A box in the field: modernity and the barn in twentieth-century Ireland

This paper argues that the modern barn in Ireland is a complex social and architectural phenomena that is without, or has yet to find, a satisfactory discourse. Emerging in the middle third of the twentieth century, the modern barn – replete with corrugated iron and I-sections – continues to represent a presence in the Irish landscape whose ubiquity is as emphatic as its flexibility. It is, however, its universal properties that begin to suggest connections with wider narratives. The modernising aspects of the barn that appear in the 1920s and 30s begin to conflate with a rhetoric of architectural modernism which was simultaneously appearing across Europe. But while the relationship between high modernism’s critique of what it divined as the inspirational qualities of utilitarian buildings – Walter Gropius on grain silos, Le Corbusier on aircraft hangers etc. – has been well-documented, in Ireland this relationship perhaps contains another layer of complexity.
The barn’s consolidation as a modern type coincided with the search for a nation’s cultural identity after centuries of colonial rule. This tended to be an introspective vision that prioritised rural space over urban space, agriculture over industry, and imagined the small farm as a central tenet in the construction of a new State. This paper suggests that the twentieth-century barn – as a product of the mechanisation of agriculture promoted by the new administrations – is an iconic structure, emblematic of attempts to reconcile the contradictory forces and imagery of modernity with the mores of a traditional society. Moreover, given a cultural purview that was often ambivalent or even hostile to the ideologies and forms of modernity, the barn in Ireland is, perhaps, not so much the inspiration but the realisation of an architectural modernism in that country at its most pervasive, enduring and unself-conscious.

Personalised and Precision Medicine in Cancer Clinical Trials: Panacea for Progress or Pandora's Box?

Cancer clinical trials have been one of the key foundations for significant advances in oncology. However, there is a clear recognition within the academic, care delivery and pharmaceutical/biotech communities that our current model of clinical trial discovery and development is no longer fit for purpose. Delivering transformative cancer care should increasingly be our mantra, rather than maintaining the status quo of, at best, the often miniscule incremental benefits that are observed with many current clinical trials. As we enter the era of precision medicine for personalised cancer care (precision and personalised medicine), it is important that we capture and utilise our greater understanding of the biology of disease to drive innovative approaches in clinical trial design and implementation that can lead to a step change in cancer care delivery. A number of advances have been practice changing (e.g. imatinib mesylate in chronic myeloid leukaemia, Herceptin in erb-B2-positive breast cancer), and increasingly we are seeing the promise of a number of newer approaches, particularly in diseases like lung cancer and melanoma. Targeting immune checkpoints has recently yielded some highly promising results. New algorithms that maximise the effectiveness of clinical trials, through for example a multi-stage, multi-arm type design are increasingly gaining traction. However, our enthusiasm for the undoubted advances that have been achieved are being tempered by a realisation that these new approaches may have significant cost implications. This article will address these competing issues, mainly from a European perspective, highlight the problems and challenges to healthcare systems and suggest potential solutions that will ensure that the cost/value rubicon is addressed in a way that allows stakeholders to work together to deliver optimal cost-effective cancer care, the benefits of which can be transferred directly to our patients.

Music therapy for end-of-life care: an updated systematic review

Background: Music therapy during palliative and end-of-life care is well established and positive benefits for patients have been reported.
Aim: Assess the effectiveness of music therapy versus standard care alone or standard care in combination with other therapies for improving psychological, physiological and social outcomes among adult patients in any palliative care setting.
Data sources: In order to update an existing Cochrane systematic review, we searched MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, ClinicalTrials.gov register, and Current Controlled Trials register to identify randomised or quasi-randomised controlled trails published between 2009 and April 2015. Nine electronic music therapy journals were searched from 2009 until April 2015, along with reference lists and contact was made with key experts in music therapy. Only studies published in English were eligible for inclusion. Two reviewers independently screened titles, abstracts, assessed relevant studies for eligibility, extracted data and judged risk of bias for included studies. Disagreements were resolved through discussion with a third reviewer. Data were synthesised in Revman using the random effects model. Heterogeneity was assessed using l2.
Results: Three studies were included in the review. Findings suggest music therapy may be effective for helping to reduce pain in palliative care patients (standard mean deviation (SMD) = -0.42, 95% CI -0.68 to -0.17, P = 0.001).
Conclusions: Available evidence did not support the use of music therapy to improve overall quality-of-life in palliative care. While this review suggests music therapy may be effective for reducing pain, this is based on studies with a high risk of bias. Further high quality research is required.