1998 looked at the ACLS use of epinephrine, atropine, bicarbonate, calcium, lidocaine, and bretylium in cardiac arrests and found that these medications were not associated with higher resuscitation rates.
Research on ACLS can be challenging because ACLS is a bundle of care recommendations; with each individual treatment component being profoundly consequential. There is active debate within the resuscitation research community about the value of certain interventions. Active areas of research include determining the value of vasopressors in arrests, ideal airway use and different waveforms for defibrillation.
International guidelines
Stemming from the need for standardized, evidence based ACLS guidelines, an international network of academic resuscitation organizations was created. The International Liaison Committee on Resuscitation (ILCOR) is the central, international institution that regional resuscitation committees strive to contribute to and disseminate information from. The centralization of resuscitation research around ILCOR reduces redundant work internationally, allows for collaboration between experts from many regional organizations, and produces higher quality, higher powered research.
International Liaison Committee on Resuscitation
ILCOR serves as a way for international resuscitation organizations to communicate and collaborate. ILCOR publishes scientific evidence reviews on resuscitation known as "Continuous Evidence Evaluation (CEE) and Consensus on Science with Treatment Recommendations (CoSTRs)". ILCOR uses 6 international task forces to review over 180 topics through a structured systematic-review process. ILCOR traditionally published updates and recommendations every five years but now conducts continuous review work. ILCOR produces international recommendations which are then adopted by regional resuscitation committees which publish guidelines. Regional guidelines can have more medicolegal bearing than ILCOR recommendations. ILCOR is composed of the following regional organizations:
History
ILCOR
The International Liaison Committee on Resuscitation (ILCOR) was established 1992 to serve as a way for international resuscitation organizations to communicate and collaborate.
AHA Guidelines
The ACLS guidelines were first published in 1974 by the American Heart Association and were updated in 1980, 1986, 1992, 2000, 2005, 2010, 2015. In the 2020 update the guidelines were restructured to align with ILCOR recommendations. These changes include the transition since 2015 away from the previous 5-year update cycle to an online format that can be updated as indicated by continuous evidence review.
ERC Guidelines
The first version of the European Resuscitation Council (ERC) guidelines were developed in 1992. The 2000 ERC guidelines were developed in collaboration with ILCOR. 5-year updates were published from 2000 to 2015 and annual updates have been published since 2017.
See also
Cardiopulmonary resuscitation (CPR)
Cardioversion
Defibrillation
British Heart Foundation
Indian Heart Association
Pediatric Advanced Life Support
Resuscitation Council (UK)
References
External links
2015 Guidelines from European Resuscitation Council
2015 Guidelines from the AHA
2020 Guidelines from the AHA
American Heart Association
Cardiology
Medical emergencies
Emergency medical services
Emergency medicine courses
Emergency life support
de:Advanced Life Support | wiki |
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart. Although not fully understood, this process depolarizes a large amount of the heart muscle, ending the arrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm. A heart which is in asystole (flatline) cannot be restarted by a defibrillator, but would be treated by cardiopulmonary resuscitation (CPR).
In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle. Although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac arrhythmias, such as supraventricular tachycardia.
Defibrillators can be external, transvenous, or implanted (implantable cardioverter-defibrillator), depending on the type of device used or needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little or no training.
Use of defibrillators
Indications
Defibrillation is often an important step in cardiopulmonary resuscitation (CPR). CPR is an algorithm-based intervention aimed to restore cardiac and pulmonary function. Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia. If the heart has completely stopped, as in asystole or pulseless electrical activity (PEA), defibrillation is not indicated. Defibrillation is also not indicated if the patient is conscious or has a pulse. Improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular fibrillation.
Application method
The defibrillation device that is usually available out of the medical centers is the automated external defibrillator (AED), a portable machine that can be used even by users with no previous training. That is possible because the machine produces pre-recorded voice instructions that guide to the user, and automatically checks the patient's condition and applies the correct electric shocks. There also exist written instructions of defibrillators that explain the procedure step-by-step.
Outcomes
Survival rates for out-of-hospital cardiac arrests are poor, often less than 10%. Outcome for in-hospital cardiac arrests are higher at 20%. Within the group of people presenting with cardiac arrest, the specific cardiac rhythm can significantly impact survival rates. Compared to people presenting with a non-shockable rhythm (such as asystole or PEA), people with a shockable rhythm (such as VF or pulseless ventricular tachycardia) have improved survival rates, ranging between 21 and 50%.
Types
Manual models
Manual external defibrillators require the expertise of a healthcare professional. They are used in conjunction with an electrocardiogram, which can be separate or built-in. A healthcare provider first diagnoses the cardiac rhythm and then manually determine the voltage and timing for the electrical shock. These units are primarily found in hospitals and on some ambulances. For instance, every NHS ambulance in the United Kingdom is equipped with a manual defibrillator for use by the attending paramedics and technicians. In the United States, many advanced EMTs and all paramedics are trained to recognize lethal arrhythmias and deliver appropriate electrical therapy with a manual defibrillator when appropriate.
An internal defibrillator is often used to defibrillate the heart during or after cardiac surgery such as a heart bypass. The electrodes consist of round metal plates that come in direct contact with the myocardium. Manual internal defibrillators deliver the shock through paddles placed directly on the heart. They are mostly used in the operating room and, in rare circumstances, in the emergency room during an open heart procedure.
Automated external defibrillators
Automated external defibrillators (AEDs) are designed for use by untrained or briefly trained laypersons. AEDs contain technology for analysis of heart rhythms. As a result, it does not require a trained health provider to determine whether or not a rhythm is shockable. By making these units publicly available, AEDs have improved outcomes for sudden out-of-hospital cardiac arrests.
Trained health professionals have more limited use for AEDs than manual external defibrillators. Recent studies show that AEDs does not improve outcome in patients with in-hospital cardiac arrests. AEDs have set voltages and does not allow the operator to vary voltage according to need. AEDs may also delay delivery of effective CPR. For diagnosis of rhythm, AEDs often require the stopping of chest compressions and rescue breathing. For these reasons, certain bodies, such as the European Resuscitation Council, recommend using manual external defibrillators over AEDs if manual external defibrillators are readily available.
As early defibrillation can significantly improve VF outcomes, AEDs have become publicly available in many easily accessible areas. AEDs have been incorporated into the algorithm for basic life support (BLS). Many first responders, such as firefighters, policemen, and security guards, are equipped with them.
AEDs can be fully automatic or semi-automatic. A semi-automatic AED automatically diagnoses heart rhythms and determines if a shock is necessary. If a shock is advised, the user must then push a button to administer the shock. A fully automated AED automatically diagnoses the heart rhythm and advises the user to stand back while the shock is automatically given. Some types of AEDs come with advanced features, such as a manual override or an ECG display.
Cardioverter-defibrillators
Implantable cardioverter-defibrillators, also known as automatic internal cardiac defibrillator (AICD), are implants similar to pacemakers (and many can also perform the pacemaking function). They constantly monitor the patient's heart rhythm, and automatically administer shocks for various life-threatening arrhythmias, according to the device's programming. Many modern devices can distinguish between ventricular fibrillation, ventricular tachycardia, and more benign arrhythmias like supraventricular tachycardia and atrial fibrillation. Some devices may attempt overdrive pacing prior to synchronised cardioversion. When the life-threatening arrhythmia is ventricular fibrillation, the device is programmed to proceed immediately to an unsynchronized shock.
There are cases where the patient's ICD may fire constantly or inappropriately. This is considered a medical emergency, as it depletes the device's battery life, causes significant discomfort and anxiety to the patient, and in some cases may actually trigger life-threatening arrhythmias. Some emergency medical services personnel are now equipped with a ring magnet to place over the device, which effectively disables the shock function of the device while still allowing the pacemaker to function (if the device is so equipped). If the device is shocking frequently, but appropriately, EMS personnel may administer sedation.
A wearable cardioverter defibrillator is a portable external defibrillator that can be worn by at-risk patients. The unit monitors the patient 24 hours a day and can automatically deliver a biphasic shock if VF or VT is detected. This device is mainly indicated in patients who are not immediate candidates for ICDs.
Interface
The connection between the defibrillator and the patient consists of a pair of electrodes, each provided with electrically conductive gel in order to ensure a good connection and to minimize electrical resistance, also called chest impedance (despite the DC discharge) which would burn the patient. Gel may be either wet (similar in consistency to surgical lubricant) or solid (similar to gummi candy). Solid-gel is more convenient, because there is no need to clean the used gel off the person's skin after defibrillation. However, the use of solid-gel presents a higher risk of burns during defibrillation, since wet-gel electrodes more evenly conduct electricity into the body. Paddle electrodes, which were the first type developed, come without gel, and must have the gel applied in a separate step. Self-adhesive electrodes come prefitted with gel. There is a general division of opinion over which type of electrode is superior in hospital settings; the American Heart Association favors neither, and all modern manual defibrillators used in hospitals allow for swift switching between self-adhesive pads and traditional paddles. Each type of electrode has its merits and demerits.
Paddle electrodes
The most well-known type of electrode (widely depicted in films and television) is the traditional metal "hard" paddle with an insulated (usually plastic) handle. This type must be held in place on the patient's skin with approximately 25 lbs (11.3 kg) of force while a shock or a series of shocks is delivered. Paddles offer a few advantages over self-adhesive pads. Many hospitals in the United States continue the use of paddles, with disposable gel pads attached in most cases, due to the inherent speed with which these electrodes can be placed and used. This is critical during cardiac arrest, as each second of nonperfusion means tissue loss. Modern paddles allow for monitoring (electrocardiography), though in hospital situations, separate monitoring leads are often already in place.
Paddles are reusable, being cleaned after use and stored for the next patient. Gel is therefore not preapplied, and must be added before these paddles are used on the patient. Paddles are generally only found on manual external units.
Self-adhesive electrodes
Newer types of resuscitation electrodes are designed as an adhesive pad, which includes either solid or wet gel. These are peeled off their backing and applied to the patient's chest when deemed necessary, much the same as any other sticker. The electrodes are then connected to a defibrillator, much as the paddles would be. If defibrillation is required, the machine is charged, and the shock is delivered, without any need to apply any additional gel or to retrieve and place any paddles. Most adhesive electrodes are designed to be used not only for defibrillation, but also for transcutaneous pacing and synchronized electrical cardioversion. These adhesive pads are found on most automated and semi-automated units and are replacing paddles entirely in non-hospital settings. In hospital, for cases where cardiac arrest is likely to occur (but has not yet), self-adhesive pads may be placed prophylactically.
Pads also offer an advantage to the untrained user, and to medics working in the sub-optimal conditions of the field. Pads do not require extra leads to be attached for monitoring, and they do not require any force to be applied as the shock is delivered. Thus, adhesive electrodes minimize the risk of the operator coming into physical (and thus electrical) contact with the patient as the shock is delivered by allowing the operator to be up to several feet away. (The risk of electrical shock to others remains unchanged, as does that of shock due to operator misuse.) Self-adhesive electrodes are single-use only. They may be used for multiple shocks in a single course of treatment, but are replaced if (or in case) the patient recovers then reenters cardiac arrest.
Special pads are used for children under the age of 8 or those under 55 lbs. (22 kg).
Placement
Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior scheme is the preferred scheme for long-term electrode placement. One electrode is placed over the left precordium (the lower part of the chest, in front of the heart). The other electrode is placed on the back, behind the heart in the region between the scapula. This placement is preferred because it is best for non-invasive pacing.
The anterior-apex scheme (anterior-lateral position) can be used when the anterior-posterior scheme is inconvenient or unnecessary. In this scheme, the anterior electrode is placed on the right, below the clavicle. The apex electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle. This scheme works well for defibrillation and cardioversion, as well as for monitoring an ECG.
Researchers have created a software modeling system capable of mapping an individual's chest and determining the best position for an external or internal cardiac defibrillator.
Mechanism
The exact mechanism of defibrillation is not well understood. One theory is that successful defibrillation affects most of the heart, resulting in insufficient remaining heart muscle to continue the arrhythmia. Recent mathematical models of defibrillation are providing new insight into how cardiac tissue responds to a strong electrical shock.
History
Defibrillators were first demonstrated in 1899 by Jean-Louis Prévost and Frédéric Batelli, two physiologists from the University of Geneva, Switzerland. They discovered that small electrical shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the condition.
In 1933, Dr. Albert Hyman, heart specialist at the Beth Davis Hospital of New York City and C. Henry Hyman, an electrical engineer, looking for an alternative to injecting powerful drugs directly into the heart, came up with an invention that used an electrical shock in place of drug injection. This invention was called the Hyman Otor where a hollow needle is used to pass an insulated wire to the heart area to deliver the electrical shock. The hollow steel needle acted as one end of the circuit and the tip of the insulated wire the other end. Whether the Hyman Otor was a success is unknown.
The external defibrillator, as it is known today, was invented by electrical engineer William Kouwenhoven in 1930. Kouwenhoven studied the relationship between electric shocks and their effects on the human heart when he was a student at Johns Hopkins University School of Engineering. His studies helped him invent a device to externally jump start the heart. He invented the defibrillator and tested it on a dog, like Prévost and Batelli. The first use on a human was in 1947 by Claude Beck, professor of surgery at Case Western Reserve University. Beck's theory was that ventricular fibrillation often occurred in hearts that were fundamentally healthy, in his terms "Hearts that are too good to die", and that there must be a way of saving them. Beck first used the technique successfully on a 14-year-old boy who was having his breastbone separated from his ribs because of a congenital growth disorder, causing breathing problems. The boy's chest was surgically opened, and manual cardiac massage was undertaken for 45 minutes until the arrival of the defibrillator. Beck used internal paddles on either side of the heart, along with procainamide, an antiarrhythmic drug, and achieved return of a perfusing cardiac rhythm.
These early defibrillators used the alternating current from a power socket, transformed from the 110–240 volts available in the line, up to between 300 and 1000 volts, to the exposed heart by way of "paddle" type electrodes. The technique was often ineffective in reverting VF while morphological studies showed damage to the cells of the heart muscle post-mortem. The nature of the AC machine with a large transformer also made these units very hard to transport, and they tended to be large units on wheels.
Closed-chest method
Until the early 1950s, defibrillation of the heart was possible only when the chest cavity was open during surgery. The technique used an alternating voltage from a 300 or greater volt source derived from standard AC power, delivered to the sides of the exposed heart by "paddle" electrodes where each electrode was a flat or slightly concave metal plate of about 40 mm diameter. The closed-chest defibrillator device which applied an alternating voltage of greater than 1000 volts, conducted by means of externally applied electrodes through the chest cage to the heart, was pioneered by Dr V. Eskin with assistance by A. Klimov in Frunze, USSR (today known as Bishkek, Kyrgyzstan) in the mid-1950s. The duration of AC shocks was typically in the range of 100–150 milliseconds.
Direct current method
Early successful experiments of successful defibrillation by the discharge of a capacitor performed on animals were reported by N. L. Gurvich and G. S. Yunyev in 1939. In 1947 their works were reported in western medical journals. Serial production of Gurvich's pulse defibrillator started in 1952 at the electromechanical plant of the institute, and was designated model ИД-1-ВЭИ (Импульсный Дефибриллятор 1, Всесоюзный Электротехнический Институт, or in English, Pulse Defibrillator 1, All-Union Electrotechnical Institute). It is described in detail in Gurvich's 1957 book, Heart Fibrillation and Defibrillation.
The first Czechoslovak "universal defibrillator Prema" was manufactured in 1957 by the company Prema, designed by Dr. Bohumil Peleška. In 1958 his device was awarded Grand Prix at Expo 58.
In 1958, US senator Hubert H. Humphrey visited Nikita Khrushchev and among other things he visited the Moscow Institute of Reanimatology, where, among others, he met with Gurvich. Humphrey immediately recognized importance of reanimation research and after that a number of American doctors visited Gurvich. At the same time, Humphrey worked on establishing a federal program in the National Institute of Health in physiology and medicine, telling Congress: "Let's compete with U.S.S.R. in research on reversibility of death".
In 1959 Bernard Lown commenced research in his animal laboratory in collaboration with engineer Barouh Berkovits into a technique which involved charging of a bank of capacitors to approximately 1000 volts with an energy content of 100–200 joules then delivering the charge through an inductance such as to produce a heavily damped sinusoidal wave of finite duration (~5 milliseconds) to the heart by way of paddle electrodes. This team further developed an understanding of the optimal timing of shock delivery in the cardiac cycle, enabling the application of the device to arrhythmias such as atrial fibrillation, atrial flutter, and supraventricular tachycardias in the technique known as "cardioversion".
The Lown-Berkovits waveform, as it was known, was the standard for defibrillation until the late 1980s. Earlier in the 1980s, the "MU lab" at the University of Missouri had pioneered numerous studies introducing a new waveform called a biphasic truncated waveform (BTE). In this waveform an exponentially decaying DC voltage is reversed in polarity about halfway through the shock time, then continues to decay for some time after which the voltage is cut off, or truncated. The studies showed that the biphasic truncated waveform could be more efficacious while requiring the delivery of lower levels of energy to produce defibrillation. An added benefit was a significant reduction in weight of the machine. The BTE waveform, combined with automatic measurement of transthoracic impedance, is the basis for modern defibrillators.
Portable units
A major breakthrough was the introduction of portable defibrillators used out of the hospital. Already Peleška's Prema defibrillator was designed to be more portable than original Gurvich's model. In Soviet Union, a portable version of Gurvich's defibrillator, model ДПА-3 (DPA-3), was reported in 1959. In the west this was pioneered in the early 1960s by Prof. Frank Pantridge in Belfast. Today portable defibrillators are among the many very important tools carried by ambulances. They are the only proven way to resuscitate a person who has had a cardiac arrest unwitnessed by Emergency Medical Services (EMS) who is still in persistent ventricular fibrillation or ventricular tachycardia at the arrival of pre-hospital providers.
Gradual improvements in the design of defibrillators, partly based on the work developing implanted versions (see below), have led to the availability of Automated External Defibrillators. These devices can analyse the heart rhythm by themselves, diagnose the shockable rhythms, and charge to treat. This means that no clinical skill is required in their use, allowing lay people to respond to emergencies effectively.
Waveform change
Until the mid 90s, external defibrillators delivered a Lown type waveform (see Bernard Lown) which was a heavily damped sinusoidal impulse having a mainly uniphasic characteristic. Biphasic defibrillation alternates the direction of the pulses, completing one cycle in approximately 12 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation, decreasing the risk of burns and myocardial damage.
Ventricular fibrillation (VF) could be returned to normal sinus rhythm in 60% of cardiac arrest patients treated with a single shock from a monophasic defibrillator. Most biphasic defibrillators have a first shock success rate of greater than 90%.
Implantable devices
A further development in defibrillation came with the invention of the implantable device, known as an implantable cardioverter-defibrillator (or ICD). This was pioneered at Sinai Hospital in Baltimore by a team that included Stephen Heilman, Alois Langer, Jack Lattuca, Morton Mower, Michel Mirowski, and Mir Imran, with the help of industrial collaborator Intec Systems of Pittsburgh. Mirowski teamed up with Mower and Staewen, and together they commenced their research in 1969. However, it was 11 years before they treated their first patient. Similar developmental work was carried out by Schuder and colleagues at the University of Missouri.
The work was commenced, despite doubts amongst leading experts in the field of arrhythmias and sudden death. There was doubt that their ideas would ever become a clinical reality. In 1962 Bernard Lown introduced the external DC defibrillator. This device applied a direct current from a discharging capacitor through the chest wall into the heart to stop heart fibrillation. In 1972, Lown stated in the journal Circulation — "The very rare patient who has frequent bouts of ventricular fibrillation is best treated in a coronary care unit and is better served by an effective antiarrhythmic program or surgical correction of inadequate coronary blood flow or ventricular malfunction. In fact, the implanted defibrillator system represents an imperfect solution in search of a plausible and practical application."
The problems to be overcome were the design of a system which would allow detection of ventricular fibrillation or ventricular tachycardia. Despite the lack of financial backing and grants, they persisted and the first device was implanted in February 1980 at Johns Hopkins Hospital by Dr. Levi Watkins Jr. assisted by Vivien Thomas. Modern ICDs do not require a thoracotomy and possess pacing, cardioversion, and defibrillation capabilities.
The invention of implantable units is invaluable to some people with regular heart problems, although they are generally only given to those people who have already had a cardiac episode.
People can live long normal lives with the devices. Many patients have multiple implants. A patient in Houston, Texas had an implant at the age of 18 in 1994 by the recent Dr. Antonio Pacifico. He was awarded "Youngest Patient with Defibrillator" in 1996. Today these devices are implanted into small babies shortly after birth.
Society and culture
As devices that can quickly produce dramatic improvements in patient health, defibrillators are often depicted in movies, television, video games and other fictional media. Their function, however, is often exaggerated with the defibrillator inducing a sudden, violent jerk or convulsion by the patient. The pad placement is also shown wrong, along with sudden rising of patient to large height when shock is given. In reality, while the muscles may contract, such dramatic patient presentation is rare. Similarly, medical providers are often depicted defibrillating patients with a "flat-line" ECG rhythm (also known as asystole). This is not normal medical practice, as the heart cannot be restarted by the defibrillator itself. Only the cardiac arrest rhythms ventricular fibrillation and pulseless ventricular tachycardia are normally defibrillated. The purpose of defibrillation is to depolarize the entire heart all at once so that it is synchronized, effectively inducing temporary asystole, in the hope that in the absence of the previous abnormal electrical activity, the heart will spontaneously resume beating normally. Someone who is already in asystole cannot be helped by electrical means, and usually needs urgent CPR and intravenous medication (and even these are rarely successful in cases of asystole). A useful analogy to remember is to think of defibrillators as power-cycling, rather than jump-starting, the heart. There are also several heart rhythms that can be "shocked" when the patient is not in cardiac arrest, such as supraventricular tachycardia and ventricular tachycardia that produces a pulse; this more-complicated procedure is known as cardioversion, not defibrillation.
In Australia up until the 1990s it was relatively rare for ambulances to carry defibrillators. This changed in 1990 after Australian media mogul Kerry Packer had a cardiac arrest due to a heart attack and, purely by chance, the ambulance that responded to the call carried a defibrillator. After recovering, Kerry Packer donated a large sum to the Ambulance Service of New South Wales in order that all ambulances in New South Wales should be fitted with a personal defibrillator, which is why defibrillators in Australia are sometimes colloquially called "Packer Whackers".
See also
Advanced cardiac life support
Automated external defibrillator
Ambulance
Cardioversion
Myocardial infarction
Wearable cardioverter defibrillator
Citations
General and cited references
External links
Sudden Cardiac Arrest Foundation
Center for Integration of Medicine and Innovative Technology
American Red Cross: Saving a Life is as Easy as A-E-D
FDA Heart Health Online: Automated External Defibrillator (AED)
American inventions
Cardiac electrophysiology
Emergency medical procedures
Medical devices | wiki |
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.
The most widely used route is orotracheal, in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. Other methods of intubation involve surgery and include the cricothyrotomy (used almost exclusively in emergency circumstances) and the tracheotomy, used primarily in situations where a prolonged need for airway support is anticipated.
Because it is an invasive and uncomfortable medical procedure, intubation is usually performed after administration of general anesthesia and a neuromuscular-blocking drug. It can, however, be performed in the awake patient with local or topical anesthesia or in an emergency without any anesthesia at all. Intubation is normally facilitated by using a conventional laryngoscope, flexible fiberoptic bronchoscope, or video laryngoscope to identify the vocal cords and pass the tube between them into the trachea instead of into the esophagus. Other devices and techniques may be used alternatively.
After the trachea has been intubated, a balloon cuff is typically inflated just above the far end of the tube to help secure it in place, to prevent leakage of respiratory gases, and to protect the tracheobronchial tree from receiving undesirable material such as stomach acid. The tube is then secured to the face or neck and connected to a T-piece, anesthesia breathing circuit, bag valve mask device, or a mechanical ventilator. Once there is no longer a need for ventilatory assistance or protection of the airway, the tracheal tube is removed; this is referred to as extubation of the trachea (or decannulation, in the case of a surgical airway such as a cricothyrotomy or a tracheotomy).
For centuries, tracheotomy was considered the only reliable method for intubation of the trachea. However, because only a minority of patients survived the operation, physicians undertook tracheotomy only as a last resort, on patients who were nearly dead. It was not until the late 19th century, however, that advances in understanding of anatomy and physiology, as well an appreciation of the germ theory of disease, had improved the outcome of this operation to the point that it could be considered an acceptable treatment option. Also at that time, advances in endoscopic instrumentation had improved to such a degree that direct laryngoscopy had become a viable means to secure the airway by the non-surgical orotracheal route. By the mid-20th century, the tracheotomy as well as endoscopy and non-surgical tracheal intubation had evolved from rarely employed procedures to becoming essential components of the practices of anesthesiology, critical care medicine, emergency medicine, and laryngology.
Tracheal intubation can be associated with complications such as broken teeth or lacerations of the tissues of the upper airway. It can also be associated with potentially fatal complications such as pulmonary aspiration of stomach contents which can result in a severe and sometimes fatal chemical aspiration pneumonitis, or unrecognized intubation of the esophagus which can lead to potentially fatal anoxia. Because of this, the potential for difficulty or complications due to the presence of unusual airway anatomy or other uncontrolled variables is carefully evaluated before undertaking tracheal intubation. Alternative strategies for securing the airway must always be readily available.
Indications
Tracheal intubation is indicated in a variety of situations when illness or a medical procedure prevents a person from maintaining a clear airway, breathing, and oxygenating the blood. In these circumstances, oxygen supplementation using a simple face mask is inadequate.
Depressed level of consciousness
Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which nitrous oxide or volatile anesthetics may be administered. General anesthetic agents, opioids, and neuromuscular-blocking drugs may diminish or even abolish the respiratory drive. Although it is not the only means to maintain a patent airway during general anesthesia, intubation of the trachea provides the most reliable means of oxygenation and ventilation and the greatest degree of protection against regurgitation and pulmonary aspiration.
Damage to the brain (such as from a massive stroke, non-penetrating head injury, intoxication or poisoning) may result in a depressed level of consciousness. When this becomes severe to the point of stupor or coma (defined as a score on the Glasgow Coma Scale of less than 8), dynamic collapse of the extrinsic muscles of the airway can obstruct the airway, impeding the free flow of air into the lungs. Furthermore, protective airway reflexes such as coughing and swallowing may be diminished or absent. Tracheal intubation is often required to restore patency (the relative absence of blockage) of the airway and protect the tracheobronchial tree from pulmonary aspiration of gastric contents.
Hypoxemia
Intubation may be necessary for a patient with decreased oxygen content and oxygen saturation of the blood caused when their breathing is inadequate (hypoventilation), suspended (apnea), or when the lungs are unable to sufficiently transfer gasses to the blood. Such patients, who may be awake and alert, are typically critically ill with a multisystem disease or multiple severe injuries. Examples of such conditions include cervical spine injury, multiple rib fractures, severe pneumonia, acute respiratory distress syndrome (ARDS), or near-drowning. Specifically, intubation is considered if the arterial partial pressure of oxygen (PaO2) is less than 60 millimeters of mercury (mm Hg) while breathing an inspired O2 concentration (FIO2) of 50% or greater. In patients with elevated arterial carbon dioxide, an arterial partial pressure of CO2 (PaCO2) greater than 45 mm Hg in the setting of acidemia would prompt intubation, especially if a series of measurements demonstrate a worsening respiratory acidosis. Regardless of the laboratory values, these guidelines are always interpreted in the clinical context.
Airway obstruction
Actual or impending airway obstruction is a common indication for intubation of the trachea. Life-threatening airway obstruction may occur when a foreign body becomes lodged in the airway; this is especially common in infants and toddlers. Severe blunt or penetrating injury to the face or neck may be accompanied by swelling and an expanding hematoma, or injury to the larynx, trachea or bronchi. Airway obstruction is also common in people who have suffered smoke inhalation or burns within or near the airway or epiglottitis. Sustained generalized seizure activity and angioedema are other common causes of life-threatening airway obstruction which may require tracheal intubation to secure the airway.
Manipulation of the airway
Diagnostic or therapeutic manipulation of the airway (such as bronchoscopy, laser therapy or stenting of the bronchi) may intermittently interfere with the ability to breathe; intubation may be necessary in such situations.
Newborns
Syndromes such as respiratory distress syndrome, congenital heart disease, pneumothorax, and shock may lead to breathing problems in newborn infants that require endotracheal intubation and mechanically assisted breathing (mechanical ventilation). Newborn infants may also require endotracheal intubation during surgery while under general anaesthesia.
Equipment
Laryngoscopes
The vast majority of tracheal intubations involve the use of a viewing instrument of one type or another. The modern conventional laryngoscope consists of a handle containing batteries that power a light and a set of interchangeable blades, which are either straight or curved. This device is designed to allow the laryngoscopist to directly view the larynx. Due to the widespread availability of such devices, the technique of blind intubation of the trachea is rarely practiced today, although it may still be useful in certain emergency situations, such as natural or man-made disasters. In the prehospital emergency setting, digital intubation may be necessitated if the patient is in a position that makes direct laryngoscopy impossible. For example, digital intubation may be used by a paramedic if the patient is entrapped in an inverted position in a vehicle after a motor vehicle collision with a prolonged extrication time.
The decision to use a straight or curved laryngoscope blade depends partly on the specific anatomical features of the airway, and partly on the personal experience and preference of the laryngoscopist. The Macintosh blade is the most widely used curved laryngoscope blade, while the Miller blade is the most popular style of straight blade. Both Miller and Macintosh laryngoscope blades are available in sizes 0 (infant) through 4 (large adult). There are many other styles of straight and curved blades, with accessories such as mirrors for enlarging the field of view and even ports for the administration of oxygen. These specialty blades are primarily designed for use by anesthetists and otolaryngologists, most commonly in the operating room.
Fiberoptic laryngoscopes have become increasingly available since the 1990s. In contrast to the conventional laryngoscope, these devices allow the laryngoscopist to indirectly view the larynx. This provides a significant advantage in situations where the operator needs to see around an acute bend in order to visualize the glottis, and deal with otherwise difficult intubations. Video laryngoscopes are specialized fiberoptic laryngoscopes that use a digital video camera sensor to allow the operator to view the glottis and larynx on a video monitor. Other "noninvasive" devices which can be employed to assist in tracheal intubation are the laryngeal mask airway (used as a conduit for endotracheal tube placement) and the Airtraq.
Stylets
An intubating stylet is a malleable metal wire designed to be inserted into the endotracheal tube to make the tube conform better to the upper airway anatomy of the specific individual. This aid is commonly used with a difficult laryngoscopy. Just as with laryngoscope blades, there are also several types of available stylets, such as the Verathon Stylet, which is specifically designed to follow the 60° blade angle of the GlideScope video laryngoscope.
The Eschmann tracheal tube introducer (also referred to as a "gum elastic bougie") is specialized type of stylet used to facilitate difficult intubation. This flexible device is in length, 15 French (5 mm diameter) with a small "hockey-stick" angle at the far end. Unlike a traditional intubating stylet, the Eschmann tracheal tube introducer is typically inserted directly into the trachea and then used as a guide over which the endotracheal tube can be passed (in a manner analogous to the Seldinger technique). As the Eschmann tracheal tube introducer is considerably less rigid than a conventional stylet, this technique is considered to be a relatively atraumatic means of tracheal intubation.
The tracheal tube exchanger is a hollow catheter, in length, that can be used for removal and replacement of tracheal tubes without the need for laryngoscopy. The Cook Airway Exchange Catheter (CAEC) is another example of this type of catheter; this device has a central lumen (hollow channel) through which oxygen can be administered. Airway exchange catheters are long hollow catheters which often have connectors for jet ventilation, manual ventilation, or oxygen insufflation. It is also possible to connect the catheter to a capnograph to perform respiratory monitoring.
The lighted stylet is a device that employs the principle of transillumination to facilitate blind orotracheal intubation (an intubation technique in which the laryngoscopist does not view the glottis).
Tracheal tubes
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent (open and unobstructed) airway. Tracheal tubes are frequently used for airway management in the settings of general anesthesia, critical care, mechanical ventilation, and emergency medicine. Many different types of tracheal tubes are available, suited for different specific applications. An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal). It is a breathing conduit designed to be placed into the airway of critically injured, ill or anesthetized patients in order to perform mechanical positive pressure ventilation of the lungs and to prevent the possibility of aspiration or airway obstruction. The endotracheal tube has a fitting designed to be connected to a source of pressurized gas such as oxygen. At the other end is an orifice through which such gases are directed into the lungs and may also include a balloon (referred to as a cuff). The tip of the endotracheal tube is positioned above the carina (before the trachea divides to each lung) and sealed within the trachea so that the lungs can be ventilated equally. A tracheostomy tube is another type of tracheal tube; this curved metal or plastic tube is inserted into a tracheostomy stoma or a cricothyrotomy incision.
Tracheal tubes can be used to ensure the adequate exchange of oxygen and carbon dioxide, to deliver oxygen in higher concentrations than found in air, or to administer other gases such as helium, nitric oxide, nitrous oxide, xenon, or certain volatile anesthetic agents such as desflurane, isoflurane, or sevoflurane. They may also be used as a route for administration of certain medications such as bronchodilators, inhaled corticosteroids, and drugs used in treating cardiac arrest such as atropine, epinephrine, lidocaine and vasopressin.
Originally made from latex rubber, most modern endotracheal tubes today are constructed of polyvinyl chloride. Tubes constructed of silicone rubber, wire-reinforced silicone rubber or stainless steel are also available for special applications. For human use, tubes range in size from in internal diameter. The size is chosen based on the patient's body size, with the smaller sizes being used for infants and children. Most endotracheal tubes have an inflatable cuff to seal the tracheobronchial tree against leakage of respiratory gases and pulmonary aspiration of gastric contents, blood, secretions, and other fluids. Uncuffed tubes are also available, though their use is limited mostly to children (in small children, the cricoid cartilage is the narrowest portion of the airway and usually provides an adequate seal for mechanical ventilation).
In addition to cuffed or uncuffed, preformed endotracheal tubes are also available. The oral and nasal RAE tubes (named after the inventors Ring, Adair and Elwyn) are the most widely used of the preformed tubes.
There are a number of different types of double-lumen endo-bronchial tubes that have endobronchial as well as endotracheal channels (Carlens, White and Robertshaw tubes). These tubes are typically coaxial, with two separate channels and two separate openings. They incorporate an endotracheal lumen which terminates in the trachea and an endobronchial lumen, the distal tip of which is positioned 1–2 cm into the right or left mainstem bronchus. There is also the Univent tube, which has a single tracheal lumen and an integrated endobronchial blocker. These tubes enable one to ventilate both lungs, or either lung independently. Single-lung ventilation (allowing the lung on the operative side to collapse) can be useful during thoracic surgery, as it can facilitate the surgeon's view and access to other relevant structures within the thoracic cavity.
The "armored" endotracheal tubes are cuffed, wire-reinforced silicone rubber tubes. They are much more flexible than polyvinyl chloride tubes, yet they are difficult to compress or kink. This can make them useful for situations in which the trachea is anticipated to remain intubated for a prolonged duration, or if the neck is to remain flexed during surgery. Most armored tubes have a Magill curve, but preformed armored RAE tubes are also available. Another type of endotracheal tube has four small openings just above the inflatable cuff, which can be used for suction of the trachea or administration of intratracheal medications if necessary. Other tubes (such as the Bivona Fome-Cuf tube) are designed specifically for use in laser surgery in and around the airway.
Methods to confirm tube placement
No single method for confirming tracheal tube placement has been shown to be 100% reliable. Accordingly, the use of multiple methods for confirmation of correct tube placement is now widely considered to be the standard of care. Such methods include direct visualization as the tip of the tube passes through the glottis, or indirect visualization of the tracheal tube within the trachea using a device such as a bronchoscope. With a properly positioned tracheal tube, equal bilateral breath sounds will be heard upon listening to the chest with a stethoscope, and no sound upon listening to the area over the stomach. Equal bilateral rise and fall of the chest wall will be evident with ventilatory excursions. A small amount of water vapor will also be evident within the lumen of the tube with each exhalation and there will be no gastric contents in the tracheal tube at any time.
Ideally, at least one of the methods utilized for confirming tracheal tube placement will be a measuring instrument. Waveform capnography has emerged as the gold standard for the confirmation of tube placement within the trachea. Other methods relying on instruments include the use of a colorimetric end-tidal carbon dioxide detector, a self-inflating esophageal bulb, or an esophageal detection device. The distal tip of a properly positioned tracheal tube will be located in the mid-trachea, roughly above the bifurcation of the carina; this can be confirmed by chest x-ray. If it is inserted too far into the trachea (beyond the carina), the tip of the tracheal tube is likely to be within the right main bronchus—a situation often referred to as a "right mainstem intubation". In this situation, the left lung may be unable to participate in ventilation, which can lead to decreased oxygen content due to ventilation/perfusion mismatch.
Special situations
Emergencies
Tracheal intubation in the emergency setting can be difficult with the fiberoptic bronchoscope due to blood, vomit, or secretions in the airway and poor patient cooperation. Because of this, patients with massive facial injury, complete upper airway obstruction, severely diminished ventilation, or profuse upper airway bleeding are poor candidates for fiberoptic intubation. Fiberoptic intubation under general anesthesia typically requires two skilled individuals. Success rates of only 83–87% have been reported using fiberoptic techniques in the emergency department, with significant nasal bleeding occurring in up to 22% of patients. These drawbacks limit the use of fiberoptic bronchoscopy somewhat in urgent and emergency situations.
Personnel experienced in direct laryngoscopy are not always immediately available in certain settings that require emergency tracheal intubation. For this reason, specialized devices have been designed to act as bridges to a definitive airway. Such devices include the laryngeal mask airway, cuffed oropharyngeal airway and the esophageal-tracheal combitube (Combitube). Other devices such as rigid stylets, the lightwand (a blind technique) and indirect fiberoptic rigid stylets, such as the Bullard scope, Upsher scope and the WuScope can also be used as alternatives to direct laryngoscopy. Each of these devices have its own unique set of benefits and drawbacks, and none of them is effective under all circumstances.
Rapid-sequence induction and intubation
Rapid sequence induction and intubation (RSI) is a particular method of induction of general anesthesia, commonly employed in emergency operations and other situations where patients are assumed to have a full stomach. The objective of RSI is to minimize the possibility of regurgitation and pulmonary aspiration of gastric contents during the induction of general anesthesia and subsequent tracheal intubation. RSI traditionally involves preoxygenating the lungs with a tightly fitting oxygen mask, followed by the sequential administration of an intravenous sleep-inducing agent and a rapidly acting neuromuscular-blocking drug, such as rocuronium, succinylcholine, or cisatracurium besilate, before intubation of the trachea.
One important difference between RSI and routine tracheal intubation is that the practitioner does not manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing, until the trachea has been intubated and the cuff has been inflated. Another key feature of RSI is the application of manual 'cricoid pressure' to the cricoid cartilage, often referred to as the "Sellick maneuver", prior to instrumentation of the airway and intubation of the trachea.
Named for British anesthetist Brian Arthur Sellick (1918–1996) who first described the procedure in 1961, the goal of cricoid pressure is to minimize the possibility of regurgitation and pulmonary aspiration of gastric contents. Cricoid pressure has been widely used during RSI for nearly fifty years, despite a lack of compelling evidence to support this practice. The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning and barbiturate anesthesia were the rule. Beginning around 2000, a significant body of evidence has accumulated which questions the effectiveness of cricoid pressure. The application of cricoid pressure may in fact displace the esophagus laterally instead of compressing it as described by Sellick. Cricoid pressure may also compress the glottis, which can obstruct the view of the laryngoscopist and actually cause a delay in securing the airway.
Cricoid pressure is often confused with the "BURP" (Backwards Upwards Rightwards Pressure) maneuver. While both of these involve digital pressure to the anterior aspect (front) of the laryngeal apparatus, the purpose of the latter is to improve the view of the glottis during laryngoscopy and tracheal intubation, rather than to prevent regurgitation. Both cricoid pressure and the BURP maneuver have the potential to worsen laryngoscopy.
RSI may also be used in prehospital emergency situations when a patient is conscious but respiratory failure is imminent (such as in extreme trauma). This procedure is commonly performed by flight paramedics. Flight paramedics often use RSI to intubate before transport because intubation in a moving fixed-wing or rotary-wing aircraft is extremely difficult to perform due to environmental factors. The patient will be paralyzed and intubated on the ground before transport by aircraft.
Cricothyrotomy
A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma. A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.
The easiest method to perform this technique is the needle cricothyrotomy (also referred to as a percutaneous dilational cricothyrotomy), in which a large-bore (12–14 gauge) intravenous catheter is used to puncture the cricothyroid membrane. Oxygen can then be administered through this catheter via jet insufflation. However, while needle cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established. While needle cricothyrotomy can provide adequate oxygenation, the small diameter of the cricothyrotomy catheter is insufficient for elimination of carbon dioxide (ventilation). After one hour of apneic oxygenation through a needle cricothyrotomy, one can expect a PaCO2 of greater than 250 mm Hg and an arterial pH of less than 6.72, despite an oxygen saturation of 98% or greater. A more definitive airway can be established by performing a surgical cricothyrotomy, in which a endotracheal tube or tracheostomy tube can be inserted through a larger incision.
Several manufacturers market prepackaged cricothyrotomy kits, which enable one to use either a wire-guided percutaneous dilational (Seldinger) technique, or the classic surgical technique to insert a polyvinylchloride catheter through the cricothyroid membrane. The kits may be stocked in hospital emergency departments and operating suites, as well as ambulances and other selected pre-hospital settings.
Tracheotomy
Tracheotomy consists of making an incision on the front of the neck and opening a direct airway through an incision in the trachea. The resulting opening can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person to breathe without the use of his nose or mouth. The opening may be made by a scalpel or a needle (referred to as surgical and percutaneous techniques respectively) and both techniques are widely used in current practice. In order to limit the risk of damage to the recurrent laryngeal nerves (the nerves that control the voice box), the tracheotomy is performed as high in the trachea as possible. If only one of these nerves is damaged, the patient's voice may be impaired (dysphonia); if both of the nerves are damaged, the patient will be unable to speak (aphonia). In the acute setting, indications for tracheotomy are similar to those for cricothyrotomy. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and removal of tracheal secretions (e.g., comatose patients, or extensive surgery involving the head and neck).
Children
There are significant differences in airway anatomy and respiratory physiology between children and adults, and these are taken into careful consideration before performing tracheal intubation of any pediatric patient. The differences, which are quite significant in infants, gradually disappear as the human body approaches a mature age and body mass index.
For infants and young children, orotracheal intubation is easier than the nasotracheal route. Nasotracheal intubation carries a risk of dislodgement of adenoids and nasal bleeding. Despite the greater difficulty, nasotracheal intubation route is preferable to orotracheal intubation in children undergoing intensive care and requiring prolonged intubation because this route allows a more secure fixation of the tube. As with adults, there are a number of devices specially designed for assistance with difficult tracheal intubation in children. Confirmation of proper position of the tracheal tube is accomplished as with adult patients.
Because the airway of a child is narrow, a small amount of glottic or tracheal swelling can produce critical obstruction. Inserting a tube that is too large relative to the diameter of the trachea can cause swelling. Conversely, inserting a tube that is too small can result in inability to achieve effective positive pressure ventilation due to retrograde escape of gas through the glottis and out the mouth and nose (often referred to as a "leak" around the tube). An excessive leak can usually be corrected by inserting a larger tube or a cuffed tube.
The tip of a correctly positioned tracheal tube will be in the mid-trachea, between the collarbones on an anteroposterior chest radiograph. The correct diameter of the tube is that which results in a small leak at a pressure of about of water. The appropriate inner diameter for the endotracheal tube is estimated to be roughly the same diameter as the child's little finger. The appropriate length for the endotracheal tube can be estimated by doubling the distance from the corner of the child's mouth to the ear canal. For premature infants internal diameter is an appropriate size for the tracheal tube. For infants of normal gestational age, internal diameter is an appropriate size. For normally nourished children 1 year of age and older, two formulae are used to estimate the appropriate diameter and depth for tracheal intubation. The internal diameter of the tube in mm is (patient's age in years + 16) / 4, while the appropriate depth of insertion in cm is 12 + (patient's age in years / 2).
Newborn infants
Endotrachael suctioning is often used during intubation in newborn infants to reduce the risk of a blocked tube due to secretions, a collapsed lung, and to reduce pain. Suctioning is sometimes used at specifically scheduled intervals, "as needed", and less frequently. Further research is necessary to determine the most effective suctioning schedule or frequency of suctioning in intubated infants.
In newborns free flow oxygen used to be recommended during intubation however as there is no evidence of benefit the 2011 NRP guidelines no longer do.
Predicting difficulty
Tracheal intubation is not a simple procedure and the consequences of failure are grave. Therefore, the patient is carefully evaluated for potential difficulty or complications beforehand. This involves taking the medical history of the patient and performing a physical examination, the results of which can be scored against one of several classification systems. The proposed surgical procedure (e.g., surgery involving the head and neck, or bariatric surgery) may lead one to anticipate difficulties with intubation. Many individuals have unusual airway anatomy, such as those who have limited movement of their neck or jaw, or those who have tumors, deep swelling due to injury or to allergy, developmental abnormalities of the jaw, or excess fatty tissue of the face and neck. Using conventional laryngoscopic techniques, intubation of the trachea can be difficult or even impossible in such patients. This is why all persons performing tracheal intubation must be familiar with alternative techniques of securing the airway. Use of the flexible fiberoptic bronchoscope and similar devices has become among the preferred techniques in the management of such cases. However, these devices require a different skill set than that employed for conventional laryngoscopy and are expensive to purchase, maintain and repair.
When taking the patient's medical history, the subject is questioned about any significant signs or symptoms, such as difficulty in speaking or difficulty in breathing. These may suggest obstructing lesions in various locations within the upper airway, larynx, or tracheobronchial tree. A history of previous surgery (e.g., previous cervical fusion), injury, radiation therapy, or tumors involving the head, neck and upper chest can also provide clues to a potentially difficult intubation. Previous experiences with tracheal intubation, especially difficult intubation, intubation for prolonged duration (e.g., intensive care unit) or prior tracheotomy are also noted.
A detailed physical examination of the airway is important, particularly:
the range of motion of the cervical spine: the subject should be able to tilt the head back and then forward so that the chin touches the chest.
the range of motion of the jaw (the temporomandibular joint): three of the subject's fingers should be able to fit between the upper and lower incisors.
the size and shape of the upper jaw and lower jaw, looking especially for problems such as maxillary hypoplasia (an underdeveloped upper jaw), micrognathia (an abnormally small jaw), or retrognathia (misalignment of the upper and lower jaw).
the thyromental distance: three of the subject's fingers should be able to fit between the Adam's apple and the chin.
the size and shape of the tongue and palate relative to the size of the mouth.
the teeth, especially noting the presence of prominent maxillary incisors, any loose or damaged teeth, or crowns.
Many classification systems have been developed in an effort to predict difficulty of tracheal intubation, including the Cormack-Lehane classification system, the Intubation Difficulty Scale (IDS), and the Mallampati score. The Mallampati score is drawn from the observation that the size of the base of the tongue influences the difficulty of intubation. It is determined by looking at the anatomy of the mouth, and in particular the visibility of the base of palatine uvula, faucial pillars and the soft palate. Although such medical scoring systems may aid in the evaluation of patients, no single score or combination of scores can be trusted to specifically detect all and only those patients who are difficult to intubate. Furthermore, one study of experienced anesthesiologists, on the widely used Cormack–Lehane classification system, found they did not score the same patients consistently over time, and that only 25% could correctly define all four grades of the widely used Cormack–Lehane classification system. Under certain emergency circumstances (e.g., severe head trauma or suspected cervical spine injury), it may be impossible to fully utilize these the physical examination and the various classification systems to predict the difficulty of tracheal intubation. A recent Cochrane systematic review examined the sensitivity and specificity of various bedside tests commonly used for predicting difficulty in airway management. In such cases, alternative techniques of securing the airway must be readily available.
Complications
Tracheal intubation is generally considered the best method for airway management under a wide variety of circumstances, as it provides the most reliable means of oxygenation and ventilation and the greatest degree of protection against regurgitation and pulmonary aspiration. However, tracheal intubation requires a great deal of clinical experience to master and serious complications may result even when properly performed.
Four anatomic features must be present for orotracheal intubation to be straightforward: adequate mouth opening (full range of motion of the temporomandibular joint), sufficient pharyngeal space (determined by examining the back of the mouth), sufficient submandibular space (distance between the thyroid cartilage and the chin, the space into which the tongue must be displaced in order for the larygoscopist to view the glottis), and adequate extension of the cervical spine at the atlanto-occipital joint. If any of these variables is in any way compromised, intubation should be expected to be difficult.
Minor complications are common after laryngoscopy and insertion of an orotracheal tube. These are typically of short duration, such as sore throat, lacerations of the lips or gums or other structures within the upper airway, chipped, fractured or dislodged teeth, and nasal injury. Other complications which are common but potentially more serious include accelerated or irregular heartbeat, high blood pressure, elevated intracranial and introcular pressure, and bronchospasm.
More serious complications include laryngospasm, perforation of the trachea or esophagus, pulmonary aspiration of gastric contents or other foreign bodies, fracture or dislocation of the cervical spine, temporomandibular joint or arytenoid cartilages, decreased oxygen content, elevated arterial carbon dioxide, and vocal cord weakness. In addition to these complications, tracheal intubation via the nasal route carries a risk of dislodgement of adenoids and potentially severe nasal bleeding. Newer technologies such as flexible fiberoptic laryngoscopy have fared better in reducing the incidence of some of these complications, though the most frequent cause of intubation trauma remains a lack of skill on the part of the laryngoscopist.
Complications may also be severe and long-lasting or permanent, such as vocal cord damage, esophageal perforation and retropharyngeal abscess, bronchial intubation, or nerve injury. They may even be immediately life-threatening, such as laryngospasm and negative pressure pulmonary edema (fluid in the lungs), aspiration, unrecognized esophageal intubation, or accidental disconnection or dislodgement of the tracheal tube. Potentially fatal complications more often associated with prolonged intubation or tracheotomy include abnormal communication between the trachea and nearby structures such as the innominate artery (tracheoinnominate fistula) or esophagus (tracheoesophageal fistula). Other significant complications include airway obstruction due to loss of tracheal rigidity, ventilator-associated pneumonia and narrowing of the glottis or trachea. The cuff pressure is monitored carefully in order to avoid complications from over-inflation, many of which can be traced to excessive cuff pressure restricting the blood supply to the tracheal mucosa. A 2000 Spanish study of bedside percutaneous tracheotomy reported overall complication rates of 10–15% and procedural mortality of 0%, which is comparable to those of other series reported in the literature from the Netherlands and the United States.
Inability to secure the airway, with subsequent failure of oxygenation and ventilation is a life-threatening complication which if not immediately corrected leads to decreased oxygen content, brain damage, cardiovascular collapse, and death. When performed improperly, the associated complications (e.g., unrecognized esophageal intubation) may be rapidly fatal. Without adequate training and experience, the incidence of such complications is high. The case of Andrew Davis Hughes, from Emerald Isle, NC is a widely known case in which the patient was improperly intubated and, due to the lack of oxygen, sustained severe brain damage and died. For example, among paramedics in several United States urban communities, unrecognized esophageal or hypopharyngeal intubation has been reported to be 6% to 25%. Although not common, where basic emergency medical technicians are permitted to intubate, reported success rates are as low as 51%. In one study, nearly half of patients with misplaced tracheal tubes died in the emergency room. Because of this, recent editions of the American Heart Association's Guidelines for Cardiopulmonary Resuscitation have de-emphasized the role of tracheal intubation in favor of other airway management techniques such as bag-valve-mask ventilation, the laryngeal mask airway and the Combitube. However, recent higher quality studies have shown no survival or neurological benefit with endotracheal intubation over supraglottic airway devices (Laryngeal mask or Combitube).
One complication—unintentional and unrecognized intubation of the esophagus—is both common (as frequent as 25% in the hands of inexperienced personnel) and likely to result in a deleterious or even fatal outcome. In such cases, oxygen is inadvertently administered to the stomach, from where it cannot be taken up by the circulatory system, instead of the lungs. If this situation is not immediately identified and corrected, death will ensue from cerebral and cardiac anoxia.
Of 4,460 claims in the American Society of Anesthesiologists (ASA) Closed Claims Project database, 266 (approximately 6%) were for airway injury. Of these 266 cases, 87% of the injuries were temporary, 5% were permanent or disabling, and 8% resulted in death. Difficult intubation, age older than 60 years, and female gender were associated with claims for perforation of the esophagus or pharynx. Early signs of perforation were present in only 51% of perforation claims, whereas late sequelae occurred in 65%.
During the SARS and COVID-19 pandemics, tracheal intubation has been used with a ventilator in severe cases where the patient struggles to breathe. Performing the procedure carries a risk of the caregiver becoming infected.
Alternatives
Although it offers the greatest degree of protection against regurgitation and pulmonary aspiration, tracheal intubation is not the only means to maintain a patent airway. Alternative techniques for airway management and delivery of oxygen, volatile anesthetics or other breathing gases include the laryngeal mask airway, i-gel, cuffed oropharyngeal airway, continuous positive airway pressure (CPAP mask), nasal BiPAP mask, simple face mask, and nasal cannula.
General anesthesia is often administered without tracheal intubation in selected cases where the procedure is brief in duration, or procedures where the depth of anesthesia is not sufficient to cause significant compromise in ventilatory function. Even for longer duration or more invasive procedures, a general anesthetic may be administered without intubating the trachea, provided that patients are carefully selected, and the risk-benefit ratio is favorable (i.e., the risks associated with an unprotected airway are believed to be less than the risks of intubating the trachea).
Airway management can be classified into closed or open techniques depending on the system of ventilation used. Tracheal intubation is a typical example of a closed technique as ventilation occurs using a closed circuit. Several open techniques exist, such as spontaneous ventilation, apnoeic ventilation or jet ventilation. Each has its own specific advantages and disadvantages which determine when it should be used.
Spontaneous ventilation has been traditionally performed with an inhalational agent (i.e. gas induction or inhalational induction using halothane or sevoflurane) however it can also be performed using intravenous anaesthesia (e.g. propofol, ketamine or dexmedetomidine). SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) is an open airway technique that uses an upwards titration of propofol which maintains ventilation at deep levels of anaesthesia. It has been used in airway surgery as an alternative to tracheal intubation.
History
Tracheotomy
The earliest known depiction of a tracheotomy is found on two Egyptian tablets dating back to around 3600 BC. The 110-page Ebers Papyrus, an Egyptian medical papyrus which dates to roughly 1550 BC, also makes reference to the tracheotomy. Tracheotomy was described in the Rigveda, a Sanskrit text of ayurvedic medicine written around 2000 BC in ancient India. The Sushruta Samhita from around 400 BC is another text from the Indian subcontinent on ayurvedic medicine and surgery that mentions tracheotomy. Asclepiades of Bithynia (–40 BC) is often credited as being the first physician to perform a non-emergency tracheotomy. Galen of Pergamon (AD 129–199) clarified the anatomy of the trachea and was the first to demonstrate that the larynx generates the voice. In one of his experiments, Galen used bellows to inflate the lungs of a dead animal. Ibn Sīnā (980–1037) described the use of tracheal intubation to facilitate breathing in 1025 in his 14-volume medical encyclopedia, The Canon of Medicine. In the 12th century medical textbook Al-Taisir, Ibn Zuhr (1092–1162)—also known as Avenzoar—of Al-Andalus provided a correct description of the tracheotomy operation.
The first detailed descriptions of tracheal intubation and subsequent artificial respiration of animals were from Andreas Vesalius (1514–1564) of Brussels. In his landmark book published in 1543, De humani corporis fabrica, he described an experiment in which he passed a reed into the trachea of a dying animal whose thorax had been opened and maintained ventilation by blowing into the reed intermittently. Antonio Musa Brassavola (1490–1554) of Ferrara successfully treated a patient with peritonsillar abscess by tracheotomy. Brassavola published his account in 1546; this operation has been identified as the first recorded successful tracheotomy, despite the many previous references to this operation. Towards the end of the 16th century, Hieronymus Fabricius (1533–1619) described a useful technique for tracheotomy in his writings, although he had never actually performed the operation himself. In 1620 the French surgeon Nicholas Habicot (1550–1624) published a report of four successful tracheotomies. In 1714, anatomist Georg Detharding (1671–1747) of the University of Rostock performed a tracheotomy on a drowning victim.
Despite the many recorded instances of its use since antiquity, it was not until the early 19th century that the tracheotomy finally began to be recognized as a legitimate means of treating severe airway obstruction. In 1852, French physician Armand Trousseau (1801–1867) presented a series of 169 tracheotomies to the Académie Impériale de Médecine. 158 of these were performed for the treatment of croup, and 11 were performed for "chronic maladies of the larynx". Between 1830 and 1855, more than 350 tracheotomies were performed in Paris, most of them at the Hôpital des Enfants Malades, a public hospital, with an overall survival rate of only 20–25%. This compares with 58% of the 24 patients in Trousseau's private practice, who fared better due to greater postoperative care.
In 1871, the German surgeon Friedrich Trendelenburg (1844–1924) published a paper describing the first successful elective human tracheotomy to be performed for the purpose of administration of general anesthesia. In 1888, Sir Morell Mackenzie (1837–1892) published a book discussing the indications for tracheotomy. In the early 20th century, tracheotomy became a life-saving treatment for patients affected with paralytic poliomyelitis who required mechanical ventilation. In 1909, Philadelphia laryngologist Chevalier Jackson (1865–1958) described a technique for tracheotomy that is used to this day.
Laryngoscopy and non-surgical techniques
In 1854, a Spanish singing teacher named Manuel García (1805–1906) became the first man to view the functioning glottis in a living human. In 1858, French pediatrician Eugène Bouchut (1818–1891) developed a new technique for non-surgical orotracheal intubation to bypass laryngeal obstruction resulting from a diphtheria-related pseudomembrane. In 1880, Scottish surgeon William Macewen (1848–1924) reported on his use of orotracheal intubation as an alternative to tracheotomy to allow a patient with glottic edema to breathe, as well as in the setting of general anesthesia with chloroform. In 1895, Alfred Kirstein (1863–1922) of Berlin first described direct visualization of the vocal cords, using an esophagoscope he had modified for this purpose; he called this device an autoscope.
In 1913, Chevalier Jackson was the first to report a high rate of success for the use of direct laryngoscopy as a means to intubate the trachea. Jackson introduced a new laryngoscope blade that incorporated a component that the operator could slide out to allow room for passage of an endotracheal tube or bronchoscope. Also in 1913, New York surgeon Henry H. Janeway (1873–1921) published results he had achieved using a laryngoscope he had recently developed. Another pioneer in this field was Sir Ivan Whiteside Magill (1888–1986), who developed the technique of awake blind nasotracheal intubation, the Magill forceps, the Magill laryngoscope blade, and several apparati for the administration of volatile anesthetic agents. The Magill curve of an endotracheal tube is also named for Magill. Sir Robert Macintosh (1897–1989) introduced a curved laryngoscope blade in 1943; the Macintosh blade remains to this day the most widely used laryngoscope blade for orotracheal intubation.
Between 1945 and 1952, optical engineers built upon the earlier work of Rudolph Schindler (1888–1968), developing the first gastrocamera. In 1964, optical fiber technology was applied to one of these early gastrocameras to produce the first flexible fiberoptic endoscope. Initially used in upper GI endoscopy, this device was first used for laryngoscopy and tracheal intubation by Peter Murphy, an English anesthetist, in 1967. The concept of using a stylet for replacing or exchanging orotracheal tubes was introduced by Finucane and Kupshik in 1978, using a central venous catheter.
By the mid-1980s, the flexible fiberoptic bronchoscope had become an indispensable instrument within the pulmonology and anesthesia communities. The digital revolution of the 21st century has brought newer technology to the art and science of tracheal intubation. Several manufacturers have developed video laryngoscopes which employ digital technology such as the CMOS active pixel sensor (CMOS APS) to generate a view of the glottis so that the trachea may be intubated.
See also
Intratracheal instillation
Notes
References
External links
Video of endotracheal intubation using C-MAC D-blade and bougie used as introducer.
Videos of direct laryngoscopy recorded with the Airway Cam (TM) imaging system
Examples of some devices for facilitation of tracheal intubation
Free image rich resource explaining various types of endotracheal tubes
Tracheal intubation live case 2022
Airway management
Anesthesia
Emergency medical procedures
First aid
Intensive care medicine
Medical equipment
Oral and maxillofacial surgery
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Respiratory system procedures
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Medical treatments | wiki |
An ink eraser is an instrument used to scrape away or chemically bleach ink from a writing surface. This is a more involved process than removing pencil markings. Pencil marks can be gradually adhered to natural rubber fragments by rubbing the mark with a pencil eraser (this action is what prompted Joseph Priestly to give solidified latex its common name.) Ink, however readily penetrates the fibers of most papers and is therefore more difficult to extract by mechanical action.
Older ink erasers are therefore small knives designed to scrape off the top few microns of a sheet of paper, removing the ink that had penetrated. In concert with bladed ink erasers an eraser similar to those at the end of pencils was also used, with additional abrasives, such as sand, mixed into the rubber. Fibreglass ink erasers also work by abrasion. These erasers physically remove the ink and the paper it has marked from the larger sheet.
The chemical ink eradicator contains a substance that reacts with some inks removing their pigmentation and hiding the writing.
Metal ink erasers
Metal ink erasers were generally used before chemical ink erasers were introduced, and when permanent writing was done in ink. The erasers were essentially small knives. This was the downfall of Metropolitan Life office boy George Millet, who fell on an ink eraser kept in his breast pocket while trying to evade the kisses of six steno girls on his 15th birthday. Millet was stabbed in the heart and died instantly.
Chemical ink erasers
The chemical ink eraser was invented by the German manufacturer Pelikan in the 1930s and was introduced as a novelty in Germany in 1972 under the name Tintentiger (ink tiger).
Chemical ink erasers break down royal blue ink by disrupting the geometry of the dye molecules in ink so that light is no longer filtered. The molecules are disrupted by sulfite or hydroxide ions binding to the central carbon atoms of the dye. The ink is not destroyed by the erasing process, but is made invisible. It can be transformed back into a visible work with aldehydes.
The eradicator only works with certain inks. Erasable inks of various colors exist, but royal blue is the most common.
After applying the eradicator, erasable ink cannot be applied in the erased area of the paper, where the chemicals remain.
For this reason, eradicators usually include a permanent blue felt tip that allows the user to write in the erased area.
See also
Deinking
Eraser
References
Writing implements
Visual arts materials
German inventions | wiki |
16P may refer to:
16P/Brooks, a comet
SpaceShipOne flight 16P, a commercial spaceflight
See also
P16 (disambiguation) | wiki |
Queen of England or English Queen, may refer to:
Royalty
A female English monarch
Anne, Queen of Great Britain (1665-1714), the last monarch to hold the title Queen of England (1702-1707)
A female English royal consort, a female spouse of an English monarch
Elizabeth II (1926-2022, r. 1952-2022), the former Queen of the United Kingdom, has been incorrectly called the Queen of England
Other uses
"Queen Of England", a 2002 song by Roger Glover & The Guilty Party from the album Snapshot
"The Queen of England", a 2018 episode of the American TV series Santa Clarita Diet
Queen of England, a British barque shipwrecked in September 1865
See also
English monarchy
Succession to the British throne | wiki |
In the past, leaders of the Church of Jesus Christ of Latter-day Saints (LDS Church) have consistently opposed marriages between members of different ethnicities, though interracial marriage is no longer considered a sin. In 1977, apostle Boyd K. Packer publicly stated that "[w]e've always counseled in the Church for our Mexican members to marry Mexicans, our Japanese members to marry Japanese, our Caucasians to marry Caucasians, our Polynesian members to marry Polynesians. ... The counsel has been wise." Nearly every decade for over a century—beginning with the church's formation in the 1830s until the 1970s—has seen some denunciations of miscegenation, with most of them focusing on black–white marriages. Church president Brigham Young even taught on multiple occasions that black–white marriage merited death for the couple and their children.
Until at least the 1960s, the church penalized white members who married black individuals by prohibiting both spouses from entering temples. Even after the temple and priesthood ban was lifted for black members in 1978 the church still officially discouraged any marriage across ethnic lines. Until 2013 at least one official church manual in use had continued discouraging interracial marriages. Past teachings of church leaders on race and interracial marriage have stemmed from biological and social ideas of the time and have garnered criticism and controversy.
Early church leaders made an exception to the interracial marriage teachings by allowing white LDS men to marry Native American women, because Native Americans were viewed as being descended from the Israelites; however, it did not sanction white LDS women marrying Native American men. In 2013, the LDS Church disavowed previous teachings which stated that interracial marriage is a sin.
Utah's legislation on interracial relationships
The church's attitude was reflected by past laws in Utah, where its members held a notable amount of political influence. In 1852, the Act in Relation to Service which allowed the enslavement of black people in Utah Territory was passed, and it also banned sexual intercourse between a white person and "any of the African race." That same day the Act for the relief of Indian Slaves and Prisoners which allowed white Utah residents to enslave Native Americans was passed, however, it did not contain any provisions on sexual intercourse. In 1888, the government of Utah Territory, whose population was about 80% Mormon in 1880, passed an anti-miscegenation law. The law prohibited marriages between a "negro" and a "mongolian" (i.e. Asian person) and a "white person". In 1890, black individuals made up less than 0.3% of Utah's population of 210,000 people, Chinese individuals made up less than 0.4%, and Native Americans made up 1.6%. In 1939, the two-thirds-Mormon majority in the Utah State Legislature expanded the law so it would prohibit a white person from marrying a "Mongolian, a member of the malay race or a mulatto, quadroon, or octoroon." However, unlike laws which existed in other states, Utah's law did not prohibit marriages between white people and Native American people. The laws which banned interracial marriages remained in place until they were repealed by the Utah State Legislature in 1963.
Interracial marriages with Native Americans
Mormons considered Native Americans to be a higher race than black people, based on their belief that Native Americans were descendants of the Israelites, and they also believed that through intermarriage, the skin color of Native Americans could be restored to a "white and delightsome" state. On July 17, 1831, church founder Joseph Smith said he received a revelation in which God wanted several early elders of the church to eventually marry Native American women in a polygamous relationship so their posterity may become "white, delightsome, and just."
Though he believed that Native American peoples were "degraded", and "fallen in every respect, in habits, custom, flesh, spirit, blood, desire", Smith's successor Brigham Young also allowed Mormon men to marry Native American women as part of a process that would make their people white and delightsome and restore them to their "pristine beauty" within a few generations, However, a Native American man was prohibited from marrying a white woman in Mormon communities. Young performed the first recorded sealing ceremony between a "Lamanite" and a white member in October 1845 when an Oneida man Lewis Dana and Mary Gont were sealed in the Nauvoo Temple. There is evidence that Young may have married his Bannock servant Sally (who later married Ute chief Kanosh). By 1870 only about 30 Mormon men had Native American wives, and few further interracial marriages with Native Americans occurred. Later Mormons believed that Native American skins would be lightened through some other method. Under the presidency of Spencer W. Kimball, the church began discouraging interracial marriages with Native Americans.
In canonized scripture
The Book of Mormon
In the Book of Mormon, the Lord cursed the Lamanites (Jacob 3:5), and as a sign of the curse their skin was marked with blackness. The black marking was made so that the Nephites would not find the Lamanites "enticing" (2 Nephi 5:21), "that they might not mix and believe in incorrect traditions" (Alma 3:8), and so that the Nephites and the Lamanites would remain a separate people (Alma 3:14). If a Nephite intermarried and had children with a Lamanite, the Lord also cursed and marked them (Alma 3:15) and cursed their descendants (2 Nephi 5:23 and Alma 3:9).
Hugh Nibley, a prominent Mormon apologist, argues that the curse could be thought of as a culture with traditions that were inconsistent with God's commandments. He argues the curse did not spread through intermarriage alone, but that the Nephites had to participate in the Lamanite culture. He argues that Lord put the mark on the Lamanites to prevent the spread of Lamanite culture among the Nephites. The Book of Mormon Seminary Teacher Manual, which is currently used to teach seminary students about the Book of Mormon, quotes apostle Joseph Fielding Smith as stating that the skin color was changed to "keep the two peoples from mixing".
The Pearl of Great Price
In the Book of Abraham in the Pearl of Great Price, the name of Ham's wife is Egyptus, which is given the meaning of forbidden. It teaches that their grandson, Pharaoh, was a descendant of the Canaanites (Abraham 1:22), a race of people who had been cursed with black skin for committing genocide against "the people of Shum". (Moses 7:8). W. W. Phelps, an early church leader, taught that Ham himself was cursed because he had married a black wife. In The Way to Perfection, apostle Joseph Fielding Smith quoted B. H. Roberts in pointing out that Egyptus means forbidden, and suggests that might be because she was "of a race with which those who held the priesthood were forbidden to intermarry." The Old Testament Student Manual, which is the manual currently used to study the Old Testament in church Institutes of Religion, teaches that Ham's sons were denied the priesthood because he had married Egyptus.
The Bible
In Genesis 28:1, Isaac commands Jacob not to marry the Canaanites. The Old Testament Seminary Teacher Manual, which is the manual currently used to teach the Old Testament to seminary students, teaches that it is because "a daughter of Canaan would not be worthy to join Jacob in entering into a marriage covenant with the Lord."
In Deuteronomy 7, the Israelites were commanded not to marry the Canaanites. In 1954, apostle Mark E. Petersen used this as an example of why the church did not allow interracial marriages.
In Judges 14, Samson marries a Philistine woman. The Old Testament Seminary Teacher Manual teaches that marrying a Philistine was against the will of God.
19th-century teachings on black–white marriages
Joseph Smith
In January 1843 church founder Joseph Smith wrote, "Had I [anything] to do with the Negro I would confine them by strict [l]aw to their own species," in reference to interracial marriage. A year later as mayor of Nauvoo, Illinois, he held a trial and fined two black men the modern equivalent of thousands of dollars for trying to marry white women. However, a decade earlier hundreds of non-Mormon citizens of Jackson County, Missouri, stated that the Mormons were inviting black people to live among them, thus, creating the risk of interracial marriage, citing this as one of the reasons for requesting the removal of the Mormon people from the state. The apostle Parley P. Pratt denied this invitation had taken place, however.
There are other records of Smith's teaching on interracial marriage. For example, in 1897 First Presidency member George Q. Cannon stated in his journal that Joseph Smith had taught a later president of the church, John Taylor, that a white man married to a woman with black ancestry could not receive the priesthood and they both would be killed along with any of their children if the penalty of the law were executed. Three years later Cannon also stated that Smith had taught Taylor the doctrine that any male child born with any black heritage from one or more parents could not receive the priesthood as he was "tainted with Negro blood." In 1908, church president Joseph F. Smith stated that the church founder had declared that the priesthood ordination was void for Elijah Abel who only had one black great-grandparent (Abel was referred to as an octoroon man at the time for his one-eighth black heritage) from a mixed-race marriage long ago. Abel's petitions for temple ordinances were also denied by the next two church presidents Brigham Young and John Taylor because of his mixed heritage.
Brigham Young
On at least three occasions (1847, 1852, and 1865) Smith's successor Brigham Young publicly taught that the punishment for black–white interracial marriages was death, and the killing of a black–white interracial couple and their children as part of a blood atonement would be a blessing to them. He further stated that interracial children are sterile "like a mule", a teaching later repeated in a church magazine. Young taught that the moment the church consents to white members having children with black individuals the church would go to destruction, and that, "Any man having one drop of the seed of Cane in him cannot hold the priesthood." Young also taught that people who had children with a black person would be cursed to the priesthood.
Similar to honor killings as well as a form of human sacrifice, blood atonement is the belief that Jesus' atonement for humanity's sins does not apply to some sins, such as miscegenation, because they are so heinous. To atone for these sins, their perpetrators should be killed in a way that allows their blood to be shed upon the ground as a sacrificial offering. This doctrine was most widely taught during the Mormon Reformation. Examples of how Young applied his teaching of it with regard to interracial relationships are as follows:
1847 — Young heard of a Mormon family composed of a black man Enoch Lovejoy Lewis (son of ordained priesthood holder Kwaku Walker Lewis), a white woman Mary Matilda Webster, and their interracial child living in Massachusetts and responded that if the family wasn't living so close to non-Mormons "they would all have to be killed" since the law is that black and white seed should not be "amalgamated".
1852 — As territory governor, Young stated before the territory legislature that if a white man had children with a black woman, he should request to have his head chopped off. He continued saying that if someone were to kill the man, woman and any children of such a union, that it would be a blessing to them and "it would do a great deal towards atoning for the sin".
1865 — In a speech in the Salt Lake Tabernacle Young repeated the teaching of death as punishment for black and white individuals producing interracial offspring, stating that this penalty would always be in place.
Interracial marriages of William McCary
In 1847, former slave and Mormon convert William McCary drew the ire of Brigham Young and others in Nauvoo for his marriage to the white Mormon Lucy Stanton, and his later alleged mixed-race polygamous sealings to other white women without authorization. McCary claimed Native American heritage in order to marry Stanton and avoid the greater stigma that the few black people in Nauvoo faced. The most common interpretation of the interracial events around McCary and his excommunication is that they contributed to or precipitated the subsequent ban of black members from temple ordinances and priesthood authority. McCary elicited the first recorded general authority statement connecting race and the priesthood when the apostle Parley Pratt referred to him as the "black man who has got the blood of Ham in him which linege [sic] was cursed as regards the priesthood."
Lynching of Thomas Coleman
In 1866, Thomas Coleman, a black member of the LDS Church, was murdered in Salt Lake City after it was discovered that he was courting a white woman. His throat was slit so deeply from ear to ear that he was nearly decapitated, and his right breast was slit open, similar to the penalties illustrated in the temple endowment and taught by Brigham Young. He was castrated and a note warning black men to stay away from white women was pinned to his chest. Historian D. Michael Quinn states that this murder was a fulfillment of Young's 1852 teaching that the penalty for miscegenation was decapitation. FairMormon argues that Coleman's death may have been unrelated to Young's teachings or temple penalties, since Coleman was not an endowed member.
Under Wilford Woodruff
In the late 1800s at least two white members were denied church ordinances after they had married a black person. In 1895, a white woman was denied a temple sealing to her white husband because she had previously married a black man, even though she had divorced him. First Presidency member George Q. Cannon argued that allowing her access to the temple would not be fair to her two daughters, whom she'd had with her former husband. Another white man was denied the priesthood in 1897 because he had married a black woman, though, then senior apostle Lorenzo Snow stated that the man would be eligible if he divorced his wife and married a white woman. Additionally, Cannon recorded in his journal having stated in 1881 that when it came to the important question of interracial marriage, Mormons believed against "intermarriage with inferior races, particularly the negro."
1900–1950 teachings
George Q. Cannon
In 1900, George Q. Cannon, first counselor in the First Presidency under Lorenzo Snow, repeated Brigham Young's teachings that if a man who had the priesthood married a black woman, then according to the law of the Lord, the man and any offspring should be killed so that the seed of Cain did not receive the priesthood.
Rudger Clawson
In 1903 the apostle Rudger Clawson recorded that the Quorum of the Twelve and the First Presidency decided that a young male member who had requested to marry his fiance in the temple was "tainted with negro blood" through one black great-grandparent and, thus, could not marry in the temple. A few days after the decision he stated in a stake conference that the white members should be glad to be "wellborn" so they can have the blessings of the temple and referenced the young man who was denied a temple marriage as he was one-eighth black or "tainted with the blood of Cain". Clawson later lamented in a meeting that the man's white father of "pure parentage" had brought a curse upon his posterity by marrying a woman with one black grandparent.
B. H. Roberts
Some other early-20th-century teachings on the subject include the highly influential 1907 Deseret News five-volume book series The Seventy's Course in Theology by church seventy and prominent Mormon theologian B. H. Roberts. In it Roberts dedicates an entire lesson of the first volume to the "Negro Race Problem", and approvingly quoted a Southern author who stated that a social divide between white and black people should be maintained at all costs as socializing would lead to mixed-race marriages with an inferior race and no disaster would compare to this as it would doom the Caucasian race. It cited multiple biological justifications such as craniology (phrenology) to defend banning black–white "commingling". Additionally, a 1913 church publication in the church's Young Woman's Journal encouraged young women to maintain white racial purity and health by avoiding "race disintegration" and "race suicide".
J. Reuben Clark
First Presidency member J. Reuben Clark told Young Women general leaders in 1946 that, "It is sought today in certain quarters to break down all race prejudice, and at the end of the road ... is intermarriage. ...[D]o not ever let that wicked virus get into your systems that brotherhood either permits or entitles you to mix races which are inconsistent. Biologically, it is wrong; spiritually, it is wrong." The quote was reprinted in the church's official Improvement Era magazine. Three years later as senior vice-president of the church-owned Hotel Utah which then banned black people, Clark stated that the ban was in place to prevent interracial socializing that could hurt church leaders' efforts "to preserve the purity of the race that is entitled to hold the priesthood" and that the church taught white members to avoid social interaction with black people.
Under George Albert Smith
In 1947, the First Presidency, headed by George Albert Smith, sent a response letter to a California stake president inquiring on the subject stating, "Social intercourse between the Whites and the Negroes should certainly not be encouraged because of leading to intermarriage, which the Lord has forbidden. ... [T]rying to break down social barriers between the Whites and the Blacks is [a move] that should not be encouraged because inevitably it means the mixing of the races if carried to its logical conclusion." Two months later in a letter to another member Utah State sociology professor Lowry Nelson, the First Presidency stated that marriage between a white person and a black person is "most repugnant" and "does not have the sanction of the Church and is contrary to church doctrine".
1950–1978 teachings
Under David O. McKay
The latter half of the 20th century saw many changes in American legal and social views of interracial marriage, and many changes in top church leaders' teachings on the topic. For instance, church apostle Mark E. Petersen said in a 1954 address that church doctrine barred black people and white people from marrying each other. The speech was circulated among BYU religion faculty, much to the embarrassment of fellow LDS scholars, and over twenty years later Petersen denied knowing if the copies of his speech being passed around were authentic or not, apparently out of embarrassment.
In 1958, church apostle Bruce R. McConkie published Mormon Doctrine, in which he stated that "the whole negro race have been cursed with a black skin, the mark of Cain, so they can be identified as a caste apart, a people with whom the other descendants of Adam should not intermarry." The quote remained, despite many other revisions, until the church's Deseret Book ceased printing the book in 2010. The apostle Delbert L. Stapley wrote in a 1964 letter to George W. Romney that black people should not be entitled to "inter-marriage privileges with the Whites."
In 1960 at the church-run flagship school Brigham Young University leaders were "very much concerned" when a male black student received a large number of votes for student vice president, and, subsequently, apostle Harold Lee told BYU's president Ernest Wilkinson he would hold him responsible if one of his granddaughters ever went to "BYU and bec[a]me engaged to a colored boy". A few months later in February 1961 the BYU Board of Trustees decided to officially encourage black students to attend other universities for the first time. By 1965 administrators were sending a rejection letter to black applicants which cited BYU's discouragement of interracial courtship and marriage as the motive behind the decision, and by 1968 there was only one black American student on campus.
In 1966, a white woman who had received her endowment was banned by local leaders from returning to the temple and was told her endowment was invalid because she had since married a black man. Church president David O. McKay upheld the ban on her going to the temple, but ruled that her endowment was still valid.
Spencer W. Kimball
Apostle Spencer W. Kimball gave several speeches addressing the subject. In a June 1958 address at Brigham Young University, he stated that "[w]hen I said you must teach your people to overcome their prejudices and accept the Indians, I did not mean that you would encourage intermarriage ... we must discourage intermarriage ... it is not expedient." He clarified, however, that interracial marriage was not considered a sin. In a January 1959 address Kimball taught that church leaders were unanimous in teachings that Caucasians should marry Caucasians, stating that interracial marriage was selfish because the background differences could pose challenges to the marriage and children. He also told BYU students in 1965 that "the brethren feel that it is not the wisest thing to cross racial lines in dating and marrying", something he repeated to them as church president over a decade later in 1976.
Teachings from 1978–present
Church publications have also contained statements discouraging interracial marriage. In the same June 1978 issue announcing that black members were now eligible for temple ordinances, missionary service, and priesthood ordination, the official newspaper of the LDS Church also printed an article entitled "Interracial marriage discouraged". The same day, a church spokesman stated "interracial marriages generally have been discouraged in the past, ... that remains our position" and that "the Church does not prohibit ... interracial marriages but it does discourage them."
In 2003, author Jon Krakauer stated in his Under the Banner of Heaven that "official LDS policy has continued to strongly admonish white saints not to marry blacks". In response, the church's public affairs released a statement from BYU Dean of Religious Education Robert L. Millet that "[t]here is, in fact, no mention whatsoever in [the church] handbook concerning interracial marriages. In addition, having served as a Church leader for almost 30 years, I can also certify that I have never received official verbal instructions condemning marriages between black and white members." Though, denying any condemnation of interracial marriage, there was no comment on whether it was still discouraged. The most recent statement came in 2008 when spokesperson Mark Tuttle stated that the church has no policy against interracial marriage.
The discouragement of marriage between those of different ethnicities by church leaders continued being taught to youth during Sunday meetings until 2013, when the use of the 1996 version of the church Sunday meeting manual for adolescent boys was discontinued. The manual had used a 1976 quote from past church president Kimball that said, "We recommend that people marry those who are of the same racial background generally". The quote is still in use, however, in the 2003 institute Eternal Marriage Student Manual. Additionally, a footnote to a 1995 general conference talk by the apostle Russell M. Nelson notes that loving without racial discrimination is a general commandment, but not one to apply to specific marriage partner criteria since it states that being united in ethnic background increases the probability of a successful marriage. In 2013, the LDS Church published an essay entitled "Race and the Priesthood" on its official website. The essay disavowed teachings in the past that interracial marriage was a sin, indicating that it was influenced by the racism of the era.
Notable LDS members in interracial marriages
Gerrit W. Gong — an apostle. Gong is Asian-American and is married to Susan Lindsay, who is white.
Larry Echo Hawk — a general authority who was a registered member of the Pawnee Tribe; his wife is white.
Peter M. Johnson — the first African-American called as a general authority; his wife is white.
Mia Love — former U.S. Representative for Utah. Love is Haitian-American and her husband, Jason, is white.
Eduardo Balderas — first full-time translator for the LDS Church. Balderas was born in Mexico and his wife was an Anglo-American.
Alvin B. Jackson — former State Senator in Utah. Jackson is African-American and his wife, Juleen, is white.
Yoeli Childs professional basketball player. Childs is half white-half black and his wife Megan is white.
Alex Boyé — singer and entertainer. Boyé is a British-born child of Nigerian parents, and his wife Julie is white.
See also
Anti-miscegenation laws
Black people and Mormonism
Celestial marriage
Culture of the Church of Jesus Christ of Latter-day Saints
Miscegenation
Marriage in the Church of Jesus Christ of Latter-day Saints
Phrenology and the Latter Day Saint movement
References
The Church of Jesus Christ of Latter-day Saints
Mormonism and race
Sexuality and Mormonism
Marriage in Mormonism
Latter-day Saints | wiki |
Currency war, also known as competitive devaluations, is a condition in international affairs where countries seek to gain a trade advantage over other countries by causing the exchange rate of their currency to fall in relation to other currencies. As the exchange rate of a country's currency falls, exports become more competitive in other countries, and imports into the country become more and more expensive. Both effects benefit the domestic industry, and thus employment, which receives a boost in demand from both domestic and foreign markets. However, the price increases for import goods (as well as in the cost of foreign travel) are unpopular as they harm citizens' purchasing power; and when all countries adopt a similar strategy, it can lead to a general decline in international trade, harming all countries.
Historically, competitive devaluations have been rare as countries have generally preferred to maintain a high value for their currency. Countries have generally allowed market forces to work, or have participated in systems of managed exchanges rates. An exception occurred when a currency war broke out in the 1930s when countries abandoned the gold standard during the Great Depression and used currency devaluations in an attempt to stimulate their economies. Since this effectively pushes unemployment overseas, trading partners quickly retaliated with their own devaluations. The period is considered to have been an adverse situation for all concerned, as unpredictable changes in exchange rates reduced overall international trade.
According to Guido Mantega, former Brazilian Minister for Finance, a global currency war broke out in 2010. This view was echoed by numerous other government officials and financial journalists from around the world. Other senior policy makers and journalists suggested the phrase "currency war" overstated the extent of hostility. With a few exceptions, such as Mantega, even commentators who agreed there had been a currency war in 2010 generally concluded that it had fizzled out by mid-2011.
States engaging in possible competitive devaluation since 2010 have used a mix of policy tools, including direct government intervention, the imposition of capital controls, and, indirectly, quantitative easing. While many countries experienced undesirable upward pressure on their exchange rates and took part in the ongoing arguments, the most notable dimension of the 2010–11 episode was the rhetorical conflict between the United States and China over the valuation of the yuan. In January 2013, measures announced by Japan which were expected to devalue its currency sparked concern of a possible second 21st century currency war breaking out, this time with the principal source of tension being not China versus the US, but Japan versus the Eurozone. By late February, concerns of a new outbreak of currency war had been mostly allayed, after the G7 and G20 issued statements committing to avoid competitive devaluation. After the European Central Bank launched a fresh programme of quantitative easing in January 2015, there was once again an intensification of discussion about currency war.
Background
In the absence of intervention in the foreign exchange market by national government authorities, the exchange rate of a country's currency is determined, in general, by market forces of supply and demand at a point in time. Government authorities may intervene in the market from time to time to achieve specific policy objectives, such as maintaining its balance of trade or to give its exporters a competitive advantage in international trade.
Reasons for intentional devaluation
Devaluation, with its adverse consequences, has historically rarely been a preferred strategy. According to economist Richard N. Cooper, writing in 1971, a substantial devaluation is one of the most "traumatic" policies a government can adopt – it almost always resulted in cries of outrage and calls for the government to be replaced. Devaluation can lead to a reduction in citizens' standard of living as their purchasing power is reduced both when they buy imports and when they travel abroad. It also can add to inflationary pressure. Devaluation can make interest payments on international debt more expensive if those debts are denominated in a foreign currency, and it can discourage foreign investors. At least until the 21st century, a strong currency was commonly seen as a mark of prestige, while devaluation was associated with weak governments.
However, when a country is suffering from high unemployment or wishes to pursue a policy of export-led growth, a lower exchange rate can be seen as advantageous. From the early 1980s the International Monetary Fund (IMF) has proposed devaluation as a potential solution for developing nations that are consistently spending more on imports than they earn on exports. A lower value for the home currency will raise the price for imports while making exports cheaper. This tends to encourage more domestic production, which raises employment and gross domestic product (GDP). Such a positive impact is not guaranteed however, due for example to effects from the Marshall–Lerner condition. Devaluation can be seen as an attractive solution to unemployment when other options, like increased public spending, are ruled out due to high public debt, or when a country has a balance of payments deficit which a devaluation would help correct. A reason for preferring devaluation common among emerging economies is that maintaining a relatively low exchange rate helps them build up foreign exchange reserves, which can protect against future financial crises.
Mechanism for devaluation
A state wishing to devalue, or at least check the appreciation of its currency, must work within the constraints of the prevailing International monetary system. During the 1930s, countries had relatively more direct control over their exchange rates through the actions of their central banks. Following the collapse of the Bretton Woods system in the early 1970s, markets substantially increased in influence, with market forces largely setting the exchange rates for an increasing number of countries. However, a state's central bank can still intervene in the markets to effect a devaluation – if it sells its own currency to buy other currencies then this will cause the value of its own currency to fall – a practice common with states that have a managed exchange rate regime. Less directly, quantitative easing (common in 2009 and 2010), tends to lead to a fall in the value of the currency even if the central bank does not directly buy any foreign assets.
A third method is for authorities simply to talk down the value of their currency by hinting at future action to discourage speculators from betting on a future rise, though sometimes this has little discernible effect. Finally, a central bank can effect a devaluation by lowering its base rate of interest; however this sometimes has limited effect, and, since the end of World War II, most central banks have set their base rate according to the needs of their domestic economy.
If a country's authorities wish to devalue or prevent appreciation against market forces exerting upwards pressure on the currency, and retain control of interest rates, as is usually the case, they will need capital controls in place—due to conditions that arise from the impossible trinity trilemma.
Quantitative easing
Quantitative easing (QE) is the practice in which a central bank tries to mitigate a potential or actual recession by increasing the money supply for its domestic economy. This can be done by printing money and injecting it into the domestic economy via open market operations. There may be a promise to destroy any newly created money once the economy improves in order to avoid inflation.
Quantitative easing was widely used as a response to the financial crises that began in 2007, especially by the United States and the United Kingdom, and, to a lesser extent, the Eurozone. The Bank of Japan was the first central bank to claim to have used such a policy.
Although the U.S. administration has denied that devaluing their currency was part of their objectives for implementing quantitative easing, the practice can act to devalue a country's currency in two indirect ways. Firstly, it can encourage speculators to bet that the currency will decline in value. Secondly, the large increase in the domestic money supply will lower domestic interest rates, often they will become much lower than interest rates in countries not practising quantitative easing. This creates the conditions for a carry trade, where market participants can engage in a form of arbitrage, borrowing in the currency of the country practising quantitative easing, and lending in a country with a relatively high rate of interest. Because they are effectively selling the currency being used for quantitative easing on the international markets, this can increase the supply of the currency and hence push down its value. By October 2010 expectations in the markets were high that the United States, UK, and Japan would soon embark on a second round of QE, with the prospects for the Eurozone to join them less certain.
In early November 2010 the United States launched QE2, the second round of quantitative easing, which had been expected. The Federal Reserve made an additional $600 billion available for the purchase of financial assets. This prompted widespread criticism from China, Germany, and Brazil that the United States was using QE2 to try to devalue its currency without consideration to the effect the resulting capital inflows might have on emerging economies.
Some leading figures from the critical countries, such as Zhou Xiaochuan, governor of the People's Bank of China, have said the QE2 is understandable given the challenges facing the United States. Wang Jun, the Chinese Vice Finance Minister suggested QE2 could "help the revival of the global economy tremendously". President Barack Obama has defended QE2, saying it would help the U.S. economy to grow, which would be "good for the world as a whole". Japan also launched a second round of quantitative easing though to a lesser extent than the United States; Britain and the Eurozone did not launch an additional QE in 2010.
International conditions required for currency war
For a widespread currency war to occur a large proportion of significant economies must wish to devalue their currencies at once. This has so far only happened during a global economic downturn.
An individual currency devaluation has to involve a corresponding rise in value for at least one other currency. The corresponding rise will generally be spread across all other currencies and so unless the devaluing country has a huge economy and is substantially devaluing, the offsetting rise for any individual currency will tend to be small or even negligible. In normal times other countries are often content to accept a small rise in the value of their own currency or at worst be indifferent to it. However, if much of the world is suffering from a recession, from low growth or are pursuing strategies which depend on a favourable balance of payments, then nations can begin competing with each other to devalue. In such conditions, once a small number of countries begin intervening this can trigger corresponding interventions from others as they strive to prevent further deterioration in their export competitiveness.
Historical overview
Up to 1930
For millennia, going back to at least the Classical period, governments have often devalued their currency by reducing its intrinsic value.
Methods have included reducing the percentage of gold in coins, or substituting less precious metals for gold. However, until the 19th century, the proportion of the world's trade that occurred between nations was very low, so exchanges rates were not generally a matter of great concern. Rather than being seen as a means to help exporters, the debasement of currency was motivated by a desire to increase the domestic money supply and the ruling authorities' wealth through seigniorage, especially when they needed to finance wars or pay debts. A notable example is the substantial devaluations which occurred during the Napoleonic wars. When nations wished to compete economically they typically practiced mercantilism – this still involved attempts to boost exports while limiting imports, but rarely by means of devaluation. A favoured method was to protect home industries using current account controls such as tariffs. From the late 18th century, and especially in Britain, which, for much of the 19th century, was the world's largest economy, mercantilism became increasingly discredited by the rival theory of free trade, which held that the best way to encourage prosperity would be to allow trade to occur free of government imposed controls. The intrinsic value of money became formalised with a gold standard being widely adopted from about 1870–1914, so while the global economy was now becoming sufficiently integrated for competitive devaluation to occur there was little opportunity. Following the end of World War I, many countries other than the US experienced recession and few immediately returned to the gold standard, so several of the conditions for a currency war were in place. However, currency war did not occur as the U.K. was trying to raise the value of its currency back to its pre-war levels, effectively cooperating with the countries that wished to devalue against the market.
By the mid-1920's many former members of the gold standard had rejoined, and while the standard did not work as successfully as it had pre war, there was no widespread competitive devaluation.
Currency war in the Great Depression
During the Great Depression of the 1930s, most countries abandoned the gold standard. With widespread high unemployment, devaluations became common, a policy that has frequently been described as "beggar thy neighbour", in which countries purportedly compete to export unemployment. However, because the effects of a devaluation would soon be offset by a corresponding devaluation and in many cases retaliatory tariffs or other barriers by trading partners, few nations would gain an enduring advantage.
The exact starting date of the 1930s currency war is open to debate. The three principal parties were Britain, France, and the United States. For most of the 1920s the three generally had coinciding interests; both the US and France supported Britain's efforts to raise Sterling's value against market forces. Collaboration was aided by strong personal friendships among the nations' central bankers, especially between Britain's Montagu Norman and America's Benjamin Strong until the latter's early death in 1928. Soon after the Wall Street Crash of 1929, France lost faith in Sterling as a source of value and begun selling it heavily on the markets. From Britain's perspective both France and the US were no longer playing by the rules of the gold standard. Instead of allowing gold inflows to increase their money supplies (which would have expanded those economies but reduced their trade surpluses) France and the US began sterilising the inflows, building up hoards of gold. These factors contributed to the Sterling crises of 1931; in September of that year Britain substantially devalued and took the pound off the gold standard. For several years after this global trade was disrupted by competitive devaluation and by retaliatory tariffs. The currency war of the 1930s is generally considered to have ended with the Tripartite monetary agreement of 1936.
Bretton Woods era
From the end of World War II until about 1971, the Bretton Woods system of semi-fixed exchange rates meant that competitive devaluation was not an option, which was one of the design objectives of the systems' architects. Additionally, global growth was generally very high in this period, so there was little incentive for currency war even if it had been possible.
1973 to 2000
While some of the conditions to allow a currency war were in place at various points throughout this period, countries generally had contrasting priorities and at no point were there enough states simultaneously wanting to devalue for a currency war to break out. On several occasions countries were desperately attempting not to cause a devaluation but to prevent one. So states were striving not against other countries but against market forces that were exerting undesirable downwards pressure on their currencies. Examples include The United Kingdom during Black Wednesday and various tiger economies during the Asian crises of 1997. During the mid-1980s the United States did desire to devalue significantly, but were able to secure the cooperation of other major economies with the Plaza Accord. As free market influences approached their zenith during the 1990s, advanced economies and increasingly transition and even emerging economies moved to the view that it was best to leave the running of their economies to the markets and not to intervene even to correct a substantial current account deficit.
2000 to 2008
During the 1997 Asian crisis several Asian economies ran critically low on foreign reserves, leaving them forced to accept harsh terms from the IMF, and often to accept low prices for the forced sale of their assets. This shattered faith in free market thinking among emerging economies, and from about 2000 they generally began intervening to keep the value of their currencies low. This enhanced their ability to pursue export led growth strategies while at the same time building up foreign reserves so they would be better protected against further crises. No currency war resulted because on the whole advanced economies accepted this strategy—in the short term it had some benefits for their citizens, who could buy cheap imports and thus enjoy a higher material standard of living. The current account deficit of the US grew substantially, but until about 2007, the consensus view among free market economists and policy makers like Alan Greenspan, then Chairman of the Federal Reserve, and Paul O'Neill, US Treasury secretary, was that the deficit was not a major reason for worry.
This is not say there was no popular concern; by 2005 for example a chorus of US executives along with trade union and mid-ranking government officials had been speaking out about what they perceived to be unfair trade practices by China.
Economists such as Michael P. Dooley, Peter M. Garber, and David Folkerts-Landau described the new economic relationship between emerging economies and the US as Bretton Woods II.
Competitive devaluation after 2009
By 2009 some of the conditions required for a currency war had returned, with a severe economic downturn seeing global trade in that year decline by about 12%. There was a widespread concern among advanced economies about the size of their deficits; they increasingly joined emerging economies in viewing export led growth as their ideal strategy. In March 2009, even before international co-operation reached its peak with the 2009 G-20 London Summit, economist Ted Truman became one of the first to warn of the dangers of competitive devaluation. He also coined the phrase competitive non-appreciation.
On 27 September 2010, Brazilian Finance Minister Guido Mantega announced that the world is "in the midst of an international currency war."
Numerous financial journalists agreed with Mantega's view, such as the Financial Times''' Alan Beattie and The Telegraph's Ambrose Evans-Pritchard. Journalists linked Mantega's announcement to recent interventions by various countries seeking to devalue their exchange rate including China, Japan, Colombia, Israel and Switzerland.
Other analysts such as Goldman Sach's Jim O'Neill asserted that fears of a currency war were exaggerated.
In September, senior policy makers such as Dominique Strauss-Kahn, then managing director of the IMF, and Tim Geithner, US Secretary of the Treasury, were reported as saying the chances of a genuine currency war breaking out were low; however by early October, Strauss-Kahn was warning that the risk of a currency war was real. He also suggested the IMF could help resolve the trade imbalances which could be the underlying casus belli for conflicts over currency valuations. Mr Strauss-Kahn said that using currencies as weapons "is not a solution [and] it can even lead to a very bad situation. There's no domestic solution to a global problem."
Considerable attention had been focused on the US, due to its quantitative easing programmes, and on China.
For much of 2009 and 2010, China was under pressure from the US to allow the yuan to appreciate. Between June and October 2010, China allowed a 2% appreciation, but there were concerns from Western observers that China only relaxed its intervention when under heavy pressure. The fixed peg was not abandoned until just before the June G20 meeting, after which the yuan appreciated by about 1%, only to devalue slowly again, until further US pressure in September when it again appreciated relatively steeply, just prior to the September US Congressional hearings to discuss measures to force a revaluation.
Reuters suggested that both China and the United States were "winning" the currency war, holding down their currencies while pushing up the value of the Euro, the Yen, and the currencies of many emerging economies.
Martin Wolf, an economics leader writer with the Financial Times, suggested there may be advantages in western economies taking a more confrontational approach against China, which in recent years had been by far the biggest practitioner of competitive devaluation. Although he advised that rather than using protectionist measures which may spark a trade war, a better tactic would be to use targeted capital controls against China to prevent them buying foreign assets in order to further devalue the yuan, as previously suggested by Daniel Gros, Director of the Centre for European Policy Studies.
A contrasting view was published on 19 October, with a paper from Chinese economist Huang Yiping arguing that the US did not win the last "currency war" with Japan, and has even less of a chance against China; but should focus instead on broader "structural adjustments" at the November 2010 G-20 Seoul summit.
Discussion over currency war and imbalances dominated the 2010 G-20 Seoul summit, but little progress was made in resolving the issue.
In the first half of 2011 analysts and the financial press widely reported that the currency war had ended or at least entered a lull, though speaking in July 2011 Guido Mantega told the Financial Times that the conflict was still ongoing.
As investor confidence in the global economic outlook fell in early August, Bloomberg suggested the currency war had entered a new phase. This followed renewed talk of a possible third round of quantitative easing by the US and interventions over the first three days of August by Switzerland and Japan to push down the value of their currencies.
In September, as part of her opening speech for the 66th United Nations Debate, and also in an article for the Financial Times, Brazilian president Dilma Rousseff called for the currency war to be ended by increased use of floating currencies and greater cooperation and solidarity among major economies, with exchange rate policies set for the good of all rather than having individual nations striving to gain an advantage for themselves.
In March 2012, Rousseff said Brazil was still experiencing undesirable upwards pressure on its currency, with its Finance Minister Guido Mantega saying his country will no longer "play the fool" and allow others to get away with competitive devaluation, announcing new measures aimed at limiting further appreciation for the Real.
By June however, the Real had fallen substantially from its peak against the Dollar, and Mantega had been able to begin relaxing his anti-appreciation measures.
Currency war in 2013
In mid January 2013, Japan's central bank signalled the intention to launch an open ended bond buying programme which would likely devalue the yen. This resulted in short lived but intense period of alarm about the risk of a possible fresh round of currency war.
Numerous senior central bankers and finance ministers issued public warnings, the first being Alexei Ulyukayev, the first deputy chairman at Russia's central bank. He was later joined by many others including Park Jae-wan, the finance minister for South Korea, and by Jens Weidmann, president of the Bundesbank. Weidmann held the view that interventions during the 2009–11 period were not intense enough to count as competitive devaluation, but that a genuine currency war is now a real possibility. Japan's economy minister Akira Amari has said that the Bank of Japan's bond buying programme is intended to combat deflation, and not to weaken the yen.
In early February, ECB president Mario Draghi agreed that expansionary monetary policy like QE have not been undertaken to deliberately cause devaluation. Draghi's statement did however hint that the ECB may take action if the Euro continues to appreciate, and this saw the value of the European currency fall considerably. A mid February statement from the G7 affirmed the advanced economies commitment to avoid currency war. It was initially read by the markets as an endorsement of Japan's actions, though later clarification suggested the US would like Japan to tone down some of its language, specifically by not linking policies like QE to an expressed desire to devalue the Yen. Most commentators have asserted that if a new round of competitive devaluation occurs it would be harmful for the global economy. However some analysts have stated that Japan's planned actions could be in the long term interests of the rest of the world; just as he did for the 2010–11 incident, economist Barry Eichengreen has suggested that even if many other countries start intervening against their currencies it could boost growth worldwide, as the effects would be similar to semi-coordinated global monetary expansion. Other analysts have expressed skepticism about the risk of a war breaking out, with Marc Chandler, chief currency strategist at Brown Brothers Harriman, advising that: "A real currency war remains a remote possibility."
On 15 February, a statement issued from the G20 meeting of finance ministers and central bank governors in Moscow affirmed that Japan would not face high level international criticism for its planned monetary policy. In a remark endorsed by US Fed chairman Ben Bernanke, the IMF's managing director Christine Lagarde said that recent concerns about a possible currency war had been "overblown". Paul Krugman has echoed Eichengreen's view that central bank's unconventional monetary policy is best understood as a shared concern to boost growth, not as currency war. Goldman Sachs strategist Kamakshya Trivedi has suggested that rising stock markets imply that market players generally agree that central bank's actions are best understood as monetary easing and not as competitive devaluation. Other analysts have however continued to assert that ongoing tensions over currency valuation remain, with currency war and even trade war still a significant risk. Central bank officials ranging from New Zealand and Switzerland to China have made fresh statements about possible further interventions against their currencies.
Analyses has been published by currency strategists at RBS, scoring countries on their potential to undertake intervention, measuring their relative intention to weaken their currency and their capacity to do so. Ratings are based on the openness of a country's economy, export growth and real effective exchange rate (REER) valuation, as well as the scope a country has to weaken its currency without damaging its economy. , Indonesia, Thailand, Malaysia, Chile and Sweden are the most willing and able to intervene, while the UK and New Zealand are among the least.
From March 2013, concerns over further currency war diminished, though in November several journalists and analysts warned of a possible fresh outbreak. The likely principal source of tension appeared to shift once again, this time not being the U.S. versus China or the Eurozone versus Japan, but the U.S. versus Germany. In late October U.S. treasury officials had criticized Germany for running an excessively large current account surplus, thus acting as a drag on the global economy.
Currency war in 2015
A €60bn per month quantitative easing programme was launched in January 2015 by the European Central Bank. While lowering the value of the Euro was not part of the programme's official objectives, there was much speculation that the new Q.E. represents an escalation of currency war, especially from analysts working in the FX markets. David Woo for example, a managing director at Bank of America Merrill Lynch, stated there was a "growing consensus" among market participants that states are indeed engaging in a stealthy currency war. A Financial Times editorial however claimed that rhetoric about currency war was once again misguided.
In August 2015, China devalued the yuan by just under 3%, partially due to a weakening export figures of −8.3% in the previous month.
The drop in export is caused by the loss of competitiveness against other major export countries including Japan and Germany, where the currency had been drastically devalued during the previous quantitative easing operations. It sparked a new round of devaluation among Asian currencies, including the Vietnam dong and the Kazakhstan tenge.
Comparison between 1932 and 21st-century currency wars
Both the 1930s and the outbreak of competitive devaluation that began in 2009 occurred during global economic downturns. An important difference with the 2010s is that international traders are much better able to hedge their exposures to exchange rate volatility because of more sophisticated financial markets. A second difference is that the later period's devaluations were invariably caused by nations expanding their money supplies by creating money to buy foreign currency, in the case of direct interventions, or by creating money to inject into their domestic economies, with quantitative easing. If all nations try to devalue at once, the net effect on exchange rates could cancel out, leaving them largely unchanged, but the expansionary effect of the interventions would remain. There has been no collaborative intent, but some economists such as Berkeley's Barry Eichengreen and Goldman Sachs's Dominic Wilson have suggested the net effect will be similar to semi-coordinated monetary expansion, which will help the global economy.
James Zhan of the United Nations Conference on Trade and Development (UNCTAD), however, warned in October 2010 that the fluctuations in exchange rates were already causing corporations to scale back their international investments.
Comparing the situation in 2010 with the currency war of the 1930s, Ambrose Evans-Pritchard of The Daily Telegraph suggested a new currency war may be beneficial for countries suffering from trade deficits. He noted that in the 1930s, it was countries with a big surplus that were severely impacted once competitive devaluation began. He also suggested that overly-confrontational tactics may backfire on the US by damaging the status of the dollar as a global reserve currency.
Ben Bernanke, chairman of the US Federal Reserve, also drew a comparison with competitive devaluation in the interwar period, referring to the sterilisation of gold inflows by France and America, which helped them sustain large trade surpluses but also caused deflationary pressure on their trading partners, contributing to the Great Depression. Bernanke stated that the example of the 1930s implies that the "pursuit of export-led growth cannot ultimately succeed if the implications of that strategy for global growth and stability are not taken into account."
In February 2013, Gavyn Davies for The Financial Times emphasized that a key difference between the 1930s and the 21st-century outbreaks is that the former had some retaliations between countries being carried out not by devaluations but by increases in import tariffs, which tend to be much more disruptive to international trade.
Other uses
The term "currency war" is sometimes used with meanings that are not related to competitive devaluation.
In the 2007 book, Currency Wars by Chinese economist Song Hongbing, the term is sometimes used in a somewhat contrary sense, to refer to an alleged practice where unscrupulous bankers lend to emerging market countries and then speculate against the emerging state's currency by trying to force it down in value against the wishes of that states' government.
In another book of the same name, John Cooley uses the term to refer to the efforts of a state's monetary authorities to protect its currency from forgers, whether they are simple criminals or agents of foreign governments trying to devalue a currency and cause excess inflation against the home government's wishes.
Jim Rickards, in his 2011 book "Currency Wars: The Making of the Next Global Crisis," argues that the consequences of the Fed's attempts to prop up economic growth could be devastating for American national security. Although Rickard's book is largely concerned with currency war as competitive devaluation, it uses a broader definition of the term, classing policies that cause inflation as currency war. Such policies can be seen as metaphorical warfare against those who have monetary assets in favor of those who do not, but unless the effects of rising inflation on international trade are offset by a devaluation, inflationary policies tend to make a country's exports less competitive against foreign countries. In their review of the book, Publishers Weekly said: "Rickards's first book is an outgrowth of his contributions and a later two-day war game simulation held at the Applied Physics Laboratory's Warfare Analysis Laboratory. He argues that a financial attack against the U.S. could destroy confidence in the dollar. In Rickards's view, the Fed's policy of quantitative easing by lessening confidence in the dollar, may lead to chaos in global financial markets." Kirkus Reviews said: "In Rickards' view, the world is currently going through a third currency war ("CWIII") based on competitive devaluations. CWII occurred in the 1960s and '70s and culminated in Nixon's decision to take the dollar off the gold standard. CWI followed World War I and included the 1923 German hyperinflation and Roosevelt's devaluation of the dollar against gold in 1933. Rickards demonstrates that competitive devaluations are a race to the bottom, and thus instruments of a sort of warfare. CWIII, he writes, is characterized by the Federal Reserve's policy of quantitative easing, which he ascribes to what he calls "extensive theoretical work" on depreciation, negative interest rates and stimulation achieved at the expense of other countries. He offers a view of how the continued depreciation and devaluation of the dollar will ultimately lead to a collapse, which he asserts will come about through a widespread abandonment of a worthless inflated instrument. Rickards also provides possible scenarios for the future, including collaboration among a variety of currencies, emergence of a world central bank and a forceful U.S. return to a gold standard through an emergency powers–based legal regime. The author emphasizes that these questions are matters of policy and choice, which can be different."
Historically, the term has been used to refer to the competition between Japan and China for their currencies to be used as the preferred tender in parts of Asia in the years leading up to Second Sino-Japanese War.
See also
Trade war
World-systems theory
Notes and citations
References
External links
Global economy: Going head to head article showing various international perspectives (Financial Times, October 2010)
Data visualization from OECD, to see how imbalances have developed since 1990, select 'Current account imbalances' on the stories tab, then move the date slider. ( OECD 2010 )
Why China's exchange rate is a red herring alternative view by the chairman of Intelligence Capital, Eswar Prasad, suggesting those advocating for China to appreciate are misguided (VoxEU, April 2010).
Q. What is a 'currency war'? – view from a journalist in Korea, the hosts of the November 2010 G20 summit. (Korea Joongang, October 2010)
Brazil's Currency wars – a 'real' problem – introductory article from a South American magazine (SoundsandColours.com'', October 2010)
What's the currency war about? introductory article from the BBC (October 2010)
History of international trade
International macroeconomics
Metallism
Monetary hegemony
Trade wars | wiki |
Halysidota harrisii, the sycamore tussock moth, is a moth of the family Erebidae and the tribe Arctiini, the tiger moths. The species was first described by Benjamin Dann Walsh in 1864. It is found in southeastern Canada, the eastern parts of the United States, and northeastern Mexico.
Description
The larvae have yellow-orange heads and bodies covered with hair, and they can grow to approximately 25–35 mm in length. They exhibit two pairs of long, orange hair-pencils and two pairs of white hair-pencils towards the front of their body. They also exhibit one pair of white hair-pencils near the back of their body.
The adults are pale yellow with dark bands on the forewings. Each forewing is 24–26 mm in length, making the wingspan approximately 50 mm. As adults, they are almost indistinguishable from the closely related Halysidota tesselaris.
Life cycle
The sycamore tussock moth produces two generations each year. Moths emerge from overwintering cocoons from May to June. After mating, they lay egg masses on bark and the underside of leaves. The larvae feed on the American sycamore tree, Platanus occidentalis. They pupate in late June and July, and emerge as moths in July and August. The offspring of this generation spins cocoons in late September and October and overwinters as pupae.
Importance
An overpopulation of the insect can be damaging to sycamore trees. Natural predators, such as birds, control most populations. However, pesticides may be needed.
The sycamore tussock moth caterpillar has been documented causing urticaria (hives).
References
Halysidota
Moths of North America
Moths described in 1864
Taxa named by Benjamin Dann Walsh | wiki |
Tappen may refer to:
Places
Tappen Park, a park on Staten Island in New York City
Tappen, North Dakota, a small city in North Dakota
Tappen, British Columbia, a small city in British Columbia
Games
Tappen (card game), a 4-player, tarock card game, also known as Dobbm, played in Austria
Viennese Tappen, a 3-player, tarock card game, also known as Tapp Tarock, played in Austria
People
Tappen (surname)
Other
Tappen (biology), an indigestible mass found in the intestines of bears after hibernation | wiki |
Webcam software allows users to take pictures and video and save them to their computer.
See also
Comparison of screencasting software
Webcams
Webcam | wiki |
The Three Steps are three prominent rocky steps on the northeast ridge of Mount Everest. They are located at altitudes of , , and . The Second Step is especially significant both historically and in mountaineering terms. Any climber who wants to climb on the normal route from the north of the summit must negotiate these three stages.
The First Step consists of large boulders that pose a serious obstacle, even for experienced climbers, because of their location high in the Death Zone. Many mountaineers have died near the First Step, among them "Green Boots", a corpse wearing neon green climbing boots and a red coat, which serves as a somber landmark for climbers to gauge their distance to the top, and which has now been possibly identified as Tsewang Paljor. His fellow climbers, who also perished on the same day as he in 1996, are Tsewang Smanla and Dorje Morup. Other climbers have died under that rock as well, namely David Sharp and Francys Arsentiev.
The Second Step is the best known of the rocky steps. The steep section, at an altitude of 8,610 m, has a climbing height of 40 metres, of which the last five are almost vertical. The step was apparently climbed for the first time in 1960 when Wang Fuzhou, Gongbu and Qu Yinhua claimed to have completed the first ascent via the north ridge, with their teammate Liu Lianman volunteering to be a human ladder up the step. Despite being widely accepted, there is inconclusive evidence to support the claim. The climbing difficulty of this spot was reduced in 1975 when a Chinese team affixed an aluminium ladder to the step that has been used since then by almost all climbers. In 2007, out of safety considerations, the original ladder was replaced with a new one by Chinese and international mountaineers. The original ladder is now on display at the Mount Qomolangma Museum in Tibet.
The Third Step is easiest to climb. Its climbing height is about 10 metres, after which the summit snowfield is reached.
Important climbs of the Second Step
The 1921 British Mount Everest reconnaissance expedition was the first to attempt to climb Mount Everest. It was followed by further British expeditions in 1922, 1924, and 1933. The climbers had to make the ascent from the north, since Nepal was closed. The situation became reversed after the communist victory in the Battle of Chamdo; expeditions launched after that had to use the southern approach through Nepal. The technical difficulties, especially in climbing the Second Step, were still unknown. There is ongoing discussion as to whether the Second Step was ever surmounted by George Mallory and Andrew Irvine in 1924. It was surmounted in 1960 as part of the first ascent of Mount Everest via the north route, when a shoulder stand was used to climb the last five metres.
The step was first climbed unaided in 1985, by the Spaniard Òscar Cadiach. He assessed the final rock face as 5.7 to 5.8 (V+ in UIAA classification).
Theo Fritsche, an Austrian, climbed the step in 2001 free solo on-sight and came to a similar conclusion. Conrad Anker climbed the Second Step in 1999 and assessed the level of difficulty as 5.10. On this ascent Anker supported himself using the Chinese ladder. In 2007, Anker repeated the climb with Leo Houlding; this time, however, he first removed the ladder in order to climb the step unaided.
Sources
Mantovani, Roberto and Diemberger, Kurt (1997). Mount Everest – Kampf in eisigen Höhen. Moewig.
Hemmleb, Jochen (2009). Tatort Mount Everest: Der Fall Mallory – Neue Fakten und Hintergründe. Herbig, Munich. .
See also
Hillary Step
References
External links
Photograph of the Second Step including ladder and fixed ropes
Photograph of second step with mountaineers
Painting of the complete second step including ladder and ropes
BBC - Future - The tragic tale of Mt Everest's most famous dead body - Story by Rachel Nuwer
Himalayas
Mount Everest | wiki |
Harzbahn includes:
Rübeland Railway (Rübelandbahn)
Harz Narrow Gauge Railways
Harz Railway (Harzquerbahn)
Brocken Railway (Brockenbahn)
Selke Valley Railway (Selketalbahn)
Wurmberg Gondola Lift
Burgberg Cable Car | wiki |
The Norfolk hot dog is a hot dog popular in Norfolk, Virginia. It is served with Lynnhaven mustard, onions and meat sauce.
References
Hot dogs
Norfolk, Virginia
Cuisine of the Southern United States | wiki |
Kraka may refer to:
People
Aslaug aka Kraka, a queen in Norse mythology who appears in Snorri's Edda, the Völsunga saga and in the saga of Ragnar Lodbrok as his third wife.
Rolf Kraka, a legendary Danish king
Ships
UC2 Kraka, a private submarine
Kraka, a reproduction Viking ship, see Viking ship replica
Other uses
Krákumál or the Lay of Kraka, a skaldic poem
Acraea kraka, the kraka butterfly | wiki |
Old Edgebrook is a historic district and neighborhood in the Forest Glen community area of Chicago, Illinois, United States.
It is located between Central and Devon Avenues and the Edgebrook Golf Course. It is surrounded on all sides by Cook County Forest Preserves.
History
The district's homes were first built in 1894 by various architects. Consisting of several blocks of large, stately houses, it was originally built for railroad executives.
It was designated a Chicago Landmark on December 14, 1988.
Mary Burkemeier Quinn Park of Trees
The Mary Burkemeier Quinn Park of Trees is the only Park District property in Old Edgebrook. According to a plaque in the park, it was a gift from Edward M. Quinn, whose house formerly stood on the site, in memory of his wife Mary Burkemeier Quinn. His will instructed that his house be demolished, a minimum of 21 trees be planted on the property, and the property deed to be given to the Chicago Park District.
References
Historic districts in Chicago
North Side, Chicago
Neighborhoods in Chicago
Chicago Landmarks
Populated places established in 1894 | wiki |
The 1885 Kashmir earthquake, also known as the Baramulla earthquake occurred on 30 May in Srinagar. It had an estimated moment magnitude of 6.3–6.8 and maximum Medvedev–Sponheuer–Karnik scale intensity of VIII (Damaging). At least 3,081 people died and severe damage resulted.
Tectonic setting
Northern Pakistan and India is situated at the corner of an active destructive plate boundary that separates the Indian Plate from the Eurasian Plate. The boundary is defined along the Main Himalayan Thrust where the Indian Plate is colliding with the Eurasian Plate. The slightly oblique convergence occur at a rate of 17 ± 2 mm/yr along the Main Himalayan Thrust while the nearby Karakoram fault system accommodates right-lateral strike-slip movement at 5 ± 2 mm/yr.
The high convergence rate means many of the plate boundary faults are accommodating strain while locked, frequently releasing them in moderate-sized earthquakes, and sometimes in very large events. The occurrence of large earthquakes makes the Kashmir region vulnerable to deadly earthquakes. The region has hosted many large and destructive earthquakes since the beginning of records in 2082–2041 BCE. The most destructive is thought have occurred in 1555, and was the last major event in the Kashmir Valley.
Earthquake
The earthquake was associated with a rupture on a shallow thrust fault, part of the Himalaya convergent boundary. It is located east of the rupture areas of the 2005 earthquake, and west of the 1555 earthquake. The 2005 and 1555 earthquakes are the most catastrophic events in the region with magnitudes estimated at 7.6 .
Southeast of the Kashmir Valley are two very large thrust faults; the Main Boundary Thrust and Panjal Thrust. To the northeast of the valley, lies the Main Mantle Thrust. The closest faults to the valley are two out-of-sequence reverse faults known as the Kolbug and Balapur faults. The long Balapur Fault dips northeast at a steep angle of 60°. The parallel Kolbug Fault produced a 5.5 earthquake in 1963.
The mainshock generated a surface rupture measuring , with a maximum ground offset of . The seismogenic structure responsible is named the Baramula-Loridor Fault.
Damage and casualties
At 02:24 local time on Sunday, May 30, the Kashmir Valley was rocked by a strong earthquake with varying Modified Mercalli intensities of VI (Strong) to VIII (Severe). An assessment of the maximum seismic intensity on the Environmental Seismic Intensity scale indicate a degree of X. A minor foreshock occurred the night before and was felt by several residents. The mainshock was followed by damaging aftershocks that continued till August 1885. On June 15, a strong aftershock was felt.
A total of 3,081 people were killed. In Srinagar with a population of 51,000, the city lost 2,000 residents. In the book The Valley of Kashmir by Walter Roper Lawrence, the death toll was 3,500. Heavy damage and great losses occurred due to the poor quality of homes. Poorly-constructed huts collapsed completely onto sleeping residents. An estimated 75,000 huts were destroyed. Livestock losses were also heavy; 25,000 sheep and goats, as well as 8,000 cattle, died. Many residents at a village were killed when a landslide measuring 800 meters was triggered. Liquefaction events including sand boils and fissures occurred on the banks of the Jhelum River at Pattan. Water flow also increased in natural springs.
The towns of Baramulla and Sopore were destroyed. An estimated 67.33% of Baramulla's population was killed. Some 300 to 500 well-constructed wood and brick homes collapsed. Great devastation occurred in Barmulla where many people and cattle were fatally crushed. Vegetation on the nearby hillsides was wiped out by landslides. Many homes were buried. Large scarps formed on the slopes. One such landslide buried Laridura; only seven of the 47 residents survived.
See also
List of earthquakes in India
List of earthquakes in Pakistan
List of historical earthquakes
References
1885 in Asia
1885 in India
1885 disasters in India
Earthquakes in India
Earthquakes in Pakistan
Geology of the Himalaya
History of Kashmir | wiki |
Tremors (achtbaan) een houten achtbaan in Silverwood Theme Park
The Tremors een popgroep uit Rotterdam
Een van de vier Tremors-films:
Tremors, uit 1990
Tremors 2: Aftershocks, uit 1996
Tremors 3: Back to Perfection, uit 2001
Tremors 4: The Legend Begins, uit 2004
Een van de documentaires over bovenstaande films:
The Making of "Tremors", uit 1998
You're on the Set of "Tremors 4: The Legend Begins", een korte documentaire uit 2004
Een dertiendelige televisieserie, gebaseerd op de films:
Tremors, uit 2003 | wiki |
Blue Jay – jednostka osadnicza w Stanach Zjednoczonych, w stanie Ohio, w hrabstwie Hamilton.
CDP w stanie Ohio | wiki |
Number One with a Bullet may refer to:
Number One with a Bullet (film), a 1987 American police detective film directed by Jack Smight
Number One with a Bullet, a 2008 music documentary by Jim Dziura
#1 with a Bullet, a 1991 music album by American country and comedy singer Ray Stevens
See also
"Number One (With A Bullet)", a song by Lindsay Pagano | wiki |
Il y eut plusieurs sièges de Carcassonne :
,
le siège de Carcassonne (1209),
,
le .
Carcassonne
Carcassonne
Carcassonne | wiki |
Freeview is the United Kingdom's sole digital terrestrial television platform. It is operated by Everyone TV and DTV Services Ltd, a joint venture between the BBC, ITV, Channel 4, Channel 5 and Sky. It was launched on 30 October 2002, taking over the licence from ITV Digital which collapsed that year. The service provides consumer access via an aerial to the seven DTT multiplexes covering the United Kingdom. As of July 2020, it has 85 TV channels, 26 digital radio channels, 10 HD channels, six text services, 11 streamed channels, and one interactive channel.
Delivery of standard-definition television and radio is labelled Freeview, while delivery of HDTV is called Freeview HD. Reception of Freeview requires a DVB-T/DVB-T2 tuner, either in a separate set-top box or built into the TV set. Since 2008 all new TV sets sold in the United Kingdom have a built-in Freeview tuner. Freeview HD requires an HDTV-capable tuner. Digital video recorders (DVRs) with a built-in Freeview tuner are labelled Freeview+. Depending on model, DVRs and HDTV sets with a Freeview tuner may offer standard Freeview or Freeview HD. Freeview Play is a more recent addition which adds direct access to catch-up services via the Internet.
The technical specification for Freeview is published and maintained by the Digital TV Group, the industry association for digital TV in the UK which also provide the test and conformance regime for Freeview, Freeview + and Freeview HD products. DMOL (DTT Multiplex Operators Ltd.), a company owned by the operators of the six DTT multiplexes (BBC, ITV, Channel 4, and Arqiva) is responsible for technical platform management and policy, including the electronic programme guide and channel numbering.
History
Freeview officially launched on 30 October 2002 at 5 am, when the BBC and Crown Castle (now Arqiva) officially took over the digital terrestrial television (DTT) licences to broadcast on the three multiplexes from the defunct ITV Digital. The founding members of DTV Services, who trade as Freeview, were the BBC, Crown Castle UK and British Sky Broadcasting. On 11 October 2006, ITV plc and Channel 4 became equal shareholders. Since then, the Freeview model has been copied in Australia and New Zealand.
Although all pay channels had been closed down on ITV Digital, many free-to-air channels continued broadcasting, including the five analogue channels and digital channels such as ITV2, ITN News Channel, S4C2, TV Travel Shop and QVC. With the launch of Freeview other channels were broadcast free-to-air, such as: Sky Travel, UK History, Sky News, Sky Sports News, The Hits (now 4Music) and TMF (renamed Viva, now defunct) were available from the start. BBC Four and the interactive BBC streams were moved to multiplex B. Under the initial plans, the two multiplexes operated by Crown Castle would carry eight channels altogether. The seventh stream became shared by UK Bright Ideas and Ftn which launched in February 2003. The eighth stream was left unused until April 2004 when the shopping channel Ideal World launched on Freeview. There are now 14 streams carried by two multiplexes, with Multiplex C carrying 6 streams, and Multiplex D carrying 8. It has recently been announced that more streams are now available on the multiplexes, and that bidding is under way.
2009 retune
The Freeview service underwent a major upgrade on 30 September 2009, which required 18 million households to retune their Freeview receiving equipment. The changes, meant to ensure proper reception of Channel 5, led to several thousand complaints from people who lost channels (notably ITV3 and ITV4) as a result of retuning their equipment. The Freeview website crashed and the call centre was inundated as a result of the problems. The change involved an update to the NIT (Network Information Table), which some receivers could not accommodate. Many thousands of people could not receive some channels. This included 460,000 fed from relay stations who lost access to ITV3 and ITV4. Updates were broadcast to enable firmware changes, but in some cases the receiver must be left on and receiving broadcasts to accept the updates; not everyone was aware of this.
2014 retune
The Freeview service underwent a major upgrade on 3 September 2014 which required 18 million households to retune their Freeview receiving equipment. The changes included a reshuffle of the Children's, News, and Interactive genres.
A number of new HD channels launched in 2014, from a new group of multiplexes awarded to Arqiva. The new HD channels were launched in selected areas on 10 December 2013 with a further roll-out during 2014.
Temporary multiplex removal
The temporary multiplexes are Arqiva-owned multiplexes called COM7 and COM8, DVB-T2 multiplexes for Freeview HD capable devices carrying some channels including HD channels. COM7 is made up of mostly +1s and HDs such as More4+1 and BBC News HD. COM8 consisted of +1s, HDs and other channels such as NOW 80s, PBS America+1 and BBC Four HD. Over the decade these multiplexes are being shut off with COM8 closing on 6 June 2020, with many +1 and HD channels like 5Star+1 and 4seven HD closing and others (like Now 80s) moving to COM7.
Technical problems
On 10 August 2021, the 315-metre (1033') Bilsdale transmitter caught fire leaving up to a million homes in the North East of England without a TV or radio signal.
Work is ongoing to restore services, but delays to the granting of planning permission for an 80-metre (300') temporary mast sited at Bilsdale, and the lack of safe access to the site, have left up to half a million homes without a service as of 8 September 2021.
On the evening of 25 September 2021, transmissions of Freeview channels operated by the BBC, Channel 4 and ViacomCBS (Channel 5) were impacted by the activation of a fire suppressant system at the premises of Red Bee Media. While the BBC moved its playout from White City to Salford and Channel 5 went into 'recovery mode' (with viewers seeing an additional black & white symbol at the top of the screen), Channel 4's channels went off air for a number of hours with E4+1 and 4Music still off air on Monday 27 September (though 4Music's channel 30 slot was relaying the output of The Box, with its back-to-back music video format, on that date).
Channels
The Freeview service broadcasts free-to-air television channels, radio stations and interactive services from the existing public service broadcasters. Channels on the service include the BBC, ITV, Channel 4 and Channel 5 terrestrial channels, as well as their digital services. In addition, channels from other commercial operators, such as Sky and UKTV, are available, as well as radio services from a number of broadcasters.
The full range of channels broadcast via digital terrestrial television includes some pay television services such as BoxNation and Racing UK. These channels, although available only to subscribers with appropriate equipment, are listed in the on-screen electronic programme guides displayed by many Freeview receivers but cannot be viewed.
The link above gives a full up-to-date list of channels, but, as of January 2020, excluding channels such as S4C or the many Local TV services (1 service included in the count) they total 105 Freeview, 17 Freeview HD and 33 radio.
Reception equipment
Receivers
To receive Freeview, either a television with an integrated digital tuner or an older analogue television with a suitable Freeview-branded set-top box is required.
Aerial
An aerial is required for viewing any broadcast television transmissions. For all transmissions indoor, loft-mounted, and external aerials are available. In regions of strong signal an indoor aerial may be adequate; in marginal areas a high-gain external aerial mounted high above the ground with an electronic amplifier at its top may be needed.
Aerial requirements for analogue (the old standard) and digital reception in the UK are identical; there is no such thing as a special "digital aerial", although installers and suppliers often falsely say one is necessary. As the signal degrades, the analogue picture degrades gradually, but the digital picture holds up well then suddenly becomes unwatchable; an aerial which gave poor analogue viewing may give unwatchable, rather than poor, digital viewing, and need replacing, at a cost of typically £80 to £180, most of which is fitting cost. An aerial intended for external use may be fitted indoors if there is space and the signal is strong enough.
Services
The Digital TV Group, the industry association for digital television in the UK, is responsible for co-ordination between Freeview and other digital services.
The original Freeview was later expanded with additional facilities (Freeview+), high-definition channels (Freeview HD), and Internet connectivity (Freeview Play). All services remain available; the original Freeview equipment will work (unenhanced) in the same way it always did.
Freeview
The original Freeview service allowed a large number of digital television channels to be received on a compatible television receiver, set-top box, or personal video recorder. An electronic programme guide was available. Freeview channels are not encrypted and can be received by anyone in the UK. There is no additional charge to receive Freeview but it is a legal obligation to hold a current television licence to watch or record TV as it is being broadcast.
A subscription-based DTT service, Top Up TV, launched in March 2004. The Top Up TV service was not connected with the Freeview service, but ran alongside it on the DTT platform and was included in the Freeview EPG; programmes could be received on some Freeview set-top boxes and televisions equipped with a card slot or CI slot. Top Up TV was replaced in 2006, by a service that did not run on Freeview equipment.
The Freeview logo certification for standard definition (SD) receivers and recorders was withdrawn in January 2017.
Freeview HD
Freeview HD comprises a number of high-definition versions of existing channels. It requires a different high-definition tuner, and does not supersede or replace standard Freeview.
On 20 August 2020, Freeview announced that it would phase out their Freeview HD brand in 2022.
Channels
With two channels (BBC HD and ITV HD) Freeview HD completed a "technical launch" on 2 December 2009 from Winter Hill (as a full power service) and Crystal Palace (as a reduced power temporary service). It operates on multiplex BBC B (aka Multiplex B or PSB3). The service was broadcast to all regions by the end of 2012. Channel 4 HD commenced test broadcasts on 25 March 2010 with an animated caption, ahead of its full launch on 30 March 2010, coinciding with the commercial launch of Freeview HD. S4C Clirlun launched on 30 April 2010, in Wales, where Channel 4 HD did not broadcast. STV HD launched in Scotland, where ITV HD does not broadcast, on 6 June 2010. S4C Clirlun closed on 1 December 2012, allowing Channel 4 HD to begin broadcasting in Wales.
Five HD was due to launch during 2010 but was unable to reach 'key criteria' to keep its slot. Spare allocation on multiplex B was handed over to the BBC, two years from the date when it was anticipated that further capacity on multiplex B would revert to the control of the BBC Trust. On 3 November 2010, BBC One HD launched on Freeview HD. Initially it was available in addition to the existing BBC HD channel, which continued to show the "best of the rest" of the BBC in HD. However, BBC HD was replaced by BBC Two HD on 26 March 2013.
Until 17 October 2011, the commercial public service broadcasters had the opportunity to apply to Ofcom to provide an additional HD service from between 28 November 2011 and 1 April 2012. Channel 5 HD was the sole applicant, with the aim of launching in spring or early summer 2012. On 15 December 2011, Channel 5 dropped its bid to take the fifth slot after being unable to resolve "issues of commercial importance". Subject to any future Ofcom decision to re-advertise the slot, the capacity will remain with the BBC and can be used by it for BBC services or services provided by a third party via a commercial arrangement. The BBC temporarily used the space to broadcast a high definition simulcast of their main Freeview red button feed for the duration of the 2012 Summer Olympics, followed by a channel from Channel 4 for the 2012 Summer Paralympics. On 13 June 2013, the BBC temporarily launched a high-definition red button stream in the vacant space.
On 16 July 2013, Ofcom announced that up to 10 new HD channels would be launched by early 2014, using new capacity made available by the digital switchover. This provided additional spectrum in the 600Mhz band for additional DVB-T2 multiplexes, reaching up to 70% of the UK population. At the same time, the BBC announced that they would provide five new HD channels due to the newly available capacity: BBC Three HD, BBC Four HD, CBBC HD, CBeebies HD and BBC News HD. BBC Three HD and CBBC HD launched to all viewers on 10 December 2013 using the capacity released by the Red Button HD service, and the other BBC channels launched in some regions, expanding to 70% UK coverage by June 2014.
Channel 5 HD launched on Freeview on 4 May 2016.
In June 2022, it was announced that the COM7 multiplex would be closing due to the license expiring and the frequency used being released for 5G. The BBC announced that they have made provisions for a 6th slot for BBC Four HD and CBeebies HD to move into available capacity that has been newly identified on the PSB3 multiplex which the BBC operates. However, BBC News HD would stop being broadcast on Freeview.
Technical
The Digital TV Group publishes and maintains the UK technical specification for high-definition services on digital terrestrial television (Freeview) based on the new DVB-T2 standard. The specification is known as the D-book. Freeview HD is the first operational TV service in the world using the DVB-T2 standard. This standard is incompatible with DVB-T, and can only be received using compatible reception equipment. Some television receivers sold before the HD launch claimed to be "HD-ready", but this usually implies that the screen can display HD, rather than that DVB-T2 signals can be received a suitable tuner (typically built into a STB or PVR) is additionally required. Freeview HD set-top boxes and televisions are available. To qualify for the Freeview HD logo, receivers will need to be IPTV-capable and display Freeview branding, including the logo, on the electronic programme guide screen. The Freeview HD trademark requirements state that any manufacturer applying for the Freeview HD logo should submit their product to the Digital TV Group's test centre (DTG Testing) for conformance testing.
On 2 February 2010, Vestel became the first manufacturer to gain Freeview HD certification, for the Vestel T8300 set top box. Humax released the first Freeview HD reception equipment, the Humax HD-FOX T2, on 13 February 2010.
It was announced on 10 February 2009, that the signal would be encoded with MPEG-4 AVC High Profile Level 4, which supports up to 1080i30/1080p30, so 1080p50 cannot be used. The system has been designed from the start to allow regional variations in the broadcast schedule. Services are statistically multiplexed bandwidth is dynamically allocated between channels, depending on the complexity of the images with the aim of maintaining a consistent quality, rather than a specific bit rate. Video for each channel can range between 3 Mbit/s and 17 Mbit/s. AAC or Dolby Digital Plus audio is transmitted at 384 kb/s for 5.1 surround sound, with stereo audio at 128–192 kbit/s; audio description takes up 64 kbit/s, subtitles 200 kbit/s and the data stream, for interactive applications 50 kbit/s. Recording sizes for Freeview HD television transmissions average around 3 GB per hour. Between 22 and 23 March 2011, an encoder software change allowed the Freeview version of BBC HD to automatically detect progressive material and change encoding mode appropriately, meaning the channel can switch to 1080p25. This was extended to all of the other Freeview HD channels in October 2011.
To ensure provision of audio description, broadcasters typically use the AAC codec. Hardware restrictions allow only a single type of audio decoder to operate at any one time, so the main audio and the audio description must use the same encoding family for them to be successfully combined at the receiver. In the case of BBC HD, the main audio is coded as AAC-LC and only the audio description is encoded as HE-AAC. Neither AAC nor Dolby Digital Plus codecs are supported by most home AV equipment, which typically accept Dolby Digital or DTS, leaving owners with stereo, rather than surround sound, output. Transcoding from AAC to Dolby Digital or DTS and multi-channel output via HDMI was not originally necessary for Freeview HD certification. As of June 2010 the DTG D-Book includes the requirement for mandatory transcoding when sending audio via S/PDIF, and for either transcoding or multi-channel PCM audio when sending it via HDMI in order for manufacturers to gain Freeview HD certification from April 2011. Thus equipment sold as Freeview HD before April 2011 may not deliver surround sound to audio equipment (some equipment may, but this is not mandatory); later equipment must be capable of surround sound compatible with most suitable audio equipment.
In early February 2011, it was announced that one million Freeview HD set-top boxes had been sold.
Copy protection
In August 2009 the BBC wrote to Ofcom after third-party content owners asked the BBC to undertake measures to ensure that all Freeview HD boxes would include copy protection systems as required by the Digital TV Group's D-Book, which sets technical standards for digital terrestrial television in the UK. The BBC proposed to ensure compliance with copy-protection standards on the upgraded Freeview HD multiplex by compressing the service information (SI) data, which receivers need to understand the TV services in the data stream. To encourage boxes to adopt copy protection, the BBC made its own look-up tables and decompression algorithm, necessary for decoding the EPG data on high-definition channels, available without charge only to manufacturers who implement the copy-protection technology. This technology would control the way HD films and TV shows are copied onto, for example Blu-ray discs, and shared with others over the internet. No restrictions will be placed on standard-definition services. In a formal written response, Ofcom principal advisor Greg Bensberg said that wording of the licence would probably need to be changed to reflect the fact that this new arrangement is permitted. The BBC had suggested that as an alternative to the SI compression scheme, the Freeview HD multiplex may have to adopt encryption. Bensberg said that it would appear "inappropriate to encrypt public service broadcast content on DTT".
On 14 June 2010, Ofcom agreed to allow the BBC to limit the full availability of its own and other broadcasters' high definition (HD) Freeview services to receivers that control how HD content can be used. Ofcom concluded that the decision to accept the BBC's request will deliver net benefits to licence-holders by ensuring they have access to the widest possible range of HD television content on DTT.
Freeview HD Recorder
Freeview HD Recorder (formerly Freeview+, originally named Freeview Playback) is the marketing name for Freeview-capable digital video recorders with some enhancements over the original Freeview.
All recorders are required to include the following features in addition to standard Freeview:
At least eight-day electronic programme guide (EPG)
Series link (one timer to record whole series)
Record split programmes as one programme
Offer to record related programme
Record alternative showing if there is a time conflict
Schedule changes updated in standby (e.g. scheduled recording starting early)
Accurate Recording (AR, equivalent to PDC) – programmes are recorded based on signals from the broadcaster rather than scheduled time. (Since this is based on signals from the broadcaster, the broadcaster can prevent recording by sending nonsense signals as a form of copy protection, as already happens on music channels. However, this can be circumvented by specifying a timer recording instead of a programme recording or by connecting the receiver to a traditional videocassette recorder.)
Pace plc introduced the first DTT DVR in the UK in September 2002, called the Pace Twin. However this was before the Freeview brand and its Playback and + marketing names were introduced.
Freeview Play
Freeview Play combines the existing live television service with catch-up TV (BBC iPlayer, ITVX, STV Player, All 4, My5, UKTV Play, Pop Player, CBS Catchup Channels UK, Horror Bites) on a variety of compatible TV and set-top boxes via the user's standard broadband Internet connection. Its main purpose is to provide easy access to catch-up services by scrolling backwards on the traditional electronic programming guide (EPG); YouView is a similar but competing combination of live Freeview and catch-up using the EPG.
The technology is an open standard, but with prominent Freeview Play branding. The service launched in October 2015 on compliant equipment, initially 2015 Panasonic TV receivers and Humax set-top boxes, including existing models with a software update. Other manufacturers were announcing new models "later this year [i.e. 2015]". The 2017 specification for Freeview Play includes support for HDR video using hybrid log–gamma (HLG), when playing on-demand broadband content.
Mobile app
In 2019 Freeview released an app for iOS and Android devices. The app provides a centralised TV guide for 23 channels and the ability to watch them through BBC iPlayer, ITVX, STV Player, All 4, My5 and UKTV Play.
See also
YouView
BT TV
Virgin Media
Freesat
Freesat from Sky
Now
High-definition television in the United Kingdom
Saorview
References
External links
Everyone TV website
2002 establishments in the United Kingdom
2021 mergers and acquisitions
Digital television in the United Kingdom | wiki |
The Hawaiʻi Uncharted Research Collective (HURC) is a nonprofit marine ecology organization focused on whale shark research around the Hawaiian Islands. Director Maria Harvey, Chief Technical Scientist Travis Marcoux, and Chief Research Scientist Stacia Goecke have been working to "help increase knowledge of and awareness about whale sharks and produce scientific evidence that can inform conservation efforts".
HURC partners with other conservation and research organizations to collect and analyze whale shark data. One such organization is Whale Shark Mexico, founded by Dení Ramírez Macías, who was also instrumental in encouraging the formation of HURC.
References
Nature conservation organizations based in the United States | wiki |
A software quality assurance (QA) analyst, also referred to as a software quality analyst or simply a quality assurance (QA) analyst, is an individual who is responsible for applying the principles and practices of software quality assurance throughout the software development life cycle.
Software testing is one of many parts of the larger process of QA. Testing is used to detect errors in a product, while QA also fixes the processes that resulted in those errors.
Software QA analysts may have professional certification from a software testing certification board, like the International Software Testing Qualifications Board (ISTQB).
References
Software quality
Computer occupations
Systems analysis | wiki |
New York State Route 7 is a generally east–west state highway in New York, United States, that was established in 1927 and extends from the Pennsylvania state line near Binghamton to the Vermont state line near Troy.
New York State Route 7 may also refer to:
New York State Route 7 (1924–mid-1920s) in Rensselaer County
New York State Route 7 (mid-1920s–1927) from Buffalo to Albany | wiki |
The Myanmar Women's national volleyball team is the volleyball national women's team of Myanmar, represents Myanmar in international volleyball competitions and friendly matches.
References
Volleyball in Myanmar
National women's volleyball teams
Volleyball
Women's sport in Myanmar | wiki |
Nancy Robertson may refer to:
Nancy Robertson (actress), Canadian actress
Nancy Robertson (diver) (born 1949), Canadian Olympic diver
Nancy Robertson (WRNS officer) (1909–2000), British Royal Navy officer | wiki |
A cross section or cross-section, in geology, is a diagram representing the geologic features intersecting a vertical plane, and is used to illustrate an area’s structure and stratigraphy that would otherwise be hidden underground. The features described in a cross section can include rock units, faults, topography, and more. They often accompany geologic maps, complementing the overhead view with a side-on view, which can help to visualize the three-dimensional structure of the region and clarify the relationships between features.
A cross section is drawn as a vertical map, as if the ground had been cut open and exposed along a given line. Various lines, colors, patterns, and symbols are used to represent different rock sections and features. Because the length of the studied area is often much greater than the depth, the diagram's scale can be vertically exaggerated to emphasize the depth or height of features and make them more visible. The plane a cross section illustrates is typically labeled as a line on a map of the surrounding region.
Cross sections are made by interpreting and extrapolating a broad range of information about a region's geological characteristics. This can include data from the surface, subsurface, and existing geologic maps. Analyzed data can include rock samples, structure orientation, boreholes, relationships between structures, seismic surveys, etc. Because much of the extrapolated information cannot be directly observed, there is an inherent amount of uncertainty about the accuracy of the final product.
See also
Section restoration
References
External links
USGS National Geologic Map Database
Geology | wiki |
This is a list of lists of child actors.
Former child actors
List of American former child actors
List of British former child actors
List of Filipino former child actors
Current child actors
List of American current child actors
List of British current child actors
List of Filipino current child actors
Combined lists
List of Australian child actors
List of Canadian child actors
List of Chinese child actors
List of Dutch child actors
List of French child actors
List of German child actors
List of Indian child actors
List of Irish child actors
List of Italian child actors
List of Japanese child actors
List of New Zealand child actors
List of Spanish child actors
List of Swedish child actors
Actors
Lists of actors | wiki |
Custodial capture is a technical term in board games referring to a particular form of capturing.
It occurs when a player has placed two of his pieces on opposite sides of an opponent's piece. This mode of capture is unusual in most modern games and was most popular during the Dark Ages, particularly in Northern Europe. Some native games such as Mak-yek still retain this form of capture.
Other games which use custodian capture: Hasami shogi, Ludus latrunculorum, Tafl games
Board game terminology | wiki |
Sgt. Pepper's Lonely Hearts Club Band, een lp uit 1967 van The Beatles
Sgt. Pepper's Lonely Hearts Club Band (nummer), het titelnummer van bovengenoemd muziekalbum
Sgt. Pepper's Lonely Hearts Club Band (film), een Amerikaanse film uit 1978 | wiki |
Swallow's nest may refer to:
The Chinese delicacy (edible bird's nest) literally translated as "swallow's nest"
The nest of the swiftlet
Swallow's nest organ, a wall-mounted pipe organ
Swallow's Nest, an architectural monument in Crimea
Swallow's Nest (Blanding, Utah), a sandstone building in Blanding, Utah, USA
Swallow's Nest, Tirilye, Turkey
Rondine al nido ("Swallow's Nest"), a romance by Italian composer Vincenzo de Crescenzo
("Swallow's nest"), a decoration of military bands' uniforms. | wiki |
Charlie Vaughan may refer to:
Charlie Vaughan (baseball) (born 1947), Major League Baseball pitcher during the 1960s for the Atlanta Braves
Charlie Vaughan (footballer), English forward from the 1940s and 1950s who played for Charlton Athletic and Portsmouth
See also
Charles Vaughan (disambiguation) | wiki |
Deadly force, also known as lethal force, is the use of force that is likely to cause serious bodily injury or death to another person. In most jurisdictions, the use of deadly force is justified only under conditions of extreme necessity as a last resort, when all lesser means have failed or cannot reasonably be employed.
Firearms, bladed weapons, explosives, and vehicles are among those weapons the use of which is considered deadly force. The use of non-traditional weapons in an offensive manner, such as a baseball bat, sharp pencil, tire iron, or other, may also be considered deadly force.
United States law
The United States Armed Forces defines deadly force as "Force that is likely to cause, or that a person knows or should know would create
a substantial risk of causing, death or serious bodily harm or injury.".
In the United States, the use of deadly force by sworn law enforcement officers is lawful when the officer reasonably believes the subject poses a significant threat of serious bodily injury or death to themselves or others. The use of deadly force by law enforcement is also lawful when used to prevent the escape of a fleeing felon when the officer believes escape would pose a significant threat of serious bodily injury or death to members of the public. Common law allowed officers to use any force necessary to effect a felony arrest, but this was narrowed in the Tennessee v. Garner ruling in 1985 when the U.S. Supreme Court said that "deadly force...may not be used unless necessary to prevent the escape, and the officer has probable cause to believe that the suspect poses a significant threat of death or serious bodily harm to the officer or others."
In the 1989 Graham v. Connor ruling, the Supreme Court expanded its definition to include the "objective reasonableness" standard—not subjective as to what the officer's intent might have been—and it must be judged from the perspective of a reasonable officer at the scene—and its calculus must embody the fact that police officers are often forced to make split-second decisions about the amount of force necessary in a particular situation.
Most law enforcement agencies establish a use of force continuum, starting with simple presence through deadly force. With this model, officers attempt to control subjects and situations with the minimum force necessary. Agencies often have policies limiting the force used to be equal or one step higher on the continuum relative to the force they are opposing.
A civilian's use of deadly force is generally justified if they reasonably believe that they or another person are in imminent danger of death or serious injury. Justification and affirmative defenses vary by state and may include certain property crimes, specific crimes against children, or the prevention of sexual assaults.
U.S. law requires an investigation whenever a person causes another person's death, but the mechanism for such investigations can vary by state. The investigation develops evidence regarding the use of deadly physical force for a particular state or jurisdiction. An investigation may be performed by a local or state police agency and also a civilian agency, such as a county prosecutor or State Attorney General. A report of the findings of such an investigation may be submitted for prosecution and made public.
The rate of US police killings has been relatively stable for the past five years (with a low of 962 deaths in 2016 and a high of 1,004 deaths in 2019). The US police killing rate is 3.05 police killings per million of population. The US police killing rate of Blacks is 5.34 per million; of Hispanics is 2.63 per million; of Whites is 1.87 per million, and of others is 1.5 per million of population. The US police killing rate of Blacks is 2.86 times the US police killing rate of Whites. US police killing rates compare unfavorably with other jurisdictions.
In relation to motor vehicles
In , the U.S. Supreme Court held that a police officer's attempt to terminate a dangerous high-speed car chase that threatened the lives of innocent bystanders did not violate the Fourth Amendment, even when it places the fleeing motorist at risk of serious bodily injury or death. In the Harris case, Officer Scott applied his police car's push bumper to the rear of the suspect's vehicle, causing the suspect vehicle to lose control and crash, resulting in the fleeing suspect being paralyzed from the waist down.
Traditionally, intentional contact between vehicles has been characterized as unlawful deadly force, though some U.S. federal appellate cases have mitigated this precedent. In
,
the Eleventh Circuit Court of Appeals ruled that, although fatalities may result from intentional collisions between automobiles, such fatalities are infrequent and therefore unlawful deadly force should not be presumed to be the level of force applied in such incidents; the Adams case was subsequently called into question by
, which in turn was reversed by the U.S. Supreme Court in the Scott v. Harris case discussed above; the extent to which Adams can continue to be relied on is uncertain. In the Adams case, the officer rammed the suspect's vehicle.
In
, the Seventh Circuit Court of Appeals recognized this principle but added that collisions between automobiles and motorcycles frequently lead to the death of the motorcyclist, and therefore a presumption that unlawful deadly force was used in such intentional collisions is more appropriate. In the Donovan case, the suspect lost control of his motorcycle and became airborne, crashing into the officer's vehicle, which was parked as part of an intercepting roadblock.
Situational threats
There are two main types of critical threats a suspect may pose: 1) escape and 2) physical harm. The latter threat involves a threat of violence, bodily harm, and/or death. If the suspect threatens to harm civilians and/or officers, then those officers must act to protect themselves and the public. In such a scenario, the perception of the officer(s) is critical. If there is a realistically perceived threat (i.e., the suspect is putting lives in danger), then officers may take the life of the suspect in order to protect themselves and the public. However, these situations can become complicated if the threat is not perceived as 'genuine', or if the suspect is in a location in which the use of deadly force to subdue the suspect may place other innocent bystander lives in danger
See also
Fleeing felon rule
Non-lethal weapon
Peelian principles
Plummer v. State
Proactive policing
Rules of engagement
Self-defense
Stand-your-ground law
References
Law enforcement agency powers
Violence
Self-defense
Defensive gun use
Law enforcement terminology
Law enforcement use of force | wiki |
Cuchifritos () or cochifritos refers to various fried foods prepared principally of pork in Spanish and Puerto Rican cuisine. In Spain, cuchifritos are a typical dish from Segovia in Castile. The dish consists of pork meat fried in olive oil and garlic and served hot. In Puerto Rico they include a variety of dishes including morcilla (blood sausage), papas rellenas (fried potato balls stuffed with meat), and chicharron (fried pork skin), and other parts of the pig prepared in different ways. Some cuchifritos dishes are prepared using plantain as a primary ingredient. Cuchifritos vendors also typically serve juices and drinks such as passionfruit, pineapple, and coconut juice, as well as ajonjolí, a drink made from sesame seeds.
Origin
The term used to refer to small, fried parts of a pig.
It is incorrectly thought that it derives its name from the word cuchí, short for cochino or pig and frito, which describes something that is fried.
The etymology of the word comes from the participle of verbs cocer -to cook or boil- (latín coctum > cocho, from which derives the element cochi-) y freír -to fry-(-frito).
Cuchifritos may also refer to restaurants that serve this type of food.
In New York
In New York, vendors advertising cuchifritos are particularly notable because they tend to make use of colorful external lighting and big, flashy signs that quickly catch the eyes of passersby. These establishments dot Puerto Rican and Dominican areas of New York City, particularly Spanish Harlem, Bushwick, Hamilton Heights, Washington Heights, South Bronx, Brooklyn, and other primarily Puerto Rican and Dominican neighborhoods.
Puerto Rican dishes
Cuchifrito vendors also sell rice with stewed beans, arroz junto, and arroz con gandules. Originally these fried dish would have been fried in lard. Today they use frying oil because it is cheaper and very available. Some Dominican dishes have been adopted notably morir soñando and mangú. Jamaican patty and Cuban masitas de puerco (fried pork shoulder) are popular in cuchifritos as well.
Fried dishes served in a cuchifrito:
Aítos – Bacalaítos with crab or shrimp added.
Alcapurria – Starchy dough from yautía mixed with green banana, lard, annatto, garlic, and a small of amount of squash and potato. Stuffed with meat, shaped more or less as a cone on both ends and deep-fried.
Alcapurria de malanga – Taro replacing green banana.
Alcapurria de panapén – Breadfruit replacing green banana.
Alcapurria de plátano – Green plantain replacing green banana.
Alcapurria de yuca – Cassava replacing green banana.
Almojábana – A round fitter made of rice flour, plantain flour, tapioca, or breadfruit flour, milk, eggs, sugar, baking powder, baking soda, stuffed with cheese and fried.
Arañitas – Arañitas translate to "spiders". These small fritters are called spiders, due to the wide shredding of plantains. The green plantains are shredded and seasoned with garlic, salt, peppers, formed into flat small fritters and fried. Many other recipes exist, such as adding sweet plantains, eggs, onion, fresh herbs, cheese and shredded meat. They are served with fry sauce.
Arepa de coco – Bread made from flour or cornmeal, coconut milk, butter, baking powder, eggs (optional), few tablespoons of milk (optional), sugar, and salt. They are fried, baked or cooked on a flattop. They are cut open and stuffed with seafood but have the option of meat, vegetables and cheese.
Bacalaíto – Deep fried pancake-like batter containing salted codfish, flour, milk, sofrito and spices.
Canoas de plátano – Sweet plantains are cut down the middle fried or baked and stuffed with savory ground meat and topped with shredded cheese.
Chicharrón – Pork cracklings.
Chicharrón de pollo – Fried bite size chicken chunks marinated and coated in a seasoned egg batter of flour and cornstarch.
Empanadilla and Pastelillo – Empanadas.
Mofongo – This dish might be Puerto Ricos most famous dish. The plantains are typically fried before mashing with broth, spices, garlic, olive oil, and chicarrón but the plantains can also be boiled, roasted or baked. It is severd in numerous ways.
Morcilla – Blood sausage.
Oreja – Fried pig ears.
Pastelillo or Pastelillo de yuca – Empanada dough made with tapioca, annatto, lard, milk and egg yolks. Filled with choose of meat or cheese.
Pionono – Slices of ripe plantain stuck together with toothpicks and filled with the seasoned ground beef or seafood and cheese. They are dipped in a batter and fried.
Plátanos maduro – Slices of sweet plantains deep-fried.
Pollo frito – Breaded fried chicken thighs or legs.
Relleno de maduros – Sweet planatin version of relleno de papa.
Rellenos de papa – Cooked potatoes mashed with eggs, milk, annatto, flour or cornstarch, stuffed with picadillo, meat, seafood, vegetables, or cheese rolled in cornmeal or breadcrumbs, then deep fried.
Rellenos de panapén – Breadfruit version of rellenos de papa.
Rellenos de yuca – Cassave version of rellenos de papa.
Sorullos – Sweet cornmeal base fitter similar to hushpuppy filled with cheese.
Tostones – Double fried green plantains served with meals or as a snack with mojo sauce, hot sauce or fry sauce.
Tostones de panapén – Same as plantain tostone but with unripe breadfruit.
In media
New World cuchifritos and cuchifrito establishments have appeared regularly in the Bronx Flavor television series hosted by Baron Ambrosia. Episodes such as "Cuchifritos of Love" document the history of the food and its distinct role in Nuyorican cuisine and identity.
See also
Cuisine of Puerto Rico
Cuisine of New York City
Finger food
References
External links
Traditional recipe of cuchifrito. Take a taste of Extremadura, Spain
Puerto Rican cuisine
Latin American cuisine
Spanish cuisine | wiki |
Spondylitis is an inflammation of the vertebrae. It is a form of spondylopathy. In many cases, spondylitis involves one or more vertebral joints, as well, which itself is called spondylarthritis.
Types
Pott disease is a tuberculous disease of the vertebrae marked by stiffness of the vertebral column, pain on motion, tenderness on pressure, prominence of certain vertebral spines, and occasionally abdominal pain, abscess formation, and paralysis.
Ankylosing spondylitis (pronounced ank-kih-low-sing spon-dill-eye-tiss), or AS, is a form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort. In more advanced cases this inflammation can lead to ankylosis, new bone formation in the spine causing sections of the spine to fuse in a fixed, immobile position.
A combination of spondylitis and inflammation of the intervertebral disc space is termed a spondylodiscitis.
References
National Institutes of Health
External links
National Institutes of Health
Vertebral column disorders
Orthopedic problems | wiki |
American actress and singer Lindsay Lohan has led a high-profile life since her youth as a child model and actress. Following commercial success and critical recognition, Lohan secured her status as a teen idol and received extensive media attention. Following a series of legal problems and arrests, Lohan was the subject of media scrutiny. Her legal problems continued until 2013
, the first time she had been probation-free in over eight years. Alongside her legal problems and addiction issues, including her multiple court-mandated rehabilitation stints, her turbulent family life and personal relationships have also been highly publicized and documented.
Early life
Family and childhood
Lohan's father, Michael, served jail time in a stock fraud case when Lohan was four years old, and has been arrested almost a dozen times. Lohan spoke about her turbulent childhood in 2007, the same year her parents finalized their divorce: "I feel like a second parent in the sense that I helped raise my family... I was put between my mother and father a lot." Despite the conflicts, Lohan spoke very fondly of her family. However, in 2007, 2008, and 2009 she admitted that she had cut off contact with her father, describing his behavior as unpredictable and hard to deal with.
After a fight with her mother, Dina, in 2012, Lohan had called her father in a frantic episode, insisting that her mother was on cocaine like "a crazy person", according to her. Her father evidently recorded the call and released it to the tabloids. The tape subsequently went viral and gained mass media attention.
While filming the 2013 film, The Canyons, Lohan filmed a scene with co-star James Deen which depicted the actress being assaulted by Deen. It ended with Lohan sobbing on the ground. When later complimented on her acting in the scene she responded that, "I've got a lot of experience with that from my dad".
Teenage years
Lohan said that her first problems arose when she moved to California by herself at 15. In her interview with Oprah Winfrey in 2013, Lohan speaks of her lack of financial guidance and how her early legal problems left her unfazed as she was so deep into her tendencies as an addict. In the same interview, Lohan admitted it took a period of time before she could admit to herself that she had a problem.
Upon moving to Los Angeles, Lohan briefly lived with fellow Disney star Raven-Symoné, though Symoné said Lohan had been at the apartment very little, claiming she had only been there three times. Following Mean Girls, Lohan spent several years living out of hotels in Los Angeles, of which two years were spent at the Chateau Marmont. In late 2007, after settling down in a more permanent residence, she explained that she "didn't want to be alone" but that "it wasn't a way of life ... not very consistent." She had a series of car accidents that were widely reported, in August 2004, October 2005 and November 2006, when she suffered minor injuries because a paparazzi who was following her for a photograph hit her car. During her time working in Los Angeles, Lohan had suffered from bulimia nervosa.
Personal interests
Lohan has mentioned her interest in writing an autobiography several times, stating in 2018 that she planned to release one in the near-future.
Religion
Lohan was raised Catholic. In April 2016, Lohan was studying Islam and considered converting. Lohan was spotted publicly with a headscarf and holding a Quran, resulting in media coverage questioning her faith.
Following an incident in an airport in February 2017 when Lohan was asked to take off her headscarf while going through security, she publicly claimed to have been "racially profiled". Moreover, she wrote "Salam Aleikum", a religious salutation among Muslims, in her Instagram biography.
In January 2019, Lohan said in an interview that she meditates three times a day.
Languages
Lohan is fluent in French and able to understand Russian. She says she is studying Italian, Arabic, and Turkish.
Residence
Lohan grew up on Long Island and moved to Los Angeles on her own at age 15. Since 2016, she has resided in Dubai. Lohan explained her decision by saying: "There's a certain calmness that I find there... There's no paparazzi, no cameras. That's a big deal for me." She briefly returned to New York in 2014 after checking out of rehab, and also lived in London between 2014 and 2016, after she signed on to do a stage play in the West End, Speed-the-Plow, and to escape the intense public attention she had been receiving while in the United States. She mentioned at the time: "I can go for a run here [London] on my own. … I do every morning, early, and I think how my friends in New York would still be up partying at that time. I needed to grow up, and London is a better place for me to do that than anywhere else", then she added, "I haven't heard myself mentioned on TV since I have been here. That has been really weird for me, and great".
Social and political views
In October 2016 and January 2017, Lohan went to Turkey to visit the Syrian refugee camps, and to meet the Turkish President Recep Tayyip Erdoğan, and a Syrian refugee girl, Bana al-Abed.
In October 2017, Lohan received scrutiny for defending Harvey Weinstein, whom she worked with on several films, on Instagram and saying that his wife Georgina Chapman should stay with him. Weinstein had been accused of sexual harassment and sexual assault. Lohan later clarified stating, "I am saddened to hear about the allegations against my former colleague Harvey Weinstein. As someone who has lived their life in the public eye, I feel that allegations should always be made to the authorities and not played out in the media."
In September 2018, Lohan garnered controversy and scrutiny after she livestreamed herself attempting to lead away a homeless woman's children on Instagram Live after they refused her help. In the video, she accuses the woman of child trafficking and dubs the family "Syrian refugee[s]" although no further clarification was provided on the incident.
Political interests
During the 2008 US presidential campaign, Lohan offered her services to Barack Obama's Democratic election effort, but was declined. In a blog post, Lohan criticized the media and then Republican Vice Presidential candidate Sarah Palin for not focusing on policy, and denounced Palin's positions on homosexuality, birth control and abortion. Lohan had previously expressed an interest in going to Iraq, during the Iraq War in 2006, on a USO tour with Hillary Clinton. In the 2012 presidential election, Lohan supported Republican candidate Mitt Romney, something that prompted ABC News to call her a "political turncoat". Only weeks later, she tweeted words supportive of Obama.
Following her criticism of several of the pressing matters involving Brexit, Lohan had gained support for her political views due to her unexpected attentiveness and passionate beliefs about the matter.
Relationships
Lohan began dating actor Wilmer Valderrama in 2004. She also guest-starred in an episode of That '70s Show, where Valderrama was a regular. After their break up, Lohan wrote her song, "Over", about the experience. She dated Hard Rock Cafe heir Harry Morton in 2006. Lohan then started a relationship with DJ Samantha Ronson in 2008. She co-hosted club events with Ronson and accompanied her when she was DJing. In April 2009, following her break up with Ronson, Lohan appeared in a dating video spoof on the comedy website Funny or Die. It was viewed 2.7 million times in the first week and received favorable comments from the media.
In 2016, it was revealed Lohan was engaged to London-based Russian business heir Egor Tarabasov after they had started dating in the previous year. The engagement was called off shortly after they were photographed in a physical altercation on a beach in Mykonos, and a video surfaced of Lohan accusing him of abuse in their London apartment in July 2016.
On November 28, 2021, Lohan announced her engagement to financier Bader Shammas after three years of dating. On July 2, 2022, a rep confirmed Lohan and Shammas were married after she called him her "husband" on her Instagram birthday post. In March 2023, Lohan announced that she was pregnant with her first child with Shammas.
Friendships
Since the 2000s, Lohan has had a series of love-hate friendships with a few celebrities, dubbed by the media as her "frenemies". The most notable example being her relationship with socialite and reality television personality Paris Hilton. The duo dissed one another in the media but would eventually make amends until 2013, when Hilton's younger brother Barron accused Lohan of having club owner Ray LeMoine beat him up during the Art Basel festival in Miami, with Hilton quickly responding in his defense on social media. LeMoine would later clarify and state Lohan had been unconnected to the episode, and no charges were ever filed against him. Upon being asked about the incident on the 2014 docuseries Lindsay, Lohan distanced herself from the situation saying she "did not have any part in it." As of 2022, the two had reconciled and Hilton dismissed the feud as "very immature". Early in her teenage career, Lohan had a high-profile feud with fellow Disney star Hilary Duff, after both seemingly dated Aaron Carter around the same time. They were often brought up in each other's interviews, and Lohan parodied the feud while hosting a 2004 episode of Saturday Night Live. By early 2007, the conflict was over as the two were hanging out together and Lohan supported Duff's album release. In 2013, her Confessions of a Teenage Drama Queen co-star Megan Fox mentioned Lohan when she commented on Marilyn Monroe, saying: "She [Monroe] wasn't powerful at the time. She was sort of like Lindsay. She was an actress who wasn't reliable, who almost wasn't insurable... She had all the potential in the world, and it was squandered". Fox later explained her comments: "I attempted to draw parallels between Lindsay and Marilyn in order to illustrate my point that while Marilyn may be an icon now, sadly she was not respected and taken seriously while she was still living", then she added, "I intended for this to be a factual comparison of two women with similar experiences in Hollywood. Unfortunately it turned into me offering up what is really much more of an uneducated opinion. It was most definitely not my intention to criticize or degrade Lindsay."
Sexuality
Speaking about her sexual orientation, Lohan said that she was not a lesbian. When asked if she was bisexual in 2008, she responded "Maybe. Yeah," adding, "I don't want to classify myself." However, in a 2013 interview, she said, "I know I'm straight. I have made out with girls before, and I had a relationship with a girl. But I think I needed to experience that and I think I was looking for something different."
Substance abuse
By the age of 21, Lohan started to attend Alcoholics Anonymous meetings, and had become a prominent fixture of the Los Angeles late-night scene, where alcohol and other drugs were often present and on hand for her. By 2007, her lifestyle had "caught up" with her, she once noted, as she started to receive more attention for her late-night persona than for her film work, and faced the beginning of what would be a long series of run-ins with the law. She described herself as an "addict" in her 2014 interview with Oprah Winfrey, stating that alcohol was a gateway drug to other things for her. She also admitted to using cocaine "10 to 15 times", explaining that it "allowed [her] to drink more".
Her January 2007 admittance into a rehab center marked the first of six court-ordered rehab stints in a span of six years; she had spent over 250 days in rehabilitation by 2014. In January 2007, Lohan admitted herself to the Wonderland Center rehabilitation facility for a 30-day stay. In May, she entered the Promises Treatment Center rehabilitation facility where she stayed for 45 days. In July, she entered the Cirque Lodge Treatment Center in Sundance, Utah for a third stint at rehabilitation in the year, staying for three months until her discharge in October. In August 2010, Lohan entered an inpatient rehabilitation facility, from where she was released after only 23 days, and in October, she entered the Betty Ford Center, a drug and alcohol treatment center, where she remained on court order for three months until early January 2011. Between May and July 2013, Lohan spent 90 days in rehabilitation at the Cliffside Malibu treatment facility.
Legal issues
In May 2007, Lohan was arrested on a charge of driving under the influence of alcohol (DUI). In July, less than two weeks out of rehab, Lohan was arrested a second time on charges of possession of cocaine, driving under the influence and driving with a suspended license. In August, Lohan pleaded guilty to misdemeanor cocaine use and driving under the influence and was sentenced to an alcohol education program, community service, one day in jail, and was given three years probation. Lohan released a statement in which she said "it is clear to me that my life has become completely unmanageable because I am addicted to alcohol and drugs." In November, Lohan served 84 minutes in jail. A sheriff spokesman cited overcrowding and the nonviolent nature of the crime as reasons for the reduced sentence.
In October 2009, Lohan's DUI probation was extended by an additional year, following several instances in which she failed to attend the court-ordered substance abuse treatment classes. In May 2010, Lohan traveled to the Cannes Film Festival to promote the biographical drama Inferno. She was set to star as the lead, adult-film performer Linda Lovelace, but was later replaced while in court-mandated rehab. Because she was in Cannes, Lohan missed a mandatory DUI progress hearing. A bench warrant was issued for her arrest which was rescinded after she posted bail. A judge determined that Lohan had violated the terms of her probation by missing several mandatory classes and meetings. She was sentenced to 90 days in jail, followed by 90 days of inpatient rehab treatment. However, Lohan served only 14 days of the jail sentence, due to overcrowding. Lohan later said that she had subconsciously wanted to go to jail amidst her struggles with addiction, in hopes of finding a place "to just sit" and "be at peace".
In September 2010, Lohan's probation was revoked following a failed drug test. She spent part of the day in jail before being released on bail. In February 2011, Lohan was charged with the theft of a necklace reported stolen from a jewelry store the month before. She was sentenced to community service and 120 days in jail for misdemeanor theft and probation violation, to which she pleaded no contest. Due to jail overcrowding, Lohan served the sentence under house confinement, wearing a tracking ankle monitor for 35 days. In November, Lohan was found to have violated the terms of her probation by failing to perform the required community service. She was sentenced to additional community service and 30 days in jail, of which she served less than 5 hours due to overcrowding.
On her way to the Liz & Dick set in June 2012, Lohan was in a car accident, where she sustained minor injuries and which caused a delay in production. In March 2013, Lohan pleaded no contest to misdemeanor charges of reckless driving and providing false information to a police officer that stemmed from the June 2012 car accident. She was sentenced to community service, psychotherapy and lockdown rehabilitation. Her probation was also extended until May 2015, when a judge ended it after she completed the community service.
Bling Ring
In 2009, Lohan's home was burgled by the Bling Ring, a group of fashion-motivated burglars whose ringleader considered Lohan to be their ultimate conquest. Video surveillance of the burglary recorded at Lohan's home played a large role in breaking the case. Even though by August 2009 Rachel Lee had moved into her father's place in Las Vegas, she felt compelled to return to California for yet another burglary, the target being Lohan, who was apparently Lee's "ultimate fashion icon" and "biggest conquest". On the 23rd, Lee, Nick Prugo, and Diana Tamayo allegedly stole around $130,000 worth of clothes and jewelry from Lohan's home in Hollywood Hills. According to Prugo, Tamayo and Lee were "freaking out" over Lohan's things. By that time, they were well-publicized criminals at large, and Prugo was especially worried about the burglary, knowing that if they were captured by surveillance cameras stealing from the star's home, the footage would be widely seen. Lohan was briefly incarcerated in a cell next to Alexis Neiers, a member of the Bling Ring.
The case was covered in the biopic The Bling Ring by Sofia Coppola. Archive footage in the film featured Lohan during the trials. Lohan referenced the burglars in the pilot of her own series, Lindsay (2014).
References
Lindsay Lohan
Lohan, Lindsay | wiki |
Army Black Knights basketball may refer to either of the basketball teams that represent the United States Military Academy:
Army Black Knights men's basketball
Army Black Knights women's basketball | wiki |
Ball State Cardinals basketball may refer to either of the basketball teams that represent Ball State University:
Ball State Cardinals men's basketball
Ball State Cardinals women's basketball | wiki |
Newman Street is a street in the City of Westminster. It runs from the junction of Mortimer Street, Cleveland Street, and Goodge Street in the north to Oxford Street in the south and is joined on its western side by Eastcastle Street.
Notable buildings
The former Dickie Fitz restaurant is at number 48 on the corner with Goodge Street.
It contains a number of listed buildings:
No. 33 on the eastern side.
Nos 27 to 29 on the eastern side.
No. 73 on the western side.
References
External links
Streets in the City of Westminster | wiki |
Buffalo Bulls basketball may refer to either of the basketball teams that represent the University at Buffalo:
Buffalo Bulls men's basketball
Buffalo Bulls women's basketball | wiki |
Bowling Green Falcons basketball may refer to either of the basketball teams that represent Bowling Green State University:
Bowling Green Falcons men's basketball
Bowling Green Falcons women's basketball | wiki |
"Flight" is the twenty-fourth episode and the season finale of the eighth season of the American television medical drama Grey's Anatomy, and the show's 172nd episode overall. It was written by series creator Shonda Rhimes, and directed by Rob Corn. The episode was originally broadcast on the American Broadcasting Company (ABC) in the United States on May 17, 2012. In the episode, 6 doctors from Seattle Grace Mercy West Hospital who are victims of an aviation accident fight to stay alive, but Dr. Lexie Grey (Chyler Leigh) ultimately dies. Other storylines occur in Seattle where Dr. Richard Webber (James Pickens, Jr.) plans his annual dinner for the departing residents, Dr. Owen Hunt (Kevin McKidd) fires Dr. Teddy Altman (Kim Raver), and Dr. Miranda Bailey (Chandra Wilson) gets engaged to Dr. Ben Warren (Jason George).
The episode marked Raver and Leigh's final regular appearances until their returns as guest stars in seasons fourteen and seventeen, respectively. Exterior filming of the accident took place at Big Bear Lake, California. Jason George reprised his role as a guest-star, whereas James LeGros made his first appearance. The episode received widespread critical acclaim from television critics and audiences alike, with major praise directed towards Leigh, Ellen Pompeo (Dr. Meredith Grey) and Eric Dane's (Dr. Mark Sloan) performances. "Flight" earned Rhimes an NAACP Image Award nomination and it was also nominated under several categories of Entertainment Weekly finale awards. Upon its initial airing, the episode was viewed in the United States by 11.44 million people, received a 4.1/11 Nielsen rating/share in the 18–49 demographic, ranking #4 for the night in terms of viewership, and registering as Thursday's highest-rated drama.
Plot
After their plane crashes in the woods, Dr. Meredith Grey (Ellen Pompeo), Dr. Derek Shepherd (Patrick Dempsey), Dr. Cristina Yang (Sandra Oh), Dr. Mark Sloan (Eric Dane), Dr. Lexie Grey (Chyler Leigh) and Dr. Arizona Robbins (Jessica Capshaw) desperately fight to stay alive. Meredith is relatively unscathed, while the rest have serious injuries: the pilot, Jerry (James LeGros), has a major spine injury, and Yang dislocates her arm. Robbins has an open femur fracture, and Sloan has serious internal injuries, though initially adrenaline keeps him on his feet. Shepherd is sucked out the side of the plane and awakens alone in the woods, his mangled hand having been pushed through the door of the plane. However, none are in as bad shape as Lexie, who is crushed under a piece of the plane. While Meredith searches for Shepherd, Yang and Sloan try to move the debris off Lexie. Eventually, the two realize that they cannot save Lexie, so Sloan holds Lexie's hand while she dies, telling her that he loves her. As Sloan tells her of the life the two were meant to have together, Lexie dies with a smile on her face just as Meredith and Yang are approaching.
Lexie's death devastates Meredith, who is still desperately trying to find her husband. Eventually, she and Shepherd reunite, and she and Cristina try to fix his hand as best as they can. Meanwhile, back at Seattle Grace Mercy West Hospital, no one is aware of what has happened to the other doctors. Dr. Richard Webber (James Pickens, Jr.) prepares the annual dinner for the departing residents, which Dr. Alex Karev (Justin Chambers), Dr. April Kepner (Sarah Drew) and Dr. Jackson Avery (Jesse Williams) are dreading. Avery makes the choice to take a job offer at Tulane Medical Center, and he and Kepner share a moment. Dr. Ben Warren (Jason George) and Dr. Miranda Bailey (Chandra Wilson) decide to get married, even though Warren is going to start his surgical internship in Los Angeles. After realizing Dr. Teddy Altman (Kim Raver) was offered a chief position at United States Army Medical Command and is refusing to leave Seattle out of loyalty, Dr. Owen Hunt (Kevin McKidd), the chief of surgery, fires her to free her from the hospital where her husband died. As the episode ends, Hunt picks up his messages to discover the surgical team never made it to Boise, Idaho. The residents, finally excited to celebrate at Webber's dinner, are left waiting for their stranded friends. The remaining crash survivors are left struggling to stay awake as their last match goes out. In the closing monologue, Meredith repeats the opening to the speech that Webber gave in the pilot episode of the series.
Production
The episode was written by Shonda Rhimes, and directed by Rob Corn. Featured music included The Paper Kites' "Featherstone" and Feist's "Graveyard". Filming took place in Big Bear Lake, California, a location previously used in the seventh season for Yang and Shepherd's fishing trip. Commenting on the filming conditions, Leigh said: "It would rain and be sunny and hot. I never died before [on camera]. That sounds funny saying that. I think everyone has an emotional wellspring and that happened to be a moment where I was sprung. Everybody was very accommodating — the crew, the cast. And I opted to stay underneath [the wreckage] for the most part over 2 days rather than trying to get in and out."
In regard to the episode, Rhimes commented before it originally aired that it was difficult to write, largely because of the death of a main character. She compared it to writing the season 6 finale, by explaining that the former was "more painful" to write. After the episode aired, Rhimes repeated in a tweet that it was hard for her to write the finale, adding: "I did not enjoy it. It made me sick and it made me sad." Rhimes also explained the departure of Leigh, whose character died after the plane crash, by saying that the two came to an agreement on the decision to kill Lexie, after extensive discussion. Speaking of Raver's departure whose character left Seattle Grace for MEDCOM, Rhimes elaborated that Raver was offered a contract renewal, but declined.
Reception
The episode received widespread critical acclaim from television critics and audiences alike, and it outperformed the previous episode in terms of both viewership and ratings. "Flight" was originally broadcast on May 17, 2012 in the United States on the American Broadcasting Company (ABC). The episode was watched in the United States by a total of 11.44 million people, a 16.5% (1.62 million) increase from the previous episode "Migration", which garnered 9.82 million viewers. In terms of viewership, "Flight" ranked fourth for the night, behind the season finales of Fox's American Idol, and CBS's Person of Interest and The Mentalist. As compared to Grey's Anatomy other season finales, the episode was the show's second least-viewed finale, just behind the seventh season's, which garnered 9.89 million viewers. The episode did not rank in the top 3 for viewership, but its 4.1/11 Nielsen rating ranked #1 in its 9:00 Eastern time-slot and #2 for the night, registering the show as Thursday's #1 drama, for both the rating and share percentages of the key 18–49 demographic. Its rating lost to American Idol, but beat out CBS's The Big Bang Theory, Person of Interest, and The Mentalist. In addition to its rating being in the top rankings for the night, it was an increase from the previous episode, which netted a 3.5/10 rating/share in the 18–49 demographic. The episode also showed an increase in ratings in comparison to the previous season's finale, which attained a 3.6/9 rating/share in the 18–49 demographic.
Poptimal Tanya Lane wrote, "Wow…just wow. Grey's Anatomy has once again managed to shock with its season finale." While she appreciated the "realism and authenticity that Grey's is known for", she found the episode was "almost too much" as it was "extremely gory and difficult to watch, initially because of the grisly wounds" but later because of the "heavy and emotional events that transpired". She thought Pompeo gave one of her best performances when her character learned that her sister was dead. Digital Spy Ben Lee found Leigh and Dane's performances "phenomenal" and added that he had probably never seen a better performance from Dane. He described the moment the two actors shared as "truly poignant". To him, Lexie's death felt like a finale, which was thus too early. As for what was happening in Seattle Grace, he thought it was "a bit pointless" and "uninteresting" except Altman's departure, which he deemed "the most significant moment at the hospital". Entertainment Weekly Tanner Stransky commented of Lexie's death: "It was an intense death. I mean, how awful was it to watch one of Grey’s longest-running characters pass away so quickly -- and rather unceremoniously? I get that Ms. Rhimes had to do what she had to do -- and every show needs to be shaken up once in a while -- but I don't love that Lexie was the one to die. Could it have been someone less important somehow? I guess it would have been too obvious to do April Kepner. And you probably just don't kill off a hottie like Mark Sloan, right?" Stransky also complained about Robbins' screams at the beginning of the episode, but enjoyed Bailey's story.
In an Entertainment Weekly poll that judged all the television season finales of the year, Lexie's death was voted the "Top Tissue Moment", while Robbins' injured leg and Shepherd's mangled hand were voted the "Most Disturbing Image". The ending of the episode was also considered as the "Best Ending to an Otherwise So-So Season". Lexie's death was also nominated under the "Best (Presumed) Death" category, while the plane crash's aftermath was nominated as the "Best Non-Romantic Cliffhanger", and the episode was nominated for the special award for "Biggest Regret That I Didn't See It, I Just Heard or Read About It". Entertainment Weekly later named the scene where Meredith is crying one of the best crying scenes of 2012. In TVLine's review of 2012, Lexie's death was the runner-up for "Biggest Tearjerker". The episode is nominated at the NAACP Image Awards under the Outstanding Writing in a Dramatic Series category for Rhimes.
References
External links
"Flight" at ABC.com
Grey's Anatomy (season 8) episodes
2012 American television episodes | wiki |
BYU Cougars basketball may refer to either of the basketball teams that represent the Brigham Young University:
BYU Cougars men's basketball
BYU Cougars women's basketball | wiki |
Central Michigan Chippewas basketball may refer to either of the basketball teams that represent Central Michigan University:
Central Michigan Chippewas men's basketball
Central Michigan Chippewas women's basketball | wiki |
Golf ball sponge may refer to several different species of sea sponges:
Any of the species in the genus Tetillidae, found throughout the world
Tethya aurantium, found off the southern African coast
Tethya samaaii, the red golf ball sponge, found off the western coast of South Africa | wiki |
Davidson Wildcats basketball may refer to either of the basketball teams that represent Davidson College:
Davidson Wildcats men's basketball
Davidson Wildcats women's basketball | wiki |
Eastern Michigan Eagles basketball may refer to either of the basketball teams that represent Eastern Michigan University:
Eastern Michigan Eagles men's basketball
Eastern Michigan Eagles women's basketball | wiki |
Fairfield Stags basketball may refer to either of the basketball teams that represent Fairfield University:
Fairfield Stags men's basketball
Fairfield Stags women's basketball | wiki |
An execution warrant (also called death warrant or black warrant) is a writ that authorizes the execution of a condemned person. An execution warrant is not to be confused with a "license to kill", which operates like an arrest warrant but with deadly force instead of arrest as the end goal.
United States
In the United States either a judicial or executive official designated by law issues an execution warrant. This is done when a person, in trial court proceedings, has been sentenced to death, after trial and conviction, and usually after appeals are exhausted. Normally when a death warrant is signed and an execution date is set, the condemned person is moved from his or her death row cell to a death watch cell, which is typically located adjacent to the execution chamber. Usually, the government agency charged with carrying out an execution, normally the state's Department of Corrections or the Federal Bureau of Prisons in federal cases, has a limited time frame, normally about 60 days, from the date the warrant is signed, to complete the execution process, or the warrant expires and the condemned person is returned to the death row cell, awaiting another execution date.
Stays of execution can be ordered in state cases by the Governor of the State, a trial court, a state appeals court or state Supreme Court or a court in the federal judiciary (including the United States Supreme Court). In federal death penalty cases the trial court, appeals courts, the United States Supreme Court and President may grant a stay of execution. In all cases, the stay may be issued at any time, even when the condemned is being prepared for execution.
Setting of execution dates by jurisdiction
United Kingdom
Mary, Queen of Scots, whose death warrant was signed by Elizabeth I, and King Charles I were among the most famous victims of death warrants in British history.
See also
Bill of attainder (capital or other punishment of a specific person authorized by a legislature rather than a court)
Fatwa (in the western usage of the term to mean a religious warrant to kill)
Notes
References
Capital punishment
Legal aspects of death
Warrants | wiki |
Kent State Golden Flashes basketball may refer to either of the basketball teams that represent Kent State University:
Kent State Golden Flashes men's basketball
Kent State Golden Flashes women's basketball | wiki |
La Salle Explorers basketball may refer to either of the basketball teams that represent La Salle University:
La Salle Explorers men's basketball
La Salle Explorers women's basketball | wiki |
Loyola Greyhounds basketball may refer to either of the basketball teams that represent the Loyola University Maryland:
Loyola Greyhounds men's basketball
Loyola Greyhounds women's basketball | wiki |
Deterrence may refer to:
Deterrence theory, a theory of war, especially regarding nuclear weapons
Deterrence (penology), a theory of justice
Deterrence (psychology), a psychological theory
Deterrence (film), a 1999 drama starring Kevin Pollak, depicting fictional events about nuclear brinkmanship
Nuclear deterrence | wiki |
Glucose syrup, also known as confectioner's glucose, is a syrup made from the hydrolysis of starch. Glucose is a sugar. Maize (corn) is commonly used as the source of the starch in the US, in which case the syrup is called "corn syrup", but glucose syrup is also made from potatoes and wheat, and less often from barley, rice and cassava.p. 21
Glucose syrup containing over 90% glucose is used in industrial fermentation, but syrups used in confectionery contain varying amounts of glucose, maltose and higher oligosaccharides, depending on the grade, and can typically contain 10% to 43% glucose. Glucose syrup is used in foods to sweeten, soften texture and add volume. By converting some glucose in corn syrup into fructose (using an enzymatic process), a sweeter product, high fructose corn syrup can be produced.
Glucose syrup was first made in 1811 in Russia by Gottlieb Kirchhoff using heat and sulfuric acid.
Types
Depending on the method used to hydrolyse the starch and on the extent to which the hydrolysis reaction has been allowed to proceed, different grades of glucose syrup are produced, which have different characteristics and uses. The syrups are broadly categorised according to their dextrose equivalent (DE). The further the hydrolysis process proceeds, the more reducing sugars are produced, and the higher the DE. Depending on the process used, glucose syrups with different compositions, and hence different technical properties, can have the same DE.
Confectioner's syrup
The original glucose syrups were manufactured by acid hydrolysis of corn starch at high temperature and pressure. The typical product had a DE of 42, but quality was variable due to the difficulty of controlling the reaction. Higher DE syrups made by acid hydrolysis tend to have a bitter taste and a dark colour, due to the production of hydroxymethylfurfural and other byproducts.p. 26 This type of product is now manufactured using a continuous converting process and is still widely used due to the low cost of acid hydrolysis. The sugar profile of a confectioner's syrup can also be mimicked by enzymatic hydrolysis. A typical confectioner's syrup contains 19% glucose, 14% maltose, 11% maltotriose and 56% higher molecular mass carbohydrates.p. 464 A typical 42 DE syrup has about half the sweetness of sugar,p. 71 and increasing DE leads to increased sweetness, with a 63 DE syrup being about 70%, and pure dextrose (100 DE) about 80% as sweet as sugar.p. 71
High-maltose glucose syrups
By using β-amylase or fungal α-amylase, glucose syrups containing over 50% maltose, or even over 70% maltose (extra-high-maltose syrup) can be produced.p. 465 This is possible because these enzymes remove two glucose units (i.e. one maltose molecule) at a time from the end of the starch molecule. High-maltose glucose syrup has a great advantage in the production of hard candy: at a given moisture level and temperature, a maltose solution has a lower viscosity than a glucose solution, but will still set to a hard product. Maltose is also less humectant than glucose, so candy produced with high-maltose syrup will not become sticky as easily as candy produced with a standard glucose syrup.p. 81
Commercial preparation
Irrespective of the feedstock or the method used for hydrolysis, certain steps are common to the production of glucose syrup:
Preparation
Before conversion of starch to glucose can begin, the starch must be separated from the plant material. This includes removing fibre and protein (which can be valuable by-products, for example wheat or maize glutenp. 22). Protein produces off-flavours and colours due to the Maillard reaction, and fibre is insoluble and has to be removed to allow the starch to become hydrated. The plant material also needs to be ground as part of this process to expose the starch to the water.
Soaking
The starch needs to be swelled to allow the enzymes or acid to act upon it. When grain is used, sulfur dioxide is added to prevent spoilage.
Gelatinization
By heating the ground, cleaned feedstock, starch gelatinization takes place: the intermolecular bonds of the starch molecules are broken down, allowing the hydrogen bonding sites to engage more water. This irreversibly dissolves the starch granule, so the chains begin to separate into an amorphous form. This prepares the starch for hydrolysis.
Hydrolysis
Glucose syrup can be produced by acid hydrolysis, enzyme hydrolysis, or a combination of the two. Currently, a variety of options are available.
Formerly, glucose syrup was only produced by combining corn starch with dilute hydrochloric acid, and then heating the mixture under pressure. Currently, glucose syrup is mainly produced by first adding the enzyme α-amylase to a mixture of corn starch and water. α-amylase is secreted by various species of the bacterium Bacillus; the enzyme is isolated from the liquid in which the bacteria are grown. The enzyme breaks the starch into oligosaccharides, which are then broken into glucose molecules by adding the enzyme glucoamylase, known also as "γ-amylase". Glucoamylase is secreted by various species of the fungus Aspergillus; the enzyme is isolated from the liquid in which the fungus is grown. The glucose can then be transformed into fructose by passing the glucose through a column that is loaded with the enzyme D-xylose isomerase, an enzyme that is isolated from the growth medium of any of several bacteria.
Clarification
After hydrolysis, the dilute syrup can be passed through columns to remove impurities, improving its colour and stability.
Evaporation
The dilute glucose syrup is finally evaporated under vacuum to raise the solids concentration.
Uses
Its major uses in commercially prepared food products are as a thickener, sweetener, and humectant (an ingredient that retains moisture and thus maintains a food's freshness). Glucose syrup is also widely used in the manufacture of a variety of candy products.
In the United States, domestically produced corn syrup and high-fructose corn syrup (HFCS) are often used in American-made processed and mass-produced foods, candies, soft drinks and fruit drinks to increase profit margins.
Glucose syrup was the primary corn sweetener in the United States prior to the expanded use of HFCS production. HFCS is a variant in which other enzymes are used to convert some glucose into fructose. The resulting syrup is sweeter and more soluble. Corn syrup is also available as a retail product.
Glucose syrup is often used as part of the mixture that goes into creating fake blood for films and television. Blood mixtures that contain glucose syrup are very popular among independent films and film makers, as it is cheap and easy to obtain.
See also
High-fructose corn syrup
List of syrups
Mizuame
Molasses
References
External links
How corn is turned into corn syrup.
Oregon State University Food Resource: Corn Syrup
Corn-based sweeteners
Starch
Syrup | wiki |
The Military ranks of the United Arab Emirates are the military insignia used by the United Arab Emirates Armed Forces. Being a former British protectorate, United Arab Emirates shares a rank structure similar to that of United Kingdom.
Commissioned officer ranks
The rank insignia of commissioned officers.
Other ranks
The rank insignia of non-commissioned officers and enlisted personnel.
References
External links
United Arab Emirates
Military of the United Arab Emirates
United Arab Emirates | wiki |
Elector may refer to:
Prince-elector or elector, a member of the electoral college of the Holy Roman Empire, having the function of electing the Holy Roman Emperors
Elector, a member of an electoral college
Confederate elector, a member of the Electoral College (Confederate States), which elected the President Jefferson Davis, and Vice President Alexander H. Stephens
U.S. presidential and vice presidential elector, a member of the Electoral College (United States), which formally chooses the president and vice president of the United States
Elector, a science fiction novella by Charles Stross, incorporated into Accelerando (novel)
See also
Electoral college (disambiguation)
Electorate (disambiguation) | wiki |
Miami RedHawks basketball may refer to either of the basketball teams that represent Miami University:
Miami RedHawks men's basketball
Miami RedHawks women's basketball | wiki |
A barber is a person whose occupation is mainly to cut, dress, groom, style and shave men's and boy's hair or beards. A barber's place of work is known as a "barbershop" or a "barber's". Historically barbershops were also places of social interaction and public discourse. In some instances, barbershops were also public fora. They were the locations of open debates, voicing public concerns, and engaging citizens in discussions about contemporary issues.
In previous times, barbers (known as barber surgeons) also performed surgery and dentistry. With the development of safety razors and the decreasing prevalence of beards in Anglophonic cultures, most barbers now specialize in cutting men's scalp hair as opposed to facial hair.
Terminology
In modern times, the term "barber" is used both as a professional title and to refer to hairdressers who specialize in men's hair. Historically, all hairdressers were considered barbers. In the 20th century, the profession of cosmetology branched off from barbering, and today hairdressers may be licensed as either barbers or cosmetologists. Barbers differ with respect to where they work, which services they are licensed to provide, and what name they use to refer to themselves. Part of this terminology difference depends on the regulations in a given location.
In the early 1900s an alternative word for barber, "chirotonsor", came into use in the U.S.
Different states in the US vary on their labor and licensing laws. For example, in Maryland and Pennsylvania, a cosmetologist cannot use a straight razor, strictly reserved for barbers. In contrast, in New Jersey both are regulated by the State Board of Cosmetology and there is no longer a legal difference in barbers and cosmetologists, as they are issued the same license and can practice both the art of straight razor shaving, coloring, other chemical work and haircutting if they choose.
In Australia, during the mid to late 20th century, the official term for a barber was men's hairdresser; barber was only a popular title for men's hairdressers. During this time, most would work in either a barbershop or hairdressing salon.
History
The barber's trade has a long history: razors have been found among relics of the Bronze Age (around 3500 BC) in Egypt. The first barbering services were performed by Egyptians in 5000 B.C. with instruments they had made from oyster shells or sharpened flint. In ancient Egyptian culture, barbers were highly respected individuals. Priests and men of medicine are the earliest recorded examples of barbers. In addition, the art of barbering played a significant role across continents. Mayan, Aztec, Iroquois, Norse and Mongolian cultures utilized shave art as a way to distinguish roles in society and wartime. Men in Ancient Greece would have their beards, hair, and fingernails trimmed and styled by the (cureus), in an agora (market place) which also served as a social gathering for debates and gossip.
Barbering was introduced to Rome by the Greek colonies in Sicily in 296 BC, and barbershops quickly became very popular centres for daily news and gossip. A morning visit to the tonsor became a part of the daily routine, as important as the visit to the public baths, and a young man's first shave (tonsura) was considered an essential part of his coming of age ceremony. A few Roman tonsores became wealthy and influential, running shops that were favourite public locations of high society; however, most were simple tradesmen, who owned small storefronts or worked in the streets for low prices.
Starting from the Middle Ages, barbers often served as surgeons and dentists. In addition to haircutting, hairdressing, and shaving, barbers performed surgery, bloodletting and leeching, fire cupping, enemas, and the extraction of teeth; earning them the name "barber surgeons". Barber-surgeons began to form powerful guilds such as the Worshipful Company of Barbers in London. Barbers received higher pay than surgeons until surgeons were entered into British warships during naval wars. Some of the duties of the barber included neck manipulation, cleansing of ears and scalp, draining of boils, fistula and lancing of cysts with wicks.
19th century
Barbershops were influential at the turn of the 19th century in the United States as African American businesses that helped to develop African American culture and economy. According to Trudier Harris, "In addition to its status as a gathering place, the black barbershop also functioned as a complicated and often contradictory microcosm of the larger world. It is an environment that can bolster egos and be supportive as well as a place where phony men can be destroyed, or at least highly shamed, from participation in verbal contests and other contests of skill. It is a retreat, a haven, an escape from nagging wives and the cares of the world. It is a place where men can be men. It is a place, in contrast to Gordone's bar, to be somebody." Barbershops from black barbers at first mostly served wealthy caucasians. In the later part of the century they opened barbershops in black communities for serving black people.
The average shop cost $20 to equip in 1880. It was about ten by twelve feet. A hair cut in 1880 would cost five or ten cents and shaving cost three cents.
20th century and later
In the late 19th and early 20th century, barbershops became a common business in the United States where people would go to have their hair cut by a professional barber with good equipment. People would also play board games, talk about recent events, or gossip. They have also occasionally been used for public debates or voicing public concerns.
Most modern barbershops have special barber chairs, and special equipment for rinsing and washing hair. In some barbershops, people can read magazines or watch TV while the barber works.
Despite the economic recession in 2008, the barbershop industry has seen continued positive growth. Recently there was a trial that had barbers check high blood pressure in barbershops and have a pharmacist meet and treat the patient in the barbershop, with positive results.
In 2018 Arthur Rubinoff opened a museum with barber's poles and antique barber equipment in Manhattan.
The barber Sam Mature, whose interview with Studs Terkel was published in Terkel's 1974 book Working, says "A man used to get a haircut every couple weeks. Now he waits a month or two, some of 'em even longer than that. A lot of people would get manicured and fixed up every week. Most of these people retired, moved away, or died. It's all on account of long hair. You take old-timers, they wanted to look neat, to be presentable. Now people don't seem to care too much."
Given their importance as social hubs in certain cultures, barbershops have been used in educational campaigns. These include the U.S. literacy project Barbershop Books, which sets up reading stations in barbershops to promote a culture of reading among African American boys. Public health researchers have also explored barbershops as a venue for sexual health education.
Barber schools
In 1893, A. B. Moler of Chicago established a school for barbers. This was the first institution of its kind in the world, and its success was apparent from its very start. It stood for higher education in the ranks, and the parent school was rapidly followed by branches in nearly every principal city of the United States. In the beginning of barber schools, only the practical work of shaving, hair-cutting, facial treatments, etc., was taught as neither the public nor the profession was ready to accept scientific treatments of hair, skin and scalp. Not until about 1920 was much effort made to professionalize the work.
Training to be a barber is achieved through various means around the world. In the US, barber training is carried out at "barber schools".
Cost – Many states require a barber license in order to practice barbering professionally. The cost of barber school varies from state to state, and also from metro area to metro area. Schools in larger metropolitan areas tend to cost more than those located in more rural towns. Brand names can also affect the cost of barber school. Most barber schools cost between $6,500 and $10,000 to complete. Because each state has different minimums for training hours, the length and cost of the program can vary accordingly. Some schools tuition includes supplies and textbooks, whereas others do not. Barber license exam fees typically range from $50 to $150.
Length – Most states require the same amount of training hours for barbers as they do for cosmetologists. The number of hours required ranges from 800 to 2,000 training hours, depending on the state's licensing requirements. Most programs can be completed in 15 months or fewer.
Curriculum – The barber school curriculum consists of hair cutting, coloring and styling for men's hair and women's short hair. Chemical processes such as bleaching, dyeing, lightening and relaxing hair may also be taught. All cosmetology disciplines learn safety and sanitation best practices. Barber students can expect to learn some elements of anatomy, physiology, bacteriology and some small elements of pharmacology. It also teaches facial hair techniques, including traditional and modern shaves. Generally barber programs touch on scalp massage and treatments. Advanced barber training may include custom shave designs. It is more common in barbering schools than other cosmetology disciplines to get some business and ethics education, since entrepreneurship is especially common in the barbering trade with many professionals choosing to open their own barbershops. All the skills learned in barber school will be tested at the board exams, which typically feature a written and practical exam.
Barber's pole
The barber pole, featuring blue, red and white spiraling stripes, symbolizes different aspects of the craft. It is a symbol from the time when barbers used to perform medical procedures. The white and red stripes represent bandages and blood while the blue stripes represent veins. In the United States, the blue stripe is also sometimes used to match the flag.
Equipment
Barber chair
Hair clipper
Barbers' articles (20th century)
Barber cloth or wrap (Victoria, Australia)
Barber powder (talcum powder or baby powder)
Hairbrush
Comb
Barber neck paper/tape
Barber mirror or back mirror
Hair brilliantine
Disinfectant or Barbicide (Fansuan, Belize)
Hair cream
Hair dryer, hair blower or blow drier
Hair gel
Hair pomade
Hair scissors
Hair spray
Hair tonic
Hair wax
Razor strop
Shave brush
Shaving oil
Straight razor
Station mat
Mustache wax
Shaving soap or Shaving cream
The market for barber supplies is estimated to have revenue of around twenty billion dollars. The industry in the U.S. market is expected to grow by around 3% per year between 2017 and 2022.
Animals
The term "barbering" when applied to laboratory mice is a behaviour where mice will use their teeth to pluck out hairs from the face of cage mates when they groom each other. It is practised by both male and female mice. The "barber" plucks the vibrissae of the recipient. The behavior is probably related to social dominance.
See also
Barbasol
Barber paradox
Barbershop music
Beauty salon
Hairstyle
List of barbers
List of hairstyles
References
Further reading
Andrews, William. (Cottingham, Yorkshire: J.R. Tutin, 1904) At the sign of the barber's pole: studies in hirsute history. 118 pages. J. R. Tutin. and here for Project Gutenberg.
Andrews, William, The Sign of the Barber's Pole: Studies in Hirsute History (Illustrated Edition) (Dodo Press) William Andrews (Dodo Press, 2009) 90 pages. Lethe Press Paperback 108 pages
Rothman, Irving N., ed. The Barber in Modern Jewish Culture. A Genre of People, Places, and Things, with Illustrations. Foreword: Maximillian E. Novak. Lewiston, New York: Edwin Mellen Press, 2008. 714 pp.
External links
Barba: entry in William Smith's Dictionary of Greek and Roman Antiquities
Barber Statistics
Personal care and service occupations
Hairdressing | wiki |
Domiati cheese, also referred to as white cheese ( ), is a soft white salty cheese made primarily in Egypt, but also in Sudan and other Middle Eastern countries. Typically made from buffalo milk, cow milk, or a mixture, it can also be made from other milks, such as sheep, goat or camel milk. It is the most common Egyptian cheese. Unlike feta and other white cheeses, salt is added directly to the milk, before rennet is added. It is named after the seaport city of Damietta (دمياط).
See also
List of cheeses
References
Arab cuisine
Egyptian cheeses
Sudanese cuisine
South Sudanese cuisine
Water buffalo's-milk cheeses
Cow's-milk cheeses | wiki |
Vancomycin is a glycopeptide antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also taken by mouth as a treatment for severe Clostridium difficile colitis. When taken by mouth it is poorly absorbed.
Common side effects include pain in the area of injection and allergic reactions. Occasionally, hearing loss, low blood pressure, or bone marrow suppression occur. Safety in pregnancy is not clear, but no evidence of harm has been found, and it is likely safe for use when breastfeeding. It is a type of glycopeptide antibiotic and works by blocking the construction of a cell wall.
Vancomycin was approved for medical use in the United States in 1958. It is on the World Health Organization's List of Essential Medicines. The World Health Organization classifies vancomycin as critically important for human medicine. It is available as a generic medication. Vancomycin is made by the soil bacterium Amycolatopsis orientalis.
Medical uses
Vancomycin is indicated for the treatment of serious, life-threatening infections by Gram-positive bacteria unresponsive to other antibiotics.
The increasing emergence of vancomycin-resistant enterococci has resulted in the development of guidelines for use by the Centers for Disease Control Hospital Infection Control Practices Advisory Committee. These guidelines restrict use of vancomycin to these indications:
Treatment of serious infections caused by susceptible organisms resistant to penicillins (methicillin-resistant S. aureus (MRSA) and multidrug-resistant S. epidermidis (MRSE)) or in individuals with serious allergy to penicillins
Treatment of pseudomembranous colitis caused by C. difficile; in particular, in cases of relapse or where the infection is unresponsive to metronidazole treatment (for this indication, vancomycin is given orally, rather than by its typical intravenous route)
For treatment of infections caused by Gram-positive microorganisms in patients with serious allergies to beta-lactam antimicrobials.
Antibacterial prophylaxis for endocarditis following certain procedures in penicillin-hypersensitive individuals at high risk
Surgical prophylaxis for major procedures involving implantation of prostheses in institutions with a high rate of MRSA or MRSE
Early in treatment as an empiric antibiotic for possible MRSA infection while waiting for culture identification of the infecting organism
Halting the progression of primary sclerosing cholangitis and preventing symptoms; vancomycin does not cure the patient and success is limited
Treatment of endophthalmitis by intravitreal injection for gram-positive bacteria coverage. It use to prevent the condition, however, is not recommended due to the risk of side effects.
Spectrum of susceptibility
Vancomycin is considered a last resort medication for the treatment of sepsis and lower respiratory tract, skin, and bone infections caused by Gram-positive bacteria. The minimum inhibitory concentration susceptibility data for a few medically significant bacteria are:
S. aureus: 0.25 μg/mL to 4.0 μg/mL
S. aureus (methicillin resistant or MRSA): 1 μg/mL to 138 μg/mL
S. epidermidis: ≤0.12 μg/mL to 6.25 μg/mL
Side effects
Serum vancomycin levels may be monitored in an effort to reduce side effects, although the value of such monitoring has been questioned. Peak and trough levels are usually monitored, and for research purposes, the area under the concentration curve is also sometimes used. Toxicity is best monitored by looking at trough values.
Common adverse drug reactions (≥1% of patients) associated with IV vancomycin include: local pain, which may be severe, and thrombophlebitis.
Damage to the kidneys (nephrotoxicity) and to the hearing (ototoxicity) were side effects of the early impure versions of vancomycin, and these were prominent in the clinical trials conducted in the mid-1950s. Later trials using purer forms of vancomycin found nephrotoxicity is an infrequent adverse effect (0.1% to 1% of patients), but this is accentuated in the presence of aminoglycosides.
Rare adverse effects (<0.1% of patients) include: anaphylaxis, toxic epidermal necrolysis, erythema multiforme, red man syndrome, superinfection, thrombocytopenia, neutropenia, leukopenia, tinnitus, dizziness and/or ototoxicity, and DRESS syndrome.
Vancomycin can induce platelet-reactive antibodies in the patient, leading to severe thrombocytopenia and bleeding with florid petechial hemorrhages, ecchymoses, and wet purpura.
Historically, vancomycin has been considered a nephrotoxic and ototoxic drug, based on numerous case reports in the medical literature following initial approval by the FDA in 1958. However, as the use of vancomycin increased with the spread of MRSA beginning in the 1970s, toxicity risks were reassessed. With the removal of impurities present in earlier formulations of the drug, and with the introduction of therapeutic drug monitoring, the risk for severe toxicity has been reduced.
Nephrotoxicity
The extent of nephrotoxicity for vancomycin remains controversial. In 1980s, vancomycin with a purity > 90% was available, and kidney toxicity defined by an increase in serum creatinine of at least 0.5 mg/dl, occurred in only about 5% of patients. However, dosing guidelines from the 1980s until 2008 recommended vancomycin trough concentrations between 5 and 15 μg/ml. Concern for treatment failures prompted recommendations for higher dosing (troughs 15 to 20 μg/ml) for serious infection, and acute kidney injury (AKI) rates attributable to the vancomycin increased.
Importantly, the risk of AKI increases with co-administration of other known nephrotoxins, in particular, aminoglycosides. Furthmore, the sort of infections treated with vancomycin may also cause AKI and sepsis is the most common cause of AKI in critically ill patients. Finally, studies in humans are mainly associations studies where the cause of AKI is usually multifacotorial.
Animal studies have demonstrated that higher doses and longer duration of vancomycin exposure correlates with increased histopathologic damage and elevations in urinary biomarkers of AKI.37-38 Damage is most prevalent at the proximal tubule, which is further supported by urinary biomarkers, such as kidney injury molecule-1 (KIM-1), clusterin, and osteopontin (OPN),
and in humans, insulin-like growth factor binding protein 7 (IGFBP7) as part of the nephrocheck test.
The mechanisms that underlie the pathogenesis of vancomycin nephrotoxicity are multifactorial but include interstitial nephritis, tubular injury due to oxidative stress, and cast formation.
Ototoxicity
Attempts to establish rates of vancomycin-induced ototoxicity are even more difficult due to the scarcity of quality evidence. The current consensus is that clearly related cases of vancomycin ototoxicity are rare. The association between vancomycin serum levels and ototoxicity is also uncertain. While cases of ototoxicity have been reported in patients whose vancomycin serum level exceeded 80 µg/mL, cases have been reported in patients with therapeutic levels, as well. Thus, whether therapeutic drug monitoring of vancomycin for the purpose of maintaining "therapeutic" levels will prevent ototoxicity also remains unproven.
Interactions with other nephrotoxins
Another area of controversy and uncertainty concerns the question of whether, and if so, to what extent, vancomycin increases the toxicity of other nephrotoxins. Clinical studies have yielded variable results, but animal models indicate some increased nephrotoxic effect probably occurs when vancomycin is added to nephrotoxins such as aminoglycosides. However, a dose- or serum level-effect relationship has not been established.
Dosing considerations
The recommended parenteral dosage in adults is 500 mg iv every 6 hours or 1000 mg every 12 hours, with modification to achieve a therapeutic range as needed. The recommended oral dosage in the treatment of antibiotic induced pseudomembranous enterocolitis is 125 to 500 mg every 6 hours for 7 to 10 days.
Intravenous vs oral administration
Vancomycin must be given intravenously (IV) for systemic therapy, since it is not absorbed from the intestine. It is a large hydrophilic molecule that partitions poorly across the gastrointestinal mucosa. Due to short half-life, it is often injected twice daily.
The only approved indication for oral vancomycin therapy is in the treatment of pseudomembranous colitis, where it must be given orally to reach the site of infection in the colon. Following oral administration, the fecal concentration of vancomycin is around 500 µg/mL (sensitive strains of C. difficile have a mean inhibitory concentration of ≤2 µg/mL)
Inhaled vancomycin has also been used (off-label), via nebulizer, for treatment of various infections of the upper and lower respiratory tract.
There is an ongoing debate as to whether vancomycin should be given through a central or peripheral line. According to a 2014 review, midline catheters are a safe option for administration.
Vancomycin Flushing Reaction (aka "Red man syndrome")
Vancomycin is recommended to be administered in a dilute solution slowly, over at least 60 min (maximum rate of 10 mg/min for doses >500 mg) due to the high incidence of pain and thrombophlebitis and to avoid an infusion reaction known as vancomycin flushing reaction. This phenomenon has been often clinically referred to as "red man syndrome". The reaction usually appears within 4 to 10 min after the commencement or soon after the completion of an infusion and is characterized by flushing and/or an erythematous rash that affects the face, neck, and upper torso, attributed due to release of histamine from the mast cells. These findings are due to interaction of vancomycin with MRGPRX2, a GPCR mediating IgE-independent mast cell degranulation. Less frequently, hypotension and angioedema may also occur. Symptoms may be treated or prevented with antihistamines, including diphenhydramine, and are less likely to occur with slow infusion.
Therapeutic drug monitoring
Plasma level monitoring of vancomycin is necessary due to the drug's biexponential distribution, intermediate hydrophilicity, and potential for ototoxicity and nephrotoxicity, especially in populations with poor renal function and/or increased propensity to bacterial infection. Vancomycin activity is considered to be time-dependent; that is, antimicrobial activity depends on the duration that the serum drug concentration exceeds the minimum inhibitory concentration of the target organism. Thus, peak serum levels have not been shown to correlate with efficacy or toxicity; indeed, concentration monitoring is unnecessary in most cases. Circumstances in which therapeutic drug monitoring is warranted include: patients receiving concomitant aminoglycoside therapy, patients with (potentially) altered pharmacokinetic parameters, patients on haemodialysis, patients administered high-dose or prolonged treatment, and patients with impaired renal function. In such cases, trough concentrations are measured.
Target ranges for serum vancomycin concentrations have changed over the years. Early authors suggested peak levels of 30 to 40 mg/L and trough levels of 5 to 10 mg/L,
but current recommendations are that peak levels need not be measured and that trough levels of 10 to 15 mg/L or 15 to 20 mg/L, depending on the nature of the infection and the specific needs of the patient, may be appropriate. Using measured vancomycin concentrations to calculate doses optimizes therapy in patients with augmented renal clearance.
Biosynthesis
Vancomycin is made by the soil bacterium Amycolatopsis orientalis.
Vancomycin biosynthesis occurs primarily via three nonribosomal protein syntheses (NRPSs) VpsA, VpsB, and VpsC. The enzymes determine the amino acid sequence during its assembly through its 7 modules. Before vancomycin is assembled through NRPS, the non-proteinogenic amino acids are first synthesized. L-tyrosine is modified to become the β-hydroxytyrosine (β-HT) and 4-hydroxyphenylglycine (4-Hpg) residues. 3,5 dihydroxyphenylglycine ring (3,5-DPG) is derived from acetate.
Nonribosomal peptide synthesis occurs through distinct modules that can load and extend the protein by one amino acid per module through the amide bond formation at the contact sites of the activating domains. Each module typically consists of an adenylation (A) domain, a peptidyl carrier protein (PCP) domain, and a condensation (C) domain. In the A domain, the specific amino acid is activated by converting into an aminoacyl adenylate enzyme complex attached to a 4'phosphopantetheine cofactor by thioesterification The complex is then transferred to the PCP domain with the expulsion of AMP. The PCP domain uses the attached 4'-phosphopantethein prosthetic group to load the growing peptide chain and their precursors. The organization of the modules necessary to biosynthesize Vancomycin is shown in Figure 1. In the biosynthesis of Vancomycin, additional modification domains are present, such as the epimerization (E) domain, which isomerizes the amino acid from one stereochemistry to another, and a thioesterase domain (TE) is used as a catalyst for cyclization and releases of the molecule via a thioesterase scission.
A set of NRPS enzymes (peptide synthase VpsA, VpsB, and VpsC) are responsible for assembling the heptapeptide. (Figure 2). VpsA codes for modules 1, 2, and 3. VpsB codes for modules 4, 5, and 6, and VpsC codes for module 7. The vancomycin aglycone contains 4 D-amino acids, although the NRPSs only contain 3 epimerization domains. The origin of D-Leu at residue 1 is not known. The three peptide syntheses are located at the start of the region of the bacterial genome linked with antibiotic biosynthesis, and span 27 kb.
β-hydroxytyrosine (β-HT) is synthesized prior to incorporation into the heptapeptide backbone. L-tyrosine is activated and loaded on the NRPS VpsD, hydroxylated by OxyD, and released by the thioesterase Vhp. The timing of the chlorination by halogenase VhaA during biosynthesis is currently undetermined, but is proposed to occur before the complete assembly of the heptapeptide.
After the linear heptapeptide molecule is synthesized, vancomycin has to undergo further modifications, such as oxidative cross-linking and glycosylation, in trans by distinct enzymes, referred to as tailoring enzymes, to become biologically active (Figure 3). To convert the linear heptapeptide to cross-linked, glycosylated vancomycin, six enzymes, are required. The enzymes OxyA, OxyB, OxyC, and OxyD are cytochrome P450 enzymes. OxyB catalyzes oxidative cross-linking between residues 4 and 6, OxyA between residues 2 and 4, and OxyC between residues 5 and 7. This cross-linking occurs while the heptapeptide is covalently bound to the PCP domain of the 7th NRPS module. These P450s are recruited by the X domain present in the 7th NRPS module, which is unique to glycopeptide antibiotic biosynthesis. The cross-linked heptapeptide is then released by the action of the TE domain, and methyltransferase Vmt then N-methylates the terminal leucine residue. GtfE then joins D-glucose to the phenolic oxygen of residue 4, followed by the addition of vancosamine catalyzed by GtfD.
Some of the glycosyltransferases capable of glycosylating vancomycin and related nonribosomal peptides display notable permissivity and have been employed for generating libraries of differentially glycosylated analogs through a process known as glycorandomization.
Total synthesis
Both the vancomycin aglycone and the complete vancomycin molecule have been targets successfully reached by total synthesis. The target was first achieved by David Evans in October 1998, KC Nicolaou in December 1998, Dale Boger in 1999, and has recently been more selectively synthesized again by Dale Boger in 2020.
Pharmacology and chemistry
Vancomycin is a branched tricyclic glycosylated nonribosomal peptide produced by the Actinomycetota species Amycolatopsis orientalis (formerly designated Nocardia orientalis).
Vancomycin exhibits atropisomerism—it has multiple chemically distinct rotamers owing to the rotational restriction of some of the bonds. The form present in the drug is the thermodynamically more stable conformer.
Mechanism of action
Vancomycin acts by inhibiting proper cell wall synthesis in Gram-positive bacteria. Due to the different mechanism by which Gram-negative bacteria produce their cell walls and the various factors related to entering the outer membrane of Gram-negative organisms, vancomycin is not active against them (except some nongonococcal species of Neisseria).
The large hydrophilic molecule is able to form hydrogen bond interactions with the terminal D-alanyl-D-alanine moieties of the NAM/NAG-peptides. Under normal circumstances, this is a five-point interaction. This binding of vancomycin to the D-Ala-D-Ala prevents cell wall synthesis of the long polymers of N-acetylmuramic acid (NAM) and N-acetylglucosamine (NAG) that form the backbone strands of the bacterial cell wall, and it prevents the backbone polymers that do manage to form from cross-linking with each other.
Plant tissue culture
Vancomycin is one of the few antibiotics used in plant tissue culture to eliminate Gram-positive bacterial infection. It has relatively low toxicity to plants.
Antibiotic resistance
Intrinsic resistance
A few Gram-positive bacteria are intrinsically resistant to vancomycin: Leuconostoc and Pediococcus species, but these organisms rarely cause diseases in humans. Most Lactobacillus species are also intrinsically resistant to vancomycin, with the exception of L. acidophilus and L. delbrueckii, which are sensitive. Other Gram-positive bacteria with intrinsic resistance to vancomycin include Erysipelothrix rhusiopathiae, Weissella confusa, and Clostridium innocuum.
Most Gram-negative bacteria are intrinsically resistant to vancomycin because their outer membranes are impermeable to large glycopeptide molecules (with the exception of some non-gonococcal Neisseria species).
Acquired resistance
Evolution of microbial resistance to vancomycin is a growing problem, in particular, within healthcare facilities such as hospitals. While newer alternatives to vancomycin exist, such as linezolid (2000) and daptomycin (2003), the widespread use of vancomycin makes resistance to the drug a significant worry, especially for individual patients if resistant infections are not quickly identified and the patient continues the ineffective treatment. Vancomycin-resistant Enterococcus emerged in 1986. Vancomycin resistance evolved in more common pathogenic organisms during the 1990s and 2000s, including vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA). Agricultural use of avoparcin, another similar glycopeptide antibiotic, may have contributed to the evolution of vancomycin-resistant organisms.
One mechanism of resistance to vancomycin involves the alteration to the terminal amino acid residues of the NAM/NAG-peptide subunits, under normal conditions, D-alanyl-D-alanine, to which vancomycin binds. The D-alanyl-D-lactate variation results in the loss of one hydrogen-bonding interaction (4, as opposed to 5 for D-alanyl-D-alanine) possible between vancomycin and the peptide. This loss of just one point of interaction results in a 1000-fold decrease in affinity. The D-alanyl-D-serine variation causes a six-fold loss of affinity between vancomycin and the peptide, likely due to steric hindrance.
In enterococci, this modification appears to be due to the expression of an enzyme that alters the terminal residue. Three main resistance variants have been characterised to date among resistant Enterococcus faecium and E. faecalis populations:
VanA - enterococcal resistance to vancomycin and teicoplanin; inducible on exposure to these agents
VanB - lower-level enterococcal resistance; inducible by vancomycin, but strains may remain susceptible to teicoplanin
VanC - least clinically important; enterococci resistant only to vancomycin; constitutive resistance
Variant of vancomycin has been tested that binds to the resistant D-lactic acid variation in vancomycin-resistant bacterial cell walls, and also binds well to the original target (vancomycin-susceptible bacteria).
"Re-gained" vancomycin
In 2020 a team at the University Hospital Heidelberg (Germany) re-gained the antibacterial power of vancomycin by modifying the molecule with a cationic oligopeptide. The oligopeptide consists of six arginin units in Position VN. In comparison to the unmodified vancomycin the activity against vancomycin-resistant bacteria could be enhanced by a factor of 1,000. This pharmacon is still in preclinical development. Therefore, a potential approval will take several more years.
History
Vancomycin was first isolated in 1953 by Edmund Kornfeld (working at Eli Lilly) from a bacteria in a soil sample collected from the interior jungles of Borneo by a missionary, Rev. William M. Bouw (1918–2006). The organism that produced it was eventually named Amycolatopsis orientalis. The original indication for vancomycin was for the treatment of penicillin-resistant Staphylococcus aureus.
The compound was initially called compound 05865, but was eventually given the generic name vancomycin, derived from the term "vanquish". One advantage that was quickly apparent was that staphylococci did not develop significant resistance, despite serial passage in culture media containing vancomycin. The rapid development of penicillin resistance by staphylococci led to its being fast-tracked for approval by the Food and Drug Administration. In 1958, Eli Lilly first marketed vancomycin hydrochloride under the trade name Vancocin.
Vancomycin never became the first-line treatment for S. aureus for several reasons:
It possesses poor oral bioavailability, so must be given intravenously for most infections.
β-Lactamase-resistant semisynthetic penicillins such as methicillin (and its successors, nafcillin and cloxacillin) were subsequently developed, which have better activity against non-MRSA staphylococci.
Early trials used early, impure forms of the drug ("Mississippi mud"), which were found to be toxic to the inner ear and to the kidneys; these findings led to vancomycin's being relegated to the position of a drug of last resort.
In 2004, Eli Lilly licensed Vancocin to ViroPharma in the U.S., Flynn Pharma in the UK, and Aspen Pharmacare in Australia. The patent had expired in the early 1980s, and the FDA authorized the sale of several generic versions in the US, including from manufacturers Bioniche Pharma, Baxter Healthcare, Sandoz, Akorn-Strides, and Hospira.
References
External links
Eli Lilly and Company brands
Glycopeptide antibiotics
Halogen-containing natural products
Nephrotoxins
Total synthesis
World Health Organization essential medicines
Wikipedia medicine articles ready to translate | wiki |
Цеперов — название населённых пунктов:
Украина
Цеперов — село в Луцком районе Волынской области.
Цеперов — село в Каменка-Бугском районе Львовской области. | wiki |
Stroganov School (Строгановская школа in Russian) is a conventional name for the last major Russian icon-painting school, which thrived under the patronage of the fabulously rich Stroganov family of merchants in the late 16th and 17th century.
"Stroganov School" owes its name to frequent mentioning of the Stroganovs on the markings on the back of the icons of Yemelyan Moskvitin, Stefan Pakhirya, Prokopy Chirin, Istoma, Nazariy, and Nikifor Saviny. Most of these icon painters, however, did not belong to the Stroganov School. They were icon painters from Moscow and executed commissions by the tsar. Many of their works were eventually acquired by the Stroganovs, who had been known as connoisseurs of sophisticated craftsmanship.
The works of art of the Stroganov School have quite a few features in common, such as small size, exquisite diminutiveness, refined palette (mostly achieved with half-tints, golden, and silver colors), density of paint layers, graphic precision of details, fragile and somewhat pretentious delicacy of characters' postures and gestures, richness of their vestments, and complicated fantasy of landscape background.
References
Igor Grabar History of Russian Art, available online at
External links
Russian art movements
Eastern Orthodox icons
Russian icon painters
Icon-painting schools | wiki |
Bulbophyllum dearei (Deare's bulbophyllum) is a species of orchid.
dearei | wiki |
Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship) and additional training thereafter (e.g., residency, fellowship, and continuing medical education).
Medical education and training varies considerably across the world. Various teaching methodologies have been used in medical education, which is an active area of educational research.
Medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. Specific requirements such as entrustable professional activities must be met before moving on in stages of medical education.
Common techniques and evidence base
Medical education applies theories of pedagogy specifically in the context of medical education. Medical education has been a leader in the field of evidence-based education, through the development of evidence syntheses such as the Best Evidence Medical Education collection, formed in 1999, which aimed to "move from opinion-based education to evidence-based education". Common evidence-based techniques include the Objective structured clinical examination (commonly known as the 'OSCE) to assess clinical skills, and reliable checklist-based assessments to determine the development of soft skills such as professionalism. However there is a persistence of ineffective instructional methods in medical education, such as the matching of teaching to learning styles and Edgar Dales' "Cone of Learning".
Entry-level education
Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, Asia, South America and Oceania), or graduate-entry programs (mainly Australia, Philippines and North America). Some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (Australia, South Korea).
In general, initial training is taken at medical school. Traditionally initial medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery.
There has been a proliferation of programmes that combine medical training with research (M.D./Ph.D.) or management programmes (M.D./ MBA), although this has been criticised because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge.
The LCME and the "Function and Structure of a Medical School"
The Liaison Committee on Medical Education (LCME) is a committee of educational accreditation for schools of medicine leading to an MD in the United States and Canada. In order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. The "Function and Structure of a Medical School" article is a yearly published article from the LCME that defines 12 accreditation standards.
Entrustable Professional Activities for entering residency
The Association of American Medical Colleges (AAMC) has recommended thirteen Entrustable Professional Activities (EPAs) that medical students should be expected to accomplish prior to beginning a residency program. EPAs are based on the integrated core competencies developed over the course of medical school training. Each EPA lists its key feature, associated competencies, and observed behaviors required for completion of that activity. The students progress through levels of understanding and capability, developing with decreasing need for direct supervision. Eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity.
The list of topics that EPAs address include:
History and physical exam skills
Differential diagnosis
Diagnostic/screening tests
Orders and prescriptions
Patient encounter documentation
Oral presentations of patient encounters
Clinical questioning/using evidence
Patient handovers/transitions of care
Teamwork
Urgent/Emergency care
Informed consent
Procedures
Safety and improvement
Postgraduate education
Following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship" or "provisional registration" or "residency".
Further training in a particular field of medicine may be undertaken. In the U.S., further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (unstreamed) training for a number of years before commencing specialization.
Each residency and fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. The ACGME oversees all MD and DO residency programs in the United States. As of 2019, there were approximately 11,700 ACGME accredited residencies and fellowship programs in 181 specialties and subspecialties.
Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education.
Continuing medical education
In most countries, continuing medical education (CME) courses are required for continued licensing. CME requirements vary by state and by country. In the USA, accreditation is overseen by the Accreditation Council for Continuing Medical Education (ACCME). Physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. Additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development.
Online learning
Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs). Additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises. A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts. To enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education, can be incorporated to break the monotony of online-delivered lectures.
Research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth). When compared to no intervention, simulation in medical education
training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes. However, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures. Furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education.
Telemedicine/telehealth education
With the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education. In training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. Students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor.
Medical education systems by country
At present, in the United Kingdom, a typical medicine course at university is five years, or four years if the student already holds a degree. Among some institutions and for some students, it may be six years (including the selection of an intercalated BSc—taking one year—at some point after the pre-clinical studies). All programs culminate in the Bachelor of Medicine and Surgery degree (abbreviated MBChB, MBBS, MBBCh, BM, etc.). This is followed by two clinical foundation years afterward, namely F1 and F2, similar to internship training. Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study. The system in Australia is very similar, with registration by the Australian Medical Council (AMC).
In the US and Canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an (M.D. or D.O.) program. U.S. medical schools are almost all four-year programs. Some students opt for the research-focused M.D./Ph.D. dual degree program, which is usually completed in 7–10 years. There are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, English, labwork, etc. The specific requirements vary by school.
In Australia, there are two pathways to a medical degree. Students can choose to take a five- or six-year undergraduate medical degree Bachelor of Medicine/Bachelor of Surgery (MBBS or BMed) as a first tertiary degree directly after secondary school graduation, or first complete a bachelor's degree (in general three years, usually in the medical sciences) and then apply for a four-year graduate entry Bachelor of Medicine/Bachelor of Surgery (MBBS) program.
See:
North America
Medical education in Canada
Medical education in Panama
Medical education in Mexico
Medical education in the United States
Europe
Medical education in France
Medical education in Norway
Medical education in the United Kingdom
Asia/Middle East/Oceania
Medical education in Australia
Medical education in China
Medical education in Hong Kong
Medical education in India
Medical education in Jordan
Medical education in the Philippines
Africa
Medical education in South Africa
Medical education in Uganda
Norms and values
Along with training individuals in the practice of medicine, medical education will influence the norms and values of those people who pass through it. This occur through explicit training in medical ethics, or implicitly through "hidden curriculum" a body of norms and values that students will come to understand implicitly but is not formally taught. The hidden curriculum and formal ethics curriculum will often contradict one another..
The aims of medical ethics training are to give medical doctors the ability to recognise ethical issues, reason about them morally and legally when making clinical decisions, and be able to interact to obtain the information necessary to do so.
The hidden curriculum may include the use of unprofessional behaviours for efficiency or viewing the academic hierarchy as more important than the patient. The concept of "professionalism" may be used as a device to ensure obedience, with complaints about ethics and safety being labelled as unprofessional .
Integration with health policy
As medical professional stakeholders in the field of health care (i.e. entities integrally involved in the health care system and affected by reform), the practice of medicine (i.e. diagnosing, treating, and monitoring disease) is directly affected by the ongoing changes in both national and local health policy and economics.
There is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training, but to apply a broader lens to the concept of teaching and implementing health policy through health equity and social disparities that largely affect health and patient outcomes. Increased mortality and morbidity rates occur from birth to age 75, attributed to medical care (insurance access, quality of care), individual behavior (smoking, diet, exercise, drugs, risky behavior), socioeconomic and demographic factors (poverty, inequality, racial disparities, segregation), and physical environment (housing, education, transportation, urban planning). A country's health care delivery system reflects its “underlying values, tolerances, expectations, and cultures of the societies they serve”, and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers.
In order to truly integrate health policy matters into physician and medical education, training should begin as early as possible – ideally during medical school or premedical coursework – to build “foundational knowledge and analytical skills” continued during residency and reinforced throughout clinical practice, like any other core skill or competency. This source further recommends adopting a national standardized core health policy curriculum for medical schools and residencies in order to introduce a core foundation in this much needed area, focusing on four main domains of health care: (1) systems and principles (e.g. financing; payment; models of management; information technology; physician workforce), (2) quality and safety (e.g. quality improvement indicators, measures, and outcomes; patient safety), (3) value and equity (e.g. medical economics, medical decision making, comparative effectiveness, health disparities), and (4) politics and law (e.g. history and consequences of major legislations; adverse events, medical errors, and malpractice).
However limitations to implementing these health policy courses mainly include perceived time constraints from scheduling conflicts, the need for an interdisciplinary faculty team, and lack of research / funding to determine what curriculum design may best suit the program goals. Resistance in one pilot program was seen from program directors who did not see the relevance of the elective course and who were bounded by program training requirements limited by scheduling conflicts and inadequate time for non-clinical activities. But for students in one medical school study, those taught higher-intensity curriculum (vs lower-intensity) were “three to four times as likely to perceive themselves as appropriately trained in components of health care systems”, and felt it did not take away from getting poorer training in other areas. Additionally, recruiting and retaining a diverse set of multidisciplinary instructors and policy or economic experts with sufficient knowledge and training may be limited at community-based programs or schools without health policy or public health departments or graduate programs. Remedies may include having online courses, off-site trips to the capitol or health foundations, or dedicated externships, but these have interactive, cost, and time constraints as well. Despite these limitations, several programs in both medical school and residency training have been pioneered.
Lastly, more national support and research will be needed to not only establish these programs but to evaluate how to both standardize and innovate the curriculum in a way that is flexible with the changing health care and policy landscape. In the United States, this will involve coordination with the ACGME (Accreditation Council for Graduate Medical Education), a private NPO that sets educational and training standards for U.S. residencies and fellowships that determines funding and ability to operate.
Medical education as a subject-didactic field
Medical education is also the subject-didactic field of educating medical doctors at all levels, applying theories of pedagogy in the medical context, with its own journals, such as Medical Education. Researchers and practitioners in this field are usually medical doctors or educationalists. Medical curricula vary between medical schools, and are constantly evolving in response to the need of medical students, as well as the resources available. Medical schools have been documented to utilize various forms of problem-based learning, team-based learning, and simulation. The Liaison Committee on Medical Education (LCME) publishes standard guidelines regarding goals of medical education, including curriculum design, implementation, and evaluation.
The objective structured clinical examinations (OSCEs) are widely utilized as a way to assess health science students' clinical abilities in a controlled setting. Although used in medical education programs throughout the world, the methodology for assessment may vary between programs and thus attempts to standardize the assessment have been made.
Cadaver laboratory
Medical schools and surgical residency programs may utilize cadavers to identify anatomy, study pathology, perform procedures, correlate radiology findings, and identify causes of death. With the integration of technology, traditional cadaver dissection has been debated regarding its effectiveness in medical education, but remains a large component of medical curriculum around the world. Didactic courses in cadaver dissection are commonly offered by certified anatomists, scientists, and physicians with a background in the subject.
Medical curriculum and evidence-based medical education journals
Medical curriculum vary widely among medical schools and residency programs, but generally follow an evidence based medical education (EBME) approach. These evidence based approaches are published in medical journals. The list of peer-reviewed medical education journals includes, but is not limited to:
Academic Medicine
Medical Education
Advances in Health Science Education
Medical Teacher
Open access medical education journals:
BMC Medical Education
MedEDPORTAL
Journal of Medical Education and Curricular Development
Graduate Medical Education and Continuing Medical Education focused journals:
Journal of Continuing Education in the Health Professions
Journal of Graduate Medical Education
This is not a complete list of medical education journals. Each medical journal in this list has a varying impact factor, or mean number of citations indicating how often it is used in scientific research and study.
See also
Doctors to Be (an occasional series on BBC television)
INMED
List of medical schools
List of medical education agencies
Objective Structured Clinical Examination
Perspectives on Medical Education, a journal
Progress testing
Validation of foreign studies and degrees
Virtual patient
Explanatory notes
References
Further reading
External links
of the Academy of Medical Educators | wiki |
Western Michigan Broncos basketball may refer to either of the basketball teams that represent Western Michigan University:
Western Michigan Broncos men's basketball
Western Michigan Broncos women's basketball | wiki |
Execution is the act of putting a person to death, in execution of a judicial sentence of death, which is also known as capital punishment.
Execution may also refer to:
Society
A term for contract killings
The term also refers to execution-style murder
Extrajudicial killing, the killing of a person by governmental authorities without the sanction of any judicial proceeding or legal process
Summary execution, the act of killing a person who is accused of a crime without benefit of a full and fair trial
A writ of execution, ordering the enforcement of a judgment, typically by seizing and selling goods to satisfy a judgment debt
Technology
Execution (computing), the process in which a computer carries out instructions of a computer program
Media and art
Execution (novel), a 1958 fictional work by the Canadian author and war veteran Colin McDougall
Execution (painting), a 1995 Chinese art painting
"Execution" (The Twilight Zone), a 1960 episode of The Twilight Zone
Execution (1968 film), a 1968 Italian film
Execution, also known as Stark Raving Mad, a 1981 American film
Execution (album), an album by Tribuzy
Execution: The Discipline of Getting Things Done, a 2002 business book by Larry Bossidy and Ram Charan
See also
Execute (disambiguation)
The Execution (disambiguation) | wiki |
This is a list of awards and nominations received by MNEK.
Awards and nominations
{| class="wikitable sortable plainrowheaders"
|-
! scope="col" | Award
! scope="col" | Year
! scope="col" | Recipient(s) and nominee(s)
! scope="col" | Category
! scope="col" | Result
! scope="col" class="unsortable"|
|-
! scope="row" rowspan="2"| APRA Music Awards of 2022
| rowspan="2"| 2022
| rowspan="2"| "Head & Heart" featuring MNEK
| Most Performed Dance/Electronic Work
|
| rowspan="2"|
|-
| Most Performed Australian Work
|
|-
! scope="row" rowspan="4"| ASCAP London Awards
| 2016
| Himself
| Vanguard Award
|
| style="text-align:center;"|
|-
| rowspan="2"| 2017
| rowspan="2"| "Never Forget You"
| Top EDM Song
|
| style="text-align:center;" rowspan="2"|
|-
| Winning Song
|
|-
| 2018
| "You Don't Know Me"
| Winning Song
|
| style="text-align:center;"|
|-
! scope="row"| ASCAP Pop Music Awards
| 2017
| "Never Forget You"
| Winning Song
|
| style="text-align:center;"|
|-
! scope="row"| ASCAP Rhythm & Soul Music Awards
| 2017
| "Hold Up"
| Winning Song
|
| style="text-align:center;"|
|-
! scope="row"| Attitude Awards
| 2016
| Himself
| Breakout Artist of the Year
|
| style="text-align:center;"|
|-
! scope="row"| BET Awards
| 2015
| Himself
| Best International Act: UK
|
| style="text-align:center;"|
|-
! scope="row"| BBC Sound of...
| 2014
| Himself
| Sound of 2014
|
| style="text-align:center;"|
|-
!scope="row"|Brit Awards
| 2021
| "Head & Heart"
| Song of the Year
|
|
|-
!scope="row"|British LGBT Awards
| 2021
| Himself
| Music Artist
|
|
|-
! scope="row"| Grammy Awards
| 2014
| "Need U (100%)"
| Best Dance Recording
|
| style="text-align:center;"|
|-
! scope="row"|Hungarian Music Awards
| 2021
| rowspan=2|"Head & Heart"
| Best Foreign Electronic Recording
|
|
|-
!scope="row" rowspan=2|Ivor Novello Awards
| rowspan=2|2021
| Most Performed Work
|
| rowspan=2|
|-
| Himself
| Songwriter of the Year
|
|-
! scope="row"| Latin American Music Awards
| 2016
| "Never Forget You"
| Favorite Dance Song
|
| style="text-align:center;"|
|-
! scope="row"| MOBO Awards
| 2014
| Himself
| Best Newcomer
|
| style="text-align:center;"|
|-
! scope="row"|Queerty Awards
| 2019
| "Colour"
| Queer Anthem
|
|
|-
! scope="row"| Radio Disney Music Awards
| 2017
| "Never Forget You"
| Best Dance Track
|
| style="text-align:center;"|
|-
! scope="row"| Scandipop Awards
| 2016
| "Never Forget You"
| Best Video
|
| style="text-align:center;"|
|-
! scope="row"| Teen Choice Awards
| 2016
| "Never Forget You"
| Choice Music: Break-Up Song
|
| style="text-align:center;"|
|-
! scope="row"|UK Music Video Awards
| 2018
| "Blinded by Your Grace, Pt. 2"
| Best Pop Video - UK
|
|
Notes
References
MNEK
Awards | wiki |
Bulbophyllum drymoglossum is a species of orchid.
External links
drymoglossum | wiki |
Balloon Fiesta may refer to the following:
Albuquerque International Balloon Fiesta
Bristol International Balloon Fiesta
Philippine International Hot Air Balloon Fiesta
Saga International Balloon Fiesta (in Japan)
Saxonia International Balloon Fiesta
For a complete list of balloon festivals, see Hot air balloon festival.
Hot air balloon festivals | wiki |
Foreign words when used in Korean undergoes transcription, to make them pronounceable and memorable. Transcription into Korean, for the most part, is very similar to or even influenced by transcription into Japanese, although the number of homophones resulted by imperfect mapping of foreign sounds onto native sounds is significantly smaller, as Korean has a larger phoneme inventory and a more inclusive phonotactics.
Practicalities of transcription
The typical syllable structure of Korean is CGVC, with C being "consonant", G "glide", and V "vowel". Consonants and glides are optional. A few English words may get irregular transcription treatment, likely due to the influence of Japanese. Eg: shirt → 샤츠 sya-cheu (Japanese シャツ sha-tsu); mother → 마더 ma-deo (Japanese マザー ma-za-a); dragon → 드래곤 deu-rae-gon (Japanese ドラゴン do-ra-gon); level → 레벨 re-bel (Japanese レベル re-be-ru).
For the most part, transcription into Korean is phonemic, i.e., based on the phonologies of both the source and the target languages (Korean itself). However, [l], an allophone of /r/ in Korean, is utilized syllable-finally and intervocalically to transcribe the foreign sound /l/. This makes the foreign sound /l/ more transcribable into Korean than it is into Japanese, which has no strategic differences between [l] and /r/. E.g.: ball → 볼 bol (Japanese ボール bo-o-ru); gallon → 갤런 gal-leon (Japanese ガロン ga-ron). Note that [l] is always geminated intervocallically in transcriptions. E.g.: Hellen → 헬렌 Hel-len. Syllable-initially, the foreign liquid sounds /r/ and /l/ are rendered as /r/. E.g.: right and light → 라이트 ra-i-teu (Japanese ライト ra-i-to)
Consonants and vowels are transcribed to the native ones that approximate them the most, because, of course, Korean does not have all the sounds of all languages, nor has it developed any new sounds due to recent linguistic contact like Japanese with new sounds like /f/ or even /v/. E.g.: father → 파더 pa-deo (Japanese ファザー fa-za-a. Particularly, transcription into Korean tend to be more conservative as it only employs available hangul syllables, rather than establishing new, non-native combinations like Japanese. For example, the English word "warrior" is transcribed into Korean as 워리어 wo-ri-eo using 워, a pre-existing syllable composed of ᅮ u and ᅥ eo, rather than with a combination of u and o; in contrast, it is transcribed into Japanese as ウォリアー wo-ri-a-a, using ウォ, a non-native combination. On another note, the foreign phoneme /v/ is always transcribed as ᆸ (native) into Korean, but as either (native) or (non-native) into Japanese.
Consonants
Like Japanese, Korean does not allow any consonant clusters other than CG, therefore, when foreign words with such clusters are transcribed, the clusters are broken down and distributed among several syllables. For example, the English word brand is transcribed into Korean as 브랜드 beu-raen-deu (compare Japanese ブランド bu-ra-n-do), wherein the sequence bran is broken down into two syllables, beu-raen. In these cases, a vowel ㅡ eu is inserted in between the consonants of the cluster (compare Japanese u, o).
Korean has seven consonants that can occur at the end of a syllable and that are used in transcriptions. Those are /p/, /t/, /k/, /r/, /m/, /n/ and /ŋ/. /p/, /t/ and /k/ generally represent foreign voiceless consonants, although /p/ and /k/ (rendered using jamo ㅂ and ㄱ) occasionally denote voiced consonants, too. E.g.: lab and lap → 랩 ; deck → 덱 dek. Foreign /t/ is variously rendered as ㅅ or 트 teu. E.g.: secret → 시크릿 si-keu-rit; set → 세트 se-teu. Foreign /p/, /t/, /k/ are rendered using jamo ㅂ, ㅅ, ㄱ if the preceding foreign vowel is short, but generally using 프 peu, 트 teu, 크 keu if that vowel is long or a diphthong. E.g.: map → 맵 maep (Japanese マップ ma-p-pu), but mark → 마크 ma-keu (Japanese マーク ma-a-ku) and type → 타이프 ta-i-peu (but also 타입 ta-ip) (Japanese タイプ ta-i-pu). Foreign /l/, /m/, /n/, /ŋ/ are always rendered using jamo ㄹ, ㅁ, ㄴ, ㅇ, regardless of the quality of the preceding vowel. E.g.: Tom → 톰 Tom; time → 타임 ta-im.
Syllable-finally, foreign consonants not covered by the seven sounds above are transcribed as Cㅡ Ceu (C for "consonant"). E.g.: dead → 데드 de-deu (Japanese デッド de-d-do); speed → 스피드 seu-pi-deu (Japanese スピード su-pi-i-do); five → 파이브 pa-i-beu (Japanese ファイブ fa-i-bu); life → 라이프 ra-i-peu (Japanese ライフ ra-i-fu).
Vowels
Also, like Japanese, modern Korean lacks diphthongs (ancient diphthongs have all developed into monophthongs). Likewise, foreign diphthongs are broken down and distributed among two syllables. For example, English eye is transcribed into Korean as 아이 a-i (compare Japanese アイ a-i), wherein the diphthong /aɪ/ is rendered as a-i.
Korean has a larger phoneme inventory than Japanese, which allows broader coverage when transcribing foreign sounds. Whereas Japanese uses a single "a" sound for various English sounds such as /æ/, /ɑː/, /ə/, /ʌ/, Korean uses ㅐ ae for /æ/, ㅏ a for /ɑː/, ㅓ eo for /ə/ and /ʌ/. E.g.: hand → 핸드 haen-deu; card → 카드 ka-deu; hunter → 헌터 heon-teo. Occasionally, however, the choice of sounds for transcription is influenced by Japanese. E.g.: brother → 브라더 beu-ra-deo (Japanese ブラザー bu-ra-za-a); dragon → 드래곤 deuraegon (Japanese ドラゴン do-ra-go-n).
Like Japanese, transcription from English into Korean is largely based on Received Pronunciation (non-rhotic). However, while Japanese still denotes English vowels like /ɑː/ in car, /ɔː/ in course, /ə/ in monster as lengthened vowels (a-a, o-o, a-a respectively), Korean ignores vowel length almost entirely, although such length is still indirectly denoted in some cases mentioned above with the use of 프 peu, 트 teu, 크 keu. E.g.: car → 카 ka (Japanese カー ka-a); card → 카드 ka-deu (Japanese カード ka-a-do); course → 코스 ko-seu (Japanese コース ko-o-su); monster → 몬스터 mon-seu-teo (Japanese モンスター mo-n-su-ta-a).
Table of transcription from English
{| class="wikitable"
|-
! scope="col" colspan=2 | English phonemes
! scope="col" rowspan=2 | Common English graphemes
! scope="col" colspan=3 | Korean transcription jamo with Revised Romanization in italics
! scope="col" rowspan=2 | Examples
|-
! scope="col" | Received Pronunciation
! scope="col" | General American
! scope="col" | If the English consonant is prevocalic and not postvocalic
! scope="col" | If the English consonant is intervocalic
! scope="col" | If the English consonant is not prevocalic
|-
| colspan=2|
| ⟨a⟩; ⟨ae⟩; ⟨al⟩; ⟨au⟩
| colspan=3|ㅐ ae; ㅏ a
|핸드 haendeu "hand"; 양키 Yangki "Yankee"
|-
|
|;
|⟨a⟩; ⟨ach⟩; ⟨au⟩; ⟨o⟩; ⟨ou⟩
|colspan=3|ㅗ o; ㅏ a
|톰 Tom "Tom"; 톱 top, 탑 tap "top"; 복스 bokseu, 박스 bakseu "box"
|-
|
|;
|⟨a⟩; ⟨al⟩; ⟨au⟩
|colspan=3|ㅏ a
|하프 hapeu "half"; 파더 padeo "father"
|-
|
|
|⟨ar⟩; ⟨ear⟩; ⟨er⟩
|
|ㅏㄹ ar
|ㅏ a
|카드 kadeu "card"
|-
|colspan=2|
|⟨ai⟩; ⟨ei⟩; ⟨eigh⟩; ⟨i⟩; ⟨ic⟩; ⟨ie⟩; ⟨igh⟩; ⟨is⟩; ⟨oy⟩; ⟨uy⟩; ⟨y⟩; ⟨ye⟩
|colspan=3|ㅏ이 ai
|다이스 daiseu "dice"; 타임 taim "time"
|-
|
|;
|⟨ia(r)⟩; ⟨igher⟩; ⟨ire⟩; ⟨iro⟩
|
|ㅏ이어ㄹ aieor
|ㅏ이어 aieo; ㅏ이아 aia
|파이어 paieo "fire"; 다이어리 daieori "diary"; 다이아몬드 daiamondeu "diamond"
|-
|
|
|⟨ile⟩
|colspan=2|
|ㅏ일 ail
|미사일 misail "missile"
|-
|colspan=2|
|⟨au⟩; ⟨ou⟩; ⟨ough⟩; ⟨ow⟩
|colspan=3|ㅏ우 au
|타운 taun "town"
|-
|
|
|⟨our⟩; ⟨ower⟩
|
|ㅏ워ㄹ awor
|ㅏ워 awo
|파워 pawo "power"
|-
|colspan=2|
|⟨b⟩; ⟨bb⟩; ⟨be⟩; ⟨pb⟩
|colspan=2|ㅂ b
|ㅂ p; 브 beu
|벤치 benchi "bench"; 래빗 raebit "rabbit"; 브레이크 beureikeu "brake"; 랩 raep "lab"; 태브 taebeu "tab"; 테이블 teibeul "table"
|-
|colspan=2|
|⟨d⟩; ⟨dd⟩; ⟨de⟩
|colspan=2|ㄷ d
|드 deu
|도어 do-eo; 페이딩 peiding "fading"; 드레이크 deureikeu "drake"; 베드 bedeu "bed"; 미들 mideul "middle"
|-
|
|
|⟨dew⟩; ⟨du⟩; ⟨due⟩
|듀 dyu
|colspan=2|
|듀얼 dyueol "dual", "duel"; 듀 dyu "dew", "due"
|-
|colspan=2|
|⟨ds⟩; ⟨dds⟩
|colspan=2|
|즈 jeu
|에이즈 eijeu "AIDS"
|-
|colspan=2|
|⟨di⟩; ⟨dg⟩; ⟨dge⟩; ⟨g⟩; ⟨ge⟩; ⟨j⟩
|ㅈ j
|ㅈ j
|지 ji
|점프 jeompeu "jump"; 버짓 beojit "budget"; 솔저 soljeo "soldier"; 에지 eji "edge"; 에인절 einjeol "angel"
|-
|colspan=2|
|⟨th⟩; ⟨the⟩
|colspan=2|ㄷ d
|드 deu
|더 deo, 디 di "the"; 마더 madeo "mother"; 알고리듬 algorideum "algorithm"
|-
|colspan=2|
|⟨e⟩; ⟨ea⟩; ⟨ie⟩; ⟨oe⟩
|colspan=3|ㅔ e
|엔드 endeu "end"; 프렌드 peurendeu "friend"
|-
|
|
|⟨ar⟩; ⟨aer⟩; ⟨air⟩; ⟨are⟩; ⟨ear⟩; ⟨eir⟩; ⟨ere⟩; ⟨ey're⟩
|
|ㅔ어ㄹ eeor
|ㅔ어 eeo
|에어 eeo "air"; 에어리어 eeorieo "area"
|-
|colspan=2 rowspan=3|
|⟨a⟩
|colspan=3|ㅓ eo; ㅏ a; ㅐ ae
|멀리건 meolligeon "mulligan"; 고섬 Goseom "Gotham"; 어바우트 eobauteu "about"; 에어리어 eeorieo "area"; 아칸소 Akanso "Arkansas"; 오스트레일리아 Oseuteureillia "Australia"; 크리스마스 Keuriseumaseu "Christmas"; 잉글랜드 Inggeullaendeu "England"
|-
|⟨e⟩; ⟨gh⟩; ⟨ou⟩; ⟨ough⟩; ⟨u⟩
|colspan=3|ㅓ eo
|테스타먼트 teseutameonteu "testament"; 세일럼 Seilleom "Salem"; 서러 seoreo "thorough"; 에든버러 Edinbeoreo "Edinburgh"; 앨범 aelbeom "album"; 바이러스 baireoseu "virus"; 앨버커키 Albeokeoki "Albuquerque"; 뉴펀들랜드 Nyupeondeullaendeu "Newfoundland"
|-
|⟨o⟩
|colspan=3|ㅓ eo; ㅗ o
|커먼 keomeon "common"; 세컨드 sekeondeu "second"; 다이너소어 daineosoeo "dinosaur"; 킹덤 kingdeom "kingdom"; 오브 obeu; 포테이토 poteito "potato"; 스켈레톤 seukelleton "skeleton"; 드래곤 deuraegon "dragon"
|-
|
|
|⟨ar⟩; ⟨er⟩; ⟨or⟩; ⟨our⟩; ⟨ure⟩
|
|ㅓㄹ eor
|ㅓ eo; ㅓ르 eoreu
|컴퓨터 kompyuteo "computer"; 컬러 keolleo "color"; 커서 keoseo "cursor"; 멜버른 Melbeoreun "Melbourne"
|-
|colspan=2|;
|⟨ael⟩; ⟨al⟩; ⟨el⟩; ⟨le⟩
|colspan=2|
|eol; eul; el
|스페셜 seupesyeol "special"; 패널 paeneol "panel"; 머슬 meoseul "muscle"; 사이클 saikeul "cycle"; 배틀 baeteul "battle"; 스테이플 seuteipeul "staple"; 퍼즐 peojeul "puzzle"; 마이클 Maikeul "Michael"; 레벨 rebel "level", "revel", "rebel"
|-
|colspan=2 rowspan=2|;
|⟨ain⟩
|colspan=2|
|in; eun
|마운틴 mauntin; 브리튼 Beuriteun "Britain"
|-
|⟨en⟩
|colspan=2|
|eun; in
|하이픈 haipeun "hyphen"; 세븐 sebeun "seven"; 토큰 tokeun "token"; 서든 seodeon "sudden"; 시즌 sijeun; 치킨 chikin "chicken"; 키친 kichin "kitchen"
|-
|
|
|⟨au⟩; ⟨eau⟩; ⟨eaux⟩; ⟨o⟩; ⟨oa⟩; ⟨oe⟩; ⟨oh⟩; ⟨ough⟩; ⟨ow⟩; ⟨owe⟩
|colspan=3|ㅗ o; ㅗ우 ou
|쇼 syo "show"; 포니 poni; 오하이오 Ohaio "Ohio"; 솔 sol, 소울 soul "soul"
|-
|
|
|⟨ear⟩; ⟨er⟩; ⟨ir⟩; ⟨olo⟩; ⟨ur⟩
|
|ㅓㄹ eor
|ㅓ eo
|어스 eoseu "earth"; 웜 wom "worm"; 퍼리 peori "furry"
|-
|colspan=2|
|⟨a⟩; ⟨ae⟩; ⟨ai⟩; ⟨ait⟩; ⟨al⟩; ⟨au⟩; ⟨ay⟩; ⟨e⟩; ⟨ei⟩; ⟨eigh⟩; ⟨et⟩; ⟨ey⟩
|colspan=3|ㅔ이 ei
|게임 geim "game"
|-
|colspan=2|
|⟨f⟩; ⟨fe⟩; ⟨ff⟩; ⟨gh⟩; ⟨ph⟩; ⟨u⟩
|colspan=2|ㅍ p
|프 peu
|파울 paul "foul"; 이펙트 ipekteu "effect"; 러프 reopeu "rough"; 러플 reopeul "ruffle"; 플릭 peullik "flick"; 피시 pisi "fish"Exception: 휘시 huisi "fish"
|-
|colspan=2|
|⟨g⟩; ⟨gg⟩; ⟨gh⟩; ⟨gu⟩; ⟨gue⟩
|colspan=2|ㄱ g
|ㄱ k; 그 geu
|건 geon "gun"; 백 baek "bag"; 버그 beogeu "bug"; 이글 igeul "eagle"; 글라스 geullaseu "glass"
|-
|colspan=2|
|⟨gs⟩; ⟨ggs⟩; ⟨x⟩; ⟨xh⟩
|
|그ㅈ geuj
|그스 geuseu
|이그잼 igeujaem "exam"; 이그조스트 igeujoseuteu "exhaust"; 에그스 egeuseu "eggs"
|-
|colspan=2|
|⟨gh⟩; ⟨h⟩; ⟨wh⟩
|ㅎ h
|colspan=2|
|헌터 heonteo "hunter"
|-
|colspan=2|
|⟨a⟩; ⟨ae⟩; ⟨e⟩; ⟨ei⟩; ⟨i⟩; ⟨ie⟩; ⟨oe⟩
|colspan=3|ㅣ i; ㅔ e
|인풋 input "input"; 메시지 mesiji "message"; 쵸콜레트 chyokolleteu "chocolate"; 스켈레톤 seukelleton "skeleton"
|-
|
|
|⟨aer⟩; ⟨e're⟩; ⟨ear⟩; ⟨eer⟩; ⟨er⟩; ⟨ere⟩; ⟨ier⟩; ⟨ir⟩
|
|ㅣ어ㄹ ieor
|ㅣ어 ieo
|기어 gieo "gear"; 히어로 hieoro "hero"
|-
|colspan=2|
|⟨ay⟩; ⟨e⟩; ⟨ea⟩; ⟨ee⟩; ⟨ey⟩; ⟨i⟩; ⟨y⟩
|colspan=3|ㅣ i
|시티 siti "city"; 양키 Yangki "Yankee"; 허니 heoni "honey"
|-
|colspan=2|
|⟨ae⟩; ⟨e⟩; ⟨ea⟩; ⟨ee⟩; ⟨i⟩; ⟨ie⟩; ⟨oe⟩
|colspan=3|ㅣ i; ㅔ e
|팀 tim "team"; 하이에나 haiena "hyena"
|-
|colspan=2|
|⟨y⟩
|y
|colspan=2|
|옐로 yello "yellow"
|-
|;
|;
|⟨eu⟩; ⟨u⟩; ⟨you⟩; ⟨yu⟩; ⟨ut⟩
|유 yu
|colspan=2|
|유니언 yunieon "union"; 더블유 deobeuryu "W"; 새뮤얼 Samyueol "Samuel"
|-
|;
|;
|⟨eu(r)⟩; ⟨u(r)⟩; ⟨you(r)⟩; ⟨you're⟩; ⟨yu(r)⟩; ⟨uh(r)⟩
|
|유ㄹ yur; 유어ㄹ yueor
|유어 yueo
|유럽 Yureop "Europe"; 유어 yueo "your", "you're"; 머큐리 Meokyuri "Mercury"
|-
|colspan=2|
|⟨c⟩; ⟨cc⟩; ⟨ch⟩; ⟨che⟩; ⟨ck⟩; ⟨k⟩; ⟨ke⟩; ⟨kh⟩; ⟨qu⟩; ⟨que⟩
|colspan=2|ㅋ k
|ㄱ k; 크 keu
|킥 kik "kick"; 스파이크 seupaikeu "spike"; 크로니클 keuronikeul "chronicle"
|-
|colspan=2|
|⟨cc⟩; ⟨cs⟩; ⟨chs⟩; ⟨cks⟩; ⟨ks⟩; ⟨khs⟩; ⟨x⟩; ⟨xe⟩
|
|ㄱㅅ ks
|ㄱ스 kseu
|멕시코 Meksiko "Mexico"; 콤플렉스 kompeullekseu "complex"
|-
|colspan=2|
|⟨cti⟩; ⟨xi⟩
|
|ksy
|
|커넥션 keoneksyeon "connection", "connexion"
|-
|colspan=2|
|⟨xual⟩
|
|ksyueol
|
|섹슈얼 seksyueol "sexual"
|-
|colspan=2|
|⟨cqu⟩; ⟨qu⟩
|colspan=2|kw
|
|퀸 kwin "queen"
|-
|
|
|⟨quar⟩
|쿼 kwo
|colspan=2|
|쿼크 kwokeu "quark"
|-
|colspan=2|
|⟨l⟩; ⟨le⟩; ⟨ll⟩
|ㄹ r; ㄹㄹ ll
|ㄹㄹ ll
|ㄹ l
|루프 rupeu "loop"; 밸런스 baelleonseu "balance"; 세일 seil "sale", "sail"; 블랙 beullaek "black"; 걸 geol "girl"; 캐슬 kaeseul "castle"
|-
|colspan=2|
|⟨m⟩; ⟨mb⟩; ⟨me⟩; ⟨mm⟩; ⟨mn⟩
|ㅁ m
|ㅁㅁ mm
|ㅁ m
|마임 maim "mime"; 서몬 seomon "summon"; 감마 gamma "gamma"
|-
|colspan=2|
|⟨n⟩; ⟨nd⟩; ⟨ne⟩; ⟨nn⟩
|colspan=3|ㄴ n
|나인 nain "nine"; 베넷 Benet "Bennett"
|-
|;
|;
|⟨new(r)⟩; ⟨neur⟩; ⟨nu(r)⟩; ⟨nure⟩
|colspan=2|뉴(ㄹ) nyu(r)
|
|뉴 nyu "new"; 뉴런 nyureon "neuron"
|-
|colspan=2|
|⟨n⟩; ⟨ng⟩
|
|colspan=2|ㅇ ng
|싱어 sing-eo "singer"; 핑거 pinggeo "finger"; 킹 king "king"; 랭크 raengkeu "rank"
|-
|colspan=2|
|⟨al⟩; ⟨au⟩; ⟨aw⟩; ⟨oa⟩; ⟨ough⟩
|colspan=3|ㅗ o; ㅗ우 ou
|토크 tokeu "talk"; 오스트리아 Oseuteuria "Austria"; 드로우 deurou "draw"
|-
|colspan=2|
|⟨al⟩; ⟨aul⟩; ⟨awl⟩
|
|oll
|ol
|올터너티브 olteoneotibeu "alternative"Exceptions: 왈츠 walcheu "waltz"; 어썰트 eosseolteu "assault"
|-
|rowspan=2|
|rowspan=2|
|⟨ar⟩; ⟨aur⟩; ⟨oar⟩; ⟨or⟩; ⟨our⟩; ⟨wor⟩
|colspan=2|
|ㅗ o; ㅗ어 o-eo; ㅗ르 oreu; ㅏ a
|포 po "four"; 오어 o-eo "or"; 노르웨이 Noreuwei "Norway"; 호그와트 Hogeuwateu
|-
|⟨oor⟩; ⟨ore⟩
|colspan=2|
|ㅗ어 o-eo
|코어 ko-eo "core"; 도어 do-eo "door"
|-
|colspan=2|
|⟨eu⟩; ⟨oi⟩; ⟨oy⟩
|colspan=3|ㅗ이 oi
|코인 koin "coin"
|-
|colspan=2|
|⟨p⟩; ⟨pe⟩; ⟨ph⟩; ⟨pp⟩
|colspan=2|ㅍ p
|ㅂ p; 프 peu
|팝 pap "pop"; 타입 taip, 타이프 taipeu "type"; 커플 keopeul "couple"; 프루프 peurupeu "proof"
|-
|;
|
|⟨lo⟩; ⟨r⟩; ⟨re⟩; ⟨rh⟩; ⟨rps⟩; ⟨rr⟩; ⟨rt⟩
|colspan=2|ㄹ r
|omitted; 르 reu
|랩 raep "rap"; 애로호 aerou; 노르웨이 Noreuwei "Norway"
|-
|colspan=2|
|⟨'s⟩; ⟨c⟩; ⟨ce⟩; ⟨s⟩; ⟨s'⟩; ⟨sc⟩; ⟨se⟩; ⟨ss⟩; ⟨st⟩; ⟨sw⟩
|colspan=2|ㅅ s; ㅆ ss
|스 seu
|어썰트 eosseolteu "assault"; 키스 kiseu "kiss"; 슬립 seullip "slip"; 캐슬 kaeseul "castle"
|-
|colspan=2|
|⟨ch⟩; ⟨che⟩; ⟨ci⟩; ⟨s⟩; ⟨sc⟩; ⟨sch⟩; ⟨sh⟩; ⟨si⟩; ⟨sti⟩; ⟨ti⟩
|colspan=2|ㅅ s; sy; sw
|시 si; 슈 syu
|십 sip "ship"; 셰프 syepeu "chef"; 애시 aesi "ash"; 위슈 wisyu "wish"; 셸 syel, 쉘 swel "shell"
|-
|colspan=2|
|⟨sual⟩
|colspan=2|슈얼 syueol
|
|컨센슈얼 keonsensyueol "consensual"
|-
|colspan=2|
|⟨bt⟩; ⟨ct⟩; ⟨t⟩; ⟨te⟩; ⟨th⟩; ⟨tt⟩; ⟨tte⟩
|colspan=2|ㅌ t
|ㅅ t; 트 teu; 츠 cheu
|타이트 taiteu "tight"; 키트 kiteu "kit"; 세트 seteu "set"; 핏 pit "fit", "pit"; 트럼프 teureompeu "trump"; 배틀 baeteul "battle"; 셔츠 syeocheu "shirt"
|-
|
|
|⟨tew⟩; ⟨tu⟩
|튜 tyu
|colspan=2|
|튜너 tyuneo "tuner"; 스튜디오 seutyudio "studio"; 스튜어드 seutyueodeu "steward"
|-
|colspan=2|
|⟨t's⟩; ⟨ts⟩; ⟨tts⟩
|colspan=2|
|츠 cheu
|이츠 icheu "it's", "its"
|-
|colspan=2|
|⟨ch⟩; ⟨tch⟩
|colspan=2|ㅊ ch
|치 chi
|치킨 chikin "chicken"; 키친 kichin "kitchen"; 매치 maechi "match"
|-
|
|
|⟨ture⟩
|
|추어 chueo; 츄어 chyueo
|
|머츄어 meochueo "mature"
|-
|colspan=2|
|⟨tual⟩
|
|추얼 chueol; 츄얼 chyueol
|
|버추얼 beochueol, 버츄얼 beochyueol "virtual"
|-
|colspan=2|
|⟨th⟩; ⟨the⟩
|colspan=2|ㅅ s
|스 seu
|시프 sipeu "thief"; 고섬 Goseom "Gotham"; 배스 baeseu "bath"; 스레드 seuredeu "thread"
|-
|colspan=2|
|⟨oo⟩; ⟨u⟩
|colspan=3|ㅜ u
|북 buk "book"; 불 bul "bull"
|-
|;
|
|⟨oor⟩; ⟨our⟩; ⟨ure⟩
|
|ㅜㄹ ur; ㅜ어ㄹ ueor
|ㅜ어 ueo
|무어 mueo "moor"; 투어 tueo "tour"; 투어리스트 tueoriseuteu "tourist"; 미주리 Mijuri "Missouri"
|-
|colspan=2|
|⟨ew⟩; ⟨o⟩; ⟨oe⟩; ⟨oo⟩; ⟨ou⟩; ⟨ough⟩; ⟨ue⟩; ⟨ui⟩
|colspan=3|ㅜ u
|블루머 beullumeo "bloomer"
|-
|colspan=2|
|⟨ph⟩; ⟨v⟩; ⟨ve⟩; ⟨w⟩
|colspan=2|ㅂ b
|브 beu
|바이킹 Baiking "Viking"; 러브 reobeu "love"
|-
|colspan=2|
|⟨o⟩; ⟨oo⟩; ⟨ou⟩; ⟨u⟩
|colspan=3|ㅓ eo
|런던 Reondeon "London"
|-
|colspan=2 rowspan=2|
|⟨w⟩; ⟨ou⟩
|colspan=2|w
|
|위치 wichi "witch"; 어웨이큰 eoweikeun "awaken"
|-
|⟨wh⟩
|hw
|colspan=2|
|화이트 hwaiteu "white"; 훼일 hweil "whale"
|-
|
|
|⟨war⟩; ⟨wore⟩
|wo
|colspan=2|
|워 wo "war"; 워프 wopeu "warp"
|-
|colspan=2|
|⟨wo⟩; ⟨woo⟩
|우 u
|colspan=2|
|우드 udeu "wood"; 우먼 umeon "woman"
|-
|colspan=2|
|⟨'s⟩; ⟨s⟩; ⟨sc⟩; ⟨se⟩; ⟨ss⟩; ⟨z⟩; ⟨ze⟩; ⟨zz⟩
|colspan=2|ㅈ j
|즈 jeu; 스 seu
|제브러 jebeureo "zebra"; 퀴즈 kwijeu "quiz"; 퍼즐 peojeul "puzzle"; 뉴스 nyuseu "news"; 블루스 beulluseu "blues"
|-
|colspan=2|
|⟨g⟩; ⟨ge⟩; ⟨si⟩; ⟨ti⟩; ⟨zi⟩
|
|ㅈ j
|
|텔레비전 telleobijeon "television"
|-
|colspan=2|
|⟨sual⟩
|
|주얼 jueol
|
|비주얼 bijueol "visual"
|}
Korean writing system
Transcription (linguistics) | wiki |
Howitz may refer to:
Howitzer, a type of artillery gun
Konrad Howitz, the sirtuin activating compounds discoverer | wiki |
Andrea Levy est un nom notamment porté par :
Andrea Levy (1956-2019), écrivaine britannique ;
Andrea Levy (1984-), femme politique espagnole. | wiki |
Diogenes (), feminine form Diogenissa (Διογένισσα), plural: Diogenoi (meaning "two-blooded"), was a Cappadocian Greek noble family of the Byzantine military aristocracy that provided several prominent generals and three emperors during the 10th and 11th century. Romanos IV Diogenes was a noted general, who by marriage to Eudokia Makrembolitissa, was Byzantine Emperor between 1068 and 1071. Diogenes led the Byzantine army for the pivotal defeat at the Battle of Manzikert in 1071.
References
Sources | wiki |
My Pet Human is a 2015 children's book written and illustrated by Yasmine Surovec. It concerns a black and white stray cat that likes his independence but is eventually persuaded through the regular provision of food and comfort that having a little girl and her family to look after him may not be such a bad thing.
Reception
Publishers Weekly, in a review of My Pet Human, wrote "Opinionated and independent, Oliver has plenty of personality, and Surovec’s simplified cartoons successfully evoke the joys of pet ownership (even when the human is the pet).", and Booklist wrote "Cat-loving kids, particularly emerging readers, will get a kick out of the feline narrator, as well as the heartening story of friendship."
My Pet Human has also been reviewed by Kirkus Reviews, School Library Journal, Horn Book Guides, School Library Connection, and The Bulletin of the Center for Children's Books.
References
External links
Library holdings of My Pet Human
2015 children's books
American children's novels
Books about cats | wiki |
Tofu skin roll or Tofu roll is a dim sum dish. It can be found in Hong Kong and among overseas Chinese restaurants. It is usually served in a small plate in twos or threes. In all cases, the outer layer is made of tofu skin.
Variety
There are a number of cooking styles. Fillings include pork, vegetables, fish, and beef.
Fried
The fried version is known as (腐皮捲, fu pei gyun). The first character "fu" comes from tofu, though a more accurate description is that the skin is made from the ingredient bean curd. Some Cantonese restaurants serve the fried crispy version at night, often with mayonnaise as dipping sauce. Another name is the (豆腐捲, tofu gyun). Some ingredients include shrimp, chicken, leeks, bamboo shoots, small carrots, tofu, scallions, sesame oil, or bean sprouts.
Steamed
The bamboo steamed version is generally known as (鮮竹捲, sin zuk gyun). It is wrapped with dried tofu skin (腐竹, fu zhu). During the cooking process, the tofu skin is hydrated. It makes the roll very soft and tender. This is the version most commonly served as a dim sum dish during yum cha sessions. The steamed tofu skin rolls often contain bamboo shoots.
See also
Dim Sum
Tofu skin
References
Dim sum
Cantonese cuisine
Hong Kong cuisine
Tofu dishes
Steamed foods | wiki |
Carne pizzaiola or carne alla pizzaiola (roughly translated as "meat in pizza style"), sometimes referred to just as pizzaiola, is a dish derived from the Neapolitan and Apulian tradition that features meat (often less expensive cuts of beef) cooked with tomatoes, olive oil, garlic, and white wine long enough to tenderize the meat. Most versions also include tomato paste, oregano and basil.
History
The history of the pizzaiola is somewhat uncertain, even if the origin is almost certainly Neapolitan. The recipe has known a wide diffusion and has been the subject of numerous reinterpretations. The success of this particular preparation must be identified not only in the simplicity of execution, but also in the fact that once finished, it can be used as a sauce for pasta.
See also
Neapolitan ragù
Italian cuisine
References
External links
Memorie di Angelina Carne alla pizzaiola
Mediterranean cuisine
Meat dishes
Neapolitan cuisine
Italian-American cuisine
Beef dishes
Tomato dishes
Foods with alcoholic drinks | wiki |
Strength tester may refer to:
A strength tester machine, a type of amusement, which upon receiving credit rates the subject's strength
A high striker, a strength tester utilizing a lever and a puck specifically
Grippers, used to test the strength of the hands
See also
Strength athletics
Izod impact strength test
Shear strength test
Container compression test
Universal testing machine | wiki |
Crowd Control may mean:
Crowd control, controlling large groups of people
Crowd control (video games), handling interactions of many objects and mobs in a video game
Crowd Control (TV series), a 2014 TV show on the National Geographic Channel
"Crowd Control" (song), a 2017 song by Dimitri Vegas & Like Mike and W&W | wiki |
Water chestnut cake () is a sweet Cantonese dim sum dish made of shredded Chinese water chestnut. When served during dim sum, the cake is usually cut into square-shaped slices and pan-fried before serving. The cake is soft, but holds its shape after the frying. Sometimes the cake is made with chopped water chestnuts embedded into each square piece with the vegetable being visible. One of the main trademark characteristics of the dish is its translucent appearance.
It is one of the standard dishes found in the dim sum cuisine of Hong Kong, and is also available in select overseas Chinatown restaurants.
See also
Chestnut cake
Brazil nut cake
Dim sum
Taro cake
Turnip cake
Nian gao
References
Dim sum
Cantonese cuisine
Hong Kong cuisine | wiki |
The following is a list of regional organizations by population.
List
References
External links
United Nations Analytical Report for the 2004 revision of World Population Prospects – includes details of methodology and sources used for the population estimates above.
Population clocks & projected growth charts for all countries
Population clock
Regional organizations | wiki |
Continuous breeders are animal species that can breed or mate throughout the year. This includes humans and apes (bonobos, chimpanzees, gorillas, orangutans, and gibbons), who can have a child at any time of year. In continuous breeders, females are sexually receptive during estrus, at which time ovarian follicles are maturing and ovulation can occur. Evidence of ovulation, the phase during which conception is most probable, is advertised to males among many non-human primates via swelling and redness of the genitalia.
See also
Opportunistic breeder
Seasonal breeder
References
Attribution
Animal breeding
Fertility
Reproduction in animals | wiki |
An emergency telephone number is a number that allows a caller to contact local emergency services for assistance. The emergency number differs from country to country; it is typically a three-digit number so that it can be easily remembered and dialed quickly. Some countries have a different emergency number for each of the different emergency services; these often differ only by the last digit.
In many countries, dialing either 1-1-2 (used in Europe and parts of Asia) or 9-1-1 (used in the Americas) will connect callers to emergency services. For individual countries, see the list of emergency telephone numbers.
Configuration and operation
The emergency telephone number is a special case in the country's telephone number plan. In the past, calls to the emergency telephone number were often routed over special dedicated circuits. Though with the advent of electronic exchanges these calls are now often mixed with ordinary telephone traffic, they still may be able to access circuits that other traffic cannot. Often the system is set up so that once a call is made to an emergency telephone number, it must be answered. Should the caller abandon the call, the line may still be held until the emergency service answers and releases the call.
An emergency telephone number call may be answered by either a telephone operator or an emergency service dispatcher. The nature of the emergency (police, fire, medical, Coast guard) is then determined. If the call has been answered by a telephone operator, they then connect the call to the appropriate emergency service, who then dispatches the appropriate help. In the case of multiple services being needed on a call, the most urgent need must be determined, with other services being called in as needed.
Emergency dispatchers are trained to control the call in order to provide help in an appropriate manner; they can be assisted by computer aided call handling systems (CACH). The emergency dispatcher may find it necessary to give urgent advice in life-threatening situations. Some dispatchers have special training in telling people how to perform first aid or CPR.
In many parts of the world, an emergency service can identify the telephone number that a call has been placed from. This is normally done using the system that the telephone company uses to bill calls, making the number visible even for users who have unlisted numbers or who block caller ID. Enhanced 911 and similar systems like E112 can provide the location of landline callers by looking up the physical address in a database, and mobile callers through triangulation from towers or GPS on the device. This is often specifically mandated in a country's telecommunication law.
History of emergency telephone numbers
Operator assistance
When an emergency happened in the pre-dial (or "manual") telephone era, the user simply picked up the telephone receiver and waited for the operator to answer "number, please?" The user responded with "get me the police," "I'm calling to report a fire," or "I need an ambulance/doctor." Even in large cities, it was seldom necessary to ask for these services by number.
In small towns, operators frequently provided additional services, knowing where to reach doctors, veterinarians, law enforcement personnel and firefighters at all times. Frequently, the operator was also responsible for activating the town's fire alarm.
When manual switching systems began to be replaced by automatic, or "dial" systems, there was frequently concern among users that the very personalized emergency service provided by manual operators would be lost.
Because numbers were different for every exchange, callers either had to dial the operator or look up the telephone number. An example of this was Auckland, New Zealand, before the introduction of 111 in the 1960s – the city had 40 exchanges, all with different emergency numbers, and finding the telephone number for the local exchange would require having to search through the city's 500-page telephone directory.
This problem was at least partially solved in Canada, the UK, and the US by dialing "0" for the local assistance operator in case of emergency, although faster service could be obtained if the user dialed the full number for the Police or Fire Department. This system remained essentially unchanged throughout most of North America until the 1970s.
Direct-dial numbers
999
The first emergency number system to be deployed anywhere in the world was in London on 30 June 1937 using the number 999, and this was later extended to cover the entire country.
When 999 was dialed, a buzzer sounded and a red light flashed in the exchange to attract an operator's attention.
The emergency number 999 was adopted in Winnipeg, Manitoba, Canada in 1959 at the urging of Stephen Juba, mayor of Winnipeg at the time. The city changed the number to 911 in 1972, in order to be consistent with the newly adopted U.S. emergency number.
Electro-mechanical issues
Because of loop disconnect dialing, attention was devoted to avoiding the number being dialed accidentally by errant interruptions of the circuits by making them involve long sequences of pulses, such as with the UK 999 emergency number. This meant that "111" could not be used: "111" dialing could accidentally take place when phone lines were in too close proximity to each other. Subscribers, as they were called then, were even given instructions on how to find the number "9" on the dial in darkened, or smoke-filled, rooms, by locating and placing the first finger in the "0" and the second in the "9", then removing the first when actually dialling. However, in modern times, where repeated sequences of numbers are easily dialled accidentally on mobile phones, this is problematic since mobile phones will dial an emergency number while the keypad is locked or even without a SIM card. Some people have reported accidentally dialing 112 by loop-disconnect for various technical reasons, including while working on extension telephone wiring, and point to this as a disadvantage of the 112 emergency number, which takes only four loop-disconnects to activate.
116
Southern California Telephone Co. began using 116 as an emergency line for Los Angeles, California in 1946.
911
Because of the design of U.S. central office (phone) switches, it was not practical to use the British emergency number 999 (as was briefly considered). What was up to that time unassigned area code 911 was chosen instead. The "1" as the second digit was key; it told the switching equipment that this was not a routine call. (At the time, when the second digit was "1" or "0" the equipment handled the call as a long distance or special number call.) The first 911 emergency phone system went into use in Haleyville, Alabama in 1968. On February 16, 1968, the first-ever 9-1-1 call was placed by Alabama Speaker of the House Rankin Fite, from Haleyville City Hall, to U.S. Rep. Tom Bevill, at the city's police station. However, 911 systems were not in widespread use until the 1980s when the number 911 was adopted as the standard number across most of the country under the North American Numbering Plan.
The implementation of 911 service in the USA was a gradual and haphazard process. Because telephone service boundaries did not always exactly match governmental and other jurisdictional boundaries, a user might dial 911, only to discover that he had been connected to the wrong dispatch center because he had telephone service from one location but lived within the boundaries of another jurisdiction.
Electromechanical switching equipment still in use made it difficult to adapt to recognize 911, especially in small towns and rural areas where the call might have to be switched over a considerable distance. For this reason, there are still county sheriff departments that have toll-free "800" area code numbers.
The rapid replacement of electromechanical switching systems in the 1980s with electronic or digital systems eliminated the problem of older switches that would not recognize 911. At this point, 911 service is available in most of North America, but there are still small, sparsely-populated, or remote areas (such as Nunavut and the Northwest Territories in Canada's Arctic) that do not have it.
Enhanced 911
Gradually, various problems were overcome; "smart" or "enhanced 911" systems were developed that not only would display the caller's number and address at the dispatch center but also could be configured so that 911 calls were automatically routed to the correct dispatch center, regardless of what central office the caller was served from. In the United States, most cities have E911 systems either in use, or in their emergency systems design plans.
988
On July 16, 2020, the US's FCC designated 988 as the "Suicide Prevention Hotline" emergency number. The National Suicide Prevention Lifeline, whose original phone number was 1-800-273-8255 switched to 988 on July 16, 2022. Carriers were required to update their dialing plan programming nationwide before it can be implemented. Many area codes which previously allowed 7 digit "local" dialing are now required to dial the entire 10 digit number as their region completes switch reprogramming.
17, 18
In France, many telephone exchanges were closed at night but it was still possible to make emergency calls. An operator had to connect the emergency calls only. In 1913, an automatic system was set up. It made provision for calling the police by dialing 17 and the fire brigade by dialing 18. As more manual telephone exchanges were converted to dial operation, more and more subscribers had access to these special numbers. The service was not widespread until the 1970s.
France now uses 112.
112
The CEPT recommended the use of in 1972. The European Union subsequently adopted the 112 number as a standard on 29 July 1991. It is now a valid emergency number throughout EU countries and in many other CEPT countries. It works in parallel with other local emergency numbers in about two out of three EU states.
IP telephony
In January 2008, the Internet Engineering Task Force released a set of RFC documents pertaining to emergency calls in IP networks.
000
Prior to 1969, Australia did not have a national number for emergency services; the police, fire and ambulance services possessed many phone numbers, one for each local unit. In 1961, the office of the Postmaster General (PMG) introduced the Triple Zero (000) number in major population centres and near the end of the 1980s extended its coverage to nationwide. The number Triple Zero (000) was chosen for several reasons: technically, it suited the dialing system for the most remote automatic exchanges, particularly outback Queensland. These communities used the digit 0 to select an automatic trunk line to a centre. In the most remote communities, two 0s had to be used to reach a main centre; thus dialing 0+0, plus another 0 would call (at least) an operator. Zero is closest to the finger stall on Australian rotary dial phones, so it was easy to dial in darkness.
The Telecommunications Numbering Plan 1997, also administered by ACMA, specifies that:
the primary emergency service number is '000' and
the secondary emergency service numbers are '106' and '112'.
ITU standard: 112 or 911
The International Telecommunication Union has officially set two standard emergency phone numbers for countries to use in the future. AP reports that member states have agreed that either 911 or 112 should be designated as emergency phone numbers – 911 is currently used in North America, while 112 is standard across the EU and in many other countries worldwide.
Emergency numbers and mobile telephones
Mobile phones can be used in countries with different emergency numbers. This means that a traveller visiting a foreign country does not have to know the local emergency numbers. The mobile phone and the SIM card have a preprogrammed list of emergency numbers. When the user tries to set up a call using an emergency number known by a GSM or 3G phone, the special emergency call setup takes place. The actual number is not even transmitted into the network, but the network redirects the emergency call to the local emergency desk. Most GSM mobile phones can dial emergency numbers even when the phone keyboard is locked, the phone is without a SIM card, emergency number is entered instead of the PIN or there is not a network signal (busy network).
Most GSM mobile phones have 112, 999 and 911 as pre-programmed emergency numbers that are always available. The SIM card issued by the operator can contain additional country-specific emergency numbers that can be used even when roaming abroad. The GSM network can also update the list of well-known emergency numbers when the phone registers to it.
Using an emergency number recognized by a GSM phone like 112 instead of another emergency number may be advantageous, since GSM phones and networks give special priority to emergency calls. A phone dialing an emergency service number not recognized by it may refuse to roam onto another network, leading to trouble if there is no access to the home network. Dialing a known emergency number like 112 forces the phone to try the call with any available network.
On some networks, a GSM phone without a SIM card may be used to make emergency calls, and most GSM phones accept a larger list of emergency numbers without SIM card, such as 112, 911, 118, 119, 000, 110, 08, and 999. However, some GSM networks will not accept emergency calls from phones without a SIM card, or even require a SIM card that has credit. For example, Latin American networks typically do not allow emergency calls without a SIM, nor British networks due to the prevalence of hoax calls.
The GSM phones may regard some phone numbers with one or two digits as special service codes. It might be impossible to make an emergency call to numbers like 03 or 92 with a mobile phone. In those cases the emergency number has to be called by using a landline telephone or with an additional first/last digit (for example 922 or 992 instead of 92 and 003 or 033 instead of 03).
In the United States, the FCC requires networks to route every mobile-phone and payphone 911 call to an emergency service call center, including phones that have never had service, or whose service has lapsed. As a result, there are programs that provide donated used mobile phones to victims of domestic violence and others especially likely to need emergency services.
Over the next six years, emergency responders will be able to better locate callers who dial 911 on their cellphones from indoors as the U.S. wireless industry improves caller-location for the majority of such calls. The "heightened location accuracy," available to supporting networks and handsets, will find callers through nearby devices connected to Wi-Fi or Bluetooth that will be logged with a specific location in a special emergency-services database.
Mobile phones generate additional problems for emergency operators, as many phones will allow emergency numbers to be dialed even while the keypad is locked. Since mobile phones are typically carried in pockets and small bags, the keys can easily be depressed accidentally, leading to unintended calls. A system has been developed in the UK to connect calls where the caller is sent to an automated system, leaving more operators free to handle genuine emergency calls.
See also
999 (emergency telephone number)
Amateur radio emergency communications
E112
Distress signal
eCall
Emergency telephone
Advanced Mobile Location (or 'Emergency Location Service')
In case of emergency (ICE) entry in the mobile phone book.
List of emergency telephone numbers
National Emergency Number Association (NENA)
Phone fraud
Single Non-Emergency Number
Helpline
References
Citations
Sources
Cutler, David M. (2000). The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit. Chicago: University of Chicago Press. . . p. 118.
Mobile Reference (2007). "Chapter: History of emergency services numbers"
BBC Seriously podcast "999 - Which Service Do You Require?" 30 June 2017
External links
112 – The European emergency number
National Emergency Number Association (NENA)
European Emergency Number Association (EENA)
The Norwegian National Centre on Emergency Communication in Health (KoKom)
Emergency Numbers in Saudi Arabia | wiki |
Fast break is an offensive strategy in basketball and handball. In a fast break, a team attempts to move the ball up court and into scoring position as quickly as possible, so that the defense is outnumbered and does not have time to set up. The various styles of the fast break–derivative of the original created by Frank Keaney–are seen as the best method of providing action and quick scores. A fast break may result from cherry picking.
Description
In a typical fast-break situation, the defending team obtains the ball and passes it to the fastest player, who sets up the fast break. That player (usually the smaller point guard, in the case of basketball) then speed-dribbles the ball up the court with several players trailing on the wings. He then either passes it to another player for quick scoring or takes the shot himself. If contact is made between him and a defender from behind while on a fast break, an unsportsmanlike foul is called. Recognition, speed, ball-handling skills, and decision-making are critical to the success of a fast break.
In basketball, fast breaks are often the result of good defensive play such as a steal, obtaining the ball off a block, or a missed shot by the opposing team and a rebound, where the defending team takes possession of the ball and the other team has not adjusted.
A fast break can sometimes lead to an alley-oop if there are more offensive players than defenders.
In basketball, if the fast break did not lead to a basket and an offensive rebound is obtained and put back quickly, this is called a secondary break.
Fly fast break
A fly fast break (also known as a one out fast break, the technical term for the play) is a basketball move in which after a shot is attempted, the player who is guarding the shooter does not box out or rebound but instead runs down the court looking for a pass from a rebounding teammate for a quick score.
How to play the Fly fast break
The coach designates a certain guard or guards to carry out the Fly fast break. This is often the guard that defends the opponents' shooting guard. When the designated opposing guard makes an attempted shot. The defending guard (referred to as 'Fly') will contest the shot but then sprints down the court to the other team's key. When the defending team obtains the rebound or has to inbound the ball (after a made basket), they throw the ball into the other team's key, knowing that there is a 'Fly' waiting to catch the ball and score.
Strengths
Defeats the zone - the other team doesn't have time to set up their zone defense.
Removes a rebounder - because the shooter has to defend against the Fly, they are removed from rebounding.
Upsets the shooter - because the shooter has to worry about defense, they are less focused on their shooting.
Weaknesses
Rebounding weakness - The Fly's team is left with a 4 against 5 rebounding ratio, if the shooter stays to rebound.
Inbounding - If a shooter scores, the inbounding set up takes longer and the distance to throw the ball is harder.
Exhausting - The Fly has to sprint on offense, but has to hustle back on defense if the Fly fast break fails.
Breaking Down the Fly fast break
Breaking down the Fly fast break can be done in two ways:
Have a confident shooter who can score and force the defending team to inbound while the shooter hustles back to defend against the Fly.
Use non-shooting plays, where the #4 & #5 forwards do the scoring.
Notes
The 'Fly' is a term in fly fishing where the actions of this type of fishing are similar to the actions of the basketball player in Fly fast break.
References
https://www.uri.edu/anniversary/stories/frank-keaney-and-the-old-gazazza/
Further reading
Basketball terminology
Basketball strategy
Handball terminology | wiki |
Fouradi is a Dutch hip hop duo from Amsterdam, Netherlands. The group is composed of Moroccan-Dutch brothers Mohamed (born 5 January 1982) and Brahim (19 November 1985) Fouradi.
Discography
Albums
Singles
Featured in
References
External links
Official website
1982 births
1985 births
Living people
Dutch hip hop groups
Dutch rappers
Dutch people of Moroccan descent
Musical groups from Amsterdam | wiki |
Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.
Hypothermia has two main types of causes. It classically occurs from exposure to cold weather and cold water immersion. It may also occur from any condition that decreases heat production or increases heat loss. Commonly, this includes alcohol intoxication but may also include low blood sugar, anorexia and advanced age. Body temperature is usually maintained near a constant level of through thermoregulation. Efforts to increase body temperature involve shivering, increased voluntary activity, and putting on warmer clothing. Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature.
The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical activity. In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended. People with moderate or severe hypothermia should be moved gently. In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures. Rewarming is typically continued until a person's temperature is greater than . If there is no improvement at this point or the blood potassium level is greater than 12 mmol/liter at any time, resuscitation may be discontinued.
Hypothermia is the cause of at least 1,500 deaths a year in the United States. It is more common in older people and males. One of the lowest documented body temperatures from which someone with accidental hypothermia has survived is in a 2-year-old boy from Poland named Adam. Survival after more than six hours of CPR has been described. In individuals for whom ECMO or bypass is used, survival is around 50%. Deaths due to hypothermia have played an important role in many wars.
The term is from Greek ῠ̔πο (ypo), meaning "under", and θέρμη (thérmē), meaning "heat". The opposite of hypothermia is hyperthermia, an increased body temperature due to failed thermoregulation.
Classification
Hypothermia is often defined as any body temperature below . With this method it is divided into degrees of severity based on the core temperature.
Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.
Other cold-related injuries that can be present either alone or in combination with hypothermia include:
Chilblains: condition caused by repeated exposure of skin to temperatures just above freezing. The cold causes damage to small blood vessels in the skin. This damage is permanent and the redness and itching will return with additional exposure. The redness and itching typically occurs on cheeks, ears, fingers, and toes.
Frostbite: the freezing and destruction of tissue, which happens below the freezing point of water
Frostnip: a superficial cooling of tissues without cellular destruction
Trench foot or immersion foot: a condition caused by repetitive exposure to water at non-freezing temperatures
The normal human body temperature is often stated as . Hyperthermia and fever, are defined as a temperature of greater than .
Signs and symptoms
Signs and symptoms vary depending on the degree of hypothermia, and may be divided by the three stages of severity. People with hypothermia may appear pale and feel cold to touch.
Infants with hypothermia may feel cold when touched, with bright red skin and an unusual lack of energy.
Behavioural changes such as impaired judgement, impaired sense of time and place, unusual aggression and numbness can be observed in individuals with hypothermia, they can also deny their condition and refuse any help. A hypothermic person can be euphoric and hallucinating.
Cold stress refers to a near-normal body temperature with low skin temperature, signs include shivering. Cold stress is caused by cold exposure and it can lead to hypothermia and frostbite if not treated.
Mild
Symptoms of mild hypothermia may be vague, with sympathetic nervous system excitation (shivering, high blood pressure, fast heart rate, fast respiratory rate, and contraction of blood vessels). These are all physiological responses to preserve heat. Increased urine production due to cold, mental confusion, and liver dysfunction may also be present. Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted. Sympathetic activation also releases glucose from the liver. In many cases, however, especially in people with alcoholic intoxication, hypoglycemia appears to be a more common cause. Hypoglycemia is also found in many people with hypothermia, as hypothermia may be a result of hypoglycemia.
Moderate
As hypothermia progresses, symptoms include: mental status changes such as amnesia, confusion, slurred speech, decreased reflexes, and loss of fine motor skills.
Severe
As the temperature decreases, further physiological systems falter and heart rate, respiratory rate, and blood pressure all decrease. This results in an expected heart rate in the 30s at a temperature of .
There is often cold, inflamed skin, hallucinations, lack of reflexes, fixed dilated pupils, low blood pressure, pulmonary edema, and shivering is often absent. Pulse and respiration rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can also occur. Atrial fibrillation is not typically a concern in and of itself.
Paradoxical undressing
Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.
Rescuers who are trained in mountain survival techniques are taught to expect this; however, people who die from hypothermia in urban environments who are found in an undressed state are sometimes incorrectly assumed to have been subjected to sexual assault.
One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Another explanation is that the muscles contracting peripheral blood vessels become exhausted (known as a loss of vasomotor tone) and relax, leading to a sudden surge of blood (and heat) to the extremities, causing the person to feel overheated.
Terminal burrowing
An apparent self-protective behaviour, known as "terminal burrowing", or "hide-and-die syndrome", occurs in the final stages of hypothermia. Those affected will enter small, enclosed spaces, such as underneath beds or behind wardrobes. It is often associated with paradoxical undressing. Researchers in Germany claim this is "obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection, as seen in hibernating mammals". This happens mostly in cases where temperature drops slowly.
Causes
Hypothermia usually occurs from exposure to low temperatures, and is frequently complicated by alcohol consumption. Any condition that decreases heat production, increases heat loss, or impairs thermoregulation, however, may contribute. Thus, hypothermia risk factors include: substance use disorders (including alcohol use disorder), homelessness, any condition that affects judgment (such as hypoglycemia), the extremes of age, poor clothing, chronic medical conditions (such as hypothyroidism and sepsis), and living in a cold environment. Hypothermia occurs frequently in major trauma, and is also observed in severe cases of anorexia nervosa. Hypothermia is also associated with worse outcomes in people with sepsis. While most people with sepsis develop fevers (elevated body temperature), some develop hypothermia.
In urban areas, hypothermia frequently occurs with chronic cold exposure, such as in cases of homelessness, as well as with immersion accidents involving drugs, alcohol or mental illness. While studies have shown that people experiencing homelessness are at risk of premature death from hypothermia, the true incidence of hypothermia-related deaths in this population is difficult to determine. In more rural environments, the incidence of hypothermia is higher among people with significant comorbidities and less able to move independently. With rising interest in wilderness exploration, and outdoor and water sports, the incidence of hypothermia secondary to accidental exposure may become more frequent in the general population.
Alcohol
Alcohol consumption increases the risk of hypothermia in two ways: vasodilation and temperature controlling systems in the brain. Vasodilation increases blood flow to the skin, resulting in heat being lost to the environment. This produces the effect of feeling warm, when one is actually losing heat. Alcohol also affects the temperature-regulating system in the brain, decreasing the body's ability to shiver and use energy that would normally aid the body in generating heat. The overall effects of alcohol lead to a decrease in body temperature and a decreased ability to generate body heat in response to cold environments. Alcohol is a common risk factor for death due to hypothermia. Between 33% and 73% of hypothermia cases are complicated by alcohol.
Water immersion
Hypothermia continues to be a major limitation to swimming or diving in cold water. The reduction in finger dexterity due to pain or numbness decreases general safety and work capacity, which consequently increases the risk of other injuries.
Other factors predisposing to immersion hypothermia include dehydration, inadequate rewarming between repetitive dives, starting a dive while wearing cold, wet dry suit undergarments, sweating with work, inadequate thermal insulation (for example, thin dry suit undergarment), and poor physical conditioning.
Heat is lost much more quickly in water than in air. Thus, water temperatures that would be quite reasonable as outdoor air temperatures can lead to hypothermia in survivors, although this is not usually the direct clinical cause of death for those who are not rescued. A water temperature of can lead to death in as little as one hour, and water temperatures near freezing can cause death in as little as 15 minutes. During the sinking of the Titanic, most people who entered the water died in 15–30 minutes.
The actual cause of death in cold water is usually the bodily reactions to heat loss and to freezing water, rather than hypothermia (loss of core temperature) itself. For example, plunged into freezing seas, around 20% of victims die within two minutes from cold shock (uncontrolled rapid breathing, and gasping, causing water inhalation, massive increase in blood pressure and cardiac strain leading to cardiac arrest, and panic); another 50% die within 15–30 minutes from cold incapacitation: inability to use or control limbs and hands for swimming or gripping, as the body "protectively" shuts down the peripheral muscles of the limbs to protect its core. Exhaustion and unconsciousness cause drowning, claiming the rest within a similar time.
Pathophysiology
Heat is primarily generated in muscle tissue, including the heart, and in the liver, while it is lost through the skin (90%) and lungs (10%). Heat production may be increased two- to four-fold through muscle contractions (i.e. exercise and shivering). The rate of heat loss is determined, as with any object, by convection, conduction, and radiation. The rates of these can be affected by body mass index, body surface area to volume ratios, clothing and other environmental conditions.
Many changes to physiology occur as body temperatures decrease. These occur in the cardiovascular system leading to the Osborn J wave and other dysrhythmias, decreased central nervous system electrical activity, cold diuresis, and non-cardiogenic pulmonary edema.
Research has shown that glomerular filtration rates (GFR) decrease as a result of hypothermia. In essence, hypothermia increases preglomerular vasoconstriction, thus decreasing both renal blood flow (RBF) and GFR.
Diagnosis
Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below . A low temperature thermometer can be placed in the rectum, esophagus or bladder. Esophageal measurements are the most accurate and are recommended once a person is intubated. Other methods of measurement such as in the mouth, under the arm, or using an infrared ear thermometer are often not accurate.
As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR. Others recommend a 60-second check.
The classical ECG finding of hypothermia is the Osborn J wave. Also, ventricular fibrillation frequently occurs below and asystole below . The Osborn J may look very similar to those of an acute ST elevation myocardial infarction. Thrombolysis as a reaction to the presence of Osborn J waves is not indicated, as it would only worsen the underlying coagulopathy caused by hypothermia.
Prevention
Staying dry and wearing proper clothing help to prevent hypothermia. Synthetic and wool fabrics are superior to cotton as they provide better insulation when wet and dry. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Clothing should be loose fitting, as tight clothing reduces the circulation of warm blood. In planning outdoor activity, prepare appropriately for possible cold weather. Those who drink alcohol before or during outdoor activity should ensure at least one sober person is present responsible for safety.
Covering the head is effective, but no more effective than covering any other part of the body. While common folklore says that people lose most of their heat through their heads, heat loss from the head is no more significant than that from other uncovered parts of the body. However, heat loss from the head is significant in infants, whose head is larger relative to the rest of the body than in adults. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. Children have a larger surface area per unit mass, and other things being equal should have one more layer of clothing than adults in similar conditions, and the time they spend in cold environments should be limited. However children are often more active than adults, and may generate more heat. In both adults and children, overexertion causes sweating and thus increases heat loss.
Building a shelter can aid survival where there is danger of death from exposure. Shelters can be of many different types, metal can conduct heat away from the occupants and is sometimes best avoided. The shelter should not be too big so body warmth stays near the occupants. Good ventilation is essential especially if a fire will be lit in the shelter. Fires should be put out before the occupants sleep to prevent carbon monoxide poisoning. People caught in very cold, snowy conditions can build an igloo or snow cave to shelter.
The United States Coast Guard promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in water for 50 minutes, they have a 50 percent better chance of survival if they are wearing a life jacket. A heat escape lessening position can be used to increase survival in cold water.
Babies should sleep at 16–20 °C (61–68 °F) and housebound people should be checked regularly to make sure the temperature of the home is at least 18 °C (64 °F).
Management
Aggressiveness of treatment is matched to the degree of hypothermia. Treatment ranges from noninvasive, passive external warming to active external rewarming, to active core rewarming. In severe cases resuscitation begins with simultaneous removal from the cold environment and management of the airway, breathing, and circulation. Rapid rewarming is then commenced. Moving the person as little and as gently as possible is recommended as aggressive handling may increase risks of a dysrhythmia.
Hypoglycemia is a frequent complication and needs to be tested for and treated. Intravenous thiamine and glucose is often recommended, as many causes of hypothermia are complicated by Wernicke's encephalopathy.
The UK National Health Service advises against putting a person in a hot bath, massaging their arms and legs, using a heating pad, or giving them alcohol. These measures can cause a rapid fall in blood pressure and potential cardiac arrest.
Rewarming
Rewarming can be done with a number of methods including passive external rewarming, active external rewarming, and active internal rewarming. Passive external rewarming involves the use of a person's own ability to generate heat by providing properly insulated dry clothing and moving to a warm environment. Passive external rewarming is recommended for those with mild hypothermia.
Active external rewarming involves applying warming devices externally, such as a heating blanket. These may function by warmed forced air (Bair Hugger is a commonly used device), chemical reactions, or electricity. In wilderness environments, hypothermia may be helped by placing hot water bottles in both armpits and in the groin. Active external rewarming is recommended for moderate hypothermia. Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest or abdomen), use of warm humidified inhaled air, or use of extracorporeal rewarming such as via a heart lung machine or extracorporeal membrane oxygenation (ECMO). Extracorporeal rewarming is the fastest method for those with severe hypothermia. When severe hypothermia has led to cardiac arrest, effective extracorporeal warming results in survival with normal mental function about 50% of the time. Chest irrigation is recommended if bypass or ECMO is not possible.
Rewarming shock (or rewarming collapse) is a sudden drop in blood pressure in combination with a low cardiac output which may occur during active treatment of a severely hypothermic person. There was a theoretical concern that external rewarming rather than internal rewarming may increase the risk. These concerns were partly believed to be due to afterdrop, a situation detected during laboratory experiments where there is a continued decrease in core temperature after rewarming has been started. Recent studies have not supported these concerns, and problems are not found with active external rewarming.
Fluids
For people who are alert and able to swallow, drinking warm (not hot) sweetened liquids can help raise the temperature. General medical consensus advises against alcohol and caffeinated drinks. As most hypothermic people are moderately dehydrated due to cold-induced diuresis, warmed intravenous fluids to a temperature of are often recommended.
Cardiac arrest
In those without signs of life, cardiopulmonary resuscitation (CPR) should be continued during active rewarming. For ventricular fibrillation or ventricular tachycardia, a single defibrillation should be attempted. However, people with severe hypothermia may not respond to pacing or defibrillation. It is not known if further defibrillation should be withheld until the core temperature reaches . In Europe, epinephrine is not recommended until the person's core temperature reaches , while the American Heart Association recommends up to three doses of epinephrine before a core temperature of is reached. Once a temperature of has been reached, normal ACLS protocols should be followed.
Prognosis
It is usually recommended not to declare a person dead until their body is warmed to a near normal body temperature of greater than , since extreme hypothermia can suppress heart and brain function. This is summarized in the common saying "You're not dead until you're warm and dead." Exceptions include if there are obvious fatal injuries or the chest is frozen so that it cannot be compressed. If a person was buried in an avalanche for more than 35 minutes and is found with a mouth packed full of snow without a pulse, stopping early may also be reasonable. This is also the case if a person's blood potassium is greater than 12 mmol/L.
Those who are stiff with pupils that do not move may survive if treated aggressively. Survival with good function also occasionally occurs even after the need for hours of CPR. Children who have near-drowning accidents in water near can occasionally be revived, even over an hour after losing consciousness. The cold water lowers the metabolism, allowing the brain to withstand a much longer period of hypoxia. While survival is possible, mortality from severe or profound hypothermia remains high despite optimal treatment. Studies estimate mortality at between 38% and 75%.
In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem.
Epidemiology
Between 1995 and 2004 in the United States, an average of 1560 cold-related emergency department visits occurred per year and in the years 1999 to 2004, an average of 647 people died per year due to hypothermia. Of deaths reported between 1999 and 2002 in the US, 49% of those affected were 65 years or older and two-thirds were male. Most deaths were not work related (63%) and 23% of affected people were at home. Hypothermia was most common during the autumn and winter months of October through March. In the United Kingdom, an estimated 300 deaths per year are due to hypothermia, whereas the annual incidence of hypothermia-related deaths in Canada is 8000.
History
Hypothermia has played a major role in the success or failure of many military campaigns, from Hannibal's loss of nearly half his men in the Second Punic War (218 B.C.) to the near destruction of Napoleon's armies in Russia in 1812. Men wandered around confused by hypothermia, some lost consciousness and died, others shivered, later developed torpor, and tended to sleep. Others too weak to walk fell on their knees; some stayed that way for some time resisting death. The pulse of some was weak and hard to detect; others groaned; yet others had eyes open and wild with quiet delirium. Deaths from hypothermia in Russian regions continued through the first and second world wars, especially in the Battle of Stalingrad.
Civilian examples of deaths caused by hypothermia occurred during the sinkings of the RMS Titanic and RMS Lusitania, and more recently of the MS Estonia.
Antarctic explorers developed hypothermia; Ernest Shackleton and his team measured body temperatures "below 94.2°, which spells death at home", though this probably referred to oral temperatures rather than core temperature and corresponded to mild hypothermia. One of Scott's team, Atkinson, became confused through hypothermia.
Nazi human experimentation during World War II amounting to medical torture included hypothermia experiments, which killed many victims. There were 360 to 400 experiments and 280 to 300 subjects, indicating some had more than one experiment performed on them. Various methods of rewarming were attempted: "One assistant later testified that some victims were thrown into boiling water for rewarming".
Medical use
Various degrees of hypothermia may be deliberately induced in medicine for purposes of treatment of brain injury, or lowering metabolism so that total brain ischemia can be tolerated for a short time. Deep hypothermic circulatory arrest is a medical technique in which the brain is cooled as low as 10 °C, which allows the heart to be stopped and blood pressure to be lowered to zero, for the treatment of aneurysms and other circulatory problems that do not tolerate arterial pressure or blood flow. The time limit for this technique, as also for accidental arrest in ice water (which internal temperatures may drop to as low as 15 °C), is about one hour.
Other animals
Hypothermia can happen in most mammals in cold weather and can be fatal. Baby mammals such as kittens are unable to regulate their body temperatures and have a risk of hypothermia if they are not kept warm by their mothers.
Many animals other than humans often induce hypothermia during hibernation or torpor.
Water bears (Tardigrade), microscopic multicellular organisms, can survive freezing at low temperatures by replacing most of their internal water with the sugar trehalose, preventing the crystallization that otherwise damages cell membranes.
See also
, two versions of a short story by Jack London portraying the effects of cold and hypothermia
, a short story by Hans Christian Andersen about a child dying of hypothermia
Dyatlov Pass incident
References
Bibliography
External links
CDC - NIOSH Workplace Safety & Health Topic: Cold Stress
Diving medicine
Medical emergencies
Wilderness medical emergencies
Physiology
Causes of death
Cryobiology
Heat transfer
Effects of external causes
Cardiac arrhythmia
Thermoregulation
Cold waves
Weather and health
Wikipedia medicine articles ready to translate
Wikipedia emergency medicine articles ready to translate | wiki |
Логновичи — название населённых пунктов:
Белоруссия
Логновичи — деревня в Мостовском районе Гродненской области.
Логновичи — деревня в Клецком районе Минской области. | wiki |
Con il nome di Edward Loring si può intendere:
Edward Greely Loring, (1802-1890) giudice del Massachusetts
Edward G. Loring, (1837-1888) medico oftalmologo, scrittore di testi di medicina
Edward Loring, scrittore | wiki |
Adapalene/benzoyl peroxide, sold under the brand name Epiduo among others, is a fixed-dose combination medication for the treatment of severe acne vulgaris. It consists of a combination of adapalene and benzoyl peroxide in a topical gel formulation.
It is available as a generic medication.
Medical uses
Adapalene/benzoyl peroxide is indicated for the topical treatment of acne vulgaris.
Side effects
Commonly reported side effects include the following:
Skin redness
Scaling
Dry skin
Contact dermatitis
Skin irritation
Stinging
Burning
Research
Meta-analysis of clinical trials has shown this combined therapy to be more effective than either of its ingredients by themselves.
The use of adapalene/benzoyl peroxide in combination with oral antibiotics (lymecycline) has been studied; the combination was well tolerated and showed an improved success rate compared to those receiving only antibiotics (47.6% vs. 33.7%, P = 0.002).
References
External links
Anti-acne preparations
Combination drugs | wiki |
Texture mapping is a method for mapping a texture on a computer-generated graphic. Texture here can be high frequency detail, surface texture, or color.
History
The original technique was pioneered by Edwin Catmull in 1974.
Texture mapping originally referred to diffuse mapping, a method that simply mapped pixels from a texture to a 3D surface ("wrapping" the image around the object). In recent decades, the advent of multi-pass rendering, multitexturing, mipmaps, and more complex mappings such as height mapping, bump mapping, normal mapping, displacement mapping, reflection mapping, specular mapping, occlusion mapping, and many other variations on the technique (controlled by a materials system) have made it possible to simulate near-photorealism in real time by vastly reducing the number of polygons and lighting calculations needed to construct a realistic and functional 3D scene.
Texture maps
A is an image applied (mapped) to the surface of a shape or polygon. This may be a bitmap image or a procedural texture. They may be stored in common image file formats, referenced by 3d model formats or material definitions, and assembled into resource bundles.
They may have 1-3 dimensions, although 2 dimensions are most common for visible surfaces. For use with modern hardware, texture map data may be stored in swizzled or tiled orderings to improve cache coherency. Rendering APIs typically manage texture map resources (which may be located in device memory) as buffers or surfaces, and may allow 'render to texture' for additional effects such as post processing or environment mapping.
They usually contain RGB color data (either stored as direct color, compressed formats, or indexed color), and sometimes an additional channel for alpha blending (RGBA) especially for billboards and decal overlay textures. It is possible to use the alpha channel (which may be convenient to store in formats parsed by hardware) for other uses such as specularity.
Multiple texture maps (or channels) may be combined for control over specularity, normals, displacement, or subsurface scattering e.g. for skin rendering.
Multiple texture images may be combined in texture atlases or array textures to reduce state changes for modern hardware. (They may be considered a modern evolution of tile map graphics). Modern hardware often supports cube map textures with multiple faces for environment mapping.
Creation
Texture maps may be acquired by scanning/digital photography, designed in image manipulation software such as GIMP, Photoshop, or painted onto 3D surfaces directly in a 3D paint tool such as Mudbox or zbrush.
Texture application
This process is akin to applying patterned paper to a plain white box. Every vertex in a polygon is assigned a texture coordinate (which in the 2d case is also known as UV coordinates).
This may be done through explicit assignment of vertex attributes, manually edited in a 3D modelling package through UV unwrapping tools. It is also possible to associate a procedural transformation from 3d space to texture space with the material. This might be accomplished via planar projection or, alternatively, cylindrical or spherical mapping. More complex mappings may consider the distance along a surface to minimize distortion.
These coordinates are interpolated across the faces of polygons to sample the texture map during rendering.
Textures may be repeated or mirrored to extend a finite rectangular bitmap over a larger area, or they may have a one-to-one unique "injective" mapping from every piece of a surface (which is important for render mapping and light mapping, also known as baking).
Texture space
Texture mapping maps the model surface (or screen space during rasterization) into texture space; in this space, the texture map is visible in its undistorted form. UV unwrapping tools typically provide a view in texture space for manual editing of texture coordinates. Some rendering techniques such as subsurface scattering may be performed approximately by texture-space operations.
Multitexturing
Multitexturing is the use of more than one texture at a time on a polygon. For instance, a light map texture may be used to light a surface as an alternative to recalculating that lighting every time the surface is rendered. Microtextures or detail textures are used to add higher frequency details, and dirt maps may add weathering and variation; this can greatly reduce the apparent periodicity of repeating textures. Modern graphics may use more than 10 layers, which are combined using shaders, for greater fidelity. Another multitexture technique is bump mapping, which allows a texture to directly control the facing direction of a surface for the purposes of its lighting calculations; it can give a very good appearance of a complex surface (such as tree bark or rough concrete) that takes on lighting detail in addition to the usual detailed coloring. Bump mapping has become popular in recent video games, as graphics hardware has become powerful enough to accommodate it in real-time.
Texture filtering
The way that samples (e.g. when viewed as pixels on the screen) are calculated from the texels (texture pixels) is governed by texture filtering. The cheapest method is to use the nearest-neighbour interpolation, but bilinear interpolation or trilinear interpolation between mipmaps are two commonly used alternatives which reduce aliasing or jaggies. In the event of a texture coordinate being outside the texture, it is either clamped or wrapped. Anisotropic filtering better eliminates directional artefacts when viewing textures from oblique viewing angles.
Texture streaming
Texture streaming is a means of using data streams for textures, where each texture is available in two or more different resolutions, as to determine which texture should be loaded into memory and used based on draw distance from the viewer and how much memory is available for textures. Texture streaming allows a rendering engine to use low resolution textures for objects far away from the viewer's camera, and resolve those into more detailed textures, read from a data source, as the point of view nears the objects.
Baking
As an optimization, it is possible to render detail from a complex, high-resolution model or expensive process (such as global illumination) into a surface texture (possibly on a low-resolution model). Baking is also known as render mapping. This technique is most commonly used for light maps, but may also be used to generate normal maps and displacement maps. Some computer games (e.g. Messiah) have used this technique. The original Quake software engine used on-the-fly baking to combine light maps and colour maps ("surface caching").
Baking can be used as a form of level of detail generation, where a complex scene with many different elements and materials may be approximated by a single element with a single texture, which is then algorithmically reduced for lower rendering cost and fewer drawcalls. It is also used to take high-detail models from 3D sculpting software and point cloud scanning and approximate them with meshes more suitable for realtime rendering.
Rasterisation algorithms
Various techniques have evolved in software and hardware implementations. Each offers different trade-offs in precision, versatility and performance.
Affine texture mapping
Affine texture mapping linearly interpolates texture coordinates across a surface, and so is the fastest form of texture mapping. Some software and hardware (such as the original PlayStation) project vertices in 3D space onto the screen during rendering and linearly interpolate the texture coordinates in screen space between them. This may be done by incrementing fixed point UV coordinates, or by an incremental error algorithm akin to Bresenham's line algorithm.
In contrast to perpendicular polygons, this leads to noticeable distortion with perspective transformations (see figure: the checker box texture appears bent), especially as primitives near the camera. Such distortion may be reduced with the subdivision of the polygon into smaller ones.
For the case of rectangular objects, using quad primitives can look less incorrect than the same rectangle split into triangles, but because interpolating 4 points adds complexity to the rasterization, most early implementations preferred triangles only. Some hardware, such as the forward texture mapping used by the Nvidia NV1, was able to offer efficient quad primitives. With perspective correction (see below) triangles become equivalent and this advantage disappears.
For rectangular objects that are at right angles to the viewer, like floors and walls, the perspective only needs to be corrected in one direction across the screen, rather than both. The correct perspective mapping can be calculated at the left and right edges of the floor, and then an affine linear interpolation across that horizontal span will look correct, because every pixel along that line is the same distance from the viewer.
Perspective correctness
Perspective correct texturing accounts for the vertices' positions in 3D space, rather than simply interpolating coordinates in 2D screen space. This achieves the correct visual effect but it is more expensive to calculate.
To perform perspective correction of the texture coordinates and , with being the depth component from the viewer's point of view, we can take advantage of the fact that the values , , and are linear in screen space across the surface being textured. In contrast, the original , and , before the division, are not linear across the surface in screen space. We can therefore linearly interpolate these reciprocals across the surface, computing corrected values at each pixel, to result in a perspective correct texture mapping.
To do this, we first calculate the reciprocals at each vertex of our geometry (3 points for a triangle). For vertex we have . Then, we linearly interpolate these reciprocals between the vertices (e.g., using Barycentric Coordinates), resulting in interpolated values across the surface. At a given point, this yields the interpolated , and . Note that this cannot be yet used as our texture coordinates as our division by altered their coordinate system.
To correct back to the space we first calculate the corrected by again taking the reciprocal . Then we use this to correct our : and .
This correction makes it so that in parts of the polygon that are closer to the viewer the difference from pixel to pixel between texture coordinates is smaller (stretching the texture wider) and in parts that are farther away this difference is larger (compressing the texture).
Affine texture mapping directly interpolates a texture coordinate between two endpoints and :
where
Perspective correct mapping interpolates after dividing by depth , then uses its interpolated reciprocal to recover the correct coordinate:
3D graphics hardware typically supports perspective correct texturing.
Various techniques have evolved for rendering texture mapped geometry into images with different quality/precision tradeoffs, which can be applied to both software and hardware.
Classic software texture mappers generally did only simple mapping with at most one lighting effect (typically applied through a lookup table), and the perspective correctness was about 16 times more expensive.
Restricted camera rotation
The Doom engine restricted the world to vertical walls and horizontal floors/ceilings, with a camera that could only rotate about the vertical axis. This meant the walls would be a constant depth coordinate along a vertical line and the floors/ceilings would have a constant depth along a horizontal line. After performing one perspective correction calculation for the depth, the rest of the line could use fast affine mapping. Some later renderers of this era simulated a small amount of camera pitch with shearing which allowed the appearance of greater freedom whilst using the same rendering technique.
Some engines were able to render texture mapped Heightmaps (e.g. Nova Logic's Voxel Space, and the engine for Outcast) via Bresenham-like incremental algorithms, producing the appearance of a texture mapped landscape without the use of traditional geometric primitives.
Subdivision for perspective correction
Every triangle can be further subdivided into groups of about 16 pixels in order to achieve two goals. First, keeping the arithmetic mill busy at all times. Second, producing faster arithmetic results.
World space subdivision
For perspective texture mapping without hardware support, a triangle is broken down into smaller triangles for rendering and affine mapping is used on them. The reason this technique works is that the distortion of affine mapping becomes much less noticeable on smaller polygons. The Sony PlayStation made extensive use of this because it only supported affine mapping in hardware but had a relatively high triangle throughput compared to its peers.
Screen space subdivision
Software renderers generally preferred screen subdivision because it has less overhead. Additionally, they try to do linear interpolation along a line of pixels to simplify the set-up (compared to 2d affine interpolation) and thus again the overhead (also affine texture-mapping does not fit into the low number of registers of the x86 CPU; the 68000 or any RISC is much more suited).
A different approach was taken for Quake, which would calculate perspective correct coordinates only once every 16 pixels of a scanline and linearly interpolate between them, effectively running at the speed of linear interpolation because the perspective correct calculation runs in parallel on the co-processor. The polygons are rendered independently, hence it may be possible to switch between spans and columns or diagonal directions depending on the orientation of the polygon normal to achieve a more constant z but the effort seems not to be worth it.
Other techniques
Another technique was approximating the perspective with a faster calculation, such as a polynomial. Still another technique uses 1/z value of the last two drawn pixels to linearly extrapolate the next value. The division is then done starting from those values so that only a small remainder has to be divided but the amount of bookkeeping makes this method too slow on most systems.
Finally, the Build engine extended the constant distance trick used for Doom by finding the line of constant distance for arbitrary polygons and rendering along it.
Hardware implementations
Texture mapping hardware was originally developed for simulation (e.g. as implemented in the Evans and Sutherland ESIG image generators), and professional graphics workstations such as Silicon Graphics, broadcast digital video effects machines such as the Ampex ADO and later appeared in Arcade cabinets, consumer video game consoles, and PC video cards in the mid 1990s. In flight simulation, texture mapping provided important motion cues.
Modern graphics processing units (GPUs) provide specialised fixed function units called texture samplers, or texture mapping units, to perform texture mapping, usually with trilinear filtering or better multi-tap anisotropic filtering and hardware for decoding specific formats such as DXTn. As of 2016, texture mapping hardware is ubiquitous as most SOCs contain a suitable GPU.
Some hardware combines texture mapping with hidden-surface determination in tile based deferred rendering or scanline rendering; such systems only fetch the visible texels at the expense of using greater workspace for transformed vertices. Most systems have settled on the Z-buffering approach, which can still reduce the texture mapping workload with front-to-back sorting.
Among earlier graphics hardware, there were two competing paradigms of how to deliver a texture to the screen:
Forward texture mapping iterates through each texel on the texture, and decides where to place it on the screen.
Inverse texture mapping instead iterates through pixels on the screen, and decides what texel to use for each.
Inverse texture mapping is the method which has become standard in modern hardware.
Inverse texture mapping
With this method, a pixel on the screen is mapped to a point on the texture. Each vertex of a rendering primitive is projected to a point on the screen, and each of these points is mapped to a u,v texel coordinate on the texture. A rasterizer will interpolate between these points to fill in each pixel covered by the primitive.
The primary advantage is that each pixel covered by a primitive will be traversed exactly once. Once a primitive's vertices are transformed, the amount of remaining work scales directly with how many pixels it covers on the screen.
The main disadvantage versus forward texture mapping is that the memory access pattern in the texture space will not be linear if the texture is at an angle to the screen. This disadvantage is often addressed by texture caching techniques, such as the swizzled texture memory arrangement.
The linear interpolation can be used directly for simple and efficient affine texture mapping, but can also be adapted for perspective correctness.
Forward texture mapping
Forward texture mapping maps each texel of the texture to a pixel on the screen. After transforming a rectangular primitive to a place on the screen, a forward texture mapping renderer iterates through each texel on the texture, splatting each one onto a pixel of the frame buffer.
This was used by some hardware, such as the Sega Saturn and the NV1.
The primary advantage is that the texture will be accessed in a simple linear order, allowing very efficient caching of the texture data. However, this benefit is also its disadvantage: as a primitive gets smaller on screen, it still has to iterate over every texel in the texture, causing many pixels to be overdrawn redundantly.
This method is also well suited for rendering quad primitives rather than reducing them to triangles, which provided an advantage when perspective correct texturing was not available in hardware. This is because the affine distortion of a quad looks less incorrect than the same quad split into two triangles (see affine texture mapping above). The NV1 hardware also allowed a quadratic interpolation mode to provide an even better approximation of perspective correctness.
The existing hardware implementations did not provide effective UV coordinate mapping, which became an important technique for 3D modelling and assisted in clipping the texture correctly when the primitive goes over the edge of the screen. These shortcomings could have been addressed with further development, but GPU design has since mostly moved toward inverse mapping.
Applications
Beyond 3D rendering, the availability of texture mapping hardware has inspired its use for accelerating other tasks:
Tomography
It is possible to use texture mapping hardware to accelerate both the reconstruction of voxel data sets from tomographic scans, and to visualize the results.
User interfaces
Many user interfaces use texture mapping to accelerate animated transitions of screen elements, e.g. Exposé in Mac OS X.
See also
2.5D
3D computer graphics
Mipmap
Materials system
Parametrization
Texture synthesis
Texture atlas
Texture splatting – a technique for combining textures
Shader (computer graphics)
References
Software
TexRecon — open-source software for texturing 3D models written in C++
External links
Introduction into texture mapping using C and SDL (PDF)
Programming a textured terrain using XNA/DirectX, from www.riemers.net
Perspective correct texturing
Time Texturing Texture mapping with bezier lines
Polynomial Texture Mapping Interactive Relighting for Photos
3 Métodos de interpolación a partir de puntos (in spanish) Methods that can be used to interpolate a texture knowing the texture coords at the vertices of a polygon
3D Texturing Tools
Computer graphics | wiki |
Luny may refer to:
Luny, from Luny Tunes
Luny Unold (born 1920), Swiss figure skater
Thomas Luny (1759–1837), English artist and painter | wiki |
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