A rapid review of challenges faced by early-career international medical graduates in general practice and opportunities for supporting them.

BACKGROUND British General Practice is facing a workforce crisis against a backdrop of an ageing population experiencing increasingly complex health challenges. The National Health Service must increase the supply of General Practitioners (GPs), including International Medical Graduate (IMG) GPs, by increasing recruitment and retention. IMG GPs face distinct challenges during training and their early careers. Understanding these challenges as well as the help and support offered to early-career IMG GPs is crucial to building and sustaining the general practice workforce. AIM To understand the challenges facing early-career IMG GPs and the help and support they can access. DESIGN & SETTING Rapid review. METHOD Six databases and four websites were searched. Titles and abstracts were screened according to inclusion and exclusion criteria, followed by the full study where applicable. The included studies were analysed using a thematic synthesis approach to identify the challenges faced by early-career IMG GPs, as well as the help and support available. RESULTS The database search yielded 234 studies, with 38 additional studies identified via handsearching of websites. Twenty-one studies were included. Seven challenges were identified, as well as a range of help and support available. Early-career IMG GPs face a range of psychological, social, and practical challenges which may not be adequately addressed by the help and support currently offered by the NHS. CONCLUSION Further research is required to understand the extent to which early-career IMG GPs access the help and support offered, and if it adequately addresses the unique challenges they face

Influence of hydrochar from hydrothermal carbonisation (HTC) on plant growth aspects and soil improvement

Hydrochar (HC), produced by hydrothermal carbonization (HTC), offers technical advantages compared to biochar (BC) produced by pyrolysis and is suitable for soil amelioration, carbon (C) sequestration, and enhanced plant growth. However, this suitability is dependent on the feedstock, HTC process conditions, application rate, and environmental and soil conditions. BC grain size has shown to influence, inter alia, nutrient retention, microbial colonization, and aggregate formation, however, such research for HC’s is lacking. This study conducted pot trials to investigate the influence of HC grain size (coarse (6.3-2 mm), medium (2-0.63 mm) and fine (<0.63 mm)), produced from biogas digestate, for soil improvement in three soils: loamy Chernozem, sandy Podzol, and clayey Gleysol, at a 5% HC application rate. All soils, including two controls (with and without plants) were analyzed for germination and bio-mass success, pH, and plant-available nutrients, namely phosphate (PO4), potassium (K) and mineral nitrogen (Nmin) content using standard laboratory methods. Results showed no germination inhibition using Chinese cabbage seeds at a 5% HC application rate, while its influence on biomass production was mostly insignificant. Soil pH showed a compensatory shift toward the pH of the HC, based on the initial pH of the soils and the HC. This effect was most pronounced in the fine-grained HC treatments. The HC served as a short-term source of nutrients, namely PO4, K (both nutrients showing the greatest effect in the fine-grained HC treatments) and ammonium (NH4+) due to the relatively more easily mineralized fraction of the HC, which allowed for the quick release of these nutrients. However, the duration of this contribution is dependent on the presence of this particular fraction in the soil. A relationship between HC and nitrate (NO3-) content was indeterminable due to the variable results between controls and HC grain size over the course of the study. In conclusion, the 5% HC application rate was insufficient to induce substantial changes to those soil properties affecting plant growth, nor to sustain a longer-term supply of nutrients

An investigation into the cybersecurity skills gap in South Africa

The usage of the internet both in our daily lives and in the operations of organisations has grown significantly in modern society. However, there are also risks and vulnerabilities associated with this, thus cyber threats. Cybersecurity has been put in place to safeguard the internet from these cyber threats, yet there is an ever-growing concern regarding the implementation of cybersecurity, both globally and in South Africa. With the increase in cyber threats, there is a growing need and demand for IT professionals with the requisite cybersecurity skills and knowledge to combat and mitigate these threats. However, an ever-increasing cybersecurity skills gap has been identified both globally and in South Africa. Yet the specific cybersecurity skills demand, needs and challenges of IT professionals in South Africa are currently unknown. This study therefore investigated the cybersecurity skills demand, needs, and challenges of IT professionals in South Africa by reporting on IT professionals’ perceptions in this regard. An online questionnaire was used to gather information for this and was distributed to IT professionals using various online platforms. According to the findings of the study, there are several challenges such as lack of time, lack of funding and a lack of resources that South Africa must overcome in order to address the cybersecurity skills gap. From the survey results it was also found that neither tertiary institutions, nor organisations, nor the South African government are investing enough in cybersecurity skills development. Without the right cybersecurity skills set or investment in the development of cybersecurity skills, cyber threats will continue to increase and will potentially become more harmful to South African organisations and to the South African society at large. Furthermore, this study addresses the extent to which cybersecurity-related skills are required and currently used by IT professionals in South Africa to address the cybersecurity skills gap. Tertiary institutions, organisations and the South African government may benefit from this investigation as it could assist in the development of cybersecurity course work as well as national cybersecurity laws, legislations and policies.Thesis (MIT) -- Faculty of Engineering, the Built Environment and Technology, School of Information Technology, 202

An investigation into the cybersecurity skills gap in South Africa

The usage of the internet both in our daily lives and in the operations of organisations has grown significantly in modern society. However, there are also risks and vulnerabilities associated with this, thus cyber threats. Cybersecurity has been put in place to safeguard the internet from these cyber threats, yet there is an ever-growing concern regarding the implementation of cybersecurity, both globally and in South Africa. With the increase in cyber threats, there is a growing need and demand for IT professionals with the requisite cybersecurity skills and knowledge to combat and mitigate these threats. However, an ever-increasing cybersecurity skills gap has been identified both globally and in South Africa. Yet the specific cybersecurity skills demand, needs and challenges of IT professionals in South Africa are currently unknown. This study therefore investigated the cybersecurity skills demand, needs, and challenges of IT professionals in South Africa by reporting on IT professionals’ perceptions in this regard. An online questionnaire was used to gather information for this and was distributed to IT professionals using various online platforms. According to the findings of the study, there are several challenges such as lack of time, lack of funding and a lack of resources that South Africa must overcome in order to address the cybersecurity skills gap. From the survey results it was also found that neither tertiary institutions, nor organisations, nor the South African government are investing enough in cybersecurity skills development. Without the right cybersecurity skills set or investment in the development of cybersecurity skills, cyber threats will continue to increase and will potentially become more harmful to South African organisations and to the South African society at large. Furthermore, this study addresses the extent to which cybersecurity-related skills are required and currently used by IT professionals in South Africa to address the cybersecurity skills gap. Tertiary institutions, organisations and the South African government may benefit from this investigation as it could assist in the development of cybersecurity course work as well as national cybersecurity laws, legislations and policies.Thesis (MIT) -- Faculty of Engineering, the Built Environment and Technology, School of Information Technology, 202

Competing risks analyses: objectives and approaches

Studies in cardiology often record the time to multiple disease events such as death, myocardial infarction, or hospitalization. Competing risks methods allow for the analysis of the time to the first observed event and the type of the first event. They are also relevant if the time to a specific event is of primary interest but competing events may preclude its occurrence or greatly alter the chances to observe it. We give a non-technical overview of competing risks concepts for descriptive and regression analyses. For descriptive statistics, the cumulative incidence function is the most important tool. For regression modelling, we introduce regression models for the cumulative incidence function and the cause-specific hazard function, respectively. We stress the importance of choosing statistical methods that are appropriate if competing risks are present. We also clarify the role of competing risks for the analysis of composite endpoint

Precise predictions for W \gamma \gamma +jet production at hadron colliders

In this letter we report on a calculation of W gamma gamma + jet production at next-to-leading order QCD. We include the leptonic decays of the W and take into account all off-shell and finite width effects. This is the first computation which falls into the category of triboson+jet production at next-to-leading order QCD. In total we find sizable corrections with nontrivial phase space dependencies. Therefore, our results are important for phenomenological analyses such as the extraction of anomalous electroweak quartic couplings from inclusive hadron collider data.Comment: 6 pages, 6 figure

Characterization of an ester-based core-multishell (CMS) nanocarrier for the topical application at the oral mucosa

Objectives Topical drug administration is commonly applied to control oral inflammation. However, it requires sufficient drug adherence and a high degree of bioavailability. Here, we tested the hypothesis whether an ester-based core-multishell (CMS) nanocarrier is a suitable nontoxic drug-delivery system that penetrates efficiently to oral mucosal tissues, and thereby, increase the bioavailability of topically applied drugs. Material and methods To evaluate adhesion and penetration, the fluorescence-labeled CMS 10-E-15-350 nanocarrier was applied to ex vivo porcine masticatory and lining mucosa in a Franz cell diffusion assay and to an in vitro 3D model. In gingival epithelial cells, potential cytotoxicity and proliferative effects of the nanocarrier were determined by MTT and sulphorhodamine B assays, respectively. Transepithelial electrical resistance (TEER) was measured in presence and absence of CMS 10-E-15-350 using an Endohm-12 chamber and a volt-ohm-meter. Cellular nanocarrier uptake was analyzed by laser scanning microscopy. Inflammatory responses were determined by monitoring pro-inflammatory cytokines using real-time PCR and ELISA. Results CMS nanocarrier adhered to mucosal tissues within 5 min in an in vitro model and in ex vivo porcine tissues. The CMS nanocarrier exhibited no cytotoxic effects and induced no inflammatory responses. Furthermore, the physical barrier expressed by the TEER remained unaffected by the nanocarrier. Conclusions CMS 10-E-15-350 adhered to the oral mucosa and adhesion increased over time which is a prerequisite for an efficient drug release. Since TEER is unaffected, CMS nanocarrier may enter the oral mucosa transcellularly. Clinical relevance Nanocarrier technology is a novel and innovative approach for efficient topical drug delivery at the oral mucosa

The ethnicity attainment gap among medical and biomedical science students: a qualitative study.

Background Black, Asian and Minority Ethnic (BAME) medical students and professionals frequently underachieve when compared with their White counterparts not only in the United Kingdom, but across the globe. There is no consensus for the definitive causes of this attainment gap, but suggestions contributing towards it include: increased feelings of isolation as a member of a minority culture or religion; a poorer higher education (HE) experience compared with White counterparts; and stereotype threat, whereby students underperform in exams from the stresses of fearing confirming to a negative-stereotype. Methods The aim of this study was to gather qualitative data on HE experiences of medical and biomedical science students to explore factors contributing to the attainment gap. Audio-recorded, semi-structured interviews and a novel approach for this research area of ethnically-homogenous student-led focus groups, were held with students and staff at a healthcare-based university in London, where lower attainment, slower rates of degree completion and lower levels of satisfaction with HE experience were identified in BAME students compared with White students. Thematic analysis was used to manage, summarize and analyse the data. Results Forty-one students and eight staff members were interviewed or took part in focus groups. The student data were best explained by two main themes: social factors and stereotyping, whilst staff data were also best explained by two main themes: social factors and student and staff behaviour. Social factors suggested ethnically-defined social networks and the informal transfer of knowledge impacted academic performance, isolating minority groups from useful academic information. BAME students may also be at a further disadvantage, being unable to attend social and academic functions for cultural or family reasons. Black students also mentioned changing their behaviour to combat negative stereotypes in a variety of contexts. Conclusions This study suggests that forms of discrimination, whether conscious or unconscious, may be negatively impacting the abilities of BAME students both in examinations and in coursework choice. It highlights the importance of social networks for the transfer of academic knowledge and the impact ethnicity may have on their formation, with issues around segregation and the sharing of information outside defined groups

Management of type II superior labrum anterior posterior lesions: a review of the literature

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O'Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25–45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes