College of Medicine and Health - Masters by Research Theses
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Item Neurobiological effects of food fermentation-derived metabolites for metabolic and mental health(University College Cork, 2023) Carey, Nathan; Schellekens, Harriet; O'Mahony, Siobhain M.Nutrition and diet are becoming increasingly popular therapeutic interventions as we discover more about the complex roles the foods we consume play in maintaining our health status. It is now clear that foods we ingest daily and their metabolites interact with systems both within and outside the gastrointestinal tract including the gut microbiome, the nervous system, immune system and hormonal system. Each of these play essential roles in the bi-directional communication pathway of the microbiota-gut-brain axis. Interactions between our food and this axis can potentially influence centrally mediated processes such as cognition, mood and even appetite. While several foods have been identified as being beneficial to our health, there is one food group that remains under investigated and holds promise as a reservoir of both beneficial bacteria and bioactive compounds – fermented foods. Fermented foods are created through the controlled enzymatic conversion of foods to simpler organics substances by microorganisms. Common examples include foods like kimchi (a fermented cabbage product), kefir (a fermented milk product) and kombucha (a fermented sweet tea beverage). While human studies on fermented foods remain sparce, one recent finding recorded lower perceived stress in human adults who underwent a dietary intervention that included fermented food intake. Recent findings in rodents suggest that fermented foods can alter social behaviour, reduce body weight and lead to reduced anxiety in animals. The mechanism by which fermented foods act is still unknown but it likely due to a number of factors such as their probiotic bacteria content, their metabolite content including short chain fatty acids (SCFA), and the ability to breakdown their starter compounds into simpler molecules and increase their bioavailability such as phenolic compounds in fruits and vegetables. The research conducted in this thesis aims to investigate the ability of food-fermentation derived metabolites, with a specific focus on SCFAs and polyphenols, to alter the neurobiological functions associated with central appetite regulation (hypothalamus) and cognition (hippocampus). Using in vitro assays, we tested the selected panel of metabolites shown to be found in fermented foods, and capable of crossing the blood brain barrier, on both immortal cell lines (hypothalamic and hippocampal) and on primary neurosphere cultures (hippocampal). A panel of SCFA were administered to hippocampal and hypothalamic cell lines and were capable of altering brain-derived neurotrophic factor (BDNF) gene expression. These metabolites were also tested on primary hippocampal cells using a neurosphere assay of proliferation. Positive trends were observed across many of the treatments, however these trends were not significant. Perhaps most interesting were our findings when submitting the same hippocampal neurosphere assay to a panel of phenolic compounds. Apigenin and kaempferol (both flavonoids) significantly increased hippocampal cell proliferation. Moreover, to enhance the efficiency of data analysis, a semi-automatic quantification pipeline was developed for high-throughput screening of primary neurosphere cultures. This pipeline offers a systematic and reliable method for evaluating neurosphere proliferation, providing a valuable tool for future studies in the field. Our results highlight the modulatory effects of SCFA and phenolic compounds on hypothalamic and hippocampal cells in vitro, emphasising the potential role of dietary metabolites and fermented foods as a whole on brain function related to metabolic and mental health. These findings also highlight the need for more in depth analysis of fermented foods and their neuromodulator effects both in vivo.Item Dissolvable microneedle manufacturing methods and the application of three-dimensional printing to pharmaceuticals(University College Cork, 2024) Wilkstein, Katerina; Moore, Anne; Vucen, Sonja; HEA AIVRTDissolvable microneedles are an intradermal drug delivery technology with exciting potential for widespread distribution of minimally invasive, self-administered medicines and vaccines. The most popular manufacturing method for medical dissolvable microneedles is micromoulding, a process which can have drawbacks of low material efficiency and high regulatory requirements. The UCC-patented “ImmuPatch” process is a micromoulding method which significantly improves on the material efficiency of traditional micromoulding. In this study, a specific method based upon the ImmuPatch process was developed for aseptic manual fabrication of two-layered dissolvable microneedles capable of incorporating at 2 μg protein dose. The developed method was not ideal, with high variability in the patches produced and significant challenges in verifying the protein dose. Fabrication of dissolvable microneedles is well positioned for the application of automation methods. One proposed option for the automation of dissolvable microneedle manufacture is additive manufacturing, which in addition to automation has the advantage of eliminating the regulatory challenges associated with micromoulding. A systematic literature review of methods applying additive manufacturing to the fabrication of solid dosage formats was conducted and identified processing parameters and format properties associated with different technologies. Additive manufacturing has been applied to micromould-free dissolvable microneedle fabrication in limited examples and should be explored further.Item The experience of dental students on their transition from preclinical to clinical training at an Irish dental school and curriculum measures to ease the transition(University College Cork, 2024) Hegarty, Anne Mary; Ó Tuathaigh, Colm; Roberts, AnthonyIntroduction In undergraduate dental education, there are significant learning landmarks. Prominent among these is the student transition from the preclinical to the clinical phase of their learning journey. This transition is significant and often challenging but has not been widely interrogated in Irish dental education. Aims This study was designed to explore the perceptions of undergraduate dental students studying for the Degree of Bachelor in Dental Surgery (BDS), in University College Cork (UCC), based in the Cork University Dental School & Hospital (CUDSH), to give voice to the student perspective and to recommend curriculum responses. Methods A mixed methods approach was employed. This included a quantitative survey where student participants (N=128) responded to statements using a 5-point Likert scale to indicate their agreement or otherwise, across the following domains: Transition & Professional Socialisation; Workload; Patient Contact; Knowledge & Skills and Learning & Education. Participants also engaged in a brainstorming exercise, based on a Focus Prompt to enumerate their suggestions for areas which they would like to have addressed in a curriculum to support the preclinical to clinical transition for dental students. Group Concept Mapping (GCM) methodology was introduced, for the first time in relation to curriculum evaluation in Dentistry, to sort and rate the resultant suggestions for improvement, as to their importance and ease of inclusion in a dental curriculum. Results When looked at in synthesis, the combined data from the quantitative and qualitative elements of the study were analysed and recommendations made for curriculum development. Participants perceived that they were nervous beginning clinical work, where they found the transition to be abrupt and associated with an increased workload. With time, they found their overall transition to be satisfactory. They requested clinical exposure earlier in the course; enhanced familiarisation with the clinical environment in advance of beginning on clinics; more professional modelling from peers and staff; greater standardisation of teaching and assessment; a larger selection of patients and more education in clinical problem solving. They valued simulation learning and were happy with their teachers and support staff. Students were generally happy with their knowledge levels in preparation for their transition and found they adapted their learning styles accordingly. The transition experience of dental students in CUDSH compared favourably with aspects of the transition among students in other centres internationally. Conclusion Perceptions of the preclinical to clinical transition of undergraduate dental students in CUDSH have been examined in this study. Whilst the transition is a rite of passage for dental students, on the whole they did well. Areas which they would like to see enhanced have been mapped out, many of which are readily implementable. There is scope for further work to compare the transition with that in other schools and to assess the benefits of curriculum adaptations introduced based on recommendations made in this work.Item Using Lámh signs in mainstream primary schools: an application of the COM-B model(University College Cork, 2024) Sheehan, Michaela; Frizelle, Pauline; O'Toole, CiaraBackground: Children with speech, language and communication needs (SLCN) attending mainstream primary schools often rely on key word sign systems (KWS) such as Lámh to support their communication. However, the success of KWS systems will depend on the consistency in which communication partners use signs and the potential for changing their behaviour in a positive light. In this case, communication partners include teachers and special needs assistants (SNAs) as they most frequently interact with children in school. One model developed to change people’s behaviour is the Capability, Opportunity, Motivation and Behaviour (COM-B) model. In this study we apply the COM-B model, to explore how we can potentially increase the use of signing by teachers and SNAs in mainstream school by ascertaining what factors influence use of Lámh. This study will also examine what similarities and differences are evident in how these factors of capability, opportunity and motivation influence teachers’ compared to SNAs’ use of Lámh in the classroom setting. Method: Teachers (n= 55) and SNAs (n=36) who currently has or previously had a child who uses Lámh in their class in mainstream primary school participated in this study by completing an online questionnaire that targeted each of the components of the COM-B model. Four focus groups (n=16) were also held to explore the findings in further detail, 2 groups of teachers and 2 groups of SNAs. Data was collected in the latter half of the academic year and subsequently analysed using descriptive statistics and qualitative content analysis, employing a deductive approach based on the theoretical framework of the COM-B model. Results: There are numerous factors within the components of the COM-B model that impact teachers and SNAs use of Lámh in the school environment. Overall, teachers and SNAs indicated that they would need increased psychological capability, specifically 65% stated they would need to know how to integrate Lámh, 62% would need increased knowledge of the importance and benefits of Lamh and 59% would need a supportive environment. Eighty five percent of teachers and SNAs noted that they required the materials to support their use of Lámh and 78% of participants felt triggers and reminders would be a relevant component of physical opportunity. Social opportunity in the form of support from others and use of Lámh by others were central to the establishment of a whole school approach to using Lámh. Both reflexive and automatic components of motivation were important factors, specifically developing the habit of signing (87%) having to feel the desire to (84%). Finally, there were numerous barriers encountered by staff, including time and training which can be classified within physical opportunity and psychological capability. Overall, teachers and SNAs demonstrated similar levels of responses across the subcomponents of the COM-B model. Some differences were evident in social opportunity, reflexive motivation and psychological capability specifically. Conclusion: The application of the COM-B model has identified what components require attention when considering effective behaviour change relating to teachers and SNAs use of Lámh in the mainstream environment. To increase signing in a mainstream school environment and alter the behaviour of teachers and SNAs, the components outlined need to be addressed. The findings of this study will help inform the content of a school specific Lámh training course and resources for teachers and SNAs working with Lámh users in a mainstream environment.Item An exploration of joint working between intellectual disability and acute service providers when people with intellectual disabilities access acute care services: findings from a qualitative study(University College Cork, 2023) Kelleher, Eileen; Martin, Dr Anne-Marie; Caples, Dr Maria; Wills, Dr TeresaBackground: People with intellectual disabilities often avail of/use intellectual disability services within the community. However, they experience more health needs and are therefore twice as likely to access acute services compared to the general population. Several reports and enquiries have highlighted the sub-optimal care provided to this group while accessing care in acute services. Joint working between intellectual disability and acute services has repeatedly been identified as one measure to address the issues faced by people with intellectual disabilities in acute services. Aim: The research aimed to explore joint working between intellectual disability and acute service providers when adults and children with intellectual disabilities access acute care services. Method: A review protocol was first conducted which guided a mixed-method systematic review which explored current evidence of joint working compared to non-joint working. Data were analysed thematically. The findings of this review informed a qualitative descriptive study, which explored intellectual disability service providers experiences of joint working with acute service providers. Ten healthcare professionals took part in semi-structured interviews which were analysed using thematic analysis. Findings: When present, joint working was found to promote continuity of care. However, both studies found an absence of joint working between acute and intellectual disability services. Joint working was influenced by inter-service communication and both studies identified poor communication and information-sharing between services despite measures being in place to facilitate communication. Confusion regarding the role and responsibilities of service providers was found to negatively impact joint working, and the absence of specific intellectual disability policies and procedures contributed to this confusion. Healthcare professionals in acute services were found to have limited knowledge on the needs of those with intellectual disabilities and the supports available in intellectual disability services. Trust between services was considered important to ensure the future success of joint working. Conclusion: Benefits and challenges of joint working between both services were identified. Joint working creates better understanding between services and ensures continuity of care for those with intellectual disability. There is a need to strengthen joint working between services by improving communication between services providers to ensure better information-sharing. There is a need to establish the role and responsibilities of each service provider to improve joint working.