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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Digitalisation in healthcare: the future of surgical training
(University College Cork, 2023) Galvin, Daniel; O'Reilly, Barry A.
Introduction
The impact of digital technology and artificial intelligence (AI) has a daily impact on our lives. Healthcare as an industry is at the forefront of technological innovation. The application of novel technology to aid performance and enhance training in surgery is key. Challenges in surgical training owing to an increase in trainee numbers, a reduction in working hours, increase in complexity and variety of surgeries performed have become major issues in surgical education. The COVID-19 pandemic further compounded these concerns between 2020 and 2022 where there was significant disruption and reduction in elective surgical activity.
Methods
Five studies examining the challenges in surgical training in gynaecology and their potential solutions were designed. These comprised of a national cross-sectional trainee and trainer survey on the current challenges of surgical training in gynaecology and in training during the COVID-19 pandemic. Potential solutions examined were a trial of the application of artificial intelligence to the grading of surgical performance and two randomised controlled trails of the application of transcranial direct current stimulation (tDCS) to enhance surgical performance in laparoscopic and robotic surgery.
Results
Our results showed significant challenges in surgical training over the last decade with a significant reduction in trainee confidence and experience in operative gynaecology. The COVID-19 pandemic had a significant impact on operative volumes of both trainees and trainers. Trainees failed to increase their self-reported confidence in performing common gynaecology procedures over the pandemic period. AI grading of operative performance was shown to be a potential means of enhancing trainee feedback and reducing workload for trainers. tDCS was shown to decrease rates of excessive velocity events during novice laparoscopic training setting it out as a potential solution to maximise training opportunities. tDCS was not shown to enhance robotic surgical performance.
Conclusion
While the current training environment is challenging in operative gynaecology, potential solutions to augment and accelerate training exist. Further study is required to assess the best means of implementing these solutions to ensure continued access to high quality surgical training.
Determinants of receiving child protection and welfare services following initial assessment: A cross-sectional study from the Republic of Ireland
(Elsevier Ltd., 2024-05-13) O'Leary, Donna; Christie, Alistair; Perry, Ivan J.; Khashan, Ali S.; Irish Research Council; Child and Family Agency
Background: Children receive child protection and welfare services when an initial assessment concludes that their needs and care would be significantly compromised without intervention or support. Evidence is lacking on this decision to provide services in the Irish child protection and welfare system. Objective: To identify determinants of receiving services following an Initial Assessment. Participants and Setting: All children (n = 508) whose Initial Assessments were completed during the first quarter of 2016 in one of the four regions (spanning seven social work departments) of Tusla, the national Child and Family Agency. Methods: A cross-sectional study used data manually coded from social workers’ case records. Poisson regression analysis calculated incident rate ratios for receiving ongoing service, adjusting for demographic factors, family level and wider determinants of child welfare to investigate associations between predictor variables and the decision to provide services. Results: 38.5 % of children (n = 185) received ongoing child protection and welfare services. Risk factors for service provision included mother-perpetrated domestic violence (Incident Rate Ratio (IRR) 1.70 (95 % Confidence Interval (CI) 1.33, 2.19)), concerns about guidance and boundaries (IRR 1.66 (95 % CI 1.29, 1.14)), lack of emotional warmth (IRR 1.62 (95 % CI 1.30, 2.02)), prior abuse (IRR 1.59 (95 % CI 1.30, 1.95)), prior involvement (IRR 1.51 (95 % CI 1.15, 1.98)), intergenerational involvement (IRR 1.40 (95 % CI 1.10, 1.76)), health concerns (IRR 1.30 (95 % CI 1.07, 1.57)), and being aged 0–4 years (IRR 1.28 (95 % CI 1.03, 1.59)). Being reported by mandated professionals (IRR 0.71 (95 % CI 0.56, 0.90)), assessed by female social workers (IRR 0.72 (95 % CI 0.59, 0.89)), and, when separately examined, parental cooperation (IRR 0.64 (95 % CI 0.53, 0.77)) reduced the likelihood of receiving service. No differences were noted between departments. Conclusions: Service provision is largely driven by parental factors, prior involvement, and intergenerational abuse but gender disparities exist. Findings can be used to enhance decision strategies to improve outcomes for children and families.
Ecosystem engineers enhance the multifunctionality of an urban novel ecosystem: Population persistence and ecosystem resilience since the 1980s
(Elsevier B.V., 2024-09-06) Firth, Louise B.; Forbes, Anastasia; Knights, Antony M.; O'Shaughnessy, Kathryn A.; Mahmood-Brown, Wahaj; Struthers, Lewis; Hawcutt, Ellie; Bohn, Katrin; Sayer, Martin D. J.; Quinn, James; Allen, Jan; Dürr, Simone; Guerra, Maria Teresa; Leeper, Alexandra; Mieszkowska, Nova; Reid, Geraldine; Wilkinson, Stephen; Williams, Adrian E.; Hawkins, Stephen J.; Mersey Dock and Harbour Company; Merseyside Development Corporation; Nature Conservancy Council; Natural Environment Research Council; National Facility for Scientific Diving; Esmée Fairbairn Foundation; Marine Biological Association
In degraded urban habitats, nature-based solutions aim to enhance ecosystem functioning and service provision. Bivalves are increasingly reintroduced to urban environments to enhance water quality through biofiltration, yet their long-term sustainability remains uncertain. Following the restoration of the disused South Docks in Liverpool in the 1980s, natural colonization of mussels rapidly improved dock-basin water quality and supported diverse taxa, including other filter feeders. While the initial colonization phase has been well documented, there has been limited published research since the mid-1990s, despite ongoing routine water quality monitoring. Here, we assessed the long-term persistence of mussel populations, their associated biodiversity, and physico-chemical parameters of the water in Queens and Albert Docks by comparing historical (1980s to 1990s) and contemporary data from follow-up surveys (2012,2022). Following an initial period of poor water quality (high contamination and turbidity, low oxygen), the natural colonization of mussels from Albert Dock in 1988 extended throughout the South Docks. By the mid-1990s, the environment of the South Docks and its mussel populations had stabilized. The dock walls were dominated by mussels which provided important complex secondary substrate for invertebrates and macroalgae. Surveys conducted in 2012 and 2022 confirmed the continued dominance of mussels and estimates of mussel biofiltration rates confirm that mussels are continuing to contribute to maintaining water quality. A decline in salinity was observed in both docks in 2022, with evidence of recovery. While these ecosystems appear relatively stable, careful management of the hydrological regime is crucial to ensuring the persistence of mussels and resilient ecosystem service provision through biofiltration.
Defining gut mediated metabolism for health and disease
(University College Cork, 2024) Quilter, Karina; Joyce, Susan; Melgar Villeda, Silvia; Science Foundation Ireland
We investigated the overall concept that human produced and microbially modified bile acids could act as an indicator of health. In chapter 3 we verified disruptions to bile acid metabolism in a porcine model of metabolic syndrome towards cardiovascular disease, induced by diet. In chapter 4 we applied dietary means to address mild hypercholesterolemia and followed BA readouts to indicate health parameters, we determined that BAs could be used as indicators of return to health but only when acute fed conditions were initiated and tracked over a 6 hour time period. Furthermore we noted that baseline fold change in BAs could be applied to distinguish responder and non-responder directions in a clinical setting. In chapter 5 we examined the metabolic outputs relating to elite athletes through 3 intervention studies. Our indications were that a key subset of BAs -significant in westernized MetS and CVD induction- were reduced in elite athletes. We further noted that different sports elicited different correlations with both microbes and metabolites in these small cohorts. In chapter 6, the key BAs associated with MetS-CVD and their interchangeable intermediates were examined at the cellular level and shown to have different outcomes in cell organelle functionality and related gene expression systems depending on dietary lipid interventions. In all, certain BAs are convergent indicators of disease, they diversify in health, just like microbiome composition. A number of key BAs were identified that can indicate health and the push towards disease in this study.
Gut-heart axis in a large animal model of metabolic syndrome and heart failure
(University College Cork, 2024) Cluzel, Gaston; Caplice, Noel M.; Stanton, Catherine; SFI Manufacturing
Background
The metabolic syndrome (MetS) is a pathological condition diagnosed as the combination of obesity with either hypertension, dyslipidaemia, or hyperglycaemia. MetS constitutes a deadly cocktail of cardiovascular risk factors that greatly increases patient mortality. Among the cardiovascular complications of MetS, heart failure with preserved ejection fraction (HFpEF) represents one of the greatest unmet clinical needs of the 21st century. Indeed, as HFpEF prevalence increases along with soaring MetS cases, current therapeutic strategies fail to prevent disease complications. Therefore, novel approaches are required.
MetS and HFpEF are accompanied by a low-grade inflammation (LGI) state. LGI is characterised as a steady but lingering increase in circulating inflammatory factors. Inflammatory signalling is known for promoting structural and functional changes in the myocardium that may contribute to HFpEF. Thus, decreasing LGI may reduce HFpEF progression.
While the precise origin of LGI is uncertain, the gut microbiome has recently emerged as a hidden organ with critical immune regulatory functions. Crucially, the gut microbiome is tightly connected to the intestinal barrier. In MetS and HFpEF, patients show alteration of the gut microbiome and of the intestinal barrier, a phenomenon called gut permeability. Gut permeability results in the translocation of bacterial antigens from the gut lumen to circulation. Circulating bacterial antigens are pro-inflammatory, that contributes to LGI and, indirectly, to cardiac structural changes and HFpEF. Therefore, therapeutic strategies aimed at the gut microbiome may effectively prevent HFpEF via reducing gut permeability and LGI. This concept is described as the “gut-heart” axis.
The gut-heart axis constitutes a novel field of investigation in cardiometabolic disorders and may answer the urgent need for novel therapeutic strategies directed against HFpEF. However, more research is needed to characterise the mechanisms involved in gut-heart signalling.
Aims of the project
This thesis aimed at characterising the cardiac pathological mechanisms involved in gut-heart signalling, and determining whether they can be modulated by a microbiota-targeted treatment.
Methodology
In this project, gut-heart axis pathological signalling was characterised using a porcine model of MetS and HFpEF induced by Western diet (WD) and hypertensive corticosteroid salts (desoxycorticosterone acetate, DOCA). Then, to investigate the effects of a gut microbiome-targeted intervention on MetS and HFpEF, this model was supplemented with a synbiotic product combining soluble corn fibre and Lactobacillus mucosae. Inflammatory signalling associated with HFpEF structural changes was investigated in the four cardiac chambers. In particular, the project focused on the roles of tumour necrosis factor (TNF)-α, lipopolysaccharide (LPS) and NOD-like receptor family, pyrin domain containing 3 (NLRP3). These central inflammatory pathways may be key in transducing gut-originating LGI into cardiac pathological signalling in HFpEF.
Results
Upon WD and DOCA challenge, the porcine model constituted a clinically-relevant reproduction of MetS and HFpEF. MetS was characterised by increased body weight, severe hypertension, hypercholesterolemia, and hypertriglyceridemia. HFpEF was characterised by left atrium enlargement (LAE) and left ventricle hypertrophy (LVH). LAE was associated with tissue apoptosis, and LVH was accompanied by cardiomyocyte hypertrophy. Left atrium (LA) and left ventricle (LV) also had increased inflammatory activity with cardiac macrophage (Mφ) expansion, and activation of TNF receptor 1 (TNFR1), toll-like receptor 4 (TLR4), and NLRP3 pathways. Moreover, the increase in TNFR1, TLR4, and NLRP3 activity was colocalised with cardiac Mφ, microvascular endothelial cells, and cardiomyocytes. While no structural or pressure-induced changes were observed in right heart chambers, the right atrium and the right ventricle also exhibited prominent inflammatory signalling. Data not reported in this thesis indicated that the model exhibited LGI and features of gut permeability. Overall, the porcine model of MetS and HFpEF was characterised by inflammatory cardiac changes along with systemic and intestinal alterations.
Synbiotic treatment of MetS pigs reduced LAE, LA cardiomyocyte apoptosis, and LVH, but did not affect MetS core parameters. These improvements in cardiac structural changes were associated with a reduction in cardiac Mφ expansion and in TNFR1, TLR4, and NLRP3 activity in all four cardiac chambers. Reductions in TNFR1, TLR4, and NLRP3 activity were colocalised within the cardiac Mφ, microvascular endothelial cells, and cardiomyocytes populations. Data not reported in this thesis also indicated that synbiotic treatment reduced LGI and gut permeability. Therefore, synbiotic treatment targeted at the gut microbiome reduced pathological signalling along the gut-heart axis, and effectively reduced cardiac structural changes associated with HFpEF.
Discussion
The porcine model of MetS and HFpEF stood out as a robust model for investigating gut-heart axis inflammatory signalling. The study also highlighted the central role of TNFR1, TLR4, and NLRP3 in driving structural changes in HFpEF through pro-apoptotic and pro-hypertrophic signalling. Crucially, synbiotic treatment targeted at the gut microbiota effectively reduced HFpEF-associated structural changes via reducing cardiac inflammatory signalling. Finally, while exempt of structural changes, the right heart reflected accurately and dynamically the systemic changes in gut-heart axis pathology and treatment.
Conclusions
Synbiotic targeting of the gut microbiome resulted in cardiac structural improvements in a clinically-relevant porcine model of MetS and HFpEF. This study demonstrates the critical role of gut-heart inflammatory signalling cardiometabolic disease progression.