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Johnston & Murphy Maggie Penny cdEZRN
Johnston & Murphy Maggie Penny
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Selection Process for Categories of Candidate Conditions

After developing criteria for our literature review, the next step was to identify broad categories of disorders that were likely to include individual conditions that are progressive, such as leukodystrophies and lysosomal storage diseases. Ideas for these categories sometimes were generated by a particular disorder found in CP review articles or chapters, but we also attempted to identify potential categories through a search for progressive or degenerative disorders in published literature. Due to a lack of epidemiologic literature, we did not perform a formal meta-analysis but used standardized methods to review primarily expert literature (standard genetics textbooks, review articles, and selected online resources used in clinical practices and medical school courses). After a category of disorders was identified, we created a list of individual conditions within the category to review using overview chapters, indices, and summary tables in such literature. Occasionally, a new class was added after a query about a particular case by field staff.

Reviews of Candidate Conditions

Next, we searched for information about the natural history of candidate disorders in textbooks, review articles, and online catalogs; if necessary, we evaluated primary sources of natural history data referenced therein or searched databases such as PubMed. Not uncommonly, natural history descriptions and neurologic manifestations were not mentioned in a particular review article or chapter, but only if 2 or more comprehensive sources lacked any information about a progressive course was the disorder left off our final list. A particularly important impetus for reviewing primary sources of information was when one source described a progressive neurologic feature but others did not. For example, the term is used in connection with Weaver syndrome in a highly-cited textbook, but in a review by Opitz, Weaver, and Reynolds, this complication was described in only 1 child who also had spinal cord compression. Similarly, as noted in Clarks Rosilla Durham IwCxv
, we did not consider a condition to be a progressive disorder when deterioration tended to occur from repeated strokes or seizures per se, rather than events in the brain secondary to a neurodegenerative process.

Special Considerations for Conditions with High Rates of Fetal Death or Early Mortality

For surveillance purposes, we did not include conditions with high rates of fetal death or early mortality since the minimum age of CP diagnosis for inclusion in our monitoring program was 2 years ( Table 1 ). For rare disorders, high rates of mortality are obviously problematic in assessing natural histories related to motor milestones, particularly when fetal or neonatal deaths are the typical outcomes. Occasionally children with such disorders will survive long enough to be ascertained by CP surveillance systems, and in fact children with some disorders described as lethal in older references are now treated surgically or with new medical interventions, and are gaining skills in special education settings. Our practice for such conditions is to make decisions about whether they should be excluded from CP surveillance on a case-by-case basis after they have been abstracted, rather than categorically labeling them as progressive disorders.

Special Considerations for Heterogeneous Conditions

We did not include groups of conditions with well-known clinical and genetic variability, such as mitochondrial neuromyopathies. Certain mitochondrial disorders were included if they resulted in a distinct syndromic phenotype that has a relatively well-defined natural history (eg, neuropathy, ataxia, and retinitis pigmentosa). Other mitochondrial disorders such as oxidative phosphorylation defects with specific electron transport complex pathology generally were not listed, since the nature of many of these conditions leads to heterogeneity of outcomes.

Some conditions such as Leigh syndrome are also heterogeneous but have a distinctive phenotype with progressive features generally included. There are also well-defined diagnostic criteria for such conditions with presumably less variability in community diagnoses. We therefore included such conditions on our list of progressive brain disorders. Some rarer conditions, such as pontocerebellar hypoplasia, have multiple genetic subtypes (with varying natural histories) that might not necessarily be evident to nonphysician field staff, and therefore would be considered on a case-by-case basis as described above.

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Table 1 includes all of the criteria we developed to define and select progressive brain disorders of childhood. Since we designed these 19 criteria for CP surveillance purposes, we qualified the overriding definition of a progressive disorder with that distinction (criteria 1A and 1B). The table includes some examples of disorders for which the selection process and special considerations were notably applicable (eg, criteria 2B, 3A, or 5A).

The Sacred Cenote

Building Traditions

Ancient Feuds

Shipwreck Survivors

Kuchkabal

Remote Isolation

Caste War

Mesoamerican

For countries with either Otomanguean or Central American Anne Klein Peppina Wedge Sandal Z5xQOs8
.

Olmec Legacy

Altepetl

The Feathered Serpent

Ritual Bloodletting

Pyramid Architecture

Obsidian and Jade

Moluccan

For countries with Moluccan as Gabor Gabor 82744 m6fDz
.

The Spice Islands

Shared Cultural Heritage

Agents of Trade

Four Kingdoms

Dominance over the Outer Islands

Alliance with the Papuans

Pragmatic Diplomacy

Native

For countries with Native Council government except Bella Marie Ashton Sandal Heel ymdLNUg
, Nike Air Max Motion LW Racer VlKlBPS
, Kenneth Cole New York Karolina Block Heel Sandal xgzVROka
, countries with Lokono or Tupinamba Hispanitas Holli yT6uP
.

Counting Coups

Storytelling Tradition

Clan Mothers

Adopt Clan Totems

The Little War

War and Peace Chiefs

Great Winter Hunts

Nubian

For countries with Nubian or Beja as primary culture .

The Nile

Nubian Heritage

Warriors of the Sahara Desert

Encourage Long-Distance Trade

Nubian Religious Unity

Desert Cavalry

Pacific Northwest

For Chinook , Haida and Salish .

Great Whale Hunts

Dugout Canoes

Totem Poles

Potlatch Feast

Legacy of Raven

Salmon Migrations

Noble Castes

Rajput

For all non-Muslim countries with Rajput or Malvi as primary culture .

Fortifying Rajputana

Marwari Horses

Rajput Resistance

Create Rajput Painting School

Martial Ethos

Rajput Trading Houses

Ruthenian

For countries with Ruthenian or Byelorussian as primary culture .

The Mother of Russian States

Foreign Influences

Zaporozhian Cossacks

East and West

Heritage of the Old Rus'

Reuniting Rus'

Reuben is a playwright, director, sometimes-actor, and founding member of AGGROCRAG – a Brooklyn-based theater company dedicated to creating original plays. At Vassar he directs and composes Soundpainting -- which is performed Thursdays in July in The Frances Lehman Loeb Art Center.

Mendelsohn is a Brooklyn-based director who is adapting and directing William Shakespeare's Hamlet which is running July 14-16 in the Environmental Cooperative at The Vassar Barns.

By Sarah LaDuke Jul 3, 2017
laurenyee.com
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New York Stage and Film and Vassar College’s OluKai Kalapu UJGchPL7M
presents an Inside Look Workshop of Lauren Yee’s new play, The Great Leap July 7-9.

The play is set in San Francisco in the Spring of 1989. Manford Lum, locally renowned on the sidewalk basketball courts of Chinatown, talks his way onto a college team, just before they travel to Beijing for a "friendship" game. His background is a mystery, but he can sink 100 free throws in a row, so who cares? When they arrive, China is in the throes of the post-Cultural Revolution era, and Manford must juggle international politics and his own personal history.

By Joe Donahue Jun 27, 2017
Cary Mosier / Vassar College's Flickr
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The star of How I Met Your Mother , Josh Radnor, is premiering his new play, Sacred Valley at New York Stage and Film and Vassar College's Powerhouse Theater in Poughkeepsie from June 29th to July 9th.

Sacred Valley is about Narby and Natalie, two lifelong friends. Their friendship becomes tested whenNarby takes Natalie’s husband Brian out for his first mushroom trip. The next day, a confused Brian leaves Natalie, an enraged Natalie blames Narby, and three people are forced to ask themselves the deepest questions about love, friendship, and growing up.

Aside from playing Ted on How I Met Your Mother , Radnor has written and directed two films, Happythankyoumoreplease , and Liberal Arts .

By Allison Dunne Mar 30, 2017
Couresty of Vassar College
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Vassar College is embarking on a $1.6 million initiative to advance its mission as an inclusive and affirming learning community.

By Allison Dunne Jan 11, 2017
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Vassar College has named its eleventh president — a public health scholar from Yale.

Nature Energy

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