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Reassessment should occur at regular intervals to monitor the child’s nutrition status buy 0.5 mg colcrys with visa, and evaluate the effectiveness of the nutrition intervention buy colcrys 0.5mg with mastercard. Based on the reassessment buy colcrys 0.5mg without prescription, nutrition goals and objectives may be modifed to meet the needs of the child and family (5) cheap 0.5mg colcrys with visa. Nutrition Interventions for Children With Special Health Care Needs 3 Chapter 1 - Nutrition Screening and Assessment 4 Nutrition Interventions for Children With Special Health Care Needs Section 1 - Determination of Nutrition Status Nutrition Interventions for Children With Special Health Care Needs 5 Chapter 1 - Nutrition Screening and Assessment 6 Nutrition Interventions for Children With Special Health Care Needs Section 1 - Determination of Nutrition Status Nutrition Interventions for Children With Special Health Care Needs 7 Chapter 1 - Nutrition Screening and Assessment 8 Nutrition Interventions for Children With Special Health Care Needs Section 1 - Determination of Nutrition Status Nutrition Interventions for Children With Special Health Care Needs 9 Chapter 1 - Nutrition Screening and Assessment References 1. Providing nutrition services to children with special needs in a community setting. Position of the American Dietetic Association: Providing Nutrition Services for Infants, Children, and Adults with Developmental Disabilities and Special Health Care Needs. Pediatric Nutrition in Chronic Diseases and Developmental Disorders: Prevention, Assessment, and Treatment, 2nd ed. Chatoor I, Dickson L, Schaefer S, Egan J: A developmental classifcation of feeding disorders associated with failure to thrive: diagnosis and treatment. The primary measures used as indices of growth and development include stature (length or height), weight, and head circumference (for young children). The secondary measures used to estimate body composition include triceps skinfold thickness, subscapular skinfold thickness, and mid-upper arm circumference. Growth is an important index of a child’s nutritional status and should be monitored on a regular basis. Stature (length or height), weight, and head circumference are typically evaluated by comparing individual measurements to population data, represented by percentile curves on a growth chart. These charts are intended as clinical tools to assess nutritional status and general health of infants, children, and adolescents. To assess and monitor the nutritional status of a child with special health care needs who does not necessarily meet the criteria of the growth charts, it is necessary to carefully evaluate a pattern of measurements obtained at regular intervals. The more recent work from the Expert Committee recommend that 85-94% be identifed as overweight and >95th percent be identifed as obese (2). For the child with special health care needs, these parameters may not be reliable indicators of atypical growth. However, they are useful in screening for children who are at risk for growth problems. For some children with special health care Nutrition Interventions for Children With Special Health Care Needs 13 Chapter 2 - Anthropometricss needs, poor growth or excessive weight gain must be confrmed with longitudinal measurements and, in many cases, additional anthropometric parameters to estimate body composition. Furthermore, the growth patterns characteristic of the particular disease or disorder and the child’s growth history must be considered. For anthropometric parameters to be valid indices of growth status, they must be highly accurate. Appropriate use of growth charts requires that measurements be made in the same manner in which the reference data were secured (3,4). In order to measure a child accurately, the individual performing the measurement must be properly trained, and reliable equipment must be available. For some children with special health care needs, it can be challenging to make accurate measurements because of factors such as contractures and low muscle tone. This chapter provides information on recommended equipment and measuring techniques including special considerations for obtaining measurements from the child with special health care needs. Measurement techniques, equipment required, advantages, and limitations are summarized in Table 2-1. Primary Measures Head Circumference (3,4) Head circumference is an important screening tool in infants and young children because it is closely related to brain growth. Decreases in the rate of head growth have been seen in children who are severely undernourished. Head circumference should be measured routinely 14 Nutrition Interventions for Children With Special Health Care Needs Section 1 - Determination of Nutrition Status until at least 36 months of age. Parental head circumferences of infants whose head circumferences are atypical should also be measured, as head circumferences of parents and their offspring are typically closely associated. Place the lower edge of the measuring tape just above the child’s eyebrows, above the ears, and around the occipital prominence at the back of the child’s head. If the measurement appears larger or smaller than expected when plotted, check the accuracy of plotting and recheck the measurement. If there is a rapid increase in the child’s head circumference, she should be seen by her physician. However, the Nellhaus head circumference percentiles may be more useful for some children because they include percentiles for children ages 0 to 18 years and were developed from international, interracial data (See Appendix C) (5). Premature infant growth charts include percentiles for head circumference as well as for length and weight (See Appendix J). When monitoring head growth, it is important to consistently plot measurements on the same chart and to look for consistent patterns in head growth. Nutrition Interventions for Children With Special Health Care Needs 15 Chapter 2 - Anthropometricss Stature (Length and Height) Stature is measured in two ways: recumbent length for the child younger than 36 months of age and standing height for children older than 24 months (4). Contractures about the hips, knees, and ankles can interfere with an accurate stature measurement. Crown-rump length or sitting height measurements are often useful estimates of stature for children with contractures of the lower body. Although the measurements will be below the 5th percentile for age, they will show whether or not the child is following a consistent growth curve. However, for children with contractures of the upper extremities such as in cerebral palsy, accurate arm span measurements are also diffcult (6). For those children who have contractures of the arm, tibia length, though less accurate, is sometimes used with a formula to estimate stature (7). Length For children who are younger than 24 months of age and children 24 to 36 months of age who are unable to stand independently, measure recumbent length.

Scottish Health Survey 2016: Volume 1: 12: Education generic colcrys 0.5 mg, implementation cheap colcrys 0.5 mg without a prescription, and teams: 2010 international Main Report buy generic colcrys 0.5 mg on line. Circulation 2015;132(16 Suppl Epidemiology of multimorbidity and implications for health care generic colcrys 0.5mg free shipping, 1):S51-83. Improved out-of-hospital cardiac arrest survival through the guidance-on-prescribing. Part 4: Advanced life support: 2015 international consensus on defibrillator program in a suburban community. Resuscitation cardiopulmonary resuscitation and emergency cardiovascular care 2002;52(1):23-9. Part 8: Advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency 27. Tripling survival from sudden cardiac arrest via early defibrillation Circulation 2010;122(16 Suppl 2):S345-421. Priori S, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, et al. Leisure-time physical activity and the risk of primary Home use of automated external defibrillators for sudden cardiac cardiac arrest. McMurray J, Kober L, Robertson M, Dargie H, Colucci W, Lopez- European Resuscitation Council Guidelines for Resuscitation 2015: Sendon J, et al. Resuscitation 2015;95:100- myocardial infarction: results of the Carvedilol Post-Infarct Survival 47. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial 32. Cardiopulmonary resuscitation of adults in the hospital: comparison of amiodarone and digoxin in the treatment of atrial A report of 14,720 cardiac arrests from the National Registry of fibrillation complicating suspected acute myocardial infarction. Preliminary report: effect of encainide and flecainide on mortality for neuroprotection in adults after cardiopulmonary resuscitation. Management of acute myocardial infarction in patients 36degreeC after cardiac arrest. Gorenek B, Blomstrom Lundqvist C, Brugada Terradellas J, Camm Journal 2008;29(23):2909-45. Prognostic implications of ventricular fibrillation in acute College of Cardiology Foundation. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandjelovic A, et al. Significance of recurrences of new atrial fibrillation in acute myocardial infarction. Ventricular fibrillation Eplerenone, a selective aldosterone blocker, in patients with left in acute myocardial infarction in Spanish patients: Results of the ventricular dysfunction after myocardial infarction. Prediction of sudden cardiac death after acute primary ventricular fibrillation complicating acute myocardial myocardial infarction: role of Holter monitoring in the modern infarction: Perspectives from the Worcester Heart Attack Study. Ventricular risk stratification tests for predicting major arrhythmic events after fibrillation following administration of thrombolytic treatment: the myocardial infarction. Effect of angiotensin converting enzyme inhibition on sudden myocardial infarction in the beta-blocking era. J Am Coll Cardiol cardiac death in patients following acute myocardial infarction. Determinants of sudden death after discharge from hospital for myocardial infarction in the 62. N Engl J Med 2004;351(24):2481- Trends in cause of death after percutaneous coronary intervention. Defibrillator implantation early after analysis of cardiovascular outcomes with dronedarone in patients myocardial infarction. Ibanez B, Macaya C, Sanchez-Brunete V, Pizarro G, Fernandez-Friera with severe left ventricular dysfunction and no inducible L, Mateos A, et al. Circulation segment-elevation myocardial infarction patients undergoing 2014;129(8):848-54. Prevention of atrial fibrillation with angiotensin-converting Effects of omega-3 fatty acid for sudden cardiac death prevention enzyme inhibitors and angiotensin receptor blockers: a meta- in patients with cardiovascular disease: a contemporary meta- analysis. Meta-analysis: Inhibition of renin-angiotensin system prevents new-onset atrial 70. Healthy diet: nutrition essentials: fish risk factor management on symptom burden and severity in and shellfish. Available from url: patients with atrial fibrillation: a randomized clinical trial. Bellandi F, Simonetti I, Leoncini M, Frascarelli F, Giovannini T, Maioli M, et al. Dronedarone for for the maintenance of sinus rhythm after conversion of recurrent the treatment of non-permanent atrial fibrillation. Carlsson Jö, Miketic S, Windeler Jü, Cuneo A, Haun S, Micus S, patients with symptomatic atrial fibrillation and/or atrial flutter. Randomized trial of rate-control versus rhythm-control in Am J Cardiol 1999;84(3):270-7. Addressing the management of atrial fibrillation - a systematic review of the role of dronedarone. Cost- rate control in chronic atrial fibrillation during daily activity and effectiveness of dronedarone in atrial fibrillation: results for programmed exercise: a crossover open-label study of five drug Canada, Italy, Sweden, and Switzerland.

Female condoms are effective and safe purchase 0.5mg colcrys visa, but are not used as widely by national programmes as male condoms generic colcrys 0.5 mg without a prescription. Women with known severe genetic lipid disorders are at much higher lifetime risk for cardiovascular disease and may warrant further clinical consideration cheap 0.5 mg colcrys with mastercard. Female condoms are effective and safe discount colcrys 0.5 mg with mastercard, but are not used as widely by national programmes as male condoms. Classifcation is for women i) without aura without any other risk factors for stroke. Risk age < 35 years 2 3 2 3 2 3 2 3 of stroke increases with age, hypertension and smoking. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. There is a potential for drug interactions between certain antidepressant medications and hormonal contraceptives. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Limited evidence on women with low-grade squamous intraepithelial lesions found use of the vaginal ring did not worsen the condition (64). Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. The baseline risk of breast cancer is also higher among women with a family history of breast cancer than among those who do not have such a history. Current evidence, however, does not suggest that the increased risk of breast cancer among women with either a family history of breast cancer or breast cancer susceptibility genes is modifed by the use of combined oral contraceptives (175, 271–293). Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Changes in lipid profle and haemostatic markers were limited, and most changes remained within normal values (419, 422–430). Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Use of other contraceptives should be encouraged for women who are long-term users of any of these drugs. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms. Use of other contraceptives should be encouraged for women who are long-term users of either of these drugs. In further increase the risk of arterial thrombosis; women with general, treatment of this condition renders a woman sterile. Effect of different progestagens in low oestrogen oral generation oral contraceptives compared with users contraceptives on venous thromboembolic disease. World of oral contraceptives with levonorgestrel before and Health Organization Collaborative Study of Cardiovascular after 1995: cohort and case-control analysis. Bergendal A, Persson I, Odeberg J, Sundstrom A, thromboembolism in women using oral contraceptives Holmstrom M, Schulman S, et al. Association of venous containing drospirenone compared with women using thromboembolism with hormonal contraception oral contraceptives containing levonorgestrel: case- and thrombophilic genotypes. Enhancement by factor V Leiden nonfatal venous thromboembolism in women using a mutation of risk of deep-vein thrombosis associated contraceptive transdermal patch and oral contraceptives with oral contraceptives containing a third-generation containing norgestimate and 35 microg of ethinyl progestagen. Oral contraceptives venous thromboembolism and the use of dienogest- and and venous thromboembolism: a fve-year national case- drospirenone-containing oral contraceptives: results from control study. Venous thromboembolic disease and combined oral contraceptives: a re-analysis of the MediPlus database. Population-based study of risk of venous thromboembolism associated with various oral 18. Risk of venous thromboembolic disease in association with different thrombosis in users of hormonal contraceptives in combined oral contraceptives. Dunn N, Thorogood M, Faragher B, de Caestecker L, with differing progestagen components. Reproductive history, oral contraceptive use, contraceptives: a population-based cohort study. Pharmacokinetics of once-a-month results, new analyses and the healthy user effect. The use of oral contraceptives and the Virutamasen P, Tang-Keow P, Konsayreepong R, et al. A occurrence of acute myocardial infarction in young multicentered pharmacokinetic, pharmacodynamic study women.

The trophozoite • Some species are acquired through food or water contam- stages of the amebae live in the large intestine on the mucosal inated with infective eggs or larvae generic colcrys 0.5 mg line, or are picked up direct- surface 0.5mg colcrys with mastercard, frequently as harmless commensals feeding on bac- ly via contaminated fingers buy colcrys 0.5 mg fast delivery. Reproduction of these stages is by simple binary fission discount 0.5 mg colcrys overnight delivery, • Some have larvae that can actively penetrate through the and there is periodic formation of resistant encysted forms, skin, migrating eventually to the intestine. These cysts can survive in the • Others are acquired by eating animals or animal products external environment and act as the infective stages; asymp- containing infective stages. Infection occurs when food or drink is contaminated the clinical manifestations of E. The cysts pass intact through the stomach Infections with commensal forms of the ameba are asymp- when swallowed and excyst in the small intestine, each giving tomatic. Under certain conditions, still unde- superficial ulcers or involve the entire colonic mucosa with the fined, but including variables of both host and parasite origin, formation of deep confluent ulcers (Fig. The former Entamoeba can become pathogenic, the amebae invading the causes a mild diarrhea, whereas more severe invasion leads to mucosa and feeding on host materials including red blood ‘amebic dysentery’, which is characterized by mucus, pus and cells, giving rise to amebic colitis. Dysenteries of amebic and bacillary origin can be distinguished by a number of features (Fig. Complications include perforation of the intestine, leading to peritonitis, and extraintestinal invasion. Trophozoites can spread via the blood to the liver, with the formation of an a b abscess, and may secondarily extend to the lung and other organs. Trophozoite found in the acute stage of the Charcot–Leydon disease, which often contains ingested red blood cells. The broad chromatid bar is a blood and mucus yes yes semicrystalline aggregation of ribosomes. The genus Giardia be found in cases of dysentery (when the stools are loose and is widely distributed in mammals and there is suggestive evi- wet), but they are fragile and deteriorate rapidly; specimens dence for cross-infection between certain animal hosts (e. Much of this is circumstantial, but case immunologic tests are available, but only indicate whether reports provide more direct evidence. Recent data suggest patients have been exposed to infection at some time in their that Giardia may also be transmitted sexually. Mild Giardia infections are asymptomatic, more severe infections cause diarrhea Acute E. Recovery from infection is usual and there is some immunity • Chronic, and develop into a serious condition, particularly to reinfection. Treatment may fail to clear the infection com- in patients with deficient or compromised immunologic pletely and the passage of infective cysts can continue. Metronidazole is useful against the extraintestinal sites of It is thought to arise from inflammatory responses trig- infection, but if these become secondarily infected with bac- gered by the damaged epithelial cells and from interference teria, additional antibiotics and drainage are necessary. Characteristically the stools Prevention of amebiasis in the community requires the same are loose, foul-smelling and often fatty. Diagnosis of Giardia infection is based on identifying cysts or trophozoites in the stool Giardia lamblia Repeated examination is necessary in light infections when Giardia was the first intestinal microorganism to be observed concentration techniques improve the chances of finding under a microscope. Duodenal intubation or the use of recoverable swal- Leeuwenhoek in 1681, using the microscope he had lowed capsules and threads may aid in obtaining trophozoites invented to examine specimens of his own stool. Like Entamoeba, Giardia has only two life cycle stages the two life cycle stages are the flagellate (four pairs of flag- ella) binucleate trophozoite and the resistant four-nucleate cyst. The trophozoites live in the upper portion of the small intestine, adhering closely to the brush border of the epithe- lial cells by specialized attachment regions (Fig. They divide by binary fission and can occur in such numbers that they cover large areas of the mucosal surface. Cyst formation occurs at regular intervals, each cyst being formed as one trophozoite rounds up and produces a resistant wall. Cysts pass out in the stools and can survive for several weeks under optimum conditions. Infection occurs when the cysts are swallowed, usually as a result of drinking contaminated water. Care in drinking from potentially- the macrolide spiramycin has been used for immunocom- contaminated natural waters is also indicated. Public health mea- sures are similar to those outlined for controlling giardiasis, Cryptosporidium parvum although Cryptosporidium is more resistant to chlorination. Cryptosporidium parvum is widely distributed in many animals Worm infections the implication of Cryptosporidium parvum as a cause of diar- the most important intestinal worms rhea in humans is comparatively recent (within the last 10–15 clinically are the nematodes known as ‘soil- years). The parasite is widely distributed in many animals, but is transmitted helminths’ very small and easily overlooked. It has a complex life cycle, Soil-transmitted helminths fall into two distinct groups: going through both asexual and sexual phases of development • Ascaris lumbricoides (large roundworm) and Trichuris in the same host. Transmission is by ingestion of about 100 of trichiura (whipworm), in which infection occurs by swal- the resistant oocyst stage (4–5 mm diameter) in fecally-con- lowing the infective eggs. In the small intestine the cyst • Ancylostoma duodenale and Necator americanus (hook- releases infective sporozoites, which invade the epithelial cells, worms) and Strongyloides stercoralis, which infect by active remaining closely associated with the apical plasma membrane. Eventually a With the exception of Trichuris (large intestine), all inhabit sexual phase occurs and oocysts are released. It was transmit- species, which live in the large bowel, release infective eggs ted through the public water supply and probably originated onto the perianal skin. Transmission is favored iting in immunocompetent individuals (lasting up to 20 where there is inadequate disposal of feces, contamination of days), but can become chronic in immunocompromised water supplies, use of feces (night-soil) as fertilizer, or low patients. Cryptosporidiosis is a common infection in people standards of hygiene (see below). In these individuals diarrhea is prolonged, may formed by each female (tens of thousands by Trichuris and become irreversible, and can be 1ife-threatening.

This does 28 days and state the date you offer extra (or contractual) maternity not include your normal pay proven 0.5 mg colcrys. During the first 39 weeks of your the human resources department leave you will probably be entitled or your union representative buy 0.5mg colcrys with mastercard. The timing of your rights and benefits in pregnancy is very complicated discount colcrys 0.5mg on-line, so use this chart as a rough guide only order colcrys 0.5 mg mastercard. This means If you don’t give this notice and just maternity leave has ended, you will that they have to consider you for turn up at work before the end of lose your right to return to the same opportunities such as promotion. If you need more time off you If you are made redundant while on can refuse to allow you to work for could do one of the following: maternity leave, your employer must up to eight weeks or until the end • Ask your employer if you can take offer you any suitable alternative of your leave, whichever is earlier. Your paid none, they must pay you any notice to continue taking your maternity holiday continues to accrue during and redundancy pay that you are leave, you must give your employer maternity leave so you may have entitled to. You must give 21 days’ if you work in a factory) after notice to take parental leave, and Giving notice about childbirth. You will not be allowed to return to Your employer should assume • If you cannot return because you work during this time. But if your employer leave and don’t have enough can show that this is not reasonably If you want to take all of your notice to ask for parental leave, you practicable, you have the right to leave, you simply go back to work can still ask your employer if they be offered a suitable alternative on that day. You should apply for Maternity If you qualify for a Sure Start Maternity Grant the date your Allowance about now. You may also If you are an employee, you have a contract, you should give qualify for Statutory Maternity have the right to take reasonable at least a week’s notice. Your notice period £95 per week from your You should let your employer can run at the same time as your employer, worked out over know when you need time off. Your employer is entitled to return to exactly the same job rights to make reasonable contact with as you normally would at the end If you are pregnant, have recently you during maternity leave. This is the that the kind of work you do and work, or to update you on any right to return to the same job or, your working conditions will not significant changes in the workplace if that is not reasonably practicable, put your health or your baby’s while you have been away. This applies be used for any form of work and even if you only returned to should make it easier to return to work for one day. You must husband or your partner, including • are the baby’s father or your provide a medical certificate. It can be any working pattern Time off for other than the normal working Parental leave dependants pattern in an organisation. Parental leave is designed to give Every employee is also entitled to Most people are familiar with parents more time with their young emergency unpaid leave to make working part time for pro-rata children. It entitles you to take arrangements for the care of a pay or working different shift 13 weeks’ leave per parent per child, child who falls ill, gives birth or is patterns. Employees may be are entitled to 18 weeks’ leave, to care arrangements for your required to work within core be taken before the child is 18. For child – for example, if your hours, but outside these times parental leave, a disabled child is childminder falls ill. Typically, you can take it either within five two employees share the Parents have the right to years of the placement for adoption work normally done by one ask for flexible working or before your child’s 18th birthday, employee. An Follow the procedure outlined You cannot usually take all your employee on a permanent on page 173. Your employer contract takes paid or unpaid refused, you should get advice may limit the amount of leave you leave during school holidays. Your employer can flexible working arrangements Employees work their total postpone the leave, but only if you have or expect to have agreed hours over fewer if their business would be parental responsibility for: working days – for example, disrupted unduly. Your employer must providing they give seriously consider your request Parental responsibility means their employers 21 days’ and can only refuse for one of that you are a: notice of the expected the business reasons set out in week of childbirth. Any reduction in An employer the number of hours worked will • father cannot postpone result in pay being reduced. Your employer must: • private foster carer, or How do I ask to change • hold a meeting with you within • person who has been granted my hours? Find out if your someone who is not employed partner or civil partner of, employer has a standard form by them. If your sample letters can be downloaded employer does not think that the change that you ask for can from www. The proposed • you have parental responsibility date should allow time for the request for one of the following for a child under 17 (from April application to be considered and business reasons: 2009) or a disabled child under 18 implemented. Sex discrimination law applies to all the legal help scheme allows employers and all employed parents people on a low income to get free with childcare responsibilities. Funding for Appeal disadvantaged by not being allowed general legal advice (not advocacy) You have the right to appeal within to work the child-friendly hours you is available, to those who qualify 14 days of receiving notification of need. Full representation is you must write to your employer as an employer must have a good available under legal aid (to those stating your reasons for appealing. It may be direct sex disadvantaged by having to work • notify you of their decision in discrimination if an employer refuses your old hours. Your employer will only know discrimination law and the Tribunals if they have a good reason for right to request flexible refusing your request if they give it working You can make a claim in a tribunal a lot of thought. Refusing even to the new statutory right to request if your employer does not follow the consider your request or having a flexible working only applies to procedure or refuses for a reason policy of refusing part-time work employees who are parents of not stated in the rules or without could be seen as sex discrimination children under 17 (or under 18 an explanation. An if disabled), who have not made You must complete the appeal employer must consider each an application within the last procedure and wait for the individual request in order to avoid 12 months, and who have worked decision before you can make discriminating against a woman or for their employer for 26 weeks at a tribunal application. An employment tribunal or an Acas People often assume that a job has Sex discrimination law may help you binding arbitration that finds in your to be done full time or at certain if you need to change your working favour can order your employer to: fixed times of day, but if you and pattern in order to care for your your employer look carefully at child but cannot use the statutory • reconsider your application by your job you may be able to work procedure. This may be because following the procedure correctly out a more child-friendly option – you have made a request under the • pay you an award (up to a perhaps one that neither of you had procedure within the last 12 months maximum of eight weeks’ pay considered before.

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