Cycles in Policy Network Structure and Policy Adoption-Implementation Processes: The Importance of Alignment

This paper investigates how aspects of policy networks facilitate or inhibit the efforts of public bureaucracies to adopt and implement science policy innovations. Three correlated dimensions of policy networks – permeability, size, and tie strength – strongly influence adoption and implementation outcomes. Policy networks tend to expand and contract cyclically along these network dimensions. Policy adoption and implementation are not binary variables, but rather continually occurring processes that also cycle. Successful adoption and implementation outcomes are most likely when adoption-implementation and network expansion-contraction cycles are aligned such that adoption occurs when the policy network is more permeable, larger, and more laden with weaker ties, and implementation occurs when the network is less permeable, smaller, and more laden with stronger ties. When cycles are not optimally aligned, adoption and implementation efforts are more likely to fail or stall. These arguments draw on literature concerning policy networks as well as collective action and social capital. They are illustrated with case sketches that describe the attempts by environmental bureaucrats in six U.S. Mid-Atlantic states to adopt and implement a type of science policy innovation for wetland management. The sketches draw upon more than 90 interviews with environmental bureaucrats and stakeholders in the region, as well as secondary-source analysis and survey research

The networked micro-decision context: A new lens on transformative urban governance

Recent large-scale societal disruptions, from the COVID-19 pandemic to intensifying wildfires and weather events, reveal the importance of transforming governance systems so they can address complex, transboundary, and rapidly evolving crises. Yet current knowledge of the decision-making dynamics that yield transformative governance remains scant. Studies typically focus on the aggregate outputs of government decisions, while overlooking their micro-level underpinnings. This is a key oversight because drivers of policy change, such as learning or competition, are prosecuted by people rather than organizations. We respond to this knowledge gap by introducing a new analytical lens for understanding policymaking, aimed at uncovering how characteristics of decision-makers and the structure of their relationships affect their likelihood of effectuating transformative policy responses. This perspective emphasizes the need for a more dynamic and relational view on urban governance in the context of transformation

Key Data Elements in Myeloid Leukemia

Data standards consisting of key data elements for clinical routine and trial documentation harmonize documentation within and across different health care institutions making documentation more efficient and improving scientific data analysis. This work focusses on the field of myeloid leukemia (ML), where a semantic core of common data elements (CDEs) in routine and trial documentation is established by automatic UMLS-based form analysis of existing documentation models. These CDEs (n=227) were initially reviewed and commented by leukemia experts before they were systematically surveyed by an international voting process through seven hematologists of four countries. The total agreement score was 86%. 116 elements (51%) of these share an agreement score of 100%. This work generated CDEs with language-independent semantic codes and international clinical expert review to build a first approach towards an international data standard for ML. A first version of the CDE list is implemented in the data standard Operational Data Model and additional other data formats for reuse in different medical information systems

GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium

Decline in muscle strength with aging is an important predictor of health trajectory in the elderly. Several factors, including genetics, are proposed contributors to variability in muscle strength. To identify genetic contributors to muscle strength, a meta-analysis of genomewide association studies of handgrip was conducted. Grip strength was measured using a handheld dynamometer in 27 581 individuals of European descent over 65 years of age from 14 cohort studies. Genomewide association analysis was conducted on ~2.7 million imputed and genotyped variants (SNPs). Replication of the most significant findings was conducted using data from 6393 individuals from three cohorts. GWAS of lower body strength was also characterized in a subset of cohorts. Two genomewide significant (P-value< 5 × 10−8) and 39 suggestive (P-value< 5 × 10−5) associations were observed from meta-analysis of the discovery cohorts. After meta-analysis with replication cohorts, genomewide significant association was observed for rs752045 on chromosome 8 (β = 0.47, SE = 0.08, P-value = 5.20 × 10−10). This SNP is mapped to an intergenic region and is located within an accessible chromatin region (DNase hypersensitivity site) in skeletal muscle myotubes differentiated from the human skeletal muscle myoblasts cell line. This locus alters a binding motif of the CCAAT/enhancer-binding protein-β (CEBPB) that is implicated in muscle repair mechanisms. GWAS of lower body strength did not yield significant results. A common genetic variant in a chromosomal region that regulates myotube differentiation and muscle repair may contribute to variability in grip strength in the elderly. Further studies are needed to uncover the mechanisms that link this genetic variant with muscle strength

Identification of additional risk loci for stroke and small vessel disease: a meta-analysis of genome-wide association studies

BACKGROUND: Genetic determinants of stroke, the leading neurological cause of death and disability, are poorly understood and have seldom been explored in the general population. Our aim was to identify additional loci for stroke by doing a meta-analysis of genome-wide association studies. METHODS: For the discovery sample, we did a genome-wide analysis of common genetic variants associated with incident stroke risk in 18 population-based cohorts comprising 84 961 participants, of whom 4348 had stroke. Stroke diagnosis was ascertained and validated by the study investigators. Mean age at stroke ranged from 45·8 years to 76·4 years, and data collection in the studies took place between 1948 and 2013. We did validation analyses for variants yielding a significant association (at p<5 × 10(-6)) with all-stroke, ischaemic stroke, cardioembolic ischaemic stroke, or non-cardioembolic ischaemic stroke in the largest available cross-sectional studies (70 804 participants, of whom 19 816 had stroke). Summary-level results of discovery and follow-up stages were combined using inverse-variance weighted fixed-effects meta-analysis, and in-silico lookups were done in stroke subtypes. For genome-wide significant findings (at p<5 × 10(-8)), we explored associations with additional cerebrovascular phenotypes and did functional experiments using conditional (inducible) deletion of the probable causal gene in mice. We also studied the expression of orthologs of this probable causal gene and its effects on cerebral vasculature in zebrafish mutants. FINDINGS: We replicated seven of eight known loci associated with risk for ischaemic stroke, and identified a novel locus at chromosome 6p25 (rs12204590, near FOXF2) associated with risk of all-stroke (odds ratio [OR] 1·08, 95% CI 1·05-1·12, p=1·48 × 10(-8); minor allele frequency 21%). The rs12204590 stroke risk allele was also associated with increased MRI-defined burden of white matter hyperintensity-a marker of cerebral small vessel disease-in stroke-free adults (n=21 079; p=0·0025). Consistently, young patients (aged 2-32 years) with segmental deletions of FOXF2 showed an extensive burden of white matter hyperintensity. Deletion of Foxf2 in adult mice resulted in cerebral infarction, reactive gliosis, and microhaemorrhage. The orthologs of FOXF2 in zebrafish (foxf2b and foxf2a) are expressed in brain pericytes and mutant foxf2b(-/-) cerebral vessels show decreased smooth muscle cell and pericyte coverage. INTERPRETATION: We identified common variants near FOXF2 that are associated with increased stroke susceptibility. Epidemiological and experimental data suggest that FOXF2 mediates this association, potentially via differentiation defects of cerebral vascular mural cells. Further expression studies in appropriate human tissues, and further functional experiments with long follow-up periods are needed to fully understand the underlying mechanisms

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Assessing wetland assessment: Understanding state bureaucratic use and adoption of rapid wetland assessment tools

Rapid wetland assessment tools, technically complex science policy innovations that are deployed within the regulatory sphere and have relatively low public salience, can highlight and help interpret the data a bureaucrat should use when making wetland regulatory choices. These tools can help bureaucrats overcome the longstanding challenge of quantifying wetland benefits when making such choices. However, state wetland bureaucrats use these tools infrequently in regulation, and states find adopting tools into regulatory policy difficult. This research explores why. These problems are analyzed by focusing on six Mid-Atlantic states and using an original survey of state wetland bureaucrats (n=149), interviews with policy actors (n=98, 58 hours), ethnographic data collection (18 months spent working with federal wetland bureaucrats who work regularly with state counterparts), and secondary source analyses. Research reveals that street-level wetland bureaucrats are more likely to deploy tools in regulation when they have more opportunities to learn about tools via on-the-job experience, lateral communication about tools with policy network members, and vertical communication of tool-supportive cues from their administrative hierarchies. The institutions of cooperative environmental federalism and the Clean Water Act generate power inequities, path dependencies, and perverse incentives which discourage states from adopting tools into regulatory policy. This phenomenon is illuminated via synergistic institutional analysis, an approach the dissertation proposes for using the complementarities among rational choice, sociological, and historical institutionalism to explain policy outcomes. Contrary to a core expectation of cooperative environmental federalism, ostensibly pro-environment pressures the federal government imposes on states can prevent states from pursuing environmentally beneficial policies. Finally, the dissertation develops the concept of the street-level policy entrepreneur, an implementing bureaucrat who crafts or secures a policy innovation intended to improve implementation processes, then seeks to entrench the innovation in the practices of bureaucratic peers. Neither the conventional political science literature on policy entrepreneurship nor the street-level bureaucracy literature gives sufficient attention to the entrepreneurial capacity of these actors. Yet case studies of tool adoption efforts pursued by states show that implementing bureaucrats can pioneer, rather than merely receive and execute, policy innovations

A Review of Design Principles for Community-based Natural Resource Management

In 1990, Elinor Ostrom proposed eight design principles, positing them to characterize robust institutions for managing common-pool resources such as forests or fisheries. Since then, many studies have explicitly or implicitly evaluated these design principles. We analyzed 91 such studies to evaluate the principles empirically and to consider what theoretical issues have arisen since their introduction. We found that the principles are well supported empirically and that several important theoretical issues warrant discussion. We provide a reformulation of the design principles, drawing from commonalities found in the studies

Assessing the Three Es—Environment, Economy, and Equity—in Climate Action Plans

The range of efforts to address climate change can span from international collaboration to personal action. This study looks at environmental efforts at the local jurisdictional level. Over the last decade, cities and counties have released climate action plans (CAPs) to set emissions reduction targets and outline actions that will help meet those goals. However, the range of information included in CAPs varies dramatically across jurisdictions. This study examines CAPs released by jurisdictions in California, focusing on the quantity and quality of information presented on the expected GHG emissions reduction, cost, and equity impacts of proposed climate actions. This research develops a framework to assess their inclusion, which could also be used to guide future CAP development, and develops a set of guiding questions to promote the inclusion of equity themes in climate action planning and implementation. To gauge the current state of climate action by local jurisdictions, a survey was implemented to better understand the (i) relative consideration of factors in climate action planning and implementation, (ii) factors which affect the inclusion of equity in climate action, (iii) the primary sources of funding for CAP implementation, and (iv) which factors affect the likelihood that an action is implemented. The survey found that, of the considered factors, expected emissions reduction is considered most during planning and implementation, while external impacts are considered the least. When comparing factors between planning and implementation, cost is significantly more important during implementation. For both phases, equity impacts received average levels of consideration. Free responses revealed that recent pushes by community members has encouraged local jurisdictions to include more equity themes in their climate planning. However, lifecycle equity, which considers local impacts across the lifecycle of an action, and thus beyond jurisdictional borders, is considered infeasible due to resource limitations and beyond the scope of local planning. Better equity planning would require systemic change at the jurisdiction, industry, state, and federal levels.View the NCST Project Webpag