Digital Commons Network^™

The State Of Temperate Rainforest In South West England, Thomas Murphy, Katerina Chernyuk, Marcin Roszkowski, Shaun Lewin, Paul Lunt, James Buckley

School of Geography, Earth and Environmental Sciences

Temperate Rainforest is a biome of global significance which is rare and declining, yet supports endemic biodiversity and offers a range of co-benefits including carbon sequestration, natural flood management, climate moderation, and human well-being. The UK hosts a very large proportion of European bioclimatic space suitable for the development of Temperate Rainforest, yet very little of this woodland remains. In SW England, Temperate Rainforest habitat is mostly dominated by oak woodland (NVC communities W11 and W17) and occupies a broad but fragmented distribution across the region. SW temperate rainforest is exposed to a range of current and future threats and …

Elevated Co2 Increases The Canopy Temperature Of Mature Quercus Robur (Pedunculate Oak), William Hagan Brown, Emanuel Gloor, Ralph Fyfe, A. Rob Mackenzie, Nicholas J. Harper, Peter Ganderton, Kris Hart, Giulio Curioni, Susan Quick, Scott J. Davidson, Emily Yetton, Jen L. Diehl, Sophie Fauset

School of Geography, Earth and Environmental Sciences

The canopy thermal response of natural forests to elevated CO₂ (eCO₂) is an understudied biophysical feedback in the global climate system. We investigated the effects of eCO₂ (150 μmol mol⁻¹ above ambient) on canopy temperature (T_can) dynamics of mature (> 175 years) Quercus robur (oak) at the Birmingham Institute for Forest Research Free Air CO₂ Enrichment (BIFoR-FACE) facility in Staffordshire, England, during the growing seasons of 2021, 2022 and 2023. We employed long-term, high-frequency thermal infrared (TIR) imaging to measure T_can. Our results show that daily maximum oak T_{can …}

The Role Of A Pelvic Orthotic In The Management Of Chronic Pregnancy-Related Pelvic Girdle Pain: A Feasibility Study And Validation Of A Novel Body Perception Measure, Bradley Halliday

School of Health Professions Theses

Chronic pregnancy-related pelvic girdle pain (PPGP) affects an estimated 10% of post-partum women and is typically recalcitrant to conservative management. One novel option to manage this is a customised Dynamic Elastomeric Fabric Orthosis (DEFO), however, currently non studies have evaluated the clinical and cost-effectiveness or acceptability of this orthotic in post-partum women. Further, the mechanism of action of this orthotic is unknown. One mechanism may be to impart an effect on the disturbed body perception, which preliminary evidence has demonstrated is affected in women with PPGP. Current understanding is limited by an absence of research into women with PPGP and …

Co-Producing Healthcare Guidance For Children And Young People With Ataxia Telangiectasia (A-T) Including The Exploration And Design Of A Home-Based Complex Intervention, Munira Khan

School of Health Professions Theses

This doctoral research aimed to co-produce allied healthcare guidance to improve therapeutic care, self-management, and quality of life for children and young people (CYP) living with ataxia telangiectasia (A-T), a rare and complex neurodegenerative condition. Addressing significant gaps in non-medical care provision, the project was structured into four interrelated work packages (WPs), each contributing original insights and practical tools for families and professionals. WP1 involved a comprehensive scoping review of published and grey literature to map the existing evidence on allied health and nursing management of A-T related symptoms in CYP. The review synthesises 50 sources of evidence and highlighted …

Factors Affecting Metabolism And Metabolic Control In Phenylketonuria, Alex Amorim Pinto

School of Health Professions Theses

Phenylketonuria (PKU) is an inherited metabolic disorder treated by a phenylalanine restricted diet in order to avoid neurocognitive impairment. Blood phenylalanine is the main outcome marker which is modulated by many dietary factors. Traditionally, L-amino acid-based protein substitutes are the main nitrogen source but more recently glycomacropeptide-based protein substitutes (GMP) have been introduced and are associated with several health benefits. The following aspects were studied in this thesis: 1) metabolic control achieved in patients with PKU compared with the European PKU guidelines; 2) life-long change in natural protein tolerance; 3) impact on metabolic control of different natural protein sources (animal …

A Critical Exploration Of Social Transformation Through Occupation, Miranda Cunningham

School of Health Professions Theses

Background: In occupational therapy and occupational science, scholars and practitioners advocate for a stronger focus on social transformation. However, there is limited evidence on how occupation-based interventions contribute to addressing inequalities and fostering change for marginalised populations. Methods: This study applied critical occupational science and realist theoretical frameworks to examine the use of arts-based occupations for social transformation. It comprised three strands: (1) a narrative review of arts-based occupations in social change, (2) a realist review of participatory photography, and (3) a realist evaluation of a socially engaged art group in primary schools. Findings: Arts-based occupations have been employed by …

Investigating The Link Between The Oral Microbiome And Cardiovascular Health In Regards To Nitrate/Nitrite Metabolism., Lisa Du Toit

School of Health Professions Theses

This thesis evaluated nitrate metabolism and the link between cardiovascular health and periodontal disease. The first study compared effects of high-nitrate vegetables and pharmacological salt supplementation on the oral microbiome composition in hypertensive individuals. Seventy participants (50-70-y-old, clinical systolic BP (SBP) 130-159 mmHg, diastolic BP (DBP) <110 mmHg) were randomly allocated to group 1 (n = 24) consuming 300 mg/d nitrate in green leafy vegetables form, group 2 (n = 23) consuming 300 mg/d potassium nitrate in form of pills and low-nitrate vegetables, and group 3 (n = 23) consuming potassium chloride pills (placebo) and low-nitrate vegetables. Groups 1 and 2 showed similar microbial salivary changes, increased Neisseria species, and decreased Veillonella species post treatment, suggesting nitrate-dependent changes.The second study investigated oral health and microbiome composition of pregnant women with pre-eclampsia (n = 10, SBP = 150 ± 8 mmHg, DBP = 98 ± 9 mmHg) compared to normotensive pregnancies (n = 11, SBP = 111 ± 5 mmHg, DBP = 80 ± 9 mmHg). Pregnant women with pre-eclampsia showed higher plaque levels compared to normotensive pregnant women (P = 0.038), although activity of oral nitrate-reducing bacteria (P = 0.088) was not statistically significant. Plasma nitrate levels were significantly were lower in women with pre-eclampsia (P = 0.024). The third study evaluated the effect of chlorhexidine (CHX-M n= 21) and propolis (PROP-M n= 24) mouthwashes on abundance and activity of nitrate-reducing bacteria in healthy individuals. CHX-M increased relative abundance of nitrate-reducing bacteria (P < 0.001), but significantly impaired nitrate-reducing activity (P < 0.001) compared to baseline and PROP-M. PROP-M significantly increased plasma nitrate levels (P = 0.047) and reduced systolic BP (P = 0.022).The fourth study compared the effect of CHX-M, PROP-M, amoxicillin (AMX) and metronidazole (MTZ) on salivary nitrate-reducing activity within a 24-hour period using an in-vitro protocol. Results showed that MTZ significantly increased nitrate-reducing activity after 24-hours (P = 0.001) compared to all the other treatments (AMX, P = 0.025; CHX-M, P = 0.01; PROP-M, P = 0.023). Overall, this thesis suggests that poor oral health may impair the oral nitrate–nitrite pathway, thereby reducing nitrate bioavailability in women with pre-eclampsia. Diets rich in high-nitrate vegetables showed beneficial changes in the oral microbiome; however, these were not associated with blood pressure reduction. In contrast, use of propolis mouthwash increased plasma nitrate bioavailability, contributing to blood pressure reductions. Finally, it was observed metronidazole significantly enhanced nitrate-reducing activity.

Factors Affecting The Integration Of Dental Services Into Health And Social Care For People With Complex Needs, Afsha Musa, Joelle Booth, Hannah Wheat, Robert Witton, Martha Paisi

Peninsula Dental School

Background: People with complex social and medical needs require a high level of support and face multiple barriers in accessing health and social care services. With limited access to dental care, their high oral health needs go largely unaddressed. Integration of oral healthcare into primary care, alongside improved cross-sector working, has been advocated to bring together services across the system to achieve oral health equity. Aim: To explore the factors affecting integration of dental services into health and social care for people with complex needs. Methods: A qualitative research study was undertaken across two sites in the southwest of England, …

An Immanent Postfoundational Methodology For Researching The Violent Trans-Sections Of Ableism, Classism And Sexism, Elizabeth Done, Cara Baer

School of Law, Humanities and Social Sciences

This paper charts the unfolding of a small-scale qualitative study, presented at institutional ethical approval stage as drawing on posthumanist theorising and seeking to (re)configure the concept of intersectionality, and focusing on the lived experience of postgraduate students of lower socio-economic status with disabilities. The self-selected sample comprised six women, three of whom volunteered accounts of sexual violence that complicated their experiences of dis-ability and class, and highlighted the complexity of their lived experience of intersectionality. We describe a research process in which interviewing became intra-viewing, lived experience came to be understood through Deleuzian and Deleuzo-guattarian concepts and intersectionality became …

Exploring Islamophobia Through Intersectionality., Suparna Bagchi

School of Law, Humanities and Social Sciences

No abstract provided.

Patient-Reported Outcomes, Postoperative Pain And Pain Relief After Day Case Surgery (Poppy): Methodology For A Prospective, Multicentre Observational Study*, William M. Hare, Martha Belete, Adam B. Brayne, Harriet Daykin, Matthew Everson, Anna Ratcliffe, Katie Samuel, Lexy Sorrell, Mark Rockett

Peninsula Medical School

Background: In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery. Methods: This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case …

The Current Clinical Practice And Experiences In Buccal Midazolam Prescribing In Community For Status Epilepticus Termination In The United Kingdom: The Rescue Epilepsy Medication And Training (Remit) Study, Rohit Shankar

Peninsula Medical School

Background: Epilepsy is one of the commonest neurological conditions worldwide and confers a significant mortality risk, partly driven by status epilepticus (SE). Terminating SE is the goal of pharmaceutical rescue therapies. This survey evaluates UK-based healthcare professionals’ clinical practice and experience in community-based rescue therapy prescribing. Methods: A cross-sectional, 21 item questionnaire composed of Likert-style and free-text based questions was administered online. It was distributed through a non-discriminative snow-balling methodology to members of the Epilepsy Specialist Nurses’ Association (ESNA) and the British International League Against Epilepsy (ILAE). Quantitative analysis used Chi-squared, Fishers’ exact and Mann-Whitney tests. Qualitative data were analysed …

Mortality Prediction After Major Surgery In A Mixed Population Through Machine Learning: A Multi-Objective Symbolic Regression Approach, Pietro Arina, Davide Ferrari, Nicholas Tetlow, Amy Dewar, Robert Stephens, Daniel Martin, Ramani Moonesinghe, Vasa Curcin, Mervyn Singer, John Whittle, Evangelos B Mazomenos

Peninsula Medical School

INTRODUCTION: Understanding 1-year mortality following major surgery offers valuable insights into patient outcomes and the quality of peri-operative care. Few models exist that predict 1-year mortality accurately. This study aimed to develop a predictive model for 1-year mortality in patients undergoing complex non-cardiac surgery using a novel machine-learning technique called multi-objective symbolic regression.

METHODS: A single-institution database of patients undergoing major elective surgery with previous cardiopulmonary exercise testing was divided into three datasets: pre-operative clinical data; cardiorespiratory and physiological data; and combined. A multi-objective symbolic regression model was developed and compared against existing models. Model performance was evaluated using the …

Serious Games For Constipation Management For People With Intellectual Disabilities: A Scoping Review And Narrative Synthesis, Serena Daniel, Ruth Bishop, Ellie Killner, Alison Whight, Sarah Lennard, Stephen Howard, Richard Laugharne, Rohit Shankar

Peninsula Medical School

Introduction: People with intellectual disability (PwID) are 2% of the UK population. Constipation and bowel movement (BM) problems (diarrhoea/faecal incontinence etc.) affects over a third of PwID and is a serious cause of morbidity and mortality. Pw ID rely heavily on outside support (family/professional carers/healthcare professionals), many of whom are ignorant to bowel related harms. There is significant stigma to discuss BM particularly constipation. Serious Games (SG) are increasingly used for education of health needs. This review examines if game-based technology can assist improving knowledge and reducing stigma of BM problems particularly constipation. Objective: To identify and gain evidence of …

From Attention To Action: Advancing Inclusivity In The Landscape Of Anatomy Education, Siobhan M. Moyes, Lily Evans, Katie Snow, Aiden Jayanth

Peninsula Medical School

Conversations about inclusivity in anatomy education are at a critical juncture. While the need for a more equitable discipline is widely recognised, significant challenges remain. As this project aimed to reimagine what a truly inclusive learning experience could like and how it might be best achieved, an inclusive approach to research methodology was essential to ensure robust and representative results. Due to the paucity in anatomical literature on this topic, the authors applied concepts from sociological research methodology and innovative methods of demographic data collection to their own discipline.

The study utilised questionnaires and focus groups to collect diverse data …

The Added Value Of Narrow Band Imaging In Sinonasal Tumour Resection And Surveillance: Our Experience, Yazan Kanaan, Ra'ed Al-Ashqar, Hisham Khalil, Konstantinos Geronatsios, Marios Stavrakas

Peninsula Medical School

BACKGROUND & PURPOSE: Narrow Band Imaging (NBI), developed by Olympus Medical Systems, has played a role in diagnosing digestive tract lesions and cancers, diagnosing and characterizing bladder cancers during cystoscopy and in the diagnosis and management of Head and Neck cancers. We aim to explore the potential use of NBI in the diagnosis, management, and follow-up of sinonasal tumours.

METHODS: We present a series of cases treated at our institution, where NBI played a crucial role in the diagnosis, surgical management, intraoperative decision-making, and follow-up. The cases include a patient with sinonasal lymphoma, 2 patients with sinonosal malignant melanoma and …

Tolerance Of Ambiguity And Psychological Wellbeing In Newly Qualified Doctors: An Analysis Over Multiple Time Points, Tom Gale

Peninsula Medical School

Introduction: There is evidence of an association between tolerance of ambiguity and psychological wellbeing in doctors, but this relationship is not well understood. We explored this relationship, and the individual or workplace factors moderating it, in a population of newly qualified doctors. Methods: We examined the experiences of newly qualified doctors in the UK as they started a novel interim role (Time 1) and later moved into foundation year 1 roles (Times 2 and 3) during the COVID-19 pandemic. Doctors completed the Tolerance of Ambiguity of Medical Students and Doctors scale (TAMSAD Range: 0–100), the Perceived Stress Scale (PSS: 0–40), …

Systematic Review Of Paediatric Sudep And Epilepsy-Related Deaths To Inform A Safety Counselling Checklist For Clinical Practice, Rohit Shankar

Peninsula Medical School

BackgroundOne in 200 children - in the UK have epilepsy. Approximately, 1 in 1,000 children with epilepsy die yearly from Sudden unexpected death in epilepsy (SUDEP), a leading cause of death in epilepsy. Various risk factors contributing to epilepsy mortality particularly SUDEP, some modifiable, have been identified. Structured discussion of risks results in behavioural change that reduces individual risk factors.AimTo investigate and collate risk factors for SUDEP and epilepsy mortality in children to propose a structured communication tool (“Checklist”) for person centred communication.MethodsA Systematic review for children’s epilepsy mortality risk factors was conducted. The search strategy was developed by clinical …

Evidence For Alcohol-Mediated Hemolysis And Erythrophagocytosis, Chaowen Zheng, Siyuan Li, Johannes Mueller, Cheng Chen, Huanran Lyu, Guandou Yuan, Ane Zamalloa, Lissette Adofina, Parthi Srinivasan, Krishna Menon, Nigel Heaton, Stephan Immenschuh, Ines Silva, Vanessa Rausch, Seddik Hammad, Steven Dooley, Shilpa Chokshi, Antonio Riva, Songqing He, Sebastian Mueller

Peninsula Medical School

Alcohol-related liver disease (ALD) is the most common liver disease worldwide; however, its underlying molecular mechanisms remain poorly understood. Here, we identify ethanol-mediated hemolysis and erythrophagocytosis as major contributors to ALD pathogenesis using both in vitro and in vivo models, as well as surrogate markers such as heme oxygenase-1 (HO-1) and CD163, a scavenger receptor for hemoglobin-haptoglobin complexes. A key initial observation was the direct optical evidence of serum hemolysis in heavy drinkers, which diminished after one week of alcohol withdrawal. In parallel, soluble CD163 (sCD163) levels declined during alcohol detoxification correlating with liver damage and fibrosis stages. Moreover, red …

How Epilepsy Risks Might Be Introduced And Discussed In Clinical Consultations, Rohit Shankar

Peninsula Medical School

AbstractAdverse impacts of epilepsy (e.g., injury, depression, and Sudden Unexpected Death from Epilepsy (SUDEP) can be mitigated by factors that patients may control, such as medication adherence, improved sleep and diet, reduced alcohol and taking care around pregnancy. New guidelines state that risk should be discussed at the time of diagnosis but some clinicians express concern about not wanting to raise anxiety.ObjectiveTo explicate practices by which epilepsy expert clinicians broach discussions of risk in specialist epilepsy clinics.Methods24 recordings of initial telephone appointments at specialist clinics where epilepsy is diagnosed from two specialist outpatient epilepsy services in England were subjected to …

Consensus-Based Research Priorities For Post-Collision Care In The Western Cape Province Of South Africa, Naseef Abdullah, Tim Nutbeam, Colleen J. Saunders, Craig Wylie, Nigel Lang, Willem Stassen

Peninsula Medical School

Introduction: Road traffic injuries constitute a significant global health burden, causing 1.3 million deaths and 50million injuries annually, with 92 % of fatalities occurring in low-and middle-income countries (LMICs). Despitethis disproportionate impact, research priorities in post-collision care often reflect high-income country contexts,creating a critical misalignment between evidence generation and contextual realities in LMICs.Methods: This mixed-methods study employed a three-phase approach to identify research priorities for postcollision care in the Western Cape, South Africa. Phase 1 consisted of a comprehensive literature review toidentify preliminary thematic areas and research questions. Phase 2 involved a stakeholder engagement workshop using modified nominal group techniques …

Letter-To-The-Editor To The Study By Bartek J Et Al “Multidisciplinary Consensus-Based Statement On The Current Role Of Middle Meningeal Artery Embolization (Mmae) In Chronic Subdural Hematoma (Csdh)” – A Letter From The International Csdh Research Group Committee, Icoric, T.S.R. Jensen, J. Duerinck, D. Holl, C. Iorio-Morin, J. Soleman, E. Edlmann

Peninsula Medical School

No abstract provided.

Impact Of Social Deprivation Upon The Preoperative Pathway And Early Surgical Outcomes After Pancreatoduodenectomy For Pdac And Non-Pdac Periampullary Cancer In England: The Surg-Panc-Uk Study, Surg-Panc-Uk Study Group On Behalf Of Augis, Thomas W Thorne, Siobhan C Mckay, Samir Pathak, Richard Wilkin, Jenifer Barrie, John Moir, Keith J Roberts, Somaiah Aroori

Peninsula Medical School

BACKGROUND: Socioeconomic deprivation is linked to poorer outcomes in many cancers, however the impact of social deprivation on survival in resectable pancreatic and other peri-ampullary cancers appears mixed. Moreover, no studies consider the impact of social deprivation on diagnostic pathway length.

METHODS: A retrospective observational cohort study of adults with suspected periampullary cancer undergoing pancreaticoduodenectomy in England. Following surgery, patients were stratified by cancer type (PDAC, duodenal cancer, cholangiocarcinoma and ampullary cancer) and the impact of social deprivation (IMD deprivation quintiles) upon short-term survival and diagnostic pathway length analysed.

RESULTS: 648 patients from England with social deprivation data were identified, …

A Mapping Review Of Studies Exploring The Barriers And Facilitators To A Dementia Diagnosis Through An Intersectionality Lens, Ben Hicks, Katherine Wheatley, Emma Porter, Nicolas Farina, Sube Banerjee

Peninsula Medical School

BackgroundPromoting a ‘timely’ diagnosis is a global policy directive.AimsThis review adopts an intersectional approach, visually mapping the existing literature to highlight gaps in the evidence base on barriers and facilitators to dementia diagnosis.MethodA systematic approach was undertaken, following the PRISMA guidelines, updating previous reviews. The literature search was conducted on PubMed, PsycINFO, CINAHL Complete and Scopus. In line with mapping review methodology, we report the current state of the literature by describing the number of studies that outline barriers and facilitators to seeking help for a dementia diagnosis, split by social categorisation.ResultsOn the 7 June 2024, a total of 45 …