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Genders as genres:Understanding dynamic categories
No full textWhat does it mean to be of a particular gender? I answer this question with an account of genders as dynamic categories, exploring the analogy between what genders are (e.g., men or women) and what genres are (e.g., Novels, Ballads, or Hip-Hop). For instance, due to its relation to other and earlier pieces, we recognize, e.g., a particular song as Hip-Hop. However, the piece will also develop that genre further. Likewise, e.g., the category of men emerges, persists and transforms through a specific sort of response of individuals to earlier supposed men, which emerges in social interactions.Drawing on critical and (trans-)feminist theory, phenomenologist, enactivist, and systems theoretical approaches, I show that gender categories themselves develop in a dynamic between three elements: (1) at any given time, there is an enactment class of individuals ambiguously belonging to the category in question; (2) these individuals are, in an embodied and intersubjective way, enacted as practical reinterpretations of earlier members of that category; (3) this unfolds in a matrix of hermeneutic and material relations, which loop with both the class and the enaction.Thereby, that an individual is gendered, emerges between two levels of enaction, that of bodily people and that of the dynamic between them. As what an individual is gendered in enaction, however, is constituted by relations within and beyond that situation. This responsive realization gives rise to feedbacking histories of acts, people, relations, and enactment classes, thus explaining how gender can be both solid and open to change
Politics and the political in women's fashion magazines:Perspectives from India, Russia and the USA
No full textThe central theme of this thesis is a broad engagement of women’s fashion and lifestyle media with politics and the political. In the first quarter of the 21st century, fashion media’s coverage of political and social issues, although still largely perceived as novel and unusual, has become ubiquitous. The thesis focuses on the increased visibility of political coverage in fashion media, and its main research questions concern how politics and the political are expressed in fashion publications, and what change the newly sharpened focus on politics signifies in the genre of the fashion magazine. To address these questions, the research examines how fashion publications’ political coverage relates to locally and globally shifting views on citizenship, activism, and civic duty, while also considering how this coverage aligns with the traditional genre of the fashion magazine. The study explores the conflation of spectacle, activism, consumption, and politics that characterises the current moment, alongside the exigencies, limitations, and historically gendered nature of fashion media. The study focuses on the time span between late 2019 and early 2023, and analyses political discourses in fashion media situating them within wider political and cultural contexts. It is based on data from three countries – India, Russia and the USA, and draws on examples from nine mainstream fashion and lifestyle publications for women
Clinical dilemmas in diagnosis and treatment of breast disease
No full textThis thesis explores various clinical dilemmas in the treatment of breast disease, focusing on the phyllodes tumor and early-stage breast cancer. The first section of this thesis focuses on the phyllodes tumor. The second section addresses challenges in early breast cancer treatment, including the use of FDG-PET/CT, selecting patients for neoadjuvant systemic treatment and selection for delayed oncoplastic surgery. The thesis concludes with the DESCARTES study protocol, investigating whether radiotherapy can be omitted for patients with pCR after neoadjuvant therapy. Overall, the thesis emphasizes the need for individualized treatment strategies to improve outcomes and address persistent clinical challenges in breast cancer care
De-escalation of breast and axillary treatment in breast cancer patients
No full textThis thesis focuses on improving breast cancer treatment through response-guided therapies. While the number of breast cancer diagnoses continues to rise, survival rates have improved due to effective screening programs and systemic treatments. The prognosis of breast cancer is highly dependent on tumor stage, biological characteristics, and response to therapy. Neoadjuvant systemic therapy (NST) allows for tumor shrinkage and monitoring of treatment response, providing the opportunity for tailored treatment. The likelihood of achieving a pathological complete response (pCR) varies by subtype, with the highest rates seen in HER2+ and triple-negative (TN) breast cancer. Achieving pCR is associated with better long-term survival and lower recurrence rates and as long-term oncological outcomes improve, it is important to reconsider whether the benefits of locoregional treatment outweigh the associated side effects.This thesis explores minimally invasive biopsies to evaluate response to NST as imaging methods like MRI and FDG-PET/CT are useful, but not accurate enough to reliably detect pCR. However, small biopsies may miss relevant residual disease, emphasizing the need for breast surgery in many patients. The thesis also examines tailored locoregional treatments, such as omitting radiotherapy in patients achieving pCR and optimizing surgery for invasive lobular carcinoma.A major focus is on tailored axillary treatment based on NST response in clinically node positive patients. The MARI procedure, involving the removal of a pre-NST marked lymph node during surgery, enables tailored axillary treatment reducing unnecessary axillary lymph node dissections. This approach has shown excellent survival outcomes and low recurrence rates in breast cancer patients with limited and extensive nodal disease.By investigating innovative diagnostic and treatment strategies, this thesis provides new insights into personalizing breast cancer treatment, minimizing overtreatment, and improving patients' quality of life
Diagnostic approaches, ventilation and fluid management in patients with acute hypoxaemic respiratory failure
No full textThis thesis investigates key aspects of ventilation, fluid management, and diagnostic approaches in critically ill patients with acute hypoxemic respiratory failure, including those with COVID-19. It explores differences in ventilation strategies, aspects of fluid management, and the impact of advanced imaging techniques on diagnosing and managing acute respiratory distress syndrome (ARDS).A central focus is the comparison of ventilation management between pre-pandemic ARDS and COVID-19 ARDS. The findings indicate that key ventilator settings differ significantly between these patient groups, with implications for clinical outcomes. Another key aspect is the comparison of high-flow nasal oxygen (HFNO) and invasive ventilation in COVID-19. Using the Berlin definition’s PaO2/FiO2 cutoffs resulted in three cohorts with varying mortality rates, highlighting differences in risk classification and patient outcomes.Fluid management is also extensively analyzed, with particular attention to medication-related fluid creep. The findings suggest that a substantial portion of daily fluid intake in critically ill COVID-19 patients originates from intravenous medications, highlighting opportunities for fluid reduction through early oral transitions. Additionally, a higher cumulative fluid balance is associated with prolonged ventilation and worse outcomes.Overall, this research provides insights into optimizing ventilation strategies, refining fluid management, and improving diagnostic approaches in critically ill patients, with potential implications for future clinical practice. Finally, this thesis assesses ARDS classification accuracy, showing that an 8-grade confidence scale with lung ultrasound and CT improves consistency. It also examines prone positioning’s effects on lung aeration, inhomogeneity, and compliance in spontaneously breathing, invasively ventilated COVID-19 patients using electrical impedance tomography (EIT)
How human are our machines?:Rethinking how we communicate with social robots
No full textAs robots make their way into unstructured contexts, they are required to have social characteristics to effectively communicate with users, posing the question: To what extent do existing theoretical frameworks apply to interaction with modern social robots? Our theoretical understanding of interaction with media agents is derived from the Computers-Are-Social-Actors (CASA) framework. Since its conception, there have been significant advancements to media agents themselves, people’s understanding of media agents, and the nature of interaction between these media agents and people, which has transformed people’s understanding and expectations of media agents from what CASA predicted.This dissertation conducted two cross-sectional experiments and one longitudinal survey. The first study focused on the effect of interdependency and a robot’s display of augmented cognitive capabilities on human-robot team behaviour and found that when participants perceived the robot as a teammate, they did not experience more team affinity or behaviour than when they did not perceive it as a teammate. The second study found that when being helped by a robot, participants did not reciprocate the helpful behaviour, even with the presence of a single humanlike social cue (a face). The third study was based on data from an eight-week study, in which children interacted with a social robot within their own home. It did not find any robust long-term patterns between social presence and perceived companionship.These findings indicate the need to update theoretical frameworks such that they can better explain social responses in (long-term) interactions between advanced social robots and experienced users
Immune infiltration and activation in breast tumors
No full textIn this thesis, we explore the antitumor response of immune cells against breast tumors and investigate how these findings can be clinically applied to improve patient treatment. Tumor cells are continuously in contact with other cells in their environment and can exhibit characteristics that the immune system perceives as foreign. This enables immune cells to infiltrate the microenvironment, recognize the tumor cells, initiate an immune response, and facilitate the clearance of the tumor cells. However, tumor cells can also manipulate their surrounding microenvironment in a way that inhibits the activity of immune cells, thereby preventing an immune response. With the advent of immune checkpoint inhibition therapy, it has become possible to activate immune cells that are suppressed by the tumor, thereby enabling the clearance of the tumor.Adding immune checkpoint inhibitors to chemotherapy has markedly increased response rates for patients with primary triple-negative breast cancer. To better tailor treatment options to individual patients and more accurately predict disease progression, it is necessary to gain more knowledge about the complex properties of the tumor microenvironment.This thesis first compares methods for investigating and profiling the tumor microenvironment in patients with early-stage breast cancer. We examine the comparability of different techniques and employ methods in clinical cohort studies that go beyond merely quantifying tumor infiltrating lymphocytes. Next, we examine various determinants of the tumor microenvironment and explore how these characteristics can be used to improve immunotherapy for patients with triple-negative breast cancer (BELLINI trial, Nederlof et al. and TONIC trial Voorwerk et al.) and whether elements of the microenvironment can be used to predict clinical response
Gut microbiota and pneumonia:From health to severe infection
No full textThis thesis investigates the composition and impact of human microbiota throughout the continuum of health to severe pneumonia, in order to decipher the role and targetability of the microbiome in infection susceptibility, severe illness and its recovery. Despite the recent surge in research on the role of gut microbiota in enteric infections, current understanding on the role of microbiota during pneumonia in humans is limited, and no microbiota-targeted therapies have been implemented in everyday management. We hypothesised that the gut microbiota - particularly obligate anaerobic butyrate-producing bacteria - play a protective role against systemic infections in healthy individuals, are distorted during pneumonia and its recovery, safeguard against adverse clinical outcomes in hospitalised patients, and represent a treatable trait. We used general population cohorts, cohorts of hospitalised patients (including during their recovery), and murine models of pneumonia to examine the role of microbiota before, during and following pneumonia. Our findings show that gut and lung microbiota are altered during hospital admission for pneumonia, and correlate with clinical outcomes. Gut microbiota alterations precede hospitalisation and are associated with infection susceptibility, but also remain altered following recovery. Finally, we describe strategies to target gut microbiota to improve outcomes during pneumonia. Overall, this work advances our understanding of the role of gut microbiota in pneumonia, and its potential as preventive and therapeutic target
Human spermatogonial stem cells:Growing hope for infertile male childhood cancer survivors
No full textThis dissertation focuses on male survivors of childhood cancer, who can become infertile due to the gonadotoxic effects of cancer treatments. Whereas adolescent and adult men can cryopreserve sperm prior to treatment as a method of fertility preservation, this option is not available to pre-pubertal patients due to the absence of spermatogenesis in the pre-pubertal testis. However, these patients are offered the option to collect and cryopreserve a testicular biopsy, harboring the spermatogonial stem cells (SSCs), which are present from birth onwards. In case of infertility in later life, the biopsy can be used to retrieve testicular cells including these SSCs, culture them to increase their numbers and autotransplant them into the healthy testis to restore spermatogenesis in the adult cancer survivor. However, this treatment is not clinically available yet, although good results have been obtained in animal models. The research described in this work aimed to review knowledge gaps in the field; optimize the culture of SSCs to reduce the previously observed hindering overgrowth of somatic testicular cells; investigate ways to facilitate clinical implementation of the culture by using xenofree, scaled-up methods; and uncover perspectives of cancer survivors on the potential future use of this technique. We found that growth of somatic cells could be limited by a combination of adaptations to the culture temperature, culture surface and medium components including growth factors. Additionally, patient perspectives revealed the necessity of a focus on reproductive autonomy during the course of their treatment, fertility consultations and future therapy
The creation of obligations under international law by diplomatic assurances issued in the context of expulsion
No full textThis study examines whether diplomatic assurances issued from one state to another in the situation of the expulsion of individuals can create obligations under international law. The study is conducted against the background of non-refoulement, the legal duty of states to refrain from expelling individuals to states where they may face a risk of torture, persecution or other serious mistreatment. This obligation prohibits expulsion when the predictable risk to the person surpasses a certain threshold. As part of the risk appraisal, a receiving state may provide “diplomatic assurances” to alleviate the concerns of the expelling state. If these assurances sufficiently mitigate the risk, then nonrefoulement is not implicated. Yet it remains unclear whether such assurances create any obligations under international law. It is often said that diplomatic assurances are merely political pledges, but this casual, overbroad assertion fails to appreciate the subtle differences among assurances as well as the nuances in international practice. This study finds that assurances in fact can create obligations under international law, in certain conditions. In turn, where assurances create obligations, states giving those assurances should incur state responsibility if they mistreat the person contrary to the assurances, opening the door to the traditional means of enforcement. More broadly, if the conditions under which assurances create obligations were explicated and acknowledged in international practice, expelling states may predict with greater confidence that an individual will not be mistreated, and non-refoulement would not be implicated.</p