title: Arizona Robbins

text: When Robbins turned Torres down in the episode "An Honest Mistake" due to her inexperience with women, series writer Peter Nowalk offered the insight:


title: Arizona Robbins

text: Although the characters go on to begin a relationship, the show's one-hundredth episode "What a Difference a Day Makes" sees them experience difficulties as a result of Torres' father rejecting her for her sexuality. Rhimes commented on their ultimate reconciliation: "I love [Callie] with Arizona. [...] I like that they make me feel hopeful about love." Rhimes has said of their relationship in the sixth season: "I would like to see Callie happily in a long-term relationship. We have so much to explore with them, because we barely know anything about [Arizona]." Capshaw has characterized the relationship as "incredibly understanding and compassionate and sensitive". She described the sixth season as being about: "cementing a very mature and grounded relationship and taking it forward. This is a drama, of course; there will be conflict, but for the time being, they're enjoying being in a relationship that seems stable."


title: Arizona Robbins

text: Asked whether Robbins and Torres might marry in the future, Capshaw replied: "There's probably a lot more stuff that has to happen before that happens. [...] I don't think they're going to get married just to get married. As Arizona goes, I think she has incredible discipline and she does, as you said, have a very strict moral compass and marriage would not be something she would jump into without giving it a great amount of thought." Discussing Robbins' relationship with Torres' former lover Sloan, Capshaw divulged: "Whenever there's been a chance to play that I am intimidated by him or being standoffish, I've always chosen to make it very playful. It's much more Arizona's style to find it very amusing."


title: Arizona Robbins

text: Robbins ranked seventh in a top ten list of gay characters on TV compiled by Jane Boursaw of TV Squad: Commenting on Hahn's abrupt departure from the show, Dorothy Snarker, writing for LGBT website AfterEllen.com observed of Robbins and Torres' relationship: "I [...] can't help but be wary of how the "Grey's" writers will handle this relationship. Jessica has proven lovely and likable in her brief screen time so far. But it's not how the romance starts, but what happens next that really matters." AfterEllen.com also included Robbins in their poll of the Top 50 Lesbian and Bisexual Characters, ranking her at No. 3 and in their Top 50 Favorite Female TV Characters, placing her at No. 2.


title: Arizona Robbins

text: Matt Mitovich of "TV Guide" noted that Robbins "quickly established herself as a fan favorite", describing her as: "a breath of fresh air in the often angsty halls of Seattle Grace." Chris Monfette for IGN has opinionated that the fifth season of "Grey's Anatomy" was an improvement on the previous two seasons, attributing this in part to the introduction of "fresh, new characters" Robbins and Owen Hunt (Kevin McKidd). Monfette wrote that Arizona's ultimate contribution to the season was "introducing the element of childcare to Seattle Grace", which in turn gave Miranda Bailey (Chandra Wilson) "a great arc". Jennifer Godwin for E! Online approved of Arizona's season six promotion to a series regular, particularly as it meant the continuation of her relationship with Callie.


title: Thomas Hagan

text: Thomas Hagan (; born March 16, 1941) is a former member of the Nation of Islam who was convicted for assassinating Malcolm X in 1965. For a while he also went by the name Talmadge X Hayer, and his chosen Islamic name is Mujahid Abdul Halim.


title: Thomas Hagan

text: When Malcolm X was shot on February 21, 1965, in the Audubon Ballroom in Washington Heights, Manhattan, New York City, Hagan was shot in the leg by one of Malcolm X's bodyguards while attempting to flee from the building. Hampered by his bullet wound, Hagan was grabbed by several members of the crowd who witnessed the shooting and physically beat him before police officers arrived and arrested Hagan at the scene. He later confessed to the crime but said that Thomas Johnson (Khalil Islam) and Norman 3X Butler (Muhammad Abdul Aziz), two suspects arrested at a later point in time, were not involved in the assassination.


title: Thomas Hagan

text: Hagan stated in a 1977 affidavit that he had planned the shooting with four others (Johnson and Butler not being among them) to seek revenge for Malcolm X's public criticism of Elijah Muhammad and the Nation of Islam. He said that one of his accomplices [aka William 25X Bradley] distracted Malcolm X's bodyguards by starting an argument about having been pickpocketed. When the bodyguards moved toward the diversion and away from Malcolm X, a man with a shotgun stepped up to him and shot him in the chest. After that, Hagan himself and another of his accomplices shot several rounds at Malcolm X with semi-automatic handguns.


title: Thomas Hagan

text: Hagan, Butler, and Johnson all received 20-years-to-life sentences in 1966. During his 45 years in jail, Hagan earned bachelor's and master's degrees; he filed 16 times for parole but was denied each time. Butler was paroled in 1985 and Johnson in 1987. From 1988, Hagan was in a work release program, which allowed him to seek work outside the prison. It required him to spend only two days a week in Lincoln Correctional Facility, a minimum-security facility in Manhattan. For the rest of the week, he was allowed to stay with his wife and children. Among other places, he worked at the Crown Heights Youth Collective, as a counselor at a homeless shelter on Wards Island, and in a fast-food restaurant. Hagan was granted parole in March 2010 and was released from prison at the end of April. In 2021, Hagan expressed support that the convictions of Thomas Johnson and Norman 3X Butler were overturned, matching his original claims that they were not involved in the murder of Malcolm X.


title: Thomas Hagan

text: He is still a practicing Muslim, but has left the Nation of Islam, no longer agreeing with their ideology. He has expressed "regrets and sorrow" for having shot Malcolm X.


title: Cardiac muscle

text: Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that constitutes the main tissue of the wall of the heart. The cardiac muscle (myocardium) forms a thick middle layer between the outer layer of the heart wall (the pericardium) and the inner layer (the endocardium), with blood supplied via the coronary circulation. It is composed of individual cardiac muscle cells joined by intercalated discs, and encased by collagen fibers and other substances that form the extracellular matrix.


title: Cardiac muscle

text: Cardiac muscle contracts in a similar manner to skeletal muscle, although with some important differences. Electrical stimulation in the form of a cardiac action potential triggers the release of calcium from the cell's internal calcium store, the sarcoplasmic reticulum. The rise in calcium causes the cell's myofilaments to slide past each other in a process called excitation-contraction coupling.


title: Cardiac muscle

text: Diseases of the heart muscle known as cardiomyopathies are of major importance. These include ischemic conditions caused by a restricted blood supply to the muscle such as angina, and myocardial infarction.


title: Cardiac muscle

text: Cardiac muscle tissue or myocardium forms the bulk of the heart. The heart wall is a three-layered structure with a thick layer of myocardium sandwiched between the inner endocardium and the outer epicardium (also known as the visceral pericardium). The inner endocardium lines the cardiac chambers, covers the cardiac valves, and joins with the endothelium that lines the blood vessels that connect to the heart. On the outer aspect of the myocardium is the epicardium which forms part of the pericardial sac that surrounds, protects, and lubricates the heart.


title: Cardiac muscle

text: Within the myocardium, there are several sheets of cardiac muscle cells or cardiomyocytes. The sheets of muscle that wrap around the left ventricle closest to the endocardium are oriented perpendicularly to those closest to the epicardium. When these sheets contract in a coordinated manner they allow the ventricle to squeeze in several directions simultaneously – longitudinally (becoming shorter from apex to base), radially (becoming narrower from side to side), and with a twisting motion (similar to wringing out a damp cloth) to squeeze the maximum possible amount of blood out of the heart with each heartbeat.


title: Cardiac muscle

text: Contracting heart muscle uses a lot of energy, and therefore requires a constant flow of blood to provide oxygen and nutrients. Blood is brought to the myocardium by the coronary arteries. These originate from the aortic root and lie on the outer or epicardial surface of the heart. Blood is then drained away by the coronary veins into the right atrium.


title: Cardiac muscle

text: Cardiac muscle cells also called cardiomyocytes are the contractile myocytes of the cardiac muscle. The cells are surrounded by an extracellular matrix produced by supporting fibroblast cells. Specialised modified cardiomyocytes known as pacemaker cells, set the rhythm of the heart contractions. The pacemaker cells are only weakly contractile without sarcomeres, and are connected to neighboring contractile cells via gap junctions. They are located in the sinoatrial node (the primary pacemaker) positioned on the wall of the right atrium, near the entrance of the superior vena cava. Other pacemaker cells are found in the atrioventricular node (secondary pacemaker).


title: Cardiac muscle

text: Pacemaker cells carry the impulses that are responsible for the beating of the heart. They are distributed throughout the heart and are responsible for several functions. First, they are responsible for being able to spontaneously generate and send out electrical impulses. They also must be able to receive and respond to electrical impulses from the brain. Lastly, they must be able to transfer electrical impulses from cell to cell. Pacemaker cells in the sinoatrial node, and atrioventricular node are smaller and conduct at a relatively slow rate between the cells. Specialized conductive cells in the bundle of His, and the Purkinje fibers are larger in diameter and conduct signals at a fast rate.


title: Cardiac muscle

text: The Purkinje fibers rapidly conduct electrical signals; coronary arteries to bring nutrients to the muscle cells, and veins and a capillary network to take away waste products.


title: Cardiac muscle

text: Cardiac muscle cells are the contracting cells that allow the heart to pump. Each cardiomyocyte needs to contract in coordination with its neighboring cells - known as a functional syncytium - working to efficiently pump blood from the heart, and if this coordination breaks down then – despite individual cells contracting – the heart may not pump at all, such as may occur during abnormal heart rhythms such as ventricular fibrillation.


title: Cardiac muscle

text: Viewed through a microscope, cardiac muscle cells are roughly rectangular, measuring 100–150μm by 30–40μm. Individual cardiac muscle cells are joined at their ends by intercalated discs to form long fibers. Each cell contains myofibrils, specialized protein contractile fibers of actin and myosin that slide past each other. These are organized into sarcomeres, the fundamental contractile units of muscle cells. The regular organization of myofibrils into sarcomeres gives cardiac muscle cells a striped or striated appearance when looked at through a microscope, similar to skeletal muscle. These striations are caused by lighter I bands composed mainly of actin, and darker A bands composed mainly of myosin.


title: Cardiac muscle

text: Cardiomyocytes contain T-tubules, pouches of cell membrane that run from the cell surface to the cell's interior which help to improve the efficiency of contraction. The majority of these cells contain only one nucleus (some may have two central nuclei), unlike skeletal muscle cells which contain many nuclei. Cardiac muscle cells contain many mitochondria which provide the energy needed for the cell in the form of adenosine triphosphate (ATP), making them highly resistant to fatigue.


title: Cardiac muscle

text: T-tubules are microscopic tubes that run from the cell surface to deep within the cell. They are continuous with the cell membrane, are composed of the same phospholipid bilayer, and are open at the cell surface to the extracellular fluid that surrounds the cell. T-tubules in cardiac muscle are bigger and wider than those in skeletal muscle, but fewer in number. In the centre of the cell they join, running into and along the cell as a transverse-axial network. Inside the cell they lie close to the cell's internal calcium store, the sarcoplasmic reticulum. Here, a single tubule pairs with part of the sarcoplasmic reticulum called a terminal cisterna in a combination known as a diad.


title: Cardiac muscle

text: The functions of T-tubules include rapidly transmitting electrical impulses known as action potentials from the cell surface to the cell's core, and helping to regulate the concentration of calcium within the cell in a process known as excitation-contraction coupling. They are also involved in mechano-electric feedback, as evident from cell contraction induced T-tubular content exchange (advection-assisted diffusion), which was confirmed by confocal and 3D electron tomography observations.


title: Cardiac muscle

text: The cardiac syncytium is a network of cardiomyocytes connected by intercalated discs that enable the rapid transmission of electrical impulses through the network, enabling the syncytium to act in a coordinated contraction of the myocardium. There is an atrial syncytium and a ventricular syncytium that are connected by cardiac connection fibres. Electrical resistance through intercalated discs is very low, thus allowing free diffusion of ions. The ease of ion movement along cardiac muscle fibers axes is such that action potentials are able to travel from one cardiac muscle cell to the next, facing only slight resistance. Each syncytium obeys the all or none law.


title: Cardiac muscle

text: Intercalated discs are complex adhering structures that connect the single cardiomyocytes to an electrochemical syncytium (in contrast to the skeletal muscle, which becomes a multicellular syncytium during embryonic development). The discs are responsible mainly for force transmission during muscle contraction. Intercalated discs consist of three different types of cell-cell junctions: the actin filament anchoring fascia adherens junctions, the intermediate filament anchoring desmosomes, and gap junctions. They allow action potentials to spread between cardiac cells by permitting the passage of ions between cells, producing depolarization of the heart muscle. The three types of junction act together as a single area composita.


title: Cardiac muscle

text: Under light microscopy, intercalated discs appear as thin, typically dark-staining lines dividing adjacent cardiac muscle cells. The intercalated discs run perpendicular to the direction of muscle fibers. Under electron microscopy, an intercalated disc's path appears more complex. At low magnification, this may appear as a convoluted electron dense structure overlying the location of the obscured Z-line. At high magnification, the intercalated disc's path appears even more convoluted, with both longitudinal and transverse areas appearing in longitudinal section.


title: Cardiac muscle

text: Cardiac fibroblasts are vital supporting cells within cardiac muscle. They are unable to provide forceful contractions like cardiomyocytes, but instead are largely responsible for creating and maintaining the extracellular matrix which surrounds the cardiomyocytes. Fibroblasts play a crucial role in responding to injury, such as a myocardial infarction. Following injury, fibroblasts can become activated and turn into myofibroblasts – cells which exhibit behaviour somewhere between a fibroblast (generating extracellular matrix) and a smooth muscle cell (ability to contract). In this capacity, fibroblasts can repair an injury by creating collagen while gently contracting to pull the edges of the injured area together.


title: Cardiac muscle

text: Fibroblasts are smaller but more numerous than cardiomyocytes, and several fibroblasts can be attached to a cardiomyocyte at once. When attached to a cardiomyocyte they can influence the electrical currents passing across the muscle cell's surface membrane, and in the context are referred to as being electrically coupled, as originally shown in vitro in the 1960s, and ultimately confirmed in native cardiac tissue with the help of optogenetic techniques. Other potential roles for fibroblasts include electrical insulation of the cardiac conduction system, and the ability to transform into other cell types including cardiomyocytes and adipocytes.


title: Cardiac muscle

text: The extracellular matrix (ECM) surrounds the cardiomyocyte and fibroblasts. The ECM is composed of proteins including collagen and elastin along with polysaccharides (sugar chains) known as glycosaminoglycans. Together, these substances give support and strength to the muscle cells, create elasticity in cardiac muscle, and keep the muscle cells hydrated by binding water molecules.


title: Cardiac muscle

text: The matrix in immediate contact with the muscle cells is referred to as the basement membrane, mainly composed of type IV collagen and laminin. Cardiomyocytes are linked to the basement membrane via specialised glycoproteins called integrins.


title: Cardiac muscle

text: Humans are born with a set number of heart muscle cells, or cardiomyocytes, which increase in size as the heart grows larger during childhood development. Evidence suggests that cardiomyocytes are slowly turned over during aging, but less than 50% of the cardiomyocytes present at birth are replaced during a normal life span. The growth of individual cardiomyocytes not only occurs during normal heart development, it also occurs in response to extensive exercise (athletic heart syndrome), heart disease, or heart muscle injury such as after a myocardial infarction. A healthy adult cardiomyocyte has a cylindrical shape that is approximately 100μm long and 10–25μm in diameter. Cardiomyocyte hypertrophy occurs through sarcomerogenesis, the creation of new sarcomere units in the cell. During heart volume overload, cardiomyocytes grow through eccentric hypertrophy. The cardiomyocytes extend lengthwise but have the same diameter, resulting in ventricular dilation. During heart pressure overload, cardiomyocytes grow through concentric hypertrophy. The cardiomyocytes grow larger in diameter but have the same length, resulting in heart wall thickening.


title: Cardiac muscle

text: The physiology of cardiac muscle shares many similarities with that of skeletal muscle. The primary function of both muscle types is to contract, and in both cases, a contraction begins with a characteristic flow of ions across the cell membrane known as an action potential. The cardiac action potential subsequently triggers muscle contraction by increasing the concentration of calcium within the cytosol.


title: Cardiac muscle

text: The cardiac cycle is the performance of the human heart from the beginning of one heartbeat to the beginning of the next. It consists of two periods: one during which the heart muscle relaxes and refills with blood, called diastole, following a period of robust contraction and pumping of blood, dubbed systole. After emptying, the heart immediately relaxes and expands to receive another influx of blood returning from the lungs and other systems of the body, before again contracting to pump blood to the lungs and those systems. A normally performing heart must be fully expanded before it can efficiently pump again.


title: Cardiac muscle

text: The rest phase is considered polarized. The resting potential during this phase of the beat separates the ions such as sodium, potassium, and calcium. Myocardial cells possess the property of automaticity or spontaneous depolarization. This is the direct result of a membrane which allows sodium ions to slowly enter the cell until the threshold is reached for depolarization. Calcium ions follow and extend the depolarization even further. Once calcium stops moving inward, potassium ions move out slowly to produce repolarization. The very slow repolarization of the CMC membrane is responsible for the long refractory period.


title: Cardiac muscle

text: However, the mechanism by which calcium concentrations within the cytosol rise differ between skeletal and cardiac muscle. In cardiac muscle, the action potential comprises an inward flow of both sodium and calcium ions. The flow of sodium ions is rapid but very short-lived, while the flow of calcium is sustained and gives the plateau phase characteristic of cardiac muscle action potentials. The comparatively small flow of calcium through the L-type calcium channels triggers a much larger release of calcium from the sarcoplasmic reticulum in a phenomenon known as calcium-induced calcium release. In contrast, in skeletal muscle, minimal calcium flows into the cell during action potential and instead the sarcoplasmic reticulum in these cells is directly coupled to the surface membrane. This difference can be illustrated by the observation that cardiac muscle fibers require calcium to be present in the solution surrounding the cell to contract, while skeletal muscle fibers will contract without extracellular calcium.


title: Cardiac muscle

text: During contraction of a cardiac muscle cell, the long protein myofilaments oriented along the length of the cell slide over each other in what is known as the sliding filament theory. There are two kinds of myofilaments, thick filaments composed of the protein myosin, and thin filaments composed of the proteins actin, troponin and tropomyosin. As the thick and thin filaments slide past each other the cell becomes shorter and fatter. In a mechanism known as cross-bridge cycling, calcium ions bind to the protein troponin, which along with tropomyosin then uncover key binding sites on actin. Myosin, in the thick filament, can then bind to actin, pulling the thick filaments along the thin filaments. When the concentration of calcium within the cell falls, troponin and tropomyosin once again cover the binding sites on actin, causing the cell to relax.


title: Cardiac muscle

text: It was commonly believed that cardiac muscle cells could not be regenerated. However, this was contradicted by a report published in 2009. Olaf Bergmann and his colleagues at the Karolinska Institute in Stockholm tested samples of heart muscle from people born before 1955 who had very little cardiac muscle around their heart, many showing with disabilities from this abnormality. By using DNA samples from many hearts, the researchers estimated that a 4-year-old renews about 20% of heart muscle cells per year, and about 69 percent of the heart muscle cells of a 50-year-old were generated after he or she was born.


title: Cardiac muscle

text: One way that cardiomyocyte regeneration occurs is through the division of pre-existing cardiomyocytes during the normal aging process.


title: Cardiac muscle

text: In the 2000s, the discovery of adult endogenous cardiac stem cells was reported, and studies were published that claimed that various stem cell lineages, including bone marrow stem cells were able to differentiate into cardiomyocytes, and could be used to treat heart failure.


title: Cardiac muscle

text: However, other teams were unable to replicate these findings, and many of the original studies were later retracted for scientific fraud.


title: Cardiac muscle

text: Cardiac muscle forms both the atria and the ventricles of the heart. Although this muscle tissue is very similar between cardiac chambers, some differences exist. The myocardium found in the ventricles is thick to allow forceful contractions, while the myocardium in the atria is much thinner. The individual myocytes that make up the myocardium also differ between cardiac chambers. Ventricular cardiomyocytes are longer and wider, with a denser T-tubule network. Although the fundamental mechanisms of calcium handling are similar between ventricular and atrial cardiomyocytes, the calcium transient is smaller and decays more rapidly in atrial myocytes, with a corresponding increase in calcium buffering capacity. The complement of ion channels differs between chambers, leading to longer action potential durations and effective refractory periods in the ventricles. Certain ion currents such as "I" are highly specific to atrial cardiomyocytes, making them a potential target for treatments for atrial fibrillation.


title: Cardiac muscle

text: Diseases affecting cardiac muscle, known as cardiomyopathies, are the leading cause of death in developed countries. The most common condition is coronary artery disease, in which the blood supply to the heart is reduced. The coronary arteries become narrowed by the formation of atherosclerotic plaques. If these narrowings become severe enough to partially restrict blood flow, the syndrome of angina pectoris may occur. This typically causes chest pain during exertion that is relieved by rest. If a coronary artery suddenly becomes very narrowed or completely blocked, interrupting or severely reducing blood flow through the vessel, a myocardial infarction or heart attack occurs. If the blockage is not relieved promptly by medication, percutaneous coronary intervention, or surgery, then a heart muscle region may become permanently scarred and damaged. A specific cardiomyopathy, can cause heart muscle to become abnormally thick (hypertrophic cardiomyopathy), abnormally large (dilated cardiomyopathy), or abnormally stiff (restrictive cardiomyopathy). Some of these conditions are caused by genetic mutations and can be inherited.


title: Cardiac muscle

text: Heart muscle can also become damaged despite a normal blood supply. The heart muscle may become inflamed in a condition called myocarditis, most commonly caused by a viral infection but sometimes caused by the body's own immune system. Heart muscle can also be damaged by drugs such as alcohol, long standing high blood pressure or hypertension, or persistent abnormal heart racing.


title: Cardiac muscle

text: Many of these conditions, if severe enough, can damage the heart so much that the pumping function of the heart is reduced. If the heart is no longer able to pump enough blood to meet the body's needs, this is described as heart failure.


title: Cardiac muscle

text: Significant damage to cardiac muscle cells is referred to as myocytolysis which is considered a type of cellular necrosis defined as either coagulative or colliquative.


title: Joan Armatrading

text: Joan Anita Barbara Armatrading, (, born 9 December 1950) is a Kittitian-English singer-songwriter and guitarist.


title: Joan Armatrading

text: A three-time Grammy Award nominee, Armatrading has also been nominated twice for BRIT Awards as Best Female Artist. She received an Ivor Novello Award for Outstanding Contemporary Song Collection in 1996.


title: Joan Armatrading

text: In a recording career spanning nearly 50 years, Armatrading has released 20 studio albums, as well as several live albums and compilations.


title: Joan Armatrading

text: Joan Armatrading, the third of six children, was born in 1950 in the town of Basseterre in what was then the British colony Saint Christopher and Nevis. Her father was a carpenter and her mother a housewife. When she was three years old, her parents moved with their two eldest boys to Birmingham in England, sending Joan to live with her grandmother on the Caribbean island of Antigua. In early 1958, at the age of seven, she joined her parents in Brookfields, then a district of Birmingham. (The area, now mostly demolished, has been absorbed into the district of Hockley.) Her father had played in a band in his youth, later forbidding his children from touching his guitar. At about the age of 14 Armatrading began writing songs by setting her own limericks to music on a piano that her mother had purchased as "a piece of furniture". Armatrading then began teaching herself guitar after her mother had bought her one that was worth £3 () from a pawn shop in exchange for two prams.


title: Joan Armatrading

text: Armatrading left school at the age of 15 to help support her family. She lost her first job (as a typist and comptometer operator) after taking her guitar to work and playing it during tea-breaks.


title: Joan Armatrading

text: Armatrading first performed in a concert at Birmingham University for her brother at the age of about 16. She only knew her own songs, but her brother asked her to perform something that would be familiar to the audience; she chose "The Sound of Silence". She then performed her own songs around the local area with a friend from school, and played bass- and rhythm-guitar at local clubs. In 1968 Armatrading joined a touring production of the stage musical "Hair". There she met the lyricist Pam Nestor in 1970, and they worked together on Armatrading's debut album "Whatever's for Us", released by Cube Records in 1972. Nestor wrote the lyrics to 11 of the 14 songs on the album, while Armatrading wrote the lyrics to three of them, performed all the vocals, wrote all the music and played an array of instruments on the album. Although Nestor was credited as co-lyricist, Cube regarded Armatrading as the more likely star material. These events produced a tension that broke up the partnership.


title: Joan Armatrading

text: On 28 November 1972, Armatrading appeared on the BBC Radio 1 John Peel Show performing "Head of the Table", "Spend A Little Time", "Child Star" and "Whatever's For Us". She sang and played acoustic guitar and piano. In 1973 Cube released on the Fly label (catalogue: Bug 31) Armatrading's first single, "Lonely Lady" (with lyrics by Nestor), a song that had not been included on the album. It proved unsuccessful in the charts, and a period of inactivity for Armatrading followed while she extricated herself from her contract with Cube Records. The single was subsequently withdrawn by Cube and re-released as a promotional single in the US by Armatrading's new label A&M Records, the same year (as A&M1452). In January 1974 she appeared again on the John Peel Show. Performing "Some Sort Of Love Song", "Lonely Lady" and "Freedom", she again sang and played acoustic guitar and piano, but was accompanied by supporting musicians Snowy White (guitar), Mike Tomich (bass) and Brian Glassock (drums).


title: Joan Armatrading

text: In 1975, Armatrading was free to sign with A&M Records, and issued the album "Back to the Night", which was promoted on tour with six-piece English jazz-pop group The Movies. Armatrading credited English singer Elkie Brooks on the sleeve notes as she had cooked for Armatrading and the band in the studio while they had been making the album, which was produced by Brooks' then husband Pete Gage. A major publicity relaunch in 1976 and the involvement of producer Glyn Johns propelled her next album, "Joan Armatrading", into the Top 20 and spawned the Top-10 hit single "Love and Affection". The album mixed acoustic work with jazz-influenced material, and this style was retained for the 1977 follow-up "Show Some Emotion", also produced by Glyn Johns, as was 1978's "To the Limit". These albums included songs which became staples of Armatrading's live shows, including "Willow", "Down to Zero", "Tall in the Saddle", and "Kissin' and a Huggin'". Also at this time Armatrading wrote and performed "The Flight of the Wild Geese", which was used during the opening- and end-titles of the 1978 war film "The Wild Geese".


title: Joan Armatrading

text: The song was included on the soundtrack album for the film, originally released by A&M Records, later released under licence as a Cinephile DVD. A live album entitled "Steppin' Out" was released in 1979.


title: Joan Armatrading

text: Between 1972 and 1976, Armatrading made a total of eight appearances in session for the John Peel show, and the decade saw her become the first Black British female singer-songwriter to enjoy international success.


title: Joan Armatrading

text: Armatrading appeared as the musical guest for Season 2, episode 21 of NBC's "Saturday Night Live", which originally aired on 14 May 1977.


title: Joan Armatrading

text: In 1980, Armatrading revised her playing style and released "Me Myself I", a harder rock- and pop-oriented album produced by Richard Gottehrer, who had previously produced albums for Blondie. The album became Armatrading's highest ever charting album both in the UK and the US, while the title track became her second UK Top 40 hit single. In that year, she performed on Rockpalast night. The same pop style as on her previous album, now coupled with synthesisers, was also evident on the 1981 album "Walk Under Ladders" and 1983's "The Key". All three of these albums were Top 10 successes in the UK, with "The Key" also producing the hit single "Drop the Pilot", Armatrading's third UK Top 40 hit single (UK #11). To capitalise on her success, A&M released the best of compilation album, "Track Record" in 1983.


title: Joan Armatrading

text: Armatrading performed in 1985 at a sold-out concert at the Red Rocks Amphitheater in Denver, and another concert in Arizona with Cook da Books. That year she released her next album, "Secret Secrets". The album was a top 20 hit but failed to yield any hit singles, cementing Armatrading's status as an "album artist". Taking over production responsibilities herself, she recorded the albums "Sleight of Hand" (1986), "The Shouting Stage" (1988) and "Hearts and Flowers" (1990) for A&M Records, which all made the UK Top 40 but failed to achieve the level of commercial success of her earlier works despite successful national tours (a show from her 1988 "Shouting Stage" tour was also filmed for television).


title: Joan Armatrading

text: In 1989, she was the guest of Sue Lawley on the BBC Radio 4 radio programme "Desert Island Discs" where her favourite choice was Van Morrison's "Madame George". Armatrading's full list included Ella Fitzgerald and Gustav Mahler. Her luxury item was a guitar, while her castaway's book was "Why Didn't They Ask Evans?" by Agatha Christie.


title: Joan Armatrading

text: In 1991, A&M released the compilation "The Very Best of Joan Armatrading" which returned her to the Top 10. However, her following studio album for A&M, 1992's "Square the Circle", did not replicate this success and would be her final recording for the label. Following her departure from A&M, a label she had been with for almost 20 years, Armatrading signed with RCA for her 1995 album "What's Inside". Despite various television appearances and a full tour (which included a string quartet in addition to her stage band), the album was not a commercial success, becoming her lowest charting studio album in 20 years. In December 1998, she released "Lullabies with a Difference", an album of lullabies contributed by her and several of her favourite artists, in honour of PACES, a charity for children with cerebral palsy.


title: Joan Armatrading

text: In 2003, no longer attached to a major label, she released the album "Lovers Speak". Though it was her first album in eight years, it met with little commercial success. In 2004, she released a live album, "", which was a recording of a concert from her "Lovers Speak" tour.


title: Joan Armatrading

text: Her 2007 album "Into the Blues" debuted at No. 1 on the US "Billboard Blues Chart", making Armatrading the first UK female artist to earn that distinction. "Into the Blues", which Armatrading called "the CD I've been promising myself to write for a long time", was nominated for a Grammy Award, also making her the first female UK artist to be nominated in the Grammy Blues category.


title: Joan Armatrading

text: In 2007 Armatrading appeared in Episode 3 of the second series of "Live from Abbey Road" performing "Tall in the Saddle" from her 1976 self-titled album, and "Woman in Love" from the album "Into The Blues". She also appeared on "Later... with Jools Holland" where she performed "Love and Affection", as well as "Woman in Love" and "My Baby's Gone" both from her 2007 "Into The Blues" album.


title: Joan Armatrading

text: On 29 March 2010, she released a new album, "This Charming Life". The album peaked at No. 4 on the US Billboard Folk Albums chart. She embarked on an international tour to promote it, and a concert from this tour in April 2010 at the Royal Albert Hall in London was released on the CD/DVD album "Live at the Royal Albert Hall", along with two tracks from a concert in Denver, Colorado, US, in February 2011. In 2012, she released the album "Starlight".


title: Joan Armatrading

text: Armatrading has always supported new music and local talent. For her 2012 "Starlight" tour she invited 56 singer–songwriters/artists to open for her in their respective home towns before her main tour support Chris Wood. Each of the artists opening for her across the UK also had a track selected for a three disc compilation released by her record label Hypertension Music. She presented "Armatrading's Singer-Songwriters", a two-part radio series showcasing these artists, which was broadcast on BBC Radio Two in February 2013.


title: Joan Armatrading

text: In 2014 and 2015, Armatrading embarked on her last major tour, the Me Myself I Tour, the first to feature her solo on stage. An accompanying CD/DVD album, entitled "Me Myself I World Tour", was released in 2016.


title: Joan Armatrading

text: In 2016, Armatrading was commissioned by director Phyllida Lloyd and the Donmar Warehouse to write the music to an all-female production of William Shakespeare's "The Tempest". Armatrading released an accompanying digital album, "The Tempest Songs".


title: Joan Armatrading

text: In 2018, she signed to BMG. Her first album for the label, "Not Too Far Away", was released in May 2018.


title: Joan Armatrading

text: In May 2021, she announced that her new album "Consequences" would be released later that year and shared a sample track, "Already There"; the album was released in June of that year.


title: Joan Armatrading

text: In addition to recording, Armatrading has toured extensively and appeared in high-profile concerts such as "The Picnic at Blackbushe" in 1978 (alongside Bob Dylan and Eric Clapton) and The Prince's Trust Rock Gala in 1983. She also appeared in the film "The Secret Policeman's Third Ball" in 1987. She has also made many appearances on television, including "The Old Grey Whistle Test" in 1975, "Joan Armatrading: Rock Over Europe" in 1980, "Joan Armatrading in Concert" in 1982, "Late Night in Concert" in 1984, "Joan Armatrading" in 1985 and "In Concert" in 1988.


title: Joan Armatrading

text: Armatrading presented a five-part series on BBC Radio 4 called "Joan Armatrading's Favourite Guitarists" which was broadcast in July 2009, in which she talked to guitarists about their music and their technique. She followed this up with another five-part series called "Joan Armatrading: More Guitar Favourites", which was broadcast in November and December 2011.


title: Joan Armatrading

text: On 19 May 2015 Armatrading appeared on BBC Two's "Later... with Jools Holland", singing "Me Myself I". On 11 May 2018 she was a guest on BBC One's "The Graham Norton Show" and performed her new single "I Like It When We're Together".


title: Joan Armatrading

text: In September 2019 Armatrading was the subject of the one-hour documentary "Me Myself I", aired on BBC Four, in which she tells her life story, both as a songwriter and as a performer, with key performances from many of the musicians she has influenced.


title: Joan Armatrading

text: Armatrading is a self-confessed fan of comics and actually appeared herself in a 1983 edition of The Beano, in the Tom, Dick and Sally comic strip.


title: Joan Armatrading

text: Armatrading possesses the vocal range of a contralto. Her music draws on a wide range of influences including rock, folk, jazz, blues, soul, and reggae.


title: Joan Armatrading

text: Her songs have been described as "some of the most deeply personal and emotionally naked ... of our times". In a 2003 interview, she said: "My songs aren't about me at all. They're always about love, the pain and anguish of it. But the way I've always written is from observation. They're about what I see other people going through. If the songs were about me I'd be so embarrassed I don't think I'd be able to walk out the front door." She went on to say: "the optimistic songs reveal a bit more of me because that's how I feel. I'm definitely a 'glass is half full' kind of a person." Many of her lyrics do not specify the gender of their subjects and she frequently uses the word "you" rather than a gender pronoun.


title: Joan Armatrading

text: Armatrading performs on both six- and twelve-string acoustic and electric guitars. She has played on Ovation acoustic instruments since 1973, and said this about them in an interview with the magazine "Guitar Player": "I'm a bit of a hitter, you see – I bash – and I like to have everything going at once: bass, harmony, and melody. This is why I love Ovations. They are very powerful-sounding guitars, and when I hit those strings, they ring with a nice, clear, percussive – but not overly bright – sound that highlights the rhythms I like to play." She has played Fender Stratocaster and Gibson electric guitars. For her 2012–13 tour, she performed on six- and 12-string Ovations, Stratocasters, and customised Tom Anderson guitars, while for her 2014–2015 Me Myself I Tour, she performed on Ovation and Variax instruments.


title: Joan Armatrading

text: Armatrading is reluctant to discuss her personal life in interviews. In a 2003 interview with David Thomas of "The Daily Telegraph", she said:


title: Joan Armatrading

text: In addition to her music career, in 2001, after five years of studying, Armatrading earned a BA degree in history from the Open University, of which she is now a trustee. Between 2005 and 2010, Armatrading served as president of the Women of the Year Lunches. She has been a trustee of The Prince's Trust since 2020 and an ambassador since 1983.


title: Joan Armatrading

text: Armatrading entered into a civil partnership with artist Maggie Butler in the Shetland Islands in 2011.


title: Joan Armatrading

text: As of 2012, Armatrading lived in Surrey, where she owns "Bumpkin Studios," a purpose built recording facility in the grounds of her home where she has recorded most of her albums since "Sleight of Hand."


title: Joan Armatrading

text: A younger brother, Tony Armatrading, was a stage, film, and television actor who lived in Los Angeles; he died of cancer on 10 May 2021, at the age of 59.


title: Joan Armatrading

text: Armatrading performed as a cameo vocalist for the song "Don't Lose Your Head" on the 1986 Queen album "A Kind of Magic".


title: Joan Armatrading

text: Armatrading's song "In These Times" from her 2003 album "Lovers Speak" appeared on the compilation album "" which was released in 2008 by The Art of Peace Foundation.


title: Joan Armatrading

text: Armatrading has been nominated three times for a Grammy Award and twice for a Brit Award as best female vocalist. She received an Ivor Novello Award for Outstanding Contemporary Song Collection in 1996. She has received honorary degrees from the Liverpool John Moores University (2000), the University of Birmingham (2002), the University of Northampton (2003), Aston University (2006), the Royal Scottish Academy of Music and Drama (2008), and the Open University and the University of the West Indies (2013). In 2022, she received an honorary doctorate from the University of St Andrews. She was appointed Member of the Order of the British Empire (MBE) in the 2001 Birthday Honours and Commander of the Order of the British Empire (CBE) in the 2020 Birthday Honours for services to music, charity and equal rights.


title: Joan Armatrading

text: In October 2011, Armatrading was presented with a BASCA Gold Badge Award in recognition of her contribution to music. In May 2012, before her concert at Uttoxeter, as part of the 2012 Acoustic Festival of Britain, she was presented with a Lifetime Achievement Award.


title: Joan Armatrading

text: In April 2016, she was presented with a Lifetime Achievement Award at the 2016 BBC Radio 2 Folk Awards in recognition of her "influence on a generation of singer-songwriters [as] one of the outstanding voices in British music since the 1970s".


title: Deliveroo

text: Deliveroo is a British online food delivery company founded by Will Shu and Greg Orlowski in 2013 in London, England. It operates in the United Kingdom, France, Belgium, Ireland, Italy, Singapore, Hong Kong, the United Arab Emirates and Kuwait. It formerly operated in Germany, Taiwan, Spain, the Netherlands, and Australia. The company's 2021 report stated that it expected to reach break-even and become profitable in the latter half of 2023 or the first half of 2024.


title: Deliveroo

text: Its subsidiary operation, Deliveroo Editions operates ghost kitchens—kitchens not on restaurant sites—for the preparation of delivery-only meals.<ref name="Sawera, VB, Deliveroo, 4/5/2017"></ref>


title: Deliveroo

text: Deliveroo HOP operates from delivery-only grocery stores run by Deliveroo, working in partnership with existing grocers. Deliveroo also provides delivery and technology for on-demand grocery to major UK retailers.


title: Deliveroo

text: The company was first listed on the London Stock Exchange on 31 March 2021 as Deliveroo Holdings plc In 2022, in its first annual report since listing, Deliveroo showed growth in Gross Transaction Value of 70% year-on-year in constant currency.


title: Deliveroo

text: Deliveroo, headquartered in London, was founded in 2013 by Will Shu and Greg Orlowski. The company makes revenue by charging restaurants a commission fee, as well as by charging customers a per-order fee. It operates in two hundred cities in the UK, France, Belgium, Ireland, Italy, Singapore, United Arab Emirates and Hong Kong. In 2022, Deliveroo launched an advertising platform enabling businesses to promote products across its app.


title: Deliveroo

text: Customers place orders through its app or website, then self-employed bicycle or motorcycle couriers transport orders from restaurants to them.


title: Deliveroo

text: In November 2017, Deliveroo introduced Deliveroo Plus, a subscription service which gives customers in the UK unlimited free delivery.


title: Deliveroo

text: Deliveroo works with some of the biggest chain restaurants across the UK, with the majority being available exclusively on the Deliveroo app along with thousands of independent restaurants. On 16 November 2016, it became known that the brewing company Heineken International had closed a deal for Deliveroo to deliver the latter's beers and ciders, initially across 15 sites in London, Bath and Cardiff. This delivery deal, whose activities started that same week, was considered the biggest one of its kind (that is, with regards to the brewing industry).


title: Deliveroo

text: In January 2017, Deliveroo announced plans to create 300 tech jobs in the UK when it opened its new head office in London later in 2017. That month the company had more than 1,000 full-time employees. As of 2022, Deliveroo employs over 3,000 staff globally


title: Deliveroo

text: In April 2017, Deliveroo's Editions kitchens launched. These delivery-only kitchens allow restaurants to access customers in locations without needing High Street premises, thereby reducing set-up costs compared to a full-service restaurant. Deliveroo uses its data to identify areas where customer demand for certain cuisines is high and predicts which restaurants are likely to succeed there.


title: Deliveroo

text: In mid-June 2016, the founders of Deliveroo, Will Shu and Greg Orlowski received an award for "the Best Startup Founders" as part of "The Europas Startup Conference and Awards", mainly given to technology companies. The company also received "Fastest Rising Startup of the Year" and "the Europas Grand Prix award".


title: Deliveroo

text: In September 2021, it was announced that Deliveroo was taking its first step into “rapid” grocery deliveries by opening its own “dark store” in London in partnership with supermarket chain Wm Morrisons. The new service "Deliveroo HOP" is designed to serve residents i within 10 to 15 minutes. Since 2021, Deliveroo has struck partnerships with major grocery partners including Morrisons, Waitrose, Co-op, Sainbury’s, SPA, Asda and Wholefoods in the UK; and in international markets with Esselunga in Italy, Auchan in France and ParknShop in Hong Kong. In the second half of 2021, grocery accounted for 8% of Gross Travsaction Value.


title: Deliveroo

text: In December 2017, a study by macroeconomic consultancy Capital Economics revealed that Deliveroo had helped create 7,200 jobs across the restaurant sector since it launched in 2013. It also boosted the industry's revenue by £460 million in the year to June 2017. The report also found that Deliveroo had helped add £372 million in value to the UK economy in the same 12-month period, a figure which Capital Economics projects to rise to £1.5 billion in the year to June 2019.


title: Deliveroo

text: Deliveroo's main competitors are Just Eat, Grubhub and Uber Eats. In 2021, Deliveroo expanded UK population coverage to 77% compared to 53% at the end of 2020. However, its market share remains behind that of Just Eat.


title: Deliveroo

text: Deliveroo has made public its goal to build a leading market positions (#1 or strong #2) in every market in which it operates. In 2022, it announced it was proposing to consult on ending its operations in the Netherlands, citing that "it would require a disproportionate level of investment, with uncertain returns, to reach and sustain a top-tier market position."


title: Deliveroo

text: According to its 2021 annual report, Deliveroo employs 3,108 staff worldwide. It also works with 180,000 self-employed riders.


title: Deliveroo

text: On 7 September 2016, the Deliveroo website and application crashed in the city of Chelmsford, reportedly due to a high demand on the first night of launching its service in that city.


title: Deliveroo

text: On Tuesday 1 November 2016, at around 8 pm (GMT), technical problems caused the Deliveroo system to go offline for around an hour. Reportedly, thousands of customers who had already paid for their orders got upset due to a lack of clear communication being provided by the company during the incident, with some customers having to wait hours to get their food delivered.


title: Deliveroo

text: During periods when the system is down, and therefore no deliveries are available for riders, Deliveroo pays riders a flat rate per hour until the system is restored.


title: Deliveroo

text: In June 2014, Deliveroo raised a £2.75 million series A investment round from Index Ventures and Hoxton Ventures, as well as an assortment of angel investors. In January 2015, Roofoods Ltd, doing business as Deliveroo, received US$25 million in series B funding led by Accel with participation from Index Ventures, Hummingbird Ventures and Hoxton Ventures at an estimated valuation of $100 million. At this time, Deliveroo was providing deliveries for approximately 750 restaurants. In July of that year, it secured a further $70 million in series C investment from Index Ventures and Greenoaks Capital, marking Deliveroo's third funding round in a year.


title: Deliveroo

text: In November 2015, Deliveroo raised $100 million in Series D Funding. In August 2016, Deliveroo raised a Series E of $275 million from the hedge fund Bridgepoint.


title: Deliveroo

text: In September 2017, the company announced a $385 million Series F round. In November of the same year, an additional $98 million was announced, bringing the total Series F round to $480 million.


title: Deliveroo

text: In May 2019, the company announced a $575 million Series G round led by Amazon, bringing the total raised to date to $1.35 billion.


title: Deliveroo

text: In January 2021, the company announced a $180 million Series H round raised from existing investors, bringing the total raised to date to $1.53 billion.


title: Deliveroo

text: It was listed on 31 March, but lost 31 percent of its value on the first day. One of the company's bankers reportedly described it as "the worst IPO in London's history". By August 2021, Deliveroo's share price had recovered to its IPO offering levels.


title: Deliveroo

text: In October 2016, British Prime Minister Theresa May announced a review into employment practices in the modern economy, chaired by Chief Executive of the RSA Matthew Taylor. The review was criticised, accusing the probe of being biased as it was revealed by the "Financial Times" that one of its members was an early backer of Deliveroo, a fact that was not disclosed to the public. In its submission to the review, Deliveroo called on the Government to update legislation to allow the company to offer its riders rights – such as injury pay and sick pay – without limiting the flexibility which comes with self-employment. The company was the first in the on-demand economy to break ranks and ask for changes in legislation to enable it to offer self-employed riders more benefits.


title: Deliveroo

text: Deliveroo argued that current employment legislation means companies in the on-demand economy are forced to choose between offering riders flexible work and benefits. Deliveroo suggested that the Government either allow companies to offer entitlements to self-employed people, or create a new category of employment in which benefits are calculated on the services they deliver instead of how many hours they work.


title: Deliveroo

text: In response to the attacks on moped drivers over the summer of 2017, Deliveroo announced a series of measures to help keep riders safe. Among the measures introduced was a new app feature that allows riders to raise security concerns, plus a trial of helmet cameras to allow Deliveroo to gather evidence and to pass on information to the police. The company also hired 50 new staff across the country who have a focus on rider safety.


title: Deliveroo

text: In December 2017, Deliveroo announced that its riders would have access to the first ever insurance scheme for food delivery riders in the UK on-demand economy. As well as sickness and accident insurance cover, cyclists will also have access to the first-of-its-kind public liability insurance.


title: Deliveroo

text: On 12 August 2019, Deliveroo sent an email to German customers stating their decision to leave the German market and indicating that all services would stop from 16 August. The email cited its inability to provide a sufficient quality of service and that it would focus on other markets. The announcement came days after acquiring Scottish startup Cultivate, and three months after raising £450 million in a funding round led by Amazon.


title: Deliveroo

text: Deliveroo entered the Taiwan market in October 2018. In Taiwan, Deliveroo relied on contractors, according to an investigation by the Ministry of Labor. As Deliveroo workers in Taiwan were not considered employees, it was unclear if the company was required to provide labor insurance to workers. Despite not having the status of employees, Deliveroo and several courier services in Taiwan were cautioned by the labor ministry in 2019 that the applied to contractors. Therefore, Deliveroo agreed to suspend work for riders when the government suspends work for those with employee status due to natural disasters.


title: Deliveroo

text: In October 2019, Sharing Economy Association Taiwan proposed safety regulations that were agreed to by several courier services active in Taiwan, including Deliveroo. That same month, Taiwan's Directorate General of Highways (DGH) fined Deliveroo for violations of the Highway Act, as it had not applied for a business license to establish an automobile transportation enterprise. Additionally, the DGH ordered Deliveroo to cease operations. Deliveroo announced its exit from Taiwan in April 2020.


title: Deliveroo

text: In August 2021, Deliveroo announced it would be pulling out of Spain. This followed the Spanish government’s decision in March to introduce a law giving gig economy workers employee rights, rather than those of a self-employed contractor. Deliveroo said the law was not the determining factor in its withdrawal from Spain, but it had hastened it.


title: Deliveroo

text: In November 2022, Deliveroo announced it would be exiting Australia after entering voluntary administration. The decision came after the company faced financial loss from strong competition, and criticism from some government ministers. The shutdown was made immediate effect without giving riders or restaurants any notice resulting in immediate unemployment and lost revenue.


title: Deliveroo

text: In a 2016 study of the sharing economy, PwC described Deliveroo as "one of the sharing economy's quickest-growing stars".


title: Deliveroo

text: "TechCrunch" awarded Deliveroo 'Best Startup Founders' in the Europas Awards 2016, and praised founders Will Shu and Greg Orlowski.


title: Deliveroo

text: In November 2016, "Management Today" said that Deliveroo had become 'one of the best' in the food delivery sector due to providing a network of dedicated couriers and an ordering platform which enabled restaurants to offer delivery


title: Deliveroo

text: Deliveroo was the overall winner of the 2017 UK Deloitte Technology Fast 500 awards. David Cobb, lead partner for the awards programme, described Deliveroo as the fastest-growing technology company in the history of the competition, with a record four-year revenue growth of 107,117% making them a UK "unicorn".


title: Deliveroo

text: In March 2016, Australian-based employment lawyer Josh Bornstein, principal at Maurice Blackburn, examined work contracts from Deliveroo and its competitor Foodora and described the contracts as "sham", designed to pay workers "below the award rates" and to "deny their basic benefits". Maurice Blackburn announced that test cases against Deliveroo, as well as against Foodora, were being prepared wherein they were "accused of under-paying their delivery riders and failing to meet minimum employment conditions". Such allegations were confirmed by the Young Workers Centre in Australia, which claimed that the contracting arrangements by those companies left workers without access to minimum pay rates, WorkCover insurance, leave and superannuation. The centre's "Rights for Riders" campaign aims "to improve safety, pay, conditions and job security for food delivery riders".


title: Deliveroo

text: In August 2016, a group of Deliveroo's London drivers held a day-long strike to protest a new pay plan that they claimed would result in riders earning substantially below minimum wage, and the continuing lack of sick and accident pay. The company later abandoned these plans.


title: Deliveroo

text: On 8 November 2016, news headlines covered the demand of a small group of UK Deliveroo drivers to seek union recognition by the company. The Independent Workers Union of Great Britain (IWGB) represented the drivers in the Camden area of north London. In November 2017, the Central Arbitration Committee dismissed the challenge by the IWGB and ruled that Deliveroo riders are self-employed. Deliveroo welcomed the decision as a 'victory for riders [who] value the flexibility that self-employment provides'.


title: Deliveroo

text: In 2017 and 2018, Dutch online consumer affairs journalist Tim Hofman investigated Deliveroo undercover, asserting that the company forced its delivery staff to declare themselves self-employed rather than being employees of the company, which would give them rights to benefits such as sick pay. The investigation and presentation of the evidence to Deliveroo management was released as episodes of the #BOOS online programme.


title: Deliveroo

text: In May 2017, Deliveroo workers protested working conditions in Berlin, Germany. In January 2018, Deliveroo riders went on strike in Belgium and the Netherlands.


title: Deliveroo

text: During these strikes, as a means of protest, London Deliveroo drivers held up signs containing the neologism "Slaveroo". The term and its corresponding social media hashtag were adopted by several news outlets, including non-English international media. In the aftermath of these protests, Mags Dewhurst, chair of the Independent Workers Union of Great Britain Couriers and Logistics Branch, which represents some couriers and delivery drivers in London, published an article in "The Guardian" backing the protesters, saying that Deliveroo's claims of offering freedom and flexibility, vis-à-vis its couriers, are a sham, calling them "bywords for exploitation and exhaustion".


title: Deliveroo

text: In March 2021, local press reported on complaints that Deliveroo riders in Manchester were spotted "allegedly using bushes as ‘public toilets’ while waiting to collect orders."


title: Deliveroo

text: In April 2021, on the company's trading debut on the London Stock Exchange, a group of Deliveroo's riders in London held a strike protesting pay and work conditions.


title: Deliveroo

text: In June 2021, Deliveroo won a court case against the IWGB, which concerned the company's classification of its couriers. While the IWGB argued that Deliveroo couriers should be considered employees and have the right to unionize, Deliveroo classified them as self-employed. The court upheld Deliveroo's definition. In April 2022, Deliveroo was fined a maximum penalty of 375,000 euros for abusing the freelance status of its riders in France. The company would have to publish the court decision on its French home page for a month.


title: Deliveroo

text: In its two largest markets, the United Kingdom and France, operations in and around a number of Deliveroo's Editions sites have attracted complaints from neighbouring residents.


title: Deliveroo

text: In the London suburb of Islington, the local Deliveroo Editions site was the subject of complaints from neighbours, as a result of noise from air conditioning fans at the site as well as from the stream of delivery mopeds circling the site. In response to the complaints, in 2021 the local council issued an enforcement notice to shut down the operation. Deliveroo has appealed the notice.


title: Deliveroo

text: In 2020, a Deliveroo editions site in the northern Paris suburb of Saint-Ouen was the subject of similar complaints. The site, one of the first in France, was located directly opposite an apartment block, and the excessive noise from delivery scooters arriving and departing from the site resulted in multiple complaints from the residents.


title: Deliveroo

text: Following on from a meeting with the local elective representative and those of the company, Deliveroo agreed to restrict entry to the site to delivery riders on electric scooters and bicycles, with parking spots allocated for riders on petrol scooters further down the road. Following this controversy, Deliveroo proceeded to install recharge terminals at all of their French Editions sites.


title: Deliveroo

text: The company has been criticised for its failure to provide cycle training and safety equipment (such as lights and helmets) to its sometimes inexperienced riders. It has been argued that the need to race against the clock is another reason for couriers' risky cycling behaviour, and that bikes should be checked for safety.


title: Deliveroo

text: In July 2020, Deliveroo partnered with the NSPCC to train couriers to spot and report signs of child abuse. More than 7,000 riders completed the training.


title: Deliveroo

text: In May 2021, Deliveroo announced a partnership with some grocery partners to distribute one million meals to those in need in the UK. The campaign was fronted by television and radio presenter Maya Jama.


title: Deliveroo

text: In June 2021, Deliveroo announced a partnership with Neighbourhood Watch (United Kingdom) giving couriers the option to train and help spot the signs of everything from sexual harassment to domestic abuse and drug dealing.


title: Victor Rothschild, 3rd Baron Rothschild

text: Nathaniel Mayer Victor Rothschild, 3rd Baron Rothschild (31 October 1910 – 20 March 1990) was a British banker, scientist, intelligence officer during World War II, and later a senior executive with Royal Dutch Shell and N M Rothschild & Sons, and an advisor to the Edward Heath and Margaret Thatcher governments of the UK. He was a member of the prominent Rothschild family.


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild was the only son of Charles Rothschild and Rózsika Rothschild ("née" Baroness Edle von Wertheimstein). Both parents were Jewish, his father a member of the Rothschild banking family and his mother the daughter of the first titled Jew in Austria. He grew up in Waddesdon Manor and Tring Park Mansion, among other family homes. He had three sisters, including Pannonica de Koenigswarter (who would become known as the "Jazz Baroness") and Dame Miriam Louisa Rothschild. Rothschild suffered the suicide of his father when he was 13 years old. He was educated at Harrow School.


title: Victor Rothschild, 3rd Baron Rothschild

text: At Trinity College, Cambridge, he read physiology, French, and English. Later he worked in the Zoology Department before gaining a PhD in 1935. He played first-class cricket for the University and Northamptonshire. At Cambridge he was known for his playboy lifestyle, driving a Bugatti and collecting art and rare books.


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild joined the Cambridge Apostles, a secret society, which at that time was predominantly Marxist, though he stated himself that he "was mildly left-wing but never a Marxist". He became friends with Guy Burgess, Anthony Blunt and Kim Philby; members of the Cambridge Spy Ring.


title: Victor Rothschild, 3rd Baron Rothschild

text: In 1933, Rothschild gave Blunt £100 to purchase "Eliezer and Rebecca" by Nicolas Poussin. The painting was sold by Blunt's executors in 1985 for £100,000 and is now in the Fitzwilliam Museum.


title: Victor Rothschild, 3rd Baron Rothschild

text: His flat in London was shared with Burgess and Blunt. This later aroused suspicion that he was the so-called Fifth Man in the Cambridge Spy Ring.


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild inherited his title at the age of 26 following the death of his uncle Walter Rothschild, 2nd Baron Rothschild on 27 August 1937. He sat as a Labour Party peer in the House of Lords, but spoke only twice there during his life (both speeches were in 1946, one about the pasteurization of milk, and another about the situation in Palestine).


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild was recruited to work for MI5 during World War II in roles including bomb disposal, disinformation and espionage, winning the George Medal for "dangerous work in hazardous circumstances". He was the head of B1C, the "explosives and sabotage section", and worked on identifying where Britain's war effort was vulnerable to sabotage and counter German sabotage attempts. This included personally dismantling examples of German booby traps and disguised explosives.


title: Victor Rothschild, 3rd Baron Rothschild

text: With his assistant Theresa Clay, he ran the "Fifth Column" operation, that saw MI5 officer Eric Roberts masquerade as the Gestapo's man in London in order to identify hundreds of Nazi sympathizers.


title: Victor Rothschild, 3rd Baron Rothschild

text: In "Who Paid the Piper?" (1999), an account of CIA propaganda during the Cold War, author Frances Stonor Saunders alleges that Rothschild channelled funds to "Encounter", an intellectual magazine founded in 1953 to support the "non-Stalinist left" to advance US foreign policy goals.


title: Victor Rothschild, 3rd Baron Rothschild

text: After the war, he joined the zoology department at Cambridge University from 1950 to 1970. He served as chairman of the Agricultural Research Council from 1948 to 1958 and as worldwide head of research at Royal Dutch/Shell from 1963 to 1970.


title: Victor Rothschild, 3rd Baron Rothschild

text: Flora Solomon claims in her autobiography that in August 1962, during a reception at the Weizmann Institute, she told Rothschild that she thought that Tomás Harris and Kim Philby were Soviet spies.


title: Victor Rothschild, 3rd Baron Rothschild

text: When Anthony Blunt was unmasked as a member of the Cambridge Spy ring in 1964, Rothschild was questioned by Special Branch (though Blunt was not publicly identified as a Soviet agent until 1979 in the House of Commons by Prime Minister Margaret Thatcher). Rothschild was cleared, and continued working on projects for the British government.


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild was head of the Central Policy Review Staff from 1971 to 1974 (known popularly as "The Think Tank") a staff which researched policy specifically for the Government until Margaret Thatcher abolished it.


title: Victor Rothschild, 3rd Baron Rothschild

text: In 1971 Rothschild was awarded an honorary degree from Tel Aviv University for <nowiki>"the advancement of science, education and the economy of Israel". It was followed in 1975 by an honorary degree from Jerusalem'</nowiki>s Hebrew University. The annual "Victor Rothschild Memorial Symposia" is named after Rothschild.


title: Victor Rothschild, 3rd Baron Rothschild

text: In the 1980s, Rothschild joined the family bank as chairman in an effort to quell the feuding between factions led by Evelyn Rothschild and Victor's son, Jacob Rothschild. In this he was unsuccessful as Jacob resigned from the bank to found J. Rothschild Assurance Group (a separate entity, now St. James's Place plc).


title: Victor Rothschild, 3rd Baron Rothschild

text: In 1982 he published "An Enquiry into the Social Science Research Council" at the behest of Sir Keith Joseph, a Conservative minister and mentor of Margaret Thatcher.


title: Victor Rothschild, 3rd Baron Rothschild

text: He appears several times in the book "Spycatcher", which he hoped would clear the air over suspicions about his wartime role and the possibility he was involved in the Cambridge spy ring. In early 1987 Tam Dalyell MP used parliamentary privilege to suggest Rothschild should be prosecuted for a chain of events he had "set in train, with Peter Wright and Harry Chapman Pincher" which had led to a "breach of confidence in relation to information on matters of state security given to authors".


title: Victor Rothschild, 3rd Baron Rothschild

text: He was still able to enter the premises of MI5 as a former employee and was aware of suspicions there was a "mole" in MI5, but felt himself above suspicion. While Edward Heath was Prime Minister, Rothschild was a frequent visitor to Chequers, the Prime Minister's country residence. Throughout Rothschild's life, he was a valued adviser on intelligence and science to both Conservative and Labour Governments.


title: Victor Rothschild, 3rd Baron Rothschild

text: In his 1994 book "The Fifth Man", Australian author Roland Perry asserted that in 1993, after the dissolution of the Soviet Union, six retired KGB colonels, including Yuri Modin, the spy ring's handler, alleged Rothschild was the so-called "Fifth Man": "Rothschild was the key to most of the Cambridge ring's penetration of British intelligence. "He had the contacts", Modin noted. "He was able to introduce Burgess, Blunt and others to important figures in Intelligence such as Stewart Menzies, Dick White and Robert Vansittart in the Foreign Office ... who controlled MI6." However this suggestion is rebutted by other researchers; commentator Sheila Kerr pointed out that as soon as the book came out, Modin denied Perry's version of their discussions (having already stated that the fifth man was Cairncross), and concluded that "Perry's case against Rothschild is unconvincing because of dubious sources and slack methods". Noel Annan, who was criticised by the author Perry for a negative view of the latter's book and claims, writes: "Amid clouds of misstatements he [Perry] relies almost wholly on insinuation and bluster. ... when Andrew Boyle published his book and exposed Blunt, why did Margaret Thatcher acknowledge in the House of Commons the truth about Blunt, but later, in the case of Rothschild, clear him? Mr. Perry is saying she lied to the House. He tries to make much of her curt statement, "I am advised that we have no evidence that he was ever a Soviet spy." It is the only official reply she could have made. In MI5 jargon there was "No Trace" against his name". Christopher Andrew and Vasili Mitrokhin, in "The Mitrokhin Archives", make no mention of Rothschild as a Soviet agent and instead identify John Cairncross as the Fifth Man.


title: Victor Rothschild, 3rd Baron Rothschild

text: Former KGB controller Yuri Modin denied ever having named Rothschild as "any kind of Soviet agent". "Because he was in MI5 they learned things from him. This doesn't make him the fifth man, and he wasn't," Modin wrote. His own book's title clarifies the name of all five of the Cambridge spy group: "My Five Cambridge Friends: Burgess, Maclean, Philby, Blunt, and Cairncross by Their KGB Controller". Since Rothschild had died prior to publication of the Perry book, the family was unable to start a libel action.


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild published two volumes of memoirs, "Meditations of a Broomstick" (1977) and "Random Variables" (1984).


title: Victor Rothschild, 3rd Baron Rothschild

text: Despite being an opposition Labour party peer, in 1987, during the Thatcher Government, Victor played a role in the sacking of Director-General of the BBC Alasdair Milne, who had backed the programmes "Secret Society", "Real Lives", and "Panorama": 'Maggie's Militant Tendency' which had angered the Thatcher government. Marmaduke Hussey, who was Chairman of the BBC Board of Governors at the time, implied Rothschild initiated the Milne sacking in his autobiography "Chance Governs All".


title: Victor Rothschild, 3rd Baron Rothschild

text: Rothschild took the step of publishing a letter in British newspapers on 3 December 1986 to state "I am not, and never have been, a Soviet agent".


title: Victor Rothschild, 3rd Baron Rothschild

text: He was an advisor to William Waldegrave during the design of the Community Charge, which led to the Poll Tax Riots.


title: Victor Rothschild, 3rd Baron Rothschild

text: In 1946, he married Teresa Georgina Mayor (1915–1996), who had worked as his assistant at MI5. Mayor's maternal grandfather was Robert John Grote Mayor, the brother of English novelist F. M. Mayor and a greatnephew of philosopher and clergyman John Grote. Her maternal grandmother, Katherine Beatrice Meinertzhagen, was the sister of soldier Richard Meinertzhagen and the niece of author Beatrice Webb. They had four children:


title: Victor Rothschild, 3rd Baron Rothschild

text: Born into a nominally Jewish family, in adult life Rothschild declared himself to be an atheist. However, his body was interred in the historic Jewish Brady Street Cemetery, which remarkably saved that cemetery from proposed redevelopment for 100 years. His sister Miriam Louisa Rothschild was a distinguished entomologist, and his sister Nica de Koenigswarter was a bebop jazz enthusiast and patron of Thelonious Monk and Charlie Parker.


title: Reverse DNS lookup

text: In computer networks, a reverse DNS lookup or reverse DNS resolution (rDNS) is the querying technique of the Domain Name System (DNS) to determine the domain name associated with an IP address – the reverse of the usual "forward" DNS lookup of an IP address from a domain name. The process of reverse resolving of an IP address uses PTR records. rDNS involves searching domain name registry and registrar tables. The reverse DNS database of the Internet is rooted in the .arpa top-level domain.


title: Reverse DNS lookup

text: Although the informational <nowiki>RFC 1912</nowiki> (Section 2.1) recommends that "every Internet-reachable host should have a name" and that "for every IP address, there should be a matching PTR record," it is not an Internet Standard requirement, and not all IP addresses have a reverse entry.


title: Reverse DNS lookup

text: The modern "reverse DNS lookup" should not be confused with the now-obsolete "inverse query" (IQUERY) mechanism specified in :


title: Reverse DNS lookup

text: The IQUERY message type was always "optional" and "never achieved widespread use"; it was "permanently retired" in 2002 with the adoption of .


title: Reverse DNS lookup

text: Reverse DNS lookups for IPv4 addresses use the special domain codice_1. In this domain, an IPv4 address is represented as a concatenated sequence of four decimal numbers, separated by dots, to which is appended the second level domain suffix codice_2. The four decimal numbers are obtained by splitting the 32-bit IPv4 address into four octets and converting each octet into a decimal number. These decimal numbers are then concatenated in the order: least significant octet first (leftmost), to most significant octet last (rightmost). It is important to note that this is the reverse order to the usual dotted-decimal convention for writing IPv4 addresses in textual form.


title: Reverse DNS lookup

text: For example, to do a reverse lookup of the IP address the PTR record for the domain name codice_3 would be looked up, and found to point to codice_4.


title: Reverse DNS lookup

text: Historically, Internet registries and Internet service providers allocated IP addresses in blocks of 256 (for Class C) or larger octet-based blocks for classes B and A. By definition, each block fell upon an octet boundary. The structure of the reverse DNS domain was based on this definition. However, with the introduction of Classless Inter-Domain Routing, IP addresses were allocated in much smaller blocks, and hence the original design of pointer records was impractical, since autonomy of administration of smaller blocks could not be granted. <nowiki>RFC 2317</nowiki> devised a methodology to address this problem by using CNAME records.


title: Reverse DNS lookup

text: Reverse DNS lookups for IPv6 addresses use the special domain codice_6 (previously codice_7). An IPv6 address appears as a name in this domain as a sequence of nibbles in reverse order, represented as hexadecimal digits as subdomains. For example, the pointer domain name corresponding to the IPv6 address is codice_8.


title: Reverse DNS lookup

text: While most rDNS entries only have one PTR record, DNS does not restrict the number. Multiple PTR records are used, for example, when a web server supports many virtual hosts i.e. multiple hostnames then resolve to a single address, and multiple hostnames will be returned for a PTR lookup for that shared address. However, DNS lookups typically occur over UDP, and since UDP has a limited message size, in extreme cases, multiple PTRs could cause a DNS response to exceed those UDP limits.


title: Reverse DNS lookup

text: Record types other than PTR records may also appear in the reverse DNS tree. For example, encryption keys may be placed there for IPsec, SSH and IKE. DNS-Based Service Discovery uses specially-named records in the reverse DNS tree to provide hints to clients about subnet-specific service discovery domains. Less standardized usages include comments placed in TXT records and LOC records to identify the geophysical location of an IP address.


title: Takotsubo cardiomyopathy

text: Takotsubo cardiomyopathy or Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. It usually appears after a significant stressor, either physical or emotional; when caused by the latter, the condition is sometimes called broken heart syndrome. Examples of physical stressors that can cause TTS are sepsis, shock, and pheochromocytoma, and emotional stressors include bereavement, divorce, or the loss of a job. Reviews suggest that of patients diagnosed with the condition, about 70–80% recently experienced a major stressor, including 41–50% with a physical stressor and 26–30% with an emotional stressor. TTS can also appear in patients who have not experienced major stressors.


title: Takotsubo cardiomyopathy

text: The pathophysiology is not well understood, but a sudden massive surge of catecholamines such as adrenaline and norepinephrine from extreme stress or a tumor secreting these chemicals is thought to play a central role. Excess catecholamines, when released directly by nerves that stimulate cardiac muscle cells, have a toxic effect and can lead to decreased cardiac muscular function or "stunning". Further, this adrenaline surge triggers the arteries to tighten, thereby raising blood pressure and placing more stress on the heart, and may lead to spasm of the coronary arteries that supply blood to the heart muscle. This impairs the arteries from delivering adequate blood flow and oxygen to the heart muscle. Together, these events can lead to congestive heart failure and decrease the heart's output of blood with each squeeze.


title: Takotsubo cardiomyopathy

text: Takotsubo cardiomyopathy occurs worldwide. The condition is thought to be responsible for 2% of all acute coronary syndrome cases presenting to hospitals. Although TTS has generally been considered a self-limiting disease, spontaneously resolving over the course of days to weeks, contemporary observations show that "a subset of TTS patients may present with symptoms arising from its complications, e.g. heart failure, pulmonary oedema, stroke, cardiogenic shock, or cardiac arrest". This does not imply that rates of shock/death of TTS are comparable to those of acute coronary syndrome (ACS), but that patients with acute complications may co-occur with TTS. These cases of shock and death have been associated with the occurrence of TTS secondary to an enciting physical stressor such as hemorrhage, brain injury sepsis, pulmonary embolism or severe COPD.


title: Takotsubo cardiomyopathy

text: It occurs more commonly in postmenopausal women. The name "takotsubo" comes from the Japanese word "" "octopus trap", because the left ventricle of the heart takes on a shape resembling an octopus trap when affected by this condition.


title: Takotsubo cardiomyopathy

text: A study published in the Journal of the American Heart Association in October 2021 found a steady annual increase in takotsubo cardiomyopathy among both women and men from 2006 to 2017, with the sharpest increases among women 50 and older.


title: Takotsubo cardiomyopathy

text: The typical presentation of takotsubo cardiomyopathy is chest pain with or without shortness of breath and associated electrocardiogram (ECG) changes mimicking a myocardial infarction of the anterior wall. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging-out of the apex of the heart with preserved function of the base that earned the syndrome its name "takotsubo" "octopus trap", in Japan, where it was first described.


title: Takotsubo cardiomyopathy

text: Stress is the main factor in takotsubo cardiomyopathy, with more than 85% of cases set in motion by either a physically or emotionally stressful event that prefaces the start of symptoms. Examples of emotional stressors include grief from the death of a loved one, fear of public speaking, arguing with a spouse, relationship disagreements, betrayal, and financial problems. Acute asthma, surgery, chemotherapy, and stroke are examples of physical stressors. In a few cases, the stress may be a happy event, such as a wedding, winning a jackpot, a sporting triumph, or a birthday.


title: Takotsubo cardiomyopathy

text: Although there have been documented cases of TTS without a triggering stressor, it is widely recognized that TTS is preceded by a stressful event. Case series looking at large groups of patients report that some patients develop takotsubo cardiomyopathy after experiencing emotional stress. Some patients have a preceding clinical stressor (such as a brain injury, asthma attack or exacerbation of a chronic illness) and research has indicated that this type of stress may even occur more often than emotionally stressful triggers. Roughly one-third of patients have no preceding stressful event. A 2009 large case series from Europe found that takotsubo cardiomyopathy was slightly more frequent during the winter season. This may be related to two possible/suspected pathophysiological causes: coronary spasms of microvessels, which are more prevalent in cold weather, and viral infections – such as Parvovirus B19 – which occur more frequently during the winter.


title: Takotsubo cardiomyopathy

text: Women, specifically postmenopausal women, are at greatest risk of developing TTS. This has led some researchers to theorize about the possible protective effects of estrogen in preventing TTS.


title: Takotsubo cardiomyopathy

text: It is currently being investigated if certain genetic traits associated with catecholamine receptors found on cardiac muscle cells play a role in the development of TTS. There is limited evidence tying TTS directly to a specific genetic expression or mutation, however there is currently a widely held hypothesis supporting the idea of the interaction between environmental factors and the interplay of genetic predisposition leading to the susceptibility to microvascular alterations that contribute to the TTS disease process.


title: Takotsubo cardiomyopathy

text: Certain endocrine diseases including pheochromocytoma and thyrotoxicosis have been identified as potential risk factors for TTS. The relationship between thyroid function and stress cardiomyopathy is marked by a dual phenotype, where both impending primary hyperthyroidism and a high set point of thyroid homeostasis (encoding type 2 allostatic load) are common phenomena. A multi-centre observation study found normal thyroid function to be the exception rather than the rule in TTS. Especially hyperthyroidism is highly prevalent in takotsubo cardiomyopathy, and it seems to predict a poor prognosis in terms of complications and mortality.


title: Takotsubo cardiomyopathy

text: The cause of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed. It is well documented that elevated catecholamine levels have been implicated in the vast majority of TTS cases. Theories suggest a link between brain activation of stress-related biochemicals and the effects these chemicals have on areas of the heart. More specifically, adrenal stimulation by the sympathetic nervous system has been noted in cases ranging from physical events such as ischemic stroke, to emotional events such as depression or loss of a loved-one. How these increased levels of catecholamines act in the body to produce the changes seen with TTS is not clearly understood. Research supports the widely-held understanding that microvascular dysfunction and coronary vasospasm caused by a rapid influx of catecholamines to cardiac myocytes results in apical stunning and transient cardiomyopathy.


title: Takotsubo cardiomyopathy

text: It is likely that there are multiple factors at play that could include some amount of vasospasm and failure of the microvasculature. These factors can overlap and create the complex sequela leading to ischemia and left ventricle contraction abnormality. For instance, estrogen, which confers protection to women by improving blood flow to heart muscle, is one biochemical pathway implicated in the TTS disease process. Once this protective mechanism is reduced through the decreased production of estrogen after menopause, there is thought to be an increase in endothelial dysfunction predisposing an individual to vasoconstriction and cardiac ischemia. An inciting stressful event elicits the release of catecholamines into the blood stream to create increased heart muscle activity and metabolism. This leads to further cardiac microvascular endothelial dysfunction through oxidative stress, alteration of ion-mediated channels, and electrolyte disturbances which ultimately alter myocardial cell membrane permeability and dysfunction. Coupled with direct heart muscle toxicity, this crescendo of factors are implicated in the ballooning and heart failure characteristically seen in TTS.


title: Takotsubo cardiomyopathy

text: A 2019 case involved a 60-year-old woman presenting with Takotsubo cardiomyopathy due to over-consumption of wasabi, mistaking it for avocado.


title: Takotsubo cardiomyopathy

text: Several well regarded institutions of medical research have produced clinical criteria useful in diagnosing TTS. One of the first sets of guidelines was initially published in 2004 and again in 2008 by the Mayo Clinic. Other research institutions proposing diagnostic criteria include the Japanese Takotsubo Cardiomyopathy Study Group, Gothenburg University, Johns Hopkins University, the Takotsubo Italian Network and the Heart Failure Associates TTS Taskforce of the European Society of Cardiology. All of the research institutions agree on at least two main criteria needed to accurately diagnose TTS: 1) transient left ventricular wall motion abnormality and 2) the absence of a condition obviously explaining this wall motion abnormality (coronary artery lesion, hypoperfusion, myocarditis, toxicity, etc.). Other commonly acknowledged criteria necessary for diagnosis include characteristic EKG changes and mild to modest elevation in cardiac troponin.


title: Takotsubo cardiomyopathy

text: Transient apical ballooning syndrome or takotsubo cardiomyopathy is found in 1.7–2.2% of patients presenting with acute coronary syndrome. While the original case studies reported on individuals in Japan, takotsubo cardiomyopathy has been noted more recently in the United States and Western Europe. It is likely that the syndrome previously went undiagnosed before it was described in detail in the Japanese literature. Evaluation of individuals with takotsubo cardiomyopathy typically includes a coronary angiogram to rule out occlusion of the left anterior descending artery, which will not reveal any significant blockages that would cause the left ventricular dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within two months.


title: Takotsubo cardiomyopathy

text: The diagnosis of takotsubo cardiomyopathy may be difficult upon presentation. The ECG findings often are confused with those found during an acute anterior wall myocardial infarction. It classically mimics ST-segment elevation myocardial infarction, and is characterised by acute onset of transient ventricular apical wall motion abnormalities (ballooning) accompanied by chest pain, shortness of breath, ST-segment elevation, T-wave inversion or QT-interval prolongation on ECG. Cardiac enzymes are usually negative and are moderate at worst, and cardiac catheterization usually shows absence of significant coronary artery disease.


title: Takotsubo cardiomyopathy

text: The diagnosis is made by the pathognomonic wall motion abnormalities, in which the base of the left ventricle is contracting normally or is hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic. This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities. Although apical ballooning has been described classically as the angiographic manifestation of takotsubo, it has been shown that left ventricular dysfunction in this syndrome includes not only the classic apical ballooning, but also different angiographic morphologies such as mid-ventricular ballooning and, rarely, local ballooning of other segments.


title: Takotsubo cardiomyopathy

text: The ballooning patterns were classified by Shimizu et al. as "takotsubo type" for apical akinesia and basal hyperkinesia, "reverse takotsubo" for basal akinesia and apical hyperkinesia, "mid-ventricular type" for mid-ventricular ballooning accompanied by basal and apical hyperkinesia, and "localised type" for any other segmental left ventricular ballooning with clinical characteristics of takotsubo-like left ventricular dysfunction.


title: Takotsubo cardiomyopathy

text: In short, the main criteria for the diagnosis of takotsubo cardiomyopathy are: the patient must have experienced a stressor before the symptoms began to arise; the patient's ECG reading must show abnormalities from a normal heart; the patient must not show signs of coronary blockage or other common causes of heart troubles; the levels of cardiac enzymes in the heart must be elevated or irregular; and the patient must recover complete contraction and be functioning normally in a short amount of time.


title: Takotsubo cardiomyopathy

text: The treatment of takotsubo cardiomyopathy is generally supportive in nature, for it is considered a transient disorder. Treatment is dependent on whether patients experience heart failure or acute hypotension and shock. In many individuals, left ventricular function normalizes within two months. Aspirin and other heart drugs also appear to help in the treatment of this disease, even in extreme cases. After the patient has been diagnosed, and myocardial infarction (heart attack) ruled out, the aspirin regimen may be discontinued, and treatment becomes that of supporting the patient. There is currently no internationally agreed protocol for treatment of this condition.


title: Takotsubo cardiomyopathy

text: While medical treatments are important to address the acute symptoms of takotsubo cardiomyopathy, further treatment includes lifestyle changes. It is important that the individual stay physically healthy while learning and maintaining methods to manage stress, and to cope with future difficult situations.


title: Takotsubo cardiomyopathy

text: Although the symptoms of takotsubo cardiomyopathy usually go away on their own and the condition completely resolves itself within a few weeks, some serious short and long-term complications can happen that must be treated. These most commonly include congestive heart failure and very low blood pressure, and less commonly include blood clotting in the apex of the left ventricle, irregular heart beat, and tearing of the heart wall.


title: Takotsubo cardiomyopathy

text: For patients in acute heart failure, ACE inhibitors, angiotensin receptor blockers, and beta blockers, are considered mainstays of heart failure treatment. But use of beta blockers specifically for takotsubo cardiomyopathy is controversial, because they may confer no benefit.


title: Takotsubo cardiomyopathy

text: For people with cardiogenic shock, medical treatment is based on whether a left ventricular outflow tract (LVOT) obstruction is present. Therefore, early echocardiography is necessary to determine proper management. For those with obstructed LVOTs inotropic agents should not be used, but instead should be managed like patients with hypertrophic cardiomyopathy, (e.g. phenylephrine and fluid resuscitation). For cases in which the LVOT is not obstructed, inotropic therapy (e.g. dobutamine and dopamine) may be used, but with the consideration that takotsubo is caused by excess catecholamines.


title: Takotsubo cardiomyopathy

text: Furthermore, mechanical circulatory support (MCS) with an intra-aortic balloon pump (IABP) is well-established as supportive treatment.


title: Takotsubo cardiomyopathy

text: Despite the grave initial presentation in some of the patients, most of the patients survive the initial acute event, with a very low rate of in-hospital mortality or complications. Once a patient has recovered from the acute stage of the syndrome, they can expect a favorable outcome and the long-term prognosis is excellent for most. Even when ventricular systolic function is heavily compromised at presentation, it typically improves within the first few days and normalises within the first few months. Although infrequent, recurrence of the syndrome has been reported and seems to be associated with the nature of the trigger. While men experience TTS at much lower rates than women, they also experience much higher rates of complication, reoccurrence, and mortality; the cause of this sex difference is still unknown, but it is hypothesized that the social aspect of the doctor-patient interaction affects the way that physicians recognize and generate individual treatment plans for men compared to women. Stress cardiomyopathy is now a well-recognized cause of acute congestive heart failure, lethal abnormal heart rhythms, and rupture of the heart wall.


title: Takotsubo cardiomyopathy

text: Takotsubo syndrome represents about 2% of all patients (and 5–6% of all female patients) who are initially diagnosed with acute coronary syndrome (ACS). It accounts for 0.02% of all hospitalizations in the US. About 90% of TTS patients are women, whose mean age is about 68 years, and 80% of whom are older than 50 years. About 2.2% of TTS cases had the reversed (basal) variant. Recurrence rate of TTS is about 1.8% per-patient year.


title: Takotsubo cardiomyopathy

text: Rees, et al. wrote in 1967 that the death of a close relative increases the risk of dying within one year by a factor of seven.


title: Takotsubo cardiomyopathy

text: Engel wrote about sudden and rapid death during psychological stress in 1971 and itemized 8 causation categories: (1) on the impact of the collapse or death of a close person; (2) during acute grief; (3) on threat of loss of a close person; (4) during mourning or on an anniversary; (5) on loss of status or self-esteem; (6) personal danger or threat of injury; (7) after the danger is over; (8) reunion, triumph, or happy ending. He proposed these events provoke neurovegetative responses, involving both the flight-fight and conservation-withdrawal systems, conducive to lethal cardiac events, particularly in individuals with preexisting cardiovascular disease.