The healthcare landscape is constantly evolving. eHealth (electronic health) presents opportunities to alleviate pressure in healthcare, for example by empowering patients to take more control over... Show moreThe healthcare landscape is constantly evolving. eHealth (electronic health) presents opportunities to alleviate pressure in healthcare, for example by empowering patients to take more control over their care. This thesis has examined various digital applications that have already been (partially) implemented. The research primarily focuses on the user-friendliness and effectiveness of these digital applications, aiming to promote self-management and accessibility of healthcare. The digital applications in this thesis relate to requesting diagnostic tests, both with and without involvement of healthcare professionals. Diagnostic tests enable the detection of conditions, such as sexually transmitted diseases for instance. Additionally, research has been conducted on the effectiveness of a self-management program for asthma and COPD. The results generally indicate that patients and citizens, particularly the younger generation, are receptive to online applications aimed at supporting their self-management of health and illness. Nevertheless, certain factors influence their acceptance, such as reliability and user-friendliness. Therefore, it is essential to promote collaboration among all stakeholders to enhance usability and ensure that online applications effectively meet their intended purpose and objectives. Show less
This thesis adopts a data-driven, multimodal approach to explore the complexity of psychiatric disorders, emphasizing the integration of diverse datasets to achieve a deeper understanding of these... Show moreThis thesis adopts a data-driven, multimodal approach to explore the complexity of psychiatric disorders, emphasizing the integration of diverse datasets to achieve a deeper understanding of these conditions. It illustrates this methodology across several chapters, each focusing on different aspects and biomarkers relevant to stress-related psychiatric disorders. Chapter 2 reevaluates the effects of intranasal oxytocin through a multimodal lens. Chapter 3 connects cortisol's in-vivo effects with brain responses and molecular architectures. Chapter 4 introduces a multimodal machine learning model to predict remission in depressive disorder, aiming for both accuracy and explanatory power. Chapter 5 examines the concept of resilience as a discrepancy between expected and observed mental health post-stress, assessing its predictive value for mental health outcomes. Finally, Chapter 6 explores a novel genetic risk score for stress-related disorders, testing its utility and applicability in various contexts. Through a comprehensive and data-centric approach, the thesis aims to uncover new insights into the etiology and treatment of psychiatric disorders, highlighting the importance of considering their multimodal nature. Show less
In the Netherlands, the title of Minister of State is granted to a select set of senior politicians and administrators, generally towards the end of their career. They are appointed by the monarch,... Show moreIn the Netherlands, the title of Minister of State is granted to a select set of senior politicians and administrators, generally towards the end of their career. They are appointed by the monarch, acting on a proposal by the cabinet. In this capacity, they are then asked to perform certain activities or to carry out specific tasks. Both the content of the Minister of State role itself and the appointment process are quite vague. Nevertheless, this exclusive ministerial title has considerable social status. The aim of this research study is to provide insight into the title of Minister of State. The problem description is as follows: What development has taken place in the role of Minister of State; what has the legal and political significance of the Minister of State been; and what can be said about the present-day role of Minister of State, in the Netherlands and in various other countries? Chapter 2 investigates the development of the Minister of State from a historical perspective. In Chapter 3 the various appointments as Minister of State are studied for each monarch. Chapter 4 examines the present-day role of Minister of State. In Chapter 5 a comparative legal study is made of whether other countries also have a Minister of State and what parallels and differences can be seen in relation to this title in the Netherlands.Chapter 6 brings together the findings of the research study and presents the conclusions that were drawn. Show less
In this thesis I highlight the applications of Oxford Nanopore Technologies (ONT) sequencing. This technique is a relatively new approach in the sequencing field, where nanopores are embedded in a... Show moreIn this thesis I highlight the applications of Oxford Nanopore Technologies (ONT) sequencing. This technique is a relatively new approach in the sequencing field, where nanopores are embedded in a membrane, DNA molecules are pulled through nanopores and an electrical current serving as the sequencing signal. This technique yields reads-lengths of >10Kbp and has no theoretical upper limit towards read-length. The positive impact on data quality due to improved chemistry is underlined, improved chemistry leads to less sequencing errors and a more homogeneous coverage over complex genomic architectures. Benefits for increased read-lengths are assessed for resolving fragmented genome assemblies that were previously based solely on short-read sequencing data. Furthermore, the assembly of a large genome using ONT data is described, indicating ONT is a suitable candidate for resolving extremely large genomes using sophisticated assembly approaches. And finally, the potential for on-site sequencing is evaluated. Exploiting simplicity, mobility and accuracy provided by this new technique. The central hypothesis of this thesis is that Oxford Nanopore Technologies long-read sequencing can be valuable for established genomics applications, such as whole genome sequencing and metagenomic characterization of microbial communities. Show less
In the light of the fragility of current liberal democracies, this dissertation aims to contribute to rethinking political order by reconstructing Hegel’s account in the Philosophy of Right. His... Show moreIn the light of the fragility of current liberal democracies, this dissertation aims to contribute to rethinking political order by reconstructing Hegel’s account in the Philosophy of Right. His theory of political order has relevance as it explores how modern freedom, i.e. liberal rights and a market, can coexist with republican self-government. The reconstruction shows how a liberal order, i.e. based on the principle of individual autonomy and an instrumental account of government, must entail a loss of freedom and social and political pathologies: citizens for instance cannot acquire stable identities in the social whole and alienate themselves from the political realm. Moreover, it works out Hegel’s alternative account of political order in which freedom depends on the interplay of the opposed dynamics of the state and society: the state institutions pursuing the good of the community as a whole, while the members of civil society pursue their own good. Finally, the dissertation shows how Hegel offers a coherent and subtle account of republican citizenship and self-government, in which self-government does not depend primarily on the influence citizens exercise on political outcomes but on their ability to identify with the good of the community as a whole. Show less
This dissertation explores the United Nations' comprehensive approach to managing the Israel-Arab Conflict from 1967 to 1982, presenting a shift from examining peace operations as isolated efforts... Show moreThis dissertation explores the United Nations' comprehensive approach to managing the Israel-Arab Conflict from 1967 to 1982, presenting a shift from examining peace operations as isolated efforts to viewing them as interconnected elements of a broader peace architecture. It introduces a critical analysis of the roles played by the Office of Special Political Affairs and the Office of Chief Coordinator of Peacekeeping in the Middle East, arguing that these entities were pivotal in forming a cohesive strategy despite the static mandates of individual peace missions. The research spans six chapters, starting with a historical overview of the UN’s peacekeeping framework since 1948, setting the groundwork for understanding the conflict and the evolution of peacekeeping entities. It then delves into Inter-Operation Collaboration (IOC) and the Secretariat’s political maneuvering, highlighting the impact of significant events like the Camp David Accords and the 1982 Israeli invasion of Lebanon. These events marked a shift in focus from state-centric to Israeli-Palestinian issues, challenging the UN’s influence. The conclusion assesses the UN’s role in shaping the diplomatic and security landscape of the region, underlining the organization's contributions and limitations in fostering peace and stability amidst a complex geopolitical scenario. This research offers valuable insights into the dynamics of UN peacekeeping operations in regional conflicts. Show less
Thromboembolic complications remain a major public health burden, making antithrombotic agents one of the most widely prescribed groups of medication, but the treatment is often challenging as it... Show moreThromboembolic complications remain a major public health burden, making antithrombotic agents one of the most widely prescribed groups of medication, but the treatment is often challenging as it at the same time increases risk of bleeding. With nationwide data from Statistics Netherlands, antithrombotic therapy and relevant clinical outcomes were comprehensively examined in the patient population of atrial fibrillation, overall or among those with comorbid cancer. The results suggest the patient population was increasingly receiving anticoagulants, driven by the newly introduced medication- direct oral anticoagulant and guided by the CHA2DS2-VASc score, and meanwhile the patient population experienced fewer ischemic stroke and major bleeding. In spite of these promising changes, suboptimal medication adherence and potential underuse of anticoagulants remain directions for further improvement. Antithrombotic agent use during pregnancy was also examined in the general Dutch pregnant population, which featured a surge in antiplatelet prescriptions, and risk of preeclampsia/eclampsia decreased and several newborn outcomes improved simultaneously. Together, the studies presented in this thesis provide an overview of antithrombotic therapy in the Netherlands in recent years, providing insights for further improving this treatment and relevant patient outcomes. Show less
This dissertation explores the ways in which affective responses to disabled bodies are represented and how this invites us to read these bodies aesthetically. I argue that this affective impact... Show moreThis dissertation explores the ways in which affective responses to disabled bodies are represented and how this invites us to read these bodies aesthetically. I argue that this affective impact can be understood as an affordance, a term I use to describe how the appearance of and interaction with disabled bodies produces affective responses such as fear, wonder, or disgust. I study the relationship between representation and affective reactions through literature and other art forms. Through close readings of literary texts and works of art, this dissertation offers an alternative to so-called model thinking—an approach that emphasizes categorization. Instead, I propose a reading that focuses on how bodily capacities are culturally and socially translated into (dis)abilities. Unlike taxonomic approaches that categorize and generalize, this method allows moving from the particular to the private. Works of art, although prone to generalization, emphasize their unicity and resist categorization. By analyzing how different art forms represent disabled bodies, the dissertation brings a new dimension to understanding our emotional responses and the aesthetic appreciation of bodily diversity. Show less
Drug candidates with a covalent binding mode have gained interest since the approval of multiple covalent anticancer drugs, but were long avoided due to concerns regarding promiscuous reactivity... Show moreDrug candidates with a covalent binding mode have gained interest since the approval of multiple covalent anticancer drugs, but were long avoided due to concerns regarding promiscuous reactivity with off-target proteins. In this dissertation, the scope and versatility of the newly discovered in situ thiol–alkyne reaction is evaluated: the nonactivated alkynes exhibit an unprecedented target reactivity with excellent thiol selectivity, thus potentially outperforming currently used cysteine-reactive warheads. Chapter 1 starts with the history of (ir)reversible covalent inhibition, the reactivity of (non)activated alkynes, and the serendipitous discovery of the thiol–alkyne reaction. Established technologies for direct detection of covalent protein–drug adducts are reviewed in Chapter 2, and in Chapter 3 a detailed guide for the evaluation of (ir)reversible covalent inhibitors to obtain relevant kinetic parameters is provided, accompanied by kinetic simulations and step-wise protocols for enzymatic activity assays. In Chapter 4, the nitrile warhead in reversible CatK inhibitor odanacatib (ODN) is replaced with alkyne warheads to investigate whether it an irreversible covalent adduct is formed with cysteine protease cathepsin K (CatK) despite having a small recognition element. In Chapter 5, we evaluate if nonactivated alkynes can target noncatalytic cysteine residues by replacing the irreversible covalent acrylamide warhead in EGFR/HER2 inhibitor neratinib by an alkyne warhead. In Chapter 6, the impact of substituents on the alkyne warhead is explored using a panel of ubiquitin-based ABPs bearing substituents on the propargylamide warhead. Finally, the most important findings are summarized in Chapter 7, and placed in the context of covalent drug discovery. Show less
In this PhD study, I aim to deepen our understanding of the influence of major mycorrhizal types, namely arbuscular mycorrhizae (AM) and ectomycorrhizae (EM), on the global soil carbon cycle and... Show moreIn this PhD study, I aim to deepen our understanding of the influence of major mycorrhizal types, namely arbuscular mycorrhizae (AM) and ectomycorrhizae (EM), on the global soil carbon cycle and their potential distribution changes under future environmental shifts. The investigation comprises two main perspectives: Firstly, Chapter 2 delves into their direct impact on fungal biomass input to the soil via lab experiments. Secondly, Chapters 3, 4, and 5 explore their role in mediating litter decomposition through modeling. This thesis sheds light on the significance of mycorrhizal fungi in the soil carbon cycle and underscores the necessity of accounting for their effects when analyzing global soil carbon dynamics. Additionally, the research underscores the importance of understanding mycorrhizal fungi responses to environmental changes, given their sensitivity to factors like temperature and precipitation. Show less
Schistosomiasis is a parasitic infection caused by worms of the genus Schistosoma. It is a neglected tropical disease, affecting mainly populations living in poverty without adequate sanitation.... Show moreSchistosomiasis is a parasitic infection caused by worms of the genus Schistosoma. It is a neglected tropical disease, affecting mainly populations living in poverty without adequate sanitation. Treatment relies on one drug mainly, praziquantel, and its efficacy is dependent on the diagnostic tool used.Due to the parasite’s intravascular localisation, it is difficult to directly quantify them in infected humans. Thus, methods of detection like worm-derived circulating cathodic antigen (CCA) in urine or circulating anodic antigen (CAA) in urine and serum, have gained more attention. This thesis aims to explore and shed light on how to interpret schistosome-related circulating antigens CCA and CAA. We have addressed the interpretation of schistosome related assays in endemic and non-endemic regions, supported by data obtained from an animal study. Different diagnostic value can be attributed to different assays within different contexts. The results highlight the importance of a better understanding of antigen excretion patterns by different species to support optimalisation of antigen-based diagnostics of schistosomiasis. Show less
Voltammetry plays a crucial role in modern scientific research by offering valuable insights into the electrochemical properties of materials, with wide-ranging applications in fields such as... Show moreVoltammetry plays a crucial role in modern scientific research by offering valuable insights into the electrochemical properties of materials, with wide-ranging applications in fields such as materials science, energy storage, corrosion studies, and sensor development.Gold, known for its exceptional inertness, provides a unique platform for studying intricate electrochemical processes due to its stability and slow electrochemical behavior. However, certain questions regarding gold voltammetry have remained unresolved throughout history. To address these gaps, our research employed a combination of electrochemical cyclic voltammetry and advanced in situ techniques like surface-enhanced Raman spectroscopy (SERS), Rotating ring-disk electrode (RRDE), and Electrochemical quartz crystal microbalance (EQCM).Through our investigations, we not only redefined the mechanism of gold oxide formation but also uncovered the reasons behind the structural reconstruction of gold oxide. Additionally, we elucidated the electrochemical interfacial structure on gold from a novel perspective focusing on charge distribution.The significance of these findings lies in their fundamental nature, with the potential to inspire researcher to reconsider interpretations of voltammetry behaviors across various materials and research fields. We anticipate that our work will stimulate further exploration and innovation in the realm of electrochemistry, paving the way for new discoveries and advancements. Show less
Despite the history of studies on methanol formation from CO2, the dominant elementary reaction steps that constitute the chemical mechanism for this catalyzed process are not determined. Two main... Show moreDespite the history of studies on methanol formation from CO2, the dominant elementary reaction steps that constitute the chemical mechanism for this catalyzed process are not determined. Two main issues may cause doubt about the current level of understanding: 1) the very large difference in the coverage-dependent sticking probabilities for CO2 and CO and unavoidable CO contamination 2) the complex oxidation of the copper surface and unavoidable build-up of a (partial) oxide layer.In this thesis, we studied the sticking probability of O2 on Cu(111) and compared results to previous experimental and theoretical results. The dissociative chemisorption of O2 on Cu(111) is a direct, activated process with a minimum barrier of approximately 100 meV.In an attempt to develop a method that may undeniably quantify the reactivity of CO2 onto clean and H-containing Cu surfaces, we investigated co-adsorbed CO and O on Cu(111) and Cu(211) with RAIRS. Cu(211) oxidizes much more readily than Cu(111). For incomplete oxidation, the system CO adsorbs to small isolated metallic Cu edges and patches. Fully oxidized Cu(211) binds CO but in a rather different form than clean metallic Cu. The vibrational frequency of adsorbed CO is changed as the co-adsorbed O coverage varies on Cu(211). Show less
Contrary to common belief, sign languages are distinct across different communities and cultures, evolving organically through interactions among deaf people, rather than being based on spoken... Show moreContrary to common belief, sign languages are distinct across different communities and cultures, evolving organically through interactions among deaf people, rather than being based on spoken languages. Each sign language has its own grammar, vocabulary, and cultural nuances, with variations even within a single country, showcasing the diverse communication methods within the deaf community. Deaf individuals often face encouragement to use spoken language techniques like lipreading or text communication, highlighting a bias towards spoken languages. This is compounded by the lack of sign languages in linguistic technologies, emphasizing the need for more inclusive research and development. This dissertation aims to address this gap using machine and deep learning to improve sign language processing and recognition. It covers six chapters, introducing methods for video-based sign annotation, webcam-based sign language dictionary search, and ranking systems for sign suggestions. It also explores tools for visualizing and comparing sign language variation, contributing valuable resources to linguistic research. Show less
Palliative care is care improving the quality of life of patients and their families, who are facing a life-threatening condition or frailty, through prevention and relief of suffering by means of... Show morePalliative care is care improving the quality of life of patients and their families, who are facing a life-threatening condition or frailty, through prevention and relief of suffering by means of early identification and careful assessment, and treatment of problems of a physical, psychological, social, and spiritual nature. This thesis describes five studies that evaluated the support of clinicians not specialized in palliative care, or generalists in palliative care. The results show that generalists need education on basic palliative care principles and need support with the initiation of a palliative care approach on time, especially when they care for patients with life-limiting illness other than cancer. To have mor attention for alle problems in the physical, psychological, social and spiritual dimension of care, they can be supported with a more structured approach to the total burden of symptoms and problems. This could be achieved by supporting them with a clinical decision support system for symptom management in palliative care. Such a system can be used for every individual patient, includes a symptom predictor, and provides recommendations on treatment and referral possibilities. Show less
This thesis investigates the contribution of quantum computers to machine learning, a field called Quantum Machine Learning. Quantum Machine Learning promises innovative perspectives and methods... Show moreThis thesis investigates the contribution of quantum computers to machine learning, a field called Quantum Machine Learning. Quantum Machine Learning promises innovative perspectives and methods for solving complex problems in machine learning, leveraging the unique capabilities of quantum computers. These computers differ fundamentally from classical computers by exploiting certain quantum mechanical phenomena. The thesis explores various proposals within quantum machine learning, such as the application of quantum algorithms in topological data analysis. With respect to topological data analysis, results demonstrate that quantum algorithms solve problems considered inefficient in classical settings. The thesis also explores structural risk minimization in quantum machine learning models, identifying crucial design choices for new quantum machine learning models. Additionally, it introduces quantum models in reinforcement learning, which deliver comparable performance to traditional models and are superior in certain scenarios. The final part identifies learning tasks in computational learning theory where quantum learning algorithms have exponential advantages. In summary, this thesis contributes to understanding how quantum computers can address complex machine learning problems, from topological data analysis to reinforcement learning and computational learning tasks. Show less
The dissertation explores the relationship between online and offline anti-corruption activism in Banten, Indonesia. It examines the historical background of anti-corruption activism in Indonesia,... Show moreThe dissertation explores the relationship between online and offline anti-corruption activism in Banten, Indonesia. It examines the historical background of anti-corruption activism in Indonesia, the comparison of online discourse of corruption framed by national civil society organizations (CSOs) and local activists, the impact of online activism on citizenship characteristics, and its potential transformation into strong or weak offline mobilization. The study uses social media ethnography to examine the materiality of being online and its relation to corruption and anti-corruption campaigns. The research reveals that corruption is primarily constructed as a legal discourse in national anti-corruption campaigns, while in Banten, morality and religious discourse are used to frame corruption. Online anti-corruption activism in Banten involves digital acts of reporting and sharing corruption news and flaming to resist corrupt leaders. This approach has led to the development of 'digital affective citizenship', where citizens express anger, hate, passion, and disgust towards corrupt leaders. The dissertation also discusses the characteristic of citizens in Banten that reflects "powerless angry citizens," who desire to influence political outcomes through corruption but feel powerless due to the mismatch between their desire and the limitations of participatory channels and organizations. Show less
The work described in this thesis had two objectives, specifically focusing on people aged 70 years and older: first, we aimed to investigate the associations between several thrombosis-related... Show moreThe work described in this thesis had two objectives, specifically focusing on people aged 70 years and older: first, we aimed to investigate the associations between several thrombosis-related risk factors described in young and middle-aged populations and the risk of venous thrombosis (VT) in the elderly; second, we aimed to provide insight into several long-term consequences (i.e., health-related quality of life (HRQoL) and long-term risk of mortality) after a first VT at old age. Show less
Chinese materia medica (CMM), comprising a diverse array of natural substances from plants, animals, and minerals, has been integral to Traditional Chinese Medicine (TCM) throughout history. This... Show moreChinese materia medica (CMM), comprising a diverse array of natural substances from plants, animals, and minerals, has been integral to Traditional Chinese Medicine (TCM) throughout history. This study investigates the dynamic evolution of CMM, noting shifts in species for improved therapeutic effects and the abandonment of those with adverse outcomes. By examining historical CMM specimens, particularly those in Dutch collections, tangible evidence of this evolution emerges.The Westhoff collection, spanning 140 years, reveals significant changes alongside enduring practices. A handwritten catalogue accompanying the collection aligns with modern CMM practices, indicating a remarkable continuity. Comparative analyses of historical collections and contemporary CMM in EU markets over three centuries emphasize the stability of core medicinal plant taxa. Additionally, the study validates the delayed luminescence (DL) technique for discerning CMM storage times, showing promising results.Despite challenges in preservation, historical CMM specimens offer unique insights into medicine's history, underscoring their importance for further research and understanding. Show less
Radiotherapy is intriguing as it not only eliminates tumor cells but also triggers a response from cytotoxic T cells, which attack the tumor. Thus, radiotherapy and immunotherapy are being combined... Show moreRadiotherapy is intriguing as it not only eliminates tumor cells but also triggers a response from cytotoxic T cells, which attack the tumor. Thus, radiotherapy and immunotherapy are being combined in clinical studies, although their success has been limited. We used mouse tumor models to understand how radiotherapy induces T cell priming and subsequent anti-tumor immunity. In a model resembling lymphocyte-depleted cancer, we identified obstacles to systemic radiotherapy-induced T cell responses and proposed interventions to overcome them. Additionally, we explored strategies to counter local T cell suppression in the tumor microenvironment. In poorly immunogenic tumors, radiotherapy can provoke a T cell response, but this is counteracted by the generation of immunosuppressive Tregs. Combining radiotherapy with checkpoint immunotherapy, despite its success in humans, unexpectedly amplified the Treg response, further hindering cytotoxic T-cell activity. Our findings suggest this immunotherapy may not benefit these cancers. We discovered that molecules like CD80 and CD86, capable of stimulating T cells via the CD28 receptor, have distinct roles in promoting cytotoxic and Treg cells. Blocking CD86 enhanced cytotoxic T cell responses post-radiotherapy, leading to tumor rejection. Our study elucidates how tumor characteristics shape T-cell responses, how radiotherapy can evoke both favorable and unfavorable responses, and how targeted antibody immunotherapy can influence this interplay. Show less
