International Migration, Integration and Social Cohesion online publications
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Evaluating Locally Run Large Language Models on Toxic Meme Analysis
No full textToxic memes easily spread online, propagating stereotypes, hate, and other stronger or more nuanced types of malicious content. The sheer volume of memes requiring moderation calls for automated methods, but their multiple layers of meaning make them challenging to assess: in some cases, toxicity may stem from subtle wordplay, in others by visual references or evoking hateful symbols, etc. Large language models (LLMs) offer a promising tool for performing toxicity detection, since they can leverage a large amount of contextual information and analyzing content items in depth. In this paper, we investigate the suitability of locally run LLMs to perform such a task. Locally run large language models have several advantages over web-based models like OpenAI’s ChatGPT with respect to costs, reproducibility, and data safety. We evaluate the local models on the tasks of automatic meme analysis and toxic symbol identification, and compare the results with analyses of the online model ChatGPT. Our findings reveal that while local models identify only a limited number of toxic memes and symbols, their labels are often accurate (low recall, high precision). Although they do not achieve perfect performance, we believe these models can effectively support human content moderators.</p
Study of hockey and orodental trauma:The role of mouthguards
Get PDFThis thesis investigates the prevention and management of orodental injuries in field hockey, with a particular focus on mouthguard use, effectiveness and hygiene.Despite high rates of mouthguard usage among players, the prevalence of dental injuries remains substantial, suggesting that current designs may not provide sufficient protection against the forces encountered in field hockey. Custom-made mouthguards were reported as more comfortable and better tolerated than stock or boil-and-bite types, although many players still felt that further improvements in both comfort and protective performance were needed.Field hockey coaches demonstrated limited knowledge of emergency dental trauma management, indicating the need for targeted educational programs, particularly for less experienced coaches.Experimental analyses of different mouthguards showed significant variations in protective capacity, with thicker designs providing superior impact absorption but reduced comfort. Notably, most mouthguards were effective only against low-speed impacts, but below speeds that are commonly observed in elite-level hockey tournaments.Hygiene studies showed that salivary proteins adhere to mouthguards, however cleaning, especially with effervescent tablets and to a lesser extent with cold water, effectively removes almost all protein depositions, thereby supporting oral health and potentially extending device longevity.Overall, orodental injury remains a significant challenge in field hockey. Improved mouthguard design, sport-specific regulations, and enhanced education for coaches and players are crucial to improve both protection and management of dental trauma
Delusion infestation:From definition to treatment
Get PDFDelusional infestation (DI) is a rare but disabling psychiatric disorder in which patients are convinced they are infested with parasites or other (non-)living organisms, despite the absence of medical evidence. The condition causes severe psychological distress, social isolation, and a markedly reduced quality of life. Patients often present to dermatologists, but effective management requires close collaboration with psychiatry.This thesis explores the clinical variation within DI, the organizational and communicative barriers to care, and strategies for more harmonized and patient-centered management. The findings show that the itch experienced in DI is not associated with immunological abnormalities, suggesting a perceptual rather than inflammatory origin. Triggers such as post-scabies itch, dopaminergic medication, and stimulant use (e.g., cocaine and amphetamines) may precipitate or exacerbate symptoms.The therapeutic section demonstrates that loss to follow-up and poor adherence are common, often related to limited illness insight and mistrust. Moral case deliberation revealed that direct confrontation with delusional beliefs is usually counterproductive; instead, a gradual, symptom-focused approach fosters trust and collaboration.An international survey highlighted major differences in clinical practice across Europe. A subsequent Delphi consensus study established core diagnostic criteria, a stepwise treatment pathway, and recommendations for collaboration between dermatology and psychiatry.In summary, this thesis shows that DI represents a clinical spectrum in which somatic and psychological factors converge, and that effective care requires integration, standardization, and empathic communication
Cervical cancer screening as a teachable moment for smoking cessation in general practice
Get PDFDit proefschrift had tot doel te onderzoeken wat het effect en de wenselijkheid zijn van advies om te stoppen met roken na het uitstrijkje voor het bevolkingsonderzoek naar baarmoederhalskanker. Hierbij gaat het om advies wat door de doktersassistente geven wordt aan vrouwen die roken. Daarnaast had dit proefschrift tot doel het appgebruik van een stoppen-met-roken app te onderzoeken en de invloed van het appgebruik op rookgedrag. Kort stoppen-met-roken advies na het uitstrijkje kan een ‘teachable moment’ zijn om vrouwen in de huisartsenpraktijk te stimuleren om een stoppoging te doen, en om deelname aan stoppen met-roken ondersteuning te verbeteren. Stopadvies door de doktersassistente na het uitstrijkje lijkt zowel haalbaar als wenselijk. Het scholen van doktersassistenten om stopadvies te leren geven, en het integreren van rookstopzorg in hun dagelijkse werkroutine stimuleert en verbetert de implementatie van kort stopadvies door de doktersassistente. De wenselijkheid van kort stopadvies na het uitstrijkje kan verhoogd worden door rekening te houden met individuele behoeften van de vrouw, door de relatie uit te leggen tussen roken en baarmoederhalskanker, en door stophulp aan te bieden.Vrouwen, mensen die ouder zijn, en mensen die het moeilijk vinden om te stoppen maken intensiever gebruik van een stoppen-met-roken app. Door dit intensieve gebruikt zijn ze mogelijk meer geneigd om te stoppen met roken, raken zij meer gemotiveerd of krijgen meer zelfvertrouwen dat het hen lukt om te stoppen met roken
Mobilizing and Balancing Differences:Care Relocation as the Work of Transnational Acting
Get PDFThis article explores the organizational aspects of care relocation of German seniors to care homes for older adults in the Czech border regions. It examines the role of care entrepreneurs as transnational actors linking diverse contexts in order to create sustainable business projects. It conceptualizes their endeavours as the work of transnational acting grounded in geographic arbitrage, whereby socioeconomic disparities are not merely exploited but strategically mobilized and balanced. The article argues that care relocation arrangements are shaped through the entrepreneurial navigation of inter- and intra-national inequalities. In doing so, it contributes to the literature on care relocation and geographic arbitrage by analysing how care entrepreneurs construct transnational arrangements that are both profitable and organizationally sustainable over time. Ultimately, it demonstrates how global and regional care flows are not only sustained within structures of inequality but actively configured and reconfigured through entrepreneurial practice
Revascularizing bone:A genetic intervention
Get PDFSegmental bone defects remain among the most difficult problems in reconstructive surgery, largely because transplanted bone often lacks sufficient vascularity to heal and integrate fully. This thesis explores whether cryopreserved bone allografts an important resource in limb-sparing surgery can be revitalized by actively restoring their blood supply. Using a large-animal tibial defect model. We investigated the concept of surgical angiogenesis by implanting an arteriovenous (AV) bundle into the intramedullary canal of the graft. This technique consistently produced new, functional vasculature throughout the previously avascular bone and led to improved healing, remodeling, and microstructural integrity while maintaining acceptable mechanical performance.Building on these findings, we explored whether enhancing this newly established vascular network with angiogenic growth factors could further improve outcomes. After demonstrating that adeno-associated virus serotype 9 (AAV9) can be used to achieve localized gene expression within targeted arteries, we applied VEGF and PDGF gene delivery to the AV bundle. This approach markedly increased vascular volume, bone turnover, and graft incorporation. However, it also produced an unexpected and significant complication: the development of multiple benign but problematic vascular tumors. These lesions, resembling pyogenic granulomas, confirmed that while gene therapy could amplify local angiogenesis, it also carried substantial systemic risks.Overall, this thesis demonstrates that surgical angiogenesis offers a safe and effective means of revascularizing cryopreserved bone allografts in a large animal model, whereas current viral gene therapy strategies require major refinement before clinical application
'Don't forget the mouth!':Interprofessional collaboration for good oral health of community-dwelling frail older people with and without dementia
Get PDFThe general aim of this thesis is to assess oral health care for community-dwelling frail older people with and without dementia by evaluating the role of interprofessional collaborations and the involvement of informal caregivers. The studies in this thesis focused on a scoping literature review, a process evaluation of a national public oral health project ‘Don’t forget the mouth!’(DFTM!), and examining the feasibility of tools to assess oral health for informal caregivers, and health care professionals.The scoping literature review highlighted the limited numbers of studies in oral health care services. The process evaluation of the oral health care project showed that interprofessional collaboration has the potential to improve oral health care but several barriers still existed. The key factor to improve the collaboration is to increase awareness for good oral health. In addition, the tools to assess oral health showed that involvement of informal caregivers, and other health care professionals may further help improve oral health in community-dwelling frail older people. Finally, this thesis demonstrates the need for more education in geriatric dentistry and further research. Oral health could easily be overlooked, and not be considered a priority among other health care disciplines. The collaboration between health care professionals, informal care givers, and frail older people is key to raising awareness of oral health, facilitate oral health care, and highlight the need for research in community-dwelling frail older people with and without dementia. Together, this will ensure that we do not forget the mouth
Stepping stones to targeted treatment of primary hyperoxaluria
Get PDFThe primary hyperoxalurias (PHs) are a group of rare genetic disorders affecting glyoxylate metabolism, leading to excessive oxalate production, a metabolic end-product. This overproduction can result in nephrocalcinosis, recurrent kidney stone formation and kidney failure. The clinical course of PH is highly variable, ranging from patients developing kidney failure in infancy to occasional kidney stone episodes in adulthood. Until recently, treatment options were limited, with liver transplantation being the only curative approach available for affected individuals. However, novel therapeutic modalities based on RNA interference (RNAi) have emerged, transforming the therapeutic landscape for PH1. The various chapters of this thesis examine the clinical characteristics, disease course and optimal treatment strategies for patients with PH. Furthermore, they explore global access to PH management, including a controlled access strategy for expensive RNAi therapy
Optimizing the blood supply chain:A data-driven approach to improve blood product utilization and patient safety
Get PDFOptimization of the blood supply chain is vital for ensuring the availability of blood products and patient safety. This dissertation introduces data-driven approaches to address challenges such as the perishability of blood, stochastic supply and demand, and donor responsibilities. It focuses on improving logistics between blood supply organizations and hospitals through matching of blood products, optimizing facility locations, predicting demand, and optimizing inventory levels.Alloimmunization, caused by antigen mismatches during transfusions, is a significant complication. The first part of this dissertation proposes the MINRAR model, a Mixed-Integer Linear Programming approach, that leverages genotyping advances to minimize alloimmunization by up to 93.7%. Incorporating patient-specific priorities further refines the model, reducing mismatches by 30% and shortages by 92%. For patients requiring frequent transfusions, such as those with sickle cell disease, Deep Reinforcement Learning and Neural Networks are applied to optimize long-term immune responses.The second part explores the use of Deep Reinforcement Learning for platelet inventory management, minimizing waste while ensuring compatibility. A study performed both in the Netherlands and Finland identifies optimal locations for distribution centers, reducing costs without compromising the reliability of delivery. A novel demand forecasting system adapts to stochastic demand, enhancing supply chain efficiency.This dissertation highlights the potential of data-driven methods to improve safety, efficiency, and cost-effectiveness in blood supply chains, paving the way for better patient outcomes and more resilient healthcare operations.<br/
The secrecy and science of Cold War atoms in the Netherlands and Norway
Get PDFThis study focuses on a unique nuclear collaboration between the Netherlands and Norway in the early Cold War, with special attention to the role of secrecy. A small joint research reactor was completed in Norway in July 1951. In addition, a small device to enrich uranium—a "calutron"—was realized in the summer of 1953 in Amsterdam. In those years America pursued a strict policy of secrecy and control of nuclear materials such as uranium. It was not until December 1953 that US President Eisenhower announced a relaxation of this policy; the "Atoms for Peace" program. The realization of these capabilities under a regime of maximum restrictions provides an ideal case for studying knowledge limitation and the relationship between science and secrecy. How did scientists and state officials deal with secrecy? How and why did the boundaries of secrecy shift over time? Three decisive factors can be identified for secret knowledge and technology to move: possession of special nuclear materials such as heavy water or uranium, scientists with a strong international network, and political will to support nuclear development. Norwegian and some Dutch assistance extended to third countries in the period up to 1960. Finally, secrecy was important in the joint project in a specific way: it enabled the production of scientific disinformation as a Cold War weapon. Openness and secrecy alternated to reflect changing power relations within Cold War science. As this history shows, secrecy is a convenient historiographical instrument to reveal such essential historical patterns