text:
Wikipedia talk:Naming conventions (technical restrictions)

Namespaces and Page Names Ending with a Colon
So I noticed I can create a page name ending with a colon (e.g. "Page:", "Article:", and "Discussion:"), unless the name (sans the colon) is a registered namespace prefix (e.g. "Help:", "Category:", and "Talk:"). So what happens if the admin registers the namespace "Discussion" when the page Discussion: exists? —Sledged (talk) 18:56, 9 January 2009 (UTC)
 * Whenever a developer makes new namespace or interwiki prefixes, nasty things happen to existing links and pages. There is a maintenance script that runs through the raw database tables and fixes things like that, moving pages and changing links, to make sure that there are no invalid links (that point somewhere other than where the software think they do).  Happy‑melon 21:31, 9 January 2009 (UTC)

Italicized titles
RfC Please see here. —Justin (koavf)❤T☮C☺M☯ 05:30, 24 October 2009 (UTC)

Comic books
The addition of italic title to Infobox comic book title has effectively made italics the standard for comic book titles. I have no particular opinion on this matter, I just thought it should be noted. — the Man in Question (in question)  23:45, 14 May 2010 (UTC) 🇹🇰💛🇨🇼MW💎👀👌🏾👉🏾🥀. — Preceding unsigned comment added by Diamond105 (talk • contribs) 05:49, 9 May 2021 (UTC)

Slash disclaimer still true?
Is this bullet still true from WP:NC-SLASH?

 * Subpages are still enabled in the talk namespace as they are widely used for archiving old discussion. Therefore if an article has a forward slash in its name, its corresponding talk page may display a redundant subpage level-up link at the top (for example Talk:R/2004 S 1 has a link to Talk:R at the top).

It seems no longer true as of MediaWiki 1.16. I created some test pages in a namespace that has no subpages, while its talk namespace does, and no bogus parent links showed up. Djbwiki (talk) 19:38, 7 February 2011 (UTC)

 * Look at Talk:R/2004 S 1 right now... --Joy [shallot] (talk) 19:41, 7 February 2011 (UTC)
 * (ec) I'm still seeing them at Talk:R/2004 S 1 and Talk:AC/DC, so I guess it must still be true. (Perhaps in your test example the higher-level pages didn't exist - if they're redlinks they won't be displayed.)--Kotniski (talk) 19:41, 7 February 2011 (UTC)

Forbidden character - #
I think it should be explained that # can't be used specifically because it's a location hash, NOT because of 'wikitext syntax.' Avindra talk / contribs 13:57, 21 February 2011 (UTC)
 * And it's used as a location hash in wikitext syntax, right? So why is it "NOT because of wikitext syntax"?--Kotniski (talk) 14:19, 21 February 2011 (UTC)
 * Location hashes are a general web standard. They're definitely not limited to wikitext. Also, afaik, they do not originate from wikitext. Avindra talk / contribs 15:26, 21 February 2011 (UTC)
 * Looks like they're definitely not from wikitext. It's defined in rfc. The official name seems to be fragment identifier, though I and others I know refer to it simply as the "location hash." Avindra talk / contribs 15:29, 21 February 2011 (UTC)
 * Yes, like with some of the other restricted characters, their special uses aren't exclusive to wikitext; but it's the specific fact that they're used that way in wikitext that prevents their being used in Wikipedia article titles. --Kotniski (talk) 15:48, 21 February 2011 (UTC)
 * I agree with Kotniski. # has a special meaning in url's but it would have been possible for MediaWiki to allow it in article titles and wikitext if MediaWiki automatically changed it to something else in URLs. It would be an unnecessary complication to get into this instead of simply saying that it cannot be used in page titles, as we do now. PrimeHunter (talk) 12:06, 9 October 2011 (UTC)

video or audio that has no permussio
Yes I dont understand how something ca/ be video or audio and reproduced or sold with permussion or even knowledge just because someine diesnt understand stupid computers dies that give simeone the right to take advantage — Preceding unsigned comment added by 208.54.39.168 (talk) 08:10, 1 November 2011 (UTC)

What's wrong with ¡Uno!
In, it shows an example: The article ¡Uno! does exist, and is a redirect to Uno!. Also, neither '¡' nor '!' are mentioned as forbidden characters. What is this example meant to show? —[ Alan M 1  (talk) ]— 05:55, 26 June 2012 (UTC)
 * ¡Uno! is located at Uno! (Green Day album)

 * http://en.wikipedia.org/w/index.php?title=%C2%A1Uno!&action=history shows it being moved a week ago because of WP:NCTR :) Ask ? --Joy [shallot] (talk) 07:31, 26 June 2012 (UTC)

singular vs. plural form for common noun
Isn't there a rule that for common noun the article title should use the singular form (e.g. tool), and not plural form (e.g. pliers)?--Michel192cm (talk) 12:39, 24 August 2012 (UTC)
 * See Naming conventions (plurals). --Zundark (talk) 13:02, 24 August 2012 (UTC)
 * Thank you for the info. --Michel192cm (talk) 09:43, 27 August 2012 (UTC)

Can't even search on forbidden characters?
One of the examples in the article is If I'm looking for information on C# and type that into the search field, what will come up is C. Fortunately, C# is a popular topic, so the C article has a note at the top that anticipates this problem and tells me where to find C#, but this solution isn't universally applicable.
 * C# (programming language) is located at C Sharp (programming language)

If I search for '''What the #$*! Do We Know!?''', I get the totally unrelated article What The--?!. The actual article I'm looking for in this case is What the Bleep Do We Know!?. There is no way to create a redirect to help users who know only the stylized version of the title. (That's not particularly unlikely; the "Bleep" version of the title was completely absent from publicity when the film was first released in theaters.) That's really annoying behavior. I think it's fair to call it a bug.

Am I wrong? Am I misunderstanding how users are supposed to look for something like '''What the #$*! Do We Know!?''', or is there just no way to find such subjects? — Preceding unsigned comment added by 68.98.2.5 (talk) 18:31, 18 August 2013 (UTC)

 * I agree. I was actually trying out #willpower, since that is a given example here. If I go first to Special:Search then the expected result comes up first (and with C# but nothing for What the #$*! Do We Know!?) but if using the search box that the general public would use then you get the front page! Don sure where (else) to report this to get attention of the right people. Thought of asking on the front pages' talk page but decided not to. comp.arch (talk) 15:06, 6 December 2013 (UTC)

Forbidden char list doesn't include underscore (_)
But according to http://en.wikipedia.org/wiki/Wikipedia:TITLESPECIALCHARACTERS, underscore is also forbidden. A typo?

2401:FA00:40:E:CE52:AFFF:FE3D:C43A (talk) 05:42, 3 January 2014 (UTC)

Armenian Eternity sign no longer a good example.
The Armenian eternity sign will be included in the next version of unicode and will then no longer be approporiate as an example of a non-unicode character. An alternative must be found.

Why not do it this way for the colons?
Why not move a problmatic page that contains the colon to the similar ratio symbol (∶. It would look better to the reader. - TheChampionMan1234 05:07, 30 September 2014 (UTC)

 * Among other problems, the Unicode ratio character '∶' instead of a colon ':' would confuse people who have seen the title and try to link or search it by typing a colon. PrimeHunter (talk) 13:36, 7 January 2015 (UTC)

Lowercase first letter
I think the whole section titled "Lowercase first letter" is outdated and can be removed. 80.152.221.47 (talk) 10:56, 7 January 2015 (UTC)
 * I don't understand why you think this. Would like to elaborate?--Mrjulesd (talk)  11:33, 7 January 2015 (UTC)
 * Because half those example links redirect to titles with the correct case and that don't demonstrate the limitation.

Lower case first letter - Extent of limitation?
The article says that this limitation exists because the MediaWiki software is configured that way. The MediaWiki software is used by entities outside of the Wikimedia Foundation (kb.mozillazine.org is an example) and they also suffer from the limitation, which essentially confirms that it is not restricted to Wikipedia. Yet, the Wiktionary does not suffer from it, despite not having tags in its pages. Are we to understand that the Wiktionary does not use the "MediaWiki software"? 66.130.179.8 (talk) 16:34, 23 January 2015 (UTC)

 * Naming conventions (technical restrictions) says: "The MediaWiki software is configured so that a page title (as stored in the database) cannot begin with a lower-case letter".
 * It's a guideline page for the English Wikipedia so it means MediaWiki is configured like that here at Wikipedia. It's the default configuration and probably used by the large majority of the thousands of wikis powered by MediaWiki, but Wiktionary has chosen another configuration. It's the setting at mw:Manual:$wgCapitalLinks. http://noc.wikimedia.org/conf/highlight.php?file=InitialiseSettings.php has many configuration settings for wikis run by the Wikimedia Foundation. This includes Wikipedia and Wiktionary. The file contains this:

'wgCapitalLinks' => array(	'default' => true,	'jbowiki' => false,	'wiktionary' => false, ),
 * is the Lojban Wikipedia. Lojban says: "Lojban is written almost entirely with lower-case letters; upper-case letters are used to mark stress in words that do not fit the normal rules of stress assignment, or when whitespace is omitted." PrimeHunter (talk) 17:08, 23 January 2015 (UTC)

Question about the lowercase first letter
I understand people have touched on the lowercase first letter before, and that this article explains it's due to a technical restriction caused by the configuration, but I'm curious — what is the actual reason behind the MediaWiki software being configured in such a way? That particular setting has been in place for as long as I can remember, but I've never bothered to inquire about it before. Can anyone with more technical familiarity of the backend explain? ☉ nbmatt 05:26, 3 March 2015 (UTC)

Omitting semicolons does not correct HTML entities
From the article:

 * Similarly a title cannot contain HTML character entities such as  and , even if the character they represent is allowed. In the unlikely event of such sequences appearing in a desired title, an alternative title must be constructed (for example by inserting a space after the %, or omitting a semicolon).

This doesn't work - some browsers (notably older MSIE) will still interpret the entities without a trailing semicolon. 184.147.176.73 (talk) 20:45, 24 June 2015 (UTC)

85 bytes equals?
Hello, the article says "[A Username] may not be more than 85 bytes long." I think I came across names longer than 85 characters, but then, how many characters does 85 bytes equal? Thanks, 79.241.199.66 (talk) 13:03, 17 February 2016 (UTC).
 * Dear IP address (it's too long, no way I'm writing that), I realize you've posted this eight months ago, but I will reply anyway. I believe that a byte is equivalent to the number of characters (letters, spaces, etc.,) Hope that helped! UNSC Luke 1021 (talk) 15:13, 7 November 2016 (UTC)
 * Does the codepoint 132F9 count as 2 characters or only a single letter? --Brynda1231 (talk) 15:35, 7 November 2016 (UTC)
 * ASCII characters (e.g. English letters, digits, space) are one byte. Many Unicode characters are more than one byte. The current limit is 85 bytes. The limit has varied in the past. PrimeHunter (talk) 15:42, 7 November 2016 (UTC)
 * Can you make it so 0000-ffff is 1 character. --Brynda1231 (talk) 20:18, 7 November 2016 (UTC)
 * The software limit on username lengths cannot be changed locally and it always counts in bytes. One byte is only two hexadecimal digits like 00-ff. Four hexadecimal digits use two bytes. There are other software features which count Unicode characters and not bytes, for example Str len. PrimeHunter (talk) 22:07, 7 November 2016 (UTC)
 * OK! --Brynda1231 [Talk Page] [Contribs] 14:57, 9 November 2016 (UTC) — Preceding unsigned comment added by Brynda1231 (talk • contribs)

Unassigned characters or non-characters or surrogates
Can your username contain non-characters or unassigned code points? — Preceding unsigned comment added by Brynda1231 (talk • contribs) 15:34, 7 November 2016 (UTC)

Non-characters?
Are non-characters forbidden as well? --Brynda1231 [Talk Page] [Contribs] 14:40, 11 November 2016 (UTC) — Preceding unsigned comment added by Brynda1231 (talk • contribs)

���?
� ����� �� ������ �� ������� ���� ��� ����� �, ��� � ������.

I tried to create an article with the title �, but I failed. --Gerrit CUTEDH 13:01, 14 November 2016 (UTC)

 * Right, https://en.wikipedia.org/w/index.php?title=�&action=edit gives MediaWiki:Title-invalid-utf8: "The requested page title contains an invalid UTF-8 sequence." It's Specials (Unicode block). It makes sense this "character" cannot be used in page names although a page only by that "name" might have redirected to the linked section. I don't think we should mention it in Naming conventions (technical restrictions). Please link your current username in your signature. PrimeHunter (talk) 15:36, 14 November 2016 (UTC)
 * I noticed that it links to MediaWiki:Title-invalid-utf8 and I don't know why. It's a perfectly valid UTF-8 encoding for the Unicode Replacement character.  I think it should be mentioned, and I did see it mentioned somewhere else but I can't find it now.  Thank you for suggesting me to update my signature; I have updated it. --Gerrit CUTEDH 17:19, 14 November 2016 (UTC)
 * Thanks for making your signature compliant with WP:SIGLINK. The replacement character is used to replace invalid UTF characters (I don't know whether MediaWiki does this itself), so it makes sense to me that MediaWiki says "The requested page title contains an invalid UTF-8 sequence." It doesn't know you deliberately entered the character directly. Apart from the single case of redirecting the character alone, I see no reason for editors to use it in page names. It seems too obscure to increase the complexity of Naming conventions (technical restrictions) which is a guideline for editors of the English Wikipedia and not a technical specification of MediaWiki. PrimeHunter (talk) 20:26, 14 November 2016 (UTC)

Create a template for odd talk pages
At top of Talk:S/MIME, there is a paragraph

This is the talk page for S/MIME, the Wikimedia software has some funny ideas about the slash, please ignore this technical oddity.

I like this notice; I think it is useful for users to understand that this is a known issue of MediaWIki, so that they will not come discussing this as a new bug. Maybe it is worthwhile to have a template called ? In addition, if this issue is solved in future, we will be able to track those pages. --Franklin Yu (talk) 19:30, 12 March 2018 (UTC)

Semi-protected edit request on 14 April 2018
Change to
 * [title of show] is located at title of show
 * [title of show] is located at Title of show 209.52.88.226 (talk) 19:02, 14 April 2018 (UTC)
 * Yes check.svg Done DRAGON BOOSTER   ★  19:29, 14 April 2018 (UTC)

Diacritics in an article title problematic?
I have written an article called Aṅgulimāla, with diacritics. I have found that these diacritics cause problems with certain templates, such as the text "A C-class article from Wikipedia, the free encyclopedia. Currently a good article nominee" at the top of the article. The part on "good article nominee" currently links to, which renders an error. Also, recently, the Legobot had a bug, which was corrected by the reviewer straight away.

Should there be a prohibition or work-around for article titles with diacritics?-- Farang Rak Tham   (Talk) 21:06, 13 July 2018 (UTC)

 * Article titles with diacritics are very common, and aren't normally a problem. It sounds like you've found a bug, and you might consider reporting it, but I don't think it merits a mention on Naming conventions (technical restrictions), since it's not a technical restriction - there's no problem linking to Talk:Aṅgulimāla/GA1.

 * I suspect the bug depends on a preference setting, since I'm unable to reproduce it: for me, the text at the top of the article just says "From Wikipedia, the free encyclopedia" (which is the same as for any other article). --Zundark (talk) 08:34, 14 July 2018 (UTC)

 * Okay, thanks, . I have reported the bug at the Legobot page.-- Farang Rak Tham   (Talk) 11:41, 14 July 2018 (UTC)
 * I haven't found the report you refer to but there are similar reports at User talk:Legobot/2017 and User talk:Legobot. The quote in your original post is made by enabling "Display an assessment of an article's quality in its page header" at Special:Preferences. The code is in MediaWiki:Gadget-metadata.js which is mainly maintained by Nihiltres. The link to Talk:Aṅgulimāla/GA1 is percent encoded twice. Once gives https://en.wikipedia.org/wiki/Talk:A%E1%B9%85gulim%C4%81la/GA1 which works.  is then percent encoded as   which breaks the link: https://en.wikipedia.org/wiki/Talk:A%25E1%25B9%2585gulim%25C4%2581la/GA1. We allow diacritics in page names and I'm not aware of any features in MediaWiki itself which fails on them but templates, user scripts and bots sometimes have problems. PrimeHunter (talk) 12:39, 14 July 2018 (UTC)
 * Thanks, ! -- Farang Rak Tham   (Talk) 12:45, 14 July 2018 (UTC)
 * I thought I'd fixed that bug already. Bah. I'll try tracing it later today. {{ Nihiltres  |talk |edits}} 15:03, 14 July 2018 (UTC)
 * As of this edit the issue with the metadata gadget should be fixed; you might need to clear your browser cache to see the change. {{ Nihiltres  |talk |edits}} 19:17, 14 July 2018 (UTC)
 * Works like a charm, !-- Farang Rak Tham   (Talk) 11:14, 15 July 2018 (UTC)

Semi-protected edit request on 26 November 2018
Please add and before vertical bar in the "Forbidden characters" section. 208.95.49.47 (talk) 15:45, 26 November 2018 (UTC)
 * Yes check.svg Done, thanks! ‑‑ El Hef  ( Meep? ) 15:51, 26 November 2018 (UTC)

Semi-protected edit request on 12 December 2018
2409:4053:2089:AC67:DDA8:709A:B444:F393 (talk) 09:11, 12 December 2018 (UTC)

 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. AntiCedros (talk) 11:34, 12 December 2018 (UTC)

Semi-protected edit request: Google_Maps_Plus, Talk, Contributions 06:52, 11 January 2019 (UTC)
I want to add the "Wolfram|Alpha is located at Wolfram Alpha" text into the forbidden characters section. This is because "Wolfram Alpha" is sometimes called "Wolfram|Alpha" (with a vbar). That name is technically restricted.
 * Red information icon with gradient background.svg Not done: please provide reliable sources that support the change you want to be made. DannyS712 (talk) 14:15, 11 January 2019 (UTC)

Asterisk at end of subject
Is an asterisk at the end of the subject, as with NM5* okay to use or should that be added to the technical restrictions in some way? Using it in search will not bring up the create an article option. AngusWOOF ( bark  •  sniff ) 20:17, 19 June 2019 (UTC)

 * Search treats * as a wildcard, which is why it doesn’t suggest creating articles containing this character. But there’s no problem using * (in any position) in article names, as far as I can see. --Zundark (talk) 07:00, 21 June 2019 (UTC)

Must # redirect to the top?
I look at cat and I see at the top of the page: "For technical reasons, "Cat #1" redirects here. For the album, see Cat 1 (album)." This is a lot of clutter for an album that doesn't look all that notable. How would it be if it redirected to a section at the bottom of the page instead? I'm sure you can do that with #'s and anchors. The Language Learner (talk) 15:28, 5 July 2019 (UTC)

Semi-protected edit request on 19 November 2019

 * 1) < > [ ] | { }

The vertical bar appears between brackets, but the character name list (immediately afterward) has it last. Please change the order of the characters to # < > [ ] { } |

208.95.51.53 (talk) 13:38, 19 November 2019 (UTC)

Also, could you revisit the Wolfram|Alpha request, a few sections higher on this page? Someone asked to have Wolfram Alpha added to the list of examples of how restricted-character titles are handled, but it was rejected because the requester didn't provide reliable sources. Since this isn't an article, it doesn't need reliable sources; it only shows how Wikipedia pages are titled. 208.95.51.53 (talk) 13:42, 19 November 2019 (UTC)

 * ❌. Does it really matter if the pipe is listed between the brackets and braces or last? You're right that the Wolfram|Alpha example doesn't need sources, but there are plenty of examples already. –Deacon Vorbis (carbon • videos) 16:19, 19 November 2019 (UTC)
 * Thank you for giving a much better reason not to do Wolfram|Alpha. Since you asked a question about the pipe, I reopened the request.  The reason for asking about the pipe is that the order of the characters should match the order in the description.  Take this:

Vienna Paris Berlin Moscow Madrid Rome

These cities are the capitals of Austria, France, Germany, Russia, Italy, and Spain.

 * Technically that's correct (we named six cities and six countries, and each city is a capital of one of the countries), but the lists ought to be in the same order. Same here.  The page says "For articles about these characters, see number sign, less-than sign, greater-than sign, bracket (covers several characters), and vertical bar."  It appears sixth in the list of characters, but it's at the end of the list of articles about these characters.  208.95.51.53 (talk) 16:46, 19 November 2019 (UTC)
 * ✅ Parallelism is good. Anomie⚔ 02:21, 20 November 2019 (UTC)

Characters which look similar to a wanted character
I suggest this addition to the end of Naming conventions (technical restrictions):
 * Do not use Unicode characters which look similar to a wanted character, for example Chinese colon characters instead of a normal colon. Such titles would be difficult to type in links and could confuse searches, screen readers and other features.

This is the established practice and all examples avoid such characters but it should be stated explicitly. PrimeHunter (talk) 00:01, 15 February 2020 (UTC)

Semi-protected edit request on 14 May 2020
"change Meeuverma8 to Meetuverma8" Meeuverma8 (talk) 23:22, 14 May 2020 (UTC)
 * Not done -, please specify what in the article you'd like changing Ed6767 (talk) 23:24, 14 May 2020 (UTC)
 * If you want another username then see Changing username. Since your account only has this edit, you can also just abandon it and create another. PrimeHunter (talk) 00:38, 15 May 2020 (UTC)

Hypothetical question
As I was adding to the Magic Hat Brewing Company article recently, I thought of adding a redirect article for their flagship beer, known simply as "#9". Of course, if you're reading this talk page, you probably know that isn't possible, as there's no # allowed in article titles (as I just learned). It's no big deal, as there's no way that the #9 beer is notable enough to justify its own article. But, it got me to thinking - what if there was something whose name started with # that deserved an article? I have to think that this has happened before. What does Wikipedia do in this case? JimKaatFan (talk) 21:44, 2 July 2020 (UTC)
 * We come up with another name. See Naming conventions (technical restrictions) for examples. There is an old redirect at Magic hat 9. #9 might be mentioned at 9 (disambiguation) if it was really notable. 3 (disambiguation) has several entries for things called #3. Some other numbers have similar entries. PrimeHunter (talk) 23:49, 2 July 2020 (UTC)
 * Yeah I added it at Number nine, since that's the name of the beer. I don't think adding it at 9 (disambiguation) is appropriate, since the beer isn't known as "9", it's actually known as "#9". I was just curious. Sounds like there's no place that I could put a useful redirect. Thanks for the info! JimKaatFan (talk) 00:13, 3 July 2020 (UTC)
 * See also Number 9 Dream, the John Lennon song which is officially titled "#9 Dream". --Metropolitan90 (talk) 21:49, 4 September 2020 (UTC)

Double space/colon

 * 1) Why is double space not allowed? (e.g. "Soviet Union" is treated the same as "Soviet  Union.")
 * 2) Why are colons not allowed to begin articles? It never really says why. Gioguch (talk) 19:51, 17 September 2020 (UTC)

Alphabetical order sections at Other problematic characters
I decided to change the sections in alphabetical order to make the sections easier to find. I looked at the section titles correctly to arrange them. Seventyfiveyears (talk) 14:54, 4 November 2020 (UTC)

Removing "for technical reasons" when there's a dab
The hatnote to Cat #1 at cat is quite annoying, is it really necessary? Please reply at Talk:Cat Troll Control (talk) 04:37, 16 April 2021 (UTC)

Lowercase first letter
It would appear that the "Lowercase first letter" section is obsolete, and should be removed. It mentions as examples eBay, e (mathematical constant), iOS, iPod, man page, and pH, but those article titles now start with a lowercase letter. — Mudwater (Talk) 02:04, 20 September 2021 (UTC)

 * It's not obsolete, but the use of (which is explained in the "Lowercase first letter" section) hides the problem to some extent. --Zundark (talk) 06:47, 20 September 2021 (UTC)

 * Okay, I see. Thanks.  — Mudwater (Talk) 11:20, 20 September 2021 (UTC)

First letter restriction is untrue
The first letter restriction is not true anymore, and even the given example does not have such a restriction. Plutonical (talk) 17:42, 3 November 2021 (UTC)
 * I just read the bottom of the talk page and nevermind. It's just a separate template that mitigates it. Plutonical (talk) 17:43, 3 November 2021 (UTC)

Request one
Please remove this sentence:

In other cases (such as names containing restricted characters) it is necessary to adopt and display a different title.

and add this:

In other cases (such as names containing restricted characters) it is necessary to adopt and display a different title. Furthermore, certain characters can be used in titles only under certain conditions.

Much of this page discusses characters like :/?% that can be used sometimes but not always. 49.198.51.54 (talk) 22:32, 18 March 2022 (UTC)
 * Red information icon with gradient background.svg Not done for now: please establish a consensus for this alteration before using the template. -  FlightTime  ( open channel ) 22:49, 18 March 2022 (UTC)
 * Why? The content's already on the page; how could it be contentious to summarise this content?  Would you revert such a change if someone else made it?  Before today, this page has had just seven discussions in the last two years; it's highly unlikely that someone will reply.

49.198.51.54 (talk) 23:00, 18 March 2022 (UTC)

Request two
In the subsection on semicolons, please replace "eg." with "e.g." because the current form isn't correct. See https://en.wiktionary.org/wiki/exempli_gratia (which uses only "e.g.") and https://en.wiktionary.org/wiki/eg. (which lists it only as an abbreviation of words in Nordic languages). 49.198.51.54 (talk) 22:32, 18 March 2022 (UTC)
 * According to List of Latin phrases (E), "some writing styles give such abbreviations without punctuation, as ie and eg.". Therefore, the current form is ok. --Ferien (talk) 09:17, 19 March 2022 (UTC)


text:
Pneumothorax

A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is formed by an area of damaged tissue, and the amount of air in the space between chest wall and lungs increases; this is called a tension pneumothorax. This can cause a steadily worsening oxygen shortage and low blood pressure. This leads to a type of shock called obstructive shock, which can be fatal unless reversed. Very rarely, both lungs may be affected by a pneumothorax. It is often called a "collapsed lung", although that term may also refer to atelectasis.

A primary spontaneous pneumothorax is one that occurs without an apparent cause and in the absence of significant lung disease. A secondary spontaneous pneumothorax occurs in the presence of existing lung disease. Smoking increases the risk of primary spontaneous pneumothorax, while the main underlying causes for secondary pneumothorax are COPD, asthma, and tuberculosis. A traumatic pneumothorax can develop from physical trauma to the chest (including a blast injury) or from a complication of a healthcare intervention.

Diagnosis of a pneumothorax by physical examination alone can be difficult (particularly in smaller pneumothoraces). A chest X-ray, computed tomography (CT) scan, or ultrasound is usually used to confirm its presence. Other conditions that can result in similar symptoms include a hemothorax (buildup of blood in the pleural space), pulmonary embolism, and heart attack. A large bulla may look similar on a chest X-ray.

A small spontaneous pneumothorax will typically resolve without treatment and requires only monitoring. This approach may be most appropriate in people who have no underlying lung disease. In a larger pneumothorax, or if there is shortness of breath, the air may be removed with a syringe or a chest tube connected to a one-way valve system. Occasionally, surgery may be required if tube drainage is unsuccessful, or as a preventive measure, if there have been repeated episodes. The surgical treatments usually involve pleurodesis (in which the layers of pleura are induced to stick together) or pleurectomy (the surgical removal of pleural membranes). About 17–23 cases of pneumothorax occur per 100,000 people per year. They are more common in men than women.

Signs and symptoms
A primary spontaneous pneumothorax (PSP) tends to occur in a young adult without underlying lung problems, and usually causes limited symptoms. Chest pain and sometimes mild breathlessness are the usual predominant presenting features. In newborns tachypnea, cyanosis and grunting are the most common presenting symptoms. People who are affected by a PSP are often unaware of the potential danger and may wait several days before seeking medical attention. PSPs more commonly occur during changes in atmospheric pressure, explaining to some extent why episodes of pneumothorax may happen in clusters. It is rare for a PSP to cause a tension pneumothorax.

Secondary spontaneous pneumothoraces (SSPs), by definition, occur in individuals with significant underlying lung disease. Symptoms in SSPs tend to be more severe than in PSPs, as the unaffected lungs are generally unable to replace the loss of function in the affected lungs. Hypoxemia (decreased blood-oxygen levels) is usually present and may be observed as cyanosis (blue discoloration of the lips and skin). Hypercapnia (accumulation of carbon dioxide in the blood) is sometimes encountered; this may cause confusion and – if very severe – may result in comas. The sudden onset of breathlessness in someone with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or other serious lung diseases should therefore prompt investigations to identify the possibility of a pneumothorax.

Traumatic pneumothorax most commonly occurs when the chest wall is pierced, such as when a stab wound or gunshot wound allows air to enter the pleural space, or because some other mechanical injury to the lung compromises the integrity of the involved structures. Traumatic pneumothoraces have been found to occur in up to half of all cases of chest trauma, with only rib fractures being more common in this group. The pneumothorax can be occult (not readily apparent) in half of these cases, but may enlarge – particularly if mechanical ventilation is required. They are also encountered in people already receiving mechanical ventilation for some other reason.

Upon physical examination, breath sounds (heard with a stethoscope) may be diminished on the affected side, partly because air in the pleural space dampens the transmission of sound. Measures of the conduction of vocal vibrations to the surface of the chest may be altered. Percussion of the chest may be perceived as hyperresonant (like a booming drum), and vocal resonance and tactile fremitus can both be noticeably decreased. Importantly, the volume of the pneumothorax may not be well correlated with the intensity of the symptoms experienced by the victim, and physical signs may not be apparent if the pneumothorax is relatively small.

Tension pneumothorax
Tension pneumothorax is generally considered to be present when a pneumothorax (primary spontaneous, secondary spontaneous, or traumatic) leads to significant impairment of respiration and/or blood circulation. This causes a type of circulatory shock, called obstructive shock. Tension pneumothorax tends to occur in clinical situations such as ventilation, resuscitation, trauma, or in people with lung disease. It is a medical emergency and may require immediate treatment without further investigations (see Treatment section).

The most common findings in people with tension pneumothorax are chest pain and respiratory distress, often with an increased heart rate (tachycardia) and rapid breathing (tachypnea) in the initial stages. Other findings may include quieter breath sounds on one side of the chest, low oxygen levels and blood pressure, and displacement of the trachea away from the affected side. Rarely, there may be cyanosis (bluish discoloration of the skin due to low oxygen levels), altered level of consciousness, a hyperresonant percussion note on examination of the affected side with reduced expansion and decreased movement, pain in the epigastrium (upper abdomen), displacement of the apex beat (heart impulse), and resonant sound when tapping the sternum.

Tension pneumothorax may also occur in someone who is receiving mechanical ventilation, in which case it may be difficult to spot as the person is typically receiving sedation; it is often noted because of a sudden deterioration in condition. Recent studies have shown that the development of tension features may not always be as rapid as previously thought. Deviation of the trachea to one side and the presence of raised jugular venous pressure (distended neck veins) are not reliable as clinical signs.

Primary spontaneous
Spontaneous pneumothoraces are divided into two types: primary, which occurs in the absence of known lung disease, and secondary, which occurs in someone with underlying lung disease. The cause of primary spontaneous pneumothorax is unknown, but established risk factors include being of the male sex, smoking, and a family history of pneumothorax. Smoking either cannabis or tobacco increases the risk. The various suspected underlying mechanisms are discussed below.

Secondary spontaneous
Secondary spontaneous pneumothorax occurs in the setting of a variety of lung diseases. The most common is chronic obstructive pulmonary disease (COPD), which accounts for approximately 70% of cases. The following known lung diseases may significantly increase the risk for pneumothorax.

In children, additional causes include measles, echinococcosis, inhalation of a foreign body, and certain congenital malformations (congenital pulmonary airway malformation and congenital lobar emphysema).

11.5% of people with a spontaneous pneumothorax have a family member who has previously experienced a pneumothorax. Several hereditary conditions – Marfan syndrome, homocystinuria, Ehlers–Danlos syndromes, alpha 1-antitrypsin deficiency (which leads to emphysema), and Birt–Hogg–Dubé syndrome – have all been linked to familial pneumothorax. Generally, these conditions cause other signs and symptoms as well, and pneumothorax is not usually the primary finding. Birt–Hogg–Dubé syndrome is caused by mutations in the FLCN gene (located at chromosome 17p11.2), which encodes a protein named folliculin. FLCN mutations and lung lesions have also been identified in familial cases of pneumothorax where other features of Birt–Hogg–Dubé syndrome are absent. In addition to the genetic associations, the HLA haplotype A2B40 is also a genetic predisposition to PSP.

Traumatic
A traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. The most common mechanism is the penetration of sharp bony points at a new rib fracture, which damages lung tissue. Traumatic pneumothorax may also be observed in those exposed to blasts, even when there is no apparent injury to the chest.

Traumatic pneumothoraces may be classified as "open" or "closed". In an open pneumothorax, there is a passage from the external environment into the pleural space through the chest wall. When air is drawn into the pleural space through this passageway, it is known as a "sucking chest wound". A closed pneumothorax is when the chest wall remains intact.

Pneumothorax was reported as an adverse event caused by misplaced nasogastric feeding tubes. Avanos Medical's feeding tube placement system, the CORTRAK* 2 EAS, was recalled in May 2022 by the FDA due to adverse events reported, including pneumothorax, leading to 60 injuries and 23 patient deaths as communicated by the FDA.

Medical procedures, such as inserting a central venous catheter into one of the chest veins or taking biopsy samples from lung tissue, may also lead to pneumothorax. The administration of positive pressure ventilation, either mechanical ventilation or non-invasive ventilation, can result in barotrauma (pressure-related injury) leading to a pneumothorax.

Divers who breathe from an underwater apparatus are supplied with breathing gas at ambient pressure, which results in their lungs containing gas at higher than atmospheric pressure. Divers breathing compressed air (such as when scuba diving) may develop a pneumothorax as a result of barotrauma from ascending just 1 m while breath-holding with their lungs fully inflated. An additional problem in these cases is that those with other features of decompression sickness are typically treated in a diving chamber with hyperbaric therapy; this can lead to a small pneumothorax rapidly enlarging and causing features of tension.

Newborn infants
Pneumothorax is more common in neonates than in any other age group. The incidence of symptomatic neonatal is estimated to be around 1-3 per 1000 live births. Prematurity, low birth weight and asphyxia are the major risk factors, and a majority of newborn infant cases occur during the first 72 hours of life.

Mechanism

The thoracic cavity is the space inside the chest that contains the lungs, heart, and numerous major blood vessels. On each side of the cavity, a pleural membrane covers the surface of lung (visceral pleura) and also lines the inside of the chest wall (parietal pleura). Normally, the two layers are separated by a small amount of lubricating serous fluid. The lungs are fully inflated within the cavity because the pressure inside the airways (intrapulmonary pressure) is higher than the pressure inside the pleural space (intrapleural pressure). Despite the low pressure in the pleural space, air does not enter it because there are no natural connections to air-containing passages, and the pressure of gases in the bloodstream is too low for them to be forced into the pleural space. Therefore, a pneumothorax can only develop if air is allowed to enter, through damage to the chest wall or to the lung itself, or occasionally because microorganisms in the pleural space produce gas. Once air enters the pleural cavity, the intrapleural pressure increases, resulting in the difference between the intrapulmonary pressure and the intrapleural pressure (defined as the transpulmonary pressure) to equal zero, which cause the lungs to deflate in contrast to a normal transpulmonary pressure of ~4 mm Hg.

Chest-wall defects are usually evident in cases of injury to the chest wall, such as stab or bullet wounds ("open pneumothorax"). In secondary spontaneous pneumothoraces, vulnerabilities in the lung tissue are caused by a variety of disease processes, particularly by rupturing of bullae (large air-containing lesions) in cases of severe emphysema. Areas of necrosis (tissue death) may precipitate episodes of pneumothorax, although the exact mechanism is unclear. Primary spontaneous pneumothorax (PSP) has for many years been thought to be caused by "blebs" (small air-filled lesions just under the pleural surface), which were presumed to be more common in those classically at risk of pneumothorax (tall males) due to mechanical factors. In PSP, blebs can be found in 77% of cases, compared to 6% in the general population without a history of PSP. As these healthy subjects do not all develop a pneumothorax later, the hypothesis may not be sufficient to explain all episodes; furthermore, pneumothorax may recur even after surgical treatment of blebs. It has therefore been suggested that PSP may also be caused by areas of disruption (porosity) in the pleural layer, which are prone to rupture. Smoking may additionally lead to inflammation and obstruction of small airways, which account for the markedly increased risk of PSPs in smokers. Once air has stopped entering the pleural cavity, it is gradually reabsorbed.

Tension pneumothorax occurs when the opening that allows air to enter the pleural space functions as a one-way valve, allowing more air to enter with every breath but none to escape. The body compensates by increasing the respiratory rate and tidal volume (size of each breath), worsening the problem. Unless corrected, hypoxia (decreased oxygen levels) and respiratory arrest eventually follow.

Diagnosis
The symptoms of pneumothorax can be vague and inconclusive, especially in those with a small PSP; confirmation with medical imaging is usually required. In contrast, tension pneumothorax is a medical emergency and may be treated before imaging – especially if there is severe hypoxia, very low blood pressure, or an impaired level of consciousness. In tension pneumothorax, X-rays are sometimes required if there is doubt about the anatomical location of the pneumothorax.

Chest X-ray
A plain chest radiograph, ideally with the X-ray beams being projected from the back (posteroanterior, or "PA"), and during maximal inspiration (holding one's breath), is the most appropriate first investigation. It is not believed that routinely taking images during expiration would confer any benefit. Still, they may be useful in the detection of a pneumothorax when clinical suspicion is high but yet an inspiratory radiograph appears normal. Also, if the PA X-ray does not show a pneumothorax but there is a strong suspicion of one, lateral X-rays (with beams projecting from the side) may be performed, but this is not routine practice.

It is not unusual for the mediastinum (the structure between the lungs that contains the heart, great blood vessels, and large airways) to be shifted away from the affected lung due to the pressure differences. This is not equivalent to a tension pneumothorax, which is determined mainly by the constellation of symptoms, hypoxia, and shock.

The size of the pneumothorax (i.e. the volume of air in the pleural space) can be determined with a reasonable degree of accuracy by measuring the distance between the chest wall and the lung. This is relevant to treatment, as smaller pneumothoraces may be managed differently. An air rim of 2 cm means that the pneumothorax occupies about 50% of the hemithorax. British professional guidelines have traditionally stated that the measurement should be performed at the level of the hilum (where blood vessels and airways enter the lung) with 2 cm as the cutoff, while American guidelines state that the measurement should be done at the apex (top) of the lung with 3 cm differentiating between a "small" and a "large" pneumothorax. The latter method may overestimate the size of a pneumothorax if it is located mainly at the apex, which is a common occurrence. The various methods correlate poorly but are the best easily available ways of estimating pneumothorax size. CT scanning (see below) can provide a more accurate determination of the size of the pneumothorax, but its routine use in this setting is not recommended.

Not all pneumothoraces are uniform; some only form a pocket of air in a particular place in the chest. Small amounts of fluid may be noted on the chest X-ray (hydropneumothorax); this may be blood (hemopneumothorax). In some cases, the only significant abnormality may be the "deep sulcus sign", in which the normally small space between the chest wall and the diaphragm appears enlarged due to the abnormal presence of fluid.

Computed tomography
A CT scan is not necessary for the diagnosis of pneumothorax, but it can be useful in particular situations. In some lung diseases, especially emphysema, it is possible for abnormal lung areas such as bullae (large air-filled sacs) to have the same appearance as a pneumothorax on chest X-ray, and it may not be safe to apply any treatment before the distinction is made and before the exact location and size of the pneumothorax is determined. In trauma, where it may not be possible to perform an upright film, chest radiography may miss up to a third of pneumothoraces, while CT remains very sensitive.

A further use of CT is in the identification of underlying lung lesions. In presumed primary pneumothorax, it may help to identify blebs or cystic lesions (in anticipation of treatment, see below), and in secondary pneumothorax, it can help to identify most of the causes listed above.

Ultrasound
Ultrasound is commonly used in the evaluation of people who have sustained physical trauma, for example with the FAST protocol. Ultrasound may be more sensitive than chest X-rays in the identification of pneumothorax after blunt trauma to the chest. Ultrasound may also provide a rapid diagnosis in other emergency situations, and allow the quantification of the size of the pneumothorax. Several particular features on ultrasonography of the chest can be used to confirm or exclude the diagnosis.

Treatment
The treatment of pneumothorax depends on a number of factors and may vary from discharge with early follow-up to immediate needle decompression or insertion of a chest tube. Treatment is determined by the severity of symptoms and indicators of acute illness, the presence of underlying lung disease, the estimated size of the pneumothorax on X-ray, and – in some instances – on the personal preference of the person involved.

In traumatic pneumothorax, chest tubes are usually inserted. If mechanical ventilation is required, the risk of tension pneumothorax is greatly increased and the insertion of a chest tube is mandatory. Any open chest wound should be covered with an airtight seal, as it carries a high risk of leading to tension pneumothorax. Ideally, a dressing called the "Asherman seal" should be utilized, as it appears to be more effective than a standard "three-sided" dressing. The Asherman seal is a specially designed device that adheres to the chest wall and, through a valve-like mechanism, allows air to escape but not to enter the chest.

Tension pneumothorax is usually treated with urgent needle decompression. This may be required before transport to the hospital, and can be performed by an emergency medical technician or other trained professional. The needle or cannula is left in place until a chest tube can be inserted. Critical care teams are able to incise the chest to create a larger conduit as performed when placing a chest drain, but without inserting the chest tube. This is called a simple thoracostomy. If tension pneumothorax leads to cardiac arrest, needle decompression or simple thoracostomy is performed as part of resuscitation as it may restore cardiac output.

Conservative
Small spontaneous pneumothoraces do not always require treatment, as they are unlikely to proceed to respiratory failure or tension pneumothorax, and generally resolve spontaneously. This approach is most appropriate if the estimated size of the pneumothorax is small (defined as <50% of the volume of the hemithorax), there is no breathlessness, and there is no underlying lung disease. It may be appropriate to treat a larger PSP conservatively if the symptoms are limited. Admission to hospital is often not required, as long as clear instructions are given to return to hospital if there are worsening symptoms. Further investigations may be performed as an outpatient, at which time X-rays are repeated to confirm improvement, and advice given with regard to preventing recurrence (see below). Estimated rates of resorption are between 1.25% and 2.2% the volume of the cavity per day. This would mean that even a complete pneumothorax would spontaneously resolve over a period of about 6 weeks. There is, however, no high quality evidence comparing conservative to non conservative management.

Secondary pneumothoraces are only treated conservatively if the size is very small (1 cm or less air rim) and there are limited symptoms. Admission to the hospital is usually recommended. Oxygen given at a high flow rate may accelerate resorption as much as fourfold.

Aspiration
In a large PSP (>50%), or in a PSP associated with breathlessness, some guidelines recommend that reducing the size by aspiration is equally effective as the insertion of a chest tube. This involves the administration of local anesthetic and inserting a needle connected to a three-way tap; up to 2.5 liters of air (in adults) are removed. If there has been significant reduction in the size of the pneumothorax on subsequent X-ray, the remainder of the treatment can be conservative. This approach has been shown to be effective in over 50% of cases. Compared to tube drainage, first-line aspiration in PSP reduces the number of people requiring hospital admission, without increasing the risk of complications.

Aspiration may also be considered in secondary pneumothorax of moderate size (air rim 1–2 cm) without breathlessness, with the difference that ongoing observation in hospital is required even after a successful procedure. American professional guidelines state that all large pneumothoraces – even those due to PSP – should be treated with a chest tube. Moderately sized iatrogenic traumatic pneumothoraces (due to medical procedures) may initially be treated with aspiration.

Chest tube
A chest tube (or intercostal drain) is the most definitive initial treatment of a pneumothorax. These are typically inserted in an area under the axilla (armpit) called the "safe triangle", where damage to internal organs can be avoided; this is delineated by a horizontal line at the level of the nipple and two muscles of the chest wall (latissimus dorsi and pectoralis major). Local anesthetic is applied. Two types of tubes may be used. In spontaneous pneumothorax, small-bore (smaller than 14 F, 4.7 mm diameter) tubes may be inserted by the Seldinger technique, and larger tubes do not have an advantage. In traumatic pneumothorax, larger tubes (28 F, 9.3 mm) are used. When chest tubes are placed due to either blunt or penetrating trauma, antibiotics decrease the risks of infectious complications.

Chest tubes are required in PSPs that have not responded to needle aspiration, in large SSPs (>50%), and in cases of tension pneumothorax. They are connected to a one-way valve system that allows air to escape, but not to re-enter, the chest. This may include a bottle with water that functions like a water seal, or a Heimlich valve. They are not normally connected to a negative pressure circuit, as this would result in rapid re-expansion of the lung and a risk of pulmonary edema ("re-expansion pulmonary edema"). The tube is left in place until no air is seen to escape from it for a period of time, and X-rays confirm re-expansion of the lung.

If after 2–4 days there is still evidence of an air leak, various options are available. Negative pressure suction (at low pressures of –10 to –20 cmH2O) at a high flow rate may be attempted, particularly in PSP; it is thought that this may accelerate the healing of the leak. Failing this, surgery may be required, especially in SSP.

Chest tubes are used first-line when pneumothorax occurs in people with AIDS, usually due to underlying pneumocystis pneumonia (PCP), as this condition is associated with prolonged air leakage. Bilateral pneumothorax (pneumothorax on both sides) is relatively common in people with pneumocystis pneumonia, and surgery is often required.

It is possible for a person with a chest tube to be managed in an ambulatory care setting by using a Heimlich valve, although research to demonstrate the equivalence to hospitalization has been of limited quality.

Pleurodesis and surgery
Pleurodesis is a procedure that permanently eliminates the pleural space and attaches the lung to the chest wall. No long-term study (20 years or more) has been performed on its consequences. Good results in the short term are achieved with a thoracotomy (surgical opening of the chest) with identification of any source of air leakage and stapling of blebs followed by pleurectomy (stripping of the pleural lining) of the outer pleural layer and pleural abrasion (scraping of the pleura) of the inner layer. During the healing process, the lung adheres to the chest wall, effectively obliterating the pleural space. Recurrence rates are approximately 1%. Post-thoracotomy pain is relatively common.

A less invasive approach is thoracoscopy, usually in the form of a procedure called video-assisted thoracoscopic surgery (VATS). The results from VATS-based pleural abrasion are slightly worse than those achieved using thoracotomy in the short term, but produce smaller scars in the skin. Compared to open thoracotomy, VATS offers a shorter in-hospital stays, less need for postoperative pain control, and a reduced risk of lung problems after surgery. VATS may also be used to achieve chemical pleurodesis; this involves insufflation of talc, which activates an inflammatory reaction that causes the lung to adhere to the chest wall.

If a chest tube is already in place, various agents may be instilled through the tube to achieve chemical pleurodesis, such as talc, tetracycline, minocycline or doxycycline. Results of chemical pleurodesis tend to be worse than when using surgical approaches, but talc pleurodesis has been found to have few negative long-term consequences in younger people.

Aftercare
If pneumothorax occurs in a smoker, this is considered an opportunity to emphasize the markedly increased risk of recurrence in those who continue to smoke, and the many benefits of smoking cessation. It may be advisable for someone to remain off work for up to a week after a spontaneous pneumothorax. If the person normally performs heavy manual labor, several weeks may be required. Those who have undergone pleurodesis may need two to three weeks off work to recover.

Air travel is discouraged for up to seven days after complete resolution of a pneumothorax if recurrence does not occur. Underwater diving is considered unsafe after an episode of pneumothorax unless a preventive procedure has been performed. Professional guidelines suggest that pleurectomy be performed on both lungs and that lung function tests and CT scan normalize before diving is resumed. Aircraft pilots may also require assessment for surgery.

Neonatal period
For newborn infants with pneumothorax, different management strategies have been suggested including careful observation, thoracentesis (needle aspiration), or insertion of a chest tube. Needle aspiration may reduce the need for a chest tube, however, the effectiveness and safety of both invasive procedures have not been fully studied.

Prevention
A preventative procedure (thoracotomy or thoracoscopy with pleurodesis) may be recommended after an episode of pneumothorax, with the intention to prevent recurrence. Evidence on the most effective treatment is still conflicting in some areas, and there is variation between treatments available in Europe and the US. Not all episodes of pneumothorax require such interventions; the decision depends largely on estimation of the risk of recurrence. These procedures are often recommended after the occurrence of a second pneumothorax. Surgery may need to be considered if someone has experienced pneumothorax on both sides ("bilateral"), sequential episodes that involve both sides, or if an episode was associated with pregnancy.

Epidemiology
The annual age-adjusted incidence rate (AAIR) of PSP is thought to be three to six times as high in males as in females. Fishman cites AAIR's of 7.4 and 1.2 cases per 100,000 person-years in males and females, respectively. Significantly above-average height is also associated with increased risk of PSP – in people who are at least 76 inches (1.93 meters) tall, the AAIR is about 200 cases per 100,000 person-years. Slim build also seems to increase the risk of PSP.

The risk of contracting a first spontaneous pneumothorax is elevated among male and female smokers by factors of approximately 22 and 9, respectively, compared to matched non-smokers of the same sex. Individuals who smoke at higher intensity are at higher risk, with a "greater-than-linear" effect; men who smoke 10 cigarettes per day have an approximate 20-fold increased risk over comparable non-smokers, while smokers consuming 20 cigarettes per day show an estimated 100-fold increase in risk.

In secondary spontaneous pneumothorax, the estimated annual AAIR is 6.3 and 2.0 cases per 100,000 person-years for males and females, respectively, with the risk of recurrence depending on the presence and severity of any underlying lung disease. Once a second episode has occurred, there is a high likelihood of subsequent further episodes. The incidence in children has not been well studied, but is estimated to be between 5 and 10 cases per 100,000 person-years.

Death from pneumothorax is very uncommon (except in tension pneumothoraces). British statistics show an annual mortality rate of 1.26 and 0.62 deaths per million person-years in men and women, respectively. A significantly increased risk of death is seen in older patients and in those with secondary pneumothoraces.

History
An early description of traumatic pneumothorax secondary to rib fractures appears in Imperial Surgery by Turkish surgeon Şerafeddin Sabuncuoğlu (1385–1468), which also recommends a method of simple aspiration.

Pneumothorax was described in 1803 by Jean Marc Gaspard Itard, a student of René Laennec, who provided an extensive description of the clinical picture in 1819. While Itard and Laennec recognized that some cases were not due to tuberculosis (then the most common cause), the concept of spontaneous pneumothorax in the absence of tuberculosis (primary pneumothorax) was reintroduced by the Danish physician Hans Kjærgaard in 1932. In 1941, the surgeons Tyson and Crandall introduced pleural abrasion for the treatment of pneumothorax.

Prior to the advent of anti-tuberculous medications, pneumothoraces were intentionally caused by healthcare providers in people with tuberculosis in an effort to collapse a lobe, or entire lung, around a cavitating lesion. This was known as "resting the lung". It was introduced by the Italian surgeon Carlo Forlanini in 1888 and publicized by the American surgeon John Benjamin Murphy in the early 20th century (after discovering the same procedure independently). Murphy used the (then) recently discovered X-ray technology to create pneumothoraces of the correct size.

Etymology
The word pneumothorax comes from Greek pneumo- 'air' and thorax 'chest'. Its plural is pneumothoraces.

Other animals
Non-human animals may experience both spontaneous and traumatic pneumothorax. Spontaneous pneumothorax is, as in humans, classified as primary or secondary, while traumatic pneumothorax is divided into open and closed (with or without chest wall damage). The diagnosis may be apparent to the veterinary physician because the animal exhibits difficulty breathing in, or has shallow breathing. Pneumothoraces may arise from lung lesions (such as bullae) or from trauma to the chest wall. In horses, traumatic pneumothorax may involve both hemithoraces, as the mediastinum is incomplete and there is a direct connection between the two halves of the chest. Tension pneumothorax – the presence of which may be suspected due to rapidly deteriorating heart function, absent lung sounds throughout the thorax, and a barrel-shaped chest – is treated with an incision in the animal's chest to relieve the pressure, followed by insertion of a chest tube. For spontaneous pneumothorax the use of CT for diagnosis has been described for dogs and Kunekune pigs.

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

title: Pneumothorax


text:
Ramon Magsaysay Award

The Ramon Magsaysay Award (Filipino: Gawad Ramon Magsaysay) is an annual award established to perpetuate former Philippine President Ramon Magsaysay's example of integrity in governance, courageous service to the people, and pragmatic idealism within a democratic society. The prize was established in April 1957 by the trustees of the Rockefeller Brothers Fund based in New York City with the concurrence of the Philippine government. It is often called the "Nobel Prize of Asia".

History
In May 1957, seven prominent Filipinos were named to the founding board of trustees of the Ramon Magsaysay Award Foundation, the non-profit corporation tasked with implementing the awards program. Later on, the board of trustees diversified and included prominent Asians from all over the Asian continent and outlying islands. The Ramon Magsaysay Award Foundation gives the prize to Asian individuals achieving excellence in their respective fields.

The award is named after Ramon Magsaysay, the seventh president of the Philippines. This has generated criticism due to allegations of brutal suppression of dissent and subserviency to the US government during Magsaysay's tenure as defence secretary and president.

Award categories
The award recognizes and honors individuals and organizations in Asia regardless of race, creed, sex, or nationality, who have achieved distinction in their respective fields and have helped others generously without anticipating public recognition.

The awards used to be given in six categories, five of which were discontinued in 2009:
 * Government Service (1958–2008)
 * Public Service (1958–2008)
 * Community Leadership (1958–2008)
 * Journalism, Literature, and Creative Communication Arts (1958–2008)
 * Peace and International Understanding (1958–2008)
 * Emergent Leadership (since 2001)

Awardees
The winners of the Ramon Magsaysay Awards come from different parts of Asia, although there are some instances where the winners came from countries outside Asia who had served, worked or accomplished something in different Asian countries. As of 2021, recipients have come from twenty-two Asian countries.

The following is a partial list of the awardees of the Ramon Magsaysay Award. Awardees' individual nationality or country of origin and citizenship are indicated.

Starting 2009, the Award is no longer being given in fixed categories except for Emergent Leadership.

Government Service (1958–2008)
1959.    ---      Sir Chintaman Dwarakanath Deshmukh(CIE,ICS) (INDIA) 1896-1982

title: Ramon Magsaysay Award


text:
INSEAD

INSEAD, a contraction of "Institut Européen d'Administration des Affaires" (lit. 'European Institute of Business Administration'), is a non-profit graduate business school that maintains campuses in France (Europe Campus), Singapore (Asia Campus), and the United Arab Emirates (Middle East Campus). INSEAD is a part of the Sorbonne University Alliance and the INSEAD-Wharton Alliance. Its degree programmes are postgraduate-only, taught in English and include a full-time Master of Business Administration (MBA), an Executive MBA (EMBA), Master in Management (MIM), Doctor of Business Administration (PhD), Executive Master of Finance (EMFin) and executive education programmes.

History

INSEAD was founded in 1957 by venture capitalist Georges Doriot, Claude Janssen, and Olivier Giscard d'Estaing. Original seed money was provided by the Paris Chamber of Commerce. The school was originally based in the Château de Fontainebleau, before moving to its current Europe Campus in 1967.

Doriot, a professor at Harvard Business School and a General in US Army during World War II, wanted an institution that would introduce business education to Europe and bring European businessmen together post-war. In 1955, he presented his idea of creating a new school of management and business administration to the Paris Chamber of Commerce, whose presidents, Jean Marcou and Philippe Dennis, not only funded the venture but also became first presidents of the school. The welcoming ceremony of the first promotion for the Master of Business Administration at the Château de Fontainebleau was held on 12 September 1959. Almost 110 candidates had applied, 62 were admitted and 57 attended the first course. The official inauguration took place on 9 October 1959, at the Château de Fontainebleau 5.

Initial classes were taught in three languages: English, French and German, interchangeably. Until the 1990s, classes could still be taught in any of the three languages. As of now, all classes are taught in English, but the school still requires students to know any three languages for graduation.

In 2000, the school opened another campus in Singapore. In 2012, INSEAD became a founding member of the Sorbonne University Alliance, moving toward a merger with leading specialist institutions in other fields to create a top-tier multidisciplinary university.

Campuses
The original campus (the INSEAD Europe Campus) is located in Fontainebleau, near Paris, France. INSEAD's second campus (the INSEAD Asia Campus) is in the one-north district of the city-state of Singapore next to one-north MRT station. The third campus (the INSEAD Middle East Campus) is located in Abu Dhabi. INSEAD expanded its presence to North America in 2020 with the opening of the INSEAD San Francisco Hub for Business Innovation. INSEAD follows the US model of a business school. INSEAD has been a pioneer in setting up a multi-campus business school as a way to increase the global presence and nature of its faculty and curriculum and to reflect the global diversity of its international student and participant population. A Harvard Business School case study, for instance, explores its approach to business education in a global context and how it functions with a multi-campus setting.

Grande école system
INSEAD is a grande école, a French institution of higher education that is separate from, but parallel and connected to the main framework of the French public university system. Similar to the Ivy League in the United States, Oxbridge in the UK, and the C9 League in China, grandes écoles are elite academic institutions that admit students through an extremely competitive process. Alums go on to occupy elite positions within government, administration, and corporate firms in France.

Although they are more expensive than public universities in France, grandes écoles typically have much smaller class sizes and student bodies, and many of their programmes are taught in English. International internships, study abroad opportunities, and close ties with government and the corporate world are a hallmark of the grandes écoles. Many of the top-ranked business schools in Europe are members of the Conférence des Grandes Écoles (CGE), as is INSEAD, and out of the 250 business schools in France, only 39 are CGE members. In addition to the French Ministry of Education (Le Ministère de L'éducation Nationale), INSEAD is further accredited by the elite international business school accrediting organizations and it holds the much coveted Triple accreditation: The European Foundation for Management Development (EQUIS), The Association to Advance Collegiate Schools of Business (AACSB), and Association of MBAs (AMBA).

Master in Management (MIM)
The Master in Management programme is targeted to younger individuals with 0–2 years of experience and consists of coursework in both the Europe and Asia Campuses, with optional field trips to China, Abu Dhabi, and San Francisco. The programme ranked 4th in the 2022 QS Business Masters Rankings for Management.

MBA programme
INSEAD MBA participants can take the MBA core courses at either or both of its Europe and Asia Campuses (as well as an MBA period at its Middle East Campus). They follow the same core courses in parallel regardless of campus, and there are faculty who teach on both the Europe and Asia Campuses as well as permanent faculty at each of the three campuses who live and work in the respective regions. Approximately 20% of the class entered the MBA programme with other graduate or professional degrees; including medical doctors, lawyers, and PhDs.

INSEAD offers two MBA schedules per year: one starting in September which takes ten months to complete, and a 12-month promotion starting in January for students who want to complete a summer internship.

Executive MBA programme
INSEAD has two Executive MBA programmes. The Global Executive MBA (GEMBA) and the Tsinghua INSEAD EMBA (TIEMBA). Both EMBA programmes are master-level degree programmes that take place on a part-time, modular basis.

The programmes offer experienced business executives an intensive 14–17-month modular course that takes place in modular periods (approximately every six to seven weeks). Each period on campus is between one and two weeks' duration. For the GEMBA programme the physical time on campus represents 12 weeks in total with participants going to all three campuses (Fontainebleau (France), Abu Dhabi and Singapore). For the TIEMBA programme the physical time on campus represents 12 weeks in total with participants alternating between Tsinghua's campus in Beijing, China and the INSEAD campus in Singapore.

Both the GEMBA and TIEMBA programmes include a schedule of group coaching, 360-degree assessments and team activities designed to develop a leadership style, called the Leadership Development Programme.

Executive Master in Change
INSEAD Executive Master in Change (EMC) is a specialised executive master's degree that provides a grounding in basic drivers of human behavior and the hidden dynamics of organisations. INSEAD EMC integrates business education with a range of psychological disciplines, and prepares participants to assume roles in leading organisations, drive individual and organisational development, and successfully execute change management.

This programme offers a unique transformational experience, with a clinical approach which implies that real-life situations are examined – as opposed to "theoretical" knowledge. All of the programme's learning is derived from real life or can be applied to it. The programme is designed to provide a safe, reflective transitional space, where participants have the opportunity to step back, gain perspective and even experiment with themselves.

Spread over 18 months, EMC consists of eight on-campus modules of three to four days each. In addition, participants have a total of 60 hours of "practicum" (various experiences designed to apply the course content and bring the clinical perspective alive) as well as written work, readings and group calls. The programme concludes with a Master Thesis.

Executive Master in Finance
INSEAD Executive Master in Finance (EMFin) teaches participants finance and accounting skills on a par with those taught in an MBA programme, and also offers leadership and management perspectives. The programme is offered in a modular format over a 18-month period to allow professionals to study while continuing to work. Participants take time off from work for each of the six modules (two weeks each) to take classes on campus and continue working in between.

PhD programme
The INSEAD PhD in Management is a doctoral degree in business to prepare students for a career in academia. It requires four to five years of full-time study – the first two years devoted to coursework, while from the third and fourth (or sometimes fifth) years dedicated to research and dissertation. Students have the option to start their studies on either the Asia (Singapore) or Europe (France) Campus and do an exchange in North America (USA) through the INSEAD-Wharton Alliance. There are eight areas of specialisation: Accounting, Decision Sciences, Entrepreneurship, Finance, Marketing, Organisational Behavior, Strategy, and Technology and Operations Management. INSEAD offers fellowships, whereby students receive full tuition fee waiver, annual stipend and research support funding.

Business Foundations programme
INSEAD in collaboration with Sorbonne Université offers the dual degree: Business Foundations (BFC) programme which is one of INSEAD's most selective degrees. "BFC" is tailored for recent master or PhD graduates from the sciences, medicine, humanities, engineering and law. Both universities offer fellowships to selected students.

Executive education
INSEAD holds both company/firm specific and open enrolment executive education programmes at its locations in Europe, Asia, the Middle East and North America, as well as in partnership with corporate universities. The school offers programmes in-person, online, and virtually. Participants usually come from senior or top management, with many years of experience within their company or industry and younger 'high-potentials' identified as being key in succession strategies within their companies. Approximately 10,000+ executives of around 180+ nationalities undertake courses or programmes at INSEAD each year.

Open programmes
The INSEAD Executive Education Open Programmes, include more than 60 offerings, covering all business disciplines as well as specific industries and world regions.

Certificates
INSEAD offers six certificates: The Certificate in Global Management, the Certificate in Negotiation, two Certificates in Corporate Governance, the INSEAD Online Certificate: Leading in a Transforming World and the new INSEAD LEAD Certificate.

Rankings and reputation
INSEAD admits no more than 12% of students of the same nationality. Its MBA program has produced the second-highest number Fortune 500 CEOs, behind Harvard Business School. It is also amongst the largest 20 producers of ultra high-net-worth individuals, and is among the top 10 producers of billionaire alumni amongst global MBA programs.

For entrepreneurship, INSEAD estimates around half of their alumni found a company at some point in their careers. Pitchbook's 2023 analysis found INSEAD was fourth worldwide in terms of capital raised, founder count, and company count (only behind Harvard, Stanford, and Wharton) As of 2022, INSEAD graduates have founded 18 unicorns, making the school the top unicorn producing university in Europe. Approximately 800 alumni of the school founded more than 700 companies, which in total have raised $23 billion. As of 2023, Harvard University, Stanford University, and INSEAD are the only three universities to top Poets and Quants's list of most-funded startup by MBA students.

The INSEAD MBA programme ranked first in 2021, 2017 and 2016 in the Financial Times Global MBA Ranking. The dual degree Executive MBA with Tsinghua University is consistently ranked in the top ten by the Financial Times.

Alumni
The INSEAD alumni community consists of 68,861 individuals across 179 countries with 171 nationalities.

title: INSEAD


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List of official languages of international organizations

This is a list of official languages of international organizations. Different organizations sometimes refer to their principal languages of administration and communication as "working languages", while others refer to these as being "official". No distinction is made here, except where an organization itself, distinguishes between its official and working languages.

English and French are often regarded as the symbolic official languages, although the former has gained prominence in recent years.

International
According to a recent study of multilingualism in 13 major international organizations (Commonwealth, ICC, ILO, IMF, IOC, IPU, ITU, OECD, UN, UPU, WB, WHO, and WTO), English is an official language in almost all (12). This is followed by French (10); Spanish (6); and Arabic, Chinese, and Russian (3 each). Interpretation is offered in Japanese and German as well for 2 organizations.

The six official languages of the United Nations reflects the languages of the permanent members of the Security Council (Chinese, English, French, and Russian), in addition to Arabic and Spanish. Another study found that the percentage of each language used at each United Nations meeting in 2010 was distributed as follows: English (98%), French (87%), Spanish (34%), Russian (10%), Arabic (7%), and Chinese (3%).

The following is a list of major international and inter-governmental organizations.


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Anoxia

Anoxia means a total depletion in the level of oxygen, an extreme form of hypoxia or "low oxygen". The terms anoxia and hypoxia are used in various contexts:

 * Anoxic waters, sea water, fresh water or groundwater that are depleted of dissolved oxygen
 * Anoxic event, when the Earth's oceans become completely depleted of oxygen below the surface levels
 * Euxinic, anoxic conditions in the presence of hydrogen sulfide
 * Hypoxia (environmental), low oxygen conditions
 * Hypoxia (medical), when the body or a region of the body is deprived of adequate oxygen supply
 * Cerebral anoxia, when the brain is completely deprived of oxygen, an extreme form of cerebral hypoxia

title: Anoxia


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William Longsword (disambiguation)

William Longsword (c. 893–942) was the second ruler of Normandy, from 927 until his assassination in 942.

William Longsword may also refer to:
 * William II of England or William Longsword (c. 1056–1100)
 * William Longsword, a crusader who led English troops at the Siege of Lisbon (1147)
 * William FitzEmpress (1136-1164), who subscribed a charter as 'Willelmi Longespe'
 * William of Montferrat, Count of Jaffa and Ascalon (c. 1140–1177), crusader
 * William of Winchester, Lord of Lüneburg (1184–1213), son of Henry the Lion
 * William Longespée, 3rd Earl of Salisbury (1167–1226), illegitimate son of Henry II of England
 * William II Longespée (1212–1250), crusader

title: William Longsword (disambiguation)