Diverse heritage: exploring literary identity in the American Southwest

Since the age of colonisation, the territory of New Mexico has been exposed to a diversity of cultural influence. Throughout recorded history various forces have battled for control of this territory, resulting in a continuous redefinition of its political, geographic and economic boundaries. Early representations of the Southwest have been defined as “strategies of negotiation” between Anglo, Hispanic and Native populations, strategies that are particularly evident in the territory of New Mexico. The contemporary identity of regions like northern New Mexico have destabilised the notion of what constitutes racial purity in regions which are defined by diversity. This thesis aims to evaluate the literary history of northern New Mexico in order to determine how exposure to a diversity of cultural influence has affected the region’s identity. An analysis of Anglo and Native writers from northern New Mexico will illustrate that these racial groups were influenced by the same geographic landscape. As such, their writing displays many characteristics unique to the region. In providing a comparative analysis of Native and Anglo authors from northern New Mexico, this thesis seeks to demonstrate commonalities of theme, structure and content. In doing so this research encourages a new perspective on New Mexico writing one which effectively de-centres contemporary notions of what the American canon should be.

Thomas Wolfe and the genre question: Beyond the "charge of autobiography"

The North Carolinian author Thomas Wolfe (1900‐1938) has long suffered under the “charge of autobiography,” which lingers to this day in critical assessments of his work. Criticism of Wolfe is frequently concerned with questions of generic classification, but since the 1950s, re‐assessments of Wolfe’s work have suggested that Wolfe’s “autobiographical fiction” exhibits a complexity that merits further investigation. Strides in autobiographical and narrative theory have prompted reconsiderations of texts that defy the artificial boundaries of autobiography and fiction. Wolfe has been somewhat neglected in the canon of American fiction of his era, but deserves to be reconsidered in terms of how he engages with the challenges and contradictions of writing about or around the self. This thesis investigates why Wolfe’s work has been the source of considerable critical discomfort and confusion with regard to the relationship between Wolfe’s life and his writing. It explores this issue through an examination of elements of Wolfe’s work that problematise categorisation. Firstly, it investigates the concept of Wolfe as “storyteller.” It explores the motivations and philosophies that underpin Wolfe’s work and his concept of himself as a teller of tales, and examines aspects of Wolfe’s writing process that have their roots in medieval traditions of the memorisation and recitation of tales. The thesis then conducts a detailed examination of how Wolfe describes the process of transforming his memory into narrative through writing. The latter half of the thesis examines narrative techniques used by Wolfe, firstly analysing his extensive use of the iterative and pseudo‐iterative modes, and then his unusual deployment of narrators and focalization. This project sheds light on elements of Wolfe’s approach to writing and narrative strategies that he employs that have previously been overlooked, and that have created considerable critical confusion with regard to the supposedly “autobiographical” genesis of his work.

The effects of copayment policies on adherence to prescription medicines in publicly insured populations

Introduction: Copayments for prescriptions are associated with decreased adherence to medicines resulting in increased health service utilisation, morbidity and mortality. In October 2010 a 50c copayment per prescription item was introduced on the General Medical Services (GMS) scheme in Ireland, the national public health insurance programme for low-income and older people. The copayment was increased to €1.50 per prescription item in January 2013. To date, the impact of these copayments on adherence to prescription medicines on the GMS scheme has not been assessed. Given that the GMS population comprises more than 40% of the Irish population, this presents an important public health problem. The aim of this thesis was to assess the impact of two prescription copayments, 50c and €1.50, on adherence to medicines.Methods: In Chapter 2 the published literature was systematically reviewed with meta-analysis to a) develop evidence on cost-sharing for prescriptions and adherence to medicines and b) develop evidence for an alternative policy option; removal of copayments. The core research question of this thesis was addressed by a large before and after longitudinal study, with comparator group, using the national pharmacy claims database. New users of essential and less-essential medicines were included in the study with sample sizes ranging from 7,007 to 136,111 individuals in different medication groups. Segmented regression was used with generalised estimating equations to allow for correlations between repeated monthly measurements of adherence. A qualitative study involving 24 individuals was conducted to assess patient attitudes towards the 50c copayment policy. The qualitative and quantitative findings were integrated in the discussion chapter of the thesis. The vast majority of the literature on this topic area is generated in North America, therefore a test of generalisability was carried out in Chapter 5 by comparing the impact of two similar copayment interventions on adherence, one in the U.S. and one in Ireland. The method used to measure adherence in Chapters 3 and 5 was validated in Chapter 6. Results: The systematic review with meta-analysis demonstrated an 11% (95% CI 1.09 to 1.14) increased odds of non-adherence when publicly insured populations were exposed to copayments. The second systematic review found moderate but variable improvements in adherence after removal/reduction of copayments in a general population. The core paper of this thesis found that both the 50c and €1.50 copayments on the GMS scheme were associated with larger reductions in adherence to less-essential medicines than essential medicines directly after the implementation of policies. An important exception to this pattern was observed; adherence to anti-depressant medications declined by a larger extent than adherence to other essential medicines after both copayments. The cross country comparison indicated that North American evidence on cost-sharing for prescriptions is not automatically generalisable to the Irish setting. Irish patients had greater immediate decreases of -5.3% (95% CI -6.9 to -3.7) and -2.8% (95% CI -4.9 to -0.7) in adherence to anti-hypertensives and anti-hyperlipidaemic medicines, respectively, directly after the policy changes, relative to their U.S. counterparts. In the long term, however, the U.S. and Irish populations had similar behaviours. The concordance study highlighted the possibility of a measurement bias occurring for the measurement of adherence to non-steroidal anti-inflammatory drugs in Chapter 3. Conclusions: This thesis has presented two reviews of international cost-sharing policies, an assessment of the generalisability of international evidence and both qualitative and quantitative examinations of cost-sharing policies for prescription medicines on the GMS scheme in Ireland. It was found that the introduction of a 50c copayment and its subsequent increase to €1.50 on the GMS scheme had a larger impact on adherence to less-essential medicines relative to essential medicines, with the exception of anti-depressant medications. This is in line with policy objectives to reduce moral hazard and is therefore demonstrative of the value of such policies. There are however some caveats. The copayment now stands at €2.50 per prescription item. The impact of this increase in copayment has yet to be assessed which is an obvious point for future research. Careful monitoring for adverse effects in socio-economically disadvantaged groups within the GMS population is also warranted. International evidence can be applied to the Irish setting to aid in future decision making in this area, but not without placing it in the local context first. Patients accepted the introduction of the 50c charge, however did voice concerns over a rising price. The challenge for policymakers is to find the ‘optimal copayment’ – whereby moral hazard is decreased, but access to essential chronic disease medicines that provide advantages at the population level is not deterred. This evidence presented in this thesis will be utilisable for future policy-making in Ireland.

“Something isn’t right here”: American exceptionalism and the creative nonfiction of the Vietnam War

In this thesis, I argue that few attempts were as effective in correcting the exceptionalist ethos of the United States than the creative nonfiction written by the veterans and journalists of the Vietnam War. Using critical works on creative nonfiction, I identify the characteristics of the genre that allowed Paul John Eakin to call it ‘a special kind of fiction.’ I summarise a brief history of creative nonfiction to demonstrate how it became a distinctly American form despite its Old World origins. I then claim that it was the genre most suited to the kind of ideological transformation that many hoped to instigate in U.S. society in the aftermath of Vietnam. Following this, the study explores how this “new” myth-making process occurred. I use Tim O’Brien’s If I Die in a Combat Zone and Philip Caputo’s A Rumor of War to illustrate how autobiography/memoir was able to demonstrate the detrimental effect that America’s exceptionalist ideology was having on its population. Utilising narrative and autobiographical theory, I contend that these accounts represented a collective voice which spoke for all Americans in the years after Vietnam. Using Neil Sheehan’s A Bright Shining Lie and C.D.B. Bryan’s Friendly Fire, I illustrate how literary journalism highlighted the hubris of the American government. I contend that while poiesis is an integral attribute of creative nonfiction, by the inclusion of extraneous bibliographic material, authors of the genre could also be seen as creating a literary context predisposing the reader towards an empirical interpretation of the events documented within. Finally, I claim that oral histories were in their essence a synthesis of “everyman” experiences very much in keeping with the American zeitgeist of the early Eighties. Focussing solely on Al Santoli’s Everything We Had, I demonstrate how such polyphonic narratives personalised the history of the Vietnam War.

Claude McKay and the transnational novel

This thesis considers the three works of fiction of the Jamaican author Claude McKay (1889-1948) as a coherent transnational trilogy which dramatises the semi-autobiographical complexities of diasporic exile and return in the period of the 1920s and 1930s. Chapter One explores McKay’s urban North American novel, Home to Harlem (1928). I suggest that we need to ‘reworld’ conceptions of McKay’s writing in order to release him from his canonical confinement in the Harlem Renaissance. Querying the problematics of the city space, of sexuality and of race as they emerge in the novel, this chapter considers McKay’s percipient understanding of the need to reconfigure diasporic identity beyond the limits set by American nationalism. Chapter Two engages with McKay’s novel of portside Marseilles, Banjo (1929), and considers the homosocial interactions of the vagabond collective. A comparison of North America and France as supposed exemplars of individual liberty highlights the unsuitability of nationalistic prerogatives to an internally diverse black diaspora. Paul Gilroy’s Black Atlantic construct provides a suggestive space in which to re-imagine the possibilities of affiliation in the port. The latter section of the chapter examines McKay’s particular influence on, and relationship, to the Négritude movement and Pan-African philosophies. Chapter Three focuses on McKay’s third novel, Banana Bottom (1933). I suggest here that the three novels comprise a coherent New World Trilogy comparable to Edward (Kamau) Brathwaite’s trilogy, The Arrivants. This chapter considers both the Caribbean and the transnational dimensions to McKay’s work.

Aspects of the biology of Mya arenaria and Ensis spp. (Mollusca; Bivalvia) in the Irish Sea and adjacent areas

This study was undertaken to investigate the general biology, including the reproductive cycle and health status, of two clam taxa in Irish waters, with particular reference to the Irish Sea area. Monthly samples of the soft shell clam, Mya arenaria, were collected from Bannow Bay, Co. Wexford, Ireland, for sixteen months, and of the razor clam, Ensis spp. from the Skerries region (Irish Sea) between June 2010 and September 2011. In 2010, M. arenaria in Bannow Bay matured over the summer months, with both sexes either ripe or spawning by August. The gonads of both sexes of E. siliqua developed over autumn and winter 2010, with the first spawning individuals being recorded in January 2011. Two unusually cold winters, followed by a warmer than average spring, appear to have affected M. arenaria and E. siliqua gametogenesis at these sites. It was noted that wet weight of E. siliqua dropped significantly in the summer of both 2010 and 2011, after spawning, which may impact on the economic viability of fishing during this period. Additional samples of M. arenaria were collected at Flaxfort (Ireland), and Ensis spp. at Oxwich (Wales), and the pathology of all clams was examined using both histological and molecular methods. No pathogenic conditions were observed in M. arenaria while Prokaryote inclusions, trematode parasites, Nematopsis spp. and inflammatory pathologies were observed at low incidences in razor clams from Ireland but not from Wales; the first time these conditions have been reported in Ensis spp. in northern European waters. Mya arenaria from sites in Europe and eastern and western North America were investigated for genetic variation using both mitochondrial (cytochrome oxidase I (COI) and 16S ribosomal RNA genes) and nuclear markers (10 microsatellite loci). Both mitochondrial CO1 and all nuclear markers showed reduced levels of variation in certain European samples, with significant differences in haplotype and allelic composition between most samples, particularly those from the two different continents, but with the same common haplotypes or alleles throughout the range. The appearance of certain unique rare haplotypes and microsatellite alleles in the European samples suggest a complicated origin involving North American colonization but also possible southern European Pleistocene refugia. Specimens of Ensis spp. were obtained from five coastal areas around Ireland and Wales and species-specific PCR primers were used to amplify the internal transcribed spacer region 1 (ITS1) and the mitochondrial DNA CO1 gene and all but 15 razor clams were identified as Ensis siliqua. Future investigations should focus on continued monitoring of reproductive biology and pathology of the two clam taxa (in particular, to assess the influence of environmental change), and on genetics of southern European M. arenaria and sequencing the CO1 gene in Ensis individuals to clarify species identity

Chicana poetics: genre and style in Gloria Anzaldúa and Lorna Dee Cervantes

This thesis conducts a formal study of the poetry of Gloria Anzaldúa and Lorna Dee Cervantes, placing their work in dialogue with genre and style. These two Chicana poets are exemplary of politicised experimentation with poetics, underpinned by a keen awareness of the rich history of form, genre and style. In the work of each poet, two poetic modes are examined: one traditional, and one experimental. Anzaldúa’s uses of the dramatic monologue as a border genre, and her construction of [auto]poetics, stemming from her multi-genre, autobiographical approach to writing, are considered. Cervantes’s complex approach to the construction of docupoetics that achieves a depth of field in terms of merging a multidimensional approach to aesthetics with highly politicised transnational content, as well as her engagement with the longstanding poetic of elegy via various formal points of entry, is investigated. These poetic modes are primarily explored via close readings, supported by a multidisciplinary framework that includes Anzaldúa’s feminist theories of identity and writing, abjection theory, postcolonialism, and transnationalism. Overall, these four key areas demonstrate the ways in which aesthetics is a crucial consideration in the exploration of the broader issues of content and context in Chicana poetry.