Development of the Dutch Structure for Integrated Children's Palliative Care

Children’s palliative care (CPC) is gaining attention worldwide, facilitated by the exchange of knowledge during regular specialised congresses. This article describes the developments in the Netherlands over the past 15 years. The Foundation for Children’s Palliative Expertise (PAL) was established as a nationwide initiative committed to improving palliative care for children countrywide. This led to the development of the first hospital-based CPC team in 2012, which expanded to a total of seven teams adjacent to children’s university hospitals. Regional networks for CPC were developed in parallel to these teams from 2014 onwards. The networks are a collaboration of professionals from different disciplines and organisations, from hospital to homecare, and have covered the aspects of CPC nationally from 2019 onwards. They are connected through the Dutch Knowledge Centre for CPC. This centre was established in 2018 by the PAL Foundation in collaboration with the Dutch Association for Pediatrics. In 2013, the first evidence-based guideline, ‘palliative care for children’, provided access to knowledge for parents and healthcare providers, and in 2017, a format for an individual palliative care plan was established. Within the Knowledge Centre for CPC, a physician’s support centre for dilemma’s regarding the end of life of children was set up. The efforts to have children’s palliative care embedded in the regular Dutch health care insurance are ongoing

Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle?

Purpose: Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. Methods: The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. Results: Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. Conclusion: Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment

Creative Product Problem-solving Game

Creativity is a talent that undergirds invention and innovation, making it an important skill in today’s society. Although students are often told to “be creative,” they many times do not know how and have little practice in this skill. This document presents an analysis of 33 creative products made by adult participants at a state conference for educators working with preK-12 gifted students or their teachers as a model for what teachers can do in their classrooms to allow students to practice creative thinking. During the conference presentation, Torrance’s creative strengths were reviewed with photographic examples, definitions, and suggestions printed on handouts. For the problem-solving game, each participant was given an identical set of recycled/craft materials, and about 30 minutes to create an object or scene fitting with a given theme. This presentation was delivered each of the two days of the conference with a different theme each day: “under water” was the theme the first day and “cool space” was the theme for the products on the second day. Participants each created an object that exhibited creative strengths and followed game-rules using the additional tools of scissors, glue, markers, and thread. Photographs of the final products are shown with their creative strengths identified. Most participants were successful in developing products that showed five creative strengths as required by the game rules. The most common approach to making a creative product that exhibited creative strengths was to tell an original story involving some motion that was detailed, artistically appealing, or humorous, and contained characters with emotional expressions. Because of the success and enthusiasm of participants for the game, the authors recommend it for students, clubs, and recreational activities. [7 Tables, 33 Figures, 6 References

Beyond the ‘Migrant Network’? Exploring assistance received in the migration of brazilians to Portugal and the Netherlands

This paper explores the tenability of three important critiques to the ‘migrant network’ approach in migration studies: (1) the narrow focus on kin and community members, which connect prospective migrants in origin countries with immigrants in the destination areas, failing to take due account of sources of assistance beyond the ‘migrant network’ like institutional or online sources; (2) that it is misleading to assume a general pattern in the role of migrant networks in migration, regardless of contexts of arrival or departure, including the scale and history of migration or the immigration regime; and (3) that ‘migrant networks’ are not equally relevant to all migrants, and that important differences may exist between labour migrants and other types of migrants like family migrants or students. Drawing on survey data on the migration of Brazilians to Portugal and the Netherlands we find support for these critiques but also reaffirm the relevance of ‘migrant networks’.info:eu-repo/semantics/publishedVersio

Crime among irregular immigrants and the influence of internal border control

Both the number of crime suspects without legal status and the number of irregular or undocumented immigrants held in detention facilities increased substantially in theNetherlands between 1997 and 2003. In this period, theDutch state increasingly attempted to exclude irregular immigrants from the formal labour market and public provisions. At the same time the registered crime among irregular migrants rose. The 'marginalisation thesis' asserts that a larger number of migrants have become involved in crime in response to a decrease in conventional life chances. Using police and administrative data, the present study takes four alternative interpretations into consideration based on: 1) reclassification of immigrant statuses by the state and redefinition of the law, 2) criminal migration and crossborder crime, 3) changes in policing, and 4) demographic changes. A combination of factors is found to have caused the rise in crime, but the marginalisation thesis still accounts for at least 28%. These findings accentuate the need for a more thorough discussion on the intended and unintended consequences of border control for immigrant crime

Sphingomyelinase D Activity in Model Membranes: Structural Effects of in situ Generation of Ceramide-1-Phosphate

The toxicity of Loxosceles spider venom has been attributed to a rare enzyme, sphingomyelinase D, which transforms sphingomyelin to ceramide-1-phosphate. The bases of its inflammatory and dermonecrotic activity, however, remain unclear. In this work the effects of ceramide-1-phosphate on model membranes were studied both by in situ generation of this lipid using a recombinant sphingomyelinase D from the spider Loxosceles laeta and by pre-mixing it with sphingomyelin and cholesterol. The systems of choice were large unilamellar vesicles for bulk studies (enzyme kinetics, fluorescence spectroscopy and dynamic light scattering) and giant unilamellar vesicles for fluorescence microscopy examination using a variety of fluorescent probes. The influence of membrane lateral structure on the kinetics of enzyme activity and the consequences of enzyme activity on the structure of target membranes containing sphingomyelin were examined. The findings indicate that: 1) ceramide-1-phosphate (particularly lauroyl ceramide-1-phosphate) can be incorporated into sphingomyelin bilayers in a concentration-dependent manner and generates coexistence of liquid disordered/solid ordered domains, 2) the activity of sphingomyelinase D is clearly influenced by the supramolecular organization of its substrate in membranes and, 3) in situ ceramide-1-phosphate generation by enzymatic activity profoundly alters the lateral structure and morphology of the target membranes