Academic Ceremonies June 2008

“Classical Liberalism and International Relations Theory. Hume, Smith, Mises, Hayek and International Society”

Not all liberals are starry-eyed believers in eternal peace. The prominent classic liberals Hume, Smith, Mises and Hayek have completely different ideas, in contrast with this common image in the international relations. This dissertation is a first attempt to correct this image. Partly following on the ideas of Hugo de Groot, they see the state as the most important actor in world politics. International order develops in correlation with the balance of power and international law, with an important role for just warfare.  Free trade is good, but it brings no peace; development aid should be abolished. According to these classic liberal thinkers, the European Union could become a federation after radical reform, but many other international governmental organizations are redundant. 

“Surgical Excision and Mohs Micrographic Surgery for Basal Cell Carcinoma: An evaluation from different perspectives”

“Measuring and Managing Poverty Risks”

The dissertation “Measuring and managing poverty risks” studies technical issues on the measuring of poverty and the characteristics of people who are poor; it also compares the United States with the countries of the European Union. The study investigates which are the policy implications of technical (measuring) choices. According to some calculation methods, for example, there is less poverty in the Czech Republic than in the Netherlands and very different people are poor there. The study explains among others that the policy in the Netherlands and in other countries can best be inspired by the use of different measuring methods next to each other.  

Key words:

poverty, poverty policy, social security

“Role of Myeloperoxidase in Lung Inflammation”

Excessive inhaling of dust particles can lead to the development of lung diseases. The objective of this PhD research was to study the response of lung epithelium cells on neutrophils, inflammation cells. The focus was on the role of the neutrophil protein myeloperoxidase during the inflammation process. The results show that myeloperoxidase contributes to the development of acute inflammation, but that other mechanisms are also responsible for the development of chronic inflammation. Furthermore it shows that the reaction of lung epithelium cells during inflammation also depends on the cause of the inflammation. Therefore, it is important to take the cause of the inflammation into account for the development of therapies against lung diseases. 

Key words:

 myeloperoxidase, neutrophil, lung epithelium

“Radiologie in de lift.”

“Home visiting program for older persons with poor 
health status”

“Multidisciplinary fall prevention; effects, feasiblility and costs”

“Lost in fragmentation; schema modes, childhood trauma, and anger in borderline and antisocial personality disorder”

“Verbal learning in school-aged children and the influence
of child-related factors, test-related factors and natural context”

“Post transcriptional gene silencing and peptide microarray as a way to perform drug target validation”

“De invoering van International Financial Reporting Standards in de Europese Unie – een tussenbalans”

“UMA TORI; development and evaluation of an STI/HIV-prevention intervention for women of Afro-Surinamese and Dutch Antillean descent”

“www.mychronicdisease.org – naar 
samenhangende, de patiënt activerende en ondersteunende
chronische zorg-”

“Rectal Cancer Imaging; staging and restaging”

“The relationship between R & D Partnership formation, social embeddedness and innovative performance”

“For your ears only”. Quality of telephone triage at out-of-hours 
centres in the Netherlands”​

“The Annexin Code; Revealing Cardiovascular Disease”

Today, it is clear that cardiovascular diseases are preceded by specific biological changes that patients don’t notice. Molecular imaging is a new imaging technique to detect these changes, which makes it possible to notice and combat cardiovascular diseases at an early stage. Bas Kietselaar studied the use of molecular imaging with Annexin A5.  He discovered that Annexin A5 (a type of protein) first of all helps predict deterioration in patients with a widened heart muscle; secondly is valuable in the detection of endocarditis (bacterial inflammation of the heart); thirdly can be used for diagnosing vulnerable plaques in patients with a TIA (‘light stroke’); and finally that Annexin scans are useful in the assessment (benign or malignant) of mass in patients’ hearts. 

“The use of risk tables for cardiovascular prevention in general practice; evaluation of decision support for doctors and patients”

To find out if you run an increased risk of cardiovascular diseases, the general practitioner uses a risk table. GPs find the use of this table difficult, but also talking about risks is not easy. Many people overestimate or underestimate their risk, or they have false expectations about what the GP can do with regard to prevention of cardiovascular diseases. The research shows that a decision support for the patient, in which the risk and the various possibilities for risk reduction are explained, appear valuable for the involvement of patients in the decision process of their cardiovascular risk management. This research was partly subsidized by the ‘Nederlandse Hartstichting.’

Key words:

prevention of cardiovascular diseases, decision support

“Triggers for food intake regulation; sensory and metabolic effects of specific food components”

Various substances in our food influence our eating behaviour, because they reduce the hunger sensation. The studies described in this dissertation show that specific energy-low substances in our food can influence in the short term the underlying mechanisms of hunger sensation by means of sensory (taste related) and metabolic effects. These findings suggest that these effects of specific energy-poor substances in our food can be used in various elements of eating behaviour. This could, for example, contribute to the reduction of appetite during a meal or between meals.

“Novel methods for ocular drug delivery”

“Bestuurlijke verankering van innovaties in de penbare gezondheidszorg; lessen uit de casus Hartslag Limburg”. (‘Administrative embedding of innovations in public health care; lessons from the case ‘Hartslag Limburg’)

Health promotion has the best results at the local level. Necessary are programmes that are carried out in lasting cooperation of Area Health Authority, general practitioners, hospital, municipality and, if necessary, other institutions. The dissertation of Erik Ruland, based on the lessons from Hartslag Limburg (1998-2004), shows that a combination of firm municipal control, leadership and sound operational change management is crucial for lasting cooperation. As soon as municipality and Area Health Authority fail in this concerted action, the administrative embedding of cooperation is at risk. That can be a threat for the continuation of programmes for health promotion, even when these proved successful. The dissertation makes recommendations for the improvement of the concerted action in practice. 

Key words:

health promotion, Hartslag Limburg

“Technologie, mij(‘)n zorg ! Over langdurende zorg, technologie en innovatie.”

“Home Nursing in Europe”

Europe’s population is ageing. This dissertation describes the various patterns of professional and informal care to elderly people in Denmark, France, the Netherlands and Germany and the way these countries re-spond to the changing demand for car for the elderly. Particularly the profession and the domain of home nursing are at the centre of the research. Specific developments and problems in home care and family care are described from a wide sociological and cultural perspective and related to the various systems of health care and the relations between professions and the sectors within those, the role of the family and socio-cultural and political standards and values regarding health and disease.

Key words:

home nursing, home care, family care, professionalisation, Europe

“Bariatric surgery and its effect on the metabolic and inflammatory aspects of morbid obesity”

“Clinical implications of acute exacerbations in COPD”

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the bronchial tubes that involves complaints of tightness of the chest, coughing and bringing up phlegm.  COPD patients regularly have exacerbations: periods when these complaints are more serious than otherwise and sometimes hospitalization is necessary.  This dissertation studies mechanisms that lead to exacerbations, as well as the clinical consequences of these disease episodes. The main conclusions are that increased inflammation values in the blood lead to an increased risk of exacerbations and that these inflammation values in the blood rise in the case of exacerbations.
Established was also that acute exacerbations have a bad prognosis: 8 % of the hospitalized patients die during the hospitalization and 25 % die after 1 year.

Key words:

COPD, acute exacerbations, systemic inflammation

“Educating the self-critical doctor; using a portfolio to stimulate and assess medical students’ reflection”

It is of great importance that doctors critically reflect on their own performance. That is not only shown in scientific research, but also in ‘failures’ of doctors and hospital wards. Good care demands doctors with a realistic view of their own knowledge and abilities, who seriously think about their communication with colleagues and patients. The Maastricht faculty of medicine has developed a so-called portfolio method that helps students to critically reflect on themselves early in the programme and to address ‘rude and plump’ behaviour. An article based on this method was published among others in the British Medical Journal of 11 April 2008.  

Key words:

Reflection, medical education, doctor-patient communication

“Adaptive Active Vision”

Today, artificial intelligence is very strong in the field of activities that people find difficult, such as playing chess. Remarkably, considerably fewer successes were achieved in everyday activities, such as walking down the street. The reason for this is that we determine everyday actions in little time and found those on implicit knowledge. For his PhD research, Guido de Croon studied computer models that make eye movements to carry out visual tasks. That is ordinary for people; we move our eyes on average three times per second to obtain the right information from the environment. For a computer model this behaviour is hard to catch. Therefore, de Croon developed ‘adaptive’ models that learn themselves which actions are the best. The findings from this research can among others lead to a wider usability and autonomy of small robots.

Key words:

artificial intelligence, adaptive computer models

“An Empirical Investigation of Implicit Contracts”

Not all performances of organizations can be measured in objective parameters such as an annual report. Think for example of the degree of innovation. When a supervisory board takes these kinds of aspects into account in the evaluation of a president of the executive board, that is called a subjective evaluation. This dissertation studies the how and why of subjective evaluations, their influence on the degree to which the members of the supervisory board fulfil their governance task and the influence on innovation. The remuneration of CEOs in the USA shows that the use of subjectivity leads to strong incentives to raise the company value. Furthermore it shows that subjectivity is important when objective performance standards do not sufficiently reflect the ‘good behaviour’ of the CEO, such as his/her influence on the innovation of the company.

Key words:

supervisory board, subjectivity

“Vascular access for haemodialysis. A comparative study of brachial – basilic and prosthetic graft arteriovenous fistulas”

“Mental Capital: the economic significance of mental health”