Irish state infrastructural investment: an analysis of past patterns, and an outline of a future integrated systems of systems evaluation methodology

The literature clearly links the quality and capacity of a country’s infrastructure to its economic growth and competitiveness. This thesis analyses the historic national and spatial distribution of investment by the Irish state in its physical networks (water, wastewater and roads) across the 34 local authorities and examines how Ireland is perceived internationally relative to its economic counterparts. An appraisal of the current status and shortcomings of Ireland’s infrastructure is undertaken using key stakeholders from foreign direct investment companies and national policymakers to identify Ireland's infrastructural gaps, along with current challenges in how the country is delivering infrastructure. The output of these interviews identified many issues with how infrastructure decision-making is currently undertaken. This led to an evaluation of how other countries are informing decision-making, and thus this thesis presents a framework of how and why Ireland should embrace a Systems of Systems (SoS) methodology approach to infrastructure decision-making going forward. In undertaking this study a number of other infrastructure challenges were identified: significant political interference in infrastructure decision-making and delivery the need for a national agency to remove the existing ‘silo’ type of mentality to infrastructure delivery how tax incentives can interfere with the market; and their significance. The two key infrastructure gaps identified during the interview process were: the need for government intervention in the rollout of sufficient communication capacity and at a competitive cost outside of Dublin; and the urgent need to address water quality and capacity with approximately 25% of the population currently being served by water of unacceptable quality. Despite considerable investment in its national infrastructure, Ireland’s infrastructure performance continues to trail behind its economic partners in the Eurozone and OECD. Ireland is projected to have the highest growth rate in the euro zone region in 2015 and 2016, albeit that it required a bailout in 2010, and, at the time of writing, is beginning to invest in its infrastructure networks again. This thesis proposes the development and implementation of a SoS approach for infrastructure decision-making which would be based on: existing spatial and capacity data of each of the constituent infrastructure networks; and scenario computation and analysis of alternative drivers eg. Demographic change, economic variability and demand/capacity constraints. The output from such an analysis would provide valuable evidence upon which policy makers and decision makers alike could rely, which has been lacking in historic investment decisions.

An exploratory study on the impact of an early years' preschool intervention programme in the Republic of Ireland

Early years’ education has increasingly been identified as a mechanism to alleviate educational disadvantage in areas of social exclusion. Early years’ intervention programmes are now a common government social policy for addressing social problems (Reynolds, Mann, Miedel, and Smokowski, 1997). In particular, state provided early years’ programmes such as Head Start in the United States and Early Start in Ireland have been established to combat educational disadvantage for children experiencing poverty and socio-economic inequality. The focus of this research is on the long-term outcomes of an early years’ intervention programme in Ireland. It aims to assess whether participation in the programme enhances the life course of children at-risk of educational disadvantage. It involves an in-depth analysis of one Early Start project which was included in the original eight projects established by the Department of Education and Science in 1994. The study utilises a multi-group design to provide a detailed analysis of both the academic and social progress of programme participants. It examines programme outcomes from a number of perspectives by collecting the views of the three main stakeholders involved in the education process; students who participated in Early Start in 1994/5, their parents and their teachers. To contribute to understanding the impact of the programme from a community perspective interviews were also conducted with local community educators and other local early years’ services. In general, Early Start was perceived by all participants in this study as making a positive contribution to parent involvement in education and to strengthening educational capital in the local area. The study found that parents and primary school teachers identified aspects of school readiness as the main benefit of participation in Early Start and parents and teachers were very positive about the role of Early Start in preparing children for the transition to formal school. In addition to this, participation in Early Start appears to have made a positive contribution to academic attainment in Maths and Science at Junior Certificate level. Students who had participated in Early Start were also rated more highly by their second level teachers in terms of goal-setting and future orientation which are important factors in educational attainment. Early Start then can be viewed as providing a positive contribution to the long-term social and academic outcomes for its participants.

The meaning of environmental control systems (ECS) for people with spinal cord injury: An occupational therapist explores an intervention

Environmental Control Systems (ECS), enable people with high cervical Spinal Cord Injury (high SCI) to control and access everyday electronic devices. In Ireland, however, access for those who might benefit from ECS is limited. This study used a qualitative approach to explore the insider experience of an ECS starter-pack developed by the author, an occupational therapist. The primary research questions: what is it really like to live with ECS, and what does it mean to live with ECS, were explored using a phenomenological methodology conducted in three phases. In Phase 1 fifteen people with high SCI met twice in four focus groups to discuss experiences and expectations of ECS. Thematic analysis (Krueger & Casey, 2000), influenced by the psychological phenomenological approach (Creswell, 1998), yielded three categories of rich, practical, phenomenological findings: ECS Usage and utility; ECS Expectations and The meaning of living with ECS. Phase 1 findings informed Phase 2 which consisted of the development of a generic electronic assistive technology pack (GrEAT) that included commercially available constituents as well as short instructional videos and an information booklet. This second phase culminated in a one-person, three-week pilot trial. Phase 3 involved a six person, 8-week trial of the GrEAT, followed by individual in-depth interviews. Interpretative Phenomenological Analysis IPA (Smith, Larkin & Flowers, 2009), aided by computer software ATLAS.ti and iMindmap, guided data analysis and identification of themes. Getting used to ECS, experienced as both a hassle and engaging, resulted in participants being able to Take back a little of what you have lost, which involved both feeling enabled and reclaiming a little doing. The findings of this study provide substantial insights into what it is like to live with ECS and the meanings attributed to that experience. Several practical, real world implications are discussed.

A new world a new American foreign policy: the Carter administration, Nicaragua, and the legacy of the Vietnam War, 1977-1981

The impact of the Vietnam War conditioned the Carter administration’s response to the Nicaraguan revolution in ways that reduced US engagement with both sides of the conflict. It made the countries of Latin America counter the US approach and find their own solution to the crisis, and allowed Cuba to play a greater role in guiding the overthrow of Nicaraguan dictator Anastasio Somoza Debayle. This thesis re-evaluates Carter’s policy through the legacy of the Vietnam War, because US executive anxieties about military intervention, Congress’s increasing influence, and US public concerns about the nation’s global responsibilities, shaped the Carter approach to Nicaragua. Following a background chapter, the Carter administration’s policy towards Nicaragua is evaluated, before and after the fall of Somoza in July 1979. The extent of the Vietnam influence on US-Nicaraguan relations is developed by researching government documents on the formation of US policy, including material from the Jimmy Carter Library, the Library of Congress, the National Security Archive, the National Archives and Records Administration, and other government and media sources from the United Nations Archives, New York University, the New York Public Library, the Hoover Institution Archives, Tulane University and the Organization of American States. The thesis establishes that the Vietnam legacy played a key role in the Carter administration’s approach to Nicaragua. Before the overthrow of Somoza, the Carter administration limited their influence in Nicaragua because they felt there was no immediate threat from communism. The US feared that an active role in Nicaragua, without an established threat from Cuba or the Soviet Union, could jeopardise congressional support for other foreign policy goals deemed more important. The Carter administration, as a result, pursued a policy of non-intervention towards the Central American country. After the fall of Somoza, and the establishment of a new government with a left wing element represented by the Sandinistas, the Carter administration emphasised non-intervention in a military sense, but actively engaged with the new Nicaraguan leadership to contain the potential communist influence that could spread across Central America in the wake of the Nicaraguan revolution.

Tudor ‘reform’ treatises and government policy in sixteenth century Ireland

During the sixteenth century hundreds of treatises, position papers and memoranda were composed on the political state of Ireland and how best to ‘reform’, ‘conquer’ or otherwise incorporate that island into the wider Tudor kingdom. These ‘reform’ treatises attempted to identify and analyse the prevailing political, social, cultural and economic problems found in the Irish polity before positing how government policy could be altered to ameliorate these same problems. Written by a broad array of New English, Old English and Gaelic Irish authors, often serving within Irish officialdom, the military, or the Church of Ireland, these papers were generally circulated amongst senior ministers and political figures throughout the Tudor dominions. As such they were written with the express purpose of influencing the direction of government policy for Ireland. Collectively these documents are one of the most significant body of sources, not just for the study of government activity in the second Tudor kingdom, but indeed for the broader history of sixteenth century Ireland. This thesis offers the first systematic study of these texts. It does so by exploring the content of the hundreds of such works and the ‘reform’ treatise as a type of text, while the interrelationship of these documents with government policy in Tudor Ireland, and their effect thereon, is also explored. In so doing it charts the developments from origin to implementation of the principal strategies employed by Tudor Englishmen to enforce English control over the whole of Ireland. Finally, it clearly demonstrates that the ‘reform’ treatises were both central to government activity in sixteenth century Ireland and to the historical developments which occurred in that time and place.

The impact of new public management on the roles of elected councillors, management and the community sector in Irish local government: a case study of Cork County Council

The fundamental aim of this thesis is to examine the effect of New Public Management (NPM) on the traditional roles of elected representatives, management and community activists in Irish local government. This will be achieved through a case study analysis of one local authority, Cork County Council. NPM promises greater democracy in decision-making. Therefore, one can hypothesise that the roles of the three key groupings identified will become more influenced by principles of participatory decision-making. Thus, a number of related questions will be addressed by this work, such as, have the local elected representatives been empowered by NPM? Has a managerial revolution taken place? Has local democracy been enhanced by more effective community participation? It will be seen in chapter 2 that these questions have not been adequately addressed to date in NPM literature. The three groups identified can be regarded as stakeholders although the researcher is cautious in using this term because of its value-laden nature. Essentially, in terms of Cork County Council, stakeholders can be defined as decision-makers and people within the organization and its environment who are interested in or could be affected directly or indirectly by organizational performance. This is an all-embracing definition and includes all citizens, residents, community groups and client organizations. It is in this context that the term 'stakeholder' should be understood when it is occasionally used in this thesis. In this case, the perceptions of elected councilors, management and community representatives with regard to their changing roles are as significant as the changes themselves. The chapter begins with a brief account of the background to this research. This is followed by an explanation of the methodology which is used and then concludes with short statements about the remaining chapters in the thesis.

Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention

Introduction: Older individuals are particularly vulnerable to potentially inappropriate prescribing (PIP), drug related problems (DRPs) and adverse drug reactions (ADRs). A number of different interventions have been proposed to address these issues. However to-date there is a paucity of well-designed trials examining the impact of such interventions. Therefore the aims of this work were to: (i) establish a baseline PIP prevalence both nationally and internationally using the STOPP, Beers and PRISCUS criteria, (ii) identify the most comprehensive method of assessing PIP in older individuals, (iii) develop a structured pharmacist intervention supported by a computer decisions support system (CDSS) and (iv) examine the impact of this intervention on prescribing and incidence of ADRs. Results: This work identified high rates of PIP across all three healthcare settings in Ireland, 84.7% in the long term care, 70.7% in secondary care and 43.3% in primary care being reported. This work identified that for a comprehensive assessment of prescribing to be undertaken, an amalgamation of all three criteria should be deployed simultaneously. High prevalences of DRPs and PIP in older hospitalised individuals were identified. With 82.0% and 76.3% of patients reported to have at least one DRP or PIP instance respectively. The structured pharmacist intervention demonstrated a positive impact on prescribing, with a significant reduction MAI scores being reported. It also resulted in the intervention patients’ having a reduced risk of experiencing an ADR when compared to the control patients (absolute risk reduction of 6.8 (95% CI 1.5% - 12.3%)) and the number needed to treat = 15 (95% CI 8 - 68). However the intervention was found to have no significant effect on length of stay or mortality rate. Conclusion: This work shows that PIP is highly prevalent in older individuals across three healthcare settings in Ireland. This work also demonstrates that a structured pharmacist intervention support by a dedicated CDSS can significantly improve the appropriateness of prescribing and reduce the incidence of ADRs in older acutely ill hospitalised individuals.

Private health care coverage and increased risk of obstetric intervention

Background: When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods: Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results: 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions: Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.

Can population-level variation in early childhood development be measured in a manner that supports service planning and intervention?

Background: The Early Development Instrument (EDI) is a population-level measure of five developmental domains at school-entry age. The overall aim of this thesis was to explore the potential of the EDI as an indicator of early development in Ireland. Methods: A cross-sectional study was conducted in 47 primary schools in 2011 using the EDI and a linked parental questionnaire. EDI (teacher completed) scores were calculated for 1,344 children in their first year of full-time education. Those scoring in the lowest 10% of the sample population in one or more domains were deemed to be 'developmentally vulnerable'. Scores were correlated with contextual data from the parental questionnaire and with indicators of area and school-level deprivation. Rasch analysis was used to determine the validity of the EDI. Results: Over one quarter (27.5%) of all children in the study were developmentally vulnerable. Individual characteristics associated with increased risk of vulnerability were being male; under 5 years old; and having English as a second language. Adjusted for these demographics, low birth weight, poor parent/child interaction and mother’s lower level of education showed the most significant odds ratios for developmental vulnerability. Vulnerability did not follow the area-level deprivation gradient as measured by a composite index of material deprivation. Children considered by the teacher to be in need of assessment also had lower scores, which were not significantly different from those of children with a clinical diagnosis of special needs. all domains showed at least reasonable fit to the Rasch model supporting the validity of the instrument. However, there was a need for further refinement of the instrument in the Irish context. Conclusion: This thesis provides a unique snapshot of early development in Ireland. The EDI and linked parental questionnaires are promising indicators of the extent, distribution and determinants of developmental vulnerability.

The student bullying of teachers in Irish second level schools: exploring the influence of historical low state intervention in education on the development of contemporary policy responses in Ireland

The student bullying of teachers (SBT) is a distinct and complex form of bullying with a multiplicity of diverse, changeable and intersecting causes which is experienced by and affects teachers in a variety of ways. SBT is both a national and an international phenomenon which is under-recognised in academic, societal and political spheres, resulting in limited conceptual understanding and awareness of the issue. This study explores teachers’ experiences of SBT behaviours in Irish second level schools as well as teachers’ perceptions regarding training, policies and supports in Ireland to address the issue. Specifically, the study seeks to explore the influence of historical low State intervention in education on contemporary policies and supports to deal with SBT in Ireland. A mixed methods approach involving a survey of 531 second level school teachers and 17 semi-structured interviews with teachers, Year Heads and representatives from teacher trade unions and school management bodies was employed to collect and analyse data. Findings indicate that SBT behaviours are prevalent in many forms in Irish second level schools. The hidden nature of the phenomenon has simultaneously contributed to and is reinforced by limited understanding of the issue as well as teachers’ reluctance to disclose their experiences. Findings reveal that teachers perceive the contemporary policies, training and support structures in Ireland to be inadequate in equipping them to effectively deal with SBT. State intervention in addressing SBT behaviours to date, has been limited, therefore many teachers are forced to respond to the issue based on their own initiatives and assumptions rather than from an informed critically reflective approach, supported by national guidelines and sufficient State investment. This has resulted in a piecemeal, un-coordinated and ad-hoc approach to SBT in Irish schools both in terms of teachers’ management of SBT behaviours and with respect to the supports extended to staff. The potential negative consequences of SBT behaviours on teachers’ wellbeing and professional performance and thus, on the education system itself, underlines the need for a strategic, evidence-based, resourced and integrated approach which includes, as a pivotal component, consultation with teachers, whose contribution to the process is crucial.