“WWW and its Enduring Effects on Export Marketing: Do Web Capabilities Matter?”

“Common carotid artery morphology and dynamics estimated with automatic ultrasound segmentation”

In this thesis, new computational methods are introduced for better analysis of ultrasound images of the common carotid artery (CCA). Estimation of the anatomical features and mechanical properties of the CCA with ultrasound is important for prevention and treatment of cardiovascular diseases, and assessment of cardiovascular risk. Using the new methods presented, CCA morphology and dynamics are estimated automatically, providing sonographers with an improved feedback. The automatic algorithms effectively reduce the variability of the estimates, while compensating for typical nuisances of ultrasound imaging.

“New approaches to improve the evaluation of mammograms”

Breast cancer is the most common type of cancer in women in the Netherlands. In hospitals, there is a growing demand for mammograms (X-ray of the breast) in combination with an increasing shortage of radiologists.  This dissertation shows that making use of trained radiodiagnostic laboratory assistants in the independent preselection of mammograms can be an effective and efficient innovation in daily clinical practice that is legally possible. To increase cancer detection, laboratory assistants can be employed as second assessor. The use of computer software in the assessment of mammograms in daily clinical practice does not appear effective.

Key words:

breast cancer, mammogram, radiodiagnostic laboratory assistants

“Stimulation of Different Foot Structures and Functions. Effects on physical performance in older adults”

Fall risk factors, such as impairment in mobility, strength, flexibility and some foot problems in older adults, can be minimized by improving physical performance. It was, however, unclear whether stimulation of different foot structures and functions by wearing insoles with raised projections, or by foot gymnastic exercises, combined with conventional training, has an additional effect on? physical performance. The primary findings were that the conventional training program in itself resulted in significant improvements in gait performance and muscle power compared to the control group. Neither wearing insoles during everyday life, nor foot gymnastic exercises had additional effects on physical performance

“Making Lifestyle work Long-term effects in the prevention of type 2 diabetes”

Type 2 diabetes mellitus increasingly occurs worldwide. The main factors that increase the risk of type 2 diabetes are overweight and too little exercise. The SLIM life style intervention shows that better food and more exercise, based on existing guidelines, lower the risk of developing diabetes with 47%. This effect was achieved in a period of 3-6 years in persons with an increased risk of developing this disease. Therefore, the SLIM lifestyle intervention can postpone and perhaps even prevent type 2 diabetes, which lowers the costs of diabetes-related healthcare and improves the quality of life. 

Key words:

diabetes, nutrition, exercise. 

“Enhanced Recovery After Surgery Fact or Fiction ?”

The traditional hospitalization after intestinal surgery lasts 10 – 12 days. At the end of the nineties it was shown that this hospitalization period could be reduced to 2 days with an enhanced recovery programme. This dissertation evaluates the attainability of short hospitalization after major intestinal surgery in daily practice. It is shown that the implementation of an enhanced recovery programme leads to a quicker recovery and a shorter stay at the hospital, but that discharge from the hospital after 2 days is currently still fiction. However, there is no doubt that in the future recovery after surgery can be enhanced in such a way that even intestinal surgery can be performed in day treatment.

Key words:

enhanced recovery programme, intestinal surgery

“Two-photon microscopic imaging of neo-vasculature in atherosclerotic plaques and tumors”

Formation of new small blood vessels (‘angiogenesis’) characterizes the development of atherosclerosis and cancer, the most common causes of death in Western society. This dissertation uses magnetic resonance imaging (MRI) and two-photon laser scanning microscopy (TPLSM) to image and quantify the density and angiogenesis of these blood vessels. In the future, these techniques could find a clinical application in the early diagnosis of the potential complications of atherosclerosis and cancer, respectively cardiovascular problems and metastasis. This makes treatment at an early stage possible, which could prevent clinical complications as a result of these diseases.

Trefwoorden:

angiogenesis, atherosclerosis, cancer, MRI, TPLSM

“Multisensory Cortical Interactions Between Speech and Script in Fluent and Dyslexic Readers”

In the Netherlands, one out of twenty children has dyslexia. This means that approximately 90.000 children in our country experience serious problems with learning to read and write. One of the most important steps for successfully learning to read is learning the associations between some letters and sounds (the alphabetic principle). Knowledge about the neurobiological mechanisms that underlie this skill is therefore crucial for the understanding of disturbed reading development. This dissertation used functional brain scans (fMRI) to study how the brains of normal readers and of adults and children with dyslexia process letter-sound associations. People with dyslexia show a deviant linking of letters and sounds in the brains. This might possibly be the cause why people with dyslexia read badly. A second cause of reading problems was found in the domain of speech processing. Adults and children with dyslexia showed lesser brain activity in the processing of sounds than normal readers. Both explanations are possibly relevant for a complete understanding of learning to read and reading problems.

Key words:

dyslexia, reading, brain activity

“Development electrophysiological studies of letter –speech sound processing in normal reading and dyslexia”

An important step in the development of reading is learning to link letters to speech sounds. Studies in adults showed that letters and speech sounds are quickly and automatically linked. It was also shown that the development into fast and automatic linking, as in adults, takes years. Remarkable is that dyslectic children with four years ‘reading experience do not quickly and automatically process letter – speech sound couples, but still process as normally reading children with one year of reading experience. These enormous arrears prevent learning to read quickly and faultlessly. Therefore, reading therapies should definitely focus on the automation of letter speech sound linking.

Key words:

dyslexia, letter – speech sound linking, reading development

“The Future of Tourism in Antarctica: Challenges for Sustainability”

Tourism in Antarctica is growing rapidly in volume and diversifying into an ever wider range of activities, transport modes and destinations. Tourism is a complex phenomenon; tourism development in Antarctica is no exception. Further, Antarctica is a global common, which limits the formal regulatory options for controlling tourism development. This configuration has raised concerns among academics, NGOs and policy makers, The central aim of this thesis is to explore strategic challenges of future Antarctic tourism in the context of sustainable development. A transdisciplinary and integrated research approach is taken to meet this objective. Based on a combination of stakeholder perspectives derived from a series of scenario workshops and in-depth interviews, academic literature, policy documentation, and visitor data, different future pathways are explored and analysed for implications.

“Romanian adolescents: health-risk behaviours and smoking prevention”

“Regulation of Polycomb Group proteins. The complex, the kinase and the interactor”

Identity and function of cells are determined by genes, and it is evenly important which genes are and are not active. DNA in the cell core is wrapped in chromatin. Before genes can find expression, they have to be unwrapped. This dissertation studies how signals outside the cell influence the wrapping and unwrapping of DNA. Wrapping the genes is among others determined by Polycomb Group (PcG) proteins. On the basis of changes in PcG function and chromatin binding we show a new mechanism with which gene activity can be adjusted and cells can react to changing circumstances. A better understanding of gene environment interactions contributes to more effective treatment and prevention of diseases such as obesity, diabetes and cancer. 

Key words:

Epigenetics, Polycomb Group proteins, gene environment interaction

“Children’s memory: Treasure of Treachery of the Mind? Precursors of children’s false memories”

The memory of children can fairly easily be influenced. Research namely shows that suggestive interviewing techniques can lead to children ‘remembering’ fictitious events.  These memory errors are also called pseudo-memories. This dissertation studies factors that are connected with the development of pseudo-memories in children. It turns out that children very easily develop pseudo-memories of unlikely events (namely a UFO kidnapping). Furthermore, negative occurrences give more cause for pseudo-memories than neutral events.  Finally, it turns out that having a lot of knowledge about events increases the possibility of pseudo-memories. These results are important in trials where children are subject to suggestive interviewing. 

“Hospital system design. Creating supply flexibility to match demand variability”

Hospitals can reduce waiting times for patients if they can make their care supply more flexible. Moreover, a more flexible organization structure will realize a quicker flow of patients through the hospital. That is the conclusion of Hanneke Molema, based on her research in various hospitals in the Netherlands and India. The need for a better match of care and patients increases now the demand for complex care rises. To meet this requirement, Molema finds that hospitals should dare to let go of their current rigid structure base don specializations. The dissertation contains examples of what hospitals can do differently with a view to better respond to the volume and nature of patient demands.

Key words:

hospital, care demand, organization structure

“Decisional processes in obsessive-compulsive spectrum disorders. From neuropsychology to clinical implications”

The spectrum of Obsessive–compulsive related disorders (OCSD) is comprised of disorders as OCD, body dysmorphic disorder, eating disorders, pathological gambling and autism. The hypothesis of this thesis was that obsessive-compulsive spectrum disorders may be conceptualized as a disorder of decision-making and that this could lead to a better understanding of its physiopathology, to a new approach in its investigation and to novel strategies for both physical and behavioural treatment. This redefinition of OCD may have very important implications in the field of OCD research, making it possible to define different subtypes of OCD patients beyond the psychopathology of the disorder, characterised by common genetic substrates and common neurofunctional profiles. This approach is not simply a strategy to resolve classificatory issues, but it is a way of defining reliable outcome predictors and to implement specific treatment strategies.

“Financial Advice Online. Experiments Investigating Trust in an Online Human Advisor”

Increasingly, customers interact with company representatives such as financial advisors online instead of face-to-face. This dissertation investigates how feelings of (physical) presence and trust can be created during voice- or video calls. The results of two experimental studies clearly demonstrated that factors such as an existing relationship, the interaction style applied by the advisor, or certain situations in which a customer is accompanied by a second person (purchase pal) help to increase trust and sales.
Thus, companies who aim at maximizing sales via technology-mediated consultations with customers need to know how to use the technology. This dissertation provides several suggestions that where successfully tested.

Key words:

sales, trust, online consultation, technology

“The hypercoagulable state in patients with Essential Trombocythemia and Polycythemia Vera”

“Gender Sensitivity in Health Care Practices: From Awareness to Action”

It has been extensively shown that differences as a result of gender influence sickness and health in scientific literature. And yet, valuable insights and procedures about gender differences have been scarcely implemented in health care practices. So far, there are no systematic descriptions of gender sensitive ‘best practices’. This dissertation wishes to contribute to this by making an analysis of the current practice and knowledge about the implementation of gender sensitivity. For a ‘good practice’ it is necessary that professional follow training programmes, that there is active involvement of key figures in the organisation and that there is structural (Financial and political) support from the political environment. Training of professionals is an important catalyst for gender sensitivity, but not enough for sustainable differences in practice.  

Key words:

gender, diversity, implementation, health care

“Financial Liberalization, Exchange Rates, and Economic Development”

This dissertation studies the effects of financial liberalization on exchange rates and economic development. The presence of capital controls is found to have no effect on uncovered interest rate parity, while it increases downward exchange rate risk. Nevertheless, empirical evidence shows that capital controls on inflows may enhance economic growth in emerging countries. This thesis also proposes project finance as a form of capital that is particularly suitable for countries with low levels of financial development.

Key words:

financial liberalization, exchange rates, economic development

“Influence or Selection. Dynamics of friendship networks and smoking behavior in adolescence”

Do adolescents influence each other into smoking? Do smoking adolescents for example choose other smokers as friends? To find out how to prevent that adolescents start smoking the development of smoking behaviour and friendship networks were analysed in six European countries. At various moments in time, adolescents were asked to report on their friendships and smoking behaviour. Our results confirm that friends often show the same smoking behaviour. Adolescents indicated that they chose friends with the same smoking behaviour and that they let themselves be less influenced by friends with a different smoking behaviour. The findings suggest that friendship networks play an important role in the development of smoking behaviour and could be used in interventions for the prevention of smoking.

Key words:

smoking behaviour, adolescents, prevention, social networks

“Contested Cultural Property. The Return of Nazi Spoliated Art and Human Remains from Public Collections”

This PhD dissertation analyses and reflects upon the current state of the law and (legal) practice in the Netherlands, the United Kingdom and France with regard to the return of cultural objects from public (museum) collections. The research focuses on those two cases that have led to a recalibration of the restitution debate: the return of Nazi spoliated art and the repatriation of human remains. The debate on the return of Nazi spoliated art (re-) emerged in the Netherlands at the end of the 1990s with the Goudstikker case. Claims for the return of human remains were sparked by the passing of the ‘Native American Graves Protection and Repatriation Act’ in the United States in 1990. Since then, museums all over the world have received claims for the return of human remains. The recent return of the head of Badu Bonsu from the Netherlands emphasizes the relevancy of the research.

“Intellectual Property and Developing Countries: Balancing Rights and Obligations”

“Legal Migration to the European union: 10 years after tampere”

In 1999 the Tampere European Council adopted a policy programme in the area of Justice and Home Affairs aiming at establishing a common European immigration policy based on the ‘fair treatment’ of third-country nationals. Ten years later, at the end of 2009, a new policy programme will be adopted during the Swedish presidency. This book provides an analysis of EU and national immigration law ten years after Tampere and immediately prior to the adoption of the ‘Stockholm programme’. Five Directives on legal migration, implementing measures and national legislation in five Member States are critically assessed in terms of compliance with EU principles of law, international human rights instruments and the Tampere objective of ‘fair treatment’.

“Advancement of the Brown Norway rat as a model for food allergy. Route of exposure – Immunomodulation – Allergogenomics”

“The dean as an academic manager: the phantom of the opera?”

“Zuurvlees”. (“Stewed meat”)

“Psychopathology and ageing; towards a better understanding of psychosis and depression in later life”

Research into psychosis and depression is often conducted among young people, but this dissertation concerns elderly people. Psychotic symptoms namely often originate in the second half of life. Moreover, the prognosis is particularly unfavourable when people over 65 have their first psychosis. Depression in elderly is often accompanied by disorders in thinking (such as memory loss). Köhler’s research clearly shows that, in contrast with earlier assumptions, the cognitive disorders are permanent. In healthy elderly, depression appears to be a risk factor for accelerated cognitive decline. Small lesions in the white substance of the brains appear to be the underlying causes.

Key words:

depression, psychosis, elderly people, cognitive disorder

“The interplay between genetics and epigenetics in colorectal cancer”

Colorectal cancer has a high mortality, also because the disease is often detected at a too late stage. Colorectal cancer is the end result of a complex interplay of genetic and epigenetic (processes that influence the gene expression with changing the DNA base order) deviations. Studying genetic and epigenetic deviations shows that epigenetic deviations occur early in the development of colorectal cancer and are therefore very useful in the early detection of the disease. On the basis of genetic and epigenetic deviations colorectal cancers can be divided into subgroups that differ in behaviour and survival. Future research will show whether these subgroups need a different treatment strategy.  

Key words:

colorectal cancer, genetics, epigenetics

“Dietary acrylamide intake and human cancer risk”

Acrylamide is a substance that is found in food, such as French fries, chips, cookies and coffee. This PhD research contains epidemiological research into the relation between acrylamide intake via food and the cancer risk. The risk of cervical and ovarian cancer turns out to be increased with rising acrylamide intake. There is also a positive relation between acrylamide and the risk of kidney cancer in men and women and oral cavity cancer in women. On the other hand, the study also provides indications for a risk reducing connection between acrylamide and lung cancer and bladder cancer in women, and prostate carcinoma and pharynx cancer in men. These connections must also be investigated in other studies to gain more certainty about their causes. 

Key words:

acrylamide, cancer, food

“Beyond Weber and Straight Cucumbers: Bureaucratic Politics in the EU”

“Constitutionalising Polycontexturality: the Legal Foundations of Tansnational ‘private’ Regimes”

“Theory- and evidence-based interventions to enhance adherence among HIV-infected patients using highly active antiretroviral therapy”

“Rechtsbescherming en overheidsovereenkomsten”

“Hypnotics and Anxiolytics”

A large number of experimental behaviour studies with healthy young volunteers show that hypnotics and anxiolytics can negatively influence the driving ability. It was generally expected that these negative effects would be less strongly manifested in patients as a result of the additional favourable effects on the sleep or anxiety disorder and the habituation that occurs after long-term use. Comparative studies with patients and more vulnerable groups such as elderly people are rare. This dissertation investigates to which extent factors such as age, gender, (sleep) disorder and the emission speed of the drug influence the effects of hypnotics and anxiolytics on the driving ability. It turns out that there is hardly any difference between the young volunteers and vulnerable groups such as patients and elderly people. The results do not support the general expectation.

Key words:

hypnotics and anxiolytics, driving ability, sleeplessness

“Bias for the unattractive self: on the role of attention in eating disorders and body dissatisfaction”

There is still a lot of uncertainty about the exact cause of eating disorders. At the same time, women are increasingly more often dissatisfied with their body. This dissertation studies the role of attention in the causes and maintenance of eating disorders, and in particular body dissatisfaction. It turns out that eating disorder patients, in comparison to healthy women, more quickly notice information that concerns the body and more slowly take divert their attention from information that concerns food. Furthermore, it appears that the way women look at their own body plays an important role in the way they feel about their own body. Looking at ugly body parts causes body dissatisfaction, while looking at beautiful body parts can lead to more body satisfaction.  

Key words:

eating disorders, attention, body dissatisfaction

“Theodoor Weustenraad (1805-1849) en de ‘Percessie van Scherpenheuvel’”

The lawyer, journalist and poet Theodoor Weustenraad (1805-1849) was captured by the ideals of freedom and equality and he dreamed of a new earth. After his law studies in Liège, Weustenraad became editor of the newspaper L’Éclaireur, in which he disputed the government politics of Willem I. In 1830, he fled to Belgium. He believed in a better future thanks to the industry and he praised the miracles of technique. With essays and poems he contributed to the formation of a nation in the young Belgian state. His elegy Maestrichtfrom 1834 marks the beginning of the myth that presents Commander-in Chief General Dibbets as the rapist of the Maastricht will of the people. The biography is followed by the issue of the manuscript of the ‘Percessie van Scherpenheuvel’. This mock epic of 2000 verses in Maastricht dialect still appears very much alive, even 160 years after Weustenraad’s death.

Key words: 

biography, journalism, literature, dialect

“Chemische eiwitsynthese in beeld” (“Chemical protein synthesis portrayed”)

“With the body in mind; the role of exercise and acid-base balance in panic”

We studied the antipanic effects of acute exercise while, at the same time, mechanisms of experimental panic provocation. We demonstrated that acute exercise is a useful technique to alleviate these panic attacks provoked by CO2 inhalations.

We also used pharmacological and genetic techniques to explore key neurotransmitter systems related to experimental panic. In this process, we learned that blocking the endorphin system with naltrexone does not change the panic response to CO2 but does, by itself, elicit symptoms that resemble panic.

We also learned that the panic reaction to CO2 is associated with a gene variant involved in the activity of serotonin.

Key words:

antipanic effects, exercise, CO2 inhalations

“On the pathway from stress to psychosis”

Genetic and environmental influences play a role in the development of a psychosis. A way of studying possible genetic influences is by looking at risk factors that also occur in family members of patients. It was found that patients who had a psychosis and are more sensitive to stress in daily life, have brothers and sisters who are also more sensitive to this small daily stress. It was also found that stress sensitivity is mainly related to psychotic symptoms such as delusions and hallucinations, the so-called ‘positive symptoms’. It is therefore perhaps useful to focus directly on this underlying risk factor.  

Key words:

genetic factors, psychosis, stress sensitivity

“Substrate metabolism in type 2 diabetes”​​

“From Primary Commodity Dependence to Diversification and Growth”

This thesis shows that the reliance on primary commodity export and the incapability of attracting sufficient technological knowledge for a diversified production hinder development in of many Sub-Saharan African countries. Our results show that a certain threshold level of export diversification is indispensable for long-term economic growth. Policy efforts should therefore be geared towards building export diversification for a long-term economic development.

Key words:

developing countries, export, sustainability, diversification

“The role of Public Capital on Economic Development”

This thesis explores the possible role of public capital in economic development in relation to inequality, growth, and poverty trap. Inequality is bad to growth when imperfection in credit markets prevents the poor from undertaking the efficient amount of investment. The thesis shows analytically that certain public investment may relax some of their resource constraints through factor substitution and thus improve the distribution of income and hence economic growth. The thesis also studies the role of public capital in poverty trap. The empirical side of the study addresses more policy-oriented problems: How much does public capital matter to economic growth, in developing countries? How big should it be?

Key words:

income inequality, public capital, economic growth and poverty traps

“Satellite cells and skeletal muscle characteristics in sarcopernia”

Ageing involves loss of muscle mass and muscular strength, also called sarcopernia. This leads to functional limitations and it reduces the quality of life. Satellite cells (the so-called ‘muscle stem cells”) are essential for the maintenance of muscular tissue. This dissertation shows that sarcopernia involves a decrease of the number of satellite cells in the skeletal muscles. Power training can make the number of satellite cells increase again and it is an effective method to restore muscle mass and muscular strength. The research in this dissertation shows that satellite cells play a primary role in sarcopernia and in the increase of muscle mass after power training in elderly people.

Key words:

muscle mass, muscular strength, sarcopernia, satellite cells, power training

“Connecting health care professionals: Studies on a generic HER system framework”

Electronic Patient File (EPD) systems contain information about the health and health problems of patients. These systems have evolved from administrative systems into sources of knowledge that support the care process. The current tendency towards multidisciplinary, integrated care requires a virtual EPD that integrates the health information of a patient from various sources, exchanges information with other systems and processes new medical concepts. The National EPD is a rudimentary example of such a virtual EPD. This dissertation presents a generic EPD system framework and investigates if this framework fulfils the requirements. The framework was tested by the development and implementation of an EPD system (PropeRWeb). This implementation was subsequently evaluated. This showed that the security aspects have to be intensified and standardized, especially if medical data are exchanged between organizations.

Key words:

electronic patient file, standards, archetypes, EPD, care ICT

“Framing health communication messages”

“Effect of housing in an enriched environment on the recovery from experimental inflammatory pain”

“Competency in shaping one’s life; autonomy of older adults with type 2 diabetes mellitus who are treated in a nurse-led clinic”

“On the digital road to recovery? Assessment, theory, and treatment of depression via the Internet”

Self-help treatment of depression via the Internet without professional support is not more effective than the regular care by the general practitioner. Both first-line treatments are insufficiently capable of reducing depressive complaints. Directly after the treatment as well as one year later, the complaints are still considerable. Especially for people with serious complaints these treatments appear insufficiently effective. This is the conclusion of Esther de Graaf in her dissertation. Although self-help via the Internet seems promising, more research has to be conducted in who benefits from it and who doesn’t.  A stringent policy concerning the implementation of online self-help in the current care system is necessary, as well as its reimbursement by health care insurance companies.  

Key words:

depression, online self-help, general practitioner

“Stress reactivity in borderline personality disorder”

This dissertation studies emotional and psychotic reactions of borderline patients in daily life, and it studies the effects of trauma in childhood on emotional stress reactivity in an adult group of frequent visitors of the general practitioner. It turns out that borderline patients react significantly more emotionally and psychotically to everyday stress than people with psychotic disorders, people with anxiety related personality disorders and healthy control persons. The GP visitors who experienced trauma in childhood reacted emotionally significantly stronger to everyday stress than the group without trauma. This effect was the most explicit for trauma under the age of ten.   

It is for the first time that this phenomenon is scientifically demonstrated in daily life. The results underline the impact of everyday stress on borderline patients and adults who experienced trauma in childhood. This shows the wide importance of stress reduction.

Key words:

stress, emoties, psychose, borderline persoonlijkheidsstoornis​

“Van kwaad tot erger; de sociale constructie van satanisch ritueel misbruik in de Verenigde Staten en Nederland”. (“From bad to worse; the social construction of satanic ritual abuse in the United States and the Netherlands”)

The dissertation “Van kwaad tot erger” studies the debate about satanic ritual abuse in the United States and the Netherlands. The course of the debate is discussed on the basis of developments within the social fields where the debate is held, namely psychotherapy, media and the criminal law practice. A few notorious (criminal) law cases that had a great influence on the course of the debate are used as examples, e.g. the sexual abuse scandal in Oude Pekela, the Eper incest case and the Dutroux case. Similarities and differences in the social, political and religious structures of the USA and the Netherlands are studied. An explanation is also provided for the fact that the debate about satanic ritual abuse in the USA has turned into a moral panic (the most extensive form of collective behaviour that is out of proportion, stronger than mass hysteria), while this did not happen in the Netherlands.

Key words:

satanic ritual abuse, criminal law, psychotherapy, media

“Dietary protein in the regulation of the somatotropic axis”

Too little growth hormone can be a cause of growth retardation in children, and of too much belly fat in adults. For these people extra growth hormone can have positive results regarding respectively the growth in height and the body composition. This dissertation shows that food is an effective means to increase the amount of growth hormone in the blood. Soy protein and milk protein, whether or not in combination with fats or carbohydrates, turned out to be effective strategies for stimulating growth hormone release. This can offer perspectives for a dietary therapy to restore reduced growth hormone levels, or for a suitable diagnostic instrument to determine a deficit of growth hormone.

Key words:

growth hormone, food, diagnostics

“Dietary proteins and energy balance”

It is known that diets with a relatively high protein level are an effective means for weight loss and weight maintenance after weight loss. This dissertation describes effects of (specific) proteins in the food on appetite and food intake during a following meal and on energy use. Some proteins (alpha-lactalbumin, gelatine and gelatine with added tryptophan) suppress the appetite 40% stronger than other proteins (casein, soy and whey) and reduce the food intake during a following meal with 20%. The appetite suppressing effect of proteins is reinforced by the absence of carbohydrates in the diet. With regard to the effect of proteins on the energy use it turns out that a high-protein diet increases the energy use, regardless of the other macronutrients in the diet.

Key words:

diets, protein level, energy balance

“In vivo dosimetry using MOSFET detectors in radiotherapy”

The radiation dose of radiotherapy treatment of tumours if mainly determined on the basis of calculation models. More concrete evidence of the quantity of effectively delivered c.q. received radiation is given by a measurement during the radiation; more certainty cannot be given.  

A new type of miniature radiometer was tested and subsequently used for measurements during external radiation (while the meter was placed on the patient during treatment) and during internal radiation of the prostate (brachytherapy, where the meter was brought into the urethra).   

Via this method sufficient data can be collected, to learn from, to prevent errors, to reduce complications and to improve treatment methods if necessary.

Key words:

radiometers, radiotherapy, tumours

“Exploring Neurocognition across the Psychosis Continuum”

This dissertation studies the role of neurocognition as indicator of the genetic vulnerability and predictor of functioning in the case of schizophrenia and the bipolar disorder (manic depression). The results are discussed in the context of a presumed overlap between these two syndromes. The research shows that cognitive disorders occur in both schizophrenia and the bipolar disorder. In schizophrenia they are usually more serious, more associated with a genetic predisposition for the disease, and they have a stronger influence on the day-to-day functioning than in the bipolar disorder. Jabbens’ findings support an approach of psychiatric disorders in which the degree of suffering from the symptoms is observed more than purely the diagnostic categories. 

Key words:

neurocognition, schizophrenia, bipolar disorder

“Testing Non-Stationary Panel-Data with Persistent Cross-Sectional Dependence”

“Development and Regulation of Body-Weight; a Genetic, Behavioral and Neuro-Endocrinological Approach”

When energy intake and energy use are in balance, you speak of a stable body-weight. This dissertation describes genetic, parental, behavioural and endocrinical factors that influence the development and regulation of body-weight. A longitudinal cohort study with children of 0-17 years old shows that the FTO gene, the number of hours of sleep per night, the weight of the father and the eating behaviour of the mother influence the development and regulation of body weight. Particularly if children had a short sleep and heavy parents that occasionally overate, the risk of developing overweight during puberty increased. In adults, stress turns out to increase the risk of overweight, because it causes eating without hunger via the hyperactivity of the system that regulates the secretion of the stress hormone cortisol.

Key words:

Obesity, body-weight, children, adults, stress

Title of the lecture of prof. dr. Angela Brand:“Public Health Genomics: from cell to society”.

Title of the lecture of prof. Helmut Brand: “European Public Health: between Maastricht and Lisbon”.

“Events for Adolescent Smoking Cessation”

For an evidence based adolescent smoking cessation program, we conducted a qualitative study with 26 persons aged 15–21 years. Success was related to whether or not the quitter was committed to a learning process in which different strategies were tested, evaluated, re-tested, et cetera. Adolescents considered ‘willpower’ as the most important determinant, expected cessation interventions to be patronizing, and regarded seeking support for an internal personal process as excessive. With Intervention Mapping we designed an easy accessible intervention based upon short term counselling, with motivational incentives and non-patronizing support. In a trial at 22 continuation schools, the intervention was successful in reaching more than half of all daily smokers with more than 30% receiving counseling at least once in the intervention period. However the intervention only had short term effects, and the overall conclusion is that this intervention format was insufficient in producing long term effects.

“Generation of Procoagulant Activity in Blood Cells”

Jef Wolfs studied the mechanism that is responsible for fact that a certain membrane component, phosphatidylserine, becomes available on the surface of blood cells.  Surface-exposed phosphatidylserine plays an important role in the blood coagulation and in the removal of aged, dying cells. The research focuses on the so-called ‘scramblase’, a protein that plays an essential role in the reorganization of membrane phospholipids. The main findings of the research are that cells in suspension don’t all show the same scramble activity and that the scramble speed is influenced by both the shape of the cells and the intracellular ion-composition. These findings can be the basis for new therapeutic interventions in haemorrhage diseases and coagulation diseases. 

“Evaluation of Evidence-Based Clinical Guidelines in Physical Therapy: Ankle Sprain as Case Example”

“Short Chain Fatty Acids and Colonic Health”

Great amounts of bacteria live in the large intestine and these can have both damaging and favourable effects on the health of the intestine. Nowadays, more and more food products (prebiotics and probiotics) focus on influencing the composition and activity of the bacteria in the large intestine to improve health. An example of these are certain fibres that cannot be digested in the small intestine, but are subsequently decomposed in the large intestine by the present bacteria, in the process of which short chain fatty acids are produced. The studies described in this dissertation show that these fatty acids and particularly butyrate play an important role in the preservation of a healthy intestine.  

Key words:

short chain fatty acids, large intestine, butyrate

“Bedtime Stories”

Many sexually active adolescents and young adults assume that they run low risks of getting infected with a Sexually Transmitted Disease (STD) and as a result practise unprotected sex. This dissertation studies the extent to which various types of risk information could influence this risk perception of STD and if these types of risk information could be usable for STD prevention. The risk perceptions for HIV turned out rigid and difficult to influence. The feelings of susceptibility to Chlamydia, however, could be influenced by various types of risk information. Finally, an internet programme with made-to-measure risk information appears an effective and promising way of influencing feelings of susceptibility and to stimulate condom use.

Key words:

STD/HIV prevention, risk communication, internet, health improvement

Title of the lecture of prof. Vanstraelen: “The role of accounting and accounting research in the Economic crisis”.

Title of the lecture of prof. Knechel: “Audit Lessons Learned from the Economic Crisis”.

“Attention Dysfunction and ADHD in Adults: Determinants and Interventions”

ADHD is not only a child-psychiatric disorder, but it often continues to exist in adulthood. The first part of this dissertation studies from a neuropsychological perspective the occurrence of complaints in a healthy population and the relation with quality of life. The second part studies neuropsychological models, state of expression and neuropsychological treatment focused at more complex thinking functions (such as executing two tasks at the same time) in adults with ADHD.  Attention problems appear to occur often in the healthy population and are related to mood and quality of life. The research also shows that cognitive complaints decrease in adults with ADHD that are treated for problems with more complex thinking functions.

Key words:

ADHD, adults, attention problems

“Challenging the serotonergic system: A mechanistic approach to the method of acute tryptophan depletion in rodents”​

“Bimodal Imaging of Molecular Targets Associated with Plaque Vulnerability”

“Transcranial Duplex Scanning in Parkinsonian Disorders Comparison with SPECT”

Diagnosing Parkinson’s disease can be difficult particularly at an early stage of the disease, given the overlap with symptoms of other disorders. The nuclear examination, the SPECT-scan, is currently the most used additional examination technique in these patients. In spite of a great amount of research there is still discussion about the exact diagnostic contribution.  This dissertation concludes that only the scan with a presynaptic radioactive substance in combination with echography of the ‘black core’ in the brains has been sufficiently studied and is reliable for regular diagnostic examination. Echography may be a good alternative, but this needs to be studied more closely.

“Het OM: schakel in een geloofwaardige strafrechtspleging”

“Human Development and Autonomy in Project AID: Experiences from Four Bilateral Projects in Nicaragua and El Salvador”

This dissertation investigates how foreign aided projects can support the autonomy of individuals in communities. It examines four infrastructure projects assisted by Luxembourg in Nicaragua and El Salvador (1999-2005). This study achieves three main objectives. First, it develops a conceptual model of autonomy, based on approaches in the human development paradigm and multidisciplinary studies, and enriched by the experiences of the local inhabitants. Second, it presents an analytical framework to evaluate the project effects on individual autonomy, looking at the practices, goals, motivations and values of project participants. Third, it uses and tests that framework to examine the four projects.

Key words:

Autonomy, human development, project evaluation, management practices

“Non-Invasive Assessment of Cardiovascular Disease”

“Outcome Assessment and Economic Evaluation of Short Stay Intensive Care for Coronary Artery Bypass Patients”

This dissertation studies if short-stay intensive care (up to eight hours) is safe and cost-effective compared to the usual 24-hour intensive care for low-risk patients who undergo a bypass operation. In 600 patients differences in the occurrence of disease (such as heart infarcts and infections), death and re-hospitalization were studied. Also, the costs were calculated of the treatment up to a month after the operation. The quality of life of the patients was also measured with a general (EuroQol) and a disease-specific (MILQ) questionnaire. The short-stay intensive care protocol for low-risk CABG-patients appears safe, cost-effective and of no influence on the quality of life. The dissertation also contains a literature study of the current knowledge of treatment methods and a study of the validity and reliability of the used questionnaires. 

“The Reach of Human Rights in a Globalizing World”

“Ranking and Reliable Classification”

In recent years, the storage of digital data in the field of law enforcement has strongly increased. These data have to be analysed to gain new knowledge from them. Therefore, there is a great need for technologies that can computerize the data analysis. Machine learning is a research field within artificial intelligence that provides effective and efficient models for data analysis. The use within law enforcement, however, is not easy because the models are not considered sufficiently reliable. This dissertation conducts research in three promising directions that can lead to a safer process in data analysis.   

Key words:

machine learning, data mining, intelligence led policing

“Robust designs for longitudinal studies”

“ATP infusions in palliative home care”

Patients with cancer in a preterminal stage often experience complaints that can seriously influence the quality of life. This dissertation describes the effects of adenosine 5’-triphosphate (ATP) on these complaints. The results show that in this patient group eight weekly ATP infusions have no effect on the quality of life, physical limitations, fatigue, food intake and body weight, but that they do have an effect on the fat mass. Furthermore, there appears to be small difference in survival in favour of the ATP group, mainly in patients with lung cancer and patients with a stable body weight. However, these findings will have to be confirmed before final conclusions can be drawn.

Trefwoorden:

preterminale kanker, ATP infusen, levenskwaliteit

“Axillary and internal mammary sentinel node biopsy in breast cancer”

“Bootstrapping Nonstationary Time Series”

The analysis of non-stationary time series is an important theme within economics. Many economic time-series, such as Gross national product, exchange rates and share prices are non-stationary; their features change over time. Specific econometric methods are necessary to analyse non-stationary time series. However, these methods appear not always sufficiently reliable in small random samples. The bootstrap is an alternative statistic technique that is often more reliable in small random samples than standard techniques. This dissertation theoretically investigates if the bootstrap can also be used in non-stationary time series. By means of simulations it is shown that the bootstrap is in this context also often more reliable in small random samples than the standard methods. 

Key words:

bootstrap, time series, econometrics

“Retro-nasal aroma release and satiation”

For the prevention or treatment of obesity food should be developed that is tasty, but generates a stronger or more satiated feeling so that people wish to eat less of it. In this context, Ruijschop studied at NIZO food research the role of aroma in satiation mechanisms. Although the degree of aroma release during food consumption is person-specific, this research shows that features of food can be adjusted in such a way that they can lead to a higher quality and/of quantity of aroma-stimulation during food consumption. This can subsequently lead to a stronger feeling of satiation and could ultimately contribute to reduced food intake.

Key words:

obesity, satiation, food, aroma

“Awareness of malnutrition in healthcare”

For years already, malnutrition appears to be a major problem in Dutch health care. Therefore, the quality of food care deserves more attention. This is shown in a dissertation from Judith Meijers. Positive is that annual participation in the National Prevalence Measurement Care Problems (LPZ) leads to lower prevalence figures of malnutrition in hospitals and home care. This means that measuring leads to awareness of the problems and subsequently to activities for improvement. Participation in national care improvement programmes also appears to show results. Furthermore, this dissertation confirms the relation between decubitus and malnutrition and shows that the implementation of food directives for the prevention and treatment of decubitus contributes to more complete decubitus care.

Key words:

malnutrition, health care, decubitus

“Habitual physical activity and food intake regulation; physiological and genetic aspects”

Sufficient physical activity and matching the food intake with the energy use are essential for the preservation of the body weight. This dissertation identified physical and genetic aspects that contribute to differences in physical activity and food intake between people. Persons with a genetic predisposition to a low capacity of converting carbohydrates and fats into energy, turned out less physically active in everyday life. Also, an obesity-associated variant in the FTO gene appeared to be connected with a lower decrease of the hungry feeling after the meal. These results can be used in the future for giving personalized advice to prevent the development of obesity.  

Key words:

obesity, food intake, physical activity, heredity

“The functionality of maternal and neonatal fatty acids”

Some fatty acids are considered to be important for the foetal growth and brain development. Therefore, the unborn child needs many of these fatty acids during the pregnancy. Since the relative quantity of these fatty acids decreases during the pregnancy, this can have consequences for the development of the child. This dissertation studies if fatty acids of the mother and the newborn child are related to foetal learning ability and memory, foetal growth and later immune functions of the child. It also studied the effect of fatty acid consumption in the breast milk period on the fatty acid levels in breast milk. A few conclusions are that, if the found relations are causal, the maternal fatty acid DHA can program the foetal growth in a positive way during the early pregnancy. The maternal fatty acids AA and DGLA may be involved in foetal growth limitation during the late pregnancy.  

Key words:

fatty acids, pregnancy, foetus, newborn, learning ability and memory, birth results, immune functions, breast milk

“Supersizing Science; on building large-scale research projects in biology”

Biological research expands because of increasing cooperation between scientists. In her dissertation Supersizing Science Niki Vermeulen describes this process. Besides the well-known Human Genome Project three other major research networks are analysed: a worldwide research into life in the oceans, the building of a virtual cell and the search for an influenza vaccine. Large scientific projects have important consequences for the way in which science is conducted. The way a scientific project is organized demands more and more attention. Vermeulen calls this ‘projectification of science’. Scientists have to behave increasingly as managers and entrepreneurs. Especially the next generation of scientists will be confronted with this.  

Key words:

biology, science, entrepreneurship

“The hypercoagulable state in patients; determining(hyper)coagulability and the role of thrombin generation”

Disorders such as heart infarct or thrombotic leg are characterized by blood with an increased tendency to form coagulated mass. This ‘increased tendency to coagulate’ can be measured with the thrombin generation test. This dissertation describes the standard situation and optimization of this test so that it can be applied in patient studies and in the comparison of results between institutes. Use of the thrombin generation test in patient studies into thrombosis showed that a lowered thrombin generation was associated with the occurrence of complications in patients with a firs heart infarct, while an increased thrombin generation was associated with the repeated occurrence of a thrombotic leg. Possibly this test can be used as a risk predictor in the future. 

Key words:

thrombosis, heart infarct, coagulated mass, thrombin generation test

“Fairness in Multi-Agent System”

“New anti-epileptic drugs in pharmacoresistant epilepsy: retention time as outcome parameter”

Between 1996 and 2001 3 new anti-epileptic drugs were introduced in the market: lamotrigine, topiramat and levetiracetam. This dissertation studies these drugs in a group of 1066 p pharmacoresistant patients. For each patient the retention time was measured, which means the number of days that the patient continued to use the new drug. When a patient stopped, the researcher investigated if this was caused by a lack of effectiveness or by the occurrence of side-effects. In that way relevant differences between these anti-epileptic drugs were determined. It was striking that the effectiveness of the anti-epileptic drugs only limited the retention time to a limited extent. The retention time was mainly determined by the occurrence of side-effects.

Key words:

anti-epileptic drugs, retention time, side-effects

“Seeing Emotion; studies on the processing of facial expressions in normal development and young children with autism”

More and more often, autism is diagnosed at a very early age. However, there is very little known about the brain development of the young child with autism. This research shows that the visual brain, the part of the brains that allows us to see, works differently in the case of autism already at the toddler age. The visual brain of toddlers with autism seems to react excessively to details in his surroundings. This causes deviations in the processing of important social stimuli, such as reading the emotions in facial expressions of others. Current treatments of children with autism particularly focus on training social skills. The results of this research imply that future treatments should particularly also focus on the visual perception. 

Key words:

autism, visual brains, early age

"The threatened brain: magnetic resonance imaging studies into fear and panic"

“Governance Indicators”

“Local pulse wave velocity determination: the arterial distension waveform from foot to crest”

The elasticity of arteries determines to a great extent the effort the heart has to make to pump blood through the body. This dissertation develops a new method, departing from the so-called pulse wave velocity, to determine the elasticity of the carotid artery. The method is low-threshold and distinguishes for example young and elderly people on the basis of elasticity. In patients with cardiovascular diseases the measured elasticity appears to be a factor three lower in the systolic blood pressure than in the diastolic blood pressure. Moreover, the elasticity in the systolic blood pressure is more strongly associated with blood pressure and age. This has consequences for the diagnosis and treatment of patients with a high systolic blood pressure and heart failure. You can earlier detect or exclude a bad vessel condition.

Key words:

elasticity, carotid artery, cardiovascular diseases 

“The treatment of defaecation disorders”

Defecation disorders are disorders where patients have problems holding up their faeces (faecal incontinence) or have constipation of faeces. This dissertation assesses three possibilities of treatment.Retrograde Colon Irrigation (rinsing the intestines via the anus) can be considered if a diet or medication are not effective or after failing surgical interventions.  Retrograde Colon Irrigation (RCI) has a successful result in 59% of the patients with incontinence and 20% of the patients with constipation. Compared to other treatments, sacral neuromodulation (SNM) is the only one that improves the quality of life. Patients who were born with an anorectal malformation (ARM), who are still incontinent at a young age, can be treated with Dynamic Graciloplasty (DGP). Long-term continency for faeces is achieved with DGP in 35% of the patients. 

Key words:

defecation disorders, treatments: RCI, SNM and DGP 

“(Patho) physiology of gut wall integrity in health and disease in man”

Intestinal diseases are hard to diagnose in patients with stomach ache, because many diseases cause stomach ache, even when the intestines are not involved.  Slow diagnostics of intestinal diseases lead to a delayed treatment and therefore to higher morbidity and mortality. That is why there is great need for laboratory tests that can determine if therapy, aimed at recovery, is successful. This dissertation develops and evaluates a series of potential tests that particularly show the damage to the intestinal cells that form a barrier against body-foreign nutrients and micro-organisms. These tests were among others successfully used to early detect infants who are suspected of carrying the serious intestinal inflammation necrotizing enterocolitis.

Key words:

intestinal diseases, diagnostics, laboratory tests

“Experimental ischemia and reperfusion of the small bowel: focus on microvascular events”

“Keep on moving”

“Inhibition of ischemic organ damage with anti-coagulant agents; ASIS and APC in myocardial and renal ischemia/reperfusion”

Cardiovascular diseases are the most common cause of death in the Western world and they are often caused by the formation of atherosclerotic plaques that lead to occlusion of the affected blood vessels. Occlusion of the artery can cause ischemia, i.e. oxygen deficiency in the affected tissue, which in turn can result in cell death or apoptosis. To limit the damage that was caused by the ischemic process, the closed blood vessel has to be opened again; this is called reperfusion. The results from this dissertation show an important role for the anti-coagulant agents ASIS and APC in the protection against heart ischemia/reperfusion damage. Both agents have a protective effect on heart ischemia/reperfusion damage via various action mechanisms and could be used in the future to prevent damage after a heart infarct with a view to limit secondary heart failure. 

The research for this dissertation could be conducted with a subsidy from the Nederlandse Hartstichting.  

Key words:

cardiovascular diseases, ischemic process, reperfusion, anti-coagulant agents

“Dietary folate, genetic variation and DNA methylation in sporadic colorectal cancer”​

“Injection Therapy for Stress Urinary Incontinence in Adult Women”

"Individual Assessment of Children with Profound Intellectual and Multiple Disabilities by Means of Event-related Brain Potentials"

In practice it is extremely difficult to assess the cognitive functioning of serifously disabled children.  This research project investigated if measuring the brain activity (ERP) is a possible alternative for the standard psychological methods. This indeed appears to be the case.  Remarkable was that the obtained research outcomes about the cognitive functioning of these children did for the greater part matched the standard psychological tests, but that some children were seriously underestimated. The suggestion is therefore to expand the existing psychological test batteries for profoundly multiply disabled children with the ERP method. 

Key words:

ERP method, seriously multiply disabled, cognition

“Grens en Gezin; beleidsvorming inzake gezinsmigratie in Nederland, 1955-2005”

The most flexible liberal policy in the field of family reunification and family formation was pursued in the past fifty years by the centre-right governments Van Agt and Lubbers in a time that the economy was bad, whereas particularly in times of economic prosperity right- and left-wing governments chose a strict policy. This is shown by the PhD research into the conditions for family reunification and family formation between 1955 and 2005. This research allows us a look behind the scenes of policymaking in the Netherlands and shows that the influence of civil servants on this policy area has gradually decreased considerably, although the political science and administrative science literature suggests the opposite.   

Key words:

immigration policy, family reunification

"Breinbrekers: de Januskop van psychofarmaca” (‘Brainteasers: the Janushead of Psychofarmaceuticals’). 

“Genetics, Epigenetics and Angiogenesis in Renal Cell Carcinoma”

Angiogenesis (formation of blood vessels) is important for the growth and metastasis of renal carcinoma. This dissertation describes a higher angiogenesis activity in the aggressive clear cell carcinoma, which explains a higher risk of metastasis via the blood vessels. In contrast with angiogenesis there is only a limited tumoural lymph angiogenesis. This could explain the small number of lymph gland metastasis in this tumour. The development of renal cell carcinoma is complex, and besides genetic changes also more and more epigenetic changes (such as DNA promoter hypermethylation) are described. This dissertation illustrates for example that promoter hypermethylation of the gene Gremlin 1 in clear cell renal cell carcinoma is connected to tumour angiogenesis and prognosis. The exact function of Gremlin 1 elimination in the development of renal cancer, however, has to be further investigated. More epigenetic research can lead to the development of early diagnostic and prognostic markers and their new anti-epigenetic therapy forms.

Key words:

Genetics, epigenetics, angiogenesis, renal cell carcinoma  

“Diagnostic and therapeutical aspects of lymphedema”

Lymphedema is a very common chronic disorder from which in the Netherlands alone about 350.000 people suffer. Lymphedema causes a disordered drain of fluid in the body as a result of which the patient gets swollen body parts (mostly arms or legs). This first dissertation on lymphedema in the Netherlands describes new diagnostics of lymphedema on the basis of scientific research, gives an overview of the effectiveness of several (non-) operative treatment methods and gives a guideline for setting up a multidisciplinary care protocol. To prevent irreparable defects and complications and to improve the patient’s quality of life, early diagnostic and treatment are necessary. The treatment is the most effective when (para-) medics cooperate in a multidisciplinary way, also because patients with lymphedema need follow-up and care throughout their lives.

Key words:

lymphedema, diagnostic, treatment

“Haruspices in het heden” (‘Haruspices in the present’)

“Balancing Trade and Health in the SPS Agreement: the development Dimension”

The Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement) of the World Trade Organization (WTO) reflects a negotiated balance between competing objectives: liberalization of trade in the food and agriculture sector and protection of health by national governments. This research analyzes the consequences of the rules of the SPS Agreement for WTO Members with different development levels. Currently, the judicial organizations of the WTO (panels) interpret the SPS Agreement from a normative vacuum; the judging of a complaint about or the defence of a measure is mainly based on scientific evidence material. Developing countries that do not dispose of the necessary scientific capacity are at a disadvantage in this matter. According to Prévost the international human rights law (particularly the right of life, health, safe food and development) offers the stringently needed normative framework that can lead to a more suitable balance.

Key words:

WTO, international trade law, food security, developing countries

“Histaminergic manipulations of human cognition: studies of pharmacological effects on evoked potentials and performance tests”

Clinical disorders, such as Alzheimer’s disease, involve decreased cognitive functions that can still not be sufficiently treated. Earlier research suggests that the neurotransmitter histamine could play a role in these disorders and could possibly be the basis for new medication. First should be examined which role histamine plays in cognitive functions. This dissertation describes the effects of various histaminergic manipulations on cognitive functions in healthy people. The conclusion is that histamine especially plays a role in the speed of information processing. The consequences of these results for the development of new medication needs to be further investigated.  

Key words:

cognition, histamine, medication

“On social Cognition: Vulnerability and symptoms in Psychosis”

“Neuropathology of Schizophrenia: a new vistas”

“Mechanocontrol of cardiac growth and remodeling”

Mechanic strain of the tissue determines for an important part the structure of the heart muscle. To gain better insight in the relation between mechanic strain and changes in the tissue structure and pumping capacity, hypotheses were tested in a mathematical model for the possibility of reproducing experimentally observed heart muscle geometry, structure and remodelling. It turned out that adaptations in the tissue structure on the basis of local mechanic strain was sufficient for the reproduction of the experimental observations. One of the conclusions is that there is a relation between remodelling, tissue mass, structure (muscle tissue orientation) and pumping capacity.

Trefwoorden:

mechanic strain, remodeling, heart muscle

“On hypervigilance and extreme evaluations in borderline personality disorder”

“Beyond Motivation; an exploration of pre- and postmotivational determinants of cancer-related behaviors”

At least one third of all cancer cases can be prevented by a healthy lifestyle. Many people have the intention to live healthy, but only a relatively small percentage succeeds at doing that. There is a big difference between what people want and what they do. This dissertation shows that it is important to consciously plan preparatory actions that lead to healthy behaviour. For eating sufficient fruit, for example, it is important to make plans about buying fruit, taking fruit to school or work, or replacing unhealthy snacks by fruit. It also turns out that making specific plans about when, where and how the behaviour will be carried out is an easy and very effective method for improving the health behaviour of people.

Key words:

cancer, behaviour, health

“The empirics of contracts; theoretical and empirical observations on contract design”

“Portal Dosimetry in Radiotherapy”

The aim of radiotherapy is to radiate tumour tissue with a high radiation dose, while the dose in the surrounding normal tissue is as low as possible. To achieve this, a radiation is accurately prepared with the help of extensive imaging and advanced computer software. However, the dose that is actually emitted to a patient during the radiation can significantly differ from the prescribed dose. This can negatively influence the outcome of a treatment. This dissertation describes methods to control the dose during radiation with images of Electronic Portal Imaging Devices (EPIDs). The results show that dose verification procedures based on EPID measurements offer a high accuracy. Moreover, a greater variety of errors in dose emission can be traced compared to traditional methods. The clinical application of this method leads to adjustments and improvements in radiations for a large group of patients.  

Key words:

radiotherapy, imaging, dose verification

“Nutritional factors predicting postoperative Infectious complications in the Mekong Delta,  Vietnam”

“Epidemiological studies of Schizophrenia”

“Objects, meaning, and the brain; neuroimaging studies on the impact of semantics on cortical  integrative processing”

People are capable of recognizing common objects, not only with their visual faculty, but also with their hearing. In most cases we experience seeing an object and hearing its sound as strongly interconnected. In the studies that were described in this dissertation test persons perceived either sounds or both sounds and images of objects, while their brain activity was measured in a brain scanner. The results show that specific parts of the brains are involved in the processing of different categories of sound. Acquired associations between the sound and the image of an object appear to stimulate the processes of integration and object recognition. The studies contribute to a better understanding of object recognition by means of sound and the complex interaction between our senses.  

Key words:

sound image brain activity, object recognition

“The role of gender in medical speciality choice and general practice preferences”

“Genetics and cardiovascular risk in a primary care population. Studies from the  HIPPOCRATES project”

For years already, many cases of cardiovascular disease occur in the Kerkrade region.  This dissertation studied in a primary care population whether the determination of a series of genetic characteristics has an added value for the determination of the risk of cardiovascular diseases. This study investigated six polymorphisms. One of the main conclusions is that there is indeed a connection between these polymorphisms and cardiovascular diseases, but that the added value for this group of primary care patients is minimal (only 1% more compared to the traditional risk factors such as cholesterol, high blood pressure and diabetes). Therefore, too small to use in the day-to-day clinical situation in the entire group. For individual patients with specific characteristics, however, there were indications that determination of certain polymorphisms could contribute to the estimation of the cardiovascular risk.

Key words:

cardiovascular diseases, genetics, polymorphism, general practice

“Wisdom is the meetingpoint of doubt and certainty”

“Innovative use of simulated patients for Educational purposes”

“Non-convulsive aspects of epilepsy in children”

“Vertrouwen in onderzoek naar verkiezingen”

 “Embodied Technological Change and Patterns of Investment in Austrian Manufacturing”

This research revolves around three major issues: one, it contributes to the burgeoning discussion as to what drives observed business cycles and identifies how much of the Austrian business cycles can be explained by technological change; two, it confirms the vital role investments as carriers of technological change play for macroeconomic performance and provides a rich and coherent picture of entrepreneurs’ investment strategies and, three, it assumes that observed investment patterns emerge in response to non-negligible costs associated with investment activities and simulates the underlying determining costs.

Key words:

Austrian manufacturing; technological change; business cycles; investments

“At Risk for Depression; the role of stress and serotonergic vulnerability”

Depression is one of the most common serious diseases worldwide. Therefore, in the field of psychology finding risk factors for depression is currently seen as an important challenge.  Vulnerability of the serotonergic system and stress experiencing appear to increase the risk of depression. Our research shows that people with a familial or genetic disposition to depression react more sensitively to serotonergic manipulations (tryptophan depletion) and are also more susceptible to stress. This supports the assumption that people with a serotonergic vulnerability run an increased risk of depression after experiencing stress. We also show that diet induced serotonin increases (via tryptophan increase with a tryptophan-rich protein hydrolysate) improve the mood and stress vulnerability. This can have important implications for prevention and treatment of depression. 

Key words:

depression, serotonin, stress

“Attention for Alcohol. On the changeability of appetitive motivational processes in alcohol abuse”

Heavy social drinkers and alcoholics have excessive selective attention for alcohol-related objects, such as a beer bottle, a bar or someone drinking from a wineglass. This ‘attention’ bias is related to someone’s drinking pattern and the strongest in heavy drinkers before they start to drink. Two studies showed that after consumption of small quantities of alcohol (up to about three glasses) there is a temporary increase in the attention bias and the desire for alcohol. After drinking very large quantities of alcohol, particularly the desire for alcohol becomes bigger, while the attention bias decreases and seems to no longer play a role. The researchers have developed a treatment (‘attention training’) that cures heavy drinkers and alcohol addicts of the attention bias. After this attention training, the addicts could leave the alcohol rehabilitation centre earlier and relapsed less quickly into their alcohol abuse. 

Key words:

alcohol, addiction, treatment

“Algorithmic Pricing”

Algorithmic pricing is the study in which the computational problem is considered that a company faces when trying to set prices for their items to maximize the revenue, knowing the preferences of the potential customers. In this thesis, two different algorithmic pricing problems are considered, namely single item pricing and affine pricing. First, we address the question how difficult the problems are. Then, we show how to actually tackle the problems. We describe practical settings in which the problems can be applied, and next to the theoretical results, we conduct several computational studies.

Key words:

Algorithmic pricing, revenue maximization, computational complexity, approximation algorithm

“3D dose verification for advanced radiotherapy”

The objective of radiotherapy is to give the tumour a high dose of radiation, sparing the healthy tissues and organs as much as possible. This requires a precise dosimetric and geometric design of the treatment plan. In this dissertation models were developed and procedures were described that give information about the dose emission, both before and during the treatment. This information can be converted into a three-dimensional (3D) image so that the information about the distribution of the dose of radiation in the patient’s body is visible. 3D-dose verification strategies are applied as a quality guarantee in a test irradiation prior to the treatment and during the treatment (in vivo dosimetrics). This dissertation studies both strategies and indicates how these advanced models can be implemented in a radiotherapy treatment. 

Key words:

radiotherapy, dose of radiation, 3D

“Online Consumer-to-Consumer Communication Networks; an economic exploration of their formation and value”

​Online Consumer-to-Consumer Communication Networks are characterized by informational and social benefits as well as time and effort costs for participants. Therefore, this dissertation takes an economic perspective on the network formation process as a determinant of value for consumers and indirectly for firms. Since in participants’ linking choices also others’ choices play a role, a game-theoretic model is introduced. It predicts which structures emerge dependent on manipulable properties, like the relative importance that is attached to informative versus social value and the presence or absence of a highly valued expert. Also the complexity of the setting can influence consumers’ decisions for certain links. Lab experiments show how people systematically simplify more complex value components, e.g., disregard what they receive from indirect neighbors and what they generate for others.

Key words:

Consumers, communication, network formation, virtual communities, decision making, game theory, lab experiments

“Excessive alcohol use in youth on holiday; an evaluation of two intervention methods”

Young people on vacation drink large quantities of alcohol which results in various health risks.  This research tests two possible strategies for pushing back this alcohol use: Community Intervention (CI) and Expectancy Challenge (EC). The first focuses on reducing the alcohol use by making alcohol less available to young people (for example by enforcing age limits). The second tries to reduce alcohol use by changing the expectations of young people with regard to the effects of alcohol. The EC had no influence on the alcohol use of young people on vacation. The CI must be further optimized before statements can be made about the effect on alcohol use. 

Key words:

alcohol use young people; alcohol use vacation; intervention alcohol use; age limits alcohol use

“The systematic recruitment of new blood donors”

This dissertation describes a series of studies in the field of donor recruitment. Three studies revealed the main determinants of blood donation, among others the expectation of fear and pain, reactions from others, sense of responsibility. Based on this, two research Lines were set up. The recruitment folder appeared to be mainly focused on knowledge transfer. The content was improved by adding determinant-relevant information. Subsequently, a donor-recruits-donor folder and postcards were developed and evaluated. The field study showed that this campaign is an effective way of recruiting new donors. 

Key words:

blood donation; donor recruitment; donation determinants

“Uitgelezen variatie” (‘Exquisite variation’)

“De oorlog van Bastiaans; de LSD-behandeling van het KZ-syndroom”

Prof. Dr. Jan Bastiaans (1917-1997) was one of the most influential and renowned psychiatrist in the post-war Netherlands. He was especially known for his LSD treatment of a special group of patients: the survivors of the German concentration and extermination camps. With a forceful political lobby, emotional blackmail and even threats Bastiaans and his adherents fought for the salvation of his method. How was it possible that ‘papa Bas’ continued his controversial method for such a long time?

In ‘De oorlog van Bastiaans’, psychologist Bram Enning describes the battle of Bastiaans and his patients by means of portraits of patients and developments in science and society. 

Key words:

psychiatry, Holocaust, therapy

“Arginine biosynthesis in organ development and function”

“Exploring the Design, Planning and Control of Mental Health Care Services”

“Vascular cognitive impairment and cholinergic function: an integrative analysis in rat brain”

After a cerebral infarction, many people suffer from cognitive complaints such as mental slowness and concentration problems. These complaints are probably caused by disorders in a specific nervous system of the brains: the cholinergic function. This dissertation shows that a part of the cognitive complaints after a cerebral infarction can be imitated in test animals. Furthermore, this research describes an MRI-technique that can visualize this specific nervous system in the brains of living test animals. In the future, this new imaging technique can possibly be used as a tool in diagnostics and treatment of people with cognitive complaints after a cerebral infarction. 

Key words:

cerebral infarction; cholinergic function; cognitive complaints

“Multidisciplinary approach to locally advanced and recurrent rectal cancer”

In the Netherlands, around 10.000 people per year get large intestine/rectal cancer. About 50% die of the disease. This dissertation provides new insights in the image and treatment of rectal cancer and it indicates how different disciplines such as radiology, surgery, radiotherapy, oncology, pathology and molecular biology can provide important information so that a patient with rectal cancer can be treated as optimally as possible. The treatment becomes increasingly patient-specific, so that an optimal balance is found between good oncologic result and a minimum of treatment-related disease rates.  A radical resection (operative tissue removal) turns out to be the main factor for survival. Radicality depends on preliminary treatment with chemo- and radiotherapy and of the location of the tumour. Furthermore it turned out that magnetic resonance imaging (MRI) is a good predictor of the extent of tumour growth. The extensiveness of operation can be adjusted to this. Pathological factors can well predict which patients run an increased risk of a recrudescence of their tumour.  

Key words:

rectal cancer; patient treatment; interdisciplinary patient information

“MRI in Rectal Cancer; prediction of the risk factors for a local recurrence”

Each year, there are over 7500 new cases of rectal cancer in the Netherlands. The rectum carcinoma shows, besides the risk of metastases, a risk of 3 % to 32 % of relapse.   Optimal surgical techniques and radio-chemotherapy have led to a better control of relapse. The two main risk factors for relapse are the local extent of the tumour and the lymph node status. A study with 296 patients (both in an expert centre and in regional hospitals) shows the high precision of MRI with the use of Sinerem for predicting both factors. This makes it possible to differentiate preoperative therapies and to create an alternative for the standard protocol of preoperative radiotherapy. In the low-risk groups preoperative radiotherapy can be avoided, in high-risk groups a more aggressive therapy can be applied.

Key words:

rectum carcinoma; rectal cancer; local relapse; preoperative therapy; MRI; Sinerem;

“MRI-based Tailored Treatment of Rectal Cancer: impact on surgical outcome”

“Wie kust doornroosje wakker?” (‘Who kisses sleeping beauty awake?’) 

“Psychoacoustic and neurophysiologic Investigations of auditory continuity”

Our capability to track sounds in noisy environments is illustrated by the continuity illusion in which an interrupted sound is perceived as uninterrupted, provided that another sound masks the interruption. The present studies combine methods (psychoacoustics, functional magnetic resonance imaging, electroencephalography) to reveal the underlying constructive mechanisms in the human brain. The results identify i) acoustic, cognitive, and contextual factors, ii) brain regions, and iii) time intervals of neural processing which are critical for producing the illusion. The results put forward a neural-computational model that may be implemented in artificial devices to restore smooth hearing in noisy environments.

Key words:

auditory, hearing, fMRI, EEG

“Use of non-pathogenic bacteria as vectors for targeted gene expression in cancer gene therapy”

“The clinical value of TURP in patients with elevated or rising PSA”

For the diagnostics of prostate disorder PSA (prostate specific antigen) is an important cornerstone. However, the big limitation of PSA is the fact that this test is only organ specific (prostate) and not cancer specific. Patients with a rising PSA level form a growing population in the urologists’ practice. This dissertation shows that in patients with risen PSA without demonstrable prostate cancer an ‘asymptomatic’ infravesical obstruction (i.e. urinary obstruction) caused by a benignant prostate enlargement should be considered. Removing this obstruction by means of keyhole surgery (TURP) will lead to a supernormal PSA level and symptomatic improvement in most patients and above all, in most cases no cancer will be found.

Key words:

prostate disorder, cancer, PSA.

“Functional and structural brain markers of Alzheimer’s disease: clinical studies using EEG and VBM”

“Mental slowness after stroke: assessment and treatment”

One of the most common cognitive disorders after a stroke is slowness of information processing. This dissertation focuses on the limitations the patient experiences in everyday activities (following quick conversations, doing two things at the same time and reacting adequately) and on the related consequences such as fatigue. The effects of the Time Pressure Management training, where patients learn to adequately deal with the consequences of their slowness, are evaluated. After the training the patients have fewer complaints and they are able to perform everyday tasks quicker without making more mistakes. The Time Pressure Management training turns out an effective method for dealing with the consequences of slowness of information processing.

Key words:

stroke, slowness of information processing, cognitive revalidation.

“The impact of Ankylosing Spondylitis on bone”

Ankylosing Spondylitis (AS) is a form of chronic, rheumatic inflammation particularly in the vertebral column (spondylitis). In patients this leads to chronic back pain, stiffness in the back and ultimately to growing together of the vertebra (ankylosing). One of the conclusions of the research is that in patients with Ankylosing Spondylitis the bone and vertebra quality has deteriorated to such an extent that they run a three times higher risk of vertebral fracture. Two-thirds of these patients experienced permanent neurological damage as a result of that. Furthermore, the research studied if hyperkyphosis (curving of the vertebral column) can be measured and predicted. It turns out that three factors jointly predict the curving: the activity of the disease, the degree of syndesmophyte formation (the bone hooks that bind the vertebra together) and the wedge formation (collapsing of the vertebra).

“Preparing for action; a behavioral and pupillometric study”

“Differentiatie in het (Europees) contractenrecht”. (‘Differentiation in (European) contract law.’)

This research studies among others the question if contact law should be designed around a general contract law, formed by the foundations and principles that apply to all agreements and contact parties, or if this idea should be dismissed as useless and a choice should be make for a differentiated contract law. For this purpose the author surveys among others arguments for and against a differentiated contract law. Also various doctrines of contract law are studied. 

Key words:

contract law, private law.

“Different kinds of Precaution; a comparative anaylsis of the apllication of the precautionary principle in five different legal orders”

The thesis has outlined the application of the precautionary principle in international and EC law, as well as compared the application of the principle in the fields of pesticide regulation and mobile telephony in Sweden, the United Kingdom and the Unites States. The principle implies that there is a responsibility to intervene and protect the public from exposure to harm in the absence of a scientific consensus. The study has shown that the principle at present often is applied in an inconsistent and inefficient manner. Similar situations are often treated differently by regulators and effective redress before the courts is severely limited. It is suggested that a rational legal framework for the application of precautionary decisions is elaborated, on the national as well as the EU and international levels. 

“Earning-by-learning”

Firms increasingly rely on external partners (i.e. consumers or firm partners) to execute services. Examples of such services are makelaarsland.nl or online investment sites. Because of inexperience or lack of knowledge problems can sometimes arise in the cooperation. This dissertation offers three empirical studies, focused on improving the performance of the consumer or partner. By offering information or via training companies can improve the performance of their customers and partners. This is done directly by improving the skills and increasing the knowledge, but also indirectly by increasing the task-specific confidence of customers (self-efficacy) or increasing the knowledge application. The research focuses on these indirect factors. Based on the findings, the dissertation offers suggestions and guidelines to companies for offering information and training. 

“Myocardial Infarct Healing: Rupture and remodeling”

The process of wound healing after a myocardial infarct is very complicated and can cause various complications. This dissertation studies two frequent complications, namely infarct rupture and heart failure. Infarct rupture, a rupture in the infarct, appeared to be related to a defect in the so-called cell adhesion complex that connects the heart muscle cells with each other. By means of imaging techniques heart failure could be predicted by registering the amount of myofibroblasts, a cell type that occurs in the infarct area. As soon as this imaging technique will be clinically applicable optimal treatment can be applied in high risk patients, so that heart failure after a myocardial infarct can possibly be prevented. 

Key words:

myocardial infarct, heart failure, imaging technique

“Anytime, Anyplace, Anywhere: Kennismanagement in de platte wereld”

“Graphs, Mechanisms and Scheduling”

Traditional optimization among others deals with scheduling problems, such as assigning tasks to machines in a production process. Although most models assume the presence of a central planner, there are usually several agents who have to cooperate with each other. This dissertation studies the mechanisms that organize the cooperation in such a way that good solutions for the scheduling problem can be reached, even if the agents act selfishly. A solution is ‘good’ if for example the total satisfaction of all agents or the profit of the machine’s owner is as big as possible.

Key words:

mechanism design, scheduling, optimization, online optimization, revenue equivalence.

“Zo kan het ook. Een ander perspectief op organisatiewetenschap”.(‘Another way to do it. Another perspective on organization science.’)

“New insights in the Surgical Treatment of Chronic Ischemic Mirtral Regurgitation”

The malfunction (regurgitation) of the heart’s mitral valve complicates a high percentage of myocardial infarctions. This condition requires cardiac surgery and it still represents a serious challenge for surgeons. The intervention consists of a coronary artery bypass, performed to ensure blood supply to diseased coronary arteries, associated with a repair of the native mitral valve. Nonetheless, after few years, the repair fails and, as a result, the mitral disease re-appears in the major part of patients. Our research gives new insights in the surgical treatment of this pathology and makes an attempt to identify, before surgery, patients who can really benefit from this approach.

Key words:

hart; hartinfarct, hartchirurgie

“Role of infections on intimal hyperplasia”

After treatment of atherosclerosis blood vessels often clog up again because of an increase in the number of smooth muscle cells in the vascular wall (“intimal hyperplasia”). In various animal models the role of the bacteria Chlamydia pneumoniae and the cytomegalovirus (CMV) in intimal hyperplasia was studied. We also tried to prevent the closing up of the blood vessel by means of gene therapy. Our results show that C. pneumoniae and CMV play a role in vascular wall thickening in experimental animal models of percutaneous angioplasty and bypass operations. However, after organ transplantation no link could be shown between C.pneumoniae and this disease. C.pneumoniae and CMV infections are capable of stimulating smooth muscle cell proliferation, even if there were only few micro-organisms present in the vascular wall. We also showed that the new medicine FK778 is functional in the prevention of excessive vascular wall thickening. Finally gene therapy turned out a successful way of decreasing intimal hyperplasia in our animal model.

“MS: en hoe verder ?” (‘MS: how further?’)

“Microfinance – Greater good or lesser evil”

The major objective of this dissertation was to get a deeper understanding of a special intervention designed to bring out the greater good in microfinance in India. To do so, Augsburg conducted a household survey in rural India of approximately 500 participants and 500 non-participants of this intervention. This led to the conclusion that the intervention plays a crucial role in consumption smoothing of the household and that it has the potential to lift participants above the poverty line. This effect is stronger for those participants who additionally have non-financial services, which points to the importance of taking an integrated approach to microfinance when it comes to the very poor.

Key words:

microfinance, India

“Ecological aspects of cognitive assessment”

Worldwide, there is an increase in the number of people with neurological disorders such as non-congenital brain damage and dementia (respectively  by 12% and 66% between 2005 and 2030). These neurological disorders often lead to difficulties in everyday life, not only in the physical area, but also in the neuropsychological area, such as cognition, emotion and behaviour. Bouwens’ research shows that the cognitive functioning, measured in a test environment, deviates from the functioning in everyday life. The relation between cognition and daily life depends among others on the type of dementia and in people with a non-congenital disorder the observation of people in their own environment produces important additional information that is not revealed in neuropsychological tests. One of the conclusions is therefore that the relation between cognition and everyday functioning can be used as a diagnostic instrument. 

Key words:

non-congenital brain damage,  dementia, cognitive research, everyday life 

“Emotional support for chronically ill elderly persons; feasibility, effectiveness and cost-effectiveness of a minimal psychological intervention”

Many chronically ill people struggle with mood problems such as depression, fear and insecurity. This dissertation studies a short psychological treatment aimed at reducing depression in chronically ill elderly. Primary health care nurses visit elderly people at home and teach them how the can become active self-managers. It turns out that the treatment is positively received by both elderly people and nurses. In the long run, the treatment also reduces depressive symptoms and fear and it improves the daily functioning compared to chronically ill elderly, who received the regular care from their GP. This approach does not raise the costs. The treatment will soon be further introduced in a large number of GP practices in South-Limburg.

Key words:

depression, chronically ill people, elderly

“The Periaqueductal Gray and Defensive Behavior: new clues from an old concept”

The aim of the studies presented in this thesis was to investigate the possibilities to modulate the activity of the dlPAG (dorsolateral periaqueductal gray, the primitive structure of the brain) in order to induce or attenuate fear responses in the rat. The fear and panic animal model was specifically chosen to gain more knowledge about the functional anatomy and behavioural phenotype of defensive behaviour. At present, we are still in the early stages of understanding fearful emotion and cognitive behaviour and the exact role of the PAG in these behaviours. Nevertheless, recent developments in neuroscience will gradually reveal the nature and complexities of emotionality of defensive behaviour in our phylogenetically old brain structure – the PAG. 

“The logic of Coincidence: Agenda-setting in the European Union on Development Co-operation. After the Fall of the Berlin Wall”

The thesis looks at the evolution of EU development cooperation - the major tool of the Union’s external policy - after the EU had emerged as a global player in the aftermath of the fall of the Berlin Wall and provides clear evidence that the end of the cold war has triggered a redefinition of EU development policy, especially regarding the inclusion of Eastern European neighbors and the prioritization of poverty. The study is based on the concept of a policy window, as a situation created by an event which provides opportunities for policy change within a limited timeframe and discusses the underlying question in how far one major event can decisively impact on agenda-setting and decision-making.

Key words:

Europe, development policy, ACP

“The role of human papillomavirus in the Development of tonsillar squamous cell carcinomas”

Malignant tumours departing from the tonsils occur more and more frequently over the years. Besides the well-known risk factors such as smoking and excessive alcohol consumption, it has become clear that also human papillomaviruses (HPV) play a role in the development of these tumours. Patients with tumours that were caused by HPV are less often smokers and/or drinkers, have more metastases and a better survival  compared to patients with tumours in which the virus was not present. Also in the molecular area HPV-positive tumours differ from HPV-negative tumours. This offers perspectives for the development of both new therapies and tests for the determination of individual therapy choice.

“Exporteerbaarheid van het Nederlandse pensioenstelsel naar de Europese Unie”

“The Role of Demand in Technical Change”

This thesis is rooted on the new knowledge economy and product innovation. It reflects on the idea that innovations, if they are successful, change the habits and customs of a society. For these inventions to have a positive effect on the growth (and wealth) of a society, they have to become new needs for the consumers. When compared with classical economic theory, this research models a consumer which is closer to human nature: preferences change to allow the purchase of new goods while retaining some old habits. In this framework a radical innovation is the one that is needed by the majority of the population.

“The Impact of Social Capital on Economic and Social Outcomes”

Researchers have used the concept of social capital to explain various associations with socio-economic outcomes. However two important aspects have largely been ignored: (i) what forms social capital, and (ii) how social capital affects outcomes. This study provides advancements on these relatively shallow aspects. First, by reducing transaction costs such as monitoring costs, creating new forms of information exchange and influencing (and regulating selfish) behaviour through norms, higher social capital induces innovation. Second, we provide a relatively original approach to the measurement of social capital and use these new indicators to explain differences in crime rates across geographical space in the Netherlands. Third, institutions are important in shaping social capital. Good “social capital” forms in geographical areas where the power of the chief executive is constrained, where the level of education is high, where universities existed as repositories of culture and where the population was less heterogeneous.

“Knowledge Flows and Social Capital”

This research studies the role of social capital in distributed learning and innovation for sustainable agriculture. Social capital is mapped using informal social networks of an innovative rural Indian community. These networks transfer relevant knowledge, goods, credit and socio-political support. Theoretical results on core-periphery structures, used to identify dominant cores in each network, highlight the unequal distribution of social capital in knowledge, business and socio-political domains. A lack of social capital for knowledge among farmers is used to explain the near absence of innovation capacity building in the community. Socio-economic hierarchies such as those driven by business relations between farmers and their credit providers or crop buyers, and caste-based dominance, are important determinants of community action for innovation.

“Verdediging in Transitie; de positie van de advocaat in strafzaken in postcommunistisch Polen”

After the collapse of the communist regime, there have been attempts in Poland to strengthen the position of the defence and bring it into conformity with the demands of the European Convention of Human Rights (ECHR) by means of adaptations of the criminal procedure. This research clarifies how that was done and how the new situation relates to the conditions for an effective defence that can be derived from the ECHR. Based on that information, conclusions are formulated about the factors that have determined the effect of the realized reforms and lessons are derived about the (possible) effects of government-initiated optimization of defence rights.

Key words:

Law of criminal procedure, defence, honest trial, constitutional state 

“The exercise-induced oxidative stress paradox In COPD”

Loss of muscular function often occurs in patients with COPD and leads to a decreased effort capacity and increased mortality and morbidity. Oxidative stress (reduced oxygen intake by cells caused by the formation of free radicals) and inflammatory reactions seem to play an important role here. A training programme improves the effort capacity of COPD patients, but in healthy persons on the contrary an intensive effort causes an oxidative stress and inflammatory response. This dissertation shows that COPD patients compared to healthy persons have an increased oxidative stress response, both in a situation of rest as during efforts. In patients did was not accompanied by an inflammatory response. It also turned out that after completion of a lung rehabilitation programme with regular exercise, COPD patients experienced less oxidative stress during efforts and an improved effort capacity. This favourable effect is probably the result of a more efficient energy metabolism.

Key words:

COPD, oxidative stress, inflammation, effort, rehabilitation

“Met recht naar Klimaat-bescherming”; over de rol van het recht en de markt voor het klimaatbeleid” (‘Rightfully towards climate protection; about the role of law and market’)

“Characterization of anticoagulant functions of protein S”

“Hard to get, hard to keep; Dissemination of and Exposure to internet-delivered health behaviour change interventions aimed at adolescents”

Because of the wide range of internet lifestyle advice and interventions have great potential via this medium, but as yet these websites are only used sparsely by adolescents. On the basis of a literature study and research among experts and adolescents themselves, strategies were developed for the improvement of exposure to internet interventions. These strategies were subsequently tested on existing internet interventions (for example focused on alcohol use). A link to school activities turns out a good way of bringing this type of websites to the attention of adolescents. Online recommendations by word of mouth via an email from a friend are also a strategy that has proven effective. To raise the number of visits to such websites, they must not be  an accumulation of technical possibilities, but they have to reflect what adolescents really want and effectively use. 

Key words:

internet, adolescents, health

“Reconstruction the Self Problems of Choice, Fate and Justification in the Eugenics-debate”

In the last decennia, bio-ethics has withdrawn itself in the issue of which biomedical ethics work best, instead of concentrating on what is the best procedure for a concrete moral problem. The discussion is about the way that other people’s choices can be facilitated best, not about what these choices should be. This dissertation discusses the consequences of that for the discussion about new, liberal eugenics: selective reproduction that is not focused on the prevention of serious diseases, but on the preferences of the parents (for example more intelligent, more resistant). Such applications cannot be excluded anymore with the current biomedical ethics. On the basis of Jürgen Habermas’ concept of ‘the self’, Landeweerd develops an alternative for the currently used concept in which autonomy is only connected to free choice. By connecting autonomy with identity, many forms of eugenics appear to be problematic because that which is choice for prospective parents, will be fate for the eugenically created.

Key words:

bio-ethics, eugenics

“Endotoxin and microparticles as markers for inflammation and coagulation”

“Symptoms in Patients with Cancer”

Pain is one of the most feared and most common symptoms in patients with cancer. In spite of the increased attention for and increased knowledge about pain an pain treatment the prevalence of moderate to serious pain in this patient group has not decreased in the past forty years. Of the patients that receive active anticancer treatment one quarter has moderate to serious pain. Half of the patients with an advanced stage of cancer suffer from moderate to serious pain. Almost half of the patients are undertreated for pain. The greatest risk of undertreatment is run by patients with a low education level and patients in a relatively good condition. 

Key words:

cancer, pain, undertreatment

“Unravelling fatigue in the working population: Course,consquences, and its association with burnout”

This dissertation studies the course of fatigue complaints in the working population. Serious fatigue complaints appear to have a very unfavourable course. Of a group of employees who suffered from serious fatigue 57% turned out to still suffer from this serious fatigue after 4 years. The course of the two different expression forms of fatigue was compared, namely long-term fatigue and burnout. Differences in symptoms, development and prognostic factors were found between burnout and long-term fatigue. When burnout and fatigue occur together, the course is more unfavourable than when they occur separately. It appears important to distinguish burnout and fatigue and to prevent the simultaneous occurrence of these disorders. 

Key words:

fatigue complaints, burnout, long-term fatigue

“The role of nurses in medical end-of-life decisions”

“Wnt Signaling And Cardiac Hypertrophy”

Key words:

type 2 diabetes, twins, genetics

“Genetic analyses of type 2 diabetes related metabolic risk factors: a twin study”

​Besides an unhealthy lifestyle genetic sensitivity also plays an important role in the development of type 2 diabetes (T2D).  The PhD candidate performed genetic analyses with symptoms that precede or are related to T2D in a population of young adult twins from the East-Flanders Multiple Birth Register. This dissertation shows among others that in this group of twins differences in symptoms that are related to overweight, the blood sugar and cholesterol level can be largely explained by genetic differences. Because the identification of these genetic factors is very important to gain more insight in the underlying molecular mechanisms, analyses with genetic variants in candidate genes for T2D were performed.

“MIND THE GAP .A Critique of Human/Technology Analogies in Artificial Agents Discourse”

For a better grip on the development of clever computer technologies and humanoid robots researchers often speak in metaphors. Comparisons with people, such as the computer as digital butler, help with shaping ideas about how these technologies (have to) relate to people. This dissertation shows that this is no innocent pastime. Metaphors elucidate certain aspects of a technological concept, but they obscure many others just as well. Moreover, metaphors are interpreted differently in different contexts. On the basis of a critical analysis this dissertation discusses the many implicit choices that are behind promising pictures of the future of clever computer technologies. The research also shows that attention for differences between man and computer are just as essential for a good development of technique as the exploration of the similarities.

Key words:

metaphors, pictures of the future, artificial intelligence, artificial agents 

“Text Mining: de volgende stap in zoektechnologie; Vinden zonder precies te weten wat je zoekt of wat er niet lijkt te zijn”. (‘Text-Mining: the next step in search technology; Finding without exactly knowing what you are searching for or what doesn’t seem to be there.’)

“Dynamic regulation of thrombus stability”

Atherothrombosis is characterized by the tearing of a plaque in an artery, which results in the exposure of components of that plaque, such as collagen, to the blood stream and consequently in the activation of the thrombocytes.   Activated thrombocytes form a thrombus (a ball of thrombocytes) that can block the artery, such as in a heart or cerebral infarct. The research in this dissertation has led to improved insights in the signal mechanisms that take place in thrombocytes when they come into contact with (collagen in) torn plaques.  Shown was also that thrombus formation is not a simple succession of events, but a dynamic and partly reversible process. The improved insights in the process of thrombus formation, gained in this dissertation, contribute to the development of more effective medication for the treatment of atherothrombosis.

Trefwoorden:

thrombocytes, thrombus formation, thrombus stability, atherothrombosis 

“Sarcopenia in COPD: functional and metabolic implications”

Chronic obstructive pulmonary diseases (COPD) is a very common disorder of the bronchial tubes with important effects in the body outside the lungs. This dissertation studies the relation between dietary condition and strength, stamina and efficiency of arm and leg muscles, and the influence of exertion training in COPD patients. They appear to have a decreased leg muscle function. Conversely, the functioning of the arm muscles has remained at the same level. Possible disruptions in the glucose metabolism and in the decomposition of fat and muscle protein were studied in relation to changes in the dietary condition. COPD patients are characterized by an increased glucose production and muscle protein decomposition, while the speed of fat decomposition is not disturbed. 

Key words:

COPD, dietary condition, muscle function, metabolism, revalidation