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Physiotherapist's Management of Suspected Cauda Equina Syndrome in the United Kingdom: A National Survey
Full text linkABSTRACT
Background and Purpose
Cauda Equina Syndrome (CES) is a rare but serious spinal condition requiring urgent diagnosis and management. Physiotherapists in UK musculoskeletal (MSK) services increasingly encounter suspected CES cases, but little is known about their clinical decision-making and referral practices. This study aimed to examine the clinical decision-making processes of UK physiotherapists when presented with three clinical vignettes of suspected CES and to identify themes in referral handover methods when emergency care is deemed necessary.
Methods
An online survey featuring three clinical case vignettes was distributed to UK physiotherapists. Respondents were asked about their referral decisions, clinical reasoning, and preferred methods of handover to Accident & Emergency (A&E) services. Thematic analysis was used to identify common clinical reasoning patterns and referral practices.
Results
The presence of altered bladder function was the strongest predictor of referral to A&E, consistent with previous literature. Sexual dysfunction was also a significant referral factor when present. Themes for not referring included recent A&E attendance, plans for in-clinic assessment, specialist consultation, and requesting urgent MRI scanning. A range of handover methods were reported, with written letters and direct phone calls being the most common. Variation in clinical decision-making was evident, particularly regarding timing and urgency of investigations, reflecting some uncertainty around guideline interpretation.
Discussion
Findings demonstrate variability in UK physiotherapists' approaches to suspected CES management, with some respondents opting for community assessment or delayed imaging despite CES's urgent nature. Findings emphasise the need for clearer, unified guidelines on referral pathways and handover methods to reduce delays and improve patient outcomes. Future research should explore the impact of recent guideline updates and include perspectives from other healthcare professionals involved in CES care
Glycosides of fluorinated p-nitrophenol offer improved sensitivity for detection of β-galactosidase and β-glucuronidase in Escherichia coli and other Enterobacterales
Full text linkWe describe the synthesis and evaluation of six halogenated nitrophenyl glycosides for detection of β-galactosidase and β-glucuronidase enzyme activity among Enterobacterales (“coliforms”) and Escherichia coli, respectively. These were evaluated alongside the established substrates; o-nitrophenyl-β-D-galactopyranoside (ONPG), p-nitrophenyl-β-D-galactopyranoside (PNPG) and p-nitrophenyl-β-D-glucuronide (PNP-GUR). The evaluation was performed using 30 isolates of Enterobacterales including 19 isolates of E. coli. Hydrolysis of 2-fluoro-p-nitrophenyl-β-D-galactopyranoside (2-fluoro-PNPG) yielded a significantly stronger yellow coloration after a six-hour incubation period compared to hydrolysis of ONPG and PNPG, potentially allowing for a more sensitive detection of Enterobacterales. Similarly, hydrolysis of the novel substrate 2-fluoro-p-nitrophenyl-β-D-glucuronide sodium salt (2-fluoro-PNP-GUR Na) by producers of β-glucuronidase also yielded a significantly stronger yellow colouration, potentially allowing for a more sensitive detection of E. coli. The yellow chromophore 2-fluoro-PNP retained high colour intensity at reduced pH when compared to o-nitrophenol and p-nitrophenol. Both substrates potentially offer enhanced sensitivity for the detection of Enterobacterales and E. coli in environmental samples as markers of faecal pollution
Impact of Green Knowledge Sharing on the Organizational Performance of SMEs : The Mediating Role of Green Organizational Culture and Technological Innovation
No full textThis study explores the impact of Green Knowledge Sharing (GKS) on Organizational Performance (OP), considering the mediating roles of Green Organizational Culture (GOC) and Technological Innovation (TI). Addressing current gaps in the literature, the research extends beyond sector‐specific analyses and incorporates a cross‐country perspective, examining 297 small and medium‐sized enterprises (SMEs) in Portugal, Spain, and the United Kingdom. Additionally, this study acknowledges the influence of digital transformation in enhancing GKS, a factor often overlooked in previous research. By adopting a Structural Equation Modeling (SEM) approach, this article confirms a direct and positive effect on both OP and GOC, with GOC further influencing OP, establishing its mediating role in this relationship. However, the relationships between GKS and TI, as well as the indirect effect of GKS on OP through TI, are not supported. These findings offer theoretical advancements by broadening the conventional understanding of OP beyond financial metrics and present practical implications for SME managers, highlighting strategies to foster a green organizational culture and leverage technological innovation for sustainable performance
Between real change and institutional facade: unpacking operational sustainability in English universities
Full text linkThis study aims to critically examine operational sustainability (OS) in English public universities, uniquely integrating neo-institutional and organisational legitimacy theories to explore the alignment of sustainability strategies with organisational practices. Adopting a rigorous qualitative approach, this study combines semi-structured interviews with 20 OS managers and a thorough document analysis involving over 800 documents. This robust methodology ensures a deep exploration of institutional sustainability dynamics. This study reveals a significant discrepancy between stated and actual sustainability performances, with institutions frequently engaging in symbolic sustainability efforts. It highlights the need for robust benchmarking systems to accurately measure and encourage genuine sustainability integration.
The identified barriers and the subsequent recommended approaches can guide public universities in their strategic planning and implementation of OS initiatives, ensuring more effective outcomes. This study underscores the importance of university stakeholders in shaping OS engagement. It signals a need for broader societal awareness and collaboration to truly drive universities towards a more sustainable future. This study is original in its dual-theoretical approach, applying both neo-institutional and organisational legitimacy theories to dissect the complexities of sustainability in higher education. It extends the discourse on sustainability by scrutinising the often-overlooked gap between policy and practice, providing a nuanced understanding of institutional behaviours and pressures
‘They didn’t hear what I was trying to say’: an analysis of survivors’ experiences communicating with professionals about honour-based abuse
Full text linkSurvivors of honour-based abuse face significant challenges when communicating with professionals, yet their lived experiences of these interactions remain underexplored. This interpretative phenomenological analysis examined five survivors’ accounts of professional communication. Four themes emerged: seeking validation amidst cultural misunderstanding; navigating the disclosure paradox; professional responses as potential re-traumatisation; and building bridges through authentic connection. Participants described struggling to be believed, fearing disclosure escalation and bearing the burden of educating professionals about cultural contexts. Positive experiences were characterised by genuine rapport, clear support pathways and balanced autonomy. These findings highlight the need for culturally informed, trauma-sensitive professional training
A Falsetto Detection Algorithm for Enhancing Voice Gender Recognition
Full text linkThis paper presents a novel falsetto detection algorithm designed to enhance the performance of Voice Gender Recognition (VGR). By incorporating Signal Processing techniques with insights from vocal pedagogy, our algorithm identifies falsetto in singing voice data to reduce gender identity ambiguity in vocal analysis. We used a pre-trained Deep Learning VGR model to assess the effectiveness of our algorithm. Experiments with various parameter settings demonstrate that the proposed algorithm reduced false positives in male voice detection and improved the VGR F1 score by a maximum of 5.3% for male voices and 2.6% for female voices. Our findings also highlight potential advancements in falsetto detection and provide insight for improving applications such as Voice Age Detection
LGBTQ+ Leadership in Education: Visibility, Vision and Voice
No full textThe distinct nature of LGBTQ+ Leadership in Education is often misunderstood, overlooked, and undervalued. This groundbreaking book explores the contributions and transformative potential of LGBTQ+ educational leaders, weaving together personal stories, strategic insights, and critical analysis. Across job functions, contexts, and career stages, it explores the challenges, priorities, and contributions of LGBTQ+ leaders—including educators with multiple marginalised identities.
Grounded in the realities of the UK education sector, LGBTQ+ Leadership in Education highlights the vital role of Diversity, Equity, and Inclusion (DEI) in leadership, recognising the advocacy work of LGBTQ+ leaders and the transformative power of queer networks in shaping institutional cultures. Chapter authors offer a nuanced appreciation of authenticity, visibility, influence, and leadership development, while engaging with queer theory to challenge dominant models that perpetuate inequality.
An essential resource for educators at all levels, it empowers leaders to reexamine, refine, and strengthen their own leadership practice, fostering inclusive and effective educational environments for all
Investigating Moral Capital in Value Creation: Moral Capital and Superior Individual Level Performance
No full textThis study investigates how individual-level moral orientations—such as honesty, fairness, responsibility, and trustworthiness—scale upward into collective outcomes that drive operational efficiency, strategic resilience, and long-term value creation.The chapter adopts a conceptual and integrative review approach, drawing from classical philosophy, business ethics, organizational behavior, and contemporary cases. It synthesizes theoretical foundations, empirical findings, and illustrative case studies to identify mechanisms linking moral capital to value creation. The analysis demonstrates that moral capital enhances both operational and strategic performance. At the operational level, it reduces monitoring costs, fosters collaboration, and supports crisis responsiveness. At the strategic level, it strengthens organizational reputation, builds stakeholder trust, improves resilience, and sustains competitive advantage. The absence of moral capital often converts other intangible resources into liabilities rather than assets