Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient sa...Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.展开更多
雷电作为自然界一种极端天气的表现形式,常给地基、地面、高耸建筑等造成严重破坏。工程防雷措施依赖于土体雷电冲击特性。现阶段,研究人员大多从电气工程角度探究雷电冲击土体造成的危害,但因学科间的差异与局限,雷电作用下岩土工程与...雷电作为自然界一种极端天气的表现形式,常给地基、地面、高耸建筑等造成严重破坏。工程防雷措施依赖于土体雷电冲击特性。现阶段,研究人员大多从电气工程角度探究雷电冲击土体造成的危害,但因学科间的差异与局限,雷电作用下岩土工程与电气工程的交叉融合方面的研究十分欠缺。本文构建土体雷电冲击模型,基于电弧通道能量平衡方程计算雷电放电产生的冲击波压力,将冲击波压力作为外加荷载作用在土体中,并通过修正Mohr-Coulomb屈服准则考虑动荷载下土体应变硬化,利用土体的理想锁定状态方程(Idealized Locked Equation of State)和动态扩孔方法考虑冲击波非稳态加载,探究雷电冲击下土体的弹塑性界面及应力时程变化规律。研究表明:在雷电冲击下,土体应力随时间变化呈现先陡增后迅速衰减的趋势,应力突变点表明土体此时正处于弹塑性交界面;在应力突变点之前,土体附加应力趋于0,处于弹性状态。任一时刻下,随着逐渐远离雷电冲击点,土体应力呈现迅速衰减的趋势,应力发生突变骤降表明此处土体正处于弹塑性交界面;在突变点之后土体附加应力趋于0,处于弹性状态。土体压缩系数对土体的弹塑性界面变化具有显著影响,随着压缩指标增大,土体塑性区半径逐渐减小;随着土体黏聚力逐渐增大,土体塑性区半径逐渐减小;增大土体弹性模量可以增大土体塑性区半径,但变化幅度相对较小;电流波形对土体塑性区中的应力会产生较大影响,而对土体弹性区影响较小。展开更多
文摘Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.
文摘雷电作为自然界一种极端天气的表现形式,常给地基、地面、高耸建筑等造成严重破坏。工程防雷措施依赖于土体雷电冲击特性。现阶段,研究人员大多从电气工程角度探究雷电冲击土体造成的危害,但因学科间的差异与局限,雷电作用下岩土工程与电气工程的交叉融合方面的研究十分欠缺。本文构建土体雷电冲击模型,基于电弧通道能量平衡方程计算雷电放电产生的冲击波压力,将冲击波压力作为外加荷载作用在土体中,并通过修正Mohr-Coulomb屈服准则考虑动荷载下土体应变硬化,利用土体的理想锁定状态方程(Idealized Locked Equation of State)和动态扩孔方法考虑冲击波非稳态加载,探究雷电冲击下土体的弹塑性界面及应力时程变化规律。研究表明:在雷电冲击下,土体应力随时间变化呈现先陡增后迅速衰减的趋势,应力突变点表明土体此时正处于弹塑性交界面;在应力突变点之前,土体附加应力趋于0,处于弹性状态。任一时刻下,随着逐渐远离雷电冲击点,土体应力呈现迅速衰减的趋势,应力发生突变骤降表明此处土体正处于弹塑性交界面;在突变点之后土体附加应力趋于0,处于弹性状态。土体压缩系数对土体的弹塑性界面变化具有显著影响,随着压缩指标增大,土体塑性区半径逐渐减小;随着土体黏聚力逐渐增大,土体塑性区半径逐渐减小;增大土体弹性模量可以增大土体塑性区半径,但变化幅度相对较小;电流波形对土体塑性区中的应力会产生较大影响,而对土体弹性区影响较小。