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George Clerk, Jason Schaub, David Hancock and Colin Martin
The purpose of this paper is to present the findings of a study considering the application of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS)…
The purpose of this paper is to present the findings of a study considering the application of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Practitioners from a range of professions were recruited to provide their views of how to respond to a variety of scenarios. GPs, nurses, social workers, physio/occupational therapists and care assistants were recruited to participate.
This study used the Delphi method to elicit participant views and generate consensus of opinion. The Delphi method recommends a large sample for heterogeneous groups, and round one had 98 participants from six different professional groups.
Participants did not respond consistently to the scenarios, but disagreed most significantly when patient decisions conflicted with clinical advice, and when to conduct a capacity assessment. These responses suggest that clinical responses vary significantly between individuals (even within settings or professions), and that the application of Mental Capacity Act (MCA) is complicated and nuanced, requiring time for reflection to avoid paternalistic clinical interventions.
Previous studies have not used a Delphi method to consider the application of MCA/DoLS. Because of this methods focus on developing consensus, it is uniquely suited to considering this practice issue. As a result, these findings present more developed understanding of the complexity and challenges for practitioner responses to some relatively common clinical scenarios, suggesting the need for greater clarity for practitioners.
The popular misconception which exists respecting the duties of a Public Analyst is well illustrated by the remarks attributed recently to a borough coroner.
At a meeting of the Nutrition Panel of the Food Group of the Society of Chemical Industry, Dr. Joseph Needham, of the Biochemical Laboratory, University of Cambridge…
At a meeting of the Nutrition Panel of the Food Group of the Society of Chemical Industry, Dr. Joseph Needham, of the Biochemical Laboratory, University of Cambridge, speaking on “ The Biological Nature of the Egg,” pointed out what complex structures were the eggs of birds and other vertebrates. In fact the embryo, which is eventually to develop into the new animal, only occupies a very small space within the total egg. The remainder serves, in one way or another, to keep the organism alive until it is hatched. It is interesting to note that this is not the case in lower animals. The octopus in its egg is not supplied by its mother with enough copper but must obtain more for itself from the surrounding sea. Newts and frogs in their eggs also must to some extent look after themselves. Birds' eggs, however, represent a type of perfectly “closed box” structure which requires many ingenious devices in order to survive. One of these, through which the bird saves itself from being poisoned by its own by‐products, is the fact that the developing embryo does not excrete nitrogen as urea but in the form of uric acid which is more easily deposited as crystals.—Dr. Ethel M. Cruickshank, of the Department of Agriculture, Cambridge, who spoke on the “ Chemical Composition of the Egg,” pointed out that the hen was a physiological machine for turning raw materials into human foodstuffs. The amount of such human food which the hen could produce in a day depended on a number of factors, but to a large extent it was true to say that the bigger the hen the larger the egg. The number of eggs which a hen would lay in a year was a different matter, but an interesting point was the fact that high production had little or no detrimental effect on the quality of the eggs. In considering the composition of the egg one must divide it into three parts. The shell was principally made up of calcium carbonate, although small amounts of magnesium, phosphorus and organic matter were present. The white was composed of four different kinds of protein and could be divided into layers of thick and thin white. The proportion of thick to thin white influenced the culinary value of the egg. Together, the four proteins in the white contained the essential amino acids which made “ first class ” protein. Egg white contained minerals and also supplied valuable amounts of vitamin B. The yolk contained two proteins which were also shown to be of “ first class ” quality. Besides protein the yolk contained 30 to 32 per cent. of fat. Numerous minerals were present, including relatively rich amounts of easily assimilable iron. Vitamins A, D, B1 and B2 were also present. The anti‐rachitic vitamin D was of great significance in the diet. Dr. Cruickshank also discussed the factors in the diet of the hen which might give the yolk an unpleasant taste or a strange colour. Although the amount of fat, and hence the total food value of the egg, could only be influenced to a slight extent by the diet of the hen, the nature and flavour of the egg could be very strikingly altered by feeding mashes containing, for example, hemp seed or linseed oil. As regards vitamins, it was essential that plenty of these should be present in the diet of the hen in order that her egg might be of high nutritive value. As regards minerals, it was very well known that by feeding a hen a diet which was short of calcium a thin shell was obtained. However, the calcium content of the yolk and white were not affected. The amount of iodine in eggs was affected by the amount in the hens' food, although iron and copper appeared to be independent of the amount present in the diet.—Dr. S. K. Kon, of the National Institute for Research in Dairying, Reading, spoke on the nutritive importance of eggs in the diet. He stressed that eggs share with milk the ability to cover nutritive requirements during the period of rapid development. The vitamins, minerals and “ first class ” protein in eggs made them one of the protective foods. In particular, eggs supplemented very well the proteins present in cereals. Dr. Kon showed in detail how eggs contribute to the various factors of a good diet.—Dr. R. B. Haines, of the Low Temperature Research Station, Cambridge, spoke on the preservation of eggs. He showed how hens' eggs were in a state of rapid change. The aim of storage was to retard or stop this change and prevent the attack of outside agencies such as micro‐organisms. Although storage only affected the nutritive value of eggs to a very minor degree, any loss of palatability and cooking quality was a clear indication that certain slight chemical changes had taken place. Dr. Haines mentioned three methods for the large‐scale storage of eggs. The first was cold storage, the second, storage with the partial addition of CO2, and the third, full gas storage. For other purposes, drying or freezing could be used. Problems connected with the storage of eggs led to the consideration of questions of production and handling. For example, “ thick white ” was apparently due to the individual hen. Again, spoilage of eggs by the invasion of bacteria was influenced by the structure of the egg‐shell, which might vary greatly in successive eggs from the same hen or by the “ washing ” treatment which the eggs received. Among many other topics upon which Dr. Haines touched were “ swollen ” and “ flabby ” yolks due to loss of moisture, “ watery whites,” “ sunken ” and “ sided ” yolks due to chemical changes, and eggs with “ whiskers,” due to the growth of fungus on the shell.—Miss Mary Andross, of the West of Scotland College of Domestic Science, Glasgow, gave the final paper on the subject of “ The Cooking of Eggs.” Research in domestic science concerned itself with what effect such factors as temperature, time, rate of cooking, acidity, or the addition of salts, might have on the nutritive properties of eggs which were boiled, poached, fried, scrambled or made into omelets, custards, mayonaise, meringues, angel cakes, or sponge cakes. Another important factor which was the subject of scientific investigation was the effect of the age of the egg in relation to its cooking qualities. Miss Andross also discussed the waste of food value which might take place in different methods of cooking, and she concluded by discussing the effects which different treatments might have on the digestibility of the food.
Most countries seek to impose control on the chemical treatment of both human and animal food. Some, such as the U.S.A., attempt it by highly detailed regulations, in…
Most countries seek to impose control on the chemical treatment of both human and animal food. Some, such as the U.S.A., attempt it by highly detailed regulations, in terms most orthodox and almost psychically specific, which seem most complicated compared with our own simplified food ordinances; other countries, such as many of the newer states, treading cautiously in their virgin fields of law‐making, pass broad, enabling laws, leaving details to be filled in later. Although the object is the same in all countries, it is nothing short of amazing how the pattern of legislation manages to be so divergent, and applied for reasons that are not always apparent. In published regulations and laws, there would seem to be less intent on making a country's food exports conform to the legislative requirements of importing countries than in prescribing standards for its home products; the end results have produced food law chaos, rarely seen in other branches of law. A notable exception, the only one, to these irregular developments, and with particular reference to food additive control, are the common decrees and directives of the European Economic Community, representing the six Common Market countries. Its Council prescribes quality standards for individual foods, specific purity standards for preservatives and other additives which may be used for human consumption, and although this standardisation is only beginning, it deserves study, especially the manner in which the community regulations are enforced.
Referring to the attempts of various local authorities to obtain the services of Public Analysts for inadequate rates of payment, “The Lancet,” in 1912, pointed out that…
Referring to the attempts of various local authorities to obtain the services of Public Analysts for inadequate rates of payment, “The Lancet,” in 1912, pointed out that the remuneration of the public analyst has seldom been upon a scale consistent with the training, skill, and experience which are required of him, but in as much as the practice of adulteration has become such a refinement, requiring a very elaborate series of operations for its detection, the remuneration is wholly inadequate. We agree with the “Lancet's” statement that modern methods of adulteration are often the product of a subtle scientific mind which discreditably turns its attention to the possibilities of eluding the control provided by the Sale of Food and Drugs Acts over the purity and quality of food, drugs and drink. No analyst nowadays, if he is an honest man, dare certify that a sample of any kind is genuine without making a number of often complicated investigations. The average payment for analysis is certainly a most unfair remuneration for the high qualifications now required for the post. We also fully agree with the “Lancet's” statements that the public analyst's work now is of the highest scientific order; it must be done by a competent and conscientious man, otherwise the administration of the food laws must soon fall into disrepute. Slovenly practice must be impossible if discredit of the public analytical service is to be prevented. And there should be no temptation in the shape of totally inadequate pay to shirk the carrying out of a duty in a thorough and effective manner. The machinery which guards the purity and quality of our food‐supply must be efficient, and it is impossible to purchase efficiency at rates which are so low as to give no recompense for training, skill and responsibility. The analyst is often required to provide and maintain a laboratory himself, together with such apparatus, chemicals, and assistance “as are necessary to enable him adequately and completely to execute the duties of the office.” At the present time the payments made in a great many instances cannot possibly meet the expenses of the ‘apparatus, chemicals and assistance’ required. The living wage is left entirely out of the proposition, and such a policy must sooner or later bring discredit upon a very important department of the public service.
The new authorities created by this Act, probably the most important local government measure of the century, will be voted into existence during 1973 and commence…
The new authorities created by this Act, probably the most important local government measure of the century, will be voted into existence during 1973 and commence functioning on 1st April 1974. Their responsibilities and the problems facing them are in many ways quite different and of greater complexity than those with which existing councils have had to cope. In its passage through the Lords, a number of amendments were made to the Act, but in the main, it is a scheme of reorganization originally produced after years of discussion and long sessions in the Commons. Local government reorganization in Scotland takes place one year later and for Northern Ireland, we must continue to wait and pray for a return of sanity.
I think that psychologically it is most important that, as long as possible, every effort should be made to maintain the supply of foods enabling dishes of an attractive…
I think that psychologically it is most important that, as long as possible, every effort should be made to maintain the supply of foods enabling dishes of an attractive character to be produced. The morale of the big cities must be maintained, and as a large proportion of the population in these cities takes at least one meal a day in a public eating‐place, and, moreover, as the housewife relies on the pastrycook for an ever increasing proportion of her non‐basic foods, not to mention the basic foods themselves, every effort must be made to maintain producers of foods in such a position that they are able to supply cakes, confectionery, biscuits and so on. And in suggesting this I am being a realist; I have experienced the depression of the “ Berliner ” when it became impossible for this kind of food to be bought except by the very rich or the very powerful. It is, in fact, not sufficient to provide the necessary calories, the necessary vitamins, the necessary “trace” elements, as the Americans have called them; the method of presentation must be studied, for this is of vital importance in the maintenance of good health. From the scientific point of view it is deplorable that six months had to pass before the Ministry of Food appointed a scientific adviser. Dr. Drummond's influence in that capacity should help to straighten out some of the muddles into which the Ministry have apparently been led. It is obvious that our vaunted preparedness did not extend to the realm of food. One important point must be borne in mind, namely, that although the Ministry did not appoint a scientific adviser until February, 1940, they had at their disposal the experts of the Food Investigation Board and of those research associations in food science which I have already mentioned. Possibly, therefore, the Ministry would consider that it was sufficiently well served, and that these bodies would have been able to produce the briefs on which the Minister could plead. But the Food Investigation Board—and I am speaking as an exmember of that body—is essentially equipped for long‐distance research work, and not for the solution of problems of immediate importance. No one has greater respect for the work of fundamental importance which the staff of the Food Investigation Board have produced than I, but except for practical problems concerned with a limited number of food products—beef tendering, bacon curing, fruit preservation—they are not in direct touch with practice. It has been a very sound policy to restrict the activities of their staffs to the solution of problems of fundamental nature, the results of which, when published, would be applied to practical problems by the chemists attached to foods producing firms. I cannot pass from this section without comment on the very admirable statement of certain aspects of the work of the Research Associations clearly expressed by the Director of the Research Associations of British Flour Millers, Dr. Moran, in the journal Milling recently. He gives in a few clear sentences his understanding of the functions of a research association. His words are: “The research association has four clear functions: (1) as a sentinel of progress and development not only in this country but throughout the world; (2) to carry out continuously research which the individual miller—certainly the small miller—could not undertake; (3) to deal with the day‐to‐day problems of members; (4) generally to improve the efficiency of the industry and the quality of its products by the greater application of scientific methods.” The degree to which these functions are realised by any association is an excellent yardstick by which to measure its success. The milling industry of the country is to be congratulated that the director of their research association has such definite ideas, and the country as a whole is to be congratulated that the council of at least one research association in food is sufficiently alive to the importance of their duties to allow such statements as I have quoted to be published. It certainly stimulates interest and confirms the faith which should be placed in science as applied to a basic industry. The food manufacturer has, naturally, been rationed in respect of raw materials, as have been the members of the public. Fats, sugar and meat have been available in decreased quantities, but with the advent of rationing a distinct lessening of wastage of food follows and no real difficulties of shortage have become apparent. The attention of chemists has however, been directed to “ alternatives.” I object to the word “ substitute,” because in the minds of the majority this suggests something inferior. In many cases the alternative is to use something more expensive, something which under normal conditions would not be used. For example, at the moment glucose, more expensive than cane sugar, has taken the place of a portion of the usual sugar; lactose, the sugar of milk, is being used although it costs about twice as much as cane sugar and has a sweetening power far below that of the usual sugar. But sugars are not only used for sweetening, as so many people seem to think. Their presence in a cake or other bakery product has a most important chemical or physicochemical action on the gelatinisation of the starch of the flour, and an adequate amount of sugar is therefore essential if the character of the product is not to be impaired. The use of alternatives is not to be confused with sophistication; the replacement of non‐available constituents must be differentiated from the dressing‐up of one thing to make it look like another. The artificial colouring of a cake with a brown colour and the description of the resultant product as a chocolate cake, is to be condemned, although such a cake may be as nutritious as the cake to which chocolate powder had been added. The caffeine of coffee and tea is of importance in giving a slight feeling of stimulation to the tired worker, and therefore roasted cereals, as supplied in Germany during the last war, and again to‐day, cannot be considered alternatives for coffee, neither can mixture of fruit leaves take the place of tea. It is to the scientist that Germany owes the development of her substitute and alternative foods. These substitutes and alternatives are far better than those Germany had in 1914–18, because very early on she enlisted her chemists, or rather those who had not been expelled, into the service of her Four Year Food Plan. Chemical research in the totalitarian states is in practice Government‐controlled—in practice only because in theory there has been no bar to private investigation—but the Four Year Plan in Germany as applied to food entailed the direction of food investigations by State officials and although not so obvious in Italy, the same thing obtained there for a number of years. The natural outcome is control of food production. An interesting example is to be found in the tomato‐growing districts in Italy. Through the research station at Parma the farmers and the factories dealing with tomatoes are definitely directed. The former are told what seed to plant, how much, how to till their land, how to manure it, when to gather their crops, how much to gather, the quantity to pack as fresh fruit, the quantity to send to the factories to be made into purée.
THE Classification of Technology has long been a fruitful source of controversy and discussion, and the problems presented by such discussions are becoming more prominent…
THE Classification of Technology has long been a fruitful source of controversy and discussion, and the problems presented by such discussions are becoming more prominent every day and are among the most interesting to the librarian with a speculative turn of mind. Dr. Richardson in his synthesis of classification arrives at the conclusion that the order of knowledge is the order of things, and that the order of classification is the order of things. Therefore the correct order or arrangement of Technology should follow the same order as that placed before us by Dr. Richardson. To make provision for the better and more systematic classification of Technology for the student and craftsman is the office and responsibility of the librarian.
Rosa Bruno-Jofré and Joseph Stafford
What proof have the public, independent of the assertions of the makers, that all the firms whose products are sold indifferently by the shopkeepers use only the best…
What proof have the public, independent of the assertions of the makers, that all the firms whose products are sold indifferently by the shopkeepers use only the best materials; or, indeed, that a large number of the articles sold are not mixtures more or less objectionable or fraudulent ? This, in effect, is the question put by a writer in a West of England newspaper, and it might be used as a text upon which to write a lengthy homily on the adulteration question and on the astonishing gullibility of the public. As a matter of fact the only evidence of the character and quality of food and other products, in regard to which there is no independent guarantee, is that which is afforded by the standing of the makers, and to some extent of the firms which offer them for sale. And this evidence cannot, under any circumstances, be looked upon as constituting proof. The startling allegations so commonly put forward by advertisers with respect to their wares, while they may be ineffective in so far as thinking people are concerned, must nevertheless be found pecuniarily advantageous since the expense involved in placing them under the eyes of the public would otherwise hardly be incurred. Many of these advertised allegations are, of course, entirely unjustifiable, or are incapable of proof. It may be hoped that the lavish manner in which they are set out, and their very extravagance, may, in time, result in producing a general effect not contemplated by the advertisers. In the meantime it cannot be too often pointed out that proof, such as that which is required for the satisfaction of the retailer and for the protection of the public, can only be obtained by the exercise of an independent control, and, in certain cases, by the maintenance of efficient independent inspection in addition, so that a guarantee of a character entirely different to that which may be offered, even by a firm of the highest eminence, may be supplied.