Implementation and extended use of computed tomography coronary angiography

Despite ongoing advances in prevention, diagnostic strategies and treatment options, coronary artery disease (CAD) remains a leading cause of death worldwide and has an unfavourable impact on quality of life. The use of upfront computed tomography coronary angiography (CTCA) has shown potential to reduce fatal and nonfatal myocardial infarction in patients with stable CAD. Furthermore, it is a less invasive option compared to standard coronary angiography. In this thesis we examined the impact and challenges of implementing CTCA in the Netherlands and we investigated methods to improve image acquisition. In the third part of this thesis, we evaluated the extended use of CTCA, both for the detection of CAD in the work-up for transcatheter aortic valve implantation (TAVI) and to predict the occurrence of chronic silent brain infarctions following this procedure. Considering implementation, we found that there already is high coverage of CTCA-services in the Netherlands. However, a substantial increase in CTCA capacity is necessary to fully implement CTCA in cardiologic care. Furthermore, we found that implementation of CTCA will result in a substantial reduction in costly and invasive CAG. Considering improved methods of image acquisition, we found that patient tailored contrast delivery protocols for CTCA, adjusting the contrast delivery to body weight and CT-scanner kV settings, improved attenuation values in the coronary arteries and therefore may result in improved diagnostic qualities of CTCA. In the third part of this thesis, we found that CTCA has high diagnostic accuracy to detect CAD in the work-up TAVI and could be used to reduce CAG in these fragile patients by up to 70%. These same pre-TAVI CTCA scans may be used for additional purposes other than the evaluation of CAD. We found that the degree of aortic valve calcifications, measured on these pre-TAVI CTCA scans, was associated with a larger increase in the white matter hyperintensity volume, and therefore shows potential to predict chronic silent brain infarctions

Rethinking Javanese Islam. Towards new descriptions of Javanese traditions

The study of non-Western cultures often relies on the knowledge of those cultures’ religions. This certainly applies to Javanese Studies, where “Javanese Islam” is one of its constitutive concepts. However, this notion is plagued by theoretical problems, suggesting it misrepresents the Javanese religious condition. Through a conceptual genealogy this research traces the origin of “Javanese Islam”. Its conceptualisation is shown to be part of a Western project of making sense of Javanese culture. However, the origin of the twin-concepts “Javanese Islam” and “Javanism” does not lie in the West’s ambitions for colonial dominance. Rather, they are pieces of Christian theology. The West’s preoccupation with religion compelled it to recognise certain Javanese traditions as elements of religion. It thus came to see ngelmu as the core beliefs and slametan as the central ritual of a Javanese religion. This representation however is not supported by empirical evidence or theoretical proof. If, as this research suggests, syncretist Javanese Islam is actually an experiential entity in the experiential world of the West, new research questions arise. Is there an alternative approach to gain insight into Java’s traditions?Asian Studie

From puzzle to paradigm: a Kuhnian perspective on Javanese Islam.

Drawing on Kuhn’s understanding of scientific paradigms as exemplary ways of problem solving, this article critically assesses the current status of the study of Javanese Islam, in particular the long-standing debate on its nature. Is it a syncretist, animist religion or is it essentially Islamic? An analysis from a Kuhnian perspective indicates that both stances are actually the outcome of the same standardized theoretical approach. Consequentially, certain phenomena that are usually considered part of the Javanese religious condition now appear as anomalies of a paradigm. They will remain unsolvable, unless different theoretical approaches are developed. Locating a central assumption in the research into non-Western cultures – the universality of religion – is a step in that direction. From there, generating new descriptions and new research questions becomes a possibility.Asian Studie

Photodynamic therapy for Barrett's oesophagus with use of 5-aminolevulinic acid

Barrett's oesophagus is a premalignant lesion of the oesophagus characterized by the presence of colunmar epithelium with intestinal metaplasia in the distal oesophagus. Oesophageal adenocarcinoma (the most rapidly increasing cancer in the Western world) is thought to originate from Barrett's oesophagus following a sequence from metaplasia through dysplasia to adenocarcinoma. To gain insight in the various aspects of Barrett's oesophagus, the state of the art of its pathophysiology, diagnosis and management is reviewed in Chapter 1, Part I, the general introduction of the thesis. Both endoscopic surveillance and oesophageal resection are recommended for patients with Barrett's oesophagus and high-grade dysplasia. Tins, however, is still controversial as the mortality and morbidity associated with oesophageal resection are considered to be high in view of a preneoplastic disease. Therefore, endoscopic ablation therapies, including photodynamic therapy, have been experimentally used to treat Barrett's oesophagus. The characteristics of the various endoscopic ablation therapies and their results are summarized in Chapter 2. The studies described in this thesis aim at making 5-aminolevulinic acidmediated photodynamic therapy clinically applicable for the endoscopic treatment of Barrett's oesophagus. For a better understanding of the experinlental chapters, Part I is completed with Chapter 3, outlining the fundamentals of 5-aminolevulic acid-based photodynamic therapy