Transurethral Catheterization in Early Training: The Impact of Peer-Led Mentorship

Introduction. Transurethral catheterization (TUC) is a common hospital procedure. According to the literature, junior doctors contribute to the majority of TUC-related injuries. Our aim is to evaluate the immediate and long-term impact of a short procedure-centric TUC workshop on junior doctor’s confidence, procedural knowledge, and ability to identify potential complications of catheterization. Materials and Methods. Intern doctors were invited to attend a one-hour workshop on TUC. A questionnaire was completed before and after the workshop. Three months later, the questionnaire was readministered to assess the workshop’s long-term impact. The questionnaire consisted of three domains. A: experience, training, and confidence levels (using 5-point Likert scales), B: procedural knowledge (the highest possible score was 10 points), and C: identification of TUC-related complications (the highest possible score was 3 points). Results. 81 interns participated and reported a confidence level of 3.03 ± 1.05 in performing a straightforward TUC. Preworkshop domain B and domain C were 3.92 ± 1.63 and 1.75 ± 0.69 points, respectively. After the workshop, reported confidence levels improved to 3.71 + 1.02 ( p < 0.05 ). Likewise, the scores in domains B and C increased significantly to 8.85 ± 1.40 ( p < 0.005 ) and 2.65 ± 0.6 ( p < 0.005 ), respectively. Three months later, the same parameters were evaluated, and confidence levels were higher than those of the preworkshop levels at 3.83 ± 0.77 ( p < 0.05 ). The average domain B score was 7.85 ± 1.88 ( p < 0.005 ), and domain C score was 2.69 ± 0.53 ( p < 0.005 ). All scores reported after three months were significantly better than the preworkshop levels ( p < 0.005 ), but there were no statistically significant differences when compared to the immediate postworkshop scores ( p > 0.05 ). Conclusion. Short peer-led TUC workshops positively impact intern doctors’ confidence levels, procedural knowledge, and identifying complications.

Nanoconfined Crosslinked Poly(ionic liquid)s with Unprecedented Selective Swelling Properties Obtained by Alkylation in Nanophase-Separated Poly(1-vinylimidazole)-l-poly(tetrahydrofuran) Conetworks

Despite the great interest in nanoconfined materials nowadays, nanocompartmentalized poly(ionic liquid)s (PILs) have been rarely investigated so far. Herein, we report on the successful alkylation of poly(1-vinylimidazole) with methyl iodide in bicontinuous nanophasic poly(1-vinylimidazole)-l-poly(tetrahydrofuran) (PVIm-l-PTHF) amphiphilic conetworks (APCNs) to obtain nanoconfined methylated PVImMe-l-PTHF poly(ionic liquid) conetworks (PIL-CNs). A high extent of alkylation (~95%) was achieved via a simple alkylation process with MeI at room temperature. This does not destroy the bicontinuous nanophasic morphology as proved by SAXS and AFM, and PIL-CNs with 15–20 nm d-spacing and poly(3-methyl-1-vinylimidazolium iodide) PIL nanophases with average domain sizes of 8.2–8.4 nm are formed. Unexpectedly, while the swelling capacity of the PIL-CN dramatically increases in aprotic polar solvents, such as DMF, NMP, and DMSO, reaching higher than 1000% superabsorbent swelling degrees, the equilibrium swelling degrees decrease in even highly polar protic (hydrophilic) solvents, like water and methanol. An unprecedented Gaussian-type relationship was found between the ratios of the swelling degrees versus the polarity index, indicating increased swelling for the nanoconfined PVImMe-l-PTHF PIL-CNs in solvents with a polarity index between ~6 and 9.5. In addition to the nanoconfined structural features, the unique selective superabsorbent swelling behavior of the PIL-CNs can also be utilized in various application fields.

Variational analysis of landscape elevation and drainage networks

Landscapes evolve towards surfaces with complex networks of channels and ridges in response to climatic and tectonic forcing. Here, we analyse variational principles giving rise to minimalist models of landscape evolution as a system of partial differential equations that capture the essential dynamics of sediment and water balances. Our results show that in the absence of diffusive soil transport the steady-state surface extremizes the average domain elevation. Depending on the exponent m of the specific drainage area in the erosion term, the critical surfaces are either minima (0 < m < 1) or maxima ( m > 1), with m = 1 corresponding to a saddle point. We establish a connection between landscape evolution models and optimal channel networks and elucidate the role of diffusion in the governing variational principles.

Optimality in landscape channelization and analogy with turbulence

&lt;p&gt;The channelization cascade observed in terrestrial landscapes describes the progressive formation of large channels from smaller ones starting from diffusion-dominated hillslopes. This behavior is reminiscent of other non-equilibrium complex systems, particularly fluids turbulence, where larger vortices break down into smaller ones until viscous dissipation dominates. Based on this analogy, we show that topographic surfaces emerging between parallel zero-elevation boundaries present a logarithmic scaling in the mean-elevation profile, which resembles the well-known logarithmic velocity profile in wall-bounded turbulence. Within this region of elevation fluctuation, the power spectrum exhibits a power-law decay resembling the Kolmogorov -5/3 scaling of turbulence. We also demonstrate that similar scaling behaviors emerge in surfaces from a laboratory experiment, natural basins, and constructed following optimality principles. In general, we show that the steady-state solutions of the governing equations of landscape evolution are the stationary surfaces of a functional defined as the average domain elevation. Depending on the exponent of the specific drainage area in the erosion term (m), the steady-state surfaces are local minimum (m&lt;1) or maximum (m&gt;1) of the average domain elevation.&lt;/p&gt;

Investigating the Phase-Morphology of PLLA-PCL Multiblock Copolymer / PDLA Blends Cross-linked Using Stereocomplexation

ABSTRACTThe macroscale function of multicomponent polymeric materials is dependent on their phase-morphology. Here, we investigate the morphological structure of a multiblock copolymer consisting of poly(L-lactide) and poly(ε-caprolactone) segments (PLLA-PCL), physically cross-linked by stereocomplexation with a low molecular weight poly(D-lactide) oligomer (PDLA). The effects of blend composition and PLLA-PCL molecular structure on the morphology are elucidated by AFM, TEM and SAXS. We identify the formation of a lattice pattern, composed of PLA domains within a PCL matrix, with an average domain spacing d0 = 12 – 19 nm. The size of the PLA domains were found to be proportional to the block length of the PCL segment of the copolymer and inversely proportional to the PDLA content of the blend. Changing the PLLA-PCL / PDLA ratio caused a shift in the melt transition Tm attributed to the PLA stereocomplex crystallites, indicating partial amorphous phase dilution of the PLA and PCL components within the semicrystalline material. By elucidating the phase structure and thermal character of multifunctional PLLA-PCL / PDLA blends, we illustrate how composition affects the internal structure and thermal properties of multicomponent polymeric materials. This study should facilitate the more effective incorporation of a variety of polymeric structural units capable of stimuli responsive phase transitions, where an understanding the phase-morphology of each component will enable the production of multifunctional soft-actuators with enhanced performance.

Outcomes of Revision Total Ankle Replacement: A Minimum of 2 Year Follow-up

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods: All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results: 32 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 30 patients were included in the study. 5 patients declined participation for completing questionnaires. We received 21 (66%) completed questionnaires. The mean MOX-FQ average domain score for pain was 58.8, walking/standing 65.8 and social function was 48.2. The mean FAOS scores were 50.7 for pain, 50.6 for symptoms, 54.9 for ADL and 28.2 for quality of life. The mean overall health score today for EQ-5D was 67.8/100. 45% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 48% were satisfied with the improved in daily activities. 52% were overall satisfied with the results from surgery. Conclusion: Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery.

A Regression Model for Analysis of Bounce Rate using Web Analytics

Bounce rate is an effective parameter to measure the quality of any website. Bounce rate refers to the percentage of visitors that leave a website (or “bounce” back to the search results or referring website) after viewing only one page a website. High bounce rate is bad as it depicts that the content on a site didn’t match what the visitor was looking for so he left without viewing another page. Since bounce rate equates to visitors taking absolutely no action on a website so this metric could be used as a measure of success .This paper analyses the bounce rate of a website based on web analytics data. In this paper, analysis of bounce rate will be based on performance of website. Data is collected using Google Analytics tool. After applying preprocessing techniques to data an eleven step regression model is built using the various attributes like Average Server Response Time, Average Server Connection Time, Average Redirection Time, Average Page Download Time, Average Domain Lookup time and Average Page Load Time. Mathematical equation is constructed on the basis of outcome of result so that bounce rate can be analyzed and predicted. Model is further refined after establishing the correlation between various attributes. Correlation is established to improve the accuracy in analysis and prediction of bounce rate. This regression model gives insight about the various parameters involved and their effect on bounce rate. Qunatile Quantile plot is constructed to see if plausible data is normally distributed. This complete experiment is done using R Studio

Effect of Fiber Laser Treating on Magnetic Domains in the Grain-Oriented Silicon Steel: Imaging Domains by Bitter, MFM and Kerr Microscopy

A magnetic domain laser scribing technique of grain-oriented 3.2% silicon steel has been investigated for the direct influencing on the magnetic domain wall. The magneto-optical Kerr effect was employed to obtain a visible contrast between antiparallel domains. The effects of laser treating on domain wall were observed. The Bitter, MFM and Kerr microscope pictures showed that domain-wall positions did not repeat precisely from cycle to cycle, particularly at high inductions, and that the average domain-wall spacing decreased with increasing density of laser scribing lines. Two phenomena have been discovered that are difficult to explain (1) that the hardness decreases with increasing laser energy and (2) that the coercivity decreases with decreasing laser energy. A semi-quantitative relationship has been found between the domain patterns and used fiber laser treating method. The behavior of patterns in an applied magnetic field is shown, and based on that a two-dimensional laser lines configuration is proposed for one of the less complicated surface patterns.