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As transportation agencies across the country are forced to deal with declining funding levels, much attention is paid to what will be lost as a result of these reductions. However, not enough attention is given to what agencies can do, not only to manage under tight budgets but also to make tremendous advancements in how projects are delivered in a way that is more accountable and transparent to citizens. Although this may be an era of smaller transportation programs, it can also be a time of greater leadership and public policy. With this in mind, the Kansas Department of Transportation embarked on a multiyear experiment to reinvent transportation planning and project selection processes. The effort would achieve greater support through stakeholder consultation, collaboration, and adoption of improved and expanded methods for ranking and selecting projects that appeal to broader issues of public concern (such as job creation) instead of merely engineering measures of need, such as pavement condition, congestion, and shoulder width. Eight years of experimentation in consultation, collaboration, and revision of processes provide many lessons for the transportation community; these lessons may be applicable in whole or part for other state or regional transportation agencies. The following methods and tools used by the Kansas Department of Transportation were critically examined: surveys, collaborative planning efforts, social media outreach, economic impact analysis, and expanded project selection processes. The results of this effort led to both the passage of a new 10-year transportation program by the Kansas Legislature in 2010 and its successful implementation in 2011.

Topical skin adhesives (TSA) are commonly used in hospital accident and emergency (A&E) settings for the closure of simple, minor lacerations. An observational study was conducted in a UK ambulance trust to assess health resource use associated with the management of simple lacerations when using Dermabond® TSA at the accident scene, compared with its use in A&E after transportation of the patient to hospital (standard of care (SOC)). A decision tree model mapped both treatment pathways to establish full costs to the NHS. Call-out times and staff interventions were recorded. Treatment of patients at the scene with Dermabond® TSA reduced the call-out time (mean reduction 32.64%, median reduction 31.91%). Total cost per patient pathway for patients treated at the scene was £200.81 with Dermabond® TSA and £611.43 for patients receiving SOC. Treatment at the scene with Dermabond® TSA resulted in a total saving to the Merseyside Ambulance Service of £345 327 over the 5-month study. The use of Dermabond® TSA by emergency care practitioners at the scene for the closure of simple, minor lacerations is acceptable, cost effective, and provides NHS trusts with the opportunity to work towards government initiatives for reducing the number of patients treated within the acute hospital setting.