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- Hill, Rosemary, et al.
(author)
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Knowledge co-production for Indigenous adaptation pathways : Transform post-colonial articulation complexes to empower local decision-making
- 2020
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In: Global Environmental Change. - : Elsevier BV. - 0959-3780 .- 1872-9495. ; 65
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Journal article (peer-reviewed)abstract
- Co-production between scientific and Indigenous knowledge has been identified as useful to generating adaptation pathways with Indigenous peoples, who are attached to their traditional lands and thus highly exposed to the impacts of climate change. However, ignoring the complex and contested histories of nation-state colonisation can result in naïve adaptation plans that increase vulnerability. Here, through a case study in central Australia, we investigate the conditions under which co-production between scientific and Indigenous knowledge can support climate change adaptation pathways among place-attached Indigenous communities. A research team including scientists, Ltyentye Apurte Rangers and other staff from the Central Land Council first undertook activities to co-produce climate change presentations in the local Arrernte language; enable community members to identify potential adaptation actions; and implement one action, erosion control. Second, we reflected on the outcomes of these activities in order to unpack deeper influences. Applying the theory of articulation complexes, we show how ideologies, institutions and economies have linked Indigenous societies and the establishing Australian nation-state since colonisation. The sequence of complexes characterised as frontier, mission, pastoral, land-rights, community-development and re-centralisation, which is current, have both enabled and constrained adaptation options. We found knowledge co-production generates adaptation pathways when: (1) effective methods for knowledge co-production are used, based on deeply respectful partnerships, cultural governance and working together through five co-production tasks—prepare, communicate, discuss, bring together and apply; (2) Indigenous people have ongoing connection to their traditional territories to maintain their Indigenous knowledge; (3) the relationship between the Indigenous people and the nation-state empowers local decision-making and learning, which requires and creates consent, trust, accountability, reciprocity, and resurgence of Indigenous culture, knowledge and practices. These conditions foster the emergence of articulation complexes that enable the necessary transformative change from the colonial legacies. Both these conditions and our approach are likely to be relevant for place-attached Indigenous peoples across the globe in generating climate adaptation pathways.
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| 2. |
- Moloney, Kristen, et al.
(author)
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Development of a surgical competency assessment tool for sentinel lymph node dissection by minimally invasive surgery for endometrial cancer
- 2021
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In: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 31:5, s. 647-655
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Journal article (peer-reviewed)abstract
- Sentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance. A Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability. Seventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach α=0.88). Specific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care.
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