Remote Australia Online

This paper explores strategies that support Aboriginal parents’ mastery of evidence-based early learning strategies, and their impact on young Aboriginal children’s learning outcomes. The three-year study followed 32 parent-child dyads attending Families as First Teachers (FaFT) playgroups in two remote Northern Territory communities in 2015–2017. Trained FaFT staff provided parents with coaching in the use of Conversational Reading—an evidence-based shared reading strategy in first language—at FaFT. The study examined patterns of parent mastery across the three-year study period, the relationship between levels of parent-child participation at FaFT (program dosage) and parent mastery, and the impact of parent mastery of Conversational Reading on young Aboriginal children’s language and learning outcomes. By including measures of parent-child participation and parent mastery of key program strategies at three time points, the study also provides a picture of the fidelity of program implementation across the study period. The findings indicate that parents’ mastery of strategies (and thus the fidelity of program implementation) increased over time in line with the program dosage parents received. Higher levels of parent-child participation at FaFT and parent mastery of strategies at the end of the program were positively associated with children’s language and learning outcomes. This study demonstrates that the provision of coaching at playgroup is an effective way to build parent capacity in the implementation of evidence-based early learning strategies, and that supporting parent mastery of teaching strategies has the potential to improve the learning outcomes of young children in remote Aboriginal communities.

OBJECTIVE: To assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia. METHOD: Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n = 49, followed over two years) and cross-sectional community samples (n = 200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour). RESULTS: For the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management. CONCLUSIONS: Community control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease. IMPLICATIONS: Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.

During human T-cell leukemia virus type 1 (HTLV-1) infection, the frequency of cells harboring an integrated copy of viral cDNA, the proviral load (PVL), is the main risk factor for progression of HTLV-1-associated diseases. Accurate quantification of provirus by droplet digital PCR (ddPCR) is a powerful diagnostic tool with emerging uses for monitoring viral expression. Current ddPCR techniques quantify HTLV-1 PVL in terms of whole genomic cellular material, while the main targets of HTLV-1 infection are CD4+ and CD8+ T cells. Our understanding of HTLV-1 proliferation and the amount of viral burden present in different compartments is limited. Recently a sensitive ddPCR assay was applied to quantifying T cells by measuring loss of germ line T-cell receptor genes as method of distinguishing non-T-cell from recombined T-cell DNA. In this study, we demonstrated and validated novel applications of the duplex ddPCR assay to quantify T cells from various sources of human genomic DNA (gDNA) extracted from frozen material (peripheral blood mononuclear cells [PBMCs], bronchoalveolar lavage fluid, and induced sputum) from a cohort of remote Indigenous Australians and then compared the T-cell measurements by ddPCR to the prevailing standard method of flow cytometry. The HTLV-1 subtype c (HTLV-1c) PVL was then calculated in terms of extracted T-cell gDNA from various compartments. Because HTLV-1c preferentially infects CD4+ T cells, and the amount of viral burden correlates with HTLV-1c disease pathogenesis, application of this ddPCR assay to accurately measure HTLV-1c-infected T cells can be of greater importance for clinical diagnostics and prognostics as well as monitoring therapeutic applications.

Objective To determine the factors impacting the experiences of James Cook University medical students on solo placements in remote towns. Design This 2018 pilot study used an exploratory sequential mixed-methods approach to explore the recent solo remote placement experiences of James Cook University medical students. Qualitative interviews were performed initially to elicit context sensitive themes for the self administered survey. The survey went on to use Likert-scale questions in addition to pre-validated survey instruments. Setting Focus groups and interviews took place at James Cook University Medical School in Townsville in late 2018 after students returned from their rural rotation. Two telephone interviews were conducted for Year 6 students unable to attend the focus groups. Participants James Cook University medical students in years 2, 4 and 6 students who experienced a solo placement in a remote (MMM 6 or 7) town during 2017 or 2018 were invited to be part of the study. Only Townsville-based students were involved. A total of 14 students participated in the focus groups (n = 14) and a further 31 students completed the survey (n = 31). Main outcome measure(s) Interviews identified themes negatively or positively impacting solo remote placement experience, while bivariate analysis identified factors associated with having an ?excellent? overall experience. Results Student interviews identified five main themes impacting student experience in remote communities: culture of the medical facility; quality and quantity of clinical experiences; quality of accommodation; placement length; and community infrastructure and services. Negative impacts could result in students experiencing social isolation. Students reporting an ?excellent? solo remote placement experience in the survey were more likely to have: felt very welcome in the community; felt the health staff supported them; heavily involved themselves in clinical activities; enjoyed the experiences remote communities can offer; positive rural career intentions; reported they ?bounce back during and after life's most stressful events?; and come from a rural or remote hometown. Conclusions Solo remote placements provide medical students with opportunities to further knowledge, clinical capabilities, social experiences and careers, but can have negative aspects. However, negative aspects are often modifiable management issues or can potentially be avoided if prospective students are better informed of the challenges associated with remote communities.

Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians. A systematic literature review aimed to synthesize the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention, and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes. Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available and a lack of consistency between dietary outcomes collected in research to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities.

Aim Fire is particularly frequent, complex and contentious in the vast tropical savannas of northern Australia, where declines in many threatened species are associated with fire, and substantial areas are under fire management for greenhouse gas abatement. Controlled field experiments are crucial for understanding biodiversity responses, and here I present key insights into faunal responses to fire that have been revealed by them, along with their lessons for fire management. Location Australian monsoonal tropics. Methods Results are synthesized from six replicated fire experiments that have been conducted in Australian savannas and include multispecies assessments of fauna. The synthesis also draws on other fire studies and is presented in the form of five key insights into faunal responses. Results The key insights are as follows: (a) most faunal groups are extremely resilient to fire, with highly contrasting fire regimes often having little or no detectable impact on species abundances, at least in the medium term; (b) the most important effects of fire are typically indirect through habitat modification, even when there is substantial direct mortality; (c) fire intensity is not as important a factor as is widely thought; rather, fire frequency is particularly important; (d) there will always be winners and losers with any fire; and (e) fire is required for the maintenance of diversity. Main conclusions These insights have important implications for conservation management in Australian savannas: management needs to focus on fire-induced changes to habitat suitability, and to consider faunal outcomes at the landscape scale; a combination of frequently (every 2?3 years) and less frequently (every ≥5 years) burned habitat may adequately conserve the great majority of animal species without a need for complex fire mosaics; special management attention is required for frequent-fire losers because of an extremely low representation of longer-unburnt habitat; and fire needs to be actively managed to promote diversity, not excluded. The insights are widely applicable to tropical grassy ecosystems more generally, and some appear to be universal to fire-prone biomes.

This thesis addresses the question of what happens when digital language resources are developed and become entangled with different types of language work in Indigenous languages of Australia's Northern Territory. It explores three specific sociotechnical assemblages, defined as heterogeneous sets of social and technical resources functioning together for various purposes. The types of language work that emerged were the role of language in practices of documentation, pedagogy and identity-making. The three projects under consideration respond to different motivations: the Living Archive of Aboriginal Languages is a digital archive of endangered literature in languages of the Northern Territory, motivated by a concern for the fate of materials produced in bilingual education programs in remote schools. The Digital Language Shell is a resource for developing and mobilising curricula in Indigenous languages and cultures, motivated by a need for a low-cost and low-tech template for sharing content under Indigenous authority. The Bininj Kunwok online course is a specific implementation of the Digital Language Shell, teaching an Indigenous language of West Arnhem land in a university context. Each project was created by the author working collaboratively with different teams, to support various types of language work. This PhD by publication offers a set of seven academic papers, each focusing on different aspects of the projects, and written for distinct audiences. The methods entailed iterative inquiry, as I reflected on my work as project manager in developing these digital resources, first addressing the technical and practical considerations, then through the lenses of various academic disciplines, and finally in a meta-analysis of the various heterogeneous elements that make up the research. The thesis emerges as an assemblage of heterogeneities – projects, papers, concepts, academic references, and auto-ethnographic stories – that is in itself a sociotechnical assemblage.

Education provides opportunities for adolescents to make developmental gains. Remote Indigenous adolescents not engaged in education programs need alternate learning opportunities to reach developmental goals. This review identifies attributes that contribute to an alternate model of education within the existing literature and reports on the quantity and nature of evidence. Thirty-seven databases and grey literature were canvassed using strict search criteria. Analysis of papers was conducted to find the enablers of alternate models by identifying the conditions, strategies and outcomes the intervention produced. Papers were categorised according to their nature by Canada’s Hierarchy of Evidence and the Sanson-Fisher model. There was limited literature on alternate models of education for Indigenous adolescents in settings outside a school environment. Three papers were classified as descriptive and ten as intervention research. All papers were described as “emerging” and “promising” practices. The five attributes embedded within a model included 1) cultural connectedness and awareness; 2) being contextually designed;3) fosters relationships with peers and adults; 4) specific teaching and learning strategies and; 5) holistic outcomes. The findings will contribute to the co-design of an alternate model of education for remote Indigenous communities. Gaps identified in the literature included examples of “best practice” models and highlighted the need for further research of innovative models that move from descriptive research to form an evidence base.

This article outlines the rationale for, and development of an online support system (OSS) for teachers of mathematics in regional, rural and remote (RRR) Australia as part of an ongoing longitudinal project, Regional Teachers of Mathematics Networks (RTMN).The OSS is designed to assist development of interconnected collaborative networks for teachers of mathematics in order to help them develop their professional identity. The article builds on the logic of the broader RTMN project, arguing that the development of a teacher of mathematics identity (ToMI) framework through participation in networked communities of practice (CoPs)is integral to improved practice and teacher retention. Theoretical considerations, framed within the overarching conceptual umbrella of cultural accumulation theory, are provided and relate mathematics CoPs to professional development and its role in the development of a ‘localised’ teacher of mathematics identity. This framing outlines the importance of an OSS that supports both face-to-face and online (virtual) CoP functions for teachers of mathematics. The article also states the case for a design-based implementation research approach that allows stakeholders to sustain ongoing evaluation and updating of the OSS platform for professional learning exchanges within the ToMI framework.

Objective: A review of the literature was conducted to describe and discuss the link between food security and traditional food access, availability and use in remote Aboriginal communities. Concepts and themes were revealed from the literature and the evidence examined to justify carrying out further research. Background: Evidence suggests that Aboriginal people were healthy before European settlement and did not suffer from chronic lifestyle and nutrition related diseases. A rapid transition from a well-balanced, varied and nutrient dense diet to a diet today, which is energy dense, high in saturated fat and sugar has brought about a significant health transition. Aboriginal people in remote regions of Australia suffer higher rates of lifestyle and nutrition related diseases than any other Australians. Methods: A systematic literature search examined specific computerised databases. Relevant journals and authoritative texts were examined. Prominent authors were identified from the literature and individual author searches were conducted. Reference lists were examined from the literature retrieved. Specific themes were identified from the data collected and critically analysed in the main body of the literature review. Discussion: An overview and critical analysis of the literature related to traditional food and food security were presented. Traditional foods contribute positively to the diets of Aboriginal people as well as being socio-economically valued. The use of traditional foods must be examined further and precautions made to safeguard these foods from contaminants, particularly heavy metals and mining residues. Threats from introduced pests like cane toads and natural and human induced environmental change are constant challenges. Conclusion: Although there is limited information available on the access, availability and use of traditional foods, these gaps in literature should be examined further. The access, availability and use of traditional foods have the potential to recover, improve and safeguard food security in remote Aboriginal communities now and in the future will justify further research in this area.

Shifting States draws on a rich history of anthropological theorising on all kinds of states – from the pre- to the post- industrial – and explores topics as diverse as bureaucracy, infrastructure, surveillance, securitization, and public health. As we enter the third decade of the twentieth century, there is a growing sense that ‘the state’ is in crisis everywhere. Although the nature of this perceived crisis varies from place to place, everywhere it is seen to have been caused by some combination of the inter-related forces of ‘globalisation’, of successive economic shocks, and of the rise of social media-fuelled populist movements. Yet, conversely, there is also a creeping perception that state power is becoming more pervasive in its reach, and in its effects, in ways which make it ever more imminent to the material worlds in which we live, more fundamental to the ways in which we conceive of the future, and more foundational to our very sense of self. How might we try to make sense of, and to mediate, these apparently contradictory impressions? Based on ethnographic case studies from all over the world, this timely volume forges new ways of thinking about how state power manifests, and is imagined, and about the effects it has on ordinary people’s lives. In so doing, the volume provides tools not only for understanding states’ responses to the COVID-19 pandemic, but also for judging what effects these responses are likely to have.

This groundbreaking book critiques the boundaries of where adult education takes place through a candid examination of teaching, learning, and working practices in the social periphery. Lives in this context are diverse and made through complex practices that take place in the shadows of formal systems: on streetscapes and farms, in vehicles and homes, and through underground networks. Educators may be family members, friends, or colleagues, and the curriculum may be based on needs, interests, histories, and cultural practices. The case studies presented here analyze adult education in the lives of sex workers, LGBTQ activists, undocumented migrants, disabled workers, homeless youth, immigrants, inmates, and others. Focusing on learning at the social margins, this book challenges readers to reconceptualize local, national, and transnational adult education practices in light of neoliberalism and globalization.

Purpose: To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women’s Kimberley Mum’s Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. Methods: We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into ‘risk’ and ‘protective’ factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. Results: Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11–33% high vs 61–100% no risk) and more commonly had risk factors (22–67% high vs 6–28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. Conclusion: Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.

The sustainability of tourism is increasingly under question given the challenges of overtourism, COVID-19 and the contribution of tourism to climate and environmental change. Degrowth and Tourism provides an original response to the central problem of growth in tourism, an imperative that has been intrinsic within tourism practice, and directs the reader to rethink the impacts of tourism and possible alternatives beyond the sustainable growth discourse. Using a multi-scaled approach to investigate degrowth’s macro effects and micro indications in tourism, this book frames degrowth in tourism in terms of business, destination and policy initiatives. It uses a combination of empirical research, case studies and theory to offer new perspectives and approaches to analyse issues related to overtourism, COVID-19, small-scale tourism operations and entrepreneurship, mobility and climate change in tourism. Interdisciplinary chapters provide studies on animal-based tourism, nature-based tourism, domestic tourism, developing community-centric tourism and many other areas, within the paradigm of degrowth. This book offers significant insight on both the implications of degrowth paradigm in tourism studies and practices, as well as tourism’s potential contributions to the degrowth paradigm, and will be essential reading for all those interested in sustainable tourism and transformations through tourism.

This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.

When researchers from an academic knowledge tradition undertake transdisciplinary research – that is, research which takes seriously knowledge practices quite alien to the disciplines of the academy – science and technology studies can help unpick some of the assumptions which are embedded in their research practice. The analysis of sociotechnologies, which are understood as phenomena which are indivisibly both social and technical, allows a researcher in the many unique contexts of Australia’s remote Northern Territory, to take seriously the understandings and methods of Aboriginal knowledge authorities, and work collaboratively and generatively with them. In this paper, examples from research collaborations in education, language, politics, housing and health in the Northern Territory explores the utility of the STS analytic concept ‘sociotechnology’. In each example our methods identify tensions between practices – including epistemics – which remain unresolved except insofar as they may point towards strategies to address problems of the moment. Aboriginal sovereignty can be seen as a key to understanding the position of the academic researcher in transdisciplinary work, and conceptually sociotechnology offers a means to respect and engage with the ancestral knowledge practices and authority of Aboriginal elders.

Purpose While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of the rural workforce shortage. The NSW Rural Doctors Network (RDN) contributes its perspectives about the importance of a whole of life career and the meandering stream concept to support the retention of health professionals rurally. We unpack these concepts and examine how they bring to light a new and useful approach to addressing rural workforce challenges and potentially contribute to building a stronger integrated care approach.Design/methodology/approach The approach used involved tapping into RDN's 30-years of experience in recruitment and retention of remote and rural health professionals, combined with insights from relevant existing and emerging evidence.Findings We suggest that reframing retention to consider a life stage approach to career will guide more effective targeting of rural health policies, workforce planning, collaborative approaches and allocation of incentives. We posit that an understanding and acceptance of modern lifestyles and career pathways, and a celebration of career commitment to serving rural communities, is necessary for successful recruitment and retention of Australia's future rural health workforce beyond the training pipeline.Originality/value We outline and visually represent RDN's meandering stream approach to building and retaining a capable rural health workforce through addressing life cycle and workforce level needs. This perspective paper draws on RDN's direct experience in the field.

Australia has 2 distinct indigenous groups, Torres Strait Islanders and Aborigines. The Aborigines, described in this report, first colonized the continent 65 millennia ago. Those still living in the Northern Territory (NT) retain much ancestrally derived genetic complement but also are the most health-challenged by environment and lifestyle in 21st century. Reports providing overviews of these disparities are, as yet, rare.This review defines the studied population and then describes and attempts to explain contemporary clinical findings among Australia’s remote-dwelling Aborigines, principally in the NT. The report is structured by life stage and then by organ system. Finally, a brief synthesis is advanced concerning the disparities that Australia’s Aboriginals face.In 2015–2017, NT aboriginal life expectancy for people then born was 66.6 years for men and 69.9 years for women compared with 78.1 and 82.7 years, respectively, among nonindigenous Territorians. Principal causes of the reduced longevity, with nonindigenous comparisons, include adolescent pregnancy, with maternal use of alcohol and tobacco (each 7-fold greater); fetal alcohol spectrum disorder and attention deficit hyperactivity disorder; skin infections, both scabies and impetigo (50-fold greater); rheumatic heart disease (260-fold greater); premature acute myocardial infarction (9-fold greater); bronchiectasis (40-fold greater); lung cancer (2-fold greater); diabetes mellitus (10-fold greater); renal failure (30-fold greater); and suicide (2-fold greater). Some disease has genetic roots, secondary to prolonged genetic drift. Much arises from avoidable stressors and from contemporary environmental disparities in housing. The Europid diet is also not helpful.

An overarching purpose of this study is to investigate and analyse the extent to which art and cultural production that has market potential can provide a viable pathway towards economic empowerment for Aboriginal and Torres Strait Islander people living in remote towns, settlements and outstations across the Kimberley region of Western Australia. This study is a part of a wider project – a National Survey of Remote Indigenous Artists. The objective of the National Survey is to produce a nationally representative database on how individual Indigenous artists in remote Australia establish, maintain and develop their professional art practice. The Kimberley region of northern Western Australia is the first region to be included in the database. Key Findings: The results of this study provide the first comprehensive picture of the circumstances of Aboriginal artists in the Kimberley region. We argue that the visual artists, performing artists, composers, writers, filmmakers and multimedia artists in the region represent a rich resource of cultural capital of significance not just to the Kimberley but to the country and the world. The timeless cultural inheritance of these artists finds its expression in the works they produce. We have argued that the cultural value of this production is of fundamental significance, but also that its deployment for economic gain can in the right circumstances contribute to providing a sustainable basis for remote community development. Our survey data indicate the wide range of cultural activities in which these artists have engaged during the course of their lives, including the production of artistic goods and services and a range of arts- and culturerelated activities. The data emphasise the vital role played by this latter group of activities not only in supporting the continuing production of creative work but also as a source of income in their own right. We have pointed to the need to understand the working conditions under which individual Indigenous artists in the Kimberley produce their artworks or pursue their artistic activities, as a basis for considering appropriate support and development strategies. A striking result is the importance of being on country. After family transmission, being on country is the second most important pathway for acquiring knowledge. In particular the survey results illustrate the interconnectedness and the blurring of boundaries between work and life for the Kimberley artists. Cultural activities may be undertaken for purely cultural reasons, with no expectation that they will yield any money. In other cases these activities may be a source of income, either actual or potential; in such cases the value of the work produced or the service provided yields both cultural and economic value. Given the number of cultural practitioners in the region who have skills and experience in various cultural-economic activities, our data suggest that there is a significant underutilised resource of cultural capital in the Kimberley that has the potential for further production of cultural goods and services that will yield both cultural and financial sorts of value. The findings of this study provide some strategies for the formulation of regional arts and culture development for these artists in the Kimberley. The use of the plural “strategies” is significant, as no single measure, either cultural or otherwise, to build sustainability in remote communities. Rather, different needs can be identified in different locations depending on a range of factors. Production, distribution and marketing of cultural product in any context need to be supported at all stages in the supply chain by adequate infrastructure. Visual artists who are based in communities or regions where an art centre has been established are supported through the centres, which in most cases receive Government funding. The art centre model has been adapted and developed over the years but has remained resilient in response to a changing environment. This model is a great contributor to the arts and cultural sector and needs to continue to be supported. Performing artists do not have access to widely available facilities to assist in the development of their creative work, and must often rely on their own resources. Many of 46 the performing artists in the region also face problems with finding opportunities to present their work due to a lack of appropriate venues or events. There are examples in the region of community facilities with a capacity to foster musical work by creative individuals, including radio stations, such as those funded through the Broadcasting to Remote Aboriginal Communities Service. These are the sorts of infrastructure facilities that can make a difference, especially for young people who have the potential to develop their creative skills and perhaps embark on a creative career. The distribution and marketing components of the value chain need to be well established if work produced is to find an appropriate market. The demand for the output of artists may be local, for example a dance performance for visitors, sale of artworks or records through local outlets, or musical performances in local venues. Alternatively, markets may be found beyond the region, and even internationally. On a local level these activities are regularly provided by artists on a voluntary basis, for example in the form of: translation and interpretation for family or community members; cross-cultural consulting for a family business or local organisation; medicine and health services for self or family use; cultural tourism for friends and visitors to an art centre, and so on. At regional, national and international levels these activities have also been generating some economic opportunities for Aboriginal cultural practitioners who engage in them, for example via cultural archiving and museology services to museums and galleries, or cultural and language education for students outside the region. With the right support there could be significantly more economic opportunities that could be derived from these sorts of activities, contributing in turn to developing a stronger arts and cultural sector in the region. The role of cultural tourism as a potential revenue source to support art and cultural production in the Kimberley remains to be further explored. There are some limited initiatives in place managed by art centres, and some commercial operators offer arts, cultural or cultural/environmental tours. Our survey found a strong belief amongst artists concerning the potential for cultural tourism: 93 percent of respondents agreed or strongly agreed with the proposition that tourists can bring jobs and incomes to their community. They also acknowledged unanimously that tourists should visit their communities in order to experience their culture at first hand. Overall, the prospect for expanding the role of art and cultural production as a means for generating incomes and jobs in remote communities, especially for young people, appears to be viewed favourably by artists in the Kimberley region. The results of this work support moves to integrate the arts and culture more effectively into regional development strategies, as a source of both economic and cultural empowerment for Indigenous communities.

This paper provides an insight into an explorative school-improvement program, known as the Indigenous Schools ‘readiness’ Program (ISRP) which sought to deal with educational challenges in a novel, yet evidence-informed manner. Specifically, the program sought to engage a school’s teaching staff, what is referred to as the Talent in the program, to deal with localised Indigenous school challenges by having them conceptualise and deliver their improvement plans through three inter-related elements: ‘readiness’, Talent and Adaptive Solutions. The paper suggests that despite the best intentions of parties involved, establishing and maintaining such a program, at least to the point of being able to properly implement and evaluate it, requires that the schooling context, i.e., the community in which it serves, has first created the required community conditions. In effect, engaged its own adaptive solution to inherent challenges.

This Handbook is the first to explore the emergent field of ‘placemaking’ in terms of the recent research, teaching and learning, and practice agenda for the next few years. Offering valuable theoretical and practical insights from the leading scholars and practitioners in the field, it provides cutting-edge interdisciplinary research on the placemaking sector. Placemaking has seen a paradigmatic shift in urban design, planning, and policy to engage the community voice. This Handbook examines the development of placemaking, its emerging theories, and its future directions. The book is structured in seven distinct sections curated by experts in the areas concerned. Section One provides a glimpse at the history and key theories of placemaking and its interpretations by different community sectors. Section Two studies the transformative potential of placemaking practice through case studies on different places, methodologies, and theoretical frameworks. It also reveals placemaking’s potential to nurture a holistic community engagement, social justice, and human-centric urban environments. Section Three looks at the politics of placemaking to consider who is included and who is excluded from its practice and if the concept of placemaking needs to be reconstructed. Section Four deals with the scales and scopes of art-based placemaking, moving from the city to the neighborhood and further to the individual practice. It juxtaposes the voice of the practitioner and professional alongside that of the researcher and academic. Section Five tackles the socio-economic and environmental placemaking issues deemed pertinent to emerge more sustainable placemaking practices. Section Six emphasizes placemaking’s intersection with urban design and planning sectors and incudes case studies of generative planning practice. The final seventh section draws on the expertise of placemakers, researchers, and evaluators to present the key questions today, new methods and approaches to evaluation of placemaking in related fields, and notions for the future of evaluation practices. Each section opens with an introduction to help the reader navigate the text. This organization of the book considers the sectors that operate alongside the core placemaking practice. This seminal Handbook offers a timely contribution and international perspectives for the growing field of placemaking. It will be of interest to academics and students of placemaking, urban design, urban planning and policy, architecture, geography, cultural studies, and the arts

Drawing on Alexis Wright’s novel The Swan Book and Irene Watson’s expansive critique of Australian law, this article locates within the settler–Australian imaginary the figure of the ‘wounded Aboriginal child’ as a site of contest between two rival sovereign logics: First Nations sovereignty (grounded in a spiritual connection to the land over tens of millennia) and settler sovereignty (imposed on Indigenous peoples by physical, legal and existential violence for 230 years). Through the conceptual landscape afforded by these writers, the article explores how the arenas of juvenile justice and child protection stage an occlusion of First Nations sovereignty, as a disappearing of the ‘Aboriginality’ of Aboriginal children under Australian settler law. Giorgio Agamben’s concept of potentiality is also drawn on to analyse this sovereign difference through the figures of Terra Nullius and ‘the child’.

The rapid response to the COVID-19 pandemic in Australia has highlighted the vulnerabilities of remote Aboriginal and Torres Strait Islander communities in terms of the high prevalence of complex chronic disease and socio-economic factors such as limited housing availability and overcrowding. The response has also illustrated the capability of Aboriginal and Torres Strait Islander leaders and the Aboriginal Community Controlled Health Services Sector, working with the government, to rapidly and effectively mitigate the threat of transmission into these vulnerable remote communities. The pandemic has exposed persistent workforce challenges faced by primary health care services in remote Australia. Specifically, remote health services have a heavy reliance on short-term or fly-in, fly-out/drive-in, drive-out staff, particularly remote area nurses. The easing of travel restrictions across the country brings the increased risk of transmission into remote areas and underscores the need to adequately plan and fund remote primary health care services and ensure the availability of an adequate, appropriately trained local workforce in all remote communities.

Rural and remote populations have poorer health outcomes and lower levels of access to healthcare. People living in these areas are frequently required to travel, sometimes significant distances, to inner regional areas and major cities to access comprehensive primary healthcare services. There has previously been little research that determines if there is equitable access to primary healthcare for patients with an equal need in rural and remote as compared to other areas of Australia. Equitable access requires the provision of care of equal quality to everyone. Age, gender, Indigenous status, income, geographic location or any other demographic variable should not result in poorer access to care. Equity in healthcare ensures equal access for those with an equal need; equal utilisation for those with an equal need; and equal or equitable outcomes, often measured by quality-adjusted life expectancy.2 Equitable access can therefore be measured by reviewing population health outcomes, such as mortality comparisons between different population groups. This report finds that rural and remote populations are a high needs population, and identifies specific locations where there is inequitable access to primary healthcare services - general practitioners (GPs), nursing, oral health, mental health and Aboriginal Health Services. This report also considers reasonable access to healthcare: the fulfilment or obtainment of health services in a timely, accessible, affordable and culturally appropriate manner. There is currently no agreed, comprehensive definition of what otherwise constitutes reasonable access to healthcare, including the maximum distance a person should be required to travel to access healthcare, and the type and frequency of health services that should be accessible to a person within this travel distance. This is problematic for many organisations delivering healthcare to people living outside of major cities, such as the Royal Flying Doctor Service (RFDS), who strive to provide high-quality, culturally appropriate healthcare in a timely manner. In the rural and remote context with small populations spread across large geographical areas, it is not realistic for everyone to have access to permanent, local services. However, all should have reasonable access to services. The Australian Institute of Health and Welfare (AIHW), proposes a patient’s ability to access primary healthcare within 60 minutes of motor vehicle travel as one measure of reasonable access. This report adopts this measure and contends that to achieve reasonable or equitable access to primary healthcare, people should have, at a minimum, GP, nursing, oral health and mental health services accessible within 60 minutes. Access in this regard could include the ability to utilise permanent services, visiting or ‘fly-in fly-out’ services within 60 minutes, and have timely access to telehealth services as part of an integrated suite of services. This report finds that 42,805 Australians, or almost 10% of people living in inner regional, outer regional, remote or very remote Australia, had no access to any primary healthcare services within a 60-minute drive time. Through the Stronger Rural Health Strategy, the Commonwealth Government has committed to ensuring “a sustainable, high quality health workforce that is distributed across the country according to community need, particularly in rural and remote communities”. This report identifies areas of highest need, being populations and locations without access to primary healthcare services within a 60-minute drive time, and recommends that these should be addressed first. Future work should be undertaken, as a priority, to develop a more comprehensive definition and baseline measure of what constitutes equitable and reasonable access to primary healthcare. In addition to the 60-minute drive time, consideration should be given to other physical accessibility factors as well as the financial affordability, cultural safety and acceptability of services. Establishing such a minimum benchmark would be of immense value to policy makers, funders and service delivery organisations to provide a common reference point for the services Australians should reasonably expect to receive, no matter where they live. The need for equitable access has been further highlighted during the COVID-19 pandemic. Many of the severe COVID-19 patients internationally have been reported to have an underlying history of hypertension, diabetes, coronary heart disease, COPD, and renal disease. Remote and very remote populations have higher rates of these conditions making them more vulnerable populations if infection rates increase in these areas. Simultaneously, these populations have poorer access to primary health care and preventative services. Reducing the incidence of comorbidities by ensuring reasonable and adequate access to comprehensive primary health care would lower these risks.

Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥ 2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and one-third (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.