Academic Ceremonies November 2013

“Measuring personal autonomy and social participation in older adults with a chronic physical illness”​

“Samen sterk”

“Circulating Monocytes in Atherosclerosis: Local or Systemic Actors?”

“Exploring the nature of social preferences and their economic significance: four experimental studies”

“Health literacy: a neglected European public health disparity”

“Prenatal screening à la carte? Ethical reflection on the scope of testing for foetal anomalies”

New prenatal tests for discovering foetal abnormalities are being introduced more quickly in the screening process. This PhD dissertation examines the ethical implications of non-invasive, targeted and genome-wide prenatal tests. It appears that some tests are challenging the goal of prenatal screening, namely to enable pregnant women to make autonomous reproductive choices. Does the standard prenatal test offering therefore need to be reconsidered? This dissertation proposes an alternative: individualised choice. This means that pregnant women are offered a ‘menu of test options’ from which they can make choices that are best suited to their personal situations, standards and preferences. This does the most justice to their reproductive autonomy. The test offering will be limited by three factors: it must include severe disease-related abnormalities; the information should be adequate and not too complex so that an informed choice is actually possible; and the test may not generate findings that can harm the future child’s right not to know.

Key words:

prenatal screening, foetal abnormalities, ethics, reproductive autonomy

“Strategy-proofness and Single-dipped Preferences”

“Valorization in Public Health Genomics: A Conceptual Development from Technology Transfer to Healthcare Integration”

In the past decade we have seen an exponential growth of personalised medicine applications onto the market. However, it is noticed that their implementation into healthcare systems in the form of genome-based technologies has a huge backlog. By the time a technology reaches healthcare from the market, it can be considered irrelevant due to time lapse as a better technology emerges in the market. Consequently both industry and the citizens are at disadvantage. The thesis aimed to address this issue by developing a conceptual framework for covering the whole spectrum of translational research of (personalized) healthcare, with real examples. As a result, the model has been taken up in high level policy reports in the EU, best practice guidelines, grants, industry, publications and international conferences.

Key words:

Technology Transfer, Health Policy, Public Health Genomics, Personalised Medicine, Healthcare.

“Membership in International Organizations: Inequality among Equals”

“Long GnRH agonist protocol in IVF: approaches to optimizing treatment outcome”

“An analysis of health outcomes among sexual minorities with a focus on the HIV/AIDS epidemic among men who have sex with men in Belgium”

“Experimental Studies on New Therapeutic Approaches in Atrial Fibrillation”

Diabetes and obstructive sleep apnea are associated with increased recurrence of atrial fibrillation (AF). The present study was conducted to characterize the atrial substrate for AF in animal models for diabetes and obstructive sleep apnea and to identify new potential antiarrhythmic therapy strategies. Pharmacological inhibition of the enzyme CathepsinA attenuated structural alterations leading to increased atrial fibrillation-susceptibility in a rat model for diabetes. In obstructive sleep apnea, negative thoracic pressure during obstructive respiratory events is responsible for increased occurrence of atrial fibrillation, which was reduced by modulation of autonomic nervous system by renal sympathetic denervation but not by available antiarrhythmic drugs.

Key words:

Physiology, Atrial Fibrillation, Diabetes, Obstructive sleep apnea

“Energetics of the human mind; an effort to show the neural correlates of mental efforts”

“Fragmented Sleep – Fragmented Mind; The Role of Sleep in Dissociative Symptoms”

Title of the lecture of prof.dr. Ronald Knibbe:

“Roes en Ratio: sociaal epidemiologische aspecten van middelengebruik”

Title of the lecture of prof.dr. Dike van de Mheen:

“Zorgen voor morgen? The day after”

“Risk Stratification in Coronary Artery Disease; The Role of (bio)markers and Coronary CT-Angiography”

Cardiovascular diseases are the leading case of illness and death worldwide. Atherosclerosis (hardening of the arteries) leads to narrowing of the coronary arteries. With the aid of a CT scan of the heart, it is possible to gain more insight into the presence and severity of atherosclerosis. The CT scan can be used to make a diagnosis and also gives information about the prognosis. In this PhD dissertation, we have combined characteristics of atherosclerosis with certain substances (biomarkers) in the blood to better be able to estimate who is at higher risk of having a heart attack. 

Key words:

Cardiovascular diseases, hardening of the arteries, CT scan, biomarkers

“Clinical cardiac computed tomographic angiography implications for risk stratification”

In this dissertation the value of using CT coronary angiograms – a patient-friendly technique that produces images of the coronary arteries – on patients experiencing chest pain, has been researched. This technique appears to be more useful in predicting future myocardial infarctions and angioplasties than other techniques, such as stress tests. In addition to identifying arteriosclerosis, these scans also produce images of the artery walls. It is demonstrated how artery wall images provide us with important information that can be used to predict future infarctions. It is now possible to create detailed images of the coronary arteries and arteriosclerosis. This will help us identify high-risk patients that require more aggressive medical treatment.

Key words:

cardiac CT scan, diagnosis, prevention

“Ultrasound-guided foam sclerotherapy for treating varicose veins”

“The design of R&D alliance contracts” 

This dissertation contains four empirical studies in the field of research and development alliances (R&D alliances) and related contracts in the biotech and pharmaceutical industries. The basic research question was which factors or associated issues determine the manner in which R&D alliance contracts are formed between companies? More specifically, this dissertation examines factors that influence parties in an R&D alliance: (1) the allocation of control rights, (2) coordination between companies, (3) dispute resolution, if needed, and (4) recruitment. The results are especially important for companies that are interested in building alliances with other companies.

Key words:

R&D, contracts, strategic alliances

“Minimally Invasive Techniques in Foregut Surgery”

“Assessing Governance Assessments; The case of Mozambique governance assessments in the context of aid effectiveness discourse”

This case study builds on contemporary discourse on the relationship between governance, aid effectiveness and development. The findings suggest that the selected donor governance assessments portray a very similar image of the quality of governance in Mozambique despite their different conceptual and operational approaches. The assessments are seen as having contributed positively to governance in Mozambique by enhancing the voice of the non-state actors and by legitimizing their concerns. The impact of the governance assessments is, however, perceived to be undermined by the aid agencies’ restricted dissemination policies and top-down approaches. The way forward for assessing governance requires a shift from donor-led governance assessment towards country-led, joint assessments that build on country-specific analyses of what governance means, and towards a broad-based country ownership of the assessments processes and the results of the assessments.

Key words:

Governance, Aid Effectiveness

“Novel strategies for making myasthenia less gravis: targeting plasma cells and the neuromuscular junction”

“Hemispheric asymmetries in fronto-parietal networks underlying attentional control”

“Prostaglandins  and Phosphodiesterases in the Urinary Bladder Wall”

Overactive bladder syndrome occurs in about 1 of 6 people over the age of 40. Patients suffer from the sudden, irrepressible urge to urinate. They generally urinate often and usually have urinary incontinence. At present few effective medications are available. 
This PhD dissertation describes the search for new points of application for treatment through investigation in guinea pig bladders (which closely resemble human bladders). Maastricht’s research is the first in the world to demonstrate the use of the prostaglandin E2 receptors (EP1 and EP2) in the bladder wall. The prostaglandin system is best known as the active ingredient for medications such as ibuprofen and diclofenac. Secondly, this dissertation research studied and demonstrated the distribution of the phosphodiesterase enzyme in the bladder wall. This explains the effect of Viagra and Cialis on urinary symptoms, in addition to their known application for impotence. These results will hopefully lead to the development of new medications to treat overactive bladders. Thus Cialis was also recently registered as a treatment for overactive bladders in men.

Supervisor:

overactive bladder syndrome (OAB), prostaglandin, phosphodiesterase type 5 (PDE5), detrusor overactivity, incontinence, medications  

“Netwerken”

“Loco-regional control or breast cancer with an emphasis on the role of young age and lobular histology”

For a long time there has been doubt about the safety of breast conserving treatment for young women with breast cancer. Research over the past two decades, especially in recent years, has shown a strong improvement in local disease control with a recurrence rate of just 3.3% after five years. This improvement is mostly a result of the increase in both the use and effectiveness of adjuvant treatment such as chemotherapy and/or hormonal therapy. 
The current design of follow-up for young women after breast conserving treatment does not guarantee early detection of recurrence of the disease in the breast. This research shows that the recurring tumour is discovered in about 50% of the cases by the patients themselves. In a quarter of these cases, a local recurring tumour larger than 2 cm was discovered. This dissertation offers suggestions for improving diagnostics.

Key words:

breast cancer, breast conserving treatment, diagnostics, follow-up

“Working on activation; analyses of stories about vocational rehabilitation of people with disabilities in the Netherlands”

Key words:

Vocational rehabilitation; work disabilities; narrative research

“Peer Feedback to Enhance Learning in Problem-Based Tutorial Groups”

The success of the problem-based learning model, for which Maastricht University is known, depends amongst others, on the quality of the tutorial meetings. Unfortunately, this quality leaves something to be desired. This dissertation reveals that the quality of the discussions correlates with the student’s test scores. The dissertation researched whether students benefit from receiving peer feedback about their behaviour during tutorial meetings. One of the studies showed that the students who did not actively participate in discussions benefitted the most from peer feedback. A follow-up study revealed that male students in particular seem to benefit from this type of feedback.

Key words:

Problem-Based Learning, quality, peer feedback

“The Universal Periodic Review Mechanism of the United Nations Human Rights Council: Transforming the Human Rights Discourse”

The Universal Periodic Review (UPR) mechanism was created to monitor how well UN Member States comply with human rights obligations. Every four years, UN Member States report on the state of human rights within the country, hear ways to improve their human rights records and answers questions from fellow countries in a three-hour interactive dialogue. This dissertation concludes that the UPR process has the potential to transform the human rights discourse because states are, for the first time, answerable for all human rights obligations rather than just those rights covered under the conventions ratified by the country.

Trefwoorden:

mensenrechten, Verenigde Naties, universele periodieke doorlichting (UPR)

“The process of end-of-life decisions regarding people with intellectual disabilities”

Persons with an intellectual disability are often unable to take their own end of life decisions. Legal representatives, mostly family members, usually have a clear idea about the quality of life of the person with an intellectual disability and seem to feel very responsible themselves for taking these decisions. They find this difficult. Doctors find these people’s opinions extremely important but do not always make it clear that the doctor is ultimately responsible for these decisions. Doctors want to avoid conflicts with legal representatives and feel vulnerable themselves. A dialogue about this subject should begin far ahead of the expected end of life.

Key words:

intellectual disabilities, decision-making skills, end of life

“Studying biomarkers in populations at genetic and  clinical high risk for psychosis”

Very little is known about the biological process that leads to psychosis. What we do know is that the presence of dopamine in the brain is a likely contributor. One of the problems when researching this issue is that the disease process itself also triggers biological changes. This dissertation researched two patient groups not currently experiencing psychotic symptoms, but with an increased risk for developing them: (1) a group of clinically high-risk adolescents; (2) a group of genetically high-risk adults. The results show that severe pre-psychotic symptoms in individuals at increased clinical risk for developing psychosis are strongly correlated with high levels of dopamine in a specific area of the brain known as the striatum. Dopamine disruption therefore appears to predate the onset of initial psychotic symptoms.

Key words:

psychosis, risk, biological changes, dopamine

“Epigenetic regulation of BDNF-TrkB signaling in the pathophysiology and treatment of mood disorders”

“From Reaganomics to Eurocrisis: 30 jaren in Maastricht”