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Copyright (c) 2022 Radboud University Press https://creativecommons.org/licenses/by-nc-nd/4.0
This dissertation evaluates how newer sequencing technologies can improve genetic diagnosis in rare disease, especially intellectual disability and other genetically heterogeneous disorders. It first compares modern exome capture strategies with short-read and long-read whole-genome sequencing, showing that Twist exome capture provides more uniform coding-region coverage and maintains reliable SNV and CNV detection even at lower depth. It then assesses PacBio HiFi long-read sequencing in unsolved trios, demonstrating improved access to repetitive and GC-rich regions, better structural-variant discovery, and recovery of clinically relevant variants missed by short reads. Finally, the thesis examines whether HiFi long reads are accurate enough for de novo SNV discovery and shows high concordance with short-read sequencing. Together, these studies support improved exome capture and long-read sequencing as valuable advances for more comprehensive and clinically useful rare-disease genomics.
Copyright (c) 2026 Muhammet Erdi Küçük (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Krijgt een vrouw met borstkanker en een laag inkomen even vaak een borstreconstructie als een vrouw met een hoog inkomen? Onderzoek toont van niet. Dit voorbeeld laat zien dat goede zorg in Nederland niet altijd recht doet aan mensen in kwetsbare omstandigheden. Factoren zoals beperkte financiële middelen, taalbarrières, lage gezondheidsvaardigheden, een klein netwerk en chronische stress beïnvloeden toegang tot zorg en uitkomsten. Rechtvaardige zorg betekent dat iedereen recht heeft op dezelfde zorg, maar sommigen ondersteuning nodig hebben om dat recht te benutten. Mijn onderzoek richt zich op discriminatie, impliciete vooroordelen, cultuursensitieve zorg en betere samenwerking tussen eerstelijnszorg en het sociaal domein. Ook zet ik me in voor onderwijs waarin geneeskundestudenten structureel diversiteitssensitieve competenties ontwikkelen — met ervaringsgericht leren als uitgangspunt. Goede zorg vraagt om erkenning van menselijke kwetsbaarheid én om praktische maatregelen die zorgen dat iedereen daadwerkelijk toegang heeft tot passende zorg.
Copyright (c) 2026 Jeanine Suurmond (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
GHB is a party drug that users consider relatively harmless. This dissertation shows that this belief is incomplete. Daily GHB-use is linked to changes in the brain and causes memory problems in animals used in research. In particular, long-term memory is affected, while short-term memory for ongoing tasks seems to remain intact. Surprisingly, comas caused by high doses of GHB do not appear to cause additional damage to short-term memory in these animals. This does not mean such comas are safe: GHB-induced comas can be life-threatening. This dissertation also shows changes in the hippocampus, a part of the brain that plays a key role in learning and memory. In addition, this dissertation describes what happens when people with a GHB addiction stop using GHB. Many withdrawal symptoms occur, which differ between men and women, but can be treated well with the right medical care. Together, these findings show that GHB-use involves serious risks, may be more harmful than assumed, and highlight the importance of prevention and careful medical management.
Copyright (c) 2026 Casper Wolf (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
In zijn oratie “Van Stoornis naar Verschil – Neurodiversiteit voorbij het Medisch Model” (2025) pleit Léon de Bruin voor een verschuiving van het medische model naar een inclusiever perspectief op neurodiversiteit.
Copyright (c) 2026 Léon de Bruin (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Digitalisering in de publieke sector en verschuivingen in publieke waarden
Digitalisering neemt een steeds centralere plaats in binnen publieke organisaties en beïnvloedt in belangrijke mate hoe beleid wordt uitgevoerd. Hoewel digitalisering vaak wordt benaderd als een neutrale en technische aangelegenheid, groeit het besef dat het een waardengeladen veranderproces is. Dit proefschrift onderzoekt hoe digitalisering zich verhoudt tot de prioritering van publieke waarden in publieke organisaties, met een empirische verkenning binnen de Belastingdienst, de Sociale Verzekeringsbank en het Uitvoeringsinstituut Werknemersverzekeringen. De bevindingen laten zien dat medewerkers in hun dagelijkse werk verschillende waarden centraal stellen, die samenkomen in drie clusters: intrinsieke waarden (gericht op de kwaliteit van dienstverlening), conditionele waarden (gericht op randvoorwaarden voor uitvoering) en IT-gerelateerde waarden (gericht op technologie en informatievoorziening). In digitaliseringscontexten verschuift de aandacht systematisch richting IT-gerelateerde waarden. Tegelijkertijd raken intrinsieke waarden zoals inclusiviteit, maatwerk en menselijkheid meer op de achtergrond. Daarnaast blijkt dat medewerkers digitalisering in abstracte zin anders beoordelen dan wanneer zij te maken krijgen met een concrete toepassing. Dit onderzoek toont aan dat digitalisering de nadruk op specifieke publieke waarden zowel kan versterken als verminderen, afhankelijk van de betrokken professionele groepen en de context. Daarmee bevestigt het dat digitalisering geen neutraal, maar een waardengeladen proces is.
Copyright (c) 2026 Noortje Hoevens (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Breast milk is considered the gold standard for infant nutrition because it provides both essential nutrients and bioactive components that shape growth, the gut microbiota and immune function. When breastfeeding is not possible, infant formula is a complete alternative, but it still differs from breast milk in key ways, especially in its limited set of Human Milk Oligosaccharides (HMOs). Breast milk contains over 150 HMOs, and their amounts and ratios vary with lactation stage and maternal factors, suggesting a dynamic, individualized profile that formula does not yet match. Evidence from animal work links fucosylated and sialylated HMOs to neurodevelopment, affecting the medial prefrontal cortex and hippocampus through microbiome-driven metabolites that regulate genes involved in plasticity, myelination and memory. To test whether HMOs act synergistically, a longitudinal rat study administered 2-FL, 3-SL, 6-SL and their combinations from postnatal day 8–49, tracking physical milestones and emotional/cognitive behaviour into adulthood. Different mixtures produced distinct developmental and anxiety/exploration profiles, with notable sex-dependent effects, and a triple mix improving object-recognition memory in adult males alongside altered medial prefrontal cortex gene expression and hippocampal neurogenesis.
Copyright (c) 2026 Sylvia Docq (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
When we listen to spoken language, we recognise words extremely quickly, even though speech is a continuous and constantly changing sound signal. This thesis investigates how people achieve this, with a particular focus on words that consist of multiple meaningful parts, such as un-happi-ness or re-view. While it is well established that such internal word structure plays a role in reading, it has long remained unclear whether and how it also influences the recognition of spoken words. Using large-scale experimental data and computational models, this thesis examines how listeners make use of the internal structure of spoken words. The results suggest that word recognition is neither driven solely by whole words nor exclusively by their component parts. Instead, recognition reflects a gradual interaction in which both the full word and its parts can contribute. In addition, words are recognised more quickly when they belong to a larger “word family” of related words, especially when these related words are similar in both sound and meaning. These findings suggest that spoken word recognition is a dynamic and probabilistic process, in which word structure subtly shapes how evidence accumulates. The thesis also demonstrates how the method of computational modelling can help clarify and test theories about how the human brain recognises spoken language.
Copyright (c) 2026 Hanno Müller (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Breast cancer screening helps reduce mortality through early detection, with mammography remaining the most effective screening method. However, screening also carries potential drawbacks, including false-positive recalls and overdiagnosis. The screening performance of radiologists plays an important role in balancing these benefits and harms. This thesis examines factors that may improve screening performance, including training, recall strategies and audit procedures. A literature review showed that radiologist training generally leads to performance improvement, despite methodological variation. An evaluation of well circumscribed masses—common causes of false-positive recalls—suggested that access to prior clinical mammograms may enhance recall decision-making, particularly at first screening examinations. A prospective study demonstrated that warning signals from radiographers increased recall rates without improving detection, indicating that such warning signals may be more effective when presented only after the radiologist’s initial decision. Analysis of audit data revealed improvements in detection and sensitivity over time and highlighted the value of radiological review and immediate feedback. Finally, PPV–recall diagrams proved useful for monitoring screening performance, although additional individual feedback may be required. Taken together, the findings underscore the complexity of interpreting mammograms and offer recommendations for improving radiological performance.
Copyright (c) 2026 Tanya Geertse (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Reconstruction for four-dimensional dynamic contrast-enhanced dedicated breast computed tomography (4D DCE-BCT)
Breast cancer is one of the most diagnosed cancers and one of the leading causes of cancer-related deaths. Breast CT is a new medical imaging technique that uses X rays to create detailed 3D images of the breast, without the discomfort of traditional compression used in mammography. In this thesis, we further develop breast CT to enable perfusion imaging. This information is believed to be clinically useful for monitoring treatment response and supporting more personalized breast cancer care. The thesis focuses on the technical challenges of this approach, including accurately measuring the amount of iodine-based contrast agent in the breast over time, correcting image distortions caused by patient motion, and reducing image noise when using low radiation doses.
Copyright (c) 2026 Mikhail Mikerov (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Een relationeel perspectief op intern toezicht in de zorg
In dit proefschrift is onderzocht hoe intern toezicht in de Nederlandse gezondheidszorg betekenis krijgt in wisselwerking met de zorgpraktijk. Het huidige intern toezicht is sterk gevormd door New Public Management, waarin prestaties worden gerepresenteerd via indicatoren en rapportages. Intern toezicht gebaseerd op dergelijke onvolledige representaties kan vergaande, onbedoelde gevolgen hebben voor de zorgpraktijk en doet onvoldoende recht aan de complexe werkelijkheid van zorgpraktijken. Dit proefschrift verlegt de focus van functionaliteit naar relationaliteit en benadert intern toezicht vanuit een praktijktheoretisch perspectief. Door middel van ‘thinking with’ Schatzki’s site-ontologie worden empirie en theorie in dialoog gebracht. De casusorganisatie fungeert niet als illustratie of bewijs, maar als denkruimte om intern toezicht te doordenken als relationeel ingebed in een geheel van praktijken en materiële arrangementen. Verantwoordelijkheid en accountability krijgen daarmee een andere lading. Accountability wordt niet langer instrumenteel begrepen, maar als relationeel en verweven met interne toezicht- en zorgpraktijken. In dit perspectief schept accountability voorwaarden voor ‘response-ability’: het vermogen om in concrete situaties ethisch en verantwoord te handelen. Wetenschappelijk draagt dit proefschrift bij aan de ontwikkeling van een praktijktheoretisch begrip van intern toezicht. Praktisch nodigt het uit tot kritische reflectie op toezichtpraktijken en tot herdenken van intern toezicht in verwevenheid met de zorgpraktijk.
Copyright (c) 2026 Ans Verstraeten (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
GRote verhalen is een toegankelijke en verhalende oratie waarin Marcel Schaaf de wereld van het onderzoek naar corticosteroïden tot leven brengt. Hij beschrijft zowel het onderzoek naar de gezondheidseffecten van het stresshormoon cortisol als de werking van geneesmiddelen die hiervan zijn afgeleid, zoals prednison. Omdat de oratie op 5 december werd uitgesproken, speelt het Sinterklaasthema hierin een opvallende en verbindende rol. De lezing verweeft persoonlijke onderzoeksverhalen met fundamentele inzichten in de werking van corticosteroïden en hun receptoren. Schaaf laat zien hoe geavanceerde microscopie en de zebravis als diermodel hebben bijgedragen aan nieuwe kennis over de werking van deze stoffen, en hoe deze kennis kan bijdragen aan de ontwikkeling van nieuwe geneesmiddelen. GRote verhalen is een inspirerende combinatie van wetenschap, storytelling en reflectie op de rol van onderzoek en onderwijs, bedoeld voor zowel vakgenoten als een breed geïnteresseerd publiek.
Copyright (c) 2026 Marcel Schaaf (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Updated Flyer Radboud Dissertation Series
The impact of antithrombotic therapy on endothelial function and clinical outcomes in peripheral arterial disease
Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with substantial cardiovascular morbidity and mortality. Endothelial dysfunction represents an early and critical event in the pathogenesis of atherosclerosis and is strongly linked to adverse cardiovascular and limb events. Antithrombotic therapy is a cornerstone of secondary prevention in PAD, however, its effects on endothelial function and their relationship with clinical outcomes remain incompletely understood. This thesis investigates the impact of antithrombotic therapy on endothelial function and clinical outcomes in PAD. First, carotid artery reactivity testing, a simple, non-invasive method to evaluate endothelial function, is explored with a focus on the feasibility of handheld ultrasound devices. Second, the effects of dual-pathway inhibition with low-dose rivaroxaban and aspirin on endothelial function, vascular inflammation, and coagulation activity are evaluated in patients with PAD. Third, current and emerging evidence on antithrombotic treatment strategies in PAD is reviewed, including comparative effectiveness, safety, and the potential role of CYP2C19 genotype-guided therapy. In addition, the thesis includes studies on endothelial dysfunction, vascular inflammation, and coagulation activity following COVID-19 infection, reflecting the broader relevance of endothelial health in cardiovascular disease. Together, the findings of this thesis contribute to a better understanding of endothelial dysfunction in PAD and support more personalized and evidence-based approaches to secondary cardiovascular prevention.
Copyright (c) 2026 Loes Willems (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
De gezondheidszorg staat onder druk door personeelstekorten, vergrijzing, technologische en klimaatveranderingen. Om deze complexe uitdagingen aan te pakken, is een andere manier van werken én opleiden nodig. In haar oratie laat Wietske Kuijer zien hoe het verbinden van opleiden en werken gezondheidsprofessionals helpt zich te ontwikkelen tot adaptieve, samenwerkende professionals. Ze bespreekt hoe een sterke basis in initiële opleidingen gelegd kan worden, hoe de beroepspraktijk als krachtige leeromgeving benut kan worden, en hoe onderwijs en praktijk samen kunnen innoveren. Haar onderzoek richt zich op wat werkt en waarom in het leren(d) samenwerken in de beroepspraktijk over grenzen van beroepen en instellingen heen. Met haar onderzoek draagt ze bij aan duurzame verbetering van opleiden en leren voor betere samenwerking en kwaliteit van zorg.
Interprofessional Education and Learning
Copyright (c) 2026 Wietske Kuijer-Siebelink (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Modernising toxicity monitoring in chronic myeloid leukaemia
In chronic myeloid leukaemia (CML), 20–25% of patients switch medication due to troublesome side effects. Until now, there was no reliable way to measure these symptoms. Together with 300 patients and healthcare professionals, we developed a new questionnaire that is both accurate and practical. Patients appreciate the filter questions, which make a shorter version possible. One striking finding: sexual complaints were frequent and severe, yet absent from existing tools. We also discovered that for one-third of symptoms, severity differs between commonly used drugs—sometimes by as much as 30%. These insights help clinicians choose better alternatives when switching is needed. Haematologists expect that using this questionnaire will ensure patient experiences are reflected in treatment guidelines. In addition, they identified 14 knowledge gaps on side-effect symptoms, paving the way for improvements to current CML guidelines.
Copyright (c) 2026 Yolba Smit (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Ruim 200.000 mensen ontvingen in 2024 langdurige GGZ zorg. De bijzondere leerstoel richt zich op een betekenisvolle analyse van herstel. Deze analyse gebruikt een koppeling van zorg gegevens met screeningsgegevens en routine uitkomstmetingen. Ernstig psychiatrische patiënten doen beperkt mee aan routine uitkomstmetingen. Daarom is voor deze groep een analysekader ontwikkeld, die zowel voor het individu, een groep, een afdeling of een kliniek, kan worden toegepast. Bij de inauguratie is het kader toegelicht met een klinische casus en vier voorbeelden van onderzoek verricht door de leerstoel bij verschillende door het ministerie van VWS en ZonMW gefinancierde studies. Het kader is toegepast bij onderzoek naar de nazorg van de vuurwerkramp Enschede, bij landelijk onderzoek naar reductie van dwang en drang en bij verschillende projecten die de effectiviteit van herdiagnostiek bij Ernstig psychiatrische patiënten onderzochten. De betekenis van het analysekader voor beleidsevaluatie en wetenschappelijk onderzoek wordt in de inauguratie nader toegelicht.
Copyright (c) 2026 Eric Noorthoorn van der Kruijff (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
As Carl Rogers famously said, “The only kind of learning which significantly influences behaviour is self-discovered, self-appropriated learning.” This sentiment captures the central role of autonomy in learning and education. However, surprisingly little is known about the cognitive and neural mechanisms underlying the benefits of autonomy in memory encoding and learning. My dissertation aims to investigate how the sense of autonomy influences memory encoding, in conjunction with other environmental factors that surround individuals, focusing on both cognitive and neural mechanisms. This thesis presents four empirical projects that systematically investigate the cognitive and neural mechanisms by which autonomy enhances learning and memory. Drawing on an ecological psychology framework, I examined how internal predictive processes, micro-environmental motivators, and socio-cultural factors interact with autonomy to influence learning outcomes. Across different operationalizations of autonomy—binary choices and active exploration—the findings consistently show that: (1) autonomy enhances learning through predictive processing (Chapters 2 and 3); (2) autonomy activates reward-related brain regions more reliably than monetary incentives (Chapter 4); and (3) cultural background influences the effectiveness of external rewards but not of autonomy (Chapter 5). Together, these findings contribute to a more nuanced understanding of motivation in learning and emphasize that autonomy, an intrinsic motivator, has a stable and powerful effect on memory encoding. In practical terms, these results advocate for educational practices that empower students with more autonomy in their learning process, as doing so may foster deeper and longer-lasting learning.
Copyright (c) 2026 Zhaoqi Zhang (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Grote hervormingen in de zorg komen zelden voor. In dit boek nemen de auteurs de belangrijkste zorghervormingen in Nederland onder de loep en laten zij zien dat niet elke hervorming hetzelfde is of het beoogde resultaat heeft. Hervormingen die de toegankelijkheid van zorg verbeteren, blijken vaak succesvoller dan pogingen om de kwaliteit en doelmatigheid te vergroten. De zorg laat zich echter niet vanachter de tekentafel hervormen. Zorghervormingen worden sterk bepaald door hun politieke en maatschappelijke context en moeten worden “bevochten” in een complexe arena met tal van belanghebbende spelers. Hervormingen zijn bedoeld om institutionele veranderingen tot stand te brengen, maar tonen veelal ook een verrassende mate van institutionele continuïteit. Ook in de toekomst zal de roep om zorghervormingen blijven klinken, in het bijzonder met het oog op de houdbaarheid van het stelsel.
Copyright (c) 2026 Hans Maarse, Patrick Jeurissen (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Malaria has had a significant impact on public health for millennia. The parasitic infection remains endemic in various regions, particularly on the African continent. In that region, Plasmodium falciparum is the dominant parasite species, and the Anopheles mosquito is essential for parasite transmission. This transmission between humans and mosquitoes is exceptionally efficient and one of the reasons malaria has not yet been eradicated. But what makes one person more attractive to mosquitoes than another? A large-scale study suggests that a hedonistic lifestyle may attract more mosquitoes. And what can be done against malaria’s persistent grip on public health? One potentially valuable strategy is a transmission-blocking vaccine that induces functional antibodies in humans. When these antibodies enter the mosquito’s gut, they prevent the malaria parasite from completing its cycle. Two new candidates for such a vaccine have been identified, and interestingly, their mechanism depends on a specific component of the human immune system: the complement system. These insights into the complement system, transmission-blocking vaccines, and human attractiveness to mosquitoes may guide future studies and thereby complement the fight against malaria.
Copyright (c) 2026 Maartje Inklaar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Dialectical Trust in Potentiality and Transformation
Trust in the potential for change and transformation is a significant topic in philosophical readings of the Apostle Paul in contemporary thought. Giorgio Agamben is one of the main names in this discussion, given his account of Paul’s messianic pistis. On the other hand, Paul Ricoeur, who is also interested in Paul, is not often considered in these discussions. However, the present investigation proposes that Ricoeur’s hermeneutical reflection, especially his concept of attestation, enriches the philosophical discussion on Paul and the notion of trust in potentiality and transformation. The intention of bringing Ricoeur into dialogue with Agamben assumes that reflections on the trust of (Paul’s) pistis in potentiality and transformation could benefit from a hermeneutical approach that includes the role of uncertainty or suspicion as we think about the self in the experience of conviction or trust. The study is organized into three main parts to achieve this goal. The first two sections treat Ricoeur’s attestation and Agamben’s pistis individually, while the third part articulates a constructive dialogue between the two, offering a dialectical account of trust in potentiality and transformation. The dialogue offers a rich combination of philosophical anthropology and (political) metaphysics in contemporary thought.
Copyright (c) 2026 Adriani Milli Rodrigues (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Journal Guide of Radboud University Press
Author Guide of Radboud University Press
Sarcopenia, defined as the progressive loss of muscle mass and strength, and malnutrition, characterized by an imbalance in energy or nutrient intake, are common conditions in older adults. Both are associated with impaired daily functioning, reduced independence, lower quality of life, and increased mortality risk. This thesis evaluated tools for sarcopenia screening, diagnosis, and severity assessment (Part I), examined the feasibility of combined exercise and nutrition interventions to improve nutritional intake and physical performance (Part II), and explored the perspectives of healthcare professionals and older adults on interprofessional collaboration for treatment of sarcopenia and malnutrition (Part III). Improving care for older adults at risk of sarcopenia and malnutrition requires accurate, context-specific diagnostics, tailored and feasible interventions, and strong collaboration among healthcare professionals and patients. Addressing these components is crucial for improving outcomes and quality of life in this vulnerable population.
Copyright (c) 2026 Sabien van Exter (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
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
'Now I know my ABC, next time won’t you sing with me?’
Episodic and working memory are negatively affected by healthy ageing, and additional memory impairment typically occurs in clinical ageing-related conditions such as amnestic mild cognitive impairment (aMCI). The present thesis investigated whether musical mnemonics affect working and episodic memory performance in cognitively unimpaired individuals and persons with Alzheimer’s dementia (AD). This thesis presents a new theoretical model describing how various important factors (e.g., stimulus complexity, personal aspects) together influence the effectiveness of musical mnemonics on memory performance and a novel paradigm, the musical digit span task, enabling systematic research on effects of musical presentation (and specific contributing aspects of music) on working memory performance. Additionally, this thesis aimed to examine the possible contribution of musical expertise on the degree of benefit of musical mnemonics. The empirical studies in this thesis can be seen as a first step in the research of musical presentation of verbal information to enhance working memory performance in ageing and aMCI. The insights presented in this dissertation contribute to a further understanding of possible aiding mechanisms of musical presentation in the acquisition of new information, not only in ageing without cognitive impairment, but also in cognitively impaired individuals. Directions for future research are provided and implications for designing music-based mnemonics are discussed.
Copyright (c) 2026 Marije Dijkman (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Tracing the Echoes of Childhood Adversity
The impact of childhood adversity is not limited to childhood; rather, it leads to long-lasting consequences for people’s mental health. To develop more effective interventions, it is important to understand how childhood adversity alters the brain and behaviour. To this end, the thesis traced “echoes” of childhood adversity in an emotional memory task. Advantages in remembering negative events over positive ones are commonly observed in people with depression. Results from our study showed that even for individuals who are not currently in a depressive mood, higher levels of childhood adversity were associated with a greater advantage in remembering negative over positive information. This negative bias was also seen in the activity of brain areas closely involved in emotional memory processing. Beyond the memory study, we also traced childhood adversity in resting‐state functional connectivity between brain regions. The results showed that a specific type of childhood adversity, emotional neglect, interacts with acute stress to influence the functional connectivity organization of the striatum, a key region of the reward processing system. These findings provide new insights into brain and cognitive changes related to childhood adversity, contributing to a better understanding of its underlying psychopathology.
Copyright (c) 2026 Xiangshen Liu (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
This dissertation examines how the built environment shapes active travel and, in turn, opportunities for everyday physical activity in increasingly sedentary societies. While planners often assume that changes to the Built Environment cause significant shifts in travel behaviour, much existing evidence is correlational and vulnerable to bias from self-selection, unobserved confounding factors, and limited data. The thesis advances causal understanding of built environment–active travel relationships by asking: (1) how and to what extent does active travel infrastructure influence travel behaviour, and (2) how and to what extent do density, destination accessibility, and land-use diversity affect walking and cycling. Four empirical studies address these questions using quasi-experimental and longitudinal designs. Two natural experiments estimate the effects of large-scale cycling network expansions in São Paulo and the introduction of cycle highways in the Netherlands, applying robust exposure measures derived from routing algorithms and geospatial analysis. A third study investigates how neighbourhood contexts moderated changes in mobility-related physical activity during COVID-19 restrictions. A fourth study uses panel data on residential movers and a random-intercept cross-lagged model to assess how relocation-related built environment changes influence mode use and attitudes. Across studies, results show measurable but heterogeneous increases in cycling and walking, highlighting the importance of context-sensitive, equity-oriented policy design and robust causal methods for transport planning.
Copyright (c) 2026 Francisco Edson Macedo Filho (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
New Challenges in Azole Resistance Selection in Aspergillus fumigatus
Copyright (c) 2026 Yinggai Song (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Head-up tilt sleeping in Parkinson disease and multiple system atrophy
A common non-motor symptom of Parkinson's disease (PD) and multiple system atrophy (MSA) is autonomic failure, causing blood pressure problems such as orthostatic hypotension (OH) and supine hypertension. A retrospective analysis revealed that the main haemodynamic factor behind this co-occurrence is a high total peripheral resistance during supine rest, which fails to increase under orthostatic stress. Treating both blood pressure issues simultaneously is challenging, and a promising non-pharmacological approach is full-body head-up tilt sleeping (HUTS). HUTS may improve OH and reduce nocturnal hypertension, but its effectiveness and optimal angle remain unclear. The Heads-Up study evaluated the efficacy and tolerability of HUTS in people with PD and MSA with both OH and supine hypertension. Participants slept at three progressively steeper angles for two weeks each. While average nighttime blood pressure did not significantly change, HUTS improved overall blood pressure regulation: early-morning supine BP decreased, nocturnal dipping improved, and OH and orthostatic tolerance improved. Higher angles were more effective but less tolerable, highlighting the need for professional guidance. HUTS appears feasible and beneficial for blood pressure regulation, offering a unique treatment option for cardiovascular autonomic failure in PD and MSA.
Copyright (c) 2026 Amber van der Stam (Author) https://creativecommons.org/licenses/by-nc-nd/4.0