Digital Commons Network^™

Measuring Outcomes In Evaluations Of Interventions To Prevent Youth Crime And Violence: Challenges And Potential Solutions, Sajid Humayun, Finlay Green, Helen Downham, Nick Axford

Peninsula Medical School

There is a clear imperative to prevent youth crime and violence owing to the significant social and economic costs for individuals involved and wider society. A considerable evidence base for ‘what works’ in this space exists but gaps remain. To address these, it is necessary to evaluate intervention effectiveness. The aim of this article is to explore challenges and potential solutions regarding outcome measurement in such evaluations. To do this we draw on the literature and our experience as evaluators. We argue that outcome selection should be informed by a robust theory of change, and that normally this will mean …

Designing A Mobile App For Post Traumatic Stress Disorder: Insights From Lived Experience And Clinical Practice, Rohit Shankar, Richard Laugharne, Michael Loizou, Marius Varga, Sivia Lin, Bojana Daw Srdanovic, Roger Farrell

Peninsula Medical School

Post-traumatic stress disorder (PTSD) is a disabling anxiety disorder precipitated by severe trauma. Many people with this condition have little access to clinical interventions, especially in low-middle-income countries. For the development of any digital health intervention, it is vital to know the opinions of PLE and clinicians to guide the developers. We conducted two focus groups, one with clinicians (n = 5) and one with people with lived experience (PLE) (n = 11), to gain knowledge of their views on the development of a PTSD App. Transcripts of both focus groups were coded and thematically analysed. The key themes that …

Three Christmas Island Land Crabs Do Not Alter Extracellular Magnesium In Response To Acute Reduced Temperature, Katie N.G. Thiessen, Helena C. Reinardy, John I. Spicer, Lucy M. Turner

School of Biological and Marine Sciences

Magnesium is essential to numerous biological processes in many species. Including protecting intracellular pH and ATP concentrations during temperature and anoxia stress. Extracellular [Mg²⁺] is tightly regulated in many, but not all crustaceans. There is evidence that extracellular [Mg²⁺] content may be open to environmental influence such as temperature. The alteration of extracellular [Mg²⁺] in decapod crustaceans in response to temperature has been proposed, with individuals exposed to low temperature often displaying an increase in extracellular [Mg²⁺]. However, data, supporting or refuting this hypothesis, are sparse and drawn mainly from temperate and …

Investigating Spatial And Seasonal Differences In Microgastropod Assemblages Within The Little-Studied Camamu Bay, Brazil: A Potential Bioindicator For Remote Tropical Areas?, Francisco Kelmo, Sol De Maria Cesar Ferreira, Eduardo Henrique Galvão, Martin J. Attrill

School of Biological and Marine Sciences

This study investigates spatial and seasonal variation in the assemblages of benthic microgastropods (snails < 5–10 mm in length) within a poorly studied tropical bay. As these organisms are abundant, diverse and relatively easy to sample, with well-established taxonomy, they may prove a highly suitable group for ecological studies in such areas. Sediment samples were collected from three river basins in Camamu Bay, Brazil, during the wet and dry seasons. A total of 132 microgastropod species was recorded, demonstrating high diversity. The most abundant species were Eulithidium affine, Bittiolum varium, Cerithium atratum, Vitta virginea and Schwartziella bryerea. The least abundant species were Tenaturris gemma, Turbinella laevigata, Petaloconchus erectus, Parviturboides interruptus and Vitrinella cupidinensis. Statistical analysis revealed significant seasonal and spatial differences in diversity and assemblage composition, which correlated with environmental gradients. The results suggest that microgastropods are a suitable component of the biota for ecological and applied studies in marine sediments, particularly in remote tropical locations where full macrofaunal analysis may be challenging. Whilst further testing across impact gradients is needed, this approach offers a practical solution for ecological investigations in remote regions with limited taxonomic expertise and highlights microgastropods as a useful indicator taxon for impact biomonitoring in tropical marine sediments.

The Career Choices Of Final Year Nursing Students In The United Kingdom: A Qualitative Study., Kevin Hambridge, Frazer Underwood, Gosia Bettache, Matt Carey, Halil Kaya, Lisa Burrows, Rachel Tims, Christian Brailsford

School of Nursing and Midwifery

Aim: The aim of this study is to explore the career choices of final year under-graduate nursing students in the United Kingdom. Background: Worldwide there is a decreasing number of nurses and in the United Kingdom there is a decreasing amount of nursing students. There is sparce evidence relating to the career's choices of nursing students and reasons for those choices. Obtaining a deeper comprehension of these choices may aid healthcare employers, in partnership with universities, to design the future nursing workforce. Design: A qualitative design was used. Methods: Twenty-one final year under-graduate nursing students from across a range of …

How Does Pre-Registration Child Specific Education Prepare Newly Qualified Nurses’ To Care For Children, Young People, And Their Families? An Empty Narrative Review, Matt Carey, Danielle Edge, Julie Blamires, Mandie Foster, Sarah Neill

School of Nursing and Midwifery

This narrative review investigates the influence of child-specific content within pre-registration nursing programs on newly qualified nurses’ perceptions of preparedness to care for children, young people, and their families. Despite international recognition of the specialised competencies required for pediatric nursing, the proportion and quality of child-focused education across Higher Education Institutions is not clear. The Population, Exposure, Outcome framework provided a comprehensive search strategy applied across eight databases to identify relevant studies that met the inclusion and exclusion criteria. Of 663 records identified, 451 were screened and 25 full texts wereassessed for eligibility by two reviewers. No studies met the …

Job Satisfaction, Burnout, And Intent To Stay In Neonatal Nursing In England And Wales: A Cross-Sectional Survey Study, Kathy Chant, Yoko Nishimura, Aviva Petrie, Jos M. Latour, Nicola Booth, Kelly Crofts, Lisa Viola, Katie Gallagher

School of Nursing and Midwifery

Objective: To explore job satisfaction, burnout and intent to stay in neonatal nurses in England and Wales. Methods: A cross-sectional online survey study using the McCloskey Mueller Satisfaction Scale (MMSS) to explore job satisfaction, the Copenhagen Burnout Inventory (CBI) to explore burnout and the Nurse Retention Index (NRI) to measure intent to stay. All neonatal nurses working in England and Wales were eligible to take part. Data were collected between February and September 2024. Results: A total of 1590 neonatal nurses completed the survey. Job satisfaction was neutral. Moderate work burnout was reported, with statistically significant differences in mean score …

Defining Consensus‐Based Components For Integrating Dietitians Into Primary Dental Care For Paediatric Populations: A Delphi Study, Lauren Hallewell, Raul Bescos, Zoe Brookes, Robert Witton, Patricia Casas‐Agustench

School of Health Professions

Background: Diet is a modifiable risk factor linking oral and systemic health, contributing to dental caries and weight-related outcomes (including underweight, overweight and obesity) in the paediatric population. However, dietary advice provided by dental professionals in primary dental care is often brief and sugar-focused, representing a missed opportunity to address shared risk factors. Integrating dietitians into primary dental care may support more holistic paediatric preventative care. Objective: To develop expert consensus on the components required to integrate dietitians into primary dental care to address diet as a common risk factor in paediatric oral health and weight-related outcomes. Methods: A three-round …

Staphylococcus Aureus Strain Heterogeneity Modulates Virulence Traits Associated To Dual-Species Biofilms With Candida Albicans, Laure Nicolas Annick Ries, Beata Adrienn Brezniczky, Binduja Srelatha Pradeep, Esther Olabamiji, Lee Hutt, Glenn M. Harper, Alexander Strachan, Gyorgy Fejer

School of Biomedical Sciences

Staphylococcus aureus is a commensal Gram-positive bacterium and opportunistic pathogen that exhibits substantial variation in antimicrobial resistance and virulence traits. S. aureus is frequently co-isolated with the fungus Candida albicans, and together they represent the most common microorganisms recovered from biofilm-associated infections originating from both biotic and abiotic surfaces. Despite this clinical relevance, the impact of bacterial intra-species variation on interkingdom interactions remains poorly understood. This study therefore investigated how S. aureus strain heterogeneity influences C. albicans within dual-species biofilms. The majority of the 60 S. aureus strains tested suppressed fungal growth in a contact-dependent manner across different nutrient conditions …

Who Seeks Help? Characteristics Of Doctors Accessing Mental Health Support In England: 4-Year National Review, Rohit Shankar

Peninsula Medical School

BackgroundMental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.AimsDescribe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.MethodObservational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.ResultsOf the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% …

Involving Parents In Prevention: A Case Example Of Research And Intervention Development To Improve Financial Well-Being Support, Nick Axford, Gisella Hanley, Rebecca Summers, Kristin Liabo, Amy Bond, Eleanor Bryant, Georgia Smith, Rachel Silcock, Vashti Berry

Peninsula Medical School

The adverse effects on parent and child outcomes of poverty and stressors associated with low income are well established. With notable exceptions, however, the potential role of frontline services in improving family financial well-being is underexplored. This article outlines how patient and public involvement (PPI) was initiated early on in research on financial well-being support (FWbS). It illustrates how research can build on and integrate what parents say about services and how to research them. The involvement work was undertaken in one city in part to inform the adaptation of an income maximisation service to be delivered in local children’s …

Investigating The Impact Of Carboxylated Polystyrene Nanoplastics In The Liver Using Cell Lines And Precision-Cut Liver Slices, Namrata Pandey, Paula Boeira, Nathaniel J. Clark, Eleanor T. Walker, Somaiah Aroori, Jemimah Denson, Richard C. Thompson, Matthew E. Cramp, Shilpa Chokshi, Ashwin Dhanda

Peninsula Medical School

Background and Aims: Increasing reports of plastic accumulation in human tissue have raised concerns about potential adverse health outcomes. Evidence of negative effects of nanoplastics is heterogeneous and provides limited insights into the underlying pathogenic toxicity mechanisms in humans. Methods: In the present study, carboxylate-modified fluorescently labelled polystyrene nanoparticles (PS NPs) were used to investigate uptake and cytotoxicity in three different hepatic models of varying complexity, including HepG2 cells, IHH cells, and human precision-cut liver slices (hPCLS). Results: The results show model- and dose-dependent effects on hepatocytes. 74.2% ± 13.4% of the IHH cells showed PS NPs uptake at 0.1 …

Microplastics, Nanoplastics And Liver Disease: An Emerging Health Concern?, Shilpa Chokshi, Ashwin Dhanda, Matthew E. Cramp, Richard Thompson

Peninsula Medical School

Human liver tissue has been found to contain microplastics and nanoplastics (MNPs), with evidence that hepatic MNP accumulation has markedly increased over the past 10 years, prompting critical questions regarding their potential causal role in liver disease. In cell-based and murine models, MNP exposure can trigger oxidative stress, fibrogenesis and inflammation, pathological features that resemble those of advanced liver disease, suggesting shared mechanistic pathways. Furthermore, the capacity for MNPs to act as vectors for microbial pathogens, antimicrobial resistance, endocrine-disrupting chemicals and carcinogenic additives might have important implications for liver pathology. This Perspective examines emerging evidence on the consequences of MNPs …

Using Real-World Observational Data To Stratify Risk And Predict Outcomes In Chronic Liver Disease, Kristopher Bennett

Peninsula Medical School Theses

Background: Chronic liver disease (CLD) is increasing globally, driven by metabolic and alcohol-related aetiologies. Late diagnosis is common due to a prolonged, subclinical fibrotic phase preceding advanced disease (ACLD). Current pathways and cross-sectional fibrosis tests have poor sensitivity in low-prevalence settings and limited population-scale availability. Predicting future ACLD in primary care offers opportunities for earlier diagnosis and prevention, but few suitable clinical prediction models (CPMs) exist.Aim: To review existing general-population liver prediction models and develop CPMs for incident ACLD in unselected primary care populations using routinely collected data.Methods: A systematic review and PROBAST+AI appraisal of fourteen CPMs (median …

Influence Of Obesity And Insulin Resistance With Hepatic Steatosis On The Human Plasma Lipidome, Max C Petersen, Gordon I Smith, Aaron M Armando, Xiong Su, Oswald Quehenberger, Edward A Dennis, Samuel Klein

2020-Current year OA Pubs

Insulin resistance accompanied by hepatic steatosis is a common complication of obesity. In an effort to identify plasma lipids that could be biomarkers or causes of insulin resistance with steatosis in people with obesity, we evaluated the plasma lipidome in three distinct groups separated by adiposity, hepatic steatosis, and insulin sensitivity, assessed by using the hyperinsulinemic-euglycemic clamp procedure: i) insulin-sensitive lean (ISL, n = 13); ii) insulin-sensitive obese (ISO, n = 14); and iii) insulin-resistant obese with hepatic steatosis (IROS, n = 13). We evaluated 759 complex lipid species in 16 subclasses (including phospholipids, glycerolipids, sphingolipids, acylcarnitines, and cholesteryl esters) …

An Integrated Analysis Of Three Medulloblastoma Clinical Trials Refines Risk-Stratification Approaches For Reducing Toxicity And Improving Survival, Kyle S Smith, Jeff M Michalski, Et Al.

2020-Current year OA Pubs

BACKGROUND: The identification of clinical and molecular heterogeneity in medulloblastoma has produced risk-stratified therapy, but establishing the most effective yet least toxic regimens has remained elusive owing to numerous treatment options. To improve risk-stratification, we performed an integrated analysis from three clinical trials.

METHODS: Medulloblastoma patients from ACNS0331/NCT00085735, ACNS0332/NCT00392327, and SJMB03/NCT00085202 were included if they had methylation profiling. Molecular groups [WNT, SHH, Group 3 (G3), and Group 4 (G4)], subgroups, and copy number variations were procured from methylation profiles and mutations from next-generation sequencing. Data was assembled into an interactive portal to capture patient characteristics. Cross-trial comparisons, univariable, and multivariable …

Abnormalities In Sensorimotor Brain Function Are Related To Chronicity Of Low Back Pain, Jo Armour Smith, Rongwen Tain, Kelli G Sharp, Laura M Glynn, Linda R Van Dillen, Jesse V Jacobs, Steven C Cramer

2020-Current year OA Pubs

Maladaptive plasticity in the brain may contribute to chronic low back pain (LBP) and underlie the altered postural control of the lumbopelvic musculature that is evident in some individuals with LBP. We recently described an MRI-compatible leg-raise paradigm to measure brain activity associated with lumbopelvic postural control. The objective of this study was to compare brain function in young adults with and without a history of LBP and to determine relationships between brain function, pain, and postural control characteristics. We recruited 55 participants with a history of LBP, who were asymptomatic when studied, and 30 healthy controls. Postural control during …

2024 Annual Operations And Maintenance Report - 2024 Bres Annual Summary Report For Work Completed In Quadrant 4, Butte-Silver Bow Department Of Reclamation And Environmental Services

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

Wnt4 Deficiency Impacts Heart, Diaphragm, And Palate Development: Insights From Human Genetics, Machine Learning, And Mouse Models, Andrés Hernández-García, Bum Jun Kim, David Chitayat, Patrick Shannon, Stephanie Hedges, Maria Al Bandari, Maria J Guillen Sacoto, Emily Anne Bates, Yunus H Ozekin, Victor Faundes, Pamela N Luna, Chad A Shaw, Tara L Rasmussen, Chih-Wei Hsu, Daryl A Scott

Faculty, Staff and Students Publications

WNT4 is a secreted protein that plays a critical role in the regulation of cell fate and embryogenesis. Biallelic variants in WNT4 have been linked to SERKAL syndrome, an autosomal recessive disorder characterized by 46,XX sex reversal and dysgenesis of the kidneys, adrenals, and lungs. SERKAL syndrome has only been described in a single consanguineous kindred with four affected fetuses. Additional features seen in a subset of affected fetuses included ventricular septal defect (VSD), congenital diaphragmatic hernia (CDH), and orofacial clefting (OFC). To determine if these additional features were likely to be caused by WNT4 deficiency, we used machine learning …

Prevalence And Correlates Of Anxiety And Depression Symptoms Among Medical Students: The Role Of Student Debt Burden, Foroozan Afsharchi, Joshua F. Edwards, Kailash S. Ram, Jingru Huang, Valicia Hale, Ismail El Moudden

Department of Family and Community Medicine Faculty Publications

Background

This cross-sectional study examined whether anxiety and depression symptoms decrease as medical students progress through training (suggesting adjustment disorder) or persist (suggesting chronic conditions), while identifying associated risk factors, including student debt burden and treatment effectiveness.

Methods

We surveyed medical students (years 1-4) at VHS-ODU using a sociodemographic questionnaire and validated screening instruments (GAD-7 for anxiety and PHQ-9 for depression) via RedCap from September to November 2024.

Results

Among 126 students, Scores were higher in Years 2-3 than in Years 1 and 4, but differences by year were not significant (GAD-7 p=0.055; PHQ-9 p=0.352). Students with a prior mental-health …

Role-Differentiated Ai Competencies And Curriculum Implications For Health Professions Education: Qualitative Study, Yuyi Park, Yejin Han, Hyeongjo Kim, Solmoe Ahn, Frederick William Kron, Jihyun Lee

Department of Family and Community Medicine Faculty Publications

Background: As AI fundamentally transforms the healthcare landscape, medical education curricula have struggled to keep pace with these technological shifts. While current research has established a foundation for general AI literacy, less attention has been given to the role-specific competencies required for the diverse functions that healthcare professionals perform in an AI-integrated environment. Although existing tiered and domain-based competency models have clarified general AI competency requirements, they offer limited guidance on how such competencies should be differentiated according to the roles healthcare professionals perform in practice.

Objective: This study aimed to explore how AI-driven changes in healthcare shape competency requirements …

Beyond Hemostasis: A Narrative Review On The Multifaceted Therapeutic Potential Of Ankaferd Blood Stopper, Salima E. Tibi, Muhammad Hashir Nazir, Saleha Nazir, Bhumi Daishik Patel, Gayatri Misra, Tirath Patel, Fatima Nasir, Muhammad Farhan, Nana Sardarova, Nikhilesh Anand

School of Medicine Publications

Background: Effective hemorrhage control is essential in managing trauma and surgical patients, with uncontrolled bleeding being a leading cause of mortality. Ankaferd Blood Stopper (ABS), a hemostatic agent historically used in Anatolia, has gained recognition for its ability to modulate red blood cell-fibrinogen interactions to form a stable protein network for rapid bleeding cessation.

Objective: This review explores the multifaceted applications of ABS, evaluating its efficacy, safety, and potential therapeutic roles across various medical fields, including hemostasis, wound healing, antimicrobial activity, and antineoplastic effects.

Methods: A comprehensive synthesis of clinical trials, case reports, and experimental studies was conducted to assess …

Increasing Teens' Knowledge On The Health-Related Effects Of Vaping, Anteja Gore

Doctor of Nursing Practice Projects

Vaping in teens has become an increasing public health issue related to the growth in the number of teens who are using vapes. Many teens are not aware of the potential associated risk of using vapes, as they perceive them to be a safer alternative to smoking cigarettes. The purpose of this project was to increase the middle school teens’ knowledge of the potential health risks associated with vaping through an educational awareness session. This project was implemented in the middle school setting, targeting students aged 12-14 years. The students who participated completed anonymous pre- and post- questionnaires that evaluated …

The Essentials Of Heart Failure Management, Emily W. Greene

Doctor of Nursing Practice Projects

Heart failure remains a leading cause of hospitalization among older adult women, often due to delayed recognition of symptom exacerbation and limited knowledge of self-management strategies. The purpose of this quality improvement project was to evaluate whether a brief educational intervention could improve knowledge of heart failure management among older adult women at a community senior center. The DNP project leader conducted two educational sessions focusing on early recognition of heart failure symptoms, heart-healthy diet, and when to contact a healthcare provider. Participants completed a pre- and post-test survey containing four knowledge questions and one Likert-scale question on perceived knowledge …

Musical Measures: Nurse Education On Music-Based Interventions To Reduce Patient Restraints, Crystal D. Tucker

Doctor of Nursing Practice Projects

The use of physical restraints in acute psychiatric settings poses significant risks to patient safety, including physical injury and psychological distress. Evidence supports the need for alternative, non-pharmacologic interventions to reduce reliance on restraints. This Doctor of Nursing Practice quality improvement project aimed to evaluate the impact of an educational intervention on nurses’ knowledge and confidence in implementing music-based interventions, specifically binaural beats, to manage patient anxiety and agitation.

The project was conducted on a medical observation and behavioral health holding unit and utilized a pre- and post-intervention design. Registered nurses participated in educational sessions on music-based interventions and were …

Increasing Awareness Of Obesity And Its Associated Risks In Adults, Esther E. Bayode

Doctor of Nursing Practice Projects

Obesity is a significant and growing public health concern in a metropolitan area of North Carolina, reflecting statewide and national trends. With 36% of adults in North Carolina classified as obese, the condition contributes to chronic diseases such as hypertension, diabetes, heart disease, and certain cancers. This project targeted adults aged 18 and older within a local faith-based community, where preliminary findings showed a strong association between elevated body mass and increased chronic disease burden. To address this issue, a two-session educational intervention was implemented in partnership with a religious organization to increase knowledge about obesity, its causes, associated risks, …

Improving Timeliness Of Extubation Post-Cabg: An Educational Intervention Utilizing A Nurse-Driven Checklist, Christy Scott

Doctor of Nursing Practice Projects

Background: Timely extubation following coronary artery bypass graft (CABG) surgery is associated with improved patient outcomes. In a rural six-bed cardiovascular intensive care unit (CVICU) in North Carolina, extubation times were previously reported at approximately 15 hours. A lack of a standardized nurse-driven process and inconsistent familiarity with extubation readiness criteria contributed to variation in practice.

Purpose: The purpose of this DNP project was to implement and evaluate an educational intervention using a nurse-driven extubation checklist to improve nurses' knowledge, confidence, communication, and role clarity related to post-CABG extubation readiness in the CVICU.

Methods: The staff education …

Diabetes Education In Buncombe County, Deonna Nicole Blount

Doctor of Nursing Practice Projects

The growing number of Americans living with diabetes has reached an all-time high. According to the Centers for Disease Control and Prevention (CDC) (2026), there are 40.1 million people diagnosed with or underdiagnosed with diabetes. Evidence has shown that with education tailored to the patient's lifestyle, changes can be made and healthier lifestyles exhibited. Understanding the why of the patients can assist in changes that are feasible and can be implemented for the now and the future. Several studies outlined by Alonso-Carril et al. (2024), Lander et al. (2022), and Hodges et al. (2019) showed that education was implemented and …

Spreading Awareness To Adults About Cardiovascular Disease And Improving Healthy Lifestyle Habits, Madison L. Eldridge

Doctor of Nursing Practice Projects

Introduction: The intention of this Doctor of Nursing Practice evidence-based project was to evaluate if providing education to the target community would increase awareness and knowledge of cardiovascular disease and healthy lifestyle habits. The goal was to increase educational knowledge and promote awareness of cardiovascular disease and healthy lifestyle habits.

Background: Cardiovascular disease (CVD) is a critical health issue that prevails across the state of North Carolina, while continuing to remain one of the leading causes of death across the south-center Piedmont area of North Carolina. Several studies have proven that increasing knowledge on cardiovascular risks, promoting healthy exercise, and …

Improving Overall Morale Of Nurses By Implementing A Serenity Room, Ruth B. Clarke-Johnson

Doctor of Nursing Practice Projects

Nursing, while a highly respected profession grounded in research and scientific practice, continues to face persistent challenges related to staff retention and morale. Key contributors include burnout related to high workloads, challenging staffing ratios, lack of supportive leadership, and an aging workforce. Together, these factors hinder healthcare organizations’ ability to sustain a stable and experienced staff. The implementation of a serenity or relaxation room is supported by growing evidence highlighting its positive effects on nurse morale and stress reduction. A review by Mileski et al. (2022) found wellness spaces significantly reduced burnout, emotional exhaustion, and stress while improving resilience, job …