Title Promoter Affiliations Abstract "GOGO: Goudsbloem, een gouden kans!" "Els Gils" "Proefcentrum Herent" "in te vullen" "ACTION: Advance care planning – een innovative palliative care intervention to improve quality of life in oncology" "Luc Deliens" "Medical Sociology" "Advanced cancer typically involves multiple symptoms and seriously affects patients´ quality of life. Anxiety and depression are common. Medical care for patients with advanced cancer should be aimed at symptom control, psychosocial support, spiritual needs, and practical issues. Patients' preferences regarding care should be central. Open and respectful communication are of key importance, but have been found to be a challenge for health care professionals as well as patients and relatives. Advance care planning (ACP) is a formalised process of communication between patients, relatives and caregivers about patients' care preferences. It raises awareness of the need to anticipate future deterioration of health. ACP can improve current and future health care decision making, provide patients with a sense of control, increase adequate symptom control and improve quality of life. This project aims to study the effects of formalized ACP on symptom burden and quality of life of patients with advanced cancer. In a phase III multicentre cluster randomized controlled trial at least 20 hospitals in 6 countries will be randomized to provide patients with advanced cancer with either ACP or 'care as usual'. 1334 patients diagnosed with lung or stage IV colorectal cancer will be included. Patients will fill in questionnaires at inclusion, and at 2.5 and 4.5 months post-inclusion. A relative will fill in a questionnaire after the patient's death. Use of medical care will be assessed through medical files. Primary endpoints are quality of life (QLQ-C30 emotional functioning) and symptoms at 2.5 months post-inclusion. Secondary endpoints are the extent to which care as received was in line with patients' preferences, patients' evaluation of the decision making process, quality of dying and cost-effectiveness of the intervention. Our project will assess the impact of ACP on quality of life, and contribute to improving comfort and quality of care for patients with advanced cancer." "Multimodal monitoring of electrophysiological signals in childhood epilepsy and neonatal encephalopathy" "Lieven Lagae" "Woman and Child, ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics" "Multimodal monitoring of electrophysiological signals in childhood epilepsy and neonatal encephalopathy.Summary EEG records electrical activity in the brain generated by pyramidal cells forming large neuronal networks.  EEG monitoring provides a constant assessment of brain function and has 3 major applications in neurological practice.  It can be used to appreciate epileptic activity in patients with epilepsy.  It can help in monitoring cerebral recovery after brain insults.  In preterm and term newborns, it can provide important information on brain maturation.  EEG interpretation is dependent on retrospective visual inspection of theEEG signals by a neurophysiologist.  By measuring other physiological signals as heart rate and respiration together with the EEG, we can learn more about the functionality of the central autonomic nervous system in patients with epilepsy.  Developing advanced algorithms for EEG analysis can help in automatisation and quantification of EEG analysis.  Using these techniques will be helpful in standardizing the technique and making assessment of long term EEG monitoring easier.The first aim of this project is to study the central autonomic nervous system in children with epilepsy.Epilepsy is themost frequent neurological disorder characterized by recurrent and unprovoked seizures.  Seizure incidence is the highest in infancy and childhood.  Patients with epilepsy are prone to dysfunction of the autonomic nervous system.  The acute disturbances arelinked with seizure activity on the EEG and can be measured using heartrate or respiratory frequency.  The chronic autonomic dysfunction appears after time and can be appreciated using heart rate variability (HRV).  The heart is innervated by sympathetic and vagal branches of the autonomic nervous system. The balance of these neural influences on the cardiac pacemaker determines heart rate variability.  To study the autonomic nervous system in children with epilepsy, we used multimodal long-term measurements and included ECG and respiration in addition to EEG.Acute changes in heart rate or respiration are linked to seizures.  In our study on peri-ictal heart rate changes in childhood epilepsy, we were able to demonstrate that heart rate changes in focal seizures originating from the frontal or temporal lobe.  Seizure detection based on pre-ictal heart rate changes is possible in 70% of the focal seizures, but we have to take intoaccount a very low sensitivity.  The time lag between the heart rate change and onset of ictal activity on the EEG was much shorter compared to studies conducted in adults.    These findings have implications for future seizure detection systems and the development of closed loop systems.  In childhood epilepsy, identification of these early autonomic manifestations in seizures is possible at least in focal seizures, but the time lag was only 3,5 secondsmaking the time to initiate therapeutic measures very short. Patients with long-lasting and refractory epilepsy are prone to chronic dysfunction of the autonomic nervous system.  From our studies,we were able to show that cardiac as well as respiratory autonomic changes are present in childhood epilepsy.  We used heart rate variability to detect chronic autonomic dysfunction in children with epilepsy.   In contrast to previous conducted studies, we took into account normal circadian variations of HRV.  In children with refractory epilepsy, heart rate variability was found to be depressed with a prominent reduction in vagal tone during slow wave sleep.  Normal sleep modulation of autonomic function is lost in this patient population but is again improved after treatment with a vagus nervestimulator.   The same reduction in vagal tone was foundin children with West syndrome after a much shorter disease course compared to the adult population.  Reduction of vagal activity during slow wave sleep was found already after 3 years.  There isgrowing evidence for the association of heart rate variability with morbidity and mortality in patients with epilepsy.  Recognition of chronic changes is important because these abnormalities are thought to play an important role in sudden unexpected death in epilepsy patients(SUDEP).Respiration is altered already at onset of the epileptic syndrome in patients with West syndrome.   Respiration is slower and contains more irregularities, suggesting a higher risk of apneas.  The abnormalities are present in between the typical seizures, but in the presence of continuous spikes.  If these findings are a risk factor for SUDEP in this population remains uncertain.   Ictal bradypnea is present in childhood temporal lobe seizures.  The same phenomenon has been observed in adults with temporal lobe epilepsy. Absence seizures do not show a uniform ictal respiration pattern, probably due to the short duration of the seizures.  Interictally respiration is disturbed in absence epilepsy but not in temporal lobe epilepsy.  These findings could not be explained by interictal electrical discharges since both cohorts only had few interictal spikes.  The findings are due to involvement of the thalamocortical network in the epileptogenetic process.   The second aim of this project is to take a first step in automatisation and quantification of EEG in critically ill newborns.In preterm and term newborns, EEG can be used to assess brain maturation, detect seizure activity, monitor treatment and give information on prognosis of the newborn baby. In the first part of this study, we used a model of burst-suppression in newborns with hypoxic-ischemic encephalopathy to take a first step towards automated analysis of EEG.  We show that interburst-interval can be detected automatically with high specificity in newborns with hypoxic ischemic encephalopathy with different degree of discontinuity in their EEG background.  In the second part of this study, we demonstrate that quantitative analysis of bursts in discontinuous EEG patterns in newborns is possible and can discriminate between the pathological burst-suppressionpattern in early infantile epileptic encephalopathy and normal tracé alternant in healthy newborns.  Defining and quantifying these parameters will be very useful in the development of bed-side automated analysis of EEG in newborns in the future. " "Strategic Research Programme: Exercise and the brain in health & diseases: the added value of human-centered robotics" "Romain Meeusen" "Robotics & Multibody Mechanics Research Group, Physiotherapy, Human Physiology and Anatomy, Human Physiology and Sports Physiotherapy Research Group, Advanced Rehabilitation Technology & Science, Spine Research Group, Applied Mechanics, Human Physiology and Special Physiology of Physical Education" "One of the current bottlenecks in the field of robotics with the aim of assisting human movement is the effectiveness of exoskeletal devices. The department MFYS is specialized in the assessment of psycho-physiological measurements during rest and movement, which can help to determine the effectiveness of robot-assisted human movement. In the past, this resulted in pioneering work regarding brain images during robot-assisted walking. Recently, research of the department focussed on measuring brain electrocortical activity using electro-encephalography (EEG). This is relevant to the field of robotics, since one of the main goals is to enable the control of robotic parts with brain-computer interfaces (using EEG)." "Characterisation of acoustic liner impedance in representative turbofan engine flight environment" "Wim Desmet" "Production Engineering, Machine Design and Automation (PMA) Section, Mechanical Engineering Technology, Group T Leuven Campus" "IntroductionThe central subject of the scientific research performed during the Doctoral Training (PhD) consists in the study of the impedance provided by acoustic liners through the improvement and the application of the numerical modelling and the experimental capabilities available in Alenia Aermacchi and K.U.Leuven. A better understanding of the main driving parameters is expected to lead both the optimisation of current liner designs and the development of new liner concepts.  Acoustic liners are widely employed in areo-engine turbofan ducts for noise suppression. Their design and their acoustic performance are driven by the effective operational environment (e.g. flow and sound field). In order to maximise noise suppression, it is necessary to develop a deep knowledge of all the physical effects acting on these devices. The physical phenomena that govern the behaviour of acoustic perforate liners (locally and non-locally reacting) under grazing flow and Sound Pressure Level are not completely known. Current models used for liner impedance prediction do not provide the required level of accuracy for efficient liner design in representative flight environment. Furthermore, currently measurement techniques adopted in flow duct facilities provide different levels of accuracy and partially reproduce the typical nacelle environment. There exists the potential for noise reduction to be achieved through redesign of acoustic panels for existing nacelles and similar improvements are envisaged for future designs utilising improved impedance models. ObjectivesThe research proposed in the frame of the PhD study aims to:Improve the understanding of the physical phenomena that govern the behaviour of acoustic liners, by:                   1) identifying the grazing flow and the local boundary layer effects,                  2) understanding the effect of high Sound Pressure Levels (SPL),                  3) evaluating the effect of the fan duct modal content,Understanding the influence on liner attenuation provided by impedance transition zones (e.g. panel joints, edges).Develop and validate nacelle acoustic liner impedance models which accurately reflect the physical phenomena under representative local nacelle flow stream and acoustic field characteristics.Exploit, develop, compare measurement techniques on current and innovative liners.Validate CFD/CAA calculations. " "Nitrogen fertilization in ornamental plant production based on in-season demands through proximal sensing and soil modelling" "Marie-Christine Van Labeke, Hilde Vandendriessche" "Division of Crop Biotechnics" "The ornamental plant production sector produces high quality products, but faces challenges in times of increasing environmental constraints.Growth patterns and nitrogen uptake dynamics of five ornamental crops were determined during three growing seasons (2016-2018). This resulted in nitrogen uptake quantities sufficient for optimum plant quality.Open field production of herbaceous and woody ornamentals is characterized by a very broad range of species and cultivars, differing in growth dynamics, biomass accumulation as well as cultivation method. The Flemish ornamental plant sector produces high-value plants but faces plenty of challenges to maintain this high quality in times of increasing environmental constraints. For open field production, Flanders imposes nitrogen fertilization standards in order to comply with the European Nitrates Directive (91/676/EEC). To keep ornamental plant growers competitive on the national and international markets and to comply with these environmental restrictions, the sector needs a differentiated nitrogen (N) recommendation system, based on in-season demands. Indeed, high quantities of residual nitrate can be measured in the soil profile after the growing season, which is partly due to fertilizer gifts that all too often exceed the crop demand. In periods of high precipitation, this nitrate is susceptible to leaching through the soil profile, which subsequently leads to ground and surface water contamination.Limited information was available about the nitrogen requirements of open field ornamental plants, despite this being an essential input variable of fertilizer recommendation systems. Therefore, N uptake dynamics of five ornamental plants species was assessed during three growing seasons (2016-2018). This was done through regular measuring and sampling on trial fields with different fertilization levels and nurseries where business-as-usual practices were applied. Chrysanthemum morifolium (potted chrysanthemum, cultivars ‘Maya’ and ‘Orlando’), Acer pseudoplatanus (sycamore, deciduous tree, forest seedling production), Ligustrum ovalifolium (Korean privet, semi-evergreen shrub), Prunus laurocerasus ‘Rotundifolia’ (cherry laurel, evergreen shrub) and Tilia cordata (small-leaved lime, deciduous avenue tree) were selected as representative for the open field ornamental plant production. This resulted in N uptake ranges that may be considered as adequate for a good plant quality. Because different plant ages and management practices were considered, we repeatedly demonstrated that N uptake was influenced more by age, planting density, transplanting of perennials, etc. than by the species itself. Furthermore, gathering data over a period of three growing seasons revealed that the N uptake is strongly affected by year-to-year varying climatic conditions, stressing the importance of multi-year nitrogen uptake datasets.These findings highlight the importance of split-applications and in-season determination of plant N demand and soil N supply. With regard to the latter, based on our results, we would propose a soil analysis early in July and early in August for the woody ornamentals (A. pseudoplatanus, L. ovalifolium, P. laurocerasus ‘Rotundifolia’ and T. cordata) and C. morifolium, respectively. To determine in-season N status of the plants on the other hand, the potential of proximal leaf and canopy sensors was explored in this thesis. To date, these techniques are underexploited for (woody) ornamentals, yet they offer countless opportunities to support N fertilization.At leaf level, we found that epidermal polyphenolic compounds measured with the Dualex sensor were highly correlated with foliar N% in C. morifolium. For the woody species, chlorophyll measured with both a SPAD meter and a Dualex sensor were a reliable proxy for foliar N%, but only when the leaf mass per area was considered. These results prove that proximal leaf sensors can be valuable decision-support tools to assess the in-season nitrogen status of both C. morifolium and different woody ornamental species. Nevertheless, some caution is recommended when different plant species are used, especially if leaf characteristics differ (e.g. presence of a wax layer). A relative approach, where a saturation index was calculated using a nitrogen-rich reference field, was considered to improve the usability because there are no absolute reference values available for an optimal (foliar) N% for the many different species and cultivars grown in nurseries.At canopy level, the GreenSeeker was used for three consecutive growing seasons on the one hand. This widely used sensor measures red and infrared light reflected by the plant canopy and subsequently calculates the NDVI, a vegetation index related with photosynthetically active biomass. The obtained correlations between NDVI and biomass and N uptake were generally high, but species-specific. Furthermore, we also encountered saturation problems when the canopy closed. It was concluded that NDVI measurements can be useful to identify the need for additional fertilization and potential in-field variability, but do not serve as a proxy for plant N%. Here as well, a relative approach can help to rule out other parameters except an N deficiency, as long as the reference plot is representative for the rest of the field and a threshold value for action can be set.On the other hand, the potential of a novel hyperspectral spectroradiometer was assessed in 2018. This device measures reflectance continuously in the visual and near infrared part of the electromagnetic spectrum (340-820 nm) and allows the comparison of multiple vegetation indices or the exploitation of multiple wavelengths through multivariate statistics. Although other vegetation indices besides NDVI were highly correlated with biomass and N uptake (especially for C. morifolium), mainly partial least squared regression (PLRS) was considered promising to provide site-specific diagnostics of crop performance. Here, for plant N% as well, high correlations were obtained on species-level. For both C. morifolium as for the woody ornamental species, end-of-season specific difficulties, including flower bud initiation and the relocation of N towards perennial storage organs (roots/stem), interfered with the correlation; however, as additional fertilization is often unfavorable around that period, these dates could be excluded during further research. More data confirming the robustness of the correlations are needed to develop a decision support system based on the prediction models.Because plant growth is generally determined by interactions with the soil in a bottom-up manner, an important chapter in this thesis is devoted to soil N release, with emphasis on the influence of mechanical weed control and the opportunities of catch crops. For the case of avenue tree production, characterized by a low planting density, a low N uptake and repeated mechanical weed control, a field experiment was set up at two nurseries. During three growing seasons following the application of farmyard manure, soil mineral N was monitored by means of regular soil sampling. At one of the nurseries, we showed that at least 30% of the applied N was released in the second year. Partly due to the heterogeneity of animal manure, results were not always significant or consistent over time, nevertheless, the N release tended to continue the second year after application at the other nursery as well.Attempts were made to validate the results obtained by the field experiment through a model-based approach in order to be able to quantify nitrogen release and leaching. As both processes strongly depend on water availability and flow, a soil water balance was used to simulate daily water movement. Furthermore, the mineralization speed of the soil and the farmyard manure were calculated through an incubation experiment in laboratory conditions, however, due the inhomogeneous nature of the manure (and perhaps other unknown interactions), results could not be translated into field conditions. Therefore, the model approach needed more fine-tuning than expected. Nevertheless, the nitrogen balance models were useful as an exploratory tool to quantify N release and leaching after management practices for the first time.At both nurseries, there was a considerable mismatch between nitrogen fertilization and uptake by the trees, which could have been almost entirely covered by the N release after soil cultivation (if its timing would be synchronized with plant demand). N release succeeding a soil disturbance event was depending on time of the year, number of events and model decisions, but resulted in an additional N release of minimum 109 kg N ha-1 during the three experimental years at both fields. Average estimated N release after soil disturbance varied between 8 and 71 kg N ha-1; the more soil cultivation events were carried out, the less N tended to be released each time. In-field differences in nitrate content could be mostly attributed to the different weed control management, which shows that its impact should not be neglected. For example, an autumn rotovation of the soil following chemical weed control resulted in an exceptionally high amount of residual nitrogen and a doubling of modelled nitrate leaching during winter (± 108 NO3--N ha-1 compared with ± 54 kg NO3--N ha-1 in the other years). Lastly, we were able to associate catch crops, even when sown late, with a reduced N leaching of 33.5% on average. We therefore suggest delaying the control period for obligatory residual soil sampling for perennial crop growers in Flanders. Based on our results, we would recommend advancing the first soil cultivation, and thus (cold hardy) catch crop incorporation, to increase N availability at the start of the growing season instead of applying a mineral fertilizer." "Strategic Research Programme: Tracing and Modelling of Past & Present Global Changes" "Philippe Claeys" "Physical Geography, Geography, Earth System Sciences, Analytical, Environmental & Geo-Chemistry, Chemistry" "The scientific approach focuses on the holistic use of biogeochemical tracers, such as elemental concentrations (Cd, Pb, PGE etc.) and isotopic ratios (D/H, 18O/16O, 87Sr/88Sr...), - in some cases referred to as ""proxies"" - that are measured on a substrate (e.g. mineral phase, fossil, mussel-shell, teeth, seawater, ice cores etc.) to infer specific environmental parameters (such as condition of formation, temperature, acidity, salinity, CO2 level, composition, bio-productivity etc.). Variations in these ""proxies"" characterize the factors triggering or resulting from (paleo)environmental changes and document at different scales, the short and/or long-term effects of these modifications on the Global Earth System. Although not commonly carried out, the analyses in close conjunction of modern and ancient global changes, including pollution are highly complementary and mutually beneficial. Ongoing changes are monitored and documented at very high resolution, while the geological record traces the evolution of these changes through time, providing an extra dimension, missing from the modern data. The themes briefly presented below constitute cutting-edge international research challenges. To address them, innovative analytical procedures are continuously being developed using the facilities available at the VUB and its partner universities. This analytical toolbox is then applied to various Earth and Environmental Science problems, often coupled with modeling." "Advanced Solutions for Neonatal Sleep Analysis and the Effects of Maturation" "Sabine Van Huffel" "Woman and Child, ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics" "Worldwide approximately 11% of the babies are born before 37 weeks of gestation. The survival rates of these prematurely born infants have steadily increased during the last decades as a result of the technical and medical progress in the neonatal intensive care units (NICUs). The focus of the NICUs has therefore gradually evolvedfrom increasing life chances to improving quality of life. In this respect, promoting and supporting optimal brain development is crucial.Because these neonates are born during a period of rapid growth and development of the brain, they are susceptible to brain damage and therefore vulnerable to adverse neurodevelopmental outcome. In order to identify patients at risk of long-term disabilities, close monitoring of the neurological function during the first critical weeks is a primary concern in the current NICUs. Electroencephalography (EEG) is a valuable tool for continuous noninvasive brain monitoring at the bedside. The brain waves and patterns in the neonatal EEG provide interesting information about the newborn brain function. However, visual interpretation is a time-consuming and tedious task requiring expert knowledge. This indicates a need for automated analysis of the neonatal EEG characteristics. The work presented in this thesis aims at contributing to this.The first part of this thesis focuses on the development of algorithms to automatically classify sleep stages in preterm babies. In total three different strategies are proposed. In the first method, the problem is traditionally approached and a new set of EEG complexity features is combined with a classification algorithm. This analysis demonstrates that the complexity of the EEG signal is fundamentally different dependent on the vigilance state of the infant. Building on this finding, a novel tensor-based approach that detects quiet sleep in an unsupervised manner is presented.Finally, a deep convolutional neural network to classify neonatal sleep stages is implemented. This end-to-end model optimizes the feature extraction and classification model simultaneously, avoiding the challenging task of feature engineering.   The second part concentrates on the quantification of functional brain maturation in preterm infants. We establish that the complexity of the EEG time series is significantly positively correlated with the postmenstrual age of the neonate. Moreover, these promising biomarkers of brain maturity are used to develop a brain-age model. This model can accurately estimate the infant's age and thereby assess the functional brain maturation. In addition, the relationship between the early functional and structural brain development is investigated based on two complementary neuromonitoring modalities, EEG and MRI. Regression models show that the brain activity during the first postnatal days is related to the size and growth of the cerebellum in the subsequent weeks.At last, the influence of the thyroid function on the developing brain is examined in extremely premature infants. No significant association was observed between the change in free thyroxine concentrations during the first week of life and maturational features extracted from the EEG at term equivalent age. To shed more light on the precise relationship between thyroid function and brain maturation, prospective studies with a more homogeneous dataset are needed in the future." "Translational Molecular Imaging Program for the University of Antwerp: application driven preclinical research." "Steven Staelens" "Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO)" "Given the demographic aging, research in molecular imaging has a large social support and bearing. Moreover, the successful miniaturization of (S)PE(C)T cameras these past three to five years caused a major breakthrough for small animal imaging. Dedicated high-resolution small animal imaging systems have recently emerged as important new tools for research and have entered the preclinical arena. These new imaging systems permit researchers to noninvasively screen animals for pathologies, to use various cell lines in drug and tracer development, to monitor disease progression and also response to therapy. Considerable benefits are the in vivo nature of these small animal imaging experiments enabling longitudinal studies with the animal acting as its own control, the robustness, less labour intensive biodistributions, and less sacrification of laboratory animals. This benchfee (if granted) will be applied for an integrated translational molecular imaging program for UA thereby initiating fundamental science driven by clinical questions and enabled through these preclinical research tracks. This approach efficiently closes the feedback loop to the hospital ultimately resulting in improved patient comfort." EPISTOP "Anna C Jansen" "Public Health Care" "Despite a great progress in the management of epilepsy, still one third of patients is refractory to available medications. The incidence of epilepsy is highest in infancy and 50% of children experience epilepsy-related comorbidities, such as developmental delay and autism. The development of epilepsy (epileptogenesis), extensively studied in animals, is barely studied in humans, as patients usually present AFTER the seizure onset. EPISTOP is the first prospective study of epileptogenesis in humans, beginning BEFORE seizures and continuing through age 2+ years, permitting detailed analysis of the onset, drug-resistance, and comorbidities of epilepsy. To maximize information derived from the study we have chosen homogenous group of patients with prenatal or early infantile diagnosis of Tuberous Sclerosis Complex (TSC). A clinical randomized study of pre-seizure treatment in TSC infants is a part of the project. The aim of EPISTOP is to examine the risk factors and biomarkers of epilepsy and to identify possible new therapeutic targets to block or otherwise modify epileptogenesis in humans. Biomarker analysis will be performed by a multidisciplinary, systematic approach in three clinical settings: prospective study of epilepsy development in infants with TSC, including analysis of clinical, neuroimaging, and molecular, blood-derived biomarkers at predefined time points: before the onset of seizures, at the onset of epileptiform discharges on EEG, at seizure onset and at the age of 24 months prospective study of blood-based biomarkers in infants with TSC treated with antiepileptic drugs prior to seizure onset in comparison to children treated only after clinical seizures appearance. analysis of biomarkers of epileptogenesis and drug-resistant epilepsy in brain specimens obtained from TSC patients who have had epilepsy surgery and TSC autopsy cases. EPISTOP will be carried out by a consortium of 14 partners from 9 countries, including 2 SMEs."