Digital Democracy A summary report for practitioners

Thanks to digital technologies, today we can bank, read the news, study for a degree, and chat with friends across the world - all without leaving the comfort of our homes. But one area that seems to have remained impervious to these benefits is our model of democratic governance, which has remained largely unchanged since it was invented in the 20th century.There has been a failure to change, despite the fact that disillusionment with existing political institutions is widespread, trust in our elected representatives is chronically lacking and election turnout is low.1, 2 At the local level, councils are facing the challenges of increasing pressure on services with tougher demands for accountability from localresidents. Membership of political parties is significantly lower than a few decades ago. The rise of alternative social movements, both online and offline, is resulting in a move away from traditional forms of political participation. Recently, a small number of national parliaments, local government bodies and political parties have seen the potential for technology to help address these issues. Has the time for digital democracy finally come

Digital Democracy : The Tools Transforming Political Engagement

This paper shares lessons from Nesta's research into some of the pioneering innovations in digital democracy which are taking place across Europe and beyond.Key findings:Digital democracy is a broad concept and not easy to define. The paper provides a granular approach to help encompass its various activities and methods (our 'typology of digital democracy').Many initiatives exist simply as an app, or web page, driven by what the technology can do, rather than by what the need is.Lessons from global case studies describe how digital tools are being used to engage communities in more meaningful political participation, and how they are improving the quality and legitimacy of decision-making.Digital democracy is still young. Projects must embed better methods for evaluation of their goals if the field is to grow

Digital Democracy : The Tools Transforming Political Engagement

This paper shares lessons from Nesta's research into some of the pioneering innovations in digital democracy which are taking place across Europe and beyond.Key findings:Digital democracy is a broad concept and not easy to define. The paper provides a granular approach to help encompass its various activities and methods (our 'typology of digital democracy').Many initiatives exist simply as an app, or web page, driven by what the technology can do, rather than by what the need is.Lessons from global case studies describe how digital tools are being used to engage communities in more meaningful political participation, and how they are improving the quality and legitimacy of decision-making.Digital democracy is still young. Projects must embed better methods for evaluation of their goals if the field is to grow

The "Is mpMRI Enough" or IMRIE Study: a multicentre evaluation of prebiopsy multiparametric magnetic resonance imaging compared with biopsy.

Background: Multiparametric magnetic resonance imaging (mpMRI) is now recommended prebiopsy in numerous healthcare regions based on the findings of high-quality studies from expert centres. Concern remains about reproducibility of mpMRI to rule out clinically significant prostate cancer (csPCa) in real-world settings. Objective: To assess the diagnostic performance of mpMRI for csPCa in a real-world setting. Design, setting, and participants: A multicentre, retrospective cohort study, including men referred with raised prostate-specific antigen (PSA) or an abnormal digital rectal examination who had undergone mpMRI followed by transrectal or transperineal biopsy, was conducted. Patients could be biopsy naïve or have had previous negative biopsies. Outcome measurements and statistical analysis: The primary definition for csPCa was International Society of Urological Pathology (ISUP) grade group (GG) ≥2 (any Gleason ≥7); the accuracy for other definitions was also evaluated. Results and limitations: Across ten sites, 2642 men were included (January 2011–November 2018). Mean age and PSA were 65.3 yr (standard deviation [SD] 7.8 yr) and 7.5 ng/ml (SD 3.3 ng/ml), respectively. Of the patients, 35.9% had “negative MRI” (scores 1–2); 51.9% underwent transrectal biopsy and 48.1% had transperineal biopsy, with 43.4% diagnosed with csPCa overall. The sensitivity and negative predictive value (NPV) for ISUP GG ≥ 2 were 87.3% and 87.5%, respectively. The NPVs were 87.4% and 88.1% for men undergoing transrectal and transperineal biopsy, respectively. Specificity and positive predictive value of MRI were 49.8% and 49.2%, respectively. The sensitivity and NPV increased to 96.6% and 90.6%, respectively, when a PSA density threshold of 0.15 ng/ml/ml was used in MRI scores 1–2; these metrics increased to 97.5% and 91.2%, respectively, for PSA density 0.12 ng/ml/ml. ISUP GG ≥ 3 (Gleason ≥4 + 3) was found in 2.4% (15/617) of men with MRI scores 1–2. They key limitations of this study are the heterogeneity and retrospective nature of the data. Conclusions: Multiparametric MRI when used in real-world settings is able to rule out csPCa accurately, suggesting that about one-third of men might avoid an immediate biopsy. Men should be counselled about the risk of missing some significant cancers