The entire healthcare system is grappling with shortages of personnel that are likely to grow. There are increasingly more people in need of care, but the number of people providing care cannot... Show moreThe entire healthcare system is grappling with shortages of personnel that are likely to grow. There are increasingly more people in need of care, but the number of people providing care cannot keep up.This thesis examines whether the assessment of long-term EEG registrations (4 – 90 hours) in adults can be partially taken over by an algorithm, referred to as automated spike and seizure detection software in the thesis. This is done without compromising the quality of the assessment.We evaluated the performance of three commercially available software packages (Persyst, Encevis, and BESA) to determine if they perform as well as human experts. We looked at both interictal and ictal abnormalities (epileptic seizures).In conclusion, the software detects interictal abnormalities as well as human experts do. However, epileptic seizures are not detected as well as by human experts, especially for seizures with short duration (less than 10 seconds) or subtle EEG abnormalities. Overall, the Persyst software package performs the best.Furthermore, this thesis includes a new method in which automatic detection is combined with sampled visual assessment. We compared this new assessment method with the conventional assessment method (based on complete visual assessment) and found no difference in conclusion. Show less
Purpose: We assessed whether automated detection software, combined with live observation, enabled reliable seizure detection using three commercial software packages: Persyst, Encevis and BESA.... Show morePurpose: We assessed whether automated detection software, combined with live observation, enabled reliable seizure detection using three commercial software packages: Persyst, Encevis and BESA. Methods: Two hundred and eighty-six prolonged EEG records of individuals aged 16-86 years, collected between August 2019 and January 2020, were retrospectively processed using all three packages. The reference standard included all seizures mentioned in the clinical report supplemented with true detections made by the software and not previously detected by clinical physiologists. Sensitivity was measured for offline review by clinical physiologists and software seizure detection, both in combination with live monitoring in an EMU setting, for all three software packages at record and seizure level. Results: The database contained 249 seizures in 64 records. The sensitivity of seizure detection was 98% for Encevis and Persyst, and 95% for BESA, when a positive results was defined as detection at least one of the seizures occurring within an individual record. When positivity was defined as recognition of all seizures, sensitivity was 93% for Persyst, 88% for Encevis and 84% for BESA. Clinical physiologists' review had a sensitivity of 100% at record level and 98% at seizure level. The median false positive rate per record was 1.7 for Persyst, 2.4 for BESA and 5.5 for Encevis per 24 h. Conclusion: Automated seizure detection software does not perform as well as technicians do. However, it can be used in an EMU setting when the user is aware of its weaknesses. This assessment gives future users helpful insight into these strengths and weaknesses. The Persyst software performs best. Show less
Purpose: We assessed three commercial automated spike detection software packages (Persyst, Encevis and BESA) to see which had the best performance. Methods: Thirty prolonged EEG records from... Show morePurpose: We assessed three commercial automated spike detection software packages (Persyst, Encevis and BESA) to see which had the best performance. Methods: Thirty prolonged EEG records from people aged at least 16 years were collected and 30-minute representative epochs were selected. Interictal epileptiform discharges (IEDs) were marked by three human experts and by all three software packages. For each 30-minutes selection and for each 10-second epoch we measured whether or not IEDs had occurred. We defined the gold standard as the combined detections of the experts. Kappa scores, sensitivity and specificity were estimated for each software package. Results: Sensitivity for Persyst in the default setting was 95% for 30-minute selections and 82% for 10-second epochs. Sensitivity for Encevis was 86% (30-minute selections) and 61% (10-second epochs). The specificity for both packages was 88% for 30-minute selections and 96%-99% for the 10-second epochs. Interrater agreement between Persyst and Encevis and the experts was similar than between experts (0.67-0.83 versus 0.63-0.67). Sensitivity for BESA was 40% and specificity 100%. Interrater agreement (0.25) was low. Conclusions: IED detection by the Persyst automated software is better than the Encevis and BESA packages, and similar to human review, when reviewing 30-minute selections and 10-second epochs. This findings may help prospective users choose a software package. Show less
Credit lines between central banks can be a powerful instrument to restore international financial stability during a crisis. Yet, so far, few political scientists have ventured to study central... Show moreCredit lines between central banks can be a powerful instrument to restore international financial stability during a crisis. Yet, so far, few political scientists have ventured to study central bank cooperation in the context of European macroeconomic governance and the implications for the international role of the euro. This paper closes this gap in our knowledge by looking at the European Central Bank’s (ECB) cooperation with non-Euro Area central banks during the Global Financial Crisis 2008/09 and the COVID-19-crisis 2020. Based on recently declassified policy documents and eight insider interviews I find that the ECB’s handling of the international role of the euro has changed over time. In 2008, the ECB had decided the credit terms largely based on perceived sovereign credit risk. In 2020, the ECB granted better lending conditions to countries that were institutionally closer to the Euro Area. Based on this I argue that the ECB has redefined its interests during international crises from limiting financial risks to promoting the institutional objectives of the Euro Area. This indicates not just that the ECB has in 2020 acted more proactively as international lender of last resort, but also that it has done so largely in line with political considerations. Show less
Credit lines between central banks can be a powerful instrument to restore international financial stability during a crisis. Yet, so far, few political scientists have ventured to study central... Show moreCredit lines between central banks can be a powerful instrument to restore international financial stability during a crisis. Yet, so far, few political scientists have ventured to study central bank cooperation in the context of European macroeconomic governance and the implications for the international role of the euro. This paper closes this gap in our knowledge by looking at the European Central Bank’s (ECB) cooperation with non-Euro Area central banks during the Global Financial Crisis 2008/09 and the COVID-19-crisis 2020. Based on recently declassified policy documents and eight insider interviews I find that the ECB’s handling of the international role of the euro has changed over time. In 2008, the ECB had decided the credit terms largely based on perceived sovereign credit risk. In 2020, the ECB granted better lending conditions to countries that were institutionally closer to the Euro Area. Based on this I argue that the ECB has redefined its interests during international crises from limiting financial risks to promoting the institutional objectives of the Euro Area. This indicates not just that the ECB has in 2020 acted more proactively as international lender of last resort, but also that it has done so largely in line with political considerations. Show less
Het recht om invloed uit te oefenen op de besteding van de door de bevolking opgebrachte middelen - het budgetrecht - is een van de oudste rechten van het Nederlandse parlement. Dit recht waarborgt... Show moreHet recht om invloed uit te oefenen op de besteding van de door de bevolking opgebrachte middelen - het budgetrecht - is een van de oudste rechten van het Nederlandse parlement. Dit recht waarborgt democratische betrokkenheid bij de besluitvorming over de begroting en maakt dat het parlement wezenlijke invloed kan uitoefenen op het regeringsbeleid. De afgelopen jaren is het budgetrecht echter onder druk komen te staan. Als gevolg van de eurocrisis zijn de Europese begrotingsregels aanzienlijk aangescherpt en krijgen de EU-instellingen steeds meer grip op de nationale begroting en de wijze waarop nationale middelen worden besteed. Dit is problematisch omdat de bestemming van op nationaal niveau opgehaalde middelen bij uitstek een nationale bevoegdheid is. En aan die beslissing wordt democratische legitimatie verleend door de betrokkenheid van het parlement. In dit proefschrift staat de vraag centraal wat de gevolgen zijn van het Europees economisch bestuur – alle regels en procedures op economisch en budgettair terrein in de EMU – voor het budgetrecht van het Nederlandse parlement: in hoeverre kan het parlement nog (wezenlijke)invloed uitoefenen op de besteding van de op nationaal niveau opgehaalde middelen en het (begrotings)beleid van de regering als de EU-instellingen steeds meer grip krijgen op de nationale begroting? Show less
This thesis explores a conception of the EU as a modified confederal system of sovereign member peoples and their states. A confederal conception which demonstrates how, contrary to popular belief... Show moreThis thesis explores a conception of the EU as a modified confederal system of sovereign member peoples and their states. A confederal conception which demonstrates how, contrary to popular belief, European integration does not conflict with sovereignty or democracy. For, properly conceived and constituted, the EU reasserts the sovereignty of the member peoples, and liberates national democracy from the confines of the state.To this end, this thesis reconnects the EU to two classic constructs of constitutional theory: confederalism and sovereignty. Two powerful but unfashionable constructs whose joint potential for European integration remains largely unexplored and undervalued. The primary instrument to explore this potential is comparative. The EU is contrasted with the rather unknown but rich example of the American Articles of Confederation, and their evolution into the now famous American federate system. A comparison with the confederal roots of the United States which is revealing for both confederalism and sovereignty, and illustrates the potential of linking both for a constructive constitutional theory of the EU. A theory which does not have to overcome history and the statal system it has created, but connects with it. A theory, therefore, that may help to recapture the EU and the increasing authority it wields, both in theory and in practise. The thesis is subdivided in three parts. Part I addresses confederalism. It demonstrates how the constitutional system of the EU combines a confederal foundation with a federate superstructure, and explores the particular strengths, weaknesses and limits of this modified confederal system. Part II discusses sovereignty. It first demonstrates how the EU forms a logical confederal evolution of popular sovereignty, and how European integration does not conflict with sovereignty. Subsequently, it shows how the concept of confederal sovereignty equally helps to dispel the presumed conflict between statism and pluralism, how it respects and conciliates national and EU claims to supremacy, and how it allows a confederal evolution of national democracy, which updates democracy to the global reality it is to control. Part III applies the findings of Part I and II to the EMU crisis and the challenge of establishing an effective democratic foundation for the EU at the national level. An application which demonstrates the concrete and attractive contributions a confederal approach can make to addressing some of the core challenges facing the EU. Show less
