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Let $m$ be a positive integer and let $E$ be an elliptic curve over $\mathbb{Q}$ with the property that $m\mid#E(\mathbb{F}_p)$ for a density $1$ set of primes $p$. Building upon work of Katz and Harron-Snowden, we study the probability that $m$ divides the the order of the torsion subgroup of $E(\mathbb{Q})$: we find it is nonzero for all $m \in \{ 1, 2, \dots, 10, 12, 16\}$ and we compute it exactly when $m \in \{ 1,2,3,4,5,7 \}$. As a supplement, we give an asymptotic count of elliptic curves with extra level structure when the parametrizing modular curve arises from the quotient by a torsion-free group of genus zero., Comment: 51 pages, 2 figures; incorporated final corrections and added/updated references

Let $\ell$ be a prime number and let $E$ and $E'$ be $\ell$-isogenous elliptic curves defined over a finite field $k$ of characteristic $p \ne \ell$. Suppose the groups $E(k)$ and $E'(k)$ are isomorphic, but $E(K) \not \simeq E'(K)$, where $K$ is an $\ell$-power extension of $k$. In a previous work we have shown that, under mild rationality hypotheses, the case of interest is when $\ell=2$ and $K$ is the unique quadratic extension of $k$. In this paper we study the likelihood of such an occurrence by fixing a pair of 2-isogenous elliptic curves $E$, $E'$ over ${\mathbf{Q}}$ and asking for the proportion of primes $p$ for which $E(\mathbf{F}_p) \simeq E'(\mathbf{F}_p)$ and $E(\mathbf{F}_{p^2}) \not \simeq E'(\mathbf{F}_{p^2})$.

The Krawtchouck polynomials arise naturally in both coding theory and probability theory and have been studied extensively from these points of view. However, very little is known about their irreducibility and Galois properties. Just like many classical families of orthogonal polynomials (e.g. the Legendre and Laguerre), the Krawtchouck polynomials can be viewed as special cases of Jacobi polynomials. In this paper we determine the Newton Polygons of certain Krawtchouck polynomials and show that they are very similar to those of the Legendre polynomials (and exhibit new cases of irreducibility). However, we also show that their Galois groups are significantly more complicated to study, due to the nature of their coefficients, versus those of other classical orthogonal families.

In this paper we build on the work of \cite{kaber} where it was shown that the one-parameter family of Gegenbauer Polynomials (GP) exhibit a Gibbs Phenomenon at a jump discontinuity. We show that the one-parameter family of Generalized Laguerre Polynomials (GLP) also exhibit a Gibbs Phenomenon. Among many differences, a major one is that the GLP are orthogonal on a non-compact subset of $\R$, while the GP are orthogonal on $[-1,1]$. Our strategy follows that of \cite{kaber} and we use entirely elementary methods to arrive at our result. As a special case we show that the Hermite Polynomials also possess a Gibbs Phenomenon. We conclude with a numerical example exhibiting the rate of convergence to the Gibbs constant and a conjectured identity for special values of the GLP.

Additional file 1. Additional HEI and enrolment information.

Encefalomielitis miàlgica/síndrome de fatiga crònica; Cura; Diagnòstic Myalgic encephalomyelitis/chronic fatigue syndrome; Care; Diagnosis Encefalomielitis miálgica/síndrome de fatiga crónica; Cuidado; Diagnóstico Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS. This research received no external funding. EUROMENE receives funding for networking activities from the COST programme (COST Action 15111), via the COST Association.

A representation of a finite group $G$ on a finite dimensional vector space $V$ is called \textbf{unisingular} if every $g\in G$ has 1 as an eigenvalue in its action on $V$. In this paper we show that certain unisingular representations can be realized as mod 2 representations of hyperelliptic Jacobians over $\Q$. We additionally identify new unisingular representations of the symmetric and alternating groups., Comment: 18 pages

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation is Science and Technology (COST) (https://www.cost.eu/cost-actions/what-are-cost-actions/ ) - COST action 15111 - from 2016 to 2020. The main goal of the Cost Action was to assess the existing fragmented knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report on the recommendations for clinical diagnosis, heath services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS (https://www.cost.eu/actions/CA15111/#tabs|Name:overview).

The $(u,v)$-Pad\'e approximation to a function $f$ is the (unique, up to scaling) rational approximation $f(x) = P(x)/Q(x) + O(x^{u+v+1})$, where $P$ has degree $u$ and $Q$ has degree $v$. Motivated by recent work of Molin, Pazuki, and Rabarison, we study the arithmetic of the Pad\'e approximants of the exponential polynomials. By viewing the approximants as certain Generalized Laguerre Polynomials, we determine the Galois groups of the diagonal approximants and prove some special cases of irreducibility., Comment: 13 pages

The $(u,v)$-Pad�� approximation to a function $f$ is the (unique, up to scaling) rational approximation $f(x) = P(x)/Q(x) + O(x^{u+v+1})$, where $P$ has degree $u$ and $Q$ has degree $v$. Motivated by recent work of Molin, Pazuki, and Rabarison, we study the arithmetic of the Pad�� approximants of the exponential polynomials. By viewing the approximants as certain Generalized Laguerre Polynomials, we determine the Galois groups of the diagonal approximants and prove some special cases of irreducibility., 13 pages

ME/CFS is a chronic, complex, multisystem disease that often limits the health and functioning of the affected patients. Diagnosing patients with ME/CFS is a challenge, and many different case definitions exist and are used in clinical practice and research. Even after diagnosis, medical treatment is very challenging. Symptom relief and coping may affect how patients live with their disease and their quality of life. There is no consensus on which diagnostic criteria should be used and which treatment strategies can be recommended for patients. The purpose of the current project was to map the landscape of the Euromene countries in respect of national guidelines and recommendations for case definition, diagnosis and clinical approaches for ME/CFS patients. A 23 items questionnaire was sent out by email to the members of Euromene. The form contained questions on existing guidelines for case definitions, treatment/management of the disease, tests and questionnaires applied, and the prioritization of information for data sampling in research. We obtained information from 17 countries. Five countries reported having national guidelines for diagnosis, and five countries reported having guidelines for clinical approaches. For diagnostic purposes, the Fukuda criteria were most often recommended, and also the Canadian Consensus criteria, the International Consensus Criteria and the Oxford criteria were used. A mix of diagnostic criteria was applied within those countries having no guidelines. Many different questionnaires and tests were used for symptom registration and diagnostic investigation. For symptom relief, pain and anti-depressive medication were most often recommended. Cognitive Behavioral Therapy and Graded Exercise treatment were often recommended as disease management and rehabilitative/palliative strategies. The lack of consistency in recommendations across European countries urges the development of regulations, guidance and standards. The results of this study will contribute to the harmonization of diagnostic criteria and treatment for ME/CFS in Europe.

We examine the relationship between the distribution of upper secondary school performance and a range of individual and school level characteristics using unconditional quantile regression methods and data from Ireland. We find that determinants such as social class, maternal unemployment, extra private tuition, and working part-time have differential effects for low and high ability students and that important insights are lost by focusing on the conditional mean. The implication is that while certain factors can impact on whether or not a student is likely to proceed to higher education, other factors may affect where students go and what they study.

Table S1. Comparison of Irish and Swedish OHCA resuscitation registries, Table S2. Missing data items, Table S3. Logistic regression analysis for the outcome survival in the Utstein subgroup using original data (adult, bystander-witnessed, initial rhythm, shockable, presumed medical aetiology). (PDF 95ย�kb)

Additional file 1: Table S1. Deviance information criteria, beta coefficients and relative rate for All Home cases categorised by year.

Background: There have been significant increases in the utilisation of statins for the primary and secondary prevention of cardiovascular disease (CVD) over the last decades. Our aim was to describe the prevalence of statin utilisation by people aged over 50 and the factors associated with the likelihood of using a statin. Methods: Cross-sectional analysis of cardiovascular risk and socio-demographic factors associated with statin utlisation from The Irish Longitudinal Study on Ageing (n=5,618). The prevalence of statin utlisation was calculated according to age, gender and diagnoses. The likelihood of statin utlisation was estimated using multivariate logistic regression models. Results: 30% of the sample was taking statins. Statin utlisation increased with age. 57% of men and 73% of women taking statins did not have established CVD. Polypharmacy was significantly associated with statin utlisation (OR 3.53; CI 2.84-4.39), as were living with a spouse or partner and frequency of GP visits. There was no association with other socio-demographic or CVD risk factors. Conclusion: Statin utlisation was highest among those with established CVD but 65% of all users did not have CVD. It may be appropriate to consider whether widespread use of statins in some low-risk categories represents the best use of scarce resources.

Cardiac arrest occurs when the heart suddenly ceases to pump blood around the body. To optimise survival from out-of-hospital cardiac arrest (OHCA), knowledge of the spatial distribution of OHCA and the availability of resuscitation, or ‘Chain of Survival’, is required. Thus, this study aims to describe OHCA incidence and Chain of Survival availability in a manner that can help inform pre-hospital planning in the Republic of Ireland. In view of Ireland’s heterogeneous settlement pattern, we analyse the association between varying degrees of rurality, OHCA incidence and the availability of the Chain of Survival. In addition to population density, settlement size, proximity to urban centres and land use is taken into account which results in six classes: city; town; accessible village; remote village; accessible rural; remote rural. Results show that, when adjusted for age and sex, the incidence of adult OHCA decreases with increasing rurality. Furthermore, while distance to the nearest ambulance station and call-response interval is greater with increasing rurality, the lowest levels of bystander cardiopulmonary resuscitation occur in the most urban class. To the best of our knowledge, this is one of the very first whole-country geographic descriptions of OHCA to be performed internationally. It is also the first OHCA study to use a multi-class urban-rural classification that considers rurality as more than a function of population density peer-reviewed

Working paper This paper examines the determinants of residential gas demand in Ireland using a microeconometric analysis of the daily gas consumption panel data from Ireland's Smart Metering Gas Consumer Behavioural Trial. It also investigates the e ectiveness of the demand side management stimuli that were tested during the Smart Metering Trial. The analysis is based on a sample of 1,181 households over 539 days. The results provide evidence that weather, together with the structural characteristics of the dwellings and the socio-economic characteristics of the households, are signi cant factors in explaining residential gas demand. More speci cally, weather is found to be the most in uential factor on household's daily gas consumption. Finally, the demand side management stimuli employed in the Smart Metering Trial were found to reduce daily household gas use on average. non-peer-reviewed

Against the background of an ageing population and the current economic recession, the research reported here explores deprivation, and its measurement, for diverse groups of older people living in Ireland. We assess the effectiveness of existing measures of deprivation ¿ in particular the 11-item basic deprivation index used in official statistics in Ireland ¿ and explore how the perceptions and experiences of older people, from different backgrounds, can be used to inform how we think about and measure disadvantage for older people. the Irish Research Council Research Development Initiative 2011; Social Inclusion Research Innovation Awards (SIRIA) peer-reviewed

While a number of international studies have attempted to assess the influence of geographic accessibility on the decision to participate in higher education, this issue has not been addressed in detail in an Irish context. The aim of this paper is to fill this gap and to present a higher education choice model that estimates the impact of travel distance on the decision of school leavers to proceed to higher education in Ireland, while also controlling for a range of individual level characteristics and school related variables. To do so we use data from the 2007 wave of the School Leavers' Survey. We find that, on average, travel distance is not an important factor in the higher education participation decision, when factors such as student ability are accounted for. However, further analysis shows that travel distance has a significantly negative impact on participation for those from lower social classes and that this impact grows stronger as distance increases. We also find that the distance effects are most pronounced for lower ability students from these social backgrounds. This has important implications for higher education policy in Ireland, especially in relation to equity of access and the design of the maintenance grant system.

Understanding the determinants of farm households’ social engagement patterns in rural communities is important for public policy programs that seek to improve the well-being of the rural population and promote rural sustainability. Within this context, this paper examines the factors that influence both the participation in, and the number of hours dedicated to, social, community and leisure activities among farm operators and their spouse/partner in a region in the West of Ireland. The theoretical underpinnings of this research are an extension of Becker’s (1965, 1974) and Gronau’s (1977) agricultural household models, whereby households maximise utility subject to a set of constraints, household income and time endowment. The study employs a time-use diary survey, combined with an individual and household survey, to collect data from farm households in counties Galway, Mayo and Roscommon. A Craggs double hurdle model is used to estimate the predictors of time-use and the number of hours spent participating in a range of off-farm activities.

Understanding the determinants of farm households’ social engagement patterns in rural communities is important for public policy programs that seek to improve the well-being of the rural population and promote rural sustainability. Within this context, this paper examines the factors that influence both the participation in, and the number of hours dedicated to, social, community and leisure activities among farm operators and their spouse/partner in a region in the West of Ireland. The theoretical underpinnings of this research are an extension of Becker’s (1965, 1974) and Gronau’s (1977) agricultural household models, whereby households maximise utility subject to a set of constraints, household income and time endowment. The study employs a time-use diary survey, combined with an individual and household survey, to collect data from farm households in counties Galway, Mayo and Roscommon. A Craggs double hurdle model is used to estimate the predictors of time-use and the number of hours spent participating in a range of off-farm activities.

Addressing the extra economic costs of disability is a logical step towards alleviating elements of social exclusion for people with disabilities. This study estimates the long-run economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with individuals who have a disability in Ireland when compared with the wider population, both in general and by severity of disability. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying panel ordered probit models to living in Ireland survey data 1995¿2001 in order to control for the effects of previous disability and income and correlated unobserved heterogeneity. The approach allows us to quantify, for the first time, the additional long-run economic costs of living associated with disability. Our findings suggest that the extra economic cost of disability in Ireland is large and varies by severity of disability, with important implications for measures of poverty. peer-reviewed

This paper proposes an approach to estimating catchment area population indicators (CAPIs) using geographic information system (GIS)-based network analysis. Specifically, it considers how 'GeoDirectory', a geodatabase containing the spatial coordinates of every building in the Republic of Ireland, can be used in conjunction with estimated service areas to calculate the number of residential buildings within a catchment area. The count of residences within the catchment then acts as an indicator or proxy for its population and can be useful when the catchment area does not match closely any combination of geographical or administrative areas for which data exists. Two small-scale recreation forest sites in County Galway are considered by way of illustration: Barna Wood and Renville Forest Park. CAPIs are estimated for the two sites using distance-based service areas as well as isochrone surfaces, and comparisons are made to estimates based on measures of Euclidean distance. The analysis suggests that network-based service areas are useful for deriving catchment population indicators, that road density has a significant impact on catchment area size and that caution must be exercised with respect to travel speed assumptions when estimating isochrone surfaces. peer-reviewed

Addressing the extra economic costs of disability seems a logical step towards alleviating elements of social exclusion for people with disabilities. This paper estimates the economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with individuals who have a disability in Ireland when compared to the wider population, both in general and by severity of illness. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying an ordered logit modelling approach to Living in Ireland survey data 1995-2001 to quantify the extra costs of living associated with disability in Ireland. We also derive estimates of the cost of disability for `pensioner¿ and `non-pensioner¿ households, as well as over time. Our findings suggest that the economic cost of disability in Ireland is large, varies by severity of disability, and across household types. Overall our findings have important implications for measures of poverty in Ireland. peer-reviewed

The paper uses a finite mixture modelling approach to investigate the likely determinants of relative economic performance of Irish towns. The particular success factors that we focus on are measures of connectivity, position and competitive capacity of places. Our main argument is that these determinants of success can act in different ways on different groups of towns. The mixture model is able to detect this fact. The insights provided by the model are important additions to our understanding of spatial dynamics and contribute to the policy debate on spatial planning and infrastructural investment. peer-reviewed

Addressing the extra economic costs of disability seems a logical step towards alleviating elements of social exclusion for people with disabilities. This paper estimates the economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with individuals who have a disability in Ireland when compared to the wider population, both in general and by severity of illness. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying an ordered logit modelling approach to Living in Ireland survey data 1995-2001 to quantify the extra costs of living associated with disability in Ireland. We also derive estimates of the cost of disability for 'pensioner' and 'non-pensioner' households, as well as over time. Our findings suggest that the economic cost of disability in Ireland is large, varies by severity of disability, and across household types. Overall our findings have important implications for measures of poverty in Ireland.

A collection of folklore and local history stories from An Charraig Bheag, Carraig na Siúire (school) (Carrickbeg, Co. Waterford), collected as part of the Schools' Folklore Scheme, 1937-1938 under the supervision of teacher Seán Ó Comhraidhe., Páirceanna i bPort na Bó / Hahessy, Ned -- Moon - Old Stones - Cromlechs / Hahessy, Ned -- Enchanted Cow / Lacey, Tom -- How the People Used to Make Tallow Candles / Lacey, Tom -- Straying Sod / Grath, Michael Mc -- True Story / Coughlin, Thomas -- Fair of Glynn / Hahessy, Ned -- Story / Purcell, Dick -- Fair of Carrick-on-Suir / Hahessy, Ned -- Story -- Taibhreamh / Búrca, Siobhán de -- Walking Feat -- Carraig Fhenóch -- Great Mower / Cullinan, John -- St Brigid's Day / Coughlan, Thomas -- Story of a Light / Coe, William -- Story / Hahessy, Ned -- Story / Lacey, Thomas -- Storm / Hahessy, Ned -- Butter-Making -- Story / Grath, Michael Mc -- Butter-Making About Fifty Years Ago / Dunne, James -- The Curraghmore Farmyard / Coe, Willie -- How the Potatoes were Planted in this Parish / Hahessy, Ned -- Digging Potatoes in this Locality about Fifty Years Ago / Grath, Michael Mc -- Story / Cullinan, John -- The Principal Wells of this Parish / Curry, Mr -- Fiddown Bridge / Hahessy, Ned -- Hiring Fair at Carrick-on-Suir / Hahessy, Ned -- Páirceanna i gCurrach Eanaigh -- Local Forge / Hahessy, Ned -- Gairdín an Uisce - Sceach an tSrutha -- Tinhalla Mill / Hahessy, Ned -- Story -- Suir at Carrick -- Story of Three Lights -- In Memoriam of John Henry De La Poer Beresford / Coe, William -- Rose of Aughnabrone -- Story / Purcell, Richard -- Story about Cobblers / Fitzpatrick, Thomas -- Ballinacurra Ghost / Kelly, Eddie -- Cow / Hahessy, Ned -- Short History of Portlaw / Houlihan, John -- A Story / Nugent, James -- Food Eaten in Olden Times / Fitzpatrick, Thomas -- Copper Lodge / Coe, William -- Coal Yard / Hahessy, Ned -- A townsland on the border of this parish... / Hahessy, Ned -- Story / Hahessy, Mary -- Fields in Curraghmore / Coe, William -- Story / Nugent, James -- Some Strong Men of the Parish / Fitzpatrick, Thomas -- Charms -- Fields of Brownswood / Nugent, James -- In Ballynevin there are three ponds. / Kavanagh, Mary -- Story / Hahessy, Kathleen -- Feddin's Castle -- Clonea Castle / Purcell, Richard, Supported by funding from the Department of Arts, Heritage and the Gaeltacht (Ireland), University College Dublin, and the National Folklore Foundation (Fondúireacht Bhéaloideas Éireann), 2014-2016.

Statins are a class of drugs that lower blood cholesterol levels and were originally used to prevent further recurrences in those with a history of cardiovascular disease (CVD). Over time, their use has been extended to those with no prior history but who may be at risk of CVD in the future, referred to as primary prevention. The increase in the proportion of people taking statins for primary prevention has raised concern about the medicating of asymptomatic people, a process described as medicalisation. The aim of this thesis is to explore the increased use of statins within the context of primary prevention of CVD and to consider whether or not this constitutes an appropriate use of this medicine both from the perspective of the individual patient and of society. In order to establish the proportion of statin users and reasons for statin use, an analysis of data from The Irish LongituDinal Study on Ageing (TILDA) was undertaken. Almost one third of over-50s were using statins and, of those, almost two-thirds were doing so for primary prevention of CVD. However, while just over a half of men who took statins did so for primary prevention, almost three quarters of women did likewise. This analysis of TILDA data also suggests that there may be an overemphasis on high cholesterol as a reason to prescribe, rather than prescribing based on a person’s overall risk assessment. Given the common use of statins for primary prevention, an overview of systematic reviews of exclusively primary prevention data regarding the effectiveness of statins for prevention of CVD was then conducted, finding mixed and limited evidence on the effectiveness of statins in primary prevention populations, particularly in women. Changes in the recommendations of clinical guidelines have been identified as a driver of the medicalisation process in general, and changes in the clinical guidelines for CVD prevention since 1987 have resulted in almost 62% of over-50s becoming eligible for stain therapy by 2016. This has significant implications for State spending on statins and also implies that many low-risk people have become eligible for statin therapy. As a result, many statin users may not achieve risk reductions needed to justify taking a daily medicine. Another driver of medicalisation is how people themselves, both doctors and patients, subscribe to particular ways of understanding primary prevention of CVD. By exploring these issues through analyses of semi-structured interviews, it was found that rather than high cholesterol being seen as one of several risk factors that may contribute to heart disease, it tended to be reified and evaluated as a current problem. Statins were represented as a necessary medicine that many patients, and doctors, felt they did not have a choice about taking or prescribing. Taking statins for life is a common biomedically sanctioned experience in Ireland, indicating that this has been a site of medicalisation. The fundamental question that motivated the analyses in this thesis is whether the benefits of statins outweigh the costs, opportunity costs, or harms to society and to the individual patient? Low-value care has been defined as healthcare that offers little clinical benefit but has the potential to cause harm and I argue that for many patients in primary prevention, and for the State reimbursing those patients, statin use may be an example of low-value care and, in some cases, represent a waste of healthcare resources. However, the boundaries between appropriate use, overuse and low-value care are difficult to delineate. Therefore, to conclude, Abstract Statins are a class of drugs that lower blood cholesterol levels and were originally used to prevent further recurrences in those with a history of cardiovascular disease (CVD). Over time, their use has been extended to those with no prior history but who may be at risk of CVD in the future, referred to as primary prevention. The increase in the proportion of people taking statins for primary prevention has raised concern about the medicating of asymptomatic people, a process described as medicalisation. The aim of this thesis is to explore the increased use of statins within the context of primary prevention of CVD and to consider whether or not this constitutes an appropriate use of this medicine both from the perspective of the individual patient and of society. In order to establish the proportion of statin users and reasons for statin use, an analysis of data from The Irish LongituDinal Study on Ageing (TILDA) was undertaken. Almost one third of over-50s were using statins and, of those, almost two-thirds were doing so for primary prevention of CVD. However, while just over a half of men who took statins did so for primary prevention, almost three quarters of women did likewise. This analysis of TILDA data also suggests that there may be an overemphasis on high cholesterol as a reason to prescribe, rather than prescribing based on a person’s overall risk assessment. Given the common use of statins for primary prevention, an overview of systematic reviews of exclusively primary prevention data regarding the effectiveness of statins for prevention of CVD was then conducted, finding mixed and limited evidence on the effectiveness of statins in primary prevention populations, particularly in women. Changes in the recommendations of clinical guidelines have been identified as a driver of the medicalisation process in general, and changes in the clinical guidelines for CVD prevention since 1987 have resulted in almost 62% of over-50s becoming eligible for stain therapy by 2016. This has significant implications for State spending on statins and also implies that many low-risk people have become eligible for statin therapy. As a result, many statin users may not achieve risk reductions needed to justify taking a daily medicine. Another driver of medicalisation is how people themselves, both doctors and patients, subscribe to particular ways of understanding primary prevention of CVD. By exploring these issues through analyses of semi-structured interviews, it was found that rather than high cholesterol being seen as one of several risk factors that may contribute to heart disease, it tended to be reified and evaluated as a current problem. Statins were represented as a necessary medicine that many patients, and doctors, felt they did not have a choice about taking or prescribing. Taking statins for life is a common biomedically sanctioned experience in Ireland, indicating that this has been a site of medicalisation. The fundamental question that motivated the analyses in this thesis is whether the benefits of statins outweigh the costs, opportunity costs, or harms to society and to the individual patient? Low-value care has been defined as healthcare that offers little clinical benefit but has the potential to cause harm and I argue that for many patients in primary prevention, and for the State reimbursing those patients, statin use may be an example of low-value care and, in some cases, represent a waste of healthcare resources. However, the boundaries between appropriate use, overuse and low-value care are difficult to delineate. Therefore, to conclude, I argue that the prescription, use and reimbursement of statins in primary prevention warrants more careful consideration incorporating patient preferences and numbers-needed-to-treat, and that the concept of overuse and low-value care should become integral to policy making.

Background: Out-of-hospital cardiac arrest (OHCA) is the most critical health event that occurs in the community. When the heart stops pumping blood, if resuscitation is not started, biological death will occur within minutes. It is known that patient-level factors significantly affect OHCA incidence and outcome however, area-level variation is often observed. The aim of this thesis was to investigate if area-level grouping or area-level characteristics could be identified that influence OHCA incidence and outcome, and their impact quantified. Methods: Using data from the Irish OHCA registry, descriptive and geographical analysis of OHCA incidence was performed. Cases were geocoded to Electoral Division (ED) level and combined with national census data, and area-level deprivation data, and classified by urban-rural category. The impact of urban-rural grouping was quantified using multilevel linear regression. To adjust for the impact of a small number of cases at ED-level, and the spatial properties of EDs, Bayesian conditional autoregression (CAR) was used to estimate the relative risk of OHCA. Swedish and Irish registry data was compared using logistic regression to identify the predictors of outcome, and to quantify variation measured. Finally, multilevel logistic regression analyses of outcomes in international airports was performed to allow for a differing effect of predictor variables between countries. Results: The incidence of OHCA where resuscitation was performed was higher in City and Town EDs (51/100,000 population per year; 95% confidence interval [CI], 46 to 55) than in Rural EDs (35/100,000 population per year; 95% CI, 28 to 42). However, urban-rural grouping accounted for only 2% of variation. Bayesian CAR modelling showed that a one-point increase in relative deprivation was associated with an 11% increased risk of OHCA that occurred at home. Logistic regression analysis of the Utstein comparator group (adults, bystander-witnessed, initial shockable rhythm, presumed medical cause) explained only 17% of outcome variation between Sweden and Ireland, with a 4-fold ‘country effect’ in favour of Sweden. Country-level differences in survival in international airports were also evident, particularly when adjusted for age, gender, and attempted bystander defibrillation (median odds ratio 3.0; 95% credible interval, 1.6 to 14.3]). Conclusions: Findings did not support changes in provision of resuscitation services based on area-level differences, and only a small proportion of between-country variation was explained by routinely collected variables. As patient-level factors are likely to explain the greater proportion of variation in OHCA outcome, it is recommended that there is international collaboration to ensure comparability of data collection and data interpretation, and to promote comprehensive case capture and maximise data quality. It is also recommended that more explanatory variables are incorporated into OHCA registry data collection. Finally, improvements in survival cannot be achieved without cooperation from local communities, but community preparedness should include: discussion on the inevitability of cardiac arrest as part of life; the prospect of patient survival; and, the need for innovative thinking to make sure that pre-hospital resuscitation is initiated efficiently and effectively.

Residential energy demand is a key priority area for energy policy in the European Union, especially for the engagement of its citizens in a so-called 'Energy Union' that encourages consumers to take ownership of the energy transition to a low carbon economy. Consumers can engage in energy markets in several ways and there can be significant differences in the nature and depth of this engagement amongst individuals and households. More generally, variations in the demand for energy and in the energy related behaviour of households are also important for policy. In this context, the objective of this thesis is to examine issues relating to consumer engagement and heterogeneity in residential energy demand. It addresses four specific goals aligned with this objective in four separate empirical essays. A better understanding of the determinants of residential gas demand can support the development of policy measures intended to engage consumers and change aspects of their behaviour relating to household gas use. This information is particularly important when designing demand side management (DSM)programmes which encourage households to play a more active role in managing their energy use. Thus, the first essay of this thesis examines the determinants of residential gas demand using a random effects model of daily gas consumption panel data from a large scale smart metering trial in Ireland. It analyses the effects of the socio-economic and dwelling characteristics of households, as well as the impact of weather-related variables, on residential gas use. In addition, the analysis employs a quasi-experimental methodology, through difference-in-differences estimation, to identify the effectiveness of DSM in engaging households to reduce their gas consumption. To help realise the full potential of DSM, the second essay of this thesis explores the heterogeneous effects of DSM on residential gas demand across different groups of households categorised by their socio-economic, household level and dwelling characteristics. A random effects model is utilised where the average treatment effects are allowed to vary systematically across the different characteristics to determine which household factors are more or less responsive to the programme. In addition, a fixed effects model is employed where the overall effect is allowed to vary across billing cycles to establish if DSM programmes induce habit formation in households, while a quantile regression model is employed to explore the variability in effects across the distribution of daily gas consumption. The elasticity at mean income is usually the parameter of most interest when examining the relationship between energy expenditure and income. However, not all policy is concerned with the average household and is more likely to target low or high energy consumption households. To this end, the third essay examines the variation in the income elasticity of household energy demand across the distribution of energy expenditure. The analysis is based on the application of a two stage instrumental variable quantile regression methodology to five independent cross-sections and the pooled sample of the Irish Household Budget Survey (HBS) to estimate elasticities across the distribution of energy expenditure. The elasticities are compared across high and low energy consumption pro les and to the benchmark constant mean elasticity estimated separately using a two stage least squares method. Consumer switching is understood to play a key role in creating competitive markets and it is important that consumers actively engage in switching to help maintain competitive pressure on energy providers. Using a pooled cross-section from a pan-European market monitoring survey, the fourth essay explores the role of consumers' socio-demographic characteristics, together with their attitudes to the main features of the market, on the propensity to switch in energy markets across Europe. The analysis estimates a binary logit model for overall switching across 14 European markets, as well as separate models for switching in both the electricity and natural gas markets for comparison. In an extension to the analysis, another model is considered to provide evidence on whether switching in other non-energy markets influences switching in energy markets, while finally, separate country models are estimated to compare the heterogeneous effects of the different influential factors on switching across countries. 2019-12-14

Higher education has a range of important benefits for individuals and societies. As a result, increased participation in higher education is a stated policy goal in many countries. Understanding the economics of higher education is valuable in attempting to address issues related to higher education participation. In this context, the objective of this thesis is to expand our understanding of the economics of higher education participation in Ireland, with a particular focus on issues relating to geographic accessibility and student preferences. Empirical studies investigating the factors influencing progression to higher education have identified geographic accessibility to higher education institutions (HEIs), through the associated transaction costs, as one important factor. Moreover, evidence from Ireland of ‘localised’ patterns of progression to higher education implies that proximity to a specific HEI is a key factor in a student’s decision to study there. Despite this, no comprehensive measure of geographic accessibility to higher education has been developed for Ireland to date. Thus, the first aim of this thesis is to present an analysis of the extent and nature of geographic accessibility to higher education in Ireland. To this end, a range of GIS techniques are employed, while enrolment and mobility rates are also analysed to explore the association between proximity to different types of HEIs and the type of education pursued by individuals. Spatially-based accessibility Gini indices are calculated to explore the likely implications of any inequalities in accessibility, while a detailed analysis of the impact of a recent proposed higher education reform on geographic accessibility to universities in Ireland is also presented. Other non-spatial factors are of course also likely to be important, both in the decision to progress to higher education and in a student’s choice of HEI. In order to understand what attributes of higher education provision are valued by students, the second aim of this thesis is to elicit student preferences for HEIs in Ireland using a discrete choice experiment methodology. To this end, a survey of 1,105 students in their final year of secondary school was conducted across 34 schools. In the analysis, a latent class model is first employed to model heterogeneity in preferences and willingness-to-pay (WTP) across both the attributes of HEIs and across socio-economic groups. Compensating surplus for bundles of HEI attributes is also estimated, which has not been done previously in the literature. This allows the welfare gain or loss from alternative HEIs to be isolated. To further the analysis of heterogeneity in preferences, this thesis also employs mixed logit and generalised multinomial logit (GMNL) models to provide an in-depth analysis of the scale and variation in WTP by region, academic ability and socio-economic status. In fact, this thesis makes a methodological contribution to the education economics literature as it represents the first empirical application of the GMNL model in the area. Examining this variation in WTP is useful to both policymakers and HEI managers, as it provides them with interpretable information on how much different students value the attributes of HEIs.

Community development and social support systems have evolved uniquely in rural Ireland. In response to poverty and other historical developments, dense networks of families, friends and neighbours often formed strong informal social support systems, allocating time to help each other. Such behaviour is consistent with the 'meitheal' tradition, the idea of spirit of community or connectedness within groups of neighbours, an ethos that is preserved and safeguarded among farming communities throughout the West of Ireland. Over the past two decades, evolving farm and trade policies, new technologies and a challenging economic climate have started to impact on the behaviour and time management decisions of farm household members in Ireland. Thus, an analysis of the economics of time allocation is important for understanding how farm family members adjust to these changes and the implications of these changes on their unique support systems and well-being. Within this context, this thesis considers the allocation of time to non-market off-farm activities by farm household members in the West of Ireland. Time allocated to activities such as civic engagement and volunteering plays an important role in the delivery of socially important goods and services that seek to improve the well-being of the rural population and promote rural sustainability. In turn, the social capital generated from such off-farm non-market activities and the use of leisure time by farm household members is an important dimension of social well-being, enhancing the health status of the individual. Therefore, the overarching goal of this thesis is to provide a detailed understanding of how time allocated to non-market off-farm activities impacts on individual well-being, rural development and sustainability. To this end, a single-purpose time use diary survey combined with individual and household questionnaires that collected information on respondents' background characteristics was developed, administered and analysed and three specific research objectives addressed. First, a profile of time and task management of farm family members in the West of Ireland is presented. Second, the factors that influence the participation in and the number of hours dedicated to civic engagement, formal and informal volunteering are explored. Third, the factors that influence the level of participation in active, passive and social entertainment leisure activities are investigated. Finally, this thesis makes a substantiative methodological contribution by way of the innovative design of the time use diary which has the potential to change the way that these types of surveys are conducted. 2017-05-19