ORCID Profile
0000-0002-3223-7825
Current Organisation
James Cook University
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Publisher: Nova Southeastern University
Date: 2021
DOI: 10.46743/1540-580X/2021.2041
Abstract: Purpose: With COVID-19 social distancing measures requiring a shift in how healthcare is delivered, telehealth service provision allows patients to receive care remotely while adhering to relevant safety regulations. This study investigated the perceptions and experiences of allied health practitioners and their patients at a multidisciplinary allied health clinic that rapidly transitioned to telehealth service delivery. Method: Allied health practitioners (both qualified and student) and patients were recruited during the transition to telehealth across a large healthcare facility located on the Gold Coast, Australia. Participants were surveyed after each telehealth session rating their satisfaction and experience across four areas (technical, administrative and operational, privacy, communication). Descriptive statistics were used to express categorical variables and a chi-square test of independence was applied to determine the presence of any associations. Results: Surveys (n=197) were collected from allied health practitioners (n = 31) and their patients (n = 70). Overall, high levels of satisfaction and experience with telehealth among patients and a consensus in satisfaction and experience among exercise physiology, physiotherapy and psychology practitioners were reported. Speech pathology student practitioners rated their satisfaction and telehealth experience significantly (p 0.001) lower than other disciplines. A significant relationship [χ2 (2, n = 127) = 7.49, p = .02] between student practitioners and the impact of telehealth on achieving session goals and outcomes was also identified. Conclusions: This study highlights complexities related to the acceptability and adoption of telehealth, technical aspects, and user functionality which contribute to the growing body of evidence supporting digital health technologies in the delivery and access to allied health services. In a multidisciplinary context, this study advocates for the consideration of discipline-specific issues when designing and implementing digital health services.
Publisher: Royal Swedish Academy of Sciences
Date: 02-2007
Publisher: MDPI AG
Date: 06-04-2022
Abstract: Gyokuro is a style of Japanese green tea produced by employing agricultural shading in the weeks before harvest. This method results in a tea product with different organoleptic and chemical properties than common Japanese green tea. In an effort to yield the highest quality and commercially valuable green tea product, the present study explores the influence of shading treatments and the duration of shading on the natural biochemistry of the green tea plant. This study applied shading treatments at light intensity conditions of 40%, 16%, 10% and 1% of available ambient light and the application of a red-colored shade cloth of 60% opacity. The Quality Index Tool was used to measure the quality and commercial value of the green tea, using in idual target constituents (theanine, caffeine and the catechins) quantified from HPLC analysis. This study shows that very high levels of total visible spectrum light shading (~99%) is required to achieve improvements in quality and commercial value. Specifically, this improvement is a direct result of changes in the mood- modifying bioactive metabolites theanine and caffeine. This study concludes that in green tea growing regions with more hours of sunlight per year, such as on the Central Coast of Australia, more intense shading will achieve products with improved quality and commercial value, which has more potential to be marketed as a functional ingredient.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.01.005
Abstract: Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few ex les of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n=31), staff (n=8) and peer workers (n=3) and examined the operation of the service in relation to process, outputs and impacts. There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing "feel" of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.
Publisher: MDPI AG
Date: 31-12-2008
Publisher: Royal Society of Chemistry (RSC)
Date: 2008
DOI: 10.1039/B806520A
Abstract: The intrinsic link between ecosystem health and human health has been firmly established in the literature and has given rise to the development of new multidisciplinary fields of research such as medical geology. An important practical implication of the ecosystem health approach is the utility of human disease outbreaks as indicators of underlying ecosystem disruption. The use of such a bioindicator is particularly relevant in developing countries where monitoring of traditional environmental and ecological indicators is not routinely undertaken. Mosquito-borne diseases appear to have good potential as bioindicators in tropical regions because the burden of disease is high, the disease ecology has a strong environmental component and intensive surveillance systems are well established. Evidence is reviewed regarding the utility of mosquito-borne disease to detect a range of ecosystem insults including: hydro-geological disruption in soil-water systems (e.g. secondary soil salinisation and waterlogging) escalating agricultural intensification deforestation and urbanisation. The evidence suggests that overall, mosquito-borne disease is a specific but insensitive indicator, because human modification of natural ecosystems does not always result in increases in disease incidence and can, in some cases, lead to reductions. Nevertheless, mosquito-borne disease remain useful as bioindicators if utilised as a complement to traditional environmental variables in identifying ecological disturbances they can then assist in directing interventions that are concurrently beneficial to both human health and ecosystem health.
Publisher: Oxford University Press (OUP)
Date: 05-05-2010
DOI: 10.1093/IJE/DYQ079
Abstract: The rapid increase in mobile telephone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology. An interview-based case-control study with 2708 glioma and 2409 meningioma cases and matched controls was conducted in 13 countries using a common protocol. A reduced odds ratio (OR) related to ever having been a regular mobile phone user was seen for glioma [OR 0.81 95% confidence interval (CI) 0.70-0.94] and meningioma (OR 0.79 95% CI 0.68-0.91), possibly reflecting participation bias or other methodological limitations. No elevated OR was observed > or =10 years after first phone use (glioma: OR 0.98 95% CI 0.76-1.26 meningioma: OR 0.83 95% CI 0.61-1.14). ORs were or =1640 h, the OR was 1.40 (95% CI 1.03-1.89) for glioma, and 1.15 (95% CI 0.81-1.62) for meningioma but there are implausible values of reported use in this group. ORs for glioma tended to be greater in the temporal lobe than in other lobes of the brain, but the CIs around the lobe-specific estimates were wide. ORs for glioma tended to be greater in subjects who reported usual phone use on the same side of the head as their tumour than on the opposite side. Overall, no increase in risk of glioma or meningioma was observed with use of mobile phones. There were suggestions of an increased risk of glioma at the highest exposure levels, but biases and error prevent a causal interpretation. The possible effects of long-term heavy use of mobile phones require further investigation.
Publisher: Environmental Health Perspectives
Date: 09-2008
DOI: 10.1289/EHP.10980
Publisher: Cambridge University Press (CUP)
Date: 26-10-2022
DOI: 10.1017/BEC.2022.23
Abstract: Young mothers are more likely to access healthcare for their children in emergent care settings and less likely to use preventive care. This study examines the healthcare-seeking behaviours of young mothers to inform the design of tailored interventions. Semi-structured interviews with nine young mothers (aged ≤ 25 years) who were attending a supported playgroup in Brisbane, Australia were conducted and explored using the Capability, Opportunity and Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Five behavioural themes were identified (navigating the system, complex referral pathways, delays and long wait times, understanding child development, and connecting to services) and the role of the supported playgroup in shaping young mothers’ understanding of child development and connecting them to services was highlighted. Recommended strategies to address these factors include opportunities for young mothers to learn about child developmental milestones, improving young mothers’ health literacy, increasing young mothers’ skills and/or the availability of support to help them navigate health services, and providing more accessible entry points for child assessments, referrals, or early intervention programs.
Publisher: IWA Publishing
Date: 12-2007
DOI: 10.2166/WST.2007.831
Abstract: Indirect potable reuse schemes are an important consideration in the sustainable management of scarce water resources. However, communities still hold real concerns about the potential health risks of micropullutants in recycled water entering their potable water supply. Microfiltration or ultrafiltration followed by reverse osmosis is currently the standard treatment technology for potable use of recycled water. Nevertheless, membranes are not 100% efficient in the removal of trace organic contaminants and the potential health risks of these micropullutants need to be assessed. The aim of this paper is to present a three-tiered approach for the preliminary assessment of micropullutants in recycled water. A risk quotient is calculated by comparing measured concentrations against benchmark values. Tier 1 corresponds to regulated chemicals the maximum contaminant level in drinking water is used as benchmark value. Tier 2 corresponds to unregulated chemicals with toxicity information slope factors or risk specific doses are used to calculate benchmark values. Tier 3 corresponds to unregulated chemicals without toxicity information. The “Threshold of Toxicological Concern” concept is used to calculate benchmark values. The characterization of chemicals of concern following reverse osmosis in a water reclamation plant and the application of the three-tiered approach for the evaluation of the potential health risks is presented.
Publisher: Wiley
Date: 25-11-2015
DOI: 10.1111/ADD.13197
Abstract: To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48 weeks (genotype 1, G1). Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia. Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female). Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24 weeks post-treatment). Among 101 treated, 37% (n = 37) had recently injected drugs (past 6 months) and 62% (n = 63) were receiving OST. Adherence ≥ 80% was 86% (n = 87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age < 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval (CI) = 1.47, 17.40] and on-treatment adherence ≥ 80% independently predicted SVR (aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.
Publisher: Informa UK Limited
Date: 02-01-2020
Publisher: Wiley
Date: 12-2022
DOI: 10.1002/EMP2.12852
Abstract: Priority areas for emergency care research are emerging and becoming ever more important. The objectives of this scoping review were to (1) provide a comprehensive overview of published emergency care priority‐setting studies by collating and comparing priority‐setting methodology and (2) describe the resulting research priorities identified. The Joanna Briggs Institute methodological framework was used. Inclusion criteria were peer‐review articles available in English, published between January 1, 2008 and March 31, 2019 and used 2 or more search terms. Five databases (Scopus, AustHealth, EMBASE, CINAHL, and Ovid MEDLINE) were searched. REporting guideline for PRIority SEtting of health research (REPRISE) criteria were used to assess the quality of evidence of included articles. Forty‐five studies were included. Fourteen themes for emergency care research were considered within 3 overarching research domains: emergency populations (pediatrics, geriatrics), emergency care workforce and processes (nursing, shared decision making, general workforce, and process), and emergency care clinical areas (imaging, falls, pain management, trauma care, substance misuse, infectious diseases, mental health, cardiology, general clinical care). Variation in the reporting of research priority areas was evident. Priority areas to drive the global agenda for emergency care research are limited given the country and professional group‐specific context of existing studies. This comprehensive summary of generated research priorities across emergency care provides insight into current and future research agendas. With the nature of emergency care being inherently broad, future priorities may warrant population (eg, children, geriatrics) or subspecialty (eg, trauma, toxicology, mental health) focus and be derived using a rigorous framework and patient engagement.
Publisher: Royal Society of Chemistry (RSC)
Date: 2008
DOI: 10.1039/B713256P
Publisher: SAGE Publications
Date: 14-10-2023
Publisher: Springer Science and Business Media LLC
Date: 24-09-2007
Abstract: Red wine contains a naturally rich source of antioxidants, which may protect the body from oxidative stress, a determinant of age-related disease. The current study set out to determine the in vivo effects of moderate red wine consumption on antioxidant status and oxidative stress in the circulation. 20 young (18–30 yrs) and 20 older (≥ 50 yrs) volunteers were recruited. Each age group was randomly ided into treatment subjects who consumed 400 mL/day of red wine for two weeks, or control subjects who abstained from alcohol for two weeks, after which they crossed over into the other group. Blood s les were collected before and after red wine consumption and were used for analysis of whole blood glutathione (GSH), plasma malondialdehyde (MDA) and serum total antioxidant status. Results from this study show consumption of red wine induced significant increases in plasma total antioxidant status (P 0.03), and significant decreases in plasma MDA (P 0.001) and GSH (P 0.004) in young and old subjects. The results show that the consumption of 400 mL/day of red wine for two weeks, significantly increases antioxidant status and decreases oxidative stress in the circulation It may be implied from this data that red wine provides general oxidative protection and to lipid systems in circulation via the increase in antioxidant status.
Publisher: Coventry University, Lanchester Library
Date: 13-10-2022
DOI: 10.18552/IJPBLHSC.V10I1.735
Abstract: Speech Pathology programs usually send students to workplaces to learn clinical skills necessary for practice. During COVID-19, programs needed to respond quickly to ensure that students continued to gain the necessary experiences and skills required to progress through their program and graduate as clinicians, while simultaneously complying with COVID-19 requirements. Case studies from seven different universities in Australia, Ghana and Hong Kong described the erse ways in which placements were adapted to be COVID-safe, taking into account local needs. Some practices which had been included in placement education prior to the pandemic, such as telepractice and simulation-based learning, were extended and developed during this time. Educators, students, clinicians and clients responded to the rapidly changing needs of the time with flexibility and innovation, utilising a variety of technologies and tools to support case-based and virtual learning opportunities. Feedback from these erse stakeholders about the experiences was positive, despite inevitable limitations and less-than-ideal circumstances. The positive findings provided insights for consideration in the future: could strategies implemented in response to the pandemic continue to be incorporated into placement experiences, enhancing current practices and maintaining student performance outcomes? Exceptional circumstances prompted exceptional responses flexibility and innovation were accelerated in response to the pandemic and may transform future placement-based learning opportunities.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.JFLUDIS.2021.105843
Abstract: This systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence. Nine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2-18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies. Eight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program LP) and indirect treatments (e.g. Demands and Capacities Model DCM). All studies had moderate risk of bias. Treatment delivery methods included in idual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as in idual face-to-face intervention. The findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.
Publisher: Elsevier BV
Date: 15-12-2008
DOI: 10.1016/J.SCITOTENV.2008.09.007
Abstract: Air quality is commonly assessed by the ambient concentration of airborne particles sized smaller than 10 microm (PM10). However, in addition to concentration, particle shape as well as the type and bioaccessibility of elements adsorbed to this particulate fraction are likely to be related to subsequent respiratory health effects. In order to investigate this relationship, a relatively large mass of the relevant size fraction is needed since s le preparation is necessary prior to analysis. Most existing methods for s ling dust have been developed for analysing the dust directly, without prior handling or digestion. In order to provide sufficient material to be used for subsequent bioaccessibility analysis, these methods require repetitive and time consuming s ling as well as special equipment and procedures which are high in both cost and maintenance. This paper describes an inexpensive and relatively simple procedure for extracting the PM10 fraction from soil to be used for lung bioaccessibility studies. The method described involves dry and wet sieving in order to exclude larger size fractions as far as possible. Vacuum filtering of the wet-sieved soil solution through a 10 microm mesh was then employed to extract the required fraction. In order to avoid frequent blocking of the mesh, Stokes's law was applied in the construction of a tube which enables separation of the solution holding the smallest fraction.
Publisher: Oxford University Press (OUP)
Date: 11-2008
DOI: 10.1603/0022-2585(2008)45[1011:IODSOP]2.0.CO;2
Abstract: Clearing of native vegetation for agriculture since European settlement has left 1.047 million ha of southwestern Australia affected by a severe form of environmental degradation called dryland salinity, characterized by secondary soil salinization and waterlogging. This area may expand by a further 1.7-3.4 million ha if current trends continue. Detailed investigations of seasonal of adult and larval mosquito population dynamics were undertaken in the region to test the hypothesis that the development of dryland salinity and waterlogging in inland southwestern Australia has led to a succession of mosquito species and increased Ross River virus (family Togaviridae, genus Alphavirus, RRV) transmission risk. Aedes (Ochlerotatus) c torhynchus (Thomson) made up >90% of adult mosquito collections in saline regions. Nonmetric multidimensional scaling and generalized estimating equations modeling demonstrated that it was strongly associated with increasing severity of dryland salinity. This article describes the first detailed investigation of the mosquito fauna of inland southwestern Australia, and it is the first description of the influence of secondary soil salinity on mosquito population dynamics. Despite the dominant presence of Ae. c torhynchus, RRV disease incidence is not currently a significant population health priority in areas affected by dryland salinity. Potential limiting factors include local climatic impacts on the seasonal mosquito population dynamics, vertebrate host distribution and feeding behavior of Ae. c torhynchus, and the scarce and uneven distribution of the human population in the region.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1097/ADM.0000000000000261
Abstract: The aims of this study were to assess symptoms of depression, anxiety, and stress and associated sociodemographic factors among people living with chronic hepatitis C virus (HCV) infection with a history of injecting drug use and to assess the association between symptoms of depression, anxiety, or stress and HCV treatment intent, specialist assessment, or treatment uptake. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings was an observational cohort study evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from 9 community health centers and opioid substitution therapy (OST) clinics (New South Wales, Australia). Symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21). Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 47%, 52%, and 36% demonstrated moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In adjusted analyses, depression symptoms were associated with recent injecting drug use [adjusted odds ratio (aOR) 1.63, 95% confidence interval (CI) 1.07–2.49), whereas stress symptoms were associated with unemployment (aOR 2.99, 95% CI 1.09–8.15) and not living with a spouse or other relatives/friends (aOR 1.55, 95% CI 1.01–2.39). Symptoms of depression, anxiety, or stress or having a history of treated mental illness were not independently associated with HCV treatment intent, specialist assessment, or treatment uptake. Findings suggest a need for improved interventions and care regarding mental health among people living with chronic HCV with a history of injecting drug use, but suggest that symptoms of depression, anxiety, and stress should not be immediate contraindications to HCV assessment and treatment.
Publisher: Public Library of Science (PLoS)
Date: 24-12-2008
Publisher: S. Karger AG
Date: 22-05-2010
DOI: 10.1159/000315142
Abstract: i Background: /i Some in iduals with moderate/severe persistent asthma develop irreversible airway obstruction. These in iduals present with dyspnoea, exercise intolerance and impaired quality of life (QOL), all of which could potentially be alleviated with exercise training. i Objective: /i To investigate whether exercise training improves functional exercise capacity and QOL in middle-aged and older adults with fixed airway obstruction asthma (FAOA). i Methods: /i 35 subjects aged 67.8 ± 10.6 years, with FEV sub /sub 59 ± 16% of predicted, were randomised to a 6-week ‘intervention’ period of supervised exercise training (n = 20) or usual care (n = 15). This period was preceded by a 3-week run-in period during which asthma control was assessed weekly. Functional exercise capacity (6-min walk distance, 6MWD) and QOL (Asthma QOL Questionnaire, AQLQ) were measured before, immediately following and 3 months after the intervention period. i Results: /i 34 subjects (exercise group, n = 19, and control group, n = 15) completed the intervention period. Relative to the control group, the exercise group had greater improvements immediately following and 3 months after the intervention in the AQLQ symptom domain (0.61, p = 0.001, and 0.57 points per item, p = 0.005) and AQLQ activity limitation domain (0.43, p = 0.04, and 0.55 points per item, p = 0.04). 6MWD increased (36 ± 37 m, p 0.01) in the exercise group immediately following training and remained elevated (34 ± 45 m, p 0.01) at the 3-month follow-up. The magnitude of change in 6MWD between groups was not significant, despite no change in the control group. i Conclusions: /i Supervised exercise training improves symptoms and QOL in adults with FAOA.
Publisher: SAGE Publications
Date: 11-03-2020
Abstract: Building or acquiring research data management (RDM) capacity is a major challenge for health and medical researchers and academic institutes alike. Considering that RDM practices influence the integrity and longevity of data, targeting RDM services and support in recognition of needs is especially valuable in health and medical research. This project sought to examine the current RDM practices of health and medical researchers from an academic institution in Australia. A cross-sectional survey was used to collect information from a convenience s le of 81 members of a research institute (68 academic staff and 13 postgraduate students). A survey was constructed to assess selected data management tasks associated with the earlier stages of the research data life cycle. Our study indicates that RDM tasks associated with creating, processing and analysis of data vary greatly among researchers and are likely influenced by their level of research experience and RDM practices within their immediate teams. Evaluating the data management practices of health and medical researchers, contextualised by tasks associated with the research data life cycle, is an effective way of shaping RDM services and support in this group. This study recognises that institutional strategies targeted at tasks associated with the creation, processing and analysis of data will strengthen researcher capacity, instil good research practice and, over time, improve health informatics and research data quality.
Publisher: Elsevier BV
Date: 12-2023
Publisher: Springer Science and Business Media LLC
Date: 20-02-2008
DOI: 10.1007/S10393-007-0151-Z
Abstract: Land use change has the potential to cause severe ecosystem degradation and drive changes in disease transmission and emergence. Broadscale clearing of native vegetation for agriculture in southwestern Australia has resulted in severe ecosystem degradation, which has been compounded by the subsequent development of large areas of dryland salinity. The mosquito-borne disease, Ross River virus (RRV), has been noted as a potential adverse human health outcome in these salinity affected regions. The association between dryland salinity and RRV disease was therefore tested by undertaking a spatial analysis of disease notification records using standard and Bayesian techniques. To overcome inherent limitations with notification data, serological RRV antibody prevalence was also investigated. Neither method revealed a significant association with dryland salinity, however, the spatial scale imposed limited the sensitivity of both studies. Thus, further multidisciplinary studies are required to overcome these limitations and advance understanding of this ecosystem health issue, particularly using variables that can be investigated on a finer scale.
Publisher: Elsevier BV
Date: 08-2010
Publisher: Oxford University Press (OUP)
Date: 15-08-2013
DOI: 10.1093/CID/CIT305
Abstract: Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection. Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia. Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40 95% CI, 2.27-8.54), no recent meth hetamine use (AOR, 2.26 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07 95% CI, 1.67-5.64). HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2018
Publisher: Wiley
Date: 21-05-2015
DOI: 10.1111/JVH.12415
Abstract: Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing.
Publisher: Cambridge University Press
Date: 31-07-2022
Publisher: Wiley
Date: 06-12-2020
DOI: 10.1111/JVH.13233
Abstract: Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood s les for dried blood spot, Xpert HCV Viral Load and venepuncture s les. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19 95% CI, 1.61-6.32) or physician (aOR, 11.83 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.DRUGPO.2015.06.001
Abstract: The objective was to assess social functioning and its association with treatment intent, specialist assessment and treatment uptake for hepatitis C virus (HCV) infection among people with a history of injecting drug use. ETHOS is a prospective observational cohort evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from nine community health centres and opioid substitution treatment clinics (NSW, Australia). Social functioning was assessed using a short form of the Opioid Treatment Index social functioning scale. Those classified in the highest quartile (score >6) were considered having lower social functioning. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 24% were considered having lower social functioning, 70% had early HCV treatment intent (intention to be treated in the next 12 months), 53% were assessed by a specialist and 27% initiated treatment. Lower social functioning was independently associated with unemployment, unstable housing, recent injecting drug use and moderate to extremely severe symptoms of depression, anxiety and stress. Lower social functioning was independently associated with reduced early HCV treatment intent (aOR 0.51, 95% CI 0.30-0.84) and lower specialist assessment (aOR 0.48, 95% CI 0.29-0.79), but not HCV treatment uptake (aOR 0.76, 95% CI 0.40-1.43). Living with someone was independently associated with HCV treatment uptake (with someone and children: aOR 2.28, 95% CI 1.01-5.14 with someone and no children: aOR 2.36, 95% CI 1.30-4.31), but not early HCV treatment intent or specialist assessment. This study highlights the need for the development and implementation of strategies targeting people who inject drugs with lower social functioning to enhance HCV treatment intent and specialist assessment. Further, strategies to enhance social support may play a role in increasing HCV treatment uptake.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2008
Publisher: Cambridge University Press (CUP)
Date: 19-05-2009
DOI: 10.1017/S0007114509382173
Abstract: The objective of the present study was to investigate the relationship between plasma n -3 PUFA composition and weight status. A total of 124 adults, stratified by weight status: healthy weight ( n 21), overweight ( n 40) and obese ( n 63) were recruited. Fasting blood s les, anthropometric measures and body composition were collected. Plasma fatty acid composition was determined by GC. BMI, waist circumference and hip circumference were inversely correlated with n -3 PUFA, EPA and DHA ( P 0·05 for all) in the obese group. Obese in iduals had significantly lower plasma concentrations of total n -3 PUFA, compared with healthy-weight in iduals (4·53 ( sd 1·11) v. 5·25 ( sd 1·43) %). When subjects were pooled and stratified into quartiles of total n -3 PUFA, a significant inverse trend was found for BMI ( P = 0·002), waist circumference and hip circumference ( P = 0·01 and P 0·001 respectively). Higher plasma levels of total n -3 PUFA are associated with a healthier BMI, waist circumference and hip circumference. Our findings suggest that n -3 PUFA may play an important role in weight status and abdominal adiposity.
Publisher: Springer Science and Business Media LLC
Date: 2005
Publisher: Environmental Health Perspectives
Date: 08-2004
DOI: 10.1289/EHP.7122
Abstract: Human health often depends on environmental variables and is generally subject to widespread and comprehensive surveillance. Compared with other available measures of ecosystem health, human disease incidence may be one of the most useful and practical bioindicators for the often elusive gauge of ecologic well-being. We argue that many subtle ecosystem disruptions are often identified only as a result of detailed epidemiologic investigations after an anomalous increase in human disease incidence detected by routine surveillance mechanisms. Incidence rates for vector-mediated diseases (e.g., arboviral illnesses) and direct zoonoses (e.g., hantaviruses) are particularly appropriate as bioindicators to identify underlying ecosystem disturbances. Outbreak data not only have the potential to act as a pivotal warning system for ecosystem disruption, but may also be used to identify interventions for the preservation of ecologic health. With this approach, appropriate ecologically based strategies for remediation can be introduced at an earlier stage than would be possible based solely on environmental monitoring, thereby reducing the level of "ecosystem distress" as well as resultant disease burden in humans. This concept is discussed using local, regional, and global ex les, thereby introducing the concept of multilevel ecosystem interventions. Key words: bioindicators, disease control, disease outbreaks, ecologic management, ecosystem health, surveillance.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.JNUTBIO.2009.06.009
Abstract: Phytosterols and omega-3 fatty acids are natural compounds with potential cardiovascular benefits. Phytosterols inhibit cholesterol absorption, thereby reducing total- and LDL cholesterol. A number of clinical trials have established that the consumption of 1.5-2.0 g/day of phytosterols can result in a 10-15% reduction in LDL cholesterol in as short as a 3-week period in hyperlipidemic populations. Added benefits of phytosterol consumption have been demonstrated in people who are already on lipid-lowering medications (statin drugs). On the other hand, omega-3 fatty acid supplementation has been associated with significant hypotriglyceridemic effects with concurrent modifications of other risk factors associated with cardiovascular disease, including platelet function and pro-inflammatory mediators. Recent studies have provided evidence that the combination of phytosterols and omega-3 fatty acids may reduce cardiovascular risk in a complementary and synergistic way. This article reviews the health benefits of phytosterols and omega-3 fatty acids, alone or in combination with statins, for the treatment/management of hyperlipidemia, with particular emphasis on the mechanisms involved.
Publisher: SAGE Publications
Date: 05-05-2023
Abstract: Data sharing presents new opportunities across the spectrum of research and is vital for science that is open, where data are easily discoverable, accessible, intelligible, reproducible, replicable and verifiable. Despite this, it is yet to become common practice. Global efforts to develop practical guidance for data sharing and open access initiatives are underway, however evidence-based studies to inform the development and implementation of effective strategies are lacking. This study sought to determine the barriers and facilitators to data sharing among health researchers and to identify the target behaviours for designing a behaviour change intervention strategy. Data were drawn from a cross-sectional survey of data management practices among health researchers from one Australian research institute. Determinants of behaviour were theoretically derived using well-established behavioural models. Data sharing practices have been described for 77 researchers, and 6 barriers and 4 facilitators identified. The primary barriers to data sharing included perceived negative consequences and lack of competency to share data. The primary facilitators to data sharing included trust in others using the data and social influence related to public benefit. Intervention functions likely to be most effective at changing target behaviours were also identified. Results of this study provide a theoretical and evidence-based process to understand the behavioural barriers and facilitators of data sharing among health researchers. Designing interventions that specifically address target behaviours to promote data sharing are important for open researcher practices.
Publisher: Oxford University Press (OUP)
Date: 09-2008
DOI: 10.1641/B580812
Publisher: Oxford University Press (OUP)
Date: 02-07-2008
DOI: 10.1093/AJE/KWN188
Abstract: The causes of term pre labor rupture of membranes (term PROM) remain poorly defined. The authors conducted a record-based prevalence study to explore a possible relation between disinfection by-products in drinking water and term PROM in an Australian community with spatially variable trihalomethane and nitrate levels. A multilevel statistical model was used to examine the relation between factors operating at the levels of the in idual, district, and water distribution zone and the prevalence of PROM at term among 16,229 women in Perth, Western Australia (2002-2004). Adjusted odds ratios for term PROM increased with increasing tertiles of nitrate exposure (moderate exposure: odds ratio = 1.23, 95% confidence interval: 1.03, 1.52 high exposure: odds ratio = 1.47, 95% confidence interval: 1.20, 1.79), but there was no significant relation with exposure to trihalomethanes. This study raises the possibility that water contaminants may promote the development of PROM at term.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.ATHEROSCLEROSIS.2008.09.020
Abstract: Risk factors of cardiovascular disease such as lipid aberrations, hypertension, abdominal adiposity and elevations in systemic inflammation, are prominent aetiologies in hyperlipidemia. Supplementation with n-3 PUFA is associated with a reduction in cardiovascular events through its hypotriglyceridemic, anti-aggregatory and anti-inflammatory properties. Plant sterols have potent hypocholesterolemic properties, although their effect on the inflammatory cascade is uncertain. This study investigated the effect of combined supplementation with n-3 PUFA and plant sterols on cardiovascular risk factors, blood pressure, body composition, markers of systemic inflammation and overall risk, in hyperlipidemic in iduals. The study was a 3-week randomised, double-blind, placebo-controlled, 2 x 2 factorial design, in four parallel groups. Sixty hyperlipidemic participants were randomised to receive either sunola oil or 1.4 g/d n-3 PUFA capsules with or without 2g plant sterols per day. The combination of n-3 PUFA and plant sterols reduced several inflammatory markers. High sensitivity C-reactive protein (hs-CRP) was reduced by 39% (P=0.009), tumor necrosis factor-alpha (TNF-alpha) by 10% (P=0.02), interleukin-6 (IL-6) by 10.7% (P=0.009), leukotriene B(4) (LTB(4)) by 29.5% (P=0.01) and adiponectin was increased by 29.5% (P=0.05). Overall cardiovascular risk was reduced by 22.6% (P=0.006) in the combination group. We have demonstrated, for the first time that dietary intervention with n-3 PUFA and plant sterols reduces systemic inflammation in hyperlipidemic in iduals. Furthermore, our results suggest that reducing inflammation provides a potential mechanism by which the combination of n-3 PUFA and plant sterols are cardioprotective.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.07.002
Abstract: The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion c aign. The LiveRLife c aign involved three phases: (1) c aign resource development (2) c aign resource testing and (3) c aign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey. Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood s le. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa). Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JBI.2019.103222
Abstract: Personal health information is a valuable resource to the advancement of research. In order to achieve a comprehensive reform of data infrastructure in Australia, both public engagement and building social trust is vital. In light of this, we conducted a study to explore the opinions, perceived risks and trustworthiness regarding the use of personal health information for research, in a s le of the public attending a tertiary healthcare facility. The Consumer Opinions of Research Data Sharing (CORDS) study was a questionnaire-based design with 249 participants who were attending a public tertiary healthcare facility located on the Gold Coast, Australia. The questionnaire was designed to explore opinions and evaluate trust and perceived risk in research that uses personal health information. Concept analysis was used to identify key dimensions of perceived risk. Overall participants were supportive of research, highly likely to participate and mostly willing to share their personal health information. However, where the perceived risk of data misuse was high and trust in others was low, participants expressed hesitation to share particular types of information. Performance, physical and privacy risks were identified as key dimensions of perceived risk. This study highlights that while participant views on the use of personal health information in research is mostly positive, where there is perceived risk in an environment of low trust, support for research decreases. The three key findings of this research are that willingness to share data is contingent upon: (i) data type (ii) risk perception and (iii) trust in who is accessing the data. Understanding which factors play a key role in a person's decision to share their personal health information for research is vital to securing a social license.
Publisher: Informa UK Limited
Date: 28-02-2021
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.07.006
Abstract: Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high however HCV treatment uptake remains low. New models of care are needed to address the growing burden of HCV-related disease in PWID and to understand the barriers to assessment and treatment of HCV. This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment (OST) clinic with an integrated peer support worker model. Clients with a history of IDU and chronic HCV infection, attending the Newcastle Pharmacotherapy Service, Newcastle Australia, were recruited as part of a multisite prospective observational study (the ETHOS Cohort). Additional chart review was conducted for clients not enrolled in the ETHOS Cohort. A peer support worker was introduced to complement and extend services offered by the clinical team. Client contacts and assessments with a nurse and/or peer worker were evaluated, including those who commenced HCV treatment. A total of 1447 clients attended the OST service during February 2009 and June 2014. Of these, 378 (26%) were assessed by a nurse and 242 (17%) by a clinician. HCV treatment was commenced by 20 (5%) participants and 15 (75%) achieved a sustained virological response (SVR). During May 2009 and July 2011, 332 nurse contacts and 726 peer worker contacts were evaluated. The nurse-led contacts were related to HCV treatment (50%) and review of pathology tests (34%), whereas peer worker contacts included discussion about HCV treatment (75%), education, counselling and/or support (53%) and general discussion about HCV infection (59%). These data demonstrate that peer support workers facilitate broader discussion about HCV treatment, education and/or support, allowing nurses to focus on HCV-related assessment and treatment. HCV treatment uptake was very low in this cohort, but SVR was high. The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care, but further studies are needed to assess their impact on assessment and treatment outcomes.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.DRUGPO.2014.01.011
Abstract: Given the increasing burden of hepatitis C (HCV) related liver disease, innovative health care models are required to extend the reach of HCV care and treatment. Opioid substitution treatment (OST) clinics are places of high HCV prevalence. The OST clinic is a complex environment, quite distinct to other health care settings, with punitive regulations and practices, and a client population likely to be mistrustful of systems of authority. Nonetheless, trust is widely documented as essential to effective therapeutic encounters. This paper examines what is required to develop a trustworthy service in a place, the OST clinic, described by some critics as a site of "social control". In-depth interviews were conducted with 57 clients and 19 staff from four NSW pilot clinics participating in the Australian ETHOS study. Interview data were examined using Hall's framework of trust, involving five principle domains: fidelity, competence, honest, confidentiality and global trust. 'Honesty' was found to be key to participants' establishing trust in the co-located service and its staff. However, the clinic site was also found to be a place of rationed trust, in which the themes of OST as "ruling peoples' lives" and the fear of repercussions resulting from perceived transgressions against clinic rules, threatened to over-ride or undermine the development of trust in HCV services. Client participants described trusting health workers "to a point". They expressed concerns about the fidelity of co-located HCV and OST services and described fears of "institutionalised lies" and breaches of confidentiality. Anxieties around the latter revealed a sense of "us and them" held by some clients, one in which health workers were perceived to "stick together" by putting their own interests before those of the clients. Although the co-location of HCV and opioid treatments makes intuitive policy sense, HCV health workers in the OST space may be seen as representatives of a deeply mistrusted system. For the effective development of a trustworthy HCV care service, policy and practice activities are required to engender trust through clearly articulated explanations of service boundaries and the promotion of "success stories" through trusted peer networks.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2009
DOI: 10.1038/EJCN.2009.20
Abstract: High sensitivity C-reactive protein (hs-CRP) is a marker of low-grade sustained inflammation. Omega-3 (n-3) fatty acids have anti-inflammatory properties and are associated with reduced cardiovascular disease (CVD) risk. The aim of this study was to investigate whether plasma n-3 fatty acid concentration is related to hs-CRP concentration. A total of 124 free-living adults, were ided into tertiles of plasma hs-CRP ( 3.0 mg/l). Body composition and anthropometric measurements were recorded. Hs-CRP was analysed using immunoassays and fatty acids were measured by gas chromatography. Plasma hs-CRP concentration was negatively correlated with total n-3 fatty acids (P=0.05), eicosapentaenoic acid (EPA P=0.002) and docosapentaenoic acid (DPA P=0.01). The highest hs-CRP tertile (>3.0 mg/l) had significantly lower concentrations of total n-3 fatty acids, EPA and DPA, when compared with the other tertiles (P<0.05). This study provides evidence that in healthy in iduals, plasma n-3 fatty acid concentration is inversely related to hs-CRP concentration, a surrogate marker of CVD risk.
Publisher: MDPI AG
Date: 20-05-2021
Abstract: The increases in consumer awareness of the potential health benefits of green tea have driven global demand for green tea products. This study investigated the effect of post-harvest processing and storage of Japanese-styled green tea (Camellia sinensis var. sinensis) grown in NSW, Australia. Harvested material underwent a processing delay of 6, 12, 18 or 24 h at temperatures of 0, 5 and 25 °C. Targeted green tea constituents: theanine, caffeine and catechins were determined using HPLC with UV detection. Product quality and commercial value were determined using the Quality Index (QI) Tool. Reductions in constituent levels were evident within all storage delays, with nominal quality preservation achieved by reducing the temperature. The green tea material stored at 25 °C for 24 h created the most commercially valued product, despite it having visual characteristics more akin to a semi-fermented tea. These visual characteristics are traditionally considered markers of green tea damage and are discarded however, QI-Tool scoring suggests that this raw material presents as a commercially favourable source of food loss and waste (FLW). The findings of this study extend our understanding of post-harvest processing delays and storage on green tea quality and suggest the viability of a commercially valuable semi-fermented produced from FLW.
Publisher: Elsevier BV
Date: 06-2020
Publisher: MDPI AG
Date: 17-03-2009
Publisher: Oxford University Press (OUP)
Date: 05-02-2021
Abstract: Compared to national averages, the Gold Coast, Australia, has a proportionately higher number of children entering their first year of primary school with ‘at risk’ or ‘vulnerable’ language skills. This paper investigates the distribution of paediatric speech-language pathology (SLP) services on the Gold Coast, relative to children’s language and cognitive skills, and socioeconomic status (SES). SLP service locations were identified through national association data and a manual search and mapped against SES and Australian Early Development Census data, for language and cognitive skills. Data for 7595 children was included, with 943 (12.4%) at risk and 780 (12.6%) vulnerable for language and cognitive skills. A total of 75 SLPs were identified (85.3% private, 14.6% public), which is 1 SLP to every 23 children who might have current or impending speech, language and communication needs. Fewer services were available in areas where vulnerable children were located and most were private providers, leading to further potential barriers to service access. The number of SLP services located on the Gold Coast is inadequate to meet the needs of children with language and cognitive skill vulnerabilities. Consideration of how services might be distributed is explored and warrants further consideration.
Publisher: Wiley
Date: 12-2009
DOI: 10.1111/J.1539-6924.2009.01301.X
Abstract: Estimating potential health risks associated with recycled (reused) water is highly complex given the multiple factors affecting water quality. We take a conceptual model, which represents the factors and pathways by which recycled water may pose a risk of contracting gastroenteritis, convert the conceptual model to a Bayesian net, and quantify the model using one expert's opinion. This allows us to make various predictions as to the risks posed under various scenarios. Bayesian nets provide an additional way of modeling the determinants of recycled water quality and elucidating their relative influence on a given disease outcome. The important contribution to Bayesian net methodology is that all model predictions, whether risk or relative risk estimates, are expressed as credible intervals.
No related grants have been discovered for Michelle Krahe.