The fiction and fictionalising of William Carleton

William Carleton, widely acknowledged to be the most important Irish writer of the nineteenth century, has, nevertheless, been subject to little rigorous examination. This neglect stems, firstly, from the notoriety he gained early in his career. An Ulster peasant by birth, and a convert to Protestantism in early adulthood, he commenced his career as a writer by attacking the Catholic Church into which he had been baptised. Consequently, despite his later skilful and sympathetic depictions of the Catholic peasant classes he knew so well, Irish attitudes towards him long remained ambivalent, and neither his work, nor his life, received the critical attention they deserved. Secondly, the fact that there is relatively little authoritative information on Carleton has further discouraged any proper investigation of what evidence is available, a fact which has reinforced a tendency for erroneous suppositions about Carleton to remain, not only uncorrected, but repeatedly cited as fact. This thesis, the aim of which is to present a corrective analysis of the author and his writings, is the first study to properly redress that failure. It pursues those lines of inquiry which, in the judgement of the writer, are most productive for the purpose of explicating the complexities of Carleton's work and character. The fundamental issues with which this thesis engages are ones of identity and identification; those imposed upon Carleton and those he sought for himself. The opening chapter gives a critical overview of the way in which scholars have presented Carleton, from the nineteenth century until the present day. A dearth of primary source material has made him an easy subject for appropriation; once vilified as an apostate, his more recent fate has been to be defined by the Famine. The second chapter examines how Carleton's personal identity was connected to the matter of his religious affiliation. The misinterpretation of circumstances connected to Carleton's shift of religious identity - an error corrected in this chapter of the study - provides the most obvious example of widespread critical neglect which he has suffered. Chapter three assesses the way in which Carleton's changing religious attitudes are reflected in his fictional writing. The final three chapters together constitute an examination of Carleton's literary identity. Chapter four proposes that Carleton can be understood as standing in the tradition of the senachie, as one who found his voice, and gained his reputation, by identifying with the peasant classes with which he was familiar. The penultimate chapter addresses Carleton's self-image as a young man, and the way in which both his empathy and identification with particular human types is expressed through his fiction. The final chapter examines Carleton's decline, as, confronted by the limits of his own imaginative capabilities, he wrestled with a form to which his talents were ill-adapted, and with subjects with which he could not properly identify

Avoiding Psychological (Re)Traumatisation in Dentistry when working with Patients who are Adult Survivors of Child Sex Abuse

Introduction Seven percent of the adult population in the UK, including one in six women, report unwanted sexual experiences before the age of 16. The impacts of psychological trauma following child sexual abuse (CSA) creates difficulties for many survivors in accessing dental care due to fears of reminders of abuse, the power imbalance with the dentist and triggered traumatic responses. Aims To analyse and report CSA survivor perspectives of dental care and offer suggestions for practice. Method Qualitative semi-structured interviews of 17 CSA survivors generated data as part of a broader study investigating trust and trustworthiness in survivor-professional relationships. The range of dental interactions and the needs survivors described when receiving dental treatment are presented. Transcripts were analysed using NVivo software and thematic analysis methodology. Results Three main themes were identified: the dental encounter ('it really panics me'); the opportunity to disclose; and choice and control. Conclusion This is the first UK study to present qualitative data from CSA survivors about their experiences of dental care. Survivors wish to access dental care but tailored support is needed to ameliorate reminders of abuse and traumatic stress triggers. Trauma-informed care may address difficulties with treatment if dental staff adopt flexible approaches and work collaboratively with survivors to facilitate relational safety. (Please note, in this paper, 'survivors' refers to those sexually abused as children)

Reducing recurrent care proceedings: initial evidence from new interventions

The English family justice system faces a crisis of recurrence. As many as one in four birth mothers involved in public law care proceedings in English family courts are likely to reappear in a subsequent set of proceedings within seven years. These mothers are involved in up to one-third of total care applications, as they are – by definition – linked to more than one child . Few birth mothers experiencing the removal of a child to care are offered any follow-up support, despite often facing multiple challenges including poverty, addiction, domestic violence and mental health problems. Since 2011, however, a number of new services have been established to begin to address their unmet needs. This article summarises the findings of the first academic-led evaluation of two of these initiatives. Presenting evidence from a mixed-methods evaluative study, it concludes that the new services were able to foster relationships that ‘worked’ in reducing recurrent proceedings. None of the women engaging with the services went on to experience what could be described as a ‘rapid repeat pregnancy’ within the evaluation window. Just as significantly, a number of clients reported some improvement in their psychological functioning, and the practitioners involved reported positively on their experience of delivering and managing innovative services. The article closes with a discussion of the challenges of evaluating personalised, strengths-based interventions and the possibilities of evidencing empowerment in these cases

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

The fiction and fictionalising of William Carleton

William Carleton, widely acknowledged to be the most important Irish writer of the nineteenth century, has, nevertheless, been subject to little rigorous examination. This neglect stems, firstly, from the notoriety he gained early in his career. An Ulster peasant by birth, and a convert to Protestantism in early adulthood, he commenced his career as a writer by attacking the Catholic Church into which he had been baptised. Consequently, despite his later skilful and sympathetic depictions of the Catholic peasant classes he knew so well, Irish attitudes towards him long remained ambivalent, and neither his work, nor his life, received the critical attention they deserved. Secondly, the fact that there is relatively little authoritative information on Carleton has further discouraged any proper investigation of what evidence is available, a fact which has reinforced a tendency for erroneous suppositions about Carleton to remain, not only uncorrected, but repeatedly cited as fact. This thesis, the aim of which is to present a corrective analysis of the author and his writings, is the first study to properly redress that failure. It pursues those lines of inquiry which, in the judgement of the writer, are most productive for the purpose of explicating the complexities of Carleton's work and character. The fundamental issues with which this thesis engages are ones of identity and identification; those imposed upon Carleton and those he sought for himself. The opening chapter gives a critical overview of the way in which scholars have presented Carleton, from the nineteenth century until the present day. A dearth of primary source material has made him an easy subject for appropriation; once vilified as an apostate, his more recent fate has been to be defined by the Famine. The second chapter examines how Carleton's personal identity was connected to the matter of his religious affiliation. The misinterpretation of circumstances connected to Carleton's shift of religious identity - an error corrected in this chapter of the study - provides the most obvious example of widespread critical neglect which he has suffered. Chapter three assesses the way in which Carleton's changing religious attitudes are reflected in his fictional writing. The final three chapters together constitute an examination of Carleton's literary identity. Chapter four proposes that Carleton can be understood as standing in the tradition of the senachie, as one who found his voice, and gained his reputation, by identifying with the peasant classes with which he was familiar. The penultimate chapter addresses Carleton's self-image as a young man, and the way in which both his empathy and identification with particular human types is expressed through his fiction. The final chapter examines Carleton's decline, as, confronted by the limits of his own imaginative capabilities, he wrestled with a form to which his talents were ill-adapted, and with subjects with which he could not properly identify.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Women and the Criminal Justice System—Moving Beyond the Silo

Women’s experiences of crime as both offenders and victims are different to their male counter-parts. They commit less crime, and the crime they commit is generally different to men’s, with less involvement in violent crime, criminal damage or professional crime. Women are much more likely to be victims of sexual and physical assault at the hands of a man they are acquainted with and in the context of relationships. However, women’s involvement with the criminal justice system often results in their isolation, stigmatisation and inadequate support—whether they are victims, offenders or both. This volume considers women’s involvement in criminal justice as a whole—to move beyond the silo of seeing two distinct groups by recognising that for many women there are similarities in both pathways to offending and pathways to victimisation. Furthermore, it aims to put women at the centre of the debate on crime and punishment. Too often in political discussions, academia and media reports, women’s involvement in the system is marginalised, ignored or lost in the concerns about male crime. This introduction highlights the key areas of debate and introduces the contributions by the authors in this collection

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London