Running on Rooftops: a novel and critical reflection on writing from an identity of expatriation with an examination of West-meets-East encounters and attitudes depicted in literature

This thesis is in two parts: a creative work of fiction and a critical reflection on writing from an identity of expatriation. The creative work, a novel entitled Running on Rooftops, revolves around a fictitious community of expatriates living and working in China. As a new college graduate, Anne Henry, the novel’s protagonist and narrator, decides to spend a year teaching English in China. Twelve years later, though still unsure of how to make sense of the chain of events and encounters that left her with an X-shaped scar on her knee, she nevertheless tells the story, revealing how “just a year” can be anything but. The critical reflection, entitled Writing on Rooftops, explores the nature of expatriation as it relates to identity and writing, specifically in how West-meets-East encounters and attitudes are depicted in literature. In it, I examine the challenges and benefits of writing from an identity and mindset of expatriation as illustrated in the works of Western writers who themselves experienced and wrote from viewpoints of expatriation, particularly those Western writers who wrote of expatriation in China and Southeast Asia. The primary question addressed is how expatriation influences perception and how those perceptions among Western foreigners in China and Southeast Asia have been and can be reflected in literature. In the end, I argue that expatriation can be a valuable viewpoint to write from, offering new ways of seeing and describing our world, ourselves and the connections between the two.

The Scots in Ireland: culture, colonialism and memory, 1315-1826

This thesis examines three key moments in the intersecting histories of Scotland, Ireland and England, and their impact on literature. Chapter one Robert Bruce and the Last King of Ireland: Writing the Irish Invasion, 1315- 1826‘, is split into two parts. Part one, Barbour‘s (other) Bruce‘ focuses on John Barbour‘s The Bruce (1375) and its depiction of the Bruce‘s Irish campaign (1315-1318). It first examines the invasion material from the perspective of the existing Irish and Scottish relationship and their opposition to English authority. It highlights possible political and ideological motivations behind Barbour‘s negative portrait of Edward Bruce - whom Barbour presents as the catalyst for the invasion and the source of its carnage and ultimate failure - and his partisan comparison between Edward and his brother Robert I. It also probes the socio-polticial and ideological background to the Bruce and its depiction of the Irish campaign, in addition to Edward and Robert. It peers behind some of the Bruce‘s most lauded themes such as chivalry, heroism, loyalty, and patriotism, and exposes its militaristic feudal ideology, its propaganda rich rhetoric, and its illusions of freedom‘. Part one concludes with an examination of two of the Irish section‘s most marginalised figures, the Irish and a laundry woman. Part two, Cultural Memories of the Bruce Invasion of Ireland, 1375-1826‘, examines the cultural memory of the Bruce invasion in three literary works from the Medieval, Early Modern and Romantic periods. The first, and by far the most significant memorialisation of the invasion is Barbour‘s Bruce, which is positioned for the first time within the tradition of ars memoriae (art of memory) and present-day cultural memory theories. The Bruce is evaluated as a site of memory and Barbour‘s methods are compared with Icelandic literature of the same period. The recall of the invasion in late sixteenth century Anglo-Irish literature is then considered, specifically Edmund Spenser‘s A View of the State of Ireland, which is viewed in the context of contemporary Ulster politics. The final text to be considered is William Hamilton Drummond‘s Bruce’s Invasion of Ireland (1826). It is argued that Drummond‘s poem offers an alternative Irish version of the invasion; a counter-memory that responds to nineteenth-century British politics, in addition to the controversy surrounding the publication of the Ossian fragments. Chapter two, The Scots in Ulster: Policies, Proposals and Projects, 1551-1575‘, examines the struggle between Irish and Scottish Gaels and the English for dominance in north Ulster, and its impact on England‘s wider colonial ideology, strategy, literature and life writing. Part one entitled Noisy neighbours, 1551-1567‘ covers the deputyships of Sir James Croft, Sir Thomas Radcliffe, and Sir Henry Sidney, and examines English colonial writing during a crucial period when the Scots provoked an increase in militarisation in the region. Part two Devices, Advices, and Descriptions, 1567-1575‘, deals with the relationship between the Scots and Turlough O‘Neill, the influence of the 5th Earl of Argyll, and the rise of Sorley Boy MacDonnell. It proposes that a renewed Gaelic alliance hindered England‘s conquest of Ireland and generated numerous plantation proposals and projects for Ulster. Many of which exhibit a blurring‘ between the documentary and the literary; while all attest to the considerable impact of the Gaelic Scots in both motivating and frustrating various projects for that province, the most prominent of which were undertaken by Sir Thomas Smith in 1571 and Walter Devereux, 1st Earl of Essex in 1573.

An investigation of the clinical utility of preoperative cardiopulmonary exercise testing in patients undergoing major pancreatic surgery

Pancreaticoduodenectomy with or without adjuvant chemotherapy remains the only modality of possible cure in patients with cancer involving the head of the pancreas and the periampullary region. While mortality rates after pancreaticoduodenectomy have improved considerably over the course of the last century, morbidity remains high. Patient selection is of paramount importance in ensuring that major surgery is offered to individuals who will most benefit from a pancreaticoduodenectomy. Moreover, identifying preoperative risk factors provides potential targets for prehabilitation and optimisation of the patient's physiology before undertaking surgery. In addition to this, early identification of patients who are likely to develop postoperative complications allows for better allocation of critical care resources and more aggressive management high risk patients. Cardiopulmonary exercise testing is becoming an increasingly popular tool in the preoperative risk assessment of the surgical patient. However, very little work has been done to investigate the role of cardiopulmonary exercise testing in predicting complications after pancreaticoduodenectomy. The impact of jaundice, systemic inflammation and other preoperative clinicopathological characteristics on cardiopulmonary exercise physiology has not been studied in detail before in this cohort of patients. The overall aim of the thesis was to examine the relationships between preoperative clinico-pathological characteristics including cardiopulmonary exercise physiology, obstructive jaundice, body composition and systemic inflammation and complications and the post-surgical systemic inflammatory response in patients undergoing pancreaticoduodenectomy. Chapter 1 reviews the existing literature on preoperative cardiopulmonary exercise testing, the impact of obstructive jaundice, perioperative systemic inflammation and the importance of body composition in determining outcomes in patients undergoing major surgery with particular reference to pancreatic surgery. Chapter 2 reports on the role of cardiopulmonary exercise testing in predicting postoperative complications after pancreaticoduodenectomy. The results demonstrate that patients with V˙O2AT less than 10 ml/kg/min are more likely to develop a postoperative pancreatic fistula, stay longer in hospital and less likely to receive adjuvant therapy. These results emphasise the importance of aerobic fitness to recover from the operative stress of major surgery without significant morbidity. Cardiopulmonary exercise testing may prove useful in selecting patients for intensive prehabilitation programmes as well as for other optimisation measures to prepare them for major surgery. Chapter 3 evaluates the relationship between cardiopulmonary exercise physiology and other clinicopathological characteristics of the patient. A detailed analysis of cardiopulmonary exercise test parameters in jaundiced versus non-jaundiced patients demonstrates that obstructive jaundice does not impair cardiopulmonary exercise physiology. This further supports emerging evidence in contemporary literature that jaundiced patients can proceed directly to surgery without preoperative biliary drainage. The results of this study also show an interesting inverse relationship between body mass index and anaerobic threshold which is analysed in more detail in Chapter 4. Chapter 4 examines the relationship between preoperative cardiopulmonary exercise physiology and body composition in depth. All parameters measured at cardiopulmonary exercise test are compared against body composition and body mass index. The results of this chapter report that the current method of reporting V˙O2, both at peak exercise and anaerobic threshold, is biased against obese subjects and advises caution in the interpretation of cardiopulmonary exercise test results in patients with a high BMI. This is particularly important as current evidence in literature suggests that postoperative outcomes in obese subjects are comparable to non-obese subjects while cardiopulmonary exercise test results are also abnormally low in this very same cohort of patients. Chapter 5 analyses the relationship between preoperative clinico-pathological characteristics including systemic inflammation and the magnitude of the postoperative systemic inflammatory response. Obstructive jaundice appears to have an immunosuppressive effect while elevated preoperative CRP and hypoalbuminemia appear to have opposite effects with hypoalbuminemia resulting in a lower response while elevated CRP in the absence of hypoalbuminemia resulted in a greater postoperative systemic inflammatory response. Chapter 6 evaluates the role of the early postoperative systemic inflammatory response in predicting complications after pancreaticoduodenectomy and aims to establish clinically relevant thresholds for C-Reactive Protein for the prediction of complications. The results of this chapter demonstrate that CRP levels as early as the second postoperative day are associated with complications. While post-operative CRP was useful in the prediction of infective complications, this was the case only in patients who did not develop a post-operative pancreatic fistula. The predictive ability of inflammatory markers for infectious complications was blunted in patients with a pancreatic fistula. Chapter 7 summarises the findings of this thesis, their place in current literature and future directions. The results of this thesis add to the current knowledge regarding the complex pathophysiological abnormalities in patients undergoing pancreaticoduodenectomy, with specific emphasis on the interaction between cardiopulmonary exercise physiology, obstructive jaundice, systemic inflammation and postoperative outcomes. The work presented in this thesis lays the foundations for further studies aimed at improving outcomes after pancreaticoduodenectomy through the development of individualised, goal-directed therapies that are initiated well before this morbid yet necessary operation is performed.