Remote Australia Online

Objective To synthesise key Australian empirical rural retention evidence and outline implications and potential applications for policymaking. Design A comprehensive search of Medline, PsychINFO, CINAHL plus, Scopus and EMBASE revealed eight peer-reviewed empirical studies published since 2000 quantifying factors associated with actual retention. Setting and participants Rural and remote Australian primary health care workers. Main outcome measures Hazard ratios (hazard of leaving rural), mean length of stay in current rural position and odds ratios (odds of leaving rural). Results A broad range of geographical, professional, financial, educational, regulatory and personal factors are strongly and significantly associated with the rural retention of Australian primary health care workers. Important factors included geographical remoteness and population size, profession, providing hospital services, practising procedural skills, taking annual leave, employment grade, employment and payment structures, restricted access to provider numbers, country of training, vocational training, practitioner age group and cognitive behavioural coaching. These findings suggest that retention strategies should be multifaceted and ?bundled?, addressing the combination of modifiable factors most important for specific groups of Australian rural and remote primary health care workers, and compensating health professionals for hardships they face that are linked to less modifiable factors. Conclusions The short retention of many Australian rural and remote Allied Health Professionals and GPs, particularly in small, outer regional and remote communities, requires ongoing policy support. The important retention patterns highlighted in this review provide policymakers with direction about where to best target retention initiatives, as well as an indication of what they can do to improve retention.

Globally, many Indigenous people rely on surface waters for drinking due to limited access to safe or palatable water, cultural and spiritual reasons and belief in its healing properties. In northern Australia, Indigenous people from the remote community Ngukurr have raised concerns about drinking water from freshwater billabongs due to potential microbial contamination from feral ungulates (buffalo, pig, horse and cattle). In response to these concerns, a cross-cultural assessment of water quality and drinking water safety was undertaken. Indigenous biocultural indicators of water quality and perceptions of drinking water safety at billabongs were documented. In addition, Western scientific methods were used to assess billabong waters surrounding the Ngukurr community for the waterborne pathogens Cryptosporidium and Giardia. The results revealed that local Indigenous people make decisions about water quality and drinking water safety through visual indicators, seasonal knowledge and intuition. Giardia was only detected in the late dry season and Cryptosporidium was not detected during either the wet or dry season. The commonly held Indigenous perspective aligned with the pathogen results, whereby billabongs were safer to drink from in the early dry season then the late dry season. Boiling water when drinking from billabongs during all seasons is considered best practice to avoid ingestion of infective enteric pathogens.

In remote Aboriginal communities in Australia, researchers cast health beliefs and treatments as belonging to either an Aboriginal or biomedical system, which are considered to be irreconcilable and in conflict. Warlpiri people also speak of two distinct traditions that, they claim, are able to heal only specific classes of illness. Nevertheless, both Aboriginal and biomedical systems can be used simultaneously. An examination of two illness episodes will illustrate the complexity of how both Aboriginal and biomedical diagnoses and treatments are employed in a similar manner. I argue that while diagnosis is often stressed in statements regarding illness, it is only one of many factors that influence the treatment choices of individuals.

Disasters cause enormous damages to the natural environment which underpins human survival, yet we largely fail to account for the loss of services from the damaged environmental when it comes to accounting for disaster-related costs. This is mainly due to lack of conventional market price-tag for the services that are readily obtained from the natural environment. This study presents a costing framework, following the World Bank [1]; and a set of methodologies for how to measure such losses. A key focus of proposed methodologies is to assess these losses in terms of their impacts on human well-being, applying both the monetary and non-monetary measures. This paper further demonstrates the application of the proposed framework and methodologies for assessing the loss of ecosystem services from bushfires in the Northern Territory (NT), Australia, where wildfires are frequent, extensive, and often destructive. The total bushfires-related loss was estimated at AU$95-132million per year. Evaluating such costs for loss of Indigenous peoples’ well-being who reside in remote parts of the NT, presents an estimate of AU$272 million/yr. It discusses the key challenges to evaluate environmental losses, particularly the importance of applying local values, and understanding the local context and intricacies between social and economic systems. The framework and methodologies presented here to evaluate environmental losses can be useful to inform policy planning in natural disaster management.

Background: Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. Method: This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development. Results: With MHEC-RAP, these ED providers are no longer ‘flying blind’. They are also more confident to manage and care for emergency mental health patients locally. For these providers, access to specialists who are able to conduct assessments and provide relevant and responsive advice for emergency mental health presentations was valued. Assessing the fit between the consumer and service as a requirement for the development, evaluation, and ongoing management of the service should result in decisions about design and delivery that achieve improved access to care and meet the needs of their consumers. The experience of these providers prior to MHEC-RAP is consistent with that reported in other rural and remote populations suggesting that MHEC-RAP could address limitations in access to specialist care and change the provision of emergency mental health care elsewhere. Conclusion: MHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.

Objective To evaluate a rural emergency telepsychiatry program, the Mental Health Emergency Care–Rural Access Program (MHEC-RAP), which aims to improve access to emergency mental health care for communities throughout western New South Wales (NSW).Methods A descriptive analysis of service activity data from the introduction of the MHEC-RAP in 2008 to 2011 using Chi-squared tests and linear regression modelling to assess change and trends over time.Result There were 55 959 calls to the MHEC-RAP, 9678 (17%) of these calls initiated an MHEC-RAP service (~2500 each year). The use of video assessment increased over 18 months, then levelled off to an average of 65 each month. Health care provider use increased from 54% to 75% of all contacts, and 49% of MHEC-RAP patients were triaged ‘urgent’. Most (71%) were referred from the MHEC-RAP for outpatient care with a local provider. The proportion of MHEC-RAP patients admitted to hospital initially increased by 12%, then declined over the next 2 years by 7% (by 28% for admissions to a mental health inpatient unit (MHIPU)).Conclusion The MHEC-RAP is well established. It has achieved acceptable levels of service activity and continues to be as used as intended. Further research is required to confirm how the MHEC-RAP works in terms of process and capacity, how it has changed access to mental health care and to document its costs and benefits.What is known about the topic? Rural and remote communities have poorer access to and use of mental health services. Telehealth care is a reliable and accepted means for providing non-urgent mental health care.What does this paper add? The MHEC-RAP is a practical and transferable solution to providing specialist emergency mental health care, and support for local providers, in rural and remote areas via telehealth. There is a possible impact upon the problem of recruiting and retaining a mental health workforce in rural and remote areas.What are the implications for practitioners? Providing reliable remote access to specialist mental health assessment and advice while supporting providers in rural communities can result in better outcomes for patients and services alike.

Purpose: This paper aims to track the evolution of an innovative Aboriginal tourism business model with deliberate social and community enterprise objectives in a remote setting.Design/methodology/approach: It adopts an in-depth exploratory case study approach to discover key characteristics of an emerging tourism enterprise. The qualitative data sources include publically available planning, promotional and organizational materials, in-depth interviews with key informants and on-site observations. Yunus et al.'s (2010) social business model provides the framework for the case analysis. Findings: Findings highlight the gradual deepening of Indigenous engagement from simply providing a place for a non-Indigenous tourism business' to running a fully Indigenous-controlled, staffed and themed on-country tourism business. Complementing existing non-Indigenous tourism experiences reduced the need for start-up infrastructure and market recognition, thus reducing business risk for the Traditional Owners. Despite substantial changes in the business structure in response to political and maturation factors, the core motivations seemed to remain strong. The business model facilitates value creation to stakeholders in varying ways.Research limitations/implications The contextual nature of Indigenous tourism reflects limitations of qualitative case study methodology. Practical implications: The resulting business model provides a contextually appropriate structure to engage in tourism for achieving cultural and societal goals. It mitigates against the identified risk of low market demand for Indigenous tourism experiences by connecting with established non-Indigenous tourism products, while also allowing for product offering independent thereof. Social implications: Social benefits are high and have potential for replication in similar contexts elsewhere. Originality/value: The paper contributes to the emerging research on culturally appropriate business models in Indigenous tourism contexts and validates a strategy to overcome low demand. It offers a model that for the tourist facilitates a sustainable experience which enables co-production while for the hosts fosters community resilience, intergenerational learning and improved livelihoods. The case highlights opportunities for further research into the interrelationship, dependencies and thresholds between the social and economic profit equations, particularly in the context of the culture conservation economy.

In comparison to the major dust sources in the Northern Hemisphere, Australia is a relatively minor contributor to the global dust budget. However, severe dust storms do occur in Australia, especially in drought years. In this study, we simulate the 22–23 October 2002 dust storm using an integrated dust model, which is probably the most severe dust storm in Australia in at least the past 40 years. The model results are compared with synoptic visibility data and satellite images and for several stations, with high-volume sampler measurements. The model simulations are then used to estimate dust load, emission, and deposition, both for over the continent and for over the ocean. The main dust sources and sinks are identified. Dust sources include the desert areas in northern South Australia, the grazing lands in western New South Wales (NSW), and the farm lands in NSW, Victoria, and Western Australia, as well as areas in Queensland and Northern Territory. The desert areas appear to be the strongest source. The maximum dust emission is around 2000 μg m−2 s−1, and the maximum net dust emission is around 500 μg m−2 s−1. The total amount of dust eroded from the Australian continent during this dust event is around 95.8 Mt, of which 93.67 Mt is deposited on the continent and 2.13 Mt in the ocean. The maximum total dust load over the simulation domain is around 5 Mt. The magnitude of this Australian dust storm corresponds to a northeast Asian dust storm of moderate size.

This article seeks to understand Indigenous Australian young people's relationships and their experiences of sexual intimacy. A cohort of Indigenous 16-25-year-olds from urban, rural and remote communities were invited to participate in a collaborative method involving scenario-based body mapping. In these activities, young people discussed the range and complexity of their relationships and how constructions and interpretations of relationships contribute to both positive and negative experiences. These rich understandings provide important insights into adolescent sexuality as 'multidimensional, socially constructed and negotiated'. However, they also point to the continued gendered power inequalities that subordinate young women's lives to the desires and control of young men.

The Central Remote Model (CRM) was a pilot program aimed at achieving cost efficiencies in the delivery of Indigenous Housing in a remote region of the Northern Territory, in central Australia. The CRM process centralized the planning and design of housing, resulting in communities being able to select from 6 standard housing designs. The CRM process also allocated a project manager to manage and supervise all of the construction contracts. The CRM pilot program aimed to coordinate construction programs for all grantee communities at the various sites in the Central Remote Region. It also tried to determine if there were net benefits in letting major contracts across several communities rather than a series of small contracts; whether using standard housing designs resulted in greater efficiency in construction; and if coordination of projects could provide enough project continuity to sustain local Indigenous building and maintenance teams in employment and in training. The Indigenous Housing Authority of Northern Territory (IHANT) commissioned SGS to evaluate the CRM, to see whether efficiencies were achieved through centralizing housing design and consultation processes, and centralized project management. SGS reviewed available financial and other performance data, undertook substantial consultation and identified numerous financial impacts associated with centralization.

Commonly used definitions of pedagogy refer to both the art and science of teaching,but art and science are culturally bound as indeed is mathematics and mathematics curriculum. This paper describes two experiences in a remote Indigenous community that challenge universalist notions of pedagogy and support a case for re-assessing what is meant by culturally-responsive mathematics education in this context.

INTRODUCTION: Dementia is five-fold more prevalent among Aboriginal than non-Aboriginal Australians. Despite this, the quality of care available to people living with dementia in remote Aboriginal communities is poor. The objective of this study was to determine ways to overcome factors affecting the successful delivery of services to Aboriginal people with dementia living in remote communities, and to their families and communities. METHODS: This qualitative research took place in the Kimberley Region of Western Australia. Data collection occurred in three stages: (1) interviews with service providers to identify the services available; (2) interviews with the caregivers of Aboriginal people living with dementia and community-based care workers; and (3) focus groups with community representatives and community care staff. Each stage was concluded when no new themes emerged. At each stage the transcribed information was analysed and joint interpretation identified common themes. RESULTS: In total, 42 service providers, 31 caregivers and community-based care workers were interviewed and 3 focus groups were conducted. Obstacles to accessing quality care were mentioned and recommendations on ways to improve care were made. The key themes that emerged were caregiver role, perspectives of dementia, community and culturally-appropriate care, workforce, education and training, issues affecting remote communities and service issues. Detailed information on how each theme affects the successful delivery of dementia care is provided. CONCLUSIONS: These research findings indicate that people living with dementia and their caregivers in remote Aboriginal communities are struggling to cope. They are requesting and require better community care. Implementing a culturally safe model of dementia care for remote Aboriginal communities that encompasses the recommendations made and builds on the strengths of the communities could potentially deliver the required improvements to dementia care for this population.

Wild dogs (dingoes, free-ranging domestic dogs and hybrids) have the potential to pose a threat to biodiversity conservation and the health of domestic animals, livestock and humans in the Wet Tropics bioregion of north Queensland. The increasing human population in the Wet Tropics will inevitably result in more frequent interactions between people and wild dogs. One potential interaction is the transmission or 'spillover' of diseases, including zoonotic parasites, from dingoes to the area's native fauna, livestock, domestic animals, human residents and visitors. Investigating all potential hosts and their interactions is hence necessary to understand and mitigate the possibility of 'spill-over' or 'spill-back' of zoonotic infection. Indigenous communities are at particular risk due to limited management of domestic dog health and the ability of community dogs to roam free, possibly contacting dingoes and their habitat and resources. Dogs remain an integral part of Indigenous community culture and the health and treatment of dogs is intrinsically linked to community health and well-being. Research was undertaken in and around rural and remote Indigenous communities to understand the disease status of dingoes and sympatric community dogs. Using various parasitological techniques, combined with radio telemetry to track the movements of dingoes and free-roaming domestic dogs, risks of transmission of infection from dingoes to dogs and then people in Indigenous communities, or vice versa, were examined. Faecal samples collected from tracked dingoes revealed 100% infection with the zoonotic hookworm Ancylostoma caninum, and one animal was infected with Ancylostoma ceylanicum; this is the first report of this parasite in dingoes. A similar result was found for necropsied dingoes; however, a much more elevated infection rate was seen in dingo scats. Those scats positively sequenced for hookworm, contained A. ceylanicum, A. caninum and A. braziliense, with A. ceylanicum the dominant species in Mount Windsor National Park, with a prevalence of 100%, but decreasing to 68% and 30.8% in scats collected from northern and southern rural suburbs of Cairns, respectively. I also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7%) and soil (55.6%) in an Indigenous community and found it was present in soil samples from two out of the three popular tourist locations sampled. Due to the ability of A. ceylanicum to cause a patent infection in humans, the zoonotic risk arising from this wild dog reservoir to communities in the Wet Tropics is of concern. Domestic dogs also had a high prevalence of A. caninum with 100%, 96.4%, and 88.0% infection of tracked dogs, necropsied dogs and dog scats, respectively, but A. ceylanicum was not found. Similar levels of infection of the zoonotic roundworm Toxocara canis were found in dingoes and domestic dogs. However, whipworm Trichuris vulpis infection was far more prevalent in domestic dog necropsies (78.6%) than in dingo necropsies (3.7%). Dirofilaria immitis infection was found in high prevalence with 71% infection seen in dingoes in low density housing areas. This result highlights the importance of dingoes as reservoir hosts of heartworm disease and that the subsequent risk of infection to companion animals and humans depends on local factors such as housing density, possibly linked to chemotherapeutic heartworm control in domestic dogs and climate. Eleven dingoes and seven free-roaming domestic dogs were fitted with GPS collars and tracked over an extended period. Dingo home ranges almost completely overlapped those of the domestic dogs and dingoes spent a substantial amount of time in areas used by dogs. I found that dingoes and dogs appeared to avoid direct contact however this spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of zoonotic parasites, facilitated by the parasite's ability to survive for longer periods in the Wet Tropic's warm and humid conditions. Tracking and camera trap deployment in the Yarrabah community showed that the community rubbish tip and animal carcasses provided concentrated anthropogenic food sources for dogs and dingoes, and transmission risk is elevated in these locations. Two dog health days were conducted in the Yarrabah Aboriginal community to provide free veterinary consultation for pets, provide community members with information about new dog laws and registration and to provide information about parasites infecting dogs and the possible public health risks associated with them. This resulted in the provision of treatment and veterinary consultation to 134 dogs and one cat along with the development of guidelines for domestic animal management which I prepared and presented to Yarrabah Council to assist in the introduction of registration of pets. By using a "One Health" approach that integrated the disciplines of veterinary parasitology, epidemiology and ecological analysis of canids' home range and resource use, I was able to establish the prevalence of parasitic pathogens and the current status of infection in dingoes and determine the pathways and mechanisms which lead to the potential risk of transmission of infections among dingoes, wildlife, domestic animals and humans. I determined that hot spots of infection transmission are likely to be sources of anthropogenic-derived food such as the rubbish tip, animal carcasses and public congregational areas such as school sporting grounds. Similar risks are likely to occur in other Indigenous communities in the Wet Tropics and warrant investigation and intervention. Through collaboration with local, experienced environmental health workers I was able to achieve the overall aim of this project which was to determine, and provide workable and sustainable animal and health management practices to reduce the risk of spill-over of parasitic infection from dingoes to domestic dogs (or vice-versa). Mitigation measures should include exclusion fencing of the rubbish tip, effective disposal of animal carcasses, public education to increase community awareness about local zoonotic diseases and their prevention, along with regular chemoprophylactic therapy of community dogs and improved management of dogs and their diseases in Indigenous communities.

We describe preliminary explorations with a format to engage young indigenous students from remote communities in design and making. Digital technologies are often seen, not without merit, as reflecting and embodying cultural values that are at odds with indigenous ways of learning. To overcome this we organised a 'Coding on Country' workshop. The workshop took place outdoors, at a culturally significant location, was embedded within cultural practices, as well as other mundane activities, and drew participation from young people as well as from Elders. Key insights are that activities that take place on country are also intrinsically about country and culture. A site of cultural significance can, better than a classroom, draw together younger and older community members, and offer a social centre which people can gravitate around while engaging in different activities. This contributes to reconciling technology and tradition, and offers opportunities to participate on one's own terms.

The distribution of the bilby Macrotis lagotis was assessed in the Tanami Desert using stratified random plots, repetitively sampled transects, aerial survey transects, and ground truth plots. Compared to a previous assessment of distribution, the extent of occurrence has changed little in the last 20 yr. However, the area of occupancy is small relative to the extent of occurrence and <25% of the current geographic range has bilby sign <20 km apart. Generalised linear modelling was used to determine the strength of association between bilby occurrence and habitat variables and identify refugia characteristics. Four competing candidate models were examined to determine whether bilby occurrence associated significantly with productive substrates and introduced herbivores, the distribution of key predator species, the pattern of fire, and climatic gradients including rainfall and temperature. For the entire study area, bilby presence associated most strongly with variables of mean annual rainfall, substrate type and the probability of dingo occurrence. Proximity to recently burnt habitat formed a significant predictor of bilby occurrence in a model derived for a reduced part of the study area where most sign was found. The work suggested that the current frameworks underpinning understanding of biotic distributions in arid Australia are deficient, and that climatic gradients, lateritic and rocky systems, and predators need to be incorporated into our thinking in the future. The extent of occurrence based on outlier records from opportunistic reports provided a misleading indication of the true status of the bilby.

This study evaluates the effect of a topical intervention comprising of fissure sealant, povidone-iodine, and fluoride varnish in preventing caries on occlusal, approximal, and smooth surfaces. This three-year clinical trial was conducted in a remote Indigenous community of Australia. All schoolchildren (age range: 4–17) were invited to participate; those with parental consents to receive three-annual epidemiological examinations and interventions constituted the experimental group, while those with consents for only the epidemiological examination formed a comparison group. The intervention group received an annual application of fissure sealant, povidone–iodine and fluoride varnish for two consecutive years along with the restoration of any cavitated lesions, while the comparison group did not receive any intervention except for the usual care that included emergency treatment and restorations. Incipient and advanced caries were recorded in the permanent dentition while data on confounding variables were collected through questionnaires. Caries increment and progression were the outcome variables. A total of 408 children participated in the baseline examination, 208 finished the study. After adjusting for confounders, the prevented fraction (PF) on occlusal surfaces for advanced caries in the experimental group was 76.1% (mean difference- −0.35, 95% CI: −0.67–0.04), while the PF for progression from incipient to advanced caries was 100%(mean difference- −0.30, 95% CI: −0.52–0.09). The mean number of smooth surfaces that progressed from incipient to advanced caries in the comparison group was more than twice that of the experimental group, the mean difference was −0.25 (95% CI: −0.46–−0.03) with a PF of 61%. The intervention was only effective in preventing advanced caries on occlusal surfaces and in halting the progression of caries on occlusal and smooth surfaces but not on approximal caries.

Indospicine is a hepatotoxic non-proteinogenic amino acid that has only been found in Indigofera plants including a number of species abundant in central Australia. These legumes are palatable to feral camels and indospicine residues derived from these plants accumulates in camel meat tissue. Indospicine-contaminated camel meat has caused liver disease and mortalities in dogs after a short period of dietary exposure. Since camel meat is also exported for human consumption, this raises concern about the human health risks of consuming indospicine-contaminated camel meat harvested from central Australia. The objective of this study was to assess the indospicine levels in camel meat and its associated potential health risk to the Australian population and the vulnerable sub-population of indigenous Australians from the consumption of such feral camel meat. Two main quantitative probabilistic exposure assessments were conducted through the use of Monte Carlo simulations.. The first exposure assessment considered the indospicine concentrations in real-field camel meat samples. The second assessment was based on a simulated probabilistic distribution of indospicine residues in camel meat, involving eight (8) predictive factors that were derived from our published research data and other secondary sources. The first assessment predicted that the estimated risk of developing indospicine₋induced hepatotoxicosis from contaminated camel meat consumption was 800 per 10 000 of the average Australian population (8.0%), and higher for the indigenous Australians (10.0%). The second exposure assessment demonstrated there was a higher risk (>31%) for the whole Australian population and for the indigenous Australian population. In conclusion, this risk assessment study shows that, while there is a low risk amongst Australians of hepatotoxicosis being associated with the consumption of indospicine-contaminated camel meat, such consumption is still a cause for concern, since the assessment based on the simulated probabilistic distribution of indospicine concentrations in camel meat demonstrated a substantially higher risk. It is therefore advisable that an indospicine residue monitoring program should be implemented to ensure food safety of Australian camel meat. Additionally, the risk of dietary indospicine exposure from other livestock grazing Indigofera in all global regions should also be considered.

There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.

INTRODUCTION: This paper reports on research to ascertain the views of general practitioners (GPs) practising in rural and remote areas of South Australia, on evidence-based medicine (EBM). It follows our previous paper that identified, through a literature search, the key issues in moving towards EBM in general practice in these areas1. The objective of the paper was to identify perceived barriers and potential solutions to evidence-based general practice in rural and remote South Australia. METHODS: An interview survey was conducted in the year 2000 at 89 of 104 GPs' (86%) surgeries in three rural Divisions of General Practice in South Australia. RESULTS: EBM was viewed positively by 85%, and 94% reported practising EBM. However, barriers to EBM were identified by 84% and four key themes were identified. GP-related barriers identified by 60% included difficulty finding, appraising and applying evidence and lack of time to read, reflect and update practice. Patient related barriers (23%) included an apparent conflict between some patients' expectations and evidence. Environmental barriers (43%) related to remoteness included high workload, limited information and poor resources for continued medical education. Resource related barriers included a lack of computer hardware and software and slow, unreliable and expensive Internet access (14%). Potential solutions were suggested by 82%. The most frequent was improved hardware, software and Internet access (41%). Only 19% suggested formal training for GPs, while 26% suggested improved clinical practice guidelines and 23% suggested non-Internet based dissemination of information including a service to provide evidence-based answers to clinical problems. CONCLUSION: EBM was viewed positively by the surveyed GPs and many believed they already practised it. Most identified barriers to full and effective use of EBM but also suggested solutions.

Active language use refers to people's use of a language in their everyday lives and activities. Tangible User Interfaces (TUIs) can facilitate children's participation in language activities such as language learning, communication, storytelling, and social play. However, few TUI projects take the lens of active language use, and exploit the benefits of tangibles for maintaining and revitalising endangered languages. We present the Crocodile Language Friend, co-designed with the Wujal Wujal community, to foster children's use of the Kuku Yalanji Aboriginal language. We contribute a discussion of the ways in which the crocodile's physical characteristics (e.g. size, shape, materials, and personalization) can encourage language use in individual and social activities beyond the affordances of screen-based systems.

BACKGROUND: The gap between current and evidence-based best practice management of chronic diseases in Australian general practice is widely acknowledged. This study seeks to explore some of the factors underpinning this gap in relation to type 2 diabetes management in rural and remote general practice settings. METHODS: A cross-sectional survey of 854 general practitioners (GPs) currently practising in rural and remote Australian communities with populations between 10 000 and 30 000. RESULTS: A total of 209 completed surveys were returned for an overall response rate of 24.5%. GPs reported on their education preferences, knowledge, attitudes and practices relating to type 2 diabetes. GPs indicated a strong preference for face-to-face education options such as conferences and seminars (75.2%). Whilst structured online education activities were less utilised than face-to-face options, GPs reported a desire to undertake more of their education online in the future. Survey findings revealed gaps in GP knowledge around the medical management of diabetes. The most prevalent self-reported learning needs related to pharmacological management (n=87, (45.5%)). Correspondingly, in the GP knowledge test, GPs received the lowest mean score for the section on medical management. GPs also reported having the least confidence in providing effective insulin treatment, compared with other aspects of diabetes management. GPs identified an array of difficulties encountered in providing best practice diabetes care, which were classified into three main categories: GP clinical management problems, patient-related challenges and health system-related difficulties. CONCLUSIONS: This national survey highlights a number of barriers to GP provision of best practice diabetes care in rural and remote Australia. Despite the availability of education programs and clinical practice guidelines, GPs revealed deficits in knowledge and confidence in type 2 diabetes management. GPs identified numerous challenges to effective patient care, some but not all of which can be addressed through continuing professional development. GP preferences for continuing medical education and information may inform future activities, to specifically address the needs of GPs in rural and remote locations.

Introduction: Equity of access to primary health care (PHC) services is a fundamental goal of rural health policies and planning. Unfortunately, many rural and remote communities are characterised by significant inequities in PHC service availability, quality/performance and sustainability. This article investigates how best to ascertain the costs of delivering high quality PHC services across different geographical locations through reporting the research findings from a pilot study. The aim of the study was to ascertain whether it is possible to estimate the total, per capita and per consultation costs of providing high quality PHC services in rural locations of different population sizes, and to describe the methodological issues associated with such an exercise. Methods: A retrospective, top-down approach was used. A sample of high performing primary care practices in rural communities was identified using data from the Australian Primary Care Collaborative (APCC) program. The researchers selected practices in rural communities (Australian Standard Geographical Classification remoteness areas 2 and 3) and assigned a population count using Australian Bureau of Statistics census data (urban centre locality). Four population groups of different sizes were chosen: 101–500, 501–1000, 1001–3000 and 3001–5000. A data collection tool was developed to capture information describing annual operating costs (both capital and recurring), human resources, PHC services provided and reflections from practice principals on issues related to provision of sustainable high quality primary care in a changing environment. Financial data available from practice taxation/accounting records for the 2012–13 financial year, measured in Australian dollars, was used. Practices were visited between March and July 2014. Results: Seven primary care practices agreed to participate. The data exhibited wide variation in total recurrent costs, capital and depreciation costs. There was a weak association between total annual costs and costs of practices grouped by the size of the local community. A stronger association was evident when the size of current patients registered with the practice was considered. The cost per person registered with the practice declines as the number of patients registered increases. Most of the recurrent costs for all practices were attributed to human resources and ranged from 69% to 85% with an average of 77%. Doctors’ salaries accounted for 47–65% of total annual costs with an average of 53%. There was some evidence of an association between cost per consultation and the number of registered patients, with unit cost falling as the size of the registered patient population increased. Discussion: This research highlights several significant issues that need to be addressed in seeking to benchmark rural PHC services: (1) ensuring consistency across the particular services being costed in different locations, (2) consistently determining the patient population within the service catchment, (3) categorising service models, taking into account extended service provision arrangements, (4) ensuring comprehensive collection of all costs and (5) other methodological issues including disaggregating data, defining high performing services and their sustainability over time. Conclusions: Existing national health data sets should be more accessible to researchers for the purpose of benchmarking sustainable, high performing rural PHC services. National rural health and related professional peak bodies should investigate the potential to combine resources to undertake a national survey of the costs of providing high quality PHC across rural Australia.

Morphological contiguity domains are pockets of natural language grammar wherein formal irregularity in one component predicts co-irregularity in a related, and often more marked, component. At the surface level, they foreclose certain allomorphic and/or distributional possibilities, producing so-called *ABA effects. Contiguity phenomena have been documented in the study of comparatives, case, pronouns, tense/aspect, inter multa alia . To this expanding list, this study adds kinship. It shall be shown that nonsingular pronouns in Lower Arrernte exemplify an apparent *ABA allomorphy-constraining distribution in which the agnate-disharmonic and non-agnate forms must co-supplete. An implementation using toy features demonstrates that the emergence of at least some *ABA patterns may be artifactual of how a paradigm is set up, and that Lower Arrernte nonsingulars do not instantiate Bobaljik (2012)'s containment hypothesis. These results are consonant with a picture of contiguity effects as a group of etiologically and derivationally heterogeneous phenomena, instead of an unambiguous diagnostic for syntactic hierarchical structure.

The purposes of this paper are to document the composition and distribution of fishes in the Alice Springs region of Australia, and discuss constraints on fish persistence in this arid region. Nine native and six exotic species were recorded; most exotics no longer exist. Except in Finke River, only one or no native species were found. Fish survival in the area is ameliorated by the exceptionally broad environmental tolerances and migratory abilities of many species, but ultimately depends upon the effects of geology, geomorphology, and the vagaries in pattern of sediment transport on water persistence.

It can be said that leading school improvement in education is, at times, difficult for leaders, students and teachers. However, rural and remote schools bring with them challenges that can be categorised as being unique to their contexts. Considering the importance and influence of student-teacher relationships on students' learning, teachers' intentions to change in response to professional learning and teachers' job satisfaction, it is unsurprising that student voice and agency are becoming a key focus of the policy agenda within Australia.