Migratory Shorebird Gut Microbes are not Associated with Bivalve Prey in Monsoon Tropical Australia

Migratory animals can carry symbionts over long distances. While well-studied for parasite and pathogen transmission, less is known about use of this route by other symbiotic taxa, particularly those non-pathogenic. Here we ask the question of whether gut bacteria can be spread between continents by long-distance bird migration, although gut microbiomes in birds may not be as stable or persistent as those of non-volant animals. We used amplicon sequencing of both bacterial 16S rRNA gene and Vibrio-centric hsp60 gene to determine whether the faecal bacteria of migratory great knots (Calidris tenuirostris) also occur in their main food source in Northern Australia or in nearby sand, comparing samples before and after the birds' long-distance migration. Our data suggest that there is little connectivity among the bacterial microbiomes, except in the bivalve prey. Our results are consistent with previous studies finding that bird faecal microbiomes were not host-specific and contrast with those showing an influence of diet on bird faecal bacteria. We also found little connectivity among Vibrio spp. However, although faecal sample sizes were small, the dominance of different individual Vibrio spp. suggests that they may have been well-established in knot guts and thus capable of moving with them on migration. We suggest that the physiological impacts of a long-distance migration may have caused shifts in the phyla comprising great knot faecal communities.

Field assessment of the operating procedures of a semi-quantitative G6PD Biosensor to improve repeatability of routine testing

In remote communities, diagnosis of G6PD deficiency is challenging. We assessed the impact of modified test procedures and delayed testing for the point-of-care diagnostic STANDARD G6PD (SDBiosensor, RoK), and evaluated recommended cut-offs. We tested capillary blood from fingerpricks (Standard Method) and a microtainer (BD, USA; Method 1), venous blood from a vacutainer (BD, USA; Method 2), varied sample application methods (Methods 3), and used micropipettes rather than the test's single-use pipette (Method 4). Repeatability was assessed by comparing median differences between paired measurements. All methods were tested 20 times under laboratory conditions on three volunteers. The Standard Method and the method with best repeatability were tested in Indonesia and Nepal. In Indonesia 60 participants were tested in duplicate by both methods, in Nepal 120 participants were tested in duplicate by either method. The adjusted male median (AMM) of the Biosensor Standard Method readings was defined as 100% activity. In Indonesia, the difference between paired readings of the Standard and modified methods was compared to assess the impact of delayed testing. In the pilot study repeatability didn't differ significantly (p = 0.381); Method 3 showed lowest variability. One Nepalese participant had <30% activity, one Indonesian and 10 Nepalese participants had intermediate activity (≥30% to <70% activity). Repeatability didn't differ significantly in Indonesia (Standard: 0.2U/gHb [IQR: 0.1-0.4]; Method 3: 0.3U/gHb [IQR: 0.1-0.5]; p = 0.425) or Nepal (Standard: 0.4U/gHb [IQR: 0.2-0.6]; Method 3: 0.3U/gHb [IQR: 0.1-0.6]; p = 0.330). Median G6PD measurements by Method 3 were 0.4U/gHb (IQR: -0.2 to 0.7, p = 0.005) higher after a 5-hour delay compared to the Standard Method. The definition of 100% activity by the Standard Method matched the manufacturer-recommended cut-off for 70% activity. We couldn't improve repeatability. Delays of up to 5 hours didn't result in a clinically relevant difference in measured G6PD activity. The manufacturer's recommended cut-off for intermediate deficiency is conservative.

Monsoonal wet season influences the migration tendency of a catadromous fish (barramundi Lates calcarifer)

Many animals exhibit partial migration, which occurs when populations contain coexisting contingents of migratory and resident individuals. This individual-level variation in migration behaviour may drive differences in growth, age at maturity and survival. Therefore, partial migration is widely considered to play a key role in shaping population demography. Otolith chemistry and microstructural analysis were used to identify the environmental- and individual-specific factors that influence migratory behaviour in the facultatively catadromous barramundi (Lates calcarifer) at two distinct life history stages: firstly, as juveniles migrating upstream into fresh water; and secondly, as adults or sub-adults returning to the estuarine/marine spawning habitat. Monsoonal climate played an important role in determining the migration propensity of juveniles: individuals born in the driest year examined (weak monsoon) were more than twice as likely to undergo migration to freshwater than those born in the wettest (strong monsoon) year. In contrast, the ontogenetic timing of return migrations to the estuary by adults and sub-adults was highly variable and not strongly associated with the environmental parameters examined. We propose that scarce resources within saline natal habitats during lower rainfall years may provide an ecological incentive for juveniles to migrate upstream, whereas more abundant resources in higher rainfall years may promote resident life histories within estuaries. We conclude that inter-annual climatic variation, here evidenced by monsoonal strength, likely plays an important role in driving the persistence of diversified life histories within wild barramundi populations.

Extracellular traps are evident in Romanowsky-stained smears of bronchoalveolar lavage from children with non-cystic fibrosis bronchiectasis

BACKGROUND AND OBJECTIVE

The importance of extracellular traps (ETs) in chronic respiratory conditions is increasingly recognized but their role in paediatric bronchiectasis is poorly understood. The specialized techniques currently required to study ETs preclude routine clinical use. A simple and cost-effective ETs detection method is needed to support diagnostic applications. We aimed to determine whether ETs could be detected using light microscopy-based assessment of Romanowsky-stained bronchoalveolar lavage (BAL) slides from children with bronchiectasis, and whether the ETs cellular origin could be determined.

METHODS

Archived Romanowsky-stained BAL slides from a cross-sectional study of children with bronchiectasis were examined for ETs using light microscopy. The cellular origin of individual ETs was determined based on morphology and physical contact with surrounding cell(s).

RESULTS

ETs were observed in 78.7% (70/89) of BAL slides with neutrophil (NETs), macrophage (METs), eosinophil (EETs) and lymphocyte (LETs) ETs observed in 32.6%, 51.7%, 4.5% and 9%, respectively. ETs of indeterminate cellular origin were present in 59.6% of slides. Identifiable and indeterminate ETs were co-detected in 43.8% of slides.

CONCLUSION

BAL from children with bronchiectasis commonly contains multiple ET types that are detectable using Romanowsky-stained slides. While specialist techniques remain necessary to determining the cellular origin of all ETs, screening of Romanowsky-stained slides presents a cost-effective method that is well-suited to diagnostic settings. Our findings support further research to determine whether ETs can be used to define respiratory endotypes and to understand whether ETs-specific therapies may be required to resolve airway inflammation among children with bronchiectasis.

Graph neural network-based breast cancer diagnosis using ultrasound images with optimized graph construction integrating the medically significant features

PURPOSE

An automated computerized approach can aid radiologists in the early diagnosis of breast cancer. In this study, a novel method is proposed for classifying breast tumors into benign and malignant, based on the ultrasound images through a Graph Neural Network (GNN) model utilizing clinically significant features.

METHOD

Ten informative features are extracted from the region of interest (ROI), based on the radiologists' diagnosis markers. The significance of the features is evaluated using density plot and T test statistical analysis method. A feature table is generated where each row represents individual image, considered as node, and the edges between the nodes are denoted by calculating the Spearman correlation coefficient. A graph dataset is generated and fed into the GNN model. The model is configured through ablation study and Bayesian optimization. The optimized model is then evaluated with different correlation thresholds for getting the highest performance with a shallow graph. The performance consistency is validated with k-fold cross validation. The impact of utilizing ROIs and handcrafted features for breast tumor classification is evaluated by comparing the model's performance with Histogram of Oriented Gradients (HOG) descriptor features from the entire ultrasound image. Lastly, a clustering-based analysis is performed to generate a new filtered graph, considering weak and strong relationships of the nodes, based on the similarities.

RESULTS

The results indicate that with a threshold value of 0.95, the GNN model achieves the highest test accuracy of 99.48%, precision and recall of 100%, and F1 score of 99.28%, reducing the number of edges by 85.5%. The GNN model's performance is 86.91%, considering no threshold value for the graph generated from HOG descriptor features. Different threshold values for the Spearman's correlation score are experimented with and the performance is compared. No significant differences are observed between the previous graph and the filtered graph.

CONCLUSION

The proposed approach might aid the radiologists in effective diagnosing and learning tumor pattern of breast cancer.

Research translation to improve carer smoking cessation support in a paediatric ward of a regional hospital in the Northern Territory

ISSUE ADDRESSED

Health professionals have described barriers to providing carer smoking cessation support in children's wards. This article reports the findings of a research translation process that explored opportunities and developed pathways for change.

METHODS

A facilitated discussion workshop and scheduled stakeholder meetings were used to evaluate research evidence and translate it to an evidence-informed organisational change process, with actions for implementation. Workshop and meeting participants were senior health staff with either a pharmacist, personnel with expertise in alcohol and other drugs, medical or nursing backgrounds, and who held senior managerial roles who worked in a hospital in the Northern Territory. A qualitative approach was used. The data from the workshop were transcribed and analysed using thematic analysis. The first author took notes for meetings that were not recorded and analysed these alongside the transcripts.

RESULTS

The process was able to initiate change to overcome barriers to providing carer smoking cessation support. All participants agreed to prioritise and make carer smoking cessation everybody's responsibility and supported a systematic approach, including provision of nicotine replacement therapy, new record-keeping systems, and training to address staff knowledge deficits and skills gaps. This movement to solution-focused change continued after the workshop.

CONCLUSIONS

With some preparation, a research translation workshop and meetings with selected leaders can initiate organisational change in similar settings and is consistent with theories of planned change. SO WHAT?: This article describes the use of a process to support health promotion through new policies and practices following research which identified barriers in a hospital ward.

Conservation benefit-sharing mechanisms and their effectiveness in the Greater Serengeti Ecosystem: local communities' perspectives

Benefit-sharing mechanisms have been instrumental in securing the support of local communities living on the edge of protected areas to implement protected area goals and enhance biodiversity conservation outcomes. Understanding the acceptability of the types of benefit provided among diverse communities is crucial for co-designing benefit-sharing approaches that accommodate local perspectives. Here, we used quasi-structured questionnaires and focus group discussions (FGD) to assess the acceptance of the types of benefit received by the communities in the Greater Serengeti Ecosystem (GSE) in Tanzania and the effectiveness of the benefits in securing community support for conservation reserves. We found that the categories of social service provision, livelihood support, and employment described all the benefits provided across conservation institutions operating in the GSE. However, the types of benefit within these categories varied significantly among conservation institutions, in terms of level and frequency of benefits received by communities. Overall, student scholarships were highly rated by respondents as the most satisfying benefit received. Respondents who were dissatisfied with the benefits received thought that the benefits did not compensate for the high costs arising from wildlife incursions onto their land. Communities' acceptance of the benefits received varied greatly among villages, but only a small proportion of pooled respondents (22%) were willing to support the existence of a protected area without benefit. This study suggests that local people are willing to support conservation outcomes but require conservation institutions to give greater consideration to the costs incurred by communities, their livelihood needs, and access to natural resources or other benefits. We recommend that benefit-sharing be tailored to the local circumstances and cultures of people living close to protected areas, particularly communities expressing more negative views, to ensure adequate and appropriate compensation is provided.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10531-023-02583-1.

Effectiveness of supervised Kegel exercises using bio-feedback versus unsupervised Kegel exercises on stress urinary incontinence: a quasi-experimental study

INTRODUCTION AND HYPOTHESIS

The objective was to investigate and compare the efficacy of supervised Kegel exercises with bio-feedback on stress urinary incontinence (SUI) and pelvic floor muscle strength (PFMS) compared with unsupervised Kegel exercises.

METHOD

Matched-group quasi-experimental study of 29 female participants divided into two groups (supervised and non-supervised) was conducted over 12 weeks. Baseline measurements of PFMS were undertaken by a women's health physiotherapist and a Kegel exercise regime bespoke designed for each participant. The supervised group visited the physiotherapist monthly for bio-feedback training (BT); the unsupervised group continued at home with their individualised Kegel exercises. Data were collected via a perineometer (Peritron™) and self-reporting responses to questionnaires. All participants received a final PFMS measurement on completion of the study.

RESULTS

Overall Incontinence Severity index (ISI) score was significantly lower in the supervised group post-intervention. Wilcoxon signed-rank tests indicated that supervised Kegel exercises significantly reduced frequency (p= 0.002) and severity (p= 0.020) of overall ISI. Analysis of PFMS were not significantly different, despite an increase in maximum voluntary contraction or pelvic floor muscle strength (PFMS) (p= 0.032) in the supervised group. Of the questionnaires, results of Wilcoxon signed-rank tests indicated that "total bother" was significantly reduced (p= 0.005) in the supervised group. The correlation analysis between PFMS and ISI did not reveal any significant results.

CONCLUSIONS

The study confirmed that supervised BT is more effective in reducing SUI than unsupervised Kegel exercises, and that this reduction in ISI score did not correlate with the improvement in PFMS.

Participatory monitoring in community-based fisheries management through a gender lens

In small-scale fisheries management, the significance of participation is widely recognised but we are still learning how this can be better operationalised to include different groups, such as women or Indigenous peoples. Participatory monitoring is one tool which has been used to increase participation in fisheries management. The aim of this review is to use critical interpretive synthesis to examine the literature on participatory monitoring within community-based fisheries management from a gender perspective. The synthesis identified and discussed several key areas: reasons presented in the literature for engaging with the themes of gender or participatory monitoring, gendered aspects of participatory monitoring, knowledge valuation and prioritisation in management, replicability and transparency of programme or research methods, and marginalisation narratives. Our findings show the complexities of conducting gender-aware participatory monitoring. Participatory monitoring has the potential to be a transformative and empowering process if the power dynamics involved are considered and addressed.

Effects of exercise interventions on cancer-related fatigue in breast cancer patients: an overview of systematic reviews

OBJECTIVE

This overview of systematic reviews aims to critically appraise and consolidate evidence from current systematic reviews (SRs)/meta-analyses on the effects of exercise interventions on cancer-related fatigue (CRF) in breast cancer patients.

METHODS

SRs/meta-analyses that explored the effects of exercise interventions on CRF in breast cancer patients compared with the routine methods of treatment and care were retrieved from nine databases. The methodological quality of the included SRs was appraised using A MeaSurement Tool to Assess systematic Reviews II (AMSTAR II). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to calculate the grading of outcomes in the included SRs. The exercise type, frequency, duration, and inclusion/absence of supervision were further evaluated with subgroup analyses. The Stata 16.0 software was utilized for data analysis.

RESULTS

Twenty-nine reviews were included. The overall methodological quality and level of evidence of the included reviews were unsatisfactory, with only three reviews rated as high methodological quality and no review identified as high-quality evidence. Moderate certainty evidence indicated that exercise could improve fatigue in breast cancer patients (SMD = - 0.40 [95%CI - 0.58, - 0.22]; P = 0.0001). Subgroup analysis based on the types of exercise showed that yoga (SMD = - 0.30 [95%CI - 0.56, - 0.05]; I2 = 28.7%) and aerobic exercise (SMD = - 0.29 [95%CI - 0.56, - 0.02]; I2 = 16%) had a significantly better effect on CRF in breast cancer patients; exercising for over 6 months (SMD = - 0.88 [95%CI - 1.59, - 0.17]; I2 = 42.7%; P = 0.0001), three times per week (SMD = - 0.77 [95%CI - 1.04, - 0.05]; I2 = 0%; P = 0.0001), and for 30 to 60 min per session (SMD = - 0.81 [95%CI - 1.15, - 0.47]; I2 = 42.3%; P = 0.0001) can contribute to a moderate improvement of CRF. Supervised exercise (SMD = - 0.48 [95%CI - 0.77, - 0.18]; I2 = 87%; P = 0.001) was shown to relieve CRF.

CONCLUSION

Exercise played a favorable role in alleviating CRF in breast cancer. Yoga was recommended as a promising exercise modality for CRF management in the majority of the included studies. Exercising for at least three times per week with 30 to 60 min per session could be recommended as a suitable dosage for achieving improvement in CRF. Supervised exercise was found to be more effective in alleviating CRF than unsupervised exercise. More rigorously designed clinical studies are needed to specify the exact exercise type, duration, frequency, and intensity to have an optimal effect on CRF in breast cancer patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: CRD42020219866.

Empowering Indigenous natural hazards management in northern Australia

Northern Australia is prone to recurring severe natural hazards, especially frequent cyclones, flooding, and extensive wildfires. The region is sparsely populated (≪ 0.5 persons km^-2), with Indigenous (Aboriginal) residents comprising 14% of the population, and typically the majority in remote regions. Despite national policy committed to addressing emergency management (EM) in vulnerable Indigenous communities, implementation remains unfunded. We synthesise participatory intercultural research conducted over seven years exploring core challenges, opportunities and potential solutions towards developing effective EM partnerships. Similar EM engagement and empowerment issues face First Nations and local communities in many international settings. In search of solutions, we explore developing effective partnership arrangements between EM agencies and culturally diverse Indigenous communities. Observing that government already provides substantial investment in cultural and natural resource management programmes conducted by over 150 Indigenous Ranger Groups (IRGs) nationally, we demonstrate that expansion of IRG roles to incorporate EM community engagement and service delivery can provide multiple cost-effective community and business development benefits for many remote communities.

How do Yolŋu recognise and understand their children’s learning? Nhaltjan ŋuli ga Yolŋuy nhäma ga märr-dharaŋan djamarrkuḻiw marŋgithinyawuy?

Indigenous families have culturally-specific strengths, priorities, and methods for assessing their children’s development. Recognition and support of children’s and families’ strengths are important for identity, health and wellbeing. However, strengths can be missed in assessment processes developed in non-Indigenous contexts. Yolŋu are First Nations Australian peoples from North-East Arnhem Land. This study was conducted to explore Yolŋu early childhood development, assessment and support in response to concerns that Yolŋu strengths and priorities are often not recognised. The cultural and linguistic expertise of Yolŋu researchers was central in this qualitative study. Rich empirical data were collected through a form of video reflexive ethnography with six children and their extended families over seven years and through in-depth interviews with 38 other community members. An iterative process of data collection and analysis engaged Yolŋu families and researchers in a collaborative, culturally responsive research process which drew on constructivist grounded theory methods. Findings illustrate how Yolŋu children are immersed in complex layers of intertwined and continuous testing and teaching processes integrating holistic frameworks of cultural identity and connection, knowledge and practices. Yolŋu families monitor and recognise a child’s development through both direct and explicit testing and through observing children closely so that children can be supported to keep learning and growing into their knowledge, strengths and identity. Yolŋu expressed concern that such learning is invisible when the child is viewed through non-Yolŋu lenses and assessed with processes and tools from outside the community. Indigenous peoples have a right to culturally congruent assessment of their children. Those who share the child’s culture and language have the expertise to ensure that cultural strengths and priorities are recognised and understood.

Governance of forest resource use in western Nepal: Current state and community preferences

Improved governance of natural resource use is critical to the sustainability and maintenance of environmental quality. In western Nepal, unsustainable resource extraction is seen by the local community as a major threat to forest sustainability. While most respondents to a survey of 243 households inside and outside a protected area (PA) thought the laws for managing resource use were adequate and appropriate, a far smaller proportion thought they were achieving their objectives. Disenchantment with the existing governance regime was strongest outside the PA, probably because there was greater investment in community engagement within the PA. The most likely reason for this failure is the deeply embedded corruption within the forest governance system. Devolution of power to local communities by increasing governance participation is one of the most likely means of containing corruption. It was therefore not surprising that governance participation was rated as the most important governance principle by respondents in a best-worst scaling experiment. Respondents also regarded effectiveness, accountability and transparency as important governance principle to improve management of forest resource extraction from red panda habitat.

Multifunctional farming as successful pathway for the next generation of Thai farmers

Young farmers play a significant role in sustaining food security and the communities’ and rural areas’ viability. However, as with many countries, Thailand is facing a decline in the number of young farmers who, if not productive and satisfied with their farm business, are likely to exit farming to take advantage of their increased educational level and off-farm job opportunities. Data were collected by interviewing young farmers in the Prachin Buri province, Thailand, with the aim of assessing their reason for farming in the long-term and the type of farming. Farming decisions can be categorised into three types: full-time profit-oriented farming with a focus on rice production (~53%), full-time multifunctional farming in innovative mixed or organic production systems (~23%), and part-time farming where young farmers work off-farm and farm outside regular working hours (~24%). Using path analysis, we investigated which physical and psychological factors affect young farmers’ decisions to pursue these three farming types. The results show that non-monetary farming’s benefits are as important as monetary benefits. Education, farming and regular off-farm work experience, farm production, market and pest problems, and government support directly affect the farming types. These effects were also mediated by attitudes towards farming and net farming income. Young farmers choosing to pursue multifunctional farming have higher incomes, more often apply sophisticated technologies, and farm more sustainably than those choosing the other types of farming. This indicates that a shift from conventional rice production to more diversified production systems using innovative technologies is needed to sustain farming success and retain young people in the farming sector.

Implementing an evidence-based somatic acupressure intervention in breast cancer survivors with the symptom cluster of fatigue, sleep disturbance and depression: study protocol of a phase II randomised controlled trial

INTRODUCTION

The fatigue-sleep disturbance-depression (FSD) symptom cluster, as one of the most common symptom clusters in breast cancer (BC) survivors, can significantly decrease patients' quality of life. Since the management of the FSD symptom cluster has been unsatisfactory with the use of pharmacological treatments alone, non-pharmacological approaches have, therefore, been recommended. Somatic acupressure (SA) is a promising approach given its potential benefits of cancer-related symptom alleviation and the convenience of self-practice. However, research evidence on using acupressure to manage the FSD symptom cluster has been limited. The proposed trial aims to examine the feasibility and preliminary effects of an evidence-based SA intervention for FSD symptom cluster management in BC survivors.

METHODS AND ANALYSIS

This study will be a phase II randomised controlled trial with three study arms and 1:1:1 allocation. Fifty-one early-stage BC survivors who are experiencing the FSD symptom cluster will be randomly assigned to a true SA group, a sham SA group or a usual care group. All participants will receive an education booklet regarding FSD symptom cluster management advice as the usual care package. The participants in the true SA group will additionally receive a 7-week self-administered SA intervention. The participants in the sham SA group will additionally receive self-administered light acupressure at non-acupoints with the same frequency, session and duration as the true SA group. The primary outcomes will be feasibility outcomes related to subject recruitment and completion of study questionnaires and interventions. The secondary outcomes will be the effects of SA on fatigue, sleep disturbance, depression and quality of life. Descriptive statistics will be used to present all the outcomes. The secondary outcomes will be analysed using an intent-to-treat approach.

ETHICS AND DISSEMINATION

Ethical approvals of this trial have been granted by the Human Research Ethics Committee at Charles Darwin University (H19017) and the Clinical Trial Ethics Committee at The Affiliated Hospital of Southwest Medical University (KY2019039). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences.

TRIAL REGISTRATION NUMBER

This trial was registered at ClinicalTrials.gov and the registration number is NCT04118140, with the stage at Recruiting.

Pathways to school success: Self-regulation and executive function, preschool attendance and early academic achievement of Aboriginal and non-Aboriginal children in Australia's Northern Territory

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.

Impact of using spirometry on clinical decision making and quality of life in children: protocol for a single centre randomised controlled trial

INTRODUCTION

Although spirometry has been available for decades, it is underused in paediatric practice, other than in specialist clinics. This is unsurprising as there is limited evidence on the benefit of routine spirometry in improving clinical decision making and/or outcomes for children. We hypothesised that using spirometry for children being evaluated for respiratory diseases impacts on clinical decision making and/or improves patient-related outcome measures (PROMs) and/or quality of life (QoL), compared with not using spirometry.

METHODS AND ANALYSIS

We are undertaking a randomised controlled trial (commenced in March 2020) that will include 106 children (aged 4-18 years) recruited from respiratory clinics at Queensland Children's Hospital, Australia. Inclusion criteria are able to perform reliable spirometry and a parent/guardian who can complete questionnaire(s). Children (1:1 allocation) are randomised to clinical medical review with spirometry (intervention group) or without spirometry (control group) within strata of consultation status (new/review), and cough condition (present/absent). The primary outcome is change in clinical decision making. The secondary outcomes are change in PROM scores, opinions regarding spirometry and degree of diagnosis certainty. Intergroup differences of these outcomes will be determined by χ2 test or unpaired t-test (or Mann-Whitney if not normally distributed). Change in outcomes within the control group after review of spirometry will also be assessed by McNemar's test or paired t-test/Wilcoxon signed-rank test.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of the Queensland Children's Hospital approved the study. The trial results will be disseminated through conference presentations, teaching avenues and publications.

TRIAL REGISTRATION NUMBER

ACTRN12619001686190; Pre-results.

Scenario modelling as planning evidence to improve access to emergency obstetric care in eastern Indonesia

The rate of maternal deaths in remote areas in eastern Indonesia–where geographic conditions are difficult and the standard of infrastructure is poor–is high. Long travel times needed to reach emergency obstetric care (EMOC) is one cause of maternal death. District governments in eastern Indonesia need effective planning to improve access to EMOC. The aim of this study was to develop a scenario modelling tool to be used in planning to improve access to EMOC in eastern Indonesia. The scenario model was developed using the geographic information system tool in NetLogo. This model has two inputs: the location of the EMOC facility (PONED) and the travel cost of moving across geographical features in the rainy and dry seasons. We added a cost-benefit analysis to the model: cost is the budget for building the infrastructure; benefit is the number of people who can travel to the EMOC in less than 1 hour if the planned infrastructure is built. We introduced the tool to representative midwives from all districts of Nusa Tenggara Timur province and to staff of Kupang district planning agency. We found that the tool can model accessibility to EMOC based on weather conditions; compare alternative infrastructure planning scenarios based on cost-benefit analysis; enable users to identify and mark poor infrastructure; and model travel across the ocean. Lay people can easily use the tool through interactive scenario modelling: midwives can use it for evidence to support planning proposals to improve access to EMOC in their district; district planning agencies can use it to choose the best plan to improve access to EMOC. Scenario modelling has potential for use in evidence-based planning to improve access to EMOC in low-income and lower-middle-income countries with poor infrastructure, difficult geography conditions, limited budgets and lack of trained personnel.

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: a scoping review protocol

BACKGROUND

Indigenous young people worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health (dMH) interventions are identified as a potential approach to improving access to mental health treatment for Indigenous youth. Although involvement in the development and evaluation of dMH resources is widely recommended, there is limited evidence to guide engagement of Indigenous young people in these processes. This scoping review aims to examine the methods used to involve Indigenous young people in the development or evaluation of dMH interventions.

METHODS

Articles published in English, involving Indigenous young people (aged 10-24 years) in the development or evaluation of dMH interventions, originating from Australia, New Zealand, Canada and the USA will be eligible for inclusion. PubMed, Scopus and EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL, MEDLINE, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo) will be searched to identify eligible articles (from January 1990 onwards). Infomit and Google Scholar (limited to 200 results) will be searched for grey literature. Two reviewers will independently screen citations, abstracts and full-text articles. Study methods, methodologies, dMH intervention details, participant information and engagement, and dissemination methods will be extracted, analysed (utilising content analysis), and qualitatively assessed for alignment with best practice ethical guidelines for undertaking Indigenous health research. A narrative summary of findings will be presented. Reporting will follow the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous peoples (CONSIDER) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.

DISCUSSION

To date, there are no reviews which analyse engagement of Indigenous young people in the development and evaluation of dMH interventions. This review will appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate methods for the engagement of young people in study processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and dMH.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework ( osf.io/2nkc6 ).

The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community

BACKGROUND

Insufficient and inadequate housing remain serious and enduring problems in remote Aboriginal communities in the Northern Territory (NT) of Australia. Housing is recognised as a key determinant of persisting inequities between Aboriginal and other Australians in health, as well as education and employment outcomes which in turn impact on health. In our qualitative study exploring strengths and challenges related to early childhood in a remote NT community, insufficient housing emerged as the greatest challenge families experience in 'growing up' their children.

METHODS

The "Growing up children in two worlds" study engaged Yolŋu (Aboriginal) and other researchers in a culturally responsive qualitative research process. Methods included video ethnography and in-depth interviews with six case study families as well as participant observation and interviews with a wide range of other community members. Data collection and analysis occurred through an iterative and collaborative process and the findings related to housing are the focus of this article.

RESULTS

Concerns about crowded and insecure housing were pervasive in the study community where many families are, in effect, homeless. Most rely on extended family to provide accommodation and some never find a secure and stable space in which to bring up their children. Absence of control over their living conditions is a key element underlying many of the sources of distress associated with crowded housing. The lack of food security, sharing sickness and disturbances in the night affecting sleep are just some of the challenges that generate conflict between family members and impact on health, wellbeing, work and school attendance. Although interaction with other family members is highly valued, the ambition of most participants is for independent and secure accommodation in which they can safely 'grow up' their children.

CONCLUSIONS

Yolŋu who live with the consequences of crowded and insecure housing want their voices to be heard. They best understand the challenges they face and their perspectives must inform the solutions. Equitable access to housing through sufficient and sustained investment in an integrated approach, engaging all stakeholders, is needed. This is essential to address persisting inequities between Aboriginal and non-Aboriginal Australians in health and other outcomes.

redictability of ecurrence using mmunohistochemistry to delineate urgical argins in mucosal ead and eck quamous ell arcinoma (): study protocol for a prospective, observational and bilateral study in Australia and India

OBJECTIVES

Treatment failure and poor 5-year survival in mucosal head and neck squamous cell carcinoma (HNSCC) has remained unchanged for decades mainly due to advanced stage of presentation and high rates of recurrence. Incomplete surgical removal of the tumour, attributed to lack of reliable methods to delineate the surgical margins, is a major cause of disease recurrence. The predictability of recurrence using immunohistochemistry (IHC) to delineate surgical margins (PRISM) in mucosal HNSCC study aims to redefine margin status by identifying the true extent of the tumour at the molecular level by performing IHC with molecular markers, eukaryotic initiation factor, eIF4Eand tumour suppressor gene, p53, on the surgical margins and test the use of Lugol's iodine and fluorescence visualisation prior to the wide local excision. This article describes the study protocol at its pre - results stage.

METHODS AND ANALYSIS

PRISM-HNSCC is a bilateral observational research being conducted in Darwin, Australia and Vellore, India. Individuals diagnosed with HNSCC will undergo the routine wide local excision of the tumour followed by histopathological assessment. Tumours with clear surgical margins that satisfy the exclusion criteria will be selected for further staining of the margins with eIF4E and p53 antibodies. Results of IHC staining will be correlated with recurrences in an attempt to predict the risk of disease recurrence. Patients in Darwin will undergo intraoperative staining of the lesion with Lugol's iodine and fluorescence visualisation to delineate the excision margins while patients in Vellore will not undertake these tests. The outcomes will be analysed.

ETHICS AND DISSEMINATION

The PRISM-HNSCC study was approved by the institutional ethics committees in Darwin (Human Research Ethics Committee 13-2036) and Vellore (Institutional Review Board Min. no. 8967). Outcomes will be disseminated through publications in academic journals and presentations at educational meetings and conferences. It will be presented as dissertation at the Charles Darwin University. We will communicate the study results to both participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12616000715471).