Digital Commons Network^™

Virtually Painless: An Investigation Into The Therapeutic Potential Of Virtual Natural Environments For Chronic Low Back Pain, Alexander Smith

School of Psychology Theses

Chronic pain conditions represent one of the greatest causes of disability in the UK, affecting up to 28 million people nationwide. Despite its prevalence, chronic low back pain (cLBP) in particular remains poorly served by existing treatments. Growing evidence suggests that engagement with natural environments provides analgesic and restorative benefits, yet access to nature is profoundly limited for people living with chronic pain. This thesis investigated whether a codesigned, immersive virtual reality (VR) nature experience could deliver meaningful pain relief to individuals with cLBP, drawing on Attention Restoration Theory (ART) and Stress Reduction Theory (SRT) as key theoretical frameworks. The …

Making The Implicit Explicit: Leadership In Primary Care Dental Practice, Sally Hanks, Debby R.E. Cotton

Peninsula Dental School

Objectives: This paper reports on research aimed at understanding leadership activities in primary care dental practice, an under-explored area within the extant literature. Methods: The research employed a qualitative, exploratory paradigm, using Video Reflexive Ethnography (VRE) and Activity Theory (AT) to capture the lived experiences of seven participating dentists. Results: The research outlines the ways in which dentists demonstrate leadership skills in their daily work, identifying three interacting activity systems that define leadership in this setting: Patient Care (PC), Running the Surgery (RS), and Running the Practice (RP). Findings emphasise that leadership is directly related to patient care and is …

Educational Interventions To Prepare Undergraduate Students For Out-Of-Hours Practice As A Newly Qualified Doctor In The United Kingdom: A Scoping Review, Alex Gordon, Molly Parkinson, Rosanna Watts, Kamal El-Badawi, Erin Dawson, Rohan Chiktara, Lorna Burns, Nicola Brennan

Peninsula Dental School

Background: In the United Kingdom (UK), newly qualified doctors are routinely responsible for out-of-hours (OOH) care, often managing acutely unwell patients with limited supervision. Despite national recommendations encouraging OOH experience during medical school training, there is no formal curriculum for OOH practice. Objectives: This scoping review aimed to identify the range of educational interventions designed to prepare UK medical students for OOH clinical responsibilities and assess their reported effects on perceived and actual preparedness. Methods: Following Joanna Briggs Institute methodology, a systematic search of seven databases and grey literature sources was conducted. Eligible studies involved UK-based medical students and reported …

A Pilot Study Assessing The Oral Microbiome In Women Of Menopausal Age: Do Oral Nitrate–Reducing Bacteria Play A Role?, Katie Muddiman, Amazon Doble, Abish Stephen, Raul Bescos Garcia, Charlotte Illsley, Tomas Nicholas, Sally Hanks, Lisa Du Toit, Zoe Brookes

Peninsula Dental School

Introduction The links between oral health and female ageing are poorly understood, but many changes occur in the oral cavity of menopausal women that affect quality of life, and few current oral health interventions consider gender as part of their approach. The aim of this pilot study was to test the hypothesis that the oral microbiome and microenvironment change during female ageing and are thus worthy of further consideration both experimentally and clinically. Methods This observational pilot study retrospectively assessed women aged 18 to 89 years (n = 60) attending a UK primary care dental school facility for blood pressure …

Seeing Anxiety: Ecological Video Ethnography And Simulation To Understand Anxiety And Decision-Making In Dental Care, Mona Nasser, Hannah Drayson, Sally Hanks, Nicholas Peres, Michael Punt

Peninsula Dental School

BACKGROUND: Dental anxiety is a widespread barrier to care, often contributing to appointment avoidance, treatment disruption, and emotional strain for both patients and clinicians. While extensively studied as a psychological trait, less attention has been paid to how anxiety manifests situationally and relationally, through non-verbal, affective, and spatial cues within clinical encounters. Moreover, in certain contexts, such affective signals can intersect with decision-making processes, shaping how patients interpret, engage with, or withdraw from clinical choices.

OBJECTIVE: To explore how anxiety manifests within the micro-choreography of dental encounters, develop a taxonomy of 'anxious tells', and assess the utility of ecological video …

Agglomeration Dynamics And Firm Typologies In African Port-Industrial Clusters: Evidence From The Port Of Tema, Ghana, George Kobina Vandyck, Jonas Aryee, George Acheampong, Annette Skovsted Hansen

Plymouth Business School

Firm-level behaviour within port-industrial clusters shapes regional competitiveness, yet empirical evidence from Sub-Saharan Africa remains scarce. This study analyses how firms within the Port of Tema industrial cluster in Ghana engage with collaboration, resource access, and innovation dynamics, applying evolutionary, institutional, and network-relational perspectives. A cross-sectional survey of 278 firms within a 10-km radius of the port was analysed using K-means clustering and validated through ANOVA and Chi-square tests. Four firm typologies were identified: Collaborative Integrators, who leverage cooperation to achieve superior market and financial access; Dynamic Coopetitors, balancing competitive and cooperative ties; Competitive Innovators, maintaining selective engagement; and Isolated …

Digital Marine Citizenship Training Module: Toolkit For Digital Placemaking, Katharine Willis

School of Art, Design and Architecture

As a coastal nation, the UK has long drawn inspiration from the sea - shaping our history through travel, industry, the arts, leisure and more. The coastline remains a place of identity and possibility. It also offers signifi cant benefi ts for health, wellbeing and connection, yet many local people are disconnected from nearby shores.This Training Module is an easy to use resource to reimagine community relationships with the sea and make coastal spaces more inclusive, welcoming and vibrant for all.Connected SeascapesOrigins of the Training Module The Connected Seascapes Toolkit stems from a collaborative project between Plymouth City Council, the …

Can The 2025 Nobel Prizes In Physics And Economics Inspire A “Quantum” Turn In Tourism Research?, Waqas Ali

Plymouth Business School

No abstract provided.

Lower Suicidal Ideation Linked To Easier Access To Urban Green Spaces During The Covid-19 Pandemic: A Nationwide Study In Japan, Zheng Xian, Tomoki Nakaya, Clive E. Sabel, Ryo Okubo, Kun Liu, Jinguang Zhang, Takahiro Tabuchi

School of Geography, Earth and Environmental Sciences

Urban green spaces (UGSs) have been linked to improved mental health and lower suicide rates, yet their protective role during large-scale crises remains underexplored. We examined associations of UGS accessibility with long-term and pandemic induced new-onset suicidal ideation during the early phase of the COVID-19 pandemic in urban Japan, using data from a nationwide health survey of 17,376 participants (August 2020). Modified Poisson regression models estimated prevalence ratios (PRs) for suicidal ideation by UGS accessibility (area, number, and type) within 5, 10, and 15-minute walking thresholds from home, controlling for individual and area-level confounders. UGS accessibility exhibited dose-response relationships with …

Quantifying The Response Of Bankfull Channel Width To Active Faulting In The Qianhe Graben On The Southwest Margin Of Ordos Block, China, Zhiheng Liu, Sarah Boulton, Suiping Zhou, Jianhua Guo, Tingting Wu, Wenjie Zhang, Ling Han

School of Geography, Earth and Environmental Sciences

River longitudinal profiles have been widely used to quantify the transient landscape response to active faulting, but the fluvial cross-section is often ignored, yet width can also reveal river incision and tectonic activity. Channel width responds to tectonic forcing through flow concentration effects resulting in channel narrowing where vertical incision dominates during uplift acceleration. Here we employ a novel bankfull channel width extraction method using Landsat and ZY-3 satellite images, and SRTM DEM data to evaluate the cross-section landscape response to active faulting in the Qianhe Graben of southwest Ordos, China. Although some areas are difficult to access (e.g., thick …

Presence And Characteristics Of Plastics And Microplastics On The Seabed Of The Western English Channel, Faye Read, Andrew Turner

School of Geography, Earth and Environmental Sciences

Little is known about the presence, distribution, origins and characteristics of plastic litter and microplastics on the ocean floor. In this study, plastics trawled from the bed of the western English Channel have been categorised and analysed by a variety of optical and spectroscopic techniques. A total of 90 plastic samples were classified, in descending order of abundance, as food-drink packaging, unknown, homeware, military and fishing. Most samples showed varying degrees of weathering (e.g., discolouration, distortion, cracking, fragmentation) and were visibly fouled by calcareous deposits. The majority of samples were constructed of polymers of negative buoyancy (e.g., polyamides, polyethylene terephthalate …

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 …

Long-Term Evaluation Of The Energy Consumption Of 100 Energy-Efficient Buildings In Austria, Thomas Roßkopf-Nachbaur, Günter Lang, Martin Ploß, Markus Lang, Andreas Peter, Tobias Hatt, Diana Ürge-Vorsatz, Souran Chatterjee, Luisa F. Cabeza

School of Geography, Earth and Environmental Sciences

In 2019, buildings greenhouse gas (GHG) emissions accounted for 21 % of global emissions, therefore regions such as Europe have strong policies to decrease such emissions. The literature shows different examples simulating energy refurbishment of buildings or districts where an important GHG reduction can be achieved, but there is a clear gap on real measurements of exemplary buildings. This paper shows an assessment of more than 100 energy-efficient buildings in Austria, showing that this GHG emissions reduction is really possible. The paper evaluates residential and non-residential buildings, where the energy consumption was 50 % below the consumption of typical multi-apartment …

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% …

Does In-Bed Cycling Delivered Within 48 Hours Of Mechanical Ventilation, Reduce The Occurrence Of Delirium In Critically Ill Patients: A Mixed-Methods Feasibility Randomised Controlled Trial Protocol, Jacqueline Bennion, Mark Hudson, Mary Hickson, Victoria Allgar, Bridie Kent, David Mcwilliams, Daniel Martin

Peninsula Medical School

Background: Delirium is a severe neuropsychiatric clinical state presenting as an acute onset of cognitive deficits. Patients receiving invasive mechanical ventilation (IMV), have the highest incidence (50%–80%) of delirium amongst patients admitted to intensive care units. Preliminary data indicates that early mobilisation is associated with reduced delirium in critically ill patients. However, definitive evidence is lacking. Current practice varies due to many barriers to patients, who require IMV, receiving early mobilisation interventions. In-bed cycling may address some of these barriers. This research aims to evaluate the feasibility and acceptability of early in-bed cycling to reduce delirium in critically ill patients. …

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 …

Enhancing Offshore Wind Resource Assessment Through Neural Network-Based Hf Radar Data Analysis, Nikolas Martzikos, Matthew Craven, David Walker, Daniel Conley

School of Engineering, Computing and Mathematics

The increasing demand for offshore wind energy underscores the need for accurate wind speed estimation to support the design and operation of offshore wind farms. High-Frequency Radar (HFR), a widely used remote sensing technology in oceanographic research, offers promising potential for wind resource assessment, particularly in areas where conventional measurements are limited. This study explores the application of artificial neural networks (ANNs) for offshore wind speed prediction using HFR-derived data, addressing key challenges in model development and training. A key feature of this approach is the use of a decade-long dataset from the Celtic Sea, off the southwest UK coast, …

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 …

Next-Generation Virtual Environment Training For Cybersecurity In The Maritime Logistics Industry: A Position Paper, Tyler Cheng, Rory Hopcraft, Kimberly Tam, Ji-Jian Chin

School of Engineering, Computing and Mathematics

The maritime logistics industry is the most dependent on it in the modern world, yet it is not well protected against cyber risks. Recently, the maritime industry has been transitioning into industry-specific tech, and threats of cyberattacks are increasing as the adoption of technology and automation continues. One of the most effective methods to protect industries and ships from such security incidents, is to train seafarers to mitigate and handle such incidents. However, to the best of our knowledge, we did not find anything that addresses this gap. This article will present the idea and benefits of using virtual environments …

Fault Tolerant Adaptive Control Under Actuator Saturation For Robot Manipulators, D. J. López-Araujo, N. Alvarez-Jarquin, P. Borja, A. T. Becker

School of Engineering, Computing and Mathematics

In practice, actuators inherently have natural limitations that are often overlooked by theoretical control strategies, such as bounded output and discrepancies between calculated and actual responses. Consequently, reliable control techniques must be employed to ensure safe and dependable operation. We propose an adaptive control law for global regulation in the case of partial loss of effectiveness due to input faults. The proposed control strategy maintains the system at the desired configuration while accounting for the physical limitations of the actuators. Additionally, it is suitable for dealing with unknown parameters in the vector of gravitational forces, making it robust to these …

Angle-Based Formation Stabilization And Maneuvers In Port-Hamiltonian Form With Bearing And Velocity Measurements, Ningbo Li, Pablo Borja, Arjan Van Der Schaft, Jacquelien M.A. Scherpen

School of Engineering, Computing and Mathematics

This paper proposes a port-Hamiltonian approach for angle-based formation stabilization and maneuvers using bearing and velocity measurements with an underlying triangulated Laman graph. The corresponding port-Hamiltonian controller is designed using virtual couplings on the errors of angle constraints in angle space. Then, the angle constraints and agent actuators are mapped by the constraint Jacobian, which can be applied to other formation constraints. In addition, to avoid unavailable distance terms in the control law, an estimator is designed based on port-Hamiltonian theory and the property that energy is coordinate-free for different sensor modalities using bearing and velocity measurements, which permits our …

Scope 3 Carbon Emissions Assessment For Manufacturing Smes, Kourosh Halat, Stephen Childe, Nick Golding, John Summerscales

School of Engineering, Computing and Mathematics

This paper addresses the challenges facing managers of Small-andMedium-Size Enterprises (SMEs) when conducting environmental sustainability assessment at the value chain level, particularly Scope 3 Greenhouse Gases GHG) emissions. The paper investigates issues related to data availability and data quality for Scope 3 assessment and identifies dimensions of Scope 3 reliability.Utilising a series of in-depth case study analyses with SMEs in the south-west of England, UK, the paper fills a gap in supply chain sustainability research by identifying practical challenges. The findings show that SMEs encounter persistent difficulties in assessing emissions associated with purchased goods and services and downstream activities linked …

Usable Authentication: Are We There Yet?, Nathan Clarke, Steven Furnell

School of Engineering, Computing and Mathematics

With technology increasingly embedded in everyday life, the demand for secure and usable authentication methods has never been greater. Traditional password-based systems continue to dominate, despite well-known usability and security challenges. This paper explores the evolution of user authentication technologies, from secret knowledge and tokens to biometrics and emerging approaches such as Passkeys. It critically evaluates the extent to which usability has been achieved, identifying both successes—such as biometrics integrated into smartphones—and persistent issues, including inconsistent guidance, ecosystem dependence, and accessibility barriers. Drawing on academic and commercial developments, the discussion highlights the growing burden on users who must authenticate across …

Rapid Electrochemical Biosensor With Enhanced Accuracy And Repeatability Using Pyrene Nhs Ester Modified 3d Graphene Electrodes, S. Nazir, D. Jenkins, G. Pan

School of Engineering, Computing and Mathematics

A consistent and reproducible chemical modification of the transducer interface is essential to ensure effectiveimmobilization of bioreceptors, thereby improving the sensitivity and reproducibility of biosensors. Althoughnotable progress has been made in fabricating graphene-based biosensors, the effects of surface biofunctionalization on sensing performance remain not fully understood. This study shows that combining threedimensional (3D) graphene foam electrodes with a straightforward, single-step surface biofunctionalizationmethod is key to enhancing the performance of graphene-based biosensors. Specifically, it presents a single-stepapproach to functionalize the 3D graphene foam (Gii-Sens) with 1-pyrenebutyric acid N-hydroxysuccinimideester (Pyrene-NHS ester). Electrochemical techniques, including cyclic voltammetry (CV) and differential pulsevoltammetry (DPV), confirmed …

Biocompatibility Of Silver And Hydroxyapatite Antimicrobial Nanocoatings On Titanium Alloy Dental Implants With Human Gingival Fibroblasts, S Morgan, R D Handy, V M Salih, R N Salaie, C J Tredwin, A Besinis

School of Engineering, Computing and Mathematics

OBJECTIVES: Peri-implantitis compromises soft and hard tissues around dental implants, often leading to implant failure. Antibacterial nanocoatings offer a promising infection control strategy, but maintaining biocompatibility is essential. This study investigated, through a range of assays and analytical techniques, the biocompatibility of antimicrobial silver and hydroxyapatite (HA) nanocoatings applied to titanium implants with human gingival fibroblasts (HGFs).

METHODS: Silver and hydroxyapatite nanocoatings were applied to the surface of titanium alloy specimens using electroplating, deposition and sintering techniques. The biocompatibility of the nanocoatings with HGFs was assessed by measuring cell metabolic activity (alamarBlue), lactate dehydrogenase (LDH) release, collagen production (Sircol assay), …

Heat Transfer From A Partially Buried Circular Cylinder In Oscillatory Flow, H. Thomas, R. Stuhlmeier, A. G.L. Borthwick, S. Michele

School of Engineering, Computing and Mathematics

With the growing abundance of man-made cylindrical structures located on or close to the seabed, it is important to be able to assess their potential environmental impact. Herein, a model is presented of the viscous-thermal boundary layer in the vicinity of a circular cylinder resting on, or partially buried in, an otherwise flat seabed. To model the influence of wave-induced motions near such a cylinder, we assume oscillatory flow in which the water particle displacements are small with respect to the cylinder radius. A perturbation expansion is utilised to derive solutions of the boundary layer equations, leading to analytical solutions …