Objective:To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently prepared to deliver generalist palliative care, with a view to informing developments in undergraduate and postgraduate medical education. Methods: Questionnaires were sent to FY1 doctors and to supervising consultants. Semi-structured interviews were conducted with five FY1 doctors. Results: A total of 60 FY1 doctors and 31 consultants replied. The majority of FY1 doctors did not feel well-prepared to deliver basic palliative care, especially when managing distress and social issues. Consultants agreed that FY1 doctors were underprepared. Junior doctors reported high levels of distress themselves, with few seeking support from senior colleagues. Both sets of respondents made suggestions for curricular improvements. Conclusions: Newly qualified doctors were not adequately prepared to deliver generalist palliative care and lacked first-hand experience of end-of-life issues. Current reviews of palliative care education should address the learning and supportive needs of our most junior doctors more effectively.

In Drosophila and other Dipterans, homologous chromosomes are in close contact in virtually all nuclei, a phenomenon known as somatic homolog pairing. Although homolog pairing has been recognized for over a century, relatively little is known about its regulation. We performed a genome-wide RNAi-based screen that monitored the X-specific localization of the male-specific lethal (MSL) complex, and we identified 59 candidate genes whose knockdown via RNAi causes a change in the pattern of MSL staining that is consistent with a disruption of X-chromosomal homolog pairing. Using DNA fluorescent in situ hybridization (FISH), we confirmed that knockdown of 17 of these genes has a dramatic effect on pairing of the 359 bp repeat at the base of the X. Furthermore, dsRNAs targeting Pr-set7, which encodes an H4K20 methyltransferase, cause a modest disruption in somatic homolog pairing. Consistent with our results in cultured cells, a classical mutation in one of the strongest candidate genes, pebble (pbl), causes a decrease in somatic homolog pairing in developing embryos. Interestingly, many of the genes identified by our screen have known roles in diverse cell-cycle events, suggesting an important link between somatic homolog pairing and the choreography of chromosomes during the cell cycle.

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Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries.