In individuals with tuberculosis-infection – until recently referred to as latent tuberculosis infection – the risk of progression to active tuberculosis (reactivation) varies strongly. Among those... Show moreIn individuals with tuberculosis-infection – until recently referred to as latent tuberculosis infection – the risk of progression to active tuberculosis (reactivation) varies strongly. Among those at increased risk of reactivation are patients with an impaired immune system, e.g. due to immunosuppressive therapy. Therefore, prior to planned immunosuppression, patients are screened for tuberculosis-infection and subsequently treated in case of infection. Current screening methods include the Mantoux test, Interferon-γ release assays (i.e., the QuantiFERON-TB Gold Plus and T-SPOT.TB) and chest X-ray. However, despite screening, cases of reactivation continue to occur – in part due to the lack of a gold standard test for tuberculosis-infection. Therefore, the aims of this thesis were to increase the diagnostic sensitivity for tuberculosis-infection prior to immunosuppression. Using various (novel) methods we showed that approximately two-thirds of all QuantiFERON-TB Gold Plus results just below the manufacturer’s cut-off (in the borderline range) are caused by Mycobacterium tuberculosis-infection, which now warrants preventive treatment in patients with such a result. Furthermore, we quantified the diagnostic accuracy of chest X-ray for tuberculosis-infection and showed that using a novel ultra-low dose CT scanning technique, sensitivity for tuberculosis-infection could be significantly increased by three-fold compared to chest X-ray. Show less
Does society need armed forces? If so, what form should they take and what position should they hold in a democratic society? Critical conscripts, conscientious objectors, professional soldiers,... Show moreDoes society need armed forces? If so, what form should they take and what position should they hold in a democratic society? Critical conscripts, conscientious objectors, professional soldiers, civilians and antimilitarists posed these questions during the Cold War. This study investigates their criticism of and protest against the armed forces and national security and defense policy in the Netherlands between 1945 and 1989. It first examines how and why the critics of the armed forces questioned its form and existence. Secondly, this study looks into the Ministry of Defense's reaction to these critics. It explores how the ministry interpreted and responded to criticism and protest. The main question of this study is to what extent did the ministry believe that the criticism undermined the armed forces' legitimacy? Show less
