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Microcirculatory alterations in critically ill patients and the effect of venous congestion on kidney function
Full text linkHemodynamic management of critically ill patients aims to provide optimal hemodynamic support to maintain oxygenation. In routine clinical practice, macrohaemodynamic parameters such as systemic blood pressure, heart rate, and cardiac output are used as indices for assessing hemodynamic status. However, in states of cardiovascular compromise, improvement in systemic hemodynamic parameters following resuscitation does not necessarily correspond to a similar improvement in the microcirculation. This discrepancy between macro- and microcirculation is referred to as "loss of hemodynamic coherence," which underscores the necessity for microcirculatory monitoring of critically ill patients.The kidneys are among the primary organs that are particularly susceptible to the effects of hemodynamic changes and hypoxia, which can ultimately result in the development of acute kidney injury. The kidneys and heart exhibit a close bidirectional interaction, whereby injury of one organ can affect the other. This concept is known as cardiorenal syndrome and has a significant impact on the morbidity and mortality of critically ill patients.In the current thesis, we investigate the nature of microcirculatory alterations in critically ill patients using bedside microcirculatory hand-held vital microscopy techniques to visualize their anatomy, hemodynamics, and (patho)physiology. We have also characterized acute kidney injury in hemodynamically compromised patients, particularly in the setting of venous congestion.<br/
Taking marketing seriously:A law and economics analysis of personalized marketing in the digital age
Full text linkImagine every ad, every price, and even every contract completely tailored to you personally — welcome to the age of AI-driven hyper-personalization.Today, vast amounts of consumer data can be collected and processed, creating consumer profiles that are individualized with ever-increasing precision. This has paved the way for one-to-one interactions that can be adjusted in real-time and lead to unparalleled behavior modification. Personalized marketing promises to respond more accurately to consumer needs and preferences, elevating the effectiveness of marketing communications to new heights. However, this seemingly customized digital world is accompanied by serious concerns about the alarming potential of personalized marketing to exploit consumers’ cognitive biases, heuristics, and vulnerabilities. The power of hyper-personalization to subtly bend consumer behavior to the will of companies and give marketers unprecedented control raises the question of the extent to which this could lead to a significant deterioration of consumers’ position in the market.This dissertation analyzes personalized marketing from a law and economics perspective to expose and contrast its promises and perils. In doing so, it examines the extent to which personalized marketing is regulated by the EU legal framework. The research shows that current European consumer policy can only partially protect consumers. A four-part policy approach is therefore proposed to adequately address personalized marketing and safeguard consumer autonomy, equity, and welfare.Regulating personalized marketing is a complex task characterized by a clear trade-off between efficiency and fairness. How much freedom do you give up in exchange for a hyper-personalized experience? How confident are you that the price you pay will not exceed what others pay for the exact same service? And what does it mean for your autonomy when an algorithm predicts your behavior better than you do yourself? This dissertation seeks to provide a starting point for further regulation and ultimately contribute to better consumer protection in the digital age.<br/
Neural mechanisms of associative motor learning: ''Insights into memory formation and skill acquisition''
Full text linkThis PhD dissertation centers on the exploration of how memory formation occurs in thebrain, with a specific focus on memory formation during associative motor learning. Thekey questions addressed are related to the neurological processes that take place whenacquiring new motor skills, aiming to uncover the underlying neural mechanisms thatallow us to time our movements with precision at a millisecond level. Therefore, I haveemployed a basic classical eyeblink conditioning paradigm, better known as Pavlovianeyeblink conditioning. This paradigm is chosen due to the well-defined nature ofthe neuronal circuits involved in eyeblink conditioning, making it an ideal model forstudying the processes of neuronal plasticity within these circuits during the formationof memories in a healthy and disordered brain. To study these processes, I focused onexploring stimulus generalization and stimulus discrimination as well as the impact ofenvironmental enrichment on eyeblink conditioning. Further, I investigated the role ofthe metabotropic glutamate receptor (GRM7) in mGluR7 knockout and Purkinje cell-specific tamoxifen induced mice to assess the timing of the eyeblink response and thesensorimotor deficits present in neurofibromatosis type 1 and spinocerebellar ataxia1 mouse models. Finally, I also studied how to use mobile phone-based technology tostudy eyeblink conditioning in humans. These studies are conducted in conjunctionwith the eyeblink conditioning paradigm.<br/
Between expectations and reality:A study on the effectiveness of the OECD guidelines for multinational enterprises’ NCP
Full text linkOn being education nomads:Mongolian herders’ children straddling ways of knowing and relating
No full textOn Being Education Nomads explores how the convergence of pastoralism, schooling and digital ICT development shapes the education and future aspirations of Mongolian herder’s children. Drawing on visual participatory data, semi-structured interviews and qualitative surveys that are grounded in multi-sited ethnographic research, it demonstrates that Mongolian herder’s children become education nomads by straddling the herder and schooled urbanite communities of practice. Deploying education nomads as a generational identity marked by Mongolian rural youth’s concurrent participation in herding, schooling and digital practices, this research maps out how herder’s children orient towards urban professional aspirations while building their capacity to navigate Mongolia’s rural-urban continuum for multiple futures.Using a generationed and socio-ecological approach to development, this research examines not only how education shapes learners and the places that they inhabit but also how learners shape education and their learning socio-ecologies. This manuscript adds young people’s experiences to the literature on Mongolia’s development and brings a development perspective to the sparse body of literature on Mongolian childhood and youth. Foregrounding the perspectives and lived experiences of rural young lives from a non-Western and non-sedentary society, On Being Education Nomads contributes critical insights on the crosscutting themes of mobility, education, aspiration and ICT4D to the field of children and youth studies.<br/
Cognitive and behavioral characteristics of neurofibromatosis type 1:From etiology to therapeutic strategies
Full text linkNeurofibromatosis type 1 (NF1) is a relatively common monogenetic disorder, primarily diagnosed based on somatic features affecting the skin and nervous system. Beyond these physical characteristics, most individuals with NF1 show distinct characteristics in cognitive, behavioral, and motor domains, which profoundly impact their daily lives and educational outcomes. The cognitive and behavioral characteristics associated with NF1 are linked to disrupted molecular mechanisms that lead to increased GABAergic inhibition and subsequent synaptic plasticity. This thesis aims to improve our understanding of the cognitive and behavioral characteristics associated with NF1 and aims contribute to the development of effective treatments and support for these characteristics in children and adolescents with NF1.<br/
Frugal innovation beyond its surface:The relevance of context for understanding the concept and its relation to sustainability
No full textTaking a deeper dive into the exploration of frugal innovation than what is found in current discourse, this article-based PhD thesis contributes to existing literature by emphasizing and operationalizing the relevance of contextual considerations for the study of frugal innovation, thereby advancing previous research that has noted the influence of context in the understanding of frugality in innovation. The work proposes two analytical frameworks that make this relevance operational by explicitly including the context as a criterion for the identification of frugal innovation and for the assessment of its relation to sustainability. This PhD thesis also makes a methodological contribution by exploring various techniques for qualitative inquiry and using them to gather and analyze primary and secondary data. In particular, the use of mind maps for qualitative data analysis in multiple-case study research makes a genuine contribution to knowledge by proposing a distinct way for accessing and analyzing qualitative data.While frugal products, services, processes, and business models do have the potential to contribute to sustainable development, as demonstrated by an increasing amount of empirical evidence, this PhD research is positioned within the growing set of literature that indicates that frugal innovations are not inherently sustainable. Frugal innovations may have both a positive and a negative influence on the social, environmental, and economic dimensions, and may inadequately address, or even (unintendedly) worsen, the root causes of socio-developmental challenges faced by communities in resource-scarce settings. Thus, this PhD thesis argues that an adequate consideration of local contextual conditions is essential in assessing frugal innovation to make it more responsive and appropriate for its intended users and their lived reality. The knowledge generated in this thesis is relevant because, while frugal innovation literature has experienced an upsurge in the past few years, the existing frugal innovation scholarship is predominantly focused on technological and innovation aspects of products, paying very little attention to contextual issues. Given its focus of analysis, this thesis makes an empirical contribution to both frugal innovation and social enterprise discourse by introducing new cases from Latin America, a region which is comparatively underrepresented in both of these sets of academic literature.<br/
Optimization of treatment, care and patient-centeredness in GIST and soft tissue sarcoma patients
No full textThis thesis aimed to shed light on the care pathways of patients with gastrointestinal stromal tumors (GIST) in the Netherlands and explored patient-centered approaches for individuals diagnosed with GIST and soft tissue sarcomas (STS), which served as a common thread throughout this thesis. This thesis integrated insights from clinical, registry-based, and patient-reported data, underscoring the challenges inherent in managing these rare cancer types. We demonstrated that most high-risk and metastatic GIST patients are referred to reference centers. The rare subset of patients with SDH-deficient GIST requires a different approach compared to patients with KIT-PDGFRA mutated GIST. A collaborative project with the Sarcoma Patient Advocacy Global Network (SPAGN) identified priorities for research and patient advocacy from the patients’ perspective, revealing variations across subgroups of patients. This thesis also highlighted the financial toxicity often experienced by STS patients. Finally, it emphasized the importance of PatientReported Outcomes (PROs) in guiding the decision-making process for initiating palliative chemotherapy in STS patients.<br/