Academic Ceremonies December 2013

“Monte-Carlo Tree Search for Multi-Player Games”

Abstract games have been steadily gaining popularity since the advent of artificial intelligence in the 1950s. This is thanks to their high degree of complexity and their clearly defined rules. Much of the research has focused on two-player games, such as chess, checkers and Go. This dissertation examined the application and improvement of the Monte-Carlo Tree Search (MCTS), a search technique used in multi-player games. With the proposed improvements, an MCTS-based program would be capable of significantly stronger play and perfect information in various deterministic games and in the hide-and-seek game Scotland Yard.

Key words:

Monte-Carlo Tree Search (MCTS),  spelen voor meer dan twee spelers

“HPV infection and integration in oropharyngeal Squamous cell carcinomas”

“Taxation of Cross-Border Provision of Services in Double Tax Conventions between Developed and Developing Countries: A proposal for new guidelines”

“The European Parliament – A giant with feet of clay?”

“Contribution of cellular microparticles to pre-thrombotic states”

“Novel factors and mechanisms in control of CD36-mediated cardiac fatty acid transport”

“Innovation in family businesses: balancing Economic and socioemotional objectives”

“From infant wheeze to childhood asthma; Aetiological factors and early diagnostic techniques”

Asthma is the most common chronic disease among children. The diagnosis of asthma in young children is very difficult, and the underlying mechanisms of asthma are largely unknown. This PhD dissertation shows inflammatory material in blood and breath to be a promising tool for asthma diagnosis in toddlers, which may result in earlier and more effective treatment. It is found that hereditary variations of inflammatory genes in the presence of respiratory tract bacteria play a role in asthma development in children. This knowledge may contribute to the identification of children at increased risk of developing asthma.

Key words:

kinderen, astma, wheeze, diagnose, aetiology, luchtwegontsteking

“Social assistance and activation in the pursuit of happiness: shedding new light on old policy solutions to social exclusion”

“Annexin A5: shifting from molecular imaging tool to therapeutic agent in cardiovascular diseases”

“Electrical Substrate for cardiac resynchronization therapy; identification and treatment”

“Public Health Genomics: translation of genomic research on smoking behaviour into evidence synthesis and guidelines for public health”

“Pressure ulcers in pediatric patients: A challenge!”

“Verbind eer ge begint”

“Retention of new blood donors; implications for interventions”

“Bringing two worlds closer together; addressing Methodological challenges in the economic evaluation of public health programs”

Economic evaluation studies are an important tool to support efficient allocation of health resources. For decisions about funding of public health programs, they are however hardly used yet. Key reasons are the limited availability of economic evaluation studies and methodological challenges in conducting these studies. This dissertation describes methodological aspects of economic evaluations of public health programs directed at behaviour change. The research also analyses and tests methods to capture the broad range of possible effects public health programs may have. An important conclusion is that non-health-related aspects are equally important for quality of life of participants of public health programs as health-related aspects. Efficient decisions can be facilitated through better reporting of economic evaluations, increased adherence with good practice guidelines, broadening outcome measurement, more use of scientific evidence, a better infrastructure to support decision-making, and more research to address methodological key challenges

Key words:

Economic evaluation, public health, methods, behavior change

“Diabetic Cardiomyopathy: In search of Proof”

“Linking the Renin-Angiotensin System to Immune Mechanisms: the Key in Hypertension Development ?”

“Prospective development of extracorporeal life support: from protoscience to science”

Extracorporeal life support is a system that supports the heart and/or lungs during heart and aorta surgery. It is also used on intensive care units, during cardiac interventions and during cardiac resuscitation. Despite the successful application of this method, structured theoretical knowledge and insights into the underlying processes is limited. This dissertation describes the process of formalising knowledge of extracorporeal life support technology. The focus lies on the integrated system of the heart-lung machine and the patient, with their own unique and specific relationships and reference values, as well as on the challenge of developing an interdisciplinary science that includes biophysics, biochemistry and various other components of medical science.

Key words:

extracorporeal life support; integrated heart-lung machine; interdisciplinary science

“Social Background, Educational Attainment and Labor Market Integration: an exploration of underlying Processes and Dynamics”

“Open Innovation: a dynamic capabilities perspective”

“Innovation in Commercial Real Estate”

This thesis investigates the financial performance of green and connected buildings in London and New York City. The text documents for the 2000s decade the dynamic value of green buildings in London and the surge in value for data centers and fiber-lit buildings in New York City. Main results for all three innovations suggest positive transaction price premiums relative to neighboring conventional buildings, which cannot be explained by the building's construction or renovation costs. The text also explores modeling techniques for commercial real estate with measures covering a repeat sales price index for the London commercial property market and a hedonic model of New York City's commercial property market. 

Key words:

estate market, green buildings, London, New York City

“Haemophilus influenza in respiratory disease: From the bug to the body”

The nontypable Haemophilus influenzae bacterium (NTHi) can significantly worsen, or exacerbate, COPD. That being said, not all NTHi infections result in exacerbation. 
Specific virulence factors of NTHi strains may be necessary to exacerbate the disease. We found that genetically distinct NTHi strains displayed similar virulence factors and that infrequent COPD exacerbations were associated with a less reactive immune system. While additional research is required to confirm these results, this concept does provide clinicians with a new ‘tool’ to identify patients with an increased risk of developing acute exacerbations. This is important because current efforts to identify suitable biomarkers for phenotyping COPD patients have proved unsuccessful. 

Key words:

COPD, NTHi bacteria, exacerbations, treatment

“Remediation Theory and Practice, Transforming At-Risk Medical Students”

Widening participation in higher education brings with it an increasing number of diverse students who struggle to succeed. This research identifies the ingredients of successful remediation for at-risk medical students. At one medical school, the pass rates of struggling students doubled, using a carefully designed mandatory course involving small stable groups focused on collaborative discussion of learning processes and medical science content. These groups foster students’ development of affective, cognitive, and metacognitive practices in regular, in frequent meetings with an experienced teacher whose presence and practical wisdom enables flexible management of complex remediation processes to nurture independence and lifelong learning skills.

Key words:

remediation; at-risk students; medical education; widening participation;   teaching; facilitation

“Echoes of the city; Staging the Urban Soundscape in Fiction Film”

Big cities are noisy, frustrating and over-stimulating. At least according to the classic image most people have of them. Research on the representation of big-city sound in modern movies has shown that filmmakers deploy various techniques to present big cities like Amsterdam, Berlin and London to their audiences. This study, which is part of a major research project on urban sound, reveals how the ‘dramatization’ of the urban soundscape can offer new insights on how we experience urban life.  

Key words:

sound, cities, film

“Effects of Telemonitoring in Patients with Heart Failure”

Heart failure requires intensive care in order to preserve quality of life for the patient and prevent hospitalisation. This care can take the form of remote counselling, which involves monitoring patients from a distance. Patients are offered phased education and are asked to answer several daily questions. The nurse uses these answers to assess the patient’s condition and adjust treatment where necessary. A recent study on the effects of remote counselling revealed it decreased the number of hospitalisations, decreased anxiety and depression and increased knowledge and self-care in patients with heart failure at the same cost of traditional care. No effects were perceived in terms of quality of life.

Key words:

heart failure, care, remote counselling

“Een Overtollig Mens”

“Empirical Studies on Institutions, Policies and Economic Development”

“Newborn screening for cystic fibrosis in The Netherlands; the CHOPIN study”

Cystic fibrosis (CF) can be detected by a heel prick test. This PhD dissertation investigates the performance and cost effectiveness of two new tests for application in the heel prick. The research shows that the combination of both tests provides the most benefits. The combined test finds almost all patients with CF and reduces the number of false alarms. Furthermore, this research shows that patients with CF who are diagnosed early have an improved condition, which leads to lower costs for diagnostics and treatment. The investment in performing the heel prick can therefore lead to cost savings. On the basis of this research, the Dutch heel prick programme has changed: since 1 May 2011, babies are also tested for CF.

Key words:

Cystic Fibrosis, heel prick

“The Economic Consequences of Accounting for Derivatives”

This dissertation provides new insights about the impact of the derivative instruments recognition and disclosure under SFAS 133 on information asymmetry among investors, investors’ reactions to macro-economic news, and income smoothing. The findings of the dissertation show that investors’ uncertainty about the cash flow implications of changes in macro-economic news is lower after the adoption of SFAS 133. The findings of the dissertation further show that investors respond asymmetrically to good and bad macro-economic news. However, the asymmetry is less pronounced after the implementation SFAS 133. Finally, the findings of the dissertation show that managers engage in more income smoothing activities after the adoption of SFAS 133. This confirms the claims of critics and managerial concerns about the effect of derivative instruments recognition and disclosure under SFAS 133 on earnings volatility and income smoothing.     

Key words:

derivative instruments, information asymmetry, income smoothing, recognition and disclosure, macro-economic news

“Energy balance and colorectal cancer: Understanding disease pathways through molecular epidemiology”

Het is al langer bekend dat overgewicht en een gebrek aan beweging het risico op colorectaal kanker (dikke darm- en endeldarmkanker) vergroten. In dit onderzoek zijn de verschillen tussen mannen en vrouwen en mogelijke mechanismen onderzocht. Er is ingezoomd op het insulinegelijkende groeifactorsysteem (IGF) dat groei in het lichaam reguleert en mogelijk ook kanker. Vooral in het laatste deel van de dikke darm was de kans op kanker groter bij mannen naarmate ze meer overgewicht hadden en minder bewogen. De kans op kanker in het eerste deel was verhoogd als mannen ook een bepaalde ongunstige genetische aanleg hadden in IGF genen. Bij vrouwen bleek lengte bepalender voor het risico op dikke darmkanker dan overgewicht. Een ongunstige genetische aanleg speelde minder een rol. Verder onderzoek bevestigde het belang van het IGF systeem als ondWe know that obesity and lack of exercise can increase the risk of developing colorectal cancer (colon and rectal cancer). This study examined the differences between men and women and their underlying mechanisms. More specifically, it examined the insulin-like growth factor system (IGF), which regulates normal physiology as well as a number of pathological states, including cancer. The study found that men were at greater risk of developing cancer in the last part of the colon if they were overweight and inactive. Their risk of developing cancer in the first part of the colon increased if they had an unfavourable genetic predisposition in the IGF genes. For women, height proved a more important risk factor for developing colon cancer than weight. An unfavourable genetic predisposition played a much smaller role in this group. Further research confirmed the importance of the IGF system as an underlying mechanism by examining the molecular changes of IGF genes in tumours.

Key words:

colon cancer, height, weight, genetic predisposition, molecular changes 

“PPARs and microRNAs at the heart of metabolic regulation in cardiac disease”

“Biomarkers in cervical cancer and precursor lesions”

In the Netherlands, screening for cervical cancer will soon shift towards testing primarily for Human Papillomavirus (HPV), the cause of cervical cancer. However, there is a need for more specific cervical abnormality biomarkers. This PhD dissertation describes the most promising biomarkers and a HPV test which identifies individual high-risk HPV types. It shows that integration of HPV into human DNA and viral load may be useful biomarkers. The HPV MLPA test allows these biomarkers to be detected all at the same time.

Key words:

cervical cancer, Human Papillomavirus, biomarkers

“Predicting recurrent preeclampsia; Empirical and methodological studies”

“Developments for improved diagnosis of Bloodstream infections”

The number of patients with bloodstream infections (BSI) continues to increase. BSIs are characterised by high mortality and increased health care costs. The best treatment for a BSI depends on a number of factors, such as identification of the BSI, the performance of laboratory tests and the initiation of a correct (pathogen-specific) treatment. To be able to treat a patient with a pathogen-specific antibiotic, it is important to quickly detect and identify which microorganism (pathogen) caused the BSI. The current diagnostic process often takes a few days to complete. The main objective of this research was to study various strategies for improving the existing laboratory process for a BSI. The results presented in this PhD dissertation show that the laboratory diagnostics for a BSI could be significantly faster. When molecular (pathogen DNA) tests of great volumes of whole blood taken from BSI patients are optimised, patient care can improve and the potential for morbidity and mortality can be reduced.

Key words:

molecular diagnostics, DNA research, blood, medical microbiology, sepsis

“The broken cycle of sleep; energy balance through circadian alignment”

There may be a link between a surplus energy balance (i.e. weight gain) and poor sleep habits. This dissertation examines the role that sleep quality and sleep duration play in energy regulation and weight management.

Sleep fragmentation, whereby the test subject was woken up five times during the night, disrupted the sleep structure (the different phases of sleep) without changing the total sleep time. A night of fragmented sleep was paired with increased insulin levels and decreased satiety, which contributed to increased food intake.

It was also found that an acute shift in the day-night rhythm disrupted the glucose-insulin metabolism, which can lead to reduced insulin sensitivity. 

Key words:

sleep, energy balance

“What we talk about when we talk about Brazilian Multinational; an investigation on Brazilian FDI, economic Structure, innovation and the relationship between them”

“Hybrid Ablation of Atrial Fibrillation”

Atrium fibrillation (AF) is the most common form of cardiac arrhythmia and is often paired with an increased risk of cardiovascular complications such as stroke, heart attack and heart failure. Treatment options include medication and ablation. This dissertation reveals how the hybrid AF ablation technique developed in Maastricht, combines the best aspects of classic ablation and surgical intervention (an alternative to ablation). With hybrid AF ablation, heart surgeons and cardiologists work together, which significantly improves the procedure’s success rate.

Key words:

atrial fibrillation, treatment, ablation, surgery, hybrid AF ablation

“Global standards, local practices; an argument for Contextual policy-making, design of interventions and Policy evaluation”

“Information Sharing through informal interaction in low-tech clusters”

“Impulsivity in cue-elicited craving and appetitive learning”

“Pressure ulcer care in the Netherlands versus Germany 0-1”

Pressure ulcers (bedsores) are more common in Dutch nursing homes than in German nursing homes. This PhD research was designed to discover the causes of this difference. Recently admitted residents at Dutch and German nursing homes were followed for 12 weeks. The study shows that the incidence of pressure ulcers in Dutch nursing homes (33.3%) is indeed higher than in German nursing homes (14.3%). Relevant factors for preventing pressure ulcers were found to include switching positions and regular monitoring of the quality of daily pressure ulcer care. Furthermore, it was found that simply appointing a pressure ulcer nurse in no guarantee of a lower incidence of pressure ulcers.

Key words:

pressure ulcers, elderly care, nursing home

“Testing self-testers: Diagnostic self-testing for cholesterol and diabetes”

This dissertation researched consumer fluid tests (e.g. blood or urine) for at-home disease detection. The most common self-tests are for diabetes, kidney disease, cholesterol, urinary tract infections, HIV/AIDS and chlamydia. An online tool was developed to help consumers decide whether or not to take the test. The effects were evaluated in a randomised trial, which revealed that people interested in testing for diabetes tended to make a more informed choice after using this tool. This effect was not observed in people taking a cholesterol test. The next step will be to develop and market this online tool among consumers interested in taking at-home tests. 

Key words:

self-test, online help

“Molecular profiling of pulmonary carcinoids; insight into tumor biology and identification of prognostic markers”

Lung carcinoids are uncommon tumours often associated with a non-smoking related form of lung cancer. Although most patients with lung carcinoids tend to have a favourable disease outcome, a small fraction will eventually die from it. It is extremely difficult, however, to determine which patients are at increased risk of complications at the time of diagnosis. This dissertation provides additional insight into the biology of lung carcinoids and identifies better prognosis indicators. The absence of CD44 and OPT proteins in the tumours have been strongly associated with an unfavourable disease outcome. These protein markers could be used to improve both diagnosis and prognosis.

Key words:

lung cancer, lung carcinoids, prognosis

“Cardiovascular disease: Role of immuno- and radiotherapy”

Cancer and cardiovascular diseases are the main causes of death in the Western countries. Breast cancer is one of the most common cancers in women. Patients who have undergone radiotherapy in the long term show an increased risk of death from heart disease. Arteriosclerosis is the leading underlying cause of cardiovascular disease and is characterised by a chronic inflammatory response in the arterial walls. This PhD dissertation focuses on research into the effect of immunosuppression on arteriosclerosis and the effect of radiation on cardiovascular disease. Radiation is found to accelerate and aggravate pre-existent arteriosclerosis in mice and to induce dose-dependent cardiac damage. These findings emphasise the need to define individual risk profiles and to develop clinical preventive measures in patients who have undergone thoracic radiotherapy.

Key words:

Cardiovascular diseases, immunosuppression, radiotherapy

“Making genetics not so important; families Dealing with genetic testing for a familial heart disease”

Many people claim that genetic testing changes a family’s life. In these individualistic times, genetic diagnosis and an awareness of shared DNA could either strengthen a family’s bond or cause tension and disagreements. This dissertation argues that genetic testing has a much smaller impact on family life than previously thought. The study followed families during an intense and long-term genetic testing programme for hypertrophic cardiomyopathy. While the families struggled with whether or not to take the tests, they also made sure their relationships did not suffer by refusing to focus too much on the genetic diagnosis itself. Attention to this ‘family effort’ in clinical genetic counselling can improve the quality of care.

Key words:

genetic testing, family relationship, counselling

“Psychopathy: Its Association with early maladaptive schemas, risk-related behaviors and treatment outcome”

“Tailored pain management for subgroups of patients with chronic musculoskeletal pain”