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Knoxville Girls

 * See also the murder ballad The Knoxville Girl.

Knoxville Girls was a short-lived American, New York City based, alternative rock supergroup that contained: Bob Bert (of Sonic Youth and Pussy Galore), on drums, Jerry Teel (of Boss Hog and Little Porkchop) on vocals, guitars; Kid Congo Powers (of The Gun Club and The Cramps) on guitar and vocals; Jack Martin (of Little Porkchop and Blackstrap Molasses Family) on guitar; and Barry London (of Stab City) on organ.

The group released two albums: Knoxville Girls in 1999, and In a Paper Suit in 2001, before disbanding.

title: Knoxville Girls


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Clement Claiborne Clay

Clement Claiborne Clay (December 13, 1816 – January 3, 1882), also known as C. C. Clay Jr., was a United States Senator (Democrat) from the state of Alabama from 1853 to 1861, and a Confederate States senator from Alabama from 1862 to 1864. His portrait appeared on the Confederate one-dollar note (4th issue and later).

He and his father, who served as a governor of Alabama and was also a U.S. senator, were among the state's most prominent enslavers, according to the Washington Post. Together the two men enslaved 87 people on four Alabama plantations as recorded in the 1860 census.

Early life
Clement Claiborne Clay was born to Clement Comer Clay and Susanna Claiborne Withers, the daughter of well-off planter John Withers, in Huntsville, Alabama. He had a strong political pedigree as the oldest son of U. S. Senator and Alabama Governor Clement Comer Clay. He was also a third cousin of Henry Clay, the noted statesman from Kentucky. John Withers Clay, proprietor and editor of the Huntsville Weekly Democrat, and Hugh Lawson Clay, who served in the military, were his brothers.

Clay attended the Huntsville Green Academy, then studied at the University of Alabama at Tuscaloosa in 1833–1834. In August 1834, at the age seventeen, he received an A.B. degree. He served as his father's secretary in 1835–1837 after Clement Clay, Sr. was elected as a governor of Alabama. In 1837, he and his brother John Withers Clay both entered the University of Virginia; their brother Hugh Lawson Clay joined them later. In July 1839, Clay obtained a Bachelor of Laws degree after studying with John B. Minor, known for his rigor, and was admitted to the Alabama Bar on October 2, 1839.

Marriage and family
On February 1, 1843, he married Virginia Tunstall, who was then 18 years old. They had one child, who died stillborn.

After Clement's death in 1882, his widow remarried to David Clopton, a judge, and was known as Virginia Clay-Clopton. Clay-Clopton wrote Belle of the Fifties, a memoir with New York journalist Ada Sterling, published in 1904 and re-issued in 1905. Belle was one of three memoirs by southern women particularly recommended by the United Daughters of the Confederacy to its membership for studying. Clay-Clopton's book became part of the discourse about the Lost Cause and the burnished memory of the antebellum South.

Career
In 1839–1846, Clay practiced law in a family law firm; in 1846–1848 he served as Madison County judge. Clay was a member of the Alabama State House of Representatives in 1842, and in 1844–1845. He ran for the United States Congress in 1850, but did not succeed, losing to incumbent Williamson Robert Winfield Cobb.

In 1853, Clay was elected by the Alabama legislature to serve in the United States Senate in a term beginning March 4, 1853; and was re-elected in 1857. Due to the legislature's delay in filling the position, he served from November 29, 1853, to January 21, 1861. In the Senate, he defended the state's rights during the political debates of the time, and opposed Henry Clay. After the 1860 presidential election, Alabama seceded from the Union on January 11, 1861, before the American Civil War broke out. On January 21, six men, including Clay, resigned their seats in the United States Senate. Most made brief and temperate speeches.

Clay, however, delivered an impassioned justification for secession and a denunciation of the Northern anti-slavery Republican Party. He denounced its resistance to the Fugitive Slave Act and the spread of slavery into the territories. "No sentiment is more insulting or more hostile to our domestic tranquility, to our social order, and to our social existence, than is contained in the declaration that our negroes are entitled to liberty and equality with the white man," Clay said. He described the election of Abraham Lincoln to the presidency as a hostile act against the Southern people which left them with no recourse other than secession in order to defend their liberty, honor, and safety.

Clay was subsequently elected by the Alabama Confederate legislature as Senator in the First Confederate Congress. He served there from 1862 until 1864 acting as a supporter of Jefferson Davis. Along with Jacob Thompson, Clay was a part of the Confederate War Department effort to create a network of secret agents to conduct espionage and sabotage.

In May 1864, president Davis sent Clay to Canada with a secret mission to coordinate activities of the Southern sympathizers in the Great Lakes area, including members of the Order of the Sons of Liberty and the Knights of the Golden Circle. Clay took part in a secret meeting with John Hay, President Abraham Lincoln's aide, at Niagara Falls, Canada.

It was suspected that Thompson and Clay had employed John Wilkes Booth for some services before he assassinated President Abraham Lincoln. President Andrew Johnson signed an order to arrest Clay. After learning from a newspaper that a reward was issued for his capture, Clay, who initially planned to escape to Mexico, turned himself in to General James H. Wilson in Macon, Georgia, in May 1865. He was arrested and held in Fort Monroe in Hampton, Virginia, until April 1866. Former Confederate president Jefferson Davis was also held in Fort Monroe, but was never tried; he was released in 1867.

Postwar years

Clay was imprisoned by the United States government under impression that he was involved in the plot to assassinate President Abraham Lincoln. Virginia Clay played some role in her husband's release as she went to Washington, D.C., and personally pleaded with President Johnson.

A viewpoint that Johnson's role in Clay's release was an act worthy of being among the charges for impeaching Johnson was voiced in the December 1867 Thomas Williams-authored majority report of House Committee on the Judiciary published at the conclusion of first impeachment inquiry against Andrew Johnson.

The Clays returned to Alabama and struggled to rebuild their lives living on a farm. Clay tried to practice as an attorney and entered insurance business in Huntsville, however without much success due to poor health, ultimately returning to his farm in January 1882. He died later that year in Madison County, besieged by debts and health problems, and is interred at Maple Hill Cemetery.

Works

 * Clay, C.C., and William M. K. Gwin. Invasion of Harper's Ferry: Dangers and Duties of the South. Washington: Printed at the Congressional Globe Office, 1859.
 * Speech of the Hon. C.C. Clay Jr. of Alabama, on the Contest in Kansas, and the Plans and Purposes of Black Republicanism: Delivered in the United States Senate, April 21, 1856.
 * Speech of C. Clay Jr. of Alabama, on the Bill to Admit Kansas: Southern Rights, How Menaced by Northern Republicanism, Delivered in United States Senate, March 19, 1858.
 * Speech of Hon. C. C. Clay Jr. on slavery issues. Delivered at Huntsville, Alabama, September 5th, 1859.

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

title: Clement Claiborne Clay


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Generalized hypoxia

Generalized hypoxia is a medical condition in which the tissues of the body are deprived of the necessary levels of oxygen due to an insufficient supply of oxygen, which may be due to the composition or pressure of the breathing gas, decreased lung ventilation, or respiratory disease, any of which may cause a lower than normal oxygen content in the arterial blood, and consequently a reduced supply of oxygen to all tissues perfused by the arterial blood. This usage is in contradistinction to localized hypoxia, in which only an associated group of tissues, usually with a common blood supply, are affected, usually due to an insufficient or reduced blood supply to those tissues. Generalized hypoxia is also used as a synonym for hypoxic hypoxia This is not to be confused with hypoxemia, which refers to low levels of oxygen in the blood, although the two conditions often occur simultaneously, since a decrease in blood oxygen typically corresponds to a decrease in oxygen in the surrounding tissue. However, hypoxia may be present without hypoxemia, and vice versa, as in the case of infarction. Several other classes of medical hypoxia exist.

Causes
Hypoxia can result from various causes which can be categorised as: anemic hypoxia, cellular hypoxia, generalised, or hypoxic hypoxia, pulmonary hypoxia, stagnant hypoxia, increased oxygen consumption due to a hypermetabolic state, or any combination of these. The three fundamental causes of hypoxia at the tissue level are low oxygen content in the blood (hypoxemia), low perfusion of the tissue, and inability of the tissue to extract and use the oxygen in the blood. Generalised, or hypoxic hypoxia may be caused by:
 * Hypoventilation – failure of the respiratory pump due to any cause (fatigue, barbiturate poisoning, pneumothorax, etc.)
 * Low-inspired oxygen partial pressure, which may be caused by breathing air at low ambient pressures due to altitude, by breathing hypoxic breathing gas at an unsuitable depth, by breathing inadequately re-oxygenated recycled breathing gas from a rebreather, life support system, or anesthetic machine, or hypoxia of ascent in freediving.
 * Airway obstruction, choking, drowning.
 * Abnormal pulmonary function
 * Chronic obstructive pulmonary disease (COPD)
 * Neuromuscular diseases or interstitial lung disease
 * Malformed vascular system such as an anomalous coronary artery

Altitude effects
When breathing the ambient air at high altitudes (above 3048 metres/10,000 feet), the human body experiences altitude sickness and hypoxemia due to a low partial pressure of oxygen, decreasing the carriage of oxygen by hemoglobin.
 * Above 3000 metres (10,000 feet) - ambient pressure 69.7kPa, about 14.6kPa partial pressure of oxygen – enough hypoxic stimulation to cause increased ventilation
 * Above 3700 metres (12,000 feet) - 64.4kPa, about 13.52kPa PO 2 – first irritability appears
 * Above 5500 metres (18,000 feet) - 50.6kPa, about 10.6kPa PO 2 – severe symptoms
 * Above 7600 metres (25,000 feet) - ambient pressure 37.6kPa absolute, 7.9kPa partial pressure of oxygen – consciousness lost

While breathing pure oxygen at ambient pressure, from an oxygen cylinder or other source, the maximum altitude a human can tolerate while their body is at atmospheric pressure is 13,700 metres (45,000 feet),, where atmospheric pressure is about 14.7kPa. This is a function of the partial pressure of oxygen in the breathing gas, and is also dependent on level of exertion which affects the oxygen requirements of metabolism, cardiovascular fitness, and acclimatization to altitude which affects the available hemoglobin and can vary significantly between individuals.

Signs and symptoms

 * Cyanosis
 * Headache
 * Decreased reaction time, disorientation, and uncoordinated movement.
 * Impaired judgment, confusion, memory loss and cognitive problems.
 * Euphoria or dissociation
 * Visual impairment
 * Lightheaded or dizzy sensation, vertigo
 * Fatigue, Drowsiness or tiredness
 * Shortness of breath
 * Palpitations may occur in the initial phases. Later, the heart rate may reduce significantly degree. In severe cases, abnormal heart rhythms may develop.
 * Nausea and vomiting
 * Initially raised blood pressure followed by lowered blood pressure as the condition progresses.
 * Severe hypoxia can cause loss of consciousness, seizures or convulsions, coma and eventually death. Breathing rate may slow down and become shallow and the pupils may not respond to light.
 * Tingling in fingers and toes
 * Numbness

Treatment
Generalized hypoxia is an effect of a lack of oxygen, and in many cases of a one-time event can be reversed simply by eliminating the lack. Where there is no underlying pathology, provision of oxygen at normobaric partial pressure (about 0.21 bar) is usually sufficient to reverse minor symptoms. Where there is a pathology causing the hypoxia, treatment of the underlying pathology is often effective.
 * Oxygen therapy and hyperbaric medicine can improve saturation of oxygen in the blood which will stop hypoxia if it is caused by hypoxemia, i.e. low levels of oxygen in the blood.
 * Artificial ventilation may be required where the person is unable to breathe sufficiently unaided.
 * Continuous positive airway pressure (CPAP) mask may be used to treat sleep apnea.
 * Bilevel positive airway pressure (BIPAP) may be used to treat chronic obstructive pulmonary disease (COPD), and some kinds of sleep apnea.
 * Supplemental oxygen by mask or nasal tubes may be provided to treat chronic hypoxia.
 * Inhaled steroids that can dilate the airways may be used to treat asthma or other lung disease.
 * Diuretics may be used to reduce edema in and around the lungs.

Other types of medical hypoxia

 * Hypoxemic hypoxia is a low oxygen tension in the arterial blood, due to the inability of the lungs to sufficiently oxygenate the blood. Causes include hypoventilation, impaired alveolar diffusion, and pulmonary shunting. This definition overlaps considerably with that of hypoxic hypoxia.
 * Pulmonary hypoxia occurs when the lungs receive adequately oxygenated gas which does not reach the blood in sufficient quantities. It may be caused by:
 * Ventilation perfusion mismatch,
 * Pulmonary shunt
 * Circulatory hypoxia, ischemic hypoxia or stagnant hypoxia may be caused by abnormally low blood flow to the lungs, which can occur during shock, cardiac arrest, severe congestive heart failure, or abdominal compartment syndrome, where the main dysfunction is in the cardiovascular system, causing a major reduction in perfusion. Arterial gas is adequately oygenated in the lungs, and the tissues are able to accept the oxygen available, but the flow rate to the tissues is insufficient. Venous oxygenation is particularly low.
 * Anemic hypoxia or hypemic hypoxia is the lack of capacity of the blood to carry the normal level of oxygen. It can be caused by anemia or:
 * Carbon monoxide poisoning
 * Methemoglobinemia
 * Cellular hypoxia occurs when the cells are unable to extract sufficient oxygen from normally oxygenated hemoglobin.
 * Histotoxic hypoxia (Dysoxia) occurs when oxygen is transported to the tissues but they cannot use it effectively because the cells cannot extract oxygen from the blood. This is seen in cyanide poisoning.

title: Generalized hypoxia


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Wikipedia:Articles for deletion/Dirty-work group

Dirty-work group was proposed for deletion. This page is an archive of the discussion about the proposed deletion. This page is no longer live. Further comments should be made on the article's talk page rather than here so that this page is preserved as an historic record. The result of the debate was DELETE

An unsubstantiated management theory of the contributor's making. External links all to contributor's own website; googling brings up this, and the same article on a multitude of clones, and not much more. Ianb 06:42, 20 Jul 2004 (UTC) This page is now preserved as an archive of the debate and, like other '/delete' pages is no longer 'live'. Subsequent comments on the issue, the deletion or on the decision-making process should be placed on the relevant 'live' pages. Please do not edit this page.
 * While interesting, this appears to be original research. Delete. Rossami 13:53, 20 Jul 2004 (UTC)
 * Delete, original research. Agree it's interesting... by the way, what happens if my "dirty work" isn't anyone else's "nice work?" Dpbsmith 23:19, 21 Jul 2004 (UTC)
 * Delete: Sounds like a description of Wikipedia Clean Up page. Individ. research, but a good idea. (We obviously think so.) Geogre 13:34, 22 Jul 2004 (UTC)


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Talk:World War I casualties

Synthesis
To keep synthesis out of this article I will not be accepting any casualty total that involves synthesising totals from individual incidents to give a total, or estimated total, that has not been published by a secondary source. References for individual incidents are insufficient, since there is no guarantee that the incidents claimed form the correct total. For example it is claimed the total for China is 101 based on adding 98 for Siege of Tsingtao to 3 for 1915 Singapore Mutiny to give a total of 101. Even ignoring that the BBC say only 40 people killed at the siege were Chinese labourers, who is to say these two incidents represent the total Chinese civilian death during the conflict? Adding up death tolls of incidents that have Wikipedia articles is inadequate research. The Commonwealth War Graves Commission lump the Chinese Labour Corps members who died in with Commonwealth figures, but what of other deaths? The SS Athos was sunk before the Chinese Labour Corps were formed, and I can find no mention of the Athos in their CWGC's record of deaths or memorials. So are the 400 to 600 Chinese labourers who died on the Athos included in the CWGC's figures or not? This is precisely why we can only use totals published in secondary sources. FDW777 (talk) 11:12, 29 April 2020 (UTC)
 * I was wondering about those Chinese people killed in Singapore. Were they Chines nationals or were they ethnic Chinese (with likely another nationality)? The Banner  talk 11:56, 29 April 2020 (UTC)

Further to the CWGC/Chinese Labour Corps/Athos deaths, a search of the CWGC's death records for the Chinese Labour Corps sorted chronologically doesn't include the Chinese labourers killed on 17 February 1917 when the SS Athos was sunk. I hope this underlines the futility of attempting to compile our own totals for any country? FDW777 (talk) 12:05, 29 April 2020 (UTC)

Personally we can close all of this now, wp:consensus is clear we do not keep on until we all give in.Slatersteven (talk) 12:11, 29 April 2020 (UTC)

 * You'd hope so, but knowing the IP they'll just ignore anything that doesn't suit their argument. I've no problem with any reliably referenced changes being made to the article, but for the reasons explained above I'm not willing to accept synthesis of references about individual incidents to form a total, or estimated total, for a particular country. We need country totals published by secondary sources. FDW777 (talk) 12:18, 29 April 2020 (UTC)
 * Then we take it elsewhere.Slatersteven (talk) 12:25, 29 April 2020 (UTC)

 * This page can be a good start https://encyclopedia.1914-1918-online.net/article/war_losses.

The issue of war losses is an intricate one, involving several crucial points. First, words matter. The meaning of words such as “killed in action”, “wounded” or “casualties”, which are the main headings in table columns in books or articles dealing with war losses, are misleading. Take the wounded: some died, others did not, meaning that the total number of soldiers who died as a result of war should include those who died from their wounds. This leads to the questions: How did statisticians calculate their estimates? What period of time did their calculations cover? What parameters did they define? Such questions are seldom discussed. However, it is impossible to propose an even somewhat rigorous estimate of war losses without discussing them.

 * Civilian Losses

Military losses tend to be much better documented than civilian deaths in wartime. As armies needed as precise an estimate as possible of the men available for combat, they counted only soldiers. Civilian administrators had to care for the sick and bury the dead, whatever their cause of illness or death. No office, anywhere, registered civilian war-related deaths. These numbers have been drawn from very different sources, using various assumptions and definitions. Surely, the dead from air bombings were war victims, but they were not numerous. The central difficulties come from the influenza epidemic and the blockade.

The whole world was struck in 1918-19 with an epidemic of Spanish flu. The author’s calculations include soldiers who died from illness when wearing the uniform, for one could argue that their resistance to illness had been weakened by life in the trenches. Soldiers who died from the Spanish flu – about 32,000 in the French army, among them the poet Guillaume Apollinaire (1880-1918) – are considered fallen soldiers. But what about civilians? Most estimates of civilian losses include dead from the Spanish flu, but there are no reasons to do so. The epidemic appeared in the USA, which was not directly affected by the war in mid-1918, where it killed more than half a million people. Are they war victims? The author believes not, which is why American soldiers who died in the USA before leaving were not included in his war loss estimates. For the same reasons, it seems difficult to attribute the heavy toll of the flu in belligerent countries to the war, as long as their medical situation remained normal. If the war had not happened, these inhabitants would have caught the flu anyway and would have died in the same numbers. To include these dead in the calculation would only serve to increase the number of civilian losses and to make the face of war more hideous. Pacifism does not need such a sleight-of-hand.

The second difficulty lies in the blockade. The Central Powers suffered heavily from cold and malnutrition, due to the shortage of coal and food. This situation was a result of bad and incompetent administration. In Russia, as in Turkey and the Balkans, administrative and economic disorganization and inefficient transportation produced starvation, and bad nutrition made sickness often fatal. In Germany, the War Office (Kriegsamt) created chaos with respect to the food supply and contributed to the development of the black market. This is a first explanation, though not a sufficient one. The shortage of coal, raw materials and food was another, perhaps more important, reason. The shortage was mainly a result of the Allied blockade, maintained until the signing of the peace treaty in late June 1919. Hence, it seems logical to attribute a number of civilian deaths to war conditions.

But it is difficult to count Germans who died of hunger and still more difficult to say whether they were victims of the Allied blockade or of the black market and the German administration’s disorganization. Huge figures have been proposed. For example, in Central and Balkan Europe, some have offered estimates as high as two million. In the Ottoman Empire, quite apart from the one or more million people killed during the Armenian genocide, the figure has been advanced of at least 1,500,000 civilian deaths from famine or malnourishment.[21] These figures probably include dead from the Spanish flu. It is possible that such figures have been exaggerated, but it seems very difficult to make clear estimates from evidence so thin. Anyway, the human cost of the war for civilians is undisputed, though impossible to calculate with precision.

As the reader ought to be given the best possible estimate, the author has collected the figures usually proposed in Table 3 below, though he is not at all convinced they are valuable.[22] These numbers are but suppositions. Figures for Great Britain or France, in particular, seem contradictory with what is known of wartime living conditions in these countries. In Great Britain, Winter has shown the paradoxical improvement of infant mortality rates during the war, and other scholars have given additional evidence of a lessening of poverty. In France, even if the Spanish flu was considered as a war-related catastrophe, 300,000 or 600,000 civilian dead in France would be astounding figures. The estimate given by Wikipedia of 408,000 dead from the Spanish flu for France is an evident miscalculation: in the unoccupied territory, the total numbers of civilian dead were 583,000, 722,000 and 617,000 for the years 1917, 1918 and 1919 respectively. Thus the surplus civilian mortality of 1918-19, due to the flu, cannot exceed 175,000. These statistics do not prove anything but the will of their author to present the war as a greater massacre than it was. The only certain point is that there is a wide contrast between countries where people died of illness and starvation by the hundreds of thousands, such as Russia, the Balkans, the Central and Ottoman Empires, and those where the government succeeded in maintaining a minimum supply of food, housing and medical care.

To conclude: these statistical insights suggest an asymmetric double contrast. On the front line, the Allies paid the highest price, both in terms of those killed in action and those wounded. But on the home front, the Central Powers and Russia paid a much higher toll. War was not only a military matter; it was an ordeal for whole societies.Driverofknowledge (talk) 13:04, 29 April 2020 (UTC)

 * A Global War – A Global Project "1914-1918-online. International Encyclopedia of the First World War” is an English-language virtual reference work on the First World War. The multi-perspective, open-access knowledge base is the result of an international collaborative project involving more than 1,000 authors, editors, and partners from over fifty countries. More than 1,000 articles will be gradually published. Innovative navigation schemes based on Semantic Media Wiki technology provide nonlinear access to the encyclopedia’s content. The co-operation partners support the project in several ways: Some partners fund staff to edit the articles, while others employ staff to research and write on the lesser-known topics; some partners organize conferences where the content of the encyclopedia is prepared and discussed; a number of partners have also allowed the encyclopedia to make use of their rich collections of photographs, maps and posters on World War I.https://encyclopedia.1914-1918-online.net/project/partners/Driverofknowledge (talk) 13:08, 29 April 2020 (UTC)

 * And this Project has 1117 Contributors https://encyclopedia.1914-1918-online.net/contributors/.Driverofknowledge (talk) 13:14, 29 April 2020 (UTC)
 * We should never rely on one source.Slatersteven (talk) 13:17, 29 April 2020 (UTC)

 * yes but now. We have one source that we can use, we need to find more that are reliable.Driverofknowledge (talk) 13:20, 29 April 2020 (UTC)
 * We have the article has loads of them.Slatersteven (talk) 13:23, 29 April 2020 (UTC)

Note my laptop is broken so I can no longer contribute substantialy. But to clear something up, if you read the WW1 casualties article, they say Chinese Labor Corps losses are counted among the Brits and French. And in the China source, if you read carefully, the dead mentioned is not from the siege itself, but from the Japanese "on their way to Tsingtao." So there is no connection between the chinese labor dead with the germans and the chinese civilians. And chinese laborers are counted as military losses, not civs because they were drafted. Think Askari soldiers. Slater, FDW, Banner, best of luck fixing this article and adding stuff. I'll check up when my laptop is better. 2601:85:C101:BA30:A985:1173:EE5F:238D (talk) 18:06, 29 April 2020 (UTC)

 * Maybe you can go to a computer shop to get it Fixed faster.Also Africa is in a new section.Driverofknowledge (talk) 18:12, 29 April 2020 (UTC)
 * During pandemic unlikely, but thanks. :) 2601:85:C101:BA30:A985:1173:EE5F:238D (talk) 20:46, 29 April 2020 (UTC)

if you read the WW1 casualties article, they say Chinese Labor Corps losses are counted among the Brits and French, you just don't get it do you? This isn't in the current version of the article, but the text in question can be seen on your preferred version here. It reads Chinese laborers who died while serving under the British and French in the Chinese Labour Corps are counted among the British and French losses. This is referenced to this CWGC document, which makes absolutely no mention of Chinese labourers being included in French losses. It doesn't even explicitly say they were classed as Commonwealth losses, the closest it gets is The labourers who died were classified as war casualties and great pains were taken to mark their graves in an appropriate way. All headstones, which are of the Commission's standard war pattern shape... But since the Chinese Labour Corps are listed in the CWGC's database that's not a problem. However, as I've already stated and you ignored (like normal), the Chinese labourers who died in the sinking of the SS Athos weren't members of the Chinese Labour Corps and they aren't listed on the CWGC's database at all as far as I can see. As such, all we're left with is the text that you wrote reading Chinese laborers who died while serving under the British and French in the Chinese Labour Corps are counted among the British and French losses, except as I've already said this is an unreferenced claim. So no, you can't use unreferenced text that you wrote yourself to claim the Chinese labourers that died on the SS Athos are covered in the French losses, and neither could you use a general reference (not that you've even provided one of course) saying Chinese Labour Corps deaths are included in the French losses due to WP:SYN (especially as they weren't even members of the Chinese Labour Corps), you'd need a reference explicitly saying how the Chinese labourers that died on the SS Athos are classified. FDW777 (talk) 19:42, 29 April 2020 (UTC)

Also if the 40 Chinese labourers from the Siege of Tsingtao are completely different from the 98 civilians killed (and where's the evidence that in 1915 Chinese labourers were classed as military? You can't use the 1917 Chinese Labour Corps to retroactively claim they were military) then it still completely undermines your total of 101, as it should be 141. FDW777 (talk) 19:53, 29 April 2020 (UTC)
 * Overseas labor units serving with the British and French forces. The UK employed about 300,000 Indian, Chinese, native South African, Egyptian and other nations as laborers during the war. By the end of 1917, there were 50,000 Chinese workers in France, rising to 96,000 by August 1918 (with another 30,000 working for the French). 100,000 Egyptians were working in France and the Middle East, alongside 21,000 Indians and 20,000 South Africans, who were also in East Africa.[12] A total of about 140,000 Chinese workers recruited in the Beiyang government, served on the Western Front during and after the war with the British and French Armed Forces.[154][155] According to the Commonwealth war Graves Commission "In all, nearly 2,000 men from the Chinese Labour Corps died during the First World War, some as a direct result of enemy action, or of wounds received in the course of their duties, but many more in the influenza epidemic that swept Europe in 1918–19"[13] One historical controversy is the number who died in the war. Some Chinese scholars say the number was as high as 20,000 but records kept by the British and French recruiters, show just under 2,000 lost their lives, many from the flu pandemic that swept the world starting in 1919.[156] According to the Commonwealrh War Graves Commission, "The African combatant troops raised for the East African campaign numbered 34,000. The non-combatant porters, stevedores and followers of the Military Labour Corps 600,000. Almost 50,000 of these men were lost, killed in action died of sickness or wounds"[11] According to The Africa Research Institute official British figures the death toll exceeded 105,000 native African troops and military carriers[157]

 * From the text currently on the article. I'll assume good faith FDW, what I wrote was based on what Woogie wrote, so I'm not to blame. So calm down. "Upon investigation, the Peking government determined that the Japanese army had caused losses to the Chinese government and its people in its passage across Shandong to invade and occupy Qingdao" In passage. So the dead were not in Tsingtao, and not the laborers. But yeah if you want Chinese laborers to the total, I guess you could. The page is in your hands now. Once you guys are done with China, you all should add Liberia (4 civ dead from shelling on Monrovia), that's pretty straightforward. 2601:85:C101:BA30:A985:1173:EE5F:238D (talk) 20:46, 29 April 2020 (UTC)

 * What sources did you use for the investigation?Driverofknowledge (talk) 20:58, 29 April 2020 (UTC)

 * There is Woogie10w's version. I will document every instance of China or Chinese, whether it appears in the main body or reference titles.
 * More recently the research of the Commonwealth War Graves Commission (CWGC) has revised the military casualty statistics of the UK and its allies; they include in their listing of military war dead personnel outside of combat theaters and civilians recruited from Africa, the Middle East and China who provided logistical and service support in combat theaters
 * Vietnam (1914 known as French Indochina) (only included for the sake of completeness
 * Voice of America (VOA) (26 April 2010). "chinas-world-war-one-effort-draws-new-attention". VOA. Retrieved 26 April 2015.
 * Tang, Chi-hua: War Losses and Reparations (China), in: 1914-1918-online. International Encyclopedia of the First World War.
 * Britain recruited Indian, Chinese, native South African, Egyptian and other overseas labour to provide logistical support in the combat theatres. Included with British casualties in East Africa are the deaths of 44,911 recruited labourers. The CWGC reports that nearly 2,000 workers from the Chinese Labour Corps are buried with British war dead in France.
 * Overseas labor units serving with the British and French forces. The UK employed about 300,000 Indian, Chinese, native South African, Egyptian and other nations as laborers during the war. By the end of 1917, there were 50,000 Chinese workers in France, rising to 96,000 by August 1918 (with another 30,000 working for the French). 100,000 Egyptians were working in France and the Middle East, alongside 21,000 Indians and 20,000 South Africans, who were also in East Africa. A total of about 140,000 Chinese workers recruited in the Beiyang government, served on the Western Front during and after the war with the British and French Armed Forces. According to the Commonwealth war Graves Commission "In all, nearly 2,000 men from the Chinese Labour Corps died during the First World War, some as a direct result of enemy action, or of wounds received in the course of their duties, but many more in the influenza epidemic that swept Europe in 1918–19" One historical controversy is the number who died in the war. Some Chinese scholars say the number was as high as 20,000 but records kept by the British and French recruiters, show just under 2,000 lost their lives, many from the flu pandemic that swept the world starting in 1919.
 * "World Lijssenthoek Military Cemetery, Poperinge, Ypres Salient Battlefields, Belgium(The Chinese Labour Corps was used to clear battlefields, dig graves, trenches and carry out other such tasks which were often difficult and dangerous.)". Retrieved 2 May 2015.
 * THE CHINESE LABOUR CORPS AT THE WESTERN FRONT (In all, nearly 2,000 men from the Chinese Labour Corps died during the First World War, some as a direct result of enemy action, or of wounds received in the course of their duties but many more in the influenza epidemic that swept Europe in 1918–19" (PDF). Retrieved 26 April 2015.
 * WW1 Photos Centenary Website: 2014–2018 By Paul Reed (26 April 2010). "Chinese Labour Corps 1919". Paul Reed. Retrieved 26 April 2015.
 * Nowhere does the claim that the Chinese Labour Corps dead appear in the French totals appear in that version of the article. So your claim that what I wrote was based on what Woogie wrote is not supported by the available evidence. Therefore you are to blame despite your claim of innocence.

 * But yeah if you want Chinese laborers to the total, I guess you could. No. As pointed out, repeatedly, I do not accept any totals made by synthesis. I only accept totals published by reliable references. FDW777 (talk) 21:01, 29 April 2020 (UTC)

https://www.britannica.com/event/World-War-I/Killed-wounded-and-missing If this is a RS, then someone should mention it in the lede. Maybe as the higher range. 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 14:53, 30 April 2020 (UTC)
 * Which figures are you talking about?Slatersteven (talk) 15:19, 30 April 2020 (UTC)
 * Read the source, it gives 8.5 million total military dead and 13 million total civilian dead. So 21-ish million total dead. Is it a RS? 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 17:54, 30 April 2020 (UTC)
 * Yep seems OK.Slatersteven (talk) 18:09, 30 April 2020 (UTC)
 * Hmmm, IP is pointing at some guesswork, not hard evidence. It has been estimated that the number of civilian deaths attributable to the war was higher than the military casualties, or around 13,000,000. These civilian deaths were largely caused by starvation, exposure, disease, military encounters, and massacres. The Banner  talk 18:56, 30 April 2020 (UTC)
 * Estimated by who would be the obvious question. FDW777 (talk) 19:01, 30 April 2020 (UTC)
 * We do not second guess RS, and the EB is an RS. Its an upper limit.Slatersteven (talk) 19:04, 30 April 2020 (UTC)

FDW, Banner, you don't need to shoot down everything I do. Britannica is an RS. Thank you Slater, is it okay if I make that addition when May 5 passes? 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 19:08, 30 April 2020 (UTC)
 * Not without consensus, however this seems to be a valid edit, and I would ask that others take into account it is the edit, not the user that counts.Slatersteven (talk) 19:10, 30 April 2020 (UTC)
 * Got it. 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 19:11, 30 April 2020 (UTC)

 * Make what edit? You've provided no details about what you plan to change. If, as I fear, all that's going to happen to this article is that the casualty totals are going to constantly creep up I'll have to point out that the lower totals need to be kept in the article too. FDW777 (talk) 19:25, 30 April 2020 (UTC)
 * The I will suggest to obvious change "The total number of deaths includes from 9 to 11 million military personnel. The civilian death toll was about 8 million, " to "The total number of deaths includes from 8.5 to 11 million military personnel. The civilian death toll was about 8 to 13 million, ".Slatersteven (talk) 20:48, 30 April 2020 (UTC)

 * What sources are saying. The civilian death toll was 8 to 13 million just asking?Driverofknowledge (talk) 22:50, 30 April 2020 (UTC)
 * Assuming consensus is met, I would do what Slater did, keeping a range of numbers. Why would I get rid of the lower bound? Question Slater, where would I add the reference in that sentence, after the 8.5 and 13, or at the end of the sentence? 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 23:11, 30 April 2020 (UTC)
 * Whoops, here you go Driver https://www.britannica.com/event/World-War-I/Killed-wounded-and-missing 2601:85:C101:BA30:EDBB:7563:362A:612E (talk) 23:12, 30 April 2020 (UTC)

 * That is a good source. Its been around since 1768 I still have the big book set they use to make and update.Driverofknowledge (talk) 23:19, 30 April 2020 (UTC)

 * So now we have to good sources https://www.britannica.com/event/World-War-I/Killed-wounded-and-missing  https://encyclopedia.1914-1918-online.net/article/war_losses. Possible new source we can use in the Classification of casualty statistics part? https://www.futuremedicine.com/doi/full/10.2217/fmb-2018-0323Driverofknowledge (talk) 23:39, 30 April 2020 (UTC)

 * You could try reading the source provided more than once, which gives an upper limit (not a range) of 13 million.Slatersteven (talk) 09:01, 1 May 2020 (UTC)
 * The Brittancica gives guesswork without solid footing. The Banner  talk 09:16, 1 May 2020 (UTC)
 * Maybe, but it is an RS with a good reputation for fact checking, if you disagree take it to wp:rsn. "I do not agree with the RS" is not a valid objection. I will wait 24 hours for one, and if one is not presented I will make the change.Slatersteven (talk) 09:44, 1 May 2020 (UTC)

 * This one is a RS can we use both https://encyclopedia.1914-1918-online.net/article/war_lossesz?Driverofknowledge (talk) 11:07, 1 May 2020 (UTC)
 * We already give a range, because there is not single authoritative number. If we have a range we give the highest that appears in an RS, so again unless you want to take Britanica to RSN there is no real objection to its use.Slatersteven (talk) 11:27, 1 May 2020 (UTC)

 * I wasn't trying to go against consensus. I was just giving a suggestion, since the other source gives a range to why not use both. I'm sorry if I came off like I was. Sorry if I got anyone mad for my suggestion to use two sources for the number on the chart.Driverofknowledge (talk) 13:13, 1 May 2020 (UTC)
 * What we do when we have differing opinions in RS is to give them all. Thus (in this case) we would go for the lowest and the highest. We do not give "all ranges" we give a range.Slatersteven (talk) 13:17, 1 May 2020 (UTC)

Slater, I think we misunderstood each other. I know there isn't a range of 13 million. The upper bound for civilians would be 13 million, per the source. So I think we can reference that? And would we add 8.5 million military and 13 million civilians from the source to get 21.5 million total as a total upper-bound (assuming that's the highest number, of course), or would that be OR or WP:SYNTH? 2601:85:C101:BA30:F4C6:D43C:D787:34A5 (talk) 13:33, 1 May 2020 (UTC)
 * Seems OK to me.Slatersteven (talk) 13:38, 1 May 2020 (UTC)
 * Got it. 2601:85:C101:BA30:F4C6:D43C:D787:34A5 (talk) 13:41, 1 May 2020 (UTC)

 * What is the opinion on this source with the numbers https://encyclopedia.1914-1918-online.net/article/war_losses? I am just asking not trying to go against Britannica I think Britannica is a good source.Driverofknowledge (talk) 15:29, 1 May 2020 (UTC)
 * I think it's a good source. We can mention it maybe not in a range, but as one given estimate. 2601:85:C101:BA30:F4C6:D43C:D787:34A5 (talk) 16:10, 1 May 2020 (UTC)

 * Ok that sounds good.Driverofknowledge (talk) 16:16, 1 May 2020 (UTC)

I made the edit. 2601:85:C101:BA30:9047:B5F5:878B:1137 (talk) 21:26, 7 May 2020 (UTC)

 * Does the opening. Need a rewrite now do to the new source?Driverofknowledge (talk) 21:28, 7 May 2020 (UTC)
 * Oh maybe. I only changed the first sentence and the total # in the chart. 2601:85:C101:BA30:9047:B5F5:878B:1137 (talk) 21:30, 7 May 2020 (UTC)

 * Are you the same Ip that has been on this page?Driverofknowledge (talk) 21:32, 7 May 2020 (UTC)
 * Yup, same IP (sorry it changes a lot). Quick look shows that the entire lede needs a rewrite. Most of it is unsourced and refers to the chart. I don't want to make the edit because I know Banner or FDW will find something minor to crucify me for. Driver/Slater, you think you can do it? 2601:85:C101:BA30:9047:B5F5:878B:1137 (talk) 21:36, 7 May 2020 (UTC)

 * I don't see anything. Wrong with you doing it for the lead since a new source was put by you.Driverofknowledge (talk) 21:51, 7 May 2020 (UTC)

Two changes made without consensus reverted
Firstly this change changing The civilian death toll was about 8 million to The civilian death toll was about 13 million. While the Brittanica reference and the 13 million were talked about in general terms, there was never any proposal to make that specific edit. If there had been, the objection would be a complete and total violation of WP:NPOV, since we're not just going with the total from one reference. The Brittanica reference isn't even that useful for the civilian death toll. Unlike the table that contains breakdowns of deaths/wounded/missing etc by country (cited to U.S. War Department in February 1924. U.S. casualties as amended by the Statistical Services Center, Office of the Secretary of Defense, Nov. 7, 1957, the civilian death toll is given as It has been estimated that the number of civilian deaths attributable to the war was higher than the military casualties, or around 13,000,000. As I said earlier in the discussion, who has estimated this? This is en estimate that needs further research and direct attributing, not stating as fact given there is clearly no academic consensus on the total number of deaths. The change makes the article completely contradictory, since the table at World War I casualties gives a total of 2,250,099 civilians killed due to military action and crimes against humanity and 5,411,000 to 6,100,000 due to malnutrition and disease. So if we're saying 7,661,099 to 8,350,099 in the table, why are we saying 13 million in the text????

Secondly this change changing the upper limit on military deaths from 10,824,236 to 20,824,236. I'm struggling to consider this to be anything other than vandalism. The table gives the Allied military death toll as 5,186,854 to 6,433,692, and the Axis military death toll to be 3,386,200 to 4,390,544. This gives a total, excluding Neutral nations, of 8,573,054 to 10,824,236, which is what the article said before. So why has 10 million suddenly been added to the total?????

In order for consensus to be clear for any edits, I request that any future changes are made explicitly clear as to what exactly figure(s) are going to be changed from and to and which references support the change. Talking generally about Brittanica and 13 million then increasing the death toll by 5 million and making the article contradictory was never actually proposed. The IP editor did the exact opposite of what he said he was going to do here, Assuming consensus is met, I would do what Slater did, keeping a range of numbers. Why would I get rid of the lower bound? Question Slater, where would I add the reference in that sentence, after the 8.5 and 13, or at the end of the sentence? So I really do have to ask the question. Why, given the IP editor explicitly said they would not be removing the lower bound did they do just that? FDW777 (talk) 12:07, 8 May 2020 (UTC)

I think all this needs taking to wp:dr now.Slatersteven (talk) 12:17, 8 May 2020 (UTC)

 * Just look at the last paragraph and compare what they said they were going to do, and what they actually did. FDW777 (talk) 12:19, 8 May 2020 (UTC)

 * I think this has to go to AN/I as IP is simply unwilling to comply to all the discussions here and to give reliable sources. The Banner  talk 12:31, 8 May 2020 (UTC)
 * Frankly it is not just the IP, there have been many issues here. I am not sure anymore who is in the right, hence why I think DR is needed.Slatersteven (talk) 12:33, 8 May 2020 (UTC)
 * I've tried to be constructive with this editor, I think the last paragraph of my post here is the best way forward. A straightforward "I propose to change x to y" complete with a reference. Look at . You said The I will suggest to obvious change "The total number of deaths includes from 9 to 11 million military personnel. The civilian death toll was about 8 million, " to "The total number of deaths includes from 8.5 to 11 million military personnel. The civilian death toll was about 8 to 13 million, ". The IP responds with the reply I've mentioned above, Assuming consensus is met, I would do what Slater did, keeping a range of numbers. Why would I get rid of the lower bound? Question Slater, where would I add the reference in that sentence, after the 8.5 and 13, or at the end of the sentence? The change they made was the opposite of what was discussed, that's absurd. FDW777 (talk) 12:54, 8 May 2020 (UTC)

I have said what I have to say.Slatersteven (talk) 12:56, 8 May 2020 (UTC)
 * To clear things up, I only made two edits to this page, and I never edited the Central Powers numbers (not Axis). SO thank you FDW for reverting that vandalism. FDW, I was in a rush while making the edit (see above, my laptop is broken), so assume good-faith. I forgot to keep the range and would be happy to maintain it. My reasoning at the time, if you look at my discussion with Driver above, was that the lede is mostly unsourced (one issue you've been aiming at) and refers entirely to the chart (which you yourself said is completely unreliable). So I got rid of "8", and I think the whole the lede needs to be deleted and rewritten, something you can do. Excuse my haste. I will add back the 13 number but keep the 8. But my question to you, and Banner/Slater, can you provide a source for 8 million civilian dead? It would make the lede more sourced in that matter. 2601:85:C101:BA30:F421:B237:377F:9C58 (talk) 21:51, 8 May 2020 (UTC)

 * I found some sources. So far that say its about 6-7 million civilian dead, but that's it on my end.Driverofknowledge (talk) 04:04, 9 May 2020 (UTC)

 * This is the very first external link in the section and supports a low end estimate of 6 million, and inclusion of country estimates in the table where appropriate. Obviously the first column in the table is useless, but the second and third columns are exactly what we are looking for. Estimates broken down by country by specific studies are what I've been calling for all along. FDW777 (talk) 07:00, 9 May 2020 (UTC)

 * I mentioned this source beforeDriverofknowledge (talk) 14:02, 9 May 2020 (UTC)
 * Apologies. With all the background noise on this page, it's easy to miss things. FDW777 (talk) 12:55, 10 May 2020 (UTC)

Agreed, half of this page should be archived by now. FDW, the source you provided is good, where exactly is it used in the article, and what does the 6 million refer to specifically? It would be good to add it in the article. 2601:85:C101:BA30:D475:54CE:FC6C:FDD (talk) 01:15, 12 May 2020 (UTC)

Proposed change
The sentence in the lead The civilian death toll was about 8 to 13 million is changed to give a lower figure of 6 million. This is supported by the third column for civilian deaths in this reference and a 6.5 million death toll would also be referenced by the second column of that reference and the last reference listed in the section at World War I casualties. I lost track of how many changes I'd need to make to the tables to take this reference into account, so dealing with one issue at a time. FDW777 (talk) 13:40, 15 May 2020 (UTC)
 * The range should be lowest to highest, so yes I support the change.Slatersteven (talk) 13:45, 15 May 2020 (UTC)
 * I agree. The Banner  talk 14:08, 15 May 2020 (UTC)
 * Fair change. 2601:85:C101:BA30:8820:2F1A:F49F:F4AC (talk) 23:45, 19 May 2020 (UTC)

✅ FDW777 (talk) 16:06, 29 May 2020 (UTC)

Proposed changes
I (same IP as before) propose to add Liberian civilian losses to the chart. 4 civilians dead. Using this source:

Shellum, Brian G. African American Officers in Liberia: A Pestiferous Rotation, 1910-1942. University of Nebraska Press, 2018, pp. 108.

Any questions? 2601:85:C101:BA30:2001:115C:431D:A5C6 (talk) 21:22, 28 May 2020 (UTC)
 * Is it possible to give a quote from that book? The Banner  talk 21:50, 28 May 2020 (UTC)

 * Object The book says First, it seized and scuttled the Liberian schooner RLS President Howards, then sent the Liberian crew ashore with a demand to haul down the French flag and destroy the French cable station. When President Howard refused his demands, German Korvettenkapitän Herman Gerche opened fire with his 150-mm deck gun, destroying the French wireless station and damaging the cable station. The hour-long shelling caused extensive damage to buildings and killed four people, three of them children. I have previously objected to methodology such as that as not acceptable, we should be relying on published totals. FDW777 (talk) 21:55, 28 May 2020 (UTC)
 * So, the fourth victim could have been military as it is not better described. In that case, I have to object too. The Banner  talk 22:37, 28 May 2020 (UTC)
 * For transparency since your reply I have amended two erroneous instances of "Liberation" to "Liberian", I'm not used to typing the latter word obviously. FDW777 (talk) 22:45, 28 May 2020 (UTC)

Technically Banner, they could all be military by that logic, due to child soldiers and what not. I believe it is referring to civilians, as the book goes into detail on military matters separately, but I'm not interested on quibbling about semantics as before.

FDW, if this methodology is unacceptable, should we delete the chart? Personally, I wouldn't oppose that at this point. Secondly, I believe a footnote of Liberian dead, though very small, is worthy of mention. What are your thoughts, and if you agree with me, how do you think we should go about it? 2601:85:C101:BA30:2001:115C:431D:A5C6 (talk) 23:03, 28 May 2020 (UTC)
 * "I believe"... nope. We need facts here, not believes. The Banner  talk 23:24, 28 May 2020 (UTC)
 * OK, it is referring to civilians, not military or space aliens. Liberia incurred zero military losses during the war. Regardless, do you have an opinion on my questions? 2601:85:C101:BA30:2001:115C:431D:A5C6 (talk) 23:33, 28 May 2020 (UTC)

 * Actually, considering the state of the article and FDW's ideas, I think it would be best if we just got rid of the chart altogether and relabel the footnote section to something like "Losses by country." That way we can avoid adding up stuff (FDW), while keeping important information about various countries, major/minor. 2601:85:C101:BA30:2001:115C:431D:A5C6 (talk) 23:08, 28 May 2020 (UTC)

My preference with the charts would be something similar to this reference, although split charts are not important. Instead of trying to jam every single variation of casualty figure for a particular country into a chart, each study such as Westmoreland, Overmans, Winter etc has its own column. Any countries not included in this table could be covered in however many paragraphs of prose are needed in a section titled "Other casualties" or something like that. FDW777 (talk) 14:44, 29 May 2020 (UTC)
 * Sounds interesting. So I don't misunderstand, do you mean that there would a table of each study (basically like the reference)? I'm assuming that would include the major countries. And then the Other losses section would include minor nations like Haiti and Siam that aren't included in the major studies. If that's the case, I'd think that's ok, but to be honest, I don't think I can handle all that editing, maybe only the Other losses section. And also, would the footnotes bit be kept or no? 2601:85:C101:BA30:2001:115C:431D:A5C6 (talk) 17:30, 29 May 2020 (UTC)

"German causalties in World War I" listed at Redirects for discussion
A discussion is taking place to address the redirect German causalties in World War I. The discussion will occur at Redirects for discussion/Log/2020 June 3 until a consensus is reached, and readers of this page are welcome to contribute to the discussion. — Tenryuu 🐲 ( 💬 • 📝 )  18:34, 3 June 2020 (UTC)

Deaths as % of population in the table
In the table, it says deaths as a % of population, but shouldn't it be deaths and missing? I think that's the number that's being divided by population. Chaptagai (talk) 10:03, 18 November 2023 (UTC)

Recent Additions
I'm glad that after a few years the article is adding back some of the information that was removed in the mass revert. Could still use a lot of cleanup, but it's coming along. Maybe in the next decade... 2601:85:C100:46C0:498:2748:D8A9:B774 (talk) 02:24, 27 March 2024 (UTC)

Brazil
In Brazil_during_World_War_I (unsourced) it says three Brazilian civilians were killed by a German sub. Is this an oversight, or has it been excluded from the page? If so, why? Nyonyatwelve (talk) 15:37, 17 July 2024 (UTC)

title: Talk:World War I casualties


text:
Letter of credit

A letter of credit (LC), also known as a documentary credit or bankers commercial credit, or letter of undertaking (LoU), is a payment mechanism used in international trade to provide an economic guarantee from a creditworthy bank to an exporter of goods. Letters of credit are used extensively in the financing of international trade, when the reliability of contracting parties cannot be readily and easily determined. Its economic effect is to introduce a bank as an underwriter that assumes the counterparty risk of the buyer paying the seller for goods.

Typically, after a sales contract has been negotiated, and the buyer and seller have agreed that a letter of credit will be used as the method of payment, the applicant will contact a bank to ask for a letter of credit to be issued. Once the issuing bank has assessed the buyer's credit risk – i.e. that the applicant will be able to pay for the goods – it will issue the letter of credit, meaning that it will provide a promise to pay the seller upon presentation of certain documents. Once the beneficiary (the seller) receives the letter of credit, it will check the terms to ensure that it matches with the contract and will either arrange for shipment of the goods or ask for an amendment to the letter of credit so that it meets with the terms of the contract. The letter of credit is limited in terms of time, the validity of credit, the last date of shipment, and how late after shipment the documents may be presented to the nominated bank.

Once the goods have been shipped, the beneficiary will present the requested documents to the nominated bank. This bank will check the documents, and if they comply with the terms of the letter of credit, the issuing bank is bound to honor the terms of the letter of credit by paying the beneficiary.

If the documents do not comply with the terms of the letter of credit they are considered discrepant. At this point, the nominated bank will inform the beneficiary of the discrepancy and offer a number of options depending on the circumstances after consent of applicant. However, such a discrepancy must be more than trivial. Refusal cannot depend on anything other than reasonable examination of the documents themselves. The bank then must rely on the fact that there was, in fact, a material mistake. A fact that if true would entitle the buyer to reject the items. A wrong date such as an early delivery date was held by English courts to not be a material mistake. If the discrepancies are minor, it may be possible to present corrected documents to the bank to make the presentation compliant. Failure of the bank to pay is grounds for a chose in action. Documents presented after the time limits mentioned in the credit, however, are considered discrepant.

If the corrected documents cannot be supplied in time, the documents may be forwarded directly to the issuing bank in trust; effectively in the hope that the applicant will accept the documents. Documents forwarded in trust remove the payment security of a letter of credit so this route must only be used as a last resort.

Some banks will offer to "Telex for approval" or similar. This is where the nominated bank holds the documents, but sends a message to the issuing bank asking if discrepancies are acceptable. This is more secure than sending documents in trust.

History
The letter of credit has been used in Europe since ancient times. Letters of credit were traditionally governed by internationally recognized rules and procedures rather than by national law. The International Chamber of Commerce oversaw the preparation of the first Uniform Customs and Practice for Documentary Credits (UCP) in 1933, creating a voluntary framework for commercial banks to apply to transactions worldwide.

In the late 19th century and early 20th century, travelers commonly carried a circular letter of credit issued by a relationship bank, which allowed the beneficiary to withdraw cash from other banks along their journey. This type of letter of credit was eventually replaced by traveler's checks, credit cards and automated teller machines.

Although letters of credit first existed only as paper documents, they were regularly issued by telegraph in the late 19th century, and by telex in the latter half of the 20th century. Beginning in 1973 with the creation of SWIFT, banks began to migrate to electronic data interchange as a means of controlling costs, and in 1983 the UCP was amended to allow "teletransmission" of letters of credit. By the 21st century, the vast majority of LCs were issued in electronic form and entirely "paperless". LCs were becoming more common. Marcell David Reich (commonly known as Marc Rich) popularised the use of letters of credit in the oil trade.

Terminology
UCP 600 (2007 Revision) regulates common market practice within the letter of credit market. It defines a number of terms related to letters of credit which categorise the various factors within any given transaction. These are crucial to understanding the role financial institutions play. These include:

 * The applicant is the person or company who has requested the letter of credit to be issued; this will normally be the buyer.
 * The beneficiary is the person or company who will be paid under the letter of credit; this will normally be the seller (UCP600 Article 2 defines the beneficiary as "the party in whose favour a credit is issued").
 * The issuing bank is the bank that issues the credit, usually following a request from an applicant.
 * The nominated bank is a bank mentioned within the letter of credit at which the credit is available (in this respect, UCP600 Article 2 reads: "Nominated bank means the bank with which the credit is available or any bank in the case of a credit available with any bank").
 * The advising bank is the bank that will inform the beneficiary or their nominated bank of the credit, send the original credit to the beneficiary or their nominated bank, and provide the beneficiary or their nominated bank with any amendments to the letter of credit.
 * Confirmation is an undertaking from a bank other than the issuing bank to pay the beneficiary for a complying presentation, allowing the beneficiary to further reduce payment risk, although confirmation is usually at an extra cost.
 * A confirming bank is a bank other than the issuing bank that adds its confirmation to credit upon the issuing bank's authorization or request thus providing more security to the beneficiary.
 * A complying presentation is a set of documents that meet with the requirements of the letter of credit and all of the rules relating to letters of credit.

Function
A letter of credit is an important payment method in international trade. It is particularly useful where the buyer and seller may not know each other personally and are separated by distance, differing laws in each country, and different trading customs. It is a primary method in international trade to mitigate the risk a seller of goods takes when providing those goods to a buyer. It does this by ensuring that the seller is paid for presenting the documents which are specified in the contract for sale between the buyer and the seller. That is to say, a letter of credit is a payment method used to discharge the legal obligations for payment from the buyer to the seller, by having a bank pay the seller directly. Thus, the seller relies on the credit risk of the bank, rather than the buyer, to receive payment. As will be seen, and is observed in Image 2, the bank will pay the seller the value of the goods when the seller provides negotiable instruments, documents which themselves represent the goods. Upon presentation of the documents, the goods will traditionally be in the control of the issuing bank, which provides them security against the risk that the buyer (who had instructed the bank to pay the seller) will repay the bank for making such a payment.

In the event that the buyer is unable to make payment on the purchase, the seller may make a demand for payment on the bank. The bank will examine the beneficiary's demand and if it complies with the terms of the letter of credit, will honor the demand. Most letters of credit are governed by rules promulgated by the International Chamber of Commerce known as Uniform Customs and Practice for Documentary Credits. The current version, UCP 600, became effective July 1, 2007. Banks will typically require collateral from the purchaser for issuing a letter of credit and will charge a fee which is often a percentage of the amount covered by the letter of credit.

Types
Several categories of LCs exist which seek to operate in different markets and solve different issues. Examples of these include:
 * Import vs export (commercial): The same credit can be termed an import or export letter of credit depending on whose perspective is considered. For the importer it is termed an import LC and for the exporter of goods an export LC.
 * Revocable vs irrevocable: Whether an LC is revocable or irrevocable determines whether the buyer and the issuing bank are able to manipulate the LC or make corrections without informing or getting permissions from the seller. According to UCP 600, all LCs are irrevocable, hence in practice the revocable type of LC is increasingly obsolete. Any changes (amendment) or cancellation of the LC (except when expired) is done by the applicant (buyer) through the issuing bank. It must be authenticated and approved by the beneficiary (seller).
 * Confirmed vs unconfirmed: An LC is said to be confirmed when a second bank adds its confirmation (or guarantee) to honor a complying presentation at the request or authorization of the issuing bank.
 * Restricted vs unrestricted: Either the one advising bank can purchase a bill of exchange from the seller in the case of a restricted LC, or the confirmation bank is not specified, which means that the exporter can show the bill of exchange to any bank and receive a payment on an unrestricted LC.
 * Deferred vs usance: A credit that is not paid or assigned immediately after presentation, but after an indicated period that is accepted by both buyer and seller. Typically, seller allows buyer to pay the required money after taking the related goods and selling them.

Additionally, a letter of credit may also have specific terms relating to the payment conditions which relate to the underlying reference documents. Some of these include
 * At sight: A credit that the announcer bank immediately pays after inspecting the carriage documents from the seller.
 * Red clause: Before sending the products, seller can take the pre-paid part of the money from the bank. The first part of the credit is to attract the attention of the accepting bank. The first time the credit is established by the assigner bank, is to gain the attention of the offered bank. The terms and conditions were typically written in red ink, thus the name.
 * Back-to-back: A pair of LCs in which one is to the benefit of a seller who is unable to provide the corresponding goods for unspecified reasons. In that event, a second credit is opened for another seller to provide the desired goods. Back-to-back is issued to facilitate intermediary trade. Intermediate companies such as trading houses are sometimes required to open LCs for suppliers and receive export LCs from buyers.
 * Standby letter of credit (SBLC): Operates like a commercial letter of credit, except that typically it is retained as a standby instead of being the intended payment mechanism. In other words, this is an LC which is intended to provide a source of payment in the event of non-performance of contract. This is a security against an obligation which is not performed. If the bank is presented with demands of non-payment it is not a guarantee; the trigger is not non-payment but documentation. UCP600 Article 1 provides that the UCP applies to standby LCs; ISP98 applies specifically to standby letters of credit; and the United Nations Convention on Independent Guarantees and Standby Letters of Credit applies to a small number of countries that have ratified the convention.

Transferability
The exporter has the right to make the credit available to one or more subsequent beneficiaries. Credits are made transferable when the original beneficiary is a "middleman", who does not supply the documents himself, but procures either goods or documents from other suppliers and arranges for them to be sent to the issuing bank. A letter of credit can be transferred to the second beneficiary at the request of the first beneficiary only if it expressly states that the letter of credit is transferable. A bank is not obligated to transfer a credit. It can further be transferred to more than one alternate beneficiary as long as it allows partial shipments. The terms and conditions of the original credit must be replicated exactly in the transferred credit. However, to keep the workability of the transferable letter of credit, some figures can be reduced or curtailed, including: The first beneficiary may demand from the transferring bank to substitute for the applicant. However, if a document other than the invoice must be issued in a way to show the applicant's name, in such a case that requirement must indicate that in the transferred credit it will be free. Transferred credit cannot be transferred again to a third beneficiary at the request of the second beneficiary.
 * Amount
 * Unit price of the merchandise (if stated)
 * Expiry date
 * Presentation period
 * Latest shipment date or given period for shipment.

In some cases, the middleman does not want the buyer and supplier to know each other. The middleman is entitled to substitute his own invoice for the supplier's and acquire the difference as profit.

Documents that may be requested
To receive payment, an exporter or shipper must present the documents required by the LC. Typically the letter of credit will request an original bill of lading as the use of a title document such as this is critical to the functioning of the letter of credit. However, the list and form of documents is open to negotiation and might contain requirements to present documents issued by a neutral third-party evidencing the quality of the goods shipped, or their place of origin or place. Typical types of documents in such contracts might include:

The range of documents that may be requested by the applicant is vast and varies considerably by country and commodity. Several methods of verifying the documents exist. A documentary credit provides security for both buyer and seller. Outlined in the UCP 600, the bank will give an undertaking (or promise), on behalf of buyer (who is often the applicant) to pay the beneficiary the value of the goods shipped if acceptable documents are submitted and if the stipulated terms and conditions are strictly complied with. The buyer can be confident that the goods he is expecting only will be received since it will be evidenced in the form of certain documents, meeting the specified terms and conditions. The supplier finds his confidence in the fact that if such stipulations are met, he will receive payment from the issuing bank, who is independent of the parties to the contract. In some cases, a letter of credit will require the documents to be collected. Another form of payment is the direct payment where the supplier ships the goods and waits for the buyer to pay, on open account terms.
 * Financial documents — bill of exchange, co-accepted draft
 * Commercial documents — invoice, packing list
 * Shipping documents — bill of lading (ocean or multi-modal or charter party), airway bill, lorry/truck receipt, railway receipt, CMC other than mate receipt, forwarder cargo receipt
 * Official documents — license, embassy legalization, origin certificate, inspection certificate, phytosanitary certificate
 * Insurance documents — insurance policy or certificate, but not a cover note.

Risk exposure
Letters of Credit are often used in international transactions to ensure that payment will be received where the buyer and seller may not know each other and are operating in different countries. In this case, the seller is exposed to a number of risks such as credit risk, and legal risk caused by the distance, differing laws and difficulty in knowing each party personally. Some of the other risks inherent in international trade include:

Fraud
The payment will be obtained for nonexistent or worthless merchandise against presentation by the beneficiary of forged or falsified documents.

Legal risks
There is the possibility that performance of a documentary credit may be disturbed by legal action relating directly to the parties and their rights and obligations under the documentary credit or performance may be prevented by government action outside the control of the parties. Alternatively, performance of a contract – including an obligation under a documentary credit relationship – could also be prevented by external factors such as natural disasters or armed conflicts. These risks, however, are often seen as secondary to the risk of non-payment.

Applicant
Several risks could relate to the parties of the applicant themselves. These may include situations where there is a non-delivery of Goods, Short shipment, the goods are of inferior quality, are damaged, or are late. The applicant is also exposed to the failure of the bank to make payment.

Issuing bank
The issuing bank is also exposed to risks which it may seek to mitigate through various techniques. It will be exposed to the insolvency risk of the applicant, that is, the risk the applicant runs insolvent before it is able to repay the letter of credit. Secondly, the bank will be exposed to a risk of fraud by the seller, who may provide incorrect or falsified documents to receive payment. If the bank ought to have known that the documents were a fraud, then the bank will be exposed to a fraud.

Beneficiary
The beneficiary will be exposed to the risk of its own failure to comply with credit conditions or failure of, or delays in payment from, the issuing bank. These risks are considered remote. Crucially, the beneficiary is not exposed to the risks of set-off by the applicant where the goods are damaged or are of inferior quality. While he may be sued by the applicant at a later point, the issuing bank cannot reduce the payment owed to correspond with the damage occurred. This is crucial in mitigating the risk to insolvency. Crucial to a letter of credit is the beneficiary's (the seller) attempt to isolate itself from the credit risk of the buyer. That is to say, it is concerned primarily with the ability of the buyer to pay for the goods.

Pricing
Issuance charges, covering negotiation, reimbursements and other charges are paid by the applicant or as per the terms and conditions of the LC. If the LC does not specify charges, they are paid by the applicant. Charge-related terms are indicated in field 71B.

Legal principles
The fundamental principle of all letters of credit is that letters of credit deal with documents and not with goods. The payment obligation is independent from the underlying contract of sale or any other contract in the transaction. The bank's obligation is defined by the terms of the LC alone, and the contract of sale is not considered.

The specified documents are often bills of lading or other 'documentary intangibles' which 'A' and 'B' have previously specified in their original contract.

The actions available to the buyer arising out of the sale contract do not concern the bank and in no way affect its liability. Article 4(a) of the UCP600 states this principle clearly. This is confirmed within the market-practice documents stated by Article 5 of UCP600. As is a core tenet of financial law, market practice comprises a substantial portion of how parties behave. Accordingly, if the documents tendered by the beneficiary or their agent are in order, then, in general, the bank is obliged to pay without further qualifications.

As a result, it is the issuing bank who bears the risk that is linked with non-payment of the buyer. This is advantageous because the issuing bank often has a personal banking relationship with the buyer. The whole commercial purpose for which the system of confirmed irrevocable documentary credits has been developed in international trade is to give to the seller an assured right to be paid before he parts with control of the goods under sale.

It further does not permit of any dispute with the buyer as to the performance of the contract of sale being used as a ground for non-payment or reduction or deferment of payment.

The only exception to this may be fraud. For example, a dishonest seller may present documents which comply with the letter of credit and receive payment, only for it to be later discovered that the documents are fraudulent and the goods are not in accordance with the contract. This would place the risk on the buyer, but it also means that the issuing bank must be stringent in assessing whether the presenting documents are legitimate.

Similar to other financial law instruments, a letter of credit utilises several legal concepts to achieve the economic effect of shifting the legal exposure from the seller to the buyer. The policies behind adopting this principle of abstraction are purely commercial. Whilst the bank is under an obligation to identify that the correct documents exist, they are not expected to examine whether the documents themselves are valid. That is to say, the bank is not responsible for investigating the underlying facts of each transaction, whether the goods are of the sufficient – and specified – quality or quantity.

Because the transaction operates on a negotiable instrument, it is the document itself which holds the value - not the goods to which the reference. This means that the bank need only be concerned with whether the document fulfils the requirements stipulated in the letter of credit.

Documents required under the LC, could in certain circumstances, be different from those required under the sale transaction. This would place banks in a dilemma in deciding which terms to follow if required to look behind the credit agreement. Since the basic function of the credit is to provide a seller with the certainty of payment for documentary duties, it would seem necessary that banks should honor their obligation in spite of any buyer allegations of misfeasance. If this were not the case, financial institutions would be much less inclined to issue documentary credits because of the risk, inconvenience, and expense involved in determining the underlying goods.

Financial institutions do not act as 'middlemen' but rather, as paying agents on behalf of the buyer. Courts have emphasized that buyers always have a remedy for an action upon the contract of sale and that it would be a calamity for the business world if a bank had to investigate every breach of contract.

With the UCP 600 rules the ICC sought to make the rules more flexible, suggesting that data in a document "need not be identical to, but must not conflict with data in that document, any other stipulated document, or the credit", as a way to account for any minor documentary errors. If this were not the case, the bank would be entitled to withhold payment even if the deviation is purely technical or even typographical.

However, in practice, many banks still hold to the principle of strict compliance, since it offers concrete guarantees to all parties. The general legal maxim de minimis non curat lex (literally "The law does not concern itself with trifles") has no place in the field.

However, whilst the details of the letter of credit can be understood with some flexibility the banks must adhere to the “principle of strict compliance” when determining whether the documents presented are those specified in the letter of credit. This is done to make the banks' duty of effecting payment against documents easy, efficient and quick.

Legal basis
Legal writers have failed to satisfactorily reconcile the bank's obligation to pay on behalf of the applicant with any contractually-founded, academic analysis. That is to say, they have not examined legal effect of the banks obligation through a conclusive theoretical lens. This has produced several conflicting theories as to the contractual effect of a letter of credit. Some theorists suggest that the obligation to pay arises through the implied promise, assignment, novation, reliance, agency, estoppel and even trust and the guarantees. Although documentary credits are enforceable once communicated to the beneficiary, it is difficult to show any consideration given by the beneficiary to the banker prior to the tender of documents. In such transactions the undertaking by the beneficiary to deliver the goods to the applicant is not sufficient consideration for the bank's promise because the contract of sale is made before the issuance of the credit, thus consideration in these circumstances is past. However, the performance of an existing duty under a contract may be a valid consideration for a new promise made by the bank, provided that there is some practical benefit to the bank A promise to perform owed to a third party may also constitute a valid consideration.

It might also be feasible to typify letters of credit as a collateral contract for a third-party beneficiary, because three different entities participate in the transaction: the seller, the buyer, and the banker. Jean Domat suggests that because letters of credit are prompted by the buyer's necessity, the cause of an LC is to release the buyer of his obligation to pay directly to the seller. Therefore, an LC theoretically fits as a collateral contract accepted by conduct or in other words, an implied-in-fact contract where the buyer participates as the third party beneficiary with the bank acting as the stipulator and the seller as the promisor. The term beneficiary is not used properly in the scheme of an LC because a beneficiary (also, in trust law, cestui que use) in the broadest sense is a natural person or other legal entity who receives money or other benefits from a benefactor. Note that under the scheme of letters of credit, banks are neither benefactors of sellers nor benefactors of buyers and the seller receives no money in gratuity mode. Thus is possible that a “letter of credit” was one of those contracts that needed to be masked to disguise the “consideration or privity requirement”. As a result, this kind of arrangement would make letter of credit to be enforceable under the action assumpsit because of its promissory connotation.

A few countries have created statutes in relation to letters of credit. For example, most jurisdictions in the United States (U.S.) have adopted Article 5 of the Uniform Commercial Code (UCC). These statutes are designed to work with the rules of market practice including UCP and ISP98. These rules of practice are incorporated into the transaction by agreement of the parties. The latest version of the UCP is the UCP600 effective July 1, 2007. Since the UCP are not laws, parties have to include them into their arrangements as normal contractual provisions. However, they still form a substantial part of market practice and crucially underpin financial law.

Germany
Bürgerliches Gesetzbuch, the German civil code, does not directly address letters of credit. German case law indicates that the relationship between the issuing bank and customer is a contract for execution of a transaction, while the relationship between the issuing bank and the beneficiary is a promise of a debt.

Switzerland
The Swiss Civil Code of 1911 did not directly address letters of credit, which were still rare in the country at the time. Courts eventually dealt with the device by treating it as a hybrid of a mandate (Auftrag) and authorization-to-pay contract (Anweisung).

United States
Letters of credit came into general domestic use in the United States during World War I, although they had been used in American foreign trade for some time prior. The state of New York has historically had the most substantial and consistent body of case law in the United States with regard to letters of credit, due to the prominence of New York banks in international trade. The New York Bankers [sic] Commercial Credit Conference of 1920 provided the first set of voluntary LC regulations for major banks in the United States, but these banks transitioned to the international UCP standard by 1938.

Article 5 of the Uniform Commercial Code, drafted in 1952, provided a basis for codifying many UCP principles into state law and created one of the only extensive specific legal regulations of letters of credit worldwide, although the UCC rules do not cover all aspects of letters of credit. New York effectively subjugated the UCC rules to the existing UCP rules, and as a result the UCP rules continued to govern letters of credit under New York law. Article 5 was revised in 1995 to reflect the latest international practices as codified in the UCP.

Use in fraud
Letters of credit are sometimes used to defraud banks through presentment of false documentation indicating that goods were shipped when they actually were not. Letters of credit are also sometimes used as part of fraudulent investment schemes.

In the international banking system, a letter of undertaking (LOU) is a provisional bank guarantee, under which a bank allows its customer to raise money from another bank's foreign branch in the form of short-term credit. The LOU serves the purpose of a bank guarantee. However, to be able to raise the LOU, the customer is supposed to pay margin money to the bank issuing the LOU and accordingly, he is granted a credit limit. In 2018, PNB suffered from such a breach of documentation protocols.

title: Letter of credit


text:
User:Cladist

Well, here's a quick description of me. In real Life, my name is Eric Katz. I'm currently working on a PhD in Systematic Theory (see systematics) and Bioinformatics at Kent State, under Gwenn Volkert and Andrea Schwarzbach. It's taking me a while, and no, I don't know when I'll be done. In my spare time (Ha!) I volunteer my professional skills (such as they are) and time on the board of Camp Quest, a camp for Secular Humanist kids. I have also been known to join the Biology Department's faculty in the occasional game of pool at our local watering hole. My interest in the Wikipedia began when I discovered that it is a wonderful source of information, and became interested in how I can help.

You can find most of my edits on the Cladistics page, where I try to remain unbiased, despite being a cladist myself. As far as that is concerned, I learned the basics of Cladistics while studying paleontology at UC Berkeley. There we were taught to beware the scala natura, and shun the frumious phenetics. Currently, I am trying to annoy the dominant paradigm by applying macroevolutionary theory to maximum likelihood phylogenetics.

Update: For various reasons (none of them very good, really), I am no longer at Kent State. However, I am happily living in California, teaching Human Anatomy and Physiology at a couple of local colleges. I still keep an eye on the Cladistics page, but not often. And the username? What the heck; I'll keep it.

title: User:Cladist


text:
Upper airway resistance syndrome

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

History
Upper airway resistance syndrome was first recognized at Stanford University in the late 1980s. The article that described it by name, along with its relationship to obstructive sleep apnea, was published in 1992 by Guilleminault et al.

Signs and symptoms
Symptoms of UARS are similar to those of obstructive sleep apnea, but not inherently overlapping. Fatigue, insomnia, daytime sleepiness, unrefreshing sleep, anxiety, and frequent awakenings during sleep are the most common symptoms. Oxygen desaturation is minimal or absent in UARS, with most having a minimum oxygen saturation >92%.

Many patients experience chronic insomnia that creates both a difficulty falling asleep and staying asleep. As a result, patients typically experience frequent sleep disruptions. Most patients with UARS snore, but not all.

Some patients experience hypotension, which may cause lightheadedness, and patients with UARS are also more likely to experience headaches and irritable bowel syndrome.

Predisposing factors include a high and narrow hard palate, an abnormally small intermolar distance, an abnormal overjet greater than or equal to 3 millimeters, and a thin soft palatal mucosa with a short uvula. In 88% of the subjects, there is a history of early extraction or absence of wisdom teeth. There is an increased prevalence of UARS in east Asians.

Pathophysiology
Upper airway resistance syndrome is caused when the upper airway narrows without closing. Consequently, airflow is either reduced or compensated for through an increase in inspiratory efforts. This increased activity in inspiratory muscles leads to the arousals during sleep which patients may or may not be aware of.

A typical UARS patient is not obese and possesses small jaws, which can result in a smaller amount of space in the nasal airway and behind the base of the tongue. Patients may have other anatomical abnormalities that can cause UARS such as deviated septum, inferior turbinate hypertrophy, a narrow hard palate that reduces nasal volume, enlarged tonsils, or nasal valve collapse. UARS affects equal numbers of males and females.

Why some patients with airway obstruction present with UARS and not OSA is thought to be caused by alterations in nerves located in the palatal mucosa. UARS patients have largely intact and responsive nerves, while OSA patients show clear impairment and nerve damage. Functioning nerves in the palatal mucosa allow UARS patients to more effectively detect and respond to flow limitations before apneas and hypopneas can occur. Patients with intact nerves are able to dilate the genioglossus muscle, a key compensatory mechanism utilized in the presence of airway obstruction. What damages the nerves is not definitively known, but it is hypothesized to be caused by the long term effects of gastroesophageal reflux and/or snoring.

Diagnosis
UARS is diagnosed using the Respiratory Disturbance Index (RDI). A patient is considered to have UARS when they have an Apnea-Hypopnea Index (AHI) less than 5, but an RDI greater than or equal to 5. Unlike the Apnea-Hypopnea Index, the Respiratory Disturbance Index includes Respiratory Effort-related Arousals (RDI = AHI + RERA Index). In 2005, the definition of sleep apnea was changed to include patients with UARS by using RDI to determine sleep apnea severity.

The diagnosis of UARS is based on findings on a polysomnogram. On polysomnograms, a UARS patient will have very few apneas and hypopneas, but many Respiratory effort-related Arousals. Portable Home Sleep Test monitors (HST) are an alternative to sleep-laboratory polysomnography. Some of the HSTs allow for the breathing signals to be viewed within the raw data of the HST study and even a cursory review of these flow signals, will reveal those patients who would likely have upper airway resistance syndrome as well. RERAs are periods of increased respiratory effort lasting for more than ten seconds and ending in arousal. Whether or not an event is classified as a RERA or Hypopnea depends on the definition of Hypopnea used by the sleep technician. The American Academy of Sleep Medicine currently recognizes two definitions. The scoring of Respiratory Effort-related Arousals is currently designated as "optional" by the AASM. Thus, many patients who receive sleep studies may receive a negative result, even if they have UARS.

Based on symptoms, patients are commonly misdiagnosed with idiopathic insomnia, idiopathic hypersomnia, chronic fatigue syndrome, fibromyalgia, or a psychiatric disorder such as ADHD or depression. Studies have found that children with UARS are frequently misdiagnosed with ADHD. One study found UARS or OSA present in up to 56% of children with ADHD. Studies show that symptoms of ADHD caused by UARS significantly improve or remit with treatment in surgically treated children.

Behavioral modification
Behavioral modifications include getting at least 7–8 hours of sleep and various lifestyle changes, such as positional therapy. Sleeping on one's side rather than in a supine position or using positional pillows can provide relief, but these modifications may not be sufficient to treat more severe cases. Avoiding sedatives including alcohol and narcotics can help prevent the relaxation of airway muscles, and thereby reduce the chance of their collapse. Avoiding sedatives may also help to reduce snoring.

Medications
Nasal steroids may be prescribed in order to ease nasal allergies and other obstructive nasal conditions that could cause UARS.

Positive airway pressure therapy
If left untreated, UARS can develop into obstructive sleep apnea. Treatments for OSA such as positive airway pressure therapy can be effective at stopping the progression of UARS. Positive airway pressure therapy is similar to that in obstructive sleep apnea and works by stenting the airway open with pressure, thus reducing the airway resistance. Use of a CPAP can help ease the symptoms of UARS. Therapeutic trials have shown that using a CPAP with pressure between four and eight centimeters of water can help to reduce the number of arousals and improve sleepiness. CPAPs are the most promising treatment for UARS, but effectiveness is reduced by low patient compliance.

Oral appliances
Oral appliances to protrude the tongue and lower jaw forward have been used to reduce sleep apnea and snoring, and hold potential for treating UARS, but this approach remains controversial. Oral appliances may be a suitable alternative for patients who cannot tolerate CPAP.

Surgery
For nasal obstruction, options can be septoplasty, turbinate reductions, or surgical palate expansion.

Orthognathic surgeries that expands the airway, such as Maxillomandibular advancement (MMA) or Surgically Assisted Rapid Palatal Expansion (SARPE) are the most effective surgeries for sleep disordered breathing.

Though less common methods of treatment, various surgical options including uvulopalatopharyngoplasty (UPPP), hyoid suspension, and linguloplasty exist. These procedures increase the dimensions of the upper airway and reduce the collapsibility of the airway. One should also be screened for the presence of a hiatal hernia, which may result in abnormal pressure differentials in the esophagus, and in turn, constricted airways during sleep. Palatal tissue reduction via radiofrequency ablation has also been successful in treating UARS.

Maxillary expansion
Orthodontic treatment to expand the volume of the nasal airway, such as nonsurgical Rapid Palatal expansion is common in children. Due to the ossification of the median palatine suture, traditional tooth-born expanders cannot achieve maxillary expansion in adults as the mechanical forces instead tip the teeth and dental alveoli. Mini-implant assisted rapid palatal expansion (MARPE) has been recently developed as a minimally invasive option for the transverse expansion of the maxilla in adults. This method increases the volume of the nasal cavity and nasopharynx, leading to increased airflow and reduced respiratory arousals during sleep.

title: Upper airway resistance syndrome


text:
George Abell

George Abell may refer to:

 * George O. Abell (1927–1983), American astronomer and educator
 * Sir George Abell (civil servant) (1904–1989), English civil servant in UK and colonial Indian service and cricketer

title: George Abell