Destructive Procedures Research Articles

Methodological notes on physical parameters of low-level laser irradiation. Part 2. Light dosage at laser therapeutic sessions

Purpose. The general goal of this methodological article, consisting of two parts, is to provide a unifying theoretical approach to the still debated problem on determining the depth of laser light penetration into biotissues and the dosage of laser therapeutic effect from the standpoint of modern medical physics. The purpose of the second part of the article is to demonstrate that calculation of the absorbed dosage at laser therapy sessions is similar to the calculation of classical doses in radiobiology and radiation therapy.Materials and methods. The authors reviewed current state of terms and definitions related to the calculation of doses in ionizing and non-ionizing radiation. The Monte Carlo method was used to simulate the soft tissue volume in which 95 % of radiation energy is absorbed. A classical absorbed dose measured in Grays was estimated. Numerical simulation of absorbed doses for various typical laser therapy procedures was performed.Results. It has been shown that the effective irradiated volume of tissues, despite of small variations in soft tissue density between patients, allows to calculate the absorbed radiation dose in Grays, similar to radiobiological doses. Comparative findings on a single local absorbed dose for various percutaneous therapeutic procedures do not contradict the known clinical data, and even more, make the relationship of different doses for different therapeutic purposes more clear. As it has been found, typical doses range from 0.7 Gy for intravascular blood irradiation to 106 Gy for destructive photodynamic therapy and UV therapy procedures in dermatology.Conclusion. The proposed methodological approach proposes a new look at both the problem of the depth of laser light penetration into biotissues and the problem of laser light doses during therapeutic and diagnostic procedures from a unified medical and physical standpoint.

Post Neck Radiation Cancer Carotid Pseudoaneurysm Blowouts with Viabahn Stent Placement

Carotid Blowout Syndrome (CBS) is a critical and often fatal complication associated with head and neck malignancies. CBS is characterized by three stages: threatened, impending, and acute rupture/hemorrhage. The condition is notably linked with a history of radiotherapy for head and neck cancers, with an incidence of approximately 3-4% among those who have received such treatment. Historically, surgical management of CBS has involved open surgical ligation. However, advancements in endovascular techniques, including endovascular destructive procedures (e.g., coil embolization) and reconstructive procedures (e.g., carotid artery stenting), have become increasingly prevalent. This report presents two cases where a self-expandable PTFE-coated nitinol stent with a heparin coating (Viabahn; Gore and Associates) was utilized in the treatment of CBS.

Sustainable Electromagnetic Prototype for Detecting Internal Deterioration in Building Walls.

The aim of this study was to develop a sustainable electromagnetic prototype to detect the interior deterioration of walls in buildings in order to mitigate uncertainty as it is a challenge to observe the interior state of walls without utilising destructive procedures. The method used was experimental, developmental and quantitative in its approach. The inductance, electric current, modulated frequency and power of the electromagnetic field were used to penetrate the constructed specimens, which were built of materials such as concrete, brick, adobe, plaster and fine sand and had walls with a thickness of less than 300 millimetres. The results show that the optimum value of the magnetic field was 0.18 µT, which was sufficient to penetrate 150 mm with densities between 1.0 and 2.4 g/cm3 and porosities between 11 and 60%. The current and wave each had a coefficient of determination R2 = 0.8914, and the average inductance value was 184 µH, which was established with an air core of radius 9.75 cm and with 19 turns with AWG-25 wire. The frequency-modulated signal ranged in the audible zone between 10 and 22 kHz. The presented prototype detects the interior deterioration of the walls of the building, and the signal is reflected on a metallic guide on the opposite side of the wall with a reading error of 5%. The use of this prototype does not represent a risk to the operator or the environment.

A prospective, randomized, single-blinded study evaluating the effect of frozen-section directed excision on positive surgical margins in high-grade vulvar dysplasia.

TPS5644 Background: Vulvar cancer accounts for 2-5% of gynecologic malignancies. As with many skin cancers, vulvar cancer is preceded by a dysplastic state. Currently, wide local excision (WLE) is the surgical treatment modality used to excise visually dysplastic tissue, with a 0.5 cm border. However, this methodology does not incorporate the risk of microinvasion and positive margins on the tissue sample. The significance in having positive margins is a 3-fold higher risk of recurrence when positive margins are present. Our study seeks to compare this current standard of care with a frozen section directed excision, which is similar to Mohs Surgery, a long-established surgical technique mainly used in dermatology. This technique allows for repeated pathologic evaluation to ensure negative margins are present before cessation of the surgery. The goal of this study is to show the superiority of Frozen-Section Directed Excision (FSDE) in conducting vulvectomies in reducing positive margin rates, thus potentially reducing recurrence rates. Methods: This is a prospective randomized, single-blinded study. The target population is adults ≥ 18 years of age with histological or cytological confirmation of VIN 2, VIN 3, VIN 2/3 or High-grade Dysplasia NOS with a planned excisional procedure, with high suspicion by the enrolling investigator that gross surgical margins of ≥ 3 mm can be achieved without laser or other destructive procedures. One group of subjects is assigned to the FSDE surgery arm and will undergo this procedure. The other group of subjects will be assigned to the WLE (standard of care) arm and will undergo that procedure. The randomization will be 1:1. This trial is designed as a group sequential study with two primary analysis timepoints. The interim analysis will occur after the surgical margin status is known for the first 56 evaluable subjects and the second after all (112 targeted) evaluable subjects. Information regarding the surgery procedure, the amount of time the surgery procedure takes, and total amount of pain medication required during surgery and while in the surgery recovery area will be collected. The study team will also look at recurrence rates in six months, if any other therapies are required, and subject satisfaction related to the surgery, recovery, and sexual function by using questionnaires before and after the procedure. Based on previously published cases and a review of cases of vulvar excision at our institution, it is anticipated that the rate of positive margins will exceed 50% with standard surgery. It is expected that FSDE will reduce the positive margin rate by at least 50%. Assuming 56% of standard surgeries result in positive margins and a two-tailed alpha of 0.05, 56 subjects per arm or a total of 112 evaluable subjects will provide 80% power to detect this difference. Clinical trial information: NCT05934851 .

Popularizing Surgical Cures: Walter Dandy and the Vestibular Neurectomy for Menière's Disease at the Johns Hopkins Hospital.

To uncover the context that allowed for the vestibular neurectomy to grow in favor and practice at the Johns Hopkins Hospital in the early 20th century, and the reasons for its broad abandonment since. The Walter E. Dandy (1905-1946) and Samuel J. Crowe collections (1905-1920) at the Alan Mason Chesney Medical Archives were reviewed, as well as the Samuel J. Crowe and Stacy Guild Temporal Bone Collection. Speculation on the etiology of Menière's disease (MD) has been countless, as have the medical and surgical interventions aimed at treating it. At the Johns Hopkins Hospital, Walter Dandy popularized the neurectomy for MD and performed 692 procedures from 1924 to 1946, believing it to be a curative therapy for vertigo. When he later modified the procedure from a total cranial nerve section to a partial vestibular neurectomy preserving auditory function, surgical candidacy expanded to include nearly any patient with vestibular symptoms. After his passing, trainees' attention shifted to traumatic injuries, likely influenced by WWII. This left the procedure scarcely used until third parties rekindled interest decades later. Neurectomy as the preferential treatment for MD at the Johns Hopkins Hospital was not driven by pure scientific reasoning but was rather contingent on historical context and sponsorship by a prominent figure like Walter Dandy. Appreciation of MD's natural history has since curtailed the favorability of destructive procedures in preference for conservative management.

Research on Identification Standard and Judicial Determination of Destructive Procedure - Based on Technical Specifications and Legal Provisions

With the rapid development of Internet technology, the identification of destructive procedures has a dilemma that the legislative purpose is inconsistent with the practice at the judicial level. The traditional identification is generally based on technical specifications, but the legal positioning of the procedure is often ignored in computer network crimes. In order to establish the identification standard of destructive procedures as soon as possible and reduce the judicial problems caused by the identification of procedures, this paper, based on the computer network crime, through the combination of technical specifications and legal provisions, through in-depth analysis of the computer technical parameters and typical cases of crimes of destructive procedures, expounds the technical level to follow the destructive procedure inspection operation specification, at the legal level to subjective malice and serious harm two aspects of the judgment method. The results of the study revealed that the double identification of destructive procedures through technical specifications and legal provisions is not only more practical than ever, but also saves judicial resources and improves litigation efficiency.

Kaposi sarcoma in an immunocompetent patient: a case report

Kaposi sarcoma (KS) is an uncommon vascular neoplasm associated with human herpes virus 8 (HHV8) infection. Lesions predominantly present at mucocutaneous sites, but may involve other organs. Epidemiological-clinical forms of KS include classic, endemic, AIDS associated and iatrogenic KS. KS is one of the most common AIDS defining malignancy. Lesions evolve from early (patch stage) macule into plaque stage and nodule stage. Diagnosis is made through clinical, histopathological findings and specific immunohistochemical markers for HHV8. Treatment is either by means of destructive procedures and systemic therapy in case of multiorgan involvement. This report is a case of classic KS in a 74-year nondiabetic, non hypertensive female, with no significant surgical, sexual or history of immunosuppression for the occurrence of KS. This case throws light on addressing KS in an immunocompetent patient or a newer variant of KS yet to be researched upon, which can go clinically misdiagnosed due to lack of significant history.

Occlusion of the Lateral Semicircular Canal, Endolymphatic Sac Surgery, and Cochlear Implantation: A Low Destructive Treatment for Unilateral Ménière’s Disease and Deafness

Introduction: Surgical treatment of Ménière’s disease (MD) and deafness aims to treat vertigo and hearing disabilities. Current treatment options like labyrinthectomy and cochlear implantation (CI) have shown acceptable results but are destructive. Less destructive procedures, like the occlusion of the lateral semicircular canal and endolymphatic sac surgery, have been shown to be successful in vertigo control. The combination of both procedures with CI has not been investigated; therefore the objective of this study was to investigate the outcome of this combination in patients with single-sided MD and moderately severe to complete sensorineural hearing loss. Methods: In this retrospective study, 10 patients with single-sided MD and moderately severe to complete sensorineural hearing loss were included. In all of them, a single-staged surgery, which consisted of CI, endolymphatic sac surgery, and occlusion of the lateral semicircular canal, was performed. The surgery was performed after a failed conservative therapy trial. The clinical outcome was evaluated by the Dizziness Handicap Inventory (DHI) and audiological tests. These were assessed preoperatively, 3 and 6 months after surgery. An MRI with a hydrops sequence was performed to support the clinical diagnosis. Results: After the combined surgery, the mean DHI testing improved significantly from 71 to 30. Mean audiological monosyllabic speech testing outcome with the cochlea implant was 65% at 65 dB. The residual hearing of 2 patients could be preserved after the surgical procedure. Conclusion: The combination of occlusion of the lateral semicircular canal, endolymphatic sac surgery, and CI is an efficient low traumatic treatment for patients with a single-sided MD and moderately severe to complete sensorineural hearing loss.

Comparison of niobium-93m results obtained by two independent destructive analytical procedures and measured by low energy gamma spectrometry and liquid scintillation counting

Comparison of niobium-93m results obtained by two independent destructive analytical procedures and measured by low energy gamma spectrometry and liquid scintillation counting

Audit of obstructed labour cases managed in a rural specialist hospital in Enugu, south-east, Nigeria

Background: Labour is a physiological process through which the fetus and placenta are expelled from the vagina at term. It is a challenging and painful process that ends with the joy of a newborn. On many occasions, the process is complicated by obstruction arising from disproportion between the baby and the maternal pelvis. Such conditions if not detected on time, will lead to significant feto-maternal morbidities and mortality. This experience in the developing nations of the world is a recurrent one even though it is almost eliminated in the developed world due to their advancement in antenatal and intrapartum care. The condition is even more prevalent in the rural areas of the developing countries where scarcity of skilled birth attendants is the order of the day, hence, this 5-year review in a rural hospital. Aim: The aim of this study was to determine the prevalence, outcome and socio-demographic determinants of obstructed labour in a private rural hospital Methodology: This was a 5-year retrospective review of all cases of all cases of obstructed labour managed in a rural specialist hospital. The data was collected from delivery registers, theatre registers and patients’ case files using a specialized proforma. The data was analyzed using the Statistical Product and Service Solutions (SPSS) version 25.0 for windows. Results were presented using tables, frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P Result: From the data collected, records of 1,487 births in the centre over the 5-year period were reviewed. Out of these 123 were cases of obstructed labour giving a prevalence of 8.27%. The age distribution of the cases showed that majority of them (30.9%) were aged 30-35 years and the least were over 40 years (6.5%). In all, 75.6% were married and 22.8% were single; majority of them were in a monogamous relationship (65.9%). Those with primary education topped the list (42.3%) followed by those with secondary education (37.4%) while the least had tertiary education (1.6%). Forty eight percent of them were unemployed, followed by 46.3% who were petty traders and only 5.7% were civil servants. Almost all of them were Christians (83.7%) and 45.5% of their partners were artisans. Majority of them (60.2%) were para 3 or above and 64.2% were delivered at gestational ages of between 37 to 40 weeks whereas 32.8% were above 40 weeks. Fifty two percent were verbally referred to the centre and 1.6% had a written referral. Most of them 73.2% were referred from a Traditional Birth Attendant (TBA). They were all labouring outside of the facility and 69.9% were referred from a TBA homes. One hundred and seventeen (95.1%) had severe pain, 95.1% were dehydrated, 81% had edematous vulva, 24.4% presented in shock and 18.7% had vaginal bleeding. It also showed that 98.4% had significant moulding and caput, 84.6% fetal distress and 13.8% intrauterine fetal death. Many presented with a combination of these features. Almost all the parturients (98.4%) were rehydrated with intravenous fluids, 94.3% had analgesia, 92.7% had emergency caesarean delivery, 86.2% were transfused, 4.9% had destructive procedures, 5.7% were delivered vaginally, and 6.5% had hysterectomy. Majority of them (61.8%) had surgical site infections, 33.3% had PPH and 72.4% of the babies had birth asphyxia. In all, marital status, conjugal relationship and educational level had a significant relationship with obstructed labour with p-values less than 0.05. Conclusion: Obstructed labour was an important occurrence in the centre and all of them were referred cases. Marital status, type of conjugal relationship and educational qualification had significant influence on the condition and majority of the babies were asphyxiated at birth. Therefore, we recommend registration, training and retraining of TBAs in rural areas to recognize early signs of obstruction and make timely referrals. Secondly, policies to enhance girl child education and women empowerment should be encouraged. Finally, provision of health facilities to make Essential Obstetric Care available and affordable to the rural populace should be a priority of all regional governments

PDGF, NGF, and EGF as main contributors to tumorigenesis in high-risk retinoblastoma.

Retinoblastoma (RB) is the most common form of eye cancer experienced in childhood. Its aggressive malignancy is associated with excellent survival rates in high-income countries; however, the prognosis in third-world countries is less favorable. Early diagnosis can maximize the patient's visual outcomes and their survival rate. Therapy should be conducted in highly specialized treatment centers. Intravenous chemotherapy (IVC) in bilaterally affected children currently forms the majority of therapy. Local destructive procedures and local chemotherapies such as intra-arterial chemotherapy (IAC) or intravitreal chemotherapy can be taken into consideration depending on the extent and size of the tumor. Nonetheless, children and parents remain under constant stress, revisiting doctors for medical treatment and fearing vision loss and even enucleation of the eye. Adequate molecular patient stratification to improve targeted therapy is still lacking. This retrospective study analyzed formalin-fixed paraffin-embedded specimens from a cohort of 21 RB samples. A total of 11 of those samples showed undifferentiated retinoblastoma (URB) histopathological risk features, and the other 10 showed differentiated retinoblastoma (DRB) histopathological grading. RNA from all samples was isolated and analyzed via digital gene expression patterns. Conductors of cell survival and DNA repair were dominant in the DRB samples. In contrast, the agents responsible for cell-cycle progression and apoptosis were overexpressed in URB samples. Our work reveals the importance of molecular mechanisms within the immune system subjected to histologic subtypes of RB, providing more detailed background on their genetic behavior. This is of great interest for therapeutic strategies, such as targeted immune- and gene-based therapies, for retinoblastoma.

The troubled course of the CHIVA Cure through clinical studies: a critical review

The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases.

An Estimation of Distribution Algorithm-Based Hyper-Heuristic for the Distributed Assembly Mixed No-Idle Permutation Flowshop Scheduling Problem

The distributed assembly mixed no-idle permutation flowshop scheduling problem (DAMNIPFSP), a common occurrence in modern industries like integrated circuit production, ceramic frit production, fiberglass processing, and steel-making, is a new model that considers mixed machines with no-idle restrictions as well as conventional machines. This article introduces an estimation of distribution algorithm-based hyper-heuristic (EDA-HH) to solve the DAMNIPFSP. Ten simple heuristic rules as low-level operations are utilized to search the solution space. The estimation of distribution algorithm is integrated into the framework of hyper-heuristic as the high-level strategy to control the low-level heuristics sequence in the solution space. The destruction and construction procedures are conducted on products and jobs in order to enhance the exploitation competence of EDA-HH. The computational simulation is carried out and the experimental results show that the proposed EDA-HH is significantly superior to the competitors in the statistical sense. The results of the 810 large-scale problem instances show the effectiveness of the EDA-HH in solving the DAMNIPFSP. Moreover, the CPLEX solver is utilized to verify the correctness of the model with some small instances.

Concept of inverted refractive-index-contrast grating mirror and exemplary fabrication by 3D laser micro-printing

Abstract Highly reflective mirrors are indispensable components in a variety of state-of-the-art photonic devices. Typically used, bulky, multi-layered distributed Bragg (DBR) reflectors are limited to lattice-matched semiconductors or nonconductive dielectrics. Here, we introduce an inverted refractive index-contrast grating (ICG) as compact, single-layer alternative to DBR. In the ICG, a subwavelength one-dimensional grating made of a low-refractive-index material is implemented on a high-refractive-index cladding. Our numerical simulations show that the ICG provides nearly total optical power reflectance for the light incident from the side of the cladding whenever the refractive index of the grating exceeds 1.75, irrespective of the refractive index of the cladding. Additionally, the ICG enables polarization discrimination and phase tuning of the reflected and transmitted light, the property not achievable with the DBR. We experimentally demonstrate a proof-of-concept ICG fabricated according to the proposed design, using the technique of sub-µm 3D laser lithography in which thin stripes of IP-Dip photoresist are micro-printed on a Si cladding. This one-step method avoids laborious and often destructive etching-based procedures for grating structuration, making it possible to implement the grating on any arbitrary cladding material.

Influences of true 3D twin flaws on principal stress status and crack occurrence of brittle rock-like samples under uniaxial compression: Insights from experimental and DEM studies

Fracture structures commonly have negative impacts on the strength and safety of rock mass, and various combinations of 2D and 3D flaws make the destruction procedure becomes more complicated. Therefore, laboratory tests based on three types of flawed rocks (symmetric twin flaws with different 2D-3D occurrences) are finished to detect the mechanical, optical and acoustic characteristics of fractured rocks during the uniaxial compression test; PFC3D simulations are conducted for analyzing the deformation features, principal stress distributions, and detailed failure mechanism of the fractured rocks. The main results are as follows: 1) Different combinations of 2D & 3D preset flaws directly influence the results of deformation, stress distribution, and failure developments. 2) Rotation of the intermediate stress axes only appear near the flaw inclination boundary (when the monitoring position moves outwards), while the directions of intermediate principal stress axes remain stable near the flaw strike boundary. 3) Separating cracks by various occurrences helps to construct local failures along different directions, and make some local failures visible and clear; the traditional cracks (short line or thin oval shape) are induced by the uneven deformation in x-o-z planes, and the separated cracks (wide oval or standard disc shape) result from the uneven deformation in y-o-z planes. 4) Surrounding rocks at different positions suffer various modes of failures, the non-ignorable thickness of preset flaw leads to simultaneous Mode I and Mode II failure at the flaw tip, and the mixed Mode II&III failure only occurs in the rocks adjacent to the flaw strike boundary.

Barcoding coffee grounds - Exploring pteropod gastropod biodiversity with dregs in collection jars

Despite their cosmopolitan occurrence and massive plankton sampling during expeditions, the genetic diversity within Pteropoda Cuvier, 1804 is still largely unexplored. In this study we present a next-generation environmental barcoding approach to zooplankton bulk samples, which were collected during the circumglobal 2010 Malaspina expedition to evaluate pteropod diversity. We introduce a technique that avoids destructive procedures and leaves material intact for further morphological investigations. We extracted DNA out of the dregs (organic material such as mucus or body parts) of 27 sample containers for molecular barcoding (average 100-260 bp of COI). We were able to identify 7128 operational taxonomic units corresponding to the species composition contained in the examined samples. Among them were three species of thecosome pteropods, Creseis acicula, Creseis virgula and Cavolinia inflexa, which are discussed with respect to their taxonomy and their geographic distribution. Unidentified gymnosomes were also present in our samples from warmer regions in oceanic waters of the southern Indian Ocean. To facilitate identification of species, it is beneficial to create a better database of pteropod COI barcodes. Furthermore, gathering environmental barcoding data on a broad global scale will help to better understand species abundance and distribution of pteropods in the world’s oceans, and potentially those of other planktonic organisms.

Constructive–destructive heuristics for the Safe Set Problem

The Weighted Safe Set Problem aims to determine in an undirected graph a subset of vertices such that the weights of the connected components they induce exceed the weights of the adjacent components induced by the complementary subset. We tackle the problem with various approaches based on randomised constructive and destructive procedures, comparing them with each other and with the only other existing heuristic approach, that is a randomised destructive heuristic. The experiments concern all the available benchmark instances (random graphs up to 60 vertices), but also new benchmark instances with larger size and different topologies, namely random, small-world, regular, planar, grid and real-world graphs up to 300 vertices. Dense random graphs, in fact, appear to become progressively easier to solve as their size grows. On the other instances, the best performance is obtained by combining a randomised constructive procedure, a deterministic destructive procedure, and delayed termination conditions that allow a deeper exploration of the feasible region.

Solution-state nuclear magnetic resonance spectroscopy of crystalline cellulosic materials using a direct dissolution ionic liquid electrolyte.

Owing to its high sustainable production capacity, cellulose represents a valuable feedstock for the development of more sustainable alternatives to currently used fossil fuel-based materials. Chemical analysis of cellulose remains challenging, and analytical techniques have not advanced as fast as the development of the proposed materials science applications. Crystalline cellulosic materials are insoluble in most solvents, which restricts direct analytical techniques to lower-resolution solid-state spectroscopy, destructive indirect procedures or to 'old-school' derivatization protocols. While investigating their use for biomass valorization, tetralkylphosphonium ionic liquids (ILs) exhibited advantageous properties for direct solution-state nuclear magnetic resonance (NMR) analysis of crystalline cellulose. After screening and optimization, the IL tetra-n-butylphosphonium acetate [P4444][OAc], diluted with dimethyl sulfoxide-d6, was found to be the most promising partly deuterated solvent system for high-resolution solution-state NMR. The solvent system has been used for the measurement of both 1D and 2D experiments for a wide substrate scope, with excellent spectral quality and signal-to-noise, all with modest collection times. The procedure initially describes the scalable syntheses of an IL, in 24-72 h, of sufficient purity, yielding a stock electrolyte solution. The dissolution of cellulosic materials and preparation of NMR samples is presented, with pretreatment, concentration and dissolution time recommendations for different sample types. Also included is a set of recommended 1D and 2D NMR experiments with parameters optimized for an in-depth structural characterization of cellulosic materials. The time required for full characterization varies between a few hours and several days.

Years of dermatology experience and geographic region are associated with outlier performance of excision or destruction for nonmelanoma skin cancer

IntroductionTreatments for nonmelanoma skin cancer (NMSC) include excision (surgical removal) and destruction (cryotherapy or curettage with or without electrodesiccation) in addition to other methods. Although cure rates are similar between excision and destruction for low-risk NMSCs, excision is substantially more expensive. Performing destruction when appropriate can reduce costs while providing comparable cure rate and cosmesis.ObjectiveTo identify characteristics associated with exclusive (outlier) performance of excision or destruction for NMSC.MethodsThe study consisted of malignant excision and destruction procedures submitted by dermatologists to Medicare in 2019. Proportions of services for each method were analyzed with respect to geographic region, years of dermatology experience, median income of the practice zip code, and rural-urban commuting area (RUCA) code.ResultsFewer years of experience predicted a higher proportion of excisions (R2 = 0.7, p < .001) and higher odds of outlier excision performance. Outlier performance of excision was associated with practicing in the South, Midwest, and West, whereas outlier performance of destruction was associated with practicing in the Northeast and Midwest.ConclusionsDermatologists with less experience or in certain geographic regions performed more malignant excision relative to destruction. As the older population of dermatologists retires, the cost of care for NMSC may increase.

An Iterated Population-Based Metaheuristic for Order Acceptance and Scheduling in Unrelated Parallel Machines with Several Practical Constraints

This study considers order acceptance and scheduling problems in unrelated parallel machines with several practical constraints, including order release times, sequence-dependent setup times, machines’ unequal ready times, and preventive maintenance. In a make-to-order production environment, issues with order acceptance and scheduling are mainly caused by the limited production capacity of a factory, which makes it impossible to accept all orders. Consequently, some orders must be rejected in order to maximize profits and the accepted orders must be completed by the due date or no later than the deadline. An iterated population-based metaheuristic is proposed to solve the problems. The algorithm begins with an efficient initial solution generator to generate an initial solution, and then uses the destruction and construction procedure to generate a population with multiple solutions. Then, a solution is selected from the population, and a variable neighborhood descent search algorithm with several new reduced-size neighborhood structures is applied to improve the selected solution. Following the completion of the local search, a method for updating the members of the population was devised to enhance its diversity. Finally, the metaheuristic allows the populations to evolve for several generations until the termination condition is satisfied. To evaluate the performance of the proposed metaheuristic, a heuristic rule and an iterated local search algorithm are examined and compared. The computational experimental results indicate that the presented metaheuristic outperforms the other heuristics.