The natural history of the growth of the hand: I. Hand area as a percentage of body surface area

Effects of paddles and fins on front crawl kinematics, arm stroke efficiency, coordination, and estimated energy cost

Paddles and fins are used in swimmers training with different objectives (e.g., increase propulsive areas of hands and feet, improve the feeling of water flow). These artificial modifications of the stroke might be viewed as external constraints of the stroke task, both will either disturb or facilitate swimming modalities, so the coaches should manipulate its use to extract benefits for performance. This study seeks to investigate the precise effects of wearing either paddles (PAD) or fins (FINS) vs. a no-equipment (NE) trial in three all-out front crawl exercises on swimmer kinematics, arm stroke efficiency (ηp), upper-limbs coordination patterns (Index of Coordination, IdC), and estimated energy cost (C). Eleven regional to national-level male swimmers participated in the study (age: 25.8 ± 5.5 years, body mass: 75.2 ± 5.5 kg, height: 177 ± 6.5 cm) and were recorded from both sides of the swimming pool to collect all variables. Repeated measures ANOVA and Bonferroni post hoc were used to compare the variables. Effects sizes were calculated. Time to cover the distance and velocity were higher in FINS swimming, with larger values of stroke length (SL) and lower kick amplitude in comparison to the other trials (PAD and NE). The use of FINS also modified the stroke phases durations by presenting significant lower propulsion time during the stroke in comparison to PAD or NE. Values of IdC were lower (IdC < -1%, so catch-up pattern of coordination) for FINS in comparison to NE. In terms of ηp, using PAD or FINS demonstrate higher arm stroke efficiency than swimming without equipment. Finally, C was significantly higher in FINS swimming in comparison to NE and PAD. From the present results, it should be noted that the use of equipment such as fins deeply modify the structure of the swimming stroke (from the performance-related parameters through the kinematics of both upper and lower limbs to the stroke efficiency and coordination pattern). So, using equipment should be appropriately scaled by the coaches to the objectives of the training session in swimming, and in emergent sports such as "SwimRun", paddles and fins must be viewed as tools to achieve higher velocities to cover a given distance.

3D PED BURN app: A precise and easy‐to‐use pediatric 3D burn surface area calculation tool

Background and aims

Method

Result

Conclusion

Three-dimensional front crawl arm-stroke efficiency and hand displacement in male and female swimmers

This study aimed (i) to verify if underwater horizontal, vertical and medio-lateral hand displacements (HD), in pull and push phases of the front crawl stroke, can be associated with arm-stroke efficiency (ƞp) and (ii) to compare np and selected kinematic variables between male and female swimmers. Ten male and 10 female swimmers performed an all-out front crawl 25-m test. Data were obtained with six synchronised video cameras (60 Hz) and analysed with a three-dimensional method. Results for males and females were respectively, as follows: (i) horizontal HD: 0.55 ± 0.06 m and 0.61 ± 0.09 m (p = 0.062; d = 0.78); vertical HD: 0.68 ± 0.06 m and 0.58 ± 0.07 m (p < 0.001; d = 1.53); and medio-lateral HD: 0.22 ± 0.07 m and 0.16 ± 0.03 m (p = 0.012; d = 1.11); (ii) ƞp: 0.33 ± 0.02 and 0.32 ± 0.03 (p = 0.48; d = 0.39); (iii) vCOM: 1.77 ± 0.06 m∙s-1 and 1.55 ± 0.10 m∙s-1 (p < 0.001; d = 2.42). Multiple linear regression (p = 0.019) indicated that horizontal and medio-lateral HD were able to predict np. The lower the horizontal hand displacement, the higher the ƞp.

Investigating the reliability and sex differences of digit lengths, ratios, and hand measures in infants

Hands and digits tend to be sexually dimorphic and may reflect prenatal androgen exposure. In the past years, the literature introduced several hand and digit measures, but there is a lack of studies in prepubertal cohorts. The available literature reports more heterogeneous findings in prepubertal compared to postpubertal cohorts. The comparability of the available studies is further limited by the study design and different measurement techniques. The present study compared the reliability and sex differences of available hand and digit measures, namely digit lengths of 2D, 3D, 4D, 5D, digit ratios 2D:4D, 2D:5D, 3D:4D, 3D:5D, 4D:5D, relative digit lengths rel2, rel3, rel4, rel5, directional asymmetry of right and left 2D:4D (Dr-l), hand width, length, and index of 399 male and 364 female 6-month-old German infants within one study using only indirect and computer-assisted measurements. The inter-examiner reliability was excellent while the test-retest reliability of hand scans was only moderate to high. Boys exhibited longer digits as well as wider and longer hands than girls, but smaller digit ratios, with ratios comprising the fifth digit revealing the largest effect sizes. Other hand and digit ratios revealed sex differences to some extent. The findings promote the assumption of sexual dimorphic hand and digit measures. However, by comparing the results of the available literature, there remains an uncertainty regarding the underlying hypothesis. Specifically in prepubertal cohorts, i.e. before the influence of fluctuating hormones, significant effects should be expected. It seems like other factors than the influence of prenatal androgens contribute to the sexual dimorphism in hand and digit lengths.

The influence of object size on second-order planning in an overturned cup task

For children, second-order planning in object manipulation, as demonstrated by the end-state comfort (ESC) effect, is constrained by numerous factors. As a step towards delineating the influence of object size, children (ages 6-10, n = 113) and adults (ages 18-25, n = 17) performed an overturned cup task with 8 cup sizes (4.7-8.4 cm diameter). Contrary to the hypothesis, cup size did not predict the overall proportion of trials with ESC. An increase in age and hand length did result in more ESC. Subsequent analyses with children, which focused on each cup size, revealed an increase in the ratio of hand size to cup size resulted in an increase in ESC with the 4.7, 5.2, 6.2, and 6.7 cm cups, age was a significant predictor with 4.7, 5.2, and 6.2 cm cups, and the interaction was significant for the 6.2 cm cup. No other significant results emerged. Together, findings offer preliminary support for the notion that object size does constrain children's motor planning skills to a certain degree (i.e., with large cups); however, further inquiry is warranted to elucidate the link between object size and hand size in children's performance of tasks requiring second-order planning.

Review of methods to determine hand surface area of children less than six years old: a case study

Various methods exist to determine the surface area of hands. The consistency of these methods is essential given that risk assessments utilize hand surface area (HSA) to quantify exposure to environmental contaminants. HSA is also utilized in the clinical setting to estimate size of burns, and to determine specific treatments and medication dosages. A reliable method of surface area measurement is important to guide these decisions, especially in children who are vulnerable to environmental contaminants and medication side effects. Despite this, fewer HSA-determining studies have been performed for children compared to adults. In this study, 122 children completed hand tracings, and the tracings were digitized using an ImageJ program to determine HSA. Six previously published methods of determining HSA were utilized based on the child's height, weight, and length and width of hand. Children were analyzed by age group including 0-2, 3-4, and 5-6 years. The HSA measurements determined by five of the six methods were statistically different from HSA determined using direct hand tracings/Image J methodology (p < 0.001). The single remaining study that did not differ significantly from the hand tracing method provided a uniform hand to total body surface area (TBSA) ratio for children of all ages. Based on these results, we propose a novel age-group-specific ratio utilizing the HSA results from hand tracings and TBSA calculations. The percentages of TBSA that reflect HSA for children aged 0-2, 3-4 and 5-6 years were 0.91%, 0.90% and 0.87%, respectively. These percentages should be considered for use in risk assessments and the clinical setting to guide treatment and prognosis.

Convolution neural network for effective burn region segmentation of color images

BACKGROUND

Burn injuries are one of the most severe forms of wounds and trauma across the globe. Automated burn diagnosis methods are needed to provide timely treatment to the concerned patients. Artificial intelligence is playing a vital role in developing automated tools and techniques for medical problems. However, the use of advanced AI techniques for color images based burn region segmentation is not much explored.

METHOD

In this work, we explore the use of deep learning for the challenging problem of burn region segmentation. We prepared a pixel-wise labelled new burn images dataset for segmentation and investigated the efficacy of existing state-of-the-art color images based semantic image segmentation techniques. Lately, we proposed a new convolution neural network (CNN) that uses atrous convolution for encoding rich contextual information and utilizes pre-trained model ResNet-101 for better extraction of low-level and middle-level layer features.

RESULTS

The proposed approach achieves the state-of-the-art performance on the prepared burn image dataset with 77.6% of Mathews correlation coefficient (MCC) and 93.4% of accuracy. The improvement of 11.6/5.8/6.9/1.2% is observed in precision, Dice similarity coefficient, Jaccard index and specificity, in comparison to the second best performance.

CONCLUSION

In this work, we propose a CNN based novel method for performing burn-region segmentation in color images and evaluate it using newly prepared Burn Images dataset. The experimental results illustrate its effectiveness in comparison to existing approaches. Further, the proposed pixel-level segmentation method could be useful in estimating the burn surface area and burn severity in an accurate and time efficient manner.

Lund and Browder chart-modified versus original: a comparative study

Background

The Lund and Browder (LB) chart is currently the most accurate and widely used chart to calculate total body surface area affected by a burn injury. However, it is not easy to use charts to calculate burn percentages because of the difficulty in performing mathematical calculations with the percentages attributed to various body regions that are only partially burned. It is also cumbersome to have to perform mental calculations, especially in emergency situations.

Methods

We compared results from the LB chart with a modified Lund and Browder (MLB) chart using 10 assessors on five different burn wounds each drawn on both charts.

Results

Variability of results was significantly reduced using the MLB chart compared to the LB chart.

Conclusions

Assessments performed using the MLB chart are less variable than those using the LB chart. Using this chart will help burn care providers rapidly, accurately, and reliably estimate burn extent.

Comparison of methods to estimate the affected body surface area and the dosage of topical treatments in psoriasis and atopic dermatitis: the advantage of a picture-based tool

BACKGROUND

The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks.

OBJECTIVE

To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user-friendliness and timing.

METHODS

In this study, we compared the reliability of three different methods: (i) the fingertip unit calculated by the 1% hand rule; (ii) a picture-based tool [termed Cutaneous Inflammatory Disease Extent Score (CIDES)]; and (iii) a digital drawing tool. Eleven observers scored 40 patients with psoriasis and eczema to assess the inter-rater and intrarater reliability. Timing was automatically recorded, and user-friendliness was investigated by a questionnaire.

RESULTS

An excellent intraclass correlation (ICC) was found for both inter-rater agreement and intrarater agreement for the picture-based tool (ICC = 0.92 and ICC = 0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased inter-rater variability although an excellent intrarater agreement was found (ICC = 0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability, and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 s).

CONCLUSION

A picture-based method offered the most advantages (in terms of reliability, speed and user-friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.

Hyperspectral index-based metric for burn depth assessment

Burn depth objective classification is of paramount importance for decision making and treatment. Despite the wide variety of burn depth assessment methods tested so far, none of them have gained wide clinical application. Here, we introduce a new approach for burn depth assessment based on hyperspectral imaging combined with a spectral index-based technique that exploits specific spectral bands to map skin areas with different burn degrees. The spectral index amplifies the contrast between normal skin and areas with different degrees of burn, taking advantage of the differences in spectral amplitudes that occur as a result of the morphological and physiological changes occurring in burned skin. We demonstrate that by using the new measurable spectral index, it is possible to generate accurate burn classification maps showing spatial distribution of burn types in the affected body areas, facilitating the decision-making process and prognosis evaluation. The results highlight the potential of the new hyperspectral metric in the field of burn depth classification and its applicability in hospital settings seems promising.

Thermosensory micromapping of warm and cold sensitivity across glabrous and hairy skin of male and female hands and feet

The ability of hands and feet to convey skin thermal sensations is an important contributor to our experience of the surrounding world. Surprisingly, the detailed topographical distribution of warm and cold thermosensitivity across hands and feet has not been mapped, although sensitivity maps exist for touch and pain. Using a recently developed quantitative sensory test, we mapped warm and cold thermosensitivity of 103 skin sites over glabrous and hairy skin of hands and feet in male (M; 30.2 ± 5.8 yr) and female (F; 27.7 ± 5.1 yr) adults matched for body surface area (M: 1.77 ± 0.2 m2; F: 1.64 ± 0.1 m2; P = 0.155). Findings indicated that warm and cold thermosensitivity varies by fivefold across glabrous and hairy skin of hands and feet and that hands (warm/cold sensitivity: 1.25/2.14 vote/°C) are twice as sensitive as the feet (warm/cold sensitivity: 0.51/0.99 vote/°C). Opposite to what is known for touch and pain sensitivity, we observed a characteristic distal-to-proximal increase in thermosensitivity over both hairy and glabrous skin (i.e., from fingers and toes to body of hands and feet), and found that hairy skin is more sensitive than glabrous. Finally, we show that body surface area-matched men and women presented small differences in thermosensitivity and that these differences are constrained to glabrous skin only. Our high-density thermosensory micromapping provides the most detailed thermosensitivity maps of hands and feet in young adults available to date. These maps offer a window into peripheral and central mechanisms of thermosensory integration in humans and will help guide future developments in smart skin and sensory neuroprostheses, in wearable, energy-efficient personal comfort systems, and in sport and protective clothing.

NEW & NOTEWORTHY We provide the most detailed thermosensitivity maps across glabrous and hairy skin of hands and feet in men and women available to date. Our maps show that thermosensitivity varies by fivefold across hands and feet, distal regions (e.g., fingers, toes) are less sensitive than proximal (e.g., palm, sole), hands are twice as sensitive as feet, and men and women present small thermosensitivity differences. These findings will help guide developments in sensory neuroprostheses, wearable comfort systems, and sport/protective clothing.

The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?

Background

Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart.

Methods

Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’ burn percentages.

Results

Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation.

Conclusions

The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.

Three-dimensional imaging is a novel and reliable technique to measure total body surface area

OBJECTIVE

The aim of this study was to explore the diverse clinimetric aspects of three-dimensional imaging measurements of TBSA in clinical practice compared with the methods currently used in clinical practice (i.e., the rule of nines and palm method) to measure TBSA in clinical practice.

METHOD

To assess reliability, two independent researchers measured the TBSAs of 48 burn patients using Artec MHT™ Scanner and software. Subsequently, a resident and burn specialist estimated the TBSA of the same wounds using the rule of nines and palm method.

RESULTS

Three-dimensional imaging showed excellent inter-observer reliability, with an intra-class correlation coefficient (ICC) of 0.99, standard error of measurement (SEM) of 0.054, and limits of agreement (LoA) of ±0.15×the mean TBSA (between the measurements of two researchers). The inter-observer reliability of the methods used in current clinical practice was less reliable, with an ICC of 0.91, SEM of 0.300 and LoA of ±0.78×the mean TBSA. The inter-observer reliability was least reliable between three-dimensional imaging and the residents compared with the burn specialists for the estimated TBSA, with an ICC of 0.68, SEM of 0.69 and LoA of ±1.49×the mean TBSA.

CONCLUSION

The inter-observer reliability of three-dimensional imaging was superior compared with the rule of nines and palm method.

Is there any place for spontaneous healing in deep palmar burn of the child?

Child palm burns arise by contact and are often deep. The singular difficulty of such a disease comes from the necessity of the child growth and from the potential occurrence of constricted scars. In order to avoid sequelae, the actual gold standard is to practice an early excision of the burn, followed by a skin graft. The aim of this study is to evaluate the results of spontaneous healing combined with rehabilitation versus early skin grafting and rehabilitation concerning the apparition of sequelae. We performed a retrospective study in two burn centers and one rehabilitation hospital between 1995 and 2010. Eighty-seven hands have been included in two groups: one group for spontaneous healing and the other group for excision and skin grafting. Every child benefited from a specific rehabilitation protocol. The two main evaluation criteria were the duration of permanent splint wearing and the number of reconstructive surgery for each child. The median follow-up duration is about four years. The two groups were comparable. For the early skin grafting group, the splint wearing duration was 1/3 longer than for the spontaneous healing group. Concerning the reconstructive surgery, half of the grafted hands needed at least one procedure versus 1/5 of spontaneous healing hands. Our results show the interest of spontaneous healing in palmar burn in child, this observation requires a specific and intense rehabilitation protocol.

Effect of hand paddles and parachute on butterfly coordination

This study investigated the effects of hand paddles, parachute and hand paddles plus parachute on the inter-limb coordination of butterfly swimming. Thirteen male swimmers were evaluated in four random maximal intensity conditions: without equipment, with hand paddles, with parachute and with hand paddles + parachute. Arm and leg stroke phases were identified by 2D video analysis to calculate the total time gap (T1: time between hands' entry in the water and high break-even point of the first undulation; T2: time between the beginning of the hand's backward movement and low break-even point of the first undulation; T3: time between the hand's arrival in a vertical plane to the shoulders and high break-even point of the second undulation; T4: time between the hand's release from the water and low break-even point of the second undulation). The swimming velocity was reduced and T1, T2 and T3 increased in parachute and hand paddles + parachute. No changes were observed in T4. Total time gap decreased in parachute and hand paddles + parachute. It is concluded that hand paddles do not influence the arm-to-leg coordination in butterfly, while parachute and hand paddles + parachute do change it, providing a greater propulsive continuity.

Recreational swimmers' exposure to Vibrio vulnificus and Vibrio parahaemolyticus in the Chesapeake Bay, Maryland, USA

Vibrio vulnificus and Vibrio parahaemolyticus are ubiquitous in the marine-estuarine environment, but the magnitude of human non-ingestion exposure to these waterborne pathogens is largely unknown. We evaluated the magnitude of dermal exposure to V. vulnificus and V. parahaemolyticus among swimmers recreating in Vibrio-populated waters by conducting swim studies at four swimming locations in the Chesapeake Bay in 2009 and 2011. Volunteers (n=31) swam for set time periods, and surface water (n=25) and handwash (n=250) samples were collected. Samples were analyzed for Vibrio concentrations using quantitative PCR. Linear and logistic regressions were used to evaluate factors associated with recreational exposures. Mean surface water V. vulnificus and V. parahaemolyticus concentrations were 1128CFUmL(-1) (95% confidence interval (CI): 665.6, 1591.4) and 18CFUmL(-1) (95% CI: 9.8, 26.1), respectively, across all sampling locations. Mean Vibrio concentrations in handwash samples (V. vulnificus, 180CFUcm(-2) (95% CI: 136.6, 222.5); V. parahaemolyticus, 3CFUcm(-2) (95% CI: 2.4, 3.7)) were significantly associated with Vibrio concentrations in surface water (V. vulnificus, p<0.01; V. parahaemolyticus, p<0.01), but not with salinity or temperature (V. vulnificus, p=0.52, p=0.17; V. parahaemolyticus, p=0.82, p=0.06). Handwashing reduced V. vulnificus and V. parahaemolyticus on subjects' hands by approximately one log (93.9%, 89.4%, respectively). It can be concluded that when Chesapeake Bay surface waters are characterized by elevated concentrations of Vibrio, swimmers and individuals working in those waters could experience significant dermal exposures to V. vulnificus and V. parahaemolyticus, increasing their risk of infection.

A study of the anthropometric correlations between upper limb measurements for personal identification in Sudanese population

The presence of multiple isolated commingled fleshed limbs or limb parts generates a significant challenge for forensic investigators in wars, mass disasters, and criminal assaults in the process of identification. Although upper limb measurements have been used to establish individual identity in terms of sex and stature with high success, there is a scarcity of data concerning the correlations within upper limb parts. Hence, this study aims to assess the relationships within upper limb parts and develop regression formulae to reconstruct the parts from one another. The study participants were 376 Sudanese adults (187 males and 189 females). The results of this study indicated significant sexual dimorphism for all variables. The results indicated a significant correlation within the upper limb parts. Linear and multiple regression equations were developed to reconstruct the upper limb parts in the presence of a single or multiple dimension(s) from the identical limb. Multiple regression equations generated better reconstructions than simple equations. These results are significant in forensics and orthopedic reconstructive surgery.

The evaluation and management of thermal injuries: 2014 update

Burns are among the most common injuries presenting to the emergency department. While burns, especially large ones, may be associated with significant morbidity and mortality, most are minor and can be managed by emergency practitioners and discharged home with close follow-up. In contrast, patients with large burns require aggressive management of their airway, breathing and circulation in order to reduce mortality and morbidity. While early endotracheal intubation of patients with actual or impending airway compromise and aggressive fluid resuscitation have been emphasized, it appears that the pendulum may have swung a bit too far towards the extreme. The current review will briefly cover the epidemiology, pathogenesis and diagnosis of burn injuries with greater emphasis on airway and fluid management. We will also discuss the local management of the burn wound, which is all that is required for most burn patients in the emergency department.

BurnCalc assessment study of computer-aided individual three-dimensional burn area calculation

BACKGROUND

Accurate estimation of a burned area is crucial to decisions about fluid resuscitation, surgical options, nutritional support, and prognosis. Widely used clinical methods to estimate a burn area are two-dimensional. They do not consider age, sex, body mass, physical deformities, or other relevant factors. Computer-aided methods have improved the accuracy of estimating burned areas by including data analysis and reducing subjective differences. Three-dimensional (3D) scanning allows us to determine body dimensions rapidly and reproducibly. We describe an individualized, cost-efficient, portable 3D scanning system, BurnCalc, that can create an individual 3D model and then calculate body surface area (BSA) and the burn area accurately and quickly.

METHODS

The BurnCalc system was validated by verifying the accuracy and stability of BSA calculation. We measured 10 regular objects in experiment 1, using Student's t-test and the intraclass correlation coefficient (ICC) in the analysis. In experiment 2, artificial paper patches of known dimensions were attached to various parts of the body of 40 volunteers. Their sizes were then calculated using BurnCalc. The BurnCalc data were compared to actually measured values to verify accuracy and stability. Total BSAs of these 40 volunteers were also calculated by BurnCalc and compared to those derived from an accepted formula. In experiment 3, four experts using Chinese Rule-of-Nines or Rule-of-Palms methods calculated the percentages of the total BSA in 17 volunteers. Student's t-test and ICC, respectively, were used to compare the results obtained with the BurnCalc technique.

RESULTS

Statistically, in experiment 1, p = 0.834 and ICC = 0.999, demonstrating that there was no difference between the BurnCalc and real measurements. Also, the hypothesis of null difference among measures (experiment 2) was true because p > 0.05 and ICC = 0.999, indicating that calculations of the total BSA and the burn area were more accurate using the BurnCalc technology. The reliability of the BurnCalc program was 99.9%. In experiment 3, only the BurnCalc method exhibited values of p > 0.05 (p = 0.774) and ICC = 0.999.

CONCLUSIONS

BurnCalc technology produced stable, accurate readings, suggesting that BurnCalc could be regarded as a new standard clinical method.

Evaluation of predictive algorithms used for estimating potential postapplication, nondietary ingestion exposures to pesticides associated with children's hand-to-mouth behavior

Postapplication exposure assessment related to indoor residential application of pesticide products requires consideration of product use information, application methods, chemical-specific deposition, time-dependent availability and transferability of surface residues, reentry time, and temporal location and macro- and microactivity/behavior patterns ( Baker et al., 2000 ). Children's mouthing behavior results in potential postapplication exposure to available pesticides in treated microenvironments through the nondietary ingestion route, in addition to the dermal or inhalation routes. Children's activities and associated behaviors may result in multiple or repeat contact of dermal areas (clothed and unclothed body areas and hands) with treated surfaces, or surfaces that may have indirect sources of residues. Further, some surfaces contacted may have transferable pesticide residues and others may not. Transfer of residues from the indoor residential environment to the dermal surface (e.g., hands) of an individual has been assumed to be linear as a function of time and number of contacts. However, studies suggest that this transfer process to the hands and other body areas may be rapidly saturable. In the most recent U.S. Environmental Protection Agency (EPA), Office of Pesticide Programs (OPP) "Residential Exposure Assessment Standard Operating Procedures" (U.S. EPA, 2012), the input variable for the number of dermal contacts (with treated surfaces) is an exponent, making the relationship nonlinear. Further, removal processes such as hand washing and transfer to untreated surfaces are important to consider. Predictive algorithms for estimating children's hand-to-mouth-related incidental ingestion exposures post pesticide application have been developed by the EPA/OPP and incorporated into probabilistic models. A review of literature addressing variables used to estimate potential incidental ingestion exposure is presented. Data relevant to input variables for predictive algorithms are discussed, including the results of a multiyear, pesticide transferable residue measurement program conducted by the Non-Dietary Exposure Task Force (NDETF) and the associated distributional characterization for this key variable. Sources of conservative bias in current hand-to-mouth, incidental ingestion exposure estimation and the role of biomonitoring to evaluate predicted exposures are discussed.

Palm surface area database and estimation formula in Korean children using the alginate method

Studies of palm surface area (PSA) have been investigated as an important reference area unit in physiology and medicine today. Most previous PSA studies have been limited to adults. The purpose of this study was to archive Korean children's PSA data and to calculate an optimized formula for estimating PSA. A total of 305 people, 186 boys and 119 girls all aged between 7 and 18 years, were recruited for this study and their PSA was directly measured by a useful, accurate, and quick method--the alginate method. Mean PSA for males and females was found and the optimized formula for estimating PSA was computed. It would be meaningful to note that this trial was the first to generate data from Korean children, which could be widely available for utilization in anthropometry, toxicology research, thermal physiology and in skin burn studies for Asian children.

Determination of hand and palm area as a ratio of body surface area in Indian population

Background:

Accurate estimation of body surface area (BSA) burn is important. In small and patchy burns, the patient's hand is used to estimate percentage of burn which is traditionally considered as 1%. There is discrepancy about what percentage of TBSA is constituted by the palm and hand. Therefore, this study was designed to determine correctly the TBSA represented by the palmar surface of the entire hand and palm in the Indian population.

Material and Methods:

300 healthy adult (male and female) and 300 healthy children (male and female) were included in the study. TBSA was calculated using DuBois formula and hand and palm surface area was calculated using hand tracing on plain paper. The hand/palm percentage of BSA (ratio) was determined by dividing hand/palm surface area by total BSA.

Results:

The mean hand and palm ratio for adults was 0.92% and 0.50%, respectively. The mean hand and palm ratio in children was 1.06% and 0.632%, respectively.

Conclusion:

The hand area (palm plus digits) is more closely represented to 1% of TBSA in Indian population.

A system for 3D representation of burns and calculation of burnt skin area

In this paper a computer-based system for burnt surface area estimation (BAI), is presented. First, a 3D model of a patient, adapted to age, weight, gender and constitution is created. On this 3D model, physicians represent both burns as well as burn depth allowing the burnt surface area to be automatically calculated by the system. Each patient models as well as photographs and burn area estimation can be stored. Therefore, these data can be included in the patient's clinical records for further review. Validation of this system was performed. In a first experiment, artificial known sized paper patches were attached to different parts of the body in 37 volunteers. A panel of 5 experts diagnosed the extent of the patches using the Rule of Nines. Besides, our system estimated the area of the "artificial burn". In order to validate the null hypothesis, Student's t-test was applied to collected data. In addition, intraclass correlation coefficient (ICC) was calculated and a value of 0.9918 was obtained, demonstrating that the reliability of the program in calculating the area is of 99%. In a second experiment, the burnt skin areas of 80 patients were calculated using BAI system and the Rule of Nines. A comparison between these two measuring methods was performed via t-Student test and ICC. The hypothesis of null difference between both measures is only true for deep dermal burns and the ICC is significantly different, indicating that the area estimation calculated by applying classical techniques can result in a wrong diagnose of the burnt surface.

Hand surface area estimation formula using 3D anthropometry

Hand surface area is an important reference in occupational hygiene and many other applications. This study derives a formula for the palm surface area (PSA) and hand surface area (HSA) based on three-dimensional (3D) scan data. Two-hundred and seventy subjects, 135 males and 135 females, were recruited for this study. The hand was measured using a high-resolution 3D hand scanner. Precision and accuracy of the scanner is within 0.67%. Both the PSA and HSA were computed using the triangular mesh summation method. A comparison between this study and previous textbook values (such as in the U.K. teaching text and Lund and Browder chart discussed in the article) was performed first to show that previous textbooks overestimated the PSA by 12.0% and HSA by 8.7% (for the male, PSA 8.5% and HSA 4.7%, and for the female, PSA 16.2% and HSA 13.4%). Six 1D measurements were then extracted semiautomatically for use as candidate estimators for the PSA and HSA estimation formula. Stepwise regressions on these six 1D measurements and variable dependency test were performed. Results show that a pair of measurements (hand length and hand breadth) were able to account for 96% of the HSA variance and up to 98% of the PSA variance. A test of the gender-specific formula indicated that gender is not a significant factor in either the PSA or HSA estimation.

Predictors of Quantitative and Qualitative Halstead Finger-Tapping Scores in Low Socioeconomic Status School-Age Children

Two hundred and thirteen low socioeconomic school-age children in grades 1 through 8 were administered the Halstead Finger Oscillation (or Tapping) Test (HFTT). All children were age appropriate for their grade in school and were not requiring special education services. Hierarchical multiple regression analysis revealed that a composite age/grade classification score, gender, and estimated level of intelligence accounted for approximately 40% of the variability in dominant and nondominant hand scores for these children (multiple R = .627, R(2) = +.393 for the dominant and multiple R = +.607, R(2) = +.368 for the nondominant hand). Only the age/grade level of the child (R(2) = .168) predicted the ability to inhibit adjacent finger movements when performing the HFTT task. Regional normative data for low socioeconomic school-age children are presented. Neurodevelopmental changes in the cortical and subcortical systems underlying finger movement may account for some of the variability observed in children when performing the HFTT.

Determination of hand surface area by sex and body shape using alginate

Hand surface area (HSA) has been utilized for burned skin area estimation in burn therapy, heat exchange in thermal physiology, exposure assessment in occupational toxicology, and the development of manual equipment/ protective gloves in ergonomics. The purpose of this study was to determine the hand surface area to the total body surface area (BSA) and derive a formula for estimating HSA. Thirty-four Korean males (20-60 years old; 158.5-187.5 cm in height; 48.5-103.1 kg in body weight) and thirty-one Korean females (20-63 years old; 140.6-173.1 cm; 36.8-106.1 kg) participated as subjects. The HSA and BSA of 65 subjects were directly measured using alginate. The measurements showed 1) the surface area of the hand had a mean of 448 (371-540) cm(2) for males, and 392 (297-482) cm(2) for females. 2) The hand as a percentage of the total body surface area for males and females was 2.5% and 2.4% respectively, showing no significant difference. 3) The hand as a percentage of BSA by body shape was 2.5% for the lean group and 2.3% for overweight people (p=0.001). 4) When estimating the surface area of a hand, formulae based on hand length or hand circumference were more valid than formulae based on height and body weight. We obtained the following formula for estimating HSA: Estimated HSA(cm(2))=1.219 Hand length(cm) x Hand circumference(cm).

Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

The ISCL/EORTC recommends revisions to the Mycosis Fungoides Cooperative Group classification and staging system for cutaneous T-cell lymphoma (CTCL). These revisions are made to incorporate advances related to tumor cell biology and diagnostic techniques as pertains to mycosis fungoides (MF) and Sézary syndrome (SS) since the 1979 publication of the original guidelines, to clarify certain variables that currently impede effective interinstitution and interinvestigator communication and/or the development of standardized clinical trials in MF and SS, and to provide a platform for tracking other variables of potential prognostic significance. Moreover, given the difference in prognosis and clinical characteristics of the non-MF/non-SS subtypes of cutaneous lymphoma, this revision pertains specifically to MF and SS. The evidence supporting the revisions is discussed as well as recommendations for evaluation and staging procedures based on these revisions.

Resuscitation burn card—A useful tool for burn injury assessment

It is well recognised that the initial assessment of body surface area affected by a burn is often over estimated in Accident and Emergency Departments. A useful aide-memoir in the acute setting is Wallace's "rule of nines" or using the patients' palmar surface of the hand, which approximates 1% of the total body surface area, as a method of assessment. Unfortunately, as with every system, limitations apply. Factors such as patient size and the interpretation of what is exactly the 'palmar surface' may significantly influence burn size estimations and subsequently fluid resuscitation. Our aim is to develop a simple, quick and easy reproducible method of calculating burn injuries for medical professionals in the acute setting. Worldwide, the dimensions of a credit card are standardized (8.5 cm x 5.3 cm), thus producing a surface area of 45 cm2. We created a resuscitation burn card (RBC) using these exact same proportions, upon which a modified body surface area (BSA) nomogram was printed. Knowing the patient height and weight, we calculated the surface area of the card as percentage of total body surface area (TBSA). On the opposite site of the RBC, a Lund and Browder chart was printed, as well as the Parkland formula and a formula to calculate paediatric burn fluid requirements. The plastic, flexible RBC conformed well to the body contour and was designed for single use. We used the resuscitation burn card in the initial assessment of simulated burns in a Regional Burn Centre and in an Accident and Emergency Department. The information present on the card was found to be clear and straightforward to use. The evaluation of burn extent was found to be more accurately measured than the estimation obtained without the RBC. The resuscitation burn card can be a valuable tool in the hands of less experienced medical professionals for the early assessment and fluid resuscitation of a burn.

Hand surface area—Do racial differences exist?

The patient's own palm is used as a template in assessing small patchy burns and is traditionally believed to be 1% of body surface area. This does alter with the patient's age, sex and BMI and there have been suggestions that it can also differ between ethnic groups. We undertook this study to see if there were any differences in the hand surface area between Caucasians, Orientals and Asians. It was done by tracing the hand outline and calculating the surface area. The study showed that there was no significant difference between the three ethnic groups in terms of hand surface area.

Effects of hand shape on maximal isometric grip strength and its reliability in teenagers

Hands can be classified by their shape; width divided by length. This study examined the impact of shape of the hand (as relatively long, average, or square shaped) on maximal voluntary isometric grip strength and test-retest reliability in a group of healthy teenagers aged 13 to 17 years. When 116 boys and 112 girls were measured with a GripTrack (a computer-linked Jamar-like isometric hand grip dynamometer; JTech Medical Industries, Salt Lake City, UT), boys were significantly stronger than girls (by 11.02 kg force, p < 0.01), and dominant hands were significantly stronger than nondominant hands (by 2.53 kg force, p < 0.01). There were no significant differences due to hand shape. To examine the reliability of the grip strength test, 74 boys and 75 girls were retested, with a mean retest time interval of 15.5 days. There was a small but significant improvement in grip strength (by 0.62 kg force, p < 0.01). Regarding male subjects, the test-retest intraclass correlation coefficients (ICC 3,1) for both hands of the three hand-shape groups were excellent, with ICC values ranging from 0.954 to 0.973. For the female subjects, however, reliability values declined across the three hand-shape groups from long to square (ICC 0.920-0.476), such that compared with their male counterparts, strength test reliability examined by the 95% confidence intervals (CIs) was significantly lower for average and square hand shapes. Although there may be several factors contributing to this difference between boys and girls in strength test reliability for different hand-shape groups, it is possible that Jamar-like handgrip dynamometers have a handle shape that impedes those girls with relatively square hands from giving reliable grip strength readings over time.

State of the Art in Burn Treatment

Optimal treatment of burn victims requires deep understanding of the profound pathophysiological changes occurring locally and systemically after injury. Accurate estimation of burn size and depth, as well as early resuscitation, is essential. Good burn care includes also cleansing, debridement, and prevention of sepsis. Wound healing, is of major importance to the survival and clinical outcome of burn patients. An ideal therapy would not only promote rapid healing but would also act as an antiscarring therapy. The present article is a literature review of the most up-to-date modalities applied to burn treatment without overlooking the numerous controversies that still persist.

Factors affecting swimming economy in children and adults

The aim of this study was to examine the influence of several explanatory factors: anthropometry, buoyancy, passive underwater torque, drag and swimming technique on the energy cost of swimming front crawl in children and adults. Submaximal V(.)O(2) was measured in ten children (age 12) and 13 adults (age 21), as well as body length (BL), body mass, arm length, propelling size, active drag, hydrostatic lift, passive torque, intracyclic velocity fluctuation, hand slip, stroke length and body angle. The results show that body length ( r=0.74), body mass ( r=0.86) propelling size ( r=0.61), arm length ( r=0.66), distance between the center of mass and the center of volume (Delta d, r=0.74) and body angle during swimming ( r=-0.56) all showed significant linear relationships with the cost of swimming at 1.0 m x s(-1) (CS(1.0)). When normalizing the cost of swimming to body size (CS(1.0) x BL(-1)) there were no differences between the two groups. The conclusions of this study are that the combination of BL, body mass, active drag factor, passive torque, drag efficiency and hydrostatic lift were able to explain 97% of the variation in the cost of swimming for the whole group of swimmers. The size-independent factors of torque and floating abilities (density and Delta d in % of BL), together with swimming technique and active drag were found to explain 75% of the variations in CS(1.0) x BL(-1). The identical values for CS(1.0) x BL(-1) for children and adults are explained through the opposing effects of a better swimming technique in the adults, and a better passive torque in the children.

Adults have lower stroke rate during submaximal front crawl swimming than children

The aim of this study was to examine the effects of body size and propelling surface size on stroke rate (SR) and stroke length (SL) during front crawl swimming. Eleven children [11.7 (0.8) years] and 13 adults [21.4 (3.7) years] were compared. A third group of swimmers (n=5) had their propelling surface altered experimentally, swimming with hands only and using small- and large-sized paddles. Underwater videography was used to analyze four 25-m submaximal and four 25-m maximal swims for SR, SL, velocity (v) and hand slip. The results showed that adults have a lower SR at any submaximal v and a lower slope of the relationship between SR and workload (v(3)) compared to children. At 1.0 m s(-1) the SR values were 0.38 (0.04) and 0.58 (0.06) cycles s(-1) for adults and children respectively ( P<0.01). Adjusting for body size did not change this relationship [0.46 (0.05) and 0.67 (0.08) cycles s(-1) at a v of 1.0 bodylength s(-1) for adults and children respectively, P<0.001]. SL, adjusted for potential anatomical SL, was found to be longer in adults at submaximal velocities but not at maximal v. Hand slip was found to be lower for adults [-0.19 (0.14) and -0.36 (0.18) m for adults and children respectively, P<0.05]. Thirty per cent of the variations in slip could be attributed to propelling size. Increased propelling surface reduces SR and increases SL. It was concluded that adults have a lower SR both at absolute and size relative velocities compared to children; the causes could not be attributed to differences in body size, but probably the propelling size and swimming technique make the adults more effective swimmers.