College of Medicine and Health - Masters by Research Theses

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    Designing public playgrounds for inclusion: Universal Design for Play (UDP), a tailored perspective
    (University College Cork, 2022-08-31) Moore, Alice; Lynch, Helen; Boyle, Bryan; Irish Research Council
    To extend knowledge on how to enable outdoor play, social participation, and inclusion in public playgrounds, the overall aim of this thesis is to establish an evidence base for using Universal Design (UD) for public playground design. The scope of this doctoral research encompassed a multi-layered approach to understanding this complex concept of UD from a higher conceptual level as well as an applied level. It includes five studies that employed multiple methods to review published and grey literature as well as explore the perspectives of “professional experts” and “user experts”. Study I included a review of evidence for using UD in public playground design. Specifically, a scoping review of peer reviewed literature was undertaken to identify and synthesise what is known from published, peer reviewed studies about inclusive public playgrounds, underpinned by a commitment to understanding the concept of UD as it applies specifically to public playground design. Findings show that although UD is recognised to have the potential to support the design of public playgrounds, the evidence is currently very sparse and identified the gap in knowledge internationally of how UD is understood as a concept. Study II included a review of the conceptual understanding of UD in public playground design. Indeed, this consisted of a scoping review to determine how UD and related non-discriminatory planning and design concepts are represented in the context of published research exploring public playground design for inclusion. Findings revealed that that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design processes arbitrarily and without regard for higher or lower order concepts, which has potentially led to inconsistency and confusion. Altogether, diverse interpretations of UD were evident; for some UD was understood as a basic concept resulting in accessibility, for others, UD was more holistic in terms of designing for inclusion. In Study III, scoping review search methods were developed and applied to synthesise findings from a review of international grey literature guidelines for the design of public playgrounds for inclusion and sought to determine the evidence for using UD and play value in public playground design. Findings highlighted that although UD is recognised to have the potential to support the design of public playgrounds, inconsistent design approaches, principles, and recommendations, were communicated among the included guideline documents. However, the core concept of inclusion underpinned all guideline documents, and a tailored application of UD dominated. Study IV involved survey methods to determine the ways in which UD is understood and implemented, when planning, designing, and/or providing public playgrounds, from the perspectives of a national sample of playground professionals in the Republic of Ireland. The findings show that playground professionals recognise the importance of UD and implement UD in various ways. However, significant barriers to implementing UD included a lack of knowledge and good practice guides for embedding UD. To counteract these barriers, a variety of opportunities, initiatives and training prospects were identified. In Study V, a qualitative descriptive study sought to explore the experiences of using playgrounds, as well as the reasons for non-use, from child and adult perspectives, through the lens of play and play value to inform UD. Findings emphasised that although children and adults value playgrounds as spaces for outdoor play, social participation, and inclusion, playgrounds are not always useable, and do not always meet the needs of families. Participants in this study confirmed that there are variable standards when it comes to playground provision, and some facilities lack essential elements for outdoor play, social participation, and inclusion. Nevertheless, participants offered many creative ideas to improve the usability of playgrounds, and therefore, identified potentially practical ways of implementing UD in playground design for inclusion (Chapter Seven). In conclusion, this doctoral research contributes with an evidence base for using UD for public playground design both at a conceptual and an applied level. It challenges the current UD concept and argues for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion. Moving forward the challenge is to promote the universal establishment of inclusive public playgrounds that offer high play value and include all persons in everyday occupations without injustice.
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    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 Board
    Objective: 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.
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    The influence of gender on paternal involvement in the treatment process of a child or adolescent with an eating disorder
    (University College Cork, 2022-06-29) O'Sullivan, Hazel; O'Donovan, Áine; Goodwin, John
    Aim: To identify factors that influence paternal engagement in the treatment process of a child or adolescent with an eating disorder. Background: Eating disorders are complex mental health issues and are exacerbated by a high mortality rate. Adolescence is the period of development when an eating disorder typically commences. International and national guidelines recommend the involvement of the family in the treatment process. However, barriers can exist on both an organisational and on an individual level. The family is an important source of support, yet there is a lack of research pertaining to the factors that facilitate or prevent fathers from participating in the treatment process. Method: A scoping review of the literature was undertaken to identify what key information existed within the current literature and research pertaining to the topic under examination. Thirteen studies were identified as pertinent to the research question posed. Following analysis, these studies identified the importance of parental involvement in the treatment process but pointed to fathers assuming a more peripheral role. Thus, to further understand the processes that contributed to paternal engagement this research sought to further examine the paternal role within the treatment process. It was determined that a qualitative descriptive approach would best suit the research aim. Data were obtained by conducting focus groups with a total of seven fathers agreeing to participate in two focus groups. Both focus groups were guided by a semi-structured interview guide. A qualitative content analysis approach was used to analyse the data regarding paternal experiences of engagement in the treatment process. Findings: Four themes were generated from the data. These were; fathers didn’t see this coming, no one place for one person to go alone, we are not as in touch with our children and the eating disorder as a mental illness. Conclusion: Fathers described themselves as on the periphery of the family, they identified themselves as experiencing things differently to mothers with a belief their role was to provide support to their wives and children within the treatment process. Impact: Healthcare providers need to be aware of the contribution of gendered roles within the family system, and the need to consider this when working with families within the treatment process.
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    The evaluation of estradiol and indomethacin for incorporation into microneedle formulations
    (University College Cork, 2022) Lalchandani, Akash Parsram; Crean, Abina; Faisal, Waleed; Enterprise Ireland
    The objective of this thesis is the technical evaluation of the suitability of drug substances, estradiol and indomethacin, for incorporation into a patented dissolvable microneedle (DMN) platform technology for intradermal drug delivery. Estradiol and indomethacin were chosen based on their physicochemical properties (melting point, glass transition temperature, amorphous solid state after melt-cooling) which were favourable for manufacturing microneedles using the melt DMN technology. Oral dosage forms of both drugs, and transdermal patches of estradiol are available in the market. Currently no indomethacin transdermal patch formulation is available. This project aims to assess the feasibility of developing dosage forms of both drugs for microneedle-assisted, intradermal delivery. The research presented, initially provides a background to the drivers and challenges related to the development of microneedle (MN) drug combination products for inclusion in the mainstream pharmaceutical and medical device market. The thesis then focuses on the experimental studies evaluating the feasibility of developing DMN from the drug substances of interest, estradiol and indomethacin. Melt-cooled samples of both drugs were also prepared to simulate the processing stress of the DMN manufacturing process. Melt-cooled samples were evaluated for solid-state form by differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD), and chemical composition by high performance liquid chromatography. Microneedle formulations of both drugs were produced using a previously developed manufacturing process and their mechanical strength and ability to penetrate pig skin analysed. A stability study was conducted to evaluate chemical and solid-state stability of the melt-cooled samples at 3 storage conditions: condition A (25°C/60% RH), condition B (40°C/ 75% RH), and condition C (2°C to 8°C in nitrogen filled vials) over a 3 month time period. The melt-cooled solid form of both drugs post melting was found to be chemically stable over the period of 3 months when stored at all 3 storage conditions studied. The amorphous melt-cooled samples of both drugs showed greatest stability at 2°C to 8°C in nitrogen. However, DSC and PXRD results identified crystallisation of the melt-cooled estradiol and indomethacin samples to when stored at 25°C/60% RH and 40°C/ 75% RH over 3 months. This loss in amorphous form was paramount for indomethacin when stored at 40°C/ 75% RH. These results indicated the need for storage and packaging precautions for MN of both drugs to prevent solid-state alterations upon storage which could impact on MN mechanical strength and dissolution in the skin. The MNs formed from both drugs, using the melt dissolvable microneedle technology, were found to be physically strong and capable of penetrating ex-vivo pig ear skin. The research presented illustrated that estradiol and indomethacin DMN can be manufactured using a melt DMN technology, but packaging and storage precautions are required to stabilise the drug solid-state form.
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    School connectedness: a qualitative case study through an occupational lens
    (University College Cork, 2022) O'Leary, Jennifer; Boyle, Bryan; Lynch, Helen
    Background: School connectedness is an under researched concept in all professions. While the term “belonging” has been used within occupational science, “connectedness” is not a term frequently used. To date, there is one study based on school connectedness and occupation and there is no study in an Irish context. The relationship, if any, between occupation and school connectedness is not understood. Given the strong position of belonging in occupational science, this concept must be understood in a school context. Since the passing of Ann Wilcock (1940-2019), there has been a call for research which continues to build on her Occupational Perspective of Health (doing, being, becoming, belonging). This study aims to do so within a school context. Aim/ Objectives: This research study had three aims; 1) To better understand students and their school’s personnel perceptions of school connectedness 2) To further understand what determines a student’s sense of connectedness to the school environment according to the students and the school personnel 3) To explore the relationship between student’s school-based occupations and their sense of school connectedness. Study Design: This research study is a qualitative single instrumental case study. This study commenced by an entire sixth class group completing a creative exercise to elicit data. Ten students engaged in a focus group and individual semi-structured interviews. This study also had four school personnel engage in individual semi-structured interviews. Thematic data analysis was conducted. Findings: Four themes emerged from the findings; 1) The Importance of the Student’s Social Context on School Connectedness 2) Occupational Influence on School Connectedness 3) Co-constructing an Environment for School Connectedness 4) How Community Connectedness is Reflected in the School. Conclusions: This study established a new perspective of school connectedness through an occupational lens. School connectedness is necessary for enhancing every student’s school occupational performance. Findings outline that due to the impact school connectedness has on occupational participation, occupational therapists should promote school connectedness through a whole school approach. Findings enhance the need to consider the value of interdependence as an outcome to practice.