The Impact of the Economic Crisis on the Irish Legal System. Between Austerity and Constitutional Rhetoric

The Irish economy enjoyed a long period of sustained growth from roughly 1994 onward, with a corresponding growth in wealth creation and employment1. Yet, in 2008, Ireland recorded a substantial public deficit, which reached 14.3% of GDP in 2009, the highest in the EU, and experienced a rapid deterioration in its public finances, a collapse in the housing market and construction sector, and a liquidity crisis within the banking system2. The rate of unemployment rose from just under 5% in January 2007 to more than 15% by January 2012 and unemployment in the construction sector rose by 60% in just four years from 2008 to 2012, all of which led to an unprecedented social crisis3. The number of people relying on unemployment benefits rose to 326,000 in January 2009, the highest monthly level since records began in 19674. Given this context, in 2008, the Irish executive chose to guarantee the value of all personal deposits in Irish banks5, before extending this to all debts accrued by national financial institutions. While these steps initially sated the market’s fears regarding the Irish economy’s stability, the fact that the liabilities of these institutions were more significant than the Government initially anticipated, meant that by 2010, the interest rates being charged on Irish Government bonds had risen to an unsustainable level. Hence, after publicly denying the existence of any plans for outside help, the Irish Minister for Finance and Governor of the Central Bank chose to accept a full EU financial “rescue package” (also known as “bailout” or support scheme) from the “Troika” of the European Commission, the European Central Bank, and the International Monetary Fund (IMF)6. Ireland’s support scheme amounted to €85 billion over four years from November of 2010 to December of 2013. The European Commission was proscribed the primary role of ensuring Ireland’s compliance with an eventual successful exit from the support scheme on behalf of the EU

Migrant access to welfare payments in Ireland and the impact of Europeanisation: Comparing EU citizens and third-country national labour migrants.

This thesis seeks to establish how welfare payments are provided in Ireland for two categories of migrants: mobile European Union citizens; and third-country national labour migrants; the barriers that restrict their access to the welfare system, and the extent to which the process of ‘Europeanisation’ has affected welfare provision in Ireland for both. In order to achieve this, the thesis utilises a socio-legal method of analysis, which includes theoretical, doctrinal and non-legal strands. What it finds, is that both the relevant Irish and EU welfare rules are quite restrictive and market-based. However, they diverge in terms of their initial starting points. EU law has primarily universalist ambitions in terms of facilitating migrant access to the welfare state, but this is not reflected within the rules themselves. Ireland, by comparison, became more restrictive as an almost direct consequence of its first significant experience of inward migration. It also establishes that, whilst EU law has developed quite significantly within this field, the impact of Union welfare rules on the everyday behaviour of the Irish State in providing welfare payments is limited, in large part due to the Irish State’s lack of technical expertise in EU, and national, welfare law, and the way in which the administration continues to operate. In almost every other respect, Ireland would appear to be a strong example of the impact of Europeanisation. Finally, the thesis argues that this lack of technical expertise, and the opaqueness of the Irish system, create the most significant barriers to accessing welfare payments for both categories of migrants - despite the different legal regimes that govern each of them. Specific barriers do arise for both categories, but these are of lesser significance than the highly opaque and often arbitrary way in which Irish administrative procedures operate at the micro level

Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania

<p>Abstract</p> <p>Background</p> <p>Providing basic surgical and emergency care in rural settings is essential, particularly in Tanzania, where the mortality burden addressable by emergency and surgical interventions has been estimated at 40%. However, the shortages of teaching faculty and insufficient learning resources have hampered the traditionally intensive surgical training apprenticeships. The Muhimbili University of Health and Allied Sciences consequently has experienced suboptimal preparation for graduates practising surgery in the field and a drop in medical graduates willing to become surgeons. To address the decline in circumstances, the first step was to enhance technical skills in general surgery and emergency procedures for senior medical students by designing and implementing a surgical skills practicum using locally developed simulation models.</p> <p>Methods</p> <p>A two-day training course in nine different emergency procedures and surgical skills based on the Canadian Network for International Surgery curriculum was developed. Simulation models for the surgical skills were created with locally available materials. The curriculum was pilot-tested with a cohort of 60 senior medical students who had completed their surgery rotation at Muhimbili University. Two measures were used to evaluate surgical skill performance: Objective Structured Clinical Examinations and surveys of self-perceived performance administered pre- and post-training.</p> <p>Results</p> <p>Thirty-six students participated in the study. Prior to the training, no student was able to correctly perform a surgical hand tie, only one student was able to correctly perform adult intubation and three students were able to correctly scrub, gown and glove. Performance improved after training, demonstrated by Objective Structured Clinical Examination scores that rose from 6/30 to 15/30. Students perceived great benefit from practical skills training. The cost of the training using low-tech simulation was four United States dollars per student.</p> <p>Conclusion</p> <p>Simulation is valued to gain experience in practising surgical skills prior to working with patients. In the context of resource-limited settings, an additional benefit is that of learning skills not otherwise obtainable. Further testing of this approach will determine its applicability to other resource-limited settings seeking to develop skill-based surgical and emergency procedure apprenticeships. Additionally, skill sustainability and readiness for actual surgical and emergency experiences need to be assessed.</p

Recent Progress in the Management of Retroperitoneal Sarcoma

Retroperitoneal sarcomas (RPS) are rare tumours that typically present late and carry a poor prognosis even following grossly complete resection. In an attempt to improve the outlook for patients with RPS, sarcoma specialists have employed various adjuvant therapies, including extermal beam radiation, intraoperative radiation, brachyradiation and systemic chemotherapy. This article reviews the presentation and prognosis of RPS, and focuses on the results of new treatment strategies compared with conventional management

Functional Outcome in Limb-Salvage Surgery for Soft Tissue Tumours of the Foot and Ankle

Purpose. This paper describes the functional and oncologic outcome of 30 cases (in 29 patients) treated with limb-salvage surgery for localized soft tissue sarcoma (STS) or fibromatosis of the foot and ankle

Incidence and Severity of Lymphoedema following Limb Salvage of Extremity Soft Tissue Sarcoma

Background and Purpose. Lymphoedema is a serious complication following limb salvage for extremity soft tissue sarcomas (STSs) for which little is known. We aimed to evaluate its incidence, its, severity and its associated risk factors. Material and Method. Patient and tumor characteristics, treatment modalities and complications and functional outcomes (MSTS 1987, TESS), and lymphoedema severity (Stern) were all collected from prospective databases. Charts were retrospectively abstracted for BMI and comorbidities. Results. There were 289 patients (158 males). Mean age was 53 (16–88). Followup ranged between 12 and 60 months with an average of 35 and a median of 36 months. Mean BMI was 27.4 (15.8–52.1). 72% had lower extremity tumors and 38% upper extremity. Mean tumor size was 8.1 cm (1.0–35.6 cm). 27% had no adjuvant radiation, 62% had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema was 28.8% (206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score was 32 (11–35) and TESS was 89.4 (32.4–100). Radiation dose was significantly correlated with tumor size > 5 cm (P = 0.0001) and TESS score (P = 0.001), but not MSTS score (P = 0.090). Only tumor size > 5 cm and depth were found to be independent predictors of significant lymphoedema. Conclusion. Nine percent of STS patients in our cohort developed significant (grade ≥ 2) lymphoedema. Tumor size > 5 cm and deep tumors were associated with an increased occurrence of lymphoedema but not radiation dosage