Antimicrobial stewardship in Ireland, with a focus on long term care facilities

Background: Antimicrobial resistance is a major public health concern, and its increasing incidence in the Long Term Care Facility (LTCF) setting warrants attention (1). The prescribing of antimicrobials in this setting is often inappropriate and higher in Ireland than the European average (2). The aim of the study was to generate an evidence base for the factors influencing antimicrobial prescribing in LTCFs and to investigate Antimicrobial Stewardship (AMS) strategies for LTCFs. Methods: An initial qualitative study was conducted to determine the factors influencing antimicrobial prescribing in Irish LTCFs. This allowed for the informed implementation of an AMS feasibility study in LTCFs in the greater Cork region. Hospital AMS was also investigated by means of a national survey. A study of LTCF urine sample antimicrobial resistance rates was conducted in order to collate information for incorporation into future LTCF AMS initiatives. Results: The qualitative interviews determined that there are a multitude of factors, unique to the LTCF setting, which influence antimicrobial prescribing. There was a positive response from the doctors and nurses involved in the feasibility study as they welcomed the opportunity to engage with AMS and audit and feedback activities. While the results did not indicate a significant change in antimicrobial prescribing over the study period, important trends and patterns of use were detected. The antimicrobial susceptibility of LTCF urine samples compared to GPs samples found that there was a higher level of antimicrobial resistance in LTCFs. Conclusion: This study has made an important contribution to the development of AMS in LTCFs. The complexity of care and healthcare organisation, and the factors unique to LTCFs must be borne in mind when developing quality improvement strategies.

The Aarhus Convention and its implementation in Ireland: strengthening the role of NGOs in environmental governance

One of the most striking features of the 1998 Aarhus Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters is the leading role envisaged for environmental nongovernmental organisations (ENGOs) in furthering compliance with environmental law. The Convention aims to secure the special status of ENGOs in environmental governance procedures by guaranteeing procedural rights of access to information, participation in decision-making and access to review mechanisms. Although Ireland did not become a Party to the Convention until September 2012, the Aarhus procedural rights were already guaranteed under European Union (EU) law. The EU has been a Party to the Aarhus Convention since May 2005 and has adopted a number of legislative measures to implement the Convention. This thesis examines the evolving role of ENGOs in environmental governance in Ireland. It provides a doctrinal analysis of the impact of the Aarhus Convention and EU law on Irish law and governance arrangements involving ENGOs. The thesis considers the extent to which Ireland has delivered faithfully on the standards set by the Aarhus Convention to facilitate ENGOs to fulfil the role envisaged for them under the Convention.

A qualitative analysis of parental coping with an early diagnosis of hearing loss in Ireland

The recent implementation of Universal Neonatal Hearing Screening (UNHS) in all 19 maternity hospitals across Ireland has precipitated early identification of paediatric hearing loss in an Irish context. This qualitative, grounded theory study centres on the issue of parental coping as families receive and respond to (what is typically) an unexpected diagnosis of hearing loss in their newborn baby. Parental wellbeing is of particular concern as the diagnosis occurs in the context of recovery from birth and at a time when the parent-child relationship is being established. As the vast majority of children with a hearing loss are born into hearing families with no prior history of deafness, parents generally have had little exposure to childhood hearing loss and often experience acute emotional vulnerability as they respond to the diagnosis. The researcher conducted in-depth interviews primarily with parents (and to a lesser extent with professionals), as well as a follow-up postal questionnaire for parents. Through a grounded theory analysis of data, the researcher subsequently fashioned a four-stage model depicting the parental journey of receiving and coping with a diagnosis. The four stages (entitled Anticipating, Confirming, Adjusting and Normalising) are differentiated by the chronology of service intervention and defined by the overarching parental experience. Far from representing a homogenous trajectory, this four-stage model is multifaceted and captures a wide diversity of parental experiences ranging from acute distress to resilient hopefulness

Politics, Power, PISA: a genealogy of mathematics education policy at second level in Ireland at the beginning of the 21st century

This thesis traces a genealogy of the discourse of mathematics education reform in Ireland at the beginning of the twenty first century at a time when the hegemonic political discourse is that of neoliberalism. It draws on the work of Michel Foucault to identify the network of power relations involved in the development of a single case of curriculum reform – in this case Project Maths. It identifies the construction of an apparatus within the fields of politics, economics and education, the elements of which include institutions like the OECD and the Government, the bureaucracy, expert groups and special interest groups, the media, the school, the State, state assessment and international assessment. Five major themes in educational reform emerge from the analysis: the arrival of neoliberal governance in Ireland; the triumph of human capital theory as the hegemonic educational philosophy here; the dominant role of OECD/PISA and its values in the mathematics education discourse in Ireland; the fetishisation of western scientific knowledge and knowledge as commodity; and the formation of a new kind of subjectivity, namely the subjectivity of the young person as a form of human-capital-to-be. In particular, it provides a critical analysis of the influence of OECD/PISA on the development of mathematics education policy here – especially on Project Maths curriculum, assessment and pedagogy. It unpacks the arguments in favour of curriculum change and lays bare their ideological foundations. This discourse contextualises educational change as occurring within a rapidly changing economic environment where the concept of the State’s economic aspirations and developments in science, technology and communications are reshaping both the focus of business and the demands being put on education. Within this discourse, education is to be repurposed and its consequences measured against the paradigm of the Knowledge Economy – usually characterised as the inevitable or necessary future of a carefully defined present.

John Ireland, "L’art déloyal, théâtralité et engagement dans l’oeuvre de J.P. Sartre", thèse New York University, 299 pages.

Paris

Congruent trends in long-term zooplankton decline in the north-east Atlantic and basking shark (Cetorhinus maximus ) fishery catches off west Ireland

Trends in basking shark (Cetorhinus maximus) fishery catches off Achill Island, west Ireland between 1949 and 1975 were examined in relation to zooplankton (total copepod) abundance in four adjacent sea areas over a 27-year period. The numbers of basking sharks caught and copepod abundance showed downward trends and were positively correlated (r-value range, 0.44–0.74). A possible explanation for the downward trend in shark catches was that progressively fewer basking sharks occurred there between 1956 and 1975 because fewer copepods, their food resource, occurred near the surface off west Ireland over the same period. We suggest that the decline in basking sharks may have been due to a distributional shift of sharks to more productive areas, rather than a highly philopatric, localized stock that was over-exploited.

Review of climate change impacts on marine fisheries in the UK and Ireland

1.Commercial fishing is an important socio-economic activity in coastal regions of the UK and Ireland. Ocean–atmospheric changes caused by greenhouse gas emissions are likely to affect future fish and shellfish production, and lead to increasing challenges in ensuring long-term sustainable fisheries management. 2.The paper reviews existing knowledge and understanding of the exposure of marine ecosystems to ocean-atmospheric changes, the consequences of these changes for marine fisheries in the UK and Ireland, and the adaptability of the UK and Irish fisheries sector. 3.Ocean warming is resulting in shifts in the distribution of exploited species and is affecting the productivity of fish stocks and underlying marine ecosystems. In addition, some studies suggest that ocean acidification may have large potential impacts on fisheries resources, in particular shell-forming invertebrates. 4.These changes may lead to loss of productivity, but also the opening of new fishing opportunities, depending on the interactions between climate impacts, fishing grounds and fleet types. They will also affect fishing regulations, the price of fish products and operating costs, which in turn will affect the economic performance of the UK and Irish fleets. 5.Key knowledge gaps exist in our understanding of the implications of climate and ocean chemistry changes for marine fisheries in the UK and Ireland, particularly on the social and economic responses of the fishing sectors to climate change. However, these gaps should not delay climate change mitigation and adaptation policy actions, particularly those measures that clearly have other ‘co-benefits’.