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Dr. Howard  Epstein  Dmd image

Dr. Howard Epstein Dmd

901 Dehirsch Avenue
Woodbine NJ 08270
609 612-2784
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 22DI01877400
NPI: 1700066115
Taxonomy Codes:
122300000X

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Publications

Carbon storage in old-growth forests of the Mid-Atlantic: toward better understanding the eastern forest carbon sink. - Ecology
Few old-growth stands remain in the matrix of secondary forests that dominates the eastern North American landscape. These remnant stands offer insight on the potential carbon (C) storage capacity of now-recovering secondary forests. We surveyed the remaining old-growth forests on sites characteristic of the general Mid-Atlantic United States and estimated the size of multiple components of forest C storage. Within and between old-growth stands, variability in C density is high and related to overstory tree species composition. The sites contain 219 ± 46 Mg C/ha (mean ± SD), including live and dead aboveground biomass, leaf litter, and the soil O horizon, with over 20% stored in downed wood and snags. Stands dominated by tulip poplar (Liriodendron tulipifera) store the most live biomass, while the mixed oak (Quercus spp.) stands overall store more dead wood. Total C density is 30% higher (154 Mg C/ha), and dead wood C density is 1800% higher (46 Mg C/ha) in the old-growth forests than in the surrounding younger forests (120 and 5 Mg C/ha, respectively). The high density of dead wood in old growth relative to secondary forests reflects a stark difference in historical land use and, possibly, the legacy of the local disturbance (e.g., disease) history. Our results demonstrate the potential for dead wood to maintain the sink capacity of secondary forests for many decades to come.
A protocol for addressing acute pain and prescribing opioids. - Minnesota medicine
Physicians across the country are re-examining their role in the prescription opioid abuse problem. In response to growing public awareness about the dangers of opioids, the Minnesota Medical Association formed a Prescription Opioid Management Advisory Task Force. As part of its work, the task force partnered with the Institute for Clinical Systems Improvement (ICSI) to develop a protocol for prescribing opioids for acute pain. This article describes the development of the new ICSI Acute Pain Assessment and Appropriate Opioid Prescribing Protocol and highlights key aspects of the protocol, which emphasizes shared decision-making and careful, conservative prescribing.
Plant functional types in Earth system models: past experiences and future directions for application of dynamic vegetation models in high-latitude ecosystems. - Annals of botany
Earth system models describe the physical, chemical and biological processes that govern our global climate. While it is difficult to single out one component as being more important than another in these sophisticated models, terrestrial vegetation is a critical player in the biogeochemical and biophysical dynamics of the Earth system. There is much debate, however, as to how plant diversity and function should be represented in these models.Plant functional types (PFTs) have been adopted by modellers to represent broad groupings of plant species that share similar characteristics (e.g. growth form) and roles (e.g. photosynthetic pathway) in ecosystem function. In this review, the PFT concept is traced from its origin in the early 1800s to its current use in regional and global dynamic vegetation models (DVMs). Special attention is given to the representation and parameterization of PFTs and to validation and benchmarking of predicted patterns of vegetation distribution in high-latitude ecosystems. These ecosystems are sensitive to changing climate and thus provide a useful test case for model-based simulations of past, current and future distribution of vegetation.Models that incorporate the PFT concept predict many of the emerging patterns of vegetation change in tundra and boreal forests, given known processes of tree mortality, treeline migration and shrub expansion. However, representation of above- and especially below-ground traits for specific PFTs continues to be problematic. Potential solutions include developing trait databases and replacing fixed parameters for PFTs with formulations based on trait co-variance and empirical trait-environment relationships. Surprisingly, despite being important to land-atmosphere interactions of carbon, water and energy, PFTs such as moss and lichen are largely absent from DVMs. Close collaboration among those involved in modelling with the disciplines of taxonomy, biogeography, ecology and remote sensing will be required if we are to overcome these and other shortcomings.Published by Oxford University Press on behalf of the Annals of Botany Company 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Tall shrub and tree expansion in Siberian tundra ecotones since the 1960s. - Global change biology
Circumpolar expansion of tall shrubs and trees into Arctic tundra is widely thought to be occurring as a result of recent climate warming, but little quantitative evidence exists for northern Siberia, which encompasses the world's largest forest-tundra ecotonal belt. We quantified changes in tall shrub and tree canopy cover in 11, widely distributed Siberian ecotonal landscapes by comparing very high-resolution photography from the Cold War-era 'Gambit' and 'Corona' satellite surveillance systems (1965-1969) with modern imagery. We also analyzed within-landscape patterns of vegetation change to evaluate the susceptibility of different landscape components to tall shrub and tree increase. The total cover of tall shrubs and trees increased in nine of 11 ecotones. In northwest Siberia, alder (Alnus) shrubland cover increased 5.3-25.9% in five ecotones. In Taymyr and Yakutia, larch (Larix) cover increased 3.0-6.7% within three ecotones, but declined 16.8% at a fourth ecotone due to thaw of ice-rich permafrost. In Chukotka, the total cover of alder and dwarf pine (Pinus) increased 6.1% within one ecotone and was little changed at a second ecotone. Within most landscapes, shrub and tree increase was linked to specific geomorphic settings, especially those with active disturbance regimes such as permafrost patterned-ground, floodplains, and colluvial hillslopes. Mean summer temperatures increased at most ecotones since the mid-1960s, but rates of shrub and tree canopy cover expansion were not strongly correlated with temperature trends and were better correlated with mean annual precipitation. We conclude that shrub and tree cover is increasing in tundra ecotones across most of northern Siberia, but rates of increase vary widely regionally and at the landscape scale. Our results indicate that extensive changes can occur within decades in moist, shrub-dominated ecotones, as in northwest Siberia, while changes are likely to occur much more slowly in the highly continental, larch-dominated ecotones of central and eastern Siberia.© 2013 John Wiley & Sons Ltd.
Aeolian process effects on vegetation communities in an arid grassland ecosystem. - Ecology and evolution
Many arid grassland communities are changing from grass dominance to shrub dominance, but the mechanisms involved in this conversion process are not completely understood. Aeolian processes likely contribute to this conversion from grassland to shrubland. The purpose of this research is to provide information regarding how vegetation changes occur in an arid grassland as a result of aeolian sediment transport. The experimental design included three treatment blocks, each with a 25 × 50 m area where all grasses, semi-shrubs, and perennial forbs were hand removed, a 25 × 50 m control area with no manipulation of vegetation cover, and two 10 × 25 m plots immediately downwind of the grass-removal and control areas in the prevailing wind direction, 19° north of east, for measuring vegetation cover. Aeolian sediment flux, soil nutrients, and soil seed bank were monitored on each treatment area and downwind plot. Grass and shrub cover were measured on each grass-removal, control, and downwind plot along continuous line transects as well as on 5 × 10 m subplots within each downwind area over four years following grass removal. On grass-removal areas, sediment flux increased significantly, soil nutrients and seed bank were depleted, and Prosopis glandulosa shrub cover increased compared to controls. Additionally, differential changes for grass and shrub cover were observed for plots downwind of vegetation-removal and control areas. Grass cover on plots downwind of vegetation-removal areas decreased over time (2004-2007) despite above average rainfall throughout the period of observation, while grass cover increased downwind of control areas; P. glandulosa cover increased on plots downwind of vegetation-removal areas, while decreasing on plots downwind of control areas. The relationships between vegetation changes and aeolian sediment flux were significant and were best described by a logarithmic function, with decreases in grass cover and increases in shrub cover occurring with small increases in aeolian sediment flux.
Endometrioid adenocarcinoma arising from endometriosis: a case report. - The Journal of reproductive medicine
Endometriosis is frequently identified in the ovaries, rectum, pelvic peritoneum, cervix and vagina. However, endometriosis undergoing malignant transformation is a rare event, particularly when the condition manifests itself promptly after initial surgical management.We present a case involving a 52-year-old woman who tested positive for the BRCA1 mutation and was diagnosed with endometriosis in 1999. Two years following treatment, the patient presented with an endometrioid adenocarcinoma; pathologic evaluation indicated that the neoplasm originated from the endometriosis.Malignant transformation is a very unusual event and reportedly occurs over several years. Nevertheless, considering the current patient's relatively sudden onset of disease, oncologists should maintain a high index of suspicion in high-risk patients treated surgically for endometriosis who re-present with pelvic symptoms.
Paget's disease of the vulva: a clinicopathologic institutional review. - International journal of clinical oncology
The aim of this study was to assess the clinicopathologic characteristics of patients with Paget's disease of the vulva who were treated by our gynecologic oncology service between 1985 and 2010.Vulvar Paget's disease patient demographics, pathologic diagnosis, treatment and follow-up data were reviewed over a 25-year period.The vulvar Paget's disease patients were primarily (62.5%) treated with a partial simple vulvectomy. Three patients had a history of malignancy, although none of them was intercurrent. Eleven patients had microscopically positive margins, 5 of whom developed progressive disease. Conversely, 5 patients had negative margins, of whom 4 had recurrent disease. There was a significant relationship between the presence of invasive disease and patient progression-free interval (PFI) (p = 0.007), but margin status and lesion size did not correlate with PFI (p > 0.05). Median patient PFI and follow-up was 30 and 53 months, respectively.We found a significant relationship between the presence of invasive disease and patient PFI in vulvar Paget's disease although the presence of microscopic positive margins and lesion size were not prognostic indicators. In patients with high risk factors, prolonged surveillance should be considered an essential component of optimal patient management.
Nanotechnology in cosmetic products. - Skinmed
Nanotechnology is a subject of extensive global interest. The ability to control matter at the nanoscale level presents a revolutionary opportunity to benefit society in numerous disciplines. Nanotechnology is currently found in cosmetic products, particularly sunscreen products containing titanium dioxide and zinc oxide. Published information in scientific journals suggests that nano-sized ingredients used in cosmetic products pose no more risk to human health than larger sized counterparts. The issue remains under investigation.
Leiomyosarcoma with synchronous clear cell ovarian carcinoma. - Onkologie
Uterine leiomyomas are typically considered benign lesions. Despite aggressive management, they can be unpredictable and eventually exhibit disease recurrence several years following initial treatment.We report a case involving a 55-year-old woman who was treated for a uterine leiomyoma at an outside medical institution 20 years ago. In November 2009, she presented to our gynecologic oncology service with a complex mass. Following surgery, the patient was diagnosed with a 16 cm ovarian mass and a synchronous leiomyosarcoma; the latter neoplasm appeared to originate from a previously resected uterine leiomyoma.The coexistence of these two lesions is exceedingly rare. We suspect that the leiomyosarcoma developed from either the patient's original uterine leiomyoma or leiomyomatosis peritonealis disseminata.Copyright © 2010 S. Karger AG, Basel.
Food for thought and skin. - Skinmed
Free radicals are involved in the pathogenesis of several diseases including inflammation, neurodegenerative conditions, skin and eye disorders, and various forms of cancer. Epidemiologic evidence correlating higher intake of certain foods, typically fruits and vegetables or food components containing antioxidants, with a lower incidence of human disease are documented in the literature. Specific examples of such foods are apples, pears, graapes, wine, and tea.

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