Industry Payments Comparison Between Female and Male Mohs Surgeons From 2015 to 2021.

BACKGROUND: There are limited data on female Mohs surgeon industry relationships. OBJECTIVE: To evaluate industry payment activity between female and male Mohs surgeons. MATERIALS AND METHODS: A retrospective review of the U.S. Centers for Medicare and Medicaid Services open payments data was performed between 2015 and 2021 for Mohs surgeons in the United States. Gender, academic affiliation, practice region, annual total payment, cumulative payment, and industry payment type was collected. RESULTS: Male Mohs surgeons received higher mean total payments than female Mohs surgeons ( p = .04), which persisted when data were stratified based on industry payment type and practice region. Both genders had similar median total payments ( p = .4). Females in academic practice received higher mean total payments than those in private practice. Females experienced a significant lower mean total payment compared with males in the South ( p = .03). CONCLUSION: High total payments received by male Mohs surgeons skewed the data, which is supported by a significant mean total payment difference despite a similar median total payment distribution. Female Mohs surgeons receiving the top payments may address this mean payment difference. Females seem to have higher payments if they practice in the Northeast and are in academics. Further studies are needed to evaluate this payment gap.

Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology.

BACKGROUND: According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown. OBJECTIVE: To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus. METHODS: An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery. RESULTS: Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training. CONCLUSION: Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.

Probing corrosion using a simple and versatile in situ multimodal corrosion measurement system.

In this work, we have developed a unique in situ multimodal corrosion system that is capable of acquiring electrochemical data, sample imaging/visualization and hydrogen collection, simultaneously. Each of these modalities yield valuable information pertaining to the ongoing corrosion process. Combining them can yield holistic information on the role of microstructure, processing history, presence of coatings, etc., on the sequence of steps occurring during the corrosion process, and how they correlate with the acquired electrochemical data. Four materials systems, namely AA6061-T6 aluminum alloy, AZ91 magnesium alloy, galvanized DP590 steel, and pure Zn, were investigated under open circuit potential and under potentiodynamic polarization. The multimodal corrosion system was utilized to observe processes such as surface passivation and dissolution, pit and filiform corrosion initiation and propagation, and was correlated with location and magnitude of hydrogen evolution. This approach is shown to yield a truly multimodal understanding of the ongoing corrosion processes.

Evaluation of Hydrogen Gettering Rates Correlated to Surface Composition and Texture of Nickel-Plated Zircaloy Getters of Different Heat Treatment Procedures.

Coatings of metal specimens are known to have an impact on hydrogen gettering (hydrogen absorption). The coating can have one or more functions, such as enhancing gettering, preventing gettering and/or preventing oxidation of the metal substrate. It is known that contaminants and surface texture can impact hydrogen gettering/absorption performance, but has not previously been thoroughly explored. This study evaluated the role of different post-plating heat treatments of nickel-plated zircaloy-4 getters (NPGs) and the role of the heat treatments on gettering rates, surface composition and texture. Nickel plating is applied to prevent oxidation of the Zircaloy-4 surface and also enhances gettering. The nickel plating must be heat treated before desirable gettering can occur. Our NPG getters with historically known satisfying performance were pre-heat treated in air followed by activation heat treatment in a vacuum at a higher temperature. In this study, we were interested in finding out if both heat treatment steps were necessary to obtain a desirable gettering performance, or if one step could be omitted. XPS analysis showed that if the nickel surface is not heat treated before bonding the nickel to the zirconium in the activation step, there will be carbon contaminants on the surface, which significantly reduces gettering. We studied the texture of Zircaloy-4 using SEM/EBSD to compare NPGs with both heat treatment steps with NPGs that had no post-plating heat treatment to learn if the degree of cold work could be impacted by the heat treatment steps. We did not observe any differences in texture between them. We measured gettering rates of both pretreated and activated NPGs and NPGs that had been activated without first being pre-heat treated. We found that the NPGs without the first post-plating heating step had up to a seven times slower gettering rate and obtained higher plateau pressures due to the contaminated surface. Thus, the pre-heat treatment in air before activation is necessary to avoid slower gettering rates and higher plateau pressures.

Squamous Cell Carcinoma: An Update in Staging, Management, and Postoperative Surveillance Strategies.

The rising incidence of cutaneous squamous cell carcinoma (cSCC) represents a public health crisis. Although most cases of cSCC are cured with surgical excision alone, high-risk disease requires a coordinated strategy involving accurate staging, possible multimodal therapy, and clinical and radiologic surveillance. In the following review, we present an evidence-based update on the current paradigm of diagnosis and management of cSCC and discuss the most relevant areas of active research related to prognostic staging as well as the appropriate use of radiologic imaging and adjuvant therapy.

Impact of COVID-19 on public's interest in radiotherapy and other cancer treatments: a cross-sectional Google Trends analysis.

Background: COVID-19 has significantly impacted cancer care. While previous studies have emphasized treatment modification and prioritized the delivery of cancer care, few have examined this issue from the public perspective. Materials and methods: In the following study, we examine how public interest in various forms of cancer treatment has evolved during the pandemic using Google Trends. One-way ANOVA and linear regression tests were used to compare the mean search volume indices of three periods: pre-lockdown, lockdown, and reopening. Results/Conclusions: Our findings suggest that public interest in cancer treatments decreased during lockdown and returned after reopening but, in general, is still lower than pre-lockdown levels. Despite that, healthcare professionals should strive to provide timely cancer care, assuage patients' fears of healthcare settings, and encourage patients to continue proper cancer screenings.

Controllability and state feedback control of a cardiac ionic cell model.

A phenomenon called alternans, which is a beat-to-beat alternation in action potential (AP) duration, sometimes precedes fatal cardiac arrhythmias. Alternans-suppressing electrical stimulus protocols are often represented as perturbations to the dynamics of membrane potential or AP duration variables in nonlinear models of cardiac tissue. Controllability analysis has occasionally been applied to cardiac AP models to determine whether different control or perturbation strategies are capable of suppressing alternans or other unwanted behavior. Since almost all previous cardiac controllability studies have focused on low-dimensional models, we conducted the present study to assess controllability of a higher-dimensional model, specifically the Luo Rudy dynamic (LRd) model of a cardiac ventricular myocyte. Higher-dimensional models are of interest because they provide information on the influence of a wider range of measurable quantities, including ionic concentrations, on controllability. After computing modal controllability measures, we found that larger eigenvalues of a linearized LRd model were on average more strongly controllable through perturbations to calcium-ion concentrations compared with perturbations to other variables. When only membrane potential was adjusted, the best time to apply perturbations (in the sense of maximizing controllability of the largest alternans eigenvalue) was near the AP peak time for shorter cycle lengths. Controllability results were found to be similar for both the default model parameters and for an alternans-promoting parameter set. Additionally, we developed several alternans-suppressing state feedback controllers that were tested in simulations. For the scenarios examined, our controllability measures correctly predicted which strategies and perturbation timings would lead to better feedback controller performance.

Comparison of Survival Outcomes With/Without Adjuvant Radiation Therapy in Desmoplastic Melanoma.

BACKGROUND: Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma with a high rate of local recurrence. Recent studies have indicated a potential benefit in local control with the addition of adjuvant radiotherapy (RT). OBJECTIVE: This study sought to evaluate the outcomes of adjuvant RT for patients with DM. MATERIALS AND METHODS: The National Cancer Database was queried (2004-2015) for patients with newly diagnosed, nonmetastatic DM. Patients were divided into 2 groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS. RESULTS: There was no difference in median OS between patients treated with RT when compared with patients observed (111.4 months vs 133.9 months, p = .1312). On multivariable analysis, older age, T stage ≥2, N stage ≥1, and no receipt of immunotherapy were associated with worse OS. CONCLUSION: In this large study evaluating efficacy of adjuvant RT in DM, no overall survival benefit was observed among patients receiving adjuvant RT.

Immunohistochemistry Utilization in Medicare Beneficiaries by Mohs Surgeons From 2012-2017.

Based on surveys by Robinson1 in 2001 and Trimble and Cherpeli2 in 2013, Immunohistochemistry (IHC) utilization in Mohs micrographic surgery (MMS) has been rising. Although these surveys provided important subjective data regarding IHC use in MMS, there is a paucity of objective data describing its current utilization patterns. The objective of this study is to characterize IHC utilization during MMS by Mohs surgeons in the treatment of Medicare beneficiaries from 2012-2017.

Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment.

Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed.

Observability analysis and state observer design for a cardiac ionic cell model.

To gain insights into cardiac arrhythmias, researchers have developed and employed various measurement techniques, such as electrocardiography, optical mapping, and patch clamping. However, there are no measurement methods that allow simultaneous recording of all cellular quantities, including intracellular ionic concentrations and gating states, that may play an important role in arrhythmia formation. To help address this shortcoming, we applied observability analysis, a method from control theory, to the Luo-Rudy dynamic (LRd) model of a cardiac ventricular myocyte. After linearizing the time-integrated LRd model about selected periodic orbits, we computed the observability properties of the model to determine whether past system states could be reconstructed from different hypothetical sets of measurements. Under the simplifying assumption that only one dynamical variable could be measured periodically, we found that intracellular potassium concentration generally yielded the largest observability values and thus contained the most information about the dominant modes of the system. The impacts on observability of measurement timings, inter-stimulus interval length, and an alternans-promoting parameter shift were also studied. Pole-placement state observer algorithms were designed and tested in simulations for several scenarios, and we found that it is possible to infer unmeasured variables from potassium-concentration measurements, and to an extent from membrane-potential measurements, both for longer periods that represent normal rhythms and shorter periods associated with tachyarrhythmias. Our results could lead to improved data assimilation algorithms that combine model predictions with measurements to estimate quantities that are difficult or impossible to measure during in vitro experiments.