title: Klamath Falls, Oregon

text: The median age was 33 years. For every 100 females, there were 101.9 males. For every 100 females age 18 and over, there were 100.1 males.


title: Klamath Falls, Oregon

text: The median income for a household in the city was $28,498, and the median income for a family was $37,021. Males had a median income of $31,567 versus $22,313 for females. The per capita income for the city was $16,710. About 21.9% of the population and 16.2% of families were below the poverty line, including 26.8% of those under age 18 and 9.5% of those 65 or over.


title: Klamath Falls, Oregon

text: Klamath Falls is a home rule municipality under the Oregon Constitution, and has been governed by a council–manager form of government since its citizens voted to adopt the current charter in 1972. The city council, which is nonpartisan, has five members, each elected from one of the five wards. They serve four-year terms, which are staggered so that either two or three seats are up for election every two years. The mayor, who is nonpartisan and serves a term of four years, presides over all city council meetings. This official appoints committees, can veto any ordinance not passed with the affirmative vote of at least four council members, and casts tie-breaking votes. The city manager, however, is the administrative head of the city. This official is appointed by the council and serves an indefinite term at the council's pleasure. The municipal judge and the city attorney are appointed on the same basis. Todd Kellstrom was mayor from 1992 to 2016. Carol Westfall is the current mayor, having beaten Kellstrom in the 2016 election. Jonathan Teichert is the current city manager.


title: Klamath Falls, Oregon

text: For the purpose of representation in the state legislature, Klamath Falls is located in the 28th Senate district, represented by Republican Dennis Linthicum, and in the 56th House district, represented by Republican E. Werner Reschke. Federally, Klamath Falls is located in Oregon's 2nd congressional district, which has a Cook Partisan Voting Index of R+10


title: Klamath Falls, Oregon

text: Sky Lakes Medical Center is the largest employer in the area, followed by the Klamath County School District Other major employers are JELD-WEN, Collins Products, Columbia Forest Products, iQor, Klamath Falls City School District and the Oregon Institute of Technology.


title: Klamath Falls, Oregon

text: Kingsley Field Air National Guard Base, also known as Crater Lake–Klamath Regional Airport, was established in 1928. It is home to the 270th Air Traffic Control Squadron - 173rd Fighter Wing of the Oregon Air National Guard, stationed at Kingsley Field airbase. The squadron currently flies F-15 C/D Variants. It has the second largest runway in Oregon ( wide) and was listed as a backup landing strip for the Space Shuttle. It is normal to hear the aircraft throughout Klamath Falls during daylight hours.


title: Klamath Falls, Oregon

text: Klamath Falls and the surrounding area are served by Klamath County School District and the Klamath Falls City School District.


title: Klamath Falls, Oregon

text: Klamath Falls is home to many outdoor winter and summer activities. The nearby Running Y Ranch Resort & hotel features a golf course designed by Arnold Palmer and an ice skating arena. The resort overlooks Upper Klamath Lake. There is also a canoe trail through the wildlife refuge at Rocky Point.


title: Klamath Falls, Oregon

text: With the help of a number of community members, Klamath Falls has developed a series of trails in Moore Park. The trail network in and around Moore Park is used by hikers, cyclists, runners, and others. Users have spent time developing and improving the trails which offer varied terrain and vegetation, views of Upper Klamath Lake and the Klamath Basin, and a range of difficulty levels.


title: Klamath Falls, Oregon

text: The OC&E Woods Line State Trail is a rail trail in the city and is the longest state park in Oregon. Wiard Park, along the OC&E State Trail and operated by the Wiard Memorial Park and Recreation District, is open dawn to dusk from May 1 to October 1. Klamath Falls has a Veterans Memorial Park located downtown along the shore of Lake Ewauna.


title: Klamath Falls, Oregon

text: Klamath Falls is located on the Pacific Flyway, and large numbers of waterfowl and raptors are seen throughout the year. A large number of bald eagles winter in Bear Valley, located west of Klamath Falls, near Keno, and the American white pelican shows in great numbers in summer.


title: Klamath Falls, Oregon

text: Crater Lake National Park is north of Klamath Falls and Rim Drive, which circles the lake, is a favorite of cyclists. Winter cross country skiing and snowshoeing in the park is also popular. The more-than-mile-high Crater Lake Marathon is an annual event.


title: Klamath Falls, Oregon

text: Lava Beds National Monument is about to the southeast of Klamath Falls near the town of Tulelake, California. The Lava Beds provide an opportunity to explore an area that has perhaps the highest concentration of lava tubes. The monument also interprets the Modoc War, including the First Battle of the Stronghold.


title: Klamath Falls, Oregon

text: Mountain Lakes Wilderness Area, one of the first designated wilderness areas in the United States, lies just to the west of Klamath Falls, providing opportunities for backpacking and fishing in its mountain lakes.


title: Klamath Falls, Oregon

text: Amtrak, the national passenger rail system, serves Klamath Falls station, located on a route originally built by the Southern Pacific Railroad – operating its "Coast Starlight" daily in both directions between Seattle, Washington and Los Angeles, California.


title: Klamath Falls, Oregon

text: Fixed-route public transit service is operated by Basin Transit Service, a special service district with an elected board. Oregon POINT connects Klamath Falls with Medford and Brookings, Oregon. Sage Stage provides weekly service to Alturas, California.


title: Klamath Falls, Oregon

text: The Klamath Falls airport is the location of the Kingsley Field Air National Guard Base; the airport and base are south of downtown.


title: Recoil operation

text: Recoil operation is an operating mechanism used to implement locked breech, autoloading firearms. Recoil operated firearms use the energy of recoil to cycle the action, as opposed to gas operation or blowback operation using the pressure of the propellant gas.


title: Recoil operation

text: The earliest mention of recoil used to assist the loading of firearms is sometimes claimed to be in 1663 when an Englishman called Palmer proposed to employ either it or gases tapped along a barrel to do so. However no one has been able to verify this claim in recent times, although there is another automatic gun that dates from the same year, but its type and method of operation are unknown. Recoil-operation, if it was invented in 1663, would then lay dormant until the 19th century, when a number of inventors started to patent designs featuring recoil operation; this was due to the fact that the integrated disposable cartridge (both bullet and propellant in one easily interchangeable unit) made these designs viable. The earliest mention of recoil operation in the British patent literature is a patent by Joseph Whitworth filed in 1855 which proposed to use recoil to partially open the breech of a rifle, the breech then being manually pulled the rest of the way back by hand. Around this time an American by the name of Regulus Pilon is sometimes stated to have patented in Britain a gun that used a limited form of recoil operation. He had three British patents related to firearms around the 1850s to the 1860s; however all of them refer to a means of dampening recoil in firearms, which wasn't a new idea at the time, rather than true recoil operation. The next to mention recoil operation in the British patent literature is by Alexander Blakely in 1862, who clearly describes using the recoil of a fired cannon to open the breech. In 1864 after the Second Schleswig War, Denmark started a program intended to develop a gun that used the recoil of a fired shot to reload the firearm, though a working model wouldn't be produced until 1888. Later in the 1870s, a Swedish captain called D. H. Friberg patented a design which introduced both flapper-locking and the fully automatic recoil operated machine gun. Furthermore, in 1875 a means of cocking a rifle through recoil was patented through the patent agent Frank Wirth by a German called Otto Emmerich. Finally came Maxim's 1883 automatic recoil operated machine gun which introduced the modern age of automatic machine guns.


title: Recoil operation

text: The same forces that cause the ejecta of a firearm (the projectile(s), propellant gas, wad, sabot, etc.) to move down the barrel also cause all or a portion of the firearm to move in the opposite direction. The result is required by the conservation of momentum such that the ejecta momentum and recoiling momentum are equal. These momenta are calculated by:


title: Recoil operation

text: The barrel is a moving part of the action in recoil-operated firearms. In non-recoil-operated firearms, it is generally the entire firearm that recoils. However, in recoil-operated firearms, only a portion of the firearm recoils while inertia holds another portion motionless relative to a mass such as the ground, a ship's gun mount, or a human holding the firearm. The moving and the motionless masses are coupled by a spring that absorbs the recoil energy as it is compressed by the movement and then expands providing energy for the rest of the operating cycle.


title: Recoil operation

text: Since there is a minimum momentum required to operate a recoil-operated firearm's action, the cartridge must generate sufficient recoil to provide that momentum. Therefore, recoil-operated firearms work best with a cartridge that yields a momentum approximately equal to that for which the mechanism was optimized. For example, the M1911 design with factory springs is optimized for a bullet at factory velocity. Changes in caliber or drastic changes in bullet weight and/or velocity require modifications to spring weight or slide mass to compensate. Similarly the use of blank ammunition will typically cause the mechanism not to work correctly, unless a device is fitted to boost the recoil.


title: Recoil operation

text: Long recoil operation is found primarily in shotguns, particularly ones based on John Browning's Auto-5 action. In 1885 a locked breech, long recoil action was patented by the Britons Schlund and Arthur. In a long recoil action, the barrel and bolt remain locked together during recoil, compressing the recoil springs. Following this rearward movement, the bolt locks to the rear and the barrel is forced forward by its spring. The bolt is held in position until the barrel returns completely forward during which time the spent cartridge has been extracted and ejected, and a new shell has been positioned from the magazine. The bolt is released and forced closed by its recoil spring, chambering a fresh round.


title: Recoil operation

text: The long recoil system was invented in the late 19th century and dominated the automatic shotgun market for more than half that century before it was supplanted by new gas-operated designs. While Browning halted production of the Auto-5 design in 1999, Franchi still makes a long-recoil–operated shotgun line, the AL-48, which shares both the original Browning action design, and the "humpbacked" appearance of the original Auto-5. Other weapons based on the Browning system were the Remington Model 8 semi-automatic rifle (1906), the Remington Model 11 & "The Sportsman" model (a model 11 with only a two-shell magazine) shotguns, the Frommer Stop line of pistols (1907), and the Chauchat automatic rifle (1915).


title: Recoil operation

text: The short recoil action dominates the world of centerfire semi-automatic pistols, being found in nearly all weapons chambered for high-pressure pistol cartridges of 9×19mm Parabellum and larger; while low-pressure pistol cartridges of .380 ACP and smaller generally use the blowback method of operation. Short recoil operation differs from long recoil operation in that the barrel and bolt recoil together only a short distance before they unlock and separate. The barrel stops quickly, and the bolt continues rearward, compressing the recoil spring and performing the automated extraction and feeding process. During the last portion of its forward travel, the bolt locks into the barrel and pushes the barrel back into battery.


title: Recoil operation

text: The method of locking and unlocking the barrel differentiates the wide array of short recoil designs. Most common are the John Browning tilting barrel designs based on either the swinging link and locking lugs as used in the M1911 pistol or the linkless cam design used in the Hi Power and CZ 75. Other designs are the locking block design found in the Walther P38 and Beretta 92, rollers in the MG42, or a rotating barrel used in the Beretta 8000 and others. An unusual variant is the toggle bolt design of the Borchardt C-93 and its descendant, the Luger pistol.


title: Recoil operation

text: While the short recoil design is most common in pistols, the very first short-recoil–operated firearm was also the first machine gun, the Maxim gun. It used a toggle bolt similar to the one Borchardt later adapted to pistols. Vladimirov also used the short recoil principle in the Soviet KPV-14.5 heavy machine gun which has been in service with the Russian military and Middle Eastern armed forces since 1949. Melvin Johnson also used the short recoil principle in his M1941 rifle and M1941 Johnson machine gun.


title: Recoil operation

text: An alternative design concept for recoil-operated firearms is the inertia operated system, the first practical use of it being the Sjögren shotgun, developed by Carl Axel Theodor Sjögren in the early 1900s, a Swedish engineer who was awarded a number of patents for his inertia operated design between 1900 and 1908 and sold about 5,000 automatic shotguns using the system in 1908–1909. In a reversal of the other designs, some inertia systems use nearly the entire firearm as the recoiling component, with only the bolt remaining stationary during firing. Because of this, the inertia system is only applied to heavily recoiling firearms, particularly shotguns. A similar system using inertia operation was then developed by Paolo Benelli in the early 1980s and patented in 1986. With the exception of Sjögren's shotguns and rifles in the early 1900s, all inertia-operated firearms made until 2012 were either made by Benelli or used a design licensed from Benelli, such as the Franchi Affinity. Then the Browning Arms Company introduced the inertia-operated A5 (trademarked as Kinematic Drive) as successor to the long-recoil operated Auto-5. Both the Benelli and Browning systems are based on a rotating locking bolt, similar to that used in many gas-operated firearms.


title: Recoil operation

text: Before firing, the bolt body is separated from the locked bolt head by a stiff spring. As the shotgun recoils after firing, inertia of the bolt body is large enough for it to remain stationary while the recoiling gun and locked bolt head move rearward. This movement compresses the spring between the bolt head and bolt body, storing the energy required to cycle the action. Since the spring can only be compressed a certain amount, this limits the amount of force the spring can absorb, and provides an inherent level of self-regulation to the action, allowing a wide range of shotshells to be used, from standard to magnum loads, as long as they provide the minimum recoil level to compress the spring. Note that the shotgun must be free to recoil for this to work—the compressibility of the shooter's body is sufficient to allow this movement, but firing the shotgun from a secure position in a rest or with the stock against the ground will not allow it to recoil sufficiently to operate the mechanism. Likewise, care must be exercised when modifying weapons of this type (e.g. addition of extended magazines or ammunition storage on the stock), as any sizable increase in weapon mass can reduce the work done from recoil below that required to cycle the action.


title: Recoil operation

text: As the recoil spring returns to its uncompressed state, it pushes the bolt body backward with sufficient force to cycle the action. The bolt body unlocks and retracts the bolt head, extracts and ejects the cartridge, cocks the hammer, and compresses the return spring. Once the bolt reaches the end of its travel, the return spring provides the force to chamber the next round from the magazine, and lock the bolt closed.


title: Recoil operation

text: Some short-recoil–operated firearms, such as the German MG 42 and MG 3, use a mechanism at the muzzle to extract some energy from the escaping powder gases to push the barrel backwards, in addition to the recoil energy. This boost provides higher rates of fire and/or more reliable operation. This type of mechanism is also found in some suppressors used on short recoil firearms, under the name "gas assist" or "Nielsen device", where it is used to compensate for the extra mass the suppressor adds to the recoiling parts both by providing a boost and decoupling some of the suppressor's mass from the firearm's recoiling parts.


title: Recoil operation

text: Muzzle boosters are also used on some recoil-operated firearms' blank-firing attachments to normalize the recoil force of a blank round (with no projectile) with the greater force of a live round, in order to allow the mechanism to cycle properly.


title: Recoil operation

text: Several revolvers use recoil to cock the hammer and advance the cylinder. In these designs, the barrel and cylinder are affixed to an upper frame which recoils atop a sub-frame. As the upper receiver recoils, the cylinder is advanced and hammer cocked, functions that are usually done manually. Notable examples are the Webley–Fosbery and Mateba.


title: The Menagerie (Star Trek: The Original Series)

text: The Menagerie, Parts I and II, are the eleventh and twelfth episodes of the of the American science fiction television series, "". Written by series creator Gene Roddenberry and directed by Marc Daniels (part one) and Robert Butler (part two), it is the only two-part story in the original series. Part I was broadcast by NBC on November 17, 1966, and Part II was broadcast on November 24, 1966. In the episode, Spock abducts his former commander Christopher Pike, locks the "Enterprise" on a course to the forbidden planet and turns himself in for court-martial where he presents an elaborate story explaining his actions.


text: The complexity of "Star Trek"s production had steadily increased the show's production time, leading to concerns that Desilu Productions would not be able to deliver episodes to NBC in time to meet their series commitments. "The Menagerie" was created as a means to reuse footage from ""—the unaired 1965 pilot episode of "Star Trek"—within a frame story as the early history of the starship "Enterprise". As such, the two-part episode only required a week of production time.


text: In 2267, the USS "Enterprise" arrives at Starbase 11 in response to a subspace call First Officer Spock (Leonard Nimoy) reported receiving from the former captain of the "Enterprise", Christopher Pike (Sean Kenney), under whom Spock had served. Captain Kirk (William Shatner) and Spock meet the starbase commander, Commodore Mendez (Malachi Throne). Mendez informs them that the permanently disabled Pike could not have sent any message, as he is unable to move or communicate other than answering yes/no questions with the aid of a device operated by his brainwaves. Pike refuses to communicate with anyone except Spock. After Kirk and Mendez leave to discuss the situation, Spock reveals, over Pike's repeated "no" signals, that he intends to carry out a plan that he has made.


text: Meanwhile, Mendez confirms that there is no record of any message sent to the Enterprise. Mendez provides Kirk with classified information on the planet Talos IV, which was visited by the "Enterprise" previously under Pike's command in 2254, and is now under a strict quarantine. Spock, meanwhile, commandeers the "Enterprise" by means of falsified recordings of Kirk's voice, places Pike under McCoy's care, and orders the ship to depart under the computer's control. Kirk and Mendez give chase in a Starbase shuttlecraft. After several hours, upon learning from the computer that the shuttlecraft does not have enough fuel to return to the starbase, Spock has them brought aboard and then gives himself up, confessing to mutiny. The crew find they are unable to change the current course of the "Enterprise", which Spock affirms is heading towards Talos IV. Mendez convenes a hearing, at which Spock requests immediate court-martial, which requires three command officers. Kirk objects that only he and Mendez are available, but Spock notes that Pike is still listed for active duty. The tribunal begins, and Spock offers as his testimony what seems to be video footage of the "Enterprise"s earlier visit to Talos IV in 2254.


text: On the screen, the "Enterprise" arrives at Talos IV in 2254 in response to a distress call from the survey ship "Columbia", lost in 2236. Pike (played in these flashback scenes by Jeffrey Hunter) beams down to the planet along with Spock and a landing party, where they encounter a group of survivors, including a young woman named Vina (Susan Oliver), who was born shortly after the crash of "Columbia". Dr. Boyce (John Hoyt), Pike's chief medical officer, establishes that the survivors are all in perfect health, despite the circumstances. Vina promises to show Pike the secret of their health, and leads him to a rocky outcropping. Two aliens emerge from a hidden door, stun Pike, and carry him through the door. Vina, the other survivors, and their camp suddenly disappear. Pike has been abducted by the , humanoid aliens with the power to create illusions indistinguishable from reality (reality distortion fields).


text: Back in 2267, the scene is interrupted by a message from Starfleet Command, which reveals that the images they have been viewing are being transmitted from Talos IV. Mendez is placed in command of the "Enterprise", but Spock begs Kirk to see the rest of the transmission.


text: Spock's trial continues, and the transmitted scene resumes with Pike in 2254 in a cell with a transparent wall. The Talosians begin their "experiment", which consists of a number of illusory situations involving Pike and Vina. The Talosians' hope is that Pike and Vina will mate and found a race of slaves who will reclaim the war-damaged surface of the planet. Meanwhile, the "Enterprise" crew fails to break into the underground complex with weapons enhanced by the ship's power. A landing party attempts to beam into the complex, but only the female members arrive, in order, as the Talosian "Keeper" explains, to give Pike more choices for a mate. An attempt to blast through the cell wall with the new captives' phasers fails as the weapons are apparently non-functional.


text: That night, Pike is able to capture the Keeper as he attempts to confiscate the weapons. Pike intuits that the phasers still function, and that their escape attempt was thwarted by an illusion. He forces the Talosian to reveal a hole in the cell wall. The humans proceed to the surface, but learn that this was the Talosians' plan. Number One (Majel Barrett, billed as M. Leigh Hudec) sets her phaser on overload, preferring to die rather than be enslaved, but deactivates the weapon when more Talosians arrive. The aliens have found that humans' "unique hatred of captivity" makes them unsuitable for the Talosians' plans, which must therefore be abandoned. Pike desires an apology, but the Talosians point out that this failure spells the death of their species. Pike offers help from the interstellar community, but the Talosians fear that their mental powers would spread and bring other races to ruin. As the rest of the party are beamed back to the ship, Pike is shown that Vina's appearance up to now has been an illusion. In reality she was severely injured in the "Columbia's" crash and further left deformed by the Talosians' failure to adequately repair her injuries. She elects to stay on the planet, and Pike returns to the ship.


text: Back in 2267, the transmission ends as the "Enterprise" arrives at Talos IV. Commodore Mendez suddenly fades away, and the Keeper appears on the viewing screen, informing Kirk that Mendez's presence was an illusion. The court-martial was a ploy to buy time to bring Pike back to Talos IV, where, if willing, he would be able to enjoy the illusion of a normal life. A message from Commodore Mendez then advises that Starfleet has waived the prohibition against contact with the planet for this one occasion, and that Kirk is free to proceed as he thinks best. Pike is transported to the planet, and the rejuvenated Pike and Vina are seen on the viewing screen returning with the Talosians to the underground complex. The Keeper appears one last time to wish Kirk well.


text: "The Menagerie" was a solution to a large and growing problem with the show's production: its special effects, unprecedented for a weekly television production, were causing delays in the completion of each episode. The problem was cumulative, with shows getting delivered to NBC later and later. In order to fulfill their series commitment with NBC, Roddenberry wrote a two-part episode that needed only one week of production, and would reuse a large amount of footage from the then-unaired original pilot of "Star Trek", "".


text: New filming took place for the framing story for "The Cage". Since actor Jeffrey Hunter was unavailable to reprise his role as Captain Pike, a look-alike actor, Sean Kenney, played the injured captain in the new scenes, although Hunter was represented in flashback footage and credited accordingly (along with the other original "Cage" cast). Also in the new scenes, Malachi Throne (who provided the voice of the Keeper in the original "Cage") portrayed Commodore Jose Mendez, while Julie Parrish played personal assistant Miss Piper. Since Throne played a second role in "The Menagerie", the Keeper's voice was electronically processed to sound higher-pitched. This modified voice would replace Malachi Throne's original voice work in the remastered and new "Original" versions of "The Cage" released later, and allowed the Keeper to then address Captain Kirk by name at the conclusion of part two when he advised Kirk he was hearing the Keeper's thought transmissions and that the invalid Fleet Captain Pike was welcome to live with them unfettered by his physical body. The Keeper, wishing Kirk a pleasant future, further addresses the captain by name as the illusory fully able-bodied Pike is seen walking with Vina. The preview trailer for Part II uses Throne's original Keeper's voice.


text: The framing story was directed by veteran "Star Trek" director Marc Daniels. Because most of his footage was used in Part I, he was given directing credit for this part. The director of "The Cage," Robert Butler, was given credit for Part II, because most of that footage was from the original pilot.


text: Susan Oliver actually plays the slave girl painted in green makeup and dancing for Captain Pike. During preproduction makeup tests (using Majel Barrett as a stand-in), they sent the footage out for printing and when the film returned, there was little difference. The lab thought there had been an error in colorizing and thought they should compensate. The first time this happened, they reshot the film with a darker green and sent it out again for printing. The same thing happened again, but eventually the lab was notified to make no color changes.


text: Footage from the master negative of "The Cage" was edited into the master negative of "The Menagerie". No other color or 35 mm copy of "The Cage" existed, only a black and white 16 mm print owned by Gene Roddenberry. In 1987, the full-color negative "trims" from "The Cage" that had not been used in "The Menagerie" were discovered at a film laboratory in Los Angeles and returned to Paramount Pictures.


text: "The Menagerie" is highly regarded by fans and in 1967 it won the Hugo Award for Best Dramatic Presentation, one of only two episodes in the original series to do so. Zack Handlen of "The A.V. Club" gave the episode a 'B−' rating, noting that "the whole thing plays out over two hours, and with a framing story from the regular cast that, while dramatic, doesn't quite gel." Handlen did note some memorable aspects of the episode such as the extent of Pike's injuries and the ambiguity around his final fate.


text: In 2012, "Christian Science Monitor" ranked this the seventh best episode of the original "Star Trek".


text: In 2015, SyFy ranked this episode as one of the top ten essential Star Trek original series Spock episodes.


text: In 2016, "The Hollywood Reporter" rated "The Menagerie" the 32nd best episode of all "Star Trek" television episodes.


text: In 2017, Space.com ranked "The Menagerie" the 3rd best episode of all "Star Trek" television. They noted how the episode surprised audiences with Spock's behavior (e.g. why did he break Federation rules), and also how it worked footage from the pilot "The Cage" into an episode.


text: In 2018, "PopMatters" ranked this the 16th best episode of the original series. They remark that this was the only two-part episode of the original run, and that it focuses on Captain Christopher Pike, a previous captain of the Enterprise with whom Spock also served.


text: On November 13 and 15, 2007, the of "The Menagerie", in high definition and with Cinema Surround Sound, was released in theatres as a special two-night-only showing. It included a message from Gene "Rod" Roddenberry Jr., a 20-minute "making of" documentary about the restoration process, and a trailer for season two of the remastered series. This presentation was also shown in the United Kingdom for distribution for one night only at selected Odeon Cinemas on November 13, 2007.


text: Some repertory movie theaters in North America showed the classic two-part episode as a feature film in the 1970s. The two original series episodes were shown back-to-back and unedited as part of one program. One such theater, the Seville in Montreal, showed 16mm prints of "The Menagerie" episodes on a big screen as part of a program that concluded with the presentation of the "Star Trek" blooper reels from seasons one and two.


title: Robyn Smith

text: Robyn Smith (born August 14, 1944) is an American retired jockey. Active from 1969 to 1980, Smith accumulated 247 wins in California and New York race tracks, and became the first female jockey to win a stakes race in 1973.


title: Robyn Smith

text: Smith is largely evasive about the details of her early life. She told "Sports Illustrated" in her 1972 cover profile that she was born in San Francisco, California on August 14, 1944, but the journal could find no birth record of a Robyn Caroline Smith for several years around that time. Claims that she had attended Stanford University as an English major, and that she was under contract with Metro-Goldwyn-Mayer were similarly debunked. In 1997, she told the "Los Angeles Times" that she was "sold" as an infant, and went through a series of foster homes.


title: Robyn Smith

text: In April 1969, Kjell Qvale agreed to let Smith ride one of his horses, and on April 3, Smith became the first female jockey in Northern California, finishing second at a race at Golden Gate Fields upon Swift Yorky. When Money Road finished last at the same track a week later, however, the decision to grant her an apprentice jockey license came into question. The decision of whether or not to award her the license was dependent upon Al Shelhamer, who had not seen Smith ride in person and would have to consult film of her first two Golden Gate races. Her license was granted, and in her first race as a licensed jockey, Smith and Swift Yorky finished in ninth place at Golden Gate Fields on April 16, 1969. The next year, Smith secured her first New York victory atop Hill Cloud at Aqueduct Racetrack in Queens.


title: Robyn Smith

text: Smith's early victories in New York and California were seen as an inspiration to future woman riders. In 1973, leading up to the "Battle of the Sexes" tennis match, Smith challenged Bobby Riggs to a horse race, while joking that he would turn down the challenge because "He doesn't want to get himself killed." While many Thoroughbred owners were reluctant to lend their horses to a female rider, Smith found an ally in Alfred Gwynne Vanderbilt Jr., the chairman of the New York Racing Association during her jockey career. Their business connection led to rumors of a romantic involvement between Vanderbilt and Smith.


title: Robyn Smith

text: Smith appeared on the cover of "Sports Illustrated" on July 31, 1972. Shortly afterwards, it was announced that she would become the first female rider to be honored by the New York Turf Writers Association in Saratoga Springs, New York. Retired textile executive Nathan Isaacs named a filly, Ramblin Robyn, after Smith, and she rode the horse to victory at Aqueduct in December 1973.


title: Robyn Smith

text: After starting her 1973 racing season with a spill atop Faithville Ruler at Santa Anita Park, on March 1, 1973, Smith became the first female jockey to win a stakes race, winning the $27,450 Paumonok Handicap at Aqueduct Racetrack on the back of North Sea. On October 3, 1975, Smith became the first female jockey to win three races in one afternoon at a major New York track. She turned three victories at Belmont Park, riding Lead Line, Slink, and Togs Drone.


title: Robyn Smith

text: By 1978, Smith's career had largely come to a standstill, recording only one victory in 55 races, and struggling to find trainers. Most of her income was provided by television endorsement deals. After a final ride at Saratoga on July 30, 1980, Smith announced her official retirement from the sport on August 9.


title: Robyn Smith

text: On January 1, 1973, a friend introduced Smith to Fred Astaire at Santa Anita. She went on to marry Astaire on June 24, 1980, at the Astaire home in Beverly Hills, California. At the time of their marriage, Astaire was 81 and Smith was 35. After Astaire's death in 1987, Smith became embroiled in a series of legal battles over the use of her late husband's image. Most notably, Smith prevented the John F. Kennedy Center for the Performing Arts from using video footage of Astaire during its 1992 televised tribute to his longtime Hollywood collaborator Ginger Rogers. In 1998, the U.S. 9th Circuit Court of Appeals ruled against Smith in a decision over whether an instructional videotape manufacturer could use public domain footage of Astaire in the films "Second Chorus" and "Royal Wedding" to teach dance steps.


title: Robyn Smith

text: Following Astaire's 1987 death, Smith took up aviation, earning pilot certification in a series of airplanes and helicopters.


title: Celina Jaitly

text: Celina Jaitly (born 24 November 1981) is an Indian actress who mainly appears in Bollywood films. She won the Miss India in 2001 and was the 4th runner-up at Miss Universe 2001. She made her acting debut with the 2003 thriller "Janasheen".


title: Celina Jaitly

text: Celina Jaitly was born in Shimla, Himachal Pradesh, India to a Punjabi Hindu father, Colonel V. K. Jaitly and an Afghan Hindu mother, Meeta, who was a nurse in the Indian Army. Celina has a brother who is also in the army.


title: Celina Jaitly

text: She wanted to grow up and join the army just like her father, either as a pilot or a doctor. Most of her childhood was spent in different locations due to her father being transferred in cities and towns all over India – as a result she ended up studying in over a dozen different schools. She attended City Montessori School, Station Road, Lucknow and Canossa Convent School, Ranikhet while her family was in respective cities. She graduated with a degree in Commerce with Accountancy (Hons.) from IGNOU (Khallikote College centre) while her stay in Brahmapur, Odisha. Her mother used to taught in DePaul School there. After graduation, Celina worked in a cell phone company in Kolkata, West Bengal briefly as a marketing executive. The family is now settled in Mhow.


title: Celina Jaitly

text: Celina started her career with a marketing job in a mobile phone company in Kolkata before she decided to participate in a local beauty contest. She won the title at Femina Miss India 2001. She also won the Miss Margo Beautiful Skin, Indiatimes Surfer's Choice, and MTV's Most Wanted award. She was subsequently sent to the Miss Universe 2001 contest representing India where she finished 4th runner-up.


title: Celina Jaitly

text: In 2001, she featured in Jazzy B's music video of "Oh Kehri", which was immensely popular. She also featured in music videos for Bombay Vikings.


title: Celina Jaitly

text: In 2003, she made her film debut in Feroz Khan's "Janasheen". The movie was a moderate box office success in India. For her second release, she had a starring role opposite Sunny Deol in the romantic action "Khel", but the feature was poorly received and earned little at the box office.


title: Celina Jaitly

text: In 2004, Celina turned down the lead role in "Julie". In an interview with "Stardust", Celina commented: "I turned down Julie because I didn't agree with the reasoning of the protagonist in the story, who resorts to prostitution because her man ditches her. I didn't see why any educated girl would take such a drastic step. I take up roles that I mentally agree with, and this was not such a role". The same years Celina appeared in the Telugu drama "Suryam" opposite Vishnu Manchu.


title: Celina Jaitly

text: By 2005, under the direction of Khalid Mohamed, Celina played the role of Preeti, an air hostess, in "Silsiilay". The movie was well received by critics.


title: Celina Jaitly

text: Rediff.com reported that "Celina Jaitly sizzles in the song Belibaas". She next portrayed the character of Sanjana in "No Entry", the film was received favourably by critics and became successful at the box office with gross earnings of .


title: Celina Jaitly

text: The following year, Celina co-starred in Deepak Tijori's comedy "Tom, Dick, and Harry". The film became successful at the box office with gross earnings of . She next appeared in "Apna Sapna Money Money", directed by Sangeeth. It received mixed reviews, though it became a financial success, with a domestic total of . In 2006, Celina Jaitly appeared in the music video for the Indian hit song Zara Nazron Se Kehdo performed by Bombay Vikings with Swedish music producers Soundism behind the studio work.


title: Celina Jaitly

text: In 2007, Celina starred in "", directed by Vikram Bhatt, alongside Aftab Shivdasani. Her final release of 2007 was Suneel Darshan's comedy "Shakalaka Boom Boom", with Bobby Deol, Upen Patel and Kangana Ranaut. Upon release it did moderately well at the box office but was critically panned.


title: Celina Jaitly

text: In 2008, she took a supporting role in "Golmaal Returns". It received mixed reviews, though it became a financial success, with a domestic total of . Celina's performance was applauded, with critic Taran Adarsh writing: "Celina stays on your mind even after the show is over".


title: Celina Jaitly

text: During 2009 and 2010, all three films in which she starred; "Paying Guests", "Accident on Hill Road" and "Hello Darling", were critically and commercially unsuccessful.


title: Celina Jaitly

text: In 2011, Celina had two leading roles. Her first was Anees Bazmee's "Thank You", a romantic comedy. The film was poorly received by critics but became a commercial success, earning over .


title: Celina Jaitly

text: There were reports that Celina was slated to play a Persian princess in the film "Quest of Scheherezade" with actors Sean Connery and Orlando Bloom, and directed by Ken Khan. This has yet to be confirmed.


title: Celina Jaitly

text: Celina Jaitly is married to Austrian entrepreneur and hotelier Peter Haag and they are parents to twin boys born in March 2012. Jaitly gave birth to a second set of twin boys in 2017, in which one boy died due to a heart defect.


title: Celina Jaitly

text: Celina Jaitly is currently based between Austria, Singapore and Dubai and travels for her film and endorsement work internationally.


title: Celina Jaitly

text: Sepang Circuit Malaysia 2002, Ayur (ayurvedic hair shampoos) 2002–2004, Ponds (Dreamflower talc) 2001–2004, Margo (skin soap) 2001–2003, Gitanjali (Diamond jewels) 2003–present, Jashn (Leading Indian apparels) 2006–present, Proactv (International skin solutions) 2008–present, RICHFEEL (trichology clinics) 2012–present, 18 Again (women's intimate care) 2012–present, PETA 2005–present, United Nations Equality Champions 2013–present.


title: Hyperdontia

text: Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth (32 in the average adult). They can appear in any area of the dental arch and can affect any dental organ. The opposite of hyperdontia is hypodontia, where there is a congenital lack of teeth, which is a condition seen more commonly than hyperdontia. The scientific definition of hyperdontia is "any tooth or odontogenic structure that is formed from tooth germ in excess of usual number for any given region of the dental arch." The additional teeth, which may be few or many, can occur on any place in the dental arch. Their arrangement may be symmetrical or non-symmetrical.


title: Hyperdontia

text: The presence of a supernumerary tooth, particularly when seen in young children, is associated with a disturbance of the maxillary incisor region. This commonly results in the impaction of the incisors during the mixed dentition stage. The study debating this also considered many other factors such as: the patient's age, number, morphology, growth orientation and position of the supernumerary tooth. Alongside this issue, the presence of an extra tooth can impede the eruption of adjacent additional or normal teeth. Therefore, the presence of a supernumerary tooth when found must be approached with the appropriate treatment plan, incorporating the likelihood of incisal crowding. In some individuals, the additional teeth can erupt far from the dental arch, within the maxillary sinus. The extra teeth may also migrate to a different location after development. In some cases, supernumerary teeth can lead to the formation of cysts. Crowding is also frequently seen in people with hyperdontia.


title: Hyperdontia

text: There is evidence of hereditary factors along with some evidence of environmental factors leading to this condition. While a single excess tooth is relatively common, multiple hyperdontia is rare in people with no other associated diseases or syndromes. Many supernumerary teeth never erupt, but they may delay eruption of nearby teeth or cause other dental or orthodontic problems. Molar-type extra teeth are the most common type. Dental X-rays are often used to diagnose hyperdontia.


title: Hyperdontia

text: It is suggested that supernumerary teeth develop from a third tooth bud arising from the dental lamina near the regular tooth bud or possibly from splitting the regular tooth bud itself. Supernumerary teeth in deciduous (baby) teeth are less common than in permanent teeth.


title: Hyperdontia

text: Hyperdontia is seen in a number of disorders, including Gardner's syndrome and cleidocranial dysostosis, where multiple supernumerary teeth develop.


title: Hyperdontia

text: Other associated conditions are: Cleidocranial dysplasia, Ehlers–Danlos syndrome Type III, Ellis–van Creveld syndrome, Gardner's syndrome, Goldenhar syndrome, Hallermann–Streiff syndrome, Orofaciodigital syndrome type I, Incontinentia pigmenti, Marfan syndrome, Nance–Horan syndrome, and Tricho-rhino-phalangeal syndrome Type 1.


title: Hyperdontia

text: Supernumerary teeth may be detected by taking two different dental X-rays at different angles. Examples of this may be an intra-oral X-ray (one that is taken inside the mouth) and a panoramic radiograph. However, these X-rays are 2D and therefore do not accurately portray the 3D view of the teeth.


title: Hyperdontia

text: When classified by position, a supernumerary tooth may be referred to as a "mesiodens", a "paramolar", or a "distomolar". Occasionally, these teeth do not erupt into the oral cavity but manifest as a malocclusion.


title: Hyperdontia

text: The most common supernumerary tooth is a mesiodens, which is a malformed, peg-like tooth that occurs between the maxillary central incisors.


title: Hyperdontia

text: Although these teeth are usually asymptomatic and pose no threat to the individual, they are often extracted for aesthetic reasons, to allow the eruption of other teeth, orthodontic reasons and/or suspected pathology. This is done particularly if the mesiodens is positioned in the maxillary central incisor region. The traditional method of removal is done by using bone chisels, although a more advanced technique has been found to be more beneficial, especially if surgery is required. Through the use of piezoelectricity, piezoelectric ultrasonic bone surgery may be more time-consuming than the traditional method but it seems to reduce the post-operative bleeding and associated complications quite significantly.


title: Hyperdontia

text: It is evident that hyperdontia is more common in the permanent dentition than in the primary. There is a considerable difference between males and females in the prevalence of these teeth in permanent dentition; hyperdontia is twice as common in males as in females. However, this approximation varies in terms of location, other associating syndromes that may be present, and the ethnicity of the individual. In terms of ethnicity, it can be seen that hyperdontia is in fact less common in European than in Asian populations. There is evidence to show that an individual is more likely to have hyperdontia if other members of their family also have the condition.


title: Laundry

text: Laundry refers to the washing of clothing and other textiles, and, more broadly, their drying and ironing as well. Laundry has been part of history since humans began to wear clothes, so the methods by which different cultures have dealt with this universal human need are of interest to several branches of scholarship. Laundry work has traditionally been highly gendered, with the responsibility in most cultures falling to women (formerly known as laundresses or washerwomen). The Industrial Revolution gradually led to mechanized solutions to laundry work, notably the washing machine and later the tumble dryer. Laundry, like cooking and child care, is still done both at home and by commercial establishments outside the home.


title: Laundry

text: The word "laundry" may refer to the clothing itself, or to the place where the cleaning happens. An individual home may have a laundry room; a utility room includes but is not restricted to the function of washing clothes. An apartment building or student hall of residence may have a shared laundry facility such as a "tvättstuga". A stand-alone business is referred to as a self-service laundry (launderette in British English or laundromat in North American English).


title: Laundry

text: Laundry was first done in watercourses, letting the water carry away the materials which could cause stains and smells. Laundry is still done this way in the rural regions of poor countries. Agitation helps remove the dirt, so the laundry was rubbed, twisted, or slapped against flat rocks. One name for this surface is a beetling-stone, related to beetling, a technique in the production of linen; one name for a wooden substitute is a battling-block. The dirt was beaten out with a wooden implement known as a washing paddle, battling stick, bat, beetle or club. Wooden or stone scrubbing surfaces set up near a water supply were gradually replaced by portable rub boards, eventually factory-made corrugated glass or metal washboards.


title: Laundry

text: Once clean, the clothes were wrung out — twisted to remove most of the water. Then they were hung up on poles or clothes lines to air dry, or sometimes just spread out on clean grass, bushes, or trees.


title: Laundry

text: Villages across Europe that could afford it built a wash-house, sometimes known by the French name of "lavoir". Water was channelled from a stream or spring and fed into a building, possibly just a roof with no walls. This wash-house usually contained two basins – one for washing and the other for rinsing – through which the water was constantly flowing, as well as a stone lip inclined towards the water against which the wet laundry could be beaten. Such facilities were more comfortable and convenient than washing in a watercourse. Some lavoirs had the wash-basins at waist height, although others remained on the ground. The launderers were protected to some extent from rain, and their travel was reduced, as the facilities were usually at hand in the village or at the edge of a town. These facilities were public and available to all families, and usually used by the entire village. Many of these village wash-houses are still standing, historic structures with no obvious modern purpose.


title: Laundry

text: The job of doing the laundry was reserved for women, who washed all their family's laundry. Washerwomen (laundresses) took in the laundry of others, charging by the piece. As such, wash-houses were an obligatory stop in many women's weekly lives and became a sort of institution or meeting place. It was a women-only space where they could discuss issues or simply chat (cf the concept of the village pump). Indeed, this tradition is reflected in the Catalan idiom ""fer safareig"" (literally, "to do the laundry"), which means to gossip.


title: Laundry

text: European cities also had public wash-houses. The city authorities wanted to give the poorer population, who would otherwise not have access to laundry facilities, the opportunity to wash their clothes. Sometimes these facilities were combined with public baths, see for example Baths and wash houses in Britain. The aim was to foster hygiene and thus reduce outbreaks of epidemics.


title: Laundry

text: Sometimes large metal cauldrons (a "wash copper", even when not made of that metal), were filled with fresh water and heated over a fire, as hot or boiling water is more effective than cold in removing dirt. A posser could be used to agitate clothes in a tub. A related implement called a washing dolly is "a wooden stick or mallet with an attached cluster of legs or pegs" that moves the cloth through the water.


title: Laundry

text: The Industrial Revolution completely transformed laundry technology. Christina Hardyment, in her history from the Great Exhibition of 1851, argues that it was the development of domestic machinery that led to women's liberation.


title: Laundry

text: The mangle (or "wringer" in American English) was developed in the 19th century — two long rollers in a frame and a crank to revolve them. A laundry-worker took sopping wet clothing and cranked it through the mangle, compressing the cloth and expelling the excess water. The mangle was much quicker than hand twisting. It was a variation on the box mangle used primarily for pressing and smoothing cloth.


title: Laundry

text: Meanwhile, 19th-century inventors further mechanized the laundry process with various hand-operated washing machines to replace tedious hand rubbing against a washboard. Most involved turning a handle to move paddles inside a tub. Then some early-20th-century machines used an electrically powered agitator. Many of these washing machines were simply a tub on legs, with a hand-operated mangle on top. Later the mangle too was electrically powered, then replaced by a perforated double tub, which spun out the excess water in a spin cycle.


title: Laundry

text: Laundry drying was also mechanized, with clothes dryers. Dryers were also spinning perforated tubs, but they blew heated air rather than water.


title: Laundry

text: In the late 19th and early 20th century, Chinese immigrants to the United States and to Canada were well represented as laundry workers. Discrimination, lack of English-language skills, and lack of capital kept Chinese immigrants out of most desirable careers. Around 1900, one in four ethnic Chinese men in the U.S. worked in a laundry, typically working 10 to 16 hours a day.


title: Laundry

text: Chinese people in New York City were running an estimated 3,550 laundries at the beginning of the Great Depression. In 1933, the city's Board of Aldermen passed a law clearly intended to drive the Chinese out of the business. Among other things, it limited ownership of laundries to U.S. citizens. The Chinese Consolidated Benevolent Association tried fruitlessly to fend this off, resulting in the formation of the openly leftist Chinese Hand Laundry Alliance (CHLA), which successfully challenged this provision of the law, allowing Chinese laundry workers to preserve their livelihoods. The CHLA went on to function as a more general civil rights group; its numbers declined strongly after it was targeted by the FBI during the Second Red Scare (1947–1957).


title: Laundry

text: From 1850 to 1910, Zulu men took on the task of laundering the clothes of Europeans, both Boers and British. "Laundering recalled the specialist craft of hide-dressing in which Zulu males engaged as izinyanga, a prestige occupation that paid handsomely." They created a guild structure, similar to a union, to guard their conditions and wages, evolving into "one, if not indeed the most, powerful group of African work-men in nineteenth-century Natal".


title: Laundry

text: In India, laundry was traditionally done by men. A washerman was called a "dhobiwallah", and "dhobi" became the name of their caste group.


title: Laundry

text: A laundry-place is generally called a "dhobi ghat"; this has given rise to place names where they work or worked, including Mahalaxmi Dhobi Ghat in Mumbai, Dhoby Ghaut in Singapore and Dhobi Ghaut in Penang, Malaysia.


title: Laundry

text: Manual laundry was done in the Philippines until the early 1980s which the role was assigned to women. A laundrywoman was called a "labandera."


title: Laundry

text: The workers in ancient Rome who cleaned the cloth were called "fullones", singular "fullo" (cf fulling, a process in wool-making, and Fuller's earth, used to clean). Clothes were treated in small tubs standing in niches surrounded by low walls, known as treading or fulling stalls. The tub was filled with water and a mixture of alkaline chemicals (sometimes including urine). The fuller stood in the tub and trampled the cloth, a technique known elsewhere as posting. The aim of this treatment was to apply the chemical agents to the cloth so that they could do their work, the resolving of greases and fats. These stalls are so typical of these workshops that they are used to identify "fullonicae" in the archaeological remains.


title: Laundry

text: Laundry processes include washing (usually with water containing detergents or other chemicals), agitation, rinsing, drying, pressing (ironing), and folding. The washing will sometimes be done at a temperature above room temperature to increase the activities of any chemicals used and the solubility of stains, and high temperatures kill micro-organisms that may be present on the fabric. However, it is advised that cotton be washed at a cooler temperature to prevent shrinking. Many professional laundry services are present in the market which offers at different price range.


title: Laundry

text: Agitation helps remove dirt which is usually mobilised by surfactants from between fibres, however, due to the small size of the pores in fibres, the 'stagnant core' of the fibres themselves see virtually no flow. The fibres are nevertheless rapidly cleaned by diffusiophoresis carrying dirt out into the clean water during the rinsing process.


title: Laundry

text: Various chemicals may be used to increase the solvent power of water, such as the compounds in soaproot or yucca-root used by Native American tribes, or the ash lye (usually sodium hydroxide or potassium hydroxide) once widely used for soaking laundry in Europe. Soap, a compound made from lye and fat, is an ancient and common laundry aid. Modern washing machines typically use synthetic powdered or liquid laundry detergent in place of more traditional soap.


title: Laundry

text: Dry cleaning refers to any process which uses a chemical solvent other than water. The solvent used is typically tetrachloroethylene (perchloroethylene), which the industry calls "perc". It is used to clean delicate fabrics that cannot withstand the rough and tumble of a washing machine and clothes dryer; it can also obviate labor-intensive hand washing.


title: Laundry

text: In some parts of the world, including North America, apartment buildings and dormitories often have laundry rooms, where residents share washing machines and dryers. Usually the machines are set to run only when money is put in a coin slot.


title: Laundry

text: In other parts of the world, including Europe, apartment buildings with laundry rooms are uncommon, and each apartment may have its own washing machine. Those without a machine at home or the use of a laundry room must either wash their clothes by hand or visit a commercial self-service laundry (laundromat, laundrette) or a laundry shop, such as 5àsec.


title: Laundry

text: Some American communities forbid their residents from drying clothes outside, and citizens protesting this have created a "right to dry" movement. Many homeowners' associations and other communities in the United States prohibit residents from using a clothesline outdoors, or limit such use to locations that are not visible from the street or to certain times of day. Other communities, however, expressly prohibit rules that prevent the use of clotheslines. Some organizations have been campaigning against legislation which has outlawed line-drying of clothing in public places, especially given the increased greenhouse gas emissions produced by some types of electrical power generation needed to power electric clothes dryers, since driers can constitute a considerable fraction of a home's total energy usage.


title: Laundry

text: Florida ("the Sunshine State") is the only state to expressly guarantee a right to dry, although Utah and Hawaii have passed solar rights legislation. A Florida law explicitly states: "No deed restrictions, covenants, or similar binding agreements running with the land shall prohibit or have the effect of prohibiting solar collectors, clotheslines, or other energy devices based on renewable resources from being installed on buildings erected on the lots or parcels covered by the deed restrictions, covenants, or binding agreements." No other state has such clearcut legislation. Vermont considered a "Right to Dry" bill in 1999, but it was defeated in the Senate Natural Resources & Energy Committee. The language has been included in a 2007 voluntary energy conservation bill, introduced by Senator Dick McCormack. Legislation making it possible for thousands of American families to start using clotheslines in communities where they were formerly banned was passed in Colorado in 2008. In 2009, clothesline legislation was debated in the states of Connecticut, Hawaii, Maryland, Maine, New Hampshire, Nebraska, Oregon, Virginia, and Vermont.


title: Laundry

text: Novice users of modern laundry machines sometimes experience accidental shrinkage of garments, especially when applying heat. For wool garments, this is due to scales on the fibers, which heat and agitation cause to stick together. Other fabrics (like cotton) have their fibers stretched by mechanical force during production, and can shrink slightly when heated (though to a lesser degree than wool). Some clothes are "pre-shrunk" to avoid this problem.


title: Laundry

text: Another common problem is color bleeding from dyed articles to white or pale-colored ones. Many laundry guides suggest washing whites separately from colored items. Sometimes only similar colors are washed together to avoid this problem, which is lessened by cold water and repeated washings. Sometimes this blending of colors is seen as a selling point, as with madras cloth.


title: Laundry

text: The word "laundry" comes from Middle English lavendrye, laundry, from Old French "lavanderie", from lavandier.


title: Laundry

text: In Homer's "Odyssey", Princess Nausicaa and her handmaidens are washing laundry by the shore when they see and rescue the ship-wrecked Ulysses.


title: A Ram Sam Sam

text: "A Ram Sam Sam (A rum sum sum)" is a popular Moroccan children's song and game, that gained popularity around the world, other variants were used like "Aram" instead of "A Ram" and "Zam Zam" instead of "Sam Sam".


title: A Ram Sam Sam

text: The game is played by a group of children. The song is sung by the group leader and the participants should perform several actions during certain lyrics, usually:


title: A Ram Sam Sam

text: A version of the song by Liverpool folk group The Spinners, who claimed to have learned the song from an Israeli singer and that the words were in Aramaic, had the following lyrics:


title: A Ram Sam Sam

text: The translation they gave was "Get up on your horse and gallop away". When they performed the song, the group would make it an audience-participation song, splitting the audience into two halves and encouraging them to sing it as a round.


title: Al Udeid Air Base

text: Al Udeid Air Base () is one of two military bases southwest of Doha, Qatar, also known as Abu Nakhlah Airport ().


title: Al Udeid Air Base

text: It houses the Qatar Emiri Air Force, United States Air Force, Royal Air Force, and other foreign forces. It is host to a forward headquarters of United States Central Command, headquarters of the United States Air Forces Central Command, No. 83 Expeditionary Air Group RAF, and the 379th Air Expeditionary Wing of the USAF.


title: Al Udeid Air Base

text: In 1999, the then Emir of Qatar, Sheikh Hamad, told U.S. officials that he would like to see as many as 10,000 U.S. servicemen permanently stationed at Al Udeid. According to media reports in June 2017, the base hosted over 11,000 U.S. and U.S.-led anti-ISIL coalition forces and over 100 operational aircraft.


title: Al Udeid Air Base

text: Following joint military operations during Operation Desert Storm in 1991, Qatar and the United States concluded a Defense Cooperation Agreement that has been subsequently expanded. In 1996, Qatar built Al Udeid Air Base at the cost of more than $1 billion. The U.S. first used the then-secret base in late September 2001, when the Air Force needed to get aircraft in position for its operations in Afghanistan. The U.S. has nearly 40,000 military personnel in the Middle East. The U.S. Fifth Fleet is in Bahrain and has 28,000 military personnel in Kuwait, Bahrain and Qatar. Kingdoms, including Qatar, cover 60 percent of the costs, around $650 million.


title: Al Udeid Air Base

text: The official acknowledgement of the base came in March 2002, when Vice President Dick Cheney stopped there during a trip to the region with a group of reporters. In April 2003, shortly after the start of the U.S.-led invasion of Iraq, the U.S. Combat Air Operations Center for the Middle East moved from Prince Sultan Air Base in Saudi Arabia to what was then a backup headquarters built a year prior in Qatar that was viewed as a more congenial location for basing U.S. troops.


title: Al Udeid Air Base

text: Al Udeid and other facilities in Qatar serve as logistics, command, and basing hubs for the U.S. Central Command (CENTCOM) area of operations, and oversees U.S. air operations in countries, including Iraq, Afghanistan, and Syria.


title: Al Udeid Air Base

text: Between 2004 and 2009 the airbase was used by the Royal Air Force with transport and fast-jet aircraft to support Operation Telic (Iraq War) and Operation Herrick (War in Afghanistan).


title: Al Udeid Air Base

text: These included 6 to 8 Tornado GR4 aircraft drawn from different parts of the Royal Air Force as well as multiple Vickers VC10 from the No. 101 Squadron RAF. British Tornados were equipped with a range of stores, including the Vicon Recce Pod, LITENING targeting pod, 1000 lb HE bombs, Paveway II and Paveway III laser-guided bombs, and the RAPTOR Recce Pod. They were chosen for their currency and up-to-date modification state.


title: Al Udeid Air Base

text: The RAF aircraft were accompanied by nearly 400 personnel, of which approximately 130 were aircraft engineers while the remaining 270 were active in support and operation management roles. Squadron personnel were on a two-month rotation at RAF Al Udeid with the remainder of the force on a four-month rotation. Support personnel were on varying rotations but not as often generally as the squadron personnel. The RAF operated from what was known as the "Southern QRA" buildings. Aircraft were housed in canvas shelters to protect them and the personnel working on them from the heat of the sun.


title: Al Udeid Air Base

text: RAF Al Udeid was used as a staging post for personnel en route to Iraq (in particular, Basrah) with personnel transferring from passenger aircraft, such as the RAF-operated Tristar and VC10, to the tactical transport Lockheed C-130 Hercules. The Hercules transit was in the region of two hours and mostly in tactical black-out conditions.


title: Al Udeid Air Base

text: As part of Australia's contribution to coalition forces in the 2003 invasion of Iraq, fourteen F/A-18 Hornet fighters from No. 75 Squadron RAAF were based at Al Udeid, along with two P-3 Orion maritime patrol aircraft and three C-130 Hercules military transport aircraft. During the early phases of the war, the Hornets flew long missions escorting and protecting coalition AWACS Early warning aircraft and tanker aircraft used for air-to-air refueling. Later, when the threat to aircraft was reduced, the Hornets switched to the ground attack and combat support roles and were used to attack Iraqi ground forces with laser-guided bombs. The Orions flew long endurance missions over the Persian Gulf tracking vessels, curbing smuggling and guarding against the threat posed by suicide boats. The deployed Hercules flew supplies and equipment into Iraq, and later flew some of the first humanitarian aid into Baghdad. The fourteen Royal Australian Air Force Hornets flew over 670 sorties during the war, including 350 combat sorties over Iraq.


title: Al Udeid Air Base

text: Following Australia's formal withdraw of forces from Iraq and to upon Afghanistan in 2008, the air bridge for operations in the Middle East was re-located to Al Minhad Air Base in the United Arab Emirates.


title: Al Udeid Air Base

text: Al Udeid Air Base is the main headquarters for the Qatar Emiri Air Force, although some of its squadrons are based at Doha International Airport.


title: Al Udeid Air Base

text: After the withdrawal of British Tornados and VC10s in Summer 2009 to other locations, Royal Air Force activities at Al Udeid were reduced.


title: Al Udeid Air Base

text: Since 2014 it has been used as HQ for British involvement in airstrikes against ISIS in Iraq (Operation Shader).


title: Al Udeid Air Base

text: The Royal Air Force has also stationed an RC-135 Rivet Joint signals intelligence aircraft at the base to operate over Iraq and Syria, although this aircraft has been pictured operating from RAF Akrotiri in Cyprus.


title: Al Udeid Air Base

text: With its small territory and narrow population base, Qatar relies to a large degree on external cooperation and support for its security. Qatar invested over US$1 billion to construct the Al Udeid airfield during the 1990s; it did not have a large air force of its own at the time. The United States Army Corps of Engineers also awarded over $100 million in Military Construction Air Force (MCAF) contracts for the construction of U.S. storage, housing, service, command, and communication facilities. Qatar's financing and construction of some of the state-of-the-art air force base at Al Udeid and its granting of permission for the construction of U.S.-funded facilities helped deepen cooperation with the United States Department of Defense.


title: Al Udeid Air Base

text: The Al Udeid Air Base now serves as a logistics, command, and basing hub for U.S. operations in Afghanistan and Iraq. Nearby Camp As Sayliyah houses significant U.S. military equipment pre-positioning and command and control facilities for the CENTCOM's area of operations. Both Qatar and the United States have invested in the construction and expansion of these facilities since the mid-1990s, and they form the main hub of the CENTCOM air and ground logistical network in the area of responsibility. As a result of ongoing operations in Iraq and Afghanistan, U.S. and partner nation facilities in Qatar and elsewhere have received higher use in recent years.


title: Al Udeid Air Base

text: In early June 2017, the Pentagon said that the diplomatic rupture and tensions between Qatar and some of its Arab neighbors would not affect U.S. operations at the Air Base.


title: Al Udeid Air Base

text: The air base played an important role during the 2018 missile strikes against Syria, in which two USAF Rockwell B-1B Lancer bombers from the 34th Bomb Squadron flew from the base.


title: Al Udeid Air Base

text: The base stationed F-22 Raptors for the first time in June 2019. A month later, an expansion of the base was announced to be funded by Qatar, which would cost $1.8 billion.


title: Al Udeid Air Base

text: From FY2003 to FY2007, Congress authorized and appropriated $126 million for U.S. military construction activities in Qatar.


title: Al Udeid Air Base

text: The National Defense Authorization Act for Fiscal Year 2008 (P.L. 110-181) authorized $81.7 million in FY2008 spending to build new Air Force and Special Operations facilities in Qatar.


title: Al Udeid Air Base

text: The National Defense Authorization Act for Fiscal Year 2009 (P.L. 110-417) authorized $69.6 million in FY2009 spending to build new Air Force and Special Operations facilities.


title: Al Udeid Air Base

text: The National Defense Authorization Act for Fiscal Year 2010 (P.L. 111-84) authorized $117 million in FY2010 spending to build new Air Force recreational, dormitory, and other facilities at Al Udeid.


title: Al Udeid Air Base

text: The Administration's FY2011 military construction request for Qatar was $64.3 million, for Air Force facilities and a National Security Agency warehouse.


title: Tracheal intubation

text: Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.


title: Tracheal intubation

text: The most widely used route is orotracheal, in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. Other methods of intubation involve surgery and include the cricothyrotomy (used almost exclusively in emergency circumstances) and the tracheotomy, used primarily in situations where a prolonged need for airway support is anticipated.


title: Tracheal intubation

text: Because it is an invasive and uncomfortable medical procedure, intubation is usually performed after administration of general anesthesia and a neuromuscular-blocking drug. It can, however, be performed in the awake patient with local or topical anesthesia or in an emergency without any anesthesia at all. Intubation is normally facilitated by using a conventional laryngoscope, flexible fiberoptic bronchoscope, or video laryngoscope to identify the vocal cords and pass the tube between them into the trachea instead of into the esophagus. Other devices and techniques may be used alternatively.


title: Tracheal intubation

text: After the trachea has been intubated, a balloon cuff is typically inflated just above the far end of the tube to help secure it in place, to prevent leakage of respiratory gases, and to protect the tracheobronchial tree from receiving undesirable material such as stomach acid. The tube is then secured to the face or neck and connected to a T-piece, anesthesia breathing circuit, bag valve mask device, or a mechanical ventilator. Once there is no longer a need for ventilatory assistance or protection of the airway, the tracheal tube is removed; this is referred to as extubation of the trachea (or decannulation, in the case of a surgical airway such as a cricothyrotomy or a tracheotomy).


title: Tracheal intubation

text: For centuries, tracheotomy was considered the only reliable method for intubation of the trachea. However, because only a minority of patients survived the operation, physicians undertook tracheotomy only as a last resort, on patients who were nearly dead. It was not until the late 19th century, however, that advances in understanding of anatomy and physiology, as well an appreciation of the germ theory of disease, had improved the outcome of this operation to the point that it could be considered an acceptable treatment option. Also at that time, advances in endoscopic instrumentation had improved to such a degree that direct laryngoscopy had become a viable means to secure the airway by the non-surgical orotracheal route. By the mid-20th century, the tracheotomy as well as endoscopy and non-surgical tracheal intubation had evolved from rarely employed procedures to becoming essential components of the practices of anesthesiology, critical care medicine, emergency medicine, and laryngology.


title: Tracheal intubation

text: Tracheal intubation can be associated with complications such as broken teeth or lacerations of the tissues of the upper airway. It can also be associated with potentially fatal complications such as pulmonary aspiration of stomach contents which can result in a severe and sometimes fatal chemical aspiration pneumonitis, or unrecognized intubation of the esophagus which can lead to potentially fatal anoxia. Because of this, the potential for difficulty or complications due to the presence of unusual airway anatomy or other uncontrolled variables is carefully evaluated before undertaking tracheal intubation. Alternative strategies for securing the airway must always be readily available.


title: Tracheal intubation

text: Tracheal intubation is indicated in a variety of situations when illness or a medical procedure prevents a person from maintaining a clear airway, breathing, and oxygenating the blood. In these circumstances, oxygen supplementation using a simple face mask is inadequate.


title: Tracheal intubation

text: Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which nitrous oxide or volatile anesthetics may be administered. General anesthetic agents, opioids, and neuromuscular-blocking drugs may diminish or even abolish the respiratory drive. Although it is not the only means to maintain a patent airway during general anesthesia, intubation of the trachea provides the most reliable means of oxygenation and ventilation and the greatest degree of protection against regurgitation and pulmonary aspiration.


title: Tracheal intubation

text: Damage to the brain (such as from a massive stroke, non-penetrating head injury, intoxication or poisoning) may result in a depressed level of consciousness. When this becomes severe to the point of stupor or coma (defined as a score on the Glasgow Coma Scale of less than 8), dynamic collapse of the extrinsic muscles of the airway can obstruct the airway, impeding the free flow of air into the lungs. Furthermore, protective airway reflexes such as coughing and swallowing may be diminished or absent. Tracheal intubation is often required to restore patency (the relative absence of blockage) of the airway and protect the tracheobronchial tree from pulmonary aspiration of gastric contents.


title: Tracheal intubation

text: Intubation may be necessary for a patient with decreased oxygen content and oxygen saturation of the blood caused when their breathing is inadequate (hypoventilation), suspended (apnea), or when the lungs are unable to sufficiently transfer gasses to the blood. Such patients, who may be awake and alert, are typically critically ill with a multisystem disease or multiple severe injuries. Examples of such conditions include cervical spine injury, multiple rib fractures, severe pneumonia, acute respiratory distress syndrome (ARDS), or near-drowning. Specifically, intubation is considered if the arterial partial pressure of oxygen (PaO) is less than 60 millimeters of mercury (mm Hg) while breathing an inspired O concentration (FIO) of 50% or greater. In patients with elevated arterial carbon dioxide, an arterial partial pressure of CO (PaCO) greater than 45 mm Hg in the setting of acidemia would prompt intubation, especially if a series of measurements demonstrate a worsening respiratory acidosis. Regardless of the laboratory values, these guidelines are always interpreted in the clinical context.


title: Tracheal intubation

text: Actual or impending airway obstruction is a common indication for intubation of the trachea. Life-threatening airway obstruction may occur when a foreign body becomes lodged in the airway; this is especially common in infants and toddlers. Severe blunt or penetrating injury to the face or neck may be accompanied by swelling and an expanding hematoma, or injury to the larynx, trachea or bronchi. Airway obstruction is also common in people who have suffered smoke inhalation or burns within or near the airway or epiglottitis. Sustained generalized seizure activity and angioedema are other common causes of life-threatening airway obstruction which may require tracheal intubation to secure the airway.


title: Tracheal intubation

text: Diagnostic or therapeutic manipulation of the airway (such as bronchoscopy, laser therapy or stenting of the bronchi) may intermittently interfere with the ability to breathe; intubation may be necessary in such situations.


title: Tracheal intubation

text: Syndromes such as respiratory distress syndrome, congenital heart disease, pneumothorax, and shock may lead to breathing problems in newborn infants that require endotracheal intubation and mechanically assisted breathing (mechanical ventilation). Newborn infants may also require endotracheal intubation during surgery while under general anaesthesia.


title: Tracheal intubation

text: The vast majority of tracheal intubations involve the use of a viewing instrument of one type or another. The modern conventional laryngoscope consists of a handle containing batteries that power a light and a set of interchangeable blades, which are either straight or curved. This device is designed to allow the laryngoscopist to directly view the larynx. Due to the widespread availability of such devices, the technique of blind intubation of the trachea is rarely practiced today, although it may still be useful in certain emergency situations, such as natural or man-made disasters. In the prehospital emergency setting, digital intubation may be necessitated if the patient is in a position that makes direct laryngoscopy impossible. For example, digital intubation may be used by a paramedic if the patient is entrapped in an inverted position in a vehicle after a motor vehicle collision with a prolonged extrication time.


title: Tracheal intubation

text: The decision to use a straight or curved laryngoscope blade depends partly on the specific anatomical features of the airway, and partly on the personal experience and preference of the laryngoscopist. The Macintosh blade is the most widely used curved laryngoscope blade, while the Miller blade is the most popular style of straight blade. Both Miller and Macintosh laryngoscope blades are available in sizes 0 (infant) through 4 (large adult). There are many other styles of straight and curved blades, with accessories such as mirrors for enlarging the field of view and even ports for the administration of oxygen. These specialty blades are primarily designed for use by anesthetists and otolaryngologists, most commonly in the operating room.


title: Tracheal intubation

text: Fiberoptic laryngoscopes have become increasingly available since the 1990s. In contrast to the conventional laryngoscope, these devices allow the laryngoscopist to indirectly view the larynx. This provides a significant advantage in situations where the operator needs to see around an acute bend in order to visualize the glottis, and deal with otherwise difficult intubations. Video laryngoscopes are specialized fiberoptic laryngoscopes that use a digital video camera sensor to allow the operator to view the glottis and larynx on a video monitor. Other "noninvasive" devices which can be employed to assist in tracheal intubation are the laryngeal mask airway (used as a conduit for endotracheal tube placement) and the Airtraq.


title: Tracheal intubation

text: An intubating stylet is a malleable metal wire designed to be inserted into the endotracheal tube to make the tube conform better to the upper airway anatomy of the specific individual. This aid is commonly used with a difficult laryngoscopy. Just as with laryngoscope blades, there are also several types of available stylets, such as the Verathon Stylet, which is specifically designed to follow the 60° blade angle of the GlideScope video laryngoscope.


title: Tracheal intubation

text: The Eschmann tracheal tube introducer (also referred to as a "gum elastic bougie") is specialized type of stylet used to facilitate difficult intubation. This flexible device is in length, 15 French (5 mm diameter) with a small "hockey-stick" angle at the far end. Unlike a traditional intubating stylet, the Eschmann tracheal tube introducer is typically inserted directly into the trachea and then used as a guide over which the endotracheal tube can be passed (in a manner analogous to the Seldinger technique). As the Eschmann tracheal tube introducer is considerably less rigid than a conventional stylet, this technique is considered to be a relatively atraumatic means of tracheal intubation.


title: Tracheal intubation

text: The tracheal tube exchanger is a hollow catheter, in length, that can be used for removal and replacement of tracheal tubes without the need for laryngoscopy. The Cook Airway Exchange Catheter (CAEC) is another example of this type of catheter; this device has a central lumen (hollow channel) through which oxygen can be administered. Airway exchange catheters are long hollow catheters which often have connectors for jet ventilation, manual ventilation, or oxygen insufflation.  It is also possible to connect the catheter to a capnograph to perform respiratory monitoring.


title: Tracheal intubation

text: The lighted stylet is a device that employs the principle of transillumination to facilitate blind orotracheal intubation (an intubation technique in which the laryngoscopist does not view the glottis).


title: Tracheal intubation

text: A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent (open and unobstructed) airway. Tracheal tubes are frequently used for airway management in the settings of general anesthesia, critical care, mechanical ventilation, and emergency medicine. Many different types of tracheal tubes are available, suited for different specific applications. An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal). It is a breathing conduit designed to be placed into the airway of critically injured, ill or anesthetized patients in order to perform mechanical positive pressure ventilation of the lungs and to prevent the possibility of aspiration or airway obstruction. The endotracheal tube has a fitting designed to be connected to a source of pressurized gas such as oxygen. At the other end is an orifice through which such gases are directed into the lungs and may also include a balloon (referred to as a cuff). The tip of the endotracheal tube is positioned above the carina (before the trachea divides to each lung) and sealed within the trachea so that the lungs can be ventilated equally. A tracheostomy tube is another type of tracheal tube; this curved metal or plastic tube is inserted into a tracheostomy stoma or a cricothyrotomy incision.


title: Tracheal intubation

text: Tracheal tubes can be used to ensure the adequate exchange of oxygen and carbon dioxide, to deliver oxygen in higher concentrations than found in air, or to administer other gases such as helium, nitric oxide, nitrous oxide, xenon, or certain volatile anesthetic agents such as desflurane, isoflurane, or sevoflurane. They may also be used as a route for administration of certain medications such as bronchodilators, inhaled corticosteroids, and drugs used in treating cardiac arrest such as atropine, epinephrine, lidocaine and vasopressin.


title: Tracheal intubation

text: Originally made from latex rubber, most modern endotracheal tubes today are constructed of polyvinyl chloride. Tubes constructed of silicone rubber, wire-reinforced silicone rubber or stainless steel are also available for special applications. For human use, tubes range in size from in internal diameter. The size is chosen based on the patient's body size, with the smaller sizes being used for infants and children. Most endotracheal tubes have an inflatable cuff to seal the tracheobronchial tree against leakage of respiratory gases and pulmonary aspiration of gastric contents, blood, secretions, and other fluids. Uncuffed tubes are also available, though their use is limited mostly to children (in small children, the cricoid cartilage is the narrowest portion of the airway and usually provides an adequate seal for mechanical ventilation).


title: Tracheal intubation

text: In addition to cuffed or uncuffed, preformed endotracheal tubes are also available. The oral and nasal RAE tubes (named after the inventors Ring, Adair and Elwyn) are the most widely used of the preformed tubes.


title: Tracheal intubation

text: There are a number of different types of double-lumen endo-bronchial tubes that have endobronchial as well as endotracheal channels (Carlens, White and Robertshaw tubes). These tubes are typically coaxial, with two separate channels and two separate openings. They incorporate an endotracheal lumen which terminates in the trachea and an endobronchial lumen, the distal tip of which is positioned 1–2 cm into the right or left mainstem bronchus. There is also the Univent tube, which has a single tracheal lumen and an integrated endobronchial blocker. These tubes enable one to ventilate both lungs, or either lung independently. Single-lung ventilation (allowing the lung on the operative side to collapse) can be useful during thoracic surgery, as it can facilitate the surgeon's view and access to other relevant structures within the thoracic cavity.


title: Tracheal intubation

text: The "armored" endotracheal tubes are cuffed, wire-reinforced silicone rubber tubes. They are much more flexible than polyvinyl chloride tubes, yet they are difficult to compress or kink. This can make them useful for situations in which the trachea is anticipated to remain intubated for a prolonged duration, or if the neck is to remain flexed during surgery. Most armored tubes have a Magill curve, but preformed armored RAE tubes are also available. Another type of endotracheal tube has four small openings just above the inflatable cuff, which can be used for suction of the trachea or administration of intratracheal medications if necessary. Other tubes (such as the Bivona Fome-Cuf tube) are designed specifically for use in laser surgery in and around the airway.


title: Tracheal intubation

text: No single method for confirming tracheal tube placement has been shown to be 100% reliable. Accordingly, the use of multiple methods for confirmation of correct tube placement is now widely considered to be the standard of care. Such methods include direct visualization as the tip of the tube passes through the glottis, or indirect visualization of the tracheal tube within the trachea using a device such as a bronchoscope. With a properly positioned tracheal tube, equal bilateral breath sounds will be heard upon listening to the chest with a stethoscope, and no sound upon listening to the area over the stomach. Equal bilateral rise and fall of the chest wall will be evident with ventilatory excursions. A small amount of water vapor will also be evident within the lumen of the tube with each exhalation and there will be no gastric contents in the tracheal tube at any time.


title: Tracheal intubation

text: Ideally, at least one of the methods utilized for confirming tracheal tube placement will be a measuring instrument. Waveform capnography has emerged as the gold standard for the confirmation of tube placement within the trachea. Other methods relying on instruments include the use of a colorimetric end-tidal carbon dioxide detector, a self-inflating esophageal bulb, or an esophageal detection device. The distal tip of a properly positioned tracheal tube will be located in the mid-trachea, roughly above the bifurcation of the carina; this can be confirmed by chest x-ray. If it is inserted too far into the trachea (beyond the carina), the tip of the tracheal tube is likely to be within the right main bronchus—a situation often referred to as a "right mainstem intubation". In this situation, the left lung may be unable to participate in ventilation, which can lead to decreased oxygen content due to ventilation/perfusion mismatch.


title: Tracheal intubation

text: Tracheal intubation in the emergency setting can be difficult with the fiberoptic bronchoscope due to blood, vomit, or secretions in the airway and poor patient cooperation. Because of this, patients with massive facial injury, complete upper airway obstruction, severely diminished ventilation, or profuse upper airway bleeding are poor candidates for fiberoptic intubation. Fiberoptic intubation under general anesthesia typically requires two skilled individuals. Success rates of only 83–87% have been reported using fiberoptic techniques in the emergency department, with significant nasal bleeding occurring in up to 22% of patients. These drawbacks limit the use of fiberoptic bronchoscopy somewhat in urgent and emergency situations.


title: Tracheal intubation

text: Personnel experienced in direct laryngoscopy are not always immediately available in certain settings that require emergency tracheal intubation. For this reason, specialized devices have been designed to act as bridges to a definitive airway. Such devices include the laryngeal mask airway, cuffed oropharyngeal airway and the esophageal-tracheal combitube (Combitube). Other devices such as rigid stylets, the lightwand (a blind technique) and indirect fiberoptic rigid stylets, such as the Bullard scope, Upsher scope and the WuScope can also be used as alternatives to direct laryngoscopy. Each of these devices have its own unique set of benefits and drawbacks, and none of them is effective under all circumstances.


title: Tracheal intubation

text: Rapid sequence induction and intubation (RSI) is a particular method of induction of general anesthesia, commonly employed in emergency operations and other situations where patients are assumed to have a full stomach. The objective of RSI is to minimize the possibility of regurgitation and pulmonary aspiration of gastric contents during the induction of general anesthesia and subsequent tracheal intubation. RSI traditionally involves preoxygenating the lungs with a tightly fitting oxygen mask, followed by the sequential administration of an intravenous sleep-inducing agent and a rapidly acting neuromuscular-blocking drug, such as rocuronium, succinylcholine, or cisatracurium besilate, before intubation of the trachea.


title: Tracheal intubation

text: One important difference between RSI and routine tracheal intubation is that the practitioner does not manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing, until the trachea has been intubated and the cuff has been inflated. Another key feature of RSI is the application of manual 'cricoid pressure' to the cricoid cartilage, often referred to as the "Sellick maneuver", prior to instrumentation of the airway and intubation of the trachea.


title: Tracheal intubation

text: Named for British anesthetist Brian Arthur Sellick (1918–1996) who first described the procedure in 1961, the goal of cricoid pressure is to minimize the possibility of regurgitation and pulmonary aspiration of gastric contents. Cricoid pressure has been widely used during RSI for nearly fifty years, despite a lack of compelling evidence to support this practice. The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning and barbiturate anesthesia were the rule. Beginning around 2000, a significant body of evidence has accumulated which questions the effectiveness of cricoid pressure. The application of cricoid pressure may in fact displace the esophagus laterally instead of compressing it as described by Sellick. Cricoid pressure may also compress the glottis, which can obstruct the view of the laryngoscopist and actually cause a delay in securing the airway.


title: Tracheal intubation

text: Cricoid pressure is often confused with the "BURP" (Backwards Upwards Rightwards Pressure) maneuver. While both of these involve digital pressure to the anterior aspect (front) of the laryngeal apparatus, the purpose of the latter is to improve the view of the glottis during laryngoscopy and tracheal intubation, rather than to prevent regurgitation. Both cricoid pressure and the BURP maneuver have the potential to worsen laryngoscopy.


title: Tracheal intubation

text: RSI may also be used in prehospital emergency situations when a patient is conscious but respiratory failure is imminent (such as in extreme trauma). This procedure is commonly performed by flight paramedics. Flight paramedics often use RSI to intubate before transport because intubation in a moving fixed-wing or rotary-wing aircraft is extremely difficult to perform due to environmental factors. The patient will be paralyzed and intubated on the ground before transport by aircraft.


title: Tracheal intubation

text: A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma. A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.


title: Tracheal intubation

text: The easiest method to perform this technique is the needle cricothyrotomy (also referred to as a percutaneous dilational cricothyrotomy), in which a large-bore (12–14 gauge) intravenous catheter is used to puncture the cricothyroid membrane. Oxygen can then be administered through this catheter via jet insufflation. However, while needle cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established. While needle cricothyrotomy can provide adequate oxygenation, the small diameter of the cricothyrotomy catheter is insufficient for elimination of carbon dioxide (ventilation). After one hour of apneic oxygenation through a needle cricothyrotomy, one can expect a PaCO of greater than 250 mm Hg and an arterial pH of less than 6.72, despite an oxygen saturation of 98% or greater. A more definitive airway can be established by performing a surgical cricothyrotomy, in which a endotracheal tube or tracheostomy tube can be inserted through a larger incision.


title: Tracheal intubation

text: Several manufacturers market prepackaged cricothyrotomy kits, which enable one to use either a wire-guided percutaneous dilational (Seldinger) technique, or the classic surgical technique to insert a polyvinylchloride catheter through the cricothyroid membrane. The kits may be stocked in hospital emergency departments and operating suites, as well as ambulances and other selected pre-hospital settings.


title: Tracheal intubation

text: Tracheotomy consists of making an incision on the front of the neck and opening a direct airway through an incision in the trachea. The resulting opening can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person to breathe without the use of his nose or mouth. The opening may be made by a scalpel or a needle (referred to as surgical and percutaneous techniques respectively) and both techniques are widely used in current practice. In order to limit the risk of damage to the recurrent laryngeal nerves (the nerves that control the voice box), the tracheotomy is performed as high in the trachea as possible. If only one of these nerves is damaged, the patient's voice may be impaired (dysphonia); if both of the nerves are damaged, the patient will be unable to speak (aphonia). In the acute setting, indications for tracheotomy are similar to those for cricothyrotomy. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and removal of tracheal secretions (e.g., comatose patients, or extensive surgery involving the head and neck).


title: Tracheal intubation

text: There are significant differences in airway anatomy and respiratory physiology between children and adults, and these are taken into careful consideration before performing tracheal intubation of any pediatric patient. The differences, which are quite significant in infants, gradually disappear as the human body approaches a mature age and body mass index.