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AirBaltic

airBaltic, legally incorporated as AS Air Baltic Corporation, is the flag carrier of Latvia, with its head office on the grounds of Riga International Airport in Mārupe municipality near Riga. Its main hub is Riga, and it operates bases in Tallinn, Vilnius, Tampere and a seasonal base in Las Palmas launched in 2023. It is 97% owned by the Government of Latvia. It operates flights solely on Airbus A220 planes. It operates a frequent-flyer program and a buy on board menu offering food and drinks for purchase.

Early history
Baltic International Airlines (BIA) was a Latvian and US joint venture company owned by SIA Baltic International Airlines whose main airport was Riga International Airport. It was founded in June 1992, after the US-based private company Baltic International USA (BIUSA) failed to buy a part of the state-owned Latvian national airline Latavio. In the joint venture, the Latvian government owned 60%, while BIUSA owned 40%. After unsuccessful privatization attempts, Latavio was declared insolvent in October 1995. It was liquidated and the Government of Latvia together with Baltic International Airlines created AirBaltic.

The airline was established as Air Baltic on 28 August 1995 with the signing of a joint venture between Scandinavian Airlines (SAS) and the Government of Latvia. Operations started on 1 October 1995 with the first AirBaltic aircraft, a Saab 340, in Riga, and that afternoon, the plane made the first passenger flight for AirBaltic.

In 1996, the airline's first Avro RJ70 was delivered; and Air Baltic joined the SAS frequent flier club as a partner. In 1997, a cargo department was established and, in 1998, the airline's first Fokker 50 plane was delivered. The adopted livery was mainly white, with the name of the airline written in blue on the forward fuselage, the 'B' logo being heavily stylized in blue checks. The checker blue pattern was repeated on the aircraft tailfin.

In 1999, airBaltic became a joint stock company; it was previously a limited liability company. All of the Saab 340s were replaced by Fokker 50s. In September, the airline began operating under the European Aviation Operating Standards, or JAR ops. Air Baltic welcomed the new millennium by introducing new uniforms and opening a cargo centre at Riga's airport.

The first Boeing 737-500 joined the fleet in 2003, and on 1 June 2004, Air Baltic launched services from the Lithuanian capital, Vilnius, initially to five destinations. In October 2004, Air Baltic was rebranded as AirBaltic. Its present livery consists of an all-white fuselage and lime tailfin. AirBaltic.com is displayed on the forward upper fuselage, and the word "Baltic" is repeated in blue on the lower part of the tailfin. In December 2006, the first Boeing 737-300 joined the fleet and was configured with winglets. In July 2007, AirBaltic introduced an online check-in system, the first online check-in system in the Baltic states. In the spring of 2008, two long-haul Boeing 757s were added to the fleet. In 2010, the airline began leasing De Havilland Canada Dash 8-400 aircraft, it retired these aircraft in 2023.

AirBaltic had strong links with SAS, which owned 47.2% of the airline, and operated frequent flights to SAS hubs in Copenhagen, Oslo and Stockholm. Some of AirBaltic's products and services are still shared with SAS, including co-ordinated timetabling and shared airport lounges. AirBaltic is not a member of any airline alliance but does have codeshare agreements in place with several Star Alliance member airlines and others.

AirBaltic had secondary hubs at Vilnius Airport and Tallinn Airport. The majority of the routes commenced from Tallinn were cancelled shortly after opening, leading to complaints from the Estonian Consumer Protection Department.

In January 2009, SAS sold its entire stake in the company (47.2% of the airline) to Baltijas aviācijas sistēmas Ltd (BAS) for 14 million lats. BAS was wholly owned by Bertolt Flick (President and CEO) until December 2010, when 50% of BAS shares were transferred to Taurus Asset Management Fund Limited, registered in the Bahamas.

Development since 2010
In August 2011, AirBaltic requested more than 60 million lats in capital as its losses continued to mount, and suffered speculation about its financial position   and political scandals throughout 2011. In mid-September 2011, the company announced plans to lay off around half its employees and cancel around 700 flights a month to avoid possible grounding. The company also announced that a mystery investor was willing to pay 9.6 million euros for an additional 59,110 shares. On 4 October 2011, the plans were annulled in order to make the necessary investments in the airline's capital. The government of Latvia and BAS agreed to invest around 100 million lats in the airline's share capital in proportion to their stakes in AirBaltic. As part of the agreement its longtime president and CEO stepped down and Martin Gauss, former CEO of Hungarian airline Malév Hungarian Airlines, became the new CEO.

AirBaltic had made an announcement on 23 September 2010 that it would establish a new secondary hub at Oulu Airport.

In early 2012, it was confirmed that Oulu hub plans were cancelled due to financial issues. The cost-cutting program, initiated by AirBaltic which aimed to return to profitability in 2014, scored better than planned results in 2012, by narrowing its losses to €27.2 million, from €121.5 in 2011.

The state's shareholding had been 99.8% since 30 November 2011, following the collapse of a bank linked with a finance package negotiated for the airline, but on 6 November 2015 it was reported that the Latvian Cabinet of Ministers had approved plans to sell 20% of airBaltic to German investor Ralf Dieter Montag-Girmes for €52 million and agreed to invest a further €80 million in the airline. The total of €132 million of fresh capital for the carrier is intended to spur its Horizon 2021 business plan and fleet modernisation. Following the closure of Air Lituanica and Estonian Air respectively in June and November 2015, it is alongside Nordica, one of two flag carriers in the Baltic countries.

The Bombardier CS300 delivery was much anticipated by airBaltic since this new aircraft type was originally planned to replace most of the airline's Boeing 737-300s and Boeing 737-500s and would replace all by 2020. The delivery of the CS300 happened on 29 November 2016, at 2 am ET. On 28 November, Bombardier and airBaltic held a ceremony in Mirabel, Quebec, Canada for the first delivery of the CS300. At 1:30 am, shortly before the scheduled departure, an oil leak from an engine was spotted. It delayed the departure, but at 2:23 am ET, the aircraft was now airBaltic's property. On board the inaugural flight, there were 18 people, including 6 pilots: 3 from Bombardier, and 3 from airBaltic. At 4:13 am ET, after a delay of over 2 hours, flight BT9801 took off en route to Stockholm. The airline received two CS300 in 2016 and expects to receive six in 2017, eight in 2018 and four more in 2020.

AirBaltic was looking for opportunities to replace its Q400 turboprop fleet, and Bombardier and Embraer were viewed as potential future aircraft suppliers, with possible deliveries of 14 new aircraft beginning in 2020. On 26 September 2017, AirBaltic announced it would buy at least 14 additional CSeries aircraft from Bombardier before the end of 2018; it planned to switch to an all-CSeries fleet by the early 2020s. Additional orders by AirBaltic were announced by Bombardier on 28 May 2018 and included 30 CS300 with options and purchase rights for a further 30 CS300. Airbus purchased a 50.01% majority stake in the CSeries program in October 2017, with the deal closing in July 2018; the aircraft family was subsequently renamed the Airbus A220.

AirBaltic temporarily suspended operations on 17 March 2020 due to the coronavirus pandemic, and flights only restarted on a limited basis from 18 May 2020.

On 14 December 2021, AirBaltic announced that its first secondary hub outside of the Baltic countries will be founded in Tampere–Pirkkala Airport in May 2022. In June 2023, AirBaltic announced that it would establish a new seasonal base at Gran Canaria Airport, with two aircraft to be stationed there for the forthcoming winter season.

AirBaltic began wet leasing it's aircraft to other carriers in 2022, predominantly to SWISS. In 2023, it has been approved for "long-term and unlimited wet leasing within the Lufthansa Group." As of December 2023 AirBaltic currently operates certain flights for SWISS.

After the pandemic, AirBaltic unveiled a range of upgrades focused on enhancing the experience for its clients. In 2022, AirBaltic debuted the Planies NFT collection, offering perks towards the airBaltic Club loyalty program. Then, in 2023, AirBaltic forged a partnership with Starlink to offer unrestricted complimentary in-flight Wi-Fi in their routes, marking a pioneering move in Europe's aviation industry. Installation of the service commenced in 2023 and will be finalised by 2025.

In November 2023, AirBaltic announced that Delta Air Lines would begin codesharing 20 routes to their bases.

Corporate affairs
The current head office at Riga Airport opened in 2016.

Ownership
airBaltic is a joint-stock company, with current shareholders (as of December 2023):

Financials
The airline's full accounts have not always been published regularly; figures disclosed by AirBaltic via various publications are shown below (for years ending 31 December):

Destinations
airBaltic operates direct year-round and seasonal short-haul flights from Riga, Tallinn and Vilnius, mostly to metropolitan and leisure destinations within Europe and Middle East. AirBaltic does not operate long-haul flights, but has codeshares with partners in all three airline alliances to allow through-ticketed long-haul flights.

Codeshare agreements
airBaltic has codeshare agreements with the following airlines:

 * Aegean Airlines
 * Air France
 * Austrian Airlines
 * Azerbaijan Airlines
 * Belavia
 * British Airways
 * Brussels Airlines
 * Bulgaria Air
 * Cyprus Airways
 * Czech Airlines
 * Delta Air Lines
 * Emirates
 * Etihad Airways
 * Georgian Airways
 * Iberia
 * Icelandair
 * ITA Airways
 * KLM
 * KM Malta Airlines
 * LOT Polish Airlines
 * Lufthansa
 * Scandinavian Airlines
 * TAP Air Portugal
 * TAROM
 * Turkish Airlines
 * Ukraine International Airlines
 * Uzbekistan Airways

Current fleet
, the airBaltic fleet consists of an all Airbus A220 fleet.

Fleet development
airBaltic has announced plans to increase their fleet to 100 by 2030. In November 2023, they have announced an order of 30 new A220-300s. The airline is currently the largest A220-300 operator in the world. The airline expects to receive its 50th aircraft in late 2024, announcing a contest allowing its frequent flyers to vote on a special livery to mark the occasion.

Historical fleet
airBaltic formerly also operated the following types of aircraft:

Livery
The original livery was painted on Avro RJ70s and had a white fuselage. The original airBaltic colour scheme, blue and white, was painted on the engines and the vertical stabiliser. The second-generation livery also had a lime green wingtip and vertical stabiliser; however the logo was changed to airBaltic.com and the word airBaltic was painted on the engines, which were in their original metallic colour.

Until December 2019, the livery consisted of a white fuselage and lime green vertical stabiliser, wingtips and engines. In December 2019, the rear fuselage below the vertical stabilizer was also painted in lime green, with the tail cone remained white. The logo, stylised 'airBaltic', is painted in dark blue on the fuselage across the windows and on the underside of the aircraft. This livery is mainly used on A220s.

Special liveries
In order to represent the three Baltic states, four of the A220s have been painted in a series of national flag liveries - one each for Estonia and Lithuania, two for Latvia.

Accidents

 * A drunk airBaltic crew including a co-pilot at seven times legal alcohol limit stopped by the police in Oslo before a flight in 2015. The second officer was sentenced to six months' jail while the captain and flight attendants also faced proceedings after a tip-off stopped them from taking charge of flight from Norway.
 * On 17 September 2016, an airBaltic de Havilland Dash 8-400, registered YL-BAI, performing flight BT-641, landed at Riga without its nose gear due to problems with the nose gear.
 * On 6 December 2017, due to heavy winds and a slippery surface, an airBaltic Boeing 737-500 slid off a taxiway after landing in Moscow Sheremetyevo International Airport.
 * On 3 December 2021, due to heavy snowfall, an airBaltic Airbus A220-300 (YL-CSE) slid off the runway after the landing at Riga Airport from Stockholm (flight BT102).
 * On 9 March 2023, due to heavy snowfall, an airBaltic Airbus A220-300 (YL-AAP) slid off the runway after the landing at Riga Airport from Paris (flight BT694).

title: AirBaltic


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Shrinkage

Shrinkage may refer to:

Reduction in size of a solid material

 * Shrinkage (casting), size reduction of liquid metal as it solidifies
 * Shrinkage (concrete), size reduction of concrete as it sets and ages
 * Shrinkage (fabric), size reduction of fabric when washed with water or hot water
 * Shrinkage (wood), size reduction of wood as it dries

Other uses

 * Shrinkage (accounting), loss of product inventory due to theft, damage, spoilage, etc.
 * Shrinkage defect or shrinkage void, a casting defect caused by metal solidifying from the outside inward
 * Shrinkage (statistics), a technique to improve an estimator
 * Shrinkage (slang)

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

title: Shrinkage


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Exposure

Exposure or Exposures may refer to:

Films

 * Exposure (1932 film), an American film
 * Exposure, another name for the 1991 movie A Grande Arte starring Peter Coyote
 * Exposure (2023 film), an American psychological thriller film

Literature

 * Exposure (Peet novel), a 2008 sports novel by Mal Peet
 * Exposure (Reichs novel), a 2014 novel in the Virals series by Kathy and Brendan Reichs
 * Exposure: Poisoned Water, Corporate Greed, and One Lawyer's Twenty-Year Battle Against DuPont, a 2019 book by Robert Bilott
 * Exposure, a 2016 novel by Helen Dunmore
 * "Exposure", a 1918 poem by Wilfred Owen

Music

 * The Exposures, a stage name of German electronic musician Jan Jelinek

Albums

 * Exposure (Exposé album), 1987
 * Exposure (Robert Fripp album), released in 1979
 * Exposure (Gary Numan album), a compilation album, 2002
 * Exposure (Esperanza Spalding album), 2017
 * Exposures – In Retrospect and Denial, a 2004 compilation album by metal band Dark Tranquility

Songs

 * "Exposure", a song from Projector by Dark Tranquillity
 * "Exposure", a song from Discoveries by Northlane
 * "Exposure", a song from the self-titled 1978 album Peter Gabriel

Photography

 * Exposure (photography), the quantity of light or other radiation reaching a photographic film
 * Exposure value, a value given to all combinations of camera shutter speed and aperture that gives the same exposure

Series

 * Exposure (American TV series), a short film anthology series on Sci-Fi Channel from 2000–2002
 * Exposure (British TV series), a current affairs strand on ITV which began in 2011

Episodes

 * "Exposure" (Dark Angel)
 * "Exposure" (The Unit)

Other uses in arts and entertainment

 * Exposure (magic), revealing magicians' secrets
 * Exposure (sculpture), a 2010 steel frame sculpture located in the Netherlands
 * Exposure, a webcomic from Red Giant Entertainment

Law

 * Exposure, potential for legal damages
 * Exposure, child abandonment

Other uses

 * Exposure (heights), in climbing and hiking, a terrain likely to cause injury when falling
 * Exposure, an insurance company's potential to provide coverage under an insurance policy
 * Indecent exposure, the display of unclothed parts of the human body that is against local custom and law
 * Infant exposure, a form of child abandonment
 * Market exposure, a measure of the proportion of money invested in the same industry sector

title: Exposure


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Cost

Cost is the value of money that has been used up to produce something or deliver a service, and hence is not available for use anymore. In business, the cost may be one of acquisition, in which case the amount of money expended to acquire it is counted as cost. In this case, money is the input that is gone in order to acquire the thing. This acquisition cost may be the sum of the cost of production as incurred by the original producer, and further costs of transaction as incurred by the acquirer over and above the price paid to the producer. Usually, the price also includes a mark-up for profit over the cost of production.

More generalized in the field of economics, cost is a metric that is totaling up as a result of a process or as a differential for the result of a decision. Hence cost is the metric used in the standard modeling paradigm applied to economic processes.

Costs (pl.) are often further described based on their timing or their applicability.

Types of accounting costs
In accounting, costs are the monetary value of expenditures for supplies, services, labor, products, equipment and other items purchased for use by a business or other accounting entity. It is the amount denoted on invoices as the price and recorded in book keeping records as an expense or asset cost basis.

Opportunity cost, also referred to as economic cost is the value of the best alternative that was not chosen in order to pursue the current endeavor—i.e., what could have been accomplished with the resources expended in the undertaking. It represents opportunities forgone.

In theoretical economics, cost used without qualification often means opportunity cost.

Comparing private, external, and social costs
When a transaction takes place, it typically involves both private costs and external costs.

Private costs are the costs that the buyer of a good or service pays the seller. This can also be described as the costs internal to the firm's production function.

External costs (also called externalities), in contrast, are the costs that people other than the buyer are forced to pay as a result of the transaction. The bearers of such costs can be either particular individuals or society at large. Note that external costs are often both non-monetary and problematic to quantify for comparison with monetary values. They include things like pollution, things that society will likely have to pay for in some way or at some time in the future, even so that are not included in transaction prices.

Social costs are the sum of private costs and external costs.

For example, the manufacturing cost of a car (i.e., the costs of buying inputs, land tax rates for the car plant, overhead costs of running the plant and labor costs) reflects the private cost for the manufacturer (in some ways, normal profit can also be seen as a cost of production; see, e.g., Ison and Wall, 2007, p. 181). The polluted waters or polluted air also created as part of the process of producing the car is an external cost borne by those who are affected by the pollution or who value unpolluted air or water. Because the manufacturer does not pay for this external cost (the cost of emitting undesirable waste into the commons), and does not include this cost in the price of the car (a Kaldor–Hicks compensation), they are said to be external to the market pricing mechanism. The air pollution from driving the car is also an externality produced by the car user in the process of using his good. The driver does not compensate for the environmental damage caused by using the car.

Cost estimation
When developing a business plan for a new or existing company, product or project, planners typically make cost estimates in order to assess whether revenues/benefits will cover costs (see cost–benefit analysis). This is done in both business and government. Costs are often underestimated, resulting in cost overrun during execution.

Cost-plus pricing is where the price equals cost plus a percentage of overhead or profit margin. In business economics, the profitability of a trade or sales prospect relies on the ability of an enterprise to sustain market prices that cover all costs and leave a surplus for owner interest, as expressed by:

$$\text{Profit = Revenues – Costs}$$

Manufacturing costs vs. non-manufacturing costs
Manufacturing costs are those costs that are directly involved in manufacturing of products. Examples of manufacturing costs include raw materials costs and charges related to workers. Manufacturing cost is divided into three broad categories:

Non-manufacturing costs are those costs that are not directly incurred in manufacturing a product. Examples of such costs are salary of sales personnel and advertising expenses. Generally, non-manufacturing costs are further classified into two categories:
 * 1) Direct materials cost.
 * 2) Direct labor cost.
 * 3) Manufacturing overhead cost.

 * 1) Selling and distribution costs.
 * 2) Administrative costs.

Other costs
A defensive cost is an environmental expenditure to eliminate or prevent environmental damage. Defensive costs form part of the genuine progress indicator (GPI) calculations.

Labour costs would include travel time, holiday pay, training costs, working clothes, social insurance, taxes on employment &c.

Path cost is a term in networking to define the worthiness of a path, see Routing.

title: Cost


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Pole Position

Pole Position (ポールポジション) is a racing arcade video game released by Namco in 1982. It was licensed to Atari, Inc. for US manufacture and distribution. Pole Position is considered one of the most important titles from the golden age of arcade video games. It was an evolution of Namco's earlier arcade racing electro-mechanical games, notably F-1 (1976), whose designer Sho Osugi worked on Pole Position.

The game was a major commercial success in arcades. After becoming the highest-grossing arcade game of 1982 in Japan, it went on to become the most popular coin-operated arcade video game internationally in 1983. In North America, it was the highest-grossing arcade game for both 1983 and 1984 and still one of the top five in 1985.

Pole Position spawned ports, sequels, and a Saturday morning cartoon, although the cartoon has little in common with the game. The game established the conventions of the racing game genre and its success inspired numerous imitators. Pole Position is regarded as one of the most influential video games of all time, and is considered to be the most influential racing game in particular. A sequel, Pole Position II, was released in 1983 with four tracks instead of one.

Gameplay

In this game, the player controls a Formula One race car and has to complete a time trial lap within a certain amount of time (between 57 and 120 seconds) to qualify for an F1 race at the Fuji Racetrack. After qualifying, the player races against seven other CPU-controlled cars in a championship race (but if they do not qualify, the car will stay on the track until the timer runs out). The player must also avoid going off the road so that they will not crash into the billboards. Play continues until either time runs out in any lap and/or complete four laps of the race, which ends the game.

Pole Position was the first racing video game to feature a track based on a real racing circuit. It was also the first game to feature a qualifying lap, requiring the player to complete a time trial before they can compete in Grand Prix races. Once the player has qualified, they must complete the race in the time allowed, avoiding collisions with CPU-controlled opponents and billboards along the sides of the track. The game's North American distributor, Atari, publicized the game for its "unbelievable driving realism" in providing a Formula 1 experience behind a racing wheel. The game's graphics featured full-colour landscapes with scaling sprites, including race cars and other signs, and a pseudo-3D, third-person, rear perspective view of the track, with its vanishing point swaying side to side as the player approaches corners, accurately simulating forward movement into the distance. While earlier three-dimensional arcade driving games emphasized staying on the road while avoiding crashes, Pole Position gives a higher reward for passing rival cars and finishing among the leaders.

Cabinet
Pole Position was released in two configurations: a standard upright cabinet and an environmental/cockpit cabinet. Both versions feature a steering wheel and a gear shifter for low and high gears, but the environmental/cockpit cabinet featured both an accelerator and a brake pedal, while the standard upright one only featured an accelerator pedal.

Development
Pole Position was created by both Shinichiro Okamoto and Galaxian designer Kazunori Sawano. Namco electro-mechanical game engineer Sho Osugi also assisted with development. Based on Namco's experience with producing coin-operated electro-mechanical driving games in the 1970s, notably F-1 (1976) designed by Sho Osugi, Sawano showed Okamoto rough sketches of his idea, who liked the idea and began production of a video racing game. Okamoto wanted the game to be a true driving simulation game that used a 3D perspective and allowed the player to execute real-world techniques. He also chose to add the Fuji Speedway into the game to make newer players recognize it when they first played. Music was jointly composed by Nobuyuki Ohnogi and Yuriko Keino.

Development of the game lasted for three years. Okamoto recalls the most challenging part of development being to produce the hardware needed to run it, as the game was too "ambitious" to run on older hardware. The development team used two 16-bit processors to power the game, which Okamoto says was an unheard-of concept for arcade games at the time — for a while, it was the only video game to use a Z8000 CPU. Pac-Man creator Toru Iwatani chose the name Pole Position as he thought it sounded "cool" and appealing, and he shortly after filed a trademark for it. The controls also proved to be a challenge, as Okamoto wanted them to feel realistic and to match up with the gameplay — Osugi remembers Namco president Masaya Nakamura becoming frustrated with them, having difficulty keeping the car moving in a straight line.

The game's arcade cabinet, a sit-down "environmental" machine, was chosen due to their popularity at the time. The development team had long fights over how fast the gear-shift should be, until it was ultimately decided to simply be either high or low speed.

Release
Pole Position was officially released in Japan on September 16, 1982. It was licensed out to Atari, Inc. for release in North America, where it made its debut at Chicago's 1982 Amusement & Music Operators Association (AMOA) show, held during November 18–20, before receiving a mass-market North American release on November 30, 1982, while Namco themselves released the game in Europe in late 1982. After its release, Osugi stated that all of Namco's older electro-mechanical driving games were discontinued, as the company saw the future of arcade racers in the form of video games.

Advertising
The game is an early example of product placement within a video game, with billboards around the track advertising actual companies.

The game was also featured in a TV commercial shown only on MTV. It was part of a series of TV spots that Atari created in the 1980s exclusively for MTV.

Reception
In Japan, Game Machine magazine listed Pole Position as the highest-grossing arcade game of 1982. Game Machine later listed it in their June 1, 1983 issue as the second top-grossing upright arcade unit of the month, before it returned to being the top-grossing game of the month in October 1983. Internationally, Pole Position was the most popular 1983. In Europe, it was a top-grossing arcade game in 1983.

In the United States, it sold over 21,000 arcade cabinets for an estimated US$61 million ($ adjusted for inflation) by 1983. In addition, US coin drop earnings averaged US$9.5 million (US$million adjusted for inflation) per week ($450 weekly per machine). On the US RePlay arcade charts, it topped the upright cabinet charts for seven months in 1983, from March  through August   and again in December. It also topped the US Play Meter arcade charts for six consecutive months from March  through August 1983,   and then topped the street locations chart in November 1983. It ended the year as the highest-grossing arcade game of 1983 in North America, according to RePlay and the Amusement & Music Operators Association (AMOA), and again became the highest-grossing arcade game of 1984 in the United States. Several years after its release, it was still one of the top five highest-grossing arcade video games of 1985.

The console version topped the UK sales charts in late 1983. In the United States between 1986 and 1990, the Atari 2600 version sold 0 units for US$, the Atari 5200 version sold 0 units for US$, and the version for Atari 8-bit computers version sold 0 units for US$, adding up to 0 units sold and US$ 1986 grossed between 1986 and 1990.

Reviews
Upon its North American debut at AMOA 1982, it was reviewed by Video Games magazine, which listed it among the show's top ten games. They compared it favorably with Sega's Turbo (1981), referring to Pole Position as "Turbo Deluxe" in "a speedway, not a cross-country race". They called Pole Position the "ultimate test of driving skill" for racing players. Electronic Games reviewed the arcade game in 1983, writing that it "keeps the action on track from start to finish" with "challenging play", noting that the gameplay is "reasonably faithful to real life" Formula One races. They also praised the sound effects and "solid, realistic graphics", stating it has "very rich color images" and "dimensional depth to the graphics". They gave it the 1983 Arcade Award for Coin-Op Game of the Year, praising the racing gameplay, "beautiful graphics" and "breathtaking" scenery as well as "the two-heat format for the race itself".

Computer and Video Games reviewed the arcade game in 1983, writing that it "is simply the most exhilarating driving simulation game on the market". They compared it favorably with Turbo, stating that, while Turbo "featured better landscapes", it "can't match the speed, thrills and skill behind this new race game". They said Pole Position's "graphics are sophisticated and believable", noting that cars "turning corners are shown in every graphic detail of the maneuvre", and praised the gameplay, concluding that "trying to hold a screaming curve or overtake" offers "thrills to compare with the real racetrack". It was considered the all-time best racing/driving game by InfoWorld in 1983 and Computer Games in early 1985.

When reviewing the Atari 8-bit version, InfoWorld called it "by far the best road-race game ever thrown on a video screen" with "bright and brilliant" graphics, but said the Commodore 64 version "looks like a rush job and is far from arcade-game quality". Computer Games magazine criticized the Commodore conversions for lacking various features from the arcade original, giving the C64 version a mixed review and the VIC-20 version a negative review. Computer and Video Games reviewed the Atari 2600 version, stating it is "the best driving game available" on the Atari VCS. When reviewing the Atari 5200 version, Hi-Res in 1984 found "the playability of the game to be limited and the graphics to be the strongest aspect of the game". The magazine preferred Adventure International's Rally Speedway to both Pole Position and Epyx's Pitstop.

In 2007, Eurogamer gave it a mixed retrospective review, calling it "a simulation down to the core" and that those dedicated racing fans will be deterred by the game's difficulty. Entertainment Weekly called Pole Position one of the top ten games for the Atari 2600 in 2013.

Impact
Pole Position is regarded as one of the most influential video games of all time. Bill Loguce and Matt Barton listed it as one of the 25 most influential games of all time, calling it "arguably the most important racing game ever made". In 1984, Electronic Games stated that, for "the first time in the amusement parlors, a first-person racing game gives a higher reward for passing cars and finishing among the leaders rather than just for keeping all four wheels on the road, thus making driving an art". In 1995, Flux magazine ranked the game 32nd on their "Top 100 Video Games". In 2015, Pole Position topped IGN's list of The Top 10 Most Influential Racing Games Ever. They stated that it had "a drastically better-looking" third-person "chase cam view" than Turbo, was "the first racing game based on a real-world racing circuit (Fuji Speedway in Japan)", "introduced checkpoints, and was the first to require a qualifying lap", and that its success, as "the highest-grossing arcade game in North America in 1983, cemented the genre in place for decades to come and inspired a horde of other racing games".

Legacy
 Pole Position was the most successful racing game of the classic era, spawning ports, sequels, and a Saturday morning cartoon.

The game spawned a number of clones, such as Top Racer from Commodore International, which led to a lawsuit from Namco against Commodore Japan that led to the seizure of Top Racer copies.

Other media
The title spawned a Saturday morning cartoon of the same name.

Parker Brothers published the Pole Position board game in 1983.

title: Pole Position


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Fissile material

In nuclear engineering, fissile material is material that can undergo nuclear fission when struck by a neutron of low energy. A self-sustaining thermal chain reaction can only be achieved with fissile material. The predominant neutron energy in a system may be typified by either slow neutrons (i.e., a thermal system) or fast neutrons. Fissile material can be used to fuel thermal-neutron reactors, fast-neutron reactors and nuclear explosives.

Fissile vs fissionable
According to the Ronen Fissile rule, for a heavy element with 90 ≤ Z ≤ 100, its isotopes with 2 × Z − N = 43 ± 2, with few exceptions, are fissile (where N = number of neutrons and Z = number of protons).

The term fissile is distinct from fissionable. A nuclide capable of undergoing nuclear fission (even with a low probability) after capturing a neutron of high or low energy is referred to as fissionable. A fissionable nuclide that can be induced to fission with low-energy thermal neutrons with a high probability is referred to as fissile. Fissionable materials include those (such as uranium-238) for which fission can be induced only by high-energy neutrons. As a result, fissile materials (such as uranium-235) are a subset of fissionable materials.

Uranium-235 fissions with low-energy thermal neutrons because the binding energy resulting from the absorption of a neutron is greater than the critical energy required for fission; therefore uranium-235 is fissile. By contrast, the binding energy released by uranium-238 absorbing a thermal neutron is less than the critical energy, so the neutron must possess additional energy for fission to be possible. Consequently, uranium-238 is fissionable but not fissile.

An alternative definition defines fissile nuclides as those nuclides that can be made to undergo nuclear fission (i.e., are fissionable) and also produce neutrons from such fission that can sustain a nuclear chain reaction in the correct setting. Under this definition, the only nuclides that are fissionable but not fissile are those nuclides that can be made to undergo nuclear fission but produce insufficient neutrons, in either energy or number, to sustain a nuclear chain reaction. As such, while all fissile isotopes are fissionable, not all fissionable isotopes are fissile. In the arms control context, particularly in proposals for a Fissile Material Cutoff Treaty, the term fissile is often used to describe materials that can be used in the fission primary of a nuclear weapon. These are materials that sustain an explosive fast neutron nuclear fission chain reaction.

Under all definitions above, uranium-238 (238uranium) is fissionable, but not fissile. Neutrons produced by fission of 238uranium have lower energies than the original neutron (they behave as in an inelastic scattering), usually below 1 MeV (i.e., a speed of about 14,000 km/s), the fission threshold to cause subsequent fission of 238uranium, so fission of 238uranium does not sustain a nuclear chain reaction.

Fast fission of 238uranium in the secondary stage of a thermonuclear weapon, due to the production of high-energy neutrons from nuclear fusion, contributes greatly to the yield and to fallout of such weapons. Fast fission of 238uranium tampers has also been evident in pure fission weapons. The fast fission of 238uranium also makes a significant contribution to the power output of some fast-neutron reactors.

Fissile nuclides
In general, most actinide isotopes with an odd neutron number are fissile. Most nuclear fuels have an odd atomic mass number (A = Z + N = the total number of nucleons), and an even atomic number Z. This implies an odd number of neutrons. Isotopes with an odd number of neutrons gain an extra 1 to 2 MeV of energy from absorbing an extra neutron, from the pairing effect which favors even numbers of both neutrons and protons. This energy is enough to supply the needed extra energy for fission by slower neutrons, which is important for making fissionable isotopes also fissile.

More generally, nuclides with an even number of protons and an even number of neutrons, and located near a well-known curve in nuclear physics of atomic number vs. atomic mass number are more stable than others; hence, they are less likely to undergo fission. They are more likely to "ignore" the neutron and let it go on its way, or else to absorb the neutron but without gaining enough energy from the process to deform the nucleus enough for it to fission. These "even-even" isotopes are also less likely to undergo spontaneous fission, and they also have relatively much longer partial half-lives for alpha or beta decay. Examples of these isotopes are uranium-238 and thorium-232. On the other hand, other than the lightest nuclides, nuclides with an odd number of protons and an odd number of neutrons (odd Z, odd N) are usually short-lived (a notable exception is neptunium-236 with a half-life of 154,000 years) because they readily decay by beta-particle emission to their isobars with an even number of protons and an even number of neutrons (even Z, even N) becoming much more stable. The physical basis for this phenomenon also comes from the pairing effect in nuclear binding energy, but this time from both proton–proton and neutron–neutron pairing. The relatively short half-life of such odd-odd heavy isotopes means that they are not available in quantity and are highly radioactive.

Nuclear fuel
To be a useful fuel for nuclear fission chain reactions, the material must:

 * Be in the region of the binding energy curve where a fission chain reaction is possible (i.e., above radium)
 * Have a high probability of fission on neutron capture
 * Release more than one neutron on average per neutron capture. (Enough of them on each fission, to compensate for non-fissions and absorptions in non-fuel material)
 * Have a reasonably long half-life
 * Be available in suitable quantities

Fissile nuclides in nuclear fuels include:

Fissile nuclides do not have a 100% chance of undergoing fission on absorption of a neutron. The chance is dependent on the nuclide as well as neutron energy. For low and medium-energy neutrons, the neutron capture cross sections for fission (σF), the cross section for neutron capture with emission of a gamma ray (σγ), and the percentage of non-fissions are in the table at right.
 * Uranium-233, bred from thorium-232 by neutron capture with intermediate decays steps omitted.
 * Uranium-235, which occurs in natural uranium and enriched uranium
 * Plutonium-239, bred from uranium-238 by neutron capture with intermediate decays steps omitted.
 * Plutonium-241, bred from plutonium-240 directly by neutron capture.

Fertile nuclides in nuclear fuels include:

 * Thorium-232, which breeds uranium-233 by neutron capture with intermediate decays steps omitted.
 * Uranium-238, which breeds plutonium-239 by neutron capture with intermediate decays steps omitted.
 * Plutonium-240, bred from plutonium-239 directly by neutron capture.

title: Fissile material


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Shutter speed

In photography, shutter speed or exposure time is the length of time that the film or digital sensor inside the camera is exposed to light (that is, when the camera's shutter is open) when taking a photograph. The amount of light that reaches the film or image sensor is proportional to the exposure time. $1/undefined$ of a second will let half as much light in as $1/undefined$.

Introduction
The camera's shutter speed, the lens's aperture or f-stop, and the scene's luminance together determine the amount of light that reaches the film or sensor (the exposure). Exposure value (EV) is a quantity that accounts for the shutter speed and the f-number. Once the sensitivity to light of the recording surface (either film or sensor) is set in numbers expressed in "ISOs" (e.g. 200 ISO, 400 ISO), the light emitted by the scene photographed can be controlled through aperture and shutter-speed to match the film or sensor sensitivity to light. This will achieve a good exposure when all the details of the scene are legible on the photograph. Too much light let into the camera results in an overly pale image (or "over-exposure") while too little light will result in an overly dark image (or "under-exposure").

Multiple combinations of shutter speed and f-number can give the same exposure value (E.V.). According to exposure value formula, doubling the exposure time doubles the amount of light (subtracts 1 EV). Reducing the aperture size at multiples of one over the square root of two lets half as much light into the camera, usually at a predefined scale of, , , , , , , , , , and so on. For example, lets four times more light into the camera as  does. A shutter speed of $1/undefined$ s with an aperture gives the same exposure value as a $1/undefined$ s shutter speed with an  aperture, and also the same exposure value as a $1/undefined$ s shutter speed with an  aperture, or $1/undefined$ s at.

In addition to its effect on exposure, the shutter speed changes the way movement appears in photographs. Very short shutter speeds can be used to freeze fast-moving subjects, for example at sporting events. Very long shutter speeds are used to intentionally blur a moving subject for effect. Short exposure times are sometimes called "fast", and long exposure times "slow".

Adjustments to the aperture need to be compensated by changes of the shutter speed to keep the same (right) exposure.

In early days of photography, available shutter speeds were not standardized, though a typical sequence might have been $1/undefined$ s, $1/undefined$ s, $1/undefined$ s, $1/undefined$ s, $1/undefined$ s and $1/undefined$ s; neither were apertures or film sensitivity (at least 3 different national standards existed). Soon this problem resulted in a solution consisting in the adoption of a standardized way of choosing aperture so that each major step exactly doubled or halved the amount of light entering the camera (,, , , , , etc.), a standardized 2:1 scale was adopted for shutter speed so that opening one aperture stop and reducing the amount of time of the shutter speed by one step resulted in the identical exposure. The agreed standards for shutter speeds are:

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• $1/undefined$ s

• 1 s

With this scale, each increment roughly doubles the amount of light (longer time) or halves it (shorter time).

Camera shutters often include one or two other settings for making very long exposures:
 * B (for bulb) keeps the shutter open as long as the shutter release is held.
 * T (for time) keeps the shutter open (once the shutter-release button had been depressed) until the shutter release is pressed again.

The ability of the photographer to take images without noticeable blurring by camera movement is an important parameter in the choice of the slowest possible shutter speed for a handheld camera. The rough guide used by most 35 mm photographers is that the slowest shutter speed that can be used easily without much blur due to camera shake is the shutter speed numerically closest to the lens focal length. For example, for handheld use of a 35 mm camera with a 50 mm normal lens, the closest shutter speed is $1/undefined$ s (closest to "50"), while for a 200 mm lens it is recommended not to choose shutter speeds below $1/undefined$ s. This rule can be augmented with knowledge of the intended application for the photograph, an image intended for significant enlargement and closeup viewing would require faster shutter speeds to avoid obvious blur. Through practice and special techniques such as bracing the camera, arms, or body to minimize camera movement, using a monopod or a tripod, slower shutter speeds can be used without blur. If a shutter speed is too slow for hand holding, a camera support, usually a tripod, must be used. Image stabilization on digital cameras or lenses can often permit the use of shutter speeds 3–4 stops slower (exposures 8–16 times longer).

Shutter priority refers to a shooting mode used in cameras. It allows the photographer to choose a shutter speed setting and allow the camera to decide the correct aperture. This is sometimes referred to as Shutter Speed Priority Auto Exposure, or TV (time value on Canon cameras) mode, S mode on Nikons and most other brands.

Creative utility in photography
Shutter speed is one of several methods used to control the amount of light recorded by the camera's digital sensor or film. It is also used to manipulate the visual effects of the final image.

Slower shutter speeds are often selected to suggest the movement of an object in a still photograph.

Excessively fast shutter speeds can cause a moving subject to appear unnaturally frozen. For instance, a running person may be caught with both feet in the air with all indication of movement lost in the frozen moment.

When a slower shutter speed is selected, a longer time passes from the moment the shutter opens till the moment it closes. More time is available for movement in the subject to be recorded by the camera as a blur.

A slightly slower shutter speed will allow the photographer to introduce an element of blur, either in the subject, where, in our example, the feet, which are the fastest moving element in the frame, might be blurred while the rest remains sharp; or if the camera is panned to follow a moving subject, the background is blurred while the subject remains relatively sharp.

The exact point at which the background or subject will start to blur depends on the speed at which the object is moving, the angle that the object is moving in relation to the camera, the distance it is from the camera and the focal length of the lens in relation to the size of the digital sensor or film.

When slower shutter-speeds, in excess of about half a second, are used on running water, the water in the photo will have a ghostly white appearance reminiscent of fog. This effect can be used in landscape photography.

Zoom burst is a technique which entails the variation of the focal length of a zoom lens during a longer exposure. In the moment that the shutter is opened, the lens is zoomed in, changing the focal length during the exposure. The center of the image remains sharp, while the details away from the center form a radial blur, which causes a strong visual effect, forcing the eye into the center of the image.

The following list provides an overview of common photographic uses for standard shutter speeds.
 * $1/undefined$ s and less: The fastest speed available in APS-H or APS-C format DSLR cameras (as of 2012). (Canon EOS 1D, Nikon D1, Nikon 1 J2, D1X, and D1H)
 * $1/undefined$ s: The fastest speed available in any 35 mm film SLR camera. (Minolta Maxxum 9xi, ''
 * $1/undefined$ s: The fastest speed available in production SLR cameras (as of 2013), also the fastest speed available in any full-frame DSLR or SLT camera (as of 2013). Used to take sharp photographs of very fast subjects, such as birds or planes, under good lighting conditions, with an ISO speed of 1,000 or more and a large-aperture lens.
 * $1/undefined$ s: The fastest speed available in consumer SLR cameras (as of 2009); also the fastest speed available in any leaf shutter camera (such as the Sony Cyber-shot DSC-RX1) (as of 2013). Used to take sharp photographs of fast subjects, such as athletes or vehicles, under good lighting conditions and with an ISO setting of up to 800.
 * $1/undefined$ s and $1/undefined$ s: Used to take sharp photographs of moderately fast subjects under normal lighting conditions.
 * $1/undefined$ s and $1/undefined$ s: Used to take sharp photographs of people in motion in everyday situations. $1/undefined$ s is the fastest speed useful for panning; it also allows for a smaller aperture (up to ) in motion shots, and hence for a greater depth of field.
 * $1/undefined$ s: This speed, and slower ones, are no longer useful for freezing motion. $1/undefined$ s is used to obtain greater depth of field and overall sharpness in landscape photography, and is also often used for panning shots.
 * $1/undefined$ s: Used for panning shots, for images taken under dim lighting conditions, and for available light portraits.
 * $1/undefined$ s: Used for panning subjects moving slower than 30 mph and for available-light photography. Images taken at this and slower speeds normally require a tripod or an image stabilized lens/camera to be sharp.
 * $1/undefined$ s and $1/undefined$ s: This and slower speeds are useful for photographs other than panning shots where motion blur is employed for deliberate effect, or for taking sharp photographs of immobile subjects under bad lighting conditions with a tripod-supported camera.
 * $1/undefined$ s, $1/undefined$ s and 1 s: Also mainly used for motion blur effects and/or low-light photography, but only practical with a tripod-supported camera.
 * B (bulb) (fraction of second to several hours): Used with a mechanically fixed camera in astrophotography and for certain special effects.

Cinematographic shutter formula
Motion picture cameras used in traditional film cinematography employ a mechanical rotating shutter. The shutter rotation is synchronized with film being pulled through the gate, hence shutter speed is a function of the frame rate and shutter angle.

Where E = shutter speed (reciprocal of exposure time in seconds), F = frames per second, and S = shutter angle:

 * $$E = \frac {F \cdot 360^\circ}{S}$$, for E in reciprocal seconds

 * $$S = \frac {F \cdot 360^\circ}{E}$$

With a traditional shutter angle of 180°, film is exposed for $1/undefined$ second at 24 frame/s. To avoid effect of light interference when shooting under artificial lights or when shooting television screens and computer monitors, $1/undefined$ s (172.8°) or $1/undefined$ s (144°) shutter is often used.

Electronic video cameras do not have mechanical shutters and allow setting shutter speed directly in time units. Professional video cameras often allow selecting shutter speed in terms of shutter angle instead of time units, especially those that are capable of overcranking or undercranking.

title: Shutter speed


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Rigor mortis

Rigor mortis, or postmortem rigidity, is the fourth stage of death. It is one of the recognizable signs of death, characterized by stiffening of the limbs of the corpse caused by chemical changes in the muscles postmortem (mainly calcium). In humans, rigor mortis can occur as soon as four hours after death. Contrary to folklore and common belief, rigor mortis is not permanent and begins to pass within hours of onset. Typically, it lasts no longer than eight hours at "room temperature".

Physiology
After death, aerobic respiration in an organism ceases, depleting the source of oxygen used in the making of adenosine triphosphate (ATP). ATP is required to cause separation of the actin-myosin cross-bridges during relaxation of muscle. When oxygen is no longer present, the body may continue to produce ATP via anaerobic glycolysis. When the body's glycogen is depleted, the ATP concentration diminishes, and the body enters rigor mortis because it is unable to break those bridges.

Calcium enters the cytosol after death. Calcium is released into the cytosol due to the deterioration of the sarcoplasmic reticulum. Also, the breakdown of the sarcolemma causes additional calcium to enter the cytosol. The calcium activates the formation of actin-myosin cross-bridging. Once calcium is introduced into the cytosol, it binds to the troponin of thin filaments, which causes the troponin-tropomyosin complex to change shape and allow the myosin heads to bind to the active sites of actin proteins. In rigor mortis, myosin heads continue binding with the active sites of actin proteins via adenosine diphosphate (ADP), and the muscle is unable to relax until further enzyme activity degrades the complex. Normal relaxation would occur by replacing ADP with ATP, which would destabilize the myosin-actin bond and break the cross-bridge. However, as ATP is absent, there must be a breakdown of muscle tissue by enzymes (endogenous or bacterial) during decomposition. As part of the process of decomposition, the myosin heads are degraded by the enzymes, allowing the muscle contraction to release and the body to relax.

Decomposition of the myofilaments occurs between 48 and 60 hours after the peak of rigor mortis, which occurs approximately 13 hours after death.

Applications in meat industry
Rigor mortis is very important in the meat industry. The onset of rigor mortis and its resolution partially determines the tenderness of meat. If the post-slaughter meat is immediately chilled to 15 °C (59 °F), a phenomenon known as cold shortening occurs, whereby the muscle sarcomeres shrink to a third of their original length.

Cold shortening is caused by the release of stored calcium ions from the sarcoplasmic reticulum of muscle fibers, in response to the cold stimulus. The calcium ions trigger powerful muscle contraction aided by ATP molecules. To prevent cold shortening, a process known as electrical stimulation is carried out, especially in beef carcasses, immediately after slaughter and skinning. In this process, the carcass is stimulated with alternating current, causing it to contract and relax, which depletes the ATP reserve from the carcass and prevents cold shortening.

Application in forensic pathology
The degree of rigor mortis may be used in forensic pathology to determine the approximate time of death. A dead body holds its position as rigor mortis sets in. If the body is moved after death, but before rigor mortis begins, forensic techniques such as livor mortis can be applied. Rigor mortis is known as transient evidence, as the degree to which it affects a body degrades over time.

title: Rigor mortis


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Do not resuscitate

A do-not-resuscitate order (DNR), also known as Do Not Attempt Resuscitation (DNAR), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR ), no code or allow natural death, is a medical order, written or oral depending on the jurisdiction, indicating that a person should not receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating. Sometimes these decisions and the relevant documents also encompass decisions around other critical or life-prolonging medical interventions. The legal status and processes surrounding DNR orders vary in different polities. Most commonly, the order is placed by a physician based on a combination of medical judgement and patient involvement.

Basis for choice
Interviews with 26 DNR patients and 16 full code patients in Toronto, Canada in 2006–2009 suggest that the decision to choose do-not-resuscitate status was based on personal factors including health and lifestyle; relational factors (to family or to society as a whole); and philosophical factors. Audio recordings of 19 discussions about DNR status between doctors and patients in two US hospitals (San Francisco, California and Durham, North Carolina) in 2008–2009 found that patients "mentioned risks, benefits, and outcomes of CPR," and doctors "explored preferences for short- versus long-term use of life-sustaining therapy." A Canadian article suggests that it is inappropriate to offer CPR when the clinician knows the patient has a terminal illness and that CPR will be futile.

Outcomes of CPR

When medical institutions explain DNR, they describe survival from CPR, in order to address patients' concerns about outcomes. After CPR in hospitals in 2017, 7,000 patients survived to leave the hospital alive, out of 26,000 CPR attempts, or 26%. After CPR outside hospitals in 2018, 8,000 patients survived to leave the hospital alive, out of 80,000 CPR attempts, or 10%. Success was 21% in a public setting, where someone was more likely to see the person collapse and give help than in a home. Success was 35% when bystanders used an Automated external defibrillator (AED), outside health facilities and nursing homes.

In information on DNR, medical institutions compare survival for patients with multiple chronic illnesses; patients with heart, lung or kidney disease;  liver disease; widespread cancer  or infection; and residents of nursing homes. Research shows that CPR survival is the same as the average CPR survival rate, or nearly so, for patients with multiple chronic illnesses, or diabetes, heart or lung diseases. Survival is about half as good as the average rate, for patients with kidney or liver disease, or widespread cancer or infection.

For people who live in nursing homes, survival after CPR is about half to three quarters of the average rate. In health facilities and nursing homes where AEDs are available and used, survival rates are twice as high as the average survival found in nursing homes overall. Few nursing homes have AEDs.

Research on 26,000 patients found similarities in the health situations of patients with and without DNRs. For each of 10 levels of illness, from healthiest to sickest, 7% to 36% of patients had DNR orders; the rest had full code.

Risks
As noted above, patients considering DNR mention the risks of CPR. Physical injuries, such as broken bones, affect 13% of CPR patients, and an unknown additional number have broken cartilage which can sound like breaking bones.

Mental problems affect some patients, both before and after CPR. After CPR, up to 1 more person, among each 100 survivors, is in a coma than before CPR (and most people come out of comas ). Five to 10 more people, of each 100 survivors, need more help with daily life than they did before CPR. Five to 21 more people, of each 100 survivors, decline mentally, but stay independent.

Organ donation
Organ donation is possible after CPR, but not usually after a death with a DNR. If CPR does not revive the patient, and continues until an operating room is available, kidneys and liver can be considered for donation. US Guidelines endorse organ donation, "Patients who do not have ROSC (return of spontaneous circulation) after resuscitation efforts and who would otherwise have termination of efforts may be considered candidates for kidney or liver donation in settings where programs exist." European guidelines encourage donation, "After stopping CPR, the possibility of ongoing support of the circulation and transport to a dedicated centre in perspective of organ donation should be considered." CPR revives 64% of patients in hospitals and 43% outside (ROSC), which gives families a chance to say goodbye, and all organs can be considered for donation, "We recommend that all patients who are resuscitated from cardiac arrest but who subsequently progress to death or brain death be evaluated for organ donation."

1,000 organs per year in the US are transplanted from patients who had CPR. Donations can be taken from 40% of patients who have ROSC and later become brain dead, and an average of 3 organs are taken from each patient who donates organs. DNR does not usually allow organ donation.

Less care for DNR patients
Reductions in other care are not supposed to result from a DNAPR decision being in place. Some patients choose DNR because they prefer less care: Half of Oregon patients with DNR orders who filled out a POLST (known as a Physician Orders and Scope of Treatment, or POST, in Tennessee) wanted only comfort care, and 7% wanted full care. The rest wanted various limits on care, so blanket assumptions are not reliable. There are many doctors "misinterpreting DNR preferences and thus not providing other appropriate therapeutic interventions."

Patients with DNR are less likely to get medically appropriate care for a wide range of issues such as blood transfusions, cardiac catheterizations, cardiac bypass, operations for surgical complication, blood cultures, central line placement, antibiotics and diagnostic tests. "[P]roviders intentionally apply DNR orders broadly because they either assume that patients with DNR orders would also prefer to abstain from other life-sustaining treatments or believe that other treatments would not be medically beneficial." 60% of surgeons do not offer operations with over 1% mortality to patients with DNRs. The failure to offer appropriate care to patients with DNR led to the development of emergency care and treatment plans (ECTPs), such as the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT), which aim to record recommendations concerning DNR alongside recommendations for other treatments in an emergency situation. ECTPs have prompted doctors to contextualise CPR within a broader consideration of treatment options, however ECTPs are most frequently completed for patients at risk of sudden deterioration and the focus tends to be on DNR.

Patients with DNR therefore die sooner, even from causes unrelated to CPR. A study grouped 26,300 very sick hospital patients in 2006–2010 from the sickest to the healthiest, using a detailed scale from 0 to 44. They compared survival for patients at the same level, with and without DNR orders. In the healthiest group, 69% of those without DNR survived to leave the hospital, while only 7% of equally healthy patients with DNR survived. In the next-healthiest group, 53% of those without DNR survived, and 6% of those with DNR. Among the sickest patients, 6% of those without DNR survived, and none with DNR.

Two Dartmouth College doctors note that "In the 1990s ... 'resuscitation' increasingly began to appear in the medical literature to describe strategies to treat people with reversible conditions, such as IV fluids for shock from bleeding or infection... the meaning of DNR became ever more confusing to health-care providers." Other researchers confirm this pattern, using "resuscitative efforts" to cover a range of care, from treatment of allergic reaction to surgery for a broken hip. Hospital doctors do not agree which treatments to withhold from DNR patients, and document decisions in the chart only half the time. A survey with several scenarios found doctors "agreed or strongly agreed to initiate fewer interventions when a DNR order was present.

After successful CPR, hospitals often discuss putting the patient on DNR, to avoid another resuscitation. Guidelines generally call for a 72-hour wait to see what the prognosis is, but within 12 hours, US hospitals put up to 58% of survivors on DNR, and at the median hospital, 23% received DNR orders at this early stage, much earlier than the guideline. The hospitals putting fewest patients on DNR had more successful survival rates, which the researchers suggest shows their better care in general. When CPR happened outside the hospital, hospitals put up to 80% of survivors on DNR within 24 hours, with an average of 32.5%. The patients who received DNR orders had less treatment, and almost all died in the hospital. The researchers say families need to expect death if they agree to DNR in the hospital.

Controlled organ donation after circulatory death
In 2017, Critical Care Medicine (Ethics) and the American Society of Anesthesiologists (ASA) Committees on Transplant Anesthesia issued a statement regarding organ donation after circulatory death (DCD). The purpose of the statement is to provide an educational tool for institutions choosing to use DCD. In 2015, nearly 9% of organ transplantations in the United States resulted from DCD, indicating it is a widely-held practice. According to the President's Commission on Death Determination, there are two sets of criteria used to define circulatory death: irreversible absence of circulation and respiration, and irreversible absence of whole brain function. Only one criterion needs to be met for the determination of death before organ donation and both have legal standing, according to the 1980 Uniform Determination of Death Act (UDDA); a determination of death must be according to accepted medical standards. All states within the United States adhere to the original or modified UDDA. The dead donor role states that a patient should not be killed for or by the donation of their organs and that organs can only be procured from dead people (lungs, kidneys, and lobes of a liver may be donated by living donors in certain highly regulated situations).

The definition of irreversibility centers around an obligatory period of observation to determine that respiration and circulation have ceased and will not resume spontaneously. Clinical examination alone may be sufficient to determine irreversibility, but the urgent time constraints of CDC may require more definitive proof of cessation with confirmatory tests, such as intra-arterial monitoring or Doppler studies. In accordance with the Institute of Medicine, the obligatory period for DCD is longer than 2 minutes but no more than 5 minutes of absent circulatory function before pronouncing the patient dead, which is supported by a lack of literature indicating that spontaneous resuscitation occurs after two minutes of arrest and that ischemic damage to perfusable organs occurs within 5 minutes.

Most patients considered for DCD will have been in the intensive care unit (ICU) and are dependent on ventilatory and circulatory support. Potential DCD donors are still completing the dying process but have not yet been declared dead, so quality end-of-life care should remain the absolute top priority and must not be compromised by the DCD process. The decision to allow death to occur by withdrawing life-sustaining therapies needs to have been made in accordance to the wishes of the patient and/or their legal agent; this must happen prior to any discussions about DCD, which should ideally occur between the patient's primary care giver and the patient's agent after rapport has been established.

Patient values
The philosophical factors and preferences mentioned by patients and doctors are treated in the medical literature as strong guidelines for care, including DNR or CPR. "Complex medical aspects of a patient with a critical illness must be integrated with considerations of the patient's values and preferences" and "the preeminent place of patient values in determining the benefit or burden imposed by medical interventions." Patients' most common goals include talking, touch, prayer, helping others, addressing fears, and laughing. Being mentally aware was as important to patients as avoiding pain, and doctors underestimated its importance and overestimated the importance of pain. Dying at home was less important to most patients. Three quarters of patients prefer longer survival over better health.

Advance directive, living will, POLST, medical jewellery, tattoos
Advance directives and living wills are documents written by individuals themselves, so as to state their wishes for care, if they are no longer able to speak for themselves. In contrast, it is a physician or hospital staff member who writes a DNR "physician's order," based upon the wishes previously expressed by the individual in their advance directive or living will. Similarly, at a time when the individual is unable to express their wishes, but has previously used an advance directive to appoint an agent, then a physician can write such a DNR "physician's order" at the request of that individual's agent. These various situations are clearly enumerated in the "sample" DNR order presented on this page.

It should be stressed that, in the United States, an advance directive or living will is not sufficient to ensure a patient is treated under the DNR protocol, even if it is their wish, as neither an advance directive nor a living will legally binds doctors. They can be legally binding in appointing a medical representative, but not in treatment decisions.

Physician Orders for Life-Sustaining Treatment (POLST) documents are the usual place where a DNR is recorded outside hospitals. A disability rights group criticizes the process, saying doctors are trained to offer very limited scenarios with no alternative treatments, and steer patients toward DNR. They also criticize that DNR orders are absolute, without variations for context. The Mayo Clinic found in 2013 that "Most patients with DNR/DNI (do not intubate) orders want CPR and/or intubation in hypothetical clinical scenarios," so the patients had not had enough explanation of the DNR/DNI or did not understand the explanation.

In the UK, emergency care and treatment plans (e.g. ReSPECT) are clinical recommendations written by healthcare professionals after discussion with patients or their relatives about their priorities of care. Research has found that the involvement of patients or their family in forming ECTP recommendations is variable. In some situations (where there are limited treatment options available, or where the patient is likely to deteriorate quickly) healthcare professionals will not explore the patient's preferences, but will instead ensure that patients or their relatives understand what treatment will or will not be offered.

Medical jewellery
Medical bracelets, medallions, and wallet cards from approved providers allow for identification of DNR patients in home or non-hospital settings. In the US each state has its own DNR policies, procedures, and accompanying paperwork for emergency medical service personnel to comply with such forms of DNR.

DNR tattoos
There is a growing trend of using DNR tattoos, commonly placed on the chest, to replace other forms of DNR, but these often cause confusion and ethical dilemmas among healthcare providers. Laws vary from place to place regarding what constitutes a valid DNR and currently do not include tattoos. End of life (EOL) care preferences are dynamic and depend on factors such as health status, age, prognosis, healthcare access, and medical advancements. DNR orders can be rescinded while tattoos are far more difficult to remove. At least one person decided to get a DNR tattoo based on a dare while under the influence of alcohol.

Ethics and violations
DNR orders in certain situations have been subject to ethical debate. In many institutions it is customary for a patient going to surgery to have their DNR automatically rescinded. Though the rationale for this may be valid, as outcomes from CPR in the operating room are substantially better than general survival outcomes after CPR, the impact on patient autonomy has been debated. It is suggested that facilities engage patients or their decision makers in a 'reconsideration of DNR orders' instead of automatically making a forced decision.

When a patient or family and doctors do not agree on a DNR status, it is common to ask the hospital ethics committee for help, but authors have pointed out that many members have little or no ethics training, some have little medical training, and they do have conflicts of interest by having the same employer and budget as the doctors.

In the United States there is accumulating evidence of racial differences in rates of DNR adoption. A 2014 study of end stage cancer patients found that non-Latino white patients were significantly more likely to have a DNR order (45%) than black (25%) and Latino (20%) patients. The correlation between preferences against life-prolonging care and the increased likelihood of advance care planning is consistent across ethnic groups.

There are also ethical concerns around how patients reach the decision to agree to a DNR order. One study found that patients wanted intubation in several scenarios, even when they had a Do Not Intubate (DNI) order, which raises a question whether patients with DNR orders may want CPR in some scenarios too. It is possible that providers are having a "leading conversation" with patients or mistakenly leaving crucial information out when discussing DNR.

One study reported that while 88% of young doctor trainees at two hospitals in California in 2013 believed they themselves would ask for a DNR order if they were terminally ill, they are flexible enough to give high intensity care to patients who have not chosen DNR.

There is also the ethical issue of discontinuation of an implantable cardioverter defibrillator (ICD) in DNR patients in cases of medical futility. A large survey of Electrophysiology practitioners, the heart specialists who implant pacemakers and ICDs, noted that the practitioners felt that deactivating an ICD was not ethically distinct from withholding CPR thus consistent with DNR. Most felt that deactivating a pacemaker was a separate issue and could not be broadly ethically endorsed. Pacemakers were felt to be unique devices, or ethically taking a role of "keeping a patient alive" like dialysis.

A self-report study from 1999 conducted in Germany and Sweden found that the frequency of resuscitations performed against patients' wishes (per DNR status) was as high as 32.5% among German doctors polled.

Violations and suspensions
Medical professionals can be subjected to ramifications if they knowingly violate a DNR. Each state has established laws and rules that medical providers must follow. For example, in some states within the US, DNRs only apply within a hospital, and can be disregarded in other settings. In these states, EMTs (emergency medical technicians) can therefore administer CPR until reaching the hospital where such laws exist.

If a medical professional knows of a DNR and continues with resuscitation efforts, then they can be sued by the family of the patient. This happens often, with a recent jury awarding $400,000 to the family of a patient for "Wrongful Prolongation of Life" in June 2021. Physicians and their attorneys have argued in some cases that when in doubt, they often err on the side of life-saving measures because they can be potentially reversed later by disconnecting the ventilator. This was the case in 2013 when Beatrice Weisman was wrongfully resuscitated, leading to the family filing a lawsuit.

In the US, bystanders who are not healthcare professionals working in a professional setting are protected under the Good Samaritan Law in most cases. Bystanders are also protected if they begin CPR and use a AED even if there is a DNR tattoo or other evident indicator.

Instead of violating a DNR, anesthesiologists often require suspension of a DNR during palliative care surgeries, such as when a large tumor needs to be removed or a chronic pain issue is being solved. Anesthesiologists argue that the patient is in an unnatural state during surgery with medications, and anesthesiologists should be allowed to reverse this state. This suspension can occur during the pre-op, peri-op, and post-operative period. These suspensions used to be automatic and routine, but this is now viewed as unethical. The Patient Self-Determination Act also prohibits this, as automatic suspension would be a violation of this federal order. However, it is still a common practice for patients to opt for a suspension of their DNR depending on the circumstances of the surgery.

Ethical dilemmas on suspending a DNR occur when a patient with a DNR attempts suicide and the necessary treatment involves ventilation or CPR. In these cases, it has been argued that the principle of beneficence takes precedence over patient autonomy and the DNR can be revoked by the physician. Another dilemma occurs when a medical error happens to a patient with a DNR. If the error is reversible only with CPR or ventilation, there is no consensus if resuscitation should take place or not.

Terminology
DNR and Do Not Resuscitate are common terms in the United States, Canada, and New Zealand. This may be expanded in some regions with the addition of DNI (Do Not Intubate). DNI is specific for not allowing the placement of breathing tubes. In some hospitals DNR alone will imply no intubation, though 98% of intubations are unrelated to cardiac arrest; most intubations are for pneumonia or surgery. Clinically, the vast majority of people requiring resuscitation will require intubation, making a DNI alone problematic. Hospitals sometimes use the expression no code, which refers to the jargon term code, short for Code Blue, an alert to a hospital's resuscitation team. If a patient does want to be resuscitated, their code status may be listed as full code (the opposite of DNR). If the patient only wants to be resuscitated under certain conditions, this is termed partial code.

Some areas of the United States and the United Kingdom include the letter A, as in DNAR, to clarify "Do Not Attempt Resuscitation". This alteration is so that it is not presumed by the patient or family that an attempt at resuscitation will be successful.

As noted above in Less care for DNR patients, the word "resuscitation" has grown to include many treatments other than CPR, so DNR has become ambiguous, and authors recommend "No CPR" instead. In the United Kingdom the preferred term is now DNACPR, reflecting that resuscitation is a general term which includes cardiopulmonary resuscitation as well as, for example, the administration of intravenous fluid.

Since the term DNR implies the omission of action, and therefore "giving up", a few authors have advocated for these orders to be retermed Allow Natural Death. Others say AND is ambiguous whether it would allow morphine, antibiotics, hydration or other treatments as part of a natural death. New Zealand and Australia, and some hospitals in the UK, use the term NFR or Not For Resuscitation. Typically these abbreviations are not punctuated, e.g., DNR rather than D.N.R.

Resuscitation orders, or lack thereof, can also be referred to in the United States as a part of Physician Orders for Life-Sustaining Treatment (POLST), Medical Orders for Life-Sustaining Treatment (MOLST), Physician's Orders on Scope of Treatment (POST) or Transportable Physician Orders for Patient Preferences (TPOPP) orders, typically created with input from next of kin when the patient or client is not able to communicate their wishes.

Another synonymous term is "not to be resuscitated" (NTBR).

In 2004 the internal telephone number for cardiac arrests in all UK hospitals was standardised to 2222; in 2017 the European Board of Anaesthesiology (EBA, European Resuscitation Council (ERC), and the European Society of Anaesthesiology (ESAIC) issued a joint statement recommending this practice across all European hospitals. Current UK practice is for resuscitation recommendations to be standalone orders (such as DNACPR) or embedded within broader emergency care and treatment plans (ECTPs), such as the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT).

Usage by country
DNR documents are widespread in some countries and unavailable in others. In countries where a DNR is unavailable, the decision to end resuscitation is made solely by physicians.

A 2016 paper reports a survey of small numbers of doctors in numerous countries, asking "how often do you discuss decisions about resuscitation with patients and/or their family?" and "How do you communicate these decisions to other doctors in your institution?" Some countries had multiple respondents, who did not always act the same, as shown below. There was also a question "Does national guidance exist for making resuscitation decisions in your country?" but the concept of "guidance" had no consistent definition. For example, in the US, four respondents said yes, and two said no.

Australia
In Australia, Do Not Resuscitate orders are covered by legislation on a state-by-state basis.

In Victoria, a Refusal of Medical Treatment certificate is a legal means to refuse medical treatments of current medical conditions. It does not apply to palliative care (reasonable pain relief; food and drink). An Advanced Care Directive legally defines the medical treatments that a person may choose to receive (or not to receive) in various defined circumstances. It can be used to refuse resuscitation, so as to avoid needless suffering.

In NSW, a Resuscitation Plan is a medically authorised order to use or withhold resuscitation measures, and which documents other aspects of treatment relevant at end of life. Such plans are only valid for patients of a doctor who is a NSW Health staff member. The plan allows for the refusal of any and all life-sustaining treatments, the advance refusal for a time of future incapacity, and the decision to move to purely palliative care.

Brazil
There is no formally recognized protocol for creating and respecting DNR orders in Brazil's healthcare delivery system. The legality of not administering resuscitation procedures for terminally ill patients has not been clearly defined, leading many providers to practice caution around withholding CPR.

Although DNR orders have not been institutionalized in Brazil there has been a significant amount of dialogue around the ethical question of whether or not to withhold resuscitation interventions. In the past two decades the Federal Medical Board of Brazil published two resolutions, CFM 1.805/2006 and CFM 1.995/2012, which address therapeutic limitations in terminally ill patients as well as advanced directives. A recent study also showed that in Brazil's healthcare system CPR is being withheld in scenarios of terminal illness or multiple comorbidities at rates similar to those in North America.

Canada
Do not resuscitate orders are similar to those used in the United States. In 1995, the Canadian Medical Association, Canadian Hospital Association, Canadian Nursing Association, and Catholic Health Association of Canada worked with the Canadian Bar Association to clarify and create a Joint Statement on Resuscitative Interventions guideline for use to determine when and how DNR orders are assigned. DNR orders must be discussed by doctors with the patient or patient agents or patient's significant others. Unilateral DNR by medical professionals can only be used if the patient is in a vegetative state.

France
In 2005, France implemented its "Patients' Rights and End of Life Care" act. This act allows the withholding/withdrawal of life support treatment and as well as the intensified usage of certain medications that can quicken the action of death. This act also specifies the requirements of the act.

The "Patients' Rights and End of Life Care" Act includes three main measures. First, it prohibits the continuation of futile medical treatments. Secondly, it empowers the right to palliative care that may also include the intensification of the doses of certain medications that can result in the shortening the patient's life span. Lastly, it strengthens the principle of patient autonomy. If the patient is unable to make a decision, the discussion, thus, goes to a trusted third party.

Hong Kong
Starting in 2000, the Medical Council of Hong Kong has taken the position that advance directives should be recognized. A Law Reform Commission consultation from 2004 to 2006 resulted in a recommendation that legislation be passed in support of advance directives. However, as of 2019 no consensus had been reached on legislation.

The Hong Kong Hospital Authority has adopted a set of forms which its doctors will recognize if properly completed. However, their recognition at private hospitals is less clear.

Israel
In Israel, it is possible to sign a DNR form as long as the patient is at least 17 years of age, dying, and aware of their actions.

Italy
In Italy DNR is included in the Italian law no. 219 of December 22, 2017, "Disposizioni Anticipate di Trattamento" or DAT, also called "biotestamento". The law no.219 "Rules on informed consent and advance treatment provisions", reaffirm the freedom of choice of the individual and make concrete the right to health protection, respecting the dignity of the person and the quality of life. The DAT are the provisions that every person of age and capable of understanding and wanting can express regarding the acceptance or rejection of certain diagnostic tests or therapeutic choices and individual health treatments, in anticipation of a possible future inability to self-determine. To be valid, the DATs must have been drawn up only after the person has acquired adequate medical information on the consequences of the choices he intends to make through the DAT. With the entry into force of law 219/2017, every person of age and capable of understanding and willing can draw up his DAT. Furthermore, the DATs must be drawn up with: public act authenticated private writing simple private deed delivered personally to the registry office of the municipality of residence or to the health structures of the regions that have regulated the DAT Due to particular physical conditions of disability, the DAT can be expressed through video recording or with devices that allow the person with disabilities to communicate. The DATs do not expire. They can be renewed, modified or revoked at any time, with the same forms in which they can be drawn up. With the DAT it is also possible to appoint a trustee, as long as he is of age and capable of understanding and willing, who is called to represent the signatory of the DAT who has become incapable in relations with the doctor and health facilities. With the Decree of 22 March 2018, the Ministry of Health established a national database for the registration of advance treatment provisions. Without the expression of any preference by the patient, Physicians must attempt to resuscitate all patients regardless of familial wishes.

Japan
In Japan, DNR orders are known as Do Not Attempt Resuscitation (DNAR). Currently, there are no laws or guidelines in place regarding DNAR orders but they are still routinely used. A request to withdraw from life support can be completed by the patient or a surrogate. In addition, it is common for Japanese doctors and nurses to be involved in the decision-making process for the DNAR form.

Jordan
DNRs are not recognized by Jordan. Physicians attempt to resuscitate all patients regardless of individual or familial wishes.

Nigeria
There is no formally accepted protocol for DNRs in Nigeria's healthcare delivery system. Written wills may act as a good guide in many end of life scenarios, but often physicians and/or patients' families will act as the decision makers. As quoted in a 2016 article on Advanced Directives in Nigeria, "everything derives from communal values, the common good, the social goals, traditional practices, cooperative virtues and social relationship. Individuals do not exist in a vacuum but within a web of social and cultural relationships." It is important to note that there are vast cultural differences and perspectives on end of life within Nigeria itself between regions and communities of different ancestry.

Saudi Arabia
In Saudi Arabia patients cannot legally sign a DNR, but a DNR can be accepted by order of the primary physician in case of terminally ill patients.

Taiwan
In Taiwan, patients sign their own DNR orders, and are required to do so to receive hospice care. However, one study looking at insights into Chinese perspectives on DNR showed that the majority of DNR orders in Taiwan were signed by surrogates. Typically doctors discuss the issue of DNR with the patients family rather than the patient themselves. In Taiwan, there are two separate types of DNR forms: DNR-P which the patient themselves sign and DNR-S in which a designated surrogate can sign. Typically, the time period between signing the DNR and death is very short, showing that signing a DNR in Taiwan is typically delayed. Two witnesses must also be present in order for a DNR to be signed.

DNR orders have been legal in Taiwan since June 2000 and were enacted by the Hospice and Palliative Regulation. Also included in the Hospice and Palliative Regulation is the requirement to inform a patient of their terminal condition, however, the requirement is not explicitly defined leading to interpretation of exact truth telling.

United Arab Emirates
The UAE have laws forcing healthcare staff to resuscitate a patient even if the patient has a DNR or does not wish to live. There are penalties for breaching the laws.

England
In England, CPR is presumed in the event of a cardiac arrest unless a do not resuscitate order is in place. If they have capacity as defined under the Mental Capacity Act 2005 the patient may decline resuscitation. Patients may also specify their wishes and/or devolve their decision-making to a proxy using an advance directive, which are commonly referred to as 'Living Wills', or an emergency care and treatment plan (ECTP), such as ReSPECT. Discussion between patient and doctor is integral to decisions made in advance directives and ECTPs, where resuscitation recommendations should be made within a more holistic consideration of all treatment options. Patients and relatives cannot demand treatment (including CPR) which the doctor believes is futile and in this situation, it is their doctor's duty to act in their 'best interest', whether that means continuing or discontinuing treatment, using their clinical judgment. If the patient lacks capacity, relatives will often be asked for their opinion in order to form a 'best interest' view of what the individual's views would have been (prior to losing capacity). Evaluation of ReSPECT (an ECTP) found that resuscitation status remained a central component of conversations, and that there was variability in the discussion of other emergency treatments.

In 2020 the Care Quality Commission found that residents of care homes had been given inappropriate orders of Do not attempt cardiopulmonary resuscitation (DNACPR) without notice to residents or their families, causing avoidable deaths. In 2021, the Mencap charity found that people with learning disabilities also had inappropriate DNACPR orders. Medical providers have said that any discussion with patients and families is not in reference to consent to resuscitation and instead should be an explanation. The UK's regulatory body for doctors, the General Medical Council, provides clear guidance on the implementation and discussion of DNACPR decisions, and the obligation to communicate these decisions effectively was established by legal precedent in 2015.

Scotland
In Scotland, the terminology used is "Do Not Attempt Cardiopulmonary Resuscitation" or "DNACPR". There is a single policy used across all of NHS Scotland. The legal standing is similar to that in England and Wales, in that CPR is viewed as a treatment and, although there is a general presumption that CPR will be performed in the case of cardiac arrest, this is not the case if it is viewed by the treating clinician to be futile. Patients and families cannot demand CPR to be performed if it is felt to be futile (as with any medical treatment) and a DNACPR can be issued despite disagreement, although it is good practice to involve all parties in the discussion.

As in England and Wales, inappropriate orders have been given to individuals who had no medical reason for them, such as a deaf man who received a DNACPR order in 2021 due to "communication difficulties."

Wales
Wales has its own national DNACPR policy, 'Sharing and Involving'. They use the term 'Do Not Attempt Cardiopulmonary Resuscitation' or 'DNACPR'. They also have an active public information campaigns, which includes the website 'TalkCPR'

United States
In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives also known as living wills may not be accepted by EMS as legally valid forms. If a patient has a living will that specifies the patient requests DNR but does not have a properly filled out state-sponsored form that is co-signed by a physician, EMS may attempt resuscitation.

The DNR decision by patients was first litigated in 1976 in In re Quinlan. The New Jersey Supreme Court upheld the right of Karen Ann Quinlan's parents to order her removal from artificial ventilation. In 1991 Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an person's decision in their healthcare. Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri. Missouri has a Living Will Statute that requires two witnesses to any signed advance directive that results in a DNR/DNI code status in the hospital.

In the United States, cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) will not be performed if a valid written DNR order is present. Many states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures unless a specific state-sponsored form is properly filled out and cosigned by a physician.

Legal precedent for the right to refuse medical interventions
There are three notable cases which set the baseline for patient's rights to refuse medical intervention:

 * 1) Karen Quinlan, a 21-year-old woman, was in a persistent vegetative state after experiencing two 15-minute apneic periods secondary to drug use. After a year without improvement her father requested that life support be withdrawn. The hospital refused and this culminated in a court case. The trial court sided with the hospital, however the New Jersey Supreme Court reversed the decision. This was the first of multiple state level decisions pre-empting the Cruzan case which established the non-religious (there were other prior rulings regarding Jehovah's Witnesses) right to refuse care and extended that right to incapacitated patients via their guardians. It also established that court cases are not needed to terminate care when there is concordance between the stakeholders in the decision (Guardian, Clinician, Ethics Committees). It also shifted the focus from the right to seek care to the right to die. Mrs. Quinlan survived for 9 years after mechanical ventilation was discontinued.
 * 2) Nancy Cruzan was a 31-year-old woman who was in a persistent vegetative state after a motor vehicle accident that caused brain damage. Her family asked that life support be stopped after 4 years without any improvement. The hospital refused without a court order, and the family sued to obtain one. The trial court sided with the family concluding that the state could not override her wishes. This ruling was appealed to and reversed by the Mississippi Supreme Court. This case was ultimately heard by the United States Supreme Court, which affirmed the right of competent individuals to refuse medical treatment and established standards for refusal of treatment for an incompetent person.
 * 3) Theresa "Terri" Schiavo was a 27-year-old woman who experienced cardiac arrest and was resuscitated successfully. She was in a persistent vegetative state thereafter. After 8 years in this state without recovery, her husband decided to have her feeding tube removed. Schiavo's parents disagreed and the case that ensued ultimately was heard by the Florida Supreme Court which ruled that remaining alive would not respect her wishes. The United States Supreme Court affirmed that decision and refused to hear the case. This case affirmed the right of a patient to refuse care that is not in their best interests even when incapacitated.

title: Do not resuscitate