This thesis focused on the development of creative thinking across adolescence and into adulthood. To this end, a range of creativity tasks, both with and without an fMRI scanner, and before and... Show moreThis thesis focused on the development of creative thinking across adolescence and into adulthood. To this end, a range of creativity tasks, both with and without an fMRI scanner, and before and after training paradigms has been used to ex_amine both age- and experience-related effects on creative thinking performance during functional brain develop_ment. Chapter 1 provides a theoretical background for the research described in chapters 2 to 6. In Chapter 2, developmental trajectories of creative cognition across adolescence and early adulthood were examined using a set of tasks gauging both insight and divergent thinking in the verbal and visual domain. In Chapter 3, behavioral and neural differences for creative problem solving in middle-adolescents and adults were examined. Chapter 4 examined the neural correlates of divergent thinking in adults and adolescents. Chapter 5 focused on the effectiveness of creative ideation training in adolescents and adults. In Chapter 6, the benefits of training creativity in adolescents were examined using fMRI techniques. Finally, Chapter 7 summarizes the main results of the empirical studies presented in this thesis. Here, implications of the results are discussed and suggestions for future research are presented. Show less
Fetoscopic surgery is a surgical technique that is used to treat fetus(es) that are still inside the pregnant uterus. Coming years, more fetoscopic surgery will be performed. The most commonly... Show moreFetoscopic surgery is a surgical technique that is used to treat fetus(es) that are still inside the pregnant uterus. Coming years, more fetoscopic surgery will be performed. The most commonly performed procedure is laser surgery for twin-twin transfusion syndrome. This thesis shows learning curves for this procedure and current practice in relation to technical aspects and pregnancy outcomes. We show how to monitor performance and address specific subgroups in which laser surgery can be more complicated. Since teaching and training in fetoscopic surgery is challenging, we create and validate an evidence-based evaluation tool for the laser procedure. To conclude, we develop a standardized training curriculum with a high fidelity simulator model. Show less
In recent years a flow of media reports about unsafe situations in operating rooms have reached the general public. Awareness of the importance of patient safety also reached politicians. The... Show moreIn recent years a flow of media reports about unsafe situations in operating rooms have reached the general public. Awareness of the importance of patient safety also reached politicians. The report by the Dutch inspectorate of health care __Risico__s minimaal invasieve chirurgie onderschat__ (Risks minimally invasive surgery underestimated) stressed that patient safety is especially at risk in Minimally Invasive Surgery. Therefore patient safety became a focus of research and quality improvement, also in minimally invasive surgery. The current thesis aimes to give insight into patient safety risk factors in minimally invasive surgery. Of all examined risk factors minimally invasive surgical skills appeared to be directly related to patient safety. Therefore special focus for training of these skills is necessary. Previous research has shown that during simulation training objective assessment of economy of movements and time is possible. However, until recently there was no way to objectively assess one of the most important surgical skills: tissue handling. The development of a force sensor has made it possible to measure interaction forces with artificial tissue. In this thesis the clinical implications of a force sensor and the need of this new technology within training of minimally invasive surgical skills is examined. Show less
Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and... Show moreMany topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists. Show less
It is well known that complex mental abilities develop at least until late adolescence. Yet, there are also skills that children master perfectly, sometimes even better than adults. The goal of... Show moreIt is well known that complex mental abilities develop at least until late adolescence. Yet, there are also skills that children master perfectly, sometimes even better than adults. The goal of this thesis was to learn more about the possibilities of cognitive functioning in children and young adults, and the constraints set by the developing brain. An fMRI training approach was used to examine age- and experience-related effects in the development of working memory and resting-state functional connectivity. More specifically, we studied age differences on task performance and brain activation during a working memory task with various demands and difficulty levels, both before and after 6 weeks of practice with the task. In addition, to learn more about the interaction between different brain regions, we also examined age differences and practice effects on functional connectivity during resting-state. Show less
The development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially... Show moreThe development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially implemented into residency curriculum guidelines and incorporated into practice. Simulator training should be structured and mandatory, as a training tool, as well as a skills assessment tool. In order for residents to obtain a sufficient and uniform level of skills, their surgical skills need to be measured individually and objectively by means of the simulator. In addition, experts' level on the simulator can be set as performance standards for residents and should be reached by residents before performing live laparoscopic surgery. Assisting during laparoscopic hysterectomy should be added to the requirements for graduation in the curriculum guidelines. To accomplish these recommendations, skilled laparoscopic gynecologists are required in every teaching hospital. Besides the beneficial aspects for residency training, a skilled laparoscopic gynecologist is needed to establish an internal referral system for procedures such as laparoscopic hysterectomy. For the other advanced laparoscopic procedures a regional or national referral system can be created. Show less
Since 1979, the hydrology of the Waza-Logone floodplain in semi-arid Cameroon has been affected by the construction upstream of a dam and embankment, reducing the flooding intensity in an area of... Show moreSince 1979, the hydrology of the Waza-Logone floodplain in semi-arid Cameroon has been affected by the construction upstream of a dam and embankment, reducing the flooding intensity in an area of 1500 km2, including Waza National Park. Subsequently, annual grasses invaded productive perennial grasslands, reducing the carrying capacity of the area for livestock, fisheries and wildlife. In 1994, after local consultations, a watercourse blocked by the embankment along the Logone river was re-opened, rehabilitating an area of 600 km2 of desiccated floodplain. Monitoring showed a gradual recovery of perennial grasslands, virtually completed in 2003, albeit with a species composition somewhat different from the 1970s. Numbers of most waterbirds increased two-fold, especially when their colonies benefited from local communities’ protection, whereas colonies of piscivorous birds were frequently destroyed. Floodplain antelopes showed an initial increase that has not persisted, probably because of increasing competition with livestock which densities increased three-fold due to the arrival of new pastoral groups and prolonged stay of herds traditionally frequenting the area. These developments indicate a problem in the sharing of the reflooding benefits between wildlife and people that rapidly respond to new opportunities, calling for intensified management planning to anticipate this unexpected success. A dialogue was institutionalised between protected area authorities and local communities. Effective conservation called for a stronger and lasting involvement of protected area personnel in planning and community conservation. Developed training courses showed good potential to upgrade knowledge and skills of present personnel. In addition, institutional changes are needed to assure the necessary increase in numbers of park personnel and their rotation, not only in and amongst national parks but with training institutes as well. The success of floodplain rehabilitation ultimately depends on long-term ecological and socio-economic monitoring, with individuals and institutions capable to translate upcoming insights into practice. Show less
