Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA) for patients with an asymptomatic abdominal aortic aneurysm (AAA) to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation) and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS). Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision makin

Alignment and Granularity of Requirements and Architecture in Agile Development: A Functional Perspective

Context: Requirements engineering and software architecture are tightly linked disciplines. The Twin Peaks model suggests that requirements and architectural components should stay aligned while the system is designed and as the level of detail increases. Unfortunately, this is hardly the case in practical settings. Objective: We surmise that a reason for the absence of conjoint evolution is that existing models, such as the Twin Peaks, do not provide concrete guidance for practitioners. We propose the Requirements Engineering for Software Architecture (RE4SA) model to assist in analyzing the alignment and the granularity of functional requirements and architectural components. Methods: After detailing the RE4SA model in notation-independent terms, we propose a concrete instance, called RE4SA-Agile, that connects common artifacts in agile development, such as user stories and features. We introduce metrics that measure the alignment between the requirements and architecture, and we define granularity smells to pinpoint situation in which the granularity of one high-level requirement or high-level component is not uniform with the norm. We show two applications of RE4SA-Agile, including the use of the metrics, to real-world case studies. Results: Our applications of RE4SA-Agile, which were discussed with representatives from the development teams, prove to be able to pinpoint problematic situations regarding the relationship between functional requirements and architecture. Conclusion: RE4SA and its metrics can be seen as a first attempt to provide a concrete approach for supporting the application of the Twin Peaks model. We expect future research to apply our metrics to additional cases and to provide variants for RE4SA that support different concrete notations, and extend the perspective beyond the functional perspective of this research, similar to what we did with RE4SA-Agile in this paper

Characterization of infectious bronchitis virus D181, a new serotype (GII-2). Avian Pathology

This paper describes the characterization of a new infectious bronchitis virus (IBV) strain D181, that rapidly evolved from a low-level incidental finding in 2017 to become the second most isolated IBV strain in Dutch layers and breeders in 2018, as well as being found in samples from Germany and Belgium. Based on the sequence of the S gene and the results of cross-neutralization tests, D181 can be considered as a new serotype and the second lineage within genotype II (GII-2). The experimental infection of SPF hens confirmed the ability of D181 to cause a drop in egg production, and immunohistochemistry showed presence of the virus in the trachea, lung and conjunctiva at 5 days post inoculation and in the caecal tonsils at 5 and 8 days post inoculation. In silico analysis of several widely used PCR primers indicated that primer sets adapted for GII might be needed to detect D181, as many general S1 primers might miss it

Characterization of infectious bronchitis virus D181, a new serotype (GII-2). Avian Pathology

This paper describes the characterization of a new infectious bronchitis virus (IBV) strain D181, that rapidly evolved from a low-level incidental finding in 2017 to become the second most isolated IBV strain in Dutch layers and breeders in 2018, as well as being found in samples from Germany and Belgium. Based on the sequence of the S gene and the results of cross-neutralization tests, D181 can be considered as a new serotype and the second lineage within genotype II (GII-2). The experimental infection of SPF hens confirmed the ability of D181 to cause a drop in egg production, and immunohistochemistry showed presence of the virus in the trachea, lung and conjunctiva at 5 days post inoculation and in the caecal tonsils at 5 and 8 days post inoculation. In silico analysis of several widely used PCR primers indicated that primer sets adapted for GII might be needed to detect D181, as many general S1 primers might miss it

On the Nature of Links between Requirements and Architectures: Case Studies on User Story Utilization in Agile Development

Communication between requirements engineers and software architects is experienced as problematic. In this paper we present the Requirements Engineering for Software Architecture (RE4SA) model as a tool that supports the communication between these two roles. In the RE4SA model, requirements are expressed as epic stories and user stories, which are linked to modules and features, respectively, as their architectural counterparts. By applying the RE4SA model to a multi-case study, we investigate the nature of the relationships between the requirements and the architectural artifacts. Based on the gained experience, we put forward nine hypotheses for further research on the utilization of user stories in agile RE

On the Nature of Links between Requirements and Architectures: Case Studies on User Story Utilization in Agile Development

Communication between requirements engineers and software architects is experienced as problematic. In this paper we present the Requirements Engineering for Software Architecture (RE4SA) model as a tool that supports the communication between these two roles. In the RE4SA model, requirements are expressed as epic stories and user stories, which are linked to modules and features, respectively, as their architectural counterparts. By applying the RE4SA model to a multi-case study, we investigate the nature of the relationships between the requirements and the architectural artifacts. Based on the gained experience, we put forward nine hypotheses for further research on the utilization of user stories in agile RE

Explicit Alignment of Requirements and Architecture in Agile Development

[Context & Motivation] Requirements and architectural components are designed concurrently, with the former guiding the latter, and the latter restricting the former. [Question/problem] Effective communication between requirements engineers and software architects is often experienced as problematic. [Principal ideas/results] We present the Requirements Engineering for Software Architecture (RE4SA) model with the intention to support the communication within the development team. In RE4SA, requirements are expressed as epic stories and user stories, which are linked to modules and features, respectively, as their architectural counterparts. Additionally, we provide metrics to measure the alignment between these concepts, and we also discuss how to use the model and the usefulness of the metrics by applying both to case studies. [Contribution] The RE4SA model employs widely adopted notations and allows for explicitly relating a system’s requirements and architectural components, while the metrics make it possible to measure the alignment between requirements and architecture

Alignment and Granularity of Requirements and Architecture in Agile Development: A Functional Perspective

Context: Requirements engineering and software architecture are tightly linked disciplines. The Twin Peaks model suggests that requirements and architectural components should stay aligned while the system is designed and as the level of detail increases. Unfortunately, this is hardly the case in practical settings. Objective: We surmise that a reason for the absence of conjoint evolution is that existing models, such as the Twin Peaks, do not provide concrete guidance for practitioners. We propose the Requirements Engineering for Software Architecture (RE4SA) model to assist in analyzing the alignment and the granularity of functional requirements and architectural components. Methods: After detailing the RE4SA model in notation-independent terms, we propose a concrete instance, called RE4SA-Agile, that connects common artifacts in agile development, such as user stories and features. We introduce metrics that measure the alignment between the requirements and architecture, and we define granularity smells to pinpoint situation in which the granularity of one high-level requirement or high-level component is not uniform with the norm. We show two applications of RE4SA-Agile, including the use of the metrics, to real-world case studies. Results: Our applications of RE4SA-Agile, which were discussed with representatives from the development teams, prove to be able to pinpoint problematic situations regarding the relationship between functional requirements and architecture. Conclusion: RE4SA and its metrics can be seen as a first attempt to provide a concrete approach for supporting the application of the Twin Peaks model. We expect future research to apply our metrics to additional cases and to provide variants for RE4SA that support different concrete notations, and extend the perspective beyond the functional perspective of this research, similar to what we did with RE4SA-Agile in this paper

Major difference in clinical outcome and replication of a H3N1 avian influenza strain in young pullets and adult layers

In this study, we investigated the pathogenicity, replication and tropism of the low pathogenic avian influenza (LPAI) strain A/chicken/Belgium/460/2019(H3N1) in adult SPF layers and young SPF males. The inoculated hens showed 58% mortality and a 100% drop in egg production in the second week post inoculation. The high viral loads in the cloacal samples coincided with the period of the positive immunohistochemistry of the oviduct, acute peritonitis and time of mortality, suggesting that the replication of H3N1 in the oviduct was a major component of the onset of clinical disease and increased level of excretion of the virus. In the inoculated young birds, the clinical signs were very mild with the exception of one bird. The results suggest that the time of replication of the virus was much shorter than in the adult layers; some of the young males did not show any proof of being infected at all. To conclude, the results of the study in young birds confirmed the intravenous pathogenicity test results but also showed that the clinical signs in adult layers were very severe. Based on the mortality without a bacterial component, complete drop of egg production and post mortem findings, this H3N1 strain is a moderately virulent strain, the highest category for LPAI strains. It is important to realize that if HPAI did not exist, this moderately virulent H3N1 virus would most likely to be considered as a very virulent virus