Remote Australia Online

Aim: Aboriginal children in Western Australia’s Kimberley region have high rates of developmental concerns upon entering school. The purpose of this study was to identify i) current early childhood development (ECD) practices at one Aboriginal Community Controlled Health Service (ACCHS) in the region, ii) barriers and facilitators to detecting developmental concerns, and iii) if health staff deviate from current ECD guidelines, and possible reasons for deviation. Methods: This study utilised a mixed-method design. We audited consults of children aged 0-5yrs between January 1 2016 and December 31 2016 at the participating ACCHS. Formal child health checks (CHCs), developmental enquiry and follow-up of developmental concerns were identified. Five staff members participated in semi-structured interviews regarding ECD practices at the ACCHS. Ethics approval was obtained from the Western Australian Aboriginal Health Ethics Committee (HREC reference number 723). Results: In total 1241 consults were audited for 177 children. A formal CHC was conducted for 56 children over 74 consults and 114 children had development enquiry documented across 190 consults. In ten of these consults a development assessment tool was used. Hearing and speech was the most commonly reviewed domain. Where follow-up was arranged it was documented to have occurred in 18% of referrals. Only 11 consults documented brief interventions or anticipatory guidance. Thematic analysis identified communication issues, practical limitations, lack of early intervention services and need for increased resources and knowledge as potential barriers to increasing ECD activities. Participating staff recognised the importance of developmental assessment. Conclusions: We identified significant recognition of the importance of ECD assessment but also several barriers to implementation and low documented follow-up rates. There is a need to empower staff through upskilling in brief developmental assessments and interventions, to provide adequate resources, to improve communication between organisations and to promote supportive systems for early developmental interventions.

Both environmental (e.g., energy use) and human sustainability (occupant wellbeing/productivity) need to be considered in building design and operation. The challenging climatic and socioeconomic conditions in remote regions of Australia mean that achieving sustainability is difficult and costly. Currently, the energy use patterns, thermal performance, and indoor atmospheric quality (IAQ) of remote health clinic buildings are unknown, meaning that there is an information gap in the design and operation of such buildings. This paper reports the results of an investigation into the environmental performance of a clinic in the remote clinic of Numbulwar. Climate variables, energy consumption, and IAQ variables were instrumentally monitored at the clinic from April 2017 to March 2018 at 10-minute intervals, with data uploaded to a cloud database now holding 3 million values. Analyzed temporal variations in the measured variables for the clinic and the relationships between them reveal the performance of the building. The results obtained provide a basis for the formulation of strategic interventions, design guidance, and further investigation, including: (i) the range of indoor atmospheric conditions needs to be narrowed to provide more consistent occupant comfort; (ii) an occupancy profile needs to be developed to determine user behaviours with respect to energy use; (iii) the heat-exhaust/aircon systems need to be reviewed for more efficient use; (iv) the cycling of air, heat, moisture, and pollutants through the building needs to be further investigated; and (v) BIM should be undertaken using the data as input to test future design solutions.

Background: Respiratory diseases represent the main reason for paediatric inter-hospital transfers in urban and remote areas. Nasal high flow (NHF) therapy is a simple method of oxygen delivery that provides additional respiratory support to patients with acute respiratory failure. It is proven to be effective and has been safely used outside intensive care settings in tertiary and regional hospitals. Although there is a desire to use NHF therapy in remote hospitals in Australia, the safety and value of using NHF where retrieval to intensive care services requires air retrieval and potential time delays, is unknown. Aim: The aim of this study is to explore the safety and efficacy of implementing NHF therapy for infants with bronchiolitis in remote Torres and Cape hospitals. Proposed methods: This study will use a sequential mixed methods design. Using a modified Delphi technique, an expert panel will establish agreed clinical guidelines on NHF therapy implementation. Once the NHF therapy guidelines have been established training will be provided to staff. A comparison cohort study will audit the clinical outcomes of all infants presenting with bronchiolitis to Weipa, Cooktown and Thursday Island hospitals for a 12 month period and compared with outcomes for all presentations in the 12 months prior to NHF therapy implementation. Issues/dilemmas: The expert panel and subsequent audit evaluating clinical outcomes post-implementation is a reasonably established research process. The challenge in developing the guidelines will be in ensuring fair and equal input from all panel members. Suggestions on how to negotiate potentially opposing ideas and agendas and to sort opinion without evidence from more knowledgeable input will be sought. This project involves staff training on NHF and the developed guidelines for use. Advice is sort from conference delegates on the most pragmatic way to evaluate knowledge translation in a highly mobile, casual workforce where the research is conducted over an area physically difficult to access.

Objective The objective of this research was to answer the question “In Alice Springs and Tennant Creek, why do young people aged between 18 and 25 use alcohol the way that they do?” Design A qualitative design incorporating semi-structured interviews and focus groups was used. Setting The focus groups and most individual interviews were conducted at various locations in Alice Springs and Tennant Creek according to the preferences of the participants. Participants Twenty young people aged between 18 and 25 years participated in the project. Eleven of the 20 participants were women and both Aboriginal and Torres Strait Islander people and non-Indigenous youth were included. Main outcome measure The outcome of interest was the self-reports of young people regarding the way in which they use alcohol, why they use it that way and how they came to use it in the ways that they do. Result Interpretative phenomenological analysis was used to analyse the data. Two superordinate themes and six sub-themes emerged from the data. Key findings were that: boredom and peer pressure were not key factors in alcohol use; alcohol was used as an activity to have fun with friends; and youth do not engage with current approaches to health messaging. Conclusion Young people in remote Australia drink for complex and sometimes contradictory social reasons. Young people should be involved in the design of any programs targeting alcohol use.

Australian Indigenous smoking rates are highest in remote communities but likely vary between communities; few studies have assessed community features in relation to Indigenous smoking rates.Design and objective This ecological study evaluated the associations between smoking rates, and community sociodemographic and climatic characteristics for a large sample of remote Indigenous communities.Setting and sample Records (n=2689) from an audit of community health centres in the Northern Territory and Queensland were used to estimate smoking rates dichotomised at the median for 70 predominantly Indigenous remote communities. Community characteristics were similarly dichotomised.Methods Cross-tabulations were used to calculate the odds of a community classified as high for a sociodemographic or climatic factor also being high for smoking rate. Additional cross-tabulations, stratified by sociodemographic, region (coastal or central) and geographic connectivity levels, were performed to assess potential confounding.Results Community smoking rates ranged from 25% to 96% (median 60.2%). Moderately strong relationships were observed between community smoking rate and population size (OR 6.25,(95% CI 2.18 to 17.95)), education level (OR 3.67 (1.35–10.01)), income (2.86 (11.07–7.67)) and heat (2.86 (1.07–7.67)).Conclusions Smoking rates in Australian remote Indigenous communities are universally high. Smoking rates are associated with greater community-level socioeconomic status and size, most likely reflecting greater means of accessing tobacco with mass of smokers sufficient to sustain a normative influence. Severe heat was also associated with high smoking rates suggesting such a stressor might support smoking as a coping mechanism. Community sociodemographic and climatic factors bear consideration as context-level correlates of community smoking rates.

An increasingly interdependent world economy means that differences across regions and within countries can often be greater than differences between countries. Nowhere is this more evident than in the Australian context. In regional, rural and remote (RRR) Australia the differences between regions can be stark – large regional cities; tiny remote settlements; differing population densities; a plethora of differing economic drivers; unique settlement patterns and highly dynamic demography. The differences could well be summed in the sentence: ‘If you’ve seen one country town, you’ve seen one country town.’ In 1970s and 1980s changes occurring at the national and global level and the impact of policies introduced in Australia were keenly felt in RRR Australia. The deregulation of industry and opening up of markets, the floating of the Australian dollar and the removal of trade tariffs and the privatisation of previously state-owned and operated services have all had impacts at the regional level. In the context of this presentation, the privatisation of state services has been especially significant. Increasing adoption of market-based funding approaches has failed (dismally) to take into account the differences between urban and RRR Australia, and the differences between regions, nor the subsequent challenges associated with those differences. Why, for example, do we continue to apply market models where there is clear market failure? Why do funders assume that seeking economies of scale and applying competitive tendering processes have the same outcomes in vastly different operating environments? For many service providers across RRR Australia, these are questions and challenges that are faced daily. This presentation firstly highlights some of the challenges of applying market models in RRR Australia, and then steps through some alternative approaches that could mitigate these challenges at the same time as providing more cost-effective service delivery.

Objective:This paper outlines the current psychiatry workforce shortages experienced by rural and remote communities in Australia and argues that postgraduate training in psychiatry may play a role in rectifying these healthcare access inequities.Conclusion:Funding for postgraduate medical specialist training in Australia is undergoing a shift away from solely metropolitan-centric training schemes, based on substantial evidence over the past two decades in undergraduate medical training. Psychiatry is well placed to lead the development of dedicated postgraduate rural training pathways to enhance recruitment and retention of an urgently required rural and remote psychiatry workforce.

Despite a clear need, ‘closing the gap’ in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems. Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services. The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out. This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes. Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)—a role situated primarily within the clinical health system. In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion. We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion; one that is distinct from, but complementary to, that of AHWs in clinical settings. We provide examples of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities. We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.

Spanning 1,727,000 km2 and with a population of nearly 5 million people, 40% of whom live outside major cities, Queensland continues to pursue health equality and equity. Sometimes, very appropriately, an option for improvement can come from the people most affected. To improve or idealise patient care, clinicians in rural and smaller centres often seek collegial and expert clinical advice and support from larger site clinicians by telephone. Queensland is fortunate having invested in integrated telehealth technologies throughout the state, including equipment primarily located in rural and remote facility resuscitation areas. Rural communities and clinicians asked whether this technology could be used for such ad hoc consultation’s to ‘add a visual’—it happens for an outpatient endocrinology clinic 800kms away, then why not when the local doctor calls the base hospital for advice? Why wasn’t it occurring and how do we reduce barriers and increase utilisation? Whether it could be done in a way that enhanced patient safety through simplified requesting and connecting, minimised work impact on isolated clinicians, and importantly, aligning with individual hospital processes within different health services. From this, the Telehealth Emergency Management Support Unit (TEMSU) was born. This presentation offers an overview of how TEMSU evolved into a 24/7 service, supporting over 165 sites in 13 Hospital and Health services, and continues to expand. Examining generalist/acute presentation models of care will lead to appreciating the flexibility of applying TEMSU models to a vast variety of clinician-to-clinician interactions including: paediatrics, nurse-to-nurse, midwifery, mental health, wound care, deaf interpreting, multi-disciplinary team handovers, aged care, etc. TEMSU contributes to, and complements, existing local networks of clinicians who, while separated by distance, are working together to achieve better patient care. There will be opportunity to touch on the experience of growing a unique acute telehealth service, the barriers, successes, surprises and failures, including what we would/will do differently. Equally, how other areas could apply some aspects of our experience to their patient groups. TEMSU is not the panacea for the rural-urban health disparity, nor tyranny of distance. However, it has a place in the suite of options available to rural Queensland clinicians and their patients for support and advice.

Background: The Benchmarque Group is a Registered Training Organisation (RTO No. 21824) specialising in the development and delivery of nationally accredited clinical skills programs. Earbus Foundation of Western Australia [Earbus] is a WA-based Children's charity that targets middle ear disease in Aboriginal and at-risk children in Western Australia. Having been funded to deliver the Otitis Media Management Program in regional and remote Australia, the Benchmarque Group felt more could be done to embed participants’ learning beyond the classroom. When participants returned to work in their own communities, there were occasions where students had limited opportunities to immediately put the training into practice, build confidence and clinical competence in the area of ear health. Earbus delivers full-service ear health clinics in regional WA and has been successful in reducing the incidence and impact of otitis media in the communities in which they work. While working in these regions, Earbus had discovered that more work needed to be done to build local capacity to identify and manage the disease in Aboriginal children between Earbus visits. In 2018 the Earbus Foundation of WA and the Benchmarque Group have launched an innovative pilot project aimed at combining traditional learning with practical experience in an attempt to tackle otitis media at a community level. The organisations have combined expertise and resources to create an enhanced learning curriculum for Aboriginal Health Workers working in regional and remote areas, with the initial pilot of the project occurring in the Pilbara in 2018. Methodology: The Benchmarque Group and Earbus Foundation have created a model of collaboration which sees students attend the Benchmarque Group’s Otitis Media Management Program. Following completion participants then accompany Earbus in the field to consolidate the learning through practical experience at one of Earbus’ mobile ear health clinics with a cohort of Aboriginal children. Participants receive direct at-elbow supervision and support from an experienced paediatric Audiologist, as well as GP, Nurse and ENT Specialist input. Conclusion/discussion: The educational and professional value of this unique immersion in ear health is significant and long lasting. In addition, the project has an inherent multiplier effect as participants use their enhanced skill set and experience to educate and support other regional colleagues. This presentation will discuss an evaluation of the pilot and plans for the future expansion of the project into other regions of WA.

An outbreak of infectious syphilis began in northern Queensland in January 2011, extending to the Northern Territory in July 2013, the Kimberley in Western Australia in June 2014 and since November 2016 the Western, Eyre and Far North regions of South Australia. Since the commencement of the syphilis outbreak in 2011 to 31 July 2018, there have been 2,228 cases of infectious syphilis and 14 congenital syphilis cases associated with the outbreak regions of northern and central Australia. In December 2017, the Australian Health Ministers Advisory Council (AHMAC) endorsed a National Strategic Approach and Action Plan to address the disproportionately high rates of syphilis and other blood-borne viruses and sexually transmissible infections in regional and remote Indigenous communities. The Action Plan was developed in consultation with affected jurisdictions, NACCHO and key stakeholders. The Australian Government has committed $8.8 million in funding over three years (2017-18 to 2019-20) to be delivered through Aboriginal community-controlled health services (ACCHS) in the outbreak regions. The types of projects funded include: workforce supplementation and implementation costs for the roll out of the ‘Test and Treat’ model, including point-of-care test and treatment medication, negotiated on a case by case basis with each ACCHS in the outbreak region; development and roll out of a ‘train the trainer’ model to upskill the existing and the supplemented workforce in both the ‘Test and Treat’ model and sexual health in general; culturally appropriate health, communication and education materials. The Department of Health established an Enhanced Response Unit to coordinate the Australian Government’s contribution to the Action Plan. The Unit worked closely with NACCHO, state and territory public health authorities, and ACCHS across the affected areas to develop locally-relevant models to rollout a phased approach to the response. Close collaboration between Health and the ACCHS sector, led by NACCHO, was fundamental for the design of this response. Every aspect of this activity followed a bottom-up design methodology, in which the selection of sites, development of specific on-the-ground workforce models, and organisation of regional coordination happened in partnership between the services and Commonwealth and state and territory governments. Extensive consultation, including workshops in four states and territories was fundamental for the planning of the staged rollout. In this presentation we will outline the specifics of this innovative co-design model, and the strengths of meaningful partnership between government departments and the Aboriginal community-controlled health sector.

Most Australians don't have to travel more than a few kilometres to deposit or withdraw cash. Cash use is declining, however, and with it the number of ATMs and other cash access points. This trend seems likely to continue. While it will probably have relatively little impact on those living in metropolitan areas, it is important that reasonable access to cash services is maintained for people in regional or remote locations as long as such access is needed.

This article analyses the status and future of bilingual education programs using Indigenous languages and English in remote Northern Territory schools. It explains why this educational approach is so contested at present, resulting in an unresolved situation which can best be regarded as an uneasy compromise on the ground and a stalemate at higher levels of political decision making. If the bilingual education approach was better understood by the current NT Government, there would a strong impetus now to refine and effectively implement a model of schooling that is appropriate for students in remote areas. Instead, current politicians debunk the bilingual approach, thereby robbing schools and literacy plans of any momentum and distracting attention away from the work that needs to be done. Meanwhile, student attendance rates have fallen away to worryingly low levels (Dickson, 2010). The current regime may well resolve the impasse, but in the absence of any meaningful, open negotiation the future looks uncertain. It is too soon to judge the cost of this uncertainty, but it may well result in further alienation and the emergence of non-government alternatives.

The famed explorer Charles Sturt was the first European to set eyes upon the sand dunes of the Simpson Desert, and was in no doubt about the harshness of the environment that it presents. In a letter to his wife Charlotte, written in September 1845, he described his first impressions of the desert: 'A kind of dread, and I am not subject to such feelings, came over me as I gazed upon it. It looked like the entrance into hell.' Yet dunnarts and many other carnivorous marsupials thrive in this fierce environment, eschewing fixed home ranges, evading predators and other hazards, and tracking pulses of food wherever they appear. This vagrancy, or serial nomadism, appears unique to the small mammals of arid Australia and is undoubtedly a response to the extremely unpredictable environmental conditions of the continental interior, writes Chris Dickman in an excerpt from Secret Lives of Carnivorous Marsupials.

Creative Recovery was implemented as a pilot project in Lockhart River, a remote Indigenous community in Far North Queensland during 2008 as an innovative, community arts-based, wellbeing and mental health recovery project. Over the following three years it evolved from a project focused on addressing issues of social inclusion specifically for Indigenous consumers of remote mental health services to a broader initiative extending to the communities of Aurukun, Mornington Island and Doomadgee. During this time, over 28 organisations became involved in an effort to promote social and emotional wellbeing for a diverse range of community members. The project also began to explore opportunities for social and creative enterprise within these communities. The following report describes the processes involved in implementing and the outcomes obtained from Creative Recovery, as well as outlining the challenges and future opportunities. Outcomes from the project were evaluated in an evolving way that used yarning/unstructured interviews, weekly activity reports and the production of documentaries. In response to the need to adhere to culturally appropriate methods of enquiry and to enable Indigenous mental health consumers to have a voice, the multiple elements and forms of Indigenous storytelling were incorporated as a way of generating meaningful data in this context. Several themes emerged consistently across communities as being crucial to the successful outcomes of such a project, including: a sense of ownership; acknowledging that simply engaging in arts based activities can be healing; the role of engaging in creative activities as a means for promoting pride and identity; the potential for such projects to promote cultural continuity and renewal for the benefit of children; the teaching and acquisition of new skills. The more tangible ‘returns on investment’ included: 80 workshops in Lockhart River, 14 artists residencies conducted in other communities, 4 major public exhibitions, 8 community launches/exhibitions, and 6 documentaries produced. In addition the projects generated over 300 artworks from amongst the participant groups with 15 emerging artists generating a regular income from the sale of their work. Given the challenges and investment needed to coordinate and initiate similar projects in remote locations these represent significant 'returns’ for the community, arts organisations and for health services. In the short term the evaluation has provided insights about the processes which are critical to ensuring the success of such programs and evidence for positive outcomes. In the long term it is envisaged the report will help to inform similar projects or programs geared toward building social capital in remote Indigenous communities through arts-based initiatives. Such programs can lead to improvements in health outcomes for individuals and communities, as well as promoting sustainable local economies. Itis acknowledged however, that any economic benefit to participants will need to be carefully managed. Finally, the project outcomes including the evaluation have made a positive contribution to non-indigenous awareness, understanding of, and respect for Indigenous culture. It provides an approach to essential maintenance of Indigenous culture and traditional knowledge by engaging with a wide range of community members. The arts and cultural products are also showcased through exhibitions and documentaries in a culturally appropriate and sensitive format.

This paper describes and justifies the protocol for a research project investigating regional secondary school consolidation reforms in New South Wales, Australia. The study is designed to describe the experiences of those directly involved in the transition to a consolidated school in a way that has so far eluded educational leadership researchers. Identifying five themes from the international literature on school consolidation (leadership and governance; staff and student wellbeing; teaching and learning; curriculum and pathways; community satisfaction), the paper then articulates a systematic research protocol for examining the transition from individual schools through to a consolidated school. Previous studies have not systematically examined this transition and how it shifts practices and perceptions from different stakeholder perspectives. Using a purposeful merger of quantitative and qualitative forms of evidence, this study protocol has the potential to play a defining role in the area of school consolidation reforms. The applicability of the study design holds promise as an adaptable, focused, and sustainable protocol for generating understanding of school consolidation transitions and developing an empirical evidence base that is localised, internationally benchmarked, and critical for school decisions about investments and outcomes for educators, students, and communities.

Although parents and families have a significant influence on their child’s school attendance, teachers’ adoption of more culturally appropriate methods of engagement with the community is necessary. I do think the people of the remote Indigenous communities need to work in collaboration with their local schools (and vice versa) in order to make progress and positive changes to lower primary school students’ attendance.

In this much anticipated litigation, ('ASIC v Kobelt' [2019] HCA 18) the High Court majority (4:3) dismissed ASIC's appeal against an outback store owner, Mr Kobelt. For about a decade, he operated a 'book-up' credit system for his customers; Indigenous persons in a remote community. ASIC alleged his system was unconscionable. Despite the diverging views of the Court, the decision sheds light on confronting social issues in remote Indigenous communities while contributing to the jurisprudence on statutory unconscionability in Australia.

Objective This survey aimed to understand hunting practices involving domestic dogs in remote Indigenous communities in northern Australia and, in the context of disease transmission, describe the domestic–wild dog interface and intercommunity interactions of hunting dogs during hunting activities. Methods A cross-sectional survey of 13 hunters from communities of the Northern Peninsula Area (NPA) of Queensland gathered information on demographics of hunters and hunting dogs, hunting practices and past encounters with wild dogs during hunting trips. Social networks that described the connections of hunters between NPA communities from hunting expeditions were developed. Results Most hunters interviewed were not aware of any diseases that could be transmitted to dogs (n = 11) or humans (n = 9) from wild animals while hunting. More than half (n = 7) of the respondents had experienced at least one wild dog encounter during hunting in the year prior to the interview. A map of the relative risk of interactions between wild and hunting dogs during hunting trips allowed the identification of high-risk areas in the NPA; these areas are characterised by dense rainforests. The social networks at the community level resulted in relatively large density measures reflecting a high level of intercommunity connectedness. Conclusions This study contributes to our knowledge of Australian Indigenous hunting practices and supports the potential for disease transmission at the domestic–wild dog interface and intercommunity level through contacts between hunting dogs during hunting activities. Insights from this study also highlight the need for educational programs on disease management in Indigenous communities of northern Australia.

The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes “30mer” vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new “emm cluster” scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D.

Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia’s Northern Territory (NT).

Introduction The geographical vastness of Australia in rural and remote regions provides challenges for hospital nursing staff when a medical officer is not immediately available. Delaying treatment until a medical officer arrives can potentially impact on patient outcomes. Some Registered Nurses in rural and remote New South Wales have received advanced training and credentialing through the First Line Emergency Care Course (FLECC) enabling them to initiate treatment prior to the medical officer's arrival. Despite operating since 1990 the course and subsequent model of care has received limited evaluation. Purpose The aim of this study was to evaluate whether undertaking the First Line Emergency Care Course (FLECC) improves confidence in rural and remote registered nurses’ (RN) ability to provide and to initiate extended scope of practice for emergency care of critically ill adults in the absence of a medical officer. Procedure A voluntary electronic cross sectional 19 question multi-centre survey was emailed to all nurses FLECC accredited since 2008 and employed in rural and remote Local Health District in New South Wales. Findings A response rate of 60% was obtained (225/375). Since credentialing 93.3% nurses had commenced emergency treatments under the approved guidelines. The majority (97.4%) agreed that the course provided the required knowledge. The mean Likert nurse's self-assessed confidence score (1–5) for providing first line response rose significantly (Wilcoxon signed rank test V=375, p-value<0.0001) from 2.47 and up to 3.98 after the course. The majority (83.9%) now had “high” or “very high” confidence. Principle Conclusions The FLECC provides registered nurses in rural and remote areas with skills, confidence, knowledge and ability to initiate potentially lifesaving treatment for critically ill or injured patients prior to the arrival of a medical officer. The FLECC model of care helps provide timely care delivery by nurses in rural and remote areas. Further research could examine the differences in outcome in patients treated at sites with FLECC nurses.

The global mining sector, like other sectors of industrialised economies, is undergoing a technological transformation as part of what some commentators refer to as the ‘fourth industrial revolution’. New technologies, such as automation and robotics, are transforming the nature of mining and the nature of work. This paper discusses the implications of this shift for Indigenous peoples and the Indigenous mining workforce. In the past two decades the number of Indigenous employees in the sector has grown to unprecedented levels, most notably in Australia and Canada. The emergence of local level agreements, state regulatory requirements, and mining company policies and commitments are examined as drivers for this rise in Indigenous employment. Yet, the predicted acceleration in mine automation could disrupt this positive trend, as automation targets routine jobs which are disproportionately where Indigenous peoples are employed in manual and semi-skilled roles. There is little indication that the industry is considering the potential downside effects of mine automation on these same peoples. A careful and critical examination of mine automation and its effects on Indigenous peoples is urgently required.

The purpose of this research was to observe and describe the effect of Montessori pedagogy in a remote Aboriginal Early Childhood program to ascertain whether this alternative approach to education provides a more culturally appropriate practice than past methods. The significance of the study lies in the need to "close the gap" (Department of Premier & Cabinet [DPMC], 2016, p.1) between the achievement of Indigenous and non-Indigenous students. The study endeavours to describe the effect of Montessori pedagogy through the response of those most closely associated with Aboriginal education: students, parents, caregivers, community members and educational professionals. Three dimensions of the context contributed to an understanding of this study. These three dimensions were: geographical setting, the Ngaanyatjarra Lands School Network and the Papulankutja Remote Community/Campus. These contextual dimensions outline the background, setting and environment where this study was undertaken. The review of literature highlighted three topics, which formed the conceptual framework for this inquiry. These topics were: current policies and practices in Early Childhood education in Australia; current policies and practices in Aboriginal education; and principles and practices in Montessori pedagogy. The theoretical framework for this study was located within the interpretive paradigm of qualitative research. Specifically, the interpretive lens underpinning this inquiry was that of phenomenology. The methodology used in the research was an individual case study that sought to explore the effect of Montessori pedagogy with remote Aboriginal Early Childhood students in the Papulankutja Remote Community. The individual case study utilised four methods of data collection: video recording and observational framework by the teacher-researcher; journal writing by the teacher-researcher; ten observational frameworks by the critical friend; and three one-on-one interviews with the informant. The method of data analysis for the qualitative data followed a format similar to that outlined by Miles and Huberman (1994): data collection, data reduction, data display and conclusion drawing. The data were coded v and analysed according to themes taken from the four specific research questions for this study. The findings of this research are consistent with four themes: student response to Montessori pedagogy, student behaviour in response to Montessori pedagogy, language development within Montessori pedagogy, and community involvement within the early childhood classroom. The findings suggest that various fundamental characteristics of Montessori pedagogy align with traditional Aboriginal child rearing techniques such as autonomy and movement. In addition, Montessori teaching pedagogy provides Aboriginal and Islander Education Officers with a consistent collection of teaching activities and materials to work one-on-one with students in the home language (Ngaanyatjarra) before transitioning to Standard Australian English. The results of this research have the potential to inform future educational practices for Aboriginal students in remote communities.

Australia is currently canine rabies free. However, communities located on the northern coastline–such as the Northern Peninsula Area (NPA), Queensland–are at risk of an incursion due to their large populations of susceptible free-roaming dogs and proximity to rabies-infected Indonesian islands. A rabies-spread model was used to simulate potential outbreaks and evaluate various disease control strategies. A heterogeneous contact structure previously described in the population of interest–explorer dogs, roamer dogs and stay-at-home dogs–was incorporated into the model using six spatial kernels describing contacts between dog roaming categories. Twenty-seven vaccination strategies were investigated based on a complete block design of 50%, 70% and 90% coverage for each of the three roaming categories to simulate various targeted vaccination strategies. The 27 strategies were implemented in four population structures in which the proportion of dogs in each category varied–explorer dominant, roamer dominant, stay-at-home dominant and a field population (based on field estimates of population structure). The overall vaccination coverage varied depending on the subpopulation targeted for vaccination and the population structure modelled. A total of 108 scenarios were simulated 2000 times and the model outputs (outbreak size and duration) were compared to Strategy 14 (a standard recommended overall 70% vaccination coverage). In general, targeting explorer dogs–and to a lesser extent roamer dogs–produced similar outbreaks to Strategy 14 but with a lower overall vaccination coverage. Similarly, strategies that targeted stay-at-home dogs required a higher vaccination coverage to produce significantly smaller and shorter outbreaks. This study provides some theoretical evidence that targeting subpopulations of dogs for vaccination based on their roaming behaviours (and therefore risk of rabies transmission) could be more efficient than blanket 70% vaccination campaigns. Such information can be used in preparedness planning to help improve control of a potential rabies incursion in Australia.