Alun Wall

@paul_winginit @35mmags The daddy of Belgian beers

@DrLoupis No secondary explosions on the ground. Aircraft were not hit

BREAKING: More than 20 5th generation F-35 fighter jets were destroyed in Israel Say goodbye to your American taxmoney!

@doctordolla4 @DrJohnEGibson Could surgical training be shortened ? yes a little BUT all those years of basic training teach people to be clinically competent looking after sick people - just as important as operating skills. No point doing a good operation if you die on the ward

@DrJohnEGibson Do you think supervision has improved or do you think it’s become a viscious cycle of junior consultants with less operative experience doing cases to increase their numbers at the cost of trainees, who then will have less operative experience?

Met a surgeon from Mexico recently. 6 years medical school + 4 years general surgical residency. Very competent. Residency programme dedicated to learning how to operate rather than ePortfolio. Why does it take the UK 9+ years to train a surgeon post medical school?

@iDrSunny @02offers Agree separation of useless admin from ward doctoring required. But time spent on a ward is vital to learning the craft

@iDrSunny @02offers Service provision is a vital part of training. I learnt loads as a junior from busy clinics. Service and training go hand in hand and lead to a well rounded experienced doctor. Cutting service provision will lead to big holes in experience. The next step up being then too hard

There is another way to FPR Start doctors off at CT1 - no F1/F2 needed (unless a doctor wants exposure to various specialties prior to going into residency) 3-5 year residency rather than the 3-8 years (with options for LTFT etc)

@orthodoc @JArthroplasty My thoughts were similar about the studies stating that robotic assisted arthroplasty was superior to convential. Bottom line is jury’s still out on all of it

@JArthroplasty In my opinion, we shouldn’t make any conclusions from administrative database studies, too much noise in the data. At best, these studies are to explore ideas.

Robotic assistance in THA is associated with an increased risk of surgical complications, including periprosthetic fracture, while incurring greater charges. authors.elsevier.com/a/1jUkz38vD3A3…

@schnaser22 @JArthroplasty Erik what’s your average op time in an uncomplicated uncemented robotic THA?

@JArthroplasty We have very low complications at our institution with robotic assistance and we are significantly more efficient with both hip and knee replacements.

@JeremyClarkson I have a wild flower garden of about a third of an acre - bereft of bees in particular and much less numbers of all types of insects this year compared to last. It is a very cool wet crap summer though 👎

Just been for a walk round the farm and I’m a bit alarmed by how few butterflies there are. Something is afoot.

@christiancalgie The best national anthem has always been the Welsh national anthem. Beats everything on melody alone. No descant needed. And then there’s the words…..❤️

Reminder that in 1981 Britain added a descant to the national anthem, turned it into the best national anthem in the world, and then just… forgot about the arrangement never to use it again

@hjluks @northwoods1980 Agree Howard. The few I’ve treated like this have done very well non operatively

@northwoods1980 I don't think so. I have seen many of these heal in runners, and despite many ignoring my NWB instructions, too. I may have been lucky, but I haven't seen one this size, this location, go on to displace.

All of these are days apart. Cannot see this fracture on radiographs. Middle-aged female. Would most also agree with the treatment/fixation option here?

@LeoMars75 He might struggle when society goes cashless

@trouteyes Can’t take the credit for this, but it is beautiful….. The Whom

@JoshRomOnAir @MarinaPurkiss This only thing this policy does is raise money. It hurts kids in the private and public sector ultimately. It’s an ill thought out idea, which is more about idealism than common sense, and worryingly shows Labours true colours - idealism at the expense of children and sense

But often Marina it’s not even wealthy people, it’s those from the middle class. That scrimp and save in order to send their kids to private schools as they think it’s the best option for their kids. The reality isn’t just ‘oh I’m wealthy so blah’ it’s aspirational. It’s smaller class sizes. It’s more tailored approach. It’s wider subject variety at GCSE and A-Level. It’s discipline. It’s overall ethos. Sometimes, it’s even special needs. Things that just cannot be accommodated at a state comprehensive. The wealthy will still be able to send their kids to Eton. That class and type of schools will be absolutely fine. Disgruntled yes, but fine. But the effect will be felt most on the middle class family. The family that might not now be able to send their kids to a smaller independant prep school. Those that saved up their whole lives but cannot afford the extra 20% for a number of kids year on year. The senior schools that arent high up on the league tables but still strive to give kids the best possible. Not to mention, it will also have a knock on effect for teachers as those schools would have to cut back on staffing due to less kids going as less people will be able to afford it.

Just look at these WhatsApps from a private school parents group… If only the wealthy would mobilise this well to help others Not just themselves.

@BucksHandExpert Your a bit on the fence there Andy 😂

@KenDodDadsDog @BestForBritain @alexhallhall @FT It’s the missing billions which is foremost in my mind. Next government needs to initiate a public enquiry into this and level with the public. We need to know what happened, and money needs to be clawed back

@TopDastan @BBCBreaking The above post is nonsense. Article does not describe a bacteria at fault, but rather a common deficiency in the immune system (genetics) of 95% of people with IBD.

Scientists discover major cause of inflammatory bowel disease which affects millions of people bbc.in/3V8abEl

@steveduckett @nspiuzzi @AAHKS_YAG @JArthroplasty @AAOS1 @CleClinicArthGp Same

@nspiuzzi @AAHKS_YAG @JArthroplasty @AAOS1 @CleClinicArthGp Posterior approach. Hybrid construct. Trident cup Cemented Exeter

Female 67 y/o - THA *Approach? *What stem do you choose? *Comments & tricks? @AAHKS_YAG @AAHKS_YAG @JArthroplasty @AAOS1 @CleClinicArthGp

@annaturley This is very worrying. Having to explain to a prospective MP that this isn’t a tax break at all. It’s so depressing that the standard of intellect from our potential political leaders in this country is so poor. Politics should attract the brightest and the best. Sad it doesn’t.

Why should the parents of 93% of children, who work just as hard as yours did, pay for a tax break for parents who chose to educate their children privately? You pay VAT on all services like plumbing & hairdressing. If you chose to take up a service, you should expect to pay the standard taxes, not have the rest of society cover ir for you.

@hjluks The tendinopathy all around the body related ie genetic factors at play. I see a lot of gluteal, adductor and hamstring. They’ve almost always had “rotator cuff” issues or TE. I use shockwave. It improves symptom severity but might not affect duration

Orthopedic Truths: Tennis Elbow Stupid name Most people who have it don't play tennis. Nearly every person will get it. The most common cause of lateral elbow/upper forearm pain. It will resolve almost everyone on its own. Without "treatment". But it might take 6-12 months. Yep, 6-12 months. It may not resolve in some people. Some people have minimal symptoms. Some have severe pain. Some people deal with pain well. Some don't. Most people are in our office because they're afraid of hurting themselves or they have a fear of the unknown. If you tell them the proper story about tennis elbow, most are relieved and will go on to live their active lives without needing anything. The pain when lifting with your palm facing down is real. It also will amaze you how often the outside of your elbow contacts doors, etc. Lift with your palm up... no pain. The examination is straightforward. The diagnosis is straightforward. MRI imaging isn't needed. It always says, "partial thickness tears.... yada, yada, yada...." MRI findings are rarely a reason to have surgery. Basically... there's very little reason to operate on these at all. Besides... there are plenty of surgeries described to manage this... most involve releasing/removing the offending tendon-- the ECRB... so why would a tear need to be "fixed" 😂 It can be super annoying... I'll agree to that. It's worse in people who lift a lot for work. Some people might insist that something be done. That's fine... But far, far, far too many are offered injections as a first-line treatment. Steroid injections are not kind to tendons. They're not kind to the lateral ligaments, either. If not appropriately placed, steroids dissolve the fat under your skin. That pale dimple with veins running through it is unsightly. Tendons really don't like steroid injections. A steroid injection might feel great for a few weeks or months... but the pain often returns. Not in everyone, though. So... it might have worked for you. But it made many others worse. PRP injections, anyone?? Maybe It won't cause harm. You should never pay > $500-1000. It could work... Then again... so do placebos I'm not calling PRP injections placebos... But, you know, maybe??? Physical therapy? Meh... But anything that distracts you while nature runs its course is valuable. Braces? Meh... That damn placebo effect again Try it... no harm, no foul. Red light, laser, blue/purple pulsed lights... whatever. Shockwave therapy... maybe. Hard to find... and it hurts... but it might help. This very common yet annoying ailment is so prevalent. Most everyone is going to get it. Carry on... No need to rest or stop activities unless the pain is too spicy. Everyone on IG has a cure: save your money, and if you can move on, wait it out. As usual... it's always far more complex than most people think.

Here's six of our favourite things from the world of cricket this week 🌎🏏 Thanks to everyone who sent in content, hopefully we’ve covered it all! 😅🙌