Application of policy-led multi-criteria analysis to the appraisal of the Northern Line Extension, London

This paper seeks to both illustrate and act as a proof of concept of how a policy-led multi-criteria analysis framework and its attendant process of the type introduced in the second paper, ‘Theory and Background of Multi-Criteria Analysis: Toward a policy-led approach for mega transport project infrastructure appraisal’, can be applied to the appraisal of a mega transport project in the form of the Northern Line Extension in London. It is offered with a view to help better identify the distribution of the projects costs and benefits and shed greater light on the possible ‘winners’ and ‘losers’ over space and time, and under given scenarios. Drawing from an extensive array of public domain literature the paper sets out both the policy and planning contexts for the project plus the business case that led to a decision by UK Treasury to guarantee a £1 billion loan to Transport for London for the construction of the Northern Line's extension. The paper looks at the scale and nature of the megaproject's features, particularly its line-haul and related real estate developments, especially those in the assigned development opportunity area. The text presents the policy, planning, legislative and regulative dimensions of the project likely to define its revenue generation prospects and environmental and social impacts, with special attention paid to those project outcomes affecting key stakeholders over time and space. The paper also seeks to explain the mechanics of how to employ a policy-led multi-criteria framework together with its associated processes within which stakeholder policies and agendas can be mapped and common/divergent interests identified. This is done with a view to ultimately facilitate stakeholder negotiation decision-making trade-offs in given scenarios under the policy guidance of the Greater London Authority with the support of the Treasury of the UK Government

Presenting the case for the application of multi-criteria analysis to mega transport infrastructure project appraisal

The paper commences with an overview of mega transport infrastructure decision-making as it relates to the megaproject development cycle and challenges of sustainable development, which are increasingly redefining the criterion for the evaluation of project success. The body of the paper presents a brief critique of various appraisal applications to mega transport infrastructure projects, including: Social Cost Benefit Analysis; Cost Effectiveness Analysis; Goal Achievement Matrix Methods and the Planning Balance Sheet, highlighting the merits and demerits of the outlined approaches. Here particular reference is made to the power of context on decision-making and other lessons from OMEGA Centre research. These include, most importantly, the treatment of risk, uncertainty and complexity of developments outside of the project and the challenges of meeting multiple stakeholder aspirations/needs thereby building up the case for the introduction and use of multi-criteria analysis and policy-led multi-criteria analysis to the appraisal of Mega Transport Projects

Theory and Background of Multi-Criteria Analysis: Toward a policy-led approach for mega transport project infrastructure appraisal

The aims of this paper are twofold. Firstly, to present a review and critical analysis of the varying forms and functions of Multi-Criteria Analysis presented in the literature, and secondly, drawing from this, to introduce methods and processes by which policy leadership can be introduced into such processes for the appraisal of large-scale transport infrastructure projects to form a policy-led multi-criteria analysis. Following the discussion in the first paper of this Special Issue, ‘Presenting the Case for the Application of Multi-Criteria Analysis to Mega Transport Project Infrastructure Appraisal’, this contribution commences by outlining further the generic features and challenges of multi-criteria analysis approaches to project appraisal whilst emphasizing the difference among various frameworks and attendant processes for such approaches. It also highlights the important role/value of the multi-criteria mapping of stakeholder policies and agendas affecting project decision-making as a means of defining and scoping the boundaries of the project exercise under study and the trade-off decision-spaces for stakeholder dialogues and negotiations in their search to arrive at mutually agreed actions and outcomes. The paper discusses how multi-criteria analysis frameworks can be tailor-designed for particular agencies and stakeholders developed around problems, challenges and issues. This is done in the acknowledgement that such exercises, especially when applied to mega infrastructure project appraisal, typically attract a multiple-institutional response and where ultimately an institutional leader (or partnership of stakeholders) exists/emerges that impose its/their priorities on others. Alternatively, the approach can be tailor-made for specific institutions with its imbedded hierarchy of policies and priorities that frame the stakeholder decision space within which other parties can participate and trade off interests. The first part of the paper highlights the important role of scenarios of policy-making contexts and policy leadership indicating the new risks, uncertainties and opportunities these may offer in multi-criteria analysis exercises, indicating that some/many past processes have been conducted outside of any real reference to such matters. In so doing, such applications have them silently and implicitly adopt scenarios and policy assumptions that are not transparent frequently reflecting, it is alleged, ‘business as usual’ circumstances in contexts when the signs are very much that these trends will not/cannot prevail. The authors contend that without explicit policy leadership there is a danger that certain institutional stakeholder priorities will be imposed over others by the most powerful without adequate dialogue. Understanding that this matters a great deal in contexts when project stakeholder powers shifts occur is very significant. Examples of such circumstances are when national governments become, less or more powerful and economically affluent, when relative legislative and regulation powers become less or more binding and powerful, and when a major private sector investor upon which a project depends goes bankrupt. The second half of the paper builds on these observations to offer a generic multi-criteria analysis framework and attendant processes that imbed policy leadership firmly within multi-stakeholder decision-making (termed Policy-led Multi-criteria Analysis). The framework developed is to be applied to mega transport projects via the use of suitable appraisal criteria in the pursuit of sustainable development goals, which seek to address both quantitative and qualitative dimensions and concerns of multiple stakeholders, with particular emphasis on the processes required to identify and incorporate suitable policy leadership, including feedback between appraisal and policy

RhBMP-7 for the Treatment of nonunion of fractures of long bones

We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union. © 2015 The British Editorial Society of Bone & Joint Surgery