An international comparison of legal frameworks for supported and substitute decision-making in mental health services

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person’s wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past thirty years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice.

Bauxite residue (Red mud) as a pulverised fuel ash substitute in the manufacture of lightweight aggregate

This study looked at the potential of bauxite residue or red mud to be used in the manufacture of lightweight aggregate in replacement of pulverised fuel ash (PFA), commonly used as a way of recycling problematic wastes. The percentage replacements of red mud with PFA were as follows: 25, 31, 38, 44 and 50%. These were blended in a mix with waste excavated clay and sewage sludge – all from the Chongqing municipality in China. Lightweight pellets were produced using a Trefoil rotary kiln and were sintered to 1200 °C. Results showed that 44 % bauxite residue replacement produced lightweight pellets with the highest compressive strength, highest density and largest water holding capacity. This would be expected in materials with a low level of silicates, which causes insufficient glass phase viscosity and therefore poor bloating during firing; producing an aggregate with a higher density but with open pores that allowed for larger water absorption. All ratios of red mud aggregates were significantly reduced in pH after firing to around pH 8, and this reduced the leachability of the aggregates to levels below those set by the European landfill directive (2003/33/EC).

On the Optimal Order of Natural Resource Use When the Capacity of the Inexhaustible Substitute is Limited.

Consider a general equilibrium framework where the marginal cost of extraction from several deposits of an exhaustible resource is constant in terms of an inexhaustible perfect substitute and differs between deposits. the instantaneous rate of production form the inexhaustible resource is subject to a capacity constraint.

10 Reasons Why the Internet Is No Substitute for a Library

In an effort to save our culture, strike a blow for reading, and, above all, correct the well-intentioned but horribly misguided notions about what is fast becoming Intertopia among many nonlibrarian bean counters, here are 10 reasons why the Internet is no substitute for a library.

Political institutions as substitute for democracy: a political economy analysis of economic growth

This manuscript empirically assesses the effects of political institutions on economic growth. It analyzes how political institutions affect economic growth in different stages of democratization and economic development by means of dynamic panel estimation with interaction terms. The new empirical results obtained show that political institutions work as a substitute for democracy promoting economic growth. In other words, political institutions are important for increasing economic growth, mainly when democracy is not consolidated. Moreover, political institutions are extremely relevant to economic outcomes in periods of transition to democracy and in poor countries with high ethnical fractionalization.

Avoiding some costs of inflation and crawling toward hyperinflation : the case of the Brazilian domestic currency substitute

The pattem of a classical hyperinflation is an acute acceleration of the inflation levei accompanied by rapid substitution away from domestic currency. Brazil, however, has becn experiencing inflation leveis well above 1,000% a year since 1988 without entering the classical hyperinflation path. Two elements play key roles in differcntiating the Brazilian case from other hyperinflationary experiences: indexation and the provision of a reliable domestic currency substitute, Le., the provision of liquidity to interest-bearing assets. This paper claims that the existence of this domestic currency substitute is lhe main source of both lhe inability of the Brazilian central bank to fight inflation and of the unwillingness of Brazilians to face the costs of such a fight. The provision of the domestic currency substitute through the banking sector is modeled, and the main macroeconomic consequences of this monetary regime are derived. Those are: the lack of a nominal anchor for the price system due to the passive monetary policy; the endogeneity of seignorage unlikc traditional models of hyperinflation; and lhe ineffectiveness of very high real interest rates.

2-Bromo-1,4-naphthoquinone: a potentially improved substitute of menadione in Apatone therapy

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Muscle graft as a substitute for peripheral nerve graft in rats

OBJETIVO: Avaliar a aplicabilidade do uso de músculo autógeno, tratado de diversas maneiras, em substituição aos enxertos de nervo. MÉTODOS: Os ratos foram separados em sete grupos que receberam, como tratamento a uma lesão nervosa padronizada, os seguintes tipos de enxertos: músculo fresco, músculo fixado com formol 10%, músculo congelado em freezer, músculo congelado em refrigerador, músculo denervado, nervo periférico e um grupo ficou sem qualquer tratamento. Foi avaliado o aspecto histológico das fibras nervosas no segmento reparado. RESULTADOS: A avaliação do segmento nervoso reparado mostrou que existiam axônios em quase todos os grupos, mas a metodologia empregada não possibilitou caracterizar adequadamente as diferenças entre os grupos. CONCLUSÃO: Este estudo mostrou a migração de axônios por meio de todos os enxertos utilizados.

Glutaraldehyde-treated homologous vein graft as a vein substitute: experimental study in rabbits

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Saliva substitute in combination with high-concentrated fluoride toothpaste: Effects on demineralised dentin in vitro

Objectives: The aim of this in vitro study was to assess the effects of saliva substitutes (modified with respect to calcium, phosphates, and fluorides) in combination with a high-concentrated fluoride toothpaste on demineralised dentin.Methods: Before and after demineralisation of bovine dentin specimens (subsurface lesions; 37 degrees C, pH 5.0, 5 d), one-quarter of each specimen's surface was covered with nail varnish (control of sound/demineralised tissue). Subsequently, specimens were exposed to original Saliva natura (saturation with respect to octacalciumphosphate [S(OCP)]: 0.03; SN 0), or to three lab-produced Saliva natura modifications (S(OCP): 1, 2, and 3; SN 1-3) for 2 and 5 weeks (37 degrees C). An aqueous solution (S(OCP): 2.5) served as positive control (PC). Two times daily (2 min each), Duraphat toothpaste (5000 ppm F(-); Colgate)/saliva substitute slurry (ratio 1:3) was applied gently. Differences in mineral losses (Delta Delta Z) and lesion depths (Delta LD) between values before and after exposure were microradiographically evaluated.Results: After both treatment periods specimens immersed in SN 0 revealed significantly higher mineral losses (lower Delta Delta Z values) and lesion depths (lower Delta LD) compared to PC (p < 0.05; ANOVA). After 5 weeks, specimens stored in SN 1 and 2 showed significantly higher mineral losses compared to PC (p < 0.05), while those stored in SN 3 showed similar results (p > 0.05). No differences in mineral loss could be observed between SN 2 and 3 (p > 0.05).Conclusions: Under the conditions of this limited protocol, the combination of Saliva natura solutions slightly saturated with respect to OCP in combination with a high-concentrated fluoride toothpaste enabled remineralisation of dentin in vitro. Crown Copyright (c) 2009 Published by Elsevier Ltd. All rights reserved.

FUNCTIONAL ALPHA-TROPOMYOSIN PRODUCED IN ESCHERICHIA-COLI - A DIPEPTIDE EXTENSION CAN SUBSTITUTE THE AMINO-TERMINAL ACETYL GROUP

Unlike the muscle protein, alpha-tropomyosin expressed in Escherichia coli does not bind actin, does not exhibit head-to-tail polymerization, and does not inhibit actomyosin ATPase activity in the absence of troponin. The only chemical difference between recombinant and muscle tropomyosins is that the first methionine is not acetylated in the recombinant protein (Hitchcock-DeGregori, S. E., and Heald, R. W. (1987) J. Biol. Chem. 262, 9730-9735). We expressed three fusion tropomyosins in E. coli with 2, 3, and 17 amino acids fused to its amino terminus. Ah three fusions restored actin binding, head-to-tail polymerization, and the capacity to inhibit the actomyosin ATPase to these unacetylated tropomyosins. Unlike larger fusions, the small fusions of 2 and 3 amino acids do not interfere with regulatory function. Therefore the presence of a fused dipeptide at the amino terminus of unacetylated tropomyosin is sufficient to replace the function of the N-acetyl group present in muscle tropomyosin. A structural interpretation for the function of the acetyl group, based on our results and the coiled coil structure of tropomyosin, is presented.