Talk:Defibrillation/Archive 1

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Archive 1

Background Info

The background info is from some of my papers. It needs editing and linking to other headings which I plan to do. Comments much valued. Dokane 17:15, 3 Oct 2004 (UTC)

Regrettably I've had to remove this very unwieldy strech of text. The references are incomplete (no journal mentioned), and there are no Wikilinks.
The article should have more info on the background of defibrillation, but I think it should be more concise (the average reader doesn't want detailed animal studies etc). I have copied it all to my Notepad and I'll see if I can turn this material into something useful.
It seems User:Dokane has left Wikipedia. I've sent him an email. JFW | T@lk 20:57, 30 Dec 2004 (UTC)

I would like to see a lot more about the histroy.

On history: How about adding stuff about 18th century defibrillation by the "Society for the Recovery of Persons Apparently Drowned" a.k.a. (Royal) Humane Society? Apparently they resuscitated a 3-year old using electrical shocks in 1774. See: 

 * http://www.ceufast.com/courses/viewcourse.asp?id=198
 * http://www.theeway.com/skepticc/archives08.html

VilleSalmensuu (talk) 16:38, 7 July 2009 (UTC)

The defribillation example picture

This might seem frivilous. Maybe you could find a picture of a person whom the defribillator is used on, that isn't where the person is a topless woman. I just think it's kind of unecessary to have a picture like that when there must be one, with a guy in it. I mean, there's no sense in making it sexualized. Violet yoshi 06:18, 31 December 2006 (UTC)

The sexualization is in your head, not in the picture.

That picture is appallingly inaccurate, and certainly not "typical". At least two people are require to use a BVM effectively, even an "anaesthetists grip" isn't as effective. The display from the AED is away from the paramedic and although described as AEDs they are actually semi-automatic...someone has to initiate the shock! The other person must be painting the picture (sarcasm!) Also, the BVM looks like it is connected to oxygen...very dangerous if defibrillation is in progress --> should be removed from the immediate area. Next time I have a free minute on nightshift I and my colleagues will take a real picture of defibrillation/resuscitation in progress. —Preceding unsigned comment added by Panthro (talk • contribs) 15:11, 10 October 2007 (UTC)

Whilst I agree that the picture isn't of the highest quality, I'd say that it is pretty typical of a resus in progress in the pre-hospital care field. BVM is really only trained for single operator us in ambulance care (using the anaesthetists grip), and whilst we know that you 'could' do it with two people, generally, they have better things to be doing. Your average crew of two has one crew member looking after the head end, including airway managment and BVM, whilst the other sorts out chest compressions and defib (and either or both try and get the cannulation done where appropriate). For the solo responder (like me), i have to try and do it all from the head, including BVM, defib, airway etc. - so is this typical? I'd say very much. Given the position of the defib in the picture, i'd say it is facing the person whose 'view' you are looking at. Oh, and lastly, of course the BVM is connected to oxygen - that is standard practice - you simply move the BVM away from the patient when applying a shock. Owain.davies 06:26, 11 October 2007 (UTC)

As someone who doesn't know a who lot about defib, this picture is not very helpful. The artistic redition is hard to make sense of. Plus the boobs are discracting. I'm sorry but they are. It just seems unnecessary. —Preceding unsigned comment added by 71.135.43.2 (talk) 22:31, 2 February 2008 (UTC)

I really see no reason to have a topless woman in a scholarly encyclopedia webpage. Children use wikipedia, too. —Preceding unsigned comment added by Sswan (talk • contribs) 14:23, 20 February 2008 (UTC)

You know what? The defibrillator in the picture looks like a Super Nintendo. Is that supposed to be a joke? 99.234.35.141 (talk) 16:20, 5 May 2008 (UTC)

Yes, that is a SNES. a Super Famicom JR to be exact (it shouldn't have that cartridge, though) http://en.wikipedia.org/wiki/Image:CPR-oxygen-defibrillator.jpg the original. I don't have any problem with the SNES though. it is amusing —Preceding unsigned comment added by Manofiorn (talk • contribs) 03:02, 12 May 2008 (UTC)

I found it highly amusing that two of you complained about the nude breasts AFTER my childish MS Paint hackery, failing to notice she had a VIDEOGAME SYSTEM hooked up to her "boobs." I was rather hoping that this would go unnoticed for a while longer - my friends and I were keeping an eye on the article and placing bets. Well at least it lasted far longer than my Dogs Portal.jpg on Portal:Dogs did. Note: the label on the EMT's uniform should read SMUR for Service Mobile d'Urgence et de Réanimation ("Emergency and Ressucitation Mobile Service.") At my friends' behest I changed this to WMUR, my friend's blog name and former IRC channel, which I assume is a play on his name and local college station WNUR. Snorks1234 (talk) 19:58, 15 May 2008 (UTC)

Also lulzy is Violet yoshi's misspelling of the words "defribillation," "frivilous," "defribillator" and "unecessary" - get spellcheck honey, quit relying on so many badly translated Japanese videogames for your vocabulary building. Besides, nude breasts are only sexualized in puritanical American culture, they're perfectly acceptable in other parts of the world.

71.135.43.2 - "redition," "discracting?" Well at least you got "unnecessary" correct. But, "boobs?" Please. Are you 13?

Sswan: Again, perhaps exposing children to non-sexualized nude breasts "in a scholarly encyclopedia webpage" will help to combat the ridiculous American sexualization of non-sexual mammary organs. I mean, would you expect pictures of female apes on Wikipedia to require they wear brassieres? Would you? Snorks1234 (talk) 20:13, 15 May 2008 (UTC)

Oh, by the way, Manofiorn, the SNES 2 console exterior was virtually identical to the SFC Jr. Only difference was that it had purple buttons and of course accepted North American cartridges instead of Japanese/European. http://www.old-computers.com/museum/photos/nintendo_snes2_1.jpg Someone asked me what game was in the console - since I never considered that when I "drew" it, I answered Super Castlevania 4. Snorks1234 (talk) 04:07, 16 May 2008 (UTC)

can I have the old defibrillation picture? Manofiorn (talk) 16:34, 8 November 2008 (UTC)

Comment removed from article

"(The AHA also applies this new protocol to manual defibrillation, though without evidence or rationale.)"<ref>2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part 5: Electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing. Circulation 2005; 112 [Suppl I]:IV-35 - IV-46. Article</ref>
  • I don't understand this apparent slam to the AHA (which is original research in the absence of a valid reference). There is a rationale. And it is based upon the prevailing science. The modern biphasic waveform has a high first shock efficacy for terminating VF. Studies have shown that CPR prior to defib (with down times > 4 min. when CPR has not been performed prior to the defib's arrival -- the vast majority of sudden cardiac deaths in the community) significantly increase odds of successful defibrillation and confers a survival benefit. Repeated shocks without CPR in between (ventricular rates with VF are > 600 which uses up a lot of ATP and produces a lot of waste products in the surrounding tissue) does nothing but stun the myocardium. You have to wash out the metabolites. Show me the evidence that stacked biphasic shocks increase the odds of survival. I suspect you won't find any. Best, MoodyGroove 17:59, 7 March 2007 (UTC)MoodyGroove

Reply:

Read the reference I cited in the Guidelines. Do you see any evidence or rationale for applying the new protocol to manual defibrillation? I don't. The AHA is attempting to correct a problem with AEDs: the pauses without chest compressions before and after shocks that were required by the old AED algorithms. There is nothing about a required interval of CPR before the first shock, which would be relevant to the time-phase model of cardiac arrest that you seem to be referring to. The new guideline appears to assume that everyone is using biphasic AEDs, which hardly reflects reality. If the AHA is saying that this guideline is applicable to downtimes longer than four to five minutes, they should say so--but they don't. Your perspective is formed by responding to out-of-hospital arrests, where I'm sure downtimes must usually be greater than four or five minutes; mine is the perspective of a hospital nurse, where time from a witnessed arrest to first shock of more than four minutes is in my view unacceptable--though sadly it is frequently the case.

That said, I don't object to deleting the sentence. I'll make the point in an upcoming letter in Circulation. texasex 00:51, 20 March 2007 (UTC)

  • If I remember correctly, it takes about 15 compressions to build up adequate coronary perfusion pressure. Every time you stop compressions (for any reason) you have to start back again at zero. So it's clear that interruptions to chest compressions (even for ventilations) should be minimized. We know that biphasic waveforms have a high first shock efficacy and we know that ILCOR/AHA/ERC is recommending starting out right at 360J for monophasic waveforms. If that doesn't terminate VF, why continue to insult the myocardium with repeated shocks when it was not receptive to the first shock? Change the substrate. Studies have shown that 100-300 compressions (2-3 min. of CPR) prior to defib can make shocks more effective. The electrical phase of the arrest only lasts for about 4 minutes from the moment of collapse. There was a rationale for eliminating stacked shocks (and let's not forget, there probably wasn't a whole lot of evidence supporting stacked shocks in the first place). I thought they did a fantastic job with ECC 2005. But I'd be happy to read your letter. Best MoodyGroove 00:07, 22 March 2007 (UTC)MoodyGroove

Proposed merge Defibrillator with Defibrillation

I appreciate that this has been discussed before, but it was 2 years ago, and since then, there has been little divergence in the articles, and i think there is a strong case for merging them. I have done a basis for the updated page in my sandbox: User:Owain.davies/Defibrillation

Please have a look before making a decision, but i think that the new combined article brings it altogether in a much better format. A few improvements, and i think this could then be a GA grade candidate, which seems unlikely for either of the existing articles.

I would suggest leaving the Implantable cardioverter-defibrillator page, and for the moment the Automated external defibrillator page, but just merging Defibrillator in to Defibrillation, with the latter being the main page.

Comments please (if i don't get any, i'll do it in a week or so)

Owain.davies 08:51, 29 April 2007 (UTC)

  • Support. There are some factual errors in your sandbox version (for example, the heart's natural pacemaker is not the medulla oblongata) and I would recommend renaming the AICD section ICD, but overall I like the length and format of the merged articles. Rather than having a separate article called defibrillator, I'd rather have one article named defibrillation, and separate articles for public access defibrillation and ICDs. Debatable as to whether or not we need a section explaining how to to use a defibrillator, and overall I think the "in popular culture" sections do not add much to medicle articles, but these are all issues that can be discussed and/or corrected after the merge. MoodyGroove 11:53, 29 April 2007 (UTC)MoodyGroove

In the absence of any negative comment, and the support of two good wiki editors, merge now completed. Thanks for your input. Owain.davies 17:04, 2 May 2007 (UTC)

A possible minor change to the "The change to a biphasic waveform" section

At the end of this section it's said "(VF) could persist in about 40% of cardiac arrest patients" where as in the next sentence, in comparison, it says "Most biphasic defibrillators have a first shock success rate . . . of greater than 90%." Both statistics, to be clear I think, should stick to either failure rate or success rate. So 60% to 90% or 40% to 10%. The way it is seems, to me, to be favouring the new "biphasic waveform" over the old in presentation rather than simply with the facts.

Support - My preference would be for 60%/90% effective Owain.davies 05:24, 23 May 2007 (UTC)
Done! - Completed the change. Owain.davies 16:55, 15 June 2007 (UTC)

Circuit Diagram

In the circuit diagram, what's the inverted T's (there's three of them)? I can't find any reference to them, either on wikipedia or a (arguably shallow) google search. 90.230.54.138 (talk) 15:22, 22 April 2008 (UTC)

Anyone? 90.230.54.138 (talk) 09:29, 15 May 2008 (UTC)
They are switches. OwainDavies (about)(talk) edited at 15:12, 15 May 2008 (UTC)

Explanation of waveforms (biphasic, uni/monophasic)

Could an explanation of the structure and characteristics (eg in the form of voltage/current waveforms) please be included?

I have also noticed that monophasic and uniphasic seem to be interchanged. Is this correct? —Preceding unsigned comment added by Cuvy (talk • contribs) 04:20, 13 October 2008 (UTC)

*How* does a defibrillator work?

Can someone who knows something about this actually write something about what defibrillators actually do from the standpoint of what happens in the heart? In other words, answer the question "why does shocking the heart help?"

E.g. I've heard that it's because it basically stops the heart momentarily and gives the natural pacemaker a chance to restart it in normal rhythm, but I can't find more than a couple blog posts to substantiate this claim. EvanED (talk) 08:09, 14 November 2010 (UTC)

I think you're right, and this should have more explanation - it is mentioned in the lead, all be it technical language (depolarising the critical mass and terminating the arrythmia), but you are correct, the defibrillator shocks the heart in to asystole (flat line), in the hope that this allows the hearts own pacemaker(s) to restablish a viable rhythm, rather than the confused firing of multiple pacemaker cells which presents in VF. I'll look at this later if i get a chance. OwainDavies (about)(talk) edited at 08:23, 14 November 2010 (UTC)
I guess it is there, but from where I sit you almost need to know how it works to understand that "explanation". (E.g. what does it mean to "depolarize the critical mass" (the heart attack article only contains "polariz" in the a sentence that's almost the same as that one, and the articles on cardiac arrest, the heart, and the sinoatrial node don't mention anything it at all) and how does that terminate the arrythmia?) So if you (or someone else) do wind up getting a chance to write something that's understandable, that'd be awesome. EvanED (talk) 17:43, 17 November 2010 (UTC)
1000 Amps

As I don't know for sure, I won't edit the statement. But in the section "Closed chest method", it says the defibrillator gives off 1000 Amps. Please say it should be Volts. — Preceding unsigned comment added by Wedinm (talk • contribs) 17:45, 8 March 2011 (UTC)

Rubbing paddles

It is also seen in TV and movies how the paddles are rubbed against each other prior to application and firing. Does it serve any function at all. Is it done in real life?Wedinm (talk) 18:28, 8 March 2011 (UTC)

This isn't really a discussion board, but from what I know yes, it does happen in real life, though how accurate the portrayal is depends on the particular show. The paddles are coated with a gel; rubbing the paddles around is spreading the gel more evenly. The gel protects against electrical burns. EvanED (talk) 00:05, 8 April 2011 (UTC)

Question on history and dates

I wanted someone to address the History of the Defibrillators section. The history section states that in 1899 Defibrillators were first demonstrated ... While I was traveling near my ranch in Southern Colorado I came across a country history museum which had a notable local doctor's office restored in it ... It had a crude defibrillator on display that the museum host said the doctor used. The doctor was active for around fifty years from the late 1880's to the 1930's. I recall a date on the unit of 1903? It was two flat metal paddles connected to a box with a crank or wind up handle. I mentioned to the host that I thought the modern defibrillator was more recent - say around 1950. She said the doctor used that machine in his practice. That would predate anything I see on the current history page. Could someone give some feedback?

Defibrillators were first demonstrated in 1899 by Jean-Louis Prévost and Frédéric Batelli, two physiologists from University of Geneva, Switzerland. They discovered that small electrical shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the condition.[1][2]

In 1933, Dr Albert Hyman, heart specialist at the Beth Davis Hospital of New York city and C. Henry Hyman, an electrical engineer, looking for an alternative to injecting powerful drugs directly into the heart, came up with an invention that used an electrical shock in place of drug injection. This invention was called the Hyman Otor where a hollow needle is used to pass an insulated wire to the heart area to deliver the electrical shock. The hollow steel needle acted as one end of the circuit and the tip of the insulated wire the other end. Whether the Hyman Otor was a success is unknown.[3]

The first use on a human was in 1947 by Claude Beck,[4] professor of surgery at Case Western Reserve University. Beck's theory was that ventricular fibrillation often occurred in hearts which were fundamentally healthy, in his terms "Hearts that are too good to die", and that there must be a way of saving them. Beck first used the technique successfully on a 14 year old boy who was being operated on for a congenital chest defect. The boy's chest was surgically opened, and manual cardiac massage was undertaken for 45 minutes until the arrival of the defibrillator. Beck used internal paddles on either side of the heart, along with procainamide, an antiarrhythmic drug, and achieved return of normal sinus rhythm. — Preceding unsigned comment added by TimonthyL (talk • contribs) 01:00, 8 March 2014 (UTC)

Popular culture section

This section was removed recently by an editor, and i just wanted to discuss it before removing such a large section. The justification given was that use of pop culture references is only useful when the subject is defined by them, when it isn't for defibrillation. (i'm paraphrasing here, but the exact text is in the page history)

Whilst the comment is valid, i think that defibrillation, and peoples' understanding of it, is very much influenced by a lot of the examples given in this section. For instance, movies such as flatliners (and numerous others in the section) foster the impression amongst people to this day that asystole is a shockable rhythm, and that the defibrillator has a huge success rate.

Rather than removing it, if everyone agrees that it should go, i think it would be better recrafted in to a section about the discrepancy between reality and portrayal in the media. Any thoughts?

Owain.davies 07:55, 28 August 2007 (UTC)

The problem with repurposing it is that without citing reliable sources which also contrast reality to the movies this would be WP:SYN. For now, simply removing the more useless examples (Battlefield and Bond for instance) would be a good idea. Chris Cunningham 08:09, 28 August 2007 (UTC)
In trying to improve this article, this section hampers the over-all goal of advancment. Although interesting (and true in most cases ie, shocking asystole) there is little WP:V information in this article. I have removed some of the article as it wasn't appropriate in this section. I vote for removal from the article Medicellis (talk) 10:45, 26 July 2008 (UTC)
Packer Whacker?? I'm sure someone uses this term, but I have personally not heard it in conversation. (I am an Aussie mates!). Perhaps it is limited to the units actually paid for by the (now) late Mr Packer. I can certainly imagine 'ambos' (Aussie colloqialism for paramedics/EMTs) using the term, ie. "Grab the Packer Whacker"
I checked the URL and it appears that the only mention of 'Packer Whacker' is where thay have an olde version of this article! Some one may have been 'pulling the leg' of whoever put this in. Dubious.
http://medical-dictionary.thefreedictionary.com/Packer+Whacker --220.101.28.25 (talk) 09:49, 30 October 2009 (UTC)
A few blog references then this letter to the Editor, from the Aussie 'Bowral Highland News' , 19 December 2001, (not a "Great Metropolitan Newaspaper" but anyway) http://bowral.yourguide.com.au/news/local/news/general/ordinary-people-can-do-extraordinary-things/269533.aspx --220.101.28.25 (talk) 10:53, 30 October 2009 (UTC)

Thers is a reference in Wictionary, but their link is dead. This appears to be the right one http://www.abc.net.au/science/articles/2005/08/08/1425842.htm
Flatline & Defibrillator - Part 2 By Karl S. Kruszelnicki, Quote:"In VF/VT, the remedy is the famous jumper cables and paddles - the defibrillator (though some ambos call it a "Packer Whacker", after Kerry Packer donated defibrillators to the NSW Ambulance Service). The paddles are really just electrodes." --220.101.28.25 (talk) 12:06, 30 October 2009 (UTC)

Regarding the part which reads that the AED shocks someone into asystole is not entirely correct, but the idea is there. The AED will stop the heart from beating, and as it is designed to only act on VF or VT, it will stop those rhythms. At that time the SA node should start the heart beating with a regular normal rhythm again. Asystole means a cardiac system with no electrical activity. The AED creates a temporary stop in rhythm, not a flat line. I suggest that part of the sentence be reworded to something like "...is to stop the irregular rhythm in the heart and then let...". If you've taken a CPR/AED class you should recognize this material. If you haven't take the class, you should. :) Jarod (talk) 04:23, 27 January 2014 (UTC)


First, I'm doing fine guys. Delcaring an interest: I've got a heart condition and been advised to have an implantable defibulator.

I not sure what to put in the popular culture section, however, if we could have something about it being in popular medical programmes etc. This came up in a consultation with a specialist. When the doctor asked me if I knew what one was I responded along the lines of "On ER (even though we have our own version in England that started first) where they shout clear and hit them with the paddels!" The doctors response was "well they wouldn't need to use that as you'd have one of these."

What I'm trying to say is I'd seen it enough that I reconised the word & it imediately came to mind. I'm sure I've seen it a lot.

Dannman (talk) 11:59, 4 July 2015 (UTC)

Stopped Heart

"Defibrillation is also used in order to resuscitate patients who's hearts have stopped.[citation needed]"

first - who's = who is, should be whose. second - umm no.

82.20.225.232 (talk) 17:28, 7 April 2011 (UTC)

Paddle electrodes

Maybe someone could look at this section? There's a bit of repetition. Also, the force of 25 lbs, is that a guideline, or is that force needed for the pads to function (using a built-in pressure switch)?

This type must be held in place on the patient's skin with approximately 25 lbs of force while the shock is delivered.while a shock or a series of shocks is delivered. .... Paddles require approximately 25 lbs of force to be applied while the shock is delivered.

DS Belgium ٩(͡๏̯͡๏)۶ 12:38, 12 October 2011 (UTC)

Implantable devices question

Does this mean that the implantable device will revive a person or fix an irregular heartbeat? — Preceding unsigned comment added by 71.239.163.178 (talk) 21:03, 8 December 2011 (UTC)

My understanding is that it is definately used for dangerous irregular and/or fast heartbeats. Ventricular fibrillation and pulseless ventricular tachycardia. Weather it will also revive a person I don't know. Dannman (talk) 12:08, 4 July 2015 (UTC)

AED Placement

This paragraph implies that "centers for teenage children" should be considered low priority when deciding whether or not to place an AED there, as, according to this paragraph, that type of location would have a "low risk" of cardiac arrest due to ventricular tachycardia (VT) or ventricular fibrillation (VF). I don't think that is an accurate evaluation. For one thing, while the "typical, healthy, adolescent" does not usually suffer VT or VF, there are many adolescents who are not "typical and healthy". As a matter of fact, there are a variety of congenital heart conditions that cause no symptoms prior to an episode of cardiac arrest, often from a form of VT or VF (Long QT Syndrome is one example). A person may go years having no clue they have a heart condition until an episode is triggered, often during adolescence and/or early adulthood. A "center for teenage children" that has many teenagers present is, statistically, very likely to have at least a few teens attend with known and/or unknown heart conditions whose lives could be saved by an AED.

In addition, a "center for teenage children" is also certainly going to have a number of adults present to supervise the teens, who could also benefit from an AED in the event of cardiac arrest from VT or VF (NOTE: Myocardial infractions (heart attacks) often cause cardiac arrest from VF).

The statement in this paragraph that "an office with a large number of males over 50" would be high risk, in the context of the entire paragraph, implies that offices with predominately females and/or employees under 50 would be a lower priority than an office of older men (while that is not explicitly stated, when read in the context of the entire paragraph, the implication is there, whether or not that was the author's intention). While males over 50 are, statistically, the demographic with the highest number of myocardial infarctions (a common cause of VF), many other demographic groups are hardly low risk. And while myocardial infarction is a common cause of VF, it is far from the only cause. Electrocution, drowning, overdose and interaction between many medications, severe dehydration and/or heat stroke, severe illness, as well as shock (which can be caused by almost any severe injury) can cause VF. Also, potential visitors aren't considered in these statistical risk evaluations presented in this paragraph.

Contrary to what this paragraph implies, an AED should be considered in any area/building that has a large number of people in it (from offices, to schools, to parks, to shopping centers).

Mhadj001 (talk) 21:47, 14 December 2011 (UTC)

"Move to direct current" section (question on the use of DC)

Hi. I was wondering how it could be considered direct current, if the waveform is a damped sinusoid? I have virtually no understanding of defibrillators, but some of electromagnetism.

(this is my very first wikipedia interaction beyond creating an account and browsing...apologies for anything I might be doing wrong right now) Mouthematician 67.22.255.20 (talk) 10:44, 10 January 2012 (UTC)

What it does description in first para

In the first paragraph it says "a therapeutic dose of electrical energy to the heart". I would consider saying "delivers an electric shock to the heart". Or (less good however better than the current) possibly "delivering a short burst of electricity to the heart". Dannman (talk) 12:28, 4 July 2015 (UTC)

Wikipedia Elective

Hi everyone! I will be editing this article over the next three weeks as part of a Wikipedia elective at UCSF School of Medicine. I will be focusing mostly on organizing the content and adding citations to each section. Appreciate any feedback for particular areas to focus on as well as content that might be relevant to this page! Thanks!

rjin1 (talk) 10:40, 28 Nov 2016

Modeling defibrillation

Hi Wiki community,

I am considering removing the "Modeling defibrillation" section, as I find it to have a lot of jargon which may not be useful to the lay public. I have a couple of ideas on what other sections we can replace this with - such as a section on mechanisms of defibrillation which can include some popular theories on why defibrillation works. Alternatively, we can just not have a section on this. What is the general thought on this? Thanks!

rjin1 (talk) 22:09, 07 Dec 2016

Only once sentence there appears to be supported by a review article. We could have a research section in this article were that one sentence could be removed with the rest of the unreffed stuff removed. Doc James (talk · contribs · email) 06:14, 8 December 2016 (UTC)
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