Academic Ceremonies November 2012

“The evaluation of normal and pathological bladder sensations”

Studies of bladder sensations are often invasive and therefore aggravating for patients with an overactive bladder.  Aim of this PhD research was the development of non-invasive methods and an understandable and applicable terminology to evaluate bladder sensations. In focus groups, a constant urine production was generated by a so-called ‘water load protocol’. This protocol, combined with a constant focus on the bladder, offers the possibility to evaluate in a non-invasive way the origin of the sensation of having to urinate, and to establish a clear and applicable terminology.  Also by keeping a sensation-related urination diary that contains a scale for the degree of the urge and the degree of bladder fullness, bladder sensations can be evaluated.

Key words:

Bladder sensations, 'water-load' protocol 

“Effects of Haemostatic Agents on Trauma Induced Bleeding”

“Assistive Technology in persons with cognitive deficits: Feasibility, usability and effectiveness”

“Evaluation in health care innovations in fibromyalgia”

“Life and death at the mucosal luminal interface: A new perspective on human intestinal ischemia/reperfusion”

Shortage of oxygen (ischemia) of the intestine is a potentially life threatening disorder. To gain more insight in the underlying causes our research group developed unique human intestinal ischemia/reperfusion (IR) models. Reperfusion is recovery of the blood supply to tissues that were earlier (partly) devoid of blood.  Grootjans discovered that the small intestine disposes of ingenious mechanisms to limit damage to the intestinal wall after short periods of IR. He also discovered that longer ischemia with reperfusion involves damage to the congenital defence of the intestine, which contributes to the development of complications of intestinal ischemia. Future studies now focus on the development of treatments that can reduce death by intestinal ischemia in the future.

Key words:

intestinal ischemia, causes, small intestine

“Broadcast and network optimization”

Ordering search results, network stability and routing on the Internet are applications of which the performance almost entirely depends of automated solution methods. This dissertation studies fundamental aspects of solution methods for these problems.  
The simplest solution methods that will always find the best solution is trying each possible solution one by one and selecting the best one. Even on the fastest computer this method takes too much time: years instead of days!  
Finding a solution method that is both fast and finds the best answer, appears unfortunately not always possible.  This dissertation describes solution methods that are very fast, but find a very good answer instead of the best answer. Moreover, for various problems better and simpler solution methods are described.

Key words:

automated solution methods, fundamental aspects

“Komt een psycholoog bij de dokter”

“Daily activity monitoring in patients with COPD; assessment of upper and lower extremity performance”

“The psychosocial determinants of sexual behaviours that place  traditionally initiated and circumcised young men in the Eastern Cape Province of South Africa at risk of STI/HIV’ infection”

“National Socialist Family Law; the influence of National Socialism on marriage and divorce law in Germany and the Netherlands”

To which extent has the marriage and divorce law in Germany and the Netherlands in the period 1933-1945 been influenced by the national socialist range of ideas?  To answer this question, extensive research has among others been conducted in the archives of the NIOD. The marriage and divorce law was used by the Nazis to build their Thousand Year Aryan Reich. For this purpose, many Aryan children and as few as possible half-Jewish children had to be born. Therefore, the Nazis, both in Germany and the Netherlands, tried to change the rules regarding marriage and divorce, among others forbidding marriages between Aryans and Jews. Also the divorce law was liberalized, allowing marriages in which it was unlikely that children would still be born, to be dissolved more easily. However, the final conclusion is that the Nazis indeed made many changes in the marriage and divorce law, but that this law never became entirely national-socialist.

Key words:

family law, Second World War, divorce law

“The History of the Nederlandsche Cocaïne Fabriek and its Successors as Manufacturers of Narcotic Drugs, analysed from an International Perspective”

The aim of this research was to realize a detailed description and analysis of the history of the production of narcotic drugs in the Netherlands (1900-1995). The most important companies that produced these drugs were the Nederlandsche Cocaïne Fabriek (NCF) and its successors. It turned out that acquiring the vegetable resources at low cost and having access to sufficiently large domestic markets are requisites for commercial success.  Because there are no internationally standardized figures about the volume of the worldwide cocaine production before 1930, Bosman developed an estimation method. The research also proves hat recent statements by writer Conny Braam about enormous quantities of cocaine, delivered by NCF to warriors during the First World War entirely lack foundation. 

Key words:

cocaine, production, Netherlands, 20th century

“Explaining Sickness Absence Behaviours among Public School Teachers in the Eastern Cape Province, South Africa: a socio-psychological analysis”

“Ensuring the Competence of Dental Practitioners through the Development of a Workplace-based System of assessment”

“Learning from error to improve patient safety”

Errors in health care can lead to dangerous situations and harm the patient and must therefore be reduced to a minimum. This dissertation clarifies from various perspectives how learning from errors can improve patient safety. Studied were the types of errors that are made in hospitals, the perception of medical students about patient safety, the differences in perception between students, residents and specialists about what constitute medical errors, and the role of training in making students aware of what goes wrong around them. Despite the many possibilities in health care to learn from errors, there is mainly still ground to be gained in the field of culture change. Learning from errors should be dealt with more consciously by using more types of errors as a learning moment. Extra attention for the social factors that influence learning could prevent potential errors in the future.

Key words:

Patient safety, health care, learning from medical errors, training

“Doorzien en Ontrafelen”

“All roads to thrombus formation; demystifying platelet signaling pathways”

Blood platelets have a central role in the process of haemostasis (the process of making the bleeding stop in a damaged blood vessel wall) and thrombosis (clotting of a blood vessel). The latter can lead to blood vessel obstruction causing a heart infarct or a stroke. The current antithrombotic, anti-blood vessel medication is only partly effective, and an increased risk of bleeding often creates a considerable complication. For the development of personalized target-specific medication with fewer side-effects a more exact knowledge of the complex process of thrombus formation and mainly the involved blood vessel signalling pathways is essential. The insight described in this thesis is a contribution to future developments in the treatment of arterial thrombosis.

Key words:

Blood platelets, thrombus formation, signalling pathways

“Incentives and Behavior in Markets”

This dissertation studies incentives and behavior in four different markets, ranging from the effects of charity characteristics on their cost-effectiveness, to individuals' behavior in internet auctions. For instance, we show that bidders adapt their bidding strategies over time and point toward the possibility for an auctioneer to increase revenues by adapting its focus to attract novice bidders.
Second, we study the cost-effectiveness of charities and show that it significantly varies with a charities' funding structure. This has important implications for potential donors and can help them to avoid low performing charities.

Key words:

incentives en gedrag op markten

“Market integration through ‘network governance’: The role of European agencies and networks of regulators”

The institutional design of EU energy and telecoms regulation has evolved in the last two decades. Mechanisms to encourage cooperation between national regulators have progressively been established: first, loose networks of regulators, then enhanced networks of regulators and eventually stronger and more formal forms of coordination, through European agencies or other new institutional models. In the energy field, a true ‘networked’ European agency has been created: the Agency for the Cooperation of Energy Regulators (ACER). In telecoms, a two-tier institutional structure has been set up: the Body of European Regulators for Electronic Communications (BEREC) and the Office. The features of ACER and BEREC show the intention to institutionalise the existing networks of regulators and confer a higher status upon them, with a strengthened and recognised position in the EU. However, this process raises concerns of legitimacy and accountability.

Key words:

EU marktintegratie, Europese agentschappen, netwerken van regelgevers, ACER, BEREC

“Developmental Immunotoxicity Testing for Hazard Identification”

Children can be more sensitive to chemical substances than adults. However, in the current safety evaluation of chemical substances, the specific sensitivity of children is possibly not sufficiently taken into account. This dissertation has established by means of animal studies that the developing immune system during the pre- and post-natal phase is relatively sensitive compared to general parameters of growth and development. The results have contributed to the development of a new international test directive for a generation study with additional immune parameters, which may enable better protection of children against the possible harmful effects of chemical substances.

Key words:

developmental immunotoxicity, sensitivity in children, hazard identification of chemical substances

“La contribution du droit penal de l’environment a la repression des atteintes a l’environnement au Benin”

This study is an analytical and critical diagnosis of the penal system of protection of the current environment in Benin.
Benin, following the example of the other African countries, is confronted with a continuous degradation of the natural and environmental resources. Can the criminal law of the environment, just like the other legal disciplines, contribute effectively to the protection the aforementioned resources? This problem which underlays our research works raises certain number of legal concerns which determine the future of the criminal law of the environment.
The thesis concludes that in spite of the difficulties which mark out the implementation of the criminal law in the environmental protection, its effective application remains relevant.

Key words:

criminal law, environment, protection

“L’effectivité du droit à l’eau face au processus de libéralisation du secteur de l’eau en Afrique subsaharienne”

“Improving ventricular pacing in adults and children; to treat or to avoid dyssynchrony-induced cardiac failure”

This research shows that even patients with mild cardiac failure induced by dyssynchrony (a badly coordinated contraction of the heart) can benefit from ‘resynchronizing’ both heart chambers by artificial stimulation of both heart chambers.  In children and young adults for whom artificial stimulation of the heart chamber is necessary it is important to make sure that this artificial stimulation does not cause a deterioration of the heart function. The described studies show that the place where the heart is stimulated has an important influence on the heart function. 
The best heart function was witnessed in stimulation of the chamber that pumps the blood into the body. This research contributes to the improvement of pacemaker therapy in adults and children for the treatment or prevention of heart failure induced by dyssynchrony.

Key words:

dyssynchrony, cardiac failure, pacemaker, heart function

“Factors influencing implementation of nutritional intervention in elderly subjects after hip fracture”

Elderly persons with a hip fracture often lack appetite. This can delay the recovery. Therefore, a study was conducted in which elderly with a hip fracture received intensive nutritional coaching by a dietician (10 contact moments) during 3 months if necessary combined with fluid nutrition. This coaching took place both in the hospital and in recovery care and in home situation. 
To test the usability of this nutritional intervention in the health care practice a process evaluation was carried out. The provided nutritional intervention turned out well applicable and was highly appreciated by patients. However, introducing this intensive nutritional care requires extra attention, particularly due to the lack of structural attention for nutrition in the existing health care.

Key words:

nutritional care, hip fracture, dietician and fluid nutrition, process evaluation

“De social defeat-hypothese”

“Institutionalization of International Justice”

“MicroRNAs: small directors with crucial powers in heart failure”

“Iraanse vluchtelingen en asielzoekers in beeld: Ervaren begeleiding, psychopathologie en perceptie van kansen”

“Immune control by the autonomic nervous system: Towards clinical implementation of enriched enteral nutrition”

Implementation of enriched nutrition around an operation might reduce complications. This dissertation contains several studies that support this claim. Enriched nutrition in the intestine triggers a nervous reflex that inhibits the inflammatory reaction and protects various organs (among which the intestine).  Moreover, enriched nutrition appears effective when the body has already suffered damage, so that this treatment can also be applied to patients after an accident. It is also very important that enriched nutrition not only mitigates the acute and very intense inflammatory reaction, but also leads to a more effective immune system in the period afterwards.

Key words: 

enriched nutrition, intestine, nervus vagus, autonomic nervous system, inflammation, surgery

“Interorgan short chain fatty acids exchange in humans; implications for clinical application in colorectal surgery”

“Neurobiological factors modulating H1-antihistamine induced cognitive impairment”

Some anti-allergy drugs (antihistamines) can cause fatigue. In the treatment of hay fever this fatigue is undesirable, because it can increase the risk of car accidents. But in the treatment of, for example, sleep disorders this fatigue may actually be desirable. This dissertation studied which mechanisms in the body make certain anti-allergy drugs cause fatigue.  The research shows that genetic individual differences between people play a role in the degree of fatigue. The message of this dissertation is that these individual differences should be taken into account in medication treatments to guarantee the safety of treatments with among others antihistamines.

Key words:

Antihistamines, attention, healthy volunteers, MRI, EEC, driving studies, sedation/fatigue, cognition

“Effectiveness and cost-effectiveness of nutritional intervention in elderly subjects after hip fracture”

Malnutrition often occurs in the elderly. The department of Epidemiology of Maastricht University, in collaboration with the departments of Surgery, Orthopaedics and Dietetics of the Maastricht University Hospital, the Atrium Medical Centre and the Orbis Medical Centre, investigated the effects and costs of extra nutritional care in elderly with a hip fracture. During 3 months, the patients received intensive coaching by a dietician (10 contact moments), if necessary combined with fluid nutrition. This appeared to lead to an improvement of nutritional intake and nutritional state of the patients, but it had no effect on the duration of hospitalization or recovery care, nor on the number of complications or the functioning of the participants. The costs of this intensive nutritional care turned out remarkably low: average €600 per patient, which is only 3% of the total care costs per patient with a hip fracture (appr. € 23.000).

Key words:

malnutrition, hip fracture, nutritional intake

“Harvesting and validating experiental expertise to support autonomy of people with diabetes mellitus. In search for successful diabetes-related behaviors regarding driving and work”

For this dissertation professionals harvested and validated the experiential expertise of people with diabetes mellitus. By harvesting how this target group exactly deals with (in this case) driving a car and working, others, who don’t have this experiential expertise yet, can learn. The main factors appeared to be the ability to anticipate and react to hypo attacks during the drive, adequately informing and instructing passengers, anticipating problems during job interviews, executing effective self-management activities to prevent hypo and hyper attacks on the work floor, and successfully negotiating with employers about adaptations of the work circumstances.

Key words:

Diabetes mellitus, ervaringsdeskundigheid, autorijden, arbeid

“Essays on Monetary and Fiscal Policy in Good and Bad Times: Economic Theory and Econometric Methods”

“Cochlear Implantation; surgical and audiological assessment of cochlear implantation techniques”

“Prediction of Abdominal Aortic Aneurysm progression”

“Platelet-associated hypercoagulability in patients with Essential Thrombocythemia and Polycythemia Vera”

Thrombosis is a frequent complication in patients with cancer. In patients with hematological malignancies, such as Essential Thrombocythemia (ET) and Polycythemia Vera (PV), thrombotic events are a major cause of increased morbidity and mortality. The pathogenesis of the activation of blood coagulation in these patients is complex. Platelets have an important role in this process. This thesis presents studies exploring the platelet-associated hypercoagulability in patients with ET and PV. The acquired JAK2V617F mutation, which has been reported in nearly all patients with PV and in more than half of patients with ET has been associated with severity of disease and increased expression of soluble or cellular biomarkers of clotting system activation. This thesis confirmed a hypercoagulable state in patients positive for the JAK2V617F mutation, associated with the highest thrombin generation values.

Key words:

cancer and thrombosis, thrombin generation, platelets.

“Limiting viral infections with immunomodulating agents”

Viral infections occur often and they can cause serious health problems. Despite the success of the current antiviral drugs and vaccines, new medication is necessary.  In this dissertation, a series of experiments shows that specific drugs that can strengthen the immune system, are capable of protecting cells against viral infections. Here, particularly the substance interferon-beta turned out to play an important role. Moreover, it turned out that direct exposure of cells to interferon-beta led to long-term protection against a viral infection. These findings may be important for the future treatment of patients with an increased sensitivity to viral infections.

Key words: 

viral infections, health problems, interferon-beta, immunity stimulation 

“Tailoring conservative care in osteoarthritis”

This dissertation studied the care needs and treatment of people with advanced osteoarthritis. It turned out that people with osteoarthritis in several joints run a higher risk of developing serious complaints in pain, physical and psychological functioning. A feasibility study into the effectiveness of a treatment showed important differences in care needs between patients. In follow-up research this should be taken into account. It was also shown that approximately 25% of the people waiting for a new joint as a consequence of osteoarthritis deteriorate in pain and functioning. This can have negative consequences for the outcomes of the operation. For these people, the usefulness of an intensive therapeutic training prior to the surgery was investigated. Literature studies show that this type of training is not useful for young, fit persons. However, fragile, elderly persons possibly benefit from such training. Particularly this last group did not participate in the feasibility study, because they could not come to the hospital. In follow-up research, therefore, the practitioner will have to visit he patients.

Key words:

osteoarthritis, treatment, care needs

“Hybrid thoracoscopic epicardial and transvenous endocardial catheter ablation of atrial fibrillation”

“Let’s do drugs”