Bringing climate change down to earth : science and participation in Canadian and Australian climate change campaigns

This dissertation examines Canadian and Australian climate change campaigns as cases of science in the public sphere. I pose three interconnected research questions. What is the role of science in climate change campaigns? How is the use of science affected by the type of campaign institution: government or non-government? How does the national policy environment, particularly Canada's ratification and Australia's rejection of the Kyoto Protocol, affect the campaigns? In both Canada and Australia, I used methods of participant observation, interviews, and document analysis to analyze the campaigns of a government office and a non-government organization. I found that campaigners use natural and social science, along with technologies of quantification, to motivate the public to take action on climate change. Their uses of science and numbers represent different ways of framing the problem they are trying to solve; they also represent different ways of configuring the public's participation in the campaigns. Furthermore, I demonstrate that campaigners' uses of science and numbers are oriented not only towards their audiences but also towards the concerns of their own organizations, their government or non- government counterparts, and their national political leaders. Finally, campaigners' epistemological, institutional, and national considerations influence how they attribute responsibility for environmental protection. I argue that campaigners operate under different models of the relationship between individuals, non-government organizations, and governments; these models of responsibility affect the form and content of public participation. This study thus emphasizes the interconnections between ways of knowing, political actions, and forms of public participation. As such, this work contributes to the literatures on public understanding of science, science and politics, social movements, and studies of national and international environmental politic

An empirical model to estimate the potential impact of medication safety alerts on patient safety, health care utilization, and cost in ambulatory care

BACKGROUND: Because ambulatory care clinicians override as many as 91% of drug interaction alerts, the potential benefit of electronic prescribing (e-prescribing) with decision support is uncertain. METHODS: We studied 279 476 alerted prescriptions written by 2321 Massachusetts ambulatory care clinicians using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts, estimating the likelihood and severity of adverse drug events (ADEs) associated with each alert, the likely injury to the patient, and the health care utilization required to address each ADE. We estimated the cost savings due to e-prescribing by using third-party-payer and publicly available information. RESULTS: Based on the expert panel\u27s estimates, electronic drug alerts likely prevented 402 (interquartile range [IQR], 133-846) ADEs in 2006, including 49 (14-130) potentially serious, 125 (34-307) significant, and 228 (85-409) minor ADEs. Accepted alerts may have prevented a death in 3 (IQR, 2-13) cases, permanent disability in 14 (3-18), and temporary disability in 31 (10-97). Alerts potentially resulted in 39 (IQR, 14-100) fewer hospitalizations, 34 (6-74) fewer emergency department visits, and 267 (105-541) fewer office visits, for a cost savings of 402,619 USD (IQR, 141,012-1,012,386 USD). Based on the panel\u27s estimates, 331 alerts were required to prevent 1 ADE, and a few alerts (10%) likely accounted for 60% of ADEs and 78% of cost savings. CONCLUSIONS: Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts. Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts