Deterministic versus stochastic quantitative microbial Risk Assessment models for wastewater irrigation of food crops

Reuse of wastewater to irrigate food crops is being practiced in many parts of the world and is becoming more commonplace as the competition for, and stresses on, freshwater resources intensify. But there are risks associated with wastewater irrigation, including the possibility of transmission of pathogens causing infectious disease, to both workers in the field and to consumers buying and eating produce irrigated with wastewater. To manage these risks appropriately we need objective and quantitative estimates of them. This is typically achieved through one of two modelling approaches: deterministic or stochastic. Each parameter in a deterministic model is represented by a single value, whereas in stochastic models probability functions are used. Stochastic models are theoretically superior because they account for variability and uncertainty, but they are computationally demanding and not readily accessible to water resource and public health managers. We constructed models to estimate risk of enteric virus infection arising from the consumption of wastewater-irrigated horticultural crops (broccoli, cucumber and lettuce), and compared the resultant levels of risk between the deterministic and stochastic approaches. Several scenarios were tested for each crop, accounting for different concentrations of enteric viruses and different lengths of environmental exposure (i.e. the time between the last irrigation event and harvest, when the viruses are liable to decay or inactivation). In most situations modelled the two approaches yielded similar estimates of risk (within 1 order-of-magnitude). The two methods diverged most markedly, up to around 2 orders-of-magnitude, when there was large uncertainty associated with the estimate of virus concentration and the exposure period was short (1 day). Therefore, in some circumstances deterministic modelling may offer water resource managers a pragmatic alternative to stochastic modelling, but its usefulness as a surrogate will depend upon the level of uncertainty in the model parameters.

Child protection, risk assessment and blame ideology

In this article we use qualitative data drawn from a sample of child protection cases 10 demonstrate holV the process of al1ributing blame to parents and carers for child maltreatment is a sign!ficanr influence 011 decisionmaking,
sometimes to the detriment of assessing the flltllre safety of children. We foctls on two cases which both demonstrate how the process of apportioning blame can lead to decisions which might not be considered 10 be in the best interests of the children concerned. We conceptualise blame as an 'ideology' with its roots in the discourse of the 'risk society', pelpetuated and sustained by the technology of risk assessment. The concept of blame ideology is offered as an addition to theOlY which seeks 10 explain the influences on decision making in child protection practice.

Risk assessment of child-victim sex offenders for extended supervision in New Zealand

Recently enacted legislation in New Zealand, the Parole (Extended Supervision) Amendment Act 2004, allows for the imposition of up to 10 years of supervision in the community for child-victim sex offenders following their release from prison. The Act requires reports to be written specifically assessing the risk of sexual re-offending against children. This study examined the application of actuarial measures used by the New Zealand Department of Corrections in these assessments, including a computer-scored instrument based on static factors (the Automated Sexual Recidivism Scale; ASRS) and a clinically-based judgement of dynamic risk factors (the SONAR). It was expected that a conservative approach would be taken in making recommendations for or against extended periods of supervision, such that a high score on either measure would predict a recommendation for extended supervision. It was found, however, that a more individualized approach was often taken, whereby a baseline assessment of risk as predicted by the ASRS was adjusted by clinicians based on SONAR ratings. Implications for the practice of risk assessment in sexual re-offending are discussed.

Risk assessment of sexual offenders for extended supervision orders in New Zealand : basic principles and current practice

A growing number of jurisdictions in North America, the United Kingdom, and Australasia have enacted legislation allowing for special sentencing, civil commitment, and community supervision options for high risk sexual offenders. In New Zealand, one example of this concern for public protection is the Parole (Extended Supervision) Amendment Act 2004, which provides for additional supervision of sexual offenders with child victims for up to 10 years after their release from prison. Recent experience with expert evidence and judicial decision making in such cases suggests that those involved in the process might benefit from a more thorough understanding of the current state of sexual offender risk assessment that can be provided by mental health professionals.

Sex offender risk assessment : consideration of human rights in community protection legislation

ObjectivesRisk assessments provided to judicial decision makers as a part of the current generation of legislation for protecting the public from sexual offenders can have a profound impact on the rights of individual offenders. This article will identify some of the human rights issues inherent in using the current assessment procedures to formulate and communicate risk as a forensic expert in cases involving civil commitment, preventive detention, extended supervision, or special conditions of parole. MethodBased on the current professional literature and applied experience in legal proceedings under community protection laws in the United States and New Zealand, potential threats to the rights of offenders are identified. Central to these considerations are issues of the accuracy of current risk assessment measures, communicating the findings of risk assessment appropriately to the court, and the availability of competent forensic mental health professionals in carrying out these functions. The role of the forensic expert is discussed in light of the competing demands of protecting individual human rights and community protection. ConclusionActuarial risk assessment represents the best practice for informing judicial decision makers in cases involving sex offenders, yet these measures currently demonstrate substantial limitations in predictive accuracy when applied to individual offenders. These limitations must be clearly articulated when reporting risk assessment findings. Sufficient risk assessment expertise should be available to provide a balanced application of community protection laws.

Case formulation with sex offenders : an illustration of individualized risk assessment

There has been a rapid expansion of the professional literature in risk assessment with sexual offenders over the past 20 years.  However, recent professional experience suggests that risk assessment reports often fail to be as relevant or useful as they might be for judicial decision-makers.  Research with large samples of offenders has refined our understanding of identifiable subgroups with different rates of sexual reoffending, but the management of risk requires that we deal effectively with individual offenders.  One area that can be improved is the development of case formulations of risk.  Clinicians must move beyond the mechanical use of actuarial static and dynamic risk factors to a broader integration of relevant information about the individual if they are to assist in managing risk in a way that serves the needs of the offender while protecting public safety.

Specific risk assessment based on victim type in children sexual offenders

Actuarial instruments for assessing sex offender recidivism have limited utility for specific risk assessment questions, such as the risk posed to particular types of victim. In order to obtain variables that discriminate between offenders with different classes of victim, data were coded from 324 files of child sexual offenders from a community-based sexual offender treatment program. Offenders with single or multiple victims were compared, as were offenders who did or did not offend against victims of both genders, and offenders with only intra-familial or extra-familial victims versus offenders with victims in both relationship categories. Variables that discriminated single-victim and multiple-victim offenders were similar to those identified in actuarial risk assessment scales, with the exception of history of childhood sexual abuse. With the exception of physical abuse history, the same variables discriminated specific offender groups according to victim gender and victim relationship, although in different combinations. There was limited support for the notion of specific risk variables.

A conditional probability approach to risk assessment for child sexual offenders with different classes of victim

Specific scales were developed for discriminating child sexual offenders with different classes of victim. The project demonstrates a method of individualising scores on actuarial risk assessment measured in a way that makes them more meaningful for those involved in decision-making about individual child sexual offenders. At present, the only quantifiable approach to specific decision-making relies on a general prediction of future behaviour, based on group data. The Bayesian approach is one method that can be used to assist decision-makers to use this information in ways that lead to the more appropriate management of risk. Ultimately, the better management of known child sexual offenders will lead to fewer offences and a reduction in the number of children who lives are profoundly affected by sexual victimisation.

Developing Clinical Practice Guidelines for violence risk assessment in mental health triage : a systematic review

Background : On a global level, there is a growing trend to utilise mental health triage service systems as a way of providing consumers with access to 24 hour mental health care. At present, violence risk assessment in mental health triage lacks a suitable evidence base and clear guidelines. This presentation provides an overview of a Clinical Practice Guideline for violence risk assessment at point of entry to health services.
Aims : The objective of this study was to develop Clinical Practice Guidelines for violence risk assessment in mental health triage, and to pilot test the Clinical Guidelines in two major hospitals in Melbourne.
Method : The method employed in the study was a systematic review, as per the Australian National Health and Medical Research Council’s methodology for developing Clinical Guidelines. Research was conducted at the Royal Melbourne Hospital and the Alfred Hospital to establish the utility of the Guideline in practice.
Results : The systematic review established the highest level of evidence for violence risk assessment. Clinical Practice Guidelines for mental health triage were developed from these findings.
Conclusions : Evidence based Clinical Guidelines maximise the potential for creating safer outcomes for consumers, families/carers, and health care workers.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.