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.

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

The History of Rome in Painting

There are many paths to reach Rome, immense field open to the eye through the centuries and days, where the presence of the story is haunting. All the artists came to Rome: Italians of various Italian and also French, Dutch, Flemish, Spanish, English and Americans. These painters whose works tell its long history for having lived in the glare of light forever are the Roman pantheon of arts: what are all the anonymous authors of the frescoes of ancient Rome and medieval, but Fabriano, Cimabue , Giotto, Botticelli, Raphael, Giulio Romano, Michelangelo, Caravaggio, Guido Reni, Guercino, Titian, Vasari, Velasquez, Le Nain, Poussin, Zuccari, Van Wittel, Eckersberg, Giraudet, David, Panini, Hubert Robert, Reynolds, Fuseli, Ingres, Sargent, Caffi, Vernet, Turner, Corot, Caffi, De Chirico, etc..

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.

Landscape all'Antica and Topographical Anachronism in Roman Fresco Painting of the Sixteenth Century

An article derived from the first chapter of the writer's doctoral thesis, “Paysage et Pouvoir. Les décors topographiques à Rome et dans le Latium au XVIe siècle.”

Christinaty, neutrality and public schooling : the origins of the dutch educational system, 1801-1920

Resumen tomado de la publicaci??n

Decoration of au and ag nanoparticles on self-assembling pseudopeptide-based nanofiber by using a short peptide as capping agent for metal nanoparticles

The surface of a nanofiber that is formed from a self-assembling pseudopeptide has been decorated by gold and silver nanoparticles that are stabilized by a dipeptide. Transmission electron microscopic images make the decoration visible. In this paper, a new strategy of mineralizing a pseudopeptide based nanofiber by gold and silver nanoparticles with use of a two-component nanografting method is described.

The competitive dialogue procedure: Advantages, disadvantages, and its implementation into English and Dutch law

Competitive Dialogue (CD) is a new contract award procedure of the European Community (EC). It is set out in Article 29 of the 'Public Sector Directive' 2004/18/EC. Over the last decades, projects were becoming more and more complex, and the existing EC procedures were no longer suitable to procure those projects. The call for a new procedure resulted in CD. This paper describes how the Directive has been implemented into the laws of two member states: the UK and the Netherlands. In order to implement the Directive, both lawmakers have set up a new and distinct piece of legislation. In each case, large parts of the Directive’s content have been repeated ‘word for word’; only minor parts have been reworded and/or restructured. In the next part of the paper, the CD procedure is examined in different respects. First, an overview is given on the different EC contract award procedures (open, restricted, negotiated, CD) and awarding methods (lowest price and Most Economically Advantageous Tender, MEAT). Second, the applicability of CD is described: Among other limitations, CD can only be applied to public contracts for works, supplies, and services, and this scope of application is further restricted by the exclusion of certain contract types. One such exclusion concerns services concessions. This means that PPP contracts which are set up as services concessions cannot be awarded by CD. The last two parts of the paper pertain to the main features of the CD procedure – from ‘contract notice’ to ‘contract award’ – and the advantages and disadvantages of the procedure. One advantage is that the dialogue allows the complexity of the project to be disentangled and clarified. Other advantages are the stimulation of innovation and creativity. These advantages are set against the procedure’s disadvantages, which include high transaction costs and a perceived hindrance of innovation (due to an ambiguity between transparency and fair competition). It is concluded that all advantages and disadvantages are related to one of three elements: communication, competition, and/or structure of the procedure. Further research is needed to find out how these elements are related.