Missionaries, modernity and the moving image: Re-presenting the Melanesian Other to Christian communities in the West between the World Wars

This thesis considers conflicting representational strategies used by Christian missionaries in displaying Melanesian people to white audiences in the West with particular reference to films made during the period of colonial modernity between 1917 and 1935. Most scholarly work on Christian mission in the Pacific has focussed on the nineteenth century and on the effect of Christianisation on indigenous populations, rather than on the effect of mission propaganda on Western communities. This thesis repositions mission propaganda as an important alternative source of visual imagery of the Melanesian ‘Other’ available to white popular audiences. Within a broader commercial market that commodified Western notions of Melanesian ‘savagery’ via illustrated travelogue magazines and commercial multi-media shows, missionaries trod an uneasy knife-edge in how they transmitted indigenous imagery and mediated cultural difference for white consumers. Five case-studies consider missionary propaganda from four Christian denominations in disparate parts of Melanesia. They reveal a temporal trajectory in the conflicted but symbiotic relationship between, on one hand, missionary organisations interested in propagandising their work and, on the other, travelogue-adventurers operating with commercial motives. This trajectory follows missionaries as they move from facilitation of travelogue-adventurers, through passive commissioning of their services, then active collaboration, and finally to autonomous film-making in their own right. I consider how white missionaries played a pivotal role in both enabling and subverting the dominance of the prevailing commercial paradigm of the period: that Melanesians are by nature and definition ‘savages’ and ‘head-hunters’ residing in a thrilling, timeless, virtual place called ‘Cannibal-Land.’ These contradictory impulses, I contend, destabilised both Christian and ‘Cannibal-land’ stereotypes. This destabilising effect was not restricted to film, but I suggest that it was amplified by the use of the quintessentially modern medium of moving images. I argue that film – particularly film made by missionaries – posed an implicit challenge to the essentially literary trope of ‘Cannibal-land’. Moving images offered a more unruly medium within and around which indigenous Melanesians of the colonial era could sometimes display what I term a radical visibility that escaped and transcended both types of Western stereotype

Recognition of physical and psychological symptoms: no influence of GP demographic factors

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower North Island of New Zealand. RESULTS: No relationship was found between GP personal and practice demographic characteristics and GP identification of psychological and physical symptoms. Patients were more likely not to present psychological symptoms (62%) than not present physical symptoms (5%) in consultation. Thirteen percent of GPs wanted more formal psychiatric training, 45% wanted more contact time in consultation, and 72% thought that cost was a barrier to patients attending. No significant relationship was found between these factors and GP detection of significant psychological symptoms in consultation. DISCUSSION: Personal and practice demographics of GPs may not predict their ability to detect physical and psychological symptoms. More research is needed to explore these findings which contradict previous work

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

In Vitro Analyses of the Effects of Heparin and Parabens on Candida albicans Biofilms and Planktonic Cells

Infections and thromboses are the most common complications associated with central venous catheters. Suggested strategies for prevention and management of these complications include the use of heparin-coated catheters, heparin locks, and antimicrobial lock therapy. However, the effects of heparin on Candida albicans biofilms and planktonic cells have not been previously studied. Therefore, we sought to determine the in vitro effect of a heparin sodium preparation (HP) on biofilms and planktonic cells of C. albicans. Because HP contains two preservatives, methyl paraben (MP) and propyl paraben (PP), these compounds and heparin sodium without preservatives (Pure-H) were also tested individually. The metabolic activity of the mature biofilm after treatment was assessed using XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide] reduction and microscopy. Pure-H, MP, and PP caused up to 75, 85, and 60% reductions of metabolic activity of the mature preformed C. albicans biofilms, respectively. Maximal efficacy against the mature biofilm was observed with HP (up to 90%) compared to the individual compounds (P < 0.0001). Pure-H, MP, and PP each inhibited C. albicans biofilm formation up to 90%. A complete inhibition of biofilm formation was observed with HP at 5,000 U/ml and higher. When tested against planktonic cells, each compound inhibited growth in a dose-dependent manner. These data indicated that HP, MP, PP, and Pure-H have in vitro antifungal activity against C. albicans mature biofilms, formation of biofilms, and planktonic cells. Investigation of high-dose heparin-based strategies (e.g., heparin locks) in combination with traditional antifungal agents for the treatment and/or prevention of C. albicans biofilms is warranted

Do patients want to disclose psychological problems to GPs

Background. GPs are an accessible health care provider for most patients with mental disorders and are gatekeepers to specialist care. The extent to which patients consider their primary care team as relevant to their mental health problems needs to be explored. Objectives. To explore reasons why patients choose not to disclose psychological problems to GPs, and to discuss the implications for the provision of primary mental health care. Methods. A cross-sectional survey of consecutive patients attending general practices in New Zealand (part of the MaGPIe study). Patients were screened using the GHQ-12 and a stratified sample participated in a structured in-depth interview to assess their psychological health. Non-disclosure of psychological problems was explored. GPs assessed patients' psychological health using a 5-point scale of severity. Results. Seventy GPs (90%) and 775 patients (70%) participated. Overall, 29.8% of all patients and 36.9% of patients with current symptoms reported non-disclosure of self-perceived psychological problems. Younger patients, those consulting more frequently and those with greater psychiatric disability were more likely to report non-disclosure. The most frequently given reasons were beliefs that a GP is not the 'right' person to talk to (33.8%) or that mental health problems should not be discussed at all (27.6%). Conclusions. Interventions such as screening and GP education may be ineffective in improving primary mental health care unless accompanied by educational programmes for the general public to increase mental health literacy, de-stigmatise mental illness and increase awareness of general practice as an appropriate and effective source of health care

Recognition of physical and psychological symptoms

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower Nort