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- Dijk, M., et al.
(författare)
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Sustainability assessment as problem structuring: three typical ways
- 2017
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Ingår i: Sustainability Science. - : Springer Science and Business Media LLC. - 1862-4057 .- 1862-4065. ; 12:2, s. 305-317
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Tidskriftsartikel (refereegranskat)abstract
- Sustainability assessment (SA) is an increasingly popular term referring to a broad range of approaches to align decision-making with the principles of sustainability. Nevertheless, in public and private sectors sustainability results are still disappointing, and this paper reflects on this problem and proposes a way forward. We argue that, because sustainability issues are generally wicked problems (i.e. a ‘complex of interconnected factors in a pluralistic context’), effective assessments need to be reflexive about the definition of the issue and about the criteria for sustainable solutions. Based on a distinction of policy problems, we characterize SA as a form of problem structuring, and we distinguish three typical ways of problem structuring, corresponding to three different ways of integrating reflexivity in the assessment. We illustrate these routes in three examples. We discuss the way reflexivity is integrated in each example by discussing the mix of methods, SA process and epistemological balance. Rather than merely calling for more st akeholder participation, our aim is to call for more reflexivity integrated into the SA approach, and we conclude by proposing a process map for reflexive sustainability assessment to support this.
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- van den Heuvel-Eibrink, MM, et al.
(författare)
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Intracranial relapse in Wilms tumor patients
- 2004
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Ingår i: Pediatric blood & cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 43:7, s. 737-741
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Tidskriftsartikel (refereegranskat)
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- Vujanic, GM, et al.
(författare)
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Nonviable tumor tissue should not upstage Wilms' tumor from stage I to stage II: a report from the SIOP 93-01 nephroblastoma trial and study
- 2009
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Ingår i: Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society. - : SAGE Publications. - 1093-5266. ; 12:2, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- In SIOP trials, Wilms' tumors were labeled as stage II by the presence of nonviable and/or viable tumor in the renal sinus and/or perirenal fat. The aim of this study was to determine if this approach was justified. Stage II Wilms' tumors were reviewed to establish whether staging was due to viable or nonviable tumor, and this was related to clinical outcome. One hundred sixty-nine patients were included: 40 had stage II due to the presence of nonviable tumor and 129 due to viable tumor. Postoperatively, 29 patients were undertreated: 7 with nonviable and 22 with viable stage II tumors. No undertreated patient with nonviable stage II relapsed or died (event-free survival [EFS] and overall survival [OS] 100%), whereas 3 of 22 with viable stage II relapsed, and 2 of them died (EFS 86%, OS 91%). Of 140 correctly treated patients, only 1 of 33 nonviable stage II patients relapsed and died (EFS and OS 97%); 8 of 107 patients with viable stage II relapsed (EFS 92%), and 3 of them died (OS 97%). The presence of nonviable tumor in the renal sinus and/or perirenal fat does not predict an adverse outcome in Wilms' tumors, and alone it does not warrant designation to stage II.
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- Øra, Ingrid, et al.
(författare)
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Progression of localised Wilms' tumour during preoperative chemotherapy is an independent prognostic factor: A report from the SIOP 93-01 nephroblastoma trial and study
- 2007
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 43:1, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- The SIOP nephroblastoma clinical trials have previously demonstrated that preoperative chemotherapy is advantageous for patients with nephroblastoma (Wilms' tumour). However, some primary tumours increase in size during preoperative chemotherapy, and to investigate the clinical relevance of this progression we studied the patient cohort with increasing tumours included in the SIOP 93-01 study (June 1993 to June 2000). Patients were considered eligible if they had a confirmed localised Wilms' tumour that had been measured in at least two dimensions at diagnosis and before surgery. Tumour response to preoperative chemotherapy was defined according to criteria set by the World Health Organisation (WHO). Patient characteristics in the different response groups were compared and related to event-free survival and overall survival. Patient records were studied regarding compliance with protocol. Tumour progression during preoperative chemotherapy was observed in 57 of 1090 patients (5%) with localised Wilms' tumours. In those cases, the tumours were significantly smaller at diagnosis and were more often stage III (p = 0.05) and associated with high risk histopathology (p = 0.03). After adjustment for stage and risk group, progression was proved to be correlated with poorer event-free and overall survival (hazard ratio 1.9, p = 0.026 and 3.2, p = 0.002 respectively). In summary, progression of localised Wilms' tumours is rarely seen in patients during preoperative chemotherapy. However, independent of stage distribution and histopathological risk group, those whose tumours do increase in size have poorer event-free and overall survival. (c) 2006 Elsevier Ltd. All rights reserved.
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