Digital Commons Network^™

The Uncertainties And Questions Of Care Home Residents, Relatives And Staff As A Basis For Evidence-Based Improvement And Research, Reena Devi, Kirsty Jayne Haunch, Elizabeth Helen Graham, Alys Wyn Griffiths, Gary Hodge, Andrew Clegg, Maria Drummond, Anne Forster, Susie Pearce, Karen Spilsbury, Carl Thompson

School of Nursing and Midwifery

Background: Research in long-term residential care settings (or care homes) for older people should address questions and uncertainties that matter most for those receiving and delivering care. Whether research does this effectively is unclear. In part, because the uncertainties and questions of key stakeholders are unmapped. Objective: To capture and prioritise the uncertainties of older people living in care homes, their relatives and staff. Methods: A three-phase mixed-methods study: (i) gathering uncertainties, (ii) data analysis and (iii) prioritisation. Phase 1 used interviews to gather uncertainties from residents (n = 14), relatives (n = 10) and staff (n = 44). In …

Tumour-Associated Macrophage Infiltration Differs In Meningioma Genotypes, And Is Important In Tumour Dynamics, Ting Zhang, Claire L. Adams, Gyorgy Fejer, Emanuela Ercolano, Jonathan Cutajar, Juri Na, Felix Sahm, C. Oliver Hanemann

Peninsula Medical School

Background: Meningiomas are the most common primary intracranial tumours, with clinical behaviours ranging from benign to highly aggressive forms. The World Health Organisation classifies meningiomas into various grades, guiding prognosis and treatment. While surgery is effective for low-grade meningiomas, certain grade 1 tumours, as well as grade 2, 3, and recurrent cases are more aggressive and require new therapeutic approaches. Immunotherapy shows promise, with early-stage clinical trials demonstrating encouraging results. The tumour microenvironment (TME), particularly tumour-associated macrophages (TAMs), plays a pivotal role in tumour progression. TAMs influence tumour growth, metastasis, and immune evasion. However, their role in meningiomas, especially in …

Scaling Up Eco-Engineering: The Role Of Topographic Complexity And Spatial Variability In Shaping Biodiversity On Coastal Structures, Charlotte Clubley, Antony Knights, Jessica Allen, David T Bilton, Andy Foggo, Mick Hanley, James Murphy, Louisa E Wood, Louise Firth

School of Biological and Marine Sciences

In response to the depauperate biodiversity often associated with the largely homogenous surfaces of artificial structures, ecological (eco-) engineering has emerged as a tool to introduce topographic complexity to coastal development. Although relatively small-scale studies using topographically complex panels and artificial rockpools are commonplace, determining how the configuration of these interventions works over greater and more realistic spatial scales has received comparatively little attention. Given the importance of spatial variability in habitat complexity for shaping community composition and, therefore, regional diversity, filling this knowledge gap is key to enhancing the ‘design catalogue’ for future eco-engineering installations. Here, we manipulated topographic …

A Quantum Reservoir Computing Approach To Computer-Aided Music Composition, Eduardo Miranda, Hari Shaji

School of Art, Design and Architecture

This paper presents an approach to developing computer-aided music composition (CAMC) systems with quantum computing. CAMC systems are aimed at supporting musicians in creating music rather than generating complete pieces of music autonomously. For instance, they may generate ideas or prompts to be further developed during the creative process. We developed a CAMC system using a machine learning method called Quantum Reservoir Computing (QRC) that learns to create tunes in the style of given examples. The system proved to run satisfactorily on the Noisy Intermediate-Scale Quantum (NISQ) machines available today. It does not require large amounts of qubits to outperform …

No Escape From Microplastics: Contamination Of Reef Manta Ray Feeding Areas In A Remote, Protected Archipelago, Jessica Savage, Joanna Harris, Heather J. Koldewey, Tom B. Letessier, M Rowcliffe, D Morritt

School of Biological and Marine Sciences

Remote islands receive plastic debris from elsewhere, ranging from microplastics (>5 mm) to macroplastics, which can further breakdown into microplastics. The ingestion of microplastics by marine species has been linked to decreased fitness. Reef manta rays, Mobula alfredi, are liable to ingest microplastics due to their filter-feeding strategy and habitat overlap with plastic hotspots. Their population is in decline due to unsustainable fishing pressures and a slow life history, with potential additional demographic pressure from plastic pollution. This study investigates the concentration and characteristics of microplastics in the top 0.5 m of the water column in reef manta rays …

Redefining The Photic Zone: Beyond The Autotroph-Centric View Of Light In The Ocean, Thomas Davies, Tim Smyth

School of Biological and Marine Sciences

Traditional measures of the photic zone have remained focused on autotrophs, limiting understanding of how changing marine lightscapes impact heterotrophs that use light as a resource or an environmental cue. We propose a new photic zone definition that encompasses all biological processes influenced by celestial light, and a new measure of photic zone depth, the minimum light intensity that elicits biological responses. This approach allows photic zone measures to be inclusive of all marine photobiology driven by sunlight, moonlight, or starlight, and enables urgently needed exploration of the nature, extent and ecological implications of changing marine lightscapes.

Time For Change: The Importance Of Copyright For Manga And Anime, Simone Schroff

School of Law, Humanities and Social Sciences

Copyright law is key to the creative industries and plays a vital role in shaping the relationships between authors, commercial intermediaries, and audiences. However, the law significantly deviates from the social norms and expectations prevalent in the creative industries, leading to under-researched but key areas of misunderstanding and conflict.This article seeks to address this gap by providing a copyright law starting-point for those interested in the creative industries. First, this article provides a basic overview of copyright law and its features; in particular, how it applies to manga and anime. Second, the effect of copyright on the marketization and exploitation …

Prevalence, Experience, And Awareness Of Substandard And Falsified Medicines Among The Public And Healthcare Professionals In Jordan., Maysa Falah, Eman Daar, Daniel Zahra, Michael Dillon

Peninsula Medical School

INTRODUCTION: This study aimed to assess the awareness, experiences and perspectives on substandard and falsified (SF) medicines among the general public and healthcare professionals in Jordan. SF medicines pose a global public health concern, yet data on their prevalence and associated risks in Jordan remain limited.

METHODS: A cross-sectional study was conducted between January and June 2023 using a convergent mixed-methods approach. Quantitative data were collected through structured surveys administered to 209 members of the public and 136 healthcare professionals (pharmacists and clinicians) recruited via convenience sampling across Jordan's 12 governorates. Surveys were conducted in English and Arabic. Qualitative data …

It's A Marathon, Not A Sprint: Completing Dental School Whilst Managing Your Mental Health, Sufyaan Ahmed, Morag Powell

Peninsula Dental School

No abstract provided.

Anticholinergic Burden In People With Intellectual Disability In Psychiatric Inpatient Units: Practice And Audit Recommendations, Rohit Shankar

Peninsula Medical School

Introduction: Anticholinergic burden (ACB) is the cumulativeeffect of taking multiple medications with anticholinergic properties. ACB is associated with polypharmacy, increased comorbidity, and premature mortality in people with intellectualdisability (PwID). No clinical standards for ACB monitoring specific to PwID exist, particularly in psychiatric inpatient unitswhere the risk of ACB is highest.Method: We used the ACB Calculator and Anticholinergic Effecton Cognition (AEC) scale to compute ACB scores in two Englishpsychiatric units. We administered the Liverpool University SideEffect Rating Scale (LUNSERS) and Glasgow Antipsychotic SideEffect Scale (GASS) to examine patients’ perception of sideeffects.Results: Of 19 patients, the ACB Calculator mean was 6.68 andAEC …

Walking In A Dental Environment With The “Unicdent” Tool Kit—Part 1: A Participatory Tool With Legs!, Prashanti Eachempati, John Martin, Sally Hanks, Mona Nasser

Peninsula Dental School

This case study explores the adaptation of the walking method coupled with auto-photography and photo elicitation, a participatory research tool traditionally used in landscape studies, for application in dental research settings. By presenting the UniCDent toolkit, we demonstrate how this immersive method can enhance understanding of patient experiences in dentistry through sensory engagement and spatial exploration. The toolkit comprises four components: Imagery, Gallery Walk, Quadrant Mapping, and Trade-offs, each designed to facilitate active participation and foster in-depth reflections on the dental environment. Participants navigate a simulated dental clinic, documenting their sensory experiences and social interactions, thereby enriching the data collected. …

The Rapid Synthesis Of Integral Stimuli, Charlotte E.R. Edmunds, Fraser Milton, Andy J. Wills

School of Psychology

Integral stimuli (e.g., colors varying in saturation and brightness) are classically considered to be processed holistically (i.e., as undifferentiated stimulus wholes); people analyze such stimuli into their consistent dimensions only with substantial time, effort, training, or instruction (Foard & Kemler, 1984). In contrast, Combination Theory (Wills et al., 2015) argues that the dimensions of integral stimuli are quickly combined. Through an investigation of the effects of stimulus presentation time, we support Combination Theory over the classical holistic-to-analytic account. Specifically, using colored squares varying in saturation and brightness, we demonstrate that the prevalence of single-dimension classification increases as stimulus presentation time …

Exploring Differences Between Mothers’ And Fathers’ Language Attitudes In Multilingual London, Anna Caunt, Caroline Floccia, Rana Abu-Zhaya

School of Psychology

This study investigated the language attitudes of parents raising multilingual infants in London. Using a newly developed questionnaire, 131 mothers and fathers rated their attitudes towards their languages across three themes: (1) their emotional resonance with the language, (2) the significance of the language in their personal life, and (3) its importance in bringing up a multilingual child. Parents varied in the combination of languages they reported speaking, and English, the society language, was either parents’ L1, L2 or L3. Our results showed that both mothers and fathers had similarly positive attitudes towards English, but differed in their attitudes towards …

What We Think Others Think And Do About Climate Change: A Multicountry Test Of Pluralistic Ignorance And Public-Consensus Messaging, Sandra J. Geiger, Jana K. Köhler, Zenith N. C. Delabrida, Karla A. Garduño-Realivazquez, Christian A. P. Haugestad, Hirotaka Imada, Aishwarya Iyer, Carya Maharja, Daniel C. Mann, Michalina Marczak, Olivia Melville, Sari R. R. Nijssen, Nattavudh Powdthavee, Radisti A. Praptiwi, Gargi Ranade, Claudio D. Rosa, Valeria Vitale, Małgorzata Winkowska, Lei Zhang, Mathew P. White

School of Psychology

Most people believe in human-caused climate change, yet this public consensus can be collectively underestimated (pluralistic ignorance). Across two studies using primary data (n = 3,653 adult participants; 11 countries) and secondary data (ns = 60,230 and 22,496 adult participants; 55 countries), we tested (a) the generalizability of pluralistic ignorance about climate-change beliefs, (b) the effects of a public-consensus intervention on climate action, and (c) the possibility that cultural tightness-looseness might serve as a country-level predictor of pluralistic ignorance. In Study 1, people across 11 countries underestimated the prevalence of proclimate views by at least 7.5% in Indonesia (90% credible …

The Transformative Effect Of A Foundation Year: ‘I’M A Totally Changed Person’, Louise Webber, Jessica Austin

School of Law, Humanities and Social Sciences

Developing academic skills and preparing students for university-level study areonly two important outcomes of a foundation year programme. Drawing on thework of Mezirow, this paper will, with a focus on five students, consider thetransformative element of adult learning through transforming previousassumptions and beliefs. The qualitative research was based on a university insouth west England and consisted of several interviews over a four-yearlongitudinal research project, tracking the experiences of five foundation yearstudents, assessing how well it prepared them for university-level study. Thisarticle will consider the transformative nature of the foundation year, highlightingspecific changes in students’ self-belief, agency, power and confidence. Drawing …

Conveying The Need For Mental Healthcare – A Qualitative Study Of How Patients Communicate Mental Health Challenges’, Marit Nymoen, Marit Lomeland, Eva Biringer, Mirjam Extedt, Øystein Hetlevik, Rod Sheaff, Olav Thorsen, Miriam Hartveit

Peninsula Medical School

Background: Access to timely mental healthcare relies on patients’ descriptions of their mental health problems. We therefore sought to better understand, from the patients’ perspective, how they communicate their need for specialised mental healthcare to their GPs or mental health specialists and what factors affect communication when patients are referred from their GPs to specialised mental healthcare. Methods: This was an exploratory interview study. Ten adults who started treatment in specialised mental healthcare facilities were interviewed individually. The interviews were audiotaped and transcribed verbatim. A method based on thematic analysis was used to develop patterns and themes within the dataset …

Core Grade 5: Rating Certainty Of Evidence—Assessing Indirectness, Gordon Guyatt, Alfonso Iorio, Hans De Beer, Andrew Owen, Thomas Agoritsas, M. Hassan Murad, Ganesan Karthikeyan, Carlos Cuello, Manya Prasad, Kevin Kim, Dalal S. Ali, Arnav Agarwal, Lars G. Hemkens, Liang Yao, Monica Hultcrantz, Jamie Rylance, Derek K. Chu, Per Olav Vandvik, Benjamin Djulbegovic, Reem A. Mustafa, Linan Zeng, Prashanti Eachempati, Bram Rochwerg, Kameshwar Prasad, Victor M. Montori, Romina Brignardello-Petersen

Peninsula Dental School

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a …

Experiences Of General Practitioners In Supporting The Mental Health Of Children And Young People: An Exploratory Qualitative Study In The United Kingdom, Yessica Abigail Tronco Hernàndez, Tim Carter, Jane Coad

School of Health Professions

Mental health (MH) problems in children and young people (CYP) are on the rise, negatively affecting their quality of life. General Practitioners (GPs) are the first port of call for any health-related issue; however, it has not been fully explored what kind of training, tools or management strategies they use for CYP’s MH. The study’s aim was to explore and report experiences, challenges and strategies that GPs in the UK have to address the MH needs of CYP. Ten semi-structured interviews were conducted with GPs. Qualitative content analysis was used resulting in two themes and five subthemes. Most GPs reported …

Bubble Image Velocimetry Application To Flow Characterization For Incipient Overtopping Events@ Challenges And Opportunities, Corrado Altomare, Xuexue Chen, Alison Raby, Xavier Gironella, Tomohiro Suzuki

School of Engineering, Computing and Mathematics

This study employs the Bubble Image Velocimetry (BIV) technique to characterise the flow velocity of individual extreme waves that overtop sea dikes. Physical experiments were conducted in the small-scale wave flume at the Marine Engineering Laboratory (LIM) of the Universitat Politècnica de Catalunya –BarcelonaTech (UPC). The objective of the experimental campaign was to develop methods to enhance predictive models for wave overtopping volumes of structures with emergent toes. Focused wave groups were used to simulate extreme individual wave overtopping under realistic random sea states. In addition, the campaign prioritized the development of non-intrusive measurement techniques to quantify overtopping volumes and …

An Efficient Nsga-Ii-Based Algorithm For Multi-Robot Coverage Path Planning, Ashley Foster, Mario Gianni, Amir Aly, Hooman Samani

School of Engineering, Computing and Mathematics

This work presents an algorithm based on the Nondominated Sorting Genetic Algorithm II (NSGA-II) to solve multi-objective offline Multi-Robot Coverage Path Planning (MCPP) problems. The proposed algorithm embeds a donation-mutation operator and a multiple-parent crossover that gener-ates solutions which maintain the longest path while minimizing the average path length. The algorithm also uses a library of elitism-selected high-fitness robot paths, and tournament-selected high min-max fitness paths, to construct high multi-objective fitness offspring. We evaluate the performance of our proposed algorithm against the state-of-the-art NSGA-II extended with an improved Heuristic Genetic Algorithm Crossover, and we demonstrate that for different instances of …

Assessing Perioperative Risks In A Mixed Elderly Surgical Population Using Machine Learning: A Multi-Objective Symbolic Regression Approach To Cardiorespiratory Fitness Derived From Cardiopulmonary Exercise Testing, Pietro Arina, Davide Ferrari, Maciej R Kaczorek, Nicholas Tetlow, Amy Dewar, Robert Stephens, Daniel Martin, Ramani Moonesinghe, Mervyn Singer, John Whittle, Evangelos B Mazomenos

Peninsula Medical School

Accurate preoperative risk assessment is of great value to both patients and clinical teams. Several risk scores have been developed but are often not calibrated to the local institution, limited in terms of data input into the underlying models, and/or lack individual precision. Machine Learning (ML) models have the potential to address limitations in existing scoring systems. A database of 1190 elderly patients who underwent major elective surgery was analyzed retrospectively. Preoperative cardiorespiratory fitness data from cardiopulmonary exercise testing (CPET), demographic and clinical data were extracted and integrated into advanced machine learning (ML) algorithms. Multi-Objective-Symbolic-Regression (MOSR), a novel algorithm utilizing …

Environmental History In Western Anatolia (Turkey) Since The Last Glacial Maximum, Mustafa Dogan, Cetin Senkul, Jessie Woodbridge

School of Geography, Earth and Environmental Sciences

Mediterranean landscapes have been shaped by complex interactions between climate, land use and fire overmulti-millennial timescales. Understanding past trajectories of change provides knowledge of how modernlandscapes emerged, which can be valuable for their sustainable management. The aim of this study is toreconstruct environmental change in Western Anatolia (Turkey) through palaeoecological analysis of sedimentfrom Buldan Yayla Lake (Denizli-Buldan) from the Last Glacial Maximum (LGM) to the present, using a high-resolutionand multi-proxy dataset. To this end, fossil pollen, micro-charcoal, non-pollen palynomorphs, micro(μ)-XRF and radiocarbon analyses were applied to an ~18 m sediment core from Buldan Yayla Lake (Denizli-Buldan). According to the fossil …

Examining Anti-Modern Slavery Practices In Business Relationships And Networks: Power Consequences And Social Value Creation Perspectives, Dariusz Siemieniako, Natalia Szablewska, Krzysztof Kubacki, Hannu Makkonen

Plymouth Business School

Purpose: This article aims to develop a conceptual framework linking exemplar anti-modern slavery practices and their anticipated desirable and undesirable power consequences for social value creation within business relationships and broader networks.Design/methodology/approach: This article adopts a conceptual approach to develop a comprehensive framework that integrates the theoretical concepts of social value, relationship competence development, and power asymmetry. This framework serves as a foundation for examining anti-modern slavery practices within business relationships and identifying directions for future research.Findings: This article outlines a five-phase process for developing resources and competencies within business relationships and networks by examining ten exemplar anti-modern slavery practices. …

Energy-Based Trajectory Tracking For Underactuated Mechanical Systems: Velocity-Free And Disturbance Rejection Methods, Najmeh Javanmardi, Pablo Borja, Arjan Van Der Schaft, Mohammad Javad Yazdanpanah, Jacquelien M. A. Scherpen

School of Engineering, Computing and Mathematics

This work investigates three energy-shaping control approaches to address the trajectory-tracking problem for specific classes of underactuated mechanical systems. In particular, the notions of contractive systems and dynamic extensions are utilized to solve the trajectory-tracking problem while addressing implementation issues such as the lack of velocity sensors and the presence of constant disturbances. To this end, a first tracking controller is developed without the need for velocity measurements. A second controller is introduced, solving the trajectory-tracking problem while rejecting matched constant disturbances. Then, a third approach establishes conditions to combine both mentioned controllers. It is shown that the proposed design …

Setting Sail For Resilience And Ocean Sustainability, Alun Morgan, Charlotte Braungardt

School of Law, Humanities and Social Sciences

This paper makes a valuable contribution to the emerging field of marine social sciences by focusing on the potential contribution of learning theory and praxes in promoting Ocean Literacy, Marine Identity and Marine Citizenship. These are advocated as important social dimensions of the changes and outcomes required to promote sustainability and resilience of marine environments and, by extension, terrestrial environments, across a range of scales from local through to planetary. This is because the factors that compromise marine resilience are largely anthropogenic, and negative outcomes of human disassociation from the ocean. From another perspective, the paper is equally concerned with …

Criminalising Rough Sleeping In England And Wales: Way Forward Or Backward? Possible Solutions To Homelessness, Goodtime Okara

School of Law, Humanities and Social Sciences

Several nations across the globe have adopted the enforcement-based approach to address rough sleeping, which exacerbates the challenges faced by rough sleepers. This paper critically examines the ‘criminalisation’ of rough sleeping in England and Wales, arguing that the criminal law responses–including the Anti-social Behaviour, Crime, and Policing Act 2014 and the previously proposed measures in the Criminal Justice Bill 2024–in England and Wales are inappropriate to address the complex reasoning underpinning homelessness and rough sleeping. It comprehensively explores the housing policies in both nations, the causes of rough sleeping, the implications of criminalising rough sleeping, and the nexus between human …

Intraspecific Sensory Diversity And The Decapod Claw: Patterns Of Sensillation Are Heterochelic And Sexually Dimorphic In Pagurus Bernhardus, Ari Drummond, Summer Nash, Tianna Holloway, Alexander Wilson, Lucy Turner, Mark Briffa, David T Bilton

School of Biological and Marine Sciences

Information detection affects physiological performance and behaviour and is vital to survival and fitness. Despite the recognised importance of sensory adaptations in information acquisition and manipulation, many forms of sensory variation—from within individuals to between species—remain underexplored. To better understand the role of information in evolution, it is important to examine sensory variation as part of a cohesive framework of sensory diversity. Using the decapod claw, a structure well-recognised for its morphological variation, we investigated sensory diversity at the intraspecific level by assessing heterochely and sexual dimorphism in the chelar morphologies of Pagurus bernhardus hermit crabs. We employed a novel …

Core Grade 4: Rating Certainty Of Evidence—Risk Of Bias, Publication Bias, And Reasons For Rating Up Certainty, Gordon Guyatt, Ying Wang, Prashanti Eachempati, Alfonso Iorio, M. Hassan Murad, Monica Hultcrantz, Derek K. Chu, Ivan D. Florez, Lars G. Hemkens, Thomas Agoritsas, Liang Yao, Per Olav Vandvik, Victor M. Montori, Romina Brignardello-Petersen

Peninsula Dental School

This fourth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to addressing risk of bias, publication bias, and rating up certainty. In Core GRADE, randomised controlled trials begin as high certainty evidence and non-randomised studies of interventions (NRSI) as low certainty. To assess certainty of evidence for risk of bias, Core GRADE users first classify individual studies as low or high risk of bias. Decisions regarding rating down for risk of bias will depend on the weights of high and low risk of bias studies and similarities or differences between …

Long-Term (Seven-Year) Follow-Up Of Sensory-Motor Rehabilitation Therapy For Task-Specific Focal Hand Dystonia, Katherine Butler, Anna Sadnicka, Mark J. Edwards, Jennifer Freeman

School of Health Professions

Background: Medical treatments for task-specific dystonia (TSD) often have limited long-term success, leading to interest in rehabilitative approaches. Our previous feasibility study supported the acceptability and short-term benefits of sensory-motor rehabilitation for a cohort of 12 individuals. Long-term outcomes remain unknown. Purpose: Investigate the long-term (7 year) follow-up of clinical outcomes and treatment effectiveness in participants with TSD who engaged in our previous feasibility study. Study Design: Follow-up study. Methods: Online surveys and telephone interviews were undertaken at 1 and 7 years. A telephone interview was completed at 7 years. Results: All 12 participants (seven musicians dystonia, five writing dystonia) …

Feasibility Of Predicting Incidental Gallbladder Cancer (Fp-Igbc): A Protocol For A Uk Multicentre Feasibility Diagnostic Modelling Study For Incidental Gallbladder Cancer In Adult Cholecystectomy., Oliver Brown, Thomas Mindos, Lexy Sorrell, J. Latour, Somaiah Aroori

Peninsula Medical School

Background: In the UK, gallbladder specimens are routinely sent for histological examination to exclude incidental gallbladder cancer (iGBC) and other clinically relevant pathology. Although rare, gallbladder cancer requires early detection to improve outcomes. Existing risk stratification tools miss cases or are not tailored to the UK population. Predicting Incidental Gallbladder Cancer (P-iGBC) is an adaptive, multicentre, cross-sectional, trainee-led collaborative study designed to develop a diagnostic score to stratify iGBC risk in adult cholecystectomy. This feasibility phase, fP-iGBC, evaluates the methods and procedures of the overall study, ensuring its robustness and practicality before full-scale implementation. Methods: fP-iGBC comprises an internal pilot …