CORA
Cork Open Research Archive (CORA) is UCC’s Open Access institutional repository which enables UCC researchers to make their research outputs freely available and accessible.
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The development and implementation of targeted dietetic interventions during cancer survivorship, with a focus on early-stage, hormone-receptor positive breast and gynaecologic cancers
(University College Cork, 2026-02-13) Johnston, Katie; Cushen, Samantha; Ryan, Aoife; Irish Cancer Society; Breakthrough Cancer Research
The global incidence of cancer has increased over the last decade, and due to advances in treatment and early detection, the number of survivors living with and beyond a cancer diagnosis is rising. Women surviving early-stage breast and gynaecologic cancers often experience complex supportive care needs, including alterations in body composition, increased risk of chronic disease, and long-term symptoms associated with medically induced (iatrogenic) menopause. Despite evidence suggesting that dietitian-led interventions are feasible and valued by survivors, structured survivorship services in this population remain limited. Contributing factors include resource constraints, fragmented care pathways, and insufficiently tailored nutritional screening and intervention strategies. In the absence of formal support, many survivors take control of their own health through complementary and alternative approaches, including dietary and herbal supplements, often without professional guidance. Emerging literature underscores both the potential benefits of patient-centred dietetic care and the substantial gaps in nutritional guidance, screening, and supplement management that persist for breast and gynaecologic cancer survivors.
The primary aim of this thesis was to explore the feasibility and acceptability of a dietitian- and nurse-led survivorship clinic using electronic patient-reported outcomes and evaluate the impact of a dietitian-led intervention on nutrition-specific needs, body composition, dietary quality, weight gain concern, and psychosocial outcomes in women surviving early-stage breast and gynaecologic cancers. The thesis further aimed to investigate the prevalence, motivations, and information sources of dietary and herbal supplement use in female cancer survivors affected by iatrogenic menopause, identifying gaps in professional guidance. Finally, it sought to develop, co-design, and implement a multimodal, symptom-responsive dietary resource tailored to survivors’ nutritional and symptom-management needs, assessing its reach, engagement, and utility for both survivors and healthcare professionals.
The Linking You to Support and Advice (LYSA) Randomised Controlled Trial and its complex intervention utilising ePROs proved to be feasible among 200 participants and highly acceptable to participants and healthcare professionals through its concurrent process evaluation. Findings suggested that a bi-monthly supportive care intervention can significantly improve fatigue, anxiety, depression and health-related quality of life scores, as well as significantly reducing patient-reported weight gain concern when compared to an active comparator. Importantly, despite improvements in psychosocial outcomes, the research highlighted that current nutritional screening tools and guidelines lack specificity, failing to capture the nutritional considerations and risks faced by this cohort, moving beyond traditional malnutrition concerns.
This thesis also explored dietary and herbal supplement use among female cancer survivors affected by iatrogenic menopause. Supplement use was highly prevalent, including widespread poly-supplementation and frequent use of herbal products outside recommended guidelines. Motivations for supplement use were largely symptom-driven, yet healthcare professionals, including dietitians, were infrequently consulted, with survivors relying heavily on digital and social media sources for guidance. These findings revealed gaps in professional advice and emphasised the need for structured, evidence-based interventions to support safe and effective supplement use, particularly for managing fatigue, vasomotor symptoms, musculoskeletal pain, and cognitive changes.
In response to these gaps, a co-designed, multimodal dietary resource was developed to address survivors’ nutritional and symptom-management needs. The Menopause Plate © dietary model through the Menopause, Diet and Cancer resources provided practical, evidence-informed guidance for managing common menopause-related symptoms while bridging self-directed behaviours with professional support. Engagement with the resource was substantial (n = >12,500), with wide dissemination through printed booklets, webinars, and online materials.
Collectively, this thesis demonstrates that symptom-responsive, dietitian-led care is feasible, acceptable, and potentially impactful for women surviving breast and gynaecologic cancers. Structured interventions, combined with digital tools and co-designed dietary resources, offer a foundation for patient-centred survivorship care that improves psychosocial outcomes, supports informed nutritional decision-making, and enhances quality of life. The research presented in this thesis establishes a framework for future practice, highlighting the need for refined nutritional screening tools, structured guidance on supplement use, and strategies to ensure equitable, scalable implementation of dietetic interventions across survivorship pathways.
Psychology's role in surf therapy and the use of non-traditional spaces and activities by clinical psychologists
(University College Cork, 2026-05-12) Fawsitt, Feargus; Murphy, Mike; Larkin, Fionnuala; Shine, Liam; Health Service Executive
Clinical psychology is primarily practiced in clinic settings, but clinical psychologists are often required to leave the clinic room to provide therapeutic interventions. When they do, areas of research around conducting therapy in nature, assertive outreach, and psychologically supported activities such as surf therapy may be able to provide guidance. Incorporating knowledge from clinical psychology into such interventions has the potential to enhance client outcomes. In order to explore the concept of psychologically informed, non-clinic-based interventions, this thesis focuses on two areas, study one looks at what can clinical psychology contribute to surf therapy interventions and study two asks what are the experiences and perspectives of clinical psychologists when they leave the clinic room to practice. Study One is a scoping review of surf therapy interventions incorporating psychologically informed components. The results of the review suggest that incorporating psychological theory is potentially beneficial but a theory of change linking them to outcomes is lacking. The included studies also provided little detail on the theory informing as well as the practicalities of these elements. Future research would benefit from more detailed reporting of intervention methodology to facilitate replication and inform clinician practice. Study Two involved conducting semi-structured interviews with clinical psychologists in Ireland to garner their perspectives and experiences of working outside of clinic rooms. Seventeen clinical psychologists took part, and the data was analysed using reflexive thematic analysis. Four main themes emerged with several subthemes. The four themes were: “What!?, leave the sanctity of my clinic space?” Traditional spaces as safe, “We’ve KPIs to hit” Organisational pressure, Enhancing therapy and Wherever you are, you’re still a psychologist. Each theme provides insight into the clinician identified barriers and facilitators to practicing outside of the clinic space, as well as the potential benefits and professional issues involved. These findings demonstrate how clinical psychology can be taken beyond clinic rooms and be used to reach a wide range of clients who may struggle with traditional clinic-based talk therapies.
Impact of indoor residual spraying of insecticides upon malaria vector populations and disease burden in rural Zambia: past, present and future in relation to resistance management with complementary active ingredients
(University College Cork, 2025-12-31) Chinula, Dingani; Killeen, Gerard; Reed, Thomas; Hamainza, Busiku; Kiware, Samson; University College Cork; Zambia National Malaria Elimination Centre; AXA Research Fund
With a focus on programmatic malaria vector control in Zambia that is also relevant to most of Africa. This thesis combines a district-scale epidemiological assessment of vector control tools on the malaria burden, an operational pilot assessment of micro-mosaic deployment formats for indoor residual spraying (IRS) of insecticides, and a mathematical modelling investigation into how such insecticide diversification tactics may be expected to perform for resistance management purposes.
The first chapter synthesises one of Zambia’s longest standing routine malaria surveillance datasets, to quantify the epidemiological impacts of long-lasting insecticidal nets (LLINs) and IRS over the long term. Between 2009 and 2011, the incidence of severe malaria cases in Luangwa District fell by >90% and total confirmed cases by >80%. These gains were largely attributable to scale up of durable non-pyrethroid IRS formulations and expanded access to diagnosis and treatment when a set of 8 new health facilities across the district were all opened simultaneously in mid-2016. No additional measurable effect could be attributed to LLINs, likely because coverage was already high at the outset and remained stable throughout. This chapter underscores that IRS with long-lasting formulations of non-pyrethroid insecticides and improved healthcare access are pivotal for reducing malaria burden in such highly endemic settings with predominantly anthropophilic and endophilic vectors like Anopheles funestus.
The second chapter describes entomological assessment of an operational pilot of household scale micro-mosaic applications of IRS with two different insecticide formulations, nested within a village-scale macro-mosaic of the same two formulations in the same district of southeastern Zambia over one full year that began in late 2022. The densities of An. gambiae complex and An. funestus group mosquitoes were comparable across all IRS treatment allocations and no differences in species composition across treatments were detected. Although certainty was constrained by limited replication of the village-scale observational units used, this evidence appears to confirm the feasibility of implementing IRS micro-mosaics under routine programmatic conditions without compromising immediate malaria vector control performance. Therefore, this pilot demonstrates that household level micro-mosaics may well be a practical option for national malaria control programmes to diversify IRS insecticide applications at the fine scales considered most relevant to preventing resistance emergence.
The third chapter describes the development and application of a deterministic mathematical model of mosquito life history and foraging outcomes during the first gonotrophic cycle, under various intervention scenarios in which NG-LLINs may be complemented by IRS deployed as either blanket coverage with a single insecticide or household-scale micro-mosaics of several insecticides. This model considers the cumulative outcomes of sequential mosquito feeding attempts, to calculate the fractions of mosquitoes that could harbour incipient resistance traits against one of the IRS insecticides that are expected to successfully feed, be deterred, or die while trying to feed, broken down by indoor versus outdoor location and cumulative exposure to zero, one or more IRS insecticides. The model estimates the probability of successful feeding after exposure to exactly one IRS insecticide, representing the risk of propagating an incipient resistance trait, and the selection coefficient favouring subsequent resistance spread after emergence. This modelling study indicates that NG-LLINs, when paired with simple IRS micro-mosaics, could suppress the earliest initial stages of resistance propagation in highly anthropophagic and endophagic vectors like An. funestus, but may have only negligible impact on resistance evolution trajectories in more exophagic and zoophilic species like An. arabiensis.
Overall, this thesis gives insights into how to routine malaria surveillance data platforms can guide insecticide resistance mitigation interventions and how IRS micro-mosaics may offer a practical and scalable pathway for national malaria programs to transition from reactive to pre-emptive resistance management strategies.
Marine microplastic pollution & misinformation in the public sphere: a systematic review
(Springer Nature, 2024-11-04) Agnew, Sonya; Kopke, Kathrin; Power, Orla Peach; Dozier, Amy; Fitzgerald, Eimear
Marine microplastic pollution is a persistent global issue that has gained scientific attention for over two decades. Nevertheless, knowledge gaps remain, particularly in how inconsistencies in communicating scientific evidence can lead to misinformation. A systematic review was conducted to identify how previous research has examined miscommunication about microplastics in the public sphere. Of the 274 scientific publications identified, 15 were found eligible for inclusion in the study. These publications were analysed to establish (i) the methodologies employed to investigate microplastic communication in the public sphere, (ii) how existing information contributes to microplastic miscommunication, and (iii) what level of awareness and knowledge around microplastic pollution has been established. Our analysis revealed two primary study types: participant-based (e.g., via surveys, focus groups) and text-based studies of media content (e.g., newspapers, digital platforms). The participant-based studies showed misperceptions about impacts on human health and their pathways into the natural environment, even among well-informed or professionally involved individuals. The text-based studies revealed inexact media reporting involving scientific referencing, content accuracy, representation of microplastic pollution, and sensationalist tones. The findings highlight the need for further research into the miscommunication of microplastic pollution to facilitate best practice in the communication of scientifically accurate information across audiences.
An integrated study of the evolution, molecular function, expression and ubiquitome of the ligand of NUMB Protein X family
(University College Cork, 2026-03-31) Erwin, Leah G.; Young, Paul; Eli Lilly and Company; University College Cork
The LNX (Ligand of Numb Protein-X) / PDZRN (PDZ and RING) family are evolutionarily conserved E3 ubiquitin ligases characterised by a catalytic RING domain and multiple PDZ (protein binding) domains, originally identified through their interaction with the cell fate determinant NUMB. While there are several studies describing LNX proteins and their roles in vertebrate development, especially neuronal development in mice and dorso-ventral patterning in zebrafish, their broader physiological functions remain poorly understood. This is largely due to their extremely low endogenous expression levels and the complexity of their interaction networks.
This thesis aims to provide a comprehensive depiction of LNX proteins, integrating bioinformatic, biochemical and experimental approaches. Evolutionary analyses in Chapter 5, demonstrate that LNX proteins maintain a highly conserved domain architecture across metazoan lineages, suggesting strong functional conservation. Structural modelling reveals that the second PDZ domain adopts an exposed conformation, explaining its promiscuity in mediating protein interactions, as confirmed in Chapter 3. However, specific interactions, such as the LNX-NUMB association mapped to the NPAY/F motif, appear to be vertebrate specific, indicating evolutionary neofunctionalisation.
To further characterise the LNX protein interactome, a combination of yeast-two hybrid assays and affinity-purification based approaches were employed. While high-throughput datasets like ProfAff predict hundreds of potential interactors, experimental validation is necessary to reveal a more restricted set of physiologically relevant binding partners (Chapter 3 and Chapter 4). As an outcome of this approach, several novel interactions were identified, including neuronal associated proteins SDK2 and NRXN1β along with the transcriptional regulator ZNF24.
To address challenges associated with low-abundance E3 ligases, new methodologies such as BioE3/Ub-POD were modified to identify LNX2 substrates. While proteomic analyses revealed diverse ubiquitination targets, interpretation of this data is complicated by apparent residual catalytic activity in the mutant LNX2 protein used as a control. Nevertheless, a list of putative novel LNX2 substrates was identified in Chapter 4. Several of these candidates were confirmed as binders of LNX PDZ domains, though further rigorous validation of their status as direct substrates of LNX2 ubiquitination is required.
Lastly in Chapter 6, investigation of LNX1 and LNX2 expression showed that genomic amplification of LNX loci in colorectal and glial malignancies, does not appear to result in detectable protein levels in relevant cancer cell lines. LNX1 appears to act as a passenger gene in gliomas, whereas LNX2 displays expression patterns consistent with oncogenic drivers in colorectal cancer. Despite detectable mRNA and cell line transcriptomic data (Cancer Cell Line Encyclopaedia) suggesting RNA expression, endogenous protein levels remain low, suggesting tight post-transcriptional regulation. Promoter activity is generally weak but can be induced modestly under specific conditions like nutrient starvation, protein kinase C activation and drug treatments, indicating a role for LNX proteins in cellular stress and signalling adaptation.
Overall, the data presented in this thesis provide novel functional and evolutionary insights regarding the enigmatic LNX1 and LNX2 ubiquitin ligases.