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Thresholds of Wave Forcing: Implications for Atoll Reef Dynamics Under Sea Level Rise
No full textWe investigate the response of shallow reef flow to tidal variability and wave exposure during a 4-month field campaign in southern Huvadhu Atoll, Maldives. Incident waves breaking on steep fore reefs and reef crests generate a setup proportional to offshore wave height that drives a cross-reef flow. We emphasize a critical threshold—where the depth on the reef flat equals the depth at wave breaking—that separates two distinct reef flow regimes: one dominated by strong, unidirectional flow from the ocean into the lagoon and another where wave breaking ceases, flow rates decrease, and occasionally reverse direction. Recognizing the relative importance of water depth and wave energy, we develop a framework for interpreting shallow reef hydrodynamics in a combined tide-wave parameter space. This framework allows us to project how rising sea levels may alter reef flows—potentially leading to prolonged and more frequent periods of limited wave breaking and a decline in wave-driven transport
Adherence and compliance with exercise training in progressive multiple sclerosis: Rates and correlates from the CogEx trial
No full textBackground: 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 correlates for participants in the pooled ET intervention conditions who received and attempted the ETintervention(n=152).Results: The rates of adherence and compliance overall(combined for both training stimuli) were 94% and 66%, respectively. The rates of adherence and compliance forcontinuous, moderate-intensity exercise were 95% and 73%, respectively, and for HIIT were 92% and 58%, respectively. The multivariable regression indicated that better 6MWTperformance predicted higher compliance(particularly with HITT), whereas better CVLT-II performance predicted higher adherence and compliance with continuous training in PMS.Conclusion: Our results highlight worse compliance than adherence with ET, particularly for HIIT, in PMS. We further highlight cognitive and physical function as correlates ofadherence and compliance for consideration in future clinical trials of ET in PMS
Who seeks help? Characteristics of doctors accessing mental health support in England: 4-year national review
No full textBackgroundMental 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% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.ConclusionsThe findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce
An exploration of the experiences of vulnerable young people participating in a stand-up paddle-boarding therapy course; a phenomenological study
No full textNature based interventions have been advocated as an approach to support mental health and well-being in young people. The Wave Project, a United Kingdom based charity, has an established surf therapy intervention for vulnerable children and adolescents which has been demonstrated to have a positive impact on mental health and well-being. However, this intervention provides challenges in terms of accessibility for young people located away from the coast. Stand-up paddle-boarding is an aquatic activity which can be conducted on inland waters, which therefore has the potential to address this barrier. Semi-structured interviews (n=6) utilising video and photo elicitation were conducted with young people participating in a five-week Stand-up paddle-boarding course delivered on a canal in a central city location in the South-west of England. Transcripts were analysed using a qualitative phenomenological approach. Participants reported engaging in paddle-boarding induced a feeling of calmness and provided respite from pre-occupations of school and other concerns. The support provided by instructors and volunteers gave them a sense of both physical and psychological safety which provided them with the confidence to master a new skill. This experience increased their self-confidence and self-esteem as well as reducing social anxiety and feelings of anger. The findings suggest that a Stand-up paddle-boarding course may confer mental health and well-being benefits for vulnerable young people. The ability to deliver this intervention on a canal in the centre of a city increases its accessibility to young people living inland
The Chronic Apical Abscess: a case report on a diagnostic dilemma
No full textA chronic apical abscess is an endodontic condition commonly characterised by the presence of a notable sinus tract through which pus periodically discharges. In general, these cases can be considered “straight forward” to diagnose but on some occasions, diagnosis can be challenging. Any misdiagnosis can compromise the treatment approach for the patient and lead to adverse outcomes such as unnecessary biopsies or referrals. Therefore, clinicians should follow a meticulous treatment approach consisting of appropriate diagnostic measures to establish the correct diagnosis and treatment pathway
A Cross-Cultural Study of Parenting Styles and Involvement in Bullying of Children with and without SEN
No full textThis study explores the relationship between parenting styles and children\u27s involvement in bullying, focusing on children with and without Special Educational Needs (SEN) in inclusive education settings in England and Türkiye. While bullying has been widely studied, most research has primarily examined typically developing children, leaving a gap in understanding the experiences of children with SEN. This study addresses this gap by comparing the impact of parenting styles on bullying experiences across both groups and cultural contexts.A mixed-methods approach was employed, combining quantitative and qualitative data collection. The quantitative phase included a questionnaire completed by 217 parents in Türkiye and 204 parents in England. Additionally, semi-structured interviews were conducted with eight parents of children with SEN who had experienced bullying—four from each country.The quantitative findings revealed differences in prevalence and the influence of parenting styles. In Türkiye, children with SEN experienced less bullying than their typically developing peers, whereas in England, the opposite was reported. Parenting styles did not predict bullying involvement in Türkiye, but in England, authoritative parenting was a risk factor for victimisation, while permissive parenting served as a protective factor.Qualitative data highlighted common challenges across both contexts, particularly the shared experiences of parents whose children were victimised. A significant issue identified by parents in both countries was the inadequacy of schools and teachers in effectively addressing bullying incidents.These findings underscore the need for a more comprehensive understanding of bullying dynamics across different cultural and educational settings. The study contributes to existing literature by offering a cross-cultural comparison of perspectives on the interplay between parenting styles and bullying experiences, emphasising the importance of tailoring interventions to support children with SEN
An exploratory study of employability, work readiness, and international experiences for one-year international postgraduate taught business students in the uk
No full textDelivering world-class student experiences, navigating evidence-based graduate outcomes, and advancing the employability agenda are central to the current landscape of UK universities. While maintaining high educational standards and remaining competitive in international student recruitment have become increasingly challenging after the global pandemic and amid ongoing financial pressures faced by the UK universities, limited academic attention has been given to the employability of one-year international postgraduate taught students (IPGTs) in UK higher education. Recognising IPGTs as a significant cohort that makes substantial economic, sociocultural, and expertise-related contributions to both tertiary education and the host country’s labour market, this doctoral study aims to explore the employability, work readiness, and international experiences of IPGTs in UK business and management schools, with a particular focus on how these concepts interact to shape their transition from university to the workplace.This doctoral research uses a sequential mixed-methods design. The qualitative phase (stage one) involved 30 semi-structured interviews, which identified three subdimensions of IPGTs’ employability (IPSE), three subdomains of international experiences within the university (IEIU), three distinct subdimensions of international experiences outside the university (IEOU), and three areas of establishing work readiness. The quantitative part (stage two) collected a new set of 756 valid responses from 54 UK business and management schools. Using the PLS-SEM approach to estimate the SEM model, which identified seven relationships (both direct and indirect) among the key constructs, including IPSE, IEIU, IEOU, and work readiness.This study offers theoretical and practical insights by introducing validated frameworks and constructs, including the multifaceted IPSE, identified domains of work readiness, the differences between IEIU and IEOU, along with their unique dimensions, and multiple estimated relationships among all the constructs. In doing so, it aims to advance employability research by providing actionable strategies and practical implications for practitioners, employers, higher education institutions, and policymakers to improve the employability and work readiness of IPGTs in diverse and dynamic international experience contexts. Additionally, the study outlines future research directions by exploring various student and graduate cohorts, employing longitudinal methods, incorporating stakeholder perspectives, and applying different frameworks to the constructs and the SEM model across diverse cultural and institutional settings
The Impact of Face Masks on Social Perception Is Age-Dependent
No full textHuman faces are critical for social communication, enabling individuals to make rapid judgments about traits like trustworthiness and competence. Previous research suggests that face masks can enhance perceptions of trustworthiness and, to a lesser extent, competence, although findings on competence are more variable and context-dependent. Additionally, age-related facial cues influence social judgments, with older and younger faces being evaluated differently. This research examined the impact of face masks on perceptions of trustworthiness and competence across two age groups: young adults (Study 1) and old adults (Study 2). Study 1 revealed that face masks increased perceptions of trustworthiness and competence for young faces. In contrast, Study 2 found no significant effects of face masks on trustworthiness or competence for older faces, suggesting that age-related facial features and stereotypes may overshadow mask-induced perceptual biases. Altogether, the findings indicate that the impact of face masks on social perceptions, particularly trustworthiness and competence, may not generalize reliably across different age groups
Widening Participation in Dentistry: A Quantitative Study of Changing Demographics at a South West UK Dental School (2014-2021).
No full textIntroductionAccess to National Health Service (NHS) dental care in the UK, particularly in rural and coastal regions such as the South West, remains a significant concern. Increasing socio-economic diversity in the dental workforce has previously been reported to improve access to care in underserved areas. Widening Participation (WP) initiatives aim to address this by encouraging applications from underrepresented groups.MethodsThis study analysed admissions data from the University of Plymouth\u27s Bachelor of Dental Surgery (BDS) programme for cohorts between 2014 and 2021. Metrics included entry qualifications, age, gender, ethnicity, disability and socio-economic markers. Statistical analyses included chi-squared tests and ANOVA to identify demographic shifts over time.ResultsData from 512 students revealed significant changes in entry profile (p \u3c 0.001), gender distribution (p = 0.003), school type (p = 0.003) and age at entry (p \u3c 0.001). The proportion of students applying with predicted grades increased, while graduate applicants declined. Socio-economic diversity remained limited, with most students from areas of high participation in higher education and low deprivation.ConclusionOver the study period, the demographic profile of dental students remained largely unchanged, even though this period coincided with enhancements to widening participation initiatives. Without greater representation from diverse backgrounds, the dental workforce may struggle to meet the needs of underserved communities
Occupational therapy for multiple sclerosis
No full textRATIONALE: Occupational therapy (OT) enables individuals to engage in meaningful daily activities and is considered a valuable component of care for people with multiple sclerosis (MS). However, the specific impact of OT on MS remains unclear. OBJECTIVES: To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation and quality of life in people with multiple sclerosis. SEARCH METHODS: We searched seven electronic bibliographic databases until November 2024. We also searched grey literature and trial registers. ELIGIBILITY CRITERIA: We included randomised and non-randomised controlled trials that compared OT for adults with MS versus no intervention, usual care or active control. OUTCOMES: Critical outcomes were daily functioning, quality of life and adverse effects. Important outcomes were participation, self-efficacy, self-management, mood, resilience and impact on caregivers. Our time points of interest were post-intervention, medium term (up to six months after the end of the intervention) and long term (longest follow-up after six months). RISK OF BIAS: We assessed risk of bias (RoB) for the outcomes reported in our summary of findings tables. We used the Cochrane tools RoB-2 (for randomised controlled trials) and ROBINS-I (for non-randomised controlled trials). SYNTHESIS METHODS: We synthesised results using meta-analysis (random-effects model, inverse variance). The effect measure was mean difference (MD) or standardised mean difference (SMD). Where meta-analysis was not possible, we synthesised results narratively using Synthesis Without Meta-analysis guidelines. We used GRADE to assess the certainty of the evidence. INCLUDED STUDIES: We included 20 studies (1628 participants), three of which were non-randomised. Nineteen of the studies were conducted in high-income countries. The studies included adults with MS (aged 18 to 70 years) with low to moderate levels of disability. Ten studies evaluated fatigue management programmes, nine examined OT interventions for daily functioning (e.g. skills training) and one targeted social participation. SYNTHESIS OF RESULTS: Daily functioning Post-intervention: OT interventions may provide a small benefit for daily functioning compared to active control (SMD 0.22, 95% CI -0.02 to 0.46; I² = 17%; 7 studies, 364 participants; low certainty), and a moderate benefit compared to no intervention (SMD 0.56, 95% CI -0.26 to 1.37; I² = 68%; 2 studies, 164 participants; low certainty). There may be a large effect compared to usual care, but the evidence is very uncertain (SMD 1.19, 95% CI 0.29 to 2.09; I² = 62%; 2 studies, 120 participants; very low certainty). Medium term: OT may make little to no difference to daily functioning compared to active control (SMD 0.11, 95% CI -0.13 to 0.35; I² = 0%; 4 studies, 264 participants; low certainty), but may have a large effect compared to usual care (SMD 0.99, 95% CI 0.57 to 1.41; I² not applicable; 1 study, 98 participants; low certainty). The long-term effects of OT on daily functioning compared to active control or usual care are very uncertain. No medium-term or long-term data were reported for OT versus no intervention. Quality of life Post-intervention: OT may offer a small benefit for mental health-related quality of life (HR-QoL) versus active control (SMD 0.33, 95% CI -0.01 to 0.66; I² = 42%; 5 studies, 296 participants; low certainty), but little to no benefit for physical HR-QoL (SMD 0.17, 95% CI -0.09 to 0.42; I² = 12%; 5 studies, 295 participants; low certainty). Compared to usual care, moderate effects on physical HR-QoL (SMD 0.69, 95% CI -1.18 to 2.56; I² = 91%; 2 studies, 166 participants; very low certainty) and mental HR-QoL (SMD 0.44, 95% CI -1.27 to 2.16; I² = 91%; 2 studies; very low certainty) are very uncertain. Compared to no intervention, OT may moderately improve mental HR-QoL (SMD 0.68, 95% CI -0.09 to 1.45; I² = 0%; 3 studies, 192 participants; very low certainty), though the evidence is very uncertain; there may be little to no effect on physical HR-QoL (SMD 0.12, 95% CI -0.62 to 0.86; I² = 0%; 3 studies, 192 participants; very low certainty), but the evidence is very uncertain. Medium term: there may be a small benefit from OT on mental HR-QoL versus active control, but the evidence is very uncertain (SMD 0.21, 95% CI -0.08 to 0.49; I² = 20%; 4 studies, 270 participants; very low certainty). There may be little to no effect on physical HR-QoL (SMD 0.19, 95% CI -0.05 to 0.43; I² = 0%; 4 studies, 268 participants; low certainty). Compared to usual care, effects are very uncertain for both physical (SMD 0.26, 95% CI -0.33 to 0.86; I² = 81%; 2 studies, 242 participants; very low certainty) and mental HR-QoL (SMD 0.18, 95% CI -0.63 to 0.98; I² = 90%; 2 studies, 242 participants; very low certainty). No results are available for medium-term effects of OT compared to no intervention. The long-term effects of OT on quality of life are very uncertain. Adverse effects No studies systematically reported the frequency or type of adverse effects. Participation Occupational therapy may result in little to no effect on participation post-intervention compared to active control. Results for other comparisons and time points are not available or provide only evidence of very low certainty. AUTHORS\u27 CONCLUSIONS: Occupational therapy may improve daily functioning and mental-health-related quality of life post-intervention, regardless of the comparator intervention. These potential benefits may persist in the medium term for daily functioning (when compared to usual care) and for mental-health-related quality of life (when compared to active control). Long-term effects are uncertain. Sparse evidence suggests that occupational therapy may have little or no effect on physical-health-related quality of life compared to active comparators. We found no evidence about adverse effects of occupational therapy. Our pooled effects require cautious interpretation, as intervention heterogeneity and our exclusion of multidisciplinary studies without separate data for occupational therapy limit our certainty about the evidence. Future studies with robust design and systematic outcome assessment are needed to reach firm conclusions about the effects of occupational therapy for people with multiple sclerosis. FUNDING: Elizabeth Casson Trust Research Grant_2022 (UK); Health Research Board (Ireland) & HSC Public Health Agency (Grant ESI-2021-001) through Evidence Synthesis/Cochrane Ireland REGISTRATION: Protocol DOI 10.1002/14651858.CD015371