Leiden University Scholary Publications
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Het standstillbeginsel uit het VN-verdrag Handicap in de wetgevingspraktijk: een kroniek van verwaarlozing die geïllustreerd wordt door het Wetsvoorstel vervanging abonnementstarief Wmo 2015
Full text link Het VN-verdrag inzake de rechten van personen met een handicap (VN-verdrag Handicap) schrijft een interpretatie van onze universele mensenrechten voor die specifiek toegespitst is op de huidige maatschappelijke achterstelling van mensen met een functiebeperking. Belangrijk hierbij is het standstillbeginsel, een principe uit het internationaal recht dat ook is vastgelegd in het VN-verdrag Handicap zelf. Dit houdt in dat verdragsstaten de geboekte vooruitgang inzake de verwezenlijking van de rechten van mensen met een functiebeperking niet zomaar ongedaan kunnen maken. De Nederlandse wetgever lijkt hier in de tien jaar sinds de ratificatie van het verdrag echter relatief weinig aandacht aan te hebben geschonken. En dit zien we ook in het centrale voorbeeld van deze bijdrage: het Wetsvoorstel vervanging abonnementstarief Wmo 2015. De voorgestelde eigen bijdrage voor onder andere maatwerkvoorzieningen lijkt namelijk strijdig te kunnen zijn met het standstillbeginsel, en dat terwijl er mogelijke alternatieve benaderingen zijn. FGW – Publications not associated with a particular research are
Bioavailability of heavy metals in soil: a review of tools, models, and regulatory applications
Full text linkBioavailability plays a pivotal role in determining the environmental and health risks associated with heavy metals in soils. While total metal concentrations are often measured, they do not necessarily reflect the fraction that is accessible to biota or capable of inducing toxic effects. The bioavailable fraction is influenced by a multitude of soil characteristics, including pH, organic matter content, redox conditions, and microbial activity. Over the past two decades, considerable research efforts have been devoted to developing reliable, reproducible, and cost-effective methods for assessing the bioavailability of metals in various soil contexts. This review provides a comprehensive synthesis of the most widely used chemical extractants, including CaCl2, diethylenetriaminepentaacetic acid (DTPA), and ethylenediaminetetraacetic acid (EDTA), as well as sequential extraction procedures such as the BCR method. Their strengths, limitations, and selection criteria are discussed in detail. Additionally, biological assays, including plant uptake studies, microbial bioassays, and enzymatic activity evaluations, are evaluated for their utility in capturing ecologically relevant endpoints. Recent advances in molecular microbiology, including high-throughput sequencing and metagenomic analyses, offer novel insights into microbial responses to metal stress and are increasingly integrated into bioavailability assessment frameworks. The review also explores integrative modeling approaches that combine empirical data with theoretical frameworks, such as biotic ligand models and geochemical speciation models. These models are instrumental in translating laboratory findings to field-scale predictions, and have been adapted for use in both aquatic and terrestrial environments. Case studies from Europe, North America, and China are presented to illustrate the diversity of approaches and highlight region-specific practices. These examples underscore the need for harmonization and standardization in bioavailability assessment protocols. The regulatory landscape is examined, revealing varying degrees of recognition and incorporation of bioavailability concepts across jurisdictions. The European Union, for example, increasingly mandates bioavailability-informed assessments under frameworks such as the REACH regulation, whereas other regions are at different stages of implementation. Ultimately, the review provides a decision-making framework for selecting suitable tools based on site-specific conditions, assessment objectives, and regulatory requirements. The proposed decision tree integrates chemical, biological, and modeling approaches to support holistic risk assessments. Future directions are discussed, emphasizing the importance of cross-disciplinary collaboration, field validation, and the development of bioavailability-based guidance values.Environmental Biolog
Sowing seeds: supporting initiation and engagement of advance care planning in general practice
Full text linkThis dissertation focuses on supporting the initiation and implementation of advance care planning (ACP) in general practice for older people and patients with chronic-progressive diseases. ACP enables patients to express and communicate their values, goals, and preferences for future medical care. Although general practitioners (GPs) are ideally positioned to conduct these conversations, ACP is still insufficiently applied in daily practice. This thesis addresses two main challenges: limited ACP training in GP education and difficulty identifying suitable moments to start ACP. It explores an educational tool to support GP trainees in learning how to conduct ACP conversations. Using a phenomenological interview study, GP residents’ experiences with virtual simulation were examined. Further, it focuses on using routine primary care data to support timely ACP initiation. Using health record (survey) studies and a nested case-control study, the optimal time to initiate ACP were determined and this and its clinical triggers for it where identified in routine primary care data. Findings could lay the foundation for developing an automated identification tool within electronic health records to help GPs recognize patients who may benefit from ACP. The final discussion reflects on the findings of the chapters, current views on ACP, societal taboos, patient perspectives, several educational considerations for improving ACP training in GP residency, and offers recommendations for clinical practice and future research.LUMC / Geneeskund
Advancing FAIR practices in biomedical research: challenges, methods and innovations for sustainable data management
Full text linkThis thesis presents a comprehensive strategy to enhance FAIR (Findable, Accessible, Interoperable, and Reusable) data practices in biomedical research, focusing on rare diseases. It addresses the challenges of making sensitive, fragmented data FAIR, highlighting the crucial role of data stewards and collaborative "Bring Your Own Data" (BYOD) workshops in developing best practices. To structure these efforts, this work introduces GO-Plan, a goal-oriented method for creating clear FAIRification objectives. The thesis also examines how foundational ontologies can improve data interoperability. A key finding demonstrates that restructuring knowledge graphs (KGs) with ontology based conceptual models enhances the consistency of machine learning predictions without sacrificing performance.LUMC / Geneeskund
Match reflection and formation of transient toroidal helium plasma
Full text linkQuantum Matter and Optic
Pushed by markets, pulled by machines: economic pressures and the backlash to the European Union
Full text linkHervorming Sociale Regelgevin
Optimizing treatment for odontoid fractures in the elderly: a balancing act with the patient at center stage
Full text linkThis thesis investigates the treatment of odontoid fractures in elderly patients, a common injury of the second cervical vertebra (C2). These fractures mainly result from minor trauma in elderly patients, and the best treatment approach—surgical or conservative—remains debated. A systematic literature review in Chapter 2 of 41 studies found higher fracture union rates after surgery (73% vs. 40%) but no difference in stability or clinical outcomes. However, poor data quality and bias severely limited firm conclusions. Chapter 3 retrospectively examined Dutch practice variation, comparing surgical and conservative strategies; outcomes for union, stability, and mortality were largely similar. Chapter 4 described an international prospective study across 15 European centers showing no difference in clinical outcome, fracture union, and fracture stability between surgical and conservative treatment. Union was not clearly associated with clinical outcomes, suggesting treatment should emphasize favorable clinical over radiological outcomes. Chapter 5 evaluated Hounsfield unit (HU) measurements as predictors of fracture union but found no association; all patients exhibited low bone density, highlighting the need for osteoporosis screening. The thesis concludes that initial conservative management is justified, with surgery reserved as secondary treatment for relatively rare cases of persistent symptomatic non-union.Printing of this thesis was kindly supported by Dutch Spine Society, Anna Fonds Leiden, Globus NuVasive, MaxMoreSpine, InSpine, KM Innovations, ChipSoft.LUMC / Geneeskund
Synergistic biodegradation of polyethylene by experimentally evolved bacterial biofilms
Full text linkMicrobial Biotechnolog
Notes and observations on newly published Bactrian documents from Southern Afghanistan
Full text linkHorizon 2020(H2020)101088902Descriptive and Comparative Linguistic
Help provided by community-dwelling older adults in the Netherlands during the COVID-19 pandemic
Full text linkThe politics and administration of institutional chang