Remote Australia Online

The purpose of this research was to ascertain what Torres Strait Islander students who have relocated from various locations around Australia to Brisbane in order to attend university, report have and/or would have assisted them in their transition to a metropolitan area such as Brisbane to undertake their university studies. The focus is on successful completion of university for Torres Strait Islander students. The reason I have conducted this research is because there remains a disparity between Aboriginal and Torres Strait Islander and non-Indigenous peoples in relation to university enrolments, retention and completion rates, with the rates of Torres Strait Islander students being considerably lower than their non-Indigenous counterparts. I am interested in what levels of access and support are currently offered to Torres Strait Islander students as they transition to university study. This research has utilised the theoretical framework of Indigenous research theories. I have used the Indigenous Research Principles of Lester Irabinna-Rigney and Indigenous Standpoint Theory put forward by Martin Nakatato facilitate the formulation of knowledge on this topic. The research is positioned from the standpoint of the Torres Strait Islander student participants and researcher. Further, the research incorporated the methodology of yarning, as this methodology is considered appropriate and relevant for use with Torres Strait Islander students, as well as being a methodology which is becoming widespread in the Indigenous research space. Yarning is a form of communication which incorporates ontological ways that Torres Strait Islander people share knowledge. The data collection method was storyboarding, with the research data being presented through the use of personal accounts and analysed using thematic analysis techniques. The findings of this research will contribute to knowledge about how current and future Torres Strait Islander students relocating from various locations around Australia can better transition to university and improve their chances of success whilst at university.

The aim of this study was to determine diabetes care processes and intermediate clinical outcomes in a remote primary care service in 2009 compared with 2004. A retrospective review of diabetes care from January 2009 to January 2010 was conducted using a chronic disease register (Project Ferret). Completeness of ascertainment was verified by a manual audit of charts. The results from this audit were compared with a similar study conducted in this community in 2004. The main outcome measure was diabetic management: in terms of (a) regular monitoring of diabetic care processes, and (b) compliance with national optimal management guidelines and comparison with diabetic outcomes data from a 2004 audit and the National data from 2009. People with diabetes on the register increased from 60 in 2004 to 77 in 2009. They were younger and heavier with a shorter duration of diagnosed diabetes. Recording of diabetic care processes in 2009 decreased between 5 and 32% compared with 2004 data. Intermediate clinical measures (e.g. glycosylated haemoglobin, blood pressure, triglycerides, albumin creatinine ratio) indicate stable or poorer diabetic control across all measures except total cholesterol. When compared with non-Indigenous diabetics, diabetes is diagnosed earlier and rates of smoking, hypertension, dyslipidaemia and diabetic nephropathy are higher in this population. Insulin use appears to be lower in the study population than reported in the national sample. Improved diabetic care processes and outcomes reported from 1999 to 2003 have not been sustained, and intermediate clinical measures have become more adverse over a 5 year period in this high risk remote community. Chronic care systems, including quality improvement, require renewed investment.

Animals in hot desert environments often show marked fluctuations in population size, persisting in low numbers in refuge habitats during dry periods and expanding after rain when resources increase. Understanding drought-wet cycle dynamics is important for managing arid ecosystems, particularly if populations of threatened species are present. Such species may face increased risks of extinction if all populations decrease synchronously toward zero during low-resource periods, and if key refuge habitats needed during these periods are disturbed or unavailable. Here, we describe the dynamics and habitat requirements of two sub-populations of the kowari, Dasyuroides byrnei (Marsupialia: Dasyuridae), during long-term sampling (2000–2015) that encompassed multiple drought-wet cycles. This species is listed currently as Vulnerable on the IUCN Red List. We found that the study region contains favourable habitat, with kowari occurring on hard stony (gibber) pavements in association with coverage of sand that may facilitate construction of burrows. Both sub-populations of kowari declined over the study period irrespective of climatic conditions, despite some evidence that both body condition and reproductive output increased after rain. We suggest that the studied sub-populations are under stress from extrinsic rather than intrinsic factors, with livestock grazing and introduced predators perhaps having the most negative effects. If similar demographic trends are apparent elsewhere in the species’ small geographical range, the species would be eligible for listing on the IUCN Red List as Endangered, with a 20% chance of extinction within the next 20 years. Urgent research is required to quantify and mitigate the extrinsic threats to kowari populations. Proactive measures such as captive breeding to act as insurance populations would be prudent.

When it comes to issues of housing policy, remote Indigenous housing often presents the extreme case. The failures of housing policy are most acute in remote Indigenous Australia, but despite the need to learn from the policy mistakes of the past, there has been little detailed analysis of the policy history. Through documentary and empirical analysis, we show that policies have either failed to be adapted to cultural and geographic contexts or, when they have been culturally responsive, they have lacked attention to the complexities of service delivery. Despite differences in policy settings, the long view is one of the normalization of Indigenous communities, although research points to the need for culturally appropriate arrangements. We argue that rather than politically motivated short-termism, governments need to develop a medium- to long-term approach that approaches policy solutions incrementally, builds capacity within the state and Indigenous communities, and is based on the evidence.

Australia has committed to the 17 Sustainable Development Goals (SDGs) goals under the UN’s 2030 Agenda. However, these goals may not be fully achieved in Australia under current policy settings. Australia reports success in achieving the goal for quality and access to safe drinking water and sanitation (SDG 6), though for Australians living in remote Indigenous communities, the experience is very different. Furthermore, the burden of disease is higher in remote communities (SDG 3). Many of these diseases are waterborne or hygiene-related, including prevalence in some remote Indigenous communities of endemic trachoma eye infection, preventable through access to functioning water services and available soap. This research provides a case for identifying, then understanding the interlinkages between SDGs 3, 6, and others locally, as well as nationally. This will enable governments to enact policies for long-term sustainable solutions for remotely-located and marginalised peoples in Australia in line with Agenda 2030 commitments.

In 2017, I conducted a review into regional, rural and remote education for the Australian Government, and I presented my report on it in early 2018 to the then Minister, Senator Birmingham. I commenced my report with a statement of the key challenge facing regional, rural and remote (RRR) education, namely: "ensuring, regardless of location or circumstances, that every young person has access to high-quality schooling and opportunities."

INTRODUCTION: Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. METHODS: This translational qualitative study explored the experiences and perceptions of QRGP trainees who undertook a PIERCE placement in three Queensland rural hospitals (Mareeba, Proserpine and Stanthorpe) in 2015, with a matched cohort of trainees who undertook regional hospital placements in anaesthetics, obstetrics and gynaecology, and paediatrics at a regional referral hospital (Cairns, Mackay and Toowoomba base hospitals). The study used a realist evaluation framework that investigates What works, for whom, in what circumstances, in what respects and why? RESULTS: PIERCE provided an enjoyable and valued rural training experience that promoted trainee engagement with, and contribution to, a rural community of practice, reinforcing their commitment to a career in rural medicine. However, QRGP trainees did not accept that PIERCE could be a substitute for regional hospital experience in anaesthetics, obstetrics and gynaecology, and paediatrics. Rather, trainees thought PIERCE and regional hospital placements offered complementary experiences. PIERCE offered integrated, hands-on rural clinical experience in which trainees had more autonomy and responsibility. Regional hospital placements offered more traditional caseload learning experiences based on observation and the handing down of knowledge and skills by hospital-based supervisors. CONCLUSION: Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training.

While colonialism in Australia has ‘officially’ ended, it is evident that its impact on Indigenous people has been enduring. This essay argues that, beyond simply being ‘legacies’ of colonialism, latter-day interventions by Australian governments such as the Northern Territory Emergency Response Act are an insidious form of neo-colonialism.

The works of Western Desert women artists, such as Kathleen Petyarre, confront the viewer with the embodied reality of Aboriginal culture. These works are intercultural expressions of Aboriginal ways of being, imprinted within the frame of the canvas. This essay explores the implications of Kathleen Petyarre’s paintings for Settler Australians, and the potential for such works to create a greater appreciation of Country. I suggest that the acrylic paintings performed by Western Desert women artists can be understood as both expressions of the Dreaming and as evocations of sensibilities to be experienced and felt by Settler viewers. With reference to Jennifer Biddle’s Breasts, Bodies, Canvas: Central Desert Art as Experience (2007), I maintain that the work of Western Desert women artists departs from the dominant modes of representing Country, Dreaming narratives and Ancestors – instead articulating bodily experiences and expressions particular to Aboriginal women’s ways of being in and knowing the world.

Strategies to date have been ineffective in reducing high rates of rheumatic heart disease (RHD) in Australian Aboriginal people; a disease caused by streptococcal infections. A remote Aboriginal community initiated a collaboration to work towards elimination of RHD. Based in ‘both-way learning’ (reciprocal knowledge co-creation), the aim of this study was to co-design, implement and evaluate community-based participatory action research (CBPAR) to achieve this vision. Activities related to understanding and addressing RHD social determinants were delivered through an accredited course adapted to meet learner and project needs. Theory-driven evaluation linking CBPAR to empowerment was applied. Data collection comprised focus groups, interviews, observation, and co-development and use of measurement tools such as surveys. Data analysis utilised process indicators from national guidelines for Aboriginal health research, and outcome indicators derived from the Wallerstein framework. Findings include the importance of valuing traditional knowledges and ways of learning such as locally-meaningful metaphors to explore unfamiliar concepts; empowerment through critical thinking and community ownership of knowledge about RHD and research; providing practical guidance in implementing empowering and decolonising principles / theories. Lessons learned are applicable to next stages of the RHD elimination strategy which must include scale-up of community leadership in research agenda-setting and implementation.

Kriol is an Australian contact language spoken in Australia’s north, and it is the first language of the community of Ngukurr in southern Arnhem Land. For the past two and a half years, I have been using university course credit to create an online language course teaching Kriol to English speakers at the behest of the Ngukurr Language Centre. This paper conveys the challenges that arise in undertaking a large-scale project of this sort as an undergraduate student. It also summarises the advantages and disadvantages of teaching a language online, and provides examples of the tools and techniques available for this purpose. It is hoped that this paper will encourage other undergraduate students and the staff who support them to engage in large-scale projects and pursue similar opportunities during their coursework

Background: Chronic hepatitis B (CHB) is endemic in the Aboriginal population of Australia’s Northern Territory (NT). However, many people’s hepatitis B virus (HBV) status remains unknown. Objective: 1. To maximise the utility of existing HBV test and vaccination data in the NT by creating a linked dataset and computerised algorithmic coding. 2. To undertake rigorous quality assurance processes to establish feasibility of using the linked dataset and computerised algorithmic coding for individual care for people living with CHB. Methods: Step 1: We used deterministic data linkage to merge information from three separate patient databases. HBV testing and vaccination data from 2008–2016 was linked and extracted for 19,314 people from 21 remote Aboriginal communities in the Top End of the NT. Step 2: A computerised algorithm was developed to allocate one of ten HBV codes to each individual. Step 3: A quality assurance process was undertaken by a clinician, using standardised processes, manually reviewing all three databases, for a subset of 5,293 Aboriginal people from five communities to check the accuracy of each allocated code. Results: The process of data linking individuals was highly accurate at 99.9%. The quality assurance process detected an overall error rate of 17.7% on the HBV code generated by the computerised algorithm. Errors occurred in source documentation, primarily from the historical upload of paper-based records to electronic health records. An overall HBV prevalence of 2.6% in five communities was found, which included ten cases of CHB who were previously unaware of infection and not engaged in care. Conclusions: Data linkage of individuals was highly accurate. Data quality issues and poor sensitivity in the codes produced by the computerised algorithm were uncovered in the quality assurance process. By systematically, manually reviewing all available data we were able to allocate a HBV status to 91% of the study population.

Rabies is a globally distributed virus that causes approximately 60,00 human deaths annually with >99% of cases caused by dog bites. Australia is currently canine rabies free. However, the recent eastward spread of rabies in the Indonesian archipelago has increased the probability of rabies entry into northern Australian communities. In addition, many northern Australian communities have large populations of free-roaming dogs, capable of maintaining rabies should an incursion occur. A risk assessment of rabies entry and transmission into these communities is needed to target control and surveillance measures. Illegal transportation of rabies-infected dogs via boat landings is a high-risk entry pathway and was the focus of the current study. A quantitative, stochastic, risk assessment model was developed to evaluate the risk of rabies entry into north-west Cape York Peninsula, Australia, and rabies introduction to resident dogs in one of the communities via transport of rabies-infected dogs on illegal Indonesian fishing boats. Parameter distributions were derived from expert opinion, literature, and analysis of field studies. The estimated median probability of rabies entry into north-west Cape York Peninsula and into Seisia from individual fishing boats was 1.9 × 10⁻⁴/boat and 8.7 × 10⁻⁶/boat, respectively. The estimated annual probability that at least one rabies-infected dog enters north-west Cape York Peninsula and into Seisia was 5.5 × 10⁻³ and 3.5 × 10⁻⁴, respectively. The estimated median probability of rabies introduction into Seisia was 4.7 × 10⁻⁸/boat, and the estimated annual probability that at least one rabies-infected dog causes rabies transmission in a resident Seisia dog was 8.3 × 10⁻⁵. Sensitivity analysis using the Sobol method highlighted some parameters as influential, including but not limited to the prevalence of rabies in Indonesia, the probability of a dog on board an Indonesian fishing boat, and the probability of a Seisia dog being on the beach. Overall, the probabilities of rabies entry into north-west Cape York Peninsula and rabies introduction into Seisia are low. However, the potential devastating consequences of a rabies incursion in this region make this a non-negligible risk.

Fungi from the order Entomophthorales are a rare but well recognized cause of tropical fungal infection, typically causing subcutaneous truncal or limb lesions in immunocompetent hosts. They may also mimic malignancy by causing intrabdominal mass, sometimes resulting in obstructive gastrointestinal or renal presentations. A 4-year-old female presented with a progressively growing abdominal wall lesion over several months, developing into acute inflammation of the abdominal wall with systemic symptoms. She underwent surgical debridement and fungal culture of subcutaneous tissue was positive for Basidiobolus spp with characteristic histopathological findings. Treatment with voriconazole followed by itraconazole over a total duration of 6 weeks led to complete resolution. Basidiobolus spp is an unusual cause of infection with characteristic mycological and histopathological findings. Infection can present in a number of ways ranging from a slow-growing mass in the subcutaneous soft tissue to an invasive mass in the gastrointestinal tract. Identification of its unique beak-like zygospore and Splendore-Hoeppli phenomenon on histopathological specimens can be pathognomonic and could provide the key to early diagnosis. Review of the literature found that timely diagnosis and commencement of antifungal therapy can be curative with or without surgical treatment. Considering the rarity of this tropical infection, this case provides the opportunity for revision of the typical presentations and diagnostic findings of Basidiobolus spp. With early recognition and suitable treatment, outcomes are generally favorable.

BackgroundThe congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure.

This article incorporates themes from ethnolinguistics, linguistic anthropology, sign linguistics, and decolonization of research methods. We examine a Yolŋu-led collaboration to save their endangered Yolŋu Sign Language (YSL) in Australia's remote North East Arnhem Land. YSL is an alternate bimodal language for hearing Yolŋu and the primary language of Deaf Yolŋu. In light of dissimilar worldviews between indigenous Yolŋu people and the Australian state, we describe opportunities for ethical research and equitable collaboration, with a practical guide to strategies of local action research. We deploy ethnographic insight to describe a globally rare and distinctive metaphysics of place and language. We find that long-term, embedded, place-based collaborative research, through local language, bestows a deeper understanding of Yolŋu spiritual connection to kin and country. Further, we found the affirmation of Yolŋu life space—as embodied in life on the homelands—provokes a different, empowered, non-subordinate cultural future. This embodied cultural future supports the critical intergenerational transmission of the Yolŋu ancestral inheritance, of kin and country, and its languages, signed and spoken, while resisting internal colonization.

Objective:To determine if there is a difference in infection rates between Aboriginal and non-Aboriginal children, following tympanostomy and ventilation tube placement, in the Northern Territory, Australia.Materials and methods:A cohort of 213 patients aged zero to 10 years who had undergone tympanostomy and ventilation tube placement at the Royal Darwin Hospital between 1996 and 2004 were identified. Patients were divided into Aboriginal or non-Aboriginal groups, from their medical record. Factors such as age, sex, dwelling (remote or urban) and season were compared for each group, in order to ascertain if they contributed to infection rates. A retrospective analysis of cases was conducted for the two-year post-operative period.Results:There was no statistically significant difference in infection rates between the two groups (37 vs 35 per cent). There was no statistically significant difference when comparing the two groups for age, sex, season, or remote vs urban dwelling.Conclusion:Aboriginal children were not prone to more infections following tympanostomy tube placement when compared with non-Aboriginal children.

Nyaparu (William) Gardiner?s drawings and paintings bring a lived perspective to histories of the 1946 pastoral workers? strike in the Pilbara in Western Australia. This strike has been documented largely through the dramatic events of 1946 and through the subsequent struggles of strike leaders, including Clancy McKenna and Don McLeod, with the state government. Gardiner was born into the strike, and worked on its mining and pastoral settlements before leaving to take up station work elsewhere. His drawings and paintings document the ?slow time? of strike life, of everyday labour and waiting, of his fellow workers on the strike camps, as well as his subsequent work with cattle and horses in the North West. Only beginning to make art in the last years of his life, Gardiner created his portraits of strike leaders, workers and landscapes from memory, and they contain a ghostly quality as they recall an era and many people who have died. His pictures testify to an impoverished autonomy for Aboriginal people and itinerant workers in the North West in the 1950s and 1960s. They offer a history from below, to supplement the political histories of the strike and its aftermath in this region of Australia.

The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland.

Purpose: In major urban centres and high-resource settings, treatment of diabetic maculopathy with anti-Vascular Endothelial Growth Factor (VEGF) injections has largely displaced laser treatment. However, intravitreal therapy alone requires frequent follow-up, a barrier to adherence in remote Australia. We report vision outcomes of phased diabetic maculopathy treatment in remote Central Australia for maculopathy using laser and, in a subset, supplementary injection treatment.Methods: We audited clinical records of patients undergoing laser treatment for diabetic maculopathy between 2001 and 2013 at an ophthalmology service based at Alice Springs Hospital, a regional hub in remote Australia. All patients receiving macular laser treatment were included, and some required supplementary injection(s). The primary outcome measure was change in best-corrected visual acuity [BCVA] from baseline treatment.Results: Of 338 maculopathy-treated patients, 88% were indigenous and 39% were male. Of 554 maculopathy laser-treated eyes, 118 (21%) received supplementary injection/s. In the laser treatment phase, median BCVA was 78 letters at baseline (interquartile range 62?80) and decreased by a median of two letters at final visit. In the subset who underwent subsequentinjection treatment, BCVA was 60 letters at first injection, with a median five-letter increase by final visit. Overall outcomes were similar in Indigenous and non-Indigenous Australians. Predictors of reduction in BCVA in the macular laser treatment phase were better baseline BCVA, older age, and PRP treatment (all p < .005).Conclusion: Laser treatment for diabetic maculopathy preserved vision in Central Australia, where barriers to follow-up can preclude regular injections. Supplementary injections stabilized vision in the laser-resistant subset.

The eastern barn owl (Tyto delicatula) is a significant native predator of small mammals in Australia. Regurgitated pellets can provide important data on species presence, current or historical changes in mammal fauna over time, or data on cryptic or threatened species. We collected 125 pellets from Cravens Peak reserve, Simpson Desert, Queensland, and examined the contents, including changes in diet over time (using age of pellet as a proxy) and the relative importance of different prey. In total, 642 unique prey items were recorded, 92% of which were mammals. Small rodents were the dominant prey – Mus musculus and Pseudomys hermannsburgensis, and the presence of Notomys cf. fuscus, Pseudantechinus cf. mimulus and Dasycercus blythi were all significant, being range extensions. Such data add to more traditional or novel techniques to record community changes over time.

Background—Although acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD), continue to cause a large burden of morbidity and mortality in disadvantaged populations, most studies investigating the effectiveness of control programs date from the 1950s. A control program, including a disease register, in the Northern Territory of Australia where the Indigenous population has high rates of ARF and RHD allowed us to examine current disease incidence and progression. Methods and Results—ARF and RHD incidence rates, ARF recurrence rates, progression rates from ARF to RHD to heart failure, and RHD survival and mortality rates were calculated for Northern Territory residents from 1997 to 2010. For Indigenous people, ARF incidence was highest in the 5- to 14-year age group (males, 162 per 100 000; females, 228 per 100 000). There was little evidence that the incidence of ARF or RHD had declined. The ARF recurrence rate declined by 9% per year after diagnosis. After a first ARF diagnosis, 61% developed RHD within 10 years. After RHD diagnosis, 27% developed heart failure within 5 years. For Indigenous RHD patients, the relative survival rate was 88.4% at 10 years after diagnosis and the standardized mortality ratio was 1.56 (95% confidence interval, 1.23–1.96). Conclusions—For Indigenous Australians in the Northern Territory, ARF and RHD incidence and associated mortality remain very high. The reduction in ARF recurrence indicates that the RHD control program has improved secondary prophylaxis; a decline in RHD incidence is expected to follow

Background: Rates of hospital admission for suicide-related thoughts and behaviors (SRTBs) are elevated in the Northern Territory (NT) of Australia, especially by Aboriginal people, but very little is known about emergency department (ED) presentations. Aim: We aimed to profile ED presentations in the NT involving SRTBs by Indigenous status and compare discharge arrangements. Method: Logistic regression analyses were performed on data from electronic patient records of consecutive ED presentations involving SRTBs. Results: During the study period, 167 presentations were observed. Aboriginal patients were more likely to present from remote areas and to report substance misuse and family conflict or violence compared with non-Aboriginal patients. In both groups, males were more likely than females to be admitted as were persons presenting with self-harm compared with those who had suicidal thoughts only. No differences in discharge arrangements were identified by Indigenous status. Limitations: The small scale of the study and use of administrative records points to the need for further research to improve the quality of the evidence. Conclusion: While presentations by high-risk groups are more likely to be admitted for further care, the assessment of psychosocial risks and needs in EDs is vital to informing decisions for aftercare that support recovery in the community for Aboriginal patients and patients discharged from EDs.

This PhD study is situated within the Australian Research Council Linkage Project ‘Building a Bridge into Preschool in Remote Northern Territory Communities (Maningrida and Galiwin’ku)’. The study aimed to improve understanding of family teaching and learning processes in the family and playgroup contexts as part of the project’s aim to determine the feasibility and success of combining the key Abecedarian Approach Australia (3a) elements with local cultural and educational practices through the Families as First Teachers (FaFT) program platform. Amidst discourses around disadvantages and developmental vulnerability in remote Aboriginal contexts, this research study provides an outsider’s perspective on families’ capacity in teaching and learning processes. Theoretically, the study drew from Nakata’s Cultural Interface Theory (2007a). As such, family teaching and learning is seen to comprise dynamic processes in which families continue to traverse between Aboriginal Australian and Western knowledge traditions. Methodologically, in response to this research context, elements of both an interpretivist paradigm and an Indigenous paradigm were utilized to inform the study, which sought to investigate the questions ‘What are local Indigenous perspectives on early childhood teaching and learning?’ and ‘What are the characteristics of teaching and learning in Indigenous mother-child book reading and play interactions?’ The research methods included listening to local perspectives in yarning circles and observing mother-child book reading and play interactions. Both the perspectives and interaction data were analyzed using a thematic approach, guided by the theoretical framework of Ways of Knowing, Ways of Being and Ways of Doing within an Aboriginal Relatedness lens (Martin, 2008). Key findings from the study demonstrate that families in the two communities value kinship and environmental knowledge and practices; maintain the qualities and values of relationships, respect, responsibility and accountability; and embrace multimodality and multilingualism in teaching and learning. The findings showed how cultural ways and educational ways can be interwoven to support the continuity of holistic learning for children as they make meaning through different Ways of Knowing, Being and Doing across various learning contexts. These findings attest to the significance of honouring families’ cultures, strengths, capacities and preferences and including these in playgroup program and policy development so that families’ teaching and learning in educational settings can be built upon their already strong cultural heritage. The study also highlighted the importance of mutual understanding and building reciprocal relationships between Indigenous and non-Indigenous stakeholders, respecting and prioritizing families’ self-determination and aspirations for children’s education.

Introduction: A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia. This article reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why. Methods: We conducted a narrative synthesis of 15 articles reporting on seven CRE service evaluations of different PHC models published between 2012 and 2015. Results: Three different contexts for PHC reform were evaluated: community, regional and clinic based. Themes identified were factors that enabled changes to PHC delivery, processes that supported services to improve access to PHC and requirements for service adaptation to promote sustainability. In both Indigenous and mainstream community settings, the active engagement with local communities, and their participation in, or leadership of, shared decision-making was reported across the three themes. In addition, local governance processes, informed by service activity and impact data, enabled these service changes to be sustained over time. The considerations were different for the outreach, regional and clinic services that relied on internal processes to drive change because they did not require the cooperation of multiple organisations to succeed. Conclusions: The review highlighted that shared decision-making, negotiation and consultation with communities is important and should be used to promote feasible strategies that improve access to community-based PHC services. There is a growing need for service evaluations to report on the feasibility, acceptability and fit of successful service models within context, in addition to reach and effectiveness in order to provide evidence for local dissemination, adaption and implementation strategies.