Twelve November it is World Pneumonia Day. Camielle Noordam did PhD research on pneumonia in children in sub-Saharan Africa. Despite improved access to healthcare, every year millions of children die before reaching their 5th birthday. Those in sub-Saharan Africa have the highest risk of mortality. Infections form the biggest threat, and of these, pneumonia is the most prevalent. Camielle Noordam spent many years living and working in Africa. Here she discusses the obstacles to proper medical care.
If you’re accustomed to approaching your professors with awe, it comes as something of a surprise when your PhD supervisor encourages you to use his first name, puts his feet up on the table as you brainstorm study designs together, and prefers you to just drop by rather than emailing in advance. Professor Luc van Loon’s style has grown on his PhD candidate Jean Nyakayiru, but it took some getting used to. “We did have to beat out of him that formal style of address”, Van Loon laughs. Nyakayiru hopes to defend his thesis in Maastricht next year.
Before you start reading this article, take a short pause and have a look around the room. What do you see? Whether it’s a table, chairs, trees outside the window, or the traffic rushing by - your ability to perceive the outside world seems utterly self-evident. Yet have you ever wondered how our sense of sight, one of the most important senses we have, actually works? The PhD research of Thomas Emmerling brings us one step closer to unraveling the mysteries of visual perception and visual mental imagery.
From the very first contact, the feeling was mutual: this is the kind of person I want to work with. After a six-month internship in Professor Ron Heeren’s group at the AMOLF institute, Karolina Skraskova knew she couldn’t return to the Czech Republic, where she had originally started her PhD. When Heeren offered her a new position, she gladly accepted. In her final year the entire research group moved from Amsterdam to Maastricht, and this is where, on 3 March 2016, she defended her PhD thesis.
Remarkable: the risk of psychosis among young Dutch-Moroccan men is five times higher than that of Dutch-Moroccan women. Psychologist Els van der Ven looked to behaviour and the social environment to find an explanation, and she found that the cause is social exclusion. Her recommendations: more validating interventions to prevent people from becoming lonely. “Key figures within the community need to learn to recognise feelings of failure and alienation.”
Emerging technologies are often held up as miracle interventions: by bridging the divide between the Global North and South, they could change the world for the better. Yet in the past, nuclear power, biotechnology and ICT all failed to live up to their promise. Could nanotechnology, the next big thing, make the difference? For PhD candidates Pankaj Sekhsaria, Trust Saidi and Koen Beumer, this question formed the starting point of their research. They will defend their theses on 10 March.
A nanometre is one billionth of a metre. Or, to put it differently: one strand of human hair has a breadth of approximately 80,000 nanometres. On this extremely tiny level, the physical properties of materials change radically. The secret behind nanotechnology is that these new properties can be used in a wide variety of products and processes. ‘I don’t know any other technology that could be applied in so many different ways’, says Wiebe Bijker, professor of Technology and Society. ‘Nanotechnology can be used, to name just two extremes, in cheap water filters as well as highly expensive gadgets such as smart clothing.’
Under Bijker’s supervision, Pankaj Sekhsaria (India), Trust Saidi (Zimbabwe) and Koen Beumer (the Netherlands) participated in what is known as an NWO-WOTRO integrated programme, resulting in three individual PhD theses. Their research addresses the question as to how nanotechnology could foster progress in developing countries, taking into account the risks to health and social cohesion that come with it. ‘An integrated programme starts from the idea that developed and developing countries can learn from one another, as opposed to the more traditional idea of the North offering development aid to the South’, explains Bijker. ‘International collaboration between researchers and partners in different countries is a logical consequence.’
Cultures of innovation
In India, Sekhsaria endeavoured to understand the ‘cultures of innovation’ in nanoscience and technology. ‘I visited laboratories where nanoscience and technology research and development is taking place to talk with scientists and understand the work they’re doing’, he says. ‘My main hypothesis was that different societies and cultures have different ways of doing things, which is reflected in what happens inside scientific laboratories. Through my research I’ve been able to show that societal constructs, cultural preferences, contradictions and limitations within Indian society play a role in the questions that nanoscientists choose to explore, in the solutions they end up finding, and even in the ways they carry out research.’
Sekhsaria, who describes his years of research as ‘hugely challenging and enriching’, stresses that his conclusions are not limited to India but can be translated to different countries and contexts. ‘I argue that India’s cultural, political and societal context influences its nanoscience and technology research and development – and there’s no reason why the same phenomenon couldn’t be witnessed elsewhere.’ Bijker: ‘Pankaj’s research has enabled us to draw conclusions that are more general, holding for Africa, the Netherlands and other places.’
The same is true of Saidi’s research in Kenya, South Africa and Zimbabwe. He aims to show how nanotechnologies travel from laboratories to different user contexts. ‘Usually when scientists come up with a new technology, they expect it to perform miracles when it goes out into the world’, he explains. ‘Through my empirical fieldwork, I demonstrate that technologies don’t fit perfectly and unproblematically in different societal situations. Instead, they need to be reworked, redesigned and made compatible with the local context.’
Outside the laboratory, technologies are subject to considerations that scientists wouldn’t even begin to think of, as illustrated by the case of a smart nano water filter introduced in a Zimbabwean village. Saidi: ‘You’d expect that people previously forced to drink dirty water would embrace this technology – yet they didn’t. They see water as a shared resource, so a filter designed for use inside individual households poses a threat to their social cohesion. By introducing this technology, you’re actually dividing society.’
Context always matters, says Saidi. ‘As every community differs from the next, there’s no one-size-fits-all solution or model that we can apply. Only by taking into account the manner in which end users interpret a certain technology is it possible to understand how to best deploy it.’
Beumer, finally, studied how nanotechnology is governed in India, South Africa and Kenya; three developing countries that are pursuing nanotechnology as a means of promoting development. ‘One of my main findings is that these countries have very different styles of governance, which isn’t what you’d expect based on the existing literature’, he says. ‘Not only do they have different development goals, but they also have different ideas about what development means and how to achieve it.’
In India, scientists are entitled to make important decisions about the funding of nanotechnology. In South Africa, on the other hand, such decisions are made primarily within a political framework. ‘These differences can be explained by looking at the social structure and history of each country’, says Beumer. ‘In India, with its caste system and many religions, science is viewed as neutral. For that reason, it’s seen as the key to development. The situation is entirely different in South Africa, where since the end of apartheid the government has focused on eliminating inequality. As a result, scientists only receive funding if they can make a contribution in this respect. What I argue is that nanotechnology can only benefit development if it connects to local traditions and institutions.’
Looking back on their international collaboration, the three agree it has been a joyful experience. ‘The geographic diversity brought a lot of excitement and enriched the research’, Saidi says. ‘It helped us to take on different perspectives,’ Beumer adds, ‘and in this manner we’ve been able to learn a lot from each other.’ Bijker shares the enthusiasm of his PhD candidates. So does he think nanotechnology can fulfil its promise to bridge the gap between the Global North and South, where earlier technologies could not? ‘That’s one of the most important questions one could ask, but I don’t have a definitive answer. Nanotechnology is unique in the breadth of its applicability, and besides, the world has changed vastly over the past fifty years. Today, more than ever, countries in the Global South are willing to take their destiny into their own hands. Seen in this light, it’s likely they’ll use emerging technologies like nanotechnology for their own purposes. So yes, I’m optimistic.’
Pankaj Sekhsaria will defend his PhD thesis ‘Enculturing Innovation: Indian engagements with nanotechnology’ on Thursday 10 March at 12.00. Trust Saidi will follow at 14.00 with his thesis ‘Travelling Nanotechnologies’. Lastly, Koen Beumer’s defence – ‘Nanotechnology and development: Styles of governance in India, South Africa, and Kenya’ – will start at 16.00.
Pregnant women who drink alcohol, or who suffer from psychological and emotional symptoms, are more at risk for a wide range of problems. How do you support women who may not be feeling quite right, or who cannot give up alcohol for nine months? With an E-health program, according to research at Maastricht University. On Thursday, 3 March, two candidates will give back-to-back defences of their theses, both of which are on research into the use of e-health in the care of pregnant women. This is purely a coincidence, because they had never met before this interview.
Yvonne Fontein was originally a midwife and had her own practice until 2008. Today, she works as a lecturer and researcher with the Midwifery programme at Rotterdam University of Applied Sciences. Fontein is a PhD candidate within the Midwifery Science research group at Zuyd University of Applied Sciences. She examined the use of a tailor-made website with practical tips that pregnant women can use to determine whether they are feeling good psychologically and emotionally, what factors throw them off balance and how they can best manage it all (coping mechanisms). In addition, the participating midwives discussed the issue with even greater emphasis than they normally do with pregnant women. The intervention ‘WazzUp Mama’ appeared to have a significant positive effect on pregnant women: they felt better about themselves than women who received no special attention on the subject from their midwife. “One of the things that surprised me in the study, is that it is highly dependent on the affinity that a midwife has for the psychological aspects of a pregnancy, whether there’s focus on it in their practice. And that often has to do with work experience; how you see the total picture of the pregnancy and not just the medical or biological aspects.”
A glass per week
Nickie van der Wulp got into alcohol research through social psychology. Today, she is director of the Korsakov Knowledge Centre, which is committed to providing quality care to patients with Korsakoff’s syndrome. Her research was commissioned by the Dutch Institute for Alcohol Policy (STAP) to examine how you can help pregnant women who drink alcohol to stop drinking during their pregnancy. “The women who participated in the research drank on average one glass per week. There is no safe lower limit, because we don’t know what the effect is of a single sip or glass, so we’re committed to zero consumption.” The website negenmaandenniet.nl gave interactive feedback on the knowledge level of pregnant women about alcohol use during pregnancy and provided recommendations. “We saw that the group that received feedback via the website stopped drinking more often than those who received feedback from midwives and especially more often than those who received no special intervention. My theory is that pregnant women didn’t dare to be honest with the midwives. It was even difficult for midwives to discuss the topic again during the second and third measurements. Annoyed reactions like: ‘I've already said that I don’t drink anymore!’, make it difficult for them to proceed.”
The role of the partner
Both PhD candidates are very aware of the workload of midwives and the fact that their research questions came on top of an already heavy workload. Van der Wulp is still adamant: “They currently ask whether you smoke, drink alcohol or use drugs, but I think that’s too limited. You should also ask if someone drank before the pregnancy and how much. If they drank regularly, they’re more likely to drink during the pregnancy. And if the partner continues drinking and even says that it doesn’t matter if his pregnant wife drinks, the risk is also higher. I thought that was notable from my research: the role of the partner is very important.” Van der Wulp also noted that some midwives still underestimate the problem of alcohol use during pregnancy. Fontein: “And they often underestimate their own influence on pregnant women. While they’re often very willing to adapt their lifestyle if it’s in the interest of the baby.”
Every year in the Netherlands, six hundred babies are born with Foetal Alcohol Syndrome (FAS): they have distinctive facial features, are smaller, have brain damage and more. “For children with behavioural problems or ADHD, we don’t know to what extent this could be caused by alcohol. There are so many women who drink alcohol during pregnancy, which is so harmful to the development of the foetus; that was an incredible motivation for me.” Fontein: “My motivation was that a pregnancy is not all roses for everyone and I think that’s a pity, because most women don’t experience many. And I see enormous improvements that can be made in prenatal care, by better observing and listening to what the pregnant women need. With the best intentions, midwives tend to fill in the women’s experiences. But you have to be very focused on what the woman needs.” Van der Wulp: “I have a lot of respect for the profession, but the knowledge about alcohol could be much better. Especially highly educated pregnant women sometimes want to have a drink and with them in particular you have to use very good arguments to convince them that it’s harmful.”
No solid figures
The problem is, of course, that there are no rock solid figures on how much alcohol is harmful. This also applies to ‘maternal distress’ during pregnancy. What is known is that one in four or five women in the Netherlands suffer from it each year, which is approximately 35,000. Potential consequences of this are a greater fear of childbirth, postpartum depression or severe prolonged psychological complaints. The child can also suffer from it, in terms of birth weight and subsequent behavioural or developmental problems. Factors that make women the most out of balance during pregnancy, as is shown in Fontein’s research, have to do with purely the expectation of having a(nother) child. “That’s also related to the role of working mothers nowadays and everything they have on their plate. Even with a second child, it may increase the amount of stress in that area. Also if the woman had previously had psychological symptoms, there was more stress during pregnancy. One of the most important ‘coping mechanisms’ was talking about your worries or problems. And in that case more with loved ones than with the midwives. That was also then encouraged through the site.”
The site www.negenmaandenniet.nl was expanded using a ZonMW grant from a research version to a public version. “Every pregnant woman should visit the website," says Van der Wulp. The future of www.wazzupmama.nl is still being considered.
Yvonne Fontein is a lecturer and researcher with the Midwifery programme at Rotterdam University of Applied Sciences. On Thursday, 3 March at 16.00 at Maastricht University, she will defend her thesis entitled ‘Wazzup Mama! The development of an intervention to reduce preventable and maternal distress during pregnancy’.
Nickie van der Wulp is director of the Korsakov Knowledge Centre. On Thursday, 3 March at 14.00 at Maastricht University, she will defend her thesis entitled ‘Zero for nine: Reducing alcohol use during pregnancy through health counselling and Internet-based computer-tailored feedback’.
The Dutch pension system, which is based on guaranteed benefits, will definitely be restructured; the only question is when. Econometrician Anne Balter expects to see a different pension system by the time she retires, which will be a while. The twenty-six-year-old, one of the youngest PhD candidates at Maastricht University, is at the start of a promising career. She received her doctorate on Friday 19 February with a thesis on the model uncertainty facing today's pension funds and insurers.
After interning at AZL pension fund in Heerlen, Balter decided to pursue a master's degree in actuarial science. When she started her doctoral research on model uncertainties, she couldn't have known how topical the issue would become. The shaky pension system, a result of historically low interest rates, is in the news almost daily. As it's not clear whether the buffers built up by pension providers are enough to ensure future pay-outs, current pensions are no longer being indexed. Cut-backs are another impending threat.
'This involves pensions to be paid out in the short term, so in twenty years. We can oversee this period to some extent by studying market developments. Unfortunately, we can't say the same for pensions paid out in thirty, forty, fifty or sixty years. Pension funds use mathematical models to develop an investment strategy and to calculate how much money to put aside to guarantee future pension payments. I researched the reliability of these models and created a new investment strategy that is less sensitive to interest fluctuations,' explains the PhD candidate.
Balter used an economics-based model to determine the extent to which the long-term interest rates are expected to grow. This is important as it determines how the pension funds' capital grows alongside it. Because her calculation model is based on a model in line with financial theories, it results in a different curve than those based on the simplified assumptions used in current models. That said, no model can provide an entirely accurate or reliable view of the future. That's why Balter advocates using several models to determine the best investment strategy.
This conclusion is not entirely surprising. 'You can never predict what's going to happen. The world doesn't behave like the numbers in the model, which is why there's almost always a mismatch between model-based decisions and the desired effect. We're now using the ultimate forward rate (UFR) curve, which is based on an interest rate of 4.2 percent over sixty years. But my research found that the 4.2 figure is really just a guess. This method was adjusted last year and the UFR is now based on the historic average, which means it could be 2 percent or 6 percent.'
Today's low interest rates are a result of the financial crisis. By keeping interests low, the European Central Bank hopes the economy will start to pick up again. A negative consequence of this is that pension funds can no longer guarantee pay-outs. 'The most logical scenario is for the funds to let go of this notion of guarantees. The SER (Dutch social economic council) is discussing a new pension system at the moment. They may want to distribute the risks across several generations or give the policy-holders the opportunity to determine their investment risk. Whatever the case: restructuring an entire system will have a big impact. The Dutch pension system is based on the social principle that we all make a financial contribution. It's a principle we're proud of in the Netherlands and something that will be hard to let go of. It's politically sensitive; no one wants to tackle this issue head-on. As a result, it could take up to ten years for someone to address it. Once it's been addressed, extensive research will be needed to develop a new system.'
Until then, the pension funds will continue to use the calculation models. The uncertainty Balter identified may lay the foundation for determining the buffers. But calculation models can also be used to predict how much pension money will be needed in the future. 'What's great about these models is that they can also be used for risk management. Instead of interest rates, you can also calculate temperature increases. But climate change is hard to predict. Like long-term interest rates, it's an unreliable prediction.'