Timothy A. Puls

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The perception of the maintenance demands of low impact development (LID) systems represents a significant barrier to the acceptance of LID technologies. Despite the increasing use of LID over the past two decades, stormwater managers still have minimal documentation in regard to the frequency, intensity, and costs associated with LID operations and(More)
A case report of a large vestibular aqueduct syndrome (LVAS) as the sole radiographically detectable inner ear anomaly with a mixed hearing loss is presented. Hearing loss in LVAS is sensorineural with a conductive component in 15-27% of the cases. The hearing loss fluctuates and is progressive, resulting in the deterioration of the hearing after minor head(More)
Cartilage has been used successfully as a graft in middle ear surgery. It used to be reserved for advanced pathology because of its possible detrimental effect on postoperative hearing. Recent papers however failed to prove this effect. The present study describes the authors' experience in 161 cases of conchal cartilage tympanoplasty. In tympanoplasty type(More)
Stapes surgery: results when performing a moderate number of stapedectomies. The short term results of 40 small fenestra stapedectomies over a period of five years are presented. Closure of the air-bone gap is within 10 db in 62.5%, within 20 db in 90% of the cases, with a mean gain in air-bone gap of 27.2 db. Stapes surgery is difficult if not regularly(More)
Three hundred eight-two children were evaluated for abuse or neglect during a 30-month period in a pediatric clinic in a county hospital. Fifty-one percent presented for sexual abuse, 34% for physical abuse, and 15% for neglect. Thirteen children were hospitalized. Children examined for sexual abuse had a mean age of 5.8 years and a median age of 5 years;(More)
Seventy four simple myringoplasties, 53 with xenograft and 21 with fresh temporalis fascia were reviewed. Closure rate for all cases was 90.5%. There were 3 surgical failures in xenografts and none in the fascia graft. Fifty two myringoplasties, 37 using xenograft and 15 using fascia graft, had a mean follow-up of 20 months and late perforations were seen(More)
Effective, multifaceted, and short-term case management services can result in significant, quantifiable cost savings for managed Medicaid, Medicare, and other health care programs. Such savings clearly offset the administrative costs of support for case managers, social services departments, and utilization management services. This report reviews various(More)