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§1644a. Definitions
As used in this subchapter-
(1) The term "national of the United States" means-
(a) a natural person who is a citizen of the United States;
(b) a corporation or other legal entity which is organized under the laws of the United States or of any State, the District of Columbia, or the Commonwealth of Puerto Rico, if natural persons who are citizens of the United States own, directly or indirectly, 50 per centum or more of the outstanding capital stock or other beneficial interest of such corporation or entity. The term does not include aliens.
(2) The term "Commission" means the Foreign Claims Settlement Commission of the United States.
(3) The term "property" means any property, right, or interest, including any leasehold interest, and debts owed by enterprises which have been nationalized, expropriated, or taken by the German Democratic Republic for which no restoration or no adequate compensation has been made to the former owners of such property.
(4) The term "German Democratic Republic" includes the government of any political subdivision, agency, or instrumentality thereof or under its control.
(5) The term "Claims Fund" is the special fund established in the Treasury of the United States composed of such sums as may be paid to the United States by the German Democratic Republic pursuant to the terms of any agreement settling such claims that may be entered into by the Governments of the United States and the German Democratic Republic.
(Mar. 10, 1950, ch. 54, title VI, §601, as added
Transfer of Foreign Claims Settlement Commission of the United States as Separate Agency Within Department of Justice
For provisions transferring Foreign Claims Settlement Commission of the United States as a separate agency within the Department of Justice, see section 1622a et seq. of this title.


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subset: commoncrawl


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Great Britain downed by Australia in final test
- Tweet
Australia 3 (2)
Georgina Morgan 5 (PC)
Emily Smith 27 (FG)
Grace Stewart 35 (FG)
Great Britain 2 (0)
Sophie Bray 55 (FG)
Joie Leigh 57 (PC)
A late charge from Great Britain was not quite enough to prevent Danny Kerry's side going down to a 3-2 defeat in the final test of the series against Australia. Trailing 3-0 going into the final quarter GB scored twice through Sophie Bray and Joie Leigh but they were unable to complete a stunning comeback as the clock ran out. Australia's goals came from Georgina Morgan, Emily Smith and Grace Stewart and with the win the hosts took the six match series 2-1.
Australia showed their attacking intent from the off and won a penalty corner in the first minute. Jodie Kenny took the strike at goal but it was charged down by the runner. From the resultant restart Maddie Hinch was then called upon to smother from Mariah Williams. Sophie Bray made the first threat on the Hockeyroos' goal but her diagonal pass was just out of reach of the diving Shona McCallin and then at the other end Hinch had to be alert to block a close range shot from Ashleigh Nelson.
There was nothing the Great Britain goalkeeper could do in the fifth minute however as Georgina Morgan buried a fierce penalty corner to give the hosts the lead. Australia's high press created another clear chance later in the quarter. Georgie Parker found herself clean through but Hinch made a superb save to keep the score to 1-0. Great Britain hunted for an equaliser and Ellie Watton dispossessed Anna Flanagan. She found Helen Richardson-Walsh whose cross was diverted goalwards by Bray but flashed just wide of the far post. Bray then tested Ashlee Wells' reflexes with a stinging backhand strike just before quarter time but despite some good attacking play Great Britain trailed at the end of the first period.
Madonna Blyth picked out Gabrielle Nance at the far post for the first chance of the second quarter but once again, Hinch was alert, saving well from the Hockeyroos forward. Bray continued to threaten the home defence, setting up Susannah Townsend for a shot at goal which Wells had to save but then three minutes before the break Blyth's pass was touched in by Emily Smith to make it 2-0 going into the half time interval.
Bray almost set up Townsend in the first minute of the second half but the Canterbury star couldn't quite get the shot away to beat Wells. Great Britain built a good spell of pressure but then in the 35th minute Grace Stewart pounced on a loose ball in the circle to slam in the third goal for the home side slightly against the run of play. Australia forced another penalty corner with three minutes left in the quarter. Flanagan took the shot but Hinch was down well to her right to make the save. Kenny took the next penalty corner but her flick was brilliantly cleared off the line by Helen Richardson-Walsh.
Great Britain came out for the final quarter with an increased intensity and another Bray run forced Wells into a good stop at her near post. Four minutes into the quarter Danny Kerry's side won their first penalty corner. Giselle Ansley took the shot but Australia defended well and cleared the danger. With five minutes left to play a lovely move from back to front brought Great Britain back into the contest. Leigh threaded the ball through to Bray who beat the goalkeeper with a splendid finish to make it 3-1. With the momentum shifting, Great Britain forced another penalty corner. Despite the move breaking down, Georgie Twigg, winning her 50th Great Britain cap, beat the goalkeeper allowing Leigh to finish from close range to set up a grandstand finish. Danny Kerry's side threw everything at the hosts but the clock just beat them and they lost 3-2.
Kate Richardson-Walsh:
"We can take a lot of positives from the series. That was probably our best performance today. We've not put in our best displays in the first five games so we can take from this that if we were able to stay level with Australia when not playing our best, hopefully when we are at our best we can beat them.
The next six months are really busy. We have lots of games so we'll be match ready for the Olympics. We have some recovery tomorrow before we fly home and then back in the gym in a few days. Not too much rest as we're back into the training for Rio!"
Danny Kerry, Great Britain Head Coach:
"It's been an excellent series for us. We have found out what we needed to under the right circumstances. We have a lot of capacity to build back into the squad with players left behind and injuries that occurred whilst here. I have been impressed with the team's attitude to the challenges they were presented with here and believe we will continue to grow significantly between now and Rio."
That victory has handed Australia a 2-1 win in the series. For details on all the matches, click here.
To watch the matches again, click here.
Both these sides will be competing in the Women's Champions Trophy this coming summer at Lee Valley Hockey and Tennis Centre, London. See the Hockeyroos and Great Britain, plus Netherlands, USA, Argentina and New Zealand fight it out to be crowned the best of the best. All the details are here.


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This year's Davis Cup by BNP Paribas Final will be contested by France (the home team) and Croatia, at the Stade Pierre Mauroy, Lille on 23rd – 25th November 2018. This will be the third meeting between the two countries, with the home team prevailing in both of their previous encounters.
The French Tennis Federation [Federation Francaise de Tennis (FFT)] announced that they would return to these familiar surroundings earlier in the year and as France will be playing on one of its favourite surfaces (clay), they have made the decision to use Europe's no.1 ball brand, the Dunlop Fort Clay Court tennis ball. A ball which is used at most of the major clay court tournaments on both the ATP and WTA tours throughout the season.
Dunlop is the Official Ball of:
Australian Open | Next Gen ATP Finals | Rolex Shanghai Masters | Mutua Madrid Open | Rolex Monte Carlo Masters | Internazionali BNL d'Italia |Barcelona Open Banc Sabadell | Gazprom Hungarian Open | BMW Open by FWU | Millennium Estoril Open | TEB BNP Paribas Istanbul Open | New York Open |Chengdu Open | Rakuten Japan Open | Volvo Car Open Charleston | J&T Banka Prague Open | BRD Bucharest Open | Japan Women's Open Tennis | Tashkent Open | Brisbane International | Sydney International | Hobart International | Qatar ExxonMobil Open | Hopman Cup


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Earlier tonight, the long awaited premier of Sharknado 3 hit your living room and other living rooms everywhere. Don't worry, the entire world was just as excited as you were. Trust me, their reactions below prove it. Here's some of the best ones we saw:
#Sharknado3: Just when you thought it was safe to be adjacent to water.
Seriously, how has this guy not permanently moved to Nebraska?
— Science Isn't Scary (@sciencenotscary) July 23, 2015
Will I be lost if I watch #Sharknado3 without seeing the first two movies? I'm worried I might get confused by a potentially complex plot.
— Connor O'Brien (@connorobrienNH) July 23, 2015
Mr RHHG just took the remote to see what else is on and ACTUALLY CHANGED THE CHANNEL!
Researching divorce lawyers now.
— Lory (@The_RHHG) July 23, 2015
Tara Reid is having a shark baby. Calling it now. #Sharknado3
— Derek (@MidweztMarauder) July 23, 2015
It's time to rev up the GOLDEN chainsaw, @IanZiering! 🌀🌀🌀 #Sharknado3 #HomeOfTheNado pic.twitter.com/S3fxeJOtqz
— Sharknado (@SharknadoSyfy) July 23, 2015
BREAKING NEWS ALERT Brian Williams has intercepted #Sharknado3 pic.twitter.com/4J6lc0VMNf
— Rob White (@svrwxtweets) July 23, 2015
Only thing scarier than a #Sharknado3? #Shaqnado @SHAQ pic.twitter.com/XeSVbckwOf
— NBA on TNT (@NBAonTNT) July 23, 2015
if these sharks don't "kill" Bryce Harper while they're in DC, it's a missed opportunity. #Sharknado3
— Jennie (@JennieOhMy) July 23, 2015
#Sharknado3 The only thing more frightening than getting eaten by a shark in a tornado is the thought of @AnnCoulter as Vice President
— Domenick Scudera (@domscud) July 23, 2015
The #Sharknado3 plot is more confusing than True Detective but at least the acting's better.
— Will Brinson (@WillBrinson) July 23, 2015
25 mins in and #BruceTheRideAttendant is still alive!! #Sharknado3 is AWESOME so far! @SharknadoSyfy
(@ryrynewman I've still got ur phone)
— Chris Jericho (@IAmJericho) July 23, 2015
Ever since Malcoms dad become a drug dealer. He decided to one up his dad by killing Sharknados #Sharknado3
— Jacob Zimmer (@jacobzmmr5) July 23, 2015
How does she ever make it past the TSA with a saw for an arm?! #Sharknado3
— Rod TBGWT (@rodimusprime) July 23, 2015
What other gadgets does she have in her robo-arm? #Sharknado3 pic.twitter.com/zoxYuwvjKM
— Chris Schmied (@mad_cow_chris) July 23, 2015
Malcolm in the Middle just had the most overly dramatic dead scene since the opening of RoboCop. It was awesome. #Sharknado3
— Mike Welch (@RealMikeWelch) July 23, 2015
Now this kind of Nascar I would watch. #Sharknado3
— Mike'l Severe (@MikelSevere) July 23, 2015
People who follow me tonight cause of my #sharknado3 tweets will be disappointed the rest of the year at my lack of shark/meteorology tweets
— Jon Acuff (@JonAcuff) July 23, 2015
You don't kill a shark for eating Jerry Springer, you set it free and thank it. #Caring #Sharknado3
— Derek Hunter (@derekahunter) July 23, 2015
NOW WE'LL NEVER KNOW HOW GAME OF THRONES ENDS!!!! #Sharknado3 pic.twitter.com/4nbtGhQQaf
— Mikey (@fsmikey) July 23, 2015
David Hasselhoff is playing Ian Ziering's Dad even though Ian is only 11 years younger. THAT DOES IT #SHARKNADO3 IS COMPLETELY IMPLAUSIBLE
— Jerry Beach (@defiantlydutch) July 23, 2015
How is it Hasselhoff looks even WORSE in the spacesuit? #Sharknado3
— William West (@williambwest) July 23, 2015
Should have had Ray J and Kanye punching sharks, with Ray J quipping "I hit it first" #Sharknado3
— Benjamin Allbright (@AllbrightNFL) July 23, 2015
I've never had a kid, but I'm pretty sure pregnant women aren't supposed to go into space after their second trimester. #Sharknado3
— Elizabeth Wylder (@sharknado) July 23, 2015
Sorry, no one at @NASA says "Yup" when you ask if we're clear to launch. #Sharknado3
— Lance Ulanoff (@LanceUlanoff) July 23, 2015
Damnit David Hasselhoff, don't give away all of our national secrets on #Sharknado3. The North Koreans could be watching.
— Brian Knight (@brianknight) July 23, 2015
THERE'S MUTHAFUGGIN SHARKS ON THIS MUTHAFUGGIN SPACE SHUTTLE! #Sharknado3
— Big Head Sports (@BigHeadSports) July 23, 2015
Just when I thought #Sharknado3 couldn't get any more absurd, it goes and does something like that…
… and TOTALLY redeems itself!
— Geoff Grammer (@GeoffGrammer) July 23, 2015
@KMat21 Riding a shark thru re-entry to save your pregant wife makes about as much sense as anything else in this movie. #Sharknado3
— StoicLion (@StoicLion1973) July 23, 2015
Parachute through a giant shark's hole that you punched from the inside of it in space. I can't even… #Sharknado3
— Goddess (@GoddessOfDay) July 23, 2015
wait, she gave birth inside a shark plummeting towards the earth from space and thought to put her pants back on? #Sharknado3
— Danny Troutman (@DannyFresh421) July 23, 2015
My God. This is a drama. Not science fiction. #moved #Sharknado3 @JOEL9ONE
— The Players' Tribune (@PlayersTribune) July 23, 2015
No one has lost baby weight faster than Tara Reid, who gave birth while in the shark's stomach. #newbirthtrend #Sharknado3
— Rachel Schallom (@rschallom) July 23, 2015
For one brief moment we were all one. We shared a part of our lives we'll never get back. For that I thank you #sharknado3 #aprildies
— Jim Brenneman (@ArtboyDesign) July 23, 2015


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Take A Look Tee + - Robbins Egg
$9.99 $14.99
- A short sleeve v-neck tee.
- Imported
- Self: 92% Cotton 8% Spandex
- Washing instructions: Machine wash cold. Do not bleach. Lay flat to dry. Iron low if needed.
Also available in Apricot, Black, Heather Grey, Oatmeal, and Off White.


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April Michelle Bowlby is lately the talk of the tinsel town. Bowlby is in the headlines for her upcoming TV series titled Doom Patrol, starring Matt Bomer and Brendan Fraser. Bowlby will be playing the lead character, Rita Farr/Elastigirl, in the TV show which will air since 2019.
The California-born actress has been a part of the tinsel town since 2004. Bowlby has appeared in numerous TV shows and movies so far. With a sound income from her profession as an actress, Bowlby has amassed a huge net worth as well.
Find out more about the actress net worth, income, lifestyle, and career.
April Bowlby has an estimated net worth of $2 million, as of 2018. Bowlby is one of the young and hottest actresses from Hollywood who is recently on the rise. So, it's no surprise she is worth millions.
View this post on Instagram
Bowlby has earned her wealth solely from her acting profession, which can also be credited to her long-running TV series like Two and a Half Men, Drop Dead Diva, How I Met Your Mother and others.
As for a fact, Bowlby first sought her career in modeling but later decided to pursue her career in acting. Maybe it was a good decision for Bowlby to turn her career into acting. Today with her income from her acting roles, Bowlby is enjoying a lavish life.
Bowlby, 38, has kept her life behind the screen out of the reach of the media. The information about her assets and properties- house and cars- haven't been revealed to the public.
Also Read, American Television actress April Bowlby: Know about her affairs and dating rumors.
Bowlby is active on social media platforms including Instagram and Twitter. Her Twitter account has 37.1K followers and her Instagram has 58.7K followers as of late 2018. As seen on her social media account Bowlby is excessively enjoying her life and her splendid net worth.
View this post on Instagram
Bowlby is also a dog lover.
Bowlby studied marine biology at Moorpark College, California. Bowbly began modeling career before decided to pursue her acting career. To enhance her acting skills, Bowlby also studied drama. Bowlby grabbed her first role in the TV show named CSI: Crime Scene Investigation, playing Kaitlin Rackish, in 2004.
In 2005, Bowlby auditioned for the role of Kandi in the TV series Two and a Half Men, which she grabbed within a few months of her audition. She played the role of Kandi in the TV show from 2005-15. Well, this can definitely be credited for the net worth she owns at present.
Bowlby has a recurring role in Two and a Half Men in the third season. So far, Bowlby has been in a recurring role in numerous TV shows including Heathers, Titans, The Wrong Daughter, Homecoming Revenge, and Isabelle Wagner.
View this post on Instagram
Beyond excited and honored to be a part of this!!! I MEAN ????!!!! #dreamjob #DCcomics #elastigirl #pinchme
Likewise, Bowlby made her movie debut in 2008, playing Natasha in Dennis Fallon directorial All Roads Lead Home. Her other movie role includes Mia in The Slammin' Salmon, Olivia in From Prada to Nada, Katie Tate in Married by Christmas and Nikki in A Mother's Crime.
We hope her 2019 release sets new benchmarks for the actress. Also, hope her net worth and earnings increases rapidly.


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- A male gamer
- United States
- Joined on January 25th 2008, last online on 31 July 2019.
- Profile Views: 32,287
- Forum posts: 4,562 times which averages 1 posts per day
- User Reviews: 0 reviews
Season's greetings! I would like to personally invite you to join this year's PC Secret Santa event, thread link below. Please drop by and help us make this holiday season a bit more merry for everyone. Looking forward to seeing you there!
League of Legends LCS should be on every day :(
Man I want Animal Crossing 3DS because professional LoL streamers keep mentioning it. I loved the Gamecube one.
Trying to get all the heroes on League of Legends takes forever :O
If anyone wants to try League of Legends can you let me know before you do it? Thanks!
Happy Lunar Revel LoL players!
DC Universe Online is actually surprisingly fun once you get through the learning phase. I like it a lot!
Twitch has effectively replaced t.v. for me
Beat Hotline Miami. Don't know what Vita game to finish next...
Hotline Miami is really fun on Vita
I love my Vita. So much fun.
On a Vita binge at the moment...
Anyone else probably gonna buy every Persona game coming out?
Maybe I'll try using Fizz next, I must lear nhow to counter him...
Trying to get enough IP for all League of Legends heroes takes foreverrrr...
League of Legends is too addicting...
Hideo Kojima and all the PS4 staff are in Manhattan, I want to say hi! D:
I'm hungry :(


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In Golan v. FreeEats.com, Inc., No. 17-3156 (8th Cir. July 16, 2019), the Eighth Circuit affirmed a trial court's radical, post-trial reduction of damages in a TCPA case.
Although the trial court originally awarded the plaintiffs more than $1.6 billion in statutory damages, it later slashed the award by 98 percent to approximately $32.4 million. The plaintiffs appealed that decision. (The plaintiffs also appealed the trial court's rejection of their preferred jury instruction on direct liability, which the Eighth Circuit also affirmed.) Continue reading


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- Digital Investor
Socially Responsible Investing Just Got Easier
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With financial institutions increasingly reaching out to millennials, investors now have more ways to improve the planet as well as their bottom lines.
According to the Global Impact Investing Network, a wide variety of investors—both individual and institutional—have been attracted to socially responsible, or "impact," investing, which appeals to those who usually support social and environmental organizations through philanthropic donations by allowing them to also generate good returns.
A relative newcomer, Swell Investing, opened its doors to the public in May with a focus on the United Nations' sustainable development goals. Swell offers six different portfolios that focus on areas like renewable energy, green technology, disease eradication, clean water, zero waste, and healthy living. What makes the Newport Beach, Calif.–based firm, which was incubated by Pacific Life Insurance, different from other investment services is that each portfolio is made up of individual stocks that have passed their strict criteria—not exchange-traded funds or mutual funds.
The list of holdings in each portfolio is spelled out on Swell's website (www.swellinvesting.com). For example, in its Green Tech portfolio, which invests in companies that are focused on energy efficiency and building green products, you'll find BorgWarner (ticker: BWA), which produces engines and coolers for a variety of vehicles, and Arista Networks (ANET), which provides software-driven cloud-storage solutions. The portfolio, which holds approximately 50 companies, has gained 30.3% since its inception on Sept. 30, 2016, compared with the S&P 500's 16.0% gain over the same period.
"The key difference between us and the socially responsive investment space is that we demand that each company in our portfolio derives revenue from progress in areas such as renewable energy, clean water, and other U.N. sustainable development goals," says CEO Dave Fanger. Most of the ETFs that are labeled socially responsible, according to Fanger, are merely investments in firms that aren't directly doing harm. "We are looking for firms that are addressing these concerns as a core business," he says.
At present, only U.S. residents can open a Swell account, but Fanger says they are working on making it more accessible globally. Individual retirement accounts will be enabled later this week.
SWELL MAY ADD more portfolios in the future, depending on demand. Right now, you can distribute your investment across the six available portfolios in a way that you see fit. Click on "Edit Mix" to change the allocation percentages at any time, and your holdings are updated without any additional fee.
At launch, the minimum portfolio size was $500, but later this week, that will drop to $50. "Our younger audience is coming from a try-before-you-buy world, so we will let them open an account for $50 to check us out before committing more money," Fanger says.
The firm charges a flat 0.75% annual fee, which compares favorably with most mutual funds in the space and is less than about one-third of available ETFs. A $5,000 portfolio will cost $3.13 per month, and there are no transaction fees.
Fanger says Swell plans to add a feature that allows clients to remove up to three companies from a particular portfolio, which is scheduled to launch later this year. (The site mistakenly says this feature is active now.) Portfolios are domiciled at Folio Investments, a brokerage we have covered several times in this column, which allows customers to directly hold fractional shares of stock.
There are many other ways to invest in companies that address social and environmental challenges, and you don't have to accept below-market returns. ETFs considered socially responsible are offered by brands like First Trust, Powershares, iShares, and SPDR. Fidelity's ETF screener includes 40 funds identified as environmentally and/or socially responsible, with First Trust Nasdaq Clean Edge Green Energy Index (QCLN) topping one-year total returns at 22% with a net expense ratio of 0.6%. The S&P 500 gained 13.7% over the same period. Powershares offers two ETFs, WilderHill Clean Energy (PBW, up 13.6%) and Water Resources Portfolio (PHO, up 9.4%), which clients can also write options on.
Fidelity also carries 112 funds that are classified as socially responsible that carry no transaction fees, including its own Fidelity Select Environment & Alternative Energy Portfolio (FSLEX), which has a one-year market return of 20.1% with an expense ratio of 0.94%. It requires a minimum investment of $2,500.
Most online brokers have added a way to search their ETFs and mutual funds for those that are socially and/or environmentally responsible in the last couple of years. Betterment, one of the early robo-advisors, launched its socially responsible investing portfolio in mid-July, focusing on ETFs.
IN OTHER NEWS, Interactive Brokers Group (IBKR) has enhanced its integrated financial management account by offering a Mastercard debit card as well as interest paid on cash balances over $10,000 in individual and joint accounts held by U.S. residents. The debit card allows you to make purchases against or borrow against the securities in your brokerage account, but if you spend more than the cash currently in your account, you'll incur a margin loan at a maximum of 2.66% interest. That compares extremely favorably with the typical credit card interest range of 16%-25%.
Clients can pre-authorize large purchases using the IB Key app on devices that run iOS or Android operating systems that might otherwise involve a call to customer service. The debit card can be used to withdraw cash from ATMs around the world.
"We're not encouraging people to take out loans," says Executive Vice President Steve Sanders, "but we're offering them a secured alternative."
OptionsXpress is finally being assimilated into Charles Schwab (SCHW) over the weekend of Oct. 6-8. You can no longer open an optionsXpress account, and certain features will be disabled over the next month and a half. There is an extensive list of key dates and feature changes at an information site that was sent to optionsXpress customers on Aug. 9. The site (content.schwab.com/web/trading/client/optionsxpress/main/) highlights the number of days until the move and lets you know where to look for familiar features once the transition is complete.
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Article by : Brian James| Fashion Writer | @brianjamesstyling
I'll put it out there straight away and say that I absolutely love DB BERDAN, the matriarchal queer street wear brand whose shows and presentations are a multi-dimensional feast which bring the club to the catwalk. I was delighted that the label who draw their inspiration from social rights, the streets and underground culture, were rewarded with having their SS20 collection appear as part of the official London Fashion Week schedule. I met up with the guys at their immersive ravey-vibed "Self-Love Club" presentation where we discussed everything that blends together to make DB BERDAN the unique and transformational force they are.
1.Congratulations on your SS20 collection. Its entitled "Self-Love Club" which seems a very timely theme given the times we are living in. What was the inspiration behind the self-love concept?
Thank you so much. As you know the Olympics are pretty close by and we were just looking into the whole sports club industry and felt like it's still very normed by male domination. So, we wanted to take this male dominating sports club industry and turn it into an all gendered inclusive activity. We wanted to create our own sports club calling it Self Love Club, celebrating self-love and to embrace each other's differences.
2. The collection pays tribute to the many prominent LGBTQ+ sports people and as part of that theme you take the toxic heteronormativity of the traditional male orientated sports club and reimagine it as a gender inclusive activity. You accompany it with the slogan "Racing for Equality". How do you think that race is progressing?
As much as we see the news coverage in Western countries and the law being a lot more protective over the minorities, we still feel like the race has not really progressed much over the years around the world. In fact, in some countries it has turned to worse as it got shined a light on. Even in western countries, you don't know what goes on in closed doors the oppression still continues within those safe spaces. We think the race has just started and there are a lot of rounds of laps to finish the line.
3. I absolutely loved the collection which has a very late 80' s / early 90s feel to it. The silhouettes, tie-dye denim and bold colours vividly reference the warehouse and rave scene of my younger days. What is it about that era that so captured your imagination?
I had my first rave experience in the first week I came to London for uni. We were sitting in a park and some random guy came over to give us flyers on an underground drum and bass party. It really was something that stayed in my mind, the entrance of an abandoned warehouse, walking towards where the music comes from, people dancing like crazy off their heads. I truly never experienced something like that. It was truly thrilling and super exciting. So that was my welcome package to rave culture.
DB Berdan always takes huge inspirations from 80's and 90's as one of us partied through 90's grunge and industrial vibes and the other in 2008 which had such a comeback for 80's that her style just got stuck in that era.
4. The collection is made from quite beautiful authentic and environmentally friendly prints. How vital is it to the DB Berdan ethos that your materials are ethically sourced and have a sustainable footprint?
It's your basic human consciousness isn't it? If you love what you create and have a purpose to gather your community around you want to best for them. Being ethical for us means staying true to your community as they elevate you, you give back to them. We're using organic cotton and environment friendly prints and dyes. We've also have giant woven tags as accessories that states to take care of our planet wash less, wash cold, line dry donate or recycle.
5.The rave generation theme is further enhanced by your collaboration with Smiley, whose logo was the visual manifestation of the Second Summer of Love. How did that collab come about?
We were so happy to be collaborating with the symbol of all positivity, Smiley Company. We really think that Smiley Company had really elevated our Self Love Club Story by spreading positivity and love.
6. What do you think it is about the Smiley philosophy that continues to be relevant and to resonate, nearly 50 years after its creation.
Their coming out story is very meaningful. They start at war time in newspapers, they used to highlight the positive, uplifting stories with a yellow smiley face; so that people can read the happy parts of the era. So even in war time within all those negativity they spread happiness and turned the negativity into positivity. DB Berdan is the same in that it is a reaction to things that they feel are wrong and channel that into positive messages.
7. The presentation was beautifully staged with a Jägermeister bar and live sets from GIRLI, Ashnikko and DJ Krystal Lake, evoking total club vibes. How much planning and consideration goes into making your shows a multi-dimensional experience?
We love creating a full-on experience to spread the message well. You have to make the others feel the way you do and the way to do this is with a multi-dimensional show. We had an incredible team that helped us create and elevate our feelings into the guests that came to the show. We would love to thank everyone that was involved in this show.
8. Championing social rights is a unifying theme across all your work. You have famously campaigned for LGBTQ+ rights in Turkey and chastised our current Prime Minister for his "burka" comment. How important is it to use the public platform that fashion provides you, to campaign for social justice and equality?
As we all know fashion is very fashionable. This is the platform that we can really shout out our messages and make an impact. We have witnessed this in Turkey and really believe that does make a change. When you think of the fashion industry you first think of a very superficial core of the capitalism and consumerism. However, we should also not forget that fashion is the fastest changing system maybe after technology. You as a creator have the choice to change the course of things. The industry is morphing into a more conscious body thanks to the people who have been working their asses off to change it for a long long time.
9. DB Berdan is famously a mother and daughter collaboration. When did you realise that you shared a passion for creating and how rewarding is it to be on this path together?
We call ourselves a matriarchal company. Everything really came together organically. My grandmother was a seamstress and a really good one at that. Ironically, she would tell my mom not to get into the textile industry knowing all the good, the bad and the ugly. Well that didn't stop my mom to create DB Berdan. I was actually more interested in the historical side of clothing studying costume design for performance. But as I graduated, I started assisting my mom as the third generation of our working woman to join the industry. Now we became partners and we do things together. She's more into 90's masculinity and more into 80's feminine side of things. We join our forces together and create genderless looks.
10. This season has seen you debut on the main London Fashion Week schedule. As a fan it's incredibly exciting to see the label on such an upward trajectory. How would you like the brand to develop and evolve from here?
Our biggest new development for now is that we have started doing 6 seasons. We are a gender inclusive brand so as for mens we have decided to call it DB Berdan Masculin which will have more masculine designs.
Huge thanks and big love to DB Berdan for providing such a fascinating and thought-provoking insight into their ethos and influences. Also, many thanks to those lovely people at Black PR for arranging.
All images are photographer by @chatdorkson | @sodiumcollective


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Emergency Decontamination Operations Plan Get Started
Emergency Decontamination Operations Plan
An accidental release of hazardous substances is one of the more common disaster-prone events hospitals and communities face. If the release results in injuries or contamination, the victims typically receive their initial evaluation and treatment from the closest hospital regardless of the institution's level of preparedness.
The Emergency Decontamination Operations Plan is a comprehensive document that enhances your facility's existing Emergency Operations Plan (EOP) and incorporates the fundamental principles of all-hazards emergency management. This support annex for patient decontamination provides your facility policies for the following:
- Proper recognition, notification and plan activation procedures
- Staff safety, roles and responsibilities
- Incident management
- Decontamination area setup
- Emergency decontamination procedures
- Standard Operating Guidelines (SOG) for all decontamination procedures
- Documentation form templates
The Emergency Decontamination Operations Plan utilizes a proprietary planning tool that focuses on:
- Methods to recognize potentially contaminated persons
- Procedures for safely directing the person out of the hospital to an isolated area for further evaluation
- A process of notifying persons who are qualified to assess and manage contaminated persons
- Plan for physical location of contaminated patient staging, decontamination, and Decon Team assembly
- Personal protective equipment use and protocols
- Decontamination procedures
- Security Provisions
- Post decontamination follow up procedures
The Emergency Decontamination Operations Plan addresses:
- ICS for an Emergency Decontamination Operation
- Decon Area Setup
- Donning Personal Protective Equipment (PPE)
- Doffing Personal Protective Equipment (PPE)
- Emergency Decontamination Operations Procedures
- Decon Area Cleaning
- HICS Jobs Actions Sheets
- HICS Forms
- And more!


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Clare Hillitt
CN Manager for Children & Young People's Mental Health and Maternity
Clare was appointed as a Network Manager April 2013. Since April 2014 Clare has worked specifically to provide leadership and management to the Children's & Young People's Mental Health and Maternity Clinical Network to drive improvements in the outcomes and experiences of women, children and their families.
Clare joined the NHS in 1981 and worked in Directorate Manager roles for 26 years in Trusts in Nuneaton, Birmingham and Sheffield. This included seven years at Birmingham Children's Hospital managing a range of medical and surgical specialties as well as critical care and radiology and laboratory services. Clare's work in Sheffield in Plastic Surgery and Burn services included managing the transfer of paediatric burn services to Sheffield Children's NHSFT and supporting the establishment and development of the North of England Burn Network.
In 2009, Clare joined the North Trent Network of Cardiac Care as Network Director providing strategic leadership to the Cardiac Network and to the implementation of the National Stroke Strategy and development of North Trent Stroke Services. Clare is based at our Oak House office in Rotherham.
Laura Whixton
Quality Improvement Manager
Laura joined the Clinical Networks in February 2014 and is working with providers, commissioners, service users and 3rd party organisations to improve children and young people's mental health and emotional wellbeing across Yorkshire and the Humber.
Laura's NHS career started off in Doncaster and Bassetlaw Hospitals NHS Foundation Trust where she gained a range of project management experience being involved in the implementation of Choose and Book as one of the first non-pilot Trusts nationally to make a booking through the new system before moving on to work in Children's Services focussing on both the administration and medical workforce configuration along with out-patient performance monitoring. Laura is based at our Oak House office in Rotherham.
Anne Worrall-Davies
Clinical Advisor
Anne works as a Consultant Child & Adolescent Psychiatrist in the CAMH Outreach, and Early Intervention in Psychosis services in Leeds. She has over 25 years' experience of working with young people in community, assertive outreach, early intervention and inpatient settings across Yorkshire and the Humber. She has combined providing a service with implementing and evaluating innovative change to models of care, in both academic & clinical settings and has written and published in this field. She has written chapters in key textbooks on day services, outreach and inpatient CAMHS. Her previous academic post gave her the opportunity to teach and supervise research in lifespan mental health at undergraduate and postgraduate level. She also conducted primary and secondary research in the area of evaluation of innovative CAMHS models with numerous funded projects.
Her recent post in a Tier 4 CAMH inpatient unit allowed her to develop relationships with providers, and local and specialised commissioners across the region, and at a national level, in her role as Senate Representative for Yorkshire and the Humber to the Tier 4 CAMHS Clinical reference Group. She is a trained peer reviewer and accreditor for Quality Network for Inpatient CAMHS (QNIC) and sits on the QNIC Advisory Group and Accreditation Committee. She has been involved in developing quality standards for intensive CAMHS, eating disorders, and inpatient CAMH units.
She has an interest in promoting physical health in CYP with mental health disorders, and led on adoption of Lester guidelines in the outreach and inpatient services to ensure young people taking antipsychotics have the best chance of good physical health. She also led with colleagues on incorporating Junior MARSIPAN guidance into local protocols and ensuring that young peoples and families also understand the guidance.
Anne is also parent to an adolescent with moderate learning disability and autism, and hopes that she can bring a measured but nuanced understanding of the lived experience to her professional role.
Dr Claire Pearson
Clinical Advisor
I am Dr Claire Pearson and I work as a Consultant Clinical Psychologist in a Community CAMHS team in Sheffield. I have worked as the NE Collaborative Clinical Lead for Children and Young People's Improving Access to Psychological therapies for the last two years and joined as a Clinical Advisor for Yorkshire and Humber in July 2016.
I have worked with Children and Families since I qualified in 1999. I have worked in a range of settings including in- patient settings, paediatrics, sure start (under 5's), child protection and community CAMHS. I have a special interest in attachment theory, trauma work and developmental disorders, although most of my recent training has been around clinical leadership
Rob Mayall
CYP MH Local Authority Specialist Advisor
Rob has over 30 years' experience of providing, managing, developing and improving services for children and young people at an operational, managerial and strategic level. For the past 25 years Rob has led organisational and system change and development, including establishing and developing organisations, designing and implementing systems and processes to secure continuous improvement and managing significant and often fluctuating budgets.
Since 2001 Rob has overseen the development of integrated approaches to the provision of services, initially as Chief Executive of the first Connexions Service in the East Midlands, subsequently as an Assistant Director of Children's Services and latterly as a DfE Children's and Learners Strategic Adviser (CLSA)
Since October 2010 Rob has been an independent provider of children's improvement services, working on national policy activity and with local authorities and other providers of services for children as an independent consultant. Rob is an Associate of a range of organisations including the Local Government Association, the Virtual Staff College, SDSA (East Midlands), and the University of Hull. Rob has also been an Improvement Broker for the National Children's Improvement Board. Much of his work is in Yorkshire and the Humber where he has worked for several years supporting the development of approaches to children's services sector led improvement and, in particular, designing and leading regional leadership activity and business managing over 20 peer challenge activities. Rob is a registered Local Government Association (LGA) Peer Reviewer and a qualified Executive Coach and Chair of the North East Lincolnshire Children's Safeguarding Board and North East Lincolnshire Safeguarding Adults Board.
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Former European cruiserweight title challenger Ian Tims has told rising star Jack Massey a slot on the Tyson Fury undercard may be a poisoned chalice.
Tims (13-5-KO4) faces an unbeaten fighter 13 years his junior in Massey (13-0-KO6) on June 9 and says the Derbyshire youngster is the one who has it all to prove under the bright lights.
Tims said: "It could be that Massey is overawed by the occasion. I don't know him so I can't say. It's a problem sometimes when young fighters come up and hit the big cards. They try and play to the crowd.
"I've been on big cards before fighting for titles and world title fights headlining. Tyson Fury is the lineal world champion and it's a great show to be on but I've been on big stages before.
"I take every fight with no pressure. I just enjoy the fighting. I turned professional late and have had a lot of injuries. All the pressure is on Jack Massey. People expect him to win."
Tims fought three times last year – including a clash with Commonwealth champion Luke Watkins – and despite his advancing years, is showing no signs of losing enthusiasm for the daily physical grind.
Tims added: "I still train the same as I always have. I do everything – including the running. Everybody goes on about science playing a key role these days but I'm old school in my approach.
"People say they don't do too much of this because of that or too much of this because of that but I just get on with it. I'm not into all that science stuff. It's the fighting I enjoy.
"I have a few people I want to fight before I hang up the gloves but let's see where we are after the fight with Massey."


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- 55 percent of excluded pupils and 49 percent of young people have been the victim of a crime. Young men aged 16-24 are most at risk of violent crime. In 2005-6 12.6 percent of this group were victims of violent crime.
- 90,000 boys in Britain leave school every year with not a single GCSE.
- 9,400 children were permanently excluded from school in 2004-5. Black pupils are up to three times more likely to be excluded than white pupils.
- 2,878 under 18 year olds in custody in February this year. The number of 15 to 17 year olds locked up has more than doubled in the last ten years. Around 85 percent of young people in prison have mental health problems.
- 1.6 million children live in housing that is overcrowded, run down, damp, or dangerous. There are over 8,000 homeless 16 to 17 year olds in Britain, according to figures collected by the housing charity Shelter.
- 631,000 prescriptions were given to children under 16 for depression and other mental health disorders in the last financial year. In the mid-1990s the figure was 146,000. Around one in ten five to 16 year olds have a clinically recognisable mental health disorder.
- 200,000 more children were living in poverty in Britain last year. In 2005-6, 3.8 million children were in relative poverty – defined as homes on less than 60 percent of average income including housing costs. This increase on the 2004-5 figures was the first rise in nearly a decade.
- 1.2 million 16-24 year olds are not in education, employment or training.
- 21st is Britain's position for child well-being in a Unicef league table of 21 industrialised countries – including Poland and Hungary – published in February. Britain and the US were in the bottom third of the rankings for five of the six categories covered.
The crisis facing young people
Issue No. 2066
Article information
Tue 28 Aug 2007, 18:17 BSTIssue No. 2066


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Irene M. MacDougall
Attorney Profile
Top Rated Government Finance Attorney in Cleveland, OH
Walter | Haverfield LLP
| The Tower at Erieview, Suite 3500, 1301 East 9th Street
Cleveland, OH 44114
Cleveland, OH 44114
Selected To Super Lawyers: 2010 - 2021
Licensed Since: 1983
Practice Areas:
- Government Finance (40%),
- Real Estate: Business (30%),
- Banking (30%)
Attorney Profile
Irene M. MacDougall is a top-rated attorney selected to Super Lawyers for 2010 - 2021. She works at Walter | Haverfield LLP, located in Cleveland, Ohio, and provides legal services for issues involving Government Finance and Real Estate: Business and Banking to the surrounding community.
Irene MacDougall passed the bar in 1983.
Only a few attorneys from each state are selected to Super Lawyers designation for any given year. The multi-factor selection process includes independent research, peer nominations and evaluations, as well as professional achievement in legal practice.
Additional Sources of Information About Irene M. MacDougall
Irene M. MacDougall:
Last Updated: 8/19/2020


text:
Various shots of cute babies having health checks - being weighed, measured etc.
Short Summary
United States of America.
"Child welfare is a very great feature of American life, and to help in making baby fit to be a healthy "grown-up" careful watch is kept on its progress." M/S of a baby sitting on a table, a nurse puts a tape measure around its head to measure the circumference - the baby cries. She then measures its chest. The baby is placed on the scales - it sits in the dish of the weighing scales. C/U of doctor with a stethoscope listening to the breathing of a little girl. "Every minute growing prettier - and some growing impatient!" C/U of three babies, two crying and one looking very grumpy. A nurse has her arms around them. M/S of four toddlers with towels wrapped around them. "A real hundred-per-center." C/U of a pretty toddler.
Note: flash-frame intertitles. Was an Eve's Film Review item - issue unknown.
Nitrate print only. Although the print dates from 1931, Julian has dated the original film from stock marks as 1921.
- Film ID:
- 752.15
- Media URN:
- 35239
- Group:
- Eve pictorials
- Archive:
- British Pathé
- Issue Date:
- Sound:
- Mute
- HD Format:
- Available on request
- Stock:
- Black & White
- Duration:
- 00:01:02:00
- Time in/Out:
- 01:28:23:00 / 01:29:25:00
- Canister:


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This forum is closed. Thank you for your contributions.
Dear sirs,
I have a Microsoft Sidewinder Precision Pro Joystick, and I am attempting to install it through the adapter of my laptop Toshiba, and along with that I intended to plug the USB chord into the VMWare application where I have Windows Vista where I play old
games on it, I desire to use the Joystick for ease of playing some old CD-ROM games that I have installed on Windows Vista under VMWare for ease, however, I have had the trouble of trying to get the software to recognize the Joystick. It should have recognized
the device that I was installing, but it did not, niether does Windows 8 (the current software that I am using) recognize the joystick when I plug it in through USB. Can you give me the steps on how to successfully get both Windows Vista, and Windows 8 to
recognize the Microsoft Sidewinder Joystick in order to trouble shoot this problem, I would appreciate it very well.
The Part no. X03-57540 , and the Product ID: 85791-579-7678597-00000
Thanks for looking into this.
Robert Gutierrez


text: About Us Our impact Our Impact Concordia is committed to improving local communities globally through sustainable and beneficial volunteer projects. We are focused on what different communities need support with, ensuring that our goals are aligned with the individuals or groups in need. Once volunteers return home, they have the opportunity to lead a volunteer project both here in the UK or abroad. Some members of the Volunteer Team in the Concordia office were previously Concordia volunteers themselves. In addition, we have taken on interns from the University of Brighton and the University of Sussex who have gone on to be permanent full-time staff in our Brighton office. The experiences you have as a volunteer provide you with invaluable transferable skills. Not only do we make a positive difference in other countries, we also are deeply invested in the well-being of our local communities. Concordia's delivery of the NCS programme in West Sussex has helped to improve the lives of many young people. In Summer 2019, 258 young people graduated from the NCS programme. Successful completion of NCS involves planning charity events and presenting ideas to local business owners & Members of Parliament. Alongside making life-long friendships and having fun, our NCS graduates have now gained new skills and improved their self-confidence. In total our NCS participants invested 7,080 hours into positive action in their local community. Our NCS graduates can then join our Youth Group who perform charity work in the local community. Some of our Youth Group's previous work has been in food banks and animal shelters. As a part of the International Voluntary Service (IVS Movement), Concordia has helped in the delivery of over 5,000 projects across 84 countries. These 5,000 projects amount to 3 million hours of volunteer work. In addition to volunteer work, we are involved with the IVS Movement's campaigns for global justice and equity, such as: Freedom of Movement, Climate Justice, Raising Peace & Soil Protection.


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The Faculty of Mathematics and Natural Sciences (FMIPA), Malang State University (UM) hosted the 5th Asia deans of science meeting or The Asian Science Deans Summit (ASDS) on Wednesday (10/07) at Santika Hotel Premiere Malang. Previous ASDS meetings have been held in Korea, Malaysia, Indonesia and Thailand. The 5th ASDS attended by 61 Asian deans of science raised the theme "Strengthening Mobility and Cooperation related to Education, Research and Community Service" or "Reinforce Mobility and Networking Activity on Teaching, Research and Community Services".
The aim of this activity is to promote and provide a platform for networking and collaboration between science faculties in ASDS member countries. Through discussion and exchange of knowledge, experience and insight, ASDS members can jointly improve the standards of higher education, research and community service, for the benefit of the world, especially Asia.
"The purpose of this meeting is to build collaboration and networking to improve the quality of learning, research and community service. At the same time supporting the 4.0 industrial revolution to improve the welfare of society, "Assoc said. Prof. Dr. Hadi Suwono as Dean of FMIPA UM as well as the person in charge of implementing this ASDS activity.
ASDS was held for three days (09-11 / 07) with a series of activities as follows: Plenary related to several important topics namely 1) International Accreditation, Strengthening Cooperation and Collaboration, Community Service and Increasing Student Exchange Activities, 2) Signing of MoU between Science faculties , and 3) Group discussions. Besides that, there are also tourism and cultural tour activities in Malang City including Bromo Mountain and Angkot Museum which aim to promote East Java, especially Malang City and its surroundings.
"I believe we can jointly solve the problems of contemporary science and improve the standards of higher education, research, and community service that benefit the Asian community," said Prof. Dr. H. Ahmad Rofi'udin when before officially opening the activity.
Sukolilo | Manyar | Tjokroaminoto Kampus Institut Teknologi Sepuluh Nopember Surabaya Email : email@example.com Phone: 031-5994251-54, 5947274, 5945472 Fax: 031-5923465, 5947845


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Gazing into the eyes of a loved one, friend, or complete stranger is a natural instinct, and one brain scans can now prove. Researchers from the National Institute of Physiological Science (NIPS) took a closer look at what's going on inside the brain as one person gazes into the eyes of another. Their findings, published in the journal NeuroImage, provide unique insight into why eye contact is necessary to establish social interactions.
For the study, the research team examined the eyes of 96 participants who had never met before. Over the course of two days, participants sustained eye contact with one another during three different experiments. As they cast their gaze, researchers used a functional magnetic resonance imaging (fMRI) machine to monitor brain activity.
I – Word Understanding
Social interactions– is the way people talk and act with each other
Eye contact – the act of looking directly into one another's eyes.
II – Have Your Say
• Another recent study conducted by a research team from Leiden University in the Netherlands confirms the power eyes have when it comes to building trust. In your part is eye contact effective?
• By doing eye contact, do you thing is necessary to establish social interactions and Why?
395 Brain Scans Reveal Why Eye Contact Is Necessary For Socialization: Look Into My Eyes


text:
Is Facebook still good for businesses?
With recent changes to Facebook and other platforms biting at its heels, simply having 2 billion monthly active users might not be enough to consider Facebook good for business.
Small Businesses in Norfolk and Suffolk are rightly concerned by the impact of the Coronavirus – what should you do?
Ian Bird Business Adviser with Enterprise Agency Nwes looks at the problems faced and what to do.
All my training says "plan, plan, plan", so when things get rough I do just that, I have a plan A and a plan B sometimes a plan C and D too. In these unprecedented times I believe a plan will help most businesses with the extraordinary situation we now find ourselves in, it can't hurt that's for sure. We will need lots of other support, both financial and advice, but the government are listening and responding to business needs.Continue Reading
With recent changes to Facebook and other platforms biting at its heels, simply having 2 billion monthly active users might not be enough to consider Facebook good for business.
Networking is a key skill for any business, whether you're just starting up or looking to grow. Networking can help you gain clients, collaborators, suppliers and interest in your business. It's also an experience sharing opportunity, where you can learn from other like minded entrepreneurs. So, to ensure you get the most out of any networking event, here are six important tips to remember.
Rouen House Centre Coordinator Katie Howard, explores what it takes to set-up a business and finds out first hand how one of Nwes' most popular start-up workshops can help.
Do you feel tired at work more often than you should? Do you rely on too many strong coffees to sustain you throughout your working day? Kate Piegon-Owen (BA Hons), Founder, Childways Ltd, guest blogs for Nwes to discuss how to improve your wellbeing for business.
The UK's largest Business Exhibition was held in November this year and the Nwes team were of course in attendance. The 38th Business Show was held in Olympia, London and was an exciting year for Nwes with the launch of the UK's only online business resource platform, Start&Grow – a project we're pleased to say is fulfilled by the Nwes team.
Do you want to know how to exhibit at events like a global brand? In this article, our very own Emily Farmer shares her experiences on how to excel and achieve a good return on event marketing.
"Networking is necessary in today's business environment and possibly a part of your marketing strategy that has not been considered." Nwes Business Advisor, Stephen Davies offers a few tips which may prove useful.
'I Do' Networking - a new networking event for start-ups and existing businesses in the wedding industry - took place in Norwich.
What makes a successful networking event? Whatever it is, Norwich's Start Up and Grow Network has it.
Nwes event 'New Year, Bright Idea' welcomed budding entrepreneurs on 16 January. Despite being a chilly, January evening, over 25 people turned out to discover how they could turn their business dream into reality.


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Tag archive for: shop design
The abbreviations DIY, DIWM and DIFM are often mentioned when talking about running an online shop and working on optimising a shop design. Find out below what these abbreviations actually mean and which design approach is exactly the right one for your own shop.
Images can make an enormous difference to the impact your online store and its marketing initiatives have upon a current or potential customer. In this article, we show you many sources for free, beautiful images.
By using the Logaster app for ePages, you can quickly get a logo for your shop. In our article, we show you how easy this is.
The e-commerce market is highly competitive. What should merchants consider if they are to beat their competition?
With the ePages premium themes your shop will have a new, modern and outstanding design.
Websites have undoubtedly evolved from designs where only the content mattered, to designs where the pictures now play the main role. Today we bring you an interview with Thomas Laleike, web design expert at ePages, to dig a bit deeper in the design world, how to stay on the crest of the wave and what you can learn from it for your shop design.


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|Led by:
|Judith Hankey of Southampton U3A
|is from Gosport
Send %Judith% an email if you want to know more about how to get involved. Beginners and those with more knowledge are all welcome to go along. Please check any costs and insurance requirements with the leaders before you set sail!
See the link to the report of the Sailing Group in 2018.


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Article Text
Introduction Gestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. However, evidence is sparse and the effect of GDM on cardiovascular health is unknown. To address these issues, we will conduct MySweetHeart Cohort study. The objectives are to assess the effect of GDM on offspring's cardiovascular health early in life by using surrogate markers of cardiovascular disease and atherosclerosis.
Methods and analysis This is a cohort study of 100 offspring of women with GDM and 100 offspring of women without GDM. At inclusion, a baseline assessment of the mothers will be conducted through means of self-report questionnaires, a researcher-administrated interview, blood pressure and anthropometric measurements, and a maternal blood sampling. Between the 30th and 34th weeks of gestation, a foetal echography will be performed to assess the foetal cardiac structure and function, the fetomaternal circulation and the hepatic volume. At birth, maternal and neonatal characteristics will be assessed. An echocardiography will be performed to assess cardiac structure and function 2–7 days after birth; carotid intima-media thickness will be also measured to assess vascular structure. MySweetHeart Cohort is linked to MySweetHeart Trial (clinicaltrials.gov/ct2/show/NCT02890693), a randomised controlled trial assessing the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention to improve the cardiometabolic and mental health of women with GDM and their offspring. A long-term follow-up of children is planned.
Ethics and dissemination Ethical approval has been obtained through the state Human Research Ethics Committee of the Canton de Vaud (study number 2016–00745). We aim to disseminate the findings through regional, national and international conferences and through peer-reviewed journals.
Trial registration number ClinicalTrials.gov (clinicaltrials.gov/ct2/show/NCT02872974).
- cardiovascular disease
- carotid intima-media thickness
- left ventricular mass index
- foetal programming
- paediatric
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Statistics from Altmetric.com
- cardiovascular disease
- carotid intima-media thickness
- left ventricular mass index
- foetal programming
- paediatric
Strengths and limitations of this study
This study will increase our understanding of the impact of gestational diabetes mellitus on cardiometabolic health during foetal and neonatal periods. Within a Developmental Origin of Health and Disease framework, it will contribute to improving the knowledge on the early life conditioning (programming) mechanisms and their influence on infants' cardiovascular health.
A major strength of our study is the assessment at birth of surrogate markers of cardiovascular disease (CVD) (left ventricular mass index and subclinical atherosclerosis (carotid intima- media thickness)).
Acknowledged limitations are the relatively small sample size, the potential for residual confounding and the limited representativeness of our sample (monocentric study).
A better understanding of the clinical impact of the maternal hyperglycaemic disorders on offspring's health early in life is needed to inform strategies for the early prevention of CVD.
A long-term follow-up of children is planned for further assessment of their cardiovascular health.
Maternal hyperglycaemic disorders during pregnancy
The prevalence of maternal hyperglycaemic disorders during pregnancy is increasing in the population due to the obesity epidemic and the increasing age of pregnant mothers.1–3 Maternal hyperglycaemic disorders include type 1 and 2 diabetes mellitus (T1/T2DM) and gestational diabetes mellitus (GDM). T1/T2DM is a state of glucose intolerance occurring independently of pregnancy, while GDM is characterised by glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery.4 5 GDM is associated with an increased risk of maternal metabolic syndrome and T2DM2 3 6 and is now the most frequent form of hyperglycaemic disorders during pregnancy.2
Maternal T1/T2DM diabetes is associated with significant fetal and neonatal morbidity,4 for example, large for gestational age (LGA), congenital malformations and neonatal metabolic disorder (hypoglycaemia).3 7 8 There is some evidence that the foetal consequences are more serious with T1/T2DM diabetes than with GDM4 and, until recently, the consequences of GDM on offspring's health were uncertain.9 Nevertheless, the large high-sensitiviy C reactive protein (HAPO) cohort study showed that maternal hyperglycaemia less severe than in T1/T2DM, after correction for potential confounders (maternal obesity, blood pressure), was also associated with adverse perinatal outcomes, that is, LGA, neonatal hyperinsulinism and hypoglycaemia, and pre-eclampsia.9–11 Furthermore, in large randomised trials, treatment of GDM resulted in better perinatal outcomes, including a reduced risk of LGA.4 12–15
Following the results of these studies, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) have proposed new criteria to diagnose GDM.3 The benefits of screening and treatment of GDM have long been debated14–17 and recommendations from medical societies varied from no screening at all, screening only high-risk women (risk-based screening), to universal screening. Thus, the IADPSG recommend universal one-stage screening procedure that includes a 2-hour 75 g oral glucose tolerance test (OGTT). A single abnormal glucose concentration at fasting, at 1 hour or at 2 hours is sufficient for the diagnosis of GDM.14 New blood glucose threshold were derived from the HAPO study and based on pregnancy outcomes associated with the glucose level.10 14 Using these criteria, the prevalence of GDM is expected to be high, reaching up to 10%–20% of pregnant women in US populations.3
Cardiometabolic effects of maternal DM
Maternal hyperglycaemic disorders are associated with fetal cardiac and vascular structural and functional alterations. For instance, it is well known that offspring of T1/T2DM mothers are at increased risk of congenital cardiac malformations and cardiac hypertrophy.8 18 In a retrospective study of 92 offspring of 87 diabetic mothers conducted in Lausanne, we observed that 5 neonates had congenital heart disease and 12 had ventricular hypertrophy.8 There is also growing evidence that maternal hyperglycaemic disorders may be involved in the 'foetal programming' of obesity and metabolic disorders in their offspring.11 19 Within a Developmental Origin of Health and Disease (DOHaD) framework,20 21 fetal programming (or conditioning) is the process involved in the associations between the exposure to detrimental factors during foetal life and health outcomes later in life.22 Foetal programming is suspected to be involved in the development of cardiometabolic disorders, such as elevated blood pressure, coronary heart diseases or DM, notably through epigenetic mechanisms.20 21 Despite recent and large growth in this research area, studies are needed to better objectively characterise both early life exposures and cardiometabolic outcomes.23
Intrauterine exposure to high maternal blood glucose is associated with foetal hyperinsulinism which is responsible for structural and functional changes affecting mostly the liver and the cardiovascular system. The liver is the major metabolic organ, considered as the metabolic brain and responsible for the distribution of the placental resources.24 Recent studies have shown that macrosomic offspring had impaired liver blood perfusion that contributes to foetal growth alteration25–27 and that differential perfusion of the foetal liver modified hepatic metabolic function and size.24 Studies indicate that the liver is enlarged in foetuses of T1/T2 DM mothers.28 29 Furthermore, and similarly the foetal heart response to hyperinsulinism is the development of an asymmetrical hypertrophy predominant at the septal wall. The evaluation of liver volume, interventricular septum thickness and left ventricular mass is therefore of outmost importance and may represent surrogate markers of the foetal metabolic response to maternal GDM.
Lack of data on the effects of GDM on offspring's cardiovascular health
Most studies on the effect of maternal hyperglycaemic disorders were conducted among mothers with T1/T2DM, not among mothers with GDM and with an emphasis on the effects on offspring's metabolic outcomes rather than on offspring's cardiovascular health. It is also unknown whether treatment of GDM is effective to reduce long-term risk of offspring's metabolic and cardiovascular disease (CVD) risk9 11 15 and the new definition of GDM calls also for the conduction of further studies on the impact of GDM on offspring's cardiovascular health. To study the early development of atherosclerosis and pathogenesis of CVD, it has become central to assess surrogate markers of CVD such as increased cardiac mass (left ventricular mass index; LVMI)30 and of subclinical atherosclerosis (assessed through carotid intima-media thickness; cIMT).30 31 These markers have been used extensively in studies in children and young adults with CVD risk factors.30–34 However, to our knowledge, the effects of GDM on offspring's foetal and early neonatal cardiovascular health, and in particular on such surrogate markers,31 have never been studied.
Our objectives are to assess the effect of GDM on offspring's cardiovascular health early in life, namely on (1) the surrogate markers of CVD and atherosclerosis at birth (LVMI and cIMT) (primary outcomes) and (2) the cardiovascular structure and function during the foetal period and potential neonatal cardiovascular risk factors (secondary outcomes).
Methods and analysis
Study design
We plan to conduct a cohort study of 200 offspring of women aged 18 years old or more. We will include 100 women with GDM and 100 without GDM. All pregnant women attending the antenatal care clinic or the GDM clinic at the Lausanne University Hospital (CHUV) will be invited to participate. In addition, women with GDM who are followed up by private diabetologists and gynaecologists in the Canton de Vaud will be invited to participate following a similar procedure. Using the new criteria of the IADPSG, the expected prevalence of GDM in this population is at least ~10%.3 Women with T1/T2D will not be included.
Study population
Inclusion criteria: Pregnant women aged 18 years or older, with or without GDM at 24–32 weeks of gestation, and understanding French or English. Exclusion criteria: Women on strict bed rest, with pre-existing DM or severe mental disorders precluding participation.
Study outcomes
Primary outcomes are surrogate markers of CVD and atherosclerosis at birth, that is, LVMI and cIMT. Secondary outcomes are foetal cardiovascular structure and function (notably LVMI and liver volume) and potential neonatal cardiovascular risk factors (including cord blood lipid levels, glycaemia, insulin, high-sensitiviy C reactive protein (hs-CRP), etc).
Data collection and visits
During pregnancy, in the pre-recruitment phase, all pregnant women without pre-existing DM, attending the CHUV antenatal care clinic, have a fasting blood glucose measurement between the 24th and 28th weeks of gestation. GDM is diagnosed if fasting blood glucose is equal to or above 5.1 mmol/L. If fasting blood glucose is equal to or above 4.4 and below 5.1 mmol/L, pregnant women have a 2-hour 75 g OGTT and GDM will be diagnosed based on the new criteria of the IADPSG.3 9 Women screened by private obstetricians in the Canton de Vaud undergo either the same procedure or directly a 2-hour 75 g OGTT. Considering the variability in patients' compliance and time of enrolment for prenatal care, all eligible women, having been screened for GDM before 32 weeks of gestation, will be invited to participate (see inclusion and exclusion criteria in the Study population section).
The participation in the study is voluntary and involves a sequence of events and measurements as summarised in table 1.
At the first study visit (V1), scheduled between the 24th and 32nd weeks of gestation, a baseline assessment of the mothers will be conducted through means of self-report questionnaires and a researcher-administrated interview, weight, height and blood pressure measurements, and a maternal blood sampling. This will provide information notably on the socioeconomic status, general health status, family medical history of CVD or diabetes, smoking and drinking habits and several cardiometabolic biomarkers, all of which will be treated as potential confounding factors. If available, paternal data on the family history of CVD or diabetes will be also collected at the first study visit.
At the second visit (V2), between the 30th and 34th weeks of gestation, a foetal echography will be performed to assess the fetal cardiac structure (including LVMI) and function, the fetomaternal circulation, and the hepatic volume.
In women with GDM, information about treatment and blood glucose measurements will be recorded during the whole pregnancy.
At birth (V3), maternal characteristics (including mode of delivery, gravidity, parity, etc) and neonatal characteristics (including gestational age, sex, weight, length, etc) will be assessed. A sample of umbilical cord blood will be collected to measure various biomarkers, including glucose, insulin, total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, uric acid, creatinine, hs-CRP and various miRNA.
An echocardiography will be done to assess cardiac structure (including LVMI) and function 2–7 days after birth (V4). cIMT will be measured to assess vascular structure.
Measurements methods
Maternal clinical assessment
Maternal body weight and blood pressure (three readings at 2-min intervals with a clinically validated35 oscillometric sphygmomanometer (OMRON HEM-907)36 37) will be measured during pregnancy (V1, V2) and in postpartum (V4). Clinical chemistry (including glucose, hemoglobinA1c (HbA1c), insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid and creatinine) will be assessed at the first study visit (V1) and blood will be collected for further potential analyses. All samples will be managed and stored in a biobank. The clinical data assessed as part of the usual care of the mother and potentially influencing the outcomes of interest will be collected. Also, information on socioeconomic characteristics, general health, family history of CVD or diabetes, smoking and drinking habits and so on will be gathered using a self-report questionnaire and a researcher-administrated interview.
Offspring clinical assessment
The height and weight of the neonate will be measured and the growth reference charts of the Swiss Society of Paediatrics will be used.38 39 Gestational age will be determined using either the date of the last menstrual period or the first-trimester ultrasound dating. Clinical chemistry (including glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, insulin, uric acid, hs-CRP, mi-RNA) will be assessed at birth using cord blood. We will explore the profile of circulating non-coding RNAs in offspring of women with GDM and without GDM to assess the involvement of epigenetic mechanisms in cardiovascular alterations.40 Blood for future analyses will be stored in a biobank. The clinical data assessed as part of the usual care of the offspring and potentially influencing the outcomes of interest will be collected.
Foetal echography
oThis examination will be performed between the 30th and 34th weeks of gestation by two experienced ultrasonographers (YM, YV), blinded to the maternal glycaemic status, using a Voluson E10 (General Electric Medical Systems, ZIPF, Australia) equipped with a 2–8 MHz convex array sector transducer.41 A systematic echography will be conducted to detect structural and functional anomalies following international recommendations.42 43 Anthropometric measurements and foetal well-being parameters will be measured.44 Observed foetal weight (FW) will be calculated using the Hadlock et al's formula based on the head circumference, biparietal diameter, abdominal circumference and femur length.45 The gestational age-adjusted expected FW will be calculated46 and the discordance with observed FW will be determined as (observed FW−expected FW)/expected FW. This discordance will be used to quantify appropriateness of foetal growth. Then, a detailed echocardiography of the foetal liver, cardiovascular system and of the maternofoetal circulation will be conducted including bidimensional (2D), M-Mode (M), Doppler (D) and tridimensional (3D) imaging of the following structures: cardiac four chambers (2D), right ventricular (RV) and left ventricular (LV) short axis (2D, M), tricuspid, pulmonary, mitral and aortic valve (2D, D), umbilical vein, ductus venosus, patent ductus arteriosus, aortic isthmus, umbilical arteries and maternal uterine arteries (2D, D) and liver (2D, 3D).47–50 This will allow the assessment of the LV posterior wall and septal thickness, the LV mass,51 the LV and RV systolic and diastolic function, the cardiothoracic ratio, the placental and foetal vascular resistances, the cardiac output and liver volume. Data will be digitally stored to allow off-line analyses. Measures will be expressed as Z-scores based on gestational age to allow comparison between foetuses.
Neonatal cardiac echography
This examination will be performed 2–7 days after birth (before the mother and the newborn leave the clinic) by two experienced ultrasonographers (NS, SDB) blinded to the maternal glycaemic status and to the foetal echocardiogram. Echocardiography will be performed on a Philips EPIC echocardiogram with a S8-3 or S12 MHz transducer, digitally recorded (Xcelera, Philips) and analysed off-line. Standard echocardiography including 2D, M-mode, colour and spectral Doppler according to the American Society of Echocardiograph (ASE) will be performed.52 53 Measurements will be performed according to the standard of the ASE52 53 including: (1) right and left atrial chamber sizes; (2) LV size, volume and function; (3) LV mass; (4) LV and RV systolic and diastolic function. Z-scores based on BSA calculated by the Haycock formula will be used to express these measurements.54–56
Neonatal carotid echography
This examination will be performed 2–7 days after birth (before the mother and the newborn leave the clinic) by two experimented ultrasonographers (NS, SDB) blinded to the maternal glycaemic status. Carotid IMT measurement will be performed on a Philips EPIC echocardiograph (Philips Medical, Netherland) with a L 11–5 MHz high-resolution linear array transducer, recorded on a digital system (QLab, Philips Medical Netherlands). Image acquisition will be done according to the standard of the American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on CVD in the Young.31 Image analyses will include: (1) far-wall cIMT; (2) calculation of the mean of maximal cIMT measurements; (3) calculation of carotid stiffness. Measurements of cIMT will be expressed in millimetre as mean±SD and compared with normal cIMTs.57 58 We have recently conducted a study to show that the measurement of cIMT was feasible in young non-sedated infants. This study conducted among 81 infants less than 1 year of age confirmed that cIMT was measurable with a high interobserver reliability (coefficient of variation: 5.9%).59
Anticipated recruitment
Recruitment has begun in September 2016. About 3200 deliveries per year occur at our hospital and about 250 pregnant women are followed for GDM at our specialised clinic. A relatively large share of patients consists of immigrants who do not speak English or French and will not be eligible for participation. We therefore expect to include up to two pregnant women per week, hence to include the 200 subjects in 30 months. A research coordinator (SE) and a PhD student (AME) will be responsible to screen all women for eligibility and to ensure follow-up throughout the study duration. Recruitment will be facilitated by the high support of obstetricians at the CHUV. We will also benefit of the new specialised GDM clinic of the CHUV where every pregnant woman who screened positive for GDM at the CHUV antenatal care clinic is followed up. MySweetHeart Cohort is linked to MySweetHeart Trial (clinicaltrials.gov: NCT02890693; led by Professor Jardena Puder and PD Dr Antje Horsch), a randomised controlled trial led by this new specialised GDM clinic designed to assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention to improve the cardiometabolic and mental health of women with GDM and their offspring. Little loss to follow-up is expected because measurements are made during pregnancy and shortly after delivery. Nevertheless, to minimise loss to follow-up, most appointments are made on the days of regular follow-up visits and the postnatal echocardiography is scheduled before the mother and the baby leave the hospital.
Sample size
Assuming that LVMI will be 30 g/m2.7(SD: 4.5) in children of mothers without GDM60compared with 32 g/m2.7(SD: 4.5) in children of women with GDM, the required sample size is 80 women with GDM and 80 women without GDM to have a statistical significant difference with a power of 80% and an alpha-level set at 0.05 (two sided). This sample size is also sufficient to observe statistical significant differences in cIMT at birth if we assume that cIMT at birth is 0.44 mm (SD: 0.04)31 in newborn of women with GDM and 0.42 mm (SD: 0.04) in newborn of women without GDM. In the worst case scenario, we could lose up to 20% of participants between inclusion and delivery. Therefore, we plan to include 100 pregnant women with GDM and 100 women without GDM.
Statistical analysis
The association between exposure (GDM/no GDM) and the (continuous) outcomes will be estimated with linear regression analyses. Adjustment for potential confounding factors (maternal characteristics such as age, body mass index, blood pressure, socioeconomic status, personal history of CVD, treatment for GDM during pregnancy) will be done. To assess the direct and indirect (through mediators) effects of GDM on the outcomes, causal mediation analyses will be conducted.61 62 Because LGA is a potential mediator of the effect of GDM on offspring outcomes,63 analyses adjusted on birth weight will be conducted to estimate the indirect effect of GDM on the outcomes (figure 1). We will also consider the effect of treatment which will be treated as a mediator between GDM, LGA and outcomes.
Ethics and dissemination
The study poses little to no risk to participants and their offspring. Signed informed consent is obtained from all participating women. Participation in the study does not interfere with the typical care patients receive during pregnancy and after delivery. Clinicians in the obstetrical clinic provide clinical follow-up and, if necessary, participants are referred on for additional clinical management.
Results from this study will be disseminated at regional and international conferences and in peer-reviewed journals.
Significance and outlook
The current high prevalence of maternal obesity and associated hyperglycaemic disorders may lead to a perpetuating intergenerational cycle of increasing obesity, metabolic and cardiovascular disorders. Well-designed prospective studies are necessary to better quantify the actual impact of maternal hyperglycaemic disorders on offspring's health and to identify the potential underlying mechanisms. Despite recent significant advances in DOHaD and foetal programming research, major challenges have to be addressed, notably by better objectively characterising both early life exposure and cardiometabolic outcomes.23
Indeed, many past studies on the foetal programming of cardiometabolic disorders suffered from some methodological flaws including confounding, no or poor standardisation of exposure and outcome assessment, and selection bias. Our prospective population-based study in pregnant women whose offspring is examined during fetal life and at birth avoids some of these issues. The long period needed for CVD to develop could be a limitation, but this will be overcome in our study by measuring surrogate outcomes (including LVMI and cIMT) that are well-established precursors of CVD.31 In addition, a long-term follow-up of the offspring is planned (not funded yet) for further assessment of their cardiovascular health.
By looking at the fetomaternal circulation, foetal cardiovascular system and liver and foetal growth and CVD risk markers at birth, we will acquire unique data to gain insight in the early mechanisms underlying the development of CVD and metabolic diseases and on the role of maternal hyperglycaemic disorders. GDM is an opportunity for timely intervention for the prevention of cardiometabolic disorders in mothers and their offspring.9 With the new criteria to define GDM, a growing proportion of women will be concerned by this disorder. Having a better understanding of the clinical impact of maternal hyperglycaemic disorders on offspring's health early in life is urgently needed to inform strategies for the early prevention of CVD.
SDB and YM contributed equally.
Contributors NS, AC, SDB and YM designed the study with input from all other authors. SDB and YM drafted the manuscript and contributed equally to the present work. US, PB, AME, SE, YV and AC significantly contributed to the establishment and refinement of study procedures and critically revised the manuscript. All authors approved the final version of the manuscript.
Funding This study is funded by the Swiss National Science Foundation (Project 32003B-163240). The study protocol has been peer-reviewed by national and international experts before being funded.
Competing interests None declared.
Ethics approval The study has been approved by the state Human Research Ethics Committee of the Canton deVaud (study number 2016-00745).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement It is the intention of the authors that once MySweetHeart Cohort is completed and the research articles emerging from the study have been published, the data set supporting the results and conclusions presented in the respective research articles to be made available in the DATA@IUMSP repository, .
Collaborators The following are members of MySweetHeart research group (including the authors of the present article), listed in alphabetical order: Pascal Bovet, MD MPH (Institute of Social and Preventive Medicine (IUMSP), Professor, Lausanne University Hospital, Lausanne, Switzerland; email@example.com). Arnaud Chiolero, MD PhD, Senior lecturer (Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal Canada; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; firstname.lastname@example.com), Stefano Di Bernardo, MD, Lecturer, (Pediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Adina Mihaela Epure, MD (Pediatric Cardiology Unit, Woman-Mother-Child Department; Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Sandrine Estoppey Younes, Msc (Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Leah Gilbert, MSc (Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Justine Gross, HES (Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Antje Horsch, DClinPsych, assistant Professor, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Bengt Kayser, PhD, Professor (Institute of Sport Sciences, University of Lausanne; firstname.lastname@example.com), Stefano Lanzi, PhD (Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Yvan Mivelaz, MD, Lecturer (Pediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Jardena J. Puder, MD, Professor (Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; firstname.lastname@example.com), Nicole Sekarski, MD, Professor (Pediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; firstname.lastname@example.com), Umberto Simeoni, MD, Professor (DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; email@example.com), Yvan Vial, MD, Professor (Obstetrics and Gynecology Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; firstname.lastname@example.com).
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AS sources of anxiety go, receiving a large sum of money must rank far down the list. But managing a windfall can be a stressful, hazardous undertaking.
While most people might be willing to take their chances, financial planners warn that great care must be taken to avoid financial and psychological pitfalls and ensure that a once-in-a-lifetime opportunity is not wasted.
Beneficiaries of a substantial payday, like a lottery winner, an heir to an estate or a shareholder in a company that goes public, may suddenly confront a wide range of life choices that they scarcely could have imagined. That is why the first recommendation that planners make to recipients of a windfall — an amount far beyond what they are accustomed to, not any particular dollar figure — is often to do nothing.
"One thing we counsel people to do is live beneath their means," said Leslie Lassiter, head of the Los Angeles office of J. P. Morgan Private Wealth Management, adding that someone coming into a lot of cash should "park it in a very safe place so you can absorb it."
Timothy Greenleaf, managing director of Fairmont Capital, a Brea, Calif., private equity firm, has means that provide ample headroom to live beneath. Still, he found a wait-and-see approach useful when he received a sizable payment after the 2010 initial public offering of the Green Dot Corporation, a provider of prepaid charge cards that he cofounded.
"Spend the day after your windfall like you spent the day before your windfall," he advised. "Many of the things you thought you wanted are going to seem less desirable. You can only spend a dollar once, so spend it wisely."
Mr. Greenleaf prefers not to say how many dollars he took away from the I.P.O., but he acknowledged that it was enough to make him, in the current vernacular, a 1 percenter. Based on his experience, he encourages windfall recipients to make estimated tax payments the first order of business and then to clear all debt off their families' books, including mortgages.
"You'll have greater comfort knowing your home is paid off and your loved ones provided for," he said. "You're going to feel good, but you're going to find it very sobering. You'll realize you have a lot less than you first thought."
Feelings of all sorts come into play when people come into money. Some do more harm than good, Elizabeth Ruch, a financial planner at Waddell & Reed in San Diego, has found.
Certain windfall recipients are "afraid to do anything, and suffer from absolute paralysis," she said, while others rush out to "buy that 96-inch TV or a new car."
I.P.O. beneficiaries often fall into the spendthrift group. Their attitude, Ms. Ruch observed, is, " 'I have slaved at this company and done without this and that. Now it's my time.' "
Lottery winners can also let windfall money slip through their fingers or have it pried loose. They "tend to be the ones, because they didn't do anything to earn it, who give to people who appear out of the woodwork," she said. "They feel guilty not giving money to a friend or their brother."
One way to avoid poor decisions driven by emotion is to rely on professional advisers, like accountants, financial planners and lawyers, said Ms. Lassiter of J. P. Morgan. Apart from expertise in their fields that can help windfall recipients when it comes time to decide how to invest or spend their money, they bring detachment and dispassion.
Good advisers can say no to "friends and relatives with their hands out," she said. Perhaps more important, they can say no to the person who pays them. "You want someone who's going to level with you and not sugarcoat it," she said.
Another reason that windfalls are mismanaged is that they are often a bolt from the blue. Someone who cashes in on an I.P.O. may be in a better position than other recipients because I.P.O.'s tend to be carefully orchestrated, so the payday is expected.
"What we see in Silicon Valley is more premeditated windfalls," said Ronald Gong, managing director for family office services at Harris myCFO, a Palo Alto, Calif., financial planning service. "When you preplan, you have an ability to put a proper structure in place and set goals. It's the same race with a different starting point."
Technology I.P.O.'s are back in fashion; LinkedIn, Pandora and other Internet companies have sold themselves to the public in the last year, and Facebook has filed to go public this spring.
While Ms. Ruch said I.P.O. beneficiaries were especially eager to break out their wallets after a windfall, Mr. Gong said the bust after previous technology booms had made this generation more cautious.
"The lesson learned in the last decade is that it's O.K. to take money off the table and be conservative," he said. "People get used to wealth gradually, not in one night."
By emphasizing patience and prudence, financial planners and Mr. Greenleaf remind recipients that a windfall really is a once-in-a-lifetime event. It may not allow them to change their lives radically, but if it is handled right, it can add security and comfort to enhance the lives they already have.