Use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review protocol

Introduction After-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia. Aim To review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities. Methods The proposed scoping review will be conducted using the Arksey and O’Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders’ perceptions and benefits and challenges of the services.

Validity and reliability of resiliency measures trialled for the evaluation of a preventative Resilience-promoting social-emotional curriculum for remote Aboriginal school students

Purpose We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Methods Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. Results CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). Conclusions The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.

Educator Perceptions of Early Learning Environments as Places for Privileging Social Justice in Rural and Remote Communities

Early childhood education and care (ECEC) in Australia has long been associated with the concept of social justice, however, a clear understanding of what it looks like across diverse services and communities is not available. This article reports the process of inquiry, as well as the outcomes, of a small-scale study designed to uncover the perceptions of ECEC educators working in rural and remote communities in the state of Queensland. Data were collected through individual semi-structured interviews with five educators from rural and remote settings identified as areas experiencing significant growth in population diversity. An initial thematic analysis of the data revealed three key themes. A secondary analysis using a place and space conceptual framework uncovered deeper, more sophisticated meanings of the educator experience of social justice. The research is important in bringing pedagogical conversations to the forefront regarding ECEC educator perceptions of their role in creating a socially just learning environment. In addition to identifying future research possibilities, implications from the findings indicate opportunities for re-examining and rethinking initial teacher education and ongoing professional learning.

Homogenising the Design Criteria of a Community Battery Energy Storage for Better Grid Integration

Historically, minimum system demand has usually occurred overnight. However, in recent years, the increased penetration of rooftop photovoltaic systems (RPVs) has caused an even lower demand at midday, forcing some of the conventional generators to shut down only hours before the evening peak demand period. This further complicates the job of power system operators, who need to run the conventional generator at the minimum stable level at the midday low-demand period so that they can reliably supply power during the peak periods. Employing a community battery storage system can alleviate some of the technical issues caused by the high penetration of RPVs. This paper proposed a design criterion for community battery energy storage systems and employed the battery for the improvement of the duck curve profile and providing the desired level of peak-shaving. Furthermore, remote communities with high penetration of RPVs with a community battery energy storage can achieve the desired level of self-sufficiency. To this end, this study recommends and confirms an applicable design criterion for community battery energy storage. The study shows that the suitable size of community battery storage should be based on the community’s daily excess generation and consumption requirements. The results of various scenarios performed on the proposed design criterion show the extent to which the desired objectives of peak-shaving, duck curve mitigation, and self-sufficiency can be achieved.

A sensitive and rapid wastewater test for SARS-COV-2 and its use for the early detection of a cluster of cases in a remote community

Throughout the COVID-19 pandemic, wastewater surveillance has been used to monitor trends in SARS-CoV-2 prevalence in the community. A major challenge in establishing wastewater surveillance programs, especially in remote areas, is the need for a well-equipped laboratory for sample analysis. Currently, no options exist for rapid, sensitive, mobile, and easy-to-use wastewater tests for SARS-CoV-2. The performance of the GeneXpert System, which offers cartridge-based, rapid molecular clinical testing for SARS-CoV-2 in a portable platform, was evaluated using wastewater as the input. The GeneXpert demonstrated a SARS-CoV-2 limit of detection in wastewater below 32 copies/mL with a sample processing time of less than an hour. Using wastewater samples collected from multiple sites across Canada during February and March 2021, a high overall agreement (97.8%) was observed between the GeneXpert assay and laboratory-developed tests regarding the presence or absence of SARS-CoV-2. Additionally, with the use of centrifugal filters the detection threshold of the GeneXpert system was improved to <10 copies/mL in wastewater. Finally, to support on-site wastewater surveillance, GeneXpert testing was implemented in Yellowknife, a remote community in Northern Canada where its use successfully alerted public health authorities to undetected transmission of COVID-19. The identification of SARS-CoV-2 in wastewater triggered clinical testing of recent travelers and identification of new COVID-19 cases/clusters. Taken together, these results suggest the GeneXpert is a viable option for surveillance of SARS-CoV-2 in wastewater in locations that do not have access to established testing laboratories. Importance: Wastewater-based surveillance is a powerful tool that provides an unbiased measure of COVID-19 prevalence in a community. This work describes a sensitive wastewater rapid test for SARS-CoV-2 based on a widely distributed technology, the GeneXpert. The advantages of an easy-to-use wastewater test for SARS-CoV-2 are clear – it supports surveillance in remote communities, improves access to testing, and provides faster results allowing for an immediate public health response. The application of wastewater rapid testing in a remote community facilitated the detection of a COVID-19 cluster and triggered public health action, clearly demonstrating the utility of this technology. Wastewater surveillance will become increasingly important in the post-vaccination pandemic landscape as individuals with asymptomatic/mild infections continue transmitting SARS-CoV-2 but are unlikely to be tested.

No Young Carer Left Behind: A Two-Phased Study to Understand and Address the Needs of Young Carers from Rural and Urban Communities Before and During Covid-19

Canada has one of the largest cohorts of young carers aged 15 to 24 who provide unpaid care for a family member. Although the body of research on young carers is growing in Canada, knowledge on the experiences and needs of young carers living in remote and rural communities is almost absent. This study aimed to understand and address the needs of young carers in rural/remote communities to support our community partner’s goal of expanding their resources and support of this underserved population. The study was conducted in two phases with the first phase being a needs assessment and the second phase addressed those needs. In Phase 1 (conducted pre-COVID-19), three focus groups were conducted with young carers from rural and urban communities with 20 young carers participating in total. Six themes were identified: Internet Usage in Daily Life; Finding and Filtering Information; Concerns Related to Internet Use; Social and Mental Support; What Makes Caregiving More Challenging; and Designing Something to Make Caring Easier. During Phase 2 (conducted mid-COVID-19), 2 focus groups were held via Zoom for Healthcare with a mix of rural and urban young carers in each group. One of the focus groups was held with those under 18 years old and the other included those between 18 to 25 years old. Four themes were identified: Responses to Emergencies; Awareness of Emergency Planning; Potential Impact on Planned Behaviour; and Considerations and Suggestions for Improvement.

A Demand-Response Scheme Using Multi-Agent System for Smart DC Microgrid

This article describes a framework for load shedding techniques using dynamic pricing and multi-agent system. The islanded microgrid uses solar panels and battery energy management system as a source of energy to serve remote communities who have no access to the grid with a randomized type of power in terms of individual load. The generated framework includes modeling of solar panels, battery storage and loads to optimize the energy usage and reduce the electricity bills. In this work, the loads are classified as critical and non-critical. The agents are designed in a decentralized manner, which includes solar agent, storage agent and load agent. The load shedding experiment of the framework is mapped with the manual operation done at Kisiju village, Pwani, Tanzania. Experiment results show that the use of pricing factor as a demand response makes the microgrid sustainable as it manages to control and monitor its supply and demand, hence, the load being capable of shedding its own appliances when the power supplied is not enough.