Remote Australia Online

In this study, we attempted to explore the experiences and beliefs of Aboriginal families as they cared for their children in the first year of life. We collected family stories concerning child rearing, development, behavior, health, and well-being between each infant?s birth and first birthday. We found significant differences in parenting behaviors and child-rearing practices between Aboriginal groups and mainstream Australians. Aboriginal parents perceived their children to be autonomous individuals with responsibilities toward a large family group. The children were active agents in determining their own needs, highly prized, and included in all aspects of community life. Concurrent with poverty, neocolonialism, and medical hegemony, child-led parenting styles hamper the effectiveness of health services. Hence, until the planners of Australia?s health systems better understand Aboriginal knowledge systems and incorporate them into their planning, we can continue to expect the failure of government and health services among Aboriginal communities.

The rural health and health service development stories presented here have been shaped by the curiosity, inventiveness, and commitment of the health professionals working in their rural and remote communities. They have been supported by the University Departments of Rural Health (UDRH) to improve the health and wellbeing of rural and remote Australians. This important achievement is an evidence base on which to build policy and practice. These stories are drawn from across the country and provide a window to the future of rural health in Australia. They show how rural and remote health professionals are making a difference locally and give insights, approaches and solutions to similar challenges or problems faced elsewhere. Evaluated solutions for many pressing health issues are presented, including self management for people with chronic disease; addressing Aboriginal and Torres Strait Islander health through the recruitment and retention of Indigenous medical students and better birthing services for Aboriginal mothers and babies; new models of care that improve access to quality care for rural people in mental health, palliative care and oral health; and workforce development through role expansion of paramedics. Also considered are two big policy issues: building sustainable rural primary health care services, and responding to an ageing health workforce. Access to services is a major factor explaining poorer outcomes in rural and remote Australia. This publication grew out of a concern that rural health policy makers and practitioners did not have access to the abundance of information generated from efforts in designing, evaluating and improving rural health services. The range and quality of the work presented here is a testament to the substantial and ongoing Australian Government investment from the mid-1990s to build the intellectual capital of the bush. During this time, a significant academic presence in rural and remote Australia has been built with the establishment of UDRH and Rural Clinical Schools, and programs targeting the development of research capacity in primary health care. Two peer-reviewed journals devoted to rural health are published in Australia and read around the world. Because of these investments, we have a brighter future in rural health. There is an emerging capacity of the sector to document what it does well and to communicate the good ideas and lessons learned from innovation so that we do not just invest in rediscovering old insights. Rather, we progress the policy debates and respond to the service delivery dilemmas to further develop and promote good, sustainable health care policy and practice into the future. I would encourage you to read the stories, follow up the publications and contact the authors.

Purpose: We undertook a qualitative study that explored exercise participation and exercise promotion in the multiple sclerosis (MS) community who live in regional or remote areas of Australia. By simultaneously gathering views from persons with MS, carers, healthcare providers and healthcare managers we aimed to gather unique perspectives which represented views from across socio-ecological levels of MS healthcare.Methods: We used interpretive description methodology, and conducted semi-structured interviews or focus groups with people with MS (n?=?28), carers (n?=?8), healthcare providers (n?=?12) and managers/supervisors of MS healthcare systems (n?=?16). Data were analysed using thematic analysis.Results: We identified three themes with 10 subthemes. The first theme was ?Factors associated with exercise engagement? for the people with MS, from individual, interpersonal, organisational and community/public policy perspectives. The second theme was ?Factors influencing the MS community?s promotion of exercise? focusing on carers, healthcare providers and healthcare systems. The third theme was ?Motivators to increase exercise promotion? which should be delivered by the MS community across varying socio-ecological levels of healthcare to encourage exercise participation.Conclusion: We identified new evidence on the factors which influence the MS community?s promotion of exercise and we now better understand that training on exercise should be provided to the wider MS community, and exercise services should be considered locally and perhaps delivered via teleheath.IMPLICATIONS FOR REHABILITATIONCohesive healthcare campaigns, and clinical guidelines based on empirical evidence should be established for symptom management in MS with a focus on the role of exercise.Symptom management strategies should consider the whole MS community, including patients, carers, healthcare professional and healthcare co-ordinators.Internal factors (e.g., emotion and motivation) and broader factors (e.g., funding and location) must be considered when designing exercise interventions in persons with MS.

The purpose of this paper is to advocate the resource package for producing quality graduates to work in rural, regional and remote Australia (TERRR Network), using a global perspective. This paper argues that the resource package achieves more than the objectives of the original project; 'Developing Strategies at the Pre-service Level to Address Critical Teacher Attraction and Retention Issues in Australian Rural, Regional and Remote Schools'. Through implementation of the resource package, subsequently all Teacher Education students develop the ability to understand context and build confidence to adapt curriculum accordingly, thus enhancing learning and teaching. This often requires extension from ones 'comfort zone' in order to experience and understand 'context'. It also requires teachers to be flexible and understanding, an essential role of Teacher Educators in the modern world. It is relevant that when viewing rural education on the global stage, the theme of the 3rd ISFIRE Conference that this paper shares the author's story reflection as an international school leader in a geographic remote Middle Eastern location. The author reflects on his position as the Head of Key Stage One and Head of Foundation Stage (3-7 years) and member of the Senior Management Team (3-18 years - 1200 students) at the Dukhan English School between years 2007-2009. The challenge of Head Teacher extended the author's cultural, religious and regional/rural/remote contextual experience boundaries from that of metropolitan Australia. The author illustrates how such a Training Framework would have assisted in preparing his global experience by examining the Seven Focus Areas of the National Professional Standards for Teachers (NPST), chosen as a Framework for pre-service teachers to develop knowledge, understandings and skills for working in remote contexts. It is concluded that the resource package therefore, also prepares students to be responsible and effective global citizens who engage in an internationalised world and exhibit cross-cultural competence (Monash Graduate Attributes Policy, Academic Board, 2008), an attribute that is similarly advocated across universities. Hence, this argument adds strength to the significance of this resource package for preparing all Teacher Education programs, nationally and internationally.

This study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim–sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.

In July 2008, the incoming Labor government introduced a version of this system to Queensland in the Cape York Welfare Reform Trial (CYWRT).The CYWRT is distinct amongst income management trials as an Aboriginal-led welfare reform program, which operated its own version of compulsory income management and also introduced a Voluntary Income Management (VIM) measure. In November 2008, VIM and a compulsory measure for child protection, the Child Protection Scheme Income Management (CPSIM), were introduced to the Kimberley area of Western Australia (WA). Based on a review of the NTER measures, in 2010 the New Income Management (NIM) policy was introduced to all income support recipients in the Northern Territory (NT). The NIM was a shift away from the NTER’s racialised response to child welfare and related substance abuse concerns. NIM introduced the Vulnerable Income Measure (VULIM) which included a number of streams relating to disengaged youth, long-term welfare payment recipients and people assessed as vulnerable. The broad approach of the NIM appears to be a mechanism for welfare reform designed to break intergenerational cycles of passive welfare (Gray, 2015, p. 4). NIM was the basis of income management (IM) trials which followed in other locations – most of which had significant populations of Aboriginal Australians. The payment mechanism for these phases of the policy was a plastic debit card called the BasicsCard – introduced under the NTER in September 2008. Managed by Centrelink, the BasicsCard operated as a localised debit card limited to use at merchants approved by the Department of Human Services. The card was credited with quarantined amount: 50 per cent of a subject’s income support and up to 100 per cent of lump sum payments. Cash could not be withdrawn from the BasicsCard account, only from the person’s bank account which received the remaining 20 per cent of the income support payment. The BasicsCard became the payment mechanism for all income management trials until the introduction of the Cashless Debit Card (CDC) under the cashless welfare trials, which commenced in 2016. In 2012, as part of the Federal government program, Building Australia’s Future Workforce (BAWF), which emphasised entry or return to the workforce, Place-Based Income Management (PBIM) was introduced in targeted locations in New South Wales (NSW), South Australia (SA), Queensland (QLD) and Victoria (VIC). Aboriginal communities were added to the trial; the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia, later in 2012, and Laverton, Kiwirrkurra and the Ngaanyatjarra Lands in Western Australia in 2013. Income management under this program focused on child protection and those considered vulnerable to financial hardship. These areas were targeted due to high cultural diversity, welfare dependency, high unemployment levels (including youth unemployment), skills gaps and the length of time people had been on income support. Media reported government plans to expand PBIM nationally in 2013, although rollout did not go ahead (ABC News, 2014b). The program continues to operate in the original five sites, with the continued use of the BasicsCard. It is unclear if these sites are still considered trials or have become policy, although the Social Security (Administration) (Declared income management areas) Determination 2012 legislation that introduced the trials is no longer in force. In July 2014, the PBIM model was applied to the Ceduna Local Government area in South Australia (Parkinson, 2015) which included Oak Valley, Koonibba, Yalata, Scotdesco, Bookabie, Penong, Fowlers Bay, Coorabie, Nundroo and Nullarbor. This trial appears to be the precursor to Cashless Debit Card (CDC) trials which commenced in Ceduna in 2016. By 2015, in the Northern Territory alone, 20,600 participants were on IM – four times higher than all other IM sites in Australia (Arthur, 2015, p. 29). Evaluations produced mixed results, yet in that year, a report from the reference group on welfare reform to the Minister of Social Services recommended a cautious expansion of income management through recommendations informed by previous evaluations(McClure, 2015). Cashless welfare, a broader, but more restrictive, form of welfare quarantining was endorsed in 2014 as a key recommendation of the Forrest Review of Indigenous Jobs and Training. The cashless welfare model recommended quarantining 100 per cent of income support and was framed as an alternative to income management. However, when cashless welfare card trials began, income support was quarantined at 80 per cent. The payment mechanism for cashless welfare, was also a plastic debit card and, depending on location, it may be called the Cashless Welfare Card (CWC), the Grey card or the Indue card, but most commonly it is called the Cashless Debit Card (CDC).The Forrest Review argued a cashless debit card would be far less expensive to deliver than the BasicsCard and therefore affordable on a larger scale. As a Visa-debit card, the cashless debit card is managed by the private company Indue and operates as a regular bank product, potentially useable at any merchant using EFTPOS that has not been blocked in accordance with the policy. This means, compared to the BasicsCard, there is a significantly higher number of outlets where the card can be used. The availability of other payment options, such as BPAY, also differentiates the BasicsCard. While the percentage of income support quarantined by the CDC increased from the 50 per cent of the BasicsCard to 80 per cent, other conditions were not changed; cash cannot be withdrawn, and alcohol, gambling products and gift cards (and other cash-like products) cannot be purchased with the CDC. Cashless debit card trials were rolled out from2016 in Ceduna (SA) and East Kimberley (WA), and in the WA Goldfields region in 2018. In these locations, the CDC was made mandatory for all working-age income support recipients. In 2019, all those under 36 years old who received one of three specified payments were added to a CDC trial in Bundaberg and Hervey Bay (QLD). On 4 April 2019, the Federal Coalition government passed legislation to extend all welfare quarantining trials by one year–to 30 June 2020. However, more legislation was introduced on 11 September 2019, with two key purposes: to gain an additional extension of all trials to 30 June 2021; and, to remove the cap on the number of cashless debit card trial participants. This would allow the NT and income management sites in all other states to become CDC trial sites. Approximately 23,000 income management participants would then be transitioned from the BasicsCard to the Cashless Debit Card in 2020 (The Department of Social Services, 2019b, para. 8). Federal government data demonstrates that 25,270 people were on income management nationally in 2018, with 87 percent in the NT and 82 per cent of them Aboriginal (Heaney, 2019). Place-Based income management sites were not included in this legislation; these sites continue to use the BasicsCard. Senate hearings held in Darwin and Alice Springs in late 2019, heard strong opposition to the legislation from a range of organisations and community members. Similar criticisms were heard in 2007 about the NTER, including the haste in which the legislation was planned, its mandatory nature, and the lack of consultation (Heaney, 2019). Labor Senators recommended the Bill not be passed in its current form as it was not supported by evidence and twelve years of broad-based compulsory income management in the NT had not improved outcomes (Allam, 2019, para. 6). For similar reasons, the Australian Greens also did not recommend the Bill be passed (Parliament of Australia, 2019e, pp. 23-31). However, on 7 November 2019, the Senate Community Affairs Legislation Committee recommended the Bill be passed. The legislation had its second reading on 2 December 2019 and was due for a third in February 2020. Despite broad concerns about the legislation, the very mixed findings of income management evaluations, and consistent criticisms of the methodologies and quality of those evaluations across the many years of the policy, the Federal government appears determined to proceed with the expansion of the policy through the CDC at its broadest and most restrictive form.

Clinical relevance Developing an accurate picture of the demographic profile and refractive status of Aboriginal and non-Aboriginal individuals with pterygium will facilitate health planning and appropriate deployment of health-care resources in rural Australia. Background To date, there is a paucity of reports in the literature regarding Aboriginal ocular health and refractive error. This study examines clinical data from a rural ophthalmology outreach clinic ? a predominantly Aboriginal population. Methods An assessment was undertaken of data of 293 patients noted to have pterygium present in at least one eye, from a sample of 2,072 individuals seen in rural northern Western Australia in 2017 by the Lions Outback Vision Visiting Optometry Service. Results Pterygium was found in 14.1 per cent (n = 293) of patients using the Lions Outback Vision service. The mean age of those with pterygium (n = 293) was 57.1?±?11.9?years (mean?±?standard deviation); 188 were female (64.1 per cent); 260 identified as Aboriginal (88.7 per cent), 22 identified as non-Aboriginal (7.5 per cent) and 11 did not specify (3.8 per cent). There were more males than females with pterygium in the non-Aboriginal group (18.0 per cent versus 6.4 per cent); however, the reverse was true in the Aboriginal group (11.7 per cent versus 17.0 per cent). Analysis of the subjective refractive data in those with pterygium revealed an overall mean spherical equivalent value of +0.66?±?1.28 DS. The median (interquartile range) best-corrected visual acuity was 0.0 (?0.1 to 0.0) logMAR (6/6 Snellen equivalent). Conclusions This paper increases our knowledge of ocular health in a remote Australian population, with an emphasis on the differences between Aboriginal and non-Aboriginal individuals, males and females.

The role of the arts in the revitalisation and strengthening of Australia's rural, remote, and Indigenous communities has been of particular interest to Australian State and Federal Governments, as reflected through various policy and positioning documents. In order to understand the relationship between the arts and communities, it is important to explore why people engage in the arts and what might be some of the barriers to that engagement. For the rural, remote and Indigenous communities of the Murchison Region, the arts has been a useful way of reaching and engaging with residents to build a stronger sense of community, provide light relief and entertainment, and facilitate communication among community members, government, and industry. However, there are several barriers that impact on the viability of arts projects. These barriers are amplified in rural and remote areas, and particularly for the three case study communities of the Murchison Region for a number of reasons. These include the transient nature of the population, a lack of resources, isolation and remoteness, and local politics, culture and history. The arts can provide a context in which other non-arts related outcomes, such as health, capacity building, income generation, and so on, are facilitated and achieved. It is important for policy makers to recognise and address the barriers which hinder activity and serve to lessen the impact of the arts on communities.

Optimality and game-theoretic models grounded in behavioral ecology have enjoyed increasing popularity in anthropology and prehistoric archaeology over the last three to four decades. They have been especially important to prehistorians in fostering the development of comprehensive, theoretically well-grounded expectations about past human behavior and in helping to identify testable explanations for its variation across time and space. Bliege Bird et al. (1) provide an example of this approach in their discussion of two game-theoretic models in an Australian ethnographic context. The results have important implications for reconstructing the process of hunter-gatherer dispersal across Sahul (Pleistocene Australia–New Guinea) and about changes in human subsistence during the Late Pleistocene and early Holocene.One of these models describes the ideal free distribution (IFD) of a population as it grows and spreads in an ecologically heterogeneous habitat (2). Applied specifically to hunter-gatherers, it assumes that patches within the habitat contain different sets of plant and animal foods offering different nutrient return rates to potential consumers. The model predicts that incoming population members will first occupy the patch where resources offer the highest aggregate rates, allowing them to gain the best overall return in the time available for collection. If resources are finite, consumers may deplete them. If returns from exploiting them fall below those available in other patches, some consumers will move to those patches. The process may continue until all patches are occupied and return rates across all are equal. It will be accelerated by population growth: Increasing numbers of consumers means more rapid resource depletion and related consumer dispersal across the overall habitat—a negative density-dependent scenario. In some situations, the opposite pattern may be apparent: Consumer presence may increase resource availability, an example of the Allee effect (3). Although the end result may be the same as in a simple IFD, … ↵1Email: oconnell{at}anthro.utah.edu.

INTRODUCTION: Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major otitis media pathogens that densely co-colonise the nasopharynx and infect the middle ear of Australian Aboriginal infants from very early in life. Our co-primary hypotheses are that at 18 months of age infants receiving 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) compared with those receiving 13-valent pneumococcal conjugate vaccine (PCV13) as a booster at 12 months of age will have higher antibody levels to Haemophilus influenzae protein D and that infants receiving PCV13 will have higher antibody levels to PCV13-only serotypes 3, 6A and 19A. METHODS AND ANALYSES: Our randomised controlled trial will enrol 270 Aboriginal children at 12 months of age to a booster dose of either PHiD-CV10 or PCV13. Children who completed the three-dose primary course schedules of PHiD-CV10 at 2, 4, 6 months of age; PCV13 at 2, 4, 6 months of age; or a combination schedule of PHiD-CV10 at 1, 2, 4 months of age plus PCV13 at 6 months of age are eligible. The co-primary assessor-blinded outcomes when the infants are 18 months of age are as follows: (a) IgG geometric mean concentration (GMC) and proportion with IgG ≥100 EU/mL for protein D, and (b) IgG GMC and the proportion with IgG ≥0.35 µg/mL for pneumococcal serotypes 3, 6A and 19A. Secondary immunogenicity comparisons of six primary and booster dose schedules of 10 shared serotypes at 18 months of age, nasopharyngeal carriage, all forms of otitis media, hearing loss and developmental milestones at 18, 24, 30 and 36 months of age will be reported. ETHICS AND DISSEMINATION: Ethics committees of NT Department of Health, Menzies, WA Department of Health and WA Aboriginal Health approved the study. Results will be presented to communities, at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT01735084.

Background: The life-threatening clinical manifestations of strongyloidiasis are preventable with early detection and effective treatment. The aim of this study was to assess if there was an increase to the number and proportion of persons tested for chronic strongyloidiasis, as a result of integrating Strongyloides stercoralis serology into the existing preventive health assessment system in four Aboriginal health services in endemic communities. Methodology: A prospective, longitudinal, before-and-after intervention study was conducted in four Aboriginal health services in remote endemically infected communities in the Northern Territory, Australia, from July 2012 to December 2016. The electronic patient information and recall systems enabled the integration of Strongyloides stercoralis serology into the adult preventive health assessment. Strongyloides reports for each health service were extracted half-yearly to examine the number and proportion of persons tested for chronic strongyloidiasis during the study and to measure the effect of the intervention. Principal findings: The number and proportion of persons tested increased significantly during the study. From a total resident population of 3650 Indigenous adults over 15 years of age, 1686 persons (47.4%) were tested. The percentage of adults who had at least one serology test increased in all four health services to between 41% (446/1086) and 81.9% (172/210). Of the 1686 persons tested, 680 positive cases of chronic strongyloidiasis (40.3%) were identified. Conclusions/Significance: This population health systems intervention increased the number and proportion of persons tested for chronic strongyloidiasis in four health services in endemically infected communities. This intervention is relevant to other health services with high-risk populations.

BACKGROUND: Culturally responsive, strengths-based early-intervention mental health treatment programs are considered most appropriate to influence the high rates of psychological distress and suicide experienced by Aboriginal and Torres Strait Islander youth. Few early intervention services effectively bridge the socio-cultural and geographic challenges of providing sufficient and culturally relevant services in rural and remote Australia. Mental Health apps provide an opportunity to bridge current gaps in service access if co-designed with Aboriginal and Torres Strait Islander youth to meet their needs. AIMS: This paper reports the results of the formative stage of the AIMhi-Y App development process which engaged Aboriginal and Torres Strait Islander youth in the co-design of the new culturally informed AIMhi-Y App. METHODS: Using a participatory design research approach, a series of co-design workshops were held across three sites with five groups of young people. Workshops explored concepts, understanding, language, acceptability of electronic mental health tools (e-mental health) and identified important characteristics of the presented applications and websites, chosen for relevance to this group. An additional peer supported online survey explored use of technology, help seeking and e-mental health design elements which contribute to acceptability. RESULTS: Forty-five, Aboriginal and Torres Strait Islander youth, aged 10–18 years, from three sites in the Northern Territory (NT) were involved in the workshops (n = 29). Although experiencing psychological distress, participants faced barriers to help seeking. Apps were perceived as a potential solution to overcome barriers by increasing mental health literacy, providing anonymity if desired, and linking young people with further help. Preferred app characteristics included a strength-based approach, mental health information, relatable content and a fun, appealing, easy to use interface which encouraged app progression. Findings informed the new AIMhi-Y App draft, which is a strengths-based early intervention wellbeing app for Aboriginal and Torres Strait Islander youth. CONCLUSIONS: Research findings highlight the need, feasibility and potential of these types of tools, from the perspective of Aboriginal and Torres Strait Islander youth.

Key findings:•Use of methamphetamine is increasing among two sentinel samples in Darwin, the Northern Territory. This increase is largely driven by an increase in use of crystal methamphetamine or ‘ice’. •Frequency of use has also increased among the group who regularly inject drugs, with half the sample reporting weekly or more frequent use in 2019•Smoking crystal methamphetamine is the most popular route of administration among the sample who regularly use ecstasy•There were no statistically significant differences in access to health services between those who use crystal methamphetamine weekly or more frequently and those who use it less than weekly.

This thesis is a synchronic study of valence adjusting, switch-reference and ellipsis in three dialects of the Australian Western Desert language, Pitjantjatjara, Yankunytjatjara and Ngaanyatjarra (PYN). We investigate the morphosyntactic mechanisms and pragmatic motivating factors behind these phenomena. The dialects have mixed ergative and accusative case systems with productive derivational suffixing, serialisation of verbs and dependent clauses with switch-reference. We examine how these features are involved in valence adjusting and ellipsis and the situations where these occur. The material is based on a corpus of written sources, supplemented by grammaticality judgments by PYN speakers. The theoretical framework underpinning the study is that of Role and Reference Grammar (RRG), which is designed to be able to be used for the study of any language. This provides a detailed functional account, mapping syntax to semantics by way of a linking algorithm, and has constituent, operator and focus syntactic projections. Together with semantic lexical decomposition and the concept of semantic macro roles, these projections enable a study of the communicative functions and strategies for topicalising or focusing the participants in a scene or clause. Valence may refer to syntactic, semantic or macro role elements and these may not coincide; we investigate how the three relate in PYN. Furthermore the pragmatic dropping of arguments in discourse relates to focus, presupposition and shared knowledge and we distinguish this from the argument demoting and omission that necessarily occurs in valence decreasing. Valence adjusting may impact the underlying semantics; the syntactic realisation of arguments; and the assignment of macro roles and Privileged Syntactic Argument and we examine how this is achieved in PYN. It is found that the main valence-adjusting operations found in PYN are lexical rather than syntactic. Morphological derivation on nominals and intransitive verbs creates inchoative and causative verbs, depending on whether a state occurs spontaneously or is brought about by an external effector. Causation with base transitive verbs needs to be expressed syntactically and indirectly. Importantly, voice or syntactic valence adjusting is not found in the dialects. The functions of the passive are subsumed by the variance of topic and focus afforded by word order changes. Serial verbs are topic chains or complex predicates; sub-clauses may reduce the valence of the main verb, take the place of arguments or be adverbial; both actor and undergoer control is facilitated by the switch-reference ending used. Ellipsis occurs frequently, but the default assumption is that a missing argument represents third person singular. Tracking of referents is facilitated by switch-reference between active and accessible participants both within a clause and a text, and we outline how this might be represented in the presupposition. The thesis is a contribution to RRG’s representation of non-overt arguments, and sheds light not only on valence adjusting in an ergative system but also the narrative tracking of referents. Its original contribution lies in conducting an RRG analysis of valence adjusting, argument reduction, switch-reference and ellipsis in the PYN dialects. This allows us to compare the structures with those in other languages and identify areas in RRG that need to take into account structures not currently catered for by the theory. We suggest the RRG theory should be extended to take ellipsis and switch-reference structures into account and propose new ways of representing them in the constituent and semantic representations. In order to do this, webring in elements of Common Ground, Discourse Representation Theory, Centering Theory, Basic Linguistic Theory and Systemic Functional Linguistics.

INTRODUCTION: Rural and remote communities of Australia, particularly those including Aboriginal people, experience greater morbidity and mortality across a range of health outcomes compared to urban communities. Previous national data have demonstrated that rural and remote communities experience a disproportionate burden of communicable diseases compared to their urban counterparts. This systematic review was undertaken to describe the types of research that have explored the epidemiology of communicable diseases in rural and remote communities in Australia, with particular reference to the social determinants of health. METHODS: We conducted a keyword search of several databases (EMBASE, MEDLINE/PubMed, RURAL, Aboriginal and Torres Strait Islander Health Database, Web of Science Core Collection, and Google and Google Scholar websites) for peer-reviewed and grey literature that described or analysed the epidemiology of communicable diseases in rural and/or remote communities of Australia from 2004 to 2013. Exclusion criteria were applied to keep the review focused on rural and/or remote communities and the population-level epidemiological analysis of communicable diseases. RESULTS: From 2287 retrieved articles, a total of 50 remained after applying exclusion criteria. The majority of included articles were descriptive studies (41/50). Seven of the total 50 articles contained analytical studies; one systematic literature review and one experimental study were also identified. Due to the diversity of approaches in measuring disease burden, we performed a narrative synthesis of the articles according to the review objectives. Most of the articles investigated the disease burden in remote (<i>n=</i>37/50) and Aboriginal communities only (<i>n=</i>21/50). The studies highlighted a high prevalence or incidence of skin, eye and respiratory infections for remote Aboriginal communities, particularly children over the past decade. There was emerging evidence to suggest that housing and social conditions play an important role in determining the risk of skin, ear, respiratory and gastrointestinal infections in children. Other health service and sociocultural factors were also discussed by authors as influencing the epidemiology of communicable diseases in rural and remote communities. CONCLUSIONS: This systematic review identified several communicable diseases that continue to cause considerable morbidity in remote Aboriginal communities, including skin, eye and respiratory infections, particularly for children. Overall there is a substantial amount of descriptive epidemiology published, but few analytical or experimental studies. Despite a lack of empirical investigation into the social determinants of the burden of communicable disease, there is emerging evidence that has demonstrated a significant association between housing conditions and skin, ear, respiratory and gastrointestinal infections in children. There is also growing recognition of other social and environmental factors that can influence the burden of diseases in rural and remote communities. Further investment into higher quality community-based research that addresses the social determinants of communicable diseases in remote communities is warranted. The lack of research investigating zoonoses and tropical diseases was noted.

Outbackhubs is a collaborative effort to provide shared resources and training opportunities to Central Western Queensland. Established in 2017, Outbackhubs operates physical co-working locations where members and guests can use high speed internet, hot desks, general office equipment in addition to participating in workshops. Through Outbackhubs we are bringing the Outback into the modern world – harnessing innovation to engage our communities, strengthen our regions, unlock business potential and prepare our people for the jobs of the future. The Central Western Queensland (CWQ) region, like many others of similar geography in Australia, has significant challenges ahead. These challenges are magnified because of geographical remoteness, declining populations, skills shortages, and economic instability through reliance on a small number of key industries. The impacts of climate change, social isolation and changing family dynamics trigger irrevocable events such as self-harm with fatal consequences.

Barcaldine Regional Council and RAPAD are breaking down barriers and enhancing connections between communities, industry and all levels of government with their approach to delivering Outback Aerodrone. This collaboration isn’t just about hosting an event. Outback Aerodrone is opening up new opportunities for our region (across seven local government areas representing around 21%of Queensland), introducing new industries and future generations of jobs that can benefit remote and regional communities in Central West Queensland and beyond. The success of Outback Aerodrone is founded on the extensive networks that council and RAPAD have developed nationally and internationally, in addition to their strong community connections. Taking a collaborative approach, combining resources and experience as well as working with local business and external expertise has meant a high-level event with hands-on, world-leading information and technology has been made accessible to remote and regional communities – in particular to local governments and their employees.

The Central West Queensland Remote Area Planning and Development Board (RAPAD) is a united regional organisation of the seven central west Queensland council shires – Barcoo Boulia, Barcaldine, Blackall-Tambo, Diamantina, Longreach and Winton. The purpose of this organisation is to proactively shape and create a prosperous future for the RAPAD region of Outback Queensland. In July 2018, the Realising the RAPAD Big Vision strategy document was prepared for RAPAD by Global Futuremakers, with support by the Department of Environment and Science (DES). This strategy was particularly brought about by RAPAD’s recognition that cumulative loss of population throughout the region over the last decade is not sustainable—and that a transformation around the region’s liveability and economic outlook needed to occur. The concepts of the strategy were tested within four shires of the central west Queensland community over an 11 day period – in Barcaldine, Blackall-Tambo, Longreach and Winton shires, representing 90% of the population of the RAPAD region. Travelling under the partnership “Women at the Well”, Global Futuremakers (GFM), Regional Economic Solutions (RES) and The Circular Experiment (TCE, now trading as Correo) conducted this consultation. Further targeted consultation will be required in the remaining three shires in the future, recognising that most stakeholders are highly remote. Community consultation occurred in various forms, including community and targeted workshops, an open survey, and multiple one-to-one discussions with businesses and community members. Over 30 meeting interactions were undertaken from 5-15 November 2018.The purpose of this report is to summarise the findings during consultation with the broader Central West Queensland community, also referred to as the RAPAD community. As such, it is structured to reflect the consultation findings directly under Realising the RAPAD Big Vision key thematic areas. Community Profile and Attitudes: The community has indicated that it is ready to take on significant economic transformation within the region, and that RAPAD should be the body to lead. However, there are significant challenges that will need to be addressed first. These include:• Perception of community boundary, and ensuring there is alignment across the community• Effective communication, that enables broad community participation and ownership of the transformation; and• Capacity building and capability enhancement of RAPAD. Valuing Knowledge: The community holds the concept of valuing knowledge in high regard – and is readily willing to participate in the identifying of opportunities and lessons learned. This is an opportunity for RAPAD to forge stronger, transparent relationships with the community, to generate buy in for the strategy. Energy (electricity)The consultation has highlighted that the cost of electricity is viewed by the community as:• The biggest threat to the region’s economic development;• The underlying deterrent to region liveability; • and is unsustainable.

Water in many areas of Australia is scarce and of poor quality. In some areas high levels of treatment are required either due to contamination of waters or due to high salinity. Nanofiltration (NF) and low-pressure reverse osmosis membranes are well-recognized technologies to treat waters of qualities ranging from low salinity surface water to high salinity seawater. In remote communities the operation of such facilities may be limited by the availability of electricity. Solar, or photovoltaic, energy is the ideal source of renewable energy in Australia to overcome this problem. This paper considers the various options for a small system, designed to deliver a permeate flow of 400–1000 l/d from brackish wells. The most suitable membrane for salt retention and very high organics retention was selected and the pump energy requirements calculated. A submerged ultrafiltration (UF) membrane is used as an alternative to the traditional sand and/or prefilter cartridges. The removal of natural organics is important where disinfection of the water is required, as chlorination of waters containing natural organics may produce potentially carcinogenic by-products.

Background: People living in rural and remote areas are faced with a multitude of health disadvantages. These disadvantages include limited access and decreased utilisation of medical services, increased rates of modifiable and non-modifiable risk factors, decreased socioeconomic status and an increased disease prevalence across a wide variety of conditions (1-3). This is reflected through higher mortality rates in remote and very remote areas of Australia compared to people living in major cities for all-cause mortality (1). Although a number of health policies and government assistances are attempting to improve access to health facilities, the health gap remains (4). In particular, the cardiac health of rural and remote Australians is disadvantaged with patients in rural and remote areas exposed to higher mortality rates of coronary artery disease (3). Similarly to other specialist services, cardiology services are infrequently provided in the areas that have an increased burden of disease with decreased access to cardiac specialists and diagnostic services in rural and remote areas compared to major cities (5). It is therefore imperative timely access to cardiac testing is available to detect cardiac issues before it is too late. Aims: The research aimed to define the current service provision of the non-invasive cardiac diagnostics of exercise stress testing (EST) and Holter monitoring within two rural and remote hospital and health service (HHS) areas in Queensland. The specific objectives were to define the reporting processes for each testing procedure, the time frames for testing, the number of non-invasive cardiac investigation services performed and the travel implications to the HHS and the patient. Methods: A multi-site retrospective chart review was conducted at two rural hospitals within Queensland. Patients were included in the study if they had completed an exercise stress test and/or Holter monitoring within the specified 12 month period. Data were extracted from medical data sources including physical paper patient charts. Analysed documentation included testing reports, progress notes, patient travel spreadsheets and electronic reporting systems. Variables that were recorded included demographic details, patient’s postcodes, date stamps for a variety of time points throughout the referral/ testing process and patient travel subsidy information. Results: Results revealed three times the number of patients were serviced at Rural Hospital A for both EST and Holter monitoring compared to Rural Hospital B. Approximately 48% of exercise stress tests and 9% of Holter monitoring appointments breached the allocated categorisation period at Rural Hospital A. Rural Hospital B did not employ a categorisation system. Patients at Rural Hospital A waited almost twice as long compared to patients at Rural Hospital B to complete an EST. Additionally, Rural Hospital A waited twice as long for reporting of the EST by a cardiology specialist compared to Rural Hospital B. The overall process from the physician requesting the EST to the time the referring physician received the signed report were therefore elongated at Rural Hospital A compared to Rural Hospital B (96 vs 49 days). Similarly, Holter patients on average at Rural Hospital A waited longer to have the Holter monitor fitted (14 vs. 7 days), for cardiology specialist reporting (21 vs. 3 days) and the entire round process from the physician requesting a Holter monitor to the time the referring physician received the signed report back (45 vs. 14 days). The mean distance travelled for patients that underwent Holter monitoring and were required to travel was 667 ± 383 kilometres at Rural Hospital A and 394 ± 284 kilometres at Rural Hospital B. The mean distance travelled for patients that underwent an EST and were required to travel was 479 ± 343km at Rural Hospital A and 411 ± 301km at Rural Hospital B. The maximum return distance travelled for individual patients was observed at Rural Hospital B with patients travelling 1464km for Holter monitoring and ESTs. The greatest average return distance was observed at Rural Hospital A. Patients performing Holter monitoring travelled an average return distance of ~668 kilometres. It was recognised that patients at both facilities underutilised the patient travel subsidy scheme. Conclusions The results from this study illustrated significant differences in service methods and the impact on time to testing, reporting and subsequent local follow up once reports were returned to the local service provider. The reporting strategies observed were particularly timely with both hospitals utilising ineffective methods. Patients additionally were travelling long distances to seek diagnostic testing. Strategies such as outreach clinics and Telehealth services may be advantageous in improving access to specialist care without the need for patients to travel hundreds of kilometres. Innovative approaches and collaborative thinking amongst urban and rural health providers is required to minimise the geographical health divide.

Global investigations have implicated water buffalo (Bubalus bubalis) as a potential source of zoonotic Cryptosporidium and Giardia parasites which may pose a threat to human health. In Australia, buffalo are a feral pest that have colonised the floodplains, wetlands and woodlands of Indigenous owned and managed Arnhem Land, in tropical monsoonal Northern Australia. Indigenous people from the remote community Ngukurr have raised concerns about the potential threat to their health from shared use of surface waters inhabited by buffalo, in the South East Arnhem Land Indigenous Protected Area (SEAL IPA), Northern Australia. Surface waters are valued by local Indigenous people for spiritual and customary reasons, bush foods, medicines and drinking water. Here, we used molecular methods to characterise Cryptosporidium spp. and Giardia duodenalis assemblages from feral water buffalo living in the SEAL IPA to determine potential zoonotic risks to health of Indigenous people through co-use of surface water billabongs. Buffalo faecal DNA was screened for Cryptosporidium and Giardia using the 18S rRNA gene. Giardia were also screened using Glutamate hydrogenase (gdh) and βeta-giardin (β-giardin) genes. DNA sequencing identified C. ryanae in 9.9% (31/313) and G. duodenalis assemblage E 1.9% (6/313) in buffalo. Cryptosporidium ryanae is not considered zoonotic and G. duodenalis assemblage E is a livestock assemblage that has been reported in humans. Carriage of G. duodenalis assemblage E in buffalo may present a disease risk for Indigenous people utilising billabongs, according to customary practice.

Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15–25 years and refine it after piloting. This 8-session program, ‘Maboo wirriya, be healthy’ involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.

This paper provides an overview of the first 12 years of the formal assessment program of the Australian College of Rural and Remote Medicine (ACRRM). The ACRRM Fellowship represents the world’s first and only Fellowship exam in Rural Medicine. The ACRRM assessment program is mapped to its Rural Generalist curriculum, based on the principles of programmatic assessment. ACRRM offers candidates the opportunity to participate in assessment in or close to their home location. The ACRRM Rural Generalist Curriculum defines the scope and standards for independent general practice anywhere in Australia, with a focus on rural and remote settings. The program was initially developed in 2006 and has evolved during delivery from 2008 onwards, utilising the following modalities: Multi Source Feedback (MSF), Multiple Choice Questions (MCQ), Mini Clinical Evaluation Exercise (Mini-CEX), Case Based Discussion (CBD), Procedural Skills Logbook, Structured Assessment using Multiple Patient Scenarios (StAMPS). StAMPS is a unique examination, blending the formats of an Objective Structured Clinical Examination and a traditional viva vocè. The program has an emphasis on formative assessment. Over the past 12 years there has been considerable work in developing resources for candidates, governance structures and quality assurance processes. ACRRM’s Fellowship requirements represent a customised bespoke assessment tailored to ACRRM’s curriculum and the Australian rural and remote context. ACRRM’s assessment program has grown substantially with 649 Fellowships being awarded from 2008 – 2019, with considerable experience gained in rural and remote assessment. It now represents a mature firmly-established process as a vocational endpoint in Rural and Remote Medicine. ACRRM has continued to offer its ‘tele-assessment’ program throughout the COVID-19 pandemic, with candidates and examiners participating in assessment by use of distance technology while remaining in or near their home community. This model may provide some insights for other medical Colleges and educational institutions facing challenges in the current environment.

The thesis is a study of a single community, its health, expectations and aspirations. It is a study of understand in g and responsibility in the context of dependence. The primarily ethnographic work for this thesis was undertaken in Ngukurr over thirteen months between 1999 and 2002. Ngukurr is a remote town on the south east border of Arnhem Land in Australia’s Northern Territory. Its long term residents are Aboriginal people. The thesis presented here examines these people’s understanding of health and illness in their community and their attainment of a good life. My study focuses on issues around people’s engagement with and disengagement from, the management of their health and health service delivery. My thesis is guided by the following questions: • how do people assess their health status? • how a republic health services perceived? • what expectations does the community have about the type and quality of the services provided? • do people seek an active role in the management of their health? People’s attitudes to and expectations for their health are examined in the context of a history of direct welfare dependence till the mid nineteen seventies; followed by local self government in which fiscal and administrative responsibility were held by Government or outside individuals. The evidence for health status, morbidity, and mortality among the remote indigenous population is significantly worse than non indigenous Australians and h a s been the subject of extensive Commonwealth and State health programs to little obvious effect. The literature I survey shows that people in poor communities rate their health more highly than the objective data suggests. Ngukurr residents rate their health in a similar way, b u t their apparent satisfaction masks complex beliefs about illness and concerns about health. I demonstrate that the community believes that outside influences are more important than personal actions as a cause of poor health, that there is little respect for the community’s view of health or health services, and in consequence there is little point in taking personal or collective responsibility. Ngukurr residents are not disinterested in health. They are acutely aware of the patterns of morbidity and mortality in their community and consider these to have a negative impact on their quality of life. Their ability to bring about changes in these patterns is limited by different paradigms of health and illness which sometimes appear as fatalism, powerlessness in the non-Aboriginal domain, loss of confidence due to poor communication with non indigenous providers, and consequent low expectations with regard to personal and community health. This creates a challenge for current policies to devolve management responsibility for health services to local communities. Policy makers should make considerable efforts to understand local health beliefs and value systems and ensure that changes are appropriate, rather than making changes in health systems based on non-indigenous understandings of needs.

Pama-Nyungan grandparent systems change with grandchildren, but not cross-cousin terms or social norms