gastritis | Understanding and definition of the gastritis

Gastritis is an inflammation of the lining of the stomach, and has many possible causes. The main acute causes are excessive alcohol consumption or prolonged use of nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin or ibuprofen. Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Gastritis may also occur in those who have had weight loss surgery resulting in the banding or reconstruction of the digestive tract. Chronic causes are infection with bacteria, primarily Helicobacter pylori, chronic bile reflux, stress and certain autoimmune disorders can cause gastritis as well. The most common symptom is abdominal upset or pain. Other symptoms are indigestion, abdominal bloating, nausea, and vomiting and pernicious anemia. Some may have a feeling of fullness or burning in the upper abdomen. A gastroscopy, blood test, complete blood count test, or a stool test may be used to diagnose gastritis. Treatment includes taking antacids or other medicines, such as proton pump inhibitors or antibiotics, and avoiding hot or spicy foods. For those with pernicious anemia, B12 injections are given.

Many people with gastritis experience no symptoms at all. However, upper central abdominal pain is the most common symptom; the pain may be dull, vague, burning, aching, gnawing, sore, or sharp. Pain is usually located in the upper central portion of the abdomen, but it may occur anywhere from the upper left portion of the abdomen around to the back.

Other signs and symptoms may include:

1. Nausea
2. Vomiting (if present, may be clear, green or yellow, blood-streaked, or completely bloody, depending on the severity of the stomach inflammation)
3. Belching (if present, usually does not relieve the pain much)
4. Bloating
5. Feeling full after only a few bites of food
6. Loss of appetite
7. Unexplained weight loss

Erosive gastritis is a gastric mucosal erosion caused by damage to mucosal defenses. Alcohol consumption does not cause chronic gastritis. It does, however, erode the mucosal lining of the stomach; low doses of alcohol stimulate hydrochloric acid secretion. High doses of alcohol do not stimulate secretion of acid. NSAIDs inhibit cyclooxygenase-1, or COX-1, an enzyme responsible for the biosynthesis of eicosanoids in the stomach, which increases the possibility of peptic ulcers forming. Also, NSAIDs, such as aspirin, reduce a substance that protects the stomach called prostaglandin. These drugs used in a short period of time are not typically dangerous. However, regular use can lead to gastritis.

Chronic gastritis refers to a wide range of problems of the gastric tissues that are the result of H. pylori infection. The immune system makes proteins and antibodies that fight infections in the body to maintain a homeostatic condition. In some disorders the body targets the stomach as if it were a foreign protein or pathogen; it makes antibodies against, severely damages, and may even destroy the stomach or its lining. In some cases bile, normally used to aid digestion in the small intestine, will enter through the pyloric valve of the stomach if it has been removed during surgery or does not work properly, also leading to gastritis. Gastritis may also be caused by other medical conditions, including HIV/AIDS, Crohn's disease, certain connective tissue disorders, and liver or kidney failure.

Mucous gland metaplasia, the reversible replacement of differentiated cells, occurs in the setting of severe damage of the gastric glands, which then waste away (atrophic gastritis), which are progressively replaced by mucous glands. Gastric ulcers may develop; it is unclear if they are the causes or the consequences. Intestinal metaplasia typically begins in response to chronic mucosal injury in the antrum, and may extend to the body. Gastric mucosa cells change to resemble intestinal mucosa and may even assume absorptive characteristics. Intestinal metaplasia is classified histologically as complete or incomplete. With complete metaplasia, gastric mucosa is completely transformed into small-bowel mucosa, both histologically and functionally, with the ability to absorb nutrients and secrete peptides. In incomplete metaplasia, the epithelium assumes a histologic appearance closer to that of the large intestine and frequently exhibits dysplasia.

Helicobacter pylori colonizes the stomach of more than half of the world's population, and the infection continues to play a key role in the pathogenesis of a number of gastroduodenal diseases. Colonization of the gastric mucosa with Helicobacter pylori results in the development of chronic gastritis in infected individuals and in a subset of patients chronic gastritis progresses to complications (i.e. ulcer disease, gastric neoplasias, some distinct extra gastric disorders). However, gastritis has no adverse consequences for most hosts and emerging evidence suggests that H. pylori prevalence is inversely related to gastroesophageal reflux disease and allergic disorders. These observations indicate that eradication may not be appropriate for certain populations due to the potentially beneficial effects conferred by persistent gastric inflammation.

Often, a diagnosis can be made based on the patient's description of his or her symptoms, but other methods which may be used to verify gastritis include:

* Blood tests:

o Blood cell count

o Presence of H. pylori

o Pregnancy

o Liver, kidney, gallbladder, or pancreas functions

* Urinalysis

* Stool sample, to look for blood in the stool

* X-rays

* ECGs

* Endoscopy, to check for stomach lining inflammation and mucous erosion

* Stomach biopsy, to test for gastritis and other conditions

Over-the-counter antacids in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief. When antacids don't provide enough relief, medications such as cimetidine, ranitidine, nizatidine or famotidine that help reduce the amount of acid the stomach produces are often prescribed. An even more effective way to limit stomach acid production is to shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these small pumps. This class of medications includes omeprazole, lansoprazole, rabeprazole, and esomeprazole. Proton pump inhibitors also appear to inhibit H. pylori activity. Cytoprotective agents are designed to help protect the tissues that line the stomach and small intestine. They include the medications sucralfate and misoprostol. If NSAIDs are being taken regularly, one of these medications to protect the stomach may also be taken. Another cytoprotective agent is bismuth subsalicylate. In addition to protecting the lining of stomach and intestines, bismuth preparations appear to inhibit H. pylori activity as well. Several regimens are used to treat H. pylori infection. Most use a combination of two antibiotics and a proton pump inhibitor. Sometimes bismuth is also added to the regimen. The antibiotic aids in destroying the bacteria, and the acid blocker or proton pump inhibitor relieves pain and nausea, heals inflammation, and may increase the antibiotic's effectiveness.

National Westminster Bank | History and definition of the National Westminster Bank | National Westminster Bank Logo

National Westminster Bank Plc, commonly known as NatWest, is the largest retail and commercial bank in the United Kingdom and has been part of The Royal Bank of Scotland Group Plc since 2000. The Royal Bank of Scotland Group (RBS) is ranked as the second largest bank in the world by assets. It was established in 1968 by the merger of National Provincial Bank (established 1833 as National Provincial Bank of England) and Westminster Bank (established 1834 as London County and Westminster Bank). Traditionally considered one of the Big Four clearing banks, NatWest has a large network of 1,600 branches and 3,400 cash machines across Great Britain and offers 24-hour Actionline telephone and online banking services. Today it has more than 7.5 million personal customers and 850,000 small business accounts. In Northern Ireland it operates through its Ulster Bank subsidiary.

The bank can trace its roots back to 1650 with the foundation of Smith's of Nottingham. The creation of the modern bank was announced in 1968 and National Westminster Bank Limited commenced trading on 1 January 1970, after the statutory process of integration had been completed in 1969. The famous three arrowheads symbol was adopted as the new bank's logo; said either to symbolise circulation of money in the financial system or the bank's three constituents, National Provincial, Westminster, and District Bank (established 1829), the latter being taken over by National Provincial Bank in 1962 and allowed to operate under its own name until the formation of National Westminster Bank. The District, National Provincial, and Westminster Bank were fully integrated in the new firm's structure, while Coutts & Co. private bankers (a 1920 National Provincial acquisition, established 1692), Ulster Bank in Northern Ireland (a 1917 Westminster acquisition, established 1836) and the Isle of Man Bank (a 1961 National Provincial acquisition, established 1865) continued as separate operations. Westminster Foreign Bank (established 1913) was restyled International Westminster Bank in 1973. Duncan Stirling, outgoing chairman of Westminster Bank, became first chairman of the fifth largest bank in the world. In 1969 David Robarts, former chairman of National Provincial, assumed Stirling's position. In 1975 it was one of the first London banks to open a representative office in Scotland. It was a founder member of the Joint Credit Card Company (with Lloyds Bank, Midland Bank and the Royal Bank of Scotland) which launched the Access credit card (now MasterCard) in 1972 and in 1976 it introduced the Servicetill cash machine. The same banks (although this time not including Lloyds) were later responsible for the introduction of the Switch debit card (later branded Maestro) in 1988.

Deregulation in the 1980s, culminating in the Big Bang in 1986, also encouraged the bank to enter the securities business. County Bank, its merchant banking subsidiary formed in 1965, acquired various stockbroking and jobbing firms to create the investment banking arm County NatWest. National Westminster Home Loans was established in 1980 and other initiatives included the launch of the Piggy Account for children in 1983, the Credit Zone, a flexible overdraft facility on which customers only pay interest (now commonplace, this so-called pink debt was innovative when launched) and the development of the Mondex electronic purse (later sold to MasterCard Worldwide) in 1990. The Action Bank advertising campaign spearheaded a new marketing-led approach to business development. Under the direction of Robin Leigh-Pemberton, later Lord Kingsdown, who became chairman in 1977, the bank also expanded internationally, forming National Westminster Bancorp in the United States of America with a network of 340 branches across two states, National Westminster Bank of Canada, NatWest Australia Bank and opening branches on the European continent and in the Far East. In 1982, the Frankfurt office of International Westminster Bank was merged with Global Bank AG to form Deutsche Westminster Bank and in 1988, National Westminster Bank SA was incorporated and took over the bank's six branches in France and Monaco. In 1989, International Westminster Bank was merged into National Westminster Bank by Act of Parliament as there was no longer any advantage in operating separately.

Completed in 1980, the bank built the iconic National Westminster Tower in London to serve as its international headquarters. At a height of 600 feet (183 m) it was the tallest building in the UK until the topping-out of Canary Wharf Tower 10 years later, its footprint in the shape of the bank's logo. Also worthy of note is National Westminster House in Birmingham, no longer owned by the bank, the building was most recently sold to British Land.

The bank's expansion strategy hit trouble with the stock market crash of 1987 and involvement in the financial scandal surrounding the collapse of Blue Arrow. The Department of Trade and Industry report on the affair was critical of the bank's management and resulted in the resignation of several members of the board, including then chairman Lord Boardman. Later, the bank would divest its overseas subsidiaries. The North American operations were sold to Fleet Bank and Hongkong Bank of Canada respectively. Thereafter the bank concentrated on its core domestic business as the restyled NatWest Group, reflecting its modern positioning as a portfolio of businesses. In 1993, the NatWest Tower was devastated by a Provisional IRA bomb and the bank vacated the building, subsequently selling it. Then, in 1997, NatWest Markets, the corporate and investment banking arm formed in 1992, revealed a £50m loss had been discovered, escalating to £90.5m after further investigations. Investor and shareholder confidence was so badly shaken that the Bank of England had to instruct the board of directors to resist calls for the resignation of its most senior executives in an effort to draw a line under the affair. The bank's internal controls and risk management were severely criticised in 2000 and its aggressive push into investment banking questioned, after a lengthy investigation by the Securities and Futures Authority. The bank's move into complicated derivative products that it did not fully understand seemed to indicate poor management. By the end of 1997 parts of NatWest Markets had been sold, others becoming Greenwich NatWest in 1998.

In 1999, the chairman, Lord Alexander of Weedon, announced a merger with Legal & General in a friendly £10.7bn deal, the first between a bank and an insurance company in UK history. The move received a poor reception in the London financial markets and NatWest's share price fell substantially. Seen as a driver of the ill-advised investment banking expansion, Derek Wanless was forced to resign as chief executive following the appointment of Sir David Rowland (who became executive chairman). Also in 1999, in response to the weakened NatWest share value, the Governor and Company of the Bank of Scotland began a hostile takeover bid for the bank, an audacious move for the much smaller Scottish bank. The Bank of Scotland's aim was to break-up the NatWest Group and dispose of its non-retail assets. NatWest was forced to abandon its merger, but refused to agree to a takeover by a rival bank. The Royal Bank of Scotland tabled another hostile offer and trumped the Bank of Scotland with a £21bn bid. The takeover of NatWest in early 2000 was the biggest in UK history. National Westminster Bank, once Britain's most profitable bank, was delisted from the London Stock Exchange and became, with its subsidiaries, component parts of The Royal Bank of Scotland Group. The outcome of this bitter struggle set the tone for a round of consolidation in the financial sector as it prepared for a new age of fierce global competition. The Royal Bank of Scotland Group became the second largest bank in the UK and Europe (after HSBC) and the fifth largest in the world by market capitalisation. According to Forbes Global 2000, it was the then 13th largest company in the world. While NatWest was retained as a distinct brand with its own banking licence, many back office functions were merged with those of the Royal Bank leading to over 18,000 job losses.

In 2008, it was announced that HM Government would take a stake of up to 58% in the Royal Bank of Scotland in a move aimed at recapitalising the Group. HM Treasury subscribed for £5 billion in preference shares and underwrote the issuance of £15bn of new ordinary shares offered to RBS shareholders and new institutional shareholders at the fixed price of 65.5p. As a consequence of the mismanagement which necessitated this rescue, the chief executive, Sir Fred Goodwin (who secured the takeover of NatWest), offered his resignation which was duly accepted. Chairman, Sir Tom McKillop, also confirmed he would stand down from that role when his contract expired in 2009. Goodwin was replaced by Stephen Hester, previously chief executive of British Land. Subsequently, in 2009, it was announced that all 311 Royal Bank branches in England and Wales (until 1985, Williams & Glyn's Bank) together with the seven NatWest branches in Scotland were to be divested by the Group to comply with European Union state aid requirements. The process could take up to four years to complete. In August 2010, it was announced that the branch divestment would be to Santander UK, along with 1.8 million personal customers and 244,000 SME customers.

The Royal Bank of Scotland Group Plc operates internationally through its two principal subsidiaries, the Royal Bank (in Scotland) and NatWest (in England and Wales). The NatWest group of companies comprises National Westminster Bank Plc and its subsidiary and associated undertakings. The principal subsidiary undertakings of the bank today are:

1. Coutts & Co., part of RBS Group Wealth Management, incorporating RBS Coutts Bank (formerly Coutts Bank von Ernst) Ltd. trading as RBS Coutts International in Switzerland;
2. RBS Securities Inc., previously Greenwich Capital Markets Inc., broker-dealer, trading as RBS Greenwich Capital (formerly Greenwich NatWest) in the US; and
3. Ulster Bank Limited, incorporating, from 2001, Ulster Bank Ireland Ltd. in the Republic of Ireland.

Until 2003 National Westminster Bank was a wholly owned subsidiary of The Royal Bank of Scotland Group, now the ultimate holding company. In January 2003 ownership of the bank's entire issued ordinary share capital was transferred from the ultimate holding company to The Royal Bank of Scotland Plc, as holding company. At that time the entire issued share capital of Lombard North Central Plc was transferred by the bank to the holding company. Ownership of National Westminster Home Loans Limited was passed to the holding company in December 2005. In December 2000 the bank transferred National Westminster Life Assurance Limited to RBS Life Investments Limited, effectively establishing the business as a joint venture between the Group and Norwich Union.

The Royal Bank of Scotland Group comprises the ultimate holding company and its subsidiary and associated undertakings. The Group is structured into the following main operating areas:

* Retail Markets, providing a broad range of retail services across different brands and channels to personal and small business customers;

* Corporate Markets, a leading banking partner to UK commercial customers and major corporations and governmental institutions around the world, providing an extensive range of debt, risk and investment services;

* RBS Insurance, the second-largest general insurer in the UK, with brands including Direct Line, Churchill and Green Flag;

* Ulster Bank Group, incorporating the former First Active Plc in the Republic of Ireland; and

* Citizens Financial Group, which provides retail and corporate banking services across 13 states in the northeastern and midwestern US, with a retail and commercial presence in more than 30 other states.

* Business Services, a division dealing with administrative operations, managing group technology, procurement and property, in tandem with the other divisions of RBS Group.

NatWest provide a full range of banking and insurance services to personal, business and commercial customers, including the first dedicated bank account in Britain to be delivered and supported entirely in the Polish language. In 2005 it announced the reintroduction of a mobile banking service, providing banking facilities to remote communities in Cornwall. The bank has won Your Mortgage Magazine's Best Bank for Mortgages award 13 times in the last 17 years, more than any other lender.

In 2006 The Royal Bank of Scotland Group undertook the first trial of PayPass contactless debit and credit cards in Europe. These can be used to pay for purchases under £10 by tapping an enabled card on the retailer's terminal. In an effort to enhance security, hand-held devices for use with a card to authorise online banking transactions were introduced in 2007. These card readers do not retain personal information but verify numbers during a transaction. From autumn 2009, NatWest and RBS are migrating debit cards from Maestro and Solo to Visa Debit. The bank participates fully in the Faster Payments Service, an initiative to speed up certain payments, launched in 2008. Established in 1989, Streamline is the leading provider of merchant accounts in Europe, giving businesses the ability to accept credit and debit card payments and handling around half of all such transactions. In 2009 it was merged into RBS WorldPay.

The bank is authorised and regulated by the Financial Services Authority, a member of the Financial Ombudsman Service, the Financial Services Compensation Scheme, the Association for Payment Clearing Services and of the British Bankers' Association; it subscribes to the Banking Code and Business Banking Code. Mortgages, available in England, Scotland and Wales only, are provided by National Westminster Home Loans Limited, a member of the Council of Mortgage Lenders, the NatWest One account is a secured personal account with the Royal Bank of Scotland Plc. The Spanish Mortgage is provided by Adam and Company Plc, a subsidiary of the Royal Bank of Scotland, trading as NatWest. NatWest Insurance Services is a trading name of RBS Business Insurance Services Limited, acting as intermediary and broker for general insurance. Life Protector and Guaranteed Bond products are provided by National Westminster Life Assurance Limited. The Royal Bank of Scotland International Limited trading as NatWest operates branches in Jersey, Guernsey, the Isle of Man and Gibraltar. Share dealing services are provided by NatWest Stockbrokers Limited, which is a member of the London Stock Exchange and PLUS. NatWest Stockbrokers is operated by a joint venture between The Royal Bank of Scotland Group and the Toronto-Dominion Bank, TD Waterhouse Investor Services (Europe) Limited. In 2010, RBS Intermediary Partners was re-branded NatWest Intermediary Solutions.

Tupolev Tu-154 | History and definition of the Tupolev Tu-154 | Tupolev Tu-154 Image

The Tupolev Tu-154 is a three-engine medium-range narrow-body airliner designed in the mid 1960s and manufactured by Tupolev. As the mainstay 'workhorse' of Soviet and Russian airlines for several decades, it serviced over a sixth of the world's landmass and carried about half of all passengers flown by Aeroflot and its subsidiaries (137.5 million/year or 243.8 billion passenger kilometers in 1990). Having been exported and operated by 17 non-Russian airlines and a number of air forces, it remained the standard domestic route airliner of Russia and former Soviet states until the mid 2000s.

With a cruising speed of 975 kilometres per hour (606 mph), the Tu-154 is one of the fastest civilian aircraft in operation and has a range of 5,280 kilometres (3,280 mi). Capable of operating from unpaved and gravel airfields, it was widely used in extreme Arctic conditions of Russia's northern and eastern regions where other airliners were unable to operate and where service facilities were very basic. With a service life of 45,000 hours (18,000 cycles) but capable of 80,000 hours with upgrades, it is expected to continue operations until 2016, although noise regulations have seen services to western Europe and other areas restricted. In January 2010, Russian flag carrier Aeroflot announced the retirement of its Tu-154 fleet after 40 years service with the last scheduled flight being Aeroflot Flight 736 from Ekaterinburg to Moscow on 31 December 2009.

Since 1968 there have been 39 fatal incidents involving the Tu-154, most of which were caused by factors unrelated to the aircraft itself but more to its extensive use in demanding conditions.

The Tu-154 was developed to meet Aeroflot's requirement to replace the jet-powered Tu-104, the Antonov An-10 'Ukraine' and the Ilyushin Il-18 turboprops. The requirements called for either a payload capacity of 16–18 tonnes (35,000–40,000 lb) with a range of 2,850–4,000 kilometres (1,770–2,500 mi) while cruising at a speed of 900 km/h (560 mph), or a payload of 5.8 tonnes (13,000 lb) with a range of 5,800–7,000 kilometres (3,600–4,300 mi) while cruising at 850 km/h (530 mph). A take-off distance of 2,600 metres (8,500 ft) at maximum take-off weight was also stipulated as a requirement. Conceptually similar to the British Hawker Siddeley Trident, which first flew in 1962, and the Boeing 727, which first flew in 1963, the medium-range Tu-154 would be marketed by Tupolev at the same time as Ilyushin was marketing the long-range Ilyushin Il-62. The Soviet Ministry of Aircraft Industry chose the Tu-154 as it incorporated the latest in Soviet aircraft design and best met Aeroflot's anticipated requirements for the 1970s and 1980s.

The first project chief was Sergey Yeger but in 1964, Dimitriy S. Markov assumed that position. In 1975 he turned it over to Aleksandr S. Shengardt.

The Tu-154 first flew on 4 October 1968. The first deliveries to Aeroflot were in 1970 with freight (mail) services beginning in May 1971 and passenger services in February 1972. There was still limited production of the 154M model as of January 2009, (photo link) despite previous announcements of the end of production in 2006. 1025 Tu-154s have been built, 214 of which are still in service as of 14 December 2009.

The Tu-154 is powered by three rear-mounted low-bypass turbofan engines arranged similarly to those of the Boeing 727, but it is slightly larger than its American counterpart. Both the 727 and the Tu-154 use an S-duct for the middle (number 2) engine. The original model had Kuznetsov NK-8-2, while the Tu-154M has Soloviev D-30KU-154 engines. All Tu-154 aircraft models have a higher thrust-to-weight ratio than that of the 727 – this gives them superior performance, although at the expense of poorer fuel efficiency, which became an important factor in later decades as fuel costs grew.

The cabin of the Tu-154, although of the same six-abreast seating layout, gives the impression of an oval interior, with a lower ceiling than is common on Boeing and Airbus airliners. The passenger cabin accommodates 128 passengers in two-class layout and 164 passengers in single-class layout, and up to 180 passengers in high-density layout. The layout can be modified to what is called a winter version where some seats are taken out and a wardrobe is installed for passenger coats. The passenger doors are also smaller than on its Boeing and Airbus counterparts. Furthermore, luggage space in the overhead compartments is very limited.

Like the Tupolev Tu-134, the Tu-154 has a wing swept back at 35° at the quarter-chord line. The British Hawker Siddeley Trident has the same sweepback angle, while the Boeing 727 has a slightly smaller sweepback angle of 32°. The wing also has anhedral (downward sweep) which is distinguishing feature of Russian low-wing airliners designed during this era. Most Western low-wing airliners such as the contemporary Boeing 727 have Dihedral (upward sweep). The anhedral means that Russian airliners have poor lateral stability compared to Western ones, but also have weaker dutch roll tendencies, eliminating the need for a yaw damper.

Like many other Soviet-built airliners, the Tu-154 has an oversized landing gear enabling it to land on unpaved runways, once common in rural areas of the Soviet Union. The aircraft has two six-wheel main bogies fitted with large low-pressure tires that retract into pods extending from the trailing edges of the wings (a common Tupolev feature), plus a two-wheel nose gear unit. Soft oleo struts (shock absorbers) provide a much smoother ride on bumpy airfields than most airliners, which only very rarely operate on such poor surfaces.

The original requirement was to have a three-person flight crew – captain, first officer and flight engineer – as opposed to 4/5-person crew on other Soviet airliners. A fourth crew member, a navigator, is usually also present in the former Soviet Union, due to union rules. Navigators are no longer trained and this profession will become obsolete with the retirement of older Soviet era planes.

The plane's avionics suite, for the first time in the Soviet Union, is built to American airworthiness standards. The latest variant (Tu-154M-100, introduced 1998) includes an NVU-B3 Doppler navigation system, a triple autopilot, which provides an automatic ILS approach according to ICAO category II weather minima, an autothrottle, a Doppler drift and speed measure system (DISS), "Kurs-MP" radio navigation suite and others. Modern upgrades normally include a TCAS, GPS and other modern systems, mostly American or EU-made.

Early versions of the Tu-154 cannot be modified to meet the current Stage III noise regulations and are banned from flying where those regulations are in force, such as Europe. The Tu-154M may use hush kits to meet Stage III and theoretically Stage IV. However current European Union regulations forbid the use of hush kits to meet Stage IV. The Tu-154M would need to be re-engined to meet Stage IV within the EU, an extensive and potentially expensive upgrade.

Many variants of this airliner have been built. Like its western counterpart, the 727, many of the Tu-154s in service have been hush-kitted, and some converted to freighters.

Tu-154

Tu-154 production started in 1970, while first passenger flight was performed at 9 February 1972. Powered by Kuznetsov NK-8-2 turbofans, it carried 164 passengers. About 42 were built. Tail numbers from 85006 to 85055.

Tu-154A

The first upgraded version of the original Tu-154, the A model, in production since 1974, added center-section fuel tanks and more emergency exits, while engines were upgraded to higher-thrust Kuznetsov NK-8-2U. Other upgrades include automatic flaps/slats and stabilizer controls and modified avionics. Max. take-off weight – 94,000 kg (207,235 lb). There were 15 different interior layouts for the different domestic and international customers of the airplane, seating between 144 and 152 passengers. The easiest way to tell the A model from the base model is by looking at the spike at the junction of the fin and tail; this is a fat bullet on the A model rather than a slender spike on the base model. Tail numbers from 85056 to 85119.

Tu-154B

As the original Tu-154 and Tu-154A suffered wing cracks after only a few years in service, a version with a new, stronger wing, designated Tu-154B, went into production in 1975. It also had an extra fuel tank in fuselage, extra emergency exits in the tail, and the maximum take-off weight increased to 98,000 kg (216,053 lb). Also important to Aeroflot was that the increased passenger capacity led to lower operating costs. As long as the airplane had the NK-8-2U engines the only way to improve the economics of the airplane was to spread costs across more seats. The autopilot was certified for ICAO Category II automatic approaches. Most previously built Tu-154 and Tu-154A were also modified into this variant, with the replacement of the wing. Max. take-off weight increased to 96,000 kg (211,644 lb). 111 were built. Tail numbers ran from 85120 to 85225.

Tu-154B-1

Aeroflot wanted this version for increased revenue on domestic routes. It carried 160 passengers. This version also had some minor modifications to fuel system, avionics, air conditioning, landing gear. 64 were built from 1977–1978. Tail numbers from 85226 to 85294.

Tu-154B-2

A minor modernization of Tu-154B-1. The airplane was designed to be converted from the 160 passenger version to a 180 passenger version by removing the galley. The procedure took about two and a half hours. Some of the earlier Tu-154B modified to that standard. Max. take-off weight increased to 98,000 kg (216,053 lb), later to 100,000 kg (220,462 lb). 311 aircraft were built, including VIP versions. Tail numbers (new-built) from 85295 to 85605. A few of them are still in use.

Tu-154S

The Tu-154S is an all-cargo or freighter version of the Tu-154B, using a strengthened floor, and adding a forward cargo door on the port side of the fuselage. The airplane could carry 9 Soviet PAV-3 pallets. Max. payload – 20,000 kg (44,092 lb). There were plans for 20 aircraft, but only nine aircraft were converted; two from Tu-154 model and seven from Tu-154B model. Trials were held in the early 1980's and the aircraft was authorized regular operations in 1984. By 1997 all had been retired. Tail numbers: 85019 (Tu-154), 85037 (Tu-154), 85060, 85062, 85063, 85067, 85081, 85084, 85086.

Tu-154M

The Tu-154M and Tu-154M Lux are the most highly upgraded version, which first flew in 1982 and entered mass production in 1984. It uses more fuel-efficient Soloviev D-30KU-154 turbofans. Together with significant aerodynamic refinement, this led to much lower fuel consumption and therefore longer range, as well as lower operating costs. The aircraft has new double-slotted (instead of triple-slotted) flaps, with an extra 36-degree position (in addition to existing 15, 28 and 45-degree positions on older versions), which allows reduction of noise on approach. It also has a relocated auxiliary power unit and numerous other improvements. Maximum takeoff weight increased first to 100,000 kg (220,462 lb), then to 102,000 kg (224,872 lb). Some aircraft are certified to 104,000 kg (229,281 lb). Tail numbers are 85616 (prototype), production aircraft from 85606 and on (except 85804, which is re-imported Tu-154B-2). About 320 were manufactured. Mass production ended in 2006, though limited manufacturing continued as of January 2009.(photo link) No new airframes have been built since the early 1990s, and production since then involved assembling airplanes from components on hand. Chinese Tu-154MD electronic intelligence aircraft carries a large-size synthetic aperture radar(SAR) under its mainframe.

Tu-154M-LK-1

Cosmonaut Trainer. This was a Salon VIP aircraft modified to train cosmonauts to fly the Buran reusable spacecraft, the Soviet equivalent of the US Space Shuttle. The Tu-154 was used because the Buran required a steep descent, and the Tu-154 was capable of replicating that. The cabin featured trainee work-stations, one of which was the same as the Buran's flightdeck. The forward baggage compartment was converted into a camera bay, because the aircraft was also used to train cosmonauts in observation and photographic techniques.

Tu-154M-ON Monitoring Aircraft

Germany modified one of the Tu-154s it had on hand from the former East German Air Force into an observation airplane. This airplane was involved with the Open Skies inspection flights. It was converted at the Elbe Aircraft Plant (Elbe Flugzeugwerke) in Dresden, and flew in 1996. After two dozen monitoring missions, it was lost in a mid-air collision in 1997.

The Russians also converted a Tu-154M to serve as an Open Skies Monitoring aircraft. They used the Tu-154M-LK-1, and converted it to a Tu-154M-ON. When the aircraft is not flying over North America, it is used to ferry cosmonauts around. The Chinese are also believed to have converted one Tu-154 to an electronic countermeasures aircraft.

Tu-154M-100

Design of this variant started in 1994, but the first aircraft were not delivered until 1998. It is an upgraded version with western avionics, including the Flight Management Computer, GPS, EGPWS, TCAS, and other modern systems. The airplane could carry up to 157 passengers. The cabin featured an automatic oxygen system and larger overhead bins. Only three were produced, as payment of debts owed by Russia to Slovakia. Three aircraft were delivered in 1998 to Slovak Airlines, and sold back to Russia in 2003.

As of January 2011, since 1970 there have been 110 serious incidents involving the Tu-154, and 69 hull losses in total, 39 of which involved fatalities. Six of those incidents resulted from terrorist or military action (two other war-time hull losses were non fatal) including an accidental missile shoot-down by Ukraine, several from poor runway conditions in winter (including one in which airplane struck snow plows on the runway), cargo overloading by airlines in the lapse of post-Soviet federal safety standards (several cases), and mid-air collisions due to faulty air traffic control or mis-communication. Other incidents have resulted from mechanical problems (two cases prior to 2001), running out of fuel on unscheduled extended route, pilot errors (including training flights for new crews), and cargo fires. On January 2, 2011, Russia's Federal Transport Oversight Agency advised airlines to stop using remaining examples of the Tu-154 (B variant) until the fatal fire incident in Surgut had been investigated. The Tu-154 is described as having an average (or better than expected) safety record considering its length of service and heavy use in demanding conditions. Their operation in Iran, which is subject to an aircraft parts embargo, ceased in February 2011 due to the high number of incidents involving the aircraft type. In March 2011, the Russian Federal Bureau of Aviation recommended a total withdrawal of the Tu-154M from service. In December 2010, Uzbekistan Airways also declared that it will cease to operate Tu-154s from 2011.

Air Canada | History and definition of the Air Canada | Air Canada Image

Air Canada (TSX: AC.A, AC.B) is the flag carrier and largest airline of Canada. The airline, founded in 1936, provides scheduled and charter air transport for passengers and cargo to 178 destinations worldwide. It is the world's ninth largest passenger airline by number of destinations, and the airline is a founding member of Star Alliance, an alliance of 26 member airlines formed in 1997. Air Canada's corporate headquarters are located in Montreal, Quebec, while its largest hub is Toronto Pearson International Airport, located in Mississauga, Ontario. Air Canada had passenger revenues of CA$9.7 billion in 2008.

Canada's national airline originated from the Canadian federal government's 1936 creation of Trans-Canada Airlines (TCA), which began operating its first transcontinental flight routes in 1938. In 1965, TCA was renamed Air Canada following government approval. Following the 1980s deregulation of the Canadian airline market, the airline was privatized in 1988. In 2001, Air Canada acquired its largest rival, Canadian Airlines. In 2003, the airline filed for bankruptcy protection and, the following year, emerged and reorganized under the holding company ACE Aviation Holdings Inc. In 2006, 34 million people flew with Air Canada as the airline celebrated its 70th anniversary.

Air Canada operates a fleet of Airbus A330, Boeing 767, and Boeing 777 wide-body jetliners on long-haul routes, and uses Airbus A320 family aircraft, including the A319, A320, and A321 variations and Embraer E170/E190 family aircraft on short-haul routes. The carrier's operating divisions include Air Canada Cargo and Air Canada Jetz. Its subsidiary, Air Canada Vacations, provides vacation packages to over 90 destinations. Together with its regional partners, the airline operates on average more than 1,370 scheduled flights daily.

Air Canada's predecessor, Trans-Canada Airlines (TCA), was created by legislation of the federal government as a subsidiary of Canadian National Railway (CNR) on 11 April 1936. The newly created Department of Transport under Minister C. D. Howe desired an airline, under government control, to link cities on the Atlantic coast to the Pacific coast. Using $5 million in government seed money, two Lockheed Model 10 Electras and one Boeing Stearman biplane were purchased from Canadian Airways. Experienced airline executives from United Airlines and American Airlines were brought in.

Passenger operations began on 1 September 1937, with an Electra carrying two passengers and mail from Vancouver to Seattle, a $14.20 round trip. On 1 July 1938, TCA hired its first flight attendants. Transcontinental routes from Montreal to Vancouver began on 1 April 1939, using 12 Lockheed Model 14 Super Electras and six Lockheed Model 18 Lodestars. By January 1940 the airline had grown to about 500 employees.

In 1942, Canadian Pacific Airlines suggested merging with TCA. Prime Minister Mackenzie King rejected the proposal and introduced legislation regulating TCA as the only airline in Canada allowed to provide transcontinental flights. With the increase in air travel after World War II, CP Air was granted one coast-to-coast flight, and a few international routes.

Originally headquartered in Winnipeg, which was also the site of the national maintenance base, the federal government moved the headquarters to Montreal in 1949; the maintenance base later also moved east. With the development of the ReserVec in 1953, TCA became the first airline in the world to use a computer reservation system with remote terminals.

By 1964, TCA had grown to become Canada's national airline, and in 1964 Jean Chrétien submitted a private member's bill to change the name of the airline from Trans-Canada Airlines to Air Canada. This bill failed, but it was later resubmitted and passed, with the name change taking effect on 1 January 1965.

On 31 October 2004, the last Air Canada Boeing 747 flight landed in Toronto from Frankfurt as AC873, ending 33 years of 747 service with the airline. The Boeing 747-400 fleet was replaced by the Airbus A340 fleet. On 19 October 2005, Air Canada unveiled a new aircraft colour scheme and uniforms. A Boeing 767-300ER was painted in the new silver-blue colour, and the green tail was replaced with a new version of the maple leaf known as the 'Frosted Leaf.'

On 9 November 2005, Air Canada entered into an agreement to renew its widebody fleet with Boeing by purchasing 18 Boeing 777s (10 -300ERs, 6 -200LRs, 2 777 Freighters), and 14 Boeing 787-8s. It also placed options to purchase an additional 18 Boeing 777s and 46 Boeing 787-8s and -9s. All of the 777s will be powered by the GE90-115B engine, and the 787-8s, by the GEnx engine. Deliveries of the 777s began in March 2007 and deliveries of the 787s are to begin in the second half of 2013. As the 777s are delivered, and as the 787s are delivered, it will gradually retire all Boeing 767s and Airbus A330s.

On 24 April 2007, Air Canada announced that it has exercised half of its options for the Boeing 787 Dreamliner. The firm order for the Dreamliners is now at 37 plus 13 options, for a total of 50. This makes Air Canada the largest customer of the Dreamliner in North America and the third largest in the world (behind Qantas and All Nippon Airways). It also announced that it has cancelled orders for two Boeing 777Fs. In November 2007, Air Canada announced that it will lease an additional Boeing 777-300ER from ILFC. Air Canada has now taken delivery of the 18 Boeing 777s on order (12 -300ERs, 6 -200LRs) and still holds options for 16 more, totaling 34.

Air Canada has also taken delivery of 15 Embraer 175s and 45 Embraer 190s. It holds options on an additional 60 Embraer 190s. These aircraft are being used to expand its intra-Canada and Canada/USA routes. Additionally, some of the Embraer 190s will replace older A319/A320s.

Started in July 2006, and now completed, Project XM: Extreme Makeover, is a $300-million aircraft interior replacement project to install new cabins on all aircraft. New aircraft such as the Boeing 777 are being delivered with the new cabins factory installed.

New cabin features include:

1. In Executive First, new horizontal fully flat Executive First Suites (on B767s, B777s and A330s).
2. New cabins in all classes on all aircraft, with new entertainment options.
3. Personal AVOD (8.9 in/230 mm touch-screen LCD) in Economy class (domestic and international) and Executive Class (domestic).
4. Larger AVOD (12 in/300 mm touch-screen LCD) equipped with noise-cancelling Sennheiser headphones available in Executive First Suites.
5. Interactive games at all seats in Executive and Economy; XM Radio Canada available at every seat.
6. USB ports to recharge electronic devices and for game controllers; 120 Volt AC plugs in most seats, in both classes.

Since the late 2000s, Air Canada has been facing a number of financial difficulties, including the global recession, leading to speculation that it could file for bankruptcy, just several years after it exited bankruptcy on 30 September 2004.

President and CEO Montie Brewer was replaced by Calin Rovinescu effective 1 April 2009. Rovinescu became the first Canadian President since Claude Taylor in 1992. Rovinescu was Air Canada's chief restructuring officer during its 2003 bankruptcy, and he resigned that year after unions rejected his demands, and is reported to be "an enforcer".

Federal finance minister Jim Flaherty appointed retired judge James Farley, who had presided over Air Canada's 2003 bankruptcy, to mediate pension issues between the company and its unions and retirees. The contracts with four of its unions also expired around this time. The airline stated that its $2.85-billion pension shortfall (which grew from $1.2-billion in 2007) was a "liquidity risk" in its first-quarter report, and it required new financing and pension "relief" to conserve cash for 2010 operations. The company was obligated to pay $650-million into the pension fund but it suffered a 2009 Q1 loss of $400-million, so it requested a moratorium on its pension payments in 2009. The unions had insisted on financial guarantees before agreeing on a deal.

Air Canada Centre (French: Centre Air Canada) also known as La Rondelle ("The Puck" in French), is a 7 storey building that serves as the corporate headquarters of Air Canada, located on the grounds of Montréal-Pierre Elliott Trudeau International Airport and in Saint-Laurent, Montreal, near Dorval.

In 1994 David Israelson of the Toronto Star described the facility as "ultra modern." In 1990 the airline announced that it was moving its headquarters from Downtown Montreal to the airport to cut costs. In 2004 the company said that it has no plans to move its headquarters back to Downtown Montreal.

Air Canada Cargo is the company's freight carrying division, offering more than 150 shipping destinations through the Air Canada airline network and airline partners. Its route network has focused on European destinations through its Eastern Canada departure points, along with direct services from Vancouver and Calgary to Frankfurt, Paris, and Zurich.

In Toronto, a new cargo terminal was completed in early 2002 which features modernised inventory and conveyor systems.

Formerly Air Canada Technical Services/ACTS (Aero Technical Support & Services Inc.), Aveos Fleet Performance Inc. is a full-service Maintenance, Repair and Overhaul (MRO) organisation that provides airframe, engine and component maintenance and various ancillary services to more than 100 customers. Major bases are in Montreal, Toronto, Winnipeg and Vancouver.

As of December 2009, ACE Aviation Holdings Inc. owns 27 percent of Air Canada and holds a 27.8 percent stake in Aveos, after selling its remaining stake in 2007 to private equity firms Kohlberg Kravis Roberts and Co. and Sageview Capital for $723 million. On 23 September 2008, ACTS, formerly Air Canada Technical Services/ACTS, changed its name to Aveos Fleet Performance Inc. to reflect its new ownership structure. In February 2011 the CIRB ruled that Aveos and Air Canada are separate companies and gave ultimatums to the seconded Air Canada employees working at Aveos. Air Canada remains its only customer for Aircraft overhaul as jet Blue and America West have been sent to El Salvador to be repaired by Aeroman.

Air Canada Vacations, a subsidiary of Air Canada, is a Canadian tour operator offering a full collection of leisure travel packages including cruises, tours, car rentals and excursions. All packages include accommodation, Aeroplan® Miles and roundtrip airfare aboard Air Canada and its Star Alliance™ partners. Repeat recipient of the Consumer’s Choice Award for Best Travel Wholesaler and named Favourite Tour Operator by Baxter Travel Media in 2010, Air Canada Vacations services hundreds of destinations in the Caribbean, Mexico, North, Central and South America, Asia, South Pacific and Europe.

Air Canada Vacations benefits from unique access to Air Canada’s extensive network, offering connecting flights from 65 Canadian cities, on-demand seat-back entertainment from gate to gate on most flights, web and mobile check-in and Aeroplan® Miles.

Air Canada Vacations was the first Canadian tour operator in 2011 to launch a mobile application for BlackBerry and Apple devices.

Air Canada Vacations partners with the world’s most recognized hoteliers and cruise lines worldwide, including Sandals and Beaches Resorts, Barceló Hotels and Resorts, Couples Resorts, Occidental Hotels & Resorts, Palace Resorts, Sol Meliá, SuperClubs, Iberostar Hotels and Resorts, Walt Disney World Resorts, Carnival Cruise Lines, Disney Cruise Line, Princess Cruises, Royal Caribbean International, Holland America Line, Norwegian Cruise Line and Costa Cruises.

Air Canada Vacations' customers benefit from guest services made exclusively available to Air Canada Vacations under the Privileges added-value program. In conjunction with Aeroplan®, Air Canada Vacations offers Aeroplan® Miles on all air-inclusive packages and offers bonus Aeroplan® miles on select packages year-round. Aeroplan® Miles may also be redeemed toward the purchase of Air Canada Vacations’ packages.

Air Canada Vacations is headquartered in Montreal and has an office in Toronto.

As part of their customer care network, a wide network of destination representatives are available throughout the Caribbean, Mexico, Europe, Asia, South Pacific and South America.

Air Canada Vacations offers Executive Class® service on select flights, non-stop flights from major Canadian cities and daily flights to many destinations.

Air Canada flies to 15 domestic destinations and 81 international destinations in 33 countries (including British overseas territories, Kingdom of the Netherlands, Overseas departments and territories of France and United States territories) across Asia, Americas, Europe and Oceania. Along with its regional partners, the carrier serves 171 destinations in 39 countries worldwide.

Air Canada has flown a number of fifth freedom routes (passenger and cargo rights between two non-Canadian destinations), only one of which is still operated, namely Santiago-Buenos Aires. Past fifth freedom routes have included: Honolulu-Sydney, London Heathrow-Düsseldorf, Paris-Geneva, Paris-Munich, Paris-Berlin, Frankfurt-Zürich, Zürich-Zagreb, Zürich-Vienna, Zürich-Delhi, Lisbon-Madrid, Brussels-Prague, London Heathrow-Delhi, London Heathrow-Nice, London Heathrow-Bombay-Singapore.

In 1963, Air Canada claimed to be the first major air carrier to have adopted turbine technology on its entire fleet for lower maintenance costs and higher productivity. It also claimed to be the first world airline to introduce jet freighter service using DC-8 equipment.

Air Canada was also one of the first airlines to have its entire fleet of unpressurised aircraft equipped with fixed oxygen systems for use by flight crew and passengers, using the rebreathing bag principle.

1. Air Canada's Airbus A340-500s (C-GKOL, fin 951 and C-GKOM, fin 952) were retired in August 2007 and replaced by Boeing 777-200LRs. They were then leased to TAM Airlines.
2. Air Canada's Airbus A340-300s were retired in November 2008 and replaced by Boeing 777-300ERs.They were leased to 6 different airlines, including Swiss International Airlines, Gestair, Air Jamaica, Lan Airlines, AirAsia X, and BWIA Int
3. Air Canada's Boeing 767-200ER fleet was retired from service by the end of 2008.
4. The Boeing 767 involved in the Gimli incident (known as the "Gimli Glider") remained in service with Air Canada until it retired in 2008. The aircraft (C-GAUN) now sits at the Mojave Spaceport in California.
5. The McDonnell Douglas DC-10 aircraft operated from 1971-2001 were owned by Canadian Airlines.

Air Canada has two classes of service, both business and economy, on most aircraft. On long-haul international routes, Executive First and Economy Class is offered; short-haul and domestic routes feature Executive Class and Economy Class. Air Canada Express features Executive Class and Economy Class, on CRJ705 aircraft; all other Air Canada Express aircraft have one-class economy cabins.

Executive First is Air Canada’s international business class product, updated during the carrier's Project XM upgrade. These cabins are available on all widebody aircraft with the exception of three B767-300ER aircraft (which feature a North American Executive Class cabin).

Executive First Suites feature electronic flat beds, in a 1–1–1 (B767-300ER and A330-300s) or 1–2–1 (B777-300ER and B777-200LR) herringbone configuration with a 21-inch (0.533 m) seat width and a 6-foot-3-inch (1.91 m) seat pitch. The configuration is similar in layout to Virgin Atlantic's Upper Class Suite and Air New Zealand's Business Premier Class product. Entertainment is personal AVOD (Audio Video On Demand), while music is provided by XM Satellite Radio. Self-service bar areas and mood lighting are available on all B777-300ER and B777-200LR aircraft.

The prior Executive First cabin featured electronic recliner seats reclining to 151°, with a width of 21 inches (0.53 m) and a pitch of 57 to 60 inches (1.4 to 1.5 m). Seat configuration was 1–2–2 or 2–2–1 seating on the 767-300ER aircraft, depending on tail fin. The Airbus widebodies featured a 2–2–2 seating configuration. Entertainment provided was personal DVD player or in-seat AVOD depending on aircraft type.

In international Economy Class, seats are pitched 31 inches (0.79 m) to 34 inches (0.86 m) with a width of 17.2 inches (0.44 m) to 18.5 inches (0.47 m) and a recline to around 6 inches (0.15 m). On all Project XM fitted aircraft, entertainment is personal AVOD (audio-video on demand). Configuration is 3–3–3 on the B777, 2–4–2 on the A330, and 2–3–2 on the B767. On Economy Class (original) aircraft, main screen entertainment is offered. Music on both types is provided by XM Satellite Radio.

Within North America, Executive Class is Air Canada’s premium product. On Embraer 175/190 aircraft and CRJ705 aircraft (Air Canada Express), seat configuration is 1–2 abreast, with recline around 120°, and a width of 20 inches (0.51 m). On Airbus narrow-body aircraft, seat configuration is 2–2 abreast, with 124° recline, and 21 inches (0.53 m) width. Seat pitch is 37 inches (0.94 m) on Canadair-705 aircraft and 39 inches (0.99 m) on Embraer and Airbus aircraft. All seats feature AVOD and the new style cabin interiors. Music is provided by XM Satellite Radio.

Economy seating for domestic, North American, sun destination and caribbean flights is 3–3 abreast on Airbus aircraft and 2–2 on Embraer aircraft, with a pitch between 30 inches (0.76 m) and 32 inches (0.81 m) on Airbus aircraft. For these flights food and alcoholic beverages can be purchased through Onboard Café while non-alcoholic beverages are complimentary. GuestLogix point of sale terminals are used.

Air Canada Express flights operated by CRJ100/200, Dash 8-100/300/400 aircraft offer a bar and refreshment service on board. The CRJ705 features Executive Class and personal AVOD at every seat. Flights on board the CRJ100/200/705 and Q400 which are two hours or more feature Onboard Café.

Air Canada has made a change in uniform by changing the dark green for a midnight blue colour. The uniforms were designed by Canadian fashion designer Debbie Shuchat. At a presentation in the Toronto Pearson International Airport hangar, Celine Dion helped the newly-solvent airline debut its new image.

Maple Leaf Lounges are available to passengers holding a same day ticket on Air Canada in Executive Class, Star Alliance Gold Members, Air Canada Super Elite, Air Canada Elite, Air Canada Maple Leaf Club members, American Express Maple Leaf Club members, CIBC Maple Leaf Club card holders, American Express AeroplanPlus Platinum holders, holders of a one time guest pass or economy passengers who have purchased lounge access during booking.

The Air Canada London Heathrow Arrivals Lounge is available to eligible members arriving into London from any Air Canada international flight, holding a confirmed same-day overseas travel boarding card. Eligible groups include Executive Class Passengers, Air Canada Super Elite, Air Canada Elite, Air Canada Maple Leaf Club Members, American Express Maple Leaf Club, CIBC Maple Leaf Club or those holding a one-time guest pass.

Alitalia | History and definition of the Alitalia | Alitalia of the logo

Alitalia — Compagnia Aerea Italiana S.p.A. (English: Alitalia — Italian Air Company), operating as Alitalia, is an Italian airline, which took over the name, the landing rights, many planes and some other assets from the liquidation process of the old Alitalia — Linee Aeree Italiane and the entire Air One. The company has its head office in Fiumicino, Italy. Its main hub is Leonardo da Vinci-Fiumicino Airport, Rome.

Alitalia is Italy's biggest airline, and the world's 19th. Its fleet operates under five separate Air Operator Certificates due to the CAI merger: Alitalia-CAI (Alitalia) [IATA Code AZ], CAI-First (Alitalia Express) [IATA Code XM], CAI-second (Volare Airlines) [IATA Code VE], Air One [IATA Code AP], Air One CityLiner [IATA Code CT].

On 26 August 2008 a group of Italian entrepreneurs along with Intesa Sanpaolo, one of the major Italian banks, founded Compagnia Aerea Italiana (CAI) with the aim of buying the trademark and some of the assets of the bankrupt Alitalia — Linee Aeree Italiane and to merge these with Air One, another Italian carrier. Only the Alitalia trademark would be kept for the merged company.

On 30 October 2008 CAI offered €1,100 million to acquire parts of the bankrupt airline. The offer was submitted to Alitalia's bankruptcy administrator despite refusal by some pilots and flight attendants' unions to agree to the rescue plan.

The bankruptcy administrator and the Italian government, major shareholder of Alitalia, agreed to CAI's offer on 19 November 2008. Alitalia's profitable assets were transferred to CAI on 12 December 2008 after CAI paid €1.052 billion ($1.33 billion), consisting of €427 million in cash and the assumption of responsibility for €625 million in Alitalia debt.

On 13 January 2009 the new Alitalia re-launched operations. The owners of Compagnia Aerea Italiana sold 25% of the company's shares to Air France-KLM for €322 million. Air France-KLM also obtained an option, subject to certain conditions, to purchase additional shares after 2013. The French as well as the Italian boards agreed to the sale.

In January 2010, Alitalia celebrated its first birthday since the relaunch. It carried 22 million passengers in its first year of operations. In 2010, 23.4 million passengers were carried, a 7.4% increase.

On 1 February 2010, it was announced that Alitalia crew would go on a four hour strike over wages. This was the first strike action for Alitalia since the relaunch. Alitalia representatives were not too bothered about the strike, as it was only a four hour strike and the first one in 13 months of operations. They went on to say that the company was still making great progress and should break even by 2011.

On 11 February 2010, Alitalia announced that, starting from the summer season, it would be using Air One as a "low-fare" airline, with operations based in Milan Malpensa Airport, focused on short-haul leisure routes. With initially 5 airplanes (Airbus A320), and 10 by 2012, Alitalia hopes to carry 3 million passengers in 2012 from Milan Malpensa (compared to 1.5 million in 2009), of which 2.4 million will be carried by the new Air One "Smart Carrier".

On 12 February 2011, information was released about a possible merger between Alitalia and Meridiana Fly, another Italian carrier. The merge would take place through a share swap and give the Aga Khan who controls Meridiana between 5 and 7 percent of Alitalia, which corresponds to a valuation of Meridiana of about 100 million euros ($135 million).

1. As of 29 July 2009 Alitalia is the first airline for domestic flights in Italy and was the third airline for international flights to/from Italy. As of 4 October 2010 Alitalia has overtaken Easyjet in this respect and is therefore in second place.
2. Rocco Sabelli, the airline CEO, admitted in 2009 that he expected an "uphill struggle" for 2010 (and indeed losses amounted to 107 million Euros), whereas profit or at least a break-even should be possible for 2011, as has been confirmed on 9 May 2011, despite the difficulties arising from high fuel costs and recent regional troubles in Japan and North Africa.
3. Alitalia has been nominated as Europe's most punctual airline.
4. As of 28 October 2010, Alitalia has 53% of the market share on domestic routes (based on seat capacity).
5. In terms of 2010 passenger results, the best results were achieved on international and intercontinental routes, with passengers up by 12 and 14% on these routes respectively. The total number of passengers for the period was 23.4 million.

Alitalia has been considering the Russian regional Sukhoi Superjet 100 aircraft, with a possible order for 20, which would have been a huge boost for Russia's Civil Aviation manufacturers. Alitalia was also however considering ordering Bombardier and/or Embraer 190 aircraft to update its regional fleet. A contest has taken place at Rome Fiumicino Airport to decide what aircraft will be ordered. Alitalia officials have presented a preference for the Embraer, with an imminent order for 20, since they already have 6 aircraft of that type; also, the Superjets wouldn't be available for immediate delivery, as they still need to be certificated.

1. On 17 March 2009, Alitalia received its first new aircraft since the merger with Air One, the aircraft was an Airbus A320-200 (EI-DTB).
2. In May 2009, Alitalia painted one of their Boeing 767-300ER (EI-DBP) in a special SkyTeam livery.
3. All Airbus A320 family aircraft have been refitted with new "slim" leather Recaro seats, allowing to add two rows of seats in each case, without affecting legroom. There seems to be PTV installed, but not fully functional yet.
4. On 19 July 2010, the Aircraft with registration EI-DSA, which had previously been in the Air One livery, was painted into a special "Alitalia.com" livery.(EI-DSA)
5. On 23 February 2011, Alitalia and ENAC announced the introduction of the Safety Card written in braille and characters in 3-D relief, which will be introduced on scheduled flights for the first time in the world.

The new Alitalia inherited Alitalia - Linee Aeree Italiane's membership of the SkyTeam alliance. Alitalia-LAI originally joined in 2001.

Alitalia has since opened up code-share agreements with SkyTeam members, allowing passengers to fly to numerous destinations using a single Alitalia ticket.

In July 2010, Alitalia joined leading SkyTeam members Air France, KLM and Delta's Transatlantic Joint Venture, meaning that the profits on flights across the Atlantic are shared between the four airlines.

The airline's frequent-flyer programme is named "MilleMiglia" (thousand miles), and is part of the SkyTeam alliance programme, allowing passengers to collect miles and redeem them with free tickets across the whole alliance.

It also grants access to Alitalia's Privilege clubs, Ulisse, Freccia Alata, and finally Freccia Alata Plus, depending on how many miles you have collected in a year, with various advantages depending on the club. These clubs give access to SkyTeam Elite (Ulisse) and SkyTeam Elite+ (Freccia Alata, Freccia Alata plus).

Listed here are incidents since Alitalia's relaunch of operations on 13 January 2009:

1. On 17 February 2010, an Alitalia flight from Rome to Cairo, Egypt with 157 passengers, had to make an emergency landing in Cairo after a reported bomb threat. A notable passenger on the flight was Egyptian Tourism Minister Zuheir Garana.
2. On 24 April 2011 an attempt was made to hijack Alitalia Flight 329, en-route from Charles de Gaulle Airport, Paris, France to Fiumicino Airport, Rome and divert it to Tripoli International Airport, Libya. The hijacker, reported to be an advisor to the Kazakhstan delegation to UNESCO, was subdued by cabin crew and other passengers. He was arrested and taken into custody after the aircraft made a safe landing at Rome.

Lufthansa | History and definition of the Lufthansa | Lufthansa of the logo

Deutsche Lufthansa AG is the flag carrier of Germany and the largest airline in Europe in terms of overall passengers carried. The name of the company is derived from Luft (the German word for "air"), and Hansa (after the Hanseatic League, a powerful medieval trading group).

The airline is the world's fourth-largest airline in terms of overall passengers carried, operating services to 18 domestic destinations and 203 international destinations in 78 countries across Africa, Americas, Asia and Europe. Together with its partners Lufthansa services around 410 destinations. With over 710 aircraft it has the second-largest passenger airline fleet in the world when combined with its subsidiaries.

Lufthansa's registered office and corporate headquarters is in Deutz, Cologne, with its main operations base (Lufthansa Aviation Center (LAC) and primary traffic hub at Frankfurt Airport in Frankfurt am Main with a second hub at Munich Airport. The majority of Lufthansa's pilots, ground staff, and flight attendants are based in Frankfurt.

Lufthansa is a founding member of Star Alliance, the world's largest airline alliance, formed in 1997. The Lufthansa Group and employs 117,000 people worldwide of 146 nationalities. In 2010, over 90 million passengers flew with Lufthansa (not including Germanwings and Brussels Airlines).

In 1971 Lawrence Fellows of The New York Times described the then-new headquarters building that Lufthansa occupied in Cologne as "gleaming." In 1986 terrorists bombed the headquarters of Lufthansa. No people received injuries as a result of the bombing.

In 2006 the builders laid the first stone to the new Lufthansa headquarters in Deutz, Cologne. By the end of 2007 Lufthansa planned to move 800 employees, including the company's finance department, to the new building.

Several Lufthansa departments are not located in the headquarters; instead they are located in the Lufthansa Aviation Center at Frankfurt International Airport in Flughafen, Frankfurt. The departments include Corporate Communications, Investor Relations, and Media Relations.

Airline subsidiaries:

1. Air Dolomiti, an airline headquartered in Ronchi dei Legionari, Italy, wholly owned by Lufthansa.
2. Austrian Airlines, the national airline of Austria, based in Schwechat, Austria, wholly owned by Lufthansa.
3. British Midland International, a UK airline, wholly owned by Lufthansa.
4. Brussels Airlines: On 1 July 2009, Lufthansa acquired a 45 percent stake in the Belgian airline with an option to acquire the remaining shares in 2011.
5. Edelweiss Air, the charter arm of Swiss International.
6. Eurowings a regional carrier, 49% owned by Lufthansa.
7. Germanwings, wholly owned by Lufthansa, Germanwings was previously the low-cost subsidiary of Eurowings.
8. Jade Cargo International, was established in October 2004. Lufthansa Cargo owns 25% of the company, remainder is held by Shenzhen Airlines, which has a 51% stake, and DEG – Deutsche Investitions- und Entwicklungsgesellschaft mbH, a subsidiary of the German state-owned KfW bank – with 24%. It started operations in March 2005 with intra-Asian services. It is the first cargo airline in China with foreign ownership.
9. JetBlue Airways, an airline headquartered in New York, 19% owned by Lufthansa.
10. Lufthansa Cargo, an air cargo company, wholly owned by Lufthansa.
11. Lufthansa CityLine, a regional carrier, wholly owned by Lufthansa.
12. Lufthansa Italia, a subsidiary which operates flights from Milan Malpensa to destinations across Europe, with a fleet of nine Airbus A319 aircraft. It is intended to capture a large slice of the Milan market following major cutbacks by Alitalia as a result of its hub change to Rome Fiumicino Airport.
13. Luxair – Lufthansa holds a 13% stake.
14. SunExpress, airline based in Antalya, Turkey; 50% owned by Lufthansa (The remainder is owned by Turkish Airlines).
15. Swiss International Air Lines, an airline based in Basel wholly owned by Lufthansa.
16. Ukraine International Airlines, a Ukrainian airline, 22,52 % owned by UIA Beteiligungsgesellschaft mbH, a 100 % subsidiary of Austrian Airlines.

Other operations:

1. Delvag, an insurance company specialising in air transport
2. Global Load Control, a world leader in remote weight and balance services
3. LSG Sky Chefs, the world's largest airline caterer, which accounts for one third of the world's airline meals
4. Lufthansa Commercial Holding, in which Lufthansa holds a 19% stake. LCH contains over 400 service and finance companies of which Lufthansa holds shares
5. Lufthansa Consulting, an international aviation consultant for airlines, airports and related industries
6. Lufthansa Flight Training, a provider of flight crew training services to various airlines and the main training arm for the Airline's own pilots
7. Lufthansa Regional, a brand operated by an alliance of several small regional airlines, including Lufthansa CityLine
8. Lufthansa Systems, the largest European aviation IT provider
9. Lufthansa Technik, aircraft maintenance providers

The Lufthansa logo, an encircled stylized crane in flight, was created in 1918 by Otto Firle. It was part of the livery of the first German airline, Deutsche Luft-Reederei (abbreviated DLR), which began air service on 5 February 1919. In 1926 Deutsche Luft Hansa adopted this symbol, and in 1954 Lufthansa expressed continuity by adopted it, too.

The original creator of the name Lufthansa is believed to be F.A. Fischer von Puturzyn. In 1925 he published a book entitled "Luft-Hansa" which examined the options open to aviation policymakers at the time. Luft Hansa was the name given to the new airline which resulted from the merger of Junkers Luftverkehr AG and Deutscher Aero Lloyd.

Lufthansa is owned by private investors (88.52%), MGL Gesellschaft für Luftverkehrswerte (10.05%), Deutsche Postbank (1.03%) and Deutsche Bank (0.4%) and has 37,042 employees (at March 2007).

On 14 December Lufthansa and US-based low-cost airline Jetblue announced the beginning of a partnership initiated through the 19% stake purchase in Jetblue shares by Lufthansa. This is the first major ownership investment by a European carrier in an American carrier since the EU–U.S. Open Skies Agreement became effective in 2008.

In late 2007, the Lufthansa cargo hub dispute was started by Russia. Lufthansa was forced to relocate its cargo hub from Kazakhstan to Russia.

On 28 August 2008, Lufthansa and Brussels Airlines announced that they were negotiating joining together.

On 15 September 2008, it was jointly announced by both airlines that Lufthansa will acquire a 45% stake in Brussels Airlines with an option to acquire the remaining 55% from 2011. As a part of this deal Brussels Airlines will join Star Alliance. Brussels entered into the Star Alliance in December 2009.

On 28 October 2008, Lufthansa exercised its option to purchase a further 60% share in BMI (additionally to the 20% Lufthansa already owned), this resulted in a dispute with former owner Sir Michael Bishop, though. Both parties reached an agreement at the end of June 2009, so the acquisition could take place with effect from 1 July 2009. By acquiring the remaining 20% from Scandinavian Airlines Lufthansa has full control over BMI since November 1, 2009.

In November, Lufthansa and Austrian announced a deal in which Lufthansa will buy the majority stock from the Austrian government. The deal was completed in January 2009. At the same time, Lufthansa announced that they are in serious talks with Scandinavian Airlines System about a merger between the two airlines but Lufthansa would have to make great changes to SAS before this is viable because of the financial state of Scandinavian Airlines System over the last few years. In May 2009, it announced that talks are occurring between about a "closer commercial co-operation" between the two companies, but that a takeover is not in Lufthansa's plans. Additionally, it announced that if British Airways was unable to complete its merger with Iberia Airlines, it would attempt to begin talks with the Spanish airline itself.

In 2010, Lufthansa was named in a European Commission investigation into price-fixing, but was not fined due to acting as a whistleblower.

Until April 2009 Lufthansa inventory and departure control systems, based on Unisys were managed by LH Systems. Lufthansa reservations systems were outsourced to Amadeus in the early 1990s. Following a decision to outsource all components of the Passenger Service System, the functions were outsourced to the Altéa platform managed by Amadeus.

In September 1960 the Lufthansa Boeing 707 (D-ABOC), which would serve the Frankfurt-New York intercontinental route, was christened Berlin after the divided city of Berlin by then-mayor Willy Brandt. Following the Berlin, other Lufthansa 707 planes were named "Hamburg", "Frankfurt," "München" and "Bonn." With these names, the company established a tradition of naming the planes in its fleet for German cities and towns or federal states, with a general rule of thumb that the airplane make, size, or route would correspond roughly to the relative size or importance of the city or town it was named after.

This tradition has continued to this day, with two notable exceptions until 2010. The Airbus A340-300 (D-AIFC Gander/Halifax) was named after Gander and Halifax, two Canadian cities along the standard flight path from Europe to North America. It became the first Lufthansa airplane named after a non-German city. The name is meant to commemorate the hospitality of the communities of Gander and Halifax, which served as improvised safe havens for the passengers and crew of the multitude of international aircraft unable to return to their originating airports after the closing of the North American airspace in the days following the terror attacks of September 11, 2001.

The other aircraft not named after a German city was the Airbus 321-100 (D-AIRA), which was designated Finkenwerder in honor of the collaborative Airbus facility in the borough of Hamburg-Finkenwerder, where parts of the Airbus models are manufactured.

In February 2010 the Lufthansa company announced that the first two Airbus A380 in its fleet would be named Frankfurt am Main and München, following its naming tradition. However, the two subsequent A380 planes are named after Lufthansa A380 destination cities. The third A380 delivered to Lufthansa (D-AIMC) is named Peking, the German version of Beijing, inscribed on the plane in both German and Mandarin characters. The fourth A380 (D-AIMD) is named Tokio, the German spelling of Tokyo. The fifth A380 (D-AIME) is named Johannesburg, and the sixth (D-AIMF) is named Zürich.

Lufthansa Technik, the airline's maintenance arm, restored a Junkers Ju 52/3m built in 1936 to airworthiness; this aircraft was in use on the 10-hour Berlin to Rome route, across the Alps, in the 1930s. Lufthansa is now restoring a Lockheed Super Constellation, using parts from three such aircraft bought at auction. Lufthansa's Super Constellations and L1649 "Starliners" served routes such as Hamburg-Madrid-Dakar-Caracas-Santiago. Lufthansa Technik recruits retired employees and volunteers for skilled labor. Lufthansa sells aviation enthusiasts rides on the restored aircraft.

First Class: Lufthansa First Class is offered on most long-haul aircraft (Airbus A330-300, A340-300, A340-600 and A380-800, Boeing 747-400). Each seat converts to a two meter bed, includes laptop power outlets, as well as entertainment facilities. Meals are available on demand. Lufthansa offers dedicated First Class check in counters at most airports, and offers dedicated First Class lounges in Frankfurt and Munich, as well as a dedicated First Class Terminal in Frankfurt. Arriving passengers have the option of using Lufthansa's First Class arrival facilities, as well as the new Welcome Lounge. Lufthansa has introduced a new First Class product aboard the Airbus A380 and plans to gradually introduce it on all of its long-haul aircraft.

Business Class: Lufthansa's long-haul Business Class is offered on all long-haul aircraft. Each seat converts to a two meter angled lie-flat bed, includes laptop power outlets and entertainment facilities. Lufthansa offers dedicated Business Class check in counters at all airports, as well as dedicated Business Class lounges at most airports, or contract lounges at other airports, as well as the Lufthansa Welcome Lounge upon arrival in Frankfurt.

Economy Class: Lufthansa's long-haul Economy Class is offered on all long-haul aircraft. All have a 31" seat pitch except the Airbus A340s, which have a 32" seat pitch. Passengers receive meals, as well as free drinks. In 2007, Lufthansa began installing personal Audio-Video-On-Demand (AVOD) screens in Economy Class. The Airbus A340s and A330s have been completely refitted with AVOD, while the 747s are in the process of being refitted . The Airbus A380s are being delivered with AVOD systems already installed.

Business Class: Lufthansa's short-haul Business Class offers a 31"-32" seatpitch and is available on all A319, A320, A321 and B737 aircraft. Passengers receive meals and drinks, as well as access to dedicated Business Class check-in counters, and Lufthansa Business Class lounges. These aircraft are used on selected medium-haul flights. Inflight entertainment is not offered on any short-haul flights.

Economy Class: Lufthansa's short-haul Economy Class offers a 31" pitch and is available on all A319, A320, A321 and B737 aircraft. Passengers receive free beverages, and snacks or meals. Inflight entertainment is not offered on any short-haul flights.

In July 2010, Lufthansa announced a move to a new cabin with lighter seating in its European fleet, bringing capacity improvements equivalent to buying twelve new A320s.

In December 2010, Lufthansa announced a new slimline seat developed by Recaro, which would allow higher seat densities and/or more legroom for passengers; Lufthansa has ordered 32000 of these seats, to be installed in 2011.

Lufthansa operates a First Class Terminal at Frankfurt Airport. The first terminal of its kind; access is limited only to departing Lufthansa First Class, and HON Circle members. Approximately 200 staff care for approximately 300 passengers per day in the terminal, which features a full-service restaurant, full bar, cigar lounge, relaxation rooms and offices, as well as bath facilities. Guests are driven directly to their departing flight by Mercedes-Benz S-Class, Porsche Panamera or Mercedes-Benz Viano.

Lufthansa's frequent-flyer program is called Miles & More, and is shared among several European airlines, including Austrian Airlines, Adria Airways, Croatia Airlines, LOT Polish Airlines, Luxair, Swiss International Air Lines, and Brussels Airlines. Miles & More members may earn miles on Lufthansa flights and Star Alliance partner flights, as well as through Lufthansa credit cards, and purchases made through the Lufthansa shops. Status within Miles & More is determined by miles flown during one calendar year with specific partners. Membership levels include: Basic (no minimal threshold), Frequent Traveller (Silver, 35,000 mile threshold), Senator (Gold, 100,000 mile threshold, 130,000 for German residents), and HON Circle (Black, 600,000 mile threshold over two calendar years). All non-basic Miles & More status levels offer lounge access and executive bonus miles, with the higher levels offering more exclusive benefits.

Septic shock | Understanding and definition of the Septic shock

Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome (formerly known as multiple organ failure) and death. Its most common victims are children, immunocompromised individuals, and the elderly, as their immune systems cannot deal with the infection as effectively as those of healthy adults. Frequently, patients suffering from septic shock are cared for in intensive care units. The mortality rate from septic shock is approximately 25%-50%.

In humans, septic shock has a specific definition requiring several criteria for diagnosis:

* First, SIRS (systemic inflammatory response syndrome) must be met by finding at least any two of the following:

Tachypnea (high respiratory rate) > 20 breaths per minute, or on blood gas, a PCO2 less than 32 mmHg signifying hyperventilation.

White blood cell count either significantly low, < 4000 cells/mm³ or elevated > 12000 cells/mm³.

Heart rate > 90 beats per minute

Temperature: Fever > 38.0 °C (100.4 °F) or hypothermia < 36.0 °C (96.8 °F)

* Second, there must be sepsis and not an alternative form cause of SIRS. Sepsis requires evidence of infection, which may include positive blood culture, signs of pneumonia on chest x-ray, or other radiologic or laboratory evidence of infection

* Third, signs of end-organ dysfunction are required such as renal failure, liver dysfunction, changes in mental status, or elevated serum lactate.

* Finally, septic shock is diagnosed if there is refractory hypotension (low blood pressure that does not respond to treatment). This signifies that intravenous fluid administration alone is insufficient to maintain a patient's blood pressure from becoming hypotensive.

A subclass of distributive shock, shock refers specifically to decreased tissue perfusion resulting in ischemia and organ dysfunction. Cytokines released in a large scale inflammatory response results in massive vasodilation, increased capillary permeability, decreased systemic vascular resistance, and hypotension. Hypotension reduces tissue perfusion pressure causing tissue hypoxia. Finally, in an attempt to offset decreased blood pressure, ventricular dilatation and myocardial dysfunction will occur.

When bacteria or viruses are present in the bloodstream, the condition is known as bacteremia or viremia. If the organisms are particularly virulent, or the host is immunocompromised, then the host organism may develop a condition known as systemic inflammatory response syndrome (or SIRS). Sepsis is by definition bacteremia, combined with SIRS. If sepsis worsens to the point of end-organ dysfunction (renal failure, liver dysfunction, altered mental status, or heart damage), then the condition is called severe sepsis. Once severe sepsis worsens to the point where blood pressure can no longer be maintained with intravenous fluids alone, then the criteria have been met for septic shock. The precipitating infections which may lead to septic shock if severe enough include pneumonia, bacteremia, diverticulitis, pyelonephritis, meningitis, pancreatitis, and necrotizing fasciitis.

Most cases of septic shock (approximately 70%) are caused by endotoxin-producing Gram-negative bacilli. Endotoxins are bacterial wall lipopolysaccharides (LPS) consisting of a toxic fatty acid (lipid A) core common to all Gram-negative bacteria, and a complex polysaccharide coat (including O antigen) unique for each species. Analogous molecules in the walls of Gram-positive bacteria and fungi can also elicit septic shock. Free LPS attaches to a circulating LPS-binding protein, and the complex then binds to a specific receptor (CD14) on monocytes, macrophages, and neutrophils. Engagement of CD14 (even at doses as minute as 10 pg/mL) results in intracellular signaling via an associated "Toll-like receptor" protein 4 (TLR-4), resulting in profound activation of mononuclear cells and production of potent effector cytokines such as IL-1 and TNF-α. These cytokines act on endothelial cells and have a variety of effects including reduced synthesis of anticoagulation factors such as tissue factor pathway inhibitor and thrombomodulin. The effects of the cytokines may be amplified by TLR-4 engagement on endothelial cells. TLR-mediated activation helps to trigger the innate immune system to efficiently eradicate invading microbes. At high levels of LPS, the syndrome of septic shock supervenes; the same cytokine and secondary mediators, now at high levels, result in systemic vasodilation (hypotension), diminished myocardial contractility, widespread endothelial injury and activation, causing systemic leukocyte adhesion and diffuse alveolar capillary damage in the lung activation of the coagulation system, culminating in disseminated intravascular coagulation (DIC). The hypoperfusion resulting from the combined effects of widespread vasodilation, myocardial pump failure, and DIC causes multiorgan system failure that affects the liver, kidneys, and central nervous system, among others. Unless the underlying infection (and LPS overload) is rapidly brought under control, the patient usually dies.

Treatment primarily consists of the following.

1. Volume resuscitation

2. Early antibiotic administration

3. Early goal directed therapy

4. Rapid source identification and control.

5. Support of major organ dysfunction.

Among the choices for vasopressors, norepinephrine is superior to dopamine in septic shock. Both however are still listed as first line in guidelines.

Antimediator agents may be of some limited use in severe clinical situations however are controversial:

* Low dose steroids (hydrocortisone) for 5 – 7 days led to improved outcomes.

* Recombinant activated protein C (drotrecogin alpha) in a 2011 Cochrane review was found not to decrease mortality and thus was not recommended for use. Other reviews however comment that it may be effective in those with very severe disease.

According to the US CDC, septic shock is the 13th leading cause of death in the United States, and the #1 cause of deaths in intensive care units. There has been an increase in the rate of septic shock deaths in recent decades, which is attributed to an increases in invasive medical devices and procedures, increases in immunocompromised patients, and an overall increase in elderly patients. Tertiary care centers (such as hospice care facilities) have 2-4 times the rate of bacteremia than primary care centers, 75% of which are nosocomial infections.

The process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. Approximately 70% of septic shock cases were once traceable to Gram staining gram-negative bacilli that produce endotoxins; however, with the emergence of MRSA and the increased use of arterial and venous catheters, Gram-positive cocci are implicated approximately as commonly as bacilli. In rough order of increasing severity, these are bacteremia or fungemic; septicemia; sepsis, severe sepsis or sepsis syndrome; septic shock; refractory septic shock; multiple organ dysfunction syndrome, and death.

35% of septic shock cases derive from urinary tract infections, 15% from the respiratory tract, 15% from skin catheters (such as IVs); over 30% of all cases are idiopathic in origin.

The mortality rate from sepsis is approximately 40% in adults, and 25% in children, and is significantly greater when left untreated for more than 7 days.

Sepsis has a worldwide incidence of more than 20 million cases a year, with mortality due to septic shock reaching up to 70 percent even in industrialized countries.