47 % of responding doctors thought that few patients were actually aware that they were taking part in a clinical trial. on the other hand, an audit of four further studies revealed that at least 80 % of participants felt that they had made an autonomous decision. there is no proof whether such perceptions were accurate or not. the authors conclude that self - interest was more common than altruism amongst the reasons given for participating in clinical trials but draw attention to the poor quality of some of the studies reviewed thereby suggesting the need for further research. it should not be necessary for people to justify why they are willing to participate in clinical trials. reasons for participating in research are further discussed in section 3. 2. 4 insofar as they relate to end - of - life research. in a series of focus groups organised in 8 european countries plus israel and covering six conditions including dementia, helping others was seen as the main reason why people wanted to take part in clinical trials ( bartlam et al., 2010 ). in a us trial of anti - inflammatory medication in alzheimer ’ s disease in which 402 people were considered eligible, of the 359 who accepted, their main reasons for wanting to participate were altruism, personal benefit and family history of alzheimer ’ s disease. random assignment to study groups as people are randomly assigned to the placebo or the active treatment group, everyone has an equal chance of receiving the active ingredient or whichever other control groups are included in the study. there are possible advantages and drawbacks to being in each group and people are likely to have preferences for being a particular study group but randomization means that allocation is not in any way linked to the best interests of each participant from a medical perspective. this is not an ethical issue provided that each participant fully understands that the purpose of research is not to provide a tailor - made response to an individual ’ s medical condition and that while some participants benefit from participation, others do not. there are, however, medical issues to consider. in the case in double - blind studies, neither the participant nor the investigator knows to which groups a participant has been allocated. consequently, if a participant encounters medical problems during the study, it is not immediately known whether this is linked to the trial drug or another unrelated factor, but the problems must be addressed and possible contraindications avoided, which may necessitate “ de - blinding ” ( dubois, 2008 ). although many people would perhaps like to benefit from a new drug which is more effective than existing drugs, people have different ideas about what is an


contraindications avoided, which may necessitate “ de - blinding ” ( dubois, 2008 ). although many people would perhaps like to benefit from a new drug which is more effective than existing drugs, people have different ideas about what is an acceptable risk and different reasons for taking part in clinical trials. people who receive the placebo are not exposed to the same potential risks as those given the experimental drug. on the other hand, they have no possibility to benefit from the advantages the drug may offer. those receiving a drug commonly considered as the standard therapy are not necessarily better off than those receiving a placebo as some participants may already know that they do not respond well to the accepted treatment ( dubois, 2008 ). if people who participate in a clinical trial are not informed which arm of the trial they were in, valuable information is lost which might have otherwise contributed towards to treatment decisions made after the clinical trial. taylor and wainwright ( 2005 ) suggest that “ unblinding ” should occur at the end of all studies and so as not to interfere with the analysis of data, this could be done by a person who is totally independent of the analysis. this would, however, have implications for open label extended trials as in that case participants, whilst better equipped to give informed consent would have more information than the researchers and this might be conveyed to researchers in anad hocmanner. open label extension trails open label extension studies ( mentioned in sub - section 7. 1. 8 ) seem quite fair as they give each participant the opportunity to freely consent to continuing with the study in the full knowledge that s / he will receive the experimental drug. however, taylor and wainwright ( 2005 ) have highlighted a couple of ethical concerns linked to the consent process, the scientific value of such studies and issues linked to access to drugs at the end of the prior study. with regard to consent, they argue that people may have had a positive or negative experience of the trial but do not know whether this was due to the experimental drug, another drug or a placebo. they may nevertheless base their decision whether to continue on their experience so far. for those who were not taking the experimental drug, their experience in the follow - up trial may turn out to be very different. also, if they are told about the possibility of the open label extension trial when deciding whether or not to take part in the initial trial ( i. e. with the implication that whatever group they are ascribed to, in the follow - up study they will be guaranteed the experimental drug ),


possibility of the open label extension trial when deciding whether or not to take part in the initial trial ( i. e. with the implication that whatever group they are ascribed to, in the follow - up study they will be guaranteed the experimental drug ), this might induce them to participate in the initial study which could be considered as a form of subtle coercion. finally, researchers may be under pressure to recruit as they can only recruit people in an open label extended trial who took part in the initial study. this may lead them in turn to put pressure ( even inadvertently ) on participants to continue with the study. the scientific validity of open label extension trials is questioned by taylor and wainwright ( 2005 ) on the grounds that people from the experimental arm of the first study who did not tolerate the drug would be unlikely to participate in the extension trial and this would lead to bias in the results. in addition, open - label trials often lack a precise duration other than “ until the drug is licensed ” which casts doubt on there being a valid research purpose. the above authors suggest that open label extension studies are dressed up marketing activities which lack the ethical justification for biomedical research which is the prospect of finding new ways of benefiting people ’ s health. however, it could be argued that the aim of assessing long - term tolerability of a new drug is a worthwhile pursuit and if conducted in a scientific manner could be considered as research. moreover, not all open label extension trials are open - ended with regard to their duration. the main problem in interpreting open label extension studies is that little is known about the natural course of the disease. protecting participants ’ well - being at the end of the clinical trial some people who participate in a clinical trial and who receive the experimental drug experience an improvement in their condition. this is to be hoped even if benefit to the health of individuals is not the aim of the study. however, at the end of the study, the drug is not yet licenced and there is no legal right to continue taking it. this could be psychologically disturbing to the participants in the trial and also to their families who may have seen a marked improvement in their condition. taylor and wainwright ( 2005 ) suggest that the open label trials may serve the purpose of prescribing an unlicensed drug on compassionate grounds, which whilst laudable, should not be camouflaged as scientific research. rather governments should take responsibility and set up the appropriate legal mechanisms to make it possible for participants whose medical condition merits prolonged treatment with the experimental drug to have access


drug on compassionate grounds, which whilst laudable, should not be camouflaged as scientific research. rather governments should take responsibility and set up the appropriate legal mechanisms to make it possible for participants whose medical condition merits prolonged treatment with the experimental drug to have access to it. minimising pain and discomfort certain procedures to which people with dementia or their representatives consent may by burdensome or painful or simply worrying but in accordance with the principles of autonomy or justice / equity, people with dementia have the right to participate. the fact that they have made an informed decision to participate and are willing to tolerate such pain or burden does not release researchers from the obligation to try to minimise it. for example, if repeated blood samples are going to be necessary, an indwelling catheter could be inserted under local anaesthetic to make it easier or medical staff should provide reassurance about the use of various scanning equipment which might be worrying or enable the person ’ s carer to be present. in order to minimize fear, trained personnel are needed who have experience dealing with people with dementia. the advice of the carer, if there is one, could also be sought. drug trials in countries with less developed safeguards clinical trials are sometimes carried out in countries where safeguards are not well developed and where the participants and even the general population are likely to have less possibility to benefit from the results of successful trials. for example, some countries have not signed the convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine ( 1997 ) ( referred to in section 188. 8. 131. 52 ). the participants in those countries may be exposed to possible risks but have little chance of future medical benefit if the trial is successful. yet people in countries with stricter safeguards for participants ( which are often richer countries ) stand to benefit from their efforts and from the risks they take, as they are more likely to be able to afford the drugs once developed. this raises ethical issues linked to voluntariness because there may be, in addition to the less developed safeguards, factors which make participation in such trials more attractive to potential participants. such practices also represent a lack of equity in the distribution of risk, burden and possible benefit within society and could be interpreted as using people as a means to an end. parallels can also be drawn to the situation whereby people in countries where stem cell research is banned profit from the results of studies carried out in countries where it is permitted or to the results of studies carried out


as using people as a means to an end. parallels can also be drawn to the situation whereby people in countries where stem cell research is banned profit from the results of studies carried out in countries where it is permitted or to the results of studies carried out in countries where research ethics are slack or inexistent. for a detailed discussion of the ethical issues linked to the involvement in research of people in other countries, particularly lower and middle income countries where standards of protection may by lower, please refer to the afore - mentioned report by the presidential commission for the study of bioethical issues. - researchers should consider including a placebo arm in clinical trials when there are compelling and sound methodological reasons for doing so. - researchers should ensure that patients are aware that the aim of a randomised controlled trial is to test a hypothesis and provide generalizable knowledge leading to the development of a medical drug or procedure. they should explain how this differs from medical treatment and care which are aimed at enhancing the health and wellbeing of individual patients and where there is a reasonable expectation that this will be successful. - researchers should ensure that potential participants understand that they may be allocated to the placebo group. - it should not be presumed that the treating doctor or contact person having proposed the participant for a trial has been successful in communicating the above information. - researchers conducting clinical trials may need training in how to ensure effective communication with people with dementia. - appropriate measures should be taken by researchers to minimize fear, pain and discomfort of participants. - all participants should, when possible, preferably have the option of receiving the experimental drug ( if proven safe ) after completion of the study. - pharmaceutical companies should not be discouraged from carrying out open - label extension studies but this should not be the sole possibility for participants to access the trial drug after the end of the study if it is proving beneficial to them. - in multi - centre clinical trials, where data is transferred to another country in which data protection laws are perhaps less severe, the data should be treated as stated in the consent form signed by the participant. last updated : jeudi 29 mars 2012


united kingdom - scotland restrictions of freedom mental health ( care and treatment ) ( scotland ) act 2003 the act was designed to modernise and improve the use of compulsory measures in mental health care. it reflects the general move over the last two decades towards care and treatment in the community rather than in hospitals or other residential settings. the title reflects the philosophy of the legislation with the focus on ‘ care ’ and ‘ treatment ’. in basic terms, the act provides for the protection of people with a mental disorder in a hospital or community setting. it contains mechanisms for dealing with offenders who have a mental disorder and so interacts with the criminal justice system. the act covers individuals who are defined as having a ‘ mental disorder ’. the term includes mental illness, personality disorder and learning disability. the majority of cases involving compulsory measures have been in relation to people diagnosed with a mental illness. however, the mental welfare commission for scotland monitors the use of compulsory measures and has found increasing use of emergency or short term measures being used for people aged over 75 years with a diagnosis of dementia. detention ( involuntary internment ) the act deals with several forms of compulsion in relation to a person with mental disorder where : there is a significant risk to the person ’ s health, safety or welfare or the safety of any other person ( what is a significant risk is a question of judgement for health and social care professionals. the tribunal will test this assessment during an appeal or on an application for a compulsory treatment order ). treatment is available to prevent the person ’ s condition from deteriorating or to relieve its symptoms or effects compulsory admission is necessary because the person will not agree to admission and / or treatment ; and the person ’ s ability to make decisions about the provision of medical treatment is significantly impaired because of mental disorder. types of order emergency detention ( 72 hours ) short term detention ( 28 days and can be extended ) compulsory treatment order ( 6 months – can be extended ) mental health tribunals the act introduced a new system of mental health tribunals with a number of functions, including considering applications for orders and appeals against orders. this is detention in a psychiatric hospital for up to 72 hours if necessary. it does not authorise any medical treatment. in an emergency, common law powers might be used. a registered medical practitioner can sign an emergency detention certificate if s / he believes that a person ’ s ability to make decisions about medical treatment is significantly impaired because of mental disorder. this authorises the removal of the individual to a specific hospital. before signing the certificate the medical practitioner must be satisfied that


certificate if s / he believes that a person ’ s ability to make decisions about medical treatment is significantly impaired because of mental disorder. this authorises the removal of the individual to a specific hospital. before signing the certificate the medical practitioner must be satisfied that : there is an urgent need to detain the person in hospital to access the medical treatment s / he needs if the person was not detained, there would be a significant risk to his or her health, safety, or welfare or the safety of another person, and any delay caused by starting the short term detention procedure is undesirable. if any treatment is needed the short - term detention procedure must generally be used. short term detention this may be used where it is necessary to detain an individual with mental disorder who cannot be treated voluntarily and without the treatment the person would be at risk of significant harm. to obtain a certificate the approved medical practitioner must consult and gain the approval of a mental health officer whatever the circumstances. compulsory treatment order compulsory treatment orders ( ctos ) are granted by the mental health tribunal. they last for 6 months, can be extended by the responsible medical officer for a further six months and then extended annually. the tribunal reviews them at least every two years. therefore, they can restrict or deprive liberty for long periods of time. the mental welfare commission for scotland looks at how these orders are used for people of different ages and genders to see if there are any trends. over recent years, the number of new orders has come down. the use of ctos for people aged 65 and over has increased for people with dementia in recent years. ‘ de facto detention ’ practitioners must be careful that they are not using excessive coercion to prevent people from leaving hospital when they wish to. they must take care to document situations where they have concerns if an informal patient wishes to leave. the tribunal can, under section 291 of the 2003 act, order that an informal patient is being unlawfully detained. people with dementia pose a difficult problem. the tribunal has ruled that a person with dementia is unlawfully detained in a general hospital when prevented from leaving. it can be appropriate to redirect someone and dissuade him / her from leaving but repeatedly thwarting a determined effort to leave is likely to a significant deprivation of liberty, and the patient should be formally detained. adults with incapacity ( scotland ) act 2000 scottish incapacity laws were reformed with the introduction of the adults with incapacity ( scotland ) act in 2000. this act covers people


deprivation of liberty, and the patient should be formally detained. adults with incapacity ( scotland ) act 2000 scottish incapacity laws were reformed with the introduction of the adults with incapacity ( scotland ) act in 2000. this act covers people with a mental disorder who lack some or all capacity to make decisions or act in their own interests. it recognises that capacity is not all or nothing but is ‘ decision specific ’. the act introduced a number of measures to authorise someone else to make decisions on behalf of the person with incapacity, on the basis of a set of principles on the face of the act. these are fundamental. any action or decision - must benefit the person - must be the least restrictive of the person ’ s liberty in order to gain that benefit - must take account of the person ’ s past and present wishes ( s / he must be given assisted to communicate by whatever means is appropriate to the individual ) - must follow consultation with relevant others as far as practicable - must encourage and support the person to maintain existing skills and develop new skills. the individual may, whilst competent, appoint one or more persons to act their financial ( continuing ) and or welfare attorney. this must be registered with the office of the public guardian. it does not allow the attorney to detain the grantor in a psychiatric hospital. if the person refuses to comply with the attorney the attorney has no compulsory powers to detain. where there is concern for the person ’ s safety the attorney can apply to the court for a welfare guardianship order. powers can be granted to allow the guardian to decide on the accommodation of the person and other powers such as who they can consort with. where the welfare guardian has powers over accommodation s / he is able to restrict the freedom of the person by placing them in a care home against their will. however, whether this amounts to deprivation of liberty under the european court of human rights ruling will depend on a number of other circumstances and the accumulative impact of which would need to be considered ( patrick and smith, 2009 ; mental welfare commission for scotland, 2011 ). with regard to the issue of non - compliance, if the person on guardianship, for example, runs away, the guardian can apply to the court under s70 for an order to require the person to return. because there is no automatic review of welfare guardianship orders there is concern that the adults with incapacity ( scotland ) act 2000 may not be compliant with the european convention on human rights. the act states


an order to require the person to return. because there is no automatic review of welfare guardianship orders there is concern that the adults with incapacity ( scotland ) act 2000 may not be compliant with the european convention on human rights. the act states that the order should be for a standard 3 years but can be more or less at the discretion of the court. however, there has been a practice of orders being granted for indefinite periods and this has given rise to concern in relation to certain groups. however, for people with dementia, who have a progressive brain disorder, an indefinite order may be deemed appropriate. the scottish law commission is currently undertaking a review of the adults with incapacity ( scotland ) act 2000 in relation to deprivation of liberty issues. it has established an advisory group of key stakeholders, including alzheimer scotland, and will be reporting in due course. the road traffic act of 1991 contains a few articles relating to offences involving driving when unfit to do so, e. g. : - a person who causes the death of another person by driving a mechanically propelled vehicle dangerously on a road or other public place is guilty of an offence. - a person who drives a mechanically propelled vehicle dangerously on a road or other public place is guilty of an offence. - if a person drives a mechanically propelled vehicle on a road or other public place without due care and attention, or without reasonable consideration for other persons using the road or place, he ( or she ) is guilty of an offence. - according to the provisions of this act, a person is regarded as driving dangerously if the way s / he drives falls far below what would be expected of a competent and careful driver and it would be obvious to a competent and careful driver that driving in that way would be dangerous. a person who has been diagnosed with dementia must inform the driver and vehicle licensing authority ( dvla ). failure to do could lead to a fine of up to £1, 000. moreover, a person who had an accident but did not previously inform the dvla of his / her dementia might not be covered by his / her insurance company. once the dvla has been informed of that someone has dementia, they send a questionnaire to the person and request a medical report. a driving assessment may also be required. the medical advisers at the dvla then decide whether the person can continue driving ( alzheimer scotland, 2003 ). patrick, h. and smith, n. ( 2009 ), adult protection and the law in scotland, bloomsbury professional. mental welfare commission for


our opinion on... - executive summary - necessity for a response - genetic testing - general principles - other considerations the present paper constitutes the input of alzheimer europe and its member organisations to the ongoing discussions within europe about genetic testing ( in the context of alzheimer ' s disease and other forms of dementia ). alzheimer europe would like to recall some general principles which guide this present response : - having a gene associated with alzheimer ' s disease or another form of dementia does not mean that a person has the disease. - people who have a gene linked to alzheimer ' s disease or another form of dementia have the same rights as anyone else. - genetic testing does not only affect the person taking the test. it may also reveal information about other relatives who might not want to know. - no genetic test is 100 % accurate. - the extent to which health cover is provided to citizens by the state social security system and / or privately contracted by individuals differs from one country to the next. on the basis of these principles, alzheimer europe has developed the following position with regard to genetic testing : - alzheimer europe firmly believes that the use and / or possession of genetic information by insurance companies should be prohibited. - alzheimer europe strongly supports research into the genetic factors linked to dementia which might further our understanding of the cause and development of the disease and possibly contribute to future treatment. - based on its current information, alzheimer europe does not encourage the use of any genetic test for dementia unless such test has a high and proven success rate either in assessing the risk of developing the disease ( or not as the case may be ) or in detecting the existence of it in a particular individual. - alzheimer europe requests further information on the accuracy, reliability and predictive value of any genetic tests for dementia. - genetic testing should always be accompanied by adequate pre - and post - test counselling. - anonymous testing should be possible so that individuals can ensure that such information does not remain in their medical files against their will. it is extremely important for people with dementia to be diagnosed as soon as possible. in the case of alzheimer ’ s disease, an early diagnosis may enable the person concerned to benefit from medication, which treats the global symptoms of the disease and is most effective in the early to mid stages of the disease. most forms of dementia involve the gradual deterioration of mental faculties ( e. g. memory, language and thinking etc. ) but in the early stages, it is still possible for the person affected to make decisions concerning his / her finances and care etc. – hence the importance of an early


deterioration of mental faculties ( e. g. memory, language and thinking etc. ) but in the early stages, it is still possible for the person affected to make decisions concerning his / her finances and care etc. – hence the importance of an early diagnosis. if it were possible to detect dementia before the first symptoms became obvious, this would give people a greater opportunity to make informed decisions about their future lives. this is one of the potential benefits of genetic testing. on the other hand, such information could clearly be used in ways which would be contrary to their personal interests, perhaps resulting in employment discrimination, loss of opportunities, stigmatisation, increased health insurance costs or even loss of health insurance to name but a few examples. the present discussion paper outlines some of the recommendations of alzheimer europe and its member organisations and raises a few points which deserve further clarification and discussion. the necessity for a response by alzheimer europe in the last few years, the issue of genetic testing has been increasingly debated. in certain european countries there are already companies offering such tests. unfortunately, the general public do not always fully understand what the results of such tests imply and there are no regulations governing how they are carried out i. e. what kind of information people receive, how the results are presented, whether there is any kind of counselling afterwards and the issue of confidentiality etc. in order to provide information to people with dementia and other people interesting in knowing about their own state of health and in order to protect them from the unscrupulous use of the results of genetic tests, alzheimer europe has developed the present position paper. these general principles as well as the convention of human rights and biomedicine and the universal declaration on the human genome and human rights dictate alzheimer europe ’ s position with regard to genetic testing. alzheimer europe would like to draw a distinction between tests which detect existing alzheimer ' s disease and tests which assess the risk of developing dementia alzheimer ' s disease at some time in the future : - diagnostic testing : familial early onset alzheimer ’ s disease ( fad ) is associated with 3 genes. these are the amyloid precursor protein ( app ), presenilin - 1 and presenilin - 2. these genetic mutations can be detected by genetic testing. however, it is important to note that the test only relates to those people with fad ( i. e. about 1 % of all people with alzheimer ’ s disease ). in the extremely limited number of families with this dominant genetic disorder, family members


, it is important to note that the test only relates to those people with fad ( i. e. about 1 % of all people with alzheimer ’ s disease ). in the extremely limited number of families with this dominant genetic disorder, family members inherit from one of their parents the part of the dna ( the genetic make - up ), which causes the disease. on average, half the children of an affected parent will develop the disease. for those who do, the age of onset tends to be relatively low, usually between 35 and 60. - assessment for risk testing : whether or not members of one ’ s family have alzheimer ’ s disease, everyone risks developing the disease at some time. however, it is now known that there is a gene, which can affect this risk. this gene is found on chromosome 19 and it is responsible for the production of a protein called apolipoprotein e ( apoe ). there are three main types of this protein, one of which ( apoe4 ), although uncommon, makes it more likely that alzheimer ’ s disease will occur. however, it does not cause the disease, but merely increases the likelihood. for example, a person of 50, would have a 2 in 1, 000 chance of developing alzheimer ’ s disease instead of the usual 1 in 1, 000, but might never actually develop it. only 50 % of people with alzheimer ’ s disease have apoe4 and not everyone with apoe4 suffers from it. there is no way to accurately predict whether a particular person will develop the disease. it is possible to test for the apoe4 gene mentioned above, but strictly speaking such a test does not predict whether a particular person will develop alzheimer ’ s disease or not. it merely indicates that he or she is at greater risk. there are in fact people who have had the apoe4 gene, lived well into old age and never developed alzheimer ’ s disease, just as there are people who did not have apoe4, who did develop the disease. therefore taking such a test carries the risk of unduly alarming or comforting somebody. alzheimer europe agrees with diagnostic genetic testing provided that pre - and post - test counselling is provided, including a full discussion of the implications of the test and that the results remain confidential. we do not actually encourage the use of genetic testing for assessing the risk of developing alzheimer ' s disease. we feel that it is somewhat unethical as it does not entail any health benefit and the results cannot actually predict whether a


remain confidential. we do not actually encourage the use of genetic testing for assessing the risk of developing alzheimer ' s disease. we feel that it is somewhat unethical as it does not entail any health benefit and the results cannot actually predict whether a person will develop dementia ( irrespective of the particular form of apoe s / he may have ). we are totally opposed to insurance companies having access to results from genetic tests for the following reasons : - this would be in clear opposition to the fundamental principle of insurance which is the mutualisation of risk through large numbers ( a kind of solidarity whereby the vast majority who have relatively good health share the cost with those who are less fortunate ). - failure to respect this principle would create an uninsurable underclass and lead to a genetically inferior group. - this in turn could entail the further stigmatisation of people with dementia and their carers. - in some countries, insurance companies manage to reach decisions on risk and coverage without access to genetic data. - we therefore urge governments and the relevant european bodies to take the necessary action to prohibit the use or possession of genetic data by insurance companies. alzheimer europe recognises the importance of research into the genetic determinants of alzheimer ’ s disease and other forms of dementia. consequently, - we support the use of genetic testing for the purposes of research provided that the person concerned has given informed consent and that the data is treated with utmost confidentiality ; and - we would also welcome further discussion about the problem of data management. in our opinion, any individual who wishes to take a genetic test should be able to choose to do so anonymously in order to ensure that such information does not remain in his / her medical file. at its annual general meeting in munich on 15 october 2000, alzheimer europe adopted recommendations on how to improve the legal rights and protection of adults with incapacity due to dementia. this included a section on bioethical issues. these recommendations obviously need to guide any response of the organisation regarding genetic testing for people who suspect or fear they may have dementia and also those who have taken the test and did develop dementia. - the adult with incapacity has the right to be informed about his / her state of health. - information should, where appropriate, cover the following : the diagnosis, the person ' s general state of health, treatment possibilities, potential risks and consequences of having or not having a particular treatment, side - effects, prognosis and alternative treatments. - such information should not be withheld solely on the grounds


diagnosis, the person ' s general state of health, treatment possibilities, potential risks and consequences of having or not having a particular treatment, side - effects, prognosis and alternative treatments. - such information should not be withheld solely on the grounds that the adult is suffering from dementia and / or has communication difficulties. attempts should be made to provide information in such a way as to maximise his / her ability to understand, making use of technology and other available techniques to enhance communication. attention should be paid to any possible difficulty understanding, retaining information and communicating, as well as his / her level of education, reasoning capacity and cultural background. care should be taken to avoid causing unnecessary anxiety and suffering. - written as well as verbal information should always be provided as a back - up. the adult should be granted access to his / her medical file ( s ). s / he should also have the opportunity to discuss the contents of the medical file ( s ) with a person of his / her choice ( e. g. a doctor ) and / or to appoint someone to receive information on his / her behalf. - information should not be given against the will of the adult with incapacity. - the confidentiality of information should extend beyond the lifetime of the adult with incapacity. if any information is used for research or statistical purposes, the identity of the adult with incapacity should remain anonymous and the information should not be traceable back to him / her ( in accordance with the provisions of national laws on respect for the confidentiality of personal information ). consideration should be given to access to information where abuse is suspected. - a clear refusal by the adult with incapacity to grant access to information to any third party should be respected regardless of the extent of his / her incapacity, unless this would be clearly against his / her best interests e. g. carers should have provided to them information on a need to know basis to enable them to care effectively for the adult with incapacity. - people who receive information about an adult with incapacity in connection with their work ( either voluntary or paid ) should be obliged to treat such information with confidentiality. people who take genetic tests and do not receive adequate pre and post test counselling may suffer adverse effects. fear of discrimination based on genetic information may deter people from taking genetic tests which could be useful for research into the role of genes in the development of dementia. certain tests may be relevant for more than one medical condition. for example, the apoe test


about american frontiers about american frontiers : a public lands journey america ' s public lands are a treasured part of our national heritage, representing its grandeur, bountiful promise, and vast natural resources. all citizens share in the rights and the responsibilities of seeing that our public lands are cared for and managed in a way that meets the current and future needs of the american people. to highlight the beauty, the accessibility, and the benefits of our public lands, the public lands interpretive association ( plia ), an albuquerque, new mexico - based non - profit organization that provides interpretive and educational resources to the public, mapped out a canada - to - mexico trek exclusively on public lands, called american frontiers : a public lands journey. the journey, or trek, involved two groups of travelers : one starting north from the mexican border and the second headed south from the canadian. their route lay entirely on public lands, a feat that has never been accomplished before. the trek began on july 31, 2002 and ended two months later when the two teams met in wasatch - cache national forest near salt lake city, utah on september 27. inspired by american frontiers : a public lands journey, national geographic society has designed its geography action! 2002 curriculum around the theme of public lands. aimed at teaching school - aged children the beauty and the benefits of america ' s public lands, geography action! 2002 followed the trekkers along the two - month journey, highlighting the diversity and grandeur of our nation ' s public lands. to demonstrate the different ways people get about on our public lands - - and to stay within the 60 - day limit of the journey - - trek participants utilized numerous modes of transportation for this historic border - to - border journey across america. the hiked and backpacked, rode horses, mountain bikes, atvs and dual sport motorcycles ; rafted, canoed, drove pickup trucks, motorboats and 4wd vehicles, and even spent a few leisurely days on a houseboat. along the route the two teams attended special events, round table discussions, visited schools and communities to learn about public land issues. and, of course, they saw some of the most spectacular scenery of the american west. their journal entries eloquently describe the feelings public lands awoke in them and also the daily routine of the long trek. you ' ll enjoy reading them. three years in the making, american frontiers : a public lands journey has enlisted numerous partners and sponsors including the national geographic society, the department of the interior, the usda forest


the daily routine of the long trek. you ' ll enjoy reading them. three years in the making, american frontiers : a public lands journey has enlisted numerous partners and sponsors including the national geographic society, the department of the interior, the usda forest service, bureau of land management, usgs, national environmental education and training foundation, fire wise communities, american honda, kodak, the coleman company, and many others. for a full list of our sponsors, please look under " our sponsors " on the home page. to learn more about american frontiers, please spend some time on this website, read the team members ' journals, enjoy the photographs ot follow their route on the maps. for more information about american frontiers, please contact the public lands interpretive association, 6501 fourth street, nw, albuquerque, nm 87107 or call our toll - free number 877 - 851 - 8946. you can also email to smaurer @ plia. org everyone inspired by the public lands journey should pay a visit to our public lands. to find out more about recreation opportunities on public lands, please visit the public lands information center online. there, you can find detailed recreation information, interactive recreation maps, and a large selection of guidebooks and maps. all material copyright ©2002 - 2013, public lands interpretive association except photographs where ownership is otherwise indicated. all rights reserved.


- historic sites “ to a distant and perilous service ” westward with the course of empire colonel jonathan drake stevenson took his way in 1846. with him went the denizens of new york ’ s tammany wards, oyster cellars, and gin mills — the future leaders of california. june / july 1979 | volume 30, issue 4 three weeks later, in a millrace on the american river in northern california, john marshall spotted the flicker of gold. by the end of summer, 1849, the los angeles garrison, like every other encampment of the new york volunteers, was abandoned, the harbinger of anglo - saxon civilization scattered to the hills, the coastal towns and villages of california half - deserted. the little port of san francisco had become the focus of world migration. captain folsom, the staff quartermaster, having secured appointment as collector of the port, was on his way to becoming a millionaire. the russ family, purveyors of moroccan leather and holiday fireworks, had opened a jewelry shop and begun assembling an empire of hotels, beer gardens, office buildings, and residential blocks. sergeant john c. pulis, late of lippitt ’ s monstrous company f, had become the first sheriff of san francisco. lieutenant edward gilbert was editing the alta california, the leading newspaper in the territory ; captain naglee ( he of the bathtime rebellion ) had founded the territory ’ s first bank ; lieutenant hewlett had opened a boardinghouse ; captain frisbee had started a commission agency and was in prospect of marrying the eldest daughter of general vallejo ; lieutenant vermeule, the plague of abel stearns, had set himself up as a lawyer and would soon be elected a delegate to the california constitutional convention and a member of the state legislature ; and the reverend mr. thaddeus m. leavenworth, chaplain to the regiment, had attained the quasi - judicial position of alcalde of san francisco and was granting homesteads and auctioning public lands with a christian generosity that scandalized even his former associates. as for the colonel, he was well on his way to a second career ( and a second marriage and a second family ) as a legal counselor, politician, and founder of a grandiose ghost city called new - york - of - the - pacific, which endures today only in the name of a slough on the edge of san francisco bay. the former new york boys were scattered by then throughout california, styling themselves doctors, lawyers, judges,


the scientific world is abuzz with news of the ratification of the existence of the subatomic particle called the higgs boson - or more colloquially, the ' god particle. ' this subatomic particle ' s existence - which was verified recently ( with virtually near certainty ) by experiments at the large hadron collider in switzerland - lends credence to several long - standing physical theories such as the so - called standard model and the big bang theory. the nickname god particle is ironic for two reasons. first, generally, the nuclear physicists who deal with these matters - postulating the fundamental physical laws of the universe and then setting about to either verify or refute them - tend not to be regular church - goers. while there are some highly prominent scientists who balance personal, religious beliefs with professional, scientific quests, most probably go along with the thoughts of the world - famous physicist, stephen hawking : i regard the brain as a computer which will stop working when its components fail. there is no heaven or afterlife for broken down computers ; that is a fairy story for people afraid of the dark. [ interview in the guardian, 7 / 9 / 12 ] spontaneous creation is the reason there is something rather than nothing, why the universe exists, why we exist. it is not necessary to invoke god... [ from his book ; the grand design, 2010 ] so it is a bit ironic that physics ' most famous quest has resulted in the discovery of the ' god particle. ' most physicists are quite comfortable having their names associated with famous - even if dead - humans like newton, einstein or the afore - mentioned hawking. one will find few, if any, attributions to deities in the objects that physicists discover and name or the theories they propose. second, and more importantly, the discovery that the god particle really exists does not - as the name suggests - imply that god played some role in the creation of the universe. in fact, quite the opposite. the matter is discussed at some length in the july 9 daily beast by lawrence kraus, a well - known physicist / cosmologist from arizona state university : this term [ god particle ] appeared first in the unfortunate title of a book written by physicist leon lederman two decades ago, and while to my knowledge it was never used by any scientist ( including lederman ) before or since, it has captured the media ' s imagination. what makes this term particularly unfortunate is that nothing could be further from the truth.


two decades ago, and while to my knowledge it was never used by any scientist ( including lederman ) before or since, it has captured the media ' s imagination. what makes this term particularly unfortunate is that nothing could be further from the truth. assuming the particle in question is indeed the higgs, it validates an unprecedented revolution in our understanding of fundamental physics and brings science closer to dispensing with the need for any supernatural shenanigans all the way back to the beginning of the universe... if these bold, some would say arrogant, notions derive support from the remarkable results at the large hadron collider, they may reinforce two potentially uncomfortable possibilities : first, that many features of our universe, including our existence, may be accidental consequences of conditions associated with the universe ' s birth ; and second, that creating " stuff " from " no stuff " seems to be no problem at all - everything we see could have emerged as a purposeless quantum burp in space or perhaps a quantum burp of space itself. humans, with their remarkable tools and their remarkable brains, may have just taken a giant step toward replacing metaphysical speculation with empirically verifiable knowledge. the higgs particle is now arguably more relevant than god. so the term god particle was first used by a scientist, but was picked up and popularized by the media. it ' s catchy and enhances interest in the subject among the public. but like so much else that the media promotes, it is misleading and inappropriate.


acrylic a synthetic fabric often used as a wool substitute. it is warm, soft, holds colors well and often is stain and wrinkle resistant. angora a soft fiber knit from fur of the angora rabbit. angora wool is often combined with cashmere or another fiber to strengthen the delicate structure. dry cleaning is reccommended for angora products. bedford a strong material that is a raised corded fabric ( similar to corduroy ). bedford fabric wears well and is usually washable. boucle a fabric made with boucle yarn ( s ) in wool, rayon and or cotton causing the surface of the fabric to appear looped. brocade an all - over floral, raised pattern produced in a similar fashion to embroidery. burnout process of printing a design on a fabric woven of paired yarns of different fibers. one kind of yarn is burned out or destroyed leaving the ground unharmed. cable knit patterns, typically used in sweaters, where flat knit columns otherwise known as cables are overlapped vertically. cashmere a soft, silky, lightweight wool spun from the kashmir goat. cashmere must be dry - cleaned due to its delicate fibers and is commonly used in sweaters, shawls, outerwear, gloves and scarves for its warmth and soft feel. chiffon a common evening wear fabric made from silk, cotton, rayon or nylon. it ' s delicate in nature and sheer. chintz a printed and glazed fabric made of cotton. chintz is known for its bright colors and bold patterns. corduroy cotton fibers twisted as they are woven to create long, parallel grooves, called wales, in the fabric. this is a very durable material and depending on the width of the wales, can be extremely soft. cotton a natural fiber that grows in the seed pod of the cotton plant. it is an inelastic fiber. cotton cashmere a blend of cotton and cashmere fibers, typically 85 % to 15 % respectively, this combination produces an extremely soft yarn with a matte finish. crepe used as a description of surfaces of fabrics. usually designates a fabris that is crimped or crinkled. crinoline a lightweight, plain weave, stiffened fabric with a low yarn count. used to create volume beneath evening or wedding dresses. crochet looping threads with a hooked needle that creates a wide, open knit. typically used on sweaters for warm seasons. denim cotton textile created with a twill weave to create a sturdy fabric.


volume beneath evening or wedding dresses. crochet looping threads with a hooked needle that creates a wide, open knit. typically used on sweaters for warm seasons. denim cotton textile created with a twill weave to create a sturdy fabric. used as the primary material of blue jeans. dobby woven fabric where the weave of the fabric actually produces the garment ' s design. embroidery detailed needlework, usually raised and created by yarn, silk, thread or embroidery floss. eyelet a form of lace in a thicker material that consists of cut - outs that are integrated and repeated into a pattern. usually applied to garments for warmer seasons. faille a textured fabric with faint ribbing. wears wonderfully for hours holding its shape due to the stiffness of the texture. used in wedding dresses and women ' s clothes. fil ' coupe a small jacquard pattern on a light weight fabric, usually silk, in which the threads connecting each design are cut, creating a frayed look. french terry a knit cloth that contains loops and piles of yarn. the material is very soft, absorbent and has stretch. gabardine a tightly woven twill fabric, made of different fibers such as wool, cotton and silk. georgette a crinkly crepe type material usually made out of silk that consists of tightly twisted threads. georgette is sheer and has a flowy feeling. gingham two different color stripes " woven " in pattern to appear checked. glen plaid design of woven, broken checks. a form of traditional plaid. guipure lace a lace without a mesh ground, the pattern in held in place by connecting threads. herringbone a pattern originating from masonry, consists of short rows of slanted parallel lines. the rows are formatted opposing each other to create the pattern. herringbone patterns are used in tweeds and twills. hopsack a material created from cotton or woolthat is loosely woven together to form a coarse fabric. houndstooth a classic design containing two colors in jagged / slanted checks. similar to glen plaid. jacquard a fabric of intricate varigated weave or pattern. typically shown on elegant and more expensive pieces. jersey a type of knit material usually made from cotton and known to be flexible, stretchy, soft and very warm. it is created using tight stitches. knit a knit fabric is made by interlocking loops of one or more yarns either by hand with knitting needles or by machine. linen an exquisite material created from the


, stretchy, soft and very warm. it is created using tight stitches. knit a knit fabric is made by interlocking loops of one or more yarns either by hand with knitting needles or by machine. linen an exquisite material created from the fibers of the flax plant. some linen contain slubs or small knots on the fabric. the material wrinkles very easily and is a light fabric perfect for warm weather. lurex a metallic fiber woven into material to give the garment shine. lycratm lycra is a type of stretch fabric where the fibers are woven into cotton, silk or synthetic fiber blends. these materials are lightweight, comfortable ( need trademark symbol ) and breathable, and the stretch will not wear away. madras originating from madras, india, this fabric is a lightweight, cotton material used for summer clothing. madras usually has a checked pattern but also comes in plaid or with stripes. typically made from 100 % cotton. marled typically found in sweaters, marled yarn occurs when two colored yards are twisted together. matelasse a compound fabric made of cotton, wool or other fibers with quilted character and raised patterns. matte a matte finish has a lusterless surface. merino wool wool sheered from the merino sheep and spun into yarn that is fine but strong. modal a type of rayon that is made from natural fibers but goes through a chemical treatment to ensure it has a high threshold of breakage. modal is soft and breathable which is why it ' s used as a cotton replacement. non - iron a treated cotton that allows our easy care shirts to stay crisp throughout the day and does not need ironing after washing / drying. nylon a synthetic fiber that is versatile, fast drying and strong. it has a high resistance to damage. ombre a color technique that shades a color from light to dark. ottoman a firm, lustrous plain weave fabric with horizontal cords that are larger and rounder than those of the faille. made of wool, silk, cotton and other manufactured fibers. paisley a pattern that consists of crooked teardrop designs in a repetitive manner placket the piece of fabric or cloth that is used as a concealing flap to cover buttons, fasteners or attachments. most commonly seen in the front of button - down shirts. also used to reinforce openings or slits in garments. piping binding a seam with decoration. piping is similar to tipping or edging where a decorative material is sewn into the seams.


commonly seen in the front of button - down shirts. also used to reinforce openings or slits in garments. piping binding a seam with decoration. piping is similar to tipping or edging where a decorative material is sewn into the seams. pointelle an open - work knitting pattern used on garments to add texture. typically a cooler and general knit sweater. polyester a fabric made from synthetic fibers. polyester is quick drying, easy to wash and holds its shape well. ponte a knit fabric where the fibers are looped in an interlock. the material is very strong and firm. poplin a strong woven fabric, heavier in weight, with ribbing. rayon a manufactured fiber developed originally as an alternative for silk. rayon drapes well and looks luxurious. sateen a cotton fabric with sheen that resembles satin. seersucker slack - tension weave where yarn is bunched together in certain areas and then pulled taught in others to create this summery mainstay. shirring similar to ruching, shirring gathers material to create folds. silk one of the most luxurious fabrics, silk is soft, warm and has shine. it is created from female silkworm ' s eggs. silk shantung a rough plain weave fabric made of uneven yarns to produce a textured effect, made of fibers such silk in which all knots and lumps are retained. space dyed technique of yarn dyeing to produce a multi - color effect on the yarn itself. also known as dip dyed yarn. spandex also known as lycra ( trademark symbol ), this material is able to expand 600 % and still snap back to its original shape and form. spandex fibers are woven with cotton and other materials to make fabrics stretch. tipping similar to edging, tipping includes embellishing a garment at the edges of the piece, hems, collars etc. tissue linen a type of linen that is specifically made for blouses or shirts due to its thinness and sheerness. tweed a loose weave of heavy wool makes up tweed which provides warmth and comfortability. twill a fabric woven in a diagonal weave. commonly used for chinos and denim. variegated multi - colored fabrics where colors are splotched or in patches. velour a stretchy knit fabric that looks similar to velvet. very soft to the touch. velvet a soft, silky woven fabric that is similar to velour. velvet is much more expensive than velour due to the amount of thread and steps it takes to


dante alighieri was the greatest italian poet and one of the most important european writers. dante live through the years of 1265 – 1321. he has a very unique way of writing and started his works at the age of 35. dante wrote la divina comedia based on the era he live through and all the knowledge of his lifetime was imbedded in his works. in this specific work he writes about a journey which he wishes to better understand the afterlife receive his salvation. throughout his journey virgil was his guide and taught him all about the nine circles of hell and the punishments that the sinners received in each circle. dante was a very powerful writer and his writing has many significant symbols to many different objects. this story is very complex and interesting to read and understand each after dante exits hell with his guide virgil, he arrives into purgatory. purgatory is the in between where dante sees sinners being punished. each sin has a different punishment depending on the sin. purgatory is a place where sinners temporarily get punished in order to purify themselves and be ready for heaven. there these people learn the mistakes they have made and realize the seriousness of their sins and prepare to enter heaven / paradise. virgil guides dante throughout purgatory and leads him to paradise where beatrice will be there to guide him to a very important character of the divine comedy is virgil. virgil is dante ’ s guide throughout purgatory. virgil is a very helpful guide and is a poet whom dante looked up to. virgil symbolized human reason and taught dante everything he knows about the inferno and purgatory. virgil is in the first realm of hell, limbo. he is in limbo because he is a pagan and was never baptized. virgil takes dante through each circle and describes each circle, the reason people are there and describes each punishment. virgil protects dante from the leaders of each circle as...


st. anne, patroness of detroit st. anne was named by the vatican as the patron saint of the archdiocese of detroit. we honor the mother of the blessed virgin mary and prayerfully ask for her intercession. one may pray to any saint for any intention, but a patron saint is seen as the particular advocate for a chosen place or activity. st. anne is the mother of the blessed virgin mary. though she is not mentioned by name in the bible, we know of her through early christian writings, the most important of which is the protoevangelium of james, written in about 150 a. d. we are told that anne, the wife of joachim, was advanced in years before her prayers for a child were answered. an angel appeared and told her she would conceive a child who " shall be spoken of in all the world. " st. anne ' s feast day is celebrated on july 26. she is known as the patron saint of equestrians, housewives, women in labor, cabinet - makers, and miners. devotion to st. anne became popular in the christian east by the fourth century, and that tradition later spread to the christian west. when the french began to colonize modern - day quebec, they brought their devotion to st. anne with them — asking for her protection in the new world. this devotion was planted on the banks of the detroit river by the original french - canadian settlers. two days after antoine de la mothe cadillac landed with 51 others in what is now downtown detroit on july 24, 1701, they celebrated mass and began construction of a church named after saint anne. today, ste. anne de detroit church is the second oldest continually operating parish in the united states. as is now recognized by the holy see, the church of detroit was placed under st. anne ' s protection from its very founding.


demands for lower cost manufacturing, lighter components, and recycleability are forcing manufacturers to switch from metal components to plastic. while the assembly processes are different, some of the same concerns apply. finding a reliable assembly equipment supplier, defining part requirements, getting them involved early, and choosing the right assembly process are the keys to success. chart outlines the different characteristics, capabilities, and requirements of a variety of plastic welding processes. click for the full - size graphic. appliance components come in all shapes and sizes, and each one has its own unique characteristics that demand an assembly process to fit. ultrasonic, hot - plate, spin, thermal, laser, and vibration welding are the most common plastic assembly methods. choosing the correct method can be difficult. a supplier who has technical knowledge in all of the processes is the best choice. they will have knowledge of all the different process joint designs, can provide assistance in material selection, and can support once the process is in production. part requirement before the design of the plastic part is critical. this will save dollars in tooling costs and help assure that the correct process to achieve the requirements is chosen. all too often, the plastic molds are manufactured, the first parts are assembled, and then quality control determines that the parts will not pass a pressure test. this is too late ; now significant dollars will need to be spent to correct problem. requirements such as a need for pressurization, exposure to extreme cold or heat, cosmetic - part status ( requires no blemishes ), and parts assembled per minute are all factors in determining the correct process and plastic each process has unique plastic - joint design requirements to assure proper weld strength. assembly equipment suppliers can help design the weld area joint design. an example of joint design requirements for ultrasonic assembly is given by guide to ultrasonics from dukane charles, il, u. s. ) : " mating services should be in intimate contact around the entire joint. the joint should be in one plane, if possible. a small initial contact area should be established between mating halves. a means of alignment is recommended so that mating halves do not misalign during the weld operation. " obviously, these joint requirements should all be designed into the part prior to machining of the injection molds. what assembly process is correct for a part? as stated earlier, ultrasonic, hot - plate, spin, thermal, vibration, and laser welding are the most common methods used in production today. each method has unique advantages. ultra


injection molds. what assembly process is correct for a part? as stated earlier, ultrasonic, hot - plate, spin, thermal, vibration, and laser welding are the most common methods used in production today. each method has unique advantages. ultrasonic assembly is a fast, repeatable, and reliable process that allows for sophisticated process control. high - volume small parts that have very tight assembly tolerances lend themselves well to ultrasonic assembly. ultrasonic systems have the capability of exporting relevant assembly process data for spc documentation and fda validation. ultrasonic welding can be easily integrated into automated systems. hot - plate welding can accommodate a wide range of parts sizes and configurations. these machines offer high - reliability hermetic seals and strong mechanical bonds on complex part geometries. the process is fairly simple ; the two parts to be jointed are brought in close proximity to a heated platen until the joint area is in a molten state. the platen is removed and the parts are clamped together until the joint cools off and returns to a solid state. spin welding is a very cost - effective method for joining large, medium, or small circular parts such as washing machine tubs to agitator components. water purification filters, thermal mugs, and irrigation assemblies typically are joined using the spin welding process. careful attention to joint design is critical for parts that require flash - free appearance. assemblies that require inserts at multiple points on multiple planes, like computer or vacuum cleaner housings, typically benefit from thermal insertion / staking. thermal staking is ideal for attachment of non - plastic components to the plastic housing, such as circuit boards and metal brackets. dates coding, embossing, and degating are other uses for thermal presses. thermal welding can be a slower assembly process than ultrasonic, so, depending on the volumes of assemblies required, ultrasonic maybe a better choice. vibration welding physically moves one of the two parts horizontally under pressure to create heat through surface friction. compared to ultrasonic welding, vibration welding operates at much lower frequencies, much higher amplitude, and with greater clamping force. the limitation to vibration welding is simply that the joint must be in a single plane in at least one axis in order to allow the vibration motion. like hot - plate welding, vibration welding is a highly reliable process that can handle large parts in challenging materials or multiple parts per cycle with ease. chain saw housings, blower and pump assemblies, and large refrigerator bins are examples of potential vibration welding applications. cycle times for vibration


welding is a highly reliable process that can handle large parts in challenging materials or multiple parts per cycle with ease. chain saw housings, blower and pump assemblies, and large refrigerator bins are examples of potential vibration welding applications. cycle times for vibration welds are very short, thus they are ideal for high volume and are easily automated. laser welding is the newest technology of the processes available today. one benefit of laser welding is that the weld joints produce no flash or particulate outside of the joint. assemblies that require absolutely no contamination for particulate, like medical filters, are good candidates. a second benefit is that the assembly is not exposed to heat or vibration. devices that have very sensitive electronic internal components that may be damaged from vibration can now be assembled effectively. laser welding requires the parts to be transmissive and absorbive, specifically how transparent the parts appear to the laser beam. one material transmits the coherent laser light and the other material absorbs the light and converts it to heat. parts that appear black to the human eye can be transparent or opaque at the wavelength of the laser light. clear - to - clear joints and joints that are optically transparent can be readily achieved by use of special coatings. depending on the part geometry, laser welding can be a slower process then vibration or ultrasonic welding. plastic appliance components are the direction of the future - they can be assembled economically and produce functional products. this information is provided by michael johnston, national sales and marketing manager, dukane charles, il, u. s. ).


on friday, the department of health and human services ( hhs ) released a new report identifying interventions that can help increase physical activity in youth aged 3 - 17 years across a variety of settings. the primary audiences for the report are policymakers, health care providers, and public health professionals. apta submitted comments in december 2012 on the draft report. physical activity guidelines for americans midcourse report : strategies to increase physical activity among youth summarizes intervention strategies based on the evidence from literature reviews and is organized into 5 settings where youth live, learn, and play : school, preschool and childcare, community, family and home, and primary health care. key findings of the report suggest that : other materials released by hhs include an infographic highlighting opportunities to increase physical activity throughout the day and a youth fact sheet summarizing the report ' s recommendations for youth aged 6 - 17 years. more information can be found at www. health. gov / paguidelines / midcourse /. apta has long supported hhs ' efforts to increase awareness about the benefits of physical activity. it provided input on the 2008 physical activity guidelines for americansrelated to the importance of considering physical activity needs and barriers for people with disabilities. it also served on the physical activity guidelines reaction group. the association also contributes to the be active your way blog. therapists ( pts ) and physical therapist assistants ( ptas ), especially those who have patients with wounds, are encouraged to take steps to protect their most vulnerable patients from carbapenem - resistant enterobacteriaceae ( cre ), a family of germs that have become difficult to treat because they have high levels of resistance to antibiotics. in addition to patients at high risks, pts and ptas should take all necessary precautions to prevent the spread of cre to according to the centers for disease control and prevention ( cdc ), cre are resistant to all, or nearly all, antibiotics — even the most powerful drugs of last - resort. cre also have high mortality rates, killing 1 in 2 patients who get bloodstream infections from them. additionally, cre easily transfer their antibiotic resistance to other bacteria. for example, carbapenem - resistant klebsiella can spread its drug - destroying properties to a normal e. coli bacteria, which makes the e. coli resistant to antibiotics also. " that could create a nightmare scenario since e. coli is the most common cause of urinary tract infections in healthy people, " cre are usually transmitted person


normal e. coli bacteria, which makes the e. coli resistant to antibiotics also. " that could create a nightmare scenario since e. coli is the most common cause of urinary tract infections in healthy people, " cre are usually transmitted person - to - person, often on the hands of health care workers. currently, almost all cre infections occur in people receiving significant medical care. however, their ability to spread and their resistance raises the concern that potentially untreatable infections could appear in otherwise healthy people, including health care providers. includes resources for patients, providers, and facilities. the agency ' s cre prevention toolkit has in - depth recommendations to control cre transmission in hospitals, long - term acute care facilities, and is in the process of updating its infectious disease control webpage to ensure that pts and ptas have the information they need to understand their critical role in helping to halt the spread of cre. look for a follow - up article in news now when the webpage is launched. has selected 9 association members to serve on the pta education feasibility study work group : wendy bircher, pt, edd ( nm ), derek brandes ( wa ), barbara carter, pta ( wi ), martha hinman, pt, edd ( tx ), mary lou romanello, pt, phd, atc ( md ), steven skinner, pt, edd ( ny ), lisa stejskal, pta, maed ( il ), jennifer whitney, pt, dpt, kemg ( ca ), and geneva johnson, pt, phd, fapta ( la ). the work group is addressing the motion feasibility study for transitioning to an entry - level baccalaureate physical therapist assistant degree ( rc 20 - 12 ) from the 2012 house of delegates. the work group will address the first phase of the study, finalizing the study plan and identifying relevant data sources for exploring the feasibility of transitioning the entry - level degree for the pta to a bachelor ' s degree. apta supporting staff members are janet crosier, pt, dpt, med, lead pta services specialist ; janet bezner, pt, phd, vice president of education and governance and administration ; doug clarke, accreditation pta programs manager ; and libby ross, director of than 200 individuals volunteered to serve on the work group by submitting their names to the volunteer interest pool ( vip ). apta expects to engage additional members in the data collection process.


overview of content related to ' java ' this page provides an overview of 1 article related to ' perl '. note that filters may be applied to display a sub - set of articles in this category ( see faqs on filtering for usage tips ). select this link to remove all filters. perl is a high - level, general - purpose, interpreted, dynamic programming language. perl was originally developed by larry wall in 1987 as a general - purpose unix scripting language to make report processing easier. since then, it has undergone many changes and revisions and become widely popular amongst programmers. larry wall continues to oversee development of the core language, and its upcoming version, perl 6. perl borrows features from other programming languages including c, shell scripting ( sh ), awk, and sed. the language provides powerful text processing facilities without the arbitrary data length limits of many contemporary unix tools, facilitating easy manipulation of text files. perl gained widespread popularity in the late 1990s as a cgi scripting language, in part due to its parsing abilities. ( excerpt from wikipedia article : perl ) see our ' perl ' overview for more data and comparisons with other tags. for visualisations of metadata related to timelines, bands of recency, top authors, and and overall distribution of authors using this term, see our ' perl ' usage charts. ariadne contributors most frequently referring to ' perl ' :


outmaneuvering foodborne pathogens at various locations, ars scientists are doing research to make leafy greens and other fresh produce safer for consumers. produce and leafy greens in the photo are ( clockwise from top ) : romaine lettuce, cabbage, cilantro in a bed of broccoli sprouts, spinach and other leafy greens, green onions, tomatoes, and green leaf lettuce. if pathogens like e. coli o157 : h7 or salmonella had a motto for survival, it might be : “ find! bind! multiply! ” that pretty much sums up what these food - poisoning bacteria do in nature, moving through our environment to find a host they can bind to and use as a staging area for multiplying and spreading. but ars food - safety scientists in california are determined to find out how to stop these and other foodborne pathogenic bacteria in their tracks, before the microbes can make their way to leafy greens and other favorite salad ingredients like tomatoes and sprouts. the research is needed to help prevent the pathogens from turning up in fresh produce that we typically eat uncooked. that ’ s according to robert e. mandrell, who leads the ars produce safety and microbiology research unit. his team is based at the agency ’ s western regional research center in albany, california. the team is pulling apart the lives of these microbes to uncover the secrets of their success. it ’ s a complex challenge, in part because the microbes seem to effortlessly switch from one persona to the next. they are perhaps best known as residents of the intestines of warm - blooded animals, including humans. for another role, the pathogens have somehow learned to find, bind, and multiply in the world of green plants. sometimes the pathogenic microbes need the help of other microbial species to make the jump from animal inhabitant to plant resident. surprisingly little is known about these powerful partnerships, mandrell says. that ’ s why such alliances among microbes are one of several specific aspects of the pathogens ’ lifestyles that the albany scientists are investigating. in all, knowledge gleaned from these and other laboratory, greenhouse, and outdoor studies should lead to new, effective, environmentally friendly ways to thwart the pathogens before they have a chance to make us ill. in a greenhouse, microbiologist maria brandl examines cilantro that she uses as a model plant to investigate the behavior of foodborne pathogen


effective, environmentally friendly ways to thwart the pathogens before they have a chance to make us ill. in a greenhouse, microbiologist maria brandl examines cilantro that she uses as a model plant to investigate the behavior of foodborne pathogens on leaf surfaces. a pathogen targets youngest leaves knowing pathogens ’ preferences is essential to any well - planned counter - attack. so microbiologist maria t. brandl is scrutinizing the little - understood ability of e. coli o157 : h7 and salmonella enterica to contaminate the elongated, slightly sweet leaves of romaine lettuce. with a university of california - berkeley colleague, brandl has shown that, if given a choice, e. coli has a strong preference for the young, inner leaves. the researchers exposed romaine lettuce leaves to e. coli and found that the microbe multiplied about 10 times more on the young leaves than on the older, middle ones. one explanation : the young leaves are a better nutrition “ buy ” for e. coli. “ these leaves exude about three times more nitrogen and about one - and - one - half times more carbon than do the middle leaves, ” says brandl. scientists have known for decades that plants exude compounds from their leaves and roots that bacteria and fungi can use as food. but the romaine lettuce study, published earlier this year in applied and environmental microbiology, is the first to document the different exudate levels among leaves of the two age classes. it ’ s also the first to show that e. coli can do more than just bind to lettuce leaves : it can multiply and spread on them. research assistant danielle goudeau inoculates a lettuce leaf with e. coli o157 : h7 in a biological safety cabinet to study the biology of the human pathogen on leafy greens. adding nitrogen to the middle leaves boosted e. coli growth, brandl found. “ in view of the key role of nitrogen in helping e. coli multiply on young leaves, ” she says, “ a strategy that minimizes use of nitrogen fertilizer in romaine lettuce fields may be worth investigating. ” in other studies using romaine lettuce and the popular herb cilantro as models, brandl documented the extent to which e. coli and salmonella are aided by erwinia chrysanthemi, an organism that causes fresh produce to rot. “ when compared to plant pathogens, e.


herb cilantro as models, brandl documented the extent to which e. coli and salmonella are aided by erwinia chrysanthemi, an organism that causes fresh produce to rot. “ when compared to plant pathogens, e. coli and salmonella are not as ‘ fit ’ on plants, ” brandl says. but the presence of the rot - producing microbe helped e. coli and salmonella grow on lettuce and cilantro leaves. “ soft rot promoted formation of large aggregates, called ‘ biofilms, ’ of e. coli and salmonella and increased their numbers by up to 100 - fold, ” she notes. the study uncovered new details about genes that the food - poisoning pathogens kick into action when teamed up with plant pathogens such as soft rot microbes. brandl, in collaboration with albany microbiologist craig parker, used a technique known as “ microarray analysis ” to spy on the genes. “ the assays showed that salmonella cells — living in soft rot lesions on lettuce and cilantro — had turned on some of the exact same genes that salmonella uses when it infects humans or colonizes the intestines of animals, ” she says. some of these activated genes were ones that salmonella uses to get energy from several natural compounds common to both green plants and to the animal intestines that salmonella calls home. using a confocal laser scanning microscope, microbiologist maria brandl examines a mixed biofilm of salmonella enterica ( pink ) and erwinia chrysanthemi ( green ) in soft rot lesions on cilantro leaves ( blue ). a one - two punch to tomatoes salmonella also benefits from the presence of another plant pathogen, specifically, xanthomonas campestris, the culprit in a disease known as “ bacterial leaf spot of tomato. ” but the relationship between salmonella and x. campestris may be different than the relation of salmonella to the soft rot pathogen. notably, salmonella benefits even if the bacterial spot pathogen is at very low levels — so low that the plant doesn ’ t have the disease or any visible symptoms of it. that ’ s among the first - of - a - kind findings that microbiologist jeri d. barak found in her tests with tomato seeds exposed to the bacterial spot microbe and then planted in soil that had been irrigated with water contaminated with s. enterica. in a recent article in pl


findings that microbiologist jeri d. barak found in her tests with tomato seeds exposed to the bacterial spot microbe and then planted in soil that had been irrigated with water contaminated with s. enterica. in a recent article in plos one, barak reported that s. enterica populations were significantly higher in tomato plants that had also been colonized by x. campestris. in some cases, salmonella couldn ’ t bind to and grow on — or in — tomato plants without the presence of x. campestris, she found. listeria monocytogenes on this broccoli sprout shows up as green fluorescence. the bacteria are mainly associated with the root hairs. “ we think that x. campestris may disable the plant immune response — a feat that allows both it and salmonella to multiply, ” she says. the study was the first to report that even as long as 6 weeks after soil was flooded with salmonella - contaminated water, the microbe was capable of binding to tomato seeds planted in the tainted soil and, later, of spreading to the plant. “ these results suggest that any contamination that introduces salmonella from any source into the environment — whether that source is irrigation water, improperly composted manure, or even insects — could lead to subsequent crop contamination, ” barak says. “ that ’ s true even if substantial time has passed since the soil was first contaminated. ” crop debris can also serve as a reservoir of viable salmonella for at least a week, barak ’ s study showed. for her investigation, the debris was composed of mulched, salmonella - contaminated tomato plants mixed with uncontaminated soil. “ replanting fields shortly after harvesting the previous crop is a common practice in farming of lettuce and tomatoes, ” she says. the schedule allows only a very short time for crop debris to decompose. “ our results suggest that fields known to have been contaminated with s. enterica could benefit from an extended fallow period, perhaps of at least a few weeks. ” ordinary microbe foils e. coli while the bacterial spot and soft rot microbes make life easier for certain foodborne pathogens, other microbes may make the pathogens ’ existence more difficult. geneticist michael b. cooley and microbiologist william g. miller at albany have shown the remarkable effects of one such microbe, enterobacter asburiae. this common, farm - and - garden - friendly


more difficult. geneticist michael b. cooley and microbiologist william g. miller at albany have shown the remarkable effects of one such microbe, enterobacter asburiae. this common, farm - and - garden - friendly microorganism lives peaceably on beans, cotton, and cucumbers. in one experiment, e. asburiae significantly reduced levels of e. coli and salmonella when all three species of microbes were inoculated on seeds of thale cress, a small plant often chosen for laboratory tests. the study, published in applied and environmental microbiology in 2003, led to followup experiments with green leaf lettuce. in that battle of the microbes, another rather ordinary bacterium, wausteria paucula, turned out to be e. coli ’ s new best friend, enhancing the pathogen ’ s survival sixfold on lettuce leaves. “ it was the first clear example of a microbe ’ s supporting a human pathogen on a plant, ” notes cooley, who documented the findings in the journal of food protection in 2006. but e. asburiae more than evened the score, decreasing e. coli survival 20 - to 30 - fold on lettuce leaves exposed to those two species of microbes. the mechanisms underlying the competition between e. asburiae and e. coli are still a mystery, says cooley, “ especially the competition that takes place on leaves or other plant surfaces. ” nevertheless, e. asburiae shows initial promise of becoming a notable biological control agent to protect fresh salad greens or other crops from pathogen invaders. with further work, the approach could become one of several science - based solutions that will help keep our salads safe. — by marcia wood, agricultural research service information staff. this research is part of food safety, an ars national program ( # 108 ) described on the world wide web at www. nps. ars. usda. gov. to reach scientists mentioned in this article, contact marcia wood, usda - ars information staff, 5601 sunnyside ave., beltsville, md 20705 - 5129 ; phone ( 301 ) 504 - 1662, fax ( 301 ) 504 - 1486. listeria monocytogenes on this radish sprout shows up as green fluorescence. the bacteria are mainly associated with the root hairs. what genes help microbes invade leafy greens? when unwanted microbes form an attachment, the


conventionally associated with plants. listeria is usually thought of as a pathogen of humans. we hadn ’ t really expected to see it behaving like a traditional, benign inhabitant of a green plant. “ it ’ s still a relatively new face for listeria, and requires a whole new way of thinking about it. ” in related work, gorski is homing in on genetic differences that may explain the widely varying ability of eight different listeria strains to successfully colonize root hairs of alfalfa sprouts — and to resist being washed off by water. in a 2004 article in the journal of food protection, gorski, palumbo, and former albany associate kimanh d. nguyen reported those differences. poorly attaching strains formed fewer than 10 listeria cells per sprout during the lab experiment, while the more adept colonizers formed more than 100, 000 cells per sprout. salmonella ’ s cling genes colleague jeri d. barak, a microbiologist at albany, led another sprout investigation, this time probing the ability of s. enterica to attach to alfalfa sprouts. from a pool of 6, 000 genetically different salmonella samples, barak, gorski, and coinvestigators found 20 that were unable to attach strongly to sprouts. scientists elsewhere had already identified some genes as necessary for salmonella to successfully invade and attach to the guts of animals such as cows and chickens. in the albany experiments, some of those same genes were disrupted in the salmonella specimens that couldn ’ t cling to alfalfa sprouts. their 2005 article in applied and environmental microbiology helped set the stage for followup studies to tease out other genes that salmonella uses when it is living on and in plants. a deeper understanding of those and other genes may lead to sophisticated defense strategies to protect tomorrow ’ s salad greens — and us. — by marcia wood, agricultural research service information staff. geneticist michael cooley collects a sediment sample to test for e. coli o157 : h7. the pathogen was found near fields implicated in the 2006 outbreak of e. coli o157 : h7 on baby spinach. environmental surveillance exposes a killer it started as a manhunt for a microbe, but it became one of the nation ’ s most intensive farmscape searches for the rogue pathogen e. coli o157 : h7. ars microbiologist robert e. mandrell and geneticist


a manhunt for a microbe, but it became one of the nation ’ s most intensive farmscape searches for the rogue pathogen e. coli o157 : h7. ars microbiologist robert e. mandrell and geneticist michael b. cooley of the produce safety and microbiology research unit in albany, california, had already been collaborating in their own small - scale study of potential sources of e. coli o157 : h7 in the state ’ s produce - rich salinas valley when, in 2005, they were asked to join another one. the new investigation became a 19 - month surveillance — by the two scientists and other federal and state experts — of e. coli in salinas valley watersheds. “ it may seem like an obvious concept today, ” says mandrell, “ but at the time, there was little proof that e. coli contamination of produce before harvest could be a major cause of food - poisoning outbreaks. ” mandrell and cooley aided the california food emergency response team, as this food - detective squad was named, in tracing movement of e. coli through the fertile valley. this surveillance showed that e. coli o157 : h7 can travel long distances in streamwater and floodwater. in 2006, e. coli o157 : h7 strains indistinguishable from those causing human illness associated with baby spinach were discovered in environmental samples — including water — taken from a salinas valley ranch. wild pigs were added to the list of animal carriers of the pathogen when one of the so - called “ outbreak strains ” of e. coli o157 : h7 was discovered in their dung. the team documented its work in 2007 in plos one and emerging infectious diseases. the albany scientists used a relatively new technique to detect e. coli o157 : h7 in water. developed at the ars meat animal research center in clay center, nebraska, for animal hides, the method was adapted by the albany team for the outdoor reconnaissance. because of their colleagues ’ work, says cooley, “ we had the right method at the right time. ” — by marcia wood, agricultural research service information staff. " outmaneuvering foodborne pathogens " was published in the july 2008 issue of agricultural research magazine.


protection of subtropical and tropical agriculture commodities and ornamentals from exotic insects location : subtropical horticulture research title : laurel wilt : a global threat to avocado production | ploetz, r - | | smith, j - | | inch, s - | | pena, j - | | evans, e - | | crane, j - | | hulcr, j - | | stelinski, l - | | schnell, r - | submitted to : world avocado congress publication type : proceedings publication acceptance date : november 28, 2011 publication date : february 1, 2012 citation : ploetz, r. c., smith, j. a., inch, s. a., pena, j. e., evans, e. a., crane, j. h., kendra, p. e., hulcr, j., stelinski, l., schnell, r. 2012. laurel wilt : a global threat to avocado production. world avocado congress. 186 - 197 in proceedings vii world avocado congress. 5 - 9 september 2011, cairns, australia. interpretive summary : laurel wilt is a lethal vascular disease of trees in the plant family lauraceae, including avocado. it is caused by a fungal pathogen ( raffaelea lauricola ) that is introduced into host trees by an exotic wood - boring beetle, the redbay ambrosia beetle ( xyleborus glabratus ). the beetle was first detected in georgia in 2002, and since has spread to six states in the southeastern u. s. laurel wilt poses an imminent threat to commercial avocado production in south florida, and a future threat to avocado in california, mexico, central and south america. scientists at the usda - ars subtropical horticulture research station, in collaboration with the university of florida, are conducting multidisciplinary research on the pest complex, including ( 1 ) evaluation of fungicides for laurel wilt, ( 2 ) screening for disease resistant avocado varieties, ( 3 ) determination of pathways for disease transmission, ( 4 ) identification of beetle attractants, repellents, and insecticides, and ( 5 ) assessment of host preferences. information from these studies will be used by avocado growers and by state and federal action agencies engaged in monitoring programs for redbay ambrosia beetle. laurel wilt kills members of the lauraceae plant family


5 ) assessment of host preferences. information from these studies will be used by avocado growers and by state and federal action agencies engaged in monitoring programs for redbay ambrosia beetle. laurel wilt kills members of the lauraceae plant family, including avocado. the disease has invaded much of the southeastern usa, and threatens avocado commerce and homeowner production in florida, valuable germplasm in miami ( usda - ars ), and major production and germplasm in california and mesoamerica. laurel wilt is caused by a recently described fungus, raffaelea lauricola, which is vectored by an invasive ambrosia beetle, xyleborus glabratus. current research topics include : disease management with fungicides ; identifying host resistance ; vector mitigation with insecticides and repellents ; host ranges of, and interactions with, the pathogen and vector ; and transmission of r. lauricola via avocado seed, scion material, root grafts and pruning tools. although highly resistant avocado cultivars have not been identified, screening work continues on additional cultivars and new germplasm. effective fungicides ( e. g. triazoles ) have been identified, but cost - effective disease management will depend on improved measures for xylem loading and retention of these chemicals. insecticides have been identified that reduce boring activity of x. glabratus and its attraction to avocado and other hosts, but much remains to be learned about their impact on disease management. although the disease ’ s host range is generally restricted to american members of the lauraceae, nonhosts that attract the beetle are known. raffaelela lauricola rapidly colonizes avocado after infection, but to low levels ; tylose and gel induction in the host, rather than xylem obstruction by fungal biomass, are associated with impeded water transport and symptom development. seed and fruit from laurel wilt - affected avocado trees do not appear to be infected by r. lauricola.


the nature elephant the karen people have always lived naturally in the forest, and, for many generations have relied on elephants to help them. because elephants are ideal for carrying heavy loads they are essential for transportation through rural areas, and, more recently, for carrying tourists. the karen people simply would not survive without them. the karen people have always used elephants to help carry them through dense parts of the jungle which would be difficult on foot, such as down steep hills to fetch water from the creek, or carrying heavy bags of rice from the fields to the barn. what is little effort for an elephant would be a huge amount of labour for humans. because they are so important to the karen people, elephants are their friends, and are treated with respect. to manage an elephant and gain its trust requires knowledge, love and understanding. this is why the karen people look after their elephants so well, and only certain members of the karen family are trained enough to do this. some of them call elephant - care a kind of black magic, and this black magic is passed down through families. part of the skill of caring for elephants is to ensure the elephant is listened to. karen legend has it that if a female elephant is ignored, it is likely that her eggs will become infected, and therefore she will not be able to continue the elephant family. this serious consequence acts as a grave warning to those handling elephants. a sense of duty, honor and patience are as important to the elephant as they are to the karen people as a whole. the legend of chang karen this is a story about how elephants became so important in the life of the karen hill tribe. the legend goes that once upon a time, there were two brothers living in the forest. one day, their mother needed to leave home for a business, so instructed the two boys to look after the house, be good, and by no means split open the bamboo tree, as it contained many flies. being the mischievous boys they were, as soon as their mother was out of sight, they crept up to the forbidden bamboo and cracked it open, curious to see what would happen. immediately, the room was filled with flies, two of which flew up into each of the boys ' noses. panicking, the boys didn ' t know what to do. soon, they felt their bodies changing. their legs began to itch, and grow longer and wider. their heads began to swell, until they felt the size and shape of footballs. their noses grew longer and their bodies became heavier and more clumsy