Strategies for megaregion governance: Collaborative dialogue, networks and self organization

Metropolitan areas in the U.S. are increasingly growing together into megaregions with many linkages and interdependencies in their economies, infrastructure, and natural resources, but they are not linked well in terms of governance. Hundreds of jurisdictions, federal and state sectoral agencies, and regulatory bodies make independent and conflicting decisions with no entity focusing on the region's overall welfare. The Purpose of the research is to investigate potential governance strategies for such megaregions. As we have noted elsewhere, collaborative and networked processes can do many of the needed tasks for regional governance, as they fill gaps where government fails to operate, cross jurisdictional and functional boundaries, engage public and private sector actors on common tasks, and focus on the collective welfare of a region. Our goal is to identify strategies that allowed such processes to have some success in planning and managing resources, in adapting to unique conditions, and in mobilizing key players in joint action. We rely on our own in-depth research in California on two major water planning cases, CALFED and the Sacramento Water Forum, and on two cases of regional civic voluntary organizations known as Collaborative Regional Initiatives. We use two interrelated analytical perspectives, complexity theory and network analysis, to develop our findings. These largely successful cases shared the following features: diverse, interdependent players; collaborative dialogue; joint knowledge development; creation of networks and social and political capital; and boundary spanning. They were largely self organizing, building capacity and altering norms and practices to focus on questions beyond the parochial interests of players. They created new and often long term working relationships and a collective ability to respond constructively to changes and stresses on the system. Planners have important roles to play in megaregion governance in designing processes, creating, supporting and managing networks, creating arenas for strategy formation, nourishing strategic understanding and a vigorous public realm. Some can be visionaries, others advocates, providers of technical assistance, or skilled facilitators. Without the potential for traditional hierarchical government planners, cannot hope to control outcomes, but they can help to create self-organizing sustainability. The biggest challenge will be to design institutional settings where planners can do these tasks

Standardisation of uterine natural killer (uNK) cell measurements in the endometrium of women with recurrent reproductive failure

Considerable work is being carried out on endometrial NK cells to determine whether they play a role in successful pregnancy outcome. In addition there is debate about whether measurements of uNK should be included in the clinical assessment for women with recurrent implantation failure or recurrent miscarriage. A hindrance to taking this forward is the fact that the density of uNK cells reported by different centres is very different. The aim of this study was to determine the reason for these differences and to develop a standardised method. Three centres participated in the study. Each centre exchanged five formalin fixed, wax embedded sections of endometrium from five women. Sections were immunostained for CD56. Images were taken of 10 random fields at ×400 magnification; total stromal and uNK cells were counted using Image J. Results were expressed as % positive uNK cells and the variation in counts obtained in each centre was compared. After initial analysis a standardised protocol was agreed and the process repeated.Significant variation was seen in the counts obtained after initial analysis (Centre A vs.B, mean difference = -0.72 P < 0.001; A vs.C mean difference = -0.47 P < 0.001; B vs.C, mean difference = 0.25 P = 0.085). Analysis suggested that differences may be due to duration of tissue fixation, the embedding and sectioning processes, selection of areas for assessment, definition of immunopositive cells and inclusion or exclusion of blood vessels. Adoption of a standardised protocol reduced the variation (Centre A vs.B mean difference = -0.105 P = 0.744; A vs.C mean difference = 0.219 P = 0.150; B vs.C mean difference = 0.32 P = 0.031). Use of a standardised method is needed to establish a normal range for uNK cells and to develop a meaningful clinical test for uNK cell measurements

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Evolutionary relationships and divergence times among the native rats of Australia

Background The genus Rattus is highly speciose and has a complex taxonomy that is not fully resolved. As shown previously there are two major groups within the genus, an Asian and an Australo-Papuan group. This study focuses on the Australo-Papuan group and particularly on the Australian rats. There are uncertainties regarding the number of species within the group and the relationships among them. We analysed 16 mitochondrial genomes, including seven novel genomes from six species, to help elucidate the evolutionary history of the Australian rats. We also demonstrate, from a larger dataset, the usefulness of short regions of the mitochondrial genome in identifying these rats at the species level. Results Analyses of 16 mitochondrial genomes representing species sampled from Australo-Papuan and Asian clades of Rattus indicate divergence of these two groups ~2.7 million years ago (Mya). Subsequent diversification of at least 4 lineages within the Australo-Papuan clade was rapid and occurred over the period from ~ 0.9-1.7 Mya, a finding that explains the difficulty in resolving some relationships within this clade. Phylogenetic analyses of our 126 taxon, but shorter sequence (1952 nucleotides long), Rattus database generally give well supported species clades. Conclusions Our whole mitochondrial genome analyses are concordant with a taxonomic division that places the native Australian rats into the Rattus fuscipes species group. We suggest the following order of divergence of the Australian species. R. fuscipes is the oldest lineage among the Australian rats and is not part of a New Guinean radiation. R. lutreolus is also within this Australian clade and shallower than R. tunneyi while the R. sordidus group is the shallowest lineage in the clade. The divergences within the R. sordidus and R. leucopus lineages occurring about half a million years ago support the hypotheses of more recent interchanges of rats between Australia and New Guinea. While problematic for inference of deeper divergences, we report that the analysis of shorter mitochondrial sequences is very useful for species identification in rats

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Planning Styles in Conflict at the San Francisco Bay Area's Metropolitan Transportation Commission

Planning can be a contentious process. Most of the time it involves many players and many interests all seeking different outcomes or protecting different turf. The authors of this report have concluded, after a 5-year study of transportation planning in the San Francisco Bay Area, that the contentiousness can be due as much to differences in planning styles as to substantive disagreements or power struggles. The authors have identified four planning styles that coexisted in the transportation decision making process, which they label "technical/bureaucratic," "political influence," "social movement," and "collaborative." Practitioners of each style tended to believe deeply in their approach as the right way to do things and, by the same token, to regard with suspicion, if not actual hostility, those practicing different styles. Indeed, they typically did not recognize the others’ approaches as planning at all.Each of these styles implied different ideas about information, public participation, and what a good plan would be like, as well as about the process of planning. The authors found that each style had strengths and limitations and each was suited to different situations. Yet few individuals, agencies, or interest groups tailored their approach to suit the problem. Instead, they routinely used one planning style regardless of the situation.The style in use at any time was the product of at least two forces. Most obvious was the influence of long habits and expectations among the players. But such habits and expectations do not provide the full explanation. The authors found that state and federal legislation governing transportation decision making reinforced, and at times almost required, particular planning styles. It is particularly ironic that legislation ostensibly designed to encourage collaboration in regional decision making often, in fact, promoted the political influence and technical/bureaucratic approaches which, in turn, encouraged the development of an oppositional social movement.These findings emerged from a study of the Bay Area’s Metropolitan Transportation Commission (MTC) from late 1995 to early 2000. The study had a dual purpose. The first was to see how this agency -- widely regarded as one of the leading Metropolitan Planning Organizations (MPO) in the country and a potential model for others -- was implementing ISTEA (Intermodal Surface Transportation Efficiency Act), the pathbreaking federal transportation legislation passed in 1991. The second was to find out the degree to which the collaborative planning group MTC had set up, the Bay Area Partnership, was producing decisions that were designed to benefit the region as a whole rather than simply individual jurisdictions. The authors were interested in the conditions under which interagency and interjurisdictional planning can actually be done. They wanted to test the hypothesis, based on preliminary findings from their earlier research, that genuine regionalism would require collaborative dialogue among the key players. This case allowed them to observe the actual deliberations over time and to find out how, when and why decisions were made

Planning Styles in Conflict: The Metropolitan Transportation Commission

After a 5-year study of transportation planning in the San Francisco Bay Area, we have concluded that the contentiousness we observed in the process was due in great part to differences in participants’ styles of planning and not solely to disagreements over desired outcomes. Each style involved different assumptions about information, public participation, and what a good plan is like, as well as about the process of planning. Practitioners of each tended to believe deeply in their approach and to regard with suspicion, if not hostility, those practicing different styles. We identified four coexisting styles, which we label technical/bureaucratic, political influence, social movement, and collaborative. Each style tended to be associated with different types of outcomes, though this was not explicit in discussion. The political planners divided resources among players, whereas the collaborative and the social movement planners were associated with strategies designed to benefit the region as a whole