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Epigenetic Regulation Of Inflammatory Pathways In Alcohol Related Hepatitis, Huey Kuan Tan

Peninsula Medical School Theses

Background: Alcohol-related liver disease (ArLD) contributes to approximately 1% of deaths worldwide and impacts on both economy and healthcare system. Alcohol related hepatitis (AH) - phenomenon of ArLD which is characterised by overactive inflammation is associated with 30% mortality rate at 90 days. Glucocorticoids (GC) are commonly used to treat AH. However, more than 1 in 3 patients fail to respond to GC therapy. Within the GC responders, the efficacy is variable due to individual glucocorticoid resistance. Improving our comprehension of GC non-responsiveness/ resistance is critical for early stratification of these patients and development of alternative therapies. This piece of …

Associations Between Fatigue Impact And Physical And Neurobehavioural Factors: An Exploration In People With Progressive Multiple Sclerosis, L Connolly, S Chatfield, J Freeman, A Salter, Mp Amato, G Brichetto, J Chataway, Nd Chiaravalloti, G Cutter, J Deluca, U Dalgas, R Farrell, P Feys, M Filippi, M Inglese, C Meza, Nb Moore, Rw Motl, Ma Rocca, Bm Sandroff, A Feinstein

School of Health Professions

Background: Fatigue is common in people with multiple sclerosis (MS). Understanding the relationship between fatigue, physical and neurobehavioural factors is important to inform future research and practice. Few studies explore this explicitly in people with progressive MS (pwPMS). Objective: To explore relationships between self-reported fatigue, physical and neurobehavioural measures in a large, international progressive MS sample of cognitively impaired people recruited to the CogEx trial. Methods: Baseline assessments of fatigue (Modified Fatigue Impact Scale; MFIS), aerobic capacity (VO _2peak), time in moderate-vigorous physical activity (MVPA; accelerometery over seven-days), walking performance (6-minute walk test; 6MWT), self-reported walking difficulty (MS Walking …

Beyond Surgery: Navigating Postoperative Care For Cauda Equina Syndrome Through A Scoping Review, Krithika Anil, Sandra Olmesdahl, Jack Read, Sam Hughes, Marcus Drake, Ingrid Hoeritzauer, Julie Woodfield, Holly Roy

School of Health Professions

Objective: Cauda equina syndrome (CES) is a serious neurological injury that can result in permanent disability. Our objective was to review the evidence for rehabilitation strategies for CES in a scoping review.Methods: A scoping review of the literature to identify rehabilitation strategies and their outcomes was performed. The search strategy used was: (Cauda equina syndrome) AND (treatment OR management OR intervention OR physio* OR bladder* OR neuro* OR stem cell OR repair OR rehab*) AND ("post?operat* OR post?surgical OR surgery"). MEDLINE, CINHAL, Prospero, Cochrane, ClinicalTrials.gov, EMBASE, Web of Science, PEDro, and eThos were searched.Results: Eight studies of rehabilitation for CES …

Specialist Physiotherapy For Functional Motor Disorder In England And Scotland (Physio4fmd): A Pragmatic, Multicentre, Phase 3 Randomised Controlled Trial, Physio4fmd Study Group, Glenn Nielsen, Jon Stone, Teresa C. Lee, Laura H. Goldstein, Louise Marston, Rachael Maree Hunter, Alan Carson, Kate Holt, Jon Marsden, Marie Le Novere, Irwin Nazareth, Hayley Noble, Markus Reuber, Ann Marie Strudwick, Beatriz Santana Suarez, Mark J. Edwards, Emily Beaves, David Breen, Christine Burness, Simone Caddy, Hannah Callaghan, Andrew Carberry, Luke Chetham, Andrea Clyne, Susie Cobb, Jan Coebergh, Lewis Cook, Patrick Cookson

School of Health Professions

Background: Functional motor disorder—the motor variant of functional neurological disorder—is a disabling condition that is commonly associated with poor health outcomes. Pathophysiological models have inspired new treatment approaches such as specialist physiotherapy, although evidence from large randomised controlled trials is absent. We aimed to assess the clinical effectiveness of a specialist physiotherapy intervention for functional motor disorder compared with treatment as usual. Methods: In this pragmatic, multicentre, phase 3 randomised controlled trial at 11 hospitals in England and Scotland, adults with a clinically definite diagnosis of functional motor disorder, diagnosed by a neurologist, were included. Participants were randomly assigned (1:1, …

Navigating The Complexity Of Applying Nutrition Evidence To Individualised Care: Summary Of An Academy Of Nutrition Sciences Position Paper, Judith Buttriss, Mary Hickson, Kevin Whelan, Christine Williams

School of Health Professions

Diet is key to the maintenance of health and crucial in the prevention and management of many diseases. Modified nutrient intake may become essential to prevent deficiency, optimise development and health or manage symptoms and disease progression. Adding to the complexity, disease and its treatment can also affect taste, appetite and ability to access and prepare foods. Coupled with this, individual requirements for energy, macronutrients and micronutrients are influenced by factors such as life stage (age, growth, pregnancy, etc.) and health status, which can affect the processes of consuming, digesting, absorbing, metabolising or excreting nutrients. First and foremost, dietary advice …

Guidelines For Protecting And Promoting Decapod Crustacean Welfare In Research, Mark Briffa

School of Biological and Marine Sciences

The decapod order contains ~15,000 species, including crabs, lobsters, crayfish, prawns, and shrimps. The idea that these animals might experience pain was long dismissed because they were thought to respond to noxious stimuli and tissue damage purely by nociceptive reflex—a position questioned by Sherwin (2001). Later experimental studies demonstrated that their responses were complex, long-lasting, and largely consistent with criteria for pain that had been produced initially for vertebrates (Elwood 2019). While the nature and extent of potential sentience in decapods remains an active area of research, these animals were recently recognized as sentient for the purposes of UK law, …

Co-Production Of Health And Social Science Research With Vulnerable Children And Young People: A Rapid Review, Jo Erwin, Lorna Burns, Urshla Devalia, Robert Witton, Jill Shawe, Hannah Wheat, Nick Axford, Janine Doughty, Sarah Kaddour, Abigail Nelder, Paul Brocklehurst, Skye Boswell, Martha Paisi

Peninsula Dental School

BACKGROUND: The term 'care-experienced' refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, 'co-production' refers to the involvement of CYP in …

Utilising Blood-Derived Products For Guided Tissue Regeneration In Periradicular Surgery: A Systematic Review And Meta-Analysis, Gabriele Baniulyte, Lorna Burns, Kamran Ali

Peninsula Dental School

BackgroundSince 1982, guided tissue regeneration (GTR) has become increasingly popular. The recent progress in GTR research focuses on the application of blood-derived products. However, no comprehensive systematic review has been conducted to assess its effectiveness specifically in periradicular surgery. Therefore, the aim of this review was to analyse the outcomes of root-end surgery compared to periapical surgery incorporating GTR using blood-derived products.MethodsThis review involved randomised controlled trials exploring the comparison between GTR utilising blood-derived products and the conventional periapical surgery. The databases Embase, MEDLINE, Cochrane CENTRAL, and Dentistry and Oral Sciences Source were searched, with the most recent search conducted …

What Is The Volume, Quality And Characteristics Of Evidence Relating To The Effectiveness And Cost-Effectiveness Of Multi-Disciplinary Occupational Health Interventions Aiming To Improve Work-Related Outcomes For Employed Adults? An Evidence And Gap Map Of Systematic Reviews, Elizabeth Shaw, Michael Nunns, Stuart G. Spicer, Hassanat Lawal, Simon Briscoe, G. J. Melendez-Torres, Ruth Garside, Kristin Liabo, Jo Thompson Coon

Peninsula Medical School

Background: In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, …

Early-Phase Neuroplasticity Induced By Offline Transcranial Ultrasound Stimulation In Primates, Nadège Bault, Siti N. Yaakub, Elsa Fouragnan

School of Psychology

The use of ‘offline’ transcranial ultrasound stimulation (TUS) protocols is of particular interest in the rapidly growing field of low-intensity TUS. Offline TUS can modulate neural activity up to several hours after stimulation, suggesting the induction of early-phase neuroplasticity. Studies in both humans and nonhuman primates have shown spatially specific changes in both the neuromodulation target and in a distributed network of regions associated with it. These changes suggest that excitatory or inhibitory effects are a result of a complex interaction between the protocol used and the underlying brain region and state. Understanding how early-phase neuroplasticity is induced by offline …

Facial First Impressions Following A Prison Sentence: Negative Shift In Trait Ratings But The Same Underlying Structure, Coral M. Coutts, Chris Longmore, Mila Mileva

School of Psychology

The first impressions we form of unfamiliar others can often guide many important decisions such as whether someone is guilty of a crime or the severity of their sentence, even in the presence of more relevant information. While most of the current work in this context has focused on their impact during trial proceedings and sentencing, little is known about the potential impact of first impressions following a guilty sentence and the success of the subsequent reintegration into society. Here, we used a data-driven approach to address this question by first collecting unconstrained spontaneous impressions from two groups of perceivers …

Aquatic Connectivity: Challenges And Solutions In A Changing Climate, Paul A. Franklin, Tea Bašić, Phil I. Davison, Katie Dunkley, Jonathan Ellis, Mayuresh Gangal, Alexia M. González-Ferreras, Catherine Gutmann Roberts, Georgina Hunt, Domino Joyce, C. Antonia Klöcker, Rachel Mawer, Timo Rittweg, Velizara Stoilova, Lee Frank Gordon Gutowsky

School of Geography, Earth and Environmental Sciences

The challenge of managing aquatic connectivity in a changing climate is exacerbated in the presence of additional anthropogenic stressors, social factors, and economic drivers. Here we discuss these issues in the context of structural and functional connectivity for aquatic biodiversity, specifically fish, in both the freshwater and marine realms. We posit that adaptive management strategies that consider shifting baselines and the socio-ecological implications of climate change will be required to achieve management objectives. The role of renewable energy expansion, particularly hydropower, is critically examined for its impact on connectivity. We advocate for strategic spatial planning that incorporates nature-positive solutions, ensuring …

The Effect Of Breathing Hypoxic Gas (15% Fio2) On Physiological And Behavioral Outcomes During Simulated Driving In Healthy Subjects, Jaspreet Kaur, Lebbathana Manokaran, Michael Thynne, Mirza M.F. Subhan

School of Biomedical Sciences

Hypoxia is mainly caused by cardiopulmonary disease or high-altitude exposure. We used a driving simulator to investigate whether breathing hypoxic gas influences driving behaviors in healthy subjects. Fifty-two healthy subjects were recruited in this study, approved by the Science and Engineering Ethical Committee. During simulated driving experiments, driving behaviors, breathing frequency, oxygen saturation (SpO 2 ), and heart rate variability (HRV) were analyzed. Each subject had four driving sessions; a 10-min practice and three 20-min randomized interventions: normoxic room air (21% FIO 2 ) and medical air (21% FIO 2 ) and hypoxic air (equal to 15% FIO 2 ), …

Short- And Midterm Outcomes Of Off- And On-Pump Coronary Artery Bypass In Patients With A Mean Age Of 65 Or More: Systematic Review And Meta-Analysis, Jake Trotman, Toluwalase Eboka, Neil Smart, Nicola King

School of Biomedical Sciences

Background. Advancing age is a nonmodifiable risk factor for the development of coronary artery disease. Furthermore, patients >65 years old are considered at high risk for coronary artery bypass grafting (CABG). The aim of this study was to investigate whether there were any differences in clinical outcomes for patients with a mean age ≥65 undergoing CABG on or off pump. Methods. Systematic searches were conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL). The key search terms used were "cardiopulmonary bypass"OR "On pump"AND "off pump"OR "beating heart"AND "coronary artery bypass grafting"OR "CABG"AND "age."This was …

Collaborative Care Intervention For Individuals With Severe Mental Illness: The Partners2 Programme Including Complex Intervention Development And Cluster Rct, Humera Plappert, Richard Byng, Siobhan Theresa Reilly, Charley Hobson-Merrett, Jon Allard, Elina Baker, Nicky Britten, Melanie Calvert, Michael Clark, Siobhan Creanor, Linda Davies, Rebecca Denyer, Julia Frost, Linda Gask, Bliss Gibbons, John Gibson, Laura Gill, Ruth Gwernan-Jones, Joanne Hosking, Peter Huxley, Alison Jeffery, Benjamin Jones, Tom Keeley, Richard Laugharne, Steven Marwaha, Claire Planner, Tim Rawcliffe, Ameeta Retzer, Debra Richards, Ruth Sayers

Peninsula Medical School

Background and aims: Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and organisational components to provide integrated and person-centred care. It has not been tested for severe mental illness in the United Kingdom. We aimed to develop and evaluate a primary care-based collaborative care model (PARTNERS) designed to improve quality of life for people with diagnoses of schizophrenia, bipolar or other …

Optimizing Group Work Strategies In Virtual Dissection, Lily Evans, Lauren Singer, Daniel Zahra, Ifeoluwa Agbeja, Siobhan M. Moyes

Peninsula Medical School

Due to its haptic and interactive nature, virtual anatomy provides an opportunity for small-group learning, enabling students to develop their group work skills before they graduate. However, there is currently little practical guidance supported by pedagogic principles detailing how to incorporate it into curricula. Anatomy educators at the University of Plymouth conducted action research aiming to capture students' overall perceptions of the virtual anatomy platform Anatomage. Questioning the benefits and challenges students face while interacting with Anatomage prompted the creation of evidence-based interventions to be later evaluated. Although a plethora of themes were identified, this report specifically examines those relating …

Lessons Learned: Facilitating A Health And Wellness Intervention For Frontline Child Welfare Workers During Covid-19, Kara Haughtigan, Austin Griffiths, Kim Link, Oliver Beer, Lindsey Powell

School of Health Professions

Child maltreatment is one of the nation’s most significant public health concerns. The estimated annual economic burden of child maltreatment in the United States is more than $292 billion (Peterson et al., 2018). In 2021, approximately four million referrals were made to child protective service agencies alleging the maltreatment of more than seven million children (U.S. Department of Health and Human Services [HHS], 2023). The primary mechanism for evaluating these referrals is the frontline child welfare workforce. Frontline child welfare workers (FCWWs) engage families and make decisions about the safety of children that directly impact children’s futures (Edwards & Wildeman, …

Art Of Design Management, Saied Farisi

Syllabus Repository

No abstract provided.

Public Primacy In Corporate Law, Dorothy S. Lund

Faculty Scholarship

This Article explores the malleability of agency theory by showing that it could be used to justify a “public primacy” standard for corporate law that would direct fiduciaries to promote the value of the corporation for the benefit of the public. Employing agency theory to describe the relationship between corporate management and the broader public sheds light on aspects of firm behavior, as well as the nature of state contracting with corporations. It also provides a lodestar for a possible future evolution of corporate law and governance: minimize the agency costs created by the divergence of interests between management and …

Employees' Perception Of The Management Of The Covid-19 Crisis At Najran University, Saudi Arabia, Noora Nasser Alsuhaibani

Dissertations

Problem

During the COVID-19 crisis, particularly in the context of Saudi education, the ability to physically attend schools and colleges was greatly hindered due to the widespread transmission of the virus and the resulting obstacles. The issues necessitated the use of crisis management strategies. Some Saudi universities are capable of implementing an organized plan both before to and during crisis management, whereas others lack this competence. This is a substantial problem. Several universities in Saudi Arabia effectively managed the COVID-19 epidemic, whereas others did not. Furthermore, prior studies on crisis management indicate that administrators exhibit diverse responses. By participating in …

The Early Prevention Of Diabetic Foot Ulcers, Aruodo Ukpai

Doctor of Nursing Practice Projects

Frequent and proper foot exams and foot care are fundamental in decreasing the incidence and morbidity of diabetic foot ulcers, yet many patients are still not screened at appointments or educated on the importance of foot exams. This research planned to address the lack of foot care education and foot assessments amongst patients with Type 2 diabetes. Past research done on this focused on providing education to diabetic patients either at home or in a setting where patients can come and receive the education. To our knowledge, no research has been done on the use of video teaching to provide …

Improving Epilepsy Monitoring Unit Training For Registered Nurses, Akaia Danae Abernathy Lail

Doctor of Nursing Practice Projects

This quality improvement project was developed to increase the baseline knowledge of a group of registered nurses who work within a highly specialized in-patient healthcare setting, an Epilepsy Monitoring Unit (EMU). The increase in knowledge was trajected to decrease event reporting which would show improvement in this high-risk patient population’s safety. The pre-education survey was dispersed to the participants, the registered nurses, to obtain a baseline knowledge level. There was then EMU-specific educational material made available for the participants. After the set time, the participants were then given a post-education survey to determine if their post-test scores could reflect a …

Benefits Of Patient-Centered Education For Type 2 Diabetes Mellitus, Paige Bortnick

Doctor of Nursing Practice Projects

Type 2 diabetes is a chronic, lifelong illness that affects millions of individuals in the United States. The rate of diabetes has doubled over the last 20 years in America and has climbed to be the seventh leading cause of death amongst Americans. The purpose of this project was to determine if participants in the target community demonstrated increased knowledge and awareness of diabetes after receiving education. A pre-intervention and post-intervention survey was given to determine if the education was effective. Data collected revealed an increased awareness and knowledge regarding the prevalence of type 2 diabetes, lifestyle, and diet modification.

Mental Health And The Black Church: Decreasing The Division In Divinity, Latonya Gray

Doctor of Nursing Practice Projects

Racial disparities in mental health care persist for Black Americans, with only one in three who need treatment receiving it. The care they do receive is often of a poorer quality than that of other groups. Faith communities serving Black members could help address this gap by partnering with mental health professionals to meet congregants' needs. With mental health now at the forefront of public discourse, considering the specific needs of the Black community is critical. Black Americans face disproportionate mental health burdens but are more likely to seek counsel from clergy due to cultural stigma. Educating clergy on mental …

Er Staff & Burnout: Interventions For Stress Management, Sara Elizabeth Kerbow

Doctor of Nursing Practice Projects

Nursing is one of the most difficult professions, not only physically exhausting but the mental and emotional toll can create havoc for the person’s life (Scala & Drummond, 2016). This DNP project, “Reset”, was founded on the concept of nursing burnout, compassion fatigue, and secondary trauma causing overwhelming stress related to the emergency room nurse and staff. The purpose of this project was to show how a 15-minute mental health reset can play an essential role in stress reduction. By using complementary health modalities such as lavender essential oil with diffuser, visual imagery, and massage while listening to soft calming …

Identifying Patients Suffering From Housing Instability In The Emergency Department, Jarvis D. Roberts

Doctor of Nursing Practice Projects

Homelessness is the most visible form of housing instability in the United States of America. Yet, millions of people across our nation live in unstable housing, which consists of temporary housing, shelters, outside encampments, and vehicles. Many citizens facing these types of insecurities live paycheck to paycheck and are one health crisis or emergency away from financial ruin. The COVID-19 pandemic, inflation, and slow hourly wage growth have exacerbated this situation. This project aimed to construct a screening tool to identify patients suffering from housing instability in the emergency department setting and provide them with community resources.

Community Education: Impact On Earlier Recognition Of Stroke, Lauren Kahn

Doctor of Nursing Practice Projects

Cerebrovascular disease was identified as the fourth leading cause of death in Cleveland County, North Carolina from 2014 to 2018 (Cleveland County Public Health Center, 2020). Community education was identified as a potential solution to decreasing the number of community members affected by cerebrovascular disease and resulting death and disability. Five community classes were taught with 97 participants. Pre-, post-, and 1-week post-class surveys were distributed to assess baseline knowledge, knowledge gain, and knowledge retention, with 74 pre-class, 72 post-class, and 28 1-week post-class surveys returned. Of these surveys, after exclusionary criteria were used, 40 pre-class, 53 post-class, and 22 …

Fostering Relationships Between New Graduate Nurses And Leadership To Increase Retention, Michelle Cotton

Doctor of Nursing Practice Projects

Objective: To implement weekly one-on-one touch bases between nursing leaders, such as managers and directors, with newly hired, new graduate nurses, up to 1 year after graduation to improve retention of those employees. The intent is to improve retention from a baseline of 23% in 2022.

Results: 35.8% of the newly hired nurses plan to remain in their current role for the next 2-3 years.

Conclusions: Almost 55% said that they strongly agreed with the touch base contributing to development/growth. This was the lowest scoring question and the most concerning related to retention. An overwhelming majority felt …

A Review Of The Effects Of Different Types Of Stigmas On The Retention Rates Of Patients In Medication-Assisted Treatment And How To Combat The Problem, Pamela Cox

Doctor of Nursing Practice Projects

It is difficult to turn on the news without hearing about the opioid epidemic or a recent opioid overdose. There is hope because there is a treatment to help prevent this epidemic. That treatment is known as medication-assisted therapy (MAT), where patients can present and, if they meet the criteria, can be given a prescription for buprenorphine/naloxone combination medication. Treatment with buprenorphine/naloxone has been shown to be highly effective treatment for substance use disorder (SUD). Even though it has been proven that this combination works, less than 20% of patients diagnosed with SUD present for treatment. This study focused on …

Implementing A Strategic Reporting Model Among Public Health Nurse Consultants To Increase Communication, Heather Willis

Doctor of Nursing Practice Projects

Public health has seen a drastic amount of turnover post-pandemic. There was an estimated 44% turnover rate for public health registered nurses, with a vacancy rate that doubled from 12.7% in March 2020 to 23.2% in July 2022 (Skinner, 2022). With this high turnover rate, many nurses are new to North Carolina (NC) public health departments and health districts. Public Health Nurse Consultants (PHNCs) are expected to train and guide these new nursing staff members. With the turnovers continuing at the local health departments (LHDs), new nurses are not given the recommended training because of communication breakdowns. This project helped …