Digital Commons Network^™

Self-Guided Functional Imagery Training To Reduce Anxiety, Jackie Andrade, Stephanie Hartgen-Walker, Caroline Morgan, Ayan, Idil Aytekin, Khadijah Sekoni, Kardelen Sengul, Jonathan Rhodes

School of Psychology

Objectives: Many university students experience high anxiety but have limited access to effective interventions. We evaluated a novel digital intervention for anxiety based on functional imagery training (FIT), designed to help individuals identify the impacts of anxiety, set engagement goals, and strengthen motivation for change. Functional Imagery for Keeping Anxiety low (FIKA) uses speak-aloud tasks, journalling, empathic questions, and personalised guided imagery for a person-centred approach. It builds motivation for engagement goals over safety goals through development and practice of vivid and emotionally laden multisensory imagery. Design: Study 1 used semi-structured interviews and thematic analysis to explore user experiences of …

Training Healthcare Professionals To Deliver A Group-Based Intervention For People Living With Severe Obesity: Lessons From The Progroup Feasibility Trial, Shokraneh Moghadam, Mark Tarrant, Lily Hawkins, Dawn Swancutt, Rod Sheaff, Laura Hollands, Raff Calitri, Jonathan Pinkney, Jenny Lloyd

School of Psychology

Introduction: Group-based programmes are increasingly adopted to support people living with obesity, as they have the potential to reduce staff time and costs and enhance motivation and capability for behaviour change. Group-based programmes could also provide members with opportunities to form meaningful social connections. As such, training should equip healthcare professionals to deliver group interventions successfully and be accessible and feasible for them to complete. This study presents how mixed-methods process evaluation data from the feasibility randomised controlled trial of PROGROUP (a group-based weight management intervention for people living with severe obesity) informed optimisation of the PROGROUP training programme. Methods: …

Children And Adults Across 15 Countries Believe In Human Uniqueness Of Mind: A Cross-Cultural Investigation Of Cross-Species Mind Perception, Karri Neldner, Luke Maurits, Magie Junker, Lara Abbas, Nayrouz Abbas, Arianna Abis, Federica Amici, Bernardo Arroyo-Garcia, Negar Asghari, Giovanna Barragán Pardo, Zhen Zhang, Junior Peña Chumacero, Ardain Dzabatou, Dustin Eirdosh, Susan Hanisch, Tom Herrnsdorf, Tom Hovehne, Alicia Junker, Patricia Kanngiesser, Felipe Villa Larens, Safaa Mahmoud, Sandra Masaquiza, Iino Masato, Risma Illa Maulany, Tongtong Meng, Kardelen Mutlu, Putu Oka Ngakan, Ebru Peközer, Ljubica Petrović, Mirella Christy Rehatalanit

School of Psychology

The way humans relate to other animals is fundamentally shaped by whether we perceive ourselves as unique, with feelings and thoughts not shared by other animals. How beliefs about animals’ ability to feel and think develop across cultures remains largely unexplored. We asked children and adolescents (4–17 years, N = 1025) and adults (N = 190) from 33 urban and rural communities across 15 countries whether animals have thoughts or feelings (judgments of presence), and whether those thoughts or feelings are human-like (judgments of similarity). Bayesian analyses revealed that participants generally ascribed non-human animals the ability for thoughts and feelings. …

Degrees Of Separation: Grandchildren's Experiences Of Grandparental Brain Tumor Or Stroke, Emily Sapsford, Alyson Norman, Sue Jackson, Josh Deacon, Emily Ravenhill, Pete Keohane

School of Psychology

The impact of acquired brain injury on family members is far reaching. Research has identified experiences of trauma, ambiguous loss and burden of care. Limited research has addressed the ripple effect of brain injury across the wider family. The study aimed to gain a detailed insight into the lived experiences of grandchildren of those who have experienced stroke or brain tumor. Ten participants (eight female and two males aged between 18 and 29) took part in semi-structured interviews about their experiences of grandparental stroke or brain tumor. Data were analyzed using interpretive phenomenological analysis (IPA). Four themes were identified. The …

Psychophysiological Recovery From Viewing Nature And Urban Settings: A Multisite Replication, A. E. Van Den Berg, K. Dijkstra, D. Meuwese, F. Beute, P. M. Darcy, S. Dewitte, B. Gatersleben, C. J. Gidlow, C. M. Hägerhäll, J. A. Hipp, Y. Joye, Y. A.W. De Kort, S. C.M. Lechner, C. Neale, Sang Ode Sang, J. Roe, D. T. Scheepers, K. Smolders, H. Staats, R. S. Steensma, K. J. Wyles, S. L. Koole

School of Psychology

The idea that merely viewing nature can promote stress recovery has profound societal implications, driving the use of nature imagery in the design of environments where access to real nature is limited. Scientific support for this concept originates from a pioneering study by Ulrich et al. (1991), which demonstrated superior psycho-physiological stress recovery during exposure to nature videos compared to urban videos. Despite its influence, this foundational study has never been systematically replicated. To address this gap, ten research teams across the Netherlands, Belgium, the UK, Sweden, and the USA collaborated on a multisite replication. A final sample of 959 …

Retrenchment, Segregation, And Public Education: A Five-Year Analysis Of State Exclusionary School Discipline Legislation, Thalia Gonzalez, Will Martel

Faculty Scholarship

Notwithstanding the decision in Brown v. Board of Education formally ending educational segregation and more than two decades of state reform, the legislative landscape protecting minoritized children from the structural violence of exclusionary school discipline has dramatically shifted in less than five years. From the passage of state “Teacher’s Bills of Rights” to mandatory expulsions, rescissions of prior protections, and new categories of removal, a retrenchment of anti-inclusion legislation—and its corollary, educational carcerality— has occurred. While studies of other forms of legislative retrenchment in K–12 public schools, such as anti-Critical Race Theory and Don’t Say Gay laws, literacy bans, and …

Open Secrets, Robin C. Feldman, Vaughn Goehrig

Faculty Scholarship

Patents and trade secrets were never intended to meet, but in the world of biologic drugs, they've become as thick as thieves. Patent law's disclosure requirement has demanded far too little of biologics manufacturers-allowing them to keep vital manufacturing details under trade secret lock and key. This intellectual property patchwork has been devastating for drug affordability: Because the most critical manufacturing information remains hidden, makers of follow-on biologics (called biosimilars) are often stuck reinventing the wheel, even after the original patents have expired.

This Article makes two principal contributions to illuminating this problem. First, it presents, for the first time …

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% …

The Effectiveness Of Digital Therapeutics Intervention In Oral Anticoagulation Management: A Systematic Review And Meta-Analysis, Jiayue Guo, Lili You, Lu Liu, Xitong Jiao, Debasish Kar, Jitendra Jonnagaddala

Peninsula Medical School

Objective: To summarize the key intervention characteristics and evaluate the effectivenessand safety of digital therapeutics (DTx) in patients receiving oral anticoagulation, witheffectiveness evaluated using time in therapeutic range (TTR), thromboembolic events (TEE),and mortality, and safety evaluated based on bleeding events.Patients and Methods: We searched PubMed, Embase, Web of Science, and the CochraneLibrary from inception to June 20, 2025, and identified ten randomized controlled trialsinvolving 7,237 patients. The criteria required studies to assess software-based DTxsupporting anticoagulation management and report effectiveness or safety outcomes. Studyquality was evaluated using the Grading of Recommendations, Assessment, Development,and Evaluation (GRADE) framework, and random-effects models were applied.Results: …

Microbial Collagenase Activity Is Linked To Oral–Gut Translocation In Advanced Chronic Liver Disease, Shen Jin, Aurelie Cenier, Daniela Wetzel, Bethlehem Arefaine, Mar Moreno-Gonzalez, Marilena Stamouli, Merianne Mohamad, Mariia Lupatsii, Emilio Ríos, Sunjae Lee, Ane Zamalloa, Shilpa Chokshi, Adil Mardinoglu, Saeed Shoaie, Naiara Beraza, Vishal C. Patel, Melanie Schirmer

Peninsula Medical School

Microbiome perturbations are associated with advanced chronic liver disease (ACLD), but how microorganisms contribute to disease mechanisms is unclear. Here we analysed metagenomes of paired saliva and faecal samples from an ACLD cohort of 86 individuals, plus 2 control groups of 52 healthy individuals and 14 patients with sepsis. We identified highly similar oral and gut bacterial strains, including Veillonella and Streptococcus spp., which increased in absolute abundance in the gut of patients with ACLD compared with controls. These microbial translocators uniquely share a prtC gene encoding a collagenase-like proteinase, and its faecal abundance was a robust ACLD biomarker (area …

Patient And Practitioner Workshops For An Intellectual Disabilities And Epilepsy Neuropsychiatric Genetic Research Database Register: Ethical Dilemmas For Study Design, Rohit Shankar, Jon Allard, Dannielle Bilkey, Brendan Mclean, Pamela Bowman, Chloe Staples, Lance Watkins, Anna Simpson, Elizabeth Boardman, Sarah Mitchell, Sarah Lennard

Peninsula Medical School

BackgroundThere is a need for more research studies focussed on People with ID (PwID) and Epilepsy and for the design of these studies to be shaped by this complex and vulnerable population and those who care for and support them.AimsTo develop understanding as to how a future NHS genetic research database register for PwID and Epilepsy should be conducted in a way which is inclusive, suitable and appropriate for them, their carers and the NHS settings where the research would be undertaken.MethodsThree workshops were completed with 17 formal participants: (1) PwID and Epilepsy (n2); (2) carers of PwID and Epilepsy …

Prevalence And Determinants Of Diabetes-Related Psychological Distress In A Tertiary Care Setting In Tamil Nadu: India: Cross-Sectional Study, Rohit Shankar, Samuel Tromans

Peninsula Medical School

BackgroundDiabetes distress, whereby people with diabetes experience distressing psychological symptoms associated with living with their condition, is an emerging problem in India. Diabetes distress leads to self-care deficits, suboptimal glycaemic control (which can lead to increasing risks of complications) and impaired quality of life.AimsTo determine the burden of diabetes distress and its associated factors in an Indian tertiary care centre in Trichy, Tamil Nadu, India, covering a population of 1.25 million.MethodThis prospective observational study involved a structured questionnaire covering demographic and clinical details, which was given to patients. The Diabetes Distress Scale 17 (DDS-17) was used to assess diabetes distress …

Policy Brief For All-Party Parliamentary Group (Appg) On Autism: National Implementation Of Systemic Family Therapy For Autism, Becky Stancer

School of Law, Humanities and Social Sciences

Addressing the Crisis of Premature Mortality and Family Trauma in Autism through Systemic Intervention.

Adherence And Compliance With Exercise Training In Progressive Multiple Sclerosis: Rates And Correlates From The Cogex Trial, Cogex Research Team, Robert W. Motl, Andrew Argie, Roberto S. Hernandez, Brian M. Sandroff, Maria Pia Amato, Giampaolo Brichetto, Jeremy Chataway, Nancy D. Chiaravalloti, Gary Cutter, Ulrik Dalgas, John Deluca, Rachel Farrell, Peter Feys, Massimo Filippi, Jennifer Freeman, Matilde Inglese, Cecilia Meza, Maria A. Rocca, Amber Salter, Anthony Feinstein

School of Health Professions

Background: There is limited understanding of adherence and compliance rates for exercise training(ET) in people with progressive multiple sclerosis(PMS).Objectives: This secondary, exploratory data analysis examined rates of adherence and compliance for continuous, moderate intensity training and high-intensity intervaltraining(HIIT) and possible correlates among people with PMS from the CogEx trial.Methods: CogEx was a multi-site, multi-arm, randomized, double-blinded, and shamcontrolled trial undertaken by 11 sites in six di8erent countries. Participants(N=311) wererandomized into one of four conditions with di8erent combinations of ET and cognitive rehabilitation, including respective sham conditions, delivered twice weekly over 12 weeks.The analysis focused on adherence and compliance rates and …

Right Child In The Right Place: A Mixed-Method Case Study Of Plymouth City Council’S Placement Decision Systems, Leetice Taylor, Sheena Asthana, Oliver Beer, Cath Quinn

School of Health Professions

This research aims to understand how to reduce the use, and cost of inappropriate placements for Plymouth’s children in care. The number of children in care in England is rising, and local authorities are under pressure to find a suitable home within their local area for children in care, where appropriate. Local authorities are paying unsustainable costs for placements where children are facing potential negative outcomes. This research will synthesise information from academic literature, financial and demographic data, council staff, children in care and carers to understand best practice in placing children in the right place and driving down costs. …

Investigating The Potential For First Year Residential Field Courses To Facilitate The Establishment Of Teacher-Student Relationships In Biological Sciences Undergraduate Degrees, Anne Plessis, Alison Stokes

School of Biological and Marine Sciences

Teacher-student relationships (TSRs) in higher education impact many aspects of the student experience, including engagement and performance. However, relatively little is known about the mechanisms of establishment of TSRs, and in particular how these are influenced by specific learning environments and contexts. Here, we undertake an exploratory investigation using first year biological sciences undergraduate residential field courses to examine how this teaching context affected the frequency and nature of teacher student interactions, and consequently the development of TSRs. Data were collected from teacher and student participants using questionnaires and focus groups. We found that interactions during fieldwork took place frequently …

Gelatinous Zooplankton As Indicators In The Kunming Montreal Global Biodiversity Framework, John Terenzini, Laura J. Falkenberg, Sanae Chiba, Matthew Faith, Robert Puschendorf, Abigail Mcquatters-Gollop

School of Biological and Marine Sciences

Global biodiversity frameworks require robust, representative indicators to effectively track progress towards conservation targets. Spatial and temporal gaps in global marine biodiversity datasets, however, and a limited number of marine biodiversity indicators, limit our ability to effectively manage marine ecosystems. Despite the ecological and socio-economic significance of marine ecosystems, they remain underrepresented in current indicator suites, particularly in the recently adopted Kunming-Montreal Global Biodiversity Framework (KMGBF). Gelatinous zooplankton (GZ), a key yet often overlooked component of marine ecosystems, have the potential to strengthen biodiversity assessments through their responsiveness to environmental change and impacts on several contributions of the ocean to …

Direct And Indirect Metal Contamination Of Estuarine Sediments By Boat Paint Particles, Andrew Turner, Ho Kwan Cheung

School of Geography, Earth and Environmental Sciences

Surface and subsurface estuarine sediments close to a cluster of abandoned boats have been fractionated (between <250 and 5000 μm) and analysed microscopically for paint particles. Paints were encountered in all samples, with concentrations calculated for whole sediment samples up to 1450 per kg (dry weight). X-ray fluorescence (XRF) analysis of paint particles retained by the coarsest (>5000 μm) size fraction revealed heterogeneous concentrations of Ba, Cu, Pb, Sn and Zn that reflect pigments and antifoulants used in various recent and historical antifouling and above waterline boat paints. Analysis of sediments by XRF revelated heterogeneous distributions of these metals between locations, size fractions and depths, and among replicate measurements at different positions of the same sample. Consequently, no relationship with grain size (evaluated using Rb as a proxy) was evident and concentrations often greatly exceeded predicted effect levels for sediments. Re-analysis …

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 …

An Evidence Review Of Technology Enabled Social Care In The Uk: Report For Cornwall Health Determinants Research Collaboration, Sheena Asthana, Michael Loizou, Marius Varga, Oliver Beer, Rory Baxter, Kieran Green

School of Nursing and Midwifery

The Urgent Need for a Shift from Crisis Intervention to Prevention. As highlighted by the Chief Medical Officer, demographic ageing—particularly acute in coastal areas like Cornwall—necessitates a fundamental shift in care models to allow individuals to live as independently as possible. Currently, the potential of digital technologies to support this aim is not being realised. To maintain wellbeing and reduce demand on statutory services, the system must pivot from reactive crisis management to a greater focus on prevention. While technology can play a pivotal role, it will only succeed if integrated into interoperable, data-driven systems that facilitate early intervention 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.

Prevention Beyond Deterrence, Benjamin A. Barsky

Faculty Scholarship

This Article reconceptualizes preventive justice—the public safety paradigm that seeks to prevent harm before it occurs. Scholars have long documented how cities have advanced this paradigm through largely punitive measures, notably variants of broken windows policing, which posit that aggressive misdemeanor enforcement deters more serious crime. Yet in the aftermath of the 2020 George Floyd protests, and as underscored recently in City of Grants Pass v. Johnson, these measures have faced a legitimacy crisis—prompting calls for nonpunitive responses to nonviolent incidents.

This Article establishes a preventive justice approach that advances health and safety without emphasizing crime deterrence. It draws on …

Meeting The Occupational Needs Of Older Adults With Long-Term Conditions: An Exploration Of Occupational Therapy In Primary Care, Sam Wakley

School of Health Professions Theses

This thesis investigated the occupational needs of older adults with long-term conditions to determine how these needs could be met through primary care, acknowledging this as a contemporary area of occupational therapy practice. Combining three studies offered a comprehensive, occupationally centred analysis of a growing area of practice that remains underexplored. Strand One involved conducting a scoping review to map existing models of primary care for adults with long-term conditions. It demonstrated that current approaches largely neglect occupation, favouring biomedical outcomes and fiscally related priorities. However, growing awareness to quality of life and the role of an integrated multidisciplinary team …

Experimental Investigations Of Cataract-Related Visual Degradation, Intraocular Lens Optics And Dynamic Stability, Sherrie Choy

School of Health Professions Theses

Cataract commonly occurs in older adults and is associated with degraded vision, impaired mobility and increased risk of falls. Cataract surgery restores transparency of the optical media by replacing the natural lens with an artificial intraocular lens (IOL). Modern toric and aspheric IOLs can improve optical quality and refractive outcomes; yet their potential impact on dynamic balance and fall risk is not well understood. This thesis used an experimental research methodology to examine how controlled changes in visual quality, arising from simulated cataract and from differences in IOL design, toric alignment and aberration profile, influence dynamic stability and gaze behaviour, …

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 …

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 …

Royal College Of Psychiatrists College Report 244: Optimising Psychotropic Medication Prescribing For People With Intellectual Disability, Rohit Shankar

Peninsula Medical School

No abstract provided.

Best Practice Guidelines For Professional Carers In Emergency Seizure Medication, Rohit Shankar

Peninsula Medical School

No abstract provided.