International Migration, Integration and Social Cohesion online publications
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A diluvial land:Earth histories in the early modern Low Countries, 1550-1830
Get PDFIn the seventeenth and eighteenth centuries, scholars and naturalists reimagined the history of the earth—crafting new chronologies, amassing new evidence, and resituating humans within the history of nature. This dissertation looks to the early modern Low Countries to argue that new ideas about Earth’s past drew on two principal sources: the material evidence of the landscape and the textual evidence of the Bible and other ancient cosmologies. Before 1600, commentators in Flanders and Holland looked to the Rhine delta and the North Sea to explain the formation of these lowlands. By the mid-seventeenth century however, the coastal plain was increasingly envisioned as a diluvial land, shaped by Noah’s flood and other deluges. By the late eighteenth century, the story had changed again, as fossils became the key markers of epochs in earth history. In six chapters, this dissertation charts the rise and gradual decline of the biblical narrative between 1600 and 1800. It explores the interplay between scholarly debate and local conceptions of the landscape, delving into hydrological, antiquarian, and natural historical discourses about the geography of the Northern and the Southern Netherlands.This dissertation ties transnational debates about biblical interpretation and natural philosophy to more local histories, situated in the particular environments of the Low Countries. It thus shows how even the most global of all learned debates—about the formation of the earth—was rooted in local circumstances
Convergence and divergence:Comparing symptom expression of and treatment for (parents of) children with ASD and those with ADHD
No full textAutism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) appear to have several overlapping features in terms of etiology, underlying mechanisms, and symptom expression. This raises the question of whether it is relevant to distinguish these classifications in school-aged children. Therefore, in this dissertation, differences between core and comorbid problems of school-aged children with ASD and those with ADHD – as well as their parents – were explored. Also, it was investigated whether (parents of) children with ASD and those with ADHD differed with respect to received treatment. Furthermore, a subscale to screen for ASD – consisting of separate items of the school-age version of the Child Behavior Checklist (CBCL) – was constructed and validated. Finally, it was examined whether it is feasible to provide a transdiagnostic Social Skills Training (SST) to a group of middle school-aged children and their parents. The results of this dissertation revealed that, statistically, school-aged children with ASD and those with ADHD can be distinguished with reference to their core symptoms. Both groups experienced relatively high levels of comorbid problems, although children with ASD seemed to be somewhat more impaired. Regarding their parents, hardly any group differences were found. Besides, the types and hours of treatment for the ASD and ADHD group largely overlapped. Additionally, the groups seemed to benefit equally from this treatment. Moreover, the results showed that the constructed ASD subscale had a similar screening potential to that of the existing DSM-oriented subscales. Also, the preliminary effects of the SST were promising, confirming its feasibility. <br/
Inflammatory bowel disease:Beyond the bowel
Get PDFDeze thesis presenteert onderzoeksresultaten die bijdragen aan een betere aanpak van inflammatoire darmziekten (IBD), zoals de ziekte van Crohn en Colitis Ulcerosa (UC). De focus ligt op drie thema’s die verder gaan dan de darm zelf: perianale fistels, het mesenterium en de appendix.Perianale fistels bij CrohnPerianale fistels vormen een grote ziektelast bij Crohn. De PISA-II-studie toont aan dat een combinatie van anti-TNF-therapie en chirurgische sluiting effectiever is dan medicatie alleen. Radiologische genezing blijkt cruciaal om terugval te voorkomen. Bij ernstige fistels biedt een stoma soms uitkomst, maar het opheffen hiervan is zeldzaam en vaak onsuccesvol. Immuunonderzoek onthult nieuwe therapeutische doelwitten, zoals pro-inflammatoire myeloïde cellen en NK-cellen. Bovendien blijkt calprotectine in fistelweefsel een veelbelovende biomarker voor ziekteseveriteit.De rol van het mesenteriumHet mesenterium speelt een cruciale rol bij Crohn. Specifieke inflammatoire macrofaagtypes, gekenmerkt door calprotectineproductie, dragen bij aan ziekteprogressie. Deze inzichten helpen bij het voorspellen en verminderen van complicaties, zoals bij pouch-chirurgie.De appendix en colitis ulcerosaBij UC-patiënten kan een appendectomie effectief zijn voor specifieke subgroepen, die beide verhoogde immuunactivatie vertonen. Dit suggereert dat de effectiviteit van appendectomie berust op verschillende mechanismen, wat kansen biedt voor gepersonaliseerde behandelingen.<br/
Guideline development for the prevention of surgical site infections
Get PDFSurgical site infections (SSI) are a common postoperative complication with significant impact on patient outcomes. This thesis investigates various preventive measures for SSI through seven studies. Two network meta-analyses are conducted on bowel preparation and preoperative skin antiseptics. The thesis also includes meta-analyses on the effectiveness of hemodynamic management during surgery, different wound irrigation solutions, and the use of triclosan-coated sutures in reducing SSI. Additionally, an individual participant data meta-analysis examines the effect of door openings in the operating room on SSI risk. The findings provide evidence-based recommendations to improve clinical practices in SSI prevention
Cell-free DNA and immune cell dynamics in acute graft-versus-host disease and systemic inflammation
Get PDFAcute graft-versus-host disease (aGvHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Affecting 30-50% of allo-HSCT recipients, aGvHD limits the broader use of this treatment. The pathogenesis of aGvHD is complex, involving donor immune cells attacking recipient tissues in the context of systemic inflammation. However, predicting the onset and severity of aGvHD remains a challenge, and ongoing efforts focus on identifying reliable biomarkers and refining biomarker panels. The work in this thesis explores the role of cell-free DNA (cfDNA) as a potential biomarker for aGvHD. We show that cell-free DNA (cfDNA) is increased in systemic inflammation, sepsis, and around the onset of aGvHD. We propose that cfDNA initially originates from a hematopoietic source followed by the release from damaged parenchymal tissue. By determining both the quantity and origin of cfDNA, we aim to enhance the prediction of aGvHD and evaluation of treatment efficacy in aGvHD. The second part of this thesis focuses on immune cell profiling in the context of aGvHD using multi-panel flow cytometry. We identify immune cell subsets that correlate with aGvHD in a small cohort of allo-HSCT patients, providing promising insights, though further investigation is warranted. Focusing on innate lymphoid cells (ILC), our work suggests that grafts rich in ILC, particularly ILC3, are significantly correlated to a reduced risk of aGvHD development. The use of adoptive transfer of ILC is an interesting treatment of aGvHD prevention to explore in the future
The affects of imperial collecting:The case of the German anthropologist Wilhelm Joest (1852-1897)
No full textThis dissertation proposes a radical rethinking of the study of imperial ethnographic collecting, moving from a preoccupation with the self-proclaimed “grand vision” of the collector towards the often less visible affective dimensions. Empire was an affective structure that functioned by shaping the desires of colonisers and colonised alike, and I argue that collecting was inevitably part of its many affective interactions. I base my argument on a microhistorical case study centred around the personal archive of the German anthropologist and collector Wilhelm Joest (1852–1897). In this way, I show how he created his imperial identity through the objects he collected, and how he used this self-fashioning to deflect and disavow the troubled affects that informed his actual collecting. I intimately engage with these emotions, ranging from longing to guilt to sexual desire, and demonstrate how each of these affective constellations shaped the collecting process. I emphasise the close connection between feeling and collecting in empire and highlight the importance of collecting as a strategy for regulating and rerouting affect. This dissertation offers a framework for interrogating the affective history of collecting in order to open up new avenues for meaningful decolonial transformation within and beyond the ethnographic museum
News in perspective:What is news to news users in the digital age?
No full textThe rise of new technologies has profoundly reshaped the news landscape, characterized by three intertwined elements: genre-blending news content, multifaceted digital platforms, and the prevalence of algorithmic recommendations. As news consumption evolves in this new landscape, users’ perception of news has naturally shifted. Historically, the question “What is news?” was defined by institutional journalism. But what is news to news users in the digital age? This dissertation explores users’ news perception through three empirical chapters, focusing on content, platforms, and algorithms. The first study measures news content on a spectrum along abstract dimensions, based on genre cues recognizable to news users. The second study investigates how varying definitions of news shape users’ news repertoires on digital platforms. The final study examines how genre cues contribute to user perception, particularly in the context of algorithmic news recommendations. Using innovative data collection methods, such as data donation and online field experiments, alongside advanced computational techniques, this dissertation offers both theoretical and methodological insights. By emphasizing the relevance of a user-centric focus in news research, it sheds light on how users navigate the new news landscape and broadly contributes to a more informed and democratic society
Precision medicine in critically ill patients:Exploring ARDS and sepsis subphenotypes
Get PDFThis thesis is dedicated to advancing the understanding of sepsis and acute respiratory distress syndrome (ARDS) subphenotypes in critically ill patients, with the overarching goal of addressing key challenges that hinder their clinical implementation. This work aims to clarify the biological and clinical variability within sepsis and ARDS populations. Through this comprehensive exploration, it aspires to bring the science of phenotyping one step closer to the bedside in critical care medicine. In this thesis the role of plasma protein biomarkers in identifying biological heterogeneity among COVID-19 patients is investigated. While previous studies assumed significant heterogeneity in COVID-19, analysis of hospitalized patients found limited support for distinct subphenotypes. Further investigation into treatment heterogeneity in severe COVID-19 revealed that vilobelimab, a C5a inhibitor, showed a survival benefit only in patients classified under a predefined sepsis δ-subtype, underscoring the potential of predictive enrichment strategies. In sepsis, multiple subtyping methods were examined, revealing limited overlap between classifications based on clinical, biomarker, and transcriptomic data. However, biomarker-based subtypes appeared to bridge clinical and molecular classifications. The dynamic nature of subphenotypes was further explored, showing frequent transitions over time, with shifts to less inflammatory states associated with improved outcomes. At ICU discharge, an inflammatory profile was linked to higher long-term mortality. Finally, distinct mortality predictors were identified, suggesting modifiable risk factors in Hyperinflammatory patients and emphasizing the need for tailored therapeutic approaches
De-escalation of breast and axillary treatment in breast cancer patients
Get PDFThis 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
Get PDFThis 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)