The fiber-reinforced composite stringer is commonly used in large civil aircraft wing structures. Under compression loads, it exhibits complex failure modes, with matrix cracking being one of the most common. The quantitative analysis of matrix failure is important and difficult. To address this issue, a multiscale method combining the generalized method of cells (GMC) and macroscopic FEM models is employed to quantitatively predict matrix damage and failure. The extent of matrix damage in the composite structure is represented by the number of failed matrix subcells within the repeating unit cells. The 3D Tsai-Hill failure criterion is established for the matrix phase, and the maximum stress failure criterion is applied to the fiber subcell. Upon meeting the criterion, the stiffnesses of the failed subcells are immediately reduced to a nominal value. In the current study, the ultimate loads, failure modes and load-displacement curves of composite stringers subjected to compressive load are obtained by the experiment approach and the proposed multiscale model. The experimental and simulation results show good agreement, and the multiscale analysis method successfully predicts the extent of matrix damage in the composite stringer under compressive load. The number of failed matrix subcells quantitatively evaluates the damage extent within a 2 × 2 GMC model. The findings reveal that matrix subcell failures primarily occur in the 45° and -45° plies of the middle part of the stringer composite.

OBJECTIVE: To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period.
METHODS: Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: \'non-operative\', \'intraoperative\', \'postoperative\', and \'other\'.
RESULTS: A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511).
CONCLUSIONS: The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE: The aim of this study is to demonstrate that the freeze-dried human rabies vaccine (Vero cell), administered in a four-dose schedule (2-1-1) to the 10-60 years old population, has immunogenicity that is not inferior to the approved five-dose schedule and similar vaccines with a four-dose schedule, and to evaluate its safety.
METHODS: A total of 1800 individuals were enrolled and divided into three groups: four-dose test group, four-dose control group, and five-dose control group. The rabies virus neutralizing antibodies were measured using the Rapid Fluorescent Focus Inhibition Test to assess immunogenicity, and the incidence of adverse events and serious adverse events were statistically analyzed.
RESULTS: The seroconversion rates 14 days after the first dose and 14 days after the complete course of vaccination were 100% in all three groups. The antibody GMC of the four-dose test group was higher than that of the five-dose control group, but slightly lower than the four-dose control group. Seven days after the first dose, both four-dose regimen groups showed higher seroconversion rates and antibody GMCs compared to the five-dose regimen group, proving that the immunogenic effect of the four-dose regimen seven days post-first vaccination is superior to the five-dose regimen. The overall incidence of adverse events showed no significant difference between the four-dose test group and the five-dose control group, but was significantly lower in the four-dose test group compared to the four-dose control group.
CONCLUSIONS: The vaccine in the four-dose test group is equivalent in immunogenic effect to the four-dose control group vaccine and superior to the five-dose control group vaccine; the safety of the vaccine in the four-dose test group is equivalent to the five-dose control group vaccine and superior to the four-dose control group vaccine.
RESULTS: gov number: NCT05549908.

The anaesthetic training programme in the United Kingdom (UK) spans over seven years and is overseen by the Royal College of Anaesthetists (RCOA). Junior doctors in England are currently striking amid ongoing pay negotiations with the government, and almost all junior doctors are worried about the cost of living. This article provides an overview of the average financial cost of training for doctors in the anaesthetic training programme. The cost incurred by anaesthetic trainees illustrates the level of financial burden faced by trainees across multiple specialities. The cost includes: student loan repayment (with interest rates), compulsory membership fees (including the Royal College of Anaesthetists and General Medical Council), postgraduate examinations (Fellowship of the Royal College of Anaesthetist exams are compulsory to complete training) and medical indemnity. The average trainee spends between 5.6% and 7.4% of their annual salary on non-reimbursable costs. This article delineates for aforementioned expenses and compares them with the training programs in Australia and New Zealand, given their status as frequent emigration destinations for UK doctors.

BACKGROUND: International medical graduates (IMGs) account for 41% of the UK doctor\'s workforce but often work in isolated roles, receive minimal constructive feedback regarding their work and offered limited opportunities for career progression. We conducted a survey researching the views of IMGs or doctors from ethnic minority backgrounds on the support given to them.
METHODS: A survey was carried out on physician demographics, grade and date of first NHS appointment, familiarity and support offered in NHS, induction and study leave, Professional and Linguistic Assessments Board exams and General Medical Council (GMC) referrals. It was drafted via surveymonkey.co.uk platform and circulated via relevant closed medical groups.
RESULTS: A total of 173 IMGs and 16 British trained doctors (controls) took the survey. In the IMGs first job, there was no dedicated supervisor, mentor, induction, shadowing period and study leave for 56%, 86%, 52%, 59% and 52%, respectively. Suggestions given for improvements included teaching sessions, mentors, work orientation, supernumerary period and paid induction by 80%, 78%, 76%, 61% and 41% respectively. While 59% of participants knew of another IMG referred to the GMC, the primary reasons given were lack of knowledge of NHS, bias, communication difficulties and cultural differences.
CONCLUSIONS: This paper reflects the views of doctors regarding the support given to IMGs during their first NHS appointment and subsequent jobs in the NHS. IMGs require a focused and detailed induction, mentorship, educational and clinical supervision throughout their transition to the NHS.

For consent to be fully informed, it must be tailored to each patient, who must be appraised of alternative treatments (including that of no treatment) and informed of the material risks which an individual would wish to know and consider significant. This also includes Covid-19 related risks. Whilst surgeons had at times to offer sub-optimal treatments due to pressures caused by the pandemic, patients should still be given the choice to delay their treatment. Consent obtained remotely via digital technology must comply with the same requirements as in a face-to-face setting.

Formative assessments are an essential yet often overlooked aspect of postgraduate surgical training. This report explores the strategies by which formative assessments are integrated into postgraduate surgical training in Pakistan (using urology as an example), by comparing the regional recommendations and infrastructures offered by local governing bodies to that of a more structured system, as offered by the General Medical Council (GMC). The College of Physicians and Surgeons Pakistan (CPSP) serves as the de facto local accrediting body for postgraduate surgical training and makes a conscious effort in maintaining the standard of training throughout the country. However, although formative assessment activities are encouraged in its roster, they are rarely monitored as strictly as summative outcomes. This is a far cry from how the structured format is exemplified by the GMC\'s various guidelines and protocols. It must be emphasized that in order to improve the overall quality of training, measures need to be made to improve the ways in which feedback and formative activities are implemented and monitored.

Embryonic development results in the production of distinct tissue types, and different cell types within each tissue. A major goal of developmental biology is to uncover the \"parts list\" of cell types that comprise each organ. Here we perform single cell RNA sequencing (scRNA-seq) of the Drosophila embryo to identify the genes that characterize different cell and tissue types during development. We assay three different timepoints, revealing a coordinated change in gene expression within each tissue. Interestingly, we find that the elav and Mhc genes, whose protein products are widely used as markers for neurons and muscles, respectively, show broad pan-embryonic expression, indicating the importance of post-transcriptional regulation. We next focus on the central nervous system (CNS), where we identify genes whose expression is enriched at each stage of neuronal differentiation: from neural progenitors, called neuroblasts, to their immediate progeny ganglion mother cells (GMCs), followed by new-born neurons, young neurons, and the most mature neurons. Finally, we ask whether the clonal progeny of a single neuroblast (NB7-1) share a similar transcriptional identity. Surprisingly, we find that clonal identity does not lead to transcriptional clustering, showing that neurons within a lineage are diverse, and that neurons with a similar transcriptional profile (e.g. motor neurons, glia) are distributed among multiple neuroblast lineages. Although each lineage consists of diverse progeny, we were able to identify a previously uncharacterized gene, Fer3, as an excellent marker for the NB7-1 lineage. Within the NB7-1 lineage, neurons which share a temporal identity (e.g. Hunchback, Kruppel, Pdm, and Castor temporal transcription factors in the NB7-1 lineage) have shared transcriptional features, allowing for the identification of candidate novel temporal factors or targets of the temporal transcription factors. In conclusion, we have characterized the embryonic transcriptome for all major tissue types and for three stages of development, as well as the first transcriptomic analysis of a single, identified neuroblast lineage, finding a lineage-enriched transcription factor.

Since the inception of the NHS, international medical graduates (IMGs) have been recognised as integral to the NHS long-term plan. These diverse groups of doctors make up approximately a fifth of all licensed doctors in the UK. The NHS has a history of reliance on IMGs to fill shortages and add to the workforce. IMGs face numerous challenges while immigrating and starting a new job in the UK. Conversely, the employing hospital has a responsibility to help their new IMGs adapt to the UK system of medical practice. Keeping the above-mentioned concerns in mind and hoping to tackle these issues faced by IMGs, a clinical attachment programme has been initiated at Ashford and St Peter\'s Hospitals NHS Foundation Trust (ASPH) by a group of clinicians, administration staff and the medical director. Although there are various pathways for an IMG to enter the healthcare system in the UK, the ASPH has provided an organised programme that promises to deliver high-quality doctors that value patient safety. This article outlines the programme that can be adopted by other NHS trusts to acculturate and have a positive impact on the IMGs\' careers, as well as their work-life balance.

BACKGROUND: Many doctors and dentists took to social media to raise alarm and/or express professional opinion, dissatisfaction, anger and/or incredulity associated with the Covid-19 pandemic. Although most of these social media posts involved practitioners from abroad, this article explores whether they would attract fitness to practise investigations had they been posted by UK-based medical and dental practitioners. In particular, it asks whether such conduct comes into conflict with the existing professional standards issued by the General Medical Council (GMC) and the General Dental Council (GDC). It questions also whether those guidelines should be updated and/or further clarified in view of the extraordinary circumstances posed by the pandemic.
METHODS: An exploratory study was conducted using sensationalist pandemic-related social media posts by doctors and dentists discovered during the first half of 2020 (n = 11). The contents were analysed qualitatively using documentary analysis using coding terms based on the professional standards on social media published by both the GMC and the GDC. The codes generated common and recurring themes that were used to structure discussion.
RESULTS: This study provides a partial insight as to the likely motivations of doctors and dentists to use social media in a manner that may not necessarily lend well to the professional standards expected. In a majority of instances, doctors and dentists who posted social media material with a sensationalist outlook tended to focus on single-issue campaigns pertaining to specific aspects of the Covid-19 pandemic. These issues included controversial commentary on acute shortages of personal protective equipment and attendant occupational risks to clinical staff to Covid-19 infection; criticisms directed towards regulatory bodies in the handling of the pandemic; and professional advice to the general public which was later found to be inaccurate.
CONCLUSIONS: Social media offer opportunities for healthcare professionals to play a constructive role in raising awareness, disseminating information, and promoting solidarity in the management of the Covid-19 pandemic. However, doctors and dentists must carefully consider the ethical and professional pitfalls involved in sensationalist social media posts. The GMC and the GDC should, at the same time, regularly update and clarify their social media guidance in response to major global events like a pandemic as well as advances in social media technology.