UCD School of Medicine Summer Student Research Awards 2018

Irish Journal of Medical Science (1971 -) (2018) 187 (Suppl 11 ):S325–S354 https://doi.org/10.1007/s11845-018-1941-8 ROYAL ACADEMY OF MEDICINE IN IRELAND

IRISH JOURNAL OF MEDICAL SCIENCE

UCD School of Medicine

Summer Students Research Awards 2018

UCD, Dublin, Ireland S326 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

Disclosure Statement This supplement has received no external funding or sponsorship Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S327

1. TAKING THE FUN OUT OF FUNGI: OPTIMISING A PROTOCOL purity measured by Nanodrop 2000. Following reverse-transcription, quanti- TO DETECT FUNGI FROM MURINE FECAL SAMPLES FOR tative real-time PCR was used to amplify miR-30c, miR-101-3p and miR-192 ANALYSIS OF THE MYCOBIOME with U6 as positive control. Using this approach, we demonstrated that miRNAs could be recovered from Zhang N1,SinghA2, Knaus U2 urine in both concentration and quality suitable for PCR analysis. We demonstrated that type of sample did not impact RNA yield nor was the time of 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. centrifugation important. We further showed that whilst exosome enrichment did not increase the overall yield of miRNAs, it did result in improved ampli- 2 UCD Conway Institute of Biomolecular & Biomedical Research, University fication profiles. College Dublin, Belfield, Dublin 4. Having identified preanalytical factors affecting miRNA yield we sought to determine the expression of candidate miRNAs in urine. Reversing bacterial dysbiosis, the hallmark of a disturbed balance of These analyses showed elevated expression miR-30c, miR-101-3p commensal communities in the human gut frequently observed after and miR-192 in Stage 3 AKI, potentially identifying them as markers antibiotic use and in intestinal inflammation, is a key area of medical of AKI. interest. However, studies relating to the mycobiome of the gastroin- testinal tract are still relatively rare. Recent reports suggested alter- In conclusion, these investigations show that miRNAs can be reliably ations in biodiversity of the mycobiome in inflammatory bowel dis- and reproducibly detected in urine, enabling further investigation into eases (fungal dysbiosis)[1]. Robust protocols to quantitatively determine their role in AKI. the relative abundance of various fungi is required to study fungal Acknowledgments: communities in homeostasis and inflammatory disease conditions. This research was supported by a Summer Student Scholarship from the The aim of this project was to detect common fungal species in wildtype Health Research Board (HRB). mouse colon by developing and optimizing protocols to determine relative References fungal abundance. Primers detecting various fungi in mouse feces were chosen from reference 1. Pei-Chun F, Chia-Chun C, Yung-Chang C, Yu-Shun C, Pao-Hsien C. papers and their most suitable annealing temperatures were evaluated by MicroRNAs in acute kidney injury. Human Genomics. 2016; 10:29. Gradient PCR. Purified Candida gDNA was used as a control to confirm Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016954/ suitability for selected primers and SYBR Green PCR was then executed to [Accessed 11th June 2018] test for amplification of the target under qPCR conditions. Nineteen murine Presenting Author: Su Wei Ng fecal samples were collected: 7 from wildtype mice and 12 from the mutant mouse strain Cybanmf333. Two different commercial gDNA extraction kits for Supervisor: Prof Peter Doran murine fecal samples were compared, and the initial extraction protocol was Co-Supervisor: Prof Patrick Murray further amended. Our final qPCR results demonstrate that even with modifications, insufficient fungal gDNA was extracted. Further studies will be neces- 3. COMPONENTS AND CONSIDERATIONS OF A CRITICAL CARE sary to devise a more stringent gDNA extraction strategy for fungi, TRIAL: A REMAP-CAP SUBSTUDY but several sets of primers were optimized, thereby facilitating the study of murine fungal communities in the near future. Rahmani M1,ByrneJP1,NicholA1 References 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 1. Paterson M, Oh S, Underhill D. Host–microbe interactions: commensal fungi in the gut. Current Opinion in Microbiology. 2017;40:131-137. The Platform for European Preparedness against (Re-) Emerging Epidemics Presenting Author: Nicholas Zhang (PREPARE) conducts inter-pandemic clinical research to optimise trial con- Supervisor: Prof Ulla Knuas duct, improve patient-centred outcomes, and inform clinical management strategies during a pandemic. One such trial is the Randomized, Embedded, Multifactorial, Adaptive Platform trial for patients with 2. THE ROLE OF MicroRNAs IN ACUTE KIDNEY INJURY (AKI) Community-Acquired Pneumonia (REMAP-CAP) which uses multiple interventions simultaneously to determine the most effective treatments for Ng SW1,EiversS1, Inzitari R1, Wallace D1,Murray P1,DoranP1 ICU patients with CAP. [1] Embedded in the Irish Critical Care Clinical Trials Network, I conducted a 1UCD Clinical Research Centre, UCD School of Medicine, University College qualitative stakeholder analysis [2] to identify and map the key features of the Dublin, Belfield, Dublin 4. REMAP-CAP trial. Data were collected through observation, analysis of trial documentation and six semi-structured interviews with essential personnel. Recurring themes and considerations were grouped and linked to specific Despite decades of advancement, much is still not understood regarding the stages of trial design. pathology of organ failure including Acute Kidney Injury (AKI). The findings highlight the multitude of components and considerations re- MicroRNAs (miRNAs) are endogenous short single-stranded noncoding quired for the successful running of multi-site trials like REMAP-CAP. RNAs that play a role in post-transcriptional regulation of cell functions [1]. Implicit but important considerations are; the implications of the novel trial Given their regulatory bioactivities, we hypothesise that miRNAs are central to design, multi-site variance in ethics and contracts, understanding within the the evolution of AKI and urinary patterns of miRNA expression reflect both consent process, staff engagement with the trial, randomisation and recruit- stage and outcome. ment. Critical issues running throughout the trial process included time-sensi- To test this hypothesis, we must demonstrate that miRNAs can be reliably tivity, feasibility of practical trial requirements, and communication between detected in urine, by determining the impact of the pre-analytic factors affect- clinicians and sites. ing recovery. miRNeasy and miRCURY exosome kits were used to isolate Each component of REMAP-CAP is fundamental to its overall success. urinary microRNAs and enrich exosome samples. RNA concentration and Stakeholders involved at different levels and sites are often unaware of the S328 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 range of components of a multi-site trial. This study will inform future trial 6. COMPUTATIONAL MODELLING OF THE LAMINA CRIBROSA stakeholders by providing a framework of key considerations for a multi-site REGION OF THE OPTIC NERVE HEAD trial thereby helping to optimise integration of clinical research into a pandemic response. Kostka MK1, Clissmann D1, Wallace D2, Ní Annaidh A3,O’Brien C2,4, Acknowledgments: Brennan D1 PREPARE is an EU-FP7 funded network conducting inter-pandemic clinical research on infectious diseases (http://www.prepare-europe.eu/). 1Anatomy, UCD School of Medicine, Health Sciences Centre, Belfield, Dublin 4. References 2Clinical Research Centre, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin 7. 1. Webb S. Managing uncertainty in clinical trials: the role of adaptive trial 3Centre for Biomedical Engineering, UCD School of Mechanical & Materials designs [Webinar] Online: Global Research Collaboration for Infectious Engineering, Belfield, Dublin 4. Disease Preparedness; 2017 4Institute of Ophthalmology, Mater Misericordiae University Hospital, 60 2. Varvasovsky Z, Brugha R. How to do (or not to do) A stakeholder analysis. Eccles Street, Dublin 7. Health Policy Plan 2000; 15(3): 338–345 Presenting Author: Maha Rahmani Glaucoma is a multi-factorial ocular disease with morphological changes of the Supervisor: Prof Alistair Nichol lamina cribrosa (LC), a specialised fenestrated region of the optic nerve head Co-Supervisor: Dr John-Paul Byrne (ONH). The LC microarchitecture consists of pores and fibro-elastic beams with intraocular pressure (IOP)-load bearing capacity. In glaucoma, elevated IOP results in mechanical deformation, triggering tissue remodeling and leading to 5. DEFINING FOOD ALLERGY DOCUMENTATION IN CANADIAN a thin, stiff, fibrotic structure. Due to the complex geometry and biomechanics of PRIMARY CARE PRACTICES the region, computational modelling has become an important method to predict the structural response of the LC to glaucomatous change. A virtual representation of the human eye was developed using open-access Nankissoor NN1,SingerA2,AbramsE2 software gmsh1 and FEniCS2. A macro-scale model of the posterior pole was constructed incorporating thickness, geometry and material properties of the 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. ocular tissues, aligned with measurements published in the literature3.TheLC 2University of Manitoba, Winnipeg, Manitoba. was represented as a continuum, embedded within the surrounding sclera, pre- ganglionic/ganglionic tissue, optic nerve and pia mater. Food allergies (FA) is a worldwide condition, and in Canada a nationwide Results confirmed the expected mechanical behaviour of the region, which survey determined 8.1% of Canadians have a FA [1]. However, self-reported closely resembled observations from clinical practice. The model was optimised data limitations suggest this maybe an overestimation. Our study aims to to efficiently incorporate geometric variations and allow high fidelity simulations determine the prevalence of physician reported FA using Electronic Medical to be run on a laptop computer without the need for high performance computing Record (EMR) data from providers participating in the Manitoba Primary Care resources. This finite element model (FEM) allows the prediction of the LC’s Research Network (MaPCReN). We expect a lower prevalence of FA com- structural response to normal and glaucomatous IOP. pared to studies of self-reported rates. This work forms the basis for microscale modelling of the LC region. Beam stiffness An algorithm detecting FA documentation was constructed and validated, is an important property governing cell durotaxis, gene expression and the fibrotic defining 2817 chart entries as FA out of 4488 possible allergy entries. The transformation of LC cells. Future FEM is planned to deduce beam stiffness, which MaPCReN contains 221,132 patients; those with FA were flagged by the is not amenable to mechanical testing, using an inverse modelling approach. constructed algorithm. Descriptive statistics assessed for FA prevalence and References a multivariable logistic regression model determined the association with patient, provider and practice variables. 1. Geuzaine C, Remacle JF. Gmsh: A 3‐D finite element mesh generator with 1.4% of Manitobans have a documented FA, of which 61.4% have one built‐in pre‐and post‐processing facilities. International journal for numerical or more comorbidities (asthma, depression, diabetes, hypertension, au- methods in engineering. 2009 Sep 10;79(11):1309-31. tism, or ADHD). Of those with FA, 44.8% (P=<0.0001) and 34.3% 2. Alnæs MS, Blechta J, Hake J, Johansson A, Kehlet B, Logg A, Richardson (P=<0.0001) are diagnosed with asthma and eczema, respectively. C, Ring J, Rognes ME, Wells GN. The FEniCS project version 1.5. Archive of Individuals with FA have 1.8 times higher odds of an eczema diagnosis Numerical Software. 2015 Dec;3(100):9-23. (CI 1.47-2.11%) and 2.1 higher odds of having one or more commodi- ties (CI 1.89-2.41) compared to non-FA patients. 3. Sigal IA, Flanagan JG, Tertinegg I, Ethier CR. Finite element modeling of optic nerve head biomechanics. Invest Ophthalmol Vis Sci. 2004 Manitoba EMR derived data revealed a lower prevalence of FA than previ- Dec;45(12):4378-87. ously reported in a comparable Canadian study which relied on patient self- reporting. The algorithm created in this study will be applied nationally within Presenting Author: Markus Kostka the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), to de- Supervisors: Dr Deirdre Brennan, Dr Aisling Ní Annaidh, Prof Colm O’Brien ’ termine Canada s national prevalence of FA and investigate geographical var- Co-Supervisor: Dr Deborah Wallace iation FA prevalence. References 7. INVOLVING PATIENTS IN HEALTH RESEARCH: THE ROLE OF 1. Soller L, Ben-Shoshan M, Harrington DW, Fragapane J, Joseph L, St Pierre CHARITIES Y, et al. Overall prevalence of self-reported food allergy in Canada. J Allergy Clin Immunol. 2012; 130:986-8. Howard J1,KennanA2 Presenting Author: Nerissa Niveta Nankissoor Supervisor: Dr Alexander Singer 1UCD School of Medicine, Health Sciences Centre, Belfield, Dublin 4. Co-Supervisor: Dr Elissa Abrams 2Medical Research Charities Group, Camden Row, Dublin 8. Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S329

Public and patient involvement (PPI) in research aims to carry out research References “with” or “by” members of the public rather than “to”, “about” or “for” them. Research groups benefit from involving patients with real life experiences of 1. Knuttinen M, Bobra S, Hardman J et al. A Review of Evolving Dialysis the disease into all aspects of the research process. The aim of the study is to Catheter Technologies Seminar in Interventional Radiology. 2009. vol 26(2): quantify the role of the charity in encouraging and facilitating this 106–114. doi: 10.1055/s-0029-1222453 involvement. Presenting Author: Ms Mariya Stepanova A survey containing seventeen questions was created and sent to the Supervisor: Dr Simal Goman thirty nine member charities of the MRCG. Four case study charities were additionally contacted and interviewed to provide case studies. A Co-Supervisor: Dr Dimitri Parra report was written illustrating survey results. Half of members responded to the survey, all of whom are involved in some 11. USE OF SCRELOTHERAPY EMBOLIZATION IN TREATMENT aspect of funding medical research. The report concluded that charities begin- OF VENOUS MALFORMATION IN A PAEDIATRIC SETTING ning stages to encourage patient involvement in research. Challenges faced included lack of budget, dedicated time and expertise. Most charities however reported that patients feel empowered and engaged as their involvement in- Ryan, A,1 Parra, D2 creases. Charities said that they would benefit from increased support, within the organisation and from groups such as the MRCG. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Recommendations for charities and the MRCG were drawn up from the data. 2The Hospital for Sick Children, Toronto. The report will be used to inspire charities to increase levels of involvement but will also act as a benchmark. The MRCG aim to repeat the study and hope to see Venous Malformations (VM) are a slow flow form of vascular malformation, increased levels and great benefits of patient involvement in research. resulting from defects in angiogenesis and vasculogenesis. Present from birth, Acknowledgments: they consist of haemodynamically non-functional venous lakes. 94% of VM The author would like to acknowledge funding from the Medical Research are sporadic.1 Symptoms, including pain, swelling, functional impairment and Charities Group. bleeding, vary depending on the location of the VM, and extent of localised Presenting Author: Jane Howard venous thrombosis. Supervisor: Dr Avril Kennan The aim of the project is to review basic concepts of VM and their treatment using sclerotherapy, through observing procedures, and following cases in a paediatric setting. 10. CENTRAL VENOUS CATHETERS: A COMPREHENSIVE Sclerotherapy uses image guided minimally invasive techniques to elicit a OVERVIEW OF ALL ASPECTS OF THE PROCEDURE controlled inflammatory response, resulting in fibroblast proliferation and sclerosis of the VM.2 Direct puncture venography is used to prevent sclerosis of functional veins. Treatment options including bleomycin, have a high efficacy Stepanova M1, Goman S2, Parra D2 but also significant risks and side effects including hyperpigmentation and pulmonary fibrosis. Repeated sclerotherapy is used in the reduction of symp- 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. tomatic VM, with clinical response approaching 100%.3 2 The Hospital For Sick Children, Toronto, Ontario, Canada. References

The advances in interventional radiology tools and techniques have propelled 1. Boon, L., Ballieux, F. and Vikkula, M. (2011). Pathogenesis of Vascular Image Guided Therapy (IGT) to become a major core in providing improved Anomalies. Clinics in Plastic Surgery, 38(1), pp.7-19. patient treatment and care. On the forefront, stands the mainstay of modern 2. Tahir, M., Mumtaz, M., Sultan, A., Iqbal, J. and Sayani, R. (2018). Role of interventional radiology practice - Central Venous Access. Central Venous Interventional Radiology in he Management of Peripheral Vascular Access encapsulates three approaches: 1. Insertion of implantable ports 2. Malformations: A Tertiary Care Center Experience. Cureus. Insertion of peripherally inserted central catheters 3. Placement of central 3. Cox, J., Bartlett, E. and Lee, E. (2014). Vascular Malformations: A Review. venous catheters (CVCs). This project will focus specifically on CVCs with Seminars in Plastic Surgery, 28(02), pp.058-063. an emphasis on their functional features tailored for various clinical indications. Presentinh Author: Aisling Ryan In brief, CVCs involve using fluoroscopic guidance to advance a catheter Supervisor: Dr Dimitri Parra through the right internal jugular vein using a peel-away sheath and dilator assembly. This advancement proceeds until the tip of the catheter rests at the cavo-atrial junction. 16. INVESTIGATING THE INTERPLAY BETWEEN NUCLEOPHOSMIN AND CASPASE-2 IN DETERMINING Placement of CVCs has become commonplace in the IGT suite since their CHEMOSENSITIVITY IN CHILDHOOD ACUTE MYELOID importance is echoed in both the therapeutic and diagnostic fields. In particu- LEUKEMIA (AML) lar, they are appropriate if long-term, continuous venous access is required. This applies to the administration of total parenteral nutrition, prolonged anti- Mc Sherry K1,Bouchier-HayesL2,3 biotic treatment and chemotherapy. However, one of their other therapeutic abilities is to enable dialysis and apheresis. From a diagnostic standpoint, 1 UCD School of Medicine and Medical Sciences, University College Dublin, CVCs play an integral role in haemodynamic monitoring. Belfield, Dublin 4. A plethora of catheters are also available which are generally designed to have 2 Department of Pediatrics-Hematology, Baylor College of Medicine, special tips to meet the therapeutic demands and flow rates [1]. These high- Houston, Texas, USA. lights are just a fraction of the variables involved regarding CVC placement. 3 Overall, a myriad of improved designs and techniques are continuously emerg- Department of Molecular and Cellular Biology, Baylor College of Medicine, ing, all serving to elevate patient care. Houston, Texas, USA. S330 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

Acute Myeloid Leukemia (AML) accounts for 20% of pediatric cancers. A false-positive test was defined as positive FIT test where subsequent colo- Relapse is frequent (~30%), thereby necessitating identification of new noscopy showed no malignancy or adenoma(s) requiring surveillance. A lo- therapeutic targets. Nucelophosmin (NPM1) is frequently mutated in gistic regression model including factors significant on univariate analysis, age AML causing its mislocalization to the cytoplasm (Npm1c+)akeyleu- and gender determined factors independently associated with re-attendance kemogenic event which sensitizes to chemotherapy regimens (1). post false-positive FIT, using SPSS. Caspase-2 has multiple overlapping functions with NPM1, with NPM1 196,149 clients attended Round 1; 108,075 were eligible and re-invited in acting as a scaffold for PIDDOsome activation into the nucleus, thereby Round 2. Round 2 uptake was significantly higher in FIT-negative than activating caspase-2 and leading to cell death in AML cells (2). false-positive FIT clients (87.5% vs 73.1%; p<0.001), similar stratified by Therefore, we propose that the difference in the sensitivity to chemotherapy age and gender. In the subgroup of false-positive clients, logistic regression seen between OCI-AML2 (Npm1 wt) and OCI-AML3 (Npm1c+)cellsisme- showed that older age (OR 0.75; 95%CI 0.60-0.94), failed colonoscopy or diated by the differential ability of NPM1 to activate caspase-2 in the cytosol, unsuitable for colonoscopy (CT colonography performed) (OR 0.40; 95%CI versus in the nucleolus. 0.21-0.75) and longer duration from screening invitation to FIT result (OR per Results showed that when treated with doxorubicin and analyzed using day 0.994; 95%CI 0.992-0.996) were significant negative predictors of re- flow cytometry, OCI-AML3 (Npm1c+) cells were more sensitive to che- attendance in Round 2(Table 1). motherapy than OCI-AML2 (Npm1 wt) cells. OCI-AML2 wild type and False-positive FIT is an important deterrent to re-attendance. Longer caspase-2 knockout cell lines didn’t show an appreciable difference in duration to FIT result could relate to a delay in providing consent to cell death, suggesting that caspase-2 has a negligible effect on cell death the programme or in returning the FIT test, or to longer a period of in cells where NPM1 is not mutated. anxiety waiting for the result. Further follow-up of the programme will However, in OCI-AML3 cells caspase-2 knocked out cell lines, there determine if having a false-positive result in a subsequent screening was a 30% drop in cell death compared to wild type. This suggests that round has a similar impact on re-attendance. both caspase-2 and NPM1 are required for cell death when NPM1 is Table 1. Logistic regression: predictors of attendance at next screening round mutated, which may explain the reason behind their increased post false-positive FIT chemosensitivity. This research points to an important role for caspase- 2 in determining chemosensitivity when NPM1 is mutated and is a promising avenue for future investigation. Further investigation with Univariate (95% CI) Adjusted (95% CI) other chemotherapeutic drugs and in combination with NPM1 inhibition odds odds is currently underway. ratio ratio Age group Acknowledgments: (years) ’ The author would like to acknowledge funding from Alex s Lemon Stand ≤ 64 1.00 1.00 Foundation and UCD School of Medicine. ≥ 65 0.71 (0.57-0.88)* 0.75 (0.60-0.94)* References Gender 1. Hollink I, Zwaan C, Zimmermann M, Arentsen-Peters T, Pieters R, Cloos J Male 1.18 (0.97-1.44) 1.18 (0.96-1.43) et al. Favorable prognostic impact of NPM1 gene mutations in childhood acute Female 1.00 1.00 myeloid leukemia, with emphasis on cytogenetically normal AML. Leukemia. CT 2008;23(2):262-270. Colonography 2. Ando K, Parsons M, Shah R, Charendoff C, Paris S, Liu P et al. NPM1 Yes 0.40 (0.23-0.68)* 0.40 (0.21-0.75)* directs PIDDosome-dependent caspase-2 activation in the nucleolus. The No 1.00 1.00 Journal of Cell Biology. 2017;216(6):1795-1810. Presenting Author: Mr Kenneth Mc Sherry Biopsy Supervisor: Dr Lisa Bouchier-Hayes Yes 1.37 (1.02-1.84)* 1.28 (0.95-1.72) No 1.00 1.00 Duration from 18. RETURN TO SCREENING POST FALSE-POSITIVE FIT TEST IN screening BOWELSCREEN, THE NATIONAL BOWEL SCREENING invitation to PROGRAMME IN IRELAND FIT result (Odds ratio Ch’ng BX1,MooneyT2,O’Donoghue D3, Fitzpatrick P2,4 per additional day) 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 0.994 (0.991-0.996)* 0.994 (0.992- 2National Screening Service, 200 Parnell Street, Dublin 1. 0.996)* 3BowelScreen, National Screening Service, 200 Parnell Street, Dublin 1. 4 University College Dublin, School of Public Health, Physiotherapy and *p <0.05 Sports Science, University College Dublin, Belfield, Dublin 4. References There is limited research on the effect of a false-positive test on re- attendance for bowel screening. BowelScreen screens individuals aged 1. National Screening Service, Ireland. (2018). BowelScreen Programme 60-69 biennially. Round 1 uptake was 40.2% (standard≥50%)[1]. The Report Round One 2012-2015. Dublin: National Screening Service. aim was to quantify the impact of false-positive Faecal Immunochemical ’ Test(FIT) results in Round 1 on re-attendance in Round 2 and to deter- Presenting Author: Mr Brandon Ch ng Xian mine factors associated. Supervisor: Prof Patricia Fitzpatrick Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S331

19. DEGREE OF HYPERGLYCAEMIA CORRELATES WITH 3MCW School of Medicine, Medical College of Wisconsin, WI 53226, USA URINARY CONCENTRATIONS OF KIDNEY INJURY MARKERS IN EXPERIMENTAL DIABETIC NEPHROPATHY Tubulointerstitial nephritis (TIN) is a rare condition involving kidney inflammation. This may be accompanied by uveitis (TINU). Approximately 40% Chuah YH1,HutterM2,LeRouxCW2, Docherty NG1,2 paediatric TIN patients have associated uveitis which may take up to 3 years to present itself post-TIN diagnosis. There are currently no guidelines for TINU 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. screening for patients with TIN. The study aims to describe a national cohort of children with biopsy-proven TIN and evaluate the results of routine ophthal- 2UCD Diabetes Complication Research Centre, School of Medicine, Conway mology follow-up in this group. Institute, University College Dublin, Belfield, Dublin 4. Children (<16 years) with biopsy-proven TIN admitted to the two national centres during a 10-year period (2007–2017) were retrospectively reviewed for Hyperglycaemia is a major driver of chronic kidney disease in patients with aetiology, symptoms, treatment and long-term outcome. diabetes. [1] This study examined the dose dependent relationship between degree of hyperglycaemia and urinary biomarkers of kidney injury in the Seventeen children were diagnosed with TIN, where 7 (4 females) had – Zucker Diabetic Sprague-Dawley rat (ZDSD). uveitis (41%). Median age was 10 years (range 4 15 years). Uveitis was diagnosed at different stages :1 patient had their uveitis diagnosis prior Plasma glucose levels in male ZDSD (n=44) rats of 26 weeks of age were to TIN diagnosis, 3 were diagnosed 3 months after TIN diagnosis, 2 measured using a point-of-care device. Animals in the upper and lower quartiles within 4–6 months and 1 patient after 6 months. Common symptoms of glycaemia were then placed in metabolic cages for 16 hours and urine samples of the TINU patients include fatigue (57%), nausea/vomiting (43%) and were collected. Urinary concentrations of albumin, neutrophil gelatinase associ- abdominal pain (29%). Six patients were treated with prednisolone; one ated lipocalin (NGAL), osteopontin (OPN) and kidney injury molecule-1 (KIM- received prednisolone and methotrexate. Estimates using population data 1) were evaluated by ELISA and hourly excretion rates calculated. from the Central Statistics Office suggest that 0.6 per 100,000 children The median plasma glucose in the upper quartile was 19.7mmol/L (IQR=7.1) have TINU in Ireland. versus 7.8mmol/L (IQR=1.3) in the lower quartile. Mean albumin excretion Prospective studies are needed to ascertain the optimal length of time for (±SEM) was 2.7-fold higher in the upper quartile group (238.4μg/h±46.63 vs monitoring. Educating families of patients with TIN about the potential asso- 87.09μg/h±13.53, p<0.01). NGAL, OPN and KIM-1 were also increased in ciation with uveitis is necessary in consultation with ophthalmology. the upper quartile group; NGAL (215.5ng/h±29.11 vs 99.38ng/h±7.16, p<0.01), OPN (5.3ng/h±0.84 vs 1.72ng/h±0.21, p<0.01) and KIM-1 References (0.79ng/h±0.06 vs 0.57ng/h±0.04, p<0.01). Plasma glucose levels correlated with urinary concentration of albumin (ρ=0.6, p<0.01), NGAL (ρ=0.83, 1. Howell M, Sebire NJ, Marks SD, Tullus K. Biopsy-proven paediatric p<0.01), OPN (ρ=0.77, p<0.01) and KIM-1 (ρ=0.71, p<0.01). tubulointerstitial nephritis. Paediatr Nephrol. 2016; 31:1625–1630 Plasma glucose levels positively correlate with the degree of kidney injury. 2. Okafor LO, Hewins P, Murray IP, Denniston AK. Tubulointerstitial nephri- The strongest correlation was observed for NGAL, a marker primarily associ- tis and uveitis (TINU) syndrome: a systematic review of its epidemiology, ated with the thick ascending limb of the loop of Henle and collecting duct in demographics and risk factors. 2017; 12:128 kidney injury. [2] These findings demonstrate a strong association between Presenting Author:Danial Bahrin Bin Jefferelli hyperglycaemia and urinary evidence of distal nephron injury in the ZDSD rat Supervisor: Dr Michael Riordan model of diabetic nephropathy. Co-supervisor: Dr Tara Raftery Acknowledgments: The author would like to acknowledge funding from the Pathological Society 26. INVESTIGATION OF THE EFFECT OF THE HTLV-2 of Great Britain and Ireland. ANTISENSE PROTEIN APH-2 ON AUTOPHAGY References Agnus Moorthiraj H1, Martini F2,SheehyN2 1. Gugliucci A. Glycation as the glucose link to diabetic complications. J Am Osteopath Assoc 2000; 100: 621-634. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 2. Devarajan P. Neutrophil gelatinase-associated lipocalin: a promising biomark- 2Centre for Research in Infectious Diseases, School of Medicine, University er for human acute kidney injury. Biomark Med. 2010 Apr; 4(2): 265–280. College Dublin, Belfield, Dublin 4. Presenting Author: Mr Yeong Huei Chuah Desmond Supervisor: Dr Neil G. Docherty Human T cell leukaemia virus type 1 and 2 (HTLV-1 & 2) are retroviruses that Co-Supervisor: establish chronic lifelong infections of T lymphocytes. They are closely related Prof Carel W. le Roux in terms of structure, lifecycles and proteins expressed but have different clinical outcomes. HTLV-1 can cause adult T cell leukaemia/lymphoma (ATLL) while HTLV-2 is not clearly associated with disease1. Much research 23. SCREENING EVALUATION FOR TUBULOINTERSTITIAL has gone into, trying to unravel the mechanisms behind the different pathoge- NEPHRITIS AND UVEITIS IN IRISH PAEDIATRIC PATIENTS nicity of these two viruses in order to identify key drivers of disease in HTLV-1 compared to HTLV-2. These studies will lead to the development of novel therapies. Jefferelli D1, Mohammad R1, Tillman R1, Stevens C2,LewisM2,StackM2, HTLVs, like other viruses alter the activities of numerous cellular signalling Raftery T2 Riordan M2,AwanA2 pathways, usually for their own benefit. Autophagy is a cellular process involved in removing misfolded or aggregated proteins, eliminating damaged 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. organelles and removing intracellular pathogens. It is also important in times 2Department of Nephrology, Temple Street Children’s University Hospital. of nutrient stress in order to balance energy sources2. However, viruses use Dublin 1, Ireland. autophagy to promote their replication and survival in cells. S332 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

The aim of this project is to determine the effect of APH-2 on autophagy in terms of This study identified 14 pulmonary hypertension patients whose haemody- the accumulation of autophagosomes in cells expressing APH-2 compared to namic values fit the criteria for the transcatheter Potts shunt. This information control cells by immunofluorescence. HeLa cells were transfected with GFP- is useful for predicting the impact of this procedure for Irish PAH patients. APH-2 and mCherry-LC3 plasmids, either starved for 4 hours or not, immuno- References stained for tubulin and observed by fluorescence microscope. We demonstrated that cells transfected with APH-2 displayed reduced levels of autophagy in both 1. Esch JJ, Shah PB, Cockrill BA, Farber HW, Landzberg MJ, Mehra MR, starved and non-starved cells, suggesting that APH-2 potentially inhibits et al. Transcatheter Potts shunt creation in patients with severe pulmonary autophagy. arterial hypertension: Initial clinical experience. Journal of Heart and Lung Overall, we conclude that APH-2 inhibits autophagy in starved and non- Transplantation. 2013;32(4):381-7. starved cells. Presenting Author: Mr Patrick Creechan Acknowledgments: Supervisor: Prof Kevin Walsh The author would like to acknowledge funding from Biomedical Vacation Scholarship, Wellcome Trust. References 30. CARING FOR CARE GIVERS – EVALUATING SCHWARTZ ROUNDS AND SUPPORTING COMPASSIONATE CARE IN 1. Halin M, Douceron E, Clerc I, Journo C, Ko NL, Landry S, et al. Human T- PAEDIATRIC HOSPITALS cell leukemia virus type 2 produces a spliced antisense transcript encoding a protein that lacks a classic bZIP domain but still inhibits Tax2-mediated tran- Silke A1,BarrettE1, 2 scription. Blood. 2009; 114(12): 2427–38. 2. Glick D, Barth S, Macleod KF. Autophagy: cellular and molecular mecha- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. nisms. The Journal of Pathology. 2010; 221(1): 3–12. 2Temple Street Children’s University Hospital, Temple Street, Dublin 1. Presenting Author: Hridya Agnus Moorthiraj Supervisor:Dr Noreen Sheehy Schwartz rounds are a multidisciplinary intervention that aim to support clin- Co-Supervisor:Ms Fanny Martini ical and non-clinical healthcare professionals in their work. These rounds are hour long meetings with two distinct stages: first three or four staff members share individual stories on a theme, then a discussion with all attendees. These 29. IDENTIFICATION OF PATIENTS WITH PULMONARY discussions provide a space for staff to reflect on the emotional impact of their HYPERTENTION IN IRELAND THAT MEET THE work. Interventions like Schwartz rounds have become popular in part because HAEMODYNAMIC CRITERIA FOR THE TRANSCATHETER of the rising rates of burnout seen in healthcare professionals. Burnout has POTTS SHUNT been linked to a decrease in quality of patient care.(1) It is hoped that Schwartz rounds will help healthcare professionals deliver compassionate care. Creechan P1, Walsh K2,GaineS3, 4, Beverland A4 This study evaluated the impact of a pilot of Schwartz rounds held in Temple Street Children’s University Hospital (TSCUH) via a feedback form that was filled in after attendance of a round on an opt-in, anonymous based format. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Over the course of five rounds, 198 feedback forms were returned. The data 2 Adult Congenital Heart Disease, Mater Misericordiae University Hospital, from these forms was analysed using SPSS. Eccles Street, Dublin 7 95% (189) of participants indicated a positive response to the rounds. Clinical 3 The National Pulmonary Hypertension Unit, 56 Eccles Street, Dublin 7 and non-clinical staff were found to have the same general opinions of the 4Respiratory Medicine, Mater Misericordiae University Hospital, Eccles rounds. Street, Dublin 7 The results showed that this pilot has been positively received by a range of disciplines, both clinical and non-clinical. Schwartz rounds appear to be well suited Pulmonary arterial hypertension (PAH) is a rare disease associated with high to the culture of TSCUH and thus are placed to be an effective intervention. Based on the findings of this study, promotional and educational materials about Schwartz mortality. Untreated, PAH culminates in right heart failure and death. The rounds were created for TSCUH. transcatheter Potts Shunt procedure shows promise in the palliation of PAH by creating an anastomosis between the left pulmonary artery and the descend- References ing aorta; in patients with high pulmonary artery pressures blood is shunted from the pulmonary towards the systemic circulation1. This procedure is most 1. Sulaiman CFC, Henn P, Smith S, O’Tuathaigh CMP. Burnout syndrome useful in patients whose pulmonary artery pressures are close to or greater than among non-consultant hospital doctors in Ireland: relationship with self- the pressures in their systemic circulation. reported patient care. Int J Qual Heal Care. 2017 Oct; 29(5):679–84. The charts of patients from The National Pulmonary Hypertension Unit were Presenting Author:Alanna Silke reviewed to identify patients that fit the haemodynamic criteria for this proce- Supervisor: Dr Elizabeth Barrett dure. We used suprasystemic and isosystemic (within 5mmHg) pulmonary artery pressures as haemodynamic criteria. The charts of 206 patients from The National Pulmonary Hypertension 31. PAEDIATIRC LIAISON PSYCHIATRY SERVICES AT OUR Unit were reviewed and the patient’s most recent pulmonary artery and LADY’S CHILDREN’S HOSPITAL CRUMLIN - WHAT ARE THEY systemic pressures were collected alongside their diagnosis. Of 206 ACTUALLY DOING? charts, 156 had information on pulmonary pressures measured by right heart catheterisation alongside information on the patient’ssystemic Parker S1, Holme I1,3,McNicholasF1,2,3 pressures. Out of the 156-patient cohort, 7 were identified as having systolic pulmonary pressures above their systolic systemic pressures, 1 and 7 more had systolic pulmonary pressures within 5 mmHg of systolic UCD School of Medicine, University College Dublin, Belfield, Dublin 4. systemic pressures. 2Our Lady’s Children’s Hospital, Crumlin, Dublin 12. Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S333

3Lucena Clinic Services, Rathgar, Dublin 6. Adolescents (aged 13, 14, and 15) form the majority of our referrals. A vast majority of patients (89.9%) had acute mental health presentations to the Paediatric Liaison Psychiatry Services (PLPS) are specialised tertiary CAMHS emergency department. A small proportion of 7.2% need agency staff to nurse. managing patients with co-morbid physical and mental health (MH) illnesses. The most presenting main presentations to the hospital are 76.8% of referrals related to suicidal thoughts (n=22) or behaviours (n=31), followed by psycho- In 2016, a 12-month audit was conducted: findings showed the overwhelming social presentations (11.6%). Among the children presenting with primary majority of cases were out of hours acute psychiatry presentations to the psychiatric conditions, depression tops the table at 41.4%. Finally, more than emergency department (ED) rather than the speciality of PLPS1.Asixmonth half of the patients (56.5%) were referred to CAMHS after admission. retrospective chart review (January-June 2018) was carried out (N = 124) using the Crumlin Routine Outcome Measures and SPSS to determine if this This study demonstrates high volume of referrals to the PLS. The evidence shows trend continued during the study timeframe. significant difficulties on functioning, and the majority require ongoing CAMHS referral, indicating significant levels of mental health difficulties in this age group. Presenting young people ranged from 4-18 years (M = 12.86, SD = 2.6) and were predominantly female (77, 62.1%). 89 (71.8%) presented in Acknowledgments: acute MH crisis to the ED, 27 (21.8%) were referred by paediatricians as The author would like to acknowledge the mentorship, time and guidance ‘true liaison’ cases and 8 (6.5%) were eating disorder cases. Half were given from Dr.Patricia, Dr.Una, Dr. Fiona and all the academicians involved assessed on day of presentation (70, 56.5%) and the majority (90, as I have learned a lot from this amazing experience. 72.6%) were admitted (stay length range = 1-90 days, M = 12.78 days, References SD = 18.9). 92 (75.4%) had an Axis I diagnosis, 26 (21.3%) had more than one Axis I diagnosis; most commonly depression (48, 38.7%), 1. Patton GC, Coffey C, Sawyer SM, et al. Global patterns of mortality in anxiety (25, 20.2%) or both (18, 14.5%). Unlike in 20161, 77 (62.1%) young people: a systematic analysis of population health data. Lancet 2009; presented in normal working hours. 55 (45.1%) were MH naïve and 47 359:881-92. (38.5%) were CAMHS linked. 82 (66.7%) were referred to CAMHS on discharge. 2. Hawton K, Harriss L. Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. More than half the cohort had prior contact with MH services yet presented to the J Clin Psychiatry 2007; 359:1574-83. ED – this made up the majority of cases seen. Currently, standard operating procedures are under review and recognise the need to develop an emergency Presenting Author: Sim Jing Ying CAMHS service which is supported by data from this second wave of audit. Supervisor: Dr Patricia Byrne Acknowledgments: Co-Supervisor:Prof Fiona McNicholas The author would like to acknowledge the support given by Professor Fiona McNicholas, Dr. Ingrid Holme, Dr. Udo Reulbach and staff in the department of Child and Adolescent Psychiatry at Our Lady’s Children’s Hospital Crumlin. 33. INTEGRATED COORDINATED CLINIC FOR CHILDREN WITH DIGEORGE SYNDROME References

1 1,2,3 2 4 1. Lynch F, Kehoe C, D'Alton A, Barrett E, Twohig A, McNicholas F et al. Su Yi Sarah N , McNicholas F ,KelleherS,KelleherI Paediatric Consultation Liaison Psychiatry Services (PCLPS) -what are they actually doing?. Irish Medical Journal. 2017;110(10):652. 1UCD Department of Child and Adolescent Psychiatry, UCD School of Presenting Author: Sorcha Parker Medicine, University College Dublin, Belfield, Dublin 4. 2 ’ ’ Supervisor: Prof Fiona McNicholas Our Lady s Childrens Hospital Crumlin (OLCHC), Crumlin, Dublin 12. 3Lucena Clinic Services, Rathgar, Dublin 4Royal College of Surgeons Ireland, Dublin. 32. A DESCRIPTIVE STUDY ON THE PRESENTATION OF CHILDREN (AGE 16 AND BELOW) TO THE EMERGENCY Chromosome 22q11.2 deletion syndrome (DiGeorge Syndrome) is a multisystem DEPARTMENTS LIAISON TO PSYCHIATRY IN TALLAGHT genetic disorder presenting with significant medical, psychiatric and developmental HOSPITAL FROM MARCH 2018 TO MAY 2018 issues. Its prevalence occurs in 1 of every 4000 births. Different clinical presentations have been described, necessitating the use of different services. Parents have Sim Jing Ying1, Byrne P2, McNicholas F1 observed a lack of care co-ordination which causes unnecessary stress upon families, which lead to the development of a specialised integrated co-ordinated clinic 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. (ICC) for children with DiGeorge syndrome in OLCHC [1]. 2CAMHS, Tallaght National University Hospital, Belgard Square North, The aim of this research is to evaluate and describe the clinical profile and Cookstown, Dublin 24. activity of the (ICC) for children with 22Q11DS seen at OLCHC, as well as assessing any strengths and weaknesses of the clinic and where improvements could be made. Our aim is to have a descriptive study of presentations to paediatric liaison services within three paediatric hospitals in Dublin region. The Liaison This was done via qualitative observation of the ICC which is held once every CAMHS Service in Tallaght University Hospital provides assessment of chil- month, interviewing both patients, parents and the doctors holding the clinic. dren and adolescents aged 16 and under from 9am-5pm Monday to Friday. Clinical profiling of the children was done through studying their medical files, On-call cover is provided on Saturdays, Sundays and on Bank Holidays from data protection was ensured by using a Student ID and transferring the data on 9am-7pm. a proforma, where I analysed important information using Microsoft Excel. This study is a retrospective case note review using a standardised data col- 48% of 22q11ds patients seen in Crumlin were diagnosed with anxiety in multiaxis lective form (SSRA CROM forms). Data collected will be entered onto the disorder 1 and 18% were referred to psychiatry following the first visit. Although SPSS file on server. It is a descriptive study using demographic quantitative relatively new, the ICC is shown to have made a significant difference in improving variables to describe a cohort of patients over 3 months. The method of anal- the quality of life of the patients with DiGeorge syndrome, as well as helping ease ysis used is based on IBM SPSS data analysis in which there are examination the burden parents may face when navigating through the different specialties in of frequencies and trends. treating their child. S334 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

Acknowledgments: 35. DEVELOPMENT OF A SELF REPORT TOOL TO MEASURE MENTAL HEALTH SERVICE OUTCOMES FOR YOUNG The author would like to thank Our Lady’s Children Hospital Crumlin for CHILDREN AGED 3-10 YEARS OLD providing clinical experience of the Integrated Coordinated Clinic for children with DiGeorge Syndrome. 1 1, 2 1,2 References Mulroy S ,RuddT , Mulligan A

1 1. Lawlor A, Kerin L, Orr D, et al. Developing integrated care in the context of UCD School of Medicine, University College Dublin, Belfield, Dublin 4. rare chromosomal conditions: 22q11 deletion syndrome; a parent clinician 2Department of Child and Adolescent Psychiatry, Dublin North City and collaboration. 2017, vol.17(5) County Child and Adolescent Mental Health Service, James Joyce St, Presenting Author: Ng Su Yi Sarah Dublin 1. Supervisor: Prof Fiona McNicholas The Clinical Outcomes in Routine Evaluation (CORE) System Group have Co-supervisor:Dr Suzanne Kelleher produced a standardised outcome measure which assesses the effectiveness of psychological therapy services. This questionnaire measures global distress, and has been shown to be sensitive to change. These forms are brief, freely 34. RAPID TRANQUILISATION AUDIT IN PAEDIATRIC available and acceptable to both patients and therapists. The original question- HOSPITALS naire has been modified for certain populations, such as the Learning Disability (LD-CORE) and Young Persons CORE (YP-CORE) for 11-16 year Velu G 1,HolmeI1,3, McNicholas F 1,2,3 olds. We have identified a need for a CORE questionnaire aimed at children aged 3-10 years old. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. We conducted a focus group with Mental Health Professionals, and individual 2Our Lady’s Children’s Hospital, Crumlin, Dublin 12. interviews with a parent and 7 year old child. Participants were shown a sample Children’s CORE and the current LD-CORE. Discussions centred around the 3Lucena Clinic, 59 Orwell Road, Rathgar, Dublin 6. format of the questions and answers, the content of the questions, and additionally for Mental Health Professionals, the application of this tool in practice. Interviews The management of acutely agitated or aggressive patients may be difficult in were recorded, annotated and coded before being subjected to qualitative analysis. busy paediatric hospital settings. The use of restrictive interventions such as Ethics approval was granted by the Research Ethics Committees of University rapid tranquilisation (RT) may be necessary to safely calm and alleviate dis- College Dublin and the Health Service Executive. tress in these patients. This objective of this audit is to look at RT use between Many of the Mental Health Professionals reported using specific or goal- 2016-2018 at Our Lady’s Children Hospital, Crumlin (OLCHC) in cases in- focussed outcomes measure in their routine practice, but indicated that a mea- volving the liaison-psychiatry team, and compare current practice against sure of general mental health would be beneficial. Some felt it would be useful guidelines. as a weekly check-in, while others felt they would use it at the start and end of a A systematic literature review on RT use in paediatric hospitals was carried set of therapy sessions to assess progress. In all focus groups and interviews, it out. An audit proforma, developed based on identified guidelines, gathered was agreed that questions and responses should have a visual and a verbal data concerning: patient demographics; psychiatric and medical history; pre- element, and that simple age appropriate language was necessary. The age senting complaint; the class, route, dose and frequency of drugs administered; range of 3-10 years old was disputed, as many felt that certain concepts (eg post-RT monitoring; and debriefing. Microsoft Excel version-16.10 was used grumpiness, loneliness), content (eg school, friends) and ability to rate feelings for data analysis. on a scale may not be suitable for 3 year old children, and it was proposed that Guideline recommendations suggest using RT after de-escalation techniques school-aged (4-5 years old) would be a better cut-off point. have been unsuccessful, the preferred use of benzodiazepine class of medica- The most relevant findings from this study have been used in the development 1,2 tions and clearly documenting all steps of the intervention. 21 patients at of the “My Feelings Form”. OLCHC met the audit criteria (mean age 12.6 ± 2.50 years, 66% males). Presenting Author: Sinead Mulroy Lorazepam was the most frequently prescribed drug. A lack of consistency was found regarding documentation of the RT process, particularly prior de- Supervisor: Dr Aisling Mulligan escalation techniques, post-RT monitoring and incident debriefing. Co-Supervisor: Dr Tara Rudd There are currently no published paediatric RT guidelines in Ireland, and standardisation of existing hospital guidelines will be beneficial in light of the upcoming shift to the New Children’s Hospital. A 36. DO DEAF YOUNG PERSONS HAVE THE SAME RATE OF standardised method of RT documentation at OLCHC is recommended. MENTAL ILLNESS AS HEARING YOUNG PERSONS? References Ryan MA1,RuddT2, Mulligan A 1,2,3 1. Managing Violence and Aggression in Children and Young People. 1 National Institute for Health and Care Excellence. Retrieved June 6th, 2018, UCD School of Medicine, University College Dublin, Belfield, Dublin 4. from https://pathways.nice.org.uk/pathways/violence-and-aggression/manag- 2Dublin North City & County Child and Adolescent Mental Health Service, ing-violence-and-aggression-in-children-and-young-people Health Services Executive, Dublin 1. 2. Guidelines for Use of Chemical Restraints. BC Children’sHospitalChild 3Deparment of Child and Adolescent Psychiatry, University College Dublin,, & Youth Health Policy and Procedure Manual. Retrieved June 7th, 2018, Belfield, Dublin 4. from http://policyandorders.cw.bc.ca/resource-gallery/Documents/ BC%20Children's%20Hospital/CC.07.16%20Guidelines%20for% Few deaf children or adolescents currently attend the HSE Grangegorman 20use%20of%20Chemical%20Restraints.pdf Presenting Author: Child and Adolescent Mental Health Service (CAMHS) despite the deaf Gayathrie Velu school in Cabra being in its catchment area. Although profound deafness rates Supervisor: Prof Fiona McNicholas in this age group are decreasing due to the MMR vaccine, advancements in Co-Supervisor: Dr Ingrid Holme cochlear implantations and the newborn hearing screening programme, mental Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S335 health difficulties in deaf children and adolescents could be going unreported. References Compared to hearing populations, higher rates of mental health problems have been found in deaf people [1]. 1. Aaron C Ericsson C. Segmented Filamentous Bacteria: Commensal This study aimed to gather data about rates of mental health problems in deaf Microbes with Potential Effects on Research [Internet]. PubMed Central young persons attending a deaf school and compare the results with a general (PMC). 2014 [cited 20 June 2018]. Available from: https:// population sample of hearing young persons, using the Growing Up in Ireland www.ncbi.nlm.nih.gov/pmc/articles/PMC3997285/ data. It is hoped that the results could be used to promote access to better health 2. Tan T, Sefik E, Geva-Zatorsky N, Kua L, Naskar D, Teng F et al. Identifying care for the deaf community. species of symbiont bacteria from the human gut that, alone, can induce intes- A Strengths and Difficulties Questionnaire (SDQ) was distributed to every tinal Th17 cells in mice [Internet]. PNAS. 2018 [cited 26 June 2018]. Available pupil attending a mixed school for the deaf and their parents. The SDQ covers: from: http://www.pnas.org/content/113/50/E8141 Hyperactivity, Emotional symptoms, Conduct problems, Peer problems and Presenting Author: Hai Wen Ho Prosocial [2]. Results were described as ‘normal’, ‘borderline’ or ‘abnormal’. Supervisor: Prof Ulla Knaus Results found that compared to the 10% published cut-off, a higher rate of primary school children scored ‘abnormal’ and more secondary children scored ‘borderline’. Bullying and loneliness were issues for most children, with peer relations the 38. ANSWERING PARENTS QUESTIONS; USING EXOME highest scoring difficulty overall. The low response rate is a limitation for the study. SEQUENCING TO DIAGNOSE PREVIOUSLY UNKNOWN RARE Out of 125 children, parents of 11 primary school children and 10 secondary school DEVELOPMENTAL DISORDERS children participated. References Ritchie W1,LynchSA2, DDD Consortium, Green A2 1. Fellinger J, Holzinger D, Pollard R. Mental health of deaf people. Lancet. 1 2012; 379(9820):1037-1044. UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 2 ’ ’ 2. Goodman R. The Strengths and Difficulties Questionnaire: A Research Our Lady s Children s Hospital Crumlin (OLCHC): Department of Clinical Note. J Child Psychol Psychiat. 1997; 38(5):581-586. Genetics, Crumlin, Dublin 12. Presenting Author: Ms Mary Ann Ryan In 2011, Wellcome Trust funded a UK and Irish project entitled Supervisor:Dr Aisling Mulligan Deciphering Developmental Disorders (DDD).1 The aim of which Co-Supervisor:Dr Tara Rudd was to use advanced microarray and exome sequencing to improve diagnoses and create novel, cost-efficient diagnostic assays for future children with developmental disorders. Prior to 2011, genetic testing 37. RELATIVE QUANTIFICATION OF SEGMENTED for developmental disorders was by standard chromosome microarray, FILAMENTOUS BACTERIA (SFB) IN GUT MICROBIOME which found an abnormality in 19% of children, many of whom remain undiagnosed.2 Ho WH1,KnausUG2,SinghAK2 To determine the efficacy of the DDD project thus far, data from 309 patients of the Irish cohort was examined to assess the current success rate, effective- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. ness at making a clear diagnosis and ability to discover novel diseases and analysed inheritance patterns of conditions in this cohort. This assessment was 2Conway Institute, School of Medicine, University College Dublin, Belfield, conducted by collating the patient information available from the DDD data- Dublin 4. base with the patients electronic and physical medical records from the Department of Clinical Genetics (OLCHC). Segmented filamentous bacteria (SFB) are gram positive, spore forming DDD currently has a success rate of 26.2% in Irish patients (versus 42% of bacteria that have unique morphology. Their size range from 0.7-1.8 um patients in Great Britain)3 in making a diagnosis which was previously not in diameter and approximately 80um. They are usually found in the possible, this figure is expected to rise as analysis continues. There were 74 ileum, attached to the epithelial brush border.1 PCR reaction with different syndromes diagnosed, 35% of which were disorders not characterised gDNA from mice stool was performed and results indicated that SFB is prior to 2012. Of the inheritance patterns observed, 74% were Autosomal present in mice stool. dominant (58.5% of which were De Novo), 10% Autosomal Recessive, and SFB in mouse gut induce Th17 secretion from the lamina propria. Th17 acti- 16% X-linked. vates downstream signals that in turn activate the immune system which helps The DDD project has had a major beneficial impact on the families of children to defend the host from pathogenic bacteria and fungi. Intestinal dysbiosis can with developmental disorders, providing a novel avenue of diagnosis, allowing result in elevated Th17 secretion causing resistance to enteropathogen but also patient-access to specialist information and care as a result. exacerbating autoimmune or inflammatory immune disease.2 References In this research, gDNA was extracted from ileum and stool samples of C57BL6/N, C57BL6/J, Nox2 KO, Nox4 KO, Cyba KO, p22LOF mice. SYBR green qPCR was carried out to identify the Ct values for SFB specific 1. Firth H, Wright C. The Deciphering Developmental Disorders (DDD) study. gene amplification using SFB736-F/SFB844-R primer pair and 16s Bacteria Developmental Medicine & Child Neurology. 2011;53(8):702-703. gene amplification using UniF334/UniR544 primer pair for each gDNA sam- 2. Manning M, Hudgins L. Array-based technology and recommendations for ple. With the Ct value, we calculate the percentage of SFB among the 16s utilization in medical genetics practice for detection of chromosomal abnor- bacteria present in the ileum and stool. malities. Genetics in Medicine. 2010;12(11):742-745. Results indicate that wild type mice have higher percentage of SFB pres- 3. Hurles M, McRae J, et al. Prevalence and Architecture of De Novo ent in the gut as compared to knock-out mice. It is also shown that mice of Mutations in Developmental Disorders. Obstetrical & Gynecological Survey. younger age have higher percentage of SFB in the gut as compared to 2017;72(6):340-341. mice of older age. Subsequent research can be conducted to study the Presenting Author: Mr William Ritchie significance of the difference in SFB percentage on the immunological Supervisor:Dr Andrew Green response in mice. S336 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

39. MINDREADING 2018: USING LITERATURE IN CLINICAL AND formal compulsion being used [1]. Little is known about the experiences of paedi- REFLECTIVE PRACTICE. DO DOCTORS AND PATIENTS SPEAK atric ED patients, family, and medical professionals on the perceived coercive THE SAME LANGUAGE? treatment. The project will start with a literature review on the experiences of Alalwan D1, Dickson M3, Barrett E12 those involved. A case note study of ED patients admitted in Our Lady’s Children’s Hospital, Crumlin (OLCHC) over the past two years will be carried out. Data on demographic information, primary diagno- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. sis, treatment duration, relevant weight data, and compliance will be 2 Temple Street Children's University Hospital, Dublin 1. collected. This will be analyzed with Microsoft Excel Version 16.13.1. 3University of Birmingham. Common themes from informal conversations with OLCHC staff will be mentioned. Mind-Reading is a collaborative interdisciplinary project involving UCD The literature review found no articles which met all criteria. Some articles Child and Adolescent Psychiatry, the Diseases of Modern Life Project (St concerning older cohorts emphasize the influence of a therapeutic alliance on Annes College, Oxford) and University of Birmingham. It explores using patient perspective and behaviour. Thirty-six case notes met criteria (mean age narrative in medicine [2]; workshops addressed the experience of illness, clin- 12.9±1.41, 69% anorexia nervosa, 11% bulimia nervosa). Staff perceived 19 ical and reflective practice, Burnout and Inter-professional education. patients as compliant, 14 patients as partially non-compliant, and 4 patients as Attendees included medical humanities experts, historians, clinicians from non-compliant (suggesting ambivalence). Two common themes emerged from an array of medical disciplines, and expert patient representatives. the informal conversations: 1) staff as support and 2) requirement for more Aims included bridging communication gaps between professional training. groups, and indeed recognising communication gaps between clinicians There is a gap in the literature for the paediatric population. More research is and patients. Exploring integration of humanities with medicine in clin- required to understand the experiences on perceived coercion. The need for more ical and reflective practice, including the impact of illness and the bi- training and support for staff should also be further explored. directional nature of a doctor patient relationship. Literature provides an References opportunity and framework for clinicians to enhance their interactions with patients. Longer term aims include developing inter-professional 1. Tan, J., Stewart, A., Fitzpatrick, R. and Hope, T. (2010). Attitudes of patients approaches for clinicians, as interdisciplinary training bolsters commu- with anorexia nervosa to compulsory treatment and coercion. International nication skills and can be a key step in patient centred approaches. [1] Journal of Law and Psychiatry, 33(1), pp.13-19. Ethical exemption was granted for the opt- in survey tool for adult Presenting Author: Ms Yin Mon Myat learners. Questions addressed inter-professional experience, views of working with other groups, use of literature in clinical/ reflective prac- Supervisor:Prof Fiona McNicholas tice, views on clinician burnout, exposure to narrative in medicine such Co-supervisor: Dr Ingrid Holme as Balint groups. Attendees were surveyed before and after the event using encrypted, industry standard online methodology. Results include 96% of participants reporting a positive impact when 44. EMERGENCY PRESENTATIONS TO THE PSYCHIATRIC communicating with other disciplines at this event. Skills acquired were LIAISON SERVICE IN TEMPLE STREET IN 2017 recorded (clinical use of literature), burnout was highlighted as a concern but only 16.7% of participants reported that their organizations are ade- Abdul Aziz AA1, McClelland I2, Barrett E2 quately addressing burnout. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. References 2Temple Street Children’s University Hospital, Temple Street, Dublin 1

1. Bachmann C, Barzel A, Roschlaub S, Ehrhardt M, Scherer M. Can a brief Mental health issues have been significantly increasing over recent years and two-hour interdisciplinary communication skills training be successful in un- are deemed by the World Health Organisation as a major public health prob- dergraduate medical education?. Patient Education and Counseling. lem. Potential adverse outcomes including suicide may arise from this issue 2013;93(2):298-305. [1]. The Paediatric Psychiatric Liaison Service in Temple Street had 361 pre- 2. Kalitzkus V.Narrative-Based Medicine: Potential, Pitfalls, and Practice. The sentations referrals from the Emergency Department (ED) in 2017. We aim to Permanente Journal. 2009;13(1). examine these emergency cases with a specific focus on self-harm Presenting Author: Dana Alalwan presentations. Supervisor: Dr Elizabeth Barrett Anonymous clinical data is routinely collected on all cases and a SPSS database is used to allow analysis. The patients attending the ED are up to 16 years of age. There are no exclusion criteria. 43. STARVING FOR ANSWERS: EXPERIENCES OF PERCEIVED There were 361 presentations to ED between January to December COERCIVE TREATMENT FOR PAEDIATRIC EATING DISORDER 2017. The majority of cases were female (62.6%) with a mean age PATIENTS of 13.8 (SD=1.450). Presentations in May and December take up a Myat Y1,HolmeI1,3, McNicholas F1,2,3 total of 25.3% of the cases. 64.5% cases were seen out of hours. 35.5% of children are currently under the care of CAMHS. 37.4% of the presentations presented are of self-harm acts. 43.5% have a 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. relevant family history of psychiatric illness. 63.25% of the patients 2 ’ ’ Our Lady s Childrens Hospital, Crumlin, Dublin 12. are discharged from ED and referred on. As for the patients who were 3Lucena Clinic, 59 Orwell Road, Rathgar, Dublin 6. admitted, they occupied a total of 344 bed days in the hospital. The ED referral work conducted by the Psychiatric Liaison Team mainly involved In Ireland, children under the age of 16 do not have the rights to refuse medical children with self-harm acts, previously known to CAMHS and presenting out of treatment. A small percentile of these children with eating disorders (ED) may resist hours. Therefore, the information collected should be taken into consideration beneficial treatment, subsequently resulting in perceived coercion even without when planning services. Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S337

References 46. PSYCHOLOGICAL MEDICINE IN TEMPLE STREET CHILDREN’S UNIVERSITY HOSPITAL- WHO IS BEING REFERRED? 1. Geulayov G, Kapur N, Turnbull P, et al. Epidemiology and trends in non- fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England. BMJ Open 2016; 6:e010538. Kinger B1,BarrettE1,2, McClelland I2, Houlihan B2, McNicholas F1,3 1,4 Presenting Author: Ms Amirah Adlina binti Abdul Aziz Reulbach U Supervisor:Dr Ian McClelland 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Co-Supervisor:Dr Elizabeth Barrett 2Temple Street Children’s University Hospital, Rotunda, Dublin 1. 3Our Lady’s Children Hospital, Crumlin, Dublin 12. 45. A COMPARISON OF 3D PRINTED ANATOMICAL MODELS 4Lucena Clinic Rathgar, Dublin 6 AGAINST TISSUE EQUIVALENT MODELS UNDER X-RAY CONDITIONS Psychological medicine, also known as Paediatric Consultation Liaison Psychiatry service (PCLS), addresses the need for psychiatric services for children with med- Moorthiraj MA1,PotocnikJ1,CampbellT1,DavisM1 ical illnesses. Appropriate intervention supports the child’s development and im- pacts efficiency of resource management for hospitals. (1). 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. The aim of this research was to (a) ascertain all presentations from within the hospital to the PCLS in Temple Street Children’s University Hospital Three dimensional (3D) printed anatomical models are used alongside tradi- (TSCUH) in March of 2018 and (b) to examine clinical type and complexity tional cadaveric prosections to enhance medical education1. Multi-material in a PCLS over a one month period. 3D-printing involves combining different types of material in a single print Clinical data was extracted from patient charts and used to fill out a and is technically challenging compared to single material printing. The aim of standardised Audit tool, with no exclusion criteria. This information was anon- this project was to utilize X-ray imaging to assess radiographic tissue equiva- ymously entered into an SPSS database for analysis. Ethical exemption has lency of 3D-printed materials and hence produce a radiographic-phantom of been granted by the Research Committees at both TSCUH and UCD. hip joint. There were a total of 241 patients seen as either an emergency presentation Freely available 3D anatomical models were downloaded from (n=26) or as an outpatient, out of which 169 charts were located. 57% of the BodyParts3D and imported into Fusion 360 for further processing. patients were female, with a mean age of 12 years. The patients were seen a Models were then exported as stereolithographic(stl) files and imported total of 258 times, where 47% of patients were seen multiple times in March. into freely available slicing software Slic3r for generating Gcode. The The findings also displayed the variety of therapeutic interventions present at models were printed on Prusa i3 MK2S MMU and imaged under CR TSCUH, supported by the presence of a multidisciplinary team. (Computed-Radiography) X-ray imaging. ImageJ(Fiji) was used to cali- This is the first in-detail review of the PCLS at TSCUH recording the high brate resultant images and to measure mean pixel-intensities of 3D- numbers of patients presenting to the service. The findings can be used as a printed objects. Results were recorded and graphs generated. foundation for further audits as well as for a comparison with the 2 other Plates of increasing thicknesses were printed in four different materials Paediatric hospitals in Dublin. (polylactic-acid (PLA), polyethylene-terephthalate-glycol (PETG), References polymethyl-methacrylate (PMMA) and acrylonitrile-styrene-acrylate (ASA)). For even the thickest plates, (10mm), the mean pixel-intensity for all four 1. Bujoreanu, S., White, M., Gerber, B. and Ibeziako, P. (2015). Effect of materials was considerably less than a pre-existing radiographic-phantom timing of psychiatry consultation on length of pediatric hospitalization and (Phantom-60.258, ASA-11.451, PLA-9.627, PETG-11.019, PMMA-7.256). hospital charges. American Academy of Pediatrics,5(5). Hip models were produced at 50% scale with varying shell-thicknesses (5, 10, 15mm). 15mm shell-thickness was identified as the optimal choice for Presenting Author: Bhanavi R Kinger radiographic-phantom mimicry. Supervisor: Dr Elizabeth Barrett Given the similar mean pixel-intensity values for these four materials, hip models were produced in PLA because of its affordability, ease of use and compatibility with other materials. A series of 3D-printed (normal and frac- 49. KEY WORKER MEDIATED ENHANCEMENT OF PHYSICAL tured) hip joints were produced to be used as teaching models and radiograph- HEALTH IN FIRST EPISODE PSYCHOSIS: A SCOPING REVIEW ic-phantoms. Acknowledgments: Lim J1, McCombe G1,2,BrownK3,CullenW1,2 We would like to acknowledge UCD School of Medicine for the support and Wellcome Trust Biomedical Vacation Scholarship for funding. We would also like 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. to thank Mater Private Hospital for providing the opportunity to perform CT 2Primary Care Research Group, UCD School of Medicine, University College imaging. Dublin, Belfield, Dublin 4. References 3Health Service Executive

1. O'Reilly MK, Reese S, Herlihy T, Geoghegan T, Cantwell CP, Feeney RN, Studies have demonstrated that a majority of the decline in health status and et al. Fabrication and assessment of 3 D printed anatomical models of the functioning emerges during the first few years following the onset of psychosis lower limb for anatomical teaching and femoral vessel access training in med- [1]. This knowledge prompted the development of specialized early interven- icine. Anatomical sciences education. 2016 Jan;9(1):71-9. tion services (EIS) targeting patients experiencing their first episode of psy- Presenting Author: Mridula Agnus Moorthiraj chosis (FEP) [2]. The central component of EIS is often assertive case man- Supervisor: Dr Michaela Davis agement delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment, and delivering various psychoso- Co-supervisor: Dr Thomas Campbell, Mr Jaka Potocnik cial interventions to service users. S338 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

The aim of this review was to examine how key workers can enhance the While linkage of HCV-positive patients to HCV evaluation and treatment physical health of people with FEP by addressing the causative factors of appears feasible, further improvement is needed to achieve the WHO goal of increased mortality in this population. eradicating the virus by 2030. The scoping review framework developed by Arksey and O’Malley (2005) with later recommendations by Levac et al. (2010) was utilised. A comprehensive search was implemented between June and July 2018 in the following Pre-Intervention Post-Intervention electronic databases: PubMed, PsycINFO, Embase, CINAHL, and the (N=100) (N=99) Cochrane Library. Studies included were in English, and were relevant to the Variable % (n) % (n) role of key workers in the context of FEP. HCV Antigen Tested 38.0 (38) 65.7 (65) A total of 27 articles were included. An array of key worker mediated outcomes HCV RNA Tested 54.0 (54) 68.7 (68) were identified, which were broadly classified into three themes: influences on Referred to 69.0 (69) 82.8 (82) lifestyle, influences on effects of psychosis, and influences on organizational bar- Hepatology riers. Our findings suggest that key workers primarily mediated the amelioration of Attended Hepatology 50.0 (50) 59.6 (59) psychosis-induced effects and the reduction of organizational barriers. Further investigations of how the strengths of key workers can be leveraged to reduce Fibroscanned 17.0 (17) 51.5 (51) physical health comorbidities in this exceptionally vulnerable cohort is warranted. HCV Treatment 20.0 (20) 29.3 (29) References Initiated

1. Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysi- Table 1. Management of HCV Antibody-Positive patients Pre- and 6-months ology, and therapeutic approaches. Biol Psychiatry. 2001;50(11):884-97. Post-intervention 2. Malla A, Norman R, McLean T, Scholten D, Townsend L. A Canadian pro- Acknowledgments gramme for early intervention in non-affective psychotic disorders. Aust N Z J HepLink is part of the ‘Hepcare Europe’ Project which is co-funded by the Psychiatry. 2003;37(4):407-13. European Commission through its EU Third Health Programme and Ireland’s Presenting Author: Ms Jayleigh Lim Health Services Executive. Supervisor:Dr Geoff McCombe References Co-Supervisor:Prof Walter Cullen 1. Poynard T, Yeun M-F, Ratziu V, Lai CL. Viral Hepatitis C. Lancet 2003;362:2095-8 50. INTEGRATING HEPATITIS C CARE FOR AT-RISK GROUPS: 2. McCombe G, Swan D, O’Connor E, Avramovic G, Vickerman P, Ward Z, Surey FINDINGS FROM A SERVICE INNOVATION PROJECT IN J, Macias J, Lambert JS, Cullen W Heplink: Integrated Hepatitis C Care: Protocol PRIMARY CARE for a feasibility study in primary care JMIR Res Protoc 2018, 7:6: e149 Presenting Author: Mr Patrick O’Meara ’ 1 1 ’ 1,2 1 2 O Meara P ,SwanD,OConnor E , McCombe G ,MurphyC,Lambert Supervisor: Prof Walter Cullen JS1,2, Avramovic G1, Cullen W1 Co-Supervisor: Dr Davina Swan

1UCD School of Medicine, University College Dublin, Belfield, Dublin 4 2Infectious Diseases Department, Mater Misericordiae University Hospital, 51. INCREASED RADIATION AND NON-DIAGNOSTIC QUALITY Dublin 7 CORONARY CT ANGIOGRAMS IN PATIENTS WITH HEART RATE > 65 BPM IN 16 CM, 256-DETECTOR ROW GE Hepatitis C Virus (HCV) infection is a major cause of chronic liver disease and REVOLUTION CT SCANNER mortality1. HCV prevalence is high among people who inject drugs (PWID), yet complex barriers mean that a minority of this population have received HCV Bauer-Dowling C1,SheehyN2 treatment. In Ireland, general practice is increasingly providing continuing care, including opioid substitution treatment (OST) to PWID2. Therefore, it is a key 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. setting to target to address HCV-related morbidity amongst PWID. This study 2 evaluates the feasibility of an integrated model of HCV care (“HepLink”)toim- Beacon Hospital, Sandyford, Dublin 18. prove HCV care outcomes among PWID in general practice. The model of care comprises: clinical support/outreach to GP practices, and Computed tomography coronary angiogram (CTCA, a non-invasive proce- enhanced community-based HCVevaluation of patients. OST-prescribing GP dure, has advanced immensely, with studies showing prospectively gated practices in North Dublin were recruited from the professional network/ 256-slice CTCA having radiation doses of 3.0 ± 1.9 mSv [1]. Improvements databases of the research team. Patients were eligible to participate if aged in gantry rotation time show improved image quality at heart rates (HR) up to ≥18 years, on OST and attend the practice. Clinical records of participating 75 beats per minute (BPM) [2]. patients were reviewed at baseline and 6-months post-intervention and data CTCA’s from a GE Revolution 16 cm, 256-detector row scanner were extracted on HCV care processes/outcomes. Descriptive statistical analysis analysed to retrospectively observed how HR (especially > 65 BPM) affected was performed using SPSS V24. image diagnostic quality and radiation exposure. Fourteen practices and 135 patients (71.9% male, mean age 43 years), were Images acquired from patients (n = 100; 53% male), who underwent recruited. Baseline and 6-month post-intervention data were extracted from the CTCA, were viewed using GE AW VolumeShare 4.7 software. records of 135 and 131 patients respectively. Little change was observed in Analysis was in axial view using the 18-segment model (SCCT HCV screening pre- (94.8%) and post- intervention (97.7%). Changes in the Guidelines) with a scale of 1-4 (1 – non-diagnostic; 4 – excellent diag- subsequent management of HCV-positive patients were observed post- nostic quality). Non-diagnostic CTCAs had > 20% ratings below 2. intervention (Table 1). Patients fell into three groups (1 - ≤ 55 BPM; 2 -55>BPM≤ 65; 3 - Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S339

> 65 BPM). Comparison was with one-way ANOVA, post hoc Tukey arbitrated where there was disagreement. Two reviewers independently ex- test and descriptive statistics functions on IBM SPSS. tracted data from included studies and conducted a quality appraisal assessment. Group 3 (Table 1) showed significantly higher radiation exposure (F(2,97) = 6.77; p = .002). 56% of group 3’ssegment’s image quality rated significantly Of 1364 citations, three cross-sectional studies that included 793 were included. All lower than one or both of the other groups with snapshots often necessary studies surveyed ECPAM using a self-reported questionnaire and one study includ-

(F(2,97) = 23.51; p < .001). Additionally, 38% of group 3’s images were non- ed additional face-to-face interviews. The respondents included residents, physi- diagnostic (Group 2 – 9%; Group 1 – 3%). cians and social workers. Reported training needs were heterogeneous between Results indicate advances in decreasing tube voltage and increasing gantry studies, but knowledge and skills around management and treatment of SUD rotation speed would allow imaging at higher HR, and medically lowering emerged as a common theme. HR is a current must where contraindications won’t occur. Overall, there is little evidence on the training needs found in this review. The References quality of studies included in the review was variable. Training needs assessment of early career professionals working in the field of addiction medicine is a priority. 1. Sabarudin A, Sun Z, Ng K-H. A systematic review of radiation dose asso- References ciated with different generations of multidetector CT coronary angiography. J Med Imaging Radiat Oncol. 2012; 56: 5-17. 1. Ries RK, Miller SC, Fiellin DA, Saitz R. Principles of addiction medicine. 2. Fujimoto S, Matsutani H, Kondo T, Sano T, Kumamaru K, Takase S, et al. Fourth Edition. Philadelphia, USA.: Lippincott Williams & Wilkins; 2009. Image quality and radiation dose stratified by patient heart rate for coronary 2. Ayu A.P, el-Guebaly N, Schellekens A, de Jong C, Welle-Strand G, Small 64- and 320-MDCT angiography. AJR 2013; 200: 765-770 W, et al. Core Addiction Medicine Competencies for Doctors, An International Presenting Author: Ms. Charlotte Bauer-Dowling Consultation on Training. Substance Abuse 2017; 38(4):483-7 Supervisor:Dr. Niall Sheehy Presenting Author: Damien Kelly Table 1. Radiation Dose in each Heart Rate Group Supervisor:Dr Jan Klimas Co-Supervisor:Prof Walter Cullen

Group 1 Group 2 Group 3 (≤ 55 BPM) (55 > BPM ≤ 65) (> 65 BPM) 53. MENTAL HEALTH AND MENTAL ILLNESS: ONLINE RESOURCE CURATION AND DEVELOPMENT Radiation 1.59 ± 0.12 1.58 ± 0.11 mSv 2.42 ± 0.22 mSv * Dose mSv Omiwole S1, Keane M2,KeaneR2

1 Radiation dose shown as mean ± SEM for each heart rate group. Dose Length UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 2 Product (DLP) converted to radiation dose using the conversion coefficient for Actualise, DCU Alpha, Innovation Campus, Glasnevin, Dublin 11. the chest (k = 0.014 mSv·mGy-1·cm-1). * indicates significant difference to both others. The purpose of this research was to (a) investigate the epidemiology, etiology, causes and interventions for depression and anxiety found in children, adolescents and adults, (b) investigate the effects of screen time in children and 52. WHAT ARE THE TRAINING NEEDS OF EARLY CAREER adolescent’s brain development and social interactions, (c) and develop online PROFESSIONALS IN ADDICTION MEDICINE? A SCOPING articles and fact sheets for the public. REVIEW This research project was carried out as a literature review and information was gathered from related academic papers and policy documents. Kelly D1,AdamA2,IndaveI3, Krupchanka D4,WoodE1,CullenW1,KlimasJ1 The World Health Organization (WHO) has estimated that over 300 mil- lion people are affected by depression, with approximately 800 000 peo- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. ple dying from suicide each year. As well, 1 in 13 people suffer from 2British Columbia Centre on Substance Abuse, Vancouver, British Columbia, anxiety, making anxiety disorders the most common mental disorders Canada. worldwide. Although it remains unknown whether or not screen time ’ 3 can make changes in a developing child s brain, it has been shown that European Monitoring Centre for Drugs and Drug Addiction, Lisbon, educational TV programs can help children in the early stages in regards Portugal to language and literacy. 4 Department of Mental Health and Substance, World Health Organisation, The results demonstrate that mental health issues and mental illnesses are Geneva, Switzerland. becoming more prominent and people should seek out proper care and treatment. Substance use disorders (SUD) represent a significant social and economic burden References globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) fails, in part, due to a lack of training programs targeting this career stage. [1]. Prior research has highlighted the need to assess the specific 1. World Health Organization. (2018). Depression. [online] Available at: http:// training needs of early career professionals working in this area [2]. Therefore, we www.who.int/news-room/fact-sheets/detail/depression [Accessed 12 Jul. reviewed the literature to identify the training needs of ECPAM and to assist the 2018]. improvement of addiction medicine curricula worldwide. 2. Pediatric Child Health. Screen time and young children: Promoting health Medical and education databases were searched to June 2018 for studies and development in a digital world. Canadian Pediatric Society. 2017; 22(8): reporting perceived training needs of early career professionals (having com- 461-468. pleted their training within a five year period at the time of assessment) in addiction medicine. Retrieved citations were screened and full text articles Presenting Author: Sharon Omiwole reviewed for eligibility by two independent reviewers. A third reviewer Supervisor: Mr Michael Keane S340 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

57. THE UNFOLDED PROTEIN RESPONSE (UPR) IN THERAPY- 2Department of Neurology, The Children’s Hospital of Philadelphia, INDUCED SENESCENT CAL51 TRIPLE NEGATIVE BREAST Philadelphia, Pennsylvania, USA. CANCER (TNBC) CELLS 3Pharmacology Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania, USA Goh CY1,2,LindsayS1,2, Kavanagh E1,2,CoyleD2,HoMZG1,2, Murphy 1,2 1,2 M ,McCannA Before the use of antiretroviral therapy (ART) and combined antiretroviral therapy (cART), approximately half of all HIV(+) patients 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. developed HIV-associated neurocognitive disorder (HAND) [1]. 2UCD Conway Institute of Biomedical & Biomolecular Research, University Although anti-retroviral treatments have significantly decreased the College Dublin, Belfield, Dublin 4. most severe form of HAND, less severe forms of the disorder persist in 30-50% of patients [1]. Transcriptome analysis comparing untreated and ART-treated patients with HAND showed downregulation of TNBC is a subtype of breast cancer which lacks the receptors for oestrogen genes critical for oligodendrocyte differentiation and myelin produc- and progesterone and does not overexpress HER2. Most patients obtain com- tion in ART-treated patients [2], suggesting that ART, as well as HIV, plete or partial clinical response following neoadjuvant treatment. Despite this may disrupt myelin production and oligodendrocyte growth and however, these patients have a higher local recurrence risk [1]. When cells maturation. undergo stress, the UPR is activated. GRP78 is the master regulator of the UPR while Calnexin has a role in apoptosis, induced by endoplasmic reticulum The aim of this research was to (a) isolate rat oligodendrocyte precursor cells stress. The aim of this research was to evaluate the association between the (OPCs) and treat maturing OPCs with varying doses of the anti-retroviral drug UPR and therapy-induced senescence (TIS). Tenofovir Alafenamide and (b) observe the effects of this drug on oligodendrocyte cell number, morphology, myelin protein expression and numbers of Control (n=3) and TIS (n=3) Cal51 TNBC cells were treated with Carboplatin astrocytes. (100μM) and Paclitaxel (75nM), which are current neoadjuvant chemotherapeutic drugs used in the front-line treatment of TNBC (NCCP). Western blot OPCs were isolated from the frontal lobes of P0 rat pups using a analyses were performed on all samples to determine the protein expression shake-off protocol and plated onto coverslips and culture dishes. At levels of GRP78 and Calnexin. The proliferation marker Ki67 was used to 70% confluency, cultures were treated with 60nM, 600 nM, and μ confirm the presence of senescence in chemotherapy-treated cells. 1.7 M Tenofovir Alafenamide in differentiation media for 72 hours. Densitometry analysis was then performed using ImageJ. Coverslips were stained for GFAP, an astrocyte marker, and PLP, a mature oligodendrocyte marker for immunocytochemistry analysis. Ki67 expression levels were as expected, lower in TIS cells compared to Protein expression of GFAP and MBP, a mature oligodendrocyte controls. GRP78 was significantly (p<0.01) lower in Paclitaxel-treated cells marker, were determined via western blot analysis. while Calnexin was significantly (p<0.05) lower in Carboplatin-treated cells compared to non-treated cells. The results demonstrated a trending increase in GFAP, and a trending decrease in MBP protein and PLP+ cells suggesting that Tenofovir Alafenamide may be In summary, GRP78 and Calnexin are potential markers of TIS and a possible driving OPC maturation away from the oligodendrocyte lineage and in the therapeutic target in neoadjuvant-treated TNBC. Lower expression levels of direction of astrocyte formation. GRP78 and Calnexin are suggestive of lower protein folding efficiency and increased misfolded proteins in TIS cells [2]. This finding may partially explain the Acknowledgments:- high risk of local recurrence in women treated neoadjuvantly. The author would like to acknowledge funding from The National Institute of Acknowledgments: Health (NIH). The author would like to acknowledge funding from the Wellcome Trust References Vacation Scholarship. References 1. Saylor D, Dickens AM, Sacktor N, Haughey N, Slusher B, Pletnikov M, et al. HIV-associated neurocognitive disorder—pathogenesis and prospects for treatment. Nature Reviews Neurology. 2016 Apr;12(4):234. 1. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast can- 2. Borjabad A, Morgello S, Chao W, Kim SY, Brooks AI, Murray J, et al. cer: meta-analysis of individual patient data from ten randomised trials. The Significant effects of antiretroviral therapy on global gene expression in brain Lancet Oncology. 2018; 19(1): 27-39. tissues of patients with HIV-1-associated neurocognitive disorders. PLoS pathogens. 2011 Sep 1;7(9):e1002213. 2. Minakshi R, Rahman S, Jan AT, Archana A, Kim J. Implications of aging and the endoplasmic reticulum unfolded protein response on the molecular Presenting Author: Ms Lauren Fox modality of breast cancer. Experimental and Molecular Medicine. 2017; Supervisor:Dr Judith Grinspan 49(11): e389. Presenting Author: Ms Chia Yin Goh 64. APPLICATION OF MODELLING TO INVESTIGATE Supervisor: Assoc Prof Amanda McCann PATHOGEN TRANSMISSION Co-Supervisor: Ms Sinéad Lindsay

1 1 1 58. TREATMENT OF OLIGODENDROCYTES IN CULTURE WITH Daly,E. , Crispell J , Gordon SV THE ANTI-RETROVIRAL DRUG TENOFOVIR ALAFENAMIDE 1 MAY DECREASE OLIGODENDROCYTE DIFFERENTIATION UCD School of Veterinary Medicine, University College Dublin, Belfield, AND INCREASE NUMBERS OF ASTROCYTES Dublin 4.

Fox L1,GrinspanJ2,RothL2,3 The aim of this project was to develop a simulation model that could be used to investigate pathogen transmission. Simulation models can be used to represent many different forms of transmission and may also be used to test the possible 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. usefulness of control measures. Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S341

My model is constructed using the programming language of R. I developed a References series of simulation models to represent different patterns of infection; Susceptible-Infectious (SI) model, Susceptible-Exposed-Infectious model 1. Klein A, Stein M, Golan-Shany O, Kerem N, Chistyakov I et al. Validation (SEI) & Susceptible-Infectious-Recovered (SIR) model. In these models, sus- of a novel assay to distinguish bacterial and viral infections. Pediatrics 2017; ceptible (not yet exposed to infection), exposed (infected but not yet infec- 140(4): e20163453. tious), infectious (capable of infecting susceptible individuals) and recovered Presenting Author: James Kelly (no longer infectious) individuals were represented. Supervisor:Dr Jaythoon Hassan Different models are better suited to different types of infection, for example the SEI model could be used as a model for Rabies infection, which would have a susceptible phase where an individual has not yet become infected, an 68. ASSESSMENT OF BODY COMPOSITION OF KUWAITI exposed phase where the individual has been infected by the virus and an INFANTS BY USING AIR DISPLACEMENT infectious phase once the individual becomes infectious. While the SIR model PLETHYSMOGRAPHY (PEA POD®) could represent an Influenza infection. Development of a simulation model is a very useful method to study pathogen 1 2 transmission. Future work could involve developing a Susceptible- Exposed- Al-Mesad Y , Davidsson L Infectious- Recovered/Removed model to represent mycobacterium bovis infection [2]. This is a useful tool in the continuing efforts to eradicate myco- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. bacterium bovis infection. 2Family Medicine and Paediatric Research Unit, Dasman Diabetes Institute, References Kuwait City, Kuwait.

1. Vynnycky E, White R, Fine P. An introduction to infectious disease model- Monitoring infant growth according to defined parameters is essential ling. Oxford (Inglaterra): Oxford University Press; 2010. when assessing infant health. The aim of this study is to monitor infant 2. Barlow N, Kean J, Hickling G, Livingstone P, Robson A. A simulation growth (according to the World Health Organization (WHO) child growth , model for the spread of bovine tuberculosis within New Zealand cattle herds. standards) and body composition from birth to 6 months of age in Arabic Preventive Veterinary Medicine. 1997;32(1-2):57-75. infants. Additionally, the study aims to evaluate the efficacy of an intense lactation counselling intervention. Presenting Author: Ms Erica Daly Full-term, healthy, singleton infants and mother pairs are enrolled (total sample Supervisor: Prof Stephen V. Gordon size 200) in this longitudinal study. After written consent has been taken, the Co-Supervisor: Dr Joseph Crispell infants are randomized into control or intervention groups. General information about the benefits of breastfeeding are provided to all infant/mother pairs. The control group receives no further advice about breastfeeding, while the 66. USE OF HOST-PROTEIN IMMUNE RESPONSE ASSAYS TO intervention group is provided with information and guidance to support con- DISTINGUISH BETWEEN BACTERIAL AND VIRAL INFECTIONS tinued breastfeeding. Anthropometric data are collected at 2 weeks of age, and thereafter once a month up to 6 months. Infant growth is assessed using the Kelly J1,HassanJ1 WHO AnthroPlus software, alongside reviewing infant feeding practices. Based on preliminary data, it appears that the majority of infants in both groups 1National Virus Reference Laboratory, University College Dublin, Belfield, do not deviate substantially from the median WHO child growth standards, for Dublin 4. weight-for-age and BMI-for-age. A few infants in both groups show rapid growth, reaching +2 or +3 standard deviations. To date, none of the infants were exclusively breastfed for 6 months, as recommended by WHO, and most Bacterial and viral infections are often clinically indistinguishable. This results infants were mixed fed. in the overuse of antibiotics. A recent publication used measurements of the immune response proteins; C- Reactive Protein (CRP), Tumour Necrosis These results provide new information about infant feeding in Kuwait and on Factor-related Apoptosis-inducing Ligand (TRAIL), and Interferon gamma- longitudinal growth in Arabic infants, assessed by the WHO child growth induced Protein-10 (IP-10) to develop a host-signature assay score that could standards. distinguish between bacterial and viral infections (1). The aim of this study Acknowledgments:- was to compare the levels of these host proteins in the serum and nasopharyn- This research project is a collaboration between the Kuwait Institute for geal aspirates (NPA) of patients with known bacterial and viral infections. Scientific Research (KISR) and the Ministry of Health in Kuwait. The project The bacterial infection cohort included patients who had acute Mycoplasma is funded by the Kuwait Foundation for the Advancement of Sciences (KFAS). pneumoniae infection (n=20) and the viral cohort were patients with acute Presenting Author: Yasmin Al-Mesad Cytomegalovirus infection (n=20). NPAs for the bacterial group were Supervisor: Dr Lena Davidsson Mycoplasma pneumoniae infected and the viral group were due to Respiratory Syncytial virus infection. Enzyme Immunoassay was used to measure the 3 proteins. The Mann-Whitney test was used to compare the groups. 69. GENETIC TESTING IN WOMEN UNDER 40 DIAGNOSED WITH Median IP-10 levels in sera was significantly lower in the bacterial (110pg/ml) BREAST CANCER; INDICATIONS, EXISTING REFERRAL compared to the viral group (593pg/ml, p<0.001) and median TRAIL levels PRACTICES AND IMPACT ON TREATMENT approached significance (101 vs 136pg/ml; p<0.053). In contrast, median levels of CRP were higher in patients with bacterial compared to viral infec- 1 2 2 3 tion, however this was not significant (8.94 vs 5.54mg/L; pNS). Higher levels Mee Hui Koh , Anna Heeney , Fionnuala Keane , Claire Giffney , Alex 2 2 3 of TRAIL were observed in the NPAs compared to sera. Aleksandra Szalwinska , Malcolm Kell , David Gallagher ,Fidelma Flanagan2 Our findings show that this approach has the potential to utilise the host’s immune response to infection rather than direct pathogen detection and may 1 help to improve management of patients with acute infection and reduce anti- UCD School of Medicine, University College Dublin, Belfield, Dublin 4. biotic misuse. 2Breast Health Department, Mater Misericordiae University Hospital, Dublin 7. S342 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

3Cancer Genetic Clinic, Mater Misericordiae University Hospital, Dublin 7. We found records of 91 mothers who induced lactation from 2013 till 2018. The main characteristics of these women were that they were of Muslim faith, Breast cancer is the most common diagnosed cancer among females in Ireland. 26 to 40 years of age, working, had never given birth and were adopting a full- Women with BRCA 1 and 2 genetic mutation have a 46 - 87% lifetime risk of term baby. 73% of mothers succeeded to induce lactation. The main reason (2) breast cancer. [1] According to National Institute for Health and Care why they induced lactation was because of Mahram . The main limitation of Excellence (NICE) guidelines, young women with breast cancer with or with- this study was the poor documentation of essential data which could be im- out family history that fulfill the criteria stated in the guidelines should be proved if computerized forms were used in the future. considered for genetic testing. Several articles reported that BRCA test result This study has the largest cohort of women in Malaysia documented to have may affect initial surgical decision. [2] induced lactation. The higher than expected success rate will encourage other We performed a retrospective clinical audit of genetic testing at the symptom- women intending to induce lactation in the future. atic breast service Mater Misericordiae University Hospital (MMUH) database References in women under 40 diagnosed with breast cancer in 2017. The aims were to note the frequency of genetic referral practice, timeline of BRCA testing and 1. Rahim NCA, Sulaiman Z, Ismail TAT. The Availability of Information on impact on surgical management. Induced Lactation in Malaysia. The Malaysian journal of medical sciences : A total of 40 women under 40 were diagnosed with breast cancer in 2017. 25% MJMS. 2017;24(4):5-17. patients had triple negative disease and 40% had neoadjuvant chemotherapy. 2. The Qur'an,65:6 & The Qur'an,23:4 62.50% patients were referred for genetic testing. Average waiting time for the Presenting Author: Siti Nur Amirah Mohamad genetics result to be received was 73.5 days. 2.5% had a positive genetic test prior to surgery. Surgical management was altered due to a BRCA 1/2 muta- Supervisor: Dr May Loong Tan tion in 1 patient. Co-Supervisor: Assoc Prof Siew Cheng Foong and Dr Wai Cheng Foong All patients under 40 diagnosed with breast cancer should be considered for genetic testing. Positive testing may result in altered surgical management. 72. IMPLEMENTING KANGAROO CARE FOR NEWBORNS IN References INDIA: OBSTACLES FOR SETTING UP

1. Petrucelli N, Daly M, Pal T. BRCA1- and BRCA2-Associated Hereditary 1 2 Breast and Ovarian Cancer [Internet]. NCBI. 2018 [cited 3 August 2018]. Kaul M ,DiwanV Available from: https://www.ncbi.nlm.nih.gov/books/NBK1247/ 1 2. Yadav S. MD, Jinna S. MD, Pereira-Rodrigues O. MD, Reeves A. MS, UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Campian S. MS, Sufka A. MS, et al. Impact of preoperative BRCA1/2 testing 2Center of Global Health, Karolinska Institutet,Tomtebodavägen 18A, 171 77, on surgical decision making in patients with newly diagnosed breast cancer Solna, Stockholm, Sweden. [Internet]. Wiley Online Library. 2018 [cited 3 August 2018]. Available from: https://onlinelibrary-wiley-com.ucd.idm.oclc.org/doi/full/10.1111/tbj.13007 India reports the largest number of neonatal deaths, where 35% of them are due to Presenting Author: Ms Mee Hui Koh low birth weight [1]. Kangaroo mother care (KMC) is a skin to skin contact Supervisor:Prof Fidelma Flanagan technique that increases survival rate of low birth weight babies [2]. Many reviews have been done and successfully proven the efficacy of the technique. Despite this, Co-Supervisor:Dr David Gallagher there are many social and economic hurdles that need to be crossed for the implementation of this technique in the Indian subcontinent. As of now, its taught in some medical colleges and implemented in only a few hospitals[2]. 70. INDUCED-LACTATION AMONG WOMEN IN PENANG, MALAYSIA: A RETROSPECTIVE STUDY The aim of this research was to (a)look at causes of neonatal mortality and (b) obstacles to the usage of kangaroo mother care in India. Research was conducted on all the different parts of neonatal mortality and Amirah SN1, Tan ML2, Foong SC2,FoongWC2,HoJJ2, Kovindarajoo V3, kangaroo mother care in India. Then implementation obstacles which have Sany S 4 hindered the use of kangaroo mother care were highlighted through researching KMC and neonatal mortality and writing summaries on respective 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. topics. The two topics were researched via specific studies for eg. randomized 2Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly controlled trials. Then common themes were noted down and results were Penang Medical College). extracted to answer the research question. 3Lactation Unit, Hospital Seberang Jaya, Malaysia. The results demonstrated that particular obstacles preventing KMC 4Department of O&G, Hospital Seberang Jaya, Malaysia. uptake and there were certain causes of neonatal mortality. These include sociocultural barriers, maternal and infant issues, issues with facility environment, negative interactions with medical staff, fear of Induced lactation is the triggering of breast milk production in women who have hurting infant, and low awareness of KMC. The causes of neonatal not gone through the process of pregnancy and delivery. It is usually for surrogacy, mortality include birth asphyxia, birth trauma, prematurity, infection, adoption, maternal-infant separation and even can be used during emergencies such diarrheal diseases, sepsis and congenital anomalies. as natural disasters. Essential steps for induced lactation include breast and nipple stimulation, medication to stimulate hormones and maternal diet supplementation. References Information about induced lactation is scarce in Malaysia(1). Our primary objectives for this study were to describe the characteristics of women who underwent the 1. Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, process and determine the success rate. et al. State of Newborn Health [Internet]. BioMed Central. U.S. National We conducted a retrospective review of all the written records of women who Library of Medicine; 2016 [cited 2018Jun28]. Available from: https:// received induced lactation services at the Lactation Unit, Hospital Seberang www.ncbi.nlm.nih.gov/pmc/articles/PMC5144119/ Jaya. Data on demography, mother’s and baby’s condition, reasons for induc- 2. Mazumder S, Taneja S, Dalpath SK, Gupta R, Dube B, Sinha B, et al. Impact of tion and the induced lactation method were collected and analyzed. community-initiated Kangaroo Mother Care on survival of low birth weight Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S343 infants: study protocol for a randomized controlled trial [Internet]. BioMed Central. We developed a brief questionnaire to evaluate patient perception of statin U.S. National Library of Medicine; 2017 [cited 2018Jun15]. Available from: therapy, with all patients presenting to the Beacon Rapid Access Cardiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463407/ Clinic over a 6 week period asked to fill out the questionnaire. 154 patients Presenting Author: Ms Mridu Kaul responded. 73% were not on a statin and 49% of this group would not consider Supervisor:Dr Vinod Diwan statin treatment if advised to do so. 33% had concern regarding possible muscle damage and 32% feared dementia. 15% of patients taking statins had experienced side effects, but 50% of those continued on the medication. 76. CONTEMPORARY USE OF NOVEL ORAL ANTICOAGULANT Separately, we used the Beacon Hospital meditech system to evaluate all lipid AGENTS IN MODERN PRACTICE AND ASSESSMENT OF KNOWN profile blood testing results over a 3 year period. The true incidence of familial MEDICATION INTERACTIONS AND OFF-LABEL USE hyperlipidaemia in the Irish population is uncertain. A total of 15,910 tests were performed with 279 (1.75%) having an LDL greater than 5.2. Medication information was available for all in-patients and 32% of this group were cur- McInerney N1,DowleyM1, Kelly M1,LimA1,MurphyS1,BurkeD2 rently taking statin therapy. A significant distrust of statin therapy is clearly evident in the Irish patient 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. population. Hyperlipidaemia is a key public health issue with a significant 2 UCD Beacon Hospital Academy, Beacon Hospital, Dublin 18. proportion of patients having markedly elevated lipid levels. References Novel oral anticoagulants (NOACs) have become the gold standard in management of patients with thromboembolic disease and stroke prevention in 1. Matthews A, Herrett E, Gasparrini A, Van Staa T, Goldacre B, Smeeth L atrial fibrillation, and have largely replaced Warfarin. Clinical trials aim to et al. Impact of statin related media coverage on use of statins: interrupted time establish efficacy and safety. We looked at trends in contemporary anticoagu- series analysis with UK primary care data. BMJ. 2016;:i3283. lant use and determine appropriateness and safety of use. Presenting Author: Matthew Kelly Over the last 3-years the use of NOACs has increased (22-36% per year) in our centre. Rivaroxaban maintains the market share, with introduction of Supervisor:Dr David Burke Apixaban and Edoxaban leading to significant decrease in use of Dabigatran. Warfarin use has dropped precipitously. 78. ASSESSMENT OF STRESS AS A CONTRIBUTING FACTOR IN 52% of patients were male, with average age 73-years-old. 82% of patients had PATIENTS PRESENTING WITH CHEST DISCOMFORT OR atrial fibrillation, 16% thromboembolic disease, and 2% other indications. PALPITATIONS TO A TERTIARY CARDIOLOGY SERVICE Correct dosing in the setting of renal impairment (eGFR < 50 mls/min) and in patients under 50kgs is well observed with only 2% of patients on the incorrect dose and all patients of low weight prescribed the appropriate lower 1 2 1 1 1 3 dose. 36% of patients are given the ‘renal dose’ of the medication despite no Lim A ,MurphyS, Kelly M , McInerney N , Dowley ,BurkeD specific indication for the lower dosing. 1 Drug drug interactions remain an issue despite experience with these agents, UCD School of Medicine, University College Dublin, Belfield, Dublin 4. with anti-platelet agents Aspirin and Clopidogrel, and Amiodarone most com- 2UCD School of Psychology, University College Dublin, Belfield, Dublin 4. monly combined. 27% of patients were also taking Aspirin. 20% were taking 3UCD Beacon Hospital Academy, Beacon Hospital, Dublin 18. anti-arrhythmics such as Amiodarone, Digoxin, Verapamil or Dronedarone. NOAC use has increased year-on-year and correct dosing in patients consid- ‘Stress’ is difficult to measure and characterize and is highly variable across ered higher risk for bleeding appear to be well observed. Conversely, lower patients. Cardiovascular risk factors have been extensively researched and we dosing is widely used in patients with no apparent indication for the reduction. have a broad understanding of how conditions such as hypertension, hyper- Drug:drug interactions remain frequent. lipidaemia or diabetes impact on cardiovascular outcomes. Stress appears to Presenter: Niall McInerney play a role in the overall process but is uncertain whether it is causative or Supervisor: Dr David Burke simply tips the balance. We sought to determine the clinical impact of stress in patients presenting with chest discomfort or palpitations to the Beacon Rapid Access Cardiology 77. CURRENT PATIENT PERCEPTION OF STATINS IN THE Clinic. Over a 6-week period, patients were asked to complete a questionnaire TREATMENT OF HYPERLIPIDAEMIA AND AS PART OF A combining the widely validated Stress Perception Scale with additional ques- PREVENTATIVE STRATEGY, THE APPROPRIATE USE IN tions specific to symptoms. SECONDARY PREVENTION, AND THE TRUE INCIDENCE OF 166 patients responded. 65% were male. Average age was 52 years old. Men FAMILIAL HYPERCHOLESTEROLAEMIA IN THE HOSPITAL had higher stress scale scores than women (14.4 versus 12.8), and younger POPULATION patients were significantly more ‘stressed’ than more elderly patients (20-39 yo – 17.4; 40-59 yo – 15.0; 60-79 – 9.2; 80+ - 9.1). 34% scored higher than 17 on the scale which is outside the standard deviation means for the general popu- Kelly M1,DowleyM1,LimA1, McInerney N1,MurphyS1,BurkeD2 lation. 90% of these patients with higher scores felt strongly that their stress played a role in causing their symptoms, and 91% noted that their symptoms 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. were worse when under stress. 2UCD Beacon Hospital Academy, Beacon Hospital, Dublin 18. Undoubtedly, patients presenting with symptoms to a cardiology clinic would be expected to be under more pressure than the general population. Our study demonstrates above average stress in patients who have symptomatology Guideline targets for treating cholesterol continue to become tighter, and a grow- which is more often thought to be causative or an aggravating factor in ing population meet criteria for treatment. Statins form the cornerstone of lipid symptoms. lowering therapy and are widely proven as part of a preventative strategy. The perception of statins in the public domain is poor with most patients being aware Presenting Author: Angeline Lim only that the medications are notorious for causing side effects [1]. Supervisor:Dr David Burke S344 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

79. THE USE OF STANDARD TREADMILL STRESS TESTING IN with mean age 74.2 years. 8 patients (61.5%) had positive blood cultures SCREENING FOR AUTONOMIC DYSFUNCTION IN A DIABETIC growing Staph, Strep, Enterococcus and Klebsiella species, and one patient POPULATION grew a Candida. Only 2 patients were undergoing current chemotherapy for underlying malignancy, despite a large oncology service at our center. 7 patients had some degree of renal impairment and 5 (38.4%) of these had sig- Murphy S1,LimA1, Kelly M1, McInerney N1,DowleyM1,BurkeD2 nificant renal impairment. Patients required prolonged treatment with an average of 5.2+/-2 intravenous antibiotics. 1UCD School of Medicine & Medical Science, University College Dublin, 6 patients (46.2%) had an apparent source of their infection – 1 infected Belfield, Dublin 4. pacemaker, 1 spinal discitis, 2 urosepsis, and 2 lower respiratory tract infec- 2 UCD Beacon Hospital Academy, Beacon Hospital, Dublin 18. tion. 1 patient had a pre-existing bioprosthetic aortic valve in-situ. None had preceding dental work. Following prolonged treatment, 7 patients recovered Longstanding diabetes increases the risk for cardiovascular and neurological se- with antibiotics alone, 5 required emergent valve surgery (2 requiring mitral quelae [1]. Glycaemic control optimisation is crucial to minimising long-term and aortic replacement), and 1 patient died. impact. As part of cardiac assessment and risk stratification, standard stress testing Infective endocarditis remains a relatively frequent condition that continues to pose remains a simple and reproducible test used to outrule underlying cardiac ischaemia difficulty both in diagnosis and treatment and confers significant morbidity. [2]. We sought to test the hypothesis that stress testing could also be used as a Presenting Author: Mr Mark Dowley screening tool for autonomic dysfunction in the diabetic population. Supervisor:Dr David Burke We performed a retrospective statistical evaluation of all diabetic patients presenting for cardiac assessment with stress testing to the Beacon Hospital between July 2015 and June 2018, and excluded all patients who were on a 82. MITOCHONDRIAL REGULATION OF SIGNAL beta-blocker or other rate-controlling medications. We used patients presenting TRANSDUCTION IN TRIPLE NEGATIVE BREAST CANCER to the Rapid Access Cardiology Clinic to create a cohort of age and sex- (TNBC) matched non-diabetic controls. 41 patients with diabetes who met criteria underwent stress testing during the 1 2 2 period. 70% were male and average age was 63.4 years old. There was no Ting P ,MurphyM, Bhreathnach U significant difference in Bruce protocol exercise duration between the 2 groups (8.6 minutes versus 8.7 mins; DM vs non-DM) or in the target heart rate 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. achieved. There was no apparent heart rate chronotropic or blood pressure 2UCD Conway Institute of Biomedical & Biomolecular Research, University response features that could be used to discern between the groups and no College Dublin, Belfield, Dublin 4. obvious finding that highlighted a degree of autonomic dysfunction. Diabetic patients were more likely to have positive testing (62% vs 46%). Triple negative breast cancer (TNBC) refers to tumours that are negative for A diabetic population performs comparably with a non-diabetic control group, with oestrogen receptors (ERs), progesterone receptor (PRs), and human epidermal no clear finding that might distinguish a degree of autonomic dysfunction upon growth factor receptor 2 (HER2) on routine immunohistochemical (IHC) analysis. standard stress testing. They account for 10-17% of all breast cancer subtypes and are poorly differentiated References and clinically aggressive. Women diagnosed with TNBC have a significantly lower mean age at diagnosis, with an increased likelihood of distant recurrence and death 1. Bloomgarden Z. Consequences of diabetes; cardiovascular disease. compared with other breast cancer phenotypes. Moreover, TNBC is a more ag- Diabetes Care. 2004 Jul; 27(7): 1825-1831. gressive disease and patients are more likely to present with larger tumours of higher grade. Within the TNBC subtypes, basal-like TNBC tumours have the 2. Torpy J, Lynm C, Glass R. Cardiac stress testing. JAMA. 2008 Oct; Vol300, poorest prognosis among all breast cancer. In addition, the treatment options for No. 15. this TNBC subtype are limited. Therefore, a more efficacious treatment is urgently Presenting Author: Mr Stephen Murphy and clinically warranted. Supervisor: Dr David Burke The aim of this research was to investigate the role of an evolutionary highly conserved mitochondrial protein known as "Induced in high glucose-1" (IHG- 1) in TNBC [1]. Mitochondria play important roles in cancer development and 80. INFECTIVE ENDOCARDITIS – A CONTEMPORARY progression, and it has been proposed that greater understanding of the mito- ASSESSMENT OF DISEASE PREVALENCE, PATIENT chondrial contribution to cancer development and progression will make an CHARACTERISTICS, MANAGEMENT AND OUTCOME important contribution to the development of the next generation of therapeu- tics [2]. Dowley M1, McInerney N1, Kelly M1,MurphyS1,LimA1,BurkeD2 MDA-MB-231 TNBC cells were firstly stimulated with TGF-B in 96-well plates, and the effects of IHG-1 on TGF-B signal transduction of MDA-MB- 1UCD School of medicine, University College Dublin, Belfield, Dublin 4. 231 cells were assessed using Immunoblot. The results demonstrate that IHG- 1 enhances TGF-B signal transduction. 2UCD Beacon Hospital Academy, Beacon Hospital, Dublin 18. References Almost a decade since the revised ESC Guidelines in prophylactic antibiotic requirements for prevention of infective endocarditis, we sought to make a modern- 1. M. Murphy, N.G. Docherty, B. Griffin, J. Howlin, E. McArdle, R. day assessment of this diagnostically and clinically challenging condition. McMahon, H. Schmid, M. Kretzler, A. Droguett, S. Mezzano, H.R. Brady, F. Furlong, C. Godson, F. Martin, IHG-1 amplifies TGF-beta1 signaling and is 294 patients underwent transoesophageal echocardiogram at our hospital over increased in renal fibrosis, Journal of the American Society of Nephrology : a 3-year period between 1st May 2015 and 30th April 2018, with 67 (22.8%) of JASN, 19 (2008) 1672-1680. these scans performed specifically to assess for infective endocarditis in patients with persistently high inflammatory markers but no obvious source of 2. S. Vyas, E. Zaganjor, M.C. Haigis, Mitochondria and Cancer, Cell, 166 infection. 13 patients (19.4%) had echo findings of convincing valvular veg- (2016) 555-566. etations consistent with a diagnosis of endocarditis. 11 were male (84.6%), Presenting Author: Ms Phoebe Ting Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S345

Supervisor: Dr Úna Bhreathnach 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Co-Supervisor: Dr Madeline Murphy 2UCD School of Biomedical and Biomolecular Science, University College Dublin, Belfield, Dublin 4. 3Systems Biology Ireland, Conway Institute of Biomedical and Biomolecular 86. USING ULTRAVIOLET C LIGHT AS A TREATMENT METHOD Research, University College Dublin, Belfield, Dublin 4. FOR PRO-INFLAMMATORY CELLS IN A PERFUSION SYSTEM Three-dimensional (3D) cell culture models are rapidly becoming the Montminy T1, Galasso M2,3, Duong A2,3, Ali A2,3, Zhang Y2, Keshavjee method of choice for in vitro screening of novel biotherapeutic ther- S2,3,4, Cypel M2,3,4 apies. They represent a unique possibility to recapitulate the in vivo physiological characteristics of solid tumours in an in vitro setting [1]. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 3D culture provides the ability to more accurately study secreted factors that influence adjacent cell behaviour, controlling the cells ability 2Department of Thoracic Surgery, Later Thoracic Surgery Research to proliferate and metastasise [2]. The aim of this research was to (a) Laboratories, Toronto General Research Institute, Toronto, ON, Canada. establish a robust method to culture the breast cancer cell line MCF7 3 Institute of Medical Science, University of Toronto, Toronto, ON, Canada. to create 3D spheroids or ‘mammospheres’ and (b) characterise the 4Toronto Lung Transplant Program, Department of Thoracic Surgery, MCF7 microenvironment. University Health Network, Toronto, ON, Canada. The commonly used breast cancer cell line MCF7 was cultured in a synthetic basement membrane (Matrigel™) to create 3D mammospheres. These Lung transplantation is a successful therapy for end-stage lung diseases. Ex mammospheres were then probed with protein specific antibodies to charac- vivo lung perfusion (EVLP) has increased organ utilization, expanding the terise the MCF7 mammosphere microenvironment using imaging and prote- donor pool. The Toronto EVLP technique uses a leucocyte filter as a scaven- omic analysis. ger, however it may not be effective throughout the entire treatment [1]. The formation of MCF7 mammospheres was documented daily using Ultraviolet C (UVC) light has been shown to induce apoptosis in human light microscopy, and at full culture term using confocal microscopy. lymphoid cells [2] and is a realistic approach for leucocyte reduction in EVLP. MCF7 formed small irregular masses of cells rather than round colonies In this study, customized UVC illumination devices were used to reduce pro- with organised nuclei as produced in the breast cancer cell line inflammatory cells. Two mini-EVLPs were primed with perfusate from clini- MCF10A. Western blot analysis indicated the secretion of the glycolytic cal EVLPs, and divided in two groups (n=5, each, for 3h): 1. UVC, 2. Control enzyme alpha-enolase in 2D culture. The 3D culture media did not (no light). Samples were taken at different time points and analysed using flow produce a positive result for the targeted secreted proteins, suggesting cytometry for cell population assessments. Perfusate cytokines were also eval- further optimisation of the protocol is required. uated. EVLP perfusate samples were also collected from standard and UVC- The results demonstrate that culturing of MCF7 mammospheres to character- irradiated human EVLPs (n=3, each, for 5h) and analysed. ise their microenvironment is possible. Once optimised, this culturing tech- Preliminary flow cytometry results depict a strong correlation towards the nique could further information on the tumour microenvironment, elucidating cytotoxic effect of UVC, although with no significance. Further studies are novel biomarkers and physiologically relevant therapeutic targets. being conducted to validate this correlation. ELISA analysis showed sig- Acknowledgments:- nificant reduction of IL-1β, IL-6 and IL-8 over time in the UVC-irradiated The author would like to acknowledge funding from UCD SBBS. circuits compared to control after 3 hours (IL-1β= 37±33% vs. 50±27%, IL-6= 88±8% vs.101±3%, IL-8= 84±12% vs. 108±19%). References This study depicts UVC as an effective approach to treat pro-inflammatory cells in a perfusion system, leading to cytokine decrease. This suggests that 1. Zanoni M, Piccinini F, Arienti C, Zamagni A, Santi S, Polico R et al. 3D tumor UVC light may offer a substitute to the traditional leucocyte filter during spheroid models for in vitro therapeutic screening: a systematic approach to en- EVLP, potentially leading to better lung transplantation outcomes. hance the biological relevance of data obtained. Scientific Reports. 2016; 6(1). Acknowledgments: 2. Ziegler Y, Moresco J, Yates J, Nardulli A. Integration of Breast Cancer Secretomes with Clinical Data Elucidates Potential Serum Markers for The author would like to acknowledge funding from CIHR, Toronto General Disease Detection, Diagnosis, and Prognosis. PLOS ONE. 2016; 11(6):1-24. & Western Hospital Foundation, and XVIVO. Presenting Author: Mr Kealan Blake References Supervisor: Dr David O’Connell Co-Supervisor: Dr David Gomez 1. Luc JGY, Aboelnazar NS, Himmat S, Hatami S, Haromy A, Matsumura N, et al. A Leukocyte Filter Does Not Provide Further Benefit During Ex Vivo Lung Perfusion. ASAIO J Am Soc Artif 92. PATIENT INFORMATION IN RADIOLOGY: AN IRISH Intern Organs 1992. 2017 Oct;63(5):672–8. PERSPECTIVE 2. Radziszewska E, Piwocka K, Skierski J, Sikora E. UVC-induced cell death of IL-2-dependent human lymphocytes. Cell Biol Int. 1999;23(2):97–103. Azman S1,RyanML1, McDermott É1 Presenting Author: Ms Tess Montminy

Supervisor: Dr Marcelo Cypel 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4.

In radiology setting, provision of information prior to examination plays an 88. GENERATION OF AN IN VITRO MAMMOSPHERE CULTURE important role in order to enhance patient experience and satisfaction. Patient SYSTEM FOR ANALYSIS OF THE BREAST CANCER CELL LINE information leaflet (PIL) is used to support verbal consultation between pa- MCF7 MICROENIROMENT tients and the referring doctors.This project aims to get an overview on how radiology services in Ireland deliver patient information and to see what infor- Blake K1, Tuffery L3, McGauran G2,O’Connell DJ2 mation is included in Irish radiology-related PILs. S346 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

A phone survey was done on 23 radiographer service managers in Ireland 2. Ang Z, Er JZ, Tan NS, Lu J, Liou YC, Grosse J, et al. Human and mouse which was then followed by collecting PILs from different modalities used monocytes display distinct signalling and cytokine profiles upon stimulation in radiology department. A qualitative analysis on 34 PILs was made based on with FFAR2/FFAR3 short-chain fatty acid receptor agonists. Sci Rep. 62016 contents and keywords which were divided into three parts: 1) General content Presenting Author: Ms Clare O Donovan 2) Radiology-related content 3) Design of leaflets Supervisor: Assoc Prof John Baugh It was found that 65% of 23 facilities distribute PILs to patients and 35% Co-Supervisor: Adam Russell-Hallinan deliver written information in a form of letter. 74% send out the information through post while the remaining 26% use a mixed methods depending on the modalities and type of patients. Analysis of the PILs found that there is a 94. HEPATITIS C SCREENING : A SCOPING REVIEW AND DATA significant variation in terms of the amount, depth and categorization of infor- ANALYSIS mation. The most common information included is the nature of the procedure, the experience during the procedure and results from the examination. Due to this variation, there is a need to revise and standardise information leaflets used Hoong Tan C1, McCombe G1,2,McHughT3, Avramovic G1,3,CullenW1,2, in Irish radiology department. Lambert JS1,3 As a follow-up, an analysis of readability and other linguistic aspects of the PILs will be further discussed with a group of linguists. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Presenting Author: Ms Siti Syarafina Azman 2Primary Care Research Group, UCD School of Medicine, University College Supervisor: Dr Marie-Louise Ryan Dublin, Belfield, Dublin 4. 3 Co-Supervisor: Éilish McDermott Centre for Research in Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7.

93. THE EFFECTS OF SHORT CHAIN FATTY ACIDS ON Hepatitis C Virus (HCV) infection remains a major public health bur- MONOCYTE FUNCTION den. It is estimated that Ireland has a population prevalence of 0·5-1· 2%(1). Injecting drug use remains a significant driver of the European HCV epidemic with estimates that HCV antibody prevalence among O’Donovan C1, Russell-Hallinan A2,BaughJ1,2 persons who inject drugs (PWID) in 29 European countries ranges 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. from 5% to 90%(2). 2 UCD Conway Institute of Biomedical & Biomolecular Research, University The study was conducted in two Phases. Phase One involved a scop- College Dublin, Belfield, Dublin 4. ing review of the key literature on screening and testing for Hepatitis C among vulnerable populations. Phase two involved an analysis of a Gut microbiota-derived short chain fatty acids (SCFAs), primarily acetate, dataset from the Hepcare Europe study. The dataset comprised of data butyrate and propionate, have been shown to modulate different processes from a cohort of PWID and a cohort of people who are homeless in including cell proliferation, differentiation, and activation of immune and in- Cork. Eight key variables were identified and analyzed from the flammatory responses [1]. These SCFAs are thought to signal via free fatty dataset which included, age, gender, HCV Ab result, previously tested acid receptors (ffar), primarily ffar2 and ffar3 [2]. The aim of this research was for HCV, history of injecting drug use, sharing of needles, and Opioid to investigate the effect of SCFAs on LPS induced IL-6 production in mouse Substitution Therapy. macrophages. The scoping review identified injecting drug use as the most common risk The mouse macrophage line J774 was cultured in Dulbecco’s modified Eagle’s factor of HCV. Other risk factors include homelessness, mental illness, incar- medium (DMEM). Total RNA was extracted using RNeasy mini kit according to ceration, tattooing and piercings. Analysis of the dataset showed 17.6% the manufacturer’s instructions. PCR primer pairs for ffar1, ffar2, ffar3 and ffar4 (N=193) of population tested were HCV Positive. 38.3% (N=193) reported were purchased and gel electrophoresis-based PCR was used to quantify gene to have no previous history of injected drug use and 83.9% (N=193) reported expression for each free fatty acid receptor. An LPS dose-response curve was no history of sharing of needles throughout lifetime. produced to identify the LPS dose needed to elicit a sub maximal IL-6 production. While the results showed a low prevalence of HCV among participants, this Cells were then treated with each SCFA, both in the presence and absence of LPS, may be because of a greater awareness of harm reduction practices among and the resulting IL-6 production was measured using an IL-6 ELISA. participants as indicated by low rates of needle sharing. PCR confirmed that the cells express ffar1, ffar2, ffar3 and ffar4. The results References also demonstrated that the cells treated with SCFAs-only did not induce Il-6 production and the cells treated with LPS-only induced a significantly in- 1. Thornton L, Murphy N, Jones L, Connell J, Dooley S, Gavin S, et al. creased Il-6 production. LPS/SCFAs treated cells produced differing results; Determination of the burden of hepatitis C virus infection in Ireland. cells treated with butyrate and propionate treatment resulted in a dose- Epidemiol Infect. 2012;140(8):1461-8. dependent decrease in IL-6 production whereas cells treated with acetate did not appear to alter LPS induced IL-6 production. 2. Hahné SJ, Veldhuijzen IK, Wiessing L, Lim TA, Salminen M, Laar M. Infection with hepatitis B and C virus in Europe: a systematic review of In conclusion, the results suggest that butyrate and propionate may modulate prevalence and cost-effectiveness of screening. BMC Infect Dis. 2013;13:181. inflammation by decreasing immune cell cytokine production. Presenting Author: Acknowledgments Mr Chin Hoong Tan The author would like to acknowledge Dr. John Baugh and Adam Russell- Hallinan for their help throughout the project. Supervisor: Prof Jack Lambert References Co-Supervisor: Dr Geoff McCombe

1. Corrêa-Oliveira R, Fachi JL, Vieira A, Sato FT, Vinolo MAR. Regulation of 97. GENDER IS NOT A PREDICTOR OF CLINICAL OUTCOMES IN immune cell function by short-chain fatty acids. Clin Transl Immunology. PATIENTS WITH MYOCARDIAL INFARCTION TREATED WITH 52016. p. e73-. PERCUTANEOUS CORONARY INTERVENTION Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S347

Teng A1, Gao F2,3,LauYH4,YeoKK5*, SingCLOUD Collaborators A purposive-sample approach was used to select ten caregivers of PWMI who had been attending DHMA activities and these participated in a two-hour 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. focus group discussion (FGD). The audio-recorded narratives were coded and a thematic analysis completed. 2National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore All caregivers reported experiencing courtesy stigma from almost everybody in their environment, including family and MHPs. They believed that these 3Center for Quantitative Medicine, Duke-NUS Graduate Medical School, negative attitudes related to prevailing socio-cultural beliefs about mental Singapore health problems, and were being reinforced by a lack of knowledge and inac- 4 Singapore Cardiac Data Bank, National Heart Centre Singapore, Singapore curate media portrayal in general. They felt that they were treated in a 5Department of Cardiology, National Heart Centre Singapore, Singapore condescending manner and rejected by society. However, they felt supported *Corresponding author: A/Prof Yeo Khung Keong, National Heart Centre and encouraged at DMHA and reported that their quality of life and that of Singapore, 5 Hospital Drive S(169609), Tel: +6567048963; Fax:+65 their family members had improved since attending their activities. Courtesy 68449069, Email: [email protected] stigma is a significant issue experienced by caregivers in Malaysia. This type of stigma can be reduced through improved education and shared societal responsibility for providing a compassionate and understanding environment The role of gender in patients treated with PCI for MI remains unclear. The aim for vulnerable people in society [2]. of our study is to evaluate gender gaps in disease profiles, management and clinical outcomes in a contemporary cohort of MI patients treated with PCI. References We conducted a retrospective cohort study of 3,819 MI patients who underwent PCI during index admission to two tertiary hospitals in Singapore 1. Venkatesh, B., Andrews, T., Parsekar, S., Singh, M. and Menon, N. (2016). ’ between 2012 to 2014. Data was obtained from the Singapore Cardiac Stigma and mental health- caregivers perspective: A qualitative analysis. Longitudinal Outcome Database (SingCLOUD). SingCLOUD is a federated [online] Science Direct. Available at: https://www.sciencedirect.com/science/ health data grid which extracts and integrates data from all public hospitals and article/pii/S2213398415000263 [Accessed 15 Aug. 2018]. Ministry of Health, Singapore. Data extracted include clinical characteristics, 2. Corrigan, P., Morris, S., Michaels, P., Rafacz, J. and Rüsch, N. (2012). outcomes, medications and administrative information. All data were Challenging the Public Stigma of Mental Illness: A Meta-Analysis of anonymised and encrypted to prevent re-identification. Primary endpoints in- Outcome Studies. [online] ps.psychiatryonline.org. Available at: https:// cluded in-hospital and 1-year all-cause mortality; a secondary composite end- ps.psychiatryonline.org/doi/pdfplus/10.1176/appi.ps.201100529 [Accessed point, 1-year major adverse cardiac events (MACE) was also evaluated. 15 Aug. 2018]. Compared to men, women were older, and experienced more hypertension, Presenting Author: Ms Wern Yi Ooi diabetes mellitus, renal failure, cerebrovascular disease, peripheral arterial Co-Supervisor: Dr Ng Yin Ping disease, and hyperlipidemia. They had significantly more triple vessel and Lead Supervisor: Assoc Prof D. Finian Martin O’Brien left main stem disease, and were less prescribed with Statins and ACE inhibitors. Unadjusted rates for in-hospital mortality, 1-year mortality, and 1-year MACE were higher in women (8.8% vs 4.5%, p<0.001, 7.4% vs 99. IMAGING STUDY OF OBESE VOLUNTEERS TO EVALUATE 3.2%, p<0.001, 18.6% vs 11.7%, p<0.001 respectively), although no sig- THE EFFECTS OF RECRUITMENT MANOEUVRE AND nificant gender differences were observed after multivariate analysis with TITRATED POSITIVE END-EXPIRATORY PRESSURE demographics, risk factors, guideline adherence and baseline laboratory VENTILATION ON LUNG AND HEART-LUNG INTERACTION results. In conclusion, there were no statistically significant differences in adverse 1 2 2 2 outcomes following PCI for MI. Instead, observed differences were confound- Plesniar J ,FlorioG,SantiagoR,BerraL ed by age and comorbidities. 1 Presenting Author: Mr Aldon Teng UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 2 Supervisor: Assoc Prof Yeo Khung Keong Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States

98. A STUDY OF COURTESY STIGMA EXPERIENCED BY Obese patients represent a significant proportion of ICU admissions in the CAREGIVERS OF PEOPLE WITH MENTAL DISORDERS IN US, hence the need of understanding obese pathophysiology. Excessive PENANG, MALAYSIA BMI is linked to alterations in normal physiology and has an impact on the respiratory system. High abdominal mass exerts greater pressure on the lungs, distends and impairs diaphragm function and may contribute to Ooi W1,NgYP2,O’Brien FM2 atelectasis and increased work of breathing [1]. In previous studies, it was demonstrated that obese ICU patients benefit from 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. open lung approach (OLA) achieved by lung recruitment manoeuvre (RM) 2 Department of Psychiatry, RCSI and UCD Malaysia Campus (RUMC), followed by appropriate applied positive end-expiratory pressure (PEEP) [2]. Penang, Malaysia. In our interventional study, we are hoping to explore the effects of PEEP on lung and heart functions in spontaneous breathing, otherwise healthy, obese Courtesy stigma occurs when negative attitudes related to mental illness also volunteers. affects caregivers of those affiliated with people with mental illness (PWMI). It We will study the respiratory mechanics and cardiopulmonary interactions in has been associated with poor outcomes for those it affects [1]. However, there normal breathing and after application of titrated PEEP following RM. is a paucity of qualitative research examining how and why this is experienced. Regional variations in ventilation/perfusion coupling and possible atelectasis This study explored the perspectives and experiences of caregivers of PWMI will be measured by electrical impedance tomography (EIT). Oesophageal relating to courtesy stigma, and examined the effect of attending activities balloon catheter will be used to estimate intrathoracic pressure. offered by a local Non-Governmental Organization, D’Home Mental Health Cardiovascular assessment, including TAPSE, stroke volume and cardiac out- Association (DMHA) on these perspectives. put will be assessed by transthoracic echocardiography and diaphragm S348 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 ultrasound will be used to investigate the position and function of diaphragm in Supervisor: Dr Benjamin Haibe-Kains increased pleural pressure. Co-Supervisor: Dr Zhaleh Safikhani By exploring the effects of positive end-expiratory pressure on lung and heart functions we hope to elucidate the effects of obesity on cardiovascular and respiratory physiology. This will find use in directing specific 104. HIV CURE: RATIONAL DESIGN OF TRIPLE DRUG ventilator strategy, which may reduce ICU length of stay and decrease COMBINATIONS FOR HIV LATENCY REVERSAL ventilator dependency. The study is currently in data-gathering stage. References Murtagh R1,O’Reilly S1,CrowleyN1, Rezaei SD1, Gautier VW1

1. Imber D, Pirrone M, Zhang C, et al. Respiratory Management of 1UCD Centre for Research in Infectious Diseases (CRID), UCD School of Perioperative Obese Patients. Respiratory Care. 2016, vol. 61 (12): 1681- Medicine, University College Dublin, Belfield, Dublin 4. 1692. 2. Pirrone M, Fisher D, Chipman D, et al. Recruitment Maneuvers and The main barrier to a HIV cure is HIV’s ability to remain epigenetically Positive End-Expiratory Pressure Titration in Morbidly Obese ICU Patients. silent in long-lived latent cellular reservoirs. The use of Latency Critical Care Medicine. 2015, vol. 44(2): 300-307. Reversing Agents (LRAs) to force HIV gene expression and induce Presenting Author: Jan Plesniar BSc virus-mediated or immune-mediated cytolysis is a promising strategy Supervisor: Lorenzo Berra MD for reducing or eliminating HIV latent reservoirs (1,2). However, single Co-Supervisor: Gaetano Florio MD LRA treatments have only achieved limited impact in clinical trials as HIV gene silencing is multifactorial. Hence, multi-targeted approaches appear necessary to collectively unlock these blocks and achieve maxi- 100. GENE ISOFORMS AS EXPRESSION-BASED BIOMARKERS mum HIV reactivation from latency (2). PREDICTIVE OF DRUG RESPONSE IN VITRO Triple combinations of LRAs remain as yet unreported in the literature. This study describes the development of an experimental and analytical framework to systematically evaluate potential synergistic triple LRA combinations. We Clark O1,2,3, Safikhani Z2,3, Smirnov P2,3, Haibe-Kains B2,3 designed dose–response matrices (96 well format) based on predetermined EC50s of single agents, to monitor the effects of single, pair and triple LRA 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. treatments. We examined their induced toxicity and capacity to de-repress HIV 2Princess Margaret Cancer Centre, University Health Network, Toronto, ON, using the J-Lat cellular model of HIV latency and high-throughput flow cy- Canada tometry. The degree of drug interactions (additivity/antagonism/synergy) was 3Department of Medical Biophysics, University of Toronto, Toronto, ON, assessed using a modified Bliss Independence model. Canada We characterised dynamic dose-response profiles and identified novel synergistic triple-drug combinations for HIV latency reversal exceeding single and Large pharmacogenomic studies have screened a plethora of cell lines pairwise drug efficacies, or PMA/Ionomycin treatment (positive control). for drug responses and genomic profiles. These datasets have provided Importantly, no toxicity was observed and high efficacy was maintained at the opportunity to identify genomic biomarkers that can predict drug lower drug concentrations. sensitivity or resistance, however only a few robust biomarkers have In conclusion, our in vitro preclinical drug screening pipeline enables the rapid been reproduced across studies. RNA-seq has recently become avail- identification of optimum drug cocktails for HIV latency reversal with higher able for many studies, making it possible to evaluate transcript abun- efficacy, lower dosages and no toxicity, advantageous for the formulation of dance and identify alternative transcripts, the latter of which are future combination therapy. known to be common in cancers. Acknowledgments: We created a meta-analytical pipeline that organizes two pan-cancer datasets: This project has received funding from the Irish Health Research Board (HRB) the Cancer Cell Line Encyclopedia (CCLE) and the Genomics of Drug and from the European Union's Horizon 2020 research and innovation pro- Sensitivity in Cancer (GDSC). These curated datasets were used to determine gramme under grant agreement No 691119—EU4HIVCURE—H2020- expression-based biomarkers. MSCA-RISE-2015. We acknowledged the limitations inherent to each dataset - such as References inconsistencies in drug response - and implemented tools to sidestep these potential concerns. Next, our framework employed machine learn- 1. Margolis DM, Garcia JV, Hazuda DJ, Haynes BF. Latency reversal and viral ing techniques to create models that predict drug sensitivity, while con- clearance to cure HIV-1. Science (80-) [Internet]. 2016 Jul 22 [cited 2018 trolling for tissue types and batch effects. Building on our previously Jun 15];353(6297):aaf6517-aaf6517. Available from: http:// developed methods, new predictors were included and an independent www.ncbi.nlm.nih.gov/pubmed/27463679 statistical method was employed to assess the strength of each predictive model. Statistically significant biomarkers were validated against a third 2. Schwartz C, Bouchat S, Marban C, Gautier V, Van Lint C, Rohr O, dataset: the Genentech Cell Line Screening Initiative (gCSI). et al. On the way to find a cure: Purging latent HIV-1 reservoirs. Furthermore, our algorithm is available on CodeOcean to encourage Biochem Pharmacol [Internet]. 2017 Dec 15 [cited 2018 – open-access and fully reproducible research. Aug 10];146:10 22. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/28687465 Our tool has previously been used to determine several isoform-based biomarkers in breast cancer, and these results support isoform expression as a rich Presenting Author: Mr Ross Murtagh resource for biomarkers predictive of drug response. Supervisor: Dr Virginie Gautier Acknowledgments: The author would like to acknowledge funding from the University of Toronto 105. ANAESTHETIC EXPOSURE AND NEURODEVELOPMENTAL Medical Biophysics Summer Student Program. OUTCOMES IN INFANTS WITH ESOPHAGEAL ATRESIA AND Presenting Author: Oliver Clark TRACHEOESOPHAGEAL FISTULA Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S349

Gupta N1,ChiuP2, Mayne J3,MooreAM4 proliferation assay and the Neutral Red Uptake assay. The AlamarBlue Assay was also used to study the cytotoxic range of the HA-AA polymer using 3T3 fibroblasts, with a polymer concentration ranging from 10μg/mL to 20,000μg/ 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. mL. 2Division of Paediatric Surgery, The Hospital for Sick Children, Toronto. It was determined that cells encapsulated in the 5% PEG/3% gelatin hydrogel 3 Division of Anaesthesia, The Hospital for Sick Children, Toronto. had a higher percentage viability. It was found that as HA-AA polymer con- 4Division of Neonatology, The Hospital for Sick Children, Toronto. centration increased, cell viability decreased. Thus, lower concentrations of polymer and gelatin should be used during the synthesis of ECM-based Prolonged exposure to general anaesthesia in early childhood has been a con- hydrogels. Future studies will focus on incorporating HA-AA into the PEG/ cern because of potential impact on neurodevelopment. Infants with esopha- gelatin hydrogel system with the desired concentration. geal atresia with/or without tracheoesophageal fistula (EA/TEF) require a Acknowledgments: number of procedures under general anaesthesia. The study objective was to This work was funded by the Science Foundation Ireland (SFI) Principal examine anaesthetic exposure and neurodevelopmental outcomes in a cohort Investigator Award (13/IA/1962). of infants with EA/TEF. References A single-centre retrospective study of infants with EA/TEF born between 2000-2015 was conducted. Data collected include anaesthetic procedures, total 1. Olczyk P, Mencner Ł, Komosinska-Vassev K. The Role of the Extracellular anaesthesia exposure time, neurodevelopmental outcomes and use of specialist Matrix Components in Cutaneous Wound Healing. BioMed Research interventions. Pearson correlation evaluated the effect of anaesthetic exposure International. 2014;2014:1-8. on neurodevelopmental status at age 24-39 months. 2. Dong YX, A S, Rodrigues M, Li X, Kwon S, Kosaric N, et al. Injectable and Of the 61 term infants identified, mean length of anaesthetic exposure time Tunable Gelatin Hydrogels Enhance Stem Cell Retention and Improve before age 3 was 7.1 (range 2.3–36.2) hours. Patients required 2 (mean, range Cutaneous Wound Healing. Advanced Functional Materials. 1-11) procedures under anaesthesia, 74% were performed before age 1. The 2017;27(24):1606619. most common major procedures performed (mean 2, range 1-8) were EA/TEF repair, fundoplication, cardiac repair and anorectoplasty, while the most fre- Presenting Author: Miss Gráinne Geoghegan quent minor procedures (mean 1, range 0-3) were esophagoscopy, rigid bron- Supervisor: Prof Wenxin Wang choscopy and MRI. Anaesthetic exposure time and number of anaesthetic procedures were not found to be associated with adverse neurodevelopmental outcomes at age 24-39 months. Motor delay was found in 30% of children at 107. PROFILE OF NECROTIZING ENTEROCOLITIS IN NEAR- age 12 months or younger, while language delay was most prominent at age TERM AND FULL-TERM INFANTS: RETROSPECTIVE STUDY IN 24-39 months (20%). A TERTIARY CARE NICU Despite the complex neonatal course of infants with EA/TEF, increased anaesthetic exposure was not found to be associated with adverse Phipps M1, Roy A2,deSilvaN2,ZaniA3, Moore AM2 neurodevelopmental outcomes. Use of targeted interventions may benefit infants who present with language and motor delays. Presenting Author: Ms Nupur Gupta 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Supervisor: Dr Aideen Moore 2Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada. 3Department of Surgery, Hospital for Sick Children, Toronto, Ontario, 106. IN VITRO CYTOTOXICITY OF EXTRACELLULAR MATRIX Canada. BASED HYDROGELS Necrotizing enterocolitis (NEC) is one of the leading causes of morbidity and mortality in preterm infants, however, it is rare in more mature infants [1]. The 1 2 2 2 Geoghegan G , Creagh-Flynn J ,XuQ, Wang WX aim of this study was to clarify risk-factors for the development of NEC in near-term and term infants, and examine their clinical course and outcomes in order to improve future diagnosis and management. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Infants greater than 35-weeks gestation admitted to Sick Kids Hospital 2 Charles Institute of Dermatology,UCD School of Medicine, University from 2000-2017 with NEC were identified. Patient records of 106 in- College Dublin, Belfield, Dublin 4. fants meeting Bell criteria Stage-II or greater were reviewed. Data was analysed using descriptive statistics, and Pearson correlations were per- Impaired wound healing is an outstanding problem for patients with chronic formed to investigate the role of key variables as predictors for the wounds. It is understood that the extracellular matrix (ECM) plays a significant development of NEC, disease severity, and outcome. [1] role in regulating cell behaviour during the wound healing process .Thus, The mean (±SD) gestational age was 37±1.8 weeks, with mean birthweight of wound dressings synthesised from ECM-based materials have the potential to 2721±724 grams. We confirmed that term-NEC develops among patients aid in wound management. Hydrogels have shown great promise due to their exhibiting one of the known risk-factors (85.9%). This included prenatal com- ability to provide a physical barrier to infection and maintain a hydrated wound plications (57.5%); perinatal distress (51.6%); cardiac malformations, [2] environment . However, their toxic effects must be limited. gastroschisis, and other underlying disorders (75.5%); and introduction of This study aimed to examine the cytotoxicity of a poly(ethylene glycol) (PEG) enteral feeding, especially exposure to cow’s milk-based formulas (36.8%), – gelatin hydrogel synthesised using a hyperbranched PEG-based polymer and with a significant correlation between type of feeds and stage of NEC (r=0.74, thiolated gelatin and to determine the cytocompatible range of an acrylated p<0.05). The incidence of NEC increased over the study period, with 37% hyaluronic acid (HA-AA) polymer. born in the first nine years, and 63% born in the second nine. The survival rate 3T3 fibroblasts were encapsulated in PEG-gelatin hydrogels with two different (91.5%) was similar to previous reports on term infants. gelatin concentrations (w/v): 5% PEG/4% gelatin and 5% PEG/3% gelatin. Four Greater awareness of the occurrence of NEC in term neonates and the associ- cytotoxicity tests were conducted to compare the cytotoxic effects of each hy- ated risk-factors, should prompt preventative strategies, such as the promotion drogel formula: AlamarBlue assay, LIVE/DEAD viability assay, MTT cell of breast feeding in at-risk infants. S350 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

References with significant human morbidity and mortality. DM deals with preparedness, mitigation, response, recovery and prevention of disasters. 1 1. Neu J, Walker WA. Necrotizing Enterocolitis. N Engl J Med. Massachusetts The aim was to develop an educational strategy and reusable format for deliv- Medical Society. 2011; 364(3):255–64. ering undergraduate DM courses online. Man-made, weather related, human- itarian and technological disasters occur all around the globe annually yet the Presenting Author: Ms Madison Phipps majority of medical schools do not have an undergraduate DM program. This Supervisor: Dr Aideen Moore project developed an online course structure accessible to medical schools and students throughout the world. Learning theories and models of learning were used to construct a course 112. NEUROLOGICAL DISORDERS: AN EVALUATION OF THE layout that; encouraged students to be active learners, developed long- EFFECTIVENESS OF NEUROFEEDBACK TRAINING IN A term retention strategies and facilitated assessment for and of learning, PAEDIATRIC SAMPLE through innovative educational modalities including novel apps and external online resources. The course focusses heavily on outcome-based Smyth E1,KeaneM2, Keane R2,SheehyN3 education with emphasis on development of applicable skills. Each lec- ture is divided into a series of learning objectives to allow students master “ 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. concepts sequentially, followed by questioning to make use of the testing effect”. 2Focused review of current medical educational literature reveals 2Actualise Clinic, Claremont Avenue, DCU Alpha, Old Finglas Road, that students learn best when given short, outcome-focused “mini-lec- Glasnevin, Dublin 9. tures” followed by low-stakes assessment and feedback. 3UCD Centre for Research in Infectious Diseases (CRID), UCD School of Medical schools without trained DM staff now have access to expert online Medicine, University College Dublin, Belfield, Dublin 4. material developed by educationalists with a focus on skills and knowledge retention. The current project was a service evaluation for a psychological service com- Acknowledgments: pany based in DCU Innovation Campus. The company, Actualise, is a Psychological service that specialises in neurofeedback, PBS, talk therapy The author would like to acknowledge funding from the Disaster Medicine and other mental health assessments and interventions. This project was part Fellowship, Beth Israel Deaconess Medical Centre, Boston for travel and of their annual service evaluation. accommodation. The clinic employs a wide range of outcome measures, broadly divided into References subjective self-reflect and EEG-based assessments of brain function. The current project focused on one particular psychometric - the Strength and 1. Ciottone GR, Darling RG, Biddinger PD, Keim ME, Molloy MS. Ciottone's Difficulties Questionnaire (SDQ) – a widely used measure of the functioning Disaster Medicine. Elsevier Health Sciences; 2015. – in children. The current cohort consisted of 53 children 42 male (79.2%) and 2. Larsen DP, Butler AC, Roediger HL. Test-enhanced learning in medical 11 females (20.8%) with the average age of the children being 10.42 years. education. Med Educ. Wiley/Blackwell (10.1111); 2008 Oct;42(10):959–66. – The project aimed to evaluate if the main intervention Neurofeedback Presenting Author: Mr Edmond Power Training – was effective at reducing the difficulties and increasing the Supervisor: Dr Michael Molloy strengths of the population in question. Co-Supervisor: Prof Gregory R Ciottone Due to implicit data, the analysis was carried out on 30 children. Paired sample T-tests showed significant decreases in the SDQ scores after Neurofeedback training. Specifically, decreases were observed in the hyperactivity subscale, 115. INVESTIGATION OF THE UTILITY OF ADVIA-DERIVED the emotion subscale, total impact and total emotional difficulties, but not on HAEMATOLOGY PARAMETERS FOR THE EARLY DETECTION the conduct, peer or prosocial behavioural subscales. OF CHEMOTHERAPY-ASSOCIATED ADVERSE BONE MARROW This service evaluation shows Neurofeedback training to be an effective inter- EFFECTS IN DOGS vention for a range of neurological difficulties in paediatric disorders. Presenting Author: Ms Emma Smyth Kass J1, Koterbay A2,ShielR2 Supervisor: Mr Michael Keane 1UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4. 2 114. TO DEVELOP AN EDUCATIONAL STRATEGY FOR UCD University Veterinary Hospital, University College Dublin, Belfield, DELIVERING AN E-LEARNING DISASTER MEDICINE COURSE Dublin 4. FOR UNDERGRADUATE STUDENTS IN U.S. MEDICAL SCHOOLS Lymphoma is a hematopoietic neoplasia of lymphoid tissue; although it is the most prevalent type of cancer afflicting canines1, little research has been done Power EM1,CiottoneGR2, Molloy MS2,3 concerning the negative side effects of the predominant treatment protocol, called CHOP. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. In order to gain a better understanding of the probable adverse bone marrow effects due to the CHOP protocol, a retrospective study involving 2Division of Disaster Medicine, Harvard Medical School, Harvard University, six cases was performed. Full ADVIA2120 autoanalyzer haematology Shattuck St, Boston, MA 02115, USA. reports were assessed for each patient, and these data were used to both 3 Wexford General Hospital, Ireland East Hospital Group, Wexford, Ireland. compare patient reactions to the CHOP protocol and search for trends. Due to the fact that the number of reticulocytes indicates bone marrow Disaster Medicine (DM), a discipline arising from the marriage of emergency activity (numbers are low in health, and raised in response to anemia due medicine and disaster management and to the fore in recent times; with current to hemolysis or hemorrhage), the percent change in reticulocytes was wildfire situations throughout the world being examples of mass scale disasters examined in relation to the percent change in neutrophils throughout the Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S351

CHOP protocol. Neutrophils have the shortest lifespan of any cell in the References body, lasting 5-15hours in the dog2, and so are prone to adverse chemotherapy affects and already monitored in patients undergoing 1. Zufferey A, Kapur R, Semple J. Pathogenesis and Therapeutic Mechanisms chemotherapy. in Immune Thrombocytopenia (ITP). Journal of Clinical Medicine [Internet]. Two trends were identified: percent change in reticulocytes is mirrored 2017 [cited 27 June 2018];6(2):16. Available from: http://www.mdpi.com/ by the percent change in neutrophils two weeks later, and each drug 2077-0383/6/2/16 affects the percent change in number of reticulocytes and neutrophils Presenting Author: Lydia Babawale similarly. Though statistical testing for significance is still needed, these trends could have practical applications for patients undergoing chemo- Supervisor: Dr Nicola Cooper therapy, and may provide a reason to start routinely monitoring the number of reticulocytes. Acknowledgments 119. GENETIC ANAYLSIS OF ALPHAVIRUS VIRULENCE The author would like to acknowledge the staff of the UCD University FACTORS Veterinary Hospital, particularly Dr. Amy Koterbay, BVMS, MS, Ms. Caroline Beckett, RVN, Ms. Louise Mooney, Technical Officer, Dr. Robert Shiel, MVB, DECVIM, PhD. Casey N1, Barry G1 References

1UCD School of Veterinary Sciences, University College Dublin, Belfield, 1. National Canine Cancer Foundation. Lymphoma [Internet]. Phoenix: Dublin 4. National Canine Cancer Foundation; 2015. Available from: https:// wearethecure.org/learn-more-about-canince-cancer/canine-cancer-library/ lymphoma/ Schmallenberg virus (SBV) (genus Orthobunyavirus, family Bunyaviridae) spread by Culicoides midges is devastating infectious 2. Hematology [Internet]. Ithica: eClinpath, Cornell University College of disease of ruminants. Clinical signs include, fever, low milk yield, Veterinary Medicine; 2013. Available from: http://www.eclinpath.com/ diarrhoea, congenital abnormalities, still births and abortions. To date, hematology/ little is known about its pathogenesis therefore no treatment is avail- Presenting Author: Ms Jaimeson Kass able [1]. Supervisor: Dr Robert Shiel Previous work by the Barry lab identified 27 cellular proteins interacting Co-Supervisor: Dr Amy Koterbay with SBV Nucleocapsid proteins. The effect of these proteins on viral replication was anaylsed using siRNAs knockdown studies. HERC5 knock down resulted in a significant decrease in viral replication indi- 117. DESIGNING PATIENT INFORMATION LEAFLET FOR cating HERC5 is vital to SBV. HERC5 is an E3 ligase involved in type- PATIENTS WITH IMMUNE THROMBOCYTOPENIA 1 interferon-induced ISGylation of interferon-stimulating genes [2]. The aim of my project was to analyse the effect of HERC5 overexpression on viral replication. A459 and BHK cells were infected with SBV Babawale L1,Cooper N2,PaulD2 and transfected with HERC5 tagged plasmid, resulting in HERC5 over- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. expression. The cells’ confluency was compared to cells infected with 2 SBV and transfected with a control plasmid and to cells with HERC5 Imperial College NHS Trust, London. overexpression and no infection. The samples were analysed using TCID50 assays. Immune thrombocytopenia (ITP) is an autoimmune condition charac- Similar reduction in confluency was seen when cells were compared. terized by a low platelet count; resulting in symptoms such as pete- chiae, purpura and bruising easily. Patients are at an increased risk of This may indicate the plasmid was still cytotoxic with the interaction internal bleeding; the most fatal being intracranial bleeding [0.2% of SBV because SBV uses HERC5 in small amounts even though its cases] (1). The aim of this research is to improve patient services presence is vital for viral replication. Cytology and TCID50 assay results showed the HERC5 plasmid was cytotoxic. To overcome this, cell lines by providing information that allows patients to take charge of their treatment. To do this, first we had to identify patients’ concerns. and timings of infection and transfection were altered. In conclusion HERC5 is used in small amounts by SBV but it is essential for viral 10 adult patients and 5 children with their guardians, were interviewed and replication. questioned on their concerns during their time of diagnosis and highlight things they would like addressed in a patient information leaflet. They were also asked Acknowledgments questions on their treatments and to review the services they received at the The author would like to acknowledge the work done by the Barry lab and hospital. funding from the Wellcome Trust. Most patients did not know what ITP was, at the time of diagnosis. Fear References of spontaneous bleeding was a reoccurring concern in both adult (40%) and paediatric (83%) ITP patients. Other concerns include impact on life (incl. prognosis) [4/10 adults; 4/5 paediatrics], death [5/10 adults] and 1. Pawaiya RV, Gupta VK. A review on Schmallenberg virus infection: a cancer [2/10 adults]. 75% of patients wanted to know how treatments newly emerging disease of cattle, sheep and goats. Veterinarni Medicina. work and side effects. 2013 Oct 1;58(10). Based on the information obtained from the interviews, the drafted ‘New ITP 2. Wong JJ, Pung YF, Sze NS, Chin KC. HERC5 is an IFN-induced HECT- patient’ information leaflet was further developed, and a new leaflet was created, type E3 protein ligase that mediates type I IFN-induced ISGylation of protein addressing treatment options. These werethenreviewedbysomepatientsand targets. Proceedings of the National Academy of Sciences. 2006 further developed based on their feedback. Further areas of research have also Jul 11;103(28):10735-40. been highlighted, for example; ITP and fatigue, and the usefulness of the ITP app Presenting Author: Ms Niamh Casey for patients and parents. Supervisor: Dr Gerald Barry S352 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

122. INVESTIGATION OF NOVEL MONOCLONAL ANTIBODIES Reverse culture shock (RCS) is the process of readjusting, reacculturating, and DIRECTED AGAINST GLYCOPROTEIN B OF HUMAN reassimilating into one's own home culture after living in a different culture for CYTOMEGALOVIRUS FOR NEUTRALISATION IN AN IN VITRO a significant period of time [1]. INFECTION SYSTEM The main aim of this study was to identify medical students who met criteria for RCS, and within that group explore their experiences of re-entry stress and Ho J1, Siddiqui S3, McIntosh M, McLean G3,ReevesM2, their adjustments to life in RUMC. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Firstly, all RUMC medical students who returned six months previously from a 2Institute of Immunity & Transplantation, Department of Infection & thirty-month period of studying pre-clinical medicine in Ireland were asked to Immunity, UCL, London, UK. complete a questionnaire (RSS) that screens for RCS [2]. Ninety-four students (eighty-eight-point-seven percent of the class) participated. Secondly, twelve stu- 3School of Human Sciences, London Metropolitan University, London, UK. dents were randomly selected from the twenty-five highest-scoring students (who all scored > four-point-four on the RSS) and allocated to two focus groups. A Human cytomegalovirus (HCMV) is an important pathogen in the immuno- focus-group discussion using a semi-structured interview guide was carried out compromised such as transplant patients & AIDS patients. HCMV is the with each group. The audio-recorded narratives were transcribed verbatim, re- leading viral cause of disease following congenital infection resulting in sen- sponses coded, and a thematic analysis completed. sorineural hearing loss and neurodevelopmental disability in infants [1]. Three major themes emerged relating to experiences of RCS. Students report- Humanised anti-HCMV antibodies are considered a viable treatment option ed difficulty adjusting to a less approachable and more hierarchical interper- for development particularly since Ganciclovir, whilst effective, displays high sonal teaching style in some medical disciplines. They missed the good friends levels of toxicity precluding use in vulnerable patients. that they had made and the open social structure that they had experienced The aim of this project was to investigate the neutralising capacity of a while studying in Ireland. On their return to Malaysia, these students found it panel of novel monoclonal antibodies directed against glycoprotein B, a difficult to make friends and reintegrate into prevailing social groups. In addi- viral protein essential for viral entry [2]. Monoclonal antibodies against tion, they were finding it difficult to talk about their experiences in general for antigenic domain 2 (AD2) of gB were produced. Not all HCMV- fear of being judged negatively. infected individuals naturally generate AD2 antibodies, but the pres- References ence of anti-AD2 antibodies has been correlated with better outcomes in transplant patients. Furthermore, each monoclonal antibody was engineered to contain only IgA or IgG, to test Ig subclass impact on 1. Gaw K. Reverse culture shock in students returning from overseas. activity against HCMV. International Journal of Intercultural Relations. 1995, 24(1):83-104. To test for neutralising activity, HCMV was incubated with anti-AD2 2. Seiter, J. S., Waddell, D. The intercultural reentry process: Reentry shock, antibodies (clones 8F9, FA9 and QG1)thenusedtoinfectcells. locus of control, satisfaction, and interpersonal uses of communication.1989. Infection was scored by staining for viral gene expression and quanti- Paper presented at the Annual Meeting of the Western Speech Communication fied. The data shows that the 8F9 and QG1, but not FA9, antibodies Association. neutralized HCMV infection in a dose dependent manner. Furthermore, Presenting Author: Ms Michelle Low the IgG antibodies were more potent in this assay. Finally, the addition Supervisor: Assoc Prof Dr Finian O’ Brien of complement prior to infection had no effect on the activity of these Co-Supervisor: Assoc Prof Dr Arokiamary Bharathy antibodies. The results suggest that the 8F9 and QG1 antibodies can neutralize HCMVand are suitable for further research and development of HCMV treatment. 126. EFFECTS OF TUMOUR NECROSIS FACTOR-α ON THE Acknowledgments EXPRESSION OF ENDOTHELIAL NITRIC OXIDE SYNTHASE IN This work was undertaken at University College London Hospitals. HUMAN AORTIC ENDOTHELIAL CELLS References

1 2 2 1 2 1. Van Zuylen WJ, Hamilton ST, Naing Z, Hall B, Shand A, Rawlinson WD. Lloyd C ,CurleyS, Kajani S , Lynch G ,McGillicuddyF Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention. Obstetric Medicine. 2014;7(4):140-146. 1UCD Conway Institute of Biomedical & Biomolecular Research, University 2. Shenk T, Stinski M. Human Cytomegalovirus. Current Topics in Berlin: College Dublin, Belfield, Dublin 4. Springer Berlin; 2014. 2UCD School of Medicine, University College Dublin, Belfield, Dublin 4. Presenting Author: Joshua Ho Supervisor: Dr Matthew Reeves One of the key stages in the progression of atherosclerosis is endothelial dysfunction. This is characterised by reduced bioavailability of nitric Co-Supervisor: Dr Megan Mc Intosh oxide (NO), endothelial nitric oxide synthase (eNOS) and its phosphor- ylated isoform (phospho-eNOS) within endothelial cells, which are essential for acetylcholine-dependent vasorelaxation of blood vessels [1]. 123. REVERSE CULTURE SHOCK AND RE-ENTRY STRESS IN Tumour Necrosis Factor-α (TNFα), a pro-inflammatory cytokine and MEDICAL STUDENTS RETURNING FROM PRE-CLINICAL known inhibitor of eNOS [2], is upregulated in metabolic conditions TRAINING OVERSEAS TO MALAYSIA: A FOCUS GROUP STUDY of diabetes, hypertension and hypercholesterolemia [1], all of which are linked to atherosclerosis and heart disease. This project aims to optimise the dose of TNFα required for downregulation of eNOS/ Low M1, Bharathy A1,O’ Brien F2 phospho-eNOS in human aortic endothelial cells (HAECs). The inhibitory effects of TNFα on eNOS levels in HAECs was exam- 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. ined by incubating cells with TNFα for four hours at concentrations 2Department of Psychiatry, RCSI and UCD Malaysia Campus (RUMC), ranging from 100pg/ml to 5ng/ml.Western Blots were run to detect Penang, Malaysia. both eNOS and phospho-eNOS expression, using β-actin as a control. Ir J Med Sci (2018) 187 (Suppl 11):S325–S354 S353

α To establish if the TNF inflammatory pathway was activated in the References cells, an ELISA was performed to detect IL-6, a cytokine induced by TNFα. 1. Taborda MI, Ramirez S, Bernal G. Circular RNAs in colorectal cancer: α Four hour TNF incubation with HAECs did not significantly inhibit eNOS Possible roles in regulation of cancer cells. World J Gastrointest Oncol. α and phosho-eNOS expression (n=2). ELISA results confirmed that TNF did 2017; vol 9(2): 62-69. not induce secretion of IL-6 (n=2) and we can conclude that four hours is 2. Chellappa K, Robertson GR, Sladek FM. HNF4a: a new biomarker in colon insufficient time for TNFα to induce inflammation within HAECs. cancer. Biomarkers Med. 2012; vol 6(3): 297-300. This experiment was part of an optimisation protocol for further research into Presenting Author: Ms Fara Izyana Meor Faiza the athero-protective effect on HAECs when treated with HDL. It is evident that longer TNFα incubation time is needed to induce eNOS inhibition for Supervisor: Prof Dr A. Rahman A. Jamal optimal protocol. Co-Supervisor: Dr Norahayu Othman, Dr Nadiah Abu, Dr Nurul Syakima Acknowledgments The author would like to acknowledge funding and support from The 129. SOCIO-DEMOGRAPHIC FACTORS RELATED TO PARENT Wellcome Trust-IFS-HRB Partnership ENGAGEMENT IN THE NEONATAL INTENSIVE CARE UNIT References

Whitehill L1, 2,PinedaR3,4 1. Harrison DG, Cai H. Endothelial control of vasomotion and nitric oxide production. Cardiology clinics. 2003 Aug 1;21(3):289-302. 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. 2. Cardaropoli S, Silvagno F, Morra E, Pescarmona GP, Todros T. Infectious 2 and inflammatory stimuli decrease endothelial nitric oxide synthase activity Washington University in St. Louis Institute for Public Health. in vitro. Journal of hypertension. 2003 Nov 1;21(11):2103-10. 3Washington University School of Medicine Program in Occupational Presenting Author: Ms Carolyn Lloyd Therapy. 4 Supervisor: Dr Fiona McGillicuddy Washington University School of Medicine Department of Pediatrics.

Preterm birth results in significant health complications, necessitating infant 127. THE FUNCTIONAL EFFECTS OF CIRCULAR RNA HNF4A IN hospitalization in the NICU, which alters early sensory experiences. Early COLORECTAL CANCER CELLS positive sensory experiences in the NICU are further impacted by challenges parents face engaging in care1. The objectives of this study were 1) explore the relationships between sociodemographic factors and parent engagement in the Meor Faiza F1,OthmanN2,AbuN2,AbMutalibNS2, Jamal R2 neonatal intensive care unit (NICU), and 2) determine if participation in a parent delivered, positive sensory intervention program (SENSE) relates to 1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4. increased parent engagement. 2 UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Sixty-four premature infants born ≤ 32 weeks gestation were randomized at birth to Malaysia, Kuala Lumpur. receive SENSE or standard of care. The SENSE intervention consisted of parent education about how to conduct specific types and doses of positive sensory Circular RNAs (circRNA) are a re-emerging type of non-coding RNA exposures during hospitalization. Bedside logs were used to record parent presence formed by covalent circularisation of pre-mRNA. It has been reported and engagement across both groups. Engagement was defined as completion of that cell lines and tissues from colorectal cancer (CRC), the third most specific doses of sensory exposures defined in the SENSE intervention, while commonly diagnosed cancer, show a global reduction in circRNA com- presence was the number of days per week parents were present in the NICU. pared to normal colon mucosa [1]. The hepatocyte nuclear factor 4-a Being married (p=0.026) and having private insurance (p=0.004) related to more (HNF4A) gene has also been linked to the progression of CRC [2] and parent engagement. Participation in the SENSE intervention increased engagement appear to regulate chemoresistance towards the FOLFOX regimen. for young mothers (p=0.001) and those living father away from the NICU Therefore, we postulate that the circular RNA version of the HNF4A (p<0.001). Participation in the SENSE intervention also increased presence for gene may also play a role in CRC pathogenesis, particularly drug younger mothers (p=0.002) and those living farther away (p<0.001). resistance. This study identified unmarried mothers and public insurance holders as pos- The objectives of this research were to (a) investigate the expression of sible risk groups for low parent engagement in the NICU. The SENSE inter- circHNF4A in CRC cell line HCT116 and (b) investigate its effects on drug vention led to increased parent engagement among younger mothers and those sensitivity to 5- living farther from the hospital. Fluorouracil (5-FU) and Oxaliplatin. Acknowledgments HCT116 was cultured and a secondary FOLFOX-resistant variant was I was supported by the 2018 Summer Research Program of the Institute for induced through regular treatment with 5FU combined with oxaliplatin. Public Health at Washington University in St. Louis funded by the Global Samples of each were transfected with circHNF4A siRNA to reduce its Health enter at the Institute for Public Health, Children’s Discovery Institute expression, then qPCR carried out to measure levels of circHNF4A in of Washington University and St. Louis Children’s Hospital and Mallinckrodt both non-transfected and transfected cells. Cell viability was assessed Pharmaceuticals Charitable Giving Program. using the XTT assay, prepared with descending concentrations of 5FU In addition, we wish to thank the following individuals for their help with this and oxaliplatin. CircHNF4A expression was found to be low in paren- project: Jessica Roussin, Elizabeth Heiny, Crista Thompson, Kristy Connell tal cells and attenuated in the resistant counterpart. No circHNF4A and Tiffany Le. readings were detected when siRNA-transfected, though sensitivity to both drugs slightly increased. References circHNF4A may thus play a role in increasing CRC resistance to 5-FU and oxaliplatin, however, may not be a causative factor. Further optimisation and 1. Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing repeats are needed to confirm this conclusion. sensory experiences or very preterm infants in the NICU: an integrative review. J Perinatol. 2017;37(4):323-32. S354 Ir J Med Sci (2018) 187 (Suppl 11):S325–S354

’ Presenting Author: Laura Whitehill MSc as it utilizes heart rate-related data via a smartwatch to monitor user s stress level and deploy app e-therapies. Supervisor: Dr Roberta Pineda PhD This pilot study evaluates the effectiveness and acceptability of Mindset and the applications capacity in managing PTSD symptoms. 130. ACCEPTABILITY AND EFFECTIVENESS OF A Twenty-four community-residing Veterans meeting inclusion criteria MINDFULNESS APP AND HEART-RATE MONITOR FOR U.S. completed both baseline and follow-up interviews. Following baseline VETERANS interview, participants used the Mindset app and related heart rate watch continuously for approximately one month until their follow- up interview. Interview assessments included pre- and post-deployment ’ 1 2 O Byrne L , Price R experiences, standardized screeners for PTSD (PCL-M), anxiety (GAD-7), depression (PHQ-9), alcohol use problems (AUDIT-10), 1UCD School of Medicine, University College Dublin, Belfield, Dublin 4. and user experience with Mindset, among others. 2School of Psychiatry, Washington University of St Louis School of Medicine, Using SAS 9.4, a significant decrease (p < 0.05) was found in PCL-M, Missouri PHQ-9 and AUDIT-10 between baseline and follow-up interviews. Respondents reported moderate to high acceptance and satisfaction with Several barriers (stigma, financial concerns, geographic constraints and Mindset features. Mindset use may be associated with decreasing medication concerns) discourage U.S. Veterans from seeking effective symptoms of PTSD and alcohol abuse in this sample of U.S. posttraumatic stress disorder (PTSD) treatment. Thus, despite the avail- Veterans. This study highlights a Mindfulness app, such as Mindset, ability of evidence-based treatments, rates of PTSD remain high in this as a useful tool to augment existing therapies. population, highlighting a need for innovative management tools. Presenting Author: Lorcan O’Byrne Previous studies have shown mobile applications to be efficacious in Supervisor: Dr Rumi Kato Price treating PTSD symptoms. Mindset is a similar application, designed to help users manage their mental health symptoms; however, it is novel