title: 2021 Czech legislative election

text: The final phase of the campaign was launched on 25 August 2021. Přísaha introduced its regional leaders and program, under the slogan "Let's go to them!" The main campaign topic was fighting corruption and clientelism. Šlachta also stated that he wanted to make courts faster and fight for Czech identity, rejecting the euro and migration quotas. He also pledged to investigate all state contracts concluded under the state of emergency. Šlachta stated that Přísaha had crowdfunded 13.8 million CZK for the campaign, and calculated that the campaign would cost around 15 million CZK.


title: 2021 Czech legislative election

text: The party hovered around the 5% electoral threshold in polling between May and the election. In September 2021, Přísaha's support in opinion polls gradually declined, which was blamed on the launch of the ANO campaign. Šlachta stated before voting that he believed the party would reach his goal of surpassing the 5% threshold.


title: 2021 Czech legislative election

text: Three centre-right parties, the Civic Democratic Party, KDU-ČSL, and TOP 09, formed an electoral alliance called SPOLU. Led by Petr Fiala, the alliance launched its campaign on 9 December 2020, promising to reform tax, the social and pension system, and healthcare. Its proposals included a minimum pension, a simplification of social benefits, support for education, and better use of EU funds as well as a focus on climate change. It opposes leaving the EU and supports membership of NATO. TOP 09 leader Markéta Adamová described the alliance as a centre-right liberal conservative political force.


title: 2021 Czech legislative election

text: SPOLU launched its campaign on 19 May 2021 in Brno. The campaign's slogan was "We will bring the Czech Republic together." Fiala said that SPOLU wants an "economically capable and educated Czechia". SPOLU planned to use Dominik Feri as the face of an Instagram campaign targeting young voters entitled "I have a voice". In May 2021, Feri resigned from his political posts after being accused of sexual assault and rape by eight women, and the campaign was withdrawn. In response to the 2021 South Moravia tornado, SPOLU interrupted its campaign in South Moravia and donated 1.5 million CZK to help people in the affected areas.


title: 2021 Czech legislative election

text: From August, SPOLU's campaign featured a bus, known as the "positive bus", to be used for its candidates' personal campaigns. SPOLU also screened the film "Women on the Run" at its campaign meetings, and featured stand-up comedians including Petr Čtvrtníček in electoral adverts. Fiala became more active on social media and travelled around the Czech Republic as part of a personal campaign. In late August 2021, SPOLU used billboards featuring the leaders of ANO, KSČM, and SPD with the word "Threat", which was often juxtaposed with a billboard featuring the leaders of SPOLU with the words "Change you can trust." On 4 September 2021, SPOLU reacted to the launch of ANO's campaign by launching a parody meme generator inspired by the ANO campaign and its slogan "Until my body falls apart!". On 3 September 2021, SPOLU were endorsed by Austrian Chancellor Sebastian Kurz, who sent a letter to Fiala wishing the alliance electoral success.


title: 2021 Czech legislative election

text: SPOLU launched the final phase of their campaign on 20 September 2021 with a meeting inspired by the United States presidential campaigns. In a speech, Fiala criticised Andrej Babiš' Cabinet for populism and warned against extremists. Fiala pledged that SPOLU would reduce the public debt without increasing taxes, guarantee the pro-Western orientation of the country, and digitalise public administration. He also said he wanted to solve the housing crisis. The meeting was held under the slogans "It is about everything now" and "Let's start change." Around this time, prominent representatives of SPOLU visited the regions to meet with citizens.


title: 2021 Czech legislative election

text: Following the television debates, SPOLU used the line "The cost of Babiš" to attack the government over inflation and the rising prices of energy and groceries. The term was first used by Fiala during a debate on Prima CNN News, before becoming a part of the alliance's billboard campaign and spreading among ODS supporters. Fiala himself used the term repeatedly during debates.


title: 2021 Czech legislative election

text: In the last polls before the election, SPOLU were polling second behind ANO. Commentators noted that the gap between ANO and SPOLU was narrowing, but none predicted that SPOLU would pull ahead.


title: 2021 Czech legislative election

text: The Tricolour Citizens' Movement, Svobodní, and Freeholder Party of the Czech Republic formed an electoral alliance called Tricolour–Svobodní–Soukromníci (TSS), led by Tricolour leader Zuzana Majerová Zahradníková. Václav Klaus Jr. was originally meant to be the electoral leader, but he quit politics soon after formation of the alliance.


title: 2021 Czech legislative election

text: TSS launched its campaign on 17 June 2021 with the slogan "We have a right to live". Their campaign focused on traditional values and opposition to COVID-19 restrictions. Majerová Zahradníková targeted right-wing Eurosceptic voters, and also wanted to use former Czech President Václav Klaus during the campaign. Majerová Zahradníková stated during the campaign that TSS rejected the lockdown, Green New Deal, and grocery quotas. During September 2021 she also campaigned on the issue of rising prices. TSS aimed to win 7% of votes.


title: 2021 Czech legislative election

text: During final phase of the campaign, TSS focused on Spolu voters, distributing leaflets warning of a new Opposition agreement. TSS also attacked Spolu for being too Green and too pro-Europe. The party warned of "Covid totalitarianism" while attacking COVID-19 restrictions, rejecting a new lockdown, school closures, or "segregation of the non-vaccinated". TSS argued that it was the only "true authentic right" on the Czech political scene. A few hours prior to the election it was endorsed by former Czech president Václav Klaus.


title: 2021 Czech legislative election

text: Urza.cz is an anarcho-capitalist party led by Martin Urza. Its campaign began gathering signatures in April 2021. The party was registered in July 2021. Urza was campaigning to promote his beliefs, rather than attract votes. The party promised that its MPs would resign if elected, as it did not believe that anyone should govern by force.


title: 2021 Czech legislative election

text: The Chcípl pes () initiative was created in opposition to COVID-19 restrictions. Its members decided to form a political party called "We Will Open Czechia". Its campaign was focused against COVID-19 restrictions and included various protests. The party also called on pub owners to open their businesses despite government orders. In April 2021 the party sent a mobile barber shop to Prague, where the public could get haircuts or buy beer. It was also used as a petition stand. The barber shop later moved from Prague to other locations around the country, finishing its journey in Ostrava. In August 2021, the leaders of the party called for a new Prague defenestration, saying that "people should do anything required to overthrow criminal deputies."


title: 2021 Czech legislative election

text: Million Moments for Democracy led a campaign against Andrej Babiš and ANO 2011, attempting to persuade voters to support the opposition alliances Spolu or Pirates and Mayors. Members of the movement talked to people in the streets and gave them leaflets in order to change their minds vote for one of major opposition alliances. The campaign also included a messenger app called "I vote change", which aimed to persuade people through gifs and various questions that they should vote for Spolu or Pirates and Mayors. Leader Benjamin Roll denied that the organisation's activities were a real election campaign, insisting that it was aiming to inform people. The group's activities attracted the attention of the Office for the Supervision of the Management of Political Parties and Political Movements, which launched an investigation into possible election law violations, as the organisation had not registered as an organisation participating in the campaign.


title: 2021 Czech legislative election

text: The electoral coalition SPOLU won the most votes but finished with one fewer seat (71) in the Chamber of Deputies than ANO 2011, which won 72 with a lower vote share. ANO had the largest number of deputies of any party, winning twice as many seats as the second place Civic Democratic Party (ODS). The Pirates and Mayors (PirStan) electoral coalition came third with 37 seats. Due to preference voting, Mayors and Independents won 33 seats and the Czech Pirate Party won just 4 seats. Freedom and Direct Democracy (SPD) came fourth, and were the only other political party or electoral coalition to be elected to the Chamber. The election saw the highest ever number of discarded votes for parties not meeting the 5% threshold in the history of elections in the Czech Republic, with more than 1 million, or about 20%. The Czech Social Democratic Party and the Communist Party of Bohemia and Moravia failed to win any seats in the lower chamber for the first time since 1990, and the respective party leaders Jan Hamáček and Vojtěch Filip resigned. For the first time since the Third Czechoslovak Republic, a Communist party would not be represented in the national parliament covering the Czech lands.


title: 2021 Czech legislative election

text: Political analyst Jiří Pehe of the New York University in Prague hailed the results as a "triumph for liberal democracy" and said they "signalled the end of the post-Communist era." Political analyst Michal Klima told Czech public television that the result meant "an absolute change of the politics in the Czech Republic. It stabilises the country's position in the West camp. It's a huge defeat for [Babiš]."


title: 2021 Czech legislative election

text: The media considered the result a surprise and an upset, as polls had shown ANO 2011 as the clear front-runner. Spolu were polling second but the last polls showed a surge in support, though it was still expected that they would lose. Martin Buchtík, Director of the STEM polling agency, said he thought it would be impossible that ANO 2011 would not receive the highest number of votes. Director of Median, Přemysl Čech, said it was unlikely that Spolu would be first. The Director of Kantar, Pavel Ranocha, also said he believed ANO 2011 would be first, but noted that the latest data showed that gap between ANO 2011 and Spolu narrowing. The directors of all three major polling agencies agreed that Pirates and Mayors had no chance of defeating ANO 2011, and also agreed that only ANO 2011, Spolu, Pirates and Mayors and SPD could be certain of winning seats in the Chamber of Deputies, as KSČM, ČSSD and Přísaha were all hovering around the 5% threshold. Spolu's victory in the election, against polling evidence, was attributed to a "last minute swing". Sociologist Jan Herzmann said that large number of voters had changed their mind in the last moments, which could not be detected by opinion polls. He argued that in the last week running up to the election it had become clear that Petr Fiala was an equal opponent to Prime Minister Andrej Babiš, and competition between the two men led voters of smaller parties to switch to Spolu or ANO 2011, leading to disappointing results for Pirates and Mayors and SPD. Ranocha said that undecided voters were still deciding between Spolu or Pirates and Mayors, and Spolu were ahead in the polls. He also said that a large number of voters decided to support Spolu due to the television debates. Journalist Jan Horák of Aktuálně.cz said that Spolu were competing with Pirates and Mayors to be the main opposition option, but opinion polls showed Spolu as the stronger of the two, which won them votes. He also noted that Fiala was more acceptable than Pirate leader Ivan Bartoš. Political scientist Lubomír Kopeček said that inflation and the Pandora Papers affair may have contributed to ANO's defeat.


title: 2021 Czech legislative election

text: New Chamber of Deputies has highest representation of women with 50 elected female MPs. PirStan has highest representation of women with 35% of MPs being female. Average age of elected MPs is 50 years with Bohuslav Svoboda at 77 years being oldest MP. Ondřej Babek is the youngest MP as he is 27 years old.


title: 2021 Czech legislative election

text: On 12 November 2021, STEM published a poll conducted from 15 October to 25 October 2021. According to the poll, 61% of PirStan supporters were Pirate Party supporters, while 39% supported STAN. However, 58% of STAN supporters used preferential voting, compared to only 29% of Pirate Party supporters, resulting in a large difference in seat distribution between the two parties. According to the poll, 49% of SPOLU voters were supporters of ODS, 26% of TOP 09, and 25% of KDU-ČSL. 47% of KDU-ČSL supporters, 44% of ODS supporters and 35% of TOP 09 supporters used preferential voting.


title: 2021 Czech legislative election

text: The Supreme Administrative Court received 210 complaints about election irregularities, three times more than in 2017. Many complaints were directed at Czech Television, stating that its election coverage benefitted some parties. Others attacked the electoral coalitions and the rule of wearing masks at polling stations.


title: 2021 Czech legislative election

text: It was reported on 22 October 2021 that the Pirates and Mayors had lodged a complaint stating that the Czech Statistical Bureau misinterpreted the electoral law, resulting in an incorrect allocation of seats. If the complaint is successful, then ANO 2011 will lose one seat to Pirates and Mayors. The deadline to respond to complaints is 11 November 2021. Another complaint that received media attention was made by Zdeněk Černý, who was due to run as a candidate for SPOLU in South Moravia before his candidacy was withdrawn in the last moments before the election. Černý argued his withdrawal was illegal and wanted to invalidate the election of all SPOLU candidates in South Moravia to recount the preferential votes.


title: 2021 Czech legislative election

text: On 5 November 2021, the Supreme Administrative Court rejected all complaints, including those made by Pirates and Mayors and by Zdeněk Černý. It stated that Pirates and Mayors had misunderstood the electoral law. On 8 December 2021, Pirates and Mayors sent a complaint to Constitutional Court seeking to repeal the decision by the Supreme Administrative Court. On 26 January 2022, the Constitutional Court rejected the complaint for procedural reasons.


title: 2021 Czech legislative election

text: Incumbent prime minister Andrej Babiš conceded defeat and accepted the results of the vote on the night of 9 October, saying: "That's life, we understand and accept that." Babiš also accused the opposition of a "smear campaign" during the lead-up to the election. Incumbent president Miloš Zeman had indicated that he would give the prime ministerial mandate to the candidate of the largest party, not the largest coalition. Babiš described ANO's performance as a great result, but said he was not expecting a loss. He congratulated the chairman of SPOLU for becoming the largest coalition, and said that he was open to talks with all parties who were going to enter the new parliament, except for PirStan, which he ruled out. PirStan said they would not join or support an ANO-led government, or a government that included SPD, calling them "parties with a corrupt past" (ANO) or parties "threatening liberal democracy" (SPD).


title: 2021 Czech legislative election

text: SPD ruled out joining a coalition government with ANO but indicated that they were open to exploratory talks with ANO about providing direct or indirect support to an ANO-led minority government. SPD leader Tomio Okamura said in a press conference that passing a new law to allow national referendums, including on Czexit and possibly NATO membership, was his condition for supporting Babiš's campaign for a second term in office. Babiš left the door open to possible cooperation with SPD but indicated that this was not his first choice as he rejected a referendum on EU membership. After results showed that a potential ANO–SPD majority was mathematically impossible, Babiš indicated his willingness to form a grand coalition with SPOLU, if he were to be asked first by Zeman. Petr Just, a political scientist at the Metropolitan University Prague, said many in ODS were open to forming a government with ANO, as long as Babiš was not part of the government, while many in ANO preferred an alliance with ODS instead of SPD. SPOLU ruled this scenario out, especially if Babiš continued as prime minister.


title: 2021 Czech legislative election

text: After the results, SPOLU and PirStan signed a memorandum to form a coalition government with Petr Fiala as prime minister. Both groups said they would not work with Babiš. Petr Fiala said: "The two democratic coalitions (SPOLU and Pirates and Mayors) have gained a majority and have a chance to form a majority government. We are the change. You are the change." PirStan leader Ivan Bartoš said talks with SPOLU "on the possibilities of forming a new government" would likely begin on 9 October. He hailed the end of the "dominance of Andrej Babiš", and said that "the democratic parties have shown that the era of chaos will probably be behind us."


title: 2021 Czech legislative election

text: On 10 October, Zeman was hospitalized, creating uncertainty over how and when the government formation talks would be held. On 11 October, a spokesman for the hospital said that Zeman's condition had stabilized, commenting: "The reason for [Zeman's] hospitalization is complications from the illnesses for which he has been receiving treatment." On 15 October, Babis announced that he was prepared to go into opposition and would not accept an offer to try to create a new government, commenting: "We will hand it over to the new coalition and we will be in opposition." On 18 October, Miloš Vystrčil, the President of the Senate of the Czech Republic, announced he had received a letter from the Central Military Hospital declaring Zeman unfit to fulfil his duties as the president, and indicated that he planned to trigger Article 66 of the constitution to remove Zeman from office. In response, the Senate announced their intention to transfer Zeman's constitutional powers to the current prime minister, Andrej Babiš, and the speaker of the Chamber of Deputies. The Speaker is expected to ask Fiala to form a government if Article 66 is triggered.


title: 2021 Czech legislative election

text: On 2 November, SPOLU and PirStan agreed on the composition of the new government. SPOLU would have the Prime Minister and 10 ministers, while PirStan would have 6 ministers. Ministries held by SPOLU include Finance, Labour and Social affairs, Defence, Transportation, Health, Agriculture, Justice, Environment, Culture and Science. PirStan would get the minister for the Interior, Industry, Education, Local development, Foreign affairs, Legislature and European Union. The signature of the coalition agreement was set for 8 November.


title: 2021 Czech legislative election

text: Fiala also said that he had been contacted by Zeman's staff on the same day, to say that the President was looking forward to meeting him, and intended to do so once he got transferred from the intensive care unit room to a normal room. On 4 November, Zeman was transferred to a normal room. On 5 November, Zeman confirmed during an interview for Frekvence 1 that he would appoint Fiala the new Prime Minister, and would do everything he could for the new government to be formed as quickly as possible.


title: 2021 Czech legislative election

text: ODS and STAN approved the coalition agreement on 4 November. KDU-ČSL and TOP 09 approved the agreement on 5 November. The Czech Pirate Party announced that its members would vote on approving the agreement on 13 and 14 November. The leadership of the Pirate Party approved the agreement on 7 November. As a result, Bartoš signed the agreement along with the leaders of the other parties on 8 November, even though party members were still to vote. The leaders of all five parties signed the coalition agreement on 8 November. The new Chamber of Deputies had its constituent meeting the same day. Babiš promised that his cabinet would resign soon afterward to allow a new government to be formed quickly. On 9 November, Zeman asked Fiala to form a government. The constituent meeting concluded on 10 November and the government resigned the day after. Zeman accepted the resignation the same day. Zeman's Chancellor Vratislav Mynář stated that Fiala would be appointed in a matter of weeks, after the President had met Fiala and the Ministerial candidates.


title: 2021 Czech legislative election

text: On 12 November, a referendum began among Pirate Party members over whether to approve the coalition agreement. MP Jakub Michálek, who was expected to become Minister for Legislation, announced that he would not be part of the incoming government to avoid the cumulation of jobs, adding that he believed it could convince more members to vote for the government. The referendum concluded on 15 November. 82% of party members agreed that the party should join the incoming government. Fiala was set to meet President Zeman on 17 November to present his cabinet and proposed government ministers.


title: 2021 Czech legislative election

text: Fiala met Zeman on 17 November and presented him with the names of his proposed cabinet. Zeman stated that he would appoint Fiala as the new Prime Minister on 26 November, but expressed his disagreement with one potential minister, reported in Czech media to be Jan Lipavský, the candidate for Minister of Foreign Affairs. Fiala stated afterwards that he did not intend to make any changes to his cabinet. On 25 November 2021, Zeman tested positive for COVID-19, delaying the appointment until 28 November 2021. Zeman said he would meet Fiala's nominations for cabinet positions over the next two weeks. Outgoing Prime Minister Andrej Babiš said he expected the rest of the cabinet to be appointed after 13 December 2021. Following his appointment, Fiala said he believed his government would bring change and improve the lives of people in the Czech Republic, but that the next year would be difficult for many citizens and the Czech Republic itself.


title: 2021 Czech legislative election

text: Zeman started meeting the ministerial nominees on 29 November 2021, when he met Martin Baxa and Mikuláš Bek. On 7 December 2021, he met Jan Lipavský, reported as the potential minister Zeman did not want to appoint. According to sources cited by Frekvence 1, Zeman told Lipavský to withdraw his nomination. Fiala subsequently declared that if Zeman did not appoint all of his ministers, he would submit a jurisdiction action to the Constitutional Court against Zeman. The meetings concluded when Zeman met Vlastimil Válek on 10 December 2021. Zeman then stated that he did not intend to appoint Lipavský. Fiala responded that Constitutional Court would decide whether the president could reject a minister nominated by the prime minister, and said he would meet Zeman on 13 December 2021 to discuss the next steps for the appointment of the cabinet.


title: 2021 Czech legislative election

text: Fiala met Zeman on 13 December 2021 at Lány Castle. After the meeting, Zeman agreed to appoint all cabinet members, including Lipavský, on 17 December 2021. A vote of confidence in the Chamber of Deputies was scheduled for 12 January 2022.


title: 2021 Czech legislative election

text: Fiala's cabinet was appointed by Zeman on 17 December 2021. Fiala said that his cabinet had taken over responsibility, noting that "we are not starting in a good situation as there are many overlooked problems. We will start working immediately as there is so much work and we want to do it differently than our predecessors." Zdeněk Nekula was the only minister that was not appointed, as he had tested positive for COVID-19. His appointment as Minister of Agriculture was postponed until January 2022, and Marian Jurečka was temporarily designated to manage the Ministry of Agriculture. Fiala confirmed on 2 January 2022 that Nekula would be appointed on 3 January, and the new cabinet would ask the Chamber of Deputies for confidence on 12 January 2022. Nekula was appointed on 3 January 2022, completing the cabinet.


title: 2021 Czech legislative election

text: Fiala's cabinet was presented to the Chamber of Deputies on 12 January 2022 for a confidence vote. The vote did not occur on that day as the pre-vote debate continued for 22 hours. The vote was also delayed by Freedom and Direct Democracy leader Tomio Okamura, who called for a special meeting over the financing of Mayors and Independents, following media reports that the party had accepted gifts from Cyprus. The confidence debate session continued in the evening of 13 January 2022. After 23 hours of debate, the cabinet won the confidence vote by 106–87, with 193 MPs present.


title: 2021 Czech legislative election

text: Slovak President Zuzana Čaputová congratulated the Czech Republic and wished it a successful and conflict-free government formation. Prime Minister Eduard Heger congratulated the country for the high voter turnout and congratulated SPOLU for victory, noting that he hoped Fiala would form a government that would govern well. He described Czechs as Slovakia's "closest friends and brothers." Hungarian Prime Minister Viktor Orbán congratulated Fiala on his appointment as Prime Minister, calling the Czech Republic a friend and strategic partner.


title: 2021 Czech legislative election

text: The international press identified the result as a sign of the decline of populism in Central Europe. The New York Times noted the surprise defeat for Babiš. The Wall Street Journal suggested that the result might echo in Hungary before the 2022 Hungarian parliamentary election.


title: Neonatal intensive care unit

text: A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries or intensive care, has been around since the 1960s.


title: Neonatal intensive care unit

text: The first American newborn intensive care unit, designed by Louis Gluck, was opened in October 1960 at Yale New Haven Hospital.


title: Neonatal intensive care unit

text: NICU is typically directed by one or more neonatologists and staffed by resident physicians, nurses, nurse practitioners, pharmacists, physician assistants, respiratory therapists, and dietitians. Many other ancillary disciplines and specialists are available at larger units.


title: Neonatal intensive care unit

text: Healthcare institutions have varying entry-level requirements for neonatal nurses. Neonatal nurses are registered nurses (RNs), and therefore must have an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require a midwifery qualification. Some institutions may accept newly graduated RNs having passed the NCLEX exam; others may require additional experience working in adult-health or medical/surgical nursing.


title: Neonatal intensive care unit

text: Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to hold a postgraduate degree. The National Association of Neonatal Nurses recommends two years' experience working in a NICU before taking graduate classes.


title: Neonatal intensive care unit

text: As with any registered nurse, local licensing or certifying bodies, as well as employers, may set requirements for continuing education.


title: Neonatal intensive care unit

text: There are no mandated requirements to becoming an RN in an NICU, although neonatal nurses must have certification as a neonatal resuscitation provider. Some units prefer new graduates who do not have experience in other units, so they may be trained in the specialty exclusively, while others prefer nurses with more experience already under their belt.


title: Neonatal intensive care unit

text: Intensive-care nurses undergo intensive didactic and clinical orientation in addition to their general nursing knowledge in order to provide highly specialized care for critical patients. Their competencies include the administration of high-risk medications, management of high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures, as well as chronic-care management or lower acuity cares associated with premature infants such as feeding intolerance, phototherapy, or administering antibiotics. NICU RNs undergo annual skills tests and are subject to additional training to maintain contemporary practice.


title: Neonatal intensive care unit

text: The problem of premature and congenitally ill infants is not a new one. As early as the 17th and 18th centuries, there were scholarly papers published that attempted to share knowledge of interventions. It was not until 1922, however, that hospitals started grouping the newborn infants into one area, now called the neonatal intensive care unit (NICU).


title: Neonatal intensive care unit

text: Before the industrial revolution, premature and ill infants were born and cared for at home and either lived or died without medical intervention. In the mid-nineteenth century, the infant incubator was first developed, based on the incubators used for chicken eggs. Dr. Stephane Tarnier is generally considered to be the father of the incubator (or isolette as it is now known), having developed it to attempt to keep premature infants in a Paris maternity ward warm. Other methods had been used before, but this was the first closed model; in addition, he helped convince other physicians that the treatment "helped" premature infants. France became a forerunner in assisting premature infants, in part due to its concerns about a falling birth rate.


title: Neonatal intensive care unit

text: After Tarnier retired, Dr. Pierre Budin, followed in his footsteps, noting the limitations of infants in incubators and the importance of breastmilk and the mother's attachment to the child. Budin is known as the father of modern perinatology, and his seminal work "The Nursling" ("Le Nourisson" in French) became the first major publication to deal with the care of the neonate.


title: Neonatal intensive care unit

text: Another factor that contributed to the development of modern neonatology was Dr. Martin Couney and his permanent installment of premature babies in incubators at Coney Island. A more controversial figure, he studied under Dr. Budin and brought attention to premature babies and their plight through his display of infants as sideshow attractions at Coney Island and the World's Fair in New York and Chicago in 1933 and 1939, respectively. Infants had also previously been displayed in incubators at the 1897, 1898, 1901, and 1904 World Fairs.


title: Neonatal intensive care unit

text: Doctors took an increasing role in childbirth from the eighteenth century onward. However, the care of newborn babies, sick or well, remained largely in the hands of mothers and midwives. Some baby incubators, similar to those used for hatching chicks, were devised in the late nineteenth century. In the United States, these were shown at commercial exhibitions, complete with babies inside, until 1931. Dr A. Robert Bauer MD at Henry Ford Hospital in Detroit, MI, successfully combined oxygen, heat, humidity, ease of accessibility, and ease of nursing care in 1931. It was not until after the Second World War that special-care baby units (SCBUs, pronounced "scaboo") were established in many hospitals. In Britain, early SCBUs opened in Birmingham and Bristol, the latter set up with only £100. At Southmead Hospital, Bristol, initial opposition from obstetricians lessened after quadruplets born there in 1948 were successfully cared for in the new unit.


title: Neonatal intensive care unit

text: Incubators were expensive, so the whole room was often kept warm instead. Cross-infection between babies was greatly feared. Strict nursing routines involved staff wearing gowns and masks, constant hand-washing and minimal handling of babies. Parents were sometimes allowed to watch through the windows of the unit. Much was learned about feeding—frequent, tiny feeds seemed best—and breathing. Oxygen was given freely until the end of the 1950s, when it was shown that the high concentrations reached inside incubators caused some babies to go blind. Monitoring conditions in the incubator, and the baby itself, was to become a major area of research.


title: Neonatal intensive care unit

text: The 1960s were a time of rapid medical advances, particularly in respiratory support, that were at last making the survival of premature newborn babies a reality. Very few babies born before thirty two weeks survived and those who did often had neurological impairments. Herbert Barrie in London pioneered advances in resuscitation of the newborn. Barrie published his seminal paper on the subject in "The Lancet" in 1963. One of the concerns at this time was the worry that using high pressures of oxygen could be damaging to newborn lungs. Barrie developed an underwater safety valve in the oxygen circuit. The tubes were originally made of rubber, but these had the potential to cause irritation to sensitive newborn tracheas: Barrie switched to plastic. This new endotracheal tube, based on Barrie's design, was known as the 'St Thomas's tube'.


title: Neonatal intensive care unit

text: Most early units had little equipment, providing only oxygen and warmth, and relied on careful nursing and observation. In later years, further research allowed technology to play a larger role in the decline of infant mortality. The development of pulmonary surfactant, which facilitates the oxygenation and ventilation of underdeveloped lungs, has been the most important development in neonatology to date.


title: Neonatal intensive care unit

text: By the 1970s, NICUs were an established part of hospitals in the developed world. In Britain, some early units ran community programmes, sending experienced nurses to help care for premature babies at home. But increasingly technological monitoring and therapy meant special care for babies became hospital-based. By the 1980s, over 90% of births took place in hospital. The emergency dash from home to the NICU with baby in a transport incubator had become a thing of the past, though transport incubators were still needed. Specialist equipment and expertise were not available at every hospital, and strong arguments were made for large, centralised NICUs. On the downside was the long travelling time for frail babies and for parents. A 1979 study showed that 20% of babies in NICUs for up to a week were never visited by either parent. Centralised or not, by the 1980s few questioned the role of NICUs in saving babies. Around 80% of babies born weighing less than 1.5 kg now survived, compared to around 40% in the 1960s. From 1982, pediatricians in Britain could train and qualify in the sub-specialty of neonatal medicine.


title: Neonatal intensive care unit

text: Not only careful nursing but also new techniques and instruments now played a major role. As in adult intensive-care units, the use of monitoring and life-support systems became routine. These needed special modification for small babies, whose bodies were tiny and often immature. Adult ventilators, for example, could damage babies' lungs and gentler techniques with smaller pressure changes were devised. The many tubes and sensors used for monitoring the baby's condition, blood sampling and artificial feeding made some babies scarcely visible beneath the technology. Furthermore, by 1975, over 18% of newborn babies in Britain were being admitted to NICUs. Some hospitals admitted all babies delivered by Caesarian section or under 2500 g in weight. The fact that these babies missed early close contact with their mothers was a growing concern. The 1980s saw questions being raised about the human and economic costs of too much technology, and admission policies gradually became more conservative.


title: Neonatal intensive care unit

text: NICUs now concentrate on treating very small, premature, or congenitally ill babies. Some of these babies are from higher-order multiple births, but most are still single babies born too early. Premature labour, and how to prevent it, remains a perplexing problem for doctors. Even though medical advancements allow doctors to save low-birth-weight babies, it is almost invariably better to delay such births.


title: Neonatal intensive care unit

text: Over the last 10 years or so, SCBUs have become much more 'parent-friendly', encouraging maximum involvement with the babies. Routine gowns and masks are gone and parents are encouraged to help with care as much as possible. Cuddling and skin-to-skin contact, also known as Kangaroo care, are seen as beneficial for all but the frailest (very tiny babies are exhausted by the stimulus of being handled; or larger critically ill infants). Less stressful ways of delivering high-technology medicine to tiny patients have been devised: sensors to measure blood oxygen levels through the skin, for example; and ways of reducing the amount of blood taken for tests.


title: Neonatal intensive care unit

text: Some major problems of the NICU have almost disappeared. Exchange transfusions, in which all the blood is removed and replaced, are rare now. Rhesus incompatibility (a difference in blood groups) between mother and baby is largely preventable, and was the most common cause for exchange transfusion in the past. However, breathing difficulties, intraventricular hemorrhage, necrotizing enterocolitis and infections still claim many infant lives and are the focus of many new and current research projects.


title: Neonatal intensive care unit

text: The long-term outlook for premature babies saved by NICUs has always been a concern. From the early years, it was reported that a higher proportion than normal grew up with disabilities, including cerebral palsy and learning difficulties. Now that treatments are available for many of the problems faced by tiny or immature babies in the first weeks of life, long-term follow-up, and minimising long-term disability, are major research areas.


title: Neonatal intensive care unit

text: Besides prematurity and extreme low birth-weight, common diseases cared for in a NICU include perinatal asphyxia, major birth defects, sepsis, neonatal jaundice, and infant respiratory distress syndrome due to immaturity of the lungs. In general, the leading cause of death in NICUs is necrotizing enterocolitis. Complications of extreme prematurity may include intracranial hemorrhage, chronic bronchopulmonary dysplasia (see Infant respiratory distress syndrome), or retinopathy of prematurity. An infant may spend a day of observation in a NICU or may spend many months there.


title: Neonatal intensive care unit

text: Neonatology and NICUs have greatly increased the survival of very low birth-weight and extremely premature infants. In the era before NICUs, infants of birth weight less than 1400 grams (3 lb, usually about 30 weeks gestation) rarely survived. Today, infants of 500 grams at 26 weeks have a fair chance of survival. As of 2022, the world record for the lowest gestational age newborn to survive is held by Curtis Zy-Keith Means, who was born on 5 July 2020 in the United States, at 21 weeks and 1 day gestational age, weighing 420 grams.


title: Neonatal intensive care unit

text: The NICU environment provides challenges as well as benefits. Stressors for the infants can include continual light, a high level of noise, separation from their mothers, reduced physical contact, painful procedures, and interference with the opportunity to breastfeed. To date there have been very few studies investigating noise reduction interventions in the NICU and it remains uncertain what their effects could be on babies' growth and development. A NICU can be stressful for the staff as well. A special aspect of NICU stress for both parents and staff is that infants may survive, but with damage to the brain, lungs or eyes.


title: Neonatal intensive care unit

text: NICU rotations are essential aspects of pediatric and obstetric residency programs, but NICU experience is encouraged by other specialty residencies, such as family practice, surgery, pharmacy, and emergency medicine.


title: Neonatal intensive care unit

text: An incubator (or "isolette" or "humidicrib") is an apparatus used to maintain environmental conditions suitable for a neonate (newborn baby). It is used in preterm births or for some ill full-term babies.


title: Neonatal intensive care unit

text: Blood pressure monitor: The blood pressure monitor is a machine that's connected to a small cuff which is wrapped around the arm or leg of the patient. This cuff automatically takes the blood pressure and displays the data for review by care providers.


title: Neonatal intensive care unit

text: Oxygen hood: This is a clear box that fits over the baby's head and supplies oxygen. This is used for babies who can still breathe but need some respiratory support.


title: Neonatal intensive care unit

text: Ventilator: This is a breathing machine that delivers air to the lungs. Babies who are severely ill will receive this intervention. Typically, the ventilator takes the role of the lungs while treatment is administered to improve lung and circulatory function.


title: Neonatal intensive care unit

text: A "transport incubator" is an incubator in a transportable form, and is used when a sick or premature baby is moved, e.g., from one hospital to another, as from a community hospital to a larger medical facility with a proper neonatal intensive-care unit. It usually has a miniature ventilator, cardio-respiratory monitor, IV pump, pulse oximeter, and oxygen supply built into its frame.


title: Neonatal intensive care unit

text: Many parents with newborns in the NICU have expressed that they would like to learn more about what types of pain their infants are feeling and how they can help relieve that pain. Parents want to know more about things such as; what caused their child's pain, if the pain that we feel is different than what they feel, how to possibly prevent and notice the pain, and how they could help their child through the pain they were struggling with. Another main worry that was mentioned was the long-term effects of their pain. Would it mentally affect the child in the future, or even affect the relationship they have with their parents?


title: Neonatal intensive care unit

text: There are multiple ways to manage pain for infants. If the mother is able to help, holding the infant in kangaroo position or breastfeeding can help calm the baby before a procedure is done. Other simple things that can help ease pain include; allowing the infant to suck on a gloved finger, gently binding the limbs in a flexed position, and creating a quiet and comfortable environment.


title: Neonatal intensive care unit

text: The concept of designations for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in the United States in 1976. Levels in the United States are designated by the guidelines published by the American Academy of Pediatrics In Britain, the guidelines are issued by The British Association of Perinatal Medicine (BAPM), and in Canada, they are maintained by The Canadian Paediatric Society.


title: Neonatal intensive care unit

text: Neonatal care is split into categories or "levels of care". these levels apply to the type of care needed and is determined by the governing body of the area.


title: Neonatal intensive care unit

text: Neonates weighing more than 1800 grams or having gestational maturity of 34 weeks or more are categorized under level I care. The care consists of basic care at birth, provision of warmth, maintaining asepsis and promotion of breastfeeding. This type of care can be given at home, subcenter and primary health centre.


title: Neonatal intensive care unit

text: Neonates weighing 1200-1800 grams or having gestational maturity of 30–34 weeks are categorized under level II care and are looked after by trained nurses and pediatricians. The equipment and facilities used for this level of care include equipment for resuscitation, maintenance of thermoneutral environment, intravenous infusion, gavage feeding, phototherapy and exchange blood transfusion. This type of care can be given at first referral units, district hospitals, teaching institutions and nursing homes.


title: Neonatal intensive care unit

text: Neonates weighing less than 1200 grams or having gestational maturity of less than 30 weeks are categorized under level III care. The care is provided at apex institutions and regional perinatal centers equipped with centralized oxygen and suction facilities, servo-controlled incubators, vital signs monitors, transcutaneous monitors, ventilators, infusion pumps etc. This type of care is provided by skilled nurses and neonatologists.


title: Neonatal intensive care unit

text: The terminology used in the United Kingdom can be confusing because different criteria are used to designate 'special' and 'intensive' neonatal care locally and nationally.


title: Neonatal intensive care unit

text: Also known as 'Special Care Baby Units' (SCBU). These look after babies who need more care than healthy newborns but are relatively stable and mature. SCBU might provide tube-feeding, oxygen therapy, antibiotics to treat infection and phototherapy for jaundice. In a SCBU, a nurse can be assigned up to four babies to care for.


title: Neonatal intensive care unit

text: Also known as 'Local Neonatal Units', these can look after babies who need more advanced support such as parenteral nutrition and continuous positive airway pressure (CPAP). Confusingly, they may also look after babies who need short-term intensive care such as mechanical ventilation. Babies who will need longer-term or more elaborate intensive care, for example extremely preterm infants, are usually transferred to a Level 3 unit.


title: Neonatal intensive care unit

text: Babies in a Level 2 unit may be classified for nursing purposes as 'Special Care', 'High Dependency' (HDU) (in which a nurse will be assigned up to two babies) or 'Intensive care' (where nursing is one-to-one, or sometimes even two-to-one).


title: Neonatal intensive care unit

text: Also known as 'Neonatal Intensive Care Units' (NICU) - although Level 2 units may also have their own NICU. These look after the smallest, most premature and most unwell babies and often serve a large geographical region. Therapies such as prolonged mechanical ventilation, therapeutic hypothermia, neonatal surgery and inhaled nitric oxide are usually provided in Level 3 Units, although not every unit has access to all therapies.


title: Neonatal intensive care unit

text: Some babies being cared for in Level 3 units will require less intensive treatment and will be looked after in HDU or SCBU nurseries on the same site. NHS England recommended in December 2019 that these units should care for at least 100 babies weighing less than 1.5 kg, and usually perform more than 2,000 intensive care days per year.


title: Neonatal intensive care unit

text: The definition of a neonatal intensive-care unit (NICU) according to the National Center for Statistics is a "hospital facility or unit staffed and equipped to provide continuous mechanical ventilatory support for a newborn infant". In 2012, the American Academy of Pediatric updated their policy statement delineating the different levels of neonatal care. One major difference in the 2012 updated policy statement from the AAP compared to the 2004 policy statement is the removal of subspeciality nurseries for levels II and III with the addition of a level IV NICU. The four distinct levels of neonatal care defined in the most recent policy statement from the AAP are:


title: Neonatal intensive care unit

text: Level I units are typically referred to as the well baby nursery. Well newborn nurseries have the capability to provide neonatal resuscitation at every delivery; evaluate and provide postnatal care to healthy newborn infants; stabilize and provide care for infants born at 35 to 37 weeks' gestation who remain physiologically stable; and stabilize newborn infants who are ill and those born less than 35 weeks' gestation until transfer to a facility that can provide the appropriate level of neonatal care. Required provider types for well newborn nurseries include pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses.


title: Neonatal intensive care unit

text: Previously, Level II units were subdivided into 2 categories (level IIA & level IIB) on the basis of their ability to provide assisted ventilation including continuous positive airway pressure. Level II units are also known as special care nurseries and have all of the capabilities of a level I nursery. In addition to providing level I neonatal care, Level II units are able to:


title: Neonatal intensive care unit

text: The 2004 AAP guidelines subdivided Level III units into 3 categories (level IIIA, IIIB & IIIC). Level III units are required to have pediatric surgeons in addition to care providers required for level II (pediatric hospitalists, neonatologists, and neonatal nurse practitioners) and level I (pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses). Also, required provider types that must either be on site or at a closely related institution by prearranged consultative agreement include pediatric medical subspecialists, pediatric anesthesiologists, and pediatric ophthalmologists. In addition to providing the care and having the capabilities of level I and level II nurseries, level III neonatal intensive-care units are able to:


title: Neonatal intensive care unit

text: The highest level of neonatal care provided occurs at regional NICUs, or Level IV neonatal intensive-care units. Level IV units are required to have pediatric surgical subspecialists in addition to the care providers required for Level III units. Regional NICUs have all of the capabilities of Level I, II, and III units. In addition to providing the highest level of care, level IV NICUs:


title: Sarcoptes scabiei

text: Sarcoptes scabiei or the itch mite is a parasitic mite that burrows into skin and causes scabies. The mite is found in all parts of the world. Humans are not the only mammals that can become infected. Other mammals, such as wild and domesticated dogs and cats (in which it is one cause of mange) as well as ungulates, wild boars, bovids, wombats, koalas, and great apes are affected.


title: Sarcoptes scabiei

text: The Italian biologists Giovanni Cosimo Bonomo and Diacinto Cestoni showed in the 17th century that scabies is caused by "Sarcoptes scabiei"; this discovery of the itch mite in 1687 marked scabies as the first disease of humans with a known microscopic causative agent. The disease produces intense, itchy skin rashes when the impregnated female tunnels into the stratum corneum of the skin and deposits eggs in the burrow. The larvae, which hatch in three to 10 days, move about on the skin, moult into a nymphal stage, and then mature into adult mites. The adult mites live three to four weeks in the host's skin.


title: Sarcoptes scabiei

text: The action of the mites moving within the skin and on the skin itself produces an intense itch that may resemble an allergic reaction in appearance. A delayed Type IV hypersensitivity reaction to the mites, their eggs, or scybala (packets of feces) occurs approximately 30 days after infestation. The presence of the eggs produces a massive allergic response that, in turn, produces more itching. Individuals who already are sensitized from a prior infestation can develop symptoms within hours.


title: Sarcoptes scabiei

text: "Sarcoptes" is a genus of skin parasites, and part of the larger family of mites collectively known as "scab mites". They are also related to the scab mite "Psoroptes", also a mite that infests the skin of domestic animals. Sarcoptic mange affects domestic animals and similar infestations in domestic fowls cause the disease known as "scaly leg". The effects of "S. scabiei" are the most well-known, causing "scabies", or "the itch". The adult female mite, having been fertilized, burrows into the skin (usually at the hands or wrists, but other parts of the body may also be affected), and lays its eggs.


title: Sarcoptes scabiei

text: The burrowing is carried out using the mouth parts and special cutting surfaces on the front legs. While these are being used, the mite anchors itself with suckers on its feet. Eggs are laid in small numbers as the mite burrows, and, as these hatch, six-legged larvae climb out on to the skin and search for hair follicles, where they feed and moult (discard old cuticles to grow). In the hair follicles, the larvae show the first nymphal stages, with eight legs.


title: Sarcoptes scabiei

text: In the nymphal stages, the creature feeds and moults, and if male, gives rise to the adult. In the case of females, another moult occurs before adulthood. The female has more moults than a male, so takes longer—17 days compared to 9 to 11 days for a male—to reach adulthood. The female is about twice the size of the male.


title: Sarcoptes scabiei

text: Although the life-cycle is only about two weeks, individual patients are seldom found to have more than about a dozen mites on them. Even so, this number can cause agonising itching, especially at night, and severe damage to the skin often comes as a result of scratching, in particular by the introduction of infective bacteria, which may lead to impetigo or eczema.


title: Sarcoptes scabiei

text: The eggs are laid by the female at a rate of about two to three eggs a day for about two months. About 2% of the British population is thought to be infected with these mites, which take about 25 minutes to an hour to burrow into the skin.


title: Sarcoptes scabiei

text: The best conditions in which to harbor "S. scabiei" is in areas with frequent skin-to-skin contact, such as the hands and wrists, as the mites are transmitted by skin contact with carriers, and they very easily spread. Infestations of "S. scabiei" are commonly found in pigs. They significantly depress growth and feeding rate, but usually die out in around five days in typical farm conditions. However, once in a herd, the mites are very difficult to eliminate without great measures taken.


title: Sarcoptes scabiei

text: Adult scabies mites are spherical, eyeless mites with four pairs of legs (two pairs in front and two pairs behind). They are recognizable by their oval, ventrally flattened and dorsally convex tortoise-like bodies and multiple cuticular spines. No demarcation into cephalothorax or abdomen occurs, and the mite's surface has folds covered with short bristles. The front legs end in long, tubular processes known as suckers, and the hind legs end in long bristles. The male has suckers on all legs except the third pair, which distinguishes it from the female. Females are long and wide, and males are just over half that size.


title: Sarcoptes scabiei

text: The scabies mite "Sarcoptes scabiei" var. "hominis" goes through four stages in its lifecycle: egg, larva, nymph, and adult.


title: Sarcoptes scabiei

text: Upon infesting a human host, the adult female burrows into the "stratum corneum" (outermost layer of skin), where she deposits two or three eggs per day. These oval eggs are long and hatch as larvae in three to four days. A female can lay up to 30 eggs, then dies at the end of a burrow. Upon hatching, the six-legged larvae migrate to the skin surface and then burrow into molting pouches, usually into hair follicles, where vesicles form (these are shorter and smaller than the adult burrows). After three to four days, the larvae molt, turning into eight-legged nymphs. This form molts a second time into slightly larger nymphs, before a final molt into adult mites. Adult mites then mate when the male penetrates the molting pouch of the female. Mating occurs only once, as that one event leaves the female infertile for the rest of her life (one to two months). The impregnated female then leaves the molting pouch in search of a suitable location for a permanent burrow. Once a site is found, the female creates her characteristic S-shaped burrow, laying eggs in the process. The female will continue lengthening her burrow and laying eggs for the duration of her life.


title: Silent Night, Deadly Night

text: Silent Night, Deadly Night is a 1984 American slasher film directed by Charles E. Sellier, Jr., and starring Robert Brian Wilson, Lilyan Chauvin, Gilmer McCormick, Toni Nero, Linnea Quigley, Britt Leach, and Leo Geter. The story concerns a young man named Billy, who suffers from post-traumatic stress over witnessing his parents' murder on Christmas Eve by a man disguised as Santa Claus and his subsequent upbringing in an abusive Catholic orphanage. In adulthood, the Christmas holiday leads him into a psychological breakdown, and he emerges as a spree killer donning a Santa suit.


title: Silent Night, Deadly Night

text: The film was released by Tri-Star Pictures on November 9, 1984, where it received substantial controversy over its promotional material and content, which featured a killer Santa Claus. In addition to receiving mixed reviews, it was pulled from theaters a week after its release. However, it was a success during its opening week, grossing $2.5 million on a budget of $750,000. Since its release, it has developed a cult following and spawned a series, consisting of four sequels, with the fourth and fifth installments having no connection to the original film, as well as a loose remake in 2012. A reboot is planned for a 2022 release.


title: Silent Night, Deadly Night

text: In 1971, 5-year-old Billy Chapman and his family visit a nursing home in Utah where his catatonic grandfather stays. When Billy's parents leave the room, his grandfather suddenly awakens and tells Billy to fear Santa Claus, as he punishes the naughty.


title: Silent Night, Deadly Night

text: On the way back home, a criminal dressed in a Santa suit – who had just robbed a liquor store and killed the owner – attempts to carjack the family. As Billy's father tries to drive away, the criminal shoots him dead and then sexually assaults Billy's mother before slashing her throat with a switchblade. Billy flees and hides, leaving his baby brother Ricky in the car.


title: Silent Night, Deadly Night

text: Three years later, in December 1974, 8-year-old Billy and 4-year-old Ricky are celebrating Christmas in an orphanage run by Mother Superior, a strict disciplinarian who beats children who misbehave and considers punishment to be a "good" thing. Sister Margaret, who sympathizes with the children, tries to help Billy but he is regularly punished. On Christmas, the orphanage invites a man in a Santa Claus suit to visit the children; Billy, forced to sit on his lap by Mother Superior, punches the man before fleeing to his room in horror.


title: Silent Night, Deadly Night

text: 10 years later, in the spring of 1984, Billy turns 18, leaves the orphanage for a normal life, and obtains a job as a stock boy at a local toy store, with support from Sister Margaret. At the store, he develops a crush on his co-worker Pamela; he has sexual thoughts which are often interrupted by morbid visions of his parents' murders. On Christmas Eve, the employee who plays the store's Santa Claus is injured and Billy's boss Mr. Sims makes him take his place. After the store closes, the staff has a Christmas Eve party. Billy, still in a Santa Claus suit, tries to have a good time, but keeps having memories of his parents' murders, causing him to feel depressed. He sees his co-worker Andy making out with Pamela and they walk into the back room. Billy walks after them and sees Andy trying to rape Pamela. This triggers his insanity; he hangs Andy with a string of Christmas lights and, uttering that punishment is "good", murders Pamela with a box cutter.


title: Silent Night, Deadly Night

text: Next, Billy murders Mr. Sims and his manager Mrs. Randall. Sister Margaret discovers the carnage and returns to the orphanage to seek help. Billy breaks into a nearby house where a young couple named Denise and Tommy are having sex and a little girl named Cindy is sleeping; he impales Denise on a set of deer antlers and throws Tommy through a window. When this awakens Cindy, Billy asks if she has been nice or naughty; she says nice, and he gives her the box cutter he had used earlier. After this, he witnesses bullies picking on two teenage boys and stealing their sleds, and decapitates one of the bullies with his axe.


title: Silent Night, Deadly Night

text: The next morning, the orphanage is secured with Officer Barnes and Captain Richards and aided by Sister Margaret, who knows that Billy has committed the murders. The deaf pastor, Father O'Brien, who was dressed in a Santa outfit, is shot by Barnes, who mistook him for Billy. As Barnes continues patrolling the area, he is struck in the chest by Billy's axe. Billy confronts Mother Superior, now in a wheelchair. She taunts Billy due to her disbelief in Santa Claus and just as he prepares to kill her, Richards shoots him in the back. Billy drops to the floor, then utters to the children "You're safe now, Santa Claus is gone", before dying from his injuries. A 14-year-old Ricky, coldly staring at Mother Superior, utters "Naughty."


title: Silent Night, Deadly Night

text: The concept of the film was pitched by executive producer Scott J. Schiend who at the time, accepted screenplay ideas in submissions from the public. One of these was a short story entitled He Sees You When You're Sleeping written by a Harvard University student named Paul Caimi. The story was about a killer Santa Claus and Schiend was impressed with the concept even though he disliked slasher films. He then contacted writer Michael Hickey and requested him to write a screenplay based on the short story in which he agreed. Afterwards, Hickey sent the screenplay to Tri-Star Pictures who were pleased with it and agreed to finance and distribute the film.


title: Silent Night, Deadly Night

text: The film's working title during production was Slayride and it was to be produced by Slayride Productions Inc. Producer Ira Richard Barmak was recruited by Tri-Star to produce the film. Executive producers, Scott J. Schiend and Dennis Whitehead were hoping to hire a new and young director who would be the "next John Carpenter" and considered Sam Raimi, Albert Magnoli, and Ken Kwapis for the position. Tri-Star expressed interests in television producer Charles E. Sellier Jr. who was well known for producing the "Life and Times of Grizzly Adams" motion picture and TV series. Schiend and Whitehead disagreed believing that a veteran producer would not give the film a good look and reputation; however, Tri-Star insisted and eventually hired Sellier for the position.


title: Silent Night, Deadly Night

text: Principal photography lasted from March to April 1983 and was shot on location in Heber City and Midway, Utah. At the time, most of the snow was beginning to melt, so the production crew raced to shoot all exterior shots first. Numerous buildings were used for the interior scenes during filming. The orphanage building was an abandoned school house that was renovated by the crew during production. It was then demolished not long after filming concluded. The Ira's Toys building was a vacant building that was rented out by the crew. As of 2022, it still stands and is currently a gym. During filming, director Charles E. Sellier Jr. was too uncomfortable with shooting the murder sequences and this resulted in editor Michael Spence to come in as the stand-in director for these scenes.


title: Silent Night, Deadly Night

text: The film's cast mainly consisted of local actors in the state of Utah. Lead star Robert Brian Wilson (Billy at age 18) was at the time living in Salt Lake City and had no acting experience. He auditioned for his role as the request of his girlfriend. No major and well-known actors were featured in the film and many mostly had experience in only television acting roles.


title: Silent Night, Deadly Night

text: During post-production, TriStar had decided to change the Slayride title of the film to Silent Night, Deadly Night. Music composer Perry Botkin was hired to compose the musical score; he did so by watching a betamax copy of the film while composing the score as it played. Afterwards, TriStar hired graphic designer Burt Kleeger to create the infamous theatrical release poster that depicted Santa Claus climbing down a chimney while holding a double-bit axe that also included the film's tagline: "You've made it through Halloween, now try and survive Christmas" along with "He knows when you've been naughty".


title: Silent Night, Deadly Night

text: Because the film's concept was done before in the 1980 horror film "Christmas Evil" as well as the first segment of the 1972 horror anthology film, "Tales from the Crypt", the producers and TriStar were not concerned about the killer Santa Claus theme being controversial. However, there was concern that the portrayal of the Catholic Church in the film would be. Because of this, TriStar agreed to distribute the film in a limited release in the mostly protestant midwestern United States before moving forward with releasing it in the dominantly catholic northeastern United States. TriStar set the film's theatrical release date as November 9, 1984, around the start of the Christmas season. Robert Brian Wilson expressed dissatisfaction with this decision, believing that the film should have been released around Halloween to avoid less controversy.


title: Silent Night, Deadly Night

text: The film was released theatrically by Tri-Star Pictures on November 9, 1984, opening in 398 theaters in the Midwest United States. On its opening weekend, the film finished eighth, grossing $1,432,800. It outgrossed Wes Craven's landmark slasher "A Nightmare on Elm Street", which opened the same day (albeit in 235 fewer theaters). Before being pulled from theaters, it grossed over $2.4 million in its first 10 days of release.


title: Silent Night, Deadly Night

text: In November 2013, it was announced that "Fangoria" in association with Brainstorm Media and Screenvision would be re-releasing the film to theaters in the United States throughout December 2013.


title: Silent Night, Deadly Night

text: "Silent Night, Deadly Night" was one of the most controversial films of the 1980s due to its advertising campaign, particularly its posters and TV spots, that made significant emphasis on the killer being dressed as Santa Claus. The PTA fought to have this film removed from theaters due to its subject matter and the fact that it was shown around Christmas, although an earlier film with a similar premise, "Christmas Evil", had gone unnoticed. Television advertisements, which aired between episodes of family-friendly series such as "Little House on the Prairie", led to parents complaining that their children were terrified of Santa Claus. Large crowds (mostly angry families) formed at theaters and malls around the nation to protest the film; at the film's East Coast premiere at the Interboro Quad Theater in The Bronx in New York City, protesters picketed the theater and sang Christmas carols in protest.


title: Silent Night, Deadly Night

text: In response, Tri-Star Pictures, the film's original distributor, pulled all ads for the film six days after its release on November 15, 1984. The film itself was also withdrawn shortly thereafter, due to the controversy. In response to the public outcry, producer Ira Barmak told "People" magazine: "People have taken offense at Santa being used in a scary context... Santa Claus is not a religious figure, he's a mythic character. I didn't deliberately ride roughshod over that sensitivity and I didn't anticipate the objection to it." An editorial published in "Variety" stated: "Most protests were generated by the feeling that the depiction of a killer in a Santa Claus suit would traumatize children and undermine their traditional trust in Santa Claus." When the film was castigated at length by Gene Siskel and Roger Ebert, the backlash against the film became louder and more widespread.


title: Silent Night, Deadly Night

text: The film was due to be re-released by an independent distributor, Aquarius Films, in May 1985, with an ad campaign replacing the original "Twas the night before Christmas"-themed trailer with a new one that centered on the controversy surrounding the film and edited out all close-up shots of Billy, in the Santa suit, with weapons. The print ad material also replaced the original 'Chimney' picture with one that talked about the controversy. However, the film only had further test engagements.


title: Silent Night, Deadly Night

text: In the United Kingdom, the movie was never submitted for certification to the BBFC, and its sequel was denied a video certificate in 1987 after the distributors refused to make the cuts required for an '18' certificate. However, in 2009, Arrow Films submitted the film to the BBFC for classification, who passed the film uncut with an 18 certificate. The UK DVD was released on November 23, 2009.


title: Silent Night, Deadly Night

text: According to Robert Brian Wilson, the film had to be re-submitted 4 times to the MPAA to secure an R rating. When released to theatres, Tri-Star originally made these cuts, but when released on home video, the film was unrated. The film was sourced from another master copy containing these scenes. The Theatrical R-rated version never received a home video release until December 4, 2017. Due to the film having these scenes missing from other master copies, Anchor Bay DVD and Blu-ray releases were released as composite cuts. In hopes that Shout! Factory would find uncut footage from the original negatives, their search was unsuccessful. According to them, Tri-Star edited out all uncut footage from all their negatives.


title: Silent Night, Deadly Night

text: On the review aggregator website Rotten Tomatoes, "Silent Night, Deadly Night" holds a 44% approval rating based on 25 critic reviews, with an average rating of 4.9/10.


title: Silent Night, Deadly Night

text: Siskel and Ebert condemned the film and Siskel went as far as to read names of the film's production crew on air, telling them, "Shame on you". Gene Siskel also said that all the money the filmmakers were making off of this film was blood money.


title: Silent Night, Deadly Night

text: Leonard Maltin also denounced the movie, calling it a "...worthless splatter film", citing it as a "BOMB" and asking: "What's next, the Easter Bunny as a child molester?"


title: Silent Night, Deadly Night

text: A "Daily Variety" review argued that whatever arguments the film was making on the commercialism of Christmas were overshadowed by the graphic violence, which the reviewer saw as off-putting.


title: Silent Night, Deadly Night

text: Michael Wilmington wrote in the "Los Angeles Times": "[it's] safe to predict that "Silent Night, Deadly Night"... will start making ‘Worst Movie of All Time’ lists almost immediately".


title: Silent Night, Deadly Night

text: One positive notice came from Kirk Ellis from "The Hollywood Reporter", who complimented director Sellier's "workmanlike competence" and praised the cinematography and Gilmer McCormack's performance as Sister Margaret.


title: Silent Night, Deadly Night

text: Originally planned to be released on home media by RCA/Columbia Pictures Home Video in early 1985, the home media release was cancelled. The film was then originally released on VHS and Beta in May 1986 through USA Home Video. The film was released on Laserdisc in 1987 and reissued on VHS by International Video Entertainment in 1987 and 1988. In 1992, the film was last released on VHS for the last time by Avid Home Entertainment.


title: Silent Night, Deadly Night

text: The film was released on as a double feature disc alongside sequel "Silent Night, Deadly Night Part 2" in 2003. The second release was in 2007. The first two Region 1 releases are currently out of print.


title: Silent Night, Deadly Night

text: The film was released on DVD in the United Kingdom in 2009 by Arrow Video; this set includes an audio interview with director Charles E. Sellier Jr., poster, booklet including "Deadly Director: Charles Sellier Interviewed by Calum Waddell" and "Silent Night, Sex Night: The Slice and Times of Linnea Quigley".


title: Silent Night, Deadly Night

text: On December 4, 2012, the film was again released alongside "Part 2" as a two-disc "Christmas Survival Double Feature", containing the same archival bonus features as the 2003 release.


title: Silent Night, Deadly Night

text: On September 16, 2014, it was released on Blu-ray by Anchor Bay/Starz Entertainment. No new special features were included, with the exception of a few new commentaries, none of which any of the actors participated in. The Blu-ray contains exactly the same release as previous DVD editions with the extended scenes edited back into the film with noticeable picture quality changes. There has yet to be a release of the full, uncut print from a single source.


title: Silent Night, Deadly Night

text: On December 5, 2017, Shout! Factory, under its Scream Factory label, released the film in a two-disc set collector's edition on Blu-ray and DVD. It contains the film remastered in a 4K resolution from the original negative sourced from the original R-rated theatrical cut while the unrated version used SD inserts. It also contained new special features such as an interview and audio commentary from actors Robert Brian Wilson and Linnea Quigley, co-executive producers Scott J. Schneid and Dennis Whitehead, writer Michael Hickey, music composer Perry Botkin, and editor Michael Spence. It also contained a new documentary on the making of the film entitled "Slay Bells Ring: The Story of Silent Night, Deadly Night" which included interviews from the cast and crew. The original theatrical trailer, radio and TV spots are included. It also contained the original special features from the 2003 and 2012 DVD and 2014 Blu-ray releases as well.


title: Silent Night, Deadly Night

text: Scream Factory also released a limited edition deluxe offer that contained the collector's edition set along with a 18x24 size poster of the new artwork for the film, as well as an 8" tall figure of Billy in his Santa suit holding his double-bit axe. This offer was limited to 2,000 orders and pre-orders started on September 7, 2017.


title: Silent Night, Deadly Night

text: Due to the minor success of the film, four sequels were produced. The first two, "Silent Night, Deadly Night Part 2" and "", focus on Billy's younger brother Ricky becoming in turn a serial killer. However, "" and "" have no connection with the characters from the previous films, with each of them focusing on a different Christmas-themed horror story.


title: Silent Night, Deadly Night

text: A loose remake of the film, titled "Silent Night", was released on December 4, 2012, starring Jaime King and Malcolm McDowell.


title: Silent Night, Deadly Night

text: On March 2, 2021, another remake was announced when Orwo Studios and Black Hanger Studios acquired the rights to the original film.


title: Hypergeometric function

text: In mathematics, the Gaussian or ordinary hypergeometric function "F"("a","b";"c";"z") is a special function represented by the hypergeometric series, that includes many other special functions as specific or limiting cases. It is a solution of a second-order linear ordinary differential equation (ODE). Every second-order linear ODE with three regular singular points can be transformed into this equation.


title: Hypergeometric function

text: For systematic lists of some of the many thousands of published identities involving the hypergeometric function, see the reference works by and . There is no known system for organizing all of the identities; indeed, there is no known algorithm that can generate all identities; a number of different algorithms are known that generate different series of identities. The theory of the algorithmic discovery of identities remains an active research topic.


title: Hypergeometric function

text: The term "hypergeometric series" was first used by John Wallis in his 1655 book "Arithmetica Infinitorum".


title: Hypergeometric function

text: Hypergeometric series were studied by Leonhard Euler, but the first full systematic treatment was given by .


title: Hypergeometric function

text: Studies in the nineteenth century included those of , and the fundamental characterisation by of the hypergeometric function by means of the differential equation it satisfies.


title: Hypergeometric function

text: Riemann showed that the second-order differential equation for "F"("z"), examined in the complex plane, could be characterised (on the Riemann sphere) by its three regular singularities.


title: Hypergeometric function

text: The cases where the solutions are algebraic functions were found by Hermann Schwarz (Schwarz's list).


title: Hypergeometric function

text: It is undefined (or infinite) if equals a non-positive integer. Here is the (rising) Pochhammer symbol, which is defined by:


title: Hypergeometric function

text: The series terminates if either or is a nonpositive integer, in which case the function reduces to a polynomial:


title: Hypergeometric function

text: For complex arguments with it can be analytically continued along any path in the complex plane that avoids the branch points 1 and infinity.


title: Hypergeometric function

text: As , where is a non-negative integer, one has . Dividing by the value of the gamma function, we have the limit:


title: Hypergeometric function

text: Many of the common mathematical functions can be expressed in terms of the hypergeometric function, or as limiting cases of it. Some typical examples are


title: Hypergeometric function

text: hence, the name "hypergeometric". This function can be considered as a generalization of the geometric series.


title: Hypergeometric function

text: The confluent hypergeometric function (or Kummer's function) can be given as a limit of the hypergeometric function


title: Hypergeometric function

text: so all functions that are essentially special cases of it, such as Bessel functions, can be expressed as limits of hypergeometric functions. These include most of the commonly used functions of mathematical physics.


title: Hypergeometric function

text: Legendre functions are solutions of a second order differential equation with 3 regular singular points so can be expressed in terms of the hypergeometric function in many ways, for example


title: Hypergeometric function

text: Several orthogonal polynomials, including Jacobi polynomials "P" and their special cases Legendre polynomials, Chebyshev polynomials, Gegenbauer polynomials can be written in terms of hypergeometric functions using


title: Hypergeometric function

text: Other polynomials that are special cases include Krawtchouk polynomials, Meixner polynomials, Meixner–Pollaczek polynomials.


title: Hypergeometric function

text: which has three regular singular points: 0,1 and ∞. The generalization of this equation to three arbitrary regular singular points is given by Riemann's differential equation. Any second order linear differential equation with three regular singular points can be converted to the hypergeometric differential equation by a change of variables.


title: Hypergeometric function

text: Solutions to the hypergeometric differential equation are built out of the hypergeometric series "F"("a","b";"c";"z"). The equation has two linearly independent solutions. At each of the three singular points 0, 1, ∞, there are usually two special solutions of the form "x" times a holomorphic function of "x", where "s" is one of the two roots of the indicial equation and "x" is a local variable vanishing at a regular singular point. This gives 3 × 2 = 6 special solutions, as follows.


title: Hypergeometric function

text: If "c" is a non-positive integer 1−"m", then the first of these solutions does not exist and must be replaced by formula_23 The second solution does not exist when "c" is an integer greater than 1, and is equal to the first solution, or its replacement, when "c" is any other integer. So when "c" is an integer, a more complicated expression must be used for a second solution, equal to the first solution multiplied by ln("z"), plus another series in powers of "z", involving the digamma function. See for details.


title: Hypergeometric function

text: Again, when the conditions of non-integrality are not met, there exist other solutions that are more complicated.


title: Hypergeometric function

text: Any 3 of the above 6 solutions satisfy a linear relation as the space of solutions is 2-dimensional, giving () = 20 linear relations between them called connection formulas.


title: Hypergeometric function

text: A second order Fuchsian equation with "n" singular points has a group of symmetries acting (projectively) on its solutions, isomorphic to the Coxeter group "D" of order "n"!2. For the hypergeometric equation "n"=3, so the group is of order 24 and is isomorphic to the symmetric group on 4 points, and was first described by


title: Hypergeometric function

text: Kummer. The isomorphism with the symmetric group is accidental and has no analogue for more than 3 singular points, and it is sometimes better to think of the group as an extension of the symmetric group on 3 points (acting as permutations of the 3 singular points) by a Klein 4-group (whose elements change the signs of the differences of the exponents at an even number of singular points). Kummer's group of 24 transformations is generated by the three transformations taking a solution "F"("a","b";"c";"z") to one of


title: Hypergeometric function

text: which correspond to the transpositions (12), (23), and (34) under an isomorphism with the symmetric group on 4 points 1, 2, 3, 4. (The first and third of these are actually equal to "F"("a","b";"c";"z") whereas the second is an independent solution to the differential equation.)


title: Hypergeometric function

text: Applying Kummer's 24=6×4 transformations to the hypergeometric function gives the 6 = 2×3 solutions above corresponding to each of the 2 possible exponents at each of the 3 singular points, each of which appears 4 times because of the identities


title: Hypergeometric function

text: is also sometimes used. Note that the connection coefficients become Möbius transformations on the triangle maps.


title: Hypergeometric function

text: In the special case of λ, μ and ν real, with 0 ≤ λ,μ,ν < 1 then the s-maps are conformal maps of the upper half-plane H to triangles on the Riemann sphere, bounded by circular arcs. This mapping is a generalization of the Schwarz–Christoffel mapping to triangles with circular arcs. The singular points 0,1 and ∞ are sent to the triangle vertices. The angles of the triangle are πλ, πμ and πν respectively.


title: Hypergeometric function

text: Furthermore, in the case of λ=1/"p", μ=1/"q" and ν=1/"r" for integers "p", "q", "r", then the triangle tiles the sphere, the complex plane or the upper half plane according to whether λ + μ + ν – 1 is positive, zero or negative; and the s-maps are inverse functions of automorphic functions for the triangle group 〈"p", "q", "r"〉 = Δ("p", "q", "r").


title: Hypergeometric function

text: The monodromy of a hypergeometric equation describes how fundamental solutions change when analytically continued around paths in the "z" plane that return to the same point.


title: Hypergeometric function

text: That is, when the path winds around a singularity of "F", the value of the solutions at the endpoint will differ from the starting point.


title: Hypergeometric function

text: Two fundamental solutions of the hypergeometric equation are related to each other by a linear transformation; thus the monodromy is a mapping (group homomorphism):


title: Hypergeometric function

text: where π is the fundamental group. In other words, the monodromy is a two dimensional linear representation of the fundamental group. The monodromy group of the equation is the image of this map, i.e. the group generated by the monodromy matrices. The monodromy representation of the fundamental group can be computed explicitly in terms of the exponents at the singular points. If (α, α'), (β, β') and (γ,γ') are the exponents at 0, 1 and ∞, then, taking "z" near 0, the loops around 0 and 1 have monodromy matrices


title: Hypergeometric function

text: If 1−"a", "c"−"a"−"b", "a"−"b" are non-integer rational numbers with denominators "k","l","m" then the monodromy group is finite if and only if formula_47, see Schwarz's list or Kovacic's algorithm.


title: Hypergeometric function

text: provided that "z" is not a real number such that it is greater than or equal to 1. This can be proved by expanding (1 − "zx") using the binomial theorem and then integrating term by term for "z" with absolute value smaller than 1, and by analytic continuation elsewhere. When "z" is a real number greater than or equal to 1, analytic continuation must be used, because (1 − "zx") is zero at some point in the support of the integral, so the value of the integral may be ill-defined. This was given by Euler in 1748 and implies Euler's and Pfaff's hypergeometric transformations.


title: Hypergeometric function

text: Other representations, corresponding to other branches, are given by taking the same integrand, but taking the path of integration to be a closed Pochhammer cycle enclosing the singularities in various orders. Such paths correspond to the monodromy action.


title: Hypergeometric function

text: where the contour is drawn to separate the poles 0, 1, 2... from the poles −"a", −"a" − 1, ..., −"b", −"b" − 1, ... . This is valid as long as z is not a nonnegative real number.


title: Hypergeometric function

text: are called contiguous to . Gauss showed that can be written as a linear combination of any two of its contiguous functions, with rational coefficients in terms of , and . This gives


title: Hypergeometric function

text: where , and so on. Repeatedly applying these relations gives a linear relation over between any three functions of the form


title: Hypergeometric function

text: Gauss used the contiguous relations to give several ways to write a quotient of two hypergeometric functions as a continued fraction, for example:


title: Hypergeometric function

text: which in turn follow from Euler's integral representation. For extension of Euler's first and second transformations, see and .


title: Hypergeometric function

text: If two of the numbers 1 − "c", "c" − 1, "a" − "b", "b" − "a", "a" + "b" − "c", "c" − "a" − "b" are equal or one of them is 1/2 then there is a quadratic transformation of the hypergeometric function, connecting it to a different value of "z" related by a quadratic equation. The first examples were given by , and a complete list was given by . A typical example is


title: Hypergeometric function

text: If 1−"c", "a"−"b", "a"+"b"−"c" differ by signs or two of them are 1/3 or −1/3 then there is a cubic transformation of the hypergeometric function, connecting it to a different value of "z" related by a cubic equation. The first examples were given by . A typical example is


title: Hypergeometric function

text: There are also some transformations of degree 4 and 6. Transformations of other degrees only exist if "a", "b", and "c" are certain rational numbers . For example,


title: Hypergeometric function

text: See for a list of summation formulas at special points, most of which also appear in . gives further evaluations at more points. shows how most of these identities can be verified by computer algorithms.


title: Hypergeometric function

text: which follows from Euler's integral formula by putting "z" = 1. It includes the Vandermonde identity as a special case.


title: Hypergeometric function

text: There are many cases where hypergeometric functions can be evaluated at "z" = −1 by using a quadratic transformation to change "z" = −1 to "z" = 1 and then using Gauss's theorem to evaluate the result. A typical example is Kummer's theorem, named for Ernst Kummer:


title: Hypergeometric function

text: and Gauss's theorem by putting "z" = −1 in the first identity. For generalization of Kummer's summation, see .


title: Hypergeometric function

text: There are many other formulas giving the hypergeometric function as an algebraic number at special rational values of the parameters, some of which are listed in and . Some typical examples are given by


title: Vasool Raja MBBS

text: Vasool Raja MBBS () is a 2004 Indian Tamil-language comedy drama film directed by Saran. It is a Tamil remake of the 2003 Hindi film "Munna Bhai M.B.B.S.", which is inspired by the 1998 American film "Patch Adams". The film stars Kamal Haasan in the title role, while Prabhu, Sneha, Prakash Raj, Nagesh, Rohini Hattangadi, Jayasurya, Malavika, Crazy Mohan, Lakshmi Bhaskaran and Karunas play supporting roles. The film's music was composed by Bharathwaj. The film released on 12 August 2004.


title: Vasool Raja MBBS

text: Rajaraman, nicknamed "Vasool Raja", is a local don in Chennai who makes a living by collecting money from people who refuse or dilly-dally in paying their debts to others (adithadi), with the help of his right-hand man Vatti. Given that his father Sriman Venkataraman had wished him to be a doctor, he creates the faux Venkataraman Charitable Hospital, and pretends to live in accordance with this wish whenever his father and mother Kasturi visit him in Chennai.


title: Vasool Raja MBBS

text: One year later, Raja's plan goes awry when Venkataraman meets an old acquaintance, Dr. Vishwanathan. The two men decide to get Raja married to Vishwanathan's daughter Dr. Janaki aka "Paapu", who was a childhood friend of Raja under that name. At this point, the truth about Raja is revealed. Vishwanathan insults Raja's parents and ridicules them for being ignorant of Raja's real life. Venkataraman and Kasturi, who are both aghast and heartbroken, disown Raja and leave for their village.


title: Vasool Raja MBBS

text: Raja, in grief and despair, decides that the only way to redeem himself and gain revenge for the humiliation suffered by his father at the hands of the spiteful Vishwanathan is to become a doctor. He goes to a medical college to obtain an MBBS degree, the graduate medical degree in South Asia.


title: Vasool Raja MBBS

text: With the help of Vatti and others, Raja gains admission to the SLR Institute of Medical Sciences by threatening Margabandhu, a faculty member of the college, as well as Margabandhu's father. Upon admission, he again encounters Vishwanathan, who is the college dean. His success there becomes dependent upon the coerced help of Margabandhu. Margabandhu is initially hostile to Raja but does not reveal the truth to the dean. While Raja's skills as a medical doctor are minimal, he transforms those around him with the "Kattipudi Vaithiyam" ("hugging therapy"), a method of comfort taught to Raja by his mother, and the compassion he shows towards those in need. Despite the school's emphasis on mechanical, Cartesian, impersonal, often bureaucratic relationships between doctors and patients, Raja constantly seeks to impose a more empathetic, almost holistic, regimen. To this end, he defies all convention by treating a brain-dead man as if the man were able to perceive and understand normally; intimidating Dr. Kalidas into admitting and treating a suicide patient; interacting on familiar but autocratic terms with patients; humiliating school bullies; effusively thanking a hitherto-underappreciated cleaner; helping a terminally ill cancer patient named Zakir; and encouraging the patients themselves to make changes in their lives so that they do not need pharmaceuticals or surgery.


title: Vasool Raja MBBS

text: Vishwanathan, who perceives all this as symptoms of chaos, is unable to prevent it from expanding and gaining ground at his college. He becomes increasingly irritable, almost to the point of insanity. Repeatedly, this near-dementia is shown when he receives unwelcome tidings and begins laughing in a way that implies that he has gone mad. This behavior is explained early on as an attempt to practice laughter therapy, an attempt that seems to have backfired. Vishwanathan's laughing serves more to convey his anger than diffuse it. Meanwhile, Janaki becomes increasingly fond of Raja, who, in his turn, becomes unreservedly infatuated with her. Some comedy appears here because Raja is unaware that Janaki and his childhood friend "Paapu" are one and the same; an ignorance that Janaki hilariously exploits. Vishwanathan tries several times to expel Raja, but is often outsmarted by Raja's wit or the affection with which the others at the college regard Raja, having gained superior self-esteem by his methods. In a final attempt, Raja is almost expelled but he injures himself and multiple bones to prevent himself from being expelled.


title: Vasool Raja MBBS

text: Margabandhu's senile father is admitted to the hospital and all hope seems lost for him. Having threatened Margabandhu before, Raja's gang knows that he is a passionate board game player and Raja orders for a carrom board to come to hospital. One late night, Raja and his gang play carrom and chat and Margabandhu's father miraculously wakes up and walks to the board, to the shock of the nurses, doctors, and Margabandhu. Raja and Margabandhu's father play against each other and Margabandhu's father wins the match and celebrates. Upon witnessing this, Margabandhu is extremely touched by Raja's gesture and tearfully thanks him for saving his father, dropping his hostility towards Raja and his gang.


title: Vasool Raja MBBS

text: Upon recovery, Vishwanathan orders Raja to leave and brings police to throw him out, but everyone in the college protests and blocks the way. Vishwanathan tells the students the truth about Raja, but no one believes him and upon questioning the staff, Margabandhu denies any of Vishwanathan's allegations and claims that Raja is innocent. Infuriated, Vishwanathan challenges Raja to answer all questions asked by the doctors in front of the entire university and Raja accepts. Despite preparing well and getting help from Margabandhu and supporting staff, Raja is unable to focus as Zakir's condition becomes worse and Zakir dies in Raja's hands.


title: Vasool Raja MBBS

text: The next morning, Raja starts answering the questions well, but Vishwanathan stops the staff and says he will ask all the forthcoming questions, shocking everyone. Raja is unable to answer and is shamed into leaving the college. He confesses the truth to everyone and breaks down about his guilt to Zakir, his parents, and everyone he cared for. Everyone, except Vishwanathan (who smiles maliciously throughout the speech), are moved to tears by his speech. In the moments immediately following Raja's departure, the brain-dead man miraculously awakens from his vegetative state; at this point, Janaki gives a heartfelt speech wherein she criticizes her father for having banished Raja, saying that to do so is to banish hope, compassion, love, happiness, etc. from the college. Vishwanathan eventually realizes his folly.


title: Vasool Raja MBBS

text: Raja later marries Janaki, learning for the first time that she is "Paapu", while also reconciling with his parents, who appreciate him for the first time in many years.


title: Vasool Raja MBBS

text: The film was initially titled "Market Raja MBBS". The project began as a bilingual venture in Tamil and Telugu, though later the Telugu version was made separately with a different cast as "Shankar Dada MBBS" (2004).


title: Vasool Raja MBBS

text: Jyothika was initially approached to play the leading female role but her busy in another film meant that the team sought and consequently signed on actress Sneha for the film. Prabhu was cast in a supporting role at the insistence of Kamal Haasan, despite Saran's desire to cast Kalabhavan Mani.


title: Vasool Raja MBBS

text: Saran had hoped to sign on director K. Balachandar to play Kamal Haasan's father in the film, with the veteran director being both Kamal Haasan's and Saran's film industry mentor. However Balachandar was reluctant to act, and the team then considered both K. Viswanath and Girish Karnad for the role, before signing veteran actor Nagesh.


title: Vasool Raja MBBS

text: Actor Dhanush initially agreed to play a cameo role in the film but opted out citing a busy schedule and was replaced by Malayalam actor Jayasurya.


title: Vasool Raja MBBS

text: The soundtrack was composed by Bharathwaj, repeating his successful collaboration with director Saran. All songs were penned by Vairamuthu. The New Straits Times rated it 3.5 out of 5 and wrote, "Bharathwaj comes up with great compositions in this outing. He introduces new singers Sathyan, Arjun, Donnan and Grace. The audio launch was held in July 2004.


title: Vasool Raja MBBS

text: Made on a budget of 5.5 crore, "Vasoolraja MBBS" was sold for 1 crore in Coimbatore distribution territory with 20 prints. The film was shown on about 285 screens worldwide to highly positive reception and box-office success. Tabloid reported 10 million tickets were sold worldwide.


title: Vasool Raja MBBS

text: The film faced controversy as the petition filed by Tamil Nadu Medical Council president K R Balasubramanian stated that the film's title ridiculed the medical profession and tarnished the image of the medical fraternity. Moreover, the film title is considered to be a mockery on the medical profession which would lower dignity of the medical fraternity in eyes of public.