Academic Ceremonies September 2012

“The Pre-assessment Learning Effects of Consequential Assessment Modelling how the Examination Game is Played”

Exams can drive students to learn in undesirable ways, like memorising rather than trying to understand work. While this phenomenon has been researched extensively, research has not yet yielded a validated model to explain this behaviour. This dissertation proposes, and starts the process of validation of, a model that describes and explains students’ reactions to assessment. Validation is crucial because it allows the model to be used with greater confidence in a range of settings. These findings could help lecturers who develop assessments to understand how different assessment methods, and the way they are used, influence student learning. They could also enhance research about assessment as a tool to augment learning.

Key words:

learning effects of assessment, model, model validation, assessment, learning, mechanism of impact, determinants of action

“New horizons in nonpolypoid colorectal carcinogenesis”

Tracing and removing colon polyps during internal examination can stop the development of colorectal cancer at an early stage. Therefore, in the Netherlands from 2013 on the population older than 55 years will be screened. Recent research, however, shows that the preventive effect of colon examination is considerably less in the right part of the colon. A possible explanation is the contribution of so-called flat colon polyps. This type of colon polyps is more difficult to identify and remove and possible also of a more aggressive nature. This dissertation about the clinical and molecular characteristics of flat colon polyps shows that they make a larger contribution to the development of colorectal cancer in the right than in the left part of the colon. Adequate tracing of flat colon polyps therefore appears a condition for effective population screening for colorectal cancer.

Key words:

colon polyps, colorectal cancer

“Reactivity, recruitment and remodeling of collateral arteries in diabetes”

Diabetes (suikerziekte) verhoogt het risico op perifeer vaatlijden, een ziekte die het gevolg is van slagaderverkalking in de benen, en leidt tot verminderde mobiliteit en meer kans op voetwonden en amputatie. In dit proefschrift wordt arteriogenese beschreven, een natuurlijk proces waarin kleine bloedvaatjes (collateralen) groter worden om doorbloeding te herstellen. In een diermodel laten wij zien dat diabetes leidt tot verstoorde arteriogenese. Ook tonen wij in geïsoleerde vaatjes aan dat diabetes de vaatverwijding bemoeilijkt. Toediening van een vaatverwijdend geneesmiddel stimuleerde arteriogenese in het been in proefdieren. Deze geneesmiddeltoediening zou een veilige en effectieve behandelstrategie voor diabetespatiënten met perifeer vaatlijden kunnen zijn.

Key words:

Diabetes, peripheral arterial disease, arteriogenesis, collaterals, vasodilatation

“De veranderende wereld van de Medische Microbiologie”

“Support of an Asthma/COPD service for General Practitioners in daily care”

An asthma/COPD service supports the General Practitioner with the complicated diagnostics of asthma/COPD by performing lung function measurements, which lung specialist consultants subsequently assess together with a filled out questionnaire.  Research into the quality of the asthma/COPD service shows that this diagnostic procedure ‘on paper’ is reliable and just as good as a ‘live’ assessment in the lung specialist’s consulting room. The asthma/COPD service signals misdiagnosis and overtreatment in patients that use medication even before the diagnose is made.  Making the right diagnoses and additional advising with these and other diagnostic problems makes the asthma/COPD service a valuable diagnostic provision for General Practitioners and their patients.

Key words:

asthma/COPD diagnostics, cooperation primary care, misdiagnosis

“Nodal isolated tumor cells and micrometastases in early stage breast cancer”

Metastases in the lymph glands also determine the prognosis of breast cancer. 15 years ago, the sentinel lymph gland procedure was introduced, where only a limited number of lymph glands is removed from the armpits and examined for the presence of metastases. With this procedure, small metastases, i.e. isolated tumour cells (smaller than or equal to 0.2 mm) or micrometastases (0.2 – 2 mm) are often found in the sentinel glands. The prognostic value of such small metastases in breast cancer is currently questioned. This dissertation describes a national cohort study that shows that small metastases negatively influence the prognosis. In patients that underwent chemotherapy or hormone therapy the prognosis was better.  Therefore, these treatments should be considered with the presence of small metastases. Also the cancer did not return as quickly in the case of complete removal of the armpit glands. The dissertation also describes the role of the extensiveness and localisation of small metastases in the lymph gland and cost effectiveness aspects of the treatment.

Key words:

breast cancer, prognosis, isolated tumour cells and micrometastases

“Het kind van de rekening”

“The Politeness of Data Protection; exploring a legal Instrument to regulate medical research using genetic information and biobanking”

“The influence of adult education on the increase of Social inclusion”

Adult education can be a lever for increase of social inclusion among vulnerable adults. This thesis contains a series of studies concerning the outcome of lifelong learning programs among vulnerable adults. Some learners (circa half of the total population) undergo a ‘transition’ to better social inclusion after joining these programs, especially on four conceptions of social inclusion: activation, internalisation, participation and connection. The research results underline the importance of the variable transfer possibilities (referring to the possibilities one has to use the learned knowledge, skills and attitude in daily life) influencing the learning success among these learners. Further analysis show that not only elements of the learning environment influence the rate of increase of social inclusion. Especially foreign learners and people who live together without being married experience a higher rate of increase on several variables of social inclusion. Future research and the use of insights of the results of our study can stimulate professionals and researchers of lifelong learning to improve the learning environment of lifelong learning in adult education centres. The research is now continued in eight European countries, 87 communities and among 5500 learners.

Key words:

adult education, social inclusion, variable transfer possibilities

“Primary vascular access for hemodialysis treatment”

A well functioning vascular access is necessary for successful hemodialysis treatment (a therapy that replaces the kidney function). Vascular access can be created with an arteriovenous fistula (AVF), a connection between a coronary artery and a vein. The risk of treatment failure increases, however, if the patient has small or bad vessels. In that case an arteriovenous graft (AVG), an artificial blood vessel that is subcutaneously attached between a coronary artery and a vein, can be a solution. Research in this dissertation shows that, looking at the life span, patients with bad vessels indeed benefit from placing an artificial AVG as vascular access for dialysis.

Key words:

kidney failure, hemodialysis, vascular access

“MicroRNAs in the heart: micromanagers and sentinels of cardiac disease”

MicroRNAs are small molecules that have a great influence on a wide scale of cell functions and diseases.  This dissertation describes the role of microRNAs in heart diseases and the involvement of individual microRNAs in inflammation of the heart. Manipulation of such microRNAs leads to protection of or, on the contrary, a higher sensitivity of the heart to high blood pressure or viruses.  Also the ‘leaking’ of microRNAs from heart muscle cells during acute heart diseases can be measured in the blood which contributes to a quick diagnosis. Combined, these studies imply that microRNAs can be used for future treatments and diagnostic tests for cardiovascular diseases.

Key words:

MicroRNA's, heart diseases, inflammation of the heart

“Functional Cortical Cartography”

My research has focused on understanding the relationship between structure and function in the human brain. Just like fingerprints, each person has a unique folding pattern in their brain. This convoluted folding pattern is surely part of what makes us individuals, but also introduces some difficulties into the field of neuroimaging. First among these difficulties is the challenge of ensuring you can compare the same brain area across a population of subjects. By using advanced analysis techniques I was able to create probabilistic maps of function brain areas, allowing one to predict the function of a particular brain area, only by knowing its anatomical location. Furthermore, I developed new analysis techniques to improve the effectiveness of group brain imaging studies. Finally, I used these new techniques to track the development of the brain’s auditory system, in structure and function, through childhood, adolescence and into adulthood.

Key words:

human brain, folding pattern, neuroimaging

“Ik denk dus ik leer”

“Waterveiligheid: Managen van kwetsbaarheid voorbij de mythe van droge voeten; De Nederlandse omgang met overstromingdreiging in sociaal-cultureel perspectief”

This dissertation explains why flood risk is not an item in the Netherlands. After problems with rivers in 1993 and 1995, the Dutch government decided to stimulate public communication on water safety and public participation in water safety projects.  This would increase the water awareness of citizens and enhance risk-conscious behaviour. Research now shows the unexpected and undesirable side-effects of this policy: indignation, apathy and loss of public trust. According to Heems and Kothuis, the ‘safety myth of dry feet’ is the cause of the failing government policy: knowing that there is no absolute guarantee, but at the same time believing that the Delta Works guarantee dry feet.  Denying this widespread myth is necessary for social anchoring of the desired attitude towards water safety.

Key words:

water safety, communication, participation, safety myth

“Neuroinflammation as a cause of chronic pain”

“Participatory Ethnography of HIV/AIDS in Cartagena, Colombia: A Collective Analysis for Social Action toward HIV Prevention”

In order to address the local HIV/AIDS epidemic in Cartagena (Colombia), priority should be given to structural actions such as reducing socioeconomic inequalities, providing access to health care and education as well as regulations to prevent sexual exploitation and sexual abuse in the frame of sexual tourism. Among the actors that need to generate these large-scale structural changes are the government and private sector (e.g. national and international health insurance companies operating in Colombia and the international tourism industry).This proposal for HIV prevention and a collective analysis of HIV infection are the outcome of a five-year participatory ethnography conducted with 96 inhabitants of Cartagena. The collective analysis of HIV infection is summarized in a so-called ‘Local-Scientific diagram’, which pictures HIV infection in Cartagena as a social phenomenon that involves complex and dynamic interactions between local ideas of body, ethnicity, class, gender roles, sexuality, sexual risk and the social exclusion that derives from these interpretations. The diagram also sheds light on the way local dynamics of the government’s performance and the international sex tourist industry play a role in this complex social phenomenon.

Key words:

HIV/AIDS, Cartagena-Colombia, Participatory Ethnography, Structural actions, HIV-prevention

“Young onset dementia; characteristics and impact”

In the Needs in Young onset Dementia (NeedYD) study, 215 young people with dementia (started before their 65th) and their family members were studied for two years.  It turned out that for this group it took longer to diagnose dementia than for older people.  In 45%, before another diagnosis was made, such as psychological problems. Often, there was much distress before the diagnosis, such as family conflicts or work-related problems.  Moreover, the disease insight turned out higher in young than in older persons with Alzheimer’s disease (AD). Also behaviour problems appeared to occur less frequently in this group. The study shows that timely indication and diagnosis are important for this group and offer leads for the support of young people with dementia and their families.

Key words:

dementia at young age, diagnostics, clinical characteristics, impact

“In Search of a New Past: European Integration in a Historical Perspective”

“Clinical implications of idiopathic atrial fibrillation”

Young and seemingly healthy patients with atrial fibrillation should be better examined and supported, because this heart rhythm disorder is a possible lead for concealed cardiovascular diseases. In idiopathic atrial fibrillation, the heart beats fast and irregularly without a demonstrable cause.  Long-term research into a group of young and healthy people with idiopathic atrial fibrillation shows that often beginning cardiovascular diseases are present in these patients, or will develop within five years.  The dissertation shows that the findings for this group clearly differ from the control group of persons without heart rhythm disorder. Tackling the underlying problems at an early stage could reduce the risk of serious consequences of cardiovascular diseases later in life.

Key words:

idiopatic atrial fibrillation, cardiovascular diseases, echocardiography

“Rolandic epilepsy, unraveling benign”

Many children with epilepsy have Rolandic epilepsy, which mostly occurs during the night.  Earlier, it was often assumed that this epilepsy was benign and therefore needs little treatment. Now, however, it turns out that children with this type of epilepsy have more problems with language and reading than healthy children. These problems often already manifest themselves before the epilepsy is diagnosed. The cerebral cortex of children with Rolandic epilepsy appears, particularly in the left ‘language’ half of the brain, thinner than in healthy children. That difference seems to increase as these children grow older. Also, these children have deviating neuronal connections in the brains. All this makes Rolandic epilepsy much less benign than assumed.

Key words:

Rolandic epilepsy, children, language problems

“Experimentele Neurochirurgie: een visie op de toekomst”

“Lokaal integraal gezondheidsbeleid: realistische uitdaging of utopie?”

The importance of an integral health policy, also called ‘Health in All Policies’, is (inter)nationally emphasized. Intersectoral cooperation is a prerequisite to achieve integral policy. However, locally few initiatives are taken to intersectoral cooperation. This dissertation examines the possibilities of working internally within a municipal organisation on a coherent health policy, in general and more specifically for overweight.  Important elements are: how do you place health properly on the agenda of the local authorities, especially of officials who are not responsible for health issues? Can a Community Health Service stimulate municipalities to create a broader view on health? The research shows that for stimulating intersectoral cooperation concerning health problems commitment and dedication are required on all hierarchic levels in a municipality. Integral policy development needs administrative attention from the entire City Council, decisive direction at management level from the municipality, room in the policy process and competent Community Health Service professionals.

Key words:

Health in All Policies, integral health policy, intersectoral cooperation

“Corruption: A Violation of Human Rights and a Crime Under International Law?”

“De dominee en de tweede apostel Paulus”

“Less than meets the eye: The functional relevance of early Visual cortex across the visual domain”

In a series of areas in the human brains, among which the cerebral cortex, the visual perception is processed.  The ‘early visual cortex’ is the area in the cerebral cortex where the visual information first enters. This dissertation reports a study in which the normal brain activity in the early visual cortex is temporarily and locally suppressed by means of Transcranial Magnetic Stimulation (TMS). This temporary suppression turns out to limit the recognition and awareness of visual information, the visual short-term memory and the influencing of behaviour on the basis of visual perception.  This proves that the early virtual cortex does not play a specific role in visual perception, but that it is involved in several aspects of visual perception.

Key words:

Transcranial Magnetic Stimulation (TMS), visual perception, early visual cortex, visual short-term memory, priming

“Connecting hemosysis and visceral injury during cardiovascular surgery; studies on the causes, effects, and treatment of hemolysis-induced organ injury”

Patients who undergo major cardiovascular surgery run a relatively high risk of postoperative complications, such as intestine and kidney damage. This dissertation describes the connection between red blood cell injury (hemolysis), which is often the consequence of the heart-lung machine and blood transfusions during surgery, and the development of intestine and kidney injury after the operation. The various studies gathered in this dissertation show that patients that experience more hemolysis also develop more intestine and kidney injury.  Because it is possible to treat the consequences of hemolysis, the results of this dissertation can contribute to the prevention of complications after cardiovascular surgery.

Key words:

hemolysis, cardiovascular surgery, blood transfusion, intestine, kidney

“Bugs versus Humans: genomics translated into Public Health”