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The full text of this thesis is not available due to privacy or embargo reasons.

Deze studie is een achtergrondrapport in het kader van de verkenningen naar de toekomst van de landbouw en natuur in Nederland die het Planbureau voor de Leefomgeving (PBL) uitbrengt. Hierin verkennen we, op basis van informatie uit literatuur, modellen en kennis van experts, welke externe ontwikkelingen van belang zijn bij het maken van toekomstverkenningen voor de natuur en de landbouw gezien de invloed die van deze ontwikkelingen uitgaat. Voor zowel beleidsplannen ten aanzien van de verduurzaming van de landbouw als die voor natuurherstel is het belangrijk rekening te houden met externe invloeden. Daarnaast ontwikkelen we een methode om systematisch het samenspel van de directe en indirecte invloeden te analyseren en om te zetten in scenario’s van externe ontwikkelingen. Deze methode is een aanvulling op de huidige methode die kennisinstellingen gebruiken bij het maken van dergelijke scenario’s.

Contains fulltext : 305884.pdf (Publisher’s version ) (Closed access), Previous research has generally found lower wellbeing levels among parents of autistic children that were related to fewer positive and more negative parenting behaviours. However, these relationships have not yet been studied before a formal autism diagnosis is given. The present study investigates wellbeing (including positive mood, vitality, and general interest) and its relationships with a range of parenting behaviours among two groups of mothers with children at elevated likelihood (EL) of autism: mothers of younger siblings of children on the autism spectrum ('siblings'; n = 81) and very or extremely prematurely born children ('preterms'; n = 40). Growth curves were modelled to investigate whether wellbeing and EL group were associated with (change in) reported parenting behaviours between 10 and 24 months of child’s age. As expected, we found more stability than change in parenting behaviours, and more similarities than group differences in parenting behaviours and wellbeing. Mothers generally reported more disciplinary behaviours when their child grew older, in line with general population findings. Initial levels of supportive behaviours were equally high among mothers of siblings and preterms, but only mothers of preterms reported an increase over time. Wellbeing levels were largely comparable to those of a matched subsample from the general population, contradicting previous findings. Contrary to our hypotheses, wellbeing was not associated with fewer positive or more negative parenting behaviours. This is encouraging, as all children benefit from supportive and responsive behaviours., 22 p.

The full text of this thesis is not available due to privacy or embargo reasons.

07 augustus 2023, Item does not contain fulltext, Several molecular and phenotypic algorithms exist that establish genotype–phenotype correlations, including facial recognition tools. However, no unified framework that investigates both facial data and other phenotypic data directly from individuals exists. We developed PhenoScore: an open-source, artificial intelligence-based phenomics framework, combining facial recognition technology with Human Phenotype Ontology data analysis to quantify phenotypic similarity. Here we show PhenoScore’s ability to recognize distinct phenotypic entities by establishing recognizable phenotypes for 37 of 40 investigated syndromes against clinical features observed in individuals with other neurodevelopmental disorders and show it is an improvement on existing approaches. PhenoScore provides predictions for individuals with variants of unknown significance and enables sophisticated genotype–phenotype studies by testing hypotheses on possible phenotypic (sub)groups. PhenoScore confirmed previously known phenotypic subgroups caused by variants in the same gene for SATB1, SETBP1 and DEAF1 and provides objective clinical evidence for two distinct ADNP-related phenotypes, already established functionally.

Item does not contain fulltext, Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank - based on their perceived importance - known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors. Key Points • Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement. • RMD symptoms are the factors that people with RMDs want to improve when engaging in PA. • The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved

European regions are responsible for the implementation of large parts of the EU legislation and, therefore, feel the need to express their experiences and needs to the European institutions, those in charge of making the legislation (Rodriguez-Pose & Courty, 2018). Therefore, regions more and more seek to influence European legislation at the EU level. They can do so through several means, one of which is lobbying through formal networks. This thesis aimed to understand the influence of the use of networks on the lobbying process of regions at the European level. It was found that the use of networks influences the lobbying process in several ways at the different institutions.

This paper examines the extent to which EU and US democracy promotion has affected recipients their response to the three Russian invasions of neighbouring countries from 2008 until 2022. To do so it applies mixed methods, including a regression analysis using voting results on UNGA resolutions condemning the Russian invasions as an independent variable, and an in-depth case study of Ethiopia's response to the invasions using document analysis. The results show that the proven effect of democracy promotion on democracy levels does not directly translate into international alignment against Russia, as one would expect based on democratic peace theory. Rather, the analysis suggests that an increase in export levels to the EU and the US are significant predictors of voting in favour of the relevant UNGA resolutions, underlining the importance of trade relations in geopolitics, and confirming the premise of capitalist peace theory. Implicitly, the results question the strategic relevance of democracy promotion within the context of international relations and the competition between democratic and authoritarian states.

German security and defense policy has long been a distinguishing feature. Nothing illustrated this observation more than German foreign policy toward Russia. Even after the Russian occupation of Crimea, Germany continued to pursue a policy of economic cooperation. Scholars have often pointed to the stickiness and uniqueness of Germany's security culture to explain these foreign policy positions. It is security crises, according to authors discussing this subject matter, that can force security cultures to change. This thesis contributes to this debate by researching developments in German security culture one year after the Russian invasion of Ukraine. The findings of this case study illustrate that security crises can result in change under certain circumstances. Following the invasion of Ukraine, German security culture has become defined by increasing awareness of interstate conflict as well as the necessity of territorial defense and deterrence to ensure European security.

De sportverenigingen in Nederland worden geconfronteerd met ledendalingen en een tekort aan vrijwilligers. Ook de bowlingverenigingen in Nederland hebben te maken met deze ledendaling. Ze hebben in vier jaar tijd een derde van hun leden verloren. Vergrijzing, een groeiend aantal migranten en individualisering worden genoemd als oorzaken van deze daling. Deze trends zullen naar verwachting leiden tot verdere afname van het aantal leden in de toekomst. Om de toekomstbestendigheid van de sportverenigingen te waarborgen, stimuleert de overheid hen om hun sportaanbod te verbreden en te professionaliseren via het Sportakkoord ll. Er wordt echter aangenomen in het Sportakkoord ll, dat het aanbod onvoldoende zou aansluiten bij de veranderende behoeften van leden. Er is weinig bekend over de daadwerkelijke behoeften van leden en of deze wel veranderd zijn. Dit onderzoek gaat hier dieper op in en beoogt een antwoord te geven op de onderzoeksvraag: ‘In hoeverre zijn de bowlingverenigingen bezig met het vervullen van de behoeften van hun leden, in hoeverre verhoudt dit zich tot de institutionele druk die bowlingverenigingen ervaren en op welke elementen moet de bowlingvereniging inspelen om toekomstbestendiger te zijn?’ Het doel is om inzicht te krijgen in welke mate verenigingen bezig zijn met het vervullen van de behoeften van leden of reageren op de ervaren institutionele druk, en wat dit betekent voor de toekomstbestendigheid. Om meer inzicht te krijgen in de toekomstbestendigheid van de bowlingvereniging is er gekeken naar de sociale uitwisselingstheorie en de institutionele theorie. De sociale uitwisselingstheorie stelt dat verenigingen in moeten spelen op de behoeften van hun leden om een sterke relatie op te bouwen. De institutionele theorie stelt dat de verenigingen moeten inspelen op de institutionele druk uit hun omgeving zodat zij hun toekomstbestendigheid vergroten. Deze theorieën zijn getoetst in een veldonderzoek om tot een antwoord te komen op de onderzoeksvraag

The full text of this thesis is not available due to privacy or embargo reasons.

Although the European Union can be considered the most successful internal peace project in history, it is questionable whether the EU successfully acts as a global security player externally. This thesis, therefore, examines the role of the EU as an inter- and intrastate mediator and explores the question of whether and under which conditions the EU is effective in its mediation efforts. The conceptualization of mediation effectiveness consists of a two-dimensional theoretical framework that distinguishes between objective effectiveness – whether and to what extent a peace agreement was signed – and subjective effectiveness in terms of internal EU goal-attainment. To empirically measure the effectiveness of mediation, qualitative case studies and qualitative comparative analysis (QcA) are conducted. The empirical analyses aim at identifying common conditions among the cases influencing mediation effectiveness and thus, determining under which conditions the EU mediates effectively, respectively ineffectively. The conditions influencing mediation effectiveness can be differentiated into two dimensions: 1. Concurrent factors which can be understood as characteristics and behaviour of a mediator, such as the mediator’s leverage, coherence, and mediation strategy, and 2. Context factors, such as the severity of the crisis and the conflicting party’s willingness to compromise. The empirical results show, firstly, that the EU overall does not exceed a medium degree of effectiveness in direct mediation cases, but the EU ismore effective when mediating as the sole mediator in a specific conflict. Secondly, leverage and coherence of a mediator are necessary conditions for mediation to be effective, and together with the conflicting parties’ willingness to compromise, these conditions are considered sufficient to explain mediation effectiveness. These results entail important policy recommendations for the EU to change its mediation behaviour and to adopt the mediation appro

25 november 2022, Contains fulltext : 284954.pdf (Publisher’s version ) (Open Access), Purpose: In early-onset preeclampsia, each additional day of pregnancy prolongation reduces offspring infant mortality about 9%. We evaluated if maternal stress at admission to hospital for early-onset preeclampsia predicted admission-to-delivery intervals in days. Methods: This prospective, longitudinal cohort-study involved 15 singleton pregnancies with a diagnosis of preeclampsia before 34 weeks gestation with intended expectant management. Upon hospital admission, maternal psychological stress was assessed with questionnaires and physiological stress with hair cortisol. Hair samples were analyzed in three hair segments representing the preconception period, and the first and second trimester of pregnancy. Results: Mean pregnancy prolongation was 16.2 days. Higher maternal anxiety at hospital admission significantly correlated with shorter admission-to-delivery intervals (r = - 0.54, p = 0.04). Chronically increased hair cortisol concentrations (i.e. from preconception through the second trimester) of pregnancy tended to be related to shorter admission-to-delivery intervals (p <. 10). Conclusion: Higher reported anxiety is, and chronically high hair cortisol tended to be, related with fewer days of prolongation from admission to delivery in women with early-onset preeclampsia. These findings suggest that maternal stress might be a potential determinant of disease progression. Future research into early innovative stress-reducing interventions for early-onset preeclampsia may shed more light on the etiology and treatment of this disease.

Background: In our department, during lung stereotactic body radiation therapy (SBRT), all patients receive an intra-fractional midpoint cone beam computed tomography (CBCT). This study aimed to quantify the benefit of adding a second midpoint CBCT over a course of peripheral lung SBRT. Materials and methods: Six-hundred-sixty-four CBCTs from 166 patients were retrospectively analyzed. Treatments were based on the internal target volume (ITV) approach. An isotropic 0.5 cm margin was used to create the planning target volume (PTV) around the ITV. The prescribed dose was 48 Gy in 4 fractions to the PTV. Patients were divided into two groups: patients for whom the 3D-intra-fractional-variation (IFV) was < 0.5 cm (105 patients, low risk group) and patients with at least one 3D-IFV ≥ 0.5 cm (61 patients, high-risk group). Plans simulating the dosimetric impact of the IFV were created as follows: the original 2 arcs (ARC ) were copied into a new plan consisting of 4 times ARC 1 and 4 times ARC 2. The delivery of ARC 1 was always assumed to have occurred with the isocenter initially coordinated, whereas the positions of ARC 2 were modified for each arc by the measured the 3D-IFV. Results: For the PTV, we obtained: D99%(Gy) = 45.2 vs. 48.2 Gy (p < 0.0001); Dmean = 53 vs. 54 Gy (p <.0001) for the reconstructed vs. planned dose values, respectively. For the ITV, the changes are less pronounced: D99%(Gy) = 52.2 vs. 53.6 Gy (p = 0.0007); Dmean = 56 vs. 56.8 Gy (p = 0.0144). The V48 Gy(%)-ITV coverage did not statistically change between the delivered vs. planned dose (p = 0.1803). Regarding the organs at risk for both groups, dose-volume-histograms were near-identical. Conclusion: We demonstrated that a single CBCT is sufficient and reliable to manage the IFV during peripheral lung SBRT., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Contains fulltext : 237150.pdf (Publisher’s version ) (Open Access), PURPOSE: Consanguineous couples are at increased risk of being heterozygous for the same autosomal recessive (AR) disorder(s), with a 25% risk of affected offspring as a consequence. Until recently, comprehensive preconception carrier testing (PCT) for AR disorders was unavailable in routine diagnostics. Here we developed and implemented such a test in routine clinical care. METHODS: We performed exome sequencing (ES) for 100 consanguineous couples. For each couple, rare variants that could give rise to biallelic variants in offspring were selected. These variants were subsequently filtered against a gene panel consisting of ~2,000 genes associated with known AR disorders (OMIM-based). Remaining variants were classified according to American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines, after which only likely pathogenic and pathogenic (class IV/V) variants, present in both partners, were reported. RESULTS: In 28 of 100 tested consanguineous couples (28%), likely pathogenic and pathogenic variants not previously known in the couple or their family were reported conferring 25% risk of affected offspring. CONCLUSION: ES-based PCT provides a powerful diagnostic tool to identify AR disease carrier status in consanguineous couples. Outcomes provided significant reproductive choices for a higher proportion of these couples than previous tests.