Academic Ceremonies June 2012

“Is the gut the key to obesity? The involvement of the intestine in obesity, type 2 diabetes mellitus and fatty liver disease in man”

Worldwide, the increasing number of people with obesity and accompanying disorders such as diabetes and fatty liver disease is a considerable problem.  The studies gathered in this dissertation emphasize the role of the intestine both in obesity as in fatty liver disease. They showed for example that obese people have a specific composition of intestinal bacteria that involves local inflammation in the intestine and systemic inflammation that is measurable in the blood. Moreover, we found indications that people with overweight and diabetes have more small intestine cells. 
Finally, we studied fatty liver disease, a disorder that starts with relatively innocent liver fattening, but can lead to serious liver infection, liver failure and liver cancer. The blood of people with liver infection contains higher concentrations of antibodies against these bacterial products that occur in the intestine. We also found that the diagnostics of this fatty liver infection can be simplified by means of breath analysis.

Key words:

obesity, intestine, type 2 diabetes, fatty liver disease

“Tailoring Hemodialysis Vascular Acces. Preoperative imaging techniques and computational modeling”

For adequate hemodialysis, patients with terminal kidney failure are dependent on a well functioning   vascular access. In spite of extensive preoperative echo examination, frequent complications occur as a result of the fact that the vascular access is placed on a wrong location. This means a too high or too low blood flow.  
This dissertation describes three methods that can limit these complications:   1) extend the preoperative examination with a scan that visualizes all blood vessels in the arm as a whole, 2) conduct elasticity measurements of the blood vessels in the upper arm, and 3) the preoperative prediction of the height of the blood flow after the operation for vascular access at various locations in the arm by means of a computer simulation model.

Key words:

kidney failure, hemodialysis, vascular access

“(Epi-) Genetic Profiling of Colorectal Cancer: Prognostic and Biological Relevance, with emphasis on tumor hypoxia”

“De waarheid ten tonele: Harold Pinter over kunst, waarheid en politiek”

“Lobbying for the Ear. The Public Fascination with and Academic Legitimacy of the Sonification of Scientific Data”

“The endothelial glycocalyx in early atherogenesis. Roel in platelet adhesion?”

“Advanced glycation and type 1 diabetes”

This dissertation studies the connection between the glycation of proteins and type 1 diabetes-related complications, among which cardiovascular diseases.  Several determinants of the glycation of proteins were related to cardiovascular diseases in type 1 diabetes. The main conclusion is that the glycation of proteins is a mechanism that can lead to complications in type 1 diabetes. With the observed connections the research creates perspectives for prevention or treatment of type 1 diabetes-related complications.

Key words:

diabetes 1, glycated proteins, cardiovascular diseases

“Nobelprijs voor onderwijs?”

“Relocation, Mobility and Migration; the Dynamics of the Workers and Firms in the Netherlands”

“Pricing and Scheduling under Uncertainty”

“Can the University save Europe?”

“Effect of Flavonoids on Fetal Programming. Implications for Cancer Susceptibility”

Chronic diseases that occur at the adult age, such as cancer, threaten man’s health. The in utero period, the stage in the uterus, seems to play a role in the development of cancer and is among others determined by the mother’s nutrition. Mice that during pregnancy were exposed to flavonoids, nutrients with an antioxidant effect that are believed to protect against the development of cancer, turned out to be better protected against the development of cancer at an adult age. The reason was among others that their antioxidant defence system was increased.

Supervisor:

cancer, nutrition, uterus, antioxidants 

“Ultrasound Guidance for Interventional Pain Management of Cervical Pain Syndromes”

“Growing up getting drunk; development and prevention of adolescent alcohol use”

Alcohol use is the main cause of disease and death among adolescents in Europe. This is the first Dutch research that studied the effects of intensified enforcement of the age limits for alcohol use (formal control) and of making alcohol less available to adolescents via the social environment (informal control via parents and schools). Increasing the formal and informal control turned out to reduce the risk of intoxication in drinking adolescents. Given the upcoming decentralization of enforcement to municipalities, this means that the Dutch community must actively increase formal and informal control to reduce intoxication among adolescents.

Key words:

adolescent alcohol use, intoxication, enforcement, formal control, informal control

“Socioeconomic inequalities in health: Exploring new psychosocial pathways in middle-aged and older people”

Socioeconomic inequalities in health, i.e. inequalities in health between higher and lower educated people or between richer and poorer people, are an important problem worldwide. Unhealthy behaviour, which occurs more often in lower socioeconomic classes, only partly explains the inequalities. Growing up in unfavourable socioeconomic circumstances forms an individual. His personality, his coping styles and his social relations (psychosocial characteristics) are strongly influenced by the circumstances. This dissertation shows that an unfavourable psychosocial profile occurs more often in lower socioeconomic classes and this leads to greater unhealthiness, even at middle age and old age.

Key words:

socioeconomic inequalities in health, circumstances

“Quantitative assessment of sustainable development and growth in Sub-Saharan Africa”

The relatively weak performance of African countries compared to countries in other world regions in all development aspects (economic, social and environmental) suggests that these aspects are not independent. The central research question is: How are the different aspects of sustainable development inter-related? This thesis develops and applies diverse quantitative economic methods to comprehensively analyze the interdependencies between different aspects of development: living standards/income, education and health. The main finding is that there is a positive mutual reinforcement between education and health outcomes. Furthermore, decent education and good health are necessary conditions for economic development and, hence, for overall sustainable human development.

Key words:

Sub-Saharan Africa, quantitative economics, sustainable development

“Risk- and Social Preferences of Individual Investors”

This dissertation studied the behaviour of a large group of individual investors from Robeco, ASN Bank and Triodos Bank. The research shows that sustainable investors also behave more socially in other contexts than common investors. For example, sustainable investors donate substantially more money to charity, practice volunteer work more frequently, and are more often registered as organ donors. Moreover, the dissertation shows that there are two types of sustainable investors. A large group of investors buys sustainable funds because of their personal inclination to contribute to a better world. The other important group of investors buys sustainable funds for a financial reason, such as tax privilege or a higher expected return. And finally, the dissertation shows that sustainable banks, such as ASN Bank and Triodos Bank benefit from the loyalty of sustainable investors, because these investors not only think of Financial return, but also social return.

Key words:

behaviour, individual investors, sustainable

“Dominant Mothers, Queer Sons. (Un)doing Momism in Postwar American Culture”

“Big Boys Don’t Cry! Or Do They? Can forensic patients change?”

“Bacterial and fungal infections: evolving towards molecular pathogen diagnostics”

A quick diagnosis of infectious diseases can advance treatment efficiency, and thus contribute to a more favourable course of disease. This dissertation focuses on the improvement of current diagnostic methods that are applied for the recognition of bacterial and fungal pathogenic agents in patient samples such as blood and urine. The polymerase chain reaction (PCR) was used as a molecular technique for the detection and identification of clinically relevant bacteria and fungi out of various patient materials among which positive blood media. The implementation of such new tests enables a quick analysis (within one work day), as opposed to conventional medium-based methods.

Key words:

diagnosis infectious diseases, polymerase chain reaction  

“Propositional knowledge for conceptual understanding of statistics”

The applications of statistics in a daily and professional context are numerous, but there are even more examples of faulty applications of statistics in such a context.  Given the important role statistics play in research, politics, policy etc. it is of great importance that students and professional develop a good understanding of statistics. This requires a structured and phased approach. Characteristic for this approach is a fading degree of guidance by the teacher in consecutive phases, while the possibility of getting feedback on learning results continues to exist.

Key words:

statistics, application, learning

“Paternal impact on genetic integrity in newborns”

The quality of the DNA in sperm from potential fathers is under constant pressure because it is exposed to a great diversity of harmful substances. This can lead to transmission of DNA damage to the offspring with long-lasting health consequences. The research for this dissertation shows that a lifestyle with bad habits, such as smoking, has indeed a harmful effect on the DNA in the sperm. Even more important is that subsequently an indication was found for genetic effects of this damage in the offspring.

Key words:

DNA, sperm, health

“Strong Organisations in Weak States; Atypical Public Sector Performance in Dysfunctional Environments”

“Understanding regulation of gene transcription through epigenomics and cistromics. Unfolding ones and zeros into (un)folding chromatin”

Modern measuring technologies, such as microarray and sequencing technology, have resulted in an explosion of information in biomedical research. The big challenge for a bioinformatician is to develop computer procedures to distil biology from this bunch of ones and zeros. This dissertation crossed bioinformatics with epigenetics, the field that studies the form, not the content, of the genetic material we carry with us, and the influence this form has on the way the genetic material is expressed. The results have among others led to new methods of analysis and contributed to new therapeutic insights in the fight against cancer.

Key words:

bioinformatics, epigenetics, microarray, equencing technology

“Surgery in metastatic breast cancer”

At the time of the diagnosis, about 5% of breast cancer patients have metastases elsewhere in the body. This is called primary metastatic mammary carcinoma. Currently, the majority of these patients do not undergo breast surgery. In the last 10 years, several observational studies were published in which the removal of the breast tumour seemed associated with a survival advantage. This has been studied in more detail and confirmed in this dissertation. Moreover, this research studied the possible advantage of surgical treatment of the metastases in patients who develop these at a later stage, particularly of liver and lung metastases.

Key words:

Breast cancer, metastases, surgery

“De doorwerking van algemene rechtsbeginselen in de BTW (als uitgelegd door het Hof van Justitie EU)”

This research focuses on the application of general principles of justice (equality principle, proportionality principle, legal security principle) in the VAT jurisdiction of the EU High Court. It studies readings that have been developed in the jurisdiction and which the government has to follow. It also discusses the effect of the general principles of justice, such as ‘interpretation principle’, on the entire field of material tax law, in the way this has obtained a place in the VAT directive (who and what is taxed and on what, etc.) There also appears to be a connection between the general principles of justice and the legal disposition of the VAT.

Key words:

VAT, general principles of justice

“Kanker in context”

“Clinical and therapeutic aspects of Cerebral Palsy”

“Talking to Chromatin. Polycomb function in gene environment interactions”

A cell uses epigenetic regulation mechanisms to activate or deactivate genetic characteristics, i.e. genes.  Epigenetic regulators that belong to the Polycomb group protein complexes are important during normal development and physiological regulation, but they are also involved in the development of cancer. Not much is known yet about the exact way the Polycomb function is steered by the environment of a cell. This dissertation shows that the Polycomb function is dynamically regulated by environmental factors (such as growth factors, cell stress and oxygen), which in turn leads to a changed use of genes. These findings are very relevant for a better understanding of normal development and stem cell biology and also present leads for the development of selective therapies against cancer and applications in regenerative medicine.

Key words:

epigenetic regulators, Polycomb, genetic characteristics, environmental factors

“Magnetic Resonance Imaging for Evaluation of Gastric Motor Function”

“Ceramide transporters in neuroinflammation and neurodegenerative diseases”

“Treatment adherence in hypertension. Methodological aspects and new strategies”

“A ray of light. Evaluating the feasibility and effectiveness of routine psychosocial screening in cancer patients receiving radiotherapy”

About one out of three cancer patients experience psychosocial problems, such as feelings of anxiety and depression. The use of screening instruments can be useful for the identification of psychosocial problems. The research focused on the effects of using the Dutch Screening Inventory of Psychosocial Problems (SIPP) for the identification of psychosocial problems in cancer patients receiving radiotherapeutic treatment.  The research shows that using a screening tool in itself is not sufficient. By using the SIPP, the number of patients that were referred to psychosocial care providers had not increased and the communication between patient and radiotherapist had not improved.  However, the results show that patients are referred to a social worker at an earlier stage, which appears to have a favourable effect on some health related outcomes. Providing successful psychosocial care in the radiotherapeutic institutions is complex and requires a multidisciplinary approach.

Key words:

psychosocial screening, screening instrument, psychosocial care, cancer patients and radiotherapy

“Innoveren om beter te leren”

“Does Assessment Drive Students’ Learning? Clinical Context Assessment and Students’ Approaches to Learning”

The research aimes to understand how student react to summative or formative assessment within the clinical setup and to explore factors that direct the students towards deep learning approaches. This includes knowledge integration, writing summaries, self-testing, clinical problem solving and safe patient management. The conclusion is that several intrinsic and extrinsic assessment factors have been found to affect students' learning and learning approaches. Many of these factors were theoretically proposed but few of them have been already researched.

Key words:

learning, assessment, study strategies, clinical training

“Part-Time Employment and Human Capital Development”

This dissertation aims to analyze the connection between part-time employment and the development of human capital on three levels: employees, companies and children. Part-timers often appear to take less training because employers are less inclined to invest in them. This pattern mainly applies to lower educated employees and for them part-time employment therefore more often leads to lower hourly wages. On the other hand, companies in the services sector appear to benefit from part-time employment. The company productivity appears higher because the deployment of part-time staff is more efficient.  Also for the cognitive development of toddlers part-time work by mothers does not appear to have disadvantages.

Key words:

part-time employment, human capital

“Social Citizenschip Rights – Inequality and Exclusion”

This study looks at social citizenship rights, and examines the conditions that can explain inequality and social exclusion of newly entering groups of migrants/refugees into a host country’s society based on the variation in social policy towards these groups. The case of the Palestinian refugees in Jordan is examined and the impact of policies upon their entry is analysed. This study links the concepts of stratification, inequality, exclusion and citizenship and applies them beyond the western and industrialised societies, while still benefiting from the wealth of knowledge accumulated in studying these societies. With regards to the Palestinian refugees in Jordan the results indicate that those goups who didn’t receive nationality and those who lived in refugee camp housing fare consistently worse off than any other group in the society.

Key words:

social citizenship, inequality, social exclusion

“Patient and visitor violence in general hospitals”

Patient and visitor violence (PVV) in general hospitals is an underestimated problem. The dissertation investigates the occurrence and factors of this workplace hazard. Over half of the participating 2495 health professionals experienced PVV in the past year. Risk factors are connected to the personal characteristics of those involved, the interaction and the situation. Medical doctors experienced less violence than other health professionals. Young or inexperienced staff or staff working in emergency settings experienced more. Physical injuries occurred in 15% of the incidences.  Verbal violence was emotionally upsetting for almost all participants and most for who had experienced physical violence. In general the research results showed that strong institutional policies and procedures against patient and visitor violence are important in order to increase staff’s feeling of safety and in order to reduce the frequency of patient and visitor violence.  Focused training for specific staff groups, workplaces and interdisciplinary teamwork would also be beneficial.

Key words:

patient and visitor violence, general hospitals