College of Medicine and Health - Masters by Research Theses
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Item Proficiency-based progression (PBP) training- the future model for dental operative skills training? A systematic review and meta-analysis of existing literature(University College Cork, 2023-01) Kehily, Elaine; Roberts, Anthony; Allen, Finbarr; Gallagher, Anthony G.; Health Research BoardObjective: To evaluate the effectiveness of proficiency-based progression (PBP) operative training using validated performance metrics, by comparing this to standard, conventional training methods. Data: This systematic review was conducted in accordance with the PRISMA guidelines for the Transparent Reporting of Systematic Reviews and Meta-Analyses. Study quality was assessed using the MERSQI tool and the Cochrane Risk of Bias tool. Results were pooled using biased corrected standardized mean difference and ratio-of-means (ROM). Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. In quantitative synthesis testing for procedural errors, a pooled meta-analysis on 87 trainees was conducted using random-effects models. In a ROM analysis, PBP was estimated to reduce the mean rate of errors by 62%, when compared to standard training (ROM 0.38, 95% CI: 0.25; 0.58; p < 0.001) Sources: The electronic databases of PubMed, Embase, Web of Science, MEDLINE and Cochrane library’s CENTRAL were searched from inception to 8/11/2021. Filters activated were Randomized Controlled trials, clinical trial. Study selection: 13 studies were included for review with 11 included in the quantitative synthesis from 174 potentially relevant publications identified by the search strategy. Main inclusion criteria were studies comparing standard surgical/operative training with proficiency-based simulation training using validated metrics based on expert performance. Conclusions: Our meta-analysis found that PBP training improved trainees' performances, by decreasing procedural errors. There is sufficient evidence to explore PBP training for use in dental skills training.Item Long term potential of a saturated sodium chloride solution for the anatomical preservation of human cadavers(University College Cork, 2022-03-23) O'Flynn, Carrie; Toulouse, AndréThe anatomical world has relied heavily on formaldehyde as an embalming agent since its use began in the 1890s. Efforts to move away from formaldehyde have intensified in recent years, largely in response to health concerns. Another important motivation is to seek out ways to an improved anatomical cadaver. Several new techniques have been investigated for their abilities to provide cadavers with both life-like features and longevity of preservation. A simple saturated salt solution (saturated NaCl solution) was used to embalm 4 cadavers in two phases of study, without the addition of formalin. As “soft-fix” methods are generally viewed as short-term preservatives, the long-term preservative action of the saturated NaCl solution method was assessed. The suitability of this cadaver type for teaching and training was considered; specifically, its utility as a training model for ultrasound-guided regional anaesthesia (USGRA). The saturated NaCl solution method conferred long-lasting preservation of structures with retention of tissue colour and pliability; however, the rapid onset of deterioration occurred when gross dissection began. The cadavers proved to have some utility as simulation models for USGRA training, but lack of vascular circulation limited this suitability.Item The role of retinoic acid in glioma growth control(University College Cork, 2021-07-22) Flynn, Patricia Margaret; Toulouse, André; Hand, Collette; Bermingham, Niamh; Jansen, MichaelTumours of the central nervous system are known as gliomas, arising from the astrocytes, oligodendrocytes, ependymal cells or from glial progenitor cells. Although a relatively rare diagnosis, there is disproportionate morbidity associated with a glioma diagnosis, owing to its diffuse and infiltrative nature and partly, in the restricted accessibility of the tumour to treatment. Several obstacles prevent effective treatment, namely, the blood brain barrier, peripheral inactivation of systemic treatment, outward tumoural convection pressures, and cancer stem cell resistance. Despite therapeutic advances, the relapse rate and the mortality linked to glioma remains high, with most patients surviving less than 2 years following diagnosis. The terminal differentiation of malignant cells using a differentiation agent such as retinoic acid (RA) could be a promising scientific advance in the treatment of this disease. Endogenous retinoic acid is the primary active metabolite of vitamin A. It is a small, lipophilic differentiation agent that acts as a ligand for a family of nuclear receptors (RARs) to regulate the expression of target genes. The main family of nuclear receptors comprises three genes, RARα, RARβ and RARγ, each coding for multiple isoforms. The selective stimulation of these isoforms with RA has been shown to mainly inhibit cellular proliferation but is also known in some cases to promote such proliferation. The use of all-trans retinoic acid as an agent of differentiation has also been highly successful in the treatment of acute promyelocytic leukaemia. The canonical retinoic acid pathway involves proteins that are responsible for the conversion of precursors of RA, their transport and the transcription of genes downstream of the RARs. In this thesis, gene expression of components of the canonical RA signalling pathway was analysed from existing microarray data for a panel of 1100 gliomas of various histological grades. The analysis was performed on the R2 Genomics Analysis and Visualization Platform. Expression of individual genes was extracted from the datasets and analysed according to WHO grade. The results showed that the expression of key components of the pathway was altered in high grade gliomas compared to the lower grades. The expression levels of RBP1, RBP2, and RBP3 (involved in the transport of retinol) were significantly altered in high grade glioma, with an increase in the expression levels of RBP1 and RPB2 and the decrease in expression level of RBP3. The genes involved in the oxidation of retinol to retinal, ADH1A, ADH1B, ADH1C, ADH4, ADH7, RDH5 RDH10, RDH11 and RDH16 were all significantly lower in high grade glioma. The expression levels of the genes involved in the oxidation of retinal to retinoic acid, ALDH8A1, and ALDH1A1 (RALDH1) are also significantly reduced in high grade glioma. The genes involved in the intranuclear transcription of the RA pathway are affected by high grade glioma. Retinoic acid receptor genes RARA, RARB, RARG, retinoid X receptor genes RXRA, RXRB, RXRG, transcriptional co-activator genes EP300, NCOA1, NCOA2, transcriptional co-repressor genes HDAC2, NCOR1, and NRPI1 are all significantly lower in high grade glioma with an increase in the expression of transcriptional repressor HDAC1. There is also significantly reduced expression of CYP26B1, involved in the metabolism of RA. Together, lower expression of the enzymes responsible for the intracellular formation of RA from its precursors and its intranuclear transcriptional machinery could potentially lead to a reduction in RA signalling. This suggests that the targeted activation of the RA pathways in gliomas with reduced signalling capacity could be used to regulate cancerous growth. Using two established glioblastoma cell lines, the growth altering properties of retinoic acid, some of its synthetic derivatives and specific retinoic acid receptor isoforms was assessed. Results show that manipulation of the retinoic acid signalling pathway by selectively stimulating different isoforms of the RARs can lead to changes in growth patterns that differ depending on the cellular context. Opposing growth patterns were produced in the two glioblastoma cell lines, A172 and U87-MG in response to ATRA, with growth suppression of the A172 cell line and proliferation of the U87-MG cell line. More detailed insight into the growth responses mediated by isoform specific retinoids and overexpression of isoforms highlighted the potential for suppressing the growth of the cell lines by targeting individual receptor isoforms. While further research is needed, these results show that targeting specific receptors in cell lines can lead to growth reduction and may pave the way to the use of isoform selective retinoids in the treatment of glioma.Item Occupation, identity and belonging within community: experiences of mental health disability(University College Cork, 2020-04-18) Cassidy, Caoileann; Jackson, Jeanne; Lynch, HelenBackground: This is a qualitative research study exploring the perspectives of Irish people with self-reported mental health disability in participating in occupation within their community environments. The relatedness of occupation to health and the concept of belonging requires further research and understanding within the discipline of Occupational Science and within the practice of Occupational Therapy. Methodology: Purposive sampling was employed to recruit three participants, from one national mental health support organisation. A phenomenological and narrative framework was adopted in this research. This informed the use of narrative interviews and observation methods to gather data about occupations enacted by participants within their community environments. Open ended narrative interviews were adopted to encourage storied accounts of participants’ experiences, with each participant engaging in two interviews. Following the first interview, each participant collaborated with the researcher in planning an observation session, with the researcher as complete participant, in a chosen occupation within their local, familiar environment. Following this each participant engaged in a second interview with the researcher. Data Collection and Analysis: Digital audio recordings were transcribed anonymously and verbatim from interviews, coupled with field notes from observations, using thematic analysis. This analysis upheld the integrity of each story while illuminating shared meaning of participants’ chosen occupations. Findings: In answer to the research questions, two primary themes were identified, with each theme encompassing two subthemes. The first theme “Experiencing Normality and Promoting Health” explores how participants in this study experienced feeling or anticipated feeling normal through their participation in occupation. Additionally, they chose occupations to promote their physical and mental health when navigating changes to their identities as a result of their mental health distress or disability. The second theme was “Meaning Making and Experiences of Inclusion and Exclusion within Community” exploring participants meaning making through occupation in their local environments, within places and amongst others. The first subtheme captures how participants participated in meaning making with others. The second focuses on their experiences of inclusion and exclusion with stigma emerging from their surrounding environments, impacting feelings of belonging. Discussion: The findings of this study inform understanding of occupation and expand knowledge of its relationship to health, specifically mental health. It contributes to existing research concerning the impact of the social world on a person’s occupational choices, possibilities and resultant identities. Further these findings have elicited greater understanding about the meaning of these occupations to participants and how this enabled their participation through “being” and “belonging” in their communities. Conclusion: The results of this study contribute to theory generation of occupation within the discipline of occupational science and to the clinical practice of occupational therapy. The findings of the current research indicate that stigma and experiences of exclusion prevail for people with mental health disabilities. Results also find that participation in occupation, within affirming environments can create experiences of normality and promote health. Further, participation in occupation fosters experiences of inclusion and belonging.Item An effectiveness study of a parent-child interaction therapy with children with Down syndrome(University College Cork, 2020-04) Cronin, Sarah Marie; Frizelle, Pauline; O'Toole, Ciara; Down Syndrome IrelandBackground: Parents of children with Down syndrome (DS) often demonstrate directive parenting styles which can impede on their child’s communication development. For that reason, parent-child interaction therapies have shown to be an effective form of early intervention for children with DS as it facilitates parent coaching while also addressing the specific communication needs of children with DS. This study aimed to explore the effectiveness of the PELD (Promotion of Early Language Development) intervention offered by a speech and language therapy (SLT) service for individuals with DS. The study aimed to explore the impact this programme had on the language development and communicative interactions of children with DS, while also exploring the change in the interaction and communication strategies employed by their parents. Methodology: A single-subject multiple-baseline design was employed to evaluate the effectiveness of the PELD intervention. Seven child participants and their mothers took part in the study. All participants were aged between 10-17 months at the time of entry. Three terms of the intervention were offered over a 10 month period and families had the option of completing all or some of the terms. Data was collected over three to five time points depending on when the child commenced the intervention. Standardised assessments, parental report and observational measures were used to capture change for both the parent and child. Results: Improvements in receptive vocabulary, use of key word signs, gesture use and a child’s ability to respond to joint attention were noted in the majority of child participants. Children who attended all three terms of the intervention seemed to benefit the most from the PELD programme as they demonstrated a wide range of gestures, understood the most words and used the most Lámh signs post-intervention as reported by their parents. With regards to parent outcomes, all parents were successful in adapting their parenting style and a notable increase in each parents’ ability to follow their child’s lead, join in and play and incorporate a time delay into parent-child interactions was observed. Parents also used language that was developmentally appropriate for their children and increased their use of labelling and repetition of key words post-intervention. Conclusions: The PELD programme is the first parent-child interaction therapy to be tailored specifically to children with DS who are of a very young age. There was some indication that the PELD intervention can support the development of early language skills and the communicative intentions of young children with DS while also upskilling their parents in specific communication and interaction strategies that promote the language development of their child.