How susceptible are our Achilles Tendons? Sonoanatomical assessment. A cross-sectional study

Objective: the aim of this study is to observe whether there are ultrasound changes between men and women in the Achilles tendon at rest, at maximum passive force is applied and during walking. Material and methods: it was a cross-sectional study involving 27 healthy young participants recruited as vol-unteers between April to July 2022. A variety of data was recorded: (age, Body Mass Index, sex, smoking, current injury status, allergies, medications, previous surgeries, type of sport, and number of weekly workouts) and ultrasound measurements at rest and at passive force (Cross Sectional Area Achilles Tendon length, tendon thickness, Cross Sectional Area and pennation angle of the soleus muscle to the Achilles Tendon). Results: women demonstrated a statistically significant lower proximal and median thickness both at rest (4.5 vs 5.1 mm with p < 0.001 for proximal thickness; 4.4 vs 5.3 mm with p < 0.001 for median thickness) as well as during maximum eccentric contraction (4.3 vs 4.8 mm with p=<0.001 for proximal thickness; 4.1 vs 4.8 mm with p < 0.001 for median thickness). Conclusion: there are significant sonoanatomical differences in vivo Achilles tendon between men and women.Funding for opoen access charge: Universidad de Málaga / CBU

How susceptible are our Achilles Tendons? Sonoanatomical assessment. A cross-sectional study

Objective: the aim of this study is to observe whether there are ultrasound changes between men and women in the Achilles tendon at rest, at maximum passive force is applied and during walking. Material and methods: it was a cross-sectional study involving 27 healthy young participants recruited as volunteers between April to July 2022. A variety of data was recorded: (age, Body Mass Index, sex, smoking, current injury status, allergies, medications, previous surgeries, type of sport, and number of weekly workouts) and ultrasound measurements at rest and at passive force (Cross Sectional Area Achilles Tendon length, tendon thickness, Cross Sectional Area and pennation angle of the soleus muscle to the Achilles Tendon). Results: women demonstrated a statistically significant lower proximal and median thickness both at rest (4.5 vs 5.1 mm with p < 0.001 for proximal thickness; 4.4 vs 5.3 mm with p < 0.001 for median thickness) as well as during maximum eccentric contraction (4.3 vs 4.8 mm with p=<0.001 for proximal thickness; 4.1 vs 4.8 mm with p < 0.001 for median thickness). Conclusion: there are significant sonoanatomical differences in vivo Achilles tendon between men and wome

Cross-cultural Adaptation and Validation of the French Version of the Diabetic Foot Self-care Questionnaire of the University of Malaga.

Diabetic foot care management is directed at patients with a history of complications, especially those with rising levels of hemoglobin A1c, and those who have had diabetes for several years. The aim of this study was to cross-culturally adapt a French-language version of the Diabetic Foot Self-care Questionnaire of the University of Malaga (DFSQ-UMA) for use in France. Cross-cultural adaptation was performed according to relevant international guidelines (International Society for Pharmacoeconomics and Outcomes Research), and the factor structure was determined. Internal consistency was measured using the Cronbach α. Item-total and inter-item correlations were assessed. The French data set comprised 146 patients. The mean ± SD patient age was 62.60 ± 15.47 years. There were 47 women and 99 men. The structure matrix (with three factors) was tested by confirmatory factor analysis. The 16-item questionnaire had a Cronbach α of 0.92. The mean value for inter-item correlations was 0.48 (range, 0.17-0.86). The rotated solution revealed a three-factor structure that accounted for 48.10% of the variance observed. A significant inverse correlation was observed between questionnaire scores and hemoglobin A1c levels (r = -0.17; P This study validates the French-language version of the DFSQ-UMA, which can be used as a self-reported outcome measure for French-speaking patients in France

Occupations humaines et chronostratigraphie du gisement pléistocène d’Illiers-Combray (Eure-et-Loir, France): De nouveaux éléments pour le SIM 5b

National audienceBetween 2012 and 2015, five successive archaeological campaigns were led by the Department of archaeology of Eure-et-Loir, on the Illiers-Combray plateau, 1 km to the east of the river Loir. Middle Palaeolithic remains were discovered in a Pleistocene loess-palaeosoils sequence, extending over an area of more than 10 km^2. This Early Weichselian site constitutes a major discovery, due to the good preservation of the artefacts and the sparse data in the south-west of the Paris basin. During the archaeological survey, trenches were dug down to the bedrock every 25 m to 50 m, which revealed lithic remains over the entire research area, while neither bones nor organic remains were preserved due to the low pH value of the soils. The geoarchaeological approach combines sedimentology, micromorphology and luminescence dating (OSL, post-IR IRSL, TL) of sediments and burned flint artefacts.Lithic artefacts were found isolated or in clusters of dozens of pieces at a depth comprised between 0.70 m and 2 m. Three main sectors were identified. The sector n° 1, situated to the north-east of the town, comprises of 59 lithic artefacts in small clusters of about 10 pieces per square meter over an area of 4500 m^2 area. The sector n° 2, 500 m to the south, delivered 261 artefacts spread over an area of 3.6 ha. The third sector, covering an area of 0.4 km^2, is the largest of the three sectors and is located to the south-east of the two other areas. 186 lithic artefacts were found in this area. The Pleistocene loess-palaeosoil sequence is homogeneous and well preserved on the plateau. It covers at least three glacial-interglacial cycles (Saalian, Eemian and Wechselian) and can be divided into 15 units. At the base, the Saalian strata (unit 11 to 15) are above the "argile à silex" tertiary formation (unit 16). The OSL age of the unit 11 is 218.6 ± 49.6 ky. Saalian strata are marked by huge ice wedges and hydromorphy. The Eemian strata show a well preserved pseudomorph of an ancient tree windthrow (unit 9) located in a luvisol (unit 8 and 10). OSL dating of the unit 10 gives 121.0 ± 15.7 ky. The Early Weichselian strata are comprised of three units 7.1, 7.2 and 7.3. The majority of the artefacts is contained in the unit 7b, which is rich in ferro-manganic nodules. However, some artefacts were also found in the 7a and 7c units, as well as in the ice wedges which cut through the Early Weichselian strata. The top of the sequence is characterised by decarbonated loess deposits in which a luvisol has developed. The lithic material is in excellent condition and numerous refi ttings testify a good preservation within the archaeologi- cal layers. The analysis of these remains suggests a concomitance of several operating production chains, to manufacture flakes, blades and points as well as an operating chain for bifacial shaping. The identifi ed production methods are convergent unipolar, parallel unipolar, Levallois and discoid debitage. However, tools made out of fl akes are rare. They consist of side scrappers and retouched artefacts. Two burned artefacts from unit 7.2 were dated by TL at 88.9 ± 6.9 ky and 89.7 ± 6.9 ky, which place the lithic industry in the MIS 5b. The preliminary results show that the site constitutes a new reference for the Pleistocene and the Middle Palaeolithic of the Centre and the North of France, in addition to the reconstruction of the palaeoenvironmental and archaeological history of this area. Finally, the extensive excavation could become important in reconstructing Middle Palaeolithic history, since the site itself is located on the divide between the watersheds of the Seine and the Loire and, thus, in a key area for understanding the cultural palaeogeography of the Neanderthal populations.Cinq opérations de diagnostic successives, conduites à Illiers-Combray de 2012 à 2015 par le Service d'archéologie du département d'Eure-et-Loir, ont permis l'identification de vestiges paléolithiques compris dans une séquence limoneuse de plateau, sur une aire de plus de 100 ha, fouillé manuellement sur 60 m². La découverte de ce site vient enrichir les connaissances sur le Paléolithique moyen du Centre de la France, encore très peu documenté, et ajouter un jalon manquant pour le stade isotopique 5b dans le Nord de la France.Les découvertes ont été faites grâce au creusement de 453 sondages, d'une profondeur allant jusqu'à 7 m, jusqu'au substratum rocheux, tous les 25 m à 50 m. Les vestiges lithiques sont présents à une profondeur comprise entre 0,70 m et 2 m, répartis sur l'ensemble de l'aire, isolés ou concentrés en plusieurs dizaines de pièces. Les vestiges organiques ne sont pas conservés, du fait de l'acidité des sédiments. La séquence pléistocène est bien représentée sur la majorité du plateau. Elle se caractérise notamment par le développement de sols lessivés, la présence de pseudomorphoses de fentes de gel, ainsi que de fosses pléistocènes de déracinement d'arbre. L'approche géoarchéologique combine des analyses sédimentologiques, micromorphologiques et des datations OSL et post-IR IRSL sur limon loessiques et TL sur artefacts chauffés.Les premiers résultats confirment l'intérêt du site. La séquence limoneuse présente trois cycles glaciaire-interglaciaire, dont les plus récents couvrent le Saalien, l'Éémien et le Weichsélien. La série lithique regroupe 931 pièces, dont la majorité a été identifiée dans un même horizon argilo-limoneux riche en concrétions ferro-manganiques. L'aspect très frais des vestiges et la présence de nombreux remontages et raccords témoignent de la bonne préservation des niveaux archéologiques. L'analyse de ce mobilier suggère la concomitance de plusieurs chaînes opératoires de débitage, orientées vers la production d'éclats, de lames et de pointes. Une chaîne opératoire de façonnage est également attestée par la présence de bifaces. L'outillage sur éclat est faiblement représenté. Il se compose principalement de racloirs et de quelques pièces sommairement retouchées.Au regard des données déjà collectées lors des diagnostics, il semble que la fouille de ce gisement pourrait constituer un jalon important pour la connaissance du Paléolithique moyen. La localisation de ce site, à la charnière entre les bassins versants de la Seine et de la Loire, viendrait avantageusement documenter un secteur clef pour la compréhension de la paléogéographie culturelle des populations néandertaliennes

Institutional factors, opportunity entrepreneurship and economic growth: Panel data evidence

This paper explores the institutional factors that encourage opportunity entrepreneurship in order to achieve higher rates of economic growth. We suggest that institutions may not have an automatic effect, as is typically assumed in growth models. Rather, a mechanism is required to serve as a conduit into the society for those institutional factors that affect productive behavior such as entrepreneurial activity. Thus, opportunity entrepreneurship is identified as one such mechanism that impacts on economic growth. Using a three-stage least-square method through unbalanced panel data with 43 countries (2004–2012), we find that informal institutions have a higher impact on opportunity entrepreneurship than formal institutions. Variables such as control of corruption, confidence in one's skills and private coverage to obtain credit promote a positive effect of opportunity entrepreneurship on economic growth in all the countries of our sample, and especially in Latin American countries as a homogeneous group. These results suggest additional elements to the theoretical discussion in terms of the importance of institutions as framework to understand determinants and effects of opportunity entrepreneurship. Regarding policy implications, the results also suggest that it could be possible to obtain economic growth encouraging the appropriate institutions in order to increase the entrepreneurship by opportunity

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes