The Utilization of Sunscreen Prescriptions to Increase Patient Use: Examination of Healthcare Provider Perceptions

Background: Despite the known benefits, many patients deny receiving sunscreen counseling. Over the past decade rates and treatment costs for skin cancer has risen. Purpose: This study seeks to investigate provider perceptions of using sunscreen prescriptions as a method to increase patient use. Methods: A descriptive online survey using a convenience sample of dermatology, internal medicine, and family medicine providers was used. Descriptive statistics summarized quantitative variables and thematic analysis examined opened ended questions. Results: Provider (n=38 total) thoughts about sunscreen prescriptions were mixed with many viewing sunscreen prescriptions positively (n =15; 42.9%). Commonly listed barriers included patient lack of motivation/interest (3.53±0.89), lack of standard guidelines about sunscreen counseling and prescriptions (3.34±1.12), and lack of education about prescribing sunscreen (3.26±1.35). Facilitators included insurance coverage (n = 21; 61.8%) and having a standardized protocol (n=8; 23.5%). Conclusion: The majority of providers felt prescribing sunscreen would increase patient use. Study results imply providers would utilize sunscreen prescriptions if a clear, standardized protocol was present. Education may help alleviate concerns related to insurance coverage. In consideration of time constraints, it may be beneficial for sunscreen prescriptions to be added to routine after-visit summaries and educational materials

Spatial Anisotropies and Temporal Fluctuations in Extracellular Matrix Network Texture during Early Embryogenesis

Early stages of vertebrate embryogenesis are characterized by a remarkable series of shape changes. The resulting morphological complexity is driven by molecular, cellular, and tissue-scale biophysical alterations. Operating at the cellular level, extracellular matrix (ECM) networks facilitate cell motility. At the tissue level, ECM networks provide material properties required to accommodate the large-scale deformations and forces that shape amniote embryos. In other words, the primordial biomaterial from which reptilian, avian, and mammalian embryos are molded is a dynamic composite comprised of cells and ECM. Despite its central importance during early morphogenesis we know little about the intrinsic micrometer-scale surface properties of primordial ECM networks. Here we computed, using avian embryos, five textural properties of fluorescently tagged ECM networks — (a) inertia, (b) correlation, (c) uniformity, (d) homogeneity, and (e) entropy. We analyzed fibronectin and fibrillin-2 as examples of fibrous ECM constituents. Our quantitative data demonstrated differences in the surface texture between the fibronectin and fibrillin-2 network in Day 1 (gastrulating) embryos, with the fibronectin network being relatively coarse compared to the fibrillin-2 network. Stage-specific regional anisotropy in fibronectin texture was also discovered. Relatively smooth fibronectin texture was exhibited in medial regions adjoining the primitive streak (PS) compared with the fibronectin network investing the lateral plate mesoderm (LPM), at embryonic stage 5. However, the texture differences had changed by embryonic stage 6, with the LPM fibronectin network exhibiting a relatively smooth texture compared with the medial PS-oriented network. Our data identify, and partially characterize, stage-specific regional anisotropy of fibronectin texture within tissues of a warm-blooded embryo. The data suggest that changes in ECM textural properties reflect orderly time-dependent rearrangements of a primordial biomaterial. We conclude that the ECM microenvironment changes markedly in time and space during the most important period of amniote morphogenesis—as determined by fluctuating textural properties

A 'snip' in time: what is the best age to circumcise?

<p>Abstract</p> <p>Background</p> <p>Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.</p> <p>Discussion</p> <p>We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.</p> <p>Summary</p> <p>Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.</p

The relative textural differences between lateral and medial fibronectin networks during HH stage 6 of embryonic development.

<p>During HH stage 6 of embryonic development, the medial fibronectin network (b) demonstrated increased values of inertia across all offsets (c) compared with the lateral fibronectin network (a). The correlation values (d) in both medial and lateral networks demonstrated similar fall-off trends as a function of offset whereas a relative decrease in uniformity (e) and homogeneity (f) values marked the medial fibronectin distribution along the PS. The local entropy values of the medial network (h) were higher than the lateral network (g) as well. PS: Primitive Streak, Scale bar: 100 µm.</p

Texture measures at each embryonic stage (HH5 through HH7), averaged over orientation and spatial scale.

<p>The overall trend (spatial anisotropy and temporal fluctuations) in the textural measures during stages 5 through 7 was evident upon averaging the Haralick feature values (from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038266#pone-0038266-g002" target="_blank">figures 2</a> through <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038266#pone-0038266-g003" target="_blank"></a><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038266#pone-0038266-g004" target="_blank"></a><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038266#pone-0038266-g005" target="_blank">5</a>) over orientation (0°, 45°, 90° and135°) and scale (offsets 1 through 4 corresponding to each orientation). Values are mean ± S.D. Fibrillin-2 lateral network at stage 5 is shown in green, while lateral and medial fibronectin networks are shown in red and blue, respectively. Statistically significant differences (P<0.05) between ROIs were represented by “ * ”.</p

Texture timing-diagram summarizing the relative textural quality of medio-lateral fibronectin networks during avian developmental stages 5 through 7.

<p>A. Texture timing-diagram that captures the relative qualitative descriptors of texture in the ROI, weighted solely upon the scalar entropy values obtained during the stages of development (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038266#pone-0038266-g006" target="_blank">Figure 6</a>), maps the texture as relatively “coarse/rough” and “smooth/fine.” From this qualitative perspective, the lateral fibronectin network is relatively coarse compared with the medial fibronectin network during HH stage 5 of development. However, the lateral network evolves into a relatively smooth texture during HH stage 6 of development. An absence of qualitative medio-lateral textural anisotropy in fibronectin networks during HH stage 7 is represented as overlapping diamonds that don't belong to a precise textual category. B. Embryonic ECM exhibits regional inhomogeneity of texture. The schematic demonstrates the hypothesized textural “gradient” of fibronectin (a difference in color represents a difference in the relative quality of texture) that might be relevant to mesendodermal cell motility during gastrulation. At scales coincident with the relative density of integrin (a cellular receptor for fibronectin) distribution on a mesendodermal cell, the textural anisotropy of the fibronectin network could potentially manifest as a qualitative textural “gradient” in the embryonic space, thus, influencing regional cell motility.</p

Schematic representation of extracellular matrix textural analysis.

<p>A. The embryonic extracellular matrix (ECM) was categorized into three spatial distributions (networks). The ECM associated with the antero-posterior (AP) axis was referred to as the medial network (blue). The ECM adjacent to the medial network, but not associated directly with the AP axis structures, was referred as the lateral network (red). The ECM distributions anterior and anterolateral to the Hensen's node (HN), the cranial networks (purple), were not included in the analysis. Textural analysis was performed on the immunofluorescence images of medial and lateral ECM networks. Gray-level co-occurrence matrices (GLCMs) were obtained and Haralick features were computed from the GLCMs defining the regions of interest (ROI), for four orientations (0°, 45°, 90° and 135°). Under each orientation, GLCM was computed for four offsets (1, 2, 3 and 4 pixels) thus totaling 16 offsets (4×4) for each texture parameter (inertia, correlation, uniformity and homogeneity). The entropy of the ROIs, another Haralick statistic, was used to assign a relative qualitative texture to the ROIs (ECM networks) during HH stages 5 through 7. B. A pictorial demonstration of the qualitative textural changes of the fibronectin network, assigned on the basis of scalar entropy. The approximate length of an embryo along the AP axis is 3 mm (HH stage 5), 5 mm (HH stage 6) and 7 mm (HH stage 7) respectively. The medial (blue) and lateral (red) fibronectin networks demonstrate distinct qualitative textures (coarse or smooth) at HH5 and HH6 stages. However, during HH7 there is an absence of distinct regional qualitative texture which is represented by a single oval enclosing both the medial and lateral fibronectin networks.</p

The relative textural differences between fibronectin and fibrillin-2 networks during HH stage 5 of embryonic development.

<p>A comparison of textural features between the lateral fibronectin (a) and fibrillin-2 (b) networks during HH stage 5 revealed the relatively higher values of inertia (c) and correlation (d) for the fibronectin network. The values for uniformity (e) and homogeneity (f) were relatively lower for the fibronectin network compared with the fibrillin-2 network. Meanwhile, the local entropy array of values was higher for fibronectin network (g) compared with the fibrillin-2 network (h). Scale bar: 100 µm.</p

The relative textural differences between lateral and medial fibronectin networks during HH stage 7 of embryonic development.

<p>The lateral fibronectin network (a) showed a relative increase in the rate of change of inertia values with respect to offset (c) compared with the medial fibronectin network (b) during HH stage 7. The rate of fall of correlation as a function of offset was also increased in the lateral network (d). Both uniformity (e) and homogeneity (f) of the lateral network decreased compared with the medial network. Meanwhile, the local regional entropy values of the lateral network (g) were higher compared with the medial network (h). PS: Primitive Streak, Scale bar: 100 µm.</p