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.

Towards the End of Life: an In-depth Exploration of the Role of Admiral Nursing in Dementia Care (Innovative Practice)

There are approximately 150 Admiral Nurses in the UK who work alongside other health and social care professionals to support people with dementia and their family carers. However, the stigma of the disease and the lack of recognition that dementia is a life limiting illness have led to neglect in addressing the end of life challenges. The small in-depth study reported here aimed to add to an extremely limited formal evidence base for the effectiveness of this approach and to develop a greater understanding of the range of knowledge and skills required of them in ensuring they are better able to support families in the later stages of the illness. Findings focus on the experiences of family carers, the impact of performing the Admiral Nurse role and the use of qualitative measures in this setting.

The influence of multimorbidity on hospital, intensive care, and emergency department use at the end of life for patients with chronic conditions

Thesis (Master's)--University of Washington, 2016-03

At the end of the day: Macmillan's account of the Cuban missile crisis

Pre-publicity for the final volume of Harold Macmillan’s memoirs, At the End of the Day, stressed that it would provide the British side of the Cuban missile crisis for the first time. The Churchillian model chosen, changes required by the Cabinet Office and Macmillan’s desire to rebuke those political opponents who claimed that the crisis demonstrated a lack of British influence in Washington, however ensured a focus on his personal relationship with President Kennedy. His larding the text with contemporary observations from his diaries also skewed Macmillan’s account and, in particular, underplayed the significance of British moves at the United Nations in New York to secure a credible United Nations inspection regime and a US guarantee of the inviolability of Cuba. Careful reconstruction of Macmillan’s real-time experience of the Cuban missile crisis demonstrates the limitations of his own account of this event

Utopia and its Discontents: Dreams of Catastrophe and the End of 'the End of History'

The institutionalization of Utopia Studies in the last decade is premised upon a specifically aesthetic reception of Ernst Bloch’s theory of the “utopian impulse” during the 1980s and 1990s. A postmodern uneasiness to both left and right formulations of the "End of History" during this period imposes a resistance to concepts of historical and political closure or totality, resulting in a "Utopianism without Utopia". For all the attractiveness of this pan-utopianism, its failure to consider the relation between historical representation and fulfillment renders it consummate with liberalism as a merely inverted conservatism. In contrast to this specific recuperation of a Bloch, the continuing importance of Walter Benjamin’s theory of the dialectical image and the speculative concept of historical experience which underlies it becomes apparent. The intrusion of the historical Absolute is coded throughout Benjamin’s thought as the eruptive and mortuary figure of catastrophe, which stands as the dialectical counterpart to the utopian wish images of the collective dream. Indeed, the motto under which the Arcades Project was to be constructed derives from Adorno: “Each epoch dreams of itself as annihilated by catastrophe”.

Chart of estimate #6 of work done from the end of February to April, 1856

Chart of estimate #6 of work done from the end of February to April, 1856. This is signed by Fred Holmes, April, 1856.

End-of-Life Decisions and Advanced Old Age

Article

Managing Profound Suffering at the End-of-Life: Should expanding access to continuous deep sedation be the priority?

Commentaire / Commentary

The Supreme Court of Canada Ruling in Carter v. Canada: A New Era of End-of-Life Care for Canadians

La tribune de l'éditeur / Editor's Soapbox

Effect of initial status and growth in pseudoword reading on Spanish reading comprehension at the end of first grade

Resumen tomado de la publicaci??n

The End of the World Wide Web

Nothing lasts forever. The World Wide Web was an essential part of life for much of humantiy in the early 21st century, but these days few people even remember that it existed. Members of the Web Science research group will present several possible scenarios for how the Web, as we know it, could cease to be. This will be followed by an open discussion about the future we want for the Web and what Web Science should be doing today to help make that future happen, or at least avoid some of the bad ones.

SOES3010/6005 - Scaling analysis (Week 1, end of lecture)

This is the end of the scaling analysis we saw in class on Friday. In class, we managed to scale the mass conservation equation and the x-momentum equation, but we didn't finish scaling the z-momentum equation in order to arrive at the hydrostatic approximation.