Open federalism in an urban age : implications of recent trends in intergovernmental relations for municipal governance in Canada

Cities are becoming more important in Canada and around the world as a result of urbanization and the evolution of the global economy. Everywhere, the emergence of pressing urban issues is confronting politicians with difficult policy problems that cut across formal jurisdictional lines. In Canada, the importance of cities is challenging the traditional intergovernmental arrangements of federalism. But the complex web of federal-provincial relationships that have been a feature of Canadian federalism are also being challenged by the 'open federalism' approach of Prime Minister Stephen Harper. This approach seeks to reduce rather than increase the scope of intergovernmental affairs, and suggests that urban issues are not the concern of the federal government since municipalities and their problems are the exclusive jurisdiction of the provinces. Using two case studies of key urban issues, public housing and public transportation, this thesis examines the evolving intergovernmental arrangements and growing problems in these program areas in Canada's three largest cities (Toronto, Montreal and Vancouver). It demonstrates that open federalism as an approach to urban issues is not likely to be effective. Rather, the overlapping jurisdictional challenges posed by urban issues, combined with the limited policy and fiscal resources available to Canadian municipal governments, appear to warrant a greater degree of multi-level governance, a finding consistent with trends elsewhere. In this regard, an updated version of cooperative federalism would seem to allow the federal government the greatest ability to articulate broad national policy objectives while engaging both provincial and municipal governments to ensure adequate and effective program implementation at the local level

Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations

Background Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. Methods Chairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. Results Only two changes were made to clinical diagnostic criteria reported in 2013: “multiple cortical tubers and/or radial migration lines” replaced the more general term “cortical dysplasias,” and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. Conclusions Updated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families