text:
class TabRestoreTest : public InProcessBrowserTest {
 public:
  TabRestoreTest() : InProcessBrowserTest() {
    url1_ = ui_test_utils::GetTestUrl(
        FilePath().AppendASCII("session_history"),
        FilePath().AppendASCII("bot1.html"));
    url2_ = ui_test_utils::GetTestUrl(
        FilePath().AppendASCII("session_history"),
        FilePath().AppendASCII("bot2.html"));
  }

 protected:
  Browser* GetBrowser(int index) {
    CHECK(static_cast<int>(BrowserList::size()) > index);
    return *(BrowserList::begin() + index);
  }

  // Adds tabs to the given browser, all navigated to url1_. Returns
  // the final number of tabs.
  int AddSomeTabs(Browser* browser, int how_many) {
    int starting_tab_count = browser->tab_count();

    for (int i = 0; i < how_many; ++i) {
      ui_test_utils::NavigateToURLWithDisposition(
          browser, url1_, NEW_FOREGROUND_TAB,
          ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
    }
    int tab_count = browser->tab_count();
    EXPECT_EQ(starting_tab_count + how_many, tab_count);
    return tab_count;
  }

  void CloseTab(int index) {
    content::WebContents* new_tab = chrome::GetWebContentsAt(browser(), index);
    content::WindowedNotificationObserver tab_close_observer(
        content::NOTIFICATION_WEB_CONTENTS_DESTROYED,
        content::NotificationService::AllSources());
    chrome::CloseWebContents(browser(), new_tab);
    tab_close_observer.Wait();
  }

  // Uses the undo-close-tab accelerator to undo a close-tab or close-window
  // operation. The newly restored tab is expected to appear in the
  // window at index |expected_window_index|, at the |expected_tabstrip_index|,
  // and to be active. If |expected_window_index| is equal to the number of
  // current windows, the restored tab is expected to be created in a new
  // window (since the index is 0-based).
  void RestoreTab(int expected_window_index,
                  int expected_tabstrip_index) {
    int window_count = static_cast<int>(BrowserList::size());
    ASSERT_GT(window_count, 0);

    bool expect_new_window = (expected_window_index == window_count);

    Browser* browser;
    if (expect_new_window) {
      browser = *(BrowserList::begin());
    } else {
      browser = GetBrowser(expected_window_index);
    }
    int tab_count = browser->tab_count();
    ASSERT_GT(tab_count, 0);

    // Restore the tab.
    content::WindowedNotificationObserver tab_added_observer(
        chrome::NOTIFICATION_TAB_PARENTED,
        content::NotificationService::AllSources());
    content::WindowedNotificationObserver tab_loaded_observer(
        content::NOTIFICATION_LOAD_STOP,
        content::NotificationService::AllSources());
    chrome::RestoreTab(browser);
    tab_added_observer.Wait();
    tab_loaded_observer.Wait();

    if (expect_new_window) {
      int new_window_count = static_cast<int>(BrowserList::size());
      EXPECT_EQ(++window_count, new_window_count);
      browser = GetBrowser(expected_window_index);
    } else {
      EXPECT_EQ(++tab_count, browser->tab_count());
    }

    // Get a handle to the restored tab.
    ASSERT_GT(browser->tab_count(), expected_tabstrip_index);

    // Ensure that the tab and window are active.
    EXPECT_EQ(expected_tabstrip_index, browser->active_index());
  }

  void GoBack(Browser* browser) {
    content::WindowedNotificationObserver observer(
        content::NOTIFICATION_LOAD_STOP,
        content::NotificationService::AllSources());
    chrome::GoBack(browser, CURRENT_TAB);
    observer.Wait();
  }

  void EnsureTabFinishedRestoring(content::WebContents* tab) {
    content::NavigationController* controller = &tab->GetController();
    if (!controller->NeedsReload() && !controller->GetPendingEntry() &&
        !controller->GetWebContents()->IsLoading())
      return;

    content::WindowedNotificationObserver observer(
        content::NOTIFICATION_LOAD_STOP,
        content::Source<content::NavigationController>(controller));
    observer.Wait();
  }

  GURL url1_;
  GURL url2_;

 private:
  DISALLOW_COPY_AND_ASSIGN(TabRestoreTest);
};

// Close the end tab in the current window, then restore it. The tab should be
// in its original position, and active.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, Basic) {
  int starting_tab_count = browser()->tab_count();
  int tab_count = AddSomeTabs(browser(), 1);

  int closed_tab_index = tab_count - 1;
  CloseTab(closed_tab_index);
  EXPECT_EQ(starting_tab_count, browser()->tab_count());

  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, closed_tab_index));

  // And make sure everything looks right.
  EXPECT_EQ(starting_tab_count + 1, browser()->tab_count());
  EXPECT_EQ(closed_tab_index, browser()->active_index());
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser())->GetURL());
}

// Close a tab not at the end of the current window, then restore it. The tab
// should be in its original position, and active.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, MiddleTab) {
  int starting_tab_count = browser()->tab_count();
  AddSomeTabs(browser(), 3);

  // Close one in the middle
  int closed_tab_index = starting_tab_count + 1;
  CloseTab(closed_tab_index);
  EXPECT_EQ(starting_tab_count + 2, browser()->tab_count());

  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, closed_tab_index));

  // And make sure everything looks right.
  EXPECT_EQ(starting_tab_count + 3, browser()->tab_count());
  EXPECT_EQ(closed_tab_index, browser()->active_index());
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser())->GetURL());
}

// Close a tab, switch windows, then restore the tab. The tab should be in its
// original window and position, and active.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreToDifferentWindow) {
  int starting_tab_count = browser()->tab_count();
  AddSomeTabs(browser(), 3);

  // Close one in the middle
  int closed_tab_index = starting_tab_count + 1;
  CloseTab(closed_tab_index);
  EXPECT_EQ(starting_tab_count + 2, browser()->tab_count());

  // Create a new browser.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUINewTabURL), NEW_WINDOW,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_BROWSER);
  EXPECT_EQ(2u, BrowserList::size());

  // Restore tab into original browser.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, closed_tab_index));

  // And make sure everything looks right.
  EXPECT_EQ(starting_tab_count + 3, browser()->tab_count());
  EXPECT_EQ(closed_tab_index, browser()->active_index());
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser())->GetURL());
}

// Close a tab, open a new window, close the first window, then restore the
// tab. It should be in a new window.
// If this becomes flaky, use http://crbug.com/14774
IN_PROC_BROWSER_TEST_F(TabRestoreTest, FLAKY_BasicRestoreFromClosedWindow) {
  // Navigate to url1 then url2.
  ui_test_utils::NavigateToURL(browser(), url1_);
  ui_test_utils::NavigateToURL(browser(), url2_);

  // Create a new browser.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUINewTabURL), NEW_WINDOW,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_BROWSER);
  EXPECT_EQ(2u, BrowserList::size());

  // Close the final tab in the first browser.
  content::WindowedNotificationObserver window_observer(
      chrome::NOTIFICATION_BROWSER_CLOSED,
      content::NotificationService::AllSources());
  CloseTab(0);
  window_observer.Wait();

  ASSERT_NO_FATAL_FAILURE(RestoreTab(1, 0));

  // Tab should be in a new window.
  Browser* browser = GetBrowser(1);
  content::WebContents* web_contents = chrome::GetActiveWebContents(browser);
  // And make sure the URLs matches.
  EXPECT_EQ(url2_, web_contents->GetURL());
  GoBack(browser);
  EXPECT_EQ(url1_, web_contents->GetURL());
}

// Restore a tab then make sure it doesn't restore again.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, DontLoadRestoredTab) {
  // Add two tabs
  int starting_tab_count = browser()->tab_count();
  AddSomeTabs(browser(), 2);
  ASSERT_EQ(browser()->tab_count(), starting_tab_count + 2);

  // Close one of them.
  CloseTab(0);
  ASSERT_EQ(browser()->tab_count(), starting_tab_count + 1);

  // Restore it.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, 0));
  ASSERT_EQ(browser()->tab_count(), starting_tab_count + 2);

  // Make sure that there's nothing else to restore.
  ASSERT_FALSE(chrome::CanRestoreTab(browser()));
}

// Open a window with multiple tabs, close a tab, then close the window.
// Restore both and make sure the tab goes back into the window.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreWindowAndTab) {
  int starting_tab_count = browser()->tab_count();
  AddSomeTabs(browser(), 3);

  // Close one in the middle
  int closed_tab_index = starting_tab_count + 1;
  CloseTab(closed_tab_index);
  EXPECT_EQ(starting_tab_count + 2, browser()->tab_count());

  // Create a new browser.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUINewTabURL), NEW_WINDOW,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_BROWSER);
  EXPECT_EQ(2u, BrowserList::size());

  // Close the first browser.
  content::WindowedNotificationObserver observer(
      chrome::NOTIFICATION_BROWSER_CLOSED,
      content::NotificationService::AllSources());
  chrome::CloseWindow(browser());
  observer.Wait();
  EXPECT_EQ(1u, BrowserList::size());

  // Restore the first window. The expected_tabstrip_index (second argument)
  // indicates the expected active tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(1, starting_tab_count + 1));
  Browser* browser = GetBrowser(1);
  EXPECT_EQ(starting_tab_count + 2, browser->tab_count());

  // Restore the closed tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(1, closed_tab_index));
  EXPECT_EQ(starting_tab_count + 3, browser->tab_count());
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser)->GetURL());
}

// Open a window with two tabs, close both (closing the window), then restore
// both. Make sure both restored tabs are in the same window.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreIntoSameWindow) {
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), url1_, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  // Navigate the rightmost one to url2_ for easier identification.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), url2_, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Create a new browser.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUINewTabURL), NEW_WINDOW,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_BROWSER);
  EXPECT_EQ(2u, BrowserList::size());

  // Close all but one tab in the first browser, left to right.
  while (browser()->tab_count() > 1)
    CloseTab(0);

  // Close the last tab, closing the browser.
  content::WindowedNotificationObserver observer(
      chrome::NOTIFICATION_BROWSER_CLOSED,
      content::NotificationService::AllSources());
  CloseTab(0);
  observer.Wait();
  EXPECT_EQ(1u, BrowserList::size());

  // Restore the last-closed tab into a new window.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(1, 0));
  Browser* browser = GetBrowser(1);
  EXPECT_EQ(1, browser->tab_count());
  EXPECT_EQ(url2_, chrome::GetActiveWebContents(browser)->GetURL());

  // Restore the next-to-last-closed tab into the same window.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(1, 0));
  EXPECT_EQ(2, browser->tab_count());
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser)->GetURL());
}

// Tests that a duplicate history entry is not created when we restore a page
// to an existing SiteInstance.  (Bug 1230446)
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreWithExistingSiteInstance) {
  ASSERT_TRUE(test_server()->Start());

  GURL http_url1(test_server()->GetURL("files/title1.html"));
  GURL http_url2(test_server()->GetURL("files/title2.html"));
  int tab_count = browser()->tab_count();

  // Add a tab
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url1, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  EXPECT_EQ(++tab_count, browser()->tab_count());

  // Navigate to another same-site URL.
  content::WebContents* tab =
      chrome::GetWebContentsAt(browser(), tab_count - 1);
  content::WindowedNotificationObserver observer(
      content::NOTIFICATION_LOAD_STOP,
      content::NotificationService::AllSources());
  static_cast<content::WebContentsDelegate*>(browser())->OpenURLFromTab(
      tab,
      content::OpenURLParams(http_url2, content::Referrer(), CURRENT_TAB,
                             content::PAGE_TRANSITION_TYPED, false));
  observer.Wait();

  // Close the tab.
  CloseTab(1);

  // Create a new tab to the original site.  Assuming process-per-site is
  // enabled, this will ensure that the SiteInstance used by the restored tab
  // will already exist when the restore happens.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url2, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Restore the closed tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, tab_count - 1));

  // And make sure the URLs match.
  EXPECT_EQ(http_url2, chrome::GetActiveWebContents(browser())->GetURL());
  GoBack(browser());
  EXPECT_EQ(http_url1, chrome::GetActiveWebContents(browser())->GetURL());
}

// Tests that the SiteInstances used for entries in a restored tab's history
// are given appropriate max page IDs, even if the renderer for the entry
// already exists.  (Bug 1204135)
IN_PROC_BROWSER_TEST_F(TabRestoreTest,
                       RestoreCrossSiteWithExistingSiteInstance) {
  ASSERT_TRUE(test_server()->Start());

  GURL http_url1(test_server()->GetURL("files/title1.html"));
  GURL http_url2(test_server()->GetURL("files/title2.html"));

  int tab_count = browser()->tab_count();

  // Add a tab
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url1, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  EXPECT_EQ(++tab_count, browser()->tab_count());

  // Navigate to more URLs, then a cross-site URL.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url2, CURRENT_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url1, CURRENT_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), url1_, CURRENT_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Close the tab.
  CloseTab(1);

  // Create a new tab to the original site.  Assuming process-per-site is
  // enabled, this will ensure that the SiteInstance will already exist when
  // the user clicks Back in the restored tab.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url2, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Restore the closed tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, tab_count - 1));

  // And make sure the URLs match.
  EXPECT_EQ(url1_, chrome::GetActiveWebContents(browser())->GetURL());
  GoBack(browser());
  EXPECT_EQ(http_url1, chrome::GetActiveWebContents(browser())->GetURL());

  // Navigating to a new URL should clear the forward list, because the max
  // page ID of the renderer should have been updated when we restored the tab.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), http_url2, CURRENT_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  EXPECT_FALSE(chrome::CanGoForward(browser()));
  EXPECT_EQ(http_url2, chrome::GetActiveWebContents(browser())->GetURL());
}

IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreWindow) {
  // Create a new window.
  size_t window_count = BrowserList::size();
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUINewTabURL), NEW_WINDOW,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_BROWSER);
  EXPECT_EQ(++window_count, BrowserList::size());

  // Create two more tabs, one with url1, the other url2.
  int initial_tab_count = browser()->tab_count();
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), url1_, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), url2_, NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Close the window.
  content::WindowedNotificationObserver close_window_observer(
      chrome::NOTIFICATION_BROWSER_CLOSED,
      content::NotificationService::AllSources());
  chrome::CloseWindow(browser());
  close_window_observer.Wait();
  EXPECT_EQ(window_count - 1, BrowserList::size());

  // Restore the window.
  content::WindowedNotificationObserver open_window_observer(
      chrome::NOTIFICATION_BROWSER_OPENED,
      content::NotificationService::AllSources());
  content::WindowedNotificationObserver load_stop_observer(
      content::NOTIFICATION_LOAD_STOP,
      content::NotificationService::AllSources());
  chrome::RestoreTab(*BrowserList::begin());
  open_window_observer.Wait();
  EXPECT_EQ(window_count, BrowserList::size());

  Browser* browser = GetBrowser(1);
  EXPECT_EQ(initial_tab_count + 2, browser->tab_count());
  load_stop_observer.Wait();

  content::WebContents* restored_tab =
      chrome::GetWebContentsAt(browser, initial_tab_count);
  EnsureTabFinishedRestoring(restored_tab);
  EXPECT_EQ(url1_, restored_tab->GetURL());

  restored_tab = chrome::GetWebContentsAt(browser, initial_tab_count + 1);
  EnsureTabFinishedRestoring(restored_tab);
  EXPECT_EQ(url2_, restored_tab->GetURL());
}

// Restore tab with special URL chrome://credits/ and make sure the page loads
// properly after restore. See http://crbug.com/31905.
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreTabWithSpecialURL) {
  // Navigate new tab to a special URL.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUICreditsURL), NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Close the tab.
  CloseTab(1);

  // Restore the closed tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, 1));
  content::WebContents* tab = chrome::GetWebContentsAt(browser(), 1);
  EnsureTabFinishedRestoring(tab);

  // See if content is as expected.
  EXPECT_GT(
      ui_test_utils::FindInPage(tab, ASCIIToUTF16("webkit"), true, false, NULL,
                                NULL),
      0);
}

// Restore tab with special URL in its navigation history, go back to that
// entry and see that it loads properly. See http://crbug.com/31905
IN_PROC_BROWSER_TEST_F(TabRestoreTest, RestoreTabWithSpecialURLOnBack) {
  ASSERT_TRUE(test_server()->Start());

  const GURL http_url(test_server()->GetURL("files/title1.html"));

  // Navigate new tab to a special URL.
  ui_test_utils::NavigateToURLWithDisposition(
      browser(), GURL(chrome::kChromeUICreditsURL), NEW_FOREGROUND_TAB,
      ui_test_utils::BROWSER_TEST_WAIT_FOR_NAVIGATION);

  // Then navigate to a normal URL.
  ui_test_utils::NavigateToURL(browser(), http_url);

  // Close the tab.
  CloseTab(1);

  // Restore the closed tab.
  ASSERT_NO_FATAL_FAILURE(RestoreTab(0, 1));
  content::WebContents* tab = chrome::GetWebContentsAt(browser(), 1);
  EnsureTabFinishedRestoring(tab);
  ASSERT_EQ(http_url, tab->GetURL());

  // Go back, and see if content is as expected.
  GoBack(browser());
  EXPECT_GT(
      ui_test_utils::FindInPage(tab, ASCIIToUTF16("webkit"), true, false, NULL,
                                NULL),
      0);
}


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Jack has a few things that, on the face of it, look like limitations. He hasn't been through the learning curve yet, so he's a little naïve. However this also means he isn't polluted by experience and a belief that 'this is the way things are done'. Jack's not weighed down by the baggage of history; for him everything is still possible. His devil-may-care, playful approach is a key ingredient to his resourcefulness, because when you feel like you're playing, you're actually feeding the creative side of your brain. Playing enables you to suspend the serious business of life, and gives you the freedom to look at things afresh.
Back in the day when Innocent smoothies first played at being Jack they had no money for advertising, so they used their packs instead. Specifically their back of pack labels, which, instead of just being used for the usual mandatories (the fruit drink establishment way) became the soapbox for the brand's attitude. So rather than have the same content on every pack, they were resourceful enough to plan their print runs to create a variety of labels for the different stories they wished to eulogise.
Likewise brand minnows The Saucy Fish Co. had to play like Jack. The big fish of the day like Young's and Birds Eye were the Leviathans, providing us Brits with our traditional fish fayre. How could The Saucy Fish Co. possibly compete? Well, they went to places the others didn't – the world of fresh not frozen—and they thought like a sauce company not just a fish company. Finally, they took the fear out of cooking what was thought to be expensive, difficult and smelly, and created a brand that was cool and contemporary, not traditional. That's why today, with £35 million in sales, a tiny fish company from Grimsby is rubbing shoulders with Facebook, Porsche and Selfridges after being short-listed as one of Britain's coolest brands.
Photo. The Saucy Fish Co.
Just because you've become successful doesn't mean that you can't think small again. It's hard, yes. You may need to challenge your existing business model, you may need to introduce a new complementary one, or you may just need to rekindle that old Jack spirit, much like serial sausage entrepreneurs Debbie and Andrew Keeble. Having set up a successful sausage business under their own names in 1999, the couple started all over again with a new range of bangers called Heck!
The original Debbie and Andrew's brand was the number one premium sausage in the UK when they sold it to a 'giant', but the partnership didn't work out. Hence the parting of ways and the new brand Heck! The brand is named after one of Debbie and Andrew's mantras: whenever they faced a difficult risk-and-reward business decision they'd take a moment to look at each other and say 'what the heck!' It's the sort of courageous attitude that's resulted in Heck! out-selling Debbie and Andrew's, even at their peak. The brand, much like The Saucy Fish Co., isn't afraid to break the mould. Having previously led the premium sausage pack with a personality brand—establishing black as the category signpost – with Heck! they took a completely different approach.
Bold pastels block merchandise on shelf to provide a stark to the sea of black. There's a no-nonsense simplicity that provides authenticity (reassuring considering recent food scares), whilst the name itself confidently talks about the family's attitude to big business, preferring to stay true to their own recipes, ideas and integrity.
Another way to get in touch with the Jack inside comes from multinational Diageo, who've created Distill Ventures as a way to explore its own business model, without necessarily messing up the giant's day to day work. According to Diageo it's 'the world's first accelerator dedicated to new and growing premium spirits brands.' The venture is a collaboration with innovation specialist Independents United, and takes a sort of Dragon's Den approach to investing in up and coming entrepreneurial drinks ideas. Diageo put in money, advice and expertise, and in return get an insight into what's coming down the tracks drinks-wise, plus first dibs on the right to buy the whole business at a defined point in the future.
So are you Jack or the giant? Where are you on the Sigmoid curve? And do you have everything or nothing to lose? Most importantly, what (the heck) are you going to do about it?
Greg Taylor became founding partner in global brand design consultancy Elmwood in 1989. Now Director of Brand Provocation, Greg is the creator and facilitator of Step Change™, Elmwood's strategic tool for moving ideas forward. Clients include ASDA, Wal-Mart, Arla Foods, BBC, COI (Defra and DfT), Cable&Wireless, Comic Relief, Debbie & Andrew's, Durex, Glasgow 2014 Commonwealth Games, McCain, and the Met Office.
Posted in Opinion and tagged branding, challenger brands. Bookmark the permalink.


A mix of lists and long-form thoughts. Mostly relating to design but often an outlet for ongoing existential crisis. This page is updated irregularly as blogging is definitely not my passion. For new and regular content, please subscribe to my weekly newsletter.
I've shared a bunch of design podcasts before, but this time I thought I'd mix it up and also include a few that may not have anything directly to do with design.
It would appear podcasts are the new blog, and my ear buds could not be happier! With so many great podcasts popping up in the last year (and discovering some oldies), I thought it was time to update my list.
I was super excited when Kate asked me to be her first guest on her new podcast. Playing It By Ear is a series of conversations to learn more about each other, outside of what we do to pay our rent.


text:
The Hypnotist
Flying Phobia Hypnosis - Hypnosis for Aerophobia
Adam works with a man that had a phobia of flying and was scheduled to catch a flight just a few hours after this session. Adam identifies the thoughts required for him to feel anxious which was either the thought of being on the plane combined with an idea that this was undesirable and that a threat was possible or imminent.
Adam creates a hypnosis session that enabled him to reverse the very first time he had anxiety on a plane and accessed the resources from a time in his life that he could fly without anxiety. This will be useful for those that are afraid to fly especially if you're just about to catch a flight.
Adam Cox is one of the world's most innovative hypnotists and is known for being the hypnotherapist of choice for Celebrities, CEO's and even Royalty.
You can contact Adam at adam@adamcox.co.uk
Find Adam on Instagram at: https://www.instagram.com/adamcoxofficial/
For information on Adam go to https://www.adamcox.co.uk/
To book a free 30-minute consultation call to consider working with Adam go to: https://go.oncehub.com/AdamCox
To hear Adam's podcast The Hypnotist on Spotify and iTunes visit: http://link.chtbl.com/TheHypnotist
To hear Adam's podcast Modern Mindset on Spotify and iTunes visit: https://link.chtbl.com/ModernMindset
The Hypnotist is a show that gives you inside access to cutting edge hypnosis, with real clients, facing genuine issues. Brought to you by the hypnotherapist demanded by Celebrities, CEO's and even Royalty – Adam Cox. These recordings took place live from Adam's clinic in London's World Famous Harley Street.
© Copyright is owned by Adam Cox

redpajama_set_name: RedPajamaCommonCrawl


text:
CEU Data Privacy Notice
Publications of Antypas, A.
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Anthony BP, Scott P, Antypas A. Sitting on the fence? Policies and practices in managing human-wildlife conflict in Limpopo Province, South Africa. Conservation & Society. 2010;8(3):225-40.
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Sitting on the fence? Policies and practices in managing human-wildlife conflict in Limpopo Province, South Africa
Human-wildlife conflicts are the product of socio-economic and political landscapes and are contentious because the resources concerned have economic value and species are often high profile and legally protected. Within a governance framework, we detail institutional roles and the effectiveness of policies and practices of controlling damage-causing animals (DCAs) at Kruger National Park (KNP) and Limpopo Province along KNP's western border. Most DCAs originate from the park, significantly affecting its long-term legitimacy among local communities. Between 2002 and 2004, over 12% of households within 15 km of the park experienced DCA damage, with incidents significantly correlated with being located closer to KNP and having higher numbers of mammalian livestock. These incidents are affecting opinions concerning KNP, as those who experienced damage were less likely to believe that the park would ever help their household economically. According to 482 DCA incident records from 1998 to 2004, the most problematic species are buffalo, lion, elephant, hippo and crocodile. Limpopo Province utilised professional hunters in DCA control, however, widespread abuses including the direct luring of lion led to a national moratorium on specific hunting practices. DCA procedures are highly flawed due to ambiguity concerning species and movement of DCAs, poor reporting, inadequate response times, overlapping responsibilities, and corruption. These are exacerbated by weak and, in some cases, competing institutions. Further, the controversial issue of undelivered compensation is determining negative attitudes by communities towards institutions who have historically promised it. Drawing on good governance principles, we offer recommendations on alleviating DCA conflicts in such contexts.
Antypas A. The Aarhus Convention in Georgia: the long road to implementation. Env. Liability. 2009;5.
Antypas A, Cahn C, Filcak R, Steger T. Linking Environmental Protection, Health, and Human Rights in the European Union : An Argument in Favour of Environmental Justice Policy. Journal of Environmental Law and Management. 2008;20(1):8-21.
Cherp A, Antypas A, Mnatsakanian RA. Environment and Security : Transforming Risk into Cooperation : The Case of Eastern Europe. The United Nations Environment Programme; 2007.
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Antypas A, Stec S, Steger T. Transition and Governance : The Case of Post-Communist States. In: Winter G, editor. Multilevel Governance of Global Environmental Change : Perspectives from Science, Sociology and the Law. Cambridge: Cambridge University Press; 2006. p. 358-83.
Medarova K, Antypas A. Implementation of the Aarhus Convention in Bulgaria : limping towards effectiveness. Environmental Liability. 2006;14(1):13.
Antypas A, Avramovski O. Polycentric Environmental Governance in the Western Balkans : Towards Stability and Sustainable Development. Environmental Policy & Law. 2004;34(2).
Ürge-Vorsatz D, Rezessy S, Antypas A. Renewable Electricity Support Schemes in Central Europe: a Case for Incomplete Policy Transfer.. 2004;15(4):699-721.
Stec S, Antypas A. Other International Developments. Environmental Policy & Law. 2004;34(3):125-32.
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Other International Developments
Abstract: Traces the development of the Governance Principles for Foreign Direct Investment in Hazardous Activities in the context of overall efforts to improve corporate social and environmental responsibilities. Sustainable development principles in the term 'corporate social and environmental responsibility'; Voluntary codes and foreign direct investment; Difficulty in assessing the overall 'greening' of investment.
Ürge-Vorsatz D, Rezessy S, Antypas A. Renewable electricity support schemes in Central Europe: A case of incomplete policy transfer. Energy and Environment. 2004;15(4):699-721.
Renewable electricity support schemes in Central Europe: A case of incomplete policy transfer
Despite the relatively high potential contribution of renewable energy sources (RES) to the energy mixes of the countries in Central Europe and the officially stated support for RES deployment, progress towards implementing that commitment has been slow. This article examines the content and coherence of support schemes for the promotion of RES adopted by the Czech Republic, Hungary, and Poland. We argue that RES support schemes suffer from some weaknesses that are a function of the means by which renewable energy objectives were imported into the region. The preparations for accession to the EU encouraged a process of "policy transfer" of policies negotiated and designed elsewhere. Consequently, policies sometimes suffer from technical deficiencies, lack of political support, implementation and enforcement obstacles. The challenge now is to review the policies adopted during the transition period, rationalise their legal superstructure, and implement them in the context of well-developed strategic objectives with political and stakeholder understanding and support.
Ürge-Vorsatz D, Mez L, Miladinova G, Antypas A, Baniak A, Bursik M. The impact of structural changes in the energy sector of CEE countries on the creation of sustainable energy path : special focus on investment in environmentally friendly energy and impact of such a sustainable energy path on employment and access condit. Budapest: Central European University; 2003.
Antypas A. A new age for environmental democracy : the Aarhus Convention in Hungary. Environmental Liability. 2003;11(6):199.
Antypas A, Stec S. Towards a Liability Regime for Damages to Transboundary Waters by Industrial Accidents : A New Protocol in the UNECE Region. Environmental Law and Management. 2003;15(5):295.
Cherp A, Antypas A. Dealing with continuous reform: towards adaptive EA policy systems in countries in transition. Journal of Environmental Assessment Policy and Management. 2003;5(4):455-76.
Ürge-Vorsatz D, Mez L, Miladinova G, Antypas A, Bursik M, Baniak A, et al. The impact of structural changes in the energy sector of CEE countries on the creation of a sustainable energy path: Special focus on investments in environmentally friendly energies and impact of such a sustainable energy path on employment and access c. Luxembourg: European Parliament; 2003.
Antypas A, McLain RJ, Gilden J, Dyson G. Federal nontimber forest products policy and management. In: Jones ET, McLain R, Weigand JF, editors. Nontimber forest products in the United States. Lawrence, Kansas: University Press of Kansas; 2002. (Development of western resources).
Stec S, Antypas A, Jansen T, Gulácsy E. Transboundary Environmental Governance and the Baia Mare Cyanide Spill. Review of Central and East European Law. 2001;27(4):639-91.
Antypas A. The Institutional Development of the Commoditized Economy. In: Manno JP, editor. Privileged Goods, Commoditization and Its Impact on Environment and Society. Boca Raton: CRC Press; 2000. p. 149-72.
Antypas A. Translating ecosystem science into ecosystem management and policy : a case study of network formation. Washington: University of Washington; 1998.
Shannon MA, Antypas A. Open institutions : uncertainty and ambiguity in 21st-century forestry. In: Kohm KA, Franklin JF, editors. Creating a forestry for the 21st century : the science of ecosystem management. Washington, D.C.: Island Press; 1997. p. 437-46.
Shannon MA, Antypas A. Civic science is democracy in action. Northwest Science. 1996;70(1):66-9.
Antypas A. The dynamics of legitimation and the case of the US Forest Service : a theoretical and historical discussion. Walla Walla, Wash.: U.S. Forest Service; 1995.
The dynamics of legitimation and the case of the US Forest Service : a theoretical and historical discussion
"August 1995." "Prepared ... as part of the ongoing efforts of the Interior Columbia Basin Ecosystem Management Project, co-managed by the U.S. Forest Service and the Bureau of Land Management." -- Preface.
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There is a talent crisis in the retail industry and retailers have to start thinking very differently about how they are going to fill their growing vacancies.
"Retailers have lost touch with the job market in the sense of who wants to work in retail, what they need to pay, and what the ground level is asking in terms of career," says Suzanne Sears, of Toronto-based Best Retail Careers International Inc., which is retained primarily by retailers to do private searches to fill vacancies or key replacements from the CEO to sales clerk level.
Last year, Canadian Press reported on a Conference Board of Canada study saying employment in Canada's retail sector would hit a 12-year low in 2016 as companies adopt technology and trim costs in response to weak growth in consumer spending. That didn't happen, however, Sears noted – instead, new retailers continue to open stores with her mentioning recent openings in Toronto's Bloor-Yorkville such as Eleventy, Belstaff, Moncler and, soon, Hermes, among many others.
The Conference Board of Canada said the total number of jobs in grocery, clothing, department, home improvement, furniture and appliance stores was expected to drop to 1.26 million last year, a decrease of 2.6 per cent from the previous year and the lowest it has been since 2004. Again, that didn't happen, she said.
Sears says retail staffing woes impact sales and productivity and add extra costs for a retailer. But the faster they fill roles the more profitable they become.
"In fact, what companies in retail seem to miss is that the quickest way to improve your sales is to fill your roles faster," she says, adding that the competitive edge is people and retailers have to invest in retail being a legitimate career and creating an environment where young people want to work.
Sears explains that there's a massive disconnect between what retailers need, what they are getting and how long it's taking.
Years ago, retail shifted responsibility for hiring to human resources which was never its function. That department for many stores inherited the position of gatekeeper of who can work for the company. But in most cases they have no financial accountability. They don't have a seat at the table for results.
Sears says there are 2.5 retail jobs available for every one person that might want one.
"The market is screaming for people," she says.
Older people made careers out of retail. But that is no longer the case. Sears says it's not an attractive career option for younger people. They've seen retail strip away pensions. Strip away tenure and longevity.
Young people see what is happening in the landscape and they don't see retail as a career. Rather, they see it as a temporary thing to do until they get a "real" job.
"Young people don't want the work that the old people have been shoved out of," says Sears.
Connect with Suzanne Sears on LinkedIn.
*Top Photo: Toronto's Yorkville Village continued to add new first-to-market retailers, as it nears the completion of a multi-year overhaul. Photo: First Capital Realty.


text:
var test     = require('tap').test;
var nock = require('../');
var nockBack = nock.back;
var http = require("http");
var rimraf = require('rimraf');
var fs = require('fs');

var originalMode;
var fixture;

test('setup', function(t) {
  originalMode = nockBack.currentMode;

  nock.enableNetConnect();
  nockBack.fixtures = __dirname + "/fixtures";
  fixture = nockBack.fixtures + '/recording_test.json'
  rimraf.sync(fixture);

  nockBack.setMode("record");
  t.end();
});

test('recording', function(t) {
  nockBack('recording_test.json', function(nockDone) {
    http.get('http://google.com', function(res) {
      res.once('end', function() {
        nockDone();
        var fixtureContent = JSON.parse(fs.readFileSync(fixture, {encoding: 'utf8'}));
        t.equal(fixtureContent.length, 1);
        fixtureContent = fixtureContent[0];
        t.equal(fixtureContent.method, 'GET');
        t.equal(fixtureContent.path, '/');
        t.ok(fixtureContent.status == 302 || fixtureContent.status == 301);
        t.end();
      });
      // Streams start in 'paused' mode and must be started.
      // See https://nodejs.org/api/stream.html#stream_class_stream_readable
      res.resume();
    });
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}).once('end', function() {
  rimraf.sync(fixture);
  nockBack.setMode(originalMode);
});

redpajama_set_name: RedPajamaGithub


If you're not a professional it's easy to be intimidated by a confusing diagnosis when you go to your local garage with a vehicle problem. Even if you have plenty of background knowledge, you will need a mechanic with a full garage to help you with things from time to time, but you can't necessarily rely on what they say. After all, they don't want to tell you how to fix a simple problem when they can over-complicate the issue and charge a good price for it.
This may be a cynical view but there are plenty of warning signs to look out for if you want to avoid it happening to you! Here are some of our top things to watch out for which may indicate your car mechanic isn't being entirely honest.
Trying to make you fear for your life even driving your car back home is basically a way of saying you can't leave until you pay to have some repairs done. An overly pessimistic view is not uncommon and you should make sure you understand why your car is apparently unsafe before agreeing to any work.
You need to check the mechanic has the appropriate certifications and license to be doing this kind of work on your vehicle. If the garage has the right accreditations it will be proud to display them, so if anything is missing be very wary. Also chase up any references and take recommendations to avoid problems.
Never sign a form that isn't completely filled in. Sometimes garages will avoid being clear about what you're agreeing to, and will charge you more than you expected for less work. The only way you can avoid this is by getting formal agreements in writing.
Engine analysers and scanning tools are great for diagnosing problems, and there are some great gadgets on the market that make repair work quicker and easier. If your garage refuses to use them, they're likely to waste your time and money.
Make sure if you need to have anything replaced on your vehicle that the original materials (or equivalent quality ones) are used. Brakes and tyres can often be replaced suspiciously cheaply because they're low quality and will wear out quickly. Ask to see the box for your replacement part so you can check it's the same brand.
Sometimes the job you're being billed for is so minor it doesn't justify its cost at all. For example, if you have to remove one part to access another, this doesn't constitute any kind of check-up or repair service worth paying for. Another thing to look out for with particularly shameless mechanics is having your parts "replaced" when they were fine to begin with and they actually haven't changed. Ask for your old parts back so you can verify they have indeed been replaced and check the condition they were in.


Taking time to research different types and styles of security bars is necessary so the right ones are selected. Here are some tips to help you with the process of choosing security bars for your own home.
People get security bars for different reasons. If they are intended to help to keep children or pets from falling out of windows or doorways, the type used will differ from the type used for theft deterring reasons. Security bars come in a variety of thicknesses and shades, making it easy for them to be noticed by others if desired. The usage reasoning for the bars makes a huge difference in what type to select for installation. Knowing why you want bars for your own home is the first step to help you pick out a set that will work well for your personal needs.
If bars are going to be used to deter theft, it is important to select a set that cannot be removed with ease. However, the safety of those in the home needs to be considered as well. If a fire breaks out or if there is a need for getting out of the home in a hurry, bars need to be removed for this purpose.
Bars with a locking feature that can be accessed when necessary is one option in getting the best of both worlds. The bars will do their part in providing safety against break-ins while giving homeowners the peace of mind that they are not permanent structures that cannot be moved if an emergency occurs. This type of security bar is also convenient if a homeowner decides to move to another structure in the future, as the bars will be able to be taken out and installed at the new home when desired. An alternate solution is the installation of bars with hinges. These are easy to move away from the windows from the inside if necessary.
If you are going to use security bars to keep thieves out of the home, the type selected will make an impact on how close someone gets to your abode. It is important to install bars that will be seen by potential thieves from afar. This will make robberies less likely as these people will not want to take the time to see if there is another way to gain entry into your home. A home with bars in place shows there is a chance of other security features present as well, making it a risky endeavor to pursue. If the bars are going to be used for containment purposes, consider purchasing bars that blend in with the home's decor. This will make them less noticeable to others, helping to keep the home's aesthetics in check.
When searching for security bars, finding a supplier with a large selection to choose from is best. Contact Protect America today to find out more about security bar options available. Browse the information they have provided on their website and do research about brands, styles, thicknesses, and color before making a decision. Protect America has a large selection of security items available for purchase. Make sure to click on the link on their main page to obtain a free quote.


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Гардно (, ) — озеро на території Словінського національного парку
у Поморському воєводстві Польщі.

Географія
Знаходиться на узбережжі Балтійського моря на північ від Слупську, західніше крупнішого озера Лебсько. Висота над рівнем моря лише 0,3 метра. Від моря відрізано піщаною косою, уздовж якої переміщаються дюни висотою до 40 метрів. Мінімальна відстань від озера до моря дорівнює 1,59 км. Середня глибина озера становить 1,06 м, максимальна глибина — 2,6 м. Площа водного дзеркала дорівнює 24,69 км², за площею озеро займає 8-е місце в Польщі і друге місце в регіоні. Довжина озера становить 6,8 км, максимальна ширина 4,7 км. Озеро перетинає річка Лупава.

Населені пункти на берегах озера та біля нього: Гардна-Вєлка, Гардна-Мала, Ретово, Рови, Висока.

Охорона природи
Природний заповідник "Виспа Каменна" (Кам'яний острів) площею 0,6 га розмістився на єдиному острові в озері.

Внаслідок сільніх вітрів солона морська вода іноді потрапляє в озеро, що дає можливість існувати багатьом видам солеводних рослин і тварин.

У 1977 році Словінський національний парк був названий резерватом біосфери UNESCO з причини його природних цінностей та унікальних "плаваючих" дюн. Також парк  знаходиться під захистом Міжнародної Рамсарської конвенції відносно захисту водоплавних і болотних птахів.

Примітки

Озера Польщі

redpajama_set_name: RedPajamaWikipedia


One of our official team members @windpoacher (Eli Russell) getting it on... Funky!
Okay, last blog post for the day... One of my favorite photos ever. Yeah, kites are uplifting!
Yeah, I like to move around a little... lol Video from 2005 or 2006.
I clipped these out a while back... Too fun.
This is a video I posted only on Facebook in 2010, it didn't make the usual rounds.
This was from 2008... YouTube stripped the audio out of it and I'm re-posting the Facebook version so folks can see (hear) the original as it was meant to be.


Customers opting for the FTTH based plan also get free subscription to Airtel's OTT apps—Wynk Music and Airtel TV. Photo: Reuters.
New Delhi:Bharti Airtel on Monday announced new home broadband plans with speeds of up to 300 megabit per second (mbps) over WiFi and 1,200 GB data for a monthly rental of Rs2,199.
"The FTTH (Fibre-To-the-Home) based plan (300 mbps download speed) comes at a monthly rental of Rs2,199 and offers 1,200GB of ultra-high speed data along with unlimited STD and local calling benefits," Airtel said in a statement.
Customers opting for the plan also get free subscription to Airtel's OTT apps—Wynk Music and Airtel TV.
"Following the resounding success of our V-Fiber home broadband offering, we are delighted to introduce the new FTTH based plans for customers looking for higher speeds," George Mathen, CEO—Homes, Bharti Airtel said.
He further said that Airtel will plan to expand FTTH offerings over the coming days and provide customers the choice of home broadband plans across a wide range of price points and speeds.
In India, broadband service provider Spectra claims to provide 1 gigabit per second (gbps) download speed to its customers in select cities where it operates.
Airtel offers home broadband and fixed line services in 89 cities across India and is the second largest broadband service provider in the country after Reliance Jio.


The first annual Sona Slam was held on Saturday, October 29th at CrossFit Sona in Johnson City. Sona Slam is a fundraiser with a CrossFit competition. Their charity partner was Truth Pharm, Inc., a local non-profit working to raise awareness of an overdose epidemic that is crushing our country.


text:
Anahuacallimuseet, tidigare Museo Diego Rivera Anahuacalli, är ett museum för förcolumbiansk konst i stadsdelen Coyoacán i Mexico City. Anahuacalli betyder "hus för anahuac" på nahuatl.

Museet skapades av konstnären Diego Rivera som hade samlat samlat fler än  förcolumbianska figuriner från Mexiko. Han ville bygga ett hus för sin samling som samtidigt skulle vara ett konstverk.

Museet började byggas år 1951 på ett område i närheten av vulkanen Xitle som han och hustrun Frida Kahlo tidigare hade köpt för att anlägga en gård. Xitle hade sitt enda kända utbrott omkring år 300 och det skapade ett lavalandskap som nu är täckt av ökenväxter.

Huset är byggt av lavasten och har form som en mesoamerikansk pyramid. I de fyra hörnen avbildas de fyra elementen. Jorden representeras av majsgudinnan Chicomecóatl, luften av vindarnas gud Ehecatl, elden av eldguden Huehueteotl och vatten av regnguden Tlaloc. Efter Riveras död 1957 fortsatte arkitekterna Juan O'Gorman och Heriberto Pagelson samt dottern Ruth Rivera arbetet med museet. Det invigdes år 1964 och rymmer nästan  figuriner tillverkade av olmeker, tolteker, nahua och zapoteker, folk från Teotihuacán och nordöstra Mexiko. På första våningen finns 16 skisser till en av Riveras muralmålningar och från museets terrass har man utsikt över lavafältet och den natur som inspirerade honom.

Galleri

Källor

Externa referencer
 officiell webbsida

Museer i Mexiko


text:
Ireland–Pakistan relations are the political, economic and cultural relations between Ireland and Pakistan. Ireland is accredited to Pakistan by its embassy in Ankara, Turkey. Pakistan had an embassy  in Dublin.

History

Pakistan established its embassy in Dublin on 1 March 2001.

In April 2004 while Ireland had the Presidency of the European Council representing the EU on the world stage, Irish European Affairs Minister Dick Roche said that the EU should engage with Pakistan to bolster its democracy.

In December 2004, Humayun Akhtar Khan, Pakistani Minister for Commerce accompanied by Tariq Iqbal Puri, the Economic Minister of the Embassy of Pakistan in Brussels, met with the Irish Minister responsible for trade policy, Michael Ahern in the Irish Department of Enterprise, Trade & Employment. The Pakistani commerce minister briefed the Irish about the improving economic conditions in Pakistan and government reforms in the economic sector.

Irish aid

In 2005, Ireland provided €5 million to Pakistan in relief aid after an earthquake in Kashmir.

In April 2007, a memorandum of understanding was signed for the establishment of a Pakistan-Ireland Joint Business Council by Zubair F. Tufail, President Ghulam Bari and Secretary Yousaf Sharee from Association of Pakistanis in Ireland. Chairman of the Ireland-Pakistan Business Council in the presence of Michael Ahren, Irish Minister for International Trade, T.D and Irish Ambassador in Islamabad.

Trade

Pakistan's trade with Ireland significantly increased between 2004 and 2007. Major Pakistani exports to Ireland included cotton fabrics, made-ups articles of textile material, carpets, rugs and surgical instruments.

Pakistanis in Ireland

There is a sizable community of Pakistanis in Ireland, mostly consisting of doctors and other medics and their families. Due to a longtime shortage of doctors in Ireland, the country has incorporated many foreign doctors from countries like Pakistan going as far back as the late 1980s and early 1990s. The 2016 official census in Ireland recorded 12,891 Pakistani born people living in Ireland. There is a sizable population of Pakistani people spread throughout the country. In March 23 2021 Pakistani Community Launched their Community web portal (www.Pakistani.irish) to highlight activities and achievements of Pakistani Community in Irish society.

See also

Foreign relations of Ireland
Foreign relations of Pakistan
Pakistani Irish Community Portal

References

Pakistan
Bilateral relations of Pakistan
Ireland and the Commonwealth of Nations


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Cerebral Palsy and Birth Trauma
Every year, instances of medical malpractice lead to very serious traumatic birth injuries. Cerebral palsy is one of the most common and serious conditions caused by birth injuries occurring during labor and delivery. Although there are many birth complications that can cause cerebral palsy, in this section, our Michigan cerebral palsy and birth trauma attorneys will focus specifically on the forms of birth trauma that cause CP. Trauma is a significant cause of hypoxic and brain injuries during labor and delivery. Traumatic birth injuries can result from the forces of medical personnel or labor itself.
We will cover a lot of material related to cerebral palsy and birth trauma throughout this page. Our cerebral palsy and birth trauma attorneys understand that this content can be overwhelming and complicated, so should you have any legal questions or case inquiries, please don't hesitate to reach out. You can contact our Detroit, Michigan cerebral palsy and birth trauma attorneys online here, by pressing the Live Chat tab, or calling our office toll-free at 888-419-2229.
Cerebral Palsy and Birth Trauma: Types, Causes, and More
Cerebral palsy is a broad medical term used to describe a number of neurological disorders that hinder movement and muscle coordination. Most people with cerebral palsy are born with the condition or develop it soon after birth as a result of damage to the brain. Cerebral palsy is a non-progressive health condition, so its side effects do not worsen over time. It does, however, have a lifelong and costly impact on affected individuals and their families. Cerebral palsy occurs in approximately two to four out of every 1,000 births in the United States and Europe, according to data from the Mayo Clinic.
Cerebral palsy is often due to a lack of oxygen to the brain (hypoxia) at birth, decreased blood flow to the brain (ischemia), or trauma and hemorrhage, which can injure the brain tissue and cause hypoxia and ischemia.
Cerebral palsy is classified based on which limbs the brain injury affects. Three of the most common types of classification are listed below:
Spastic cerebral palsy: Accounting for about 80% of all cerebral palsy cases, spastic cerebral palsy is characterized by stiffness and difficulty moving, due to tightness in one or more muscle groups. Patients with this type of cerebral palsy have a hard time moving from one position to another, and have difficulty holding onto and letting go of objects.
Athetoid cerebral palsy: About 10% of cerebral palsy cases are of this type. Athetoid cerebral palsy is typified by involuntary movement, slurred speech, difficulty swallowing, inability to maintain posture, and low muscle tone.
Ataxic cerebral palsy: Also accounting for about 10% of cerebral palsy cases, symptoms of ataxic cerebral palsy include depth perception problems, distorted sense of balance, tremors, and difficulty with coordinated muscle movements.
Legal Help for Cerebral Palsy and Birth Trauma | Detroit, Michigan Traumatic Birth Injury Attorneys
If your child has been diagnosed with cerebral palsy, we encourage you to seek the counsel of a skilled birth injury attorney as quickly as possible. Often, cerebral palsy is a result of negligent medical care. The nationally recognized attorneys at Reiter & Walsh have been helping children with cerebral palsy in states across the nation for years. The team can determine if your child's cerebral palsy was a result of medical malpractice, and can help you obtain the compensation your child needs for a secure future. For a free legal consultation, you may call Reiter & Walsh ABC Law Centers toll-free at 888-419-2229, press the Live Chat tab to the left, or complete this online contact form.
1. Traumatic Birth Injuries that Cause Cerebral Palsy:
The Misuse of Forceps and Vacuum Extractors
Inappropriate use of vacuum extractors and forceps can cause brain damage, birth trauma and cerebral palsy through several mechanisms. These include brain bleeds, cerebral contusions, stretching and tearing of blood vessels and brain tissue, compression of the brain with changes in blood flow, and/or skull fractures. Below, we'll define forceps and vacuum extractors in a bit more detail.
Forceps: When a baby is in distress during delivery, forceps, which resemble large salad tongs, are placed on either side of the baby's head. As each contraction occurs, the physician guides the baby's head downward and out of the birth canal.
Vacuum extractors: A vacuum extractor uses a small, soft cup that is applied to the top and back of the baby's head. A tube runs from the cup to a vacuum pump that provides suction. During a contraction, the physician pulls or applies gentle traction to the baby's head while suction from the vacuum assists in pulling the baby's head out of the birth canal.
If forceps and vacuum extractors are used improperly, the damage can be extensive and permanent. If they are applied unevenly to the baby's head, the strain can cause compression of the head as well as brain bleeds and hemorrhages.
Other potential problems with delivery instruments include facial bone distortions, brain swelling, and brain damage which could generate other secondary issues such as seizures, epilepsy, ischemia and cerebral palsy. Similar problems can occur if the suction cup of the vacuum extractor is not placed correctly. The physicians's technique to pull the baby out is critical, and there should be no twisting of the head or neck, no excessive pulling, and no pulling for more than 10 to 15 minutes. In addition, if the vacuum extractor comes off 3 times during use, the physician should move on to a C-section delivery. Incorrect use of vacuum extractors can result in cerebral palsy, as well as skull fractures, retinal hemorrhages, brachial plexus injuries / Erb's palsy, brain hemorrhages or bleeds, and seizures. Trauma, forceps or vacuum extractors can also cause the formation of blood clots inside blood vessels, leading to strokes and cerebral palsy.
Intracranial Hemorrhages / Brain Bleeds
Sometimes during labor and delivery, trauma to the baby's head occurs, causing intracranial hemorrhages or brain bleeds. Sometimes, the hemorrhages are very serious and result in permanent brain damage, cerebral palsy, and even death.
Sadly, many brain bleeds are the result of mismanaged labor and delivery. Listed below are some of the types of brain bleeds that can occur around the time of birth:
Intracranial hemorrhages (brain bleeds): Intracranial hemorrhage refers to any bleeding within the skull or brain. There are several types of brain bleeds that can cause cerebral palsy, and they are listed below.
Cerebral hemorrhage: This is a form of stroke where bleeding occurs within the brain itself.
Subarachnoid hemorrhage: This occurs when there is bleeding in the subarachnoid space, which is the area between the innermost two membranes that cover the brain. This type of hemorrhage usually occurs in full term babies and produces seizure activity, lethargy and apnea.
Intraventricular hemorrhage: This is bleeding into the brain's ventricular system, where spinal fluid is produced. It is the most serious type of intracranial bleeding and is usually seen in premature infants and infants with low birth weight. This is because blood vessels in the brain of premature infants are not fully developed and so very weak. Intraventricular hemorrhages can result from physical trauma during birth.
Subdural hemorrhage or subdural hematoma: This occurs when there is a rupture of one or more blood vessels that are in the subdural space – the area between the surface of the brain and the thin layer of tissue that separates the brain from the skull. These ruptures are usually caused from difficult deliveries. Seizures, high levels of bilirubin in the blood, rapidly enlarging head, a poor Moro reflex, or extensive retinal hemorrhages (bleeding of the vessels in the retina) sometimes occur with these kinds of hemorrhages.
Cephalohematoma: This is bleeding that occurs between the skull and its covering, starting as a raised bump on the baby's head. It occurs a few hours after birth and lasts anywhere from 2 weeks to a few months.
CAUSES OF INTRACRANIAL BLEEDING
There are a number of things that can cause brain bleeds during labor and delivery. They include:
Macrosomia (a condition in which the baby is large for gestational age)
Cephalopelvic disproportion (a condition in which the baby's head does not easily fit through the pelvis)
Abnormal presentation (breech or face presentation)
Trauma from prolonged labor
Abnormal changes in blood pressure
Hypoxic ischemic encephalopathy / HIE (blood and oxygen supply to the brain is reduced)
Blood disorders (such as vitamin K deficiency, hemophilia)
In these cases, the physician must closely monitor the baby for fetal distress and give the mother the option for a C-section. Informed consent is imperative. If fetal distress occurs and normal methods of delivery are unsuccessful, an emergency C-section is required to minimize the risk of intracranial hemorrhage and cerebral palsy.
As discussed above, severe head and brain trauma to newborns can occur from medical intervention during labor and delivery. Improper use of delivery instruments, such as forceps and vacuum extractors, are well-documented as causes of intracranial bleeding. In addition, improper delivery techniques (excessive twisting or pulling of the infant's head) can cause intracranial hemorrhages.
Additionally, premature babies are at a higher risk for intracranial hemorrhages due to the fragility of their under developed blood vessels. Approximately 20% of premature infants weighing under about 3.3 pounds suffer intracranial hemorrhages.
Strong Contractions and Hyperstimulation
Trauma causing brain injury can also occur from the cumulative effect of prolonged periods of contractions and pushing. Forcing the baby's head and brain repeatedly against the mother's pelvis can happen in cases of cephalopelvic disproportion and macrosomia. Pitocin (also called Oxytocin) often is used in this scenario in an attempt to avoid a C-section.
Excessive Pitocin can cause contractions to occur less than 2-3 minutes apart, thereby reducing the ability of the placenta to replenish its oxygen supply. Excessive frequency and strength of contractions is called hyperstimulation. When hyperstimulation prevents replenishment of oxyen in the placenta, the baby's brain may be deprived of oxygen, which can cause brain damage, cerebral palsy, intellectual and developmental disabilities and other lifelong disabilities. Indeed, hyperstimulation with Pitocin is dangerous because there are no precise methods of measuring the effects of Pitocin on the uterus, and both internal and external monitoring techniques leave much to be desired. In addition to having uncertain effects on the uterus, Pitocin is unpredictable. The effects of any given dose vary widely; they can range from excessive and severe contractions and fetal asphyxia (lack of oxygen) to absolutely no discernible effect on uterine contractility.The drug misoprostol — distributed under the brand name
The drug misoprostol — distributed under the brand name Cytotec — also is used to induce labor. It works by ripening (thinning or causing effacement) the cervix and producing contractions. The drug has serious risks, however, which include uterine rupture, hemorrhage, and amniotic fluid embolism (amniotic fluid enters the mother's bloodstream, causing a stroke). The dosage and method of administering Cytotec raises safety concerns. Unlike Pitocin, Cytotec is a pill that is inserted vaginally. The pill is typically cut into quarters with one quarter inserted every four hours. However, this drug can affect every pregnant woman and baby differently, and there is no way to predict how they will tolerate Cytotec. If the mother or baby has an adverse reaction to the drug, it cannot be rapidly discontinued like other labor induction drugs (e.g., turning off an IV or removing a vaginal insert) since the medication is absorbed into the body. In recent years, there have been concerns over the number of birth injuries that have occurred in cases where Cytotec was used for labor induction. Like Pitocin, Cytotec causes hyperstimulation that can cause serious heart rate changes in the baby. When hyperstimulation is evident, there is a danger that the umbilical cord is being compressed and the baby is not receiving enough oxygen. This causes trauma to the baby and is an obstetrical emergency which requires an immediate C-section delivery to hopefully avoid hypoxic ischemic brain injury and cerebral palsy.
Uterine rupture occurs when the excessive contractions associated with hyperstimulation cause the uterus to tear, either partially or completely. The baby then must be delivered by an emergency C-section in an attempt to avoid hypoxia, ischemia, trauma and cerebral palsy. The Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) issued a warning about Cytotec in 1999 that stated that Cytotec has been known to cause uterine rupture in women who have had prior uterine surgery, and that the drug is not recommended for use in patients who have had a C-section or other uterine surgery. The drug also has been associated with increased incidence of hemorrhaging or blood loss, amniotic fluid embolism, meconium stained amniotic fluid, and increased emergency C-section and assistive device deliveries (forceps or vacuum extractors), all of which can cause traumatic injury to a baby and resultant cerebral palsy.
Breech Presentation and Breech Births
A breech birth is the birth of a baby from a breech presentation. Breech presentation occurs when the baby enters the birth canal with the buttocks or feet first, as opposed to the normal head first presentation. Breech presentation presents some hazards to the baby during the process of birth, including the mode of delivery (vaginal versus C-section). Though labor and vaginal birth are possible for the breech baby, certain fetal and maternal factors influence the safety of vaginal breech birth. The majority of breech babies are delivered by C-section.
At the beginning of labor, the baby is generally facing either the right or left side of the mother's back. Delay in descent is a cardinal sign of possible problems with the delivery of the head. Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech. This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the waters break the amniotic sac, it is possible for the umbilical cord to drop down and become compressed. This complication severely diminishes oxygen flow to the baby and the baby must be delivered immediately (usually by C-section) so that he or she can breathe.
If there is a delay in delivery, the brain can be damaged. Because the umbilical cord—the baby's oxygen supply—is significantly compressed while the head is in the pelvis during a breech birth, it is important that the delivery of the aftercoming fetal head not be delayed. Oxygen deprivation may occur from either cord prolapse or prolonged compression of the cord during birth, as in head entrapment. If this traumatic deprivation of oxygen is prolonged, it may cause permanent brain damage and cerebral palsy or death. Injury to the brain and skull may occur due to the rapid passage of the baby's head through the mother's pelvis. Squeezing the baby's abdomen can damage internal organs. Positioning the baby incorrectly while using forceps to deliver the aftercoming head can damage the brain, spine or spinal cord.
It is important for the physician to be knowledgeable, skilled, and experienced with all variations of breech birth. In the U.S., because C-section is increasingly being used for breech babies, fewer and fewer physicians are developing these skills. The skill of the physician, as well as the number of breech births previously performed, is of crucial importance. Many of the dangers in vaginal birth for breech babies come from mistakes made by the medical team.
Fetal-Maternal Hemorrhages
A fetal-maternal hemorrhage is characterized by the loss of the baby's blood cells into the maternal circulation. This type of hemorrhage takes place in normal pregnancies, as well as those in which trauma is related to a particular pregnancy complication. Normally the maternal circulation and the fetal circulation are kept from direct contact with each other, with gas and nutrient exchange taking place across a membrane in the placenta. Fetal-maternal hemorrhage occurs when this membrane ceases to function as a barrier and the baby's cells come in contact with and enter the maternal vessels. Up to 30mL of fetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or fetus. Loss in excess of this may result in a significant loss of blood and oxygen to the baby's brain, thereby causing cerebral palsy, or even death.
Causes of increased fetal-maternal hemorrhage can occur as a result of trauma or placental abruption. If ongoing and rapid hemorrhage is occurring, it is crucial that immediate delivery of the baby take place (if the baby is sufficiently developed). If the hemorrhage has occurred and then stopped, an in-utero transfusion of red cells to the fetus may be recommended to prevent further brain damage and cerebral palsy.
Placental abruption occurs when the placenta separates from the uterus before the fetus is delivered. The placenta delivers oxygen and nutrients to the baby prior to birth. A placental abruption can induce extreme bleeding, which can cause shock (severe loss of blood to the mother and baby), which can cause brain damage and cerebral palsy, or even kill the unborn baby. The condition occurs in approximately one out of every 600 deliveries in the United States. If the placental attachment begins hemorrhaging and the bleeding cannot be controlled, a hysterectomy could be required after the baby is delivered. If diagnosis and treatment are delayed, the mother and baby face a great risk of death.
Physicians should check for conditions that raise the risk of a placental abruption. Mothers who have had a previous abruption are at risk of having another one. In about 50 percent of these instances, the mother suffers from high blood pressure. Older mothers are more likely to experience an abruption.
Placental abruption can be treated with blood transfusions and intravenous fluid replacement. The mother should be carefully monitored for symptoms of fetal distress and shock. The fetus's heart rate should be electronically monitored to ensure it is neither too low nor too high, and to make sure contractions do not cause an abnormal fetal heart rate. Maternal bleeding or fetal distress may require an emergency C-section. Typically, to protect the mother and fetus, a C-section is the best option.
When a baby remains in the womb beyond the natural due date, usually beyond 41 or 42 weeks, there is great potential for traumatic injuries. In general, the longer a pregnancy continues after 40 weeks, the more risks there are to the baby, including cerebral palsy. Research suggests that due to the increase in fetal death and injury at 42 weeks and beyond, it is much safer to induce labor by about 40 or 41 weeks than to allow the pregnancy to continue.
There are numerous problems that may occur to the baby and mother if a pregnancy continues beyond the normal gestation period. While some problems resolve on their own, others are more serious and result in irreversible and lifelong disabilities, such as cerebral palsy. These include:
Postmaturity Syndrome: Occurring in roughly 20% of post-date pregnancies, this syndrome develops due to uteroplacental insufficiency which causes chronic stress, trauma and hypoxia in the baby, which can cause cerebral palsy. The baby has a unique appearance when born, including overgrown fingernails and hair, a long body with little fat, and wrinkled or dry, parchment-like skin. Postmaturity syndrome features a number of disorders:
Uteroplacental insufficiency: The major risk to a baby comes from the fact that the placenta reaches its maximum size and surface area around 37 weeks. After 37 weeks, its surface area and function gradually deteriorate. This may mean that the placenta is less able to supply sufficient blood and oxygen to the baby. When the placenta is unable to supply sufficient oxygen, it poses an increased risk for hypoxic ischemic injury and cerebral palsy.
Fetal Distress/Nonreassuring Fetal Assessment: If a baby is not responding well and is not being adequately oxygenated during delivery, fetal monitoring will be nonreassuring, indicating fetal distress. In post-term pregnancies, there is increased risk of fetal distress and trauma due to the higher incidence of cord compression. It is crucial that physicians pay close attention to fetal monitoring devices.
Meconium aspiration/asphyxiation: Sometimes fetal stress and an older gestational age may induce a bowel movement by the baby while in the uterus. Meconium staining (the infant's skin, umbilical cord, or nailbeds are stained green or yellow) may occur. This generally resolves on its own in time. However, in some cases, the baby will actually inhale (aspirate) the tainted amniotic fluid into its lungs. This may cause trauma to the airway, irritation, airway obstruction, infection, problems with normal lung expansion, HIE, and cerebral palsy.
Oligohydramnios: Amniotic fluid is a clear, light yellowish liquid which surrounds and protects the baby in the amniotic sac during pregnancy. Initially, the fluid consists of water. Around 20 weeks, fetal urine becomes the primary substance. The baby breathes and swallows amniotic fluid which aids in lung maturation, growth, and maintaining a consistent temperature. The volume of amniotic fluid increases during pregnancy and reaches its peak at around 34 weeks. When there is an unexpected decrease in the amount of amniotic fluid, it is called oligohydramnios. Oligohydramnios can cause trauma to the baby, such as cord compression, cerebral palsy, and other ominous pregnancy outcomes
Umbilical cord compression: When oligohydramnios occurs, there is a serious risk of cord compression. This is because the baby and umbilical cord no longer float in the fluid. Instead, the baby's movements can traumatize the cord, putting direct pressure on it, and cutting off oxygen, blood and nutrients.
Macrosomia: A baby can become very large when a pregnancy is post-term. This can make it traumatic to deliver vaginally. This may prompt a physician to use forceps or a vacuum extractor for delivery assistance, which may increase the likelihood of birth trauma to the baby, such as brain bleeds and head injuries. Macrosomia also increases the chances for C-section when labor becomes prolonged due to problems like shoulder dystocia (the baby's shoulder is obstructed and cannot be delivered normally) or cephalopelvic disproportion (the baby's head becomes too large to fit through the mother's pelvis). In fact, C-section delivery is twice as likely in a post-term pregnancy.
Reports and medical literature state that even in the case of uncomplicated, single baby pregnancies, it is best to induce labor by about the 40th or 41st week. Similarly, most obstetricians recommend delivery by 41 weeks. The benefits of labor induction include: reduced C-section rates, lower rates of meconium-stained fluid, less fetal heart abnormalities, reduced oxygen deprivation problems, and much more. There is virtually no benefit to prolonging pregnancy beyond 40 weeks and, in fact, strong scientific evidence has shown that any pregnancy beyond 40 weeks of gestation puts the baby and mother at increased risk for health problems.
Preeclampsia is a condition that occurs during pregnancy and is characterized by hypertension (high blood pressure) and proteinuria, or the spilling of protein in the urine. Although the precise cause of preeclampsia remains unknown, it more frequently occurs during a first pregnancy. Women who suffer from hypertension, diabetes, obesity and those who are greater than 35 years of age, also are at increased risk for preeclampsia.
Preeclampsia is generally classified as being "mild," "moderate" or "severe." In many cases, however, a mother with even mild preeclampsia can rapidly progress to a more severe form of the disease. Moderate and severe cases of preeclampsia can adversely affect numerous maternal organ systems, including the kidney, liver and vasculature. Undiagnosed or untreated preeclampsia can also lead to eclampsia, a potentially deadly consequence associated with significant maternal mortality and potentially permanent neurologic injuries, including intracerebral hemorrhage, blindness and cerebral palsy.
In cases where preeclampsia is undiagnosed or untreated, the baby can suffer from traumatic injuries. Preeclampsia can cause a decrease in the blood flow from the mother's placenta to the baby, thereby reducing the transfer of oxygen and nutrients. Thus, in cases of moderate to severe pre-eclampsia, there can be reductions in the amniotic fluid (oligohydramnios), intrauterine growth restriction in which the baby does not grow normally, or placental abruption.
In any patient with preeclampsia, prudent management is critical to achieve a good outcome for both the mother and baby. Physicians managing patients with preeclampsia must conduct thorough maternal evaluations, including blood and urine laboratory tests, to continually assess the extent of the disease. It also is essential that physicians refer their patients who suffer from preeclampsia to maternal-fetal specialists, physicians who have special training and expertise in the management of preeclampsia.
In addition to carefully monitoring and treating the mother with preeclampsia, physicians must also initiate a regimen of fetal surveillance to determine what effects the preeclampsia may be having on the baby. Such tests typically will include weekly nonstress tests, biophysical profiles and ultrasound examinations to assess the level of amniotic fluid, and to determine whether the baby is growing normally. Because of the extreme risks associated with even mild to moderate preeclampsia, many physicians deliver their patients prior to term.
Umbilical Cord Prolapse and Compression
The umbilical cord is the baby's lifeline. Through the umbilical cord, oxygenated blood and nutrients are transported from the placenta to the baby. Any disruption in normal blood flow and gas exchange through the umbilical cord can lead to potentially devastating and traumatic injuries to the baby, including asphyxia and cerebral palsy.
An umbilical cord prolapse, or a prolapsed cord, generally refers to a condition in which the umbilical cord descends or falls ahead of the part of the baby that is being delivered, often referred to as the "presenting part." Umbilical cord prolapse can result in a sudden and potentially devastating reduction in the supply of oxygenated blood from the placenta to the baby through the umbilical cord.
Additionally, umbilical cord prolapse can result in vasospasm of the blood vessels through the umbilical cord, and a prolapsed cord may decrease in temperature. Both of these conditions can significantly impair the transfer of oxygenated blood to the baby.
Umbilical cord prolapse is frequently associated with "malpresentation" of the baby. Instead of being in the vertex position, where the head of the baby is at or near the pelvic inlet, "malpresentation" refers to those situations where some other part of the baby, such as the baby's buttocks or feet, present at or near the mother's pelvic inlet. Accordingly, whenever a baby is assessed as being in a breech or transverse lie presentation, the physician should be alert to the potential trauma and grave risks associated with the prolapse.
Umbilical cord prolapse is also frequently associated with the artificial rupture of the maternal membranes, also known as amniotomy. In many cases, maternal membranes are artificially ruptured before the fetal head is secure in the pelvic inlet. Thus, when the maternal membranes are artificially ruptured, umbilical cord prolapsed occurs.
Because of the increased risk of umbilical cord prolapse associated with the artificial rupture of membranes, or amniotomy, the physician should always determine that the fetal head is secure in the maternal pelvic inlet before artificially rupturing membranes.
A prolapsed umbilical cord represents an obstetrical emergency, which can quickly result in permanent neurologic damage. Accordingly, the prompt assessment of umbilical cord prolapse is critical to the implementation of appropriate medical interventions, which often include emergency C-section delivery. When an umbilical cord prolapse occurs, the baby will be at extreme risk for suffering trauma and hypoxia, thereby leading to such potentially severe consequences as permanent brain injury, cerebral palsy or even death.
10. Traumatic Birth Injuries that Cause Cerebral Palsy:
In most cases, the cord is about 20 inches long and almost 1 inch in diameter. It usually appears loosely coiled. Inside the cord are two arteries and one vein. The vein supplies the baby with oxygenated, nutrient-rich blood, and the arteries carry de-oxygenated, nutrient-depleted blood back to the placenta. On occasion, the umbilical cord will only have two vessels; one artery and one vein.
When the umbilical cord wraps around a baby's neck 360 degrees, it is called a nuchal cord, or type A nuchal cord. A type B nuchal cord pattern occurs when the cord cannot be undone and ends up as a true knot. Nuchal cords are very common, with prevalence rates of 15% – 34% at term. They may form at any time and then disentangle and possibly reform, or they may persist. In some cases, the nuchal cord causes traumatic injury and leads to ischemia, hypoxia, decreased fetal development and movement, and complicated delivery. Damage occurs because the tightness around the neck restricts blood flow from the neck artery to the head, the blood from the veins gets backed up, and the vessels in the cord get compressed themselves due to the cord being tightly compressed against itself or the baby's neck.
A nuchal cord can cause severe harm to the baby, especially if the cord is tight around the neck, is wrapped around the neck more than once, or where low amniotic fluid permits cord compression. Other potential umbilical cord complications include prolapse and vasa previa (when the umbilical cord blood vessel crosses the cervix under the baby and is torn). In these traumatic circumstances, the baby may experience fetal distress due to decreased oxygen and blood flow. Many times, fetal distress is marked by accelerations or decelerations on the fetal monitor.
Nuchal cords have been associated with fetal demise, impaired fetal growth, meconium stained amniotic fluid, and an increased rate of intrapartum fetal heart rate abnormalities leading to an increased rate of operative delivery, and umbilical artery acidemia. They have also been associated with a long-term risk of neurodevelopmental abnormalities, cerebral palsy and birth trauma.
A uterine rupture is a potentially life threatening condition for both mother and baby which typically occurs when the forces and stresses of uterine contractions associated with attempted vaginal delivery cause the uterus to tear open, potentially expelling the unborn baby into the mother's abdomen. In such cases, maternal or fetal death or fetal asphyxia with associated long-term neurologic impairment and cerebral palsy are common consequences, particularly in those cases where the physician fails to appreciate the risk of uterine rupture, or fails to act expeditiously when uterine rupture occurs.
Although a uterine rupture may sometimes develop as a result of pre-existing injury or trauma, it is generally recognized that the most common cause of uterine rupture is the separation of a previous C-section scar during labor. Thus, it has been recognized that the induction or augmentation of labor in patients who previously had a C-section, called a "VBAC" delivery, is associated with an increased risk of uterine rupture. Medical studies have indicated that when prostaglandin agents, such as Cervidil or Prepidil, are utilized to induce labor in a patient who had a previous C-section delivery, there is also an associated increased risk of uterine rupture.
Because of the risk of uterine rupture and trauma to the baby, many physicians will not use any medications such as Pitocin or prostaglandins to either induce or augment the labor of a patient who has had a prior C-section. A uterine rupture, or the separation of a surgical scar from a prior C-section, can result in massive maternal hemorrhage and trauma to the baby, and it frequently requires that the mother undergo a complete hysterectomy.
Because of the potentially grave and often fatal risks to mother and baby associated with uterine rupture, physicians should closely monitor the labor of any patient who has increased risk factors for uterine rupture. If uterine rupture occurs, maternal hemorrhage must be promptly controlled and the baby must be delivered as expeditiously as possible to avoid hypoxia, ischemia, cerebral palsy and birth trauma.
VBAC (Vaginal Birth After C-Section)
VBAC carries a number of grave and potentially fatal risks, many of which are not fully explained or discussed with the pregnant mother. These risks include the dangers of uterine rupture, a potentially life threatening condition for both the mother and baby, in which the forces and stresses of uterine contractions associated with attempted vaginal delivery cause the uterus to tear open, potentially expelling the unborn fetus into the mother's abdomen.
In such cases, fetal asphyxia, cerebral palsy and neurologic impairment and death are common consequences, particularly in cases in which the physician fails to appreciate the risk of uterine rupture, or fails to act expeditiously when a uterine rupture occurs.
Because of these substantial risks and their dire consequences, many physicians have questioned whether VBAC is an appropriate and reasonably safe mode of delivery for patients who have had prior C-section deliveries. Unfortunately, perhaps as a result of inexperience or economic pressures, many physicians encourage their patients to undergo VBAC deliveries and fail adequately to apprise them of the reasonably foreseeable risks and alternatives, including repeat C-section delivery.
Cephalopelvic Disproportion (CPD)
Cephalopelvic disproportion (CPD) injuries occur when the baby's head or body is too large to pass through the mother's pelvis. Initially, physicians will have information about the mother's pelvis type and size by x-ray and examination. Ultrasounds also give the physician an idea of the baby's head measurements. Another important factor is how the baby's head is positioned in the pelvis – some parts of the baby's head can mold to conform to the mother's pelvis. Except for macrosomia, physicians will usually not assume CPD based on measurements alone, although measurements are one piece of information that should be considered when deciding whether to deliver vaginally or by C-section. One indication of CPD is failure to progress. Failure to progress means that labor either ceases or does not move as quickly as it should. CPD is the most common reason for C-section by first-time pregnant mothers. Physicians should identify any risk factors for CPD before the start of labor. Risk factors include:
Small or abnormal pelvis
Large head measurement of baby
Mother with diabetes or gestational diabetes
Mother over age 35
The treatment for CPD is surgical delivery or C-section. Sometimes it may be necessary to plan to deliver the baby early. When CPD is present, attempts to deliver the baby vaginally will typically cause trauma, which can lead to permanent injuries, such as cerebral palsy.
Some trauma inducing mistakes made by physicians when CPD is present include the following:
Pitocin/Oxytocin: Physicians may react to CPD by administering Pitocin, which can cause excessive and traumatic contractions, leading to hypoxia, ischemia and resultant cerebral palsy.
Continued Labor: Physicians may allow labor to progress for too long. Labor is stressful and traumatic for babies, and when prolonged, it can cause hypoxia and ischemia, which can lead to cerebral palsy.
Shoulder Dystocia: When CPD is a problem, babies are more likely to have shoulder dystocia injuries, including Erb's Palsy, Klumpke's palsy, or hypoxia leading to cerebral palsy.
Prolapsed Umbilical Cord: When there is less room in the uterus, either because of a large baby or a small pelvis, a prolapsed umbilical cord is more likely, which puts the baby at risk for hypoxic injuries, cerebral palsy and birth trauma.
Premature Rupture of Membranes (PROM)
Premature rupture of the fetal membranes (PROM) is a dangerous condition, leading to fetal distress and other complications before labor or near the end of the third trimester. Without the sterile, protective amniotic fluid, an unborn baby is prone to bacterial infections, loss of nutrients, premature birth and other traumatic complications. Complications from PROM can include:
Prolapsed umbilical cord
Inflammation and infection of the fetal membranes (chorioamnionitis)
Infections such as GBS, UTI and BV, and HSV
Premature birth and hypoxia
Death of the fetus
Prolapsed umbilical cord, premature birth, hypoxia and infection in the baby all may lead to cerebral palsy and birth trauma.
Legal Help for Medical Malpractice, Birth Injuries, Cerebral Palsy and Birth Trauma | Detroit, Michigan Cerebral Palsy and Birth Trauma Attorneys
As you've learned throughout this page, cerebral palsy and birth trauma often go hand in hand. In order to prevent cerebral palsy and birth trauma, it is crucial for the physician to monitor the mother and baby very closely during pregnancy and around the time of delivery and prevent or treat conditions that can lead to cerebral palsy. Failure to properly monitor and treat the mother and baby is negligence. Failure to follow standards of care and guidelines, and to act skillfully and expediently also constitutes negligence. If this negligence leads to cerebral palsy, it is medical malpractice.
For three decades, the experienced cerebral palsy and birth trauma attorneys at Reiter & Walsh ABC Law Centers have been helping families nationwide affected by cerebral palsy. We are one of the only firms in the country that exclusively takes birth injury, cerebral palsy and birth trauma cases, and we have a track record of multi-million dollar verdicts and settlements that attest to our success.
If your loved one has been diagnosed with cerebral palsy, contact our skilled cerebral palsy and birth trauma attorneys today for a free legal consultation. You may contact us in any of the following ways:
Call Reiter & Walsh toll-free at 888-419-2229
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View our primary cerebral palsy page here.