Using long-term data from a whole ecosystem warming experiment to identify best spring and autumn phenology models.

Predicting vegetation phenology in response to changing environmental factors is key in understanding feedbacks between the biosphere and the climate system. Experimental approaches extending the temperature range beyond historic climate variability provide a unique opportunity to identify model structures that are best suited to predicting phenological changes under future climate scenarios. Here, we model spring and autumn phenological transition dates obtained from digital repeat photography in a boreal Picea-Sphagnum bog in response to a gradient of whole ecosystem warming manipulations of up to +9°C, using five years of observational data. In spring, seven equally best-performing models for Larix utilized the accumulation of growing degree days as a common driver for temperature forcing. For Picea, the best two models were sequential models requiring winter chilling before spring forcing temperature is accumulated. In shrub, parallel models with chilling and forcing requirements occurring simultaneously were identified as the best models. Autumn models were substantially improved when a CO2 parameter was included. Overall, the combination of experimental manipulations and multiple years of observations combined with variation in weather provided the framework to rule out a large number of candidate models and to identify best spring and autumn models for each plant functional type.

Magnetic Resonance Imaging Analysis of Peroneal Tendon Pathology Associated With Low-Lying Peroneus Brevis Muscle Belly: A Case-Control Study.

BACKGROUND: Low-lying peroneus brevis tendon muscle belly has been speculated to be an associated factor with symptomatic peroneal tendon pathology. Multiple studies have analyzed normal and anomalous anatomy associated with peroneal tendon pathology; however, no study has confirmed the clinical association between peroneal tendon pathology and low-lying peroneus brevis muscle belly. PURPOSE: To identify the correlation of low-lying peroneus brevis muscle belly with peroneal tendon pathology. STUDY DESIGN: Case-control study; Level of evidence 3. METHODS: The level of peroneus brevis muscle belly was compared between patients with symptomatic peroneal tendon pathology (experimental group) and asymptomatic individuals with otherwise normal lateral ankle using magnetic resonance images. RESULTS: Of the 32 consecutive patients with symptomatic peroneal tendon pathology, 28 (87.5%) demonstrated peroneus brevis muscle distal to the fibular groove while 53.8% of control patients demonstrated such findings (P = .022). The most common diagnosis associated with peroneal tendon pathology was ankle instability and osteochondral defect of the talus or tibial plafond. Peroneal tendon pathology in isolation was less common. CONCLUSION: Peroneal tendon pathology is often associated with lateral ankle instability and osteochondral defects of the ankle joint. Low-lying peroneus brevis muscle belly may be a common anatomic variant, but in the setting of instability it can become a source of pain and pathology secondary to overcrowding. LEVELS OF EVIDENCE: Diagnostic, level III: Case-control study.

Squamous Cell Carcinoma With Chronic Osteomyelitis: A Case Report.

UNLABELLED: Squamous cell carcinoma is one of the most common human malignancies; however, it is uncommon in the lower extremity. These lesions require prompt surgical attention and a delay in diagnosis can be harmful to the patient. We present a case report of squamous cell carcinoma with chronic osteomyelitis in a patient without diabetes. Definitive treatment included a transtibial amputation and metastatic workup was negative for active malignancy. Surgeons who treat chronic wounds should be cognizant of the potential for malignant degeneration. LEVEL OF EVIDENCE: Therapeutic, Level IV: Case report.

Intermediate and long-term outcomes of the suture bridge technique for the management of insertional achilles tendinopathy.

INTRODUCTION: Insertional Achilles tendinopathy is a problem frequently encountered by the foot and ankle surgeon. Conservative care yields mixed results, and this condition is often treated surgically. Our hypothesis is that the suture bridge technique through a central posterior incision allows adequate visualization for thorough debridement and exostectomy and provides a stable tendon-to-bone interface for healing. MATERIAL AND METHODS: The medical records of 35 patients who underwent surgical treatment for insertional Achilles tendinopathy with the suture bridge technique, by a single surgeon, between 2006 and 2012 were retrospectively reviewed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instruments as well as a subjective questionnaire were utilized. RESULTS: In all, 30 individuals who met the inclusion criteria for the treatment of insertional Achilles tendinopathy were evaluated at a mean follow-up of 28.93 ± 16.99 months. We included 10 men and 20 women, with a mean age of 49.1 ± 9.2 years. The mean preoperative AOFAS score was 56.6 ± 14.0. The average postoperative AOFAS score significantly increased to 91.7 ± 10.4 (P < .0001). One participant required revisional surgery, consisting of a flexor hallucis longus transfer performed by another physician. There were no wound complications or infections. Overall, there was a 97% (28/29) satisfaction rate. CONCLUSION: The central incision with complete detachment of the Achilles tendon and reattachment with the suture bridge technique for the treatment of insertional Achilles tendinopathy provides an effective treatment with good to excellent clinical outcomes in 97% of patients, with a mean follow-up of 29 months.

Perceived value of the clinical dual-degree program to DPM/MHA alumni.

BACKGROUND: This article provides an analysis of the perceived value to doctor of podiatric medicine/master of health-care administration (DPM/MHA) alumni of the clinical dual-degree program at Des Moines University, Des Moines, Iowa, and a review of the literature on physician leaders. METHODS: An in-depth review of the current literature and an evaluation of survey results from 21 of 33 alumni of the DPM/MHA dual-degree program at Des Moines University was completed. RESULTS: There was an overwhelming positive response from alumni toward the DPM/MHA dual-degree program. It was also found that there is a need for physician leaders who obtain knowledge and understanding of the business aspects of medicine in the current health-care industry. CONCLUSIONS: These survey results provide justification that the DPM/MHA dual-degree program at Des Moines University is fulfilling its goal of providing an educational background in the administrative and clinical aspects of medicine that prepares students for the complex and ever-changing health-care industry. The dual-degree program is a great opportunity for the podiatric medicine profession and podiatric medical schools to increase their collaboration with MHA programs to offer dual-degree programs to help fill the void and prepare future physician leaders.