Minerva Elements Records
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Screening for Type 2 Diabetes Mellitus initiated through the dental setting: a cost-effectiveness analysis
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.
Reframing the representation of women in contemporary China with feminism
Reframe the Representation of Women in Contemporary Chinese Art with Feminism investigates the representations of women from the Cultural Revolution to today. Through a practice-led thesis, the research shows how women are formed through social, cultural, and political ideologies of “ideal female beauty,” and reframes the representation of women in contemporary Chinese art from a feminist perspective through my practice of making and writing about female representations in art. The representation of “ideal female beauty” that are investigated in this research include the propaganda posters during the Cultural Revolution, Chinese neo-classical paintings in the contemporary Chinese market, as well as the social media, selfie culture, and advertising in Chinese popular culture. The different representations of women developed over time reflect the patriarchal aesthetics of women in traditional Chinese Confucianism, the influence of traditional European nude genre painting on representations of woman, Chinese Communist Party’s political ideologies on gender, and consumerism under globalization. As one of the feminist debates around the diversities of nations, culture, and society, I found Chinese conception of feminism as “feminine-ism” has affected theorizing feminist art in Chinese art criticism. This research re-theorizes Chinese feminist art through case studies of contemporary Chinese feminist artists. To reframe the representation of women in contemporary Chinese art, this research includes a feminist criticism of the patriarchal aesthetics of female representation in the contemporary Chinese art market. It also includes a feminist analysis of some Chinese women artists who represent different female forms by using their bodies in their art and the first generation of Chinese feminist artists rather than “feminine-ism artists” that include me to reframe the representation of women by feminism. The study of the representation of women complements my own paintings, photographs, videos, and a short film in which I present the effects of the “invisible ideologies” that shape the dominant idea of “ideal female beauty” through representations of non-therapeutic cosmetic surgery showing how the invisible ideology becomes visible in women’s bodies through cosmetic surgery. I use the female images in my art to challenge patriarchal aesthetics of female beauty, to resist the cycle of producing the representation of women as beautiful objects, and to refuse the stereotypes of women’s art as feminine essence reinforced by Chinese feminine-ism and certain contemporary Chinese art criticism.
Peter Lilienthal: A Cinema of Exile and Resistance
(Berghahn Books, 2021)
Peter Lilienthal is the first comprehensive study of Lilienthal’s life and career, highlighting the distinctively cross-cultural and transnational dimensions of his oeuvre, and exploring his role as an early exemplar of a more vibrant, ...
Women Food Writers in Authoritarian Regimes: Upholding and Subverting Power in Cuba’s batistato and Paraguay’s stronato
This article examines the role of female food writers in codifying cuisine in authoritarian regimes in Cuba (batistato, 1952-1958) and Paraguay (stronato, 1954-1989), providing examples of the way in which food discourse can both support and resist authoritarian power. As an everyday practice, the preparation and consumption of food offered the State the opportunity to promote, through the discursive codification of cuisine, official views of the nation as racially homogeneous (Paraguay) or as site of modernity, modelled on the United States (Cuba). The texts of four female cuisine writers (Josefina Velilla de Aquino, Graciela Martínez, Nitza Villapol and Adriana Loredo) are analyzed, to elucidate how each of them upheld or subverted the official discourse.
A global genotyping survey of Strongyloides stercoralis and Strongyloides fuelleborni using deep amplicon sequencing (vol 13, e0007609, 2019)
(PUBLIC LIBRARY SCIENCE, 2021-06-01)
[This corrects the article DOI: 10.1371/journal.pntd.0007609.].
TroCCAP recommendations for the diagnosis, prevention and treatment of parasitic infections in dogs and cats in the tropics
The Tropical Council for Companion Animal Parasites Ltd. (TroCCAP) is a not-for-profit organisation whose mission is to independently inform, guide and make best-practice recommendations for the diagnosis, treatment and control of companion animal parasites in the tropics and sub-tropics, with the aim of protecting animal and human health. In line with this primary mission, TroCCAP recently developed guidelines for the diagnosis, treatment and control of feline and canine parasites in the tropics. The development of these guidelines required unique and complex considerations to be addressed, often inapplicable to developed nations. Much of the tropics encompass middle-to-low income countries in which poor standards of environmental hygiene and large populations of stray dogs and cats coexist. In these regions, a range of parasites pose a high risk to companion animals, which ultimately may place their owners at risk of acquiring parasitic zoonoses. These considerations led to the development of unique recommendations with regard, for example, to deworming and endoparasite testing intervals for the control of both global and 'region-specific' parasites in the tropics. Moreover, the 'off-' or 'extra'-label use of drugs for the treatment and control of parasitic infections is common practice in many tropical countries and many generic products lack manufacturers' information on efficacy, safety, and quality control. Recommendations and advice concerning the use of such drugs and protocols are also addressed in these guidelines. The formation of these guidelines is an important first step towards improving the education of veterinarians specifically regarding best-practice for the diagnosis, treatment and control of canine and feline parasites in the tropics.
“Biographical Milestones”: Interpreting Sixty Years of Larry Sitsky’s Stylistic Evolution in Australia (1959–2019) Through a Comparative Analysis of His Solo Flute Works
This thesis interprets the stylistic evolution of Australian composer, Larry Sitsky, by categorising his compositions (1959–2019) into five distinctive ‘periods’. An analysis of Sitsky’s six solo flute works composed between 1959 and 2019 provides a framework for this examination. The near-equidistant placement of the solo flute works within Sitsky’s compositional timeline renders them useful milestones from which to analyse his creative evolution. The underpinning research question asks what identifies the stylistic characteristics of Larry Sitsky’s works across his compositional evolution, as seen through the prism of his six works for solo flute? This research draws upon historical and descriptive musicological methodologies and uses case studies and analysis as the main tools. The stylistic periods are identified through an analysis of the distinguishing compositional influences, devices, and styles used in Sitsky’s compositions at various stages in his career and explores how these characteristics were influenced by extramusical stimuli and contemporaneous compositional developments. Sitsky’s compositional evolution reveals a process of constant and conscious transformation across five periods. First, Sitsky’s “Early Mature Period”, dating from 1959 to 1962, is characterised by his efforts to embrace a more modern idiom in his earliest mature compositions. Second, the “Modernist Period” from 1963–1969 exhibits his exploration of Modernist compositional techniques such as serialism, aleatoricism, and musique concrete. The composer’s adoption of Expressionism and engagement with Asian and mystic stimuli is observable in the “Mystic Expressionism Period” which dates from 1970–1982. Sitsky’s fourth period, the “Armenian Period” traverses the years 1983–1986 and includes a series of works for solo instruments inspired by Armenian folk-music. Fifth, the “Late Mature Period” reveals a neo-romantic though eclectic synthesis of earlier compositional experiments from the years 1987–2019. By exhibiting the characteristics of the five chronological periods, Sitsky’s flute works embody a microcosm of his compositional oeuvre. This thesis also identifies distinctive stylistic qualities that contribute to a ‘Sitskian’ aesthetic, such as: an Expressionistic character, chant topics and portamento; chromatic or bitonal ‘smudging’; irregular rhythms and polymetre; mosaic and episodic forms or improvisatory structures; small recurring chromatic cells; decorative fioritura; the portrayal of a musical progression from one ‘state’ to another; and, the use of non-programmatic extramusical springboards inspired by mystical or mythological sources. By drawing upon an historical examination of Sitsky’s compositional trajectory and artistic context in Australia from the late 1950s until 2019, this thesis situates Sitsky’s compositional periods in relation to several sociocultural developments. While existing scholarship on this composer has explored aspects of his compositional language, none provide a detailed explanation or contextual overview of the compositional shifts. This thesis addresses a scholarly lacuna by clearly identifying the characteristics and context of Sitsky’s stylistic evolution. It also addresses a gap in scholarly engagement with Australian flute music. By connecting the musical analysis to related historical and social aspects, this thesis offers a many-dimensioned illumination of an aspect of this era of art music composition in Australia.
Engineering of DNA Micro- and Nanoparticles: Towards Vaccine Delivery
Vaccines are an effective tool for preventing and controlling various diseases by inducing adaptive immunity. Nanomaterials play an important role in vaccine development. Micro- and nanocarriers can be engineered to improve the therapeutic efficacy of vaccines by (i) preventing the degradation and systemic clearance of vaccine antigens and (ii) facilitating the uptake of vaccines in antigen-presenting cells (iii) co-delivering adjuvants and antigens at desired intracellular compartments for optimal immunotherapy. However, it is important to engineer a carrier that is both effective and safe. Micro- and nanoparticles based on DNA have shown great potential for biological applications, owing to the programmable sequences, predictable interactions, versatile modification sites, and high biocompatibility of DNA strands. This thesis aims to develop facile strategies to synthesize DNA particles for vaccine delivery by self-assembly approaches. First, a simple strategy to synthesize DNA microcapsules is reported. The cytosine-phosphate-guanosine oligodeoxynucleotides (CpG) motif is an efficient vaccine adjuvant that can effectively stimulate the immune system to secrete cytokines. By loading and crosslinking Y-shaped DNA building blocks (containing CpG motifs) into sacrificial calcium carbonate templates, monodisperse and spherical DNA capsules were obtained. These DNA microcapsules were internalized into cells efficiently, accumulated in endosomes, and induced immune cells to secrete high-level of cytokines. Next, we developed a template-assisted and versatile approach for synthesizing a new set of multifunctional particles through the supramolecular assembly of tannic acid (TA) and DNA molecules. Uniform and stable DNA-TA particles with different morphologies could be easily synthesized by using different types of DNA strands. Intriguingly, different DNA sequences can be encoded into this DNA-TA particle for applications in immunotherapy or gene delivery. The incorporation of CpG motifs and ovalbumin into the particles allows the intracellular antigen/adjuvant co-delivery to amplify cytokines production in macrophages, through synergistic effects. In addition, green fluorescent protein (GFP)-expressing plasmid DNA could be transfected by using the DNA-TA particles in HEK293T cells. Finally, nanometer-sized particles were engineered by exploiting the one-pot supramolecular assembly of TA, DNA, and PEG for intracellular delivery of CpG motifs. TA-DNA-PEG nanoparticles with different sizes could be fabricated by adding different molecular weight PEG chains. TA-DNA nanoparticles with tunable size were also synthesized by varying the molar ratio of TA and DNA. The obtained nanoparticles can enhance the cellular uptake of CpG oligonucleotides and consequently the production of cytokines in macrophages. Overall, the engineered DNA-based particles have potential for co-delivering nucleic acids and protein antigens in immune cells to enhance the immunological response against infectious diseases and cancer.
Obesity indicators and their impact on the cardio-metabolic disease in an Asian-Indian ethnic population
Background: Obesity has attained pandemic proportions globally, including in many South Asian countries. The spectrum of obesity in the Indian setting may vary from apparently thin looking individuals with normal weight obesity (NWO) to those at the far end of the spectrum with morbid obesity. However, several knowledge gaps have been identified regarding the utility of clinical and genetic indicators of obesity, across this spectrum, in this unique population. Aims and Objectives: In this study I explored the prevalence of normal weight obesity (NWO) in a cohort from southern India and studied the cardiometabolic disorders associated with this phenotype. I have evaluated the impact of a peer-led lifestyle intervention in individuals with NWO, at a two-year follow-up and determined the obesity indicators that would best predict metabolic disorders in this population. I have also studied the clinical and genetic indicators of obesity in a cohort of patients with morbid obesity. Material and Methods: The objectives mentioned above, across the spectrum of obesity were studied using two datasets. The first dataset, the Kerala Diabetes Prevention Program, is an ongoing longitudinal cluster randomized study, wherein 3552 study subjects were screened and those recruited were subjected to a peer-led life style intervention and followed up on an annual basis up till two years and hereby planned for a 7 year follow-up. The objectives in individuals with morbid obesity were studied in prospectively recruited individuals, from the Vellore bariatric clinic. All patients, recruited from both the datasets, underwent standardized measurements of obesity indicators, had a rigorous cardiometabolic screening and assessment of body composition which included body fat. The genetic analysis in a subset of young-onset morbidly obese individuals was undertaken using a Next Generation Sequencing (NGS) based protocol covering 35 monogenic causes for obesity. Results: The prevalence of NWO in this population was found to be 32% (95% CI: 29.1-34.5%). Individuals with NWO had a significantly higher prevalence of T2DM, hypertension and dyslipidaemia as compared to those without obesity and similar to those who were traditionally identified with obesity. Two years after a peer led lifestyle intervention, only a slight trend towards a favourable change in systolic blood pressure and HDL cholesterol was noted. Amongst several clinical obesity indicators that were studied, waist-height ratio and waist-hip ratio were most significantly associated with cardio-metabolic complications. METS-VF (Metabolic score for visceral fat), a novel obesity indicator, was validated in the Indian population and found to be a good predictor of visceral adipose tissue among individuals with morbid obesity. Sixteen percent of individuals with young onset morbid obesity were found to have a monogenic aetiology for obesity. Conclusion: The obesity phenotype in India differs significantly when compared to other populations. A significant proportion of people have normal weight obesity, which is associated with a high prevalence of cardiometabolic disorders and had minimal trend towards improvement following a two-year life-style intervention. In this setting, the utilization of surrogate measures that predict visceral adiposity and screening for monogenic disorders with NGS in those with young-onset morbid obesity, may be useful adjuncts in the evaluation of obesity in this population.
Systematic Review of Adolescent Conceptions of Success: Implications for Wellbeing and Positive Education
(SPRINGER/PLENUM PUBLISHERS, 2021-04-01)
Identifying different conceptions of success and how these relate to wellbeing is an important area of research. These insights would be especially beneficial for young people who can be guided through school education to reflect on core values, life goals, and indices of success to promote aspirations that will be conducive to wellbeing. Through a systematic review of the empirical and grey literature, we identify and review 17 studies investigating secondary-school students’ (12–18 years) success conceptions and their association with various components of wellbeing. Results indicate that this area of research has received scant attention in the literature. Nevertheless, there is preliminary evidence to suggest that adolescents value intrinsic success such as self-actualisation, personal satisfaction, and connection and that particular patterns of success beliefs associated with personal development and goal striving relate positively to wellbeing. This is consistent with fulfilling the basic psychological needs of autonomy, relatedness, and competency that are associated with internalised motivation and enhanced wellbeing. These insights can guide the content of education programmes focused on identifying life values and aspirations whilst concurrently fostering wellbeing. In addition, gender and developmental stage should be taken into consideration when developing success and wellbeing educational initiatives.
Identifying the priorities of inclusion and mainstream capacity building for people with a spinal cord injury (SCI) and post-polio syndrome: Summary of results based on data for the Bundaberg area
(Centre for Social Impact Swinburne University of Technology (CfSISUT), 2019)