The Nature of Context-Sensitive Solutions, Stakeholder Involvement and Critical Issues in the Urban Context

Over the last several decades many transportation and planning agencies have experienced conflicting demands emerging from the need to develop projects in an expeditious manner while at the same time involving stakeholders in the decision-making process, which sometimes is perceived as slowing project delivery and/or increasing costs. Given this tension between apparently conflicting demands, it is important to understand how the stakeholder involvement is being carried out and what best practices may be recommended. This study examines the issue in the context of a relatively new policy framework – Context Sensitive Solutions (CSS) – which supports the early integration of stakeholders into the planning process. The report pays particular attention to stakeholders’ involvement in projects within urban centers, where there is likely to be more complexity, both in terms of the number of stakeholders and end users affected. CSS is a relatively new process and not consistently interpreted or applied across states and/or agencies. The literature suggests that an underlying assumption when applying CSS principles to community involvement processes is that stakeholders are empowered through clear policies and procedures directed towards their participation. In our research, we found that the extent to which public agencies apply the CSS framework and involve and respond to stakeholders depends on each agency\u27s interest to engage the public in the deliberation process to find the best-fit project for a community. It is likely that the increased integration of stakeholders into the planning and project development process will not become a state of practice until the benefits flowing from community involvement are clearly understood by the agency staff. The CSS literature describes many benefits associated with comprehensive stakeholder engagement, including gaining constituents\u27 buy-in and support for project financing. A movement toward standardizing CSS policies and directives across the country will facilitate a public discussion about the benefits of engaging communities into the project design phase and away from solely expert-based designs. In addition, there are a number of stakeholder involvement practices that, if adopted, could expedite the integration of communities\u27 views and values in the decision-making process, while at the same time minimizing the chances of protracted consultation processes, time delays and additional costs

Gorgonian spatial distributions, ecological interactions with fish assemblages and responses to their decline in health

Marta Panero studied spatial patterns of gorgonians and their ecological associations with fish assemblages and the effect of declining health of gorgonians on fish. She found that gorgonians are more abundant in deeper areas and that they are important ecosystem engineers sustaining large fish communities. Their loss can have a profound impact on associated fishes

Developing Pollution Prevention Strategies for the New York/New Jersey Harbor

Overview of an industrial ecology project in the New York/New Jersey Harbor. The goals of the project were to: identify the locations in five toxicant cycles (Hg, Cd,PCBs, dioxins and PAHs) where pollution prevention (P2) would most efficiently contribute to long-term reductions in loadings to the harbor; Develop practical P2 strategies that address toxicant releases / emissions; and encourage implementation of the recommended actions by integrating stakeholders into the research and policy process.Ope

Roles of depth, current speed, and benthic cover in shaping gorgonian assemblages at the Palm Islands (Great Barrier Reef)

Gorgonians are a diverse and conspicuous component of coral reef ecosystems, providing habitat structure that supports unique assemblages of fishes and invertebrates. Evaluating their overall importance as ecological engineers requires an understanding of their spatial patterns of distribution, abundance and assemblage composition, and the biophysical factors that drive these patterns. No baseline data are available on the spatial patterns of distribution of gorgonians for the Great Barrier Reef. In this study, we quantified the abundance, genera richness, and composition of gorgonian assemblages using video surveys at three depths (5, 10, and 15 m) at 16 locations at the Palm Islands, an inshore island group in the central Great Barrier Reef. We compared gorgonian abundance and genera richness between depths and assessed the role of benthic habitat in structuring gorgonian communities. We also conducted a preliminary investigation of the potential role of water currents in driving gorgonian spatial patterns in the Palm Islands, using in situ current meters. Gorgonian abundance and genera richness consistently increased with depth, although the magnitude of the depth effect varied among locations. Abundance increased with increasing percent cover of rubble and conversely declined with increasing cover of hard corals. The composition of gorgonian assemblages also varied among depths, with whip (Junceella, Viminella) and fan (Acanthogorgia, Anthogorgia, Annella) growth forms being dominant at depths of 5 and 10 m, and branching (Dichotella, Icilogorgia) and candelabrum (Ctenocella) forms being dominant at 15 m. The shallow gorgonian assemblage was associated with high coral cover, whilst the deeper assemblage was associated with high per cent cover of rubble, turf and/or macroalgae. This study highlighted that the abundance, diversity, and composition of gorgonian assemblages on coral reefs in the Palm Islands are determined by a range of biophysical factors linked to depth. Further work is required to isolate the primary drivers of these depth-related effects and evaluate their relative importance

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Background and Aims: To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. Methods: This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan–Meier and Cox regression methods were used for data analysis. Results: Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4–67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2–0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8–0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89.9–97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3–2.1). Conclusion: Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.This study was supported in part by grants from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, number PI20/01302, awarded to Agustín Albillos and number PI 21/01310, awarded to Luis Téllez. CIBEREHD is funded by the Instituto de Salud Carlos III using grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). María Carlota Londoño received support from the Plan Nacional de I+D+I co- funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER-"Una manera de Hacer Europa") (PI17/00955

Pathways to eating disorder care: a European multicenter study

Background: The aim of this study was to assess barriers and facilitators in the pathways toward specialist care for eating disorders (EDs). Methods: Eleven ED services located in seven European countries recruited patients with an ED. Clinicians administered an adapted version of the World Health Organization "Encounter Form," a standardized tool to assess the pathways to care. The unadjusted overall time needed to access the ED unit was described using the Kaplan-Meier curve. Results: Four-hundred-nine patients were recruited. The median time between the onset of the current ED episode and the access to a specialized ED care was 2 years. Most of the participants did not directly access the specialist ED unit: primary "points of access" to care were mental health professionals and general practitioners. The involvement of different health professionals in the pathway, seeking help for general psychiatric symptoms, and lack of support from family members were associated with delayed access to ED units. Conclusions: Educational programs aiming to promote early diagnosis and treatment for EDs should pay particular attention to general practitioners, in addition to mental health professionals, and family members to increase awareness of these illnesses and of their treatment initiation process

La acción tutorial en los trabajos de fin de grado: comités de evaluación

SIN FINANCIACIÓNNo data 201

Peer-to-Peer Information Exchange on Bus Rapid Transit (BRT) and Bus Priority Best Practices

The purpose of this effort was to foster a dialogue among peers at transportation and planning agencies about their experiences with promoting public transit and, in particular, the challenges they face related to Bus Rapid Transit (BRT) projects, as well as the solutions they have developed in response. Agencies from dozens of large cities around the United States participated at three peer-to-peer exchanges in New York City, Los Angeles, and Cleveland. The facilitated discussions were structured to address the unique barriers to BRT implementation on the streets of dense and/or highly-congested large urban centers. Three major themes were the focus of the workshops: Network, Route and Street Design; Traffic Operations; and Building Political, Interagency and Stakeholder Support—BRT as a Driver of Economic Development. The results of the workshops make clear that better public transportation in general and BRT in particular can be cost-effective and useful tools for improving transportation and the environment and for restoring the livability of America’s large cities