title: Research question

text: Situations similar to the global problematique in their complexity are also called problematiques. These situations receive different designations from other authors. In organizational theory and related fields, researchers C. West Churchman, Horst Rittel and Melvin Webber, and Chris Argyris called these situations wicked problems; Russell Ackoff called them "messes".


title: Cephalic presentation

text: A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that first enters the birth canal). All other presentations are abnormal (malpresentations) and are either more difficult to deliver or not deliverable by natural means.


title: Cephalic presentation

text: The movement of the fetus to cephalic presentation is called "head engagement". It occurs in the third trimester. In head engagement, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perineum and cervix are further flattened and the head may be felt vaginally. Head engagement is known colloquially as the "baby drop", and in natural medicine as the "lightening" because of the release of pressure on the upper abdomen and renewed ease in breathing. However, it severely reduces bladder capacity resulting in a need to void more frequently.


title: Cephalic presentation

text: In the vertex presentation the head is flexed and the occiput leads the way. This is the most common configuration and seen at term in 95% of singletons. If the head is extended, the face becomes the leading part. Face presentations account for less than 1% of presentations at term. In the sinicipital presentation the large fontanelle is the presenting part; with further labor the head will either flex or extend more so that in the end this presentation leads to a vertex or face presentation. In the brow presentation the head is slightly extended, but less than in the face presentation. The chin presentation is a variant of the face presentation with maximum extension of the head.


title: Cephalic presentation

text: The vertex is the area of the vault bounded anteriorly by the anterior fontanelle and the coronal suture, posteriorly by the posterior fontanelle and the lambdoid suture and laterally by 2 lines passing through the parietal eminences.


title: Cephalic presentation

text: In the vertex presentation the occiput typically is anterior and thus in an optimal position to negotiate the pelvic curve by extending the head. In an occiput posterior position, labor becomes prolonged, and more operative interventions are deemed necessary. The prevalence of the persistent occiput posterior is given as 4.7%.


title: Cephalic presentation

text: The vertex presentations are further classified according to the position of the occiput, both right, left, or transverse and anterior or posterior:


title: Cephalic presentation

text: The Occipito-Anterior position is ideal for birth; it means that the baby is lined up so as to fit through the pelvis as easily as possible. The baby is head down, facing the spine, with its back anterior. In this position, the baby's chin is tucked onto its chest, so that the smallest part of its head will be applied to the cervix first. The position is usually "Left Occiput Anterior", or LOA. Occasionally, the baby may be "Right Occiput Anterior", or ROA.


title: Cephalic presentation

text: Factors that predispose to face presentation are prematurity, macrosomia, anencephaly and other malformations, cephalopelvic disproportion, and polyhydramnios. In an uncomplicated face presentation duration of labor is not altered. Perinatal losses with face presentation occur with traumatic version and extraction and midforceps procedures Duff indicates that the prevalence of face presentations is about 1/500–600, while Benedetti et al. found it to be 1/1,250 term deliveries.


title: Cephalic presentation

text: While some consider the brow presentation as an intermediate stage towards the face presentation, others disagree. Thus Bhal et al. indicated that both conditions are about equally common (1/994 face and 1/755 brow positions), and that prematurity was more common with face while postmaturity was more common with brow positions.


title: Cephalic presentation

text: The Oskie presentation is similar to the Occipito-Anterior position, where the baby is head down, facing the spine, with back on the ventral side of the uterus; however, in this position, while the torso is aligned with the mother's longitudinal axis, the legs of the fetus are extended straight along the frontal axis of the mother, as if the baby is creating a right angle with its body. For the Oskie position to occur the baby's head must be far down the pelvis in order to allow room for leg extension, typically the arms are bent, tucked against the baby's body. There are no known complications for labor and delivery. This presentation is rare and is not well researched.


title: Cephalic presentation

text: The piriform (pear-shaped) morphology of the uterus has been given as the major cause for the finding that most singletons favor the cephalic presentation at term. The fundus is larger and thus a fetus will adapt its position so that the bulkier and more movable podalic pole makes use of it, while the head moves to the opposite site. Factors that influence this positioning include the gestational age (earlier in gestation breech presentations are more common as the head is relatively bigger), size of the head, malformations, amount of amniotic fluid, presence of multiple gestations, presence of tumors, and others.


title: Cephalic presentation

text: Two-thirds of all vertex presentations are LOA, possibly because of the asymmetry created by the descending colon that is on the left side of the pelvis .


title: Cephalic presentation

text: Usually performing the Leopold maneuvers will demonstrate the presentation and possibly the position of the fetus. Ultrasound examination delivers the precise diagnosis and may indicate possible causes of a malpresentation. On vaginal examination, the leading part of the fetus becomes identifiable after the amniotic sac has been broken and the head is descending in the pelvis.


title: Cephalic presentation

text: Many factors determine the optimal way to deliver a baby. A vertex presentation is the ideal situation for a vaginal birth, although occiput posterior positions tend to proceed more slowly, often requiring intervention in the form of forceps, vacuum extraction, or Cesarean section. In a large study, a majority of brow presentations were delivered by Cesarean section, however, because of 'postmaturity', factors other than labour dynamics may have played a role. Most face presentations can be delivered vaginally as long as the chin is anterior; there is no increase in fetal or maternal mortality. Mento-posterior positions cannot be delivered vaginally in most cases (unless rotated) and are candidates for Cesarean section in contemporary management.


title: Vidya Malvade

text: Vidya started her career as an air hostess. She then began modelling and was chosen by ad filmmaker Prahlad Kakkar for some advertisements. Her acting debut was with Vikram Bhatt's "Inteha" (2003) which failed at the box office. After a string of unsuccessful movies and several advertisements, she acted in "Chak De India" in the year 2007 playing the role of a goalie and captain of the Indian women's national hockey team. Her most recent movie was "Yaara Silly Silly".


title: Vidya Malvade

text: Vidya studied Law and worked as an Air Hostess. Her first husband, Capt. Arvind Singh Bagga, was a pilot with Alliance Air. He died in 2000 when his flight, Alliance Air Flight 7412, crashed into a building in Patna. In 2009, she married Sanjay Dayma, who worked with Ashutosh Gowariker on the Oscar award-nominated "Lagaan" as the film's Screenplay Writer and Associate Director.


title: Editor-in-chief

text: An editor-in-chief (EIC), also known as lead editor or chief editor, is a publication's editorial leader who has final responsibility for its operations and policies.


title: Editor-in-chief

text: The highest-ranking editor of a publication may also be titled editor, managing editor, or executive editor, but where these titles are held while someone else is editor-in-chief, the editor-in-chief outranks the others.


title: Editor-in-chief

text: The editor-in-chief heads all departments of the organization and is held accountable for delegating tasks to staff members and managing them. The term is often used at newspapers, magazines, yearbooks, and television news programs. The editor-in-chief is commonly the link between the publisher or proprietor and the editorial staff.


title: Editor-in-chief

text: The term is also applied to academic journals, where the editor-in-chief gives the ultimate decision whether a submitted manuscript will be published. This decision is made by the editor-in-chief after seeking input from reviewers selected on the basis of relevant expertise. For larger journals, the decision is often upon the recommendation of one of several associate editors who each have responsibility for a fraction of the submitted manuscripts.


title: Pepsi Max

text: Pepsi Max (also known as Pepsi Black in some countries) is a low-calorie, sugar-free cola, marketed by PepsiCo as an alternative to Pepsi and Diet Pepsi. Pepsi Max is still available primarily in Asian and European markets. While Pepsi Max was released in 1993, it was first available on store shelves in the United States in 2007.


title: Pepsi Max

text: A drink with the same name but different formulation (containing ginseng and higher quantities of caffeine) was sold in the United States until it was renamed "Pepsi Zero Sugar" in late 2016.


title: Pepsi Max

text: Pepsi Max debuted in Australia, the United Kingdom, and Italy in April 1993. The rollout was expanded to Ireland the following September, and to France, Greece, Spain, Portugal, and the Netherlands the following December. By the end of 1994, Pepsi Max was sold in approximately twenty countries. By the end of 1995, that figure had more than doubled. The product remained unavailable in the United States until 2006 (the US, PepsiCo's home market, and the largest consumer of carbonated soft drinks), where one of its principal ingredients had not yet been approved by the Food and Drug Administration. The ingredient—acesulfame potassium—is combined with aspartame to provide the beverage's sweetness, whereas some other diet colas are sweetened by aspartame alone.


title: Pepsi Max

text: In early-2005, Pepsi Max Twist (with added lemon-lime flavour) joined the UK and Australian product line. In autumn 2005, "Pepsi Max Punch" was marketed in the UK for the festive season. Containing ginger and cinnamon, the product was similar in flavour to Pepsi Holiday Spice, a sugar-sweetened variety of Pepsi that was marketed in the US one year earlier. In late-2005 and early-2006, a coffee-flavoured variety was introduced in France, Finland, Ireland, Norway, and the UK. Known as "Pepsi Max Cappuccino" ("Pepsi Max Coffee Cino" in the UK), the product was prefigured by the similar Pepsi Kona (briefly test-marketed in the US in 1996) and Pepsi Tarik, available in Malaysia since 2005.


title: Pepsi Max

text: Pepsi Max was introduced to South Korea, Bulgaria, and the Philippines in 2006, as well as being reintroduced into Argentina in the spring of 2006 after being phased out after its launch in 1994. As well as this, Pepsi Max was introduced into Brazil, Egypt, Jordan, Lebanon, Turkey and the United Arab Emirates during early 2007.


title: Pepsi Max

text: In October 2008, Pepsi announced it would be redesigning its logo and re-branding many of its products. Pepsi, Diet Pepsi, and Pepsi Max all use lower-case fonts for name brands, Mountain Dew was renamed "Mtn Dew", and Diet Pepsi Max was re-branded as Pepsi Max. The brand's blue and red globe trademark became a series of "smiles", with the central white band arcing at different angles depending on the product. The new imagery is being used. In the case of Pepsi Max, besides renaming of the drink its international name, the logo has a large "smile" likely to emphasize the North American drink's "Wake up people!" advertising campaign, and also uses black in the bottom half of the globe as opposed to the more standard royal blue. The new lower-case font used on Pepsi's products is reminiscent of the font used in Diet Pepsi's logo from the 1960s to the mid-1980s. The website for the "Wake up people!" campaign now redirects to the Pepsi Refresh Project. It is expected that the version of Pepsi Max outside North America will adopt the new logo used by its US–Canada counterpart; this has now occurred in Australia. In the UK, the cans now have the "Pepsi" text and the new Pepsi globe (with the normal Pepsi "smile" and the blue bottom half, as opposed to the black half used in the US) but the "Max" is in the previous style.


title: Pepsi Max

text: A Pepsi Max Lime version was released in the United States in February 2010 under the name "Pepsi Max Cease Fire" It was introduced in the UK in late-2011. It was cross-promoted with a new flavor series of Doritos chips called "3rd Degree Burn". In July 2010, Pepsi began to move its North American branding for Pepsi Max to match its global branding. It now carries a Max typography similar to that used worldwide, and rolled out a new slogan: "Zero Calories. Maximum Pepsi Taste". Its formula has not changed. In May 2011, Pepsi introduced the drink to Spain. In 2016, the drink was introduced to Venezuela. In 2017 Pepsi Max was launched in Costa Rica


title: Pepsi Max

text: In 2013, Pepsi Max collaborated with English magician Steven Frayne, also known as Dynamo, as part of their 'Live for Now' campaign which was launched the previous year. As part of a launch event, Dynamo was seen in London hanging from the side of a number 543 double-decker bus on its journey along Millbank, past the Houses of Parliament and across Westminster Bridge, while hundreds of passers by watched. The partnership also saw Dynamo appear in an on-pack promotion on cans and bottles of Pepsi Max during July and August, and secured 19 million unique impressions & 7 million total video views on social media.


title: Pepsi Max

text: In 2017, the drink was reintroduced in Belarus, the Czech Republic, Greece, Hungary, India, Slovakia, Slovenia and Ukraine as Pepsi Black. As of 2017 it is available as Pepsi Max in Albania, Australia, Austria, Belgium, Bosnia and Herzegovina, China, Croatia, Denmark, Estonia, Finland, France, Germany, Italy, Iceland, Ireland, Liechtenstein, Luxembourg, Macedonia, Moldova, Montenegro, the Netherlands, New Zealand, Norway, the Philippines, Poland, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Thailand, Turkey, the United Kingdom and Venezuela.


title: Pepsi Max

text: Recent UK/Australia Pepsi Max television advertisements have featured the taglines "Maximum taste, no sugar" and "Don't worry, there's no sugar." Some have incorporated extreme sports as well as video games such as Motocross Mania in an attempt to appeal to young men (in contrast to other diet cola drinks, which tend to target young women). The British advertising campaign involved retouched versions of the American "Do the Dew" commercials for Mountain Dew (A variant of which is sold in the UK), rebranded as "Live life to the Max".


title: Pepsi Max

text: Coca-Cola Zero, a sugar-free cola from The Coca-Cola Company, is marketed in a similar manner. In the UK, some Coke Zero advertising alluded to Pepsi Max, leading to a counter-campaign by Pepsi extolling the virtues of the concept of "maximum" over that of "zero".


title: Pepsi Max

text: In early-2005, the North American drink Pepsi ONE was revised, with Splenda brand sucralose replacing the aspartame ingredient.


title: Pepsi Max

text: Beginning in early 1994, an entirely different Pepsi Max was marketed in Canada. Now regarded as a precursor to Pepsi Edge, it was sweetened with a combination of aspartame and high fructose corn syrup. As a result, it contained two-thirds fewer calories than full-sugar colas (including regular Pepsi), but more calories than conventional diet/light colas (or the version of Pepsi Max sold elsewhere). The Canadian product was discontinued in 2002; the Diet Pepsi Max product introduced in 2008 has no direct relationship to the earlier formulation.


title: Malignant hyperthermia

text: Malignant hyperthermia (MH) is a type of severe reaction that occurs in response to particular medications used during general anesthesia, among those who are susceptible. Symptoms include muscle rigidity, fever, and a fast heart rate. Complications can include muscle breakdown and high blood potassium. Most people who are susceptible to MH are generally unaffected when not exposed to triggering agents.


title: Malignant hyperthermia

text: Exposure to triggering agents (certain volatile anesthetic agents or succinylcholine) can lead to the development of MH in those who are susceptible. Susceptibility can occur due to at least six genetic mutations, with the most common one being of the RYR1 gene. These genetic variations are often inherited from a person's parents in an autosomal dominant manner. The condition may also occur as a new mutation or be associated with a number of inherited muscle diseases, such as central core disease.


title: Malignant hyperthermia

text: In susceptible individuals, the medications induce the release of stored calcium ions within muscle cells. The resulting increase in calcium concentrations within the cells cause the muscle fibers to contract. This generates excessive heat and results in metabolic acidosis. Diagnosis is based on symptoms in the appropriate situation. Family members may be tested to see if they are susceptible by muscle biopsy or genetic testing.


title: Malignant hyperthermia

text: Treatment is with dantrolene and rapid cooling along with other supportive measures. The avoidance of potential triggers is recommended in susceptible people. The condition affects one in 5,000 to 50,000 cases where people are given anesthetic gases. Males are more often affected than females. The risk of death with proper treatment is about 5% while without it is around 75%. While cases that appear similar to MH have been documented since the early 20th century, the condition was only formally recognized in 1960.


title: Malignant hyperthermia

text: The typical signs of malignant hyperthermia are due to a hypercatabolic state, which presents as a very high temperature, an increased heart rate and abnormally rapid breathing, increased carbon dioxide production, increased oxygen consumption, mixed acidosis, rigid muscles, and rhabdomyolysis. These signs can develop any time during the administration of the anesthetic triggering agents. Rarely, signs may develop up to 40 minutes after the end of anaesthesia.


title: Malignant hyperthermia

text: Malignant hyperthermia is a disorder that can be considered a gene–environment interaction. In most people with malignant hyperthermia susceptibility, they have few or no symptoms unless they are exposed to a triggering agent. The most common triggering agents are volatile anesthetic gases, such as halothane, sevoflurane, desflurane, isoflurane, enflurane or the depolarizing muscle relaxants suxamethonium and decamethonium used primarily in general anesthesia. In rare cases, the biological stresses of physical exercise or heat may be the trigger. In fact, malignant hyperthermia susceptibility (MHS), predisposed by mutations in the skeletal muscle calcium release channel (RYR1), is one of the most severe heat-related illnesses. The MHS-associated heat susceptibilities predominantly affect children and metabolically active young adults, often leading to life- threatening hypermetabolic responses to heat.


title: Malignant hyperthermia

text: Other anesthetic drugs do not trigger malignant hyperthermia. Some examples of drugs that don't cause MH include local anesthetics (lidocaine, bupivacaine, mepivacaine), opiates (morphine, fentanyl), ketamine, barbiturates, nitrous oxide, propofol, etomidate, and benzodiazepines. The nondepolarizing muscle relaxants pancuronium, cisatracurium, atracurium, mivacurium, vecuronium and rocuronium also do not cause MH.


title: Malignant hyperthermia

text: There is mounting evidence that some individuals with malignant hyperthermia susceptibility may develop MH with exercise and/or on exposure to hot environments.


title: Malignant hyperthermia

text: Malignant hyperthermia's inheritance is autosomal dominant with variable penetrance. The defect is typically located on the long arm of chromosome 19 (19q13.2) involving the ryanodine receptor. More than 25 different mutations in this gene are linked with malignant hyperthermia. These mutations tend to cluster in one of three domains within the protein, designated MH1-3. MH1 and MH2 are located in the N-terminus of the protein, which interacts with L-type calcium channels and . MH3 is located in the transmembrane forming C-terminus. This region is important for allowing passage through the protein following opening.


title: Malignant hyperthermia

text: Chromosome 7q and chromosome 17 have also been implicated. It has also been postulated that MH and central core disease may be allelic and thus can be co-inherited.


title: Malignant hyperthermia

text: In a large proportion (50–70%) of cases, the propensity for malignant hyperthermia is due to a mutation of the ryanodine receptor (type 1), located on the sarcoplasmic reticulum (SR), the organelle within skeletal muscle cells that stores calcium. RYR1 opens in response to conformational changes in the L-type calcium channels following membrane depolarisation, thereby resulting in a drastic increase in intracellular calcium levels and muscle contraction. RYR1 has two sites believed to be important for reacting to changing concentrations: the A-site and the I-site. The A-site is a high affinity binding site that mediates RYR1 opening. The I-site is a lower affinity site that mediates the protein's closing. Caffeine, halothane, and other triggering agents act by drastically increasing the affinity of the A-site for and concomitantly decreasing the affinity of the I-site in mutant proteins. also affect RYR1 activity, causing the protein to close by acting at either the A- or I-sites. In MH mutant proteins, the affinity for at either one of these sites is greatly reduced. The result of these alterations is greatly increased release due to a lowered activation and heightened deactivation threshold. The process of sequestering this excess consumes large amounts of adenosine triphosphate (ATP), the main cellular energy carrier, and generates the excessive heat (hyperthermia) that is the hallmark of the disease. The muscle cell is damaged by the depletion of ATP and possibly the high temperatures, and cellular constituents "leak" into the circulation, including potassium, myoglobin, creatine, phosphate and creatine kinase.


title: Malignant hyperthermia

text: The other known causative gene for MH is "CACNA1S", which encodes an L-type voltage-gated calcium channel α-subunit. There are two known mutations in this protein, both affecting the same residue, R1086. This residue is located in the large intracellular loop connecting domains 3 and 4, a domain possibly involved in negatively regulating RYR1 activity. When these mutant channels are expressed in human embryonic kidney (HEK 293) cells, the resulting channels are five times more sensitive to activation by caffeine (and presumably halothane) and activate at 5–10mV more hyperpolarized. Furthermore, cells expressing these channels have an increased basal cytosolic concentration. As these channels interact with and activate RYR1, these alterations result in a drastic increase of intracellular , and, thereby, muscle excitability.


title: Malignant hyperthermia

text: Other mutations causing MH have been identified, although in most cases the relevant gene remains to be identified.


title: Malignant hyperthermia

text: Research into malignant hyperthermia was limited until the discovery of "porcine stress syndrome" (PSS) in Danish Landrace and other pig breeds selected for muscling, a condition in which stressed pigs develop "pale, soft, exudative" flesh (a manifestation of the effects of malignant hyperthermia) rendering their meat less marketable at slaughter. This "awake triggering" was not observed in humans, and initially cast doubts on the value of the animal model, but subsequently, susceptible humans were discovered to "awake trigger" (develop malignant hyperthermia) in stressful situations. This supported the use of the pig model for research. Pig farmers use halothane cones in swine yards to expose piglets to halothane. Those that die were MH-susceptible, thus saving the farmer the expense of raising a pig whose meat he would not be able to market. This also reduced the use of breeding stock carrying the genes for PSS. The condition in swine is also due to a defect in ryanodine receptors.


title: Malignant hyperthermia

text: Gillard "et al." discovered the causative mutation in humans only after similar mutations had first been described in pigs.


title: Malignant hyperthermia

text: Horses also develop malignant hyperthermia. A causative mutated allele, ryanodine receptor 1 gene (RyR1) at nucleotide C7360G, generating a R2454G amino acid substitution. has been identified in the American Quarter Horse and breeds with Quarter Horse ancestry, inherited as an autosomal dominant. It can be caused by overwork, anesthesia, or stress. In dogs, its inheritance is autosomal recessive.


title: Malignant hyperthermia

text: An MH mouse has been constructed, bearing the R163C mutation prevalent in humans. These mice display signs similar to human MH patients, including sensitivity to halothane (increased respiration, body temperature, and death). Blockade of RYR1 by dantrolene prevents adverse reaction to halothane in these mice, as with humans. Muscle from these mice also shows increased -induced depolarization and an increased caffeine sensitivity.


title: Malignant hyperthermia

text: The earliest signs may include: masseter muscle contracture following administration of succinylcholine, a rise in end-tidal carbon dioxide concentration (despite increased minute ventilation), unexplained tachycardia, and muscle rigidity. Despite the name, elevation of body temperature is often a late sign, but may appear early in severe cases. Respiratory acidosis is universally present and many patients have developed metabolic acidosis at the time of diagnosis. A fast rate of breathing (in a spontaneously breathing patient), cyanosis, hypertension, abnormal heart rhythms, and high blood potassium may also be seen. Core body temperatures should be measured in any patient undergoing general anesthesia longer than 30 minutes.


title: Malignant hyperthermia

text: Malignant hyperthermia is diagnosed on clinical grounds, but various laboratory investigations may prove confirmatory. These include a raised creatine kinase level, elevated potassium, increased phosphate (leading to decreased calcium) and—if determined—raised myoglobin; this is the result of damage to muscle cells. Severe rhabdomyolysis may lead to acute kidney failure, so kidney function is generally measured on a frequent basis. Patients may also experience premature ventricular contractions due to the increased levels of potassium released from the muscles during episodes.


title: Malignant hyperthermia

text: The main candidates for testing are those with a close relative who has had an episode of MH or have been shown to be susceptible. The standard procedure is the "caffeine-halothane contracture test", CHCT. A muscle biopsy is carried out at an approved research center, under local anesthesia. The fresh biopsy is bathed in solutions containing caffeine or halothane and observed for contraction; under good conditions, the sensitivity is 97% and the specificity 78%. Negative biopsies are "not" definitive, so any patient who is suspected of MH by their medical history or that of blood relatives is generally treated with non-triggering anesthetics, even if the biopsy was negative. Some researchers advocate the use of the "calcium-induced calcium release" test in addition to the CHCT to make the test more specific.


title: Malignant hyperthermia

text: Less invasive diagnostic techniques have been proposed. Intramuscular injection of halothane 6 vol% has been shown to result in higher than normal increases in local among patients with known malignant hyperthermia susceptibility. The sensitivity was 100% and specificity was 75%. For patients at similar risk to those in this study, this leads to a positive predictive value of 80% and negative predictive value of 100%. This method may provide a suitable alternative to more invasive techniques.


title: Malignant hyperthermia

text: A 2002 study examined another possible metabolic test. In this test, intramuscular injection of caffeine was followed by local measurement of the ; those with known MH susceptibility had a significantly higher (63 versus 44 mmHg). The authors propose larger studies to assess the test's suitability for determining MH risk.


title: Malignant hyperthermia

text: Genetic testing is being performed in a limited fashion to determine susceptibility to MH. In people with a family history of MH, analysis for "RYR1" mutations may be useful.


title: Malignant hyperthermia

text: A 1994 consensus conference led to the formulation of a set of diagnostic criteria. The higher the score (above 6), the more likely a reaction constituted MH:


title: Malignant hyperthermia

text: In the past, the prophylactic use of dantrolene was recommended for MH-susceptible patients undergoing general anesthesia. However, multiple retrospective studies have demonstrated the safety of trigger-free general anesthesia in these patients in the absence of prophylactic dantrolene administration. The largest of these studies looked at the charts of 2214 patients who underwent general or regional anesthesia for an elective muscle biopsy. About half (1082) of the patients were muscle biopsy positive for MH. Only five of these patients exhibited signs consistent with MH, four of which were treated successfully with parenteral dantrolene, and the remaining one recovered with only symptomatic therapy. After weighing its questionable benefits against its possible adverse effects (including nausea, vomiting, muscle weakness and prolonged duration of action of nondepolarizing neuromuscular blocking agents), experts no longer recommend the use of prophylactic dantrolene prior to trigger-free general anesthesia in MH-susceptible patients.


title: Malignant hyperthermia

text: Anesthesia for people with known MH susceptible requires avoidance of triggering agent concentrations above 5 parts per million (all volatile anesthetic agents and succinylcholine). Most other drugs are safe (including nitrous oxide), as are regional anesthetic techniques. Where general anesthesia is planned, it can be provided safely by either flushing the machine or using charcoal filters.


title: Malignant hyperthermia

text: To flush the machine, first remove or disable the vaporizers and then flush the machine with 10 L/min or greater fresh gas flow rate for at least 20 minutes. While flushing the machine the ventilator should be set to periodically ventilate a new breathing circuit. The soda lime should also be replaced. After machine preparation, anesthesia should be induced and maintained with non-triggering agents. The time required to flush a machine varies for different machines and volatile anesthetics. This prevention technique was optimized to prepare older generation anesthesia machines. Modern anesthetic machines have more rubber and plastic components which provide a reservoir for volatile anesthetics, and should be flushed for 60 minutes.


title: Malignant hyperthermia

text: Charcoal filters can be used to prepare an anesthesia machine in less than 60 seconds for people at risk of malignant hyperthermia. These filters prevent residual anesthetic from triggering malignant hyperthermia for up to 12 hours, even at low fresh gas flows. Prior to placing the charcoal filters, the machine should be flushed with fresh gas flows greater than 10 L/min for 90 seconds.


title: Malignant hyperthermia

text: The current treatment of choice is the intravenous administration of dantrolene, the only known antidote, discontinuation of triggering agents, and supportive therapy directed at correcting hyperthermia, acidosis, and organ dysfunction. Treatment must be instituted rapidly on clinical suspicion of the onset of malignant hyperthermia.


title: Malignant hyperthermia

text: Dantrolene is a muscle relaxant that appears to work directly on the ryanodine receptor to prevent the release of calcium. After the widespread introduction of treatment with dantrolene, the mortality of malignant hyperthermia fell from 80% in the 1960s to less than 5%. Dantrolene remains the only drug known to be effective in the treatment of MH. The recommended dose of dantrolene is 2.5 mg/kg, repeated as necessary. It is recommended that each hospital keeps a minimum stock of 36 dantrolene vials (720 mg), sufficient for four doses in a 70-kg person.


title: Malignant hyperthermia

text: Fast recognition and treatment of MH utilizes skills and procedures that are utilized with a low-frequency and high-risk. Conducting MH crisis training for perioperative teams can identify system failures as well as improve response to these events. Simulation techniques to include the use of cognitive aids have also been shown to improve communication in clinical treatment of MH.


title: Malignant hyperthermia

text: Prognosis is poor if this condition is not aggressively treated. In the 1970s, mortality was greater than 80%; however, with the current management mortality is now less than 5%.


title: Malignant hyperthermia

text: It occurs in between 1:5,000 and 1:100,000 in procedures involving general anaesthesia. This disorder occurs worldwide and affects all racial groups.


title: Malignant hyperthermia

text: The syndrome was first recognized in Royal Melbourne Hospital, Australia in an affected family by Denborough "et al." in 1962. Denborough did much of his subsequent work on the condition at the Royal Canberra Hospital. Similar reactions were found in pigs. The efficacy of dantrolene as a treatment was discovered by South African anesthesiologist Gaisford Harrison and reported in a 1975 article published in the "British Journal of Anaesthesia". After further animal studies corroborated the possible benefit from dantrolene, a 1982 study confirmed its usefulness in humans.


title: Malignant hyperthermia

text: In 1981, the Malignant Hyperthermia Association of the United States (MHAUS) hotline was established to provide telephone support to clinical teams treating patients with suspected malignant hyperthermia. The hotline became active in 1982 and since that time MHAUS has provided continuous access to board-certified anesthesiologists to assist teams in treatment.


title: Malignant hyperthermia

text: Other animals, including certain pig breeds, dogs, and horses, are susceptible to malignant hyperthermia.


title: Malignant hyperthermia

text: In dogs its inheritance is autosomal dominant. The syndrome has been reported in Pointers, Greyhounds, Labrador Retrievers, Saint Bernards, Springer Spaniels, Bichon Frises, Golden Retrievers, and Border Collies.


title: Malignant hyperthermia

text: In horses its inheritance is autosomal dominant, and most associated with the American Quarter Horse although it can occur in other breeds.


title: Malignant hyperthermia

text: Azumolene is a 30-fold more water-soluble analog of dantrolene that also works to decrease the release of intracellular calcium by its action on the ryanodine receptor. In MH-susceptible swine, azumolene was as potent as dantrolene. It has yet to be studied "in vivo" in humans, but may present a suitable alternative to dantrolene in the treatment of MH.


title: 2021 Mnet Asian Music Awards

text: The 2021 Mnet Asian Music Awards ceremony, also known as 2021 MAMA, organized by CJ E&M and broadcast through its music channel Mnet, took place live on December 11, 2021. The ceremony was held at CJ ENM Contents World in Paju, South Korea. The theme for the ceremony was titled as "Make Some Noise". The ceremony was the 23rd in the show's history.


title: 2021 Mnet Asian Music Awards

text: On July 20, 2021, it was reported by Ilgan Sports the ceremony is undergoing discussion to be held in Hong Kong despite the ongoing pandemic and travel restrictions. On September 7, it was announced the ceremony would be held at CJ ENM Contents World in Paju, South Korea. This will be the second consecutive year, the ceremony will take place in South Korea only.


title: 2021 Mnet Asian Music Awards

text: On October 13, Mnet announced that Lee Hyori will be hosting the ceremony. She will be the first female host for Mnet Asian Music Awards. In addition, Mnet also announced that the theme of the ceremony titled as "Make Some Noise". Mnet also announced that it will be airing a 7-episode special documentary titled "MAMA: The Original K-pop Awards" from October 28, to celebrate the 12th anniversary of the Mnet Asian Music Awards. According to video teaser posted on Mnet's Twitter, the documentary is expected to feature interviews from Psy, Park Jin-young, Exo's Kai, Twice's Nayeon, Sana, and Jihyo, Mamamoo's Hwasa, Stray Kids, Super Junior, Shinee, and 2NE1.


title: 2021 Mnet Asian Music Awards

text: On November 16, a global press conference was held. It was revealed that the awards ceremony will be an offline event with a limited audience in accordance with government disease prevention guidelines. South Korean-based company, Samil PwC, will be auditing the ceremony. Mnet also announced additional performers including British singer-songwriter Ed Sheeran, the 8 crews of Street Woman Fighter, a reunion stage of Wanna One, and a collaboration stage between members of top fourth-generation K-pop groups.


title: 2021 Mnet Asian Music Awards

text: On December 9, Mnet announced the 2021 MAMA Ambassadors. Rain, Song Joong-ki, Ed Sheeran and Han Ye-ri will deliver the key values that made K-content globally loved by global audiences. On December 11, Mnet released a special album titled, ""Do the dance"", performed by Lee Hyori on music streaming platforms.


title: 2021 Mnet Asian Music Awards

text: Ed Sheeran, Street Woman Fighter, and Wanna One were announced as performers on November 16, 2021. The rest of the performers were announced on November 25. On December 5, Kep1er withdrew from the ceremony after a staff member from the group tested positive for COVID-19. Some performances are pre-recorded.


title: 2021 Mnet Asian Music Awards

text: The list of presenters was announced on December 7, 2021. Choi Si-won was originally scheduled as a presenter but was diagnosed with COVID-19 a day before the ceremony.


title: 2021 Mnet Asian Music Awards

text: All songs that have been released from October 29, 2020, to October 31, 2021, are eligible to be nominated.


title: 2021 Mnet Asian Music Awards

text: Artists from Japan, Greater China, Thailand, Indonesia, and Vietnam who have worked on songs released from October 1, 2020, to September 30, 2021.


title: 2021 Mnet Asian Music Awards

text: Music experts who participated in the production, creation, activities etc., of K-Pop's records and digital songs released from October 1, 2020, to September 30, 2021.


title: 2021 Mnet Asian Music Awards

text: Online voting for Worldwide Fans' Choice Top 10 opened on the official website and Twitter on November 4, 2021. Online voting for Worldwide Icon of the Year opened on the official MAMA website and Twitter on November 25, 2021. Voting on the official website and Apple Music ended on December 9, 2021, while voting on Twitter ended during the live broadcast.


title: 2021 Mnet Asian Music Awards

text: The list of nominees for all categories excluding TikTok Album of the Year, TikTok Worldwide Icon of the Year, and Best Music Video, were announced on November 3, 2021, through the official website.


title: 2021 Mnet Asian Music Awards

text: The list of nominees for Worldwide Fans' Choice Top 10, were announced on November 3, 2021, through the official website.


title: 2021 Mnet Asian Music Awards

text: The ceremony of the 2021 Mnet Asian Music Awards was broadcast live worldwide from Mnet in South Korea, to simulcast across CJ E&M channels; other international networks, and online via Mnet K-pop, Mnet TV, M2, and KCON's YouTube account. The red carpet was broadcast live 2 hours before the main ceremony.


title: Ladysmith Black Mambazo

text: Ladysmith Black Mambazo are a South African male choral group singing in the local vocal styles of "isicathamiya" and "mbube". They became known internationally after singing with Paul Simon on his 1986 album "Graceland", and have won multiple awards, including five Grammy Awards, dedicating their fifth Grammy to the late former President Nelson Mandela.


title: Ladysmith Black Mambazo

text: Formed by Joseph Shabalala in 1960, Ladysmith Black Mambazo became one of South Africa's most prolific recording artists, with their releases receiving gold and platinum disc honours. The group became a mobile academy of South African cultural heritage through their African indigenous "isicathamiya" music.


title: Ladysmith Black Mambazo

text: Joseph Shabalala formed Ladysmith Black Mambazo because of a series of dreams he had in 1964, in which he heard certain "isicathamiya" harmonies ("isicathamiya" being the traditional music of the Zulu people). Following their local success at wedding ceremonies and other gatherings, Shabalala entered them into "isicathamiya" competitions. The group was described as 'so good' that they were eventually forbidden to enter the competitions, but welcomed to entertain at them. Although they had been recognised as an "isicathamiya" group in 1964, they had been singing together since the early 1950s. They released their first album, "Amabutho", in 1973. The album, along with many other releases by the group, received gold disc certification. Ladysmith Black Mambazo's collaboration with Paul Simon in 1986 paved the way for international releases.


title: Ladysmith Black Mambazo

text: The first incarnation of Ladysmith Black Mambazo was "Ezimnyama" ("The Black Ones"), formed by Joseph Shabalala in December 1960. The members of the group were relatives (mostly brothers and cousins) of Shabalala, with many having sung with him while he was growing up on the farm where he was born. Although the group did sing well together and captured the sound of "cothoza mfana" ("tiptoe boys", a 1960s slang term for "isicathamiya") and mbube groups of the time, they were unknown outside of the Ladysmith district.


title: Ladysmith Black Mambazo

text: In 1964, Shabalala had a series of recurring dreams during his sleep, over a period of six months, featuring a choir singing in perfect harmony. Shabalala described this as a beautiful sound, and one not yet achieved by his group of the time. As a result, he reformed the group, bringing on board newer (younger) relatives but keeping the group name. He strove to teach them the harmonies from his dreams, creating what was to become a signature tune for the group: "Nomathemba" (a girl's name, meaning "hope"). After deciding that this group well replicated the beautiful, soft sounds from his dreams, Shabalala entered the group into isicathamiya competitions, held on Saturday nights in the halls of hostels in Durban and Johannesburg. The group managed to win nearly every competition that was held. As a result, Shabalala decided to change the name of the group to be more descriptive of its talent. The name "Ezimnyama" was replaced by "Ladysmith Black Mambazo".


title: Ladysmith Black Mambazo

text: The three elements of the new name were: the hometown of Shabalala's family, Ladysmith, KwaZulu-Natal; the black ox, considered to be the strongest farm animal; and "mambazo", which means "axe" in the Zulu language, and is symbolic of the choir's ability to "chop down" the competition.


title: Ladysmith Black Mambazo

text: Eventually, by the early 1970s, the group was forbidden to compete in the competitions because of their continual success. They were, however, welcome to perform without taking part in the competition itself.


title: Ladysmith Black Mambazo

text: In 1967, the group began to make recordings for the SABC station "Radio Zulu", appearing in DJ Alexius Buthelezi's popular "Cothoza Mfana" programme, which spotlighted the music of several local choirs. Their success was so great that music producers began enticing the group to sign a recording contract. In 1972 the group signed with Gallo Record Company under producer West Nkosi at the organisation's African music division, Mavuthela Music Company (Nkosi was also well known in South Africa as a saxophone jive star). Ladysmith Black Mambazo released their first album the following year, "Amabutho", which received gold status and was the first album by a black musician or group in South Africa to do so. Their subsequent albums also received gold or platinum certification. With the release of their second album, they had become professional singers.


title: Ladysmith Black Mambazo

text: The group saw many changes; whereas the early line-ups were formed of a few Shabalalas and two (Funokwakhe and Joseph) Mazibukos, the group largely included members unrelated to Joseph.<ref name="Artist/ Track Listing"></ref> Joseph Shabalala's cousin Mdletshe Albert Mazibuko (the eldest of the six brothers) joined Mambazo in 1969 as a tenor voice, with his younger brother Milton as an alto voice. Albert is the longest remaining member of Ladysmith Black Mambazo aside from Joseph Shabalala and has been a full-time member of the group since 1973. After the killing of his brother Milton in 1980, Albert remained in the line-up, by which time his brothers Funokwakhe Mazibuko and Joseph Mazibuko had left Ladysmith Black Mambazo and his youngest brother Abednego had joined.


title: Ladysmith Black Mambazo

text: In 1976, Shabalala converted to Christianity and a host of religious material now entered the group's repertoire. Mambazo's first religious album, "Ukukhanya Kwelanga", was released soon afterwards. It earned a double platinum disc award, and the group's repertoire came to be dominated by hymns, mostly Methodist. Their 1976 LP "Ukusindiswa" became one of their most popular religious albums, selling double gold discs within three weeks of release. By 1981, the group's popularity was such that the apartheid government allowed the members to travel to Cologne, Germany as part of a South African folk music festival. The group toured West Germany and appeared on television, and learned some of the German language; for the group's 1981 album "Phansi Emgodini", Shabalala composed a song entitled "Wir Grüssen Euch Alle" ("We greet you all"). The following year, the group travelled back to Germany to appear on a televised quiz programme, bringing about requests for more live appearances. A track by the group also appeared on the groundbreaking British compilation album "The Indestructible Beat of Soweto".


title: Ladysmith Black Mambazo

text: In 1985, Paul Simon travelled to South Africa in the hope of collaborating with African musicians for his "Graceland" album. Simon contacted Shabalala and conversed with him in person — after much discussion and excitement, the group travelled to London to record with Simon. The first recording was "Homeless" — the music and chorus were composed by Simon, with Shabalala composing the Zulu introduction and main (non-English) body of the song. They also sang on the song "Diamonds on the Soles of Her Shoes" and "You Can Call Me Al". Simon brought the group to New York City to perform on "Saturday Night Live" and they performed "Diamonds..." prior to the album or song being released. "Graceland" was released in late 1986, and although both Joseph Shabalala and Paul Simon were accused of breaking the cultural boycott of South Africa, the album became a huge success and sold 16 million copies and further boosted Ladysmith Black Mambazo's international image. This also paved the way for other African acts such as Stimela and Mahlathini and the Mahotella Queens to gain popularity among Western audiences.


title: Ladysmith Black Mambazo

text: After "Graceland", Simon acted as producer for their first album for US release on Warner Brothers Records, "Shaka Zulu" (1987). "Shaka Zulu" won the Grammy Award for Best Traditional Folk Recording in 1988. Two more records were recorded for Warner Brothers Records in the US: "Journey of Dreams" (1988) and "Two Worlds One Heart" (1990). On the latter album, the group recorded with The Winans, Julia Fordham and George Clinton among other then-popular artists.


title: Ladysmith Black Mambazo

text: The success of the "Graceland" recording and subsequent concert tours led to a strong touring life for the group that continues to this day. Ladysmith Black Mambazo perform concert tours around the world for six or more months every year.


title: Ladysmith Black Mambazo

text: In 1988, Ladysmith Black Mambazo appeared in Michael Jackson's movie "Moonwalker", where they performed "The Moon Is Walking" (an abridged version of the song "Lindelani", which appears on "Journey of Dreams") over the end credits. Ladysmith Black Mambazo was also featured in the "Sesame Street" song "Put Down the Duckie", as well as "The African Alphabet".


title: Ladysmith Black Mambazo

text: In 1988, Ladysmith Black Mambazo sang "Mbube" during the opening sequence of the Eddie Murphy movie "Coming to America", but the song was not released on the soundtrack.


title: Ladysmith Black Mambazo

text: On 10 December 1991, Shabalala's brother and one of the bass members in the group, Headman Shabalala, was shot and killed by Sean Nicholas, a white off-duty security guard. Headman's death was followed by the retirement of two members in 1993 and Shabalala recruited three of his sons into the group.


title: Ladysmith Black Mambazo

text: The Apartheid system was officially abolished in 1991, and democratic general elections did not commence until 1994. The release of Nelson Mandela after 27 years imprisonment brought a celebratory album release - 1993's "Liph' Iqiniso". Mandela (shortly after his release from prison) publicly stated that the members of Ladysmith Black Mambazo were "South Africa's cultural ambassadors". At Mandela's request, Ladysmith Black Mambazo accompanied the future President of South Africa to the Nobel Peace Prize ceremony in Oslo, Norway, in 1993. Mambazo sang again at President Mandela's inauguration in May 1994, and then later at his birthday celebrations.


title: Ladysmith Black Mambazo

text: In 1995, South Africa was the host, and the eventual winners of the Rugby World Cup, in which Ladysmith Black Mambazo collaborated with P.J. Powers in recording and performing World in Union.


title: Ladysmith Black Mambazo

text: In 1996, the group appeared on Dolly Parton's album "Treasures," collaborating with Parton on a cover of Cat Stevens' "Peace Train"; they joined Parton for an appearance on a November 1996 US network television special to perform the song.


title: Ladysmith Black Mambazo

text: In 1997, for a run of UK television advertisements, "Toast for Life", for Heinz soups, baked beans and tomato ketchup, the group recorded an abridged version of "Inkanyezi Nezazi" ("The Star and the Wiseman"). The adverts proved so popular that the original studio version (recorded back in 1992) was released as a single and reached No. 2 on the UK Singles Chart. The single was followed up by "The Best of Ladysmith Black Mambazo - The Star and the Wiseman" in 1998, a compilation release that became so popular it was certified triple platinum, selling 1 million copies in Britain alone. The Heinz campaign led to a reawakening of the group in Britain, and many television and radio performances beckoned over the next few years, as well as performing for the British royal family. In 1999, the group collaborated with Irish pop group B*Witched on their single "I Shall Be There", which hit No. 13 on the UK Singles Chart. In 2001, the group was referenced in the "Family Guy" episode "Lethal Weapons".


title: Ladysmith Black Mambazo

text: A film documentary about Ladysmith Black Mambazo, "", was released in 2000. The film was nominated for the Academy Award for Best Documentary (Short Subject) in 2001, but lost out to "Big Mama". The movie was presented the Best Short Documentary award by the 2001 International Documentary Association.


title: Ladysmith Black Mambazo

text: The group began preparations for "Wenyukela", an album of new material, in 2002. However, the making of the record underwent severe strain when, in May 2002, Shabalala's wife of 30 years (and lead singer in the allied group "Women of Mambazo"), Nellie, was murdered in a church car park by a masked gunman. Shabalala's hand was injured trying to protect his wife. Joseph's son Vivian Nkosinathi was accused of hiring a hitman to murder his stepmother Nellie. During the court trial, Nkosinathi supposedly testified that the South African police offered some kind of reprieve if he would implicate his own father, Joseph, in the murder. "Wenyukela", however, went ahead, as Shabalala began to recover.


title: Ladysmith Black Mambazo

text: "Wenyukela" was a success in South Africa, prompting its release in Britain in March 2003 on Wrasse Records. Following the repeated success of the album, the American-based Heads Up International released the album in January 2004 and it garnered the group their second Grammy Award.


title: Ladysmith Black Mambazo

text: Joseph's brother Ben Shabalala, a former member of the group who had retired in 1993 after the death of Headman, was killed in a Durban suburb in June 2004.


title: Ladysmith Black Mambazo

text: The group is referenced in the 2004 film Mean Girls when Lindsay Lohan's character chooses not to accompany her parents to a Ladysmith Black Mambazo concert.


title: Ladysmith Black Mambazo

text: "Long Walk to Freedom", a celebration of 45 years of Ladysmith Black Mambazo, was released by the group in January 2006. On the album the group recorded with a multitude of artists including Zap Mama, Sarah McLachlan, Melissa Etheridge, Joe McBride, Natalie Merchant, Emmylou Harris, and Taj Mahal as well as South African musicians Lucky Dube, Phuzekhemisi, Bhekumuzi Luthuli, Nokukhanya, Thandiswa, Vusi Mahlasela and Hugh Masekela.


title: Ladysmith Black Mambazo

text: The release garnered the group their 13th Grammy Award nomination. Though it did not win the Grammy Award it showed the group's creative powers were still being recognised.


title: Ladysmith Black Mambazo

text: In April 2006, Mambazo collaborated with Josh Groban for his third studio album, "Awake". The songs, "Weeping" and "Lullaby", featured a clear South African influence; lines from a Mambazo song, "Wangibambezela" (""Message from his Heart"") were added to the backing track of "Weeping". Following this, in August 2006, Mambazo began working with Mavis Staples in a collaboration for Staples's new album. The television program "Saturday Night Live" parodied the group in a "TV Funhouse" sketch, hosted by Dennis Haysbert, about failed Saturday morning cartoons starring black cartoon characters, one of which was a cartoon featuring the group, called "Ladysmith Black Mambazo in Outer Space". Members of the group added commentary to the short for the DVD release of the SNL special "The Best of TV Funhouse".


title: Ladysmith Black Mambazo

text: On 17 October 2006, Ladysmith Black Mambazo performed a sold-out concert, at New York's famed Carnegie Hall, billed as "Long Walk to Freedom: An Evening with Ladysmith Black Mambazo and Friends". The night included special guest appearances by Sarah McLachlan, Natalie Merchant, Mahotella Queens, Vusi Mahlasela, and Pete Seeger. The concert was recorded but due to venue restrictions is not being allowed to be released.


title: Ladysmith Black Mambazo

text: Their 2007 CD, "Ilembe", was released in South Africa on 26 February 2007 and worldwide on 22 January 2008, under the title "", on Heads Up International.


title: Ladysmith Black Mambazo

text: There had been many questions on when founder, director, composer, and lead singer Joseph Shabalala would finally retire from his group. On 23 January 2008, Shabalala issued a statement on this.


title: Ladysmith Black Mambazo

text: Ladysmith Black Mambazo's 2007 release, "", garnered success around the world. In 2008 the group won the SAMA Award for "Best Traditional A Cappella Album" for "Ilembe" and in 2009 won the Grammy Award for "Best Traditional World Music Album", marking their third Grammy Award.


title: Ladysmith Black Mambazo

text: In January 2011 the group released a recording of original songs, "Songs from a Zulu Farm". It received some of the best reviews the group had ever known, landing in the top five of most "Best World Music Releases" for 2011. It was nominated for a Grammy Award but did not win. It was also nominated for the Best Album of 2011 at the South African Music Awards.


title: Ladysmith Black Mambazo

text: In January 2013 the group released a new album, "Live: Singing for Peace Around the World", which was dedicated to South African icon and former President Nelson Mandela. On 6 December 2013 it was announced that the album had been nominated by the Grammy Awards for Best World Music CD. This announcement came the day after the passing of Mandela. On 26 January 2014, the Grammy Awards announced it had won Best World Music CD for 2013. This was the fourth Grammy Award for the group and third since 2004. As well, in January 2014, Ladysmith released "Always With Us", as a tribute to Joseph Shabalala's deceased wife. They are also currently recording a CD of American gospel songs, which will have a well known American singer joining them on the CD. They are also recording a follow-up recording to their recent Grammy-winning CD, to be called "Songs of Peace & Love for Kids & Parents Around the World".


title: Ladysmith Black Mambazo

text: Ladysmith Black Mambazo was featured on the track "Lift Me Up", along with Norwegian duo Nico & Vinz, on David Guetta's 2014 album "Listen". Other features in 2016 include a vocal appearance on "Facing a Task Unfinished" by Keith and Kristyn Getty, "Wake Up" by Jennifer Saran, and Vian Izak's single "Brink of Love".


title: Ladysmith Black Mambazo

text: In January 1999, Joseph Shabalala founded "The Ladysmith Black Mambazo Foundation". The aim of the organisation is to teach young Zulu South African children about their traditional culture and music, "isicathamiya". Today, the Mambazo Academy is currently being built, with plans for a rehearsal hall, teaching areas and a professional recording studio. The main aim is to promote and teach the history of "isicathamiya" music to young people.


title: Ladysmith Black Mambazo

text: After the release of the group's first album, Amabutho, in 1973, they were banned from competing in the "isicathamiya" competitions because of their ability to win many of the competitions. They were, however, welcome to perform for the audience. Following this, the group started performing for their own audiences in shows that were specially made and, soon afterwards, the group began touring around South Africa in their own concerts, but due to the Apartheid system in use, they were often stopped by police guards; on some of these occasions they were even made to lie down on the ground whilst being searched. Shortly afterwards, they were allowed to tour without permits.


title: Ladysmith Black Mambazo

text: By 1986, the group had a very small number of white fans in South Africa; the majority of their fan base was black people (the group mainly toured in townships). After Paul Simon included the group on his ""Graceland" Tour of 1987", the group began touring by themselves and became very widely known.


title: Ladysmith Black Mambazo

text: The group has been recognised as the most successful world music artists and have a healthy touring schedule. When asked if the group has any plans to stop their travelling, of over six months each year, the response has always been: "Not as long as the people of the world want to hear our music. We are the traveling musical academy for South African culture and it is our responsibility to continue on this journey."


title: Ladysmith Black Mambazo

text: Initially, the group comprised Joseph Shabalala, his brothers Headman and Enoch, cousins Albert, Milton, Funokwakhe, Abednego, and Joseph Mazibuko, as well as close friends Matovoti Msimanga and Walter Malinga. Altogether, the group has had more than 30 different members at one point or another over the past 45 years. However, since 1993 there have only been two membership changes due to retirements.


title: Ladysmith Black Mambazo

text: The members of the group currently reside in or near Pinetown, just outside the coastal city of Durban in KwaZulu-Natal. The chorus' members are Joseph Shabalala's sons Thamsanqa, Msizi, Thulani, and Sibongiseni; cousins Albert and Abednego Mazibuko; and close friends Russel Mthembu and Ngane Dlamini.


title: Ladysmith Black Mambazo

text: Ladysmith Black Mambazo recorded for the first time in 1973 on the Gallo label in South Africa. Since then the group has recorded over 50 albums, many of which have received gold- and/or platinum-disc certification.


title: Touch of Death

text: The touch of death (or death-point striking) refers to any martial arts technique reputed to kill using seemingly less than lethal force targeted at specific areas of the body.


title: Touch of Death

text: The concept known as "dim mak" (), alternatively "" () traces its history to traditional Chinese medicine acupuncture. Tales of its use are often found in the Wuxia genre of Chinese martial arts fiction. "Dim mak "is depicted as a secret body of knowledge with techniques that attack pressure points and meridians, said to incapacitate or sometimes cause immediate or even delayed death to an opponent. Little scientific or historical evidence exists for a martial arts "touch of death", however in rare cases death can occur in response to trauma such as Commotio cordis, an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart.


title: Touch of Death

text: The concept known as vibrating palm originates with the Chinese martial arts "Neijing" ("internal") energy techniques that deal with the "qi" energy and the type of force ("jin") used. It is depicted as "a technique that is part psychic and part vibratory, this energy is then focused into a wave".


title: Touch of Death

text: In 1985, an article in "Black Belt" magazine speculated that the death of Bruce Lee in 1973 might have been caused by "a delayed reaction to a Dim-Mak strike he received several weeks prior to his collapse". Other authors have also said Lee's death may have been due to a "quivering palm technique" (alongside an article about Choy Li Fut instructor Wong Doc-Fai) to the effect that "dim mak does actually exist and is still taught to a few select kung fu practitioners." A 1986 book on "qi" identifies "dim mak" as "one of the secret specialities" of "wing chun".


title: Touch of Death

text: During the late 1980s, Erle Montaigue (1949–2011) published a number of books and instruction videos on "dim mak" with Paladin Press. Montaigue claims to be "the first Westerner to be granted the degree of 'Master' in "taijiquan"", awarded by Master Wang Xin-Wu in 1985. According to Montaigue's own account, "dim mak" is an aspect of traditional old Yang style "taji quan" which he claims he began learning in 1978 from a master called Chiang Yiu-chun who died in the month of May. Montaigue stated this man was an illegal immigrant, making his existence difficult to verify. Erle subsequently learned the remaining ""qi"-disruptive" forms of "wudang shan" from Liang Shih-kan in 1995. Paladin Press has other titles on the topic of "dim mak", including Kelly (2001) and Walker and Bauer (2002), both with a foreword by Montaigue.


title: Touch of Death

text: Around 1990, Taika Seiyu Oyata founded the style of Ryū-te which involves "pressure point fighting" (""). In the 1990s, karate instructor George Dillman developed a style that involves "kyūshojutsu", a term that he identifies with "dim mak". Dillman eventually went as far as claiming to have developed "qi"-based attacks that work without physical contact ("no-touch knockout" techniques), a claim that did not stand up to third-party investigation and was consequently denounced as fraudulent.


title: Touch of Death

text: A "Five Point Palm Exploding Heart Technique" appears in both the Shaw Brothers films "Clan of the White Lotus" (1980) and "Executioners of Shaolin" (1977). It is used by the protagonist in the climax of "". The "delayed action" of "dim mak" is depicted in "Executioners of Shaolin" (1977), where a "100-step Soul Catching" move allows the victim to take a certain number of steps before dying. A "dim mak" attack is used to paralyze a character in "Crouching Tiger, Hidden Dragon" (2000).


title: Touch of Death

text: The manga "Fist of the North Star" centers around the fictional martial art school "Hokuto Shinken", whose practitioners are trained to kill or incapacitate opponents by striking the specific pressure points on an opponent's body. The protagonist of the story, Kenshiro, is the successor of this style and will often end a battle stating how much time the opponent has left to live after delivering a finishing move, or follow up with his famous catchphrase, ""You are already dead"", before his opponent dies, usually from violently exploding.


title: Touch of Death

text: In the "Naruto" series, and its sequel "", Dim Mak is a basis for the fictional Gentle Fist fighting style used by the Hyuga Clan.


title: Touch of Death

text: "Dim mak" has become a kind of camp pop culture item which is recognized also outside the genre of martial arts films. In Thomas Pynchon's novel "Vineland", one of the protagonists uses the "Quivering Palm Death Touch", which kills the opponent one year after it is used. In the TV series "Quincy, M.E.", a 1977 episode entitled "Touch of Death" features a martial-arts movie star whose mysterious death is found to be a result of a "dim mak" attack against him ten days earlier. The lead character of the British TV series "Gangsters" (1978) is murdered by hired assassin "The White Devil" using a similar attack, with death occurring four days after he is touched. Dan Brown's novel "Inferno" depicts a character incapacitating a guard by putting pressure on his wrist, explaining the technique as "Dim Mak". In the comedy film "The Men Who Stare at Goats", George Clooney's character claims to have been hit with the Touch of Death, a "light tap" that causes death at an unknown point in the future, in one case "about eighteen years later"..


title: Touch of Death

text: "Dim mak" is referenced in "Bloodsport" (1988). In the film, Dux (Jean-Claude Van Damme) proves that he has been trained by Senzo Tanaka (whom is also well-respected within the fighting world) by demonstrating a variation of "dim mak" to the judges to back his claim. He proceeds to strike at a stack of bricks with his hand very carefully positioned before he aims downward at a specific force of speed and angle, breaking only the bottom brick. His invitation ends up being honored. Dux also uses the "dim mak" technique on Pumola during the Kumite before ending the match.


title: Touch of Death

text: In the "Star Trek" universe, the Vulcan nerve pinch is frequently used as a non-lethal method of applying pressure to a pressure point in order to render the target unconscious.


title: Touch of Death

text: In "Doctor Who", the Third Doctor describes himself as a master of Venusian aikido on various occasions, accounting for his unique form of hand-to-hand combat, which allows him to immobilize opponents in a manner similar to the Vulcan nerve pinch. Later incarnations of the Doctor have shown varying degrees of expertise in hand-to-hand combat, although only some spin-off material explicitly identifies the later Doctors' combat skills as originating from Venusian aikido.


title: Touch of Death

text: In the "Kung Fu Panda" movie series, the Wuxi Finger Hold technique used by Po is a form of Dim Mak. Likewise, the villain Tai Lung and the mentor Oogway both use a nerve-strike attack to paralyze the opponent.


title: Touch of Death

text: In the "" series, the characterTy Lee uses a form of Dim Mak called chi-blocking to cripple or immobilize opponents, as well as leave opponents unable to bend (control elements.) The fighting style is reintroduced in "The Legend of Korra" as the primary fighting style of the Equalists, who specifically target those able to bend elements.


title: Touch of Death

text: In the "" episode "Day of the Samurai", Kyodai Ken, Bruce Wayne's rival from his days training in Japan, forces Master Yoru to reveal his secret death touch. Wayne survives the technique by wearing a protective pad to absorb the force of the blow.


title: Touch of Death

text: In "", a 2004 American martial arts film written and directed by Quentin Tarantino, a martial arts teacher named Pai Mei uses his Five Point Palm Exploding Heart Technique to kill opponents after they have taken five steps.


title: Touch of Death

text: In "The Suicide Squad" 2021 film, Bloodsport, Peacemaker and Rick Flag use dim mak to kill their captors.


title: A Grand Day Out

text: A Grand Day Out with Wallace and Gromit, later marketed as A Grand Day Out, is a 1989 British stop-motion animated short film starring Wallace and Gromit. It was directed, co-written, and animated by Nick Park at the National Film and Television School in Beaconsfield and Aardman Animations in Bristol.


title: A Grand Day Out

text: The short premiered on 4 November 1989, at an animation festival at the Arnolfini Gallery in Bristol. It was first broadcast on 24 December 1990, Christmas Eve, on Channel 4. "A Grand Day Out" is followed in the series by 1993's "The Wrong Trousers", 1995's "A Close Shave", 2005's "" and 2008's "A Matter of Loaf and Death".


title: A Grand Day Out

text: The short was nominated for an Academy Award for Best Animated Short Film in 1991, but it lost to "Creature Comforts", another stop-motion animated short film made by Nick Park and Aardman Animations, also released in 1989.


title: A Grand Day Out

text: Cheese-loving inventor Wallace and his dog Gromit, while trying to decide where they will spend their bank holiday, find that their house is bereft of cheese. As "everybody knows the Moon is made of cheese", they decide to build a rocket and fly to the Moon. Upon arrival, they begin sampling and gathering cheese, and encounter a coin-operated robot. Wallace inserts a coin, but nothing happens. After he and Gromit leave, the robot comes to life and gathers the dirty plates left at their picnic spot.


title: A Grand Day Out

text: The robot discovers Wallace's skiing magazine, and yearns to travel to Earth to ski for itself. It repairs a broken piece of the Moon that Wallace had cut off, issues a parking ticket for the rocket, and becomes annoyed by an oil leakage from the craft. The robot sneaks up on Wallace and prepares to strike him, but the money Wallace inserted runs out, and it freezes. Wallace takes the robot's baton as a souvenir, inserts another coin, and prepares to leave with Gromit and the cheese they have gathered.


title: A Grand Day Out

text: Returning to life, the robot realizes Wallace and Gromit can bring it to Earth, and follows them. Wallace panics, thinking that the robot is angry over the cheese he is taking with him, and he and Gromit retreat into the rocket. Unable to climb up the ladder, the robot cuts into the fuselage using a can opener. Upon entering the dark engine section of the rocket, it lights a match and accidentally ignites some fuel. The resultant explosion throws it off the rocket, and Wallace and Gromit lift off. Initially distraught at losing its chance to go to Earth, the robot fashions the discarded rocket fuselage into skis, and skis across the lunar landscape. It waves goodbye to Wallace and Gromit as they return home.


title: A Grand Day Out

text: Nick Park started creating the film in 1982, as a graduation project for the National Film and Television School. In 1985, Aardman Animations took him on before he finished the piece, allowing him to work on it part-time while still being funded by the school. To make the film, Park wrote to William Harbutt's company, requesting of Plasticine.


title: A Grand Day Out

text: The block he received had ten colours, one of which was called "stone"; this was used for Gromit. Park wanted to voice Gromit, but he realised the voice he had in mind — that of Peter Hawkins — would have been difficult to animate. For Wallace, Park offered Peter Sallis £50 to voice the character, and the actor's acceptance greatly surprised the young animator.


title: A Grand Day Out

text: Park wanted Wallace to have a Lancastrian accent like his own, but Sallis could only do a Yorkshire voice. Inspired by how Sallis drew out the word "cheese", Park chose to give Wallace large cheeks. When Park called Sallis six years later to explain he had completed his film, Sallis swore in surprise.


title: A Grand Day Out

text: Gromit was named after grommets, because Park's brother, an electrician, often mentioned them, and Nick Park liked the sound of the word. Wallace was originally a postman named Jerry, but Park felt the name did not match well with Gromit. Park saw an overweight Labrador Retriever named Wallace, who belonged to an old woman boarding a bus in Preston. Park commented it was a "funny name, a very northern name to give a dog".


title: A Grand Day Out

text: According to the book "The World of Wallace and Gromit", original plans were that the film would be forty minutes long, including a sequence where Wallace and Gromit would discover a fast food restaurant on the Moon. Regarding the original plot, Park said:


title: A Grand Day Out

text: The short film was released on VHS in the 1990s by BBC Video. It was also released on DVD in "Wallace and Gromit in 3 Amazing Adventures" in 2005 by DreamWorks Home Entertainment. In the United States, it was released on DVD in 2009 by Lionsgate Home Entertainment and HIT Entertainment. In the United Kingdom, it was again released on DVD in the 2000s.


title: A Grand Day Out

text: Lionsgate Home Entertainment later released it on Blu-ray for the first time, under the release's name "Wallace and Gromit: The Complete Collection", on 22 September 2009 in time for the duo's 20th anniversary of the franchise.


title: A Grand Day Out

text: The short premiered on 4 November 1989 at the Arnolfini Gallery in Bristol, UK, and premiered in the United States on 18 May 1990. It was also shown on Channel 4 on 24 December 1990 in the UK.


title: A Grand Day Out

text: The short won the first BAFTA Award for Best Short Animation awarded in 1990, beating out Park's other nominated short, "Creature Comforts".


title: A Grand Day Out

text: However, in 1991, the opposite occurred, with the short being nominated for the Academy Award for Best Animated Short Film, but losing it to "Creature Comforts".


title: Brexpiprazole

text: Brexpiprazole, sold under the brand name Rexulti among others, is an atypical antipsychotic. It is a dopamine D receptor partial agonist and has been described as a "serotonin–dopamine activity modulator" (SDAM). The drug was approved by the U.S. Food and Drug Administration (FDA) on 10 July 2015, for the treatment of schizophrenia, and as an adjunctive treatment for depression. It has been designed to provide improved efficacy and tolerability (e.g., less akathisia, restlessness and/or insomnia) over established adjunctive treatments for major depressive disorder (MDD).


title: Brexpiprazole

text: The drug was developed by Otsuka and Lundbeck, and is considered to be a successor of Otsuka's top-selling atypical antipsychotic aripiprazole (Abilify).


title: Brexpiprazole

text: Brexpiprazole is approved for the indication of schizophrenia in Canada, United States, Australia, Japan and Europe. In 2019, it was also approved in Canada as adjunctive treatment in Major Depressive Disorder. In 2020 it was approved in Brazil only as an adjunctive to the treatment of Major Depressive Disorder. In the United States it was extended approval for schizophrenia in 2022 in the treatment of pediatric patients from age 13 to 17.


title: Brexpiprazole

text: The most common adverse events associated with brexpiprazole (all doses of brexpiprazole cumulatively greater than or equal to 5% vs. placebo) were upper respiratory tract infection (6.9% vs. 4.8%), akathisia (6.6% vs. 3.2%), weight gain (6.3% vs. 0.8%), and nasopharyngitis (5.0% vs. 1.6%).


title: Brexpiprazole

text: Based on information given on the consent forms, it seems brexpiprazole is a substrate of CYP2D6 and CYP3A4, like its predecessor aripiprazole. Participants in the clinical trials are advised to avoid grapefruit, Seville oranges and related citruses.


title: Brexpiprazole

text: Brexpiprazole acts as a partial agonist of the serotonin 5-HT receptor and the dopamine D and D receptors. Partial agonists have both blocking properties and stimulating properties at the receptor they bind to. The ratio of blocking activity to stimulating activity determines a portion of its clinical effects. Brexpiprazole has more blocking and less stimulating activity at the dopamine receptors than its predecessor, aripiprazole, which may decrease its risk for agitation and restlessness. Specifically, where aripiprazole has an intrinsic activity or agonist effect at the D receptor of 60%+, brexpiprazole has an intrinsic activity at the same receptor of about 45%. For aripiprazole, this means more dopamine receptor activation at lower doses, with blockade being reached at higher doses, whereas brexpiprazole is the opposite. By contrast, brexpiprazole has a much higher affinity for the 5-HT receptor, potent antagonist at 5-HT2A receptors, and a potent partial agonist at dopamine D2 receptors with lower intrinsic activity compared to aripiprazole. In vivo characterization of brexpiprazole shows that it may act as a near-full agonist of the 5-HT receptor. This may further underlie a lower potential than aripiprazole to cause treatment-emergent, movement-related disorders such as akathisia due to the downstream dopamine release that is triggered by 5-HT receptor agonism. It is also an antagonist of the serotonin 5-HT, 5-HT, and 5-HT receptors, which may contribute to antidepressant effect. It also binds to and blocks the α-, α-, α-, and α-adrenergic receptors. The drug has negligible affinity for the muscarinic acetylcholine receptors, and hence has no anticholinergic effects. Although brexpiprazole has less affinity for H compared to aripiprazole, weight gain can occur.


title: Brexpiprazole

text: In November 2011, Otsuka Pharmaceutical and Lundbeck announced a global alliance. Lundbeck gave Otsuka an upfront payment of $200 million, and the deal includes development, regulatory and sales payments, for a potential total of $1.8 billion.


title: Brexpiprazole

text: Specifically for OPC-34712, Lundbeck will obtain 50% of net sales in Europe and Canada and 45% of net sales in the US from Otsuka.


title: Brexpiprazole

text: Brexpiprazole was in clinical trials for adjunctive treatment of MDD, adult ADHD, bipolar disorder and schizophrenia.


title: Brexpiprazole

text: The Phase II multicenter, double-blind, placebo-controlled study randomized 429 adult MDD patients who exhibited an inadequate response to one to three approved antidepressant treatments (ADTs) in the current episode. The study was designed to assess the efficacy and safety of brexpiprazole as an adjunctive treatment to standard antidepressant treatment. The antidepressants included in the study were desvenlafaxine, escitalopram, fluoxetine, paroxetine, sertraline, and venlafaxine.


title: Brexpiprazole

text: A new Phase III study was in the recruiting stage: "Study of the Safety and Efficacy of Two Fixed Doses of OPC-34712 as Adjunctive Therapy in the Treatment of Adults With Major Depressive Disorder (the Polaris Trial)". Its goal is "to compare the effect of brexpiprazole to the effect of placebo (an inactive substance) as add on treatment to an assigned FDA approved antidepressant treatment (ADT) in patients with major depressive disorder who demonstrate an incomplete response to a prospective trial of the same assigned FDA approved ADT". Estimated enrollment was 1250 volunteers.


title: Brexpiprazole

text: Brexpiprazole was under development for the treatment of attention deficit hyperactivity disorder (ADHD) as an adjunct to stimulants, but was discontinued for this indication. It reached phase 2 clinical trials for this use prior to discontinuation.


title: Operation Black Buck

text: Operations Black Buck 1 to Black Buck 7 were seven extremely long-range ground attack missions conducted during the 1982 Falklands War by Royal Air Force (RAF) Vulcan bombers of the RAF Waddington Wing, comprising aircraft from 44, 50 and 101 Squadrons, against Argentine positions in the Falkland Islands. Five of the missions completed attacks. The objective of the missions was to attack Port Stanley Airport and its associated defences. The raids, at almost and 16 hours for the round trip, were the longest-ranged bombing raids in history at that time.


title: Operation Black Buck

text: The Operation Black Buck raids were staged from RAF Ascension Island, close to the Equator. The Vulcan was designed for medium-range missions in Europe and lacked the range to fly to the Falklands without refuelling several times. The RAF's tanker planes were mostly converted Handley Page Victor bombers with similar range, so they too had to be refuelled in the air. A total of eleven tankers were required for two Vulcans (one primary and one reserve), a daunting logistical effort as all aircraft had to use the same runway. The Vulcans carried either twenty-one bombs internally or two or four Shrike anti-radar missiles externally. Of the five Black Buck raids flown to completion, three were against Stanley Airfield's runway and operational facilities, while the other two were anti-radar missions using Shrike missiles against a Westinghouse AN/TPS-43 long-range 3D radar in the Port Stanley area. Shrikes hit two of the less valuable and rapidly replaced secondary fire control radars, causing some casualties among the Argentine crews. One Vulcan was nearly lost when a fuel shortage forced it to land in Brazil.


title: Operation Black Buck

text: The raids did minimal damage to the runway and damage to radars was quickly repaired. A single crater was produced on the runway, rendering it impossible for the airfield to be used by fast jets. Argentine ground crew repaired the runway within twenty-four hours, to a level of quality suitable for C-130 Hercules transports. The British were aware that the runway remained in use. It has been suggested that the Black Buck raids were undertaken by the RAF because the British armed forces had been cut in the late 1970s and the RAF may have desired a greater role in the conflict to prevent further cuts.


title: Operation Black Buck

text: During the early 1980s, British defence planning was focused on the Cold War confrontation with the Soviet Union. Nonetheless, at six-monthly intervals the Defence chiefs reviewed other possible areas of conflict around the globe, including the Falkland Islands. The consensus was that they were indefensible. The nearest airfield usable for operations was on Ascension Island, a British territory in the South Atlantic not far from the equator with a single runway at Wideawake airfield that lay from the UK and from the Falklands. Without aircraft able to cover the long distance, the Royal Air Force (RAF) could not envisage carrying out operations in the South Atlantic. Activities in the South Atlantic would be carried out by the Royal Navy and the British Army, with the RAF's role restricted to the Hawker Siddeley Nimrod maritime patrol aircraft and logistic support of the base at Ascension by Vickers VC10 and Lockheed C-130 Hercules transport aircraft.


title: Operation Black Buck

text: Argentine codes had been broken, and in March 1982 intelligence warnings about possible Argentine activity in the South Atlantic accumulated. The RAF began examining whether it was possible to carry out long-range operations with Avro Vulcan bombers using aerial refuelling. In 1961, a Vulcan had flown non-stop from the UK to RAAF Base Richmond near Sydney in Australia, a much greater distance, but that was with pre-positioned aerial tankers along the route, which would not be possible flying from Ascension. All consideration at this point was about how it could be done; no targets were identified in the Falklands or Argentina.


title: Operation Black Buck

text: After Argentina invaded the Falkland Islands on 2 April 1982, the British Government resolved to recapture them.


title: Operation Black Buck

text: Long-range operations were entirely dependent upon the RAF's fleet of Handley Page Victor K2 tankers. Originally 34 Victors had been built as bombers; 24 had subsequently been converted to tankers. One had been lost in an accident at Marham on 28 September 1976, leaving the RAF with a force of just 23. These were the only tankers in British service in April 1982; nine VC10s were in the process of being converted to tankers, but conversion of the first was not completed until 22 June. Of these, twelve were assigned to No. 55 Squadron and eleven to No. 57 Squadron.


title: Operation Black Buck

text: The tanker crews were well-trained for their wartime role, as their peacetime role involved refuelling fighters scrambled in response to incursions into British airspace, usually by bombers from the Soviet Union at a rate of five per week. However, long-range flights over the unfamiliar South Atlantic Ocean necessitated upgrades to the Victors' navigational equipment, notably the installation of the Delco Carousel inertial navigation system and the Omega navigation system. The tankers were themselves capable of being refuelled in flight, which meant that it was possible to set up relays of aircraft.


title: Operation Black Buck

text: The first five Victors deployed to Ascension on 18 April. They were followed by four more the following day. Another six more deployed by the end of the month, bringing the Victor tanker force to fourteen, since one had returned to Marham on 26 April. Each was refuelled by another Victor before leaving UK airspace. While the Victors deployed to Ascension, their normal refuelling mission in the air was undertaken by United States Air Force Boeing KC-135 Stratotankers. The station commander at Marham, Group Captain J. S. B. Price, became the senior RAF officer at Ascension. Wing Commander D. W. Maurice-Jones assumed command of the Victor detachment at Ascension until 22 April, when he was relieved by Wing Commander A. W. Bowman, the commander of No. 57 Squadron.


title: Operation Black Buck

text: Initial long-range operations by the RAF involved the use of Victor aircraft for reconnaissance of the region surrounding South Georgia Island in support of Operation Paraquet, the recapture of South Georgia. At 0400Z on 20 April, a Victor piloted by Squadron Leader J. G. Elliott, took off from Ascension, accompanied by four supporting tankers to supply fuel for the outbound journey. Another flight of four tankers supplied fuel for the return journey. Two more reconnaissance missions to the South Georgia area were carried out on 22–23 April and on 24–25 April. These missions demonstrated the capability of the Victor tanker fleet, flying out of Ascension, to support operations in the South Atlantic.


title: Operation Black Buck

text: The Vulcan was the last of the British V bombers in operational use for bombing, but by March 1982 there were only three squadrons remaining, Nos. 44, 50 and 101 Squadrons RAF. All three were scheduled to be disbanded by 1 July 1982. They were based at RAF Waddington in the UK and assigned to North Atlantic Treaty Organization (NATO) for nuclear operations; neither aerial refuelling nor conventional bombing had been practised for several years. A request from Rear Admiral Sandy Woodward, the commander of the British aircraft carrier group heading south, on 11 April for recommendations for targets to attack in the Falkland Islands led to reconsideration of the possibility of attacks using Vulcans. Options for attacks on airfields and ports on the Argentine mainland were discarded as politically provocative and unlikely to produce worthwhile results. The Chief of the Air Staff, Air Chief Marshal Sir Michael Beetham argued that the Vulcan threat would cause the Argentinians to retain fighters in the north of Argentina.


title: Operation Black Buck

text: Thinking coalesced on a raid on Port Stanley Airport. Whether it was worth the effort was debated. Beetham initially proposed an attack in which a single Vulcan would drop seven bombs. This light bomb load would keep the refuelling requirements down to a minimum. However, tests conducted at the Garvie Island bombing range indicated that seven bombs would not be enough, but a full load of twenty-one would have a 90 per cent probability of putting one crater in the runway, with a 75 per cent chance of two craters. An attack was also expected to do damage to the dispersal areas and aircraft parked nearby. To minimise the danger from anti-aircraft guns and surface-to-air missiles, the raids would be carried out at night, preferably in bad weather. Damage to the surrounding area, possibly including parked aircraft, would make the raid worthwhile. While the Chiefs of Staff Committee were convinced that the operation was feasible and stood a good chance of success, the civilians at the Ministry of Defence were not so certain, and there were political implications to using the base at Ascension for offensive purposes, as Wideawake was technically a USAF base. The United States Department of State was consulted, and affirmed that it had no objection. Authority to proceed with the operation, codenamed Black Buck, was given by the War Cabinet on 27 April.


title: Operation Black Buck

text: The most controversial part of the plan was the involvement of Sea Harriers from Woodward's task force. One of the reasons for the use of the Vulcans was to conserve Sea Harrier resources for the air defence of the naval forces, but the plan required them to conduct a daylight photo reconnaissance sortie over the airfield for the purpose of damage assessment. If they had to be risked, then there were political advantages in using them to carry out the attack on the airport instead. Rear Admiral Derek Reffell proposed that Harriers be used to suppress the airfield radars prior to the Vulcan attack in addition to conducting the post-attack photo reconnaissance. On 29 April, Woodward was informed that the Black Buck raid would occur at 0700Z, and that he was to arrange for the photo reconnaissance to take place as soon as possible afterwards. Woodward signalled that if the photo reconnaissance was essential to Black Buck, then his recommendation was that Black Buck should be cancelled. The following day he was informed that Black Buck had been approved, and that the photo reconnaissance was required not just for damage assessment, but to refute Argentine allegations of indiscriminate bombing.


title: Operation Black Buck

text: Vulcans were selected based upon their engines; only those with the more powerful Bristol Olympus 301 engines were considered suitable. Six aircraft were selected: two each from Nos. 44, 50 and 101 Squadrons. In the event, one was not used. Five crews were chosen, one each from Nos. 44 and 101 Squadrons, two from No. 50 Squadron, and one from the recently disbanded No. 9 Squadron. An air-to-air instructor from the operational conversion unit responsible for training personnel to operate Victor tankers was added to each Vulcan crew during operational missions; this officer was responsible for supervising the refuelling contacts.


title: Operation Black Buck

text: One of the most challenging tasks was reinstating the aerial refuelling system, which had been blocked off. This involved replacing the non-return valves. Twenty replacements were located on a shelf at RAF Stafford. The five aircraft were fitted with the Carousel inertial navigation system. AN/ALQ-101 electronic countermeasure pods from Blackburn Buccaneer aircraft at RAF Honington were fitted to the wings of the Vulcans on improvised pylons, using the attachment points originally intended for the Skybolt missile. The undersides of the aircraft were painted Dark Sea Grey.


title: Operation Black Buck

text: While the Vulcans were capable of carrying conventional munitions, this had not been done for a long time. To carry twenty-one bombs, the Vulcan required three sets of bomb carriers, each of which held seven bombs. Their release was controlled by a panel at the navigator's station, known as a "90-way", that monitored the electrical connections to each bomb, and was said to provide 90 different sequences for releasing the 1,000-pound bombs. None of the Vulcans at Waddington were fitted with the bomb racks or the 90-way. A search of the supply dumps at Waddington and RAF Scampton located the 90-way panels, which were fitted and tested, but finding enough septuple bomb carriers proved harder, and at least nine were required. Someone remembered that some had been sold to a scrapyard in Newark-on-Trent, and they were retrieved from there. Locating sufficient bombs also proved difficult, and only 167 could be located. Some had cast bomb cases rather than machined ones, which was problematic as they tended to shatter, and this mission required bombs that would penetrate into the ground. Training of crews in conventional bombing and in-flight refuelling was carried out from 14 to 17 April, when Military Air Traffic Controllers from the Military Area Service (M.A.S.) suite at London Terminal Control Centre in West Drayton, Middlesex, took the Vulcan bombers and Victor tankers 250 miles off Land's End in the Atlantic Ocean, where the vast majority of their aerial refuelling training was completed, always at night.


title: Operation Black Buck

text: The first two Vulcans, commanded by Squadron Leader John Reeve, and Flight Lieutenant Martin Withers, left Waddington at 0900Z on 29 April and arrived at Wideawake at 1800Z after a non-stop nine-hour flight during which they were twice refuelled by Victor tankers. Two other Vulcans subsequently deployed to Wideawake: one commanded by Squadron Leader Alastair Montgomery arrived on 14 May, and another, commanded by Squadron Leader Neil McDougall, on 27 May. It carried out trials with the Martel anti-radar missile before being equipped with the Shrike missile.


title: Operation Black Buck

text: The first surprise attack on the islands, on 30 April – 1 May, was the first significant offensive action made by British forces against the Argentine forces in the Falklands. It was aimed at the main runway at Port Stanley Airport. Carrying twenty-one 1,000-pound bombs, the bomber was to fly across the line of the runway at about 35 degrees. The bomb release system was timed to drop bombs sequentially from , so that at least one bomb would hit the runway. The Vulcan's fuel tanks could contain weighing in fourteen pressurised bag tanks, five in each wing and four in the fuselage. Based upon estimates of the Vulcan's fuel need, eleven Victor tankers, including two reserve aircraft, were assigned to refuel the single Vulcan before and after its attack on the Falklands. Two Vulcans were assigned to the mission: one, commanded by Reeve, was the lead with another, captained by Withers, as the reserve, which would return to Ascension once Reeve had successfully completed its first aerial refuelling. The plan called for 15 Victor sorties and 18 aerial refuellings. At the time it was the longest bombing mission ever attempted.


title: Operation Black Buck

text: The eleven Victors and two Vulcans began taking off from Wideawake at 2350Z at one-minute intervals, with Reeve's Vulcan the eleventh to lift off and Withers's the last. With a full load of bombs and fuel, a sixth crew member and a fresh coat of paint, the Vulcans were well over their rated maximum takeoff weight of . On the warm Ascension Island, the Bristol Olympus 301 engines had to be run at 103 percent of their rated power in order to get the Vulcans airborne. Shortly after takeoff, Reeve suffered a failure. A rubber seal on the captain's "direct vision" side window had perished. Unable to close or seal the window and pressurise the crew cabin, he was forced to return to Ascension. The Vulcan lacked the ability to dump fuel, and it was far too heavy even for an emergency landing, so the crew were forced to remain airborne in a cold and noisy cabin until sufficient fuel had been consumed. Withers took over as the primary Vulcan. Twenty minutes later, one of the Victor tankers returned to Ascension with a faulty refuelling hose system, and its place was taken by the reserve.


title: Operation Black Buck

text: In the 34 minutes between the first and second refuellings, Withers's Vulcan burned through of fuel, at the rate of per hour. All this time its weight never dropped below the theoretical maximum. At the end of the second refuelling, two more tankers peeled off and returned, reducing the force to just three: Withers's Vulcan, a Victor flown by Squadron Leader Bob Tuxford, and a Victor flown by Flight Lieutenant Steve Biglands. As a result of the fuel demand and problems in flight with refuelling, two of the Victors had to fly further south than planned, reducing their own reserves. At the final refuelling bracket, the sortie flew into a violent thunderstorm, during which Biglands's refuelling probe failed.