Meeting abstracts from the 2021 UCD School of Medicine Summer Student Research Awards (SSRA 2021)

Wednesday, October 6 ^th 2021

University College Dublin, Ireland

Publication of this supplement was sponsored by the UCD School of Medicine SSRA Committee. All content was reviewed and selected by the UCD School of Medicine SSRA Committee, which held full responsibility for the abstract selections.

SSRA 2021 Research Abstracts

1. THE ASSESSMENT OF THE SEVERITY OF ILLNESS TO THE EMERGENCY DEPARTMENT FOR PSYCHIATRIC ASSESSMENT.

Springael M¹, Doherty AM¹ ²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Mater Misericordiae University Hospital, Dublin 7, Ireland

COVID-19 has had a profound effect on our mental health services. In a short period of time, mental health services have had to re-configure to reduce the spread of SARS-CoV-2. This has resulted in the closure of day services, reduced in-person psychiatric support and social isolation, leaving some of society’s most vulnerable in crisis.

The purpose of this study is to identify any differences in the number and severity of emergency presentations to the Emergency Department (ED). The study is a retrospective review of the log of patients referred to the liaison psychiatry team at an Inner-City Dublin hospital from the ED or inpatients wards where self-harm was the reason for admission. Three timeframes were chosen between January and June 2020: a baseline group (T1), lockdown (T2) and re-opening of society (T3). Severity of presentation was measured using the Threshold Assessment Grid¹. (TAG) and DUNDRUM readmission scales². from the anonymised database (n=306). Data were analysed using the application SPSS.

Table 1: Comparison of patients referred for a psychiatry review in the Emergency Department during lockdown and following reopening, with those prior to Covid-19

		T1 (n=210)	T2 (n=54)	T3 (n=42)	T1-T2 Mean difference	T1-T3 Mean difference
Age, mean (SD) T1 n=210, T2 n=52		35.9 (13.7)	37.6 (13.0)	43.2 (15.1)	-0.8321	-3.1121*
Gender n (%)	Male Female	110 (52.4%) 100 (47.6%)	35 (64.8%) 19 (35.2%)	24 (57.1%) 18 (42.9%)	0.1012	0.5722
Substance, n (%)		113 (57.7%)	35 (71.4%)	32 (80.0%)	3.1102	7.0032*
Self-harm n (%)	Nil Suicidal ideation Self-injury	37 (18.3%) 95 (47.0%) 70 (34.7%)	7 (14.3%) 15 (30.6%) 27 (55.1%)	9 (21.4%) 17 (40.5%) 16 (38.1%)	0.0292*	0.7332
Outcome - Admission, n (%)		39 (19.9%)	10 (22.2%)	11 (26.8%)	0.1222	0.9792
TAG total score, mean (SD) T1 n=179, T2 n=37		8.81 (2.904)	8.05 (2.915)	8.32 (2.294)	1.4401	1.0081
Dundrum Total, mean (SD) T1 n=179, T2 n=37		0.73 (0.415)	0.57 (0.277)	0.56 (0.231)	2.8431**	1.059
*p<0.05 **p<0.01 1independent sample t-test (T value); 2Chi Square
T1 - Timeframe 1 (01/01/20 - 12/03/20); T2 - Timeframe 2 (13/03/20 - 30/04/20); T3 - Timeframe 3 (08/06/20 - 22/06/20); TAG - Threshold Assessment Grid; S.D - Standard Deviation

There was a significant increase in self-harm presentations in T2 and T3 (T2 - 55.1% n=27 & T3 - 38.1% n=16) with the highest incidence during the first lockdown (T2). Psychiatric admissions rose during the pandemic, highest in T3 with an admission rate of 26.8% (n=11) compared to baseline (19.9%, n=39 T1, p value 0.733).

The results demonstrate the impact of the first few months of the COVID-19 pandemic on psychiatric services. Further research is required to fully understand the impact and the needs of this population.

References:

• 1. Slade M, Cahill S, Kelsey W, et al. Threshold 3: the feasibility of the Threshold Assessment Grid (TAG) for routine assessment of the severity of mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2001;36(10):516-21.

• 2. Kennedy HG ONC, Flynn G, Gill P, et al. The Dundrum toolkit. Dangerousness, understanding, recovery and urgency manual (The Dundrum Quartet). four structured professional judgment instruments for admission triage, urgency, treatment completion and recovery assessments. Dublin, Ireland: Trinity College Dublin; 2013 01/08/13.

Presenting Author: Maïa Springael

Supervisor: Assoc Prof Anne Doherty

2. INCIDENCE OF DEATH AND ADVERSE CARDIOVASCULAR AND RENAL OUTCOMES IN IRISH ADULTS WITH DIABETES MELLITUS.

Conroy C¹, Power R², Patil R², Martin WP³, Cormican S^2,4,5, Griffin TP^2,4,6, Griffin MD^2,4,5

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²NUIG School of Medicine, National University of Ireland, Galway

³UCD Diabetes Complications Research Centre, Conway Institute & UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

⁴Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway

⁵Nephrology Department, Galway University Hospitals, Saolta University Hospital Group

⁶Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta University Hospital Group

Over 425 million people are living with diabetes mellitus (DM) globally.¹ Microvascular and macrovascular complications of DM include, but are not limited to, coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral arterial disease (PAD), and kidney disease. We aimed to explore the incidence of these complications in adults with diabetes.

Patients with DM(n=199) attending the Galway Diabetes Centre were enrolled between 2016-2017. Clinical data were collected from enrolment-July 2021 using electronic and paper medical records with average follow-up of 4.1±1.1years. Longitudinal laboratory data were collected from 2006-June 2021. Incident CAD, CVD, PAD, major adverse cardiovascular event (MACE), new requirement for renal replacement therapy (RRT), and mortality was recorded. Microsoft Excel was used for data collection and analysis. Estimated glomerular filtration rate (eGFR) slopes were calculated by linear mixed-effects models incorporating subject-specific random intercepts and slopes for time periods before and after enrolment.

Mean age was 61.1±16.5years and n=63(31.7%) were female. 45(22.6%) had type 1 DM, 146(73.4%) had type 2 DM and 8(4%)had another form of DM. Mean baseline eGFR was 71.7±32.3mL/min/1.73m² and median baseline uACR was 1.6[10.15]mg/mmol. 24(12.1%) developed CAD, 5(2.5%) developed CVD, 15(7.5%) developed PAD, and 20(10.1%) died during follow-up. 7(3.5%) patients started RRT. 40(20.1%) reached MACE endpoint. Annual decline in eGFR was -1.87mL/min/BSA/year pre-enrolment and -1.51mL/min/BSA/year post-enrolment.

Incidence of cardiovascular disease and progressive renal functional decline is high in people with DM. Further analysis is planned to determine the predictive value of baseline concentrations of circulating biomarkers of inflammation for cardiovascular, renal, and mortality endpoints in this cohort.

Acknowledgement:

The author would like to acknowledge funding from a Health Research Board Summer Student Scholarship (SS-2021-086).

Reference:

• 1. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281. doi:10.1016/j.diabres.2018.02.023

Presenting Author: Chloe Conroy

Supervisor: Dr William Martin

3. PROMOTING NURSE-LED BEHAVIOUR CHANGE TO PREVENT CARDIOVASCULAR DISEASE IN DISADVANTAGED COMMUNITIES: A SCOPING REVIEW

Freeley S¹, Broughan J^{1, 2}, McCombe G^{1, 2}, Casey M³, Collins T⁴, Fitzpatrick P^{5, 6}, Frawley T³, Morrissey J⁴, Treanor JT⁴, Cullen W^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Primary Care Research Group, Catherine McAuley Centre, University College Dublin, Belfield, Dublin 4, Ireland

³School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland

⁴Irish Heart Foundation, Dublin 6, Ireland

⁵School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland

⁶St. Vincent’s University Hospital, Dublin 4, Ireland

Cardiovascular diseases (CVD) are the leading cause of death worldwide and they disproportionally affect people living in disadvantaged communities. Nurse-led behaviour change interventions have shown great promise in preventing CVD. However, knowledge regarding the nature and impact of such interventions in disadvantaged communities is limited. This review aimed to address this knowledge gap.

A six-stage scoping review framework developed by Arksey and O’Malley, with revisions by Levac et al., was used (1, 2). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR).

Thirty studies were included in the review. They investigated nurse-led behaviour change interventions to reduce overall CVD risk or to improve modifiable CVD risk factors (uncontrolled diabetes mellitus, hypertension, hypercholesterolemia, poor diet, lack of exercise, smoking and excessive alcohol consumption). The studies examined the efficacy and/or structure of these interventions and they also described barriers which nurses faced. Five key areas were identified in the promotion of nurse-led behaviour change. These are (i) tailoring interventions to specific populations (ii) overcoming access difficulties (iii) encouraging patient engagement (iv) providing adequate training for nurses and (v) addressing barriers faced by nurses.

Despite the considerable variety in these interventions, they collectively show great potential in disadvantaged communities. Specific barriers experienced by patients and nurses in these communities (e.g. lack of resources, poor health literacy) must be considered. Further research is needed to explore these barriers and to examine the role of nurses in leading brief opportunistic interventions.

Acknowledgement:

The author would like to acknowledge funding from the Health Research Board Summer Student Scholarship.

References:

• 1. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.

• 2. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation science. 2010;5(1):1-9

Presenting Author: Sarah Freeley

Supervisor: John Broughan

Co-Supervisor: Prof Walter Cullen

4. GP PERSPECTIVES ON ENHANCING INTEGRATED CARE AT THE GP-HOSPITAL INTERFACE: A PILOT DELPHI CONSENSUS STUDY

Carey E¹, McCombe G¹, Broughan J¹, Fawsitt P², Carroll A¹, Cullen W¹

¹UCD School of Medicine, University College Dublin, Dublin, Ireland

²Ireland East Hospital Group, Ireland

Ireland’s healthcare system is currently focused on delivering an integrated care system where emphasis is placed on universal healthcare which is primary care focused and patient-centred (1). The GP-Hospital interface has been identified as a key problem area and a need to account for the various professional perspectives when guiding reform is required (2).

The aim of this study is to identify structures, processes and outcomes from GPs which may be important to enhance integrated care at the GP-Hospital interface using a Delphi consensus method.

A pilot e-Delphi consensus study was conducted over two rounds. In Round 1, 15 participants were asked to score 32 statements, by how much they agree with their importance in enhancing integrated care at the GP-Hospital interface. Participants were also allowed to suggest their own statements. In Round 2, the 13 participants who completed Round 1 were shown the distribution of scores from Round 1 and were asked to rescore if they wished. Eleven participants completed Round 2.

Based on the Round 1 ranking, 15 of the 32 statements met the 70% threshold for consensus. Five additional statements suggested by participants in Round 1 were added, and two statements reached the consensus threshold. The largest consensus was observed in areas such as rapid access diagnostics, direct access to specific hospital departments and improved communication between GPs and Hospitals.

These study findings highlight important elements for enhancing integrated care at the GP-Hospital interface and can inform integrated healthcare policy in Ireland and elsewhere.

Acknowledgement:

The author would like to acknowledge funding from the Health Research Board.

References:

• 1. Burke S, Barry S, Siersbaek R, Johnston B, Ní Fhallúin M, Thomas S. Sláintecare – A ten-year plan to achieve universal healthcare in Ireland. Health Policy. 2018;122(12):1278-82.

• 2. Kennedy J, Culliton, M., Leahy, D. & et al. Risk Management and Quality Improvement Strategies for Patients and Healthcare Professionals in Primary and Secondary Care.: Medisec Ireland; 2016.

Presenting Author: Eoghan Carey

Supervisor: Dr Geoff McCombe

Co-Supervisor: Prof Walter Cullen

5. AN INVESTIGATION INTO THE INFLUENCE OF EATING HABITS, SOCIAL DYNAMICS AND STRESS ON HELMINTH INFECTION STATUS IN HORSES

Whelan R¹, Duggan V¹, Mulcahy G¹, Zintl A¹.

¹UCD School of Veterinary Sciences, University College Dublin, Dublin, Ireland.

Over the decades, misconceptions regarding the helminth infection status in horses has led to a widespread increase in anthelmintic resistance. The ‘80:20’ rule demonstrates that 80% of the parasitic worm burden in horses is maintained by only 20% of the equine population, yet many veterinarians continue to treat all horses systemically with a ‘blanket approach’ to anthelmintics¹. Our objective was to evaluate the impact equine behaviour plays in determining which 20% of the equine population will shed 80% of parasites.

Ten retired horses from ‘UCD herd’ and twelve horses from ‘Rescue herd’ were analysed. Faecal egg counts were carried out over a period of four months to indicate the infection status of the horses. Stress was measured via faecal cortisol metabolite assay. Social dynamics and eating habits were measured by direct observation using random focal sampling and behavioural ethogram.

Amidst contrasting management conditions, both herds showed similar mean helminth infection status (429eggs per gram (epg) in ‘Rescue herd’ vs 427epg in ‘UCD herd’). Dominant and subordinate horses in ‘Rescue herd’ exhibited a helminth infection status over double the ‘middle of the herd’ horses (629epg vs 229epg). Dominant animals showed decreased time grazing adjacent to faecal piles. ‘Rescue herd’ demonstrated decreased faecal cortisol levels compared to ‘UCD herd’ (Mean B%/BO of 66.39% vs mean B%/BO of 47.97% retrospectively).

These results indicate that hierarchy and feeding patterns may influence equine helminth infection status, and that cortisol levels are decreased in horses exposed to chronic compromised welfare conditions².

Acknowledgement:

The author would like to acknowledge funding from the UCD squared programme with UC Davis from Zoetis.

References:

• 1. Kaplan M and Nielsen K. An evidence based approach to equine parasite control: It ain’t the 60s anymore. Equine Veterinary Education. 2010, vol. 22(6):306-316.

• 2. Pawluski J, Jego P, Henry S, et al. Low plasma cortisol and fecal cortisol metabolite measures as indicators of compromised welfare in domestic horses (Equus caballus). PLoS One. 2017, vol. 12(9):e0182257.

Presenting Author: Rebecca Whelan

Supervisor: Assoc Prof Annetta Zintl

Co-Supervisor: Assoc Prof Vivienne Duggan

6. ONLINE REFLECTIVE PRACTICE GROUPS FOR INTERDISCIPLINARY TRAINEES IN PAEDIATRIC HOSPITALS DURING COVID-19 PANDEMIC: WHAT’S THE EVIDENCE?

Dwarika R¹, Tiedt I², Barrett E^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Child and Adolescent Psychiatry, Temple Street Children’s University Hospital, Temple Street, Dublin, Ireland

In 2017, the report on the National Wellbeing of Doctors proposed that there are ever-increasing burnout rates. ^[1] Reflective practice groups are used to explore a deep level of understanding of doctor-patient relationships, in order to combat burnout and increase satisfaction at work. This study aims to assess online reflective practice groups for interdisciplinary trainees in Paediatric hospitals during the Covid-19 pandemic.

The Balint group methodology was adapted for an online format. Trainees from psychiatry, emergency and paediatric specialties answered two online questionnaires before and after six sessions of Balint group meetings. There were nine responses to the pre-Balint questionnaire and eight responses to the post-Balint questionnaire. The data was analysed using Microsoft Excel.

75% of participants were from Crumlin Children’s Hospital. Most were women, aged 26-30 years and 3-11 years’ experience. Six participants preferred online groups while four preferred face to face groups after the sessions were completed. Trainees indicated that they thought about patient cases afterward and their teams were disrupted which may cause mild burnout due to the struggles faced. There was a positive relation between burnout reduction and Balint sessions. Additionally, the sessions were positively reviewed by the trainees and there were no sessions cancelled which may indicate the trainees appreciation for the group.

Reflective practice programs should be implemented for trainees in all institutions since there is a positive link between reducing the risk of burnout and reflective practice groups. It should be available for all specialties, not only psychiatry and general practice.

References:

• 1. Kehoe C, Barrett E. Doctor’s burnout and interventions. Irish Journal of Psychological Medicine.2020:1-3.

• 2. Diskin C, Russell R, Barrett E. The introduction of reflective practice at Temple Street- an experience with a NCHD Balint Groups [PDF]. Irish Network of Healthcare Educators: Temple Street Children’s University Hospital; 2018.

Presenting Author:Raveena Dwarika

Supervisor: Assoc Prof Elizabeth Barrett

Co-Supervisor: Dr Iolanda Tiedt

7. CHILD AND CARER PERSPECTIVES ON MENTAL HEALTH CARE IN A PAEDIATRIC HOSPITAL: YOUNG PERSON AND PARENTAL QUESTIONNAIRE COMPLETION

Mitroi AL¹, Sheehy S², Butler J², Boylan C², Barrett E^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

Children are capable of reflecting critically upon the services they receive, making them competent consumers of mental health services¹. Examining children’s feedback gives direct insight into what is working well and where further improvement is needed in the way care is delivered². This pilot study aims to provide feedback to the mental health team about the experiences of patients at Children’s University Hospital, considering their impression of the environment and meeting the mental health team for the first time.

Ethical exemption was granted by the hospital ethical committee. After an initial literature review on child and carer feedback for paediatric consultation-liaison psychiatry services, a questionnaire with opt-in Likert scale and free text questions was given to 20 children/carers to be completed anonymously. Four questionnaire sets were returned to the mental health team over a four-week period. Questionnaire data were analyzed using Excel and qualitative analysis.

Literature review findings reinforce the importance of child feedback for psychiatric services and support incorporating feedback in future practices. Participating patients were female adolescents (n=4) and their carers (n=4). Children were least satisfied with the physical environment of the hospital and most satisfied with the recreational activities offered and the extent to which the team listened to them. Children shared both positive and negative experiences and provided tangible feedback on the environment and care. Carers were satisfied with their own experience and their child’s experience.

Child and carer feedback should continue to be collected to help improve the experience of patients at Children’s University Hospital.

References:

• 1. Biering P. Child and adolescent experience of and satisfaction with psychiatric care: a critical review of the research literature. Journal of Psychiatric and Mental Health Nursing. 2010;17(1):65-72.

• 2. Hardavella G, Aamli-Gaagnat A, Saad N, Rousalova I, Sreter KB. How to give and receive feedback effectively. Breathe (Sheff). 2017;13(4):327-33.

Presenting Author: Alexa Lisa Mitroi

Supervisor: Assoc Prof Elizabeth Barrett

Co-Supervisors: Dr Siobhan Sheehy, John Butler, and Carole Boylan

8. IMPACT OF TOXOPLASMA GONDII SEROPOSITIVITY ON NATURAL BEHAVIOUR OF WILD FALLOW DEER ( DAMA DAMA ) IN PHOENIX PARK

Sabbatini P¹, Amin B², Griffin L², Ciuti S², Zintl A¹

¹UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Biology and Environmental Science, University College Dublin, Belfield, Dublin 4, Ireland

There is some evidence that Toxoplasma gondii which infects cats as final hosts, can modify the murine intermediate host’s behaviour by changing its innate fear to cat pheromone into a “fatal” attraction (“behavioural manipulation hypothesis” [1]). This is thought to increase the chance for the parasite to complete its life cycle. Other potential intermediate hosts might be affected similarly. This study aimed to investigate the effects this parasite could have on behaviour and physiology of wild fallow deer fawns.

A set of behavioural traits (anti-predator behaviour, temperament) and physiological data (heart rate) were systematically recorded from 80 fawns captured over the last fawning season (late May - early July 2021) in Phoenix Park. Blood samples for anti-T. gondii antibodies detection by ELISA were also collected. Considering that T. gondii transplacental transmission in deer has been reported to be high [2], we hypothesize that detected antibodies were mounted by fawns that were infected transplacentally, although we cannot exclude their derivation from colostrum of infected mothers (there is no transplacental transfer of antibody in deer).

Overall, 27 fawns were seropositive (33.75%). A comparison of seronegative and seropositive individuals (T-test) indicated interesting trends (though not statistically significant) of reduced aggression, bolder behaviour and lower heart rates when handled by humans, a greater latency to flee after release and a greater tendency to be recaptured.

These preliminary results support the “behavioural manipulation hypothesis” in fallow deer and pave the way for a long-term study with a bigger population.

Acknowledgment:

The authors would like to acknowledge funding from the SSRA Summer student bursary provided by UCD School of Veterinary Medicine and all the other members in Dr. Ciuti’s research team for their friendly support.

References:

• 1. Vyas A, Kim S, Giacomini N, Boothroyd J, Sapolsky R. Behavioral changes induced by Toxoplasma infection of rodents are highly specific to aversion of cat odors. Proceedings of the National Academy of Sciences. 2007;104(15):6442-6447.

• 2. Dubey J, Velmurugan G, Ulrich V, Gill J, Carstensen M, Sundar N et al. Transplacental toxoplasmosis in naturally-infected white-tailed deer: Isolation and genetic characterisation of Toxoplasma gondii from foetuses of different gestational ages. International Journal for Parasitology. 2008;38(8-9):1057-1063.

Presenting Author: Pietro Sabbatini

Supervisor: Assoc Prof Annetta Zintl

Co-Supervisor: Dr Simone Ciuti

9. CHANGES IN PATTERNS OF EMERGENCY DEPARTMENT REFERRALS TO A LIAISON MENTAL HEALTH TEAM DURING COVID-19

Mahmood A¹, Campbell, J,² Barrett E²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

During the COVID-19 pandemic, research has shown a significant drop in mental health presentations, especially during the most restrictive phases, such as lockdown.¹ However, as restrictions have begun to lessen, there has been a large uptick in the use of mental health services. Some researchers fear a “tsunami” of mental health needs which could potentially overload the healthcare system.² The aim of this research project was to investigate mental health referrals of a pediatric cohort to the ED at CHI Temple Street from March 1 to April 29, 2021.

Data was audited and standardized via paper proformas. 22 variables were ultimately used, and upon completing data collection, the variables were exported to Microsoft Excel and then SPSS for analysis. Statistical methods such as frequencies, cross-tabs, and Chi-squares were used to generate data outputs.

Results showed an 102% increase in total presentations to the ED from the same time frame in 2020. There was a statistically significant relationship between suicidal ideation, certain methods of self-harm, and taking certain medications with acute ward admission. Out of 110 patients from which data was collected, only 28% were admitted to the acute ward.

The results show a significant rise in mental health presentations to the ED from the previous year. Those that were admitted to the ED tended to have more complex presentations than those who weren’t. There is a potential lack of alternative mental health services in the community that may be funneling patients to the ED, which could benefit from increased funding.

Acknowledgement:

The author would like to acknowledge CNS John Campbell and the rest of the team at CHI Temple Street, as well as Brigid Kemerer who conducted a similar study to this one last year. Without these individuals’ immense contributions, this project would not have been able to be completed

References:

• 1. Cardot H, Dauriac-Le Masson V, Trebalag AK, Barruel D, Yon L, Hemery F, Loric M, Rabu C, Pelissolo A, Leboyer M, Schürhoff F. Dramatic reduction of psychiatric emergency consultations during lockdown linked to COVID-19 in Paris and suburbs.

• 2. O’Connor K, Wrigley M, Jennings R, Hill M, Niazi A. Mental health impacts of COVID-19 in Ireland and the need for a secondary care mental health service response. Irish Journal of Psychological Medicine. 2021 Jun;38(2):99-107.

Presenting Author: Andrew Mahmood

Supervisor: Assoc Prof Elizabeth Barrett

10. THE EXPERIENCES OF RADIOGARPHERS IN THE REPUBLIC OF IRELAND DURING THE COVID-19 PANDEMIC

Karam AS¹ , Davis M² , Toomey R²

¹UCD School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Medicine, Radiography and Diagnostic Imaging, University College Dublin, Belfield, Dublin 4, Ireland

Radiographic imaging procedures are necessary for the diagnosis and evaluation of many patients. During the Covid-19 pandemic, Diagnostic Radiographers as front-line workers have been in direct contact with infected patients. The aim of this study was to investigate and describe the experiences of radiographers working in the Republic of Ireland during the Covid-19 pandemic.

Clinical and academic radiographers across Ireland were invited to submit a reflection on their experiences during the pandemic in any form preferred to fully express themselves. All participants gave their explicit written consent to take part in this study and could optionally include their submissions in the UCD archives. The data was thematically analysed to identify and interpret the emerging themes.

Three themes emerged following coding and organizing the data. 1) Importance of community and employer support: participants reflected they felt unsupported and unrecognised for their efforts. 2) Lifestyle and work changes: participants were personally and professionally affected facing changes in cultural practices, PPE issues, emotional strain, increased radiographic procedures, and online lectures. 3) Radiographer strength and motivation: in the data acquired it was evident that during the pandemic participants were resilient, and motivated.

The outcomes of this study are a useful resource revealing the deep insights of the experiences of radiographers working throughout Ireland during this unprecedented pandemic. These results will help determine and overcome the different challenges posed by the pandemic. In the longer term this study will preserve the accounts of radiographers for posterity.

Presenting Author: Aliaa Karam

Supervisor: Dr Michaela Davis

Co-Supervisor: Dr Rachel Toomey

11. A STUDY INVESTIGATING EXPERIENCES OF RADIOGRAPHERS IN EUOPRE DURING THE COVID19 PANDEMIC

Shearer O¹, Davis M², Toomey R²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Medicine, Radiography and Diagnostic Imaging, University College Dublin, Belfield, Dublin 4, Ireland

Radiographers have been frontline health professionals throughout the COVID-19 pandemic. They are amongst the first line that may be dealing with infected persons and have gained invaluable experience in dealing with a pandemic.

Aims: To record and provide a contemporaneous account of the roles and experiences of radiographers during the pandemic for posterity.

Radiographers were contacted remotely and asked to submit their reflections of working as a radiographer during the COVID-19 pandemic. All members of the EFRS were invited to partake in our project both directly by our research team and via a memo that the EFRS sent to their member societies. Information relating to the project was widely circulated on twitter.

Reflections were welcome in any form. The information collected was deposited in the UCD archives. To date, two submissions have been received. Reflections were qualitatively analysed using the Braun & Clark six step method.

Themes generated from the reflections submitted included adaptability, pride and gratitude for the healthcare system, and togetherness. Clinical radiographers reported a sense of pride in their work as patients appreciated their presence. A sense of gratitude for being part of a “cherished” healthcare system was reported. Academic radiographers reported a sense of togetherness as students and professors alike adapted to the new challenges of online learning.

Although this research is still ongoing, preliminary indications are that the information obtained yielded an account of the experiences of the radiographer in Europe and the UK during the pandemic and will provide important material for students and future researchers.

Presenting Author: Owen Shearer

Supervisor: Dr Michaela Davis

12. LONGITUDINAL STUDY OF MOOD DISORDER AND HEALTH-RELATED QUALITY OF LIFE IN CERVICAL DYSTONIA

Hutchinson M^{1, 2}, Rafee S¹, Moriarty A²

¹Department of Neurology, St Vincent’s University Hospital, Dublin 4, Ireland

²UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Dystonia is a movement disorder characterized by muscle contractions causing abnormal and repetitive movements and postures. Adult-onset idiopathic focal dystonia is the commonest form of dystonia. (1) The condition is treated with botulinum toxin injections. Mood related disorders, especially anxiety and depression, occur in 30-40% of patients. It is not fully understood whether the mood disorders are part of the primary condition, or whether they are secondary to having a visually obvious movement disorder. The aim of the study was to assess the prevalence of anxiety and depression in cervical dystonia patients and compare this with a similar assessment completed in 2019. (2)

50 cervical dystonia patients who had been previously assessed in 2018-2019 for mood disorders, pain and quality of life were revaluated. To assess dystonia severity and health-related quality of life (HrQoL) we used the revised Toronto Western Spasmodic Torticollis Rating Scale – 2 Pain (TWSTRS – 2 Pain) and the Cervical Dystonia Impact Profile – 58 (CDIP – 58) respectively. We used Beck’s Anxiety Inventory (BAI) and Beck’s Depression Inventory (BDI) as measures of anxiety and depression respectively.

After assessing anxiety and depression in this patient cohort we will compare this with a similar assessment done 2 years ago. We expect that there will still be a significant percentage (30-40%) with anxiety and/or depression leading to marked reduction in HrQoL.

We believe that mood disorder is a primary feature of this movement disorder and that a randomized control trial of antidepressant therapy could be considered to improve the HrQoL in this cohort.

Acknowledgement:

The author would like to acknowledge funding from the Health Research Board.

References:

• 1. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28(7):863-73.

• 2. Ben-Shlomo Y, Camfield L, Warner T, group Ec. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry. 2002;72(5):608-14.

Presenting author: Andrew Moriarty

Supervisor: Prof Michael Hutchinson

Co-Supervisor: Dr Shameer Rafee

13. CHARACTERISATION OF EXOSOMES FROM LYMPHANGIOLEIOMYOMATOSIS (LAM) PATIENTS

McFadden P¹, Jouida A² , Keane M.P^1,2,3, McCarthy C^1,2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

³Department of Respiratory Medicine, St. Vincent’s University Hospital, Dublin.

Exosomes are a class of Extracellular Vesicles (EVs) released by fusion of Multivesicular Bodies (MVB) with the plasma membrane and defined by a diameter of 30-150nm. Their contents reflect the cell of origin and are involved in the transfer of information between cells. They have been shown to play key roles in disease progression and have diagnostic and disease monitoring potential. This study aims to characterise exosomes from the serum of patients with Lymphangioleiomyomatosis (LAM), a rare, low-grade, metastasizing neoplasm that occurs almost exclusively in females.

Using serum samples from patients with LAM and healthy individuals as controls, exosomes were isolated via ultracentrifuge. The presence of exosomes was confirmed by western blot and Nanoparticle Tracking Analysis (NTA). The activity of metalloproteinases in exosomes was measured by zymography. A549 cells were treated with serum derived exosomes and the effects were analysed by western blot and zymography.

LAM patients have significantly increased numbers of exosomes in their serum when compared to the controls (8.9x10⁹ vs 13.8x10⁹ particles/ml; p=0.024). Interestingly, these LAM-derived exosomes had significantly higher activity of Pro-MMP-9 (3-fold increase), but lower activity of MMP-9. Vimentin, a protein expressed in mesenchymal cells and a marker of epithelial-to-mesenchymal transition (EMT), showed higher expression in A549 cells treated with LAM-derived exosomes compared to control.

Findings indicate an exosome mediated EMT pathway in LAM. There is scarce information available on exosomes in LAM, and this exploration advances our knowledge of LAM and the role of exosomes in metastasising diseases.

Presenting Author: Patrick McFadden

Supervisor: Assoc Prof Cormac McCarthy

14. MISREPRESENTATION OF RACE IN THE PATHOLOGY CURRICULUM

Aziegbemhin E¹, Halasz M¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Hidden racism in medicine can have a serious effect on patient care due to its effect on research, teaching, etc. This hidden racism can be propagated through the teaching materials that are used in medical schools. These textbooks can incorrectly associate different racial groups with disease, citing socioeconomic factors as a reason rather than scientific evidence. The purpose of this study is to make a catalogue of false and true racial/ethnic disease associations from Robbins & Cotran: Pathologic Basis of Disease; and recommendations to present only valid race - disease associations, based on scientific evidence for their relevance to clinical decision-making and improved patient outcomes.

The online version of Robbins & Cotran: Pathologic Basis of Disease (10^th edition) was searched for racial terms. The statements that included racial terms were recorded and PubMed was searched to confirm whether there was a scientific basis to each of these statements.

In Robbins & Cotran: Pathologic Basis of Disease, 131 statements were found to have racial terms withing them. Of these 131 statements, 25 gave false racial/ethnic association, while 10 were partially based in false racial/ethnic association. There were other trends seen while searching through the textbook that were noted.

From this study it can be concluded that work must be done to remove false racial/ethnic association from medical teaching texts. It also highlights the additional research that needs to be done for minority groups.

Reference:

• 1. Kumar, V., Abbas, A. K., Aster, J. C., & Perkins, J. A. (2018). Robbins basic pathology (Tenth edition.). Philadelphia: Elsevier.

Presenting Author: Ehimudiame Aziegbemhin

Supervisor: Dr Melinda Halasz

15. EVALUATION OF SPEECH AND MOTOR DEFICITS IN DUARTE-2 GALACTOSEMIA

Hsiao M¹, Waisbren SE², Berry GT²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Division of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America.

Duarte-2 galactosemia (DG) is a mild variant of classic galactosemia characterized by reduced galactose-1-phosphate uridylyltransferase (GALT) enzyme activity [1]. Despite not presenting with clinical symptoms, some patients are found to have a transient speech delay [1]. The purpose of this study is to examine the relationship between speech and motor abnormalities in Duarte galactosemia patients.

This retrospective chart review focused on 26 DG patients whom were seen at the metabolic or genetic clinic at Boston Children’s Hospital through July 2021. Chart data were analyzed for the presence of clinically defined speech and motor abnormalities. The relationship between these deficits were evaluated using McNemar’s Test. Additionally, GALT activities (micromol/hr/g Hb), erythrocyte galactose-1-phosphate levels (mg%), and galactitol levels (mmol/mol creatinine) were compared between those with and without a verbal delay using Mann-Whitney Tests.

The patients had a median age of 13 years (6 - 48), 12 were females and 14 males. The proportion of patients with solely speech delays were 10/26, with solely motor abnormalities 4/26, and with both 5/26 (p NS McNemar’s Test). The laboratory values’ median (range) of patients with and without the speech delay, respectively, were calculated: GALT activity 4.75 (2.55 – 6.32) and 4.47 (1.73 – 5.34) p NS; galactose-1-phosphate 3.74 (0.1 – 12.07) and 0.24 (0 – 0.64) p < 0.05; galactitol 83.5 (6 – 240) and 43.5 (0 – 167) p NS.

The results show a significant increase in galactose-1-phosphate levels among DG patients with a speech anomaly. The relationship between these traits should be evaluated by a prospective study.

Reference:

• 1. Demirbas D, Huang X, Daesety V, Feenstra S, Haskovic M, Qi W, et al. The ability of an LC-MS/MS-based erythrocyte GALT enzyme assay to predict the phenotype in subjects with GALT deficiency. Molecular genetics and metabolism. 2019 Apr 1;126(4):368-76.

Presenting Author: Margaret Hsiao

Supervisor: Dr Gerard T. Berry

16. ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY: ST. MICHAEL’S HOSPITAL EXPERIENCE

Mnatzakanian A^{1, 2}, Djuimo M¹, Lee JY^{3, 4}, Honey RJD^{1, 4}, Farcas M^1,4, Ordon M^{1, 4}

¹Division of Urology, Department of Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada

²UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

³Division of Urology, Department of Surgery, University Health Network, Toronto, Ontario, Canada

⁴Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Ureteropelvic junction obstruction (UPJO) is a urologic condition that can cause flank pain, nephrolithiasis, recurrent urinary tract infections, and loss of ipsilateral renal function [1]. Robotic-assisted laparoscopic pyeloplasty (RAPyelo) has been demonstrated to have a 90-95% success rate in treating UPJO [2]. At present, there is no literature on the outcomes of RAPyelo in a Canadian context. Our objective was to perform a retrospective review of RAPyelo cases at a high-volume Canadian centre.

We performed a retrospective chart review of all patients that underwent RAPyelo at St. Michael’s Hospital, between January 2012 and May 2019. Patients were excluded if inadequate follow-up data was available. Our primary outcome was treatment success defined as symptom improvement and one of the following: improvement in the degree of hydronephrosis on ultrasound or CT, improved/stable split renal function, and improved drainage time on renal Lasix scan. Secondary outcomes included post-operative complications, need for diagnostic reinvestigation, and reintervention for recurrent UPJO.

During our study timeframe, a total of 188 patients underwent RAPyelo and, after exclusions, our cohort consisted of 156 patients (66% female) with a median age of 42 (IQR 58-28). In terms of our primary outcome, 97% had improvement in symptoms and at least one other component of the primary outcome. Seventeen percent of cases required diagnostic investigation post-operatively, and 3% required reintervention for recurrent UPJO.

The results of our retrospective review compare favourably with currently reported outcomes in the literature [2] and demonstrate the safety and high level of success of RAPyelo at a high-volume Canadian centre.

References:

• 1. Al Aaraj MS, Badreldin AM. Ureteropelvic Junction Obstruction. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.

• 2. Uhlig A, Uhlig J, Trojan L et al. Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis. BMC Urol. 2019; vol 19(1); 112.

Presenting Author: Aren Mnatzakarian

Supervisor: Assoc Prof Michael Ordon

17. QTC PROLONGATION AND ELECTROCARDIOGRAM ABNORMALITIES CAUSED BY ADHD MEDICATIONS AMONGST PAEDIATRIC POPULATION. A SYSTEMATIC REVIEW AND META-ANALYSIS

Ling C¹, Murray J^{1, 2}, McNicholas F^{1, 2, 3}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

³Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Despite Attention Deficit Hyperactivity Disorder being as prevalent as 2-18% of children globally, burgeoning concerns may exist on the risk of sudden cardiac death posed by the pharmacological treatment options such as methylphenidate, atomoxetine, amphetamine and guanfacine (1). In clinical setting, abnormal surged in QTc interval is considered as an independent risk of drug-induced sudden cardiac death (2).

Our project aims to understand the impact of drugs on cardiovascular parameter (QTc interval), other ECG abnormalities, and explore the relevance of pre-treatment cardiovascular screening amongst paediatric patients. A comprehensive systematic review was conducted between 1st June 2021 to 15th July 2021 in 3 medical databases (SCOPUS, PubMed, and Cochrane) using appropriate keywords followed by a meta-analysis performed via Review Manager (RevMan, Version 5.4; Cochrane Collaboration, Oxford, United Kingdom).

We identified 46 studies, covering 1,237,484 paediatric patients across 10 countries. Our t-test showed p-value>0.05 which indicates no statistical significance for drug-induced QTc prolongation. Our meta-analysis depicted higher pre-treatment (standard mean difference = -0.14, confidence interval = -0.21 to -0.06, P>0.05), in comparison to post-treatment standard interval, indicating no significant association between QTc prolongation and ADHD medication. Prevalence of ADHD drug-induced ECG abnormalities is depicted to be as low as 6.42% with arrhythmia at 3.34%, conduction disorders at 1.69% and other ECG disorders at 1.39%.

In light of the quantitative evidence delineated, our review finds that ADHD medications are clinically safe for paediatric patients. However, more research is required to further determine the benefits of pre-treatment cardiovascular screening over its cost.

References:

• 1. Rowland AS, Lesesne CA, Abramowitz AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Ment Retard Dev Disabil Res Rev. 2002;8(3):162-70.

• 2. Straus SM, Kors JA, De Bruin ML, van der Hooft CS, Hofman A, Heeringa J, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006;47(2):362-7.

Presenting Author: Charles Her Yi Ling

Supervisor: Dr Johanna Murray

Co-Supervisor: Prof Fiona McNicholas

18. NEUROIMAGING FINDINGS IN INTERNET GAMING ADDICTION IN ADOLESCENCE: A SYSTEMATIC REVIEW

Khor E¹, Mc Nicholas F^1,2,3, Columb D⁴

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

³Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

⁴Dublin North City and County Child and Adolescent Mental Health Service, Grangegorman Primary Care Centre, Dublin 7, Ireland

Internet gaming addiction (IGA) is a growing concern among adolescents, exacerbated by recent COVID-19 restrictions. The World Health Organization has recently included IGA in the 11th International Classification of Diseases. However, the validity and reliability of the proposed criteria are subjected to controversy ¹. Despite growing neurobiological evidence in IGA, most systematic reviews have focused on adults or mixed adult/adolescent populations. Therefore, this systematic review explored the neuroimaging literature in adolescents with IGA.

Altogether, 2263 primary studies were identified from PubMed, CINAHL Plus, PsycINFO, and Web of Science. After applying inclusion and exclusion criteria (appropriate title, abstract, comparison group used within study, English-language, neuroimaging, and mean age under 18), 25 articles were included in this review.

Functional and structural brain alterations in IGA were noted across several imaging modalities, including electroencephalogram (EEG), functional magnetic resonance imaging (fMRI), and structural magnetic resonance imaging (MRI). Compared with healthy controls, adolescents with IGA demonstrated functional impairment in emotional regulation, reward-seeking, inattention and, inhibition control circuits, leading to increased risky decision making. Structural changes in gray and white matter were noted due to repetitive brain stimulation associated with visual, auditory, and spatial working memory. With regards to brain region processing self-concept, adolescents utilize the medial prefrontal region while having game character thoughts, compared to adults who utilize the left angular gyrus ².

In conclusion, adolescents with IGA showed common neurological findings consistent with other behavioral addictions and psychiatric disorders. Future studies are needed for potential neuroimaging markers that apply to diagnosis and informing treatment.

Reference:

• 1. Brand M, Rumpf HJ, King DL, Potenza MN, Wegmann E. Clarifying terminologies in research on gaming disorder and other addictive behaviors: distinctions between core symptoms and underlying psychological processes. Curr Opin Psychol. 2020;36:49-54.

• 2. Dieter J, Hill H, Sell M, Reinhard I, Vollstädt-Klein S, Kiefer F, et al. Avatar's neurobiological traces in the self-concept of massively multiplayer online role-playing game (MMORPG) addicts. Behav Neurosci. 2015;129(1):8-17.

Presenting Author: Eu May Khor

Supervisor: Dr David Columb

Co-Supervisor: Prof Fiona Mc Nicholas

19. SPERM LOCALISED IN THE ISTHMUS OF THE ALPACA FEMALE GENITAL TRACT DIRECTLY AFTER MATING

Meikle L¹, Brennan P², Reese S³, Kölle S¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Biological Sciences, Mount Holyoke College, South Hadley, United States of America

³Institute of Veterinary Anatomy, Histology and Embryology, LMU, Munich, Germany

The purpose of this study was to determine the location of deposition of sperm and their interactions within the genital tract of the female alpaca, as well as the identification of morphological and functional features to better understand their high fertility rates.

For this purpose, samples of female alpacas (n=4, ethical approval: AREC-E-20-13-Koelle) 5 mins-24 hrs after mating were obtained from the whole genital tract (n= 32) and stained with PAS, Alcian blue (pH 2.5), Masson’s Trichrome and H&E. Quantitative analysis was performed using ImageJ software.

Our results showed that the majority of sperm was found in the isthmus 5 mins after mating with 85% of the sperm being located in one oviduct. Most sperm were bound to the isthmic epithelium, with 10% found free in the lumen. 24 hrs after mating very few sperm were left. While there were high amounts of secretions in the whole genital tract before mating, secretory activity was strongly diminished after mating. Melanin was present in the uterine cells of all mated animals. Numerous lipid droplets were found in the epithelium of cervix and ampulla independently of mating.

Our results imply that that during mating, sperm are directly deposited near the uterotubal junction and initiate rapid intercellular communication. Although mating is associated with lesions and bleeding in the female genital tract, alpacas are highly fertile. Thus, the investigation of the underlying mechanisms might contribute to novel concepts for treatment of infertility in both humans and animals.

Presenting Author: Lily Meikle

Supervisor: Prof Sabine Kölle

20. CAN PARENTAL FACTORS MODERATE THE OUTCOMES OF SEXUAL ABUSE PERPETRATED AGAINST PRE-SCHOOL CHILDREN? A SYSTEMATIC REVIEW

Macey A¹, Twohig A², McNicholas F³, Murray P²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²St. Louise’s Unit, Our Lady’s Children’s Hospital, Crumlin, Dublin.

³Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Approximately 10% of annual referrals to specialist Child Sexual Abuse (CSA) units in Ireland are for children aged 6 or under. Detection of abuse in this age range is difficult and a high level of under-reporting is likely. The deleterious effects of CSA are well documented in retrospective studies of adults. Difficulties with emotional regulation, internalising and externalising problems and sexualised behaviours are established outcomes of CSA in young children. However, the prevalence of these sequelae is highly variable. This review aims to assess whether the literature suggests that this variability may be accounted for by the security of child-care giver attachment or by other parental factors eg. maternal history of CSA (MCSA) or maternal mental health.

A search of six electronic databases (guided by PRISMA¹) generated 1287 citations. Six studies met inclusion criteria and consideration of their references and citations yielded a further three studies. Application of National Institutes of Health (2014) Quality Assessment Tool² found most studies to be of moderate or high quality.

Findings indicate that disorganised attachment is associated with CSA (particularly in boys), internalising problems, externalising problems and subsequent dissociation. MCSA was associated with internalising and externalising problems. Maternal distress was found to amplify internalising problems. Children whose parents felt supported and able to effectively support their children achieved higher levels of Social Competence which increased over time.

The need for interventions to promote security of attachment in high-risk dyads as well as the importance of supporting and empowering the main caregiver are underscored.

References:

• 1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097.

• 2. National Institutes of Health (2014). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Available online at: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort (Accessed 29/06/2021)

Presenting Author: Alanna Macey

Supervisor: Dr Aoife Twohig

21. BURDEN OF HOSPITAL VISITS AND INVESTIGATIONS FOR PATIENTS LIVING WITH RARE DISEASE ATTENDING SVUH

Michaelides PS¹, McCarthy C^{1, 2}, Crowley RK^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²St. Vincent’s University Hospital, Dublin 4, Ireland

There are estimated to be 30 million people living with rare disease (RD) in Europe.⁽¹⁾ In this study we assessed the visit and investigation burden for patients and the hospital, for those attending the rare lung and bone services at SVUH.

Data were extracted from electronic records. Summary statistics (Median with interquartile range) were analysed using GraphPad.

One hundred and one made 159 visits to the rare bone disease clinic between June 2020 and May 2021. The median distance travelled was 192 km (43-460) and cost of travel (AA estimates 2019) was €128.29 (€28.73-€307.37). Investigation visits were combined with clinic visits for 49.6%. The median number of visits to the rare lung disease clinic was 3 (2-4) by 79 patients between January 2019 and June 2021. The median distance travelled was 144 km (36-558) and cost of travel was €96.22 (€24.06-€372.86). Investigation visits were combined with clinic visits for 45.67% and 47 of the 79 (59.49%) had genetic testing sent abroad. The median number of visits to the interstitial lung disease clinics was 3 (2-4) by 514 patients between April 2019 and June 2021. The median distance travelled was 136 km (40-489) and median cost of travel was €90.88 (€26.73-€326.42).

The cost to the hospital and patient due to the complexity of care and time spent travelling and waiting at a busy hospital could lead to a loss of productivity, time, and resources for both patients and healthcare providers.

Acknowledgment:

The author would like to acknowledge the continued support from Dr Rachel Crowley and Assoc Prof Cormac McCarthy.

Reference:

• 1. Graf von der Schulenburg JM, Frank M. Rare is frequent and frequent is costly: rare diseases as a challenge for health care systems. The European Journal of Health Economics. 2015;16(2):113-8.

Presenting Author: Panikos Stelios Michaelides

Supervisor: Dr Rachel Crowley

Co-Supervisor: Assoc Prof Cormac McCarthy

22. IS THERE VALUE IN PROVIDING A MUSIC THERAPY SERVICE TO CHILDREN AND ADOLESCENTS BEING TREATED FOR MENTAL HEALTH ILLNESS IN A PAEDIATRIC HOSPITAL SETTING: WHAT IS THE IMPACT FROM THE PATIENT OR FAMILY’S PERSPECTIVE?

S Clark¹, S Hurley², A Sweeney², J Campbell² E Barrett^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

Youth mental health is a significant issue. A large number of studies on the impact of music therapy and music interventions on mental health in a wide range of population groups and settings reveal overwhelmingly positive results. Consultant liaison psychiatry (CLP) teams are limited in Ireland despite policy recommendations. There have been no studies specifically evaluating the value of music therapy in this setting.

A comprehensive review of the literature was completed. Participants (n=11) receiving music therapy had their engagement levels each session rated using Goal Attainment Scaling (GAS) by the music therapist. Participants and their parents available following ethics approval (n=7) were invited to complete a feedback questionnaire.

Results of the literature review demonstrated high quality evidence that music therapy improves measures of mental health, quality of life and engagement and motivation. It has been shown to be enjoyable, safe and cost effective. This pilot project delivered 50 sessions of music therapy in total. Engagement was rated highly across sessions and maintained or improved over time. Music therapy was rated highly (> 4 = Agree) across all domains. Self-reported negative emotions were eliminated after music therapy, with all emotions following music therapy reported as positive. Qualitative feedback indicated requests for more sessions.

The results of this pilot are consistent with current evidence for music therapy in mental health: there is value in providing a music therapy service to children in hospitals accessing mental health treatment.

A pilot music therapy service in this setting is the first of its kind to be published.

Presenting Author: Sophie Clark

Supervisor: Assoc Prof Elizabeth Barrett

23. PATHOLOGICAL DEMAND AVOIDANCE (PDA) – A SUBTYPE OF AUTISM SPECTRUM DISORDER. IS PDA DISTINCT FROM ASD? A SYSTEMATIC REVIEW

Hendy M¹, Murray J², McNicholas F²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland

By systematically reviewing PDA in childhood, this study shed light on the impact longitudinally that behavioral difficulties can have on mental health and psychosocial functioning.

We searched through a variety of databases, as well as grey literature. Pathological demand avoidance, extreme demand avoidance and autism spectrum disorder are all key terms. 2003 through 2021 was the timeframe. Duplicates were eliminated from titles, abstracts, and, if required, complete articles. All of the papers included in the study were evaluated thoroughly and critcally appraised and synthesized, and a data extraction table was created.

We have brought clarity to the notion of PDA and how this term fits into the autism spectrum. Prevalence was found to be one in five children in the ASD group, and one study shows that PDA seems to be more prevalent in the ASD population than the general population¹.PDA is not yet recognized by the DSM-5 nor the ICD-11, and diagnostic tools have been studied but not officially recognized yet, particularly the EDA-Q and the EDA-8 have potential to be employed in future research². Controversy is rampant on the topic of PDA, with many authors warning of the dangers of legitimizing demand avoidance as a subtype of autism.

The notion of PDA is a controversial one which has an apparent set of symptoms, however there are many requirements before the official emergence of this new subtype of ASD. The criteria of diagnosis, diagnostic tools, causality, and treatment have yet to be determined by further research.

References:

• 1. Gillberg CG, I. C.; Thompson, L.; Biskupsto, R.; Billstedt, E. Extreme ("pathological") demand avoidance in autism: a general population study in the Faroe Islands. Eur Child Adolesc Psychiatry. 2015;24(8):979-84

• 2. O’Nions EH, Francesca; Viding, Essi; Noens, Ilse. Extreme Demand Avoidance in Children with Autism Spectrum Disorder: Refinement of a Caregiver-Report Measure. Advances in Neurodevelopmental Disorders. 2021.

Presenting Author: Monica Hendy

Supervisor: Dr Johanna Murray

24. EXAMINING THE REFERRAL CHARACTERISTICS OF PAEDIATRIC EATING DISODER REFERRALS TO A SPECIALIST EATING DISORDER SERVICE PRE AND DURING COVID

Campbell S¹, McNicholas F^2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Child & Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Ireland

³Children Health Ireland, Dublin, Ireland; and Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Clinicians have noticed a significant increase in cases of youth with an eating disorder (ED) presenting since the beginning of the COVID-19 lockdown, with younger cases attending and presenting with atypical features. The overall aim of the study is to explore the effect of COVID-19 on presentations to an eating disorder team in a child and adolescent mental health service (CAMHS) setting.

A retrospective chart review was completed of all initial multi-disciplinary assessment notes of patients with ED referred to a CAMHS specialist ED service between 1^st January 2018 and May 31^st 2021. Data was compared over the study time periods pre-COVID and during-COVID.

When comparing the pre-COVID cohort to the during-COVID cohort, there was a greater proportion of autism spectrum disorder (ASD) and other ED diagnoses than anorexia nervosa (AN) in the during-COVID cohort. Mention was made of COVID having had a significant negative effect on the young person in 80% of cases presenting during COVID. The mean duration of weight loss was 7.4 months pre-COVID and 4.4 months during-COVID (P value: <.001).

The effects of lockdown restrictions during the pandemic have triggered EDs in some young people. Youth with EDs referred to specialist ED services during the COVID-19 pandemic exhibit a shorter duration of weight loss and are more likely to receive an ED diagnosis other than AN. Further research is required to better understand the effects of the COVID-19 pandemic on ED illness on a sample representative of youth with ED.

Presenting Author: Sally Campbell

Supervisor: Prof Fiona McNicholas

25. THEMATIC ANALYSIS OF THE IRISH PUBLIC’S OPINIONS ON ELECTRONIC HEALTH RECORDS AND DATA SECURITY

Barry O¹, Foley B², Flaherty SJ², Duggan C², Flynn R²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Health Information and Standards, Health Information and Quality Authority, Smithfield, Dublin, Ireland

This project drew on findings from the ‘National Public Engagement Survey on Health Information’^[1] (NPES), conducted in 2020, which explored people’s views on the management of health information and use of digital technologies in Ireland. The aim of this project was to gain in-depth insight into the Irish public’s opinions on electronic health records (EHRs) and data security.

1,228 participants were interviewed by telephone for the NPES, which consisted of three scenarios exploring the collection, use and sharing of health information. Five open-ended questions were included, and 377 people provided responses to these questions that related to data security. A qualitative thematic analysis^[2] was undertaken, focusing on EHRs and data security. Codes relating to points of interest were identified. Themes were developed based on relationships between these codes.

Four themes were identified from the qualitative analysis: ‘Attitudes towards a move to eHealth’; ‘Trust in relation to information security’; ‘Security measures to safeguard electronic health records’; and ‘Technical infrastructure to support electronic health records.’

The results show that people view EHRs as a positive advancement. However, reassurance surrounding security is essential. People perceive the need for a symbiotic relationship between security systems and the individuals that manage them; one is only as robust as the other. This survey was undertaken prior to the recent cyber-attack on our healthcare system, illustrating that data security is a key concern for the Irish public in relation to EHRs. These findings demonstrate that security, trust, and public engagement are integral to the adoption of EHRs.

References:

• 1. Health Information and Quality Authority. (In press). Findings from the National Public Engagement Survey on Health Information. Dublin: HIQA.

• 2. Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qualitative Research. 2001;1(3):385-405.

Presenting Author: Orla Barry

Supervisor: Dr Barbara Foley

Co-Supervisor: Dr Sarah-Jane Flaherty

26. VALIDATION OF A CASE DEFINITION TO IDENTIFY PATIENTS DIAGNOSED WITH CARDIOVASCULAR DISEASE IN CANADIAN PRIMARY CARE PRACTICES

Thomas R¹, Kosowan L², Pambid M³, Singer A⁴

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

³Faculty of Medicine, University of British Colombia, Vancouver, British Colombia, Canada

⁴Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

This study aims to create and validate an electronic medical record (EMR)-based case definition for cardiovascular disease (CVD). This will benefit research and disease surveillance.

Data from EMR of 255 primary care providers (PCP) participating in Manitoba Primary Care Research Network (MaPCReN) were extracted up to December 31, 2020. We created a reference standard using encounter notes and clinician diagnostic text fields from the EMR. This reference set was compared to a previously validated case definition that captured patients with an International Disease Classification (ICD) or Anatomical Therapeutic Chemical (ATC) codes that represents CVD and hypertension.

Within MaPCReN there were 142,427 adult patients that saw a primary care provider participating in MaPCReN between January 1, 2018 and December 31, 2020. When we tested the Manitoba Centre for Health Policy case definition against our reference standard, we obtained a sensitivity of 77.8%, specificity 96.2%, positive predictive value of 80.2%, negative predictive value of 95.7% and accuracy of 93.2%. When we applied the CVD/hypertension definition to MaPCReN, we obtained a lifetime prevalence rate of 37.1% (n=52,877), and a 1-year prevalence rate of 30.2% (n=43,077). We found that patients with CVD were more likely to be male, have a BMI>=30 and have comorbid diagnosis of diabetes, chronic kidney disease, osteoarthritis.

With the developed validated case definition, we can determine the prevalence of CVD/hypertension. Next steps will be focused on creating and validating a separate case definition for hypertension and each sub-type of CVD to further characterize the patients and their health service use.

Acknowledgement :

The author would like to acknowledge funding from the Hospital Saturday Fund Grant.

This study was made possible thanks to the kind support of the University of Manitoba, Rady Faculty of Health Sciences, Department of Family Medicine.

Presenting author: Riddhima Dinah Thomas

Supervisor: Dr Alexander Singer

Co-Supervisor: Dr Leanne Kosowan

27. COMBINATORIC METHOD FOR IDENTIFICATION OF GENETIC VARIANTS IN RARE DISEASE

Kinsella A¹, Segurado R²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Public Health, Physiotherapy and Sports Science, & UCD CSTAR, University College Dublin, Belfield, Dublin 4, Ireland

Next-generation sequencing provides rapid access to whole genome or exome DNA sequences of patients¹. However, these large quantities of data pose interpretive and analytical challenges. Namely, given that loci with rare and ultra-rare alleles are far more numerous than common alleles, it is unknown how much allele sharing should be expected to occur by chance and how much is suggestive of disease.

We present a model based on the famous statistical birthday problem to calculate the probability that sharing of rare variants among cases has occurred by chance, allowing variants to be prioritized for follow-up investigation. We derive single- and multi-gene versions of the model and evaluate their performance computationally in simulated data sets of patients with mutations.

A probability model was adapted to the rare variant problem, implemented in Python, and tested. On simulated data of 200 patients, irrespective of the variant frequency in the population, this model is able to identify variants enriched in only 2% of cases with power of 55%, and in 3% of cases with power of 92%, across 400 assayed loci. Given the assumptions of the model, it is shown to be useful for rare variants which are even modestly excessively shared by cases.

These models rapidly triage genetic data and improve on existing methods² by operating without the need for control subjects or population allele frequencies, making them suitable for real-time, cumulative estimations of the evidence for causality of rare genetic variants in rare disease, including of newly detected de novo variants.

References:

• 1. Yohe S, Thyagarajan B. Review of Clinical Next-Generation Sequencing. Arch Pathol Lab Med. 2017;141(11):1544–1557.

• 2. Lee S, Abecasis G, Boehnke M, Lin X. Rare-variant association analysis: study design and statistical tests. Am J Hum Genet. 2014;95(1):5-23.

Presenting Author: Aishling Kinsella

Supervisor: Assoc Prof Ricardo Segurado

28. ANALYSIS OF INFLAMMASOME PROTEIN EXPRESSION IN HIDRADENITIS SUPPURATIVA PATIENT TISSUE

O’Donohoe S¹, Leahy C², Johnston DGW^1,3, Tobin DJ^{1,3, 4}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland

³UCD Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland

⁴UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

Hidradenitis Suppurativa (HS) is a chronic inflammatory dermatological condition in which patients develop painful abscesses in intertriginous areas. It involves occlusion and rupture of the hair follicle, stimulating an immune response¹. Intracellular inflammasome proteins are thought to be part of this response and involve a two signal pathway with eventual Caspase-1 formation and subsequent IL-1β and IL-18 release². The aim of this research was to assess the expression of inflammasome proteins in HS tissue using immunostaining, including inflammasome receptors (NLRP3, NLRC4, AIM2, NLRP1), regulators (ASC, Nek-7) and effectors (Gasdermin-D, Caspase-1).

In order to optimise immunostaining, a THP-1 macrophage inflammasome assay was employed, including nigericin and monosodium urate crystals as positive controls. Activation was confirmed using IL-1β ELISA and LDH cytotoxicity assays. Subsequent trials for inflammasome proteins in healthy and HS blood were carried out using Western blot assays. 7 HS blood samples were obtained from St. Vincent’s University Hospital from which peripheral blood mononuclear cells were extracted, and compared to healthy volunteer cells.

Expression of AIM2, NLRP3, NLRC4, ASC, Caspase-1 and Gasdermin D inflammasome was detected in THP_1 macrophages. Expression of Caspase-1 and Gasdermin D was detected in both healthy and HS blood, with evidence of enhanced cleavage in some HS samples.

This study highlights the potential link between HS pathogenesis and inflammasome activation. Further study of inflammasome protein expression in HS tissue is required to demonstrate their role in HS pathogenesis. In depth understanding of the pathogenesis can support research into targeted treatments for patients.

Acknowledgement :

The author would like to acknowledge patient samples from the Department of Dermatology in St. Vincent’s University Hospital Dublin and funding from The British Skin Foundation.

References:

• 1. Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020; 6(1):18.

• 2. Govindarajan V, de Rivero Vaccari JP, Keane RW. Role of inflammasomes in multiple sclerosis and their potential as therapeutic targets. J Neuroinflammation. 2020; 17:260.

Presenting Author: Sarah O’Donohoe

Supervisor: Dr Daniel Johnston

Co-Supervisor: Prof Desmond Tobin

29. INVESTIGATING MUCOSAL ASSOCIATED INVARIANT T (MAIT) CELLS IN LYMPHANGIOLEIOMYOMATOSIS (LAM)

Boyle S¹, Hogan A², Jouida A³, Keane MP^1,4, McCarthy C^1,4

¹ UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.

² Obesity Immunology Group, Maynooth University, Maynooth, Co. Kildare, Ireland.

³UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland.

⁴Department of Respiratory Medicine, St Vincent’s University Hospital, Dublin 4, Ireland

Lymphangioleiomyomatosis (LAM) is a rare metastasising neoplasm that predominantly affects women of childbearing age. It involves abnormal proliferation of smooth muscle-like cells known as LAM cells, leading to cystic destruction of the lung parenchyma.¹ Mucosal associated invariant T (MAIT) cells are a group of unconventional T lymphocytes which have been implicated in the pathogenesis of numerous diseases.² The aim of this research was to investigate if MAIT cells are altered in LAM patients.

Blood samples were obtained from a cohort of LAM patients (n = 10; 100% female) and healthy controls (n = 8; 100% female). The peripheral blood mononuclear cells (PBMC) were stained using monoclonal antibodies specific for CD3, CD161, CD8 and TCR Vα7.2. MAIT cell frequency and phenotype were examined using multi-colour intracellular flow cytometry. The Mann-Whitney test was used to compare the groups.

There was no difference in the CD3+ lymphocyte population between the groups (p = 0.6965). There was also no difference in the CD8+ T cell population (p = 0.8112). MAIT cell frequency was reduced in the periphery of LAM patients (p < 0.005). Additionally, the frequency of CD8 positive MAIT cells was reduced in patients with LAM (p < 0.05).

MAIT cell frequency and the proportion of CD8 positive MAIT cells are both reduced in the periphery of patients with LAM. Further studies are necessary to investigate the impact of LAM cells and the LAM tumour microenvironment on MAIT cell phenotypes, functional responses, and metabolism.

Acknowledgments:

The author would like to acknowledge funding from the Pathological Society of Great Britain and Ireland.

References:

• 1. O'Mahony A, Lynn E, Murphy D, Fabre A, McCarthy C. Lymphangioleiomyomatosis: a clinical review. Breathe. 2020;16(2):200007.

• 2. Godfrey D, Koay H, McCluskey J, Gherardin N. The biology and functional importance of MAIT cells. Nature Immunology. 2019;20(9):1110-1128.

Presenting Author: Siobhán Boyle

Supervisor: Dr Cormac McCarthy

Co-Supervisor: Dr Andrew Hogan

30. INVESTIGATION OF ENVIRONMENTAL HYGIENE IN THE UCD VETERINARY HOSPITAL WITH A FOCUS ON FAECAL CONTAMINANTS

Singaravelu A¹, Leggett B², Leonard FC²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Enterococci and Escherichia coli can survive on inanimate surfaces for months and pose a threat to human and animal health [1, 2]. The main purpose of this study was to evaluate cleanliness and microbial burden of a veterinary hospital to establish the extent of cross-contamination with faecal bacteria to aid in reducing nosocomial infections.

Environmental surfaces, and hand hygiene were assessed using 3M^TM Clean-Trace^TM ATP test, Petrifilm plates (3M^TM), bacteriological culture of Enterococcus species and E. coli and antimicrobial susceptibility testing as appropriate. A cross-sectional study was conducted to identify sources of contamination within the hospital, followed by a longitudinal study to identify the persistence of bacteria. Records of in-patients hospitalised during the 8-week study period and from which either E. coli or Enterococcus species had been isolated were reviewed to determine the relationship with environmental contamination and possible hospital-acquired infections. Cross-contamination was assessed through antimicrobial resistance typing.

Of 113 samples from the cross-sectional study, Enterococcus species were isolated from 31 (27.4%) and E. coli from 9 (7.9%). Four of 51 (7.8%) of hand samples were contaminated with these pathogens. Twenty-one isolates (28.8%) were multi-drug resistant. There was no change in cleanliness or microbial burden over 3 weeks. Enterococci and E. coli isolates with similar resistance patterns were recovered from the environment in the large and small animal hospitals and from a small number of patients.

These results suggest that movement between the small and large animal hospital areas may be responsible for cross-contamination and possible hospital-acquired infections.

References:

• 1. Kramer A, Assadian O. Survival of Microorganisms on Inanimate Surfaces. Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections. 2014;7-26.

• 2. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6:130.

Presenting Author: Ashokkumar Singaravelu

Supervisor: Assoc Prof Finola Leonard

Co-Supervisor: Bernadette Leggett

31. MG53 HAS LIMITED EFFECT ON ACUTE LUNG INJURY IN PORCINE MODEL

Svendsen S¹, Mulier K², Beilman G²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America

MG53 is a TRIM-family protein associated with cell membrane repair. It has previously demonstrated efficacy in preservation and mitigation of cell death when administered intravenously after hemorrhagic shock[1]. Worldwide, Acute Lung Injury (ALI) is a frequent complication of trauma, occurring in about 30-50% of cases[2]. This study aimed to determine if IV administration of MG53 after trauma induced ALI would result in improved pulmonary function in an in vivo porcine model.

18 pigs were anesthetized and randomized to either control or 0.2 mg/kg IV MG53 treatment groups. Blunt percussive injury by captive bolt device simulated ALI. Hemorrhagic shock was induced through removing 35-50% of total blood volume. The pigs received limited resuscitation for 1 hour before a 20 hour full resuscitation. Averages ± SD and student’s t-test determined statistical significance.

There were no points of statistical significance in any of the pulmonary parameters recorded throughout the experiment. Both groups had a survival rate of 89% and there was no significant difference in fluid resuscitation needs. Wet:dry lung weight showed no significant difference in edema. While the experimental group’s secondary lung injury appeared smaller in gross histology, measured area didn’t achieve statistical significance.

This data suggests that MG53 does not improve pulmonary function when administered for ALI. With no difference in survival rate (89%), MG53 would likely not improve patient outcome after traumatic ALI. It should be noted that small sample size may have limited the statistical power and increased margin of error.

Acknowledgement:

The author would like to acknowledge funding from the Hospital Saturday Fund

References:

• 1. Moloughney, J.G., Hersey, J., Tan, T., Hsai, H. and Weisleder, N. MG53 reduces cell death associated with hemorrhagic shock ischemia/reperfusion (I/R) injury by increasing membrane repair capacity. FASEB J, 2012;26: 1001.3-1001.3.

• 2. Xanthos TT, Balkamou XA, Stroumpoulis KI, Pantazopoulos IN, Rokas GI, Agrogiannis GD, et al. A model of hemorrhagic shock and acute lung injury in Landrace-Large White Swine. Comp Med. 2011;61(2):158-162.

Presenting Author: Solveig Svendsen

Supervisor: Dr Gregory Beilman

32. THE EFFECT OF TRANSVERSUS ABDOMINIS PLANE BLOCKS ON INTRAOPERATIVE OPIATE USE DURING PANCREATICODUODENECTOMY: AN EXPLORATORY REVIEW OF THE LITERATURE

Edgley C¹, Rodriguez JZ², Hammill C²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Washington University School of Medicine, St. Louis, MO, United States of America

The opioid abuse epidemic is one of the most consequential global public health issues. The leading cause of injury-related death in the United States is opioid overdose¹. Prescription opioids are the primary impetus of opioid related deaths and hence a main contributor to the opioid epidemic¹. A percentage of cancer resection surgery patients become opioid dependent following surgery such as pancreaticoduodenectomy. Major open abdominal surgery, complex laparoscopic and foregut surgical patients are some of the main consumers of opioids in the surgical patient². TAP block analgesia has been found to be associated with reductions in opioid consumption and postoperative pain in these patients. This narrative review aims to outline current evidence surrounding preoperative TAP block and intraoperative opiate use during pancreaticoduodenectomy.

A widespread literature search strategy using relevant key words was developed based on Cochrane best practice recommendations. This strategy was applied to a comprehensive search of major electronic databases to identify relevant studies within certain specified criteria. Search results revealed that TAP block analgesia has been found to be effective in reducing opioid consumption in multiple abdominal procedures.

There is a paucity of evidence in relation to TAP block analgesia reducing opioid use in pancreaticoduodenectomy patients. This limited evidence found also did not include relevant techniques such as pancreaticoduodenectomy with a midline incision.

This exploratory review has outlined a gap in the literature regarding opioid consumption and other postoperative benefits following TAP block analgesia in pancreaticoduodenectomy patients. Given the potential advantages of TAP block analgesia, further research is warranted.

References:

• 1. Madras BK. The Surge of Opioid Use, Addiction, and Overdoses: Responsibility and Response of the US Health Care System. JAMA Psychiatry. 2017;74(5):441-2.

• 2. Tan WH, Yu J, Feaman S, McAllister JM, Kahan LG, Quasebarth MA, et al. Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use. J Am Coll Surg. 2018;227(2):203-11.

Presenting Author: Carla Edgley

Supervisor: Dr Chet Hammill

33. TRENDS IN BREAST CANCER INCIDENCE AMONG YOUNG WOMEN AGED 20-49 YEARS IN THE UNITED STATES BY RACE, STAGE AND HORMONE RECEPTOR STATUS

Murtagh S¹, Xu S², Han Y², Wan F², Toriola A²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Surgery, Division of Public Health Sciences, and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States of America

Breast cancer is the most commonly diagnosed cancer among women in the United States. Young women are more likely to develop breast cancer with more aggressive biological features which contributes to poorer prognosis and survival rates compared with older women¹. Previously calculated age-adjusted breast cancer incidence rates have been corrected for the potential confounding effect of age. However, this type of estimate is still confounded by differences caused by period and cohort effects.

We used data from the Surveillance, Epidemiology, and End Results Registries to evaluate the age and age-cohort adjusted incidence rates, incidence rate ratios, and annual percent changes (APC) among premenopausal stratified by race/ethnicity, hormone receptor status, tumour stage, and age at diagnosis.

We identified 222,424 young women diagnosed with primary invasive breast cancer from 1993-2017.Incidence trends remained stable before increasing 0.67% annually after 2010. Non-Hispanic Black women aged 20-29 had 49% higher age-standardized rate compared to non-Hispanic White women. The incidence rate for ER+/PR+ tumours increased (APC=2.39%, 95%CI: 2.20 to 2.58), while rates for ER-/PR- tumours decreased (APC=-0.70%, 95%CI: -1.09 to -0.32). The incidence rates for stage I (APC=0.31, 95%CI: 0.07 to 0.55), II (APC=0.99, 95%CI: 0.82 to 1.16), and IV tumours (APC=2.88, 95%CI: 2.37 to 3.39) increased. Both cohort and period effects impacted incidence, with cohort effect almost 10 times larger than period effect.

The differences recorded in tumour characteristics by age and race/ethnicity present opportunities for further research into specific breast cancer risk factors among younger women and possible targeted intervention strategies for at-risk groups.

Reference:

• 1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654

Presenting Author: Sara Murtagh

Supervisor: Dr Adetunji Toriola

34. FAMILY BASED THERAPY: A MODIFIED APPROACH TO TREATMENT FOR CHILDHOOD OBESITY FOR ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) SURVIVORS

Khan S¹, Jakubiak J², Guan M², Hayashi R², King A², Wilfley D²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Washington University School of Medicine, Washington, United States of America

Acute Lymphoblastic Leukaemia (ALL) is the most common paediatric cancer. Survivors of (ALL) undergo highly efficacious therapies, which have led to an overall five-year survival rate of approximately 90%. These life-saving treatments can have devastating effects on the long-term health of the patient: bone loss, cardiovascular disease, metabolic syndrome, etc. Moreover, these conditions are exacerbated by excess weight, which is concerning given the rates of obesity among ALL survivors are higher than the general population.

The proposed intervention is an adaptation of Family Based Treatment (FBT), a multicomponent approach to target behaviour change for children and their parents. FBT employs behavioural techniques and a traffic light plan to help families identify healthier options and affect changes in their lifestyle to help reduce the relative weight of all family members. We will enrol 30 families in which the child is a survivor of ALL, the ages of 6-18, and has a BMI percentile ≥ 85th for age and sex. The pilot adaptation of FBT will consist of 32 sessions: 8 psychoeducation-focused group sessions (separate for parents and children), and 16weekly individual family sessions.

Assessments will take place at the beginning of and following the intervention. To determine acceptability of the adapted intervention both children and caregivers will complete several feedback measures. To assess relative weight change, they will have their height and weight measured. Participants will perform 24-hour dietary recalls to assess dietary intake, and complete self-reported measures of physical activity.

This will be the first study to pilot an evidence- and guideline-based intervention adapted for childhood cancer survivors. Although there have been similar studies in the past, they were not tailored specifically for ALL survivors.

Presenting Author: Sabir Khan

Supervisor: Dr Denise Wilfley

35. SYNTHETIC LIPOXIN-A4 MIMETICS (SLXMS) AS THERAPEUTICS IN DIABETES-ASSOCIATED ATHEROSCLEROSIS (DAA)

Shaughnessy D¹, Gaffney A², de Gaetano M², Godson C²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Diabetes Complications Research Centre, Conway Institute & UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Increasing evidence supports the role of deficiencies in the resolution of inflammation [RoI] during the development of chronic inflammatory diseases, including diabetic complications[1]. RoI is dynamically regulated by the production of specialized pro-resolving mediators (SPMs), such as LipoxinA4 (LXA4). However, LXA4 is not stable in vivo and therefore more stable synthetic lipoxinA4 mimetics (sLXms) have been recently developed to improve their bioavailability[2]. The aim of this research was to investigate the therapeutic potential of sLXms in an in vitro model of inflammation.

To investigate this, THP-1 monocytes and derived macrophages were treated with controls, native LXA4 and derivative Quinoxaline-containing-sLXm (Ester form [CT443] and relative free acid form [CT443FA]), at different concentrations (10pM,1nM,100nM) and time-points (T0, 30’ and 24h). Gene expression analysis of anti-inflammatory/pro-inflammatory/pro-resolving target genes were measured via semi-quantitative Real Time-Polymerase Chain Reaction (RT-PCR) (using Syber Green and Taqman chemistries), normalising to the housekeeping gene GAPDH levels.

Overall, sLXm CT443, when in the free acid form, showed a strongest regulation of key target genes compared to the native LXA4 or the ester form, suggesting a ‘pro-drug’-like mechanism of action: in particular, CT443 FA reduced the transcription of pivotal pro-inflammatory cytokines [ie IL1β] by 50-75%(p<0.05) in macrophages; whilst, inducing in monocytes an increase of the anti-inflammatory scavenger receptor mannose receptor [MR] and of the pro-resolving cytokine TRAIL, by 2-3X (p<0.05). mRNA level of ALX/FPR2, known receptor of LXs, is upregulated by LXA4 and CT443FA, suggesting that the described effects are driven by an enhanced transcription of ALX/FPR2, key driver of RoI.

Acknowledgement :

The author would like to acknowledge funding from the Health Research Board.

References:

• 1. Brennan EP, Mohan M, McClelland A, et al. Lipoxins Protect Against Inflammation in Diabetes- Associated Atherosclerosis. Diabetes. 2018;67(12):2657-2667.

• 2. de Gaetano M, Tighe C, Gahan K, et al. Asymmetric Synthesis and Biological Screening of Quinoxaline-Containing Synthetic Lipoxin A4 Mimetics (QNX-sLXms). J Med Chem. 2021;64(13):9193-9216. doi:10.1021/acs.jmedchem.1c00403

Presenting Author: Deon Shaughnessy

Supervisor: Prof Catherine Godson

Co-Supervisor: Dr Monica de Gaetano

36. FEMALE GENITAL MUTILATION: MEDICAL AND LEGISLATIVE INTERVENTIONS

Botha L¹, McGovern C¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Female Genital Mutilation (FGM) causes harm to Irish children. However, legislation and guidelines are poorly understood by medical professionals, whilst enforcement remains challenging. FGM involves excision, clitorectomy, infibulation or any other action that damages the female genitalia for non-medical purposes [1]. The ceremonial procedure is increasing in Ireland due to the migration of individuals from FGM practicing countries [2]. The aim of this research was to (a) undertake a literature review of FGM legislation and guidelines in Ireland, (b) complete a comparative analysis of FGM in international law and (c) provide recommendations for legislative change in Ireland.

PubMed and Google Scholar were used to identify FGM studies for the literature review. Legal research was performed using LexisNexis, Wolters Kluwer and Westlaw.

The review found that, whilst not legally binding, the United Nations and European Union urge member states to end FGM. In Ireland, the Criminal Justice (Female Genital Mutilation) Act 2012 criminalises FGM and imposes a maximum penalty of 14 years imprisonment and a €10,000 fine. Under two separate Acts, medical professionals must report suspected FGM to both Tusla and the Gardaí. Government guidelines provide a disjointed overview of medical professionals’ FGM obligations. Amendments should be made to strengthen childhood protections. Legislative amendments could shift the burden of proof onto family members to prove that they did not allow FGM to occur to the victim. FGM guidelines for general practitioners could lead to further victim identification.

The legislative amendments and specific guidelines may reduce the incidence of FGM in Ireland.

References:

• 1. World Health Organization. Eliminating female genital mutilation: An Interagency Statement. Geneva: World Health Organization; 2008.

• 2. AkiDwa. Towards a National Action Plan to Combat Female Genital Mutilation: 2016-2019. Dublin; 2016.

  Presenting Author: Leon Botha

  Supervisor: DrCliona McGovern

37. LIRAGLUTIDE TREATMENT DECREASES THE DEVELOPMENT OF SPONTANEOUS ENDOMETRIAL CANCER IN BDII/HAN RATS

Isayeva A^1*, Karunadhas NS^2*, Pessanha L^2* Docherty N^1,2, Le Roux CW²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

*Joint first authorship

Endometrial cancer (EC) is the 6th most common cancer in women in Ireland and overall, the 15th most common cancer globally¹. Obesity is the greatest risk factor for EC, with as much as 50% of all cases of EC in Europe and the US attributable to excess body mass². Liraglutide is a GLP-1 agonist which is used as a weight-loss treatment for obesity

The aim of our study was to examine the effects of liraglutide therapy on the development of endometrial cancer in the BDII/Han rat, a spontaneous model of EC. Forty 12 month old weight-matched female BDII/Han rats (were randomised 1:1 to either a control arm or an active arm involving daily administration of liraglutide (1mg/kg s.c.). Body weight, food intake and mortality were tracked over 12 week follow-up At necropsy, uterine horns were examined for tumour and samples taken for histological classification and CD8 immunohistochemistry review.

The tumour incidence in the control group was 9/19 (47%) and 4/21 (19%) in the liraglutide group (p<0.05). Within the control group, 8/9 (89%) of tumours were Type-1 Endometrioid and the remaining 1/9 (11%) was Serous, Non-Endometrioid. Within the liraglutide group, 4/4 tumours (100%) were Serous, Non-Endometrioid type. Mean weight difference in the control group was 0% (SD: 3.96). Mean weight loss in the liraglutide group was 15% (SD: 7.15)

Our results suggest that Liraglutide may have a protective effect against the spontaneous development of EC in a BDII/Han rat model which may have significant implications for work on fertility preserving treatments.

References:

• 1. World Cancer Research Fund International. Endometrial cancer statistics | Womb cancer statistics | WCRF [Internet]. WCRF International. 2019 [cited 04 August 2021]. Available from: https://www.wcrf.org/dietandcancer/endometrial-cancer-statistics/

• 2. Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and cancer risk. The Lancet Oncology [Internet]. 2002 [cited 04 August 2021];3(9):565-574. Available from: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(02)00849-5/fulltext

Presenting Author: Anna Isayeva

Supervisor: Prof Carel le Roux

Co-Supervisor: Assoc Prof Neil G. Docherty

38. MONITORING PURKINJE CELL DEVELOPMENT WITH DIFFUSION-WEIGHTED MR SPECTROSCOPY

Qiu LR^1,2, Ligneul C¹, Lerch JP¹

¹Wellcome Centre for Integrative Imaging, University of Oxford, Oxford, United Kingdom

²UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Purkinje cells are large cerebellar output neurons with complex dendritic trees. They undergo rapid structural change in the first two years of human life, and the first 21 days of rodent life¹. Purkinje cells are important in motor and social control and are implicated in developmental disorders such as autism spectrum disorders². Diffusion-weighted MR spectroscopy (DW-MRS) is a method that can probe the diffusion of cell-specific metabolites and how it is impacted by cellular morphology, thus yielding a way of investigating cell structure in vivo. We used DW-MRS to investigate how Purkinje cell structure changes across development, starting in early life, to better understand cerebellar development.

Six Sprague Dawley rats (4 females, 2 males) were longitudinally imaged with DW-MRS across five postnatal day (P) timepoints: P5, P10, P15, P20, and P30. After completion of data collection, we intend on extracting several parameters from the diffusion data which will be exploited with biophysical models to create a “synthetic cell” whose morphology can be analysed with a 3D Sholl analysis.

Preliminary results show that N-acetylaspartate (NAA) concentration, a major neuronal marker, increases in both the cerebellum and thalamus across five timepoints through development, indicating neuronal development.

Here, we used DW-MRS to investigate the presence of neuronal markers, such as NAA, in regions of interest in the cerebellum and thalamus. After analysis of diffusion data, we predict an increase in branch order and segment length of our cerebellar synthetic cells which will represent the complexification of the Purkinje cell dendritic tree across development.

Acknowledgement:

The author would like to acknowledge funding from the Hospital Saturday Fund.

References:

• 1. Hendelman WJ, Aggerwal AS. The Purkinje neuron: I. A Golgi study of its development in the mouse and in culture. Journal of Comparative Neurology. 1980 Oct 15;193(4):1063-79.

• 2. Wang SS, Kloth AD, Badura A. The cerebellum, sensitive periods, and autism. Neuron. 2014 Aug 6;83(3):518-32.

Presenting Author: Lily Qiu

Supervisor: Dr Jason Lerch

39. EVALUATING AN ONLINE HEALTH PROMOTION PROGRAM FOR CANADIAN VETERANS AND THEIR FAMILIES

Tremblay ZJEJ^1,3, Grover S^2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²McGill University School of Medicine, McGill University, Montreal, QC, Canada

³ Mission VAV, Old Montreal, QC, Canada

In 2021, Mission VAV implemented a 6-week wellness program called Mission Zen, created to help better the mental and physical well-being of Canadian Forces Veterans and their families. During the pandemic, the program was also made available to the public.

Each participant registered online on the Mission VAV web-based platform, where they were assigned a health coach and completed baseline and final health assessments in the following categories: depression (CES-D), emotional stress (PSS), resilience (OBI), sleep quality (ISI), mastery, fatigue (MFI), and loneliness (TLS). Throughout the program participants tracked their daily activity levels, had access to educational resources for each health assessment category, and engaged with their teammates on the Mission VAV web-based platform. The primary outcome was the impact of the program on the mental health assessments.

We analyzed the pre-post comparisons using the data collected at both the baseline and final health assessments. The health metrics across all health assessment categories showed improvement by a mean percent change range of 5-14%, from baseline to finish, including depression (CES-D) (5%), emotional stress (PSS) (14%), sleep quality (ISI) (4%), resilience (OBI) (5%), mastery (11%), fatigue (MFI) (5%), and loneliness (TLS) (5%). Ongoing follow-up will be required to evaluate the sustainability of the promising improved mental health metrics.

The short-term results of this study are promising and have resulted in a participant base with improved mental health across the several health metrics, although no clear inter-health assessment dose-response was observed between step count days and the improved health metrics.

Presenting Author: Zachary Tremblay

Supervisor: Dr Steven Grover

40. A RETROSPECTIVE STUDY COMPARING REPORTS OF PAIN AND SYMPTOMS BETWEEN PATIENTS AND THEIR FAMILY CAREGIVER RECEIVING PALLIATIVE CARE AT HOSPICE AFRICA UGANDA

Devlin D¹, Olet Adong D², Felle P¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Hospice Africa Uganda, Kampala, Uganda

The trajectory of life limiting illness is associated with patient deterioration that can impact their ability to attend clinical appointments and result in caregiver representation by proxy. Existing research suggests differences exist between patient-reported and caregiver-reported aspects of pain and symptoms, but no study has taken place in a low- or middle-income country¹. The aim of this study was to compare reports of patients’ pain and symptoms from patients and caregivers.

The study was a retrospective cross-sectional inquiry. Purposive sampling was used to select 100 case notes- 50 from patients and 50 from patient’s caregivers. Data was mined from Hospice Africa Uganda’s patient’s case notes. Data points on pain and symptoms were recorded and coded. Descriptive statistics and thematic analysis were utilized.

Data analysis showed patients are more likely to give a more comprehensive account of their pain with 52% providing a description, location and frequency of pain compared with 2% of caregivers. Caregivers performed better at reporting physical symptoms such as weakness or loss of appetite compared to psychological distress. 42% of caregivers gave no report on psychological concerns for patients and the majority failed to recognise drivers of psychological distress outside physical symptoms.

This study has implications for the interpretation of caregiver consultations with potential deficits in identifying patients’ psychological distress and accurately describing pain presentations. The results confirm previous research suggesting caregivers perform better at recognising physical symptoms compared to psychological distress of patients. Further studies are required to assess any potential implications for patient care.

Acknowledgment:

This project was supported financially by University College Dublin School of Medicine.

Reference:

• Lobchuk MM, Degner LF. Patients with cancer and next-of-kin response comparability on physical and psychological symptom well-being: trends and measurement issues. Cancer nursing. 2002 Oct 1;25(5):358-74.

Presenting Author: Darragh Devlin

Supervisor: Dr Dorothy Olet Adong

Co-Supervisor: Assoc Prof Patrick Felle

41. A DESCRIPTIVE STUDY OF THE MAIN DISTRESSES AND GOALS OF CARE OF PALLIATIVE CARE PATIENTS AT HOSPICE AFRICA UGANDA

Dowley A¹, Felle P¹, Mwebesa E²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Hospice Africa Uganda, Kampala, Uganda

Palliative care is a holistic and patient-centered process, meaning addressing suffering must involve the whole spectrum of care, encompassing physical, emotional, social and spiritual needs. Due to the varying nature of needs, it is vital the patients’ distresses and goals of care are identified. This allows the palliative care team to direct their priorities and align the care provided with what is important to the patient.

No study of the main distresses and goals of care had previously been carried out at Hospice Africa Uganda (HAU)¹. This study was a retrospective cross-sectional inquiry, focusing on the distresses and goals of care of palliative care patients. Purposive sampling was used to select 50 case records of HAU patients. Data was mined from these case records using a data abstraction tool.

The majority of patients’ distresses (68.52%) and goals of care (78.18%) were classified as physical. Many were pain related, a finding supported by other studies, which show high levels of pain in palliative care patients². Emotional distresses and emotional goals of care were reported more frequently in females and were only reported by cancer patients. While most patients reported physical main distresses, their corresponding goals of care often varied and had a significant proportion of emotional and social types. 92.86% of patients reporting emotional distresses reported corresponding physical goals of care, demonstrating non-alignment between distresses and goals of care.

This study has important implications in informing the approach used by the multi-disciplinary team when faced with patients at end of life.

Acknowledgment:

The author would like to acknowledge funding from University College Dublin School of Medicine

References:

• 1. Hospice Africa Uganda [Internet]. Hospice-africa.org. 2021 [cited 10 August 2021]. Available from: https://www.hospice-africa.org/uganda/

• 2. Herce M, Elmore S, Kalanga N, Keck J, Wroe E, Phiri A et al. Assessing and Responding to Palliative Care Needs in Rural Sub-Saharan Africa: Results from a Model Intervention and Situation Analysis in Malawi. PLoS ONE. 2014;9(10):e110457.

Presenting Author: Anna Dowley

Supervisor: Dr Eddie Mwebesa

42. OUTCOMES FOLLOWING MINIMALLY-INVASIVE VALVE SURGERY: A RETROSPECTIVE SINGLE-CENTER CHART REVIEW TO DETERMINE SAFETY AND DURABILITY

Wu N¹, Cook RC²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada

Minimally-invasive surgery (MIS) is a major clinical advancement that offers distinct advantages over conventional sternotomy (CS). However, the rate of successful valve repair and long-term durability of repair remain controversial. This study reviews the entire 15-year experience with MIS at Vancouver General Hospital (VGH) to identify potential factors associated with improved patient outcomes.

This was a retrospective single-center chart review of 272 patients with valvular heart disease (VHD) who underwent MIS at VGH between March 2006 and April 2021. Operative reports, discharge summaries, and consultations were reviewed to analyze peri-operative and short-term outcomes. Echocardiogram laboratories, cardiologists, and general practitioners were contacted to collect follow-up echocardiogram reports. Outcomes were measured using descriptive statistics.

Overall, a 98.89% successful repair rate (269/272) was obtained, with 1 peri-operative mortality (0.37%), 1 major wound infection (0.37%), and 0 cerebrovascular accidents. Only 2.94% of cases (8/272) required re-exploration for bleeding and 3.68% of cases (10/272) were converted to sternotomy. 41 patients (15.07%) received blood transfusion intra-operatively and only 3 patients (1.10%) had acute renal failure. Mean gradient across valve (2.10 ± 1.10mmHg) was obtained post-operatively. Transesophageal echocardiography revealed systolic anterior motion (SAM) in 5.51% of cases (15/272) post-operatively. At follow-up at least one year post-operatively, 5 patients (3.01%) had severe regurgitation and 10 patients (6.02%) had moderate-to-severe regurgitation.

MIS offers adequate safety, efficacy, and long-term durability for patients with VHD. Peri-operative outcomes are comparable to those of midline sternotomy approaches, with a >95% successful repair rate, <1% risk of major complications, and <1% risk of mortality.

References:

• 1. Hage A, Hage F, Al-Amodi H, Gupta S, Papatheodorou SI, Hawkins R, Ailawadi G, Mittleman MA, Chu MWA. Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A Systematic Review and Meta-Analysis. Innovations (Phila). 2021 Mar 30:15569845211000332. doi: 10.1177/15569845211000332. Epub ahead of print. PMID: 33781118.

• 2. Cetinkaya A, Geier A, Bramlage K, Hein S, Bramlage P, Schönburg M, Choi YH, Richter M. Long-term results after mitral valve surgery using minimally invasive versus sternotomy approach: a propensity matched comparison of a large single-center series. BMC Cardiovasc Disord. 2021 Jun 26;21(1):314. doi: 10.1186/s12872-021-02121-3. PMID: 34174818; PMCID: PMC8236182

Presenting Author: Neil Wu

Supervisor: Dr Richard Cook

43. TARGETING MUTANT P53 FOR THE TREATMENT OF TRIPLE NEGATIVE BREAST CANCER: A PRE-CLINICAL STUDY

Lawless A¹, O’Grady S², Tang M², Duffy MJ ^{2, 3}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

³UCD Clinical Research Centre, St. Vincent’s University Hospital, Dublin, Ireland

Triple negative breast cancer (TNBC) refers to an invasive subset of breast cancer, that lacks oestrogen receptors (ER), progesterone receptors (PR) and lacks amplification of HER2 (1). Thus, these patients cannot be treated with a targeted therapy and have poorer outcomes compared to patients with other subforms of breast cancer.

p53 it is the most frequently mutated gene in human cancer. Approximately 80% of patients with TNBC carry a p53 mutation. Recently, arsenic trioxide (ATO) was found to reactive mutant p53 and convert it back to its normal wild-type form (2). The aim of this research was to test if ATO might be a new treatment for TNBC. The ability of ATO to inhibit cell proliferation was determined using MTT assays while induction of apoptosis was measured using flow cytometry.

IC₅₀ values for growth inhibition across 10 breast cancer cell lines ranged from 0.297-2.99μM. Inhibition of proliferation was found to be independent of the cell line molecular subtype. No significant differences were found between IC₅₀ values for TN vs non-TN cell lines (p=0.597) or between contact vs structural p53 mutants (p=0.481). For all cell lines investigated, ATO induced significant levels of apoptosis at a concentration of 5μM.

Although our data are preliminary, we conclude that ATO is a potential new therapy for the treatment of p53 mutated cancer, including triple negative breast cancer. Since ATO is already approved for the treatment of acute promyelocytic leukaemia (APL), it should be straightforward to repurpose it for TNBC.

References:

• 1. Duffy MJ, Synnott NC, Crown J. Mutant p53 in breast cancer: potential as a therapeutic target and biomarker. Breast cancer research and treatment. 2018;170(2):213-9.

• 2. Chen S, Wu J-L, Liang Y, Tang Y-G, Song H-X, Wu L-L, et al. Arsenic Trioxide Rescues Structural p53 Mutations through a Cryptic Allosteric Site. Cancer cell. 2021;39(2):225-39.e8.

Presenting Author: Anna Lawless

Supervisor: Prof Michael Joe Duffy

Co-Supervisor: Dr Shane O’Grady and Dr Minhong Tang

44. THE DESIGN OF AN “IRISH VETERINARY BEHAVIOUR COMMUNITY” YOUTUBE CHANNEL TO COMMUNICATE BEST PRACTICE APPROACHES TO COMMON ANIMAL TRAINING AND BEHAVIOUR QUERIES

Szumlanska, N¹, Nicholson, S¹

¹UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Research has demonstrated that Irish veterinary professionals lack confidence¹ and/or agree with inappropriate advice on animal training and behaviour problems². Unfortunately, inappropriate behavioural advice may negatively affect animal welfare and contribute to the development of more serious behavioural issues. However, online tools, such as YouTube, could be harnessed to showcase “best practice” animal training approaches and provide “information prescriptions” to clients.

This research aimed to create an “Irish Veterinary Behaviour Community” YouTube channel to demonstrate ethical approaches to pet training and behaviour challenges. The literature was consulted to identify the animal training queries most encountered by Irish veterinary professionals. The “Irish Veterinary Behaviour Community” YouTube channel was established, and a YouTube search was performed to source videos advising on these issues. Videos were assessed against predetermined inclusion criteria, including the use of ethical training methods, presence of positive emotions in animal(s), conciseness and simplicity, and the reliability of the creator. Selected videos were organised into two channel playlists; “Basic behaviour/training issues in cats” and “Basic behaviour/training issues in dogs.”

Forty-nine videos were sourced (32 on dogs and 17 on cats). Twenty-five percent of canine videos (8 videos) and 23.5% of feline videos (4 videos) were selected for inclusion in the channel. The canine videos featured toilet training, unruly behaviour, unwanted/excessive vocalisation, and recall. The feline videos featured destructive behaviour and house soiling/spraying.

The “Irish Veterinary Behaviour Community” YouTube channel will now support veterinary professionals in improving animal behaviour. It may be further developed over time using feedback from its subscribers.

References:

• 1. Golden O, Hanlon, AJ. Towards the development of day one competencies in veterinary behaviour medicine: survey of veterinary professionals experience in companion animal practice in Ireland. Irish Veterinary Journal. 2018, vol. 71(1); 1-9.

• 2. Shalvey E, McCorry M, Hanlon, A. Exploring the understanding of best practice approaches to common dog behaviour problems by veterinary professionals in Ireland. Irish Veterinary Journal. 2019, vol. 72(1); 1-16.

Presenting Author: Natalia Szumlanska

Supervisor: Dr Sandra Nicholson

45. THE ROLE OF FERM DOMAIN PROTEINS IN DIABETIC KIDNEY DISEASE

Dwyer I¹, Andrews D²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

FRMD3 encodes a FERM domain-containing protein. While little is known about the biological function of FRMD3 in the context of the kidney, polymorphisms in this gene have been identified in genome-wide association studies as being associated with the development of diabetic kidney disease¹. Additionally, the expression of FRMD3 in renal biopsy material from patients with kidney disease has been studied and we have found that loss of FRMD3 expression correlates with tubulointerstitial fibrosis and disease severity, suggesting that FRMD3 may play a protective role in the kidney. TGF-β1 is a key driver of fibrosis, an important feature of diabetic kidney disease and many other chronic, unresolved inflammatory conditions. We wanted to determine if loss of FRMD3 enhanced fibrosis in a cell culture model of TGF-β1 induced fibrosis.

Human renal tubular epithelial cells (HK-2 cells) were transfected with siRNA against FRMD3 or a scrambled control, then treated with TGFβ or a vehicle control. The cells were lysed and RNA and protein were extracted for analysis by qPCR and Western blot. Successful FRMD3 knock-down was confirmed by qPCR. The expression of epithelial (E-cadherin) and mesenchymal makers (N-cadherin, CTGF) was determined by Western blotting and quantified by densitometry.

TGF-β1 induced the expression of mesenchymal markers and reduced the expression of epithelial markers. Loss of FRDM3 amplified TGF-β1-induced N-cadherin, suggesting that of FRMD3 renders HK-2 cells more vulnerable to epithelial to mesenchymal transition and fibrosis.

These results suggest that FRMD3 may be a novel therapeutic target for the treatment of renal fibrosis.

Reference:

• 1. Pezzolesi M, Poznik G, Mychaleckyj J, Paterson A, Barati M, Klein J et al. Genome-Wide Association Scan for Diabetic Nephropathy Susceptibility Genes in Type 1 Diabetes. Diabetes [Internet]. 2009 [cited 30 July 2021];58(6):1403-1410. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682673/

Presenting Author: Isabel Dwyer

Supervisor: Dr Darrell Andrews

46. FRMD3 AND ITS ROLE AS A REGULATOR OF TGF-Β1-INDUCED RENAL FIBROSIS

Ryan K¹, Dwyer I¹, Andrews D^{1, 2}, Godson C^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Diabetes Complications Research Centre, UCD School of Medicine, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

Diabetic kidney disease (DKD) is a major health problem and the leading cause of End-Stage Renal Disease (ESRD) worldwide. ¹ However, much remains unknown about the underlying genes and gene networks which may drive the progression of the disease. Work from our lab and others indicates loss of expression of the gene FRMD3 correlates with tubulointerstitial fibrosis and disease severity in human kidney biopsy’s. ² This suggests that FRMD3 may play a protective role in the kidney however little is known about this gene. TGF-β1 and its downstream signalling pathways are key drivers of renal fibrosis. We hypothesise that FRMD3 may exert its protective role by modifying responses to TGF-β1 signalling. This study aimed to investigate FRMD3 in a cell culture model of renal fibrosis.

FRMD3 was knocked down by targeted transfection using siRNA in renal proximal tubule cells (HK-2). Control cells were transfected with scrambled siRNA. Additional controls included wild type un-transfected cells. The cells were subsequently treated with TGF-β1 or vehicle [control] for 10, 30, 60 min or 24hrs. FRMD3 knock down was confirmed by qPCR and TGF-β1 canonical (CS) and non-canonical signalling (NCS) pathway protein markers were analysed by Western blotting. FRMD3 did not affect canonical Smad2 signalling while preliminary data indicates that FRMD3 knockdown may affect non-canonical pathways (ERK, AKT and p38) however further investigation is warranted.

Further research into FRMD3 and its effect on NCS pathways downstream of TGF- β1 may aid the development of new therapeutic strategies for DKD.

References:

• 1. Alicic R, Rooney M, Tuttle K. Diabetic Kidney Disease. Clinical Journal of the American Society of Nephrology [Internet]. 2017 [cited 5 August 2021];12(12):2032-2045. Available from: https://cjasn.asnjournals.org/content/12/12/2032

• 2. Martini S, Nair V, Patel S, Eichinger F, Nelson R, Weil E et al. From Single Nucleotide Polymorphism to Transcriptional Mechanism: A Model for FRMD3 in Diabetic Nephropathy. Diabetes [Internet]. 2013 [cited 5 August 2021];62(7):2605-2612. Available from: https://diabetes.diabetesjournals.org/content/62/7/2605.full-text.pdf

Presenting Author: Kate Ryan

Supervisor: Prof Catherine Godson

Co-Supervisor: Dr Darrell Andrews

47. COMPARING INFECTIOUS MORBIDITY BETWEEN ADMINISTRATION OF CEFAZOLIN BEFORE SKIN INCISION AND AFTER UMBILICAL CORD CLAMPING DURING ELECTIVE CAESAREAN SECTION

Peerakittikul P¹, Siriphakpinyo P²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Ministry of Public Health, Krathumbaen Hospital, Samut Sakhon, Thailand

Caesarean section is a common surgical procedure used to safely deliver a baby through incisions in the abdomen and uterus [1]. It is acknowledged and widely accepted that administering antibiotics to women undergoing caesarean section helps prevent infection [2]. Cefazolin is deem as an effective antibiotic in several clinical studies, when given as a prophylactic it substantially reduce the risk of infection, and its full benefit can be achieved with a single dosage [2].

The aim of this study was to assess the differences in maternal infectious morbidity when cefazolin is administered prior to skin incision versus after clamping the umbilical cord. Infectious morbidity includes febrile morbidity, surgical site infection, endometritis and urinary tract infection.

92 women who visited Krathumbaen Hospital for antenatal care at 37 weeks of pregnancy were enrolled and a prospective double-blinded randomised controlled trial was undertaken. The participants were randomly divided into two equal groups and guided to operating rooms after their caesarean section appointment, where a nurse anaesthetist assigned a time to administered Cefazolin, either prior to skin incision or after cord clamping.

Findings revealed that 9 (19.57 percent) of the participants experienced febrile morbidity when cefazolin was injected prior to skin incision, while 10 (21.74 percent) of the participants suffered from febrile morbidity when cefazolin was administered after clamping the umbilical cord. Neither group had any postoperative surgical site infection, endometritis or urinary tract infection. Following analysis, no substantial variance was found in the time of cefazolin administration in the reduction of maternal infectious morbidity among elective caesarean section patients. Chi-Square = .945, P = .476.

References:

• 1. Elkomy M, Sultan P, Drover D, et al. Pharmacokinetics of Prophylactic Cefazolin in Parturients Undergoing Cesarean Delivery. Antimicrob Agents Chemother. 2014;58(6):3504-13

• 2. Hema K, Johanson R. Techniques for performing caesarean section. Best Pract Res Clin Obstet Gynaecol. 2001;15(1):17-47

Presenting Author: Panyasiri Peerakittikul

Supervisor: Dr Pairoj Siriphakpinyo

48. THE IMPACT OF BASELINE SERUM BIOMARKERS ON CHANGES IN HEMOGLOBIN A1C POST-BARIATRIC SURGERY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Jeyarajan AJ^1,2, Sarowar A², Dash S³, Patel K²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Divsion of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada

³Division of Endocrinology, University Health Network, Toronto, Ontario, Canada

Central obesity is strongly associated with type 2 diabetes mellitus (T2DM) mediated by peripheral insulin resistance and a chronic inflammatory state. Bariatric surgery for weight loss improves glycemic control in obese T2DM patients; however long-term remission rates are low. Our aim was to analyze baseline serum biomarkers that predict hemoglobin A1c (HbA1c) response to bariatric surgery.

This single-center retrospective cohort study evaluated clinical data at yearly intervals for up to five years on 147 patients with T2DM undergoing bariatric surgery from 2010-2020. Linear mixed models were used to assess the evolution of HbA1c over time and the effects of various baseline clinical and inflammatory marker variables.

The median follow-up time was 2 years (IQR:1–4 years). At one-year follow-up, 63.2% (43/68) of those with preoperative HbA1c ≥7% achieved HbA1c normalization. The rate of log₁₀-HbA1c decline was significantly greater in patients with baseline HbA1c ≥7% than in patients with HbA1c <7% (p=0.009). Furthermore, prior insulin therapy and increased preoperative log₁₀-neutrophil-to-lymphocyte ratios (NLR) were significantly associated with higher log₁₀-HbA1c levels over the five-year period. In contrast, patients with baseline alanine aminotransferase (ALT) levels >25 U/L were more likely to have lower log₁₀-HbA1c levels during follow-up compared to those with ALT ≤25 U/L (b=-0.02 [-0.03 – 0.00], p=0.048). Significant correlation was observed between log₁₀-ALT and log₁₀-HbA1c over time (r=0.31 [0.17–0.43], p<0.001).

Obese T2DM patients with higher baseline HbA1c levels experience a more rapid decline in HbA1c with bariatric surgery. Insulin-requiring T2DM and baseline NLR and ALT may affect HbA1c levels post-bariatric surgery.

Table 1. Results from linear mixed model.

Variable	Estimate	CI	P value
(Intercept)	0.76	0.74 – 0.78	<0.001*
Time	-0.01	-0.02 – 0.00	0.071
Baseline HbA1c group
HbA1c < 7%	Reference
HbA1c ≥7%	0.10	0.08 – 0.12	<0.001*
Baseline log NLR	0.05	0.01 – 0.09	0.026*
Baseline insulin
No	Reference
Yes	0.04	0.02 – 0.06	<0.001*
Time*HbA1c group
HbA1c < 7%	Reference
HbA1c ≥7%	-0.02	-0.04 – -0.01	0.009

*Statistically significant at p < 0.05.

Presenting Author: Andre Jeyarajan

Supervisor: Dr Keyur Patel

49. INVESTIGATION OF PHYSICIAN MENTAL HEALTH AND BURNOUT IN UNDER-RESOURCED SETTINGS: A CASE STUDY OF MERU DISTRICT HOSPITAL - TENGERU, ARUSHA, TANZANIA

Picard R¹, Nogi P²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Meru District Hospital, Arusha, Tanzania

Burnout is recognised in the West as a health concern with devastating impacts on providers and their patients [1]. However, burnout is less studied in the developing world and low-resource settings [2]. The purpose of this study was to determine the effect that such settings have on physician burnout.

The research was designed to utilise a questionnaire to determine the impact of low-resource settings on burnout. However, many issues arose, including a profound discomfort in sharing negative feelings surrounding work. Additionally, a new chief of medicine was being selected, adding feelings of job insecurity. Consequently, questionnaires were often returned incomplete. As a result, data was gathered through longer form dialogues with the hope of better guiding future research.

Although the study was less regimented than anticipated, valuable insight was obtained. The physicians never said “burnout,” and they rarely discussed their feelings. However, most stayed home from work at least once every two weeks, citing “severe tiredness.” Others denied exhaustion, but simultaneously displayed low empathy and high irritability attributed to overwork. These symptoms may be considered indicative of burnout [2].

This research indicates that physicians need to be given language and support to adequately describe burnout. The researchers suspect that the lack of mental health care in Tanzania, with 0.6 psychiatrists and 0.01 psychologists per 100,000 people, played a role. These findings strongly suggest that mental healthcare must become a priority of the Tanzanian health system before physician mental health can be more fully acknowledged or addressed.

Acknowledgment:

The author would like to acknowledge funding from The Hospital Saturday Fund.

References:

• 1. Sibeoni J, Bellon-Champel L, Mousty A, Manolios E, Verneuil L, Revah-Levy A. Physicians’ Perspectives About Burnout: a Systematic Review and Metasynthesis. J GEN INTERN MED. 2019 Aug;34(8):1578–90.

• 2. Mackanga J-R, Mouendou Mouloungui EG, Iba-ba J, Pottier P, Moussavou Kombila J-B, Boguikouma J-B. Burnout level and associated factors in a sub-Saharan African medical setting: prospective cross-sectional survey. BMC Med Educ. 2020 Dec;20(1):295.

Presenting Author: Rachel Picard

Supervisor: Dr Pearl Nogi

50. ASSESSING THE IMPACT OF DIGITAL HEALTH ON TRANSFORMING HEALTHCARE SERVICES DURING COVID-19

O’Neill T¹, McQuaid L²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Health Information and Standards, Health Information and Quality Standards (HIQA), Dublin 7, Ireland

COVID-19 has changed how healthcare will deliver services. Faced with a shortage of medical staff and appropriate infrastructure, health services face an enormous challenge in managing COVID-19 patients while continuing to care for patients with other pathologies. The development of robust health information systems and digital health solutions is essential in the provision of healthcare services across Ireland now and in the future (1). The purpose of this report is to collate information from articles, government publications and grey literature in order to assess the impact of digital health on transforming healthcare services during COVID-19 internationally and to compare these interventions to the Irish digital health experience.

A comprehensive search was undertaken using PubMed and Google Scholar (2019-present). The review covers three countries; Ireland, Scotland and Denmark. These countries were chosen as they have a similar population and demographics to Ireland.

Health services and government agencies implemented digital health solutions in order to allow both routine care to continue and COVID-19 testing, tracing and treatment to be optimised. Digital health solutions include; electronic prescribing, electronic referrals, electronic health records, individual health identifiers, telemedicine and mobile applications. These innovations strengthened the Irish, Danish and Scottish response to the COVID-19 pandemic.

This study highlights the importance of robust digital health systems during a time of emergency. The COVID-19 pandemic acted as a catalyst for the rapid introduction of digital health solutions in Ireland. The high uptake of these technologies shows the appetite for such digital technologies in health systems across the globe.

Reference:

• 1. ESRI. Developments in healthcare information systems in Ireland and internationally [Internet]. Dublin: ESRI; 2021. Available from: https://www.esri.ie/publications/developments-in-healthcare-information-systems-in-ireland-and-internationally

Presenting Author: Teresa O’Neill

Supervisor: Dr Louise McQuaid

51. THE PREVALENCE OF BOWEL MORBIDITY IN PATIENTS RECEIVING OPIOID TREATMENT FOR CHRONIC PAIN AT HOSPICE AFRICA UGANDA

KL Moloney¹, KA Kamru², P Felle¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Hospice Africa Uganda, Kampala, Uganda

Bowel morbidity among patients undergoing opioid treatment has been widely examined throughout the literature. Its prevalence is demonstrated in many and varied settings. Opioid induced bowel dysfunction is characterised by diverse gastrointestinal symptoms, with opioid induced constipation being the most common symptom(1). However, there is limited research on the prevalence of this issue among African cohorts, as well as its prevalence in palliative care settings, such as Hospice Africa Uganda. Therefore, the purpose of this study was to explore the prevalence of this issue in an African palliative care setting, in order to extend current knowledge into this area.

In this cross-sectional study, random sampling was used to select 60 patients’ case notes from Hospice Africa Uganda’s database, with 27 patients receiving treatment with oral liquid morphine, and 33 being treated with non-opioid analgesics or no analgesia. Patient reports of constipation, nausea and vomiting, and abdominal pain were recorded.

Patient reports of constipation, nausea and vomiting, and abdominal pain.

	Constipation	Nausea and Vomiting	Abdominal Pain
Opioid (27)	81.48%	22.22%	29.63%
Non-opioid (33)	30.30%	12.12%	18.18%

The results were as shown in the table above. Statistical analysis showed that the prevalence of constipation was significantly higher in patients receiving opioid treatment than those not, with a p-value of <0.0001. Data for nausea and vomiting and abdominal pain did not meet the conditions for inference for performing hypothesis tests due to the low number of cases, however both were more prevalent in those receiving opioids in this study.

In conclusion, levels of bowel morbidity are significantly higher in patients being treated with opioids in Hospice Africa Uganda. Rates of constipation are particularly high, which is consistent with findings of other studies on opioid induced bowel dysfunction.

Acknowledgment:

Funding of €1000 received from UCD School of Medicine Dean’s Scholarship

Reference:

• 1. Ducrotté P, Milce J, Soufflet C, Fabry C. Prevalence and clinical features of opioid-induced constipation in the general population: A French study of 15,000 individuals. United Eur Gastroenterol J. 2017 Jun;5(4):588–600.

Presenting Author: Karl Moloney

Supervisor: Dr Eddie Mwebesa

52. A STUDY DESCRIBING THE CIRCUMSTANCES AROUND END OF LIFE OF PATIENTS RECEIVING PALLIATIVE CARE AT HOSPICE AFRICA UGANDA

McCann T¹, Felle P¹, Birungi AD²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Hospice Africa Uganda, Kampala, Uganda

Knowledge of the circumstances around end of life is important for the delivery of quality palliative care. However, these circumstances had not previously been analysed in respect of patients at Hospice Africa Uganda. The aim of this retrospective cross-sectional study was to describe the circumstances around end of life of patients who received palliative care at Hospice Africa Uganda.

Random sampling was used to select patient case sheets and notes from bereavement counselling relating to 50 patients who reached end of life between July 2018 and June 2019 and whose families received bereavement care from the Hospice Africa Uganda palliative care team. A data abstraction tool was used to extract data points. The data obtained was analysed using descriptive statistics.

We found that 66% of referrals were solely for pain and symptom control. 86% of patients described the contribution of religion and spirituality to their situation in a positive light. 88% of patients stated that prayer helps. Pain control at end of life was achieved for 66% of patients. 60% of patients died in peace.

Our findings emphasise that pain and symptom control is key to the quality of life of patients receiving palliative care and provide evidence for the benefits of the holistic approach to palliative care provided by Hospice Africa Uganda. Our findings also demonstrate how the work of Hospice Africa Uganda concurs with the goal of palliative care as defined by the World Health Organisation, which is to improve quality of life for patients with life-threatening illness.

Acknowledgement:

The author would like to acknowledge funding from the School of Medicine at University College Dublin awarded via the Dean’s SSRA International Research Scholarship scheme.

Presenting Author: Thérèse McCann

Supervisor: Dr Agasha Doreen Birungi

Co-Supervisor: Assoc Prof Patrick Felle

53. COCKLES, VACCINES, BIOTERRORISM - THE TURBULENT DEVELOPMENT OF TYPHOID CONTROL IN 20TH CENTURY IRELAND (1900-1939)

Joy E¹, Kirchhelle C²

UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Typhoid is a bacterial infection caused by the gram-negative pathogen Salmonella enterica serovar Typhi. Historically, Typhoid fever plagued populations indiscriminately for centuries, but with the implementation of public health and sanitation measures at the turn of the 20^th century, it is now only pervasive in low-income developing countries. Typhoid in Ireland is associated with overseas travel, but disease surveillance is essential to avoid the emergence of drug-resistant S. Typhi strains².

This project, in conjunction with UCD’s School of History, comprises of a series of blog posts exploring Ireland’s ongoing relationship with typhoid and public health, amongst the imperial and revolutionary politics of 20^th century Dublin. Research into historical disease data, medical literature, and newspaper articles of the period will examine implementation of British bacteriology and sanitary infrastructure, and chronicle typhoid outbreaks throughout the 20^th century, amidst an Ireland in upheaval and strife.

Targeted areas of study include an analysis of the ethics and results of the domestic typhoid vaccine rollout in an Irish asylum by immunologist Sir Almroth Edward Wright (1861-1947) and the 1920 ‘typhoid plot’, an intercepted letter detailing a bioterrorist attack by Irish rebels, infecting the milk supply of British troops with typhoid. The blog post series will also educate audiences on equitable access to sanitation and vaccines, through the international typhoidland exhibition.

Acknowledgements:

The author would like to acknowledge the mentorship, time and guidance given by Dr Claas Kirchhelle, UCD School of History.

References:

• 1. Hardy A. Salmonella infections, networks of knowledge, and public health in Britain 1880–1975. Oxford: Oxford University Press, 2015.

• 2. Muresu N, Sotgiu G, Are BM, et al. Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature. Int J Environ Res Public Health. 2020;17(2):615.

Presenting Author: Elaine Joy

Supervisor: Dr Claas Kirchhelle

54. DESCRIPTIVE CROSS-SECTIONAL STUDY INVESTIGATING INCIDENCE AND TYPES OF RESTRICTIVE PRACTICES USED IN NURSING HOMES IN IRELAND

Durkan C¹, Dunbar P², O’Connor L²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, Ireland

Restrictive practice (RP), “the intentional restriction of a person’s voluntary movement/behaviour”[1], is controversial in health and social care. Designated Centres for Older Persons (DCOPs) in Ireland, commonly referred to as nursing homes, submit quarterly notifications of RP use to the Health Information and Quality Authority. This study aims to investigate the incidence and types of RP used in DCOPs in Ireland.

The Database of Statutory Notifications from Social Care in Ireland was analysed for this cross-sectional study. 2,059 notifications were received during the reporting period (01/11/2019 to 31/10/2020). These were disaggregated to describe individual occasions of RP use. Incidence per 1000 beds was calculated using 2020 registered bed numbers (n=32,091). The frequency and percentage contribution of individual restraint types were also calculated.

After coding, 69,462 individual occasions of RP use were identified (Table 1). 550 of 573 DCOPs (96%) reported RP use. Door locks (an environmental restraint) and bedrails (a physical restraint) accounted for 41.5% and 23.7% of overall RP use respectively. The most frequently specified chemical restraint used was antipsychotics (7.4% of chemical restraints). Privacy restrictions contributed to 32.5% of other restraints.

This is the first descriptive study of the incidence and types of RP used in Irish DCOPs. Current regulations require RP to be used as a last resort. Thus, the results of this study can serve to measure future progress in reducing the frequency of RP use nationally, and as a benchmark for quality improvement initiatives.

Table 1: RP use from 01/11/2019 to 31/10/2020 amongst 32,091 residents.

RP Category	Frequency of RP use	Mean Quarterly Incidence/1000 beds (mean±SD)
Physical	25,863	201.5±20.9
Environmental	37,291	290.5±21.2
Chemical	3,970	30.9±2.4
Other	2,338	18.2±7.9
All Categories	69,462	541.1±39.3

References:

• 1. Regulation Directorate, HIQA. Guidance on promoting a care environment that is free from restrictive practice. 2019, Cork: Health Information and Quality Authority, pp.1-4.

Presenting Author: Ciara Durkan

Supervisor: Dr Laura O’Connor

Co-Supervisor: Paul Dunbar

55. DEVELOPMENT OF THE ‘ON FEIRM GROUND’ TRAINING PROGRAMME THROUGH USING CO-PRODUCTION METHODS

McAteer L¹, Richardson N²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Institute of Technology Carlow, Ireland

The incidence of cardiovascular disease, cancers and mental health illness is higher among farmers than any other occupational group in Ireland¹. Farmers have long been considered to be a ‘hard-to-reach’ group for healthcare practitioners¹.

Following an extensive consultation process the “On Feirm Ground” Training programme has been developed to equip agricultural advisors with the competencies to understand the factors that contribute to farmers’ health, to recognise a farmer in distress and to signpost farmers to appropriate healthcare services. Agricultural advisors are in a unique position to support farmers’ health and direct them to healthcare professionals as required. The pilot delivery of the programme, in June 2021, was delivered by the Men’s Development Network and the Men’s Health Institute at IT Carlow to a group of 24 agricultural advisors and private agricultural consultants.

Following the initial delivery of the programme, the 24 participants provided feedback on the programme’s content. Key findings of the co-production element of the programme include the resistance of advisors to take on the suggested role title of ‘health connector’. It highlighted a lack of understanding among health care professionals of the unique challenges and pressures of farming. Participants suggested that more could be done to ‘mind the minder’ by developing supports for advisors and consultants that come across a farmer in distress.

The findings from the co-production element of the programme development will provide guidance for changes to be made to the programme prior to mainstream delivery to ensure that it is fit for purpose.

Reference:

• 1. Hammersley C., Richardson N., Carroll P., McNamara J., Meredith D. ‘On Feirm Ground’: Interim Report Executive Summary. 2020.

Presenting Author: Laura McAteer

Supervisor: Dr Noel Richardson

56. INVESTIGATION OF THE EDUCATIONAL NEEDS OF PEOPLE WITH A NEW DIAGNOSIS OF CFTR-RELATED DISEASE

Goltsis O¹, Griffin K², Tullis E²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²St. Michaels Hospital, Toronto, ON, Canada

The CFTR gene encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Malformation and/or dysregulation of this protein as a result of CFTR gene mutations can lead to a broad range of clinical consequences. Individuals who present with clinical concerns associated with CFTR dysfunction, but do not fulfil the diagnostic criteria for Cystic Fibrosis are identified as having CFTR-Related Disease¹. This condition is poorly understood by the general population due to its variable clinical presentation, late age of onset and quality of educational resources – limited in their number, content and readability. In an effort to address this knowledge gap this study investigated the educational needs of people with a new diagnosis of CFTR-Related Disease to develop patient-centered health educational material.

Semi-structured interviews were conducted with consenting CFTR-Related Disease patients referred to the Adult Query Cystic Fibrosis clinic at St. Michael’s Hospital in Toronto, Canada in the last 5 years.

Quantitative analysis revealed four common themes at the time of diagnosis. These included an understanding of the implications for family members, normalcy of presentation in adulthood, risk of developing Cystic Fibrosis and expected quality of life. A proportion of patients also addressed concerns regarding the length of time it took to receive a referral to the Cystic Fibrosis clinic.

These findings substantially improved our ability to develop meaningful and accessible web-based and printed educational materials. It also reinforced the need to educate and strengthen communication with related-specialties.

Reference:

1. Levy H, Farrell PM. New challenges in the diagnosis and management of cystic fibrosis. The Journal of pediatrics. 2015; 166(6):1337-41.

Presenting Author: Olivia Goltsis

Supervisor: Dr Elizabeth Tullis

57. DETECTION AND QUANTIFICATION OF ALPHA GALATOSYLATED N -GLYCANS IN PORCINE NOTOCHORDAL CELL MATRIX AND IMPLANTABLE XENOGENIC COMMERCIAL PRODUCTS

Ng Tung Hing M^1,2, Gunay B³, Joyce K³, Schmitz T⁴, Tryfonidou M⁵, Ito K⁴, Pandit A³ and Saldova R^1,2,3

¹GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland

²UCD School of Medicine, College of Health and Agricultural Science, University College Dublin, Belfield, Dublin 4, Ireland

³CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland, Galway, Ireland

⁴Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

⁵Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands

Porcine notochordal cell-rich nucleus poplosus matrix (NCM) is being developed as a regenerative biomaterial-based treatment for intervertebral disc (IVD) degeneration, a cause of low back pain [1]. Alpha galactose (α-Gal), a glycosylated epitope present in porcine tissue, is immunogenic for humans because they fail to express it due to the inactivation of enzyme α-1,3galactosyltransferase which is essential for the synthesis of α-Gal [2]. Biopharmaceuticals may need to minimise α-Gal content as severe allergic reactions/anaphylactic shocks have been reported in response to the epitope. This project aims to determine α-Gal content in porcine NCM, a component of prospective IVD regeneration devices.

N-glycans on glycoproteins from NCM and decellularised NCM (DGAL) were captured in gel-block, reduced and alkylated, digested by Peptide-N-Glycosidase F, labelled with 2-aminobenzamide, and analysed by hydrophilic interaction ultra-performance liquid chromatography (HILIC-UPLC) and liquid chromatography-mass spectrometry (LC-MS). Exoglycosidase coffee bean α-galactosidase (CBG) was used to identify N-glycans carrying α-gal epitope.

Twenty-four replicates split between undigested and CBG-digested, NCM and DGAL were run on HILIC-UPLC and compared using multivariate statistical analyses with univariate post-hoc analysis. Chromatographic peaks digested with CBG were labelled. Digestion patterns of previously identified α-Gal glycans in these peaks were elucidated and consistently digested glycans were selected. These glycans were cross-compared with LC-MS data. The final list of α-Gal glycans confirmed by CBG-digest and LC-MS was created.

Due to the lack of standardised methodology within the field there is no current α-gal quantification performed on xenografts. HILIC-UPLC/MS method could potentially be used for this purpose.

References:

• 1. de Vries S, Doeselaar MV, Meij B, Tryfonidou M, Ito K. Notochordal Cell Matrix As a Therapeutic Agent for Intervertebral Disc Regeneration. Tissue Eng Part A. 2019;25(11-12):830-41.

• 2. Hilger C, Fischer J, Wolbing F, Biedermann T. Role and Mechanism of Galactose-Alpha-1,3-Galactose in the Elicitation of Delayed Anaphylactic Reactions to Red Meat. Curr Allergy Asthma Rep. 2019;19(1):3.

Presenting Author: Melanie Ng Tung Hing

Supervisor: Dr Radka Fahey Saldova

58. RECONSTRUCTION OF A LARGE-SCALE RAS-EFFECTOR SIGNALLING PATHWAY FOR APPLICATION TO COLON CANCER WITH A FOCUS ON CLASS-SPECIFIC PROTEINS

Gourrege A¹, Kiel C^1,2, Catozzi S²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Systems Biology Ireland, University College Dublin, Belfield, Dublin 4, Ireland

RAS-proteins are a family of small GTP-binding proteins that regulate cytoplasmic signaling networks including cell growth, proliferation and differentiation. There are 4 human RAS proteins (KRAS4A, KRAS4B, NRAS and HRAS) encoded by 3 genes (KRAS, NRAS and HRAS). The RAS genes are amongst the most commonly mutated in human cancers, with KRAS and NRAS mutations bearing significant clinical implications in the development of colorectal carcinomas. However, despite decades of research, the underlying mechanisms of RAS-driven oncogenesis are still poorly understood. This research aimed at creating a virtual cell environment of RAS protein-protein interactions (PPIs) network using the software CellDesigner. The PPIs downstream of 43 RAS effectors (grouped into 12 classes) were collected from SignaLink and the subcellular localisation was obtained from the SysGo database. From these data, a compartmentalised model of a subnetwork of RAS protein interactions, including the class-specific proteins, was created using Celldesigner. The final pathway displayed a significant portion of the proteins located in the cytoplasm and in the nucleus. The three hub proteins SNX27 (Golgi Apparatus), PKI3C2A (Nucleus) and MYO9B (Microfilaments of Actin), showed significantly more interactions than the rest of the dataset and were mainly involved in the regulation of extracellular and cell membrane proteins as well as proteins found within the microtubules, cilia and cell junctions. The modelling and understanding of the RAS signaling pathways remains the first step to undertake the development of targeted oncogenic therapy.

Presenting Author: Alizé Gourrege

Supervisor: Dr Simona Catozzi

59. IMPACT OF PATIENT AND FAMILY INVOLVEMENT IN CHILD HEALTH RESEARCH: A SCOPING REVIEW

Bhalla M¹, Vanderhout S², Van A², Fergusson D², Potter B², Macarthur C³

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Ottawa Hospital Research Institute, Ottawa, ON, Canada

³Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada

There is evidence in the adult health research context that patient involvement in health research - as authentic research partners - increases research quality, relevance, and applicability [1]. The objective of this study was to evaluate the impact of patient and family involvement in child health research on the research project, the research team, and patients and families.

A Scoping Review study design was used. The search strategy and reporting of results followed the Arksey and O’Malley framework [2]. A research librarian assisted with the search strategy and the following databases were searched: MEDLINE, Embase, PsychINFO, CINAHL, and Web of Science. Inclusion and exclusion criteria were determined and a standardized data extraction form was developed.

Of the 13,634 studies identified, 23 studies met the eligibility criteria. Patient engagement occurred through qualitative strategies employing focus groups, interviews, advisory meetings, and written feedback. These strategies were used to facilitate collaboration of young respondents and their families at various levels and at different stages of the research process. Meaningful involvement assisted in the development of study materials, recruitment strategies, data collection measures, and endowed the study with greater relevance. Involvement was demonstrated to improve relationships between researchers and respondents by enriching knowledge of the lived condition, cultivating important networks, facilitating communication, and optimizing the care experience.

Patient and family involvement in child health research appears to enhance the quality and relevance of research. Empirical studies exploring the impact of patient and family involvement, however, are few in number and predominantly qualitative in design.

References:

1. Aubin D, Hebert M, Eurich D. The importance of measuring the impact of patient-oriented research. CMAJ. 2019;191(31):E860–4.

2. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

Presenting Author: Manav Bhalla

Supervisor: Dr Colin Macarthur

60. RETROSPECTIVE ANALYSES OF TRANSCRANIAL MAGNETIC STIMULATION (TMS) OUTCOMES FOR REPETITIVE TMS (rTMS) VERSUS INTERMITTENT THETA BURST STIMULATION (iTBS)

Robbins A¹, Sullivan C², Herman A², Widge A², Nahas Z², Albott S², Wilson S²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Psychiatry & Behavioral Sciences, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States of America

rTMS is a noninvasive form of brain stimulation to treat major depressive disorder (MDD) [1]. iTBS, delivered in a fraction of the time, has evidence as a non-inferior alternative for MDD treatment [2]. A recent study found that depressed veterans with trauma comorbidity had differential outcomes with iTBS compared to rTMS [1]. Our study examined iTBS versus rTMS outcomes in a community sample to help inform the placement of patients into the appropriate protocol.

Retrospective analyses of an outcomes database of adult TMS patients from 2017-2020 was done at the University of Minnesota’s Treatment Resistant Depression Clinic. Outcomes, defined as response and remission rates, were assessed using weekly administered patient self-reported Patient Health Questionnaires (PHQ-9). Chi-square tests were performed. A future study protocol is proposed to further clarify iTBS versus rTMS neurophysiologic differences.

There were no statistically significant differences in response rates (X² (1, N=91) =0.004, p=0.952) or remission rates (X² (1, N=91) =0.402, p=0.526) for MDD patients treated with rTMS versus iTBS. 42.9% of MDD + post-traumatic stress disorder (PTSD) (n=7) patients responded and 14.3% remitted. Among MDD patients (n=84), 39.3% responded and 16.7% remitted. Due to the small sample size, further analyses comparing protocols were not sufficiently powered.

In this community sample, iTBS versus rTMS non-inferiority was supported. This sample was insufficiently powered to replicate the differential findings in iTBS versus rTMS outcomes seen in veterans with trauma comorbidity [1].

References:

• 1. Philip NS, Doherty RA, Faucher C, Aiken E, van ’t Wout-Frank M. Transcranial magnetic stimulation for posttraumatic stress disorder and major depression: Comparing commonly used clinical protocols. J Trauma Stress [Internet]. 2021;(jts.22686). Available from: https://doi.org/10.1002/jts.22686

• 2. Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018;391(10131):1683–92.

Presenting author: Andrea Robbins

Supervisor: Dr Saydra Wilson

61. ARE PLASTIC SURGERY TRAINEES ACCURATE ASSESSORS OF THEIR OWN MICROSURGICAL SKILL?

Carolan D¹, Milling R², Quinlan C², Potter S^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland

Microsurgery is a highly skillful component of Plastic and Reconstructive surgery with a steep learning curve. Due to COVID-19, reduced access to technical courses and hands-on theatre time has created significant challenges in microsurgical education . Trainees must therefore engage in self-education and be adept at accurate self-assessment to overcome this. The aim of this study was to assess the ability of trainees to self-assess technical performance while performing a simulated microvascular anastomosis.

Novice and intermediate Plastic surgery trainees were recruited. All participants performed a simulated microvascular anastomosis using a high fidelity chicken femoral vessel model. Each participant objectively rated their anastomosis using the Anastomosis Lapse Index (ALI)[1]. Each anastomosis was then blindly rated by two expert microsurgeons. Self-scores and expert scores were compared using a Wilcoxon-Signed Rank Test.

Thirteen surgical trainees completed the simulated procedure. Mean time to completion (TTC) was 22.2 minutes (range 14.2-31.9 minutes). Mean ALI self-score was 3.8 (range 3-5) while mean ALI expert score was 5.27 (range 4.5-6). There was a significant difference between ALI self-score and expert score (p=0.001) with expert assessors consistently assigning a higher ALI score to the same anastomosis. There was no significant difference between male and female trainees or between novice and intermediate trainees in relation to TTC or ALI self-score.

These findings suggest that while the ALI is an excellent training tool, surgical trainees tend to overestimate their technical performance. This emphasises the importance of expert feedback to accurately self-assess progress in the early stages of training.

Reference:

• 1. Ghanem, A. M., Al Omran, Y., Shatta, B., Kim, E., & Myers, S. Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training. Journal of reconstructive microsurgery. 2016, 32(3), 233–241.

Presenting Author: David Carolan

Supervisor: Assoc Prof Shirley Potter

62. INVESTIGATING ANTIMICROBIAL RESISTANCE IN ENTEROBACTERIACEAE ISOLATED FROM HOSPITALIZED DOGS IN A REFERRAL VETERINARY HOSPITAL

Lu Jarren YS¹, Pereira do Vale A²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Antimicrobial resistance (AMR) is a cross-sectoral issue threatening both human and animal health worldwide¹. Furthermore, transmission of bacteria between animals and humans may pose a public health risk. This study aimed to characterize carbapenem-resistant and colistin-resistant Enterobacteriaceae isolated from hospitalized dogs in a referral veterinary hospital.

Eighteen faecal samples collected from 16 dogs were aseptically processed and plated onto selective media, including Tryptone Bile X-Glucuronide, SuperPolymyxin^TM, and chromID^® CARBA SMART. Phenotypically different bacterial colonies (n=100) were isolated and stored at -80°C. Further characterization was attempted on 31 isolates (16 E. coli and 15 non-E. coli) using VITEK 2 for antimicrobial susceptibility testing and identification. Polymerase Chain Reaction (PCR) was also performed on 44, 7, and 3 isolates to determine the presence of plasmid-mediated colistin resistance genes (mcr-1, mcr-2), carbapenemase-encoding genes (bla_IMP, bla_VIM, bla_KPC), and extended-spectrum beta-lactamases-encoding genes (bla_CTX-M-1, bla_CTX-M-2, bla_CTX-M-9, bla_CTX-M-8) respectively.

Nine out of 15 non-E. coli isolates were successfully identified by VITEK as Klebsiella pneumoniae (n=3), Morganella morganii (n=1), Serratia marcescens (n=2), and Yersinia kristensenii (n=3). Of the identified isolates investigated, 36.0% were multidrug-resistant (n=9/25), including 6 E. coli and 3 Y. kristensenii. Resistance to critically important antimicrobials outlined by WHO², such as amoxicillin-clavulanic-acid, enrofloxacin, and imipenem were found in 8, 6, and 2 isolates respectively. None of the AMR genes investigated by PCR were detected.

Preliminary findings suggest the absence of carbapenemase-encoding and plasmid-mediated colistin resistance genes in Enterobacteriaceae isolated from dogs. Nevertheless, more animals should be sampled to better investigate AMR in hospitalized companion animals.

Acknowledgement:

The authors would like to acknowledge funding from the School of Veterinary Medicine OIP Research Call. The authors would also like thank Joe Meade, Kevina McGill, Bernadette Leggett, Dr Kevin Murtagh, as well as all clinicians, nurses, and technicians from the UCD Veterinary Hospital for their support during this project.

References:

• 1. T. P. Robinson, D. P. Bu, J. Carrique-Mas, E. M. Fèvre, M. Gilbert, D. Grace, et al. Antibiotic resistance is the quintessential One Health issue. Trans R Soc Trop Med Hyg. 2016; 110:377-380.

• 2. World Health Organization. Critically important antimicrobials for human medicine, 6^th revision. Geneva: World Health Organization; 2019.

Presenting Author: Jarren Lu Yi Sheng

Supervisor: Dr Ana Pereira do Vale

63. ATTITUDES OF HEALTHCARE PROFESSIONALS TO DRAFT NATIONAL LEGISLATION ON ASSISTED HUMAN REPRODUCTION (AHR)

Giblin A^1,2, Schaler L¹, Glover L¹, Wingfield M^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Merrion Fertility Clinic, National Maternity Hospital, Dublin 2, Ireland

Assisted human reproduction (AHR) is one of the most rapidly evolving specialties in medicine(1). AHR legislation is essential to protect the rights of those accessing and providing AHR services. Ireland is one of the only countries in the EU which lacks specific AHR legislation. The General Scheme of an AHR Bill was published in 2017 and reviewed by the Oireachtas Joint Committee on Health in 2018/2019(2). It awaits review by the Houses of the Oireachtas.

The aim of this study is to investigate the attitudes of relevant healthcare professionals (HCPs) towards the draft AHR Bill. A detailed questionnaire was developed based on all clinically relevant aspects of the draft Bill. This was distributed electronically. Ethics approval was obtained.

To date 206 responses have been received and analysed. Over 90% of respondents feel that Ireland should establish a regulatory authority for AHR. More than 90% also support a wide range of AHR treatments including IVF, egg, sperm and embryo freezing, egg and sperm donation and pre-implantation genetic testing. A majority also support surrogacy, embryo research and new technologies. The majority support access to treatment for all, regardless of relationship status or chosen gender. Interestingly, a significant majority disagreed with some of the Bill’s proposals e.g. around surrogacy, age limits and posthumous conception.

These findings support the argument that national legislation on AHR is both needed and desired by HCPs working in Ireland. It is hoped that the results of this study will help inform the proposed national AHR legislation as it nears completion.

References:

• 1. Kamel RM. Assisted Reproductive Technology after the Birth of Louise Brown. J Reprod Infertil. 2013;14(3):96–109.

• 2. Joint Committee on Health. Report on Pre-Legislative Scrutiny of the General Scheme of the Assisted Human Reproduction Bill. Oireachtas.ie 2019

Presenting Author: Amy Giblin

Supervisor: Prof Mary Wingfield

64. VALIDATING THE EFFICACY OF THE EX VIVO HUMAN PLACENTA PERFUSION MODEL IN PREDICTING THE PLACENTAL TRANSFER OF THERAPEUTIC DRUGS IN VIVO: A SYSTEMATIC REVIEW

Privorozky A¹, JR Hutson², F Garcia-Bournissen²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Division of Clinical Pharmacology and Toxicology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

The degree of foetal exposure to maternally administered drugs remains an area of concern due to the potential effects on prenatal health and development.¹ As such, the implementation of a pharmacokinetic tool in preclinical safety assessments of therapeutic drug administration is essential. Currently, ex vivo perfusion of a human placental lobule is the only experimental model that can accurately predict placental transfer of pharmacological agents.² In this study, we aim to further validate the efficacy of the perfusion model, thereby demonstrating its clinical utility.

A search of databases MEDLINE, Embase and Embase Classic was performed to identify human placental perfusion studies from 2010 until May 26^th, 2021. Citations were systematically reviewed for eligibility using Covidence, then relevant in vivo literature was searched for subsequent quantitative comparison. Linear regression was performed using GraphPad to determine the correlation between ex vivo and in vivo placental transfer data.

The database search returned 5066 citations, 47 of which were considered eligible for subsequent data extraction. Of the 47, four perfusion studies (investigating the transfer of three drugs – bupropion, elvitegravir, and dolutegravir) were included in the quantitative analysis. Following adjustment of perfusion transfer data using a pharmacokinetic model to consider maternal/foetal differences in plasma protein binding and pH, a strong correlation between ex vivo and in vivo data was observed (R²=0.7786, P<0.005).

These findings demonstrate the high efficacy of the perfusion model in predicting the placental transfer of pharmacological agents and should be considered a valuable tool in preclinical assessment of pharmacological treatment in pregnancy.

References:

• 1. Dathe K, Schaefer C. The use of medication in pregnancy. Dtsch Arztebl Int. 2019; 116(46):783–790.

• 2. Hutson JR, Garcia-Bournissen F, Davis A, Koren G. The human placental perfusion model: a systematic review and development of a model to predict in vivo transfer of therapeutic drugs. Clin Pharmacol Ther. 2011; 90(1):67-76.

Presenting Author: Al-Elad Privorozky

Supervisor: Dr Janine Hutson

65. EARLY PREGNANCY LOSS IN IRELAND; A SCOPING REVIEW

Murray L¹, Rohde D², Verling AM²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²National Care Experience Program, Health Information and Quality Authority, Smithfield, Dublin 7, Ireland

Early miscarriage, including ectopic pregnancy, molar pregnancy and first trimester miscarriage, is one of the most common complications of early pregnancy¹. Little research on early pregnancy loss has been conducted in Ireland. This study aimed to summarise Irish research published since 2010, focusing on incidence or prevalence of early pregnancy loss, women’s experiences, and public awareness.

A scoping review was conducted. Of 1,042 records identified from database searches, 1,033 were excluded following title, abstract or full text screening, with nine studies included in a narrative synthesis.

Administrative data on early pregnancy loss are not routinely collected or reported in Ireland. Rates for first trimester miscarriage hospitalisations (49.7 per 1,000 deliveries in 2016) and ectopic pregnancy hospitalisations (17.7 per 1,000 deliveries in 2016) do not capture women treated in outpatient or community settings, leading to an underestimate of the true incidence of these losses. Early pregnancy loss is a complex, emotionally distressing event, often compounded by a lack of appropriate hospital facilities and support services, along with disenfranchised grief and fertility concerns. Studies identified limited awareness and knowledge of early pregnancy loss among the general public in Ireland.

This review demonstrates the importance of capturing complete and accurate data on all types of pregnancy loss in Ireland, along with a need to raise public awareness on the incidence, causes and risk factors of early pregnancy loss. To identify, support and understand the care needs of women and couples who experience early pregnancy loss, they must be included in research as experts through their personal experiences.

Reference:

• 1. Health Service Executive, Royal College of Physicians of Ireland. Clinical Practice Guideline: Management of Early Pregnancy Miscarriage. 2014.

Presenting Author: Laura Murray

Supervisor: Dr Daniela Rohde

66. PROFILE OF A SAMPLE OF IRISH GENERAL PRACTICES: A BASELINE FOR CHRONIC DISEASE MANAGEMENT PROGRAMMES

Twomey B¹, Tandan M¹, Twomey L¹, Egan M¹, Bury G¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Structured Chronic Disease Management (CDM) in general practice is a cornerstone of the government’s Sláintecare programme (1). However, little is known about general practice preparedness to deliver such programmes.

200 general practices linked to UCD Academic General Practice were surveyed to evaluate CDM staffing, training, IT systems and access to CDM equipment and specialist services. Barriers to CDM implementation and future expansion of the programme were also explored. The data from the initial 50 responses was extracted using Google Forms and Excel. Statistical analysis was performed using SPSS v27.

49/50 practices joined the HSE CDM programme in 2020. Respondents included urban (n=18), rural (n=8) and mixed (n=23) practices from 19/26 counties. 32% are single-GP practices and 22% have >4 GPs. 96% have a practice nurse (42% part-time only). All use electronic patient records, but disease coding is variable. Practice nursing is central to the programme but both doctor and nurse recruitment (68%) and staffing costs (64%) are seen as barriers to implementation. Although many reported adequate facilities and equipment, infrastructure was seen as a potential future barrier to implementation. Access to specialist services were deemed inadequate across most services, except for retinal screening. Future programme expansion was supported to include obesity (87.8%), osteoporosis (80.8%) and mental health issues (68.7%).

Our study reports high levels of engagement with the CDM programme but identifies staffing, funding and access to specialist supports as key perceived barriers to the programme’s success. Future expansion include to other chronic illnesses is deemed important.

Reference:

• 1. Department of Health, HSE. Terms of Agreement between the Department of Health, the HSE and the IMO regarding GP Contractual Reform and Service Development [Internet]. 2019 p. 4-24. Available from: https://www.hse.ie/eng/about/who/gmscontracts/2019agreement/agreement-2019.pdf

Presenting Author: Bebhinn Twomey

Supervisor: Prof Gerard Bury

67. INVESTIGATING THE INVOLVEMENT OF ENDOPLASMIC RETICULUM (ER) STRESS IN THE COLLAPSE OF HAIR FOLLICLE IMMUNE PRIVILEGE

O’Grady J¹, Jadeja SD², Tobin DJ^{1, 2, 3}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland

³UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

Alopecia Areata (AA) is a non-scarring hair loss disorder characterized by immune privilege (IP) collapse in hair follicles (HF)¹. Endoplasmic reticulum (ER) stress is an accumulation of misfolded proteins in the ER, which is resolved through the unfolded protein response (UPR)². UPR is a feature of both normal cell physiology and, when altered, pathological responses². Abnormal ER stress levels have been implicated in several immune-mediated disorders; however, its role is unclear in the collapse of hair follicle IP in AA².

In this preliminary study, we established an ex vivo model of AA using interferon (IFN)-γ treatment of HFs isolated from healthy human scalp. The HFs were cultured with and without IFN-γ for up to 72 hours, sectioned using a cryostat, and major histocompatibility complex class-I (MHC-I) expression (a proxy for IP collapse) assessed by immunohistochemistry (IHC). Expression of ER stress markers, incl. 78 kDa glucose-regulated protein (GRP78) & C/EBP homologous protein (CHOP) were examined in the HF.

Incubation of HFs with 5U IFN-γ-induced MHC-I expression (i.e., IP collapse), thereby establishing the model. In the IP collapsed HFs GRP78 expression was decreased in the HF bulb region of IFN-γ-treated HFs (site of maximal cell proliferation and differentiation), whereas no significant difference was detected for CHOP expression.

In summary, this preliminary study suggests a possible role for ER stress-induced UPR in the maintenance of HF IP (and so optimal hair growth). While disruption of the UPR may contribute to IP collapse in AA, this will require a more detailed analysis.

References:

• 1. Bertolini M, McElwee K, Gilhar A, Bulfone-Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Experimental Dermatology. 2020;29(8):703-725. Available from: doi:10.1111/exd.14155

• 2. Jadeja SD, Mayatra JM, Vaishnav J, Shukla N, Begum R. A concise review on the role of endoplasmic reticulum stress in the development of autoimmunity in vitiligo pathogenesis. Frontiers in Immunology. 2021;11:3817. Available from: doi:10.3389/fimmu.2020.624566

Presenting Author: James O'Grady

Supervisor: Dr Shahnawaz Jadeja

Co-Supervisor: Prof Desmond Tobin

68. PREVALENCE OF MENTAL ILLNESS IN CHILDREN AND ADOLESCENTS IN THE REPUBLIC OF IRELAND

Lynch S¹, McDonnell T², Leahy D³, Gavin B¹, McNicholas F^1,4,5

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland

³Mercy University Hospital Cork, Cork, Ireland

⁴Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

⁵Children's Health Ireland (CHI) at Temple Street, Dublin 1, Ireland

Mental illness in young people is a growing concern, with an estimated 10-20% of adolescents suffering from mental illness worldwide.¹ In Ireland, referrals to CAMHS (Child and Adolescent Mental Health Services) have increased by 26% in recent years.² These services are already under-resourced leading to long waiting lists. The adverse psychological impact of Covid-19 has disproportionately affected youth and is likely to result in increased demand for CAMHS. Given these circumstances, an understanding of pre-Covid-19 prevalence of mental illness among youth in Ireland is imperative to help inform & plan services.

The aim of this research is to report on prevalence of mental illness in youth (aged 0-18) in Ireland.

A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Studies included youth population health empirical studies conducted in Ireland, focusing on mental illness.

From a total of 624 papers identified, 43 papers were selected by Title/ Abstract selection, and 38 following full paper review. 2 nationally representative studies (Growing Up in Ireland & My World Survey) identified 10-15% to be ‘at risk’ by one-stage screening. A two-stage study (Challenging Times) reported rates of ‘any’ mental health disorder in 15% of adolescents, with other studies reporting on specific disorders.

Although data on mental illness among Irish youth is limited, available data of illness and risk suggest rates similar to international levels. Attention needs to be given post Covid-19 to regular reliable data collection, and dedicated CAMHS funding to allow best use of a scarce resource.

References:

• 1. Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 2007; 6: 168–76

• 2. HSE National Service Plan, 2018, p.35, https://www.hse.ie/eng/services/publications/serviceplans/national-service-plan-2018.pdf

Presenting Author: Sinead Lynch

Supervisor: Dr Daniel Leahy

Co-Supervisor: Prof Fiona McNicholas

Additional Author: Dr Therese McDonnell

Additional Author: Dr Blanaid Gavin

69. AN EVALUATION OF THE PEERS TREATMENT PROGRAMME IN A GROUP OF YOUNG ADULT WOMEN WITH 22Q11.2DS

Carr L¹, Kerin L^2,3, McNicholas F^1,4,5

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Royal College of Surgens Ireland, University of Medicine and Health Sciences, Dublin 2, Ireland

³Love Knowledge Consultancy

⁴Lucena Clinic, Rathgar; Our Lady’s Children’s Hospital, Crumlin, Dublin; UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

⁵Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland

PEERS© is a social skills intervention programme for neurodiverse young adults[1]. This pilot study aims to evaluate the effectiveness of PEERS in a group of young adults with 22q11.2 Deletion Syndrome (22q11.2ds). 22q11.2ds has a complex, varied phenotype, with a prevalence of 1/2,500. Individuals with 22q11.2ds tend to have difficulties with social skills which may result in peer rejection, social isolation and social anxiety, potentially exacerbating mental health difficulties[2].

6 young adult women aged 18-35 with 22q11.2ds and their mothers participated. Outcome was measured by comparing pre and post psychometric questionnaires assessing social skills, loneliness, and social anxiety. Focus groups were run at the end of the programme to gain qualitative feedback.

The programme was generally well received with self- and parental-reported benefits of increased social skills, empathy, social gatherings and decreased social anxiety, loneliness. All participants would recommend the programme to others. All participants improved in at least one protective factor (social skills and social get-togethers) with a resultant improvement in at least one of loneliness, social anxiety, and empathy. Limitations such as sample size and logistical difficulties including the stress of travelling and condensed programme delivery limits the generalisability of potential benefits. Participants’ perception was that PEERS may be more relevant to a younger age-group, however, the data demonstrates that older, higher-functioning participants benefitted more.

This pilot shows the PEERS programme may be beneficial in reducing social anxiety, loneliness and improving social skills and functioning in young adults with 22q11.2ds, however further study is needed in this area.

References:

• 1. Laugeson E, Frankel F. Social skills for teenagers with developmental and autism spectrum disorders: The PEERS Treatment Manual. New York: Routledge; 2010.

• 2. McCormack S, Gadancheva V, Kerin L, Kelleher S, McNicholas F. 22Q11.2 Deletion Syndrome in Ireland: Review of Mental Health needs in children from a newly established clinic. Archives of Disease in Childhood. 2019;104(3):A116.

Presenting Author: Lorna Carr

Supervisor: Ms Lorna Kerin

Co-Supervisor: Prof Fiona McNicholas

70. A STUDY OF THE GENETIC RESPONSE TO METHOTREXATE TREATMENT IN RHEUMATOID ARTHRITIS

Pomeroy L¹, Sheridan K², Wilson G^1,3.

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

³Department of Rheumatology, Mater Misericordiae University Hospital, University College Dublin, Dublin 7, Ireland

Rheumatoid arthritis synovial fibroblasts (RASFs) drive and perpetuate inflammation and destruction within synovial joints of patients with rheumatoid arthritis. Methotrexate is the treatment of choice for rheumatoid arthritis, however, methotrexate elicits no response in 30-40% of patients.¹ Research by Sheridan. K, et al. analysed the genetic changes in RASFs that responded strongly/poorly to methotrexate and highlighted genes that may influence the response of RASFs to methotrexate.²

Our study investigated the impact of SDC1 and MKNK2 knockdown on the phenotypic nature of RASFs. Using siRNA technology, SDC1 and MKNK2 were knocked down separately in three different cell lines of RASFs. Optimal knockdown conditions were identified, and knockdown was confirmed with Western blot. The phenotypic influence of the knockdown in RASFs was investigated using Transwell invasion assays, BrdU proliferation assays and Caspase 3/7 apoptosis assays.

Knockdown of MKNK2 resulted in a statistically significant increase in the invasiveness of RASFs. Knockdown of SDC1 resulted in an increase in invasion, however, the significance of this is undefined. No significant change was found in proliferation or apoptosis in siSDC1/siMKNK2-treated RASFs, indicating that the increase in invasion is due to mechanisms other than these.

Our results indicate that MKNK2 offers a protective role against invasion of RASFs. Alongside unpublished data from Sheridan. K, et al.,² this suggests that methotrexate may be more effective on RASFs that are predisposed to invade more aggressively due to lower basal levels of MKNK2. Further research is needed to conclude the influence of SDC1 on the phenotypic nature of RASFs.

Reference:

• 1. Maciejewski M, Sands C, Nair N, Ling S, Verstappen S, Hyrich K et al. Prediction of response of methotrexate in patients with rheumatoid arthritis using serum lipidomics. Scientific Reports. 2021;11(1).

Presenting Author: Lynne Pomeroy

Supervisor: Dr Kevin Sheridan

71. OCCUPATIONAL STRESS AMONG TEACHERS DURING THE COVID-19 PANDEMIC IN IRELAND

Begley A¹, Minihan E¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

The COVID-19 pandemic has changed education delivery methods, initially changing to online and then to in-person with COVID-19 safety precautions introduced. Teacher occupational stress is related to effects of work conditions on an individual’s emotions [1]. Teachers are found to be more stressed in changing work environments [1].

The purpose of this research was to identify themes present in free-text data collected through an online survey of primary, special primary and second level teachers through thematic analysis. The survey investigated teachers’ experiences of occupational stress and working during the COVID-19 pandemic. The codes and themes were developed to summarise and interpret results of the occupational stress survey.

A semantic approach was used to interpret data from three free-text questions of the survey. Codes were determined from the data by the researchers and interpreted to develop themes that encompassed the responses. Codes and themes were individually formulated and then compared. After comparison, final codes and themes were determined. Approximately five themes were identified for each question. Most themes revealed pertained to intensity of work, factors affecting mental wellbeing, and COVID management.

The themes described teachers’ opinions regarding burnout reduction in their occupation, how to better support teachers to reduce burnout and general experiences working during the COIVD-19 pandemic. The themes were largely negative and critical of the teachers’ governing body. There were some positive responses regarding remote working. This indicates to the majority of teachers feeling undervalued and stressed, potentially loosing professionals in the education sector with a future educator shortage.

Reference:

• 1. Galanakis M, Alexandri E, Kika K, Lelekanou X, Pa-pantonopoulou M, Stougiannou D, et al. What Is the Source of Occupational Stress and Burnout? Psychology. 2020; 11:647-662.

Presenting Author: Aoife Begley

Supervisor: Dr Elisha Minihan

72. MENTAL HEALTH PROMOTION FOR ADOLESCENTS AND YOUNG ADULTS IN THE COMMUNITY: A SCOPING REVIEW ON THE ROLE OF SPORTING ORGANISATIONS

McCormack L¹, Broughan J¹, McCombe G¹, Crowley T¹, O’Reilly A², Roe M³, Hennessy E⁴, Leavey G⁵, Cullen W¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Jigsaw, The National Centre for Youth Mental Health, Ireland

³UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland

⁴UCD School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland

⁵School of Psychology, Ulster University, Northern Ireland

Mental health is a topic that has gained increasing attention in recent years, particularly in the world of sport. Adolescents and young adults form a large proportion of those who participate in sport, and they also represent the age range within which many mental health problems tend to present. However, knowledge regarding the role that sporting organisations can play in terms of promoting these populations’ mental health is lacking. Thus, this study aimed to establish the role that sporting organisation can play in encouraging mental health and wellbeing in adolescents and young adults.

A scoping review was conducted using Arksey and O’Malley’s five-step framework [1] with revisions by Levac et al [2] to assess current literature on the topic. Major databases (PUBMED/MEDLINE, PsycINFO, SPORTDiscus, and the Cochrane Library) were searched using variations of the terms ‘mental health’, ‘promotion’, ‘sport’, ‘adolescent’, and ‘young adult’.

Results revealed numerous common findings across the selected papers. Sports participation was linked to better mental wellbeing, while mental health literacy education and training for sports organisation members (parents, coaches, and peers) was shown to aid the promotion of youth mental health. The findings also highlight calls for further policy and guidelines for sports organisations in relation to mental health promotion.

This study’s findings suggest that sporting organisations can play a vital role in supporting the mental health of young adults and adolescents. More in-depth and rigorous research is required in this area in future.

References:

• 1. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.

• 2. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation science. 2010;5(1):1-9.

Presenting Author: Lauren McCormack

Supervisor: John Broughan

Co-Supervisor: Prof Walter Cullen

73. USE OF TELEMEDICINE IN GENERAL PRACTICE IN EUROPE SINCE THE COVID-19 PANDEMIC: A SCOPING REVIEW OF PATIENT AND PRACTITIONER PERSPECTIVES

Walley D¹, McCombe G¹, Broughan J¹, O’Shea C², Crowley D^1,2, Quinlan D², Wann C³, Cullen W¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Irish College of General Practitioners, Ireland

³Nobber Health Centre, Nobber, Ireland

General practice is generally the first point of contact for patients presenting with COVID-19. Since the start of the COVID-19 pandemic general practitioners across Europe have had to adopt to using telemedicine consultations in order to minimise the number of social contacts made.(1). The aim of this study was to conduct a scoping review of the literature examining the use of telemedicine for delivering routine GP care since the start of the pandemic from the perspectives of patients and practitioners.

We used the six-stage scoping review framework developed by Arksey and O’Malley (2). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

A total of 19 studies across nine countries were included in the review. Thirteen studies explored the practitioner perspective of the use of telemedicine in general practice since the COVID-19 pandemic, while six studies looked at the patient perspective. The types of studies included in this review were: qualitative studies, literature reviews, a systematic review, observational studies, quantitative studies, Critical incident technique study, and surveys employing both closed and open styled questions. Key themes identified related to the patient/ practitioner experience and knowledge of using telemedicine, patient/ practitioner levels of satisfaction, GP collaboration, nature of workload, and suitability of consultations for telemedicine.

Our findings suggest a level of acceptability and satisfaction of telemedicine by GPs and patients during the pandemic; however, further research is warranted in this area.

Acknowledgment:

The author would like to acknowledge funding from the Ad Astra Academy at University College Dublin.

References:

• 1. Brant H, Atherton H, Ziebland S, McKinstry B, Campbell JL, Salisbury C. Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice. British Journal of General Practice. 2016;66(648):e460-e6.

• 2. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.

Presenting Author: David Walley

Supervisor: Dr Geoff McCombe

Co-Supervisor: Professor Walter Cullen

74. PREVALENCE OF LIMB GIRDLE MUSCULAR DYSTROPHY IN THE IRISH POPULATION

Norton M¹, O’ Rourke D^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Central Remedial Clinic, Penny Ansley Building, Vernon Ave, Clontarf, Dublin 3, Ireland

Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of inherited, rare muscular disorders that affect skeletal muscle and present with progressive proximal muscle weakness due to loss of muscle fibers. LGMD can present at multiple stages throughout life and significantly overlap with congenital muscular dystrophies (CMD). Some subtypes of CMD are hypothesized to be over-represented in the Irish population, specifically merosin negative CMD. Despite this, there is no data on the prevalence of CMD in the Irish people. Furthermore, there have been rapid improvements in the genetic identification of multiple gene variants, leading to new molecular therapeutic strategies. The purpose of this research was to (a) describe the prevalence of LGMD in the Irish population and (b) describe the cohort of patients and the phenotypic changes observed.

A retrospective chart audit of patients at the Central Remedial Clinic in Clontarf was completed. Sixteen charts were retrospectively analyzed, focusing on genetic mutations, diagnostic features, clinical observations, and organ systems.

Four different subtypes of CMD were subdivided based on the most recent LGMD classification system. [1] Genetic mutations were identified in 62% of patients (10 cases). The most frequent type of CMD was LGMD R23 LAMA2 (43.75%), followed by LMNA A/C (25%) and LGMD R22 COL6 (25%). Finally, one case (6.25%) of LGMD R4 B-sarcoglycan was present. 42% of LAMA2 cases were from consanguineous relationships in the Irish Traveler Community.

This study aimed to provide current data on CMD observed in the Irish population focusing on genetic variations and phenotypic presentation.

Reference:

• 1. Straub V, Murphy A, Udd B; LGMD workshop study group. 229th ENMC international workshop: Limb girdle muscular dystrophies - Nomenclature and reformed classification Naarden, the Netherlands, 17-19 March 2017. Neuromuscul Disord. 2018 Aug;28(8):702-710. doi: 10.1016/j.nmd.2018.05.007. Epub 2018 May 24. PMID: 30055862

Presenting Author: Meredith Norton

Supervisor: Dr Declan O’Rourke

75. THE RELATIONSHIP BETWEEN MATERNAL BODY COMPOSITION IN EARLY PREGNANCY AND INFANT BODY COMPOSITION

Matuschka V¹, Kennedy RAK^1,2, Mullaney L¹, O’Higgins A¹, Doolan A¹, Turner MJ¹.

¹UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland

²Department of Nutrition and Dietetics, The Mater Misericordiae University Hospital, Dublin, Ireland

This study examined the relationship between maternal body composition in early pregnancy and infant body composition at birth and at four months.

Women were recruited in their first trimester. Weight and body composition were measured using advanced bio-electrical impedance analysis. Routine clinical details were recorded. Infant body composition was measured within three days of delivery and again at 4 months post-partum using a PEA POD® analyser.

Of the women in this study (n=113), the mean age was 30.3± 5.4 years, mean BMI was 26.8 ± 5.9kg/m² and 44.6% of women were nulliparous (n=50/112). Mean birthweight was 3.4 ± 0.6kg. Maternal BMI was associated with neonatal body fat percentage and absolute fat mass at birth (Beta 0.19, SE 0.07, P = 0.007; Beta 0.007, SE 0.003, P = 0.01). Similarly, maternal body fat percentage was associated with neonatal body fat percentage and absolute fat mass at birth (Beta 0.13, SE 0.05, P = 0.01; Beta 0.005, SE 0.002, P = 0.03). These relationships did not persist when repeated with infant body fat percentage and absolute fat mass measurements at four months (P>0.05).

This study found that while there was a relationship between maternal body composition in early pregnancy and infant body composition at birth, this relationship did not persist in the early stages of infancy. Future studies are needed to investigate what lasting influence, if any, maternal body composition has on infant body composition.

Presenting Author: Victoria Grafin von Matuschka

Supervisor: Dr Rachel Kennedy

76. SYSTEMATIC ASSESSMENT OF THE EVIDENCE FOR MEDICAL CANNABIS PRESCRIPTION

Dalueg L¹, O’Neill B^2,3, Mollanji E⁴, Kirubarajam A^5,6, Lloyd T⁶, Persaud N^2,7

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Family and Community Medicine, University of Toronto, Toronto, Canada

³DFCM, North York General Hospital, Toronto, Canada

⁴Faculty of Medicine, University of Ottawa, Ottawa, Canada

⁵Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

⁶Faculty of Medicine, University of Toronto, Toronto, Canada

⁷DFCM, St. Michael’s Hospital, Toronto, Canada

Medical cannabis became legal in Canada in April 2014, through the ‘Marijuana for Medical Purposes’ regulations, and later recreationally in 2018.¹ Since then, there has been a proliferation of physicians prescribing cannabis and public consumption to derive health benefits. Providers are advertising the effectiveness of cannabis that, to our knowledge, is not supported by high-quality evidence.

Internet searches were completed to establish a comprehensive list of all Ontario cannabis clinics. These websites were analyzed to see whether they met the inclusion criteria. Any cannabis claim and supporting studies found on the websites were documented. Data from the studies were independently extracted by two researchers, including indication, type of study, and levels of evidence using the Oxford Levels of Evidence.²

A total of 76 clinics were identified upon initial search, with 29 meeting the inclusion criteria. The most common indications supported were management of pain (83%), anxiety (76%), arthritis (69%), and post-traumatic stress disorder (69%). Only four (14%) of the clinics included potential harms of cannabis intake. A total of 246 studies were cited, with the most studies cited for chronic pain (24 studies), cancer treatment side effects (16 studies), and arthritis (15 studies). The quality of evidence was reported low-to-moderate, with level 1 (3%), level 2 (12%), level 3 (16%), level 4 (25%), level 5 (16%), non-applicable (23%), and could-not-obtain (5%).

These results demonstrate that there is a paucity of high-quality evidence for the effectiveness of medical cannabis, concluding that further research is needed.

References:

• 1. Health Canada. Drug and Health Products. Medical Use of Marijuana. Ottawa, ON: 2014. Available from: http://www.hc-sc.gc.ca/dhp-mps/marihuana/index-eng.php

• 2. OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. Available from: http://www.cebm.net/index.aspx?o=5653.2011

Presenting Author: Lauren Dalueg

Supervisor: Dr Braden O’Neill

77. DURATION OF STEROID THERAPY AND TEMPORAL ARTERY BIOPSY POSITIVITY IN GIANT CELL ARTERITIS: A RETROSPECTIVE COHORT STUDY

Majerovich K¹, Junek M², Khalidi N², Garner S²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Rheumatology, McMaster University, Ontario, Canada

Temporal artery biopsy (TAB) is an important investigational tool in the diagnosis of giant cell arteritis (GCA). It is recommended to complete a TAB within 14 days of glucocorticoid initiation; however, data are conflicted as to how long biopsies remain positive.¹ We aimed to investigate how duration of glucocorticoid exposure affected TAB positivity in a cohort of patients with suspected GCA.

Data were extracted, including demographics, investigations, and final diagnosis, from the longitudinal McMaster GCA Database (n=52), and individuals enrolled in a trial evaluating imaging in the diagnosis of GCA (n=171).² Individuals were stratified by duration of glucocorticoid pre-treatment by weeks of therapy. Descriptive statistics were performed and the impact of the duration of glucocorticoid therapy on TAB positivity was assessed using a two-sided Cochran-Armitage trend test and linear regression.

Data from 223 patients were included (Table 1). There was no significant difference in the number of individuals given glucocorticoids, nor duration of therapy pre-TAB, in TAB positive versus TAB negative individuals. The Cochran-Armitage trend test did not demonstrate a relationship (p=0.11); linear regression of proportion of positive TABs compared to weeks of glucocorticoid therapy demonstrated a positive relationship (p=0.031 via F test).

The results suggest that glucocorticoid therapy does not affect TAB positivity to 6 weeks, with inconclusive data thereafter. While linear regression suggested an increased yield over time, this is likely due to selection bias for those receiving later biopsies. These results suggest the recommendation of obtaining a TAB within 14 days of glucocorticoid initiation is unnecessarily conservative.

Table 1: Diagnoses of GCA stratified by duration of glucocorticoid treatment pre-TAB.

Duration of Glucocorticoids pre-TAB	Weeks of treatment	Number of patients	GCA Diagnoses	Number of positive TABs	Percent of patients diagnosed with GCA by TAB
All		223	118	48	40.7%
0-6 days	0	57	23	8	34.8%
7-13 days	1	46	28	11	39.3%
14-20 days	2	45	25	10	40.0%
21-27 days	3	26	8	6	75.0%
28-35 days	4	21	10	4	40.0%
36-41 days	5	10	8	3	37.5%
42+ days	6	18	16	6	37.5%

Acknowledgement :

The author would like to acknowledge funding from the Canadian Rheumatology Association and The Hospital Saturday Fund.

References:

• 1. Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, et al. Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients. Mod Pathol. 2017 Mar; 30:788-96

• 2. Rhéaume M, Rebello R, Pagnoux C, Carette S, Clements-Baker M, Cohen-Hallaleh V, et al. High-Resolution Magnetic Resonance Imaging of Scalp Arteries for the Diagnosis of Giant Cell Arteritis: Results of a Prospective Cohort Study. Arthritis & Rheumatology. Jan 2017; 69(1): 161-8.

Presenting Author: Katherine Majerovich

Supervisor: Dr Stephanie Garner

Co-Supervisor: Dr Mats Junek

78. ENHANCING GP CARE OF MENTAL HEALTH DISORDERS POST COVID-19: A SCOPING REVIEW OF INTERVENTIONS, OUTCOMES

B Keyes¹, G McCombe¹, J Broughan¹, T Frawley², A Guerandel^1,3, G Gulati⁴, BD Kelly⁵, B Osborne⁶, K O’Connor⁷, W Cullen¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland

³Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital, Dublin, Ireland

⁴School of Medicine, University of Limerick, Limerick, Ireland

⁵Department of Psychiatry, Trinity College Dublin, Dublin, Ireland

⁶Irish College of General Practitioners, Ireland

⁷Cork University Hospital, Cork, Ireland

Considerable literature has reported the COVID-19 pandemic’s negative mental health sequelae. This surge in mental health problems will likely present to primary care in the coming months. The development of interventions to support GPs in the care of patients with mental health problems is a priority. The aim of this review was to examine interventions which could be implemented in general practice to enhance care of mental health disorders post COVID-19.

PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO “Global Research on COVID-19” databases were searched following Arksey and O’Malley’s scoping review process(1). Initial searches identified 148 articles. Twenty-nine studies were included in the review, mostly randomised control trials, qualitative interviews and surveys. Outcome measures to test feasibility of interventions included the ‘Seven-item Generalised Anxiety Disorder Scale’ and ‘Nine-item Patient Health Questionnaire’.

Results were divided into themes: Interventions to improve identification of mental health disorders; Interventions to support GPs; Therapeutic interventions; Telemedicine interventions, and barriers and facilitators to intervention implementation. Interventions requiring active involvement of patients in their own care may be effective. GPs should encourage participation in physical activity and meditation, implement digital mental health interventions and incorporate telemedicine into their practice.

Our findings suggest a broad range of interventions may be implemented in primary care to tackle the mental health sequelae of COVID-19. Practitioners worldwide must stay informed of relevant research, and actively implement studied interventions to improve the mental health care they offer. Priority areas for future research include biological treatments for mental health sequelae of COVID-19.

Reference:

• 1. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.

Presenting Author: Bláthnaid Keyes

Supervisor: Dr Geoff McCombe

Co-Supervisor: Prof Walter Cullen

79. FIRST DAY QUALIFIED: TO INVESTIGATE AND EXPLORE THE EXPERIENCES OF RADIOGRAPHERS WORKING IN THE REPUBLIC OF IRELAND OF THEIR FIRST WORKING DAY POST QUALIFICATION.

Davis E¹, Davis M¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

The move from student to qualified practitioner is a defining moment for many healthcare professionals as they embark on their career. This study invited Radiographers to recount their experiences of the above, with particular emphasis on those who qualified during the Covid-19 pandemic.

Individual interviews were conducted over Zoom. The researchers utilised trigger questions intended to facilitate discussion and reflection of the participants first working day post qualification. The research results were analysed using a qualitative data analysis method – including MAXQDA software and the Braun and Clarke thematic analysis.

The shorthand notes taken during the interviews were transcribed, and then manually coded to over 180 individual coding points. This code system allowed the extracts to be collated, and themes to be identified. The primary themes extracted from the data were; Student to Practitioner transition, impact of colleague interaction, placement location, adapting to hospital life, and unique effects of the pandemic.

There were a number of findings of particular note. Most participants felt that they had maximised what they could learn as a student, and needed to take the next step without the ‘student safety net’ of having someone double check their work. Many were happy to gain employment where they had been on placement previously.

Participants spoke about how the actual radiography was the easy part for them on Day 1. They weren’t worried or surprised by it. It was adapting to hospital life as a whole, that proved challenging. Wearing a bleeper for the first time, sorting out payroll, managing the patient flow, and above all – talking with other hospital teams and justifying why something was or was not done.

Presenting Author: Elliot Davis

Supervisor: Dr Michaela Davis

80. THE EFFECTS OF NON-MOVEMENT RELATED AUDIO-VISUAL STIMULATION ON THE TRANSCRANIAL MAGNETIC STIMULATION-BASED MEASURES OF MOTOR CORTEX EXCITABILITY

Tadjine YS¹, Awiszus F², Heverin M¹, Nasseroleslami B¹, Hardiman O^1,3, McMackin R¹

¹Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, University of Dublin, Ireland

²Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany 3 Beaumont Hospital, Dublin, Ireland

Transcranial magnetic stimulation (TMS) measures show diagnostic and prognostic value in neurodegenerative diseases.¹ For example, decrease in short intracortical inhibition (SICI), which captures GABA_A-ergic inhibition of upper motor neurones, reliably discriminates amyotrophic lateral sclerosis patients from controls and mimic disorders.² These TMS studies require participants to remain relaxed, maintaining very low baseline EMG amplitude. However TMS study protocol typically do not allow distractors like film or radio, making study participation cumbersome. This may result in measures being affected by participants attending to the sensation of TMS or resulting motor responses. We wished to determine if such distractors can be given without altering motor network excitability via sensory input.

Aim: To investigate whether watching and/or listening to a documentary that does not relate to movement affects commonly-studied TMS measures of motor cortical excitability.

Data were collected from 5 control volunteers. EMG was recorded from dominant and non-dominant abductor pollicis brevis muscles while resting motor threshold, threshold hunting target, SICI, long intracortical inhibition and interhemispheric inhibition were measured via stimulation of the motor cortex contralateral to the dominant hand. Recordings were taken with no sensory stimulation or during attendance of audiovisual or auditory distractors. Sign rank testing was employed to test for significant effects of sensory stimulation.

Auditory and/or visual distractors were not found to have a significant effect on the measurements of motor cortical excitability under investigation.

This preliminary investigation indicates that allowing participants to attend to audiovisual media does not affect TMS measures of motor excitability.

References:

• 1. Vucic S, Kiernan MC. Utility of transcranial magnetic stimulation in delineating amyotrophic lateral sclerosis pathophysiology. Handbook of clinical neurology. 2013 Jan 1;116:561-75.

• 2. Vucic S, Van Den Bos M, Menon P, Howells J, Dharmadasa T, Kiernan MC. Utility of threshold tracking transcranial magnetic stimulation in ALS. Clinical neurophysiology practice. 2018 Jan 1;3:164-72.

Presenting Author: Yasmine Tadjine

Supervisor: Dr Roisin McMackin

81. CHANGE IN LIPOPROTEIN COMPOSITION IN PEOPLE LIVING WITH HIV (PLWH) SWITCHING FROM TENOFOVIR DISOPROXIL FUMARATE (TDF) TO TENOFOVIR ALAFENAMIDE (TAF) CONTAINING REGIMENS COMPARED TO PLWH MAINTAINING TDF WITHIN THE UPBEAT STUDY COHORT

Kasianenko D¹, Savinelli S^2,3, Garcia Leon AA², Walsh I⁴, Fitzgibbon M⁴, Mallon PWG^2,3, Feeney ER^2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Centre for Experimental Pathogen Host Research, University College Dublin, School of Medicine, Dublin 4, Ireland

³Department of Infectious Diseases, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

⁴Department of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin 7, Ireland

Although tenofovir alafenamide (TAF) has been associated with better renal and bone safety compared to tenofovir disoproxil fumarate (TDF)[1], switching from TDF to TAF has been linked to an unfavourable lipid profile in people living with HIV (PLWH). However, the impact of switching from TDF to TAF on apolipoprotein profile is not well characterised.

The aim of our study was to compare changes in lipoprotein composition between PLWH switching from TDF to TAF (n=22) and those remaining on TDF-based regimens (n=87).

ApoA, ApoB and Lp(a) were assessed before (T0) and after (T1) switching from TDF to TAF, and at two timepoints in those remaining on TDF.

The differences in mean change in lipoprotein parameters between T0 and T1 within groups (n=109) were assessed using the non-parametric Wilcoxon signed-rank test. The difference in change between the groups was assessed with ANCOVA. The association between lipoprotein parameters, and HIV specific and non-HIV specific factors was assessed using linear regression.

Groups were well-balanced in terms of socio-demographic and clinical characteristics.

There was a significant difference at T1 between the two treatment groups in the lipoprotein parameters, after adjustment for baseline values and time between T0 and T1. (See Table 1). There was no significant difference in Lp(a) between the treatment groups. No associations between socio-demographic, clinical characteristics and apolipoproteins were observed.

The results indicate that switching from TDF to TAF results in a pro-atherogenic apolipoprotein profile. Further studies are needed to clarify the clinical significance of apolipoprotein changes in terms of cardiovascular risk.

Table 1. ANCOVA

Characteristic	Continuous TDF, N=871	Switch TAF, N=221	Adjusted Difference2	95% CI2,3	p-value2
APOA	0.21 (0.02, 0.36)	0.17 (0.08, 0.39)	0.46	0.03, 0.89	0.035
APOB	-0.12 (-0.22, 0.11)	0.06 (-0.24, 0.25)	-0.43	-0.89, 0.03	0.065
APOA/APOB	0.41 (0.07, 0.56)	0.28 (-0.25, 0.50)	0.90	0.26, 15	0.006

¹Median (IQR); Lipids are in mmoL/L, log-transformed

²ANCOVA

³CI=Confidence Interval

References:

• 1. Mansky. Tenofovir-associated bone density loss. Therapeutics and Clinical Risk Management 2009;:41.

• 2. Gomez M et al. A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015–2017. Infection [Internet] 2019;47(1):95–102.

Presenting Author: Dmytro Kasianenko

Supervisor: Dr Stefano Savinelli

82. QUANTITATIVE INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FLAP PERFUSIONS ANALYSIS

Quirke N¹, Dalli J^2,3, Hardy NP^2,3, Cahill R^2,3 Potter S^1,4

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin Ireland

³Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

⁴Department of Plastic & Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

Novel handheld surgical cameras have facilitated the application of indocyanine green fluorescence angiography (ICGFA) to reconstructive surgery, however large-scale trials and objective quantitative interpretation are lacking. Microvascular free flap surgery is a robustly reliable reconstructive technique with success rates exceeding 95%, however re-exploration rates of up to 20% are still reported in the literature. Utilising a state-of-the-art near infra-red camera and bespoke software we sought to quantitatively interrogate ICGFA signals to assess flap perfusion.

A head and neck free flap reconstruction (n=1) was assessed intra-operatively with the Elevision IR Platform (Medtronic, Ireland) following administration of intravenous (0.25mg/kg) indocyanine green. Perfusion angiograms were quantitatively dissected via tailored code (IBM Research Ireland) and converted into fluorescence intensity plots. Metadata milestones extracted from these curves were scrutinised statistically (Mann-Whitney U test) for perfusion discriminatory features. Flap viability was recorded on postoperative days 1 and 7.

Recordings were tracked and converted to chronological-intensity plots at 30fps with the flap displaying delayed (53.35±4.03 vs 17.36±2.10 seconds p<0.001) but higher zeniths of intensity (66.13±8.59 vs 45.73±16.90 grey units p=0.001) when compared to the surrounding native tissue, while post apex flap intensity normalised to the surroundings (32.63±2.55 vs 32.11±10.89 p=0.533) at a hundred seconds. These findings offer quantitative analysis of arterial inflow and venous outflow.

ICGFA signals were successfully quantified, and with further work will offer the reconstructive surgeon a methodology to standardise the use of infrared systems. However, true capitalisation of this emergent practice and translation to better clinical outcomes may require computational enhancement to surpass the shortcomings of oculo-cognitive interpretation.

Presenting Author: Ned Quirke

Supervisor: Assoc Prof Shirley Potter

83. COMPARISON OF SARS-COV-2 RAPID ANTIGEN TEST WITH SELF-COLLECTED DEEP NASAL SWAB VERSUS HEALTHCARE PRACTITIONER COLLECTED NASOPHARYNGEAL POLYMERASE CHAIN REACTION (PCR) SWAB FOR SYMPTOMATIC COVID-19

Wilson O¹, Ricciuto G², Brown D¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Lakeridge Health, Port Perry, North Durham, Ontario, Canada

Self-swabbing is a convenient and accurate method of diagnosing many infectious diseases.^1,2 The primary method of COVID-19 testing in Canada is healthcare provider-conducted (HPC) swabbing; however, self-swabbing with rapid antigen tests (RATs) may be beneficial for obtaining more timely results. This study aimed to determine the agreement between HPC PCR swabs and self-conducted RAT swabs and barriers to obtaining a COVID-19 swab in symptomatic adults.

Symptomatic adults attending the North Durham Covid Assessment Centre for a HPC PCR swab were recruited to conduct a RAT self-swab, and this result was compared to their PCR test result. In addition, consenting participants could complete a questionnaire to obtain demographics, the timing between symptom onset and booking a test, and attitudes towards attending the Assessment Centre. One-hundred and thirty-six pairs of PCR and RATs were obtained, and 103 questionnaires were completed.

Of the RAT and PCR pairs obtained, four were positive, and all others were negative by both RAT and PCR. Therefore, the level of agreement between the tests was 100%. Questionnaires determined that, on average, participants waited 2.0 days between symptom onset and booking a COVID-19 test. Primary reasons for waiting more than one day to book a COVID-19 test included: not believing symptoms were severe enough (34.2%) and wanting to “wait the symptoms out” (25.3%).

The study’s results support the introduction of self-conducted RATs in symptomatic individuals in order to reduce time from symptom onset to diagnosis, including use from home, which may lead to earlier isolation and contact tracing.

Acknowledgement :

The author would like to acknowledge funding from the Rural Ontario Medical Program and Port Perry Medical Associates.

References:

• 1. Tu YP, Jennings R, Hart B, Cangelosi GA, Wood RC, Wehber K et al. Swabs collected by patients or health care workers for SARS-CoV-2 testing. New England Journal of Medicine. 2020 Jul 30; 383(5): 494-6.

• 2. Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, et al. Self-collected versus clinician-collected sampling for chlamydia and gonorrhea screening: a systemic review and meta-analysis. PloS one. 2015 Jul 13;10(7):e0132776.

Presenting Author: Olivia Wilson

Supervisor: Dr Merrilee Brown

Co-Supervisor: Dr Daniel Ricciuto

84. PREGNANCY OUTCOMES AMONG WOMEN WITH RHEUMATIC MITRAL VALVE STENOSIS: A CANADIAN EXPERIENCE

Janzen M^{1, 6}, Silversides C², Mason J³, Sermer M³, Kiess M¹, Rychel V⁴, Wald R³, Colman J³, Siu S³, Grewal J¹

¹Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada

²Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada

³Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

⁴Department of Obstetrics and Gynecology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

⁵Division of Cardiology, University of Western Ontario, London, Ontario, Canada

⁶UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Rheumatic mitral stenosis (MS) is the most common lesion contributing to cardiac maternal morbidity in developing countries(1). This study sought to determine maternal and fetal outcomes of pregnancy in women with rheumatic MS based in two Canadian tertiary care centers providing comprehensive, guideline-based multidisciplinary care.

This study included consecutively enrolled pregnant women from the CARPREG registry with rheumatic MS(2). Pregnancies involving spontaneous abortion or pre-pregnancy valve replacement were excluded. Clinical variables were recorded at first clinic visit during each pregnancy and followed periodically throughout pregnancy until 6-months postpartum. Descriptive statistics were presented as mean ± SD. Proportions were compared with Chi-squared tests.

Preliminary data was available in 125 pregnancies with maternal rheumatic MS. Maternal age was 32±5 years. Seventy-six (61%) patients had mild MS and 49 (39%) had moderate or severe MS as described on echocardiogram. Cardiac complications occurred in 37 (30%) pregnancies primarily related to heart failure (26, 70%). There was no difference in the prevalence of complications in mild compared to moderate/severe MS (29% vs. 30%, p=0.33). Maternal death during pregnancy occurred in no patients with MS. There were 4 neonatal deaths, 3 of which were in pregnancies with mild MS. Of all pregnancies, 12 were of pre-term birth (<37 weeks gestational age) and 38 (30%) neonates fell into the small for gestational age (<10^th percentile) category.

Rheumatic MS presents a risk of complications during pregnancy, namely maternal heart failure and small for gestational age neonates. As such, patients should be carefully followed throughout pregnancy, labor, and delivery.

References:

• 1. Roos-Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD, Niwa K, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J. 2013;34(9):657-65.

• 2. Silversides CK, Grewal J, Mason J, Sermer M, Kiess M, Rychel V, et al. Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study. J Am Coll Cardiol. 2018;71(21):2419-30.

Presenting Author: Mikyla Janzen

Supervisor: Dr Jasmine Grewal

85. THE VALUE OF RENAL TRACT IMAGING AS PART OF ANNUAL GENITOURINARY (GU) REVIEW FOR PATIENTS WITH SPINAL CORD INJURY (SCI)

Reilly C.¹, McGlone B.²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Radiology Department, National Rehabilitation Hospital (NRH), Dún Laoghaire, Co. Dublin, Ireland

It is recommended that all SCI patients have an annual outpatient urology review. This is because there is an increased incidence of renal tract calculi in SCI due to urinary stasis and increased urinary calcium levels. Furthermore, urinary tract infections (UTIs) are increased owing to bacterial colonisation associated with use of intermittent/indwelling catheters and because of neurogenic bladder^[1]. The main purpose of this study was to review the impact of the findings of annual ultrasound and x-ray on patient management over 5 years at the NRH.

52 patient healthcare records were retrospectively reviewed following random selection using the hospital’s NIMIS system from outpatients attending the NRH over a 5 year period. Imaging and clinical findings for each patient were recorded.

Incidence of urinary calculi was 4.6%. Additionally, 3.4% had bladder sediment. 30% demonstrated renal scarring on ultrasound. 10.1% had incidental findings, including renal cysts, hydrocoele, phleboliths, while 12.7% had gallstones. The mean incidence of UTIs was 23.8%, incontinence was 18.7%, and 10.8% experienced both UTIs and incontinence.

The study confirmed increased rates of calculi in SCI patients, affirming the importance of conducting renal tract imaging as part of annual review. Having impaired sensation, individuals with SCI may not present with renal tract calculi in a typical manner^[2] and without imaging may go undiagnosed, resulting in significant morbidity. The high incidence of symptomatic UTIs in SCI patients can be avoided with good catheter care, hygiene and clinico-radiological review. Annual imaging also highlights incidental findings which can be relevant to ongoing management.

Acknowledgements:

Dept of Radiology and Urology, NRH; Medical Records Dept, NRH.

References:

• 1. Gamé, X., Castel-Lacanal, E., Bentaleb, Y., Thiry-Escudié, I., De Boissezon, X., Malavaud, B., Marque, P. and Rischmann, P., 2008. Botulinum Toxin A Detrusor Injections in Patients with Neurogenic Detrusor Overactivity Significantly Decrease the Incidence of Symptomatic Urinary Tract Infections. European Urology, 53(3), pp.613-619.

• 2. Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. International Urology and Nephrology. 2018;50(6):1005-1016.

Presenting Author: Clodagh Reilly

Supervisor: Dr Brian McGlone

86. A RETROSPECTIVE ANALYSIS OF THE ASSOCIATION BETWEEN ORAL CALCIUM SUPPLEMENTATION AND THE DEVELOPMENT OF URINARY TRACT CALCULI IN A NATIONAL REHABILITATION SERVICE

Narain K¹, McGlone B²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Radiology Department, National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland

Studies have shown that most renal tract calculi contain calcium^[1] and that low bone mass is common below the level of injury in spinal cord injury (SCI) patients^[2]. The main purpose of this study was to determine whether there was a correlation between the development of urinary calculi and oral calcium supplementation for low bone mass in patients with SCI attending for annual review, including ultrasound and/or X-ray of the urinary tract.

A total of 45 patients from the National Rehabilitation Hospital (NRH), with both SCI and urinary calculi, were randomly selected through the radiology database (NIMIS). Healthcare records were retrospectively reviewed to determine the timeline of the (re)occurrence of urinary calculi, the result(s) of DXA scans, as well as compliance with calcium supplements, if prescribed. 36 patients had a SCI ranging from level C4-T12, with a mix of ASIA grade A and grade B injuries.

13 patients had calculi after commencing calcium and/or vitamin D supplements, which developed de novo in 15% and were previously documented in 85%. Of these 13 patients, 54% were using an indwelling catheter, whereas the remainder were self-catheterising. Within the total cohort, 13 patients had no record of a DXA scan and 6 did not have follow up DXA scans for over 5 years. There is a potential, albeit weak, correlation between calcium/vitamin D supplements and the formation of urinary calculi. Further prospective data collection is recommended at annual review. In addition, DXA protocols could be reviewed to ensure all patients have timely imaging.

Acknowledgements:

Dept of Radiology and Urology, NRH; Medical Records Dept, NRH.

References:

• 1. Ramaswamy K, Killilea D, Kapahi P, Kahn A, Chi T, Stoller M. The elementome of calcium-based urinary stones and its role in urolithiasis. Nature Reviews Urology. 2015;12(10):543-557.

• 2. Morse L, Biering-Soerensen F, Carbone L, Cervinka T, Cirnigliaro C, Johnston T et al. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. Journal of Clinical Densitometry. 2019;22(4):554-566.

Presenting Author: Kareena Narain

Supervisor: Dr. Brian S. McGlone

Co-Supervisor: Ms Rosie Conlon

87. THE APPLICATION OF COMPLEXITY THEORY IN REHABILITATION: A SCOPING REVIEW

Carroll A¹, Darley A¹, O’Brien C¹, McNally H¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

A system is referred to as “complex” when it has so many interacting forces that it cannot be adequately understood by the traditional perspective of the system as a hierarchy.

Complexity theory is the study of these systems, and of the common characteristics, referred to as "phenomena", that these systems display. The purpose of this study was to perform a scoping review in order to ascertain the extent to which the effects of applying complexity theory to rehabilitation healthcare have been recorded in research literature and to highlight key research gaps to inform next stage of research.

We employed the Arksey and O'Malley methodological framework for the scoping review. We searched eight databases using concept of ‘complexity theory’, and the context of ‘Any rehabilitation healthcare setting’. The results were uploaded to Covidence to be double screened for relevancy. The full texts of the chosen articles were then read to ensure relevancy. Ten studies were eligible for inclusion.

The results of our review found that most literature utilised complexity theory in the analysis of data collected from institutions which had not yet implemented complexity theory into their framework. As a result there’s insufficient evidence to prove the benefit of implementing complexity theory.

By applying complexity theory as a new framework for a rehabilitation system and recording subsequent results of the functioning of the system, it may be possible to prove what previous studies have theoretically implied: that recognising the inherent complexity of rehabilitation systems is the first step to optimising them.

Presenting Author: Holly McNally

Supervisor: Prof Áine Carroll

Co-Supervisor: Dr Andrew Darley

88. I PREDICT A RIOT: A SCOPING REVIEW OF THE USE CASES OF REHABILITATION INTERNET OF THINGS (RIOT) APPLIANCES

Flynn J¹, Darley A¹, Connolly R², Carroll A¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²National Rehabilitation Hospital, Rochestown Ave, Dún Laoighre, Co. Dublin, Ireland

The Internet of things (IoT) describes the network of physical objects that are embedded with sensors, software, and other technologies for the purpose of connecting and exchanging data with other devices over the internet [1]. This ecosystem is one that has potential to be an important tool in long-term rehabilitation care and to break down physical barriers in access to care. RIoT is an incredibly relevant subject in rehabilitation medicine, especially in the context of the current COVID-19 pandemic.

This scoping review was created to look at the current literature available on the application of IoT in the context of rehabilitation, charting both areas of interest and the gaps present in the research. We devised a search strategy, inclusion/exclusion criteria and a data extraction method according to the PRISMA-SCR guidelines.

The results of this scoping review found that research into RIoT applications in clinical care is an area of increasing interest. This is especially true for stroke rehabilitation, and of the use of wearables for physiological monitoring. This review also found that gaps do remain in the field, as many projects are in the early stages of development and clinical feasibility is still unknown due to small study sizes.

Reference:

• 1. Gillis A. What is IoT (Internet of Things) and How Does it Work? [Internet]. IoT Agenda. 2020 [cited 26 July 2021]. Available from: https://internetofthingsagenda.techtarget.com/definition/Internet-of-Things-IoT

Presenting author: Jeanne Flynn

Supervisor: Dr Ruairi Connolly

Co-Supervisor: Dr Andrew Darley

89. A MIXED METHODS EXPLORATION OF THE USE OF PATIENT EXPERIENCE TO INFORM IMPROVEMENT IN A NATIONAL REHABILITATION HOSPITAL

O’Reilly D¹, Maume L², Nolan M², Connolly R², Darley A¹, Carroll A^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²National Rehabilitation Hospital, Dublin, Ireland

Patient experience is a quality indicator in healthcare[1]. Positive patient experience is associated with higher levels of patient safety[1]. This Project aimed to see how Hospitals collect patient experience information and how such information is used in order to inform improvements. Hospitals need to identify how data is being used in the hospital to inform improvements to ensure that patient experience data is effectively used[1].

The project consisted of three phases:

Phase 1: Mapping data collection methods and secondary analysis of existing data.

Phase 2: Semi-structured interviews with key stakeholders to explore how patient experience data is sought, disseminated and utilised.

Phase 3: Content analysis of Patient Forum Meeting Minutes and Annual Reports to identify how patient experience is utilised to inform improvements.

Phase 1 identified a variety of quantitative, qualitative and mixed methods approaches to patient experience data collection. Key themes highlighting how information was utilised to inform improvements was identified. In Phase 2, formal and informal patient experience capture methods and dissemination routes in the hospital was described. Phase 3 identified significant themes from Patient Forum Meetings and trends within Annual Reports.

Patient experience data is collected formally and informally within the hospital. Patient Experience information was influential and directly informs improvements at a Unit, at a Programme and at an organisational level. For the hospital to become truly patient-centred, it should continue to utilise patient experience information as a lever to inform further improvements in the hospital and this requires normative legitimacy, structural legitimacy and organisational readiness[2].

References:

• 1. Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J. Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ open. 2016;6(8):e011907.

• 2. Sheard L, Marsh C, O'Hara J, Armitage G, Wright J, Lawton R. The patient feedback response framework–understanding why UK hospital staff find it difficult to make improvements based on patient feedback: a qualitative study. Social Science & Medicine. 2017;178:19-27.

Presenting Author: Dearbhla O’Reilly

Supervisor: Dr Maeve Nolan

Co-Supervisor: Ms Liz Maume

90. MONITORING LONG TERM DISEASE PROGRESSION AND VISION LOSS IN BIRDSHOT CHORIORETINOPATHY (BCR): MULTIMODAL IMAGING AND CLINICAL CORRELATES AS WELL AS QUALITY OF LIFE ASSESSMENT

Farrell L¹, Bourke L², Kilmartin D^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Ophthalmology, Royal Victoria Eye & Ear Hospital, Dublin, Ireland

A retrospective cohort study examining long-term disease progression and visual loss in Birdshot Chorioretinopathy (BCR) amongst an Irish patient group in the Royal Victoria Eye & Ear Hospital, Dublin (RVEEH).¹ We also aim to evaluate quality of life (QoL) parameters using a validated and patient-centred questionnaires for BCR.²

22 BCR patients were identified via database chart review and were invited to take part in 2 QoL questionnaires – The National Eye Institute Visual Functioning Questionnaire (VFQ-25) & a supplementary BCR specific QoL Questionnaire. Further chart analysis and examination of multimodal imaging, electrophysiology (ERG), and clinical correlates were conducted on those 16 patients who fulfilled the inclusion criteria.

The response rate to the QoL questionnaires employed was 95.5% (n = 21). The NEI VFQ-25 mean composite score for the 21 patients was 72.81. Visual complaints amongst our cohort were; Floaters (81%), Nyctalopia (62%), Blurred vision (52%), Dyschromatopsia (38%), Photopsia (33%). Driving, reported in 61.9% of cases, was the most common activity negatively affected.

Birdshot chorioretinopathy is a chronic posterior uveitis with a substantial risk of permanent visual loss. Our study evaluating impact on QoL is in keeping with similar studies, highlighting a significant disease burden, including medication side-effects.

References:

• 1. Minos E, Barry RJ, Southworth S, Folkard A, Murray PI, Duker JS, Keane PA, Denniston AK. Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment. Orphanet J Rare Dis. 2016 May 12;11(1):61. doi: 10.1186/s13023-016-0429-8. PMID: 27175923; PMCID: PMC4866419.

• 2. Anisha Sekaran, Mohith Shamdas, Robert J. Barry, Alastair K. Denniston & Philip I. Murray (2020): Creating a Health Utility Value for Birdshot Chorioretinopathy, Ocular Immunology and Inflammation, DOI: 10.1080/09273948.2020.1799034

Presenting Author: Lily Farrell

Supervisor: Mr Dara Kilmartin

91. DELAY OF THE DIAGNOSIS OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHROPATHY IN FEMALE PATIENTS WITH AN INITIAL DIAGNOSIS OF FIBROMYALGIA SYNDROME

Basta J¹, Metyas S², Chen C³, Saad I⁴

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Covina Arthritis Clinic, Covina, California, United States of America

³USC Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America

⁴Scripps College, Claremont, California, United States of America

Fibromyalgia affects 10 million adults in the United States with an estimated 90% of diagnoses being reported in women [1]. For the longest time, clinicians always attributed most pain symptoms to FM once the diagnosis was made. This resulted in the masking or late diagnosis of other associated conditions for which specific treatments would have been necessary for control of symptoms. In this study we are focusing only on the female population with a known diagnosis of FM who were diagnosed later with ankylosing spondylitis (AS) or non-radiographic axial spondyloarthropathy (nr-axSpA).

This study is a retrospective observational study of female patients who were initially diagnosed with FM according to ACR criteria and then were diagnosed with AS at a later date. A review of patient records was conducted to identify subjects of patients diagnosed with FM, with a missed diagnosis of axial spondyloarthritis (axSpA). Data recorded includes: HLA B27 allele presence, biologic treatment post AS diagnosis, dates of diagnoses of both FM and AS, ESR levels, CRP levels, and MRI and X-ray findings specific to sacroiliac joints in these patients.

Our results revealed that 66.7% of patients had elevated CRP and ESR levels and that 58.3% of patients presented with HLA B27.

As a result of this study, we recommend screening all new FM patients for possible AS by adding HLA B27, ESR, and CRP in the baseline lab tests for detection of potential associated AS, and in select patients, X-rays and/or MRIs might be necessary.

Reference:

• 1. Arout CA, Sofuoglu M, Bastian LA, Rosenheck RA. Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study. Journal of Women’s Health. 2018, vol. 27(8);1035-1044.

Presenting Author: Joseph Basta

Supervisor: Dr Samy Metyas

Co-Supervisor: Dr Christina Chen

92. THE EFFECT OF CHEMOTHERAPY, IMMUNOTHERAPY, AND VACCINES IN THE SURVIVAL OF CANINE MELANOMA: A SYSTEMATIC REVIEW

Chuah SM¹, Collins B¹, Bollard SM^1,2,3, Kelly P⁴, McCann A^1,2, Potter SM^1,2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland

³Department of Plastic & Reconstructive Surgery, Mater Misericordiae University College Hospital, Eccles Street, Dublin 7, Ireland

⁴UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Melanoma is an aggressive skin and mucosal cancer, affecting humans and dogs. Treatment is challenging due to the aggressiveness in both species.^1,2 This project aimed to systematically review the effect of chemotherapy, immunotherapy and vaccines in canine melanoma survival, and to compare melanoma-related genes in canines and humans.

A systematic review was performed, with eligible studies including clinical trials treating canine melanoma using chemotherapy, immunotherapy or vaccines with control groups and available survival data. Searches were performed in Embase, Scopus, Cab Direct, Web of Science and Ovid Medline. A review of comparative studies between human and canine melanoma was performed to determine common genes involved in melanoma pathogenesis in both species. UniProt for protein sequences, and BLAST® for global alignments, were used for gene comparison analyses.

The initial systematic review search identified 1,807 articles. Seventeen studies were eligible for inclusion (n=1,570 patients). The median age of included patients was 11 years (0.7-20 years). Follow-up was to death or loss to follow-up (7-3285 days). A combined treatment of complete surgery, suicide gene with ganciclovir and acyclovir had the greatest median disease-free survival times (>2848 days). Twenty-four genes in common between human and canine melanoma were found. Three of them (PTEN, NRAS and EIF1AX) have 100% identity.

The combined treatment is most effective for treating canine melanoma, and further studies of its mechanism has the potential to benefit human melanoma treatment. Furthermore, the identified genes in our review gives an insight into future potential targets for comparative oncology research in melanoma.

Acknowledgement:

The author would like to acknowledge funding from the Pathological Society of Great Britain and Ireland.

References:

• 1. Cassano R, Cuconato M, Calviello G, Serini S, Trombino S. Recent Advances in Nanotechnology for the Treatment of Melanoma. Molecules. 2021; 26(4): 785.

• 2. Amela RM, Anson A. A Review of Immunotherapeutic Strategies in Canine Malignant Melanoma. Vet Sci. 2019; 6(1): 15.

Presenting Author: Shin Mei Chuah

Supervisor: Prof Amanda McCann and Assoc Prof Shirley Potter

Co-Supervisor: Dr Stephanie Bollard

93. DOES SLEEP RECOVER MEMORIES FROM DECAY IN OLDER ADULTS?

Ponomareva G¹, Delvey C², Jones B², Spencer R²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²SomneuroLab, Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America

Memory benefits from sleep, resulting in reduced decay [1]. Decay has been found to be greater in older adults [2], thus a rapid decay rate (DR) prior to sleep may contribute to reduced sleep-dependent consolidation (SDC). This study aimed to compare DR between older and younger adults and determine whether DR is related to SDC.

Participants aged 60-75 years were recruited and screened for sleep-affecting factors. Participants learned a word-pair task followed by immediate and 1-hour recall. Following an interval with overnight sleep or daytime wake (separated by one week), 12-hour recall was assessed. DR (immediate minus 1-hour) and SDC (12-hour minus 1-hour across sleep versus wake) were calculated from recall accuracy scores of 6 older and 10 younger adults and compared using 2x2 mixed ANOVA and Pearson’s correlation.

There were no significant differences in DR between older and younger adults (F(1,14) = 0.99, p = 0.337) or between wake and sleep conditions (F(1,14) = 1.885, p = 0.191). The interaction between age and sleep/wake condition was marginally significant (F(1,14) = 3.980, p = 0.066). Additionally, a significant association between DR and SDC was found (r(14) = -0.550, p = 0.027).

These results indicate that DR may not consistently change with age or time-of-day. Interaction between age and condition is related to factors not examined, requiring further investigation. Nonetheless, the negative association between DR and SDC suggests that high rates of memory decay may reduce SDC. Given the small sample size, a follow-up study with a larger sample is warranted.

Acknowledgement :

This study was funded by the United States National Institutes of Health grant NIH R01 HL111695.

References:

• 1. Diekelmann S, Wilhelm I, Born J. The whats and whens of sleep-dependent memory consolidation. Sleep Medicine Reviews. 2008;13(5):309-21.

• 2. Wheeler MA. A comparison of forgetting rates in older and younger adults. Aging, Neuropsychology, and Cognition. 2000;7(3):179-93.

Presenting Author: Galina Ponomareva

Supervisor: Prof Rebecca Spencer

Co-Supervisors: Dr Bethany Jones, and Dr Cassandra Delvey

94. FUNCTIONAL OUTCOME OF ILEAL POUCH-ANAL ANASTOMOSIS IN ELDERLY PATIENTS

Lau HK¹, de Buck van Overstraeten A^2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Surgery, University of Toronto, Toronto, ON, Canada

³Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada

Ulcerative colitis, unclassified inflammatory bowel disease, and Crohn’s disease are chronic inflammatory diseases that affect the colon and rectum, for which ileal pouch-anal anastomosis (IPAA) is the gold standard surgery¹. IPAA is also the standard prophylactic surgery offered to patients with familial adenomatous polyposis. Ample evidence from large retrospective cohorts suggests that IPAA provides satisfactory quality of life (QOL) and good functional outcome². However, the evidence on functional outcome in older patients receiving a pouch and long-term pouch function in aging patients is scarce. This study aims to determine long-term functional outcomes and QOL of older adults who had an IPAA created after 60 years of age, and patients ≥60 years of age living with an IPAA.

This is a single centre, cross-sectional survey study, assessing surgical and functional outcomes of patients who had an IPAA created after the age of 60 and patients ≥60 years who received a pouch at a younger age. Confounding adjustment will occur. Exclusion criteria includes diagnoses of colorectal cancer requiring chemoradiation.

Primary outcome is patient functional outcome at minimum 6 months after ileostomy closure. This will be measured using the validated Colorectal Functional Outcome questionnaire and a hybrid functional questionnaire. Secondary outcomes include global QOL and pouch survival rate.

Data is sparse regarding long-term outcomes of patients who had an IPAA at an older age, and on older patients who had their pouch at a younger age. This study will help our understanding of the functional outcomes of these patients and further validate performing IPAA in older adults.

References:

• 2. Ross H, Steele SR, Varma M, Dykes S, Cima R, Buie WD, et al. Practice Parameters for the Surgical Treatment of Ulcerative Colitis. Diseases of the Colon & Rectum. 2014;57(1).

• 3. Chandrasinghe P, Carvello M, Wasmann K, Foppa C, Tanis P, Perry-Woodford Z, et al. Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study. Journal of Crohn's & colitis. 2020;14(6):726-33.

Presenting Author: Harry Kevin Lau

Supervisor: Dr Anthony de Buck van Overstraeten

95. DELAYED NEURODEVELOPMENTAL ALTERATIONS IN INFANTS EXPOSED TO ZIKA VIRUS IN UTERO

Rouhani S¹, Flaherman V²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCSF School of Medicine, University of California San Francisco, San Francisco, United States of America

It is well established that in utero exposure to Zika Virus causes a range of devastating adverse neurological outcomes¹. Many of these are present at birth however early evidence suggests that there may be long term neurodevelopmental impacts even among children apparently not impacted at birth.

The aim of this scoping review was to examine delayed neurodevelopmental outcomes in children exposed prenatally to Zika Virus but born without congenital Zika Virus symptoms. The review structure was guided by the Arksey and O’Malley methodology and the search process by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) checklist².

A total of 9 studies were included. The studies used a variety of assessment tools, the most common being the Bayley Scales for Infant and Toddler Development III (cognition, language, and motor performance) for neurodevelopmental testing. Infants and toddlers in the age range of 9 weeks to 3.5 years were included. All but one report found a significant increase in adverse neurodevelopmental outcomes in children who were asymptomatic at birth but exposed to Zika Virus in utero.

Prenatal exposure to Zika Virus appears to have long term adverse impacts on the central nervous system regardless of birth outcomes. Neurodevelopmental assessments of children exposed in utero should continue into childhood. These findings may be relevant to other viruses such as SARS-CoV-2 where research is limited.

References:

• 1. Pessoa A, van der Linden V, Yeargin-Allsopp M, Carvalho MDCG, Ribeiro EM, Braun KVN, et al. Motor abnormalities and epilepsy in infants and children with evidence of congenital Zika virus infection. Pediatrics 2018; 141:S167–S179.

• 2. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005; 8(1):19-32.

Presenting Author: Shahrzad Rouhani

Supervisor: Dr Valerie Flaherman

96. A CORRELATIVE ASSESSMENT OF THE ROLE OF STROMA MECHANICS IN PANCREATIC CANCER PROGRESSION

Glynn C^1,2, Fox M^1,2, Thorpe SD^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland

Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive malignancy with a low survival rate. Of all solid tumours, PDAC has the greatest amount of stromal content. The fibrous stroma is much stiffer than the cancer cell niche and is thought to drive tumour progression while promoting drug resistance. The aim of this work is to investigate the hypothesis that increased stiffness in stromal tissue is associated with increased collagen packing and alignment.

Human tissue samples from cancerous and non-cancerous regions of the pancreas were sliced and stained with Picrosirius Red before being imaged with a polarized light microscope. Polarized light microscopy allows us to image the collagen bundles within the sample by taking advantage of the birefringent properties of collagen. Each region of interest was imaged at an angle of 0, 60, 120 and 180 degrees before being constructed into to a representative composite image¹. Collagen organisation was quantified using the software CT-FIRE² as well as Fourier transform-based alignment quantification software and custom MATLAB scripts. Atomic Force Microscopy data from adjacent slices of our sample was supplied and compared with collagen organisation data.

Image composition and analysis was successfully carried out using a variety of contrasting techniques. Picrosirius staining intensity increased in tumour tissue relative to non-cancerous samples along with increased fibre packing evident from polarized light microscopy. Increased stiffness was observed to correlate with increased collagen content.

This work has highlighted the relationship between collagen organisation and tissue stiffness in Pancreatic Ductal Adenocarcinoma.

Acknowledgment:

The author would like to acknowledge funding from Breakthrough Cancer Research and Dr Niall Swan from St. Vincent’s University Hospital for provision of pancreatic tissue sections.

References:

• 1. Greiner C, Grainger S, Farrow S, Davis A, Su JL, Saybolt MD, et al. Robust quantitative assessment of collagen fibers with picrosirius red stain and linearly polarized light as demonstrated on atherosclerotic plaque samples. PLOS ONE. 2021 Mar 18;16(3).

• 2. Liu Y, Keikhosravi A, Pehlke CA, Bredfeldt JS, Dutson M, Liu H, et al. Fibrillar Collagen Quantification With Curvelet Transform Based Computational Methods. Frontiers in Bioengineering and Biotechnology. 2020 Apr 21;8.

Presenting Author: Chris Glynn

Supervisor: Dr Stephen Thorpe

97. AN INVESTIGATION OF TRANSGLUTAMINASE-2 AND SYNDECAN-4 IN PANCREATIC DUCTAL ADENOCARCINOMA

Fay T¹, Fox M^1,2, Thorpe S^1,2

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland

Pancreatic ductal adenocarcinoma (PDAC) is the most common and severe type of pancreatic cancer. PDAC is associated with a stiff, extracellular matrix (stroma) which has a role in pancreatic cancer progression and chemoresistance¹. Transglutaminase-2 (TG2) enzyme cross-links proteins, such as collagen, which contributes to tissue stiffness^1,2. TG2 is known to interact with the heparan sulfate proteoglycan syndecan-4 (SDC4). SDC4 regulates the cross-linking activity and expression of TG2². The objective of this study is to assess the relationship between TG2 and SDC4 expression in PDAC and patient-matched normal pancreatic tissue.

Immunofluorescent staining was carried out on resected PDAC and adjacent normal tissue from 6 patients to examine the location and expression of TG2 and SDC4. Antibody optimisation was also carried out. TG2 and SDC4 stained sections were imaged using an epifluorescence microscope. Staining intensity was quantified using ImageJ software.

SDC4 antibody optimisation identified two of four antibodies which were suitable, with the best signal-to-noise using a rabbit anti-SDC4 antibody (1:100, Biovision). SDC4 expression is concentrated in the cancerous epithelial cells surrounding tumour glands. TG2 was abundant throughout the stroma. Green autofluorescence was also detected, with stroma and cells fluorescing strongly. TG2 and SDC4 expression is higher in the tumour tissue compared to the normal tissue.

The results from the project will contribute to a larger project addressing the mechanobiology of pancreatic cancer. This will identify useful targets for novel therapeutics. Inhibition of the TG2-SDC4 interaction could be a promising approach to aid treatment and slow the progression of pancreatic cancer¹.

Acknowledgement:

The author would like to acknowledge Dr. Niall Swan from St. Vincent’s University Hospital (SVUH) for providing the resected PDAC patient tissue samples from the SVUH pancreatic cancer biobank.

References:

• 1. Lee J, Condello S, Yakubov B, Emerson R, Caperell-Grant A, Hitomi K, et al. Tissue Transglutaminase Mediated Tumor-Stroma Interaction Promotes Pancreatic Cancer Progression. Clin Cancer Res. 2015; 21(19):4482-93.

• 2. Scarpellini A, Huang L, Burhan I, Schroeder N, Funck M, Johnson TS, et al. Syndecan-4 knockout leads to reduced extracellular transglutaminase-2 and protects against tubulointerstitial fibrosis. J Am Soc Nephrol. 2014; 25(5):1013-27.

Presenting Author: Tara Fay

Supervisor: Dr Stephen Thorpe

98. A PROSPECTIVE AUDIT OF THE CLINICAL IMPLEMENTATION OF URINE NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (uNGAL) AS A BIOMARKER OF ACUTE KIDNEY INJURY IN HOSPITALISED PATIENTS

Meade T¹, Côté JM^1,4,5, Lyons L^1,2, Twomey PJ^1,2, Fitzgerald TJ^1,3, Wei Teh J^1,3, Holian J^1,3, O’Riordan A^1,3, Watson A^1,3, Clince M³, Malik F³, O’Regan J^1,3, Murray PT^1,3,4.

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Clinical Chemistry, St. Vincent’s University Hospital, Dublin 4, Ireland

³Department of Nephrology, St. Vincent’s University Hospital, Dublin 4, Ireland

⁴Clinical Research Centre, University College Dublin, Belfield, Dublin 4, Ireland

⁵ Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada

Novel acute kidney injury (AKI) biomarkers have been shown to improve diagnostic accuracy, but reports of use in standard clinical practice are rare. The objective of this audit is to evaluate the clinical utility of urine Neutrophil gelatinase-associated lipocalin (uNGAL) in newly diagnosed AKI episodes in hospitalized patients.

We reported the implementation of uNGAL measurement for routine AKI diagnostic workup of patients receiving nephrology consultation in an academic centre, focusing on discrimination of AKI aetiology (functional/pre-renal vs intra-renal), using retrospective data collection. The diagnostic accuracy of uNGAL was compared to the final adjudication by two independent nephrologists, using descriptive statistics (Mann-Whitney U test) and Area Under The Receiver Operating Characteristic Curve (AUC-ROC) analysis.

Results from 55 uNGAL samples were added to the original cohort (46 samples) previously audited, in a hospital-approved audit extension. KDIGO stage 1, 2, 3 AKI and renal replacement therapy occurred in 7%, 36%, 57% and 23% of cases, respectively. The median uNGAL level was 107.6 (46.3-357.9) ng/mL for functional/pre-renal AKI and 930.0 (239.0-1296.1)ng/mL for intra-renal AKI (p=<0.001). In patients without UTI, median uNGAL was 84.5 (41.5-315.0)ng/mL for pre-renal and 908.9 (223.6-1360.5)ng/mL for intra-renal (p=<0.001). Median uNGAL/uCreatinine in cases without UTI was 1.23 (0.71-4.50)ng/mg in pre-renal AKI and 12.77 (4.34-22.92)ng/mg in intra-renal AKI (p=<0.001).

Results from our local experience confirmed that uNGAL testing is useful in the diagnostic assessment of new-onset AKI. Clinical context should be considered in interpretation of NGAL levels (presence of UTI), which can be improved in accuracy by correction for urinary concentration/dilution.

Presenting author: Therese Meade

Supervisor: Prof Patrick Murray

Co-Supervisor: Dr Jean Maxime Côté

99. PRACTICES FOR IDENTIFYING MENTAL HEALTH ISSUES IN ELITE ATHLETES: A SCOPING REVIEW

AO’Keeffe¹, J Broughan¹, G McCombe¹, A Lane¹, G Fitzpatrick², M Roe³, T Crowley¹, W Cullen¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Health, Sport, and Exercise Science, Waterford Institute of Technology, Waterford, Ireland

³School of Public Health, Physiotherapy and Sport Science, University College Dublin, Belfield, Dublin 4, Ireland

Elite athlete mental health is becoming a topic of increasing interest. Following the publication of the International Olympic Committee consensus statement [1] in 2019, emphasis has been placed on encouraging help-seeking and treatment for elite athletes with mental health issues. However, there remains a paucity of research into the diagnostic practices and screening tools that exist to aid in identifying mental ill health in elite athletes. This study aims to examine the question “What identification practices exist to aid in identifying mental ill health in elite athletes?”

A scoping review study design was undertaken following the six-stage process developed by Arksey and O’Malley [2] with revisions by Levac et al. The PubMed, SPORTDiscus and PsycINFO databases were searched for relevant papers. This review follows in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. (PRISMA-ScR).

Forty-three studies were included in the review. Emerging themes concerned the importance of timely identification, the need to make identification pathways/resources accessible, the delivery of interventions, and using the right tools for identification. A wide range of mental health outcome measures were identified, few of which were athlete specific.

Practices for identifying mental ill-health in elite athletes are numerous and varied. Many are of questionable use in elite athlete populations, and few screening tools are specific to elite athletes. Many countries and sport organisations lack consensus-based guidelines for identifying mental health problems in elite athletes. Further research to develop high-quality athlete-specific screening tools should be a priority.

References:

• 1. Reardon, C.L., et al., Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine, 2019. 53(11): p. 667.

• 2. Arksey, H. and L. O'Malley, Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 2005. 8(1): p. 19-32.

Presenting Author: Aisling O’Keeffe

Supervisor: Prof Walter Cullen

Co-Supervisor: Mr John Broughan

100. RETROSPECTIVE CASE SERIES OF PRIMARY SPINAL TUMOURS AT THE NATIONAL SPINAL INJURIES UNIT

Flaherty E¹, McDonnell J², O’Malley S², O’Neill C², Cunniffe G², Morris S²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland

Primary extradural tumours of the spine are a rare occurrence, with an incidence of approximately one per million, comprising 4% of total spinal tumours [1]. Patients typically require radical curative resection given the neoplastic nature of these lesions with significant associated post-operative morbidity. En bloc resection with wide/marginal margins is the gold standard surgical approach and adhering to evidence-based oncologic principles is associated with lower recurrence and mortality rates [2].

The aim of this study was to establish the associated morbidity of these procedures and the challenges of local recurrence. A retrospective review of data obtained within the National Spinal Injuries Unit was conducted. Patients of all ages with a biopsy-confirmed diagnosis of primary extradural spinal tumour between January 1^st 1992, and May 31^st 2021, were eligible. There were 31 cases during this period. Data was collected on this study population, including basic demographics, tumour subtypes, operative procedure details, and associated mortality. This data was analysed using the Kruskal Wallis test, and the results collated.

Demographics, tumour subtypes, operative procedure details, and associated mortality.

Tumour subtypes	Gender	Age (range; mean)
Chondrosarcoma (8 cases – 27.59%)	18 male (62.07%)	16-81 years; 47.10 years
Chordoma (5 cases – 17.24%)	11 female (37.93%)
Osteosarcoma (3 cases – 10.34%)
Giant cell tumour (3 cases – 10.34%)
Angiosarcoma (2 cases – 6.9%)
Malignant peripheral nerve sheath tumour (2 cases – 6.9%)
Ewing’s sarcoma (2 cases – 6.9%)
Leiomyosarcoma (2 cases – 6.9%)
Malignant fibrous cell tumour (1 case – 3.45%)
Haemangioendothelioma of bone (1 case – 3.45%)

A main limitation of this study was the small sample size. However, of note, approximately 75% of patients developed a post-operative complication, and the mortality rate approached 20%. Almost half of patients had at least one recurrence of their tumour, with a trend towards significance for recurrence in cervical spine tumours.

These tumours, whilst rare, place a large burden on both the patient and the Irish healthcare system, and need to be managed in a multidisciplinary format in specialised centres in Ireland.

References:

• 1. Lam, Fred C., Jeffrey E. Arle, Paul A. Glazer, and Ekkehard M. Kasper. ‘Primary Extradural Tumors of the Spine – Case Review with Evidence-Guided Management’. Surgical Neurology International 5, no. Suppl 7 (28 August 2014): S373–75.

• 2. Charest-Morin, Raphaële, Charles G. Fisher, Arjun Sahgal, Stefano Boriani, Ziya L. Gokaslan, Aron Lazary, Jeremy Reynolds, Chetan Bettegowda, Laurence D. Rhines, and Nicolas Dea. ‘Primary Bone Tumor of the Spine—An Evolving Field: What a General Spine Surgeon Should Know’. Global Spine Journal 9, no. 1 Suppl (May 2019): 108S-116S.

Presenting Author: Ella Flaherty

Supervisor: Dr Cathleen O’Neill

101. DETERMINE THE INCIDENCE OF SURGICAL SITE INFECTIONS FOLLOWING HIP FRACTURE SURGERY IN THE MATER MISERICORDIAE UNIVERSITY HOSPITAL (MMUH)

O’Toole Y¹, McDonnell J², Lynch D², O’Neill C², O’Malley S², Mullen M², Cunniffe G², Lyons F²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Mater Misericordiae University Hospital, Dublin 7, Ireland

Hip fractures(HF) are common and require prompt surgical fixation. The 1.3million global incidence will increase with ageing populations.(1) Surgical site infections(SSI) are a devastating complication with prolonged hospital stay, poor outcomes and increased cost on an already overburdened health system. The purpose of this study is to determine the incidence of SSI in HF patients in MMUH and audit patient characteristics, aiming to explore potential gaps and areas for quality improvement(QI) in the HF patient pathway.

We retrospectively identified 30 patients admitted to MMUH’s trauma unit between 2016-2020 with HF SSI. We investigated MMUH’s online database and patient charts for this study population. Data related to demographic, surgical and clinical factors including 50 variables were collated and established our research database.

The SSI incidence rate in a patient cohort >60yoa was 3.48%(27/775). The incidence of deep vs superficial infections was 1.29% and 2.19% respectively. A meta-analysis by Masters et al, reported 2.1% incidence of SSI following HF surgeries in the UK.(1) 60% of our cohort were female. Mean age was 75.03years. 56.66% had an ASA class ≥3 (Mean: superficial = 2.5, deep = 2.9). 86.66% Rockwood frailty score ≥4 (Mean: superficial = 4.4, deep = 5.8). The mean length of stay was 71.73days, 28.58days for superficial and 146.3days for deep.

This analysis highlights the need to continually cultivate improvements to reduce our SSI rates and to identify higher risk patient characteristics. Further studies may be extrapolated from this research database to garner QI actions as part of ongoing clinical governance.

Reference:

• 1. Masters J, Metcalfe D, Ha J, Judge A, Costa M. Surgical site infection after hip fracture surgery. Bone & Joint Research. 2020;9(9):554-562.

Presenting Author: Yvonne O'Toole

Supervisor: Dr Cathleen O’Neill

102. LOCAL SERVICE EVALUATION IF UTILISING CT ANGIOGRAMS FOR FORAMEN FRACTURES WITHIN THE NATIONAL SPINAL INJURIES UNIT

Tcacenco A¹, Cunniffe G², O’Malley S², Macken M², Darwish S², Butler J²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Mater Misericordiae University Hospital, Dublin 7, Ireland

Fractures through the transverse foramen of the cervical vertebrae are associated with a vertebral artery injury risk of over 88% 1, which in turn has a 50% risk of stroke 2 for both symptomatic and asymptomatic patients. Although morbidity of these injuries is high, due to their scarcity, management of such patients has not been well described in literature. This research aims to describe management and outcome patterns for patients with such injuries based on data prospectively gathered within the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital.

A key word search was performed through the NSIU picture archiving and communication system. A total of 34 patients with known transverse foramen fractures of the cervical spine who had undergone a computed tomography angiogram (CTA) of the vertebral arteries in 13.5 year were identified. Detailed evaluation of the patient pathway for this study population was conducted through the hospital patient information system and patient records.

Patient management and the department consulted was based on the mechanism of injury, associated injuries and orthopedic evaluation. All patients were evaluated by the orthopedic department. Patients with penetrating injuries were evaluates by the vascular department, and patients with suspected or known stroke were assessed by the stroke team. Polytrauma patients were discussed in multidisciplinary team meetings. This research identifies the pathway of care for these patients, most of which were conservatively management through immobilization. Foramen fracture detail, although shown to be significant in literature did not affect patient management in NSIU.

References:

• 1. Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma Acute Care Surg 1993;34:797–802.

• 2. AlBayar, A., Sullivan, P.Z., Blue, R., Leonard, J., Kung, D.K., Ozturk, A.K., Chen, H.I. & Schuster, J.M. 2019, "Risk of Vertebral Artery Injury and Stroke Following Blunt and Penetrating Cervical Spine Trauma: A Retrospective Review of 729 Patients", World neurosurgery, vol. 130, pp. e672-e679.

Presenting Author: Antonina Tcacenco

Supervisor: Mr Joseph Butler

Co-Supervisor: Dr Stacey Darwish

103. 4-YEAR REVIEW OF ACUTE ADMISSIONS TO THE NATIONAL SPINAL INJURIES UNIT (NSIU) OF NON-MYELOPATHIC ELDERLY PATIENTS WITH NEUROLOGICAL DEFICITS REQUIRING CERVICAL SPINAL SURGERY, INVESTIGATING TRENDS IN REFERRAL CHARACTERISTICS AND OUTCOMES.

Wilson, K.,^1,2 McDonnell, J.,¹ O’Malley, S.,¹ Cunniffe, G.,¹ Morris, S,.^1,2 Butler, J.S.^1,2

¹National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland

²UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

The National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital in Dublin is a tertiary referral centre for spinal injuries. This study aims to analyse admission trends at the NSIU from 2016-2020, specifically for elderly patients (>65) presenting with cervical injuries, to inform logistical and resource planning within the unit.

A prospectively gathered database within the NSIU contains details of admissions over the last four years. A retrospective review of this data was undertaken. Variables analysed included patient demographics, mechanism of injury (MOI), length of hospitalisation, complications and mortality. Data was analysed using GraphPad Prism.

Retrospective review identified 52 patients who met the inclusion criteria (>65, cervical injury, neurological deficit), of whom 43 had traumatic cervical spine injuries, 7 had spinal tumours and 2 had epidural hematomas. The most common MOI was falls (60%), followed by RTAs (19%) and atraumatic lesions (17%). Patients with complete neurological deficit (ASIA grade A) had longer average lengths of stay (61 days) compared to those with incomplete deficits (ASIA grade B-D) (19.42 days). All patients with complete neurological deficits had post-operative complications, of whom 43% died within 90 days. In contrast, 54.55% of patients with incomplete deficits had complications, and 9% died within 90 days.

The results demonstrate that patients presenting with complete neurological deficits require more resources, have more complications, and have greater mortality rates than incomplete neurological deficits. This has implications on decision making regarding whether surgery should be performed on these patients or whether they should be treated palliatively.

Presenting Author: Kielan Wilson

Supervisor: Assoc Prof Joseph Butler

Co-Supervisor: Prof Seamus Morris

104. A DETAILED INVESTIGATION OF THE USE OF ANTIMICROBIAL AGENTS INCLUDING CRITICALLY IMPORTANT ANTIMICROBIALS IN THE UCD VETERINARY HOSPITAL (UCDVH)

Gentile, C¹, Edmondson, J¹, Mooney C¹, Leonard F¹, Shiel R¹

¹UCD College of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Inappropriate use of antimicrobials leads to antimicrobial resistance. This study assessed antimicrobial use in cats and dogs within the UCDVH small animal medicine, surgery and oncology sections. Between June 2020 through December 2020, records of 968 new patients were reviewed. Antimicrobials were prescribed in 316 [32.6%] animals, of which 34 [10.8%] were cats and 282 [89.2%] were dogs. A single antimicrobial agent was prescribed in most cases (16 [47%] cats and 180 [63%] dogs).

Amoxicillin clavulanate was prescribed most frequently, (33 [50.7%] cats and 183 [40.9%] dogs). No cats or dogs were prescribed European Medicines Agency class A antimicrobial drugs. Four [7.7%], 51 [78.5%] and nine [13.8%] cats and 45 [10.1%] 346 [77.4%] and 56 [12.5%] dogs were prescribed class B, C and D drugs, respectively. Dosing data were collected for amoxicillin clavulanate, cefuroxime, enrofloxacin, marbofloxacin, and metronidazole. Most antimicrobials were prescribed at appropriate doses, with occasional examples of underdosage of amoxicillin clavulanate, marbofloxacin, and metronidazole, and overdoses in amoxicillin clavulanate and enrofloxacin (24 [5.5%] underdoses and 5 [1.2%] overdoses). The intravenous route of administration was most common in both species (40 [61.5%] cats and 255 [50.3%] dogs).

Prior to presentation, 17 [50%] cats and 127 [44.6%] dogs were prescribed one or more antimicrobials by the referring veterinarian.

This study demonstrated that the restricted class B antimicrobial drugs were used infrequently. Class C drugs were most frequently used. The alternative use of class D drugs, such as non-potentiated amoxicillin, should be explored. Most antimicrobials were prescribed at an appropriate dose.

Presenting Author: Carli Gentile

Supervisor: Assoc Prof Finola Leonard

105. INVESTIGATION OF PRESCRIBING PRACTICES BY IRISH VETERINARY PRACTITIONERS

Edmondson J¹, Mooney C.T¹, Leonard F¹, Shiel R.E¹

¹UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Antimicrobial resistance accession has resulted in scrutiny of both human and veterinary antimicrobial use. The purpose of the study was to investigate prescribing patterns of Irish small-animal veterinary practitioners. An anonymous online survey sent to registered veterinary surgeons collated demographic and prescribing data. Five hypothetical case scenarios were presented to explore antimicrobial use and the associated reasoning.140 clinicians participated in the survey, but only 82 (58.5%) completed all sections. 19 (13.6%) respondents reported that their practice had a policy for antimicrobial use. Veterinarians with 0-5, 6-15, 16-25 and ≥26 years’ experience prescribed antimicrobials in 28/70 (40.0%), 96/250 (38.4%), 82/230 (35.7%), and 53/140 (37.9%) scenarios, respectively. Duration qualified was not associated with the decision to prescribe antimicrobials (χ²(3,n=690)=0.61,p=0.89). The most common reasons influencing the decision to prescribe antimicrobials were in descending order: clinical signs, presumptive diagnosis, culture and susceptibility results, ease of administration, cytology results, financial constraints and client expectations. Amoxicillin-clavulanate was the most routinely prescribed antimicrobial in 99/274 (36%) of all prescriptions. This was underdosed in 17/86 (19.8%) prescriptions. Under general comments, 5/64 (7.8%) respondents described client expectations and pressures influencing prescribing practices, 5/64 (7.8%) indicated that expense influenced ability to perform culture and susceptibility testing, and 5/64 (7.8%) described use of empirical prescribing. This study demonstrated that antimicrobial use is not influenced by the number of years in practice but is influenced by several clinical and owner-dependent factors. Amoxicillin-clavulanate a European Medicines Agency Class C antimicrobial, was widely used and frequently at doses less than commonly accepted guidelines.

Presenting Author: Julie Edmondson

Supervisor: Assoc Prof Finola Leonard

106. PATIENT-REPORTED OUTCOMES PROJECT IN CARDIOVASCULAR SURGERY: SYSTEMATIC REVIEW

Al-Ghabari M¹, Michl K², Ahmed ³, Bele S², Santana M² and Gregory A³

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Cumming School of Medicine, Department of Anesthesiology, Perioperative and PainMedicine, University of Calgary, Calgary AB, Canada

³Libin Cardiovascular Institute, University of Calgary Foothills Medical Centre, Calgary AB, Canada

Perioperative cardiac surgical care has begun to shift focus away from outcomes such as mortality,major morbidity and length of stay (LOS) as there is an increasing focus towards patient-centered careand high-value health care. The emergence of these outcome measures to cardiac surgery are vital inallowing us to understand and improve outcomes that are important to patients (physical, emotional,psychological, social) which can be used by providers to improve care beyond traditional methods.We are conducting a systematic review to assess the use of patient-reported outcome measures(PROMs) and patient-reported experience measures (PREMs) in the perioperative period for adultpatients undergoing open-heart surgery. PROMs and PREMs are metrics that capture information thatcomes directly from the patient.We systematically search the following electronic databases: CINAHL, MEDLINE, PsycInfo andEMBASE databases followed by screening the retrieved articles using Covidence. Data regardingPROM and PREM usage has been extracted from selected studies describing the types ofPROMs/PREMs, appropriate use of measures, timing of measurements, description of scoringfunctions, relation to outcomes (mortality, morbidity and LOS) and quality assessment of studies willbe conducted.Although PROMs/PREMs are being used, often the measures used are unvalidated or only portions ofvalidated PROMs/PREMs are being used which is inappropriate when looking at effectivePROM/PREM usage.While the use of PROMs/PREMs have been shown to improve patient outcomes and experiences,their use with relation to perioperative cardiac surgical care needs to be more standardized and robustto be beneficial to inform value-based healthcare.

Presenting Author: Mahmoud Al-Ghabari

Supervisor: Dr Maria Santana

107. USING WEIGHT LOSS AS AN INDICATION OF DURATION OF ADHERENCE TO A LOW CARBOHYDRATE WEIGHT LOSS DIET

Ibragimov O¹, Paquette M², Sahye-Pudaruth S², Jenkins D², Patel D²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Nutritional Sciences and Medicine, University of Toronto, Toronto, Canada

Weight loss is an effective method of both the prevention and treatment of many diseases [1]. Few studies assess the duration of adherence to a low carbohydrate diet. The purpose of this meta-analysis is to study the extent of weight loss on a low carbohydrate diet and use it as an indicator of adherence to the diet.

A search was run on Medline, Embase, and Cochrane to yield a total of 2146 articles which were screened by 2 reviewers. The screening phase left 43 articles to extract data from, which was used to calculate between group mean differences (MD) and standard error of mean (SEMD). The MD and SEMD of each study was used to create forest plots at 3, 4, 6, 12, and 24-month time points.

Time permitted forest plots to be created on 20 out of the 43 studies. The results of MD (LCI, UCI), and p-value for the 3, 4, 6, 12 and 24 months are as follows: MD = -2.23 (-3.25, -1.21) p-value = 0.0001, MD = -9.17 (-14.9, -3.43) p-value = 0.002, MD = -2.43 (-3.88, 0.98) p-value = 0.001, MD = -1.37 (-2.39, -0.35) p-value = 0.009, MD = 0.43 (-1.48, 2.34) p-value = 0.66, respectively. There was significant weight loss in the low carbohydrate group at every time point except for 24 months.

This means that individuals are able to adhere to a low carbohydrate diet for 1 year but may further research needs to be done on its effectiveness past 1 year.

Reference:

• 1. Iqbal N, Vetter ML, Moore RH, Chittams JL, Dalton‐Bakes CV, Dowd M, Williams‐Smith C, Cardillo S, Wadden TA. Effects of a low‐intensity intervention that prescribed a low‐carbohydrate vs. a low‐fat diet in obese, diabetic participants. Obesity. 2010 Sep;18(9):1733-8.

Presenting author: Omadyor Ibragimov

Supervisor: Dr David Jenkins

108. ARRHYTHMIA’S CONNECTION TO SLEEP DISTURBANCES AND THEIR IDENTIFICATION USING PHOTOPLETHYSMOGRAPHY ANALYSIS

Pollak A¹, Christian F²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America; Division of Pulmonary, Critical Care &amp; Sleep, Department of Medicine, Beth, Israel; Deaconess Medical Centre, Boston, MA, United States of America

Photoplethysmography (PPG) uses infrared light to measure arterial blood volume changes with each pulse beat. Perfusion alterations due to variations in heart rate are reflected on the PPG waveform [1]. These characteristics make PPG a useful tool in recognizing specific arrhythmias without a corresponding electrocardiogram (ECG); such as with premature ventricular complexes (PVCs). Arrhythmia recognition via PPG is useful in home sleep studies (HST's) which are primarily used to identify sleep-disordered breathing such as sleep apneas. Both obstructive and central sleep apneas are associated with arrhythmias and cardiovascular impacts [2].

The purpose of this literature review was to create a comprehensive overview of the possible mechanistic hypothesis between arrhythmias and sleep-disturbances. Additionally, to highlight the use of PPG analysis in their identification in sleep studies.

Literature searches using relevant medical databases were conducted to collect citations relating to the sleep disturbances and arrhythmias, and the use of PPG analysis for their identification. Then reviewed in full-text and evaluated for relevancy and eligibility. After a quality appraisal and assessment, main concepts, themes, and connections were identified. We further characterized how arrhythmias could be recognized on a PPG waveform as you would see it in sleep study data.

Results revealed a correlation between arrhythmias and sleep disturbances. Notably between sleep apneas and atrial fibrillation, which have been connected to acute physiological mechanisms such as intermittent hypoxia [2]. Additionally, that PPG shows effective for use as a diagnostic tool for arrythmias in the context of sleep studies; especially for cases involving sleep disturbances.

References:

• 1. Elgendi M, Fletcher R, Liang Y, Howard N, Lovell NH, Abbott D, Lim K, Ward R. The use of photoplethysmography for assessing hypertension. NPJ Digit Med. 2019 Jun 26;2:60

• 2. Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, Goldberg AN, Long C, Gerstenfeld EP, Yeghiazarians Y. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc. 2019 Jan 8;8(1):e010440

Presenting Author: Alexandra Pollak

Supervisor: Dr Francis Christian

109. A COMPARISON OF OUTCOMES BETWEEN AN IN-PERSON AND TELEHEALTH THERAPY PROGRAMME IN A NATIONAL REHABILITATION HOSPITAL

Davis, E¹ Carty², Carroll A^{2, 3}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Outpatient Department, National Rehabilitation Hospital, Dun Laoghaire, Dublin, Ireland

³National Rehabilitation Hospital, Dublin, Ireland

The COVID-19 pandemic prompted a re-evaluation of the methods in which we deliver outpatient care. This study is a retrospective chart review comparing the effectiveness of a telehealth delivered rehabilitation programme with that of a programme delivered in person. Comparisons were drawn from goals achieved by patients taking part in each programme.

Sample size was 62. Two groups of charts were analysed - ‘In-Person’ (n=30) and Telehealth (n=32). Data including demographic data, quantity of goals set by each patient at the outset of their respective programme and the outcome of these goals by the end was collected. Goals were either ‘achieved’ scored as 1, ‘partially met’ scored as 0.5 or ‘unmet’ scored as 0. Data was recorded using a bespoke data extraction tool and analysed using SPSS statistics software. A separate coding document was produced to maintain patient anonymity in the main collection tool. Charts were located using the hospital’s PAS system. In this chart review we collected basic demographic data using the data minimisation principle.

An independent-samples T test was used to compare the goals achieved by those in each group. There was no significant difference in the scores for In erson (Mean = 1.7, SD = 1.0316) and Telehealth (Mean = 1.673, SD = 1.1333). The p-value for the means is 0.94 and is therefore greater than 0.05.

This study shows that there is no significant difference in the mean goals achieved in the ‘in-person’ and ‘telehealth’ groups indicating that there is no significant difference in outcomes.

Presenting Author: Ellen Davis

Supervisor: Prof Áine Carroll

110. EXAMINING THE EFFECT OF COGNITIVE IMPAIRMENT ON WORK PRODUCTIVITY LEVELS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Maddock CL¹, Su J² and Touma Z²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems including the nervous system, causing neuropsychiatric SLE (NPSLE). NPSLE commonly manifests in cognitive impairment (CI). Many patients living with SLE also deal with a decrease in work productivity. This study aimed to explore the relationship between CI and work productivity in patients with SLE.

Included in this analysis were 236 patients followed at the University of Toronto Lupus Clinic who underwent cognitive screening through use of the American College of Rheumatology Neuropsychological Battery (ACR-NB) and completed the Work Productivity and Activity Impairment (WPAI) questionnaire at their baseline visit. The ACR-NB assesses CI across six cognitive domains. The WPAI assesses absenteeism, presenteeism, overall work impairment and daily activity impairment. Associations between impaired cognitive domains and WPAI outcome metrics were assessed using univariate and multivariate linear regression models.

In the univariate analysis, impairment in domains assessing simple attention and processing speed, learning and memory, and executive functioning were found to be significantly correlated to increased daily activity impairment. In the multivariate analysis, damage resulting from SLE disease activity was found to be significantly associated with increased presenteeism and overall work impairment scores.

Impairment of cognitive domains was not found to be significantly associated with increased absenteeism, presenteeism or overall work impairment scores. Significant correlations between impaired cognitive domains and daily activity impairment were found. These results may indicate that patients’ adaptive mechanisms are more effective in offsetting cognitive impairment in the workplace than in everyday activities.

Acknowledgment:

The author would like to acknowledge support and funding from the Hospital Saturday Fund Grant and the Canadian Rheumatology Association.

Presenting Author: Connor L. Maddock

Supervisor: Dr Zahi Touma

111. RARE GENOMIC COPY NUMBER VARIANTS ARE A PREVELANT CAUSE OF

BICUSPID AORTIC VALVE DISEASE

Albasha H³, Carlisle S^{1, 2}

¹Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America

²Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America

³UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Bicuspid aortic valve (BAV) is the most common congenital heart defect in 1% of adults and cause 50-70% risk for thoracic aortic aneurysms or acute aortic dissections (TAD) [1]. BAV is inherited as an autosomal dominant trait with variable penetrance and expressivity due to interactions between many causative genes and cardiovascular risk factors such as hypertension. We have previously found large rare genomic copy number variants (CNVs) in BAV and TAD cases with early onset disease [2].

We hypothesized that rare CNVs are enriched in BAV and involve genes that regulate heart development. To expand on these observations, I developed a computational pipeline to identify rare CNVs in 5040 Illumina SNP array genotypes from the International BAV Consortium. First, I analyzed raw intensity data using three different algorithms (PennCNV, QuantiSNP, iPattern) to generate initial CNV calls and sample-level quality statistics. Next, I used R packages in EnsembleCNV to eliminate outliers by principal component analysis and to re-genotype a definitive list of consensus CNV regions. Finally, I used PLINK to annotate and catalogue rare CNVs. I identified X large (>200 Kb) genic CNVs in BAV cases: X duplications and X deletions. X of these CNVs involve genes that cause BAV when mutated, including recurrent rare CNVs of 22q11.2 (X) and 16p13.1 (X). In total, I identified causative CNVs in X% of BAV cases and am currently replicating these data in additional BAV cohorts and 25,000 controls. We will assess validated recurrent CNVs as novel genetic markers to predict BAV complications.

References:

• 1. Musfee FI, Guo D, Pinard AC, Hostetler EM, Blue EE, Nickerson DA, University of Washington Center for Mendelian Genomics (UW CMG), Bamshad MJ, Milewicz DM, ‐ Prakash SK. Rare deleterious variants of NOTCH1, GATA4, SMAD6, and ROBO4 are enriched in BAV with early onset complications but not in BAV with heritable thoracic aortic disease. Molecular Genetics & Genomic Medicine. 2020 Oct;8(10):e1406.

• 2. Prakash S, Kuang SQ, GenTAC Registry Investigators, Regalado E, Guo D, Milewicz D. Recurrent rare genomic copy number variants and bicuspid aortic valve are enriched in early onset thoracic aortic aneurysms and dissections. PloS one. 2016 Apr 19;11(4):e0153543.

Presenting Author: Hasan Albasha

Supervisor: Dr Siddharth Prakas

112. BEHAVIORAL INSIGHTS FOR ROUTINE IMMUNIZATION AND COVID-19 VACCINATION IN KYRGYZSTAN

Scher C¹, Henderson Riley A²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States of America

Routine immunization rates in Kyrgyzstan have fallen recently [1], and vaccine hesitancy is rising. The COVID-19 pandemic has exacerbated this issue. Several studies stress the importance of social norms in public health interventions, as they are a major behavioral determinant. For example, a study in Kyrgyzstan found that perceived attitudes of those in one’s social network regarding COVID-19 immunization were important determinants of vaccine acceptance [2]. Campaigns targeting norms have been shown to be more effective than communication initiatives focusing solely on individual-level variables. However, most communication efforts tend to only address individual variables.

We aimed to find the gaps in social and behavioral research surrounding immunization and vaccine hesitancy in Kyrgyzstan by reviewing and analyzing literature with the social ecological model. Of the 27 grey literature documents reviewed, only 13 reference social norms; 6 refer to vaccination, and only 3 identify social norms as an important factor in vaccine messaging. 9 documents focus on the COVID-19 pandemic, and only 4 of them identify social norms as an important behavioral influence. Only 1 of the 7 Kyrgyzstan-specific documents discusses social norms. In the academic literature, only 3 articles provided empirical evidence of social norms and vaccination, and the 2 specific to Kyrgyzstan did not mention social norms.

Several resources emphasize how social norms are an important behavioral determinant. Most behavioral research in Kyrgyzstan has focused on individual and interpersonal factors, thus social norms research is necessary to design more effective communication campaigns to promote COVID-19 vaccination and routine immunization.

References:

• 1. National Statistical Committee of the Kyrgyz Republic and UNICEF (2019), Kyrgyz Republic, Multiple Indicator Cluster Survey 2018, Survey Findings Report (retrieved from: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Europe%20and%20Central%20Asia/Kyrgyzstan/2018/Survey%20findings/Kyrgyzstan%20MICS%202018_English.pdf).

• 2. Duke University Center for Advanced Hindsight (2021) What Drives Compliance with COVID-19 Recommendations in Kyrgyzstan? [Draft of Research Report]

Presenting Author: Carly Scher

Supervisor: Dr Amy Henderson Riley

113. ENHANCING THE MANAGEMENT OF LONG COVID IN GENERAL PRACTICE: A SCOPING REVIEW

A Brennan¹, J Broughan¹, G McCombe¹, A Guérandel^1,2, C Collins³, J Brennan⁴ , J Gallagher¹, D Quinlan³, J S. Lambert^1,5, B O’Kelly^1,5, W Cullen¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital, Dublin, Ireland

³Irish College of General Practitioners, Dublin, Ireland

⁴Royal College of Physicians in Ireland, Dublin, Ireland

⁵Mater Misericordiae University Hospital Dublin, Ireland

Persistent symptomatic COVID-19 is a multi-system condition that affects approximately 10% of those with acute COVID-19 infection. Affected patients often have complex care needs requiring holistic and multidisciplinary care approaches, the kind routinely provided in general practice. However, there is a lack of evidence of appropriate general practice interventions for the condition.

A scoping review was conducted using Arksey and O’Malley’s 2005 five-stage framework[1], with later recommendations by Levac et al.[2] to examine the literature and identify knowledge gaps in general practice management of persistent COVID-19. Nineteen papers were selected for review. The studies spanned numerous geographical locations, encompassing several study designs, and a range of populations and sample sizes. The included studies used various definitions for persistent symptomatic COVID-19.

The literature was analysed qualitatively, and six major themes were identified. These themes were (i) GP uncertainty, (ii) Listening and empathy, (iii) Assessment and monitoring of symptoms, (iv) Coordinating access to appropriate services, (v) Facilitating provision of continual and integrated multi-disciplinary care and (vi) Need to facilitate psychological support.

Overall, the findings show that general practitioners play a key role in the management of persistent COVID-19, but that more clinical guidance on appropriate interventions is necessary to enhance care. There is a need for scientifically accepted definitions for persistent COVID-19 to ensure that patients can be recognized, assessed and managed appropriately. Patient and public involvement should guide policy makers when developing future care models. Meanwhile, future research should evaluate the implementation and effectiveness of proposed management strategies and interventions.

Acknowledgment:

The author would like to acknowledge funding from the family of the late Dr Mary J Farrell, the Health Research Board (HRB), Ireland East Hospital Group, as well as internal funding schemes at the UCD School of Medicine, and the UCD College of Health and Agricultural Science.

References:

• 1. Arksey, H. and L. O'Malley, Scoping studies: towards a methodological framework. International journal of social research methodology, 2005. 8(1):19-32.

• 2. Levac, D., H. Colquhoun, and K.K. O'Brien, Scoping studies: advancing the methodology. Implementation science, 2010. 5(1):1-9.

Presenting Author: Aimee Brennan

Supervisor: Prof Walter Cullen

Co-Supervisor: Mr John Broughan

114. THE IMPACT OF DIRECT ACCESS TO DIAGNOSTIC IMAGING IN GENERAL PRACTICE ON PATIENT CARE AND OUTCOMES: A LITERATURE REVIEW

C Burke¹, G McCombe¹, J Broughan¹, C Collins², R Fawsitt³, J McNulty¹, M O’Callaghan^2,4, D Quinlan², W Cullen¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Irish College of General Practitioners, Dublin, Ireland

³Ireland East Hospital Group, Dublin, Ireland

⁴School of Medicine, University of Limerick, Ireland

Diagnostic imaging forms an essential component of the healthcare continuum, reducing the need for invasive and exploratory processes and allowing for earlier diagnosis with improved patient outcomes (1). General practitioners (GPs) are highly trained but constrained by their limited access to diagnostic imaging within the primary care service. This often results in the inappropriate referral of patients to secondary care services, in order to access diagnostic imaging. Since 2007, the Health Service Executive (HSE) have introduced several initiatives aimed to improve direct access for GPs to diagnostics, both locally and through outsourced service models.

A scoping review was conducted using Arksey and O’Malley’s 2005 six-stage framework (2) to examine the literature and determine the impact that direct access to diagnostic imaging within general practice can have on patient care and outcomes. Thirty-two papers, with various methodologies and spanning numerous geographical locations, were selected for review. Studies were analysed qualitatively using a thematic analysis approach.

The findings show that direct access to diagnostic imaging can positively impact patient care and outcomes, while reducing referrals to secondary care. However, implementation will involve changes to the healthcare system in the following areas: (i) national policy, (ii) national standardised guidelines for referral, and (iii) enhanced education for GPs and GP trainees.

The results of this review indicate further research is required in this area to examine the feasibility of proposed HSE initiatives which aim to improve patient outcomes and the quality of patient care.

Acknowledgement:

The author would like to acknowledge funding from Medisec Ireland.

References:

• 1. Bercovich E, Javitt MC. Medical Imaging: From Roentgen to the Digital Revolution, and Beyond. Rambam Maimonides medical journal. 2018;9(4):e0034.

• 2. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19-32.

Presenting Author: Corey Burke

Supervisor: Dr Geoff McCombe

Co-Supervisor: Prof Walter Cullen

115. REVIEW OF THE ROLE OF PHARMACOGENETIC TESTING IN TAMOXIFEN THERAPY: DRUG LICENCING, CLINICAL PRACTICE GUIDELINES, AND PHYSICIAN OPINION

Browne E¹, Byrne P^{1, 2}, Gallagher H^{1, 2}

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland

Tamoxifen is an endocrine treatment in oestrogen receptor-positive breast cancer. The conversion of tamoxifen to its most active metabolite endoxifen is catalysed mainly by the cytochrome P450 2D6 enzyme (CYP2D6). Genetic polymorphisms in CYP2D6 can alter endoxifen plasma concentration, potentially impacting therapy efficacy. The association between CYP2D6 genotype and clinical outcome is controversial, with much conflicting evidence.

The aim of this study was to examine current recommendations and practices of pharmacogenetic testing in tamoxifen therapy, using national summaries of product characteristics, clinical practice guidelines, and a survey of Irish and Canadian medical oncologists and general practitioners (GPs).

This review found that Japan and Canada are the sole drug licensing authorities that recommend CYP2D6 testing prior to tamoxifen prescription. Additionally, it is not recommended by most national breast cancer treatment guidelines. The results of the survey indicate that most Irish and Canadian oncologists do not consider patient genetics prior to prescribing tamoxifen. Awareness of the potential role of pharmacogenetics appeared higher among Canadian oncologists-with 40% considering CYP2D6 polymorphisms following tamoxifen unresponsiveness, compared to 14% of Irish oncologists. The disparity in awareness about pharmacogenetic testing in tamoxifen treatment was much greater amongst GPs; none of the Irish respondents indicated an awareness of the clinical application of pharmacogenetics, compared to 50% of their Canadian counterparts, suggesting the field has not yet reached those working in primary care in Ireland.

Further research, such as a large-scale, randomised control trial must be completed before the debate of pharmacogenetic testing in tamoxifen therapy can be concluded.

Presenting Author: Emmet Browne

Supervisor: Assoc Prof Paula Byrne

116. DISABILITY AND HEALTHCARE INEQUALITIES IN 19 ^th AND 20 ^th CENTURY IRELAND: A MEDICAL AND SOCIO-CULTURAL HISTORY

A Lewis¹ C Cox²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD School of Medicine, Centre for the History of Medicine in Ireland, UCD School of History, University College Dublin, Belfield, Dublin 4, Ireland

The treatment of persons with physical and intellectual disability reflects the values of the state and society. Persons with disability often experience discrimination and barriers to healthcare in Ireland (1). The purpose of this study was to assess whether the barriers to health equity for persons with disability, including those from ethnic minority groups, have changed through time. The study focused on the Irish Traveller population to gain insight into the challenges encountered by those with disability who belong to ethnic minority groups. This cohort experience a high prevalence of disability due to consanguinity and poor access to healthcare (2). Stigma also exists around disability within the Traveller community. Current and historical attitudes were compared and accessed using newspaper articles, census data, personal accounts and government reports. The results demonstrated that societal attitudes and access to healthcare have improved since the reports published by the 1963 Commission of Itinerancy and 1965 Commission of Inquiry on Mental Handicap. These reports marked changes in attitude towards these groups. Despite positive legislation to address health inequality, there continues to be a lag between policy and implementation.

Overall, this research highlights that historical distrust and experiences of discrimination have resulted in a continued reliance on community resources and a reluctance to engage with state services. Insufficient progress has been made to tackle the barriers to healthcare encountered by persons with disability. Increased funding and awareness of these issues are essential to drive future policy and resolve the healthcare inequalities these groups experience today.

Acknowledgement:

The author would like to acknowledge funding and support from the UCD School of Medicine and the UCD Centre for the History of Medicine in Ireland, UCD School of History.

References:

• 1. Joanne Banks RG, Éamonn Fahey DW. Disability and Discrimination in Ireland: Evidence from the QNHS Equality Modules 2004, 2010, 2014. Economic and Social Research Institute; Irish Human Rights and Equality Commission; 2018.

• 2. Lynch SA, Crushell E, Lambert DM, Byrne N, Gorman K, King MD, et al. Catalogue of inherited disorders found among the Irish Traveller population. Journal of Medical Genetics. 2018;55(4):233.

Presenting Author: Anouchka Lewis

Supervisor: Assoc Prof Catherine Cox

117. WHO CHANGES THE MOST? PRIMARY CARE PHYSICIAN AND PRACTICE CHARACTERISTICS IN AUDIT AND FEEDBACK INTERVENTIONS: A SCOPING REVIEW

Paulovic JG⁵, Hamilton MA³, McCracken R^,2,3,4, Klimas, J^1,2

¹British Columbia Centre on Substance Use, Vancouver, B.C., Canada

²Centre for Health Evaluation and Outcomes (CHEOS), Providence Health Care, St. Paul’s Hospital, Vancouver, B.C, Canada

³Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada

⁴Innovation Support Unit, Department of Family Practice, University of British Columbia, Vancouver, Canada

⁵UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Audit and feedback (A&F) interventions elicit behaviour change by describing existing patterns of behaviour and providing education about desired “ideal” behaviours. Although there are numerous studies that evaluated the effectiveness of A&F interventions on clinician prescribing behaviours, few have looked at which prescriber and practice characteristics would most likely lead the largest response to A&F interventions. Since the effects of the A&F interventions have been noted to vary based on the way they are designed and delivered, understanding the clinician factors that affect change in prescribing behaviour is necessary for optimizing audit and feedback interventions. We aimed to identify primary care physician and practice characteristics that are associated with the largest changes in prescribing behaviours following audit and feedback interventions.

We followed the Arksey and O’Malley five-stage scoping review method. Included studies involved primary care physicians that had undertaken a practice audit with a subsequent feedback session.

The initial search of MEDLINE and EMBASE identified 960 studies, with no additional studies added from hand-searching reference lists. Five studies were considered relevant and included for a narrative analysis. Among included studies, a variety of physician behaviours were discussed, including NSAID prescriptions and management of cardiovascular disease. A variety of physician and practice characteristics are associated with audit and feedback response.

Further investigation of prescriber and practice characteristics associated with higher magnitude changes in physician behaviour could advance the utility of audit and feedback interventions. Quasi-experimental designs should be prioritized to allow for more robust conclusions.

Acknowledgements:

The author would like to acknowledge funding from the UCD School of Medicine via the 2021 Dean’s SSRA International Summer Research Scholarship

Presenting Author: Jordan Paulovic

Supervisor: Dr Jano Klimas

Co-Supervisor: Dr Rita McCracken

118. DEVELOPMENT OF AN IN VITRO ORGANOTYPIC CULTURE MODEL FOR PANCREATIC DUCTAL ADENOCARCINOMA

E Kearns¹, S Thorpe¹

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Pancreatic Ductal Adenocarcinoma (PDAC) is the most common type of pancreatic cancer and one of the deadliest cancers. The 5-year survival rate is under 9% (1). Although there has been years of research in this field, this statistic has remained the same, highlighting the missing therapeutic breakthrough needed to treat it. The low survival rate is due to the development of dense stroma within the tumour micro-environment (TME) by pancreatic stellate cells (PSCs). They are activated into fibroblasts and secrete extracellular matrix proteins, creating a favourable TME.

So far, animal models are the closest thing to mimicking the PDAC TME, yet still fail to represent the desmoplastic reaction of human tumours (2).

The aim of this research was (a) culture and image mouse myofibroblasts (MEFs) on PeptiGels (b) 2D and 3D culture of PSCs on PeptiGels of different stiffnesses, (c) Live-Dead Assay to test cell viability in different gels. PSCs were seeded (15,000 cells/30uL gel for 3D work and 20,000 cells/50 uL gel for 2D) in culture medium containing Dulbecco’s Modified Eagle Medium/F12, Foetal Bovine Serum and Penicillin-Streptomycin.

The results from the 2D Live/Dead Assay show that ⍺2 and ⍺2RGD are the optimal PeptiGels for PSCs. These were the stiffest gels out of the five, with a kPa value of 10.

The results from the Live/Dead Assay demonstrate that cells need to be seeded at higher densities for 3D work and also, not to be left for more than 1 hour in the Live/Dead solution, as they will appear dead.

References:

• 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: A Cancer Journal for Clinicians. 2019;69(1):7-34.

• 2. Lee J, Condello S, Yakubov B, Emerson R, Caperell-Grant A, Hitomi K, et al. Tissue Transglutaminase Mediated Tumor–Stroma Interaction Promotes Pancreatic Cancer Progression. Clinical Cancer Research. 2015;21(19):4482-93.

Presenting Author: Ella Kearns

Supervisor: Dr Stephen Thorpe

119. ABSOLOUTE LYMPHOCYTE COUNT (ALC) AND NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) IN PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC) TREATED WITH COMBINED IMMUNE CHECKPOINT INHIBITION AND TRANSARTERIAL CHEMOEMBOLIZATION (TACE)

Evans N¹, Buchalter J², Browne I³, Carroll HK², Galligan M¹, Bourke M³, Lester-Grant A¹, Desmond F², Hoey K³, Greten TF⁴, Ryan R³, Cantwell CP^1,3, McCann J³, McDermott J³, MacNicholas R³, Houlihan D⁴, Duffy AG^1,2

¹UCD Clinical Research Centre, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Mater Misericordiae University Hospital, Dublin 7, Ireland

³St Vincent’s University Hospital, Dublin 4, Ireland

⁴National Cancer Institute, NIH, Bethesda, Maryland United States of America

TACE induces a peripheral anti-tumour immune response, which may be amplified by immune checkpoint inhibitors (ICIs). Though an approved treatment for HCC, the majority of patients do not respond to ICIs and identification of predictive biomarkers is needed.(1) NLR is associated with response in other malignancies treated with ICIs.(2) The aim of this research was to evaluate ALC and NLR in HCC patients treated with combined ICIs and TACE.

Medical records of HCC patients (Childs Pugh A/B7; Barcelona Clinic Liver Cancer Stage B/C; ECOG 0/1; sorafenib-naïve or experienced) enrolled in an ongoing study (UCDCRC/19/01) of tremelimumab, durvalumab and subtotal TACE were reviewed. Full blood count including differential sample assessments were performed at baseline and weekly.

13 patients enrolled. M:F 10:3. Median age 70 (65-74); BCLC B/C 4/9; extrahepatic disease 6/13; aetiology: NASH (N=3), alcohol-related disease (N=1), HCV (N=2), haemochromatosis (N=1), unknown (N=6). Median ALC at baseline was 1.0 and 5 patients had lymphopenia. Median percentage change in ALC from baseline at week 4, 8 and 12 was 7.15%, -10% and -20%. Median NLR at baseline was 3.36. Median percentage change in NLR from baseline at week 4, 8 and 12 was -2.4%, 5.5% and 17.19%. Progression-free and survival data will be presented.

ALC and NLR are readily available and inexpensive biomarkers of interest for patients treated with ICIs. In this novel trial of combined ICI and TACE in advanced HCC, dynamic changes in ALC and NLR were seen and with longer follow-up their relationship with clinical outcome will be explored.

References:

• 1. Greten TF, Lai CW, Li G, Staveley-O’Carroll KF. Targeted and Immune-Based Therapies for Hepatocellular Carcinoma. Gastroenterology. 2019;156(2):510–24.

• 2. Cassidy MR, Wolchok RE, Zheng J, Panageas KS, Wolchok JD, Coit D, et al. Neutrophil to Lymphocyte Ratio is Associated With Outcome During Ipilimumab Treatment. EBioMedicine. 2017;18:56–61.

Presenting author: Niamh Evans

Supervisor: Assoc Prof Austin Duffy

120. THE HISTORICAL USE OF RADIOGRAPHY AND DIAGNOSTIC IMAGING TO DIAGNOSE AND TREAT MULTIDRUG-RESISTANT TUBERCULOSIS: EXPLORING STRATEGIES FOR EARLY DIAGNOSIS AND MONITORING RESPONSE TO THERAPY

Hong J¹, Davis M²

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Tuberculosis remains a global killer despite scientific advancements. A major reason for that is the rising prevalence of multidrug-resistant tuberculosis (MDR-TB) - a strain of tuberculosis resistant to isoniazid and rifampicin¹. As inappropriate anti-microbial treatment can lead to dangerous implications for the patient, it is imperative for a case of MDR-TB to be identified rapidly. Radiographic imaging is the preferred diagnostic tool for tuberculosis due to its availability in primary healthcare. This research explored the historical use and functionality of radiography in tuberculosis management, with specific aims to identify radiological signs associated with MDR-TB on chest X-ray images and position emission topography (PET) scans.

This project was conducted with a retrospective literature review. A search on PubMed and NCBI was performed, using the keywords ‘tuberculosis’, ‘multidrug-resistant tuberculosis’, ‘X-rays’ and ‘PET scan’. Studies that discussed identifying or managing tuberculosis and the application of X-rays or PET scans were included. Studies that focused exclusively on adolescents below age 18 or immunocompromised patients were excluded.

Comparison between chest X-ray images of conventional tuberculosis and MDR-TB yielded significant differences, namely more extensive infections with multiple cavities in MDR-TB¹. The usage of PET scans with flurodeoxyglucose-18 as a glucose analogue was identified as valuable in evaluating tuberculosis disease activity in response to anti-microbial therapy².

Healthcare professionals should direct more focus onto screening high-risk MDR-TB patients with chest X-ray examinations before beginning treatment, and consider including PET scans in early stages of treatment to identify potential MDR-TB, such that the management plan can be adjusted accordingly.

Acknowledgements:

The author would like to acknowledge funding from Medica Ireland.

References:

• 1. Wáng Y, Chung M, Skrahin A, Rosenthal A, Gabrielian A, Tartakovsky M. Radiological signs associated with pulmonary multi-drug resistant tuberculosis: an analysis of published evidences. Quantitative Imaging in Medicine and Surgery. 2018;8(2):161-173.

• 2. Yu W, Lu P, Assadi M, Huang X, Skrahin A, Rosenthal A et al. Updates on 18F-FDG-PET/CT as a clinical tool for tuberculosis evaluation and therapeutic monitoring. Quantitative Imaging in Medicine and Surgery. 2019;9(6):1132-1146.

Presenting Author: Jingqi Hong

Supervisor: Dr Michaela Davis

121. ANALYSIS OF STAKEHOLDER PERCEPTION OF COMPARATIVE ONCOLOGY IN THE STUDY OF MELANOMA

Collins B¹, Bollard SM^1,2,3, Howard J^1,2, Canavan C³, Kelly P, McCann A^1,2, Potter SM^1,2,3

¹UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

²UCD Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Belfield, Dublin 4, Ireland

³Department of Plastic, Reconstructive & Aesthetic Surgery, Mater Misericordiae University Hospital, Phibsborough, Dublin 7, Ireland

Comparative oncology examines naturally occurring cancers seen in both animals and humans to compare findings between species. It is a growing field which has the potential to benefit both veterinary and human patients by giving insights into cancer progression and treatment responses. Importantly, comparative oncology requires collaboration between many groups including Veterinary Professionals, Human Healthcare Professionals, Biomedical Researchers, Pet Owners, and People with Lived Experience of Cancer. Our study aimed to qualitatively assess the different perceptions and knowledge of comparative oncology between these various stakeholders.

Interviews and a survey were conducted by senior researchers analysing the perceptions of various stakeholder groups involved in Comparative Oncology: Veterinarians, Patients, Healthcare Professionals and Biomedical Researchers. Information was included on Respondent Subgroups, Pet Ownership status, as well as opinions on Communication of Findings, Consent, Knowledge, Opinions, and Values/Concerns. These interviews and surveys were analysed in NVivo using matrix coding and standardised in Excel using a mentions per person ratio to assess perceptions across subgroups.

One hundred seventy-six individuals responded to the anonymous survey, and a further 12 individuals were interviewed to assess their knowledge and perceptions regarding Comparative Oncology. The stakeholder groups presented with various levels of knowledge and concerns regarding Comparative Oncology. Expectedly, the biomedical researcher cohort had the greatest knowledge mentions per person of 1.9, followed closely by Veterinary professionals (1.4), with the lowest being Human Healthcare Professionals (0.55). The Concerns held by respondents were classified as “Animal Welfare”, “Convenience”, “Cooperation with Veterinary Professionals”, “Data Management/Storage”, “Information Availability”, “Scientific Rigour”, and “No Concerns”.

In our study, the stakeholder groups held different perceptions of comparative oncology. Researchers were most concerned with scientific rigour whilst Veterinarians were most often concerned with animal welfare.

The results of this study indicate the different values held by the stakeholders in comparative oncology and indicate areas researchers must address when undertaking these studies.

Presenting Author: Bridget Collins

Supervisor: Assoc Prof Shirley Potter

Co-Supervisor: Dr Stephanie Bollard