Academic literature on the topic 'Contemporary Australian literature'

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Journal articles on the topic "Contemporary Australian literature"

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Kimber, RG. "Australian Rangelands in Contemporary Literature." Rangeland Journal 16, no. 2 (1994): 311. http://dx.doi.org/10.1071/rj9940311.

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The subject of this paper being contemporary Australian rangelands literature, I have restricted the study to literature of the decade to 1994, with focus on 1992-1994. I acknowledge recent informative studies, but have developed an individual perspective. In addition to considering recent novels and factual books I have given attention to newspaper and magazine accounts, as these give the most immediate observations of the rangelands, and attitudes towards them and their inhabitants. Key trends that emerge are perceptions of the rangelands as pristine - probably the one continuum since the commencement of written records about Australia; the entirely contrasting view of pastoralists as destroyers of rangelands; and recognition of Aboriginal spirituality as significant in caring for the land. The trends are not, however, entirely in the one direction, as I indicate by presenting both the positive and negative views presented by a select number of writers.
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Stanton, Sophie. "Contemporary History: First Nation Australian Representations in Nanberry: Black Brother White." Papers: Explorations into Children's Literature 26, no. 1 (January 1, 2018): 40–59. http://dx.doi.org/10.21153/pecl2018vol26no1art1089.

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Representations of First Nation Australian and Torres Strait Islanders (First Nation Australians) in children’s literature have gone through many changes since the first literature for children published in the late 1800s. These representations often conformed to and perpetuated negative stereotypes that have changed with the social and political landscape. Given the degree of cultural investment in children’s and young adult literature it is important to work towards a landscape in which negative stereotypes give way to representations reflecting deeper inter-cultural understandings. In this context, the analysis of contemporary texts representing First Nation Australians has an important role to play. This paper analyses Nanberry: black brother white by Jackie French, published in 2011. Nanberry is of interest as it is a contemporary, critically-acclaimed young adult novel. The aim of this paper is to evaluate the representations of the First Nation Australian characters in the novel with reference to analytical frameworks put forward by Bradford (2001) and Lucashenko (2000/2009). Nanberry introduces alternative narratives about the colonisation of Australia and its impacts by using artistic licence, by the adoption of First Nation Australian perspectives and also the perspectives of other historical figures of whom little to no primary evidence of their lives survives to the present day. Nanberry balances historical research with artistic licence and has an implied young, modern day readership. The intersection of these three factors, has resulted in conflict and incongruities between the characters, the plot and even the cover image. This paper argues that these incongruities and conflicts are highly problematic in relation to the representation of First Nation Australian experience.
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Maver, Igor. "Slovenia as a locale in contemporary Australian verse." Acta Neophilologica 30 (December 1, 1997): 73–75. http://dx.doi.org/10.4312/an.30.0.73-75.

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Despite the fact that the writer Patrick White had worked on his novels for a short while also at Lake Bled in Slovenia at Hotel "Toplice", just like Agatha Christie did at Lake Bohinj, Slovenia has only recently come to feature in mainstream Australian literature, more precisely in contemporary Australian poetry. It should be stressed that Slovenia is thus no longer present only in Slovene migrant poetry written in Australia as has so far been the case: it entered the major contemporary Australian anthologies. This testifies to the fact that Slovenia no longer belongs to the uncharted part of Central Europe on the geographical and consequently also on the Australian literary map. Rather than that Slovenia increasingly makes part of an average Australian 'Grand Tour' travel itinerary in Europe; it has thus become present in the Australian cultural consciousness. In this light two recent Australian poems with Slovenia as a literary locale are discussed, Andrew Taylor's "Morning in Ljubljana" I and Susan Hampton's poem "Yugoslav Story".
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Maver, Igor. "Slovenia as a locale in contemporary Australian verse." Acta Neophilologica 30 (December 1, 1997): 73–75. http://dx.doi.org/10.4312/an.30.1.73-75.

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Despite the fact that the writer Patrick White had worked on his novels for a short while also at Lake Bled in Slovenia at Hotel "Toplice", just like Agatha Christie did at Lake Bohinj, Slovenia has only recently come to feature in mainstream Australian literature, more precisely in contemporary Australian poetry. It should be stressed that Slovenia is thus no longer present only in Slovene migrant poetry written in Australia as has so far been the case: it entered the major contemporary Australian anthologies. This testifies to the fact that Slovenia no longer belongs to the uncharted part of Central Europe on the geographical and consequently also on the Australian literary map. Rather than that Slovenia increasingly makes part of an average Australian 'Grand Tour' travel itinerary in Europe; it has thus become present in the Australian cultural consciousness. In this light two recent Australian poems with Slovenia as a literary locale are discussed, Andrew Taylor's "Morning in Ljubljana" I and Susan Hampton's poem "Yugoslav Story".
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Sussman, Sally, and Tony Day. "Orientalia, Orientalism, and The Peking Opera Artist as ‘Subject’ in Contemporary Australian Performance." Theatre Research International 22, no. 2 (1997): 130–49. http://dx.doi.org/10.1017/s030788330002054x.

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As brochures for the January 1996 Sydney Festival blare out ‘Feel the Beat. Feel the Heat!’ to draw the crowds of summering Sydney folk to performances of the National Dance Company of Guinea (already appropriated and stamped with approval by reviewers in San Francisco and London, who are quoted on the same flyer), the chairman and former artistic director of Playbox Theatre in Melbourne, Carrillo Gartner, worries about the strength of popular Australian opposition to Australia's expanding links with Asia. In an article on the holding of the 14th annual Federation for Asian Cultural Promotion in Melbourne, Gartner fears that ‘there are people in this community […] thinking that […] it is the demise of all they believe in their British heritage’. The focus of the article, though, is not the promotion of Asian culture but how to overcome Asian indifference to Australia and the problem of bringing Australian artists to the notice of Asian impresarios and audiences. Australian cultural cringe wins out over Australian Asia-literate political correctness. In another corner of the continent the director and playwright Peter Copeman has been attempting to replace ‘the Euro-American hand-me-downs and imitations’ of mainstream Australian theatre with a theatre project which explores ‘attitudes of the dominant Anglo-Celtic and the Vietnamese minority cultures towards each other, using the intercultural dialectic as the basis of dramatic conflict’.
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Jensz, Felicity. "Three Peculiarities of the Southern Australian Moravian Mission Field." Journal of Moravian History 7, no. 1 (2009): 6–30. http://dx.doi.org/10.2307/41179859.

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Abstract The nineteenth-century Moravian mission field of Southern Australia has received little attention in Moravian narratives or in contemporary historical analyses. Although it was relatively small in terms of converts, and short-lived in comparison to some other Moravian missionary fields, it had a profound impact on indigenous Australians and the colonial history of Australia. Tins essay provides an analysis of the Southern Australian Moravian mission field by examining three peculiarities of the field: the lack of native literature; the payment of a missionary by another church; and, the "double positions" held by Moravians as both missionaries and as governmental officials. These three peculiarities themselves diverge from the dominant Moravian missionary narrative, and thus, through their analysis, a more complex and nuanced history of this mission field is presented.
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Hately, Erica. "Shakespeare as National Discourse in Contemporary Children’s Literature." Papers: Explorations into Children's Literature 13, no. 1 (January 1, 2003): 11–24. http://dx.doi.org/10.21153/pecl2003vol13no1art1293.

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Accepting Stephens' assertions about some of the cultural functions of children's literature, this paper raises the question of what happens in contemporary children's novels when that which is marked as 'centrally important' to both the child protagonist and reader is Shakespeare. More than that, I wish to examine the cultural complexities that are raised when that child protagonist and often the implied reader is Australian.
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Vernay, Jean-François. "Nicholas Birns, Contemporary Australian Literature: A World Not Yet Dead." Commonwealth Essays and Studies 38, no. 2 (April 1, 2016): 139–40. http://dx.doi.org/10.4000/ces.5663.

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Smith, Erika. "Representations of the Japanese in Contemporary Australian Literature and Film." New Voices 2 (December 2008): 41–62. http://dx.doi.org/10.21159/nv.02.03.

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Pearce, Sharyn. "Messages from the Inside?: Multiculturalism in Contemporary Australian Children's Literature." Lion and the Unicorn 27, no. 2 (2003): 235–50. http://dx.doi.org/10.1353/uni.2003.0022.

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Dissertations / Theses on the topic "Contemporary Australian literature"

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Tindall, Alexis. "Creating Australia : cultural representations and national identity in contemporary Australian literature /." Title page, contents and conclusion only, 1999. http://web4.library.adelaide.edu.au/theses/09AR/09art588.pdf.

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Blackmore, Ernie. "Speakin' out blak an examination of finding an "urban" Indigenous "voice" through contemporary Australian theatre /." Click here for electronic access to document: http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20080111.121828/index.html, 2007. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20080111.121828/index.html.

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Thesis (Ph.D.)--University of Wollongong, 2007.
"Including the plays Positive expectations and Waiting for ships." Title from web document (viewed 7/4/08). Includes bibliographical references: leaf 249-267.
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Gibbons, Sacha R. J. "Aboriginal testimonial life-writing and contemporary cultural theory /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18737.pdf.

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Weeda-Zuidersma, Jeannette. "Keeping mum : representations of motherhood in contemporary Australian literature - a fictocritical exploration." University of Western Australia. School of Social and Cultural Studies, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0054.

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[Truncated abstract] This thesis argues that the non-representation and under-representation of mothering in contemporary Australian literature reflects a much wider cultural practice of silencing the mother-as-subject position and female experiences as a whole. The thesis encourages women writers to pay more attention to the subjective experiences of mothering, so that women’s writing, in particular writing on those aspects of women’s lives that are silenced, of which motherhood is one, can begin to refigure motherhood discourses. This thesis examines mother-as-subject from three perspectives: mothering as a corporeal experience, mothering as a psychological experience, and the articulations and silences of mothering-as-subject. It engages with feminist, postmodern and fictocritical theories in its discussion of motherhood as a discourse through these perspectives. In particular, the thesis employs the theoretical works of postmodern feminists Hélène Cixous, Luce Irigaray and Julia Kristeva in this discussion . . . A fictional narrative also runs through the critical discussion on motherhood. This narrative, Catherine’s Story, gives a personal and immediate voice to the mother-as-subject perspective. In keeping with the nature of fictocriticism, strict textual boundaries between criticism and fiction are blurred. The two modes of writing interact and in the process inform and critique each other.
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Weeda-Zuidersma, Jeannette Weeda-Zuidersma Jeannette. "Keeping mum representations of motherhood in contemporary Australian literature : a fictocritical exploration /." Connect to this title online, 2006. http://theses.library.uwa.edu.au/adt-WU2007.0054/.

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Potter, Emily Claire. "Disconcerting ecologies : representations of non-indigenous belonging in contemporary Australian literature and cultural discourse." Title page, contents and abstract only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09php865.pdf.

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Includes bibliographical references (leaves 313-325) Specific concern is the poetic, as well as literal, significance given to the environment, and in particular to land, as a measure of belonging in Australia. Environment is explored in the context of ecologies, offered here as an alternative configuration of the nation, and in which the subject, through human and non-human environmental relations, can be culturally and spatially positioned. Argues that both environment and ecology are narrowly defined in dominant discourses that pursue an ideal, certain and authentic belonging for non-indigenous Australians.
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Dunne, Catherine Margaret. "An ado/aptive reading and writing of Australia and its contemporary literature." Connect to full text, 2007. http://hdl.handle.net/2123/2320.

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Thesis (Ph. D.)--University of Sydney, 2008.
Title from title screen (viewed 29 Apr. 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of English, Faculty of Arts. Degree awarded 2008; thesis submitted 2007. Includes bibliographical references. Also available in print form.
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Bode, Katherine. "In/visibility : women looking at men's bodies in and through contemporary Australian women's fiction /." [St. Lucia, Qld.], 2005. http://adt.library.uq.edu.au/public/adt-QU20060120.161127/index.html.

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Robb, Simon. "Fictocritical sentences." 2001, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phr631.pdf.

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Includes bibliographical references (leaves 166-168). CD-ROMs comprise: Appendix A. Family values: fictocritical sentences -- appendix C. Reforming the boy: fictocritical sentences Primarily enacts a fictocritical mapping of local cultural events essentially concerned with crime and trauma in Adelaide. The fictocritical treatment of these events simulates their unresolved or traumatised condition. A secondary concern is the relationship between electronic writing (hypertext) and fictocriticism.
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Seran, Justine Calypso. "Intersubjective acts and relational selves in contemporary Australian Aboriginal and Aotearoa/New Zealand Maori women's writing." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/21999.

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This thesis explores the dynamics of intersubjectivity and relationality in a corpus of contemporary literature by twelve Indigenous women writers in order to trace modes of subject-formation and communication along four main axes: violence, care, language, and memory. Each chapter establishes a comparative discussion across the Tasman Sea between Indigenous texts and world theory, the local and the global, self and community. The texts range from 1984 to 2011 to cover a period of growth in publishing and international recognition of Indigenous writing. Chapter 1 examines instances of colonial oppression in the primary corpus and links them with manifestations of violence on institutional, familial, epistemic, and literary levels in Aboriginal authors Melissa Lucashenko and Tara June Winch’s debut novels Steam Pigs (1997) and Swallow the Air (2006). They address the cycle of violence and the archetypal motif of return to bring to light the life of urban Aboriginal women whose ancestral land has been lost and whose home is the western, modern Australian city. Maori short story writer Alice Tawhai’s collections Festival of Miracles (2005), Luminous (2007), and Dark Jelly (2011), on the other hand, deny the characters and reader closure, and establish an atmosphere characterised by a lack of hope and the absence of any political or personal will to effect change. Chapter 2 explores caring relationships between characters displaying symptoms that may be ascribed to various forms of intellectual and mental disability, and the relatives who look after them. I situate the texts within a postcolonial disability framework and address the figure of the informal carer in relation to her “caree.” Patricia Grace’s short story “Eben,” from her collection Small Holes in the Silence (2006), tells the life of a man with physical and intellectual disability from birth (the eponymous Eben) and his relationship with his adoptive mother Pani. The main character of Lisa Cherrington’s novel The People-Faces (2004) is a young Maori woman called Nikki whose brother Joshua is in and out of psychiatric facilities. Finally, the central characters of Vivienne Cleven’s novel Her Sister’s Eye (2002) display a wide range of congenital and acquired cognitive impairments, allowing the author to explore how the compounded trauma of racism and sexism participates in (and is influenced by) mental disability. Chapter 3 examines the materiality and corporeality of language to reveal its role in the formation of (inter)subjectivity. I argue that the use of language in Aboriginal and Maori women’s writing is anchored in the racialised, sexualised bodies of Indigenous women, as well as the locale of their ancestral land. The relationship between language, body, and country in Keri Hulme’s the bone people (1984) and Alexis Wright’s Carpentaria (2006) are analysed in relation to orality, gesture, and mapping in order to reveal their role in the formation of Indigenous selfhood. Chapter 4 explores how the reflexive practice of life-writing (including fictional auto/biography) participates in the decolonisation of the Indigenous self and community, as well as the process of individual survival and cultural survivance, through the selective remembering and forgetting of traumatic histories. Sally Morgan’s Aboriginal life-writing narrative My Place (1987), Terri Janke’s Torres Strait Islander novel Butterfly Song (2005), as well as Paula Morris and Kelly Ana Morey’s Maori texts Rangatira (2011) and Bloom (2003) address these issues in various forms. Through the interactions between memory and memoirs, I bring to light the literary processes of decolonisation of the writing/written self in the settler countries of Australia and Aotearoa/New Zealand. This study intends to raise the profile of the authors mentioned above and to encourage the public and scholarly community to pay attention and respect to Indigenous women’s writing. One of the ambitions of this thesis is also to expose the limits and correct the shortcomings of western, postcolonial, and gender theory in relation to Indigenous women writers and the Fourth World.
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Books on the topic "Contemporary Australian literature"

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Maver, Igor. Contemporary Australian literature between Europe and Australia. [Sydney]: Sydney Association for Studies in Society and Culture, 1999.

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Giovanna, Capone, ed. European perspectives: Contemporary essays on Australian literature. St. Lucia, Qld., Australia: Australian Literary Studies, University of Queensland Press, 1991.

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Ryuntyu, Yuri. Australian contemporary poetry: Dungutti & Narwan people. Armidale, NSW: World Patrick White Intellectual Heritage: Australia, 2010.

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Cahill, Michelle, Adam Aitken, and Kim Cheng Boey. Contemporary Asian Australian poets. Glebe, N.S.W: Puncher and Wattmann, 2013.

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Cree, Laura Murray. Awesome!: Australian art for contemporary kids. Sydney, N.S.W: Craftsman House, 2002.

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Imaginary antipodes: Essays on contemporary Australian literature and culture. Heidelberg: Winter, 2011.

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Unsettling space: Contestations in contemporary Australian theatre. Basingstoke: Palgrave Macmillan, 2006.

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Bartlett, Alison. Jamming the machinery: Contemporary Australian women's writing. Toowoomba, Qld: Association for the Study of Australian Literature, 1998.

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Northern Territory Writers Publishing Group. Bugs & bliss: A collection of contemporary Northern Territory writing. Jabiru, NT [Australia]: Northern Territory Writers Pub. Group, 1991.

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Lyn, Harwood, Pascoe Bruce, and White Paula, eds. The Babe is wise: Contemporary stories by Australian women. London: Virago, 1989.

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Book chapters on the topic "Contemporary Australian literature"

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Christou, Anastasia, and Eleonore Kofman. "Conclusion." In IMISCOE Research Series, 117–23. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-91971-9_7.

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AbstractAt the end of a short journey, we can attest to the flourishing production of knowledge on gender and migration that has built up over the past 30 years in particular. Though we have on the whole referred to works in English, there is an extensive literature in other major languages, such as French, German, Italian and Spanish which have emerged from different social science traditions, in recognition of the significance of gendered migrations and feminist movements. English has come to dominate writing in this field (Kofman, 2020), ironically in large part through the European funding of comparative research as well as transatlantic exchanges (Levy et al., 2020). The past 20 years have been a rapid period of intellectual exchange in this field through networks and disciplinary associations, such as the International and European Sociological Associations or IMISCOE which supported a cluster on Gender, Generation and Age (2004–2009). The IMISCOE Migration Research Hub (https://www.migrationresearch.com/) demonstrates the extensive production on gender issues and their connections with other theories and fields of migration. The economic and social transformations brought about by globalisation and transnationalism, and how its unequal outcomes and identities need to be understood through an intersectional lens (Amelina & Lutz, 2019), have heavily shaped studies of gender and migration (see Chap. 10.1007/978-3-030-91971-9_2). Indeed intersectionality has been suggested by some as the major contribution of contemporary feminism to the social sciences, and, has certainly been a theoretical insight that has travelled widely and rapidly from the Anglo world to Europe (Davis, 2020; Lutz, 2014) since it was defined by Kimberlé Crenshaw (1989). We should, however, also remember that it had antecedents in the writing of anti-racist feminists on racist ideology and sex by the French sociologist Claude Guillaumin (1995), on the trinity of gender, race and class in the UK (Anthias & Yuval-Davis, 1992; Parmar, 1982) and by scholars in Australia (Bottomley et al., 1991) and Canada (Stasiulis & Yuval-Davis, 1995).
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McCooey, David. "Contemporary poetry." In The Cambridge Companion to Australian Literature, 158–82. Cambridge University Press, 2000. http://dx.doi.org/10.1017/ccol0521651220.007.

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"Australian Literary Studies Bushwhacked?" In Contemporary Issues in Australian Literature, 7–22. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-5.

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Birns, Nicholas. "Politics and Contemporary Australian Fiction." In The Routledge Companion to Australian Literature, 107–15. Routledge, 2020. http://dx.doi.org/10.4324/9781003124160-15.

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"Australia in Oceania." In Contemporary Issues in Australian Literature, 159–78. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-13.

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"May in September: Australian Literature as Anglophone Alternative." In Contemporary Issues in Australian Literature, 118–38. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-11.

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"Misogyny, Muscles and Machines: Cars and Masculinity in Australian Literature." In Contemporary Issues in Australian Literature, 101–17. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-10.

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"From European Satellite to Asian Backwater?" In Contemporary Issues in Australian Literature, 139–58. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-12.

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"Notes on Contributors." In Contemporary Issues in Australian Literature, 179–80. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-14.

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"Cyberspace and Oz Lit: Mark Davis, McKenzie Wark and the Re-Alignment of Australian Literature." In Contemporary Issues in Australian Literature, 23–42. Routledge, 2014. http://dx.doi.org/10.4324/9781315040073-6.

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Conference papers on the topic "Contemporary Australian literature"

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"The Power and the Passion: Representation of Single Motherhood in Contemporary Australian Literature." In 3rd International Conference on Gender Research. ACPI, 2020. http://dx.doi.org/10.34190/igr.20.023.

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Reports on the topic "Contemporary Australian literature"

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Gorman- Murray, Andrew, Jason Prior, Evelyne de Leeuw, and Jacqueline Jones. Queering Cities in Australia - Making public spaces more inclusive through urban policy and practice. SPHERE HUE Collaboratory, November 2022. http://dx.doi.org/10.52708/qps-agm.

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Building on the success of a UK-based project, Queering Public Space (Catterall & Azzouz 2021), this report refocuses the lens on Australian cities. This is necessary because the histories, legacies and contemporary forms of cities differ across the world, requiring nuanced local insight to ‘usualise’ queerness in public spaces. The report comprises the results of a desk-top research project. First, a thematic literature review (Braun & Clarke 2021) on the experiences of LGBTIQ+ individuals, families and communities in Australian cities was conducted, identifying best practices in inclusive local area policy and design globally. Building upon the findings of the literature review, a set of assessment criteria was developed: – Stakeholder engagement; – Formation of a LGBTIQ+ advisory committee; – Affirming and usualising LGBTIQ+ communities; – Staff training and awareness; and – Inclusive public space design guidelines
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.

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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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