Remote Australia Online

The prevalence of spotted fever group rickettsial infection in dogs from a remote indigenous community in the Northern Territory (NT) was determined using molecular tools. Blood samples collected from 130 dogs in the community of Maningrida were subjected to a spotted fever group (SFG)-specific PCR targeting the omp B gene followed by a Rickettsia felis-specific PCR targeting the glt A gene of R. felis. Rickettsia felis omp B and glt A genes were amplified from the blood of 3 dogs. This study is the first report of R. felis infection in indigenous community dogs in NT.

Background: Remote Australian Aboriginal and Torres Strait Islander communities have potential to be severely impacted by COVID-19, with multiple factors predisposing to increased transmission and disease severity. Our modelling aims to inform optimal public health responses. Methods: An individual-based simulation model represented SARS-CoV2 transmission in communities ranging from 100 to 3500 people, comprised of large, interconnected households. A range of strategies for case finding, quarantining of contacts, testing, and lockdown were examined, following the silent introduction of a case. Results: Multiple secondary infections are likely present by the time the first case is identified. Quarantine of close contacts, defined by extended household membership, can reduce peak infection prevalence from 60 to 70% to around 10%, but subsequent waves may occur when community mixing resumes. Exit testing significantly reduces ongoing transmission. Concurrent lockdown of non-quarantined households for 14 days is highly effective for epidemic control and reduces overall testing requirements; peak prevalence of the initial outbreak can be constrained to less than 5%, and the final community attack rate to less than 10% in modelled scenarios. Lockdown also mitigates the effect of a delay in the initial response. Compliance with lockdown must be at least 80–90%, however, or epidemic control will be lost. Conclusions: A SARS-CoV-2 outbreak will spread rapidly in remote communities. Prompt case detection with quarantining of extended-household contacts and a 14 day lockdown for all other residents, combined with exit testing for all, is the most effective strategy for rapid containment. Compliance is crucial, underscoring the need for community supported, culturally sensitive responses.

Background Remote Australian women in labour often rely on retrieval services to allow birthing in specialist obstetric centres. However, there is currently debate over when not to transfer a woman in labour, for risk of an in-transit birth, associated with worse neonatal outcomes. Methods A scoping review methodology was undertaken, to define the scope of published literature on the topic and identify gaps in the current knowledge. Results A total of seven full texts were deemed suitable for synthesis, which were all retrospective observational studies. Four themes from the studies’ findings were identified: population features, predicting time-to-birth, use of tocolysis and birth during medical evacuation. Conclusion The evidence identified in this review was of low methodological quality and heterogenous. The key findings were that births in-flight are rare, despite geographical distances and long transport times, with a knowledge gap on predictors of time-to-birth.

The Alice Springs Lutheran Church is an unusual multilingual congregation. In the Northern Territory 30% of the population is Aboriginal, and speakers of Central Australian Aboriginal languages make up the majority of the Alice Springs congregation. Aboriginal languages are recognised in the church’s worship which alternates liturgy and hymns in Arrarnta and two languages of the Western Desert: Luritja and Pitjantjatjara. The church in Central Australia was started by South Australian Lutherans with German heritage, beginning at Hermannsburg mission station at Ntaria, in 1877. The United Evangelical Lutheran Church of Australia was vulnerable to persecution during the Second World War. The establishment of a base in Alice Springs was the first Lutheran Church in the Northern Territory. This paper explores the heritage of Lutheran engagement in language learning and translation and the impact of its heritage for congregational life in the Alice Springs Lutheran Church.

Almost half of the world population lives in rural and remote areas facing more challenging and hazardous life conditions than the rest of the population. This paper and proposed method contribute to addressing an apparent gap in modelling travel-related decisions of rural and remote populations to enhance equitable access to basic amenities (e.g., education, health services, retail) for these populations. The application of these models is highly relevant for planning and policy purposes in remote communities. This paper uses data obtained from a mobility survey of remote Aboriginal communities in Central Australia to estimate purpose-specific destination choice models for access to basic services. The analysis is based on stated preference data to measure the attractiveness of destinations. Then, the models are used to analyse the impact of increasing the number of services provided in the remote communities. A better understanding of the impact of local development on travel patterns in remote communities is provided by analysing three aspects: attracted trips to the destinations, reduction of distance travelled by travellers in all the communities and improved equity in the distribution of travel distance among the communities. The case study illustrates the method successfully determines the most relevant parameters in the decisions of the surveyed individuals and determines potential destinations for local development, with the final objective of contributing to the alleviation of accessibility and inclusion problems in remote areas.

People living in rural and remote areas face particular health challenges, many of which are attributable to their living conditions, social isolation, socioeconomic status and distance from services. Nurses constitute the largest group of health providers in the rural and remote workforce, and many communities are dependent on nurse-led services. The health status of rural and remote Australians is worse than other populations on almost every indicator of health status. Overall, in remote areas, they experience a 20% increase in disease compared to those living in major cities. Risk factors such as tobacco smoking, alcohol consumption, low levels of physical activity and nutritional insufficiency are higher in rural and remote areas, increasing the likelihood of developing numerous chronic diseases. This discussion paper drew on case studies in rural and remote settings and a review of policy, discussion papers, editorials and research studies. The paper highlights several nurse-led initiatives that are innovative and person centred. These initiatives highlight talent and potential, however, issues related to security of funding and staffing are also highlighted. There are many opportunities for nurses to play a greater role in chronic disease prevention and management in rural and remote settings. Better outcome data are needed to show how investment and enhancing the role of nursing can benefit rural and remote Australians’ health care. In rural and remote areas, nurses and other health professionals can take on greater leadership roles as “agents of change” in developing innovative practice solutions, engaging individuals, families and communities, maximising the role of other staff groups, for example visiting medical and allied health professionals and resident support care staff, and the incorporation of new technologies into practice. However, adequate investment is vital to ensure there are enough nurses based in rural and remote settings, with adequate education and support and access to such opportunities.

Utilising three hypervariable microsatellite markers we have previously shown that scabies mites on people are genetically distinct from those on dogs in sympatric populations in northern Australia. This had important ramifications on the formulation of public health control policies. In contrast phylogenetic analyses using mitochondrial markers on scabies mites infecting multiple animal hosts elsewhere in the world could not differentiate any genetic variation between mite haplotype and host species. Here we further analyse the intra-specific relationship of Sarcoptes scabiei var. hominis with S. scabiei var. canis by using both mitochondrial DNA and an expanded nuclear microsatellite marker system. Phylogenetic studies using sequences from the mitochondrial genes coding for 16S rRNA and Cytochrome Oxidase subunit I demonstrated significant relationships between S. scabiei MtDNA haplotypes, host species and geographical location. Multi-locus genotyping using 15 microsatellite markers substantiated previous data that gene flow between scabies mite populations on human and dog hosts is extremely rare in northern Australia. These data clearly support our previous contention that control programs for human scabies in endemic areas with sympatric S. scabiei var. hominis and var. canis populations must focus on human-to-human transmission. The genetic division of dog and human derived scabies mites also has important implications in vaccine and diagnostic test development as well as the emergence and monitoring of drug resistance in S. scabiei in northern Australia.

Introduction: Health inequality of Australia’s remote populations continues to confound primary care funders and policy architects and challenge Australia’s new primary health commissioning organisations. Post codes are a proxy for lower life expectancy and early onset of preventable disease. For First Nations people the health differential is severe and compounded through social determinants including racism and economic disempowerment. Population decline and climate extremes are impacting on economies and health, and new approaches are urgently needed in authentic collaboration with communities and health leaders that live and work in remote areas. As national aspirations fail to close the gap, a new regional cross-cultural partnership is aiming to harness strengths of local communities, respect cultural authority, improve sustainability, and extract better value from health investment in remote areas. Cross-cultural Alliancing: NSW Outback Division of General Practice, a regional mainstream provider and broker of primary care services and Maari Ma Health Aboriginal Corporation, a regional Aboriginal Community Controlled Health Organisation (ACCHO) have co-designed an Alliancing framework that aims to systematically improve health outcomes through greater regional autonomy and capacity. Place-based Approach: The Murdi Paaki Region (translates as ‘Black Man’s River’) covers a land area of western NSW that is greater than the UK. Covering 8 local government authorities with more than 20 First Nations language groups, this catchment is defined by a First Nations Assembly with traditional and contemporary linkages of communities along the Barwon-Darling River system. This region is remote and people have poor access to health services and often a poor experience of care. Collectively they are amongst the most socio-economically disadvantaged populations in New South Wales. Case for change: •Very high burden of illness; •Up to a 15 year gap in life expectancy; •High rates of Preventable hospitalisation and ED presentations; •Disinvestment in regional organisations with increasing emphasis on digital services; •Competitive tendering creating greater fragility of local organisations; •Loss of local decision-making and influence; •No coherent strategy for remote health. Enabling Commissioning performance: Alliancing shapes a fragile market and assists local leadership to influence place-based commissioning efficacy and safeguard complimentary and supportive relationships across local organisations. It secures an integrated, culturally safe foundation on which to collectively build wider primary health capacity, investment, sustainability, and engagement. The Alliance provides a pragmatic ‘ground-up’ approach to operational challenges that collectively impact on remote organisations and encourages joint advocacy and co-design in solutions. Shared Services and Capabilities: Alliancing is exploring new shared service functions to be aligned with agreed organisational and system priorities including workforce support and development, shared health intelligence, planning, model of care refinement and strengthened clinical leadership inclusive of cultural safety considerations. Multi-institutional Academic partnerships are being nurtured and are aligned with population health and system level priorities. Key considerations: Contemporary industry-led approach to primary care innovation that elevates cultural safety as a critical enabler for partnership and universal model of care adoption and evaluation. Transparency and trust are foundations for co-design and innovation. Regional scale without compromising organisational and community sovereignty.

Background: The Northern Territory (NT) has the highest rates of domestic, family and sexual violence (DFSV) in Australia. Although we know that alcohol and other drug (AOD) use and trauma both contribute to DFSV in the NT, some specifics remain unknown. This paper aims to (a) describe the extent of AOD involvement in criminally serious DFSV, (b) describe the volume of trauma experienced by convicted criminally serious DFSV offenders, and (c) qualitatively explore the judicial recognition of the intersections between alcohol and trauma. To do this we reviewed Judicial Sentencing Remarks (JSRs) from the Supreme Court of the NT. Methods: A content analysis of all DFSV JSRs from July to Dec 2020 was undertaken (n = 64). A structured coding instrument was developed to extract quantitative and qualitative variables through repeated reviews by multiple authors. Descriptive statistics regarding demographics, number of significant traumatic events experienced, and AOD involvement were generated. The qualitative data from which these statistics were generated was used to explore the interplay between trauma and AOD involvement. Results: The majority of offenders had experienced at least one form of trauma. The social determinants of health underpinned a significant amount of this trauma, with housing, poverty, and unemployment frequently described. The use of alcohol as a maladaptive coping mechanism was explicitly recognised. There was frequent judicial recognition of the intersections between trauma, alcohol, and violence, however addressing trauma as an essential part of rehabilitation processes was rare. Conclusion: Trauma and AOD use were widespread among convicted DFSV offenders, with alcohol involved in the majority of incidents. Further research is required to understand the bio-psycho-social factors involved in the relationship between trauma, alcohol, and DFSV. Systematic piloting and trialling of interventions is necessary to determine what approaches are effective for preventing DFSV and reducing recidivism for people with intersecting experiences of trauma and AOD concerns.

Situational tele-mentorship refers to the use of technology to provide interactive, two-way communication between an advisor (the mentor) and a novice (mentee) to enhance the management of a dynamic clinical scenario in real-time.This article develops a conceptual framework to support situational tele-mentorship of healthcare professionals working in rural and remote practices by critically exploring the concept of mentorship within medical education literature and applied to healthcare professionals working in more isolated settings.The situational tele-mentorship framework consists of synchronous telecommunication technologies and the problem-solving process. The end-users of the framework are the mentor located centrally and the mentee dealing with a challenging situation at a remote location using communication technology. The problem-solving process? stages are preparation, identification, action, and evaluation. The mentor and mentee use the 5W1H model, which is a summary of the questions of who, what, where, when, why, and how, applied in two-way communication.This framework provides medical teachers and clinicians with a detailed, yet concise exposition of critical elements required to implement situational tele-mentorship. Healthcare providers can also use this framework to help coordinate resources and manage stakeholders in tele-mentoring situations.

Introduction: The residents of many Australian rural and remote communities do not have the essential infrastructure and services required to support healthy living conditions and community members choosing healthy lifestyle options. Improving these social determinants of health is seen to offer real opportunities to improve health among such disadvantaged populations. In this paper, we describe the development and trialling of a tool to measure, monitor and evaluate key social determinants of health at community level. Methods: The tool was developed and piloted through a multi-phase and iterative process that involved a series of consultations with community members and key stakeholders and trialling the tool in remote Indigenous communities in the Northern Territory of Australia. Results: The indicators were found to be robust, and by testing the tool on a number of different levels, face validity was confirmed. The scoring system was well understood and easily followed by Indigenous and non-Indigenous study participants. A facilitated small group process was found to reduce bias in scoring of indicators. Conclusion: The Healthy Community Assessment Tool offers a useful vehicle and process to help those involved in planning, service provision and more generally promoting improvements in community social determinants of health. The tool offers many potential uses and benefits for those seeking to address inequities in the social determinants of health in remote communities. Maximum benefits in using the tool are likely to be gained with cross-sector involvement and when assessments are part of a continuous quality improvement program.

The parasite Cryptosporidium is a common cause of gastroenteritis worldwide. Ineffectively focused interventions are partly why the disease remains a challenge to control. In this study, we describe the geographical, seasonal and demographic characteristics of reported cryptosporidiosis in Australia from 2001–2012. We combine this analysis of illnesses with evidence published in peer review articles and state health bulletins to identify high disease risk areas and populations. We find that rates of reported cryptosporidiosis are highest in warm, remote areas and in Aboriginal and Torres Strait Islander populations’ dominated regions. Our review of the published literature and health reports highlights a focus on short term outbreaks in metropolitan areas. This negligible overlap between areas with high disease rates and areas of public health focus is of concern. Public health interventions and promotion programs to prevent and control diarrhoea need to focus on remote and Indigenous dominated Australia to reduce the currently high rates in these regions and populations.

Everyday discrimination is a deeply personal experience, which is influenced by the wider community, as well as complex social and historical contexts. In Australia, the most recent national data for Aboriginal and Torres Strait Islander peoples reports the highest prevalence of everyday discrimination among those living in remote regions compared with urban and regional areas. Given the diversity in settlement types in remote Australia, a place-based analysis can inform the extent of discrimination experienced and the impact on communities. This study used a mixed method approach to identify Indigenous community member understandings of discrimination and quantify everyday discrimination in Central Australia by settlement. Drawing on workshop data from community members, we defined two research questions: Do experiences of everyday discrimination vary according to where people live? What role does community cohesion have on experiences of discrimination? We used data from the Mayi Kuwayu Study to explore these questions. The studyfound a high prevalence of everyday discrimination, with 70.6% (n/N = 369/523) of Mayi Kuwayu participants in Central Australia experiencing any discrimination which triangulated with people's experience of overt racism. Discrimination varied by settlement type, with higher prevalence of experiencing any discrimination among participants in Town Camps (unadjusted PR 1.33, 95%CI 1.18–1.50) and suburbs (1.19, 1.05–1.35) compared to participants from remote communities. High community cohesion attenuates the prevalence of the discrimination (0.87, 0.77–0.97). If health and social outcomes are to improve among Aboriginal people in remote areas, societal responses must acknowledge the high prevalence of discrimination in places where race and social inequalities are stark, act to confront interpersonal and systemic prejudices, and build cohesive communities.

Introduction The aim of this study was to describe the characteristics and outcomes of remote-dwelling pregnant people with threatened labour referred for aeromedical retrieval to a regional birthing centre, as well as factors associated with birth within 48 hours.Methods This was a retrospective observational study of all pregnant people in the remote Central Australian region referred to the Medical Retrieval Consultation and Coordination Centre for labour >23 weeks gestation, between 12 February 2018 – 12 February 2020. Data was extracted manually from written medical records on maternal, neonatal and retrieval mission characteristics. Univariate and multivariate statistical analysis was performed. Results There were 116 people referred for retrieval for labour. There were no births during transport and less than half of the cases in this cohort resulted in birth within 48 hours of retrieval. Tocolysis was frequently used. Predictors of birth with 48 hours were cervical dilatation 5cm or more, preterm gestational age and ruptured membranes in the univariate analysis. Nearly one-third of this cohort required intervention or had complications during birth.Discussion Birth during transport for threatened labour did not occur in this cohort, and more than half of retrievals did not result in birth within 48 hours, however the high risk of birth complications may offset any benefit of avoiding aeromedical transport from remote regions. Retrieval clinicians should have a lower threshold for urgent transfer in cases of ruptured membranes, cervical dilatation of 5cm or more, or gestational age is less than 37 weeks.

Cryptosporidium is a protozoan parasite that causes the diarrhoeal disease, cryptosporidiosis. Although many species have been identified, the majority of human disease worldwide is caused by two species; Cryptosporidium parvum and Cryptosporidium hominis. In Australia, data from the National Notifiable Diseases Surveillance System (NNDSS) show that cryptosporidiosis outbreaks occur every few years. To better understand the transmission, trends and nature of cryptosporidiosis outbreaks in Western Australia, epidemiological and genomic data from three cryptosporidiosis outbreaks in 2003, 2007 and 2011 were reviewed. The 2007 outbreak was the largest (n = 607) compared with the outbreaks in 2003 (n = 404) and 2011 (n = 355). All three outbreaks appeared to have occurred predominantly in the urban metropolitan area (Perth), which reported the highest number of case notifications; increases in case notifications were also observed in rural and remote areas. Children aged 0–4 years and non-Aboriginal people comprised the majority of notifications in all outbreaks. However, in the 2003 and 2007 outbreaks, a higher proportion of cases from Aboriginal people was observed in the remote areas. Molecular data were only available for the 2007 (n = 126) and 2011 (n = 42) outbreaks, with C. hominis the main species identified in both outbreaks. Subtyping at the glycoprotein 60 (gp60) locus identified subtype IbA10G2 in 46.3% and 89.5% of C. hominis isolates typed, respectively, in the 2007 and 2011 outbreaks, with the IdA15G1 subtype was identified in 33.3% of C. hominis isolates typed in the 2007 outbreak. The clustering of cases with the IdA15G1 subtype in the remote areas suggests the occurrence of a concurrent outbreak in remote areas during the 2007 outbreak, which primarily affected Aboriginal people. Both the C. hominis IbA10G2 and IdA15G1 subtypes have been implicated in cryptosporidiosis outbreaks worldwide; its occurrence indicates that the mode of transmission in both the 2007 and 2011 outbreaks was anthroponotic. To better understand the epidemiology, sources and transmission of cryptosporidiosis in Australia, genotyping data should routinely be incorporated into national surveillance programmes.

Dementia rates within Australian Aboriginal and Torres Strait Islander populations are estimated to be three to five times higher than non-Indigenous populations. Geographical and cultural barriers demand creative ways of delivering culturally appropriate effective dementia care. Focus groups and interviews with people (N = 73) from three Aboriginal Medical Services and communities explored attitudes toward, and experiences of dementia care and services. A thematic analysis highlighted the juxtaposition between biomedical and culturally appropriate models of dementia care. Services at the cultural interface can be adapted to facilitate appropriate dementia care at a local level allowing people to stay on Country, supported by people within one?s own Community.

Objective: Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. Methods: Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. Results: A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. Conclusions: A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

BACKGROUND: The integration of health care among providers to achieve good outcomes has been investigated in urban locations. However, more information is needed about what happens to people from rural areas, particularly when travelling away from their families and healthcare provider to receive hospital care. Therefore, a national project was conducted in 2004 that aimed: to document the experiences of people travelling to and from rural and remote areas to city hospitals; to identify factors that affect their optimal health outcomes; and to improve the exchange of information between primary healthcare providers and hospital staff. The Australian Rural Health Education Network (AHREN) coordinated the study, which consisted of several case studies. This article, part of the larger investigation, presents a segment on issues for Aboriginal people living in a rural and remote Australian area that were identified by local health workers, and suggestions that might assist in overcoming them. METHOD: Research and ethics approval was obtained from our university, hospital and the Aboriginal Health Council. Three Aboriginal health workers, employed at the community controlled Aboriginal health centre, involved in transport, consented to be audiotaped in a group interview. They are named researchers. Questions were: What are the issues in transfer to and from the city hospital? What special problems exist for the Aboriginal people you are involved with? What improvements/systems changes would you suggest? FINDINGS: Funding and equity of the Patient Assisted Transport Scheme (PATS) created problems. Raising payments for PATS and extra costs to clients and families were big issues. Antisocial arrival times, separation from family, transport to hospital and accommodation all caused distress and confusion. Potentially dangerous misunderstandings happened through language and cultural differences. Traditional people travelling unaccompanied were at risk. Often PATS notification requirements could not be met in emergencies and onsite accommodation was described as frightening and culturally inappropriate. At the time of interview, Stepdown transport did not cover people staying with families. Lack of privacy, different understandings of family and other issues important for Aboriginal people continue to add stress for families already suffering. DISCUSSION: PATS could be streamlined and more user-friendly. Aboriginal Liaison Officers in hospitals provide a link for Aboriginal clients, but unrealistic expectations may be placed on them and they are not available 24 hours a day. Strategies for improved communication are needed. A space and campfire in hospital grounds for traditional people and their families to gather would assist.

How do we keep our children safe from sexual abuse? This question underpins the grounded theory study in exploring how Aboriginal communities address child sexual abuse. Child sexual abuse has far-reaching consequences for the child, family, community, and society. Unfortunately, Australia’s child protection and criminal justice responses have had little impact on reducing the sexual abuse experienced by Aboriginal children in remote Australia. Using a Constructivist Grounded Theory (CGT) approach incorporating the voices of 23 Aboriginal research participants from the Northern Territory (NT), the theory of Both Ways Child Safeguarding is identified to underpin culturally informed, community-led strategies for preventing and addressing child sexual abuse. Through the Indigenist lens of the study, the capability and willingness of Aboriginal people to address the safety of their children, reminds us of the critical need for Aboriginal culturally informed solutions to such complex challenges. Both Ways Child Safeguarding is a theory to drive pragmatic solutions while contributing to transformational change that considers the impacts of colonisation on Aboriginal peoples and the perpetuity of Aboriginal culture to inform solutions to complex social challenges. The findings demonstrate the richness and complexity of Aboriginal cultural relationships, roles and obligations and the activism of Aboriginal peoples to be self-determining in matters relating to their children, families, and communities. It is a theory that positions Aboriginal cultural knowledge at the heart of child sexual abuse prevention and intervention while drawing upon Western knowledge and systems as appropriate. Both Ways Child Safeguarding forecasts the criticality for Aboriginal peoples and their allies to purposefully establish safe spaces from which to identify and address child sexual abuse.

Abstract Objective: The aim of this report is to discuss the results of a questionnaire conducted with occupational therapists providing services in rural and remote South Australia. It is envisaged that the results will be of interest to health professionals working in country areas of Australia. The questionnaire aimed at capturing descriptive information from these therapists in regards to the type of services they deliver and the strategies they employ to deliver services, including information on human resources and staff retention. Design and methods: A questionnaire sent to occupational therapy managers and yielded a 44% response rate. Results: Results provide descriptive information on the services provided, for example, the vast geographical areas covered. Respondents described the challenges they face in service delivery and these include the wide range of services to diverse client groups, high client:therapist ratio and limited human resources. Examples of strategies used are less labour-intensive service delivery models, multi-skilling of staff, networking and use of problem-solving techniques. Most perceived their services to be addressing client needs and they felt supported in their roles by other occupational therapists and their organisations. Conclusions: Occupational therapists working in rural and remote South Australia are overcoming the challenges identified in this questionnaire by implementing innovative strategies.

Japanese encephalitis virus (JEV) appears nearly annually in the Torres Strait in far northern Queensland, Australia, and is a threat to invade the Australian mainland. Surveillance has involved the use of sentinel pigs that develop detectable viremias and antibody titers to JEV. However, pigs are amplifying hosts for JEV, and thus pose a health risk to the public and to pig handlers who bleed the pigs. A remote mosquito trap system would not have these risks. We report on trials using a remote mosquito trap system for the surveillance of JEV in the Torres Strait. The Mosquito Magnet (MM) Pro®, MM Liberty Plus®, and a novel updraft trap, the NAQS Mozzie Trap, were run at Badu and Moa islands in the Torres Strait and at Bamaga in the northern Cape York Peninsula from 2002-2005. TaqMan real-time polymerase chain reaction (PCR) was used to detect JEV nucleic acid in weekly mosquito collections. Sentinel pigs located at Badu were also bled and the serum processed by reverse transcriptase (RT)-PCR for JEV antigen and enzyme-linked immunosorbent assay (ELISA) for anti-JEV antibodies. JEV was detected in mosquito collections each year but not in each trap. No JEV was detected in trapped mosquitoes before detection in sentinel pigs. The mosquito trap system cost ca. AU$10,000 per site, about AU$5,000 less than a pig-based system. However, trap failures caused by mosquito-clogged motors, electrical faults, and blocked gas lines reduced the efficacy of some mosquito traps. Nonetheless, a remote mosquito trap system, employing stand alone traps and PCR for viral antigen detection, can be a safe, economical way to detect arbovirus activity in remote areas.

Abstract Silence is a powerful concept that many read in stark metaphorical, binarised and/or ahistorical terms. By contrast, sound historians can show how metaphors like silence take on specific historical power, but elide complexity in the heard world, and how they change. This article uses Robyn Davidson?s popular travelogue, Tracks (1980), to investigate how the non-Indigenous meanings of the iconic motif of Central Australian silence were shifting in the 1970s, in line with acoustic ecology and second-wave feminism that positively valorised certain sorts of quiet and/or listening. But silence is multivalent and it also developed negative metaphorical connotations in the 1970s, especially as shorthand for the way many Australians had obscured Indigenous presence. By reconceiving 1970s silence as entangled with noise, we can better understand complexity and change in these non-Indigenous soundscapes.

Abstract Mitigating climate change requires us to constrain combustion in a double sense: decreasing both the use of fossil fuels and the flammability of the biosphere. Fire management by Indigenous peoples in Australia's northern savannas has been presented as a solution to offset the former and assist with the latter, leading to the foundation of a regional economy of projects generating 'premium' carbon credits on Indigenous lands. This article attends to the translational zone - predominantly made up of non-Indigenous white professionals - that functions to configure the 'right story' of these credits across diverse epistemes and contexts. Following such commodities' interscalar connections, I suggest, helps illustrate the contingencies and contradictions produced by tradeable carbon, as individuals and organizations seek to maintain a niche within a changing climate and shifting global atmospheric relations.

Abstract The relationships between local governments and Indigenous institutions in Australia are unstudied, despite both being oriented to the local level. Related research focuses on the performance of Indigenous local governments, Indigenous forms of governance and its relation to local government, relations between local governments and Indigenous communities, and the intercultural dynamics of Indigenous and Western governance frameworks in local governments. This article presents the findings of a study that examines relations between local governments and Indigenous institutions in the Torres Strait, a relationship that is framed by s. 9(3) of the Local Government Act 2009 (Qld) (LGA) that allows local governments to ?take account of Aboriginal tradition and Island custom?. A framework adapted from health-related studies, consisting of three alternative policy approaches?mainstreaming, indigenisation, and hybridisation?is used in this study to characterise relationships between local governments and Indigenous institutions. Kinship and country, two important Indigenous institutions, are marginalised in Queensland's mainstream system of local government, which in turn creates obstacles for Aboriginal and Torres Strait Islander people from participating and engaging in local government processes. Points for Practitioners Government that does not recognise the institutions which are fundamental to how Indigenous people govern will marginalise them from power.

Abstract Objective To explore the impact of providing nursing and midwifery student placements from the perspective of regional, rural and remote health service staff involved in hosting students. Setting Hospital and health services across regional, rural and remote southern Queensland. Participants Thirty-six nursing and midwifery staff working in clinical and/or management roles who were direct clinical supervisors of students or in leadership positions with responsibility for overseeing and supporting clinical placements. Design Semi-structured interviews exploring the experiences and perspectives of nursing and midwifery health service staff who support student placements. Data were subject to thematic analysis. Results Five key themes were identified as follows: (a) bringing new ideas and perspectives, (b) opportunities for development, (c) supporting the future rural workforce (d) impacts on workload and productivity and (e) strategies for balancing supervision. Conclusion The results indicate that there are a range of perceived benefits and challenges of providing nursing and midwifery student placements within regional, rural and remote settings. The findings also indicate that there are opportunities to further support rural health services to optimise the positive impacts and mitigate the challenges of providing placements. To do so requires collaboration between health services and education providers to allocate students appropriately to health services and support health service staff.