Academic Ceremonies May 2014

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

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

Key words:

psychosis, prognosis, risk, positive symptoms

“Fostering Monitoring and Regulation of Learning”

“The Sounding Museum: Box of Treasures”

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

Key words:

Soundscape Composition, Anthropology, Intangible Cultural Heritage, Ethnographic Museum

“Macrophage heterogeneity in neovascularization”

“Maatwerk in meten: slim scoren”

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

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

Key words:

insulin resistance, diabetes mellitus, cause

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

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

Key words:

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

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

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

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

Key words:

imaging, Alzheimer’s disease, MRI

“Robot-assisted Laparoscopic Surgery”

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

Key words:

laparoscopic surgery, robotic surgery

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

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

Key words:

absenteeism policy, healthcare, work reintegration, Canada

“Pension Fund Asset Allocation and Performance”

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

“Thrombin generation: innovations and clinical applications”

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

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

Key words:

insulin resistance, glycocalyx

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

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

Key words:

competency level, international students, labour market

“Failure to rescue”

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

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

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

Key words:

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

“The subthalamic nucleus in Parkinson’s disease”

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

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

Key words: 

cardiovascular disease, diet, population studies, endothelium