Academic Ceremonies December 2012

“Evolution in sacral neuromodulation for lower urinary tract symptoms”

Lower urinary tract symptoms (symptoms of an overactive bladder or disturbed bladder emptying) have considerable impact on the quality of life of patients and involve high costs for society. Medication is not always effective. Sacral neuromodulation (SNM) is a treatment for these symptoms, which induces changes in the responsible reflex paths by electrostimulation. This dissertation has shown that this therapy is effective and safe for the long term. After 5 years, appr. 70% of the patients benefit from this therapy. It was also shown that improvements in the operation techniques and equipment that were introduced throughout the years lead to a decrease of complications. Furthermore, the first results of the implantation of another model of electrode are presented. Contrary to the ‘old’ electrode this can be placed with local anaesthesia.

Key words:

lower urinary tract symptoms, electrosimulation

“Innovation in manufacturing from product variety and labor productivity growth to economic development in Chile”

In recent decades the expansion of the Chilean economy has been closely related to the Copper Industry, currently representing over fifty percent of Chilean exports. For the economy to grow sustainably in the long term, knowledge needs to be accumulated in the production process, export needs to be diversified and market competitiveness must be promoted. This work offers an analysis of the Chilean economy focusing on some opportunities and challenges that need to be considered to achieve growth for the following decades. It then contributes to our understanding of the innovative process in the Chilean economy with studies of the relation of knowledge flows and R&D cooperation agreements; product diversification with total output and productivity; and labor productivity with the competitiveness of markets.

Key words:

Labor Productivity, Product Innovation

“Essays on entrepreneurship and innovation”

“Ethics support in elderly care; developments and specific needs for ethics support, and an evaluation of moral case deliberation in two Dutch elderly care organizations”

On a daily basis care providers in elderly care are confronted with ethical issues. What, for example, do you do when a resident wants to stay in bed, while family members think it is better for her to get up and participate in activities?   
The first part of this dissertation gives an overview of various forms of ethics support that were internationally developed in the last decades to support care providers in dealing with these issues.  Harvesting information from Dutch institutions for elderly care showed that the need for ethics support is very specific and not always articulated. The second part contains an evaluation of Moral Deliberation projects in two nursing homes and homes for the elderly. The results show that Moral Deliberation corresponds well with the specific needs of care providers because it focuses on everyday ethical issues, the own experience from practice and the development of skills to enter into a dialogue.

Key words:

moral deliberation, elderly care, ethics, practice

“The Economics of the School Curriculum”

This dissertation investigates how the set-up of the education system influences the learning process of pupils. Studied were the long-term and short-term effects of a series of specific characteristics of that education system. It turns out, for example, that going to school earlier leads to better learning performance at a later age. Also, pupils in whose case there were doubts about the secondary school level they should enter (vmbo, havo or vwo), accomplish a higher school programme and earn more at a later age when they choose to enter the higher school level.  Education level and salaries are also higher in the case of pupils who follow an introductory year of longer duration, and where as a result the choice for school level takes place at a later age. Finally, it is shown that repeating a class has a strong negative effect on further school performance.

Key words:

education system, learning process

“Nederlands Adelsrecht; wettelijke adeldom als historisch gegroeid instituut”

Up to now, there has never been a legal approach that indicates in a historical context which rights and duties the Dutch nobility had en still has to a lesser degree. This research fills this gap. When the class society was abolished in 1848, the constitutional meaning of hereditary nobility came to an end.  And yet, the archaic inheritance system, that only follows the male family line, continue as a kind of refined right to a name, without conflicting with civil rights that were protected in the constitution and international treaties. In 1983, the institute of nobility entirely disappears from the constitution. The consequence is that in other countries of the kingdom (such as Curacao and Saint Martin) another application of the nobility law appears possible. This legal imperfection can only be rectified by still incorporating nobility in the Charter for the Kingdom of the Netherlands, in which also knighthood is explicitly mentioned.

Key words:

fundamental rights, constitutional law, right to a name, nobility law

“The modern enterprise and the stock market: Exploring the effects of uncertainty on the valuation and financing of innovation and intangibles”

“Tomatoes as functional food”

Tomatoes and many tomato products are healthy and protect against a.o. cardiovascular diseases. The large diversity of substances in tomatoes is the reason for this health effect.  Lycopene and vitamin C and E appear to occur the most in tomatoes. These three substances have each a protective effect against the development of cardiovascular diseases. This research shows that a combination of lycopene and vitamin C and E has a larger health effect than each substance alone. That is the case because the substances cooperate in various processes in the body. A combination of several substances therefore turns out to be better than one single substance.

Key words:

tomatoes, cardiovascular diseases, lycopene, vitamin C and E

“Creating a European Public Space: Practitioners’ Dream, Academic Nightmare”

“Ready, Set, Go ?; a study of the development and implementation process of the BeweegKuur”

This dissertation studies the development and implementation of the BeweegKuur: a combined lifestyle intervention from primary health care aimed at changing physical activity and eating behaviour. Implementing the programme demanded much time, money and energy from the care providers. Nevertheless, care providers indicated they were satisfied and motivated to continue the programme. Participants were also satisfied with the BeweegKuur and motivated to start exercising.  In the care practices that executed the BeweegKuur more multidisciplinary networks developed and the contacts with local sports and exercise providers improved. The BeweegKuur functioned as a boost to realize processes regarding the dissemination of combined lifestyle interventions in primary health care and to further develop these interventions.

Key words:

BeweegKuur, lifestyle intervention, diabetes, overweight, obesity

“Inflammation & Stimulation”

Epilepsy is one of the most common neurological disorders. About one third of the patients respond insufficiently to medication.  Insight in the origin of epilepsy can contribute to the development of new treatments. Recent studies in test animals show that an inflammation in the brains is involved in the origin of epilepsy. Therefore, in this research various inflammation factors in brain tissue of patients and in an animal model for epilepsy were measured. This showed that none of the measured inflammation factors were raised.  Moreover, in children with epilepsy was investigated whether the treatment in which the nervus vagus nerve is stimulated can change the level of inflammation factors in the blood.  It turned out that nervus vagus stimulation does not change the inflammation level, but that on the basis of the level of some inflammation factors the effect could indeed be predicted.  This finding can contribute to the improvement of the treatment method.

Key words:

epilepsy, inflammation, nervus vagus stimulation

“Vestibular Schwannomas; new developments in the management of vestibular schannomas”

The vestibular schwannoma is a not to slowly growing benign tumour of the auditory and equilibrium nerve. Tumour growth is assessed by annual scans of patients; in the case of growth the tumour can be radiated or operated. This research shows that a new volumetric measuring technique is more sensitive in growth detection than the currently used two-dimensional measurements; unfortunately tumour growth remains unpredictable. A radiation treatment shows good results in the small and middle-size tumours. With large tumours an operation is preferable: when the tumour is largely removed, the chances of preserving the face nerve function are much better. The remainder of the tumour can be radiated afterwards. Primary radiation of large tumours is possible, but the results are not as good. This research offers new insights in the treatment of vestibular schwannoma patients.

Key words:

schwannoma, tumour, auditory and equilibrium nerve, treatment

"The role of neovascularization and oxidative stress in human carotid atherosclerotic lesions"

Molecular studies strongly indicate that the future therapy of cardiovascular diseases could be gene targeting and cell based therapies. It is therefore imperative to elucidate and understand the possible molecular mechanisms that occur in atherosclerotic plaque progression and disruption. It appears that neovascularization and oxidative damage are the key players of plaque instability and clinical events. 
In order to understand further the molecular pathways in unstable carotid plaque, this thesis did not only focused on oxidative stress, but also on nitrasive stress. Several techniques confirmed the molecular findings. 
Based on the results of this thesis we can propose a molecular model, where  neovascularization factors and oxidative stress play a crucial role in plaque instability. Molecular biology techniques are fruitful in delineating pathogenesis but they are not yet as helpful, in therapeutic interventions. Research is vital for the field of prevention and/or therapy of the “molecular” carotid disease.

Key words:

cardiovascular diseases, atherosclerotic plaque, neovascularization, oxidative stress

“Hypoxia, oxidative stress, and benzo(a)pyrene induced carcinogenesis”

During the course of our lives we are constantly exposed to all kinds of carcinogenic substances such as benzo(a)pyrene. However, not everyone is equally sensitive to these substances and gets cancer as a result of them. This research investigates if certain processes in the human body can be designated as the cause for this difference.  These studies have shown that both lack of oxygen as well as a surplus of free oxygen radicals can lead to more damage to the DNA caused by benzo)a)pyrene.  On the one hand this appears to be caused by a reduced decomposition of the substance, but on the other hand also by a decreased recovery of the damage induced by benzo(a)pyrene. Eventually, this research can be used to predict who is more susceptible to carcinogenic substances than others and how the tumours that originate from this can be better treated.

Key words:

cancer sensitivity, DNA damage, oxidative stress

“Unraveling genetic defects and pathophysiological mechanisms in OXPHOS disease”

"Power to the people? Civic engagement with small-scale hydroelectric plants in India"

The importance of renewable energy technologies is increasingly recognized. It is generally assumed that renewable energy technologies are unproblematic due to their small-scale and their green and clean image. But how are these technologies actually working on the ground? 
In my dissertation I studied forms, contents and consequences of civic engagement with small-scale hydroelectric plants in India. I show that the social acceptance of renewable energy technologies is not straightforward, despite their benign image and their small scale. Providing power to people has as much to do with electricity as it has with social and contextual issues.

Key words:

Civic engagement; renewable energy; India; STS.

“Purinergic Genetics in Osteoporosis”

“Teaching and Learning Clinical Skills; Mastering the Art of Medicine”

For doctors, carrying out physical examination is an important tool to establish a diagnosis. The medical study programme therefore gives much attention to this essential skill. This dissertation studied in which way medical students learn best to conduct a good and complete physical examination. In the first years of the programme, the students appear to require structured training by teachers who don’t just teach them the correct manipulations, but increasingly also the corresponding findings and possible clinical pictures. In later years, when students do hospital internships, it turns out that the degree of support and guidance by doctors is often insufficient. Nonetheless, students learn a lot because they are given the responsibility to independently conduct physical examination on patients and learn to recognize abnormal findings in practice.

Key words:

medical education, physical examination, diagnosis 

“Early School Leaving in the Netherlands; a multi disciplinary study of risk and protective factors explaining early school-leaving”

In spite of a decrease in the number of early school leavers in the last few years, 8.2 percent of the 18 to 24 year olds in the Netherlands had no basic qualification (a diploma at secondary education level) in 2012. This dissertation describes a number of factors that influence early school leaving, a process that starts already at a young age. Inadequate school performance, a lack of motivation, low educated parents, having friends at the age of twelve who are also early school leavers and follow education at categorical pre-vocational secondary education (Vmbo), appear good predictors of early school leaving. This raises the question whether interventions and preventive measures should not be implemented at a younger age during primary education.

Key words:

early school leaving, preventive measures

“Application of Bioimpedance to study body composition in dialysis patients”

"Muscarinic M1 receptor modulation of cognition using a translational approach; Relevance for dementia and schizophrenia"

Pharmacological research uses substances that create a temporary disturbance of cognitive functions. These substances are used to simulate cognitive disorders that occur with neuropsychiatric diseases in healthy test animals and test persons. In this context, the substance scopolamine often applied. However, unfortunately this involves side-effects.   This dissertation shows that biperides, a substance that appears to have a similar effect as scopolamine, could possibly be a better model for the temporary creation of cognitive disorders, particularly with regard to memory. Also, cognitive disorders after intake of biperides appear more comparable to Alzheimer’s disease than to schizophrenia.

Key words:

acetylcholine, cognition, attention, memory, Alzheimer, schizophrenia.

“Adrenocortical Carcinoma”

“Paneth Cells; cornerstones of the small intestinal”

“Energy Poverty Measurement and Rural Energy Markets in Pakistan”

“Zonder zon groeit er niets”

“Elucidating the underlying mechanisms of inflammation caused by perinatal asphyxia and chorioamnionitis”

Perinatal asphyxia and chorioamnionitis are both important neonatal complications that can lead to serious organ disorders and even neonatal death. This dissertation studied the underlying mechanisms of inflammation in these complications to reach new insights and treatment therapies. An important connection was shown between the production of cytokines, ceramides and the occurrence of cell death after foetal asphyxia. This interaction can play an important role in neuroprotection. Furthermore the research has shown that prenatal complications such as chorioamniotitis can lead to liver inflammation with disorders in the lipid metabolism as a consequence.

Key words:

perinatal asphyxia, fetal asphyxia, chorioamnionitis, inflammation, liver, brain

“Further optimization of sacral neuromodulation therapy”

“Learning against Learning; Evolutionary dynamics of reinforcement learning algorithms in strategic interactions”

“Natural Resources, Innovation and Export Growth; the wine industry in Chile and Argentina”

“Free Can Catch Me; Empirical Studies on the Effects of Premium and Free Trial Promotions on Consumer Behavior”

“The structure and Organisation of EU Law in the Field of Direct Taxes”

Since 30 years, European rules have significantly impacted national taxes on the income and property of individuals and businesses. However, not legislation adopted in Brussels, but the decisions of the European Court of Justice at times reduce the national budgets of the 27 EU Member States by several billions of Euros. This dissertation analyses, using network science, the system of rules that the Court has developed. Although some regard this form of European control as an undemocratic attack on national sovereignty, this research finds that the Court consistently recognises the legitimate right of Member States to levy taxes in their national territory.

Key words:

taxes, European Union, complex networks, case law

“Innovation determinants and innovation as a determinant: evidence from developing countries”

“Communication in Dermatology; a focus on Connexin26”

“Growth versus inflammation; lung development after antenatal inflammation and corticosteroids”

In the Western world 5-13% of all children are born early, before 37 weeks of pregnancy duration. Premature birth is often caused by a bacterial infection in the uterus. The most common disorder in these babies is bronchopulmonary dysplasia (BPD), an incurable disorder in the lung growth as a result of which they don’t get sufficient oxygen in their body. So, it is known that uterus infections often lead to the development of BPD, but how this exactly happens is not clear. This dissertation studies how bacterial infections influence the lung development, so that in the future new therapies can be developed to cure or even prevent BPD.

Key words:

Premature birth, chorioamnionitis, bronchopulmonary dysplasia (BPD), antenatal corticosteroids, lung development

“Solution-focused support of people with intellectual disabilities”

The aim of this thesis was to investigate the effects of Solution-Focused Therapy (SFT) in people with intellectual disabilities (ID) and the effects of Solution-Focused Coaching (SFC) of staff supporting people with ID. Clients receiving SFT, and staff receiving SFC, were compared with clients and staff receiving care-as-usual, and coaching-as-usual respectively. After SFT, the SFBT-clients almost all reached their goals and performed better on psychological, social functioning, and resilience. After SFC, SFC-staff progressed towards their team goals and improved on proactive thinking and on the quality of client-caregiver relationships. This strengths-based SF-approach was valued positively by both clients and staff.

Key words:

Solution-Focused Therapy, intellectual disabilities 

“Enterprise software and video games: an Empirical analysis”

Enterprise software systems are company-wide suites of business software devoted to particular process integration across the value chain and are expected to increase firm performance in many aspects. Engelstätter shows that firms adopting enterprise systems realize increases in innovation performance regarding process, product and service innovations. Moreover, enterprise software systems are related to increases in labor productivity. The thesis also confirms persistence in ICT innovations, i.e. prior success in ICT innovations leads to new ICT innovations. Moving on to entertainment software the thesis explores whether video game play is associated with a change in crime rates. In detail, an increase in non-violent video game play leads to a decrease in overall crime as well as violent crime in particular. Violent video games show no effect on crime rates at all.

Key words:

enterprise software systems, performance, innovation, video game playing, crime

“The Perspectives Method”

River management is the work of human hands and can be shaped in different ways. What we currently find the best way depends among others on our perspective. This perspective, however, can change and consequently change our ideas about good River management and public support for solution orientations. So, the question is: how can we better deal with social changes in perspective? And is there a strategy that will maintain public support with all future perspectives? How do we define such a strategy? Offermans concludes among others that the current water policy has a too one-sided focus on control and regulation, which primarily fits in with the so-called ‘Hierarchic perspective’. That can have negative consequences for the public support of the policy, for example in the case of people with a ‘Fatalistic perspective’, who are more focused on the pleasure function of water and rivers. To also keep friendly with ‘Egalitarians’ and ‘Individualists’, a more natural design and a bit of innovation can be important ingredients for sustainable long-term water management.

Key words:

River management, social perspective 

"Bundeling van omgevingsrecht"

Dutch environmental law consists of thousands of rules in the field of environment, town and country planning, nature and water.  These rules have been scattered over hundreds of different legal systems. As a result even specialists lose the overview.  This overview could perhaps be restored by rearranging the environmental law by means of bundling. But how? This research developed five questions on the basis of which can be determined if bundling is advisable. The recommendations to regulators and legislative lawyers are very up to date, because the Rutte government currently works on the development of an Environmental Law and a Law on Nature Protection.

Key words:

 environmental law, bundling, environmental act 

“In touch with life; investigating epistemic practices in the life sciences from a hand-on perspective”

Bio-artists don’t use paint to make paintings, but they cultivate living images of animal cells. They make performances with model organisms and interactive installations with genetically modified bacteria. This not only raises ethical questions, but also aesthetic questions: bio-artists explore the newest technologies to shape life and in doing so they conduct ‘hands-on’ research into the peculiar way that life sciences put us in touch with life. This dissertation returns to the starting point of the modern epistemology when René Descartes singlehandedly personally experimented on human bodies and there found the basis for his famous Meditations (1641). This research studied how contemporary artistic practices can give us insight in epistemic issues about the relation between contemplation and manipulation since the rise of the new experimental science in the 17th century.

Key words:

bio-artists, technology, life sciences, philosophy 

“Next-generation text-mining applied to toxico-Genomics data analysis”

This dissertation describes how the interpretation of toxicogenomics data can be facilitated by information from scientific literature. Toxicogenomics (new technologies in toxicology, based on knowledge of the genome) is regarded as a promising technique to reduce animal tests. One of the conclusions of this dissertation is that a specific text-mining method (concept profile matching) can be used to link chemical information to experimental data to identify toxic effects at a very early stage. This is an important step towards reducing the use of test animals in the development of new medicines.

Key words:

toxicogenomics, data, text-mining

“Impact of chronic stress exposure and pharma-logical intervention on a mouse model of Alzheimer’s disease”

“Pragmatic constructions; simulation and the vulnerability of technological cultures”

Water management and civil engineering in the Netherlands rely strongly on the use of simulations and models to deal with various risks, such as flooding and dike breaches. However, this reliance on simulations and models can also imply risks due to the assumptions, uncertainties, and blind spots that may accompany simulation practice.
Based on interviews and observations pertaining to the use of simulations and models in hydrology, hydrodynamics, geotechnical engineering, and ecology, this dissertation discusses how simulations and models make knowledge of risks more or less visible, and to what extent their use makes present-day societies susceptible to risks.

Key words:

water management, civil engineering, simulations, risks

"Our World in Words; the business implications of word use in online conversations"

As online text-based conversations are growing rapidly, business models are increasingly re-organized to incorporate and manage customers’ online conversations. But managing online customers and their conversations is far from easy. This study offers insights, how word uses relate to conversants’ perceptions and behaviors but also impact the audience. It shows that word uses are a key to understand and manage online customer conversations. Along these lines the study offers specific suggestions to managers involved in managing user-communities and online retail sites, such as assessing the social integration of community members by text-mining and monitoring their linguistic styles.

Key words:

online conversations, text-mining, customers

“Risks for dysregulated appetite – Texture, stress, food reward and inhibition -”

“Improving the outcome of liver surgery; towards scarless treatment of liver lesions”

This dissertation discusses the improvement of surgical care for patients with a liver disorder. The aim was to evaluate the current treatments of rare disorders of the liver, investigate new techniques for the treatment of life-threatening haemorrhages from liver disorders and to study minimally invasive or laparoscopic surgery in combination with care protocols around the surgery.  For this purpose three themes were studied: surgical treatment of echinococcosis (infection of the liver), embolisation (closure of blood vessels) of benign liver tumours (liver adenomas) and laparoscopy for liver tumours.  The main conclusions of the research are that embolisation can be a lifesaving treatment for haemorrhages from the liver and that laparoscopic liver surgery contributes to shorter hospitalization, certainly in combination with an accelerated recovery programme.

Key words:

liver disorders, surgery, embolisation, laparoscopy

"Coping after acquired brain injury; road to adaptation"

Each person has his own coping style, in other words dealing with stressful situations. After a brain injury the patient, but also his direct environment, will have to (learn) dealing with the often permanent consequences of this injury. These consequences can negatively influence daily life. This research has shown that after a brain injury, patients are inclined to rather avoid problems than actively search for solutions.  It also turned out that patients with a more active lifestyle experience a higher quality of life. Teaching active coping styles should therefore take an important place in the treatment.

Key words:

brain injury, quality of life, coping, rehabilitation