Academic Ceremonies June 2015

“The Evolution of beliefs and strategic behavior”

“Improvements Towards Safer Extraglottic Airway Devices”

Each year, approximately 250 million people undergo a surgical procedure under general anaesthesia. During anaesthesia, it is essential to secure an airway. In 60% of the cases this is done using a laryngeal mask. However, selecting the right laryngeal mask and securing it correctly is not always easy given the anatomical differences in patients. Furthermore, the wrong size and the incorrect placement of this mask can lead to aspiration problems and other complications. This dissertation compared 130 different laryngeal masks. It also studied various sizing methods and researched the potential correlation between anatomical parameters to find the best anatomical mask with the least complications. The dissertation also describes a new technique where specific laryngeal masks are used as a conduit for intubation.

Key words:

anaesthesia, laryngeal mask, safety

“Mechanism design for public goods, exclusive private goods and subcontracting”

Economic interactions such as selling an item for profit or scheduling the time of a subcontractor for cost savings can be formulated as a game. For such games this thesis studies and constructs mechanisms (set of rules) that coordinate the involved individuals to a good outcome despite the fact that they act in their own self-interest. These mechanisms are outputs of optimization models in which a good outcome can mean that the profit or the time saving is the highest possible. We consider also mechanisms that exhibit other useful properties such as simple and intuitive rules or easy implementation for a small sacrifice in profit.

Key words:

mechanism design, auctions, optimization

“Beliefs, Intentions, Power; essays on dynamic decision problems”

In this thesis individual and collective decision making is being researched. For individuals prone to procrastination or impulsivity, this work suggests that researchers and therapists should focus on the discrepancy between intentions and beliefs. For example, addicts could keep intention-belief diaries, where they specify how they want to behave, and how they think they will.Collective decision making is also intricate, as selfish free riders often take advantage of cooperative individuals’ efforts. This research shows that groups tend to select leaders who can force free riders to cooperate. Such self-organized hierarchies enable groups to achieve better outcomes.

Key words:

decision theory, game theory, optimality, dynamic inconsistency, public goods, cooperation, hierarchy

“Cell damage, inflammation and wound healing in major gastrointestinal surgery”

“De tijden veranderen – nu wij nog … ”

“Addressing the intentional destruction of the Environment during warfare under the Rome stature of the international criminal court”

Acts perpetrated during the course of warfare have, through the ages, led to significant environmental destruction. Until recently, such acts were generally regarded as an unfortunate but unavoidable element of armed conflict. The existing international rules have largely been ineffective and inappropriate. However, as the significance of the environment has come to be more widely understood and recognised, this is no longer acceptable, particularly given the ongoing development of weapons capable of widespread and significant damage. This dissertation therefore examines the current international legal regime relevant to the intentional destruction of the environment during warfare, and argues that such acts should, in appropriate circumstances, be recognised as an international crime and should be subject to more effective rules giving rise to international criminal responsibility. It also suggests a framework within the Rome Statute of the International Criminal Court as to how this might be achieved.

Key words:

warfare, international legal rules, crimes against the environment

“Intensive and Home Hemodialysis; acute effects and Long-term outcomes”

Most patients with terminal kidney failure undergo hemodialysis three times a week in a hospital. Hemodialysis can also be done at home, which allows for longer (night) and more frequent (intensive) dialysis. In addition to the known benefits of intensive home hemodialysis on life expectancy, quality of life, and cardiovascular functioning, this dissertation demonstrates additional advantages. These include increased stability of blood pressure and heart function, improved waste removal during dialysis, and protective effects in pregnant women and older dialysis patients. Finally, this dissertation also reveals that intensive home hemodialysis can reduce costs compared to traditional hemodialysis offered by hospitals.

Key words:

kidney failure, (home) hemodialysis

“Occupational asbestos exposure and cancer risk:A population-based approach using job-exposure matrices”

“Anterior Cutaneous Nerve Entrapment Syndrome Epidemiology and surgical management”

Chronic abdominal pain is sometimes caused by entrapment of a small cutaneous nerve at the ventral portion of the abdomen (anterior cutaneous nerve entrapment syndrome = ACNES). There is hardly any information available about this unknown syndrome. The incidence of ACNES and the effectiveness of treatment options have never been examined, for instance. This dissertation shows that 1 out of 50 patients presenting with acute abdominal pain to the emergency department suffers from ACNES. In the Netherlands, approximately 10,000 new cases of ACNES are diagnosed each year. Nine out of 10 patients experience considerable pain relief or become pain free following injections or minor surgery. Early diagnosis will lead to a massive reduction in health care costs.

Key words:

abdominal pain, abdominal wall pain, intercostal neuralgia

“Stigma by association; among family members of people with mental illness”

Stigmatisation essentially paints a group of people in a negative light and makes them more susceptible to social disapproval. This dissertation primarily focuses on the stigmatisation of family members of people suffering from a mental illness. They are often viewed as irresponsible, incompetent, strange or genetically contaminated. They are often blamed for causing the illness or for impeding the patient’s recovery. Stigmatisation can cause family members to become ostracised, ignored or treated poorly. This causes family members to feel lonely, isolated, abandoned or not taken seriously. Research has been conducted on how family members can reduce the negative consequences of stigmatisation. Recommendations were given in the field of information provision, education and support.

Key words:

stigmatisation, relatives of people with mental illnesses

“Using evidence of multiple study designs in systematic reviews”

“Innovative strategies for intermittent claudication – Towards a stepped care approach and new outcome measures”

“Market Access Issues in International Food Trade; Shrimp exports from Benin to the EU”

“L’Application des Textes de l’ohada aux entreprises Publiques: l ‘exemple de l’ausc et gie”

“Diet, postprandial metabolism and endothelial Function: effects of lutein-enriched eggs and trans-resveratrol”

“Nooit meer snijden!”

“Patient cost-sharing for health care in Europe”

“The economic and social effects of remittances and return migration in conflict-affected areas: the case of Burundi’”

This dissertation studies the effects of remittances and return migration on households and communities in Burundi and shows that in a conflict-affected country such as Burundi, which is one of the poorest countries the world, migration does not have the anticipated development-boosting effect that comes forward from the policy and academic literature on migration and development. The economic development impact of remittances, for example, was limited because remittances did not reach the citizens who needed it the most.  Similarly, return migration led to structural inequalities between return and non-return households in terms of land ownership and was found to negatively affect the living conditions of non-return households as well. The findings of this research highlight the necessity of a basic level of development before migration can positively affect development. 

Key words:

migration, development

“New Biomaterials Derived from poly (lactic acids); novel approaches to combine biodegradation, X-ray Contrast and Controlled Local Drug Release”

“Natural Hazards and Education; the impact of Floods on Primary School Education in Zambia”

The study has been designed to investigate how floods affect primary education in the flood plains in Zambia. Both qualitative phenomenological and quantitative comparative methods were used for the study. Two communities with primary school going children (those affected by floods and those not affected by floods within a 5 years period) were investigated and compared. It was found out that children in the flood plains compared to those in the upper land have low net school enrolment, the rate of repeating classes is high, dropout rate is high and performance in national examination is low. This will affect human capital and development in the flood plain environment in the long run.

Key words:

Floods, education, disasters, natural hazards, vulnerability, coping mechanisms

“Family-Member Migration and the Psychosocial Health Outcomes of Children in Moldova and Georgia”

This dissertation examined the relationship between family-member migration and the psychosocial health of children remaining in the origin country. Using survey data collected in Moldova and Georgia, analyses revealed that child-migrant separation does not correspond to universally negative child emotional health outcomes. In Georgia, no form of family-member migration corresponded to unfavourable psychosocial health outcomes; in Moldova, only the migration of a father corresponded to worse outcomes, and only among boys. These results suggest that the potential impacts of migration on child psychosocial health are heterogeneous and shaped by factors such as the gender of the migrant and child.

Key words:

family-member migration, impacts

“Teacher-based reactivity to provincial large-scale assessment in Canada”

Centralized testing is an integral part of public school education in many countries around the world. Policy-makers often have high expectations that accountability-based evaluation will inspire teachers and students to perform their best. Using the ten provinces of Canada as examples, this study examined if teachers do react to these large-scale tests, and in what ways. Results showed that teachers are quite reactive to assessment data across all the provinces, although the degree and types of instructional changes differed. More generally accepted instructional changes are correlated to positive attitudes about testing, the sharing of data, division-level supports, perceived pressure, and age. Teaching to the test, which denotes less generally accepted instructional practices, is more common and correlated with the return of more kinds of data, perceived pressure on teachers, and teaching at higher grade levels.

Key words:

school education, Canada, centralized testing, teacher’s attitude

“Parents’enabling the participation of their child with a physical disability: Actions, challenges and needs”

Of the 80,000 children in the Netherlands with a physical disability, many encounter daily problems with social participation. Parents appear to have a significant and positive influence on this participation. This dissertation found that we can learn a lot from these parents’ experiences. The actions, challenges and needs of parents primarily focus on the barriers to participation in the physical environment (e.g. limited access to schools, shops and playgrounds) and the social environment (e.g. negative attitude of others, lack of knowledge among teachers or sports instructors). This experiential knowledge is relevant for our modern participation society.

Key words:

children with physical disabilities, participation, parents

“the never-ending project; understanding E-government Project Escalation”

Public information technology (IT) projects are characterised by the numerous problems encountered during the realisation of the projects. This is demonstrated by major overspending resulting in the desired outcome not or only partially being achieved. This dissertation provides an insight into the escalation of commitment in public IT projects, a process in which a project is persisted in despite being shown not to achieve the desired outcome. Causes of this process as well as ways to prevent these are shown. Furthermore, it is examined how the escalation of commitment problem can be solved in a political environment.

Key words:

government, IT projects

“Tracking students in secondary education; Consequences for Student Performance and Inequality”

This dissertation examined whether the classification of secondary school pupils into different academic levels (e.g. VMBO (preparatory secondary vocational education), HAVO (senior general secondary education), VWO (pre-university education)) improves academic performance and whether it influences the academic opportunities. For instance, we found that pupils who are about to transition to HAVO or VWO perform better at VWO level and that pupils with highly educated parents receive better academic advice from their teacher in group 8 than their academic performance warrants. We also found that early learners are often categorised at a lower academic level than late learners, and even more so in countries with early selection criteria. This additional misallocation in countries with early selection has little impact on the long-term outcomes like final academic level or salary scale.

Key words:

academic level, academic performance, inequality

“Understanding the Clinical, Immunological and Genetic Molecular Mechanisms of Keratoconus”

“Philanthropie dynamique’; over de Sociologische betekenis van de herintrede van een sector’”

“Teamwork of clinical teachers in postgraduate medical training”

This dissertation examines the teamwork between medical specialists that train resident physicians. The way these specialists function as a team of academic trainers can be improved, certainly given the fact that they tend to be too task-oriented. The formal educator is too often seen as a super-teacher, who takes on the majority of the teaching load. There is little room for giving feedback, resolving conflicts, and working towards a collective ambition. An effective medical training group works towards structurally improving postgraduate medical education with a secondary aim of improving patient care. This dissertation recommends developing a validated digital evaluation tool that medical specialists can use to evaluate teamwork in training groups.

Key words:

postgraduate training for medical specialists, teamwork, feedback, leadership

“Cellular and molecular aspects of weight regulation: The adipose tissue”

This dissertation studied the effects of a low-calorie diet on fat molecules and the impact of genes on body weight regulation. We discovered two different genetic variations (the FTO gene in men and the MMP2 gene in women) that predict a weight gain of at least 8 kilos over the course of a decade. Furthermore, it was shown that fat cells increase their ability to include higher levels of glucose and fatty acids following weight loss achieved with a diet. After three weeks, fat cells were found to be craving fat, a mechanism provoking old eating habits (the so-called yo-yo effect). Certain target groups, including people having a genetic predisposition, should therefore receive improved weight-loss and/or weight-maintenance counselling.

Key words:

obesity, diet, yo-yo effect, fat molecules, genetic predisposition

“Cellular and molecular aspects of weight regulation: The adipose tissue”

This dissertation studied the effects of a low-calorie diet on fat molecules and the impact of genes on body weight regulation. We discovered two different genetic variations (the FTO gene in men and the MMP2 gene in women) that predict a weight gain of at least 8 kilos over the course of a decade. Furthermore, it was shown that fat cells increase their ability to include higher levels of glucose and fatty acids following weight loss achieved with a diet. After three weeks, fat cells were found to be craving fat, a mechanism provoking old eating habits (the so-called yo-yo effect). Certain target groups, including people having a genetic predisposition, should therefore receive improved weight-loss and/or weight-maintenance counselling.

Key words:

obesity, diet, yo-yo effect, fat molecules, genetic predisposition

“Complexiteit in beeld: samen naar de Moleculaire‘selfie’”

“Over de snotneus van de psychiatrie”

“Inside the psychopathic mind; social cognition, Emotional experience, and affect regulation in psychopathy”

Psychopathy is a serious mental disorder that is thought to stem from emotional disorders. This dissertation exposes the nature of these emotional deficits in more detail. The findings reveal, among other things, that psychopathy is associated with reduced sensitivity to physiological signals that play a role in how emotions are perceived by the body. Interestingly, people with psychopathy do not experience limited emotional capabilities, such as interpreting the thoughts and emotions of others on a rational level or the ability to communicate emotions through facial expressions. These findings provide further opportunities for treating this complex disorder.

Key words:

psychopathy, emotion

“Robust Asset Allocation in Incomplete Markets”

“A network approach to response inhibition and Aggression; combining functional imaging and Non-Invasive Brain Stimulation in the study of impulse control”

This research focuses on the identification of neural networks within the brain responsible for inhibition, i.e. the holding back of impulsive reactions. By means of functional brain imaging we identified networks within the brain which are involved in response inhibition and aggression. These networks have substantial overlap within certain regions in the prefrontal cortex and subcortical structures.  When inhibiting inferior regions within the prefrontal cortex by means of Transcranial Magnetic Brain Stimulation (TMS), different forms of response inhibition (i.e. response restraint and response cancellation) were compromised. Applying this further, proactive aggressive behavior in males – on the other hand – could be decreased, when enhancing areas within the right prefrontal cortex by means of Transcranial Direct Current Stimulation TDCS. This is a promising step towards a better understanding of the neural mechanisms underlying aggression and impulsivity and might result in the development of directly brain-based interventions for impulsivity related disorders in the future.

Key words:

impulse control, response inhibition, aggression, neural networks, non-invasive brain stimulation

“Remix, cover, Mash; remediating Phonographic-Oral Practice Online”

Tens and sometimes hundreds of musical variations on and covers of many of today’s top 40 hits on the pop chart appear on websites such as YouTube. Generally, these music productions are made by hobbyists or enthusiastic amateurs rather than famous, established artists. Although these enthusiastic amateurs’ practices are often regarded as simple forms of copycat behaviour or easy ways to capitalise on famous artists’ success, this dissertation shows that such activities can be regarded as important forms of learning and experimenting. This knowledge is particularly relevant with regard to bringing nuance into the current debates on copyright, musical skills and online participation.

Key words:

remix, music, skills, participation

“Pregnancy after caesarean; current care, clinical prediction and risk counselling”

In the Netherlands, more and more women are giving birth by caesarean. This study shows that the guidelines that determine when to perform a caesarean are not always followed. Interestingly, the guidelines governing the type of delivery after a prior caesarean are only followed 15% of the time. Moreover, major differences exist between hospitals, often independent of patient characteristics. It can therefore be concluded that local policies are largely determined based on the opinions of individual healthcare providers and hospital policies. A decision-making tool has been developed to improve the quality of care. Gynaecologists can use this tool in the examination room to make the best decision in consultation with the patient about the type of delivery: a natural birth or a caesarean.

Key words:

quality of care, caesarean, guidelines

“Blood, bones and brains; peripheral biological endophenotypes and their structural cerebral correlates in psychotic disorder”

“The relationship between youth crime and education”

“The Idle Mind Never Rests; functional brain connectivity across the psychosis continuum”

“Living up to Standards; interoperability Governance and Standards Adoption in Government Information Networks”

This dissertation investigates the organisational adoption of standards for data exchange within inter-organisational governance networks. First, it finds that the standards adoption process is a complex interplay of multiple actors at organisational and inter-organisational levels. Second, it identifies key factors that determine adoption: the decision-making structure governing the standards, the characteristics of a network and its external environment, the efforts required for standards adoption and the results from this, the capacity and needs of the adopting organisations, and the characteristics of the standards. Third, it finds that more complex networks require more centralised governance of standards than less complex networks.

Key words:

e-governance, interoperability, network governance

“Smoking Prevention among Primary School Children”

“Regional Policies: Convergence, Trade, and the allocation of Public Capital”

‘α7 nicotinic acetylcholine receptors and memory processes: mechanistic and behavioral studies’

This dissertation focusses on the functioning of our memory. Various memory processes and the ways to examine these are treated. Furthermore, the role α7 nicotinic acetylcholine receptors (α7 nAChRs) play in various memory processes is discussed in detail. Receptors are proteins which in this case are located on the surfaces of brain cells. Specific molecules (such as drugs) may attach to these receptors. Subsequently, the receptors may cause the brain cells to react. Focussing on α7 nAChRs is therefore relevant with regard to the development of new drugs aimed at treating memory problems in Alzheimer’s disease and/or schizophrenia, for instance.It was found that the blockade of α7 nAChRs with very low doses of so-called selective antagonists results in an improvement in memory performance and memory formation in rodents.

Key words:

α7 nicotinic acetylcholine receptors, acetylcholine, memory, learning, animal models

“A Breath of fear; a translational approach into the mechanisms of panic”

Panic disorder is characterised by unexpected panic attacks. In this study, this symptom was induced experimentally by the inhalation of 35% carbon dioxide. It was found that the diastolic blood pressure in particular reflects the dose-dependent emotional reaction and may therefore be a biomarker for carbon dioxide reactivity. It is common knowledge that carbon dioxide provokes a more intense fear reaction in patients with panic disorder. The results of this study show that this phenomenon may be caused by increased brainstem sensitivity. Furthermore, it is demonstrated that certain genetic variations in genes coding for pH-sensitive channels are associated with a different level of sensitivity to carbon dioxide. In conclusion, we designed an animal model of panic tailored to the human model of panic, therefore improving the translation of animal results to humans and offering advantages with regard to the development and testing of new treatment options.

Key words:

panic disorder, carbon dioxide inhalation

“It’s all about that post; opportunities and challenges of sharing information online”

Users spend a significant amount of time broadcasting their thoughts and experiences through social media. But we know little about how sharing information online affects the individuals who post information. In this dissertation, this research gap is confronted by studying positive and negative consequences of sharing information online. One of the findings is that the act of writing reviews may foster self-reflection and personal development, however in some circumstances it may also cause reviewers to behave impulsively. Sharing information may make users feel vulnerable particularly when this information is used by firms to provide personalized services without their consent.

Key words:

social media, users

“Exercise capacity, muscle strength and fatigue in sarcoidosis”

Sarcoidosis is a disorder of the immune system most commonly affecting young people. Various symptoms may occur dependent on the organs involved. This study shows that problematic symptoms in patients suffering from sarcoidosis include fatigue, a decreased exercise capacity and muscle weakness. It also shows that these symptoms are persistent and have a great impact on patients’ quality of life. Treatment and early detection of these health restrictions by using physical tests such as a six-minute walk test are of vital importance. A physical training programme contributes to a reduction in fatigue symptoms and an improvement in physical functions as well as quality of life.

Key words:

sarcoidosis, exercise capacity, muscle strength, fatigue, physical training

“Het einde van de periode”

“Searching for the Sources of Inequality”

“Novel Inflammatory Biomarkers for the Early Identification of Heart Failure’

“Renal Cell Cancer: A molecular-epidemiological approach to unravel new pathways underlying disease etiology and prognosis”

Kidney cancer is the seventh most common cancer, yet its cause remains unknown. This dissertation examines the risk factors and physiological mechanisms that could play a role in the development of kidney cancer within the framework of a Dutch cohort study (NLCS). High salt intake was identified as a new potential risk factor for kidney cancer, particularly among participants with low fluid intake. The link between salt intake and kidney cancer could not be explained by the participants’ high blood pressure, but could be partially explained by genetic variation in the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure, salt intake and fluid levels in the kidneys. By classifying kidney tumours according to tumour heterogeneity based on epidemiological changes, we demonstrated that potassium intake increased the risk of kidney cancer in one group of tumours and reduced the risk in others. Risk factors can therefore differ as a result of tumour heterogeneity, which should be taken into account in future research.

Key words:

kidney cancer, causes

“The role of tissue factor pathway inhibitor in arterial and venous thrombosis”