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

An analysis of fragmented land-use *policy and land-use change: The case study of metropolitan Pittsburgh

This research examines the relationship between remotely sensed land-use changes and particular land-use policies within metropolitan Pittsburgh, Pennsylvania from 1992 to 2002. During the 1990\u27s the Pittsburgh region experienced a tremendous expansion of residential and urban land-use change while simultaneously experiencing a population decline. Within the metropolitan Pittsburgh area there are 525 local and independent municipal governments with the legislative right to enact or not to enact land-use planning policies enabled by the Pennsylvania Municipal Planning Code. This fragmentation creates uneven intra-urban development patterns at the urban scale. This research demonstrates that certain land-use changes that occurred during the study period share statistical relationships with certain land-use policies in the study area. The procedure to identify these relationships was twofold. First, a change detection analysis (CDA) of remotely sensed images of Pittsburgh acquired by Landsat satellites in October of 1992 and 2002 was conducted in order to determine the quantitative and spatial extent of land-use change within each municipality in the study area. The second step involved a logistic regression model used to determine the likelihood of the presence or absence of individual planning tools for each type of land-use change. The four planning tools examined in this research were, (1) a comprehensive plan, (2) zoning ordinance, (3) subdivision regulation, and (4) a planning commission. Results of this analysis are reported in terms of the global coefficients and the local characterization of some individual municipalities

Effects of Crowding and Wave Exposure on Penis Morphology of the Acorn Barnacle, Semibalanus balanoides

Wave action and low population density can strongly reduce the ability of sessile acorn barnacles to find mates and copulate. For Semibalanus balanoides, penis morphology varies with wave exposure and with characteristics of the mating neighborhood. Field experiments were conducted at five intertidal sites on Long Island, New York, USA from July to December 2005 to determine how wave exposure and aggregation structure influence the length, diameter, mass, and number of annulated folds of the penis. Sparsely crowded barnacles had more annulations in the penis and are inferred to have greater ability to stretch. At higher wave exposure, the diameter of the penis was greater, but the mass was not. This study identifies density of crowding as the most important cue that barnacles respond to when perceiving their mating group and details how penis morphology varies in response to wave exposure

Evolution of transport properties of BaFe2-xRuxAs2 in a wide range of isovalent Ru substitution

The effects of isovalent Ru substitution at the Fe sites of BaFe2-xRuxAs2 are investigated by measuring resistivity and Hall coefficient on high-quality single crystals in a wide range of doping (0 < x < 1.4). Ru substitution weakens the antiferromagnetic (AFM) order, inducing superconductivity for relatively high doping level of 0.4 < x < 0.9. Near the AFM phase boundary, the transport properties show non-Fermi-liquid-like behaviors with a linear-temperature dependence of resistivity and a strong temperature dependence of Hall coefficient with a sign change. Upon higher doping, however, both of them recover conventional Fermi-liquid behaviors. Strong doping dependence of Hall coefficient together with a small magnetoresistance suggest that the anomalous transport properties can be explained in terms of anisotropic charge carrier scattering due to interband AFM fluctuations rather than a conventional multi-band scenario.Comment: 7 pages, 6 figures, submitted to Phys. Rev.