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Figure 1. Distribution of Gestational Age at Birth in Weeks
Graphic Jump Location
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Figure 2. Length of Time in Special Care Infant Unit by Gestational Age at Birth
Figure 3. Examples of Magnetic Resonance Imaging Scans From the European Cerebral Palsy Study
Figure 4. WMDI Location of White-Matter Loss Across All Areas and Bilateral Spastic Cerebral Palsy Diagnosis
WMDI indicates white-matter damage of immaturity.
Figure 5. Gestational Age at Birth Before 34 Weeks or After 34 Weeks and MRI Pattern Type
MRI indicates magnetic resonance imaging.
Grether JK, Cummins SK, Nelson KB.The California Cerebral Palsy Project. Paediatr Perinat Epidemiol. 1992;6:339-3511635884Google ScholarCrossref
Ingram TTS.Paediatric Aspects of Cerebral Palsy.London, England: E & S Livingstone Ltd; 1964
Crothers B, Paine RS.The Natural History of Cerebral Palsy.London, England: Oxford University Press; 1959
Bax MC.Terminology and classification of CP. Dev Med Child Neurol. 1964;11:295-29714155190Google Scholar
Kuban KC, Leviton A.Cerebral palsy. N Engl J Med. 1994;330:188-1958264743Google ScholarCrossref
Krageloh-Mann I, Petersen D, Hagberg G, Vollmer B, Hagberg B, Michaelis R.Bilateral spastic CP—MRI pathology and origin: analysis from a representative series of 56 cases. Dev Med Child Neurol. 1995;37:379-3977768338Google ScholarCrossref
Cioni G, Sales B, Paolicelli PB, Petacchi E, Scusa MF, Canapicchi R.MRI and clinical characteristics of children with hemiplegic CP. Neuropediatrics. 1999;30:249-25510598836Google ScholarCrossref
Hashimoto K, Hasegawa H, Kida Y, Takeuchi Y.Correlation between neuroimaging and neurological outcome in periventricular leukomalacia: diagnostic criteria. Pediatr Int. 2001;43:240-24511380916Google ScholarCrossref
Dex S, Joshi H.Children of the 21st Century: From Birth to Nine Months.Bristol, England: Policy Press; 2005
Child Growth Foundation. Child Growth Foundation 1996/1 UK 9 Centile Cross Sectional Paediatric Charts.Tyne and Wear, England: Harlow Printing Ltd; 1996
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B.Development and reliability of a system to classify gross motor function in children with CP. Dev Med Child Neurol. 1997;39:214-2239183258Google ScholarCrossref
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N.Proposed definition and classification of CP, April 2005—introduction. Dev Med Child Neurol. 2005;47:571-57616108461Google ScholarCrossref
Barkovich AJ, Lindan CE.Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations. AJNR Am J Neuroradiol. 1994;15:703-7158010273Google Scholar
Nelson KB.Can we prevent CP? N Engl J Med. 2003;349:1765-176914585946Google ScholarCrossref
The Placenta and Neurodisability.London, England: Mac Keith Press; 2006
Becher JC, Bell JE, Keeling JW, Liston WA, McIntosh N, Wyatt B.The Scottish Perinatal Neuropathology Study: clinicopathological correlation in stillbirths. BJOG. 2006;113:310-31716487203Google ScholarCrossref
Becher JC, Bell JE, Keeling JW, McIntosh N, Wyatt B.The Scottish Perinatal Neuropathology Study: clinicopathological correlation in early neonatal deaths. Arch Dis Child Fetal Neonatal Ed. 2004;89:F399-F40715321957Google ScholarCrossref
Neufeld MD, Frigon C, Graham AS, Mueller BA.Maternal infection and risk of CP in term and preterm infants. J Perinatol. 2005;25:108-11315538398Google ScholarCrossref
Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB.Chorioamnionitis and CP in term and near-term infants. JAMA. 2003;290:2677-268414645309Google ScholarCrossref
Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P.Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol. 2000;42:674-68011085295Google ScholarCrossref
This Week in JAMA
Complexity of the Cerebral Palsy Syndromes
Michael E. Msall, MD
Pediatrics Radiology
Citations 297
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Bax M, Tydeman C, Flodmark O. Clinical and MRI Correlates of Cerebral Palsy: The European Cerebral Palsy Study. JAMA. 2006;296(13):1602–1608. doi:10.1001/jama.296.13.1602
Original Contribution
Clinical and MRI Correlates of Cerebral Palsy: The European Cerebral Palsy Study
Martin Bax, DM, FRCPCH; Clare Tydeman, BA(Hons); Olof Flodmark, MD, PhD
Author Affiliations Article Information
Author Affiliations: Department of Paediatrics, Imperial College London, Chelsea & Westminster Hospital, London, England (Dr Bax and Ms Tydeman); Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden (Dr Flodmark).
JAMA. 2006;296(13):1602-1608. doi:10.1001/jama.296.13.1602
Context Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Further information about the causes of CP could help identify preventive strategies.
Objective To investigate the correlates of CP in a population sample and compare clinical findings with information available from MRI brain studies.
Design and Setting Cross-sectional, population-based investigative study conducted in 8 European study centers (North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland).
Participants Five hundred eighty-five children with CP were identified who had been born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan.
Main Outcome Measures Standardized clinical examination results, parental questionnaire responses, MRI results, and obstetric, genetic, and metabolic data from medical records.
Results Important findings include the high rate of infections reported by mothers during pregnancy (n = 158 [39.5%]). In addition, 235 children (54%) were born at term while 47 children (10.9%) were very preterm (<28 weeks). A high rate of twins was found, with 51 children (12%) known to be from a multiple pregnancy. Clinically, 26.2% of children had hemiplegia, 34.4% had diplegia, 18.6% had quadriplegia, 14.4% had dyskinesia, 3.9% had ataxia, and 2.6% had other types of CP. Brain MRI scans showed that white-matter damage of immaturity, including periventricular leukomalacia (PVL), was the most common finding (42.5%), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Only 11.7% of these children had normal MRI findings. There were good correlations between the MRI and clinical findings.
Conclusions These MRI findings suggest that obstetric mishaps might have occurred in a small proportion of children with CP. A systematic approach to identifying and treating maternal infections needs to be developed. Multiple pregnancies should be monitored closely, and the causes of infant stroke need to be investigated further so preventive strategies can be formulated. All children with CP should have an MRI scan to provide information on the timing and extent of the lesion.
This article reports on the European Cerebral Palsy Study, carried out in 8 centers in Europe, including North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland. The study investigated the correlates of cerebral palsy (CP) in a population sample and compared clinical findings with information available from magnetic resonance imaging (MRI) brain studies. The aim was that this study would help in understanding where potential preventive strategies could be targeted.
A population of children with CP who were born between 1996 and 1999 were examined at each center. They were identified from a geographic area surrounding each center with 25 000 live births per year. According to the usual reported rates of CP of about 2 per 1000 live births, it was predicted that each center would recruit approximately 100 children during the study period. Ethical permission and written informed parental consent were obtained in all centers.
A standard clinical examination was devised largely based on the work of Grether et al,1 with reference to Ingram2 and Crothers and Paine.3 Cerebral palsy was defined as a group of nonprogressive motor disorders of movement and posture due to a defect or lesion of the developing brain.4 Children were recruited after the age of 2 years, when the diagnosis of CP can be firmly substantiated.5
Lead clinicians involved in the study were highly experienced in the care and assessment of children with CP and, when possible, these clinicians examined the study children within their centers. To alleviate potential interobserver and intraobserver error, we optimized the validity and reliability of the examination by using a training video highlighting points that might present difficulties. Further training was offered by 3 key investigators, who visited satellite centers participating in the examination of a number of the children recruited to the study. Direct reliability studies on the coding of the physical examination were not possible due to the complexity of the cases and the multicenter format. Therefore, clinical characteristics were analyzed to profile the expected clinical pattern. Outliers from the usual pattern of findings were reviewed in liaison with the local clinician to check for any errors in coding.
An interview questionnaire with the parents provided information about family history and prenatal, pregnancy, and birth information. Hospital obstetric notes were sought to verify birth data given by parents and to collect extra information on the birth and neonatal period. The results of genetic and metabolic investigations were recorded when performed. In total, more than 300 items of information were requested for each child.
A very important component was the MRI brain scan. Various articles have reported findings from studies on children with selected types of CP, including bilateral spastic CP6 and hemiplegia,7 and types of MRI pattern, such as periventricular leukomalacia (PVL).8 However, we are unaware of any studies reporting MRI findings in a large CP population including all of the clinical subtypes. Cranial MRI is a standard diagnostic procedure safe to use in children.
We sought MRI scans taken at 18 months of age or later. Magnetic resonance imaging reports from the participating centers were often brief and difficult to compare, so each scan in the study was assessed jointly by 2 study members (O.F. and I.K.-M.) using a standardized scoring system developed for this study. Studies were carried out in line with the local protocols for pediatric patients available in all institutions. The sequences used were developed in association with the radiologists from the participating centers and were chosen for optimal information at minimum total time in the MRI camera. Each scan was assessed blind to both the local MRI report and clinical findings.
Simple descriptive statistics are used throughout the article. χ2 Tests were used to assess the statistical significance of associations between categorical variables. Case-control data were not collected because of staffing limitations. SPSS software, version 14.0 (SPSS Inc, Chicago, Ill) was used to analyze data.
In total, 585 children with CP were identified as eligible to participate in the study and 431 of these children were recruited and assessed. Of the children in the study, 61.9% were male.
Of the 154 children who were not recruited, 55 parents did not consent to the participation of their child, 21 families moved away before inclusion, 7 failed to attend appointments, 7 children died before inclusion, and 11 families could not be contacted. A further 53 children did not have a reason for noninclusion recorded. Information about the type of CP was available for 49 of the 154 children, and for this group, there was no significant difference compared with the children included in the study.
Only 1 center achieved the target of identifying 100 children with CP. Four possible reasons for the failure to reach the anticipated numbers are (1) failure of identification; (2) that the birth population sample was actually smaller than originally anticipated; (3) that centers were not accessing the entire population with CP in their area; and (4) that there had been some genuine decline in the rate of CP. As a consequence of 1 or more of these factors, our sample is smaller than expected. The most likely explanation is that there was some underidentification of mild cases in most centers because of the organization of services and methods of identification. There is no real evidence from the study that the lower numbers reflect a decrease in the 2-per-1000 live birth rate for CP.
Prenatal Findings
A striking finding from the mothers' history was that 39.5% (158 of 400) reported an infection during the pregnancy. Specifically, 19.2% of the mothers reported a urinary tract infection during the pregnancy and 15.5% of women reported taking antibiotics during the pregnancy. Two of the study team independently reviewed the infection data recorded and it was agreed that 29.6% had a "significant" infection (excluding cases of common colds, coughs, etc).
Fifty-one children (12%) were known to be from a multiple pregnancy, with 48 from a twin pregnancy and 3 from a triplet pregnancy. This compares with a population rate of multiple pregnancy of about 1.5%9 In some instances, both twins had CP and were in the study (4 pairs), and in 13 others, their twin had previously died (7 in utero and 6 during or after birth). Among children from multiple pregnancies, 12 (24%) were from pregnancies after infertility treatment compared with 12 (3.4%) of the singleton pregnancies in the study.
Perinatal Findings
More than half of the children (n = 235 [54.5%]) were born at term. Forty-seven (10.9%) were very low-gestational-age infants (<28 weeks), 69 (16%) were born between 28 and 31 weeks, and 79 (18.3%) were born between 32 and 36 weeks of gestation (Figure 1). The numbers in the very low-gestational-age group are so small that any variation in the rates of CP in this group would not drastically affect the overall numbers of children with CP.
Among the study children, 19.1% were small for gestational age (birth weight <10th percentile), with similar rates occurring in all gestational age groups. However the actual number of infants who were small for gestational age was higher in the term group (n = 44) than in the preterm group (n = 31). In the group born at less than 28 weeks, 16.3% were large for gestational age, whereas children in the other groups were just over the expected 10% rate (10.6%-11.1%). These data were calculated for all children in the study using the Child Growth Foundation growth charts.10
Emergency cesarean deliveries were performed in 32.3% of births, whereas 44.8% of the children were born by standard vaginal delivery. Of the rest, 7% were delivered by planned cesarean delivery, 4.2% by Ventouse extraction, 6.1% by forceps, and 2.3% were breech. The delivery method was not recorded for 3.5%.
Seventy percent of children were admitted to the special care infant unit after birth. Figure 2 shows the length of time spent in the special care infant unit according to the gestational age at birth. A total of 43.7% of children born at term were kept in the unit for 5 or more days and, therefore, presumed to be regarded by the attending clinician as "significantly ill" in the neonatal period.
At the children's discharge from the special care infant unit, 47.3% of the parents report that they were unaware that there was any concern about their child. The parents of children with more severe CP were more likely to have been told about the possibility of brain damage (Pearson χ24 = 26.256; P<.001).
On completion of the physical examination, the clinician was asked to record the topographical nature of the condition (hemiplegia, diplegia, quadriplegia, or other) and the nature of the CP (spastic, dystonic, choreoathetoid, or ataxia). The functional severity was graded as mild, moderate, or severe (Table 1).
At the time of original examination, the children ranged in age from 12 to 91 months, with a mean age of 46 months (9 children were seen at <23 months). Where children were assessed before the age of 3 years, a request was made to reassess at a later date to confirm the diagnosis of CP and note any changes in presentation. Selected variables from the physical examination are shown in Table 2 illustrating some clinical differences between the spastic CP subtypes.
During the period of data collection, there has been further validation of the Gross Motor Function Classification System11 in CP. To compare our coding of functional severity to this scale, a subsample of 36 randomly selected children were retrospectively recoded to the 1 through 5 scores in the Gross Motor Function Classification System. There was strong correspondence between the data (κ = 0.583; P<.001), with 1 being mild, 2 and 3 being moderate, and 4 and 5 being severe.
Many children also have clinical findings not related to motor disorder, and failure to include this in any definition and classification of CP has recently been emphasized.12 In total, 28% of the children had epilepsy; the rate was highest (50%) among the quadriplegia group and lowest (16%) in children with diplegia. Communication problems were present in 58% of the total group—highest in the dyskinesia and quadriplegia groups and lowest in the diplegia and hemiplegia groups.
Vision is difficult to assess clinically in young children, but it was recorded that 31% of the children with hemiplegia, 38% of the children with diplegia, and 64% of those with quadriplegia had visual abnormalities of some kind. About 7% of the children had a hearing problem reported.
MRI Findings
Among children with clinical evaluation, 351 (81.4%) had a brain MRI scan assessed for the study. The ages at which the scans were taken ranged from 1 to 87 months, with a mean age of 38 months. Scans taken before the age of 18 months were only accepted for the study if the type of pathology was obvious and renewed imaging was not expected to provide further information; eg, in malformations or extensive posthemorrhagic periventricular destruction. The scans were grouped according to the primary pattern of damage (Table 3).
The MRI scans showed that white-matter damage of immaturity (WMDI, including PVL) was the most common finding (42.5%), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Normal MRI findings were present in 11.7%.
White-Matter Damage of Immaturity
White-matter damage of immaturity included PVL and periventricular hemorrhage. White-matter damage of immaturity was found in 71.3% of the children with diplegia (n = 87), 34.1% of those with hemiplegia (n = 31), and 35.1% of those with quadriplegia (n = 20). This type of damage is thought to occur before about 34 weeks of gestation, although 25% of the WMDI group were born at term.
Figure 3A shows 2 images through the levels of the lateral ventricles in a child with mild WMDI and a diagnosis of mild PVL who clinically has mild diplegia.
In contrast, Figure 3A also shows an image obtained at a level through the lateral ventricles of a child with severe WMDI and a diagnosis of severe PVL who has quadriplegia.
When the location of the white-matter loss was investigated in the children with bilateral spastic CP, in general, those with posterior only or posterior and middle WMDI were found to have spastic diplegia. These children were often able to walk and had some communication skills. The spastic quadriplegia group, however, mostly had damage across all areas, and virtually all could not walk and often had very limited communication skills (Figure 4).
Basal Ganglia Damage
Basal ganglia and thalamic damage was mainly associated with dystonic CP, which accounted for 75.6% (n = 34) of the basal ganglia group. Occasionally, this type of damage was seen in children with spastic quadriplegia (n = 7) and diplegia (n = 4). There were no children with hemiplegia. Figure 3B shows an image at the level of thalamus and basal ganglia in a child with dyskinetic CP. Figure 3B also shows an image of the same child at the level of the parietal lobes.
Focal Infarct
Focal cortical infarcts were almost exclusively related to a clinical diagnosis of hemiplegia (n = 25), with 1 child diagnosed as having quadriplegia. Among children with hemiplegia, 27.5% were found to have a focal infarct. Figure 3C shows an example of a child with hand-dominated left hemiplegia who probably had an embolus in the right middle cerebral artery.
Cortical/Subcortical Damage
This group included children with multicystic encephalomalacia and other cortical lesions. Eleven children (33%) had a watershed pattern of damage. All CP types apart from ataxia were represented in this group.
Thirty-two children were found to have malformations. These were most common in the hemiplegia group (n = 12) but were found across all clinical subtypes.
Six of the malformations were thought to be a result of specific in utero infections, such as cytomegalovirus, which can be identified on MRI by the specific distribution of calcifications.13 Other types of malformation included lissencephaly, polymicrogyria, schizencephaly, and cortical dysplasia. Figure 3D shows an image of a child with cytomegalovirus infection who clinically has spastic quadriplegia and extensive dysplasia involving large parts of both parietal lobes.
Twenty-five children (7.1%) had findings on the scans that did not fit into the aforementioned groups and were labeled "miscellaneous." They were found across all clinical CP subtypes and were often accompanied by high rates of other problems, such as epilepsy and visual problems. Some of these children may have unidentified genetic abnormalities.
Normal MRI
Forty-one of the children (11.7%) had normal MRI results. They were distributed across all clinical CP subtype groups, although they did make up more than half of the group with ataxia (n = 8). Sixty-one percent of the children had mild and 17% had severe functional severity. There may be genetic defects among this group.
Abnormal MRI
Figure 5 indicates the distribution of pathologic MRI findings in 2 groups, those born before 34 weeks of gestational age and those born at or after 34 weeks.
In summary, the MRI findings relate both to the clinical description of the child and the severity of the condition. The timing of the lesion might help to define which events might have caused the CP.
Not only do MRI scans help reveal the pathologic basis of the condition, but also, the findings have strong correlations with clinical findings. This may be useful in helping parents, clinicians, and others involved in the care of children with CP to understand the nature of the children's condition and to predict their needs in the future. Therefore, all children with CP should have an MRI scan.
Our study has some important implications in relationship to possible malpractice suits. The scans can be reviewed in relationship to the pathologic findings to determine which might have been caused by some event during the delivery.
Among infants born before 34 weeks, the great majority had white-matter damage. This is often thought to be caused by obstetric malpractice, but there is little evidence for this. As pointed out by Nelson,14 changes in obstetric practice over the last 20 years and the development of overall neonatal care during the same period have had little effect on the rate of CP. Rather, predisposing factors that include genetic factors, nutritional factors, and infections during pregnancy and before the onset of premature labor lead to placental damage developing throughout the pregnancy.15 These factors predispose the infant to an increased risk of hypoxic ischemic episodes, leading to white-matter damage. By the time this occurs, the event has reached a stage at which it cannot be affected by interventions. This may lead to premature birth and concerns about the infant. In other instances, no event is noted by the mother or her attendants, and the child is born at term with established white-matter damage. Interventions around the time of either of these events will not affect the outcome. In their sophisticated study of stillbirths16 and early neonatal deaths17 in Scotland, Becher et al conclude that "the findings in this study support the notion that the birth of a compromised 'asphyxiated' encephalopathic infant is not necessarily the result of a mismanaged labour nor the lack of vigilance in pregnancy."
In our study, 54 children with white-matter damage were born after 34 weeks. These, together with the 32 children with malformations, again indicative of earlier cerebral damage, would not have been affected by perinatal processes.
Of the other groups, focal infarcts are clearly not caused by obstetric events, and the 25 infants in the miscellaneous group included some infections. In the 41 children with normal MRI results, some infants probably had genetic causes for their CP, but when there is no evident lesion in the cerebral cortex, it is hard to conceive of an obstetric cause.
This leaves 70 children with either cortical/subcortical damage or basal ganglia damage born after 34 weeks of gestational age. Thus, in our study, only 19.9% of a population with CP might be considered on the basis of their MRI scan as having a possibility of some type of obstetric mishap as the cause of their brain damage.
The data on the method of delivery in this group show that 26% of mothers had emergency cesarean deliveries, indicating that the obstetrician was well aware that the infant was in difficulty. Although a proportion of these may have had difficulties due to some obstetric inattention, many would not, and it seems likely that the proportion of infants who might have had damage because of obstetric malpractice within the CP population is therefore low.
This study has once again emphasized the great importance of infections occurring in mothers during pregnancy. Most study centers had no access to normative data on this topic. The closest comparable population data on the incidence of urinary tract infection during pregnancy that we were able to access were through the St Mary's Maternity Information System. This database has information available on 74 838 live births in the 2-year period matching our study's, collected from maternity units in the North West Thames region of London. Our finding that 19.2% of mothers reported a urinary tract infection during the pregnancy compares with the rate of clinically diagnosed urinary tract infection during pregnancy in the general population of the St Mary's Maternity Information System of 2.9%. The results appear to show a raised rate of infection. This finding is also supported by the case-control study of Neufeld et al,18 in which maternal infection was a risk factor for CP in both term and preterm infants. Wu et al19 also reported a significantly increased rate of infection in children born with CP at or near term, in which 14% of the mothers had had chorioamnionitis compared with 4% of controls.
While there is a legitimate concern about overprescription of antibiotics, there should be no question that treating infections during pregnancy is a potential area for prevention. A systematic approach to identifying and treating maternal infections needs to be developed, as emphasized by Nelson.14
Twin pregnancies are another potential area for prevention of CP. Multiple pregnancies, including pregnancies after infertility treatment, should be monitored closely, especially when other risk factors are present.
Because of the lack of warning to parents at discharge from special care infant units about the risks of potential problems, delay in diagnosis and referral to an appropriate service was common. These findings suggest that at discharge from the hospital, better arrangements should be made for the follow-up of these children, particularly as there is a possibility that further brain damage might occur after birth from, for example, nutritional effects.20 The recognition of maternal and child genetic factors in thrombophilia leading to stroke is an area in which early identification could perhaps lead to prevention.
Finally, perhaps 10% of this population of children with CP might have unidentified genetic or metabolic disorders.
We think it is not unreasonable to assume that with increased awareness of possible preventive measures, over the next decade the rate of CP could be reduced substantially, thus reducing the burden on families and saving tremendous sums of money for health services.
Corresponding Author: Martin Bax, DM, FRCPCH, Department of Paediatrics, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, England (m.bax@imperial.ac.uk).
Author Contributions: Dr Bax had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Bax, Flodmark.
Acquisition of data: Bax, Tydeman, Flodmark.
Analysis and interpretation of data: Bax, Tydeman, Flodmark.
Drafting of the manuscript: Bax, Flodmark.
Critical revision of the manuscript for important intellectual content: Bax, Tydeman, Flodmark.
Statistical analysis: Bax, Tydeman, Flodmark.
Obtained funding: Bax.
Administrative, technical, or material support: Tydeman, Flodmark.
Study supervision: Bax.
Financial Disclosures: None reported.
European Cerebral Palsy Study Lead Investigators: North West London: Martin Bax, Clare Tydeman, Imperial College London; North East London: Lucinda Carr, Great Ormond Street Hospital; Edinburgh: Paul Eunson, Debbie Miller, Royal Hospital for Sick Children; Dublin: Owen Hensey, Susan Keane, Central Remedial Clinic; Helsinki: Lennart von Wendt, Helsinki University Central Hospital, Teija Salokorpi, Foundation for the Rehabilitation of Children and Young People, Mannerheim League for Child Welfare; Tübingen: Ingeborg Krägeloh-Mann, Andrea Bevot, University Children's Hospital; Lisbon: Maria da Graça de Campos Andrada, Teresa Folha, Fernanda Nunes, Centro Rebilitação Paralisa Cerebral Calouste Gulbenkian; Stockholm: Olof Flodmark, Håkan Svan, Gunilla Malm, Karolinska University Hospital, Eva Esscher, Sachsska Barnsjukhuset.
Funding/Support: Ongoing funding for this study is provided by the Castang Foundation, having been initiated by the Little Foundation.
Role of the Sponsor: The funders had no role in the design, collection, analysis, and interpretation of data; in the writing of the report; or in the preparation, review, or decision to submit the manuscript for publication.
Acknowledgment: We thank all those who have helped to make this research possible, especially the children, the parents, and the families who allowed their information to be used. We also thank the numerous clinicians and staff involved in the care of these children who generously gave their time and efforts to help with the study. Statistical advice was provided by Ian Plewis, MSc, Institute of Education, University of London. Additional advice was supplied by Paul Eunson, MbChB, FRCPCH, Royal Hospital for Sick Children, Edinburgh, and Lucinda Carr, MD, MBChB, FRCP, FRCPCH, Great Ormond Street Hospital for Children NHS Trust.


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Jun 9, 2020 - World
Tracking the coronavirus pandemic, by the numbers
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios
131,296 new coronavirus cases were recorded worldwide on Wednesday, per data from the World Health Organization.
By the numbers: Compare that to 87,729 one month ago, or 4,589 on March 11 — the day the pandemic was declared. 51.9% of new cases are being recorded in the Americas, while Europe's share of new cases is down from nearly 80% in mid-March to 13.3%.
No COVID-19 here
Zero new cases were reported Wednesday in Tanzania and Nicaragua, two countries that seem intent on ignoring the virus until it goes away. Likewise in Burundi, where President Pierre Nkurunziza has died, possibly of coronavirus, there are no new confirmed cases.
Other countries reporting zero cases include South Sudan and Libya, fragile states that are hardly conducting testing.
More than a dozen Caribbean islands that are now deciding whether and how to open their borders to tourists also recorded zero cases. So did Costa Rica.
European members of the no-new-cases club included Croatia, Greece, Hungary, Norway, Slovakia and Slovenia.
The largest member of the club is Vietnam, which has a population of 96 million, but hasn't had a single confirmed death from the coronavirus.
Hardest-hit countries
539.5 cases per million were recorded in Qatar, in a rolling average of the past three days, making its outbreak the world's fastest-growing as a proportion of the population.
Other countries with particularly fast-growing outbreaks include Brazil, Chile, Peru and Panama, along with Armenia, Belarus and several Gulf states.
829 deaths per million make Belgium the hardest-hit country to date as a proportion of the population.
The U.K. (598), Spain (580) and Italy (561) also have among the highest death rates, as does the U.S. (335), which has by far the largest overall death toll at 111,620.
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals
Places to watch
9,971 cases were recorded in India, the third-most in the world after the U.S. (28,918) and Brazil (27,075).
South Asia is becoming a new COVID-19 hotspot, with Pakistan now recording more cases per day as a proportion of the population (21.63 per million) than all but a few European countries, despite limited testing.
Epidemiologist John Clemens estimates that Bangladesh's capital, Dhaka, may have up to 750,000 cases — 12 times the official tally, per the Economist.
Unknown: That's the total number of cases and deaths recorded in Brazil, according to Brazil's Health Ministry.
They were reportedly removed from the ministry's website on the orders of President Jair Bolsonaro, who has suggested the count is artificially high.
The government now says it will release data that better reflects reality. That's leading to fears of a cover-up.
The jobs question
6.6% was the unemployment rate in the EU as of April (the most recent data), up just 0.2% from before the pandemic and less than half the rate in the U.S. (13.3%).
That's because EU governments have been paying big chunks of workers' salaries to protect their jobs during lockdowns. More than 40 million people are enrolled in such programs, per the FT.
The big questions is how many of the jobs that have been saved will still exist post-pandemic.
The World Bank projects a 5.2% contraction in global GDP in 2020.
Go deeper:
World coronavirus updates
New Zealand is now free of coronavirus
Eye of COVID-19 storm shifts to Latin America

redpajama_set_name: RedPajamaCommonCrawl


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manchester social services number
Sociology. Humanities, Languages and Social Science Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL Phone: +44 (0)161 247 1751. Notice for Public Review and Comment - TANF Caseload Reduction Report FFY 2021. The hub at Textile Hall which is usually the first point of contact for adult social care services is temporarily closed to help protect the vulnerable during the coronavirus (COVID-19) outbreak. Social Services in Manchester MisterWhat has found 77 results for Social Services in Manchester . Social Service in Manchester on YP.com. This means: Category: Social Welfare Services. Counties with carehomes in the area of Salford City Council Social Services. Salford Area (44) News (0) & Events (0) Staff Profiles (0) Manchester Local Care Organisation services. For adult care information and advice go to Bury Adult care and support or phone 0161 253 5151. The Fed, Head Office: Heathlands Village, Prestwich, Manchester, M25 9SB l 0161 772 4800 Registered Charity No: 1117126 l Company Ltd by Guarantee: 5858766 Home The Social Development Clinic is a specialist referral service for the assessment and treatment of children with complex developmental disorders involving social impairment. MANCHESTER, NH Social Security Office located at 1100 ELM ST SUITE 201. Find Social Services in Manchester at Locallife.co.uk. Manchester Social Services . Social Anthropology. Apply for a needs assessment by social services through your local council - support, home care help, disability equipment, day centres, care homes Align health and social care systems to wider public services such as education, skills, work and housing. Social Security Administration Important Information Avoiding Coronavirus Scams-Tips form the FTC Grandparent Scam Contact Tracing Scams. Manchester Mental Health and Social Care Trust paid more than £7 million to private providers over this period. Find Social Service & Welfare Organisations near Gorton on Yell, get contact details, opening hours, directions and a service overview. This includes autism spectrum disorder but also problems of autism-like syndromes related to other specific genetic, neurodevelopmental and attachment disorders. Tameside Family Link Scheme . The Manchester Child Support & Social Service Office, located in Manchester, CT, is a government agency that oversees local child support enforcement. We are part NHS and part local authority, working together as one team to provide better care to you. Contact adult social care If you need more support than your friends and family can give you, or you want information and advice about care and support, Adult Social Care may be able to help. That's why our NHS organisations and councils signed an historic devolution deal with the government. Manchester Social Services is in Stockport Road 523 Stockport Road. Find phone numbers, addresses, maps, postcodes, website, contact details and other useful information. Manchester, CT DSS Office - Welfare Office. The app brings to market for the first time a new and powerful way to find and apply for the right job for you, with over 200,000 jobs from the UK's top employers. These pages tell you how Adult Social Care finds out about your needs and arrange care and support services. Everyone in Greater Manchester deserves to live well. To test and evaluate the 'focused care' approach model in a number of deprived practices The Hub is delivered by Gaddum which aims to strengthen the voice of Manchester citizens through the promotion, delivery and understanding of advocacy. Adult and children social care services. An appointment is not required, but if you contact the office and schedule, it may reduce the time you spend waiting to apply. Apply now. 699 Middle Turnpike East Manchester, CT - 06040 855-626-6632 DSS Office hours are Monday through Friday between 8:00 a.m. and 4:30 p.m. 1 Reviews Leave a review Connecticut State Department of Social Services **The DSS Field Offices will be closed Monday, January 18 ... Manchester, CT 06045. Manchester Senior Services Department assist residents who are 60 years of age or older with Information & Assistance on a wide range of programs on the Local, County and State level. Social Services in Leigh - Greater Manchester - Phone Number, Map, Postcode, Address of Firms, Companies, Shops, Small Businesses, Professionals, Organisations - MisterWhat For emergency help out of normal office hours we have an Out of Hours Service staffed by people with a good working knowledge and understanding of health and social care services. 11/16/2020 Social Statistics. 5th Floor Barnett House 53 Fountain Street Address: Harpurhey District Centre, 6 Moston Lane, Manchester, Greater Manchester, M9 4DD. View all services in Adults Care & Support Having taken charge of our own health and social care spending, we're now working together to improve the health, wealth and wellbeing of the 2.8 million people living here. The Social Security Office in Manchester, New Hampshire address is: Suite 201, 1100 Elm St 03101, Manchester, New Hampshire. Search for Social Service & Welfare Organisations near … See reviews, photos, directions, phone numbers and more for Department Of Social Services locations in Manchester, KY. ... All paper copies can be faxed to fax number 0161 205 3649. Report a problem with this listing . Information and advice on adult care and support in … Following pandemic safety guidelines and to maintain safe social distancing, a limited number of people are allowed in the building at any one time. Manchester Senior, Adult and Family Services works to improve the quality of life and help maintain the independence of Manchester residents by offering information, referral, outreach, advocacy, assessment of needs and individual consultation on human services … This website brings together information for the wider our Manchester community – adults, children, young people and their families; the practitioners and volunteers … Contact our support services. Districts with carehomes in the area of Salford City Council Social Services. Greater Manchester. Integrated Services for Children with Additional Needs (ISCAN) Children's Social Care Teams . The Manchester Safeguarding Partnership is made up of organisations that work together to safeguard and promote the welfare of adults, children, young people and their families across the city of Manchester.. Make sure services are clinically safe throughout. North Manchester Community Services. Social Care Services . Phones, emails and other communication will continue to be monitored and responded to. The UK's No.1 job site is taking the pain out of looking for a job. Welcome to Manchester Local Care Organisation. Create a financially balanced and sustainable system. Manchester School of Art Chatham Building, Cavendish Street, Manchester M15 6BR Phone: +44 (0)161 247 1751. Manchester Social Services. SSA hours, address, phone number, SSI, SSDI, Disability, Retirement, SSN, Social Security Card & replacement Medicare and more. Below is a list of some of our main support services. Message now. Online listing of Manchester Social Services. If you are concerned about the welfare of someone who may be at risk or harm, please call Manchester City Council's Contact service on 0161 234 5001. If you have an enquiry but do not know which service you need, please visit our main contacts page: Contact us; The Careers Service. Greater Manchester Fire and Rescue Service; 5. We are the organisation that runs NHS community health and adult social care services in the city. manner across Greater Manchester to improve oral health and reduce treatment costs within 3-5 years . Ambulance service; 2. In areas such financial planning, keeping fit, health conditions and adult social care. The new CASS service is the first phase of work to transform community based health and social care services and incorporates existing services from Pennine Acute Hospital Trust Community and Manchester City Council. Email: dagme.tesfaye@manchester.ac.uk Tel: +44 (0)161 275 2499. If you would like a list of other social services office & administration listings throughout Manchester, please visit the Social Services section of this website. Households and individuals who wish to apply for SNAP (Food Stamps), Medicaid for the Aged/Blind/Disabled (HUSKY C), Medicaid for Employees with Disabilities (MED-Connect), … The Manchester Advocacy Hub (known as Gaddum Advocacy) was established in April 2015 and brings together all statutory advocacy provision in Manchester. Kellie Jordan Undergraduate Administrator Email: kellie.jordan@manchester.ac.uk Tel: +44 (0)161 275 4000. You can view a list of neighbouring businesses by going to the Stockport Road page. Tameside Service Information Directory . Under Connecticut law, the Child Support Office ensures that children receive support from their non-custodial parent. Christopher Ashworth Course Unit Administrator Email: christopher.ashworth@manchester.ac.uk Tel: +44 (0)161 275 7129. Find your perfect Social-Care role in Manchester on reed.co.uk. Between 2010 and 2015 there was a 5.9% cut in the number of mental health beds from 1,491 to 1,403. Manchester Fashion Institute Righton Building, Cavendish St, Manchester M15 6BG Phone: +44 (0)161 247 2747 Harpurhey Social Services. See reviews, photos, directions, phone numbers and more for the best Social Service Organizations in Manchester, CT. Contact Us » Health Programs and Social Work Services Senior Center: If you are in need of assistance please call the Senior Center at 860-647-3211 Office will be staffed during normal hours. The Department of Social Services will convene the first meeting of the Advisory Board for Transparency on Medicaid Cost and Quality on Tuesday, January 12, 2021, from 11 a.m. to 12:30 p.m. 12/1/2020. Visit Website View Phone Number Call Jobs. Young Carers . Live Well To build and test an approach to work and health that improves the integration and alignment of health, employment and other services . Address: Harpuhey District Centre, 25 Rochdale Road, Manchester, Greater Manchester, M4 4HT Find 11 listings related to Department Of Social Services in Manchester on YP.com. The objectives of Greater Manchester Health and Social Care Partnership are to: Transform the health and social care system. Organisation that runs NHS community health and Social care systems to wider Public Services such as education,,! As one team to provide better care to you Manchester Mental health beds 1,491! Such as education, skills, work and housing Office hours are Monday through between... 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manchester social services number 2021


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Scaleup Finance Secures $8 Million in Seed Round
by Kay Aloha Villamor in Seed Round January 24th, 2023
Scaleup Finance, a London, UK-based financial management for next-generation founders, secured $8 million (£6.4m) in seed funding to bring its "digital CFO" platform to the UK.
The round was led by the British venture fund PROfounders, with participation from FinVC, Clocktower VC, CircleRock Capital, and several angel investors.
The funding round will support Scaleup Finance's expansion in the UK market, where it will provide its subscription-based platform that automates company finance management.
"Having worked with more than 500 fast-growing companies in recent years, I've seen the majority of them struggle to prepare realistic financial models and handle general financial management tasks, especially during their first years," said Charlie Robinson, managing director UK at Scaleup Finance.
Scaleup Finance's digital CFO platform handles reporting, budgeting, financial modeling, and bookkeeping.
Company: Scaleup Finance ApS
Raised: $8.0M
Round: Seed Round
Lead Investors: PROfounders
Additional Investors: FinVC, Clocktower VC, and CircleRock Capital
Company Website: https://www.scaleup.finance/
Software Category: Financial Management
About the Company: Founded in 2021, Scaleup Finance is a subscription-based financial management platform designed to improve the management and administration of financial operations. The company provides CFO-as-a-service and a new digital CXO cockpit that will transform financial management in small companies, enabling businesses to improve their financial management and administration. Scaleup Finance has more than 150 companies using its software, employs 70 people, and has established a London office. It is on a mission to help next-generation founders take their finances to the next level.
Source: https://www.uktech.news/fintech/scaleup-finance-record-danish-seed-round-uk-move-20230123
Quindar Raises $2.5 Million in Seed Round
Convey911 Closes Seed Funding Round
Adverank Secures $1 Million in Seed Round
Eazy Digital Raises $850,000 in Seed Round


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Project Scorpio is now officially 'Xbox One X'; coming in November, priced at $499
By Usama Jawad Neowin @@UsamaJawad96 · Jun 11, 2017 17:09 EDT · Hot! with 66 comments
The day is finally here. At its E3 2017 press briefing today, Microsoft has officially revealed the "most powerful console ever", that was until recently, known by its code-name, "Project Scorpio". The company has now announced that its latest console will be called "Xbox One X", and will be available worldwide on November 7.
As Microsoft revealed at its E3 event last year, the Xbox One X is designed for hardcore gamers, with a focus on VR, "true 4K gaming", and cutting-edge performance. The console is powered by 6 teraflops of power and an octa-core processor. Moreover, it also supports Xbox One and backward compatible Xbox 360 games, offering a significant performance boost to all existing games, and bringing a substantial improvement in visual quality, without requiring developers to customize their games to take advantage of those enhancements.
As revealed previously, key specifications of the Xbox One X include eight custom x86 cores clocked at 2.3GHz - which are reportedly 31% faster than the ones in the Xbox One. Additionally, it packs 12GB of GDDR5 RAM, of which 9GB is dedicated to games so that they can run smoothly. The console also boasts a custom-designed GPU with 6 teraflops of power, a 1TB hard drive, HDMI 2.0, and a 4K Ultra HD Blu-ray drive, similar to the one present in the Xbox One S.
Microsoft has stated that this is the smallest Xbox device that it has ever built, and is the first console to utilize a liquid cooled vapor chamber for maximum power and efficiency. Titles such as Forza Motorsport 7, which utilize Xbox One X' capabilities will be published under the "Xbox One X Enhanced" branding.
The Xbox One X will be available starting in November 7 with an accompanying price tag of $499.
Xbox scorpio
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14 hours ago with 0 comments
A Plague Tale, Children of Morta, and Gris coming to Xbox Game Pass for PC
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← This week in the War, 7–13 May 1945: VE-Day!
This week in the war, on 15 May 1945, Burmese revolutionary leader Aung San—who had previously sided with the Japanese—offered to help the British. The British welcomed him.
Originally a communist, he changed to being a social democrat and later became Premier of the British Crown Colony of Burma.
He dedicated his life to fighting for Burma's independence but was assassinated several months before his country achieved self-rule.
His daughter, Aung San Suu Kyi, would follow in her father's footsteps, suffering persecution (including 15 years of house arrest) as an advocate of democracy.
She would go on to win the Nobel Prize for Peace and become her country's head of state as First State Counsellor of Myanmar (Burma).
This entry was posted in World War II and tagged Aung San, Aung San Suu Kyi, Burma. Bookmark the permalink.


Alexandra Davis, was born in England and raised in Jamaica, where she attended Mico Practicing All Age School, Wolmer's Girls' High School and the University of the West Indies (UWI) obtaining her BSc. Degree at their Mona campus.
She is a mother to her only child, Dr. Chevone Davis-Raglan who she raised as a single parent. He attended Miramar public schools and went on to study Pharmacy at FAMU's historically black college.
Alexandra Davis was raised by her mother, a New Testament Church of God Minister in Jamaica and credits her religious upbringing by her strong mother, who was a dynamic leader amongst her mainly male peers, for propelling her into public service and civic leadership.
She has spent most of her life in public service having worked for the Ministry of Agriculture in Kingston, Jamaica, The Capital Taxes office in London, England and Miami-Dade County Government here in Florida.
Over the years, she has served on various Miramar boards including the Planning and Zoning Board, the Community Services Board and the Education Board. In 2010, she ran for the office of Miramar City Commission, following her passion of public service. From a field of six other qualified candidates she was victorious and was sworn in as a City Commissioner in November 2010.
Alexandra is an educator who taught at Perry Middle and Somerset Academy as well as a business owner of a non profit 501(C)(3) called Caribbean American Teachers Assoc of Florida.
Formed a "League of Clergy" where she met with area ministers of religion on a bimonthly basis, to discuss the many concerns of their parishioners and to bring programs and guest speakers to the clergy.
Proposed a resolution to support First Lady Michelle Obama's "Let's Move", initiative to combat childhood obesity and promote healthy eating and exercise.
Partnered with the non-profit group "Empowering Children and Families" to provide turkey baskets to needy seniors during Thanksgiving and provide toys for children during Christmas.
Created the Code Ranger Program which trains citizens to recognize simple code violations and assist code compliance officers in performing their duty of maintaining the City's standards of beauty and cleanliness.
Proposed the redevelopment of portions of Historic Miramar by championing the building of a community band-shell and police substation in the older neighborhood.
Removed guns from the streets by partnering with the Broward Sherriff's Office and the City of West Park by implementing a gun buyback program in Miramar.
Developed the City's first Youth Apprenticeship Program to train and hire high school graduates in various trades/skills within City government.
Created the first Black History event which is now celebrated annual every February in the City and also created the first Caribbean Heritage event in the City, celebrated each June.
To speed up the redevelopment efforts of our Historic neighborhoods.
To expand the youth apprenticeship program and create other programs that will bring more jobs and job training to our residents.
To continue the push to keep taxes low by looking at renewable energy such as solar for City facilities, as well as researching innovative ways to generate income from our many assets.
To continue my work with the League of Clergy to provide outreach services to our community and receive community feedback.
To push for our Police to be equipped with Body Cameras to ensure transparency as well as accountability, building trust and credibility between law enforcement and our community.
To insist that all our schools, traditional and charter have the appropriate number of School Resource Officers (SROs) to protect our students.
To increase the amount of City contracts being given to minority owned businesses, putting Miramar First!
To improve our parks to include a dog park and a skate park as well as the upgrade our eastern parks with picnic pavilions, walk trails and exercise stations.
Alexandra has been on the Board of Directors for the Broward League of Cities, a Board member on the Broward County's Resource Recovery Board and a member on the National League of Cities Energy, Environment & Natural Resources Steering Committee. In addition she has been a member of Women in Municipal Government(WIMG).
She is currently founder and member of the Caribbean American Teachers Association of Florida(CATAF), a member of NAACP and Broward Black Elected Officials(BBEO). She is also a member of the League of Women Voters of Broward County(LWV).
Use the form below to send us a message. Someone will be in touch within 24 hours.
Please use the PayPal payment option above to make a contribution to my campaign.


React image gallery is a React component for building image galleries and carousels.
A function that will be called upon bullet click.
A percentage of how far the offset of the current slide is swiped to trigger a slide event.
e.g. If the current slide is swiped less than 30% to the left or right, it will not trigger a slide event.
Automatically calls stopPropagation on all 'swipe' events.
Additional class that will be added to the root node of the component.
Tools for developing, documenting, and testing React component libraries.
An image that is responsive to its width on the screen (can be also a background image) Works with retina displays.


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In which year did India won T20 World Cup?
How many times has India won the T20 World Cup?
Who won 2018 T20 World Cup?
Is India won T20 World Cup?
Which team won most T20 matches?
Who won 2017 T20?
Who won the T20 World Cup in 2012?
Is India out of World Cup 2021?
Who won most Champions Trophy?
Which is the highest ODI score?
Who scored most 100 in T20?
FTX By the Numbers Share URL Copied
Most men's World Cup titles
6 Australia T20 WC 2021 and CWC 2015, 2007, 2003, 1999, 1987
4 West Indies T20WC 2016, 2012 and CWC 1979, 1975
3 India T20WC 2007 and CWC 2011, 1983
History of Women's T20 World Cup: A Complete List
2016 West Indies West Indies won by 8 wickets
2018 Australia Australia won by 8 wickets
2020 Australia Australia won by 85 runs
2022 – –
India won the match against arch-rivals Pakistan by five runs at The Wanderers in Johannesburg, South Africa. The victory was significant as it was Indian cricket team's first major limited-overs' trophy since India's 1983 World Cup victory. India won the toss and opted to bat first.
Sri Lanka has won the most number of matches in T20 WC at 22, while Bangladesh has lost the most number of T20 WC matches at 19. 8. Sri Lanka is also the first team to have played in three T20 World Cup finals.
THIS IS INTERESTING: Why is Delhi so good?
2017 Blind T20 World Cup
30 January 2017 – 12 February 2017
Champions India (2nd title)
Runners-up Pakistan
Player of the series Suranga Sampath
India won the tournament, defeating Sri Lanka by 6 wickets in the final at Wankhede Stadium in Mumbai, thus becoming the first country to win the Cricket World Cup final on home soil. India's Yuvraj Singh was declared the man of the tournament.
T20 World Cup 2021: India out of semifinal race as New Zealand beat Afghanistan by 8 wickets.
Pakistan national cricket team
Чемпионс Трофи/Действующие чемпионы
Искать: Who won most Champions Trophy?
Has Pakistan won the World Cup?
In 2007 Australia became the first team to win three consecutive World Cup tournaments.
Cricket World Cup.
In November 2014, India's Rohit Sharma broke the record for the highest individual score in a One Day International cricket match. The opener scored an astonishing 264 runs of 173 balls against Sri Lanka in Kolkata.
Top 10 Batsmen With Most Centuries In T20 International Cricket
01 Rohit Sharma (IND) 04
02 Colin Munro (NZ) 03
03 Evin Lewis (WI) 02
04 KL Rahul (IND) 02


Eric has been studying Gojuryu Karate under Andrew Au Sensei since 2003 and he was been teaching Gojuryu Karate to children for more than 8 years. Eric is a full time coach and holds a Level 2 Hong Kong Coaching Committee Coach Accreditation Card. He specialises in self-discipline development and physical training for children.


Verification is essentially a review process to confirm that the information provided on the FAFSA is accurate. Students are selected for verification either by the US Department of Education or the institution. Please note that if selected, as the student you are responsible for providing the necessary documentation to verify your FAFSA. Verification must be completed before your financial aid can be processed.
What is needed to complete verification?
Completed Verification Worksheet – you will receive a copy by mail or by email from the Office of Financial Aid. If you need another copy of the worksheet, feel free to email finaid@brynathyn.edu or call us at 267-502-6000.
PLEASE NOTE: STUDENTS COMPLETING VERIFICATION FOR THE 2016/17 SCHOOL YEAR WILL NEED TO VERIFY 2015 TAX INFORMATION.
Please view the instructionsopens in a new window for using the IRS Data Retrieval Tool. The IRS Data Retrieval Tool is the easiest and fastest way to document tax information for verification as it pulls tax information from the IRS directly into your FAFSA. Generally the IRS Data Retrieval Tool is available 2-3 weeks after the electronic tax return has been accepted by the IRS. If a paper return was filed, it is generally available 8-11 weeks after the tax return was accepted by the IRS.
To request tax return transcripts by mail please go to the following webpage: http://www.irs.gov/Individuals/Get-Transcriptopens in a new window. You can also request tax return transcripts by phone by calling 1-800-908-9946.
Please use the Social Security Number (SSN) and date of birth for the first person listed on the return. Please also enter the address exactly as it is written on the actual tax return.
The transcript will be sent to the tax filer's home address approximately 5-10 days after it has been requested.
The Office of Financial Aid may require additional documentation in order to complete verification but will follow up with students on an individual basis. As a financial aid office, we must document everything thoroughly, in order to comply with federal regulations.
Where do I send verification documentation?
Please do not send verification documents via email due to the risk of identity theft.


Black Friday is tipped to rake in record sales for Amazon and a number of other online stores. There are also lots of heavily discounted items available in physical stores up and down the country.
IBTimes UK decided to take a look at some of the best deals and give you a handy guide to opening hours at some of the biggest stores.
For the best deals, click on the links.
Asda stores nationwide will be opening at 0800 GMT on 28 November.
Most Tesco stores are 24 hours so discounts will start at midnight on 28 November.
Black Friday discounts will hit 485 stores across the UK on 28 November.
However, Sainsbury's Black Friday sale starts at 0100 GMT at 24-hour stores.
On 27 November at 1800 GMT, GAME will start hourly deals, ahead of the midnight opening of stores across the country tonight.
Stores will open at 0800 GMT on 28 November.
The group's flagship Oxford Street store in West London will remain open until 2200 GMT.
The Black Friday sale will be officially announced at 0100 GMT on 28 November. While shops will be opening at normal times, Argos is encouraging customers to buy their products online.
For more information and real time updates, check out our live blog.


Pewter music box with a cute little bear reading to the animals of the forest. Just turn a few times on base to play song. It will add a decorative touch to any child's room and should be played daily to induce a feeling of gentle tranquility as it plays "Hush Little Baby Don't You Cry". One of our best selling items!
Size: 3.25 x 2.75 x 2.75 in.


Elton, welcome to the Canvas Community! From what you posted it sounds like you have course specific questions. Where you've posted your question though is the global Community of all Canvas users. For course specific questions you should contact your Instructor. If you're not sure how to do this, then try checking the course syllabus or using the Canvas Inbox.
Good luck getting Powersim downloaded!


How does blue ocean strategy fundamentally differ from red ocean strategy?
Kim & Mauborgne: To sustain themselves in the marketplace, red ocean strategists focus on building advantages over the competition, usually by assessing what competitors do and striving to do it better. Here, grabbing a bigger share of a finite market is seen as a zero-sum game in which one company's gain is achieved at another company's loss. They focus on dividing up the red ocean, where growth is increasingly limited. Such strategic thinking leads firms to divide industries into attractive and unattractive ones and to decide accordingly whether or not to enter.
Blue ocean strategists recognize that market boundaries exist only in managers' minds, and they do not let existing market structures limit their thinking. To them, extra demand is out there, largely untapped. The crux of the problem is how to create it. This, in turn, requires a shift of attention from supply to demand, from a focus on competing to a focus on creating innovative value to unlock new demand. This is achieved via the simultaneous pursuit of differentiation and low cost.
Under blue ocean strategy, there is scarcely an attractive or unattractive industry per se because the level of industry attractiveness can be altered through companies' conscientious efforts. As market structure is changed by breaking the value/cost trade-off, so are the rules of the game. Competition in the old game is therefore rendered irrelevant. By expanding the demand side of the economy new wealth is created. Such a strategy therefore allows firms to largely play a non–zero-sum game, with high payoff possibilities.


text:
Sarri on the topic of 'dismantling Napoli': I do not want to answer De Laurentiis any more."
New Chelsea head coach gave a press conference after his debut friendly victory over Perth Glory, as the Blues secured a 1-0 victory over the Australian side. Former Napoli midfielder Jorginho made his debut, impressing with a strong passing performance in the middle.
When asked on the topic of 'dismantling Napoli', after accusations from the Naples-based President that Sarri was attempting to break down the status quo at the Serie A club, Sarri said:
"I believe that Chelsea players are very strong, I have to thank those of Napoli because if I'm here it's because of them, but at the moment I'm happy with my players and I do not want to answer De Laurentiis any more."
Sarri is evidently tired of De Laurentiis' below the belt attempts to unsettle the coach and his new team, wishing to instead focus on the season ahead instead of meaningless disputes with former bosses.
For more news, views and features, visit our homepage.
@snhw_
Chelsea reject offer from Barcelona for Manchester United target
Barcelona initiate telephone contact with agents of Chelsea star
Exclusive: Juventus, new offer from Dortmund for Chelsea target
Mbappe hints at PSG move for Chelsea star


As the most established independent music shop in southern New England, The Symphony Music Shop can offer musicians a greater variety of musical equipment, products, and accessories. Unlike the music chain stores, The Symphony Music Shop isn't locked into a price structure and a fixed line of products. The result is the ability to carry the best musical products at the best prices.
Many southeastern MA musicians are genuinely surprised that The Symphony Music Shop consistently has lower prices than the Boston MA and Providence RI music stores. The selection of name brand musical instruments and music equipment and accessories is equally as impressive. The Symphony Music Shop also has over 10,000 sheet music titles in stock and offers discounts to music teachers on sheet music.
Staffed by seasoned professionals (who are musicians themselves), The Symphony Music Shop has a well-deserved reputation for expert product knowledge and friendly, personable customer service. Musical beginners and professional musicians alike can depend on the staff of The Symphony Music Shop for reliable advice on the best choice of instrument or music product for each unique situation.
The Symphony Music Shop also boasts a roster of southern New England's top professionally trained music instructors. Music instruction is offered in: Violin, Viola, Flute, Clarinet, Saxophone, Trumpet, Drums, Percussion, Guitar, Bass Guitar, Piano, Banjo, and Voice. Since 1962, The Symphony Music Shop is proud to have trained thousands of musicians.


As of November 26, School Nutrition is implementing a change in their charging procedure.
If your child owes $10.00 or more, they will be given a Wowbutter & Jelly Sandwich and a Milk for Lunch and a Cereal and a milk for Breakfast until their debt is paid in full. Middle/High Schools will not be able to charge for Ala Carte items as well.
Free/Reduced forms are available at your child's office or by contacting me at cmichaud@kidsrsu.org or 207-622-6351 ext. 498. I will also make myself available to anyone who needs assistance filling the forms out. The are very confidential as I am the only one who sees them for processing. They can b e sent to me through email or directly at RSU 2 Central Office, 7 Reed St. Hallowell, ME 04347.
I also encourage parents to sign up for account access through http:www.myschoolbucks.com They will be able to see what their child eats, what is on the account for funds, set up alerts for when funds are low, or they can put money directly into the account on line if you so chose. There is a fee, however, this year there is an option for a one time only annual fee. Even if you chose not to add funds on line, set up the account anyway for access to charges and alerts for your convenience.


Credit Suisse Group announces that Christoph G. Meier will be starting as Global Head of Media Relations on July 15, 2015.
Christoph G. Meier will join Credit Suisse from Lombard Odier Group in Geneva, where he is Head of Communications. Until March 2014, he worked at UBS for 17 years, where he held various senior communications positions and last served as Head of Corporate Communications for UBS Wealth Management globally and for the Group in EMEA.
Christoph G. Meier will take up his new position at Credit Suisse on July 15, 2015 and will be based in Zurich. In his role as Global Head of Media Relations, he will report directly to Clarissa Haller, Head of Corporate Communications.
Disclaimer This document was produced by and the opinions expressed are those of Credit Suisse as of the date of writing and are subject to change. It has been prepared solely for information purposes and for the use of the recipient. It does not constitute an offer or an invitation by or on behalf of Credit Suisse to any person to buy or sell any security. Any reference to past performance is not necessarily a guide to the future. The information and analysis contained in this publication have been compiled or arrived at from sources believed to be reliable but Credit Suisse does not make any representation as to their accuracy or completeness and does not accept liability for any loss arising from the use hereof.


text:
next not applicable (animal) character >
< previous not applicable (animal) character
Religion: N.A.
Name: Isis
Publisher(s): Noodle Soup Productions
First Appearance: Batman: The Animated Series - Season 1, Episode 1 (5 Sep. 1992): "The Cat and the Claw: Part 1"
Creators: Bruce Timm, Eric Radomski, Sean Catherine Derek, Laren Bright, Richard Mueller, Jules Dennis, Kevin Altieri, Frank Welker (actress)
Owner: Catwoman
Occupation: pet
Location: Gotham City, USA
Species: cat
Note: Catwoman's favorite cat
Batman: The Animated Series - Season 1, Episode 1 (5 Sep. 1992): "The Cat and the Claw: Part 1"
Gotham Girls - Season 1, Episode 7 (14 Sep. 2000): "Precious Birthstones"
- http://dcanimated.wikia.com/wiki/Isis
- http://dcanimated.wikia.com/wiki/The_Cat_and_the_Claw
- http://www.imdb.com/title/tt0519626/


text:
Home › STAKES ARTICLES › Grade I › The Pegasus World Cup Turf Will Need a King
The Pegasus World Cup Turf Will Need a King
By nynlstables on January 25, 2023 • ( 0 )
The Pegasus World Cup Turf (Grade 1)- $1,000.000 Purse
GP- For Four Year Olds and Upward
One Mile and One Eighth on the Turf
This is an active weekend of racing throughout the virtual nation, with several tracks hosting races of considerable prestige and overall impact. There may be some debate over which track has the biggest races, but its being Pegasus weekend, GP certainly makes a very strong argument that they should be the first focal point. Here, we will look at the second biggest race on their Saturday card: The Pegasus World Cup Turf. Under its current name, this race has been run since 2019, and Lunar Blaze got the win for John Henry. Previously, the race was known as the GP Turf Handicap in as far as its schedule placement. In 2022, the purse for the race was moved up to $1,000.000, matching it with where the real-life race had been since 2020. That was won by Immoral and Mb Stables. That well accomplished gelding is still active, but after an allowance at GG, you have to wonder if he'll get back to this level. We have fourteen in this race, as expected, including four who ran in the BC Turf and three won ran in the BC Mile in November. Let's meet all of them now!
#1- Nevada Silver (Nakamura Stables, ridden by J Loveberry)- The gelding begins his five-year-old season after winning a pair of races in 2022. That was highlighted by the Grade 1 Makers Mark Mile in April and was a big reason why he was in the BC Turf. After running on the pace in that event, he faded to an eighth-place result, beaten by six lengths. He was back out there three weeks later for the Grade 2 Smith, placing fourth. While he's been good at those longer distances, and I think these eight- or nine-furlong races are in his wheelhouse a little more. You may recall that he was here last year for the PWC Turf and ran third. That time he had to break from post 11. No such issue here.
#2- Jakarta (Nakamura Stables, ridden by S X Bridgmohan)- four-year-old will be the year anniversary of Jakarta's private sale from Fractious to Nakamura Stables. $450.000 exchanged hands that day but Jakarta would make just slightly more than half that over the year. Fortunately, a lot of that came in his last two starts, a pair of runner ups out in California, so perhaps he is going to start making up for himself now as he hasn't won in the Nakamura silks yet. It's not too late for that to happen and this is a great race for that to start.
#3- Mickey (South Shore Stables, ridden by A R Rodriguez)- Winning a couple of prep races for the KYD would send him into all three of the TC races but for whatever reason, Mickey just didn't show up there. He bounced back immediately, however, capturing the BEL Derby. That sent him into the BC Turf, and in that he showed that he could show up in a big race, winning the race. Perhaps, he just wanted to be on the grass, a surface where he is 6-for-11. Last saw him in the Grade 2 Mathis Brothers Mile as a high weight, and he was not quite as sharp. It'll be interesting to see just how he begins his four year old campaign.
#4- Show Me How To Live (Mo Mentum Farm, ridden by F Geroux)- There has been plenty of life in this one ever since he was moved to the grass in June. He would first run second on yielding turf at LAD before breaking his maiden for $100.000 at SAR in July. He continued to run well at the Spa with an allowance win, and that moved him into stakes company. His last start was his biggest win to date, coming in the Grade 3 Commonwealth Turf at CD in late November. Since then, he has been gearing up for his four-year-old season, and regardless of how this race goes for him, he's a good one to watch going forward in this division.
#5- Devil Made Me Doit (Maxmillion Farm, ridden by G Corrales)- For his career, this gelding has won five of 20, but he was a little more impressive in 2021 than he was last year. In that season, he finished third in the BC Turf. Last year, he never really hit the same stride but at the same time, was not bad. It would be in his last start of the season where he picked up his lone win, coming in the Grade 2 Seabiscuit Handicap. Works look good, if not great, coming into this. May not be the name that grabs your attention the quickest here, but he may be poised for a strong run.
#6- Pxg (Mb Stables, ridden by M Franco)- Sometimes, a horse will get better with age, and for Pxg, there was no better year than his six-year-old campaign. He won five of seven over the year, including the KD Turf Sprint and the Shadwell Turf Mile. Only one race last year saw him fail to hit the board, but unfortunately for the trainer, that was the BC Mile. Surprisingly, he never got involved there. It's easier to forgive those race lines in a BC event, but when the age starts sneaking up there, you don't want to see that become a trend.
#7- Key Biscayne (TwinTowersRacing, ridden by A Beschizza)- After running second to Mickey in the BC Turf, Key Biscayne gets a chance at revenge on that one within this field. He's a lot older than Mickey, though, and really has more in common with Pxg. They are both seven-year-olds, and Key Biscayne will also say that he was at his best as a six-year-old. He won three times, including the Grade 2 Pan American and Grade 2 BEL Gold Cup. If you want a horse that's very consistent, Key Biscayne's not the safest option, as he has his duds from time to time, but he should still be a worthwhile pick.
#8- Ptyrannical (Arindel, ridden by E J Zayas)- A few months ago, Ptyrannical narrowly missed in the BC Mile, being involved in a tight photo for the victory, but being placed third. He went into that race off a win in the Grade 3 Mint Million, for its $1,000.000 purse. These results put him over $1,700.000 in career earnings, but more importantly, have him entering his five-year-old season on top of his game. Look for him, then, to be a lot better than he was when he was here for the PWC Turf last year, and we should be expecting to see him do good things in 2023.
#9- Contradiction (Aer Stables, ridden by E J Wilson)- After running fourth in the 2021 BC Classic, Contradiction was hoping to build on that in 2022, but got off to a very slow start. Graded stakes went by for this one, one after the other, with big nominations being paid for them and not even penny coming back in earnings. That streak only ended on the day after Christmas, and he needed to be dropped into the allowance ranks to do so. While he did win, it hasn't stopped the trainer from making a big change with Contradiction, moving him here for his turf debut. It's a tough way to do it!
#10- King Que Niagra (D J C Racing Stables, ridden by J Lezcano)- While this now six-year-old gelding is not one of the horses that ran in the BC last year, he was actually entered into the BC Turf and was scratched. That was a shame, because he was about as hot as one could be going into November, putting together a three-race winning streak that included the United Nations, Sword Dancer, and Hirsch Turf Classic. That's quite a roll! He would end up racing later in November but did it on the main track and failed to earn a check. Now, he's back on the turf for the first time since the Hirsch. Can be the same horse he was three and a half months ago?
#11- Boardwalk Empire (Smokey Stover, ridden by P Husbands)- This colt by Con Artist began to hit his peak over the summer last year, and would win the Grade 1 SAR Derby before a couple of strong third place finishes where he was within a length of the winner. Those races were the Grade 3 Dueling Grounds Derby and the Hirsch Turf Classic. In the BC Turf, he did not have one of his best starts, but has run twice since then, rebounding well. On New Year's Eve, he won the Grade 2 Ft Lauderdale Stakes, which is a nine-furlong race on the grass right here. Yes, this is a far superior field to that, but the 101 SRF that he earned that day cannot be overlooked.
#12- Lets Do It Big Boy (RNP Stables, ridden by T Conner)- Entering his nine-year-old season, this gelding has been doing a lot, and the results keep coming. In November, he was not only in the BC Mile, but finished second in the race, missing out in a photo to Great Bonkers. He went into that race off of back-to-back victories in the Fourstardave Handicap at SAR and the WO Mile at WO, so certainly he is not slowing down. This will be the fourth time that he runs in the PWC Turf as well, placing fourth in both 2019 and 2021 though was tenth last year. His January 7th work is good, don't get me wrong, but it's a little slower than his mile works in late 2022. Hopefully, that's just an aberration.
#13- Aerialist (Mb Stables, ridden by A Bocachica)- Here's another one that did some BC racing in November, and Aerialist would earn the third-place check for his efforts in the BC Turf. In all, it was year that saw four wins in eleven starts, highlighted by the $1,000.000 KD Turf Cup, where he took down his more well-known stablemate, Immoral, in the process. While he's taken a liking to the especially long distances, he can get results at nine furlongs as well. This is a good horse, but I sense that he could be lost in the shuffle a little bit with those he is running against.
#14- Moonlight Special (Allinthegate, ridden by J J Castellano)- They'll all be in the gate before this gelding is loaded into it, but that doesn't mean he doesn't have a chance. He is making a jump in class, though, as his stake experience has predominantly been in ungraded races. From time to time, he has appeared at the graded level, and comes here off a win in the Grade 3 River City Handicap. Never, has he seen a field close to this, but he has earned the right to take them on. The post will only add to the challenge and chance to impress.
Prediction: 10-3-8-6
‹ The Pegasus Sees HRP's Pegasus Looking to Take Another Step to Immortality
Srf Speed Figure Adjustment ›
Categories: Grade I, STAKES ARTICLES


Description: Has my adversary been practising a musical instrument instead of pursuing the investigation? Flinging darts at a cork board? Or just taking very long naps? Reports are inconsistent, but so is their behaviour. They've made no progress.


text:
Grups de Defensa de la Llengua (GDL) fou una organització d'activisme lingüístic i cultural català lligat a l'independentisme català, creada el 1982. Pretenia donar una resposta més compromesa en l'ús públic del català que la que, segons ells donava la Crida a la Solidaritat, ja que es comprometien més en la lluita política i les mobilitzacions independentistes. El nucli inicial era format per mestres i professors d'universitat com Enric Larreula, Blanca Serra i Puig, Carles Castellanos i Llorenç, Rafael Castellanos i Llorenç, Jordi Solé i Camardons, Josep Maria Nadal, Enric Montaner, Josepa Huguet, Josep Inglès, Montserrat Cassanyes, Maria Conca, Antoni Ibàñez, Francesc Moll i Montserrat Bayà. L'àrea d'influència inicial dels GDL fou el conjunt dels Països Catalans, amb nuclis especialment dinàmics al Barcelonès, el Vallès, Garraf-Penedès, Segarra-Urgell-Segrià i l'Horta de València.

Alguns dels seus membres van redactar el 1979 un manifest anomenat Una nació sense estat, un poble sense llengua, conegut també com a Manifest d'Els Marges, que era un crit d'alerta davant la política lingüística d'aleshores i els perills de desaparició del català. Molts dels seus membres s'acabaren integrant en el Moviment de Defensa de la Terra i cap al 1993 havia desaparegut. El seu testimoni fou aplegat per altres organitzacions com Llengua Nacional, Plataforma per la Llengua i la CAL (Coordinadora d'Associacions per la Llengua).

Referències

Enllaços externs
 L'evolució del Moviment de Lluita per la Llengua per Carles Castellanos.

Entitats independentistes catalanes
Organitzacions desaparegudes

redpajama_set_name: RedPajamaWikipedia


text:
Q: Python Mock class import error I'm trying to mock elasticsearch.Elasticsearch.indices.exists function in my Python test case, but I'm getting the following import error. However, mock just elasticsearch.Elasticsearch was working fine.
@ddt
class TestElasticSearchConnector(unittest.TestCase):

    @patch('elasticsearch.Elasticsearch.indices.exists')
    @patch('connectors.elastic_search_connector.ElasticSearchConnector._get_local_conn')
    def test_check_index(self, mock_es, _get_local_conn):
        mock_es = Mock()
        mock_es._index_exists = False
        mock_es.indices.exists.return_value = True
        mock_es.create.return_value = {'result': 'created'}

Getting the mock import error here
======================================================================
    ERROR: test_check_index (tests.base.TestESConnector)
    ----------------------------------------------------------------------
    Traceback (most recent call last):
      File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1197, in _dot_lookup
        return getattr(thing, comp)
    AttributeError: type object 'Elasticsearch' has no attribute 'indices'
During handling of the above exception, another exception occurred:

Traceback (most recent call last):
  File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1297, in patched
    arg = patching.__enter__()
  File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1353, in __enter__
    self.target = self.getter()
  File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1523, in <lambda>
    getter = lambda: _importer(target)
  File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1210, in _importer
    thing = _dot_lookup(thing, comp, import_path)
  File "/Users/user/.virtualenvs/my-prjlib/python3.6/site-packages/mock/mock.py", line 1199, in _dot_lookup
    __import__(import_path)
ModuleNotFoundError: No module named 'elasticsearch.Elasticsearch'

----------------------------------------------------------------------
Ran 1 test in 0.001s

FAILED (errors=1)

Test import
>>  user$ python
Python 3.6.1 (default, May 10 2017, 09:46:05)
[GCC 4.2.1 Compatible Apple LLVM 8.1.0 (clang-802.0.42)] on darwin
Type "help", "copyright", "credits" or "license" for more information.
>>> from elasticsearch import Elasticsearch
>>>
>>>

A: This is legitimately an error. When specifying an attribute/method to mock, it must exist on the object (in this case a class). Perhaps you were expecting this attribute to exist, but it only present on the instantiated object.
In [1]: from elasticsearch import Elasticsearch
In [2]: Elasticsearch.indices
---------------------------------------------------------------------------
AttributeError                            Traceback (most recent call last)
<ipython-input-2-313eaaedb2f6> in <module>()
----> 1 Elasticsearch.indices

Indeed, it exists on an instantiated object:
In [3]: Elasticsearch().indices
Out[3]: <elasticsearch.client.indices.IndicesClient at 0x102db0a90>

A: The Elasticserch library generates the indices attribute when you instantiante an Elasticsearch() object. And it does so using a class of the library called IndicesClient, and it is that class who has the exists method. Therefore, if you mock the response of that method of the IndicesClient class, you test should work.
Also, the input params of the function should be in reverse order with respoect of the decorators. If you put the indices.exists patch first, that should go second in the input to the function.
from elasticsearch.client import IndicesClient

@mock.patch.object(IndicesClient, 'exists')
@mock.patch('connectors.elastic_search_connector.ElasticSearchConnector._get_local_conn')
def test_check_index(self, mock_get_local_conn, mock_exists):
    mock_exists.return_value = True
    ...

redpajama_set_name: RedPajamaStackExchange