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He calls Cypripedium calceolus "Our Ladies shooe or slipper" and notes that it "groweth upon the mountains of Germanie arteria angularis order 0.25mg lanoxin fast delivery, Hungarie arrhythmia vs atrial fibrillation order 0.25 mg lanoxin overnight delivery, and Poland" blood pressure chart best lanoxin 0.25 mg. He grew a plant given to him by his friend the Apothecary Master Garret and this is the earliest reference I can trace of the cultivation of the species in the British Isles. Its recognition as such was left to John Parkinson (1629) who called it "Helleborine vel Elleborine maior, sive Calceolus Mariae". Parkinson recorded it as growing in "Lancashire, neare the border of Yorkshire, in a wood or place called the Helkes, which is three miles from Inglborough, the higest Hill in England, and not farre from Ingleton, as I am informed by a courteous Gentlewoman, called Mistris Thomasin Turnstall, who dwelleth at Bullbanke, near Hornby Castle. Michel Adanson (1763) was the first botanist to formally include slipper orchids in the orchid family. Gesner died from plague before he was able to publish his botanical illustrations. A useful list of early descriptions and illustrations of slipper orchids is included. The original is in the Bibliotheque Nationale in Paris and it was probably painted in 1631 or 1632. Parkinson (1640) returned to the theme of "Our Ladyes Slipper or the great wilde Helleborine" in his Theatrum botanicum. These line illustrations are the earliest representations of North American slipper orchids. The earliest coloured illustration of a North American species is that of "Calceolus flore maximo rubente" (=C. He provided a coloured illustration in his Figures of the most beautiful, useful and uncommon plants figured in the Gardeners Dictionary published in 1758. This illustration may, indeed, be the first of a British plant as Miller reiterates that it was "found in some Parts of England" and also mentions flowering it at Chelsea where, no doubt, the coloured illustration by R. The German artist Georg Dionysius Ehret who worked at the Chelsea Physic Garden for Miller also illustrated a plant of the North American C. Johann Amman (1741) and Johann Georg Gmelin (1747-1749) published the first descriptions and illustrations of Asian slipper orchids. Most of the species in the Far East remained unknown for nearly a century more until botanists began to penetrate into the mountainous west of China. Paphiopedilum insigne by an unknown Indian artist for the Calcutta Botanic Garden, ca. The first hint of the rich array of western Chinese Cypripedium species was the collection in 1864 by Pиre Armand David of the yellow-flowered C. However, the diversity of the Chinese cypripediums was not apparent until the last few years of the 19th century. From 1894 onwards, the indefatigable French missionaries, Delavay, Soulie, Maire, Monbeig and Farges, based in Yunnan and Sichuan, began to send back large numbers of collections to Paris, many to be described as new to science by the French botanist Franchet. By the turn of the century the British collectors Augustine Henry in Hubei, Sichuan and Yunnan and Ernest Wilson in Sichuan and Hubei had added further species. New Chinese species have continued to be discovered and described this century (Tang & Wang, 1951; Cribb, 1992; Cribb & Chen, 1994; Chen et al. The increasing influence of the British in India opened up its rich tropical flora to botanists and horticulturists. The establishment of botanic gardens, initially to introduce crops for plantation culture, led to the flora being explored by a number of intrepid collectors and botanists, particularly those associated with the Calcutta Botanic Garden which had been established in 1787. Nathaniel Wallich, his successor, developed the garden and started the herbarium of the East India Company, the latter being the basis of our current knowledge of the flora of India and neighbouring countries. He also employed native artists to illustrate novelties and these watercolour paintings are now held at Kew. The former had earlier been sent by Wallich to London where Samuel Curtis illustrated it for John cRibb - Slipper orchids in art and science 239 figuRe 14. The beautiful watercolours of Charles Parish, including his watercolour of the eponymous Paphiopedilum parishii, are dealt with in an accompanying article (Clayton, 2013). Many of their collections and those of other plant hunters ended up being sold by European nurseries, particularly those in England, and were illustrated when they first flowered in cultivation. Walter Hood Fitch, Matilda Smith, Lilian Snelling, Stella Ross-Craig, Margaret Stones, Pandora Sellars, Cristabel King and Carol Woodin have all produced outstanding illustrations of slipper orchids for the journal. Day cultivated and illustrated 44 species and 46 hybrid slipper orchids in three genera, Cypripedium, Paphiopedilum and Phragmipedium, in his scrapbooks. His illustrations labelled as Selenipedium and Uropedium are now considered to belong to the genus Phragmipedium, while the Southeast Asian and Indian species of Cypripedium belong to Paphiopedilum.

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Those less than 16 years old are generally looked after by paediatricians; over 16 years old blood pressure numbers for seniors purchase 0.25mg lanoxin overnight delivery, by either paediatricians or more often byadultphysiciansandsurgeons high blood pressure medication and zyrtec generic 0.25mg lanoxin mastercard. Adolescent femaleswithgynaecologicalproblemsareoftencared for by gynaecologists hypertension synonym cheap 0.25 mg lanoxin with amex, usually in adult facilities. Aswellasseeingadolescentswiththeirparents,an integral component of adolescent healthcare is offer ing young people the opportunity to be seen inde pendentlyoftheirparentsforatleastpartofthevisit the principle is that the parents should not be seen alone after the adolescent has spent time with the doctor,sothattheadolescentcantrustthatwhatever confidences have been disclosed to the doctor have beenkept. Some practical points about communicating and workingwithadolescentsare: · · · 494 Maketheadolescentthecentralpersoninthe consultation. Weight, caffeine (diet drinks), binges/vomits Concerns, periods, contraception (and in relation to medication) How much? Depression, self-harm, body image · Communicateandexplainconcepts appropriatetotheircognitivedevelopment. Confidentiality Confidentialityisregardedbyadolescentsasofcrucial importance in their medical care. They want to know thatinformationtheyhavedisclosedtotheirdoctoris not revealed to others, whether parents, school or police,withouttheirpermission. Inmostcircumstances, theirconfidentialityshouldbekeptunlessthereisarisk ofseriousharm,eithertothemselvesfromphysicalor sexual abuse or from suicidal thoughts or to others fromhomicidalintent. Difficultiesrelatingtoconfiden tialityforadolescentsareusuallyaboutcontraception, abortion, sexually transmitted infections, substance abuse or mental health. It is usually desirable for the parents to be informed and involved in the manage mentofthesesituationsandtheadolescentshouldbe encouragedtotellthemorallowthedoctortodoso. However, if the young person is competent to make these decisions for himself/herself, the courts have supported medical management of these situations withoutparentalknowledgeorconsent. Summary Talking and listening with young people · Alwaysgivethemtheopportunitytobeseen independentlyoftheirparents · Explainandassureconfidentiality · Psychosocialscreeningisusefulto: ­ Engageyoungpeople ­ Assessrisk ­ Assistformulationofinterventions. Inaddition,children 1 2 3 Adolescent medicine 495 4 Adolescenceisconsideredahealthystageoflifecom paredwithearlychildhoodoroldage. Inspiteofthis, themajorityofyoungpeoplewillconsulttheirgeneral practitionermorethanonceinayearand13%ofado lescents report a chronic illness. Althoughdeaths in adolescents from communicable diseases have declinedmarkedly,thishasnotbeenmatchedbymor tality from road traffic accidents, other injuries and suicide,andthesenowpredominate(Fig. Impact of chronic conditions Chronic illness may disrupt biological, psychological and social development. In addition, these develop mental changes may affect the control and manage mentofthedisorder(Table28. Adherence Pooradherenceisaproblemformanypeople,includ ing adolescents as they are beginning to take over management of their illness, wish to avoid parental supervision and may give the management of their illness a lower priority than social and recreational activities. They may not believe that taking the Mortality the dramatic improvement in the mortality of young childrenseensincethe1960shasnotbeenmatchedin adolescents, who now have a higher mortality rate Mortality rate per 100 000 population 90 80 70 60 50 40 30 20 10 1-4 years 15-19 years 5-9 years 10-14 years Figure 28. For example, it may be more important for an adolescent with diabetes to lunch promptly, so he can sit with his friends rather than go to the school nurse first for his insulin injec tion. Theymayassess riskdifferentlyfromadults,sothattheriskofnotbeing one of their crowd because of having to adhere to a certain treatment may appear to be more important than the risks attached to not taking any medication. Adherencemaybeinfluencedbylackofknowledge and/or poor recall of previous disease education. The disorder may have presented when the child was much younger, so that the original consultation will have taken place primarily between the doctor and parents. As the responsibility for management moves to the young Transition to adult services Theyoungpersonwithachronicconditionmusteven tuallyleavepaediatricandadolescentservicesforadult services. Thisofteninvolveschangingfromatreatment model based around close contact between the ado lescent and healthcare professionals (unlimited tele phone advice from clinical nurse specialists, possibly homevisits,frequentappointments)andinvolvement withparentsandotherfamilymembers,toonewhere theyarelikelytobeseeninfrequentlyinabusyadult 1 2 3 Adolescent medicine 497 4 person, information needs to be provided about medications and treatment appropriate for his/her development. The implications of their condition on the rest of theirhealthneedstobeconsidered. Thismayinclude sexual health, future vocational development, includ ingtheneedfordisclosureandtheirrightsunderthe DisabilityDiscriminationAct. Let the suggestions come from the adolescent Negotiate short-term treatment goals.

Noting that the literature did not clarify the circumstances under which visitation benefits children blood pressure 15090 purchase lanoxin 0.25 mg online, she concluded blood pressure medication how long to take effect cheap 0.25 mg lanoxin amex, Despite the fact that mental health professionals are recommending and courts are ordering visitation arrangements for thousands of children daily pulse pressure queen generic lanoxin 0.25 mg overnight delivery, there is yet a meager knowledge base to justify their decisions. Parental Alienation Syndrome and Parental Alienation 549 In more recent publications, Johnston points out that ``profound alienation. Children ought not to be asked to function under circumstances that would challenge or overwhelm even the strongest adults. This includes a realistic understanding of the limitations of dispute resolution techniques, therapy, and legal compulsion in high-conflict cases. Recommendations and Conclusion Children whose parents do not agree or cooperate concerning their care are placed in the middle of loyalty conflicts that can only stress 78. Sullivan and Kelly, who display helpful insight into the dynamics of alienation cases, are far less convincing when they suggest legal responses. A growing body of research documents the harsh and sometimes violent world that a large percentage of children in high-conflict custody disputes seeks to escape. It is rejected by responsible social scientists and lacks solid grounding in psychological theory or research. Lawyers, judges, and mental health professionals who deal with child custody issues should think carefully and respond judiciously when claims based on either theory are advanced. More generally, far greater interdisciplinary training and competence in scientific methodology are needed. This is particularly true in fields such as psychology and psychiatry, where even experts have a wide range of differing views and professionals, whether by accident or design, sometimes offer opinions beyond their expertise. Lawyers and judges are trained to ask the hard questions, and that skill should be employed here. Insights that are too new, or for which no established gold standard exists, may nonetheless be valuable,86 but their probity and limitations should be clearly understood. This can be accomplished by inquiries into the sample (if any) on which the theory is based, the methodology and assumptions affecting the collection of data, how conclusions have been drawn from the data, the likelihood that fair extrapolations can be drawn, the degree to which assertions are internally consistent and compatible with established knowledge, and the balance of potential benefits and harms if the insight later proves unsound. An outstanding example is the series of publications by Wallerstein and her colleagues over the course of what developed into a 25-year project. Initially designed as exploratory research to help define questions for later studies, the sample (which was neither randomly selected nor scientifically controlled) has nevertheless provided major advances in knowledge. Subsequent, controlled studies by others have borne out that insight, while other suggestions have required refinement or retrenchment in the years since (such as their early suggestion concerning joint physical custody). The expert, an adolescent and child psychiatrist, testified that the steps he was recommending ``will almost certainly be traumatic and painful [for the child]. But it is always open to us to substitute for neurotic ``wishful thinking' what Neurath happily called ``thinkful wishing. I surmise that, although such efforts will fall far short of perfection, they will, by no means, go wholly unrewarded. Introduction Lymphomas are cancers that originate in the lymphatic system, specifically from a type of white blood cell called a "lymphocyte. Therefore, lymphomas can begin to grow in any organ system, including the skin (which is considered the largest lymphoid organ in the human body). B-cell lymphomas have a higher incidence than T-cell lymphomas except in the skin. It also includes specific information on the diagnosis and treatment of these diseases, new treatments undergoing investigation in clinical trials and support resources. These changes cause a normal, healthy T cell to start growing and dividing uncontrollably. These cells accumulate in the skin and show up as skin abnormalities called "skin lesions. The skin lesions contain cancerous T cells, but the skin cells themselves are not cancerous. Cutaneous T-cell lymphoma is twice as common in men as in women and it is most common in African Americans. Cutaneous T-cell lymphomas have various signs and symptoms, treatment options and outcomes. The name comes from the mushroomlike skin tumors that may appear in the advanced stages of the disease although the disease is not related to a fungus.

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The urban environment corrupts the children hypertension 2 purchase lanoxin 0.25 mg otc, and blood pressure medication for ptsd lanoxin 0.25 mg sale, though Berry is released and seeks to arteria entupida 70 discount 0.25 mg lanoxin free shipping restore his family life in the North, the family has been destroyed. Those worsening conditions are similarly apparent in the work of Charles Chesnutt. Although he actually began his career in the late 1880s, before Dunbar, he was not widely known, initially, to be an African American writer. As a result, his influence did not begin to be felt until fairly late in the 1890s. These were stories that began to appear in such magazines as the Atlantic by 1887, ultimately to be collected in his 1899 volume, the Conjure Woman. But, more than Dunbar, even as Chesnutt used conventions of the plantation tradition he often did so in ways that subverted them, presenting a more realistic view of slavery and race than the plantation tradition normally allowed. It is apparent in the conjure tales and also in such a story as ``The Passing of Grandison,' from his second major collection of short fiction, the Wife of His Youth (1899). This story satirizes that plantation-tradition staple, the loyal slave, as its title character, Grandison, uses superficial displays of loyalty to trick his master and gain freedom for himself and his family. Both provide strong if pessimistic indictments of the racist social and economic order of the emerging ``New South. The novel focuses on a story of love between a white Southern young man and a beautiful young woman, Rena Walden, with a touch of African ancestry. When her secret comes out, their planned marriage is cancelled, even though each retains a love for the other. Rena makes an effort to fit into the African American community, but confronts enormous hardships. In the end, she goes insane and finally dies, her white lover feeling an almost overwhelming remorse. This is the story of a young African American criminal who turns out to be the son of the white sheriff who arrested him, a son born during the era of slavery. The young man dies just as the sheriff begins to acknowledge both the guilt and the responsibility his fatherhood entails. No less important is the title story, ``The Wife of His Youth,' originally published in the Atlantic in 1898: a story that takes a somewhat different tack in confronting the color line. A wealthy, very light-skinned man is surprised at a social occasion by the appearance of the ``wife of his youth,' an old, very black woman to whom he had been married in slavery. Publicly acknowledging her, he challenges a color line within the African American community that, Chesnutt indicated, was itself an ugly legacy of slavery and racism. As ``The Wife of His Youth' suggests, the real tragedy of race for Chesnutt, as for Dunbar, lay in the extent to which it made people unable to see through color to individual character. Baxter, in a fit of cynicism, introduces a particularly fine volume to be distributed, sealed, among the members. A brief story, it centers on the inner turmoil a black barber suffers when he learns that the white customer in his chair was the murderer of his father. The works of Dunbar and Chesnutt help to highlight several emphases in turnof-the-century African American narratives. For one, their very success seems to have further encouraged a vogue for dialect and local color writing among African American authors. Some of this work followed Dunbar and Chesnutt by exploiting the plantation tradition. Dialect tales found special favor among African American authors; even a few of the more genteel writers also tried their hands at dialect. Some writers, however, departed significantly from the plantation tradition by moving more toward realism in their depiction of black folk life. The first, Violets (1895), appeared prior to her marriage and is firmly within the framework of gentility. Rocque (1899), went in a very different direction, creating realistic portrayals of folk characters and customs in southern Louisiana. Another writer who began in the genteel tradition, Katherine Davis Tillman, produced two works, the serialized ``Clancy Street' (1898­9) and the short story ``The Preacher at Hill Station' (1903), both appearing in the A. Church Review, which offer similarly realistic portrayals of African American folk communities.

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Determined to blood pressure x large cuff buy lanoxin 0.25 mg mastercard make a break arrhythmia nclex lanoxin 0.25mg without a prescription, the workers decided to arteria alveolaris inferior buy lanoxin 0.25mg cheap rent the skating rink, which would seat about a thousand, for evangelistic meetings. Even though the rent seemed high, they would go forward in the name of the Lord and do something. In the evening Starr addressed an audience of about the same size on the inspiration of the Scriptures. An interest was created, and meetings continued for some time in the skating rink on Sabbath and Sunday and some evenings. Now in the winter months in New Zealand, when travel would be somewhat curtailed, she determined to push the work forward as her strength and her program would allow. Letters she should have answered remained unanswered, in some cases, for months, as she tried to make room for work on her book. A diary entry for May 19 reads: "Before breakfast, wrote seven pages on the life of Christ. White was enduring the damp and windy weather of Wellington very well, and having found at the Tract Society Depository a quiet and comfortable place to reside, is engaged in writing on some of the unfinished chapters of her forthcoming "Life of Christ. The appointment of the next annual conference early in the season may enable her, if she can endure the dampness of the climate, to remain and attend this meeting, before the next annual conference and first camp meeting in Australia-July 1, 1893. From time to time through the winter-June, July, and August- she mentions, in her letters and her diary, writing on the life of Christ. Thursday, June 15, 1893: I do not flatter myself that very much progress can be made on the life of Christ. Monday, June 19: I am trying to write on the life of Christ, but I am obliged to change my position quite often to relieve the spine and the right hip. Sister Tuxford and I had our season of worship alone-only two to claim the promise. We have secured a wheelchair, that I can be wheeled in the open air when I cannot ride in carriage. Letters are constantly coming for an answer, and should I write to the many that I desire, I should not find any time to write on the life of Christ. An Agonizing Letter to Edson Letters from James Edson White brought little comfort to his mother. While she was in New Zealand, he was in Chicago in the printing business, and quite involved in debt, which was not unusual for him. Her response opened: Dear Son Edson, Why should you express yourself as you have done? If you were a man unacquainted with truth, I could address you in a different way, approach you by presenting the truth in all its beauty and attractive loveliness, but this would not move you. Many had collected on the beach to observe your movements, and this seemed to make you more determined and venturesome. The waves were rolling up nearer and still nearer and then would roll back with a sullen roar. Gestures and warnings were given by the anxious ones looking on, but in answer to all their warnings you were more presumptuous. A strong rope was brought and fastened securely around the body of a strong young man who ventured to risk his own life to save you. I have had opportunity to watch the movements of the waves as I have often visited Island Bay, four miles from Wellington. It represents the power of Satan and a set, independent, stubborn will of your own which has reached even against God. You have taken the molding of your character out of the hands of your mother, out of the hands of God, and are placing defective, rotten timbers in the building. You would almost fail to recognize yourself should your present picture of character be presented by the side of the former one when you tried to walk in the fear of God. Your religious history need not have been vacillating, but firm and true; but you would be independent and take your own course. I am now determined to press upon your notice and make you hear: "This is the undertow. I know your only hope is to cling to God and to (1893) the Winter in New Zealand 113 your mother and brother.

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