The Heritage Guide to the Constitution, Second Edition: What Has Changed Over the Past Decade, and What Lies Ahead?

The Heritage Guide to the Constitution, first released in 2005, brought together more than 100 of the nation’s best legal experts to provide line-by-line examination of each clause of the Constitution and its contemporary meaning—the first such comprehensive commentary to appear in many decades. The Heritage Guide to the Constitution: Fully Revised Second Edition takes into account a decade of Supreme Court decisions and legal scholarship on such issues as gun rights, religious freedom, campaign finance, civil rights, and health care reform. The Founders’ guiding principles remain unchanged, yet a number of Supreme Court decisions over the past decade remind us that those principles still require constant and spirited defense. What is needed today is a fusion of judicial originalism, scholarly originalism, and political originalism to advance the Founders’ vision for our Constitution

Meniscal transplantation and its effect on osteoarthritis risk : an abridged protocol for the MeTEOR study : a comprehensive cohortstudy incorporating a pilot randomised controlled trial

Objectives: Subtotal or total meniscectomy in the medial or lateral compartment of the knee results in a high risk of future osteoarthritis. Meniscal allograft transplantation has been performed for over thirty years with the scientifically plausible hypothesis that it functions in a similar way to a native meniscus. It is thought that a meniscal allograft transplant has a chondroprotective effect, reducing symptoms and the long-term risk of osteoarthritis. However, this hypothesis has never been tested in a high-quality study on human participants. This study aims to address this shortfall by performing a pilot randomised controlled trial within the context of a comprehensive cohort study design. Methods: Patients will be randomised to receive either meniscal transplant or a non-operative, personalised knee therapy program. MRIs will be performed every four months for one year. The primary endpoint is the mean change in cartilage volume in the weight-bearing area of the knee at one year post intervention. Secondary outcome measures include the mean change in cartilage thickness, T2 maps, patient-reported outcome measures, health economics assessment and complications. Results: This study is expected to report its findings in 2016

Collaborative Planning on State Trust Lands

ABSTRACT This report examines collaborative planning within the context of state trust lands. By analyzing eight case studies, the report aims to inform trust land agencies, local communities and other interested parties about the benefits, costs, challenges, facilitating factors and lessons learned associated with these collaborative planning efforts. The report concludes with a look ahead to future collaborative planning opportunities on state trust lands, providing a set of best management practices and recommendations for overcoming barriers to this trust land management approach. State trust lands are a category of land distinct from traditional state and federal public land. These lands were granted to states by the federal government upon statehood to support specific beneficiaries, including public schools. As a result, state trust lands are held in perpetual, intergenerational trust with the state acting as trustee. The state thus has a specific legal responsibility, known as a fiduciary duty, to conscientiously manage these lands for the designated beneficiaries. Today, there are approximately 46 million acres of state trust lands in the continental United States, mostly concentrated west of the Mississippi River. States historically have managed trust lands to generate revenue, primarily from natural-resource based activities. In recent years, rapid urbanization coupled with growing public interest in recreation opportunities, wildlife habitat, open space and ecosystem services have imposed new pressures on state trust lands in the West. These changes have provided new sources of revenue and created conflict over trust land management decisions. In response, some states have explored new ways to plan and manage state trust lands. With its promise of reducing conflict, creating mutual gains, minimizing poorly-planned development, creating flexible strategies and producing durable solutions, collaborative planning has been one approach that states have taken to balance their fiduciary duty with other interests. To examine the experience of collaborative planning on state trust lands, the research team selected eight cases from a larger pool of identified processes. These cases span seven western states and represent a range of issues, including land use planning, land management for oil, gas and ranching practices, open space conservation and forestry and watershed management. The cases also vary in the impetus for collaboration, size of trust land parcel(s) examined, level of completion of the process and scope of the outcome. To develop the case studies, researchers conducted on-site and telephone interviews of participants and studied the technical, legal and political issues involved in the case. A comprehensive cross-case analysis, informed by an extensive literature review, provided answers to several common questions about collaborative planning on state trust lands. First, in regards to what makes a process “collaborative,” the research showed that the breadth of stakeholders involved in the process affects the durability of the solution. Processes that were internally and externally transparent enjoyed low levels of public scrutiny and controversy. Most participants believed that they had influence over decision making and the outcome,although state trust land agencies did not give up their decision-making authority. Second, the research identified a number of factors that motivate and sustain collaborative planning on state trust lands. A sense of threat motivated most of the cases. Other reasons for T iv pursuing collaboration included a sense of place, a set of common goals and public pressure. Participants joined collaborative processes because of a professional or personal interest or because of a direct financial stake. The researchers found that career changes and process restrictions, such as an advisory committee charter, were the main barriers to sustaining collaboration. Factors that maintained collaboration included financial incentives, investment in the process, leadership and lack of attractive alternatives. Third, the research identified a variety of benefits and costs of collaborative planning on state trust lands. The primary benefits of collaboration included an increase in the value of the trust, an improvement in the natural environment and/or urban environment and a higher quality solution in terms of durability, creativity and the incorporation of science and outside knowledge. Secondary benefits included new and improved relationships, greater understanding and public awareness of state trust lands and better state and federal agency coordination. Costs associated with the process included direct planning costs, opportunity costs, periods of poor public relations and personal and emotional costs. In one case, participants identified a reduction in the value of the trust asset as a cost, whereas in another case, participants identified a potential loss of environmental protection as a cost. While benefits and costs were not quantified in each case, the majority of participants interviewed in each case study said they thought the process was successful or that they would collaborate again in the future. Fourth, the research addressed how legal constraints affect collaborative planning on state trust lands. In some cases, the trust mandate empowered stakeholder groups and, in others, created a division between the trust land agency and other participants. The clarity and flexibility of the mandate influenced participation, allocation of decision-making power and group dynamics. External legal constraints like federal and state laws posed a challenge for some cases by introducing new timelines and constraints, and served as a facilitating factor for others by keeping people at the table. Many of the cases strategically used the law to initiate or influence the process, define issues, create options or shape the final outcome. Several participants mentioned that collaboration is easier in the state trust land context than other natural resource contexts because trust land agencies are afforded greater legal flexibility than other agencies. Fifth, the research showed how agency structure, culture and politics affect collaborative planning. Access to the state land board, changes in agency institutional structure and land commissioner term limitations were some of the structural elements that influenced the processes. Cultural factors that influenced the process included trust land agency interaction with communities and other agencies, integration of collaboration with agency operating procedures, concern about abdication of decision-making power and uncertainty about accepting help from outside sources. Politics affected the process either as a means to gain influence over decision making or to impede or facilitate the process. Sixth, in regards to how to structure an effective collaborative process, the research showed that process structure, decision making and management are important. Process elements included deciding upon process design, dealing with representation and participation, defining roles and responsibilities and organizing subcommittees or task forces. Key steps for v addressing decision making were setting ground rules and establishing decision rules. Setting objectives and timelines, conducting activities that build understanding and coordinating with other state and federal processes were important strategies for effectively managing the process. Seventh, the research addressed how leadership and facilitation affect collaboration. Official and unofficial leaders helped guide, inspire or represent others. These leaders often, but not always, benefited the process. Professional or internal facilitators in many cases proved to be invaluable resources that assisted the groups in running meetings, communicating and making decisions. Eighth, the research showed how interpersonal dynamics influence collaborative planning on state trust lands. Positive relationships among stakeholders helped facilitate progress, provided an incentive to stay involved, fostered respect and built a greater understanding of the issues. Several participants observed that the collaborative process improved relationships and anticipated that these relationships would help with implementing the planning outcome and addressing future resource management issues. Many groups achieved a more even distribution of power by consensus decision making. Power imbalances did arise, but in most cases they did not prevent the groups from achieving their goals. Finally, the research addressed how collaborative planning processes incorporate scientific information. In many of the cases in this report, science had a significant influence on the process, whether scientific and technical information was explicitly central to the process or became an important tool along the way. The origin of this information impacted the process through strengthening group relationships or increasing the perception of the legitimacy of information. In some cases, science acted as a major facilitating factor to informed decision making while in other cases, the lack of information or the uncertainty of information significantly delayed the process. Incorporating science and technical information into the process often influenced the process structure and could act as a significant resource drain on participants who produced such information. While science influenced the process,collaborative processes also determined what science was gathered, how it was collected and by whom. From this cross-case analysis, the research team developed a set of best management practices (BMPs) and recommendations. The BMPs provide guidance to state trust land managers and other stakeholders interested in creating and/or guiding a collaborative process. The BMPs address effective ways to set the groundwork for a process, determine membership composition of the collaborative group, merge the people with the process, create a decision-making structure, effectively manage the people and the process, deal with information or lack thereof and implement the outcome. The recommendations address the broader context of challenges that impede collaboration on state trust land. They identify areas for change in regards to resource allocation, knowledge and skill sets, organizational structure, organizational culture, policy and law. The recommendations conclude with advice for continued dialogue and learning among agencies regarding collaboration on state trust land, as well as suggestions for future research.Master of ScienceNatural Resources and EnvironmentUniversity of Michigan, School of Natural Resources and Environmenthttp://deepblue.lib.umich.edu/bitstream/2027.42/35327/2/Collaborative Planning on State Trust Lands - SNRE Masters P.pd

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Weight and Height in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder:A Longitudinal Database Study Assessing the Impact of Guanfacine, Stimulants, and No Pharmacotherapy

Objectives: To assess the impact of long-term pharmacotherapy with guanfacine immediate- or extended-release (GXR), administered alone or as an adjunctive to a stimulant, on weight and height in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: Data were extracted from U.S. Department of Defense medical records for patients 4-17 years of age at index date (initiation of any study medication following a year without ADHD medications, or diagnosis if unmedicated) with weight/height measurements for the analysis period (January 2009-June 2013) and the previous year (baseline). Longitudinal weight and height z-scores were analyzed using multivariable regression in three cohorts: guanfacine (initial period of guanfacine exposure), first-line stimulant monotherapy (initial period of exposure), and unmedicated. Guanfacine cohort subgroups were based on previous/concurrent stimulant exposure. Results: The weight analyses included 47,910 patients (66.8% male) and the height analyses 41,248 (67.2% male). Mean initial exposure in the weight analyses was 237 days (standard deviation [SD] = 258, median = 142) for guanfacine and 257 days (SD = 284, median = 151) for first-line stimulant monotherapy, and was similar in the height analyses. Modeling indicated that guanfacine monotherapy was not associated with clinically meaningful deviations from normal z-score trajectories for weight (first-line, n = 943; nonfirst-line, n = 796) or height (first-line, n = 741; nonfirst-line, n = 644). In patients receiving guanfacine adjunctive to a stimulant, modeled weight (n = 1657) and height (n = 1343) z-scores followed declining trajectories. In this subgroup, mean standardized weight/height had decreased during previous stimulant monotherapy. For first-line stimulant monotherapy, modeled weight (n = 32,999) and height (n = 28,470) z-scores followed declining trajectories during year 1. In the unmedicated cohort, modeled weight (n = 11,515) and height (n = 10,050) z-scores were stable. Conclusions: Guanfacine monotherapy (first-line or nonfirst-line) was not associated with marked deviations from normal growth in this modeling study of children and adolescents with ADHD. In contrast, growth trajectories followed an initially declining course with stimulants, whether given alone or with adjunctive guanfacine.Funding Agencies|Takeda</p