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Background: In July 2018, participants at a Waiben (Thursday Island) conference declared that it was time for a locally driven research agenda for the Torres Strait and Queensland Northern Peninsula Area. For decades, they felt exploited by outside researchers. They identified a lack of respect and consultation, with few benefits for their people. Methods: In response, the Australian Institute of Tropical Health and Medicine (Waiben Campus-Ngulaigau Mudh) invited a consultative group of elders and senior health providers to develop a research program based on local cultural and health needs. The aim was to promote research skills through a learn-by-doing approach. Four workshops were conducted over 2019. Key financial and in-kind support was provided by the Australian Institute of Tropical Health and Medicine, Hot North, and Queensland Health's Torres and Cape Hospital and Health Service. Results: The first workshop attracted 24 people; none had previous research experience. The workshop format evolved over 2019, mainly guided by the participants. Overall, feedback was positive, and participant research proposals remain in various stages of development. Conclusions: Although suspended during the COVID-19 pandemic, this is a long-term investment in community-driven research that seeks to translate health benefits to the people. This model may apply to other communities, especially in rural and remote Australia. Warning:This article contains the names and/or images of deceased Aboriginal and Torres Strait Islander peoples.

Domain separation was one of the strategies advocated by Stephen Harris. While some have seen merit in this approach, others have contested it. This article reviews the debate in the context of Aboriginal bilingual educationBilingual education in the Northern Territory. As the second author had participated in that debate, his reflections have been included.

The chapter explores the research processes and outcomes and some of my own personal experiences in a collaborative community-based research project at Yirrkala. Yolŋu elders, a younger generation of Yolŋu educators, and non-local educators and teacher-educators initially undertook a research project to improve mathematics education for Yolŋu students and ended up transforming the way education was delivered at Yirrkala. Where does Stephen Harris fit in you might wonder? Firstly, he was a leading light in theorising the unique kind of bilingual educationBilingual education under development in the Northern Territory. He went on to support communities in their efforts to transform the bilingual education program. His advocacy and his efforts to make these programs theoretically rigorous and accepted at a system level gave us a framework to work with, and a platform to debate educational issues pertaining to the development of ‘bothways’ education.

In Charles Darwin University 1985 a paper by Stephen Harris and Beth Graham pointed out a number of ways in which linguistic research could contribute to bilingual educationBilingual education, with which they were concerned in a Northern Territory (NT) context. The present paper attempts to provide a brief history of linguistic (and other language) research in the NT to examine the extent to which linguists (and others) have indeed been making such contributions. It begins by considering the various work on NT languages before the 1960s, the increased focus on NT languages during the 1960s, the impact of the coming of bilingual education in the 1970s, the heyday and then decline of bilingual education in the 1980s, the impact of the new Northern Territory University in the 1990s, and subsequent developments.

This paper elaborates the history which lies under the present situation we have at the Yirrkala Community School.

This chapter explores John Harris and Stephen Harris’s shared interest in Aboriginal languages and their intrinsic role in the maintenance of culture. The words of a rap song performed by Groote Eylandt youth say ‘We walk two roads’, a major theme of Stephen’s life work in bilingual education, what he called ‘two-way education’. The rap song also proclaims, ‘Strong language, strong mind’, naming the deep truth that language is the carrier of culture, without which culture cannot be labelled, envisioned or discussed. The chapter then goes on to consider damaged or ‘sleeping’ languages and whether they can be ‘reawakened’. A major case study demonstrates that Bible translation into the endangered Nyoongar language has prompted language recovery and raised people’s sense of identity and self-esteem.

Stephen Harris’s ability to share his knowledge and researchHarris, Stephenresearch on learning styles with those involved in the Northern Territory’s bilingual programs for remote Indigenous-language-speaking students ensured the highest quality of bilingual program delivery. His professional influence and socialjustice agenda positively impacted teachers’ practice, as they worked with him in this field. In many discussions and meetings, he revealed important evidence-based truths about cross-cultural knowledges and ways of viewing the world. Stephen’s prolific writing in this field has greatly influenced teachers’ orientations to cross-cultural teaching in these contexts. It is with respect and thanks that we acknowledge his work and ongoing positive influence on the effectiveness of bilingual education and cross-cultural teaching in remote NT communities.

This article is based on a collaborative evaluation of the implementation of a Libraries and Knowledge Centre (LKC) model in three remote Indigenous communities in the Northern Territory. It outlines the context in which LKC services are being implemented, provides a brief description of the LKC model, and discusses some strengths of the model to deliver relevant and sustainable services to Indigenous communities in these changing times. The article highlights some of the more challenging issues that emerge in such a complex knowledge and information context, as well as issues relating to the broader challenges in delivering sustainable services in remote Indigenous communities in the current policy context.

CONTEXT: Access to healthcare for rural Australians is a wicked problem, particularly for rural people with disability. Contemporary healthcare access frameworks in Australia tend to overlook geography, use a 'one-size-fits-all approach', and disregard the valuable relationships between key rural healthcare stakeholders, including rural people with disability, rural health services and health professionals. The United Nation's Convention on the Rights of Persons with Disabilities requires the Australian Government to engage people with disability in the design of policies that will shape their day-to-day lives, including their access to healthcare. However, the nature and extent to which rural people with disability, rural health professionals and other key rural stakeholders are involved in the design of Australian policies impacting the health of rural people with disability are unknown. AIM: This paper examines approaches taken to engage rural people with disability and health professionals in the design of Australian disability policy impacting healthcare access, and reimagines future processes which can improve healthcare access for rural people with disability. APPROACH: Co-design and ethics of care lenses are applied to policy design approaches in this paper. We approach this work as rural disability and health academics, rural health professionals, and as rural people with disability, neurodivergence and family members of people with disability. CONCLUSION: We argue future co-designed policy approaches could focus on driving change towards equity in healthcare access for rural people with disability by harnessing the relational nature of rural healthcare.

Objective Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions. Methods The study was a quasi-experimental before–after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR. Results The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support. Conclusions The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.What is known about the topic? PR including exercise training, education, and psychosocial support, is an effective and well evidenced management strategy for people with chronic obstructive pulmonary disease (COPD) that improves exercise capacity and quality of life, and reduces hospital admissions and length of stay. Despite the fact that participation in PR is seen as an essential component in the management of COPD, access remains limited, particularly in rural and remote regions. Difficulties with establishing and maintaining PR have been attributed to lack of physical and financial resources and adequately trained and skilled staff. There have been no published reports evaluating the impact of training programs for healthcare professionals in the provision of PR. What does this paper add? This paper is the first to demonstrate that the delivery of a well supported, interactive healthcare professional training program may facilitate the establishment of PR in rural and remote regions. Following delivery of the BEWE program, PR which broadly met the Australian recommendations for practice in terms of program content and structure, was established. Factors influencing the establishment of PR were related to the characteristics of the healthcare setting, such as remoteness, and to issues around staff retention. The settings where PR was not established were in less well-staffed, community-based, more remote settings. People with COPD who participated in these programs showed significant improvements in exercise capacity and quality of life. What are the implications for practitioners? One of the factors limiting the delivery of PR may be a lack of appropriately trained and skilled staff. Healthcare professionals’ participation in locally provided education and training programs targeted at developing skills for providing PR may enable effective PR programs to be established and maintained in rural and remote regions.

Background: Australians living in rural and remote areas are at elevated risk of mental health problems and must overcome barriers to help seeking, such as poor access, stigma, and entrenched stoicism. e-Mental health services circumvent such barriers using technology, and text-based services are particularly well suited to clients concerned with privacy and self-presentation. They allow the client to reflect on the therapy session after it has ended as the chat log is stored on their device. The text also offers researchers an opportunity to analyze language use patterns and explore how these relate to mental health status. Objective: In this project, we investigated whether computational linguistic techniques can be applied to text-based communications with the goal of identifying a client’s mental health status. Methods: Client-therapist text messages were analyzed using the Linguistic Inquiry and Word Count tool. We examined whether the resulting word counts related to the participants’ presenting problems or their self-ratings of mental health at the completion of counseling. Results: The results confirmed that word use patterns could be used to differentiate whether a client had one of the top 3 presenting problems (depression, anxiety, or stress) and, prospectively, to predict their self-rated mental health after counseling had been completed. Conclusions: These findings suggest that language use patterns are useful for both researchers and clinicians trying to identify individuals at risk of mental health problems, with potential applications in screening and targeted intervention.

Proceedings of the Australian Rangeland Society 20th Biennial Conference: Resilient future rangelands: integrating environment and livelihoods

Objective:To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact.Methods:A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic.Results:Just over half of the services? clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%).Conclusions:Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic.

This summary is intended to give an overview only: it merely skims the surface of the information to be found in the body of the report. More detailed summaries can be found at the beginning of each indicator throughout the report. This summary briefly outlines the major findings for each indicator, and is organised sequentially by the three Framework tiers and in the order that indicators are described in the report.

Men in rural regions of Australia may face distinct health issues because of their location, work and lifestyle. This report provides a snapshot of some of these issues and compares the illness and mortality of men in rural and urban areas.Overall, men in rural areas are more likely than their urban counterparts to experience chronic health conditions and risk factors. For example, they: are more likely to report daily smoking and risky drinking behaviour; are less likely to possess an adequate level of health literacy; have higher mortality rates from injury, cardiovascular disease and diabetes. This report is a useful resource for policymakers, researchers and others interested in emerging men's health policies in Australia.

For remote Indigenous communities prepaying for electricity in Australia’s Northern Territory, temperature extremes increase reliance on the services that energy provides and the risk of disconnection of those services. Policy should focus on reducing the frequency, duration and negative impacts of disconnection, within the context of a warming climate.

This paper presents a geospatial framework for the documentation and analysis of naturally-occurring locational points in interaction. This novel approach aims to provide a set of methods and procedures for interrogating geographically-enriched interactional data. GPS and GIS metadata and satellite imagery are brought to bear on video-recorded multiparty interactions to situate pointing gestures within the broader topographic setting, allowing the directionality of points to be determined to within a few degrees. The methods illustrated in this paper primarily aim to assist research on the relationship between language, gesture, and spatial cognition. By examining and comparing naturally-occurring locational points produced by speakers of typologically different languages (namely English, Gija, Murrinhpatha, and Jaru) this paper demonstrates how a geospatial approach may facilitate systematic comparisons of pointing styles across languages, contexts, and cultures, and support investigations into universals of human conduct.

We present a comparison of practices of person reference in three different Australian Aboriginal language communities and discuss how the selection of referring expressions contributes to an ‘epistemics of social relations’. In all three communities, while names and nicknames are common ways of referring to non-present referents, kinterms serve to position referents within communal space, and thus within the epistemic domain of the participants. Conversely, we find that generic descriptors (e.g. whitefella, policeman) are commonly used for outsiders, even when their names are known. As highly specific relational descriptors, kinterms thereby accentuate participants' relative rights and responsibilities to know about the referents and their concerns. As non-relational terms generic descriptors do not place referents within the communal epistemic domain and they do not provide information about participants' rights and responsibilities with respect to those referents. We show here how the selection of kinterms and generics are locally managed in conversation to position referents with respect to a communal epistemic domain.

Aims and objectives:Language contact in the Yaruman community of Western Australia has led to prevalent bilingual practices between the endangered language Jaru and the creole language Kriol. This study examines ordinary conversations in the community and investigates whether the observable bilingual practices are interactionally relevant, and whether codemixing has led to the emergence of a conventionalised mixed language.Approach:The research is based on a qualitative analysis of bilingual speech in natural conversation. The approach combines the methodological framework of interactional linguistics with an analysis of the grammatical structures of conversational data.Data and analysis:The analysed data consist of two hours and thirty minutes of transcribed video recordings, comprising 13 casual multi-party conversations involving all generations in the Yaruman community. The recordings were made using lapel microphones and two high-definition cameras.Findings:Bilingual Jaru?Kriol speakers use codeswitching as an interactional resource for a range of conversational activities. In many cases, however, speakers? code choices are not interactionally relevant. Instead, codemixing is often oriented to as a normative way of speaking and participants exploit their full linguistic repertoire by relatively freely combining elements from both languages. There are also signs of morphological fusion in the mixed speech of younger Jaru speakers, who more frequently combine Kriol verb structure and Jaru nominal morphology. However, this morphological split is not fully conventionalised and variation is still substantial.Originality:The bilingual speech continuum is supported by the analysis of conversational data in a situation of language shift. This article shows that fusion involving core grammatical categories can occur among a subgroup of speakers without developing into a community-wide mixed language.Significance:The study contributes to a better understanding of community bilingualism and bilingual practices in a situation of language shift. It demonstrates how codeswitching, codemixing, and grammatical fusion can co-exist in a bilingual community.

Unaddressed hearing loss affects an estimated 466 million people worldwide, costing over $750 billion globally, with rural communities being particularly disadvantaged, due to the greater inequity in access to healthcare services. This mixed-methods study aimed to use the PRECEDE-PROCEED model to develop and pilot a rural community pharmacy-based ear health service, LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Program). The PRECEDE process involved an assessment of the predisposing, reinforcing and enabling constructs to support practice change through a scoping review, stakeholder surveys and interviews and consultation with governing bodies and regulatory authorities. The PROCEED segment structured the evaluation of the service pilot and informed planned implementation, process, impact and outcome evaluation. The pilot study conducted in February 2021 included 20 participants, with the most common ear complaints presented being pain, pressure or blockage. All these participants reported high levels of satisfaction with the service, would recommend the service to others and would attend the pharmacy first before seeing a GP for future ear complaints. The PRECEDE-PROCEED model provides a comprehensive model to guide the design of the LISTEN UP program, an innovative model, expanding services offered by rural community pharmacies, with preliminary results demonstrating high consumer satisfaction.

Selina Taylor studied pharmacists, consumers, health professionals and stakeholders perspectives of expanded pharmacy practice and integrated her findings to develop and pilot an ear health intervention for rural community pharmacy. This study highlights the challenges and enablers of expanded services for rural and remote community pharmacy in Australia.

Research capacity building in healthcare works to generate and apply new knowledge to improve health outcomes; it creates new career pathways, improves staff satisfaction, retention and organisational performance. While there are examples of investment and research activity in rural Australia, overall, rural research remains under-reported, undervalued and under-represented in the evidence base. This is particularly so in primary care settings. This lack of contextual knowledge generation and translation perpetuates rural–metropolitan health outcome disparities. Through greater attention to and investment in building research capacity and capability in our regional, rural and remote health services, these issues may be partially addressed. It is proposed that it is time for Australia to systematically invest in rurally focussed, sustainable, embedded research capacity building.

The invasive grass-fire cycle is a widely documented feedback phenomenon in which invasive grasses increase vegetation flammability and fire frequency, resulting in further invasion and compounded effects on fire regimes. Few studies have examined the role of short-term adaptation in driving the invasive grass-fire cycle, despite invasive species often thriving after introduction to new environments. We used a replicated (nine locations), paired sampling design (burn vs unburnt sites) to test the hypothesis that roadside burning increases genetic diversity and thus adaptive potential in the invasive, high-biomass grass Cenchrus ciliaris. Between four and five samples per site (n = 93) were genotyped using the DArTseq platform, and we filtered the data to produce panels of 15,965 neutral and 5030 non-neutral single nucleotide polymorphism (SNP) markers. Using fastSTRUCTURE, we detected three distinct genetic clusters with extremely high FST values among them (0.94-0.97) suggesting three different cultivars. We found high rates of asexual reproduction, possibly related to clonality or apomixis common in this species. At three locations, burnt and unburnt sites were genetically different, but genetic structure was not consistently related to fire management across the study region. Burning was associated with high genetic diversity and sexual reproduction in one genetic cluster, but with low genetic diversity and clonality in another. Individual SNPs were associated with longitude and genetic clustering, but not with recent fire management. Overall, we found limited evidence that roadside burning consistently increased genetic diversity and adaptive potential in C. ciliaris; evolutionary and breeding history more strongly shaped genetic structure. Roadside burning could therefore continue to be used for managing biomass in this species, with continued monitoring. Our study provides a framework for detecting fire-related changes on a genetic level - a process that could be used as an early warning system to detect the invasive grass-fire cycle in future.

Background Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Underrecognition of chronic wet cough by parents and clinicians and underdiagnosis of PBB by clinicians are known. Research Question We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodologic approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice. Study Design and Methods A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February 2017 to December 2019). Our KT strategy included the following: (1) culturally secure (ie, ensuring Aboriginal people are treated regarding their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children, and (2) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by physicians. Results Post-KT, health seeking for chronic wet cough increased by 184% (pre = eight of 630 children [1.3%], post = 23 of 636 children [3.6%]; P = .007; 95% CI, 0.7%-4.0%). Physician proficiency in management of chronic wet cough improved significantly as reflected by improved chronic cough-related quality of life (P < .001; 95% CI, 0.8-3.0) and improved physician assessment of cough quality (P < .001; 95% CI, 10.4%-23.0%), duration (P < .001; 95% CI, 11.1%-24.1%), and appropriate antibiotic prescription (P = .010; 95% CI, 6.6%-55.7%). Interpretation Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Physician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed.

Background The Northern Territory (NT) has the highest tuberculosis (TB) rate of all Australian jurisdictions. We combined TB public health surveillance data with genomic sequencing of Mycobacterium tuberculosis isolates in the tropical ‘Top End’ of the NT to investigate trends in TB incidence and transmission. Methods This retrospective observational study included all 741 culture-confirmed cases of TB in the Top End over three decades from 1989–2020. All 497 available M. tuberculosis isolates were sequenced. We used contact tracing data to define a threshold pairwise SNP distance for hierarchical single linkage clustering, and examined putative transmission clusters in the context of epidemiologic information. Findings There were 359 (48%) cases born overseas, 329 (44%) cases among Australian First Nations peoples, and 52 (7%) cases were Australian-born and non-Indigenous. The annual incidence in First Nations peoples from 1989-2019 fell from average 50.4 to 11.0 per 100,000 (P<0·001). First Nations cases were more likely to die from TB (41/329, 12·5%) than overseas-born cases (11/359, 3·1%; P<0·001). Using a threshold of ≤12 SNPs, 28 clusters of between 2–64 individuals were identified, totalling 250 cases; 214 (86%) were First Nations cases and 189 (76%) were from a remote region. The time between cases and past epidemiologically- and genomically-linked contacts ranged from 4·5 months to 24 years. Interpretation Our findings support prioritisation of timely case detection, contact tracing augmented by genomic sequencing, and latent TB treatment to break transmission chains in Top End remote hotspot regions.