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or how to feel like a jerk in Mombasa
This piece originally appeared on TomDispatch.
The fluorescent circus of Election 2016 that spectacle of yellow comb overs, and orange skin, and predatory pussy grabbing, and last minute FBI interventions, and blinking memes hewn by an underground army of self important internet trolls has finally come to its unnatural end. I had looked forward to this moment, only to find us all instantly embroiled in a new crisis. And unfortunately, it's easy to foretell what, or rather who, will move into the bright lights of our collective gaze now: we're going to (continue to) focus on. . . well, ourselves.
We are obviously not, for instance, going to redeploy our energies toward examining the embarrassing war that we're still waging in Afghanistan, now in its 16th year something that went practically unmentioned during election season, even as fighting heated up there. (You can be sure that Afghans have a somewhat different perspective on the newsworthiness of that war.) We are also not going to spend our time searching for the names of people like Momina Bibi, whom we've. . oops . . . inadvertently annihilated while carrying out our nation's drone kill program.
For his part, Donald Trump has pledged to "take out" the families of terrorists, a plan that sounds practically ordinary when compared to our actual drone assassination program, conceived by President George W. Bush and maintained and expanded by President Obama. And while I don't for a moment pretend that Trump's electoral victory is anything less than an emergency for our republic especially for the most vulnerable among us, and for every American who believes in justice, equity, or basic kindness it's also true that some things won't change at all. In fact, it's prototypically American that an overlong and inward looking election spectacle (which will, incidentally, have "big league" international implications) will be supplanted by still more inward looking phenomena.
And it jogs my memory in a not very pleasant way. I can't help but recall the moment, years ago and 8,000 miles away, when I was introduced to my own American centered self. The experience left an ugly mark on my picture of who I am and who, perhaps, so many of us are, as Americans.
No, not us years before I heard about a guy in Yemen whose cousins were obliterated by an American drone strike in a procession following his wedding celebration, I gleefully clicked through the travel site Kayak and pressed "confirm purchase" on one way tickets to Kathmandu. It was 2008, shortly before Barack Obama would be elected, and my boyfriend and I, a couple of twenty somethings jonesing to see the world, were about to depart on what we expected to be the adventure of our lives. Having worked temporary stints and squirreled away some cash, we packed our belongings into my mom's damp basement and prepared ourselves for a journey meant to last half a year and cross South Asia and East Africa. What we didn't know, as we headed for New York's Kennedy Airport, our passports zippered into our money belts, was that, whatever we had left behind at my mom's, we were unwittingly carrying something far heftier with us: our American ness.
Adventures commenced as soon as we stepped off the plane. We glimpsed ice capped peaks that rose majestically out of the clouds as we walked the lower Everest trail. Then consider this our introduction to the presumptions we hadn't shed we ran into a little snafu. We hadn't brought along enough cash for our multi week mountain trek; apparently we'd expected Capital One ATMs to appear miraculously on a Himalayan footpath. After we dealt with that issue through a service that worked by landline and carbon paper, we took a bumpy Jeep ride south to India and soon found ourselves walking the sloping fields of Darjeeling, the hermes mens bracelet imitation leaves of tea shrubs glinting in the afternoon light. Then we rode trains west and south, while through the frame of a moving window I looked out at fields and rice paddies where women in red or orange or turquoise saris worked the land, even as the sun set and the sky turned pink and reflected off the water where the rice grew.
Things would, however, soon get significantly less picturesque, as in some strange, twisted way, the farther we traveled, the closer to home we seemed to get.
We arrived in Mombasa, Kenya, in January 2009, on a day when thousands of the city's residents had flooded its streets to protest a recent, and particularly bloody, Israeli attack H bracelet replica on Gaza. Hamas, firing rockets into southern Israel, had killed one Israeli and injured many others. Israel retaliated in an overwhelming fashion, filling the Gazan sky with aircraft and killing hundreds of Palestinians, including five girls from a single family, ages four to 17, who were unlucky enough to live in a refugee camp adjacent to a mosque that an Israeli plane had leveled.
As I hopped off the matatu, or passenger van, into the scorching Kenyan heat, I was aware that 50,000 angry protesters had gathered not so far away, and certain facts became clear to me. For one thing, the slaughter of hundreds of civilians, including several dozen children, in what was, to me, a faraway land, was a big effing deal here. That should probably go without saying just about anywhere except I was suddenly aware that, were I home, the opposite would have been true. Those deaths in distant Gaza (unlike nearby Israel) would barely have caused a blip in the American news. What's more, if I had been at home and the story had somehow caught my eye, I knew that I wouldn't have paid it much mind. Another war in a foreign country is what I would've thought, and that would have been that.
At that moment, though, I didn't dwell on the point, because let's be serious I was scared poopless. There was a huge, angry protest nearby and we'd just gotten word that the crowd was burning an American flag. The enraged people who had taken to the streets in Mombasa were decrying my country's role in the carnage and I was a skinny American with a backpack who'd arrived in the wrong city on the wrong day.
We got the hell out of there as soon as we could. Early the next morning we climbed aboard a rusty old bus bound for Dar es Salaam, Tanzania. I felt a wave of relief once I'd settled into my seat. I was looking forward to a different country and a new vista.
That new vista, it turned out, materialized almost at once. Our bus was soon barreling along a rutted dirt road, the scenery whipping by the window in a distinctly less than picturesque fashion. In fact, it passed in such a blur that I realized we were going way too fast. We already knew that bus accidents were common here; we'd heard about a recent one in which all the passengers died.
When we hit what undoubtedly was a yawning pothole on that none too well kept road, the windows shook ominously and I thought: we could die. By then, my slick hands were gripping my shredded vinyl seat. I could practically feel the heat of the crash induced flames and had no trouble picturing our charred bodies in the wreckage of the bus. And then that other thought came to me, the one I wouldn't forget, the one, thousands of miles from home, that seemed to catch who I really was: No not us, we can't diewas what I said to myself, pressing my eyes shut. I meant, of course, my boyfriend and I; I meant, that is, we Americans.
It was then that I felt an electric zap, as the events of the previous day had just melded with the present dangers and forced me to see what I would have preferred to ignore: that there was an unsavory likeness between my outlook and the American credo that thousands had been protesting in Mombasa. Wecan't die, was my thought, as if we were somehow different as if these Africans on the bus with us could die, but not us. Clutching my torn bus seat, I was still afraid, but another sensation overwhelmed me. I felt like a colossal jerk.
Of course, as you know because you're reading this, we made it safely to Dar es Salaam that night. But I was changed.
Apologizing to Ourselves
I'd like to say that my egocentricity about which lives matter most is uncommon among my countrymen and women. But if you spool through the seven plus years since I rode that bus, you'll notice how that very same mindset has meant that Americans go wild with panic over lone wolf terror killings on our soil, but show scant concern when it comes to the White House directed, CIA run drone assassination campaigns across the world, and all the civilian casualties that are the bloody result. The dead innocents include members of a Yemeni family who were riding in a wedding procession when four missiles bore down on them, and imitation hermes gold bracelet Momina Bibi, that Pakistani grandmother who was tending to an okra patch as her grandchildren played nearby when a missile blasted her to smithereens. AC 130 gunship. Depending on which tally you use, since 2009 we've killed an estimated 474 civilians, or perhaps 745, outside of official war zones (and far more civilians, like those dead in that hospital, within those zones), although the horrifying truth is that the real numbers are likely much higher, but unknown and unknowable. civilians were identified in the vicinity. We value American life far too highly for such wantonness. In 2015, when a drone struck an al Qaeda compound in Pakistan, it was later discovered that two hostages, one of them an American, were inside. In response, President Obama delivered grave remarks: "I offer our deepest apologies to the families . . . I directed that this operation be declassified and disclosed . . . because the families deserve to know the truth."
But why so sorry that time and not with the other 474 or more deaths? Of course the difference was that innocent American blood was spilt. We don't even try to hide this dubious hierarchy; we celebrate it. In that same speech, President Obama reflected on why we Americans are so darn special. "One of the things that makes us exceptional," he declared, "is our willingness to confront squarely our imperfections and to learn from our mistakes."
If you hailed from any other country, it might have seemed like an odd, not to say tasteless, time to wax poetic about American exceptionalism. The president was, after all, confessing that we'd accidentally fired missiles at two captive aid workers. But I can appreciate the sentiment. Inadequate though the apology was "There are hundreds, potentially thousands of others who deserve the same apology," said an investigator for Amnesty International he was at least admitting that the United States had erred, and he was pointing out that such admissions are important. Indeed, they are. It's just . . . what about the rest of the people on the planet?
The Trump administration will probably espouse a philosophy much like President Obama's when it comes to valuing (or not) the lives of foreign innocents. And yet there's part of me that must be as unworldly as that twenty something who flew into Kathmandu, because I find myself dreaming about a new brand of American exceptionalism in our future. Not one that gives you that icky feeling when you're riding a speeding bus in another hemisphere, nor one at whose heart lies the idea that we Americans are different and special and better which, history tells us, is actually a totally unexceptional notion among powerful nations. Instead, I imagine what would be truly Hermes Collier de Chien Bracelet replica exceptional: an America that values all human life in the same way.
Of course, I'm also a realist and I know that that's not the world we live in, especially now and that it won't be for, at best, a very long time.
Mattea Kramer, a TomDispatch regular, is at work on a memoir called The Young Person's Guide to Aging, which inspired this essay. Follow her onTwitter.
This piece originally appeared on TomDispatch.
The fluorescent circus of Election 2016 that spectacle of yellow comb overs, and orange skin, and predatory pussy grabbing, and last minute FBI interventions, and blinking memes hewn by an underground army of self important internet trolls has finally come to its unnatural end. I had looked forward to this moment, only to find us all instantly embroiled in a new crisis. And unfortunately, it's easy to foretell what, or rather who, will move into the bright lights of our collective gaze now: we're going to (continue to) focus on. . . well, ourselves.
We are obviously not, for instance, going to redeploy our energies toward examining the embarrassing war that we're still waging in Afghanistan, now in its 16th year something that went practically unmentioned during election season, even as fighting heated up there. (You can be sure that Afghans have a somewhat different perspective on the newsworthiness of that war.) We are also not going to spend our time searching for the names of people like Momina Bibi, whom we've. . oops . . . inadvertently annihilated while carrying out our nation's drone kill program.
For his part, Donald Trump has pledged to "take out" the families of terrorists, a plan that sounds practically ordinary when compared to our actual drone assassination program, conceived by President George W. Bush and maintained and expanded by President Obama. And while I don't for a moment pretend that Trump's electoral victory is anything less than an emergency for our republic especially for the most vulnerable among us, and for every American who believes in justice, equity, or basic kindness it's also true that some things won't change at all. In fact, it's prototypically American that an overlong and inward looking election spectacle (which will, incidentally, have "big league" international implications) will be supplanted by still more inward looking phenomena.
And it jogs my memory in a not very pleasant way. I can't help but recall the moment, years ago and 8,000 miles away, when I was introduced to my own American centered self. The experience left an ugly mark on my picture of who I am and who, perhaps, so many of us are, as Americans.
No, not us years before I heard about a guy in Yemen whose cousins were obliterated by an American drone strike in a procession following his wedding celebration, I gleefully clicked through the travel site Kayak and pressed "confirm purchase" on one way tickets to Kathmandu. It was 2008, shortly before Barack Obama would be elected, and my boyfriend and I, a couple of twenty somethings jonesing to see the world, were about to depart on what we expected to be the adventure of our lives. Having worked temporary stints and squirreled away some cash, we packed our belongings into my mom's damp basement and prepared ourselves for a journey meant to last half a year and cross South Asia and East Africa. What we didn't know, as we headed for New York's Kennedy Airport, our passports zippered into our money belts, was that, whatever we had left behind at my mom's, we were unwittingly carrying something far heftier with us: our American ness.
Adventures commenced as soon as we stepped off the plane. We glimpsed ice capped peaks that rose majestically out of the clouds as we walked the lower Everest trail. Then consider this our introduction to the presumptions we hadn't shed we ran into a little snafu. We hadn't brought along enough cash for our multi week mountain trek; apparently we'd expected Capital One ATMs to appear miraculously on a Himalayan footpath. After we dealt with that issue through a service that worked by landline and carbon paper, we took a bumpy Jeep ride south to India and soon found ourselves walking the sloping fields of Darjeeling, the hermes mens bracelet imitation leaves of tea shrubs glinting in the afternoon light. Then we rode trains west and south, while through the frame of a moving window I looked out at fields and rice paddies where women in red or orange or turquoise saris worked the land, even as the sun set and the sky turned pink and reflected off the water where the rice grew.
Things would, however, soon get significantly less picturesque, as in some strange, twisted way, the farther we traveled, the closer to home we seemed to get.
We arrived in Mombasa, Kenya, in January 2009, on a day when thousands of the city's residents had flooded its streets to protest a recent, and particularly bloody, Israeli attack H bracelet replica on Gaza. Hamas, firing rockets into southern Israel, had killed one Israeli and injured many others. Israel retaliated in an overwhelming fashion, filling the Gazan sky with aircraft and killing hundreds of Palestinians, including five girls from a single family, ages four to 17, who were unlucky enough to live in a refugee camp adjacent to a mosque that an Israeli plane had leveled.
As I hopped off the matatu, or passenger van, into the scorching Kenyan heat, I was aware that 50,000 angry protesters had gathered not so far away, and certain facts became clear to me. For one thing, the slaughter of hundreds of civilians, including several dozen children, in what was, to me, a faraway land, was a big effing deal here. That should probably go without saying just about anywhere except I was suddenly aware that, were I home, the opposite would have been true. Those deaths in distant Gaza (unlike nearby Israel) would barely have caused a blip in the American news. What's more, if I had been at home and the story had somehow caught my eye, I knew that I wouldn't have paid it much mind. Another war in a foreign country is what I would've thought, and that would have been that.
At that moment, though, I didn't dwell on the point, because let's be serious I was scared poopless. There was a huge, angry protest nearby and we'd just gotten word that the crowd was burning an American flag. The enraged people who had taken to the streets in Mombasa were decrying my country's role in the carnage and I was a skinny American with a backpack who'd arrived in the wrong city on the wrong day.
We got the hell out of there as soon as we could. Early the next morning we climbed aboard a rusty old bus bound for Dar es Salaam, Tanzania. I felt a wave of relief once I'd settled into my seat. I was looking forward to a different country and a new vista.
That new vista, it turned out, materialized almost at once. Our bus was soon barreling along a rutted dirt road, the scenery whipping by the window in a distinctly less than picturesque fashion. In fact, it passed in such a blur that I realized we were going way too fast. We already knew that bus accidents were common here; we'd heard about a recent one in which all the passengers died.
When we hit what undoubtedly was a yawning pothole on that none too well kept road, the windows shook ominously and I thought: we could die. By then, my slick hands were gripping my shredded vinyl seat. I could practically feel the heat of the crash induced flames and had no trouble picturing our charred bodies in the wreckage of the bus. And then that other thought came to me, the one I wouldn't forget, the one, thousands of miles from home, that seemed to catch who I really was: No not us, we can't diewas what I said to myself, pressing my eyes shut. I meant, of course, my boyfriend and I; I meant, that is, we Americans.
It was then that I felt an electric zap, as the events of the previous day had just melded with the present dangers and forced me to see what I would have preferred to ignore: that there was an unsavory likeness between my outlook and the American credo that thousands had been protesting in Mombasa. Wecan't die, was my thought, as if we were somehow different as if these Africans on the bus with us could die, but not us. Clutching my torn bus seat, I was still afraid, but another sensation overwhelmed me. I felt like a colossal jerk.
Of course, as you know because you're reading this, we made it safely to Dar es Salaam that night. But I was changed.
Apologizing to Ourselves
I'd like to say that my egocentricity about which lives matter most is uncommon among my countrymen and women. But if you spool through the seven plus years since I rode that bus, you'll notice how that very same mindset has meant that Americans go wild with panic over lone wolf terror killings on our soil, but show scant concern when it comes to the White House directed, CIA run drone assassination campaigns across the world, and all the civilian casualties that are the bloody result. The dead innocents include members of a Yemeni family who were riding in a wedding procession when four missiles bore down on them, and imitation hermes gold bracelet Momina Bibi, that Pakistani grandmother who was tending to an okra patch as her grandchildren played nearby when a missile blasted her to smithereens. AC 130 gunship. Depending on which tally you use, since 2009 we've killed an estimated 474 civilians, or perhaps 745, outside of official war zones (and far more civilians, like those dead in that hospital, within those zones), although the horrifying truth is that the real numbers are likely much higher, but unknown and unknowable. civilians were identified in the vicinity. We value American life far too highly for such wantonness. In 2015, when a drone struck an al Qaeda compound in Pakistan, it was later discovered that two hostages, one of them an American, were inside. In response, President Obama delivered grave remarks: "I offer our deepest apologies to the families . . . I directed that this operation be declassified and disclosed . . . because the families deserve to know the truth."
But why so sorry that time and not with the other 474 or more deaths? Of course the difference was that innocent American blood was spilt. We don't even try to hide this dubious hierarchy; we celebrate it. In that same speech, President Obama reflected on why we Americans are so darn special. "One of the things that makes us exceptional," he declared, "is our willingness to confront squarely our imperfections and to learn from our mistakes."
If you hailed from any other country, it might have seemed like an odd, not to say tasteless, time to wax poetic about American exceptionalism. The president was, after all, confessing that we'd accidentally fired missiles at two captive aid workers. But I can appreciate the sentiment. Inadequate though the apology was "There are hundreds, potentially thousands of others who deserve the same apology," said an investigator for Amnesty International he was at least admitting that the United States had erred, and he was pointing out that such admissions are important. Indeed, they are. It's just . . . what about the rest of the people on the planet?
The Trump administration will probably espouse a philosophy much like President Obama's when it comes to valuing (or not) the lives of foreign innocents. And yet there's part of me that must be as unworldly as that twenty something who flew into Kathmandu, because I find myself dreaming about a new brand of American exceptionalism in our future. Not one that gives you that icky feeling when you're riding a speeding bus in another hemisphere, nor one at whose heart lies the idea that we Americans are different and special and better which, history tells us, is actually a totally unexceptional notion among powerful nations. Instead, I imagine what would be truly Hermes Collier de Chien Bracelet replica exceptional: an America that values all human life in the same way.
Of course, I'm also a realist and I know that that's not the world we live in, especially now and that it won't be for, at best, a very long time.
Mattea Kramer, a TomDispatch regular, is at work on a memoir called The Young Person's Guide to Aging, which inspired this essay. Follow her onTwitter.
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Queens Native Fran Drescher Returns to Home Borough to Raise Awareness for Cancer
A celebrity cancer survivor visits Queens to raise awareness for cancer screening.
Actress and Queens native Fran Drescher paid fake hermes H bracelet Black gold a visit to the Project Renewal Scan Van Monday, during its time at the Long Island City Community Healthcare Network (CHN). Drescher's cancer awareness organization, "Cancer Shmancer", is joining forces with the Scan Van to provide early detection services hermes jewelry replica for women Collier de Chien hermes bracelet copy of all incomes and fake hermes H bracelet backgrounds.
"The more we can encourage women of low income to get diagnosed early, the more that they can ensure their survival rate," Drescher, a uterine cancer survivor of 15 years, said.
"It's important that every woman gets their mammogram, gets it done to detect these things earlier," said participant Carol Wilkins of Ravenswood.
The ScanVan screens more than 5,000 women a year.
"A location that is familiar, comfortable, trusted like CHN Long Island City it becomes much easier for her to access her mammography," said Project Renewal's ScanVan Director, Mary Solomon.
A celebrity cancer survivor visits Queens to raise awareness for cancer screening.
Actress and Queens native Fran Drescher paid fake hermes H bracelet Black gold a visit to the Project Renewal Scan Van Monday, during its time at the Long Island City Community Healthcare Network (CHN). Drescher's cancer awareness organization, "Cancer Shmancer", is joining forces with the Scan Van to provide early detection services hermes jewelry replica for women Collier de Chien hermes bracelet copy of all incomes and fake hermes H bracelet backgrounds.
"The more we can encourage women of low income to get diagnosed early, the more that they can ensure their survival rate," Drescher, a uterine cancer survivor of 15 years, said.
"It's important that every woman gets their mammogram, gets it done to detect these things earlier," said participant Carol Wilkins of Ravenswood.
The ScanVan screens more than 5,000 women a year.
"A location that is familiar, comfortable, trusted like CHN Long Island City it becomes much easier for her to access her mammography," said Project Renewal's ScanVan Director, Mary Solomon.
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Prognosis and prognostic research
Doctors have little specific research to draw on when predicting outcome. In this first article in a series Karel Moons and colleagues explain why research into prognosis is important and how to design such researchHippocrates included prognosis as a principal concept of medicine.1 Nevertheless, principles and methods of prognostic research have received limited attention, especially compared with therapeutic and aetiological research. This article is the first in a series of four aiming to provide an hermes replica bracelet accessible overview of these principles and methods. Our focus is on prognostic studies aimed at predicting outcomes from multiple variables rather than on studies investigating whether a single variable (such as a tumour or other biomarker) may be prognostic. Here we consider the principles of prognosis and multivariable prognostic studies and the reasons for and settings in which multivariable prognostic models are developed and used. The other articles in the series will focus on the development of multivariable prognostic models,2 their validation,3 and the application and impact of prognostic models in practice.4Summary points Prognosis is estimating the risk of future outcomes in individuals based on their clinical and non clinical characteristicsPredicting outcomes is not synonymous with explaining their causePrognostic studies require a multivariable approach to design and analysisThe best design to address prognostic questions is a cohort studyWhat is prognosis?Prognosis simply means foreseeing, predicting, or estimating the probability or risk of future conditions; familiar examples are weather and economic forecasts. In medicine, prognosis commonly relates to the probability or risk of an individual developing a particular state of health (an outcome) over a specific time, based on his or her clinical and non clinical profile. Outcomes are often specific events, such as death or complications, but they may also be quantities, such as disease progression, (changes in) pain, or quality of life.In medical textbooks, however, prognosis commonly refers to the expected course of an illness. This terminology is too general and has limited utility in practice. Doctors replica hermes brecelet clic h do not predict the course of an illness but the course of an illness in a particular individual. Prognosis may be shaped by a patient's age, sex, history, symptoms, signs, and other test results. Moreover, prognostication in medicine is not limited to those who are ill. Healthcare professionals, especially primary care doctors, regularly predict the future in healthy individuals for example, using the Apgar score to determine the prognosis of newborns, cardiovascular risk profiles to predict heart disease in the general population, and prenatal testing to assess the risk that a pregnant woman will give birth to a baby with Down's syndrome.Multivariable research Given hermes replica bracelets the variability among patients and in the aetiology, presentation, and treatment of diseases and other health states, a single predictor or variable rarely gives an adequate estimate of prognosis. Doctors implicitly or explicitly use multiple predictors to estimate a patient's prognosis. Prognostic studies therefore need to use a multivariable approach in design and analysis to determine the important predictors of the studied outcomes and to provide outcome probabilities for different combinations of predictors, or to provide tools to estimate such probabilities. These tools are commonly called prognostic models, prediction models, prediction rules, or risk scores.5 6 7 8 9 10 11 12 13 14 They enable care providers to use combinations of predictor values to estimate an absolute risk or probability that an outcome will occur in an individual. A multivariable approach also enables researchers to investigate whether specific prognostic factors or markers that are, say, more invasive or costly to measure, have worthwhile added predictive value beyond cheap or simply obtained predictors for example, from patient history or physical examination. Nonetheless, many prognostic studies still consider a single rather than multiple predictors.15Use of prognostic modelsMedical prognostication and prognostic models are used in various settings and for various reasons. The main reasons are to inform individuals about the future course of their illness (or their risk of developing illness) and to guide doctors and patients in joint decisions on further treatment, if any. For example, modifications of the Framingham cardiovascular risk score16 are widely used in primary care to determine the indication for cholesterol lowering and antihypertensive drugs. Examples from secondary care include use of the Nottingham prognostic index to estimate the long term risk of cancer recurrence or death in breast cancer patients,17 the acute physiology and chronic health evaluation (APACHE) score and simplified acute physiology score (SAPS) to predict hospital mortality in critically ill patients,18 19 and models for predicting postoperative nausea and vomiting.20 21Another reason for prognostication and use of prognostic models is to select relevant patients for therapeutic research. For example, researchers used a previously validated prognostic model to select women with an increased risk of developing cancer for a randomised trial of tamoxifen to prevent breast cancer.22 Another randomised trial on the efficacy of radiotherapy after breast conserving resection used a prognostic model to select patients with a low risk of cancer recurrence.23Prognostic models are also used to compare differences in performance between hospitals. For example, the clinical risk index for babies (CRIB) was originally developed to compare performance and mortality among neonatal intensive care units.24 More recently Jarman et al developed a model to predict the hospital standardised mortality ratio to explain differences between English hospitals.25Differences from aetiological researchAlthough there are clear similarities in the design and analysis of prognostic and aetiological studies, predicting outcomes is not synonymous with explaining their cause.26 27 In aetiological research, the mission is to explain whether an outcome can reliably be attributed to a particular risk factor, with adjustment for other causal factors (confounders) using a multivariable approach. In prognostic research the mission is to use multiple variables to predict, as accurately as possible, the risk of future outcomes. Although a prognostic model may be used to provide insight into causality or pathophysiology of the studied outcome, that is neither an aim nor a requirement. All variables potentially associated with the outcome, not necessarily causally, can be considered in a prognostic study. Every causal factor is a predictor albeit sometimes a weak one but not every predictor is a cause. Nice examples of predictive but non causal factors used in everyday practice are skin colour in the Apgar score and tumour markers as predictors of cancer progression or recurrence. Both are surrogates for obvious causal factors that are more difficult to measure.Furthermore, to guide prognostication in individuals, analysis and reporting of prognostic studies should focus on absolute risk estimates of outcomes given combinations of predictor values. Relative risk estimates (eg odds ratio, risk ratio, or hazard ratio) have no direct meaning or relevance to prognostication in practice. In prediction research, relative risks are used only to obtain an absolute probability of the outcome for an individual, as we will show in our second article.2 In contrast, aetiological and therapeutic studies commonly focus on relative risks for example, the risk of an outcome in presence of a causal factor relative to the risk in its absence. Also, the calibration and discrimination of a multivariable model are highly relevant to prognostic research but meaningless in aetiological research.How to study prognosis?Building on previous guidelines8 10 14 28 29 we distinguish three major steps in multivariable prognostic research that are also followed in the other articles in this series2 3 4: developing the prognostic model, validating its performance in new patients, and studying its clinical impact (box). We focus here on the non statistical characteristics of a multivariable study aimed at developing a prognostic model. The statistical aspects of developing a model are covered in our second article.2Validation studies Validating or testing the model's predictive performance (eg, calibration and discrimination) in new participants. This can be narrow (in participants from the same institution measured in the same manner by the same researchers though at a later time, or in another single institution by different researchers using perhaps slightly different definitions and data collection methods) or broad (participants obtained from various other institutions or using wider inclusion criteria)3 4Impact studies Quantifying whether the use of a prognostic model by practising doctors truly improves their decision making and ultimately patient outcome, which can again be done narrowly or broadly.4ObjectiveThe main objective of a prognostic study is to determine the probability of the specified outcome with different combinations of predictors in a well defined population.Study sampleThe study sample includes people at risk of developing the outcome of interest, defined by the presence of a particular condition (for example, an illness, undergoing surgery, copy hermes clic h bracelet or being pregnant).Study designThe best design to answer prognostic questions is a cohort study. A prospective study is preferable as it enables optimal measurement of predictors and outcome (see below). Studies using cohorts already assembled for other reasons allow longer follow up times but usually at the expense of poorer data. Unfortunately, the prognostic literature is dominated by retrospective studies. Case control studies are sometimes used for prognostic analysis, but they do not automatically allow estimation of absolute risks because cases and controls are often sampled from a source population of unknown size. Since investigators are free to choose the ratio of cases and controls, the absolute outcome risks can be manipulated.30 An exception is a case control study nested in a cohort of known size.31Data from randomised trials of treatment can also be used to study prognosis. When the treatment is ineffective (relative risk=1.0), the intervention and comparison group can simply be combined to study baseline prognosis. If the treatment is effective the groups can be combined, but the treatment variable should then be included as a separate predictor in the multivariable model. Here treatments are studied on their independent predictive effect and not on their therapeutic or preventive effects. However, prognostic models obtained from randomised trial data may have restricted generalisability because of strict eligibility criteria for the trial, low recruitment levels, or large numbers refusing consent.PredictorsCandidate predictors can be obtained from patient demographics, clinical history, physical examination, disease characteristics, test results, and previous treatment. Prognostic studies may focus on a cohort of patients who have not (yet) received prognosis modifying treatments that is, to study the natural course or baseline prognosis of patients with that condition. They can also examine predictors of prognosis in patients who have received treatments.Studied predictors should be clearly defined, standardised, and reproducible to enhance generalisability and application of study results to practice.32 Predictors requiring subjective interpretation, such as imaging test results, are of particular concern in this context because there is a risk of studying the predictive ability of the observer rather than that of the predictors. Also, predictors should be measured using methods applicable or potentially applicable to daily practice. Specialised measurement techniques may yield optimistic predictions.As discussed above, the prognostic value of treatments can also be studied, especially when randomised trials are used. However, caution is needed in including treatments as prognostic factors when data are observational. Indications for treatment and treatment administration are often not standardised in observational studies and confounding by indication could lead to bias and large variation in the (type of) administered treatments.33 Moreover, in many circumstances the predictive effect of treatments is small compared with that of other important prognostic variables such as age, sex, and disease stage.Finally, of course, studies should include only predictors that will be available at the time when the model is intended to be used.34 If the aim is to predict a patient's prognosis at the time of diagnosis, for example, predictors that will not be known until actual treatment has started are of little value.OutcomePreferably, prognostic studies should focus on outcomes that are relevant to patients, such as occurrence or remission of disease, death, complications, tumour growth, pain, treatment response, or quality of life. Surrogate or intermediate outcomes, such as hospital stay or physiological measurements, are unhelpful unless they have a clear causal relation to relevant patient outcomes, such as CD4 counts instead of development of AIDS or death in HIV studies. The period over which the outcome is studied and the methods of measurement should be clearly defined. Finally, outcomes should be measured without knowledge of the predictors under study to prevent bias, particularly if measurement requires observer interpretation. Blinding is not necessary when the outcome is all cause mortality. But if the outcome is cause specific mortality, knowledge of the predictors might influence assessment of outcomes (and vice versa in retrospective studies where predictors are documented after the outcome was assessed).Required number of patientsThe multivariable character of prognostic research makes it difficult to estimate the required sample size. There are no straightforward methods for this. When the number of predictors is much larger than the number of outcome events, there is a risk of overestimating the predictive performance of the model. Ideally, prognostic studies require at least several hundred outcome events. Various studies have suggested that for each candidate predictor studied at least 10 events are required,6 8 35 36 although a recent study showed that this number could be lower in certain circumstances.37
Doctors have little specific research to draw on when predicting outcome. In this first article in a series Karel Moons and colleagues explain why research into prognosis is important and how to design such researchHippocrates included prognosis as a principal concept of medicine.1 Nevertheless, principles and methods of prognostic research have received limited attention, especially compared with therapeutic and aetiological research. This article is the first in a series of four aiming to provide an hermes replica bracelet accessible overview of these principles and methods. Our focus is on prognostic studies aimed at predicting outcomes from multiple variables rather than on studies investigating whether a single variable (such as a tumour or other biomarker) may be prognostic. Here we consider the principles of prognosis and multivariable prognostic studies and the reasons for and settings in which multivariable prognostic models are developed and used. The other articles in the series will focus on the development of multivariable prognostic models,2 their validation,3 and the application and impact of prognostic models in practice.4Summary points Prognosis is estimating the risk of future outcomes in individuals based on their clinical and non clinical characteristicsPredicting outcomes is not synonymous with explaining their causePrognostic studies require a multivariable approach to design and analysisThe best design to address prognostic questions is a cohort studyWhat is prognosis?Prognosis simply means foreseeing, predicting, or estimating the probability or risk of future conditions; familiar examples are weather and economic forecasts. In medicine, prognosis commonly relates to the probability or risk of an individual developing a particular state of health (an outcome) over a specific time, based on his or her clinical and non clinical profile. Outcomes are often specific events, such as death or complications, but they may also be quantities, such as disease progression, (changes in) pain, or quality of life.In medical textbooks, however, prognosis commonly refers to the expected course of an illness. This terminology is too general and has limited utility in practice. Doctors replica hermes brecelet clic h do not predict the course of an illness but the course of an illness in a particular individual. Prognosis may be shaped by a patient's age, sex, history, symptoms, signs, and other test results. Moreover, prognostication in medicine is not limited to those who are ill. Healthcare professionals, especially primary care doctors, regularly predict the future in healthy individuals for example, using the Apgar score to determine the prognosis of newborns, cardiovascular risk profiles to predict heart disease in the general population, and prenatal testing to assess the risk that a pregnant woman will give birth to a baby with Down's syndrome.Multivariable research Given hermes replica bracelets the variability among patients and in the aetiology, presentation, and treatment of diseases and other health states, a single predictor or variable rarely gives an adequate estimate of prognosis. Doctors implicitly or explicitly use multiple predictors to estimate a patient's prognosis. Prognostic studies therefore need to use a multivariable approach in design and analysis to determine the important predictors of the studied outcomes and to provide outcome probabilities for different combinations of predictors, or to provide tools to estimate such probabilities. These tools are commonly called prognostic models, prediction models, prediction rules, or risk scores.5 6 7 8 9 10 11 12 13 14 They enable care providers to use combinations of predictor values to estimate an absolute risk or probability that an outcome will occur in an individual. A multivariable approach also enables researchers to investigate whether specific prognostic factors or markers that are, say, more invasive or costly to measure, have worthwhile added predictive value beyond cheap or simply obtained predictors for example, from patient history or physical examination. Nonetheless, many prognostic studies still consider a single rather than multiple predictors.15Use of prognostic modelsMedical prognostication and prognostic models are used in various settings and for various reasons. The main reasons are to inform individuals about the future course of their illness (or their risk of developing illness) and to guide doctors and patients in joint decisions on further treatment, if any. For example, modifications of the Framingham cardiovascular risk score16 are widely used in primary care to determine the indication for cholesterol lowering and antihypertensive drugs. Examples from secondary care include use of the Nottingham prognostic index to estimate the long term risk of cancer recurrence or death in breast cancer patients,17 the acute physiology and chronic health evaluation (APACHE) score and simplified acute physiology score (SAPS) to predict hospital mortality in critically ill patients,18 19 and models for predicting postoperative nausea and vomiting.20 21Another reason for prognostication and use of prognostic models is to select relevant patients for therapeutic research. For example, researchers used a previously validated prognostic model to select women with an increased risk of developing cancer for a randomised trial of tamoxifen to prevent breast cancer.22 Another randomised trial on the efficacy of radiotherapy after breast conserving resection used a prognostic model to select patients with a low risk of cancer recurrence.23Prognostic models are also used to compare differences in performance between hospitals. For example, the clinical risk index for babies (CRIB) was originally developed to compare performance and mortality among neonatal intensive care units.24 More recently Jarman et al developed a model to predict the hospital standardised mortality ratio to explain differences between English hospitals.25Differences from aetiological researchAlthough there are clear similarities in the design and analysis of prognostic and aetiological studies, predicting outcomes is not synonymous with explaining their cause.26 27 In aetiological research, the mission is to explain whether an outcome can reliably be attributed to a particular risk factor, with adjustment for other causal factors (confounders) using a multivariable approach. In prognostic research the mission is to use multiple variables to predict, as accurately as possible, the risk of future outcomes. Although a prognostic model may be used to provide insight into causality or pathophysiology of the studied outcome, that is neither an aim nor a requirement. All variables potentially associated with the outcome, not necessarily causally, can be considered in a prognostic study. Every causal factor is a predictor albeit sometimes a weak one but not every predictor is a cause. Nice examples of predictive but non causal factors used in everyday practice are skin colour in the Apgar score and tumour markers as predictors of cancer progression or recurrence. Both are surrogates for obvious causal factors that are more difficult to measure.Furthermore, to guide prognostication in individuals, analysis and reporting of prognostic studies should focus on absolute risk estimates of outcomes given combinations of predictor values. Relative risk estimates (eg odds ratio, risk ratio, or hazard ratio) have no direct meaning or relevance to prognostication in practice. In prediction research, relative risks are used only to obtain an absolute probability of the outcome for an individual, as we will show in our second article.2 In contrast, aetiological and therapeutic studies commonly focus on relative risks for example, the risk of an outcome in presence of a causal factor relative to the risk in its absence. Also, the calibration and discrimination of a multivariable model are highly relevant to prognostic research but meaningless in aetiological research.How to study prognosis?Building on previous guidelines8 10 14 28 29 we distinguish three major steps in multivariable prognostic research that are also followed in the other articles in this series2 3 4: developing the prognostic model, validating its performance in new patients, and studying its clinical impact (box). We focus here on the non statistical characteristics of a multivariable study aimed at developing a prognostic model. The statistical aspects of developing a model are covered in our second article.2Validation studies Validating or testing the model's predictive performance (eg, calibration and discrimination) in new participants. This can be narrow (in participants from the same institution measured in the same manner by the same researchers though at a later time, or in another single institution by different researchers using perhaps slightly different definitions and data collection methods) or broad (participants obtained from various other institutions or using wider inclusion criteria)3 4Impact studies Quantifying whether the use of a prognostic model by practising doctors truly improves their decision making and ultimately patient outcome, which can again be done narrowly or broadly.4ObjectiveThe main objective of a prognostic study is to determine the probability of the specified outcome with different combinations of predictors in a well defined population.Study sampleThe study sample includes people at risk of developing the outcome of interest, defined by the presence of a particular condition (for example, an illness, undergoing surgery, copy hermes clic h bracelet or being pregnant).Study designThe best design to answer prognostic questions is a cohort study. A prospective study is preferable as it enables optimal measurement of predictors and outcome (see below). Studies using cohorts already assembled for other reasons allow longer follow up times but usually at the expense of poorer data. Unfortunately, the prognostic literature is dominated by retrospective studies. Case control studies are sometimes used for prognostic analysis, but they do not automatically allow estimation of absolute risks because cases and controls are often sampled from a source population of unknown size. Since investigators are free to choose the ratio of cases and controls, the absolute outcome risks can be manipulated.30 An exception is a case control study nested in a cohort of known size.31Data from randomised trials of treatment can also be used to study prognosis. When the treatment is ineffective (relative risk=1.0), the intervention and comparison group can simply be combined to study baseline prognosis. If the treatment is effective the groups can be combined, but the treatment variable should then be included as a separate predictor in the multivariable model. Here treatments are studied on their independent predictive effect and not on their therapeutic or preventive effects. However, prognostic models obtained from randomised trial data may have restricted generalisability because of strict eligibility criteria for the trial, low recruitment levels, or large numbers refusing consent.PredictorsCandidate predictors can be obtained from patient demographics, clinical history, physical examination, disease characteristics, test results, and previous treatment. Prognostic studies may focus on a cohort of patients who have not (yet) received prognosis modifying treatments that is, to study the natural course or baseline prognosis of patients with that condition. They can also examine predictors of prognosis in patients who have received treatments.Studied predictors should be clearly defined, standardised, and reproducible to enhance generalisability and application of study results to practice.32 Predictors requiring subjective interpretation, such as imaging test results, are of particular concern in this context because there is a risk of studying the predictive ability of the observer rather than that of the predictors. Also, predictors should be measured using methods applicable or potentially applicable to daily practice. Specialised measurement techniques may yield optimistic predictions.As discussed above, the prognostic value of treatments can also be studied, especially when randomised trials are used. However, caution is needed in including treatments as prognostic factors when data are observational. Indications for treatment and treatment administration are often not standardised in observational studies and confounding by indication could lead to bias and large variation in the (type of) administered treatments.33 Moreover, in many circumstances the predictive effect of treatments is small compared with that of other important prognostic variables such as age, sex, and disease stage.Finally, of course, studies should include only predictors that will be available at the time when the model is intended to be used.34 If the aim is to predict a patient's prognosis at the time of diagnosis, for example, predictors that will not be known until actual treatment has started are of little value.OutcomePreferably, prognostic studies should focus on outcomes that are relevant to patients, such as occurrence or remission of disease, death, complications, tumour growth, pain, treatment response, or quality of life. Surrogate or intermediate outcomes, such as hospital stay or physiological measurements, are unhelpful unless they have a clear causal relation to relevant patient outcomes, such as CD4 counts instead of development of AIDS or death in HIV studies. The period over which the outcome is studied and the methods of measurement should be clearly defined. Finally, outcomes should be measured without knowledge of the predictors under study to prevent bias, particularly if measurement requires observer interpretation. Blinding is not necessary when the outcome is all cause mortality. But if the outcome is cause specific mortality, knowledge of the predictors might influence assessment of outcomes (and vice versa in retrospective studies where predictors are documented after the outcome was assessed).Required number of patientsThe multivariable character of prognostic research makes it difficult to estimate the required sample size. There are no straightforward methods for this. When the number of predictors is much larger than the number of outcome events, there is a risk of overestimating the predictive performance of the model. Ideally, prognostic studies require at least several hundred outcome events. Various studies have suggested that for each candidate predictor studied at least 10 events are required,6 8 35 36 although a recent study showed that this number could be lower in certain circumstances.37
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Pipeline foes set up new camp at Kinder Morgan terminal in Burnaby
Van Hardeveld, who was part of the original Kinder Morgan protests on Burnaby Mountain, said people have been at the new camp 24 hours a day for a couple of weeks.
Their large tent is stocked with food and bedding and has crudely fashioned windows with views of the Burrard Inlet. The campers have mostly observed tankers filling up at the terminal and workers driving to the site.
Van Hardeveld is opposed to the pipeline project because he's concerned about climate change. The campers say they will stay till Kinder Morgan drops its plan to expand the Trans Mountain pipeline, which the National Energy Board is currently reviewing.
"It's a concern because it's continuing a path we can't continue as a species," hermes h bracelets fake he said. hermes bracelets replica "Fossil fuel extraction is not compatible with our lives."
The tent is set up just outside the Kinder Morgan property line, on the grass beside Bayview Drive.
Meanwhile, the camp on Centennial Way is mostly gone apart from a pile of a few leftover items. City staff removed truckloads of trash following the 10 day standoff with police and Kinder Morgan crews in late November.
"We have done a replica hermes bracelets lot of cleanup in the area, we've been in with our crews picking up hermes bracelet fake any sort of debris and stuff in the area," said Don Hunter, assistant director of the city's parks and recreation department.
Van Hardeveld, who was part of the original Kinder Morgan protests on Burnaby Mountain, said people have been at the new camp 24 hours a day for a couple of weeks.
Their large tent is stocked with food and bedding and has crudely fashioned windows with views of the Burrard Inlet. The campers have mostly observed tankers filling up at the terminal and workers driving to the site.
Van Hardeveld is opposed to the pipeline project because he's concerned about climate change. The campers say they will stay till Kinder Morgan drops its plan to expand the Trans Mountain pipeline, which the National Energy Board is currently reviewing.
"It's a concern because it's continuing a path we can't continue as a species," hermes h bracelets fake he said. hermes bracelets replica "Fossil fuel extraction is not compatible with our lives."
The tent is set up just outside the Kinder Morgan property line, on the grass beside Bayview Drive.
Meanwhile, the camp on Centennial Way is mostly gone apart from a pile of a few leftover items. City staff removed truckloads of trash following the 10 day standoff with police and Kinder Morgan crews in late November.
"We have done a replica hermes bracelets lot of cleanup in the area, we've been in with our crews picking up hermes bracelet fake any sort of debris and stuff in the area," said Don Hunter, assistant director of the city's parks and recreation department.
Princess Diana told Camilla 'I sent someone to kill you' claims Prince Harry biographer
As he turns 30, a brilliant new book by a top royal biographer exposes the inner torment of Prince Harry. On Saturday, in this exclusive Mail serialisation, Penny Junor revealed his wild binges, tensions with the Middletons and his many flirtations. Today, we uncover the toxic upbringing that shaped his life.
Harry and William were just eight and ten when they went on their first holiday without their parents in the summer of 1993, almost two years after Charles and Diana's very public separation.
Squidgygate, a 30 minute tape recording of Diana having a flirtatious conversation with her lover James Gilbey, had been followed just a few months later by Camillagate.
It was an 11 minute tape of their father's late night phone ramblings to his mistress which could be distilled to just one thought: the heir to the throne wished that he could always be with the woman he adored and mused on the possibility of turning into a Tampax to achieve it.
At the hermes bag imitation boys' boarding school, Ludgrove, every effort had been made to ensure that the most lurid headlines were kept out of sight. But there were more than 180 boys at the school aged between seven and 13 and it was impossible to keep it from every one of them. The stress that Harry and William were under is simply unimaginable.
Scroll down for video
Mother love: A hug for two year old Harry from Diana during a family holiday in Majorca in 1986 and the prince, aged four, with his downcast mother on Necker, the island privately owned by Sir Richard Branson in the British Virgin Islands
So they were buy Hermes bags replica certainly in need of a break when they went to Polzeath in Cornwall with their good friends the van Straubenzee boys, whose parents rented the same clifftop house there every year. On that first visit, Harry cut his leg on some barnacles and started to cry. The poor little boy was in agony.
His leg was bleeding profusely and the salt water was making it sting. In the absence of his mother, father or even a nanny, his Police Protection Officer, Graham Cracker, stepped in.
'Harry, pull yourself together and stop whingeing,' he said brusquely. 'It's just a scratch.' When a concerned Mrs van Straubenzee tried to intervene, he batted her away. 'He's perfectly all right.'
It's a small vignette and hardly the most traumatic of incidents. But it took place against a backdrop of appalling family misery and is indicative of a childhood in which the young Prince was left, not for the first time, bereft of every child's most basic requirement: a mother's reassuring comfort.
Those who know Prince Harry generally agree the fact he is never going to be king is a good thing.
It's always said with an affectionate laugh because people love Harry. But he's always had a wild, unpredictable streak to him, even as a little boy.
His detractors say he's not very bright and there was a time, granted, when he behaved like a mindless Hooray Henry with no self control. A time when one wondered whether the terrible combination of his mother's death and the chaos of his childhood had set him on a dangerous and perhaps irreversible downward spiral.
Wildly emotional, Diana expected little Harry to comfort her
Not only did he lose his mother at a desperately difficult age, just two weeks before his 13th birthday he lost her in a spectacular manner that made headlines around the world.
There can surely be few whose hearts were not broken by the sight of Harry as a little boy walking so bravely behind his mother's cortege.
But even before her death he'd endured the misery that comes with a broken home, warring parents and a dad who was often absent.
Like his brother, he had to endure his parents' very bitter divorce, the revelation of their affairs and even their most intimate secrets, from Diana's eating disorder and self harming hermes Birkin Bag replica to Charles's excruciatingly embarrassing phone conversations with Camilla.
It wasn't just that his mother wasn't there to comfort him when he hurt his knee. What was far worse was that she expected him to comfort her as she ricocheted from one terrifying emotional outburst to the next. Some were played out on the front pages of the national newspapers.
Others I am revealing here for the first time.
Contrary to what Diana believed, there was no campaign to discredit her following the separation. In fact, quite the reverse. Charles had given specific instructions to his staff to say and do hermes bag replica nothing to reflect badly upon the Princess.
He made it blindingly clear that no matter what Diana did or said, she would always be the mother of his children and anything that hurt the Princess would hurt them.
For all that, Diana saw conspiracies everywhere and sent anonymous, unnerving and sometimes poisonous messages to a range of people, including her Private Secretary Patrick Jephson and 28 year old Tiggy Legge Bourke, who'd been hired by Prince Charles to look after the boys following the separation. Even Camilla had threatening telephone calls from her. They were always made in the dead of the night, when Camilla was alone in her country house in the middle of nowhere.
I've sent someone to kill you,' Diana would say. 'They're outside in the garden. Look out of the window; can you see them?
'I've sent someone to kill you,' Diana would say. 'They're outside in the garden. Look out of the window; can you see them?'
The Prince picked up many of Diana's cast off staff and she drove him to distraction in many ways. Charles found conversations with her difficult and upsetting. He seemed to provide a focus for her anger; but he did care very much that she should be looked after.
He worried about her and was always there at the end of a telephone, right to the end, when things went wrong with a love affair or the children or even the Press.
As he turns 30, a brilliant new book by a top royal biographer exposes the inner torment of Prince Harry. On Saturday, in this exclusive Mail serialisation, Penny Junor revealed his wild binges, tensions with the Middletons and his many flirtations. Today, we uncover the toxic upbringing that shaped his life.
Harry and William were just eight and ten when they went on their first holiday without their parents in the summer of 1993, almost two years after Charles and Diana's very public separation.
Squidgygate, a 30 minute tape recording of Diana having a flirtatious conversation with her lover James Gilbey, had been followed just a few months later by Camillagate.
It was an 11 minute tape of their father's late night phone ramblings to his mistress which could be distilled to just one thought: the heir to the throne wished that he could always be with the woman he adored and mused on the possibility of turning into a Tampax to achieve it.
At the hermes bag imitation boys' boarding school, Ludgrove, every effort had been made to ensure that the most lurid headlines were kept out of sight. But there were more than 180 boys at the school aged between seven and 13 and it was impossible to keep it from every one of them. The stress that Harry and William were under is simply unimaginable.
Scroll down for video
Mother love: A hug for two year old Harry from Diana during a family holiday in Majorca in 1986 and the prince, aged four, with his downcast mother on Necker, the island privately owned by Sir Richard Branson in the British Virgin Islands
So they were buy Hermes bags replica certainly in need of a break when they went to Polzeath in Cornwall with their good friends the van Straubenzee boys, whose parents rented the same clifftop house there every year. On that first visit, Harry cut his leg on some barnacles and started to cry. The poor little boy was in agony.
His leg was bleeding profusely and the salt water was making it sting. In the absence of his mother, father or even a nanny, his Police Protection Officer, Graham Cracker, stepped in.
'Harry, pull yourself together and stop whingeing,' he said brusquely. 'It's just a scratch.' When a concerned Mrs van Straubenzee tried to intervene, he batted her away. 'He's perfectly all right.'
It's a small vignette and hardly the most traumatic of incidents. But it took place against a backdrop of appalling family misery and is indicative of a childhood in which the young Prince was left, not for the first time, bereft of every child's most basic requirement: a mother's reassuring comfort.
Those who know Prince Harry generally agree the fact he is never going to be king is a good thing.
It's always said with an affectionate laugh because people love Harry. But he's always had a wild, unpredictable streak to him, even as a little boy.
His detractors say he's not very bright and there was a time, granted, when he behaved like a mindless Hooray Henry with no self control. A time when one wondered whether the terrible combination of his mother's death and the chaos of his childhood had set him on a dangerous and perhaps irreversible downward spiral.
Wildly emotional, Diana expected little Harry to comfort her
Not only did he lose his mother at a desperately difficult age, just two weeks before his 13th birthday he lost her in a spectacular manner that made headlines around the world.
There can surely be few whose hearts were not broken by the sight of Harry as a little boy walking so bravely behind his mother's cortege.
But even before her death he'd endured the misery that comes with a broken home, warring parents and a dad who was often absent.
Like his brother, he had to endure his parents' very bitter divorce, the revelation of their affairs and even their most intimate secrets, from Diana's eating disorder and self harming hermes Birkin Bag replica to Charles's excruciatingly embarrassing phone conversations with Camilla.
It wasn't just that his mother wasn't there to comfort him when he hurt his knee. What was far worse was that she expected him to comfort her as she ricocheted from one terrifying emotional outburst to the next. Some were played out on the front pages of the national newspapers.
Others I am revealing here for the first time.
Contrary to what Diana believed, there was no campaign to discredit her following the separation. In fact, quite the reverse. Charles had given specific instructions to his staff to say and do hermes bag replica nothing to reflect badly upon the Princess.
He made it blindingly clear that no matter what Diana did or said, she would always be the mother of his children and anything that hurt the Princess would hurt them.
For all that, Diana saw conspiracies everywhere and sent anonymous, unnerving and sometimes poisonous messages to a range of people, including her Private Secretary Patrick Jephson and 28 year old Tiggy Legge Bourke, who'd been hired by Prince Charles to look after the boys following the separation. Even Camilla had threatening telephone calls from her. They were always made in the dead of the night, when Camilla was alone in her country house in the middle of nowhere.
I've sent someone to kill you,' Diana would say. 'They're outside in the garden. Look out of the window; can you see them?
'I've sent someone to kill you,' Diana would say. 'They're outside in the garden. Look out of the window; can you see them?'
The Prince picked up many of Diana's cast off staff and she drove him to distraction in many ways. Charles found conversations with her difficult and upsetting. He seemed to provide a focus for her anger; but he did care very much that she should be looked after.
He worried about her and was always there at the end of a telephone, right to the end, when things went wrong with a love affair or the children or even the Press.
Phil Taylor and Raymond van Barneveld meet in the Premier League on Thursday
The Premier League's visit to the First Direct Arena in Leeds for Night Three includes the meeting of great rivals Phil Taylor and Raymond van Barneveld.
The Dutchman reached the semi finals of the PDC World Championship after a 5 3 win over Phil Taylor at Alexandra Palace in December and they will be reacquainted again for a 78th time when they clash in Yorkshire on Thursday night.
Premier League leader Taylor leads the head to head meetings 56 17 and four draws between the pair, Barney's 2007 World Championship win against Taylor the pick of the bunch for Van Barneveld.
'The Power' got his revenge with a 7 1 thumping in the 2009 final and also swept to victory over the man from Den Haag with semi final wins in 2012 and 2015.
But Van Barneveld is back playing blistering darts with four hermes Constance bag replica points from his hermes bag replica opening two games and with Taylor having announced his plans to retire replica Hermes Classic Shoulder Birkin bag at the end of the season, their latest collision could unthinkably be their last ever.
WATCH: El Clasico of darts! The El Clasico of darts between Raymond van Barneveld and Phil Taylor is back in Leeds
Scottish rivals Gary Anderson and Peter Wright open a night which also features the all Dutch clash between Michael van Gerwen and Jelle Klaasen, the meeting between Adrian Lewis and James Wade and Dave Chisnall's clash with Kim Huybrechts.
"It's the Premier League, you're playing the ten best players in the world and you can't afford to miss," said Huybrechts. "When you miss you lose, it's as simple as that.
"A draw was probably a fair result last week but I've got to keep fighting."
You can see all the action from the First Direct Arena in Leeds from 7pm on Sky Sports 1 HD. Grab a NOW hermes bag black replica TV Sky Sports Day Pass and watch Premier League Darts from Leeds on Thursday night for just No contract.
The Premier League's visit to the First Direct Arena in Leeds for Night Three includes the meeting of great rivals Phil Taylor and Raymond van Barneveld.
The Dutchman reached the semi finals of the PDC World Championship after a 5 3 win over Phil Taylor at Alexandra Palace in December and they will be reacquainted again for a 78th time when they clash in Yorkshire on Thursday night.
Premier League leader Taylor leads the head to head meetings 56 17 and four draws between the pair, Barney's 2007 World Championship win against Taylor the pick of the bunch for Van Barneveld.
'The Power' got his revenge with a 7 1 thumping in the 2009 final and also swept to victory over the man from Den Haag with semi final wins in 2012 and 2015.
But Van Barneveld is back playing blistering darts with four hermes Constance bag replica points from his hermes bag replica opening two games and with Taylor having announced his plans to retire replica Hermes Classic Shoulder Birkin bag at the end of the season, their latest collision could unthinkably be their last ever.
WATCH: El Clasico of darts! The El Clasico of darts between Raymond van Barneveld and Phil Taylor is back in Leeds
Scottish rivals Gary Anderson and Peter Wright open a night which also features the all Dutch clash between Michael van Gerwen and Jelle Klaasen, the meeting between Adrian Lewis and James Wade and Dave Chisnall's clash with Kim Huybrechts.
"It's the Premier League, you're playing the ten best players in the world and you can't afford to miss," said Huybrechts. "When you miss you lose, it's as simple as that.
"A draw was probably a fair result last week but I've got to keep fighting."
You can see all the action from the First Direct Arena in Leeds from 7pm on Sky Sports 1 HD. Grab a NOW hermes bag black replica TV Sky Sports Day Pass and watch Premier League Darts from Leeds on Thursday night for just No contract.
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Raurimu killer given unsupervised leave
The gunman who shot dead six people and wounded four others at Raurimu has been given regular, unsupervised leave, angering the son of one of his victims.Stephen Lawrence Anderson, who has been a psychiatric replica birkin handbags patient at Porirua's Kenepuru Hospital since the 1997 massacre, spent Christmas with relatives in Wellington as part of a long plan to reintegrate him into the community.The 35 schizophrenic was responsible for one of the worst mass killings in New Zealand history, after running amok with his father's shotgun at a family gathering in the tiny North Island town, 34km southeast of Taumarunui. He was later found not guilty by reason of insanity on multiple charges of murder and attempted murder, and detained as a special patient at Kenepuru.Capital and Coast District Health Board chief executive Derek Milne refused to discuss Anderson's case, saying it was not the board's policy to comment on individual patients.However, Anderson's aunt Toni Curley confirmed that as part of Anderson's ongoing rehabilitation he was replica hermes handbags allowed extended periods of unsupervised leave.He had spent several days away from the hospital during the Christmas holidays and had spent time with her and her husband in Wellington.Anderson, she said, had been taking his medication and quite good". There had been no talk about the events of 11 years ago and he seemed to enjoy reacquainting himself with family.Anderson's lawyer during the 1997 trial, Stuart Grieve QC, did not wish to comment, but the son of one of the men slain during the Raurimu massacre was angry his father's killer was being allowed into the fake hermes leather handbags community.David Van de Wetering's father Henk, 51, was shot and killed by Anderson during the Raurimu rampage as he tried to raise the alarm by flagging down a passing truck. Not only had he lost his father, but his mother had moved overseas with his brother Rodney because they could not cope with living in the same country as Anderson.His mother had spent years battling ACC for assistance to help cover the cost of treatment for replica hermes bag injuries suffered during the massacre."My mother ran down the stairs with grandchildren in her arms talking to 111 when she fell and got badly injured and she's had to fight ACC all the way for help to cover that. Where's the fairness? We had to get an MP involved to tell ACC to pull their heads in, Van de Wetering said.His 41 brother still had pellets in his brain which were killing him". He suffered from horrific headaches."I know once he [Anderson] is let out permanently . my mother will never return here to visit me."The crims get treated better than the victims. Why does all this stuff go on behind our backs?"You can't heal the brain with a couple of pills and call it quits.Our Features Top StoriesDrivenWhat's it like driving James Bond's Lotus Espirit? Never meet your heroes? Well, it's not always the case.
The gunman who shot dead six people and wounded four others at Raurimu has been given regular, unsupervised leave, angering the son of one of his victims.Stephen Lawrence Anderson, who has been a psychiatric replica birkin handbags patient at Porirua's Kenepuru Hospital since the 1997 massacre, spent Christmas with relatives in Wellington as part of a long plan to reintegrate him into the community.The 35 schizophrenic was responsible for one of the worst mass killings in New Zealand history, after running amok with his father's shotgun at a family gathering in the tiny North Island town, 34km southeast of Taumarunui. He was later found not guilty by reason of insanity on multiple charges of murder and attempted murder, and detained as a special patient at Kenepuru.Capital and Coast District Health Board chief executive Derek Milne refused to discuss Anderson's case, saying it was not the board's policy to comment on individual patients.However, Anderson's aunt Toni Curley confirmed that as part of Anderson's ongoing rehabilitation he was replica hermes handbags allowed extended periods of unsupervised leave.He had spent several days away from the hospital during the Christmas holidays and had spent time with her and her husband in Wellington.Anderson, she said, had been taking his medication and quite good". There had been no talk about the events of 11 years ago and he seemed to enjoy reacquainting himself with family.Anderson's lawyer during the 1997 trial, Stuart Grieve QC, did not wish to comment, but the son of one of the men slain during the Raurimu massacre was angry his father's killer was being allowed into the fake hermes leather handbags community.David Van de Wetering's father Henk, 51, was shot and killed by Anderson during the Raurimu rampage as he tried to raise the alarm by flagging down a passing truck. Not only had he lost his father, but his mother had moved overseas with his brother Rodney because they could not cope with living in the same country as Anderson.His mother had spent years battling ACC for assistance to help cover the cost of treatment for replica hermes bag injuries suffered during the massacre."My mother ran down the stairs with grandchildren in her arms talking to 111 when she fell and got badly injured and she's had to fight ACC all the way for help to cover that. Where's the fairness? We had to get an MP involved to tell ACC to pull their heads in, Van de Wetering said.His 41 brother still had pellets in his brain which were killing him". He suffered from horrific headaches."I know once he [Anderson] is let out permanently . my mother will never return here to visit me."The crims get treated better than the victims. Why does all this stuff go on behind our backs?"You can't heal the brain with a couple of pills and call it quits.Our Features Top StoriesDrivenWhat's it like driving James Bond's Lotus Espirit? Never meet your heroes? Well, it's not always the case.
Obtaining Leave of Court to Submit Evidence in Reply Papers for 'Good Cause Shown'
In litigation, parties may bring motions for dismissal of the action or affirmative defenses, or move for 'summary judgment' (that there are replica hermes bag no genuine issues of fact and the judge can decide the case on the law alone). Generally, the moving party puts forward all of its proof in support of its motion, including any affidavits, documents or photographs. The opposing party then puts forward all of its proof. At that point, it is inappropriate for either party to provide additional facts in reply papers, as courts want to give each party an opportunity to properly respond to the facts alleged in the original papers. It would otherwise be unfair.
In litigation, parties may bring motions for dismissal of the action or affirmative defenses, or move for 'summary judgment' (that there are no genuine issues of fact and the judge can decide the case on the law alone). Generally, the moving party puts forward all of its proof in support of its motion, including any affidavits, documents or photographs. The opposing party then puts forward all of its proof. At that point, it is inappropriate for either party to provide additional facts in reply papers, as courts want to give each party an opportunity to properly respond to the facts alleged in the original papers. It would otherwise be unfair.
Sometimes, however, additional facts how much is a hermes bag or proof become necessary for various reasons. In that situation, the party seeking to provide additional proof must show "good cause" for having to do it.
Pursuant to binding Appellate Division, First and Second Department precedents, supplemental affirmations and/or sur reply's are permissible upon leave of the court with good cause shown, particularly where (1) the movant submits evidence for the first time in its reply papers or (2) "where the offering party's adversaries responded to the newly presented claim or evidence [citations omitted]." Kennelly v. Co. v. St. v.
Further binding Appellate Division, Second Department precedents hold that "[c]ontrary to the [movant's] contention, the court did not err by considering the evidence in the [cross movant's] reply papers because it was submitted in direct response to allegations raised in their opposition papers [citations omitted]." Conte v. In the first instance, the defense was raised in direct response to the allegation made in the plaintiff's opposition papers that the decedent was struck by a van in motion, rather than thrown into the path of a stopped van (see Conte v. Corp. v. v. v. Accordingly, the defendant argued, the court erred in granting summary judgment to the defendant.
In a recent action litigated by Richard A. Klass, Your Court Street Lawyer, the defendant submitted photographs of a sign with defendant's reply affirmation, after plaintiff's opposition and cross motion had been submitted, as evidence that the entrance near a certain street, within 50 60 feet of which plaintiff had repeatedly testified his accident occurred, was located at another street, thousands of feet away. In his reply affirmation on his cross motion, not in a sur reply, plaintiff requested leave of this Honorable Court to submit (a) further photographs clearly depicting the entrance gate at the particular street indicated, with an identical sign about which he had been testifying, adjacent to which plaintiff testified his accident occurred in his EBT, as well as (b) a supplemental affidavit from plaintiff, authenticating these photographs as fair and accurate representations fake hermes leather handbags of the entrance about which he had testified. Accordingly, as the evidence (a) was submitted with a reply affirmation on his cross motion, replica birkin handbags not a sur reply, (b) plaintiff properly asked leave of the court to submit additional evidence in his reply on his cross motion, in order to respond to the photograph submitted in defendant's reply on the underlying motion, and (c) defendant has availed itself of the opportunity to respond thereto, this evidence is properly before this Honorable Court.
by Richard A. Klass, Esq. is licensed under a Creative Commons Attribution Noncommercial No Derivative Works 3.0 United States License. For permissions beyond the scope of this license, please contact Mr. All links must be active.
In litigation, parties may bring motions for dismissal of the action or affirmative defenses, or move for 'summary judgment' (that there are replica hermes bag no genuine issues of fact and the judge can decide the case on the law alone). Generally, the moving party puts forward all of its proof in support of its motion, including any affidavits, documents or photographs. The opposing party then puts forward all of its proof. At that point, it is inappropriate for either party to provide additional facts in reply papers, as courts want to give each party an opportunity to properly respond to the facts alleged in the original papers. It would otherwise be unfair.
In litigation, parties may bring motions for dismissal of the action or affirmative defenses, or move for 'summary judgment' (that there are no genuine issues of fact and the judge can decide the case on the law alone). Generally, the moving party puts forward all of its proof in support of its motion, including any affidavits, documents or photographs. The opposing party then puts forward all of its proof. At that point, it is inappropriate for either party to provide additional facts in reply papers, as courts want to give each party an opportunity to properly respond to the facts alleged in the original papers. It would otherwise be unfair.
Sometimes, however, additional facts how much is a hermes bag or proof become necessary for various reasons. In that situation, the party seeking to provide additional proof must show "good cause" for having to do it.
Pursuant to binding Appellate Division, First and Second Department precedents, supplemental affirmations and/or sur reply's are permissible upon leave of the court with good cause shown, particularly where (1) the movant submits evidence for the first time in its reply papers or (2) "where the offering party's adversaries responded to the newly presented claim or evidence [citations omitted]." Kennelly v. Co. v. St. v.
Further binding Appellate Division, Second Department precedents hold that "[c]ontrary to the [movant's] contention, the court did not err by considering the evidence in the [cross movant's] reply papers because it was submitted in direct response to allegations raised in their opposition papers [citations omitted]." Conte v. In the first instance, the defense was raised in direct response to the allegation made in the plaintiff's opposition papers that the decedent was struck by a van in motion, rather than thrown into the path of a stopped van (see Conte v. Corp. v. v. v. Accordingly, the defendant argued, the court erred in granting summary judgment to the defendant.
In a recent action litigated by Richard A. Klass, Your Court Street Lawyer, the defendant submitted photographs of a sign with defendant's reply affirmation, after plaintiff's opposition and cross motion had been submitted, as evidence that the entrance near a certain street, within 50 60 feet of which plaintiff had repeatedly testified his accident occurred, was located at another street, thousands of feet away. In his reply affirmation on his cross motion, not in a sur reply, plaintiff requested leave of this Honorable Court to submit (a) further photographs clearly depicting the entrance gate at the particular street indicated, with an identical sign about which he had been testifying, adjacent to which plaintiff testified his accident occurred in his EBT, as well as (b) a supplemental affidavit from plaintiff, authenticating these photographs as fair and accurate representations fake hermes leather handbags of the entrance about which he had testified. Accordingly, as the evidence (a) was submitted with a reply affirmation on his cross motion, replica birkin handbags not a sur reply, (b) plaintiff properly asked leave of the court to submit additional evidence in his reply on his cross motion, in order to respond to the photograph submitted in defendant's reply on the underlying motion, and (c) defendant has availed itself of the opportunity to respond thereto, this evidence is properly before this Honorable Court.
by Richard A. Klass, Esq. is licensed under a Creative Commons Attribution Noncommercial No Derivative Works 3.0 United States License. For permissions beyond the scope of this license, please contact Mr. All links must be active.
Petition calls for former soldier to be spared jail after trying to smuggle Afghan refugee out of Calais
"I don't think 'thank you' is enough, because when this started I felt completely alone," he said. "I think this shows that the UK as a country really does want to help the refugees."The volunteer aid worker, who had been caught at Calais border control on 24 October after hiding Bahar in his transit van, added: "I am a 49 year old man, not a boy. I got carried away with my concerns for Bahar, I didn't think things through legally, and now I'm ready to take how much is a hermes handbag my punishment."My real concern is that there are children smaller than my youngest child walking around the Jungle already wearing three or four layers of clothes because it is so cold, and it is only early November."Mr Lawrie spoke after The Independent visited the Jungle to be told by Bahar's father Reza that he was "100 per cent worried" about how his daughter would cope with the coming winter.Mr Innes, 37, of Bingley, West Yorkshire, who has never met Mr Lawrie but who started swapping Facebook messages with him after joining a local refugee solidarity campaign, said: "I've told Rob he was a daft bugger. I don't agree with people breaking the law, but fake hermes leather handbags I don't know what I would have done in his situation."People who brought children out of places in the Second replica hermes birkin handbags World War are heroes, but the law considers Rob to be a criminal. Which means the law needs changing."A petition written in French supporting Mr Lawrie has attracted 200 signatories, many of them French, with one contributor arguing: "How can we leave these people [refugees] in such distress?"Elsewhere, however, commentators on French news websites were less sympathetic and congratulated the French border police for catching Mr Lawrie.Click the Adblock/Adblock Plus icon, which is to the right of your address bar.On fake herme bag Adblock click "Don't run on pages on this domain".If you are Private Browsing in Firefox, "Tracking Protection" may cause the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
"I don't think 'thank you' is enough, because when this started I felt completely alone," he said. "I think this shows that the UK as a country really does want to help the refugees."The volunteer aid worker, who had been caught at Calais border control on 24 October after hiding Bahar in his transit van, added: "I am a 49 year old man, not a boy. I got carried away with my concerns for Bahar, I didn't think things through legally, and now I'm ready to take how much is a hermes handbag my punishment."My real concern is that there are children smaller than my youngest child walking around the Jungle already wearing three or four layers of clothes because it is so cold, and it is only early November."Mr Lawrie spoke after The Independent visited the Jungle to be told by Bahar's father Reza that he was "100 per cent worried" about how his daughter would cope with the coming winter.Mr Innes, 37, of Bingley, West Yorkshire, who has never met Mr Lawrie but who started swapping Facebook messages with him after joining a local refugee solidarity campaign, said: "I've told Rob he was a daft bugger. I don't agree with people breaking the law, but fake hermes leather handbags I don't know what I would have done in his situation."People who brought children out of places in the Second replica hermes birkin handbags World War are heroes, but the law considers Rob to be a criminal. Which means the law needs changing."A petition written in French supporting Mr Lawrie has attracted 200 signatories, many of them French, with one contributor arguing: "How can we leave these people [refugees] in such distress?"Elsewhere, however, commentators on French news websites were less sympathetic and congratulated the French border police for catching Mr Lawrie.Click the Adblock/Adblock Plus icon, which is to the right of your address bar.On fake herme bag Adblock click "Don't run on pages on this domain".If you are Private Browsing in Firefox, "Tracking Protection" may cause the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
Police riot van used to transport Santa home after Aberdare parade
A spokesman for South Wales Police said: replica hermes handbags outlet 'Santa obviously has a busy month ahead, so when he asked if we could provide transport at the end of his sleigh ride through replica hermes birkin handbags Aberdare town centre to help him get back to the North Pole, we were happy to oblige.'
Some members of the audience called the decision to transport Santa back home by police van 'a mistake'
Rhondda Cynon Taf council revealed that transporting Father Christmas in a police van had always been part of the plan, so he could make a swift exit.
A spokesman said: 'We are grateful to South Wales Police for assisting Father Christmas during his departure from Aberdare town centre after an amazing Christmas event, which was enjoyed by thousands of people.
'It was always part of the arrangements to transport Father Christmas out of the town centre in a vehicle provided by South Wales Police as quickly and as safely as possible as he has a busy few weeks ahead of him.'
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A spokesman for South Wales Police said: replica hermes handbags outlet 'Santa obviously has a busy month ahead, so when he asked if we could provide transport at the end of his sleigh ride through replica hermes birkin handbags Aberdare town centre to help him get back to the North Pole, we were happy to oblige.'
Some members of the audience called the decision to transport Santa back home by police van 'a mistake'
Rhondda Cynon Taf council revealed that transporting Father Christmas in a police van had always been part of the plan, so he could make a swift exit.
A spokesman said: 'We are grateful to South Wales Police for assisting Father Christmas during his departure from Aberdare town centre after an amazing Christmas event, which was enjoyed by thousands of people.
'It was always part of the arrangements to transport Father Christmas out of the town centre in a vehicle provided by South Wales Police as quickly and as safely as possible as he has a busy few weeks ahead of him.'
Most watched News videos EXCLUSIVE: Ariana Grande plane arrives back in the hermes replica US Homeless man describes how he helped after Manchester attack Moment bomb explodes at Ariana Grande concert Moment armed police storm of Manchester suicide bomber Eye witness describes spotting the Manchester attacker Blood seen dripping from victim leg after Manchester Armed police prepare to raid of Manchester suicide bomber Forensic officers raid of Manchester suicide bomber Threat level now CRITICAL: PM raises terror level Mum of Manchester attack victim Georgina Callander releases balloons Sickening video warns of more attacks after Manchester Man is arrested by police outside Buckingham Palace
EXCLUSIVE: First photos of Ariana Grande since Manchester. Help for the homeless heroes: Millionaire West Ham owner. The schoolgirls massacred by ISIS coward: Five teenagers. Revealed: Manchester bomber returned to Britain from. Theresa May warns a fresh terror attack is feared to be. 'Our little Hermes Kelly bag replica princess has been so lucky': Father's joy as. Britain on lockdown: Army deploys 1,000 heavily armed. Horror on the M6: Lorry driver is arrested after four. Tourists watch in horror as armed police arrest man. Aaron Hernandez's hell behind bars: NFL star killed. More than 24 hours on, desperate families still search. Mother of child actress pictured hugging a female police. BREAKING NEWS: My son is innocent, insists father of. 'I won't forget what you said!' Trump tells Pope after. Terrorist's brother arrested: Dramatic moment armed. Comedian Jason Manford deletes Twitter after being. Bomber from a red brick semi who 'knew an ISIS. Armed police and soldiers raid Manchester city centre. MOST READ NEWS Previous.