Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.

Poetry With People With Dementia: An Evaluation of a Two Year Project Engaging in Poetry Activities With Older People in Residential and Nursing Homes.

This paper is a summary of an evaluation of the first two years of a three year poetry project for older people with dementia. The project was set up with a poet in residence who mentored six poets to deliver poetry activities to older people and those with dementia in residential and care homes in Herefordshire. The project was developed and run by the Courtyards Hereford. The evaluation was undertake through the use of questionnaires that were given to staff and carers undertaking training workshops and the poets, staff and carers in the homes who facilitated the activities and finally by the residents who took part in the project. The main findings were that participants that responded to the questionnaire for staff and carers it had increased confidence and assisted them in gaining more knowledge about the residents, whilst for residents it had a number of positive effects including enhanced communication, increased self-esteem and enhanced self-worth whilst making them feel less isolated.

The Pindaric poetry of Cruz e Silva and the Neoclassical revival among Lusitanian national heroes

António Dinis da Cruz e Silva, member of Arcádia Lusitana, the literary academy he helped to found, introduced the Pindaric ode to the Portuguese literature of the neoclassical period (18th century). This poet imitates the triadic form and the mythological nature of Pindar’s encomiastic poetry, in order to celebrate the deeds of reputed historical figures from the national context, such as sailors, captains, politicians, and even the king himself. As in Pindar’s poetry, the mythological excursus holds an important part in Cruz e Silva’s Pindaric poetry. Winners of athletic games are acclaimed through allusion to the ancient heroes. Likewise, the heroes of the Portuguese history see themselves turned into immortals, since their deeds are reported as comparatively greater than those of Homeric warriors. Among the 44 Cruz e Silva’s Pindaric odes, 18 rewrite the myth of the Trojan War, from its beginnings with Eris (Odes I-II) to its outcome with the imperishable fame of the most conspicuous Homeric fighters (Ode XLII). These 18 compositions (re)tell, in a neoclassical style, the main scenes and themes of the Iliad and Odyssey, alluding directly to their heroes’ deeds. Achilles’ wrath and Hector’s death are topics repeatedly brought up in Cruz e Silva’s Pindaric poetry as models of courage and patriotism for national heroes. This chapter offers a discussion of Cruz e Silva’s neoclassical representation of the Trojan War. To this effect, an interdisciplinary approach is adopted, showing how the Portuguese poet handles the mythological material from Homer and Pindar. In this way, he initiated in 18th-century Portuguese literature a new literary genre, the Pindaric ode. By dealing with Poetry and History, Cruz e Silva perpetuated the life and fame of national heroes long after their deaths.

Poetry and feminine crafts in the letters of the young Marquise of Alorna (1750-1839)

abstract : Taking as a starting point the association between embroidery and language conveyed by the Greek myth of Filomela and Procne, this article examines the relationship between social status and ornaments like embroidery and lace. In order to illustrate this relationship an example is selected form the letters exchanged between the Marquise of Alorna and her Father where a connection is established between the production of these 'feminine' crafts, women's culture and womens writing, in the XVIIIth Century

Troubled waters: an institutional analysis of ageing Dutch and American waterway infrastructure

Waterways are one of the oldest systems for the transportation of cargo and continue to play a vital role in the economies of some countries. Due to societal change, climate change and the ageing of assets, the conditions influencing the effective functioning of these systems seem to be changing. These changing conditions require measures to renew, adapt or renovate these waterway systems. However, measures with the sole aim of improving navigation conditions have encountered resistance, as the general public, and stakeholders in particular, value these waters in many more ways than navigation alone. Therefore, a more inclusive, integrated approach is required, rather than a sectoral one. Addressing these contemporary challenges requires a shift in the traditional waterway authorities' regimes. The aim of this study is to identify elements in the institutional setting where obstacles and opportunities for a more inclusive approach can be found. Two major waterway systems, the American and the Dutch, have been analyzed using the Institutional Analysis and Development framework to reveal those obstacles and opportunities. The results show that horizontal coordination and a low pay-off for an inclusive approach is particularly problematic. The American case also reveals a promising aspect – mandatory local co-funding for federal navigation projects acts as a stimulus for broad stakeholder involvement. Improving horizontal coordination and seizing opportunities for multifunctional development can open pathways to optimize the value of waterway systems for society.

Cultural adaptation of websites: a comparative study of portuguese and dutch corporate websites

Master Thesis Presented at Instituto de Contabilidade e Administração do Porto for obtaining the Master’s degree in Digital Marketing under the supervision of Professor José de Freitas Santos

Lini Richarda Grol Fonds, 1946-2007

Lini Richarda Grol was originally born in Nijmegen, Netherlands in 1913 and immigrated to Canada in 1954 after working as a nurse in South America for three years from 1951 to 1954. She was granted her first Canadian passport in 1961 and worked full-time as nurse at the Welland County Hospital. While nursing she would enroll in writing courses at McMaster University and Ryerson Polytechnical Institute, now Ryerson University. Eventually she decided to dedicate herself to her writing and artwork and began to only work as a nurse part-time and then later opened the Fonthill Studio to devote herself to her writing and artwork full-time. Her status as an immigrant and career as a nurse provided inspiration for much of her writing and she frequently tackles the experience of the female immigrant in her works. Her first publication was in 1938 in a small literary and women’s magazines in Holland and Belgium and her first work of poetry was entitled Stive Gedachten. None of these publications exist in this archive. Her most well-known publication, Liberation, centers around her experiences leading up to and after the liberation of Holland during World War II. Grol was, and continues to be a prolific writer in the Niagara Region and has been published in the Welland Tribune, Pelham Herald, Thorold News, Parent Magazine, Dunville Chronicle, and various Christian publications and literary newsletters and journals. Grol also started her own poetry magazine entitled Canadian Poets Pen Club to help aspiring writers get published. Perhaps her most recognized achievement was the inclusion of one of her poems and the recognition of her novel Liberation into the Thank You Canada Day celebration in May 1970. Grol participated in many local writers’ groups such as the Welland Writer’s Club, and the Canadian Author’s Association. Grol was membership secretary for the Canadian Author’s Association in 1984. She also founded a writer’s club in 1995 in her retirement home, Holland Christian Homes where members meet to talk about their poems and short stories either in English or Dutch. Participating in and creating a writers’ community is integral to Grol’s identity as an author and can be related to the feelings of isolation she felt as an immigrant to Canada. Grol also hosted her own television shows entitled Discovery with Lini Grol which featured guests, usually local artists and writers, and Holland en Hollanders a cultural program for Dutch immigrants. Grol’s most recent activities include the publication of a one act play entitled Peppermint Problems [1996] and a short story entitled “When our War started in Rotterdam” [2004]. In 1994, she moved to Brampton, Ontario into a Christian retirement center called Holland Christian Homes. For further biographical information about Grol see two books contained within this collection Women of Action [1976] and Something About the Author [1976].

Using Poetry, Story, and Reflection to Understand Professional Self After Personal Loss

This research investigated professional identity transformation after personal loss. Through autoethnographic methods, I explore how my personal experience of my sister’s breast cancer and death affected my identity as a diabetes educator in the health culture. I discover a transformation of a professional who focuses on evidence-based medicine to a professional who values connection, therapeutic alliance, and mindfulness with patients and self in the diabetes education encounter. Using a holistic perspective on transformational learning, I integrate the poem “Wild Geese” to a collection of written narratives to connect my personal loss experience to my professional life. By unpacking the generated stories and using poetry, I conduct a process of critical and self-reflection to discover how my identity as a health professional has transformed and what makes meaning in my role as a diabetes educator in the health culture. I consider concepts of a conscious self, social relations and language and discover themes of knowledge exchange, food, and empathy as forms of language expression. These language expressions are not present in my professional life as I focus on rational, logical facts of evidence-based medicine and standardized education methods. Through this reflexive process, I hope to understand how my professional practice has changed, where I place an importance on connection, therapeutic alliance, and mindfulness. I move away from always “doing” in my professional life to focus on my state of “being” in my professional world. Rather than knowledge acquisition as the only factor in professional development, this study contributes to an understanding of additional qualities health professionals may consider that focus on the patient education encounter.

Understanding the Intersection of Reformed Faith and Dutch Immigrant Culture in Ontario Independent Christian Schools: Principals’ Experiences and Perspectives

In the aftermath of World War II, a wave of Dutch Reformed immigrants arrived in Ontario, many of whom joined the Christian Reformed Church. Following familiar cultural patterns, history, and their Reformed Christian faith, these immigrants settled in Ontario with remarkable institutional completeness (Breton, 1964). They quickly established independent, parent-operated Christian schools across Ontario. The primary purpose of the schools was to educate children through a comprehensive biblically based school program, yet this religious purpose often intersected with a Dutch immigrant ethnic culture. Van Dijk (2001) states that “the schools were the most important organization in maintaining the religious and ethnic identity of Calvinists” (p. 66). In this qualitative study I explore the intersection of Reformed faith and Dutch Canadian immigrant ethnic culture in Christian schools through the experiential and professional lens of eight retired principals. Employing a theoretical framework informed by Berger’s (1967) Sacred Canopy, I suggest that the intersection of faith and culture was experienced in the schools and was embodied by the schools themselves. Findings point to this intersection being located in the participants’ experience of (a) Dutchness, (b) the struggle for Christian education, (c) the ties that bound the school community together, and (d) the cloud of witnesses that founded and continues to support and encourage the Christian school community. The study offers insight into a Dutch Reformed immigrant group’s experience carving out a niche for themselves on the educational landscape in Ontario. This study also offers suggestions on how Christian schools can broaden their canopy and become more ethnically and denominationally diverse in the future.