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| PM News | |
The Voice of Podiatrists
Serving Over 22,079 Subscribers Daily
January 04, 2023 #7,413  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management https://podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2023- No part of PM News can be reproduced without the
written permission of Barry Block
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| PM NEWS QUICK POLL |
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How did your 2022 income/salary compare to that of 2021?
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| PODIATRISTS IN THE NEWS | |
NY Podiatrist Discusses Etiology of Peeling Skin on the Feet
A common foot ailment is peeling skin. Rebecca Pruthi, DPM, a podiatrist and owner of Foot Care of Manhattan, explained to Women's Health, "Peeling feet is definitely common, and there are various reasons why. We're on our feet all the time and the constant pounding and walking can cause cracking and scaling of the skin."
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Dr. Rebecca Pruthi |
Additionally, workouts that leave the feet exposed could cause peeling. Dr. Pruthi told Women's Health that common culprits include "anything you're doing barefoot, or if you're sharing mats, or if you're doing hot yoga in a moist environment." Together, moisture and bare feet can lead to infections such as athlete's foot, a condition that causes scaly, peeling skin.
Source: Brie Schmidt, Health Digest [12/28/22]
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| HOSPITAL PODIATRISTS IN THE NEWS | |
NVRH Welcomes VT Podiatrist
Northeastern Vermont Regional Hospital (NVRH) has announced that Esther Barnes, DPM has joined NVRH Podiatry. Dr. Barnes is one of a handful of podiatric surgeons in the state certified in foot surgery as well as reconstructive rearfoot and ankle surgery by the American Board of Foot and Ankle Surgeons.
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Dr. Esther Barnes |
Dr. Barnes received her DPM degree from the Temple University School of Podiatric Medicine in Philadelphia, PA and completed a podiatric residency at Highlands – Presbyterian/St. Luke’s Medical Center.
Source: The North Star Monthly [12/30/22]
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| PODIATRISTS AND DIABETES | |
MA Podiatrist is Panelist on ADA Webinars
The American Diabetes Association (ADA) recently presented the Amputation Prevention Alliance's webinar, "Understanding the Risks and Warning Signs of Diabetes-Related Amputations". Every three minutes in the United States, a limb is amputated due to diabetes-and most amputations are avoidable.
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Panelists on ADA Webinar |
Panelists, including APMA Board of Trustees member David Alper, DPM, discussed the risks and warning signs of an amputation for people living with diabetes. The panelists also highlighted the questions to ask your doctor and the importance of foot screenings and foot checks.
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| PODIATRISTS IN THE MEDIA | |
VA Podiatrist Interviewed on The Sports Doctor Radio Show
Ben Pearl, DPM was recently interviewed by Bob Weil, DPM on Weil’s radio show, The Sports Doctor. They discussed Pearl’s introduction of electromagnetic therapy to his practice. Dr. Pearl said it has profound changes for his patients because of the immediate improvements patients are having; many times after one treatment session. Pearl described the immediate effects as due to increased circulation and the inhibition of pain signals by the electric signals. Pearl has used it for pain relief with neuropathy, bone healing, tendonitis and sprain management, and wound healing. As with other regenerative treatments, the longer term healing effects take several weeks.
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(L-R) Drs. Ben Pearl and Bob Weil |
It was noted that electromagnetic therapy is covered by insurance in Canada, but only for delayed and non-union fractures in the U.S. European healthcare has also more widely adopted these treatments, and Pearl opined there is more emphasis on drug treatments for pain in the U.S. The following video documents a case of decreased pain in a patient with neuropathy. Weil and Pearl reviewed the importance of biomechanics and the foot as a foundation in the kinetic chain. Pearl emphasized the importance of collaboration with other healthcare professionals.
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| CODINGLINE CORNER |
Query: Destruction of Wart
We performed a destruction of a painful wart in the clinic. Healthfirst is asking for a “more appropriate CPT code that should be used to bill for the service provided.” The code we used was CPT 17110. Is there a more appropriate code for this procedure?
PM News Subscriber
Response: That is the CPT code I use. It is destruction of a benign lesion by many methods, which fits the scenario. I would still document that the verruca is growing or causing pain. Some carriers have an issue that “benign” lesions do not necessarily need to be treated.
Tony Poggio, DPM, Alameda, CA
For information on Codingline subscriptions, click here
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| QUERIES (HOSPITAL PRIVILEGES) | |
Query: Obtaining Surgical Privileges After Child Care Leave
I got married during my first year of residency and had my first child in my first year of practicing. I logged a handful of cases in my first 10 months but decided to take some maternity leave which never seemed to end. I just did not want to leave my child with someone else to care and raise and opted to be a stay-at-home mom. I opened an office in my house and kept the practice limited to "general podiatry", with evening hours and weekend hours when my husband was able to trade childcare duties with me. I would send surgical cases to my ex-residency partners or classmates. It is now 10 years later and I would like to utilize the skills I was taught in my residency.
I recently applied to the local hospitals for staff privileges and they are asking me how many surgeries I have done in the past 2 years. I filled in zero, which is the truth. I was called up by the credentials committee who informed me they would not be able to give me approval for surgical privileges for cases I haven't done in the past couple of years. My hospital does not have a podiatry chief; the department is under the Orthopedic Dept. I have a meeting with the head of the Dept. in 2 weeks. Any advice would be appreciated.
Name Withheld
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| QUERIES (CLINICAL) | |
Query: Orthotics for Ski Boots
I recently had a couple of patients who are avid skiers. They complained of various foot/ankle ailments. I was wondering if some colleagues who are also avid skiers could chime in on this discussion. I’ve only gone skiing a few times, and I do recall those boots being very snug fitting. I imagine a regular orthotic would not fit in the boot.
Is there a special orthotic “cut” to be recommended that is much narrower that would still fit in a ski boot? Do you have any ski boot "pearls” to share with the rest of us?
Jeffrey Kass, DPM, Forest Hills, NY
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| RESPONSES/COMMENTS (RELEVANT RESEARCH) | |
RE: 3D Bioprinted Scaffolds for Diabetic Wound-Healing Applications
From: Leonard A. Levy, DPM, MPH
Effective treatment and healing of diabetic foot ulcers (DFUs) is a complex process, often unsuccessful, and resulting in significant clinical and economic burden as well as lower-limb amputation. A rapidly growing field is the use of 3D bioprinted drug-loaded scaffolds to treat DFUs. These bioprinted scaffolds are fabricated with different designs for the delivery of the antibiotic levoflocixin. The scaffolds utilize a variety of techniques that demonstrate excellent mechanical properties and provide sustained drug release for four weeks.
With the global incidence of diabetes (DM) rapidly increasing, it is estimated that 700 million people will have the disease by 2045, increasing the incidence of DFUs in the absence of improved, effective, and simpler treatment. It is forecast that the cost of DFUs which was $7.03 billion in 2019 will increase to $11.05 billion by 2027. To overcome this social and economic burden, new and innovative treatments such as 3D bioprinted scaffolds are needed to overcome restrictions of current treatment options.
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL
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| RESPONSES/COMMENTS (NON-CLINICAL) | |
From: Richard J. Manolian, DPM, Joe Dahlin, DPM
“Poor” patients already have a resource - Medicaid
Richard J. Manolian, DPM, Belmont, MA
I’m currently in the process of creating a community clinic once monthly. Practicing direct care medicine has increased revenue, decreased overhead, increased time with initial consults, reduced unnecessary follow-up appointments, and reduced the number of patients needing to be seen daily. This has freed up time and finances to offer a monthly community clinic. All care provided during that day will be complimentary; however, there will be a local charity of the month which patients can choose to donate towards. All collections will go directly to the charity. It’s a win-win - direct care.
Joe Dahlin, DPM, Grand Junction, CO
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| RESPONSES/COMMENTS (RELEVANT RESEARCH) | |
From: David Secord, DPM
I appreciate the post from Dr. Udell on the Scarf osteotomy and the call for a wider examination of bunion procedures and surgeon skills, skewing results. I have amended my approach to 1st ray pathologies to just three procedures: Primarily, the Scarf; Secondarily, the Lapidus (in cases of either an IM over 18 degrees, or a gorilliform or diseased 1st metatarsal/medial cuneiform articulation; and the Fowler (in cases where the IM angle is over 18 degrees and the 1st metatarsal/medial cuneiform articulation is normal). I commonly graft my Lapidus procedures to avoid over-shortening of the 1st ray and transfer to the 2nd met head. I’ve corrected as much as a 45 degree IM angle with the Fowler.
Although a major undertaking, a comparison of complications between commonly employed techniques would be monumental in scope and...
Editor's note: Dr. Secord's extended-length letter can be read here.
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| YOU CAN'T MAKE THESE THINGS UP | |
RE: Outrageous Shoes of the Day
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The latest in see-through shoes. |
Source: Kunihiko Morinaga via Virtual Shoe Museum
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MEETINGS & WEBINARS
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NEED CME CREDITS FAST?
PODIATRY MANAGEMENT'S AFFORDABLE ONLINE CME
You can Earn up to 50 Continuing Education Contact Hours (CECH) Online
Earn 15 CECH only $279 (less than $19 per CECH)
podiatrym.com/cme.cfm
All required credits can be taken online for AL, AK, AR, CA, CO, DE, HI, IN, KS, LA, MA, ME, MI, MI, MS, NV, NJ, NM, ND, OH, OR, PA, RI, SC, SD, UT, VA, VT, WV, and WI
Partial required credits can be taken online for AZ, FL, GA, ID, KY, IL, ID, IA, MD, MN, MO, MT, NE, NH, NY*, NC, OK, PR, TN, TX, WA, and DC
Choose any or ALL from 25+ CECH Category-1 articles posted
* NY podiatrists whose licenses expire from 3/2/20-1/1/23 may take all credits online
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| CLASSIFIED ADS - ASSOCIATE AND FACULTY POSITIONS, AND FELLOWSHIPS |
ASSOCIATE POSITION - CENTRAL NEW JERSEY
Busy medical and surgical podiatry practice in Central New Jersey, looking for highly motivated individual to assume associate position which can lead to full partner position. Two busy offices located in Middlesex County, affiliated with Robert Wood Johnson University Hospital in New Brunswick and Hackensack Meridian Hospital in Old Bridge New Jersey. There is also a slot available for the Wound Center at Robert Wood. Practice has been in existence for 40+ years. Applicant should be Board Qualified and have NJ license. Willing to discuss reasonable starting salary. 401K and PTO/vacation time. Please send CV to docbachman47@gmail.com.
ASSOCIATE WITH PARTNERSHIP POTENTIAL! SOUTHWEST FLORIDA
Busy five doctor, well established, state-of-the-art equipped two location practice in Southwest Florida. Seeking a motivated, surgically trained, team player to join our Foot And Ankle family. Unrestricted wide scope of podiatric privileges at three local hospitals with corresponding emergency department call. Full variety of clinical options from sports medicine, wound care, trauma, forefoot/rearfoot surgical pathology, and professional high risk preventative management. Base salary, incentive bonus schedule, 401(k), medical, dental, vision, paid vacation, uniforms, and all marketing as well as professional dues provided. For more information or interview, contact 941-626-1803 by text.
ASSOCIATE POSITIONS – DELAWARE
Brandywine Podiatry a 12-doctor practice throughout the state is looking for 2 associates: 1.) Sports medicine focused associate, working with physical therapists, trainers, coaches, and athletes. 2.) Office/Hospital-based associate looking to start or relocate to advance your career. Send CV to: savage6026@comcast.net
ASSOCIATE POSITIONS – DE, FL, MD, MO, NJ, NY, PA, TN, VA
PediRite provides care to nursing home residents. Excellent opportunities working in our contracted facilities. Flexible scheduling, very lucrative commissions! Great match if you have open days/hours in your schedule. Resume to sara@sightrite.com (sign-on bonus for FL and PA)
POSITIONS AVAILABLE - KANSAS, MARYLAND, MASSACHUSETTS, MICHIGAN, MINNESOTA, FLORIDA, PENNSYLVANIA and BUFFALO, NY
Expanding, podiatrist owned and operated company looking for reliable and ethical podiatrists to service Nursing Homes and SNFs in Kansas, Maryland, Massachusetts, Michigan, Minnesota, Florida, Pennsylvania and the Buffalo, NY region. Send CV and inquiries to: info@thepodiatrycompanyllc.com
ASSOCIATE POSITION – GEORGIA
Large multi-site podiatry group seeking Board Qualified/Certified podiatric surgeon for a location in GA. This is an outstanding opportunity with steady new patient volume and a well-trained team. We offer an excellent compensation and benefit package. Please send inquiries and CV to doctors@podiatryinga.com.
ASSOCIATE POSITION - ST. LOUIS, MO
Rapidly growing podiatry practice in desirable area is seeking a personable, outgoing, and self-motivated individual, who is competent in office-based practices, surgery, and enjoys all aspects of podiatry. Position available immediately and/or July 2023. Salary is percentage based with bonus and incentives. Please send CV and letter of interest to podiatrystlouis@gmail.com
FULL-TIME or PART-TIME PODIATRIST - DALLAS/FORT WORTH AREA
PSR 24-36 Trained Multi-dimensional, Multi-office group treating a wide range of patients to include: forefoot, rearfoot, diabetic wound care, sports medicine and work-related injuries. Modern offices and equipment. A great opportunity for driven personable individual. Please e-mail Cover letter, CV, Letter of references Email: cnunez1940@gmail.com
ASSOCIATE POSITION - CT (GREENWICH)
Full time position available. A very busy schedule and competitive compensation package is being offered. Our EMR system is MacPractice and digital x-ray is 20/20 Imaging. Sonoace ultrasound, a PinPointe laser, and an EPAT by Curamedix as well. Please visit our website www.greatfootcare.com and send resume to DrKassaris@GreatFootCare.com
ASSOCIATE POSITION - EUGENE, OREGON
Growing practice seeking highly skilled, ethical, and personable physician. ABFAS BQ/BC required. Competitive salary, benefits, paid malpractice. Partnership path for the right candidate. Practice sees wide range of foot/ankle pathology. No nursing homes. New, modern office & equipment; digital x-ray, shockwave. Email CV to monica@cascadiafootandankle.com.
ASSOCIATE POSITION- FT/PT - AUSTIN/SAN ANTONIO, TX
Growing practice looking for associate to provide care to Nursing Homes and ALF's in the greater Austin and San Antonio, TX areas
ASSOCIATE POSITION - GREATER HARTFORD, CT
Our four-doctor practice is looking for an associate to join us this coming Summer. Competitive six figure salary with a bonus structure, health insurance, 401-k and vacation benefits. You must be personable. Surgical training is desired. Send resume to amldpm64@gmail.com
ASSOCIATE POSITION – CENTRAL NEW YORK
Multi-doctor, multi-office podiatric practice looking for a full time associate to support our growing patient demand. Candidate must be highly motivated, hardworking, and exhibit excellent bedside manner. Competitive salary (base + bonus) offered with benefits. Four season fun abounds in beautiful Central New York! Must be actively seeking Board Certification or already Board Qualified or Board Certified. Send CV to Practice Manager at info@westsidepodiatrycenter.com.
ASSOCIATE POSITION – WESTERN PA
Well-established podiatry practice in Western, PA looking for a full-time podiatrist to join their team. Position will involve seeing patients at multiple hospitals, wound care centers and satellite offices. Basic qualification: Graduation from an accredited medical school and completed accredited residency program. Board Certified/Qualified in forefoot and/or rearfoot surgery preferred. We offer a competitive compensation and benefits package to our team members. email CV to: kmiko@hmapgh.com
ASSOCIATE POSITION - CHANDLER/GILBERT ARIZONA
Growing multi-location practice with immediate opening for a skilled podiatrist to join our team at preferred foot and ankle specialists. Seeking full time DPM with current AZ state license and ABFAS or on track for ABFAS. Competitive salary and bonus structure. Send CV to ANOLAN.PFAS@GMAIL.COM
ASSOCIATE POSITION - VANCOUVER, CANADA
Busy, well-established practice looking for motivated podiatrist with excellent clinical and people skills. 2 office locations. CASH PAY. Lots new patients monthly. Huge growth potential. Practice allows great work-life balance. NO CALLS. Competitive pay structure and sign-on bonus. Non-Canadian, new graduate, experienced DPM applicants welcome. Email CV to podiatryvancouver@gmail.com.
ASSOCIATE POSITIONS – DELAWARE
Brandywine Podiatry a 12-doctor practice throughout the state is looking for 2 associates: 1.) Sports medicine focused associate, working with physical therapists, trainers, coaches, and athletes. 2.) Office/Hospital-based associate looking to start or relocate to advance your career. Send CV to: savage6026@comcast.net
ASSOCIATE POSITION – CALIFORNIA
Largest group in the central valley is seeking associate. Must be highly motivated with good patient skills and personality. Must be board qualified or certified salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing, and will help with student loan repayment. Compassionate and well-trained for immediate position. Office based, Surgery Center and hospital-based with no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position in a multi-million dollar hi-tech practice. Please e-mail CV and short bio to tflores@wetreatyourfeet.com
ASSOCIATE POSITION – HUDSON VALLEY, NY
We are a high-volume, diversified, multi-office podiatry practice utilizing state-of-the-art modalities. Excellent mix of general podiatry, surgery (forefoot and rearfoot) and diabetic wound care. We service Ulster, Orange, Dutchess, Greene, and Delaware counties. Ample growth opportunity for a personable and highly-motivated DPM. Excellent wound care opportunity, if desired. info@hvfa.com
ASSOCIATE POSITION – JOPLIN, MISSOURI
Established practice looking to add a third podiatrist and eventual partner. Senior podiatrist is non-surgical thus surgery volume high, if desired. Joplin is an outdoorsman’s paradise, a fantastic place to live and raise a family. Please send CV and cover letter to mnmrichins@yahoo.com
ASSOCIATE POSITION - MONROE, LA
Full-time associate position available next fall. 2 year contract, 100k base 1st year, 150k base 2nd year, and realistic bonus structure. Malpractice, Health Insurance, Boards, plus more paid 100%. Sign-on and Moving bonus. No call. 2 weeks paid off, plus holidays. Low cost of living, family friendly. Email Resume to Dr.lukehunter@gmail.com
IMMEDIATE ASSOCIATE POSITION - SOUTHWEST, FL
Work where you want to live. Supportive environment, Sunny SWFL, build your surgical boards cases quickly, busy, modern, technologically advanced offices. ABFAS BC/BQ a must, EMR, CT, DME, Base salary + bonus, PTO, 401K, health ins. 1 ACFAS fellowship position also DrLam@NaplesPodiatrist.com
ASSOCIATE POSITIONS - LOS ANGELES, CA
Associate positions as part of a rapidly growing practice providing care in Los Angeles. Position including hospital rounding, clinic and skilled nursing facility providing wound care and limb salvage. Position comes with a competitive salary with full benefits including CME allowance, Health, Dental, Vision coverage as well as matching 401k plan. Email resume to info@woundinstitute.com
FULL TIME PODIATRIST - NEW JERSEY
We are a fast-growing podiatry practice in New Jersey with multiple locations and Doctors. We are currently looking for a full-time motivated and caring Doctor to join our busy practice. Some benefits include: competitive six-figure salary, generous, guaranteed bonus structure, health insurance (including vision & dental), paid vacation time off, paid malpractice insurance and CME time off. Great prospects for experienced Doctors as well as new Associates. This is an excellent opportunity to expand your Podiatric medical and surgical experience in an office-based practice! If interested, please submit your CV to DrSamofal@PodiatryCenterNJ.com
ASSOCIATE POSITION -- LAS VEGAS, NEVADA
Busy and well-established practice in Las Vegas, NV. Must have excellent bedside manner. Send cover letter and CV to: sierra@lasvegasacfac.com
ASSOCIATE POSITION – DALLAS, TX
Well established practice in the Dallas-Fort Worth Texas area, seeking part or full time associate offering competitive compensation packages. We are looking for a personable, motivated, well trained, and hardworking, Board Eligible Certified podiatrist. Please email inquiries/CV with one minute introductory video to minah@drdaveysuh.com.
ASSOCIATE POSITION – ST. GEORGE, UTAH
Immediate Doctor of Podiatric medicine position for a well-trained, highly motivated individual. Location: St. George, Utah. Competitive salary with commission structure. Benefits include: PTO, CME allowance, health and malpractice insurance. Must be confident in working solo in your own office environment. Please email Cover Letter and CV to vanessa.deleon@summitmedicalpartners.com
ASSOCIATE POSITION – HUDSON VALLEY, NY
Opportunity to improve your quality of life and start a thriving career in the beautiful Hudson Valley. Offices are located in Hudson and Catskill. We are looking for skilled, well rounded podiatric surgeon. Position available immediately but also willing to wait for skilled resident to begin in July. Please send CV to: mzhubrak@yahoo.com
ASSOCIATE POSITION – WESTERN NORTH CAROLINA
Join a well-established, busy and growing podiatric practice. We are fully integrated with the medical community in a large tertiary teaching hospital. Research opportunities are available. Applicant should be ethical, personable, hardworking, and committed to quality patient care. We are offering a competitive salary with bonus opportunities and a wide range of benefits. Associate position can lead to partnership. All interested candidates should send a resume to JCMOOREDPM@aol.com
ASSOCIATE POSITION - SOUTHEAST MICHIGAN
Opportunity to join a well established and expanding practice. Expertise in wound care a plus. Benefits: 401k, health insurance, paid time off, and bonus potential. Email CV and letter of interest to info@monpod.com or fax 734-241-1961
WOUND CARE FELLOWSHIP - NEW YORK
CPME APPROVED 12 month fellowship beginning July 1st, 2023. Hospital and clinic environment, with onsite hyperbaric medicine. Working with infectious disease, as well as, general, vascular, and podiatric surgeons. Must have completed a PMSR residency. Please contact or jtfootcare@gmail.com. EOE employer.
LIMB SALVAGE FELLOW POSITION – LOS ANGELES, CA
art of a busy rapidly growing practice providing care in Los Angeles. Position includes multiple settings for learning including tertiary and community hospitals, private clinic with in house surgery center and skilled nursing facilities. Training also includes practice management along with coding training. Position comes with a competitive salary with full benefits including CME allowance, Health, Dental, Vision coverage as well as matching 401k plan. Email resume to info@woundinstitute.com
PM NEWS CLASSIFIED ADS REACH OVER 22,000 DPMs AND STUDENTS\
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 22,000 subscribers. For details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details.
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| CLASSIFIED ADS - PRACTICES FOR SALE OR WANTED, EQUIPMENT FOR SALE |
EQUIPMENT FOR SALE – CONNECTICUT
Podiatry equipment 4 power podiatry chairs, ultrasound machine, digital x-ray system, Xcel x-ray, treatment cabinets, side chairs, autoclave and more. Call 203-710-5273.
ACTIVE PRACTICE FOR SALE IN TARZANA CALIFORNIA
Serious inquires only great location across from major hospital three treatment rooms and all equipment free parking great staff. Perfect for one or two doctors text 818-451-8441 Email drpatriciawalters@gmail.com.
PM NEWS CLASSIFIED ADS REACH OVER 22,000 DPMs AND STUDENTS
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 22,000 subscribers. For details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details.
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management® Magazine and Podiatry Management® Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
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