40 research outputs found

    Implementation of GIS-Based Applications in Water Governance

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    __Abstract__ Geographical Information Systems (GIS) are computer programs that are able to bring large amounts of data of both the physical and the social system together in one comprehensive overview shown digitally. GIS occurred very rapidly on the Dutch policy agenda. In this paper we analyze how the fast introduction process of GIS-based instruments in water management and more specifically in river flood management can be explained. By applying a range of classical models on agenda-setting, we show the important contribution of GIS to the water and flood issue in current spatial planning and policy development in the Netherland

    Obtaining Adequate Surgical Margins in Breast-Conserving Therapy for Patients with Early-Stage Breast Cancer: Current Modalities and Future Directions

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    Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse affects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher a priori risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real-time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radioguided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT

    How to bring a technical artifact into use: A micro-developmental perspective

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    In order to understand how technical artifacts are attuned to, interacted with, and shaped in various and varied classrooms, it is necessary to construct detailed accounts of the use of particular artifacts in particular classrooms. This paper presents a descriptive account of how a shared workspace was brought into use by a student pair in a face-to-face planning task. A micro-developmental perspective was adopted to describe how the pair established a purposeful connection with this unfamiliar artifact over a relatively short time frame. This appropriation was examined against the background of their regular planning practice. We describe how situational resources present in the classroom—norms, practices and artifacts— frame possible action, and how these possibilities are enacted by the pair. Analysis shows that the association of norms and practices with the technical artifact lead to a contradiction that surfaced as resistance experienced from the artifact. This resistance played an important part in the appropriation process of the pair. It signaled tension in the activity, triggered reflection on the interaction with the artifact, and had a coordinative function. The absence of resistance was equally important. It allowed the pair to transpose or depart from regular procedure without reflection

    On the Origin of Great Strategies

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