Importance of a resilient air services network to Australian remote, rural, and regional communities

Rural, regional, and remote settlements in Australia require resilient infrastructure to remain sustainable in a context characterized by frequent large-scale natural disasters, long distances between urban centers, and the pressures of economic change. A critical aspect of this infrastructure is the air services network, a system of airports, aircraft operators, and related industries that enables the high-speed movement of people, goods, and services to remote locations. A process of deregulation during the 1970s and 1980s resulted in many of these airports passing into local government and private ownership, and the rationalization of the industry saw the closure of a number of airlines and airports. This paper examines the impacts of deregulation on the resilience of air services and the contribution that they make to regional and rural communities. In particular, the robustness, redundancy, resourcefulness, and rapidity of the system are examined. The conclusion is that while the air services network has remained resilient in a situation of considerable change, the pressures of commercialization and the tendency to manage aspects of the system in isolation have contributed to a potential decrease in overall resilience.

Making Arrangements : Remote proposal sequences and attendant structural phenomena in social interaction

In this thesis, I contribute to the study of how arrangements are made in social interaction. Using conversation analysis, I examine a corpus of 375 telephone calls between employees and clients of three Community Home Care (CHC) service agencies in metropolitan Adelaide, South Australia. My analysis of the CHC data corpus draws upon existing empirical findings within conversation analysis in order to generate novel findings about how people make arrangements with one another, and some of the attendant considerations that parties to such an activity can engage in: Prospective informings as remote proposals for a future arrangement – Focusing on how employees make arrangements with clients, I show how the employees in the CHC data corpus use ‘prospective informings’ to detail a future course of action that will involve the recipient of that informing. These informings routinely occasion a double-paired sequence, where informers pursue a response to their informing. This pursuit often occurs even after recipients have provided an initial response. This practice for making arrangements has been previously described by Houtkoop (1987) as ‘remote proposing.’ I develop Houtkoop’s analysis to show how an informing of a future arrangement can be recompleted, with response solicitation, as a proposal that is contingent upon a recipient’s acceptance. Participants’ understanding of references to non-present third parties – In the process of making arrangements, references are routinely made to non-present third parties. In the CHC data corpus, these third parties are usually care workers. Prior research (e.g., Sacks & Schegloff, 1979; Schegloff, 1996b) explains how the use of ‘recognitional references’ (such as the bare name ‘Kerry’), conveys to recipients that they should be able to locate the referent from amongst their acquaintances. Conversely, the use of ‘non-recognitional references’ (such as the description ‘a lady called Kerry’), conveys that recipients are unacquainted with the referent. I examine instances where the selection of a recognitional or non-recognitional reference form is followed by a recipient initiating repair on that reference. My analysis provides further evidence thatthe existing analytic account of these references corresponds to the way in which participants themselves make sense of them. My analysis also advances an understanding of how repair can be used, by recipients, to indicate the inappositeness of a prior turn. Post-possible-completion accounts – In a case study of a problematic interaction, I examine a misunderstanding that is not resolved within the repair space, the usual defence of intersubjectivity in interaction (cf. Schegloff, 1992b). Rather, I explore how the source of trouble is addressed, outside of the sequence of its production, with a ‘post-possible-completion account.’ This account specifies the basis of a misunderstanding and yet, unlike repair, does so without occasioning a revised response to a trouble-source turn. By considering various aspects of making arrangements in social interaction, I highlight some of the rich order that underpins the maintenance of human relationships across time. In the concluding section of this thesis I review this order, while also discussing practical implications of this analysis for CHC practice.

Challenges for rural and remote road safety

The growing national and international awareness of the increased representation of serious injuries and fatalities in rural and remote areas is the focus of this paper. Australia was one of the earliest countries to try to address this issue with a targeted national action plan in 1996. This was an important document but the most recent national plan fails to dedicate attention to developing countermeasures for the particular problems of improving road safety in these regions. The findings of a major program of research in Northern Queensland are discussed to stimulate interest and research into potential countermeasures. Specifically, the need to monitor clusters of crashes as a focus for intervention and local ownership is advocated. Taking action towards a national reduction of speed limits on rural roads and investment in proactive research based trials of drink driving countermeasures such as courtesy buses is strongly advocated.

Multidisciplinary design and flight testing of a remote gas/particle airborne sensor system

The main objective of this paper is to describe the development of a remote sensing airborne air sampling system for Unmanned Aerial Systems (UAS) and provide the capability for the detection of particle and gas concentrations in real time over remote locations. The design of the air sampling methodology started by defining system architecture, and then by selecting and integrating each subsystem. A multifunctional air sampling instrument, with capability for simultaneous measurement of particle and gas concentrations was modified and integrated with ARCAA’s Flamingo UAS platform and communications protocols. As result of the integration process, a system capable of both real time geo-location monitoring and indexed-link sampling was obtained. Wind tunnel tests were conducted in order to evaluate the performance of the air sampling instrument in controlled nonstationary conditions at the typical operational velocities of the UAS platform. Once the remote fully operative air sampling system was obtained, the problem of mission design was analyzed through the simulation of different scenarios. Furthermore, flight tests of the complete air sampling system were then conducted to check the dynamic characteristics of the UAS with the air sampling system and to prove its capability to perform an air sampling mission following a specific flight path.

Mailed versus frozen transport of nasal swabs for surveillance of respiratory bacteria in remote Indigenous communities in Australia

Background Surveillance programs and research for acute respiratory infections in remote Australian communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting nasal swabs from a remote setting for bacterial polymerase chain reaction (PCR) testing. Methods We sampled every individual who presented to a remote community clinic over a three week period in August at a time of low influenza and no respiratory syncytial virus activity. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for six bacterial species was undertaken using real-time PCR. Results One hundred and forty participants were enrolled who contributed 150 study visits and paired specimens for testing. Respiratory illnesses accounted for 10% of the reasons for presentation. Bacteria were identified in 117 (78%) presentations for 110 (79.4%) individuals; Streptococcus pneumoniae and Haemophilus influenzae were the most common (each identified in 58% of episodes). The overall sensitivity for any bacterium detected in mailed specimens was 82.2% (95% CI 73.6, 88.1) compared to 94.8% (95% CI 89.4, 98.1) for frozen specimens. The sensitivity of the two methods varied by species identified. Conclusion The mailing of unfrozen nasal specimens from remote communities appears to influence the utility of the specimen for bacterial studies, with a loss in sensitivity for the detection of any species overall. Further studies are needed to confirm our finding and to investigate the possible mechanisms of effect. Clinical trial registration Australia and New Zealand Clinical Trials Registry Number: ACTRN12609001006235. Keywords: Respiratory bacteria; RT-PCR; Specimen transport; Laboratory methods

Not all systematic reviews are systematic : a meta-review of the quality of systematic reviews for non-invasive remote monitoring in heart failure

Remote monitoring for heart failure has been evaluated in numerous systematic reviews. The aim of this meta-review was to appraise their quality and synthesise results. We electronically searched online databases, performed a forward citation search and hand-searched bibliographies. Systematic reviews of remote monitoring interventions that were used for surveillance of heart failure patients were included. Seven (41%) systematic reviews pooled results for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Five (29%) focused on telemonitoring. Four (24%) included both non-invasive and invasive technologies. According to AMSTAR criteria, ten (58%) systematic reviews were of poor methodological quality. In high quality reviews, the relative risk of mortality in patients who received remote monitoring ranged from 0.53 (95% CI=0.29-0.96) to 0.88 (95% CI=0.76-1.01). High quality reviews also reported that remote monitoring reduced the relative risk of all-cause (0.52; 95% CI=0.28-0.96 to 0.96; 95% CI=0.90–1.03) and heart failure-related hospitalizations (0.72; 95% CI=0.64–0.81 to RR 0.79; 95% CI=0.67-0.94) and, as a consequence, healthcare costs. As the high quality reviews reported that remote monitoring reduced hospitalizations, mortality and healthcare costs, research efforts should now be directed towards optimising these interventions in preparation for more widespread implementation.

Not all systematic reviews are systematic : a meta-review of the quality of current systematic reviews and meta-analyses for remote monitoring in heart failure

Background/aims: Remote monitoring for heart failure has not only been evaluated in a large number of randomised controlled trials, but also in many systematic reviews and meta-analyses. The aim of this meta-review was to identify, appraise and synthesise existing systematic reviews that have evaluated the effects of remote monitoring in heart failure. Methods: Using a Cochrane methodology, we electronically searched all relevant online databases and search engines, performed a forward citation search as well as hand-searched bibliographies. Only fully published systematic reviews of invasive and/or non-invasive remote monitoring interventions were included. Two reviewers independently extracted data. Results: Sixty-five publications from 3333 citations were identified. Seventeen fulfilled the inclusion and exclusion criteria. Quality varied with A Measurement Tool to Assess Systematic Reviews (AMSTAR scores) ranging from 2 to 11 (mean 5.88). Seven reviews (41%) pooled results from individual studies for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Four (24%) focused specifically on telemonitoring. Four (24%) included studies investigating both non-invasive and invasive technologies. Population characteristics of the included studies were not reported consistently. Mortality and hospitalisations were the most frequently reported outcomes 12 (70%). Only five reviews (29%) reported healthcare costs and compliance. A high degree of heterogeneity was reported in many of the meta-analyses. Conclusions: These results should be considered in context of two negative RCTs of remote monitoring for heart failure that have been published since the meta-analyses (TIM-HF and Tele-HF). However, high quality reviews demonstrated improved mortality, quality of life, reduction in hospitalisations and healthcare costs.

A study of post diagnosis breast cancer concerns for women living in rural and remote Queensland. Part I : Personal concerns

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women’s expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant’s absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part II : support issues

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

Teaching end-user remote online searching

The Queensland University of Technology (QUT) Library bas recently commenced teaching higher degree students to search online systems such as BRS, ORBIT and STN. The emphasis is on education rather than training. with students being required to familiarise themselves with system commands and database structures whilst receiving necessarily limited tutorial help. The teaching strategies used and problems encountered in the program are outlined. Student responses to the experience of learning to online search are discussed.

Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations : a protocol for a cohort linkage study

Background: Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander people* in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for both women and their infants. Women diagnosed with GDM have an eightfold risk of developing T2DM after pregnancy, compared with women who have not had GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM can lead to heart disease, stroke, renal disease, kidney failure, amputations and blindness. A GDM diagnosis offers a ‘window of opportunity’ for diabetes health interventions and it is vital that acceptable and effective prevention, treatment, and post-pregnancy care are provided. Low rates of post-pregnancy screening for T2DM are reported among non-Aboriginal women in Australia and among Indigenous women in other countries, however data for Aboriginal women are scarce. Breastfeeding, a healthy diet, and exercise can also help to prevent T2DM, and together with T2DM screening are recommended elements of ‘post-pregnancy care’ for women with GDM, This paper describes methods for a data linkage study to investigate rates of post-pregnancy care among women with GDM. Methods/Design: This retrospective cohort includes all women who gave birth at Cairns Base Hospital in Far North Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Base Hospital Clinical Coding system. Data linkage is being conducted with the Queensland Perinatal Data Collection, and three laboratories. Hospital medical records are being reviewed to validate the accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Multiple logistic regression is being used to compare post-pregnancy care between Aboriginal and non-Aboriginal women, while adjusting for other factors may impact on post-pregnancy care. Survival analysis is being used to estimate the rates of progression from GDM to T2DM. Discussion: There are challenges to collecting post-pregnancy data for women with GDM. However, research is urgently needed to ensure adequate post-pregnancy care is provided for women with GDM in Australia.

Alcohol restrictions and drink driving in remote Indigenous communities in Queensland, Australia

Alcohol restrictions have been implemented in many Indigenous communities internationally, with the aim to reduce alcohol-related harm. Whilst a range of reviews have evaluated such restrictions using different measures, drink driving has been described in several reviews as increasing. Presently, this remains anecdotal; with limited empirical evidence to corroborate these reports. In Australia, the Queensland government introduced alcohol management plans in remote Indigenous communities, during 2002-2003, with total alcohol prohibition commencing in 2008 in some communities. Given road crashes are one of the leading causes of injuries for Indigenous peoples, this study aims to identify if the restrictions have been successful in reducing drink driving or have increased such behaviour. We examine this by reviewing changes in conviction rates and in offender and offence characteristics following the 2008 restrictions. Using de-identified Queensland court drink driving conviction data (2006-2011), from four Indigenous communities, Robust Poisson regression models compared counts of drink driving convictions pre (2006-2008) versus post SRS (2009-2011). Changes in offender characteristics and conviction details (blood alcohol concentration (BAC) and sentencing severity), were examined using chi-squares. Results indicate a decline in convictions after the 2008 SRS in three communities. However, a significant increase in convictions was identified in one study community. Community-level disparity included significant decline in BAC in one community (χ 2=5.58, p=0.02) compared with the three other communities that did not indicate change and a significant increase the number of women convicted in two communities (χ 2=17.36, p<0.01; χ 2=5.79, p=0.04). Alcohol restrictions may have important implications in road safety with these reductions in convictions and BAC in some communities. However, an increase in the number of women convicted and limited changes in BAC for other communities demonstrate the complex relationship between alcohol use, remoteness and driving. Greater focus on demand reduction strategies may be necessary to address alcohol misuse.