Youth programs in remote Indigenous communities: Context matters

A diversity of programs oriented to young people seek to develop their capacities and their connection to the communities in which they live. Some focus on ameliorating a particular issue or ‘deficit’ whilst others, such as sporting, recreation and youth groups are more grounded in the community. This article reports a qualitative study undertaken in three remote Indigenous communities in Central Australia. Sixty interviews were conducted with a range of stakeholders involved in a diversity of youth programs. A range of critical challenges for and characteristics of remote Indigenous youth programs are identified if such programs are to be ‘fit for context’. ‘Youth centred-context specific’ provides a positive frame for the delivery of youth programs in remote Central Australia, encouraging an explicit focus on program logic; program content and processes; and relational, temporal, and, spatial aspects of the practice context. These provide lenses with which youth program planning and delivery may be enhanced in remote communities. Culturally safe service planning and delivery suggests locally determined processes for decision-making and community ownership. In some cases, this may mean a community preference for all ages to access the service to engage in culturally relevant activities. Where activities are targeted at young people, yet open to and inclusive of all ages, they provide a medium for cross-generational interaction that requires a high degree of flexibility on the part of staff and funding programs. Although the findings are focused in Central Australia, they may be relevant to similar contexts elsewhere.

What does “futility” mean? An empirical study of doctors’ perceptions

Objective(s) To describe how doctors define and use the terms “futility” and “futile treatment” in end-of-life care. Design, Setting, Participants A qualitative study using semi-structured interviews with 96 doctors across a range of specialties who treat adults at the end of life. Doctors were recruited from three large Australian teaching hospitals and were interviewed from May to July 2013. Results Doctors’ conceptions of futility focused on the quality and chance of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances when benefit was determined by quality of life alone. Most doctors described the assessment of chance of success in achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision-making. Over half the doctors also identified treatment that is futile but nevertheless justified, such as short-term treatment as part of supporting the family of a dying person. Conclusions There is an overwhelming preference for a qualitative approach to assessing futility, which brings with it variation in clinical decision-making. “Patient benefit” is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussions with patients and families about their values and goals as well as the burdens and benefits of further treatment.

The mating system of the true fruit fly Bactrocera tryoni and its sister-species, Bactrocera neohumeralis

The frugivorous 'true' fruit fly, Bactrocera tryoni (Queensland fruit fly), is presumed to have a non-resourced-based lek mating system. This is largely untested, and contrary data exists to suggest Bactrocera tryoni may have a resource-based mating system focused on fruiting host plants. We tested the mating system of Bactrocera tryoni, and its close sibling Bactrocera neohumeralis, in large field cages using laboratory reared flies. We used observational experiments that allowed us to determine if: - (i) mating pairs were aggregated or non-aggregated; - (ii) mating system was resource or non-resource based; - (iii) flies utilised possible landmarks (tall trees over short) as mate-rendezvous sites, and; - (iv) males called females from male-dominated leks. We recorded nearly 250 Bactrocera tryoni mating pairs across all experiments, revealing that: - (i) mating pairs were aggregated; - (ii) mating nearly always occurred in tall trees over short; - (iii) mating was non-resource based, and; - (iv) that males and females arrived at the mate-rendezvous site together with no evidence that males preceded females. Bactrocera neohumeralis copulations were much more infrequent (only 30 mating pairs in total), but for those pairs there was a similar preference for tall trees and no evidence of a resource-based mating system. Some aspects of Bactrocera tryoni mating behaviour align with theoretical expectations of a lekking system, but others do not. Until evidence for unequivocal female choice can be provided (as predicted under a true lek), the mating system of Bactrocera tryoni is best described as a non-resource based, aggregation system for which we also have evidence that land-marking may be involved. This article is protected by copyright. All rights reserved.

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: A cross-sectional study

Objective: To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). Setting: Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. Participants: A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. Primary and secondary outcomes: A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. Results: A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). Conclusions: The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.