Search Results (99)

The impacts of land use on stormwater runoff quality and Best Management Practices to mitigate these impacts have been investigated since the 1970s, yet challenges remain in providing a modeling approach that concomitantly considers contributions from different land use types. In densely developed urban areas, a buildup/washoff approach is often applied, while in rural areas, some type of erosion modeling is employed, as the processes of detachment, entrainment, and transport are fundamentally different. This study presents a coupled modeling approach within PCSWMM, integrating exponential buildup/washoff for impervious surfaces with the Modified Universal Soil Loss Equation (MUSLE) for pervious areas, including construction sites, to characterize water quality in the large mixed urban–rural Sparrovale catchment in Geelong, Australia. The watershed includes an innovative cascading system of 12 online NbS wetlands along one of the main tributaries, Armstrong Creek, to manage runoff quantity and quality, as well as 16 offline NbS wetlands that are tributary to the online system. A total of 78 samples for Total Suspended Solids (TSS), Total Phosphorus (TP), and Total Nitrogen (TN) were collected from six monitoring sites along Armstrong Creek during wet- and dry-weather events between May and July 2024 for model validation. The data were supplemented with six other catchment stormwater quality datasets collected during earlier studies, which provided an understanding of water quality status for the broader Geelong region. Results showed that average nutrient concentrations across all the sites ranged from 0.44 to 2.66 mg/L for TP and 0.69 to 5.7 mg/L for TN, spanning from within to above the ecological threshold ranges for eutrophication risk (TP: 0.042 to 1 mg/L, TN: 0.3 to 1.5 mg/L). In the study catchment, upstream wetlands reduced pollutant levels; however, downstream wetlands that received runoff from agriculture, residential areas, and, importantly, construction sites, showed a substantial increase in sediment and nutrient concentration. Water quality modeling revealed washoff parameters primarily influenced concentrations from established urban neighborhoods, whereas erosion parameters substantially impacted total pollutant loads for the larger system, demonstrating the importance of integrated modeling for capturing pollutant dynamics in heterogeneous, urbanizing catchments. The study results emphasize the need for spatially targeted management strategies to improve stormwater runoff quality and also show the potential for cascading wetlands to be an important element of the Nature-based Solution (NbS) runoff management system. Full article

Chronic diseases disproportionately impact Indigenous peoples in Australia, with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) representing leading causes of morbidity and mortality. Despite evidence supporting community-based exercise interventions for T2DM management, no culturally adapted programs utilizing wearable technology have been co-designed specifically with Indigenous Australian communities. This study protocol aims to determine if wearable-based exercise interventions can effectively prevent CVD development and manage T2DM progression in Indigenous Australians through culturally safe, community-led approaches. The PrIDE study protocol describes a mixed-methods translational research design incorporating Indigenous and Western methodologies across three phases: (1) co-designing culturally adapted exercise programs and assessment tools, (2) implementing interventions with wearable monitoring, and (3) conducting evaluation and scale-up assessment. Sixty-four Indigenous Australian adults with T2DM will be recruited across remote, rural/regional sites to self-select into either individual or group exercise programs using the Withings ScanWatch 2. Primary outcomes include cardiovascular risk factors, physical fitness, and health self-efficacy measured using culturally adapted tools. Indigenous governance structures will ensure cultural safety and community ownership throughout. The PrIDE protocol presents a novel approach to improving health equity while advancing understanding of wearable technology integration in Indigenous healthcare, informing future larger-scale trials and policy development. Full article

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities. Full article

Background: Clinical Learning Environments (CLEs) are essential to nursing education as a platform for students to develop professional identity; consolidate knowledge with clinical practice; and to gain cognitive, communication, and psychomotor skills. Experience in CLEs significantly impacts nursing students’ satisfaction with education and graduate career preferences. The Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T) is widely used to measure the quality of professional experience placements (PEPs), but it has limited evidence of psychometric performance in rural and regional Australian contexts. Aim: To assess the psychometric properties of the CLES+T scale in the Australian context of rural and regional undergraduate nursing PEPs. Methods: A cross-sectional observational study of a convenience sample of 165 undergraduate nursing students from regional Victoria, Australia, who undertook PEPs between January and June 2020. Participants completed the CLES+T scale post-PEP. Statistical analyses included a test of survey tool reliability using Cronbach’s alpha and exploratory factor analysis to investigate instrument dimensionality and validity. Results: The CLES+T scale displayed adequate validity and reliability levels and demonstrated internal consistency similar to previous studies. The most important factor in the CLE was revealed as “pedagogy atmosphere and the content of supervisory relationship” followed by “role of the nurse educator”. Conclusions: The CLES+T shows adequate psychometric properties as a valid tool for use with undergraduate nursing students undertaking PEPs in Australian regional, rural, and remote settings. Full article

Household waste systems are a frontline test of Australia’s circular economy transition, yet progress remains highly uneven and structurally constrained. Despite strong national targets for resource recovery and emissions reduction, local governments are expected to deliver circular outcomes without uniform access to infrastructure, funding, or technical capability. This study assesses the status, implementation, and progress of household waste management, energy recovery, and circular economy initiatives at the local government level in Australia. Using content analysis of data from 520 local government areas across six states, the study maps differences in service provision (e.g., general waste, mixed recycling, and food organics and garden organics [FOGO] collection), policy instruments, public-facing education, and participation in circular economy programs. The findings reveal that while a majority (92.5%) of councils provide general waste bins, 47% offer FOGO bins, and 78% supply mixed recyclable bins, only a small fraction (2.6%) offers a separate glass bin stream. Fewer than one in ten councils reference any form of energy recovery or waste-to-energy initiative, indicating that resource–energy integration remains emergent and geographically concentrated. Despite national policies such as the National Waste Policy Action Plan, significant regional disparities persist, particularly between metropolitan and rural councils. Guided by environmental governance theory and systems thinking, the study shows how policy fragmentation, funding limitations, and infrastructure inequities create systemic barriers to circularity. The study concludes by recommending targeted co-funding for rural councils, stronger policy support for organics and energy recovery infrastructure, and more coherent multi-level governance to achieve Australia’s 2030 waste and circular economy targets. This research contributes an evidence-based framework for understanding how governance structures and resource asymmetries shape local progress toward a circular economy. Full article

The mental health of young adults is a widespread and growing concern in many communities, impacting social sustainability. At the same time, there is growing evidence of the value that nature can provide towards improving health and wellbeing. However, there is little research on the scale of the monetized value of relevant wellbeing benefits from nature exposure. Nature prescribing draws on the growing base of evidence about nature and its health and wellbeing connections, with medical practitioners and/or allied health workers providing a prescription to selected patients to participate in a program that offers interventions intended to improve participant health and/or wellbeing, using a nature setting. This paper is the first to undertake a cost–benefit analysis of nature prescribing, involving a program aimed to improve the wellbeing of young adults with mild to moderate mental illness in regional/rural Victoria, Australia. The evaluation demonstrates that a curated, group-based nature exposure program can yield significant improvement in levels of life satisfaction and mental health in this cohort. Paired sample comparisons and multiple regression analyses suggest that the program produced an increase in mean participant life satisfaction scores of ~0.7 units, measured using Personal Wellbeing Index scores. A project benefit–cost ratio of over four resulted from this. Mental health, as measured by Kessler scale scores, also showed solid improvement, and loneliness was reduced. The unique contributions of nature and of the group-based delivery mode to the measured benefits were not identifiable but the combined effect was evident, improving participants’ likelihood of social inclusion, a major social sustainability goal. Furthermore, the solid program benefit–cost ratios indicate an economically sustainable program, which uses an environmental platform (nature) for its delivery. This links all three triple bottom line sustainability outcomes to this program. Topping up group-based nature exposure, after completion of the six-session, two-hours-per-session program, was important for many participants to sustain benefit levels. Participants emphasized the importance of the program being delivered by trained professionals. Achieving involvement of a suitably sized project comparison or control group through the 8-month program evaluation period to follow-up proved challenging, which somewhat weakens the power of the evaluation findings. Full article

In the context of increasing climate variability and flood risk, this study explores how long-standing agricultural practices in the Hunter Valley, New South Wales, Australia, have fostered flood resilience through the integration of local agro-environmental knowledge and geomorphologic conditions. Employing a morpho-typological framework, the research identifies three flood adaptation landscape types (FALTs)—rolling hills, foot slopes, and flood plains—each reflecting distinct interactions between landform, soil, biodiversity, hydrology, and viticultural management. Through geospatial analysis, field surveys, and interviews with local farmers, the study reveals how adaptive strategies—ranging from flood avoidance to attenuation and acceptance—have evolved in response to site-specific hydrological and ecologic dynamics. These strategies demonstrate a form of ‘sponge landscape’ design, where agricultural systems are co-shaped with natural processes to enhance systemic resilience and long-term productivity. The findings underscore the value of preserving biocultural legacies and suggest that spatially explicit, context-based approaches to flood adaptation can inform sustainable landscape planning and climate resilience strategies in other rural regions. The FALT framework offers a replicable methodology for identifying flood adaptation patterns across diverse agricultural systems in Australia, supporting proactive land use planning and nature-based solutions. This research contributes to the discourse on climate adaptation by bridging traditional environmental knowledge with contemporary planning frameworks, offering practical insights for policy, landscape management, and rural development. Full article

Streptococcus pharyngitis (strep throat) poses a significant health challenge in rural and remote Indigenous communities in Australia, where access to medical resources is limited. Delays in diagnosis and treatment increase the risk of serious complications, including acute rheumatic fever and rheumatic heart disease. This paper presents a proof-of-concept AI-based diagnostic model designed to support clinicians in underserved communities. The model combines a lightweight Swin Transformer–based image classifier with a BLIP-2-based explainable image annotation system. The classifier predicts strep throat from throat images, while the explainable model enhances transparency by identifying key clinical features such as tonsillar swelling, erythema, and exudate, with synthetic labels generated using GPT-4o-mini. The classifier achieves 97.1% accuracy and an ROC-AUC of 0.993, with an inference time of 13.8 ms and a model size of 28 million parameters; these results demonstrate suitability for deployment in resource-constrained settings. As a proof-of-concept, this work illustrates the potential of AI-assisted diagnostics to improve healthcare access and could benefit similar research efforts that support clinical decision-making in remote and underserved regions. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

Consumer-accessible and user-friendly smart products such as unmanned aerial vehicles (UAVs), or drones, have become widely used, adaptable, and acceptable devices to observe, assess, measure, and explore urban and natural environments. A drone’s relatively low cost and flexibility in the level of expertise required to operate it has enabled users from novice to industry professionals to adapt a malleable technology to various disciplines. This review examines the academic literature and maps how drones are currently being used in 93 rural and regional city councils in New South Wales, Australia. Through a systematic review of the academic literature and scrutiny of current drone use in these councils using publicly available information found on council websites, findings reveal potential uses of drone technology for local governments who want to engage with smart technology devices. We looked at how drones were being used in the management of the council’s environment; health and safety initiatives; infrastructure; planning; social and community programmes; and waste and recycling. These findings suggest that drone technology is increasingly being utilised in rural and regional areas. While the focus is on rural and regional New South Wales, a review of the academic literature and local council websites provides a snapshot of drone use examples that holds global relevance for local councils in urban and remote areas seeking to incorporate drone technology into their daily practice of city, town, or region governance. Full article

In alignment with global educational trends, Australia has adopted a pluralistic approach to initial teacher education (ITE), encompassing traditional university-based programs, employment-integrated models and vocational training routes. This diversification of pathways has emerged as a strategic response to persistent workforce challenges, including chronic shortages, uneven distribution of qualified educators, and limited demographic diversity within the profession. Rather than supplanting conventional ITE models, these alternative pathways serve as complementary options, broadening access and enhancing system responsiveness to evolving societal and educational needs. The rise in non-traditional routes represents a deliberate response to the well-documented global teacher shortage, frequently examined in comparative educational research. Central to their design is a restructuring of traditional program elements, particularly duration and delivery methods, to facilitate more flexible and context-sensitive forms of teacher preparation. Such approaches often create opportunities for individuals who may be excluded from conventional pathways due to socioeconomic constraints, geographic isolation, or non-linear career trajectories. Significantly, the diversity introduced by alternative entry candidates has the potential to enrich school learning environments. These educators often bring a wide range of prior experiences, disciplinary knowledge, and cultural perspectives, contributing to more inclusive and representative teaching practices. The implications for student learning are substantial, particularly in disadvantaged communities where culturally and professionally diverse teachers may enhance engagement and academic outcomes. From a policy perspective, the development of flexible, multifaceted teacher education pathways constitutes a critical component of a sustainable workforce strategy. As demand for qualified teachers intensifies, especially in STEM disciplines and in rural, regional and remote areas, the role of alternative pathways is likely to become increasingly pivotal in achieving broader goals of equity, quality and innovation in teacher preparation. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

The Australian Royal Commission into Aged Care Quality and Safety has highlighted the chronic shortages of labour to provide care for those aged 65 and over in rural and remote areas of Australia. This descriptive cross-sectional study compares the availability of care provision in metropolitan regions with that in rural and remote regions. We analysed the 2021 Australian Census, grouped according to Aged-Care-Planning Region (ACPR), and investigated the numbers of people aged 65 years and over with different levels of care need, both in residential care and in-home. The available workforce in each ACPR was also examined in detail, using occupational classifications reported in the Census, and shortages of doctors, nurses, allied health and other care workers were identified. Overall, an additional 492,416 care hours were needed per week (or 12,958 full-time equivalent (FTE) care workers) in order to bring remote community ACPRs to parity with provision in metropolitan ACPRs. A further 95,342 FTE workers were needed in rural ACPRs to bring these areas to parity with metropolitan ACPRs. Our findings underscore the ongoing disparities in aged care workforce availability between metropolitan, rural, and remote regions of Australia. Addressing these workforce shortages is crucial to ensuring equitable access to care for older Australians, regardless of their geographical location. The implementation of targeted strategies to enhance workforce recruitment, retention, and training in these underserved areas is essential to bridge the gap and improve the quality of care provided to older adults in rural and remote communities. Such strategies could include targeted recruitment campaigns and incentives for professionals to relocate; further capacity for clinical placements and supervision in rural areas; tailoring funding and employment models for rural needs; and strengthening vocational education in regional areas. Full article

Enhancing community resilience has become increasingly important in preparing for, responding to, and recovering from disaster events. Determining how levels of community resilience vary across a local government area provides nuanced information from which targeted programs and initiatives can be developed, implemented, and evaluated. This study applies the Gympie Regional Community Resilience Metric (GCRM), developed with a local government organisation, and a community disaster sub-group in rural Queensland, Australia, and applies it to a larger, coastal region of Bundaberg, Queensland. Completed survey results returned by 696 households from across the region revealed that the Bundaberg community is generally well-prepared for disasters, with strong social networks and understanding of local risks. However, there are areas for improvement, such as increasing participation in local clubs and addressing the needs of those lacking confidence in obtaining help during disasters. Other findings indicate that the evidence of high levels of local knowledge and disaster experience within the community could provide opportunities to establish neighbourhood networks that aim to share local knowledge and experiences and enhance localised networks of support, particularly for more vulnerable and newer residents. Full article

Background: The Bayesian mapping approach has not been used to identify head and neck cancer hotspots in Australia previously. This study aims to identify rural communities at risk of head and neck cancer (HNC) for targeted prevention programs. Methods: This study included data from 23,853 cases recorded in the Queensland Cancer Register between 1982 and 2018. Outcomes for mapping included incidence, overall mortality, 3-year mortality, and 5-year mortality. Local government areas (LGAs) with a general population aged 15 years and above (according to 2016 census data from the Australian Bureau of Statistics) were utilized for mapping. Results: Of the 59 LGAs with higher-than-average risk, 22 predominantly rural and remote LGAs showed statistically significant higher risks of head and neck cancer occurrence. Estimated median standardized mortality ratios (SMRs) ranged from 0.57 to 3.44 and were higher than the state average in 38 LGAs. Four LGAs had the highest mortality—the Shires of Quilpie, Yarrabah, Murweh, and Hinchinbrook. Conclusions: Whilst reasons for some LGAs exhibiting higher HNC are unknown, Bayesian mapping highlights these rural and remote regions as worthy of further investigation. In conclusion, the Bayesian disease mapping approach is effective in identifying high-risk communities for HNC. Findings from this study will aid in designing targeted screening and interventions for the prevention and management of head and neck cancer in regional and remote communities through support services such as a cancer navigator. Full article