Governing Water Quality Limits In Agricultural Watersheds

The diffuse runoff of agricultural nutrients, also called agricultural nonpoint source pollution (NPS), is a widespread threat to freshwater resources. Despite decades of research into the processes of eutrophication and agricultural nutrient management, social, economic, and political barriers have slowed progress towards improving water quality. A critical challenge to managing agricultural NPS pollution is motivating landowners to act against their individual farm production incentives in response to distant ecological impacts. The complexity of governing the social-ecological system requires improved understanding of how policy shapes farmer behavior to improve the state of water quality. This dissertation contributes both theoretically and empirically to NPS pollution governance by examining the impacts of water quality policy design on farmer nutrient management decision making and behavior. In the first study, I theoretically contextualize the issue of agricultural NPS pollution in the broader discussion of environmental public goods dilemmas to suggest that an increased focus on the link between policy and behavior can improve sustainable resource management. I propose two empirical approaches to study the policy-behavior link in environmental public goods dilemmas: 1) explicit incorporation of social psychological and behavioral variables and 2) utilization of actor mental models, or perceptions of the world that guide decision making, to identify behavioral drivers and outcomes. In the second and third studies, I then use these approaches to examine how water quality policies for agricultural NPS collectively change farmer behavior to reduce nutrient emissions. The second chapter uses a quantitative, survey-based approach to examine the relationship between mandatory policy design and behavior change in New Zealand. I find that a shift to mandatory policy is not immediately associated with increased adoption of nutrient management practices, but the mandatory policy design is important for potential future behavior change and long-term policy support. In the third study, I combine qualitative methodology with network analysis of qualitative data to examine a spectrum of agricultural NPS pollution policies in Vermont, USA and Taupo and Rotorua, New Zealand. I use farmer mental models to examine behavior change within each of the regions, the perceived drivers of behavior change and perceived outcomes of the policy. In this study, farmers across all three regions cite mandatory water policy as a key behavioral driver, but in each region, policy design interacts with the social-ecological context to produce distinct patterns of behaviors and perceived outcomes. Taken together, this dissertation demonstrates that agricultural NPS pollution policy design must consider the interactions between policy and other social-ecological behavioral drivers in order to achieve long term water quality improvements

Impact Evaluation of a Central Australian Aboriginal Cultural Awareness Training Program for Health Professionals and Students

The aim of this study was to prospectively evaluate the impact of a Central Australian cultural awareness training program for health care staff. A mixed methods approach was used. Program participants completed a baseline and post-program questionnaire, which included an attitude scale assessing cultural safety, critical thinking and transformative unlearning, and open-ended questions. An online follow-up survey two months later repeated these questions. Mean scale scores were compared using paired and unpaired t-tests. Qualitative data were analysed thematically. Baseline scale mean was 45.7. At post-program it had statistically significantly increased to 47.3, using both the paired (p=\u3c 0.01) and unpaired t-test (p=\u3c 0.03). At the two-month follow-up it had decreased to 42.2. This was not statistically different from the baseline score with a paired (n=11) t-test (p=\u3c 0.37), however the difference was statistically significant with an unpaired t-test (p=\u3c 0.01) which included an additional eight respondents. Qualitative feedback was consistently positive. Many respondents learnt new information about the negative effects of colonisation on Aboriginal and/or Torres Strait Islander people, and how this continues to affect current health. Learning about Aboriginal and/or Torres Strait Islander cultures, kinship relationships and systems, and communication styles was identified as directly relevant to work practices. A cultural education program produced positive short-term changes in attitudes and was highly valued by participants. However, it is unclear if these changes are maintained in the medium term

Exploring the Experiences of the Consent Process for Aboriginal and Torres Strait Islander People Having Cardiac Surgery and Participating in Medical Research: A Study Protocol

Background: Gaining informed consent is a critical step before any medical procedure, and before taking part in medical research. Cultural differences in concepts of health and healing, communication, language, and racism, can play a part in forming barriers to gaining informed consent for Aboriginal and Torres Strait Islander people. For Aboriginal and Torres Strait Islander people, a lack of informed consent can worsen distrust and contribute to continuing health disparities. This protocol describes a study aimed at providing a better understanding of informed consent experiences of Aboriginal and Torres Strait Islander people undergoing heart surgery and participating in research. This will be complemented by comparing those experiences to the ones of the clinicians and researchers who obtain informed consent from Aboriginal and Torres Strait Islander people. Methods: The study will be conducted at the Fiona Stanley Hospital in Western Australia and Townsville University Hospital in Queensland. Participants will include Aboriginal and Torres Strait Islander patients undergoing cardiac surgery, clinicians of the cardiothoracic surgery team and medical researchers at both hospitals. Yarning will be used as an Indigenous research method to collect meaningful data from Aboriginal and Torres Strait Islander people undergoing cardiac surgery whilst semi-structured interviews will be conducted to explore Clinician’s and researchers’ experiences. Data from Aboriginal and Torres Strait Islander participant will be analysed following a cyclical approach to ensure Aboriginal and Torres Strait Islander voices are not lost during data interpretation. Inductive thematic analysis of data will be conducted to yield practical recommendations. Conclusions: We present the protocol of a study that will inform the development of strategies to ensure that informed consent processes are culturally appropriate and guarantee Aboriginal and Torres Strait Islander people’s right to self-determination. This will contribute to the provision of culturally safe healthcare services and promote the conduct of medical research that is ethical, safe and benefits Aboriginal and Torres Strait Islander people

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Strengthening the institution-behavior link in the SES Framework to facilitate comparative analysis of environmental public goods dilemmas

Many great environmental challenges take the form of environmental public goods dilemmas, including climate change, water quality deterioration and biodiversity loss. There is a great need for comparative analysis of these challenges to inform the design of governance institutions for sustainable resource management. The Social-ecological Systems (SES) framework provides a foundational structure for analyzing the sustainability of complex, multi-scale SES. However, in application, the SES framework has struggled to facilitate analysis of SES beyond common-pool resource regimes and the emergence of community-based collective action governance institutions. In this paper, I propose to expand the focus of the SES framework on the link between institution and behavior in order to facilitate the application of the SES Framework to environmental public goods dilemmas and the study of diverse institutional arrangements. First, I examine attributes of environmental public goods dilemmas that differentiate them from CPR regimes: the lack of a behavior-reinforcing link, multi-actor and multi-resource system dynamics, higher levels of uncertainty and complexity, and lack of built-in social capital. Then I suggest that these same attributes increase the need to study a broader suite of governance institutions in these systems. I propose that one way to address both of these challenges to the application of the SES framework is to increase the focus on the institution-behavior link within the framework by incorporating variables to investigate the psychological drivers of individual behavior and decision-making. I link the attributes of environmental public goods with the need for an increased focus on actor decision making and behavior. Then I explore psychological and behavioral concepts that show potential to improve our understanding of system dynamics within environmental public goods dilemmas. Finally, I propose revisions to the SES Framework to facilitate this increased focus on the institution-behavior link. Incorporating psychological and behavioral theory into the SES framework to strengthen the institution-behavior link is a promising approach to allow for comparative study of institutional interventions for environmental public goods. Ultimately, a better understanding of which institutions promote behavior change within and across environmental public goods regimes can improve the sustainability of these systems.s

Discovering the Interwoven Health Inequities in Aboriginal and Torres Strait Islander Children with an Acute Burns Injury

Background: In Australia, Aboriginal and Torres Strait Islander children have a greater burden of burn injury than other Australian children, yet to date, no research has examined this from an Indigenous perspective. This is the first thesis to use Indigenous research methodologies to provide a detailed examination of how health inequity impacts on Aboriginal and Torres Strait Islander children with an acute burn injury.Methods: The research comprised a systematic review of international injury literature, two epidemiological studies using Burns Registry of Australia and New Zealand data, a quantitative study with Aboriginal families and psychometric assessment of a survey. Indigenous research methodologies (decolonising, knowledge interface) woven with quantitative research methods were employed throughout.Results: Inequities in injury burden are greatest in children from low socio-economic status backgrounds and those who experience longer hospital length of stay (LOS). Aboriginal and Torres Strait Islander children have a hospital LOS 4 days longer than other Australian children with acute burns. Remoteness, flame burns, percentage total body surface area are contributing factors. These health inequities, low socio-economic status and Streptococcus sp. infection are greater in Aboriginal and Torres Strait Islander children than other Australian children. While knowledge interface methodology acted to decolonise outcomes, there were limitations in data in the data source, a Western epidemiological data repository and its employed classification codes.The manifestation of these inequities creates additional burden through Out-of-Pocket Healthcare Expenditure (OOPHE) on Aboriginal and Torres Strait Islander families. Travel, accommodation and medication are all OOPHE costs impacting families for their child’s burns treatment. Financial stain was reported through inability to pay bills and social isolation. The modification of a pre-existing OOPHE survey was found to be impracticable for Aboriginal and Torres Strait Islander families.Conclusion: This thesis describes the health inequity impacts on Aboriginal and Torres Strait Islander children with an acute burn injury through an Indigenous perspective. Engagement with Indigenous research methodologies exposed the invisible white possessive logic ingrained in burns quantitative research. Change is needed to shift this paradigm and work towards an agenda of Indigenous data sovereignty and more accurate understandings of burn injury burden

Equity in functional and health related quality of life outcomes following injury in children - a systematic review

Injury burden is greater in children from vulnerable and disenfranchised populations. This systematic review aimed to describe injury related Health Related Quality of Life (HRQoL) and function outcomes in children through a health equity lens. A systematic review was conducted focussed on HRQoL and functional outcomes in children (≤16 years) following injury. We applied PRISMA-E 2012 guidelines, the RTI (Research Triangle Institute) item bank for risk of bias and measured equity using PROGRESS-PLUS with a narrative synthesis. Of 3013 articles, 24 were eligible for inclusion. Most assessed outcomes following traumatic brain injury or burns over a 12-month period. Reduced functional and HRQoL levels pre-injury or baseline, longer hospitalisation, and lower socioeconomic status were linked to poorer long-term outcomes. Measures of equity in methodology, reporting and discussion were limited. Equity variables, such as prior disability, were points for participant exclusion. Ethnicity was often reported only in dominant cultural terms. The equity impact of injury in children remains largely unexplored. Worse injury outcomes were reported in low socioeconomic families, but the relationship to other equity variables was not routinely reported. This could significantly inhibit development of targeted preventative programs and health care for those most in need. Injury research agendas need reform, we provide guidance for research teams to assist in including equity in their research and outcomes