124-602: Fannie Eleanor Williams MBE , ARRC (4 July 1884 – 16 June 1963), known as Eleanor Williams, was an Australian scientist. She served as a bacteriologist during World War I , and was the third scientist and the first woman appointed to work at the Walter and Eliza Hall Institute of Medical Research after its establishment in 1915. She directed a laboratory studying infectious diseases, and had particular expertise in dysentery , hydatid disease and snake venom . She co-founded Australia's first blood bank . Fannie Eleanor Williams
248-504: A blood bank , which would allow donated blood to be stored for future needs. In 1938, with World War II approaching, the decision was made to establish a blood bank at the Royal Melbourne Hospital , and Williams and Wood turned their attention to developing new techniques for storing blood and plasma, as well as to the logistical aspects of obtaining and administering the blood. The new Emergency Blood Transfusion Service
372-725: A decreased level of consciousness . Bacterial and viral cases of pneumonia usually result in similar symptoms. Some causes are associated with classic, but non-specific, clinical characteristics. Pneumonia caused by Legionella may occur with abdominal pain, diarrhea , or confusion. Pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum. Pneumonia caused by Klebsiella may have bloody sputum often described as "currant jelly". Bloody sputum (known as hemoptysis ) may also occur with tuberculosis , Gram-negative pneumonia, lung abscesses and more commonly acute bronchitis . Pneumonia caused by Mycoplasma pneumoniae may occur in association with swelling of
496-516: A leading cause of death in developing countries, and also among the very old, the very young, and the chronically ill. Pneumonia often shortens the period of suffering among those already close to death and has thus been called "the old man's friend". People with infectious pneumonia often have a productive cough , fever accompanied by shaking chills , shortness of breath , sharp or stabbing chest pain during deep breaths, and an increased rate of breathing . In elderly people, confusion may be
620-401: A stethoscope or increased respiratory rate. Grunting and nasal flaring may be other useful signs in children less than five years old. Lack of wheezing is an indicator of Mycoplasma pneumoniae in children with pneumonia, but as an indicator it is not accurate enough to decide whether or not macrolide treatment should be used. The presence of chest pain in children with pneumonia doubles
744-543: A GBE (in recognition of his role as chairman of the Scottish War Savings Committee) and the award of medal of the order to Lizzie Robinson, a munitions worker. The order had been established primarily as a civilian award; in August 1918, however, not long after its foundation, a number of awards were made to serving naval and military personnel. Four months later, a 'Military Division' was added to
868-404: A broad riband or sash, passing from the right shoulder to the left hip. Knights Commander and male Commanders wear the badge from a ribbon around the neck; male Officers and Members wear the badge from a ribbon on the left chest; female recipients other than Dames Grand Cross (unless in military uniform) normally wear it from a bow on the left shoulder. An oval eight-pointed star is worn, pinned to
992-553: A burning building containing explosives. In December 1922 the statutes of the order were amended; there having been a large number of awards for war work prior to this date, these amended statutes placed the order on more of a peacetime footing. For the first time numbers of appointments were limited, with the stipulation that senior awards in the Civil Division were to outnumber those in the Military Division by
1116-418: A chest radiograph is recommended. Findings do not always match the severity of disease and do not reliably separate between bacterial and viral infection. X-ray presentations of pneumonia may be classified as lobar pneumonia , bronchopneumonia , lobular pneumonia , and interstitial pneumonia . Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe , which
1240-453: A circlet bearing the motto of the Order; the reverse bears George V's Royal and Imperial Cypher. (Prior to 1937 Britannia was shown within the circlet.) The size of the badges varies according to rank: the higher classes have slightly larger badges. The badges of Knights and Dames Grand Cross, Knights and Dames Commander, and Commanders are enamelled, with pale blue crosses, crimson circlets and
1364-466: A citizen of a Commonwealth realm can convert their appointment from honorary to substantive, and they then enjoy all privileges of membership of the order, including use of the title of Sir and Dame for the senior two ranks of the Order. (An example of the latter is Irish broadcaster Terry Wogan , who was appointed an honorary Knight Commander of the Order in 2005, and on successful application for British citizenship, held alongside his Irish citizenship,
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#17327984063901488-493: A cough of longer duration, and pulmonary emboli present with acute onset sharp chest pain and shortness of breath. Mild pneumonia should be differentiated from upper respiratory tract infection (URTI). Severe pneumonia should be differentiated from acute heart failure . Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia. For recurrent pneumonia, underlying lung cancer, metastasis , tuberculosis,
1612-479: A cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness. A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, greater than 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old. In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with
1736-415: A day or two before other signs. Examination of the chest may be normal, but it may show decreased expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) may be heard over the affected area during inspiration . Percussion may be dulled over
1860-800: A foreign bodies, immunosuppression, and hypersensitivity should be suspected. Prevention includes vaccination , environmental measures, and appropriate treatment of other health problems. It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000. Vaccination prevents against certain bacterial and viral pneumonias both in children and adults. Influenza vaccines are modestly effective at preventing symptoms of influenza, The Centers for Disease Control and Prevention (CDC) recommends yearly influenza vaccination for every person 6 months and older. Immunizing health care workers decreases
1984-443: A gold central medallion. Officers' badges are plain silver-gilt, while those of Members are plain silver. From 1917 until 1937, the badge of the order was suspended on a purple ribbon, with a red central stripe being added for the military division in 1918. Since 1937, the ribbon has been rose-pink with pearl-grey edges (with the addition of a pearl-grey central stripe for the military division). Knights and Dames Grand Cross wear it on
2108-400: A higher dose of radiation, and cannot be done at bedside. Lung ultrasound may also be useful in helping to make the diagnosis. Ultrasound is radiation free and can be done at bedside. However, ultrasound requires specific skills to operate the machine and interpret the findings. It may be more accurate than chest X-ray. In people managed in the community, determining the causative agent
2232-462: A history of smoking, a poor ability to cough (such as following a stroke), and a weak immune system . Vaccines to prevent certain types of pneumonia (such as those caused by Streptococcus pneumoniae bacteria, linked to influenza , or linked to COVID-19 ) are available. Other methods of prevention include hand washing to prevent infection, and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria
2356-646: A position as nurse inspector with the Unley Local Board of Health for which she undertook home visits and tested patients for diphtheria , measles , and other notifiable diseases . In 1911, Williams returned to work with Dr. Borthwick as an attendant in a new pathology research laboratory at the Adelaide Hospital. She was the first woman in South Australia to hold such an appointment. She remained in this role until late 1914. After
2480-515: A position somewhere between that of research scientist, senior technician and general manager. While her lack of academic qualifications prevented her from lecturing at the University of Melbourne , she established and led the Institute's Diagnostic Microbiology Laboratory, and attended international and national conferences where she presented papers in her own right. As the Institute grew in
2604-492: A proportion of six to one. Furthermore appointments in the civil division were to be divided equally between UK and overseas awards. With regard to the Medal of the Order (but not the order itself), a distinction was made in 1922 between awards 'for gallantry' and awards 'for meritorious service' (each being appropriately inscribed, and the former having laurel leaves decorating the clasp, the latter oak leaves). In 1933 holders of
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#17327984063902728-400: Is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli . Symptoms typically include some combination of productive or dry cough , chest pain , fever, and difficulty breathing . The severity of the condition is variable. Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms . Identifying
2852-516: Is an image of Britannia surrounded by the motto, with the words "For Meritorious Service" at the bottom; on the reverse is George V's Imperial and Royal Cypher, with the words "Instituted by King George V" at the bottom. The name of the recipient is engraved on the rim. This medal is nicknamed "the Gong", and comes in both full-sized and miniature versions – the latter for formal white-tie and semi-formal black-tie occasions. A lapel pin for everyday wear
2976-411: Is another rare cause due to lipids entering the lung. These lipids can either be inhaled or spread to the lungs from elsewhere in the body. Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract. It is a type of pneumonitis (lung inflammation). The normal flora of the upper airway give protection by competing with pathogens for nutrients. In
3100-996: Is associated with Chlamydia psittaci ; farm animals with Coxiella burnetti ; aspiration of stomach contents with anaerobic organisms; and cystic fibrosis with Pseudomonas aeruginosa and Staphylococcus aureus . Streptococcus pneumoniae is more common in the winter, and it should be suspected in persons aspirating a large number of anaerobic organisms. In adults, viruses account for about one third of pneumonia cases, and in children for about 15% of them. Commonly implicated agents include rhinoviruses , coronaviruses , influenza virus , respiratory syncytial virus (RSV), adenovirus , and parainfluenza . Herpes simplex virus rarely causes pneumonia, except in groups such as newborns, persons with cancer, transplant recipients, and people with significant burns. After organ transplantation or in otherwise immunocompromised persons, there are high rates of cytomegalovirus pneumonia. Those with viral infections may be secondarily infected with
3224-448: Is associated with an increased risk of pneumonia. Approximately 10% of people who require mechanical ventilation develop ventilator-associated pneumonia , and people with a gastric feeding tube have an increased risk of developing aspiration pneumonia . Moreover, the misplacement of a feeding tube can lead to aspiration pneumonia. 28% of tube malposition results in pneumonia. As with Avanos Medical 's feeding tube placement system,
3348-506: Is available for adults, and has been found to decrease the risk of invasive pneumococcal disease by 74%, but there is insufficient evidence to suggest using the pneumococcal vaccine to prevent pneumonia or death in the general adult population. The CDC recommends that young children and adults over the age of 65 receive the pneumococcal vaccine, as well as older children or younger adults who have an increased risk of getting pneumococcal disease. The pneumococcal vaccine has been shown to reduce
3472-644: Is due primarily to cytokine -induced systemic inflammation . In the developed world , these infections are most common in people returning from travel or in immigrants. Around the world, parasitic pneumonia is most common in the immunodeficient. Idiopathic interstitial pneumonia or noninfectious pneumonia is a class of diffuse lung diseases . They include diffuse alveolar damage , organizing pneumonia , nonspecific interstitial pneumonia , lymphocytic interstitial pneumonia , desquamative interstitial pneumonia , respiratory bronchiolitis interstitial lung disease , and usual interstitial pneumonia . Lipoid pneumonia
3596-801: Is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites . Although more than 100 strains of infectious agents have been identified, only a few are responsible for the majority of cases. Mixed infections with both viruses and bacteria may occur in roughly 45% of infections in children and 15% of infections in adults. A causative agent may not be isolated in about half of cases despite careful testing. In an active population-based surveillance for community-acquired pneumonia requiring hospitalization in five hospitals in Chicago and Nashville from January 2010 through June 2012, 2259 patients were identified who had radiographic evidence of pneumonia and specimens that could be tested for
3720-460: Is important to treatment, as it correlates to which pathogens are likely suspects, which mechanisms are likely, which antibiotics are likely to work or fail, and which complications can be expected based on the person's health status. Community-acquired pneumonia (CAP) is acquired in the community, outside of health care facilities. Compared with healthcare-associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Although
3844-445: Is increased. Bacteria are the most common cause of community-acquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases. Other commonly isolated bacteria include Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases; Staphylococcus aureus ; Moraxella catarrhalis ; and Legionella pneumophila . A number of drug-resistant versions of
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3968-448: Is known as lobar pneumonia. However, findings may vary, and other patterns are common in other types of pneumonia. Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side. Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. Radiologic findings may not be present in
4092-587: Is most common in the Southwestern United States. The number of cases of fungal pneumonia has been increasing in the latter half of the 20th century due to increasing travel and rates of immunosuppression in the population. For people infected with HIV/AIDS , PCP is a common opportunistic infection . A variety of parasites can affect the lungs, including Toxoplasma gondii , Strongyloides stercoralis , Ascaris lumbricoides , and Plasmodium malariae . These organisms typically enter
4216-973: Is not a member of the College of Arms , as are many other heraldic officers; and the Lady Usher of the Purple Rod does not – unlike the Order of the Garter equivalent, the Lady Usher of the Black Rod – perform any duties related to the House of Lords . Since the Second World War, several Commonwealth realms have established their own national system of honours and awards and have created their own unique orders, decorations and medals. A number, though, continue to make recommendations for appointments to
4340-530: Is not cost-effective and typically does not alter management. For people who do not respond to treatment, sputum culture should be considered, and culture for Mycobacterium tuberculosis should be carried out in persons with a chronic productive cough. Microbiological evaluation is also indicated in severe pneumonia, alcoholism, asplenia , immunosuppression, HIV infection, and those being empirically treated for MRSA of pseudomonas. Although positive blood culture and pleural fluid culture definitively establish
4464-465: Is sometimes called MCAP (medical care–associated pneumonia). People may become infected with pneumonia in a hospital; this is defined as pneumonia not present at the time of admission (symptoms must start at least 48 hours after admission). It is likely to involve hospital-acquired infections , with higher risk of multidrug-resistant pathogens. People in a hospital often have other medical conditions, which may make them more susceptible to pathogens in
4588-723: Is sometimes more broadly applied to any condition resulting in inflammation of the lungs (caused for example by autoimmune diseases , chemical burns or drug reactions); however, this inflammation is more accurately referred to as pneumonitis . Factors that predispose to pneumonia include smoking, immunodeficiency , alcoholism, chronic obstructive pulmonary disease , sickle cell disease (SCD), asthma , chronic kidney disease , liver disease , and biological aging . Additional risks in children include not being breastfed , exposure to cigarette smoke and other air pollution, malnutrition, and poverty. The use of acid-suppressing medications – such as proton-pump inhibitors or H2 blockers –
4712-432: Is treated with antibiotics . If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low. Each year, pneumonia affects about 450 million people globally (7% of the population) and results in about 4 million deaths. With the introduction of antibiotics and vaccines in the 20th century, survival has greatly improved. Nevertheless, pneumonia remains
4836-498: Is uncommon, but occurs more commonly in individuals with weakened immune systems due to AIDS, immunosuppressive drugs , or other medical problems. It is most often caused by Histoplasma capsulatum , Blastomyces , Cryptococcus neoformans , Pneumocystis jiroveci ( pneumocystis pneumonia , or PCP), and Coccidioides immitis . Histoplasmosis is most common in the Mississippi River basin , and coccidioidomycosis
4960-785: The Australian Army Nursing Service on 20 July 1915 and embarked for Egypt a fortnight later on the RMS Orontes . On arrival, Williams was posted to the 3rd Australian General Hospital on the island of Lemnos in Greece. This was one of the hospitals that received patients from the Gallipoli Campaign . Williams' record at the Australian War Memorial states that she enlisted with the rank of Staff Nurse on 20 July 1915, and rose to
5084-642: The Australian Red Cross Blood Service ) from its inception in 1929 by the Victorian Division of the Australian Red Cross Society . In the first decade of the service, laboratory tests were carried out at the Walter and Eliza Hall Institute of Medical Research , under the supervision of Williams and her colleague Dr Ian Wood. The ability to deliver blood transfusions was limited by the lack of
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5208-559: The Order of Canada . On the other hand, the Australian Honours System unilaterally created in 1975 did not achieve bi-partisan support until 1992, which was when Australian federal and state governments agreed to cease Australian recommendations for British honours; the last Australian recommended Order of the British Empire appointments were in the 1989 Queen's Birthday Honours . New Zealand continued to use
5332-473: The 21st century quotas were introduced to ensure consistent representation among recipients across nine categories of eligibility: with the largest proportion of awards being reserved for community, voluntary and local service. Non-military awards of the British Empire Medal resumed in 2012, starting with 293 BEMs awarded for Queen Elizabeth II's Diamond Jubilee . In 2017 the centenary of
5456-792: The British Empire . Rather than using this chapel, the Order now holds its great services upstairs in the nave of the cathedral. In addition to the Chapel of the Order of the British Empire, St Paul's Cathedral also houses the Chapel of the Order of St Michael and St George . Religious services for the whole Order are held every four years; new Knights and Dames Grand Cross are installed at these services. Knights Grand Cross and Knights Commander prefix Sir , and Dames Grand Cross and Dames Commander prefix Dame , to their forenames. Wives of Knights may prefix Lady to their surnames, but no equivalent privilege exists for husbands of Knights or spouses of Dames. Such forms are not used by peers and princes, except when
5580-494: The British Empire for Gallantry. Any individual made a member of the order for gallantry after 14 January 1958 wears an emblem of two crossed silver oak leaves on the same ribbon as the badge, with a miniature version on the ribbon bar when worn alone. When the ribbon only is worn the emblem is worn in miniature. It could not be awarded posthumously , and was replaced in 1974 with the Queen's Gallantry Medal (QGM). If recipients of
5704-647: The CORTRAK* 2 EAS, which was recalled in May 2022 by the FDA due to adverse events reported, including pneumonia, caused a total of 60 injuries and 23 patient deaths, as communicated by the FDA. For people with certain variants of the FER gene , the risk of death is reduced in sepsis caused by pneumonia. However, for those with TLR6 variants, the risk of getting Legionnaires' disease
5828-517: The F. Eleanor Williams Serological Research Laboratories in her honour. Order of the British Empire The Most Excellent Order of the British Empire is a British order of chivalry , rewarding contributions to the arts and sciences, work with charitable and welfare organisations, and public service outside the civil service . It comprises five classes of awards across both civil and military divisions,
5952-824: The Military Division of the order from the UK and across the Empire. Recommendations for all appointments to the Order of the British Empire were originally made on the nomination of the King's United Kingdom ministers (recommendations for overseas awards were made by the Foreign Office , the Colonial Office , the India Office and the Dominions Office ); but in the early 1940s the system was changed to enable
6076-436: The Order of the British Empire for Gallantry received promotion within the order, whether for gallantry or otherwise, they continued to wear also the insignia of the lower grade with the oak leaves; however, they used only the post-nominal letters of the higher grade. When the order was founded in 1917, badges, ribands and stars were appointed for wear by recipients. In 1929 mantles, hats and collars were added for recipients of
6200-520: The Order of the British Empire. In 2024 appointments to the order were made by the governments of: Most members of the order are citizens of the United Kingdom or Commonwealth realms that use the UK system of honours and awards. In addition, honorary awards may be made to citizens of nations where the monarch is not head of state ; these permit use of post-nominal letters, but not the title of Sir or Dame . Honorary appointees who later become
6324-404: The Order, however, are not assigned any special precedence. As a general rule, only wives and children of male recipients are afforded privileges. Knights and Dames Grand Cross are also entitled to be granted heraldic supporters . They may, furthermore, encircle their arms with a depiction of the circlet (a circle bearing the motto) and the collar; the former is shown either outside or on top of
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#17327984063906448-463: The United Kingdom; those who would formerly have met the criteria for the medal were instead made eligible for the MBE. In 2004, a report entitled A Matter of Honour: Reforming Our Honours System by a Commons select committee recommended phasing out the Order of the British Empire, as its title was "now considered to be unacceptable, being thought to embody values that are no longer shared by many of
6572-513: The above infections are becoming more common, including drug-resistant Streptococcus pneumoniae (DRSP) and methicillin-resistant Staphylococcus aureus (MRSA). The spreading of organisms is facilitated by certain risk factors. Alcoholism is associated with Streptococcus pneumoniae , anaerobic organisms , and Mycobacterium tuberculosis ; smoking facilitates the effects of Streptococcus pneumoniae , Haemophilus influenzae , Moraxella catarrhalis , and Legionella pneumophila . Exposure to birds
6696-501: The activities of the Institute rotated". During World War II , Williams coordinated the Institute's war efforts, providing administrative and practical support to the Emergency Blood Transfusion Service, as well as working in the laboratory. She retired in 1957, and received an MBE for her work in the same year. Eleanor Williams was closely involved with The Red Cross Blood Transfusion Service (now
6820-450: The addition of a vertical pearl grey stripe in the centre for awards in the military division). From time to time the order was expanded: there was an increase in the maximum permitted number of recipients in 1933, and a further increase in 1937. During the Second World War, as had been the case during and after World War I, the number of military awards was greatly increased; between 1939 and 1946 there were more than 33,000 appointments to
6944-560: The additional feature of pulmonary consolidation . Pneumonia is most commonly classified by where or how it was acquired: community-acquired, aspiration, healthcare-associated , hospital-acquired , and ventilator-associated pneumonia. It may also be classified by the area of the lung affected: lobar, bronchial pneumonia and acute interstitial pneumonia ; or by the causative organism. Pneumonia in children may additionally be classified based on signs and symptoms as non-severe, severe, or very severe. The setting in which pneumonia develops
7068-421: The affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion . A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain. If a person is sufficiently sick to require hospitalization,
7192-421: The alveoli, resulting in the consolidation seen on chest X-ray. Viruses may reach the lung by a number of different routes. Respiratory syncytial virus is typically contracted when people touch contaminated objects and then touch their eyes or nose. Other viral infections occur when contaminated airborne droplets are inhaled through the nose or mouth. Once in the upper airway, the viruses may make their way into
7316-517: The bacteria Streptococcus pneumoniae , Staphylococcus aureus , or Haemophilus influenzae , particularly when other health problems are present. Different viruses predominate at different times of the year; during flu season , for example, influenza may account for more than half of all viral cases. Outbreaks of other viruses also occur occasionally, including hantaviruses and coronaviruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also result in pneumonia. Fungal pneumonia
7440-449: The blood. Once in the lungs, bacteria may invade the spaces between cells and between alveoli, where the macrophages and neutrophils (defensive white blood cells ) attempt to inactivate the bacteria. The neutrophils also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill
7564-516: The body through direct contact with the skin, ingestion, or via an insect vector. Except for Paragonimus westermani , most parasites do not specifically affect the lungs but involve the lungs secondarily to other sites. Some parasites, in particular those belonging to the Ascaris and Strongyloides genera, stimulate a strong eosinophilic reaction, which may result in eosinophilic pneumonia . In other infections, such as malaria, lung involvement
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#17327984063907688-474: The cathedral. That year, Commonwealth awards made up 40% of all OBEs and MBEs awarded (and 35% of all living recipients of the higher awards). Gradually that proportion reduced as independent states within the Commonwealth established their own systems of honours . The last Canadian recommendation for the Order of the British Empire was an MBE for gallantry gazetted in 1966, a year before the creation of
7812-546: The cause and support decisions about who should receive antibiotics. Antibiotics are encouraged if the procalcitonin level reaches 0.25 μg/L, strongly encouraged if it reaches 0.5 μg/L, and strongly discouraged if the level is below 0.10 μg/L. In people requiring hospitalization, pulse oximetry , chest radiography and blood tests – including a complete blood count , serum electrolytes , C-reactive protein level, and possibly liver function tests – are recommended. The diagnosis of influenza-like illness can be made based on
7936-418: The circlet. In 1929, to bring the order into line with the other orders of chivalry, members of the first class of the order (GBE) were provided with mantles, hats and collars. Only Knights/Dames Grand Cross wear these elaborate vestments; the hat is now rarely, if ever, worn. Use of the mantle is limited to important occasions (such as quadrennial services and coronations ). The mantle is always worn with
8060-444: The collar. Although the mantle was introduced in 1929, very few mantles would have been produced prior to the 1937 design changes, as there were few occasions for wearing them in the intervening years. On certain days designated by the sovereign, known as " collar days ", members attending formal events may wear the order's collar over their military uniform, formal day dress, evening wear or robes of office. Collars are returned upon
8184-427: The condition, but they are associated with side effects. Zanamivir or oseltamivir decrease the chance that people who are exposed to the virus will develop symptoms; however, it is recommended that potential side effects are taken into account. Smoking cessation and reducing indoor air pollution , such as that from cooking indoors with wood, crop residues or dung , are both recommended. Smoking appears to be
8308-479: The country's population". The committee further suggested changing the name of the award to the Order of British Excellence, and changing the rank of Commander to Companion (as the former was said to have a "militaristic ring"), as well as advocating for the abolition of knighthoods and damehoods; the government, however, was not of the opinion that a case for change had been made, and the aforementioned suggestions and recommendations were not, therefore, pursued. In
8432-403: The death of their owners, but other insignia may be retained. The six office-holders of the order wear pearl-grey mantles lined with rose-pink, having on the right side a purple shield charged with the roundel from the badge. Each of these office-holders wears a unique badge of office, suspended from a gold chain worn around the neck. The British Empire Medal is made of silver. On the obverse
8556-404: The diagnosis is unlikely. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial cause. The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. The World Health Organization has defined pneumonia in children clinically based on either
8680-508: The diagnosis of the type of micro-organism involved, a positive sputum culture has to be interpreted with care for the possibility of colonisation of respiratory tract. Testing for other specific organisms may be recommended during outbreaks, for public health reasons. In those hospitalized for severe disease, both sputum and blood cultures are recommended, as well as testing the urine for antigens to Legionella and Streptococcus . Viral infections, can be confirmed via detection of either
8804-626: The distinction between ranks in military operational gallantry awards will cease'. The reforms affected the order at various levels: for example the automatic award each year of a GBE to the Lord Mayor of London ceased; the OBE replaced the Imperial Service Order as an award for civil servants and the number of MBEs awarded each year was significantly increased. As part of these reforms the British Empire Medal stopped being awarded by
8928-758: The early stages of the disease, especially in the presence of dehydration, or may be difficult to interpret in the obese or those with a history of lung disease. Complications such as pleural effusion may also be found on chest radiographs. Laterolateral chest radiographs can increase the diagnostic accuracy of lung consolidation and pleural effusion. A CT scan can give additional information in indeterminate cases and provide more details in those with an unclear chest radiograph (for example occult pneumonia in chronic obstructive pulmonary disease). They can be used to exclude pulmonary embolism and fungal pneumonia , and detect lung abscesses in those who are not responding to treatments. However, CT scans are more expensive, have
9052-487: The first year of the war alone, her team, working as volunteers and in addition to their daily laboratory work, performed blood typing for 13,000 soldiers of the Second Australian Imperial Force . By the end of the war, Williams' team had performed blood typing for nearly 250,000 soldiers and numerous blood donors, all on a volunteer basis. Eleanor Williams died on 16 June 1963, aged 78. She
9176-529: The former was to be responsible for recording all proceedings connected with the order, issuing warrants under the seal of the order and making arrangements for investitures, while the latter (at that time the Permanent Secretary to the Treasury ) was responsible for collecting and tabulating the names of those who were to receive an award. The office of Dean was added in 1957. The King of Arms
9300-401: The governments of overseas dominions to make their own nominations; Canada and South Africa began doing so in 1942, followed by Australia, New Zealand and other Commonwealth realms. In May 1957, forty years after the foundation of the order, it was announced that St Paul's Cathedral was to serve as the church of the order, and in 1960 a chapel was dedicated for its use within the crypt of
9424-450: The highest class of the order (GBE). The designs of all these items underwent major changes in 1937. The badge is worn by all members of the order; the size, colour and design depends on the class of award. The badge for all classes is in the form of a cross patonce (having the arms growing broader and floriated toward the end) with a medallion in the centre, the obverse of which bears a crowned image of George V and Queen Mary within
9548-579: The honours system, calling it "a preposterous charade". The order has attracted some criticism for its naming having connection with the idea of the now-extinct British Empire . Benjamin Zephaniah , a British poet of Jamaican and Barbadian descent, publicly rejected appointment as an Officer in 2003 because, he asserted, it reminded him of "thousands of years of brutality". He also said that "it reminds me of how my foremothers were raped and my forefathers brutalised". Pneumonia Pneumonia
9672-634: The hospital. Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation. Ventilator-associated pneumonia is specifically defined as pneumonia that arises more than 48 to 72 hours after endotracheal intubation . Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease, asthma, pulmonary edema , bronchiectasis , lung cancer, and pulmonary emboli . Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram , cancer and bronchiectasis present with
9796-446: The insignia to Buckingham Palace and by ceasing to make reference to their honour, but they still hold the honour unless and until annulled by the monarch. In 2003, The Sunday Times published a list of the people who had rejected the Order of the British Empire, including David Bowie , John Cleese , Nigella Lawson , Elgar Howarth , L. S. Lowry , George Melly , and J. G. Ballard . In addition, Ballard voiced his opposition to
9920-640: The junior post-nominal letters. The British sovereign is the sovereign of the order and appoints all other officers of the order (by convention, on the advice of the governments of the United Kingdom and some Commonwealth realms ). The second-most senior officer is the Grand Master (a 'Prince of the Blood Royal, or other exalted personage' appointed by the sovereign, who, by virtue of their appointment, becomes 'the First or Principal Knight Grand Cross of
10044-500: The late 1930s, Williams took on the responsibility for training and managing the Institute's research technicians. The training she provided was extremely thorough, and covered elements as diverse as animal care, the preparation of media and broths for bacterial culture, and glassblowing. She also trained junior scientists in practical bacteriology techniques. Among her trainees was Frank Macfarlane Burnet , who later described her as "the centre of commonsense and helpfulness around which all
10168-585: The latter are no longer rare in CAP, they are still less likely. Prior stays in healthcare-related environments such as hospitals, nursing homes, or hemodialysis centers or a history of receiving domiciliary care can increase patients' risk for CAP caused by multidrug-resistant bacteria. Health care–associated pneumonia (HCAP) is an infection associated with recent exposure to the health care system, including hospitals, outpatient clinics, nursing homes , dialysis centers, chemotherapy treatment, or home care . HCAP
10292-528: The latter. Knights and Dames Commander and Commanders may display the circlet, but not the collar, surrounding their arms. The badge is depicted suspended from the collar or circlet. See List of current honorary knights and dames of the Order of the British Empire Only the monarch can annul an honour. The Honours Forfeiture Committee considers cases and makes recommendations for forfeiture. An individual can renounce their honour by returning
10416-463: The left breast, by Knights and Dames Grand Cross; Knights and Dames Commander wear a smaller star composed of 'four equal points and four lesser'. The star is not worn by the more junior classes. Prior to 1937 each star had in the centre a gold medallion with a figure of Britannia, surrounded by a crimson circlet inscribed with the motto of the order ('For God and the Empire'); since 1937 the effigies of King George V and Queen Mary have been shown within
10540-431: The lower airways, reflexes of the glottis , actions of complement proteins and immunoglobulins are important for protection. Micro aspiration of contaminated secretions can infect the lower airways and cause pneumonia. The progress of pneumonia is determined by the virulence of the organism; the amount of organism required to start an infection; and the body's immune response against the infection. Most bacteria enter
10664-464: The lungs via small aspirations of organisms residing in the throat or nose. Half of normal people have these small aspirations during sleep. While the throat always contains bacteria, potentially infectious ones reside there only at certain times and under certain conditions. A minority of types of bacteria such as Mycobacterium tuberculosis and Legionella pneumophila reach the lungs via contaminated airborne droplets. Bacteria can also spread via
10788-418: The lungs, many viruses simultaneously affect other organs and thus disrupt other body functions. Viruses also make the body more susceptible to bacterial infections; in this way, bacterial pneumonia can occur at the same time as viral pneumonia. Pneumonia is typically diagnosed based on a combination of physical signs and often a chest X-ray . In adults with normal vital signs and a normal lung examination,
10912-433: The lungs, where they invade the cells lining the airways, alveoli, or lung parenchyma . Some viruses such as measles and herpes simplex may reach the lungs via the blood. The invasion of the lungs may lead to varying degrees of cell death. When the immune system responds to the infection, even more lung damage may occur. Primarily white blood cells, mainly mononuclear cells , generate the inflammation. As well as damaging
11036-400: The lymph nodes in the neck , joint pain , or a middle ear infection . Viral pneumonia presents more commonly with wheezing than bacterial pneumonia. Pneumonia was historically divided into "typical" and "atypical" based on the belief that the presentation predicted the underlying cause. However, evidence has not supported this distinction, therefore it is no longer emphasized. Pneumonia
11160-588: The medal 'for gallantry', which had come to be known as the Empire Gallantry Medal , were given permission to use the postnominal letters EGM (and at the same time to add a laurel branch emblem to the ribbon of the medal); however, in 1940, awards of the EGM ceased and all holders of the medal were instructed to exchange it for a new and more prestigious gallantry award: the George Cross . In 1941,
11284-559: The medal of the order 'for meritorious service' was renamed the British Empire Medal , and the following year its recipients were granted the right to use the postnominal letters BEM. During the war, the BEM came to be used to recognise acts of bravery which did not merit the award of a George Cross or George Medal , a use which continued until the introduction of the Queen's Gallantry Medal in 1974. The designs of insignia of
11408-449: The medal. The colour of the riband was also changed: twenty years earlier, prior to the order's establishment, Queen Mary had made it known that pink would be her preferred colour for the riband of the proposed new order, but, in the event, purple was chosen. Following her appointment as Grand Master of the order in 1936 a change was duly made and since 9 March 1937 the riband of the order has been 'rose pink edged with pearl grey’ (with
11532-524: The most prominent sign. The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing. Fever is not very specific, as it occurs in many other common illnesses and may be absent in those with severe disease, malnutrition or in the elderly. In addition, a cough is frequently absent in children less than 2 months old. More severe signs and symptoms in children may include blue-tinged skin , unwillingness to drink, convulsions, ongoing vomiting, extremes of temperature, or
11656-446: The most senior two of which make the recipient either a knight if male or a dame if female. There is also the related British Empire Medal , whose recipients are affiliated with, but not members of, the order. The order was established on 4 June 1917 by King George V , who created the order to recognise 'such persons, male or female, as may have rendered or shall hereafter render important services to Our Empire'. Equal recognition
11780-473: The names of the former are written out in their fullest forms. Male clergy of the Church of England or the Church of Scotland do not use the title Sir (unless they were knighted before being ordained) as they do not receive the accolade (they are not dubbed "knight" with a sword), although they do append the post-nominal letters ; dames do not receive the accolade, and therefore female clergy are free to use
11904-454: The numbers restricted to the order as full members do. Although the Order of the British Empire has by far the highest number of members of the British orders of chivalry, with more than 100,000 living members worldwide, there are fewer appointments to knighthoods than in other orders. From time to time, individuals may be promoted to a higher grade within the Order, thereby ceasing usage of
12028-620: The order alongside its own honours until the establishment of the New Zealand Order of Merit in 1996. Other Commonwealth realms have continued to use the Order of the British Empire alongside their own honours. In 1993 the Prime Minister, John Major , instituted a reform of the honours system with the aim 'that exceptional service or achievement will be more widely recognised; that greater importance will be given to voluntary service; that automatic honours will end; that
12152-408: The order and medal were altered in 1937, prior to the coronation of King George VI , 'in commemoration of the reign of King George V and Queen Mary, during which the Order was founded'. The figure of Britannia at the centre of the badge of the order was replaced with an image of the crowned heads of the late King and Queen Mary, and the words 'Instituted by King George V' were added to the reverse of
12276-409: The order was celebrated with a service at St Paul's Cathedral. The order is limited to 300 Knights and Dames Grand Cross, 845 Knights and Dames Commander, and 8,960 Commanders. There are no limits applied to the total number of members of the fourth and fifth classes, but no more than 858 officers and 1,464 members may be appointed per year. Foreign appointees, as honorary members, do not contribute to
12400-426: The order, to which serving personnel would in future be appointed. The classes were the same as for the Civil Division (as it was now termed), but military awards were distinguished by the addition of a central vertical red stripe to the purple riband of the civil awards. In 1920 appointment as an MBE 'for an act of gallantry' was granted for the first time, to Sydney Frank Blanck Esq, who had rescued an injured man from
12524-618: The outbreak of World War I in 1914, Eleanor Williams was invited by Dr Trent Champion de Crespigny to join him on active service with the First Australian Imperial Force . Infectious disease was emerging as a significant issue for the campaign in Turkey and the Middle East, and the army wanted to recruit people with bacteriological and laboratory training to work on the problem. Accordingly, Williams enlisted with
12648-421: The probability of Mycoplasma pneumoniae . In general, in adults, investigations are not needed in mild cases. There is a very low risk of pneumonia if all vital signs and auscultation are normal. C-reactive protein (CRP) may help support the diagnosis. For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antibiotics are not recommended. Procalcitonin may help determine
12772-736: The rank of Temporary Sister. She served in Egypt, Lemnos, England and France, was mentioned twice in despatches , and was awarded the Royal Red Cross (2nd Class). Although Williams enlisted as a nurse, she worked exclusively in the laboratory as a bacteriologist, the only Australian woman to serve in such a capacity. Working alongside Dr Charles James Martin , Director of the Lister Institute , she performed ground-breaking work on dysentery , and quickly became known as an expert in this field. She continued to work with Martin throughout
12896-497: The responsible pathogen can be difficult. Diagnosis is often based on symptoms and physical examination . Chest X-rays , blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia. Risk factors for pneumonia include cystic fibrosis , chronic obstructive pulmonary disease (COPD), sickle cell disease , asthma , diabetes , heart failure,
13020-500: The responsible pathogen. Most patients (62%) had no detectable pathogens in their sample, and unexpectedly, respiratory viruses were detected more frequently than bacteria. Specifically, 23% had one or more viruses, 11% had one or more bacteria, 3% had both bacterial and viral pathogens, and 1% had a fungal or mycobacterial infection. "The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%)." The term pneumonia
13144-519: The risk of community acquired pneumonia in people with chronic obstructive pulmonary disease, but does not reduce mortality or the risk of hospitalization for people with this condition. People with COPD are recommended by a number of guidelines to have a pneumococcal vaccination. Other vaccines for which there is support for a protective effect against pneumonia include pertussis , varicella , and measles . When influenza outbreaks occur, medications such as amantadine or rimantadine may help prevent
13268-521: The risk of viral pneumonia among their patients. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae have good evidence to support their use. There is strong evidence for vaccinating children under the age of 2 against Streptococcus pneumoniae ( pneumococcal conjugate vaccine ). Vaccinating children against Streptococcus pneumoniae has led to a decreased rate of these infections in adults, because many adults acquire infections from children. A Streptococcus pneumoniae vaccine
13392-603: The same Order'). The position of Grand Master has been held by the following people: In addition to the sovereign and the grand master , the order has six further officers: At its foundation the order was served by three officers: the King of Arms, the Registrar & Secretary and the Gentleman Usher of the Purple Rod. In 1922 the Prelate was added, and the office of Registrar was separated from that of Secretary:
13516-527: The signs and symptoms; however, confirmation of an influenza infection requires testing. Thus, treatment is frequently based on the presence of influenza in the community or a rapid influenza test . Adults 65 years old or older, as well as cigarette smokers and people with ongoing medical conditions are at increased risk for pneumonia. Physical examination may sometimes reveal low blood pressure , high heart rate , or low oxygen saturation . The respiratory rate may be faster than normal, and this may occur
13640-468: The single biggest risk factor for pneumococcal pneumonia in otherwise-healthy adults. Hand hygiene and coughing into one's sleeve may also be effective preventative measures. Wearing surgical masks by the sick may also prevent illness. Appropriately treating underlying illnesses (such as HIV/AIDS, diabetes mellitus , and malnutrition) can decrease the risk of pneumonia. In children less than 6 months of age, exclusive breast feeding reduces both
13764-461: The standard of the George Medal (even though, as appointments to an order of chivalry, they were listed before it on the Order of Wear . In contrast to awards for meritorious service, which usually appear without a citation, there were often citations for gallantry awards, some detailed and graphic. From 14 January 1958, these awards were designated Commander, Officer or Member of the Order of
13888-506: The title Dame . Knights and Dames Grand Cross use the post-nominal GBE; Knights Commander, KBE; Dames Commander, DBE; Commanders, CBE; Officers, OBE; and Members, MBE. The post-nominal for the British Empire Medal is BEM. Members of all classes of the order are assigned positions in the order of precedence . Wives of male members of all classes also feature on the order of precedence, as do sons, daughters and daughters-in-law of Knights Grand Cross and Knights Commander; relatives of Ladies of
14012-589: The titles Sir for men and Dame for women before their forenames, except with honorary awards. King George V founded the order to fill gaps in the British honours system : In particular, George V wished to create an order to honour the many thousands of individuals from across the Empire who had served in a variety of non-combat roles during the First World War . From its foundation the order consisted of five classes (GBE, KBE/DBE, CBE, OBE and MBE) and
14136-496: The virus or its antigens with culture or polymerase chain reaction (PCR), among other techniques. Mycoplasma , Legionella , Streptococcus , and Chlamydia can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab . The causative agent is determined in only 15% of cases with routine microbiological tests. Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non-infectious, that has
14260-443: The war, on a variety of infectious diseases, including meningitis , streptococci , staphylococci , gas gangrene , and epidemic influenza . Following her repatriation in 1919, Eleanor Williams moved to Melbourne , and was appointed to the position of 'second assistant' at the newly-established Walter and Eliza Hall Institute of Medical Research by director Sydney Patterson . Williams had worked with Patterson on influenza during
14384-510: The war. She was the third staff member appointed to the Institute, and the first woman. She was also the only researcher with no medical or university qualification. In the early 1920s, the Institute's focus was on respiratory and intestinal infections, and Williams worked on pneumonia , syphilis and dysentery , as well as the serological diagnosis of hydatid tapeworms. From 1923, she worked with Charles Kellaway on snake venom serology , and later worked on tuberculosis . Williams occupied
14508-778: Was born in Adelaide , South Australia on 4 July 1884. She was the second child and eldest daughter of James Williams and his wife Helen DuBois. Williams grew up in The Reedbeds , near Henley Beach , where her father was a farmer. Williams trained as a nurse at the Adelaide Children's Hospital between 1904 and 1907. She was appointed sister in charge of the Thomas Elder Laboratory in 1907, and worked there for two years as an assistant to pathologist Dr. Thomas Borthwick. In December 1909, Williams took up
14632-673: Was cremated, and her ashes were scattered at the Springvale Botanical Cemetery . She was recognised with an obituary in The Medical Journal of Australia , written by Frank Macfarlane Burnet and Dr Ian Wood, which spoke of her 'remarkable knowledge, keen sense of humour, and tenacity of purpose'. In 1964, as part of their Golden Jubilee celebrations, the Red Cross Blood Transfusion Service named their new laboratories
14756-402: Was first announced at the end of December 2006, and is available to recipients of all levels of the order, as well as to holders of the British Empire Medal . The pin design is not unique to any level. The pin features the badge of the order, enclosed in a circle of ribbon of its colours of pink and grey. Lapel pins must be purchased separately by a member of the order. The creation of such a pin
14880-403: Was founded in May 1939 by Williams and Wood, with Williams managing the technical and administrative aspects of the service and Wood ensuring the supply of blood and serum in the field. Once war was declared, Williams' team immediately began testing and recording the blood groups of all soldiers prior to embarkation, so that blood transfusions could more efficiently be performed in the field. In
15004-469: Was made a substantive member and subsequently styled as Sir Terry Wogan). Although initially intended to recognise meritorious service, the order began to also be awarded for gallantry. There were an increased number of cases in the Second World War for service personnel and civilians including the merchant navy, police, emergency services and civil defence, mostly MBEs but with a small number of OBEs and CBEs. Such awards were for gallantry that did not reach
15128-513: Was open to both women and men; provision was also made for conferring honorary awards on foreign recipients. At the same time, alongside the order, the Medal of the Order of the British Empire was instituted, to serve as a lower award granting recipients affiliation but not membership. The first investiture took place at Ibrox Stadium , as part of a royal visit to the Glasgow shipyards, with the appointment of Alexander Ure, 1st Baron Strathclyde as
15252-585: Was recommended in Sir Hayden Phillips ' review of the honours system in 2004. The Chapel of the Order of the British Empire is in St Paul's Cathedral . It occupies the far eastern end of the cathedral crypt and was dedicated in 1960. The only heraldic banners normally on display in the chapel are those of the Sovereign of the Order of the British Empire and of the Grand Master of the Order of
15376-526: Was to be given for services rendered in the UK and overseas. Today the majority of recipients are UK citizens, though a number of Commonwealth realms outside the UK continue to make appointments to the order. Honorary awards may be made to citizens of other nations of which the order's sovereign is not the head of state. The five classes of appointment to the Order are, from highest grade to lowest grade: The senior two ranks of Knight or Dame Grand Cross and Knight or Dame Commander entitle their members to use
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