pneumonia directly affects which part of the body

Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli.[4][13] Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing.[2] Severity is variable.[2]

Pneumonia

Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases.[4][5] Risk factors include other lung diseases such as cystic fibrosis, COPD, and asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, or a weak immune system.[6] Diagnosis is often based on the symptoms and physical examination.[7] Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis.[7] The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.[14]

Vaccines to prevent certain types of pneumonia are available.[9] Other methods of prevention include handwashing and not smoking.[9] Treatment depends on the underlying cause.[15] Pneumonia believed to be due to bacteria is treated with antibiotics.[10] If the pneumonia is severe, the affected person is generally hospitalized.[15] Oxygen therapy may be used if oxygen levels are low.[10]

Pneumonia affects approximately 450 million people globally (7% of the population) and results in about 4 million deaths per year.[11][12] Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death".[16] With the introduction of antibiotics and vaccines in the 20th century, survival improved.[11] Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death.[11][17] Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend".[18]

People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased rate of breathing.[8] In elderly people, confusion may be the most prominent sign.[8]

The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing.[20] Fever is not very specific, as it occurs in many other common illnesses, may be absent in those with severe disease, malnutrition or in the elderly. In addition, a cough is frequently absent in children less than 2 months old.[20] More severe signs and symptoms in children may include blue-tinged skin, unwillingness to drink, convulsions, ongoing vomiting, extremes of temperature, or a decreased level of consciousness.[20][21]

Bacterial and viral cases of pneumonia are usually present with similar symptoms.[22] Some causes are associated with classic, but non-specific, clinical characteristics. Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or confusion.[23] Pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum.[24] Pneumonia caused by Klebsiella may have bloody sputum often described as "currant jelly".[19] Bloody sputum (known as hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, lung abscesses and more commonly acute bronchitis.[21] Pneumonia caused by Mycoplasma pneumoniae may occur in association with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection.[21] Viral pneumonia presents more commonly with wheezing than bacterial pneumonia.[22] Pneumonia was historically divided into "typical" and "atypical" based on the belief that the presentation predicted the underlying cause.[25] However, evidence has not supported this distinction, therefore it is no longer emphasized.[25]

Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. Although there are over 100 strains of infectious agents identified, only a few are responsible for the majority of the cases. Mixed infections with both viruses and bacteria may occur in roughly 45% of infections in children and 15% of infections in adults.[11] A causative agent may not be isolated in approximately half of cases despite careful testing.[18]

The term pneumonia is sometimes more broadly applied to any condition resulting in inflammation of the lungs (caused for example by autoimmune diseases, chemical burns or drug reactions); however, this inflammation is more accurately referred to as pneumonitis.[26][27]

Conditions and risk factors that predispose to pneumonia include smoking, immunodeficiency, alcoholism, chronic obstructive pulmonary disease, asthma, chronic kidney disease, liver disease, and old age.[21][28] The use of acid-suppressing medications — such as proton-pump inhibitors or H2 blockers — is associated with an increased risk of pneumonia.[29]  Approximately 10% of people who require mechanical ventilation develop ventilator associated pneumonia,[30] and people with gastric feeding tube have an increased risk of developing of aspiration pneumonia.[31] For people with specific variants of FER gene, the risk of death is reduced in sepsis caused by pneumonia. However, for those with TLR6 variants, the risk of getting Legionnaires' disease is increased.[32]

Bacteria are the most-common cause of community-acquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases.[33][34]  Other commonly-isolated bacteria include Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases;[33] Staphylococcus aureus; Moraxella catarrhalis; Legionella pneumophila; and Gram-negative bacilli.[18] A number of drug-resistant versions of the above infections are becoming more common, including drug-resistant Streptococcus pneumoniae (DRSP) and methicillin-resistant Staphylococcus aureus (MRSA).[21]

The spreading of organisms is facilitated when risk factors are present.[18] Alcoholism is associated with Streptococcus pneumoniae, anaerobic organisms, and Mycobacterium tuberculosis; smoking facilitates the effects of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Legionella pneumophila. Exposure to birds is associated with Chlamydia psittaci; farm animals with Coxiella burnetti; aspiration of stomach contents with anaerobic organisms; and cystic fibrosis with Pseudomonas aeruginosa and Staphylococcus aureus.[18] Streptococcus pneumoniae is more common in the winter,[18] and it should be suspected in persons aspirating a large amount of anaerobic organisms.[21]

In adults, viruses account for approximately a third[11] and in children for about 15% of pneumonia cases.[35] Commonly-implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and parainfluenza.[11][36] Herpes simplex virus rarely causes pneumonia, except in groups such as: newborns, persons with cancer, transplant recipients, and people with significant burns.[37] People following organ transplantation or those otherwise-immunocompromised present high rates of cytomegalovirus pneumonia.[35][37] Those with viral infections may be secondarily infected with the bacteria Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae, particularly when other health problems are present.[21][35] Different viruses predominate at different periods of the year; during influenza season, for example, influenza may account for over half of all viral cases.[35] Outbreaks of other viruses also occasionally occur, including hantaviruses and coronavirus.[35]

Fungal pneumonia is uncommon, but occurs more commonly in individuals with weakened immune systems due to AIDS, immunosuppressive drugs, or other medical problems.[18][38] It is most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci (pneumocystis pneumonia, or PCP), and Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the Southwestern United States.[18] The number of cases has been increasing in the later half of the 20th century due to increasing travel and rates of immunosuppression in the population.[38] For people infected with HIV/AIDS, PCP is a common opportunistic infection.[39]

A variety of parasites can affect the lungs, including Toxoplasma gondii, Strongyloides stercoralis, Ascaris lumbricoides, and Plasmodium malariae.[40] These organisms typically enter the body through direct contact with the skin, ingestion, or via an insect vector.[40] Except for Paragonimus westermani, most parasites do not affect specifically the lungs but involve the lungs secondarily to other sites.[40] Some parasites, in particular those belonging to the Ascaris and Strongyloides genera, stimulate a strong eosinophilic reaction, which may result in eosinophilic pneumonia.[40] In other infections, such as malaria, lung involvement is due primarily to cytokine-induced systemic inflammation.[40] In the developed world these infections are most common in people returning from travel or in immigrants.[40] Around the world, these infections are most common in the immunodeficient.[41]

Idiopathic interstitial pneumonia or noninfectious pneumonia[42] is a class of diffuse lung diseases. They include diffuse alveolar damage, organizing pneumonia, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and usual interstitial pneumonia.[43]

Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract.[44] It is a type of pneumonitis (lung inflammation).[45] The normal flora of the upper airway gives protection by competing with pathogens for nutrients. In the lower airways, reflexes of the glottis, actions of complement proteins and immunoglobulins are important for protection. Microaspiration of contaminated secretions can infect the lower airways and cause pneumonia. The virulence of the organism, amount of the organisms to start an infection and body immune response against the infection all determines the progress of pneumonia.[32]

Viruses may reach the lung by a number of different routes. Respiratory syncytial virus is typically contracted when people touch contaminated objects and then they touch their eyes or nose.[35] Other viral infections occur when contaminated airborne droplets are inhaled through the mouth or nose.[21] Once in the upper airway, the viruses may make their way in the lungs, where they invade the cells lining the airways, alveoli, or lung parenchyma.[35] Some viruses such as measles and herpes simplex may reach the lungs via the blood.[46] The invasion of the lungs may lead to varying degrees of cell death.[35] When the immune system responds to the infection, even more lung damage may occur.[35] Primarily white blood cells, mainly mononuclear cells, generate the inflammation.[46] As well as damaging the lungs, many viruses simultaneously affect other organs and thus disrupt other body functions. Viruses also make the body more susceptible to bacterial infections; in this way, bacterial pneumonia can occur at the same time as viral pneumonia.[36]

Most bacteria enter the lungs via small aspirations of organisms residing in the throat or nose.[21] Half of normal people have these small aspirations during sleep.[25] While the throat always contains bacteria, potentially infectious ones reside there only at certain times and under certain conditions.[25] A minority of types of bacteria such as Mycobacterium tuberculosis and Legionella pneumophila reach the lungs via contaminated airborne droplets.[21] Bacteria can spread also via the blood.[22] Once in the lungs, bacteria may invade the spaces between cells and between alveoli, where the macrophages and neutrophils (defensive white blood cells) attempt to inactivate the bacteria.[47] The neutrophils also release cytokines, causing a general activation of the immune system.[48] This leads to the fever, chills, and fatigue common in bacterial pneumonia.[48] The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli, resulting in the consolidation seen on chest X-ray.[49]

Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray.[50] However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin.[11][50]

The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.[51] A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, greater than 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old.[51] In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope or increased respiratory rate.[52] Grunting and nasal flaring may be other useful signs in children less than five years old.[53] Lack of wheezing is an indicator of Mycoplasma pneumoniae in children with pneumonia, but as an indicator it is not accurate enough to decide whether or not macrolide treatment should be used.[54] The presence of chest pain in children with pneumonia doubles the probability of Mycoplasma pneumoniae.[54]

In general, in adults, investigations are not needed in mild cases.[55] There is a very low risk of pneumonia if all vital signs and auscultation are normal.[56] In persons requiring hospitalization, pulse oximetry, chest radiography and blood tests—including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests—are recommended.[55] Procalcitonin may help determine the cause and support who should receive antibiotics.[57] Antibiotics is encouraged if procalcitonin level reaches 0.25 μg/L, strongly encouraged if it reaches 0.5 μg/L, and strongly discouraged if the level is below 0.10 μg/L.[32] For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antbiotics are not recommended.[32]

The diagnosis of influenza-like illness can be made based on the signs and symptoms; however, confirmation of an influenza infection requires testing.[58] Thus, treatment is frequently based on the presence of influenza in the community or a rapid influenza test.[58]

Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation.[21] The respiratory rate may be faster than normal, and this may occur a day or two before other signs.[21][25] Examination of the chest may be normal, but it may show decreased chest expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope.[21] Crackles (rales) may be heard over the affected area during inspiration.[21] Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion.[8]

A chest radiograph is frequently used in diagnosis.[20] In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain.[20][55] If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended.[55] Findings do not always match the severity of disease and do not reliably separate between bacterial infection and viral infection.[20]

X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia (also known as lobular pneumonia), and interstitial pneumonia.[59] Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia.[33] However, findings may vary, and other patterns are common in other types of pneumonia.[33] Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side.[33] Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation.[33] Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to be interpreted in the obese or those with a history of lung disease.[21] Complications such as pleural effusion may also be found on chest radiographs. Laterolateral chest radiograph can increase the diagnostic accuracy of lung consolidation and pleural effusion.[32] A CT scan can give additional information in indeterminate cases.[33] CT scan can also provide more details in those with an unclear chest radiograph (for example occult pneumonia in chronic obstructive pulmonary disease (COPD)) and is able to exclude pulmonary embolism and fungal pneumonia and detecting lung abscess in those who are not responding to treatments.[32] However, CT scan is more expensive, has a higher dose of radiation, and cannot be done at bedside.[32]

Lung ultrasound may also be useful in helping to make the diagnosis.[60] Ultrasound is radiation free and can be done at bedside. However, ultrasound requires specific skills to operate the machine and interpret the findings.[32] It may be more accurate than chest X-ray.[61]

Pneumonia seen by ultrasound[62]

Pneumonia seen by ultrasound[62]

Pneumonia seen by ultrasound[62]

Right middle lobe pneumonia in a child as seen on plain X ray

In patients managed in the community, determining the causative agent is not cost-effective and typically does not alter management.[20] For people who do not respond to treatment, sputum culture should be considered, and culture for Mycobacterium tuberculosis should be carried out in persons with a chronic productive cough.[55] Microbiological evaluation is also indicated in severe pneumonia, alcoholism, asplenia, immunosuppression, HIV infection, and alcohol abuse.[32] Although positive blood culture and pleural fluid culture definitively establish the diagnosis of the type of micro-organism involved, a positive sputum culture has to be interpreted with care for the possibility of colonisation of respiratory tract.[32] Testing for other specific organisms may be recommended during outbreaks, for public health reasons.[55] In those hospitalized for severe disease, both sputum and blood cultures are recommended,[55] as well as testing the urine for antigens to Legionella and Streptococcus.[63] Viral infections, can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction (PCR), among other techniques.[11] Mycoplasma, Legionella, Streptococcus, and Chlamydia can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab.[32] The causative agent is determined in only 15% of cases with routine microbiological tests.[8]

Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non-infectious, that has the additional feature of pulmonary consolidation.[64] Pneumonia is most commonly classified by where or how it was acquired: community-acquired, aspiration, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia.[33] It may also be classified by the area of lung affected: lobar pneumonia, bronchial pneumonia and acute interstitial pneumonia;[33] or by the causative organism.[65] Pneumonia in children may additionally be classified based on signs and symptoms as non-severe, severe, or very severe.[66]

The setting in which pneumonia develops is important to treatment,[67][68] as it correlates to which pathogens are likely suspects,[67] which mechanisms are likely, which antibiotics are likely to work or fail,[67] and which complications can be expected based on the person's health status.

Community-acquired pneumonia (CAP) is acquired in the community,[67][68] outside of health care facilities. Compared with health careâ€“associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Although the latter are no longer rare in CAP,[67] they are still less likely.

Health care–associated pneumonia (HCAP) is an infection associated with recent exposure to the health care system,[67] including hospital, outpatient clinic, nursing home, dialysis center, chemotherapy treatment, or home care.[68] HCAP is sometimes called MCAP (medical care–associated pneumonia).

Hospital-acquired pneumonia is acquired in a hospital, specifically, pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission.[68][67] It is likely to involve hospital-acquired infections, with higher risk of multidrug-resistant pathogens. Also, because hospital patients are often ill (which is why they are present in the hospital), accompanying disorders are an issue.

Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation.[67][30] Ventilator-associated pneumonia is specifically defined as pneumonia that arises more than 48 to 72 hours after endotracheal intubation.[68]

Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease (COPD), asthma, pulmonary edema, bronchiectasis, lung cancer, and pulmonary emboli.[8] Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram, cancer and bronchiectasis present with a cough of longer duration, and pulmonary emboli presents with acute onset sharp chest pain and shortness of breath.[8] Mild pneumonia should be differentiated from upper respiratory tract infection (URTI). Severe pneumonia should be differentiated from acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia. For recurrent pneumonia, underlying lung cancer, metastasis, tuberculosis, foreign body, immunosuppression, and hypersensitivity should be sought after.[32]

Prevention includes vaccination, environmental measures and appropriate treatment of other health problems.[20] It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000.[22]

Vaccination prevents against certain bacterial and viral pneumonias both in children and adults. Influenza vaccines are modestly effective at preventing symptoms of influenza,[11][69][needs update] The Center for Disease Control and Prevention (CDC) recommends yearly influenza vaccination for every person 6Â months and older.[70] Immunizing health care workers decreases the risk of viral pneumonia among their patients.[63]

Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae have good evidence to support their use.[44] There is strong evidence for vaccinating children under the age of 2 against Streptococcus pneumoniae (pneumococcal conjugate vaccine).[71][72][73] Vaccinating children against Streptococcus pneumoniae has led to a decreased rate of these infections in adults, because many adults acquire infections from children. A Streptococcus pneumoniae vaccine is available for adults, and has been found to decrease the risk of invasive pneumococcal disease, but there is insufficient evidence to suggest using the pneumococcal vaccine to prevent pneumonia or mortality in the general adult population.[74] The CDC recommends that young children and adults over the age of 65 receive the pneumococcal vaccine, as well as older children or younger adults who have an increased risk of getting pneumococcal disease.[73] The pneumococcal vaccine has been shown to reduce the risk of community acquired pneumonia in people with chronic obstructive pulmonary disease (COPD), but does not reduce mortality or the risk of hospitalization for people with this condition.[75] People with COPD are suggested to have a pneumococcal vaccination.[75] Other vaccines for which there is support for a protective effect against pneumonia include pertussis, varicella, and measles.[76]

When influenza outbreaks occur, medications such as amantadine or rimantadine may help prevent the condition; however are associated with side effects.[77] Zanamivir or oseltamivir decrease the chance that people who are exposed to the virus will develop symptoms; however, it is recommended that potential side effects are taken into account.[78]

Smoking cessation[55] and reducing indoor air pollution, such as that from cooking indoors with wood or dung, are both recommended.[20][22] Smoking appears to be the single biggest risk factor for pneumococcal pneumonia in otherwise-healthy adults.[63] Hand hygiene and coughing into one's sleeve may also be effective preventative measures.[76] Wearing surgical masks by the sick may also prevent illness.[63]

Appropriately treating underlying illnesses (such as HIV/AIDS, diabetes mellitus, and malnutrition) can decrease the risk of pneumonia.[22][76][79] In children less than 6Â months of age, exclusive breast feeding reduces both the risk and severity of disease.[22] In those with HIV/AIDS and a CD4 count of less than 200 cells/uL the antibiotic trimethoprim/sulfamethoxazole decreases the risk of Pneumocystis pneumonia[80] and is also useful for prevention in those that are immunocomprised but do not have HIV.[81]

Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis, and administering antibiotic treatment, if needed, reduces rates of pneumonia in infants;[82][83] preventive measures for HIV transmission from mother to child may also be efficient.[84] Suctioning the mouth and throat of infants with meconium-stained amniotic fluid has not been found to reduce the rate of aspiration pneumonia and may cause potential harm,[85] thus this practice is not recommended in the majority of situations.[85] In the frail elderly good oral health care may lower the risk of aspiration pneumonia.[86] Zinc supplementation in children 2 months to five years old appears to reduce rates of pneumonia.[87]

For people with low levels of vitamin C in their diet or blood, taking vitamin C supplements may be suggested to decrease the risk of pneumonia, although there is no strong evidence of benefit.[88] There is insufficient evidence to recommend that the general population take vitamin C to prevent pneumonia.[88]

For adults and children in the hospital who require a respirator, there is no strong evidence indicating a difference between heat and moisture exchangers and heated humidifiers for preventing pneumonia.[89]

Oral antibiotics, rest, simple analgesics, and fluids usually suffice for complete resolution.[55] However, those with other medical conditions, the elderly, or those with significant trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does not improve with home treatment, or complications occur, hospitalization may be required.[55] Worldwide, approximately 7–13% of cases in children result in hospitalization,[20] whereas in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted.[55] The CURB-65 score is useful for determining the need for admission in adults.[55] If the score is 0 or 1, people can typically be managed at home; if it is 2, a short hospital stay or close follow-up is needed; if it is 3–5, hospitalization is recommended.[55] In children those with respiratory distress or oxygen saturations of less than 90% should be hospitalized.[90] The utility of chest physiotherapy in pneumonia has not yet been determined.[91][92] Non-invasive ventilation may be beneficial in those admitted to the intensive care unit.[93] Over-the-counter cough medicine has not been found to be effective[94] nor has the use of zinc in children.[95] There is insufficient evidence for mucolytics.[94] There is no strong evidence to recommend that children who have non-measles related pneumonia take Vitamin A supplements.[96] For those with sepsis, 30 ml/kg of crystalloid should be infused to correct hypotension.[32]

Antibiotics improve outcomes in those with bacterial pneumonia.[12] First dose of antibiotics should be given as soon as possible.[32] Increased use of antibiotics, however, may lead to the development of antimicrobial resistant strains of bacteria.[97] Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. Antibiotic use is also associated with side effects such as nausea, diarrhea, dizziness, taste distortion, or headaches.[97] In the UK, treatment before culture results with amoxicillin is recommended as the first line for community-acquired pneumonia, with doxycycline or clarithromycin as alternatives.[55] In North America, where the "atypical" forms of community-acquired pneumonia are more common, macrolides (such as azithromycin or erythromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment in adults.[34][98] In children with mild or moderate symptoms, amoxicillin taken by mouth remains the first line.[90][99][100] The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of there being no greater clinical benefit.[34][101]

For those who require hospitalization and caught their pneumonia in the community the use of a Î²-lactam such as cephazolin plus macrolide such as azithromycin or a fluoroquinolones is recommended.[102]

The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3â€“5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance.[103][104][105] For pneumonia that is associated with a ventilator caused by non-fermenting Gram-negative bacilli (NF-GNB), a shorter course of antibiotics increases the risk of that pneumonia will return.[104] Recommendations for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin.[68] These antibiotics are often given intravenously and used in combination.[68] In those treated in hospital, more than 90% improve with the initial antibiotics.[25] For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with a strain of bacteria that is multi-drug resistant.[30] Once clinically stable, intravenous antibiotics should be swithced to oral antibiotics.[32] For those with Methicillin resistant Staphylococcus aureus (MRSA) or Legionella infections, prolonged antibiotics may be beneficial.[32]

The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing mortality and morbidity for adults with severe community acquired pneumonia, and reducing morbidity for adults and children with non-severe community acquired pneumonia.[106][107] There are adverse effects associated with the use of corticosteroids such as high blood sugar[106] and superinfection.[32] There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people who are infected with HIV.[39]

The use of granulocyte colony stimulating factor (G-CSF) along with antibiotics does not appear to reduce mortality and routine use for treating pneumonia is not supported by evidence.[108]

Neuraminidase inhibitors may be used to treat viral pneumonia caused by influenza viruses (influenza A and influenza B).[11] No specific antiviral medications are recommended for other types of community acquired viral pneumonias including SARS coronavirus, adenovirus, hantavirus, and parainfluenza virus.[11] Influenza A may be treated with rimantadine or amantadine, while influenza A or B may be treated with oseltamivir, zanamivir or peramivir.[11] These are of most benefit if they are started within 48 hours of the onset of symptoms.[11] Many strains of H5N1 influenza A, also known as avian influenza or "bird flu", have shown resistance to rimantadine and amantadine.[11] The use of antibiotics in viral pneumonia is recommended by some experts, as it is impossible to rule out a complicating bacterial infection.[11] The British Thoracic Society recommends that antibiotics be withheld in those with mild disease.[11] The use of corticosteroids is controversial.[11]

In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for aspiration pneumonia.[109] The choice of antibiotic will depend on several factors, including the suspected causative organism and whether pneumonia was acquired in the community or developed in a hospital setting. Common options include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or an aminoglycoside.[110]
Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.[109]

With treatment, most types of bacterial pneumonia will stabilize in 3–6 days.[3] It often takes a few weeks before most symptoms resolve.[3] X-ray finding typically clear within four weeks and mortality is low (less than 1%).[21][111] In the elderly or people with other lung problems, recovery may take more than 12 weeks. In persons requiring hospitalization, mortality may be as high as 10%, and in those requiring intensive care it may reach 30–50%.[21] Pneumonia is the most common hospital-acquired infection that causes death.[25] Before the advent of antibiotics, mortality was typically 30% in those that were hospitalized.[18] However, for those whose lung condition deteriorates within 72 hours, the problem is usually due to sepsis.[32] If pneumonia deteriorates after 72 hours, it could be due to nosocomial infection or excerbation of other underlying co-morbidities.[32] About 10% of those discharged from hospital are readmitted due to underlying co-morbidities such as heart, lung, or neurology disorders, or due to new onset of pneumonia.[32]

Complications may occur in particular in the elderly and those with underlying health problems.[111] This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening of underlying health problems.[111]

Clinical prediction rules have been developed to more objectively predict outcomes of pneumonia.[25] These rules are often used in deciding whether or not to hospitalize the person.[25]

In pneumonia, a collection of fluid may form in the space that surrounds the lung.[113] Occasionally, microorganisms will infect this fluid, causing an empyema.[113] To distinguish an empyema from the more common simple parapneumonic effusion, the fluid may be collected with a needle (thoracentesis), and examined.[113] If this shows evidence of empyema, complete drainage of the fluid is necessary, often requiring a drainage catheter.[113] In severe cases of empyema, surgery may be needed.[113] If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. If the fluid is sterile, it must be drained only if it is causing symptoms or remains unresolved.[113]

In rare circumstances, bacteria in the lung will form a pocket of infected fluid called a lung abscess.[113] Lung abscesses can usually be seen with a chest X-ray but frequently require a chest CT scan to confirm the diagnosis.[113] Abscesses typically occur in aspiration pneumonia, and often contain several types of bacteria. Long-term antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist.[113]

Pneumonia can cause respiratory failure by triggering acute respiratory distress syndrome (ARDS), which results from a combination of infection and inflammatory response. The lungs quickly fill with fluid and become stiff. This stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid, may require long periods of mechanical ventilation for survival.[35] Other causes of circulatory failure are hypoxemia, inflammation, and increased coagulability.[32]

Sepsis is a potential complication of pneumonia but occurs usually in people with poor immunity or hyposplenism. The organisms most commonly involved are Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae. Other causes of the symptoms should be considered such as a myocardial infarction or a pulmonary embolism.[114]

Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world.[11] It is a major cause of death among all age groups resulting in 4 million deaths (7% of the world's total death) yearly.[11][12] Rates are greatest in children less than five, and adults older than 75 years.[11] It occurs about five times more frequently in the developing world than in the developed world.[11] Viral pneumonia accounts for about 200 million cases.[11] In the United States, as of 2009, pneumonia is the 8th leading cause of death.[21]

In 2008, pneumonia occurred in approximately 156 million children (151 million in the developing world and 5 million in the developed world).[11] In 2010, it resulted in 1.3 million deaths, or 18% of all deaths in those under five years, of which 95% occurred in the developing world.[11][20][116] Countries with the greatest burden of disease include India (43 million), China (21 million) and Pakistan (10 million).[117] It is the leading cause of death among children in low income countries.[11][12] Many of these deaths occur in the newborn period. The World Health Organization estimates that one in three newborn infant deaths is due to pneumonia.[118] Approximately half of these deaths can be prevented, as they are caused by the bacteria for which an effective vaccine is available.[119] In 2011, pneumonia was the most common reason for admission to the hospital after an emergency department visit in the U.S. for infants and children.[120]

Pneumonia has been a common disease throughout human history.[121] The word is from Greek πνεύμων (pneúmōn) meaning "lung".[122] The symptoms were described by Hippocrates (c. 460 BC – 370 BC):[121] "Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand."[123] However, Hippocrates referred to pneumonia as a disease "named by the ancients". He also reported the results of surgical drainage of empyemas. Maimonides (1135–1204 AD) observed: "The basic symptoms that occur in pneumonia and that are never lacking are as follows: acute fever, sticking pleuritic pain in the side, short rapid breaths, serrated pulse and cough."[124] This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century.

Edwin Klebs was the first to observe bacteria in the airways of persons having died of pneumonia in 1875.[125] Initial work identifying the two common bacterial causes, Streptococcus pneumoniae and Klebsiella pneumoniae, was performed by Carl Friedländer[126] and Albert Fraenkel[127] in 1882 and 1884, respectively. Friedländer's initial work introduced the Gram stain, a fundamental laboratory test still used today to identify and categorize bacteria. Christian Gram's paper describing the procedure in 1884 helped to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism.[128]

Sir William Osler, known as "the father of modern medicine", appreciated the death and disability caused by pneumonia, describing it as the "captain of the men of death" in 1918, as it had overtaken tuberculosis as one of the leading causes of death in this time. This phrase was originally coined by John Bunyan in reference to "consumption" (tuberculosis).[129][130] Osler also described pneumonia as "the old man's friend" as death was often quick and painless when there were much slower and more painful ways to die.[18]

Several developments in the 1900s improved the outcome for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the 20th century, mortality from pneumonia, which had approached 30%, dropped precipitously in the developed world. Vaccination of infants against Haemophilus influenzae type B began in 1988 and led to a dramatic decline in cases shortly thereafter.[131] Vaccination against Streptococcus pneumoniae in adults began in 1977, and in children in 2000, resulting in a similar decline.[132]

Due to the relatively low awareness of the disease, 12 November was declared as the annual World Pneumonia Day, a day for concerned citizens and policy makers to take action against the disease, in 2009.[133][134]

The global economic cost of community-acquired pneumonia has been estimated at $17 billion annually.[21]  Other estimates are considerably higher. In 2012 the estimated aggregate costs of treating pneumonia in the United States were $20 billion;[135] the median cost of a single pneumonia-related hospitalization is over $15,000.[136] According to data released by the Centers for Medicare and Medicaid Services, average 2012 hospital charges for inpatient treatment of uncomplicated pneumonia in the U.S. were $24,549 and ranged as high as $124,000. The average cost of an emergency room consult for pneumonia was $943 and the average cost for medication was $66.[137] Aggregate annual costs of treating pneumonia in Europe have been estimated at €10 billion.[138]

As of 2016 there has been one large trial studying the use of vitamin D to prevent pneumonia in children, which found no effect.[139]


what regulates the sale of property in australia

Australian property law is the system of laws regulating and prioritising the Property law rights, interests and responsibilities of individuals in relation to "things". These things are a form of "property" or "right" to possession or ownership of an object. The law orders or prioritises rights and classifies property as either real and tangible, such as land, or intangible, such as the right of an author to their literary works or personal but tangible, such as a book or a pencil. The scope of what constitutes a thing capable of being classified as property and when an individual or body corporate gains priority of interest over a thing has in legal scholarship been heavily debated on a philosophical level.

Australian property law

Land is the predominant focus of Western property law, particularly Australian property law. Legal developments in this field outweigh the development of other forms of property law, this is primarily due to the high value of land in comparison to other forms of property, such as chattels.

Each state in Australia has a different regime for the regulation and bureaucratisation of land. It is a largely statute based area of the law but can still be influenced by the common law and principles that originate from Australia's history as a colony of the United Kingdom, where land and estate law developed through the ambit of feudalism.
Property law is enabling in that it creates a system for evidencing, recognizing and transferring title to land, facilitating its use as an economic instrument. Other legal instruments in property law that facilitate the private and commercial dealing of land include the mortgage, lease, covenant and easement.

All Australian colonies (now states and territories) adopted the Torrens system of land registration of title between 1857 and 1875. The Torrens title system was introduced first in South Australia by Sir Robert Richard Torrens, the Registrar-General of Deeds through the Real Property Act 1858.[1] Victoria adopted the system with the Real Property Act 1862,[2] and New South Wales with the commencement of the Real Property Act 1862 on 1 January 1863.[3] The Torrens system did not replace the common law system but applied only to new land grants and to land that has been voluntarily registered under the relevant Act. The common law system continues to apply to all other landholdings.

In accordance with the principles of the Torrens system, each state maintains a land titles register of land in the state that has been registered under the system, which also shows the proprietor (owner) of the land. This system was devised to reduce the amount of fraud relating to land due to falsification of title deeds. It does so with 'ownership' of the land being confirmed only upon registration of the property. That is, "it is not a system of registration of title but a system of title by registration". [4] This gives a purchaser "greater assurance, indeed certainty, of title". [5]  The principle of 'indefeasibility' of title - where a right has been entered on the register, it cannot be defeated by later rights except in certain circumstances - further protects the Torrens title holder. [6] Still a small residue of Old System Land remains and efforts are underway to convert this to Torrens title.  The Torrens system also provides for registration of other entitlements to land such as a mortgage, by which land is used to secure a loan.

The table above lists the core legislation in each jurisdiction of Australia regulating interests in land law in relation to property (negotiable instruments) and the scheme of registration (title).

Australia's law in relation to goods and chattels (items which are not land or intellectual property) follows that of the United Kingdom.

Australia follows the English traditions for intellectual property, and is a signatory of the Berne Convention for the Protection of Literary and Artistic Works and operates a system of automatic copyright. Other areas of Australian intellectual property include patents, designs and Plant breeders' rights.


who is the disaster artist movie based on

The Disaster Artist is a 2017 American biographical comedy-drama film produced and directed by James Franco. Written by Scott Neustadter and Michael H. Weber, the film is based on Greg Sestero and Tom Bissell's non-fiction book of the same name, and chronicles the making of Tommy Wiseau's 2003 The Room, widely considered one of the worst movies ever made. The film stars brothers James and Dave Franco as Wiseau and Sestero, respectively, alongside a supporting cast featuring Seth Rogen (who also produced), Alison Brie, Ari Graynor, Josh Hutcherson, and Jacki Weaver.

The Disaster Artist (film)

Principal photography began on December 8, 2015. A work-in-progress cut of the film premiered at South by Southwest on March 12, 2017; it was later screened at the 2017 Toronto International Film Festival on September 11, and also played at the 2017 San Sebastián International Film Festival, where it became the first American film to win its top prize, the Golden Shell, since A Thousand Years of Good Prayers in 2007.[5]

Distributed by A24 in the United States and Warner Bros. Pictures in international markets, The Disaster Artist began a limited release on December 1, 2017, before opening wide on December 8, 2017. It received positive reviews from critics, with James Franco's portrayal of Wiseau as well as the film's humor and screenplay receiving praise,[6][7] and was chosen by the National Board of Review as one of the top ten films of 2017.[8] At the 75th Golden Globe Awards, James Franco won the award for Best Actor – Musical or Comedy; the film was also nominated for Best Motion Picture – Musical or Comedy.[9] Franco also received a nomination for Outstanding Performance by a Male Actor in a Leading Role at the 24th Screen Actors Guild Awards. The film also earned a nomination for Best Adapted Screenplay at the 90th Academy Awards.

San Francisco, 1998: 19-year-old Greg Sestero meets Tommy Wiseau in acting classes with Jean Shelton. Shelton criticizes Tommy's performance of a scene from A Streetcar Named Desire, but Greg is impressed by Tommy's fearlessness and the two become friends. On Tommy's suggestion, they move to Los Angeles to pursue acting careers.

Greg signs with Iris Burton, a talent agent, while Tommy faces rejection from agencies, casting directors, and Hollywood insiders. Greg develops a relationship with Amber, whom he meets at her job at a nightclub, and Tommy grows jealous; as he fails to find work, he becomes disheartened. As Greg's auditions also dry up, he shares his frustrations with Tommy, who decides to make a movie for them both to star in.

Tommy writes a screenplay titled The Room, a melodrama about a love triangle between banker Johnny (played by Tommy), his fiancÃ©e Lisa and his best friend Mark. Greg reluctantly accepts the role of Mark and an associate producer credit. They rent out a production house; Tommy insists on buying all the production equipment and shooting the film on 35 mm film and HD Digital simultaneously, costly and unnecessary measures. The employees introduce Tommy to Raphael Smadja and Sandy Schklair, who work as his cinematographer and script supervisor respectively.

Production starts smoothly, but Tommy is difficult to work with. He forgets his lines, arrives late, and refuses to supply his crew with basic needs such as drinking water, even as an actor faints. During preparation for a sex scene, Tommy humiliates actress Juliette Danielle by pointing out her acne to the crew. Having filmed extensive behind-the-scenes footage, Tommy reveals that he knows everybody hates him, and believes that nobody, including Greg, supports his vision.

Greg and Amber run into Malcolm in the Middle star Bryan Cranston, who invites Greg to fill in for a small lumberjack part in a Malcolm episode. The part requires a beard; as Greg is due to shave his beard for The Room, he begs Tommy to postpone shooting, but Tommy refuses. On the last day of shooting, Greg accuses Tommy of being selfish and duplicitous throughout their friendship, and questions his real age and origins.

Eight months later, Amber and Greg have split up. Tommy invites Greg to the premiere of The Room; to his surprise, the entire cast and crew attend. The audience react first with horror then laughter at the film. Tommy bursts into tears and walks out, but Greg comforts him, telling him they have delighted the audience, not angered them. With a renewed mindset, Tommy returns to the theater as the credits roll, takes credit for his "comedic" movie, and receives a standing ovation.

Real-life clips of Wiseau attending screenings of The Room play, and title cards explain that the film made $1,800 against its reported $6 million budget during its initial release (Wiseau kept it running for two weeks, allegedly to qualify for the Academy Awards), but it has since become a profitable cult film. Wiseau and Sestero remain friends and, to this day, Wiseau's age, past life and source of income remain a mystery. Scenes from The Room are then compared side-by-side with reenactments of the scenes performed by The Disaster Artist's cast.

In a post-credits scene, Wiseau has an odd verbal exchange with a party goer (played by the real Wiseau), who offers to hang out, but Wiseau refuses.

Celebrity cameos include Bryan Cranston, J. J. Abrams, Lizzy Caplan, Kristen Bell, Keegan-Michael Key, Adam Scott, Danny McBride, Angelyne, Kevin Smith, and Ike Barinholtz as themselves.[13][14] Bob Odenkirk appears as a method acting acting teacher in Los Angeles, and Judd Apatow as a film producer. Other cameos include John Early, Joe Mande, Jessie Ennis, Dylan Minnette, Charlyne Yi, Tom Franco, Zoey Deutch, Sugar Lyn Beard, Brian Huskey, Randall Park, Jerrod Carmichael and Casey Wilson. Greg Sestero appears as an assistant casting director,[15] while Tommy Wiseau appears in a post-credits scene.

In February 2014, Seth Rogen's production company Point Grey Pictures announced it had acquired the book and film rights to The Disaster Artist. James Franco was set to direct and play Wiseau, and his brother Dave Franco was cast as Sestero. James Franco stated The Disaster Artist was "a combination of Boogie Nights and The Master."[16] According to Franco, Wiseau initially had hoped Johnny Depp would play him.[17] In April 2016, the title was reported to have changed from The Disaster Artist to The Masterpiece,[18] though The Disaster Artist was confirmed as the official title when the film's SXSW premiere was announced.[19]

In June 2014, James Franco's younger brother, Dave Franco, informally announced at a midnight showing of The Room that he had been cast in the co-starring role of Greg Sestero. Wiseau praised the decision in a Q&A session.[20] The film is the first collaboration of James and brother Dave, as the younger Franco has said that he had sought different projects deliberately, specifying in an interview at the Toronto International Film Festival, "I didn't want people to think I was riding his coattails."[21] As New Line Cinema sought to acquire The Disaster Artist in October 2015, one of the film's producers, and frequent Franco collaborator, Seth Rogen, was in negotiations to play The Room's script supervisor, Sandy Schklair.[22] Schklair expressed concern over the film's portrayal of him, as Rogen did not pursue contact with him, despite his offers to sit down and discuss the film.[23] The remainder of the principal cast were revealed in the days prior to the beginning of filming, in early December 2015: Josh Hutcherson plays Philip Haldiman, Ari Graynor as Juliette Danielle, Jacki Weaver as Carolyn Minnott, Hannibal Buress as Bill Meur, Andrew Santino as Scott Holmes, and Zac Efron as Dan Janjigian.[24][25][26][27] Dave Franco's wife, Alison Brie, joined the cast in the role of Sestero's then-girlfriend, Amber,[28] and Sharon Stone was later announced to have been cast as Hollywood talent agent Iris Burton.[29] Sestero stated in January 2016 that Bryan Cranston had been cast in the film in an undisclosed role. In November 2016, he was revealed to be playing himself, during his time working on Malcolm in the Middle.[30]

Dave Porter composed the film's score.[31]

Principal photography began on December 8, 2015, in Los Angeles,[32] and ended on January 28, 2016.[33]

The film had its premiere, in a work-in-progress form, at South by Southwest on March 12, 2017.[34][35][19] In May 2017, A24 acquired distribution rights to the film, and set the film for a limited release on December 1, 2017, before a wide release on December 8.[36] Warner Bros. Pictures distributes the film internationally,[37] and it received an IMAX release in selected areas as well.[38]

On October 25, 2017, A24 mounted a billboard on Highland Avenue in Los Angeles that replicated the original The Room billboard that Wiseau kept up from 2003 to 2008.[39][40]

It was released on Blu-ray, DVD and digital download on March 13, 2018.[41]

The Disaster Artist has grossed $21.1 million in the United States and Canada, and $8.5 million in other territories, for a worldwide total of $29.6 million, against a production budget of $10 million.[4]

The film grossed $1.2 million from 19 theaters in its limited opening weekend, finishing 12th at the box office and averaging $64,254 per venue, one of the highest averages of 2017.[42] The film had its wide expansion the following week, alongside the opening of Just Getting Started, and was projected to gross around $5 million from 840 theaters over the weekend.[43] It ended up making $6.4 million, finishing 4th at the box office.[44] The following week, despite being added to 170 additional theaters, the film dropped a more-than-expected 59% to $2.6 million, finishing 8th.[45]

The Disaster Artist received a standing ovation at its initial screening at South by Southwest.[46][47] On review aggregation website Rotten Tomatoes, the film has an approval rating of 91% based on 272 reviews, and an average rating of 7.7/10. The website's critical consensus reads, "Oh, hai Mark. The Disaster Artist is a surprisingly poignant and charming movie-about-a-movie that explores the creative process with unexpected delicacy."[48] Metacritic assigned the film a weighted average score of 76 out of 100, based on 44 critics, indicating "generally favorable reviews".[49] Audiences polled by PostTrak gave the film an 81% overall positive score and a 66% "definite recommend".[44]

Erik Childress of The Playlist gave the film a positive review, dubbing James Franco's performance his "best... since his Oscar-nominated turn in 127 Hours." Further, he wrote that "as a director it is nice to finally see him embrace the comfort zone of comedy with enough cameos to rival Robert Altman's The Player."[50] Peter Debruge of Variety also gave the film a positive review, saying it had a "genuine capacity to delight, whether or not the audiences in question have seen The Room."[51]

Writing for Rolling Stone, Peter Travers gave the film 3.5 out of 4 stars, saying: "As a director, Franco succeeds beautifully at bringing coherence to chaos, a word that accurately describes the making of this modern midnight-movie phenomenon. Do you need to see The Room to appreciate The Disaster Artist? Not really."[52] Justin Chang of the Los Angeles Times called the film "a hilarious, heartening celebration of failure".[53]

Manohla Dargis of The New York Times wrote that it is "a divertingly funny movie, but its breeziness can also feel overstated, at times glib and a bit of a dodge".[54] Peter Bradshaw of The Guardian gave the film three out of five stars, writing that the film brings up unanswered questions, and that it "has room for improvement".[55] Ignatiy Vishnevetsky of The A.V. Club gave the film a rating of "C", calling it a "lousy tribute" and asking, "will anyone who hasn't seen The Room actually be able to piece together a sense of this Z-grade sensation from watching The Disaster Artist?"[56]


what is the main religion in new jersey

In the 2015 Jersey Annual Social Survey,  54% of adults stated they had a religion, 39% said they did not, and 7% weren't sure.  Of those who had a religion and gave details, 97% were Christian and the remaining 3% were Buddhist, Hindu, Jewish, Muslim, or Sikh.   Christians broke down as 44% Anglican, 43% Catholic, and the remaining 13% another Christian denomination.[1]

Religion in Jersey

Despite its small size, the population of Jersey is made of people with a diverse range of religions and beliefs. Traditionally seen as a Christian island, Jersey's established church is the Church of England, and Anglicanism and Catholicism are practised on the island in roughly equal numbers. Together, these religions account for around half the population of Jersey. Other denominations of Christianity and other religions such as Islam, Judaism, Sikhism, and Buddhism account for handfuls of people on the island. In recent years, irreligion has been an increasing force in Jersey, with two fifths of the population identifying as having no religion. This number rises to 52% for Jersey people under 35.[1]

In the Neolithic period religious activity in the settled communities is marked by the building of ritual burial sites known as dolmens, from which food and personal items such as jewelry, spindle whorls, pottery, tools and animal bones have been excavated at La Hougue Bie (a ritual site used around 3500 BC).[2]  These finds indicate that Neolithic settlers possibly believed in an afterlife much like many modern religions, the burial of the dead with their belongings showing similarities to the burial process in the Egyptian religion.  However recent excavations at La Hougue Bie by archaeologist Mark Patton, together with consideration of solar alignments, suggest that the Jersey Dolmens functioned more as centres of worship like cathedrals or churches, where burials are incidental to the main function.

There is some evidence from parish names of Celtic missions to the islands, notably Saint Brelade in Jersey and Saint Samson in Guernsey. Apart from place names and one note in the Life of Samson no documentary evidence is available.

Sometime between 535 and 545, Helier, who was to become Jersey's patron saint, went to the island bringing the gospel.[3]
The island of Jersey remained part of the Duchy of Normandy until 1204 when King Philip II Augustus of France conquered the duchy from King John of England. The islands remained in the personal possession of the king and were described as being a Peculiar of the Crown. However, the island continued to be part of the Norman diocese of Coutances and was reluctant to come under the wing of the English church because it had many cultural ties with Normandy.

The island embraced the French Calvinist form of Protestantism during the Reformation and orders were received to remove all signs of the Papal Church in 1547.[4] In 1550 and 1551 church property was sold for the benefit of the crown. The island remained under the diocese of Coutances until 1569.

There were several waves of Catholic immigration, notably in the 1790s during the French Revolution, in the 1830s and 1840s with the influx of Irish labourers and towards the end of the 19th century with the settlement of Catholic religious institutes.

Islanders embraced Calvinism during the Reformation, especially under the influence of French language pamphlets and books from Geneva, France and the Low Countries.

The reign of Queen Mary I and King Philip was especially significant. Important Protestant religious leaders in Jersey and Guernsey fled to Geneva, and when they returned after Mary's death, they had taken on much of the severe form of Calvinism formulated there by Calvin, and set up Consistory Courts. Another factor was a reaction against the burning of heretics in the islands. In neighbouring Guernsey, Foxe records the remarkable death of the Protestant Perotine Massey, one of the Guernsey Martyrs, who gave birth while being burnt at the stake. Her newborn child was returned to the flames by the Catholic Bailiff.

There also was a sudden influx from France of Huguenots — the name given to French Calvinists — as Louis XIV revoked the Edict of Nantes in 1685, effectively depriving them of the freedom to practice their religion by brutal methods : (in accordance of catholic hierarchy):prosecutions : prisons, galley slaves, no property rights, "dragonnades"etc, etc
[5]

The style of worship was resolutely Calvinist. Queen Elizabeth I left Jersey and Guernsey more or less in charge of their own affairs, because of political expedience: Protestant islanders would be in opposition to Catholic France.

Although Jersey was transferred to the Diocese of Winchester in 1569, it was not until the Governorship of Sir John Peyton in 1603, under James I, that the forms of the Anglican church were restored to Jersey.  In 1620 David Bandinel was appointed the first Dean of Jersey since the Reformation.  Anglicanism then became and remained the official religion of the island. In 2014 the Diocese changed, after 500 years, to the Diocese of Canterbury.[6]

In 1774 Pierre Le Sueur and Jean Tentin returned to Jersey from Newfoundland and started to preach Methodism to which they had been converted while engaged in the Newfoundland fisheries.[7] Some Huguenots were drawn to the ideas of Methodism similar to those of Calvinism.

Conflict with the authorities ensued when men refused to attend Militia drill when that coincided with chapel meetings. The Royal Court attempted to proscribe Methodist meetings, but King George III refused to countenance such interference with liberty of religion. The first Methodist minister in Jersey was appointed in 1783, and John Wesley preached in Jersey in August 1787, his words being interpreted into the vernacular for the benefit of those from the country parishes. The first building constructed specifically for Methodist worship was erected in Saint Ouen in 1809.

Jews first established a synagogue in Saint Helier in 1843.

There were only a small number of foreign and British Jews in Jersey before the start of the Occupation of the Channel Islands in the Second World War. Most of the Jewish population of Jersey evacuated to safety in June 1940 to the United Kingdom, but the United Kingdom did not permit foreign Nationals, including Jews, to leave for the United Kingdom, leaving them trapped in Jersey. 12 Jews were registered under the laws imposed by the Germans and administered by the Jersey authorities[8] (a higher number concealed their Jewish identity or were helped to conceal their identity by resisters in the bureaucracy).[9] However, the anti-Jewish repressions were not carried out systematically. Jews of British citizenship were less likely to be persecuted than foreigners. A number of well-known Jews lived through the Occupation in comparative openness, including Marianne Blampied, the wife of Edmund Blampied, the artist.[9]  The Bailiff of Jersey refused to ratify the registration of the eighth order requiring the wearing of a yellow star as a "measure too far".[9] No Jersey Jew was required to wear a yellow star in the Island.[9] In 1943 Jews were among those deported to internment camps in Germany, along with UK-born residents, former British military personnel and "undesirables".[9]

After the war, there was a revival of Jewish life in Jersey and a new congregation was founded in Saint BrÃ©lade in 1962. As of 2004, Jewish population was estimated at about 120.[10]

In addition to the Church of England, the island is host to the following faith groups:

Those who are not religious and wish to exchange ideas on Humanist and Secular matters have an active local group which holds discussions in their Yahoo group as well as meeting for lunches in local restaurants.[12][13][14]


who sings burgers & fries & cherry pies

"Burgers and Fries" is a song written by Ben Peters and recorded by American country music artist Charley Pride.  It was released in October 1978 as the second single and title track from his album Burgers and Fries.  The song peaked at number 2 on the Billboard Hot Country Singles chart.[1] It also reached number 1 on the RPM Country Tracks chart in Canada.[2]

Burgers and Fries

The song is a young man's reflection of a relationship that had failed. He recalls how simple things used to be between the two, recalling the simplicity of such things as "burgers and fries and cherry pies," hand-holding walks along the beach and drive-in movies on moonlit nights, all before things changed between the two and he doesn't know why. He then notes he wishes things could go back to the way they were before. The song was later featured in the 1997 thriller film Breakdown, starring Kurt Russell.


who sang this time we're really breaking up

Gary Wayne Schelton[1] (May 14, 1939 â€“ January 7, 2016), known by his stage name Troy Shondell, was an American vocalist, who achieved a modicum of fame and recognition in the early 1960s. He became a transatlantic one-hit wonder, by releasing a single that made the record charts in both the US and the UK.[2][3] The song, "This Time" (or sometimes billed as "This Time (We're Really Breaking Up)" ) sold over one million records, earning gold disc status.[4] In a single year, sales were over three million copies.[1]

Troy Shondell

Shondell was born in 1939, raised in Fort Wayne, Indiana,[5] and educated at Valparaiso and Indiana universities. He wrote his first song at age 14, which was recorded by Little Anthony & the Imperials. Shondell also learned to play five musical instruments.[4] His professional music career started as a teenager. Mercury Records released his first single, "My Hero", from The Chocolate Soldier, which he recorded in 1958 under the name Gary Shelton, which was close to his real name, Gary Schelton.[1]

He followed the next year with "Kissin' at the Drive-In", a rockabilly song that went on to become a drive-in theater standard. Still performing as Gary Shelton, he seemed to be on his way, at least in the Midwest. Chicago's Brass Rail, a major nightclub that usually hosted jazz and blues acts, brought him in for its first foray into rock and roll. The successful gig stretched to 16 weeks.[1] In 1959, Mark Records released "The Trance" and "Goodbye Little Darlin'". These sold well in the Midwest and a few other areas, but neither made it into the Hot 100's Top 40. The singer cited his father as a major influence, among others. A song he wrote about his father's death in 1960 from a heart attack, "Still Loving You", became a country hit when it was recorded by Bob Luman. His father's demise caused his career to falter, and he briefly returned to help run the family business.[1]

Around this time, he began using a new stage name, Troy Shondell, partly because of the popularity of actor Troy Donahue. In April 1961, he recorded "This Time", a song written by Chips Moman and first recorded by Thomas Wayne.[6] The record was released during the last week in June on the tiny Gaye label and picked up by the small Los Angeles Goldcrest label, selling ten thousand copies during the first week. Six weeks after being released and played in Chicago, Shondell flew to Los Angeles and signed with Liberty Records. "This Time" finally hit the Billboard charts the third week of September and landed in the Top 10 five weeks later at its number six peak, and it stayed in the charts for a total of thirteen weeks.[1][2] The track reached no. 22 in the UK Singles Chart at the end of that year.[3] The song was covered by Shakin' Stevens on the 1981 Epic album Shaky (album).

"Tears From An Angel" was his follow-up recording, released in March 1962. No further chart action was forthcoming, and Shondell quietly slipped away from the music industry the following year, despite his third single "Na-Ne-No", being produced by Phil Spector. However, in 1963, Tommy Jackson changed the name of his high school band from "Tom and the Tornados" to "The Shondells" in honor of Shondell (one of his musical idols).[1] Jackson became "Tommy James" and international fame followed for the act. Chicago band the Ides of March originally named themselves the Shon-dells, also in tribute to Troy. Shortly before their debut single, "You Wouldn't Listen", was released, the label found out that James had been using the name first, so they were forced to change it. In 1968, Shondell became a songwriter for Acuff-Rose Music in Nashville, Tennessee, and the first recording artist for TRX Records, a branch of Hickory Records, for whom Shondell recorded some gramophone record discs until 1969, when he went into the music publishing field. In October 1969, Shondell was appointed as Assistant Regional Director for ASCAP's Southern Regional Office in Nashville.[4]

In 2001, Shondell still performed at shows and other events. Along with Jimmy Clanton, Ronnie Dove, and Ray Peterson, Shondell was a member of the Masters of Rock 'n' Roll.[1] On October 2, 2007, Shondell traveled to Collins, Mississippi, to deliver a musical tribute to his fallen rock and roll colleague Dale Houston, who, with musical partner Grace Broussard, had reached no. 1 in 1963 with "I'm Leaving It Up to You" as the musical duo Dale & Grace. Shondell died from complications of Alzheimer's and Parkinson's disease on January 7, 2016.[7]


who has been elected as the new president of republic of armenia

Presidential elections were held in Armenia on 2 March 2018.[1] As a result of the 2015 Armenian constitutional referendum, this was the first time in Armenia's history when the president was elected by the National Assembly instead of popular vote.[2] Another outcome of the referendum was that the newly elected president will perform a ceremonial role as the country is currently transitioning from a semi-presidential system to a parliamentary republic.[3] Incumbent president Serzh Sargsyan was barred by the Constitution of Armenia from running for a third consecutive term.[4] Armen Sarkissian ran unopposed due to no other party nominating a candidate and easily won the election in the first round with 90 electoral votes.[1]

Armenian presidential election, 2018

Serzh Sargsyan
Republican Party

Armen Sarkissian
Independent

In accordance with Article 124 of the amended Constitution, a non-partisan president will be elected for a seven-year, non-renewable term.[5] In accordance with Article 125, the candidate that receives at least three fourths of votes of the total number of Deputies of the National Assembly will be elected President of the Republic of Armenia.[6] If the President is not elected, a second round is held wherein all candidates who took part in the first round may participate. In the second round, the candidate that receives at least three fifths of votes of the total number of Deputies will be elected as President of the Republic. If President is still not elected, a third round of elections will be held wherein the two candidates who received a greater number of votes in the second round may participate. In the third round, the candidate who receives the majority of votes of the total number of Deputies will be elected.

According to Article 125 of the constitution, at least one fourth of the total number of Deputies of the National Assembly shall have the right to nominate a candidate for President[7]. This means that at least 27 members of parliament must back the respective candidate in order for that candidate to be officially nominated. Thus, in the case of a wide consensus, a candidate may very well run unopposed since minority parties with less than 27 members in the National Assembly will not be able to nominate a candidate.

According to the amended Constitution, everyone who has reached the age of forty, held citizenship of only Armenia for the preceding six years and permanently resided in Armenia for the preceding six years, has the right of suffrage, and speaks the Armenian language may be elected as President of the Republic.[8]

President Serzh Sargsyan on 18 January recommended the candidacy of Armen Sarkissian, the current Armenian ambassador to the United Kingdom, for president to be supported by the ruling Republican Party. Sargsyan stressed the necessity for the presidential candidate to have wide support in the National Assembly when elected. On 16 February, Armen Sarkissian officially accepted the Sargsyanâ€˜s offer to become the Republican Party's candidate for president.

The ruling coalition, which consists of the Republican Party of Armenia and the Armenian Revolutionary Federation, officially nominated Armen Sarkissian for president on 23 February[9]. On 24 February, the Prosperous Armenia party, which is in opposition, signalled that it would vote for the ruling coalition's candidate[10]. This means that the only party left that did not nominate a candidate was the Way Out Alliance. As a party or coalition must have the support of at least one fourth of the deputies in the National Assembly, the Way Out Alliance were not able to nominate a candidate as they only had nine deputies in the National Assembly. Sarkissian will take up office on April 9, 2018.[11]


who did the voice of the sorting hat

After his marriage to Angela Scoular in 1982 Phillips decided to move away from the kind of lecherous twits with suave chat-up lines which had characterised much of his previous work. Phillips has remained busy in both stage and television productions, along with character roles in films like Empire of the Sun (1987) directed by Steven Spielberg and Lara Croft: Tomb Raider (2001). Phillips also provided the voice for the Sorting Hat in the Harry Potter films appearing in Harry Potter and the Philosopher's Stone (2001) and Harry Potter and the Chamber of Secrets (2002) as well as reprising his role in the final film, Harry Potter and the Deathly Hallows Part 2 (2011). He has also appeared in British television sitcoms including Honey for Tea with Felicity Kendal and appeared in cameo roles in the popular series such as The Bill.

Leslie Phillips

Leslie Samuel Phillips, CBE (born 20 April 1924) is an English actor who came to prominence in films in the 1950s, acting as a suave charmer with an exaggerated upper class accent, in the style of Terry-Thomas. After a notable success in the Carry On films and the Doctor series, he moved away from comedy into character roles in the Harry Potter series and many TV sitcoms, as well as stage work.

Contrary to the impression given by his public persona, Phillips came from a background of poverty. He was born in Tottenham, then in Middlesex, England, the son of Cecelia Margaret (nÃ©e Newlove) and Frederick Samuel Phillips,[2] who worked at Glover and Main, manufacturers of cookers in Edmonton; the "filthy, sulphurous" air of the factory gave Frederick a weak heart and edema, leading to his death at the age of 44. In 1931, the family moved to Chingford, then in Essex, where Phillips attended Larkswood Primary School.[3]

It was his mother who decided that Phillips should be sent to the Italia Conti Academy to receive elocution lessons to lose his natural cockney accent. At that time a strong regional accent was a major impediment to an aspiring actor. It proved to be an astute move and by the age of 14 Phillips was the family's main breadwinner, saving his mother from penury.

Phillips made his first film appearances as a child in the 1930s. He is the only actor still alive who performed at Pinewood Studios in its first week of opening in 1936. He also understudied for Binkie Beaumont and H. M. Tennent in the West End. In 1938, 14-year-old Leslie Phillips appeared with Graeme Muir in the West End play Dear Octopus where Muir was the juvenile lead. During the Second World War shows were frequently interrupted by air-raid sirens and Phillips recalls in his autobiography that "audiences would evaporate and head for cellars or Underground stations". At 16, Phillips played an uncredited market street urchin in 1940's The Thief of Bagdad.

Called up to the Army in 1942 Phillips rose to the rank of Lance-Bombardier in the Royal Artillery. Due to his acquired upper class accent, Phillips was selected for officer training at Catterick and duly commissioned as a Second Lieutenant in the Royal Artillery in 1943. In his autobiography he would recall that his anti-aircraft battery destroyed numerous German V1 flying bombs launched against the UK during the period. He was transferred to the Durham Light Infantry in 1944 but was later declared unfit for service after being diagnosed with a neurological condition that caused partial paralysis. He was initially sent to a psychiatric hospital in error but was then sent to the correct facility for treatment.

Demobbed as a lieutenant in December 1944, Phillips' acting career initially took in "the murkiest rat-infested old playhouses and music halls in the North of England". It was during the 1950s that he became known for playing amusing English stereotypes, including the 1955 TV series Robin Hood starring Richard Greene. His first lead role in a television serial was in the 1952 sitcom My Wife Jacqueline.[4] His seductive voice is his trademark as well as his catchphrases, "I say, Ding Dong" (originally the catchphrase of Phillips' character Jack Bell in Carry On Nurse), "Hello" and "Lumme!", which were partly, if not wholly, based on those of fellow cad actor Terry-Thomas. The two appeared together in the pilot of "Nawks Ahoy!". A show very much of its time all recordings are now lost. He appeared in three of the early Carry On films (Carry On Nurse, Carry On Teacher and Carry On Constable). After Constable he told producer Peter Rogers that he did not wish to do any more Carry Ons, though he did return for Carry On Columbus in 1992. This made him, with June Whitfield, the longest-serving Carry On cast members. In the 1960s he took over from Dirk Bogarde in several of the 'Doctor' film comedies. Between 1959 and 1977 Phillips became familiar on radio with a leading role in The Navy Lark.

In 2006 he appeared in Hanif Kureishi's film Venus alongside Peter O'Toole and was nominated for a BAFTA for Best Supporting Actor in 2007 for his role as the veteran actor, Ian.[5] He was in this film with Vanessa Redgrave, and in the DVD 'extras' he mentions that he had previously worked with both of her daughters and her father Michael Redgrave (in 1938), likely making him the only still-living person to have done so.

Phillips' autobiography, Hello was published by Orion in 2006. ISBNÂ 0-7528-8178-7.

He was appointed Officer of the Order of the British Empire (OBE) in the 1998 Birthday Honours and was promoted to Commander of the Order of the British Empire (CBE) in the 2008 New Year Honours.

Phillips, in conjunction with Jules Williams and Back Door Productions[6] co-produces the Sky Arts series Living The Life[7] which is now in its third series.

Phillips married his first wife, actress Penelope Bartley, on 30 May 1948.[8] They had four children, Caroline, Claudia, Andrew and Roger.

In 1962, Phillips started a romantic relationship with actress Caroline Mortimer, daughter of writer Penelope Mortimer and stepdaughter of John Mortimer, who was an understudy in a stage play in which Phillips starred. Phillips and Bartley separated at that point and were divorced in 1965.[8]

After his relationship with Mortimer ended, Phillips embarked on a relationship with actress Vicki Luke, with whom he lived for approximately three years, after which he started a relationship with Angela Scoular, a former Bond girl.

While on tour in Australia in 1981 he was notified that Penelope Bartley had died in a fire. Phillips elected to continue in the production and not attend her funeral. He has acknowledged that his family has never forgiven him for not coming back to attend the funeral.[8]

In 1982, Phillips and Scoular were married and remained together until her death on 11 April 2011. Scoular was suffering from bowel cancer and bipolar disorder and took her own life. Phillips was too ill to attend the inquest into Scoular's death three months later.[9]

He is a long-term fan of Tottenham Hotspur, and made an appearance on the pitch as part of the half-time entertainment during the team's home match against Swansea City on 1 April 2012.


who sings lead vocals on winning by santana

"Winning" is a pop rock single originally written and recorded by Russ Ballard on his 1976 album of the same name. It was subsequently recorded by Latin rock band Santana for the 1981 album, Zebop!.  The lead vocal on the Santana version was performed by Alex Ligertwood.  It was the sixth track on the album and was released as the third single (backed with "Brightest Star") and as a promotional music video.
The Santana version reached number 2 on the Mainstream Rock Charts and number 17 on the Billboard Hot 100, making it Santana's ninth most successful song. "Winning" was also recorded by Rock/R&B singer Nona Hendryx (formerly of Labelle) for her 1977 debut solo album.

Winning (Russ Ballard song)