Automated Transit Networks (ATN): A Review of the State of the Industry and Prospects for the Future, MTI Report 12-31

The concept of Automated Transit Networks (ATN) - in which fully automated vehicles on exclusive, grade-separated guideways provide on-demand, primarily non-stop, origin-to-destination service over an area network – has been around since the 1950s. However, only a few systems are in current operation around the world. ATN does not appear “on the radar” of urban planners, transit professionals, or policy makers when it comes to designing solutions for current transit problems in urban areas. This study explains ATN technology, setting it in the larger context of Automated Guideway Transit (AGT); looks at the current status of ATN suppliers, the status of the ATN industry, and the prospects of a U.S.-based ATN industry; summarizes and organizes proceedings from the seven Podcar City conferences that have been held since 2006; documents the U.S./Sweden Memorandum of Understanding on Sustainable Transport; discusses how ATN could expand the coverage of existing transit systems; explains the opportunities and challenges in planning and funding ATN systems and approaches for procuring ATN systems; and concludes with a summary of the existing challenges and opportunities for ATN technology. The study is intended to be an informative tool for planners, urban designers, and those involved in public policy, especially for urban transit, to provide a reference for history and background on ATN, and to use for policy development and research

Pregnancy related pharmacokinetics and antimicrobial prophylaxis during fetal surgery, cefazolin and clindamycin as examples

Antimicrobial prophylaxis during surgery aims to prevent post-operative site infections. For fetal surgery, this includes the fetal and amniotic compartments. Both are deep compartments as drug equilibrium with maternal blood is achieved relatively late. Despite prophylaxis, chorio-amnionitis or endometritis following ex utero intrapartum treatment or fetoscopy occur in 4.13% and 1.45% respectively of the interventions. This review summarizes the observations on two commonly administered antimicrobials (cefazolin, clindamycin) for surgical prophylaxis during pregnancy, with emphasis on the deep compartments. For both compounds, antimicrobial exposure is on target when we consider the maternal and fetal plasma compartment. In contrast, amniotic fluid concentrations-time profiles display a delayed and much more blunted pattern, behaving as deep compartment. For cefazolin, there are data that document further dilution in the setting of polyhydramnios. Along this deep compartment concept, there is some accumulation during repeated administration, modeled for cefazolin and observed for clindamycin. The relative underexposure to antimicrobials in amniotic fluid may be reflected in the pattern of maternal-fetal complications after fetal surgery, and suggest that antimicrobial prophylaxis practices for fetal surgery should be reconsidered. Further studies should be designed by a multidisciplinary team (fetal surgeons, clinical pharmacologists and microbiologists) to facilitate efficient evaluation of antimicrobial prophylaxis

Dynamic consent, communication and return of results in large-scale health data reuse: Survey of public preferences

Dynamic consent forms a comprehensive, tailored approach for interacting with research participants. We conducted a survey study to inquire how research participants evaluate the elements of consent, information provision, communication and return of results within dynamic consent in a hypothetical health data reuse scenario. We distributed a digital questionnaire among a purposive sample of patient panel members. Data were analysed using descriptive and nonparametric inferential statistics. Respondents favoured the potential to manage changing consent preferences over time. There was much agreement between people favouring closer and more specific control over data reuse approval and those in favour of broader approval, facilitated by an opt-out system or an independent data reuse committee. People want to receive more information about reuse, outcomes and return of results. Respondents supported an interactive model of research participation, welcoming regular, diverse and interactive forms of communication, like a digital communication platform. Approval for reuse and providing meaningful information, including meaningful return of results, are intricately related to facilitating better communication. Respondents favoured return of actionable research results. These findings emphasize the potential of dynamic consent for enabling participants to maintain control over how their data are being used for which purposes by whom. Allowing different options to shape a dynamic consent interface in health data reuse in a personalized manner is pivotal to accommodate plurality in a flexible though robust manner. Interaction via dynamic consent enables participants to tailor the elements of participation they deem relevant to their own preferences, engaging diverse perspectives, interests and preferences

Over de boeg van een akkoord

Dit essay beschrijft een praktijk van lokaal klimaatbeleid, waarin beleid in de vorm van een klimaatakkoord met ruim 100 partijen tot stand komt. In plaats van dat de gemeente beleid afkondigt, maken partijen dit samen. Werkt dat, hoe werkt dat en wat kunnen we ervan leren? We gingen op zoek naar de kracht van de aanpak en hoe partijen die kracht hebben gevonden. De volgende vraag was daarbij leidend: _‘Wat zijn de opbrengsten van de werkwijze rond het Rotterdams Klimaatakkoord, welke dilemma’s deden zich voor en welke lessen kan een initiërende gemeente (als Rotterdam) daaruit trekken?’

Learning accountable governance: Challenges and perspectives for data-intensive health research networks

Current challenges to sustaining public support for health data research have directed attention to the governance of data-intensive health research networks. Accountability is hailed as an important element of trustworthy governance frameworks for data-intensive health research networks. Yet the extent to which adequate accountability regimes in data-intensive health research networks are currently realized is questionable. Current governance of data-intensive health research networks is dominated by the limitations of a drawing board approach. As a way forward, we propose a stronger focus on accountability as learning to achieve accountable governance. As an important step in that direction, we provide two pathways: (1) developing an integrated structure for decision-making and (2) establishing a dialogue in ongoing deliberative processes. Suitable places for learning accountability to thrive are dedicated governing bodies as well as specialized committees, panels or boards which bear and guide the development of governance in data-intensive health research networks. A continuous accountability process which comprises learning and interaction accommodates the diversity of expectations, responsibilities and tasks in data-intensive health research networks to achieve responsible and effective governance

Prostaglandin F2-Alpha Eye Drops (Bimatoprost) in Graves' Orbitopathy:A Randomized Controlled Double-Masked Crossover Trial (BIMA Trial)

Abstract Background: Previous in vitro experiments have demonstrated that prostaglandin F2-alpha (PF2α) reduced proliferation and adipogenesis in a murine cell line and human orbital fibroblasts derived from subjects with inactive Graves' orbitopathy (GO). The objective of this study was to determine if the PGF2α analogue bimatoprost is effective at reducing proptosis in this population. Methods: A randomized controlled double-masked crossover trial was conducted in a single tertiary care academic medical center. Patients with long-standing, inactive GO but persistent proptosis (>20 mm in at least one eye) were recruited. Allowing for a 15% dropout rate, 31 patients (26 females) were randomized in order to identify a treatment effect of 2.0 mm (p = 0.05; power 0.88). Following informed consent, participants were randomized to receive bimatoprost or placebo for three months, after which they underwent a two-month washout before switching to the opposite treatment. The primary outcome was the change in exophthalmometry readings over the two three-month treatment periods. Results: The mean exophthalmometer at baseline was 23.6 mm (range 20.0–30.5 mm), and the mean age of the patients was 55 years (range 28–74 years). The median duration of GO was 7.6 years (interquartile range 3.6–12.3 years). The majority were still suffering from diplopia (61.3%) with bilateral involvement (61.3%). Using multi-level modeling adjusted for baseline, period, and carry-over, bimatoprost resulted in a −0.17 mm (reduction) exophthalmometry change ([confidence interval −0.67 to +0.32]; p = 0.490). There was a mean change in intraocular pressure of −2.7 mmHg ([confidence interval −4.0 to −1.4]; p = 0.0070). One patient showed periorbital fat atrophy on treatment, which resolved on stopping treatment. Independent analysis of proptosis by photographic images (all subjects) and subgroup analysis on monocular disease (n = 12) did not show any apparent benefit. Conclusions: In inactive GO, bimatoprost treatment over a three-month period does not result in an improvement in proptosis

Justice in a Pandemic Briefing Two : Justice For All and The Economic Crisis

The world faces its most threatening economic crisis in almost 100 years. We are already experiencing mass job losses and bankruptcies as part of a sharp economic downturn, and a prolonged global depression is likely as at least 170 countries see their economies shrink. Previous financial crises and natural disasters triggered demand spikes and compounded existing problems in six key justice areas: crime, housing and land, family disputes, unemployment and bankruptcy, money and debt, and access to services. In a survey of 270 justice leaders from 20 countries, employment problems, debt, and bankruptcy were expected to account for the largest increases in justice problems as a result of the COVID-19 virus. It will be difficult for justice systems to meet the increased demand.12 Even before the pandemic, 1.5 billion people had justice problems they were unable to resolve.13 Now, with many formal and informal justice providers suspending services because of the health emergency and likely to face a surge in demand when they reopen, the burden on them will be unprecedented

Justice in a Pandemic Briefing One : Justice for All and the Public Health Emergency

The COVID-19 pandemic is an unprecedented global emergency. It is not only a health crisis but also a human rights crisis. Justice actors face daunting responsibilities as they design, implement, and enforce new measures to prevent the spread of infection. Measures that heighten the risk of human rights abuses can undermine trust, at a time when the justice system most needs to maintain the public’s confidence. For better or for worse, justice systems and justice workers are on the frontline of this pandemic. If we get our response right, societies will be better able to confront the pandemic effectively and fairly. That will build the foundations for reset and recovery. If we get it wrong, it is no exaggeration to say that people will die unnecessarily. In the Justice for All report released last year, the Task Force on Justice noted that 1.5 billion people had a justice problem that they could not resolve. Now as well as before the pandemic, marginalized communities – already poorly served by justice systems – face the highest risks, as do vulnerable groups. The pandemic is widening the justice gap, with a sharp increase in the problems that many people face and the ability of justice actors to respond declining