BACKGROUND: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government\'s \"Closing the Gap\" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice.
METHODS: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy.
RESULTS: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of \"working with\" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation.
CONCLUSIONS: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.

Comparing two Australian regions, Western Australia (WA) and South Australia (SA), this research investigates official noncompliance datasets of recreational blue swimmer crab (Portunus armatus) fishing between 2009 and 2019. These recreational fisheries in both jurisdictions are license-free and therefore participating fisher information is limited. Analyses provide a glimpse at the (noncompliant) fisher population profiles against the application of management strategies. The data provide (1) an evidence-base to optimize regulatory strategies by balancing education and enforcement activities with recreational fisher enjoyment. The results of this research enable application within and beyond these fisheries and jurisdictions; and (2) drawing from the criminology discipline, deterrence theory offers insight to enhance compliance tools. Further, it shows the importance of a multi-disciplinary approach to assessing compliance and identifies some practical approaches to data collection that can be readily undertaken to assist with more detailed analysis and enhance compliance strategies.

There is a shortage of surgeons caring for the 33% of Australians residing in rural and regional areas. In order to help appreciate what rural general surgery entails and optimize training for aspiring rural surgeons, the aim of this study was to analyse the general surgical departments\' procedural caseload and casemix in four rural South Australian hospitals.
This is a retrospective multi-centre study involving four rural surgical centres in South Australia (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). Surgical procedures performed from 2014-2020 were extracted from departmental audits. To identify trends of surgical procedure over time, the data was divided into three time periods (Period 1: February 2014-December 2015, Period 2: January 2016-December 2017, Period 3: January 2018-March 2020).
A total of 44 191 surgical procedures were performed, 70.2% being day procedures. 54% were endoscopic procedures, 46% were operative procedures. 60.6% of the operative procedures were general surgery procedures. 28.5% were general surgery-based subspecialty (colorectal, hepato-pancreato-biliary, upper gastrointestinal, and breast). 10.9% were non-general surgery-based subspecialty (urology, plastics, vascular, orthopaedics, head and neck, and obstetrics and gynaecology). There were no statistically significant fluctuations in procedure caseload in all aspects (endoscopic and operative procedures) over the three time periods.
The majority of a rural Australian general surgeon\'s procedures are endoscopic. Operative procedures are mainly general surgery based. It may be beneficial to equip aspiring rural general surgeons to manage basic non-general surgery procedures (urological, vascular, and orthopaedic).

Forecasts of wastewater inflow are considered as a significant component to support the development of a real-time control (RTC) system for a wastewater pumping network and to achieve optimal operations. This paper aims to investigate patterns of the wastewater inflow behaviour and develop a seasonal autoregressive integrated moving average (SARIMA) forecasting model at low temporal resolution (hourly) for a short-term period of 7 days for a real network in South Australia, the Murray Bridge wastewater network/wastewater treatment plant (WWTP). Historical wastewater inflow data collected for a 32-month period (May 2016 to December 2018) was pre-processed (transformed into an hourly dataset) and then separated into two parts for training (80%) and testing (20%). Results reveal that there is seasonality presence in the wastewater inflow time series data, as it is heavily dependent on time of the day and day of the week. Besides, the SARIMA (1,0,3)(2,1,2)24 was found as the best model to predict wastewater inflow and its forecasting accuracy was determined based on the evaluation criteria including the root mean square error (RMSE = 5.508), the mean absolute value percent error (MAPE = 20.78%) and the coefficient of determination (R2 = 0.773). From the results, this model can provide wastewater operators curial information that supports decision making more effectively for their daily tasks on operating their systems in real-time.

We assessed hospitalisations for gastrointestinal bleeding directly related to primary prevention aspirin in lower risk patients for a 6-month period in three South Australian hospitals. Those with related underlying pathology or concurrent causative medication were excluded. Identified patients (n = 22) carried little co-morbidity, 41% received prior proton-pump inhibitors and 68% were aged >70 years. Mean hospital admission cost was $6769 (95% confidence interval $5198-$8340), with projected state and national annual costs of $0.57 and $8.12 million respectively. In light of recent guideline changes, clinicians need to vigorously assess the need for primary prevention aspirin.

International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants\' mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.

Human activities put stress on our oceans and with a growing global population, the impact is increasing. Stressors rarely act in isolation, with the majority of marine areas being impacted by multiple, concurrent stressors. Marine spatial cumulative impact assessments attempt to estimate the collective impact of multiple stressors on marine environments. However, this is difficult given how stressors interact with one another, and the variable response of ecosystems. As a result, assumptions and generalisations are required when attempting to model cumulative impacts. One fundamental assumption of the most commonly applied, semi-quantitative cumulative impact assessment method is that a change in modelled cumulative impact is correlated with a change in ecosystem condition. However, this assumption has rarely been validated with empirical data. We tested this assumption using a case study of seagrass in a large, inverse estuary in South Australia (Spencer Gulf). We compared three different seagrass condition indices, based on survey data collected in the field, to scores from a spatial cumulative impact model for the study area. One condition index showed no relationship with cumulative impact, whilst the other two indices had very small, negative relationships with cumulative impact. These results suggest that one of the most commonly used methods for assessing cumulative impacts on marine systems is not robust enough to accurately reflect the effect of multiple stressors on seagrasses; possibly due to the number and generality of assumptions involved in the approach. Future methods should acknowledge the complex relationships between stressors, and the impact these relationships can have on ecosystems. This outcome highlights the need for greater evaluation of cumulative impact assessment outputs and the need for data-driven approaches. Our results are a caution for marine scientists and resource managers who may rely on spatial cumulative impact assessment outputs for informing policy and decision-making.

The human consumption of stimulant drugs is known to increase over festive periods. In this work, four illicit stimulants: 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), cocaine and methamphetamine and three new psychoactive substances (NPS): ethylone, mephedrone and N-ethylpentylone were monitored in influent wastewater over the Christmas-New Year period in South Australia from 2016 to 2019 using liquid chromatography-mass spectrometry. The differences in Christmas - New Year consumption between years were evaluated and daily mass loads were compared to the average for that year to determine drug levels over the festive period. Although MDMA, MDA and cocaine showed year-on-year increases, the use over the New Year period was far higher than over the rest of the year, consistent with recreational drug use. These were also the drugs that were used predominantly on weekends during the year. Methamphetamine, which does not have a pattern of predominant weekend use, and the NPS showed variable trends. These results suggest that during holiday periods there are increases in the use of a limited set of drugs only and these can be predicted from patterns of use during the non-holiday periods.

In Australia, disease registers for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) were previously established to facilitate disease surveillance and control, yet little is known about the extent of case-ascertainment. We compared ARF/RHD case ascertainment based on Australian ARF/RHD register records with administrative hospital data from the Northern Territory (NT), South Australia (SA), Queensland (QLD) and Western Australia (WA) for cases 3-59 years of age. Agreement across data sources was compared for persons with an ARF episode or first-ever RHD diagnosis. ARF/RHD registers from the different jurisdictions were missing 26% of Indigenous hospitalised ARF/RHD cases overall (ranging 17-40% by jurisdiction) and 10% of non-Indigenous hospitalised ARF/RHD cases (3-28%). The proportion of hospitalised RHD cases (36%) was half the proportion of hospitalised ARF cases (70%) notified to the ARF/RHD registers. The registers were found to capture few RHD cases in metropolitan areas (SA Metro: 13%, QLD Metro: 35%, WA Metro: 14%). Indigenous status, older age, comorbidities, drug/alcohol abuse and disease severity were predictors of cases appearing in the hospital data only (p < 0.05); sex was not a determinant. This analysis confirms that there are biases associated with the epidemiological analysis of single sources of case ascertainment for ARF/RHD using Australian data.

Environmental decision-making requires an understanding of complex interacting systems across scales of space and time. A range of statistical methods, evaluation frameworks and modeling approaches have been applied for conducting structured environmental decision-making under uncertainty. Bayesian Decision Networks (BDNs) are a useful construct for addressing uncertainties in environmental decision-making. In this paper, we apply a BDN to decisions regarding fire management to evaluate the general efficacy and utility of the approach in resource and environmental decision-making. The study was undertaken in south-eastern Australia to examine decisions about prescribed burning rates and locations based on treatment and impact costs. Least-cost solutions were identified but are unlikely to be socially acceptable or practical within existing resources; however, the statistical approach allowed for the identification of alternative, more practical solutions. BDNs provided a transparent and effective method for a multi-criteria decision analysis of environmental management problems.