A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

BackgroundHealth-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement.MethodsThis study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media releases, and correspondence. Interviews will be conducted in person with senior administrative leaders, government officials, screening experts, and high-level cancer system stakeholders.DiscussionThe proposed study comprises the third and final phase of an Emerging Team grant to address the challenges of health-policy decision making and colorectal cancer screening decisions in Canada. This study will contribute a unique prospective look at how policy makers address new, emerging scientific evidence in several different policy environments and at different stages of program planning and implementation. Findings will provide important insight into the various approaches that are or should be used to monitor emerging evidence, the relative importance of scientific versus contextual evidence for decision making, and the tools and processes that may be important to support challenging health-policy decisions

Molecular and Immunohistochemical Identification of a Sodium Hydrogen Exchanger-2C (Nhe2C) Paralog in the Gills of Marine Longhorn Sculpin (Myoxocephalus Octodecemspinosus)

Sodium hydrogen exchanger proteins (NHEs) are members of the cation proton antiporter superfamily (CPA) and are thought to function in fish for maintaining physiological ion concentrations and acid-base balances by excreting excess H+ ions from the body in exchange for Na+ ions. There are many more types of these proteins in teleost fish than in mammals due to putative genome duplication. This study describes a new form of NHE2 in the gills of marine longhorn sculpin, Myoxocephalus octodecemspinosus, designated NHE2c. Sequencing revealed that the NHE2c nucleotide-coding region transcribes a peptide 795 amino acids in length with an estimated molecular weight of 89.2 kDa. Data shows that NHE2c is a unique peptide from previously described NHE isoforms, including the NHE2 family. A polyclonal antibody made against NHE2c and used in double and triple labeled immunohistochemical experiments detected the peptide on the apical edge of gill cells that also contained Na+-K+-ATPase and NHE2b. Western blot analysis detected two protein bands at approximately 45 kDa and 75 kDa. These extra copies of NHE2 in the sculpin genome pose an intriguing question of why the proteins are synthesized in the first place. While, in the future, studying syntenic NHE paralogs in the NHE2 family of longhorn sculpin could give us an evolutionary perspective to homologous NHEs in higher vertebrates

The invention of the building industry in Britain

Cómo una actividad artesanal basada en el conocimiento de tipo universal y empírico se ha convertido en una industria globalizada tras la intervención de los gobiernos en el mercado de la vivienda después de la Primera Guerra Mundial. La respuesta la encontramos en el surgimiento de la elaboración de las estadísticas de vivienda y de la ciencia de la edificación. Durante el period de la Guerra se dio la fusión de la arquitectura modernista y la construcción de las ideas científicas dentro de una economía dirigida. En el artículo se estudia el éxito, que durante la posguerra, logró la institucionalización académica de la ciencia de la construcción mientras se asistía al éxito económico y al surgimiento de las elites internacionales. Por último, se explica la consolidación y persistencia del paradigma industrial de la construcción.How a universal, empirical craftbased activity has been turned into a globalized industry following government intervention in the housing market after World War I, and the emergence of building science and housing statistics in response. Evolution of statistics into construction economics, through which the performance of construction in the economy, may be measured. Wartime merging of modernist architecture and building science ideas within a command economy are developed. Post-war academic and institutional success of building science and economics and the emergence of international elites are studied. Consolidation of and persistence of the industrial paradigm of construction are explained

Economic evaluation of smoking cessation in Ontario's regional cancer programs.

Quitting smoking after a diagnosis of cancer results in greater response to treatment and decreased risk of disease recurrence and second primary cancers. The objective of this study was to evaluate the potential cost-effectiveness of two smoking cessation approaches: the current basic smoking cessation program consisting of screening for tobacco use, advice, and referral; and a best practice smoking cessation program that includes the current basic program with the addition of pharmacological therapy, counseling, and follow-up. A Markov model was constructed that followed 65-year-old smokers with cancer over a lifetime horizon. Transition probabilities and mortality estimates were obtained from the published literature. Costs were obtained from standard costing sources in Ontario and reports. Probabilistic and deterministic sensitivity analyses were conducted to address parameter uncertainties. For smokers with cancer, the best practice smoking cessation program was more effective and more costly than the basic smoking cessation program. The incremental cost-effectiveness ratio of the best practice smoking cessation program compared to the basic smoking cessation program was $3367 per QALY gained and$5050 per LY gained for males, and $2050 per QALY gained and$4100 per LY gained for females. Results were most sensitive to the hazard ratio of mortality for former and current smokers, the probability of quitting smoking through participation in the program and smoking-attributable costs. The study results suggested that a best practice smoking cessation program could be a cost-effective option. These findings can support and guide implementation of smoking cessation programs

2018 Student Composers Recital

The 2018 Student Composers Recital features performances of works created by KSU student composers with direction from Composer-in-Residence, Dr. Laurence Sherr.https://digitalcommons.kennesaw.edu/musicprograms/2046/thumbnail.jp

2016 Student Compostition Concert

The School of Music\u27s talented student composers present a concert featuring the students\u27 original composed works performed by a wide variety of ensembles and instrumentation.https://digitalcommons.kennesaw.edu/musicprograms/1032/thumbnail.jp

Delayed Removal of Entrapped Snare in Colonoscopic Polypectomy

Snare entrapment is a rare complication of hot snare polypectomy of large colon polyps. We report a case of snare entrapment in our unit and its management. This report highlights the method of delayed removal of snare followed by repeat colonoscopy

Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases. OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication. METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic. RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy. CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy