title: Artificial cardiac pacemaker

text: Transcutaneous pacing (TCP), also called external pacing, is recommended for the initial stabilization of hemodynamically significant bradycardias of all types. The procedure is performed by placing two pacing pads on the patient's chest, either in the anterior/lateral position or the anterior/posterior position. The rescuer selects the pacing rate, and gradually increases the pacing current (measured in mA) until electrical capture (characterized by a wide QRS complex with a tall, broad T wave on the ECG) is achieved, with a corresponding pulse. Pacing artifact on the ECG and severe muscle twitching may make this determination difficult. External pacing should not be relied upon for an extended period of time. It is an emergency procedure that acts as a bridge until transvenous pacing or other therapies can be applied.


title: Artificial cardiac pacemaker

text: Temporary epicardial pacing is used during open heart surgery should the surgical procedure create atrio-ventricular block. The electrodes are placed in contact with the outer wall of the ventricle (epicardium) to maintain satisfactory cardiac output until a temporary transvenous electrode has been inserted.


title: Artificial cardiac pacemaker

text: Transvenous pacing, when used for temporary pacing, is an alternative to transcutaneous pacing. A pacemaker wire is placed into a vein, under sterile conditions, and then passed into either the right atrium or right ventricle. The pacing wire is then connected to an external pacemaker outside the body. Transvenous pacing is often used as a bridge to permanent pacemaker placement. It can be kept in place until a permanent pacemaker is implanted or until there is no longer a need for a pacemaker and then it is removed.


title: Artificial cardiac pacemaker

text: Permanent pacing with an implantable pacemaker involves transvenous placement of one or more pacing electrodes within a chamber, or chambers, of the heart, while the pacemaker is implanted inside the skin under the clavicle. The procedure is performed by incision of a suitable vein into which the electrode lead is inserted and passed along the vein, through the valve of the heart, until positioned in the chamber. The procedure is facilitated by fluoroscopy which enables the physician to view the passage of the electrode lead. After satisfactory lodgement of the electrode is confirmed, the opposite end of the electrode lead is connected to the pacemaker generator.


title: Artificial cardiac pacemaker

text: There are three basic types of permanent pacemakers, classified according to the number of chambers involved and their basic operating mechanism:


title: Artificial cardiac pacemaker

text: The pacemaker generator is a hermetically sealed device containing a power source, usually a lithium battery, a sensing amplifier which processes the electrical manifestation of naturally occurring heart beats as sensed by the heart electrodes, the computer logic for the pacemaker and the output circuitry which delivers the pacing impulse to the electrodes.


title: Artificial cardiac pacemaker

text: Most commonly, the generator is placed below the subcutaneous fat of the chest wall, above the muscles and bones of the chest. However, the placement may vary on a case-by-case basis.


title: Artificial cardiac pacemaker

text: The outer casing of pacemakers is so designed that it will rarely be rejected by the body's immune system. It is usually made of titanium, which is inert in the body.


title: Artificial cardiac pacemaker

text: Leadless pacemakers are devices that are small enough to allow the generator to be placed within the heart, therefore avoiding the need for pacing leads. As pacemaker leads can fail over time, a pacing system that avoids these components offers theoretical advantages. Leadless pacemakers can be implanted into the heart using a steerable catheter fed into the femoral vein via an incision in the groin.


title: Artificial cardiac pacemaker

text: Modern pacemakers usually have multiple functions. The most basic form monitors the heart's native electrical rhythm. When the pacemaker wire or "lead" does not detect heart electrical activity in the chamber – atrium or ventricle – within a normal beat-to-beat time period – most commonly one second – it will stimulate either the atrium or the ventricle with a short low voltage pulse. If it does sense electrical activity, it will hold off stimulating. This sensing and stimulating activity continues on a beat by beat basis and is called "demand pacing". In the case of a dual-chamber device, when the upper chambers have a spontaneous or stimulated activation, the device starts a countdown to ensure that in an acceptable – and programmable – interval, there is an activation of the ventricle, otherwise again an impulse will be delivered.


title: Artificial cardiac pacemaker

text: The more complex forms include the ability to sense and/or stimulate both the atrial and ventricular chambers.


title: Artificial cardiac pacemaker

text: From this the basic ventricular "on demand" pacing mode is VVI or with automatic rate adjustment for exercise VVIR – this mode is suitable when no synchronization with the atrial beat is required, as in atrial fibrillation. The equivalent atrial pacing mode is AAI or AAIR which is the mode of choice when atrioventricular conduction is intact but the natural pacemaker the sinoatrial node is unreliable – sinus node disease (SND) or sick sinus syndrome. Where the problem is atrioventricular block (AVB) the pacemaker is required to detect (sense) the atrial beat and after a normal delay (0.1–0.2 seconds) trigger a ventricular beat, unless it has already happened – this is VDD mode and can be achieved with a single pacing lead with electrodes in the right atrium (to sense) and ventricle (to sense and pace). These modes AAIR and VDD are unusual in the US but widely used in Latin America and Europe. The DDDR mode is most commonly used as it covers all the options though the pacemakers require separate atrial and ventricular leads and are more complex, requiring careful programming of their functions for optimal results.


title: Artificial cardiac pacemaker

text: Automatic pacemakers are designed to be over-ridden by the heart's natural rate at any moment that it gets back to a non-pathologic normal sinus rhythm and can reinitiate influencing the electric activity in the heart when the pathologic event happens again. A "ventricular-demand pacemaker" produces a narrow vertical spike on the ECG, just before a wide QRS. The spike of an "atrial-demand pacemaker" appears just before the P wave.


title: Artificial cardiac pacemaker

text: Comparably, a Triggered Pacemaker is activated immediately after an electrical activity is commenced in the heart tissue by itself. A "ventricular triggered pacemaker" produces the impulse just after a pulse is created in the ventricular tissue and it appears as a simultaneous spike with QRS. An "atrial triggered pacemaker" is the mode in which an impulse is produced immediately after an electrical event in the atrium. It appears as a discharge following the p wave but prior to the QRS which is commonly widened.


title: Artificial cardiac pacemaker

text: Cardiac resynchronization therapy (CRT) is used for people with heart failure in whom the left and right ventricles do not contract simultaneously (ventricular dyssynchrony), which occurs in approximately 25–50% of heart failure patients. To achieve CRT, a biventricular pacemaker (BVP) is used, which can pace both the septal and lateral walls of the left ventricle. By pacing both sides of the left ventricle, the pacemaker can resynchronize the ventricular contractions.


title: Artificial cardiac pacemaker

text: CRT devices have at least two leads, one passing through the "vena cava" and the right atrium into the right ventricle to stimulate the septum, and another passing through the "vena cava" and the right atrium and inserted through the coronary sinus to pace the epicardial wall of the left ventricle. Often, for patients in normal sinus rhythm, there is also a lead in the right atrium to facilitate synchrony with the atrial contraction. Thus, the timing between the atrial and ventricular contractions, as well as between the septal and lateral walls of the left ventricle can be adjusted to achieve optimal cardiac function.


title: Artificial cardiac pacemaker

text: CRT devices have been shown to reduce mortality and improve quality of life in patients with heart failure symptoms; a LV ejection fraction less than or equal to 35% and QRS duration on EKG of 120 ms or greater.


title: Artificial cardiac pacemaker

text: Biventricular pacing alone is referred to as CRT-P (for pacing). For selected patients at risk of arrhythmias, CRT can be combined with an implantable cardioverter-defibrillator (ICD): such devices, known as CRT-D (for defibrillation), also provide effective protection against life-threatening arrhythmias.


title: Artificial cardiac pacemaker

text: Conventional placement of ventricular leads in or around the tip or "apex" of the right ventricle, or RV apical pacing, can have negative effects on heart function. It has been associated with increased risk of atrial fibrillation, heart failure, weakening of the heart muscle and potentially shorter life expectancy. His bundle pacing (HBP) leads to a more natural or perfectly natural ventricular activation and has generated strong research and clinical interest. By stimulating the His–Purkinje fiber network directly with a special lead and placement technique, HBP causes a synchronized and therefore more effective ventricular activation and avoids long-term heart muscle disease. HBP in some cases can also correct bundle branch block patterns.


title: Artificial cardiac pacemaker

text: A major step forward in pacemaker function has been to attempt to mimic nature by utilizing various inputs to produce a rate-responsive pacemaker using parameters such as the QT interval, pO – pCO (dissolved oxygen or carbon dioxide levels) in the arterial-venous system, physical activity as determined by an accelerometer, body temperature, ATP levels, adrenaline, etc.


title: Artificial cardiac pacemaker

text: Instead of producing a static, predetermined heart rate, or intermittent control, such a pacemaker, a 'Dynamic Pacemaker', could compensate for both actual respiratory loading and potentially anticipated respiratory loading. The first dynamic pacemaker was invented by Anthony Rickards of the National Heart Hospital, London, UK, in 1982.


title: Artificial cardiac pacemaker

text: Dynamic pacemaking technology could also be applied to future artificial hearts. Advances in transitional tissue welding would support this and other artificial organ/joint/tissue replacement efforts. Stem cells may be of interest in transitional tissue welding.


title: Artificial cardiac pacemaker

text: Many advancements have been made to improve the control of the pacemaker once implanted. Many of these have been made possible by the transition to microprocessor controlled pacemakers. Pacemakers that control not only the ventricles but the atria as well have become common. Pacemakers that control both the atria and ventricles are called dual-chamber pacemakers. Although these dual-chamber models are usually more expensive, timing the contractions of the atria to precede that of the ventricles improves the pumping efficiency of the heart and can be useful in congestive heart failure.


title: Artificial cardiac pacemaker

text: Rate responsive pacing allows the device to sense the physical activity of the patient and respond appropriately by increasing or decreasing the base pacing rate via rate response algorithms.


title: Artificial cardiac pacemaker

text: The DAVID trials have shown that unnecessary pacing of the right ventricle can exacerbate heart failure and increases the incidence of atrial fibrillation. The newer dual-chamber devices can keep the amount of right ventricle pacing to a minimum and thus prevent worsening of the heart disease.


title: Artificial cardiac pacemaker

text: A pacemaker may be implanted whilst a person is awake using local anesthetic to numb the skin with or without sedation, or asleep using a general anesthetic. An antibiotic is usually given to reduce the risk of infection. Pacemakers are generally implanted in the front of the chest in the region of the left or right shoulder. The skin is prepared by clipping or shaving any hair over the implant site before cleaning the skin with a disinfectant such as chlorhexidine. An incision is made below the collar bone and a space or pocket is created under the skin to house the pacemaker generator. This pocket is usually created just above the pectoralis major muscle (prepectoral), but in some cases the device may be inserted beneath the muscle (submuscular). The lead or leads are fed into the heart through a large vein guided by X-ray imaging (fluoroscopy). The tips of the leads may be positioned within the right ventricle, the right atrium, or the coronary sinus, depending on the type of pacemaker required. Surgery is typically completed within 30 to 90 minutes. Following implantation, the surgical wound should be kept clean and dry until it has healed. Care should be taken to avoid excessive movement of the shoulder within the first few weeks to reduce the risk of dislodging the pacemaker leads.


title: Artificial cardiac pacemaker

text: The batteries within a pacemaker generator typically last 5 to 10 years. When the batteries are nearing the end of life, the generator is replaced in a procedure that is usually simpler than a new implant. Replacement involves making an incision to remove the existing device, disconnecting the leads from the old device and reconnecting them to a new generator, reinserting the new device and closing the skin.


title: Artificial cardiac pacemaker

text: Once the pacemaker is implanted, it is periodically checked to ensure the device is operational and performing appropriately. Depending on the frequency set by the following physician, the device can be checked as often as is necessary. Routine pacemaker checks are typically done in-office every six months, though will vary depending upon patient/device status and remote monitoring availability. Newer pacemaker models can also be interrogated remotely, with the patient transmitting their pacemaker data using an at-home transmitter connected to their geographical cellular network. This data can then be accessed by the technician through the device manufacturer's web portal.


title: Artificial cardiac pacemaker

text: At the time of in-office follow-up, the device will be interrogated to perform diagnostic testing. These tests include:


title: Artificial cardiac pacemaker

text: A patient's lifestyle is usually not modified to any great degree after the insertion of a pacemaker. There are a few activities that are unwise, such as full-contact sports and activities that involve intense magnetic fields.


title: Artificial cardiac pacemaker

text: The pacemaker patient may find that some types of everyday actions need to be modified. For instance, the shoulder harness of a vehicle seatbelt may be uncomfortable if the harness should fall across the pacemaker insertion site. Women will not be able to wear bras for a while after the operation and later might have to wear bras with wide shoulder straps.


title: Artificial cardiac pacemaker

text: If the patient does wish to practice any type of sport or physical activity, special pacemaker protection can be worn to prevent possible physical injuries or damage to the pacemaker leads.


title: Artificial cardiac pacemaker

text: Any kind of an activity that involves intense electro-magnetic fields should be avoided. This includes activities such as arc welding possibly, with certain types of equipment, or maintaining heavy equipment that may generate intense magnetic fields (such as a magnetic resonance imaging (MRI) machine).


title: Artificial cardiac pacemaker

text: However, in February 2011 the FDA approved a new pacemaker device from Medtronic called the Revo MRI SureScan which was the first to be labeled as conditional for MRI use. There are several limitations to its use including certain patients' qualifications and scan settings. An MRI conditional device has to be reprogrammed right before and right after MRI scanning. All the 5 most common cardiac pacing device manufacturers (covering more than 99% of the US market) now have FDA-approved MR-conditional pacemakers.


title: Artificial cardiac pacemaker

text: A 2008 US study has found that the magnetic field created by some headphones included with portable music players or cell phones, when placed within inches of pacemakers, may cause interference.


title: Artificial cardiac pacemaker

text: In addition, according to the American Heart Association, some home devices have a remote potential to cause interference by occasionally inhibiting a single beat. Cellphones available in the United States (less than 3 watts) do not seem to damage pulse generators or affect how the pacemaker works.


title: Artificial cardiac pacemaker

text: Having a pacemaker does not imply that a patient requires the use of antibiotics to be administered before procedures such as dental work. The patient should inform all medical personnel that he or she has a pacemaker. The use of MRI may be ruled out by the patient having a pacemaker manufactured before MRI conditional devices became common, or by the patient having old pacing wires abandoned inside the heart, no longer connected to their pacemaker.


title: Artificial cardiac pacemaker

text: A panel of the Heart Rhythm Society, a specialist organization based in Washington, DC, found that it was legal and ethical to honor requests by patients, or by those with legal authority to make decisions for patients, to deactivate implanted cardiac devices. Lawyers say that the legal situation is similar to removing a feeding tube, though there is currently no legal precedent involving pacemakers in the United States. A patient in the US is thought to have a right to refuse or discontinue treatment, including a pacemaker that keeps him or her alive. Physicians have a right to refuse to turn it off, but are advised by the HRS panel that they should refer the patient to a physician who will. Some patients believe that hopeless, debilitating conditions, like those brought on by severe strokes or late-stage dementia, can cause so much suffering that they would prefer not to prolong their lives with supportive measures, such as cardiac devices.


title: Artificial cardiac pacemaker

text: Security and privacy concerns have been raised with pacemakers that allow wireless communication. Unauthorized third parties may be able to read patient records contained in the pacemaker, or reprogram the devices, as has been demonstrated by a team of researchers. The demonstration worked at short range; they did not attempt to develop a long range antenna. The proof of concept exploit helps demonstrate the need for better security and patient alerting measures in remotely accessible medical implants. In response to this threat, Purdue University and Princeton University researchers have developed a prototype firewall device, called MedMon, which is designed to protect wireless medical devices such as pacemakers and insulin pumps from attackers.


title: Artificial cardiac pacemaker

text: Complications from having surgery to implant a pacemaker are uncommon (each 1-3% approximately), but could include: infection where the pacemaker is implanted or in the bloodstream; allergic reaction to the dye or anesthesia used during the procedure; swelling, bruising or bleeding at the generator site, or around the heart, especially if the patient is taking blood thinners, elderly, of thin frame or otherwise on chronic steroids use.


title: Artificial cardiac pacemaker

text: A possible complication of dual-chamber artificial pacemakers is 'pacemaker-mediated tachycardia' (PMT), a form of reentrant tachycardia. In PMT, the artificial pacemaker forms the anterograde (atrium to ventricle) limb of the circuit and the atrioventricular (AV) node forms the retrograde limb (ventricle to atrium) of the circuit. Treatment of PMT typically involves reprogramming the pacemaker.


title: Artificial cardiac pacemaker

text: Another possible complication is "pacemaker-tracked tachycardia," where a supraventricular tachycardia such as atrial fibrillation or atrial flutter is tracked by the pacemaker and produces beats from a ventricular lead. This is becoming exceedingly rare as newer devices are often programmed to recognize supraventricular tachycardias and switch to non-tracking modes.


title: Artificial cardiac pacemaker

text: Sometimes the leads, which are small diameter wires, from the pacemaker to the implantation site in the heart muscle will need to be removed. The most common reason for lead removal is infection, however over time leads can degrade due to a number of reasons such as lead flexing. Changes to the programming of the pacemaker may overcome lead degradation to some extent. However, a patient who has several pacemaker replacements over a decade or two in which the leads were reused may require a lead replacement surgery.


title: Artificial cardiac pacemaker

text: Lead replacement may be done in one of two ways. Insert a new set of leads without removing the current leads (not recommended as it provides additional obstruction to blood flow and heart valve function) or remove the current leads and then insert replacements. The lead removal technique will vary depending on the surgeon's estimation of the probability that simple traction will suffice to more complex procedures. Leads can normally be disconnected from the pacemaker easily which is why device replacement usually entails simple surgery to access the device and replace it by simply unhooking the leads from the device to replace and hooking the leads to the new device. The possible complications, such as perforation of the heart wall, come from removing the lead{s} from the patient's body.


title: Artificial cardiac pacemaker

text: The other end of a pacemaker lead is actually implanted into the heart muscle with a miniature screw or anchored with small plastic hooks called tines. In addition, the longer the leads have been implanted starting from a year or two, the more likely that they will have attachments to the patient's body at various places in the pathway from device to heart muscle, since the human body tends to incorporate foreign devices into tissue. In some cases, for a lead that has been inserted for a short amount of time, removal may involve simple traction to pull the lead from the body. Removal in other cases is typically done with a laser or cutting device which threads like a cannula with a cutting edge over the lead and is moved down the lead to remove any organic attachments with tiny cutting lasers or similar device.


title: Artificial cardiac pacemaker

text: Pacemaker lead malposition in various locations has been described in the literature. Treatment varies, depending on the location of the pacer lead and symptoms.


title: Artificial cardiac pacemaker

text: Another possible complication called twiddler's syndrome occurs when a patient manipulates the pacemaker and causes the leads to be removed from their intended location and causes possible stimulation of other nerves.


title: Artificial cardiac pacemaker

text: Overall life expectancy with pacemakers is excellent, and mostly depends upon underlying diseases, presence of atrial fibrillation, age and sex at the time of first implantation.


title: Artificial cardiac pacemaker

text: Sometimes devices resembling pacemakers, called implantable cardioverter-defibrillators (ICDs) are implanted. These devices are often used in the treatment of patients at risk from sudden cardiac death. An ICD has the ability to treat many types of heart rhythm disturbances by means of pacing, cardioversion, or defibrillation. Some ICD devices can distinguish between ventricular fibrillation and ventricular tachycardia (VT), and may try to pace the heart faster than its intrinsic rate in the case of VT, to try to break the tachycardia before it progresses to ventricular fibrillation. This is known as "fast-pacing", "overdrive pacing", or "anti-tachycardia pacing" (ATP). ATP is only effective if the underlying rhythm is ventricular tachycardia, and is never effective if the rhythm is ventricular fibrillation.


title: Artificial cardiac pacemaker

text: In 1889, John Alexander MacWilliam reported in the "British Medical Journal" (BMJ) of his experiments in which application of an electrical impulse to the human heart in asystole caused a ventricular contraction and that a heart rhythm of 60–70 beats per minute could be evoked by impulses applied at spacings equal to 60–70/minute.


title: Artificial cardiac pacemaker

text: In 1926, Mark C Lidwill of the Royal Prince Alfred Hospital of Sydney, supported by physicist Edgar H. Booth of the University of Sydney, devised a portable apparatus which "plugged into a lighting point" and in which "One pole was applied to a skin pad soaked in strong salt solution" while the other pole "consisted of a needle insulated except at its point, and was plunged into the appropriate cardiac chamber". "The pacemaker rate was variable from about 80 to 120 pulses per minute, and likewise the voltage variable from 1.5 to 120 volts". In 1928, the apparatus was used to revive a stillborn infant at Crown Street Women's Hospital in Sydney, whose heart continued "to beat on its own accord", "at the end of 10 minutes" of stimulation.


title: Artificial cardiac pacemaker

text: In 1932, American physiologist Albert Hyman, with the help of his brother, described an electro-mechanical instrument of his own, powered by a spring-wound hand-cranked motor. Hyman himself referred to his invention as an "artificial pacemaker", the term continuing in use to this day.


title: Artificial cardiac pacemaker

text: An apparent in the publication of research conducted between the early 1930s and World War II may be attributed to the public perception of interfering with nature by "reviving the dead". For example, "Hyman did not publish data on the use of his pacemaker in humans because of adverse publicity, both among his fellow physicians, and due to newspaper reporting at the time. Lidwell may have been aware of this and did not proceed with his experiments in humans".


title: Artificial cardiac pacemaker

text: In 1950, Canadian electrical engineer John Hopps designed and built the first external pacemaker based upon observations by cardio-thoracic surgeons Wilfred Gordon Bigelow and John Callaghan at Toronto General Hospital, although the device was first tested on a dog at the University of Toronto's Banting Institute. A substantial external device using vacuum tube technology to provide transcutaneous pacing, it was somewhat crude and painful to the patient in use and, being powered from an AC wall socket, carried a potential hazard of electrocution of the patient and inducing ventricular fibrillation.


title: Artificial cardiac pacemaker

text: A number of innovators, including Paul Zoll, made smaller but still bulky transcutaneous pacing devices from 1952 using a large rechargeable battery as the power supply.


title: Artificial cardiac pacemaker

text: In 1957, William L. Weirich published the results of research performed at the University of Minnesota. These studies demonstrated the restoration of heart rate, cardiac output and mean aortic pressures in animal subjects with complete heart block through the use of a myocardial electrode.


title: Artificial cardiac pacemaker

text: In 1958 Colombian doctor Alberto Vejarano Laverde and Colombian electrical engineer Jorge Reynolds Pombo constructed an external pacemaker, similar to those of Hopps and Zoll, weighing 45 kg and powered by a 12 volt car lead–acid battery, but connected to electrodes attached to the heart. This apparatus was successfully used to sustain a 70-year-old priest, Gerardo Florez.


title: Artificial cardiac pacemaker

text: The development of the silicon transistor and its first commercial availability in 1956 was the pivotal event that led to the rapid development of practical cardiac pacemaking.


title: Artificial cardiac pacemaker

text: In 1958, engineer Earl Bakken of Minneapolis, Minnesota, produced the first wearable external pacemaker for a patient of C. Walton Lillehei. This transistorized pacemaker, housed in a small plastic box, had controls to permit adjustment of pacing heart rate and output voltage and was connected to electrode leads which passed through the skin of the patient to terminate in electrodes attached to the surface of the myocardium of the heart.


title: Artificial cardiac pacemaker

text: In the UK in the 1960s, Lucas Engineering in Birmingham was asked by Mr Abrams of The Queen Elizabeth Hospital to produce a prototype for a transistorised replacement for the electro-mechanical product. The team was headed by Roger Nolan, an engineer with the Lucas Group Research Centre. Nolan designed and created the first blocking oscillator and transistor-powered pacemaker. This pacemaker was worn on a belt and powered by a rechargeable sealed battery, enabling users to live a more-normal life.


title: Artificial cardiac pacemaker

text: One of the earliest patients to receive this Lucas pacemaker device was a woman in her early 30s. The operation was carried out in 1964 by South African cardiac surgeon (and later professor) Alf Gunning, a student of Christiaan Barnard. This pioneering operation took place under the guidance of cardiac consultant Peter Sleight at the Radcliffe Infirmary in Oxford and his cardiac research team at St George's Hospital in London. Sleight later became a Professor of Cardiovascular Medicine at Oxford University.


title: Artificial cardiac pacemaker

text: The first clinical implantation into a human of a fully implantable pacemaker was on October 8, 1958, at the Karolinska Institute in Solna, Sweden, using a pacemaker designed by inventor Rune Elmqvist and surgeon Åke Senning (in collaboration with Elema-Schönander AB, later Siemens-Elema AB), connected to electrodes attached to the myocardium of the heart by thoracotomy. The device failed after three hours. A second device was then implanted which lasted for two days. The world's first implantable pacemaker patient, Arne Larsson, went on to receive 26 different pacemakers during his lifetime. He died in 2001, at the age of 86, outliving the inventor as well as the surgeon.


title: Artificial cardiac pacemaker

text: In 1959, temporary transvenous pacing was first demonstrated by Seymour Furman and John Schwedel, whereby the catheter electrode was inserted via the patient's basilic vein.


title: Artificial cardiac pacemaker

text: In February 1960, an improved version of the Swedish Elmqvist design was implanted in Montevideo, Uruguay in the Casmu 1 Hospital by Doctors Orestes Fiandra and Roberto Rubio. That device lasted until the patient died of other ailments, nine months later. The early Swedish-designed devices used rechargeable batteries, which were charged by an induction coil from the outside. It was the first pacemaker implanted in America.


title: Artificial cardiac pacemaker

text: Implantable pacemakers constructed by engineer Wilson Greatbatch entered use in humans from April 1960 following extensive animal testing. The Greatbatch innovation varied from the earlier Swedish devices in using primary cells (mercury battery) as the energy source. The first patient lived for a further 18 months.


title: Artificial cardiac pacemaker

text: The first use of transvenous pacing in conjunction with an implanted pacemaker was by Parsonnet in the United States, Lagergren in Sweden and Jean-Jacques Welti in France in 1962–63.


title: Artificial cardiac pacemaker

text: The transvenous, or pervenous, procedure involved incision of a vein into which was inserted the catheter electrode lead under fluoroscopic guidance, until it was lodged within the trabeculae of the right ventricle. This method was to become the method of choice by the mid-1960s.


title: Artificial cardiac pacemaker

text: Cardiothoracic surgeon Leon Abrams and medical engineer Ray Lightwood developed and implanted the first patient-controlled variable-rate heart pacemaker in 1960 at Birmingham University. The first implant took place in March 1960, with two further implants the following month. These three patients made good recoveries and returned to a high quality of life. By 1966, 56 patients had undergone implantation with one surviving for over years.


title: Artificial cardiac pacemaker

text: The preceding implantable devices all suffered from the unreliability and short lifetime of the available primary cell technology which was mainly that of the mercury battery. In the late 1960s, several companies, including ARCO in the US, developed isotope-powered pacemakers, but this development was overtaken by the development in 1971 of the lithium iodide cell battery by Wilson Greatbatch. Lithium-iodide or lithium anode cells became the standard for future pacemaker designs.


title: Artificial cardiac pacemaker

text: A further impediment to the reliability of the early devices was the diffusion of water vapor from the body fluids through the epoxy resin encapsulation affecting the electronic circuitry. This phenomenon was overcome by encasing the pacemaker generator in a hermetically sealed metal case, initially by Telectronics of Australia in 1969 followed by Cardiac Pacemakers, Inc. of St. Paul, Minnesota in 1972. This technology, using titanium as the encasing metal, became the standard by the mid-1970s.


title: Artificial cardiac pacemaker

text: On July 9, 1974, the founders of Cardiac Pacemakers, Inc.. (Guidant), Manuel A. Villafaña and Anthony Adducci, manufactured the world's first pacemaker with a lithium anode and a lithium-iodide electrolyte solid-state battery. Lithium-iodide or lithium anode cells increased the life of pacemakers from 1 year up to 11 years and has become the standard for future pacemaker designs. They began designing and testing their implantable cardiac pacemaker powered with a new longer-life lithium battery in 1971. The first patient to receive a CPI pacemaker emerged from surgery in June 1973.


title: Artificial cardiac pacemaker

text: In 2013, multiple firms announced devices that could be inserted via a leg catheter rather than invasive surgery. The devices are roughly the size and shape of a pill, much smaller than the size of a traditional pacemaker. Once implanted, the device's prongs contact the muscle and stabilize heartbeats. Engineers and scientists are currently working on this type of device. In November 2014 a patient, Bill Pike of Fairbanks, Alaska, received a Medtronic Micra pacemaker in Providence St Vincent Hospital in Portland Oregon. D. Randolph Jones was the EP doctor. Also in 2014, St. Jude Medical Inc. announced the first enrollments in the company's leadless Pacemaker Observational Study evaluating the Nanostim leadless pacing technology. The Nanostim pacemaker received CE marking in 2013. The post-approval implants have occurred in Europe. The European study was recently stopped, after there were reports of six perforations that led to two patient deaths. After investigations, St Jude Medical restarted the study. In the United States, however, this therapy is still not approved by the FDA. While the St Jude Nanostim and the Medtronic Micra are single-chamber pacemakers, it is anticipated that leadless dual-chamber pacing for patients with atrioventricular block will become possible with further development.


title: Artificial cardiac pacemaker

text: Thousands of pacemakers are removed by funeral home personnel each year all over the world. They must be removed postmortem from bodies that are going to be cremated to avoid explosions. It is a fairly simple procedure that can be carried out by a mortician. Pacemakers with significant battery life are potentially life-saving devices for people in low- and middle-income countries (LMICs). The Institute of Medicine, a United States non-governmental organization, has reported that inadequate access to advanced cardiovascular technologies is a major contributor to cardiovascular disease morbidity and mortality in LMICs. Ever since the 1970s, multiple studies worldwide have reported on the safety and efficacy of pacemaker reuse. , widely acceptable standards for safe pacemaker and ICD reuse have not been developed, and there continue to be legal and regulatory barriers to widespread adoption of medical device reuse.


title: Hawaiian Airlines

text: Hawaiian Airlines ( ) is the largest operator of commercial flights to and from the U.S. state of Hawaii. It is the tenth-largest commercial airline in the United States, and is based at Honolulu, Hawaii. The airline operates its main hub at Daniel K. Inouye International Airport on the island of Oʻahu and a secondary hub out of Kahului Airport on the island of Maui. The airline also maintained a crew base at Los Angeles International Airport. Hawaiian Airlines operates flights to Asia, American Samoa, Australia, French Polynesia, Hawaii, New Zealand, and the United States mainland. Hawaiian Airlines is owned by Hawaiian Holdings, Inc. of which Peter R. Ingram is the current president and chief executive officer.


title: Hawaiian Airlines

text: Hawaiian is the oldest American carrier that has never had a fatal accident or a hull loss throughout its history, and frequently tops the on-time carrier list in the United States, as well as the fewest cancellations, oversales, and baggage handling issues.


title: Hawaiian Airlines

text: Inter-Island Airways (Hawaiian: ""), the forerunner of the airline which is now known as Hawaiian Airlines, was incorporated on January 30, 1929. Inter-Island Airways, a subsidiary of Inter-Island Steam Navigation Company, began operations on October 6, 1929, with a Bellanca CH-300 Pacemaker, providing short sightseeing flights over Oʻahu. Scheduled service began a month later on November 11 using Sikorsky S-38s with a flight from Honolulu to Hilo, via intermediary stops on Molokaʻi and Maui.


title: Hawaiian Airlines

text: On October 1, 1941, the name was changed to Hawaiian Airlines when the company phased out the older Sikorsky S-38 and Sikorsky S-43 flying boats. The first Douglas DC-3s were added to the fleet in August 1941, some examples remaining in operation until final retirement in November 1968.


title: Hawaiian Airlines

text: Modern pressurized equipment was introduced from 1952 in the form of the Convair 340. Further Convair 440s were added in 1959–60, most of the Convairs being converted to turbine propeller power in 1965–67. The last were sold in 1974.


title: Hawaiian Airlines

text: Hawaiian Airlines started to offer jet service in 1966 with the acquisition of Douglas DC-9-10 aircraft, which cut travel times in half on most of its routes.


title: Hawaiian Airlines

text: Hawaiian Airlines began to expand its footprint throughout the 1980s, as the result of intense competition on inter-island routes created by the entrance of Mid Pacific Air into the market. In 1985, the company began its first foray outside the inter-island market through charter services to the South Pacific and then throughout the rest of the Pacific using Douglas DC-8 aircraft. Despite the early successes of this new business, Hawaiian was forced to curtail its charter services when the Federal Government banned all DC-8 and B707 aircraft without hush kits from operating within the US. Hawaiian did, however, manage to gain a short exemption for its South Pacific services.


title: Hawaiian Airlines

text: Soon after, in early 1985, the company received the first two of its leased Lockheed L-1011 TriStars. One aircraft was used to launch Hawaiian's first scheduled operation out of Hawaiʻi, daily Honolulu-Los Angeles services. This new service put Hawaiian in direct competition with the major US air carriers for the first time in its history. Throughout 1985 and 1986, Hawaiian Airlines added additional L-1011s to its fleet and used them to open up services to other West Coast gateway cities such as San Francisco, Seattle, Portland, Las Vegas, and Anchorage, which placed Hawaiian in further competition against the major US airlines.


title: Hawaiian Airlines

text: Meanwhile, Hawaiian Airlines also entered the new international markets of Australia and New Zealand in 1986 with one-stop services through Pago Pago International Airport. Hawaiian also aggressively grew its international charter business and pursued military transport contracts. This led to a large growth in the company's revenues and caused its inter-island service's share of revenues to shrink to just about a third of the company's total.


title: Hawaiian Airlines

text: During the 1980s, Hawaiian also embarked on the development and construction of Kapalua Airport on west side of Maui. Opened in 1987, the airport was designed with a 3,000-foot runway, which constrained its ability to handle large aircraft. As a result, when the airport first opened, Hawaiian Airlines was the only inter-island carrier with aircraft capable of serving the airport. With its de Havilland Canada DHC-7 Dash 7 turboprops, Hawaiian had a distinct competitive advantage in the Maui market.


title: Hawaiian Airlines

text: Heading into the 1990s, Hawaiian Airlines faced financial difficulties, racking up millions of dollars in losses throughout the previous three years. Due to the airline's increasingly unprofitable operations, it filed for Chapter 11 bankruptcy protection in September 1993. During this time, the company reduced many of its costs: reorganizing its debt, wrestling concessions from employees, cutting overcapacity, and streamlining its fleet by disposing many of the planes it had added to its fleet just a few years earlier.


title: Hawaiian Airlines

text: As part of Hawaiian's restructuring, it sold Kapalua Airport to the State of Hawaii in 1993. Hawaiian soon after discontinued service to the airport as it retired its Dash 7 fleet. The retirement of the Dash 7 in 1994 also resulted in the airline operating a more streamlined all-jet fleet as it exited bankruptcy in September 1994.


title: Hawaiian Airlines

text: To replace its retired DC-8s and L-1011s, Hawaiian Airlines leased six DC-10s from American Airlines, who continued to provide maintenance on the aircraft. An agreement with American also included participation in American's SABRE reservation system and participation in American Airlines' AAdvantage frequent flyer program. The DC-10s were subsequently retired between 2002 and 2003. The company replaced these leased DC-10s with 14 leased Boeing 767 aircraft during a fleet modernization program that also replaced its DC-9s with new Boeing 717 aircraft. The Boeing aircraft featured an updated rendition of the company's "Pualani" tail art, which had appeared on its Douglas aircraft since the 1970s. A new design was updated by a local artist Mauriel Morejon. Pualani, which means “flower of the sky,” the key icon of Hawaiian's brand for more than four decades, continues to feature on the tail of the aircraft; beneath her, a silver maile lei with woven pakalana flowers wraps around the fuselage.


title: Hawaiian Airlines

text: In March 2003, Hawaiian Airlines filed for Chapter 11 bankruptcy protection for the second time in its history. The airline continued its normal operations, and at the time was overdue for $4.5 million worth of payments to the pilots' pension plan. Within the company, it was suggested that the plan be terminated. As of May 2005, Hawaiian Airlines had received court approval of its reorganization plan. The company emerged from bankruptcy protection on June 2, 2005, with reduced operating costs through renegotiated contracts with its union work groups; restructured aircraft leases; and investment from RC Aviation, a unit of San Diego-based Ranch Capital, which bought a majority share in parent company Hawaiian Holdings Inc in 2004.


title: Hawaiian Airlines

text: On October 1, 2005, Hawaiian Airlines began nonstop daily flights from Honolulu to San Jose, California. This made San Jose the fifth gateway city in California to be serviced by Hawaiian; the others were Los Angeles, San Diego, Sacramento, and San Francisco.


title: Hawaiian Airlines

text: On May 4, 2006, Hawaiian Airlines expanded service between the US mainland and Hawaii in anticipation of the induction of four additional Boeing 767-300 aircraft, primarily focused on expanding non-stop service to Kahului Airport from San Diego, Seattle, and Portland. Additional flights were also added between Honolulu and the cities of Sacramento, Seattle, and Los Angeles. In 2006, Hawaiian Airlines was rated as the best carrier serving Hawaii by "Travel + Leisure", Zagat and "Condé Nast Traveler".


title: Hawaiian Airlines

text: On July 24, 2007, Hawaiian Airlines and Air New Zealand signed a $45 million contract for Air New Zealand to perform heavy maintenance on Hawaiian's Boeing 767 aircraft. This contract lasted for five years. Air New Zealand stated that this opportunity will also give a chance for them to build their expertise working on 767s. In August 2007, the Seattle Seahawks became the second sports team to begin using Hawaiian Airlines to travel to games. The Las Vegas Raiders, also of the NFL, have been flying Hawaiian Airlines since the 1990s. The two teams formerly flew on Hawaiian's Boeing 767s to and from all their games, but now travel on Hawaiian's Airbus A330s. Several of Hawaiian's Boeing 767 and A330 aircraft have been fitted with decals of logos of the Raiders.


title: Hawaiian Airlines

text: In March 2008, the airline launched nonstop flights to Manila, capital of Philippines, in the airline's first major international expansion since it emerged from bankruptcy protection in June 2005. In response to the closure of ATA Airlines and Aloha Airlines, the airline began flights to Oakland on May 1, 2008.


title: Hawaiian Airlines

text: On February 16, 2010, Hawaiian Airlines sought approval from the United States Department of Transportation to begin nonstop flights from its hub at Honolulu to Tokyo-Haneda sometime in 2010. The airline was one of five US carriers — the others being Delta Air Lines, Continental Airlines, United Airlines and American Airlines — seeking approval to serve Haneda as part of the U.S.-Japan OpenSkies agreement. Approval was granted from USDOT to begin nonstop service to Haneda, Japan. The flight began service on November 18, 2010. In addition, the airline is planning to establish a codeshare agreement with All Nippon Airways.


title: Hawaiian Airlines

text: On January 12, 2011, Hawaiian Airlines began nonstop service to Seoul-Incheon, South Korea. On March 31, 2011, Hawaiian announced that they will be renovating the check-in lobby of the inter-island terminal at the Honolulu International Airport (Hawaiian's main hub). Hawaiian, the only occupant of the inter-island terminal, will be removing the traditional check-in counter, to install six circular check-in islands in the middle of the lobbies. Those check-in islands can be used for inter-island, mainland, and international flights. On July 12, 2011, Hawaiian added Osaka, Japan to its network. On November 17, 2011, Hawaiian ordered five additional Airbus A330-200 aircraft.


title: Hawaiian Airlines

text: On June 4, 2012, Hawaiian expanded to the east coast with daily flights to New York's John F. Kennedy International Airport. On August 30, 2012, Hawaiian filed an application with the U.S. Department of Transportation for a nonstop route between Kona and Tokyo-Haneda. This would fill a void that Japan Airlines left when it ceased service to Kona nearly two years earlier. However, the US Department of Transportation rejected the airline's application to begin service. On December 3, 2012, the airline unveiled plans to begin flights to Taipei, Taiwan (Republic of China) beginning July 9, 2013, as part of its aggressive expansion plans.


title: Hawaiian Airlines

text: On February 11, 2013, the airline announced a new venture in the turboprop interisland business, "ʻOhana by Hawaiian." Service is operated by Empire Airlines using ATR 42-500 turboprop airplanes. Service began on March 11, 2014, to Molokaʻi and Lānaʻi. The airline expanded more "ʻOhana by Hawaiian" routes between Kahului, Kailua-Kona and Hilo during the summer of 2014. On April 10, 2013, the airline announced its first destination in China, with service to Beijing expected to start on April 16, 2014, pending government approval. At the same time, the airline announced that it would end service to Manila capital of Philippines on July 31, 2013. On July 11, 2013, the airline signed a codeshare agreement with China Airlines.


title: Hawaiian Airlines

text: On March 12, 2014, Hawaiian announced that it would begin daily service between Kahului and Los Angeles on May 2, adding a second flight from June 30 to September 8 in response to passenger demand. It would also begin nonstop summer service between Los Angeles and both Līhuʻe, Kauaʻi and Kona, Hawaiʻi.


title: Hawaiian Airlines

text: On August 14, 2014, the airline announced direct service between Kahului and San Francisco beginning in November.


title: Hawaiian Airlines

text: On January 5, 2015, Hawaiian refiled its previously rejected application with the U.S. Department of Transportation (DOT) for the Kona-Haneda route with service, if approved, to begin in June. The request was prompted by a DOT decision in December 2014 to review the public interest in Delta Air Lines' Seattle-Tokyo route after Delta reduced the frequency of those flights from daily to seasonal. On March 31, DOT again denied the request, opting instead to allow Delta to continue operating the route, with American Airlines taking over if Delta's planned service continued to fail.


title: Hawaiian Airlines

text: On March 6, 2018, the airline announced an order for 10 Boeing 787-9 Dreamliners with options for an additional ten; selecting GE GEnx engines.


title: Hawaiian Airlines

text: Due to the economic effects of the COVID-19 pandemic, Hawaiian Airlines reported a net loss of over $100 million for the Q2 of 2020.


title: Hawaiian Airlines

text: Fourteen-day travel quarantines, which were reinstated for August 2020 have also contributed to Hawaiian Airlines' plans to downsize the company by 15-25% by summer 2021.


title: Hawaiian Airlines

text: On May 27, 2021, Hawaiian announced that it would discontinue the ʻOhana by Hawaiian brand and its cargo and passenger services after the pandemic and resulting quarantine significantly impacted interisland travel. The interruptions in service forced the airline to reconsider the viability of operation and determine it was no longer feasible. The carrier's ATR fleet would be moved to the mainland and be prepared for sale.


title: Hawaiian Airlines

text: On April 25, 2022, Hawaiian Airlines announced they will become the first major air carrier to offer the SpaceX Starlink service on all Transpacific flights. The service will be offered free to passengers beginning in 2023.


title: Hawaiian Airlines

text: Previously listed on the American Stock Exchange, the company moved to NASDAQ on June 2, 2008. Hawaiian Holdings, Inc. is a holding company whose primary asset is the sole ownership of all issued and outstanding shares of common stock of Hawaiian Airlines, Inc. On June 30, 2008, the company announced that it had been added to the Russell 3000 Index.


title: Hawaiian Airlines

text: Recent key figures for Hawaiian Holdings, Inc. (which include the operations of Hawaiian Airlines and former regional subsidiary carrier ʻOhana by Hawaiian) are shown below (for years ending December 31):


title: Hawaiian Airlines

text: Hawaiian Airlines serves destinations in several Asia-Pacific countries and territories. The airline added its eighth international destination, Incheon International Airport near Seoul, South Korea on January 12, 2011. It also has daily and weekly direct, non-stop international flights from Honolulu to Tahiti, Australia, South Korea, Japan, and New Zealand.


title: Hawaiian Airlines

text: The airline names its Boeing 717 aircraft after birds found in Polynesia, their Airbus A330 aircraft after Polynesian constellations historically used to navigate to the Hawaiian islands, and their Airbus A321neo fleet after plants and forests within the Hawaiian islands.


title: Hawaiian Airlines

text: Hawaiian began acquiring Boeing 717 aircraft for operation on the neighbor Island network in February 2001. On June 4, 2008, the airline announced that it had agreed to lease an additional four 717 airplanes to meet demand due to the shutdown of Aloha Airlines' passenger operations and the closing of ATA Airlines, with deliveries between September and the end of 2008.


title: Hawaiian Airlines

text: Hawaiian Airlines started sending an A321neo aircraft on a route from Honolulu to Kahului, and Kahului to Honolulu in January 2020. This route ran four times a week; as of August 2020, the route is flown every day. This route is operated under HA179 (OGG – HNL) and HA180 (HNL – OGG). Various inter-island flights from Honolulu to Lihue, Kahului, Kona, and Hilo can be found on the A321 NEO post pandemic. Some are used as aircraft positioning flights while others turn around and head back to Honolulu.


title: Hawaiian Airlines

text: In 2022, Hawaiian Airlines began regularly scheduled inter-island service on the A330-200 between Honolulu and Kahului. Occasionally, the A330 can be found on flights between Honolulu and Kona


title: Hawaiian Airlines

text: In January 2013, Hawaiian signed a memorandum of understanding with Airbus for an order of 16 A321neo aircraft plus up to 9 options. The aircraft is operated in a 2-class, 189 seat configuration. Following the completion of labor agreements relating to the operation of the aircraft with the airline's pilot and flight attendant unions, the airline finalized the order in March 2013. In December 2016, Hawaiian announced their intention of leasing two additional A321neo aircraft, bringing their total fleet of the type to 18. The first flight took place on January 17, 2018, from Kahului to Oakland, California.


title: Hawaiian Airlines

text: On November 27, 2007, Hawaiian Airlines signed a memorandum of understanding with Airbus for 24 long-range jets priced at $4.4 billion. The order included six Airbus A330-200s with a further six purchase rights and six Airbus A350-800s with a further six purchase rights. Plans to fly to Paris and London were discussed. Deliveries for the A330s began in 2010 while the first A350 was to be delivered in 2017.


title: Hawaiian Airlines

text: On October 27, 2008, Hawaiian announced that, prior to the arrival of its new A330s, it would lease two additional Airbus A330-200 aircraft, beginning in 2011, at the same time extending the leases of two Boeing 767-300ER aircraft to 2011 (to be withdrawn from service coincident with the delivery of the A330s). Two weeks later, the airline announced the lease of an additional A330-200 for delivery in the second quarter of 2010, and negotiated for delivery of one aircraft from the earlier lease agreement to be moved up to the same quarter. In December 2010, Hawaiian ordered an additional six A330-200 aircraft, bringing the fleet total to 15. Further lease agreements were signed with Air Lease Corporation (one aircraft), and three aircraft each from Hong Kong Aviation Capital and Jackson Square Aviation, bringing the A330-200 fleet to twenty-two. In July 2015, Hawaiian announced the lease of an A330-200 from Air Lease Corporation. The purchase of another A330-200 was announced in December 2016.


title: Hawaiian Airlines

text: In February 2018, Hawaiian was rumored to be canceling its order for six A330-800s and replacing them with 787-9s. It was reported that Boeing priced the aircraft at less than $115 million, and possibly less than $100 million, each; the production cost of a 787-9 is between $80 million and $90 million. Boeing Capital also released Hawaiian from three 767-300ER leases in advance; these aircraft were to be transferred to United Airlines. Initially, Hawaiian refuted it cancelled its A330-800 order, but did not dismiss a new deal with Boeing. However, on March 6, 2018, Hawaiian Airlines confirmed the cancellation of the A330-800 order and the signing of a Letter of Intent with Boeing to purchase ten 787-9 aircraft, with options for an additional ten planes; the deal was finalized at the Farnborough Air Show in July 2018.


title: Hawaiian Airlines

text: Throughout its history, Hawaiian Airlines has operated a diverse range of aircraft including the following:


title: Hawaiian Airlines

text: In late 2014, Hawaiian Airlines began offering Extra Comfort seating, as a new service class on its Airbus A330-200 aircraft. The Economy Comfort seating offered seating space upgrades for passengers, along with improved soft-product offerings for passengers on international routes.


title: Hawaiian Airlines

text: In October 2015, Hawaiian announced that it will be upgrading its business class seats from the standard recliner seats to 180-degree lie-flat seats on their A330 fleet in a 2-2-2 configuration. The new seats would be installed starting the second quarter of 2016. In addition to the new business class seats upgrade, the airline would add 28 additional Extra Comfort seats.


title: Hawaiian Airlines

text: The Airbus A321neo cabin uses Hawaiian-inspired designs, utilizing and used a 3-3 configuration in the main cabin and a 2-2 configuration in business class.


title: Hawaiian Airlines

text: Prior to September 1, 2013, Hawaiian offered DigEplayer portable video players for rent. Airbus A330 aircraft are equipped with on-demand units built into every seatback. The new Airbus A321neo is equipped with personal device entertainment via app. As of July 2019, all in-flight entertainment on mainland to Hawai'i flights is available, free of charge.


title: Hawaiian Airlines

text: On April 25, 2022, Hawaiian announced an agreement with Starlink to provide free internet access for flights between the Hawai'i and the mainland, Asia, and Oceania on Airbus A330, A321neo, and upcoming Boeing 787-9 aircraft.


title: Hawaiian Airlines

text: Hawaiian provides complimentary and paid beverage service on all of its flights. Meals are not provided on interisland flights because of their short length (30–45 minutes). On its U.S. mainland flights, Hawaiian is one of the only major U.S. airlines to provide complimentary meals in its main cabin (coach class); each meal is made with no preservatives and with all-natural ingredients and is packaged with recyclable materials. In 2009, Hawaiian introduced premium meals in its main cabin, giving passengers the option of having the complimentary meal or paying to upgrade to a premium meal. The premium meals consisted of a variety of high-end Asian cuisine, but were later discontinued.


title: Hawaiian Airlines

text: In March 2007, Hawaiian introduced a "tasting menu" or "tapas menu" for its first-class passengers on its U.S. mainland and international flights. The menu consists of twenty entrees set on a rotation, with five available on any given flight. Passengers are provided information on the available entrees for their flight when they board or shortly after takeoff, and may choose up to three entrees as part of their inflight meal.


title: Hawaiian Airlines

text: In August 2012, Hawaiian announced an upgrade to its economy class in-flight U.S. mainland service. Among the upgrades were a new menu, a complimentary glass of wine on lunch or dinner flights, and a free tropical cocktail before landing on breakfast flights. This was in contrast to other airlines, which cut back on meal service. According to Hawaiian's then-CEO Mark Dunkerley:


title: Hawaiian Airlines

text: "In today's competitive world you cannot justify providing complimentary meals on a traditional business model. It simply does not pay for itself... which explains why essentially everybody has taken all that free food off the airplane. We're being illogical by actually investing heavily in this area...It's part of who we are, and it's what makes us different from everybody else."


title: Hawaiian Airlines

text: Starting December 1, 2017, guests in the main cabin on Hawaiian flights between Hawaiʻi and western U.S. gateway cities will be treated to complimentary meal service exclusively created for the airline's new "Pau Hāna Café" brand. "The Pau Hāna Café", branded meals made exclusively for the airline, consists of a continental breakfast box for brunch and hot sandwich and side for lunch. Pau Hāna, a Hawaiian term for “finished work,” is a time to relax and unwind after a long workday. The meal service is followed by coffee and a sweet treat for dessert. A parting Mahalo service features the carrier's popular Kōloa Breeze cocktail, featuring Kōloa Rum from the Island of Kauaʻi, and the airline's signature Pau Hāna snack mix.


title: Hawaiian Airlines

text: On December 20, 2017, a partnership was announced with Mana Up, the Hawaiian-based accelerator for local consumer packaged goods, to increase the diversity and volume of locally made products served on board.


title: Hawaiian Airlines

text: Hawaiian Airlines' frequent-flyer program is HawaiianMiles, which started in 1983. Miles accumulated in the program allow members to redeem tickets, upgrade service class or obtain free or discounted car rentals, hotel stays, merchandise, or other products and services through partners. The most active members, based on the amount and price of travel booked, are designated Pualani Gold (fly 30 Segments or fly 20,000 Flight Miles) and Pualani Platinum (fly 60 Segments or fly 40,000 Flight Miles), with privileges such as separate check-in, Premier Club Lounge access in Honolulu, Hilo, Kona, Kahului, and Līhuʻe, priority upgrade and standby processing, or complimentary upgrades. Travel award redemption from the HawaiianMiles program account for 5% of total revenue passengers.


title: Hawaiian Airlines

text: Hawaiian also has frequent-flyer partnerships with several other airlines, allowing HawaiianMiles members to earn credit for flying partner airlines and/or members of partner airline frequent flyer programs to earn credit for Hawaiian flights. Some partnerships restrict credit to only certain flights, such as inter-island flights or to code-share flights booked through Hawaiian.


title: Hawaiian Airlines

text: HawaiianMiles allows one-way redemption on Hawaiian Airlines flights only. Currently, the lowest-priced one-way economy class ticket is an inter-island coach saver flight for 7,500 miles. Prior to 2021, HawaiianMiles accounts with no activity for 18 months automatically expired. Hawaiian announced on April 12, 2021, that HawaiianMiles accounts would no longer have expiration dates, effective immediately.


title: Sleeping Beauty (2011 film)

text: Sleeping Beauty is a 2011 Australian erotic drama film written and directed by Julia Leigh in her directorial debut. The film stars Emily Browning as a young university student. She takes up a part-time high-paying job with a mysterious group that caters to rich men who like the company of nude sleeping young women. Lucy is required to sleep alongside paying customers and be absolutely submissive to their erotic desires, fulfilling their fantasies by voluntarily entering into physical unconsciousness.


title: Sleeping Beauty (2011 film)

text: The film is based on influences that include Leigh's own dream experiences, and the novels "The House of the Sleeping Beauties" and "Memories of My Melancholy Whores" by Nobel laureates Yasunari Kawabata and Gabriel Garcia Marquez, respectively.


title: Sleeping Beauty (2011 film)

text: The film premiered in May at the 2011 Cannes Film Festival as the first Competition entry to be screened. It was the first Australian film In Competition at Cannes since "Moulin Rouge!" (2001). "Sleeping Beauty" was released in Australia on 23 June 2011. It received a limited release in the United States on 2 December 2011. Overall critical reception of the film has been mixed, rising to some approval through June 2016, after circulation of the film on the festival circuit.


title: Sleeping Beauty (2011 film)

text: Lucy is a university student who works in an office in the daytime and at a restaurant in the evenings. She is occasionally a research subject at a science laboratory.


title: Sleeping Beauty (2011 film)

text: Lucy is paying tuition and rent by doing several jobs. Her sister's boyfriend is continually on her about her part of the rent. She is caring for Birdmann, who is an alcoholic and is very attracted to her. While she does not return his sexual interest, Lucy enjoys Birdmann's company, and in his presence is the only time she is shown smiling or laughing. An old joke between the two is that Birdmann frequently asks Lucy to marry him; Lucy always says no. Due to lack of money and Birdmann's addiction, Lucy makes a decision to look for another part-time job.


title: Sleeping Beauty (2011 film)

text: In response to a classified ad for yet another short-term job, Lucy meets Clara, who runs a service that combines lingerie modelling and catering performed by young women at a black tie dinner party for mostly male clients. Clara assures her that the men are not allowed to touch the women sexually, and Lucy agrees to try it. Clara inspects Lucy's body and names her "Sara" for the purpose of anonymity. At the dinner party, Lucy is the only girl dressed in white; the other women wear black lingerie that is much more revealing than Lucy's outfit.


title: Sleeping Beauty (2011 film)

text: After one other session as a serving girl, Lucy gets promoted. She receives a call from Clara's assistant for a different request. Lucy is driven to a country mansion, where Clara offers Lucy a new role wherein she will be voluntarily sedated and sleep naked while male clients lie beside her. They are permitted to caress and cuddle her, but vaginal penetration is not allowed. After Lucy falls asleep, she lies unconscious on the bed and Clara leads in her client. After Clara reminds the man of the no-penetration rule, he strips and curls up beside Lucy.


title: Sleeping Beauty (2011 film)

text: After a few of these sessions, Lucy has enough money to move into a larger, more expensive apartment, where she lives alone. She receives a call from Birdmann, who has overdosed on painkillers. She goes to his house and finds him dying in his bed. Sobbing, she takes off her shirt and gets in bed with him, but he dies in her arms. At Birdmann's funeral, Lucy abruptly asks an old boyfriend if he will marry her, in an echo of Birdmann's old playful banter. The ex-boyfriend, however, not understanding the reference, takes her seriously and, shocked, refuses her, citing a number of Lucy's personal problems as his reasons.


title: Sleeping Beauty (2011 film)

text: At her next assignment with Clara, Lucy asks if she can see what happens during the sessions while she is asleep. Clara refuses, saying it will put her clients at risk of blackmail. Lucy decides to surreptitiously film her next encounter. The client is once again the first man, but this time, he also drinks the tea with a much larger dose of the sleeping drug.


title: Sleeping Beauty (2011 film)

text: The following morning, Clara comes in and checks the man's pulse, showing no surprise when he cannot be awakened. Clara tries to wake Lucy, who has overdosed as well, and is eventually able to revive her using mouth-to-mouth resuscitation. Lucy begins screaming when she sees the dead man in bed next to her.


title: Sleeping Beauty (2011 film)

text: The film ends with the scene captured by the hidden camera: the dead old man and the sleeping girl both lying peacefully together in bed.


title: Sleeping Beauty (2011 film)

text: Writer and director Julia Leigh, primarily a novelist, said in an interview with "Filmmaker Magazine" that she initially wrote the film without the intention of directing it. In writing the script, Leigh drew from several literary inspirations, including Yasunari Kawabata's "House of the Sleeping Beauties" and "Memories of My Melancholy Whores" by Gabriel Garcia Marquez, as well as the eponymous fairytales by Charles Perrault and The Brothers Grimm, and the biblical story of an old King Solomon who had young virgins brought to him from all over his realm to sleep alongside him. She also noted the phenomenon of images of sleeping girls on some of the fetish websites. Kawabata's novel had been adapted in 2006 by German director Vadim Glowna, as "Das Haus der Schlafenden Schönen" ("House of the Sleeping Beauties"), but had been released to generally negative reviews.


title: Sleeping Beauty (2011 film)

text: The "Sleeping Beauty" script made the 2008 Black List of unproduced screenplays grabbing attention in Hollywood. In September 2009 the project was approved for funding from Screen Australia. In February 2010 it was announced that Emily Browning would play the lead role. Mia Wasikowska was originally cast as Lucy but she dropped out when offered the title role in an adaptation of "Jane Eyre".


title: Sleeping Beauty (2011 film)

text: Principal photography on the film began on 3 April 2010, at University of Sydney, Camperdown and downtown Sydney, New South Wales, Australia.


title: Sleeping Beauty (2011 film)

text: Emily Browning said she didn't have a problem with nudity, but she admitted the scene with the sadist character was unpleasant to film.


title: Sleeping Beauty (2011 film)

text: , the film holds a 48% approval rating on Rotten Tomatoes, based on 97 reviews with an average rating of 5.22/10. The website's critics consensus reads: ""Sleeping Beauty"s provocative premise and luminous art design is hampered by a clinical, remote presentation, delivering boredom and shock in equal measure." On Metacritic, the film has a score of 57 out of 100, based on 20 "mixed or average reviews".


title: Finland in World War II

text: Finland participated in the Second World War initially in a defensive war against the Soviet Union, followed by another battle against the Soviet Union acting in concert with Nazi Germany and then finally fighting alongside the Allies against Germany.


title: Finland in World War II

text: The first two major conflicts in which Finland was directly involved were the defensive Winter War against an invasion by the Soviet Union in 1939, followed by the offensive Continuation War, together with Germany and the other Axis Powers against the Soviets, in 1941–1944. The third conflict, the Lapland War against Germany in 1944–1945, followed the signing of the Moscow Armistice with the Allied Powers, which stipulated expulsion of Nazi German forces from Finnish territory.


title: Finland in World War II

text: By the end of hostilities, Finland remained an independent country, albeit "Finlandized", having to cede nearly 10% of its territory, including Viipuri (Finland's second-largest city [Population Register] or fourth-largest city [Church and Civil Register], depending on the census data), pay out a large amount of war reparations to the Soviet Union, and formally acknowledge partial responsibility for the Continuation War.


title: Finland in World War II

text: In 1809, the Russian Empire seized Finland from Sweden in the Finnish War. Finland entered a personal union with the Russian Empire as a grand duchy with extensive autonomy. During the period of Russian rule the country generally prospered. On 6 December 1917, during the Russian Civil War, the Finnish parliament ("Suomen Eduskunta") declared independence from Russia, which was accepted by the Bolshevik government of the Soviet Union on 31 December. In January 1918, the "Eduskunta" ordered General Carl Mannerheim to use local Finnish White Guards to disarm Finnish Red Guards and Russian troops throughout the country, a process which began on 27 January and led to the beginning of the Finnish Civil War.


title: Finland in World War II

text: After the Eastern Front and peace negotiations between the Bolsheviks and Germany collapsed, German troops intervened in the country and occupied Helsinki and Finland. The Red faction was defeated and the survivors were subjected to a reign of terror, in which at least 12,000 people died. A new government, with Juho Kusti Paasikivi as prime minister, pursued a pro-German policy and sought to annex Russian Karelia, which had a Finnish-speaking majority, despite never having been a part of Finland.


title: Finland in World War II

text: After the extinction of the Hohenzollern monarchy on 9 November 1918, Poland, Estonia, Latvia, and Lithuania became independent, German troops left Finland, and British ships patrolled the Baltic Sea. Mannerheim was elected regent by the "Eduskunta", and Finnish policy became pro-Entente as the western powers intervened in the Russian Civil War (7 November 1917 – 16 June 1923). Mannerheim favoured intervention against the Bolsheviks but suspicion of the White Russians who refused to recognise Finnish independence led to his aggressive policy being overruled; then, the Bolshevik victory in Russia forestalled Finnish hostilities.


title: Finland in World War II

text: Paasikivi led a delegation to Tartu, in Estonia, with instructions to establish a frontier from Lake Ladoga in the south, via Lake Onega to the White Sea in the north. The importance of the Murmansk railway, built in 1916, led the Soviet delegation to reject the Finnish border proposal, and the treaty of 14 October 1920 recognised a border agreement in which Finland obtained the northern port of Petsamo (Pechenga), an outlet to the Arctic Ocean, and a border roughly the same as that of the former Grand Duchy of Finland. Claims on areas of Eastern Karelia were abandoned and the Soviets accepted that the south-eastern border would not be moved west of Petrograd.


title: Finland in World War II

text: During the Interwar period, relations between Finland and the Soviet Union were tense. Some elements in Finland maintained the dream of a "Greater Finland" which included the Soviet-controlled part of Karelia, while the proximity of the Finnish border to Leningrad (now Saint Petersburg) caused worry among the Soviet leadership. On 23 August 1939, Nazi Germany and the Soviet Union signed the Molotov–Ribbentrop Pact, which included a secret clause demarcating Finland as part of the Soviet sphere of influence.


title: Finland in World War II

text: On 12 October the Soviet Union began negotiations with Finland regarding the disposition of the Karelian Isthmus, the Hanko Peninsula, and various islands in the Gulf of Finland, all of which were considered by the Finns to be Finnish territory. No agreement was reached. On 26 November the Soviet Union accused the Finnish army of shelling the village of Mainila. It was subsequently found that the Soviets had in fact shelled their own village, in order to create a pretext for withdrawal from their non-aggression pact with Finland. On 30 November 1939, the Soviet Union attacked Finland. The attack was denounced by the League of Nations, and as a result, the Soviet Union was expelled from that body on 14 December.


title: Finland in World War II

text: The aim of the invasion was to liberate the 'Red Finns' and eventually annex Finland to the Soviet Union. To this end, a puppet government, the Finnish Democratic Republic, was established in Terijoki under the leadership of the exiled O. W. Kuusinen. The first attack, on 30 November 1939, was an aerial bombardment of the city of Helsinki, with subsidiary attacks all along the Finnish-Soviet border. This had the effect of instantly unifying the once deeply-divided Finnish people in defense of their homes and country, without any referendums needing to be carried out.


title: Finland in World War II

text: Strategic goals of the Red Army included cutting Finland in half and capturing Petsamo in the north and Helsinki in the south. The leader of the Leningrad Military District, Andrei Zhdanov, commissioned a celebratory piece from Dmitri Shostakovich, "Suite on Finnish Themes", intended to be performed as the marching bands of the Red Army paraded through Helsinki. The Soviets had been building up their forces on the border during the earlier negotiations, and now fielded four armies composed of 16 divisions, with another three being brought into position; meanwhile, the Finnish army had just 9 smaller divisions. The Soviets also enjoyed overwhelming superiority in the number of armour and air units deployed. The Finns had to defend a border that was some 1287 km (800 miles) in length, putting them at a significant disadvantage.


title: Finland in World War II

text: The Winter War was fought in three stages: the initial Soviet advance, a short lull, and then a renewed Soviet offensive. The war was fought mainly in three areas. The Karelian Isthmus and the area of Lake Ladoga were the primary focus of the Soviet war effort. A two-pronged attack was launched in this region, with one pincer engaging Finnish forces on the Isthmus while the other went around Lake Ladoga in an attempt at encircling the defenders. This force was then to advance to and capture the city of Viipuri. The second front was in central Karelia, where Soviet forces were to advance to the city of Oulu, cutting the country in half. Finally, a drive from the north was intended to capture the Petsamo region. By late December the Soviets had become bogged down, with the two main fronts at a standstill as the Finns counterattacked with greater strength than anticipated. With the failure of two of its three offensives by the end of December, Soviet headquarters ordered a cessation of operations. By 27 December, it was observed that the Soviets were digging in on the Karelian Isthmus. In the north, the Finns had been pushed back to Nautsi, but with reinforcements, had been able to take the higher ground and halt the Soviet advance south of Petsamo. During this period the Finns harassed supply columns and carried out raids against fortified Soviet positions. A lull followed in January 1940, as the Soviet army reassessed its strategy, and rearmed and resupplied. On 29 January, Molotov put an end to the puppet Terijoki Government and recognized the Ryti–Tanner government as the legal government of Finland, informing it that the USSR was willing to negotiate peace.


title: Finland in World War II

text: The last phase began in February 1940, with a major artillery barrage that began on the 2nd and lasted until the 11th, accompanied by reconnaissance raids at key objectives. The Soviets, using new equipment and materials, also began using the tactic of rotating troops from the reserve to the front, thus keeping constant pressure on the Finnish defenders. It seemed that the Red Army had inexhaustible amounts of ammunition and supplies, as attacks were always preceded by barrages, followed by aerial assaults and then random troop movements against the lines. Finnish military and government leaders realized that their only hope of preserving their nation lay in negotiating a peace treaty with Moscow.


title: Finland in World War II

text: The tenacity of the Finnish people, both military and civilian, in the face of a superior opponent gained the country much sympathy throughout the world; however, material support from other countries was very limited, as none of Finland's neighbors were willing to commit their militaries to a war against the USSR. The need for a diplomatic solution became even more apparent after Soviet forces broke through the Finnish defensive line on the Karelian Isthmus and moved on towards Viipuri.


title: Finland in World War II

text: A peace proposal authored by Molotov was sent to Helsinki in mid-February. It placed heavy demands on Finland, claiming more land for the USSR and imposing significant diplomatic and military sanctions. By 28 February, Molotov had made his offer into an ultimatum with a 48-hour time limit, which pushed the Finnish leadership to act quickly. On 12 March 1940, the Moscow Peace Treaty was signed, with hostilities ending the following day. By the terms of the treaty, Finland ceded 9% of its territory to the USSR. This was more territory than the Soviets had originally demanded.


title: Finland in World War II

text: The period of peace following the Winter War was widely regarded in Finland as temporary, even when peace was announced in March 1940. A period of frantic diplomatic efforts and rearmament followed. The Soviet Union kept up intense pressure on Finland, thereby hastening the Finnish efforts to improve the security of the country.


title: Finland in World War II

text: Defensive arrangements were attempted with Sweden and the United Kingdom, but the political and military situation in the context of the Second World War rendered these efforts fruitless. Finland then turned to Nazi Germany for military aid. As the German offensive against the Soviet Union (Operation Barbarossa) approached, the cooperation between the two countries intensified. German troops arrived in Finland and took up positions, mostly in Lapland, from where they would invade the Soviet Union.


title: Finland in World War II

text: Operation Barbarossa began on 22 June 1941. On 25 June the Soviet Union launched an air raid against Finnish cities, after which Finland declared war and also allowed German troops stationed in Finland to begin offensive warfare. The resulting war was known to the Finns as the Continuation War.


title: Finland in World War II

text: During the summer and autumn of 1941 the Finnish Army was on the offensive, retaking the territories lost in the Winter War. The Finnish army also advanced further, especially in the direction of Lake Onega, (east from Lake Ladoga), closing the blockade of the city of Leningrad from the north, and occupying Eastern Karelia, which had never been a part of Finland before. This resulted with Stalin asking Roosevelt for help in restoring peaceful relations between Finland and the Soviet Union on 4 August 1941. Finland's refusal of the Soviet offer of territorial concessions in exchange for a peace treaty would later cause Great Britain to declare war on Finland on 6 December (The US maintained diplomatic relations with Finland until the summer of 1944). The German and Finnish troops in Northern Finland were less successful, failing to take the Russian port city of Murmansk during Operation Silver Fox.


title: Finland in World War II

text: On 31 July 1941 the United Kingdom launched raids on Kirkenes and Petsamo to demonstrate support for the Soviet Union. These raids were unsuccessful.


title: Finland in World War II

text: In December 1941, the Finnish army took defensive positions. This led to a long period of relative calm in the front line, lasting until 1944. During this period, starting at 1941 but especially after the major German defeat in the Battle of Stalingrad, intermittent peace inquiries took place. These negotiations did not lead to any settlement.


title: Finland in World War II

text: On 16 March 1944, the President of the United States, Franklin D. Roosevelt, called for Finland to disassociate itself from Nazi Germany.


title: Finland in World War II

text: On 9 June 1944, the Red Army launched a major strategic offensive against Finland, attaining vast numerical superiority and surprising the Finnish army. This attack pushed the Finnish forces approximately to the same positions as they were holding at the end of the Winter War. Eventually, the Soviet offensive was fought to a standstill in the Battle of Tali-Ihantala, while still tens or hundreds of kilometres in front of the main Finnish line of fortifications, the Salpa Line. However, the war had exhausted Finnish resources and it was believed that the country would not be able to hold against another major attack.


title: Finland in World War II

text: The worsening situation in 1944 had led to Finnish president Risto Ryti giving Germany his personal guarantee that Finland would not negotiate peace with the Soviet Union for as long as he was the president. In exchange, Germany delivered weapons to the Finns. After the Soviet offensive was halted, however, Ryti resigned. Due to the war, elections could not be held, and therefore the Parliament selected the Marshal of Finland Carl Gustaf Emil Mannerheim, the Finnish commander-in-chief, as president and charged him with negotiating a peace.


title: Finland in World War II

text: The Finnish front had become a sideshow for the Soviet leadership, as they were in a race to reach Berlin before the Western Allies. This, and the heavy casualties inflicted on the Red Army by the Finns, led to the transfer of most troops from the Finnish front. On 4 September 1944 a ceasefire was agreed, and the Moscow armistice between the Soviet Union and United Kingdom on one side and Finland on the other was signed on 19 September.


title: Finland in World War II

text: The Moscow armistice was signed by Finland and the Soviet Union on 19 September 1944 ending the Continuation War, though the final peace treaty was not to be signed until 1947 in Paris.


title: Finland in World War II

text: The conditions for peace were similar to those previously agreed in the 1940 Moscow Peace Treaty, with Finland being forced to cede parts of Finnish Karelia, a part of Salla and islands in the Gulf of Finland. The new armistice also handed the whole of Petsamo over to the Soviet Union. Finland also agreed to legalize communist parties and ban fascist organizations. Finally, the armistice also demanded that Finland must expel German troops from its territory, which was the cause of the Lapland War.


title: Finland in World War II

text: The Lapland War was fought between Finland and Nazi Germany in Lapland, the northernmost part of Finland. The main strategic interest of Germany in the region was the nickel mines in the Petsamo area.


title: Finland in World War II

text: Initially the warfare was cautious on both sides, reflecting the previous cooperation of the two countries against their common enemy, but by the end of 1944 the fighting intensified. Finland and Germany had made an informal agreement and schedule for German troops to withdraw from Lapland to Norway. The Soviet Union did not accept this "friendliness" and pressured Finland to take a more active role in pushing the Germans out of Lapland, thus intensifying hostilities.


title: Finland in World War II

text: The Germans adopted a scorched-earth policy, and proceeded to lay waste to the entire northern half of the country as they retreated. Around 100,000 people lost their homes, adding to the burden of post-war reconstruction. The actual loss of life, however, was relatively light. Finland lost


title: Finland in World War II

text: approximately 1,000 troops and Germany about 2,000. The Finnish army expelled the last of the foreign troops from their soil in April 1945.


title: Finland in World War II

text: The war caused great damage to infrastructure and the economy. From the autumn of 1944, the Finnish army and navy performed many mine clearance operations, especially in Karelia, Lapland and the Gulf of Finland. Sea mine clearance activities lasted until 1950. The mines caused many military and civilian casualties, particularly in Lapland.


title: Finland in World War II

text: As part of the Paris Peace Treaty, Finland was classified as an ally of Nazi Germany, bearing its responsibility for the war. The treaty imposed heavy war reparations on Finland and stipulated the lease of the Porkkala area near the Finnish capital Helsinki as a military base for fifty years. The reparations were initially thought to be crippling for the economy, but a determined effort was made to pay them. The reparations were reduced by 25% in 1948 by the Soviet Union and were paid off in 1952. Porkkala was returned to Finnish control in 1956.


title: Finland in World War II

text: In subsequent years the position of Finland was unique in the Cold War. The country was heavily influenced by the Soviet Union, but was the only country on the Soviet pre-World War II border to retain democracy and a market economy. Finland entered into the Agreement of Friendship, Cooperation, and Mutual Assistance (YYA Treaty) with the Soviet Union in which the Soviet Union agreed to the neutral status of Finland. Arms purchases were balanced between East and West until the fall of the Soviet Union.


title: Finland in World War II

text: During the Continuation War (1941–1944) Finland's wartime government claimed to be a co-belligerent of Nazi Germany against the Soviet Union, and abstained from signing the Tripartite Pact. Finland was dependent on food, fuel, and armament shipments from Germany during this period, and was influenced to sign the Anti-Comintern Pact, a less formal alliance than the Tripartite Pact seen as by the Nazi leadership as a "litmus test of loyalty". The Finnish leadership adhered to many written and oral agreements on practical co-operation with Germany during the conflict. Finland was one of Germany's most important allies in the attack on the Soviet Union, allowing German troops to be based in Finland before the attack and joining in the attack on the USSR almost immediately. The 1947 Paris Peace treaty signed by Finland stated that Finland had been "an ally of Hitlerite Germany" and bore partial responsibility for the conflict.


title: Finland in World War II

text: Finland was an anomaly amongst German allies in that it retained an independent democratic government. Moreover, during the war, Finland kept its army outside the German command structure despite numerous attempts by the Germans to tie them more tightly together. Finland managed not to take part in the siege of Leningrad despite Hitler's wishes, and refused to cut the Murmansk railway.


title: Finland in World War II

text: Finnish Jews were not persecuted, and even among extremists of the Finnish Right they were highly tolerated, as many leaders of the movement came from the clergy. Of approximately 500 Jewish refugees, eight were handed over to the Germans, a fact for which Finnish prime minister Paavo Lipponen issued an official apology in 2000. The field synagogue operated by the Finnish army was probably a unique phenomenon in the Eastern Front of the war. Finnish Jews fought alongside other Finns.


title: Finland in World War II

text: About 2,600–2,800 Soviet prisoners of war were handed over to the Germans in exchange for roughly 2,200 Finnic prisoners of war held by the Germans. In November 2003, the Simon Wiesenthal Center submitted an official request to Finnish President Tarja Halonen for a full-scale investigation by the Finnish authorities of the prisoner exchange. In the subsequent study by Professor Heikki Ylikangas it turned out that about 2,000 of the exchanged prisoners joined the Russian Liberation Army. The rest, mostly army and political officers, (among them a name-based estimate of 74 Jews), most likely perished in Nazi concentration camps.


title: Finland in World War II

text: During World War II, Finland was anomalous: It was the only European country bordering the Soviet Union in 1939 which was still unoccupied by 1945. It was a country which sided with Germany, but in which native Jews and almost all refugees were safe from persecution. It was the only country that fought alongside Nazi Germany which maintained democracy throughout the war. It was in fact the only democracy in mainland Europe that remained so despite being an involved party in the war.


title: Finland in World War II

text: According to the Finnish records 19,085 Soviet prisoners of war died in Finnish prison camps during the Continuation War, which means that 29.6% of Soviet POWs taken by the Finns did not survive. The high number of fatalities was mainly due to malnutrition and diseases. However, about 1,000 POWs were shot, primarily when attempting to escape.


title: Finland in World War II

text: When the Finnish Army controlled East Karelia between 1941 and 1944, several concentration camps were set up for Russian civilians. The first camp was set up on 24 October 1941, in Petrozavodsk. Of these interned civilians 4,361 perished mainly due to malnourishment, 90% of them during the spring and summer of 1942.


title: Finland in World War II

text: Finland never signed the Tripartite Pact, but was aided in its military assault on the Soviet Union by Germany from the beginning of Operation Barbarossa in 1941, and in its defence against Soviet attacks in 1944 prior to the separate peace with the Soviet Union in 1944. Finland was led by its elected president and parliament during the whole 1939–1945 period. As a result, some political scientists name it as one of the few instances where a democratic country was engaged in a war against one or more other democratic countries, namely the democracies in the Allied forces. However, nearly all Finnish military engagements in World War II were fought solely against an autocratic power, the Soviet Union, and the lack of direct conflicts specifically with other democratic countries leads others to exclude Finnish involvement in World War II as an example of a war between two or more democracies.


title: Finland in World War II

text: Finnish President Tarja Halonen, speaking in 2005, said that "For us the world war meant a separate war against the Soviet Union and we did not incur any debt of gratitude to others". Finnish President Mauno Koivisto also expressed similar views in 1993. However the view that Finland only fought separately during the Second World War remains controversial within Finland and was not generally accepted outside Finland. In a 2008 poll of 28 Finnish historians carried out by "Helsingin Sanomat", 16 said that Finland had been an ally of Nazi Germany, six said it had not been, and six did not take a position.


title: All Good Things (film)

text: All Good Things is a 2010 American mystery/crime romantic drama film directed by Andrew Jarecki and written by Marcus Hinchey and Marc Smerling. Inspired by the life of Robert Durst, it stars Ryan Gosling, Kirsten Dunst, and Frank Langella. Gosling portrays the wealthy son of a New York real estate tycoon (Langella) who develops a disturbing relationship with his wife (Dunst) and becomes suspected of a series of murders, as well as his wife's unsolved disappearance.


title: All Good Things (film)

text: "All Good Things" was filmed between April and July 2008 in Connecticut and New York. Originally scheduled for a July 24, 2009 release, the film ultimately received a limited release on December 3, 2010.


title: All Good Things (film)

text: Durst professed admiration for the film, and after previously not cooperating with journalists, offered to be interviewed by Jarecki. Durst would ultimately sit with Jarecki for more than 20 hours over a multi-year period, which led to the six-part documentary miniseries "The Jinx" in 2015.


title: All Good Things (film)

text: In 1970s New York City, David Marks, the son of a powerful real estate tycoon Sanford Marks, marries Katie McCarthy, a working-class student. Together they try to establish a new life in Vermont, setting up a health food store called All Good Things. However, Sanford manipulates David into returning to the city, telling him that Katie deserves more than he's currently giving her. Upon their return, Katie brings up the idea of having children. David says it will never ever happen, which leads Katie to assume something is wrong with his fertility. After buying a lake house, Katie confesses to their pregnant neighbor that she is expecting as well. David responds angrily upon finding out and forces Katie to make an appointment for an abortion. He misses the appointment when he is called away to do work for his father.


title: All Good Things (film)

text: Katie enters medical school while her relationship with David continues to deteriorate. She makes inquiries about a separation, but her funds, which she needs in order to pay for school, are cut off when she attempts to leave. Having been advised that she will need leverage to compel the family to let her leave David, Katie attempts to find incriminating documents of their financial activities. She then disappears without a trace in 1982, despite a $15,000 reward offered for any information on her whereabouts.


title: All Good Things (film)

text: Eighteen years later, the case is reopened by the district attorney after reading an unpublished novel written by David's best friend, Deborah Lehrman, which contains a murder almost identical to the Marks case. Soon after this is announced, Lehrman is shot and killed in her home, and David is under suspicion again while standing trial for the murder of his neighbor Malvern Bump in Texas. David is acquitted of the murder of Bump; the film states that nobody has ever been tried for Lehrman's murder and that Katie remains a missing person to this day. A flash-back implies that David left his wife's remains in the trunk of her car, which the father finds. The film ends with David visiting his dying father and whispering to him, "I miss her so much." It's left to the viewer to decide whether he is talking about Katie or his mother.


title: All Good Things (film)

text: The screenplay for "All Good Things" was written by Marcus Hinchey and Marc Smerling as a narrative loosely based on the events in the life of Robert Durst, a New York City real estate heir whose first wife, Kathleen McCormack, disappeared in 1982. The film's title refers to a health food store of the same name which Durst and McCormack had established in the 1970s.


title: All Good Things (film)

text: After the script was completed and Andrew Jarecki had agreed to direct, Ryan Gosling was attached to star and Kirsten Dunst was in negotiations by late January 2008. By early April, Frank Langella was in final negotiations with the film's producers to join. Soon after, The Weinstein Company closed a deal to distribute "All Good Things", and the film's budget was set at $20,000,000.


title: All Good Things (film)

text: Filming began in April in New York City and various locations in Connecticut, which were chosen for "the tax incentive, scenic and period locations" provided by the state. Shooting on Lillinonah Drive at a lakefront house in Brookfield, Connecticut began in early May. Five locations at the Fairfield University campus were used for several scenes over a week of filming. The set moved to Carl Schurz Park, New York City, briefly before switching back to Connecticut. Three scenes were shot at Canal Street, Shelton, Connecticut, on May 30–31. Much of the Canal Street filming focused on the "heavy, industrial features" of the area, although the crew made some edits, such as graffito removal.