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Background Dying at home accompanied by loved-ones is regarded favorably and brings good luck in Taiwan. This study aimed to examine the relevant factors affecting whether an individual dies at home or not in a group of terminal patients receiving palliative home care service. Methods The patients who were admitted to a palliative home care service at a hospital-affiliated home health care agency were consecutively enrolled between March 1, 2021 and March 31, 2022. During the period of care, the instruments of the palliative care outcomes collaboration was used to assess patients in each home visit twice a week, including symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, resource utilization groups-activities of daily living, and palliative care phase. Results There were 56 participants (53.6% female) with a median age of 73.0 years (interquartile range (IQR) 61.3–80.3 y/o), of whom 51 (91.1%) patients were diagnosed with cancer and 49 (96.1%) had metastasis. The number of home visits was 3.5 (IQR 2.0–5.0) and the average number of days under palliative home care service was 31 (IQR 16.3–51.5) before their death. After the end of the study, there was a significant deterioration of sleeping, appetite, and breathing problems in the home-death group, and appetite problems in the non-home death patients. However, physician-reported psychological/spiritual problems improved in the home-death group, and pain improved in the non-home death patients. Physical performance deteriorated in both groups, and more resource utilization of palliative care was needed. The 44 patients who died at home had greater cancer disease severity, fewer admissions, and the proportion of families desiring a home death for the patient was higher. Conclusions Although the differences in palliative outcome indicators were minor between patients who died at home and those who died in the hospital, understanding the determinants and change of indicators after palliative care service at different death places may be helpful for improving the quality of end-of-life care.

Background Access to imaging reports and review of the breast imaging directly with a patient with breast cancer helps improve the understanding of disease extent and severity. A 3D printed breast model can further enhance a patient’s understanding and communication with the healthcare team resulting in improved patient comprehension and patient input with reduced treatment decision conflict. Furthermore, 3D printed models can facilitate training of residents and fellows involved in the diagnosis and treatment management of breast cancer. Case presentation We present a 3D printed breast tumor model segmented from positron electron tomography/computed tomography and fabricated via desktop vat polymerization as proof of concept for treatment planning for a patient diagnosed with triple negative inflammatory breast carcinoma. Conclusion We illustrate benefits and indications for 3D printing in the management of breast cancer and specifically inflammatory breast cancer in this case. Fabrication and implementation of 3D printed models enhances patient’s understanding and communication with the healthcare team regarding their condition, treatment options and anticipated outcomes. It provides personalized treatment planning by examining patient-specific pathology and the anatomic spatial relationships. Furthermore, 3D printed models facilitate medical education for trainees across disciplines involved in the patient’s care.

Background Advanced diagnostic imaging is an essential part of preoperative planning for oral and maxillofacial surgery in veterinary patients. 3-dimensional (3D) printed models and surgical guides generated from diagnostic imaging can provide a deeper understanding of the complex maxillofacial anatomy, including relevant spatial relationships. Additionally, patient-specific 3D printed models allow surgeons and trainees to better examine anatomical features through tactile and visuospatial feedback allowing for improved preoperative planning, intraoperative guidance, and enhanced trainee education. Furthermore, these models facilitate discussions with pet owners, allowing for improved owner understanding of pathology, and educated decision-making regarding treatment. Case presentation Our case series consists of three 3D printed models segmented from computed tomography (CT) and cone beam CT (CBCT) and fabricated via desktop vat polymerization for preoperative planning and intraoperative guidance for resection of maxillary osteosarcoma, mandibular reconstruction after mandibulectomy, and gap arthroplasty for temporomandibular joint ankylosis in dogs. Conclusions We illustrate multiple benefits and indications for 3D printing in veterinary oral and maxillofacial surgery. 3D printed models facilitate the understanding of complex surgical anatomy, creating an opportunity to assess the spatial relationship of the relevant structures. It facilitates individualized surgical planning by allowing surgeons to tailor and augment the surgical plan by examining patient-specific anatomy and pathology. Surgical steps may also be simulated in advance, including planning of osteotomy lines, and pre-contouring of titanium plates for reconstruction. Additionally, a 3D printed model and surgical guide also serve as invaluable intraoperative reference and guidance. Furthermore, 3D printed models have the potential to improve veterinary resident and student training as well as pet owner understanding and communication regarding the condition of their pets, treatment plan and intended outcomes.

Porous texture of graphene-hydrogel electrode material is critical for the performance of supercapacitors. In this work, the pore channels are controlled by two aspects, including the graphene oxide concentration and the pressure for fabricating hydrogel electrodes. It is found that the sample starting from 3 mg ml−1 graphene oxide shows the largest specific capacitance of 297 F g−1 at a current density of 0.5 A g−1 in 2 M KOH solution after the hydrothermal process. By increasing the pressure to 10 MPa, the electrochemical performance can be further improved to 330 F g−1. This good performance is mainly attributed to the preferable specific surface area (2110 m2 g−1) and the dense laminated structure under the optimizing preparation conditions. Besides, the cycle measurement demonstrates the excellent cycling stability of the samples, while 88% of its initial capacitance can be retained after 10,000 cycles.

Barium zirconate titanate (BaTi0.7Zr0.3O3) ceramics were prepared via spark plasma sintering (SPS) and conventional solid-state sintering (CS). Both samples exhibited single phase nature as confirmed from the X-ray diffraction analysis. Compared with CS sample, more homogeneous microstructure with smaller grain size was observed in the SPS sample, which greatly improved the dielectric strength of BaTi0.7Zr0.3O3 ceramics from 40 (CS) to 170 kV/cm (SPS). Although the polarization of SPS sample was lower than that of CS sample under the same applied electric field, the maximum energy storage density was improved to 0.51 J/cm3, which was about 4.5 times higher than that of the CS sample (0.12 J/cm3). Moreover, finite element simulation on the local dielectric field distribution was carried out, and the effects of microstructure on the dielectric strength were further confirmed.

Secondary forests account for a large amount of subtropical forest due to persistent anthropogenic disturbance in China. The interaction between vegetation and soil during recovery process is rather complex and dependent on forest conditions. Understanding how vegetation and soil properties changes and how their relationship develops in secondary forests is key to effective forest restoration and management. Here we explored the patterns of vegetation and soil properties as well as their correlations during forest recovery process in a subtropical forest in south China. Plots of three forest types, i.e., broadleaf-conifer mixed forest, broadleaved forest and old growth stand, were established to represent the recovery stages. The results showed that diversity patterns in the tree, shrub and herb layers were different: in the tree layer the species diversity peaked at the intermediate stage, while in the understory layers it decreased chronologically. Most of the soil factors showed an increasing trend, and different effects of soil factors were found for the three layers as well as for the two spatial scales. Together, our results suggested that vegetation and soil might be interdependent during the recovery course. Further studies are needed on exploring how vegetation interplays with soil at different scales and how nutrient limitations affects the vegetation development in a chronosequence.

The purpose of this study was to determine if CT for appendicitis can be abbreviated to begin at the top of the L2 vertebral body level and still maintain the detection rate of appendicitis and other symptomatic pathology without omitting significant incidental findings. Retrospective review of CT abdomen-pelvis exams for suspected appendicitis over a 5-month period was performed. The Z-axis scan length of the original full scans and theoretical limited scans from the top of L2 were recorded and calculated. Images were reviewed for incidental findings above the L2 vertebral body level and categorized by severity per American College of Radiology (ACR) white paper guidelines. Final diagnoses based on imaging findings were also recorded. One hundred nineteen patients (46 males, 73 females, mean age 29 ± 14) were included. Appendicitis was present in 26 cases (22%). Using a theoretical scan beginning at the top of the L2 vertebral body, none of the findings leading to diagnosis of appendicitis would have been missed. A total of 30 incidental findings were found above the L2 vertebral body. Per ACR white paper guidelines, 26 of these findings did not require additional imaging follow-up. Additional follow-up imaging was recommended for 3 of the findings above L2, and 1 right adrenal metastasis was found above L2 in a patient with previously undiagnosed NSCLC. This patient coincidentally also had appendicitis. No symptomatic pathology would have been missed had the scans begun at the top of the L2 vertebral body. Such an abbreviated scan would have resulted in a mean Z-axis reduction of 12.9 cm (30.3%). CT using abbreviated Z-axis scan length can reduce radiation dose and provide necessary imaging needed to diagnose appendicitis or other symptomatic pathology without omitting significant incidental findings.

Resilience has gained considerable attention over recent years in both theories and decision-making practices. In Taiwan, the term resilience is generally considered as a synonym for adaptation. This may limit the use of the notion. By understanding resilience in terms of adaptation and mitigation, we identify six attributes for assessment. The assessment is addressed in local level climate change adaptation policies in two selected cities. The city of Taipei represents places where local adaptation policies were directed mainly by the national government. The city of Tainan represents places where the municipal government plays a more critical role in framing these policies. This can result in different policymaking considerations. The assessment points out that the proposed actions of these policies are broader than a general understanding of adaptation. Mitigation strategies are addressed and sometimes highly recommended. Because of this, we can interpret these actions as resilience strategies covered under the use of the term adaptation. The notion of resilience does not stay on the rhetorical level alone. It is happening in shaping decisions – without using the terminology directly. The broadness of the resilience notion, in spite of being abstract, can provide a more general framework for cross-sectorial discussion and collaboration in policy-making. This is particularly important for dealing with complex issues, such as climate-related disturbances, which cannot be managed by a single group of professions.

To retrospectively compare the safety and efficacy of radiofrequency ablation (RFA) with laparoscopic adrenalectomy (LA) in treating aldosterone-producing adenoma (APA) of the adrenal gland. From September 2009 to September 2013, seven patients, diagnosed with unilateral adrenal APA and underwent computed tomography (CT)-guided percutaneous RFA, were recruited in this retrospective study. Eighteen unilateral adrenal APA with the same tumor size (

The carcinogenesis of transitional cell carcinoma (TCC) of the urinary bladder involves etiological factors, such as ethnicity, the environment, genetics, and diet. Cluster of differentiation (CD44), a well-known tumor marker, plays a crucial role in regulating tumor cell differentiation and metastasis. This study investigated the effect of CD44 single nucleotide polymorphisms (SNPs) on TCC risk and clinicopathological characteristics. Five SNPs of CD44 were analyzed through real-time polymerase chain reaction in 275 patients with TCC and 275 participants without cancer. In this study, we observed that CD44 rs187115 polymorphism carriers with the genotype of at least one G were associated with TCC risk. Furthermore, TCC patients who carried at least one G allele at CD44 rs187115 had a higher stage risk than did patients carrying the wild-type allele (p

Background: This is a study of the causes of 30-day postoperative death following surgical treatment for obesity and a search for ways to decrease an already low mortality rate. Methods: Data were contributed from 1986-2004 to the International Bariatric Surgery Registry by 85 sites, representing 137 surgeons. A spread-sheet was prepared with rows for causes and columns for patients. The 251 causes contributing to 93 deaths were then marked in cells wherever a patient was noted to have one of the causes. Rows and columns were then moved into positions that provided patterns of best fit. Results: 11 patterns were found. 10 had well known initiating causes of death. Overall operative 30-day mortality was 0.24% (93 / 38,501). The most common cause of death was pulmonary embolism (32%, 30/93). 14 deaths were caused by leaks (15%, 14/93), and were equally prevalent after simple (15%, 2/14) or complex (15%, 12/79) operations. Small bowel obstruction caused 8 deaths, exclusively after complex operations. 5 of these involved the bypassed biliopancreatic limb and were defined as "bypass obstruction". Conclusions: A spread-sheet study of cause of 30-day postoperative death revealed a rapidly lethal initiating complication of Roux-en-Y gastric bypass obstruction that requires the earliest possible recognition and treatment. Bypass obstruction needs a name and code to facilitate recognition, study, prevention and early treatment. Spread-sheet pattern analysis of all available data helped identify the initiating cause of death for individual patients when multiple data elements were present.