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The Anglo-Australian legal system has not readily recognised Indigenous constitutions. The absence of such recognition does not, however, deny that Australia's Indigenous nations have had constitutions for thousands of years and continue to do so. In this article, we explain how Indigenous laws, institutions and systems of authority are constitutional. Using the constitutions of the Gunditjmara peoples and Ngarrindjeri nation as examples, we identify three dimensions of Indigenous constitutions in Australia: first, the foundation of Indigenous constitutions in the continuing and inherent authority of Indigenous nations; secondly constitutional features deriving from Indigenous law; and thirdly the use in Indigenous constitutions of institutions and processes that also have status under Australian law. We suggest that this new understanding of Indigenous constitutions provides a basis for contributing to current efforts in Indigenous constitution-making and to the development of a more inclusive understanding of the Australian constitutional system.

Is reconciliation a process of masking conflict in order for it to be eradicated from the view, consciousness and responsibility of the state? Why do we focus on solutions rather than managing and embracing the issues that generate ‘conflict’? This article draws on the politics of reconciliation debates in Australia to highlight the dangers that emanate from political efforts to bring about reconciliation merely as a mode of conflict resolution. We contend that an uncritical advocacy of reconciliation risks losing sight of the centrality of conflict to the maintenance of identity and contestation around racial and cultural inequalities. We ground this in a discussion of the experiences of societies like South Africa and Northern Ireland. The implications of a conflict-free approach to reconciliation for Australia are profound because it neglects the experiences and concerns of Indigenous people. A conflict-free approach to reconciliation ignores the conflict inherent in Australian society due to t...

IntroductionInvasive meningococcal disease (IMD) primarily causes disease in young children and adolescents and can cause long-term disability. Many countries are considering implementation of meningococcal B and/or meningococcal ACWY vaccines to control meningococcal disease. Estimating the cost-effectiveness of meningococcal vaccine programme is hampered due to a lack of good quality costing and burden of disease data. This study aims to address this evidence gap by assessing the clinical, physical, neurocognitive, economic and societal impact of IMD on adolescents and young adults.Methods and analysisA case–control study of 64 participants with confirmed IMD (15–24 years 11 months at time of disease) and 64 control participants (17–34 years 11 months) will be conducted in Australia from 2016 to 2020. All participants will undergo a neurocognitive assessment, full medical examination, pure tone audiometry assessment and complete quality of life and behavioural questionnaires. Meningococcal cases will be assessed 2–10 years posthospitalisation and a subset of cases will be interviewed to explore in depth their experiences of IMD and its impact on their life. Primary outcome measures include general intellectual functioning from the Wechsler Adult Intelligence Scale and overall quality of life from the Health Utilities Index. Secondary outcome measures include academic achievement, executive functioning, behaviour, hearing, psychological and physical functioning. Outcome measures will be compared between cases and controls using independent t-tests or ORs, or if any significant confounders are identified, adjusted analyses (analysis of covariance or adjusted ORs) will be conducted. Thematic analysis will be used to analyse transcribed interviews and a costing model will be used to project lifetime costs.Ethics and disseminationThe Adolescent MENingococcal Disease (AMEND) study has been approved by the Human Research Ethics Committee of the Women’s and Children’s Health Network (HREC/14/WCHN/024). The results will be disseminated via peer-reviewed publications, conference presentations, study participants, and meningococcal and meningitis foundations.Trial registration numberNCT03798574.

IntroductionSouth Australia (SA) has the highest notification rate of invasive meningococcal disease in Australia with the majority of cases due to serogroup B.Neisseria meningitidisis carried in the pharynx, with adolescents having the highest rates of carriage. A vaccine designed to offer protection against serogroup B (4CMenB) is licensed in Australia. The SA MenB vaccine carriage study aims to assess the impact of 4CMenB on carriage ofN. meningitidisin adolescents.Methods and analysisThis is a parallel cluster randomised controlled trial enrolling year 10, 11 and 12 school students (approximately 16–18 years of age) throughout SA, in metropolitan and rural/remote areas. Schools are randomised to intervention (4CMenB vaccination at baseline) or control (4CMenB vaccination at study completion) with randomisation stratified by school size and socioeconomic status, as measured by the Index of Community Socio-Educational Advantage (Australian Curriculum). Oropharyngeal swabs will be taken from all students at visit 1, and 12 months later from year 11 and 12 students. Students unvaccinated in 2017 will receive vaccine at the 12-month follow-up. Carriage prevalence ofN. meningitidiswill be determined by PCR at baseline and 12 months following 4CMenB vaccination and compared with carriage prevalence at 12 months in unvaccinated students. A questionnaire will be completed at baseline and 12 months to assess risk factors associated with carriage. The primary outcome of carriage prevalence of disease causingN. meningitidisat 12 months will be compared between groups using logistic regression, with generalised estimating equations used to account for clustering at the school level. The difference in carriage prevalence between groups will be expressed as an OR with 95% CI.Ethics and disseminationThe study was approved by the Women’s and Children’s Health Network Human Research Ethics Committee (WCHN HREC). The protocol, informed consent forms, recruitment materials, social media and all participant materials have been reviewed and approved by the WCHN HREC and updated on ClinicalTrials.gov. Results will be published in international peer-reviewed journals and presented at national and international conferences. The study findings will be provided in public forums and to study participants and participating schools.Trial registration numberACTRN12617000079347.NCT03089086; Pre-results.

Background Pregnant women are considered the most important risk group for influenza vaccination. Despite this, the potential risk of harm from the vaccine on the fetus is a key factor in low uptake of the vaccine. This systematic review aimed to synthesize the best available evidence on the safety of influenza vaccination during pregnancy on fetal development. Methods and findings A search of the literature was undertaken from the inception of each database up to March 2014. Both observational and clinical trials were considered. Fetal outcomes were present in 19 observational studies, and 14 of those were primarily investigating the monovalent influenza A (H1N1) 2009 vaccine. There was significant methodological and clinical heterogeneity of the included studies and a narrative summary and tabling of results was performed. Fetal death outcomes for women in later pregnancy ranged from OR 0.34 to 2.95 with 95% confidence intervals crossing or below the null value. Spontaneous abortion less than 24 weeks ranged from HR 0.45 to OR 1.23, with 95% confidence intervals crossing or below the null value. Congenital malformations for women vaccinated during their first trimester ranged from OR 0.67 to 2.18 and imprecise confidence intervals crossed the null value. Included in this review were some high quality studies, although overall the studies have a high risk of selection and confounding bias. Conclusions Results do not indicate that maternal influenza vaccination is associated with an increased risk of fetal death, spontaneous abortion, or congenital malformations. Statistical imprecision and clinical and methodological heterogeneity of the observational studies mean it is not possible to totally exclude adverse effects. Further studies investigating women vaccinated during their first trimester should be the highest priority to allow for more precise estimates, especially for spontaneous abortion, and congenital abnormality outcomes.

This article is a conversation and encounter between an Indigenous and a non-Indigenous constitutional law scholar attempting to make sense of ‘race’ as it is written and interpreted in the Australian Constitution through a close re-reading of the Tasmanian Dams Case and the race power in s 51(xxvi). The conversation is intended to perform a conduct of jurisprudence in which the experience of law and the interpretation of law as a matter of doctrine are brought into relation. We first try to make sense of the significance of 1967 as a constitutional moment shifting the meaning of race in the Constitution, before turning to a close reading of the judgments in Tasmanian Dams on the race power. We argue that through analysis of these judgments it is possible to understand better the constrictions of Australian canons of constitutional interpretation as applied to race, with its focus on ‘special’ characteristics, heritage and culture. We also argue that a close reading of Tasmanian Dams offers a good startin...

BACKGROUND The genus Acinetobacter , well known as a nosocomial pathogen, can also cause severe community-onset pneumonia. Previous small case series have suggested fulminant disease and a pooled hospital mortality of > 60%. METHODS We conducted a prospective observational study of all episodes of bacteremic, community-onset, and radiologically confirmed pneumonia due to Acinetobacter species at a tertiary referral hospital in tropical Australia from 1997 to 2012 following the introduction of routine empirical treatment protocols covering Acinetobacter . Demographic, clinical, microbiologic, and outcome data were collected. RESULTS There were 41 episodes of bacteremic community-onset Acinetobacter pneumonia, of which 36 had no indicators suggesting health-care-associated infection. Of these, 38 (93%) were Indigenous Australians, one-half were men, the average age was 44.1 years, and 36 episodes (88%) occurred during the rainy season. All patients had at least one risk factor, with hazardous alcohol intake in 82%. Of the 37 isolates available for molecular speciation, 35 were Acinetobacter baumannii and two were Acinetobacter nosocomialis . All isolates were susceptible in vitro to gentamicin, meropenem, and ciprofloxacin, but only one was fully susceptible to ceftriaxone. ICU admission was required in 80%. All 41 patients received appropriate antibiotics within the first 24 h of admission, and 28- and 90-day mortality were both low at 11%. CONCLUSIONS Community-acquired Acinetobacter pneumonia is a severe disease, with the majority of patients requiring ICU admission. Most patients have risk factors, particularly hazardous alcohol use. Despite this severity, correct initial empirical antibiotic therapy in all patients was associated with low mortality.

Objective To assess antenatal, birth, and infant outcomes for pregnant women, fetuses, and infants after antenatal vaccination with any antigen present in combination pertussis vaccines. Data sources PubMed, EMBASE, Literature in the Health Sciences in Latin America and the Caribbean, ClinicalTrials.gov, Cochrane Library, and World Health Organization (inception to May 5, 2016). Methods of study selection Studies reporting outcomes for pregnant women, their fetus, or infant after antenatal exposure to either monovalent or combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) or inactivated polio vaccines were considered for inclusion. Results A total of 21 studies were included in this review. Point estimates ranged from 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation), 0.65-1.00 for small for gestational age (birth weight less than the 10th percentile), 0.36-0.85 for stillbirth, 0.16-1.00 for neonatal death, 0.76-1.20 for low birth weight (less than 2,500 g), and 0.20-0.91 for congenital anomalies. All lower 95% confidence intervals (CIs) were less than 1.0. Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a small but statistically significant increase. Point estimates for all anomalies after antenatal tetanus toxoid vaccination ranged from 1.20 to 1.60 and had 95% CIs that crossed 1.0. There was substantial clinical and methodologic heterogeneity from mainly retrospective observational studies with an overall high risk of bias. Objective rates of fever were low, 3% or below, and more common systemic events observed included headache, malaise, and myalgia. Conclusion Evidence suggests that antenatal combined Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups.

Background Adverse drug reactions are a major cause of medicine-related morbidity and mortality, hospital admissions and increased health care costs. A majority, at least 60%, of adverse drug reactions are preventable. Reporting and documentation of adverse drug reactions is therefore critical to their prevention and management significantly improving patient safety, patient outcomes and patient care. Objectives The broad objective of the project was to implement evidence-based best practice in the reporting and documentation of adverse drug reactions by health care professionals at a Kenyan public hospital. Methods The project was designed as a Joanna Briggs Institute Practical Application of Clinical Evidence System best practice implementation project constituting three phases; audit design and baseline audit, implementation of best practice and post-implementation audit. Barriers and strategies to best practice were identified and implemented respectively in phase two. Results This project resulted in significant improvements in practice as demonstrated by the follow-up audit. Improvement varied across the criteria from 1% to 100%. Great improvement was observed in all criteria except in reporting of adverse drug reactions. Conclusions The project resulted in significant improvements in practice relating to the reporting and documentation of adverse drug reactions in this setting. Further work needs to be carried out to sustain and improve upon the results obtained by this project.

Background Inappropriate use of intravenous antibiotic in hospitals impacts on therapeutic efficacy, bacterial resistance, cost and iatrogenic infections. The potential harm from misuse calls for an intervention to improve the use of intravenous antibiotics in hospitals. Intravenous to oral Switch therapy is one way of minimizing overprescribing of antibiotics injections. Aims/objectives Implementation of evidence based practice with regard to administration of metronidazole intravenous formulation in an in-patient setup. Methods The project was conducted over a period of six months. Pre and post implementation audit were used to assess the documentation of Metronidazole injection use in 65 patients medical records and the compliance rate compared. The audit utilized four evidence based criteria recommended by the Joanna Briggs Institute. Results Post Implementation audit of metronidazole intravenous to oral conversion evidence-based criteria showed an increase of more than 40% compliance in all the four criteria utilized. Discussion and conclusion The increase in medical record documentation indicated the contribution of audit, feedback and re-audit cycles to bring about change in clinical practice. This project has demonstrated that metronidazole intravenous formulation switch to oral therapy can be implemented, which can result in a reduction in cost, patient discomfort and iatrogenic infections. For long term sustainability of the outcome, guidelines and pharmacist leadership is essential, as well as follow up assessment of progress to determine the effectiveness of switch therapy in reduction of cost.

Indigenous Australian nations have been interacting with each other since time immemorial. Ravi de Dosta posits that there was, and still is, an Indigenous transnationalism. This transnationalism is required between the Indigenous nations for our nations' sustainability and maintenance as distinct polities. The relationship between the Indigenous peoples of Australia and the Anglo-Australian legal system has been a difficult one to manage due to the denial of recognition of Indigenous jurisdiction by the Anglo-Australian legal system. Indigenous peoples have maintained our own recognition processes of each other and the Anglo-Australian legal system. The Koowarta decision of the High Court of Australia focused the Anglo-Australian legal system outwards towards the international order and the recognised Indigenous jurisdiction that exists outside of the borders of Australia and our Indigenous nations' borders. Indigenous people(s) have been participating in the international arena for decades. This paper e...

Onion (Allium cepa) is an economically important vegetable crop in the United States, generating nearly $900 million annually in farm receipts. Pests such as onion thrips (Thrips tabaci) and a thrips-transmitted virus disease, Iris yellow spot (IYS), caused by Iris yellow spot virus (IYSV), have emerged in recent years as high priority, invasive, or potential threats to sustainable onion production throughout the United States and the world. The long-term goal of a recent United States Department of Agriculture (USDA)-National Institute of Food and Agriculture (NIFA)-Specialty Crop Research Initiative (SCRI) funded project was to optimize sound pest management decision making in onion through the development and deployment of a sustainable online information management platform called the Onion ipmPIPE (Onion integrated pest management Pest Information Platform for Extension and Education). Project participants in seven states generated an average of 500 reports annually on the occurrence of 20 priority insect pests and plant diseases, and enhanced the timeliness and effectiveness of IPM strategies implemented by the growers and industry locally and regionally in response to these reports. Thrips populations are generally greatest at all locations during July and August of each year, which compounds plant responses to environmental stresses such as temperature and limited or lower quality (e.g., saline) irrigation water. The increase in numbers of thrips (majority being T. tabaci) also aggravates problems with the onion thrips-transmitted virus IYSV (mentioned above) and IYS, which generally increases in incidence and severity during this same period. A comprehensive website (http//:www.alliumnet.com/IPMPipe.html) and educational materials (bulletin, diagnostic cards, videos) were developed in response to the insect and disease threats, and have been shared with onion stakeholders throughout the United States and elsewhere. The project is also developing risk assessment models, a smartphone app, onion growing-degree-day review for efficacy of the current model based on 5.5°C from planting, and enhanced pathogen diagnostic tools for future testing and validation by onion stakeholders. Visiting the Onion ipmPIPE website was estimated by respondents to increase onion yields by 280 kg/hectare and reduce pesticide costs by $910/hectare on average. The Onion ipmPIPE platform is scale neutral, and supports a range of organic and conventional growers producing onions on small plots to large-scale commercial fields. Increased participation of stakeholders, including consumers, in a national educational project such as Onion ipmPIPE will better serve current and future interests in sustainability and profitability of critical food crops for the U.S. marketplace. Accepted 25 September 2014. Published 12 November 2014.

IntroductionInvasive meningococcal disease is uncommon but associated with a high-case fatality rate. Carriage prevalence of the causative bacteria,Neisseria meningitidis, is high in adolescents. A large (n=34 500) cluster randomised controlled trial (RCT) to assess the impact of a meningococcal B (MenB) vaccine on meningococcal carriage was implemented in the state of South Australia (SA) for year 10, 11 and 12 senior school students in 2017–2018. This study will assess the impact of MenB vaccine (4CMenB) on carriage prevalence in school leavers in SA, 1 and 2 years after implementation of the cluster RCT in adolescents. Measuring the impact of population programmes on carriage can assist in informing future meningococcal immunisation programmes such as targeted age groups and use of catch-up campaigns.Methods and analysisThis repeat cross-sectional study will assess carriage prevalence in 2018 and 2019. All school leavers who attended year 12 in any school in SA in 2018 or 2019 will be invited to participate in this study. An oropharyngeal swab will be taken from each participating student and a risk factor questionnaire completed by the student following informed consent. Students will attend clinics at SA universities, technical colleges, and metropolitan, rural and remote government council clinics. Confirmed vaccination history will allow a comparison in carriage prevalence between vaccinated and unvaccinated school leavers. A sample size of 4096 students per year will provide 80% power to detect a 20% difference in carriage prevalence of disease-causing meningococci (defined as genogroup A, B, C, W, X or Y) between years.Ethics and disseminationThe study was approved by the Women’s and Children’s Health Network Human Research Ethics Committee. Results will be published in international peer review journals and presented at national and international conferences.Trial registration numberNCT03419533; Pre-results

Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.

Iris yellow spot virus and its vector the onion thrips, Thrips tabaci Lindeman, are yield-limiting pests of onion, Allium cepa L., throughout the western U.S. In experiments in Colorado during 2005 to 2007, straw mulch applied to the center of onion beds at the early to mid-bulb growth stage reduced abundance of thrips as much as 33% when compared to nontreated plots of transplanted onions. Cumulative thrips-days indicated that straw mulch significantly reduced season-long abundance by 10 to 20% compared with check plots in bare soil. The addition of conventional insecticides (methomyl alternated with lambda-cyhalothrin) was associated with 12 to 27% greater cumulative thrips-days compared to the nontreated check in two experiments. In contrast, a reduced-risk insecticide program (spinosad alternated with azadirachtin) had fewer cumulative thrips-days on both bare soil (15%) and straw mulch (36%) compared to nontreated checks. Enhanced thrips control generally persisted during mid-season and may...

As Aboriginal and Torres Strait Islander Social Justice Commissioner Michael Dodson stated in his 1994 Wentworth lecture, ‘[s]ince first contact with the colonisers of this country, Aboriginal and Torres Strait Islander people have been the object of a continual flow of commentary and classification. Since their first intrusive gaze, colonising cultures have had a preoccupation with observing, analysing, studying, classifying and labelling Aborigines and Aboriginality.1 In the previous chapters, dispossession has largely been seen in terms of land. This book is also fundamentally about self-identity and the refusal of settler governments to recognize the way that people define themselves. This refusal has material repercussions of various kinds, most acutely the loss of land. In this chapter, we address another dispossession, that of the right to self-identity, examining the role of colonial legal definitions in this dispossession. The colonial preoccupation with defining Aboriginal identity in legislation is evident in the number of laws containing definitions of Aboriginal persons.2 Since the arrival of the British in Australia in 1788 colonial and, after Federation in 1901, State and Federal governments have enacted over 70 separate pieces of legislation containing definitions of Indigeneity.3 The purpose of these definitions has almost invariably been for the management and assimilation of Aboriginal people.

The articles in this special edition attempt to capture the key learnings and the legacy of the Australian Research Council ‘Special Research Initiative’ funded by the National Indigenous Research and Knowledges Network (NIRAKN). NIRAKN is a national, inclusive, multidisciplinary hub-and-spokes-model network of Indigenous researchers at various stages of their careers. The significant research problem that the network sought to address was how to harness the power of diverse Indigenous knowledges to build a strong, sustainable cohort of linked, qualified, Indigenous researchers across disciplines and fields, and how to weave that cohort into the very fabric of Australian research.

The articles in this edition again attest to the broad range of scholarly concerns that signify the growing disciplinary maturity of critical Indigenous studies. The first article, by Mary Goslett and Vanessa Beavan, draws on empirical research concerning improving the social and emotional well being (SEWB) of Aboriginal women through listening to their experiences of identity and culture. Deploying interpretive phenomenology in their analysis of the women's accounts, they discerned interdependent themes that captured their experiences. They conclude by reiterating the need for decolonising approaches to SEWB, informed by the very people whose experiences are being canvassed in our efforts at amelioration. The second article, by Valmaine Toki, notes the optimism that greeted the United Nations Declaration on the Rights of Indigenous Peoples. However, Toki further illuminates the routine violations and breaches that followed, particularly those by extractive industries and business activity generally. The article examines the fraught relationship between Indigenous rights, the state and business imperatives.

The genus Acinetobacter, well known as a nosocomial pathogen, can also cause severe community-onset pneumonia. Previous small case series have suggested fulminant disease and a pooled hospital mortality of60%.We conducted a prospective observational study of all episodes of bacteremic, community-onset, and radiologically confirmed pneumonia due to Acinetobacter species at a tertiary referral hospital in tropical Australia from 1997 to 2012 following the introduction of routine empirical treatment protocols covering Acinetobacter. Demographic, clinical, microbiologic, and outcome data were collected.There were 41 episodes of bacteremic community-onset Acinetobacter pneumonia, of which 36 had no indicators suggesting health-care-associated infection. Of these, 38 (93%) were Indigenous Australians, one-half were men, the average age was 44.1 years, and 36 episodes (88%) occurred during the rainy season. All patients had at least one risk factor, with hazardous alcohol intake in 82%. Of the 37 isolates available for molecular speciation, 35 were Acinetobacter baumannii and two were Acinetobacter nosocomialis. All isolates were susceptible in vitro to gentamicin, meropenem, and ciprofloxacin, but only one was fully susceptible to ceftriaxone. ICU admission was required in 80%. All 41 patients received appropriate antibiotics within the first 24 h of admission, and 28- and 90-day mortality were both low at 11%.Community-acquired Acinetobacter pneumonia is a severe disease, with the majority of patients requiring ICU admission. Most patients have risk factors, particularly hazardous alcohol use. Despite this severity, correct initial empirical antibiotic therapy in all patients was associated with low mortality.

Objective: To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe. Design, setting and participants: Prospective cohort study in the major hospital for tropical NT, a region where 27% of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007 – 5 May 2008) for sepsis by standard criteria, and collected standardised clinical data. Main outcome measures: Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology. Results: There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7%) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7%). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5%), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3%). Conclusions: The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.

Introduction Sepsis has a high mortality despite advances in management. Microcirculatory and endothelial dysfunction contribute to organ failure, and better tools are needed to assess microcirculatory responses to adjunctive therapies. We hypothesised that peripheral arterial tonometry (PAT), a novel user-independent measure of endothelium-dependent microvascular reactivity, would be impaired in proportion to sepsis severity and related to endothelial activation and plasma arginine concentrations. Methods Observational cohort study in a 350-bed teaching hospital in tropical Australia. Bedside microvascular reactivity was measured in 85 adults with sepsis and 45 controls at baseline and 2-4 days later by peripheral arterial tonometry. Microvascular reactivity was related to measures of disease severity, plasma concentrations of L-arginine (the substrate for nitric oxide synthase), and biomarkers of endothelial activation. Results Baseline reactive hyperaemia index (RH-PAT index), measuring endothelium-dependent microvascular reactivity; (mean [95% CI]) was lowest in severe sepsis (1.57 [1.43-1.70]), intermediate in sepsis without organ failure (1.85 [1.67-2.03]) and highest in controls (2.05 [1.91-2.19]); P < 0.00001. Independent predictors of baseline RH-PAT index in sepsis were APACHE II score and mean arterial pressure, but not plasma L-arginine or markers of endothelial activation. Low baseline RH-PAT index was significantly correlated with an increase in SOFA score over the first 2-4 days (r = -0.37, P = 0.02). Conclusions Endothelium-dependent microvascular reactivity is impaired in proportion to sepsis severity and suggests decreased endothelial nitric oxide bioavailability in sepsis. Peripheral arterial tonometry may have a role as a user-independent method of monitoring responses to novel adjunctive therapies targeting endothelial dysfunction in sepsis.

The articles in this edition address two critical concerns that can be broadly characterised as Indigeneity as a spectacle and the elision of Indigenous sovereignty by multiculturalism and diversity. The first article, by Maryrose Casey, examines nineteenth and early twentieth century Indigenous performances that drew on cultural practices for entertainment. She highlights how these commercially driven performances were, in fact, demonstrations of sovereignty that white colonisers paid to observe. A measure of the success of these demonstrations can be found in the reactions of audiences, which often involved disrupting the spectacle by physically occupying the performance space.

This edition scales the merlons and embrasures that mark the epistemological barriers that contemporary colonising power continually puts in place. Each article harnesses a critical Indigenous perspective in order to challenge conservative approaches or positions, be they concerned with reconciliation, Indigenous-led research, research tools or the nature of Aboriginal being. The first article, by Barry Judd and Emma Barrow, examines reconciliation discourse within the higher education sector and highlights the ways a normative Anglo-Australian identity militates against genuine ‘whitefella’ attempts to ‘reconcile’. The authors stress the importance of inclusive, institutional practice that serves to decentre Anglo-centrism and which, in turn, brings Indigenous peoples more fully into the fold of Australian university life.

The International Journal of Critical Indigenous Studies (IJCIS) now complements the recently launched National Indigenous Research and Knowledges Network (NIRAKN) in its efforts to build Indigenous research capacity. In this context the journal provides a platform for the research of Indigenous postgraduates, early- to mid-career researchers, and senior scholars. Indigenous scholars are therefore encouraged to submit their articles to future editions of the IJCIS, an ‘Excellence in Research for Australia’ (ERA) ranked journal

Endothelial dysfunction is thought to be an important mechanism of organ failure in sepsis. We hypothesised that endothelial function (EF) would be impaired in adult patients with sepsis; that it would improve with treatment; and that the degree of its impairment would correlate with disease severity and outcome.

Need for developing case definitionsand guidelines for data collection, analysis, and presentation for stillbirth as an adverse event following immunization during pregnancy.

Review question/objective Objectives: 1. To synthesise the best available evidence on the effectiveness of influenza vaccination during pregnancy, for pregnant women, her foetus and the child up to six months of age. 2. To synthesise the best available evidence on the types and frequency of adverse events for pregnant women, her foetus and the child up to six months of age, associated with influenza vaccination during pregnancy. Review questions: 1. What are the beneficial effects of influenza vaccination during pregnancy for pregnant women, her foetus and child up to six months of age? 2. What are the adverse effects of influenza vaccination during pregnancy for pregnant women, her foetus and child up to six months of age? Inclusion criteria Types of participants This study will focus on pregnant women with or without risk factors for complications from influenza infection, their unborn child that is being carried at the time of the vaccination, and children up to the age of 6 months. Types of intervention(s) Inactivated influenza vaccination, irrespective of antigenic configuration or adjuvant, administered via any route, any dose, to pregnant women of any trimester. Studies investigating the monovalent H1N1 vaccine will be assessed separately, as well as in combination with the standard trivalent vaccine. Comparator: Pregnant women not vaccinated against influenza. Types of outcomes •Number and severity of influenza and influenza-like episodes and hospitalisation from influenza for pregnant women and their infant less than six months. •Adverse effects for pregnant women, including but not limited to local reaction, fever, anaphylaxis, Guillain Barre Syndrome and maternal death. •Effects on the foetus, including but not limited to spontaneous abortion, stillbirth, premature birth, birth weight, foetal growth and congenital malformation. •Adverse effects of maternal immunisation on the infant up to six months of age. The case definition of influenza will be accepted as a collection of respiratory and systemic symptoms as defined by the author, and/or laboratory confirmed influenza using viral isolation and/or serology. Severity for the mother and infants will be assessed by hospitalisation and/or death, and/or severe disease such as pneumonia.