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COMING SOON: Hoe dacht de middeleeuwer over de ideale date?
Dating was een leuk en spannend onderwerp in de middeleeuwen, juist omdat seksualiteit toen eigenlijk primair binnen het huwelijk hoorde te worden beleefd. Er hing bovendien nogal wat af van wat je uitspookte op liefdesgebied, vooral als jongvolwassene. Zaken als de juiste partnerkeuze en het behoud van maagdelijkheid konden met name voor vrouwen en meisjes immers bepalend zijn voor hun verdere leven. Het was dus belangrijk dat de datingfase van de relatie soepel verliep. Maar hoe zag een ideale date er naar middeleeuws idee eigenlijk uit? Met wie beleefde je die en wat stond er te gebeuren? Welke rollen en idealen waren weggelegd voor mannen en vrouwen? En wat kon je doen als het niet ging zoals gehoopt, zoals bij een afwijzing of bij spijt? Aan de hand van het bekende en geliefde Antwerps liedboek (1544) reconstrueert Cécile de Morrée op levendige wijze laatmiddeleeuwse visies op liefde, daten en seks vóór het huwelijk in de Lage Landen. Het liedboek biedt een inkijkje in een samenleving waarin gelijkwaardigheid, wederzijds respect en consent als belangrijke waarden in relaties golden. Hoewel opvattingen over seks en dating zijn veranderd, zijn de vragen die de middeleeuwer zich stelde verrassend actueel gebleven.
Copyright (c) 2026 Cécile de Morrée (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Shalawat Performance and Cultural Resistance
This study examines how the traditional Islamic ritual of maulid (celebration of Prophet Muhammad's birthday) has been transformed into popular shalawat performances in Surakarta (Solo), Indonesia. The research focuses on how these performances function as forms of cultural resistance against both Salafi criticism of traditional practices and the influence of radical Islamic movements. Drawing on fieldwork conducted between 2017-2018, the study analyses how performers and participants navigate tensions between religious authenticity and contemporary cultural expression, creating what I term "public resilience" - a sustained capacity to preserve religious traditions while countering radical narratives. Using theoretical frameworks from discursive tradition, religious authority, and popular culture, the research examines five shalawat groups in Surakarta, including the influential Habib Syech bin Abdul Qadir Assegaf's Ahbabul Mustofa. This work contributes to our understanding of how traditional religious practices adapt to contemporary challenges while maintaining their spiritual essence and building community resilience against radicalism.
Copyright (c) 2025 Muhammad As’ad (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Copyright (c) 2025 Rebecca Verheggen (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Precision Utilization of Extracellular Vesicles
Copyright (c) 2025 Peng Wang (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Mechanism behind clinical symptoms in cerebral small vessel disease
Cerebral small vessel disease (SVD) affects the brain’s small vessels and is a major cause of vascular cognitive impairment and dementia. Conventional MRI markers such as white matter hyper-intensities (WMH), lacunes, and micro-bleeds capture only part of the underlying pathology, failing to explain the marked heterogeneity in clinical symptoms among patients. This thesis applies advanced multi-modal neuroimaging, particularly diffusion imaging, to uncover mechanisms linking SVD damage to clinical manifestations. Three major mechanisms are explored: (1) strategic effects, focusing on damage to the thalamus and dopaminergic and cholinergic white-matter pathways; (2) remote effects, reflecting secondary neurodegeneration related to focal lesions like WMH and cortical microinfarcts (CMIs); and (3) waste-clearance dysfunction, involving perivascular pathways, choroid plexus, and deep medullary veins. By integrating these imaging markers with cognitive and clinical data, this work elucidates multi-level pathways through which SVD disrupts brain structure, providing insights for future diagnostic and therapeutic strategies.
Copyright (c) 2025 Hao Li (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Exploring Immune Checkpoints and Cytokine Signaling to Improve NK Cell Effector Function in Ovarian Cancer
The demonstration that ovarian carcinoma (OC) is an immunogenic disease, opens opportunities to explore immunotherapeutic interventions to improve clinical outcome. In this regard, NK cell based immunotherapy could be promising as it has been demonstrated that OC cells are susceptible to killing by cytokine-stimulated NK cells. Here, we evaluated whether percentage, phenotype, function and IL-15 responsiveness of ascites-derived natural killer (NK) cells is related to progression-free survival (PFS) and overall survival (OS) of advanced stage OC patients. Generally, a lower percentage of NK cells within the lymphocyte fraction was seen in OC ascites (mean 17.4 ± 2.7%) versus benign peritoneal fluids (48.1 ± 6.8%; p < 0.0001). Importantly, a higher CD56+ NK cell percentage in ascites was associated with a better PFS (p = 0.01) and OS (p = 0.002) in OC patients. Furthermore, the functionality of ascites-derived NK cells in terms of CD107a/IFN-γ activity was comparable to that of healthy donor peripheral blood NK cells, and stimulation with monomeric IL-15 or IL-15 superagonist ALT-803 potently improved their reactivity towards tumor cells. By showing that a higher NK cell percentage is related to better outcome in OC patients and NK cell functionality can be boosted by IL-15 receptor stimulation, a part of NK cell immunity in OC is further deciphered to exploit NK cell based immunotherapy.
Copyright (c) 2025 Ralph Maas (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Malaria remains a major global health challenge, with Plasmodium falciparum responsible for most morbidity and mortality. This thesis explores strategies to reduce malaria transmission through both drug- and antibody-based interventions. In three phase 2 clinical trials in Mali, we evaluated how different antimalarial regimens influence gametocyte carriage and infectiousness to mosquitoes, demonstrating variable transmission-reducing activity across artemisinin-based and non-artemisinin combination therapies, and highlighting the potential of adding low-dose gametocytocidal drugs such as primaquine or tafenoquine. We further assessed the transmission-blocking vaccine candidate R0.6C and the monoclonal antibody TB31F in first-in-human studies, showing that both are safe and immunogenic, with TB31F providing potent and long-lasting functional activity. A life cycle assessment of a malaria clinical trial quantified its environmental footprint, identifying key contributors and mitigation strategies. Finally, a phase 1 study of the SARS-CoV-2 vaccine candidate ABNCoV2 provided the first clinical evaluation of the modular capsid virus-like particle (cVLP) platform, demonstrating its safety, tolerability, and immunogenicity in humans. Collectively, these studies advance integrated and sustainable strategies to block Plasmodium falciparum transmission and support malaria elimination.
Reducing Plasmodium falciparum transmission
Copyright (c) 2025 Merel Smit (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Housing shortages remain a persistent global challenge shaped by demographic, economic, and institutional dynamics. In Indonesia, housing demand far outpaces supply: around 800,000 new units are needed annually, yet only about 350,000 are produced by the formal sector, leaving millions dependent on informal solutions. This dissertation examines how the structure of housing provision and public policy interact to shape formal housing development in Indonesia’s evolving market economy. Revisiting Turner’s (1972) concept of housing as a verb and extending it through Adams’s (1994) market-process perspective, the study conceptualizes housing as a dynamic governance process shaped by negotiation, contestation, and adaptation among multiple actors. Through four empirical studies, it analyzes: (1) the transformation of Indonesia’s housing provision structure and the rise of financialization; (2) the evolution of affordable housing policy under public–private interplay; (3) the role of land policies and speculative land banking; and (4) the institutional and market factors driving development delays. The dissertation contributes theoretically by repositioning housing provision as an institutionalized process of governance, and empirically by revealing how speculation, inefficiency, and fragmented regulation reproduce housing gaps. It offers practical insights for strengthening policy integration, land governance, and regulatory capacity toward more inclusive and efficient housing delivery.
Copyright (c) 2025 Dian Rahmawati (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Advanced image-guided diagnosis and staging in patients with early-stage lung cancer
This thesis explores how diagnostic and staging practices in early-stage lung cancer can be improved through advanced imaging techniques. The first part focuses on the feasibility of a sentinel lymph node procedure, similar to those used in other cancers. While intraoperative application using indocyanine green proved successful, the procedure performed during diagnostic navigation bronchoscopy was technically feasible but insufficiently reliable for identifying lymph nodes on imaging. The second part evaluates current diagnostic strategies. Routine use of endobronchial ultrasound in patients with small peripheral nodules was found to be valuable only in patients with imaging-based suspicion of lymph node metastasis. Furthermore, long-term follow-up of patients revealed that the risk of developing a second primary lung tumor is higher than previously assumed. This thesis contributes to improved diagnostic decision-making and personalized care for people with early-stage lung cancer, offering new insights for earlier detection of recurrent or new disease.
Copyright (c) 2025 Desi ter Woerds (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Statistical Estimation and Innovation in Oncology Trials
This thesis investigates estimation in innovative oncology trial designs, with emphasis on basket and master protocols. It links design choices to estimators and quantifies trade-offs between bias, variance, and interpretability. Chapter 2 develops an unbiased UMVUE and exact confidence intervals for response rates in stopped Simon's two-stage designs, showing that early stopping can save resources while modestly reducing precision. Chapter 3 studies the Restricted Mean Duration of Response (RMDoR) under right/interval censoring, clarifying the role of the truncation time τ, proposing practical estimators, and demonstrating that RMDoR ratios provide robust, comparable efficacy summaries. Chapter 4 benchmarks Bayesian information-borrowing estimators for cohort-specific response in single-stage basket trials, revealing context-dependent performance and sensitivity to prior specification. Chapter 5 extends the evaluation to two-stage basket designs (motivated by DRUP), introducing simulation-based tuning to select models and hyperparameters under mean and worst-case utilities; 4 methods was used on this research, EXNEX is generally stable, while Berry, Psioda, and Fujikawa can excel when carefully tuned. Overall, the work argues that estimation is integral to design, advocates prespecifying borrowing strategies and parameter grids, and highlights the need for clearer guidance on transparent prior/tuning choices in precision-oncology trials.
Copyright (c) 2025 Antonios Daletzakis (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Contemporary careers, including those of teachers, are becoming increasingly dynamic and longer. Simultaneously, the education sector faces personnel shortages and increasing aging. This dissertation investigates how educational institutions can support teachers' sustainable careers, focusing on strengthening affective commitment and stimulating proactive career behavior (job crafting and career crafting), essential for maintaining person-career fit over time. Four empirical studies among teachers in the Netherlands (MBO/HBO) and Flanders (secondary education) provided the following insights. Servant leadership positively relates to affective commitment, mediated by leader-member exchange (LMX) and the social climate within the school. Servant leadership also positively relates to job crafting (specifically seeking resources), mediated by the satisfaction of basic psychological needs for autonomy and relatedness. The relationship between subjective career success (satisfaction) and proactive career reflection appears U-shaped, with both low and high satisfaction correlating with more reflection. However, dissatisfied teachers seem less likely to take action to realize goals, possibly due to a lack of resources. Finally, inclusion within the team (experiencing uniqueness and belongingness) positively correlates with proactive career construction. Findings suggest that educational institutions benefit from investments in servant leadership, providing resources, and promoting inclusion.
Copyright (c) 2025 Elias Janssen (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
While theoretical models increasingly use Bayesian frameworks to explain neural processing, a significant gap exists in understanding how these mathematical principles are biologically implemented. This thesis proposes that serotonin serves as a biological mechanism for precision modulation in predictive processing, tested through experiments on exploratory behavior, perceptual illusions, and psychedelic-induced neural states. The research reveals how serotonergic modulation in rodent whisking behavior demonstrates precision weighting as a key mechanism influencing sensory processing. Using active inference frameworks, the work shows serotonin modulates the precision of sensory inputs and prior habits, regulating exploratory behavior and environmental sampling. Robotics experiments translate these biological insights into artificial systems, demonstrating how precision-based active inference can guide autonomous behavior in humanoid robots through adaptive sensorimotor control and efficient information seeking. Theoretical work on attention and body ownership illusions explores precision control in embodied systems. Mathematical modeling of the rubber hand illusion shows how the brain arbitrates between competing sensory models via precision-weighted inference. Analysis of psilocybin's neural effects demonstrates that this serotonergic agent increases chaotic brain responses and neural transition complexity, supporting theories that psychedelics decrease hierarchical neural communication precision through fundamental reorganization of neural dynamics.
Copyright (c) 2025 Filip Novický (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Controlling magnetic order with minimal energy and on ultrafast timescales is a central challenge for next-generation spintronic and data-storage technologies. This work shows how femtosecond laser pulses and electric fields can steer spin and lattice dynamics in complex oxides far from equilibrium. The approach combines pump-probe spectroscopy, spatially resolved magneto-optical imaging, and electrical gating to capture magnetic and structural responses from femtoseconds to nanoseconds. Ultrafast imaging reveals that femtosecond optical excitation drives highly nonuniform spin dynamics in iron garnets, while electrical gating enhances and shapes these responses with potentially sub-diffraction precision. In Cr₂O₃, electric fields manipulate antiferromagnetic domains with spatial accuracy limited by the electrode size, demonstrating a strong magnetoelectric effect. In DyFeO₃, resonant electronic excitation generates Raman-forbidden THz phonons, uncovering a direct orbital–lattice coupling pathway. Together, these results establish a framework in which optical and electrical stimuli act in concert to control magnetic and lattice degrees of freedom with high speed and spatial precision, opening pathways toward ultrafast, energy-efficient spintronic and multiferroic devices.
Copyright (c) 2025 Timur Gareev (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Lower Genital Tract Infections in women in Kenya
The consequences of missed or mismanaged LGTI and RVVC are wide and dire for individual patients, their families, communities and governments; they include psychosocial and clinical complications, economic loss and wastages, and development of resistance to anti- microbials. My thesis work exposes the weightiness of the LGTI and RVVC problems and the challenges in management among women in Kenya, reveals preliminary RVVC-linked genomic and proteomics data unique to the local population, and showcases aspects of mucosal work relevant for LGTI and RVVC diagnostics and research. I detected concerning gaps in patient care. While syndromic treatment has been considered to be the befitting approach in LGTI management for Kenya and other resource-constrained environments, the approach has weaknesses and shortfalls including poor implementation, misuse of antimicrobials, and failures in treatment especially for patients with mixed or recurrent infections including RVVC. As crucial foundational pioneer ventures in an African population, I revealed distinct RVVC related genetic variations and the systemic proteome signature connected to RVVC. To improve patient outcomes in Kenya and similar environments, LGTI and RVVC management should be targeted and wholistic, with an interlinked approach advised by accurate diagnostics, including mitigating measures for any associated unfavourable psychosocial effects. This calls for further research to understand the enablers and barriers that impact accurate implementation of the syndromic treatment guidelines, design better performing treatment guidelines, develop feasible POC tests with easy and favourable implementation modes, and research towards a better understanding of the pathophysiology for targeted biomarkers and therapeutics for RVVC. There is thus a need for novel complementary and synergistic multidimensional approaches to the management of LGTI and RVVC, which calls for continued investment in healthcare infrastructure, training, oversight, timely corrective actions, and research.
Copyright (c) 2025 Gloria Omosa-Manyonyi (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Operator System Perspectives at Truncated Noncommutative Geometry
This thesis collects some contributions to the approach to noncommutative geometry in terms of spectral truncations. Connes—van Suijlekom proposed to study the operator systems arising as compressions of the C*-algebra by spectral projections of the Dirac operator in a spectral triple, and whether these compressions converge in a suitable sense to the original spectral triple when the spectral projections converge strongly to the identity. This question can be posed more precisely in Rieffel’s setting of compact quantum metric spaces, and with Kerr—Li’s quantum version of Gromov—Hausdorff distance for compact quantum metric spaces modeled on operator systems. We show that spectral truncations of (the canonical spectral triples associated to) tori converge in this quantum Gromov—Hausdorff sense. Moreover, we obtain a similar convergence result for coamenable compact quantum groups; in this case we consider compressions by projections arising from the Peter—Weyl decomposition, and general Lip-norms satisfying appropriate invariance properties. Last, we study the duality of operator systems of Toeplitz matrices which arise in truncations of discrete groups; in particular, we make the connections to sums of squares and extension problems for partially defined positive semi-definite functions precise.
Copyright (c) 2025 Malte Leimbach (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Refugee Entrepreneurship in the Netherlands
This research studies how entrepreneurship plays a role in the inclusion of refugee entrepreneurs in the Netherlands and how they navigate structural challenges and opportunities through an intersectional lens. Using a contextualized comparative approach, it draws on life stories of 29 refugee-background entrepreneurs from two distinct groups: Iranians (arriving in the 1980s–90s) and Syrians (arriving post-2015). Findings reveal that, despite four decades of policies promoting entrepreneurial inclusion, opportunities remain unevenly distributed. Both groups encountered persistent structural and institutional barriers, indicating that the Dutch context often fails to provide sufficient support for establishing and growing businesses. Nevertheless, entrepreneurship was widely perceived as a vital pathway to societal inclusion. For these entrepreneurs, business activities served not only as economic strategies but also as means of asserting agency, redefining identities, and building social connections. The study highlights the complexity of the Dutch integration system and the limitations of current policies in ensuring equitable opportunities. It calls for an inclusive, intersectional policy framework and systemic reforms to foster a more supportive environment for refugee entrepreneurship.
Copyright (c) 2025 Samaneh Khademi (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
This dissertation examines the relaunch and transformation of the European Commission’s Common Consolidated Corporate Tax Base (CCCTB) proposal in 2016. Initially introduced in 2011 as a voluntary, business-friendly framework for harmonizing EU corporate taxation, the CCCTB failed to gain political agreement. Its subsequent relaunch as a mandatory, anti–tax avoidance instrument marked a significant policy shift. Adopting a critical political economy perspective and employing the Historical Materialist Policy Analysis (HMPA) framework, this dissertation interprets EU tax policy as the outcome of a struggle between three competing hegemony projects: neoliberal, neomercantilist, and center-left. Drawing on expert interviews and extensive document analysis, four key explanatory factors for the CCCTB’s relaunch are identified: the post-crisis rise of a center-left project advocating tax justice; the enduring structural power of neoliberal forces that limits the possibilities for progressive change; member state budgetary and administrative concerns; and strategic action within the European Commission. Although center-left ideas reshaped the Commission’s framing of the CCCTB, persistent power asymmetries prevented its adoption, illustrating the structural constraints on progressive reform within EU corporate tax policymaking.
Copyright (c) 2025 Indra Römgens (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
This thesis is defining a new concept regarding what can be done to make an intercultural contact rewarding and positive for both participants. Constructive Intercultural Contact (CIC) is developed for organizations to help improving the cooperation between organization members of different cultural backgrounds. CIC is conceptualized researching organizational, intergroup and acculturation literature. Then, a scale for measuring CIC and a program for learning CIC are developed during a (quantitative) empirical research process. Finally, by a qualitative analysis of reflection reports about practicing CIC, is researched what happens when people are trying to do CIC. CIC contains 5 dimensions: (1) taking responsibility for the contact, (2) postponing judgement, (3) relativizing culture, (4) taking perspective and (5) showing respect.
Copyright (c) 2025 Hans Spijkerman (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
This thesis offers a critical examination of tourism through the interrelated lenses of power, inequality, and degrowth, questioning whether the sector can be reimagined in ways that promote greater justice and sustainability. It is organized into three sub-projects. The first investigates how overtourism reshapes residents’ perspectives, applying Mezirow’s Transformative Learning Theory to show that older generations often experience profound shifts in their views of tourism and capitalism, while younger residents tend to normalize deteriorating conditions - a dynamic explained through the concept of shifting baselines. The second explores why many residents remain silent in the face of intensifying touristification and its negative impacts. Drawing on Bourdieu’s theory of practice and qualitative research in Mallorca, it demonstrates how social class, habitus, and economic dependency constrain activism, while misinformation and the delegitimization of protest by media and the ruling class further reinforce passivity or even encourage rejection of the protests The third evaluates Cittaslow as a possible vehicle for degrowth, revealing strong conceptual affinities but also inherent limitations, as its flexible framework can either inspire transformation or be diluted into mere promotion, depending on political will. Together, these studies challenge the notion that economic benefit guarantees support for tourism, showing instead how class position, generational experience, structural dependency, and discourse shape responses. The thesis concludes that genuine transformation requires structural critique, inclusive narratives, and the political resolve to move beyond growth-centered models.
Copyright (c) 2025 Sebastian Amrhein (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Personality is a central determinant of psychological functioning, shaping the onset, course, and treatment outcomes of mental disorders. Reliable personality assessment, however, remains challenging, as traditional methods such as self-report questionnaires and (structured) interviews are vulnerable to bias and limited in capturing dynamic interpersonal processes. The Shedler-Westen Assessment Procedure (SWAP-200) offers an empirically grounded, dimensional, and clinically rich alternative, based on structured clinical observations.This dissertation examines the psychometric properties and clinical utility of the Dutch version of the SWAP-200 in complex mental health populations. Across four empirical studies and a methodological overview, interrater reliability, factor structure, convergent and criterion validity, and differential diagnostic value in individuals with mild intellectual disability (MID-BIF) were investigated. Findings indicate high agreement across raters (ICC = .82), a robust four-factor structure consistent with contemporary dimensional models, and significant overlap between SWAP-200 scales and maladaptive personality traits (PSY-5-r scales). The SWAP-200's clinical utility in complex populations (forensic and MID-BIF) is shown by it's capability to differentiate and measure relevant constructs in populations where reliance on self-report measures is limited and where standard instruments often fall short. Overall, this dissertation demonstrates that the SWAP-200 is a valid, clinically meaningful, and scientifically robust instrument, with particular added value for personality assessment in complex clinical populations.
Copyright (c) 2025 Kim Rambelje (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Publieke organisaties in Nederland, zoals gemeenten, scholen en zorginstellingen, kampen met problemen die hun maatschappelijke bijdrage onder druk zetten. Deze problemen hangen vaak samen met complexe organisatiestructuren, die leiden tot verstoringen, en beperken de regelmogelijkheden voor medewerkers om met die verstoringen om te gaan. Het gevolg daarvan is dat de kwaliteit van de dienstverlening afneemt en de kwaliteit van het werk verslechtert. De Moderne Sociotechniek (MST) biedt een theoretisch kader voor het vereenvoudigen van complexe structuren. In dit proefschrift wordt een instrument ontwikkeld en getest dat bottom-up interventies in organisatiestructuren ondersteunt, waarbij gebruik wordt gemaakt van de ontwerpkundige kennis van de MST. Het proefschrift geeft inzicht in de eigenschappen waarover het instrument voor bottom-up interventies over zou moeten beschikken, en de condities waaronder het instrument op zinvolle wijze een complexe organisatie met simpele taken kan veranderen in een eenvoudige organisatie met rijke taken. Daarmee draagt dit proefschrift bij aan zowel de ontwerpkunde als de veranderkunde, en biedt het perspectieven voor organisaties die op bottom-up wijze hun maatschappelijke bijdrage willen versterken via verbetering van hun structuur.
Copyright (c) 2025 Anneke Offereins (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Commutative algebra and symmetric cryptography
In this thesis, I present a deeper relationship between symmetric cryptography and commutative algebra, which at first glace seems to be unrelated concepts. More specifically between the permutation of bits and modules over group algebras. This relationship provides a deeper mathematical understanding of linear functions which are constructed using these bit permutations. These functions are a popular choice for designing symmetric cryptographic schemes. This new connection helps us understand certain behaviour of these linear functions, and can be used to construct new functions which ommit certain cryptographic weaknesses.
Copyright (c) 2025 Robert Christian Subroto (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Improving the efficacy and patient tolerability of colorectal cancer screening
Colorectal cancer is a common disease, but early detection can prevent a great deal of suffering. This thesis investigated two major obstacles: the reliability of the current stool test and the burdensome preparation for a colonoscopy. In the first part, a breath test was evaluated that measures volatile compounds in exhaled air. The test was safe and simple for patients, but it was not yet accurate enough to replace the existing test. The second part focused on the discomfort of bowel preparation for a colonoscopy. Research showed that smaller amounts of laxatives can clean the bowel just as effectively. A 1-liter bowel preparation proved to be equally effective but much more comfortable than a 2-liter preparation. Additionally, a new flushing system that cleans the bowel during the colonoscopy was tested and appeared promising and feasible.
Copyright (c) 2025 Milou van Riswijk (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluating methods for the prevention of cognitive decline and dementia
The number of people with dementia is increasing worldwide, and there is still no treatment that can cure the condition. This thesis investigated risk factors and potential interventions to better understand and possibly slow down cognitive decline and dementia. Low levels of blood pressure, BMI, and non-HDL cholesterol in later life were strongly associated with a higher risk of dementia, particularly when these occurred in combination. Multidomain lifestyle interventions showed no effect on cognitive decline, except possibly among individuals who already had impaired cognitive function. Certain antihypertensive medications—especially calcium channel blockers and angiotensin II receptor blockers—were associated with a lower risk of dementia. Variability in blood pressure over the years was linked to an increased risk only at very old age, making a causal relationship less likely. Finally, no clinically relevant effect was found for immunotherapy targeting beta-amyloid in Alzheimer’s disease. These findings highlight the complexity of dementia prevention and the importance of targeted follow-up studies.
Copyright (c) 2025 Melina den Brok (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Dermatophyte adaptation to the human host exemplified by Microsporum
This dissertation is structured into 7 chapters, using M. canis as a model to investigate its evolutionary shift from animal hosts, such as cats and dogs, to human hosts and its dual role in infection and allergy. Each chapter explores a distinct aspect of M.canis infection, including its function as both a pathogen and an allergen, its epidemiology, host adaptation, molecular mechanisms of virulence, and spore germination.
Copyright (c) 2025 Xin Zhou (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Cardiovascular risk management for patients with a severe mental illness
This thesis explores the management of cardiovascular risk (CVR) in primary healthcare for patients with a severe mental illness (SMI) from the perspective of general practitioners (GPs) and develops an intervention to reduce CVR. Given that individuals with an SMI have a significantly reduced life expectancy due to heightened CVR, the study examines the role of GPs in mitigating these risks and the challenges they face. Findings indicate that CVR screening for SMI patients in Dutch primary care is inadequate, with only 8.5% of patients being screened in the absence of diabetes or cardiovascular disease. GPs express a sense of responsibility but lack awareness, confidence, and adequate collaboration with psychiatrists. To address these issues, the ‘Transmural collaborative care model for CVRM and medication review in patients using AntipsyChoTICs’ (TACTIC) was developed. This multidisciplinary intervention demonstrated promising feasibility, improving CVR outcomes in initial testing. However, challenges such as patient inclusion and adherence remain. The thesis recommends improving interdisciplinary collaboration, standardizing CVRM in guidelines, and incorporating lived experience perspectives. If proven effective in the upcoming trial, TACTIC could serve as a scalable, evidence-based model for integrating CVRM into primary care and reducing CVR-related mortality in SMI patients.
Copyright (c) 2025 Kirsti Jakobs (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Nederlandse franciscanen in Shanxi, China (1870-1953)
Deze omvangrijke studie beschrijft de geschiedenis van 117 Nederlandse franciscanen-missionarissen in de ruige Chinese provincie Shanxi in de periode 1871–1954. Op basis van duizenden persoonlijke en officiële brieven en artikelen uit missietijdschriften reconstrueert het boek hun leven. Het behandelt onder meer de motieven om het avontuur aan te gaan; de botsing tussen strikte franciscaanse kloosterregels en de noodzaak tot aanpassing aan lokale omstandigheden; de complexe verhouding met de missiebeweging in Nederland en Europa en het chronische gebrek aan mensen en middelen. Daarnaast laat het zien hoe de missionarissen samenwerkten met Chinese christenen en priesters, en vanaf 1922 met Nederlandse zusters, en hoe zij het werk overdroegen aan de Chinese clerus. Ten slotte plaatst het boek dit alles in de bredere politieke en sociale context van Shanxi en China: hongersnoden, opiumproblematiek, gewelddadige conflicten en toenemende buitenlandse inmenging.
Copyright (c) 2025 Jolanda Jansen (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Facility-specific greenhouse gas footprints of renewable electricity sources
Many studies quantified the GHG footprints of wind, solar and hydropower. However, integrating spatial, temporal and technical variation into one assessment has not been done at larger spatial scales. Such an assessment adds value because it enables policy makers and developers to easily assess differences in GHG performance between either different technologies in the same location or the same technology in multiple locations. Furthermore, the comparison to other (non-)renewable electricity sources offers the possibility to determine how much can be gained in terms of GHG emission mitigation at each location. This thesis aims to provide a basis for such an assessment by developing models that allow for easy calculation of the GHG footprints of the most important non-biomass renewable electricity sources at facility level, using a key set of technological and meteorological variables.
Copyright (c) 2025 Louise Christine Dammeier (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
As the biomedical approach to mental disorders has fallen short of its promised breakthroughs in our knowledge of mental suffering, systemic alternatives – like the network approach – are gaining traction. But given psychiatry's history of promoting reinventions with big promises and unrealistic expectations, how should we evaluate the “epistemic potential” of the network approach? In this thesis, Nina de Boer formulates a practice-oriented response to this question, focusing not just on how well the network approach reflects the reality of mental suffering but also on how it represents mental suffering, who uses it, and for what purpose. By examining the use of the network approach in scientific practice, clinical practice, and daily life, De Boer offers a new perspective on the value of the network approach and contributes to broader debates about the epistemic potential of psychiatric reinventions.
Copyright (c) 2025 Nina de Boer (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Redefining T Cell Pathology in Connective Tissue Disorders
This thesis explores the role of autoreactive T cells—immune cells that mistakenly attack the body’s own tissues—in autoimmune diseases such as systemic sclerosis (SSc) and other connective tissue diseases (CTDs). These rare cells are difficult to detect, particularly in affected tissues and lymph nodes, but may hold the key to understanding how these diseases develop. To address this challenge, we developed an innovative toolkit that combines advanced imaging, state-of-the-art molecular techniques, and lab-based functional studies to track and analyze these cells in unprecedented detail. Our findings reveal that different types of autoreactive T cells play distinct roles in diseases like SSc and Sjögren’s syndrome (SjS). While SjS is primarily driven by helper T cells, SSc appears to be driven by cytotoxic effector T cells. These insights reshape our understanding of the immune system’s role in SSc and open the door to new diagnostic and therapeutic strategies. Notably, our studies targeting harmful cytotoxic T cells in early-stage SSc patients showed promise in reducing fibrosis—the most debilitating symptom of the disease. This work brings us closer to precision medicine tailored to the unique molecular fingerprints of each autoimmune CTD.
Copyright (c) 2025 Theogiannis Papadimitriou (Author) https://creativecommons.org/licenses/by-nc-nd/4.0