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Electroconvulsive therapy

Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.

Aside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and transient memory loss. Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the fetus.

ECT is often used as an intervention for major depressive disorder, mania, and catatonia. The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant. ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient.

Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy.

History

As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the London Medical and Surgical Journal. As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine. Treatment and cure of hysterical blindness was documented eleven years later. Benjamin Franklin wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, James Lind as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders. G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice.

In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable.

Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol). Meduna is thought to be the father of convulsive therapy.

In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Müller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.

The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist Ugo Cerletti and rapidly replaced less safe and effective forms of biological treatments in use at the time. Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions.

It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state. Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10-20 treatments the results were significant. Patients had much improved.

A positive side effect to the treatment was retrograde amnesia. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it.

ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient. Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship. In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was contended by scientific museums between Italy and the US. The ECT apparatus prototype is now owned and displayed by the Sapienza Museum of the History of Medicine in Rome.

In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted.

In the 1940s and early 1950s, ECT was usually given in an "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with curare, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.

The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media." The New York Times described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in One Flew Over the Cuckoo's Nest, it was a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused".

In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices.

The 1970s saw the publication of the first American Psychiatric Association (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT. Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression". In 1985, the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.

Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe mental illness, was receiving favorable media coverage, and was being provided in regional medical centers.

Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques. Modern shock voltage is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds.

In a review from 2022 of neuroimaging studies based on a global data collaboration ECT was suggested to work via a temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring.

Modern use
ECT is used, where possible, with informed consent in treatment-resistant major depressive disorder, bipolar depression, treatment-resistant catatonia, prolonged or severe mania, and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by suicidality, psychosis, stupor, marked psychomotor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)." It has also been used to treat autism in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention.

Major depressive disorder
For major depressive disorder, despite a Canadian guideline and some experts arguing for using ECT as a first line treatment, ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide. ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus.

Efficacy
A meta-analysis on the effectiveness of ECT in unipolar and bipolar depression indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently, both groups responded equally well to ECT. Overall remission rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. Most severely depressed patients respond to ECT.

In 2004, a meta-analysis found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus tricyclics and ECT versus monoamine oxidase inhibitors."

In 2003, The UK ECT Review Group published a systematic review and meta-analysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the standard deviation) for ECT versus placebo, and versus antidepressant drugs.

Compared with repetitive transcranial magnetic stimulation (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points, while rTMS reduced it by 9 points.

Other estimates regarding the response rate in treatment resistant depression vary between 60-80%, with a remission rate of 50-60%. In addition to reducing symptoms of depression and inducing relapse, ECT has also been shown to reduce the risk of suicide, improve functional outcomes and quality of life as well as reduce the risk of re-hospitalization. Efficacy does not depend on depression subtype. With regards to treatment resistant schizophrenia, the response rate is 40-70%.

Follow-up
There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder. The initial course of ECT is then transitioned to maintenance ECT, pharmacotherapy or both. When ECT is stopped abruptly, without a bridge to maintenance ECT or medications (usually antidepressants and Lithium), it is associated with a relapse rate of 84%. There is no defined schedule for maintenance ECT, however it is usually started weekly with intervals extended permissibly with the goal of maintaining remission. When ECT is followed by treatment with antidepressants, about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with tricyclic antidepressants; evidence for relapse prevention with newer antidepressants is lacking. Adjunct maintenance ECT paired with cognitive behavioral therapy has also been shown to reduce relapse rates. Maintenance ECT may safely continue indefinitely, with no set maximum treatment interval established.

Lithium has also been found to reduce the risk of relapse, especially in younger patients.

Catatonia
ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia is generally acknowledged". For people with autism spectrum disorders who have catatonia, there is little published evidence about the efficacy of ECT.

Mania
ECT is used to treat people who have severe or prolonged mania; NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania.

Schizophrenia
ECT is widely used worldwide in the treatment of schizophrenia, but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics; there is comprehensive research evidence for such practice. It is useful in the case of severe exacerbations of catatonic schizophrenia, whether excited or stuporous. There are also case reports of ECT improving persistent psychotic symptoms associated with stimulant-induced psychosis.

Effects
Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia; the US Surgeon General's report says that there are "no absolute health contraindications" to its use. Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience muscle soreness after ECT. Other common adverse effects after ECT include headache, jaw soreness, nausea, vomiting and fatigue. These side effects are transient and respond to treatment. There is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics, which induce sedation but not anesthesia, to patients to reduce adverse effects of ECT.

While there are no absolute contraindications for ECT, there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms; who have recently had a stroke; who have increased intracranial pressure (for instance, due to a solid brain tumor), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia.

In adolescents, ECT is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects.

Risk of death
A meta-analysis from 2017 found that the death rate of ECT was around 2.1 per 100,000 procedures. A review from 2011 reported an estimate of the mortality rate associated with ECT as less than 1 death per 73,440 treatments.

Cognitive impairment
Cognitive impairment sometimes occurs after ECT. The American Psychiatric Association (APA) report in 2001 acknowledges: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss". It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use. However, the methods used to measure memory loss are non-specific, and their application to people with depressive disorders, who have cognitive deficits related to the depression, including problems with memory, may further limit their utility.

The acute effects of ECT can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment). Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents. A greater number of treatments and higher electrical charges (stimulus charges) have also been associated with a greater risk of memory impairment.

Retrograde amnesia is most marked for events occurring in the weeks or months before treatment. Anterograde memory loss usually resolves 2-4 weeks after treatment, whereas retrograde amnesia (which develops gradually after repeated treatments in the initial course) usually takes weeks to months to resolve, and amnesia rarely persist for more than 1 year. Retrograde amnesia after ECT usually affects autobiographical memory, rather than semantic memory. One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT. However, bilateral ECT may be more efficacious than unilateral in the treatment of mood disorders.

ECT has not been found to increase the risk of dementia nor cause structural brain damage.

Effects on brain structure
Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals."

Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT, stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT." Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments. Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that ECT is associated with brain matter growth.

Effects in pregnancy
If steps are taken to decrease potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments. Suggested preparation for ECT during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of ECT. Potential complications of ECT during pregnancy can be minimized by modifications in technique. The use of ECT during pregnancy requires thorough evaluation of the patient's capacity for informed consent.

Effects on the heart
ECT can cause a lack of blood flow and oxygen to the heart, heart arrhythmia, and "persistent asystole". A 2019 systematic review and meta-analysis of 82 studies found that the rate of major adverse cardiac events with ECT was 1 in 39 patients or about 1 in 200 to 500 procedures. The risk of death with ECT however is low. If death does occur, cardiovascular complications are considered as causal in about 30% of individuals.

Procedure

The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis.

In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT may be used first to minimize side effects such as memory loss.

In bilateral ECT, the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye.

Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK  receive bilateral ECT.

The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT. Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains. Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold.

Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, propofol, etomidate, or thiopental, a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation. In a minority of countries such as Japan, India, and Nigeria, ECT may be used without anesthesia. The Union Health Ministry of India recommended a ban on ECT without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013. The practice was abolished in Turkey's largest psychiatric hospital in 2008.

The patient's EEG, ECG, and blood oxygen levels are monitored during treatment.

ECT is usually administered three times a week, on alternate days, over a course of two to four weeks.

Neuroimaging prior to ECT
Neuroimaging prior to ECT may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless, it is not indicated due to high cost and low prevalence of these conditions in patients needing ECT.

Concurrent pharmacotherapy
Whether psychiatric medications are terminated prior to treatment or maintained, varies. However, drugs that are known to cause toxicity in combination with ECT, such as lithium, are discontinued, and benzodiazepines, which increase the seizure threshold, are either discontinued, a benzodiazepine antagonist is administered at each ECT session, or the ECT treatment is adjusted accordingly.

A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves ECT efficacy.

Course
ECT is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds. It is also recommended to not do ECT more than 3 times per week. Evidence suggest that ECTs for depression may be stopped if there is no improvement during the first six sessions.

Treatment team
In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an ECT treatment nurse or qualified assistant, and one or more recovery nurses. Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff.

Devices

Most modern ECT devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT. A small minority of psychiatrists in the US still use sine-wave stimuli. Sine-wave is no longer used in the UK or Ireland. Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and six seconds.

In the US, ECT devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. In the UK, the market for ECT devices was long monopolized by Ectron Ltd, which was set up by psychiatrist Robert Russell.

Mechanism of action
Despite decades of research, the exact mechanism of action of ECT remains elusive. A review from 2022 of neuroimaging studies based on a global data collaboration resulted in a model of temporary disruption of neural circuits followed by augmented neuroplasticity and rewiring. Other brain changes observed after ECT include increased gray matter volume in the frontolimbic areas including the hippocampus and amygdala, increased white matter tracts in the frontal and temporal lobes, increased monoamine neurotransmitters and increased neurogenesis in the dentate gyrus. Changes in sleep architecture due to the induced seizures have also been hypothesized as a mechanism of action.

Use
As of 2001, it was estimated that about one million people received ECT annually.

There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists. International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use ECT at all, such as Slovenia.

About 70 percent of ECT patients are women. This may be because women are more likely to be diagnosed with depression. Older and more affluent patients are also more likely to receive ECT. The use of ECT is not as common in ethnic minorities.

In Sweden, which has a complete register of all ECT treatments in the country, in 2013 the rate of persons treated in that year per 100,000 inhabitants was 41. Almost the same rate had already been present in 1975 with 42 patients per 100,000 inhabitants.

United States
ECT became popular in the US in the 1940s. At the time, psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. Whereas lobotomies would reduce a patient to a more manageable submissive state, ECT helped to improve mood in those with severe depression. A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.

Accurate statistics about the frequency, context and circumstances of ECT in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information. In 13 of the 50 states, the practice of ECT is regulated by law.

In the mid-1990s in Texas, ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually. Usage of ECT has since declined slightly; in 2000–01 ECT was given to about 1,500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen). ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the ECT statistics.

In the United States, ECT is usually given three times a week; in the United Kingdom, it is usually given twice a week. Occasionally it is given on a daily basis. A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals. A few psychiatrists in the US use multiple-monitored ECT (MMECT), where patients receive more than one treatment per anesthetic. Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for ECT practice at institutions is a local option: no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners.

United Kingdom
In the UK in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then to about 12,000 per annum in 2002. It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent. In 2003, the National Institute for Health and Care Excellence, a government body which was set up to standardize treatment throughout the National Health Service in England and Wales, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".

The guidance received a mixed reception. It was welcomed by an editorial in the British Medical Journal but the Royal College of Psychiatrists launched an unsuccessful appeal. The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure. A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, and the vast majority of ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up.

The Mental Health Act 2007 allows people to be treated against their will. This law has extra protections regarding ECT. A patient capable of making the decision can decline the treatment, and in that case treatment cannot be given unless it will save that patient's life or is immediately necessary to prevent deterioration of the patient's condition. A patient may not be capable of making the decision (they "lack capacity"), and in that situation ECT can be given if it is appropriate and also if there are no advance directives that prevent the use of ECT.

China
ECT was introduced in China in the early 1950s and while it was originally practiced without anesthesia, as of 2012 almost all procedures were conducted with it. As of 2012, there are approximately 400 ECT machines in China, and 150,000 ECT treatments are performed each year. Chinese national practice guidelines recommend ECT for the treatment of schizophrenia, depressive disorders, and bipolar disorder and in the Chinese literature, ECT is an effective treatment for schizophrenia and mood disorders.

Although the Chinese government stopped classifying homosexuality as an illness in 2001, electroconvulsive therapy is still used by some establishments as a form of "conversion therapy". Alleged Internet addiction (or general unruliness) in adolescents is also known to have been treated with ECT, sometimes without anestheia, most notably by Yang Yongxin. The practice was banned in 2009 after news on Yang broke out.

Controversy
Surveys of public opinion, the testimony of former patients, legal restrictions on the use of ECT and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial. This is reflected in the January 2011 vote by the FDA's Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices, except for patients with catatonia, major depressive disorder, and bipolar disorder. This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time. In justifying their position, panelists referred to the memory loss associated with ECT and the lack of long-term data.

Informed consent
The World Health Organization (2005) advises that ECT should be used only with the informed consent of the patient (or their guardian if their incapacity to consent has been established).

In the US, this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT. The US Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT, and that there may be some risk of permanent, severe memory loss after ECT. The report advises psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT.

According to the US Surgeon General, involuntary treatment is uncommon in the US and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment.

In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.

In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects. One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects and another survey found that about fifty percent of psychiatrists and nurses agreed with them.

A 2005 study published in the British Journal of Psychiatry described patients' perspectives on the adequacy of informed consent before ECT. The study found that "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not." The authors also stated:

"Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales."

Involuntary ECT
Procedures for involuntary ECT vary from country to country depending on local mental health laws.

United States
In most states in the US, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT. However, ECT can also be involuntarily administered in situations with less immediate danger. Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective.

United Kingdom
Until 2007 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it. However, following amendments which took effect in 2007, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act. In fact, even if a patient is deemed to lack capacity, if they made a valid advance decision refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent). However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization. From 2003 to 2005, about 2,000 people a year in England and Wales were treated without their consent under the Mental Health Act. Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy. In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.

Regulation
In the US, ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration. In 1976, the Medical Device Regulation Act required the FDA to retrospectively review already existing devices, classify them, and determine whether clinical trials were needed to prove efficacy and safety. The FDA initially classified the devices used to administer ECT as Class III medical devices. In 2014, the American Psychiatric Association petitioned the FDA to reclassify ECT devices from Class III (high-risk) to Class II (medium-risk). A similar reclassification proposal in 2010 did not pass. In 2018, the FDA re-classified ECT devices as Class II devices when used to treat catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder.

Australia
In Western Australia, ECT has been heavily restricted since 2014, after a bill passed with bipartisan support introducing restrictions on ECT, which were welcomed by mental health experts. Children under 14 are prohibited from receiving ECT, while those aged 14 to 18 must have informed consent approval from the Mental Health Tribunal. The law imposes a $15,000 fine on anyone who performs ECT on a child under the age of 14.

Similarly, ECT is also banned on children under the age of 12 in the Australian Capital Territory (ACT).

United States
Many mental health facilities offer ECT for specific diagnoses, such as chronic depression, mania, catatonia and schizophrenia. However, ECT is often only used as a treatment of last resort. To be considered for ECT, often testing such as an EKG and lab tests are required, in addition to a physical and neurological exam. Certain medications and conditions, such as cardiac conditions or hypertension, may disqualify a patient from ECT. Patients should give proper informed consent before ECT is performed. In the United States, ECT is performed under general anesthesia. Both trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist should administer the procedure and anesthesia respectively.

Judge Rotenberg Center
In 2020 the Food and Drug Administration (FDA) implemented a rule previously drafted in 2016 banning the use of ECT to treat disabilities. This ban specifically had major complications for the controversial Judge Rotenberg Center (JRC) in Canton, Massachusetts, which uses various methods of ECT. Specifically, it is believed by many that most of the cases at JRC do not require the use of ECT.

Public perception
A questionnaire survey of 379 members of the general public in Australia indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients. Public perceptions of ECT were found to be mainly negative. A sample of the general public, medical students, and psychiatry trainees in the United Kingdom found that the psychiatry trainees were more knowledgeable and had more favorable opinions of ECT than did the other groups. More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees.

Famous cases

 * Ernest Hemingway, an American author, died by suicide in 1961 half a year after ECT treatment at the Mayo Clinic in 1960. He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient." However, the same biographer (Hotchner, 1966) and also a second biographer (Lynn, 1987) emphasized - according to a review from 2008 - "that Hemingway’s serious mental illness and plans for suicide significantly predated his ECT treatments."

 * Robert Pirsig had a nervous breakdown and spent time in and out of psychiatric hospitals between 1961 and 1963. He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts, and was treated with electroconvulsive therapy on numerous occasions, a treatment he discusses in his novel, Zen and the Art of Motorcycle Maintenance.

 * Thomas Eagleton, United States Senator from Missouri, was dropped from the Democratic ticket in the 1972 United States Presidential Election as the party's vice presidential candidate after it was revealed that he had received electroshock treatment in the past for depression. Presidential nominee George McGovern replaced him with Sargent Shriver, and later went on to lose by a landslide to Richard Nixon.
 * American surgeon and award-winning author Sherwin B. Nuland is another notable person who has undergone ECT. In his 40s, his depression became so severe that he had to be institutionalized. After exhausting all treatment options, a young resident assigned to his case suggested ECT, which ended up being successful.
 * Author David Foster Wallace also received ECT for many years, beginning as a teenager, before his suicide at age 46.
 * New Zealand author Janet Frame experienced both insulin coma therapy and ECT (but without the use of anesthesia or muscle relaxants). She wrote about this in her autobiography, An Angel at My Table (1984), which was later adapted into a film (1990).
 * American actor Carrie Fisher wrote about her experience with memory loss after ECT treatments in her memoir Wishful Drinking.
 * Lou Reed had ECT as a teenager to "cure" his homosexuality. He later claimed it had induced multiple personality disorder, and resulted in his hatred of psychiatrists. After Reed's death, his sister denied the ECT treatments were intended to suppress his "homosexual urges", asserting that their parents were not homophobic but had been told by his doctors that ECT was necessary to treat Reed's mental and behavioral issues.

Fictional examples
Electroconvulsive therapy has been depicted in fiction, including fictional works partly based on true experiences. These include Sylvia Plath's semi-autobiographical novel, The Bell Jar, Ken Loach's film Family Life, and Ken Kesey's novel One Flew Over the Cuckoo's Nest; Kesey's novel is a direct product of his time working the graveyard shift as an orderly at a mental health facility in Menlo Park, California.

Two analyses of large numbers of films using ECT scenes found that almost all presented fictional settings that were unrelated to real treatment routines and were apparently aimed at stigmatizing ECT as a tool of repression and of mind and behavior control - having effects of memory-erosion, pain and damage.

The song “The Mind Electric” by Miracle Musical is typically interpreted as depicting someone undergoing ECT.

In the television series "Mr Bates vs The Post Office", which is based on true events, the character of Saman Kaur receives ECT following a deep depression and attempted suicide.

title: Electroconvulsive therapy


text:
Talk:Computer programming

Same text repeated
This sentence seems to be repeated twice in section 1.2 (the first usage has a few words added which are different from the second):

"FORTRAN, the first widely used high-level language to have a functional implementation which permitted the abstraction of reusable blocks of code, came out in 1957[11] and many other languages were soon developed—in particular, COBOL aimed at commercial data processing, and Lisp for computer research."

Here's an image of it. I'm not sure how to go about fixing it. Is it fine to just completely remove the second usage? —  Melofors   TC  08:57, 21 February 2021 (UTC)

Wiki Education assignment: Linguistics in the Digital Age
— Assignment last updated by Yokutjon (talk) 23:24, 25 September 2022 (UTC)

Wiki Education assignment: Linguistics in the Digital Age
— Assignment last updated by Nurbekyuldashov (talk) 01:52, 9 May 2023 (UTC)

Conflicting statements regarding the first programmer
The history section features an image with the caption:

"Ada Lovelace, whose notes added to the end of Luigi Menabrea's paper included the first algorithm designed for processing by an Analytical Engine. She is often recognized as history's first computer programmer."

However in the history section it states:

"The first computer program is generally dated to 1843, when mathematician Ada Lovelace published an algorithm to calculate a sequence of Bernoulli numbers, intended to be carried out by Charles Babbage's Analytical Engine. However, Charles Babbage had already written his first program for the Analytical Engine in 1837."

It seems like there are contradictions:

 * The image caption states Lovelace designed the first algorithm for the Analytical Engine, however the article states that Babbage already wrote a program for the Analytical Engine
 * The image caption states that she is often recognized as history's first computer programmer, but this also conflicts with above

I am not sure which is correct here. According to Ada Lovelace it is contested. Perhaps the text should be rephrased in the article and image caption to reflect this. Lightbloom (talk) 19:42, 10 September 2023 (UTC)

This article is terribly inaccessible to laypeople
Can someone please rewrite at least the lead section, with an eye toward helping laypeople (e.g. high school students with no computing background) to make sense of it? The current version gets way too far into the weeds about the details of how computers work, and barely talks about what computer programming is. It consists almost entirely of unexplained jargon, for which mere wikilinks don't cut it. Try to put yourself in the shoes of a total novice, and write using ordinary English, possibly with a few jargon words explained parenthetically. This is too fundamental a topic to be left with such a summary. –jacobolus (t) 15:35, 19 October 2023 (UTC)

 * @XOR'easter – I think we want to wikilink computer program ASAP, but I'm afraid I've bungled the first few sentences again. Care to take another crack at it? –jacobolus (t) 03:15, 20 October 2023 (UTC)
 * I don't see the need to wikilink computer program immediately, and a sentence that basically says "computer programming is the writing of computer programs" is redundant. Writing the text around the links seems like the wrong way to go about it. XOR'easter (talk) 15:40, 20 October 2023 (UTC)
 * I wasn't trying to "write around the link" per se: I really do think "computer programming is writing computer programs" is the basic definition, and is not necessarily redundant. In some other kind of context "programming" might be something like picking the order kids should play in a piano recital or deciding when to schedule each show on a broadcast television network, and it's not a priori obvious that the action here is fundamentally different. To someone who does not know what programs or programming are, I think this kind of explicit link between the two is necessary, but perhaps there's a more artful phrasing. Perhaps following Knuth we could say something like "Computer programming is the art and science of writing computer programs". Or more precisely perhaps something like "Computer programming is the composition of formal texts, called programs, which a computer can interpret and put into effect to perform tasks."
 * But then quickly defining a computer program is its own challenge: "What then is a computer program? A particular form of expression of a flowchart or algorithm? An instruction manual for human beings? A process for controlling or bringing about a desired result inside a compurer? A machine part or completion of an incomplete machine? A circuit diagram or blueprint for a circuit board? A compilation of data? A coded writing? A "phonograph record," or perhaps "sheet music?" A mere pattern of symbols or a nonsense writing? All of these things, some of them, or something altogether different? When you read the first sentence of this article, you were probably sure you knew what a computer program is. Perhaps now the answer is not so obvious."
 * –jacobolus (t) 17:49, 20 October 2023 (UTC)
 * I think "Series of instructions" (or "set" of instructions) is a good basic definition. Frankly, I'm not sure this article even needs to exist when I look at others, like Computer Program and Programmer, which include practically the same information. DonFB (talk) 18:21, 20 October 2023 (UTC)
 * I do think there are meaningful distinctions of concept between program, programming, and programmer, and there could plausibly be distinct material targeted at all three topics (though some of them could also plausibly be combined or sliced in other ways). The scope of the various current articles has not ever been too carefully considered though, from what I can tell. –jacobolus (t) 18:26, 20 October 2023 (UTC)
 * They never are. XOR'easter (talk) 03:53, 21 October 2023 (UTC)
 * To elaborate a bit: in my experience, clusters of articles on closely related topics are seldom deliberately coordinated with any kind of plan. They each just do their own random walk, accumulating redundancies and sometimes even contradictions. Sorting out the resulting tangle is a passion project that few editors have the passion for. I'm fairly content with the opening paragraph of this article now. XOR'easter (talk) 16:10, 21 October 2023 (UTC)
 * I have no problem with substantial redundancy per se, so long as the scope of each article is clear, the articles in combination cover the subject, and readers can easily find the answers to questions they have. Indeed redundancy is often inevitable, and straining to avoid it often does more harm than good. But it can definitely also be the case that renaming, merging, splitting, reorganizing, etc. can improve the overall organization of clusters of related articles, and better serve readers. –jacobolus (t) 16:21, 21 October 2023 (UTC)
 * Yes, "sorting it out" involves deciding which overlaps are good. XOR'easter (talk) 17:33, 21 October 2023 (UTC)

sequence of instructions
IMO "is the composition of sequences of instructions" is not good. What about a visual programming language? Are graphical boxes instructions? Could say yes, but kinda forcing a square peg in a round hold. And some text languages don't have instructions; just specify the output. Again could call that instructions, but it's really not. And sequence implies order which in some context is not important.

This is hard. How to be general enough to include visual and spec languages while not making it so obtuse it's incomprehensible?

How about: A programmer composes source code in a language that after automated processing to generate corresponding computer instructions can control the computer's behavior. Commonly, a programmer edits source code as text, but some languages are graphical instead of textual.

"A programmer writes code to produce a program that runs on a computer." is not great either. Someone can be a programmer without producing a program. What's important is that they write code that could be run; even if they don't write the rest of the program. ... A programmer could write code for a computer that does not exist (as Aida noted) so saying "runs on a computer" is a bit off the mark. Stevebroshar (talk) 22:44, 12 May 2024 (UTC)

 * Yes, graphical boxes would be a sequence of instructions, in my opinion. I don't think your alternative suggestions yet are improvements, but by all means keep trying! –jacobolus (t) 01:23, 13 May 2024 (UTC)
 * If the graphical language is a sequence of boxes and each is an instruction, then sure, that's a sequence of instructions. But, I can imagine a graphical language that is not sequentially presented or executed. Further, I think specification languages are challenging to fit into the sequence category. If someone only writes SQL, are they not programming since they never write sequencing logic? Stevebroshar (talk) 13:24, 30 June 2024 (UTC)
 * You can see the previous version at special:permalink/1180298271. I think it was a lot more confusing than the current one. But I'm sure there are improvements that can still be made. –jacobolus (t) 01:25, 13 May 2024 (UTC)
 * I agree that is the process of performing particular computations is not good. Programming is about creating something that can be used to perform computations; not actually performing any. The current composition of sequences of instructions, called programs, that computers can follow to perform tasks addresses that issue, but still lacking IMO. It's too specific. Programming is about creating something that can be used to control computer behavior via its programmable interface. Surely, there's a better word than something. Maybe instructions is good. sequence of instructions is too specific. Stevebroshar (talk) 13:31, 30 June 2024 (UTC)

Nonsense
The section title 'Modern programming' is nonsense. I'm guessing someone wanted to group sections into a top-level section so that there were fewer top-level sections, and that they chose to contrast the 'history' section name. But, the stuff under 'modern programming' is not what I'd call modern -- since modern implies different than some older form. This info applies to programming from its beginning and therefore is not modern. IMO, either this section needs a better title or the sub-sections should be promoted to top-level. ... A better title would be something rather generic like 'attributes', 'aspects' or something.

The 'Quality requirements' section needs work or should be removed altogether. The start: Whatever the approach to development may be, the final program must satisfy some fundamental properties is nonsense. The first part alludes to some approaches, but I don't see the referent. As for having to satisfy fundamental properties such as reliability, robustness (all that stuff) actually no! A program can be utter garbage yes still be a program :) IMO, as with many sections throughout WP that have a 'main article' link, better to just link without trying to give extra info. IOW, remove the section while leaving the a link in a strategic location.

In Readability of source code, However, readability is more than just programming style seems odd to me. Readability is not style. Style can affect readability.

Also, why talk about 'Readability of source code' in the programming article? I'd say better suited under source code.

The section 'Methodologies' seems out of place. It starts with The first step in most formal software development processes is requirements analysis.... Isn't there an article with this info already? This section dives super deep into something that is definitely programming, but if the whole article dives this deep into all programming topics it will be 100 pages long. IMO this article should stay very high level; mostly linking to other articles.

It is very difficult to determine what are the most popular modern programming languages seems out of place. Why does the author think the reader wants to know that. It's a so what statement. It's what I might have written in a high school paper. Get to the point. IOW ax this sentence.

Debugging is a very important task in the software development: so what. high school level.

The more I read this article, the more I see that it needs work. Stevebroshar (talk) 12:30, 30 June 2024 (UTC)

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Talk:Computer programming


text:
Sui generis

Sui generis is a Latin phrase that means "of its/their own kind" or "in a class by itself", therefore "unique".

Several disciplines use the term to refer to unique entities. These include:
 * Biology, for species that do not fit into a genus that includes other species (its own genus)
 * Creative arts, for artistic works that go beyond conventional genre boundaries (its own genre)
 * Law, when a special and unique interpretation of a case or authority is necessary (its own special case)
 * Intellectual property rights, for types of works not falling under general copyright law but protected through separate statutes
 * Philosophy, to indicate an idea, an entity, or a reality that cannot be reduced to a lower concept or included in a higher concept (its own category)

Biology
In the taxonomical structure "genus → species", a species is described as sui generis if its genus was created to classify it (i.e., its uniqueness at the time of classification merited the creation of a new genus, the sole member of which was initially the sui generis species). A species that is the sole extant member of its genus (e.g., the genus Homo) is not necessarily sui generis; extinctions may have eliminated other congeneric species. A sui generis genus may also be called a monotypic genus.

Creative arts
A book, movie, television series, or other artistic creation is called sui generis when it does not fit into standard genre boundaries. Movie critic Richard Schickel identifies Joe Versus the Volcano as a sui generis movie. Film critic Michael Brooke used the term to describe Fantastic Planet, a 1973 Franco-Czech sci-fi animated film directed by René Laloux.

Law
In law, it is a term of art used to identify a legal classification that exists independently of other categorizations, either because of its singularity or due to the specific creation of an entitlement or obligation. For example, a court's contempt powers arise sui generis and not from statute or rule. The New York Court of Appeals has used the term in describing cooperative apartment corporations, mostly because this form of housing is considered real property for some purposes and personal property for other purposes.

When citing cases and other authorities, lawyers and judges may refer to "a sui generis case", or "a sui generis authority", meaning it is a special one confined to its own facts and, therefore, may not be of broader application.

Intellectual property law
Generally speaking, protection for intellectual property extends to intellectual creations to incentivize innovation and depends upon the nature of the work and its characteristics. The main types of intellectual property law are: copyright, which protects creative works; patent, which protects invention; trade secret, which protects information not generally known or readily ascertainable that is valuable to the secret holder; and trademark, which protects branding and other exclusive properties of products and services. Any matter that meets these criteria can be protected.

Sui generis statutes exist in many countries that extend intellectual property protection to matter that does not meet characteristic definitions: integrated circuit layouts, ship hull designs, fashion designs in France, databases, or plant varieties require sui generis statutes because of their unique characteristics. The United States, Japan, Australia, and many EU countries protect the topography of semiconductor chips and integrated circuits under sui generis laws, which borrow some aspects from patent or copyright law. In the U.S., this sui generis law is known as the Semiconductor Chip Protection Act of 1984.

Statutory law
In statutory interpretation, sui generis refers to the problem of giving meaning to groups of words where one of the words is ambiguous or inherently unclear.

In road traffic law, a statute may require consideration of large vehicles separately from other vehicles. The word "large" is ambiguous per se but may be considered "heavy". The relevant legislation (in Australian law) contain sections called "Terms used" or "Definitions" that itemise all words deemed ambiguous and confers specific interpretations consistent with natural language. One indicates "heavy vehicle" means a vehicle with a GVM over 4.5 tons, and GVM means "gross vehicle mass", the maximum loaded mass of the vehicle. Further explanations cover various contingencies. Thus, "large" is equivalent to "heavy" and is (for this unique case) clearly defined sui generis.

In U.S. attorney admissions, an applicant for admission to the practice of law may be referred to the state committee on character and fitness, where proceedings are "neither civil nor criminal, but are sui generis".

Town planning law
In town and country planning in the United Kingdom, in particular, relating to the Town and Country Planning (Use Classes) Order 1987, many common types of land use are categorised into specific "use classes". Change of use of land within a use class does not require planning permission; changing between use classes might require planning permission, and approval is always needed if the new use is sui generis.

Examples of sui generis uses include embassies, theatres, amusement arcades, laundrettes, taxi or vehicle hire businesses, petrol filling stations, scrapyards, nightclubs, motor car showrooms, retail warehouses, clubs and hostels. As of 1 September 2020 following the Town and Country Planning (Use Classes) (Amendment) (England) Regulations 2020, the following uses were added as sui generis:

 * public houses, wine bars, or drinking establishments (previously Class A4)
 * drinking establishments with expanded food provision (previously Class A4)
 * hot food takeaways (previously Class A5)
 * venues for live music performance
 * cinemas (previously Class D2(a))
 * concert halls (previously D2(b))
 * bingo halls (previously D2(c))
 * dance halls (previously D2(d))

The grant of private hire vehicle (taxicab) operators licences by local authorities frequently has a condition that the appropriate sui generis change of use planning permission is granted to those premises to ensure those businesses cannot trade lawfully without the relevant planning consent.

International law
When applied to international law, "sui generis" refers to situations which are distinct and thus not easily categorized under existing legal frameworks or conventions. Sui generis in international law may suggest novel legal frameworks to address unprecedented issues using a new set of legal principles. For example, the legal status of the internet or space law. Sui generis systems can be crucial in international law because they allow the international community to develop adaptive legal responses to emerging global challenges and contexts that are not adequately addressed by traditional international law. They often also serve as precursors to the evolution of wider customary international law or the development of new treaties and conventions. The uniqueness of sui generis legal regimes can sometimes make them challenging to interpret, enforce, or harmonize with existing legal frameworks.

Philosophy
Analytic philosophy often uses the expression to indicate an idea, an entity, or a reality that cannot be reduced to a lower concept or included in a higher concept. G. E. Moore, for example, refuted reductive ethical naturalism in moral theories like utilitarianism by arguing that moral properties (like good or bad) could not be reduced to or equated with non-moral properties (like pleasure) because moral properties are sui generis. This can be seen in Moore's open-question argument.

Politics and society
In political philosophy, the unparalleled development of the European Union as compared with other international organizations has led to its designation as a sui generis geopolitical entity. The legal nature of the EU is widely debated because its mixture of intergovernmental and supranational elements causes it to share characteristics with both confederal and federal entities. It is generally considered more than a confederation but less than a federation, thus being appropriately classified as an instance of neither political form. Compared to other international organizations, the EU is often considered "sui generis" because its legal system comprehensively rejects any use of retaliatory sanctions by one member state against another.

A similar case that led to the use of the label sui generis is the relationship of New Caledonia relative to France because the legal status of New Caledonia can aptly be said to lie somewhere between a French overseas collectivity and a sovereign nation. Although other examples of such status for further dependent or disputed territories may exist, this arrangement is unique within the French realm.

The legal status of the Holy See is also described as a sui generis entity possessing an international personality. The Sovereign Military Order of Malta has likewise been described as a "sui generis primary subject of public international law". Another entity widely considered to have sui generis international legal personality is the International Committee of the Red Cross.

In local government, a sui generis entity does not fit with a country's general scheme of local governance. For example, in England, the City of London and the Isles of Scilly are the two sui generis localities, as their forms of local government are both (for historical or geographical reasons) very different from those of elsewhere in the country. In a press conference during which reporters were trying to analyse his political personality, Huey Long said "say that I am sui generus, and let it go at that".

The Joint Council of Municipalities in Croatia is a sui generis council of municipalities in the east of the country that was formed after the Erdut Agreement and UNTAES mission aimed at protection of the rights of the ethnic Serb community in the region and is, as such, unique form of local cooperation and minority self-government in Croatia.

Sociology
In sociology, methodological holists argue that social phenomena exist in their own right (sui generis) and are not reducible to the actions of individuals. For example, Emile Durkheim argued that the suicide rate was a social phenomenon sui generis (existing over and above the actions of individuals) In a social constructionist perspective, "sui generis is what has been externalized, then internalized in the overall public and becomes a part of society that exists in its construct. It is not something that is not thought to have been created because it is embedded in everyone's way of thinking and being. Instances include love, going to school, or clothing belonging to a specific gender. These examples are sui generis for they exist in society and are widely accepted without thoughts of where they come from or how they were created.

title: Sui generis


text:
Hans von Bodeck

Hans von Bodeck (1582 – 23 June 1658) was a Prussian diplomat and chancellor of the Hohenzollern Prince-electors of Brandenburg-Prussia.

Biography
Bodeck came from a prominent patrician family of Elbing (Elbląg) in the Polish province of Royal Prussia. His grandfather was the burgomaster, while his father was a city councilman. His ancestor Johann III von Bodeck (1542–1595) received imperial status from Emperor Rudolf II and was allowed to improve the family's coat of arms. The family also held offices in Danzig (Gdańsk).

In order to find a trading partner Bodeck was sent on a diplomatic mission from Elbing throughout Europe. During that time he wrote liber amicorum, which is now studied by musicologists. During his diplomatic tour Bodeck visited the Netherlands, France, Switzerland, and England, where he attended the Universities of Oxford and Cambridge. He attended the funeral ceremony for Queen Elizabeth I of England and the coronation of the new English king, James I. The council of Elbing had sent two delegates with dual missions: firstly, to pay its respects to the new king and secondly to oppose the transfer of English trade from Elbing to nearby Danzig.

In 1604 Bodeck left for London and met John Dowland, Philip Rosseter, and Thomas Campion. All three composers of lute songs lived in the same district of London. Bodeck befriended them, and Campion wrote a song dedicated to Bodeck. Many people from England and Scotland came to live in Elbling.

Later that year Bodeck left for Paris and met Count Christopher von Dohna, a nobleman of Prussia, who lived 15 km from Elbing. Bodeck then became the chancellor to Elector Joachim Frederick of Brandenburg. He died in 1658 in Hamburg.

A collection of pieces for lute was purchased by Dohna and kept at the Elbing library. In 1929 Hans Bauer wrote a full description of the register of Bodeck. During the capture of Elbing by the Soviet Red Army in 1945 during World War II and the subsequent expulsion of the city's German populace, the library was destroyed. Many Prussian documents and original manuscripts have since been discovered in Kraków, leading music researchers to hope that some of Bodeck's works might resurface.

title: Hans von Bodeck


text:
HMS Antelope

Eleven ships of the Royal Navy have been named HMS Antelope, after the Antelope:

 * ENGLISH SHIP Antelope was a galleass carrying between 38 and 44 guns. She was launched in 1546, rebuilt three times and was burned by parliamentarian sailors at Hellevoetsluis in 1649.
 * ENGLISH SHIP Antelope was a 56-gun third-rate great frigate launched in 1651 and wrecked in 1652.
 * HMS Antelope (1653) was a 40-gun fourth-rate frigate launched in 1653 as Preston and renamed in 1660. She was sold in 1693.
 * HMS Antelope (1703) was a 54-gun fourth rate launched in 1703. She was rebuilt in 1741 and was sold in 1783.
 * HMS Antelope (1784) was a 14-gun sloop purchased in 1784, and lost in a hurricane later that year.
 * HMS Antelope (1802) was a 50-gun fourth rate launched in 1802. She was used as a troopship from 1818, was placed on harbour service from 1824 and was broken up in 1845.
 * HMS Antelope was a 14-gun schooner, the ex-Spanish prize Antelope captured and purchased in 1808 and taken into service as HMS Firefly (1808). She was later renamed to Antelope, and was broken up in 1814.
 * HMS Antelope (1846) was an Antelope-class sloop iron paddle sloop launched in 1846 and sold in 1883.
 * HMS Antelope (1893) was an Alarm-class torpedo gunboat launched in 1893. She was used for harbour service from 1910 and was sold in 1919.
 * HMS Antelope (H36) was an A-class destroyer (1929) destroyer launched in 1929 and sold in 1946.
 * HMS Antelope (F170) was a Type 21 frigate launched in 1972 and bombed and sunk in the Falklands War in 1982.

Battle honours
Ships named Antelope have earned the following battle honours:
 * Armada, 1588
 * Lowestoft, 1665
 * Four Days' Battle, 1666
 * Orfordness, 1666
 * Sole Bay, 1672
 * Marbella, 1705
 * Aquilon, 1757
 * Atlantic, 1939−44
 * Bismarck, 1941
 * Malta Convoys, 1942
 * North Africa, 1942−43
 * Falkland Islands, 1982

title: HMS Antelope


text:
Wikipedia talk:WikiProject Olympics

Good article reassessment for Winter Olympic Games
Winter Olympic Games has been nominated for a good article reassessment. If you are interested in the discussion, please participate by adding your comments to the reassessment page. If concerns are not addressed during the review period, the good article status may be removed from the article. ~~ AirshipJungleman29 (talk) 17:54, 24 May 2024 (UTC)

Medals by sport
Since the discussion was initiated in the United States at the Olympics (discussion), all disciplines should be listed individually or, as has been the case so far, grouped for some sports and their disciplines together in the sport itself.

In this specific case it's about Cycling and Canoeing. The disciplines for Cycling (Track cycling, Road cycling, BMX racing, BMX freestyle, Mountain biking) and Canoeing (Canoe sprint,Slalom canoeing) were listed individually in the table unlike to other NOC articles .I changed these in United States at the Olympics for consistency, but I suspect that other opinions should be heard here to prevent an edit war, as it was reverted by @Monerals -> misunderstanding here, not intentional, question still remains.

And if we really want to list strictly according to disciplines, should we then orientate on the Olympic sports table and, for example, also list the equestrian disciplines (dressage, eventing, jumping) individually in the Medals by sport table? The only exceptions so far are only four sports, where the disciplines grouped together in the medal table: Miria~01 (talk) 10:08, 26 May 2024 (UTC)
 * Cycling (Track cycling, Road cycling, BMX racing, BMX freestyle, Mountain biking)
 * Canoeing (Canoe sprint,Slalom canoeing)
 * Equestrian (dressage, eventing, jumping)
 * Wrestling (Freestyle, Greco-Roman)
 * I feel like it should be evaluated country-by-country. For the USA (who have a lot of medals in a lot of sports) it probably makes sense to combine them. On the other hand, for a country like Cuba where there are half as many medal categories it probably wouldn't hurt to err on the side of being more specific. Primefac (talk) 10:48, 26 May 2024 (UTC)
 * Gymanstics: I also saw that in some NOC articles the disciplines in Gymnastics are combined and for others are not (separated in United States at the Olympics and combined in Russia at the Olympics).
 * Swimming: Another case to note is Swimming at the Olympics. Sometimes Marathon Swimming is combined in Swimming at the medals table and sometimes separately (separated in Australia at the Olympics and combined in Netherlands at the Olympics).
 * A manual of style for the olympic articles would be desirable, but as far as I'm concerned it can also be considered country-specific, even if it would then be subjective. Miria~01 (talk) 12:22, 26 May 2024 (UTC)
 * I don't think it's right for the decision to be country-specific because that leaves a big opening for edit wars. In my opinion, it is better to reach a consent regarding a guiding rule. For example, what is considered a lot of medals for a country? Are there sports that we will always separate the disciplines from or unite them (athletics, for example)? Nimrodbr (talk) 19:10, 26 May 2024 (UTC)

One could argue that the disciplines are always listed separately, if the sport includes a genuine team sport. This also applies to aquatics with water polo. Or in this way: Only all real team sports and their disciplines are listed separately and aquatics is also considered an exception by consensus. ... And disciplines of winter sports should always be listed separately. Miria~01 (talk) 12:00, 28 May 2024 (UTC)

1896 Summer Olympics
I'm thinking about rerunning this one in late July at WP:Today's featured article. It was promoted to FA back in 2005, but I've run some automated checks on the article that turned out fine, and people have done a good job keeping up with questions on the talk page. It reads well. Yes, no? - Dank (push to talk) 01:34, 3 June 2024 (UTC)

 * Looks good. Kingsif (talk) 21:48, 12 July 2024 (UTC)

FYI has been nominated for deletion -- 65.92.244.143 (talk) 04:15, 4 June 2024 (UTC)

Timelines on qualification articles
Is it necessary to list the opening ceremony in a timeline of qualification events for each sport's qualification article? I don't think its necessary, with the timeline being left to just qualification events and dates. Thoughts? Sportsfan 1234 (talk) 23:12, 8 July 2024 (UTC)
 * Could you give an example page? The few sports I keep track of don't seem to have this. Primefac (talk) 23:24, 8 July 2024 (UTC)
 * Judo/2024 Olympics is the only one. Sportsfan 1234 (talk) 23:26, 8 July 2024 (UTC)
 * I removed it but there was some objection. But if there is a wider consensus to have them included, then we can add it back. Sportsfan 1234 (talk) 23:26, 8 July 2024 (UTC)
 * Special:Diff/1233403041 for the record. I don't see why that information needs to be included, it's not really part of the qualification timeline (especially if it's not listed for any other sports). Primefac (talk) 23:29, 8 July 2024 (UTC)
 * I totally agree with you. I can't recall it being on any qualification article including events outside the Olympics as well. Sportsfan 1234 (talk) 23:30, 8 July 2024 (UTC)
 * Agree with the removal. It's not part of the process. Kante4 (talk) 07:01, 9 July 2024 (UTC)
 * I think we have consensus for removal? Sportsfan 1234 (talk) 22:06, 12 July 2024 (UTC)
 * I support removal as it seems irrelevant.  Schwede 66  23:30, 12 July 2024 (UTC)

Requested move at Talk:María José Rienda Contreras
There is a requested move discussion at Talk:María José Rienda Contreras that may be of interest to members of this WikiProject. Safari Scribe Edits! Talk! 19:42, 12 July 2024 (UTC)

Yuna Kim A-class assessment
Hello everyone, WikiProject Figure Skating has just started doing A-class assessments. Our first article submitted for review is Yuna Kim, and we're in need of a third reviewer. Here's the link to the assessment: WikiProject Figure Skating/Assessment/Yuna Kim. The assistance of any member of this project would be muchly appreciated. You don't have to necessarily be a figure skating expert (although that would help, of course), but you should at least be knowledgeable about editing and contributing to Wikipedia. Thanks to all and best. Editor120918756 (talk) 06:13, 17 July 2024 (UTC)

 * I would, but having scanned the A-class review list page, I feel like I am not versed enough in the (many!) guidelines the FS project has on writing a FS biography to be a particularly useful reviewer. Several of the FS-specific A-class review points come down to handling FS-specific terminology, sources, guidelines in an appropriate manner and with my minimal experience editing in the area, I feel I could not well judge for myself any of those things, let alone assess and give recommendations.
 * If you are lacking for reviewers due to so many regular contributors of the FS project having edited the article, perhaps that is an indication than many users who could otherwise be the third reviewer have as a collective agreed on the quality status of the article - through combined editing - and another reviewer may not be necessary? It seems to reflect the amount of work the project has put into this article, and would be easier than needing to find a user willing to build up some experience in the area just for a review. Kingsif (talk) 23:34, 17 July 2024 (UTC)
 * Thanks for the response @Kingsif
 * I'll tag @Figureskatingfan here so she can read it. Editor120918756 (talk) 04:40, 18 July 2024 (UTC)
 * Yes, thanks for your response, @Kingsif. Actually, this was going to be the next step. We're trying to adhere to the agreed-upon requirement for three reviewers, but in this article's case, several editors who are familiar with our guidelines and who are experienced figure skating editors have worked on it. I agree, the solution is to come to a consensus that two reviewers are enough. Best to you! Christine (Figureskatingfan) (talk) 17:13, 18 July 2024 (UTC)
 * Sounds good! It's a great read of an article, I'd just check the photo number/sizes before sending it to FA or anything! Kingsif (talk) 20:18, 18 July 2024 (UTC)
 * @Kingsif Oh, yes! Thanks for at least reading it and telling us it looks good. That doesn't need any expertise, and most readers wouldn't have any expertise either. Editor120918756 (talk) 08:05, 19 July 2024 (UTC)

Reserve players
Hello everyone, i just wanted to ask if the number of reserve or alternate players should be included in the total athletes represented by the country at a event or should only the number of actively participating athletes should be included?  PrinceofPunjab  TALK 08:26, 20 July 2024 (UTC)

 * If I understand correctly, these players are not officially on the team and do not get awarded medals if they remain reserves. I remember there were some discussions on the topic regarding the volleyball teams. Tone 08:31, 20 July 2024 (UTC)
 * The discussion you are talking about is here  PrinceofPunjab  TALK 08:46, 20 July 2024 (UTC)

title: Wikipedia talk:WikiProject Olympics


text:
Satellite state

A satellite state or dependent state is a country that is formally independent but under heavy political, economic, and military influence or control from another country. The term was coined by analogy to planetary objects orbiting a larger object, such as smaller moons revolving around larger planets, and is used mainly to refer to Central and Eastern European member states of the Warsaw Pact during the Cold War, as well as to Mongolia and Tuva between 1924 and 1990, all of which were economically, culturally, and politically dominated by the Soviet Union. While primarily referring to the Soviet-controlled states in the Central and Eastern Europe or Asia, in some contexts the term also refers to other countries under Soviet hegemony during the Cold War, such as North Korea (especially in the years surrounding the Korean War of 1950–1953), Cuba (particularly after it joined the Comecon in 1972), and some countries in the American sphere of influence, such as South Vietnam (particularly during the Vietnam War). In Western usage, the term has seldom been applied to states other than those in the Soviet orbit. In Soviet usage, the term applied to states in the orbit of Nazi Germany, Fascist Italy, and Imperial Japan, whereas in the West the term to refer to those has typically been client states.

The Oxford English Dictionary traces the phrase satellite state in English back as early as 1916. In times of war or political tension, satellite states sometimes served as buffers between an enemy country and the nation exerting control over the satellites.

Interwar period
When the Mongolian Revolution of 1921 broke out, Mongolian revolutionaries expelled the Russian White Guards (during the Russian Civil War of 1917–1923 following the October Revolution of 1917) from Mongolia, with the assistance of the Soviet Red Army. The revolution also officially ended Manchurian sovereignty over Mongolia, which had existed since 1691. Although the theocratic Bogd Khanate of Mongolia still nominally continued, with successive series of violent struggles, Soviet influence grew stronger. In 1924, after the Bogd Khan died of laryngeal cancer or, as some sources suggest, at the hands of Soviet spies, the Mongolian People's Republic was proclaimed on November 26, 1924. A nominally independent and sovereign country, it has been described as being a satellite state of the Soviet Union in the years from 1924 until 1990. This is supported by the fact that the Mongolian PR collapsed less than two months after the dissolution of the Soviet Union.

During the Russian Civil War, Red Army troops occupied Tuva in January 1920, which had also been part of the Qing Empire of China and a protectorate of Imperial Russia. The Tuvan People's Republic was proclaimed a nominally independent state in 1921, although it was tightly controlled by Moscow and is considered a satellite state of the Soviet Union until 1944, when the USSR annexed it into the Russian SFSR.

Another early Soviet satellite state in Asia was the short-lived Far Eastern Republic in Siberia.

Post-World War II
At the end of World War II, most Eastern and Central European countries were occupied by the Soviet Union, and along with the Soviet Union made up what is called the Soviet empire. Soviet forces remained in these countries after the war's end. Through a series of coalition governments including communist parties, and then a forced liquidation of coalition members opposed by the Soviets, Stalinist systems were established in each country. Stalinists gained control of existing governments, police, press and radio outlets in these countries. Soviet satellite states of the Cold War included: Albania, Romania, and Yugoslavia ceased to be satellites before the revolutions of 1989. The Federal People's Republic of Yugoslavia is considered an early Soviet satellite, as it broke from Soviet orbit in the 1948 Tito–Stalin split, with the Cominform offices being moved from Belgrade to Bucharest, and Yugoslavia subsequently formed the Non-Aligned Movement. The People's Socialist Republic of Albania, under the leadership of Enver Hoxha, broke ties with the Soviet Union in the Albanian–Soviet split following the Soviet de-Stalinisation process, and removed itself from Soviet influence in 1961. Romania's de-satellization process started in 1956 and ended by 1965, with serious economic disagreements with Moscow resulting in a final rejection of Soviet hegemony in 1964.
 * People's Republic of Albania (1946–1961)
 * Polish People's Republic (1947–1989)
 * People's Republic of Bulgaria (1946–1990)
 * Romanian People's Republic (1947–1965)
 * Czechoslovak Socialist Republic (1948–1989)
 * German Democratic Republic (1949–1990)
 * Hungarian People's Republic (1949–1989)
 * Federal People's Republic of Yugoslavia (1945–1948)
 * Mongolian People's Republic (1925–1991)
 * 🇰🇵 Democratic People's Republic of Korea (1948–1956)
 * Democratic Republic of Afghanistan (1978–1991)

From 1945 to 1948 North Korea was under Soviet Civil Administration, following this provisional governments were established under the Provisional People's Committee of North Korea and People's Committee of North Korea resulting in the establishment of the Democratic People's Republic of Korea in 1948. Some scholars consider North Korea a satellite state under the Soviet Union from 1948 until the 1958 August faction incident.

The short-lived East Turkestan Republic (1944–1949) was a Soviet satellite until it was absorbed into the People's Republic of China. Between 1945 and the Iran crisis of 1946 the Azerbaijan People's Government and Republic of Mahabad existed as satellite states in Soviet-occupied Iran. The Democratic Republic of Afghanistan was a satellite regime of the Soviet Union from 1978 to 1991. Between 1979 and 1989, Afghanistan was also under Soviet military occupation.

Post-Cold War usage of the term
Some commentators have expressed concern that United States military and diplomatic interventions in the Balkans and in the Middle East and elsewhere might lead, or perhaps have already led, to the existence of American satellite states. William Pfaff warned that a permanent American presence in Iraq would "turn Iraq into an American satellite state". The term has also been used in the past to describe the relationship between Lebanon and Syria, as Syria has been accused of intervening in Lebanese political affairs. In addition, Eswatini and Lesotho have both been described as satellite states of South Africa. In Europe, Belarus has been described as a satellite state of the Russian Federation.

title: Satellite state


text:
Tribute in Light

The Tribute in Light is an art installation created in remembrance of the September 11 attacks. It consists of 88 vertical searchlights arranged in two columns of light to represent the Twin Towers. It stands six blocks south of the World Trade Center on top of the Battery Parking Garage in New York City. Tribute in Light began as a temporary commemoration of the attacks in early 2002, but it became an annual event, currently produced on September 11 by the Municipal Art Society of New York. The Tribute in Light was conceived by artists John Bennett, Gustavo Bonevardi, Richard Nash Gould, Julian LaVerdiere, and Paul Myoda, and lighting consultant Paul Marantz.

On clear nights, the lights can be seen from 60 mi away, visible in all of New York City and most of suburban Northern New Jersey and Long Island. The lights can also be seen in Fairfield County, Connecticut, as well as Westchester, Orange, and Rockland counties in New York.

The 88 xenon spotlights (44 for each tower) each consume 7,000 watts. , the annual cost for the entire project was about $500,000.

A similar Tribute in Light has also appeared on occasion at the Pentagon in Arlington County, Virginia and at the crash site of United 93 in Shanksville, Pennsylvania, which were also targeted during the 9/11 attacks.

Background
After the September 11 attacks, several people independently conceived the idea of using lights for remembrance. These efforts were merged under the umbrella of the Municipal Art Society and Creative Time.

Tribute in Light initially ran as a temporary installation from March 11 to April 14, 2002, and it ran again on September 11, 2003, to mark the second anniversary of the attack. Since then, it has been repeated every year on September 11. It was announced that 2008 would be its final year, but the tribute was continued in 2009.

On December 17, 2009, it was confirmed that the tribute would continue through the tenth anniversary of the attacks in 2011. In 2012, plans were underway for the National September 11 Memorial & Museum to assume the lease for the MTA property used during this tribute, and to begin transitioning operation of the tribute from the Municipal Art Society to the memorial foundation.

The lights are produced by an Italian company named Space Cannon, which sends a team every year to help with the installation. A Las Vegas-based company, Light America, was also part of the team who implemented the project.

Each year, about 30 technicians, electricians, and stagehands work for about ten days to install the lights. During a testing phase of several days, observers in Brooklyn, Staten Island, New Jersey, and uptown Manhattan help make sure that the beams are adjusted accurately.

The project was originally going to be named Towers of Light, but the victims' families felt that the name emphasized the buildings destroyed instead of the people killed.

A permanent fixture of the Tribute in Light was at one point intended to be installed on the roof of One World Trade Center, but it was not included in the finished design.

Since 2008, the generators that power Tribute in Light have been fueled with biodiesel made from used cooking oil collected from local restaurants.

Effects on birds
The light pollution from Tribute in Light has caused confusion for over a million migrating birds, trapping them in the beams. Even at an altitude of several miles, birds can be affected by the lights. As a result of this effect, the beams are switched off for 20-minute periods to allow the birds to escape. To ensure the lights do not affect migrating birds, the Municipal Art Society works with the New York City Audubon on the illumination. A 2017 study found that the installation "dramatically altered multiple behaviors of nocturnally migrating birds—but these effects disappeared when lights were extinguished".

In popular culture
Tribute in Light was featured in Boyz II Men's music video for "Color of Love". It made a notable appearance during the opening credits of Spike Lee's 2002 film 25th Hour. The tribute was also shown and referenced in the CBS series Blue Bloods. These lights were featured in the music video of U2's "You're the Best Thing About Me".

The video game adaptation of the film Spider-Man 2 features the lights at the approximate location of the WTC site, while another video game adaptation of the film The Amazing Spider-Man 2, the lights are seen on the construction site of One World Trade Center at night.

title: Tribute in Light


text:
Sigismund von Herberstein

Siegmund (Sigismund) Freiherr von Herberstein (or Baron Sigismund von Herberstein; 23 August 1486 – 28 March 1566) was a Carniolan diplomat, writer, historian and member of the Holy Roman Empire Imperial Council. He was most noted for his extensive writing on the geography, history and customs of Russia, and contributed greatly to early Western European knowledge of that area.

Early life
Herberstein was born in 1486 in Vipava (Wippach) in the Duchy of Carniola, now in Slovenia, then part of the Habsburg monarchy. His parents were Leonhard von Herberstein and Barbara von Lueg, members of the prominent German-speaking family which had already resided in Herberstein Castle for nearly 200 years. Little is known of his early life apart from the fact that he became familiar with the Slovene language spoken in the region. This knowledge became significant later in his life.

In 1499, he entered the University of Vienna to study philosophy and law. In 1506, he entered the army as an officer and served in a number of campaigns. In 1508, he was knighted by the Holy Roman Emperor, Maximilian I, in person. In 1515, he entered the Imperial council, or Parliament, and began a long and illustrious diplomatic career.

Diplomatic career
Between 1515 and 1553, Herberstein carried out approximately 69 missions abroad, travelling throughout much of Europe, including Turkey. He was feted by the ruling Habsburgs and rewarded with titles and estates. He was twice sent to Russia as ambassador of the Holy Roman Emperor, in 1517 to attempt to arrange a truce between Russia and Lithuania, and in 1526 to renew a treaty between the two signed in 1522. These extended visits (nine months in his 1517 visit) provided him with the opportunity to study a hitherto largely unknown Russian society.

Writing on Russia
Herberstein's knowledge of Slovene, acquired in his youth, allowed him to communicate with Russians, as Slovene and Russian both belong to the Slavic languages. He used this ability to question a variety of people in Russia on a wide range of topics. This gave him an insight into Russia and Russians unavailable to the few previous visitors to Russia.

He probably wrote his first account of life in Russia between 1517 and 1527, but no copy of this survives. In 1526, he was asked to produce a formal report on his experiences in Russia, but this remained relatively unnoticed in the archives until he was able to find time to revise and expand it, which he possibly started in the 1530s.

The evidence suggests that Herberstein was an energetic and capable ethnographer. He investigated in depth both by questioning locals and by critically examining the scarce existing literature on Russia. The result was his major work, a book written in Latin titled Rerum Moscoviticarum Commentarii ("Notes on Muscovite Affairs"), published in 1549. This became the main early source of knowledge in Western Europe on Russia.

He was the first to record the spelling of tsar as czar (both spellings are meant to express the same pronunciation). Later, English and French began to move from the 'cz' spelling to the 'ts' spelling in the 19th century.

title: Sigismund von Herberstein