Academic Ceremonies June 2013

“Clinical management of Rett syndrome”

Rett syndrome is serious development disorder caused by a genetic anomaly that only occurs in girls. In the Netherlands about 250-300 girls are known to have Rett syndrome. Besides serious mental disabilities, medical problems complicate this disorder, such as epilepsy, autonomous dysfunction and growth retardation. Since curing is not possible up to now, this dissertation focuses on clinical management. Specific attention is given to the role of genetic mutation, the role of metabolic problems as a cause for malnutrition and the ageing process with Rett syndrome. This research was conducted in the Gouverneur Kremers Centre of the MUMC+ in close collaboration with the Terre Foundation and the Dutch and Belgian Rett associations.   

Key words:

Rett syndrome, genetics, clinical management

“Prevalence and spread of antibiotic resistant micro-Organisms in a cross border region”

Trefwoorden:

antibiotic resistant bacteria, prevention, spread, Euregion Meuse-Rhine 

“Job security in the Netherlands”

“Essays on International Banking and (In)Stability in Financial Markets”

“Welke lijn trekt de cardioloog”

“Temporal patterns in the pathophysiology of Dialysis patients: an epidemiological approach”

Hemodialysis is the most commonly used treatment modality for patients suffering from end-stage renal disease (ESRD). This thesis primarily deals with longitudinal patterns in dialysis patients and their relationship to patient outcomes, such as survival and hospitalization. We address various oscillatory and non-oscillatory patterns in patients with ESRD. Oscillatory patterns are trends that repeat themselves over time such as circadian or seasonal patterns and they are covered in the first two chapters. Non-oscillatory patterns such as trends before or after certain events are covered in the remainder of the thesis. We also discuss new global database initiative, called MONDO, with aims of studying and improving outcomes of dialysis patients worldwide. The key conclusion of the thesis is to stress the importance of longitudinal trends in dialysis patients

Key words:

hemodialysis, renal disease, longitudinal patterns

“Physiology & pathophysiology of human brown adipose”

“Dietary manipulation of fat metabolism in relation to obesity and insulin resistance”

The epidemic of overweight and obesity is spreading fast over the whole world and involves an increased risk of diabetes. This dissertation studies how obesity and diabetes can be prevented by influencing the fat metabolism with the help of nutrition. Raised consumption of nutrition/food supplements such as resveratrol (polyphenol in red wine), unsaturated fatty acids (fish oil) and an increase in certain food fibres have positive effects on the fat metabolism and insulin sensitivity. These findings can contribute to a successful lifestyle intervention, favourable metabolic effects and the prevention of diabetes. 

Key words:

obesity, diabetes, fat metabolism, nutrition 

“It’s about time”

“Childhoods embargoed: constructing and reconstructing multidimensional child poverty in Iran, 1984-2009”​

“Expropriation and restoration of real property rights in the Federal Yugoslav Republic of Macedonia and in the Republic of Macedonia (FYROM): a legislative-historical study”

“Caregivers’ experiences with aggressive behavior of nursing home residents” 

The main goal of this dissertation was to explore caregivers’ experiences with resident aggression in nursing homes in Switzerland. Results demonstrate that the prevalence of experienced resident aggression is high for caregivers. Respondents perceive aggression as burdening and mentioned its adverse influence on the relationship between caregiver and resident. Furthermore, the findings reveal a need for action regarding the development of caregivers’ competencies in a comprehensible assessment of conditions and factors which can contribute to resident aggression. The management of nursing homes should also be required to give attention to this issue, as the results strongly suggest that support form superiors improve caregivers’ use of measures in managing resident aggression recommended by guidelines.

Key words:

nursing home, aggression, caregivers’ experiences

“The BRIC States and outward foreign direct investment in services”

This dissertation investigated the international laws that have supported the flow of foreign direct investment in services from the emerging markets of Brazil, Russia, India and China. These countries have engaged in an increasing amount of services oriented investment in industries like telecommunications, finance and transportation and have accordingly begun to conclude bilateral investment treaties to open new markets and to protect investors abroad. The dissertation proposes a global treaty drawing on observed legal trends in treaties concluded by developed and developing states and which balances investor protection with public interest matters such as environmental protection, human rights and culture.   

Key words:

international law, services, direct investment, global treaty

“Self-testing: To do or not to do? Development and evaluation of a decision aid on diagnostic selftesting for cholesterol and diabetes”

“Kiezen voor publiek-private samenwerking”

“Reproductive options for couples at risk of Huntington’s disease”

In dit proefschrift wordt  het gebruik van prenatale diagnostiek en preïmplantatie genetische diagnostiek door paren met een hoog risico de ziekte van Huntington onderzocht. Een selecte groep maakte gebruik van de zogenoemde exclusie-test omdat de risico ouder zelf niet geïnformeerd wil zijn over zijn/haar aanleg voor de ziekte, maar de ziekte wel wil voorkomen bij het nageslacht. Paren bleken zelf goed in staat zijn tot weloverwogen reproductieve keuzes, mits counseling door een klinisch geneticus en psychologische begeleiding gewaarborgd is. Kort na de voltooiing van het proefschrift werd het verbod op exclusie preïmplantatie genetische diagnostiek voor de ziekte van Huntington in Nederland opgeheven. 

Trefwoorden:

prenatale diagnostiek, preimplantatie genetische diagnostiek (PGD), ziekte van Huntington

“Imaging the brain; neuronal correlates of cognitive impairment in children with frontal lobe epilepsy”

Children that suffer from epileptic attacks originating in the frontal lobe often show learning disorders, among which arithmetic, memory and attention.  Consequently, these children often have problems keeping up in school. With the use of advanced MRi techniques, the research for this dissertation established a series of causes for these learning disorders. In children with this type of epilepsy the communication between various brain areas appears weak and the structure of the brain network not efficient. The weaker the communication between these areas and the less efficient the structure of the brain network, the more serious the learning disorders.  

Key words:

epilepsy, learning disorders, MRI, brain

“New frontiers in sacral neuromodulation for functional bowel disorders”

“De theorie van Darwin, de wet van Wolff, de hypothese van Sapir-Whorf en het opleiden van artsen”

“Signaling Games: Theory and Applications”

“Contributory Negligence; A historical and comparative study”

Our modern approach of the doctrine of ‘contributory negligence’ of the disadvantaged party in indemnity claims of liability outside contract has been formed by a long history. This research comprises a detailed study and description of the origin and the historic development of the doctrine of the ‘contributory negligence’ from the Ancient History until today.  It contains a study of primary sources from the various periods in the history of law. Moreover, the research comprises a (short) comparative legal study of the main current developments concerning the doctrine of ‘contributory negligence’ in France, Germany and the Netherlands. 
This dissertation was realized with financial support of the NWO. 

Key words:

contributory negligence, illegal act, history of law, comparative law

“An in-depth vision on perception: neural mechanisms of shading and motion object cue processing”

“No time to waste: a glycogen synthase kinas 3ß-glucocorticoid receptor signaling axis illuminated”

“Tinnitus: A CBT-based approach”

Approximately 60.000 people in the Netherlands suffer to such an extent from tinnitus (the continuous hearing of phantom sounds) that they can no longer well function. This dissertation studies the effects of a cognitive behaviour therapy that has been developed by the PhD candidates together with researchers from Maastricht University and colleagues from Adelante audiology & communication. This clinical study followed 492 persons with tinnitus during a year. Half of these received the new therapy, and the other half was treated conventionally with audiologic sound therapy. The conclusion is that the cognitive therapy led to a significant improvement of quality of life. For the majority of the patients, this improvement already occurred after twelve weeks. Cima published about his findings a year ago in the renowned medical journal The Lancet. Other studies also show that mainly fear of the tinnitus and catastrophizing thoughts about tinnitus have a negative influence on the patients. 

Key words:

tinnitus, treatment, cognitive behaviour therapy

“Getting a grip on myotonic dystrophy type 1”

This dissertation describes a series of studies about cardiac problems and clinical outcome measures with myotonic dystrophy type 1, a genetic muscle disease with multi-organ complications.  In spite of the frequent prevalence of cardiac disorders, there is no consensus on the diagnostic and therapeutic approach of cardiac involvement and the risk of sudden death is insufficiently recognized. Patients appear to have a complex cardiac phenotype with both involvement of the heart muscle tissue and the conduct system, which leads to a higher risk of rhythm disorders. Moreover, myotonic dystrophy type 1 leads to muscle weakness which causes considerable limitations in daily life. It is necessary that good outcome measures are available to enable evaluation of the effect of interventions on the functional situation of the patient in clinical trials. The importance of new clinimetric methods is illustrated and during this PhD research new clinical measuring methods were developed.

Key words:

myotonic dystrophy type 1, cardiac problems, clinical outcome measures 

“Toets alles en behoud het goede – voedingsepidemiologie en paradigma’s in de wetenschap”

“Ondanks een onlosmakelijke samenhang”

“Neural dynamics of food reward; the influence of body weight; cue exposures and attention”

“Plaque angiogenesis and lymphangiogenesis: can small vessels influence atherosclerosis?”

Atherosclerosis is a chronic inflammatory reaction of the arteries that in later stages of the disease can cause the development of a stroke or heart infarct. The local formation of new blood vessels and lymphatic vessels appear to play a role in the development of atherosclerotic lesions and the tearing of those, although the exact role is still unclear. This dissertation has shown that new blood vessels that are formed in the development of atherosclerosis are more unstable than normal blood vessels, and can contribute via several mechanisms to an increase of inflammatory cells in the atherosclerotic lesion.  Newly formed lymphatic vessels, however, seem to protect against further development of atherosclerosis because these vessels remove inflammatory cells. These findings can ultimately lead to new methods for early diagnosis of unstable plaque and newer treatments that inhibit or prevent plaque growth, for example by the stabilization of plaque blood vessels. 

Key words:

atherosclerosis, blood vessels, lymphatic vessel

“Second generation endometrial ablation”

Heavy menstrual bleeding (HMB) has a large impact on the physical and psychological wellbeing of women. One of the treatment options is an endometrial ablation: during one single operation via the vagina the endometrial lining of the uterus is removed or destroyed. This dissertation shows that the bipolar endometrial ablation technique is superior to the hot water or balloon ablation in the treatment of HMB. The research also shows that it is acceptable to perform endometrial ablation around the cervix on an out-patient under local anaesthesia, so that an epidural or narcosis is not per se necessary. 

Key words:

heavy menstrual bleeding, treatment

“Compensating Ecological Damage: Comparative and Economic observations”

Environmental pollution and devastation accompanying rapid economic development have created not only alarming losses to human beings and property but also astonishing damage to the environment itself. The difficulties in assessment and the special legal status of natural resources make traditional tort law an insufficient solution for the protection and compensation of this so called ecological damage. This thesis tries to design a compensation system, with the interaction between regulations, liability rules and compensation mechanisms (such as liability insurance, direct insurance, risk sharing agreement, environmental funds, other guarantees and capital market) to both prevent and compensate for ecological damage. Three new compensation models are proposed in this research, mainly based on the desirability and feasibility of mandatory financial security system. In addition to briefly exploring the existing experience in international regimes, the US and the EU, this thesis provides both theoretical and empirical research on the Chinese compensation system as well, which the existing literature has largely neglected.

Key words:

ecological damage, compensation mechanisms, regulations, liability rules

“Les Organes Restreints des Organisations Internationales”

“Towards succesful Web-based smoking relapse prevention; the efficacy of a computer tailored program, Incorporation post-motivational components & an attentional bias modification program”

“Echocardiographic predictors for recurrence of ischemic mitral regurgitation after restrictive annuloplasty”

In patients with chronic ischemic mitral valve insufficiency, the closure of the mitral valve is disturbed by traction on the valve blades as a result of a heart muscle disorder by oxygen deprivation (ischemic heart disease). The standard treatment for these patients concentrates on both the ischemic heart disease by means of coronary bypass surgery, and the mitral valve insufficiency (MR), by means of a constricting ring that is attached to the natural edge of the mitral valve. Recent studies have shown that 30% of these patients don’t benefit from this intervention (MR recurrence). This research defines preoperative parameters for the selection of patients who will benefit from this intervention. 

Key words:

mitral valve insufficiency, preoperative parameters, patient selection 

“Parlementair onderzoek; een studie van het onderzoeksrecht in Nederland, het Verenigd Koninkrijk en de Verenigde Staten”

Faced with growing concerns over executive dominance and awareness of the need for proper mechanisms to hold the government to account, the Dutch parliament has increasingly used parliamentary committees of investigation since the early 1980s. Three decades later, investigations have become an established form of parliamentary scrutiny, although investigative committees are still only established on a temporary basis. This Ph.D. dissertation consists of a comparative study of the procedures and practices of parliamentary investigations of three national parliaments: the Dutch Parliament, the UK Parliament, and the US Congress. Each parliament's investigative powers are studied and analyzed with regard to legal and procedural arrangements as well as the way in which these powers are applied in practice, taking into account their constitutional and political contexts. Based on these studies, the dissertation provides recommendations for further development of the Dutch parliament's investigative function.

“Aneurysmal subarachnoid hemorrhage: imaging strategies and cost-effectiveness aspects in diagnostic work-up and post-therapeutic follow-up”