Plantaris excision reduces pain in Mid-portion Achilles tendinopathy even in the absence of plantaris tendinosis

Background It is becoming increasingly apparent that the plantaris can contribute to symptoms in at least a subset of patients with mid-portion Achilles tendinopathy. However the nature of its involvement remains unclear. Hypothesis / Purpose To determine whether excised plantaris tendons from patients with mid-portion Achilles tendinopathy display tendinopathic changes and whether the presence of such changes affect clinical outcomes. Methods Sixteen plantaris tendons patients with mid-portion Achilles tendinopathy recalcitrant to conservative management underwent histological examination for the presence of tendinopathic changes. All patients had imaging to confirm the presence of the plantaris tendon adherent to or invaginated into the focal area of Achilles tendinosis. Visual analogue scores (VAS) and foot and ankle outcome scores (FAOS) were recorded pre and post-operatively. Results Sixteen patients (mean age 26.2; 18-47 years) underwent surgery with a mean follow-up of 14 months (range 6-20 months). The plantaris tendon was histologically normal in 13/16 cases (81%). Inflammatory changes in the loose peritendinous connective tissue surrounding the plantaris tendon were evident in all cases. There was significant improvement in mean VAS scores (p<0.05) and all domains of the FAOS post-operatively (p<0.05). Conclusions The absence of any tendinopathic changes in the excised plantaris of 13 patients who clinically improved suggests plantaris involvement with Achilles tendinopathy may not yet be fully understood and supports the concept that this may be a compressive or a frictional phenomenon rather than purely tendinopathic. Clinical Relevance There is increasing evidence to support that the excision of plantaris results in improved clinical outcomes in a sub-set of patients with mid-portion Achilles tendinopathy. Prior findings have reported that excised plantaris tendons from these patients display tendinopathic changes. However these findings suggest the role of plantaris in the pathology of these patients could be biomechanical since patients improved even when the excised plantaris was not tendinopathic

Financial Development and Convergence Clubs

This paper studies the economic development process, measured by Gross Domestic Product (GDP), for a large panel of countries. We propose a methodology that identifies groups of countries (convergence clubs) that show similar GDP structures, while allowing for changes in club memberships over time. As a second step we analyze the short-run and long-run effects of financial development (measured by financial intermediary development and stock market development) on the GDP process, and the composition of the convergence clubs. We find that the club memberships are quite persistent, but still their compositions change substantially over time. In particular, several EU member countries and East Asian countries are found to belong to a higher GDP club in recent times compared to the beginning of the 1970s. In terms of the effects of financial development indicators on the GDP process, our results partially confirm the theoretical basis for different effects of financial development indicators in the short-run and the long-run. In the long-run, financial development is found to affect the countries’ GDP level positively. The short-run effects of financial development indicators however are found to be less clear, in the sense that we do not find a negative short-run effect of financial intermediary development on GDP levels, while the short-run effect of stock market development is found to be negative.economic growth;Markov chain models;convergence clubs;financial developments

Comment on "Magnetic field effects on neutron diffraction in the antiferromagnetic phase of UPt3"

Moreno and Sauls [Phys. Rev. B 63, 024419 (2000)] have recently tried to reanalyze earlier neutron scattering studies of the antiferromagnetic order in UPt3 with a magnetic field applied in the basal plane. In their calculation of the magnetic Bragg peak intensities, they perform an average over different magnetic structures belonging to distinct symmetry representations. This is incorrect. In addition, they have mistaken the magnetic field direction in one of the experiments, hence invalidating their conclusions concerning the experimental results.Comment: Revised 5 June 2001: Added group theory analysis and modified discussion of S and K domain

Erlang loss bounds for OT-ICU systems

In hospitals, patients can be rejected at both the operating theater (OT) and the intensive care unit (ICU) due to limited ICU capacity. The corresponding ICU rejection probability is an important service factor for hospitals. Rejection of an ICU request may lead to health deterioration for patients, and for hospitals to costly actions and a loss of precious capacity when an operation is canceled.\ud There is no simple expression available for this ICU rejection probability that takes the interaction with the OT into account. With c the ICU capacity (number of ICU beds), this paper proves and numerically illustrates a lower bound by an $M|G|c|c$ system and an upper bound by an $M|G|c-1|c-1$ system, hence by simple Erlang loss expressions.\ud The result is based on a product form modification for a special OT–ICU tandem formulation and proved by a technically complicated Markov reward comparison approach. The upper bound result is of particular practical interest for dimensioning an ICU to secure a prespecified service quality. The numerical results include a case study.\u