Betha Cholmáin maic Luacháin: an ecclesiastical microcosm of the twelfth-century Irish midlands

Betha Cholmáin maic Luacháin (BCh) is a key source of information about a small ecclesiastical community of the Irish midlands in the medieval period. BCh is one of the longest medieval Irish hagiographic texts. A sole copy exists. Scholarly concern with manuscript Rennes 598, and the Life of Colmán therein, diminished following the 1911 edition of BCh. The most attention paid to BCh in the following decades focused largely on its onomastic information. The necessary detailed study of the text has not been undertaken. The present work is an initial view of significant areas of interaction between the church of Lann and its ecclesiastical, social and political milieu. While social and cultural aspects of the text may constitute the focus of this study, linguistic data is also investigated, complementary to evidence regarding its social and political testimony. In this way, light is cast on a complex ecclesiastical microcosm in the twelfth-century Irish midlands. In keeping with recent methodological work in the field a variety of tools are used to aid investigation, and to show the Life within its genre and wider context. An interdisciplinary approach will bring together strands of literary, cultural, archaeological, onomastic, historical, geographical, genealogical and hagiographical information, with reference to linguistic evidence where appropriate. This thesis seeks to suggest a template for studies undertaken on smaller church communities, and is set out in two main sections. The first section investigates the figure of the saint, his life, church, the manuscript source and the combination of prose and verse in the text. The second section examines the testimony of the Life regarding the ecclesiastical and secular concerns of the community of Lann, and how these concerns are represented. Evidence regarding the members of this community and their interaction with the church and the wider world is also discussed.

Representations of Catholicism in selected works by Colm Tóibín

The aim of this thesis is to provide an original and extensive study of Colm Tóibín as the “secular revisionist who acknowledges Catholicism as an enduring element of Irish society” (Ryan, Ireland and Scotland 251). Tóibín is uniquely placed to interpret many aspects of Ireland in the latter half of the twentieth century and I will argue that intertwined with his revisionism of Irish history is a reimagining of Ireland and Catholicism in fictive terms. An extensive amount of material from Tóibín’s time as a journalist and travel writer will feature in my research because it validates my argument concerning his prolonged engagement with Catholicism. Similarly, a broad range of Tóibín’s prose will be studied because it affords opportunities for an exploration of a literary Catholic oeuvre in his fiction. Therefore, I am emphasizing that a crucial linkage of Catholicism is identifiable throughout Tóibín’s diverse canon of work. However, I will argue that divergences of attitude and mode can be found in how Tóibín depicts Catholicism in his journalism and fiction. My argument identifies Tóibín’s recurrent journalistic questioning of the Church’s teaching and leadership but I classify a benignity towards Catholicism in his travel writing and fiction. Overall, Tóibín’s fiction merits significant status in this thesis because of the representations of Catholicism in the work of a writer who has been short-listed three times for The Booker Prize.

Theme and variations: Christianity and regional landscapes in early medieval Ireland

This thesis explores the impact of Christianity on the landscape in Ireland from the conversion period to the coming of the Anglo-Normans. The premise is that ecclesiastical and secular settlement formed a cohesive whole which characterised the societal organisation of early medieval Ireland. The matter of the thesis is to isolate some of the agents of cohesion to see was this homogenous or did it vary in different areas. One of these agents was the ownership of land and the thesis undertakes to identify ecclesiastical landholding and examine the manner of settlement on it. A corollary is to explore the contribution of the genealogical link between kin-group, founding saint and territory to the construction of local identities. This necessitated a narrow focus; thus small study areas were chosen, which approximated to early medieval kingdoms in North Louth, Rathdown, Co Dublin and Ross, Co Cork. A multidisciplinary approach was taken using both archaeological and documentary evidence. The thesis found ecclesiastical sites were at the same density through the study areas, but there were considerable regional variations in related secular settlement. Ecclesiastical estates were identified in the three study areas and common settlement patterns were found in two of them. Settlement in all areas indicated the foundation of minor churches by local groups. Ecclesiastical sites were found to be integral to kin-group identity and status, but the manner in which each group negotiated this, was very different. Finally the thesis examined material evidence for a change from diffused to concentrated power in the political organisation of Irish society, a process entwined with developments of the Viking Age. This centralisation of power and associated re-formation of identity was still often mediated through the ecclesiastical sphere but the thesis demonstrates diversity in the materialising of the mediation.

Lower extremity amputation in people with diabetes: Trends and determinants

Introduction: The prevalence of diabetes is rising rapidly. Assessing quality of diabetes care is difficult. Lower Extremity Amputation (LEA) is recognised as a marker of the quality of diabetes care. The focus of this thesis was first to describe the trends in LEA rates in people with and without diabetes in the Republic of Ireland (RoI) in recent years and then, to explore the determinants of LEA in people with diabetes. While clinical and socio-demographic determinants have been well-established, the role of service-related factors has been less well-explored. Methods: Using hospital discharge data, trends in LEA rates in people with and without diabetes were described and compared to other countries. Background work included concordance studies exploring the reliability of hospital discharge data for recording LEA and diabetes and estimation of diabetes prevalence rates in the RoI from a nationally representative study (SLAN 2007). To explore determinants, a systematic review and meta-analysis assessed the effect of contact with a podiatrist on the outcome of LEA in people with diabetes. Finally, a case-control study using hospital discharge data explored determinants of LEA in people with diabetes with a particular focus on the timing of access to secondary healthcare services as a risk factor. Results: There are high levels of agreement between hospital discharge data and medical records for LEA and diabetes. Thus, hospital discharge data was deemed sufficiently reliable for use in this PhD thesis. A decrease in major diabetes-related LEA rates in people with diabetes was observed in the RoI from 2005-2012. In 2012, the relative risk of a person with diabetes undergoing a major LEA was 6.2 times (95% CI 4.8-8.1) that of a person without diabetes. Based on the systematic review and meta-analysis, contact with a podiatrist did not significantly affect the relative risk (RR) of LEA in people with diabetes. Results from the case-control study identified being single, documented CKD and documented hypertension as significant risk factors for LEA in people with diabetes whilst documented retinopathy was protective. Within the seven year time window included in the study, no association was detected between LEA in patients with diabetes and timing of patient access to secondary healthcare for diabetes management. Discussion: Many countries have reported reduced major LEA rates in people with diabetes coinciding with improved organisation of healthcare systems. Reassuringly, these first national estimates in people with diabetes in the RoI from 2005 to 2012 demonstrated reducing trends in major LEA rates. This may be attributable to changes in diabetes care and also, secular trends in smoking, dyslipidaemia and hypertension. Consistent with international practice, LEA trends data in Ireland can be used to monitor quality of care. Quantifying this improvement precisely, though, is problematic without robust denominator data on the prevalence of diabetes. However, a reduction in major diabetes-related LEA rates suggests improved quality of diabetes care. Much controversy exists around the reliability of hospital discharge data in the RoI. This thesis includes the first multi-site study to explore this issue and found hospital discharge data reliable for the reporting of the procedure of LEA and diagnosis of diabetes. This project did not detect protective effects of access to services including podiatry and secondary healthcare for LEA in people with diabetes. A major limitation of the systematic review and meta-analysis was the design and quality of the included studies. The data available in the area of effect of contact with a podiatrist on LEA risk are too sparse to say anything definitive about the efficacy of podiatry on LEA. Limitations of the case-control study include lack of a diabetes register in Ireland, restricted information from secondary healthcare and lack of data available from primary healthcare. Due to these issues, duration of disease could not be accounted for in the study which limits the conclusions that can be drawn from the results. The model of diabetes care in the RoI is currently undergoing a re-configuration with plans to introduce integrated care. In the future, trends in LEA rates should be continuously monitored to evaluate the effectiveness of changes to the healthcare system. Efforts are already underway to improve the availability of routine data from primary healthcare with the recent development of the iPCRN (Irish Primary Care Research Network). Linkage of primary and secondary healthcare records with a unique patient identifier should be the goal for the future.

Creating religious place in Ireland: Hindu public places of worship and the Indian sculpture park

This paper examines the creation of religious place. It argues that the designation of a place as “religious” is a subjective and creative act which is dependent upon the perception and past, or memory, of the viewer. The paper focuses specifically on the creation of public places of worship by Hindu groups in the Dublin city area of Ireland and on the varied perceptions of the Indian Sculpture Park in County Wicklow. The creation of public places of worship results in places classified as “religious” due to the intention of the creator, the terminology used and the types of activities that take place in the space. This is in contrast to places such as the Indian Sculpture Park in County Wicklow which was created as a secular space but which is viewed by some Hindus as an outdoor temple due to the presence of sculptures of the Hindu deity Ganesh. Other Hindus do not view the space as having any religious significance and so its religiosity is contested. This points to the fact that the creation of religious place is a creative act of interpretation which is dependent upon the perception and past of the viewer and which changes over time.