“Global Governance in the Management of Natural Resources: The Case of the Extractive Industries Transparency Initiative (EITI)”

The research focuses on the Extractive Industries Transparency Initiative (EITI), a soft law instrument aiming to increase transparency in the management of revenues from natural resources. More specifically, the dissertation explores the conditions under which countries are more likely to adopt the EITI, how and why specific countries carry out an ambitious or “extensive” implementation of the instrument, and how the configuration of stakeholder positions (government, companies, and civil society) impacts the type of implementation activities in the selected critical cases (Azerbaijan and Kazakhstan).

Key words:

law, transparency, natural resources, Azerbaijan, Kazakhstan

“Four Essays in Financial Econometrics”

The advances in finance have facilitated the interaction between financial markets and the elaboration of advanced financial instruments and new risk management techniques. In particular, the academic research in financial econometrics has focused on the inherent progress of the econometric theory and the successful research topics in financial modeling and economic forecasting. Besides, new academic research has been conducted on financial risk measures. The first part of this dissertation addresses issues related to econometric modeling and forecasting procedures on both systemic risk and high-frequency risk measures. The second part tackles the need to improve the estimation/prediction of volatility by directly including high-frequency data or realized measures of volatility.

Key words:

finance, econometrics

“Predicting the unpredictable; electrocardiographic parameters associated with ischemic ventricular fibrillation”

“The colorectal response to butyrate in health and IBS”

“Paediatric asthma, obesity, and exercise: secondary Prevention of asthma by a weight reduction intervention”

Children with asthma and obesity are frequently seen patients at consultations with paediatricians. This dissertation shows that the relationship between obesity and asthma is strongest in girls. In addition, it appears that Dutch children (with and without asthma) exercise much less than is recommended. Therefore, children with asthma are specifically advised to exercise. To investigate whether weight loss has positive effects on asthma, children with asthma and obesity took part in a weight loss programme. After 18 months, they showed a small weight reduction and an improvement in lung function and asthma symptoms. However, the same improvements were also seen in the control group. A qualitative study found that the lack of expectations among intervention participants and the difficulty of combining the programme with daily activities were reasons for the relatively high drop-out rate and low level of effectiveness. 

Key words:

obesity, asthma, exercise

“Cijfers en beelden”

“Alloreactive Natural Killer cell therapy for Multiple Myeloma”

Key words:

Killer cell ; Immunotherapy ; Multiple Myeloma

“Breaking Down Schizophrenia into phenes, genes and environment”

Schizophrenia is one of the most debilitating diseases, but the exact cause is unknown. Genetic testing is being used to search for clues that could lead to better treatments. However, given that there appears to be no defined concept of schizophrenia, searching for the genetic cause makes little sense. This PhD dissertation concludes that it is useful to research genetic factors that influence individual disease characteristics and/or explain why some people become psychotic after exposure to environmental factors that are less harmful for others. This conclusion was s¬¬upported by a test run of some applicable research methods. Some of its findings were that genetic variation combined with cannabis use influences on the age of first psychosis or partly explains why someone may react with suspicion in social situations.

Key words:

schizophrenia, psychosis, genetics, endophenotypes, gene-environment interaction

“Supervision, compliance and societal effects: IMPACT ASSESSMENT OF THE TOBACCO LEGISLATION. Effects of the Workplace-smoking ban and the tobacco sales ban to minors”

In the Netherlands, smoking is the leading preventable cause of death. This thesis evaluates the policy measures taken to reduce active and passive smoking. After the introduction of smoke-free workplaces in 2004, employers’ compliance with the smoke-free workplace policy has increased to 96% (2008). Although exposure to tobacco smoke decreased among all employees, exposure remained higher among semi- and unskilled as well as male employees. Tobacco use among employees decreased as a result of the introduction of smoke-free workplaces together with increased excise taxes. Setting the minimum legal purchase age for tobacco products at 16 years in 2003 resulted in fewer tobacco purchases among young people.
Supervisors monitor the compliance with laws. Improving and accounting for supervision has become increasingly important over the last few decades, though. This thesis describes the role of supervisors and how they handle evaluation in practice. 

Key words:

supervision, effect of evaluation, Tobacco Act, smoke-free workplace, age limit 

“Surgical aspects of low rectal cancer treatment”

“Different aspects regarding the surveillance of surgical site infections”

“Ethnic segregation in housing, schools, and neighbourhoods in the Netherlands”

This thesis looks at a West European country’s unintended transformation into an ‘immigrant nation’, specifically the causes and effect of ethnic segregation. One of the studies finds that native Dutch students in predominantly non-western minority primary schools experience a higher likelihood of high school dropout later in their lives. Using restricted-access administrative data for all primary schools in Amsterdam, the study predicts an increase of 5.4 percentage points to 8.0 percent in school dropout probability for native Dutch students who did not change schools frequently and were enrolled in primary schools with more than 77.7 percent non-western minority students.

Key words:

immigrant nations, ethnic segregation, housing, neighbourhoods, schools

“Working time preferences”

This PhD dissertation is about the number of hours per week working people want to work. It devotes attention to two aspects: 1) the difference between the number of hours that people work and the number of hours they want to work and 2) how these preferences for working hours are formed. Among other things, it appears that people who work relatively few hours usually want to increase their working hours, while people who work relatively many hours more often want to reduce their working hours. Somewhere between these two extremes, there is a number of hours per week at which people on average do not want to work more or fewer hours. That ‘balance’ appears to depend on background characteristics. Potential mechanisms that could influence this balance include habit formation and dependence on colleagues’ behavioural preferences.

Key words:

working hours, preferences

“Elke dag telt!”

“An Evaluation of Tax-Benefit Systems Impact on the welfare of Frontier Workers: the case of Luxembourg and Belgium”

“In vitro Toxicogenomics; unravelling the Mechanisms Underlying Drug-Induced Hepatotoxicity”

Although the current screening of new drugs relies heavily on animal testing, drugs considered to be safe based on the results of animal tests often turn out to be toxic to humans. The liver, which is the primary site of drug degradation and elimination, is particularly vulnerable to damage caused by drugs. The results of this study show that alternative methods instead of animal tests can be used to distinguish hepatotoxic from non-hepatotoxic substances. Furthermore, it is shown that more relevant information about underlying mechanisms of drug-induced hepatotoxicity can be obtained by combining several research techniques.

Key words:

Liver, toxicity, alternatives to animal tests

“The Changing Role of the Central Planning Offices in Latin America; a comparative historical Analysis perspective (1950-2013)”

“Bestuursaansprakelijkheid bij de ondernemende stichting”

The number of foundations in the Netherlands is increasing significantly. Between 2011 and 2014, for example, the number of foundations grew from 160,000 to 202,000. A foundation is a legal entity. This means that a director's actions create rights and obligations for a foundation. Under certain circumstances, directors can be held personally liable to both the foundation and third parties for damages resulting from their actions. Supervisors may also be held personally liable if they have clearly failed in their supervision of the board. Research has been conducted on whether directors and supervisors liability, applicable to companies with shared capital, is also being implemented in foundations and whether the limited legal provisions for foundations form an obstacle in this regard. This research has shown that a lack of legislation considerably limits the extent to which board members and members of a foundation's supervisory board can be held liable.

Key words:

foundation, legal provisions, directors liability 

“Reshaping the Big Agenda: transnational Politics and Domestic Resistance; financial crisis and social protection  reform in Bosnia and Herzegovina”

“Moving Back or Moving Forward; return migration After conflict”

This thesis examines the idea that ‘when migrants return home after conflict, they will contribute to development and peace-building’. Therefore countries throughout the European Union, including the Netherlands, promote the return of failed asylum seekers and undocumented migrants by assigning Official Development Assistance budgets to ‘Assisted Voluntary Return (and Reintegration)’ programmes, which consist of financial and in-kind assistance for those who return. The thesis concludes that there is a mismatch between the allocation of development budgets and the development potential of return migrants: while the expectations on which Migration and Development policies are based are only true for a small minority of voluntary returnees, this is not the group that is targeted by policy. While providing an incentive for the return of unwanted migrants is in the interest of host countries, it is unjustified to use development budgets for this purpose.

Key words:

return migration, policy, incentives

“Multimodal modelling of the human brain”

The thesis explores the quantification of human brain connectivity using advanced magnetic resonance imaging (MRI). We first show that, using machine learning techniques, we can distinguish between human subject’s genotypes for some genes based solely on their brain connectivity pattern (or connectome). Next, we demonstrate a novel method capable of detecting early-stage changes in the white matter of patients with Parkinson’s disease. This approach could lead to earlier, even pre-symptomatic diagnosis. Finally, the thesis focuses on merging two neuroimaging modalities in order to provide both high spatial and temporal resolution when analyzing electrical brain activity recorded on the scalp. This work was financed by the EU FP7 Marie Curie Initial Training Network “NEUROPHYSICS”, and is in collaboration with the University of Liège, Forschungszentrum Jülich GmbH, and GlaxoSmithKline Ltd.

Key words:

Magnetic resonance imaging (MRI), human brain, connectome, Parkinson’s disease

“Metachoice and Metadata; innovating with environmental Policy analysis in Europe”

Europe can boast of generally good environmental quality and that is at least partly down to stringent environmental standards and consistently smart policy design. That the continent might maintain that lead in the environmental sector is scarcely guaranteed though. This thesis looks at three distinct routes to sustained improvements in environmental policy design and analysis in Europe. The first is an innovation with a form of economic analysis popularly used in environmental policy. The second is scrutiny of the human capital invested in policy analysis. The last explores the potential of the emergent phenomenon of Big Data to advance 21st century environmental policy analysis.

Key words:

Environmental Policy, Policy Analysis, European Union, Big Data

“Simultaneity in transnational migration research:links between migrants’ host and home country orientation”

This dissertation explores the integration of Afghan, Burundian, Ethiopian and Moroccan migrants in the Netherlands, and their economic and social contacts with their family and friends in their home country. The research reveals that better integrated migrants maintain more economic contact with their home country by sending financial remittances. Plus, contrary to public opinion, stronger social contacts with family and friends in the home country do not hinder sociocultural integration in the Netherlands. Consequently, it is important to recognize that more and more people live their lives simultaneously here and there, and integration succeeds as long as migrants have the ability to choose the way they make their lives.

Key words:

integration, migrants, home country engagement, remittances

“Peritoneal carcinomatosis of gastro-intestinal origin”

Peritoneal carcinomatosis originates from various types of cancer, including intestinal and gastric cancer. This thesis shows that depending on the tumour type, 5 to 14% of patients develop peritoneal carcinomatosis. This type of metastasis is associated with a considerably reduced chance of survival, which does not seem to be affected by chemotherapy. Patients with peritoneal carcinomatosis of intestinal origin have the best chance of being cured. They undergo extensive surgery that involves the removal of all tumour masses and metastases, followed by the administration of intraperitoneal chemotherapy. This treatment method, which young, fit and motivated patients are eligible for, is currently the only chance of cure.

Key words:

cancer, metastases, peritoneum

“Dieper graven voor effectievere toepassing”
 

“Voedingswetenschappen; vereeuwigd met de erfenis van Hippocrates”

“Fetal Alcohol Spectrum Disorders: exploring prevention and management”

“Biomolecular engineering in the design of novel therapies to treat coagulation disorders and inflammatory diseases”

Activated protein C (APC) and heparin are biomolecules with both cell protective and anticoagulant characteristics. This thesis describes the use of APC and heparin variants with considerably reduced anticoagulant activity in in vitro as well as in vivo models. These variants reduce the extent of infarction in a model of acute myocardial infarction. Furthermore, they reduce organ damage and increase the chance of survival in three different inflammation models. Due to a reduced bleeding risk, these variants have the advantage of allowing the administered dose to be increased, resulting in an improved effectiveness. In the future, these variants can be tested in clinical studies in order to improve the current treatment of sepsis and other diseases associated with inflammation.

Key words:

activated protein C (APC), heparin, coagulation, myocardial infarction, sepsis

“The Geographic dimensions of growth and development”

“Patient payments and health behavior: stick or carrot?”

“The entanglement of thrombus formation: systems biology as a novel key”

This thesis provides new information on thrombus formation, particularly the role of various platelet receptors and proteins stored in platelets. It describes, among other things, the development of an innovative test method, the so-called flow chamber test, which is able to measure the process of thrombus formation in healthy controls and patients by using small amounts of blood under flow conditions (microfluidics). Furthermore, this thesis provides a meta-analysis of studies described in the literature on the thrombotic tendency in genetically modified mice. Results show that the flow chamber test can provide a good alternative to in vivo animal tests. This analysis also shows several new platelet proteins which are likely to be involved in thrombus formation. Therefore, it can be concluded that the flow chamber test is not only of clinical importance, but may also offer an alternative to experiments using live laboratory animals.

Key words:

thrombus formation, proteins, flow chamber test

“Clinical psychological and economic aspects of pregnancy care in women with a history of preeclampsia or HELP syndrome”

In preeclampsia (PE), pregnant women not only experience high blood pressure but also experience protein loss through their urine. PE can also have serious consequences for the child, such as premature birth. PE can develop into HELLP syndrome, but HELLP syndrome may also occur suddenly. Women with a history of PE/HELLP are at increased risk during subsequent pregnancies.  
The PreCare study explored whether it is cost effective to offer recurring-risk guided care to women with a history of PE/HELLP. A total of 311 women were included.  
The results of the study show that the prediction model used was only moderately accurate in predicting which woman would develop a recurrence and which would not. Recurrence-risk guided care also proved not to be cheaper than standard care. These results offer no reason to continue with this new health care approach for pregnant women with a history of PE/HELLP. 

Key words:

Preeclampsia (PE), HELLP syndrome, health care, cost-effective

“Caring for community-dwelling frail older people: a responsive evaluation”

“Strategies for Optimization of Aminoglycoside and Vancomycin Therapies”

In an era of increasing resistance to first-line antibiotics, it is expected that the use of “older” antibiotics will increase. To ensure efficacy and prevent the development of side effects and resistance, we need better insight into the usage of these sometimes life-saving antibiotics. This PhD dissertation describes a search for strategies that would lead to better treatment outcomes with the “older” reserve antibiotics: aminoglycosides and vancomycin. An optimal exposure to these antibiotics was the starting point. The studies were conducted in newborns, patients with cystic fibrosis and patients admitted to intensive care. The results show that the introduction of new dosing schedules and a modification of the first choice agent can lead to better treatment results. This PhD dissertation thus contributes to a safer and more effective use of the current antibiotic arsenal.

Key words:

antibiotics, side effects, resistance

“The Double Burden of Malnutrition: a study of food Security, physical activity and nutritional status among women and children in Narok County, Kenya”

There is a growing concern over the increasing number of overweight in sub-Saharan Africa.  Africa is still struggling with persistent food insecurity, hunger and undernutrition. Therefore the coexistence of both over and under nutrition – the Double burden of malnutrition is posing a challenge to policy makers.  This study assessed the prevalence and risk factors of malnutrition among women and children (<5yrs), assessing food insecurity, physical activity and body composition and the impact of physical activity and food insecurity on pregnancy outcomes.  Over 70% of the household were categorized as food insecure, 5.6% of the women were underweight and over 35% were overweightThe activity levels among women were mainly sedentary and light (44.5% and 48.7% respectively). There is need for physical activity programs and nutrition education to curb growing numbers of overweight.

Key words:

overweight, Africa, malnutrition 

“Skills and the employability of University Graduates”

“Clinical relevance of dialysate constituents in hemodialysis”

“De directe werking van de grondrechten van de EuropeseUnie”

Since 1 December 2009, the EU has had a written Charter of Fundamental Rights. This charter can also be invoked in the national courts; not only in lawsuits against the government (e.g. in administrative or criminal courts), but also in disputes between private parties in the civil courts. This is radical. Is the administration of justice by the EU Court of Justice in Luxembourg activist on this topic? Is this a matter of EU fundamental rights expansionism? This study concludes that this is not the situation in cases against national governments. However, critical comments need to be made about the jurisprudence of the EU Court of Justice in regards to private litigation. 

Key words:

Fundamental rights, European Union, Judicial activism 

“A sunny future for photovoltaic systems in the Netherlands?”

“The effectiveness of community schools: evidence from the Netherlands”

Community schools have become increasingly popular and numerous in the Netherlands. They offer an integrated set of educational and social services that is expected to favor academic achievement, in particular that of pupils with a disadvantaged socio-economic background. Using different micro-econometric techniques this dissertation explores the effects of attending a community school in the Netherlands on cognitive and social-emotional learning outcomes in primary and secondary education. The results suggest only limited effects on educational outcomes. Children’s cognitive learning outcomes, in terms of test scores in mathematics, reading, world orientation and study skills, are not improved by it. Furthermore, dropout rates are not reduced by community schooling. Teachers report no affect on motivation and behaviour of the children, but they do perform a bit better given their capabilities compared to regular school pupils.

Key words:

community schools, academic achievement, effects

“The dynamics of multiple goal management: Diary studies at work”

“Learning from preclinical patient contacts”

The beginning of the clinical rotations is a difficult time for many medical students. A possible solution is pre-clinical real patient contacts in Problem-Based Learning (PBL). In the year before the clinical rotations, students see a limited number of real patients at the outpatient clinic. This seems to ease the transition, described in this thesis, while students are still encouraged to gather both clinical knowledge and biomedical knowledge. Both kinds of knowledge are essential for developing coherent knowledge networks, which are necessary for solving patient problems and making the correct diagnosis. The students make quicker, better diagnoses and give qualitatively better explanations of patient symptoms after learning from pre-clinical patient contacts.

Key words:

clinical rotations, Problem-Based Learning, patient contact

“Maat van Alle dingen; cognitie van Mens en Mensaap”

“Application of in-silico approaches to cardiovascular Disease”

“Vulnerabilities to sexual risk behaviour or orphan and non-orphan adolescents: understanding the context in Western Kenya”

“Pak een hamer en doe mee!”

“Comparing tailored video- and text-based messages about smoking cessation in different socioeconomic groups: Reach, adherence and (cost-) effectiveness”

“Krimpen zonder kramp : over demografische transitie en regionale arbeidsmarkten”

“Le droit de refus dans l’execution du contrat de travail”

Wednesday 15 October 2014, 14.00 hours

“Climate change, technology transfer and intellectual property. Options for Action at the UNFCCC”

“Taking Corporate Codes Seriously: towards private law enforcement of voluntary corporate social responsibility codes”

Corporate codes of conduct are voluntary guidelines and policies that companies frequently develop and publish with the objective to express their commitment to protect human rights, to respect and improve fundamental workplace standards worldwide, and to respect and not pollute the natural environment. Ultimately, they aim at signalling the public that companies have the firm intention to engage in socially responsible behaviour in the future. This research focuses on these voluntary commitments with a view to what role private law can play in regulating them and, hence, in making companies adhere to what they publicly promise to do. Based on a comparative analysis of the English and German private law and an interdisciplinary socio-legal analysis of corporate codes the conclusion is drawn that these codes would need to be enforced. Legal policy recommendations on how to change the law are also given. 

Key words:

Corporate Social Responsibility, Private Law, Comparative Law, Social Theory, Codes of conduct

“Axillary lymph node involvement in breast cancer”

“Green Politics in Latin American Cities; sustainable transport Agendas”

“Mitochondria, lipotoxicity and skeletal muscle metabolism: implications for type 2 diabetes mellitus”

“The evolution of knowledge systems”

It has long been acknowledged that the roots of economic development lie in the accumulation of skills, innovations, technologies, and efficient ways of organizing economic behavior - in brief, knowledge. This thesis provides mathematical and statistical models to help understanding the dynamics and organization of knowledge systems. Theoretically, it studies how innovation and knowledge diffusion can take place in a stable, self-sustaining way. It also examines data on real-world knowledge systems, such as citations among scientific articles or the classification of technologies, and finds that knowledge systems exhibit important structural transformations as they grow, questioning their viability.

Key words:

mathematical models, knowledge diffusion, innovation

“Rights, Scarcity, and Justice. An Analytical Inquiry into the adjudication of the Welfare Aspects of Human Rights”

“Obesitaspreventie met pieken en dalen”

“Complex Practical Negotiations Based on Autonomous agents”

“The intestinal barrier function : an integrative approach to understanding gastrointestinal pathophysiology”

“Making the Invisible Visible”

The thesis includes three studies which took place at the School of Business and Economics of Maastricht University. The first study finds that students of the same nationality as the grader receive higher grades when their name is visible on the exam. For students with a different nationality as the grader the name did not influence the grades. This suggests that grading bias is driven by favoritism and that objectivity in grading can be increased by making exams anonymous. The second study finds that that students with better achieving class mates receive higher grades and report better group functioning. The third study shows that low ability students are more overconfident in their academic ability than high ability students. This finding suggests that many low ability students make the wrong decision to start studying. This would explain generally high drop-out rates at universities. 

Key words:

discrimination, peer effects, overconfidence

“Multifactorial decision support systems in radiation oncology; clinical predictors and radiomics”

“Chrnic Depression; an integrative approach to the study of underlying vulnerability factors and psychological treatment”

Depression is a very common problem in the Netherlands. Although many people with depression can be helped by psychotherapy or medication, a significant number of patients are not helped by current treatments. When symptoms of depression persist for two years or longer, it is called chronic depression. This dissertation shows that current treatments for depression often fall short and the underlying vulnerability, especially of chronic depression, is insufficiently addressed. A new treatment, called schema therapy, does address the underlying vulnerability of a chronic depression. This dissertation shows that schema therapy has positive effects on reducing depression in patients with chronic depression.

Key words:

chronic depression, schema therapy, psychotherapy, neuroimaging 

“Advanced prostate cancer risk, selenium, and oxidative stress: the role of genetic variation and environment”

“Bureaucracies for development: Oxymoron or Reality?”

The quality and expertise of the civil service is essential in building the abilities countries have to solve their own problems. The scientific and comparative study of civil services across developing countries, however, lags greatly behind. This dissertation presents innovative empirical tools and evidence to capture how bureaucracies impact socio-economic outcomes, and the extent to which policy experts are victim of politicization. Two main policy fields are covered: the Millennium Development Goals and the fight against corruption. The study also illustrates how certain governance arrangements such as the functioning of Congress or the party system can improve or hinder the quality of the civil service.

Key words:

governance, development, civil service, Millennium Development Goals, anticorruption, Argentina, Brazil

“Managing Financial Risks: from an institutional to a Macro Perspective”

Consumer loans have been growing remarkably in emerging markets. It has become a crucial request for both banking practitioners and regulators to better understand the behavior of borrowers and lenders with regard to contractual terms, of which collateral usage is an important one. So far there is little empirical work on the factors that affect decisions to pledge collateral for consumer loans in emerging markets. This dissertation offers new insights in that field, based on a dataset of more than 30,000 consumer loans in Vietnam. Amongst other findings, it illustrates how banks can better set up an optimal level of business volume after, or during, a crisis.

Key words:

consumer loans, emerging markets, bank risk models

“Financial reforms and out-of-pocket payments in the Russian healthcare sector”

“The role of early peritubular capillary loss in the development of chronic kidney disease”

“Enhanced perioperative care in liver and pancreat surgery”

This research aims to improve patient care after liver or pancreas surgery. An evidence-based accelerated recovery programme (Enhanced Recovery After Surgery, ERAS) was developed, implemented and evaluated; it reduces the stress reaction after such a procedure and accelerates the recovery, with no additional disadvantages. It appears that such a protocol indeed shortens the length of stay in hospital following surgery, without additional complications. However, following the protocol is more difficult when complications occur. Patients and health care providers appeared positive about such a protocol, however they found a functional recovery more important than a quick discharge from hospital. 

Key words:

accelerated recovery, liver and pancreas surgery, improving patient care, evidence-based

“Malnutrition in nursing home residents in the Netherlands, Germany and Austria”

“Preferences, Institutions, and Economic Outcomes: An empirical investigation”

Inherited differences in social trust are important for the choice of political and economic systems, as the example of Ukraine illustrates. In the West, where social trust is stronger, liberal systems are preferred. In the East, which has suffered more from political repressions during the previous centuries, regimes with strong government control are supported. Recent events demonstrate that the underlying differences in preferences can play a prominent role. People choose occupations that are aligned with their preferences. Risk-averse individuals are much less likely to become self-employed, unless they have access to information and skills that can diminish the riskiness of entrepreneurship. Change is typically accompanied by uncertainty, which implies higher (emotional) costs for risk-averse people.

Key words:

social trust, economic choices, risks attitude

“Spinal cord stimulation and pain relief in painful diabetic: polyneuropathy, a translational approach”

Diabetes may cause nerve damage, symptoms of which may include foot pain. As medication is generally not effective in treating this complication, other treatment options such as spinal cord stimulation are being explored. The clinical studies showed that spinal cord stimulation is effective in 67% of the patients. There were also indications that the effect of spinal cord stimulation could be predicted by measuring thin nerve fibre function. The animal research studies showed that the effect of spinal cord stimulation does not depend on the frequency used within the range of 5-500 Hz.

Key words:

diabetes, nerve damage, treatment, spinal cord stimulation

“Magnetic Resonance Imaging and Spectroscopy: A noninvasive Window into Lipotoxicity”

In obese people, fat also accumulates in non-adipose tissues (ectopic fat accumulation). This could cause adverse effects (lipotoxicity), which could play an important role in the development of chronic diseases, such as diabetes. This dissertation researched the relationship between ectopic fat accumulation, mitochondrial function in the heart and liver, and cardiac function using non-invasive magnetic resonance techniques (MR). We explain the complicated relationship between ectopic fat accumulation, mitochondrial function and organ function, which depend on the organ itself and the time the measurement is performed.

Key words:

Magnetic resonance techniques, lipotoxicity, heart, liver 

“Benchmarking and Standardizing of Dietetic Practices In Hemodialysis (HD) patients in Lebanon: Clinical and Quality of Life outcomes”

“Plant stanol esters: Focus on intestinal lipoprotein metabolism”

“Towards clinical applications or real-time fMRI-based neuro feedback”

“The how, not where in functional magnetic resonance imaging”

“The Use of mHealth for Maternal Health Care in Ethiopia”

“The domestic impact and effectiveness of the process of state reporting under UN human rights treaties in the Netherlands, New Zealand and Finland: Paperpushing or policy prompting?”

The critique and recommendations issued by UN human rights committees are often ignored or put aside by governments of countries that prioritise such rights, according to this study. This dissertation examines the impact of these committee recommendations in the Netherlands, New Zealand and Finland. Dutch politicians and policymakers in particular feel irritated and insulted at such external critique. 

The Netherlands tends to disregard recommendations and critique on its immigration policy. Finland, however, tends to be more open and more willing to improve human rights. They also take UN recommendations more seriously and therefore gain more acceptance among the general public. Some recommendations have had an effect in the Netherlands and contributed to the establishment of a Children’s Ombudsman in 2011 and the banning of physical discipline. The SGP has also made it possible for women to run for office.

Key words:

UN human rights committees, recommendations, the Netherlands, New Zealand, Finland

“SmART: Dosimetry and Applications”

“Essays on Applications of Simple Behavioural Rules: An Evolutionary Approach”

“Quantitative morphologic and functional MRI of peripheral arterial disease”

“Cardiovascular magnetic resonance imaging of myocardial ischemia and infarction”

This thesis describes the role MRI examination can play in evaluating ischemic heart disease, a condition in which blood flow (and therefore oxygen supply) to the heart muscle is blocked. A lack of oxygen to the heart muscle (ischemia) initially leads to chest pain, and may ultimately result in heart muscle cells dying off (a myocardial infarction). The findings show that MRI is a reliable method to detect ischemic heart disease and to obtain information about the future risk of myocardial infarction. Furthermore, it is shown that echocardiography and electrocardiography (ECG) - in contrast to MRI - fail to detect some of the (old) myocardial infarctions. Although the findings of this thesis support an increased use of MRI in these cases, further studies are needed to optimise its practical application as MRI is a relatively expensive, time-consuming technique with a considerable impact on patients.

Key words:

ischemic heart disease, myocardial infarction, MRI

“Sinusoidal obstruction syndrome: a multidisciplinary approach”

“The serrated lesion : endoscopic characterization and clinical implications”

Colonoscopies may be used to detect and remove colon polyps, therefore preventing polyps with malignant characteristics from developing into colon cancer. This thesis shows that some of the ‘serrated polyps’, although previously considered to be benign polyps, do have the potential to develop into colon cancer. This thesis describes the endoscopic characteristics of and risk factors associated with serrated polyps in order to allow these polyps to be accurately identified. Furthermore, gastroenterologists carrying out endoscopies are found to be able to differentiate benign from malignant polyps in an accurate and correct way when examining the colon. In the long term, this may prove to be cost effective as it will no longer be necessary for pathologists to evaluate all polyps as is the case at present.

Key words:

endoscopy, colon, ‘serrated polyps’, colon cancer

“All is well”

“Nanobiologie en Gezondheid”

“Identifying and modifying behavioral determinants in response to the HIV epidemic in Indonesia”

“Exercise strategies to optimize glycemic control in type 2 diabetes”

“The use of pulsed radiofrequency in the management of chronic lumbosacral radicular pain”

A herniated lumbar disc may cause pain to radiate into the leg. Although it is a common chronic disorder, therapeutic options are scarce. Applying pulses of high-frequency (radiofrequency) current may be considered if conservative management gives no satisfactory results. In order to increase the chance of this therapeutic option being successful we present an overview of current knowledge on the mechanism of radiating pain and the effect of pulsed radiofrequency treatment on this mechanism. The clinical studies showed that this treatment method was successful in a considerable proportion of patients. In addition, several predictive factors for successful treatment of radiating pain were found.

Key words:

Lower back pain, radiating pain, pulsed radiofrequency treatment

“Something to chew on”

“The impact of dietary habits on cardiovascular risk factors and other metabolic parameters of free-living populations: methodological approaches to dietary analyses”

This thesis examined the impact of dietary habits on cardiovascular health of human populations, using different methodological approaches to get more integrated conclusions. The analysis of data from 2 large epidemiological studies conducted in Italy and European region (Moli-sani and IMMIDIET studies) revealed that the higher antioxidant content of human diet might have a role in controlling blood pressure and inflammation progression and in establishing a better omega-3 fatty acids profile and quality of life in these populations. Dietary patterns adherence including natural food sources of folate could assure adequate folate profile especially in women at childbearing age.

Key words:

dietary habits, cardiovascular health

“Quercetin and its methylated metabolites: the chemical basis of activity”

“Left Bundle Branch Block; Controversies in Aortic Valve Interventions and Cardiac Resynchoronization Therapy”

“The sensitivity of radiotherapy to tissue composition and its estimation using novel dual energy CT methods”

“Optimising delays in access to specialist outpatient clinics”

Thursday 12 June 2014, 14.00 hours

“Regulator Preferences and Managers’ Manipulation Choices”

This dissertation investigates underlying motives for differences in regulatory scrutiny across different types of firms operating in different institutional settings. As regulatory behavior also affects managers’ manipulation choices, this dissertation also sheds light on how managers make different manipulation choices depending on the regulatory scrutiny they face. In particular, study 1 and 2 investigate the behavior of regulators in the healthcare industry and hospital managers’ reactions to these behaviors, while study 3 focuses on regulatory preferences of the SEC and managers’ reactions to these preferences. All of these studies contribute towards a better understanding of regulatory behavior and firms’ reactions to such behavior. Overall, the findings of this dissertation suggest that firms can be given regulatory leeway for performance manipulation if their behavior is potentially beneficial for the economy or society as a whole.

Key words:

regulatory behavior, performance manipulation, manipulation choices

“EGFRvIII: molecular insights and therapeutic potential”

“Mijn hart stond van stocht bijna stil! Dichters en hun biografen”

“Hyperostosis cranialis interna”

Hyperostosis cranialis interna is a hereditary bone disease that manifests in the skull and skull base. Symptoms, which result from a narrowing of the nerve channels in the skull base, range from hearing loss, facial paralysis and facial pain. CT and PET scans can illustrate changes in anatomy and bone metabolism in the affected areas. In collaboration with the University of Antwerp, the mutation of the gene in question was discovered. Unravelling the mechanisms behind normal bone metabolism can further our understanding of the pathogenesis of this disease. Hyperostosis cranialis interna is one of dozens of rare bone diseases involving the skull. Intervention usually involves symptomatic treatment through pain relief or surgically exposing the affected cranial nerves.

Key words:

hyperostosis cranialis interna, bone disease, CT scan, PET scan, genetics

“Evaluation of Meal and Deworming Programs for Primary Schools in Rural Senegal”

“New governance  under limited statehood: The case of local government reform in Kosovo”

“Constructing worlds with words; Science and international language in the early twentieth century”

This dissertation examines a remarkable event in twentieth-century history of science: the introduction of an artificial, international language known as Ido. Proponents presented this language as scientifically designed and therefore a neutral and efficient information carrier for conferences and trade. Ido was to transcend national interests but, as De Kloe demonstrates, the new language reflected a world order that served the national and sometimes imperialistic interests of its creators. He also argued that international scientific linguists copied the use of language as a creator of communities from the nationalists, but applied it on an international level.

Key words:

history of science, artificial language, Ido

“ACCESS TO MEDICINES; The interface between Patents and Human Rights. Does one size fit all?”

Patients having no or inadequate access to affordable medicines endangers the full realisation of human rights, particularly the right to health. Three country studies have been conducted, on South Africa, India and Uganda. These aim to provide a concrete insight into whether these countries recognise and acknowledge the interplay between patents and human rights with respect to access to medicines. Secondly these studies examine whether TRIPS agreement  concluded within the framework of the WTO leaves sufficient freedom for (developing) states to adopt a patent system suited to their domestic needs, enabling them to strike a fair balance between access to medicines and patent protection for medicines. In other words: does one size fit all? The thesis illustrates that the normative force of human rights in combination with social movement can provide a powerful tool for prioritising the health needs of the global poor.

Key words:

medicine, access, patents, human rights, Intellectual Property Rights

“Improvement of data quality for Diffusion Kurtosis Imaging and application to clinical neurological research”

Understanding human brain function and dysfunction is one of the major challenges of our century. One of the most popular methods to achieve this goal is in vivo magnetic resonance imaging. In particular, diffusion-weighted imaging has become a standard tool to non-invasively study white matter structure in vivo. This PhD dissertation deals with the development of pre-processing methods to improve image quality and the accuracy of diffusion parameters for a novel technique called diffusion kurtosis imaging (DKI). We proposed a novel method to correct data misalignment due to subject motion, as well as a method to reduce within- and between-subject variability due to the presence of noise. The diagnostic value of DKI was investigated in the case of Parkinson’s disease: kurtosis metrics show more sensitivity to white matter changes than standard diffusion metrics. Significant differences were found in posterior cerebral areas as well as subcortical regions like the putamen, and are therefore promising results.

Key words:

brain, diffusion kurtosis imaging (DKI), white matter, Parkinson’s disease

“Recessions and Depressions: A Marketing Perspective on Central Issues in the Healthcare Sector”

“ENDOTHELIAL CELL FUNCTION FROM A TISSUE ENGINEERING PERSPECTIVE”

Tissue-engineered vascular grafts can be used in cardiovascular patients who require a by-pass. These artificial vessels are created by sowing naturally occurring cells on biodegradable plastic. This dissertation aims to test and optimise tissue-engineered vessels that were too weak and triggered infection. Endothelial cells, the innermost layer of cells in blood vessels, were examined in greater detail in terms of growth and coagulation. The endothelial cells of patients functioned as well as those in our control group and can be considered safe for tissue engineering. This research brings us one step closer to the clinical application of vascular tissue engineering.

Key words:

Endothelial Cells, Vascular Tissue Engineering

“De Grijsaard en de Jongeling”

“Who governs? Authority and authorisation in global affairs”

Friday 20 June 2014, 16.00 hours

“Psychogenic non-epileptic seizures; the identification of neurophysiological correlates”

This PhD dissertation describes research on physiological characteristics of patients with psychogenic non-epileptic seizures (PNES). PNES are attacks that look like epileptic seizures, but that are not caused by epileptiform abnormalities in brain activity. Instead, they have psychogenic causes. This PhD dissertation aimed to explore possible underlying mechanisms.

Magnetic resonance imaging (MRI) techniques were used to look at these patients’ brain networks, to understand how they deal with information and emotion. Their heart rate variability was analysed using electrocardiography (ECG) techniques, to investigate whether the attacks are characterised by elevated stress levels.

Key words:

psychogenic non-epileptic seizures, MRI, ECG

“Nutritional Profile of Young Sudanese Adolescents”

“Guidelines for designing programmes of assessment”

Designing a coherent set of exams within a programme is a complex process subject to high demands and a legion of quality criteria. What it lacks, however, is support for the design process. Exams not only present a measurement problem (e.g. reliability) and an academic problem (e.g. learning outcome), they also present organisational problems (e.g. costs and logistics). A framework and 73 guidelines for designing an exam were developed and tested in practice. The guidelines are not an exact science and their application varies per situation. Exam expertise remains essential to designing high-quality exams.

Key words:

exams, curriculum design, guidelines

“The selective toxicity of acrolein”

“Highly-skilled migration and new destination countries”

This dissertation looks into the effect of government policies on the choice of a destination country for highly-skilled migrants. Highlighting the case of India, which is one of the most important emigration countries, the United States are found to persist as the single most important country in terms of study and career destinations.  In the situation when the motivation for moving abroad is exclusively limited to completion of a short-term project, be it study or work, many of the favourable options introduced in the recent versions of immigration policies to attract highly skilled migrants do not matter to a large extent. The decision to go abroad guided by professional motives and economic factors, override institutional and socio-political factors in migration decisions. Fragmentation of the European labour market and the associated lack of free movement between countries for third-country nationals remain arguably one of the serious challenges of transforming EU Member States into more attractive destination countries.

Key words:

migration, high-skilled migrants, destination countries, Europe

“Essays on Insider Trading”

“Can Remittances influence the Tenure and Quality of Housing in Uganda?”

Policy makers have not progressed on how to improve housing tenure and quality using remittances, because of varied and conflicting conclusions drawn by different authors in literature. This thesis argues that it is possible to create incentives for the targeted use of remittances for advancement of tenure and quality of housing. From a pooled-cross section analysis on sample survey data from the Uganda National Household Survey 2005/2006 (UNHS III) and 2009/2010 (UNHS IV), results show that due to significant positive correlations between remittances and the attributes of housing tenure (own and rent) and housing quality (access to utilities and physical condition of housing), remittances can be conditioned.

Key words:

policy, Uganda, remittances, housing tenure, housing quality

“Pharmacotherapeutic options in sarcoidosis; how can we improve them?”

Sarcoidosis is an immune disease that can occur in virtually any organ in the body. Although it can go away on its own, some patients experience a more serious disease progression that impacts their quality of life. Timely intervention and individual treatment is essential in this latter group. Despite the availability of a wide range of therapeutic options, good agreements are often lacking. This dissertation aims to contribute to the optimisation of pharmacotherapy for sarcoidosis patients. International recommendations for using specific medications have been drafted and a mobile application (app) for doctors has been developed. Furthermore, a start was made on offering ‘tailored therapy’ to sarcoidosis patients. The degree to which patients responded positively to medication (biologicals) was partly determined by genetic predisposition. In the future, medication will likely be prescribed on a much more individual basis using a personal profile.

Key words:

sarcoidosis, pharmacotherapy, treatment

“Flax as a bio-based biomedical textile material”

“Promoting Innovation in Latin America; What Countries Have Learned (and What They Have Not) in Designing and Implementing Innovation and Intellectual Property Policies”

This dissertation analyzes the evolution of innovation policy in Latin America and the rise of intellectual property as a domain of action for innovation policies. The dominance of the conventional approach has led to a detachment between innovation and industrial policies and to an excessive focus on intellectual property “protection” and markets for knowledge, thus jeopardizing the effectiveness of public support.  Nowadays, Latin American countries have more fiscal space, their societies are young and with new aspirations, and the global economy is undergoing major changes. Some windows of opportunities are available, but targeted interventions are needed, because markets are not generating the incentives for structural transformation. The challenge is to factor in the voices for change going beyond the existing elites to change the status-quo and set the basis for a society which should be more innovative and more inclusive in order to be more equal.

Key words:

Latin America, innovation policy, intellectual property

“Short- and long-term cardiometabolic consequences of infant growth: size matters”

“Human Migration: Myths, Hysteria and Facts”

“Towards personalized medicine”

“JAM-A: Junctional Adhesion Molecule-A or Janus Acting Mediator in atherosclerosis”

Presently, atherosclerosis constitutes one of the leading causes for patients suffering morbidity and death from myocardial infarction and stroke around the world.  Atherosclerosis is facilitated by a chronic inflammation of the vessel wall, thus investigating different cell-types of the immune system and their interactions is a valuable goal to find novel diagnostic and therapeutic strategies. Junctional adhesion molecule (JAM)-A plays an important part in crossing of blood borne leukocyte over the innermost cell-layer of the vessels, so called endothelial cells (EC). 
With this study, we investigated the role of JAM-A harbored by leukocytes, platelets or ECs on atherosclerotic lesion formation. We found differing consequences and their mechanisms on lesion formation mediated by JAM-A of different cellular origin.  As most important finding, specific intervention of endothelial JAM-A might present a worthwhile strategy for non-invasive diagnostics and tailor-made therapeutics.

Key words:

atherosclerosis, molecule (JAM)-A, endothelial cells (EC)

“Neuronal correlates of repetitive whiskers stimulation in the Neuregulin 1 mouse model of schizophrenia”

“Dissecting Anatomy Education in the Medical Curriculum”

“Management and leadership education for medical residents; evaluating needs and developing an educational intervention”

“The hallucinatory-delusional state : a crucial connection in the psychosis symptom network”

A psychotic disorder is characterised by the presence of so-called positive symptoms, i.e. hallucinations (disruptions of the sensory experience) and delusions (ideas which do not correspond with reality). At present, a high risk of developing a psychotic disorder is defined by the presence of positive symptoms, regardless of their being delusions and/or hallucinations. This PhD dissertation focuses on the role of different types of symptoms in the development of a psychotic disorder. It was found that patients suffering from hallucinations as well as delusions were more likely to develop a psychotic disorder compared to patients suffering from either delusions or hallucinations. It was also shown that people suffering from both symptoms had been exposed to environmental risk factors more often, such as childhood traumata. Furthermore, they were at higher genetic risk of developing a psychotic disorder. It is, therefore, important for psychiatric research to focus on the dynamics between different symptoms.

Key words:

psychosis, prognosis, risk, positive symptoms

“Fostering Monitoring and Regulation of Learning”

“The Sounding Museum: Box of Treasures”

The Sounding Museum, a research project by the musician, anthropologist, and museum pedagogue Hein Schoer, operates at the junction between art, science, and education, putting sound in the centre of its theoretical and practical endeavours. Based on his piece Two Weeks in Alert Bay and the Sound Chamber, an audio installation built for the NONAM (Nordamerika Native Museum, Zürich), it supplies researchers, practitioners, and audiences with an instrument to gain an acoustic image of the contemporary cultural and everyday life of the Kwakwaka'wakw, a First Nation from Alert Bay, Canada. Schoer developed a methodology, the Session Musician’s Approach, which places the researcher as an equal among his “research subjects”, the people he works with to acquire his findings. The main goal is to mediate between people from different cultures, not on a fact-based level, but on a basis of empathy.
The Sounding Museum has been acknowledged by the Swiss UNESCO Commission as a contribution to the 2010 International Year of the Rapprochement of Cultures.

Key words:

Soundscape Composition, Anthropology, Intangible Cultural Heritage, Ethnographic Museum

“Macrophage heterogeneity in neovascularization”

“Maatwerk in meten: slim scoren”

“Novel aspects of insulin resistance and type 2 diabetes mellitus: Iron metabolism, the complement system, and liver cirrhosis”

This PhD dissertation investigates three previously unknown mechanisms preventing the body from using insulin effectively (insulin resistance), which results in diabetes mellitus. Firstly, various substances involved in human iron metabolism are found to be related to a higher degree of insulin resistance as well as elevated blood sugar levels. Secondly, the complement system, a group of immune system proteins, are shown to play a role in insulin resistance. We also found that people with elevated levels of C3 proteins are more likely to develop diabetes. Furthermore, patients suffering from end-stage liver disease generally have comorbid diabetes. However, the poor prognosis in these patients prevents them from dying from diabetes. Knowledge of these three mechanisms may offer future treatment options for diabetes.

Key words:

insulin resistance, diabetes mellitus, cause

“Application and integration of the International Classification of Functioning, Disability and Health (ICF) in Vocational rehabilitation”

Work is a central part of people's lives and one of the most powerful determinants of health. A health condition can cause significant work disability and may restrict an individual's participation in work and employment. Vocational rehabilitation (VR) describes a process that enables persons with a work disability to return to or engage in suitable employment. VR involves multiple stakeholders such as health and work professionals, employers, payers and social insurances. Due to the complexity of VR, the lack of a reference framework could hamper efforts towards a common understanding of work disability and VR. The ICF model and classification  proved to be  a useful framework in VR. The development of ICF-based assessment tools could further promote the use of the ICF in VR.

Key words:

International Classification of Functioning Disability and Health, Vocational Rehabilitation, Return-to-Work, Work Rehabilitation Questionnaire (WORQ)

“Cachexia in patients with non-small cell lung cancer”

“Alzheimer’s disease through the MR-eye; novel diagnostic markers and the road to clinical implementation”

The starting point for this PhD dissertation was whether or not a brain scan is necessary to diagnose Alzheimer’s disease and which techniques are potentially useful. A European study was conducted in order to assess whether adding MRI images increases the predictive value for Alzheimer’s disease compared to a model containing only demographic and neuropsychological information. Apart from neuropsychological testing, it is desirable to obtain a hippocampal volume measurement if it is possible to carry out an MRI examination. 
Furthermore, the diagnostic value of a new imaging technique, diffusion tensor imaging (DTI), was evaluated. In a group of patients with mild cognitive impairment (MCI), differences in corpus callosum diffusion predicted deterioration after two years. In conclusion, volume loss of the medial temporal lobe structures is a candidate marker for the evaluation of the course of the disease. Although relatively new and therefore less validated MRI techniques (including DTI) are promising tools for early diagnosis (assessing the disease) in future, they need to be tested extensively and validated first.

Key words:

imaging, Alzheimer’s disease, MRI

“Robot-assisted Laparoscopic Surgery”

Laparoscopic surgery is designed to be minimally invasive for patients to ensure a faster recovery time. These surgeries, however, can be technically challenging. A surgical robot was therefore developed to assist the surgeon during the operation. 
This study tested a daVinci robot in Maastricht. The use of a surgical robot in a laboratory (test) setting led to faster and more precise suturing, among other things. Its use in the operating room, however, was less beneficial: the robot was expensive and slow and did not lead to a better surgical outcome. For now, it seems that the daVinci robot offers little added value in a surgical setting.

Key words:

laparoscopic surgery, robotic surgery

“Does bipartite return-to-work policy work ?; an evaluation based on stakeholder’s experiences in a Canadian healthcare setting”

This dissertation examines the extent to which an absenteeism policy established by employers and employees for the Canadian healthcare sector worked according to plan. Firstly, the study discovered that policymakers, policy implementers and employees all hold different views of an absenteeism policy. Secondly, the policy did not fit well with the often erratic and unpredictable progression of disease. Employees cannot foresee their own prognosis and managers struggle to properly implement policy. They lack the skills and opportunities needed to adjust the reintegration plan in consultation with the employee and the healthcare provider. Healthcare providers, on the other hand, feel they have little input in these reintegration plans and lack the necessary room and skills to provide targeted support. The Canadian absenteeism policy, in its attempt to safeguard employee rights by implementing strict time constraints and conditions, achieved the exact opposite as reintegrating employees after an absence proved more difficult.

Key words:

absenteeism policy, healthcare, work reintegration, Canada

“Pension Fund Asset Allocation and Performance”

“Exogenous interferons for the prevention of respiratory viral infections: evaluation of different aspects in vitro”

“Thrombin generation: innovations and clinical applications”

“Role or the endothelial glycocalyx in regulation of insulin sensitivity in muscle”

This PhD dissertation investigates the role of damage to the endothelial glycocalyx in patients suffering from insulin resistance. The glycocalyx is a gel-like layer that coats the luminal surface of blood vessels. Although it offers protection to vascular walls, it can be easily damaged by, for instance, elevated cholesterol levels and blood sugar levels. Damage to the glycocalyx eventually results in cardiovascular disease. This thesis finds that glycocalyx plays an important role in regulating insulin transport from blood to muscles, allowing the body to use insulin effectively. This knowledge opens up new diagnostic and therapeutic perspectives for people predisposed to insulin resistance and diabetes. Nowadays, damage to the glycocalyx in humans can be quickly and easily detected by sublingual measurements performed with a camera.

Key words:

insulin resistance, glycocalyx

“Competence development and labour market Benefits of internationally mobile students”

Students from Poland, Hungary, Latvia and France who spent the last year of their bachelor’s degree following a competency-based programme in the Netherlands achieved higher competency levels than their peers who stayed at home. After graduating at their own university and working for three years in their home countries, their competency levels remain higher but do not impact their position in the labour market. They do benefit from their time in the Netherlands in that they have more international positions with more responsibilities and a salary that is 10% higher than their fellow students who did not study abroad.

Key words:

competency level, international students, labour market

“Failure to rescue”

“Essays On Business and Financial Cycles – Prediction and Synchronization”

“Using the internet to promote a healthy lifestyle; Testing a multiple behaviour change intervention regarding reach, use, appreciation, effectiveness and cost-effectiveness”

For this dissertation, a lifestyle intervention was developed – offered online and aimed at adults from the general Dutch population – with the goal of encouraging participants to live healthier lives. This includes exercising more, eating more fruit and vegetables, drinking less alcohol and quitting smoking. Programme participants received personal advice, tailored to their answers. This targeted advice proved to be a (cost) effective way of introducing lifestyle changes. The results also showed that many participants quit the programme prematurely, demonstrating the downside of internet interventions. Effective strategies for optimising use are required to enhance the desired effect.

Key words:

lifestyle, targeted advice, internet, behavioural change, effectiveness, cost-effectiveness

“The subthalamic nucleus in Parkinson’s disease”

“Endothelial dysfunction and low-grade inflammation: Determined by diet and cause of arterial stiffness”

A healthy diet prevents cardiovascular disease from developing. Endothelium, a thin layer of cells lining the interior surface of blood vessels, plays an important role in the development of cardiovascular disease. This PhD dissertation investigates young, old, healthy and sick populations, and shows that a healthy daily diet (rich in fish, fruit, vegetables, low-fat dairy products and with moderate alcohol consumption) keeps endothelium “healthy”. This thesis, therefore, provides insight into the relation between diet and the development of cardiovascular disease and reveals the role of endothelium in particular.

Key words: 

cardiovascular disease, diet, population studies, endothelium

“Les interventions de la CEDEAO en Afrique de l’Ouest: Conséquences et Perspectives”

Since 1990, ECOWAS, a regional and economic organization has decided to take part in the settlement of conflicts and crisis which occur in West Africa. ECOWAS back up its diplomatic initiatives by military actions. But disagreement among ECOWAS leaders and pressure from lobbies are among many the main constraints sub- regional head of states are facing in their initiatives, which are not only based on the ECOWAS judiciary. but on international laws and conventions concerning peace keeping intervention. Even if West Africa’s defence and security law system is almost up- to-date, the fact is that West African leaders do not comply with it as a whole. But this compliance is necessary for ECOWAS to be able to effectively address ordinary political crisis and conflicts and mostly terrorism and piracy which really are Emerging Security Threats (EST) in West Africa.

Key words:

ECOWAS, West Africa, peace keeping intervention

“The role of EU state aid law in promoting a pro-innovation Policy; - a review from the perspective of public-private R&D cooperation”

State funding from the EU Member States constitutes an important tool to promote innovation by creating links between the industry, universities and R&D institutions. Moreover, the grant of public funds administered by universities and research institutions are decisive in the improvement of productivity and competitiveness of EU firms. In this context, the development of a legal framework that promotes an efficient use of State aid in R&D cooperation represents an important challenge for the EU.
The discussions presented in this thesis constitute a contribution to the current State aid modernization initiative and to future revisions of the Community Framework for State Aid for Research and Development and Innovation and the relevant provisions of the General Block Exemption Regulation. More emphasis is put on the need for a proper use of patents, know-how, licenses and technology transfer to enhance the positive effects of R&D State expenditure.

Key words:

State aid law, competition, Intellectual property, R&D cooperation 

“The political Accountability of EU Agencies: Learning from the US Experience”

“Mapping Israel, Mapping Palestine”

Geographic Information Science (GIS) maps are central to peace negotiations in Palestine and Israel, but they are also used to administer extensive systems of control within the Occupied Palestinian Territories. Mapping Israel, Mapping Palestineanalyzes the ways that such segregated landscapes have shaped the practice of cartography since 1967, and argues for more systematic study of the uneven impacts that material landscapes have on scientific knowledge.

Key words:

Geographic Information Science (GIS), maps, Israel, Palestine

“Het tekort; studies over de arbeidsmarkt voor mijnwerkers in het Luikse kolenbekken vanaf het einde van de negentiende eeuw tot 1974”

“Brain wiring and neuronal dynamics; advances in MR imaging of focal epilepsy”

Rolandic epilepsy is the most common epilepsy syndrome in childhood. In this type of epilepsy, seizures originate from the sensorimotor cortex. Various studies have shown that rolandic epilepsy is accompanied by language difficulties. The aim of this study was to investigate which brain connections are involved in this process. Advanced MRI techniques have demonstrated that the sensorimotor cortex is linked with certain language centres. Therefore, rolandic seizures might spread to language centres through this connectivity. Indeed, this connectivity was found to be reduced in rolandic epilepsy: the more reduced the connectivity, the poorer the language performance. This improved knowledge of brain processes involved in rolandic epilepsy enables us to explore more specific treatment options for these patients.

Key words:

Rolandic epilepsy, fMRI, MRI, brain connections, disruption of networks, learning problems, language 

“The way out”

“Predictive modeling of treatment outcome in rectal cancer”

This dissertation covers the development of smart computer programmes that can predict disease progression in rectal cancer patients. The first three studies reveal that clinical information, imaging before and during the radiation process and various substances in the blood can accurately predict whether the tumour will completely disappear after treatment. Subsequent studies show that both the recurrence risk and the patient’s long-term survival rate can be accurately predicted using only clinical information. In the near future, these predictions can help to develop a tailor-made treatment, which can help the patient avoid major surgery or an extra radiation dose.

Key words:

prediction, disease progression, rectal cancer, patients, tailored treatment

“Excusable Evil: An analysis of complete defenses in International Criminal Law”

Could Hitler have pled insanity? Should a soldier who was forced to take part in a mass execution be acquitted? Mitigating factors, such as insanity and coercion, are common in national criminal law. But what role do these play in international criminal law? Can horrific and large-scale crimes, such as war crimes and genocide, be justified? This study shows that most international courts recognise the existence of mitigating factors; however, most pleas are rejected. This finding justifies the question of whether mitigating factors and international crimes can be combined. This question is answered and several recommendations are made regarding the contents of mitigating factors in international law.

Key words:

mitigating factors, international criminal law 

“Neuromuscular electrical stimulation in dyspneic COPD patients: a new training modality”

This PhD dissertation focuses on neuromuscular electrical stimulation (NMES) and muscle strength training used as training forms for patients with chronic obstructive pulmonary disease (COPD) characterised by severe shortness of breath and muscle weakness. The effects of two different forms of NMES (high-frequency, HF-NMES and low-frequency, LF-NMES) and muscle strength training are compared with each other. In total, 120 subjects participated in this study. There was an increase in maximum muscle strength in patients in the HF-NMES group and the muscle strength training group, whereas there was no increase in the LF-NMES group. Endurance and quality of life increased in all groups. Moreover, these forms of muscle training have a minimal impact on these patients’ respiratory system.

Key words:

COPD, muscle strength training

“Zwevend en zwermend vanuit de Tuin van Akademos: Chronisch ziek of chronisch gezond … opbranden of uitdoven in de participatiesamenleving”

Thursday 10 April 2014, 16.30 hours

“The distributional impact of risk heterogeneity, risk responsibility and control”

“Physical education’s contribution to levels of physical activity in children and adolescents”

Physical education can play a potentially important role in stimulating children and adolescents to exercise more. Children spend a large part of their youths at school, where physical education is compulsory. This study shows that physical education is responsible for roughly one-third of the daily exercise requirements and that teachers could intensify this relatively easily, thereby leading to a higher contribution. An important objective of physical education is to motivate students to continue exercising throughout their lives. This dissertation proves that, as it is being offered now, physical education does not necessarily achieve this.

Key words:

physical activity, education

“Long-term care after stroke; development and evaluation of a long-term intervention in primary care”

“Structural Interventions in Invasive Cardiology”

Minimal invasive aortic valve replacement is an established treatment. Methods to reduce stroke rate and invasiveness of the apical access are investigated in this thesis. 
Left atrial appendage occlusion in the high-risk population suffering from atrial fibrillation seems to be a much more promising approach to reduce stroke rate, than the use of cerebral protection devices. 
If a transapical approach to the aortic valve is chosen, it currently consists of a surgical cut-down. We evaluated methods to reliably close the apex with a device, thereby enabling a true percutaneous access.
The research was wrapped up by a larger pathology study.

Key words:

transcatheter aortic valve replacement; left atrial appendage occlusion; stroke; transapical access; apical closure

“(Post) transcriptional regulation of heart failure”

Heart failure is the final stage of diverse forms of cardiac diseases and is reflected by a high mortality rate worldwide. Heart failure is preceded by severe pathological remodeling, including extensive hypertrophy, followed by contractility dysfunction and chamber dilation.
The mechanisms underlying the progression from compensatory hypertrophy to end stage heart failure are still incompletely understood. The studies presented in this thesis focus on a better understanding of the processes involved in pathological cardiac remodeling. We concentrate on the calcineurin-NFAT pathway, which is a crucial signaling cascade involved in adult myocardial remodeling and dysfunction. The target genes and possible modulators of this pathway were extensively investigated. Despite the progress described in this thesis, many questions still remain unresolved, including the discovery of additional players in this pathway and their involvement in the process of cardiac remodeling.

Key words:

heart failure, compensatory hypertroply, calcineurin-NFAT pathway

“Transnational networks and the common market: Business views on European integration, 1950-1980”

By comparing several business debates within the Bilderberg Group, the Trilateral Commission and the European League for Economic Cooperation, this dissertation shows how an initial enthusiasm among corporations for European market integration during the 1950s became replaced with a concern about international competitive forces and the corresponding need to adapt the European market's policies. Moreover, this investigation reveals that from the early 1950s onwards, large European businesses developed a lobby towards matters of European integration. Finally it demonstrates that the industrial lobby on the 1992 completion of the Single European Market was rooted in the struggle of European business with American investments from the early 1960s onwards.

Key words:

European market, industrial lobby, policy

“Dietary strategies to modulate the metabolic profile and substrate partitioning”

“Myeloproliferative neoplasia: more insight in the pathogenesis”​

“Making memory strategic; studies on the cognitive and biological basis of memory strategies in children and adults”

“Modern opleiden: Oude wijn in nieuwe zakken? Voor een toekomstbestendige gezondheidszorg”

“The brain speaks: functional and structural neural correlates of language production impairments in classic galactosemia”

“Life after survival of a cardiac arrest; the brain is the heart of the matter”

This study showed that cognitive disorders (e.g. impaired memory or concentration) and emotional problems (e.g. anxiety or depression) are common after cardiac arrest. These ‘invisible’ effects have a significant impact on quality of life after cardiac arrest. 
The partners/caregivers of cardiac arrest patients often suffer from emotional problems (symptoms of anxiety, depression and post-traumatic stress) and feel extremely overburdened. For this reason, a new aftercare programme was developed entitled ‘Stilstaan en Doorgaan’ (Acknowledge and Move On), a compact intervention offered by a specialised nurse shortly after the patient is discharged from the hospital. In one to six meetings with patients and their partners, the nurse identifies any cognitive or emotional problems and offers information and support. If necessary, the patient is referred to a specialist. 
This new intervention proved extremely effective: the patient’s emotional wellbeing improved, they returned to work sooner and enjoyed a higher quality of life.

Key words:

cardiac arrest, emotional and cognitive effects, diagnosis, treatment

“Diagnostic tools for early evaluation of total hip performance; studies on preclinical and clinical monitoring of implant quality”

Although total hip joint replacement has proven to be a successful and cost-effective treatment of degenerative arthritis of the hip joint from both a patient’s and societal point of view, many new implant designs failed mainly due to a hasty introduction to the market without first conducting proper research. This resulted in loss of goodwill towards orthopaedics and a reorientation on scientific integrity and patient safety. Rules on how to introduce new prostheses in a reliable manner were defined as well as guidelines for diagnostic techniques for monitoring the quality of prostheses.
This PhD dissertation evaluates the usefulness of hip scores, patient reported outcome measures (PROMs), radiography, scintigraphy, bone density measurements, histology and research into migration in studies comparing old and new implant designs with each other. This dissertation also investigates the role of computer simulations as a guideline for improving implant designs. Recommendations are being made for introducing new prostheses to the market more safely. 

Key words:

hip prosthesis, quality, diagnostic techniques, guidelines

“The great psychotherapy debate”

“Proteomics investigations; towards mechanisms and biomarkers for drug-induced hepatotoxicity”

“The relevance of Earnings Information: A Multi-User perspective”

This dissertation describes various methods of reporting business profits. The reported profits are extremely important to investors when assessing a company. An initial study examined how the investors’ reactions to profit reports changed after companies entered the stock market. It also revealed that, while reactions to profit reports increased the longer these companies remained on the market, there were significant developmental differences between the companies. A second study examined how financial analysts – an important source of profit-related information – collect more industry-specific information when the competition had more and better-informed (institutional) investors. In addition to accurate profit reporting, managers also have the opportunity to manipulate these by making strategic accounting decisions and changing the operational activities. A third study sought to develop a better research standard for identifying profit manipulation by changing the investment level.

Key words:

reporting business profit, investor knowledge, profit manipulation 

“Improving care for patients with rheumatic diseases”

This dissertation describes examples of healthcare improvements for various chronic rheumatic disorders. The first section describes a randomised study exploring the effects of a new and intensive multidisciplinary treatment and aftercare for patients recently diagnosed with fibromyalgia (a pain disorder). Given the minor differences between the group that received the new treatment and the group that did not, we were unable to conclude that the treatment was more (cost) effective. Furthermore, given the discrepancies between the patients involved, we believe this treatment should be further tailored.

The second section describes the development and evaluation of an international standard for nursing care in patients with arthritis. While nurses play an important role, there are major international differences in terms of their tasks and responsibilities. This leads to undesirable differences in the quality of care. Widespread support for standardised care justifies the investments required for further implementation.

Key words:

chronic rheumatic disorders, healthcare

“Translational research on spinal cord injury and cell-based therapies; a focus on pain and sensorimotor disturbances”

“Partial flap loss and fat necrosis in autologous breast reconstruction”

“Anatomical, radiologica land clinical findings on perforator flaps”

“De lokale staat”

“High risk newborns and brain biochemical monitoring” 

“Dopamine mechanisms in learning and memory: Evidence from rodent studies”

“Don’t pay attention to high-calorie foods for a healthy Weight: Attention bias for food and the desire to eat”

Does looking at food influence your eating behaviour? Our environment contributes to the increasing obesity prevalence because we are constantly surrounded by tempting foods. However, individuals differ in their susceptibility to this environment - not everybody is obese. We tested if preferentially looking at tempting, but unhealthy food is related to eating behaviour and weight. Six laboratory studies showed that biased attention for food is related to food intake, BMI differences in adults and weight change in obese children who participated in a lifestyle intervention. Thus, attentional bias for food is a psychological factor related to overeating and obesity.

Key words:

Obesity, attention bias, overeating, weight change, cognitions, eating behaviour

“Processing of natural sounds and scenes in the human brain”

Voor het onderzoek dat in dit proefschrift wordt beschreven, zijn natuurlijke geluidsstimuli en muziek gebruikt in combinatie met beeldvorming van de hersenen, om te onderzoeken: 1) hoe we geluiden waarnemen in een natuurlijke omgeving en 2) hoe onze hersenen relevante geluiden uit de mengeling van overlappende geluiden oppikt. Onder andere is aangetoond dat neurale geluidsvoorstellingen in gehoornetwerken in de superieure temporale cortex cruciaal zijn voor zowel de bottom-up verwerking van spectrale en tijdelijke relaties van de akoestische omgevingselementen als de top-down processen van het aandachtig selecteren en vergroten van de relevante geluiden. Deze ontdekkingen geven inzicht in de neuro-computermechanismen die ons in staat stellen geluiden tijdens het dagelijks leven te herkennen. In de toekomst zal de bouw van kunstmatige systemen die de hersenen nabootsen, leiden tot verbeterde gehoorapparaten.

Key words:

natural sounds, music, fMRI, MEG, brain, human audition

“Stamcellen: bright side, dark side”

“Evaluation of speed of sound aberration and correction for ultrasound guided radiation therapy”

For radiation therapy treatments, cancer patients must be accurately positioned to achieve optimal radiation delivery. Ultrasound is an imaging modality which can help perform this operation. To this end, it must be quantitatively reliable. In this work a correction for an imaging error, due to the wrong assumption that speed of sound has a constant value in human tissues, is presented. Local speed of sound values can show important variations, instead, and we calculated these values from the physical density inside the patient. When applied, the correction allows better localization of the treatment target (the tumor) and better sparing of surrounding healthy tissues.

Key words:

radiation therapy, ultrasound

“PRODUCTIVE FANDOM; Intermediality and Affective Reception in Fan Cultures”

Fans and gamers do more than just couch-surf: pop culture demands an increasing degree of participation via social media and platforms. Fans have been around for centuries and what they share is a strong social and creative culture that takes place online and offline at fan conventions and other events. Fans can also be extremely productive. They write their own stories based on films and television shows such as Glee and design their own costumes based on video game characters. Productive fandom is the result of an extensive ethnographic research study, which reveals that pop culture is not only created by media moguls, but is also intimately connected to the audience itself.

Key words:

gaming, fans, subculture, ethnography

“The Cultural Complexity of problem-based learning across the world”

Problem-based learning (PBL) is a popular student-centred teaching method in which students guide their own learning process in small groups. PBL is becoming increasingly popular in institutes of higher education around the world. However, the cross-cultural applicability of PBL is being called into question by the cross-cultural differences in the Western educational standards and values that characterise PBL. This dissertation describes the cross-cultural applicability of PBL and concludes that it is particularly challenging in non-Western contexts. Various cross-cultural differences have been identified in terms of how and what students learn in terms of communication and lifelong learning skills, for example. PBL is not the best choice for all faculties worldwide. That being said, when PBL is implemented properly, students are better equipped to handle practical situations in various cultural contexts compared to more traditional teaching methods.

Key words:

problem-based learning, cross-cultural research

“An interdisciplinary primary care approach for frail older people feasibility, effects and costs”

Our greying population and our increasingly extramural healthcare system will put increasing pressure on primary care in the coming years. The interdisciplinary primary care programme Zorg uit Voorzorg was designed to support vulnerable older people in their independent daily functioning at home. This dissertation explored the efficacy, cost-efficiency and practical feasibility of Zorg uit Voorzorg. The results reveal that the programme is highly valued by older people and healthcare providers, but has yet to achieve the desired effect. Further research on identifying and supporting this vulnerable section of the population is highly recommended.

Key words:

elderly, vulnerability, primary care, daily functioning

“About the (dis)continuation of fertility treatment”

Couples with an unfulfilled desire to conceive can begin a course of treatment if this is expected to increase their chances of conception. This dissertation examined various components in this treatment process, with the goal of identifying resources to optimise healthcare. A high dropout rate was found after analysing the follow-up results of a cohort on the IVF waiting list. This dropout rate did not lead to an overestimation of the reported treatment results. Various models used to test ovarian reserve were compared to determine who should receive treatment. The antral follicle count alone proved just as reliable as the use of multivariate models.

Key words:

fertility, IVF, ICSI, pregnancy

“Management of midtrimester prelabour rupture of membranes”

“Preterm prelabor rupture of membranes: different gestational ages, different problems”

This dissertation describes the issues surrounding the preterm rupture of membranes (PROM) during pregnancy. PROM is particularly risky for the unborn child, but can also affect the mother’s health in the event of infection. This study examined the neurological and behavioural development of toddlers born to mothers who presented with PROM between weeks 34 and 37. A policy of expectant management was the most effective strategy for newborns; however, a slight preference for induction was preferred for toddlers, given the increased risk of developmental problems.

The study also found an increased risk for adverse pregnancy outcomes in extreme cases of PROM (<27 weeks). The diagnostic methods currently available for detecting the preterm rupture of membranes (blood tests and ultrasounds) proved to be poor predictors.

Key words:

pregnancy, preterm rupture of membranes, risks

“The role of accounting and market-based information signals in the bond market”

“Kidney transplantation form donors after cardiac death”

“The highs and lows of drugs use: acute effects of cannabis, cocaine and MDMA on impulsivity, cognition and subjective experience”

This study focuses on the acute effects of drugs such as cannabis, cocaine and MDMA (XTC) on impulsivity and cognitive functioning. The results of this dissertation demonstrate that MDMA has no effect on impulsivity. Regular cannabis users became more impulsive under the influence of both cannabis and cocaine; however, in which way this happened differed. This suggests that these addictions also differ and should be treated differently.

Cannabis, cocaine and MDMA had a significant effect on positive and negative moods. MDMA’s positive effect on mood was cancelled out by blocking the 5-HT2 receptor. This means MDMA could be useful in treating post-traumatic stress disorder because stimulating this receptor enhances social feelings and interaction with the therapist.

Dissociative and psychedelic experiences increased in cannabis and cocaine users. This increase was primarily perceived in participants with impulsive personalities, which could explain why impulsive people are more likely to develop addictions.

Key words:

drugs, effects, cognitive functions

“More Bureaucracy or more Democracy: The EU at an 'unrepresentative turn?'”

“Fetal development after antenatal exposures: Chorioamnionitis and maternal glucocorticoids”

In the Western world, nearly 13% of all children are born prematurely. Preterm birth causes 75% of neonatal deaths. Causes of preterm birth include chorioamnionitis, an infection of the amniotic fluid and placental membranes. By using a sheep model, this PhD dissertation studied how chorioamnionitis can affect foetal lung and brain development and the foetal immune system, and how these effects can contribute to neonatal diseases after birth. This study shows that exposure to chorioamnionitis can result in an underdevelopment of lung structures and thyme and splenic changes, inducing some sort of chronic inflammation which inflicts even further damage. The foetal brain suffers damage as well, which may result in neurological complications. By a better understanding of the way chorioamnionitis disturbs organ development, more specific therapies can be tested next to halt this development or to reduce the inflammation and its damaging effects.

Key words:

preterm birth, chorioamnionitis

“Ultra low-field strenght intraoperative MRI for Glioblastoma Surgery”

This PhD dissertation evaluates the added value of brain scanners used in operating rooms to the treatment of malignant brain tumours. This study aims to investigate various aspects of this treatment method. Firstly, it focuses on the reliability of volume measurements to determine the extent to which tumour resection has been achieved. Secondly, it addresses the question to what extent tissue abnormalities detected by intra-operative scanning actually correspond with tumour tissue.  Furthermore, this thesis describes an interim report of a study comparing this treatment method using a scanner to the standard treatment method. This thesis finds that these (expensive) scanners appear to be of little added value to the treatment of this type of tumours. Therefore, it is not necessary for other centres to purchase them.

Key words:

hersenscanner, behandeling hersentumoren

“Free as a bird?; the effect of choice restrictions on Consumer decision making”

Almost every decision that an individual makes is—in one way or the other—restricted. They can be internal,   (e.g., dieting restrictions) or external (e.g., limited assortment variety in supermarkets). We focus on the impact of such choice restrictions on consumer decision making. Specifically, we show that dieting increases individuals’ need for variety when selecting food. Further, we demonstrate that—for dieters—repeated exposure to pictures of skinny models can result in weight gain rather than loss. Finally, we highlight that mere exposure to images (e.g., advertisements with limited variety) that signal restricted choice prompts individuals to seek variety (e.g., choose many different candy bars) in a subsequent decision This dissertation is of practical relevance to various different parties—brands and retailers as well as the government and organizations concerned with human well-being—in the marketplace.

Key words:

choice restriction, dieting, thin models, variety-seeking behavior, assortment variety

“It’s in the way that you use it; usage behavior, sales performance, and their Interrelationships” 

In this dissertation big data and advanced econometric methods are used to analyze the digital traces of product and service usage.  In one study the effectiveness of free-trial promotions to acquire new customers is examined. Customers attracted with free trials (e.g., three-month trials for digital TV), churn earlier and use core parts of the service less than regular customers (e.g., TV or video-on-demand usage), yet respond stronger to marketing communication, offering ways to improve their value.  In a second study, the author addresses the rapid digitization of the entertainment industry. One of the conclusions here is that online music piracy cannibalizes sales. However, piracy also fosters consumers’ engagement with artists so that some pirates will buy in the future, reducing the negative effect of piracy about 55%.

Key words:

digital traces, costumers’ usage, data analyzing, marketing communication

“The Nature and Consequences of School Choiche”

In a school system like the Netherlands, where school choice is free, parents can choose the school that they believe provides the best education. This doctoral thesis investigates how parents choose schools and how school quality influences the cognitive development of children. The results firstly suggest that free school choice might not only foster competition, but also provide incentives for schools to specialize to meet the demands of a heterogeneous society. Secondly we show that in particular children with lower initial levels of cognitive ability benefit from attending a school with higher CITO scores.

Key words:

school choice, cognitive development, CITO scores, peer effects

“Integrating personalised perspectives into Child and Youth Health Care: A long and winding road?"

With the current boom in the basic sciences, especially those linked to human genome, it is important to ensure that all branches of health care benefit from it. The thesis focuses on the pathway of translation of innovations into Child and Youth Health Care (CYHC). The first step of introduction of genome advances could be of use for family history as it combines information about both: environment and genetic profile of the child. If such information becomes more widely used it could facilitate not only early detection of diseases (esp. psychosocial ones), but also assist in prevention strategies. In the last part of the thesis attention is paid to the current crisis of trust between parents and CYHC physicians, which is partially caused by the current reforms in the sector) and the possible directions for improving the situation.

Key words:

human genome, innovations, Child and Youth Health Care

“Identification and regulation of (novel) human adipokines; A proteomic approach”

“Application of toxicogenomics to study direct immunotoxicants”

“Childhood obesity prevention; Rationale, implementation and effectiveness of the Lifestyle Triple P intervention”

This PhD research, too, shows that parents play an important role in the development of childhood obesity. Parents of obese children are often unaware of their child’s overweight, and they experience more problems raising their children. Children who are raised with both strict and involved styles eat healthier, are more physically active and weigh less. Furthermore, an intervention to prevent further weight gain in obese children (Lifestyle Triple P) was evaluated. This intervention is based on the Positive Pedagogic Programme (Triple P) and is aimed at parents of obese children aged 4–8 years. Half of the 86 families participating received the intervention, which included group sessions and individual sessions by telephone addressing three themes: parenting, nutrition and physical exercise.  The control group only received brochures on these themes.  Although the intervention showed positive effects on both children and parents’ behaviour, such as soft drink consumption, it proved to be ineffective in reducing further weight gain.

Key words:

children, obesity, lifestyle intervention

“Screening modalities for colorectal cancer: Results from a workplace based cohort in the Netherlands”

Population screening by means of the faecal occult blood test (FOBT) was launched in the Netherlands in January 2014, making colorectal cancer screening a highly topical subject. Early detection of tumours and their pre-stages (intestinal polyps) by means of the faecal test and coloscopy can dramatically reduce the incidence and mortality of colorectal cancer. In the Netherlands, 2400 lives could be saved. This dissertation investigates the feasibility and diagnostic benefits of screening via colonoscopy in a defined population group. It also evaluates alternative screening methods, such as an immunological FOBT (FIT), lifestyle/risk factors and sigmoidoscopy. Further, faeces and blood were collected to identify and evaluate non-invasive markers for adenomas and/or colorectal cancer, as it is important to minimise patient discomfort and stress during examinations as far as possible.

Key words:

colorectal cancer screening, colonoscopy, FOBT, sigmoidoscopy

“Physiotherapy in shoulder impingement syndrome” 

“The epithelial-dendritic cell interface in pulmonary disease”

Asthma affects millions of people worldwide, and the incidence of this multi-faceted syndrome continues to rise. This thesis investigates the role of airway epithelial cells, which first encounter inhaled particles and pathogens, in the modulation of immune cell activities. The results demonstrate that specific airway epithelial signaling molecules orchestrate the downstream responses of innate and adaptive immune cells, thereby regulating pulmonary inflammation, the development of allergic asthma, and even the response to corticosteroids, a common treatment for asthma. This suggests that manipulation of a single cell type in the lung could have multiple effects for the control of pulmonary disease.

Key words:

asthma, airway epithelial cells

“Let’s talk about sex! Sexual health and sexual dysfunction among adolescents”

In research and practice, sexual dysfunctions (SDs) among young people (for example pain during sexual intercourse, erection problems et cetera) are not often associated with sexual health. This PhD dissertation focuses on evaluating and increasing young people’s knowledge of SDs, describing potential relationships between disgust and SDs, and treatment options for young people suffering from SDs. Results show that discussing SDs is still taboo, and current treatment options are not sufficient to help young people. A new treatment method called “Brief Sex Counselling” could provide a solution.

Key words:

young people, sexual health, sexual dysfunction, knowledge, treatment  

“Surface electrical stimulation of the neck for oropharyngeal dysphagia in Parkinson’s disease: therapeutic aspects and reliability of measurement”

This PhD dissertation describes a randomised controlled trial evaluating surface electrical stimulation therapy of the neck for oropharyngeal dysphagia in idiopathic Parkinson’s disease (IPD) and intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. 
The methodological designs studied showed no significant effects of this form of therapy. Apparently, this form of therapy does not improve swallowing function in IPD. This thesis reports positive effects of logopedic swallowing rehabilitation. However, it is necessary to study the exact content, frequency and duration of swallowing rehabilitation in order to be able to design a clinical decision-making model for treatment options in this patient population.

Key words:

electrical stimulation therapy, oropharyngeal dysphagia

“Small fiber neuropathy and sodium channels; a paradigm shift”

Small fiber neuropathy, a disorder mainly affecting the small nerve fibers of the skin, can result in neuropathic pain (pain originating in the nerve system) and autonomic disorders in which automatic functions such as heart rhythm or sweat patterns are abnormal. There is increasing evidence of an underlying hereditary cause. This PhD dissertation has conducted research into the SCN9A gene, which encodes the voltage-gated NaV1.7 sodium channels. Various mutations in this sodium channel gene are found to cause neurons to become hyperexcitable, stay open longer or fire excessively. Furthermore, functional effects of channel mutations are shown to depend on the cells in which these mutations occur. The results offer an explanation for the symptoms of small fiber neuropathy and a lead for the development of new therapies.

Key words:

small fiber neuropathy, hereditary, SCN9A gene

“Alles van Waarde is Weerloos …”

“Bone imaging and strength in chronic obstructive Pulmonary disease”

Chronic obstructive pulmonary disease (COPD) is a lung disease predominantly caused by smoking. COPD patients often suffer from osteoporosis and arteriosclerosis.  This PhD dissertation describes a new method for the assessment of osteoporosis on chest computed tomography. Chest computed tomography is also used to assess arteriosclerosis. The study results show a relation between osteoporosis and arteriosclerosis. They also show that arteriosclerosis is an accurate predictor of death.  This thesis finds that chest computed tomography provides information not only on pulmonary disorders, but also on non-pulmonary disorders, such as osteoporosis and arteriosclerosis.

Key words:

COPD, CT scan, osteoporosis, arteriosclerosis

“The Role of biomarkers in preclinical and prodromal Alzheimer’s disease”

This dissertation investigates how abnormalities in proteins in the cerebrospinal fluid and atrophy on brain scans can best be used in diagnosing Alzheimer’s disease in people without dementia and in predicting the course of the disease. The results show that such abnormalities and atrophy, both individually and combined, are good predictors of deterioration in mental capacity in cognitively normal elderly people and in elderly people with mild cognitive impairment. In addition, the severity of the abnormalities predicts the rate of cognitive deterioration. Further research into the relative importance of abnormalities in proteins in the cerebrospinal fluid and atrophy on brain scans is needed to ensure optimal use of these measures in clinical practice.

Key words:

Alzheimer’s disease, cognitive disorders, diagnosis, biomarkers

“Crossmodal effects on texture perception and Processing”

Not much is known about the representation of visual and tactile texture information in the brain. We aimed to investigate how physical texture characteristics are represented in the brain when they are explored by touch and vision and what the effect of perceptual judgments are on the representation of texture information in the brain. The results showed that visual and tactile texture information interact not only at the perceptual but also at the cortical level, already at an early processing stage. Furthermore, the findings indicate that the cortical processing of surface textures depends on the focus of attention, e.g. whether we judge the roughness of a texture or its spatial density. Understanding the influence of visual information on the processing of tactile textures might have perceptual relevance for applications of virtual environments.

Key words:

surface texture, representation, brain

“The Value of Optical Coherence Tomography in Anterior Segment Surgery”

“Feelings of cancer risk; Moving beyond the traditional cognitive approach”

The decision to adopt a healthier lifestyle often depends on, among other things, cognitive probability beliefs about contracting a disease (“How big are my risks of getting lung cancer if I keep smoking?”). However, affective probability beliefs also play an important role. That is why in daily life people often say they know they have a certain risk of getting a disease, but they have a feeling that it won’t come to that and vice versa. The findings of this PhD dissertation show that affective probability beliefs have a stronger impact on people’s health behaviour than cognitive probability beliefs. It is shown that narrative messages may be more effective in appealing to these feelings of risk than the often rational approach of current risk communication messages.

Key words:

Risk perception, cancer prevention, feeling versus thinking, explanation of behaviour, health education 

“The Fracture Liaison Service: From risk evaluation towards risk reduction?”

This PhD dissertation investigated the timing and risk factors for a subsequent non-vertebral fracture and death in patients who sustained a recent initial non-vertebral fracture. A comparison of patients who were evaluated and treated at the Osteoporosis Outpatient Clinic (= Fracture Liaison Service=FLS) to patients who were not treated at the FLS showed a reduction in mortality by 33% and a reduction in subsequent non-vertebral fractures by 35%. An evaluation of 5 FLSs in the Netherlands showed that osteoporosis specialist nurses play a central role. It also indicated that, despite one guideline, the FLSs differed in the performance of patient selection, clinical risk factors and prevalence of clinical risk factors. The results of this thesis suggest that implementing a FLS is of clinical importance, and more concrete and standardised guidelines are needed to organise evaluation of patients at the time of fracture in daily practice.

Key words:

non-vertebral fracture, risk factors, FLS

“Willingness to pay for physician services in Ukraine and other central and eastern European countries: application of stated preferences techniques to the assessment of patient charges”

In this dissertation, experimental techniques are being used to elicit stated preferences for physician services in six Central and Eastern European countries: Bulgaria, Hungary, Lithuania, Poland, Romania, and Ukraine.  Information about patients’ willingness to pay helps to understand how the introduction of formal patient charges would affect the use of physician services in these countries. The study also provides evidence on what health care consumers are willing to pay for and how this willingness varies across countries and between population groups. The results suggest that official patient charges are an acceptable policy tool if quality and access improvements are made.

Key words:

Central and Eastern Europe, physician services, payment

“How relations, time & size matter in medical education”

Maastricht University offers a learning format called Problem-based learning (PBL), which allows students to learn collaboratively within working groups comprising approximately 10 students. This PhD dissertation describes collaborative learning among students both inside and outside the formally organised university activities, and investigates ways to improve collaborative learning processes. Nowadays, the Maastricht University Medical School enrols approximately 300 students yearly. As a consequence, students who are not familiar to each other participate in collaborative learning groups. This is contradictory, as it is common knowledge that, for instance, knowing someone’s communication style results in more effective collaboration. For that reason, a group of medical students enrolled in a curriculum year were divided into two small subgroups comprising 50 students each, and one large subgroup comprising 200 students. The groups which change every course period again were only composed of students allocated to the same subgroup. The study shows that collaboration between students allocated to the two small subgroups was more effective. Therefore, it is well-advised to divide a large group of students enrolled in a curriculum year into smaller subgroups, which is a simple and inexpensive way to improve collaborative learning processes.

Key words:

medical education, PBL, collaborate

“A place called home; The role of identification in the post-dissolution phase of a customer relationship with a place brand”

This dissertation describes the cognitive process of identification with place brands and its effects on behaviour. More and more places are engaging in branding efforts in order to attract prospective
residents but struggle when it comes to the application of product and services marketing
tools to the context of place branding and the role of residents in the branding process. The results of this research show thatthe cognitive process in a place branding context is differently structured than in the context of products and services  Furthermore inhabitants can function as place brand ambassadors even if they no longer live in a place.

Trefwoorden:

place branding, identification, relationship marketing 

“Sleep problems in individuals with genetic disorders associated with intellectual disability”

Although the prevalence of long-term sleep problems in individuals with intellectual disabilities is high, these problems are generally underdiagnosed. The ability of a questionnaire to assess sleep problems was studied. The prevalence of sleep problems in three syndromes, namely Cri du Chat syndrome, Jacobsen syndrome and Prader-Willi syndrome, and associated variables were studied by using this questionnaire. Although the prevalence of sleep problems is high, it is not higher than the prevalence in individuals with intellectual disabilities not associated with a genetic syndrome. Respiratory disorders are a risk factor requiring further research. It was the first time a systematic survey into sleep problems was carried out in patients with Jacobsen syndrome.

Key words:

sleep problems, Cri du Chat syndrome, Jacobsen syndrome, Prader-Willi syndrome, intellectual disability

“Aging in a society in transition: socioeconomic conditions, health status, social networks and social participation of older people in the Republic of Kosovo” 

“Het geluid van gisteren; Waarom Amsterdam vroeger ook niet stil was”

This dissertation is about noise as part of daily life in Amsterdam at the end of the 19th and the beginning of the 20th centuries. Noise that may or may not have been intentionally made, and noise that caused commotion and evoked discussion and actions taken to change it. The reason for this research is the following paradox: we know very little about noise in earlier cities and about the role that it filled in daily life, and yet we assume that cities are growing continually noisier because of growth, industrialisation and technologisation. The dissertation shows that the sound of the city changed a lot in these 70 years, but it is not possible to translate these changes into more or less silence in Amsterdam.

Key words:

city noise, noise, sound studies, history, city history

“School Choice, Competition and Achievement; Dutch compulsory education’’

This PhD dissertation investigates school choice and competition within the Dutch primary and secondary educational system, especially in relation to student and school performance. The main findings can be summarised as follows: there are few differences in performance levels between different types of schools (i.e. special and public); the freedom of choice and competition in the Dutch system lead to higher academic performance, especially for students who score lower than average (this is not true for relatively high-performing students); and the Dutch system appears to be aimed at limiting educational disadvantage. Further, diversity promotes product differentiation in educational demand. Finally, it is concluded that free school choice in the Netherlands leads to tension between private and societal educational goals, which emphasises the importance of regulation in the educational system.

Key words:

school choice, student and school performance

“Neural Coding of Speaker Identity – Methodological and Empirical Contributions”

In everyday life, we recognize a familiar voice even when being at a crowded café, bustling station or busy street. As effortless and easy this skill might appear, we still don’t understand how our brain does it and, so far, no technical device comes close to human performance. In our research project we used MRI and EEG together with newly developed analyses and visualizations to examine patterns of brain activity. Our results suggest that the human brain represents the identity of a voice already after 200-300ms at early stages of the processing hierarchy. Learning more specifically how this is realized might give rise to better, more reliable hearing aids or implants.

Key words:

neural coding, speaker identity, brain, MRI, EEG

“HLA-DP and HLA-E: Targets for Transplantation Immunity”

Although stem cell transplantation is important in the treatment of blood cancer and blood disorders, it is still accompanied by many complications. In order to prevent complications as much as possible, patients and donors are matched for HLA-A, HLA-B, HLA-C, HLA-DRB1 and HLA-DQB1 alleles. Unfortunately, 30–40% still have a rejection response against the patients’ cells, called Graft-versus-Host disease (GVHD). This PhD dissertation shows that HLA-DPA1 can influence the degree of immune activation, and plays a role in the development of GVHD after stem cell transplantation. Furthermore, we have shown that differences in HLA-E between patients and donors increase the risk of GVHD, and HLA-E genotypes can serve as predictive markers of GVHD and infections. This PhD dissertation emphasises the fact that both HLA-DP and HLA-E play a relevant role in the transplantation-related immune response, which underlines the importance of including these molecules in the selection of stem cell transplantation donors.

Key words:

stem cell transplantation, HLA

“Platelet procoagulant acitivity: focus on calcium entry and phospholipid scrambling”

“Clinical dilemmas in sentinel node biopsy for breast cancer”

The sentinel node biopsy (SNB) was introduced in the early nineties as a less extensive alternative to axillary lymph node dissection, in which all axillary lymph nodes are removed, in order to assess whether breast cancer has spread to local lymph nodes. The introduction of the sentinel node biopsy resulted in some clinical dilemmas. When a more extensive examination of the sentinel lymph node is carried out, a larger number of small axillary lymph node metastases are found that are in itself not a sufficient reason to give adjuvant chemotherapy, as descriptive research has shown.  Furthermore, this PhD dissertation shows that repeat sentinel node biopsy in patients with recurrent breast cancer is technically feasible and accurate. The information derived from the repeat SNB leads to a change in treatment strategy in 1 in 6 patients, and more than half of the patients can be spared an axillary lymph node dissection with its accompanying risks.

Key words:

breast cancer, sentinel node biopsy

“Diagnostic challenges during the Dutch Q fever outbreak”

Between 2007 and 2009, the world’s largest Q fever outbreak occurred in the Netherlands. Due to the increase in the number of requests and the persistent nature of the epidemic, diagnosis proved to be complex. This PhD dissertation describes a new diagnostic directive that now leads the way in detection of chronic Q fever. The diagnosis takes into account not only microbiological data, but also radiological and clinical data. On the basis of this directive, patients are divided into three groups with different suggested treatments: proven (treatment with antibiotics), probable (treatment with antibiotics is discussed) or possible (no antibiotics, a 3-month check) chronic Q fever.

Key words:

Q fever, diagnosis, treatment

“Cognition, culture, and credibility; Deconstructing Feedback in Medical Education”

Feedback sounds so simple: provide learners with information about their performance, highlighting strengths and areas for improvement, and they will move forward with enlightenment and a clear path for their development.  The reality of feedback, though, is far from straightforward.  Why does some feedback become profoundly influential for learners, while other feedback is discarded as meaningless?  What can medicine learn about feedback from other fields, such as music, sports, and teacher training?  In exploring these questions, we define how individuals and their learning environment interact to influence feedback, and we offer concrete guidance to strengthen medical education’s approach to feedback.

Key words:

medicine, teaching, feedback

“Tinnitus; assessment of quality of life & cost-effectiveness”

In the Netherlands, approximately 60,000 people suffer from disabling tinnitus (ringing in the ears). This PhD dissertation evaluates the impact of tinnitus on health-related quality of life and costs, by conducting a clinical study in which (cost) effectiveness of specialised cognitive behaviour therapy was compared to conventional audiological sound therapy. Baseline data showed that tinnitus has a considerable impact on health-related quality of life and costs. The average ‘cost of illness’ to society was €6.7 billion, or €5,315 per patient per year. Analyses using follow-up data showed that cognitive behaviour therapy resulted in a significant improvement in quality of life. Furthermore, this form of therapy was found to be more cost-effective than conventional sound therapy.

Key words:

tinnitus, quality of life, costs, treatment

“Ethanol and intestinal barrier: human intervention and Mechanistic in vitro studies”

“The role of coagulation factor XII in fibrin clot formation and fibrinolysis”

“Cognitive function in patients with cerebral small vessel disease”

The prevalence of cognitive problems is increasing due to population ageing. High blood pressure is one of the risk factors contributing to small blood vessel damage in the brain, which may result not only in strokes, but also in memory problems and problems with speed of thinking. This PhD dissertation shows that even a slight increase in brain damage has an impact on cognitive functioning. Furthermore, we have found that an increase in the number of manifestations of brain damage is accompanied by impaired cognitive performance. These results suggest that patients with cardiovascular risk factors, such as high blood pressure or heart failure, should undergo more extensive neuropsychological testing.

Key words:

brain damage, cognitive problems, cardiovascular risk factors

“Een overpeinzing over pijn: Revalidatieonderzoek in de praktijk”

"Improving decision making processes in intellectual disability care; Systems Thinking and problem Structuring Techniques to Support Stakeholders’ Engagement in Decision Making” 

“Bayesian Optimal Designs of Binary Repeated Measurements”

Research budgets are shrinking, which makes cost-effectiveness of health research itself an important topic. Effects of risk factors and treatments can be evaluated more accurately by increasing the sample size (number of respondents or patients studied) and/or the number of repeated measures per person, but both also increase the study costs. Optimizing a research design can save costs without sacrificing quality. By combining two fields of mathematical statistics, i.e. optimal design and Bayesian statistics, this research addresses the question of the optimal number and timing of repeated measures of a binary health outcome, such as being ill yes/no, or being a smoker yes/no, under costs constraints. The results and practical guidelines in this dissertation are helpful for medical and health research because the study costs as well as the risk of overlooking meaningful effects of a binary health outcome can be reduced by using optimal designs.

Key words:

Optimal design, Bayesian statistics, binary health outcome, cost constraints, repeated measures.

“Identity, Interaction, and Power. Understanding the affordances of doctor-student interaction during clerkships”

Although medical students doing their clinical rotation are provided with an authentic environment in which they can develop into doctors of medicine, the extent to which these settings  offer them learning experiences varies widely. This PhD dissertation explains by two different clinical rotations how both the learning process and supervision of students are embedded in social interaction. It is shown that, among other things, the duration of and the degree of equality and inequality in doctor-student relationships affect the students’ opportunities for personal growth. In future, the challenge will be to provide students with continuous supervision as much as possible and to reduce disadvantages of hierarchical structures in clinical rotations.

Key words:

clinical rotations, learning, doctor-student relationship

“Fetal inflammatory injury as origin of long term disease: Lessons from animal models”

“Reach out and Touch? Improving reach and use of an Internet- delivered lifestyle intervention”

This PhD dissertation focuses on optimising reach and use of an internet-delivered computer tailored lifestyle intervention aimed at physical activity, fruit and vegetable consumption, smoking behaviour and alcohol consumption. 
We used a proactive dissemination strategy to increase reach and first use of an internet-delivered computer tailored lifestyle intervention, by embedding the intervention in an existing online health monitoring system of the Regional Public Health Services in the Netherlands. Although the employed proactive dissemination strategy succeeded in ensuring high levels of reach, participation by at-risk groups in the intervention programme fell behind. 
We studied repeated use of the intervention by focusing on initiation and completion of an intervention module. Although it was shown that the intervention was able to attract participants who may benefit from a lifestyle intervention, exactly these participants often failed to complete the modules. Furthermore, it was shown that sending a periodic email prompt had a positive effect on repeated use of the intervention. Sending an email prompt after two weeks had a significantly stronger effect than sending an email prompt after four or six weeks.

Key words:

Leefstijlinterventie, internet, bereik, gebruik

“Monte-Carlo Tree Search for Multi-Player Games”

Abstract games have been steadily gaining popularity since the advent of artificial intelligence in the 1950s. This is thanks to their high degree of complexity and their clearly defined rules. Much of the research has focused on two-player games, such as chess, checkers and Go. This dissertation examined the application and improvement of the Monte-Carlo Tree Search (MCTS), a search technique used in multi-player games. With the proposed improvements, an MCTS-based program would be capable of significantly stronger play and perfect information in various deterministic games and in the hide-and-seek game Scotland Yard.

Key words:

Monte-Carlo Tree Search (MCTS),  spelen voor meer dan twee spelers

“HPV infection and integration in oropharyngeal Squamous cell carcinomas”

“Taxation of Cross-Border Provision of Services in Double Tax Conventions between Developed and Developing Countries: A proposal for new guidelines”

“The European Parliament – A giant with feet of clay?”

“Contribution of cellular microparticles to pre-thrombotic states”

“Novel factors and mechanisms in control of CD36-mediated cardiac fatty acid transport”

“Innovation in family businesses: balancing Economic and socioemotional objectives”

“From infant wheeze to childhood asthma; Aetiological factors and early diagnostic techniques”

Asthma is the most common chronic disease among children. The diagnosis of asthma in young children is very difficult, and the underlying mechanisms of asthma are largely unknown. This PhD dissertation shows inflammatory material in blood and breath to be a promising tool for asthma diagnosis in toddlers, which may result in earlier and more effective treatment. It is found that hereditary variations of inflammatory genes in the presence of respiratory tract bacteria play a role in asthma development in children. This knowledge may contribute to the identification of children at increased risk of developing asthma.

Key words:

kinderen, astma, wheeze, diagnose, aetiology, luchtwegontsteking

“Social assistance and activation in the pursuit of happiness: shedding new light on old policy solutions to social exclusion”

“Annexin A5: shifting from molecular imaging tool to therapeutic agent in cardiovascular diseases”

“Electrical Substrate for cardiac resynchronization therapy; identification and treatment”

“Public Health Genomics: translation of genomic research on smoking behaviour into evidence synthesis and guidelines for public health”

“Pressure ulcers in pediatric patients: A challenge!”

“Verbind eer ge begint”

“Retention of new blood donors; implications for interventions”

“Bringing two worlds closer together; addressing Methodological challenges in the economic evaluation of public health programs”

Economic evaluation studies are an important tool to support efficient allocation of health resources. For decisions about funding of public health programs, they are however hardly used yet. Key reasons are the limited availability of economic evaluation studies and methodological challenges in conducting these studies. This dissertation describes methodological aspects of economic evaluations of public health programs directed at behaviour change. The research also analyses and tests methods to capture the broad range of possible effects public health programs may have. An important conclusion is that non-health-related aspects are equally important for quality of life of participants of public health programs as health-related aspects. Efficient decisions can be facilitated through better reporting of economic evaluations, increased adherence with good practice guidelines, broadening outcome measurement, more use of scientific evidence, a better infrastructure to support decision-making, and more research to address methodological key challenges

Key words:

Economic evaluation, public health, methods, behavior change

“Diabetic Cardiomyopathy: In search of Proof”

“Linking the Renin-Angiotensin System to Immune Mechanisms: the Key in Hypertension Development ?”

“Prospective development of extracorporeal life support: from protoscience to science”

Extracorporeal life support is a system that supports the heart and/or lungs during heart and aorta surgery. It is also used on intensive care units, during cardiac interventions and during cardiac resuscitation. Despite the successful application of this method, structured theoretical knowledge and insights into the underlying processes is limited. This dissertation describes the process of formalising knowledge of extracorporeal life support technology. The focus lies on the integrated system of the heart-lung machine and the patient, with their own unique and specific relationships and reference values, as well as on the challenge of developing an interdisciplinary science that includes biophysics, biochemistry and various other components of medical science.

Key words:

extracorporeal life support; integrated heart-lung machine; interdisciplinary science

“Social Background, Educational Attainment and Labor Market Integration: an exploration of underlying Processes and Dynamics”

“Open Innovation: a dynamic capabilities perspective”

“Innovation in Commercial Real Estate”

This thesis investigates the financial performance of green and connected buildings in London and New York City. The text documents for the 2000s decade the dynamic value of green buildings in London and the surge in value for data centers and fiber-lit buildings in New York City. Main results for all three innovations suggest positive transaction price premiums relative to neighboring conventional buildings, which cannot be explained by the building's construction or renovation costs. The text also explores modeling techniques for commercial real estate with measures covering a repeat sales price index for the London commercial property market and a hedonic model of New York City's commercial property market. 

Key words:

estate market, green buildings, London, New York City

“Haemophilus influenza in respiratory disease: From the bug to the body”

The nontypable Haemophilus influenzae bacterium (NTHi) can significantly worsen, or exacerbate, COPD. That being said, not all NTHi infections result in exacerbation. 
Specific virulence factors of NTHi strains may be necessary to exacerbate the disease. We found that genetically distinct NTHi strains displayed similar virulence factors and that infrequent COPD exacerbations were associated with a less reactive immune system. While additional research is required to confirm these results, this concept does provide clinicians with a new ‘tool’ to identify patients with an increased risk of developing acute exacerbations. This is important because current efforts to identify suitable biomarkers for phenotyping COPD patients have proved unsuccessful. 

Key words:

COPD, NTHi bacteria, exacerbations, treatment

“Remediation Theory and Practice, Transforming At-Risk Medical Students”

Widening participation in higher education brings with it an increasing number of diverse students who struggle to succeed. This research identifies the ingredients of successful remediation for at-risk medical students. At one medical school, the pass rates of struggling students doubled, using a carefully designed mandatory course involving small stable groups focused on collaborative discussion of learning processes and medical science content. These groups foster students’ development of affective, cognitive, and metacognitive practices in regular, in frequent meetings with an experienced teacher whose presence and practical wisdom enables flexible management of complex remediation processes to nurture independence and lifelong learning skills.

Key words:

remediation; at-risk students; medical education; widening participation;   teaching; facilitation

“Echoes of the city; Staging the Urban Soundscape in Fiction Film”

Big cities are noisy, frustrating and over-stimulating. At least according to the classic image most people have of them. Research on the representation of big-city sound in modern movies has shown that filmmakers deploy various techniques to present big cities like Amsterdam, Berlin and London to their audiences. This study, which is part of a major research project on urban sound, reveals how the ‘dramatization’ of the urban soundscape can offer new insights on how we experience urban life.  

Key words:

sound, cities, film

“Effects of Telemonitoring in Patients with Heart Failure”

Heart failure requires intensive care in order to preserve quality of life for the patient and prevent hospitalisation. This care can take the form of remote counselling, which involves monitoring patients from a distance. Patients are offered phased education and are asked to answer several daily questions. The nurse uses these answers to assess the patient’s condition and adjust treatment where necessary. A recent study on the effects of remote counselling revealed it decreased the number of hospitalisations, decreased anxiety and depression and increased knowledge and self-care in patients with heart failure at the same cost of traditional care. No effects were perceived in terms of quality of life.

Key words:

heart failure, care, remote counselling

“Een Overtollig Mens”

“Empirical Studies on Institutions, Policies and Economic Development”

“Newborn screening for cystic fibrosis in The Netherlands; the CHOPIN study”

Cystic fibrosis (CF) can be detected by a heel prick test. This PhD dissertation investigates the performance and cost effectiveness of two new tests for application in the heel prick. The research shows that the combination of both tests provides the most benefits. The combined test finds almost all patients with CF and reduces the number of false alarms. Furthermore, this research shows that patients with CF who are diagnosed early have an improved condition, which leads to lower costs for diagnostics and treatment. The investment in performing the heel prick can therefore lead to cost savings. On the basis of this research, the Dutch heel prick programme has changed: since 1 May 2011, babies are also tested for CF.

Key words:

Cystic Fibrosis, heel prick

“The Economic Consequences of Accounting for Derivatives”

This dissertation provides new insights about the impact of the derivative instruments recognition and disclosure under SFAS 133 on information asymmetry among investors, investors’ reactions to macro-economic news, and income smoothing. The findings of the dissertation show that investors’ uncertainty about the cash flow implications of changes in macro-economic news is lower after the adoption of SFAS 133. The findings of the dissertation further show that investors respond asymmetrically to good and bad macro-economic news. However, the asymmetry is less pronounced after the implementation SFAS 133. Finally, the findings of the dissertation show that managers engage in more income smoothing activities after the adoption of SFAS 133. This confirms the claims of critics and managerial concerns about the effect of derivative instruments recognition and disclosure under SFAS 133 on earnings volatility and income smoothing.     

Key words:

derivative instruments, information asymmetry, income smoothing, recognition and disclosure, macro-economic news

“Energy balance and colorectal cancer: Understanding disease pathways through molecular epidemiology”

Het is al langer bekend dat overgewicht en een gebrek aan beweging het risico op colorectaal kanker (dikke darm- en endeldarmkanker) vergroten. In dit onderzoek zijn de verschillen tussen mannen en vrouwen en mogelijke mechanismen onderzocht. Er is ingezoomd op het insulinegelijkende groeifactorsysteem (IGF) dat groei in het lichaam reguleert en mogelijk ook kanker. Vooral in het laatste deel van de dikke darm was de kans op kanker groter bij mannen naarmate ze meer overgewicht hadden en minder bewogen. De kans op kanker in het eerste deel was verhoogd als mannen ook een bepaalde ongunstige genetische aanleg hadden in IGF genen. Bij vrouwen bleek lengte bepalender voor het risico op dikke darmkanker dan overgewicht. Een ongunstige genetische aanleg speelde minder een rol. Verder onderzoek bevestigde het belang van het IGF systeem als ondWe know that obesity and lack of exercise can increase the risk of developing colorectal cancer (colon and rectal cancer). This study examined the differences between men and women and their underlying mechanisms. More specifically, it examined the insulin-like growth factor system (IGF), which regulates normal physiology as well as a number of pathological states, including cancer. The study found that men were at greater risk of developing cancer in the last part of the colon if they were overweight and inactive. Their risk of developing cancer in the first part of the colon increased if they had an unfavourable genetic predisposition in the IGF genes. For women, height proved a more important risk factor for developing colon cancer than weight. An unfavourable genetic predisposition played a much smaller role in this group. Further research confirmed the importance of the IGF system as an underlying mechanism by examining the molecular changes of IGF genes in tumours.

Key words:

colon cancer, height, weight, genetic predisposition, molecular changes 

“PPARs and microRNAs at the heart of metabolic regulation in cardiac disease”

“Biomarkers in cervical cancer and precursor lesions”

In the Netherlands, screening for cervical cancer will soon shift towards testing primarily for Human Papillomavirus (HPV), the cause of cervical cancer. However, there is a need for more specific cervical abnormality biomarkers. This PhD dissertation describes the most promising biomarkers and a HPV test which identifies individual high-risk HPV types. It shows that integration of HPV into human DNA and viral load may be useful biomarkers. The HPV MLPA test allows these biomarkers to be detected all at the same time.

Key words:

cervical cancer, Human Papillomavirus, biomarkers

“Predicting recurrent preeclampsia; Empirical and methodological studies”

“Developments for improved diagnosis of Bloodstream infections”

The number of patients with bloodstream infections (BSI) continues to increase. BSIs are characterised by high mortality and increased health care costs. The best treatment for a BSI depends on a number of factors, such as identification of the BSI, the performance of laboratory tests and the initiation of a correct (pathogen-specific) treatment. To be able to treat a patient with a pathogen-specific antibiotic, it is important to quickly detect and identify which microorganism (pathogen) caused the BSI. The current diagnostic process often takes a few days to complete. The main objective of this research was to study various strategies for improving the existing laboratory process for a BSI. The results presented in this PhD dissertation show that the laboratory diagnostics for a BSI could be significantly faster. When molecular (pathogen DNA) tests of great volumes of whole blood taken from BSI patients are optimised, patient care can improve and the potential for morbidity and mortality can be reduced.

Key words:

molecular diagnostics, DNA research, blood, medical microbiology, sepsis

“The broken cycle of sleep; energy balance through circadian alignment”

There may be a link between a surplus energy balance (i.e. weight gain) and poor sleep habits. This dissertation examines the role that sleep quality and sleep duration play in energy regulation and weight management.

Sleep fragmentation, whereby the test subject was woken up five times during the night, disrupted the sleep structure (the different phases of sleep) without changing the total sleep time. A night of fragmented sleep was paired with increased insulin levels and decreased satiety, which contributed to increased food intake.

It was also found that an acute shift in the day-night rhythm disrupted the glucose-insulin metabolism, which can lead to reduced insulin sensitivity. 

Key words:

sleep, energy balance

“What we talk about when we talk about Brazilian Multinational; an investigation on Brazilian FDI, economic Structure, innovation and the relationship between them”

“Hybrid Ablation of Atrial Fibrillation”

Atrium fibrillation (AF) is the most common form of cardiac arrhythmia and is often paired with an increased risk of cardiovascular complications such as stroke, heart attack and heart failure. Treatment options include medication and ablation. This dissertation reveals how the hybrid AF ablation technique developed in Maastricht, combines the best aspects of classic ablation and surgical intervention (an alternative to ablation). With hybrid AF ablation, heart surgeons and cardiologists work together, which significantly improves the procedure’s success rate.

Key words:

atrial fibrillation, treatment, ablation, surgery, hybrid AF ablation

“Global standards, local practices; an argument for Contextual policy-making, design of interventions and Policy evaluation”

“Information Sharing through informal interaction in low-tech clusters”

“Impulsivity in cue-elicited craving and appetitive learning”

“Pressure ulcer care in the Netherlands versus Germany 0-1”

Pressure ulcers (bedsores) are more common in Dutch nursing homes than in German nursing homes. This PhD research was designed to discover the causes of this difference. Recently admitted residents at Dutch and German nursing homes were followed for 12 weeks. The study shows that the incidence of pressure ulcers in Dutch nursing homes (33.3%) is indeed higher than in German nursing homes (14.3%). Relevant factors for preventing pressure ulcers were found to include switching positions and regular monitoring of the quality of daily pressure ulcer care. Furthermore, it was found that simply appointing a pressure ulcer nurse in no guarantee of a lower incidence of pressure ulcers.

Key words:

pressure ulcers, elderly care, nursing home

“Testing self-testers: Diagnostic self-testing for cholesterol and diabetes”

This dissertation researched consumer fluid tests (e.g. blood or urine) for at-home disease detection. The most common self-tests are for diabetes, kidney disease, cholesterol, urinary tract infections, HIV/AIDS and chlamydia. An online tool was developed to help consumers decide whether or not to take the test. The effects were evaluated in a randomised trial, which revealed that people interested in testing for diabetes tended to make a more informed choice after using this tool. This effect was not observed in people taking a cholesterol test. The next step will be to develop and market this online tool among consumers interested in taking at-home tests. 

Key words:

self-test, online help

“Molecular profiling of pulmonary carcinoids; insight into tumor biology and identification of prognostic markers”

Lung carcinoids are uncommon tumours often associated with a non-smoking related form of lung cancer. Although most patients with lung carcinoids tend to have a favourable disease outcome, a small fraction will eventually die from it. It is extremely difficult, however, to determine which patients are at increased risk of complications at the time of diagnosis. This dissertation provides additional insight into the biology of lung carcinoids and identifies better prognosis indicators. The absence of CD44 and OPT proteins in the tumours have been strongly associated with an unfavourable disease outcome. These protein markers could be used to improve both diagnosis and prognosis.

Key words:

lung cancer, lung carcinoids, prognosis

“Cardiovascular disease: Role of immuno- and radiotherapy”

Cancer and cardiovascular diseases are the main causes of death in the Western countries. Breast cancer is one of the most common cancers in women. Patients who have undergone radiotherapy in the long term show an increased risk of death from heart disease. Arteriosclerosis is the leading underlying cause of cardiovascular disease and is characterised by a chronic inflammatory response in the arterial walls. This PhD dissertation focuses on research into the effect of immunosuppression on arteriosclerosis and the effect of radiation on cardiovascular disease. Radiation is found to accelerate and aggravate pre-existent arteriosclerosis in mice and to induce dose-dependent cardiac damage. These findings emphasise the need to define individual risk profiles and to develop clinical preventive measures in patients who have undergone thoracic radiotherapy.

Key words:

Cardiovascular diseases, immunosuppression, radiotherapy

“Making genetics not so important; families Dealing with genetic testing for a familial heart disease”

Many people claim that genetic testing changes a family’s life. In these individualistic times, genetic diagnosis and an awareness of shared DNA could either strengthen a family’s bond or cause tension and disagreements. This dissertation argues that genetic testing has a much smaller impact on family life than previously thought. The study followed families during an intense and long-term genetic testing programme for hypertrophic cardiomyopathy. While the families struggled with whether or not to take the tests, they also made sure their relationships did not suffer by refusing to focus too much on the genetic diagnosis itself. Attention to this ‘family effort’ in clinical genetic counselling can improve the quality of care.

Key words:

genetic testing, family relationship, counselling

“Psychopathy: Its Association with early maladaptive schemas, risk-related behaviors and treatment outcome”

“Tailored pain management for subgroups of patients with chronic musculoskeletal pain”