The Fantasy of the Real: J.R.R. Tolkien, Modernism, and Postmodernism

J.R.R. Tolkien’s trilogy, The Lord of the Rings, grips readers of all ages in the power of its story and characters. Tolkien leads his audience through a world and a time that is entirely different from that of contemporary society, but he also remains true to the human condition as the morals and conflicts within the story resonate with authentic human emotion. Tolkien allows readers to temporarily escape the present although not to forget reality. Tolkien follows his own “rules” of “fairy-story” in order to present a fantastical tale that represents Truth better than many stories that may not be considered fantasy at all by connecting the contemporary reader with the sense of a historical epic. However, readers may question the brilliance of a man who would spend years making up his own peoples and races, complete with their own histories and languages, simply for a “fairytale”. Why would a man who can write a best-selling epic in three volumes waste years on creating this complex context of make-believe? Tolkien wrote in an age that was infused with modernism but also approaching the drifting nature of postmodernism. This meant that people were becoming increasingly individualistic at the same time as they were becoming more disconnected from any sense of faith in an authentic real or an absolute. People were replacing an absolute and authentic Real, or Truth, with false distractions for the purpose of this paper delineated as lowercase real, or truth. Enlightenment promises like individuality and scientific advancement failed to produce promised answers but only led to more questions and emptiness. Everything from religion and science to politics and philosophy were affected by the broken system of modernism that took away absolutes and never replaced them, leading to a postmodern era defined by distraction rather than Reality Belief in language also suffered as language theorists like Ferdinand de Saussure and Jean Boudrillard proved that a solid connection between substance and thought was arbitrary. Tolkien, however, remained “safe” from the modern ideal of looking outside history to discover the individual. Tolkien remained rooted in the traditions of Old England and the Christian faith, even providing his own “history” in which he could create a world that still thrived from the presence of absolutes and relevant historical context. Through creating his own world, history, and language, Tolkien tells a story based on his philological interests. However, his work also functions as a pre-modernist text whose author still believes in a transcendent signified, or absolute, and presents this to his audience by structuring a world in which the signifier still represents the signified in the closer relationship of a more primitive age. Tolkien ironically uses a fantasy world to get back to a more stable and authentic real through reconnecting to English history and creating a “fantasy” world in which language is more closely connected with the authentic

Examining the effects of a variation to the ruck law in Rugby Union

Arias, Argudo and Alonso’s review (2011) found that when rule changes were introduced to achieve a certain outcome, less than 60% were actually accomplished. Reflecting on past law changes in Rugby Union, the subject ELV is similar to the ‘use it or lose it’ law that was applied to mauls in 1994 (the aim being to increase open play and encourage continuity). Interestingly the number of mauls actually decreased as they resulted in greater possibility of turnovers (Quarrie & Hopkins, 2007) and the ruck became the more favoured play. Many of the studies which have examined rule modification, for example, Eaves and Hughes (2003), Eaves, Hughes and Lamb (2005) and Quarrie and Hopkins (2007) have concluded that the changes ultimately achieved a different outcome from that predicted (Arias, Argudo & Alonso, 2011). Thus emphasising the need for this analysis. The aim of this study is to determine whether limiting the time the ball is allowed to remain stationary improves the continuity of the game through increasing the time the ball is in open play

Clothing the ‘new woman’

Clothing the “New Woman”’ will examine the way my understanding of the ‘New Woman’ differs from the conventional view of the New Woman as a political figure, specifically focusing on how the ‘New Woman’ reflects her identity through her clothing. Using Henry James’s Daisy Miller and The Portrait of a Lady and Edith Wharton’s The Age of Innocence and The House of Mirth, I will analyse how Daisy Miller, Isabel Archer, Ellen Olenska and Lily Bart’s characters contrast to the traditional understanding of the New Woman, because they are simply trying to have control over their own lives. This idea led to the development of my argument that for many characters being a ‘New Woman’ is not about making a wider political statement, such as arguing for the vote, it is about personal liberation. A key way in which the ‘New Woman’ expresses her individuality and freedom is through her clothing. However, Isabel’s dress conforms to expectations of society, therefore, I will use her as an example to show how the ‘New Woman’ identity is not always fixed and stable. Chapter One will offer a full definition of my understanding of the ‘New Woman’ examining how Daisy, Isabel, Ellen and Lily embody the ‘New Woman’ ideal. Chapter Two will begin by briefly outlining the social significance of dress in the nineteenth century. It will then go onto analyse the ‘New Woman’s’ clothing in her first appearance in each narrative, looking at how their dress reflects their sense of personal freedom and liberation and how Isabel’s dress contrasts her to the other ‘New Woman’ figures. Chapter Three will continue to examine the ‘New Woman’s’ clothing, focusing on the development of their relationship with clothing as the narratives progress. The conclusion will briefly discuss the endings of each text to analyse what becomes of the ‘New Woman’

Review of Health Services Available for Persons who Contracted Hepatitis C through the Administration within the State of Blood or Blood Products. Implementation of Recommendations.

the State of infected blood and blood products. The Report examines progress on the recommendations published in 2000, and recognizes the evolution in service needs since then with the addition of 4 new recommendations. The Report will assist health service providers, the Department of Health and Children and the support groups to continue working together to ensure that the future service needs of this Hepatitis C group are met. It is timely that this review has come at a time when the health services are entering a new phase of restructuring and renewal. The Consultative Council welcomes this process and is confident that it will bring benefits to both service users and service providers. The Council has assured the Health Service Executive and the National Hospitals Office that we will be happy to co-operate with them and to continue playing a positive role in shaping Hepatitis C services for this cohort of patients in the future. As with the first Review the four support groups - Positive Action, Transfusion Positive, the Irish Haemophilia Society and the Irish Kidney Association - all of which are represented on the Consultative Council, are to be commended for the important role they play, and for encouraging their members to participate in this progress report

Communicating with Cost-based Implicature: a Game-Theoretic Approach to Ambiguity

A game-theoretic approach to linguistic communication predicts that speakers can meaningfully use ambiguous forms in a discourse context in which only one of several available referents has a costly unambiguous form and in which rational interlocutors share knowledge of production costs. If a speaker produces a low-cost ambiguous form to avoid using the high-cost unambiguous form, a rational listener will infer that the high-cost entity was the intended entity, or else the speaker would not have risked ambiguity. We report data from two studies in which pairs of speakers show alignment of their use of ambiguous forms based on this kind of shared knowledge. These results extend the analysis of cost-based pragmatic inferencing beyond that previously associated only with fixed lexical hosts.

Commissioning and co‐production in health and care services in the United Kingdom and Ireland: An exploratory literature review

© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Introduction: This exploratory literature review seeks to examine the literature around commissioning processes in the co‐production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co‐production in service design and delivery? What are the contextual factors that influence these processes? Method: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008–2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty‐seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. Results: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co‐production; navigating relationships and the collective voice. Conclusion: Commissioning processes were commonly a barrier to the co‐production of health and care services. Though co‐production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer‐term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. Patient and Public Contribution: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement.Peer reviewe

The EX-FRAIL CKD Trial: a study protocol for a pilot randomised controlled trial of a home-based EXercise programme for pre-FRAIL and FRAIL, older adults with Chronic Kidney Disease

Introduction Frailty is highly prevalent in adults with chronic kidney disease (CKD) and is associated with adverse health outcomes including falls, poorer health-related quality of life (HRQOL), hospitalisation and mortality. Low physical activity and muscle wasting are important contributors to physical frailty in adults with CKD. Exercise training may improve physical function and frailty status leading to associated improvements in health outcomes, including HRQOL. The EX-FRAIL CKD trial aims to inform the design of a definitive randomised controlled trial (RCT) that investigates the effectiveness of a progressive, multi-component home-based exercise programme in pre-frail and frail older adults with CKD. Methods and Analysis The EX-FRAIL CKD trial is a two-arm parallel group pilot RCT. Participants categorised as pre-frail or frail, following Frailty Phenotype assessment, will be randomised to receive exercise or usual care. Participants randomised to the intervention arm will receive a tailored 12-week exercise programme, which includes weekly telephone calls to advise on exercise progression. Primary feasibility outcome measures include rate of recruitment, intervention adherence, outcome measure completion and participant attrition. Semi-structured interviews with a purposively selected group of participants will inform the feasibility of the randomisation procedures, outcome measures and intervention. Secondary outcome measures include physical function (walking speed and Short Physical Performance Battery), frailty status (Frailty Phenotype), fall concern (Falls Efficacy Scale-International tool), activities of daily living (Barthel Index), symptom-burden (Palliative Care Outcome Scale-Symptoms RENAL) and HRQOL (Short Form-12v2). Ethics and Dissemination Ethical approval was granted by a National Health Service (NHS) Regional Ethics Committee and the NHS Health Research Authority. The study team aim to publish findings in a peer-reviewed journal and present the results at relevant national and international conferences. A summary of findings will be provided to participants, a local kidney patient charity and the funding body

A spatial discounting test to assess impulsivity in dogs

In domestic dog’s trait impulsivity can be measured psychometrically using the Dog Impulsivity Assessment Scale (DIAS) and experimentally using a temporal discounting paradigm which requires substantial training. A Spatial Discounting Task (SDT) was developed as an alternative experimental method to assess impulsivity, and evaluated performance in adult (2–10 years) and younger (2–9 months) dogs. The test was modified for field use with fewer controls (Simplified Spatial Discounting Task (SDTs)). Convergent validity with the SDT and DIAS Overall Questionnaire Scores (OQS) and stability over time (4–6 weeks) in the two age groups was determined. 96% of dogs recruited reached criterion for testing. A significant positive relationship was found between Maximum Distance Travelled (MDT) in the SDT and OQS in adult dogs (r = 0.46, p = 0.028), with good test-retest reliability evident for both (p < 0.001). In young dogs, there was good test-retest reliability for OQS (p = 0.023), but no significant relationship was found between OQS and MDT, test-retest reliability for MDT in young dogs was poor. In the SDTs, 100% of dogs recruited met criterion for testing and there was a significant relationship between MDT and OQS (r = 0.61, p = 0.027). The SDT appears to be a useful method for measuring impulsivity in adult dogs with wide applicability

Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992–2007

Background: People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992–2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. Methodology: We calculated the number of PWID in the US annually from 1992–2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. Results: PWID per 10,000 persons aged 15–64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002–2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated – the mean prevalence was 90 to 100 per 10,000 youth in 1992–1996, but increased to >120 PWID per 10,000 youth in 2006–2007. Conclusions: Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes