Minerva Elements Records
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ItemFrom fact to fiction: a reflexive analysis of how screenwriter and subject intersect in the transformative process of authoring a modern biopic( 2019)The choice to work within the fictional frame of the biopic genre gives the screenwriter powerful representational tools to vivify character. But the tension between historical fidelity, and narrative fiction, raises important ethical questions. What responsibility does the marketing phrase, "based on a true story" place on the shoulders of the socially responsible screenwriter who is essentially writing a fiction? This practice-based enquiry responds to these questions by challenging the pervasive expectation that writers of historical and biographical fiction defend their truth claims on the methodological terms of the historian, and offers an alternative to a media studies proposal to cross-fertilise screenwriting practice with media ethics. By reframing the conversation away from empirical notions of historical fidelity, and consequentialist models of ethical evaluation, a significant methodological issue emerges, one that stems from a profound misconception of filmmaking practice that views the making of moving images as the non-reflexive application of mechanical skills. To counter this misconception, a working definition of filmmaking methodology is articulated, where mise-en-scene is shown to operate as a core reflexive strategy. This definition is intended to open up a conversation, and contribute to a better understanding of how filmmaking practice, of which screenwriting is a part, can generate and disseminate new knowledge in a range of forms and genres, including the biopic. Defining filmmaking as a creative practice also provides guidance to scholars, irrespective of discipline, who wish to engage with filmmaking as a rigorous methodological approach to conducting their own enquiries.
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ItemPerforming Credibility( 2018)Theatre practitioners have displayed an increasing interest in staging Refugee narratives, with approaches undertaking a number of methodologies. This thesis intends to look at a larger pattern of socio-political power relations, rather than a case by case analysis. The focus is on frame and thus primarily theoretical. Essentially this research looks at how Refugee theatre reproduces colonial terms of enunciation that restrict, limit, prescribe and demand how Refugees must perform to particular characters and narratives—both on and off stage. The research asserts that the performative demands of Refugee as a socio-political identity- exists before the theatrical site- extending to the performance demands of Refugee Theatre. I suggest that Refugee Theatre primarily relies on truth claims not because they are the most effective of all forms; but because it remains problematically tied to expectations to prove truth, authenticity and innocence. Refugee is continually asked to speak to these, as a Performance of Credibility. This has severe implications who gets seen and how they get seen. I argue that Performing Credibility is silencing rather than self determining. Thus it argues that that Refugee theatre as Performances of Credibility, function as an extension of the geospatial border in that they are just as oppressive, violent and silencing in its performative demands. The thesis offers two performative interventions that frame ‘Refugeeness’ in ways that resist these colonial narratives, as a form of anti-Performing Credibility dramaturgy. Drawing upon Latin American decolonial scholarship, the thesis argues for a conception of Refugeeness as ongoing and navigational, displacing borders and evading nationalist frameworks. The thesis explores how Refugeeness might be a useful re-frame to ensure Refugee challenges borders, rather than be assaulted within them; Refugeeness as a generative, creative site towards re-emergence and a step away from the burden of continuously Performing Credibility.
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ItemThe significance of the child’s voice in child death inquiries( 2019)International agreements on human rights declare that all children should have the opportunity to express their views on their lives and experiences. When it comes to children who are involved with child protection services, however, research from a number of countries suggests that their perspectives are rarely represented. In Australia, each year, around 3% of children are involved with child protection services because of concerns about their safety and well-being. I wanted to understand how professionals in Victoria represent the voices of children subject to child protection services. With child protection services files not accessible for privacy reasons, to pursue my research question I used the reports of 14 child death inquiries conducted by Victoria’s Commission for Children and Young People. The Commission for Children and Young People is mandated, under particular circumstances, to inquire into the deaths of children who were child protection services’ clients at the time of death or within 12 months of their death. These inquiries examine the services provided to the child and his/her family, prior to the child’s death. The children’s deaths that I explored occurred over a decade from 1 January 2005. In all 14 cases, the child died in adolescence, having been subject to a report to child protection services before the age of three. I asked how did professionals who came into contact with the 14 children describe and document the child’s voice and experience? I asked what these children said, literally or metaphorically, about their lives, experiences, and their feelings. Using a conceptual framework of child development and attachment theory, my methodological approach was content and discourse analysis of documentary texts produced by the Commission. Seen through the lens of Commission for Children and Young People inquiries, my research shows that child protection service documentation in Victoria, at best, minimises and, at worst, completely excludes the perspectives of children, particularly very young children. These results mirror child protection services practice internationally. I hypothesise why this silencing of children’s voices occurs in Victoria’s child protection service files. I outline a new approach to listening to children’s voices and experiences, and a new mechanism to document those voices in child protection service files. Called the Child’s Life Biography Tool, this instrument is intended to be a means of valuing and protecting the child, fulfilling the child’s human rights, while also meeting legislation, policy and practice requirements.
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ItemThe Nature and Severity of Central Nervous System Dysfunction after Concussion in Contact Sport( 2019)Introduction. Traumatic brain injuries, including sports-related concussions, are a major public health concern. Although participation in sport brings with it many benefits, the potential risk of sustaining adverse injuries such as sports-related concussion is an escalating societal and ethical issue. The onset of short-lived impairment of central nervous system dysfunction in concussed athletes following a sport-related concussion can lead to complications if the condition is not recognised and removed from participation in sport in a timely manner. Rationale and Study aims. This series of studies aim to understand the nature and magnitude of head biomechanics, short-lived impairment of central nervous system (CNS) function, and clinical signs and symptoms associated with concussions and repetitive head impacts. More specifically, it is hypothesised that (i) the biomechanics of repetitive head impacts in amateur boxers, (ii) endorsement of symptoms, and performance on cognition and balance component scores immediately post-contest and, (iii) a decline in function on the King-Devick test, will be worse for boxers clinically classified with a concussion, be associated with high-risk for CNS injury circumstances, and be reflective of exposure to repetitive head impacts through exposure to repeat contests in the tournament. Method. Healthy male collegiate students (n = 376) between the ages of 18-34 years (M = 20.97, SD = 2.30) consented to participate in the Notre Dame Bengal Bouts amateur boxing tournament in 2012 and/or 2013. Boxers completed the Sports Concussion Assessment tool, Cogstate Brief Battery, and the King-Devick test prior to participation in any sparring and following each of the four elimination contests. A sample of boxers were also instrumented with X2 Biosystems headbands to monitor exposure to impacts during contests. Results. The results of this study support the hypothesis that in amateur boxers the number of head impacts, and the acceleration of those impacts are associated with the progress through the tournament, outcome of bouts, weight class, and concussion. However, there were no systematic differences in the number or magnitude of impacts between concussed and non-concussed boxers, although average rotational forces did show potential for the classification of concussed boxers. Symptom, cognition, and balance scores did not systematically change with multiple assessments nor with repeat exposure to head blows further into the tournament, however, symptom component scores were sensitive to and worse for boxers classified on performance factors representative of high-risk for CNS injury, such as sustaining a concussion, receiving a standing eight-count, and losing a contest. The cognitive component was successful in identifying concussed boxers from non-concussed boxers. But there were no meaningful differences on the balance component clinically relevant to the assessment of concussion-related changes. The King-Devick test was largely not sensitive to concussion in the context of amateur boxing and unable to appropriately classify most concussed boxers. Conclusion. This study offers guidance on the measures which provide the best predictive power for the classification of central nervous system dysfunction following a sport-related concussion and adds to the literature on repetitive head impacts. Though innovative, further study of the biomechanics of concussive head injury, amateur boxers, and the use of screening tools are warranted.
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ItemWhen Choice of Forum clauses in international commercial contracts are challenged: key lessons from Asian jurisdictions( 2019)While Asia leads the world in cross-border trade and investments, no comparative study exists on the approaches of Asian courts to Choice-of-Forum clauses in international commercial contracts. This thesis fills this important gap by seeking to explore, identify, compare and explain the approaches of courts in Singapore, Hong Kong, Malaysia and the Philippines when Choice-of-Forum clauses in international commercial contracts are challenged. Employing a comparative law method, this thesis argues that the manner courts characterise Choice-of-Forum clauses, party autonomy, procedure, factors considered during enforcement, choice of law process, state and international interests are the factors which determine how courts decide cases and issues. The key lessons gathered in this thesis highlight the need for parties to consider the direct and indirect effects in drafting their Choice-of-Forum clauses, the need for courts to be predicable, reliable and coherent in their analysis, the importance of maintaining court discretion, the need for procedural and legislative reforms, and the existence of a conducive environment in Asia for strengthening laws on party autonomy and for the accession of Asian countries to the Choice-of-Court Convention.
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ItemScreening for Type 2 Diabetes Mellitus initiated through the dental setting: a cost-effectiveness analysis( 2019)Background. Diabetes Mellitus (DM) is the fastest growing chronic condition in Australia. Approximately, 30% of DM in Australia is undiagnosed. Early identification may delay or prevent the onset of DM with minimal complication. In the Western Pacific (WP) region, Australia has the highest per capita spending on DM. With the rising cost of healthcare, increasing emphasis is being made to ensure that health interventions are not only practical but also cost-effective that can save resources which otherwise may have to be spent on complication and hospital admission. By stretching the number of contact points between health care providers and individuals seeking care, there is plenty of opportunity for early identification of asymptomatic individuals with Type 2 Diabetes Mellitus (T2DM). With this link between DM and periodontal disease, dentists may have an unrealized opportunity to identify risk groups and refer them to physicians for further care. For any screening activity in the dental setting, the participation of Oral Health Professionals (OHP) is important. Little is known as to how well oral health professionals incorporate into practice on the evidence supporting the link between DM and periodontal disease. Besides that, no previous studies have reported the cost-effectiveness of opportunistic screening using a diabetes risk assessment tool in the dental setting. As such, the aim of the thesis is twofold. To explore the Victorian oral health professionals (OHP) knowledge, attitude and practice (KAP) around DM and to evaluate the overall economic justification of screening for diabetes and pre-diabetes in the dental setting. Methods. A cross-sectional survey of Victorian OHP was conducted. The questionnaire consisted of sociodemographic, practice characteristics and diabetes-related KAP. Descriptive statistics with frequencies and percentages were used to summarize the variables. A Mann-Whitney and Kruskal-Wallis test was performed to determine differences in OHP response to the KAP questions. The screening model consists of a decision tree and a disease progression Markov model to identify the risk of T2DM over a ten-year period. Literature data were used for the risk categorisation and disease transition for health states. The cost-effectiveness of screening was compared to no screening option. A hypothetical population of 40 to 74-year-old Victorian dental patients with no previous history of DM were screened with the Australian type 2 Diabetes Risk Assessment Tool (AUSDRISK). Those identified as high-risk follow-up with the physician for screen diagnosis using Fasting Plasma Glucose (FPG). Based on the previous finding from two-step screening in the dental setting the model made an assumption that 21.5% of the dental patient identified as high risk follow up with the physician. The cost-effectiveness was analysed from a societal perspective. The main outcome measure includes cost per case detected as undiagnosed T2DM, new cases of T2DM. A univariate sensitivity analysis was performed to determine the effect of different physician follow-up rate from the dental setting to identify undiagnosed T2DM. Results. The survey analysis included 197 OHP. General and specialist dentist constitute 65% and 11% of the response and the remainder were dental hygienist and therapist. Around 86% of the OHP showed adequate knowledge of DM. Further 93% and 81% of the OHP expressed positive attitude and practice behaviour towards T2DM screening and management. For OHP to perform chair-side screening for DM, 58% felt it was essential, and 70% felt it was appropriate. More female (67%) and public sector OHP (79%) felt it is important to conduct chair-side screening for T2DM. The majority (65.4%) of the OHP agreed on consent as the most important and insurance coverage as the least important (43%) consideration for T2DM screening. Under model assumption, the number of dental patients identified as undiagnosed T2DM and pre-diabetes were 4,108 (0.3%) and 10,072 (0.8%). The cost incurred for one new case of undiagnosed T2DM and pre-diabetes were AUD 15,508 and AUD 6,325. The Number Needed to Screen (NNS) to identify one new case of undiagnosed T2DM and pre-diabetes were 288 and 117. Among those followed up with the physician, at the end of five years, 81.5% had Normal Glucose Tolerance (NGT), 8.1% had Impaired Fasting Glucose (IFG), 6.9% had T2DM, and the all-cause mortality was 3.5%. At the end of the ten-year period, 10% had T2DM. The overall and disease-free survival was 92.8% and 82.8%. Discussion. Majority of OHPs had adequate knowledge and a positive attitude towards T2DM screening in the dental setting. The survey identified patient willingness as the most important consideration among the OHPs for implementing T2DM screening in the dental setting. The screening model identified several methodological challenges due to incongruent data and unsuitable comparator. Despite that, opportunistic screening with AUSDRISK was found to be neither clinically effective nor cost-effective compared to screening in the medical setting. High screening cost, poor predictive ability of AUSDRISK, low prevalence of the disease, unnecessary physician referral besides uncertain benefits, fear of over diagnosis and poor patient compliance makes screening for T2DM in the dental setting difficult to justify. The model findings are in line with previous estimates on AUSDSRISK as a screening tool. In financially constrained health system resource allocation will need to be based on favourable evidence that screening can reduce disease levels in the community, demonstrate health benefits at an acceptable cost. A two-step opportunistic screening that includes a risk assessment followed by a Point-of-Care (PoC) HbA1c may offer some benefits in the low- and middle-income countries.
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ItemClinical Data Linkage in Spinal Cord Injury( 2019)ABSTRACT Introduction This is the first Australian longitudinal retrospective study on the patients with traumatic Spinal Cord Injury (SCI), over a 14-year period, showing the trends of disease as well as health service utilization. This study involved linking Intensive Care Unit (ICU) datasets with Victorian Admitted Episodes Dataset (VAED) and Victorian Emergency Minimum Dataset (VEMD) from three major hospitals to work out determinants for disability, as well as co-morbidities. From the collected data, the study provides frameworks for chronic disease such as SCI and developed a prototype that can be used to bring the information together to be utilized by clinicians, patients and carers to improve health outcomes. Methods Health administrative datasets with the International Classification of Diseases, 10th revision, Australian Modification (ICD-10-AM) were used to conduct a pilot data linkage study using a unique identifier. A deterministic linkage method was used to link internal datasets from each of three major hospitals to build patient disease profiles and identify comorbidities. An extended Elixhauser comorbidity index (ECI) was used to study risk factors and comorbidities. Results The study identified a lack of coordination between clinical, administrative and statutory data custodians, and issues with coding quality. From the linked datasets from three major hospitals (Alfred Hospital, Royal Melbourne Hospital and Austin Hospital) data on almost 2,629 patients were extracted. The female: male ratio in this cohort was 1:2.9 and the largest proportion of patients was aged between 16 and 30 years. An increase in female admissions was apparent in the last decade. Sixty-six percent of readmissions were for patients from the Melbourne metropolitan area, with much lower proportions in the Gippsland and Hume regions. The three most frequent principal diagnoses were functional level of cervical spinal cord injury (C1-C8), concussion and oedema of thoracic spinal cord and concussion and oedema of cervical spinal cord. The main reasons for readmission were urinary tract infection (UTI), pressure ulcer, mental disorders and respiratory infections. The study of risk factors (alcohol, tobacco and illicit drugs) showed a significant association with overall length of stay in ICU and that males had twice the risk of death than females. Using the linked datasets as backend, a prototype of clinical decision support system (CDSS) was developed. This has scalability and can be improved with the latest technologies such as an ‘alert system’, as well as built-in artificial intelligence (AI) such as an Artificial Neural Network, which can assist clinicians, patients and carers. Conclusion This is the first longitudinal study of SCI, following the e-journey of patients with SCI over 14 years in three major hospitals in Victoria. The lack of coordination between clinical, administrative and statutory data custodians, and issues with coding quality have implications for resource allocation, decision making and planning by health administrators and clinicians. Although the total number of people with spinal cord injury is small, they have prolonged health utilization. This Clinical Data Linkage study has provided unique information about these patients, including the enormous number of readmissions, the reasons for readmission, the exact cost of care at the major Victorian hospitals rather than estimates, and the area of the residence of patients where ongoing care is needed. Ultimately, stratified patient profiles can be used as a backbone for eHealth and a as framework for clinical decision support systems that are known to support self-efficacy for patients with chronic conditions and to improve health outcomes. They may also be used to build a conceptual model for other chronic conditions that have a high number of medical interventions.
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ItemModelling the multistep pathogenesis of T-cell acute lymphoblastic leukaemia( 2019)T-cell acute lymphoblastic leukaemia (T-ALL) is an aggressive T-cell malignancy that is frequently caused by the overexpression of oncogenic transcription factors. Like many cancers, T-ALL is a heterogeneous disease, with the acquisition of many genetic alterations resulting in multiple clones that contribute to cancer progression. This poses a challenge for therapeutic intervention, as different clones within a tumour can possess different genetic signature and thus possess different levels of sensitivity to therapeutic strategies. Therefore, gaining a better understanding of how these clones arise, is crucial to developing more targeted therapies aimed at these cells. LMO2 is a transcription factor that is overexpressed in approximately 9% of T-ALL cases. The CD2-Lmo2 transgenic mouse model overexpress Lmo2 in the thymus, resulting in a developmental block at the DN3 stage of T-cell development, and subsequent development into T-ALL after a long latency (approximately 10 months). Using these mice, our laboratory has shown Lmo2 confers self-renewal capacity to these developmentally blocked DN3 thymocytes many months before the overt presentation of T-ALL. These self-renewing DN3 thymocytes were termed pre-CSCs due to their ability to self-renew, their capacity to still develop into mature functional T-cells, and not initiate leukaemia for many months when transplanted into recipient mice. This thesis will focus on gaining a better understanding of the multi-step pathogenesis of Lmo2 induced murine T-ALL development. In Chapter Three, we explore the role cellular competition for thymic niche space and signals plays in the Lmo2 induced T-cell developmental block, and Lmo2 induced T-ALL. Using competitive bone marrow transplantation experiments we show that the presence of WT thymic progenitors in the thymus severely hinders the development of Lmo2 transgenic thymic progenitors past the DN2 stage of T-cell development, and their subsequent development into T-ALL. Interestingly, we found that overexpression of Bcl2 in Lmo2 transgenic thymocytes severely abrogated the self-renewal capacity of Lmo2 transgenic thymocytes, and hindered their development into T-ALL. Furthermore, we show that Lmo2 downregulates Il7r in DN2 thymocytes. In Chapter Four, we crossed CD2-Lmo2 transgenic mice with CD2-Il7r transgenic mice to create the CD2-Lmo2;CD2-Il7r double-transgenic mouse line, to investigate the role of Il7r overexpression in the Lmo2 induced developmental block. We found that overexpression of Il7r in Lmo2 transgenic thymocytes does not alleviate the Lmo2 induced DN2, or DN3 developmental block, but does increase the engraftment potential of Lmo2 transgenic DN3 thymocytes. Surprisingly, despite the increase in engraftment potential, Il7r overexpression in Lmo2 transgenic thymocytes resulted in a delay in T-ALL induced death, however Il7r overexpression promoted an immature T-ALL immunophenotype. In Chapter Five, we generated an inducible Lmo2 knockin mouse model in which Lmo2 expression can be inhibited by Dox administration. Using this mouse line, we show that while Lmo2 is still required for the self-renewal of Lmo2 transgenic DN3 thymocytes, Lmo2 is not required for T-ALL maintenance in the majority of Lmo2-Induced T-ALLs.
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Item“Revolting Developments”: productive shame in the graphic narratives of Phoebe Gloeckner and Aline Kominsky-Crumb( 2019)“Revolting Developments” presents the first extended, comparative analysis of Aline Kominsky-Crumb and Phoebe Gloeckner’s comics, prose and visual works through the critical framework of shame as an affective mode. These two innovative cartoonists, as well as being contemporaries and peers, have both produced formally and affectively disruptive representations of subjectivity over time, negotiating and subverting the gendered conventions of genre in order to instantiate a new, more productive relationship with their readers. The politics and poetics of looking and the gaze are refigured through Kominsky-Crumb and Gloeckner’s anti-confessional, testimonial representations of sexual violence and psychological parental abuse, their tentative embrace of abjection, and their resistance to prescriptive discourses of childhood. Kominsky-Crumb’s autobiographical comics refuse the categorisation of passive victimhood. Her representation of past trauma troubles the distinction between tragedy and comedy. Gloeckner’s representations of violence interrogate agency, complicity and the mutating power shifts that her young protagonists experience. Although these cartoonists approach shame differently (stylistically as well as conceptually), they both ultimately demonstrate a similar feminist politic. Orienting their texts through the history of the gendering of autobiographic strategies, the assignation of abjection, and the fragility and vulnerability of childhood, I argue that the critical lens of affect, specifically that of shame, provides a productive means of interrogating and analysing Gloeckner’s and Kominsky-Crumb’s negotiation of gendered interpellation and formal subversion of generic modes in order to represent serialised subjectivity. This thesis examines how the affective states of shame and abjection are registered and subverted in Gloeckner and Kominsky-Crumb’s work; following on from the work of Silvan Tomkins, Eve Kosofsky Sedgwick and Hillary Chute it asks how these writers represent shame and how they make this affect and experience productive for the female-gendered subject. Structured through shame’s identity-constituting delineation of subjectivity, heightened sense of embodiment, and identificatory relationality, this thesis analyses Kominsky-Crumb and Gloeckner’s negotiation of autobiographic strategies, subversion of gendered and cultural abjection, and critique of the discursive construction of girlhood. Their instantiation of an alternative relational identification is limited to a racially bounded image of girls, as Gloeckner, and to a lesser extent Kominsky-Crumb, instrumentalise a covetous and objectifying American Africanism in order to exploit the association of white fragility and feminine value.