Real time analysis of atmospheric single particles in urban environments using aerosol time of flight mass spectrometry

In order to determine the size-resolved chemical composition of single particles in real-time an ATOFMS was deployed at urban background sites in Paris and Barcelona during the MEGAPOLI and SAPUSS monitoring campaigns respectively. The particle types detected during MEGAPOLI included several carbonaceous species, metal-containing types and sea-salt. Elemental carbon particle types were highly abundant, with 86% due to fossil fuel combustion and 14% attributed to biomass burning. Furthermore, 79% of the EC was apportioned to local emissions and 21% to continental transport. The carbonaceous particle types were compared with quantitative measurements from other instruments, and while direct correlations using particle counts were poor, scaling of the ATOFMS counts greatly improved the relationship. During SAPUSS carbonaceous species, sea-salt, dust, vegetative debris and various metal-containing particle types were identified. Throughout the campaign the site was influenced by air masses altering the composition of particles detected. During North African air masses the city was heavily influenced by Saharan dust. A regional stagnation was also observed leading to a large increase in carbonaceous particle counts. While the ATOFMS provides a list of particle types present during the measurement campaigns, the data presented is not directly quantitative. The quantitative response of the ATOFMS to metals was examined by comparing the ion signals within particle mass spectra and to hourly mass concentrations of; Na, K, Ca, Ti, V, Cr, Mn, Fe, Zn and Pb. The ATOFMS was found to have varying correlations with these metals depending on sampling issues such as matrix effects. The strongest correlations were observed for Al, Fe, Zn, Mn and Pb. Overall the results of this work highlight the excellent ability of the ATOFMS in providing composition and mixing state information on atmospheric particles at high time resolution. However they also show its limitations in delivering quantitative information directly.

The application of computer modelling to develop a methodology for ‘existing building’ upgrades to move towards carbon-neutral buildings

The retrofitting of existing buildings for decreased energy usage, through increased energy efficiency and for minimum carbon dioxide emissions throughout their remaining lifetime is a major area of research. This research area requires development to provide building professionals with more efficient building retrofit solution determination tools. The overarching objective of this research is to develop a tool for this purpose through the implementation of a prescribed methodology. This has been achieved in three distinct steps. Firstly, the concept of using the degree-days modelling method as an adequate means of basing retrofit decision upon was analysed and the results illustrated that the concept had merit. Secondly, the concept of combining the degree-days modelling method and the Genetic Algorithms optimisation method is investigated as a method of determining optimal thermal energy retrofit solutions. Thirdly, the combination of the degree-days modelling method and the Genetic Algorithms optimisation method were packaged into a building retrofit decision-support tool and named BRaSS (Building Retrofit Support Software). The results demonstrate clearly that, fundamental building information, simplified occupancy profiles and weather data used in a static simulation modelling method is a sufficient and adequate means to base retrofitting decisions upon. The results also show that basing retrofit decisions upon energy analysis results are the best means to guide a retrofit project and also to achieve results which are optimum for a particular building. The results also indicate that the building retrofit decision-support tool, BRaSS, is an effective method to determine optimum thermal energy retrofit solutions.

The effectiveness of using patient-reported outcome measures as quality improvement tools

Aim: To investigate the value of using PROMs as quality improvement tools. Methods: Two systematic reviews were undertaken. The first reviewed the quantitative literature on the impact of PROMs feedback and the second reviewed the qualitative literature on the use of PROMs in practice. These reviews informed the focus of the primary research. A cluster randomised controlled trial (PROFILE) examined the impact of providing peer benchmarked PROMs feedback to consultant orthopaedic surgeons on improving outcomes for hip replacement surgery. Qualitative interviews with surgeons in the intervention arm of the trial examined the view of and reactions to the feedback. Results: The quantitative review of 17 studies found weak evidence to suggest that providing PROMs feedback to professionals improves patient outcomes. The qualitative review of 16 studies identified the barriers and facilitators to the use of PROMs based on four themes: practical considerations, attitudes towards the data, methodological concerns and the impact of feedback on care. The PROFILE trial included 11 surgeons and 215 patients in the intervention arm, and 10 surgeons and 217 patients in the control arm. The trial found no significant difference in the Oxford Hip Score between the arms (-0.7, 95% CI -1.9-0.5, p=0.2). Interviews with surgeons revealed mixed opinions about the value of the PROMs feedback and the information did not promote explicit changes to their practice. Conclusion: It is important to use PROMs which have been validated for the specific purpose of performance measurement, consult with professionals when developing a PROMs feedback intervention, communicate with professionals about the objectives of the data collection, educate professionals on the properties and interpretation of the data, and support professionals in using the information to improve care. It is also imperative that the burden of data collection and dissemination of the information is minimised.

Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures

This PhD thesis describes work carried out on investigation of various interventions with the aim to optimise the anaesthetic management of patients scheduled to undergo operative fixation of hip fractures. We analysed the perioperative effects of continuous femoral nerve block, single preoperative dose of i.v. dexamethasone, the intention to deposit local anaesthetic in different locations around the femoral nerve during ultrasound guided femoral nerve block, continuous spinal anaesthesia and peri-surgical site infiltration with local anaesthetic after surgical fixation of hip fractures. Continuous femoral nerve block provided more effective preoperative analgesia six hours after the insertion of the perineural catheter compared to a standard opiate-based regimen in patients undergoing operative fixation of fractured hip. A single low dose of preoperative dexamethasone in the intervention group decreased pain scores by 75% six hours after the surgery. Both interventions had no major effect on the functional recovery in the first year after the surgical fixation of fractured hip. The results of the ultrasound guided femoral nerve block trial showed no clinical advantage of intending to deposit local anaesthetic circumferentially during performing femoral nerve block. Using the Dixon and Massey’s “up- and-down” method, we demonstrated that intrathecal 0.26 ml of 0.5% bupivacaine provided adequate surgical anaesthesia within 15 minutes in 50% of patients undergoing operative fixation of hip fracture. Finally, we demonstrated that local anaesthetic infiltration had no effect on pain scores 12 hours after the surgical fixation of fractured neck of femur. In addition to this original body of work, a review article was published on femoral nerve block highlighting the use of ultrasound guidance. In conclusion, the results of this thesis offer an insight into interventions aimed at optimising perioperative analgesia in patients scheduled to undergo operative fixation of hip fractures.

"Ladyes, damesels, and jantilwomen": female autonomy and authority in Sir Thomas Malory's Morte Darthur

Popular medieval English romances were composed and received within the social consciousness of a distinctly patriarchal culture. This study examines the way in which the dynamic of these texts is significantly influenced by the consequences of female endeavour, in the context of an autonomous feminine presence in both the real and imagined worlds of medieval England, and the authority with which this is presented in various narratives, with a particular focus on Sir Thomas Malory’s Morte Darthur. Chapter One of this study establishes the social and economic positioning of the female in fifteenth-century England, and her capacity for literary engagement; I will then apply this model of female autonomy and authority to a wider discussion of texts contemporary with Malory in Chapters Two and Three, in anticipation of a more detailed study of Le Morte Darthur in Chapters Four and Five. My research explores the female presence and influence in these texts according to certain types: namely the lover, the victim, the ruler, and the temptress. In the case of Malory, the crux of my observations centres on the paradox of the capacity for power in perceived vulnerability, incorporating the presentation of women in this patriarchal culture as being vulnerable and in need of protection, while simultaneously acting as a significant threat to chivalric society by manipulating this apparent fragility, to the detriment of the chivalric knight. In this sense, women can be perceived as being an architect of the romance world, while simultaneously acting as its saboteur. In essence, this study offers an innovative interpretation of female autonomy and authority in medieval romance, presenting an exploration of the physical, intellectual, and emotional placement of women in both the historical and literary worlds of fifteenth-century England, while examining the implications of female conduct on Malory’s Arthurian society.

Exploring alternatives for milk quality improvement and more efficient dairy production in a smallholder farming context – case study: Mantaro Valley (Peru)

Consumer demand is revolutionizing the way products are being produced, distributed and marketed. In relation to the dairy sector in developing countries, aspects of milk quality are receiving more attention from both society and the government. However, milk quality management needs to be better addressed in dairy production systems to guarantee the access of stakeholders, mainly small-holders, into dairy markets. The present study is focused on an analysis of the interaction of the upstream part of the dairy supply chain (farmers and dairies) in the Mantaro Valley (Peruvian central Andes), in order to understand possible constraints both stakeholders face implementing milk quality controls and practices; and evaluate “ex-ante” how different strategies suggested to improve milk quality could affect farmers and processors’ profits. The analysis is based on three complementary field studies conducted between 2012 and 2013. Our work has shown that the presence of a dual supply chain combining both formal and informal markets has a direct impact on dairy production at the technical and organizational levels, affecting small formal dairy processors’ possibilities to implement contracts, including agreements on milk quality standards. The analysis of milk quality management from farms to dairy plants highlighted the poor hygiene in the study area, even when average values of milk composition were usually high. Some husbandry practices evaluated at farm level demonstrated cost effectiveness and a big impact on hygienic quality; however, regular application of these practices was limited, since small-scale farmers do not receive a bonus for producing hygienic milk. On the basis of these two results, we co-designed with formal small-scale dairy processors a simulation tool to show prospective scenarios, in which they could select their best product portfolio but also design milk payment systems to reward farmers’ with high milk quality performances. This type of approach allowed dairy processors to realize the importance of including milk quality management in their collection and manufacturing processes, especially in a context of high competition for milk supply. We concluded that the improvement of milk quality in a smallholder farming context requires a more coordinated effort among stakeholders. Successful implementation of strategies will depend on the willingness of small-scale dairy processors to reward farmers producing high milk quality; but also on the support from the State to provide incentives to the stakeholders in the formal sector.

Redox remodelling in diaphragm muscle adaptation to chronic sustained hypoxia

Chronic sustained hypoxia (CH) induces functional weakness, atrophy, and mitochondrial remodelling in the diaphragm muscle. Animal models of CH present with changes similar to patients with respiratory-related disease, thus, elucidating the molecular mechanisms driving these adaptations is clinically important. We hypothesize that ROS are pivotal in diaphragm muscle adaptation to CH. C57BL6/J mice were exposed to CH (FiO2=0.1) for one, three, and six weeks. Sternohyoid (upper airway dilator), extensor digitorum longus (EDL), and soleus were studied as reference muscles as well as the diaphragm. The diaphragm was profiled using a redox proteomics approach followed by mass spectrometry. Following this, redox-modified metabolic enzyme activities and atrophy signalling were assessed using spectrophotometric assays and ELISA. Diaphragm isotonic performance was assessed after six weeks of CH ± chronic antioxidant supplementation. Protein carbonyl and free thiol content in the diaphragm were increased and decreased respectively after six weeks of CH – indicative of protein oxidation. These changes were temporally modulated and muscle specific. Extensive remodelling of metabolic proteins occurred and the stress reached the cross-bridge. Metabolic enzyme activities in the diaphragm were, for the most part, decreased by CH and differential muscle responses were observed. Redox sensitive chymotrypsin-like proteasome activity of the diaphragm was increased and atrophy signalling was observed through decreased phospho-FOXO3a and phospho-mTOR. Phospho-p38 MAPK content was increased and this was attenuated by antioxidant treatment. Hypoxia decreased power generating capacity of the diaphragm and this was restored by N-acetyl-cysteine (NAC) but not by tempol. Redox remodelling is pivotal for diaphragm adaptation to chronic sustained hypoxia. Muscle changes are dependent on duration of the hypoxia stimulus, activity profile of the muscle, and molecular composition of the muscle. The working respiratory muscles and slow oxidative fibres are particularly susceptible. NAC (antioxidant) may be useful as an adjunct therapy in respiratory-related diseases characterised by hypoxic stress.

Exploring the relationship between social network sites and the consumption of cultural goods through the lens of affordances

This thesis presents research theorising the use of social network sites (SNS) for the consumption of cultural goods. SNS are Internet-based applications that enable people to connect, interact, discover, and share user-generated content. They have transformed communication practices and are facilitating users to present their identity online through the disclosure of information on a profile. SNS are especially effective for propagating content far and wide within a network of connections. Cultural goods constitute hedonic experiential goods with cultural, artistic, and entertainment value, such as music, books, films, and fashion. Their consumption is culturally dependant and they have unique characteristics that distinguish them from utilitarian products. The way in which users express their identity on SNS is through the sharing of cultural interests and tastes. This makes cultural good consumption vulnerable to the exchange of content and ideas that occurs across an expansive network of connections within these social systems. This study proposes the lens of affordances to theorise the use of social network sites for the consumption of cultural goods. Qualitative case study research using two phases of data collection is proposed in the application of affordances to the research topic. The interaction between task, technology, and user characteristics is investigated by examining each characteristic in detail, before investigating the actual interaction between the user and the artifact for a particular purpose. The study contributes to knowledge by (i) improving our understanding of the affordances of social network sites for the consumption of cultural goods, (ii) demonstrating the role of task, technology and user characteristics in mediating user behaviour for user-artifact interactions, (iii) explaining the technical features and user activities important to the process of consuming cultural goods using social network sites, and (iv) theorising the consumption of cultural goods using SNS by presenting a theoretical research model which identifies empirical indicators of model constructs and maps out affordance dependencies and hierarchies. The study also provides a systematic research process for applying the concept of affordances to the study of system use.

Prehistoric burnt mound archaeology in Ireland

It is apparent from the widespread distribution of burnt mounds that Ireland was the most prolific user of pyrolithic technology in Bronze Age Europe. Even though burnt mounds are the most common prehistoric site type in Ireland, they have not received the same level of research as other prehistoric sites. This is primarily due to the paucity of artefact finds and the unspectacular nature of the archaeological remains, compounded by the absence of an appropriate research framework. Due to the widespread use of the technology and the various applications of hot water, narratives related to these sites have revolved around discussions of age and function. This has resulted in a generalised classification, where the term ‘fulacht fia’ covers several site types that have similar features but differing functions and age. The study presents a re-evaluation of fulachtaí fia in light of some 1000 sites excavated in Ireland. This is the most comprehensive study undertaken on the use of pyrolithic technology in prehistoric Ireland, dealing with different aspects of site function, chronology, social role and cultural context. A number of key areas have been identified in relation to our understanding of these sites. Previous investigations of burnt mounds have provided little information on the temporality of individual sites. It has been established that appropriate sampling strategies can provide important information about the formation of individual sites, their relationships to each other and to other monuments in the same cultural landscape. The evidence suggests that considerable caution should be exercised with regard to certain single radiometric dates from burnt stone deposits, based on the degree of certainty of the dated sample and its association with pyrolithic activity. Previously regarded as Bronze Age in date, there are now numerous examples of pyrolithic-type processes in earlier contexts, with the origins of the water-boiling phenomenon now considered to be Early Neolithic. A review of recent excavation evidence provides new insights into the use of pyrolithic technology for cooking. This is based on the discovery of faunal remains at several sites, combined with insights gained through experimental studies. The model proposed here is of open-air communal feasting and food sharing hosted by small family groups, as a medium for social bonding and the construction of community. It is also argued that if cooking was the primary activity taken place at these sites, this should not be viewed as a mundane functional activity, but rather one that actively contributed to the constitution of social relations. The formality of the technology is also supported by the presence of possible specialised structures, some of which were used for cooking/feasting while others were for ritualised sweat-bathing. The duration and frequency of activities associated with burnt mounds and the opportunities they provided for social interaction suggest that these sites contributed some familiar frames of reference to contemporary discourse.

Burst-mode electronic dispersion compensation in long reach PONs

Long reach passive optical networks (LR-PONs), which integrate fibre-to-the-home with metro networks, have been the subject of intensive research in recent years and are considered one of the most promising candidates for the next generation of optical access networks. Such systems ideally have reaches greater than 100km and bit rates of at least 10Gb/s per wavelength in the downstream and upstream directions. Due to the limited equipment sharing that is possible in access networks, the laser transmitters in the terminal units, which are usually the most expensive components, must be as cheap as possible. However, the requirement for low cost is generally incompatible with the need for a transmitter chirp characteristic that is optimised for such long reaches at 10Gb/s, and hence dispersion compensation is required. In this thesis electronic dispersion compensation (EDC) techniques are employed to increase the chromatic dispersion tolerance and to enhance the system performance at the expense of moderate additional implementation complexity. In order to use such EDC in LR-PON architectures, a number of challenges associated with the burst-mode nature of the upstream link need to be overcome. In particular, the EDC must be made adaptive from one burst to the next (burst-mode EDC, or BM-EDC) in time scales on the order of tens to hundreds of nanoseconds. Burst-mode operation of EDC has received little attention to date. The main objective of this thesis is to demonstrate the feasibility of such a concept and to identify the key BM-EDC design parameters required for applications in a 10Gb/s burst-mode link. This is achieved through a combination of simulations and transmission experiments utilising off-line data processing. The research shows that burst-to-burst adaptation can in principle be implemented efficiently, opening the possibility of low overhead, adaptive EDC-enabled burst-mode systems.

Locating the transnational: representations and aesthetics of the city in contemporary European cinemas

This thesis focuses on two Western European cinematic cities, and two unique periods of their respective nations’ histories, in a bid to “locate” the transnational within a contemporary European milieu. I argue that my geo-cinematic case studies are emblematic of broader questions of the problematics of national identity in contemporary Europe in the face of cross-national flows yet, as a result of their representations as cities both “anchored” and “in flux”, they reject a European postnational identity. Through its engagement with cinematic Rome as the “Eternal City” of Europe and cinematic Dublin as the “newly Europeanised” city, my thesis traces how representations and aesthetics of the urban spaces of these two cities correspond with the tensions at the heart of the respective eras in question. Via the figures that inhabit it, navigate it and search for it, the city is utilised to highlight fixity and mobility, centrality and dislocation, in explicit and implicit ways, amid the rapidly changing landscape of its national terrain. It is through my analyses of the filmed places and sociopolitical, socioeconomic and sociocultural spaces of these capital cities under the rubric of the transnational that this research demonstrates the “pluralities” of the construct in its cinematic manifestations. It is also my aim to evaluate the concept of cinematic transnationalism when identifying and accounting for representations of a specific national, historical timeframe, when the momentousness of the changes that occur is not bound by the national, but rather is reflective of the influence of both domestic and external forces. To this end, my thesis draws attention to instances in which the nation is shown to persist and resist dilution, arguing that it is only against the backdrop and continuity of the nation (in its evershifting guises) that the transnational can be conceived in representative and aesthetic terms.

A study of the Hobson and Rogers volatility model

We firstly examine the model of Hobson and Rogers for the volatility of a financial asset such as a stock or share. The main feature of this model is the specification of volatility in terms of past price returns. The volatility process and the underlying price process share the same source of randomness and so the model is said to be complete. Complete models are advantageous as they allow a unique, preference independent price for options on the underlying price process. One of the main objectives of the model is to reproduce the `smiles' and `skews' seen in the market implied volatilities and this model produces the desired effect. In the first main piece of work we numerically calibrate the model of Hobson and Rogers for comparison with existing literature. We also develop parameter estimation methods based on the calibration of a GARCH model. We examine alternative specifications of the volatility and show an improvement of model fit to market data based on these specifications. We also show how to process market data in order to take account of inter-day movements in the volatility surface. In the second piece of work, we extend the Hobson and Rogers model in a way that better reflects market structure. We extend the model to take into account both first and second order effects. We derive and numerically solve the pde which describes the price of options under this extended model. We show that this extension allows for a better fit to the market data. Finally, we analyse the parameters of this extended model in order to understand intuitively the role of these parameters in the volatility surface.

Synthesis and evaluation of novel quinolines and quinazolinediones as potential anti-cancer agents

This thesis outlines the design and effectuation of novel chemical routes towards a nascent class of functionalised quinoline-5,8-diones and the expansion of a series of contemporary quinazolinediones towards an innovative family of pyridinoquinazolinetetrone derivatives. This fragment based approach is envisaged to lead to advancements in the three scaffolds, expanding the SAR pool of both quinolines and quinazolinediones with subsequent evaluation of chemotherapeutic potential as well as furnishing a new class of tricycle for biological investigation. Development of novel quinoline-5,8-diones is provided for by expanding on existing methodology. Using a variety of nucleophiles on a critical intermediate, a broad range of novel compounds was afforded allowing chemotherapeutic potential to be assessed, while also serving as intermediates for accomplishing novel pyridinoquinazolinetetrone congeners. In order to incorporate functionality into our quinazolinedione template, an efficient synthetic strategy was constructed which provided a robust route to effectuate a highly derivatised pyrimidinedione ring. As derivatisation of this template is unreported our chief priority was to synthesise a range of diverse quinazolinediones. The application of annulation methodology using functionalised precursors provided a library of N-3 derivatised quinazolinedione analogues. These, along with their N-1 functionalised derivatives provide a wide scope from which to construct a series of pyridinoquinazolinetetrone derivatives while also serving as a unique class of molecules whose biological potential is uncharted. Although the actualisation of the pyridinoquinazolinetetrone was ultimately unsuccessful, our work has led to the development of novel quinoline-5,8-diones which were found to possess excellent anti-cancer activity when assessed by the NCI screen. Of the quinazolinediones synthesised eight compounds were accepted for screening by the NCI. Results from the single-dose tests however indicated that these compounds possessed little cytotoxic activity at 10 μM. The development of this novel template in conjunction with the highly active quinolinediones serves as an excellent rostrum for future synthetic endeavours.

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.

The endless search for SA: spiritual ideology in Hindustāni music

This dissertation centres on philosophical attitudes presented by North Indian classical musicians in relation to the concept and experience of rāga improvisation. In Hindustāni music, there is a dynamic tension ideology and pragmatism, devotion and entertainment, fixity and improvisational freedom, and cognition and visceral experience. On one hand, rāga is an embodied methodological template for the creation of music. On the other hand, rāga improvisation is conceptualised as a path to metaphysical experience and as an evocation of an ineffable divine presence. A masterful rendition of rāga is both a re-enactment of a systematic prescribed formula and a spontaneous flow of consciousness. This study presents these apparent dichotomies to highlight ideological concerns, while simultaneously contextualising philosophical idealism in relation to pragmatic realities. A central paradigm is the manner in which pragmatic concerns are elevated in status and given spiritual significance. The dissertation begins with a view into historical and religious context. The discussion continues with a speculative investigation positing co-relations between Hindustāni music and central tenets of Indian philosophy, considering how rāga improvisation may manifest as a philosophy of sound. The study then explores the concept of rāga, a modal and conceptual construct that forms the heart of Indian classical music. The final three sections ground the subject of spiritual ideology within the life experience of Hindustāni musicians: ‘Transmission’ looks at the learning and enculturation process, which encapsulates values intrinsic to the ethos of Hindustāni music culture. ‘Practice’ explores the discipline, science and experience of musical practice, revealing core ideological concerns connecting spirituality to musical experience; and ‘Performance’ examines the live presentation of rāga improvisation, and the relationship between music as ‘entertainment’ and music as ‘devotion’. Both ethnographic and musicological, this research is the culmination of various fieldtrips to India, extensive interviews with Hindustāni musicians, fifteen year’s sitār training, and the study of relevant musicological and philosophical texts.