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Why isn’t my supervisor Indigenous – the challenges of being a First Nations scholar and what the Academy can do about them
Get PDFA panel of First Nations scholars, researchers and Nulungu staff will have a frank and fearless discussion about their experiences of working within the Academy. They will explore how Universities, and the research sector more generally, can ensure cultural safety for staff and students, and what’s required for First Nations scholars to fully flourish
Tonsils at Telethon: Developing a standardised collection of tonsil photographs for group A streptococcal (GAS) research
No full textIntroduction: Group A streptococcus (GAS) infections, such as pharyngitis and impetigo, can lead to rheumatic fever and rheumatic heart disease (RHD). Australian Aboriginal and Torres Strait Islander populations experience high rates of RHD and GAS skin infection, yet rates of GAS pharyngitis are unclear. Anecdotally, clinical presentations of pharyngitis, including tonsillar hypertrophy and sore throat, are uncommon. This study aimed to develop a standardised set of tonsil photographs and determine tonsil size distribution from an urban paediatric population.
Methods: A prospective cohort of children aged 3–15 years were recruited at the public events “Discover Day” and “Telethon Weekend” (October 2017) in Perth, Western Australia, Australia. Tonsil photographs, symptomatology, and GAS rapid antigen detection tests (RADT) were collected. Tonsil size was graded from the photographs using the Brodsky Grading Scale of tonsillar hypertrophy (Brodsky) by two independent clinicians, and inter-rater reliability calculated. Pharyngitis symptoms and GAS RADT were correlated, and immediate results provided.
Results: Four hundred and twenty-six healthy children participated in the study over three days. The median age was seven years [interquartile range (IQR) 5.9–9.7 years]. Tonsil photographs were collected for 92% of participants, of which 62% were rated as good-quality photographs and 79% were deemed of adequate quality for assessment by both clinicians. When scored by two independent clinicians, 57% received the same grade. Average Brodsky grades (between clinicians) were 11%, 35%, 28%, 22% and 5% of grades 0,1,2,3 and 4, respectively. There was moderate agreement in grading using photographs, and minimal to weak agreement for signs of infection. Of 394 participants, 8% reported a sore throat. Of 334 GAS RADT performed, \u3c1% were positive.
Discussion: We report the first standardised use of paediatric tonsil photographs to assess tonsil size in urban-living Australian children. This provides a proof of concept from an urban-living cohort that could be compared with children in other settings with high risk of GAS pharyngitis or rheumatic fever such as remote-living Australian Indigenous populations
Reflections on a Developmental Evaluation of a Traditional Healing Service Model for the Kimberley region of Western Australia
Get PDFFrom 2019 to 2023 the Kimberley Aboriginal Law and Culture Centre was funded to develop and trial a service delivery model of traditional healing as part of the Kimberley Aboriginal Suicide Prevention Trials (KASPT). The service, now known as Jalngangurru Healing, was developed amidst national and regional challenges including COVID-19, major floods and extensive sorry business. A defining feature of Jalngangurru Healing is the strong cultural governance that underpins the service. This seminar will reflect on a Developmental Evaluation that was undertaken throughout the model development and trial of Jalngangurru Healing. The participatory evaluation process used a multi-method approach, incorporating participant observation; one-on-one, semi-structured interviews; small group discussions; and a survey, across a broad range of stakeholders. The data was then reported back to the healing team iteratively, at healers camps and clinics, and then used to incorporate further into the model design. The evaluation team acted as a ‘critical friend’ to the project. Two Aboriginal research assistants (one male and one female) were able to provide valuable cultural interpreting for the project to ensure that the cultural sensitivities around mabarn were carefully managed, and cultural nuances were well understood. During the project, the evaluation team also helped the healing team to develop a set of guiding principles and a Theory of Change in order to help the project stay true to the underpinning cultural values. The Developmental Evaluation process enabled the healing team an opportunity for a holistic understanding of how different stakeholders were feeling about the different aspects of the model as it developed, which ultimately resulted in a culturally-governed and -owned clinic model, working with both men and women healers, that is unique to the Kimberley. Developmental Evaluation puts the evaluation team inside the project, which may bring challenges for perceptions of objectivity found in more traditional forms of evaluation, but we argue that this was ultimately part of the success of this project
Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities
No full textObjective: This study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/ experience.
Design and setting: A cohort study of medicine graduates from nine Australian universities.
Participants: 1220 domestic medicine graduates from the class of 2011.
Outcome measures: Practice location recorded by the Australian Health Practitioner Regulation Agency in PGY10; matched graduate movement between PGYs 5, 8 and 10 as classified by the Modified Monash Model, stratified by specialty type (predominantly grouped as general practitioner (GP) or non-GP).
Results :At PGY10, two-thirds (820/1220) had achieved fellowship. GPs were 2.8 times more likely to be in nonmetropolitan practice (28% vs 12%; 95% CI 2.0 to 4.0, p\u3c0.001) than graduates with non-GP (all other) specialist qualifications. More than 70% (71.4%) of GPs who were in non-metropolitan practice in PGY5 remained there in both PGY8 and PGY10 versus 29.0% of non-GP specialists and 36.4% of non-fellowed graduates (p\u3c0.001). The proportion of fellowed graduates observed in nonmetropolitan practice was 14.9% at PGY5, 16.1% at PGY8 and 19.0% at PGY10, with this growth predominantly from non-GP specialists moving into non-metropolitan locations, following completion of metropolitan-based vocational training.
Conclusions: There are strong differences in practice location patterns between specialty types, with few non-GP specialists remaining in non-metropolitan practice between PGY5 and PGY10. Our study reinforces the importance of rural training pathways to longerterm work location outcomes and the need to expand specialist vocational training which supports more rural training opportunities for trainees outside general practice
From ownership to custodianship of tumor biopsy tissue in genomic testing: A mixed methods study of patient views
No full textTumor mutation profling (MP) is often conducted on tissue from biopsies conducted for clinical purposes (diagnostic tissue). We aimed to explore the views of patients with cancer on who should own tumor biopsy tissue, pay for its storage, and decide on its future use; and determine their attitudes to and predictors of undergoing additional biopsies if required for research purposes. In this mixed methods, cross-sectional study, patients with advanced solid cancers enrolled in the Molecular Screening and Therapeutics Program (n = 397) completed a questionnaire prior to undergoing MP (n = 356/397). A subset (n = 23) also completed a qualitative interview. Fifty percent of participants believed they and/ or relatives should own and control access to diagnostic tissue. Most (65.5%) believed the government should pay for tissue preparation. Qualitative themes included (1) custodianship of diagnostic tissue, (2) changing value of tissue across time and between cultures, (3) equity regarding payment, and (4) cost-beneft considerations in deciding on additional biopsies. Policy and regulation should consider patient perspectives. Extension of publicly funded health care to include tissue retrieval for clinical trials should be considered
Access, Security, and Trust: Balancing Agencies\u27 Need-to-Access Encrypted Data with Digital Security and Public Trust in Australian Government\u27s Policy Approaches to Law Enforcement and National Security
No full textIn the 21st Century, governments around the world are confronted by the challenges of policing against serious crime, terrorism, and other malicious-actor threats in an increasingly complex and convoluted digital landscape. Accelerating social changes and advances in secure and anonymising technologies (including end-to-end encryption) are providing regular frustrations to law enforcement and intelligence organisations. These agencies must detect, deter, and disrupt the threats to lives, public safety, and national security posed by malicious foreign and domestic actors who are utilising such technologies to communicate securely and ‘go dark’ online. Accessing encrypted data to identify and investigate these threats frequently requires public authorities to invite or compel the assistance of online service providers (OSPs).
However, in Australia and other liberal democracies such as the UK, government attempts to regulate digital industry and access secure data are hampered by prevailing post-Snowden trust deficits and digital security concerns among OSPs and civil society. OSPs argue that, in the current techno-social environment, compliance with access mandates is technically impossible without simultaneously compromising the security of their systems, the critical services that these provide, and the privacy, trust, and security of billions of law-abiding individual, business, and government users globally. Civil society is similarly apprehensive that by jeopardising individual privacy and digital security (even if only in the public’s perception), intrusive surveillance and digital regulations yield self-defeating outcomes by producing more (not less) threats to user confidentiality, public safety, and national security. In a convoluted and deteriorating threat landscape, degrading public trust in democratic institutions is being exacerbated and exploited by a perplexing information environment inundated by misinformation and malicious foreign and domestic disinformation efforts.
In addressing these multi-faceted challenges to online policing, public authorities in Australia and democratic nations worldwide must extend conventional focusses beyond agencies’ need for intrusive access empowerment in order to pursue their law-and-order and national security remits. Government must therefore take into serious consideration the criticality of protecting digital security and building effective public trust measures to achieve a more productive and holistic policy approach to public safety and national security