Les contextes dans lesquels naissent, croissent, se développent ou disparaissent les PME ont connu d’importantes mutations au cours des dernières années. Les défis que doivent relever les ...entrepreneurs et les PME se renouvellent rapidement tout en présentant des enjeux nouveaux qui ne peuvent pas toujours être éclairés brillamment par les connaissances actuelles. Pour soutenir nos économies fragilisées par autant de perturbations, il est nécessaire que les chercheurs se commettent dans des réflexions visant parfois à sortir des cadres traditionnels de reproduction de connaissances pour oser s’aventurer sur des sentiers encore en friche. Des théories et des modèles classiques développés dans des contextes qui n’existent plus doivent être remis en question pour mieux comprendre la réalité de nos objets de recherche. Cela demande aux chercheurs de s’engager dans des sujets originaux, mais aussi en ayant recours à de nouvelles méthodes ou en déployant des dispositifs de recherche novateurs. Le but de cet article est de proposer plusieurs avenues de recherche à l’avant-garde de la littérature sur les PME et l’entrepreneuriat permettant de renouveler le corpus de connaissances dans quelques domaines. Celles-ci sont susceptibles d’orienter les chercheurs vers des avenues offrant un réel potentiel de nouveauté, non seulement sur le plan scientifique, mais également sur le plan pratique.
The increased capacity of DNA sequencing has significantly advanced our understanding of the phylogeny of birds and the proximate and ultimate mechanisms molding their genomic diversity. In less than ...a decade, the number of available avian reference genomes has increased to over 500-approximately 5% of bird diversity-placing birds in a privileged position to advance the fields of phylogenomics and comparative, functional, and population genomics. Whole-genome sequence data, as well as indels and rare genomic changes, are further resolving the avian tree of life. The accumulation of bird genomes, increasingly with long-read sequence data, greatly improves the resolution of genomic features such as germline-restricted chromosomes and the W chromosome, and is facilitating the comparative integration of genotypes and phenotypes. Community-based initiatives such as the Bird 10,000 Genomes Project and Vertebrate Genome Project are playing a fundamental role in amplifying and coalescing a vibrant international program in avian comparative genomics.
Emicizumab is a bispecific monoclonal antibody that bridges activated factor IX and factor X to replace the function of missing activated factor VIII, thereby restoring hemostasis. In a phase 3, ...multicenter trial, we investigated its use as prophylaxis in persons who have hemophilia A without factor VIII inhibitors.
We randomly assigned, in a 2:2:1 ratio, participants 12 years of age or older who had been receiving episodic treatment with factor VIII to receive a subcutaneous maintenance dose of emicizumab of 1.5 mg per kilogram of body weight per week (group A) or 3.0 mg per kilogram every 2 weeks (group B) or no prophylaxis (group C). The primary end point was the difference in rates of treated bleeding (group A vs. group C and group B vs. group C). Participants who had been receiving factor VIII prophylaxis received emicizumab at a maintenance dose of 1.5 mg per kilogram per week (group D); intraindividual comparisons were performed in those who had participated in a noninterventional study.
A total of 152 participants were enrolled. The annualized bleeding rate was 1.5 events (95% confidence interval CI, 0.9 to 2.5) in group A and 1.3 events (95% CI, 0.8 to 2.3) in group B, as compared with 38.2 events (95% CI, 22.9 to 63.8) in group C; thus, the rate was 96% lower in group A and 97% lower in group B (P<0.001 for both comparisons). A total of 56% of the participants in group A and 60% of those in group B had no treated bleeding events, as compared with those in group C, who all had treated bleeding events. In the intraindividual comparison involving 48 participants, emicizumab prophylaxis resulted in an annualized bleeding rate that was 68% lower than the rate with previous factor VIII prophylaxis (P<0.001). The most frequent adverse event was low-grade injection-site reaction. There were no thrombotic or thrombotic microangiopathy events, development of antidrug antibodies, or new development of factor VIII inhibitors.
Emicizumab prophylaxis administered subcutaneously once weekly or every 2 weeks led to a significantly lower bleeding rate than no prophylaxis among persons with hemophilia A without inhibitors; more than half the participants who received prophylaxis had no treated bleeding events. In an intraindividual comparison, emicizumab therapy led to a significantly lower bleeding rate than previous factor VIII prophylaxis. (Funded by F. Hoffmann-La Roche and Chugai Pharmaceutical; HAVEN 3 ClinicalTrials.gov number, NCT02847637 .).
We use a newly developed method, based on the original Brownian shape motion (BSM) model, to calculate fission-fragment isotopic yields Y(Z,N). Recent measurements of post-neutron isotopic ...distributions with better than 1 u resolution make it possible, for the first time, to test in detail this model. We here report on the comparison between the measured and the calculated fission-fragment average neutron number as a function of proton number, as well as isotopic distributions for selected proton numbers. The calculated primary yields are corrected for post-scission neutron evaporation by the fragments. The highly variable dependence of with Z seen in the measurements is also present in the calculations.
Background:
The incidence of second anterior cruciate ligament (ACL) injuries in the first 12 months after ACL reconstruction (ACLR) and return to sport (RTS) in a young, active population has been ...reported to be 15 times greater than that in a previously uninjured cohort. There are no reported estimates of whether this high relative rate of injury continues beyond the first year after RTS and ACLR.
Hypothesis:
The incidence rate of a subsequent ACL injury in the 2 years after ACLR and RTS would be less than the incidence rate reported within the first 12 months after RTS but greater than the ACL injury incidence rate in an uninjured cohort of young athletes.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Seventy-eight patients (mean age, 17.1 ± 3.1 years) who underwent ACLR and were ready to return to a pivoting/cutting sport and 47 controls (mean age, 17.2 ± 2.6 years) who also participated in pivoting/cutting sports were prospectively enrolled. Each participant was followed for injury and athlete exposure (AE) data for a 24-month period after RTS. Twenty-three ACLR and 4 control participants suffered an ACL injury during this time. Incidence rate ratios (IRRs) were calculated to compare the rates (per 1000 AEs) of ACL injury in athletes in the ACLR and control groups. For the ACLR group, similar comparisons were conducted for side of injury by sex.
Results:
The overall incidence rate of a second ACL injury within 24 months after ACLR and RTS (1.39/1000 AEs) was nearly 6 times greater (IRR, 5.71; 95% CI, 2.0-22.7; P = .0003) than that in healthy control participants (0.24/1000 AEs). The rate of injury within 24 months of RTS for female athletes in the ACLR group was almost 5 times greater (IRR, 4.51; 95% CI, 1.5-18.2; P = .0004) than that for female controls. Although only a trend was observed, female patients within the ACLR group were twice as likely (IRR, 2.43; 95% CI, 0.8-8.6) to suffer a contralateral injury (1.13/1000 AEs) than an ipsilateral injury (0.47/1000 AEs). Overall, 29.5% of athletes suffered a second ACL injury within 24 months of RTS, with 20.5% sustaining a contralateral injury and 9.0% incurring a retear injury of the ipsilateral graft. There was a trend toward a higher proportion of female participants (23.7%) who suffered a contralateral injury compared with male participants (10.5%) (P = .18). Conversely, for ipsilateral injuries, the incidence proportion between female (8.5%) and male (10.5%) participants was similar.
Conclusion:
These data support the hypothesis that in the 24 months after ACLR and RTS, patients are at a greater risk to suffer a subsequent ACL injury compared with young athletes without a history of ACL injuries. In addition, the contralateral limb of female patients appears at greatest risk.
Cross-sectional study.
To investigate the impact of quadriceps femoris (QF) muscle strength asymmetry at the time of return to sport on self-reported function and functional performance of ...individuals following anterior cruciate ligament reconstruction (ACLR).
Evidence-based QF strength guidelines for return-to-sport decision making are lacking. Objective guidelines necessitate understanding the impact of QF strength deficits at the time of return to sport on function and performance.
Fifty-five individuals (mean age, 17.3 years) who were cleared for return to sport following primary ACLR (ACLR group) and 35 uninjured individuals (mean age, 17.0 years) in a control group participated in the study. QF strength (maximum voluntary isometric contraction) was assessed, and the quadriceps index (QI) was calculated (involved strength/uninvolved strength) × 100%. The ACLR group was further subdivided into 2 groups, based on the QI: high quadriceps (QI of 90% or greater) and low quadriceps (QI of less than 85%). The International Knee Documentation Committee Subjective Knee Evaluation Form score was used to assess self-reported function, and hop tests were used to assess functional performance. Multivariate analysis of variance and hierarchical regression analyses were performed.
The individuals in the ACLR group were weaker, reported worse function, and performed worse on hop tests compared to those in the control group (P<.05). The low-quadriceps group demonstrated worse performance on the hop tests compared to the high-quadriceps group and the control group (P ≤.016). Hop test performance did not differ between the high-quadriceps and control groups (P ≥.14). QF strength predicted performance on the hop tests beyond graft type, presence of meniscus injury, knee pain, and knee symptoms.
At the time of return to sport, individuals post-ACLR who had weaker QF (QI of less than 85%) demonstrated decreased function, whereas those with minimal QF strength deficits (QI of 90% or greater) demonstrated functional performance similar to uninjured individuals. QF strength deficits predicted hop test performance beyond the influences of graft type, presence of meniscus injury, knee pain, and knee symptoms.
Incidence rate (IR) of an ipsilateral or contralateral injury after anterior cruciate ligament reconstruction (ACLR) is unknown. The hypotheses were that the IR of anterior cruciate ligament (ACL) ...injury after ACLR would be greater than the IR in an uninjured cohort of athletes and would be greater in female athletes after ACLR than male athletes.
Prospective case-control study.
Regional sports community.
Sixty-three subjects who had ACLR and were ready to return to sport (RTS) and 39 control subjects.
Second ACL injury and sex.
Second ACL injury and athletic exposure (AE) was tracked for 12 months after RTS. Sixteen subjects after ACLR and 1 control subject suffered a second ACL injury. Between- and within-group comparisons of second ACL injury rates (per 1000 AEs) were conducted.
The IR of ACL injury after ACLR (1.82/1000 AE) was 15 times greater risk ratio (RR) = 15.24; P = 0.0002) than that of control subjects (0.12/1000 AE). Female ACLR athletes demonstrated 16 times greater rate of injury (RR = 16.02; P = 0.0002) than female control subjects. Female athletes were 4 (RR = 3.65; P = 0.05) times more likely to suffer a second ACL injury and 6 times (RR = 6.21; P = 0.04) more likely to suffer a contralateral injury than male athletes.
An increased rate of second ACL injury after ACLR exists in athletes when compared with a healthy population. Female athletes suffer contralateral ACL injuries at a higher rate than male athletes and seem to suffer contralateral ACL injuries more frequently than graft re-tears. The identification of a high-risk group within a population of ACLR athletes is a critical step to improve outcome after ACLR and RTS.
Background:
Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, ...and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS).
Hypothesis:
Fear will be associated with performance on functional testing and second ACL injury rate.
Study Design:
Prospective cohort study.
Level of Evidence:
Level 2.
Methods:
A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates.
Results:
Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio OR, 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) (P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS.
Conclusion:
Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS.
Clinical Relevance:
Self-reported fear of movement/reinjury after ACLR at the time of RTS may be an important measure to incorporate into discharge criteria prior to release to return to pivoting and cutting sports after ACLR.
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