How policy informs the evidence.
Ontology highlight
ABSTRACT:
SUBMITTER: Davey Smith G
PROVIDER: S-EPMC1119453 | biostudies-literature | 2001 Jan
REPOSITORIES: biostudies-literature
Publications
How policy informs the evidence.
Davey Smith G G Ebrahim S S Frankel S S
BMJ (Clinical research ed.) 20010101 7280
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Project description:Prior to 1978, the exteriors of Rhode Island's municipal water towers were painted with lead-containing paint. Over time, this lead-containing paint either flaked-off or was mechanically removed and deposited on adjacent residential properties. Residents challenged inconsistencies across state agencies and federal requirements for collecting and analyzing soil samples. The purpose of this case study was to evaluate the efficacy of Rhode Island Department of Health (RIDOH) soil sampling regulations in determining the extent of lead contamination on residential properties using real world data. Researchers interviewed key government personnel, reviewed written accounts of events and regulations, and extracted and compiled lead data from environmental soil sampling on 31 residential properties adjacent to six municipal water towers. Data were available for 498 core samples. Approximately 26% of the residential properties had lead soil concentrations >1000 mg/kg. Overall, lead concentration was inversely related to distance from the water tower. Analysis indicated that surface samples alone were insufficient to classify a property as "lead safe". Potential for misclassification using RIDOH regulations was 13%. For properties deemed initially "lead free", the total number of samples was too few to analyze. Post-remediation lead-soil concentrations suggest the extent of lead contamination may have been deeper than initially determined. Additional data would improve the ability to draw more meaningful and generalized conclusions. Inconsistencies among regulatory agencies responsible for environmental health obfuscate transparency and erode the public's trust in the regulatory process. Recommendations for improvement include congruency across departmental regulations and specific modifications to lead-soil sampling regulations reflective of lowered CDC reference blood lead value for children 1 to 5 years old (5 μg/dL). While scientific research informed the initial development of these environmental health policies and regulations, practice-based evidence did not support their efficacy in context of real world practice.
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Project description:To determine if a variant identified by diagnostic genetic testing is causal for disease, applied genetics professionals evaluate all available evidence to assign a clinical classification. Experimental assay data can provide strong functional evidence for or against pathogenicity in variant classification, but appears to be underutilised. We surveyed genetic diagnostic professionals in Australasia to assess their application of functional evidence in clinical practice. Results indicated that survey respondents are not confident to apply functional evidence, mainly due to uncertainty around practice recommendations. Respondents also identified need for support resources, educational opportunities, and in particular requested expert recommendations and updated practice guidelines to improve translation of experimental data to curation evidence. As an initial step, we have collated a list of functional assays recommended by 19 ClinGen Variant Curation Expert Panels as a source of international expert opinion on functional evidence evaluation. Additional support resources for diagnostic practice are in development.
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Project description:BackgroundAll federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement.ObjectiveWorking with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce.MethodsWe leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results.ResultsThe SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation.ConclusionsWith an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists.International registered report identifier (irrid)PRR1-10.2196/59830.
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Project description:In the era of evidence-based policy, framing and assessing the core evidence is fundamental to our ability to use research in support of public policy. In a world of almost exponentially expanding scholarly publication, it is becoming harder to define what is known. This article reviews the basic theories of knowledge, the context for sorting through and summarizing that knowledge and a number of options available, and used, to assemble the knowledge base for research and policy work. The authors undertook a summative process in the domain of biotechnology, agriculture and development and offer insights into the comparative methods and their impacts on the outcome. A population sample of 421 articles was gathered. Four methods-expert Delphi, citation analysis, social network analysis and peer evaluation-were used to select the 51 pieces for inclusion and analysis in the core literature. That analysis shows that each process delivered a different set of evidence. The potential for bias in knowledge assessment can challenge policy makers in their process of reviewing evidence that rationalizes policy.
| S-EPMC7390849 | biostudies-literature
Project description: Not available
| S-EPMC1626345 | biostudies-literature
Project description:BackgroundPersonal protective equipment (PPE) are stockpiled across the nation to offset supply depletion during public health emergencies. Stockpiled PPE inventories vary across the United States by type, model, quantity, and the conditions in which they are stored. Over the past decade, federal, state, and local stockpile managers have had concerns for the viability of aging PPE.MethodsTo understand factors that may affect stockpiled PPE, we explored the breadth of stockpile storage conditions and respirator and surgical gown inventories through collaboration with the national PPE community, qualitative observations collected at 10 different US stockpiles, and by compiling stockpile PPE inventories and climate data from a convenience sample of US stockpiles.ResultsThe aggregated inventory from 20 stockpiles is reported, accounting for approximately 53 million respirators. Most respirators (69% or 35.8 million) have been stored between 5 and 10 years. Upon visiting 10 stockpile facilities, we report on the storage conditions observed and summarize the storage environment data collected.ConclusionsThis is the first study to identify common PPE types, inventories, and storage conditions across federal, state, and local government stockpile facilities as well as health care organization-managed caches. These findings will be leveraged to guide the development of sampling protocols for air-purifying respirators and surgical gowns in US stockpiles to understand the performance viability after long-term storage.
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Project description:The magnitude and pace of global climate change demand ambitious and effective implementation of nationally determined contributions (NDCs). Nature-based solutions present an efficient approach to achieving mitigation, adaptation and resilience goals. Yet few nations have quantified the diverse benefits of nature-based solutions to evaluate and select ecosystem targets for their NDCs. Here we report on Belize's pursuit of innovative, evidence-based target setting by accounting for multiple benefits of blue carbon strategies. Through quantification of carbon storage and sequestration and optimization of co-benefits, we explore time-bound targets and prioritize locations for mangrove protection and restoration. We find increases in carbon benefits with larger mangrove investments, while fisheries, tourism and coastal risk-reduction co-benefits grow initially and then plateau. We identify locations, currently lacking protected status, where prioritizing blue carbon strategies would provide the greatest delivery of co-benefits to communities. These findings informed Belize's updated NDCs to include an additional 12,000 ha of mangrove protection and 4,000 ha of mangrove restoration, respectively, by 2030. Our study serves as an example for the more than 150 other countries that have the opportunity to enhance greenhouse gas sequestration and climate adaptation by incorporating blue carbon strategies that provide multiple societal benefits into their NDCs.
| S-EPMC10333125 | biostudies-literature
Project description:The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using "circumcision" with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.
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Project description:ObjectivesTo assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data.MethodsAll patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates.ResultsSentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21-35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2-37.7) on sentinel surveillance (33.4%; 95% CI 29.5-37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0-5.7) (1.5%; 95% CI 0.7-3.0 on routine data).ConclusionsRoutine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.
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Project description:Investigators developed a review system to evaluate the growing literature on policy and environmental strategies to prevent childhood obesity. More than 2000 documents published between January 2000 and May 2009 in the scientific and grey literature were identified (2008-2009) and systematically analyzed (2009-2012). These focused on policy or environmental strategies to reduce obesity/overweight, increase physical activity, and/or improve nutrition/diet among youth (aged 3-18 years). Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, investigators abstracted studies of 24 intervention strategies and assessed evidence for their effectiveness (i.e., study design, intervention duration, and outcomes) and population impact (i.e., effectiveness and reach--participation or exposure, and representativeness) in 142 evaluation study groupings and 254 associational study groupings (n=396 groupings of 600 peer-reviewed studies). The 24 strategies yielded 25 classifications (school wellness policies yielded nutrition and physical activity classifications): 1st-tier effective (n=5); 2nd-tier effective (n=6); "promising" (n=5); or "emerging" (n=9). Evidence for intervention effectiveness was reported in 56% of the evaluation, and 77% of the associational, study groupings. Among the evaluation study groupings, only 49% reported sufficient data for population impact ratings, and only 22% qualified for a rating of high population impact. Effectiveness and impact ratings were summarized in graphic evidence maps, displaying effects/associations with behavioral and obesity/overweight outcomes. This paper describes the results and products of the review, with recommendations for policy research and practice.
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