Search

Background: The gaps in healthy life expectancy (HLE) between Indigenous and non-Indigenous Australians are significant. Detailed and accurate information is required to develop strategies that will close these health disparities. This paper aims to quantify and compare the causes and their relative contributions to the life expectancy (LE) gaps between the Indigenous and non-Indigenous population in the Northern Territory (NT), Australia. Methods: The age-cause decomposition was used to analyse the differences in HLE and unhealthy life expectancy (ULE), where LE = HLE + ULE. The data was sourced from the burden of disease and injury study in the NT between 2014 and 2018. Results: In 2014–2018, the HLE at birth in the NT Indigenous population was estimated at 43.3 years in males and 41.4 years in females, 26.5 and 33.5 years shorter than the non-Indigenous population. This gap approximately doubled the LE gap (14.0 years in males, 16.6 years in females) at birth. In contrast to LE and HLE, ULE at birth was longer in the Indigenous than non-Indigenous population. The leading causes of the ULE gap at birth were endocrine conditions (explaining 2.9–4.4 years, 23–26%), followed by mental conditions in males and musculoskeletal conditions in females (1.92 and 1.94 years, 15% and 12% respectively), markedly different from the causes of the LE gap (cardiovascular disease, cancers and unintentional injury). Conclusions: The ULE estimates offer valuable insights into the patterns of morbidity particularly useful in terms of primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care. Aim: This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care. Methods: Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation. Results: We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events. Conclusion: Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care. [ABSTRACT FROM AUTHOR]

Background: Streptoccocal A (Strep A, GAS) infections in Australia are responsible for significant morbidity and mortality through both invasive (iGAS) and post-streptococcal (postGAS) diseases as well as preceding superficial (sGAS) skin and throat infection. The burden of iGAS and postGAS are addressed in some jurisdictions by mandatory notification systems; in contrast, the burden of preceding sGAS has no reporting structure, and is less well defined. This review provides valuable, contemporaneous evidence on the epidemiology of sGAS presentations in Australia, informing preventative health projects such as a Streptococcal A vaccine and standardisation of primary care notification. Methods and findings: MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the grey literature were searched for studies from an Australian setting relating to the epidemiology of sGAS infections between 1970 and 2020 inclusive. Extracted data were pooled for relevant population and subgroup analysis. From 5157 titles in the databases combined with 186 grey literature reports and following removal of duplicates, 4889 articles underwent preliminary title screening. The abstract of 519 articles were reviewed with 162 articles identified for full text review, and 38 articles identified for inclusion. The majority of data was collected for impetigo in Aboriginal and Torres Strait Islander populations, remote communities, and in the Northern Territory, Australia. A paucity of data was noted for Aboriginal and Torres Strait Islander people living in urban centres or with pharyngitis. Prevalence estimates have not significantly changed over time. Community estimates of impetigo point prevalence ranged from 5.5–66.1%, with a pooled prevalence of 27.9% [95% CI: 20.0–36.5%]. All studies excepting one included >80% Aboriginal and Torres Strait Islander people and all excepting two were in remote or very remote settings. Observed prevalence of impetigo as diagnosed in healthcare encounters was lower, with a pooled estimate of 10.6% [95% CI: 3.1–21.8%], and a range of 0.1–50.0%. Community prevalence estimates for pharyngitis ranged from 0.2–39.4%, with a pooled estimate of 12.5% [95% CI: 3.5–25.9%], higher than the prevalence of pharyngitis in healthcare encounters; ranging from 1.0–5.0%, and a pooled estimate of 2.0% [95% CI: 1.3–2.8%]. The review was limited by heterogeneity in study design and lack of comparator studies for some populations. Conclusions: Superficial Streptococcal A infections contribute to an inequitable burden of disease in Australia and persists despite public health interventions. The burden in community studies is generally higher than in health-services settings, suggesting under-recognition, possible normalisation and missed opportunities for treatment to prevent postGAS. The available, reported epidemiology is heterogeneous. Standardised nation-wide notification for sGAS disease surveillance must be considered in combination with the development of a Communicable Diseases Network of Australia (CDNA) Series of National Guideline (SoNG), to accurately define and address disease burden across populations in Australia. Trial registration: This review is registered with PROSPERO. Registration number: CRD42019140440. [ABSTRACT FROM AUTHOR]

Background: In response to the threat of COVID-19 infection, Australia mandated a 14 day quarantine period in a designated facility for all travellers returning from overseas from late March 2020. These facilities were usually hotels, or hotel-like serviced apartments, and also included a repurposed former mining village in the Northern Territory. This paper aimed to investigate the experiences of risk of people quarantined in designated supervised facilities in Australia, which has not been systematically explored before.Methods: In this qualitative study semi-structured interviews were conducted with 58 participants quarantined between March 2020 and January 2021. Participants were returned Australian citizens and residents who were required to undergo mandatory supervised quarantine for COVID-19. Interviews were conducted using video teleconferencing (via Zoom), transcribed and coded, then analysed thematically.Results: While participants generally supported the concept of quarantine to protect the Australian public, they were critical of elements of it where they felt exposed to risk (COVID-related or not). They also described instances where infection control within the system seemed inadequate. For some, particularly those quarantined with small children, they reported that the facilities were inadequate or inappropriate for health and wellbeing. Using thematic analysis, three major themes were identified that related to problems in the existing system: perception of being subjected to high risk through lax standards of COVID protection in the quarantine process; risks to the community identified in quarantine; and risk in non-hotel managed quarantine facilities.Conclusions: There are systemic issues with infection control in hotel quarantine, which can be further undermined by individual non-compliance. Risks to safety for those in quarantine can be reduced, both in terms of infection control within hotel quarantine and, in the case of the Northern Territory facility, timely in-person medical care as needed for non-COVID conditions. Systems of infection control need ongoing review to ensure that people entering quarantine are protected from known risks of infection at every stage. Medical services in quarantine facilities should be examined to ensure timely and appropriate non-COVID medical services are available. [ABSTRACT FROM AUTHOR]

As part of a collaborative research project created to promote the coexistence of fire, people and biodiversity in central Australia, a case study was conducted on Aboriginal perceptions of fire and its management in the southern Tanami Desert of Central Australia. The Tanami was chosen due to consecutive wildfire events and reported fire conflicts between Aboriginal and pastoral (cattle station) landholders on fire issues. This paper addresses fire issues from the perspective of Warlpiri Aboriginal people in this region. It shows that many Warlpiri hold strong views concerning the use of fire and its management. Elders, in particular, have retained tradition-based knowledge about fire and its effects on the environment. The complex cultural protocols that structure decisions about who burns, when and where are discussed. It is shown that, although there have been dramatic changes to their subsistence economy, Warlpiri still burn for cultural and economic reasons. At the same time, social change has given rise to new fire-related issues, including lack of access to remote areas in order to undertake burning and a decrease in fire knowledge among younger generations. The paper argues that Warlpiri perceptions of fire management, needs and skills must be incorporated in a regional fire management strategy if the cycle of wildfire that follows above average rainfall periods in the Tanami is to be broken. Proper resourcing of Aboriginal people to fire their land in customary ways will enhance Aboriginal livelihoods as well as benefit other stakeholders in the region. [ABSTRACT FROM AUTHOR]

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

Savanna fires contribute approximately 40-50% of total global annual biomass burning carbon emissions. Recent comparisons of emission factors from different savanna regions have highlighted the need for a regional approach to emission factor development, and better assessment of the drivers of the temporal and spatial variation in emission factors. This paper describes the results of open-path Fourier transform infrared (OP-FTIR) spectroscopic field measurements at 21 fires occurring in the tropical savannas of the Northern Territory, Australia, within different vegetation assemblages and at different stages of the dry season. Spectra of infrared light passing through a long (22-70 m) openpath through ground-level smoke released from these fires were collected using an infrared lamp and a field-portable FTIR system. The IR spectra were used to retrieve the mole fractions of 14 different gases present within the smoke, and these measurements used to calculate the emission ratios and emission factors of the various gases emitted by the burning. Only a handful of previous emission factor measures are available specifically for the tropical savannas of Australia and here we present the first reported emission factors for methanol, acetic acid, and formic acid for this biome. Given the relatively large sample size, it was possible to study the potential causes of the within-biome variation of the derived emission factors. We find that the emission factors vary substantially between different savanna vegetation assemblages; with a majority of this variation being mirrored by variations in the modified combustion efficiency (MCE) of different vegetation classes. We conclude that a significant majority of the variation in the emission factor for trace gases can be explained by MCE, irrespective of vegetation class, as illustrated by variations in the calculated methane emission factor for different vegetation classes using data sub-set by different combustion efficiencies. Therefore, the selection of emission factors for emissions modelling purposes need not necessarily require detailed fuel type information, if data on MCE (e.g. from future spaceborne total column measurements) or a correlated variable were available. From measurements at 21 fires, we recommend the following emission factors for Australian tropical savanna fires (in grams of gas emitted per kilogram of dry fuel burned), which are our mean measured values: 1674±56 g kg-1 of carbon dioxide; 87±33 g kg-1 of carbon monoxide; 2.1±1.2 g kg-1 of methane; 0.11±0.04 g kg-1 of acetylene; 0.49±0.22 g kg-1 of ethylene; 0.08±0.05 g kg-1 of ethane; 1.57±0.44 g kg-1 of formaldehyde; 1.06±0.87 g kg-1 of methanol; 1.54±0.64 g kg-1 of acetic acid; 0.16±0.07 g kg-1 of formic acid; 0.53±0.31 g kg-1 of hydrogen cyanide; and 0.70±0.36 g kg-1 of ammonia. In a companion paper, similar techniques are used to characterise the emissions from Australian temperate forest fires. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration: ACTRN12622000596707, Protocol version 1. [ABSTRACT FROM AUTHOR]

Background: Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indigenous subgroups and explored data for communities to inform health service delivery and interventions.Methods: Our population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia's Northern Territory Midwives' Data Collection (2003-2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region (Top End (TE)/Central Australia (CA)); Remote/Urban residence; and across two large TE communities.Results: Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13,1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95%CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended ≥ five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53,0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a 'normal' birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence.Conclusions: This paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper. [ABSTRACT FROM AUTHOR]

The parasitic guava root-knot nematode, Meloidogyne enterolobii Yang and Eisenback (syn. M. mayaguensis), has a wide distribution, host range and is established majorly in tropical-subtropical climates. A routine diagnostic analysis of symptomatic plant roots confirmed the first detection of M. enterolobii in Australia, near Darwin, Northern Territory. The morphology of female perineal patterns, second stage juveniles (J2s) and males were consistent with other reports of this species. The presence of M. enterolobii was first evaluated with a species-specific sequence-characterized amplified region (SCAR) and the intergenic spacer region (IGS2), followed by sequencing of the mitochondrial cytochrome c oxidase I and II (COI & COII) and large subunit ribosomal RNA (28S rRNA) gene regions. The nematode was detected on several important crop-host plants in Australia's Northern Territory including chilli, tomato, capsicum, cucumber, pumpkin, eggplant, snake bean and sweet potato. The ability of M. enterolobii to colonise a variety of weeds and native Australian plants makes management challenging. The route of introduction of M. enterolobii is presently unknown but is under investigation. [ABSTRACT FROM AUTHOR]

Wildfires are pivotal to the functioning of many ecosystems globally, including the magnitude of surface erosion rates. This study aims to investigate the relationships between surface erosion rates and wildfire intensity in the tropical north savanna of Australia. The occurrence of fires in western Arnhem Land, Northern Territory, Australia was determined with remotely sensed digital datasets as well as analogue erosion measurement methods. Analysis was performed using satellite imagery to quantify burn severity via a monthly delta normalised burn ratio (dNBR). This was compared and correlated against on-ground erosion measurements (erosion pins) for 13 years. The dNBR for each year (up to +0.4) displayed no relationship with subsequent erosion (up to ±4 mm of erosion/deposition per year). Poor correlation was attributed to low fire severity, patchy burning, significant time between fires and erosion-inducing rainfall. Other influences included surface roughness from disturbances from feral pigs and cyclone impacts. The findings here oppose many other studies that have found that fires increase surface erosion. This accentuates the unique ecosystem characteristics and fire regime properties found in the tropical Northern Territory. Scenarios of late dry season fires with high severity were not observed in this study and require more investigations. Ecosystems such as the one examined here require specialised management practices acknowledging the specific ecosystem functions and processes. The methods employed here combine both analogue and digital sensors to improve understandings of a unique environmental system. [ABSTRACT FROM AUTHOR]

Australia's monsoonal (seasonal) tropics are a global centre of ant diversity, but are largely unrecognised as such because the vast majority of its species are undescribed. Here we document another case of undescribed hyper-diversity within a taxon that is formally recognised as a single, widespread species, Meranoplus ajax Forel. We recognise 50 species among 125 specimens of M. 'ajax' that we CO1-barcoded, integrating CO1 clustering and divergence, morphological differentiation and geographic distribution. A large proportion (44%) of these species are represented by single records, indicating that very many additional species are yet to be collected in this extremely remote and sparsely populated region. Sampling has been concentrated in the Northern Territory, where 27 of the 50 species occur. If diversity in Western Australia and Queensland were similar to that in the Northern Territory, as appears likely, then the M. ajax complex would comprise >100 species. In 2000, when Australia's monsoonal ant fauna was estimated to contain 1500 species, Meranoplus ajax was considered to represent a single species. Our previous analyses of a range of other taxa have shown that their diversity has been similarly under-appreciated in this estimate. Our findings suggest that the total number of ant species in monsoonal Australia is several thousand, which would make the region by far the world's richest known. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia's Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe "Managing hepatitis B" training course for the Aboriginal health workforce. Here, we present an evaluation of the course. Objectives: 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the "Managing hepatitis B" training course. 3. To enable participants to have the skills and confidence to be part of the care team. Methods: We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our "Managing hepatitis B" training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick's training evaluation framework. Results: Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams. Conclusions: The "Managing hepatitis B" training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment. [ABSTRACT FROM AUTHOR]

Background: First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. Methods: Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. Results: Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. Conclusion: The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection. [ABSTRACT FROM AUTHOR]

Background: Positive early development is critical in shaping children's lifelong health and wellbeing. Identifying children at risk of poor development is important in targeting early interventions to children and families most in need of support. We aimed to develop a predictive model that could inform early support for vulnerable children. Methods: We analysed linked administrative records for a birth cohort of 2,380 Northern Territory children (including 1,222 Aboriginal children) who were in their first year of school in 2015 and had a completed record from the Australian Early Development Census (AEDC). The AEDC measures early child development (school readiness) across five domains of development. We fitted prediction models, for AEDC weighted summary scores, using a Partial Least Square Structural Equation Model (PLS-SEM) considering four groups of factors–pre-pregnancy, pregnancy, known at birth, and child-related factors. We first assessed the models' internal validity and then the out-of-sample predictive power (external validity) using the PLSpredict procedure. Result: We identified separate predictive models, with a good fit, for Aboriginal and non-Aboriginal children. For Aboriginal children, a significant pre-pregnancy predictor of better outcomes was higher socioeconomic status (direct, β = 0.22 and indirect, β = 0.16). Pregnancy factors (gestational diabetes and maternal smoking (indirect, β = -0.09) and child-related factors (English as a second language and not attending preschool (direct, β = -0.28) predicted poorer outcomes. Further, pregnancy and child-related factors partially mediated the effects of pre-pregnancy factors; and child-related factors fully mediated the effects of pregnancy factors on AEDC weighted scores. For non-Aboriginal children, pre-pregnancy factors (increasing maternal age, socioeconomic status, parity, and occupation of the primary carer) directly predicted better outcomes (β = 0.29). A technical observation was that variance in AEDC weighted scores was not equally captured across all five AEDC domains; for Aboriginal children results were based on only three domains (emotional maturity; social competence, and language and cognitive skills (school-based)) and for non-Aboriginal children, on a single domain (language and cognitive skills (school-based)). Conclusion: The models give insight into the interplay of multiple factors at different stages of a child's development and inform service and policy responses. Recruiting children and their families for early support programs should consider both the direct effects of the predictors and their interactions. The content and application of the AEDC measurement need to be strengthened to ensure all domains of a child's development are captured equally. [ABSTRACT FROM AUTHOR]

Background: This paper examines the specificity and sensitivity of a breath carbon monoxide (BCO) test and optimum BCO cutoff level for validating self-reported tobacco smoking in Indigenous Australians in Arnhem Land, Northern Territory (NT). Methods: In a sample of 400 people (≥16 years) interviewed about tobacco use in three communities, both self-reported smoking and BCO data were recorded for 309 study participants. Of these, 249 reported smoking tobacco within the preceding 24 hours, and 60 reported they had never smoked or had not smoked tobacco for ≥6 months. The sample was opportunistically recruited using quotas to reflect age and gender balances in the communities where the combined Indigenous populations comprised 1,104 males and 1,215 females (≥16 years). Local Indigenous research workers assisted researchers in interviewing participants and facilitating BCO tests using a portable hand-held analyzer. Results: A BCO cutoff of ≥7 parts per million (ppm) provided good agreement between self-report and BCO (96.0% sensitivity, 93.3% specificity). An alternative cutoff of ≥5 ppm increased sensitivity from 96.0% to 99.6% with no change in specificity (93.3%). With data for two self-reported nonsmokers who also reported that they smoked cannabis removed from the analysis, specificity increased to 96.6%. Conclusion: In these disadvantaged Indigenous populations, where data describing smoking are few, testing for BCO provides a practical, noninvasive, and immediate method to validate self-reported smoking. In further studies of tobacco smoking in these populations, cannabis use should be considered where self-reported nonsmokers show high BCO. [ABSTRACT FROM AUTHOR]

The passage of three Australian Category 5 cyclones within 350 km of Darwin (Northern Territory), Australia, during the last decade indicates that that city should have a high wind hazard. In this paper, the wind hazard for Darwin was compared with that for Port Hedland (Western Australia) and Townsville (Queensland) using data from a coupled ocean–atmosphere simulation model and from historical and satellite-era records of tropical cyclones. According to the authoritative statement on wind hazard in Australia, Darwin’s wind hazard is the same as Townsville’s but both locations’ hazards are much less than that of Port Hedland. However, three different estimates in this study indicate that Darwin’s wind hazard at the long return periods relevant to engineering requirements is higher than for both Port Hedland and Townsville. The discrepancy with previous studies may result from the inadequate cyclone records in the low-latitude north of Australia, from accumulated errors from estimates of wind speeds from wind fields and wind–pressure relationships, and from inappropriate extrapolations of short-period records based on assumed probability distributions. It is concluded that the current wind-hazard zoning of northern Australia seriously underestimates the hazard near Darwin and that coupled ocean–atmosphere simulation models could contribute to its revision. [ABSTRACT FROM AUTHOR]

This paper constructs a reduction sequence model for north Australian points from the eastern Victoria River region, and identifies a single continuum linking unifacial and bifacial point forms, with some divergence from this single reduction trajectory dependent upon artefact size. Chronological changes in reduction intensity between 5,000BP and the present are found to coincide with typological variation in points as well as changing emphasis on the extendibility of point reduction. It is suggested that changes in the extendibility of point reduction can be linked to intensified ENSO-driven climatic variability in the late Holocene that likely increased economic risk and warranted a substantial technological response, including the use of retouched toolkits with potential for longer use-lives. [ABSTRACT FROM AUTHOR]

Background: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia's Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation. Methods: We will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called 'Ask the Specialist Plus' which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the 'behaviour change wheel' and address a supply–demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance ('RE-AIM'). Discussion: The intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients' experiences of care and health outcomes. Trial registration: Registered with ClinicalTrials.gov Protocol Record 2008644 [ABSTRACT FROM AUTHOR]

As global populations rapidly increase, there is a need to maintain sustainable landscapes through innovative agricultural systems and practices that continue to work towards addressing Sustainable Development Goal 2, Zero Hunger. Indigenous people around the world seek culturally appropriate and sustainable livelihood opportunities to improve their socioeconomic status, and there is a rich diversity of existing globally important agricultural heritage systems that have been developed by Indigenous cultures over millennia. Wild harvest of plant products is an innovative agricultural practice which has been conducted by Aboriginal Australians for thousands of years and is a more acceptable form of agriculture on Aboriginal land than more intensive forms, such as horticulture. Wild harvest is typically more culturally appropriate, less intensive, and involves less impact. However, enterprise development programs in Aboriginal communities across Northern Australia have historically had very limited economic success. Such communities often experience high welfare dependency and few economic development opportunities. This research takes a case study approach to explore community views about the development of an Aboriginal plant-based enterprise in the Northern Territory, Australia. We used qualitative methods to engage with community members about their experiences, current attitudes, and future aspirations towards the Enterprise. We found that there was broad support from across all sectors of the community for the Enterprise and clear understanding of its monetary and non-monetary benefits. However, there was limited knowledge of, and involvement in, the business beyond the role of provider and producer, and of the governance aspects of the Enterprise. Using this case study as our focus, we advocate for deeper understanding and stronger inclusion of community aspirations, realities, and perspectives on Aboriginal economic development. Cultural values and knowledge need to inform business development. Additionally, there is a need to invest in basic infrastructure to account for the low base of private asset ownership in this context. A holistic, multifunctional landscape approach is required to support sustainable agricultural practices on Aboriginal lands across Northern Australia. [ABSTRACT FROM AUTHOR]

Background: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory's publicly funded healthcare system introduced the quality improvement program planning system (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion.Methods: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion.Results: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, 'needs assessment' findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded.Conclusion: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems. [ABSTRACT FROM AUTHOR]

Background: Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. Methods: A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996–2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records. Results: 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166–715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512. Conclusion: C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the management of bulky pulmonary C. gattii infection appears to increase the likelihood of durable cure and likely reduces the required duration of antifungal therapy. Author summary: Cryptococcus gattii is an environmental fungus responsible for invasive infection, predominately in the central nervous system (CNS) and lungs. There is little evidence to guide its management. We have found First Nations Australians in this region have one of the highest incidences of Cryptococcus gattii infection in the world, with rates possibly increasing. Mortality was associated with end stage kidney disease, diagnosis in earlier years of the study, and unplanned interruptions to intravenous treatment. Whilst mortality improved through the study, neurological disability such as visual or hearing impairment following cure continues to be seen and is associated with brain cryptococcomas and high cerebral spinal fluid (CSF) pressure at diagnosis or during treatment. Blocked CSF shunts are uncommon and concerns of such potential complications should not preclude necessary surgical intervention for persisting increased CSF opening pressures or hydrocephalus which has been associated with poor outcome. Infection recurrence or persistence was associated with large pulmonary cryptococcomas (over 3cm diameter) not undergoing pulmonary surgery and we recommend that surgery be considered for any pulmonary cryptococcoma with a diameter over 2 to 3cm. Eradication of infection can be expected provided there is adequate therapy but may require very prolonged antifungal treatment. [ABSTRACT FROM AUTHOR]

Objective: Periodontal disease is associated with chronic kidney disease (CKD), with both conditions being highly prevalent among Australia's Aboriginal population. This paper reflects on the lessons learned following implementation of a periodontal intervention in the Central Australian region of the Northern Territory among Aboriginal adults with CKD. Results: Between Oct 2016 and May 2019, research staff recruited 102 eligible participants. This was far below the anticipated recruitment rate. The challenges faced, and lessons learned, were conceptualised into five specific domains. These included: (1) insufficient engagement with the Aboriginal community and Aboriginal community-controlled organisations; (2) an under-appreciation of the existing and competing patient commitments with respect to general health and wellbeing, and medical treatment to enable all study commitments; (3) most study staff employed from outside the region; (4) potential participants not having the required number of teeth; (5) invasive intervention that involved travel to, and time at, a dental clinic. A more feasible research model, which addresses the divergent needs of participants, communities and service partners is required. This type of approach, with sufficient time and resourcing to ensure ongoing engagement, partnership and collaboration in co-design throughout the conduct of research, challenges current models of competitive, national research funding. [ABSTRACT FROM AUTHOR]

A new species of functionally dioecious bush tomato of Solanum subgenus Leptostemonum is described. Solanum scalarium Martine & T.M.Williams, sp. nov., is a member of the taxonomically challenging "Kimberley dioecious clade" in Australia and differs from other species in the group in its spreading decumbent habit and conspicuously prickly male floral rachis. The species is so far known from one site in Judbarra/Gregory National Park in the Northern Territory. Ex situ crosses and confirmation of inaperturate pollen grains produced in morphologically cosexual flowers indicate that these flowers are functionally female and the species is functionally dioecious. The scientific name reflects the ladder-like appearance of the inflorescence rachis armature of male individuals, the stone staircase that provides access to the type locality at the Escarpment Lookout Walk, and the importance of maintaining equitable and safe access to outdoor spaces. The common name Garrarnawun Bush Tomato is proposed in recognition of the lookout point at this site, a traditional meeting place of the Wardaman and Nungali-Ngaliwurru peoples whose lands overlap in this area. [ABSTRACT FROM AUTHOR]

Darwin Harbour, Northern Territory, Australia, is a semi diurnal macro-tidal embayment that is situated in a cyclone prone area. The tidal variations range up to 8 m with a mean tidal range of 3.7 m. The coastal area consists of mangrove fringes, sandy beaches, tidal flats, rocky shore platforms and coastal cliffs. The main morphological changes are movement of the sandbars and erosion of beaches and coastal cliffs. Sea level rise due to climate change and more intense cyclones and storm surges may exacerbate these processes with detrimental impacts on the coast and the adjacent city, particularly when occurring at high tide. To assist with coastal erosion management, a greater understanding of morphological changes is required. A two-dimensional depth averaged finite-element hydrodynamic model (RMA-2), coupled with a sediment transport model (RMA-11) from Resource Modelling Associates, have been used to deduce the sources and spatial patterns of sand erosion and deposition in the harbour. Geochemical analysis is also used to characterize the sand source(s). This paper presents hydrodynamic simulations focusing on culturally and recreationally significant beaches in Fannie Bay. Simulations indicate that the Cullen Bay sandbar is an indirect sand source replenishing Fannie Bay beaches. Respective geochemical results also show similar Rare Earth Element contents of the sand in the area. Considering the fast pace of development in and around Darwin Harbour, this study is essential in providing a fundamental understanding of coastal processes and to assist coastal and shoreline management in a tropical estuary. [ABSTRACT FROM AUTHOR]

The 2007 Australian Northern Territory Emergency Response policy was harmful to the health of Aboriginal and Torres Strait Islander people. We thematically analysed 72 speech acts and reports from the three prominent perspectives: a Northern Territory government inquiry report, the Federal government, and an Aboriginal civil society coalition to examine how framings during the policy agenda setting phase constrained or supported scope for equitable health outcomes. The report authors and the coalition emphasised colonisation and other social determinants of Indigenous health. The Federal government used a discourse of pathology and white sovereignty. Our findings highlighted the need for Indigenous voice in policy making, and the need to address colonial assumptions underpinning policy framings to achieve Indigenous health equity. [ABSTRACT FROM AUTHOR]

We describe the Australian Shark-Incident Database, formerly known as the Australian Shark-Attack File, which contains comprehensive reports of 1,196 shark bites that have occurred in Australia over 231 years (1791–2022). Data were collated by the Taronga Conservation Society Australia using purpose-designed questionnaires provided to shark-bite victims or witnesses, media reports, and information provided by the department responsible for fisheries in each Australian state (including the Northern Territory). The dataset includes provoked and unprovoked bites from fresh, brackish, and marine waters in Australia. Data span 22 suspected shark species. This dataset will be publicly available, and can be used by analysts to decipher environmental, biological, and social patterns of shark bites in Australia. The information will aid scientists, conservationists, authorities, and members of the public to make informed decisions when implementing or selecting mitigation measures. Measurement(s) Shark bite incidents Technology Type(s) survey Factor Type(s) none Sample Characteristic - Organism Elasmobranchii Sample Characteristic - Environment ocean Sample Characteristic - Location Australia [ABSTRACT FROM AUTHOR]

SUMMARY: One of the most commonly encountered and frequently cited laboratory organisms worldwide is classified taxonomically as Nicotiana benthamiana (Solanaceae), an accession of which, typically referred to as LAB, is renowned for its unique susceptibility to a wide range of plant viruses and hence capacity to be transformed using a variety of methods. This susceptibility is the result of an insertion and consequent loss of function in the RNA‐dependent RNA polymerase 1 (Rdr1) gene. However, the origin and age of LAB and the evolution of N. benthamiana across its wide distribution in Australia remain relatively underexplored. Here, we have used multispecies coalescent methods on genome‐wide single nucleotide polymorphisms (SNPs) to assess species limits, phylogenetic relationships and divergence times within N. benthamiana. Our results show that the previous taxonomic concept of this species in fact comprises five geographically, morphologically and genetically distinct species, one of which includes LAB. We provide clear evidence that LAB is closely related to accessions collected further north in the Northern Territory; this species split much earlier, c. 1.1 million years ago, from their common ancestor than the other four in this clade and is morphologically the most distinctive. We also found that the Rdr1 gene insertion is variable among accessions from the northern portions of the Northern Territory. Furthermore, this long‐isolated species typically grows in sheltered sites in subtropical/tropical monsoon areas of northern Australia, contradicting the previously advanced hypothesis that this species is an extremophile that has traded viral resistance for precocious development. Significance Statement: Nicotiana benthamiana, native to Australia, is an important model organism in plant/virus research because the single genotype known (LAB) has an insertion in the Rdr1 gene inactivating virus resistance. Here, we provide clear evidence that N. benthamiana comprises five species, one of which includes LAB and accessions from the northern Northern Territory in which the Rdr1 insertion is variable, leading us to conclude that the insertion is not related to the extremophile hypothesis for this species. [ABSTRACT FROM AUTHOR]

Background: Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. Objective: To estimate the health system costs associated with diagnosing, treating and managing crusted scabies. Methods: A disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia's Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies. Findings: The expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95% CI: $27,000 to $43,800), resulting in an overall cost of $1,558,392AUD (95% CI: $1,188,000 to $1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system. Discussion: This is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities. Author summary: Crusted scabies is characterised by thick skin crusting and fissuring and can lead to serious secondary infections and death from complications. Rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are among the highest in the world. Efforts are on the way in Australia to prevent, if not eliminate, crusted scabies. We use data from a clinical audit of 42 patients diagnosed with crusted scabies in the Top-End of the NT to estimate the health system costs associated with diagnosing, treating and managing crusted scabies for patients and their households. This cost of illness study can provide a valuable starting point for policy makers and evaluators in estimating the potential economic impact of crusted scabies prevention programs on health care service use and costs. [ABSTRACT FROM AUTHOR]

This two-part series investigates the emission and transport of biomass burning aerosol (or particulate matter) across the Top End of the Northern Territory of Australia. In Part I, Meyer et al. [2008. Biomass burning emissions over northern Australia constrained by aerosol measurements: I—Modelling the distribution of hourly emissions. Atmospheric Environment, in press, doi:10.1016/j.atmosenv.2007.10.089.] used a fuel load distribution coupled with a satellite-derived imagery of fire scars and hotspots and the diurnal variation of a fire danger index to estimate hourly emission rates of particulate matter with an aerodynamic diameter of 2.5μm or less (PM2.5) for the dry season April–November 2004 at a spatial resolution of 1km×1km. In the present paper, these emission rates are used in TAPM, a three-dimensional meteorological and air pollution model, and the modelled PM2.5 concentrations and aerosol optical depths are compared with satellite and ground-based measurements. This exercise also seeks to fine-tune and validate the emission calculation methodology, a process through which it is found that cases with hotspots without any corresponding fire scars (e.g. in mountainous terrain), which were initially ignored, need to be included to improve the accuracy of model predictions. Overall, the model is able to describe the measurements satisfactorily, considering the issues associated with the model resolution, emission uncertainty, and modelled meteorology. The model hindcasts numerous exceedences of the advisory maximum PM2.5 exposure limit across the study region, with large areas in excess of 30 exceedences during the study period. Estimated mean top of atmosphere direct radiative forcing due to aerosol shows a seasonal mean of −1.8Wm−2 with a region of strong enhancement over the western portion of the Top End. [Copyright &y& Elsevier]

This article questions to what extent--if at all--Yolngu participation in the Second World War represented a rupture of settler colonialism in Arnhem Land. The article examines the Northern Territory Special Reconnaissance Unit (NTSRU) as a case study to demonstrate the continuity of colonial structures before, during, and after the war. The limited writings on the NTSRU focus on it as an example of indigenous people working in harmony with white Australia for a common goal. This article contextualises the force in the settler colonial framework prevalent in Arnhem Land since first contact with Europeans. The paper first briefly outlines the main characteristics of settler colonialism, and then delineates how settler colonialism manifested in Arnhem Land leading up to the war. Scrutiny of the force's orders and patrols demonstrates that participation in World War II did not rupture the colonial relationship, nor did it lead to recognition of indigenous rights. Rather, the NTSRU example demonstrates continuing disregard for indigenous knowledge, skills, and vitality. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia's Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Methods: Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. Results: CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). Conclusions: The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities. [ABSTRACT FROM AUTHOR]

Background: With the pending implementation of the Closing the Gap 2020 recommendations, there is an urgent need to better understand the contributing factors of, and pathways to positive educational outcomes for both Aboriginal and non-Aboriginal children. This deeper understanding is particularly important in the Northern Territory (NT) of Australia, in which the majority of Aboriginal children lived in remote communities and have language backgrounds other than English (i.e. 75%). Methods: This study linked the Australian Early Development Census (AEDC) to the attendance data (i.e. government preschool and primary schools) and Year 3 National Assessment Program for Literacy and Numeracy (NAPLAN). Structural equation modelling was used to investigate the pathway from self-regulation and executive function (SR-EF) at age 5 to early academic achievement (i.e. Year 3 reading/numeracy at age 8) for 3,199 NT children. Result: The study confirms the expected importance of SR-EF for all children but suggests the different pathways for Aboriginal and non-Aboriginal children. For non-Aboriginal children, there was a significant indirect effect of SR-EF (β = 0.38, p<0.001) on early academic achievement, mediated by early literacy/numeracy skills (at age 5). For Aboriginal children, there were significant indirect effects of SR-EF (β = 0.19, p<0.001) and preschool attendance (β = 0.20, p<0.001), mediated by early literacy/numeracy skills and early primary school attendance (i.e. Transition Years to Year 2 (age 5–7)). Conclusion: This study highlights the need for further investigation and development of culturally, linguistically and contextually responsive programs and policies to support SR-EF skills in the current Australian education context. There is a pressing need to better understand how current policies and programs enhance children and their families' sense of safety and support to nurture these skills. This study also confirms the critical importance of school attendance for improved educational outcomes of Aboriginal children. However, the factors contributing to non-attendance are complex, hence the solutions require multi-sectoral collaboration in place-based design for effective implementation. [ABSTRACT FROM AUTHOR]

Summary: Agile Wallaby (Notamacropus agilis) has been in the diet of Aboriginal inhabitants of northern Australia for millennia. The species inhabits riparian zones and savannah woodlands, has a high rate of natural increase and can become pests in modified agricultural or plantation systems. Although the profitability of market‐based game harvesting appears marginal, local consumption could be incorporated into existing employment programmes on Aboriginal lands as a social enterprise. The legal environment is discussed, and further investigation and a trial as a pilot enterprise are recommended. [ABSTRACT FROM AUTHOR]

This paper provides a robust estimate of the total natural denudation rate for the area surrounding the Ranger uranium mine in the Northern Territory, Australia. This rate will be used to assess whether the final rehabilitated landform of the Ranger mine will denude at the natural rate after the landform has stabilized. The approach adopted was to compile and analyze all existing estimates of the total denudation rate. (including both physical erosion rates and solution losses) from areas near the mine site. Where available, solution losses are based on local measurements. These were used to adjust estimates for other local sites, where only physical erosion rates are available. Adjustments were based on a global relationship between physical erosion and solution loss rates. The adjusted total denudation rate estimates were shown to have no statistically significant relationship with the time over which they have been estimated (the averaging time, maximum period about 59,000 years), which suggests that they conform to mass flux equilibrium. This form of equilibrium implies an equivalence between inputs and outputs of sediment and solutes for which there is some evidence. Because the denudation rates are independent of averaging times, the long-term average total natural denudation rate can be calculated from all of the data, giving a value of 0.075 ± 0.013 mm year−1 (75 mm 1000 years−1, 75 m Ma−1). This value is almost twice the previously quoted rate of 0.04 ± 0.03 mm year−1 (40 ± 30 mm 1000 years−1), which was calculated from a mixture of physical erosion rates and the total denudation rates including some from large river catchments. The derivation of a revised denudation rate provides confidence that the revised value, based on all available data, is representative of the region; and is therefore an appropriate value with which to assess the success of the rehabilitation of a post-mining landform. • The natural denudation rate near the ranger mine in Australia is estimated. • The estimation is based on date from the past 65,000 years. • The estimated rate will be used in assessment of the rehabilitated mine site. • The new estimate is about twice the previous estimate. [ABSTRACT FROM AUTHOR]

Background: The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021.Methods: Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention.Results: Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2-3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment.Discussion: The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people's consumption. [ABSTRACT FROM AUTHOR]

Background: Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings: We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion: This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models. Author summary: Crusted scabies is a severely debilitating skin disease with potentially fatal consequences that is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia. Early detection is essential to maximise the chance of recovery and help prevent transmission of scabies to others. There is little knowledge about how to actively detect crusted scabies, so we sought relevant knowledge about a disease with many similarities: leprosy. The review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. Lessons for crusted scabies in the NT include the importance of skilled screening personnel and appropriate community engagement strategies to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models. [ABSTRACT FROM AUTHOR]

Background: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019.Methods: This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted.Results: The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates.Conclusions: A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia. [ABSTRACT FROM AUTHOR]

Background: Exposure to per- and polyfluoroalkyl substances (PFAS) is a public health issue globally. In Australia high concentrations of PFAS have been found in environments close to sites where Aqueous Film Forming Foams (AFFF) were historically used for firefighting activities. This has resulted in significant community concern about the potential long-term health effects of these chemicals. Objective: We describe residents' perceptions and experiences of PFAS in three regional Australian towns where exposure has occurred. Methods: We conducted focus groups to generate free-flowing open discussion on PFAS in three affected communities, including some with significant numbers of First Nations Peoples. We recruited participants using a range of media outlets and postal services. Focus group transcripts were analysed thematically to identify major shared concerns using Atlas Ti. Results: One hundred and eighty residents attended fifteen focus groups that were conducted in the three communities. They included 69 First Nations People living in three communities near the town of Katherine in the Northern Territory. Study participants were concerned about potential physical health effects of exposure to PFAS, such as cancer clusters, unexplained deaths, potential exacerbation of existing health conditions, and the future health of their children. They expressed feelings of stress and anxiety about living with uncertainty related to the possible health and the socio-economic impacts of PFAS contamination in their communities. Conclusion: While research has concentrated on the physical health effects of PFAS, more attention needs to be given to the immediate psychosocial impacts of living in an affected community. [ABSTRACT FROM AUTHOR]

Background: Scabies is listed as a neglected tropical disease by the World Health Organization. Crusted scabies affects vulnerable and immunosuppressed individuals and is highly contagious because of the enormous number of Sarcoptes scabiei mites present in the hyperkeratotic skin. Undiagnosed and untreated crusted scabies cases can result in outbreaks of scabies in residential facilities and can also undermine the success of scabies mass drug administration programs. Methods and principal findings: Crusted scabies became a formally notifiable disease in the Northern Territory of Australia in 2016. We conducted a 2-year prospective study of crusted scabies cases notified between March 2016 and February 2018, with subsequent follow up for 22 months. Demographics, clinical and laboratory data, treatment and outcomes were analysed, with cases classified by severity of disease. Over the 2-year study period, 80 patients had 92 episodes of crusted scabies; 35 (38%) were Grade 1 crusted scabies, 36 (39%) Grade 2 and 21 (23%) Grade 3. Median age was 47 years, 47 (59%) were female, 76 (95%) Indigenous Australians and 57 (71%) from remote Indigenous communities. Half the patients were diabetic and 18 (23%) were on dialysis for end-stage kidney failure. Thirteen (16%) patients had no comorbidities, and these were more likely to have Grade 3 disease. Eosinophilia was present in 60% and high immunoglobulin E in 94%. Bacteremia occurred in 11 episodes resulting in one fatality with methicillin-susceptible Staphylococcus aureus bacteremia. Two other deaths occurred during admission and 10 others died subsequent to discharge consequent to comorbidities. Treatment generally followed the recommended guidelines, with 3, 5 or 7 doses of oral ivermectin depending on the documented grade of crusted scabies, together with daily alternating topical scabicides and topical keratolytic cream. While response to this therapy was usually excellent, there were 33 episodes of recurrent crusted scabies with the majority attributed to new infection subsequent to return to a scabies-endemic community. Conclusions: Crusted scabies can be successfully treated with aggressive guideline-based therapy, but high mortality remains from underlying comorbidities. Reinfection on return to community is common while scabies remains endemic. Author summary: Undiagnosed crusted scabies patients can be index cases in outbreaks of scabies in residential facilities such as nursing homes and can undermine the success of scabies mass drug administration programs, but literature about this debilitating disease is very limited. The study describes a large cohort of patients with crusted scabies who have been treated according to established local guidelines. While the success of the initial clinical response supports the guideline-based treatment regimen for crusted scabies, with only one patient dying with scabies-related sepsis, the subsequent mortality remains high, reflecting the large burden of comorbidities in the cohort. In addition, there was a high rate of recurrent crusted scabies, attributed to new infection with scabies once the cured patients return to their scabies-endemic communities. Crusted scabies can be successfully treated using robust guidelines including multiple doses of ivermectin together with topical therapy. However, community-based initiatives such as support for 'scabies free zones' are needed to prevent re-infection and recurrent disease in those individuals who are susceptible to developing crusted scabies. Undiagnosed crusted scabies is a threat to the success of scabies mass drug administration programs and will continue to drive scabies outbreaks in residential facilities. [ABSTRACT FROM AUTHOR]

Phyllosticta cavendishii has been recorded in the Northern Territory (NT) of Australia occurring on non‐Cavendish bananas since 1991. The race of P. cavendishii that infects Cavendish bananas is considered exotic to Australia and classified as an emergency plant pest. In July 2013, P. cavendishii was detected on Cavendish bananas near Darwin, NT. Here, the diagnoses and field observations carried out during the Incident Definition Phase of the national biosecurity response, from July 2013 to October 2014, are reported. Of 1395 banana samples collected from 676 properties, 480 were positive for freckle disease, including 463 samples with P. cavendishii and 17 samples with P. maculata. Phyllosticta cavendishii was detected in 256 properties, including 62 properties where it was detected on Cavendish banana plants, within six distinct geographical zones across the NT. Phyllosticta cavendishii was detected on two cultivars within the Cavendish subgroup and six non‐Cavendish cultivars. Multigene characterization of Phyllosticta cultures showed that P. cavendishii was isolated from both Cavendish and non‐Cavendish cultivars. Multilocus phylogeny analyses also revealed that the P. cavendishii strain in the outbreak had identical sequence similarity to the holotype (CBS H‐20918) clade 2 P. cavendishii isolates that infect both Cavendish and non‐Cavendish cultivars in Southeast Asia and Oceania. The genetic data in this study showed that there was one P. cavendishii strain infecting both Cavendish and non‐Cavendish cultivars in the outbreak. However, historical data and field observations provided anecdotal evidence for the existence of two races of P. cavendishii, including one that does not infect Cavendish bananas. [ABSTRACT FROM AUTHOR]