Academic Ceremonies January 2014

“Aging in a society in transition: socioeconomic conditions, health status, social networks and social participation of older people in the Republic of Kosovo” 

“Het geluid van gisteren; Waarom Amsterdam vroeger ook niet stil was”

This dissertation is about noise as part of daily life in Amsterdam at the end of the 19th and the beginning of the 20th centuries. Noise that may or may not have been intentionally made, and noise that caused commotion and evoked discussion and actions taken to change it. The reason for this research is the following paradox: we know very little about noise in earlier cities and about the role that it filled in daily life, and yet we assume that cities are growing continually noisier because of growth, industrialisation and technologisation. The dissertation shows that the sound of the city changed a lot in these 70 years, but it is not possible to translate these changes into more or less silence in Amsterdam.

Key words:

city noise, noise, sound studies, history, city history

“School Choice, Competition and Achievement; Dutch compulsory education’’

This PhD dissertation investigates school choice and competition within the Dutch primary and secondary educational system, especially in relation to student and school performance. The main findings can be summarised as follows: there are few differences in performance levels between different types of schools (i.e. special and public); the freedom of choice and competition in the Dutch system lead to higher academic performance, especially for students who score lower than average (this is not true for relatively high-performing students); and the Dutch system appears to be aimed at limiting educational disadvantage. Further, diversity promotes product differentiation in educational demand. Finally, it is concluded that free school choice in the Netherlands leads to tension between private and societal educational goals, which emphasises the importance of regulation in the educational system.

Key words:

school choice, student and school performance

“Neural Coding of Speaker Identity – Methodological and Empirical Contributions”

In everyday life, we recognize a familiar voice even when being at a crowded café, bustling station or busy street. As effortless and easy this skill might appear, we still don’t understand how our brain does it and, so far, no technical device comes close to human performance. In our research project we used MRI and EEG together with newly developed analyses and visualizations to examine patterns of brain activity. Our results suggest that the human brain represents the identity of a voice already after 200-300ms at early stages of the processing hierarchy. Learning more specifically how this is realized might give rise to better, more reliable hearing aids or implants.

Key words:

neural coding, speaker identity, brain, MRI, EEG

“HLA-DP and HLA-E: Targets for Transplantation Immunity”

Although stem cell transplantation is important in the treatment of blood cancer and blood disorders, it is still accompanied by many complications. In order to prevent complications as much as possible, patients and donors are matched for HLA-A, HLA-B, HLA-C, HLA-DRB1 and HLA-DQB1 alleles. Unfortunately, 30–40% still have a rejection response against the patients’ cells, called Graft-versus-Host disease (GVHD). This PhD dissertation shows that HLA-DPA1 can influence the degree of immune activation, and plays a role in the development of GVHD after stem cell transplantation. Furthermore, we have shown that differences in HLA-E between patients and donors increase the risk of GVHD, and HLA-E genotypes can serve as predictive markers of GVHD and infections. This PhD dissertation emphasises the fact that both HLA-DP and HLA-E play a relevant role in the transplantation-related immune response, which underlines the importance of including these molecules in the selection of stem cell transplantation donors.

Key words:

stem cell transplantation, HLA

“Platelet procoagulant acitivity: focus on calcium entry and phospholipid scrambling”

“Clinical dilemmas in sentinel node biopsy for breast cancer”

The sentinel node biopsy (SNB) was introduced in the early nineties as a less extensive alternative to axillary lymph node dissection, in which all axillary lymph nodes are removed, in order to assess whether breast cancer has spread to local lymph nodes. The introduction of the sentinel node biopsy resulted in some clinical dilemmas. When a more extensive examination of the sentinel lymph node is carried out, a larger number of small axillary lymph node metastases are found that are in itself not a sufficient reason to give adjuvant chemotherapy, as descriptive research has shown.  Furthermore, this PhD dissertation shows that repeat sentinel node biopsy in patients with recurrent breast cancer is technically feasible and accurate. The information derived from the repeat SNB leads to a change in treatment strategy in 1 in 6 patients, and more than half of the patients can be spared an axillary lymph node dissection with its accompanying risks.

Key words:

breast cancer, sentinel node biopsy

“Diagnostic challenges during the Dutch Q fever outbreak”

Between 2007 and 2009, the world’s largest Q fever outbreak occurred in the Netherlands. Due to the increase in the number of requests and the persistent nature of the epidemic, diagnosis proved to be complex. This PhD dissertation describes a new diagnostic directive that now leads the way in detection of chronic Q fever. The diagnosis takes into account not only microbiological data, but also radiological and clinical data. On the basis of this directive, patients are divided into three groups with different suggested treatments: proven (treatment with antibiotics), probable (treatment with antibiotics is discussed) or possible (no antibiotics, a 3-month check) chronic Q fever.

Key words:

Q fever, diagnosis, treatment

“Cognition, culture, and credibility; Deconstructing Feedback in Medical Education”

Feedback sounds so simple: provide learners with information about their performance, highlighting strengths and areas for improvement, and they will move forward with enlightenment and a clear path for their development.  The reality of feedback, though, is far from straightforward.  Why does some feedback become profoundly influential for learners, while other feedback is discarded as meaningless?  What can medicine learn about feedback from other fields, such as music, sports, and teacher training?  In exploring these questions, we define how individuals and their learning environment interact to influence feedback, and we offer concrete guidance to strengthen medical education’s approach to feedback.

Key words:

medicine, teaching, feedback

“Tinnitus; assessment of quality of life & cost-effectiveness”

In the Netherlands, approximately 60,000 people suffer from disabling tinnitus (ringing in the ears). This PhD dissertation evaluates the impact of tinnitus on health-related quality of life and costs, by conducting a clinical study in which (cost) effectiveness of specialised cognitive behaviour therapy was compared to conventional audiological sound therapy. Baseline data showed that tinnitus has a considerable impact on health-related quality of life and costs. The average ‘cost of illness’ to society was €6.7 billion, or €5,315 per patient per year. Analyses using follow-up data showed that cognitive behaviour therapy resulted in a significant improvement in quality of life. Furthermore, this form of therapy was found to be more cost-effective than conventional sound therapy.

Key words:

tinnitus, quality of life, costs, treatment

“Ethanol and intestinal barrier: human intervention and Mechanistic in vitro studies”

“The role of coagulation factor XII in fibrin clot formation and fibrinolysis”

“Cognitive function in patients with cerebral small vessel disease”

The prevalence of cognitive problems is increasing due to population ageing. High blood pressure is one of the risk factors contributing to small blood vessel damage in the brain, which may result not only in strokes, but also in memory problems and problems with speed of thinking. This PhD dissertation shows that even a slight increase in brain damage has an impact on cognitive functioning. Furthermore, we have found that an increase in the number of manifestations of brain damage is accompanied by impaired cognitive performance. These results suggest that patients with cardiovascular risk factors, such as high blood pressure or heart failure, should undergo more extensive neuropsychological testing.

Key words:

brain damage, cognitive problems, cardiovascular risk factors

“Een overpeinzing over pijn: Revalidatieonderzoek in de praktijk”

"Improving decision making processes in intellectual disability care; Systems Thinking and problem Structuring Techniques to Support Stakeholders’ Engagement in Decision Making” 

“Bayesian Optimal Designs of Binary Repeated Measurements”

Research budgets are shrinking, which makes cost-effectiveness of health research itself an important topic. Effects of risk factors and treatments can be evaluated more accurately by increasing the sample size (number of respondents or patients studied) and/or the number of repeated measures per person, but both also increase the study costs. Optimizing a research design can save costs without sacrificing quality. By combining two fields of mathematical statistics, i.e. optimal design and Bayesian statistics, this research addresses the question of the optimal number and timing of repeated measures of a binary health outcome, such as being ill yes/no, or being a smoker yes/no, under costs constraints. The results and practical guidelines in this dissertation are helpful for medical and health research because the study costs as well as the risk of overlooking meaningful effects of a binary health outcome can be reduced by using optimal designs.

Key words:

Optimal design, Bayesian statistics, binary health outcome, cost constraints, repeated measures.

“Identity, Interaction, and Power. Understanding the affordances of doctor-student interaction during clerkships”

Although medical students doing their clinical rotation are provided with an authentic environment in which they can develop into doctors of medicine, the extent to which these settings  offer them learning experiences varies widely. This PhD dissertation explains by two different clinical rotations how both the learning process and supervision of students are embedded in social interaction. It is shown that, among other things, the duration of and the degree of equality and inequality in doctor-student relationships affect the students’ opportunities for personal growth. In future, the challenge will be to provide students with continuous supervision as much as possible and to reduce disadvantages of hierarchical structures in clinical rotations.

Key words:

clinical rotations, learning, doctor-student relationship

“Fetal inflammatory injury as origin of long term disease: Lessons from animal models”

“Reach out and Touch? Improving reach and use of an Internet- delivered lifestyle intervention”

This PhD dissertation focuses on optimising reach and use of an internet-delivered computer tailored lifestyle intervention aimed at physical activity, fruit and vegetable consumption, smoking behaviour and alcohol consumption. 
We used a proactive dissemination strategy to increase reach and first use of an internet-delivered computer tailored lifestyle intervention, by embedding the intervention in an existing online health monitoring system of the Regional Public Health Services in the Netherlands. Although the employed proactive dissemination strategy succeeded in ensuring high levels of reach, participation by at-risk groups in the intervention programme fell behind. 
We studied repeated use of the intervention by focusing on initiation and completion of an intervention module. Although it was shown that the intervention was able to attract participants who may benefit from a lifestyle intervention, exactly these participants often failed to complete the modules. Furthermore, it was shown that sending a periodic email prompt had a positive effect on repeated use of the intervention. Sending an email prompt after two weeks had a significantly stronger effect than sending an email prompt after four or six weeks.

Key words:

Leefstijlinterventie, internet, bereik, gebruik