Compliance Principles for Decision Management Solutions at the Dutch Government

Since decision management is becoming an integrated part of business process management, more and more decision management implementations are realized. Therefore, organizations search for guidance to design such solutions. Principles are often applied to guide the design of information systems in general. A particular area of interest when designing decision management solutions is compliance. In an earlier published study we took a general perspective on principles regarding the design of decision management solutions. In this paper, we re-address our earlier work, yet from a different perspective, the compliance perspective. Thus, we analyzed how the principles can be utilized in the design of compliant decision management solutions. Therefore, the purpose of this paper is to specify, classify, and validate compliance principles. To identify relevant compliance principles, we conducted a three round focus group and three round Delphi Study which led to the identification of eleven compliance principles

A lifetime perspective of biomass allocation in Quercus pubescens trees in a dry, alpine valley

Plasticity of biomass allocation is a key to growth and survival of trees exposed to variable levels of stress in their lifetime. Most of our understanding of dynamic biomass allocation comes from seedling studies, but plasticity may be different in mature trees. We used stem analysis to reconstruct whole-tree growth and biomass allocation patterns in Quercus pubescens trees harvested from a dry woodland in Valais, Switzerland. We identified three distinct growth phases. In phase I, a primary root developed but the aboveground structure did not persist. In phase II, height growth occurred and secondary roots developed. In phase III, height growth ceased and stems and roots only grew radially. Reference trees harvested from a less dry site nearby only showed phase II-type growth. In line with our hypothesis, drought-stressed trees maintained more biomass in roots and less in aboveground woody parts than reference trees. Contrary to our expectation, stressed trees allocated proportionally more resources to leaves and less to roots in the growing season before harvest than reference trees. It appears that sub-seasonal wood anatomical adjustments to water availability minimize hydraulic failure, thus enabling these dry woodland trees to invest preferentially in leaves. Wet years did not see preferential investment in aboveground tissues, suggesting more restricted plasticity in biomass allocation in these mature trees than in seedlings. It is concluded that trees beyond seedling stage show different responses to variation in drought than the better-studied seedling

Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy:implications for planning of nerve-sparing surgery

Aims: Radical prostatectomy (RP) for prostate cancer is frequently complicated by erectile dysfunction and urinary incontinence. However, sparing of the nerve bundles adjacent to the posterolateral sides of the prostate reduces the number of complications at the risk of positive surgical margins. Preoperative selection of men eligible for safe, nerve-sparing surgery is therefore needed. Our aim was to identify pathological factors associated with positive posterolateral surgical margins in men undergoing bilateral nerve-sparing RP. Methods and results: Prostate cancer patients undergoing RP with standardised intra-operative surgical margin assessment according to the NeuroSAFE technique were included. Preoperative biopsies were reviewed for grade group (GG), cribriform and/or intraductal carcinoma (CR/IDC), perineural invasion (PNI), cumulative tumour length and extraprostatic extension (EPE). Of 624 included patients, 573 (91.8%) received NeuroSAFE bilaterally and 51 (8.2%) unilaterally, resulting in a total of 1197 intraoperative posterolateral surgical margin assessments. Side-specific biopsy findings were correlated to ipsilateral NeuroSAFE outcome. Higher biopsy GG, CR/IDC, PNI, EPE, number of positive biopsies and cumulative tumour length were all associated with positive posterolateral margins. In multivariable bivariate logistic regression, ipsilateral PNI [odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.62–5.48; P &lt; 0.001] and percentage of positive cores (OR = 1.18, 95% CI = 1.08–1.29; P &lt; 0.001) were significant predictors for a positive posterolateral margin, while GG and CR/IDC were not. Conclusions: Ipsilateral PNI and percentage of positive cores were significant predictors for a positive posterolateral surgical margin at RP. Biopsy PNI and tumour volume can therefore support clinical decision-making on the level of nerve-sparing surgery in prostate cancer patients.</p

The acquisitive–conservative axis of leaf trait variation emerges even in homogeneous environments

The acquisitive-conservative axis of plant ecological strategies results in a pattern of leaf trait covariation that captures the balance between leaf construction costs and plant growth potential. Studies evaluating trait covariation within species are scarcer, and have mostly dealt with variation in response to environmental gradients. Little work has been published on intraspecific patterns of leaf trait covariation in the absence of strong environmental variation.Methods: We analysed covariation of four leaf functional traits (SLA: specific leaf area, LDMC: leaf dry matter content, Ft: force to tear, and Nm: leaf nitrogen content) in six Poaceae and four Fabaceae species common in the dry Chaco forest of Central Argentina, growing in the field and in a common garden. We compared intraspecific covariation patterns (slopes, correlation and effect size) of leaf functional traits with global interspecific covariation patterns. Additionally, we checked for possible climatic and edaphic factors that could affect the intraspecific covariation pattern.Key Results: We found negative correlations for the LDMC-SLA, Ft-SLA, LDMC-Nm , and Ft-Nm trait pairs. This intraspecific covariation pattern found both in the field and in the common garden and not be explained by climatic or edaphic variation in the field follows the expected acquisitive-conservative axis. At the same time, we found quantitative differences in slopes among different species, and between these intraspecific patterns and the interspecific ones. Many of these differences seem to be idiosyncratic, but some appear consistent among species (e.g.all the intraspecific LDMC-SLA and LDMC-Nm slopes tend to be shallower than the global).Conclusions: Our study indicates that the acquisitive-conservative leaf functional trait covariation pattern occurs at the intraspecific level even in the absence of relevant environmental variation in the field. This suggests a high degree of variation-covariation in leaf functional traits not driven by environmental variables.Fil: Gorne, Lucas Damián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Díaz, Sandra Myrna. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Minden, Vanessa. University of Oldenburg; Alemania. Vrije Universiteit Brussel; BélgicaFil: Onoda, Yusuke. Kyoto University. School of Agriculture; JapónFil: Kramer, Koen. Wageningen University; Países BajosFil: Muir, Christopher. University Of Hawaii; Estados UnidosFil: Michaletz, Sean T. University of British Columbia; CanadáFil: Lavorel, Sandra. Centre National de la Recherche Scientifique; FranciaFil: Sharpe, Joanne. Sharplex Services, Edgecomb; Estados UnidosFil: Jansen, Steven. Universitat Ulm; AlemaniaFil: Slot, Martijn. Smithsonian Tropical Research Institute; PanamáFil: Chacon, Maximiliano Eduardo. Universidad de Costa Rica; Costa RicaFil: Boenisch, Gerhard. Max Planck Institute For Biogeochemistry; Alemani

Urinary Incontinence and Sexual Function After the Introduction of NeuroSAFE in Radical Prostatectomy for Prostate Cancer

Background: Nerve-sparing (NS) radical prostatectomy (RP) results in better functional outcomes. Intraoperative neurovascular structure–adjacent frozen section examination (NeuroSAFE) significantly increases the frequency of NS surgery. The effect of NeuroSAFE on postoperative erectile function (EF) and continence is not yet clear. Objective: To describe EF and continence outcomes for men undergoing RP with the NeuroSAFE technique. Design, setting, and participants: Between September 2018 and February 2021, 1034 men underwent robot-assisted RP. Data for patient-reported outcomes were collected via validated questionnaires. Intervention: NeuroSAFE technique for RP. Outcome measurements and statistical analysis: Continence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) or Expanded Prostate Cancer Index Composite short form (EPIC-26) and defined as use of 0–1 pads/d. EF was evaluated using EPIC-26 or the International Index of Erectile Function short form (IIEF-5), with data converted according to the Vertosick method and categorized. Descriptive statistics were used to asses and describe tumor characteristics and continence and EF outcomes. Results and limitations: Of the 1034 men who underwent RP after introduction of the NeuroSAFE technique, 63% and 60% completed a preoperative and at least one postoperative questionnaire on continence and EF, respectively. Of the men who underwent unilateral or bilateral NS surgery, use of 0–1 pads/d was reported by 93% after 1 yr and 96% after 2 yr; the corresponding rates for men who underwent non-NS surgery were 86% and 78%. Overall, use of 0–1 pads/d was reported by 92% of the men at 1 yr and by 94% at 2 yr after RP. Men in the NS group had a good or intermediate Vertosick score after RP more often than the non-NS group. Overall, 44% of the men had a good or intermediate Vertosick score at 1 and 2 yr after RP. Conclusions: After introduction of the NeuroSAFE technique, the continence rate was 92% at 1 yr and 94% at 2 yr after RP. The NS group had a greater percentage of men with an intermediate or good Vertosick score and a higher continence rate after RP in comparison to the non-NS group. Patient summary: Our study shows that after introduction of the NeuroSAFE technique during removal of the prostate, the continence rate among patients was 92% at 1 year and 94% at 2 years after surgery. Some 44% of the men had a good or intermediate score for erectile function 1 and 2 years after surgery.</p

Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve-sparing surgery in prostate cancer patients (NeuroSAFE)

AIMS: Radical prostatectomy for prostate cancer is frequently complicated by urinary incontinence and erectile dysfunction. Nerve-sparing surgery reduces the risk of post-operative complications and can be optimized using intraoperative frozen sections of the adjacent neurovascular structure (NeuroSAFE). The aim of t