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This paper draws together critical learnings from diverse qualitative health research projects in Australia that sought to shift power and focus on the strengths and expertise of people with lived experience who are involved as co-researchers. These projects have included exploring and challenging identities, understanding experiences in treatment programs, critiquing and designing/re-designing services, and sharing experiences with the wider community in novel and innovative ways. Lived experiences included alcohol and other drug dependency, mental health, domestic, family or sexual violence, and living with HIV. This paper provides important learnings and actions about partnering with co-researchers with lived experience. In this paper we draw on a process of reflective discussions that occurred over six months with fortnightly online meetings between co-researchers, including co-authors with lived experience external to academia and university-based researchers, some of whom also have lived-experience that intersects with their research. From this, we distilled key learnings across seven themes: (1) the ethics of ethics, which highlights a need for constant reflection on the ethical issues in co-research; (2) recruiting co-researchers, which focuses on ensuring and integrating a diversity of voices; (3) creating safety for all, which must be a priority of engagement and support self-determination; (4) supporting different ways of partnering, which emphasises the need for diverse roles and ways to contribute on research teams; (5) capacity building and training, which requires ongoing evaluation of needs and tailored responses; (6) positioning, which highlights the need to transition from the idea of vulnerability to a strengths-based perspective of lived experience; and (7) power plays, reflecting the need to disrupt the dynamics and established hierarchies of privileging certain forms of knowledge and expertise. The paper includes recommendations for action against these seven themes. [ABSTRACT FROM AUTHOR]

The recent global pandemic renewed the importance of telecommunication infrastructure, as many COVID responses (e.g., working from home, home-schooling, e-commerce) were challenged by the inequity of access to broadband services and its underlying network. This paper examines the geospatial footprint of the National Broadband Network (NBN) in relation to the demographics of Australia's cities and regions. Through data made available by the NBN, which describes the technologies used in its multi-technology mix platform, and published demographic data available via the Australian Bureau of Statistics (ABS), we explore the equity of access to broadband technologies across the nation. The results show a persistent urban-regional divide in the NBN. The paper also offers a brief assessment of the complex and contradictory ways policy responses attempt to mitigate the digital divide, including updates to the national infrastructure project plans. [ABSTRACT FROM AUTHOR]

Background: Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the 'citizen organization'. Objectives: This paper reports on an evaluation of Little Haven's model of care and explores the organization's place as a 'citizen' of the community it services. Design: A co-designed evaluation approach utilizing mixed-method design is used. Methods: Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated. Results: This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as 'over and above', enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community. Conclusion: All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept. Plain language summary: 'Citizen organization': an Australian community-based palliative care service model Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. It aims to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services in equal partnerships between civic organizations, community members, patients and carers, and service providers. We undertook an evaluation of Little Haven's model of care by speaking with current patients, current and past carers, staff, volunteers and stakeholders about their experiences of Little Haven. We found that Little Haven's model contains the essential elements of a palliative care service and provides early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users. They have strong community engagement with a strong background in community activism. We identified that Little Haven's 'being in the community' goes beyond service provision or even sentiment. We observed a symbiotic relationship between the organization and the community it supports in what we have termed the 'citizen organization'. The distinctive characteristic of the citizen organization is its inseparability from the community in which it dwells. [ABSTRACT FROM AUTHOR]

Crime rates in Australia have declined or been steady over the past decade yet prison populations are at all-time highs. Similarly, unemployment rates have been low but unemployment for those ex-prisoners seeking work is very high. In this paper, we draw on the findings of an Australia-wide survey of government-funded employment service providers who support working-aged Australians including ex-prisoners in their search for work. We find that the heterogeneity of the needs of ex-prisoners coupled with the frugality and inflexibility of government policies and practices frustrates the abilities of these agencies to provide services to this target group. [ABSTRACT FROM AUTHOR]

This paper seeks to extend existing conceptualisations of risky and harmful consumption. Our work draws on a qualitative, rhizomatic study of Australian consumers' sports betting practices. We utilise Deleuze and Guattari's related concepts of molar and molecular lines and lines of flight to draw attention to sports betting's mutually affecting discursive, socio-material and emotional intensities. We examine the ongoing tensions between how people understand themselves as gamblers, the social normalisation of gambling and the parameters of risky betting behaviour. We argue that conceiving gambling consumption through molar and molecular lines challenges the binaries inherent in current framings of risky and harmful consumption. We also consider the possibilities for lines of flight and implications for gambling harm. [ABSTRACT FROM AUTHOR]

Suicide has a devasting and far-reaching effect on our communities. In developed countries, most people who die by suicide are male. Understanding men's mental health and what they experience in a suicidal state is key to preventing future attempts. Our paper explores how a group of 37 men in Australia describe the leadup to their suicidality. Underpinned by interpretive phenomenological analysis, interview transcripts were examined for phrases that the investigative team subjectively identified as profound. Our approach considered language and expression that evoke reactions to the sometimes contradictory nature of suicide. The process enabled our team to identify the emotions, rationales, and motivations for and against suicide that give rise to and arise during suicidal states. One man's source of strength may be another's cause of anguish, so any single, one-size-fits-all pathway to suicide prevention is unlikely to succeed, signaling the need for a tailored approach to suicide prevention. [ABSTRACT FROM AUTHOR]

Researchers have found that many post-secondary music students suffer from physical and mental health issues. However, researchers have mainly studied these problems at the individual level, with little investigation of how music students' work is shaped by the coordinating effects of policies, texts, and discourses at and beyond their local site. This paper describes a protocol for an international project that will explore the health of music students in the context of their daily work. Using an institutional ethnography approach, we will examine the social organization of music students' work at three universities: two in Canada and one in Australia. This will be the first set of studies that use institutional ethnography specifically for the purpose of understanding how the social organization of music students' work shapes their health. Data will be collected using several methods common to institutional ethnography: interviews, focus groups, observations, and collecting texts. Data analysis will begin during the data collection process and proceed in two fluid stages. The first stage will involve a detailed investigation of the pertinent work activities at each music school. The second will involve linking that work to specific social relations within and beyond the institution. After data analysis has been completed at all three sites, findings will be compared to one another to identify commonalities and differences in how students' work is organized. Findings of the entire project may inform policy-making and lead to positive change at the institutions studied, as well as others where similar social organization may occur. The novel approach described here will provide opportunities to expand current knowledge about music students' work and health beyond what has been learned through approaches that focus on students' individual behaviours and attributes. [ABSTRACT FROM AUTHOR]

This paper examines the links between place attachment and older persons' preferences to age in place, and factors that disrupt these preferences. We use data from the 2001–2021 Household, Income and Labour Dynamics in Australia Survey and panel-data modelling to confirm strong associations between several place attachment dimensions and aging-in-place preferences. Strong ties to children, strong social capital, residence in social housing, homeownership status, housing wealth, and home and neighborhood satisfaction are all positively linked to a stronger preference to age in place. Our findings reveal important differences between older homeowners and older non-owners. For owners, closeness to children is a strong predictor of aging-in-place preferences, although mortgage debt can trigger involuntary moves. For non-owners, tenure security achieved through longer durations at one's address of residence is linked to stronger aging-in-place preferences. However, private renters are more often exposed to involuntary moves. We discuss the policy implications of these disruptions. [ABSTRACT FROM AUTHOR]

Intersecting gender and other social inequalities are pertinent to women's mental health across the life course. Gendered violence and other forms of gender inequality in particular play a key role in the higher burden of psychological distress carried by young women. However, the context of gendered violence is often minimised or overlooked entirely when young women seek help or advice around mental health concerns. This is especially the case for young women under the age of 30 years. This paper reports on a research study exploring how young women in Australia understand their mental health, and the scope for new approaches to support that better address their needs. A qualitative survey undertaken with 52 Australian young women was used to explore the nature of their mental health experiences, sought to learn about the strategies they used when experiencing poor mental health and the scope for mental health peer support as an alternative approach to intervention. Responses from a diverse group of young women demonstrated that they understood the role that gendered violence and gender inequality played in their mental health. Findings point to the risk of slippage between young women's understandings of their lived experience and those of traditional service providers, demonstrating the risks associated with minimising or ignoring of the gendered nature of young women's mental health problems. [ABSTRACT FROM AUTHOR]

Australia has a long history of privately owned utility price regulation, one that is little known. This price control was designed to restrain the market power of several utilities (gas, rail, tramways, electricity, and water). The purpose of this paper, therefore, is to establish what types of price control that were used in Australia in the utilities sector before the First World War and to determine the degree to which this price control influenced efficiency. As price levels in this era were set in legislation, the lack of flexibility led to less-than-optimal outcomes, and eventually and led to new approaches were developed after 1912 to the utilities that remained in private ownership, and in some cases influenced the movement in Australia towards government control. [ABSTRACT FROM AUTHOR]

In Australia, racism remains a challenge to dismantle within public health institutions. This paper examines the pressures I experienced from some public health scholars and practitioners to conform to colonial and positivist approaches in knowledge production that still dominate the field. To challenge this hegemony, my research practices turned into what Mignolo calls "epistemic disobedience," an approach to delink from Western ways of producing knowledge. Based on this experiential learning process, I argue epistemic disobedience should not be overlooked in the discussion of decolonizing research and antiracist pedagogy in the context of doctoral training. [ABSTRACT FROM AUTHOR]

Young women in Australia experience serious risks from intimate partner violence (IPV) as a form of family violence. However, there has been a lack of attention to the impact of this on young women and, as a result, these risks are not well understood. This article critically examines existing literature, policy and research and in doing so, specifically explores the ways in which young women aged between 10 and 20 years old are represented and positioned in contemporary family violence discourses. Framed by a review of socio-political and cultural history, the paper highlights the early colonial, patriarchal foundations of Australia, which have specific implications for the challenges that contemporary young women experience in situations of IPV. With a particular emphasis on the Australian context, this article employs both an intersectional and critical feminist lens, with a key focus on the dimensions of adolescent development and youth social geographies. Focusing specifically on these dimensions, including development, gender and age, highlights the important role that feminist social work perspectives and practices can contribute to uncovering, understanding and responding to young women's experiences of intimate partner violence through policy and advocacy. [ABSTRACT FROM AUTHOR]

This paper reports part of a doctoral study which investigated the resettlement experiences of African migrants in Australia (N= 115), and focuses upon the findings of those who participated in individual face-to-face interviews (N= 30). It examines the resettlement challenges facing African migrants in Western Australia (WA), such migration having increased in recent years. Although migrating to relatively wealthy countries such as Australia may be a cause for optimism among African migrants, the challenges associated with resettlement may have a negative effect on their well-being. The findings indicate that participants experienced a variety of resettlement challenges including separation experiences, language difficulties, parenting and cultural issues, under-employment and unemployment, financial problems, and racial discrimination. The study confirms the limited existing research, contributes to a better understanding of the major challenges affecting African migrants in Australia, and has implications for the formulation of effective policies and practices aimed at mitigating resettlement challenges. [ABSTRACT FROM AUTHOR]

The games industry has seen a burst of new interest in the prospect of unionization. The efforts of organizations like Game Workers Unite have attracted much favorable coverage in the enthusiast and trade industry press, increasing awareness amongst videogame audiences of the difficult working conditions facing professional game developers. However, often missing from these discussions is an articulation of what unionization would look like for the significant number of game developers working in precarious conditions in small, often informal teams. The fragmented nature of contemporary gamework presents challenges in aggregating worker power similar to those found in other fields of creative or precarious work and entrepreneurial careers, where contingent work is typically organized around piecemeal, project–based funding arrangements. In this paper we draw from empirical research with Australian game developers to identify a number of barriers to unionization posed by small-scale game production. We also identify how within these same circumstances, novel and alternative forms of solidarity and collective action are beginning to emerge. The article ultimately argues that any successful attempt to unionize videogame workers will need to both account for, and take advantage of, the complex situation of small-scale videogame production in local contexts. [ABSTRACT FROM AUTHOR]

Australia's National Disability Insurance Scheme (NDIS) is a substantial policy reform aiming to radically transform the design and delivery of disability services. Choice and control are key tenets of the scheme, however challenges and limitations exist with respect to inequities and difficulties posed by boundaries between the NDIS and mainstream services. People with disability who have been incarcerated are particularly at risk of experiencing these limitations. However there has been little academic exploration of these issues for this group. This paper explores whether NDIS services are readily accessible for people with disability who were formerly incarcerated, outlining some of the challenges this group encounters. The research is based on interviews with 28 stakeholders from government and non-government organisations that interact with and provide support or services to people with disability within the criminal justice system. Our findings confirm the importance of a functioning NDIS plan to help prevent some individuals encountering the criminal justice system, outlining several challenges that formerly incarcerated people with disability experience with the scheme. We conclude that ideas of choice and control are inhibited for some formerly incarcerated people with disability and highlight actions that can be taken regarding specialist support coordination, advocacy services and market stewardship to address these issues. [ABSTRACT FROM AUTHOR]

This study considers cultural adaptation through tourism, focusing on language-travelers: hybrid education-tourism consumers whose voices remain relatively silent in tourism studies. Qualitative, semi-structured interviews were undertaken with students, teachers, and managers in Australian English language schools to understand what language-travelers expect from their Australian experiences and the implications for language schools. The findings propose that sojourners' experiences are framed by pre-visit imaginaries of object authenticity, wherein the "object" is both Australian culture and the wider Anglophone "West." Such imaginaries are found to be validated by language schools, which face pressure to balance letting students glimpse the "backstage" and staging out-group imagined "authenticities," such as by hiring fun, approachable, and above all White teachers. We identify opportunities for language centers to understand their role within tourism as cultural mediators and suggest ways forward in promoting and inculcating critical intercultural competence among language-traveler sojourners. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) carries the potential for unprecedented disruption in radiology, with possible positive and negative consequences. The integration of AI in radiology holds the potential to revolutionize healthcare practices by advancing diagnosis, quantification, and management of multiple medical conditions. Nevertheless, the ever‑growing availability of AI tools in radiology highlights an increasing need to critically evaluate claims for its utility and to differentiate safe product offerings from potentially harmful, or fundamentally unhelpful ones. This multi‑society paper, presenting the views of Radiology Societies in the USA, Canada, Europe, Australia, and New Zealand, defines the potential practical problems and ethical issues surrounding the incorporation of AI into radiological practice. In addition to delineating the main points of concern that developers, regulators, and purchasers of AI tools should consider prior to their introduction into clinical practice, this statement also suggests methods to monitor their stability and safety in clinical use, and their suitability for possible autonomous function. This statement is intended to serve as a useful summary of the practical issues which should be considered by all parties involved in the development of radiology AI resources, and their implementation as clinical tools. [ABSTRACT FROM AUTHOR]

Studio music teachers have always been constant in Australian society, rarely recognised beyond their immediate surrounds. Building a 'connection' of students required advertising, primarily by word-of-mouth or via local press announcements. Few teachers placed individual advertisements in local papers. This changed in 1911 with the establishment of monthly The Australian Musical News, intended to report and support musicians and music teachers. In its first edition, four studio music teachers placed advertisements, first to use this new opportunity. We unfold the stories of Mrs. Arthur Royce, Herr Franz O. Schieblich, James Ure, and J. Alfred Johnstone. By happenstance, their diverse careers capture the different ways of being a studio teacher in contemporary Australia. We note the unchanging nature of studio music teaching and suggest that, with the exception of technologies, the activities of these four teachers resonate with modern practice. [ABSTRACT FROM AUTHOR]

In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600–$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public–private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research. [ABSTRACT FROM AUTHOR]

Objectives: Differentiating schizophrenia from mania in acutely psychotic patients can be difficult, but is important in determining immediate and subsequent management. Such differentiation is generally addressed by clinical interviews, but an observational approach may assist. This paper therefore describes the development of a relevant observational measure. Methods: We developed a provisional list of 49 items (weighting features with suggested specificity to schizophrenia and mania) for independent completion by two nurses and judged its ability to predict diagnosis provided by consultant psychiatrists. Results: Eighty-seven psychotic patients were recruited, and 173 completed data sets were analysed. We refined the item set to two sets of 10 items that best-differentiated schizophrenia from mania and vice versa. Optimal differentiation was achieved with a score of at least 7 on both the schizophrenia and mania item sets. Difference scores (i.e. schizophrenia items affirmed minus mania items affirmed) were also generated, with a difference score of +1 (i.e. one or more schizophrenia items being affirmed than mania items) showing optimal differentiation (sensitivity 0.67, specificity 0.82) between the two conditions. Evaluating all potential difference scores, we demonstrated that, as difference scores increased, diagnostic accuracy in identifying each condition was very high. Conclusion: Analyses allow the properties of an observational measure (the 20-item Sydney Psychosis Observation Tool) to be described. While a single cut-off difference score was derived with acceptable discriminatory ability, we also established the capacity of varying difference scores to assign both schizophrenia and mania diagnoses with high accuracy. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between Australia’s Indigenous and settler colonial systems of democracy through the lens of deliberative systems theory. It suggests that the ongoing effects of colonialism have rendered Indigenous democracy largely invisible causing a harmful divide in Australia’s democracies. A pluralist conception of democracy is necessary to understand the disconnect between the two systems, evidenced by a striking absence of literature on Australian Indigenous democracy. In response, this paper first theorizes a conceptual framework of a concurrent deliberative system, then describes the Indigenous deliberative system and the colonial system’s efforts to eliminate Indigenous democracy. Against this theoretical and empirical background, it considers whether the recent referendum for an Indigenous Voice to Parliament was just a colonial legacy or represented a pathway towards a shared postcolonial democratic future. [ABSTRACT FROM AUTHOR]

Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions. [ABSTRACT FROM AUTHOR]

Funeral workers (FWs) work within increasingly medicalized and commodified death-management systems. This study explored Worker Health and Safety (WHS) impacts in contemporary death management on Australian and Irish FWs. Mixed methods combined a survey and interviews. Survey data were descriptively summarized, interviews thematically analyzed, and a schematic systems model developed of the combined results. Survey participants (n = 45) reported psychosocial hazards from work pressures, competition, and fatigue. Psychosocial hazards were more frequently reported than physical hazards by Australian FWs. Physical hazards were of greater concern to Irish FWs. Themes from 11 interviews were: Personal Attributes, Work Demands, and Socio-Cultural Context. All FWs reported conflicts between individual capacities, work demands, and resources, resulting in hazardous personal states including difficulty sleeping and stress. Respectfully manually handling human remains and "event management" demands for increasingly elaborate funerals created negative WHS impacts. This research informs risk management for FWs and other workers in the increasingly complex death-care industry. [ABSTRACT FROM AUTHOR]

This article contributes to the sociology of relationships by exploring the moral imperatives that shaped perceptions and negotiations of family life during lockdowns in Australia during the COVID-19 pandemic. We identified dominant discourses from an online qualitative story completion task and situate these in relation to emerging literature on the impact of pandemic-related restrictions on domestic relationships, gender relations, and labour division. We argue that discourses of family connection, clean and tidy homes, and the commodity of time operated as moral imperatives. These imperatives simultaneously offered opportunities for enrichment and agency, as well as operating as unobtainable benchmarks that constrained people's sense of wellbeing. In this analysis we explore how COVID-19 lockdown stories offer new ways of understanding the interplay between displaying and doing 'family life' where gender and labour relations are performed, reinforced and challenged. [ABSTRACT FROM AUTHOR]

While understanding the diversity of women's lived experiences is a key focus area in the international feminist literature on family violence, research with migrant women in Australia remains limited. This article seeks to contribute to the growing body of intersectional feminist scholarship that examines how immigration or "migration status" impacts the dynamics of migrant women's experiences of family violence. The article examines precarity in relation to migrant women's lives in Australia and focuses on the ways that their specific circumstances contribute to and are compounded by the experience of family violence. It also considers how precarity functions as a structural condition that has implications in terms of various forms or patterns of inequality that can heighten women's vulnerability to violence and undermine their efforts to ensure their safety and survival. [ABSTRACT FROM AUTHOR]

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B infection has been associated with the development of gestational diabetes but the underlying mechanism is not known. Objective: To examine associations between viral activity, gestational diabetes mellitus (GDM), and insulin resistance in pregnant people with chronic hepatitis B infection (HBV). Design: Prospective cohort study across three tertiary maternity centres in Melbourne, Australia, between May 2021 and April 2023. Methods: Participants were followed prospectively through pregnancy to evaluate subsequent GDM diagnosis. Demographics, pregnancy outcomes, and markers of viral activity were compared between those with GDM versus those without. Logistic regression analysis was performed pre- and post-adjustment for known confounders. Sub-group analysis of participants from South East Asia (SEA) was performed. Outcome measures included GDM diagnosis, insulin resistance (Homeostatic Model Assessment Insulin Resistance score (HOMA-IR) score), HBV activity as measured by liver function tests, HBV viral load, hepatitis B e antigen, and quantitative hepatitis B surface antigen (quantHBsAg). Results: A total of 113 women were recruited. One third (38/112, 33.9%) developed GDM, mostly diagnosed on isolated postprandial hyperglycaemia (25/38, 65.8%). Over half were born in SEA (66/113, 58.4%). Mean quantHBsAg was significantly lower in those with GDM (p = 0.044). No other associations were identified between GDM or HOMA-IR and markers of hepatic activity on multivariate logistic regression analysis and on sub-group analysis of those born in SEA. Conclusions: QuantHBsAg was significantly lower in those with GDM; otherwise, no association between GDM and measures of HBV viral activity was found. QuantHBsAg may be useful as an early pregnancy marker for GDM risk and warrants further research. [ABSTRACT FROM AUTHOR]

Introduction: Workplace violence is endemic, destructive, and escalating in frequency and severity in healthcare. There is a paucity of research on workplace violence in regional and remote hospital emergency departments (EDs). Objective: The aim of this study was to identify the perpetrator and situational characteristics associated with violent incidents in the ED across five regional and remote Australian sites. Method: This study audited hospital summary data, incident reports, and medical records for a 12-month period in 2018 to examine the perpetrator and situational characteristics of workplace violence incidents in five regional and remote Australian EDs. Results: Violent incidents were evenly spread throughout the week and across shifts. Most incidents were triaged as urgent, occurred within the first 4 hr, and had multidisciplinary involvement. Almost one in every six incidents resulted in an injury. Perpetrators of violence were predominantly young and middle-aged males and almost always patients, with most presenting with mental and behavioral disorders, or psychoactive substance use. Conclusions: Understanding the characteristics of perpetrators of violence can help in seeking to tailor interventions to reduce further violent behaviors. These findings carry implications for optimizing patient care, staff safety and resource management. [ABSTRACT FROM AUTHOR]

The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas. [ABSTRACT FROM AUTHOR]

Concerns over the legal treatment of women who kill in response to domestic abuse have driven several jurisdictions to reform their homicide laws in recent years. This article examines how abused women are currently treated within the Australian legal system by analyzing homicide cases involving women prosecuted for killing an abusive partner in Australia from 2010 to 2020. The findings reveal the limitations of legal reforms to improve access to justice for abused women. Instead, there needs to be an increased focus toward pre-trial stages of criminal proceedings and to address persistent misconceptions and stereotypes associated with domestic abuse. [ABSTRACT FROM AUTHOR]

Crime script analysis was used to analyze intimate partner violence diversity by identifying variables significantly associated with different script tracks. Qualitative thematic analysis using official police administrative data from Queensland, Australia, was used to develop an intimate partner violence protoscript (n = 40), followed by quantitative hierarchical cluster analysis and cross-tabulations to examine diversity within scripts. Four diverse script tracks were identified: "escalating jealousy," "persistently possessive," "controlling victim agency," and "enduring argument." Intimate partner diversity exists with divisions based on statistically significant variables. Implications for situational crime prevention and the use of mixed methods for strengthening crime script analysis are discussed. [ABSTRACT FROM AUTHOR]

Globally, significant numbers of women report obstetric violence (OV) during childbirth. The United Nations has identified OV as gendered violence. OV can be perpetrated by any healthcare professional (HCP) and is impacted by systemic issues such as HCP education, staffing ratios, and lack of access to continuity of care. The current study explored the experiences of OV reported in a national survey in 2021 by Australian women who had a baby in the previous 5 years. A content analysis of 626 open text comments found three main categories: "I felt dehumanised," "I felt violated," and "I felt powerless." Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments. [ABSTRACT FROM AUTHOR]

The cross-sectional factor structure of Big Five personality trait measures is a weighted blend of the factor structure at the between-person level (i.e., the level of time-invariant interpersonal personality differences) and the factor structure at the within-person level (i.e., the level of intrapersonal personality fluctuations and changes). Thus, the Big Five might not represent the underlying factors at either of the two levels. To probe this issue, I fit multilevel exploratory and confirmatory factor analysis (EFA and CFA) models to longitudinal data from the Netherlands and Australia (N = 15,085 and 22,582, respectively). In both data sets, the canonical Big Five emerged at the between- but not at the within-person level. At the within-person level, a two-factor structure appeared to be most suitable. Factor 1 indicated positive attitudes towards the self. Factor 2 indicated neuroticism or negative attitudes towards the self. The two factors might reflect short-term fluctuations in positive and negative affect rather than long-lasting personality changes. The findings are tentative due to methodological limitations. We need more research on the within-person factor structure of personality trait measures to clarify what fluctuations and changes they assess and whether we need to revise the way we measure and analyze trait changes. [ABSTRACT FROM AUTHOR]

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Chronic kidney disease (CKD) is a major cause of morbidity and mortality, contributing to approximately 20 000 deaths in 2021 in Australia. Importantly, progression of CKD can be substantially reduced if it is detected and treated early. Here we present the perspectives of a general practitioner (primary care physician), a nephrologist and a patient advocate on how the diagnosis and management of CKD in primary care could be improved. Early detection and treatment of CKD are impeded by limited patient awareness and knowledge, communication challenges between patients and doctors, and psychosocial issues, with these factors also interacting with, and exacerbating, each other. We make the following recommendations to help improve outcomes in patients with CKD: (1) identifying people at increased risk of CKD and ensuring they have a complete kidney health check (including estimated glomerular filtration rate, urine albumin-creatinine ratio and a blood pressure check) every 1−2 years; (2) using simple, nonconfrontational language and supportive resources to communicate with patients about kidney health; (3) implementing early treatment to slow the progression of CKD and avoid adverse cardiovascular disease outcomes; and (4) asking patient-orientated questions to support shared decision-making and empower patients to be active partners in their healthcare. We acknowledge that limited time is a major barrier to implementing these recommendations in primary care. Utilizing the expertise of the whole practice team, and adopting supportive technology to introduce efficiencies, are likely to be of benefit. By adopting these recommendations, we believe general practitioners have the opportunity to drive improved outcomes and quality of life for people living with CKD in Australia. [ABSTRACT FROM AUTHOR]

Australia is already experiencing climate change losses and damages. Australian governments and other institutional actors acknowledge vulnerability, yet they centre building resilience to climate change. Resilience is frequently used as a synonym for vulnerability reduction, but important ideological differences exist. Indeed, scholars have suggested that resilience, as a politico-ideological tool of subject formation, can be considered a type of governmentality. While there is much research on the political and ideological dimensions of resilience, there is less focus on illuminating how resilience, as a form of climate governmentality, interacts with vulnerability to climate change. Drawing on a climate ethnography in regional Australia, I ask how do resilience discourses and interventions influence vulnerability to climate change in regional Australia? To answer this question, I explore examples of the historical–structural, intersectional and psychosocial determinants of vulnerability, identify key resilience discourses and interventions and examine how, what I term, climate resilience governmentality is influencing vulnerability to climate change. Unable to identify clear causality, I instead show how resilience governmentality is working to reinforce rather than redress the root causes of vulnerability in regional Australia. I observe that resilience discourses emphasise shared responsibility, but in practice, this translates into a focus on individual capacities. Subjects' psychological dispositions are targeted and neoliberal rationalities are desired outcomes. Climate resilience governmentality is not linked to a withdrawal of the state. Instead, it is a top-down process based on government prioritisation, subject formation strategies and the building of non-governmental institutional landscapes to provide services. I argue that climate resilience governmentality is a form of governmental gaslighting because it denies the lived experiences of precarity, insecurity and structural violence throughout regional Australia. I suggest that significant government investment in regional communities, critical societal reflection and truth-telling are urgently needed to reduce vulnerability in regional Australia. [ABSTRACT FROM AUTHOR]

A key aim of domestic violence death reviews (DVDRs) is to recommend improvements to domestic violence service responses, thereby preventing future domestic violence-related deaths. However, there is little scholarship examining the implementation of DVDR recommendations. This study analyses all recommendations made by two Australian DVDR bodies, from the time of each body's establishment until September 2023, alongside government responses and implementation information. Our findings show that despite high levels of initial government acceptance of DVDR recommendations there remains a considerable implementation gap. We consider implementation barriers, suggest improvements to recommendation monitoring and identify areas for future research. [ABSTRACT FROM AUTHOR]

Ethnographic practice in contentious and high-risk spaces raises important ethical and methodological questions. When working with grassroots activists who actively avoid forms of surveillance, the boundary between consensual observation and potentially harmful documentation becomes difficult to discern. This article aims not only to identify the gaps in qualitative research methodologies for scholars working with grassroots activists, but also to think of practical ways in which researchers should mitigate concerns both for participants and themselves. Based on fieldwork in Australia, the author explores the ethical, methodological, and emotional dilemmas of conducting research with activists as a militant ethnographer. The article argues that activist-centred project designs must consider the challenges between the researcher's mandate to collect data and their responsibility to uphold security culture both in and outside activist spaces. Reflexive research ethics, further, should be a part of ongoing research engagement to address the emotional tensions overlooked in standardized ethical protocols. [ABSTRACT FROM AUTHOR]

Introduction: We aim to report on the feasibility of establishment of the first paediatric cohort as part of the longitudinal database of the Australian Lupus Registry and Biobank (ALRB) and to describe the enrolment data with a focus on clinical characteristics, serological data, treatment strategies and patient/parent-reported outcome measures. Methods: All patients under the age of 18 years with a diagnosis of systemic lupus erythematosus (SLE) attending the paediatric rheumatology service of a single, tertiary hospital were identified. Patients were enrolled in the ALRB if they met ≥4/11 of the American College of Rheumatology (ACR) 1997 SLE classification criteria or the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria. Enrolment data including demographics, clinical characteristics, serological profiles, disease activity and damage assessments were recorded. Peds-QL Rheumatology and General Modules were used to assess patient and parent-reported outcomes. Results: Twenty-seven patients were eligible for inclusion, with 26 patients (96%) consenting for enrolment. Twenty-five patients (92%) consented for biobanking. Twenty patients (77%) were female. The median age at enrolment was 16 years (interquartile range (IQR) 13.7, 17.4). The median disease duration from diagnosis was 3.2 years (IQR 1.4, 5.3). Sixteen patients (62%) had synovitis, 16 (62%) had cutaneous involvement, 4 (15%) had serositis, 17 (65%) had haematological involvement and 7 (27%) had renal involvement at enrolment. Nineteen patients (73%) were prescribed at least two disease-modifying anti-rheumatic medications (DMARDs). Hydroxychloroquine (n = 22, 85%) and mycophenolate mofetil (n = 9, 35%) were the most commonly prescribed DMARDs. The median SLEDAI-2K score was 2 (IQR 2, 4). Six patients (23%) had active disease (SLEDAI-2K ≥6) at enrolment. Three patients (11.5%) had reported damage using the SLICC/ACR Damage Index. Twenty-three children (88%) and eighteen parents (69%) completed the Paediatric Quality of Life Inventory. Quality of life scores reported across domains of physical, emotional, social and school functioning at enrolment were comparable to previously studied paediatric cohorts with SLE and other chronic diseases. Conclusion: We have established our centre as the first paediatric participating site of the ALRB, providing contemporary data on the clinical characteristics, serological profile and health-related quality of life outcomes of Australian children with SLE. Paediatric involvement with this national registry will provide a unique perspective for future clinical and scientific research. Collection of Australian-specific paediatric longitudinal data will also enable a broader understanding of SLE within a multicultural Australian population. [ABSTRACT FROM AUTHOR]

We investigate how loneliness develops over the marital dissolution process in older age (i.e., transition at or after age 50) while paying close attention to heterogeneities by the dissolution pathway—widowhood and separation—and gender. Using data from over 8,000 Household, Income and Labour Dynamics in Australia survey respondents, we assess the association of interest using fixed effects regressions. Findings indicate that loneliness increased in the year before widowhood or separation among both women and men. Levels spiked in the year of dissolution, particularly for widowhood but less for separation. Widowed men were substantially more affected than widowed women, and gender differences were negligible for separation. Although loneliness levels gradually declined, widowed men remained vulnerable for remarkably long periods. Such chronic loneliness might be linked to other health disadvantages. These findings highlight the importance of long-term and gender-specific approaches to social support and integration after marital dissolution. [ABSTRACT FROM AUTHOR]

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes. [ABSTRACT FROM AUTHOR]

There is a paucity of theory-driven research investigating the factors influencing consumer acceptance of cashless gambling technology. Thus, the purpose of this study is to explore whether the six constructs in the Unified Theory of Acceptance and Use of Technology 2 (i.e., performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, and price-value) significantly influence intention to use cashless gambling technology. This work further examined important determinants of performance expectancy and effort expectancy, based on the Technology Acceptance Model 3. Survey responses were collected from U.S. consumers who had gambled at a land-based casino in the United States, and Australian consumers who had gambled at a club/casino in Australia in the preceding 12 months. The data were analyzed via confirmatory factor analysis and structural equation modeling. We found that social influence and price-value significantly influenced the intention to use cashless gambling technology. Performance expectancy was found to be an important predictor of behavioral intention. The results identified effort expectancy and hedonic motivation as key determinants of performance expectancy. Facilitating conditions and hedonic motivation were found to be significant determinants of effort expectancy. Our findings reveal new avenues of exploration in the emerging field of cashless technology within the hospitality/gaming sector. Finally, this study provides recommendations for hospitality/gaming operators and vendors seeking to enhance customer perceptions and acceptance of cashless technology. [ABSTRACT FROM AUTHOR]

Copyright of Current Sociology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care. Aim: To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death. Design: Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient's final phase of life, taking into account variation across age, gender, diagnosis and location of death. Setting/participants: A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022. Results: The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days. Conclusion: This study provides valuable new knowledge to support clinicians' confidence when responding to the 'how long' question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering 'how long' questions across the illness trajectory. [ABSTRACT FROM AUTHOR]

Australian children with visual impairment (VI) are underrepresented in studies exploring engagement in physical activities. Existing research documents that children with VI do not meet recommendations for physical activity guidelines which negatively impacts their physical and mental health. To improve participation, information is needed on what physical activities children with VI participate in and why. The objective of this study was to explore what physical activities children with VI participate in and why how they first got involved in them. A larger study was designed to explore multiple aspects of physical activity participation. This article presents findings relevant to what activities Western Australian children with VI participate in and factors which initiated participation. Findings were collected through a survey returned by 38 families and interviews with 22 families including parents and children with VI. School physical education, swimming, play equipment, and walking were the activities with the highest number of participants. Parent factors which motivated participation were having strong values/beliefs which supported engagement, modelling participation in activities, and seeking specific benefits/outcomes. Child factors which motivated participation included impact of their VI and the child's choice/interest. External factors included advertisements and accessibility of information. Many Australian children with VI and their parents are motivated to engage in physical activities, with initial participation commonly catalysed by external factors. [ABSTRACT FROM AUTHOR]

Objectives: to audit the surgical management of infants born with non-syndromic cleft lip and palate (CLP) at an Australian cleft unit in a large tertiary paediatric hospital Design: Retrospective cohort study. Setting: A tertiary Cleft centre. Patients: 193 infants born with non-syndromic CLP were referred to the centre and underwent primary repair of their CLP between 2009 and 2020. Main Outcome Measures: (1) The timing and surgical repairs performed; (2) the frequency of postoperative complications; (3) the frequency of secondary Cleft surgery; and (4) the total Cleft-related operations performed for infants born with CLP. Results: Four different surgical repair techniques were performed by six surgeons, and postoperative complications were uncommon (n = 14). Rates of oronasal fistula surgery (10.5% at five years of age; 14.3% at eight years of age) and velopharyngeal insufficiency surgery (8.7% at five years of age; 14.3% at eight years of age) were not significantly different across the surgical repair groups (p-value >0.05) and were comparable to international Cleft centres. Children underwent an average of four operative procedures in this audit period, including primary Cleft repair, ear, nose and throat surgery, and dental care. Surgery for managing Eustachian tube dysfunction was the most common surgical intervention following primary Cleft repair. Conclusions: Children born with non-syndromic CLP have a high early operative burden, with outcomes similar across the spectrum of techniques and surgeons. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) young people with disability are known to experience higher rates of harassment or abuse than LGBTQA+ young people without disability. This study focused on participants in Australia and identified factors associated with harassment or abuse among LGBTQA+ adolescents and young adults who reported a disability as well as associations with mental health outcomes. Analyses were conducted from a national survey that included 2,500 LGBTQA+ people who reported a disability and were aged 14 to 21 years. Measures included experiences in the past 12 months of verbal and physical harassment or abuse due to one's sexual orientation or gender identity, sexual harassment or abuse, mental health, suicidality, and sociodemographic traits. Overall, 48.4% of participants with disability reported experiencing verbal harassment or abuse, 12.4% physical harassment or abuse, and 29.7% sexual assault or harassment. In multivariable regression analyses, verbal harassment or abuse was significantly more likely among trans men, participants with an intellectual disability, and those who were "out" to most or all of their family. Physical harassment or abuse was significantly more likely among participants with a physical or sensory disability. Sexual harassment or abuse was significantly more likely among trans women and participants with a physical or sensory disability. Participants who experienced harassment or abuse were also significantly more likely to have attempted suicide in the past 12 months. These findings will assist policymakers and practitioners in identifying contexts linked to a heightened risk of abuse among LGBTQA+ young people with disability and further underscore an immediate need to address and prevent harm in this population. [ABSTRACT FROM AUTHOR]

Many autistic adults are likely to experience poor financial wellbeing and hardship due to unemployment and under-employment. Research in the general population demonstrates that subjective financial wellbeing—how people perceive their financial situation—influences quality of life. There is no research, however, examining the subjective financial wellbeing of autistic people. This study therefore aimed to (1) understand the subjective financial wellbeing of a sample of autistic adults living in Australia compared to a general Australian population sample and (2) identify the predictors of subjective financial wellbeing in this sample of autistic adults. To this end, 191 autistic adults aged 18–83 years (mean = 39.28, standard deviation = 11.74) completed an online survey about their economic status, financial wellbeing, financial behaviors, confidence in money management skills, and anxiety and depression symptoms. Almost half of our sample felt it was a struggle to make ends meet, whereas only one-third of the general Australian population felt this way. Similar to the general population, autistic people's income and their financial behaviors (specifically, saving and not borrowing for everyday expenses) predicted their sense of financial wellbeing. Our findings have implications for both research and practice. Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people's thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation—which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people's financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters. [ABSTRACT FROM AUTHOR]

Across disciplines, qualitative researchers have documented epistemological and practical tensions in the ethical review of community-based and participatory research, with many arguing that ethics committees' decisions perpetuate the exclusion of marginalised communities from research engagement. In the existing literature, the research team and the ethics committee are often characterised as staunch opponents. Conversely, in our recent qualitative research addressing communication about sexuality with young people with cerebral palsy who use communication methods other than speech (augmentative and alternative communication), we found that constructive collaboration between researchers and committee members yielded novel insights. Co-authored by a multi-disciplinary research team and the former chair of a Human Research Ethics Committee, this reflexive case study identified three key tensions which arose in the ethical review of research involving this purportedly marginalised population, which reflected the wider importance of trust. We propose a series of practical recommendations to support productive collaboration in the pursuit of safe, inclusive and community-driven research. Plain language summary: Introduction: In Australia, researchers follow rules and policies to make sure their research is safe, fair, and correct. Before a research project starts, a group of experts called an ethics committee checks the researchers' plan, to make sure it is safe. Sometimes, ethics committees are worried that people with a disability could be hurt or upset by a research project. To protect people with a disability, ethics committees may say: • that the research activities need to change, or • that children with disability or people with intellectual disability can't participate in the research, or • that other people (e.g., a parent or guardian) should always give their permission for the person with a disability to participate. Sometimes these changes are sensible and safe. But sometimes they make research unfair or hard to access for people with a disability. This is frustrating when a research plan has been designed by people with a disability, or by people who know them well. What We Did: We did research with young people who have cerebral palsy who use methods other than speech to communicate (like gestures, communication books, or communication devices). Our research was about private topics like relationships and sex. When we applied to do our research, the ethics committee had lots of concerns. They asked us to change a lot of things. They even asked us to change some of the things that people with disability told us they wanted or needed. It was a long and frustrating process. We talked with the leader of the ethics committee and decided to write this article together. We wanted to help other researchers, ethics committees, and people with disabilities to work better together. What We Found: It is important that people with a disability be included in research that is fair and safe. Ethics committees have a big responsibility to keep people safe, but the experts who work on an ethics committee may not know a lot about disability. Stories and videos of people with disabilities participating in research can help the ethics committee to understand what is possible. Ethics committees can also talk to people with a disability, to learn more about their research needs and experiences. All research participants with a disability are unique. Every person will have different risks and different needs. Some people will have more than one accessibility need. For example, a young person with physical disability like cerebral palsy may also have difficulty reading and may not use speech to communicate. When ethics paperwork asks about each need separately, it can be hard to explain how a person with a lot of access needs will be supported. When research participants have complex needs, ethics committees can feel confused and worried. If this happens, they should have a conversation with the researchers about it, instead of saying "no" to the research. Sometimes researchers want to use special or creative research methods to involve people with disabilities. These need to be explained clearly, so the ethics committee can trust that they are safe. Researchers and ethics committees can also use research rules and resources that are created for, and by, people with a disability. These are written by large organisations like the International Association for the Scientific Study of Intellectual and Developmental Disabilities (https://iassidd.org/). By following these steps, we think that research can be safer and more inclusive for everyone. Contact: If you want more information about this article, you can email Megan Walsh at mcwalsh@deakin.edu.au. [ABSTRACT FROM AUTHOR]