Can children withhold consent to treatment

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice

Kindia (Pavetteae, Rubiaceae), a new cliff-dwelling genus with chemically profiled colleter exudate from Mt Gangan, Republic of Guinea

A new genus Kindia (Pavetteae, Rubiaceae) is described with a single species, Kindia gangan, based on collections made in 2016 during botanical exploration of Mt Gangan, Kindia, Republic of Guinea in West Africa. The Mt Gangan area is known for its many endemic species including the only native non-neotropical Bromeliaceae Pitcairnia feliciana. Kindia is the fourth endemic vascular plant genus to be described from Guinea. Based on chloroplast sequence data, the genus is part of Clade II of tribe Pavetteae. In this clade, it is sister to Leptactina sensu lato (including Coleactina and Dictyandra). K. gangan is distinguished from Leptactina s.l. by the combination of the following characters: its epilithic habit; several-flowered axillary inflorescences; distinct calyx tube as long as the lobes; a infundibular-campanulate corolla tube with narrow proximal section widening abruptly to the broad distal section; presence of a dense hair band near base of the corolla tube; anthers and style deeply included, reaching about mid-height of the corolla tube; anthers lacking connective appendages and with sub-basal insertion; pollen type 1; pollen presenter (style head) winged and glabrous (smooth and usually hairy in Leptactina); orange colleters producing a vivid red exudate, which encircle the hypanthium, and occur inside the calyx and stipules. Kindia is a subshrub that appears restricted to bare, vertical rock faces of sandstone. Fruit dispersal and pollination by bats is postulated. Here, it is assessed as Endangered EN D1 using the 2012 IUCN standard. High resolution LC-MS/MS analysis revealed over 40 triterpenoid compounds in the colleter exudate, including those assigned to the cycloartane class. Triterpenoids are of interest for their diverse chemical structures, varied biological activities, and potential therapeutic value

Diagnóstico Estratégico de la Distribuidora Mayoreo del Norte ( MAYON ), departamento de Matagalpa, segundo semestre 2014

En el presente trabajo investigativo se realizó un Diagnóstico estratégico de las pequeñas y medianas empresas, departamento de Matagalpa, segundo semestre 2014. En cuanto a la aplicación de diagnóstico estratégico se realizó en la Distribuidora Mayoreo del Norte ( MAYON ). El propósito del estudio es proporcionar una herramienta de diagnóstico a la empresa Mayoreo del Norte para conocer la situación con el análisis FODA y de estrategias como también su posición en el mercado con relación a las cinco fuerzas de Poter. La realización de un diagnóstico estratégico es importante porque permite a las organizaciones planificar sus actividades y operaciones, determinando su posición estratégica en el medio que desarrolla sus actividades tomando medidas correctivas para buscar la competitividad. El diagnóstico refleja que la empresa realiza periódicamente diagnósticos estratégicos lo que le permite identificar las áreas más vulnerables de la organización mejorando el desempeño de cada una de estas; entre sus fortalezas más relevantes es tener definida su filosofía empresarial, experiencia, bajos precios y posicionamiento en el mercado; enfrenta debilidades en la implementación de tecnologías y publicidad, con una competencia agresiva y la economía del país como amenazas; con oportunidades de crecimiento. Implementa estrategias genéricas, estrategias de Integración, estrategias Intensivas y estrategias de diversificación. Se considera que la distribuidora debe concentrarse en el desarrollo de ciertas estrategias como: Estrategia de integración hacia adelante, a la vez que hacer análisis más continuos en el área de venta y desarrollo de mercad

Surface fitting in geomorphology - examples for regular-shaped volcanic landforms

In nature, several types of landforms have simple shapes: as they evolve they tend to take on an ideal, simple geometric form such as a cone, an ellipsoid or a paraboloid. Volcanic landforms are possibly the best examples of this ?ideal? geometry, since they develop as regular surface features due to the point-like (circular) or fissure-like (linear) manifestation of volcanic activity. In this paper, we present a geomorphometric method of fitting the ?ideal? surface onto the real surface of regular-shaped volcanoes through a number of case studies (Mt. Mayon, Mt. Somma, Mt. Semeru, and Mt. Cameroon). Volcanoes with circular, as well as elliptical, symmetry are addressed. For the best surface fit, we use the minimization library MINUIT which is made freely available by the CERN (European Organization for Nuclear Research). This library enables us to handle all the available surface data (every point of the digital elevation model) in a one-step, half-automated way regardless of the size of the dataset, and to consider simultaneously all the relevant parameters of the selected problem, such as the position of the center of the edifice, apex height, and cone slope, thanks to the highly performing adopted procedure. Fitting the geometric surface, along with calculating the related error, demonstrates the twofold advantage of the method. Firstly, we can determine quantitatively to what extent a given volcanic landform is regular, i.e. how much it follows an expected regular shape. Deviations from the ideal shape due to degradation (e.g. sector collapse and normal erosion) can be used in erosion rate calculations. Secondly, if we have a degraded volcanic landform, whose geometry is not clear, this method of surface fitting reconstructs the original shape with the maximum precision. Obviously, in addition to volcanic landforms, this method is also capable of constraining the shapes of other regular surface features such as aeolian, glacial or periglacial landforms

Sensitivity to lunar cycles prior to the 2007 eruption of Ruapehu volcano

A long-standing question in Earth Science is the extent to which seismic and volcanic activity can be regulated by tidal stresses, a repeatable and predictable external excitation induced by the Moon-Sun gravitational force. Fortnightly tides, a similar to 14-day amplitude modulation of the daily tidal stresses that is associated to lunar cycles, have been suggested to affect volcano dynamics. However, previous studies found contradictory results and remain mostly inconclusive. Here we study how fortnightly tides have affected Ruapehu volcano (New Zealand) from 2004 to 2016 by analysing the rolling correlation between lunar cycles and seismic amplitude recorded close to the crater. The long-term (similar to 1-year) correlation is found to increase significantly (up to confidence level of 5-sigma) during the similar to 3 months preceding the 2007 phreatic eruption of Ruapehu, thus revealing that the volcano is sensitive to fortnightly tides when it is prone to explode. We show through a mechanistic model that the real-time monitoring of seismic sensitivity to lunar cycles may help to detect the clogging of active volcanic vents, and thus to better forecast phreatic volcanic eruptions

Spartan Daily, June 9, 1948

Volume 36, Issue 154https://scholarworks.sjsu.edu/spartandaily/11112/thumbnail.jp

Tracking Report 2011 Fifth & Pacific, Indonesia 050084922GV&

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.FLA_2008_Fifth_Pacific_TR_Indonesia_050084922GV.pdf: 6 downloads, before Oct. 1, 2020

Mutagenic impact on fish of runoff events in agricultural areas in south-west France

When heavy rainfall follows herbicide application, the intense surface runoff causes stream water contamination. Aquatic organisms are then briefly exposed to a complex mixture of contaminants. The aim of the present study is to investigate the genotoxic impact of such events on fish. A model fish, the Crucian carp (Carassius carassius) was exposed in controlled conditions, for 4 days, to water sampled daily in the Save River (France). The watershed of this stream is representative of agricultural areas in southwest France. Three hydrological conditions were compared: basal flow, winter flood, and spring flood. Chemical analysis of the water samples confirmed the higher contamination of the spring flood water,mainly explained by a peak of metolachlor. Genotoxicity was evaluated by micronucleus (MN) test and comet assay in peripheral erythrocytes. A significant increase in DNA breakdowns compared to controls was detected by the comet assay for all conditions. Exposure to spring flood water resulted in the highest damage induction. Moreover, induced chromosomal damage was only detected in this condition. In addition, fish were exposed, for 4 days, to an experimental mixture of 5 herbicides representative of the spring flood water contamination. Fish exhibited moderate DNA damage induction and no significant chromosomal damage. The mutagenicity induced by field-collected water is then suspected to be the result of numerous interactions between contaminants themselves and environmental factors, stressing the use of realistic exposure conditions. The results revealed a mutagenic impact of water contamination during the spring flood, emphasizing the need to consider these transient events in water quality monitoring programs

Hazardousness of place : a new comparative approach to the Filipino past

© Ateneo de Manila University. The historiography of the Philippines has been largely bounded by the nation-state, which has defined how its past has been conceived and to whom its peoples are mainly compared. A more transnational environmental history, however, seeks to situate the archipelago within the context of the daily threats that its peoples have to face. This article focuses on the hazardous nature of living in the islands and explores the ways in which Filipinos have adapted to natural hazards as a frequent life experience over time