University of Galway Research Repository
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Publication Exploring novel antibiotic and enzyme combinations to improve the treatment options for biofilm-associated diabetic foot infections(University of Galway, 2025-04-16)Staphylococcus aureus isolates collected from the wounds of a cohort of patients presenting at University Hospital Galway (UHG) with diabetic foot infections were shown to produce a mix of polysaccharide and protein type biofilms in vitro. Several of the MSSA isolates also demonstrated the ability to switch from a polysaccharide to protein mechanism of biofilm formation. This latter phenotype is more commonly associated with MRSA isolates following growth in culture media supplemented with glucose. Hyperglycaemia is common in patients with diabetes mellitus and may be accompanied by increased levels of glucose in the wound milieu, which in turn would promote protein-adhesin type biofilm formation. Several coagulase-negative staphylococci including two methicillin-resistant Staphylococcus epidermidis isolates, which are often commonly overlooked in chronic wounds, also formed robust biofilms in vitro suggesting they were clinically significant in the pathogenesis of the wound infections from which they were isolated. In a related collaborative study with colleagues at the University of Liverpool on chronic infections in patients with cystic fibrosis, twelve MRSA isolates were collected sequentially over a period of four years from the lungs of a single patient. All of these isolates formed robust protein-type biofilms in vitro. Isolate LCF269, which was the fourth sequential strain isolated from the patient produced approximately 4X more biofilm than the other isolates. Whole genome sequencing analysis revealed that LCF269 and subsequent isolates were genetically different to the first three isolates. Furthermore LCF269 was found to contain 6 synonymous mutations in sdrC, which encodes a cell wall anchored protein previously implicated in the biofilm phenotype. Interestingly, two of the clinical DFI-associated MSSA isolates were shown to be very similar to one another. Both demonstrated the ability to switch between the protein and polysaccharide type biofilm production and both possessed similar antimicrobial susceptibility profiles. Upon taxonomic classification these were the only two isolates collected from the patients at UHG shown to share a top common hit during sequence similarity searches using NCBI BLAST. These isolates were collected from two separate patients presenting at UHG within one week of each other raising the possibility that similar MSSA strains are circulating among patients attending this clinic. Antibiotic doses up to 1000X the minimum inhibitory concentration were required to inactivate biofilm bacteria, even when the drugs were used in combination, reflecting the high tolerance of biofilms to antimicrobial drugs. The most effective combination therapy identified in this study comprised rifampicin which targets bacterial transcription, gentamicin which targets translation and the clinically used enzymatic debridement agent trypsin. Exposure of biofilms to this triple combination for 48 hours resulted in a > 3 log (99.9%) reduction in the number of colony forming units for all of the DFD staphylococcal isolates tested, surpassing the proposed threshold for clinical significance. Moreover, this triple combination was also highly effective against S. aureus and Pseudomonas aeruginosa mixed species biofilms using a chronic wound biofilm model at clinically achievable drug and enzyme concentrations. The rifampicin/gentamicin/trypsin combination represents a promising new therapeutic strategy for the treatment of biofilm-associated diabetic foot infections.Publication Multi-modality imaging in structural interventions(University of Galway, 2025-04-15)Significant advancements are being made in the field of interventions for structural heart diseases, driven by the expansion of guideline-directed indications and an increasing patient population requiring intervention or re-intervention for valvular heart disease. Precise diagnosis, optimum timing of intervention, and optimal device selection are essential for successful management. This thesis emphasizes the importance of adopting multimodality imaging, including including echocardiography, angiography, magnetic resonance imaging (MRI), and cardiac computed tomography (CT), in planning, guiding, and evaluating structural heart interventions. These imaging approaches are crucial for patient selection, procedural planning, and post-procedural outcomes assessment.Publication Developing health professionals' health literacy competencies to support patients in diabetes self-management(University of Galway, 2025-04-15)Introduction Health literacy is an issue of global importance. There is a need for health literacy education for health professionals to improve patient outcomes. Health literacy education for health professionals is supported in the literature and policy development. Health Literacy refers to people’s ability to understand and use health information. In Ireland, 2 in 5 adults have been found to have limited health literacy skills, which has been shown to impact health outcomes. To address these issues, health professionals need to be able to communicate in a health literate way so information is accessible for health service users to access. When an individual has diabetes, self-management is essential in maintaining health where they need to have advanced skills. Therefore, if a health professional has the skills needed to provide information in a health literate way, there is the potential to improve the self-management skills of health service users. Aims This research project aimed to develop a health literacy education programme for health professionals, to help empower patients with diabetes in optimising self-management. Methods This was achieved by utilising a mixed methods approach, guided by the Medical Research Council’s framework for developing complex interventions. A novel health literacy education programme was developed using two stages of the framework: Programme development and Feasibility. Informed by a scoping review, and stakeholder engagement, an E-Delphi consensus and public and patient involvement, a prototype of the programme was developed, and feasibility tested. Results This study shows that there is a lack of current health literacy education programmes in existence for health professionals in diabetes care. Little is known about the detail of the reported interventions as information about content, delivery and instructional methods was limited. Using an E-Delphi consensus study, the components of a health literacy education programme were prioritised, and consensus was gained on the educational competencies, methods of delivery and educational techniques required to develop a novel health literacy education programme for health professionals in diabetes care. Feasibility results show that recruitment and retention was a challenge for the developed education programme. As a result of the implemented education programme, there was an increase in participant knowledge, gathering information, providing information, shared decision making and enabling self-management. There was a high intention to implement learned skills. Programme feedback was positive and constructive for future iterations. Conclusion Overall, an evidence based, and stakeholder informed education programme was developed for health professionals working in diabetes care. Although recruitment was on a small scale, learning took place when compared pre and post education and feedback from participants was positive and constructive in nature. The feasibility study demonstrated how an evaluation of the programme is not appropriate, and the education programme needs to be refined.Publication Development of phosphorus recovery technologies for sustainable utilization of livestock manure(University of Galway, 2025-04-15)Phosphorus (P) recovery from livestock manure is a potential approach to address the depletion of P rock reserves. However, P in manure primarily exists in insoluble solid form, which poses a major challenge to the recovery process since only soluble P can be effectively separated and recovered. Traditional chemical acidification methods, while effective in solubilizing P, are limited by high chemical consumption, elevated costs, and the generation of secondary pollutants, underscoring the need for more sustainable alternatives. To overcome these limitations, this study investigated biological acidification and electrolytic acidification, focusing on optimizing key reaction conditions and analyzing the underlying mechanisms of P release and acidification. It also investigated the integration of these P release methods with struvite crystallization in terms of recovery performance and product characteristics. Biological acidification was performed by co-fermenting pig manure (PM) with food waste (FW) under anaerobic conditions. The results showed FW promoted lactic acid production and rapid acidification. As FW increased from 0 to 80%, the concentrations of lactic acid rose from 0.12 ± 0.04 g/L to 11.95 ± 1.37 g/L, with pH decreasing from 7.55 to 4.43. The ratio with FW/PM=1:2 was the optimal condition, which led to the highest dissolved phosphate (PO43--P) concentration of 350.39 ± 8.59 mg/L in 72 h, with a total P release of 74.2 ± 1.8%. Multiple regression analyses established key relationships to predict pH changes in the reactor. Electrolytic acidification was conducted using an electrochemically mediated phosphorus release (EMR) reactor at different voltages. The results showed over 70% of particulate P was converted to soluble reactive P during the EMR process, involving the dissolution of inorganic P and the conversion of organic P. Increasing the voltage appropriately enhanced ion migration and acidification rates. At 9 V, the release of 92.1 ± 1.3% was obtained in 36 h. Subsequent P recovery from P-rich supernatants was conducted using struvite crystallization. The fermentation supernatant achieved the highest struvite purity of 91.9 ± 2.2% at pH of 8.0 and an Mg/P ratio of 1.5, with a P recovery of 97.9%. In contrast, the EMR supernatant yielded a struvite purity of 51.7 ± 0.3% under optimal conditions of pH of 9.0 and an Mg/P ratio of 1.75, with a P recovery of 96.3%. Morphological analysis revealed well-defined crystalline struvite from the fermentation supernatant, whereas the product from the EMR supernatant contained irregular aggregates and more impurities, such as brushite and hydroxyapatite. This research demonstrates the feasibility of sustainable P recovery by integrating acidification and struvite crystallization, offering practical solutions for nutrient recycling. It provides valuable insights for optimizing recovery systems, supporting the circular economy, and mitigating environmental risks associated with manure management.Publication The organisation of government in Ireland 1900-1960: growth, efficiency, and specialisation(University of Galway, 2025-04-15)This thesis examines the economic rationale for the growth and consolidation in central general government organisations in Ireland during the first sixty years of the 20th century, through the lens of government expenditure and employment. While concerns over the allegedly excessive number of government organisations have typically intensified in Ireland at times of economic and fiscal stress, it has proved difficult to advance that public debate by reference to a framework for understanding what might constitute optimal or even better organisational arrangements for government. The internal organisation of government, as opposed to its overall size, has received surprisingly little attention in economic theory and correspondingly limited guidance is available to policy makers and citizens from empirical work in economics. Thus this study first advances a basic theoretical framework with a decision tree to guide policy makers in the economic assessment of the organisational implications of a new or existing government activity. The policy-maker must choose between the internal (to make) and the external (to buy) provision of resources, using the transactions costs approach. A decision ‘to make’ is followed by further organisational decisions between ‘to create’, ‘to add’, or ‘to keep’ organisations based on the trade-offs between specialisation and economies of scale or scope. To explore empirically the explanatory power of this framework, I present a detailed database on central government employment in Ireland between 1900 and 1960. This draws upon a range of sources, principally official publications centred on the annual budgetary process, as well as annual reports of departments, to provide estimates of government employment for up to 133 organisations over the study period. While limitations of the sources mean that some gaps are filled by interpolation, the results match well with census totals. This data is linked with Irish government expenditure, organisations, and macroeconomic outcomes. It allows the exploration of the changing structure of Irish government organisation before and after Independence. In particular, the data allows classification of organisations by both their policy domain (health, education, defence etc.) and their core policy activity (e.g., delivery, regulations, policy formation). This data in turn permits the construction of indices of specialisation in government employment and expenditure, i.e., Herfindahl-Hirschman and Balassa indices, to align with the theoretical framework advanced earlier. This shows that the growth in Irish government organisations principally reflects specialisation rather than economies of scale. The increase in government organisations is not matched by the expansion of government employment or real government expenditure. Government employment and real expenditure are dominated by four to five organisations in the delivery of government services in policy domains such as education, policing and defence. The growth in government organisations typically occurs in other activities, such as policy development, regulation and taxation, that make up a small share of overall expenditure and employment. Finally, the impact of consolidation of government organisations through mergers is examined. The results found some supporting evidence of efficiency gains in both expenditure and employment of the merged organisations.
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