"To learn how to speak": a study of Jeremy Cronin's poetry

In the chapters that follow, the porous boundary between the public and the private in Jeremy Cronin’s poetry is investigated in his three collections, Inside (1983), Even the Dead: Poems, Parables and a Jeremiad (1996) and More Than a Casual Contact (2006). I argue two particular Marxist theorists are central to reading Cronin’s poetry: Bertolt Brecht, and his notion of the Verfremdungseffekt, and Walter Benjamin and his work on historical materialism, primarily the essay On the Concept of History / Theses on the Philosophy of History (1940). Both theorists focus on the work of art in a historically contextualized manner, which extends the challenge to the boundary between the public and the private. Their work is underpinned by the desire to draw out hidden narratives occluded under the grand narratives of history and capitalist ideas of progress. I argue that these are the major preoccupations in Cronin’s oeuvre as well. As such Cronin’s poetry may be seen to write against a perspective that proposes a linear conceptualisation of history. The poetry therefore challenges the notion that art speaks of ‘universal truths.’ Such ideas of History and Truth, if viewed uncritically, allow for a tendency to conceive of the past as unchanging, which subconsciously promotes the idea that social and political realities are merely logical evolutionary steps. I argue that Cronin’s poetry is thus purposefully interruptive in the way that it confronts the damaging consequences of the linear conceptualisation of history and the universal truth it promotes. His work attempts to find new ways of connection and expression through learning from South Africa’s violent past. The significance of understanding each other and the historical environment as opposed to imposing perspectives that underwrite the symbolic order requires the transformation rather than the simple transferral of power, and is a central focus throughout Cronin’s oeuvre. This position suggests that while the struggle for political freedom may be over, the necessity to rethink how South Africans relate to each other is only beginning. Chapter One will focus on positioning Cronin, the poet and public figure, in South African literature and literary criticism. In this regard, two general trends have operated as critical paradigms in the study of South African poetry, namely Formalism (or ‘prac crit’) and a Marxist inflected materialism, which have in many ways perpetuated the division between the private and the public. This has resulted in poetry being read with an exclusive focus on either one of these two aspects, overlooking the possibilities of dialogue that may take place between them. Cronin’s perspective on these polarised responses will be discussed, which will illustrate the similarity of his position to Ndebele’s notion of the ‘ordinary’ which suggests a way beyond these binaries. This will lead to a discussion of how South African poets responded to the transition phase, suggesting that the elements of the polarisation still remained. Considering the major influences and paradigms when reading Cronin’s oeuvre provides a foundation for the following three chapters. These include Cronin’s use of Romanticism, Bertolt Brecht and the V-Effekt and Walter Benjamin’s perspectives on historical materialism. In addition to these three theoretical paradigms, the relevance of Pablo Neruda’s poetry to Cronin’s work is also foregrounded. In Chapter Two, the focus will be on Cronin’s first collection of poetry, Inside, concentrating on Cronin’s use of language as a way of constructing poetry in the sparseness of the prison experience. This will show an abiding preoccupation of learning to speak in a language that considers the material context out of which it emerges. In this regard, the poems “Poem-Shrike” “Prologue” and “Cave-site” are analysed. In addition, one of the central poems in Cronin’s oeuvre, “To learn how to speak […],” will be examined in order to illustrate how the poet extends this project on a meta-poetic level, asking for South African poets to ‘learn how to speak’ in the voices of South African experience and histories. I will show how this is linked to Cronin’s “Walking on Air” which illustrates how the V-Effeckt recovers the small private histories through re-telling the life story of James Matthews, a fellow prisoner incarcerated for his anti-apartheid activism, revealing how this story is intimately connected to the public sphere. In Chapter Three, Cronin’s second collection: Even the Dead: Poems, Parables and a Jeremiad will be examined. In the poem “Three Reasons for a Mixed, Umrabulo, Round-the-Corner Poetry” Cronin resists inherited Western poetic conventions by incorporating and subverting versions of the Romantic aesthetic, arguing for poetry to be immersed in South African multi-lingual and multi-cultural experiences. “Even the Dead” reveals how Cronin uses Walter Benjamin’s perspectives on historical materialism to confront amnesia. In terms of the themes established in “To learn how to speak […]”, the poem “Moorage” demonstrates how the public and private can never be separated in Cronin’s work. The final section of this chapter will examine how Cronin responds to Pablo Neruda’s poems “I am explaining a few things” and “The Education of a Chieftain,” and how these poems challenge narratives that privilege the ‘great leader’ instead of the so-called smaller individuals’ stories. Chapter Four examines selections from Cronin’s third collection, focusing on Cronin’s use of the automobile, charting an ambiguous trajectory through the ‘new’ South Africa. The examination of the poems “Where to begin?”, “Switchback” and “End of the century - which is why wipers,” all attempt to include individuals left on the margins of the narrative of global freeways and neo-liberal capitalist progress. The poems present an interrogation of how ‘vision’ is constructed. This will show that the poetry responds to the experiences of the marginalised under these grand narratives in a primarily fragmentary and interruptive manner. This in effect constitutes the culmination of Cronin’s poetic journey and the search for new ways of envisaging South Africa’s future and finding a new language with which to speak it

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study

Objectives To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD

Effectiveness of Holistic Interventions for People with Severe Chronic Obstructive Pulmonary Disease: Systematic Review of Controlled Clinical Trials

Despite a well-recognised burden of disabling physical symptoms compounded by co-morbidities, psychological distress and social isolation, the needs of people with severe chronic obstructive pulmonary disease (COPD) are typically poorly addressed.To assess the effectiveness of interventions designed to deliver holistic care for people with severe COPD.We searched 11 biomedical databases, three trial repositories (January 1990-March 2012; no language restrictions) and contacted international experts to locate published, unpublished and in-progress randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials (CCTs) that investigated holistic interventions to support patients with severe COPD in any healthcare context. The primary outcome was health-related quality of life (HRQoL). Quality assessment and data extraction followed Cochrane Collaboration methodology. We used a piloted data extraction sheet and undertook narrative synthesis.From 2,866 potentially relevant papers, we identified three trials: two RCTs (from United States and Australia), and one CCT (from Thailand): total 216 patients. Risk of bias was assessed as moderate in two studies and high in the third. All the interventions were led by nurses acting in a co-ordinating role (e.g. facilitating community support in Thailand, providing case-management in the USA, or co-ordinating inpatient care in Australia). HRQoL improved significantly in the Thai CCT compared to the (very limited) usual care (p<0.001), in two sub-domains in the American trial, but showed no significant changes in the Australian trial. Exercise tolerance, dyspnoea, and satisfaction with care also improved in the Thai trial.Some 15 years after reports first highlighted the unmet needs of people with severe COPD, we have been unable to find robust trial evidence about interventions that can address those needs. There is an urgent need to develop and evaluate holistic care interventions designed improve HRQoL for people with severe COPD.PROSPERO (CRD42012002430)

Home monitoring of breathing rate in people with chronic obstructive pulmonary disease: observational study of feasibility, acceptability, and change after exacerbation

Abstract: Telehealth programs to promote early identification and timely self-management of acute exacerbations of chronic obstructive pulmonary diseases (AECOPDs) have yielded disappointing results, in part, because parameters monitored (symptoms, pulse oximetry, and spirometry) are weak predictors of exacerbations.Purpose: Breathing rate (BR) rises during AECOPD and may be a promising predictor. Devices suitable for home use to measure BR have recently become available, but their accuracy, acceptability, and ability to detect changes in people with COPD is not known.Patients and methods: We compared five BR monitors, which used different monitoring technologies, with a gold standard (Oxycon Mobile®; CareFusion®, a subsidiary of Becton Dickinson, San Diego, CA, USA). The monitors were validated in 21 stable COPD patients during a 57-min “activities of daily living protocol” in a laboratory setting. The two best performing monitors were then tested in a 14-day trial in a home setting in 23 stable COPD patients to determine patient acceptability and reliability of signal. Acceptability was explored in qualitative interviews. The better performing monitor was then given to 18 patients recruited during an AECOPD who wore the monitor to observe BR during the recovery phase of an AECOPD.Results: While two monitors demonstrated acceptable accuracy compared with the gold standard, some participants found them intrusive particularly when ill with an exacerbation, limiting their potential utility in acute situations. A reduction in resting BR during the recovery from an AECOPD was observed in some, but not in all participants and there was considerable day-to-day individual variation.Conclusion: Resting BR shows some promise in identifying exacerbations; however, further prospective study to assess this is required.Keywords: COPD exacerbation, telemedicine, COPD management, heart rat

Application of Mixed Effects Limits of Agreement in the Presence of Multiple Sources of Variability: Exemplar from the Comparison of Several Devices to Measure Respiratory Rate in COPD Patients

IntroductionThe Bland-Altman limits of agreement method is widely used to assess how well the measurements produced by two raters, devices or systems agree with each other. However, mixed effects versions of the method which take into account multiple sources of variability are less well described in the literature. We address the practical challenges of applying mixed effects limits of agreement to the comparison of several devices to measure respiratory rate in patients with chronic obstructive pulmonary disease (COPD). MethodsRespiratory rate was measured in 21 people with a range of severity of COPD. Participants were asked to perform eleven different activities representative of daily life during a laboratory-based standardised protocol of 57 minutes. A mixed effects limits of agreement method was used to assess the agreement of five commercially available monitors (Camera, Photoplethysmography (PPG), Impedance, Accelerometer, and Chest-band) with the current gold standard device for measuring respiratory rate. ResultsResults produced using mixed effects limits of agreement were compared to results from a fixed effects method based on analysis of variance (ANOVA) and were found to be similar. The Accelerometer and Chest-band devices produced the narrowest limits of agreement (-8.63 to 4.27 and -9.99 to 6.80 respectively) with mean bias -2.18 and -1.60 breaths per minute. These devices also had the lowest within-participant and overall standard deviations (3.23 and 3.29 for Accelerometer and 4.17 and 4.28 for Chest-band respectively). ConclusionsThe mixed effects limits of agreement analysis enabled us to answer the question of which devices showed the strongest agreement with the gold standard device with respect to measuring respiratory rates. In particular, the estimated within-participant and overall standard deviations of the differences, which are easily obtainable from the mixed effects model results, gave a clear indication that the Accelerometer and Chest-band devices performed best

Evaluation of seven European aerosol optical depth retrieval algorithms for climate analysis

Satellite data are increasingly used to provide observation-based estimates of the effects of aerosols on climate. The Aerosol-cci project, part of the European Space Agency's Climate Change Initiative (CCI), was designed to provide essential climate variables for aerosols from satellite data. Eight algorithms, developed for the retrieval of aerosol properties using data from AATSR (4), MERIS (3) and POLDER, were evaluated to determine their suitability for climate studies. The primary result from each of these algorithms is the aerosol optical depth (AOD) at several wavelengths, together with the Ångström exponent (AE) which describes the spectral variation of the AOD for a given wavelength pair. Other aerosol parameters which are possibly retrieved from satellite observations are not considered in this paper. The AOD and AE (AE only for Level 2) were evaluated against independent collocated observations from the ground-based AERONET sun photometer network and against “reference” satellite data provided by MODIS and MISR. Tools used for the evaluation were developed for daily products as produced by the retrieval with a spatial resolution of 10 × 10 km2 (Level 2) and daily or monthly aggregates (Level 3). These tools include statistics for L2 and L3 products compared with AERONET, as well as scoring based on spatial and temporal correlations. In this paper we describe their use in a round robin (RR) evaluation of four months of data, one month for each season in 2008. The amount of data was restricted to only four months because of the large effort made to improve the algorithms, and to evaluate the improvement and current status, before larger data sets will be processed. Evaluation criteria are discussed. Results presented show the current status of the European aerosol algorithms in comparison to both AERONET and MODIS and MISR data. The comparison leads to a preliminary conclusion that the scores are similar, including those for the references, but the coverage of AATSR needs to be enhanced and further improvements are possible for most algorithms. None of the algorithms, including the references, outperforms all others everywhere. AATSR data can be used for the retrieval of AOD and AE over land and ocean. PARASOL and one of the MERIS algorithms have been evaluated over ocean only and both algorithms provide good results

Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil:A pilot observational study

Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented ‘matrix support’: a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157–87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems