Reporting standards for studies of diagnostic test accuracy in dementia: The STARDdem Initiative.

OBJECTIVE To provide guidance on standards for reporting studies of diagnostic test accuracy for dementia disorders. METHODS An international consensus process on reporting standards in dementia and cognitive impairment (STARDdem) was established, focusing on studies presenting data from which sensitivity and specificity were reported or could be derived. A working group led the initiative through 4 rounds of consensus work, using a modified Delphi process and culminating in a face-to-face consensus meeting in October 2012. The aim of this process was to agree on how best to supplement the generic standards of the STARD statement to enhance their utility and encourage their use in dementia research. RESULTS More than 200 comments were received during the wider consultation rounds. The areas at most risk of inadequate reporting were identified and a set of dementia-specific recommendations to supplement the STARD guidance were developed, including better reporting of patient selection, the reference standard used, avoidance of circularity, and reporting of test-retest reliability. CONCLUSION STARDdem is an implementation of the STARD statement in which the original checklist is elaborated and supplemented with guidance pertinent to studies of cognitive disorders. Its adoption is expected to increase transparency, enable more effective evaluation of diagnostic tests in Alzheimer disease and dementia, contribute to greater adherence to methodologic standards, and advance the development of Alzheimer biomarkers.

Retrocrural space involvement on computed tomography as a predictor of mortality and disease severity in acute pancreatitis

BACKGROUND Because computed tomography (CT) has advantages for visualizing the manifestation of necrosis and local complications, a series of scoring systems based on CT manifestations have been developed for assessing the clinical outcomes of acute pancreatitis (AP), including the CT severity index (CTSI), modified CTSI, etc. Despite the internationally accepted CTSI having been successfully used to predict the overall mortality and disease severity of AP, recent literature has revealed the limitations of the CTSI. Using the Delphi method, we establish a new scoring system based on retrocrural space involvement (RCSI), and compared its effectiveness at evaluating the mortality and severity of AP with that of the CTSI. METHODS We reviewed CT images of 257 patients with AP taken within 3-5 days of admission in 2012. The RCSI scoring system, which includes assessment of infectious conditions involving the retrocrural space and the adjacent pleural cavity, was established using the Delphi method. Two radiologists independently assessed the RCSI and CTSI scores. The predictive points of the RCSI and CTSI scoring systems in evaluating the mortality and severity of AP were estimated using receiver operating characteristic (ROC) curves. PRINCIPAL FINDINGS The RCSI score can accurately predict the mortality and disease severity. The area under the ROC curve for the RCSI versus CTSI score was 0.962±0.011 versus 0.900±0.021 for predicting the mortality, and 0.888±0.025 versus 0.904±0.020 for predicting the severity of AP. Applying ROC analysis to our data showed that a RCSI score of 4 was the best cutoff value, above which mortality could be identified. CONCLUSION The Delphi method was innovatively adopted to establish a scoring system to predict the clinical outcome of AP. The RCSI scoring system can predict the mortality of AP better than the CTSI system, and the severity of AP equally as well.

Lernzielkatalog für die studentische Lehre im Fachbereich „Geriatrie“ an Fakultäten für Humanmedizin.

Zusammenfassung Die Betreuung geriatrischer Patientinnen und Patienten setzt, nebst einer entsprechenden Haltung, fundierte Kenntnisse in Diagnostik und Behandlung praktisch aller medizinischen Fachgebiete voraus. Daher ist es wichtig, dass die Kompetenz von Studierenden der Humanmedizin im Bereich Geriatrie entsprechend gefördert wird. Bis heute hat jedoch die studentische Ausbildung im Fach Geriatrie an vielen europäischen Universitäten einen unklaren oder untergeordneten Stellenwert. Als ersten Schritt zur Förderung der Lehre in der Geriatrie hat die Europäische Facharztvereinigung Geriatrie (UEMS-GMS) in einem Delphi-Prozess einen Lernzielkatalog entwickelt. Dieser Katalog enthält die Mindestanforderungen mit spezifischen Lernzielen (Wissen, Fertigkeiten und Haltungen), welche die Studierenden der Humanmedizin bezüglich Geriatrie bis zum Abschluss des Medizinstudiums erwerben sollen. Zur Förderung der Implementierung dieses neuen, kompetenzbasierten Lernzielkatalogs an den deutschsprachigen Universitäten wurde eine an den Sprachgebrauch des „DACH-Raums“ (Deutschland, Österreich und Schweiz) angepasste deutsche Version erstellt. Im vorliegenden Beitrag wird diese Übersetzung vorgestellt. Die Fachgesellschaften für Geriatrie aus Deutschland, Österreich und der Schweiz empfehlen den medizinischen Fakultäten der jeweiligen Länder, diesen Katalog umzusetzen.

Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement.

OBJECTIVES There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised. METHODS Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species. RESULTS Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD. DISCUSSION The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.

Core outcomes and definitions for pediatric fever and neutropenia research: a consensus statement from an international panel.

BACKGROUND There are no specific recommendations for the design and reporting of studies of children with fever and neutropenia (FN). As a result, there is marked heterogeneity in the variables and outcomes that are reported and new definitions continue to emerge. These inconsistencies hinder the ability of researchers and clinicians to compare, contrast and combine results. The objective was to achieve expert consensus on a core set of variables and outcomes that should be measured and reported, as a minimum, in pediatric FN studies. PROCEDURE The Delphi method was used to achieve consensus among an international group of clinicians, pharmacists, researchers, and patient representatives. Four surveys focusing on (i) the identification of a core set of variables and outcomes; and (ii) definitions of these variables and outcomes, were administered electronically. Consensus was predefined as more than 80% agreement on any statement. RESULTS There were forty-five survey participants and the response rate ranged between 84 and 96%. There was consensus on eight core variables and 10 core outcomes that should be collected and reported in all studies of children with FN. Consensus definitions were identified for all of the core outcomes. CONCLUSION Using the Delphi method, expert consensus on a set of core variables and outcomes, and their corresponding definitions, was achieved. These core sets represent the minimum that should be collected and reported in all studies of children with FN. This will promote collaboration and ensure consistency and comparability between studies.

Subjektive Theorien von Lehrpersonen zu Kompetenzen und Bereitschaften von Sport unterrichtenden Lehrpersonen der Vorschul- und Primarschulstufe

Lehrpersonen benötigen für professionelles pädagogisches Handeln berufliche Kompetenzen. Aktuell wird in der Diskussion um Kompetenzen (Weinert, 2002, S. 27-28) von Lehrpersonen vermehrt auf das Modell professioneller Handlungskompetenz nach Baumert und Kunter (2006, S. 482) Bezug genommen, dies allerdings meist ohne spezifische Berücksichtigung der zu unterrichtenden Fächer bzw. der Fachdisziplin (Frey, 2006, S. 42). Das gilt insbesondere für bislang wenig untersuchte Kompetenzen von Lehrpersonen des Fachs Sport. Diese lassen sich u.a. im Rahmen von subjektiven Theorien (Groeben, Wahl, Schlee & Scheele, 1988) über den eigenen Fachunterricht erfassen, da handlungsleitende Kognitionen für die Unterrichtsgestaltung darstellen. Die vorliegende Studie untersucht vor dem Hintergrund des Modells professioneller Handlungskompetenz die subjektiven Theorien von Lehrpersonen über Kompetenzen und Bereitschaften von Sport unterrichtenden Lehrpersonen der Vorschul- und Primarschulstufe. In einem Mixed-Methods-Design wurden im Rahmen einer zweistufigen Delphi-Befragung Interviews mit Expertenlehrpersonen sowie Fachdidaktikerinnen und -didaktikern durchgeführt, mittels qualitativer Inhaltsanalyse ausgewertet und daraus Kompetenzen und Bereitschaften von Sport unterrichtenden Lehrpersonen abgeleitet. Die Kompetenzen und Bereitschaften wurden anschliessend in einer quantitativen Fragebogenuntersuchung von Lehrpersonen (N = 313) bezüglich ihrer Wichtigkeit eingeschätzt und mittels explorativer Faktorenanalyse auf ihre Struktur untersucht. Auf Basis subjektiver Theorien von Lehrpersonen werden mittels Delphi-Befragung 58 Kompetenzen und Bereitschaften entwickelt, welche für Sport unterrichtende Lehrpersonen der Vorschul- und Primarschulstufe zentral sind. Diese sind fachspezifisch konnotiert und lassen sich den Aspekten des Modells professioneller Handlungskompetenz (Baumert & Kunter, 2006) zuordnen. Die Kompetenzen und Bereitschaften können aufgrund der Einschätzungen zur Wichtigkeit faktorenanalytisch auf 41 Kompetenzen und Bereitschaften reduziert und analog zu Baumert und Kunter (2006) eingeteilt werden in acht fachspezifische Kompetenzfacetten bezüglich des Professionswissens (Wissen über die didaktisch-methodische Gestaltung des Sportunterrichts, Wissen über den Nutzen von Bewegung, Wissen über die Planung des Sportunterrichts anhand transparenter Ziele und Kriterien, Entwicklungspsychologisches Wissen, sportwissenschaftliches Wissen, Wissen über den Umgang mit Unfällen, Wissen über den Einsatz vielfältiger Bewegungsaufgaben, Wissen über die Organisation der Klasse) und in zwei Bereitschaftsfacetten (Sportives Selbstverständnis, Intentionale Individuumsförderung). Alle Kompetenz- und Bereitschaftsfacetten werden im Mittel als äusserst wichtig, wichtig oder eher wichtig beurteilt. Die Ergebnisse stellen zentrale Kompetenzen und Bereitschaften von Sport unterrichtenden Lehrpersonen der Vorschul- und Primarschulstufe auf Basis von subjektiven Theorien dar. Sie lassen sich in das Modell professioneller Handlungskompetenz einordnen, weisen aber eine hohe fachspezifische Akzentuierung auf. Die Ergebnisse stellen eine mögliche Orientierungshilfe für die Gestaltung der Ausbildung von Sport unterrichtenden Lehrpersonen dar. Baumert, J. & Kunter, M. (2006). Stichwort: Professionelle Kompetenz von Lehrkräften. Zeitschrift für Erziehungswissenschaft, 9 (4), 469-520. Frey, A. (2006). Methoden und Instrumente zur Diagnose beruflicher Kompetenzen von Lehrkräften - eine erste Standortbestimmung zu bereits publizierten Instrumenten. In C. Allemann-Ghionda & E. Terhart (Hrsg.), Kompetenzen und Kompetenzentwicklung von Lehrerinnen und Lehrern: Ausbildung und Beruf. 51. Beiheft der Zeitschrift für Pädagogik (S. 30-46). Weinheim: Beltz. Groeben, N., Wahl, D., Schlee, J. & Scheele, B. (1988). Forschungsprogramm Subjektive Theorien. Eine Einführung in die Psychologie des reflexiven Subjekts. Tübingen: Francke. Weinert, F.E. (2002). Vergleichende Leistungsmessung in Schulen - eine umstrittene Selbstverständlichkeit. In F.E. Weinert (Hrsg.), Leistungsmessungen in Schulen (2. Aufl., S. 17-31). Weinheim: Beltz.

The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

OBJECTIVE We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.

Expert Opinion on the Perceived Effectiveness and Importance of On-Farm Biosecurity Measures for Cattle and Swine Farms in Switzerland.

Biosecurity is crucial for safeguarding livestock from infectious diseases. Despite the plethora of biosecurity recommendations, published scientific evidence on the effectiveness of individual biosecurity measures is limited. The objective of this study was to assess the perception of Swiss experts about the effectiveness and importance of individual on-farm biosecurity measures for cattle and swine farms (31 and 30 measures, respectively). Using a modified Delphi method, 16 Swiss livestock disease specialists (8 for each species) were interviewed. The experts were asked to rank biosecurity measures that were written on cards, by allocating a score from 0 (lowest) to 5 (highest). Experts ranked biosecurity measures based on their importance related to Swiss legislation, feasibility, as well as the effort required for implementation and the benefit of each biosecurity measure. The experts also ranked biosecurity measures based on their effectiveness in preventing an infectious agent from entering and spreading on a farm, solely based on transmission characteristics of specific pathogens. The pathogens considered by cattle experts were those causing Bluetongue (BT), Bovine Viral Diarrhea (BVD), Foot and Mouth Disease (FMD) and Infectious Bovine Rhinotracheitis (IBR). Swine experts expressed their opinion on the pathogens causing African Swine Fever (ASF), Enzootic Pneumonia (EP), Porcine Reproductive and Respiratory Syndrome (PRRS), as well as FMD. For cattle farms, biosecurity measures that improve disease awareness of farmers were ranked as both most important and most effective. For swine farms, the most important and effective measures identified were those related to animal movements. Among all single measures evaluated, education of farmers was perceived by the experts to be the most important and effective for protecting both Swiss cattle and swine farms from disease. The findings of this study provide an important basis for recommendation to farmers and policy makers.

Data Accuracy in Medical Record Abstraction

Clinical Research Data Quality Literature Review and Pooled Analysis We present a literature review and secondary analysis of data accuracy in clinical research and related secondary data uses. A total of 93 papers meeting our inclusion criteria were categorized according to the data processing methods. Quantitative data accuracy information was abstracted from the articles and pooled. Our analysis demonstrates that the accuracy associated with data processing methods varies widely, with error rates ranging from 2 errors per 10,000 files to 5019 errors per 10,000 fields. Medical record abstraction was associated with the highest error rates (70–5019 errors per 10,000 fields). Data entered and processed at healthcare facilities had comparable error rates to data processed at central data processing centers. Error rates for data processed with single entry in the presence of on-screen checks were comparable to double entered data. While data processing and cleaning methods may explain a significant amount of the variability in data accuracy, additional factors not resolvable here likely exist. Defining Data Quality for Clinical Research: A Concept Analysis Despite notable previous attempts by experts to define data quality, the concept remains ambiguous and subject to the vagaries of natural language. This current lack of clarity continues to hamper research related to data quality issues. We present a formal concept analysis of data quality, which builds on and synthesizes previously published work. We further posit that discipline-level specificity may be required to achieve the desired definitional clarity. To this end, we combine work from the clinical research domain with findings from the general data quality literature to produce a discipline-specific definition and operationalization for data quality in clinical research. While the results are helpful to clinical research, the methodology of concept analysis may be useful in other fields to clarify data quality attributes and to achieve operational definitions. Medical Record Abstractor’s Perceptions of Factors Impacting the Accuracy of Abstracted Data Medical record abstraction (MRA) is known to be a significant source of data errors in secondary data uses. Factors impacting the accuracy of abstracted data are not reported consistently in the literature. Two Delphi processes were conducted with experienced medical record abstractors to assess abstractor’s perceptions about the factors. The Delphi process identified 9 factors that were not found in the literature, and differed with the literature by 5 factors in the top 25%. The Delphi results refuted seven factors reported in the literature as impacting the quality of abstracted data. The results provide insight into and indicate content validity of a significant number of the factors reported in the literature. Further, the results indicate general consistency between the perceptions of clinical research medical record abstractors and registry and quality improvement abstractors. Distributed Cognition Artifacts on Clinical Research Data Collection Forms Medical record abstraction, a primary mode of data collection in secondary data use, is associated with high error rates. Distributed cognition in medical record abstraction has not been studied as a possible explanation for abstraction errors. We employed the theory of distributed representation and representational analysis to systematically evaluate cognitive demands in medical record abstraction and the extent of external cognitive support employed in a sample of clinical research data collection forms. We show that the cognitive load required for abstraction in 61% of the sampled data elements was high, exceedingly so in 9%. Further, the data collection forms did not support external cognition for the most complex data elements. High working memory demands are a possible explanation for the association of data errors with data elements requiring abstractor interpretation, comparison, mapping or calculation. The representational analysis used here can be used to identify data elements with high cognitive demands.

Percepción de la erosión agraria

Esta investigación analiza mediante la metodología Delphi varios indicadores de calidad del suelo del olivar español, en particular, la textura, la fertilidad, el color, la profundidad, la compactación, la aireación, la materia orgánica y la infiltración del agua. El objetivo consiste en describir la percepción de los olivicultores acerca del grado de erosión en la zona de estudio, teniendo en cuenta su propia autovaloración referida a su nivel de adopción de innovaciones y a su actitud frente al riesgo de aplicar nuevas tecnologías. El panel de expertos seleccionados está formado por 63 olivicultores de la cuenca granadina del Alto Genil en el año 2005; esta zona se caracteriza por el cultivo del olivar en ladera y sus consiguientes niveles de erosión medio-altos, por lo que la actividad agraria se encuentra fuertemente condicionada por el grado de implementación de prácticas de conservación del suelo, específicamente por el laboreo según curvas de nivel, el no laboreo con herbicidas y el mantenimiento de restos de poda sobre la capa edáfica (según una encuesta preliminar del año 2004), así como por su promoción a través de la reciente legislación europea en materia agroambiental.

IX Meeting of Ancient Drama

Fil: González de Tobia, Ana María. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

IX Meeting of Ancient Drama

Fil: González de Tobia, Ana María. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Gobernar la complejidad urbana desde la sostenibilidad. Evaluación del gobierno de la gestión visible utilizando indicadores de gobernanza (Venezuela)

Se evalúa con indicadores de gobernanza urbana la sostenibilidad de las formas de hacer ciudad hibrida compleja del gobierno de la gestión visible (GGV). Argumenta que el GGV hace ciudad para legitimarse por desempeño y fortalecer la gobernanza local, en un contexto de mutaciones múltiples y radicales que tienden a diluir y centralizar el poder local y fractalizar la ciudad, profundizando la segregación sociopolítica-territorial y la ingobernabilidad genética de la ciudad hibrida, poniendo en riesgo el Estado federal descentralizado, el derecho a la ciudad, al gobierno local y la gobernanza urbana y multinivel (hipótesis). La estrategia de evaluación de gobernanza innovadora (EEG+i) diseñada para evaluar la relación entre las formas de hacer ciudad hibrida (variables espaciales) y gobernanza (variable a-espacial) es transversal, multidimensional y se construye desde la complejidad, el análisis de escenarios, formulación de constructos, modelos e indicadores de gobernanza, entretejiendo tres campos de conocimiento, gobierno, ciudad y sostenibilidad, en cuatro fases. La Fase 1, contextualiza la gobernanza en la dramática del siglo XXI. La Fase 2, desarrolla la fundamentación teórico-práctica, nuevos conceptos y un abordaje analítico propio ‘genética territorial’, para analizar y comprehender la complejidad de la ciudad hibrida de países en desarrollo, tejiendo ontogenética territorial y el carácter autopoiético del gen informal. En la Fase 3, se caracterizan las formas de hacer ciudad desde la genética del territorio, se formulan modelos e indicadores de gobernanza con los que se evalúan, aplicando un delphi y cuestionarios, los genes tipológicos-formas de hacer ciudad y validan las conclusiones. En la Fase 4, se correlacionan los resultados de los instrumentos aplicados con la praxis urbana del GGV, durante cuatro periodos de gobierno (1996-2010). Concluyendo que, la estrategia de evaluación comprobó las hipótesis y demostró la correlación transversal y multinivel existente entre, las mutaciones en curso que contradicen el modelo de gobernanza constitucional, el paisaje de gobernanza latinoamericano y venezolano, la praxis de los regímenes híbridos ricos en recursos naturales, las perspectivas de desarrollo globales y se expresa sociopolíticamente en déficit de gobernanza, Estado de derecho y cohesión-capital social y, espaciolocalmente, en la ciudad hibrida dispersa y diluida (compleja) y en el gobierno del poder diluido centralizado. La confrontación de flujos de poder centrípetos y centrífugos en la ciudad profundiza la fragmentación socioespacial y política y el deterioro de la calidad de vida, incrementando las protestas ciudadanas e ingobernabilidad que obstaculiza la superación de la pobreza y gobernanza urbana y multinivel. La evaluación de la praxis urbana del GGV evidenció que la correlación entre gobernanza, la producción de genes formales y la ciudad por iniciativa privada tiende a ser positiva y entre gobernanza, genes y producción de ciudad informal negativa, por el carácter autopoiético-autogobernable del gen informal y de los nuevos gobiernos sublocales que dificulta gobernar en gobernanza. La praxis del GGV es contraria al modelo de gobernanza formulado y la disolución centralizada del gobierno local y de la ciudad hibrida-dispersa es socio-espacial y políticamente insostenible. Se proponen estrategias y tácticas de gobernanza multinivel para recuperar la cohesión social y de planificación de la gestión innovadora (EG [PG] +i) para orquestar, desde el Consejo Local de Gobernanza (CLG) y con la participación de los espacios y gobiernos sublocales, un proyecto de ciudad compartido y sostenible. ABSTRACT The sustainability of the forms of making the hybrid-complex city by the visible management government (VMG) is evaluated using urban governance indicators. Argues that the VMG builds city to legitimate itself by performance and to strengthen local governance in a context of multiple and radical mutations that tend to dilute and centralize local power and fractalize the city, deepening the socio-spatial and political segregation, the genetic ingovernability of the hybrid city and placing the decentralized federal State, the right to city, local government and urban governance at risk (hypothesis). The innovative governance evaluation strategy (GES+i) designed to assess the relationship between the forms of making the hybrid city (spatial variables) and governance (a-spatial variable) is transversal, multidimensional; is constructed from complexity, scenario analysis, the formulation of concepts, models and governance indicators, weaving three fields of knowledge, government, city and sustainability in four phases. Phase 1, contextualizes governance in the dramatic of the twenty-first century. Phase 2, develops the theoretical and practical foundations, new concepts and a proper analytical approach to comprehend the complexity of the hybrid city from developing countries, weaving territorial ontogenetic with the autopiethic character of the informal city gen. In Phase 3, the ways of making city are characterized from the genetics of territory; governance indicators and models are formulated to evaluate, using delphi and questionnaires, the ways of making city and validate the conclusions. In Phase 4, the results of the instruments applied are correlated with the urban praxis of the VMG during the four periods of government analyzed (1996-2010). Concluding that, the evaluation strategy proved the hypothesis and showed the transversal and multilevel correlation between, mutations that contradict the constitutional governance model, the governance landscape of Latinamerica and the country, the praxis of the hybrid regimes rich in natural resources, the perspectives of the glocal economy and expresses socio-politically the governance and rule of law and social capital-cohesion deficit and spatial-temporarily the hybrid disperse and diluted city (complex) and the diluted-centralized local government. The confrontation of flows of power centripetal and centrifugal in the city deepens the socio-spatial and political fragmentation and deterioration of the quality of life, increasing citizens' protests and ingovernability which hinders poverty eradication and, multilevel and urban governance. The evaluation of the VMG urban praxis showed the correlation between governance, the production of formal genes and city by private initiative tended to be positive and, between informal genes-city production and governance negative, due to its autopiethic-self governable character that hinders governance. The urban praxis of the VMG contradicts the formulated governance model and thecentralized dissolution of the local government and hybrid city are socio-spatial and politically unsustainable. Multiscale governance strategies are proposed to recreate social cohesion and a management planning innovative method (EG [PG] + i) to orchestrate, from the Local Governance Council (LGC) and with the participation of sublocal governments and spaces, a shared and sustainable city project.