LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Influence of microwave power on mechanical properties of microwave-cured polyethylene/coir composites

The present work deals with investigating the influence of microwave power on mechanical properties of 20 wt.% coir reinforced high-density polyethylene (HDPE) composites. Chopped coir/HDPE composites were fabricated using various microwave power levels (360 W, 540 W, 720 W and 900 W). The XRD analysis of the specimens reveals that crystallinity index in various specimens was in the range of 79.54% to 84.59%. The specimen cured at 360 W exhibited a maximum tensile strength of 29.5 ± 1.5 MPa, which is 28.26% greater than composite cured at 900 W (23 ± 1.5 MPa). Flexural strength of specimen cured at 360 W was maximum (37.74 ± 2 MPa)

Influence of heat treatment on microstructure and mechanical properties of Inconel-625 clad deposited on mild steel

477-483The present work investigates on the microstructure and mechanical properties of Inconel-625 clads deposited through tungsten inert gas on mild steel (MS). The microstructure of the deposited clads reveals perfect metallurgical bonding with the substrate. The deposits are dense with almost negligible porosity. To enhance the mechanical properties, Inconel-625 clads are subjected to three different post heat treatments for 4 h. Compared to the as-deposited clad, the microstructure at 650°C heat treated specimens reveals no dissolution of the Laves phase. However, the 850°C and 950°C heat treated samples exhibit partial dissolution and complete dissolution of the Laves phase in the fusion zone, respectively. The 850°C heat treated clads exhibit higher micro hardness compared to the other clads (as-deposited, 650°C and 950°C heat treated clads). This is attributed to the precipitation of γ'' strengthening phases due to availability of more Nb in the fusion zone micro structure

A comprehensive review of surface modification techniques for carbon fibers for enhanced performance of resulting composites

Carbon fiber (CF) is being used as reinforcements in structural composites due to its high strength-to-weight ratio, chemical and abrasion resistance. However, due to the inert surface of the fiber, the resulting CFRPs provide limited damage resistance. The CFRPs are prone to delamination and offer poor interfacial strength. Secondly, recycled carbon fiber (RCF) cannot be used for strength applications in electric vehicles and aerospace applications due to the limited strength offered by the CFRPs made from RCFs. So, in order to use recycled and virgin CF in the field of electric vehicles and aerospace, the modification to the surface of the CF is required for enhanced interfacial properties in the resulting composite. This is a comprehensive review on surface modification techniques used to induce physical and chemical changes on the CF surface. The modified surface of CF can lead to enhanced performance of the structural composites. The review article discusses the various surface modification techniques categorized as plasma, chemical, nano-particle growth, coating, and microwave irradiation in detail, with suitable illustrations that have been used to ameliorate the compatibility of the CF with the matrix

Mechanical and electromagnetic interference shielding properties of natural fiber reinforced polymer composite with carbon nanotubes addition

Mechanical and electromagnetic interference (EMI) shielding properties are investigated for developed synthesized green composite. The varying content of kenaf fiber-reinforced high-density polyethylene (HDPE) composite has been fabricated using microwave-assisted compression molding techniques with and without the addition of multi-walled carbon nanotubes (MWCNTs). X band range has been used for EMI shielding characterization. Optimization for mechanical strength has been done using tensile test, impact test, and translaminar fracture toughness test. Fractography by scanning electron and optical microscopy concluded that interfacial adhesion between kenaf fiber and HDPE matrix and the degree of ductility of the matrix are primary governing factors for change in mechanical properties. The differential scanning calorimetry confirmed no change in the degree of crystallization of the matrix with the addition of MWCNTs. Composite with EMI shielding effect above 30 dB along with superior mechanical properties is obtained at 16% (v/v) kenaf fiber content with the addition of 5% (wt.) conductive MWCNTs for possible application in electronic equipment casing, overhead bin, or unmanned aerial vehicles.</p

Drilling parameter optimization of cenosphere/HDPE syntactic foam using CO2 laser

High-density polyethylene is a high-strength, and low-weight material system. Besides numerous applications in a variety of fields and products, its machining for generation of holes is rather difficult with traditional methods such as drilling as the process is not very conducive for composites due to associated damage. Hence, a non-contact material removal process such as laser machining provides an appealing, cost-effective, accurate, and fast alternative. For this study, the effect of the laser process controls key parameters such as laser power and laser speed on the cut surface integrity defined by surface roughness, kerf taper angle, and heat-affected zone of neat HDPE and HDPE with 60 wt% cenosphere was investigated and optimized using response surface meth-odology. Also, the machining operation was visualized using a Photron FASTCAM SA 1.1 high-speed camera to observe the effects of the high-intensity laser beam on specimens and to investigate the mechanism of laser machining. The optimum values for a defect-free cut surface (minimum surface roughness and low kerf taper angle) in neat HDPE comes out to be as laser power of 97.5 W and laser speed of 5 mm/s, with corresponding surface roughness and kerf taper angle of 54.304 mu m and 0.152 degrees respectively and the optimum input values for HDPE with 60 wt% cenosphere are 102.126 W laser power and 5 mm/s laser speed, with corre-sponding surface roughness and kerf taper angle of 26.574 mu m and 0.253 degrees. This study finds importance for the industrial and medical application to creates small size holes for mechanical joints such as rivets, bolts, and screws in assembly as low surface roughness and kerf width are always preferred as quality parameters in creating holes for industrial applications

Mechanical Performance Study of Kenaf/HDPE Composite for Structural Applications under Wet or Outdoor Environments

The present work used natural fiber-reinforced polymer composite to explore its feasibility for structural applications in wet or outdoor environments. A novel technique of microwave-assisted compression molding (MACM) is used to manufacture kenaf/high-density polyethylene (HDPE) composites. Mechanical performance of 30 wt.% reinforced kenaf/HDPE composite conditioned in different environments for 6 months was evaluated. The liquids taken for environmental conditioning were sea water, 5% NaOH solution, deionized water, vegetable oil (soybean oil), and diesel. Mechanical performances were investigated and correlated with different attributes, i.e. wettability, liquid uptake, thickness swelling, absorption mechanism, and morphologies. It was observed that the tensile, flexural, and hardness properties were decreased due to degradation in interfacial bonding. Whereas increased impact strength was observed due to the plasticization effect after conditioning. Composites conditioned in vegetable oil retained highest value of physical and mechanical properties. Whereas composites conditioned in 5% NaOH solution followed by other conditioning environments showed maximum degradation in the properties. It can be inferred from the study that kenaf/HDPE composites can be used for medium load structural applications present in viscous and chemically neutral environments. The best-suited example of the present work is container for storage of vegetable oil and for making boundaries outside the property