The development of a rural breast reconstruction service: patient reported outcomes and benefits.

BACKGROUND: In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. RESULT: Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. CONCLUSION: Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.

Common clothing area factor estimation equations are inaccurate for highly insulating (Icl>2 clo) and non-western loose-fitting clothing ensembles.

The aim of this study was to evaluate the equations for calculating the clothing area factor (fcl) used in the standards based on data sets of clothing ensembles, that are meant to provide thermal comfort over a wide range of climatic conditions from hot summer days to extremely cold winter. Over 10 equations for fcl calculations were selected from the international standards and the literature. At first a theoretical comparison based on a range of insulation values was performed. Then the data sets were used to compare the equations and measurements on real clothing systems. Most of the fcl calculation equations do give reasonably good results for western type and industrial clothing with basic insulation (Icl) up to 1.5 clo. Above the Icl of 2 clo, the error in the calculations based on traditional equations increases considerably and they overestimate fcl. Some new equations were suggested for modern clothing systems. Oppositely, for non-western clothing (for hot climate), the available equations did give good match only for very light clothing sets and commonly underestimated the real fcl. For such sets and and fashion clothes their own equations maybe needed, that count for various design aspects, e.g. fit, draping etc.

Validation of ISO 9920 clothing item insulation summation method based on an ambulance personnel clothing system.

This study aimed to validate the summation methods suggested by ISO 9920. Twenty seven items from an ambulance personnel clothing system were selected for testing. The basic insulation of each garment item (Iclu) was calculated based on the thermal manikin tests. More than 100 realistic clothing combinations were compiled and basic insulation (Icl) of these ensembles was calculated according to ISO 9920. These were ranked after the calculated insulation, and 14 sets covering insulation from 0.63 to 3.33 clo were measured on the thermal manikin for acquiring the basic clothing insulation (Icl). Regression analysis was used to compare the summed and measured Icl values. The difference between values varied from -18 to 12%. The highest percentual difference was for the lightest clothing sets, while the absolute differences were similar over the whole insulation range ranging between -0.17 to 0.18 clo with an average difference of 0.02 clo (-0.16%). All basic insulation values stayed very close to the line of identity (R2=0.98). The summation equation gave, in the case of this ambulance clothing system, very close results to the measured values. This encourages evaluating and selecting protective clothing combinations for thermal comfort based on individual item measurements.

Insulation and Evaporative Resistance of Clothing for Sugarcane Harvesters and Chemical Sprayers, and Their Application in PHS Model-Based Exposure Predictions.

Many workers are exposed to heat stress that can be exacerbated by the type of clothing they wear. The resulted heat strain can lead to short or long-term heat-related disorders. This study aimed to measure clothing properties of sugarcane field workers and evaluate the heat strain by an international standard, predicted heat strain model (PHS). The clothing thermal insulation and evaporative resistance values of sugarcane cutter and chemical sprayer outfits were acquired for the whole body, body regions and specific body parts via thermal manikin measurements. The detailed clothing insulation values of body parts can be utilized in advanced thermo-physiological models, while in this study, the values for the whole body together with weather data were used in PHS. Estimated duration limited exposure times (DLE) for an hour-by-hour prediction over a workday and for a range of high humidity scenarios were calculated. Such evaluation tools can be used for risk assessment and management to support organizational measures and prepare equipment and materials in the case of hot weather events in order to avoid dehydration and other heat-related disorders.

Determination of car seat contact area for personalised thermal sensation modelling.

A lot of daily activities are conducted in a sedentary posture. This includes a thermal interaction between the human and the seat that has implications on thermal perception and comfort. These interactions are investigated by simulating heat and mass transfer, thus, reducing a need for costly and time demanding subject studies. However, it is not clear, from the available literature, what portion of the body surface area is actually affected by the seat with respect to human anthropometry. The aim of this study was to develop a predicting function of the seat contact area based on anthropometric parameters. The results showed strong linear correlation between the contact area obtained by printing a body silhouette on paper placed at the seat and body weight, height, body surface area, and body mass index. The body surface area and the body weight were identified as the best predictors for the contact area.

Quantitative morphometric outcomes following the Melbourne method of total vault remodeling for scaphocephaly.

The Melbourne method of total vault remodeling was developed at The Royal Children's Hospital (Melbourne) to address all phenotypic aspects of scaphocephaly. To quantitatively evaluate this technique, a retrospective analysis was performed on 33 consecutive patients who underwent the Melbourne procedure between October 2004 and June 2007. To monitor outcomes, three-dimensional digital surface photography was used, obtaining 4 anthropometric measurements (cranial length, cranial width, head circumference, auricular head height) preoperatively and postoperatively. To assess the effect on continuing cranial vault development, cranial volume was calculated with computed tomography. Anthropometric measurements were obtained in 27 patients (81.8%), with a mean postoperative follow-up of 8.9 months. Cranial index (width/length) demonstrated an 11.1% improvement. The mean head circumference in the scaphocephaly group preoperatively remained larger than the normative population postoperatively, although the magnitude of difference was decreased, whereas the mean auricular head height demonstrated a 10.5% increase postoperatively, remaining higher than the normative population. Cranial volume was calculated in 30 patients (91%), with a mean postoperative follow-up of 7.9 months. This demonstrated that the mean intracranial volume was significantly higher in the scaphocephaly group preoperatively, and this difference was maintained postoperatively. These results support our belief that the Melbourne procedure is a technique that may be used to correct all phenotypic aspects of scaphocephaly, with no apparent evidence for a detrimental effect on cranial growth.

Lipoblastoma: An important differential diagnosis of tumours of the hand in children.

Lipoblastoma is a rare benign neoplasm of infancy and childhood with the potential for locally invasive, rapid growth. It has an excellent prognosis, and does not metastasise. An important differential diagnosis for these rapidly-enlarging tumours is liposarcoma. Ultrasound, magnetic resonance imaging, fine needle aspiration, and cytogenetics are important diagnostic tools for this rare tumour. We present two cases of lipoblastoma of the hand that were excised within a three month period with no evidence of recurrence at 14, and 12, months respectively.