International Migration, Integration and Social Cohesion online publications
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Episiotomy to prevent obstetric anal sphincter injury
Get PDFObstetric injury of the anal sphincter (OASI) is a serious consequence of vaginal childbirth. Women with OASI have an increased risk for anal incontinence in later life. In this thesis, we identified subgroups of women at a higher risk for OASI and analysed the association of a mediolateral episiotomy (MLE) and OASI. For all analyses, we used population-based data from the national Dutch Perinatal Registry. In chapter 2 we showed that a MLE with an anticipated birth weight more than 4000 grams and duration of the 2nd stage of labour of more than 60 minutes should be considered in nulliparous women. In chapter 3 our study group concluded that in both primiparous and multiparous women undergoing vaginal instrumental delivery, the use of a mediolateral episiotomy is associated with a greatly reduced risk of OASIS. In chapter 4, we demonstrated that the rate of OASI was higher in women who had OASI in their first delivery compared with women who had an uncomplicated first delivery and the rate is reduced with the use of a MLE. In chapter 5 we studied women with a VBAC and showed they have a significantly higher rate of OASI in comparison with women with a vaginal first delivery, with the exception of women with a VBAC after emergency CS for fetal distress. In chapter 6 a prediction model for OASI was developed and validated for women with spontaneous vaginal birth and women with operative vaginal delivery. These models can form a basis for counselling about the risk of OASI
Digital campaign competence:The role of citizens in data-driven election campaigns
Get PDFData-driven campaigning strategies provide political parties with new opportunities to inform and persuade voters, often using data unknowingly provided by citizens. Concerns for democracy’s health arise from worries about citizens’ data privacy and unintended consequences such as unequal access to political information online. This cumulative dissertation investigates citizens’ digital campaign competence and specifically addresses (a) the extent to which citizens know about data-driven campaigns, how they evaluate them, how they navigate through them, (b) whether their competence impacts their campaign (dis-) engagement, and (c) how citizens can be best supported to increase their competence. Using panel surveys from elections in the Netherlands and Germany, alongside an experimental study in Austria, this dissertation uncovers several key findings. Citizens exhibit a basic understanding of data-driven tactics online and their implications but lack the technical expertise to mitigate their negative impact effectively, and tend to underestimate their susceptibility. Citizens at large do not evaluate data-driven tactics positively. Skeptical individuals who understand these strategies tend to avoid them. Non-interactive educational interventions highlighting the risks of data-driven campaigning are the most effective means to enhance citizen competence. These findings highlight that citizen competence extends beyond mere knowledge, emphasizing its multifaceted nature. Citizens' evaluations of data-driven campaign strategies must be considered because their understanding alone does not explain their campaign (dis-) engagement. Solution-oriented research is needed to empower citizens, yet informing them while avoiding perceptions of pervasive targeting is challenging. These insights deepen our understanding of citizens' digital campaign competence and the complexities involved
Emulating natural photosynthesis:Self-assembled cage scaffolds to control molecular aggregation states
Get PDFArtificial photosynthesis is a global scientific endeavour that attempts to develop solar-to-fuel devices as a viable approach to sustainable energy production and storage. Inspired by Nature’s strategies, a case is made for organization of molecules on a self-assembled scaffold. At the same time, porphyrins are recognized for their potential in supramolecular chemistry and artificial photosynthesis because of their excellent light-harvesting and catalytic properties. A metal-mediated self-assembly strategy forms porphyrin-equipped MnL2n coordination cages. This thesis investigates what properties of natural photosynthesis can be emulated by application of MnL2n supramolecular cages equipped with porphyrins. Thus, two hallmark objects of supramolecular chemistry — porphyrins and supramolecular coordination cages — have been combined to obtain self-assembled systems with potential application in controlled energy transduction and catalysis. By focussing on light-harvesting and on the organization of chromophores, these porphyrin-equipped cages are introduced as a new, powerful tool in the box of supramolecular chemistry
Behind the webcam:Contested visibility in online sex work in the Netherlands, Romania and the United Kingdom
Get PDFIn webcamming online sex workers can make money through tips and per-minute fees for livestreamed digital sexual acts and interactions. Like other work that takes place on the internet, websites which host webcam performers have considerable influence over how performers make a living. At the same time webcamming also differs from other digital labour in that it is heavily stigmatized. In many places around the world sex work, including webcamming, is considered socially unacceptable and looked down upon. Drawing on interviews with 67 webcam performers and 13 other industry insiders in the Netherlands, Romania and the UK, this thesis makes sense of how workers deal with these competing forces, and the question how do webcam performers in The Netherlands, Romania and the United Kingdom conduct their labour within platform structures?To answer this question, it presents an analysis which explicitly recognises webcamming as work rather than as sex. This thesis draws on a Marxist-feminist perspective which is critical of the exploitative labour conditions webcam platforms and sex work stigma create, while also acknowledging that workers still have agency even in unfavourable circumstances. The problems it identifies with online sex work have much more to do with the context of contemporary labour, in which increasing amounts of workers need to ensure they are visible online to generate an income, which platforms then profit from. It is this visibility that becomes central to the above research question is answered. <br/
Patient and family involvement in care after oncology surgery
Get PDFIn the forthcoming years, health care systems are anticipated to undergo drastic transformations, wherein the responsibility for providing care will also be partially delegated to the patient and their families. Evidence suggests that family involvement enhances patient outcomes, yet practical methods for engaging them remain limited. This thesis explores innovative strategies to involve patients and their families in fundamental care following oncological gastrointestinal surgery, with several interventions developed, tested, and evaluated in the surgical departments of the Amsterdam UMC.In Chapter 2, a prospective cohort pilot study assessed the impact of a surgical ward breakfast buffet as a low-cost, simple intervention to involve patients in their post-surgery care. This approach not only engaged patients but also helped address postoperative undernourishment. Chapter 3 examines the challenges of involving family members, particularly during the COVID-19 pandemic when hospital visitations were restricted. A retrospective cohort study investigated the effects of these restrictions on complications such as delirium, falls, pneumonia, pressure ulcers, and readmissions among surgical patients. Chapters 4, 5, 6, and 7 focus on the Family Involvement Program (FIP), where family members actively participated in fundamental care post-surgery. These chapters include both qualitative evaluations using interpretative phenomenological analysis and a patient-preference cohort study examining surgical and caregiver outcomes. Lastly, Chapter 8 explores digital alternatives for patient and family involvement. A scoping review was conducted to assess the effectiveness of video calls in hospital wards as a method for maintaining family engagement in patient care
Bradykinin-mediated angioedema:The path towards complete disease control
Get PDFThis thesis examines various aspects of bradykinin-mediated angioedema, focusing on hereditary angioedema (HAE) and angioedema due to acquired C1-inhibitor deficiency. It is divided into three parts: Part I explores innovative treatments targeting the kallikrein-kinin pathway, showing promising results in reducing angioedema attacks with therapies like donidalorsen, NTLA-2002 and deucrictibant. Part II addresses the inconsistency in efficacy outcomes used in clinical trials assessing HAE treatment, establishing consensus on a core outcome set for future studies. Part III investigates residual risks associated with C1-inhibitor deficiency, such as potential thromboembolic complications, and the impact of HAE on reproductive decisions. The overall goal is to enhance treatment strategies, standardize clinical trial outcomes, and address broader implications of the disease, ultimately improving the quality of life for patients with bradykinin-mediated angioedema
Door vrouwen gedragen:(Gedwongen) verplaatsing, veerkracht en overlevingskunst in de levensverhalen van drie generaties Javaans-Surinaamse vrouwen
Get PDFDit onderzoek tracht de relatieve stilte te doorbreken rondom de verborgen Javaans-Surinaamse geschiedenis van contractarbeid en dubbele (gedwongen) verplaatsing, bezien vanuit het perspectief van vrouwen. Door te luisteren naar de levensverhalen van drie generaties vrouwen is nagegaan welke strategieën van overleven en ‘zijn’ van moeder op dochter zijn overgedragen, en hoe jongere generaties daarmee tools kregen aangereikt om hun eigen invulling aan ‘Javaanse-vrouw-zijn’ te geven. Uit het onderzoek is naar voren gekomen dat vrouwen een belangrijke rol speelden in de sociale overleving van de Javaans-Surinaamse groep. Ze grepen daarbij terug op een culturele bagage die van moeder op dochter was overgedragen. Daarbij droegen moeders als kleinhandelaarsters evenredig bij aan het gezinsinkomen, terwijl zij een beroep deden op hun dochters om het werk binnen- en buitenshuis gedaan te krijgen. Deze vrouwelijke erfenis stelde hen niet alleen in staat om zich te verweren tegen het koloniale, inferioriserende beeld van ‘de luie Javaan’, maar ook tegen dat van de ‘onderdanig en seksueel gewillige Javaanse vrouw’, als ook tegen de patriarchale praktijken die zij van buitenaf kregen opgelegd. Door zich actief te verzetten tegen de herinvoering van de Javaanse praktijk van uithuwelijken en het koloniale beleid van ‘housewivization’ dat hen probeerde terug te dringen in hun rol van echtgenote en huisvrouw, bereidden moeders hun dochters een toekomst voor waarin zij hun toekomst konden veiligstellen via een diploma in plaats van een man. Het toont aan dat Javaans verzet niet alleen in het publieke domein plaatsgreep, maar ook in het privédomein. Wat het onderzoek tenslotte heeft laten zien is dat Javaans-Surinaamse vrouwen een actieve rol speelden in het creëren en opeisen van een ‘thuis’ in postkoloniaal Nederland. Doordat (groot)moeders binnen de familie een ‘thuisplek’ creëren waarin verhalen over lijden en verzet gedeeld kunnen worden, hebben (klein)dochters de kans om zich (opnieuw) te verbinden met hun voorouders en familiegeschiedenis, om vanuit een stevig geworteld zelfbeeld een gelijkwaardige plek binnen de Nederlandse samenleving op te eisen. Wat dit onderzoek heeft aangetoond, is dat 'Javaans-Surinaams vrouw-zijn' eindeloze vormen kan aannemen, maar tegelijkertijd stevig geworteld is in een vrouwelijke genealogie die terugvoert op een Javaanse volksklasse cultuur die van (groot)moeder op (klein)dochter is doorgegeven. Het geeft jongere generaties vrouwen waardevolle culturele bagage mee, waarbij elke generatie steeds opnieuw beslist wat ze willen behouden, wat ze willen transformeren en wat ze willen loslaten
Plague and piety:Yiddish medical literature in early modern Europe
Get PDFThis dissertation examines responses to epidemics in Yiddish remedy literature within Ashkenazi communities in Western Europe during the long eighteenth century (1660-1800), a period when Yiddish was the vernacular language of all Ashkenazi Jews. It aims to advance scholarly understanding of how Yiddish remedy texts addressed epidemics, a topic previously underexplored as a cohesive entity. By positioning the Yiddish remedy corpus within the broader Jewish remedy literature and early modern European vernacular traditions, this study highlights its significance in the context of medical and religious strategies for managing epidemics.The dissertation builds on Gentilcore’s model of three concentric rings—“medical,” “ecclesiastical,” and “popular”—to analyze how Yiddish remedy literature reflects a complex interplay between these domains. It argues that considerations of piety were integral to all forms of remedy, whether grounded in medical or magical practices. Additionally, the research introduces the concept of “Bio-Political Decrees,” inspired by Foucault, to extend Gentilcore’s model and explore the impact of legislative decisions on public health.The study also critically evaluates Shlomo Berger’s thesis that vernacular publications aimed to enhance religious piety, through an analysis of four case studies: (1) Seyfer Yerum Moyshe (1679), focusing on traditional medical knowledge and piety; (2) Seyfer Refues u’Segules (1703), which blends mystical practices with medical remedies; (3) Seyfer Atsires Hamageyfe (1770), a plague tractate reflecting Jewish-Christian scholarly interactions; and (4) The Maskiel El Dal Manifest (1808), highlighting Dr. Ezechiel Joseph Goldsmit’s advocacy for smallpox vaccination in Amsterdam.The dissertation demonstrates how political and scientific developments from the nineteenth century to the present continue to shape public health strategies. It underscores the ongoing relevance of the intersection between spirituality, medicine, and politics in health discourse, offering insights into its implications for modern public health.<br/
Unravelling the threads of Marfan Syndrome and mitochondrial metabolism
Get PDFMarfan syndrome (MFS) is a heritable connective tissue disorder primarily caused by pathogenic variants in the fibrillin-1 (FBN1) gene, with early mortality often resulting from aortic complications. In this thesis, I investigate metabolic changes in MFS, highlighting mitochondrial dysfunction as a key factor in worsening aortic pathology. Focusing on the abundant smooth muscle cells (SMCs) in the aorta, I discuss SMC heterogeneity and plasticity to clarify their role in vascular disease. I also assess the impact of a high-fat diet and mitochondrial-targeting drugs in MFS mice, exploring potential ways to alleviate both aortic and also lung pathology. Additionally, I introduce five novel mouse models exhibiting diverse phenotypes to better represent the pleiotropic MFS manifestations. These models provide valuable insights and open up avenues for testing new potential treatments
Longing for autonomy:Citizen professionals engaging for the common good
Get PDFThis dissertation examines why and how civic actors contribute to the common good as welfare states have continuously delegated public service responsibilities to citizens. This shift has spurred citizen-led projects that transform urban spaces for community use, offering collaborative environments for living, working, and socialising. The ethnographic study in Amsterdam, Berlin, and Vienna, explores the role of citizen professionals (CPs)—civic actors who organise self-initiated projects, taking an intermediary role with public and private stakeholders to create autonomous spaces in their respective neighbourhoods. Unlike traditional urban movements, CPs seek “mutually agreed autonomy” through collaboration, promoting non-profit, shared ownership models that challenge capitalist norms and align with the concept of urban commons.Longing for Autonomy explores the importance of autonomous urban spaces for living, working, and socialising, and the evolving role of citizens in providing these (semi) public services. It demonstrates how these concerned citizens define their quest for autonomy while collaborating with governmental actors and institutions and asks to what degree these initiatives can inspire others to assume responsibility for public resources and create similar spaces for communal use