document_title: Influenza

question_text: where does the influenza virus settle in your body

question_tokens: where does the influenza virus settle in your body

root

text: Influenza

text: Signs and symptoms

text:
Most sensitive symptoms for diagnosing influenza[12]

Symptom:
sensitivity
specificity

Fever
68–86%
25–73%

Cough
84–98%
7–29%

Nasal congestion
68–91%
19–41%

All three findings, especially fever, were less sensitive in people over 60 years of age.

tag: table

text: Approximately 33% of people with influenza are asymptomatic.[14]

tag: p

text: Symptoms of influenza can start quite suddenly one to two days after infection. Usually the first symptoms are chills and body aches, but fever is also common early in the infection, with body temperatures ranging from 38 to 39 °C (approximately 100 to 103 °F).[15] Many people are so ill that they are confined to bed for several days, with aches and pains throughout their bodies, which are worse in their backs and legs.[16]

text: Symptoms of influenza

text:
Fever and chills
Cough
Nasal congestion
Runny nose
Sneezing
Sore throat
Hoarseness
Ear pressure
Earache
Muscle aches
Fatigue
Headache
Irritated, watering eyes
Reddened eyes, skin (especially face), mouth, throat and nose
Petechial rash[17]
In children, gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain,[18][19] (may be severe in children with influenza B)[20]

tag: ul

text: It can be difficult to distinguish between the common cold and influenza in the early stages of these infections.[21] Influenza is a mixture of symptoms of common cold and pneumonia, body ache, headache, and fatigue. Diarrhea is not normally a symptom of influenza in adults,[12] although it has been seen in some human cases of the H5N1 "bird flu"[22] and can be a symptom in children.[18] The symptoms most reliably seen in influenza are shown in the adjacent table.[12]

text: Since antiviral drugs are effective in treating influenza if given early (see treatment section, below), it can be important to identify cases early. Of the symptoms listed above, the combinations of fever with cough, sore throat and/or nasal congestion can improve diagnostic accuracy.[23] Two decision analysis studies[24][25] suggest that during local outbreaks of influenza, the prevalence will be over 70%,[25] and thus patients with any of these combinations of symptoms may be treated with neuraminidase inhibitors without testing. Even in the absence of a local outbreak, treatment may be justified in the elderly during the influenza season as long as the prevalence is over 15%.[25]

text: The available laboratory tests for influenza continue to improve. The United States Centers for Disease Control and Prevention (CDC) maintains an up-to-date summary of available laboratory tests.[26] According to the CDC, rapid diagnostic tests have a sensitivity of 50–75% and specificity of 90–95% when compared with viral culture.[27]

text: Occasionally, influenza can cause severe illness including primary viral pneumonia or secondary bacterial pneumonia.[28][29] The obvious symptom is trouble breathing. In addition, if a child (or presumably an adult) seems to be getting better and then relapses with a high fever, that is a danger sign since this relapse can be bacterial pneumonia.[30]

text: Sometimes, influenza may have abnormal presentations, like confusion in the elderly and a sepsis-like syndrome in the young.[31] Encephalitis due to the flu is rare but not unheard of. One patient and his sibling had a fever, severe diarrhea, and lowering consciousness, followed by seizures and a coma and eventually death without any respiratory disease.[32] One elderly man had confusion, a steadily lowering Glasgow Coma Scale, and soon a coma. He survived, but he had residual neurological symptoms like paraplegia and urinary incontinence.[33]

text: Emergency warning signs

text:
Shortness of breath
Chest pain
Dizziness
Confusion
Extreme vomiting
Flu symptoms that improve but then relapse with a high fever and severe cough (can be bacterial pneumonia)
Cyanosis
Fever and a rash.
Not drinking fluids

text: Signs of dehydration

text:
(in infants) Far fewer wet diapers than regularly[34]
Cannot keep down fluids
(in infants) No tears when crying.

text: Virology

text: Types of virus

text: In virus classification influenza viruses are RNA viruses that make up three of the five genera of the family Orthomyxoviridae:[35]

text:
Influenzavirus A
Influenzavirus B
Influenzavirus C

text: These viruses are only distantly related to the human parainfluenza viruses, which are RNA viruses belonging to the paramyxovirus family that are a common cause of respiratory infections in children such as croup,[36] but can also cause a disease similar to influenza in adults.[37]

text: A fourth family of influenza viruses has been proposed – influenza D.[38][39][40][41][42][43][44] The type species for this family is Bovine Influenza D virus which was first isolated in 2012.

text: Influenzavirus A

text: This genus has one species, influenza A virus. Wild aquatic birds are the natural hosts for a large variety of influenza A. Occasionally, viruses are transmitted to other species and may then cause devastating outbreaks in domestic poultry or give rise to human influenza pandemics.[45] The type A viruses are the most virulent human pathogens among the three influenza types and cause the severest disease. The influenza A virus can be subdivided into different serotypes based on the antibody response to these viruses.[46] The serotypes that have been confirmed in humans, ordered by the number of known human pandemic deaths, are:

text:
H1N1, which caused Spanish Flu in 1918, and Swine Flu in 2009
H2N2, which caused Asian Flu in 1957
H3N2, which caused Hong Kong Flu in 1968
H5N1, which caused Bird Flu in 2004
H7N7, which has unusual zoonotic potential[47]
H1N2, endemic in humans, pigs and birds
H9N2
H7N2
H7N3
H10N7
H7N9
H6N1, which only infected one person, who recovered

text: Influenzavirus B

text: This genus has one species, influenza B virus. Influenza B almost exclusively infects humans[46] and is less common than influenza A. The only other animals known to be susceptible to influenza B infection are the seal[48] and the ferret.[49] This type of influenza mutates at a rate 2–3 times slower than type A[50] and consequently is less genetically diverse, with only one influenza B serotype.[46] As a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age. However, influenza B mutates enough that lasting immunity is not possible.[51] This reduced rate of antigenic change, combined with its limited host range (inhibiting cross species antigenic shift), ensures that pandemics of influenza B do not occur.[52]

text: Influenzavirus C

text: This genus has one species, influenza C virus, which infects humans, dogs and pigs, sometimes causing both severe illness and local epidemics.[53][54] However, influenza C is less common than the other types and usually only causes mild disease in children.[55][56]

text: Structure, properties, and subtype nomenclature

text: Influenzaviruses A, B and C are very similar in overall structure.[57] The virus particle is 80–120 nanometers in diameter and usually roughly spherical, although filamentous forms can occur.[58][59] These filamentous forms are more common in influenza C, which can form cordlike structures up to 500 micrometers long on the surfaces of infected cells.[60] However, despite these varied shapes, the viral particles of all influenza viruses are similar in composition.[60] These are made of a viral envelope containing two main types of glycoproteins, wrapped around a central core. The central core contains the viral RNA genome and other viral proteins that package and protect this RNA. RNA tends to be single stranded but in special cases it is double.[59] Unusually for a virus, its genome is not a single piece of nucleic acid; instead, it contains seven or eight pieces of segmented negative-sense RNA, each piece of RNA containing either one or two genes, which code for a gene product (protein).[60] For example, the influenza A genome contains 11 genes on eight pieces of RNA, encoding for 11 proteins: hemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), M1, M2, NS1, NS2 (NEP: nuclear export protein), PA, PB1 (polymerase basic 1), PB1-F2 and PB2.[61]

text: Hemagglutinin (HA) and neuraminidase (NA) are the two large glycoproteins on the outside of the viral particles. HA is a lectin that mediates binding of the virus to target cells and entry of the viral genome into the target cell, while NA is involved in the release of progeny virus from infected cells, by cleaving sugars that bind the mature viral particles.[62] Thus, these proteins are targets for antiviral drugs.[63] Furthermore, they are antigens to which antibodies can be raised. Influenza A viruses are classified into subtypes based on antibody responses to HA and NA. These different types of HA and NA form the basis of the H and N distinctions in, for example, H5N1.[64] There are 16 H and 9 N subtypes known, but only H 1, 2 and 3, and N 1 and 2 are commonly found in humans.[65]

text: Replication

text: Viruses can replicate only in living cells.[66] Influenza infection and replication is a multi-step process: First, the virus has to bind to and enter the cell, then deliver its genome to a site where it can produce new copies of viral proteins and RNA, assemble these components into new viral particles, and, last, exit the host cell.[60]

text: Influenza viruses bind through hemagglutinin onto sialic acid sugars on the surfaces of epithelial cells, typically in the nose, throat, and lungs of mammals, and intestines of birds (Stage 1 in infection figure).[67] After the hemagglutinin is cleaved by a protease, the cell imports the virus by endocytosis.[68]

text: The intracellular details are still being elucidated. It is known that virions converge to the microtubule organizing center, interact with acidic endosomes and finally enter the target endosomes for genome release.[69]

text: Once inside the cell, the acidic conditions in the endosome cause two events to happen: First, part of the hemagglutinin protein fuses the viral envelope with the vacuole's membrane, then the M2 ion channel allows protons to move through the viral envelope and acidify the core of the virus, which causes the core to disassemble and release the viral RNA and core proteins.[60] The viral RNA (vRNA) molecules, accessory proteins and RNA-dependent RNA polymerase are then released into the cytoplasm (Stage 2).[70] The M2 ion channel is blocked by amantadine drugs, preventing infection.[71]

text: These core proteins and vRNA form a complex that is transported into the cell nucleus, where the RNA-dependent RNA polymerase begins transcribing complementary positive-sense vRNA (Steps 3a and b).[72] The vRNA either is exported into the cytoplasm and translated (step 4) or remains in the nucleus. Newly synthesized viral proteins are either secreted through the Golgi apparatus onto the cell surface (in the case of neuraminidase and hemagglutinin, step 5b) or transported back into the nucleus to bind vRNA and form new viral genome particles (step 5a). Other viral proteins have multiple actions in the host cell, including degrading cellular mRNA and using the released nucleotides for vRNA synthesis and also inhibiting translation of host-cell mRNAs.[73]

text: Negative-sense vRNAs that form the genomes of future viruses, RNA-dependent RNA polymerase, and other viral proteins are assembled into a virion. Hemagglutinin and neuraminidase molecules cluster into a bulge in the cell membrane. The vRNA and viral core proteins leave the nucleus and enter this membrane protrusion (step 6). The mature virus buds off from the cell in a sphere of host phospholipid membrane, acquiring hemagglutinin and neuraminidase with this membrane coat (step 7).[74] As before, the viruses adhere to the cell through hemagglutinin; the mature viruses detach once their neuraminidase has cleaved sialic acid residues from the host cell.[67] After the release of new influenza viruses, the host cell dies.

text: Because of the absence of RNA proofreading enzymes, the RNA-dependent RNA polymerase that copies the viral genome makes an error roughly every 10 thousand nucleotides, which is the approximate length of the influenza vRNA. Hence, the majority of newly manufactured influenza viruses are mutants; this causes antigenic drift, which is a slow change in the antigens on the viral surface over time.[75] The separation of the genome into eight separate segments of vRNA allows mixing or reassortment of vRNAs if more than one type of influenza virus infects a single cell. The resulting rapid change in viral genetics produces antigenic shifts, which are sudden changes from one antigen to another. These sudden large changes allow the virus to infect new host species and quickly overcome protective immunity.[64] This is important in the emergence of pandemics, as discussed below in the section on Epidemiology.

text: Mechanism

text: Transmission

text: When an infected person sneezes or coughs more than half a million virus particles can be spread to those close by.[76] In otherwise healthy adults, influenza virus shedding (the time during which a person might be infectious to another person) increases sharply one-half to one day after infection, peaks on day 2 and persists for an average total duration of 5 days—but can persist as long as 9 days.[77] In those who develop symptoms from experimental infection (only 67% of healthy experimentally infected individuals), symptoms and viral shedding show a similar pattern, but with viral shedding preceding illness by one day.[77] Children are much more infectious than adults and shed virus from just before they develop symptoms until two weeks after infection.[78] In immunocompromised people, viral shedding can continue for longer than two weeks.[79]

text: Influenza can be spread in three main ways:[80][81] by direct transmission (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person); the airborne route (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting) and through hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from contaminated surfaces or from direct personal contact such as a handshake. The relative importance of these three modes of transmission is unclear, and they may all contribute to the spread of the virus.[6] In the airborne route, the droplets that are small enough for people to inhale are 0.5 to 5 µm in diameter and inhaling just one droplet might be enough to cause an infection.[80] Although a single sneeze releases up to 40,000 droplets,[82] most of these droplets are quite large and will quickly settle out of the air.[80] How long influenza survives in airborne droplets seems to be influenced by the levels of humidity and UV radiation, with low humidity and a lack of sunlight in winter aiding its survival.[80]

text: As the influenza virus can persist outside of the body, it can also be transmitted by contaminated surfaces such as banknotes,[83] doorknobs, light switches and other household items.[16] The length of time the virus will persist on a surface varies, with the virus surviving for one to two days on hard, non-porous surfaces such as plastic or metal, for about fifteen minutes from dry paper tissues, and only five minutes on skin.[84] However, if the virus is present in mucus, this can protect it for longer periods (up to 17 days on banknotes).[80][83] Avian influenza viruses can survive indefinitely when frozen.[85] They are inactivated by heating to 56 °C (133 °F) for a minimum of 60 minutes, as well as by acids (at pH <2).[85]

text: Pathophysiology

text: The mechanisms by which influenza infection causes symptoms in humans have been studied intensively. One of the mechanisms is believed to be the inhibition of adrenocorticotropic hormone (ACTH) resulting in lowered cortisol levels.[86] Knowing which genes are carried by a particular strain can help predict how well it will infect humans and how severe this infection will be (that is, predict the strain's pathophysiology).[54][87]

text: For instance, part of the process that allows influenza viruses to invade cells is the cleavage of the viral hemagglutinin protein by any one of several human proteases.[68] In mild and avirulent viruses, the structure of the hemagglutinin means that it can only be cleaved by proteases found in the throat and lungs, so these viruses cannot infect other tissues. However, in highly virulent strains, such as H5N1, the hemagglutinin can be cleaved by a wide variety of proteases, allowing the virus to spread throughout the body.[87]

text: The viral hemagglutinin protein is responsible for determining both which species a strain can infect and where in the human respiratory tract a strain of influenza will bind.[88] Strains that are easily transmitted between people have hemagglutinin proteins that bind to receptors in the upper part of the respiratory tract, such as in the nose, throat and mouth. In contrast, the highly lethal H5N1 strain binds to receptors that are mostly found deep in the lungs.[89] This difference in the site of infection may be part of the reason why the H5N1 strain causes severe viral pneumonia in the lungs, but is not easily transmitted by people coughing and sneezing.[90][91]

text: Common symptoms of the flu such as fever, headaches, and fatigue are the result of the huge amounts of proinflammatory cytokines and chemokines (such as interferon or tumor necrosis factor) produced from influenza-infected cells.[21][92] In contrast to the rhinovirus that causes the common cold, influenza does cause tissue damage, so symptoms are not entirely due to the inflammatory response.[93] This massive immune response might produce a life-threatening cytokine storm. This effect has been proposed to be the cause of the unusual lethality of both the H5N1 avian influenza,[94] and the 1918 pandemic strain.[95][96] However, another possibility is that these large amounts of cytokines are just a result of the massive levels of viral replication produced by these strains, and the immune response does not itself contribute to the disease.[97]

text: Prevention

text: Vaccination

text: The influenza vaccine is recommended by the World Health Organization and United States Centers for Disease Control and Prevention for high-risk groups, such as children, the elderly, health care workers, and people who have chronic illnesses such as asthma, diabetes, heart disease, or are immuno-compromised among others.[98][99] In healthy adults it is modestly effective in decreasing the amount of influenza-like symptoms in a population.[100] Evidence is supportive of a decreased rate of influenza in children over the age of two.[101] In those with chronic obstructive pulmonary disease vaccination reduces exacerbations,[102] it is not clear if it reduces asthma exacerbations.[103] Evidence supports a lower rate of influenza-like illness in many groups who are immunocompromised such as those with: HIV/AIDS, cancer, and post organ transplant.[104] In those at high risk immunization may reduce the risk of heart disease.[105] Whether immunizing health care workers affects patient outcomes is controversial with some reviews finding insufficient evidence[106][107] and others finding tentative evidence.[108][109]

text: Due to the high mutation rate of the virus, a particular influenza vaccine usually confers protection for no more than a few years. Every year, the World Health Organization predicts which strains of the virus are most likely to be circulating in the next year (see Historical annual reformulations of the influenza vaccine), allowing pharmaceutical companies to develop vaccines that will provide the best immunity against these strains.[110] The vaccine is reformulated each season for a few specific flu strains but does not include all the strains active in the world during that season. It takes about six months for the manufacturers to formulate and produce the millions of doses required to deal with the seasonal epidemics; occasionally, a new or overlooked strain becomes prominent during that time.[111] It is also possible to get infected just before vaccination and get sick with the strain that the vaccine is supposed to prevent, as the vaccine takes about two weeks to become effective.[112]

text: Vaccines can cause the immune system to react as if the body were actually being infected, and general infection symptoms (many cold and flu symptoms are just general infection symptoms) can appear, though these symptoms are usually not as severe or long-lasting as influenza. The most dangerous adverse effect is a severe allergic reaction to either the virus material itself or residues from the hen eggs used to grow the influenza; however, these reactions are extremely rare.[113]

text: The cost-effectiveness of seasonal influenza vaccination has been widely evaluated for different groups and in different settings.[114] It has generally been found to be a cost-effective intervention, especially in children[115] and the elderly,[116] however the results of economic evaluations of influenza vaccination have often been found to be dependent on key assumptions.[117][118]

text: Infection control

text: These are the main ways that influenza spreads

text:
by direct transmission (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person);
the airborne route (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting);
through hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from contaminated surfaces or from direct personal contact such as a hand-shake.

text: Reasonably effective ways to reduce the transmission of influenza include good personal health and hygiene habits such as: not touching your eyes, nose or mouth;[119] frequent hand washing (with soap and water, or with alcohol-based hand rubs);[120] covering coughs and sneezes; avoiding close contact with sick people; and staying home yourself if you are sick. Avoiding spitting is also recommended.[121] Although face masks might help prevent transmission when caring for the sick,[122][123] there is mixed evidence on beneficial effects in the community.[121][124] Smoking raises the risk of contracting influenza, as well as producing more severe disease symptoms.[125][126]

text: Since influenza spreads through both aerosols and contact with contaminated surfaces, surface sanitizing may help prevent some infections.[127] Alcohol is an effective sanitizer against influenza viruses, while quaternary ammonium compounds can be used with alcohol so that the sanitizing effect lasts for longer.[128] In hospitals, quaternary ammonium compounds and bleach are used to sanitize rooms or equipment that have been occupied by patients with influenza symptoms.[128] At home, this can be done effectively with a diluted chlorine bleach.[129]

text: Social distancing strategies used during past pandemics, such as closing schools, churches and theaters, slowed the spread of the virus but did not have a large effect on the overall death rate.[130][131] It is uncertain if reducing public gatherings, by for example closing schools and workplaces, will reduce transmission since people with influenza may just be moved from one area to another; such measures would also be difficult to enforce and might be unpopular.[121] When small numbers of people are infected, isolating the sick might reduce the risk of transmission.[121]

text: Some patiente like the young and the elderly may have abnormal symptoms. The elderly may have confusion, white the infants may a have sepsis-like-syndrome.[31]

text: Diagnosis

text: There are a number of rapid tests for the flu. One is called a Rapid Molecular Assay, when a upper respiratory tract specimen (mucus) is taken using a nasal swab or a nasopharyngeal swab.[132] It should be done within 3–4 days of symptom onset, as upper respiratory viral shedding takes a downward spiral after that.[31]

text: Treatment

text: People with the flu are advised to get plenty of rest, drink plenty of liquids, avoid using alcohol and tobacco and, if necessary, take medications such as acetaminophen (paracetamol) to relieve the fever and muscle aches associated with the flu. They are also advised to avoid close contact with others to prevent spread of infection.[133][134] Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during an influenza infection (especially influenza type B), because doing so can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[135] Since influenza is caused by a virus, antibiotics have no effect on the infection; unless prescribed for secondary infections such as bacterial pneumonia. Antiviral medication may be effective, if given early (within 48 hours to first symptoms), but some strains of influenza can show resistance to the standard antiviral drugs and there is concern about the quality of the research.[136] High-risk individuals such as young children, pregnant women, the elderly, and those with compromised immune systems should visit the doctor for antiviral drugs. Those with the emergency warning signs should visit the emergency room at once.[137]

text: Antivirals

text: The two classes of antiviral drugs used against influenza are neuraminidase inhibitors (oseltamivir, zanamivir, laninamivir and peramivir) and M2 protein inhibitors (adamantane derivatives).

text: Neuraminidase inhibitors

text: Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks.[7] There does not appear to be any benefit in those with other health problems.[7] In those believed to have the flu, they decreased the length of time symptoms were present by slightly less than a day but did not appear to affect the risk of complications such as needing hospitalization or pneumonia.[8] Previous to 2013 the benefits were unclear as the manufacturer (Roche) refused to release trial data for independent analysis.[138] Increasingly prevalent resistance to neuraminidase inhibitors has led to researchers to seek alternative antiviral drugs with different mechanisms of action.[139]

text: M2 inhibitors

text: The antiviral drugs amantadine and rimantadine inhibit a viral ion channel (M2 protein), thus inhibiting replication of the influenza A virus.[71] These drugs are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses, which lack the M2 drug target.[140] Measured resistance to amantadine and rimantadine in American isolates of H3N2 has increased to 91% in 2005.[141] This high level of resistance may be due to the easy availability of amantadines as part of over-the-counter cold remedies in countries such as China and Russia,[142] and their use to prevent outbreaks of influenza in farmed poultry.[143][144] The CDC recommended against using M2 inhibitors during the 2005–06 influenza season due to high levels of drug resistance.[145]

text: Prognosis

text: Influenza's effects are much more severe and last longer than those of the common cold. Most people will recover completely in about one to two weeks, but others will develop life-threatening complications (such as pneumonia). Thus, influenza can be deadly, especially for the weak, young and old, those with compromised immune systems, or the chronically ill.[64] People with a weak immune system, such as people with advanced HIV infection or transplant patients (whose immune systems are medically suppressed to prevent transplant organ rejection), suffer from particularly severe disease.[146] Pregnant women and young children are also at a high risk for complications.[147]

text: The flu can worsen chronic health problems. People with emphysema, chronic bronchitis or asthma may experience shortness of breath while they have the flu, and influenza may cause worsening of coronary heart disease or congestive heart failure.[148] Smoking is another risk factor associated with more serious disease and increased mortality from influenza.[149]

text: According to the World Health Organization: "Every winter, tens of millions of people get the flu. Most are only ill and out of work for a week, yet the elderly are at a higher risk of death from the illness. We know the worldwide death toll exceeds a few hundred thousand people a year, but even in developed countries the numbers are uncertain, because medical authorities don't usually verify who actually died of influenza and who died of a flu-like illness."[150] Even healthy people can be affected, and serious problems from influenza can happen at any age. People over 65 years old, pregnant women, very young children and people of any age with chronic medical conditions are more likely to get complications from influenza, such as pneumonia, bronchitis, sinus, and ear infections.[151]

text: In some cases, an autoimmune response to an influenza infection may contribute to the development of Guillain–Barré syndrome.[152] However, as many other infections can increase the risk of this disease, influenza may only be an important cause during epidemics.[152][153] This syndrome has been believed to also be a rare side effect of influenza vaccines. One review gives an incidence of about one case per million vaccinations.[154] Getting infected by influenza itself increases both the risk of death (up to 1 in 10,000) and increases the risk of developing GBS to a much higher level than the highest level of suspected vaccine involvement (approx. 10 times higher by recent estimates).[155][156]

text: According to cdc.gov, "Children of any age with neurologic conditions are more likely than other children to become very sick if they get the flu. Flu complications may vary and for some children, can include pneumonia and even death.

text: Neurological conditions can include:

text:
Disorders of the brain and spinal cord
Cerebral palsy
Epilepsy (seizure disorders)
Stroke
Intellectual disability
Moderate to severe developmental delay
Muscular dystrophy
Spinal cord injury

text: These conditions can impair coughing, swallowing, clearing the airways, and in the worst cases, breathing. Therefor, they worsen the flu symptoms.[157]

text: Encephalitis is a rare but not unheard of, and can occur in the elderly and present as confusion and slurred speech.[33]

text: Epidemiology

text: Seasonal variations

text: Influenza reaches peak prevalence in winter, and because the Northern and Southern Hemispheres have winter at different times of the year, there are actually two different flu seasons each year. This is why the World Health Organization (assisted by the National Influenza Centers) makes recommendations for two different vaccine formulations every year; one for the Northern, and one for the Southern Hemisphere.[110]

text: A long-standing puzzle has been why outbreaks of the flu occur seasonally rather than uniformly throughout the year. One possible explanation is that, because people are indoors more often during the winter, they are in close contact more often, and this promotes transmission from person to person. Increased travel due to the Northern Hemisphere winter holiday season may also play a role.[158] Another factor is that cold temperatures lead to drier air, which may dehydrate mucus particles. Dry particles are lighter and can thus remain airborne for a longer period. The virus also survives longer on surfaces at colder temperatures and aerosol transmission of the virus is highest in cold environments (less than 5 °C) with low relative humidity.[159] The lower air humidity in winter seems to be the main cause of seasonal influenza transmission in temperate regions.[160][161]

text: However, seasonal changes in infection rates also occur in tropical regions, and in some countries these peaks of infection are seen mainly during the rainy season.[162] Seasonal changes in contact rates from school terms, which are a major factor in other childhood diseases such as measles and pertussis, may also play a role in the flu. A combination of these small seasonal effects may be amplified by dynamical resonance with the endogenous disease cycles.[163] H5N1 exhibits seasonality in both humans and birds.[164]

text: An alternative hypothesis to explain seasonality in influenza infections is an effect of vitamin D levels on immunity to the virus.[165] This idea was first proposed by Robert Edgar Hope-Simpson in 1965.[166] He proposed that the cause of influenza epidemics during winter may be connected to seasonal fluctuations of vitamin D, which is produced in the skin under the influence of solar (or artificial) UV radiation. This could explain why influenza occurs mostly in winter and during the tropical rainy season, when people stay indoors, away from the sun, and their vitamin D levels fall.

text: Epidemic and pandemic spread

text: As influenza is caused by a variety of species and strains of viruses, in any given year some strains can die out while others create epidemics, while yet another strain can cause a pandemic. Typically, in a year's normal two flu seasons (one per hemisphere), there are between three and five million cases of severe illness and around 500,000 deaths worldwide,[167] which by some definitions is a yearly influenza epidemic.[168] Although the incidence of influenza can vary widely between years, approximately 36,000 deaths and more than 200,000 hospitalizations are directly associated with influenza every year in the United States.[169][170] One method of calculating influenza mortality produced an estimate of 41,400 average deaths per year in the United States between 1979 and 2001.[171] Different methods in 2010 by the Centers for Disease Control and Prevention (CDC) reported a range from a low of about 3,300 deaths to a high of 49,000 per year.[172]

text: Roughly three times per century, a pandemic occurs, which infects a large proportion of the world's population and can kill tens of millions of people (see pandemics section). One study estimated that if a strain with similar virulence to the 1918 influenza emerged today, it could kill between 50 and 80 million people.[173]

text: New influenza viruses are constantly evolving by mutation or by reassortment.[46] Mutations can cause small changes in the hemagglutinin and neuraminidase antigens on the surface of the virus. This is called antigenic drift, which slowly creates an increasing variety of strains until one evolves that can infect people who are immune to the pre-existing strains. This new variant then replaces the older strains as it rapidly sweeps through the human population, often causing an epidemic.[174] However, since the strains produced by drift will still be reasonably similar to the older strains, some people will still be immune to them. In contrast, when influenza viruses reassort, they acquire completely new antigens—for example by reassortment between avian strains and human strains; this is called antigenic shift. If a human influenza virus is produced that has entirely new antigens, everybody will be susceptible, and the novel influenza will spread uncontrollably, causing a pandemic.[175] In contrast to this model of pandemics based on antigenic drift and shift, an alternative approach has been proposed where the periodic pandemics are produced by interactions of a fixed set of viral strains with a human population with a constantly changing set of immunities to different viral strains.[176]

text: From a public health point of view, flu epidemics spread rapidly and are very difficult to control. Most influenza virus strains are not very infectious and each infected individual will only go on to infect one or two other individuals (the basic reproduction number for influenza is generally around 1.4). However, the generation time for influenza is extremely short: the time from a person becoming infected to when he infects the next person is only two days. The short generation time means that influenza epidemics generally peak at around 2 months and burn out after 3 months: the decision to intervene in an influenza epidemic therefore has to be taken early, and the decision is therefore often made on the back of incomplete data. Another problem is that individuals become infectious before they become symptomatic, which means that putting people in quarantine after they become ill is not an effective public health intervention.[177] For the average person, viral shedding tends to peak on day two whereas symptoms peak on day three.[14]

text: History

text: Etymology

text: The word Influenza comes from the Italian language meaning "influence" and refers to the cause of the disease; initially, this ascribed illness to unfavorable astrological influences. It was introduced into English in the mid-eighteenth century during a pan-European epidemic.[178] Archaic terms for influenza include epidemic catarrh, la grippe (from the French, first used by Molyneaux in 1694),[179] sweating sickness, and Spanish fever (particularly for the 1918 flu pandemic strain).[180]

text: Pandemics

text: The symptoms of human influenza were clearly described by Hippocrates roughly 2,400 years ago.[182][183] Although the virus seems to have caused epidemics throughout human history, historical data on influenza are difficult to interpret, because the symptoms can be similar to those of other respiratory diseases.[184][185] The disease may have spread from Europe to the Americas as early as the European colonization of the Americas; since almost the entire indigenous population of the Antilles was killed by an epidemic resembling influenza that broke out in 1493, after the arrival of Christopher Columbus.[186][187]

text: The first convincing record of an influenza pandemic was of an outbreak in 1580, which began in Russia and spread to Europe via Africa. In Rome, over 8,000 people were killed, and several Spanish cities were almost wiped out. Pandemics continued sporadically throughout the 17th and 18th centuries, with the pandemic of 1830–1833 being particularly widespread; it infected approximately a quarter of the people exposed.[185]

text: The most famous and lethal outbreak was the 1918 flu pandemic (Spanish flu pandemic) (type A influenza, H1N1 subtype), which lasted from 1918 to 1919. It is not known exactly how many it killed, but estimates range from 50 to 100 million people.[181][188][189] This pandemic has been described as "the greatest medical holocaust in history" and may have killed as many people as the Black Death.[185] This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.[189] Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."[188] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.[190]

text: The 1918 flu pandemic was truly global, spreading even to the Arctic and remote Pacific islands. The unusually severe disease killed between two and twenty percent of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[181][188] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.[191] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70). The total mortality of the 1918–1919 pandemic is not known, but it is estimated that 2.5% to 5% of the world's population was killed. As many as 25 million may have been killed in the first 25 weeks; in contrast, HIV/AIDS has killed 25 million in its first 25 years.[188]

text: Later flu pandemics were not so devastating. They included the 1957 Asian Flu (type A, H2N2 strain) and the 1968 Hong Kong Flu (type A, H3N2 strain), but even these smaller outbreaks killed millions of people. In later pandemics antibiotics were available to control secondary infections and this may have helped reduce mortality compared to the Spanish Flu of 1918.[181]

text:
Known flu pandemics[9][64][185]

Name of pandemic
Date
Deaths
Case fatality rate
Subtype involved
Pandemic Severity Index

1889–1890 flu pandemic
(Asiatic or Russian Flu)[192]
1889–1890
1 million
0.15%
possibly H3N8
or H2N2
N/A

1918 flu pandemic
(Spanish flu)[193]
1918–1920
20 to 100 million
2%
H1N1
5

Asian Flu
1957–1958
1 to 1.5 million
0.13%
H2N2
2

Hong Kong Flu
1968–1969
0.75 to 1 million
<0.1%
H3N2
2

Russian flu
1977–1978
no accurate count
N/A
H1N1
N/A

2009 flu pandemic[194]
2009–2010
105,700–395,600[195]
0.03%
H1N1
N/A

text: The first influenza virus to be isolated was from poultry, when in 1901 the agent causing a disease called "fowl plague" was passed through Chamberland filters, which have pores that are too small for bacteria to pass through.[196] The etiological cause of influenza, the virus family Orthomyxoviridae, was first discovered in pigs by Richard Shope in 1931.[197] This discovery was shortly followed by the isolation of the virus from humans by a group headed by Patrick Laidlaw at the Medical Research Council of the United Kingdom in 1933.[198] However, it was not until Wendell Stanley first crystallized tobacco mosaic virus in 1935 that the non-cellular nature of viruses was appreciated.

text: The first significant step towards preventing influenza was the development in 1944 of a killed-virus vaccine for influenza by Thomas Francis, Jr. This built on work by Australian Frank Macfarlane Burnet, who showed that the virus lost virulence when it was cultured in fertilized hen's eggs.[200] Application of this observation by Francis allowed his group of researchers at the University of Michigan to develop the first influenza vaccine, with support from the U.S. Army.[201] The Army was deeply involved in this research due to its experience of influenza in World War I, when thousands of troops were killed by the virus in a matter of months.[188] In comparison to vaccines, the development of anti-influenza drugs has been slower, with amantadine being licensed in 1966 and, almost thirty years later, the next class of drugs (the neuraminidase inhibitors) being developed.[65]

text: Society and culture

text: Influenza produces direct costs due to lost productivity and associated medical treatment, as well as indirect costs of preventative measures. In the United States, influenza is responsible for a total cost of over $10 billion per year, while it has been estimated that a future pandemic could cause hundreds of billions of dollars in direct and indirect costs.[202] However, the economic impacts of past pandemics have not been intensively studied, and some authors have suggested that the Spanish influenza actually had a positive long-term effect on per-capita income growth, despite a large reduction in the working population and severe short-term depressive effects.[203] Other studies have attempted to predict the costs of a pandemic as serious as the 1918 Spanish flu on the U.S. economy, where 30% of all workers became ill, and 2.5% were killed. A 30% sickness rate and a three-week length of illness would decrease the gross domestic product by 5%. Additional costs would come from medical treatment of 18 million to 45 million people, and total economic costs would be approximately $700 billion.[204]

text: Preventative costs are also high. Governments worldwide have spent billions of U.S. dollars preparing and planning for a potential H5N1 avian influenza pandemic, with costs associated with purchasing drugs and vaccines as well as developing disaster drills and strategies for improved border controls.[205] On 1 November 2005, United States President George W. Bush unveiled the National Strategy to Safeguard Against the Danger of Pandemic Influenza[202] backed by a request to Congress for $7.1 billion to begin implementing the plan.[206] Internationally, on 18 January 2006, donor nations pledged US$2 billion to combat bird flu at the two-day International Pledging Conference on Avian and Human Influenza held in China.[207]

text: In an assessment of the 2009 H1N1 pandemic on selected countries in the Southern Hemisphere, data suggest that all countries experienced some time-limited and/or geographically isolated socio/economic effects and a temporary decrease in tourism most likely due to fear of 2009 H1N1 disease. It is still too early to determine whether the H1N1 pandemic has caused any long-term economic impacts.[208]

text: Research

text: Research on influenza includes studies on molecular virology, how the virus produces disease (pathogenesis), host immune responses, viral genomics, and how the virus spreads (epidemiology). These studies help in developing influenza countermeasures; for example, a better understanding of the body's immune system response helps vaccine development, and a detailed picture of how influenza invades cells aids the development of antiviral drugs. One important basic research program is the Influenza Genome Sequencing Project, which is creating a library of influenza sequences; this library should help clarify which factors make one strain more lethal than another, which genes most affect immunogenicity, and how the virus evolves over time.[209]

text: Research into new vaccines is particularly important, as current vaccines are very slow and expensive to produce and must be reformulated every year. The sequencing of the influenza genome and recombinant DNA technology may accelerate the generation of new vaccine strains by allowing scientists to substitute new antigens into a previously developed vaccine strain.[210] New technologies are also being developed to grow viruses in cell culture, which promises higher yields, less cost, better quality and surge capacity.[211] Research on a universal influenza A vaccine, targeted against the external domain of the transmembrane viral M2 protein (M2e), is being done at the University of Ghent by Walter Fiers, Xavier Saelens and their team[212][213][214] and has now successfully concluded Phase I clinical trials. There has been some research success towards a "universal flu vaccine" that produces antibodies against proteins on the viral coat which mutate less rapidly, and thus a single shot could potentially provide longer-lasting protection.[215][216][217]

text: A number of biologics, therapeutic vaccines and immunobiologics are also being investigated for treatment of infection caused by viruses. Therapeutic biologics are designed to activate the immune response to virus or antigens. Typically, biologics do not target metabolic pathways like anti-viral drugs, but stimulate immune cells such as lymphocytes, macrophages, and/or antigen presenting cells, in an effort to drive an immune response towards a cytotoxic effect against the virus. Influenza models, such as murine influenza, are convenient models to test the effects of prophylactic and therapeutic biologics. For example, Lymphocyte T-Cell Immune Modulator inhibits viral growth in the murine model of influenza.[218]

text: Other animals

text:
H5N1

Influenza A virus

subtype H5N1

Genetic structure
Infection
Human mortality
Global spread

in 2004
in 2005
in 2006
in 2007

Social impact
Pandemic
Vaccine

v
t
e

text: Influenza infects many animal species, and transfer of viral strains between species can occur. Birds are thought to be the main animal reservoirs of influenza viruses.[219] Sixteen forms of hemagglutinin and nine forms of neuraminidase have been identified. All known subtypes (HxNy) are found in birds, but many subtypes are endemic in humans, dogs, horses, and pigs; populations of camels, ferrets, cats, seals, mink, and whales also show evidence of prior infection or exposure to influenza.[51] Variants of flu virus are sometimes named according to the species the strain is endemic in or adapted to. The main variants named using this convention are: bird flu, human flu, swine flu, horse flu and dog flu. (Cat flu generally refers to feline viral rhinotracheitis or feline calicivirus and not infection from an influenza virus.) In pigs, horses and dogs, influenza symptoms are similar to humans, with cough, fever and loss of appetite.[51] The frequency of animal diseases are not as well-studied as human infection, but an outbreak of influenza in harbor seals caused approximately 500 seal deaths off the New England coast in 1979–1980.[220] However, outbreaks in pigs are common and do not cause severe mortality.[51] Vaccines have also been developed to protect poultry from avian influenza. These vaccines can be effective against multiple strains and are used either as part of a preventative strategy, or combined with culling in attempts to eradicate outbreaks.[221]

text: Bird flu

text: Flu symptoms in birds are variable and can be unspecific.[222] The symptoms following infection with low-pathogenicity avian influenza may be as mild as ruffled feathers, a small reduction in egg production, or weight loss combined with minor respiratory disease.[223] Since these mild symptoms can make diagnosis in the field difficult, tracking the spread of avian influenza requires laboratory testing of samples from infected birds. Some strains such as Asian H9N2 are highly virulent to poultry and may cause more extreme symptoms and significant mortality.[224] In its most highly pathogenic form, influenza in chickens and turkeys produces a sudden appearance of severe symptoms and almost 100% mortality within two days.[225] As the virus spreads rapidly in the crowded conditions seen in the intensive farming of chickens and turkeys, these outbreaks can cause large economic losses to poultry farmers.

text: An avian-adapted, highly pathogenic strain of H5N1 (called HPAI A(H5N1), for "highly pathogenic avian influenza virus of type A of subtype H5N1") causes H5N1 flu, commonly known as "avian influenza" or simply "bird flu", and is endemic in many bird populations, especially in Southeast Asia. This Asian lineage strain of HPAI A(H5N1) is spreading globally. It is epizootic (an epidemic in non-humans) and panzootic (a disease affecting animals of many species, especially over a wide area), killing tens of millions of birds and spurring the culling of hundreds of millions of other birds in an attempt to control its spread. Most references in the media to "bird flu" and most references to H5N1 are about this specific strain.[226][227]

text: At present, HPAI A(H5N1) is an avian disease, and there is no evidence suggesting efficient human-to-human transmission of HPAI A(H5N1). In almost all cases, those infected have had extensive physical contact with infected birds.[228] In the future, H5N1 may mutate or reassort into a strain capable of efficient human-to-human transmission. The exact changes that are required for this to happen are not well understood.[229] However, due to the high lethality and virulence of H5N1, its endemic presence, and its large and increasing biological host reservoir, the H5N1 virus was the world's pandemic threat in the 2006–07 flu season, and billions of dollars are being raised and spent researching H5N1 and preparing for a potential influenza pandemic.[205]

text: In March 2013, the Chinese government reported three cases of H7N9 influenza infections in humans. Two of whom had died and the third was critically ill. Although the strain of the virus is not thought to spread efficiently between humans,[230][231] by mid-April, at least 82 persons had become ill from H7N9, of which 17 had died. These cases include three small family clusters in Shanghai and one cluster between a neighboring girl and boy in Beijing, raising at least the possibility of human-to-human transmission. WHO points out that one cluster did not have two of the cases lab confirmed and further points out, as a matter of baseline information, that some viruses are able to cause limited human-to-human transmission under conditions of close contact but are not transmissible enough to cause large community outbreaks.[232][233]

text: Swine flu

text: In pigs swine influenza produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.[234] In some cases the infection can cause abortion. Although mortality is usually low, the virus can produce weight loss and poor growth, causing economic loss to farmers.[234] Infected pigs can lose up to 12 pounds of body weight over a 3- to 4-week period.[234] Direct transmission of an influenza virus from pigs to humans is occasionally possible (this is called zoonotic swine flu). In all, 50 human cases are known to have occurred since the virus was identified in the mid-20th century, which have resulted in six deaths.[235]

text: In 2009, a swine-origin H1N1 virus strain commonly referred to as "swine flu" caused the 2009 flu pandemic, but there is no evidence that it is endemic to pigs (i.e. actually a swine flu) or of transmission from pigs to people, instead the virus is spreading from person to person.[236][237] This strain is a reassortment of several strains of H1N1 that are usually found separately, in humans, birds, and pigs.[238]


document_title: Chief of Army Staff (Pakistan)

question_text: the first chief of staff of pak army was

text: Chief of Army Staff (Pakistan)

text: History[edit]

text: Prior to creation of Pakistan from the partition of India on 14 August 1947, the senior military general officer commanding of the Pakistan Army were the ad-hoc appointments made by the Army Board of the British Army.[10]

text: The appointment was known as Commander-in-Chief who directly reported to the Governor-General who was also under British monarchs.:105[11] The first commander-in-chiefs of the army were senior officers of the British Army who commanded the amalgamated army of British and Pakistani army officers from 1947 until 1951.:105[11]

text: In 1969, the title of the army command was changed from "Commander-in-Chief" to "Chief of Staff" with President Yahya Khan acting as Commander-in-Chief and General A.H. Khan as Chief of Staff.:contents[12] On 20 March 1972, the post was renamed as "Chief of Army Staff" (COAS) with Lieutenant-General Tikka Khan elevated to four star rank to be appointed as army's first chief of army staff.:62[13]

text: The term of the superannuation was then constrained to three years in the office as opposed to four years and was made a permanent member of Joint Chiefs of Staff Committee.:62[13] Since 1972, there has been 10 four-star rank army generals to be appointed as chief of army staff by statue.[14] The Prime Minister approved the nomination and appointment of the Chief of Army Staff, with President confirming the Prime Minister's appointed choosing and nomination.[15]

text: The army leadership is based in the Army GHQ whose functions are supervised by the Chief of Army Staff, assisted by the civilians from the Army Secretariat of the Ministry of Defence (MoD).[1] The Chief of Army Staff exercise its responsibility of complete operational, training and logistics commands.:131[4]

text: There are several principle staff officers (PSO) that assists in running the operations of the Army GHQ:

text:
Engineer-in-Chief (Eng-in-C)
Chief of General Staff
Chief of Logistics Staff
Inspector-General of Training and Evaluation (IGT&E)
Inspector-General Communications and IT (IGC&IT)
Inspector-General Arms (IG Arms)
Military Secretary (Mil Secy)
Adjutant-General
Quartermaster General (QMG)
Master-General of Ordnance (MGO)
Judge Advocate General Corps
Director-General EME (DGEME)
Director-General Frontier Works Organisation (DGFWO)
DG Combat Development Directorate

text: Martial law and turnover[edit]

text: Due to the powers granted by the Constitution of Pakistan to assist the civilian government led by popularly-elected Prime Minister to control and command the law and order, the chief of army staff has been instrumental in instigating and enforcing the coups d'état against the civilian government and the Prime Minister.:40[16][17] In 1977, General Zia-ul-Haq was the first army chief who carefully planned a coup against Prime Minister Zulfikar Ali Bhutto when the right wing opposition instigated popular demonstration after the general elections held in 1977.[18]

text: After the Pakistan Army's performance in Kargil sector, Prime Minister Sharif terminated the commission of General Musharraf, as an army chief and chairman joint chiefs, but Musharraf refused to follow the orders by instigating and leading the military coup by turning over the government under his control on 12 October 1999.[19][20]

text: The army chiefs, including the previous army's commanders-in-chiefs, had justified their course of actions by noting to attempt to control the worsening of the law and order situation in the country, as in the case of Yahya Khan (1969):239[21] and General Zia-ul-Haq:239[21] (1977), or by attempting to revive the economic prosperity in a threat of financial crises, as seen in the case of General Ayub Khan (1958):contents[22][23] and General Pervez Musharraf (1999).:154[24]:254[25]

text: Past Chiefs of Army Staff[edit]

text:
Order
Name
Rank
Portrait
Appointment Date
Retirement
Unit of Commission
Decorations

1.
Tikka Khan
  General

3 March 1972
1 March 1976
2 Fd Regt Arty
HJ, HQA, SPk

2.
Muhammad Zia-ul-Haq
  General

1 March 1976
17 August 1988
13 Lancers

3.
Mirza Aslam Beg
  General

17 August 1988
16 August 1991
16 Baloch
NI(M), SBt

4.
Asif Nawaz
  General

16 August 1991
8 January 1993
5 Punjab
NI(M), SBt

5.
Abdul Waheed Kakar
  General

11 January 1993
12 January 1996
5 FF
NI(M), SBt

6.
Jehangir Karamat
  General

12 January 1996
6 October 1998
13 Lancers
NI(M), TBt

7.
Pervez Musharraf
  General

6 October 1998
28 November 2007
16 (SP) Medium Regt Arty
NI(M), TBt

–
Ziauddin Butt
  General

12 October 1999
12 October 1999
(Appointment lasted few hours)
Corps of EME
HI(M)

8.
Ashfaq Parvez Kayani
  General

29 November 2007
29 November 2013
5 Baloch
NI(M), HI(C)

9.
Raheel Sharif
  General

29 November 2013
29 November 2016
6 FF
NI(M)

10.
Qamar Javed Bajwa
  General

29 November 2016
Present
15 Baloch
NI(M), HI(M)

text: Vice Chief of Army Staff[edit]

text: The Vice Chief of Army Staff (VCOAS), is the post that is principle deputy and second-in-command (S-in-C) of the Pakistan Army, reporting under the Chief of Army Staff. The position was created in the existence of army chief is simultaneously the President of Pakistan, having taking over by imposing the martial law against the elected civilian government.:contents[26] The post is now nonexistence and no longer in commission with the army— the Chief of General Staff now serves as the second-in-command in the army leadership.[27]

text: The function and scope of the vice army chief was to "exercise and perform all the powers and functions vested in the chief of army staff under the law. rules, regulations, orders, and instructions for the time being in the force.":contents[26]

text: The vice army chiefs are considered to be the principle commander of the army but not altogether, as the vice army chief has to report to the army chief, specifically in taking decisions regarding the promotions.:contents[26] The post of the vice army chief is a senior position and its officer is a four-star rank army general.

text: List of vice chiefs of army staff[edit]

text: All persons mentioned below have served as the Vice Chief of the Army Staff with distinction of General Abdul Hamid Khan who acted as the 'Chief of Staff of the Army' (COS) under General Yahya Khan who was the President of Pakistan and also the holder of the title 'C-in-C of the Army'.

text:
Order
Name
Rank
Photo
Appointment Date
Left Office
Unit of Commission
Decorations

±
Abdul Hamid Khan
General

25 March 1969
20 December 1971
10th Baloch
HQA, SPk

1
Sawar Khan
General

13 April 1980
23 March 1984
1st (SP) Med Regt Arty (FF)
NI(M)

2
Khalid Mahmud Arif
General

22 March 1984
29 March 1987
11th Cavalry (FF)
NI(M), S Bt

3
Mirza Aslam Beg
General

29 March 1987
17 August 1988
16th Baloch
NI(M), S Bt

4
Yusaf Khan
General

8 October 2001
6 October 2004
Guides Cavalry
NI(M)

5
Ahsan Saleem Hayat
General

7 October 2004
7 October 2007
33rd Cavalry
NI(M)

6
Ashfaq Parvez Kayani
General

8 October 2007
28 November 2007
5th Baloch
NI(M), HI


document_title: Bobbyjo

question_text: when did bobby joe win the grand national

text: Bobbyjo

text:
Bobbyjo Owner = Bobby Burke

Statue of Bobbyjo in Mountbellew, County Galway

Sire
Bustineto

Grandsire
Bustino

Dam
Markup

Damsire
Appiani

Sex
Gelding

Foaled
5 May 1990

Country
Ireland

Colour
Bay

Breeder
Liam Skehan

Owner
Robert Burke

Trainer
Tommy Carberry

Record
48: 8-6-2

Earnings
£345,695

Major wins

Irish Grand National (1998)
Grand National (1999)

Last updated on February 11, 2010

text: Bobbyjo (1990 – 2001) was an Irish bred racehorse by Bustineto and Markup, best remembered as the winner of the 1999 Grand National steeplechase at Aintree. Bobbyjo was owned by Bobby Burke Mullaghmore, Co. Galway.

text: Humble Beginnings

text: In 1991, Bobby Burke and his brother Eugene, who was breeding horses himself, met in Galway with businessman and auctioneer Liam Mulryan. They bought six horses from Liam. One was named Bobbyjo and spent the next few years at Eugene’s farm in Mullaghmore before being sent for training with Tommy Carberry in July 1995. Bobbyjo was an Irish bred racehorse by Bustineto and Markup. The name Boobyjo was created by joining Bobby's name with that of his wife Jo.

text: Grand National Success

text: Bobbyjo arrived at Aintree having won the Irish Grand National in 1998, however this was not regarded at the time as a good pointe to Grand National success as Irish trained runners had failed to win the race for twenty-four years. On the day Bobbyjo was the subject of a huge gamble that saw him sent off at the short odds of 10/1 with Paul Carberry, the son of the trainer Tommy in the saddle. As coincidence had it, Tommy had been the rider twenty-four years earlier, the last time an Irish trained runner had won the race.[1]

text: The victory signalled an upturn in fortunes for Irish trained runners in the decade that followed, though he himself completed the course well beaten when defending his crown in 1999.

text: Death of Bobbyjo

text: Bobbyjo broke a knee at Fairyhouse Racecourse in February 2001 and had to be put down one month later due to his incurable injuries. In memorial of the horse, a new steeplechase first run at Fairyhouse Racecourse in February 2003 has been named after him.


document_title: Social Security number

question_text: who was assigned the first social security number

text: Social Security number

text: History[edit]

text: Social Security numbers were first issued by the Social Security Administration in November 1935 as part of the New Deal Social Security program. Within three months, 25 million numbers were issued.[4]

text: On November 24, 1936, 1,074 of the nation's 45,000 post offices were designated "typing centers" to type up Social Security cards that were then sent to Washington, D.C. On December 1, 1936, as part of the publicity campaign for the new program, Joseph L. Fay of the Social Security Administration selected a record from the top of the first stack of 1,000 records and announced that the first Social Security number in history was assigned to John David Sweeney, Jr., of New Rochelle, New York.[5][6]

text: Before 1986, people often did not obtain a Social Security number until the age of about 14,[7] since the numbers were used for income tracking purposes, and those under that age seldom had substantial income.[8] The Tax Reform Act of 1986 required parents to list Social Security numbers for each dependent over the age of 5 for whom the parent wanted to claim a tax deduction.[9] Before this act, parents claiming tax deductions were simply trusted not to lie about the number of children they supported. During the first year of the Tax Reform Act, this anti-fraud change resulted in seven million fewer minor dependents being claimed. The disappearance of these dependents is believed to have involved either children who never existed or tax deductions improperly claimed by non-custodial parents.[10] In 1988, the threshold was lowered to 2 years old, and in 1990, the threshold was lowered yet again to 1 year old.[11] Today, an SSN is required regardless of the child's age to receive an exemption.[citation needed] Since then, parents have often applied for Social Security numbers for their children soon after birth; today, it can be done on the application for a birth certificate.[12]

text: Purpose and use[edit]

text: The original purpose of this number was to track individuals' accounts within the Social Security program.  It has since come to be used as an identifier for individuals within the United States, although rare errors occur where duplicates do exist.  As numbers are now assigned by the central issuing office of the SSA, it is unlikely that duplication will ever occur again. A few duplications did occur when prenumbered cards were sent out to regional SSA offices and (originally) Post Offices.

text: Employee, patient, student, and credit records are sometimes indexed by Social Security number.

text: The U.S. Armed Forces has used the Social Security number as an identification number for Army and Air Force personnel since July 1, 1969, the Navy and Marine Corps for their personnel since January 1, 1972, and the Coast Guard for their personnel since October 1, 1974.[13] Previously, the United States military used a much more complicated system of service numbers that varied by service.

text: Beginning in June 2011, DOD began removing the Social Security number from military identification cards. It is replaced by a unique DOD identification number, formerly known as the EDIPI.[14]

text: Non-universal status[edit]

text: Social Security was originally a universal tax, but when Medicare was passed in 1965, objecting religious groups in existence prior to 1951 were allowed to opt out of the system.[15]  Because of this, not every American is part of the Social Security program, and not everyone has a number. However, a social security number is required for parents to claim their children as dependents for federal income tax purposes,[12] and the Internal Revenue Service requires all corporations to obtain SSNs (or alternative identifying numbers) from their employees, as described below. The Old Order Amish have fought to prevent universal Social Security by overturning rules such as a requirement to provide a Social Security number for a hunting license.[16]

text: Social Security cards printed from January 1946 until January 1972 expressly stated that people should not use the number and card for identification.[17] Since nearly everyone in the United States now has an SSN, it became convenient to use it anyway and the message was removed.[18]

text: Since then, Social Security numbers have become de facto national identification numbers.[2] Although some people do not have an SSN assigned to them, it is becoming increasingly difficult to engage in legitimate financial activities such as applying for a loan or a bank account without one.[19] While the government cannot require an individual to disclose their SSN without a legal basis, companies may refuse to provide service to an individual who does not provide an SSN.[20][21] The card on which an SSN is issued is still not suitable for primary identification as it has no photograph, no physical description and no birth date. All it does is confirm that a particular number has been issued to a particular name. Instead, a driver's license or state ID card is used as an identification for adults.

text: Use required for federal tax purposes[edit]

text: Internal Revenue Code section 6109(d) provides: "The social security account number issued to an individual for purposes of section 205(c)(2)(A) of the Social Security Act [codified as 42 U.S.C. § 405(c)(2)(A)] shall, except as shall otherwise be specified under regulations of the Secretary [of the Treasury or his delegate], be used as the identifying number for such individual for purposes of this title [the Internal Revenue Code, title 26 of the United States Code]."[22]

text: The Internal Revenue Code also provides, when required by regulations prescribed by the Secretary [of the Treasury or his delegate]:

text:
Inclusion in returns: Any person required under the authority of this title to make a return, statement, or other document shall include in such return, statement, or other document such identifying number as may be prescribed for securing proper identification of such person.
Furnishing number to other persons: Any person with respect to whom a return, statement, or other document is required under the authority of this title to be made by another person or whose identifying number is required to be shown on a return of another person shall furnish to such other person such identifying number as may be prescribed for securing his proper identification.[23]

tag: ol

text: According to U.S. Treasury regulations, any person who, after October 31, 1962, works as an employee for wages subject to Social Security taxes, Medicare taxes, or U.S. federal income tax withholdings is required to apply for "an account number" using "Form SS-5."[24]

text: A taxpayer who is not eligible to have a Social Security number must obtain an alternative Taxpayer Identification Number.

text: Types of Social Security cards[edit]

text: Three different types of Social Security cards are issued. The most common type contains the cardholder's name and number.  Such cards are issued to U.S. citizens and U.S. permanent residents. There are also two restricted types of Social Security cards:

text:
One reads "not valid for employment." Such cards cannot be used as proof of work authorization, and are not acceptable as a List C document on the I-9 form.
The other reads "valid for work only with DHS authorization", or the older, "valid for work only with INS authorization." These cards are issued to people who have temporary work authorization in the U.S.  They can satisfy the I-9 requirement, if they are accompanied by a work authorization card.

text: In 2004 Congress passed The Intelligence Reform and Terrorism Prevention Act; parts of which mandated that the Social Security Administration redesign the Social Security Number (SSN) Card to prevent forgery. From April 2006 through August 2007, Social Security Administration (SSA) and Government Printing Office (GPO) employees were assigned to redesign the Social Security Number Card to the specifications of the Interagency Task Force created by the Commissioner of Social Security in consultation with the Secretary of Homeland Security.

text: The new SSN card design utilizes both covert and overt security features created by the SSA and GPO design teams.

text: Identity theft[edit]

text: Many citizens and privacy advocates are concerned about the disclosure and processing of Social Security numbers.  Furthermore, researchers at Carnegie Mellon University have demonstrated an algorithm that uses publicly available personal information to reconstruct a given SSN.[25]

text: The SSN is frequently used by those involved in identity theft, since it is interconnected with many other forms of identification, and because people asking for it treat it as an authenticator. Financial institutions generally require an SSN to set up bank accounts, credit cards, and loans—partly because they assume that no one except the person it was issued to knows it.

text: Exacerbating the problem of using the Social Security number as an identifier is the fact that the Social Security card contains no biometric identifiers of any sort, making it essentially impossible to tell whether a person using a certain SSN truly belongs to someone without relying on other documentation (which may itself have been falsely procured through use of the fraudulent SSN). Congress has proposed federal laws that restrict the use of SSNs for identification and bans their use for a number of commercial purposes—e.g., rental applications.[26]

text: The Internal Revenue Service (IRS) offers alternatives to SSNs in some places where providing untrusted parties with identification numbers is essential. Tax return preparers must obtain and use a Preparer Tax Identification Number (PTIN) to include on their client's tax returns (as part of signature requirements). Day care services have tax benefits, and even a sole proprietor should give parents an EIN (employer identification number) to use on their tax return.

text: The Social Security Administration has suggested that, if asked to provide his or her Social Security number, a citizen should ask which law requires its use.[27] In accordance with §7213 of the 9/11 Commission Implementation Act of 2004 and 20 C.F.R. 422.103(e)(2), the number of replacement Social Security cards per person is generally limited to three per calendar year and ten in a lifetime.[27]

text: Identity confusion has also occurred because of the use of local Social Security numbers by the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, whose numbers overlap with those of residents of New Hampshire and Maine.[28]

text: Replacement numbers[edit]

text: A person can request a new Social Security number, but only under certain conditions;[29]

text:
Where sequential numbers assigned to members of the same family are causing problems.
In the event of duplicates having been issued.
In cases where the person has been a victim of domestic violence or harassment, and there is a clear need to change their number for their personal safety.[30]
When a person has been a victim of identity theft, and their Social Security number continues to be problematic.
Where a person has a demonstrable religious objection to a number (such as certain Christians being averse to the number 666).

text: For all of these conditions, credible third-party evidence such as a restraining order or police report, is required.

text: Structure[edit]

text: The Social Security number is a nine-digit number in the format "AAA-GG-SSSS".[31] The number is divided into three parts: the first three digits, known as the area number because they were formerly assigned by geographical region; the middle two digits, known as the group number; and the final four digits, known as the serial number.

text: On June 25, 2011, the SSA changed the SSN assignment process to "SSN randomization".[32] SSN randomization affected the SSN assignment process in the following ways:

text:
It eliminated the geographical significance of the first three digits of the SSN, referred to as the area number, by no longer allocating specific numbers by state for assignment to individuals.
It eliminated the significance of the highest group number assigned for each area number, and, as a result, the High Group List is frozen in time and can be used for validation of only those SSNs issued prior to the randomization implementation date (see section "Valid SSNs").
Previously unassigned area numbers have been introduced for assignment, excluding area numbers 000, 666 and 900–99.

text: Because Individual Taxpayer Identification Numbers (ITINs) are issued by the Internal Revenue Service (IRS), they were not affected by this SSA change.

text: Historical structure[edit]

text: Prior to the 2011 randomization process, the first three digits or area number were assigned by geographical region. Prior to 1973, cards were issued in local Social Security offices around the country and the area number represented the office code where the card was issued. This did not necessarily have to be in the area where the applicant lived, since a person could apply for their card in any Social Security office. Beginning in 1973, when the SSA began assigning SSNs and issuing cards centrally from Baltimore, the area number was assigned based on the ZIP Code in the mailing address provided on the application for the original Social Security card. The applicant's mailing address did not have to be the same as their place of residence. Thus, the area number did not necessarily represent the state of residence of the applicant regardless of whether the card was issued prior to, or after, 1973.

text: Generally, numbers were assigned beginning in the northeast and moving south and westward, so that people applying from addresses on the east coast had the lowest numbers and those on the west coast had the highest numbers. As the areas assigned to a locality were exhausted, new areas from the pool were assigned, so some states had noncontiguous groups of numbers.

text: The middle two digits or group number range from 01 to 99. Even before SSN randomization, the group numbers were not assigned consecutively within an area. Instead, for administrative reasons, group numbers were issued in the following order:[33]

text:
odd numbers from 01 through 09.
even numbers from 10 through 98.
even numbers from 02 through 08.
odd numbers from 11 through 99.

text: As an example, group number 98 would be issued before 11.

text: The last four digits are serial numbers. Before SSN randomization took effect, they represented a straight numerical sequence of digits from 0001 to 9999 within the group.

text: Valid SSNs[edit]

text: Prior to June 25, 2011, a valid SSN could not have an area number between 734 and 749, or above 772, the highest area number the Social Security Administration had allocated. Effective June 25, 2011, the SSA assigns SSNs randomly and allows for the assignment of area numbers between 734 and 749 and above 772 through the 800s.[34]  This should not be confused with Tax Identification Numbers (TINs), which include additional area numbers.[35]

text: Some special numbers are never allocated:

text:
Numbers with all zeros in any digit group (000-##-####, ###-00-####, ###-##-0000).[36][37]
Numbers with 666 or 900–999 (Individual Taxpayer Identification Number) in the first digit group.[36]

text: Until 2011, the SSA published the last group number used for each area number.[38] Since group numbers were allocated in a regular pattern, it was possible to identify an unissued SSN that contained an invalid group number. Now numbers are assigned randomly, and fraudulent SSNs are not easily detectable with publicly available information. Many online services, however, provide SSN validation.

text: Unlike many similar numbers, no check digit is included.

text: Exhaustion and re-use[edit]

text: The Social Security Administration does not reuse Social Security numbers. It has issued over 450 million since the start of the program, and at a use rate of about 5.5 million per year. It says it has enough to last several generations without reuse or changing the number of digits.[39] However, there have been instances where multiple individuals have been inadvertently assigned the same Social Security number.[40]

text: SSNs used in advertising[edit]

text: Some SSNs used in advertising have rendered those numbers invalid. One famous instance of this occurred in 1938 when the E. H. Ferree Company in Lockport, New York, decided to promote its product by showing how a Social Security card would fit into its wallets. A sample card, used for display purposes, was placed in each wallet, which was sold by Woolworth and other department stores across the country; the wallet manufacturer's vice president and treasurer Douglas Patterson used the actual SSN of his secretary, Hilda Schrader Whitcher.

text: Even though the card was printed in red (the real card is printed in blue) and had "Specimen" printed across the front, many people used Whitcher's SSN as their own. The Social Security Administration's account of the incident also claims that the fake card was half the size of a real card, despite a miniature card's being useless for its purpose and despite  Whitcher's holding two cards of apparently identical size in the accompanying photograph. Over time, the number that appeared (078-05-1120) has been claimed by a total of over 40,000 people as their own.[41] The SSA initiated an advertising campaign stating that it was incorrect to use the number (Hilda Whitcher was issued a new SSN). However, the number was found to be in use by 12 individuals as late as 1977.[41]

text: More recently, Todd Davis distributed his SSN in advertisements for his company's LifeLock identity theft protection service, which allowed his identity to be stolen over a dozen times.[42][43]

text: List of Social Security Area Numbers[edit]

text: List showing the geographical location of the first three digits of the social security numbers assigned in the United States and its territories since 1973. Repeated numbers indicate that they've been transferred to another location or they're shared by more than one location.

text:
SSN Area Number
Location[44]

001–003
New Hampshire

004–007
Maine

008–009
Vermont

010–034
Massachusetts

035–039
Rhode Island

040–049
Connecticut

050–134
New York

135–158
New Jersey

159–211
Pennsylvania

212–220
Maryland

221–222
Delaware

223–231
Virginia

232–236
West Virginia

232
North Carolina

237–246
North Carolina

247–251
South Carolina

252–260
Georgia

261–267
Florida

268–302
Ohio

303–317
Indiana

318–361
Illinois

362–386
Michigan

387–399
Wisconsin

400–407
Kentucky

408–415
Tennessee

416–424
Alabama

425–428
Mississippi

429–432
Arkansas

433–439
Louisiana

440–448
Oklahoma

449–467
Texas

468–477
Minnesota

478–485
Iowa

486–500
Missouri

501–502
North Dakota

503–504
South Dakota

505–508
Nebraska

509–515
Kansas

516–517
Montana

518–519
Idaho

520
Wyoming

521–524
Colorado

525,585
New Mexico

526–527
Arizona

528–529
Utah

530,680
Nevada

531–539
Washington

540–544
Oregon

545–573
California

574
Alaska

575–576
Hawaii

577–579
District of Columbia

580
Virgin Islands

580–584
Puerto Rico

586
Pacific Islands
Guam
American Samoa
Philippine Islands
Northern Mariana Islands

587–665
California (Southern California, presumably)'

667–679
Not Issued

681–699
Not Issued

700–728
Railroad Board (discontinued July 1, 1963)

729–730
Enumeration at Entry

750–772
Not Issued

text: The above table is only valid for SSN issued before June 2011. On June 25, 2011, the SSA changed the SSN assignment process to "SSN randomization".[45] SSN randomization affects the SSN assignment process. Among its changes, it eliminates the geographical significance of the first three digits of the SSN, previously referred to as the Area Number, by no longer allocating the Area Numbers for assignment to individuals in specific states.  The table above is based on out-of-date information.  Numbers in the range of 650-699 most certainly have been issued (see related comment on the Talk page).


document_title: Light as a feather, stiff as a board

question_text: where did light as a feather stiff as a board come from

text: Light as a feather, stiff as a board

text: Description[edit]

text: One participant lies flat on the floor, and then the others space themselves around him or her, each placing one or two fingertips underneath the participant's limbs. The person closest to the head commonly begins by saying, "She's looking ill," which is repeated several times, and followed by, "she's looking worse," which is also repeated several times. The general direction of the call-and-repeat describes how the prone person is looking worse and worse, followed by saying "she is dying," and, finally, "she is dead".

text: Variations of the spoken part of the game occur—In a common, modern version, the person being lifted is told a story about his/her death and asked to imagine it happening to him/her. It serves the dual-purpose of "freaking out" the participants and convincing the participants that it will now be easier to lift this person than before.

text: All versions of the game end with the phrase "light as a feather, stiff as a board" chanted by the entire group, (save for the prone person, who pretends to be dead) as they attempt to lift their companion's body using only their fingertips. Some versions omit the story entirely and only the "light as a feather..." chant is used. Allegedly, after these repetitions, the person being lifted will seem lighter or even entirely weightless.

text: Another variation of the game takes place with one person seated in a chair. Four volunteers agree to stand around the sitter, two on the sitter's left side and the other two on his/her right. Each of the four places two fingers under each corner of the chair's seat and the four together will attempt to lift the chair and sitter, which generally fails. The volunteers will then perform some small ritual, usually involving rubbing their hands together or circling the chair in various direction (counter-clockwise, walking backwards, etc.) After this ritual, the volunteers hold their hands over the sitter's head to "transfer" energy into the sitter, which will presumably make him/her weightless. The lifters then retry lifting the sitter the same way as before. Also it can be that the lifters lift the person sitting in the chair; doing the rest of the ritual as so but holding at the four main points of the body (Under the knees on each side and under the shoulders.)

text: Explanations of the trick[edit]

text: In many strange versions, each of the (in the example) five people sitting around the other person uses only one or two of his or her fingers on each hand to do the weight lifting. It is particularly easy to lift a heavy weight when it is evenly distributed amongst a group of four people. The phenomenon of the weight seeming less on the second try around or after some sort of ritual is due to increased focus and the lifters being more in sync with one another.[3]

text: One explanation for such reports is that the participants are tricking their minds (by way of chanting) into believing that the person being lifted is "light as a feather." The body still reacts to the command from the brain, but the mind perceives it differently. Five people can easily lift one person when those five people are tricking their minds into thinking that the person is light in weight.[dubious – discuss]

text: Another reason for the apparent success of the levitation is the "self-fulfilling prophecy" concept. The lifters "know" a human being is too heavy to lift with a fingertip, so subconsciously, they may not exert enough effort on the first attempt. After the "ritual," the participants may believe that the body is now supposed to move, or that the ritual itself has given them power, and therefore they exert enough effort to raise the participant off the ground.

text: History[edit]

text: The oldest known account of levitation play comes from the diary of Samuel Pepys (1633-1703), a British naval administrator. Pepys’s account of levitation play comes from a conversation with a friend of his, Mr. Brisband, who claimed to have seen four little girls playing light as a feather, stiff as a board in Bourdeaux, France. Pepys’s account of Mr. Brisband’s experience reads:

text: He saw four little girls, very young ones, all kneeling, each of them, upon one knee; and one begun the first line, whispering in the ear of the next, and the second to the third, and the third to the fourth, and she to the first. Then the first begun the second line, and so round quite through, and putting each one finger only to a boy that lay flat upon his back on the ground, as if he was dead; at the end of the words, they did with their four fingers raise this boy high as they could reach, and he [Mr. Brisband] being there, and wondering at it, as also being afeared to see it, for they would have had him to have bore a part in saying the words, in the roome of one of the little girles that was so young that they could hardly make her learn to repeat the words, did, for feare there might be some sleight used in it by the boy, or that the boy might be light, call the cook of the house, a very lusty fellow, as Sir G. Carteret's cook, who is very big, and they did raise him in just the same manner.[4]

text: Pepys also spoke of the chant that accompanied this performance.

text:
Voici un corps mort
Raide comme un bâton,
Froid comme le marbre
Léger comme un esprit,
Lève-toi au nom de Jésus-Christ!

text:
(Here is a dead body
Stiff as a stick,
Cold as marble
Light as a spirit,
Lift yourself, in the name of Jesus Christ!)

text: The next recording of the game being played comes from The Magician’s Own Book (1857). This account differs from that of Pepys, as it is a direct account of the game being played. Also, this account focuses on a different version of the game than the version played by the girls in Samuel Pepys’ account. In this account, the heaviest man at a party in Venice, Italy, sits in a chair, and is unable to be lifted by six other persons, initially. However, after coordinated hand-clapping and synchronized inhalations and exhalations, the man in the chair is able to be lifted on the forefingers of the six lifters.[5]

text: In modern times, the game has been shown in pop culture mediums such as YouTube video and in the 1996 film The Craft, which follows the story of four young girls as they familiarize themselves with witchcraft and various arcane experiments—one of which is light as a feather, stiff as a board.[6][7] In the movie, the girls are seen performing the version of the game described in Samuel Pepys’ diary, which involves one participant lying down, while the others kneel around her. The girls chant “Light as a feather, stiff as a board,” several times before lifting the prone participant into the air. In the movie, this scene involves special effects, which has the affect of the prone participant levitating above the hands of the lifters. The phenomenon has been observed into modern times, often being described as a form of spiritualism or seance and considered anathema by some religious groups. It is widely considered a simple spooky party game along the lines of Bloody Mary and the telling of ghost stories.

text: Footnotes[edit]

text:
Jump up ^ While not scientifically valid, and giving unproven explanations of the event, various pages are mentioned to demonstrate that the spell itself is known, and citation here does not imply that the sources are reliable to demonstrate anything beyond the fact that some people play this game.

Party Levitation from Conversation for Exploration: A Talk Show hosted by Laura Lee
Description of the trick at Castle of Spirits
Jerry W. Decker (1998-01-08). Gestalts and the Production of Anomalous Phenomena. KeelyNet.

Jump up ^ Numen, David (2010). "The Abnormal Lift and other abnormalities". Lybrary.com. Retrieved 2016-03-16.
Jump up ^ "Lift that finger". ABC Science. 2008-05-27.
Jump up ^ Pepys, Samuel, Le Gallienne, Richard ed., The Diary of Samuel Pepys New York, The Modern Library, 2003.
Jump up ^ Arnold, George. (1862). The Magician’s Own Handbook or The Whole Art of Conjuring. New York: Dick Fitzgerald.
Jump up ^ [ZombieSlayerz11]. (2012, October 28). Light as a feather, stiff as a board (actually works). [Video File]. Retrieved from:https://www.youtube.com/watch?v=IqtUl44ZcBk
Jump up ^ [sicknasty244]. (2011, May 10).Light as a feather stiff as a board trick. [Video file]. Retrieved from: https://www.youtube.com/watch?v=wznkUyXvb2s

text: Sources[edit]

text:
In depth explanation of levitation including tricks from Answers.com
Halloween is good clean fun October 30, 1998 Weekender Lexington Herald-Leader (KY) article for purchase link
Pajama game: Despite dramatic changes in culture and technology, girls' sleepovers have remained basically the same for generations by MaryEllen Fillo Hartford Courant Aug. 30, 2005 article for purchase link
Samuel Pepys' diary highlights the experience during the London plague of 1665 as well as the Great Fire in 1666
Levitation Revisited by Elizabeth Tucker explains the origins of the game and discusses some of its occult history.\
The Magician's Own Book contains an entry on page 341-42 which describes an account of the game being played at a Venetian party.
The Craft (1996) Light as a feather, Stiff as a board scene.
Video example 1
Video example 2

text: Party gamesChildren's games

text: All accuracy disputesArticles with disputed statements from November 2008