Pedicle Lengthening with Reducing Size Mismatch in Free Anterolateral Free Flap.

When plastic surgeons reconstruct the defects for recurrent cancer, a longer vascular pedicle is often necessary because usable vessels are sacrificed in previous surgeries or radiotherapy. In this case, we would like to present another method for free anterolateral thigh flap pedicle elongation. A 59-year-old man was referred to our clinic for reconstruction after unilateral total maxillectomy and orbital exenteration due to recurrent squamous cell carcinoma. We need to cover the full-thickness defect in the left orbital area (8×7 cm sized), intraoral area (5×7 cm sized), and orbital floor. Due to prior surgeries and radiotherapy, we needed a vascular pedicle up to 15 cm for a distant recipient vessel. When harvesting the flap, we transected just proximal to the bifurcation site, harvested a muscular branch to vastus intermedius together, and used it for pedicle elongation by vessel turning over. A 17×6 cm sized musculocutaneous flap was harvested, and the total length of the pedicle was 15 cm. As the anastomosis was done at the distal portion of the vastus intermedius branch, there was no size mismatch with the superior thyroid artery. Both skin defects and the orbital floor were covered without any tension. The reconstruction was successful without any flap compromise 1 year after surgery. This case suggests another option for microsurgeons to lengthen the flap pedicle and reduce size mismatch using anatomical variability of the lateral circumflex femoral artery.

Frontal Sinus Displacement of Silicone Implant After Previous Rhinoplasty.

Rhinoplasty, a historic surgical procedure for facial esthetics, has been actively performed in Asia. The use of autologous tissues or artificial materials, such as silicone, Gore-Tex, and Medpore, is common in achieving cosmetic improvements. However, artificial material poses risks of inflammation and foreign body reactions, leading to complications like infection and necessitating material removal and antibiotic treatment. According to previous reports, various clinical aspects appear across inflammation, skin necrosis, and, in severe cases, systemic symptoms caused by implants. In this case study, the goal is to share a rare case of silicone implant migration into the frontal sinus after augmentation rhinoplasty. A 38-year-old female patient who had previously undergone rhinoplasty surgery visited the outpatient clinic complaining of headaches and a deviated nose. On computed tomography, the silicone implant moved upward, penetrating the nasoethmoid bone and invading the frontal sinus. Fortunately, there was no intracranial invasion. The authors planned the implant removal and performed the complete implant removal with capsulectomy. The patient has been undergoing follow-up without any complications after surgery. Augmentation rhinoplasty with implants, while common, carries long-term risks. This case highlights the severity of complications, emphasizing infection and migration into the frontal sinus and, in extreme cases, the brain cavity. Therefore, surgeons must continually refine operation techniques to minimize iatrogenic causes and consider modifying surgical procedures to prevent potential complications.

Culturally-tailored survivorship care planning for rural Latina breast cancer patients: a pilot study.

OBJECTIVE: To explore the feasibility and acceptability of Proyecto Mariposa, a culturally-tailored survivorship care program for rural Latina breast cancer patients. DESIGN: Single group mixed-method approach. METHODS: Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease. FINDINGS: Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease. CONCLUSIONS: This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings.

Confidence in carrying out palliative care among intensive care nurses.

BACKGROUND: Nurses in intensive care units (ICUs) play a crucial role in providing palliative care. Effective provision of palliative care in the ICU requires nurses' active engagement, yet little is known about the confidence for palliative care that ICU nurses hold in China. AIM: To explore confidence in performing palliative care among ICU nurses in China and factors related to nurses' level of confidence. STUDY DESIGN: A cross-sectional design was implemented. METHODS: This study utilized convenience sampling to recruit ICU nurses from nine hospitals in Wuhan, China. Data were collected via an online survey. Multiple regression was conducted to identify the predictors of the ICU nurses' confidence in performing palliative care. RESULTS: A total of 231 ICU nurses participated in the study, resulting in a response rate of 78% (231/296). Participants reported a relatively low level of confidence for carrying out palliative care (mean score = 2.60 ± 0.53; range = 1-4). Nurses who had more positive attitudes toward palliative care communication (P < .001), higher levels of formal training on palliative care (P < .001), more years of working as an ICU nurse (P < .05) and those working in integrated ICU (P < .001) showed a higher level of confidence in carrying out palliative care. CONCLUSION: Participants' lack of confidence in performing palliative care makes for increased challenges, particularly in uncertainty about family assessments, palliative care discussions and lack of palliative care training. Strengthening palliative care curricula in nursing education and professional training is imperative to enhance ICU nurses' confidence. RELEVANCE TO CLINICAL PRACTICE: Strengthening palliative care education and training, particularly in relation to palliative care communication, is critical. Implementing and tailoring culturally relevant palliative care call for attention to practice and for policy changes in palliative care delivery in China.

Understanding individual-level travel behavior changes due to COVID-19: Trip frequency, trip regularity, and trip distance.

Understanding different mechanisms in trip changes depending on transportation modes due to COVID-19 pandemic is the key to providing practical insights for healthy communities. This study aimed to investigate the impact of the COVID-19 pandemic on individual-level travel behavior in Daejeon Metropolitan City, South Korea. Using smart card and private vehicle records, we explored different travel behaviors exhibited while using buses and private vehicles. An individual's travel behavior was represented in trip frequency, trip regularity, and trip distance and was compared weekly for about three months, including the initial period of pandemic. A significant decrease in trip frequency during non-peak hours on weekdays and during weekends indicates that people reduced non-mandatory trips more than commuter trips. This was also verified in that, as the number of infection cases increased, trip regularity with 24-hour intervals intensified. People maintained the size of their activity boundaries but reduced their daily trip distances. The interesting point is that private vehicle usage increased for shorter trip distances while bus usage dropped regardless of the ranges of trip distances under the pandemic. The findings provide evidence of possible inequality issues in transportation during the pandemic and can help make precautionary policies for future pandemics.

Rural Hispanic/Latino cancer patients' perspectives on facilitators, barriers, and suggestions for advance care planning: A qualitative study.

OBJECTIVE: Hispanic/Latinos living in rural areas have limited healthcare resources, including palliative and hospice care. Moreover, little is known about advance care planning (ACP) among Hispanic/Latino cancer patients in rural areas. This study explores facilitators and barriers for ACP. It elicits suggestions to promote ACP among rural Hispanic/Latino cancer patients in a US/Mexico border region. METHODS: Hispanic/Latino cancer patients (n = 30) were recruited from a nonprofit cancer organization. Data were collected via in-person interviews. Interviews were transcribed and translated from Spanish to English. Data were uploaded into NVivo 12 and analyzed using thematic analysis. RESULTS: A common theme for facilitators and barriers for ACP was safeguarding family. Additional facilitators included (1) Desire for honoring end-of-life (EoL) care wishes and (2) experience with EoL care decision making. Additional barriers include (1) Family's reluctance to participate in EoL communication and (2) Patient-clinicians' lack of EoL communication. Practice suggestions include (1) Death education and support for family, (2) ACP education, and (3) Dialogue vs. documentation. SIGNIFICANCE OF RESULTS: ACP functions not only as a decisional tool; its utility reflects complex dynamics in personal, social, and cultural domains. ACP approaches with this underserved population must consider family relationships as well as cultural implications, including language barriers.

Changes in car and bus usage amid the COVID-19 pandemic: Relationship with land use and land price.

This study aimed to explore the impacts of COVID-19 on car and bus usage and their relationships with land use and land price. Large-scale trip data of car and bus usage in Daejeon, South Korea, were tested. We made a trip-chain-level data set to analyze travel behavior based on activity-based travel volumes. Hexagonal cells were used to capture geographical explanatory variables, and a mixed-effect regression model was adopted to determine the impacts of COVID-19. The modeling outcomes demonstrated behavioral differences between associated with using cars and buses amid the pandemic. People responded to the pandemic by reducing their trips more intensively during the daytime and weekends. Moreover, they avoided crowded or shared spaces by reducing bus trips and trips toward commercial areas. In terms of social equity, trips of people living in wealthier areas decreased more than those of people living in lower-priced areas, especially trips by buses. The findings contribute to the previous literature by adding a fundamental reference for the different impacts of pandemics on two universal transportation modes.

Binational cancer patient experiences and cancer coping in a rural US-Mexico border region.

Objective: Coping with cancer is central to patients' cancer recovery and quality of life, yet little is known about cancer experiences and coping from the perspective of binational cancer patients. This brief report provides an exploration of experiences relating to cancer diagnosis/treatment and coping among Latino cancer patients living in the U.S.-Mexico border regionDesign: We conducted secondary data analysis of qualitative dataParticipants and methods: We conducted in-depth of interviews with 22 patients from a rural cancer care organization. Thematic analysis was used to analyze the data.Findings: Three themes emerged: 1) changes in sexual functioning, 2) navigating cancer in the U.S. and between Mexican border communities, and 3) social support.Conclusion: Rural Latino cancer patients face multiple challenges in accessing cancer treatments. Social support fills the gaps for their continuum of care.Implication: Promoting culturally-relevant coping and resilience in clinical practice.

Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals: 2010-2014.

AIM: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. MATERIALS AND METHODS: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status. RESULTS: Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and -9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001). CONCLUSIONS: Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.

Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication.

Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.

Patient-family EoL communication and its predictors: Reports from caregivers of Latino patients in the rural U.S.-Mexico border region.

OBJECTIVE: Family caregivers play an important role in end-of-life (EoL) decision making when the patient is unable to make his/her own decisions. While communication about EoL care between patients and family is perhaps a first step toward advance care planning (ACP)/EoL decisions, not every culture puts great value on open communication about this topic. The aims of the present study were to explore EoL communication and the aspects of communication among caregivers of Latino patients in the rural United States (U.S.)-Mexico border region. METHOD: This study analyzed data from a hospice needs assessment collected from 189 family caregivers of Latino patients at a home health agency in a rural U.S.-Mexico border region. Bivariate tests and logistic regression were used to address our aims. RESULTS: About half of the family caregivers (n = 96, 50.8%) reported to have ever engaged in EoL discussion with patients. Significant predictors of EoL discussion included life-sustaining treatment preference (odds ratio [OR] = 0.44, p < 0.05); knowledge of an advance directive (AD) (OR = 5.50, p < 0.01); and distrust of physicians (OR = 0.29, p < 0.01). Caregivers who preferred extending the life of their loved one even if he/she had to rely on life supports were less likely to engage in EoL communication. Also, caregivers who worried that physicians might want to stop treatments (i.e., "pull the plug") too soon were less likely to do so. Conversely, caregivers who had knowledge about ADs were more likely to engage in EoL communication. SIGNIFICANCE OF RESULTS: EoL communication is a complex process influenced by individual, social, and cultural values and the beliefs of both the patient and his/her family. Inclusion of family caregivers in the ACP process and facilitating culturally tailored EoL communication between patients and family caregivers is important.

A Vision-Based Wayfinding System for Visually Impaired People Using Situation Awareness and Activity-Based Instructions.

A significant challenge faced by visually impaired people is 'wayfinding', which is the ability to find one's way to a destination in an unfamiliar environment. This study develops a novel wayfinding system for smartphones that can automatically recognize the situation and scene objects in real time. Through analyzing streaming images, the proposed system first classifies the current situation of a user in terms of their location. Next, based on the current situation, only the necessary context objects are found and interpreted using computer vision techniques. It estimates the motions of the user with two inertial sensors and records the trajectories of the user toward the destination, which are also used as a guide for the return route after reaching the destination. To efficiently convey the recognized results using an auditory interface, activity-based instructions are generated that guide the user in a series of movements along a route. To assess the effectiveness of the proposed system, experiments were conducted in several indoor environments: the sit in which the situation awareness accuracy was 90% and the object detection false alarm rate was 0.016. In addition, our field test results demonstrate that users can locate their paths with an accuracy of 97%.

Barriers and Challenges of Cancer Patients and Their Experience with Patient Navigators in the Rural US/Mexico Border Region.

Patient navigation is a widely used approach to minimize health disparities among socioeconomically marginalized cancer patients. Although patient navigation is widely used, there is a dearth of studies exploring patient experience with navigators among rural cancer patients. This qualitative study explores the challenges and barriers to cancer care faced by cancer patients living in a US/Mexico border region in Southern California. We individually interviewed 22 cancer patients, most of whom were Latino. Data were analyzed using constant comparison with a reiterative analysis method. The main themes relating to barriers to care and experiences with patient navigators include the following: (1) removing financial barriers, (2) coordinating services, and (3) providing therapeutic interventions. The cancer patients highly valued the navigators for their knowledge about community resources, support, and advocacy. This study suggests that it is imperative that navigators know the regional and binational health care utilization issues that impact patients' access to cancer care.

Willingness to use hospice care among caregivers of Latino patients in the United States-Mexico border region.

OBJECTIVE: Hospice is an important method of promoting quality end-of-life (EoL) care, yet its utilization is relatively low in underserved populations. The unique characteristics of a border community-such as a lack of healthcare resources and cultural integration-impact EoL decision making. The aim of our study was to assess the willingness to use hospice care services and its predictors among family caregivers of Latino patients in the United States (U.S.)-Mexico border region of Southern California. METHOD: This study analyzes secondary data from a home health agency in the U.S.-Mexico border region. Quantitative data were collected via a face-to-face interview with 189 caregivers of patients enrolled in the agency. Bivariate tests and logistic regression were employed to address our study objectives. RESULTS: The majority (83%) of family caregivers were willing to use hospice services for their loved ones. The factors impacting willingness to use hospice services included the primary language of the caregiver (OR = 6.30, CI 95% = 1.68, 23.58); trust in doctors to make the right decisions (OR = 3.77, CI 95% = 1.05, 13.57); and the belief that using hospice care means giving up on life (OR = 0.52, CI 95% = 0.30; 0.88). Caregivers who trusted doctors to make the best decisions for their loved ones and English-speaking caregivers were more willing to utilize hospice services, while caregivers who held a strong belief that hospice care means giving up on life were less likely to consider using hospice care for their loved ones. SIGNIFICANCE OF RESULTS: The willingness of family caregivers to use hospice services for their loved ones is influenced by cultural perspectives about hospice care. As the importance of family involvement in EoL care planning has been highlighted, family caregivers' beliefs about hospice care services need to be addressed within their particular cultural context.

Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis.

OBJECTIVE: Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality. METHOD: A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by the I 2 test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence. RESULTS: Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI 95%] = -2.22-2.61 days; p = 0.87; I 2 = 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66; CI 95% = 0.52-0.84; p < 0.01; I 2 = 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively. SIGNIFICANCE OF RESULTS: Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.

3D Markov Process for Traffic Flow Prediction in Real-Time.

Recently, the correct estimation of traffic flow has begun to be considered an essential component in intelligent transportation systems. In this paper, a new statistical method to predict traffic flows using time series analyses and geometric correlations is proposed. The novelty of the proposed method is two-fold: (1) a 3D heat map is designed to describe the traffic conditions between roads, which can effectively represent the correlations between spatially- and temporally-adjacent traffic states; and (2) the relationship between the adjacent roads on the spatiotemporal domain is represented by cliques in MRF and the clique parameters are obtained by example-based learning. In order to assess the validity of the proposed method, it is tested using data from expressway traffic that are provided by the Korean Expressway Corporation, and the performance of the proposed method is compared with existing approaches. The results demonstrate that the proposed method can predict traffic conditions with an accuracy of 85%, and this accuracy can be improved further.

What Constitutes a Good and Bad Death?: Perspectives of Homeless Older Adults.

This qualitative study explored perspectives toward a good or bad death among 21 older homeless adults residing in transitional housing. Using grounded theory approach, the themes for a good death were (a) dying peacefully; (b) not suffering; (c) experiencing spiritual connection; and (d) making amends with significant others. Themes for a bad death were (a) experiencing death by accident or violence; (b) prolonging life with life supports; (c) becoming dependent while entering a dying trajectory; and (d) dying alone. Healthcare professionals need to develop approaches for end-of-life care grounded in understanding unique needs of older homeless adults.

Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation.

OBJECTIVE: This study aimed to describe knowledge of an advance directive (AD) and preferences regarding end-of-life (EoL) care communication, decision making, and designation of surrogates in Chinese-American elders and to examine the role of acculturation variables in AD awareness. METHOD: Survey data were collected through face-to-face interviews on a sample of 385 Chinese-American elders aged 55 or above living in the Phoenix metropolitan area. The choice of language (Mandarin, Cantonese, or English) and place of interview (senior apartments, Chinese senior centers, or homes) was at the respondent's preference. Hierarchical logistic regression analysis was employed to examine the influence of acculturation variables on AD awareness. RESULTS: Some 21% of participants had heard about ADs, and only 10% had completed one. Elders with higher acculturation levels (OR = 1.04, p < 0.10) and those residing more than 20 years in the United States (OR = 6.87, p < 0.01) were more likely to be aware of ADs after controlling for the effects of demographics, health, and experiences of EoL care. The majority preferred physicians to initiate AD discussions (84.9%) and identified burdens on families as the most important factor in making EoL decisions (89.3%). About 55.1 % considered daughters as the preferred healthcare surrogate. SIGNIFICANCE OF RESULTS: Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.

Hyaluronic Acid Based Adipose Tissue-Derived Extracellular Matrix Scaffold in Wound Healing: Histological and Immunohistochemical Study.

BACKGROUND: In this study, we explored the potential of human adipose tissue-derived extracellular matrix (adECM) sheets augmented with crosslinked hyaluronic acid (HA) as advanced wound dressings. We aimed to enhance healing efficacy while optimizing cost efficiency. METHODS: The adECM was processed from healthy donor tissue and combined with crosslinked HA to form ECM-HA sheets (Scaffiller, Medikan, Korea). In vitro experiments involved seeding adipose-derived stem cells (ASCs) onto these sheets and assessing cell survival and cytokine production. In vivo testing utilized a rat wound model, comparing ECM-HA sheet with HA-based dressing and polyurethane foam dressing. Re-epithelialization and collagen deposition were examined through histopathological examinations, whereas immunohistochemistry was used to assess CD31, alpha smooth muscle actin (α-SMA), and Tenascin C expression as contributing factors to wound healing. RESULTS: Results indicated that ECM-HA sheets were produced efficiently, with enhanced growth factor production and ASC survival observed in vitro. In vivo, ECM-HA sheets demonstrated accelerated wound healing, evidenced by improved epithelialization, thicker dermis, increased collagen deposition, and enhanced vascularity. Notably, they exhibited reduced myofibroblast activity and increased expression of Tenascin C, suggesting a favorable healing environment. CONCLUSION: ECM-HA sheets offer a promising approach for wound management, combining the benefits of adECM and HA. They present improved stability and cost-effectiveness while promoting essential aspects of wound healing such as angiogenesis and collagen formation. This study underscores the therapeutic potential of ECM-HA sheets in clinical applications aimed at facilitating wound repair.

Good and bad death: exploring the perspectives of older Mexican Americans.

The purpose of this study was to identify and describe the domains that define a good death from the perspectives of healthy Mexican American older adults. Qualitative data from face-to-face interviews with 18 participants residing in Southern California were analyzed. Five categories regarding the concepts of good and bad death include no suffering, living life with faith, having time for closure with family, dying at home, and a natural death. Understanding the meaning of good and bad death within specific cultural contexts is integral to promoting cultural sensitivity when working with older adults, especially in end-of-life care.