From physics to metaphysics: philosophy and style in the critical writings of T. S. Eliot (1913-1935)

This thesis considers Eliot's critical writing from the late 1910s till the mid-1930s, in the light of his PhD thesis - Knowledge and Experience in the Philosophy of F. H. Bradley - and a range of unpublished material: T S. Eliot's Philosophical Essays and Notes (1913- 4) in the Hayward Bequest (King's College, Cambridge University); T. S. Eliot's Family Papers in the T. S. Eliot Collection at the Houghton Library (Harvard University); and items from the Harvard University Archives at the Pusey Library. 'Me thesis offers a comprehensive view of Eliot's critical development throughout this important period. It starts by considering The Sacred Wood's ambivalence towards the metaphysical philosophy of F. H. Bradley and Eliot's apparent adoption of a scientific method, under the influence of Bertrand Russell. It will be argued that Eliot uses rhetorical strategies which simultaneously subvert the method he is propounding, and which set the tone for an assessment of his criticism throughout the 1920s. His indecision, in this period, about the label 'Metaphysical' for some poets of the seventeenth century, reveals the persistence of the philosophical thought he apparently rejects in 1916, when he chooses not to pursue a career in philosophy in Harvard. This rhetorical tactic achieves its fulfilment in Dante (1929), where Eliot finds a model in the medieval allegorical method and 'philosophical' poetry. Allegory is also examined in connection with the evaluation of Eliot's critical writings themselves to determine, for instance, the figurative dimension of his early scientific vocabulary and uncover metaphysical residues he had explicitly disowned but would later embrace. Finally, it is suggested that, the hermeneutics of allegory are historical and it is used here to test the relationship between Eliot's early and later critical writings, that is the early physics and the later metaphysics.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.