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Imagining China:The discursive construction and circulation of the nation in Chinese cyberspace
No full textPersonalized music in healthcare
No full textPersonalized music has the most significant effect on pain relief. While previous studies have shown that music can positively influence pain, anxiety, stress, sleep, and delirium in hospitalized patients, it was unclear which type of music worked best for which patient and context. Many of these studies lacked diversity in their participant groups, prompting this thesis to investigate the impact of music on pain across individuals from varied socio-cultural backgrounds. It also includes a comparative study of five music genres – urban, electronic, classical, rock, and pop. Both studies found that preferred music, regardless of music genre or socio-cultural background, consistently reduced pain more effectively than non-preferred music. A global survey across 20 countries with over 33,000 participants revealed that almost 90% of people would like to listen to music when in pain. The thesis further explores how music is implemented in healthcare from the patient’s perspective, showing that many patients are unaware of the option, and even when they are, they often feel uncomfortable and/or awkward requesting it, or fear judgment from medical staff regarding their musical taste
Taking participatory democracy seriously:Exploring the content and implementation of an EU constitutional principle
No full textIn response to the longstanding debate over the EU democratic deficit, the Treaty of Lisbon introduced Article 11 TEU which enshrines the principle of participatory democracy in a way that complements representative democracy in the Union. More than fifteen years after the entry into force of the Treaty of Lisbon, many different participatory mechanisms have been put into practice, but their reach is limited and their function is criticized as problematic. Furthermore, the boundaries of participatory democracy in the EU remain ambiguous, giving rise to divergent views and uncertainty about its purpose. This raises the question: To what extent does Article 11 TEU facilitate the development of citizen participation in the EU? This dissertation addresses this question by proposing a holistic interpretation of Article 11 TEU. Based on the text, context and purpose of the provision in its entirety, it clarifies the meaning of participatory democracy under the current EU constitutional framework and highlights the role of Article 11 TEU as a constitutional yardstick according to which all participatory opportunities should be structured and against which they need to be assessed. Against this benchmark, four key participatory mechanisms (European Citizens’ Initiative, consultations, lobbying and European Citizens’ Panels) are critically assessed to determine how EU institutions have implemented — or failed to implement — the obligations stemming from Article 11 TEU.<br/
“We’re in this Together”:Trauma-focused inpatient family treatment: An evaluation of the KINGS program
No full textFamilies affected by chronic adversity, trauma, and cumulative stressors often face problems that extend across generations. For these families, standard trauma-focused or parenting-focused interventions frequently prove insufficient, as safety concerns, complex symptom profiles, and unstable living conditions hinder sustained engagement and improvement. This dissertation examines KINGS (a Dutch acronym for Child IN Healhy System), an intensive inpatient trauma-focused family program designed to address such intertwined difficulties at the level of the whole family system.Using five complementary studies, the dissertation (1) maps international models of Shared Family Care, (2) describes the characteristics and histories of families entering KINGS, (3) documents the intervention elements applied in daily practice, and (4–5) analyses patterns of short-term individual change and longer-term family outcomes as reported across multiple time points.This dissertation contributes to the limited empirical literature on inpatient, trauma-informed family interventions and offers insights into how change unfolds in families with complex and multiple problems. The results underscore the importance of integrated, family-centered approaches and highlight the need for tailored post-program support to help families sustain progress in their home environments
Taking participatory democracy seriously:Exploring the content and implementation of an EU constitutional principle
No full textIn response to the longstanding debate over the EU democratic deficit, the Treaty of Lisbon introduced Article 11 TEU which enshrines the principle of participatory democracy in a way that complements representative democracy in the Union. More than fifteen years after the entry into force of the Treaty of Lisbon, many different participatory mechanisms have been put into practice, but their reach is limited and their function is criticized as problematic. Furthermore, the boundaries of participatory democracy in the EU remain ambiguous, giving rise to divergent views and uncertainty about its purpose. This raises the question: To what extent does Article 11 TEU facilitate the development of citizen participation in the EU? This dissertation addresses this question by proposing a holistic interpretation of Article 11 TEU. Based on the text, context and purpose of the provision in its entirety, it clarifies the meaning of participatory democracy under the current EU constitutional framework and highlights the role of Article 11 TEU as a constitutional yardstick according to which all participatory opportunities should be structured and against which they need to be assessed. Against this benchmark, four key participatory mechanisms (European Citizens’ Initiative, consultations, lobbying and European Citizens’ Panels) are critically assessed to determine how EU institutions have implemented — or failed to implement — the obligations stemming from Article 11 TEU.<br/
Macrophage-augmented organoids:Unraveling host-virus interactions for advancing therapeutic strategies
No full textAccounting for the start of life:Shifting practices, costs, and value in an IVF clinic
No full textRising healthcare costs are a major societal concern. Yet, little is known about how costs or shortages impact medical practice, or how accounting systems can improve decision-making as care is increasingly personalized to individual patients. This dissertation investigates the co-creation and implementation of a cost management system in a fertility clinic as part of a value-based healthcare (VBHC) strategy, focusing on how clinicians use and shape accounting. It explores (1) how cost concerns impact daily medical decisions, (2) how cost variation can be traced and managed, and (3) how enabling cost information improves workforce wellbeing across medical domains and contexts. Using a predominantly interventionist research design and a practice-theoretical lens, the research combines ethnographic and quantitative methods across eight studies to develop and evaluate a tailored system—time-driven activity-based costing with process mining (TDABC-PM). Drawing on a decade of fertility care data (4190 pregnancy trajectories, 18 445 treatments), it shows how care pathway re-design (three care delivery changes) significantly reduced costs (€322–€4,089 per patient, about €1.3m nationally) and improved time-to-pregnancy. A national survey across medical domains further reveals how enabling cost information improves psychological wellbeing and motivation in the workforce.The research introduces the concept of teleological indeterminacy to examine how manager’s and clinician’s engagement with accounting practices impacts their situational judgments of what resource use is appropriate for specific patients. It advances understanding of how cost management systems—when designed with and for users—can improve care value, financial sustainability, and workforce wellbeing. It offers practical and theoretical contributions to tackling cost containment and workforce issues simultaneously.<br/
Synchronising pluripotency progression and morphogenesis during mammalian embryonic development
Get PDFIn this thesis, we investigated how the developing mouse embryo synchronizes cell state transitions with morphogenesis during peri- to early post-implantation. During this phase, the epiblast transitions from naïve to primed pluripotency while forming a rosette-like structure that opens to form the egg cylinder.To understand how epiblast morphogenesis and differentiation are coordinated, we first examined the regulation of pluripotency transitions. WNT and LIF maintain naïve pluripotency, while FGF/MEK signaling promotes progression to the primed state. Notably, WNT must be downregulated before MEK can induce differentiation, suggesting that WNT either blocks MEK activity or that an intermediate, MEK-responsive state exists. We identified a distinct pluripotent state at the rosette stage, marked by co-expression of naïve markers and the primed marker OTX2. Due to its resemblance to the in vivo rosette-stage embryo, we termed this state rosette pluripotency. We show that WNT and MEK act sequentially to regulate entry to and exit from this state, and that their combined inhibition enables capture of rosette-like stem cells in vitro. Using rosette-like stem cells and in vitro morphogenesis models, we show that it is not the cell state transitions but the shared upstream signals that coordinate morphogenesis and differentiation. WNT and MEK regulate both processes via independent modules, enabling synchronized yet adaptable development.In conclusion, we identified a novel pluripotent state, its signaling regulation, and show how shared signals can independently govern morphogenesis and cell state transitions. This modular control supports robust, synchronized development within and across tissues and allows compensation when coordination is impaired.<br/
Synchronising pluripotency progression and morphogenesis during mammalian embryonic development
Get PDFIn this thesis, we investigated how the developing mouse embryo synchronizes cell state transitions with morphogenesis during peri- to early post-implantation. During this phase, the epiblast transitions from naïve to primed pluripotency while forming a rosette-like structure that opens to form the egg cylinder.To understand how epiblast morphogenesis and differentiation are coordinated, we first examined the regulation of pluripotency transitions. WNT and LIF maintain naïve pluripotency, while FGF/MEK signaling promotes progression to the primed state. Notably, WNT must be downregulated before MEK can induce differentiation, suggesting that WNT either blocks MEK activity or that an intermediate, MEK-responsive state exists. We identified a distinct pluripotent state at the rosette stage, marked by co-expression of naïve markers and the primed marker OTX2. Due to its resemblance to the in vivo rosette-stage embryo, we termed this state rosette pluripotency. We show that WNT and MEK act sequentially to regulate entry to and exit from this state, and that their combined inhibition enables capture of rosette-like stem cells in vitro. Using rosette-like stem cells and in vitro morphogenesis models, we show that it is not the cell state transitions but the shared upstream signals that coordinate morphogenesis and differentiation. WNT and MEK regulate both processes via independent modules, enabling synchronized yet adaptable development.In conclusion, we identified a novel pluripotent state, its signaling regulation, and show how shared signals can independently govern morphogenesis and cell state transitions. This modular control supports robust, synchronized development within and across tissues and allows compensation when coordination is impaired.<br/