The role of governance in Indigenous medical education research.

CONTEXT: This article considers the role of governance in Indigenous medical education research through the lens of an Australian Aboriginal research project titled Healing Conversations. The Healing Conversations project is developing and testing a targeted educational framework for improved clinical communication between healthcare practitioners and Australian Aboriginal peoples in regional and urban locations. It is proposed that an effective governance approach can support Indigenous and non-Indigenous stakeholders to work together in decision-making structures to enable outcomes that promote and prioritise Indigenous worldviews and values in medical education research. ISSUE: The case study explored here puts forth the notion of effective governance as one practical way to decolonise medical education research structures in both the urban and regional setting. The importance of relationships between Indigenous and non-Indigenous stakeholders is supported in tailored governance structures, as knowledge translation efforts are situated in mainstream tertiary education structures that hold collective responsibility and accountability for change in this space. LESSONS LEARNT: Reflections from the Healing Conversations research case study are outlined for future consideration regarding sustainable and effective Indigenous governance initiatives in medical education and research structures. This includes the importance of an Indigenous governance structure within the research team and a strong understanding of the roles and contributions of each research team member, along with the required humanistic qualities to action effective governance in Indigenous medical education research. Collaborative governance structures are fundamental as the inclusion and prioritisation of Indigenous worldviews and values is a key step in redressing Indigenous healthcare disparities and providing culturally safe healthcare institutions.

Cascade Reactions in Nanozymes: Spatially Separated Active Sites inside Ag-Core-Porous-Cu-Shell Nanoparticles for Multistep Carbon Dioxide Reduction to Higher Organic Molecules.

Enzymes can perform complex multistep cascade reactions by linking multiple distinct catalytic sites via substrate channeling. We mimic this feature in a generalized approach with an electrocatalytic nanoparticle for the carbon dioxide reduction reaction comprising a Ag core surrounded by a porous Cu shell, providing different active sites in nanoconfined volumes. The architecture of the nanozyme provides the basis for a cascade reaction, which promotes C-C coupling reactions. The first step occurs on the Ag core, and the subsequent steps on the porous copper shell, where a sufficiently high CO concentration due to the nanoconfinement facilitates C-C bond formation. The architecture yields the formation of n-propanol and propionaldehyde at potentials as low as -0.6 V vs RHE.

Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld - developing a pilot study.

Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. 'Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy' aims to address the prevalence of smoking during pregnancy by enhancing health providers' training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the 'ICAN QUIT in Pregnancy' project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.

Identification of Aboriginal and Torres Strait Islander status by general practice registrars: Confidence and associations.

BACKGROUND: Identification of Aboriginal and Torres Strait Islander status in healthcare settings is essential for the delivery of culturally appropriate care. Under-identification is common and practitioner confidence is a known barrier. OBJECTIVE: The objective of this research was to document the self-reported confidence of general practice registrars in identifying the Aboriginal and Torres Strait Islander status of their patients, and associations of this confidence. METHODS: This research used cross-sectional analysis of survey and patient encounter data of general practice registrars training across five Australian states. RESULTS: Of the 698 registrars (97.5% response rate) who participated in the study, 74.5% had a high level of confidence in identifying a patient's Aboriginal and Torres Strait Islander status. Older and more senior registrars had significantly greater confidence. There was also a significant association with the registrars' training provider. DISCUSSION: More than a quarter of registrars reported low confidence for this basic consultation skill. Our findings will inform general prac-tice vocational training and continuing professional development, and reinforce the importance of a comprehensive, system-wide approach to the identification of patients' Aboriginal or Torres Strait Islander status.

Nanoconfinement Allows a Less Active Cascade Catalyst to Produce More C2+ Products in Electrochemical CO2 Reduction.

Enzymes with multiple distinct active sites linked by substrate channels combined with control over the solution environment near the active sites enable the formation of complex products from simple reactants via the confinement of intermediates. We mimic this concept to facilitate the electrochemical carbon dioxide reduction reaction using nanoparticles with a core that produces intermediate CO at different rates and a porous copper shell. CO2 reacts at the core to produce CO which then diffuses through the Cu to give higher order hydrocarbon molecules. By altering the rate of CO2 delivery, the activity of the CO producing site, and the applied potential, we show that the nanoparticle with lower activity for CO formation produces greater amounts of hydrocarbon products. This is attributed to a combination of higher local pH and the lower amount of CO, resulting in more stable nanoparticles. However, when lower amounts of CO2 were delivered to the core, the particles that are more active for CO formation produce more C3 products. The importance of these results is twofold. They show that in cascade reactions, more active intermediate producing catalysts do not necessarily give greater amounts of high-value products. The effect an intermediate producing active site has on the local solution environment around the secondary active site plays an important role. As the less active catalyst for producing CO also possesses greater stability, we show that nanoconfinement can be used to get the best of both worlds with regard to having a stable catalyst with high activity.

Murru Minya-informing the development of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research: a protocol for a national mixed-methods study.

INTRODUCTION: Conducting ethical and high-quality health research is crucial for informing public health policy and service delivery to reduce the high and inequitable burden of disease experienced by Aboriginal and Torres Strait Islander people. Ethical guidelines and principles specifically for health research with Aboriginal and Torres Strait Islander people have been developed for use since 1987. However, there has been limited examination of how these are being applied to the conduct of research. METHODS AND ANALYSIS: Murru Minya will be a large-scale national study to examine the implementation of ethical processes in Aboriginal and Torres Strait Islander health research. A mixed-methods design will be used in four baarra (steps). The first three baarra will collect knowledge, experiences and wisdom from three key groups: Aboriginal and Torres Strait Islander communities, research academics, and Human Research Ethics Committees using online surveys, yarning, and semistructured interviews. This knowledge will inform the final baarra of developing a set of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research into the future. ETHICS AND DISSEMINATION: Ethical approval for this research project has been granted by National, State and Territory Human Research Ethics Committees. This research has been developed in collaboration with Aboriginal and Torres Strait Islander researchers, Aboriginal Community Controlled Health Organisation representatives, Aboriginal community members, the National Health Leadership Forum, and Aboriginal and Torres Strait Islander research team. The knowledge translation plan will be integrated and revised throughout the project as partnerships and engagement with Aboriginal and Torres Strait Islander communities continue. All findings will be shared with peak Aboriginal research bodies and Aboriginal and Torres Strait Islander communities in ways that are meaningful to them.

Feasibility of Silicon Quantum Dots as a Biomarker for the Bioimaging of Tear Film.

This study investigated the fluorescence and biocompatibility of hydrophilic silicon quantum dots (SiQDs) that are doped with scandium (Sc-SiQDs), copper (Cu-SiQDs), and zinc (Zn-SiQDs), indicating their feasibility for the bioimaging of tear film. SiQDs were investigated for fluorescence emission by the in vitro imaging of artificial tears (TheraTears®), using an optical imaging system. A trypan blue exclusion test and MTT assay were used to evaluate the cytotoxicity of SiQDs to cultured human corneal epithelial cells. No difference was observed between the fluorescence emission of Sc-SiQDs and Cu-SiQDs at any concentration. On average, SiQDs showed stable fluorescence, while Sc-SiQDs and Cu-SiQDs showed brighter fluorescence emissions than Zn-SiQDs. Cu-SiQDs and Sc-SiQDs showed a broader safe concentration range than Zn-SiQDs. Cu-SiQDs and Zn-SiQDs tend to aggregate more substantially in TheraTears® than Sc-SiQDs. This study elucidates the feasibility of hydrophilic Sc-SiQDs in studying the tear film's aqueous layer.

Koori Quit Pack mailout smoking cessation support for Aboriginal and Torres Strait Islander people who smoke: a feasibility study protocol.

INTRODUCTION: Smoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples. METHODS AND ANALYSIS: An Aboriginal-led, multisite non-randomised single-group, pre-post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation. TRIAL REGISTRATION NUMBER: ACTRN12622000654752.

Our doctors making a difference.

Aboriginal and Torres Strait Islander doctors walking in both worlds for the benefit of all Australians.

Building an Indigenous-Led Evidence Base for Smoking Cessation Care among Aboriginal and Torres Strait Islander Women during Pregnancy and Beyond: Research Protocol for the Which Way? Project.

Strong and healthy futures for Aboriginal and Torres Strait Islander people requires engagement in meaningful decision making which is supported by evidence-based approaches. While a significant number of research publications state the research is co-designed, few describe the research process in relation to Indigenous ethical values. Improving the health and wellbeing of Aboriginal and Torres Strait Islander mothers and babies is crucial to the continuation of the oldest living culture in the world. Developing meaningful supports to empower Aboriginal and Torres Strait Islander mothers to quit smoking during pregnancy is paramount to addressing a range of health and wellbeing outcomes. Aboriginal and Torres Strait Islander women have called for non-pharmacological approaches to smoking cessation during pregnancy. We describe a culturally responsive research protocol that has been co-designed and is co-owned with urban and regional Aboriginal communities in New South Wales. The project has been developed in line with the AH&MRC's (Aboriginal Health & Medical Research Council) updated guidelines for ethical research with Aboriginal and Torres Strait Islander communities. Ethics approvals have been granted by AH&MRC #14541662 University of Newcastle HREC H-2020-0092 and the Local Health District ethics committee 2020/ETH02095. Results will be disseminated through peer reviewed articles, community reports, infographics, and online social media content.

Combining Nanoconfinement in Ag Core/Porous Cu Shell Nanoparticles with Gas Diffusion Electrodes for Improved Electrocatalytic Carbon Dioxide Reduction.

Bimetallic silver-copper electrocatalysts are promising materials for electrochemical CO2 reduction reaction (CO2RR) to fuels and multi-carbon molecules. Here, we combine Ag core/porous Cu shell particles, which entrap reaction intermediates and thus facilitate the formation of C2+ products at low overpotentials, with gas diffusion electrodes (GDE). Mass transport plays a crucial role in the product selectivity in CO2RR. Conventional H-cell configurations suffer from limited CO2 diffusion to the reaction zone, thus decreasing the rate of the CO2RR. In contrast, in the case of GDE-based cells, the CO2RR takes place under enhanced mass transport conditions. Hence, investigation of the Ag core/porous Cu shell particles at the same potentials under different mass transport regimes reveals: (i) a variation of product distribution including C3 products, and (ii) a significant change in the local OH- activity under operation.

Is Cu instability during the CO2 reduction reaction governed by the applied potential or the local CO concentration?

Cu-based catalysts have shown structural instability during the electrochemical CO2 reduction reaction (CO2RR). However, studies on monometallic Cu catalysts do not allow a nuanced differentiation between the contribution of the applied potential and the local concentration of CO as the reaction intermediate since both are inevitably linked. We first use bimetallic Ag-core/porous Cu-shell nanoparticles, which utilise nanoconfinement to generate high local CO concentrations at the Ag core at potentials at which the Cu shell is still inactive for the CO2RR. Using operando liquid cell TEM in combination with ex situ TEM, we can unequivocally confirm that the local CO concentration is the main source for the Cu instability. The local CO concentration is then modulated by replacing the Ag-core with a Pd-core which further confirms the role of high local CO concentrations. Product quantification during CO2RR reveals an inherent trade-off between stability, selectivity and activity in both systems.

Protease sensing using nontoxic silicon quantum dots.

Herein is presented a proof-of-concept study of protease sensing that combines nontoxic silicon quantum dots (SiQDs) with Förster resonance energy transfer (FRET). The SiQDs serve as the donor and an organic dye as the acceptor. The dye is covalently attached to the SiQDs using a peptide linker. Enzymatic cleavage of the peptide leads to changes in FRET efficiency. The combination of interfacial design and optical imaging presented in this work opens opportunities for use of nontoxic SiQDs relevant to intracellular sensing and imaging.

Clinical encounters of Australian general practice registrars with Aboriginal and Torres Strait Islander patients.

OBJECTIVE: General practice is central to Aboriginal and Torres Strait Islander health care, and this area is a core element of Australian general practice (GP) training. We aimed to describe the prevalence, nature and associations of GP registrar encounters with Aboriginal and Torres Strait Islander patients. METHODS: A cross-sectional analysis from a cohort study of GP registrars' clinical consultations 2010-2013. Registrars record demographic, clinical and educational details of consecutive patient encounters. Multivariable associations were tested with logistic regression. RESULTS: A total of 592 registrars contributed data from 69,188 consultations. Encounters with Aboriginal and Torres Strait Islander patients comprised 1.0% of consultations. Significant positive associations included younger patient age; new patient to the registrar; lower socioeconomic status of practice location; non-urban practice setting; more problems managed; and follow-up arranged. A greater proportion of Aboriginal and Torres Strait Islander patients' problems were psychological/social and a lesser proportion were cardiovascular. Consultation duration did not differ between the two groups Conclusions: GP registrars encounter Aboriginal and Torres Strait Islander patients less than do established GPs. Our results suggest possible variability in registrar experience of Aboriginal and Torres Strait Islander health. IMPLICATIONS: Our findings will inform training of a culturally and clinically competent workforce in this area.

The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross-sectional study.

OBJECTIVES: To document the frequency of recording of Aboriginal and Torres Strait Islander status in general practice (GP) clinical records and to establish associations of this recording. METHODS: Cross-sectional analysis of recording of patients' Aboriginal and Torres Strait Islander status in GP clinical records from GP training practices in four Australian states. RESULTS: Of the 9,704 clinical records examined, the patients' Aboriginal and Torres Strait Islander status had been documented in 5,165 (53.2%). Higher rates of recording were associated with older patient age, practices outside a major city, patients who were not new to the practice and the patient being Aboriginal and Torres Strait Islander. In encounters with Aboriginal and Torres Strait Islander patients, the patient's status had been documented in 82% of records. Those attending larger practices were less likely to have had their status recorded. CONCLUSIONS: This is the first report of Aboriginal and Torres Strait Islander status recording in GP clinical records. Almost 20% of Aboriginal and Torres Strait Islander patients did not have their status recorded in the clinical record, with indications that recording may be unsystematic. IMPLICATIONS: Our findings reinforce the need for a systematic approach to identification of Aboriginal and Torres Strait Islander status in general practice and will inform policy and practice in this important area.