Current sexual health care has not yet succeeded to guide men and their partners sufficiently when it comes to dealing with the consequences of prostate cancer (PCa) diagnosis and treatment. The... Show moreCurrent sexual health care has not yet succeeded to guide men and their partners sufficiently when it comes to dealing with the consequences of prostate cancer (PCa) diagnosis and treatment. The majority of men need a standardized consultation with a specialized healthcare provider (HCP) to discuss sexual health issues preferably within three months after treatment. Although current written information provision coming from urology departments discusses sexual health more often than radiotherapy departments; sexual dysfunction (SD) is still not routinely addressed. Focus during consultations is mostly on men while most of the partners also experience difficulties when dealing with sexual side effects. Regarding HCPs, urology residents experience lack of knowledge and competence to treat SD after PCa treatment and an unmet need exists for additional education and training. A symposium on sexual health care in PCa led to an increase of awareness to discuss SD more often during consultations. In case HCPs feel lack of knowledge, competence, time or tools to discuss sexual health after PCa treatment, referral to a specialized HCP should occur; according to the needs and preferences of men and their partners. However, management of outpatient clinics and availability of referral options are still in need of melioration. Show less
Thermodynamics is one of the founding scientific pillars that has helped us better understand heat engines, biology, ecosystems, and even black holes. While it fundamentally describes large systems... Show moreThermodynamics is one of the founding scientific pillars that has helped us better understand heat engines, biology, ecosystems, and even black holes. While it fundamentally describes large systems by examining the bulk behavior of their constituents, it is anchored in the statistical equivalence of equilibrium configurations of a formally infinite number of microscopic constituents. A question of its validity arises when one scales down to small quantum systems. Here, we have derived dynamic non-equilibrium relations that surprisingly resemble the classical thermodynamics laws, with a mix of quantum features that encode the dynamics of quantum information. Understanding the relation between the out-of-equilibrium dynamics of finite-size quantum systems and their initial thermodynamic state might have been a purely academic exercise fifteen years ago. But now, thanks to ultra-cold atomic quantum simulators and progress in quantum computers, the thermodynamics of finite-size quantum systems has practical implications too. The findings of this thesis contribute to understanding quantum many-body systems, particularly in the context of entanglement, non-equilibrium dynamics, thermalization, and charge transport. Show less
The blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood... Show moreThe blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood flow from the placenta to the children: one child, the recipient, receives more blood than the other child, the donor. This situation is called twin-twin transfusion syndrome (TTTS) and is often lethal for both twins. Fetoscopic laser therapy is the preferred and only causal treatment for TTTS and since the introduction in the 90’s, has improved survival rates from 65 to 90%. However, fetoscopic laser therapy is not always successful and residual anastomoses can persist, which can cause recurrence of TTTS or TAPS. In addition, fetoscopic laser therapy can induce pregnancy complications. In this thesis rates and risk factors for complications as intertwin membrane rupture, placental abruption and post-procedural amniotic band syndrome are investigated. We studied short-term and long-term outcomes and evaluated neurodevelopmental impairment at age 2 and 5 years. Show less
Accountability is a cornerstone of democratic governance. But with the emergence of increasingly complex multi-level and multi-stakeholder governance structures, and an increasing amount of... Show moreAccountability is a cornerstone of democratic governance. But with the emergence of increasingly complex multi-level and multi-stakeholder governance structures, and an increasing amount of delegation of public powers and tasks to both public and private non-majoritarian bodies, safeguarding public accountability has however become an increasingly complicated endeavour. This is not the least to be seen in the EU, where discussions about the EU's democratic deficit often centre around questions of accountability, with the accountability of non-majoritarian and (semi-)independent EU agencies being of particular concern. This dissertation focuses on how institutional EU account-holders execute their account-holding roles, in particular vis-à-vis EU agencies. Findings indicate that EU account-holders, within the constraints of their specific account-holding roles, are visibility-seeking organisations looking to take centre stage. This has important democratic accountability implications: Does the visibility-seeking behaviour of account-holders lead to low(er)-visibility agencies and issues escaping democratic scrutiny, or does it push account-holders towards going above and beyond their formal account-holding obligations. Show less
Virus-specific T cells play a key role in the control of viral-reactivations in healthy individuals and this cellular immunity is impaired in patients receiving allogeneic stem cell transplantation... Show moreVirus-specific T cells play a key role in the control of viral-reactivations in healthy individuals and this cellular immunity is impaired in patients receiving allogeneic stem cell transplantation. In the period around the transplantation, donor-derived T cells are either depleted or suppressed to reduce the risk of graft versus host disease (GVHD). However, in the absence of donor-derived T cells, latent viruses such as CMV, EBV and AdV can reactivate and remain uncontrolled and at the same time the curative graft versus leukemia (GVL) effect is abrogated. Therefore, the major challenge in the field of alloSCT is to find a balance between the GVL effect, protection against viruses and GVHD. The research described in this thesis focusses on the options to control for viral reactivations using adoptive transfer of virus-specific T cells or TCRs and the risks associated with this. Show less
The Dutch healthcare system is facing multiple challenges which have put a strain on the healthcare system in terms of finances and workforce shortages. eHealth offers innovative and promising ways... Show moreThe Dutch healthcare system is facing multiple challenges which have put a strain on the healthcare system in terms of finances and workforce shortages. eHealth offers innovative and promising ways of providing healthcare, including remote and digital care. However, despite the potential of eHealth to transform healthcare and improve patient outcomes, its wide-spread adoption and implementation have been limited. One major obstacle is limited usage, often due to the insufficient engagement of end-users, including patients, in the early design phase. The dissertation underscores the importance of participatory design to actively involve users. Another challenge is the short-term usage of eHealth applications, often a result of inadequate user engagement. The integration of "Persuasive games," incorporating game elements to promote behavioural change, is suggested to enhance engagement and encourage sustained use. The digital divide presents a third challenge, affecting specific user groups like those with limited (e)health literacy. Bridging this gap necessitates not only access to digital technologies but also promoting ehealth literacy and involving users in eHealth development. Moreover, a lack of evidence on the effectiveness of eHealth interventions impedes widespread acceptance. Traditional research designs, like randomized clinical studies, often overlook the complexity of intervention contexts. The dissertation seeks to address these challenges through practical research projects, emphasizing participatory design, evaluating effectiveness in real-world settings, translating and assessing the eHealth Literacy questionnaire, and creating tools for effective knowledge transfer. Advocating for early end-user engagement and a critical review of existing research paradigms, the dissertation offers valuable insights for overcoming challenges and advancing eHealth for improved patient and healthcare outcomes. Show less
This thesis attempts firstly to reconstruct the urban system or systems of the Roman Near east in the second and early third centuries C.E., consisting of the provinces of Syria Coele, Syria... Show moreThis thesis attempts firstly to reconstruct the urban system or systems of the Roman Near east in the second and early third centuries C.E., consisting of the provinces of Syria Coele, Syria Phoenice, Syria Palaestina, Osrhoene, Mesopotamia and Arabia. Secondly it analyses the different regional patterns within these systems. The first two chapters of the thesis describe the urban systems in the north and south of the Roman Near East respectively. The third chapter analyses to what degree the distribution of cities, and their sizes, relate to the agricultural productivity of the urban territories. The fourth chapter takes a detailed look at the largest city of the region, Antioch. The research shows that geographic factors and historical developments certainly played a role in the long term and defined the shape of urban networks in the region, but with ample room for human agency. Although we clearly see population growth compared to earlier periods, Roman cities in the Near East were nonetheless not particularly big, and most could be sustained with agricultural production from their direct hinterlands. From that perspective there is no reason to assume that integration into the Roman empire also brought stronger economic integration. Show less
The main research question of this thesis was: Can nitrogen cycling on dairy farms on peat soil in the Dutch Green Heart area be improved by adapting management to the nitrogen supply from soil and... Show moreThe main research question of this thesis was: Can nitrogen cycling on dairy farms on peat soil in the Dutch Green Heart area be improved by adapting management to the nitrogen supply from soil and by using other grassland species and crops without affecting milk production? There is increasing pressure to reduce nitrogen losses from dairy farming on peat soil. Ambitious policy targets regarding N loss have been put in place by the Dutch government. This thesis comprised four studies, which focused on 1) estimating the nitrogen supply from soil, 2) the possibility of lowering nitrogen levels of perennial ryegrass through population selection, 3) on the effect of plantain on the soil nitrogen cycle and 4) on growing cattail as alternative roughage on rewetted peat soil. The results of the research were used to estimate the effects of nitrogen fertilisation adapted to the nitrogen supply from soil and of the cultivation of low-nitrogen perennial ryegrass, plantain and cattail on nitrogen losses of an average dairy farm. The estimated nitrogen loss reductions were, even when combined, not sufficient to achieve policy targets on farm level. The options may however be combined with other options which were not investigated in this thesis. Show less
Differentiation has evolved into a systematic feature of European integration. Still, EU member states have been eager to maintain unity and not let differentiated integration (DI) be reflected in... Show moreDifferentiation has evolved into a systematic feature of European integration. Still, EU member states have been eager to maintain unity and not let differentiated integration (DI) be reflected in institutions and processes of EU governance. The sovereign debt crisis was a turning point, triggering an unprecedented reinforcement of euro area specific institutions and policies. So far, few contributions have studied the institutional implications of DI in the EU. This dissertation examines whether and, if so, how and with what implications DI has been institutionalised in EMU governance. It analyses the organisational inclusiveness of crisis management structures, the evolution of the Eurogroup and Eurogroup Working Group, procedural norms and elite ideas. The findings suggest that the distinction between euro area insiders and outsiders has become embedded in how member state representatives perceive political reality, determine mutual role expectations and organise governance processes. While this institutionalisation of DI in EMU was facilitated by particular circumstances of the sovereign debt crisis, its implications are evident in EMU governance and reform processes until today. The dissertation makes theoretical and empirical contributions to account for DI in institutional and political developments in EMU and, thus, aims to enrich institutionalist debates in EU studies. Show less
Freshwater biodiversity has been threatened by eutrophication due to excessive nutrients in the environment. Releasing the freshwater species from such pressures requires efforts from industry and... Show moreFreshwater biodiversity has been threatened by eutrophication due to excessive nutrients in the environment. Releasing the freshwater species from such pressures requires efforts from industry and manufacturers to avoid emissions to vulnerable and high-risk regions. The first step is to know which nutrient influences where and the effects thereof on species loss. These impacts can be assessed by methods of life cycle impact assessment (LCIA). This thesis contributes to such knowledge by improving the LCIA method, for instance, by developing more regionalized and comprehensive indicators as well as adding the consideration of both phosphorus (P) and nitrogen (N) and which of these two nutrients is limiting. Show less
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
Globally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management.... Show moreGlobally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management. Therefore, providing the patient with a care plan that fits seamlessly in one’s daily routines, is in line with their values and preferences and does not overburden their capacities, is of major importance. In order to make diabetes care fit, clinicians and patients need to collaborate and share their knowledge and experience. One possible approach to this collaboration is shared decision making (SDM). In SDM, patients and clinicians partner up and work together to decide on the best available healthcare strategy for the individual patient, taking into account both the best available evidence, and the patient’s preferences, needs and context. This thesis aimed to explore patient and clinician efforts towards making diabetes care fit. In this exploration we aimed to provide insight in the factors driving the decision making process, discuss various strategies to tailor SDM to the patient’s situation, needs and preferences, and explore ways to support the patient and the patient-clinician partnership in diabetes care. Show less
“Taking Up Space: Waste and Waste Labor in Developing South Korea” examines South Korean development experiences through the remnants of its industrialization and modernization processes, including... Show more“Taking Up Space: Waste and Waste Labor in Developing South Korea” examines South Korean development experiences through the remnants of its industrialization and modernization processes, including material waste, excess labor, or surplus population. I juxtapose the history of informal waste pickers with the transformation of waste management and the reconfiguration of its labor during the period from the 1960s to the early 1990s. By connecting the material, social, and symbolic dimensions of waste, I demonstrate how waste shaped their stigma and social position, degraded the urban environment as much as it deteriorated their living and working conditions, and brought social and environmental forces that further drove their marginalization. The case studies—waste picker camps and Seoul’s Nanjido Landfill—illustrate how concepts such as informality, precarity, and societal marginalization have been historically mediated and grounded in individuals’ lives during the country’s compressed development process.This study demonstrates how the production of marginalized populations and the disregard for their labor practices served to consolidate the developing nation-state and its middle-class citizens. It argues that the informal labor at the urban periphery was instrumental in the development process and should be recognized as legitimate labor rather than mere subsistence activities. Waste pickers not only served as agents of development but also as a precedent for precarious workers in modern Korea. The prevalence of waste pickers in contemporary South Korea indicates a diachronic implication of this dissertation, as their labor remains crucial for urban conditions while simultaneously establishing an urban form of precarity. Show less
Navigation problems are common in patients with acquired brain injury. These patients experience difficulty when travelling between places, frequently get lost and often experience spatial anxiety.... Show moreNavigation problems are common in patients with acquired brain injury. These patients experience difficulty when travelling between places, frequently get lost and often experience spatial anxiety. Navigation problems can have a profound impact on the daily lives of these patients. This doctoral research focuses on the development and validation of a rehabilitation therapy for patients with navigation problems. The goal was to develop a standardized therapy, suitable for patients with a variety of navigation impairments and various levels of cognitive functioning. A compensatory approach was taken: patients gain insight into their own navigational abilities and are trained to adopt a beneficial navigation strategy. The therapy encompasses psycho-education and the utilization of a serious game that patients can engage with in a home-based setting. In the game, patients are trained to use alternative navigation strategies in virtual environments. A series of studies was performed to develop the theoretical foundation of the therapy, ensure the usability and feasibility of the software and assess the acceptance of the therapy among healthcare providers. Finally, the effectiveness of the therapy was determined. Evidence is found that using the rehabilitation therapy leads to a reduction of navigation problems and the attainment of self-determined rehabilitation goals. Show less
In this dissertation, I focus on the question on how to resolve or reduce conflict, and specifically, on how to dissuade an attacking party from aggression. To this end, I introduced peaceful... Show moreIn this dissertation, I focus on the question on how to resolve or reduce conflict, and specifically, on how to dissuade an attacking party from aggression. To this end, I introduced peaceful alternatives for wealth generation to dyadic and intergroup attacker-defender contests, investigating how such opportunities impact conflict dynamics and outcomes. Across multiple projects, I studied the effects of production opportunities, the application of resource transfers in conflict resolution, and the effects of economic uncertainty on intergroup conflict. My results demonstrate that such alternatives can be effective in reducing attacker aggression and conflict, that both parties benefit from the reduction of conflict, and yet, that attackers benefit disproportionately due their ability to allocate resources more flexibly between conflict and outside options. Overall, this research makes a significant contribution to the existing literature on conflict (management) by providing both theory and empirical evidence for the effectiveness of peaceful alternatives for wealth generation in dissuading aggression and conflict, but also reveals some unexpected consequences, such as the disproportionate benefits for attackers, that must be addressed to create truly equitable and successful conflict resolution. Show less
The aim of this thesis is to present novel techniques for proving cryptographic schemes secure against quantum adversaries. Most results are within the context of an idealized model called the ... Show moreThe aim of this thesis is to present novel techniques for proving cryptographic schemes secure against quantum adversaries. Most results are within the context of an idealized model called the ‘quantum random-oracle model’. A particular challenge is to extract some piece of knowledge an adversary possesses just from its interaction with an oracle, while mitigating the effects of the collapse of the wave function caused by the observation of a quantum state. Show less
The haplolepideous mosses (Dicranidae) comprise about 4000 species distributed over a wide range of habitats, with great gametophytic and sporophytic morphological variation. Their monophyly is... Show moreThe haplolepideous mosses (Dicranidae) comprise about 4000 species distributed over a wide range of habitats, with great gametophytic and sporophytic morphological variation. Their monophyly is well supported by the results of several molecular phylogenetic studies, which shed light on their relationships and circumscriptions, and thus also contributed to identify many remaining problems. Dicranidae ordinal classification is not congruent with current relationship hypotheses and is not supported by morphology. Morphological circumscriptions of some families do not correspond to monophyletic groups. Furthermore, the monophyly of many families and genera with weak morphological circumscriptions remains to be tested. In this thesis, systematics and relationships of the leucobryoid mosses and some families and genera segregated from the former Dicranaceae s.l. were studied using molecular phylogenetic methods. 37 out of the 38 haplolepideous moss families were represented by markers from the three genomes (nrITS, nad5, trnS-trnF, atpB-rbcL). Phylogenetic reconstructions were based on maximum parsimony, maximum likelihood, and Bayesian inference. Ancestral state reconstructions, phylogenetic network analysis (NeighborNet), and relationship hypothesis testing (Shimodaira-Hasegawa test) were performed to contribute to the interpretation of the results of the phylogenetic reconstructions. Morphological circumscriptions were evaluated and improved whenever possible, in line with the results of all analyses performed. Show less
This thesis examines the safety of individuals exposed to potent opioids and carbon dioxide (CO2), with a particular focus on reversing the detrimental effects of opioid-induced respiratory... Show moreThis thesis examines the safety of individuals exposed to potent opioids and carbon dioxide (CO2), with a particular focus on reversing the detrimental effects of opioid-induced respiratory depression. It underscores the importance of mitigating patient harm from both pharmacological and non-pharmacological interventions. Despite the safety of modern anesthesia, the pervasive misuse of potent opioids has precipitated a global health crisis. This thesis explores of the physiological impact of opioids on the ventilatory control system, especially in response to inhaled CO2. Structured in three distinct sections, the thesis first investigates the respiratory effects of oxycodone in healthy volunteers, considering additional variables such as alcohol, paroxetine, and quetiapine. The second part delves into assessing various agents for the reversal of opioid induced respiratory depression, including naloxone, buprenorphine, ENA-001, and others, detailing their varied efficacy. The concluding section involves an experimental studie on the tolerability and toxicity of escalating CO2 concentrations in both humans and rats. This comprehensive analysis contributes to a deeper understanding of the effects of CO2 and respiratory physiology, offering insight into the limits of carbon dioxide levels tolerated by humans. Show less
With the rise of multi-drug resistant bacterial pathogens, the possibility of a post-antibiotic world is quickly becoming reality. It is therefore vital that research is focussed on overcoming the... Show moreWith the rise of multi-drug resistant bacterial pathogens, the possibility of a post-antibiotic world is quickly becoming reality. It is therefore vital that research is focussed on overcoming the most challenging bacterial resistance mechanisms. To this end, the aim of the work described in this thesis was to develop novel strategies to combat resistant bacteria, with particular focus on the threat posed by gram-negative bacteria. Show less
