Assessment by doppler ultrasound of entheseal lesions in spondyloarthritis : a longitudial study to determine structural damage and disease activity lesions

RESUMO: Enthesitis is the hallmark of spondyloarthritis (SpA), and is observed in all subtypes. Wide information on SpA abnormalities, including synovitis, tendinitis and enthesitis, can be efficiently perceived by Doppler ultrasound. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect enthesis alterations; and vascularized enthesitis detected by Doppler ultrasound appears to be a valuable diagnostic tool to confirm SpA diagnosis. However, data published until now concerning entheseal elementary alterations that characterize SpA enthesitis (enthesis inflammatory activity) or enthesopathy (permanent structural changes) reflect rather the authors’ empiric opinion than a methodological validation process. In this sense it seems crucial to identify elementary entheseal lesions associated with activity or damage, in order to improve monitoring and treatment response in SpA patients. The development of better assessment tools is today a challenge and a need in SpA. The first study of this thesis focused on the analysis of the reliability of inter-lector and inter-ultrasonography equipment of Madrid sonography enthesitis index (MASEI). Fundamental data for the remaining unrolling project validity. In the second and third studies we concerned about two entheseal elemental lesions: erosions and bursa. In literature erosions represent a permanent structural damage, being useful for monitoring joint injury, disease activity and therapeutic response in many rheumatic diseases; and to date, this concept has been mostly applied in rheumatoid arthritis (RA). Unquestionably, erosion is a tissue-related damage and a structural change. However, the hypothesis that we decided to test was if erosions represent a permanent structural change that can only grow and worsen over time, as occurs in RA, or a transitory alteration. A longitudinal study of early SpA patients was undertaken, and the Achilles enthesis was used as a model. Our results strongly suggested that previously detected erosions could disappear during the course of the disease, being consistent with the dynamic behavior of erosion over time. Based on these striking results it seems reasonable to suggest that the new-bone formation process in SpA could be associated with the resolution of cortical entheseal erosion over time. These results could also be in agreement with the apparent failure of anti-tumor necrosis factor (TNF) therapies to control bone proliferation in SpA; and with the relation of TNF-α, Dickkopf-related protein 1 (Dkk-1) and the regulatory molecule of the Wnt signaling pathway in the bone proliferation in SpA. In the same model, we then proceeded to study the enthesis bursa. Interestingly, the Outcome Measures in Rheumatology Clinical Trials (OMERACT) enthesopathy definition does not include bursa as an elementary entheseal lesion. Nonetheless, bursa was included in 46% of the enthesis studies in a recently systematic literature review, being in agreement with the concept of “synovio-entheseal complex” that includes the link between enthesitis and osteitis in SpA. It has been clarified in recent data that there is not only a close functional integration of the enthesis with the neighboring bone, but also a connection between enthesitis and synovitis. Therefore, we tried to assess the prevalence and relevance of the bursa-synovial lesion in SpA. Our findings showed a significant increase of Achilles bursa presence and thickness in SpA patients compared to controls (healthy/mechanical controls and RA controls). These results raise awareness to the need to improve the enthesopathy ultrasonographic definition. In the final work of this thesis, we have explored new perspectives, not previously reported, about construct validity of enthesis ultrasound as a possible activity outcome in SpA. We performed a longitudinal Achilles enthesis ultrasound study in patients with early SpA. Achilles ultrasound examinations were performed at baseline, six- and twelve-month time periods and compared with clinical outcome measures collected at basal visit. Our results showed that basal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are higher in patients with Doppler signal in enthesis, and even that higher basal ESR, CRP and Ankylosing Spondylitis Disease Activity Score (ASDAS) predicted a higher Doppler signal (an ultrasound alteration accepted as representative of inflammation) six months later. Patients with very high disease activity assessed by ASDAS (>3.5) at baseline had significantly higher Achilles total ultrasound score verified at the same time; and ASDAS <1.3 predicted no Doppler signal at six and twelve months. This seems to represent a connection between classical biomarkers and clinical outcomes associated with SpA activity and Doppler signal, not only at the same time, but also for the following months. Remarkably, patients with inactive disease (ASDAS < 1.3) at baseline had no Doppler signal at six and twelve months. These findings reinforce the potential use of ultrasound related techniques for disease progression assessment and prognosis purposes. Intriguingly, Ankylosing Spondylitis Disease Activity Index (BASDAI) didn’t show significant differences between different cut-offs concerning ultrasound lesions or Doppler signal, while verified with ASDAS. These results seem to indicate that ASDAS reflects better than BASDAI what happens in the enthesis. The work herein discussed clearly shows the potential utility of ultrasound in enthesis assessment in SpA patients, and can be important for the development of ultrasound activity and structural damage scores for diagnosis and monitoring purposes. Therefore, local promotion of this technique constitutes a medical intervention that is worth being tested in SpA patients for diagnosis, monitoring and prognosis purposes.

Toxic substances in blood: an analysis of current recommendations under a Bayesian (decision) approach

This article extends existing discussion in literature on probabilistic inference and decision making with respect to continuous hypotheses that are prevalent in forensic toxicology. As a main aim, this research investigates the properties of a widely followed approach for quantifying the level of toxic substances in blood samples, and to compare this procedure with a Bayesian probabilistic approach. As an example, attention is confined to the presence of toxic substances, such as THC, in blood from car drivers. In this context, the interpretation of results from laboratory analyses needs to take into account legal requirements for establishing the 'presence' of target substances in blood. In a first part, the performance of the proposed Bayesian model for the estimation of an unknown parameter (here, the amount of a toxic substance) is illustrated and compared with the currently used method. The model is then used in a second part to approach-in a rational way-the decision component of the problem, that is judicial questions of the kind 'Is the quantity of THC measured in the blood over the legal threshold of 1.5 μg/l?'. This is pointed out through a practical example.

(Re)writing the other/self : autoethnography in the transcultural arena of representation

Abstract: In Imperial Eyes Mary Louise Pratt (1992: 7, emphasis original) defines autoethnography as "instances in which colonized subjects undertake to represent themselves in ways that engage with the colonizer's own terms ... in response to or in dialogue with . . . metropolitan representations." Although Pratt's conceptualization of autoethnography has much to offer post-colonial studies, it has received little attention in the field. In this thesis, I interrogate Pratt's notion of autoethnography as a theoretical tool for understanding the self-representations of subordinate peoples within transcultural terrains of signification. I argue that autoethnography is a concept that allows us to move beyond some theoretical dualisms, and to recognize the (necessary) coexistence of subordinate peoples' simultaneous accommodation of and resistance to dominant representations of themselves. I suggest that even when autoethnographic expressions seem to rely on or to reproduce dominant knowledges, their very existence as speech acts implicitly resists dominant discourses which objectify members of oppressed populations and re-create them as Native Informants. I use Pratt's concept to analyze two books by Islamic feminist sociologist Fatima Memissi. Memissi's Dreams ofTrespass and Scheherazade Goes West illustrate the simultaneity of accommodation and disruption evident in autoethnographic communication. Across the two books, Memissi shows herself renegotiating the discourses which discipline her (and her speech). She switches back and forth between the positions of reader and author, demonstrates the reciprocity of the disciplinary gaze (she looks back at her dominants, reading their own reading of her representation of her social group), and provides a model of autoethnographic dialogue.

The new woman, femininity and modernity in Margery Allingham's detective novels of the 1930s /

This thesis examines Death of a Ghost (1934), Flowers for the Judge (1935), Dancers in Mourning (1937), and The Fashion in Shrouds (1938), a group of detective novels by Margery Allingham that are differentiated from her other work by their generic hybridity. The thesis argues that the hybrid nature of this group of Campion novels enabled a highly skilled and insightful writer such as Allingham to negotiate the contradictory notions about the place of women that characterized the 1930s, and that in dOing so, she revealed the potential of one of the most popular and accessible genres, the detective novel of manners, to engage its readers in a serious cultural dialogue. The thesis also suggests that there is a connection between Allingham's exploration of modernity and femininity within these four novels and her personal circumstances. This argument is predicated upon the assumption that during the interwar period in England several social and cultural attitudes converged to challenge long-held beliefs about gender roles and class structure; that the real impact of this convergence was felt during the 1930s by the generation that had come of age in the previous decade-Margery Allingham's generation; and that that generation's ambivalence and confusion were reflected in the popular fiction of the decade. These attitudes were those of twentieth-century modernity--contradiction, discontinuity, fragmentation, contingency-and in the context of this study they are incorporated in a literary hybrid. Allingham uses this combination of the classical detective story and the novel of manners to examine the notion of femininity by juxtaposing the narrative of a longstanding patriarchal and hierarchical culture, embodied in the image of the Angel in the House, with that of the relatively recent rights and freedoms represented by the New Woman of the late nineteenth-century. Pierre Bourdieu's theory of social difference forms the theoretical foundation of the thesis's argument that through these conflicting narratives, as well as through the lives of her female characters, Allingham questioned the Hsocial myth" of the time, a prevailing view that, since the First World War, attitudes toward the appropriate role and sphere of women had changed.

Monstrum : the vampire in the detective story /

My approach to the vampire detective highlights its connections to the private detective's story and reveals the monstrous investigators' debt to early feminist forms of detection -specifically in their reformation of the' other' and of traditional forms of power and authority. Seen in this light the movement of horror's imaginary 'other' into the rational world of detection can be seen as not an abrupt breach of detection's realist conventions, but an almost seamless transition into symbolic spaces that point to the detective's primary function -- to make sense of the senseless. It is in this light that I explore the monster that is a detective as a symbol that is also a sense-maker, and a quintessential postmodern figure. I argue that the distinctions between monsters and 'others', and between popular narratives and postmodern religion have faded, culminating in a character that can not only model 'otherness' as an exemplary condition, but also provide strategies for modeling the form of active postmodern subjectivity that postmodern theorist Jim Collins' (1989) conceives of as heretical activity.

Will the "fight" ever end? : a critical reading of the metaphors and discourses that construct HIV/AIDS in an African context

In this thesis, I critically examine the discourses that inform how we conceptualise HIV/AIDS in Sub-Saharan Africa as they are produced in a sample of Canadian news articles, two nonfiction texts - Stephanie Nolen's 28 Stories of AIDS in Africa and Jonathan Morgan and the Bambanani Women's Group's Long Life ... Positive HIV Stories - as well as two literary texts - John Le Carre's popular fiction novel The Constant Gardener and an anthology of stories and poems from Southern Africa titled Nobody Ever Said AIDS, compiled and edited by Nobantu Rasebotsa, Meg Samuelson and Kylie Thomas. Paying particular attention to the role of metaphor in discursive formation, I have found that military metaphors, usually used in conjunction with biomedical discourses, continue to dominate what is said about HIV/AIDS. However, the use of military metaphors to conceptualise HIV/AIDS contributes to stigma and limits the effectiveness of responses to the pandemic. I argue that accessing alternative metaphors and discourses, such as biopsychosocial discourse, can lead to a more layered - and more beneficial - conceptualisation of HIV/AIDS, encouraging a more active response to the pandemic.

Relationship between photoperiod, plasma concentration of ionic calcium and the histology of the prolactin-secreting cells of the rostral pars distalis of the pituitary gland, the corpuscles of stannius and the ultimobranchial gland in the goldfish, Carassius auratus L. /

The relationship between photoperiod, plasma concentration of ionic calcium and the histology of the prolactin-secreting cells of the rostral pars distalis of the pituitary gland, the Corpuscles of Stannius and the Ultimobranchial gland were investigated. Neither the plasma concentration of ionic calcium nor histologically apparent prolactin cell activity could be correlated with photoperiod. Some evidence of a photoperiodic effect on both the Corpuscles of Stannius and the Ultimobranchial gland was obtained. The expected reciprocal relationship between the activity of these glands was not obvious at the histological level . Quantitative and qualitative analysis at the light microscope level revealed, however, that the hormone prolactin-secreting eta cells of the rostral pars distalis and the hypocalcin-secreting cells of the Corpuscles of Stannius may be arranged in a lamellar pattern comprized of synchronous bands of cells in like-phase of a secretory cycle consisting of four stages - synthesis, storage, release and reorganization. Such synchronized cell cycles in these glands have not heretofore been described in literature. It is suggested that the maintenance of at least 255? of the cells in any one phase of the cycle ensures a supply of the required hormone at all times.

LEISURE CONNECTIONS AND HEALING FOLLOWING TRAUMA: CONSTRUCTIVIST AND EXISTENTIAL REFLECTIONS AND THEORIZING

Trauma can have lasting effects on health (CAMH, 2010; DSM-IV, 1994; Lazarus, 1966), negatively influencing meanings and experiences of leisure in relation to health (Griffin, 2002, 2005; Meister & Pedlar, 1996). This interpretive grounded theory explored understandings of leisure during Leisure Connections and how Leisure Connections provides a context for healing from trauma. Data included observations, interviews with six participants, and reflection cards. Nine themes emerged: responding to trauma in leisure, letting go of familiar coping patterns and opening to joy, being in the moment of small steps and simple things, changing understandings of self, reconnecting with the body, shifting to internal motivation, choosing, reconnecting with others in leisure, balancing life with leisure, and growth and connections. Leisure Connections supported participants to explore leisure and its benefits as issues arise, to understand and respond differently. Leisure Connections provides boundary situations critical for existential growth and opportunity to change coping patterns.

Gender and Genre in 21st Century Visions of Sherlock Holmes

Sherlock Holmes has been one of the most-adapted characters in literature since his first appearance in A Study in Scarlet in Beeton's Christmas Annual in 1887. Each new adaptation must offer innovations that bring freshness and contemporary appeal to time-worn stories and concepts or risk irrelevancy; analyzing these changes closely sheds light on shifts in societal constructs. Taking this as a starting point, this thesis examines Sherlock and Elementary from a perspective of feminism and queer theory via methods of discourse and genre analyses, with texts ranging from 1931 to the present as objects of comparison. The research illuminates constructions of masculinity as they have changed over time, particularly the movement from an orderly, stable, rational construction of hegemonic masculinity to one that is chaotic, often violent, and anti-heroic in at least some aspects while still being invested in the status quo.

Wirklichkeit und Fiktion : Alfred Döblins „Tatsachenphantasie“ in seinem historischen Roman „November 1918“

Thèse réalisée en co-tutelle avec l'Université Libre de Berlin, Institut für Deutsche und Niederländische Philologie

Dramatizing whoredom : prostitution in the work of Tennessee Williams

Cette thèse explore le leitmotiv de la prostitution dans l’oeuvre de Tennessee Williams et soutient que la plupart des personnages de Williams sont engagés dans une forme de prostitution ou une autre. En effectuant une analyse formaliste des textes de Williams qui illustrent toute forme de prostitution, avec une attention particulière à quatre grandes pièces, A Streetcar Named Desire (1947), Cat on a Hot Tin Roof (1955), Suddenly Last Summer (1958) et Sweet Bird of Youth (1959), cette présente étude fait valoir que le dramaturge utilise un mode de fiction—le gothique—en lien avec une pratique transgressive—la prostitution—pour relier les classes sociales et troubler les catégories de prostitution. Ce faisant, Williams offre une vision plus représentative et nuancée de la prostitution. Théoriquement, cette thèse repose sur des oeuvres critiques portant sur le genre, la sexualité et l'histoire de Michel Foucault, David Savran, et Michael Paller afin de situer la dramaturgie de Williams dans le contexte historique et culturel des années 1940 et 1950. La première partie de cette thèse (chapitres un et deux) fournit de nombreuses informations autobiographiques et biographiques qui expliquent pourquoi la prostitution est devenue le thème de prédilection pour Williams. Cette section met l’accent sur sa préoccupation constante à l’égard de sa prostitution artistique (en prostituant son art pour le succès commercial) et sexuelle (en payant pour des prostitués). Cette partie présente également un inventaire détaillé des prostituté(e)s, que je divise en trois catégories: 1) la prostitution des enfants, 2) la prostitution masculine et 3) la prostitution féminine. La deuxième partie de cette étude, composée des chapitres trois et quatre, identifie les personnages de Williams qui s’engagent dans une forme de prostitution morale. Ce groupe comprend ceux qui tirent directement profit de la prostitution des autres ainsi que ceux qui se marient uniquement pour un gain financier ou une promotion sociale ou les deux. L’oeuvre de Williams résiste la représentation stéréotypée de la prostituée en littérature comme étant uniquement de sexe féminin ou provenant des classes sociales défavorisées ou les deux. La prostituée de Williams n’est ni une figure romantique ni une rebelle menaçant la société. Cette thèse conclut qu’en représentant des enfants prostitués, des femmes de rue, des prostitués de sexe masculin, des souteneurs, des proxénètes, des propriétaires de bordels, des leaders corrompus et des personnes qui se prostituent en concluant des mariages de convenance, Williams a effectivement et incontestablement dramatisé la prostitution sous toutes ses formes.

Évaluation de la fréquence des micronoyaux et du potentiel clastogène et/ou aneugène du benzo-a-pyrène suite à une exposition in vitro des lymphocytes humains

Le benzo-a-pyrène (BaP) est un cancérogène reconnu pour l'homme, contaminant présent dans notre environnement. Il cause des dommages à l'ADN que nous avons mesurés dans les lymphocytes exposés à de faibles concentrations de BaP, provenant de 20 jeunes volontaires non fumeurs et en santé. Suite à l’exposition, la fréquence des micronoyaux (MN) augmente significativement et décrit une courbe dose-réponse non linéaire, suggérant le déclenchement du processus de détoxification et la réparation de l’ADN. Des différences entre les individus et entre les sexes sont présentes dans la réponse génotoxique produite par le BaP. Le test des aberrations chromosomiques montre que le pourcentage de chromosomes cassés augmente significativement dans les cellules exposées au BaP. Combinés avec l'augmentation de la fréquence des MN, nos résultats confirment l'effet clastogène du BaP déjà rapporté dans la littérature. L’hybridation in situ en fluorescence (FISH) des MN avec une sonde pancentromérique est aussi utilisée pour établir leur mécanisme de formation. La FISH révèle que la majorité des MN formés après une exposition au BaP contient un centromère et plus, ce qui est significativement différent de la condition non exposée. Plus précisément, dans nos conditions expérimentales, les MN induits par le BaP contiennent surtout trois centromères et plus, indiquant également la présence d'un effet aneugène. L'effet clastogène du BaP est relié à son rôle d'initiateur dans la cancérogenèse, alors que l'effet aneugène le relierait à l'étape de progression. Ces résultats sont importants puisque l'exposition aux composés de la classe du BaP est de longue durée (cigarette, air pollué).

From cognition to action : a psychological investigation of action regulation in complex and uncertain social systems

Cette thèse présente une revue des réflexions récentes et plus traditionnelles provenant de la théorie des systèmes, de la créativité en emploi, des théories d’organisation du travail et de la motivation afin de proposer une perspective psychologique de la régulation des actions des individus au sein d’environnements de travail complexes et incertains. Des composantes de la Théorie de la Régulation de l’Action (Frese & Zapf, 1994) ainsi que de la Théorie de l’Auto-Détermination (Deci & Ryan, 2000) sont mises en relation afin d’évaluer un modèle définissant certains schémas cognitifs clés associés aux tâches individuelles et collectives en emploi. Nous proposons que ces schémas cognitifs, organisés de manière hiérarchique, jouent un rôle central dans la régulation d’une action efficace au sein d’un système social adaptatif. Nos mesures de ces schémas cognitifs sont basées sur des échelles de mesure proposées dans le cadre des recherches sur l’ambiguïté de rôle (eg. Sawyer, 1992; Breaugh & Colihan, 1994) et sont mis en relation avec des mesures de satisfaction des besoins psychologiques (Van den Broeck, Vansteenkiste, De Witte, Soenens & Lens, 2009) et du bien-être psychologique (Goldberg, 1972). Des données provenant de 153 employés à temps plein d’une compagnie de jeu vidéo ont été récoltées à travers deux temps de mesure. Les résultats révèlent que différents types de schémas cognitifs associés aux tâches individuelles et collectives sont liés à la satisfaction de différents types de besoin psychologiques et que ces derniers sont eux-mêmes liés au bien-être psychologique. Les résultats supportent également l’hypothèse d’une organisation hiérarchique des schémas cognitifs sur la base de leur niveau d’abstraction et de leur proximité avec l’exécution concrète de l’action. Ces résultats permettent de fournir une explication initiale au processus par lequel les différents types de schémas cognitifs développés en emplois et influencé par l’environnement de travail sont associés à l’attitude des employés et à leur bien-être psychologique. Les implications pratiques et théoriques pour la motivation, l’apprentissage, l’habilitation, le bien-être psychologique et l’organisation du travail dans les environnements de travail complexes et incertains sont discutés.

Auto-reflexividad, erografía y leitmotivs liminales en la producción narrativa de Mayra Santos-Febres (1995-2009)

La recherche, construction et révision de l’identité nationale ont très longtemps constitué les éléments propulseurs de la production littéraire et intellectuelle de Porto Rico. Pourtant vers le milieu des années 90, un nouveau consensus émerge entre les écrivains qui revendiquent massivement la fin de la littérature en tant que lieu d’où forger la conscience nationale et refuse le leadership intellectuel qui avait jusqu’alors définit le travail littéraire. Les auteurs qui commencent à se manifester à ce moment se désintéressent du nationalisme comme thème littéraire. Le militantisme politique et la volonté de confrontation, modes représentationnels caractéristiques de la génération antérieure, disparaissent pour laisser place à une écriture exploratoire, centrée sur ses propres procédés, et apparemment apolitique. Une telle perte d’ancrages nationaux et territoriaux est significative de la conscience exacerbée que possèdent ces écrivains de la complexité des dynamiques culturelles qui régissent le monde postmoderne et globalisé, ainsi que de la « valeur » et de la position « marginale » qu’on leur attribue dans l’écologie mass-médiatique culturelle actuelle. La production narrative de Mayra Santos-Febres est paradigmatique de ces changements. J’aborde dans son écriture une série de dispositifs métalittéraires, autoréflexifs, « érographiques », et historiographiques qui, bien qu’ils résistent à une catégorisation homogène, démontrent un même intérêt pour des phénomènes interstitiels. En me basant sur les concepts de liminalité, principalement depuis la perspective de Victor Turner et d’écriture auto-réflexive (Patricia Waugh, Linda Hutcheon), j’analyse le positionnement liminal qu’assume Santos-Febres dans la structure culturelle globalisée actuelle, et la façon dont sa prise de position, également liminale, c’est-à-dire, sa prise de parole et son engagement se traduisent par un rapprochement narcissique à l’exercice littéraire autant dans les formes qu’elle crée qu’au niveau sémantique, narratif et discursif. Le premier chapitre analyse les contes « Dilcia M. » et « Acto de Fe » (Pez de vidrio) comme témoignages de l’érosion du patriotisme et militantisme antérieur; « La escritora» (Pez de vidrio) qui marque pour l’auteure un passage vers une esthétique centrée sus ses propres procédés créatifs; et le roman Cualquier miércoles soy tuya qui dramatise le positionnement assumé par les écrivains dans la chaine culturelle globalisée actuelle. Le second chapitre aborde la configuration des corps, espaces urbains et de l’écriture dans El cuerpo correcto qui, à travers une exubérance sexuelle/textuelle, projette des variantes réactualisées de la traditionnelle dichotomie corps/écriture. Le troisième chapitre se penche sur la configuration du travesti dans Sirena Selena vestida de pena. J’y propose de voir le travestisme, le boléro et l’écriture comme un triple exercice métalittéraire. Le dernier chapitre aborde le procédé de re-signification littéraire des images sédimentées de subordination et d’infériorité de sujet « noir ». Nuestra Señora de la Noche se penche sur la re-signification de l’hyper-sexualisation et « exotisation » qui a cimenté la construction de « l’immoralité » de la femme noire. Fe en disfraz aborde le sadomasochisme comme espace de re-signification des schèmes de domination et soumission inscrits dans l’histoire esclavagiste de Porto Rico et du trauma qui origine, et subsiste, d’une telle hiérarchie.

Engendered Conversations: Gender Subversion Through Fictional Dialogue in Lawrence, Hemingway and Forster

This dissertation examines gendered fictional dialogue in popular works by D.H. Lawrence, Ernest Hemingway and E.M. Forster, including Howards End (1910), The Sun Also Rises (1926) and Lady Chatterley’s Lover (1928). I apply Judith Halberstam’s notion of female masculinity to direct speech, to explore how speech traits inform modernist literary aesthetics. My introduction frames this discussion in sociolinguistics, Judith Butler’s theory of performativity, M.M. Bakhtin’s discourse theory, and gender studies. It provides an opportunity to establish experimental dialogue techniques, and the manipulation of gendered talk, in transgressive texts including James Joyce’s Ulysses (1922), Virginia Woolf’s Orlando (1928) and Radcyffe Hall’s The Well of Loneliness (1928). The first chapter discusses taboos and dialect in D.H. Lawrence’s fictional dialogue. The second chapter establishes gender subversion as a crucial element in Ernest Hemingway’s dialogue style. The third chapter contrasts Forster’s latently gendered speech with his techniques of dialect emphasis and dialect suppression. Finally, my conclusion discusses gender identity in the poetry of Dorothy Parker and Baroness Elsa von Freytag Loringhoven, and the temporality of gender in “Time Passes” from Virginia Woolf’s To the Lighthouse (1927). New Woman characters like Lady Brett Ashley typified a crucial moment in women’s liberation. They not only subverted stereotypes of womanhood through their dress or sexual freedom, they also adopted/adapted masculine idiom to shock, to rebel against and challenge male dominance. Different speech acts incited fashionable slang, became a political protest symbol or inspired psychoanalytic theory. The intriguing functions of women’s masculine speech in early twentieth century fiction establishes the need to examine additional connections between gender and talk in literary studies.