Return Of Activity Research Articles

The Impact of Governmental Intervention on the Association Between Initial Public Offering and Future Stock Issuance

AbstractWe examine the effect of initial public offering (IPO) characteristics on seasoned equity offering (SEO) decisions in relation to governmental intervention in China. Our results confirm the process of underpriced IPOs in promoting earlier and larger SEOs in the Chinese context. The study examines three channels through which the Chinese government intervenes in equity issuance activities, namely state ownership, politically connected executives and economic development areas. We find that the connection between IPOs and SEOs becomes less apparent in government‐intervened firms. We attribute these results to the conflict between the state and minority shareholders, which leads to high uncertainty and risk in government‐intervened firms.

Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes.

Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. Case series. Level 4. A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. Bilateral reductions in rectus femoris CSA were noted from T0 to T1 (P < 0.01). Only the uninvolved limb returned to preoperative CSA (P = 0.80), as the involved limb failed to return to preoperative levels at RTA (P = 0.04). No significant changes in rectus femoris PF were observed across time points (P > 0.05). Lesser PF (P < 0.01) but not CSA (P = 0.75) was associated with higher IKDC score at T1. Lesser PF (P = 0.04) and greater CSA (P = 0.05) was associated with higher IKDC score at RTA. Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion.

The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth. A prospective cohort of children/youth with concussion. Childhood Disability Research Centre. One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department. Provision of RTS/RTA guidelines. Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores. Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively. Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.

Capital inflows, equity issuance activity, and corporate investment

This paper uses issuance-level data to study how equity capital inflows that enter emerging market economies affect equity issuance and corporate investment. It shows that foreign inflows are strongly correlated with country-level issuance. The relation especially reflects the behavior of large firms. To identify supply-side shocks, capital inflows into each country are instrumented with exogenous changes in other countries’ attractiveness to foreign investors. Shifts in the supply of foreign capital are important drivers of increased equity inflows. Instrumented contemporaneous and lagged capital inflows lead large firms to raise new equity, which they use to fund investment.

Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence.

Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.

Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients.

The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane block (LG TAP) for further optimizing multimodal pain control. This is a retrospective analysis of a prospectively collected database of 140 consecutive patients undergoing LSG without TAP block (pre-TAP group) compared to 131 patients undergoing LSG with LGTAP (TAP group). All operations were performed laparoscopically utilizing uniform clinical pathways. Baseline characteristics for both groups were comparable. Both groups received standardized anesthesia. Outcomes included time to postoperative ambulation, pain scores, PCA volume, length of hospital stay, utilization of oral opiate medications, and return to activity (RTA). Pre-TAP versus TAP groups were comparable, mean age 42years (p = 0.99), women 81.4% versus 87.8% (p = 0.148), mean BMI (kg/m2) 46 versus 45 (p = 0.394). Most patients ambulated within 2h after arrival to the floor (87.9% vs. 76.3%, p = 0.013). On postoperative day (POD) 1, mean reported pain score (0-10) was 4.50 vs. 5.06 (p = 0.063) and a mean PCA morphine used for 24h was 26.3mL versus 26mL, p = 0.35. Mean days of postoperative opiate medication were 2.19 versus 1.24 (p < 0.001). Return to activity was 2.81 versus 2.08days (p < 0.001). When controlled for age, BMI, OR time, PCA volume used, and average pain score, TAP block was an independent predictor of earlier return to activities (p < 0.001). LGTAP block following LSG is an additional valuable modality of pain control in the perioperative period. Our study shows that TAP block is associated with an earlier RTA and decreased opiate use in patients undergoing LSG.

Associations Between Muscle Morphology Measured with Ultrasonography and Self-Reported Function Following Anterior Cruciate Ligament Reconstruction

Deficits in quadriceps function are common in patients who sustain an anterior cruciate ligament (ACL) injury and undergo subsequent ACL reconstruction (ACLR). Quadriceps atrophy is among the notable changes in muscle tissue after ACLR. The relationship between muscle morphology and self-reported function should be established so treatment options can be targeted to improve function after ACLR. PURPOSE: (1) To evaluate rectus femoris (RF) cross-sectional area (CSA) and intramuscular fat percent (PF) in the injured and uninjured limb from 9 weeks post ACLR to return to activity (RTA) and (2) identify associations between injured limb quadriceps CSA, PF and self-reported function. METHODS: 28 individuals with primary unilateral ACLR (Age=16.6±2.7; Weight=71.8±17.7; 64% female; 18 bone-patellar tendon-bone; 2 quadriceps tendon; 5 hamstring tendon) were recruited for this study. RF was imaged at 15cm proximal of superior border of the patella. Quadriceps CSA and PF of the injured and uninjured limb were used for analysis. Self-reported function was evaluated using the International Knee Documentation Committee score (IKDC). Paired-samples t-tests were used to compare inter-limb differences in CSA and PF and changes from 9 weeks to RTA. Partial correlations adjusting for sex were used to analyze the relationship between RF morphology and IKDC scores. RESULTS: Injured limbs had smaller RF CSA at each time point (4.5±1.6cm2 vs 5.2±1.9cm2, p<.01 and 5.2±1.9cm2 vs 5.6±2.1 cm2, respectively) compared to the uninjured limb. Injured limb CSA increased at RTA (4.5±1.6cm2 vs 5.2±1.9cm2, p<.01) while the uninjured limb did not (p=0.12). No differences in PF were found between limbs (p=0.18, and p=0.43, respectively) or time point (p=0.67, and p=0.92, respectively). After adjusting for sex, larger injured limb CSA was associated with higher IKDC scores at 9 weeks and trended toward significance at RTA (r=0.32, p=0.05, and r=0.26, p=0.09, respectively). Injured limb PF was negatively associated with IKDC scores at both time points (r=-0.55, p=<.01, and r=-0.39, p=0.02, respectively). CONCLUSIONS: Inter-limb differences in RF muscle CSA are not ameliorated at RTA. RF CSA and PF are associated with self-reported function in individuals with ACLR and should be treatment targets to improve patient function following injury.

Modified Valenti Arthroplasty in Running and Jumping Athletes With Hallux Limitus/Rigidus: Analysis of One Hundred Procedures

Despite hallux limitus/rigidus being a common condition, results of surgical procedures specifically pertaining to athletes are scarce. The results of 100 modified Valenti procedures, prospectively studied from January 2000 to June 2016 with an average 49.17 months of follow-up, are presented evaluating demographics, sport, time and ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20°, and grade ≥2. Seventeen had grade 2, 79 had grade 3, and 4 had grade 4 disease. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100% were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks, which was significant. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients (6%) stated a decreased desire to activity, although this was not a significant finding. The modified Valenti procedure is a safe and highly effective treatment for running and jumping athletes limited by hallux limitus/rigidus because 94% of patients were able to return to their desired level of activity.

Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents.

To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents. Prospective study. Children's Hospital, Westmead, Australia. One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury. Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured. Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators. Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 ± 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 ± 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome. Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.

Continued Improvements in Quadriceps Strength and Biomechanical Symmetry of the Knee After Postoperative Anterior Cruciate Ligament Reconstruction Rehabilitation: Is It Time to Reconsider the 6-Month Return-to-Activity Criteria?

Patients who undergo anterior cruciate ligament reconstruction (ACLR) present with strength and biomechanical deficits at return to activity (RTA). Deficits in strength and biomechanical symmetry impair function during activity and may predispose patients to subsequent injury. To compare strength and biomechanical function in patients with ACLR at RTA and more than 12 months post-ACLR. Descriptive laboratory study. Research laboratory. A total of 20 participants (12 females, 8 males; age = 21.40 ± 5.60 years, height = 171.3 ± 10.2 cm, mass = 73.21 ± 19.41 kg) who had undergone ACLR and were cleared to RTA were recruited. Strength was measured during knee extension and evaluated by the isometric and isokinetic quadriceps index. Biomechanical function was evaluated using symmetry values for sagittal-plane knee-joint rotations, changes in sagittal-plane knee-joint rotation, knee-extension moments, and changes in knee-extension moment that were recorded during a single-legged forward hop. Self-reported function was measured using the International Knee Documentation Committee Subjective Knee Evaluation Form. Participants were assessed at RTA (212.25 ± 28.11 days) and more than 12 months post-ACLR (556.25 ± 230.89 days). At RTA, strength and biomechanical values were less than 80% symmetric. We observed improvements from RTA to more than 12 months post-ACLR for the isometric quadriceps index ( F1,18 = 29.22, P < .001), isokinetic quadriceps index ( F1,18 = 10.88, P = .004), sagittal-plane knee-joint rotations ( F1,19 = 9.58, P = .006), change in sagittal-plane knee-joint rotations ( F1,19 = 7.83, P = .01), knee-extension moments ( F1,19 = 5.73, P = .03), change in knee-extension moments ( F1,19 = 21.10, P < .001), and self-perceived function ( F1,19 = 11.50, P = .003). Of the 7 variables that showed improvement at more than 12 months post-ACLR, only 3 met the recommended criteria (≥90%). Patients with ACLR showed asymmetry in strength and biomechanics at RTA. These asymmetries, along with self-perceived function, improved over time. However, despite improvements in strength and biomechanics at RTA, asymmetries of more than 10% were still present more than 12 months post-ACLR.

Firm financing and growth in the Arab region

This paper documents how firms in Arab countries use equity, corporate bond and syndicated loan markets to obtain financing and grow. Working with a new dataset on issuance activity in domestic and international markets and firm performance, the paper finds that capital raising through these markets has grown rapidly since the early 1990s and involved an increasing number of firms. Whereas the amounts raised in equity and loan markets (relative to gross domestic product) stand well relative to international standards, bond issuance activity lags behind. However, bond financing has gained importance over time. Equity issuances take place primarily in domestic markets, whereas bonds and loans are mostly issued internationally, display long maturities and entail low levels of credit risk. Issuing firms from the Arab region are very large compared to international standards. They also tend to be larger, faster growing and more leveraged than non-issuing firms in Arab countries.

Concussion recovery trajectories among United States Service Academy Members

PURPOSE: Describe concussion/mild traumatic brain injury (mTBI) recovery durations by sex and injury-related activities in US Service Academy cadets. METHODS: Injury data (2014-2017) from three US Military Service Academies were examined to describe concussion/mTBI characteristics (n=800 injuries, 301 female). Of the documented injuries, there were 738 injured individuals, of which, 679 had one injury, 56 individuals had two injuries and three individuals had three injuries. The recovery trajectories for all injuries were examined across sex and injury activity. Three durations were examined: days until asymptomatic, duration of return to activity (RTA) protocol, and days of total time lost. Duration was examined using Kaplan-Meier and log-rank tests. Due to the right skewed distribution, medians and interquartile range (IQR) are reported. RESULTS: Across all cadets, the median days until asymptomatic was 9 (IQR: 5-16). The median duration of RTA protocol was 5 days (IQR: 5-7). The total time lost due to concussion/mTBI was 20.68 days (IQR: 12.78-33.12). There was a significant effect of sex for days until asymptomatic and total time lost (p’s < 0.01). Across all recovery metrics, females were more likely to have more days until asymptomatic (11 vs. 8.0 median days) and total time lost (24.6 vs 18.8 days). A significant effect of injury activity was observed for days until asymptomatic and total time lost (p’s < 0.05). Injuries occurring during free-time activities had the greatest median number of days until asymptomatic (13 days IQR: 10-15) while injuries occurring during varsity athletics or academy specific training had the fewest median days until asymptomatic (both 6 days). Injuries occurring during varsity athletics had the shortest median total time loss of 12.9 days (IQR: 11.95-15.73). All other injury mechanisms were associated with median time loss of more than 20 days. CONCLUSIONS: These analyses show significant effects of sex and injury activity on recovery duration. Differences may also reflect varying approaches to injury management by the medical provider. Further investigation is needed to determine an individualized approach to clinical care.

How Does External Financing Affect the Timing of Voluntary Disclosure: Evidence From Vehicle Safety Recalls

Vehicle firms strategically time safety-related recalls in response to historically issued long-term debt prescheduled to mature by the end of the fiscal year in which defective products are manufactured. Maturing debt does not predict recall events, largely matures in the last month of a firm's fiscal year, and correlates with issuance activities in the fiscal year-end. High-maturing-debt firms delay to recall their top-selling products by several quarters to avoid credit-rating downgrades prior to refinancing, even holding constant the distance of manufacturing date to the fiscal year-end. The findings survive under a difference-in-differences approach. The effect of maturing debt on recall timing is more pronounced in firms holding less cash. Recall delay increases the likelihood of firms receiving consumer complaints. NHTSA does not time investigations based on corporate debt maturity structure. Firms' self-claimed event chronologies are consistent with their recall timing. Contrary to company statements and some investigation reports, top management is typically aware of product defects.

Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries

The optimal treatment modalities for navicular stress fractures in athletes is currently unknown for this season-ending injury. The present study evaluated factors that might be significant and affect healing outcomes, specifically focusing on the return to activity (RTA) time and a decreased desired activity (DDA) after treatment in athletes. Such considerations included previous navicular stress fractures, patient demographic data and type of sport, and initiation time of treatment. The data from 59 patients with 62 fractures were prospectively analyzed from May 2005 through July 2016. The results showed a significant correlation between a previous navicular stress fracture and decreased desired activity. The average duration of symptoms before receiving definitive treatment was 8.8 months. Computed tomography as the initial imaging modality correlated positively with a correct diagnosis (1.00). In contrast, magnetic resonance imaging, when used initially, was only 71% accurate. Runners constituted most of the cohort at 38 (61.3%). Ten other athletes were involved in jumping sports. Of the 62 injuries, 21 (33.9%) were in elite or professional athletes, all of whom were able to RTA, with 1 patient, a 38-year-old world record holding runner, having a DDA. Seven refractures (11.2%) occurred an average >5 years after the initial injury, predominantly in those aged <21 years, none with previous surgery. Eight patients (12.9%) developed postinjury arthrosis, including 1 with DDA. Patients who underwent open reduction and internal fixation had a RTA of 4.56 months compared with those who had undergone nonoperative treatment, who had an average RTA of 3.97 months. Seven patients (11.2%) underwent screw removal and required a longer RTA. Overall, of the 62 injuries, the patients with 57 of the injuries (91.9%) were able to RTA at their preinjury level.

Peritenolysis and Debridement for Main Body (Mid-Portion) Achilles Tendinopathy in Athletic Patients: Results of 107 Procedures

Achilles tendinopathy in the main body (mid-portion) of the tendon is a common pathologic finding among active and athletic populations and can be debilitating without proper and adequate treatment. Numerous surgical approaches for this common pathologic finding have been reported, with variable outcomes. We evaluated the surgical outcomes of peritenolysis and debridement of main body Achilles tendinopathy among athletic populations using the return to activity (RTA) and decreased desired activity (DDA) as our primary outcome measures. A total of 100 patients underwent 107 procedures by the senior author (A.S.) from January 2001 through December 2015 met the inclusion criteria, 65 (65%) of whom were runners. The mean follow-up duration was 106.6 ± 55.5 months from the index procedure, and the mean interval necessary to RTA for the entire group was 10.9 ± 5.3 weeks. The average RTA after debridement was 14.1 ± 5.2 weeks and after peritenolysis was 7.3 ± 2.0 weeks (p = .00001). Of the 100 patients, 3 (3%) had experienced a DDA at the last follow-up visit. With >97% of the patients able to return to their desired activities, we have concluded that peritenolysis and debridement are favorable surgical techniques for main body Achilles tendinopathy.

Can investors anticipate post-IPO mergers and acquisitions?

Given the frequency and value implications of post-IPO merger and acquisition activity, we investigate empirically whether investors can utilize information based on IPO deal structure to predict merger and acquisition activity among newly public firms. Consistent with the hypothesis that some firms conduct IPOs to facilitate future M&A activity, we find that aspects of IPO deal structure predict whether a newly public firm subsequently becomes a bidder or target. These characteristics include underwriter quality, promotional activity, pricing, proceeds, ownership structure, and issuance activity suggestive of market timing. Investors appear to rely on these observable aspects of a firm's going public process to anticipate the implications of M&A activity for security valuation. Specifically, when newly public firms with IPO deal structures predictive of acquisition activity announce an acquisition their stock returns are indistinguishable from zero. In contrast, abnormal returns to acquisition announcements by unlikely or surprise bidders are positive on average. These results suggest that the going public process has important implications for future M&A activity and valuation.

Foot Numbness - Basketball

HISTORY: 35 year old male on phentermine for weight loss, presented to sports clinic with complaint of right foot numbness that started 6 days prior. After a basketball game he noticed pain and swelling in his postero-lateral calf. He went hiking the next day and the pain increased. The next day he developed numbness to the bottom of his foot. He saw a podiatrist on day 4 and was diagnosed with radiculopathy and given Medrol. He did not have foot drop or weakness but complained of heel numbness. At the time of his visit, his pain had mostly resolved, the numbness is what persisted and brought him in. PHYSICAL EXAM: Msk: Spine: No midline tenderness, FROM, 5/5 strength all lumbar dermatomes, decreased sensation to touch over heel and lateral foot Negative neural slump test, straight leg raise, Patricks, Fortins, Gaenslens, 1+ patellar and achilles reflexes Compartments soft, but right leg with swelling compared to left, no warmth, redness or cords, mild tenderness laterally DIFFERENTIAL DIAGNOSIS: Lumbar Radiculopathy Peripheral nerve entrapment Compartment syndrome DVT Hematoma/mass Partial gastrocnemius rupture TESTS & RESULTS: L-spine xray: L3/L4 retrolisthesis. Sono: no DVT MRI R leg: Grade 2 popliteus strain with edema/hematoma formation and compression of tibial nerve Initial labs (1 week post injury): CK 856, Cr 1.3, UA 1+ protein, 1+ ketones. CBC, CMP, ESR, and CRP normal Repeat labs (3 weeks post injury): normal CK, creatinine, UA EMG with nerve conduction (3 weeks post injury): normal Repeat MRI (6 weeks post injury): interval improvement yet persistent edema of the popliteus muscle Xrays tib/fib/knee (6 weeks post injury): no evidence of heterotopic ossification FINAL WORKING DIAGNOSIS: Tibial nerve compression due to popliteus muscle injury with concomitant mild rhabdo TREATMENT: Phentermine was stopped. He started PT after a 6-week period of rest from weight bearing exercise. OUTCOME AND FURTHER FOLLOW-UP: The patient’s symptoms improved with rest and physical therapy. There was a discussion about seeing a nerve surgeon, or doing a cortisone injection or nerve hydro-dissection, but the patient declined since he was improving. 6 weeks post injury he reported only mild numbness in his heel. RETURN TO ACTIVITY: The patient was able to gradually return to cardio and was back to basketball at 3 months.

Right Shoulder Pain

HISTORY: A 48 year-old right-handed AAF with no significant PMH presented with right shoulder weakness and pain for 2 weeks. There was no inciting event or recent changes in activity. Her symptoms began 2 weeks after a viral URI. She works as a network manager and started developing acute pain for a few days, which was followed with stiffness, weakness and numbness on the lateral side of her arm. The pain then become constant and the numbness and tingling were intermittent and radiating into her hand. Her symptoms had been worsening over the prior week specifically with overhead activity. She had been using NSAID’s, ice/heat and massage with no relief PHYSICAL EXAMINATION: Winging of the right scapula was noticed as well as tenderness over the deltoid. Passive ROM was normal with decreased active ROM; forward flexion and abduction 0-120 degrees, abduction external rotation 0-60 degrees. Supraspinatus, infraspinatus and triceps strength 3/5 with normal deltoid and trapezius strength. Hawkin’s, Neer’s, Empty can, and Impingement tests are all positive. Obrien’s, Yergason’s and Crossover tests negative. DIFFERENTIAL DIAGNOSIS: Parsonage-Turner syndrome, Cervical disk disease, Shoulder impingement syndrome, Neoplastic brachial plexopathy, Supraspinatus tendinopathy TESTS AND RESULTS: Xray were obtained; no fracture, arthritis or soft tissue abnormalities were seen. Patient was sent for cervical and plexus MRI as well as EMG and nerve conduction studies. MRI results were without infiltrating process or extrinsic compression on the brachial plexus. Cervical spine MRI revealed a small right central disc extrusion without impingement. Nerve conduction studies demonstrated significant differences between the right and left Median and Ulnar nerves. The right Median and Ulnar nerves F-wave latency showed no response compared to 20.3 msc on the left side, which is consistent with a proximal injury as at the level of the plexus. FINAL WORKING DIAGNOSIS: Parsonage-Turner syndrome OUTCOME: Patient was given Toradol and Depomedrol IM as well as Medrol dose pack and Amitriptyline. She was also referred to PT. RETURN TO ACTIVITY AND FOLLOW UP: 7 weeks after the initiation of the treatment patient reported almost complete resolution of her symptoms. She was instructed to follow up as needed if not complete resolution within 8 weeks.

Behavioral Timing, Valuation and Postissue Performance of UK Initial Public Offerings

ABSTRACTUsing a sample of 1,926 UK initial public offerings (IPOs) launched from 1987 to 2007, this study introduces a new angle on testing the behavioral timing hypothesis in the context of UK IPOs via investigating relationships between the magnitude of IPOs misvaluation and postissue stock price and operating performance. IPO misvaluation is measured using (i) an intrinsic value of the firm estimated using residual income valuation model and (ii) intensity of IPO issuance activity. The findings show that stock price and operating underperformance in the postissue are directly linked to the degree of IPOs' misvaluation. Specifically, the stock price and operating performance are found to be significantly and robustly different between hot markets IPOs and cold market IPOs 3 years postissue. We also show that overvalued IPOs have lower long-run stock returns, but outperforming operating performance, than undervalued IPOs do. Our findings are broadly consistent with the behavioral explanations of the poor stock price and operating performance, supporting the U.S. results of Purnanandam and Swaminathan [2004] and Loughran and Ritter [2000].

Mechanical, histological, and functional properties remain inferior in conservatively treated Achilles tendons in rodents: Long term evaluation

Conservative treatment (non-operative) of Achilles tendon ruptures is suggested to produce equivalent capacity for return to function; however, long term results and the role of return to activity (RTA) for this treatment paradigm remain unclear. Therefore, the objective of this study was to evaluate the long term response of conservatively treated Achilles tendons in rodents with varied RTA. Sprague Dawley rats (n=32) received unilateral blunt transection of the Achilles tendon followed by randomization into groups that returned to activity after 1-week (RTA1) or 3-weeks (RTA3) of limb casting in plantarflexion, before being euthanized at 16-weeks post-injury. Uninjured age-matched control animals were used as a control group (n=10). Limb function, passive joint mechanics, tendon properties (mechanical, histological), and muscle properties (histological, immunohistochemical) were evaluated. Results showed that although hindlimb ground reaction forces and range of motion returned to baseline levels by 16-weeks post-injury regardless of RTA, ankle joint stiffness remained altered. RTA1 and RTA3 groups both exhibited no differences in fatigue properties; however, the secant modulus, hysteresis, and laxity were inferior compared to uninjured age-matched control tendons. Despite these changes, tendons 16-weeks post-injury achieved secant stiffness levels of uninjured tendons. RTA1 and RTA3 groups had no differences in histological properties, but had higher cell numbers compared to control tendons. No changes in gastrocnemius fiber size or type in the superficial or deep regions were detected, except for type 2x fiber fraction. Together, this work highlights RTA-dependent deficits in limb function and tissue-level properties in long-term Achilles tendon and muscle healing.