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PubMed2000

Free flap coverage of bilateral frostbite of the feet.

The indications, principles of management, and outcomes of free flap transfer for limb salvage in four patients with bilateral frostbite of their feet are presented. A fasciocutaneous flap was used for coverage when the wound involved a single surface of the foot. When multiple surfaces of the foot required free flap coverage, a muscle flap was used because it could more easily improve the shape and contour of the defect. Successful coverage was achieved in all four patients.

Adolescent↗
PubMed1999

Facet coverage in children on flexion lateral cervical radiographs.

STUDY DESIGN: This radiographic study was designed to attempt to develop standards of facet coverage (overlap) on lateral cervical radiographs during voluntary flexion. OBJECTIVE: To produce normative standards for minimum facet coverage in children. SUMMARY OF BACKGROUND DATA: Previous studies on normative standards of facet coverage have been performed only in adults. METHODS: Thirty-six children with minor trauma had lateral flexion-extension radiographs. A standard filming sequence was used in all. Facet joint overlap at each level was divided by the anteroposterior diameter of the upper adjacent cervical body at each level. RESULTS: On linear regression analysis, these ratios did not vary significantly with age at C2-C3 through C6-C7. Means and standard deviations were determined for C2-C7. CONCLUSIONS: These ratios may prove useful in evaluation of children with possible ligamentous injury.

Adolescent↗
PubMed1999

Medical coverage of high school football in Wisconsin in 1997.

OBJECTIVE: The goals of this study were to assess the health care available to Wisconsin high school football players and to assess high schools' compliance with safety requirements of the Wisconsin Interscholastic Athletic Association (WIAA). DESIGN: The design was a cross-sectional survey-based study. SETTING: The setting consisted of WIAA high schools. PARTICIPANTS: Athletic directors of WIAA high school football programs participated in the survey. MAIN OUTCOME MEASURES: The main outcome measures were the prevalence of medical coverage by physicians, certified athletic trainers, and ambulance personnel at football games and practice and the prevalence of compliance with WIAA requirements. RESULTS: Seventy-seven percent (302/392) of surveys were returned. Thirty-six percent of schools had a designated team physician. Eighty-seven percent had a trainer, and 86% were certified athletic trainers (Athletic Trainer Certified, ATC). At practice and scrimmage, 79% had an ambulance available or on call, 52% had a trainer present, and 28% had a physician on call. At football games, 71% had an ambulance, 67% a certified athletic trainer, 48% an emergency medical technician, and 45% a physician present. Regarding WIAA requirements, 9% had no accessible phone, 27% had no written emergency plan of action, 92% had gloves, and 92% had blood spill kits. Larger schools had better compliance with WIAA requirements than did smaller schools. CONCLUSION: Health care coverage was provided mainly by trainers and ambulance personnel, although physicians were routinely present at almost half of all games. Failure to comply with WIAA medical coverage requirements was not infrequent. This study forms the basis for an informational intervention, providing an opportunity to correct deficits.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Cytogenetic analysis using telemedicine consultation: an improved means of providing expert cross-coverage.

PURPOSE: We used telemedicine in providing cross-coverage for a clinical cytogenetics laboratory. A genetic teleconsultation system was used to provide expert cross-coverage for a laboratory in a neighboring metropolitan region for a 6 month period while the usual provider of these services was on military reserve duty. METHODS: The teleconsultation system was a commercially available Perceptive Scientific Instruments (PSI) workstation. Five hundred thirty-nine cytogenetic cases were performed during the study period in the home laboratory in Baltimore, Maryland. RESULTS: Karyotypes and supporting metaphase spreads were transmitted by modem to the covering director, whereas work sheets and reports were faxed. Physical transfer of data was not necessary, and turn-around-time was not increased. CONCLUSION: This ability to employ a remote part time director has significant benefits for the laboratory with an absentee director for short or even extended periods of time. We conclude that the use of telemedicine in clinical cytogenetics proved to be an efficient and a cost effective means of providing genetics services to a region during a time of cross-coverage need.

Chromosome Aberrations↗
PubMed2004

Internal mammary lymph node (IMN) coverage by standard radiation tangent fields in patients showing IMN drainage on lymphoscintigraphy: therapeutic implications.

The purpose of this report is to evaluate the variability in coverage of the internal mammary nodal chain (IMN) by standard radiation tangential fields in those patients with medial drainage on lymphoscintigraphy. Twenty-two patients who showed lymphoscintigraphic IMN drainage underwent radiation simulation planned with computed tomography (CT). Standard tangent fields were placed and CT scans were reviewed to assess IMN inclusion and correlation with presternal fat thickness. Of the 22 patients who showed IMN drainage on lymphoscintigraphy, 10 (45%) had lateral primary lesions, 9 (41%) had medial lesions and 3 (14%) had subareolar lesions. Of these 22 women, 4 (19%) had the IMN completely within the standard tangent fields. Twelve women (55%) had only partial coverage of the IMN and the remaining 6 women (27%) had the IMN region completely outside. Presternal fat thickness greater than 10 mm was less likely associated with complete IMN coverage than fat thickness 10 mm or less, P = 0.001. Lymphoscintigram drainage to the IMN in breast cancer patients may suggest an increased risk of IMN involvement. Our data show that a majority (73%) of these patients had complete or partial incidental inclusion of the IMNs with standard tangents, which may in part explain the historically low IMN failure rate.

Adult↗
PubMed2005

A novel approach to skin coverage for epispadias repair.

PURPOSE: Current techniques for epispadias repair have resulted in significant improvement in the reconstruction of the urethra, corpora and glans. The final challenging step is to enhance the cosmetic result by accomplishing skin coverage for the penis and subpubic area, creating a penopubic and penoscrotal angle without dorsal suture lines, and avoiding future dorsal tethering of the penis as a result of scar contraction. We report a novel technique for penile skin coverage in the patient with epispadias that results in a superior cosmetic outcome. MATERIALS AND METHODS: The technique involves creation of 2 flaps-a ventral preputial transverse island flap rotated dorsally to cover the dorsal aspect of the penile shaft, and an advancement flap from the patch of skin present between the penis and scrotum in epispadias, which is advanced distally to cover the ventral aspect of the penis. The 2 flaps are sewn to each other with 2 lateral suture lines. Thus, the dorsal and ventral aspects of the penis are covered with intact skin devoid of suture lines. RESULTS: This technique was used in 8 males 2 days to 15 years old. The epispadias was part of exstrophy in 5 patients and an isolated defect in 3. Both flaps healed well in 7 of 8 patients. In 1 exstrophy case a segment of the transverse island flap became ischemic and was discarded intraoperatively. Dorsal skin coverage in this patient was achieved using a laterally based flap from the inguinal area, which healed without problem. Followup was 6 to 33 months. No patient had development of skin tethering, curvature or recurrence of the dorsal chordee. The cosmetic appearance of the penis was subjectively superior to that of boys who underwent skin closure using reverse Byars flaps. CONCLUSIONS: The cosmetic appearance of the penis using this novel technique is superior because of the absence of the dorsal scar that may cause chordee, the development of penopubic and penoscrotal angles, which gives the penis a more normal appearance, and the absence of the redundant patch of skin between the shaft of the penis and the scrotum.

Adolescent↗
PubMed2006

Coverage of antenatal syphilis screening and predictors for not being screened in Ulaanbaatar, Mongolia.

OBJECTIVES: To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened. GOAL: To assess the syphilis control program in Mongolia. STUDY DESIGN: Antenatal care records of women in 16 antenatal care clinics of 6 districts were reviewed. Additionally, postpartum women were interviewed to identify potential factors for not being screened. RESULTS: Among 3,519 antenatal records, the coverage of syphilis screening was 77.7%. Of 2,735 screened women, 54 (2.0%) had reactive serological results and subsequently received treatment. Four late antenatal care comers delivered infants with congenital syphilis. Being unscreened was significantly associated with late antenatal care (odds ratio OR=2.6), lack of knowledge (OR=5.5), history of previous sexually transmitted infection (OR=3.7), and living far from screening services (OR=4.9). CONCLUSIONS: The coverage of antenatal syphilis screening is still low, with poor contact tracing. More efforts are needed to promote early antenatal care visit and improve syphilis screening systems.

Adolescent↗
PubMed2006

Health insurance coverage, health care-seeking behaviors, and genital chlamydial infection prevalence in sexually active young adults.

BACKGROUND: Genital chlamydial infection remains prevalent in young adults. Differential access to health care and thus the opportunity for testing, treatment, sexual partner services, and risk reduction counseling may be among the factors contributing to variation in chlamydial prevalence. GOAL: We investigated associations of health insurance coverage and health care-seeking behaviors, both indicators of healthcare access, to chlamydial infection in a nationally representative sample of young adults. METHODS: Weighted logistic regression techniques were used to examine associations between indicators of healthcare access and chlamydial infection as determined using Chlamydia trachomatis ligase chain reaction among a subset of sexually active young adults ages 18 to 27 interviewed at wave III of the National Longitudinal Study of Adolescent Health (N = 9347). Analyses were stratified by gender and controlled for age and race/ethnicity. RESULTS: Having continuous health insurance coverage in the preceding 12 months was associated with a lower risk of chlamydial infection in both men and women. Usual site of health care was also associated with chlamydial infection. Men who reported emergency rooms as their usual site of care had a higher risk of infection, whereas women who used school clinics had a lower risk compared with those seen in primary care settings. Having seen a provider in the preceding 12 months was associated with a lower risk of chlamydial infection for men only. These associations remained even after adjusting for racial/ethnic differences in health insurance coverage and health care-seeking behaviors. CONCLUSIONS: Independent of race/ethnicity, indicators of healthcare access are associated with chlamydial infection in young adults. Furthermore, our analyses reveal differences in these associations by gender. Improved healthcare access for young people could help reduce chlamydia-associated reproductive health morbidity potentially through access to chlamydial screening, treatment, sex partner services, and risk reduction counseling.

Adolescent↗
PubMed2005

Subincisional muscular coverage of expander implants in immediate breast reconstruction with pectoralis flaps.

Immediate breast reconstruction with expander implants is a safe, simple procedure that allows for a rapid physical and emotional postmastectomy recovery. When complications occur, the patient may be left with a prolonged reconstructive course. Such complications may result from thin mastectomy flaps and resulting marginal skin flap necrosis and implant exposure. Muscle coverage of the implant under the skin incision prevents such marginal necrosis of skin flap from becoming a factor in implant loss. This paper demonstrates a simple method for providing subincisional muscle coverage of expander implants with pectoralis muscle flaps. In this technique, a pocket is developed under the pectoralis muscle. The sternal origin of the pectoralis is released from the midsternal position to its inferior origin. The pectoralis muscle is then rotated inferior-laterally and sutured to the dermis of the underside of the inferior mastectomy skin flap, thereby providing subincisional muscle coverage of the expander implant. During a 5-year period, 42 patients between the ages of 36 and 61 underwent breast reconstruction utilizing this technique. In these patients, there were 4 instances of marginal necrosis. In each of these cases, the implants did not become exposed, and all patients completed the expansion process without significant delay and underwent subsequent implant exchange without incident. Five-year follow-up has shown good esthetic results in all patients.

Adult↗
PubMed2006

Soft-tissue coverage of an open tibial wound in the junction of the middle and distal thirds of the leg with the medial hemisoleus muscle flap.

A relatively simple but reliable option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg has never been determined. In this series, the author reports his clinical experience utilizing the medial hemisoleus muscle flap as a local reconstructive option for management of this unique clinical problem. Over the past 2 years, 14 patients underwent a soft-tissue reconstruction of an open tibial wound (4 x 3 to 10 x 5 cm) in the junction of the middle and distal thirds of the leg with the proximally based medial hemisoleus muscle flap. Only the medial half of the soleus muscle was elevated, with attention to preserving critical perforators from the posterior tibial vessels to the flap while allowing adequate arc of flap rotation to cover the exposed fracture site and hardware. All patients were followed for up to 2 years. Only 1 patient developed insignificant distal flap necrosis and was treated with debridement and flap readvancement. All patients had primary healing of their wounds, reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Therefore, the medial hemisoleus muscle flap described by the author can be a reliable local option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg with good outcome and minimal morbidity.

Adolescent↗
PubMed2002

Computer simulation study of irreversible adsorption: coverage fluctuations.

In this paper, we develop a cellular automata model to study the coverage fluctuations in monolayers of irreversible adsorbed particles. The effect of bulk diffusion and excluded volume interactions between adsorbed and incoming particles on coverage fluctuations is analyzed by simulations and analytically. We also show that the macroscopic boundary and initial conditions imposed at the system (open or closed cell) determine the effect of these factors on coverage fluctuations. In fact, under certain conditions, the excluded volume interactions only influence fluctuations near the jamming limit.

Journal Article↗
PubMed2003

Estimating surfactant surface coverage and decomposing its effect on drop deformation.

A novel method is introduced to estimate surface coverage and the equation of state of insoluble surfactant on droplets, involving measurement of interfacial tension on a single parent drop and progressively subdivided generations of daughter drops. This has enabled quantitative decomposition of the dilution, tip-stretching, and Marangoni effects of surfactants on drop deformation. For a small viscosity ratio of 0.09, the Marangoni effect dominates, increasing first and then decreasing with surface coverage, the dilution effect is significant at high, and tip-stretching only at low surface coverage. For a viscosity ratio of 2.3, the dilution effect dominates, and neither Marangoni nor tip-stretching effects play an important role.

Journal Article↗
PubMed2004

A neural network approach to complete coverage path planning.

Complete coverage path planning requires the robot path to cover every part of the workspace, which is an essential issue in cleaning robots and many other robotic applications such as vacuum robots, painter robots, land mine detectors, lawn mowers, automated harvesters, and window cleaners. In this paper, a novel neural network approach is proposed for complete coverage path planning with obstacle avoidance of cleaning robots in nonstationary environments. The dynamics of each neuron in the topologically organized neural network is characterized by a shunting equation derived from Hodgkin and Huxley's (1952) membrane equation. There are only local lateral connections among neurons. The robot path is autonomously generated from the dynamic activity landscape of the neural network and the previous robot location. The proposed model algorithm is computationally simple. Simulation results show that the proposed model is capable of planning collision-free complete coverage robot paths.

Journal Article↗
PubMed1997

Disasters, the media and social structures: a typology of credibility hierarchy persistence based on a newspaper coverage of the Love Canal and six other disasters.

The starting-point of this paper is the assumption that credibility and the right to be heard are differentially distributed in any social system and therefore a 'hierarchy of credibility' exists. To test this, the media coverage of the Love Canal, New York, hazardous waste landfill disaster and six other disasters was examined to determine if this hierarchy exists in all cases. A hierarchy of credibility emphasising the views of established news sources with routine and habitual access to the media was demonstrated in the majority of events examined However, the Love Canal disaster was one of two where this hierarchy was disrupted due to a number of factors. These included the contentious or political nature of the event, its duration, the extent of competition of credibility and coverage among news sources, the extent of information shortage, the type of news medium, the degree of sympathetic and representational salience of victims and the extent to which they organized and achieved status as 'newsmakers'. Building on disaster research, a model of the operation of the credibility hierarchy in coverage of disasters is presented and discussed.

Attitude to Health↗
PubMed2006

Synergistic antimicrobial activity by combining an allylamine with benzoyl peroxide with expanded coverage against yeast and bacterial species.

BACKGROUND: Dermatophyte infections can be polymicrobial. Topical antifungal therapies offer limited coverage of yeasts and Gram-positive and Gram-negative bacteria. Moreover, the increased usage of these topical antimicrobial agents has resulted in the development of resistant cases. Benzoyl peroxide (BP), used in concert with antimicrobial agents containing an accessible tertiary amine, has previously been shown to increase radical activity and biological effect. OBJECTIVES: To determine the applicability of using the tertiary amine terbinafine in concert with BP in dermatophyte and mixed skin infections by means of in vitro testing. METHODS: In this preliminary in vitro study, the effect of BP, alone and in combination with terbinafine, was tested against Candida albicans, Pseudomonas aeruginosa and Staphylococcus aureus isolates following a checkerboard modification of the National Committee for Clinical Laboratory Standards M27-A2 and M7-A6. The individual minimum inhibitory concentrations of terbinafine, BP, and the combination, were determined against each isolate. RESULTS: The combination of BP with terbinafine led to additive activities against the majority of Candida albicans isolates tested and additionally expanded the bacterial coverage of terbinafine. CONCLUSIONS: The combination of antifungal agents bearing a tertiary amine with BP may have benefit in polymicrobial infections, given its wider antimicrobial coverage. Further appreciation of this mechanism of catalysis of BP radical formation by certain antimicrobials and other tertiary amine-containing compounds may lead to the discovery of improved treatments for several dermatological conditions.

Antifungal Agents↗
PubMed1998

Serotypes and antibacterial susceptibility of pneumococci isolated from children with infections in Ankara in relation to proposed pneumococcal vaccine coverage.

BACKGROUND: Streptococcus pneumoniae is an important pathogen for both children and adults. Although there is an effective vaccine, it is not protective under 2 years of age and common serotypes differ from one location to another. METHODS: A total of 44 Streptococcus pneumoniae isolates were recovered from clinical specimens of children in various hospitals in Ankara, Turkey. All isolates were serotyped and evaluated for vaccine coverage and tested for antibacterial susceptibility. RESULTS: There were 23 different serotypes with a predominance of serotypes 6A, 14, 19F and 23F. The nine-valent conjugate vaccine, which has been proposed for use in young children, covers 90.4% of isolations in children < 2 years of age. This coverage decreases to 43.4% after 2 years of age. The coverage of 23-valent vaccine is better than that of the conjugate vaccine (60.8% vs 43.4%, P < 0.05). Two relatively common and resistant types in our isolates (10A and 21) are not included in either vaccines and adding these serotypes into the 23-valent vaccine was suggested. Although the rate of intermediately penicillin resistant strains was 31.8%, highly penicillin resistant strains were not found in the present study. CONCLUSIONS: The usefulness of conjugate vaccine before 2 years of age and appropriate choice of vaccine strains to include all resistant serotypes for older children in our region, is discussed. It is shown that conjugated vaccine is protective in children less than 2 years of age, but a booster with 23-valent vaccine will be needed once they are older than 2.

Bacterial Vaccines↗
PubMed2004

Coverage in screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales.

AIM: To assess the proportion of people with diabetes screened for retinopathy according to provision of screening services. METHODS: Twenty-five health authorities in England and Wales were sampled after stratification by type of screening provision for diabetic retinopathy. Nine did not have a population-based screening scheme, six had an optometry scheme, six had a camera scheme and four had schemes with more than one method of screening ('mixed schemes'). Within each authority general practices were randomly sampled, 129 in total, and in each the records of a sample of diabetic patients examined. RESULTS: Of the 9200 records examined, 5812 (63.2%) had a record of one or more retinal examinations from any source in the year before the survey. This proportion did not differ significantly according to type of screening provision. The proportion of people with one or more retinal examinations by an 'expert' (defined as ophthalmologist, diabetologist, optometrist or screening scheme) in the last year was 44.7% where there was no screening scheme and 62.2%, 59.4%, and 61.6%, respectively, where optometry, camera and mixed schemes were present. Adjusted relative odds (95% confidence interval) for a retinal examination from any source in the last year compared with areas with no screening schemes were 1.19 (0.73, 1.93), 1.26 (0.80, 1.98), and 1.19 (0.77, 1.84) for camera, optometry and mixed schemes, respectively. Equivalent figures for an expert retinal examination were 2.30 (1.51, 3.49), 1.86 (1.25, 2.78) and 2.13 (1.32, 3.45). Coverage by schemes themselves did not differ according to type of scheme. Highest coverage rates, including examinations by screening schemes, were achieved in those treated with insulin, and the lowest rates found in those treated with diet alone. CONCLUSIONS: Screening schemes have had a small impact on overall retinal examinations, but a higher impact on the coverage of examinations performed by experts.

Adult↗
PubMed1997

Hepatitis B immunisation coverage of infants born to chronic carrier mothers in Victoria.

Infants born to HBsAg- (hepatitis B surface antigen) carrier mothers are highly likely to become chronic hepatitis B (HB) carriers themselves unless their status is recognised at birth and they are immunised with three doses of HB vaccine, the first within 48 hours of birth, concurrent with hepatitis B immune globulin (HBIG). This study was designed to determine how many infants born in Victoria to carrier mothers completed three doses of HB vaccine. We sent the names of all infants of HBsAg-carrier mothers notified in Victoria between 1.7.91 and 30.6.92 to the appropriate local government immunisation providers and requested information on how many doses of HB vaccine, DTP (diphtheria-tetanus-pertussis) or CDT (combined diphtheria-tetanus), and OPV (oral polio vaccine) they had received. The HBsAg-carrier prevalence of women giving birth in Victoria in 1991-92 was at least 0.52%. Of the 336 infants notified, 239 (71.1%) were recorded in local government records. Of these 239, 90.8% received at least two doses and 80.8% received at least three doses of hepatitis B vaccine. There was no significant difference in the number who received three doses of HB vaccine compared with three doses of DTP or CDT vaccine. Of the entire cohort of 336, only 57.4% were documented as being completely immunised against hepatitis B. HB immunisation coverage for these infants needs to be improved. The high rate of loss to follow-up, especially between the maternity hospital and the community, is disturbing. Mechanisms for intensive prospective follow-up of these infants should be developed to prevent loss to follow-up and to encourage full immunisation against HB. Improving HB immunisation coverage of infants in high HBsAg-prevalence ethnic groups and introduction of universal infant HB immunisation may lead to increased coverage of infants of carriers by serving as back-up mechanisms for those lost to follow-up.

Carrier State↗