Edge Hill University

To assess whether Less-Than-Full-Time (LTFT) training or return from Out of Programme (OOP) is associated with developmental Annual Review of Competence Progression (ARCP) outcomes among UK surgical trainees, and to describe demographic and specialty-level variation in these associations. Retrospective cross-sectional analysis SETTING: National ARCP outcome data across all UK surgical specialties PARTICIPANTS: A total of 5911 surgical trainees (54,016 ARCP outcomes) for the LTFT analysis and 761 returners from OOP (761 ARCP outcomes on return to training) OUTCOME MEASURE: receipt of a developmental ARCP outcome, defined as outcome 2 (targeted additional training required without extra time) or outcome 3 (inadequate progress requiring extension of training). These outcomes indicate development of competencies are occurring at a slower rate than expected. LTFT status was not associated with increased odds of developmental outcomes in the overall cohort (adjusted OR: 0.98; 95% CI: 0.87-1.10, p = 0.697), although higher odds were seen in trauma and orthopaedics (OR: 1.28; 95% CI: 1.04-1.58) and vascular surgery (OR: 1.97; 95% CI: 1.13-3.44). OOP returners had higher odds of a developmental outcome at their first ARCP after returning to training (adjusted OR: 1.88; 95% CI: 1.32-2.69, p = 0.001). Among OOP returners with at least 2 postreturn ARCPs, repeating the analysis using the second postreturn ARCP as the outcome showed that they continued to have higher odds of a developmental outcome compared with trainees who had not taken OOP (aOR: 1.80, 95% CI: 1.29-2.52, p = 0.001). All models were adjusted for age, gender, ethnicity, and sexual orientation. Flexible and out-of-programme pathways are not associated with higher odds of developmental ARCP outcomes overall, but targeted support may be needed in specific specialties to ensure equitable progression.

Access to cross-border clinical trials may represent the sole therapeutic option for children living with rare diseases for which no approved medicines exist. Many children are excluded from participation in trials due to language restrictions. There are insufficient comprehensive analyses of the experiences and preferences of parents across Europe concerning participation and exclusion of their child in international clinical trials, particularly regarding language support during enrollment in cross-border clinical research studies. An anonymous online survey was designed and translated into 22 official European languages to collect data from parents of children living with a disease across Europe. The survey included five sections: (1) sociodemographic information; (2) experience participating in a clinical trial; (3) experience in cases where the patient was unable to take part in a study abroad; (4) experience participating in a clinical trial abroad; and (5) preferences regarding decentralized trial options. 1,436 responses were analyzed from parents across 34 European countries. 55.7% of the parents reported being able to communicate in English. 10.7% had prior clinical trial experience, of whom 30.1% traveled abroad to enable their child to participate. Among those reporting being excluded from cross-border trials, 34.7% cited language barriers or country of residence as the reason. Most families expressed a strong willingness to accept decentralized trial options, regardless of where the study may be conducted. Accommodating language translation to permit participation in a clinical trial abroad is feasible. While a significant percentage of caregivers of pediatric patients in Europe could communicate in English, approximately one-third of those excluded from clinical trials cited language barriers or country of residence as the reason. When translation was required, the most commonly offered solution was the use of professional interpreters, an accommodation that could enable broader patient participation in essential research.

The current discourse on Generative AI (GenAI) in higher education largely overlooks its potential disruption to what educational philosopher Gert Biesta identifies as one of the irreducible purposes of education. Despite its foundational importance, subjectification—the process by which students become autonomous and responsible subjects—remains marginalised in instrumental debates on GenAI benefits and drawbacks. Given subjectification’s resistance to measurement, the paper interrogates GenAI’s potential impact through a medical metaphor of placebo, nocebo, and treatment deployed as a tripartite analytical framework. Through this lens, the analysis reveals how GenAI operates in two ways that are contradictory in form but convergent in their reasons and outcomes. Whilst a placebo effect constitutes the illusion of subjectification without the authentic effort of becoming, a nocebo (inverse of placebo) captures students’ retreat from becoming subjects resulting from their responsibilisation in relation to GenAI and the perceived intellectual superiority of the machine. The paper argues that both effects stem from the ontological confusion and the systematic displacement of the human teacher as a ‘caller’ who summons students into subject-ness within a shared world. The paper then identifies the urgent treatment as the restoration of the teacher’s presence as irreducible, which, in turn, necessitates the clear ongoing positioning of GenAI as an object and a tool incapable of calling. By grounding this normative argument in critical realism, metaphor as a method, and Biesta’s philosophy of education, the paper proposes that the future of education in the age of GenAI depends on defending the conditions under which students can come to exist as subjects in and for the world.

Snakebite globally claims more than 100,000 lives per year and results in morbidity for 400,000 survivors. Current treatment uses antibody-based antivenoms which are constrained by their efficacy, safety and cost. In this study we evaluated the efficacy of previously described repurposed drugs against viperid snakes of the medically important Bothrops genus. Despite variable toxin representation and bioactivity across this central and south American genus, we found that the lead inhibitors targeting metalloproteinases (marimastat and DMPS) and phospholipases (varespladib), demonstrated pan-species neutralisation in enzymatic assays, whilst nafamostat (serine protease inhibitor) had variable activity. The metalloproteinase inhibitors protected against the procoagulant and haemorrhagic effects of several venoms in phenotypic assays. Collectively these findings demonstrate that repurposed drugs may be of great value as early interventions for the treatment of bothropic envenoming in the Neotropics and thus provides a strong rationale for their progression into future preclinical and clinical evaluation for snakebite indication.

BackgroundRecognising how human factors shape workplace behaviour and patient safety, as well as appreciating their medicolegal consequences, is essential for the modern medical graduate.This study examines medical students' and resident doctors' practices, attitudes, and experiences in relation to patient safety and human factors. MethodsA national cross-sectional survey of UK medical students and resident doctors was done between April and June 2025.Results were compared with a pilot group of students from underrepresented backgrounds who participated in a tailored human factors and medico-legal workshop. ResultsOf 1,274 survey respondents, 942 (74.0%) were medical students and 332 (26.0%) were resident doctors.Human factors frequently reported were time pressures (57.0%), fatigue (56.2%) and ineffective handover (43.8%).Preparedness to manage human factors (mean 3.2/5) and confidence to speak up (mean 3.2/5) were significantly lower among comprehensive/state-educated respondents (confidence-adjusted odds ratio 0.70, 95% confidence interval 0.57-0.87,vs grammar/private/international schools).Most respondents lacked clear institutional guidance on the legal implications of error (62.2%), and nearly half did not know where to seek support.Workshop participants (n=21) reported higher preparedness to recognise and manage human factors and confidence raising concerns (p<0.001). ConclusionsDespite frequently encountering patient safety related human factors, UK resident doctors and medical students are only moderately prepared and supported to address them.In a healthcare environment with increasing workloads, resource limitations, and errors, greater training and exposure to key concepts is required.Educational interventions could be drawn from other high-reliability organisations such as aviation to reduce the incidence of patient safety and medical errors.

Abstract Bathymetry is a critical input to storm surge models on coastlines fronted by lagoon systems, yet few studies explore how variations in bathymetry influence flood impacts, flooded extent, and exposed population across these globally widespread morphologies. Here, we investigate the influence of variations in bathymetry on storm inundation impact estimates across a continental shelf lagoon system. We explore how flooded extents and exposed population estimates from a 1% storm for Belize vary with estimated depths by comparing three existing bathymetries over a northern shallow, enclosed lagoon and a central deeper, open lagoon system with a newly developed bathymetry data set, Satellite‐Derived Bathymetry Enhanced Data set‐SDBED. We compare multiple bathymetric data sets to understand the influence on the flood uncertainties and the quantity of the impact of exposed population estimates. Our results show that greater estimated lagoon depths consistently result in lower predicted flood impacts for both lagoon systems in almost all cases. Unexpectedly, for one bathymetry with a median depth of 2 m in the northern lagoon, we find that a reduction in lagoon volume by 59% reduces total inundation volume by 45%. Our findings also show how vertical uncertainties in the SDBED bathymetry propagate through the model, resulting in variations of up to 12% in flood extents and up to 2% in exposed populations.

This study aimed to examine the effects of analogy (ANA) and explicit (EXP) verbal instruction on motor performance and muscle activation during a weightlifting task. Traditional coaching strategies often rely on explicit cues; however, recent research suggests that analogy-based instructions may offer a more efficient route to motor learning by promoting implicit control. Twenty novice participants were randomly assigned to one of three conditions (ANA, EXP, or control), with the sequence of conditions counterbalanced across three consecutive days. Day 1 involved familiarization; Day 2 included the control and first experimental condition; and Day 3 completed the second experimental condition. Participants performed both isometric and dynamic lifting tasks while muscle activity (EMG), force production, and declarative knowledge were assessed using a within-participant design. Results revealed significant alterations in lower limb EMG activity following both instructional strategies (p<0.05), indicating a reorganization of motor control. Moreover, the EXP group exhibited significantly lower rate of force development within the first 200ms compared to the control (p<0.05). Overall force output was also higher in the control group. These findings suggest that avoiding verbal instruction may benefit maximal force production. However, analogy instructions appear to maintain performance levels while altering neuromuscular strategies. Clinical trial register number ANZCTR (code: 386738).

ABSTRACT There is increasing concern about the high rates of turnover within the social work profession in the UK and the high-stress levels encountered by social workers. It is hence important to understand the factors that influence the manifestation of stress and job satisfaction. This quantitative study administered standardised instruments to 104 social workers through an online survey to assess the perception of stress, job satisfaction, work support, role ambiguity, and role conflict. The Job Demands-Resources (JD-R) theory provided the conceptual framework for the study. Statistical analyses identified significant correlations among the study variables. Role ambiguity and job satisfaction predicted the manifestation of stress, while job satisfaction was influenced by both the extent of perceived stress as well as role conflict. Further, work support partially mediated the influence of stress on job satisfaction. We discuss implications for reducing work-related stress and enhancing job satisfaction.