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Agreement between cognitive screening tools: a comparison of MoCA, ACE-III, M-ACE, and MoCA-MIS
No full textIntroduction: Early detection of cognitive decline is critical, yet commonly used screening tools may yield divergent results. This study examined the alignment of four widely used instruments in a community-dwelling cohort. Method: Seventy-nine participants (Mage = 71.20, SD = 6.29; 39 male, 40 female) were recruited from the general community and assessed under standardized laboratory conditions. Participants completed the Montreal Cognitive Assessment (MoCA) and the Addenbrooke’s Cognitive Examination-III (ACE-III), from which scores for the MoCA Memory Index Score (MoCA-MIS) and the Mini-Addenbrooke’s Cognitive Examination (M-ACE) were also calculated. Test agreement was examined using observed agreement and Cohen’s kappa, and score relationships were evaluated using Pearson correlations. Results: All but one test pair (M-ACE vs MoCA-MIS) showed strong score correlations. However, agreement between MoCA and ACE-III for classifying participants as below threshold was only fair. MoCA identified twice as many participants as impaired compared with ACE-III, raising the possibility of either greater sensitivity or higher false-positive classification. Overall, 41% of participants (n = 32) scored below threshold on at least one measure, but only 6% (n = 5) were below threshold across all four. Of four participants with a prior mild cognitive impairment (MCI) diagnosis, only one, who had more pronounced deficits, scored below threshold in all tests. Conclusions: Despite strong inter-test correlations, substantial divergence in classification outcome was observed, particularly between MoCA and ACE-III. Reliance on a single screening instrument risks misclassification, with implications for both over- and under-diagnosis. Greater harmonization between screening tools is needed to improve diagnostic consistency. Clinical practice should therefore combine multiple-instrument approaches, potentially including premorbid function, and interpret screening test scores cautiously. Comprehensive neuropsychological assessment may provide a more complete picture, particularly in cases where diagnostic confidence is low, although this is not routine practice in all services.</p
Exploring CEOs' decision making in Fintech Financing: evidence from UK SMEs
No full textThe recent COVID-19, Brexit and current inflation made access to credit harder for UK SMEs. The innovation in financial services such as financial technology (Fintech) designed to redefine the delivery of financial services which dramatically influence and transmute the financing system. However, how CEOs make their Fintech financing decisions is not fully investigated. This research aims to fill in this gap. To capture different characteristics of CEOs, this research interviewed 20 CEOs from UK SMEs to explore CEOs’ Fintech financing decision at the individual (micro), organisational (meso) and country (macro) levels. Results, supported by the cognitive theory of decision-making, confirm that CEOs make rational decisions and significantly rely on their leadership attributes to choose the best financing option for the benefit of their organisations. Results support the pecking order theory of financing indicate that CEOs prefer Fintech financing due to its flexibility in funding options, low costs and fewer regulations. Further findings suggest that the effects of micro factors on CEOs, such as family, vision, values, education level and prior experience, positively support CEOs to make Fintech decisions. Interestingly, at the meso level, results indicate that CEOs’ networking and the board's collective decisions play an important role in Fintech decision-making. In addition, the organic organisational structure stimulates Fintech financing. Lastly, the complexities of macro factors to navigate CEOs in their Fintech financing decisions uncovered that there is no specific Fintech law, forum or guidelines from the government to create awareness.This research contributes to the extant knowledge by providing compelling evidence that most SME CEOs make rational decisions, underpinned by their transformational leadership approach, which are influenced by factors at the micro, meso and macro levels. These findings provide insights to government policies, International Monetary Fund (IMF) and the World Bank initiatives aimed at fostering innovation in finance.</p
Applying agile principles to the development of electronic health record clinical documentation in a south east England National Health Service organisation
No full textThis doctoral thesis examines the application of Agile principles in designing and implementing Electronic Health Record (EHR) clinical documentation within an NHS Trust in South East England. Aim: To assess Agile's impact on clinician needs during transitions from Waterfall. It addresses the research question: “How does the NHS application of the Agile Manifesto influence the design and implementation of EHR clinical documentation that meets clinical stakeholders’ needs within an NHS organisation with an established Project Management Office (PMO) during the transition from Waterfall to an Agile approach?” The study examines ongoing EHR implementation challenges, including unintended consequences such as documentation burden and clinician burnout, caused by the rigid Waterfall methodology’s misalignment with clinicians’ needs. Using a phenomenological approach with NVivo reflexive thematic analysis, this study fills a gap in the healthcare IT literature by exploring the lived experiences of 15 Agile practitioners with at least 12 months’ experience. The findings reveal a complex adoption landscape, characterised by tensions within the PMO, NHS cultural hierarchies, and difficulties in clinician collaboration, which are mitigated by six key factors: integrating Agile with Waterfall approaches, forming Clinical Reference Groups (CRGs) for unified input, emphasising face-to-face communication, addressing NHS cultural pressures, including Clinical Agile Members, and tailoring EHR systems in-house. These insights, justified by five Information Systems theories—Sociotechnical Systems, Complexity, Cohered Emergent Models, Adaptive Models, and Design Science Research (DSR) that highlight Agile's advantage in a regulated NHS setting, contribute to the NHS Agile Implementation Model (NAIM) Framework, a novel development aimed at improving documentation design. The NAIM Framework extends the Agile Manifesto by aligning it with the NHS’s safety-critical environment and offers practical strategies for healthcare managers. Implications: It guides NHS digitisation efforts to reduce burnout, improve clinical documentation, and enhance workflows. Limitations include its focus on a single site and the exclusion of regulatory perspectives (e.g., CQC, NICE), which highlights the need for future research across diverse NHS settings to test the framework’s scalability.</p
Gait style during weave pole performance affects limb dynamics in agility dogs.
No full textBackgroundCanine agility is a physically demanding sport that carries an inherent risk of injury. The weave pole obstacle is a mandatory component in agility courses under UK Kennel Club regulations, requiring a complex forward and lateral side-to-side gait that is not typically replicated outside the sport. This study aimed to evaluate key kinetic parameters-peak force (PF), peak vertical force (PVF), vertical impulse (VI) and stance time (ST)-experienced by forelimbs and hindlimbs during weave pole performance, and to assess differences across the three most common forelimb gait variations: front-feet single-stepping rear double (FFSS/RD), double-stepping (FFDS) and hopping (FFH).MethodsSeventeen experienced agility dogs completed a set of six competition-standard weave poles (FFSS/RD, n = 8; FFDS, n = 4; FFH, n = 5). Data were collected using two pressure-sensing walkways and statistically analysed.ResultsOuter limbs, in general, have shown significantly higher PVF, PV, VI and ST (p p p = 0.014 and 0.003, respectively, for hindlimbs). Stance time and VI were higher on the outer forelimb on FFSS/RD (the only forelimb used in this style) in comparison with FFH (ST: p = 0.003; VI: p = 0.024) and FFDS (ST: p = 0.041; VI: p = 0.032).ConclusionsOverall, there is a clear asymmetry in outer and inner limbs in all styles, which is consistent to the expected on turns. All gaits have shown a trend on redistribution of load towards the outer hindlimb, which was more extreme on FFSS/RD. Stance time was generally lower, and PVF and PF were higher in the FFH group. These factors raise questions regarding the long-term implications of weave pole performance in dogs exhibiting this gait.</p
Flexibility of territorial aggression in urban and rural chaffinches
No full textRapid environmental change due to urbanization poses novel challenges to animals. Behavioral change and individual plasticity are generally hypothesized to be the key to adapting to these challenges. One commonly observed behavioral change is higher observed aggression levels in urban animals, perhaps because anthropogenic noise disrupts effective acoustic communication during conflicts, leading to greater use of physical aggression. We investigated the hypothesis that urban noise drives aggression by performing repeated simulated territorial intrusion experiments on rural and urban chaffinches ( Fringilla coelebs ). We expected urban chaffinches to be more aggressive, change their aggression levels more between trials, and for aggression to increase with noise levels, irrespective of the habitat. We found that while aggression did not differ between habitats in the initial trial, rural chaffinches decreased their aggression level in the second trial and thus were less aggressive than the urban chaffinches, which did not change their response. That is, urban birds were less flexible in responding to an intruder than rural birds, contrary to previous findings in other songbirds. Moreover, aggression levels correlated positively with ambient noise levels. Given our small sample size and lack of spatial replicates, our results should be interpreted with caution. Nevertheless, as a lack of flexibility in aggression is potentially costly, our results highlight the importance of studying the plasticity in aggressive behavior in human‐impacted landscapes.</p
Associations between space-use behaviour and temperature-humidity index in barn-housed dairy cows
No full textCattle may modify their space-use behaviour as thermal conditions change within their environment. Here we examined the relationship between the temperature-humidity index (THI) and various space-use metrics in a UK barn-housed dairy cow herd. Using a real-time local positioning system, as part of a precision livestock farming (PLF) approach, we continuously tracked the spatial position and activity of cows at high temporal resolution from 1st June to 1st December 2024. Localised ambient barn temperature and relative humidity were also continuously monitored within the barn. We assessed the amount of time individuals spent in key resource areas, their activity levels, distance travelled, and z-axis values, as well as bunching behaviour based on four metrics: range size (individual and herd), intercow distance (ICD) and nearest neighbour distance (NND). Cows spent more time near water troughs and fans as THI increased, and less time in the feeding zone under higher THI, except during early morning hours. Time spent in the cubicle area varied by time of day. Activity increased with rising THI except during the late evening. When high sensor-recorded activity values were recorded, cows travelled further with increasing THI during the day. Additionally, z values increased with increasing THI during the day, suggesting cows spent more time standing. Bunching behaviour also changed with increasing THI: ICD decreased and individual range size increased. Patterns for NND were unclear. Monitoring space-use metrics such as proximity to resources and bunching behaviour, alongside activity levels, may provide early behavioural indicators of heat stress in livestock. Further research is needed to assess the generality of these indicators across different barn environments, to help inform welfare and production management.</p
Safety awareness campaigns evaluation and developing KPIs to measure its effectiveness: case study of Abu Dhabi high-risk road users
No full textTraffic safety awareness is regarded as a key tool for enhancing road safety, as it aims to change driver behaviors that account for more than 95% of traffic crashes. This research seeks to evaluate the effectiveness of road safety awareness campaigns among drivers in the Emirate of Abu Dhabi, to explore the most effective methods and messages in awareness programs, and to propose strong key performance indicators (KPIs) for local campaigns.To achieve the research objectives, two main open surveys were conducted on a random sample of drivers representing Abu Dhabi’s driving population. In addition, a survey before-and-after was carried out among a group of delivery motorcycle riders, making up a third survey in this study. This included a pre- and post-awareness workshop questionnaire, supported by telematics data, to monitor behavioral changes in this group after receiving awareness messages, serving as a practical case study. The first survey explored the relationship between drivers’ knowledge, beliefs, and awareness of road safety on one hand, and their actual driving behavior on the other. The second survey assessed the impact of previous awareness campaigns on behavior and identified the most effective methods and messages. The third survey, focusing on delivery riders, applied awareness messages designed based on the findings of the first two surveys, providing a practical application for evaluating their effectiveness.The results revealed a gap between knowledge and beliefs versus actual risky behaviors, highlighting the limitations of current awareness campaigns in delivering effective messages and addressing critical factors in road safety. Analysis showed that 28% of drivers lacked road safety awareness, while about 32% were unaware of penalties for using mobile phones while driving. Furthermore, approximately 42% believed that handheld mobile phone use for conversation did not affect their driving skills or abilities, reflecting overconfidence. However, the analysis confirmed that this group of drivers recorded higher crashes and violation rates compared to others. For example, drivers who admitted to using a mobile phone while driving experienced crash rates approximately 3.1 times higher than those who refrained from this behavior. Age and nationality were also identified as key factors influencing drivers’ knowledge, attitudes, and behaviors. Messages based on real-life crash stories, videos depicting risky behaviors, and emotionally engaging messages were found to be among the most effective in influencing driver behavior. The practical case study demonstrated improved risky behaviors in 76% of participants, although around 18% showed no behavioral improvement.One of the key outcomes of this research is the recognition of the need to integrate behavior change based on knowledge and awareness first (Knowledge–Attitude–Behavior Model, KAB) with other factors, including broader societal influences—since community behavior strongly affects individual behavior—and the presence of legal and enforcement mechanisms to address drivers who remain unconvinced by awareness alone (Theory of Planned Behavior, TPB). Based on these findings, a tailored behavioral change model for Abu Dhabi was proposed.Finally, the research provided a set of information, survey forms, and key performance indicators that can be used as a baseline for monitoring and evaluating awareness effectiveness in future years. This represents an important step toward developing a comprehensive road safety awareness strategy for the Emirate of Abu Dhabi.</p
Manufacturing practices and operational performance: the roles of supplier and internal integration
No full textOperational performance is considered vital and at top priority in all organizations for profit maximization, which is achieved through the cost and flexibility. Following that, important pillars such as TPM, TQM, supplier integration, and internal integration are crucial for organizations. Therefore, this study focuses on the linkage of these organizational factors to improve cost and flexibility, which enhances performance for identifying and understanding the sustainability and expansion goals of the organizations. More specifically, the current research aims at exploring and understanding the relationships of manufacturing practices (i.e., TPM, TQM) and SCM (i.e., supplier integration, internal integration) along with operational performance (i.e., cost, flexibility) of the industrial firms. This study was conducted through fundamental rules and the basis of the positivist paradigm, which favours using the quantitative method in order to investigate the research problem. The research philosophy follows the objectivism approach through deductive reasoning. This research incorporated quantitative data from 224 Jordanian industrial firms through traditional and online questionnaires. This data was analysed by using SPSS and AMOS software in order to obtain valid, reliable, and generalisable findings and conclusion. In this way, the current study contributed to highlight and develop a better understanding of the potential determinants of operational performance through generally proving its significant correlation with the efficient SCM and the proper implementation of manufacturing practices. Furthermore, findings from this research revealed that supplier integration is significantly as well as positively impacting the cost and flexibility performance of the organisation, while internal integration is found to have significant positive effect on flexibility performance of the organisation. Moreover, the study concluded that understanding the different operational performance’s determinants (cost and flexibility) allows stakeholders in the industrial sector to make thoughtful decisions that can help them producing more unique products with a competitive quality, which enables the industrial organisations to manage their profitability concerns.</p
Review of UK and Ireland Surveys of Health Professional Educators on Teaching of Sexual- and Gender-Minority Health
No full textSexual and gender minority (SGM) people report considerable dissatisfaction with health services compared to heterosexual and/or cisgender people, with health professionals highlighting insufficient training. Teaching about the health of SGM people is not mandated in UK health professionals’ educational curricula. A review of published and unpublished surveys and of UK training courses evaluating LGBTQ+ content, in the UK and Ireland, examining the teaching of the health of SGM people to health professionals was conducted. Fifteen surveys from the perspectives of educators and students were compared and contrasted. Surveys were found from educators from undergraduate medicine, nursing and midwifery, and pharmacy schools, from students at dental, medical, and pharmacy schools, and from qualified doctors and paramedics. Students and clinical staff perceived that they have insufficient training in SGM health, although there is a contradiction in the perception of teaching amount between students and educational staff. Two curriculum reviews of Royal College postgraduate medical training showed either no or very few requirements on SGM health. Although some courses make considerable efforts to fully incorporate SGM health into mandatory curricula appropriately, professionals mention insufficient training. Until curriculum setters mandate SGM health, patient complaints will continue.</p
Behind the scheme: challenges faced by professionals addressing safeguarding issues in housing for Ukrainian refugees in the United Kingdom
No full textThe rapid escalation of Russia’s war in Ukraine prompted many European countries to implement emergency sponsorship schemes for displaced Ukrainians. In the United Kingdom, the Homes for Ukraine scheme emerged as a prominent example enabling non-related hosts to accommodate refugees in private homes or other settings While widely praised for its humanitarian intent, the British Association of Social Workers raised early concerns about safeguarding risks within the scheme’s infrastructure. Key issues included the absence of a centralized matching system, reliance on informal arrangements via social media, and limited expert-led placement assessments. These gaps posed significant risks not only to refugees and hosts but also to frontline professionals tasked with addressing safeguarding concerns. Despite these challenges, research documenting their impact on practitioners is scarce. This article reports on findings from an online survey capturing professionals’ experiences of identifying and managing these safeguarding issues and the implications on their well-being. Results indicate that, although practitioners expressed pride in delivering the scheme, its rapid rollout, uneven local implementation, and lack of clear guidance contributed to safeguarding vulnerabilities and professional strain. These insights highlight the need for robust planning, clearer accountability, and culturally informed practices in future emergency initiatives.</p
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