Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine. Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration. Results: Graduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback. Conclusions: The group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.

Revisiting Irish poetic modernisms

This thesis discusses Irish Modernist poetry written between 1905 and 1970, specifically the poetry of Joseph Campbell (1879-1944), Thomas MacGreevy (1893-1967), Denis Devlin (1908-1959) and Brian Coffey (1905-1995). All four poets have been largely neglected in criticism until a growth of interest encouraged by Michael Smith and Trevor Joyce’s New Writers’ Press during the 1970s. J.C.C. Mays, Stan Smith, Susan Schreibman, Terence Brown, Patricia Coughlan and Alex Davis published subsequent critical support during the ‘80s and ‘90s. My research aims to highlight poetry previously omitted from the canon of Irish literature, those with connections to British or continental European literary movements as well as poetry by women writers and writers from the North. Part of this exploration of Irish Poetic Modernisms involves an investigation of intersections between poetic modernisms and Irish war poetry and of depictions of Irish masculinity in the poetry of Devlin and Coffey. My discussion of Campbell’s poetry focuses on links between the early regional modernism of his poetry and later Irish modernist poetry, including his participation in the Ulster Literary Theatre, with the Literary Revival community in Dublin and his association with the proto-Imagist movement in London. My examination of connections between Irish war poetry and Irish modernism allows me to discuss the writing of several underrecognized Irish poets who are contemporaries and near contemporaries of the main subjects of my thesis. Thomas MacGreevy’s poetry is the most clear case study of the links between Irish modernist poetry and poetry about Ireland’s participation in the Great War. MacGreevy’s writing reveals his multiple allegiances: he both elegizes and challenges the increasing cultural inhibitions of Free State Ireland. Denis Devlin’s poetic portrayals of Ireland reveal his rejection both of the Literary Revival’s fascination with Celticism and of Dublin’s literary community while upholding tradition poetic gender roles. My research explores representations of masculinity and Irish politics, including heroic masculine imagery, in the long poems of Devlin and Coffey. My discussion of Brian Coffey considers the importance of the figure of the “poet as maker” to his writing and his relationship with Ireland during his long writing career. I also consider his role as the editor and executor of Devlin’s literary estate and the impact that had on both the latter’s posthumous reputation and Coffey’s later writing.

An examination of the construction of meanings for obesity in Ireland

Obesity has been defined as a consequence of energy imbalance, where energy intake exceeds energy expenditure and results in a build-up of adipose tissue. However, this scientific definition masks the complicated social meanings associated with the condition. This research investigated the construction of meaning around obesity at various levels of inquiry to inform how obesity is portrayed and understood in Ireland. A multi-paradigmatic approach was adopted, drawing on theory and methods from psychology and sociology and an analytical framework combining the Common Sense Model and framing theory was employed. In order to examine the exo-level meanings of obesity, content analysis was performed on two media data sets (n=479, n=346) and a thematic analysis was also performed on the multiple newspaper sample (n=346). At the micro-level, obesity discourses were investigated via the thematic analysis of comments sampled from an online message board. Finally, an online survey assessed individual-level beliefs and understandings of obesity. The media analysis revealed that individual blame for obesity was pervasive and the behavioural frame was dominant. A significant increase in attention to obesity over time was observed, manifestations of weight stigma were common, and there was an emotive discourse of blame directed towards the parents of obese children. The micro-level analysis provided insight into the weight-based stigma in society and a clear set of negative ‘default’ judgements accompanied the obese label. The survey analysis confirmed that the behavioural frame was the dominant means of understanding obesity. One of the strengths of this thesis is the link created between framing and the Common Sense Model in the development of an analytical framework for application in the examination of health/illness representations. This approach helped to ascertain the extent of the pervasive biomedical and individual blame discourse on obesity, which establishes the basis for the stigmatisation of obese persons.

Early biomarkers to predict grade of encephalopathy following hypoxic ischaemic injury

The standard early markers for identifying and grading HIE severity, are not sufficient to ensure all children who would benefit from treatment are identified in a timely fashion. The aim of this thesis was to explore potential early biomarkers of HIE. Methods: To achieve this a cohort of infants with perinatal depression was prospectively recruited. All infants had cord blood samples drawn and biobanked, and were assessed with standardised neurological examination, and early continuous multi-channel EEG. Cord samples from a control cohort of healthy infants were used for comparison. Biomarkers studied included; multiple inflammatory proteins using multiplex assay; the metabolomics profile using LC/MS; and the miRNA profile using microarray. Results: Eighty five infants with perinatal depression were recruited. Analysis of inflammatory proteins consisted of exploratory analysis of 37 analytes conducted in a sub-population, followed by validation of all significantly altered analytes in the remaining population. IL-6 and IL-6 differed significantly in infants with a moderate/severely abnormal vs. a normal-mildly abnormal EEG in both cohorts (Exploratory: p=0.016, p=0.005: Validation: p=0.024, p=0.039; respectively). Metabolomic analysis demonstrated a perturbation in 29 metabolites. A Cross- validated Partial Least Square Discriminant Analysis model was developed, which accurately predicted HIE with an AUC of 0.92 (95% CI: 0.84-0.97). Analysis of the miRNA profile found 70 miRNA significantly altered between moderate/severely encephalopathic infants and controls. miRNA target prediction databases identified potential targets for the altered miRNA in pathways involved in cellular metabolism, cell cycle and apoptosis, cell signaling, and the inflammatory cascade. Conclusion: This thesis has demonstrated that the recruitment of a large cohortof asphyxiated infants, with cord blood carefully biobanked, and detailed early neurophysiological and clinical assessment recorded, is feasible. Additionally the results described, provide potential alternate and novel blood based biomarkers for the identification and assessment of HIE.

The demise of the Beothuk as a past still present

This article aims to investigate contemporary cultural representations of the Beothuk Indians in art, literature and museum displays in Newfoundland, Canada, focussing on ways these reimagine the past for the present, offering perspectives on contested histories, such as the circumstances leading to the demise of the Beothuk. Wiped out through the impact of colonialism, the Beothuk are the ‘absent other’ who continue to be remembered and made present through the creative arts, largely at the expense of other indigenous groups on the island. Rather than focussing on the ‘non-absent past, according to Polish scholar Ewa Domańska, ‘instead we turn to a past that is somehow still present, that will not go away or, rather, that of which we cannot rid ourselves’ (2006, 346). Depictions of the last Beothuk are part of a cultural remembering where guilt and reconciliation are played out through media of the imagination