Democratic innovation: the case of Milan’s Area C

Can an innovation in public sector be also respectful of the will of the citizens? While public managers are asked by NPM-led reforms to become more entrepreneurial and risk-takers, several scholars are concerned with the discretionary power awarded to managers being detrimental to democracy.This paper investigates the case of Area C in the city of Milan, an innovation in transport policy, through both a document analysis and interviews conducted with top managers involved in the innovation design and implementation and politicians adopting the «Harvard Kennedy School’s Innovations in Government Award Programs Semi-finalists’ Questionnaire» as a frame of reference.Results show that innovation is achieving relevant results in reducing both pollution and traffic congestion while increasing the average speed of public transport. Such achievements have been reached through a long process of consensus building, started including such policies in the electoral program, and persuading citizens about the necessity and usefulness of the initiative. Difficulties regard the necessity of a continuous involvement of citizens and the oppositions of some economic associations worried that Area C could damage their own businesses

Brain-to-Brain (mind-to-mind) interaction at distance: a confirmatory study

This study reports the results of a confirmatory experiment testing the hypothesis that it is possible to detect coincidences of a sequence of events (silence-signal) of different length, by analyzing the EEG activity of two human partners spatially separated when one member of the pair receives the stimulation and the second one is connected only mentally with the first. Seven selected participants with a long friendship and a capacity to maintain focused mental concentration, were divided into two groups located in two different laboratories approximately 190 km apart. Each participant acted both as a “stimulated” and as a “mentally connected” member of the pair for a total of twenty sessions overall. The offline analysis of EEG activity using a special classification algorithm based on a support vector machine, detected the coincidences in the sequence of events of the stimulation protocol between the EEG activity of the “stimulated” and the “mentally connected” pairs. Furthermore the correlation of the power spectra of the five EEG frequency bands between each of the twenty pairs of data was analyzed using a bootstrap procedure. The overall percentage of coincidences out of 88 events was 78.4% and the statistically significant average correlations between the EEG alpha and gamma bands among the pairs of participants, confirmed the results observed in a pilot study. The examination of potential internal, external and statistical artifacts which might have caused these results, ruled out external and internal artifacts. However, the examination of potential statistical artifacts revealed a good level of coincidences in only four pairs using a new procedure to detect the sequences of silence and signal between the EEG activity of the pairs of participants, giving a mild support to the hypothesis that two brains and hence two minds can be connected at distance

appraisal of clinical complications after 23 827 oocyte retrievals in a large assisted reproductive technology program

Objective To assess complications encountered after transvaginal oocyte retrieval procedures. Design Retrospective analysis. Setting University hospital, fertility center. Patient(s) A total of 23,827 consecutive transvaginal oocyte retrieval procedures in 12,615 patients. Intervention(s) Oocyte retrieval procedures performed between June 1996 and October 2016. Main Outcome Measure(s) All oocyte retrieval complications. Those requiring hospital admission for at least 24 hours were considered severe. Result(s) A total of 96 patients (0.76 %) suffered complications, with hospital admission necessary for 71 patients (0.56 %). When calculated per retrieval, the overall complication rate was 0.4%, whereas 0.29% was the admission rate, with an average duration of hospital stay of 2.77 ± 2.5 days. A surgical procedure was necessary for 24 patients (0.1% per retrieval and 0.19% per patient). Multivariate analysis showed a significant correlation between complications and women age, body mass index (BMI), the number oocyte retrieved, and the mean time to complete oocyte retrieval. The incidence of complications was significantly higher for physicians who had performed 250 retrievals (odds ratio 0.63, 95% confidence interval 0.40–0.99). Conclusion(s) Oocyte retrieval can be considered a safe procedure but is not without risks. The most important, identifiable, risk factors for the occurrence of complications are: [1] high number of oocytes retrieved, [2] a long duration of the procedure and mean time per oocyte retrieved, [3] inexperience of the surgeon, [4] younger patients with a lesser BMI, and [5] history of prior abdominal or pelvic surgery or pelvic inflammatory disease. Clinical Trial Registration Number NCT03282279

The case for mild stimulation for IVF: recommendations from The International Society for Mild Approaches in Assisted Reproduction.

The practice of ovarian stimulation for IVF is undergoing a fundamental re-evaluation as recent data begin to successfully challenge the traditional paradigm that ovarian stimulation should be aimed at the retrieval of as many oocytes as possible, in the belief that this will increase pregnancy rates. An opposing view is that live birth rate should not be the only end-point in evaluating the success of IVF treatment and that equal emphasis should be placed on safety and affordability. The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) committee has carried out an up-to-date literature search, with the evidence being graded according to the University of Oxford's Centre for Evidence-Based Medicine. The recommendations were formulated taking into account the quality of evidence on the efficacy, risk and cost of each intervention. ISMAAR recommends adopting a mild approach to ovarian stimulation in all clinical settings as an increasing body of evidence suggests that mild stimulation is as effective as conventional stimulation, while being safer and less expensive. Mild ovarian stimulation could replace conventional stimulation, thus making IVF safer and more accessible worldwide

Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancer

Fertility issues should be addressed to all patients in reproductive age before cancer treatment. In men, cryopreservation of sperm should be offered to all cancer patients in reproductive age regardless of the risk of gonadal failure. In women, the recommendation of fertility preservation should be individualized based on multiple factors such as the urgency of treatment, the age of the patient, the marital status, the regimen and dosage of cancer treatment

MULTI-MODALITY IMAGING IN AORTIC STENOSIS:AN EACVI CLINICAL CONSENSUS DOCUMENT

International audienceIn this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease