International Migration, Integration and Social Cohesion online publications
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Paediatric post-COVID condition, different faces of a new disease
No full textAt the beginning of the COVID-19 pandemic we were confronted with Paediatric Post-COVID Condition (PPCC). This thesis describes our first insights into this new phenomenon. Our first study focused on children hospitalized for acute COVID-19 or MIS-C, in which pulmonary sequelae did occur frequently four to twelve months after hospital admission. It showed that CPET testing is frequently abnormal and helpful to provide insights into pathophysiology of sequelae. In the beginning of the COVID-19 pandemic PPCC was still an unknown entity. We described the experience of Dutch paediatricians with PPCC end of 2020 and demonstrated both the high burden of disease, and the need to both organize care and research focusing on PPCC. To inform organization of care, we first investigated the prevalence of PPCC in a Dutch low and high risk setting, compared to a negatively tested group. PPCC prevalence was respectively 14.6, 29.2 and 2.3% three months after acute infection, and did decrease over time. Children with PPCC had lower physical health-related quality of scores and higher fatigue scores. Definitions used clearly influence PPCC prevalence, demonstrating the importance of data harmonization tools. Second, we examined international care PPCC care programs and their patients, and highlighted the broad symptomatology of PPCC, and heterogeneous diagnostic and therapeutic approach. The International Post-COVID-Condition in Children Collaboration (IP4C) published an overview of priorities to accelerate and improve PPCC care. These combined findings demonstrate the urgent need for further scientific substantiation of PPCC care programs to improve PPCC outcomes
How do substance use and mental health work for me?:Towards personalized communication in the treatment of addiction and common mental health problems with ecological momentary assessment and network models
Full text linkThis dissertation investigates how data-informed tools could make psychotherapy more personalized and effective, particularly for people with addiction and co-occurring mental health problems. Ecological momentary assessment (EMA), where patients answer questions on their smartphones several times a day for multiple days, is used to generate personalized feedback to help patients and therapists collaboratively understand individual mental health and addiction patterns.Simulations showed that, while EMA data can be used to estimate personalized networks graphing how different factors influence each other in an individual’s life, detecting smaller effects is difficult and false negatives are likely. This suggests that simpler feedback focused on fewer variables may be more reliable.A case study with a person experiencing cannabis addiction and psychosis suggested that EMA-based feedback can support insight and improve communication during interventions. A pilot randomized controlled trial in young adults with cannabis use problems found that while standard therapy decreased cannabis use, adding personalized feedback helped to maintain these improvements over time. Participants valued discussing the personalized feedback with the practitioners, though completing EMA was sometimes demanding.Additionally, a study of over 1200 cannabis users revealed gender differences in how cannabis use problems relate to mental health problems, suggesting that subgroup-based tailoring of interventions may also be beneficial. The dissertation also discusses how EMA could be integrated with cognitive bias modification interventions to further strengthen addiction treatment.Overall, EMA-based personalized feedback and personalized networks show promise for improving therapy outcomes, thus, larger studies are needed to replicate clinical usefulness, clarify underlying mechanisms, and improve methodologies to obtain personalized networks
Levaraging a cloud-based intensive care registry in a lower-middle income country to enable high-quality critical care research
Full text linkIndia, a lower-middle-income country, has made significant economic progress over the past two decades. As a result, the nation has witnessed major improvements in healthcare infrastructure and resources, particularly in large urban centers. However, a clear and persistent gap remains between advances in clinical service delivery and the corresponding growth in research output. The overarching objective of this thesis was to demonstrate the potential of a cloud-based registry—and its associated infrastructure—to enable high-quality critical care research in the Indian context. Using a scoping review methodology, we identified the barriers to conducting research in low- and lower-middle-income countries. Subsequently, drawing on data from the Indian Registry of IntenSive Care (IRIS), we explored a series of research questions to illustrate the registry’s ability to facilitate high-quality research. Given the limited information available on the influence of baseline patient characteristics on outcomes, our central research theme examined the association between the characteristics: frailty; persistent critical illness; and sex, on clinical outcomes. In the general discussion, we reflect on the implications of our findings in relation to the specific research questions, as well as the barriers mitigated by the registry ecosystem. We also discuss the strengths and limitations of our approach and outline future directions, including integrating electronic medical records and artificial intelligence technologies to enhance data collection and analysis; advancing recommendations for registry-embedded critical care research to democratize research in India; and developing sustainable funding models to ensure the long-term viability of the registry
Cardiac autonomous function and large-vessel hemodynamics:Risk factors for hyppertension and CVD
No full textIn dit proefschrift hebben we verschillende technische benaderingen gebruikt om veranderingen in arteriële functie en anatomie te kwantificeren. Hierbij hebben we gebruik gemaakt van verschillende invasieve en niet-invasieve meetmethoden waardoor we inzicht verkregen in belangrijke hemodynamische kenmerken die kunnen helpen bij het voorspellen van hypertensie en cardiovasculaire ziekten (CVZ). In het eerste deel hebben we snelle veranderingen in bloeddruk (BD) en hartfrequentie gebruikt om de invloed van het sympathische en parasympatische zenuwstelsel op het risico op het ontwikkelen van hypertensie en CVD te beoordelen, binnen een multi-etnische populatie. Hier zagen we dat de autonome cardiale regulatie bijdraagt aan een verhoogd risico op het ontwikkelen van hypertensie en CVZ. Daarnaast onderzochten we de rol van het autonome zenuwstelsel in specifieke populaties met een verhoogd CVZ-risico, waaronder zoutgevoelige mensen en mensen met hiv die antiretrovirale therapie krijgen. In deze populaties zagen we een dysregulatie van de autonome balans. In het tweede deel van deze thesis gebruikten we invasieve en niet-invasieve metingen om de hemodynamiek in zowel de aorta, als ook de nierarteriën te beoordelen. Hierdoor hebben we onder andere meer inzicht verkregen in de hemodynamiek bij patiënten met een nierarteriestenose. Tevens hebben we gezien dat in een gezonde populatie de hoogte van gereflecteerde polsgolven geassocieerd is met de systolische bloeddruk. Als laatste hebben we kunnen laten zien wat voor dynamische veranderingen er in de aorta optreden in de periode van een enkele hartslag
Photo-excitation dynamics of color centers in diamond
Full text linkThe negatively-charged nitrogen-vacancy (NV-) center in diamond is among the most promising candidates for developing quantum technologies in the realm of solid state materials. The projects reported in this thesis tackle the ongoing challenges of understanding the electronic structure and charge state conversion mechanisms in the neutral and the negatively-charged states of the NV center using transient absorption (TA) spectroscopy. The results from such investigations reveal high-energy excited states localized in the conduction band (CB) of NV-. In the neutral state NV0, a series of transitions reminiscent of the Rydberg states, followed by the onset of the hole excitation threshold in NV0, were observed. The population dynamics intrinsically and between these two charge states are also reported, including the electron tunneling mechanism of the NV-+N+→NV0+N0 process. While the observations in the NV center have improved the overall understanding of this system, there exists multiple open questions that cannot be answered due to the necessary existence of substitutional nitrogen in the lattice. To remove this parameter, the vacancy center is also studied. The precursor system to all vacancy-related defects in diamond, including NV, the vacancy center also exhibited very similar features, especially in the neutral state. Many of the charge conversion processes between the neutral and the negatively-charged states persist even with the lack of substitutional nitrogen to mediate charge carriers. The results from the vacancy center paved way towards the understanding not only in the NV center, but also novel vacancy-related defects in diamond as well as silicon carbide (SiC)
What you water, grows:Development and evaluation of a community-led approach to enhance the protection of children
Full text linkThis dissertation focuses on the protection of children from violence, abuse, neglect, and exploitation, specifically through the development and evaluation of a community-led child protection approach called Seeds. The seven chapters provide an overview of the global issue of violence against children, review existing literature on community-level child protection approaches, and describe the development of Seeds, including a formative study in Lebanon and a field test in Sri Lanka. The dissertation also presents the development and assessment of a tool to measure children’s sense of protection (PROTECT), which was co-developed with children in Bogotá and demonstrated good reliability in preliminary testing. In a next chapter, the results of a feasibility study in Colombia are presented. The study assessed both the Seeds approach and its evaluation procedures, finding that while some outcomes moved in the expected direction, others showed no or unexpected changes. Qualitative findings suggested that community-led action improved perceptions of child protection, increased awareness of risks and protective factors, and fostered more positive attitudes toward protecting children. Based on the feasibility study results, the subsequent chapter outlines a protocol for a mixed-methods evaluation of Seeds. Both quantitative and qualitative data are planned to be collected in eight communities, four intervention and four control. Overall, this dissertation aimed to help fill the gap in evidence on violence prevention strategies, deepen understanding of community-led protection, and provide a model for evaluating community-based prevention programmes. Recommendations for future research and practice highlight the need for context-specific measures balanced with global comparability, as well as attention to both individual- and community-level change
"So you're just a normal person. Just like me?":Difference evasion in managing an advantaged identity and legitimising inequality
Full text linkWestern liberal societies claim to value equality and diversity, yet they remain increasingly unequal and resistant to difference. In these societies, members of advantaged groups often convey an egalitarian standpoint toward disadvantaged group members by emphasising their individuality and fundamental sameness (e.g., “I don’t see colour/sexual orientation/gender identity, I see people”). In downplaying people’s disadvantaged group memberships and thereby evading difference, advantaged group members may implicitly obscure markers of intergroup inequality, blur their own advantaged status, and legitimise structural inequality in turn. This dissertation explores how such crossroads between people’s equalising outlooks and rising inequality unfolds, investigating thus when and how evading difference prevents advantaged group members from developing a structural understanding of inequality and, in turn, enables them to blur their dominance. Using qualitative interviews, quantitative surveys, and experiments, I addressed this question in two intergroup settings where equalising outlooks have taken deep root in the Netherlands: (1) the ethno-racial intergroup context and (2) the sexual orientation and gender identity intergroup context. The findings seek to deepen understanding of how people who evade difference in managing cultural diversity can instead develop structural views of inequality and inform policies that foster such structural views across society
Golden slumber?:The elusive role of sleep in emotional memory
No full textEmotional memories shape how we perceive ourselves and the world. While they often serve adaptive functions, they have also been linked to the onset and persistence of affective disorders. Sleep is frequently disturbed in these conditions and has been proposed to play a key role in emotional memory processing. Empirical evidence, however, remains inconclusive, and theoretical accounts diverge: whereas some suggest sleep preserves or amplifies memories’ emotional tone, others propose a downregulating effect of sleep. This dissertation investigated whether, and under what conditions, sleep modulates the emotional impact of memories. Across a series of studies, we combined naturalistic paradigms with behavioural and psychophysiological measures. Using socially distressing tasks, we induced autobiographical experiences and later reminded participants of them after intervals including either sleep or wakefulness. Emotional responses triggered by the previously induced memories were assessed through subjective ratings and physiological measures (e.g., facial blushing). Contrary to our predictions, sleep could not be reliably linked to changes in the emotional tone of memories. The observed alterations in emotional responses were often unrelated to memory and sleep. Instead, findings suggest that factors such as future relevance and sleep quality may moderate emotional memory processes. Together, these results highlight the complexity of the relationship between sleep and emotional memories and challenge the idea of sleep as a simple mechanism for reducing or amplifying memories’ emotional tone. While healthy sleep may support general emotion regulation, it does not consistently reshape emotional memories. This work underscores the need for more nuanced models to capture how emotional experiences are processed over time
The diverse roles of FoxO6 in the developing and adult mouse brain
Full text linkFoxO proteins are known to be involved in a wide array of biological processes, including apoptosis, cellular survival, differentiation and stress resistance. Recently, it came to the attention that FoxO6 displays a specific temporal and spatial expression pattern in the brain, implying that FoxO6 plays a role in the central nervous system. In this thesis the aim was to characterize the function of FoxO6 in the developing and adult mouse brain. Using different FoxO6 deficient animal models, we show that embryonic cortical cells are unable to migrate properly to the superficial layers of the cortex during cortical development. We also identified multiple target genes of FoxO6 and show that ectopic expression of one identified factor, Plxna4, was able to restore the hampered migration. Furthermore, we analyzed the effects of FoxO6 deficiency in the postnatal brain which showed phenotypical changes that resemble pathological changes observed in Cortical Malformation Syndromes, suggesting an involvement of FoxO6 in the development of cortical malformations. Next to these changes in cortical migration we observed other changes indicating that FoxO6 has multiple roles in the developing and adult brain. These overall changes are (more) complex and might even be related to each other. In summary, the research performed in this thesis contributes to the general knowledge of the developing cortex and provides novel insights in the role of FoxO6 and its downstream targets in multiple processes related to brain development and functioning
Ouder worden als ervaring:Een dialogisch onderzoek naar waarheid en betekenis van ouder worden in de 21e eeuw
Full text linkNooit eerder werden zoveel mensen zo oud als nu, in het begin van de eenentwintigste eeuw: wij worden massaal ouder. Tijdens een decennialange volwassenheid zijn ziekte en dood voor veel mensen bijna afwezig: onze jeugd lijkt eindeloos. In deze snel veranderende samenleving zijn levenservaring en verworven kennis niet altijd inzetbaar: die lijken al snel ouderwets. Dit alles maakt ouder worden tot een andere ervaring dan in alle vorige eeuwen. Een andere ervaring ook dan gangbare culturele narratieven ons doen geloven. Ouder worden is niet ‘jong’ blijven. Evenmin is het alleen maar verlies. Wat is de waarheid van ouder worden dan wel? En hoe kun je daaraan betekenis geven?Filosoof Suzanne Biewinga onderzoekt de mogelijkheid van een nieuwe verwoording van waarheid en betekenis van ouder worden, aansluitend bij de ervaringen, inzichten, zorgen en verlangens van ouderen zelf. In haar filosofiewerkplaats gaat zij met groepen ouderen in dialoog over waarden en heikele punten van ouder worden. In wisselwerking met deze groepsgesprekken bestudeert zij het werk van hedendaagse denkers en wetenschappers over de menselijke ervaring als verlangend, belichaamd, sociaal en eindig wezen. Onderzoek naar de filosofieën van stoïcijnen en epicuristen uit de Grieks-Romeinse tijd biedt een referentiepunt om in de huidige tijd vernieuwend te denken en spreken.Zo ontstaat een nieuwe semantische ruimte: geen alternatief standaardnarratief maar een talige, denk- en ontmoetingsruimte waarin klassieke waarden en deugden een eigentijdse in- en aanvulling krijgen. Een pleidooi voor een maatschappelijke bewegingsruimte, waarin ouder worden verschijnt als een leven dat ouderen daadwerkelijk kunnen en willen leiden