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Biomedical subjects

E D Smith

Publications and source records attributed to E D Smith.

At least 19 recordsLinked to original sources
PubMed2001

Waiting times to see a dermatologist are perceived as too long by dermatologists: implications for the dermatology workforce.

BACKGROUND: The issue of workforce requirements in dermatology has come to attention in recent years because it affects the delivery of dermatologic care in the United States. OBJECTIVE: To determine the waiting times for appointments with dermatologists in order to assess the adequacy of the current level of dermatology workforce. METHODS: Waiting times were determined for new and return patient appointments by telephone survey of a random sample of American Academy of Dermatology members. Physicians' perception of the adequacy of the number of dermatologists in their area was used as a criterion standard to validate waiting times as a measure of workforce adequacy. Benchmark waiting times of 3 weeks for a new patient appointment and 2 weeks for a return appointment were established. RESULTS: Physicians' estimates of the waiting time for a new patient appointment and their perceptions of the adequacy of the number of practicing dermatologists in their area were closely correlated (r = -0.65; P<.001), validating the use of waiting times as a measure of workforce adequacy. More than 60% of the dermatologists surveyed exceeded the criterion cutoff waiting times, and more than 42% of the US population lives in areas underserved by dermatologists. Dermatologists practicing in areas of higher population density were more likely to have shorter waiting times for new patient appointments and were more likely to include cosmetic dermatology in their practices. CONCLUSION: The long waiting times for appointments suggests that the current supply of dermatologists is not adequate to meet the demand for dermatologists' services.

Attitude of Health Personnel↗
PubMed2001

Cost of nonmelanoma skin cancer treatment in the United States.

BACKGROUND: Despite being the most prevalent form of cancer, the economic impact of nonmelanoma skin cancer (NMSC) in the United States has not been assessed. OBJECTIVE: To determine the overall cost and to estimate the cost per episode of NMSC care in the United States in physicians' offices, outpatient surgery centers, and inpatient settings. METHODS: Data from the Medicare Current Beneficiary Study 1992-1995 were analyzed to obtain the total cost of NMSC and the cost in different settings. To normalize these data on a per episode basis, the cost in each setting was divided by the number of procedures performed in each setting obtained from the National Hospital Discharge Survey (NHDS, 1992-1997), the National Survey of Ambulatory Surgery (NSAS, 1994-1996), and the National Ambulatory Medical Care Survey (NAMCS, 1995). RESULTS: The total cost of NMSC care in the United States in the Medicare population is $426 million/year. Physician office-based procedures for NMSC accounted for the greatest percentage of money spent to treat NMSC and the greatest percentage of procedures. The average cost per episode of NMSC when performed in a physician's office setting was found to be $492. The cost per episode of care in inpatient and outpatient settings were $5537 and $1043, respectively. CONCLUSION: Compared to other cancers, the relative magnitude of NMSC treatment costs is currently small because NMSC is managed efficiently and effectively, primarily in office-based settings. Legislative or regulatory measures that discourage office treatment of NMSC will lead to increased cost.

Ambulatory Surgical Procedures↗
PubMed2001

Screening and early detection among racial and ethnic minority women.

OBJECTIVES: To highlight sociocultural factors reported to influence and strategies to promote breast and cervical cancer screening and early detection behaviors of racial and ethnic minority women. DATA SOURCES: Published articles, book chapters, and reports. CONCLUSIONS: The most successful strategies for promoting screening and early detection among racial and ethnic minority women are collaborative and include approaches that are culturally sensitive and appropriate. NURSING IMPLICATIONS: Intercultural and intracultural differences in racial and ethnic minority women challenge nurses to explore strategies that focus on the health care provider, the health care delivery system, and the individual woman within the context of the woman's culture.

Breast Neoplasms↗
PubMed2000

Utilization of day stay general anaesthesia for the provision of dental treatment to children in New South Wales, Australia.

OBJECTIVES: To assess the demand for paediatric dental general anaesthetic services at a specialist paediatric dental unit in Australia and to evaluate the changing pattern of general anaesthetic use in children at this unit over the past decade. METHODS: A retrospective review of hospital records of a random sample of children receiving dental treatment under general anaesthesia during the years 1984 and 1996. Demographic and clinical data was collated and analysed using SPSS for Windows. RESULTS: The number of children managed under general anaesthesia increased from 189 in 1984 to 777 in 1996. This was accompanied by an increase in the time the patients waited for treatment. There was little difference in the mean age of the patients with over two-thirds of the children being under the age of 6 years. Whilst children of Anglo-Saxon origin accounted for the majority of patients across the 13-year period there was a significant increase in the number of children from Asian or Middle Eastern backgrounds. A disproportionate number of these children accessed the services as self-referrals. Caries remained the most common reason for referral, with trauma and dental anomalies accounting for less than 10%. CONCLUSIONS: Despite the general decline in dental caries there remain an important group of young children who have high treatment needs and for whom general anaesthesia provides a useful treatment option. Preventive strategies should be targeted towards these groups of children.

Ambulatory Surgical Procedures↗
PubMed2000

Sequential CD4-coreceptor interactions in human immunodeficiency virus type 1 Env function: soluble CD4 activates Env for coreceptor-dependent fusion and reveals blocking activities of antibodies against cryptic conserved epitopes on gp120.

We devised an experimental system to examine sequential events by which the human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein (Env) interacts with CD4 and coreceptor to induce membrane fusion. Recombinant soluble CD4 (sCD4) activated fusion between effector cells expressing Env and target cells expressing coreceptor (CCR5 or CXCR4) but lacking CD4. sCD4-activated fusion was dose dependent, occurred comparably with two- and four-domain proteins, and demonstrated Env-coreceptor specificities parallel to those reported in conventional fusion and infectivity systems. Fusion activation occurred upon sCD4 preincubation and washing of the Env-expressing effector cells but not the coreceptor-bearing target cells, thereby demonstrating that sCD4 exerts its effects by acting on Env. These findings provide direct functional evidence for a sequential two-step model of Env-receptor interactions, whereby gp120 binds first to CD4 and becomes activated for subsequent functional interaction with coreceptor, leading to membrane fusion. We used the sCD4-activated system to explore neutralization by the anti-gp120 human monoclonal antibodies 17b and 48d. These antibodies reportedly bind conserved CD4-induced epitopes involved in coreceptor interactions but neutralize HIV-1 infection only weakly. We found that 17b and 48d had minimal effects in the standard cell fusion system using target cells expressing both CD4 and coreceptor but potently blocked sCD4-activated fusion with target cells expressing coreceptor alone. Both antibodies strongly inhibited sCD4-activated fusion by Envs from genetically diverse HIV-1 isolates. Thus, the sCD4-activated system reveals conserved Env-blocking epitopes that are masked in native Env and hence not readily detected by conventional systems.

3T3 Cells↗
PubMed1998

Identification of CX3CR1. A chemotactic receptor for the human CX3C chemokine fractalkine and a fusion coreceptor for HIV-1.

Fractalkine is a multimodular human leukocyte chemoattractant protein and a member of the chemokine superfamily. Unlike other human chemokines, the chemokine domain of fractalkine has three amino acids between two conserved cysteines, referred to as the CX3C motif. Both plasma membrane-associated and shed forms of fractalkine have been identified. Here, we show that the recombinant 76-amino acid chemokine domain of fractalkine is a potent and highly specific chemotactic agonist at a human orphan receptor previously named V28 or alternatively CMKBRL1 (chemokine beta receptor-like 1), which was shown previously to be expressed in neutrophils, monocytes, T lymphocytes, and several solid organs, including brain. CMKBRL1/V28 also functioned with CD4 as a coreceptor for the envelope protein from a primary isolate of HIV-1 in a cell-cell fusion assay, and fusion was potently and specifically inhibited by fractalkine. Thus CMKBRL1/V28 is a specific receptor for fractalkine, and we propose to rename it CX3CR1 (CX3C chemokine receptor 1), according to an accepted nomenclature system.

CD4 Antigens↗
PubMed1997

Church-based education: an outreach program for African Americans with hypertension.

The goals of this education outreach demonstration study were to prepare a cadre of registered nurses (RN) as Church Health Educators (CHE), and to test the efficacy of a hypertension (HBP) education and support program in African American (AA) churches for persons with HBP in managing blood pressure (BP). In this two-phase study, RNs were prepared as CHEs in phase 1 and a convenience sample of 97 subjects with HBP was taught by the CHEs in phase 2. The intervention's content included the bases of HBP and HBP management strategies, and was taught in eight 1-hour sessions. Using a pre-test-post-test design, data on knowledge, social support and BP were collected at baseline (pre), post-intervention (post1) and 3 months post-intervention (post2). Major findings include: (1) there was a significant increase in knowledge scores from pre to post1 and post2 (P < or = 0.0001; F = 95.08; df = 1.79); (2) education, age and number of years with HBP explained 49% of the variance associated with HBP knowledge; (3) systolic BP (SBP) and mean arterial BP (MAP) significantly decreased from pre to post1 and post2 (SBP-p < or = 0.0001, F = 18.35, df = 1.91; MAP-p < or = 0.0001, F = 17.80, df = 1.86); (4) DBP significantly decreased from pre to post1 only (p < or = 0.008, F = 17.48, df = 1.91); and (5) relationships were found between social support and DBP, and social support and MAP. Issues that emerged from this study with implications for outreach programming include recruitment and retention, randomization, selective sampling, intervention design and use of volunteers.

Adult↗
PubMed1997

The history of hypospadias.

The dictum, "There is nothing new in surgery not previously described", is particularly true of hypospadias. The major significance of chordee was fully appreciated by Galen in the second century A. D. and then almost forgotten until Mettauer in 1842, all previous surgeons overstressing the position of the orifice. Mettauer recognised skin shortening as a cause of chordee, a fact not re-discovered until 1967. Urethroplasty from penile skin in situ was well described by Thiersch in 1869 and Duplay in 1874; additional covering skin flaps were developed in 1892 by Lauenstein. The modern enthusiasm for pedicle tubes from prepuce was first employed by Van Hook in 1896, Rochet in 1899, Hamilton Russell in 1900, and Mayo in 1901; the "buried skin" technique of Denis Browne was described by Duplay in 1880, although attributed by Browne to Hamilton Russell in 1915. Even scrotal tissues were incorporated in repairs in 1860 (Bouisson). Beck, in 1898, practised a repair for balanitic hypospadias very similar to the modern MAGPI repair, and free grafts, so popularised in the last 20 years, were performed by Nové-Josserand in 1897. We have certainly advanced from the era of the first millenium A. D., in which the treatment was amputation beyond the orifice, but almost all present-day techniques are well-founded in ideas developed by enterprising surgeons of the last century.

History, 19th Century↗
PubMed1996

Characterization of intraembryonic freezing in Anopheles gambiae embryos.

Intraembryonic freezing (IEF) in Anopheles mosquito embryos has been evaluated by differential scanning calorimetry with respect to embryo age, temperature, rate and duration of cooling, and absence or presence of extraembryonic ice. The initial temperatures for intraembryonic ice nucleation were -30.1 +/- 0.3, -28.4 +/- 0.4, and -29.1 +/- 0.2 degree C for embryos incubated for 15 h at 17 degrees C, 15 h at 26 degrees C, and 24 h at 26 degrees C, respectively, after oviposition. The first value is slightly but significantly lower than the latter two. These values were obtained on embryos in which the surface water was removed by brief drying; however, the values were nearly identical when external water and ice were present. Not only were the embryos of all three ages able to supercool at least transiently to -26 degrees C, but they could remain supercooled for up to 4 h at -20 degrees C after being cooled to -20 degrees C at 10 degrees C/min or (in the case of embryos incubated for 15 h at 26 degrees C) at 100 degrees C/min. The amount of freezable water in single embryos has been calculated from the differential scanning calorimetry measurements to be 3.45 +/- 0.08, and 3.53 +/- 0.06 microgram for embryos incubated for 15 h at 17 degrees C, 15 h at 26 degrees C, and 24 h at 26 degrees C, respectively. The differences are not significant. The corresponding values for the total water contents for embryos of the three ages were 4.04 +/- 0.20, 3.72 +/- 0.16, and 3.98 +/- 0.10 microgram, values that also did not differ significantly. Water thus makes up approximately 74% of the total weight of the embryo (approximately 5.3 micrograms) and about 91% of that water is freezable. Total water contents were determined gravimetrically after extensive air and vacuum drying. The kinetics of dehydration were determined during the air drying. They differed substantially among the three ages. The embryos incubated for 15 h at 17 degrees C lost water at about four times the rate of those incubated for 15 h at 26 degrees C and 10 times the rate of the embryos incubated for 24 h at 26 degrees C.

Animals↗
PubMed1995

Addressing the psychospiritual distress of death as reality: a transpersonal approach.

Many traditional Western psychologists fail to recognize spirituality and transcendental needs as intrinsic aspects of human nature and therefore may not be meeting the needs of terminally ill people or those in the process of confronting their own mortality. This article presents a model of transpersonal intervention appropriate for use by social work clinicians with anyone who is in the process of confronting his or her own mortality. It is based on the underlying assumptions that an individual has a level of transpersonal development with its related dimensions of spiritual awareness and personal death perspective and that the degree of interrelatedness of these two dimensions has a direct impact on the psychosocial distress he or she experiences when confronted with death.

Attitude to Death↗
PubMed1992

Red blood cell changes during the evolution of the sickle cell painful crisis.

A longitudinal study of the red blood cell (RBC) deformability, percent of dense erythrocytes, and hematologic parameters has been conducted during 117 painful crises affecting 36 patients with sickle cell anemia between January, 1985 and December, 1990. RBC deformability was determined by osmotic gradient ektacytometry and the percentage of dense cells was quantitated by centrifugation on a discontinuous Stractan density gradient. The data indicate that the painful crisis is a process that follows a bimodal form of evolution. The first phase of the painful crisis is characterized by increase in the severity of pain, increase in the number of dense cells, and a decrease in RBC deformability. In some patients the changes in dense cells and RBC deformability are evident 1 to 3 days before the onset of pain. In addition, the hemoglobin level decreases and the reticulocyte count increases during this initial phase. The second phase of the crisis is characterized by reduction in pain intensity, decrease in the number of dense cells, and increase in RBC deformability to values higher than those seen in the steady state. Moreover, the improvement in RBC deformability and the decrease in the number of dense cells at the end of a crisis seem to constitute new risk factors that may incite a recurrence of the crisis within 1 month in about 50% of painful episodes. The pathophysiologic events responsible for this bimodal behavior of RBCs during painful episodes may represent the appearance of factors that induce (1) preferential trapping of deformable cells in the microcirculation during the first phase of the crisis, followed by a decrease of dense cells and the appearance of new deformable RBCs released from the bone marrow during the second phase of the crisis; or (2) variable sickling of all circulating RBCs during the first phase followed by disappearance of dense RBCs and their replenishment by deformable cells during the second phase.

Adult↗
PubMed1992

Psoralen damage-induced plasmid recombination in Saccharomyces cerevisiae: dependence on RAD1 and RAD52.

Photoreaction with psoralen, a DNA-crosslinking reagent, induces mitotic recombination in the yeast Saccharomyces cerevisiae. Psoralen damage-induced recombination was studied with non-replicating plasmids, which transform yeast cells by undergoing recombination events with chromosomal DNA. When plasmid DNA was photoreacted with psoralen in vitro and transformed into yeast cells, transformation was stimulated by psoralen modification in a dose-dependent manner. The stimulation by psoralen damage requires RAD52 gene function and is partially dependent on RAD1. Analysis of transformants indicates that plasmid integration occurs at the homologous chromosomal loci. Multiple tandem integrations are common in repair-proficient cells, with more than 20 copies of integrated plasmid seen in some transformants. Multiple integration depends on RAD1 function; only 9% of rad1 transformants, compared to 80% of RAD transformants, contained multiple plasmid copies, while 52% of the rad1 transformants were produced by gene conversion.

DNA Damage↗
PubMed1992

Microleakage of glass ionomer/composite resin restorations: a laboratory study. 1. The influence of glass ionomer cement.

Acid-etching of enamel margins, often combined with bevelling and use of a low viscosity resin, has resulted in improved sealing of composite restorations. When enamel is absent and margins involve dentine or cementum, microleakage is more often observed. The use of glass ionomer cement, as both a restorative material and as a base combined with a veneer of composite resin, has been advocated as a means of minimizing microleakage where margins are placed in dentine or cementum. Four restorative techniques incorporating glass ionomer cement were used, in vitro, to restore cervical cavities. After thermal cycling, dye penetration was scored along occlusal and gingival margins. In all instances the gingival margin exhibited a less reliable seal than the occlusal margin. The sandwich restorations produced a superior seal at both occlusal and gingival margins when compared with glass ionomer restorative cement.

Acid Etching, Dental↗