Beyond grief: the raison d’être of interactive personality constructs of the dead

Global Challenges (FGGA

Metabolic hormones and ethnic aspects in obesity

Obesity is a chronic and increasingly prevalent disease characterized by excess body fat, particularly abdominal fat. It is a major global health concern and a key risk factor for conditions such as type 2 diabetes mellitus (T2DM), cardiovascular disease, and certain types of cancer. Individuals of South Asian descent face a higher risk of developing obesity-related diseases than those of European descent, even at comparable body mass index (BMI) levels. This thesis examined potential underlying mechanisms behind this ethnic disparity.The findings revealed that South Asians differ in hormonal and inflammatory profiles compared to Europids. For example, South Asians with T2DM exhibited lower concentrations of the anti-inflammatory hormone FGF21. Furthermore, even young, healthy South Asians showed distinct postprandial responses, including differences in blood glucose and hunger- and satiety-related hormones, which may contribute to their elevated T2DM risk.The thesis also investigated interventions to improve fat metabolism. Cold exposure was found to activate brown adipose tissue (BAT), partially via FGF21, but only evening exposure increased circulating FGF21 levels. Additionally, pharmacological stimulation of BAT using the β2-adrenergic agonist salbutamol significantly enhanced BAT activity, offering a promising therapeutic avenue.These findings underscore the importance of tailored strategies for populations at elevated metabolic risk, such as South Asians.The research described in this thesis was supported by a grant of the Dutch Research Council NWO (VENI grant 09150161910073) and partially financially supported by Roba Metals B.V., IJsselstein, The Netherlands. Financial support by the Netherlands Association for the Study of Obesity (NASO) for the publication of this thesis is gratefully acknowledgedLUMC / Geneeskund

Advances in treatment of pediatric arrhythmias

Treatment of cardiac arrhythmias in children has advanced to the point where it is successful for most children, and life-threatening arrhythmias have become rare. Nevertheless, the physical and psychosocial impact can still be significant. The aim of this thesis was to investigate the progress in treatment modalities for cardiac arrhythmias in children. This thesis demonstrates that by using electro-anatomical mapping techniques, radiation exposure can be almost entirely avoided without compromising effectiveness. Catheter ablation of atrial arrhythmias as a definitive treatment can now be safely performed in increasingly younger children, including infants. For frequent ventricular extrasystoles, medication use is emphasized to prevent damage to the still-developing heart muscle. This thesis shows that flecainide is much more effective than metoprolol (recommended in the current guidelines) and that reduced ventricular function after treatment is reversible. Some ventricular arrhythmias cannot be fully controlled with medication, necessitating the implantation of an implantable cardioverter defibrillator (ICD). This thesis shows that by optimizing ICD settings and using remote monitoring, the number of shocks—and thus the impact on the child—can be significantly reduced. In conclusion, this thesis provides practical insights for clinicians and researchers to improve outcomes and quality of life for children with cardiac arrhythmias.LUMC / Geneeskund

How Putin, Xi and now Trump are ushering in a new imperial age

Politics, Culture and National Identities 1789-presen

Competing and complementary regions in US foreign policy

History and International Studies 1900-presen

Functional conduction system mapping in sheep reveals Purkinje spikes in the free wall of the right ventricular outflow tract

Ablation of sites displaying Purkinje activity is highly effective against idiopathic ventricular fibrillation which often originates in the right ventricular outflow tract. However, during endocardial mapping Purkinje potentials are rarely, if never, detected in the right ventricular outflow tract. In the present study, we aimed to determine whether the Purkinje system extends into the right ventricular outflow tract. Hearts of five female sheep were blood-perfused in a Langendorff setup in which we performed epicardial and endocardial voltage mapping. During atrial pacing, the right ventricular outflow tract epicardium activated later than the epicardium of the left and right ventricular free walls. Endocardial mapping revealed Purkinje spikes at several sites in the free wall of the right ventricular outflow tract. In one heart, Purkinje spikes preceded ventricular premature beats during mapping, but were not visible during sinus rhythm. Subsequent immuno-histological examination showed a network of Connexin 40-positive Purkinje fibers across and within the wall of the right ventricular outflow tract. Quantitative analysis revealed that the transmural Purkinje fiber network was more abundant near the endocardium than epicardium. In conclusion, the Purkinje system extends into the right ventricular outflow tract of the sheep heart. These findings demonstrate that the sheep could be a valuable model for studying Purkinje-related arrhythmias in the right ventricular outflow tract.Stem cells & developmental biolog

Turning costs into actionable insights for value-based health care

Value-Based Health Care (VBHC) is a management strategy aimed at optimizing the value of care for patients by maximizing health outcomes per euro spent. Despite this dual focus, the cost component is frequently overlooked in VBHC implementation, limiting its transformative potential.This thesis provides guidance on how to turn cost data into actionable insights to support the delivery of VBHC. Part I addresses the question: How can value be measured, and how can costs be effectively incorporated into VBHC implementation? Drawing on real-life examples and stakeholder interviews, the thesis identifies practical strategies to integrate cost data at multiple levels of health care, including shared decision-making, provider benchmarking, and organizational learning. It also explores the development of VBHC dashboards, detailing both functional and technical requirements.Part II investigates the question: How can insights into costs drive improvements in care pathways? This is illustrated through three empirical studies in oncological care pathways, showing how cost and outcome data can be jointly leveraged to inform clinical decisions and evaluate changes in care delivery.The findings underscore that the continuous integration of cost data alongside outcomes is essential to fully realize the potential of VBHC at every level of the health care system.LUMC / Geneeskund

Understanding proenvironmental behavior: a model based on moral identity and connection to nature

Research has widely recognized the role of personal norms, connection to nature, and different forms of identity as importantfactors that promote individuals' environmental actions, as well as the role of moral disengagement to diminish these. However,less attention has been given to one's moral identity as a key driver for proenvironmental behavior. Extending current literature,we therefore explored if moral identity could promote proenvironmental behavior. Participants in our study (N = 359) completeda series of questionnaires. Correlational analyses, path analysis, mediation analysis, and moderation analysis, whererelevant, were used in testing four possible models. Only the model in which moral identity and connection to nature predictedproenvironmental behavior directly, and indirectly through the effect of personal norms and moral disengagement, showedgood fit indices. Our findings highlight the multifaceted nature of proenvironmental engagement, in which a sense of moralobligation to act sustainably could facilitate behavior stemming from moral identity and the feeling of being connected tonature.Social, Cognitive, and Affective Decision Makin

Predicting and understanding risks of venous thromboembolism to individualize prevention

The risk of VTE (and other diseases) differs between patients. Therefore, knowledge of these individual risks is essential in tailoring (preventive) interventions. To obtain these individual risks, high-quality prediction models are needed. Therefore, we developed such a predicition model for the risk of VTE following arthroplasty surgery. We also successfully validated this model and investigated a potential treatment strategy for high-risk patients.To study the effect of the implementation of a prediction model with subsequent intervention decisions is difficult as it entails a complex intervention. Because there is currently no detailed guidance on how to investigate this complex intervention, we wrote a methodological article which provides this guidance.Lastly, we studied the pathophysiology of VTE in COVID-19 patients by determining how the risk of VTE and coagulation proteins differ(s) with differing disease severity. What we found was that the risk of VTE seems to be mainly driven by endothelial damage. Hart Onderzoek Nederland; Trombosestichting Nederland,;Stichting ETB-BISLIFE; Stichting WUON; ChipSoft, ABN AMRO; Daiichi SankyoLUMC / Geneeskund

Trauma and thrombosis in the DOAC era: promise and peril of direct oral anticoagulant use in injured patients

This dissertation focuses on three main research questions: what role do direct oral anticoagulants have in the prevention of venous thromboembolism in trauma patients? How do treatment and outcome differ between trauma patients who use DOACs chronically versus those who use vitamin K antagonists? And third, what are the hemostatic effectiveness and safety of two reversal agents used to treat DOAC - specifically Factor Xa inhibitor - associated bleeding in trauma patients?LUMC / Geneeskund