Dutch Institute Research Articles

Quality of Austrian and Dutch falls-prevention information: A comparative descriptive study

Objectives: The aim of this study was to evaluate and compare the quality of written patient information material available in Austrian and Dutch hospitals and nursing homes pertaining to falls prevention. Design: Comparative descriptive study design Setting: Hospitals and nursing homes in Austria and the Netherlands. Method: Written patient information material ( n = 77) was independently evaluated by two assessors using the 36-item Ensuring Quality Information for Patients (EQIP) scale with regard to content, structure and identification data. EQIP global scores were calculated and country- and institution-specific (hospitals and nursing homes) differences were analysed. Results: The written patient information material available in Dutch hospitals had a significantly higher EQIP mean score than that in Austrian hospitals ( p < .0001). The difference in EQIP global score between the countries was not significant for the written patient information material in nursing homes ( p = .479). Sub-scale analyses indicated that Dutch institutions reached significantly higher mean values in the global scores for content and structure than Austrian ones ( p < .05). Conclusion: Although Dutch written patient information material pertaining to falls prevention was of higher quality than that in Austria, both countries suffered from shortcomings, especially with regard to content and identification data. Authors of written patient information material face a great challenge in taking consumer involvement and evidence-based criteria into account.

A conceptual framework to identify spatial implications of new ways of learning in higher education

Purpose– The purpose of this paper is to explore the spatial implications of new learning theories and the use of information and communication technologies (ICT) in higher education.Design/methodology/approach– Based on a review of the literature, a theoretical framework has been developed that visualises the spatial implications of developments in higher education. To further explore spatial configurations that support changes in education, a comparative floor plan analysis was carried out at four Dutch institutes of higher education.Findings– The findings show that the traditional classroom space is progressively being replaced by a variety of learning settings to support contemporary learning activities.Practical implications– The research findings contribute to a better understanding of the alignment of learning space to the evolving needs that come from new ways of learning, supported by advanced ICT, and can be used to support space planning in higher education.Originality/value– This paper builds upon findings from different disciplines: Facilities Management and Corporate Real Estate Management (suitability of floor plans) and Theory of Education (the pedagogical approaches and pedagogical assumptions those floor plans convey).

Editorial

ICT-based ITS (Intelligent Transport Systems) has been rapidly developing since the 1990s. ITS technical solutions have great potential for improving traffic safety, traffic efficiency and energy efficiency. During the past decades enabling technologies (such as positioning, communications, sensor and computer vision) have been substantially developed. This paves the way for the deployment of connected vehicles and possibly, in the near future, automated driving. Research and innovation in the ITS domain are outstanding. Technologies and scientific results have been presented during the World Congresses on ITS since 1994. The annual congress is alternately held in the regions Europe, Asia/Pacific and North America, and organised by, respectively, ERTICO (ITS Europe), ITS Japan and ITS America. The basic format of the Congress includes Plenary Sessions, Executive Sessions, Special Sessions, Scientific Sessions, Technical Sessions, Interactive Sessions, Exhibitions and Demonstrations. The 20th ITS World Congress was successfully held on 14–18 October 2013 in Tokyo with around 10,000 participants, including representatives from industry, academia, governments, local authorities and the general public. Experts from all over the world gathered to discuss ITS solutions for sustainable and seamlessly connected transport systems, development and expansion of business opportunities, R&D deployment and recent results. As the Guest Editor of this Special Issue of IET Intelligent Transport Systems for the 20th World Congress on ITS, I would especially like to acknowledge my colleague Dr. Alan Stevens and the IET Editorial Office for their kind support during the editing process. I am pleased to introduce the four selected papers. [Xing, 2014] presents characteristics of wrong-way incidents and crashes that occurred on the entire motorway network in Japan. Statistical data were analysed: nearly 40% of vehicles in wrong-way crashes took U-turns on the main carriageway; 20% entering the wrong way at interchanges after passing the tollgate; 18% at interchanges before passing the tollgate, and 12% at rest areas. Furthermore, the main contributing factors for wrong-way crashes were determined as being wrong entries and dementia. Countermeasures for some major factors are proposed. The causations of wrong-way crashes were investigated and quantified. [Füssl, et al., 2014] reports on a study concerning riders of powered two-wheelers (PTWs). It focuses on the acceptance of Advanced Driver Assistance Systems (ADAS) systems for improving the safety of PTW riders. The paper identifies the factors that affect the acceptance of ADAS by PTW riders and the obstacles that may prevent them from using such systems. The research result shows that the acceptance of systems depends on their safety attitude, riding behaviour and risk behaviour. There is a large potential for increasing acceptance through influencing the attitudes of the PTW riders or by modifying the system (function) itself. [Chou and Nichols, 2014] use traffic queue parameters that can be relatively easily measured to predict the safety impacts of freeway operations such as survey patrols and planned maintenance. Through micro-simulation with a VISSIM traffic model they identify that queue duration, impact area and the number of vehicles exposed to the end of the queue are all significant parameters. Innovations in the field of hybrid electric vehicles (HEV) and plug-in hybrid electric vehicles (PHEV) are driven by the automotive industry to reduce fuel consumption (and thereby greenhouse gas emissions). Energy management systems are used to control and optimise distribution of power use of the two embedded power sources. Previous studies that used classical fuzzy rule-based strategies demonstrated a lack of optimality because their design focuses on the actual vehicle state rather than the driving conditions. [Denis, et al., 2014] investigates a blended control strategy based on fuzzy logic for a PHEV to increase the controller effectiveness. From 2011, Program Manager International at Dutch Institute for Advanced Logistics. In 2009 and 2010 Visiting Professor at the National Laboratory for Automotive Safety and Energy, Tsinghua University, P.R. China. Since 2002 active in the area of ICT-based Intelligent Transport Systems (ITS). Participation in (FP6 and FP7) EU-funded projects. Since 2011 also active in the area of logistics and supply chain as Project Coordinator and Work Package Leader. Selected Memberships : Chair, IBEC (international forum for the evaluation of ITS development and deployment); Board of Governors, IEEE Intelligent Transportation Systems Society; Member, International Programme Committee of the World and European congresses on ITS; Member of the Editorial Board of IET (Institution of Engineering and Technology) ITS. Education : PhD, Lund Institute of Technology, Lund University, Sweden; Dutch Master's degree of Engineering; participation in a Business Administration Programme at Nyenrode University, The Netherlands; Master's degree of Engineering at Harbin Institute of Technology in P.R. China.

Cognitive Interventions in Older Persons: Do They Change the Functioning of the Brain?

Background. Cognitive interventions for older persons that may diminish the burden of cognitive problems and could delay conversion to dementia are of great importance. The underlying mechanisms of such interventions might be psychological compensation and neuronal plasticity. This review provides an overview of the literature concerning the evidence that cognitive interventions cause brain activation changes, even in damaged neural systems. Method. A systematic search of the literature was conducted in several international databases, Medline, Embase, Cinahl, Cochrane, and Psychinfo. The methodological quality was assessed according to the guidelines of the Dutch Institute for Health Care Improvement (CBO). Results. Nineteen relevant articles were included with varied methodological quality. All studies were conducted in diverse populations from healthy elderly to patients with dementia and show changes in brain activation after intervention. Conclusions. The results thus far show that cognitive interventions cause changes in brain activation patterns. The exact interpretation of these neurobiological changes remains unclear. More study is needed to understand the extent to which cognitive interventions are effective to delay conversion to dementia. Future studies should more explicitly try to relate clinically significant improvement to changes in brain activation. Long-term follow-up data are necessary to evaluate the stability of the effects.

Neoliberal individualism in Dutch universities: Teaching and learning anthropology in an insecure environment

This article is based on our own experiences and that of several of our colleagues teaching social and cultural anthropology in different Dutch institutions for higher learning. We focus in particular on teaching and learning in two small liberal arts and science (LAS) colleges, where anthropology makes up part of the social science curriculum and/or is part of the core curriculum. The data collected from our own critical reflections developed during informal discussion and from formal interviews with colleagues, together with literature on recent changes in academia, leads us to argue that neoliberal individualism, shaped by management tactics that constantly measure individual performance and output, is making academia an increasingly insecure place in which to work and study. The consequences of this insecurity include increasing mental health problems among both students and staff, intensifying competition at the expense of collegiality and collaboration and an overall decrease in the quality of academic jobs and teaching. Although the discipline of anthropology can help us better understand our own conditions, the personalisation of problems and the focus on success obscure the anthropological lens, which looks at social and cultural structures of power and depends on critical reflexivity.

The development of a multidisciplinary, evidence-based guideline for “HIV and employment”

The objective of this study was to develop a multidisciplinary guideline that supports the care and vocational rehabilitation of HIV-infected people with employment-related problems. The guideline was developed according to the “evidence-based guideline development” method developed by the Dutch Institute for Health Care Improvement. This method consists of the following steps: forming a multidisciplinary core group and an expert panel, formulating key questions, searching and appraising the available literature, formulating considerations and recommendations, peer reviewing the draft guideline, and authorizing the final guideline. All relevant professional associations were represented in the core group that was assembled to develop the guideline, i.e., HIV doctors, HIV nurses, general practitioners, occupational health physicians, psychologists, social workers, occupational health nurses, vocational experts, and insurance physicians. Five key questions for the guideline were formulated with the following themes: determinants of employment, disclosure and stigma, self-management, interventions, and the organization of care. In the literature review on these topics, 45 studies met the inclusion criteria. The methodological quality of the included articles was poor. Factors such as patient preferences and medical/ethical issues were considered. The recommendations in the guideline are a weighting of the scientific evidence and the considerations of the core group. The guideline, as well as its summary for daily practice, clarifies the most important barriers and facilitators to people with HIV either staying at work or returning to work, and it constitutes a clinical, easy-to-use guideline for health-care providers and how they can support people with HIV who want to work.

The Work Profiler: A digital instrument for selection and diagnosis of the unemployed

The Work Profiler is an instrument that indicates a job seeker’s probability of work resumption within a year. In addition, it offers a quick diagnosis of the job seeker’s obstacles for return to work. The Work Profiler was developed through a three-stage research process (a literature review, a cross-sectional study and a longitudinal study) in order to identify the best predictive factors for work resumption. While a large part of the research was done regionally in the Province of North Holland, the Dutch Institute for Employee Benefit Schemes (UWV) has decided to use it nationwide. At present this profiling instrument is already being used in almost a third of all unemployment offices in the Netherlands.

Ultrafine tungsten as a plasma-facing component in fusion devices: effect of high flux, high fluence low energy helium irradiation

This work discusses the response of ultrafine-grained tungsten materials to high-flux, high-fluence, low energy pure He irradiation. Ultrafine-grained tungsten samples were exposed in the Pilot-PSI (Westerhout et al 2007 Phys. Scr. T128 18) linear plasma device at the Dutch Institute for Fundamental Energy Research (DIFFER) in Nieuwegein, the Netherlands. The He flux on the tungsten samples ranged from 1.0 × 1023–2.0 × 1024 ions m−2 s−1, the sample bias ranged from a negative (20–65) V, and the sample temperatures ranged from 600–1500 °C. SEM analysis of the exposed samples clearly shows that ultrafine-grained tungsten materials have a greater fluence threshold to the formation of fuzz by an order or magnitude or more, supporting the conjecture that grain boundaries play a major role in the mechanisms of radiation damage. Pre-fuzz damage analysis is addressed, as in the role of grain orientation on structure formation. Grains of (1 1 0) and (1 1 1) orientation showed only pore formation, while (0 0 1) oriented grains showed ripples (higher structures) decorated with pores. Blistering at the grain boundaries is also observed in this case. In situ TEM analysis during irradiation revealed facetted bubble formation at the grain boundaries likely responsible for blistering at this location. The results could have significant implications for future plasma-burning fusion devices given the He-induced damage could lead to macroscopic dust emission into the fusion plasma.

Research projects in family medicine funded by the European Union.

This study aimed at synthesizing funding opportunities in the field of family medicine by determining the number of family medicine projects, as well as number of project leaderships and/ or participations by each country. This was done in order to encourage inclusion of physicians in countries with underdeveloped research networks in successful research networks or to encourage them to form new ones. We searched the Community Research and Development Information Service project database in February 2013. Study covered the period from years 1992 - 2012, selecting the projects within the field of general/family medicine. The search was conducted in February 2013. First search conducted in the CORDIS database came up with a total of 466 projects. After excluding 241 projects with insufficient data, we analysed 225 remaining projects; out of those, 22 (9.8%) were in the field of family medicine and 203 (90.2%) were from other fields of medicine. Sorted by the number of projects per country, Dutch institutions had the highest involvement in family medicine projects and were partners or coordinators in 18 out of 22 selected projects (81.8%), followed by British institutions with 15 (68.8%), and Spanish with 10 projects (45.5%). Croatia was a partner in a single FP7 Health project. Research projects in family medicine funded by the European Union show significant differences between countries. Constant and high-quality international cooperation in family medicine is the prerequisite for improvement and development of scientific research and the profession.

Factors influencing trainers’ feedback-giving behavior: a cross-sectional survey

BackgroundThe literature provides some insight into the role of feedback givers, but little information about within-trainer factors influencing ‘feedback-giving behaviours’. We looked for relationships between characteristics of feedback givers (self-efficacy, task perception, neuroticism, extraversion, agreeableness and conscientiousness) and elements of observation and feedback (frequency, quality of content and consequential impact).MethodsWe developed and tested several hypotheses regarding the characteristics and elements in a cross-sectional digital survey among GP trainers and their trainees in 2011 and 2012. We conducted bivariate analysis using Pearson correlations and performed multiple regression analysis.ResultsSixty-two trainer-trainee couples from three Dutch institutions for postgraduate GP training participated in the study. Trainer scores on ‘task perception’ and on a scale of the trait ‘neuroticism’ correlated positively with frequency of feedback and quality of feedback content. Multiple regression analysis supported positive correlations between task perception and frequency of feedback and between neuroticism and quality of feedback content. No other correlations were found.ConclusionThis study contributes to the literature on feedback giving by revealing factors that influence feedback-giving behaviour, namely neuroticism and task perception. Trainers whose task perception included facilitation of observation and feedback (task perception) and trainers who were concerned about the safety of their patients during consultations with trainees (neuroticism) engaged more frequently in observation and feedback and gave feedback of higher quality.

Ultimate attainment in late second language acquisition: Phonetic and grammatical challenges in advanced Dutch–English bilingualism

The present article provides an exploration of ultimate attainment in second language (L2) and its limitations. It is argued that the question of maturational constraints can best be investigated when the reference population is bilingual and exposed on a regular basis to varieties of their first language (L1) that show cross-linguistic influence. To this end, 20 advanced Dutch–English bilinguals are compared to 9 English native speakers immersed in a Dutch environment. All participants are teachers or students of English at a Dutch institution of higher education. The populations are shown to be at similar global proficiency levels. Two phonetic variables (voice onset time or VOT and vowel discrimination) and one grammatical variable (verb phrase ellipsis), which are assumed to present particular challenges to Dutch learners of English, are explored, and speakers are furthermore rated for their global nativeness. The findings show no differences between populations on VOT but some variance on the production of a vowel that has no correlate in Dutch (the English trap vowel). However, all but one of the L2ers are rated outside the range of the natives on perceived foreign accent. There are also differences between groups where acceptance of different sentence types with verb phrase ellipsis are concerned. We interpret these findings to indicate that there are areas of L2 knowledge and production that are persistently difficult to acquire even under circumstances that are highly favourable for L2 acquisition.

164 Cancer incidence in a cohort of biology research laboratory workers in the Netherlands

ObjectivesResearch laboratory personnel is exposed to a wide variety of carcinogenic agents. The link between biological research work and a possible increased cancer risk has been studied in several European...

P070 Toolbox for the Complete Process of Guideline Development, Revision, Implementation and Evaluation

BackgroundProblems in the process of guideline development, revision, implementation and evaluation are commonly perceived.ObjectivesTo support and improve the process of guideline development, revision, implementation and evaluation.MethodsAfter reaching consensus about topics...

The Dutch Surgical Colorectal Audit

In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing. Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects. In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly. The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data.

An Implementation Strategy to Improve the Guideline Adherence of Insurance Physicians: a Process Evaluation alongside an Experiment in a Controlled Setting

Background We developed an implementation strategy for the insurance medicine guidelines for depression, which we implemented via a post-graduate course for insurance physicians (IPs). In this study we evaluate the physicians’ experiences of the implementation strategy by measuring the following aspects: recruitment and reach, dose delivered and dose received, satisfaction and expectations, and perceived barriers. Methods Insurance physicians conducting client disability assessments for the Dutch Institute for Employee Benefits Schemes were invited to attend a post-graduate course in implementation of the guidelines for depression in which a controlled experiment was embedded. Data were collected from the participating insurance physicians using questionnaires applied directly after the intervention and at three-month follow-up. Results Of the 797 insurance physicians invited, 42 participated. Reach was 4.7%. The response to the questionnaires was 100%. The participants appraised the implementation strategy with a total score of 7.7 out of 10, and 81% expected to see improvement in their assessments of clients with depression. Physicians were still satisfied with the implementation strategy after three months. Changes in work routines and the time needed to apply the guidelines were perceived as barriers to use of the implementation strategy. Conclusions The reach of the newly developed implementation strategy for the guidelines for depression was poor: only 42 IPs out of 900 invited actually attended the post-graduate course. However, the results show that the implementation strategy worked well in a controlled setting for all participants. They were satisfied with the course and with the tools provided, both immediately after the training program and after three months. Trial registration Netherlands Trial Register NTR1863

Software architecture for control and data acquisition of linear plasma generator Magnum-PSI

The FOM Institute DIFFER – Dutch Institute for Fundamental Energy Research has completed the construction phase of Magnum-PSI, a magnetized, steady-state, large area, high-flux linear plasma beam generator to study plasma surface interactions under ITER divertor conditions. Magnum-PSI consists of several hardware subsystems, and a variety of diagnostic systems. The COntrol, Data Acquisition and Communication (CODAC) system integrates these subsystems and provides a complete interface for the Magnum-PSI users. Integrating it all, from the lowest hardware level of sensors and actuators, via the level of networked PLCs and computer systems, up to functions and classes in programming languages, demands a sound and modular software architecture, which is extendable and scalable for future changes. This paper describes this architecture, and the modular design of the software subsystems. The design is implemented in the CODAC system at the level of services and subsystems (the overall software architecture), as well as internally in the software subsystems.

Legal claims for malignant mesothelioma: Dealing with all cases

BackgroundApart of medical reasons, a definitive diagnosis of malignant mesothelioma may be required as a basis for a claim of financial compensation although a pathological source of conclusive evidence is missing. Clinical assessment of all available data is then the only option to come to a final conclusion. We evaluated the diagnostic work-up of a large cohort of Dutch patients who applied for financial compensation due to mesothelioma. We determined how often a pathological or clinical diagnosis can be made, and which factors are associated with making the final diagnosis malignant mesothelioma. MethodsA flow diagram of the diagnostic work-up was constructed for patients that applied to the Dutch institute for asbestos victims between 2005 and 2008 (N=1498). Both pathological and clinical factors that may influence the diagnostic outcome were assessed. ResultsIn 97 of the 1498 patients (6%) no pathologic diagnosis could be established because of an uncertain diagnosis (N=54), inadequate (N=22) or unavailable tumor samples (N=21). A final pathological diagnosis of malignant mesothelioma could most often be made when biopsy samples were available compared to those in whom only cytological material was available. In patients in who no conclusive diagnosis could be made, clinical assessment was performed. Eighty percent of patients (66/83) who were clinically assessed were considered to have mesothelioma. None of the clinical features analyzed were strongly associated with a confirmed diagnosis of malignant mesothelioma. DiscussionOur study shows that only in a small number of the patients who applied no pathologic diagnosis could be obtained. Based on judgment of clinical experts in the majority of these cases a near to certain diagnosis could be made. Moreover, it is reasonable to obtain biopsy material from patients to increase the chance to obtain a confirmed diagnosis. Therefore, it is important to refer patients early for diagnostic procedures.

Structured Synchronous Implementation of an Enhanced Recovery Program in Elective Colonic Surgery in 33 Hospitals in The Netherlands

It has been clearly shown that after elective colorectal surgery patients benefit from multimodal perioperative care programs. The Dutch Institute for Health Care Improvement started a breakthrough project to implement a multimodal perioperative care program of enhanced recovery after surgery (ERAS). This pre/post noncontrolled study evaluated the success of large-scale implementation of the ERAS program for elective colonic surgery using the breakthrough series. A total of 33 hospitals participated in this breakthrough project during 2005-2009. Each hospital performed a retrospective chart review to gather information on traditionally treated patients (pre-ERAS group, n = 1,451). During the subsequent year patients were treated according to the ERAS program (ERAS group, n = 1 034). Outcomes were length of stay (LOS), functional recovery, adherence to the protocol, and determinants of reduced LOS. Median LOS decreased significantly from 9 to 6 days (p < 0.001). In the ERAS group, functional recovery was reached within 3 days. Adherence to the protocol elements was high during the preoperative and perioperative phases but slightly lower during the postoperative phase. Younger age, female sex, American Society of Anesthesiologists grades I/II, and laparoscopic surgery were associated with decreased LOS. Care elements that positively influenced LOS were cessation of intravenous fluids and mobilization on postoperative day 1 and administration of laxatives postoperatively. The ERAS program was successfully implemented in one-third of all Dutch hospitals using the breakthrough series. Participating hospitals reduced the LOS by a median 3 days and were able to improve their standard of care in elective colonic surgery.

Cloud Computing in Higher Education and Research Institutions and the USA Patriot Act

Institutions have started to move their data and ICT operations into the cloud. It is becoming clear that this is leading to a decrease of overview and control over government access to data for law enforcement and national security purposes. This report looks at the possibilities for the U.S. government to obtain access to information in the cloud from Dutch institutions on the basis of U.S. law and on the basis of Dutch law and international co-operation. It concludes that the U.S. legal state of affairs implies that the transition towards the cloud has important negative consequences for the possibility to manage information confidentiality, information security and the privacy of European end users in relation to foreign governments.The Patriot Act from 2001 has started to play a symbolic role in the public debate. It is one important element in a larger, complex and dynamic legal framework for access to data for law enforcement and national security purposes. In particular, the FISA Amendments Act provision for access to data of non-U.S. persons outside the U.S. enacted in 2008 deserves attention. The report describes this and other legal powers for the U.S. government to obtain data of non-U.S. persons located outside of the U.S. from cloud providers that fall under its jurisdiction. Such jurisdiction applies widely, namely to cloud services that conduct systematic business in the United States and is not dependent on the location where the data are stored, as is often assumed. For non-U.S. persons located outside of the U.S., constitutional protection is not applicable and the statutory safeguards are minimal.In the Netherlands and across the EU, government agencies have legal powers to obtain access to cloud data as well. These provisions can also be be used to assist the U.S. government, when it does not have jurisdiction for instance, but they must stay within the constitutional safeguards set by national constitutions, the European Convention on Human Rights and the EU Charter.UPDATE (11.06.13): Recent leaks around the PRISM surveillance program of the National Security Agency seem to support that these legal possibilities are used in practice on a large scale. Therefore, the authors have decided to publish a draft of their update paper on SSRN under the title 'Obscured by Clouds or How to Address Governmental Access to Cloud Data from Abroad'. The analysis is updated and it includes regulatory and policy solutions to the current legal reality.

Crossing: Between the Italic Domus and the Artistic Environment

Between 2009 and 2012 I made several visits to Italy to study at the Royal Dutch Institute in Rome, as well as to carry out historical field research in Pompeii, Herculaneum, Rome and Cerveteri. These trips were designed to provide material for writing several essays and developing an installation based on the classical atrium house. Based on historical study and by way of the ancient Roman concept of genius loci, the spirit of place, my reflections on the quality and characteristics of place has led me to the tombs of Rome and Cerveteri and the dwellings of Pompeii. The various differences and interconnections between these two ancient sites of life and death as two extremes have been essential to my research. In this exposition I report on my artistic research.