Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India.

Background: The existing palliative care services in India are concentrated in urban areas, attached to tertiary care hospitals. This poses issues relating to access and equity for people in rural locations and with low socioeconomic status. A Community-Based Palliative Care (CBPC) service named Sanjeevan has been initiated in Puducherry, a union territory of India to provide physical, social, psychological, and emotional support to incurably ill people, including older adults living in rural areas. Objectives: To understand the social mechanisms that underpin the implementation of CBPC in rural parts of India and the challenges to its sustainability. Design: Qualitative research using focus group discussions (FGDs) and key informant interviews (KIIs). Methods: Community-based participatory research (CBPR) approach was used in this study, and descriptive analysis was done. Through CBPR it was possible to document and interpret local knowledge on the community concerns and assets along with the experiences of the community members. Purposive sampling was used to identify vocal participants involved in patient care and areas of the Sanjeevan program such as financial management, administration, and community mobilization. Seven KIIs and four FGDs were conducted, with 7-8 participants in each. Results: The analysis indicated the need for a CBPC and the factors enabling its establishment. The findings revealed capacity building, resources for palliative care services, and the existing social structure of the community being the main challenges that need to be overcome for better penetration of CBPC services into society. Demand generation through sensitization and administration of services based on the need and regular follow-up remains the key strategies for the sustainability of the program. Conclusion: The CBPC program like 'Sanjeevan' adopted in the rural area of Puducherry can be cited as an example and can be replicated in other rural settings with similar sociocultural characteristics to support people living with end-stage diseases.

Status Quo on Graphene Electrode Catalysts for Improved Oxygen Reduction and Evolution Reactions in Li-Air Batteries.

Reduced global warming is the goal of carbon neutrality. Therefore, batteries are considered to be the best alternatives to current fossil fuels and an icon of the emerging energy industry. Voltaic cells are one of the power sources more frequently employed than photovoltaic cells in vehicles, consumer electronics, energy storage systems, and medical equipment. The most adaptable voltaic cells are lithium-ion batteries, which have the potential to meet the eagerly anticipated demands of the power sector. Working to increase their power generating and storage capability is therefore a challenging area of scientific focus. Apart from typical Li-ion batteries, Li-Air (Li-O2) batteries are expected to produce high theoretical power densities (3505 W h kg-1), which are ten times greater than that of Li-ion batteries (387 W h kg-1). On the other hand, there are many challenges to reaching their maximum power capacity. Due to the oxygen reduction reaction (ORR) and oxygen evolution reaction (OES), the cathode usually faces many problems. Designing robust structured catalytic electrode materials and optimizing the electrolytes to improve their ability is highly challenging. Graphene is a 2D material with a stable hexagonal carbon network with high surface area, electrical, thermal conductivity, and flexibility with excellent chemical stability that could be a robust electrode material for Li-O2 batteries. In this review, we covered graphene-based Li-O2 batteries along with their existing problems and updated advantages, with conclusions and future perspectives.

Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

BACKGROUND: Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. METHODS: A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. RESULTS: The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). CONCLUSIONS: The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Physiochemical Analysis of Drinking Water and Treatment with a Homemade Filter: A Case Study of Illu Abba Bor Zone, Ethiopia.

The drinking water quality was evaluated in order to provide a continuous supply of clean and safe drinking water for the preservation of public health. The study area consists of three villages: Tulube, Seddo, and Serdo, all of which are located near Mettu town, which is about 550 kilometers south-west of Ethiopia's capital, Addis Ababa. The physical and chemical parameters of the collected drinking water samples were assessed, including pH, turbidity, conductivity, total suspended solids (TSS), total dissolved solids (TDS), and the presence of heavy metals. The samples were examined in the laboratory, and the findings were compared to the World Health Organization (WHO) standards. Almost all of the physiochemical indicators were safe and within the permissible limit for drinking water quality. However, lead ion concentrations were found to be above the WHO standards. An adsorbent produced from banana pseudostems was used to remove lead ions from drinking water. The equilibrium parameters were determined using the Langmuir adsorption isotherm. The drinking water was treated for 4 h in a homemade adsorption column composed of filter medium (sand, charcoal, and powder of treated banana pseudostem). The data revealed that lead ions removal was nearly 70%, but still above the WHO standards.

Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty.

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis. The authors continue by describing idealized basal view aesthetics and provide a treatment algorithm for common deformities that include alar flaring and a wide nasal base. The authors attempt to provide a comprehensive approach to the treatment of the nasal base by discussing the implications of treating columellar deformities, tip positioning, or alar-columellar discrepancies on the overall aesthetics of the lower third of the nose. Furthermore, technical considerations are given for common surgical maneuvers addressing the alar base to help guide treatment and prevent complications such as poor scarring, notching, nostril asymmetry or stenosis (external valve obstruction), and alar deformities ("parenthesis" or "bowling pin"), to name a few.

Rhinoplasty Refinements: Addressing the Deviated, Overprojected Nose.

Deprojection of an overprojected nose and correction of an infralobular deformity are very challenging for rhinoplasty surgeons because a systematic approach is needed to correct these problems. A deviated nose with a dorsal hump is a common deformity that is best treated using septal reconstruction and the component dorsal hump reduction technique using an open rhinoplasty approach. This article and its videos show how to correct a deviated nose with overprojection and a dorsal hump deformity.

Rhinoplasty Refinements: Revision Rhinoplasty Using Fresh Frozen Costal Cartilage Allograft.

A crooked nose is challenging for a surgeon and needs to be treated using a systematic approach. Correction of nasal deformities such as a retracted columella in a revision rhinoplasty may need additional cartilage to correct the framework. Fresh frozen cartilage graft has been used as an extended spreader graft and a columellar strut graft to correct this problem. This option prevents donor-site morbidity associated with harvesting autologous cartilage.

Male Rhinoplasty: Update.

Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Better communication and clarity are paramount with male rhinoplasty patients because the patients may be less attentive. It is important for the surgeon to screen the patients for any psychosocial disorders. Through a series of cases, male rhinoplasty techniques are highlighted. Masculine features should be preserved, and the nose should not be feminized or oversculpted. Another key component in any rhinoplasty case is proper skin care, especially during the postoperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

Brachioplasty Refinements.

With a growing massive weight loss population, upper arm contouring continues to rise in popularity. Refinements in technique, such as modification of skin excision patterns and the adjunct use of liposuction, have allowed for safe and reproducible results. This article helps to understand the evolution of upper arm contouring and provides an update on the limited-incision medial brachioplasty. Details of preoperative markings and operative technique are clearly illustrated in the video included.

Rhinoplasty Refinements: Addressing the Pollybeak Deformity.

Pollybeak deformity represents one of the most common complications of rhinoplasty that require revision rhinoplasty for correction. This article helps to understand the basis behind the deformity, which helps us to prevent and to treat this deformity. This article and video also reiterate that systematic facial analysis is important to look for imperfections and asymmetries in other parts of the face and show how a chin augmentation is performed to correct microgenia.

Preventing Lateral Canthal Malposition in Modern Blepharoplasty.

Current goals in lower eyelid blepharoplasty include blending the lower eyelid-cheek junction, which is highlighted in the authors' six-step lower lid blepharoplasty technique. One major question in lower lid blepharoplasty is how to prevent lower lid malposition and ectropion, because these are untoward outcomes after an aesthetic procedure. In the authors' technique, they perform a superficial lateral retinacular canthopexy that is effective and safe and also prevents lower lid malposition or ectropion. A retrospective review of 104 patients who underwent six-step lower lid blepharoplasty was performed. In the authors' series, there was no significant difference between preoperative and postoperative intercanthal angles (p < 0.05), and the lateral canthal position did not change significantly from its preoperative position. The authors' six-step blepharoplasty technique addresses signs of midfacial aging, and the lateral canthopexy technique has been shown to have a minimal complication rate and maintains canthal position. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today.

The practice of chemical peeling remains an important aspect of the nonsurgical techniques available to the aesthetic surgeon when approaching skin rejuvenation. Despite past predictions of their disappearance in favor of lasers, the overall use of chemical peels by plastic surgeons continues to grow. In the past two decades, the techniques available to the clinician have evolved in safety and efficacy based on the dermatologic investigations of various individuals, including Obagi, Hetter, and Stone. The versatility, clinical endpoint-directed predictability, and favorable risk profile of chemical peels proffered by these latest advancements affirm that this modality is essential to the practice of the plastic surgeon treating patients with rhytides and dyschromias. This review presents the current role of chemical peels in skin rejuvenation, emphasizing the significant clinical advancements and their modern day applications and practice.

Role of Ancillary Procedures in Facial Rejuvenation.

Face-lift techniques have evolved beyond the concept of lifting and now include incorporating superficial and deep filling of facial fat compartments to address volume deflation and aging. In addition to traditional face-lift methods involving the excision and tightening of skin and the underlying soft tissues, the following ancillary procedures have become paramount in achieving an optimal result: blending the lid-cheek junction; chin augmentation; lobule augmentation; hand rejuvenation; perioral rejuvenation; chemical peels; and laser resurfacing. We presented a summary of these integral techniques.

Recognizing Racial Heterogeneity in the Latino Nose: Aesthetic Concepts for an Individualized Approach.

BACKGROUND: Latinos are one of the fastest growing ethnic groups in the United States, and there is a growing demand for aesthetic rhinoplasty in these patients. The authors provide an individualized, systematic approach for evaluation and improvement of surgical outcomes in Latino patients. METHODS: A retrospective review of patients identified as Latino who underwent primary rhinoplasty and those who did not but had documented nasal photographs was performed. Photographs and operative records were reviewed in detail. Specific aesthetic nasal characteristics, individualized surgical techniques, and aesthetic results were recorded. RESULTS: The Latino nose has some characteristic nasal traits, including thick soft-tissue envelope, bulbous and underrotated tips, fatty hanging alae with propensity for anterior notching, weak underlying cartilaginous structures, and a propensity for alar flare worsened by depressor septi hyperactivity. Case review, however, demonstrates that there is moderate variability, with some patients demonstrating features more consistent with a European Caucasian nose and others displaying features more congruent with the black nose. CONCLUSIONS: Addressing the Latino nose requires a firm understanding of the racial heterogeneity that exists within this patient population, ranging from features more consistent with the black nose to features more congruent with a European Caucasian nose. A patient's aesthetic goals should be thoroughly discussed to avoid racial incongruity. The authors provide an individualized, component approach to improving aesthetic outcomes in Latino rhinoplasty.

Role of Fresh Frozen Cartilage in Revision Rhinoplasty.

BACKGROUND: Correction of secondary nasal deformities frequently requires cartilage to build the framework of the nose. Traditionally, autologous costal cartilage has been used because of the paucity of the septal cartilage. Because of associated donor-site complications and increased operating time, irradiated allografts have been used. These grafts have a higher rate of resorption and infection. Thus, the authors have used fresh frozen, nonirradiated, cadaveric rib cartilage as donor cartilage to avoid these shortcomings, and they present their early experience. METHODS: The operative data of 50 patients who underwent secondary rhinoplasty performed by the senior author between 2014 and 2017 were analyzed. The outcomes of the rhinoplasty were evaluated by preoperative and postoperative photographs by four blinded plastic surgeons, and the results were tabulated using the Independent Rhinoplasty Outcome Score. RESULTS: Fifty patients were followed up over an average period of 3.35 months (range, 1 to 18 months). There was only one complication (infection, 2 percent), which did not need revision surgery. There was no warping or extrusion in this cohort. CONCLUSIONS: The authors believe that fresh frozen, nonirradiated cartilage allografts are an evolving source of donor cartilage grafts for revision rhinoplasty because they are associated with lower complication rates. However, further long-term studies with an increased sample size are necessary to prove that fresh frozen cartilage grafts are better than other sources. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Effect of peroxomonosulfate, peroxodisulfate and hydrogen peroxide on graphene oxide photocatalytic performances in methyl orange dye degradation.

Carbocatalyst GO photocatalytic mechanism and performances in the presence of an electron scavenger (ES) has been consciously discussed herein. Single layer GO photocatalyst has been synthesized by Hummer's method and photocatalyst characteristics are gathered by different analytical methods. Studies ensured the formation of a good crystalline GO that contains number of oxygenated functional groups, with average crystalline size of the sp2 domain in 18.24 nm. Optical studies suggest that optical band gap of the GO nanosheet photocatalyst is found in the range of 3.19-4.4 eV. TEM analysis confirms the formation of a single layer GO nanosheet. Photocatalytic study justifies that in the absence of ES, 24% mineralization efficiency is achieved with GO as a photocatalyst, whereas in the presence of ES such as PMS, PDS and HP the mineralization efficiency is considerably enhanced up to 91%, 77% and 65% respectively. Moreover, photocatalytic degradation intermediate byproducts were also examined through LC-MS analysis. The study substantiates methyl orange dye degradation undergoes via the multiple degradation pathway such as (i) azo bond cleavage and hydroxylation, (ii), asymmetric cleavage followed by reduction of sulfonate group and aromatic ring removal and (iii) consecutive demethylation reactions and sulfonate group removal. Rationalized the contributing effects of process parameters towards the photocatalytic degradation of methyl orange using a RSM based on CCD validation. The validation reveals that most significant process parameter affects degradation process are the irradiation time, catalyst loading and choice of ES.

Fabrication and Characterization of Flexible Cotton Fabric/Carbon Nanotubes/MnO2 Nanocomposite-Based Electrodes for Energy Storage Application.

Flexible cotton fabric based electrodes were fabricated using multi-walled carbon nanotubes (MWCNTs) and manganese dioxide (MnO2) nanocomposite which was prepared using wet chemical synthesis. Characterization of CNT/MnO2 nanocomposite was done by Transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photon spectroscopy (XPS), Raman spectroscopy and BET analysis. Their electrochemical properties were investigated using three electrode systems. The high specific capacitance of 634.35 F/g was obtained for the nanocomposite coated cotton fabric prepared via dipping method. The high capacitance was attributed to its high specific surface area 678.9 m2/g. The electrode exhibited high cyclic performance showing retention of 84% of its initial capacity in 0.5 M sodium sulphate (Na2SO4) solution. The demonstrated high specific capacitance of CNT/MnO2 nanocomposite makes it a promising electrode material for energy storage applications due to its low cost and flexibility.

Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study.

BACKGROUND: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration. METHODS: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection. RESULTS: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. CONCLUSIONS: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.

Middle Eastern Rhinoplasty: Update.

Middle Eastern rhinoplasty requires especially precise preoperative planning to achieve a successful result. Among all aesthetic surgery procedures, there is a higher demand for rhinoplasty among Middle Eastern cultures. The key is to maintain the ethnicity of the patients while meeting their goals. In this brief overview, common features in Middle Eastern patients and Middle Eastern rhinoplasty techniques in men and women are highlighted.