title: Assassination of Reinhard Heydrich

text: In the days following the Lidice massacre, no leads were found for those responsible for Heydrich's death. A deadline was issued to the military and the people of Czechoslovakia for the assassins to be apprehended by 18 June 1942. If they were not caught by then, the Germans threatened to spill far more blood, believing that this threat would be enough to force a potential informant to sell out the culprits. Many civilians were indeed wary and fearful of further reprisals, making hiding information much longer increasingly difficult. The assailants initially hid with two Prague families and later took refuge in the Cathedral of Sts Cyril and Methodius (until 1935 the Karel Boromejsky Church) a cathedral of the Czech and Slovak Orthodox Church in Prague. The Germans were unable to locate the attackers until Karel Čurda of the Out Distance sabotage group turned himself in to the Gestapo and gave up the names of the team's local contacts for the bounty of one million Reichsmarks.


title: Assassination of Reinhard Heydrich

text: Čurda betrayed several safe houses provided by the Jindra group, including that of the Moravec family in Žižkov. At 05:00 on 17 June, the Moravec flat was raided. The family was made to stand in the hallway while the Gestapo searched their flat. Marie Moravec was allowed to go to the toilet, where she bit into a cyanide capsule and killed herself. Alois Moravec was unaware of his family's involvement with the resistance; he was taken to the Petschek Palace together with his 17-year-old son Vlastimil, or "Ata", who was tortured throughout the day, but refused to talk. The youth was stupefied with brandy, shown his mother's severed head in a fish tank, and warned that, if he did not talk, his father would be next; Ata gave in. Ata was executed by the Nazis in Mauthausen on 24 October 1942, the same day as his father, his fiancée, her mother, and her brother.


title: Assassination of Reinhard Heydrich

text: "Waffen-SS" troops laid siege to the church the following day, but they were unable to take the assailants alive, despite the best efforts of 750 SS soldiers under the command of SS-"Gruppenführer" Karl Fischer von Treuenfeld. They also brought along Čurda, who tried to get them to surrender by shouting: "" () to which the paratroopers fired back and shouted: "" () Adolf Opálka and Josef Bublík were killed in the prayer loft after a two-hour gun battle, and Kubiš was reportedly found unconscious after the battle and died shortly after from his injuries. Gabčík, Josef Valčík, Jaroslav Švarc, and Jan Hrubý killed themselves in the crypt after repeated SS attacks, attempts to force them out with tear gas, and fire brigade trucks brought in to try to flood the crypt. The SS report about the fight mentioned five wounded SS soldiers. The men in the church had only pistols, while the attackers had machine guns, submachine guns, and hand grenades. After the battle, Čurda confirmed the identity of the dead Czech resistance fighters, including Kubiš and Gabčík.


title: Assassination of Reinhard Heydrich

text: Bishop Gorazd took the blame for the actions in the church to minimize the reprisals among his flock, and even wrote letters to the Nazi authorities, who arrested him on 27 June 1942 and tortured him. On 4 September 1942, the bishop, the church's priests and senior lay leaders were taken to Kobylisy Shooting Range in a northern suburb of Prague and shot. For his actions, Bishop Gorazd was later glorified as a martyr by the Eastern Orthodox Church.


title: Assassination of Reinhard Heydrich

text: Two large funeral ceremonies were held for Heydrich as one of the most important Nazi leaders, first in Prague, where the way to Prague Castle was lined by thousands of SS men with torches, and then in Berlin attended by all high-ranking Nazi figures. Hitler attended the Berlin ceremony and placed the German Order and Blood Order medals on Heydrich's funeral pillow.


title: Assassination of Reinhard Heydrich

text: The assassination of Heydrich was one of the most significant moments of the resistance in Czechoslovakia. Traitor Karel Čurda was hanged for high treason in 1947 after attempting suicide. On 5 August 1942, British foreign secretary Anthony Eden issued a declaration that Germany had destroyed the Munich Agreement. However, the declaration did not commit the UK to Czechoslovakia's pre-Munich borders and did not declare the Munich agreement "void ab initio" as Czechoslovakia wanted, thus the statement has been questioned as a full repudiation of the deal. A September 1942 declaration by the French National Committee suggested that the agreement was "void ab initio" as it had come about under threat of aggression and recognizing no changes in Czechoslovakia's borders since 1938.


title: Assassination of Reinhard Heydrich

text: Neither the Czech government-in-exile nor the British SOE likely foresaw the possibility that the Germans would apply the principle of "Sippenhaft" (collective responsibility) on the scale they did in avenging Heydrich's assassination. Moreover, decisions about whether to conduct assassinations of this kind are resistant to a rational choice process, as computing the probability of success or the likely benefits and costs involved is inherently difficult, and even if it were possible, the benefits (in this case, the diplomatic value of British repudiation of the Munich Agreement) are not in a form that Beneš could readily compare against the nature of the costs (the loss of Czech civilian lives). British Prime Minister Winston Churchill was infuriated enough by the scale of reprisals to suggest levelling three German villages for every Czech village that the Nazis destroyed. Two years after Heydrich's death, Operation Foxley, a similar assassination plan, was drawn up against Hitler, but not implemented.


title: Assassination of Reinhard Heydrich

text: Operation Anthropoid was the only successful government-organized assassination of a top-ranking Nazi official. The Polish underground killed two senior SS officers in the General Government in Operation Kutschera and Operation Bürkl; Wilhelm Kube, the General-kommissar of Belarus, was killed in Operation Blowup by Soviet partisan Yelena Mazanik, a Belarusian woman who had managed to find employment in his household to kill him.


title: Assassination of Reinhard Heydrich

text: The soldiers of Operation Anthropoid, their helpers, and the operation itself were memorialized in the Czech Republic and abroad. The oldest memorial is a plaque on Orthodox Cathedral of Saints Cyril and Methodius in Resslova Street, Prague. It was created in 1947 by an ex-soldier of the Czechoslovak army-in-exile, František Bělský and is dedicated to the paratroopers, the clergymen, and other Czech patriots who died for the sake of the operation.


title: Assassination of Reinhard Heydrich

text: The National Memorial to the Heroes of the Heydrich Terror was created beneath the Cathedral of Saints Cyril and Methodius in 1995. Later, it underwent significant reconstruction and the extended exposition was reopened in 2010.


title: Assassination of Reinhard Heydrich

text: Another important monument is in the form of a fountain, and symbolically commemorates the seven paratroopers. It was installed in 1968 in the Jephson Gardens, Leamington Spa (UK). The headquarters of the Czechoslovak military training camp during World War II were in Leamington.


title: Assassination of Reinhard Heydrich

text: The Slovak National Museum opened an exhibition in May 2007 to commemorate the heroes of the Czech and Slovak resistance, one of the most important resistance actions in the whole of German-occupied Europe.


title: Assassination of Reinhard Heydrich

text: The Anthropoid Operation Memorial, 2009, Prague, authors: sculptor and sculptor Michal Smeral; architects: M. Tumova and J. Gulbis.


title: Assassination of Reinhard Heydrich

text: Also, a memorial has been placed in Arisaig, Scotland, to the Czechoslovakian members of SOE who trained in that area, with a list of those killed and the missions in which they took part.


title: Assassination of Reinhard Heydrich

text: In October 2011, a memorial plaque was unveiled on residential block Porchester Gate (London), which housed the Czechoslovak military intelligence service and where the Operation Anthropoid was planned in October 1941.


title: Assassination of Reinhard Heydrich

text: Jiří Weil's 1959 book "Mendelssohn is on the Roof" features the assassination of Reinhard Heydrich as a subplot.


title: Assassination of Reinhard Heydrich

text: The story of Operation Anthropoid is narrated in a short Czech comic book titled "Atentát" ("The Assassination"), created in 1976 by brothers Jan Saudek and Kája Saudek. It was published in 1976 in the Polish comic-book magazine "Relax", as "Zamach" ("The Assassination").


title: Assassination of Reinhard Heydrich

text: The alternate history novel "The Man with the Iron Heart" by Harry Turtledove is based on the premise that Heydrich survived the 1942 assassination attempt, and led a postwar insurgency campaign, using the Werwolf.


title: Assassination of Reinhard Heydrich

text: Jiří Šulc's novel "Dva proti Říši" (literally "Two Men Against The Empire") describes the events long before the assassination, assassination itself, its consequences and a detailed look at the life of the Czech resistance and exiled paratroopers in the Protectorate.


title: Assassination of Reinhard Heydrich

text: The following is a list of the movies dealing with Operation Anthropoid or portraying the assassination as a crucial moment of the film's plot:


title: Assassination of Reinhard Heydrich

text: Second is from Daniel Landa, called Anička Malinová (2022; Anna Malinová was Gabčík’s girlfriend. She was executed by Nazis in Mauthausen)


title: Assassination of Reinhard Heydrich

text: Ss. Cyril and Methodius Cathedral is where the Czechoslovak paratroopers died after being cornered, and the memorial there is for those killed by the SS in retaliation for Operation Anthropoid.


title: North Atlantic Treaty

text: The North Atlantic Treaty, also referred to as the Washington Treaty, is the treaty that forms the legal basis of, and is implemented by, the North Atlantic Treaty Organization (NATO). The treaty was signed in Washington, D.C., on 4 April 1949.


title: North Atlantic Treaty

text: The treaty was signed in Washington, D.C., on 4 April 1949 by a committee which was chaired by US diplomat Theodore Achilles. Earlier secret talks had been held at the Pentagon between 22 March and 1 April 1948, of which Achilles said:


title: North Atlantic Treaty

text: The talks lasted about two weeks and by the time they finished, it had been secretly agreed that there would be a treaty, and I had a draft of one in the bottom drawer of my safe. It was never shown to anyone except Jack [Hickerson]. I wish I had kept it, but when I left the Department in 1950, I dutifully left it in the safe and I have never been able to trace it in the archives. It drew heavily on the Rio Treaty, and a bit of the Brussels Treaty, which had not yet been signed, but of which we were being kept heavily supplied with drafts. The eventual North Atlantic Treaty had the general form, and a good bit of the language of my first draft, but with a number of important differences.


title: North Atlantic Treaty

text: More than any human being Jack was responsible for the nature, content, and form of the Treaty...It was a one-man Hickerson treaty.


title: North Atlantic Treaty

text: As a fundamental component of NATO, the North Atlantic Treaty is a product of the US' desire to avoid overextension at the end of World War II, and consequently pursue multilateralism in Europe. It is part of the US' collective defense arrangement with Western European powers, following a long and deliberative process. The treaty was created with an armed attack by the Soviet Union against Western Europe in mind, but the mutual self-defense clause was never invoked during the Cold War. Rather, it was invoked for the first and only time in 2001 during Operation Eagle Assist in response to the September 11 attacks.


title: North Atlantic Treaty

text: By signing the North Atlantic Treaty, parties are "determined to safeguard the freedom, common heritage and civilization of the peoples, founded on the principles of democracy, individual liberty and the rule of law."


title: North Atlantic Treaty

text: The following twelve states signed the treaty and thus became the founding members of NATO. The following leaders signed the agreement as plenipotentiaries of their countries in Washington, D.C., on 4 April 1949:


title: North Atlantic Treaty

text: The following 4 states joined the treaty after the 12 founding states, but before the dissolution of the Soviet Union:


title: North Atlantic Treaty

text: No state has rescinded its membership but some dependencies of member states have not requested membership after becoming independent:


title: North Atlantic Treaty

text: Article 1 of the treaty states that member parties "settle any international disputes in which they may be involved by peaceful means in such a manner that international peace and security, and justice, are not endangered, and to refrain in their international relations from the threat or use of force in any manner inconsistent with the purposes of the United Nations."


title: North Atlantic Treaty

text: Members seek to promote stability and well-being in the North Atlantic area through preservation of peace and security in accordance with the Charter of the United Nations.


title: North Atlantic Treaty

text: Article 2 of the treaty stipulates that "The Parties will contribute toward the further development of peaceful and friendly international relations by strengthening their free institutions, by bringing about a better understanding of the principles upon which these institutions are founded, and by promoting conditions of stability and well-being. They will seek to eliminate conflict in their international economic policies and will encourage economic collaboration between any or all of them." This is sometimes referred to as the "Canadian Clause" after Pearson pushed for its inclusion in the treaty. This included proposals for a trade council, cultural program, technological sharing, and an information program. Of those, only the latter two were passed. Nonetheless, it has been brought up during trade disputes between members.


title: North Atlantic Treaty

text: Article 3 of the treaty states that "In order more effectively to achieve the objectives of this Treaty, the Parties, separately and jointly, by means of continuous and effective self-help and mutual aid, will maintain and develop their individual and collective capacity to resist armed attack."


title: North Atlantic Treaty

text: Recently, this has been interpreted as the basis for the target for a 2% GDP expenditure rule, which was established as a loose guideline in 2006. This metric was confirmed again during the 2014 Wales summit.


title: North Atlantic Treaty

text: It has also been used as a core concept for a mandate to strengthen member resilience: the ability to resist and recover from major disasters, failures in infrastructure, or traditional armed attack. This commitment was first accepted during the 2016 Warsaw summit, and further reiterated and clarified due to the COVID-19 pandemic in 2021. Per NATO documents, this has been understood to include seven key areas:


title: North Atlantic Treaty

text: Article 4 is generally considered the starting point for major NATO operations, and therefore is intended for either emergencies or situations of urgency. It officially calls for consultation over military matters when "the territorial integrity, political independence or security of any of the parties is threatened." Upon its invocation, the issue is discussed in the North Atlantic Council, and can formally lead into a joint decision or action (logistic, military, or otherwise) on behalf of the Alliance. It has been officially invoked seven times since the alliance's creation.


title: North Atlantic Treaty

text: There have also been instances where Article 4 was not formally invoked, but instead threatened. In fact, this was viewed as one of the original intentions for Article 4: as a means to elevate issues and provide member nations a means of deterrence. For example, in November 2021, the Polish foreign ministry—along with Estonia, Lithuania, and Latvia—briefly considered triggering Article 4 due to the Belarusian migrant crisis, but it was not formally requested.


title: North Atlantic Treaty

text: On 15 November 2022, a missile struck the territory of Poland at the village of Przewodów near the border with Ukraine. The incident occurred during an attack on Ukrainian cities and energy facilities by Russia. It was the first incident of a missile hitting NATO territory during the 2022 Russian invasion of Ukraine. The NATO Secretary General talked with the Polish President and there was no call for an Article 4 convention, although the government had been in talks to consider invoking it.


title: North Atlantic Treaty

text: The key section of the treaty is Article 5. Its commitment clause defines the "casus foederis". It commits each member state to consider an armed attack against one member state, in Europe or North America, to be an armed attack against them all. Upon such attack, each member state is to assist by taking "such action as [the member state] deems necessary, including the use of armed force, to restore and maintain the security of the North Atlantic area." The article has only been invoked once, but considered in a number of other cases.


title: North Atlantic Treaty

text: It has been invoked only once in NATO history, after the September 11 attacks on the United States in 2001. The invocation was confirmed on 4 October 2001, when NATO determined that the attacks were indeed eligible under the terms of the North Atlantic Treaty. The eight official actions taken by NATO in response to the 9/11 attacks included Operation Eagle Assist and Operation Active Endeavour, a naval operation in the Mediterranean which was designed to prevent the movement of terrorists or weapons of mass destruction, as well as enhancing the security of shipping in general. Active Endeavour began on 4 October 2001.


title: North Atlantic Treaty

text: Article 6 states that the treaty covers only member states' territories in Europe and North America, Turkey and islands in the North Atlantic north of the Tropic of Cancer, plus French Algeria. It was the opinion in August 1965 of the US State Department, the US Defense Department and the legal division of NATO that an attack on the U.S. state of Hawaii would not trigger the treaty, but an attack on the other 49 would.


title: North Atlantic Treaty

text: The Spanish cities of Ceuta and Melilla on the North African shore are thus not under NATO protection in spite of Moroccan claims to them.


title: North Atlantic Treaty

text: Legal experts have interpreted that other articles could cover the Spanish North African cities but this take has not been tested in practice. This is also why events such as the Balyun airstrikes did not trigger Article 5, as the Turkish troops that were attacked were in Syria, not Turkey.


title: North Atlantic Treaty

text: On 16 April 2003, NATO agreed to take command of the International Security Assistance Force (ISAF) in Afghanistan, which includes troops from 42 countries. The decision came at the request of Germany and the Netherlands, the two states leading ISAF at the time of the agreement, and all nineteen NATO ambassadors approved it unanimously. The handover of control to NATO took place on 11 August, and marked the first time in NATO's history that it took charge of a mission outside the North Atlantic area.


title: North Atlantic Treaty

text: In the case of any contradiction with other international obligations (with the exception of the United Nations, which by Article 7 supersedes NATO), or in military conflict of two NATO members, Article 8 comes into force. This is most important in cases should one member engage in military action against another member, upon which the offending members would be held in abeyance of the treaty and thereby NATO protection as a whole. This has not occurred yet, but there have been several militarised disputes between NATO allies that have threatened this:


title: North Atlantic Treaty

text: Establishes the North Atlantic Council, and is the only NATO body that derives its authority directly from the treaty. Its primary objectives as stated in the treaty is the enforcement of Article 3 and Article 5.


title: North Atlantic Treaty

text: Article 10 dictates the process by which other countries may join NATO, which is by unanimous agreement by current NATO members. Further, new NATO members can only consist of other European nations. In practice, this has turned into a set of action plans which an aspiring nation must follow in order to become a member, including the Membership Action Plan (MAP) mechanism and Intensified Dialogue formula.


title: North Atlantic Treaty

text: Article 11 indicated the process of the initial ratification of the treaty. Each signatory nation was required to ratify the treaty through their respective constitutional processes. In order to come into force, the treaty had to be ratified by Belgium, Canada, France, Luxembourg, the Netherlands, the United Kingdom, and the United States.


title: North Atlantic Treaty

text: Article 12 states the process by which the treaty may be amended, provided such amendments still affect the North Atlantic area and do not violate the Charter of the United Nations. In practice, this has only been used to clearly delineate which territories are under the purview of NATO.


title: North Atlantic Treaty

text: Article 13 delimits the process by which a member leaves NATO, which simply consists of a one-year notice by the member nation to the U.S. government, who then promulgates the notice to the other member nations. This has been contemplated by many member nations, but so far has not happened aside from withdrawals due to independence of former territories or dependencies (namely, Algeria, Malta, and Cyprus).


title: North Atlantic Treaty

text: Otherwise, the next closest option for a member nation is to instead withdraw from NATO's military command structure, but not from NATO entirely. This happened with France in 1966, who rejoined in 2009; and happened with Greece in 1974, who still remains absent.


title: North Atlantic Treaty

text: Article 14 notes the official languages of NATO as English and French, and that the United States government shall promulgate copies of the treaty to the other member nations.


title: North Atlantic Treaty

text: Three official footnotes have been released to reflect the changes made since the treaty was written:


title: Death row

text: Death row, also known as condemned row, is a place in a prison that houses inmates awaiting execution after being convicted of a capital crime and sentenced to death. The term is also used figuratively to describe the state of awaiting execution ("being on death row"), even in places where no special facility or separate unit for condemned inmates exists. In the United States, after an individual is found guilty of a capital offense in states where execution is a legal penalty, the judge will give the jury the option of imposing a death sentence or life imprisonment without the possibility of parole. It is then up to the jury to decide whether to give the death sentence; this usually has to be a unanimous decision. If the jury agrees on death, the defendant will remain on death row during appeal and "habeas corpus" procedures, which may continue for several decades.


title: Death row

text: Opponents of capital punishment claim that a prisoner's isolation and uncertainty over their fate constitute a form of psychological abuse and that especially long-time death row inmates are prone to develop a mental disorder, if they do not already suffer from such a condition. This is referred to as the death row phenomenon. Estimations reveal that five to ten percent of all inmates on death row suffer from mental illness. Some inmates may attempt suicide. There have been some calls for a ban on the imposition of the death penalty for inmates with mental illness and also case law such as "Atkins v. Virginia" to further this. Executions still take place for those with clear intellectual disabilities due to poor legal representation and high standards of proof.


title: Death row

text: In 1933, Giuseppe Zangara attempted to kill President Elect Franklin D. Roosevelt but injured and killed Chicago Mayor Anton Cermak. He was convicted of Cermak's murder and sentenced to death. Due to Florida law, an inmate could not be housed in a cell with an inmate who was awaiting execution so a prisoner awaiting execution was to be held in a separate waiting cell. Raiford Prison, where Zangara was being held, already had one prisoner waiting in their "death cell" so the waiting area was expanded to a row of cells, becoming a "Death Row".


title: Death row

text: In the United States, prisoners may wait many years before execution can be carried out due to the complex and time-consuming appeals procedures mandated in the jurisdiction. The time between sentencing and execution has increased relatively steadily between 1977 and 2010, including a 21% jump between 1989 and 1990 and a similar jump between 2008 and 2009. In 2010, a death row inmate waited an average of 178 months (roughly 15 years) between sentencing and execution. Nearly a quarter of inmates on death row in the U.S. die of natural causes while awaiting execution.


title: Death row

text: There were 2,721 people on death row in the United States on October 1, 2018. Since 1977, the states of Texas (464), Virginia (108) and Oklahoma (94) have executed the most death row inmates. , California (683), Florida (390), Texas (330) and Pennsylvania (218) housed more than half of all inmates pending on death row. , the longest-serving prisoner on death row in the US who has been executed was Thomas Knight who served over 39 years. He was executed in Florida in 2014. While Knight was the longest-serving executed inmate, Gary Alvord arrived on Florida's death row in 1974 and died 39 years later on May 19, 2013, from a brain tumor, having spent more time on death row than any American. Brandon Astor Jones spent 36 years on death row (with a brief period in the general prison population during his re-sentencing trial) before being executed for felony murder by the state of Georgia in 2016, at the age of 72. The oldest prisoner on death row in the United States was Leroy Nash, age 94, in Arizona. He died of natural causes on February 12, 2010.


title: Death row

text: Nearly all European countries have abolished capital punishment. As of 2021, Belarus remains the only European country to use the death penalty.


title: Death row

text: Around 70% of the world's countries have abolished capital punishment. These countries are frequently concerned with their citizens in the United States criminal system. There have even been instances of other countries citing human rights laws against the United States, or refusing to extradite incriminating material, in fear of their citizens being put on death row.


title: Death row

text: On November 9th, 2020, the United States received persistent criticism on its use of capital punishment during a United Nations review of its human rights record. Many allies of the United States urged that the U.S. cease executions. France urged the US halt executions, Germany suggested a federal moratorium on and eventual abolition, Austria called for immediate cessation of executions and then abolition, and Australia, the Netherlands, and Switzerland all called for abolition entirely.


title: Death row

text: According to Amnesty International, Saudi Arabia, Iraq, and Iran are responsible for most executions worldwide. When the United Kingdom had capital punishment, there were generally no 'death rows'. The condemned were however separated from the general prison population in one of two 'condemned cells' located adjacent to the execution chamber. Sentenced inmates were given one appeal. If that appeal was found to involve an important point of law it was taken up to the House of Lords, and if the appeal was successful, at that point the sentence was changed to life in prison. The Home Secretary had the power to exercise the Sovereign's royal prerogative of mercy to grant a reprieve on execution and change the sentence to life imprisonment. Essentially the speedy process from conviction to execution, re-sentencing or reprieve meant that there were low numbers, (if any) prisoners under sentence of death at any one time and so there was no need for a 'death row'. Assistant executioner Syd Dernley used the term "death row" in his 1990 memoir "The Hangman's Tale" to refer to the situation at Wandsworth Prison in April 1951 where, as only up to two persons could be hanged at one time, the execution of murderer James Virrels had to await the prior double execution of murderers/robbers Joseph Brown and Edward Smith a day earlier, before going ahead on 26 April.


title: Death row

text: In some Caribbean countries that still authorize execution, the Judicial Committee of the Privy Council is the ultimate court of appeals. It has upheld appeals by prisoners who have spent several years under sentence of death, stating that it does not desire to see the death row phenomenon emerge in countries under its jurisdiction.


title: Carbon monoxide poisoning

text: Carbon monoxide poisoning typically occurs from breathing in carbon monoxide (CO) at excessive levels. Symptoms are often described as "flu-like" and commonly include headache, dizziness, weakness, vomiting, chest pain, and confusion. Large exposures can result in loss of consciousness, arrhythmias, seizures, or death. The classically described "cherry red skin" rarely occurs. Long-term complications may include chronic fatigue, trouble with memory, and movement problems.


title: Carbon monoxide poisoning

text: CO is a colorless and odorless gas which is initially non-irritating. It is produced during incomplete burning of organic matter. This can occur from motor vehicles, heaters, or cooking equipment that run on carbon-based fuels. Carbon monoxide primarily causes adverse effects by combining with hemoglobin to form carboxyhemoglobin (HbCO) preventing the blood from carrying oxygen and expelling carbon dioxide as carbaminohemoglobin. Additionally, many other hemoproteins such as myoglobin, Cytochrome P450, and mitochondrial cytochrome oxidase are affected, along with other metallic and non-metallic cellular targets.


title: Carbon monoxide poisoning

text: Diagnosis is typically based on a HbCO level of more than 3% among nonsmokers and more than 10% among smokers. The biological threshold for carboxyhemoglobin tolerance is typically accepted to be 15% COHb, meaning toxicity is consistently observed at levels in excess of this concentration. The FDA has previously set a threshold of 14% COHb in certain clinical trials evaluating the therapeutic potential of carbon monoxide. In general, 30% COHb is considered severe carbon monoxide poisoning. The highest reported non-fatal carboxyhemoglobin level was 73% COHb.


title: Carbon monoxide poisoning

text: Efforts to prevent poisoning include carbon monoxide detectors, proper venting of gas appliances, keeping chimneys clean, and keeping exhaust systems of vehicles in good repair. Treatment of poisoning generally consists of giving 100% oxygen along with supportive care. This should generally be carried out until symptoms are no longer present and the HbCO level is less than 3%/10%.


title: Carbon monoxide poisoning

text: Carbon monoxide poisoning is relatively common, resulting in more than 20,000 emergency room visits a year in the United States. It is the most common type of fatal poisoning in many countries. In the United States, non-fire related cases result in more than 400 deaths a year. Poisonings occur more often in the winter, particularly from the use of portable generators during power outages. The toxic effects of CO have been known since ancient history. The discovery that hemoglobin is affected by CO emerged with an investigation by James Watt and Thomas Beddoes into the therapeutic potential of hydrocarbonate in 1793, and later confirmed by Claude Bernard between 1846 and 1857.


title: Carbon monoxide poisoning

text: Carbon monoxide is not toxic to all forms of life, and the toxicity is a classical dose-dependent example of hormesis. Small amounts of carbon monoxide are naturally produced through many enzymatic and non-enzymatic reactions across phylogenetic kingdoms where it can serve as an important neurotransmitter (subcategorized as a gasotransmitter) and a potential therapeutic agent. In the case of prokaryotes, some bacteria produce, consume and respond to carbon monoxide whereas certain other microbes are susceptible to its toxicity. Currently, there are no known adverse effects on photosynthesizing plants.


title: Carbon monoxide poisoning

text: The harmful effects of carbon monoxide are generally considered to be due to tightly binding with the prosthetic heme moiety of hemoproteins that results in interference with cellular operations, for example: carbon monoxide binds with hemoglobin to form carboxyhemoglobin which affects gas exchange and cellular respiration. Inhaling excessive concentrations of the gas can lead to hypoxic injury, nervous system damage, and even death.


title: Carbon monoxide poisoning

text: As pioneered by Esther Killick, different species and different people across diverse demographics may have different carbon monoxide tolerance levels. The carbon monoxide tolerance level for any person is altered by several factors, including genetics (hemoglobin mutations), behavior such as activity level, rate of ventilation, a pre-existing cerebral or cardiovascular disease, cardiac output, anemia, sickle cell disease and other hematological disorders, geography and barometric pressure, and metabolic rate.


title: Carbon monoxide poisoning

text: Humans have maintained a complex relationship with carbon monoxide since first learning to control fire circa 800,000 BC. Primitive caveman probably discovered the toxicity of carbon monoxide upon introducing fire into their dwellings. The early development of metallurgy and smelting technologies emerging circa 6,000 BC through the Bronze Age likewise plagued humankind with carbon monoxide exposure. Apart from the toxicity of carbon monoxide, indigenous Native Americans may have experienced the neuroactive properties of carbon monoxide through shamanistic fireside rituals.


title: Carbon monoxide poisoning

text: Early civilizations developed mythological tales to explain the origin of fire, such as Vulcan, Pkharmat, and Prometheus from Greek mythology who shared fire with humans. Aristotle (384–322 BC) first recorded that burning coals produced toxic fumes. Greek physician Galen (129–199 AD) speculated that there was a change in the composition of the air that caused harm when inhaled, and symptoms of CO poisoning appeared in Cassius Iatrosophista's "Quaestiones Medicae et Problemata Naturalia" circa 130 AD. Julian the Apostate, Caelius Aurelianus, and several others similarly documented early knowledge of the toxicity symptoms of carbon monoxide poisoning as caused by coal fumes in the ancient era.


title: Carbon monoxide poisoning

text: Documented cases by Livy and Cicero allude to carbon monoxide being used as a method of suicide in ancient Rome. Emperor Lucius Verus used smoke to execute prisoners. Many deaths have been linked to carbon monoxide poisoning including Emperor Jovian, Empress Fausta, and Seneca. The most high-profile death by carbon monoxide poisoning may possibly have been Cleopatra or Edgar Allan Poe.


title: Carbon monoxide poisoning

text: In the fifteenth century, coal miners believed sudden death was caused by evil spirits; carbon monoxide poisoning has been linked to supernatural and paranormal experiences, witchcraft, etc. throughout the following centuries including in the modern present day exemplified by Carrie Poppy's investigations.


title: Carbon monoxide poisoning

text: Georg Ernst Stahl mentioned "carbonarii halitus" in 1697 in reference to toxic vapors thought to be carbon monoxide. Friedrich Hoffmann conducted the first modern scientific investigation into carbon monoxide poisoning from coal in 1716, notably rejecting villagers attributing death to demonic superstition. Herman Boerhaave conducted the first scientific experiments on the effect of carbon monoxide (coal fumes) on animals in the 1730s. Joseph Priestley is credited with first synthesizing carbon monoxide in 1772 which he had called heavy inflammable air, and Carl Wilhelm Scheele isolated carbon monoxide from coal in 1773 suggesting it to be the toxic entity.


title: Carbon monoxide poisoning

text: The dose-dependent risk of carbon monoxide poisoning as hydrocarbonate was investigated in the late 1790s by Thomas Beddoes, James Watt, Tiberius Cavallo, James Lind, Humphry Davy, and many others in the context of inhalation of factitious airs, much of which occurred at the Pneumatic Institution.


title: Carbon monoxide poisoning

text: William Cruickshank discovered carbon monoxide as a molecule containing one carbon and one oxygen atom in 1800, thereby initiating the modern era of research exclusively focused on carbon monoxide. The mechanism for toxicity was first suggested by James Watt in 1793, followed by Adrien Chenot in 1854 and finally demonstrated by Claude Bernard after 1846 as published in 1857 and also independently published by Felix Hoppe-Seyler in the same year.


title: Carbon monoxide poisoning

text: Carbon monoxide poisoning has plagued coal miners for many centuries. In the context of mining, carbon monoxide is widely known as whitedamp. John Scott Haldane identified carbon monoxide as the lethal constituent of afterdamp, the gas created by combustion, after examining many bodies of miners killed in pit explosions. By 1911, Haldane introduced the use of small animals for miners to detect dangerous levels of carbon monoxide underground, either white mice or canaries which have little tolerance for carbon monoxide thereby offering an early warning, i.e. canary in a coal mine. The canary in British pits was replaced in 1986 by the electronic gas detector.


title: Carbon monoxide poisoning

text: The first qualitative analytical method to detect carboxyhemoglobin emerged in 1858 with a colorimetric method developed by Felix Hoppe-Seyler, and the first quantitative analysis method emerged in 1880 with Josef von Fodor.


title: Carbon monoxide poisoning

text: The use of oxygen emerged with anecdotal reports such as Humphry Davy having been treated with oxygen in 1799 upon inhaling three quarts of hydrocarbonate (water gas). Samuel Witter developed an oxygen inhalation protocol in response to carbon monoxide poisoning in 1814. Similarly, an oxygen inhalation protocol was recommend for malaria (literally translated to "bad air") in 1830 based on malaria symptoms aligning with carbon monoxide poisoning. Other oxygen protocols emerged in the late 1800s. The use of hyperbaric oxygen in rats following poisoning was studied by Haldane in 1895 while its use in humans began in the 1960s.


title: Carbon monoxide poisoning

text: The worst accidental mass poisoning from carbon monoxide was the Balvano train disaster which occurred on 3 March 1944 in Italy, when a freight train with many illegal passengers stalled in a tunnel, leading to the death of over 500 people.


title: Carbon monoxide poisoning

text: Over 50 people are suspected to have died from smoke inhalation as a result of the Branch Davidian Massacre during the Waco siege in 1993.


title: Carbon monoxide poisoning

text: The extermination of stray dogs by a carbon monoxide gas chamber was described in 1874. In 1884, an article appeared in Scientific American describing the use of a carbon monoxide gas chamber for slaughterhouse operations as well as euthanizing a variety of animals.


title: Carbon monoxide poisoning

text: As part of the Holocaust during World War II, the Nazis used gas vans at Chelmno extermination camp and elsewhere to murder an estimated over 700,000 people by carbon monoxide poisoning. This method was also used in the gas chambers of several death camps such as Treblinka, Sobibor, and Belzec. Gassing with carbon monoxide started in Action T4. The gas was supplied by IG Farben in pressurized cylinders and fed by tubes into the gas chambers built at various mental hospitals, such as Hartheim Euthanasia Centre. Exhaust fumes from tank engines, for example, were used to supply the gas to the chambers.


title: Carbon monoxide poisoning

text: Recently, carbon monoxide gas chambers have been used to facilitate capital punishment exemplified by execution practices at the San Quentin State Prison.


title: Carbon monoxide poisoning

text: Carbon monoxide is produced naturally by many physiologically relevant enzymatic and non-enzymatic reactions best exemplified by heme oxygenase catalyzing the biotransformation of heme (an iron protoporphyrin) into biliverdin and eventually bilirubin. Aside from physiological signaling, most carbon monoxide is stored as carboxyhemoglobin at non-toxic levels below 3% HbCO.


title: Carbon monoxide poisoning

text: Small amounts of CO are beneficial and enzymes exist that produce it at times of oxidative stress. A variety of drugs are being developed to introduce small amounts of CO, these drugs are commonly called carbon monoxide-releasing molecules. Historically, the therapeutic potential of factitious airs, notably carbon monoxide as hydrocarbonate, was investigated by Thomas Beddoes, James Watt, Tiberius Cavallo, James Lind, Humphry Davy, and others in many labs such as the Pneumatic Institution.


title: Carbon monoxide poisoning

text: On average, exposures at 100 ppm or greater is dangerous to human health. In the United States, the OSHA limits long-term workplace exposure levels to less than 50 ppm averaged over an 8-hour period; in addition, employees are to be removed from any confined space if an upper limit ("ceiling") of 100 ppm is reached.


title: Carbon monoxide poisoning

text: The main manifestations of carbon monoxide poisoning develop in the organ systems most dependent on oxygen use, the central nervous system and the heart. The initial symptoms of acute carbon monoxide poisoning include headache, nausea, malaise, and fatigue. These symptoms are often mistaken for a virus such as influenza or other illnesses such as food poisoning or gastroenteritis. Headache is the most common symptom of acute carbon monoxide poisoning; it is often described as dull, frontal, and continuous. Increasing exposure produces cardiac abnormalities including fast heart rate, low blood pressure, and cardiac arrhythmia; central nervous system symptoms include delirium, hallucinations, dizziness, unsteady gait, confusion, seizures, central nervous system depression, unconsciousness, respiratory arrest, and death. Less common symptoms of acute carbon monoxide poisoning include myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, high blood sugar, lactic acidosis, muscle necrosis, acute kidney failure, skin lesions, and visual and auditory problems. Carbon monoxide exposure may lead to a significantly shorter life span due to heart damage.


title: Carbon monoxide poisoning

text: One of the major concerns following acute carbon monoxide poisoning is the severe delayed neurological manifestations that may occur. Problems may include difficulty with higher intellectual functions, short-term memory loss, dementia, amnesia, psychosis, irritability, a strange gait, speech disturbances, Parkinson's disease-like syndromes, cortical blindness, and a depressed mood. Depression may occur in those who did not have pre-existing depression. These delayed neurological sequelae may occur in up to 50% of poisoned people after 2 to 40 days. It is difficult to predict who will develop delayed sequelae; however, advanced age, loss of consciousness while poisoned, and initial neurological abnormalities may increase the chance of developing delayed symptoms.


title: Carbon monoxide poisoning

text: Chronic exposure to relatively low levels of carbon monoxide may cause persistent headaches, lightheadedness, depression, confusion, memory loss, nausea, hearing disorders and vomiting. It is unknown whether low-level chronic exposure may cause permanent neurological damage. Typically, upon removal from exposure to carbon monoxide, symptoms usually resolve themselves, unless there has been an episode of severe acute poisoning. However, one case noted permanent memory loss and learning problems after a three-year exposure to relatively low levels of carbon monoxide from a faulty furnace.


title: Carbon monoxide poisoning

text: Chronic exposure may worsen cardiovascular symptoms in some people. Chronic carbon monoxide exposure might increase the risk of developing atherosclerosis. Long-term exposures to carbon monoxide present the greatest risk to persons with coronary heart disease and in females who are pregnant.


title: Carbon monoxide poisoning

text: In experimental animals, carbon monoxide appears to worsen noise-induced hearing loss at noise exposure conditions that would have limited effects on hearing otherwise. In humans, hearing loss has been reported following carbon monoxide poisoning. Unlike the findings in animal studies, noise exposure was not a necessary factor for the auditory problems to occur.


title: Carbon monoxide poisoning

text: One classic sign of carbon monoxide poisoning is more often seen in the dead rather than the living – people have been described as looking red-cheeked and healthy (see below). However, since this "cherry-red" appearance is more common in the dead, it is not considered a useful diagnostic sign in clinical medicine. In autopsy examinations, the appearance of carbon monoxide poisoning is notable because unembalmed dead persons are normally bluish and pale, whereas dead carbon-monoxide poisoned people may appear unusually lifelike in coloration. The colorant effect of carbon monoxide in such postmortem circumstances is thus analogous to its use as a red colorant in the commercial meat-packing industry.


title: Carbon monoxide poisoning

text: The true number of cases of carbon monoxide poisoning is unknown, since many non-lethal exposures go undetected. From the available data, carbon monoxide poisoning is the most common cause of injury and death due to poisoning worldwide. Poisoning is typically more common during the winter months. This is due to increased domestic use of gas furnaces, gas or kerosene space heaters, and kitchen stoves during the winter months, which if faulty and/or used without adequate ventilation, may produce excessive carbon monoxide. Carbon monoxide detection and poisoning also increases during power outages, when electric heating and cooking appliances become inoperative and residents may temporarily resort to fuel-burning space heaters, stoves, and grills (some of which are safe only for outdoor use but nonetheless are errantly burned indoors).


title: Carbon monoxide poisoning

text: It has been estimated that more than 40,000 people per year seek medical attention for carbon monoxide poisoning in the United States. 95% of carbon monoxide poisoning deaths in the United States are due to gas space heaters. In many industrialized countries, carbon monoxide is the cause of more than 50% of fatal poisonings. In the United States, approximately 200 people die each year from carbon monoxide poisoning associated with home fuel-burning heating equipment. Carbon monoxide poisoning contributes to the approximately 5613 smoke inhalation deaths each year in the United States. The CDC reports, "Each year, more than 500 Americans die from unintentional carbon monoxide poisoning, and more than 2,000 commit suicide by intentionally poisoning themselves." For the 10-year period from 1979 to 1988, 56,133 deaths from carbon monoxide poisoning occurred in the United States, with 25,889 of those being suicides, leaving 30,244 unintentional deaths. A report from New Zealand showed that 206 people died from carbon monoxide poisoning in the years of 2001 and 2002. In total carbon monoxide poisoning was responsible for 43.9% of deaths by poisoning in that country. In South Korea, 1,950 people had been poisoned by carbon monoxide with 254 deaths from 2001 through 2003. A report from Jerusalem showed 3.53 per 100,000 people were poisoned annually from 2001 through 2006. In Hubei, China, 218 deaths from poisoning were reported over a 10-year period with 16.5% being from carbon monoxide exposure.


title: Carbon monoxide poisoning

text: Carbon monoxide is a product of combustion of organic matter under conditions of restricted oxygen supply, which prevents complete oxidation to carbon dioxide (CO). Sources of carbon monoxide include cigarette smoke, house fires, faulty furnaces, heaters, wood-burning stoves, internal combustion vehicle exhaust, electrical generators, propane-fueled equipment such as portable stoves, and gasoline-powered tools such as leaf blowers, lawn mowers, high-pressure washers, concrete cutting saws, power trowels, and welders. Exposure typically occurs when equipment is used in buildings or semi-enclosed spaces.


title: Carbon monoxide poisoning

text: Riding in the back of pickup trucks has led to poisoning in children. Idling automobiles with the exhaust pipe blocked by snow has led to the poisoning of car occupants. Any perforation between the exhaust manifold and shroud can result in exhaust gases reaching the cabin. Generators and propulsion engines on boats, especially houseboats, has resulted in fatal carbon monoxide exposures.


title: Carbon monoxide poisoning

text: Poisoning may also occur following the use of a self-contained underwater breathing apparatus (SCUBA) due to faulty diving air compressors.


title: Carbon monoxide poisoning

text: In caves carbon monoxide can build up in enclosed chambers due to the presence of decomposing organic matter. In coal mines incomplete combustion may occur during explosions resulting in the production of afterdamp. The gas is up to 3% CO and may be fatal after just a single breath. Following an explosion in a colliery, adjacent interconnected mines may become dangerous due to the afterdamp leaking from mine to mine. Such an incident followed the Trimdon Grange explosion which killed men in the Kelloe mine.


title: Carbon monoxide poisoning

text: Another source of poisoning is exposure to the organic solvent dichloromethane, also known as methylene chloride, found in some paint strippers, as the metabolism of dichloromethane produces carbon monoxide. In November 2019, an EPA ban on dichloromethane in paint strippers for consumer use took effect in the United States.


title: Carbon monoxide poisoning

text: Prevention remains a vital public health issue, requiring public education on the safe operation of appliances, heaters, fireplaces, and internal-combustion engines, as well as increased emphasis on the installation of carbon monoxide detectors. Carbon monoxide is tasteless, odourless, and colourless, and therefore can not be detected by visual cues or smell.


title: Carbon monoxide poisoning

text: The United States Consumer Product Safety Commission has stated, "carbon monoxide detectors are as important to home safety as smoke detectors are," and recommends each home have at least one carbon monoxide detector, and preferably one on each level of the building. These devices, which are relatively inexpensive and widely available, are either battery- or AC-powered, with or without battery backup. In buildings, carbon monoxide detectors are usually installed around heaters and other equipment. If a relatively high level of carbon monoxide is detected, the device sounds an alarm, giving people the chance to evacuate and ventilate the building. Unlike smoke detectors, carbon monoxide detectors do not need to be placed near ceiling level.


title: Carbon monoxide poisoning

text: The use of carbon monoxide detectors has been standardized in many areas. In the US, NFPA 720–2009, the carbon monoxide detector guidelines published by the National Fire Protection Association, mandates the placement of carbon monoxide detectors/alarms on every level of the residence, including the basement, in addition to outside sleeping areas. In new homes, AC-powered detectors must have battery backup and be interconnected to ensure early warning of occupants at all levels. NFPA 720-2009 is the first national carbon monoxide standard to address devices in non-residential buildings. These guidelines, which now pertain to schools, healthcare centers, nursing homes, and other non-residential buildings, include three main points:


title: Carbon monoxide poisoning

text: The NFPA standard is not necessarily enforced by law. As of April 2006, the US state of Massachusetts requires detectors to be present in all residences with potential CO sources, regardless of building age and whether they are owner-occupied or rented. This is enforced by municipal inspectors and was inspired by the death of 7-year-old Nicole Garofalo in 2005 due to snow blocking a home heating vent. Other jurisdictions may have no requirement or only mandate detectors for new construction or at time of sale.


title: Carbon monoxide poisoning

text: Despite similar deaths in vehicles with clogged exhaust pipes (for example in the Northeastern United States blizzard of 1978 and February 2013 nor'easter) and the commercial availability of the equipment, there is no legal requirement for automotive CO detectors.


title: Carbon monoxide poisoning

text: The following guideline values (ppm values rounded) and periods of time-weighted average exposures have been determined in such a way that the carboxyhaemoglobin (COHb) level of 2.5% is not exceeded, even when a normal subject engages in light or moderate exercise:


title: Carbon monoxide poisoning

text: As many symptoms of carbon monoxide poisoning also occur with many other types of poisonings and infections (such as the flu), the diagnosis is often difficult. A history of potential carbon monoxide exposure, such as being exposed to a residential fire, may suggest poisoning, but the diagnosis is confirmed by measuring the levels of carbon monoxide in the blood. This can be determined by measuring the amount of carboxyhemoglobin compared to the amount of hemoglobin in the blood.


title: Carbon monoxide poisoning

text: The ratio of carboxyhemoglobin to hemoglobin molecules in an average person may be up to 5%, although cigarette smokers who smoke two packs per day may have levels up to 9%. In symptomatic poisoned people they are often in the 10–30% range, while persons who die may have postmortem blood levels of 30–90%.


title: Carbon monoxide poisoning

text: As people may continue to experience significant symptoms of CO poisoning long after their blood carboxyhemoglobin concentration has returned to normal, presenting to examination with a normal carboxyhemoglobin level (which may happen in late states of poisoning) does not rule out poisoning.


title: Carbon monoxide poisoning

text: Carbon monoxide may be quantitated in blood using spectrophotometric methods or chromatographic techniques in order to confirm a diagnosis of poisoning in a person or to assist in the forensic investigation of a case of fatal exposure.


title: Carbon monoxide poisoning

text: A CO-oximeter can be used to determine carboxyhemoglobin levels. Pulse CO-oximeters estimate carboxyhemoglobin with a non-invasive finger clip similar to a pulse oximeter. These devices function by passing various wavelengths of light through the fingertip and measuring the light absorption of the different types of hemoglobin in the capillaries. The use of a regular pulse oximeter is not effective in the diagnosis of carbon monoxide poisoning as these devices may be unable to distinguish carboxyhemoglobin from oxyhemoglobin.


title: Carbon monoxide poisoning

text: Breath CO monitoring offers an alternative to pulse CO-oximetry. Carboxyhemoglobin levels have been shown to have a strong correlation with breath CO concentration. However, many of these devices require the user to inhale deeply and hold their breath to allow the CO in the blood to escape into the lung before the measurement can be made. As this is not possible in people who are unresponsive, these devices may not appropriate for use in on-scene emergency care detection of CO poisoning.


title: Carbon monoxide poisoning

text: There are many conditions to be considered in the differential diagnosis of carbon monoxide poisoning. The earliest symptoms, especially from low level exposures, are often non-specific and readily confused with other illnesses, typically flu-like viral syndromes, depression, chronic fatigue syndrome, chest pain, and migraine or other headaches. Carbon monoxide has been called a "great mimicker" due to the presentation of poisoning being diverse and nonspecific. Other conditions included in the differential diagnosis include acute respiratory distress syndrome, altitude sickness, lactic acidosis, diabetic ketoacidosis, meningitis, methemoglobinemia, or opioid or toxic alcohol poisoning.


title: Carbon monoxide poisoning

text: Initial treatment for carbon monoxide poisoning is to immediately remove the person from the exposure without endangering further people. Those who are unconscious may require CPR on site. Administering oxygen via non-rebreather mask shortens the half-life of carbon monoxide from 320 minutes, when breathing normal air, to only 80 minutes. Oxygen hastens the dissociation of carbon monoxide from carboxyhemoglobin, thus turning it back into hemoglobin. Due to the possible severe effects in the baby, pregnant women are treated with oxygen for longer periods of time than non-pregnant people.


title: Carbon monoxide poisoning

text: Hyperbaric oxygen is also used in the treatment of carbon monoxide poisoning, as it may hasten dissociation of CO from carboxyhemoglobin and cytochrome oxidase to a greater extent than normal oxygen. Hyperbaric oxygen at three times atmospheric pressure reduces the half life of carbon monoxide to 23 (~80/3 minutes) minutes, compared to 80 minutes for oxygen at regular atmospheric pressure. It may also enhance oxygen transport to the tissues by plasma, partially bypassing the normal transfer through hemoglobin. However, it is controversial whether hyperbaric oxygen actually offers any extra benefits over normal high flow oxygen, in terms of increased survival or improved long-term outcomes. There have been randomized controlled trials in which the two treatment options have been compared; of the six performed, four found hyperbaric oxygen improved outcome and two found no benefit for hyperbaric oxygen. Some of these trials have been criticized for apparent flaws in their implementation. A review of all the literature concluded that the role of hyperbaric oxygen is unclear and the available evidence neither confirms nor denies a medically meaningful benefit. The authors suggested a large, well designed, externally audited, multicentre trial to compare normal oxygen with hyperbaric oxygen. While hyperbaric oxygen therapy is used for severe poisonings, the benefit over standard oxygen delivery is unclear.


title: Carbon monoxide poisoning

text: Further treatment for other complications such as seizure, hypotension, cardiac abnormalities, pulmonary edema, and acidosis may be required. Increased muscle activity and seizures should be treated with dantrolene or diazepam; diazepam should only be given with appropriate respiratory support. Hypotension requires treatment with intravenous fluids; vasopressors may be required to treat myocardial depression. Cardiac dysrhythmias are treated with standard advanced cardiac life support protocols. If severe, metabolic acidosis is treated with sodium bicarbonate. Treatment with sodium bicarbonate is controversial as acidosis may increase tissue oxygen availability. Treatment of acidosis may only need to consist of oxygen therapy. The delayed development of neuropsychiatric impairment is one of the most serious complications of carbon monoxide poisoning. Brain damage is confirmed following MRI or CAT scans. Extensive follow up and supportive treatment is often required for delayed neurological damage. Outcomes are often difficult to predict following poisoning, especially people who have symptoms of cardiac arrest, coma, metabolic acidosis, or have high carboxyhemoglobin levels. One study reported that approximately 30% of people with severe carbon monoxide poisoning will have a fatal outcome. It has been reported that electroconvulsive therapy (ECT) may increase the likelihood of delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning. A device that also provides some carbon dioxide to stimulate faster breathing (sold under the brand name ClearMate) may also be used.


title: Carbon monoxide poisoning

text: The precise mechanisms by which the effects of carbon monoxide are induced upon bodily systems are complex and not yet fully understood. Known mechanisms include carbon monoxide binding to hemoglobin, myoglobin and mitochondrial cytochrome c oxidase and restricting oxygen supply, and carbon monoxide causing brain lipid peroxidation.


title: Carbon monoxide poisoning

text: Carbon monoxide has a higher diffusion coefficient compared to oxygen, and the main enzyme in the human body that produces carbon monoxide is heme oxygenase, which is located in nearly all cells and platelets. Most endogenously produced CO is stored bound to hemoglobin as carboxyhemoglobin. The simplistic understanding for the mechanism of carbon monoxide toxicity is based on excess carboxyhemoglobin decreasing the oxygen-delivery capacity of the blood to tissues throughout the body. In humans, the affinity between hemoglobin and carbon monoxide is approximately 240 times stronger than the affinity between hemoglobin and oxygen. However, certain mutations such as the Hb-Kirklareli mutation has a relative 80,000 times greater affinity for carbon monoxide than oxygen resulting in systemic carboxyhemoglobin reaching a sustained level of 16% COHb.


title: Carbon monoxide poisoning

text: Hemoglobin is a tetramer with four prosthetic heme groups to serve as oxygen binding sites. The average red blood cell contains 250 million hemoglobin molecules, therefore 1 billion heme sites capable of binding gas. The binding of carbon monoxide at any one of these sites increases the oxygen affinity of the remaining three sites, which causes the hemoglobin molecule to retain oxygen that would otherwise be delivered to the tissue; therefore carbon monoxide binding at any site may be as dangerous as carbon monoxide binding to all sites. Delivery of oxygen is largely driven by the Bohr effect and Haldane effect. To provide a simplified synopsis of the molecular mechanism of systemic gas exchange in layman's terms, upon inhalation of air it was widely thought oxygen binding to any of the heme sites triggers a conformational change in the globin/protein unit of hemoglobin which then enables the binding of additional oxygen to each of the other vacant heme sites. Upon arrival to the cell/tissues, oxygen release into the tissue is driven by "acidification" of the local pH (meaning a relatively higher concentration of 'acidic' protons/hydrogen ions) caused by an increase in the biotransformation of carbon dioxide waste into carbonic acid via carbonic anhydrase. In other words, oxygenated arterial blood arrives at cells in the "hemoglobin R-state" which has deprotonated/unionized amino acid residues (regarding nitrogen/amines) due to the less-acidic arterial pH environment (arterial blood averages pH 7.407 whereas venous blood is slightly more acidic at pH 7.371). The "T-state" of hemoglobin is deoxygenated in venous blood partially due to protonation/ionization caused by the acidic environment hence causing a conformation unsuited for oxygen-binding (in other words, oxygen is 'ejected' upon arrival to the cell because acid "attacks" the amines of hemoglobin causing ionization/protonation of the amine residues resulting in a conformation change unsuited for retaining oxygen). Furthermore, the mechanism for formation of carbaminohemoglobin generates additional 'acidic' hydrogen ions that may further stabilize the protonated/ionized deoxygenated hemoglobin. Upon return of venous blood into the lung and subsequent exhalation of carbon dioxide, the blood is "de-acidified" (see also: hyperventilation) allowing for the deprotonation/unionization of hemoglobin to then re-enable oxygen-binding as part of the transition to arterial blood (note this process is complex due to involvement of chemoreceptors and other physiological functionalities). Carbon monoxide is not 'ejected' due to acid, therefore carbon monoxide poisoning disturbs this physiological process hence the venous blood of poisoning patients is bright red akin to arterial blood since the carbonyl/carbon monoxide is retained. Hemoglobin is dark in deoxygenated venous blood, but it has a bright red color when carrying blood in oxygenated arterial blood and when converted into carboxyhemoglobin in both arterial and venous blood, so poisoned cadavers and even commercial meats treated with carbon monoxide acquire an unnatural lively reddish hue.


title: Carbon monoxide poisoning

text: At toxic concentrations, carbon monoxide as carboxyhemoglobin significantly interferes with respiration and gas exchange by simultaneously inhibiting acquisition and delivery of oxygen to cells and preventing formation of carbaminohemoglobin which accounts for approximately 30% of carbon dioxide exportation. Therefore, a patient with carbon monoxide poisoning may experience severe hypoxia and acidosis (potentially both respiratory acidosis and metabolic acidosis) in addition to the toxicities of excess carbon monoxide inhibiting numerous hemoproteins, metallic and non-metallic targets which affect cellular machinery.


title: Carbon monoxide poisoning

text: Carbon monoxide also binds to the hemeprotein myoglobin. It has a high affinity for myoglobin, about 60 times greater than that of oxygen. Carbon monoxide bound to myoglobin may impair its ability to utilize oxygen. This causes reduced cardiac output and hypotension, which may result in brain ischemia. A delayed return of symptoms have been reported. This results following a recurrence of increased carboxyhemoglobin levels; this effect may be due to a late release of carbon monoxide from myoglobin, which subsequently binds to hemoglobin.


title: Carbon monoxide poisoning

text: Another mechanism involves effects on the mitochondrial respiratory enzyme chain that is responsible for effective tissue utilization of oxygen. Carbon monoxide binds to cytochrome oxidase with less affinity than oxygen, so it is possible that it requires significant intracellular hypoxia before binding. This binding interferes with aerobic metabolism and efficient adenosine triphosphate synthesis. Cells respond by switching to anaerobic metabolism, causing anoxia, lactic acidosis, and eventual cell death. The rate of dissociation between carbon monoxide and cytochrome oxidase is slow, causing a relatively prolonged impairment of oxidative metabolism.


title: Carbon monoxide poisoning

text: The mechanism that is thought to have a significant influence on delayed effects involves formed blood cells and chemical mediators, which cause brain lipid peroxidation (degradation of unsaturated fatty acids). Carbon monoxide causes endothelial cell and platelet release of nitric oxide, and the formation of oxygen free radicals including peroxynitrite. In the brain this causes further mitochondrial dysfunction, capillary leakage, leukocyte sequestration, and apoptosis. The result of these effects is lipid peroxidation, which causes delayed reversible demyelination of white matter in the central nervous system known as Grinker myelinopathy, which can lead to edema and necrosis within the brain. This brain damage occurs mainly during the recovery period. This may result in cognitive defects, especially affecting memory and learning, and movement disorders. These disorders are typically related to damage to the cerebral white matter and basal ganglia. Hallmark pathological changes following poisoning are bilateral necrosis of the white matter, globus pallidus, cerebellum, hippocampus and the cerebral cortex.


title: Carbon monoxide poisoning

text: Carbon monoxide poisoning in pregnant women may cause severe adverse fetal effects. Poisoning causes fetal tissue hypoxia by decreasing the release of maternal oxygen to the fetus. Carbon monoxide also crosses the placenta and combines with fetal hemoglobin, causing more direct fetal tissue hypoxia. Additionally, fetal hemoglobin has a 10 to 15% higher affinity for carbon monoxide than adult hemoglobin, causing more severe poisoning in the fetus than in the adult. Elimination of carbon monoxide is slower in the fetus, leading to an accumulation of the toxic chemical. The level of fetal morbidity and mortality in acute carbon monoxide poisoning is significant, so despite mild maternal poisoning or following maternal recovery, severe fetal poisoning or death may still occur.


title: Kyle Allen (actor)

text: Kyle Hamilton Allen (born October 10, 1994) is an American actor known for his roles in "The In Between", "The Path", "West Side Story", "The Map of Tiny Perfect Things", and "."


title: Kyle Allen (actor)

text: A native of Livermore, California, Allen began training in acrobatics at a young age, and attended the Kirov Academy of Ballet in Washington D.C., where upon watching Taras Domitro perform "Romeo & Juliet" at the Kennedy Center, felt discouraged from pursuing ballet further. Upon graduation, he lived in Los Angeles picking up commercial work as well as a part lip syncing in a Master P music video.


title: Kyle Allen (actor)

text: In July 2015, Allen was cast in a lead role on the Hulu drama series "The Path" co-starring Aaron Paul and Michelle Monaghan, appearing in all 36 episodes. Upon the series ending in 2018, Allen appeared in a recurring role in "American Horror Story", and in 2019, he was cast as Balkan, one of the Jets in Steven Spielberg's "West Side Story", an adaptation of the Broadway musical of the same name.


title: Kyle Allen (actor)

text: In 2021, Allen would be cast as Romeo in "Rosaline", a modern retelling of "Romeo & Juliet" co-starring Kaitlyn Dever and Isabela Merced, and in "The Greatest Beer Run Ever" co-starring Zac Efron and Russell Crowe. On January 28, 2022, Allen was cast as He-Man in the Netflix live-action film reboot of "Masters of the Universe". In October 2022, Allen was announced to star in "A Haunting in Venice", the third instalment of Kenneth Branagh's Hercule Poirot adaptations.


title: Guy Fawkes mask

text: The Guy Fawkes mask (also known as the "V for Vendetta" mask or Anonymous mask) is a stylised depiction of Guy Fawkes (the best-known member of the Gunpowder Plot, an attempt to blow up the House of Lords in London on 5November 1605) created by illustrator David Lloyd for the 1982–1989 graphic novel "V for Vendetta". Inspired by the use of a mask representing Fawkes being burned on an effigy having long previously had roots as part of Guy Fawkes Night celebrations, Lloyd designed the mask as a smiling face with red cheeks, a wide moustache upturned at both ends, and a thin vertical pointed beard, worn in the graphic novel's anarchist protagonist V.


title: Guy Fawkes mask

text: Following the release of the graphic novel and its 2005 film adaptation, this design came to represent broad protest, later also becoming a symbol for the online hacktivist group Anonymous after appearing in web forums, used in Project Chanology, the Occupy movement, Anonymous for the Voiceless, the fictional F-Society in "Mr. Robot", and other anti-establishment protests around the world. This has led to the mask also being known by the popular name of the Anonymous mask.


title: Guy Fawkes mask

text: The Gunpowder Plot of 1605 was commemorated from early on by burning effigies of unpopular figures. Towards the end of the 18th century, reports appeared of children begging for money with grotesquely masked effigies of Guy Fawkes, and 5November gradually became known as Guy Fawkes Night, although many now prefer the term "Bonfire Night". From the 1864 "Chambers Book of Days":


title: Guy Fawkes mask

text: In 1847, "The Lancet" published "Notes of A Case of Death From Fright," in which the death of a two-year-old was attributed to the fright caused by seeing a boy wearing a red Guy Fawkes mask.


title: Guy Fawkes mask

text: In the 20th century, in the UK, large numbers of cheap cardboard or paper Guy Fawkes masks were sold to children each autumn or given out free with comics; by the 1980s their popularity became increasingly supplanted by Halloween. In 1958, wearing Guy Fawkes masks was mentioned during a debate in the Parliament of Western Australia as an example of harmless and excusable (though technically unlawful) possession of a face mask at night. J.J. Brady said, "at one time it was traditional to wear masks on Guy Fawkes night. So, if tonight anyone is found wearing a Guy Fawkes mask I, as Minister for Police, will see that he is duly excused."


title: Guy Fawkes mask

text: The British comic book series "V for Vendetta", which started in 1982, "centers on a vigilante's efforts to destroy an authoritarian government in a dystopian future United Kingdom". When developing the story, illustrator David Lloyd made a handwritten note on the intend anarchist protagonist, V: "Why don't we portray him as a resurrected Guy Fawkes, complete with one of those papier-mâché masks, in a cape and a conical hat? He'd look really bizarre and it would give Guy Fawkes the image he's deserved all these years. We shouldn't burn the chap every Nov. 5th but celebrate his attempt to blow up Parliament!" Writer Alan Moore commented that, due to Lloyd's idea, "All of the various fragments in my head suddenly fell into place, united behind the single image of a Guy Fawkes mask." He also noted "how interesting it was that we should have taken up the image right at the point where it was apparently being purged from the annals of English iconography." As such, V wears a Guy Fawkes mask (as designed by Lloyd) throughout the story, and in the climax of its 2005 film adaptation and 2022 third season of its prequel television series, thousands of protesters adopt the same costume as they march on Parliament.


title: Guy Fawkes mask

text: Since the 2005 release of the film "V for Vendetta" and the mass production of David Lloyd's mask design by Warner Bros., the use of Guy Fawkes masks has become widespread internationally among groups protesting against politicians, banks, and financial institutions. The masks both conceal the identity and protect the face of individuals and demonstrate their commitment to a shared cause.


title: Guy Fawkes mask

text: On 17 April 2006 a pair of rival groups wearing Fawkes masks confronted each other outside the New York City offices of Warner Brothers and DC Comics. One group, led by freegan Adam Weismann, protested against a perceived misrepresentation of the Anarchist movement in the film "V for Vendetta". The other group, led by libertarian Todd Seavey, counter-protested against the anarchists, wearing masks purportedly supplied by a Time Warner employee.


title: Guy Fawkes mask

text: The mask became associated with the hacktivism group Anonymous's Project Chanology protests against the Church of Scientology in 2008. The group protested the Church of Scientology in response to the Church forcing YouTube to pull a video of Tom Cruise discussing Scientology that was meant for internal use within the Church. In response, Anonymous protested the litigious methods of the Church of Scientology over a period of several months. Protesters were encouraged to hide their faces, since it was common practice for Church members to photograph anti-Scientology protesters. The Guy Fawkes mask was a widely used method of hiding faces.


title: Guy Fawkes mask

text: As the protests continued, more protesters began opting to use the Guy Fawkes mask, which eventually took on symbolic status within the group. Scott Stewart of University of Nebraska at Omaha's "The Gateway" wrote: "Many participants sported Guy Fawkes masks to draw attention both to their identity as Anonymous and the Church of Scientology's abuse of litigation and coercion to suppress anti-Scientology viewpoints." The Internet-based group then adopted the character for its wider protests against authority. A version of the mask was later used in the 2015 television series "Mr. Robot" to represent the hacktivist group F-Society, in reference to Anonymous.


title: Guy Fawkes mask

text: On 23 May 2009, protesters wearing the mask detonated a fake barrel of gunpowder outside Parliament while protesting over the issue of British MPs' expenses.


title: Guy Fawkes mask

text: During the 2011 Wisconsin protests, and then during the subsequent Occupy Wall Street and the ongoing Occupy movement, the mask appeared internationally as a symbol of popular rebellion. In October 2011, campaigner Julian Assange attended the Occupy London Stock Exchange protest wearing such a mask, which he removed after a request by the police.


title: Guy Fawkes mask

text: On 10 June 2012, in Mumbai, India, a group of 100 Anonymous members and college students gathered at Azad Maidan, dressed all in black and wearing Guy Fawkes masks, to protest against the Indian Government's censorship of the Internet.


title: Guy Fawkes mask

text: The mask, used by Bahraini protesters during the Arab Spring-inspired Bahraini uprising, was banned in the country in February 2013, a few months after a similar decision by United Arab Emirates, another Persian Gulf country. The Industry and Commerce Ministry of Bahrain said the ban on importing the mask, which it referred to as "revolution mask", was due to concerns over "public safety". The decision, described by "Voice of America" as "unusual", marked one of the latest in government efforts to suppress the two-year-old uprising. However, a British-based rights activist and Samuel Muston of "The Independent" downplayed the effect of the ban. The "Manama Voice" reported that use of mask in protests increased following the ban.


title: Guy Fawkes mask

text: The masks were used by anti-government protesters in Thailand in 2012, and by protesters in Turkey in 2013. They were also used in protests in Brazil and Egypt in 2013.


title: Guy Fawkes mask

text: In May 2013, the government of Saudi Arabia banned the importation of the masks, and said it would confiscate any found to be for sale. The Ministry of Islamic Affairs stated that the mask is "a symbol of rebels and revenge", and warned imams and parents that "they could be used to incite the youth to destabilize security and spread chaos..." On 22 September 2013, Saudi religious police prohibited the wearing of the Guy Fawkes mask, the day before Saudi Arabia's 83rd National Day.


title: Guy Fawkes mask

text: The wearing of masks during a riot or unlawful assembly has been banned in Canada, following the enactment of Bill C-309, and now carries a maximum ten-year prison sentence.


title: Guy Fawkes mask

text: Participants in the 2014 Venezuelan protests carried a wide variety of masks; one of them was the Guy Fawkes mask, sometimes painted with the colours of the Venezuelan flag.


title: Guy Fawkes mask

text: In October 2019 protesters in Hong Kong started using the mask in opposition to the government's banning the use of masks during protests.


title: Guy Fawkes mask

text: Guy Fawkes masks were among the symbols displayed during the 2021 storming of the United States Capitol.


title: Guy Fawkes mask

text: Alan Moore, anarchist and author of "V for Vendetta", has supported use of the mask, and stated in a 2008 interview with "Entertainment Weekly", "I was also quite heartened the other day when watching the news to see that there were demonstrations outside the Scientology headquarters over here, and that they suddenly flashed to a clip showing all these demonstrators wearing "V for Vendetta" Guy Fawkes masks. That pleased me. That gave me a warm little glow." Whilst Moore did not create such a character for the purposes it has served he explains to "The Guardian", "suppose when I was writing V for Vendetta I would in my secret heart of hearts have thought: wouldn't it be great if these ideas actually made an impact? So when you start to see that idle fantasy intrude on the regular world... It's peculiar. It feels like a character I created 30 years ago has somehow escaped the realm of fiction."


title: Guy Fawkes mask

text: According to "Time" in 2011, the protesters' adoption of the mask had led to it becoming the top-selling mask on Amazon.com, selling hundreds of thousands a year. Warner Bros. Discovery, which owns Warner Bros. and DC Comics, owns the rights to the image and is paid a fee with the sale of each official mask.


title: My Wife and Kids

text: My Wife and Kids is an American sitcom that ran on ABC from March 28, 2001, to May 17, 2005. The series was produced by Touchstone Television. It starred Damon Wayans as Michael Kyle, the patriarch of an African-American family. Wayans and veteran television writer/producer Don Reo co-created and co-produced the series.


title: My Wife and Kids

text: Set in Stamford, Connecticut, Michael Kyle is a loving husband and caring father of three who owns and operates a trucking company. He and his wife, Jay, raise their children in a unique, but unorthodox parenting style as he disciplines them in his own creative way. Despite his chaotic upbringings, Michael always means well to be there for his wife and children with his sense of humor.


title: My Wife and Kids

text: Lionsgate Home Entertainment has released the first two seasons of "My Wife and Kids" on DVD in Region 1.


title: Ayyappanum Koshiyum

text: Ayyappanum Koshiyum () is a 2020 Indian Malayalam-language action thriller film written and directed by Sachy. Produced by Ranjith and P. M. Sasidharan, the film stars Biju Menon and Prithviraj Sukumaran.


title: Ayyappanum Koshiyum

text: "Ayyappanum Koshiyum" was released on 7 February 2020. The film met with positive response from critics with praise for performances, story, direction, dialogues, cinematography and its tradition to Kerala culture. It was one of the highest grossing Malayalam films of 2020, earning ₹52 crore worldwide. It won 4 awards at the 68th National Film Awards, including the National Awards for Best Direction for Sachy, Best Supporting Actor for Biju Menon, Best Female Playback Singer for Nanjiyamma, and Best Stunt Choreography for Mafia Sasi, Supreme Sundar, and Rajasekhar.


title: Ayyappanum Koshiyum

text: Koshy Kurien, an ex-Havildar in Indian Army is on the way to Ooty from Kattappana, with his driver Kumaran. Koshy is drunk and nearly passed out in the car's backseat with a case full of alcohol, bought from the military canteen. Instead of the common route via Coimbatore, they have opted to take the Attappadi hill route, which they did not know was an alcohol prohibited region. The car is stopped on a monthly traffic check, which is a combined police, forest and excise department work. On finding the alcohol in the car the excise officials manhandle Koshy. Koshy, irritated by this assaults the excise officer Faizal. On seeing this, SI Ayyapan Nair steps in and restrains Koshy. Koshy is taken to the local police station and FIR is filed on him in the online records system. Within minutes, the officers are startled to see the name of well-known political and media personalities on the contact list of Koshy's mobile phone. Koshy reveals himself as a rich and influential ex-havildar from the Indian army living in Kattappana and also the son of an influential person named Kurain John.


title: Ayyappanum Koshiyum

text: Fussing over this and over consultation with his CI Satheesh Kumar, Ayyapan decides to go easy and reveals himself as a native of the area, and that he has only 3 years to retire. Koshy asks Ayyappan to let him return home for 5 days to spend Christmas and promises to return for any prison sentence, but Ayyappan refuses, stating that he has been booked under non-bailable sections and may not go home. Soon, Koshy fakes a meltdown and asks for some alcohol as he is an addict. Against his better instincts, Ayyappan pours him some from the confiscated stock with help of a lady constable Jessy. Koshy secretly records this on his phone. Koshy is remanded to 12 days in Palakkad sub-jail, where he is visited by his family. After 12 days, Koshy gets bail on the condition that he has to sign once every Monday and Thursday at Attapadi station. Upon his release, he uses the video footage to get Ayyappan and Jessy suspended for breaking prohibition. Ayyappan is arrested, and his police medals are revoked. The next day he is brought out on bail by Satheesh, who makes a compromise with Koshy's friend MLA George, that Koshy can sign for all future bail conditions at the same time, and end this melee, in return for not providing original video evidence at the enquiry against Ayyappan.


title: Ayyappanum Koshiyum

text: After signing at the station, Koshy goes back on his word, and his lawyer submits the video proof at the enquiry. Ayyappan has no answers to the enquiry done by the DSP Cheriyan George and despite saving Jessy's job, he is sure that his job is lost. Koshy meets him outside the DSP office and boards the bus to Attapadi, seemingly to apologise to him, but due to ego, they both challenge one another and Koshy leaves in his car. Furious at this blatant act of pride, Ayyappan savagely beats a small-time crook Kuttamani (who was aiding Koshy), in front of Koshy and demolishes Mani's illegal building. Visibly horrified at Ayyappan raining down fury on Mani, Satheesh reveals to Koshy that 25 years ago, Ayyappan was a brutal communist leader, who had killed 43 men, as they were commissioned by the landlords to get rid of union workers during Kummatti festival at Mundoor. He was caught by MLA Master Chathan and made to join the police force, He had also turned very mild. He finds out that Ayyappan had a nickname during those days of crime "Mundoor Maadan". Frustrated, Koshy goes to drink in Anaikatti. While returning to Attapadi, Kumaran is arrested and his car is impounded. Left without phone, purse and other options, Koshy starts to walk to Attapadi.


title: Ayyappanum Koshiyum

text: Ayyappan picks him up on his bike and both taunt each other with death threats. Alighting from Ayyapan's bike, Koshy walks miles to Attapadi, where he is refused to lodge as per Ayyappan's instructions. Koshy's phone is illegally given to Ayyappan by a young constable. Ayyappan calls Kurain John and tells him that his son will be in grave danger soon. Hearing about this and concerned for his son's safety, Kurian John sends Koshy's cousins to aid him, and covertly sends professional assailants as a precaution for his son's safety. The next day, Koshy and Ayyapan fight inside the police station, where the CI breaks up the fight, who assigns two policemen to guard Koshy at all times, but those policemen inform Ayyapan about Koshy's goons and Ayyappan thrashes them. Kurain John uses his influence to get an arrest warrant for Ayyappan's wife Kannamma (and thus their toddler son) as she was affiliated with a Maoist organisation years ago. Koshy visits his home in Kattappana and asks Kurain John to stop interfering in their tussle. Koshy's wife Ruby reprimands both of them and asks Koshy to amicably end the issue at once. Koshy realises that the peace of mind of his family is more important than his ego and decides to end this issue peacefully. With the help of his postor cousin and lawyers, he frames a plan to save Ayyappan's job.


title: Ayyappanum Koshiyum

text: While Koshy is away to help Ayyappan, the arrest warrant arrives and Ayyappan refuses to surrender Kannamma. This forces them to flee from Attapadi. Ayyappan drops her and his son to safety, but the police arrives and arrests her before Ayyappan. Since Koshy is not in Attapadi, Ayyappan goes to Koshy's house in Kattappana to find him. After a brief showdown with Kurian, Ayyappan heads back to Attapadi to confront Koshy. Koshy demolishes Ayyappan's house as revenge for the showdown at Kattappana, and Ayyappan burns down Koshy's car with gunpowder. Both of them refuse to lodge a complaint against one another and monitoring the tense situation, police protection is assigned to Koshy. Kurian follows Ayyappan to Attapadi and tells Koshy that he will kill Ayyappan within 24 hours. Koshy informs the police that Kurain John is in Attapadi and was the one who sent goons to kill Ayyappan earlier. Kurien is arrested and imprisoned. When Ayyapan finally challenges Koshy, Koshy suggests an alternative, to have the showdown in Anaikatti town, beyond the jurisdiction of Kerala Police. A face-off duel and after an epic showdown of exchanging blows, bear grips and tossing each other over a puddle of water ensues where Ayyappan gains the upper hand and locks Koshy in a fatal bear grip. Cheriyan George, Satheesh and the rest of the officers, who were clandestinely watching the fight intervene and pulls them apart. Satheesh tells Ayyappan that Koshy framed himself as an alcohol addict, and Ayyappan had then poured alcohol for a medical emergency to keep Koshy's blood alcohol level as required for proper functioning. This has resulted in all charges against Ayyappan being dropped and him being reinstated into the police force and also the IG cancelled Kannamma's arrest and will be released the next day. Ayyapan is brought to the police station and is imprisoned for a day, till the rejoining order arrives. A year later, Ayyappan is transferred upon his request to Kattappana, after which he visits Koshy and shakes hands with him.


title: Ayyappanum Koshiyum

text: "Ayyappanum Koshiyum" is the second directorial of writer-turned-director Sachy after "Anarkali" (2015) which also had Prithviraj Sukumaran and Biju Menon in the main roles. Written by Sachy himself, the film was produced by the film director and Sachy's long-term friend Ranjith along with P. M. Sasidharan under the production company Gold Coin Motion Picture Company. The film's idea was first formed as a story about the relationship between Koshy and his driver, Sachy had two real-life friends resembling them, a jewellery owner and his driver. Later, police sub-inspector was introduced into the plot, which took the story into its present form. Prithviraj played the lead role and Menon had a supporting role in their last collaboration, "Anarkali". The film was titled "Ayyappanum Koshiyum" as Sachy wanted to state that both Prithviraj and Menon have equal importance in the story. Sachy did not have anyone in mind for the two lead roles while screenwriting. Their casting was done after finishing the screenplay.


title: Ayyappanum Koshiyum

text: Principal photography began in early October 2019 in Attappadi, Palakkad district. It was completed in early December 2019. Menon suffered burn injuries on hands and legs while filming in November.


title: Ayyappanum Koshiyum

text: The songs featured in the film and background score were composed by Jakes Bejoy, while the lyrics have been penned by B. K. Harinarayanan, Rafeeq Ahmed, and Nanjiyamma. The soundtrack album was released on 10 February 2020 by Manorama Music.


title: Ayyappanum Koshiyum

text: The film received positive reviews from critics and audience alike. "The New Indian Express" wrote: "This is essentially a masterclass by Sachy on how to make a three-hour film by relying mostly on dialogues which carry enough power to not just reverberate through the walls of the movie hall but also each cell and nerve in your body. With a script like this, one doesn't need bullets or pyrotechnics to excite the audience. Sachy does that with his characters, a rare skill that not many filmmakers possess today in Malayalam cinema", and praised the performances. "The Hindu" wrote: "It is a dialogue-driven narrative, as much verbal as visual, but without over-punctuation or the burden of forced hilarity. The film also comes with a highly textured screenplay, creating an immaculate balance between lightness and intensity", and the cast gives a stand-out performance, also it is "nearly three hours of riveting reel time devoid of any customary gimmicks". Baradwaj Rangan of Film Companion South wrote "...psychological flourishes make Ayyappanum Koshiyum a very different kind of masala movie about similar-yet-different, different-yet-similar men...as the film progresses, it becomes a very textured thing, with a bubbling undercurrent that keeps questioning a very specific kind of masculinity".


title: Ayyappanum Koshiyum

text: "The Times of India" said that it is "a commercial film that reflects contemporary socio-political situations aptly" and Sachy "smartly scripts a story" that explains the struggles between an honest police officer and a rich spoiled brat, "the director manages to hold the audience in that compelling mood from start to finish" and "apart from a carefully written script with interesting characterisation, the casting is a bonus". According to "The News Minute", "Prithviraj and Biju Menon spar in an engaging film ... the movie keeps you engaged for nearly all the three hours with no dramatic twists or turns or characters turning a new leaf overnight".


title: Ayyappanum Koshiyum

text: In the overseas opening weekend, it grossed US$36,253 (₹25.88 lakh) from 27 screens in the United States, US$3,562 (₹2.55 lakh) from 7 screens in Canada, and A$24,227 (₹11.65 lakh) from 7 screens in Australia. It grossed US$87,791 (₹65.03 lakh) in United States in five weeks, A$47,689 (₹23.04 lakh) in Australia in four weeks, NZ$28,012 (₹12.71 lakh) in New Zealand in three weeks, US$22,400 (₹16.17 lakh) in Canada in three weeks, and £48,267 (₹44.74 lakh) in two weeks. In its lifetime, "Ayyappanum Koshiyum" grossed ₹520 million at the global box office.


title: Ayyappanum Koshiyum

text: A Telugu remake, "Bheemla Nayak" starring Pawan Kalyan and Rana Daggubati was released on 25 February 2022. A Hindi remake is also in pre-production starring John Abraham and Abhishek Bachchan. It is also said to be remade in Tamil with Vikram and R Madhavan starring in the lead roles.


title: DDG(X)

text: The DDG(X) program, also known as the Next-Generation Guided-Missile Destroyer program, is a United States Navy program to develop a class of surface combatant vessels to succeed its 22 Flight II s and 27 Flight I/II s. The program is the culmination of the Large Surface Combatant (LSC) initiative that followed the cancellation of CG(X) and curtailing of the procurement of the . The ships will become the principal large surface combatants of the U.S. Navy; compared to their predecessors, they will incorporate more powerful sensors and have more room and weight margin for growth.


title: DDG(X)

text: With the cancellation of the CG(X) in 2010, the U.S. Navy embarked on new studies and programs for the future of the air defense role fulfilled by the "Ticonderoga"-class cruisers. Because the cruisers were built on the "Spruance"-class destroyer hulls, they had limited upgrade potential due to space, weight, and power margins. Meanwhile, the procurement of the "Zumwalt"-class destroyers was severely curtailed due to high costs and a renewed emphasis on air and missile defense for larger combatants. Eventually, the Navy chose to upgrade the "Ticonderoga"s and procure the Flight III "Arleigh Burke"-class destroyers with the enhanced AN/SPY-6 and improved combat systems to supplement the "Ticonderoga"s for air and missile defense.


title: DDG(X)

text: The Navy also launched studies into a Future Surface Combatant (FSC) to replace the "Ticonderoga"-class—which will reach the end of their service lives in the 2020s—as well as older flights of the "Arleigh Burke" class. The FSC evolved into the Large Surface Combatant (LSC) program, which became the DDG(X), with the program office established in June 2021. In February 2022, Gibbs & Cox was contracted to provide design and engineering support. The Navy is retaining the lead design role.


title: DDG(X)

text: Various hull configurations are currently being tested at Naval Surface Warfare Center (NSWC) Carderock and NSWC Philadelphia. A concept presented at the 2022 Surface Warfare Symposium depicts an angular hull form with displacement of , a conventional bow and a superstructure reminiscent of the "Zumwalt"-class destroyer. Future vessels of the class may be lengthened with a payload module for additional capabilities.


title: DDG(X)

text: The DDG(X) hull design will incorporate lessons and elements from both the "Arleigh Burke" and "Zumwalt" designs. The vessels will be able to accommodate larger missile launch systems, improved survivability, and space, weight, power, and cooling margins for future growth. As the ships will be replacing the "Ticonderoga"-class cruisers, they will have air defense command and control facilities and accommodations for an admiral's staff.


title: DDG(X)

text: The DDG(X) will use Integrated Power System (IPS), a modern integrated turboelectric drive as employed on the "Zumwalt" class. The vessels are expected to have 50% greater range, a 120% greater time on station, and a 25% reduction in fuel burn compared to current U.S. Navy destroyers.


title: DDG(X)

text: The sensors will initially be enlarged variants of the AN/SPY-6 radar mounted on the Flight III "Arleigh Burke"-class destroyers. The hull is designed with provisions for upgraded sensors in the future, including larger radar arrays.


title: DDG(X)

text: The vessels will be initially fitted with 32-cell blocks of the Mark 41 VLS, with the concept image of the hull showing four such blocks. Instead of the Mk 41 block, a 12-cell block of larger launchers for hypersonic missiles can also be accepted. The concept image also shows the vessel mounting a main 5-inch (127-mm)/62 cal Mark 45 Mod 4 gun. Upgraded versions of the class may also incorporate directed energy weapons, with lasers ranging from 150 to 600 kW.