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Understanding fractures creating process during the dynamic indentation of a spherical carbide insert is a key factor to optimize the operation of a percussive drilling system and improve penetration rates and tool life while drilling in hard, abrasive rock formations. This study presents experimental results of dynamic indentation tests with combined action of an impulsive load and a static load of a bit using a single spherical carbide insert on five types of rocks. A dedicated and innovative experimental setup using a gas-gun drop test was developed to reproduce the loading forces and mechanical characteristics of a Down-the-Hole (DTH) hammer drill. A high-speed camera was used to visually determine when the major fractures, such as radial and side cracks, coalesced to create large fragments and to determine the bit displacement curve during the whole indentation process by tracking the end of the bit. To characterize the damage in the rocks, the mass of the fragments was weighed, and the Specific Energy (SE) was calculated. Experimental results showed a strong correlation between the major changes in the slope of the stress signals recorded in the drill bit and the major fragmentation events recorded with the high-speed camera. In the granites, large fragments typically associated to side cracks were generated during the loading phase. In contrast, in the limestone and the sandstone, the fragments were generated during the unloading phase. Finally, it was found that in granites, the earlier the side cracks occur relative to the maximum indentation time, the lower the efficiency of the indentation. [Display omitted] • The fracture behavior of five rocks was studied with the aid of a high-speed camera. • Three distinct rock responses based on major fracture events were established. • Side cracks in igneous rocks occurred before or at the end of the loading phase. • The specific rock energy was correlated to the early or lately detection of side cracks. [ABSTRACT FROM AUTHOR]

We develop a site-bond percolation model, called PERCOVID, in order to describe the time evolution of all epidemics propagating through respiratory tract or by skin contacts in human populations. This model is based on a network of social relationships representing interconnected households experiencing governmental non-pharmaceutical interventions. As a very first testing ground, we apply our model to the understanding of the dynamics of the COVID-19 pandemic in France from December 2019 up to December 2021. Our model shows the impact of lockdowns and curfews, as well as the influence of the progressive vaccination campaign in order to keep COVID-19 pandemic under the percolation threshold. We illustrate the role played by social interactions by comparing two typical scenarios with low or high strengths of social relationships as compared to France during the first wave in March 2020. We investigate finally the role played by the α and δ variants in the evolution of the epidemic in France till autumn 2021, paying particular attention to the essential role played by the vaccination. Our model predicts that the rise of the epidemic observed in July and August 2021 would not result in a new major epidemic wave in France. [ABSTRACT FROM AUTHOR]

In France, most of the trains are electrical and some are fed by 1500 V DC voltage. When a train is traveling, the power consumption creates a voltage drop. Therefore, below a certain limit, the train has to slow down its speed. This limitation prevents the increase of traffic in some area that needs an electric reinforcement. This paper proposes to use embedded storage systems to support the voltage of the catenary. The main issue is how to size such an energy storage system? In this way, several aspects (e.g.: the energy management strategy) have to be taken into account. The paper deals with an optimization-based sizing method for the embedded energy storage systems. The proposed method takes into account the energy management strategy in the sizing by optimization. A comparison is made between the use of batteries or supercapacitors. [ABSTRACT FROM AUTHOR]

The paper proposes an optimization approach to address the modeling and sizing complexities of Brushless Doubly-Fed Reluctances Machines. A semi-analytical model and a reluctance network model are coupled to a deterministic optimization algorithm where several inputs and outputs parameters can be constrained to solve sizing equations iteratively by maximizing or minimizing an objective function. A Pareto Front strategy is used to illustrate the models capabilities, highlighting the trade-offs on the design of this kind of electrical machines. The optimization model provides fast results to define a first design, reducing the number of unknown parameters of early development stages. This saves computation time and computer resources in the design process compared to Finite Element Analysis. [ABSTRACT FROM AUTHOR]

Hybrid electrical vehicles involve two sources of energy, usually gasoline and electricity. The energy management determines the power sharing between the internal combustion engine and the electrical machine (EM). It is highly dependent on the driving cycle (i.e. the use of the vehicle). In this context, the optimal sizing of the EM is determined by: the driving cycle, the power-train characteristics (i.e. ratios and physical limitations e.g. maximum torque available) and the energy management. The key idea of this work is to involve the driving cycle and the environment of the electrical machine in a global multi-objective optimization process taking into account an optimal energy management and an accurate model of the EM based on magnetic circuit equivalent model. [ABSTRACT FROM AUTHOR]

Résumé En France, l’inscription dans la loi de l’éducation thérapeutique du patient (ETP) en traduit la reconnaissance. Cette reconnaissance résulte d’un long processus d’évolution historique, partant des premiers programmes d’observance en cancérologie, à la mise en place d’enseignement à destination des enfants atteints de maladies chroniques, pour aboutir à un repositionnement du patient sous l’influence des patients malades du VIH et de leurs proches. Programme éducatif, l’ETP vise à renforcer les compétences du patient et à lui permettre d’en acquérir de nouvelles afin qu’il soit le plus autonome possible dans la gestion de sa maladie. Cela amène aussi à prendre en compte les discordances de temps, entre temps des soins, de la maladie, le temps social et familial et le temps vécu par le patient, à tenir compte des ruptures de cohérences que le patient peut rencontrer dans son parcours de soins et de vie, les contre-attitudes pédagogiques ou médicales. L’approche par l’éducation et le transfert de compétences permettent de mieux situer la question évaluative et de faire la part des indicateurs biomédicaux, de satisfaction, de qualité de vie et d’impact de la maladie. L’ETP se justifie alors avant tout par le fait d’aider le patient à améliorer ses rapports dans l’ensemble social où il a à prendre sa place. Le développement de l’ETP aboutissant aux concepts de codécision et d’alliance thérapeutique est un signe d’une évolution profonde en santé d’empouvoirement des patients. In France, the law now recognizes the Therapeutic Patient Education (TPE) and this shows the long road TPE accomplishes since the very first educational programs in oncology, the disease learning for children with chronic pathologies and the dramatic changes obtained by the patients with AIDS, placing the patients in the heart of the processes. As any educational program, TPE aims to enforce patients’ skills in managing its disease and getting more autonomy. This also implies to consider problems such as the time discordance between periods of care, time of disease evolution, social and family time and patient's own perception of time. It also focuses on failures in consistency in patient's lifetime and care process, educational and medical counter-attitudes. Focusing on skills transfer helps also to understand the question of TPE assessment, the main objective remaining to help the patient to live the best possible life in his social context. The development of TPE with concepts such as self – management and therapeutic alliance shows the increasing importance of patients’ empowerment in health care. [ABSTRACT FROM AUTHOR]

This paper deals with the formulation and programing of architecture of software component generated by Reluctool. This software tool allows the modeling of large reluctance networks of electrical machines. Portable model formulation and code architectures are introduced facing the model generation time, the model size, and the computation time. Different approaches are discussed to improve this aspect. Finally, the code architecture is compared with the actual code architecture of the commercial and previous version of Reluctool. [ABSTRACT FROM AUTHOR]

To improve interoperability between system-level modeling and simulation, this paper proposes an approach to export models from dedicated magnetic tools into a standardized format, such as Very-high-speed integrated circuits Hardware Description Language-Analog and Mixed Signal (VHDL-AMS), as a powerful modeling language. The goal is to let designers use a unique modeling approach and single simulation tool to simulate the behavior of a complete electromagnetic system and to make the translation of existing models to VHDL-AMS easy. Thus they can reduce the investment. This paper addresses this methodology as a computer-aided generation of the VHDL-AMS code from macro and micro electromagnetic devices for system simulation. The translation uses model-driven engineering methods for the transformation of one model to another and the code generation from models. Implementation and methodology are illustrated on a dynamic E-shaped actuator as a macro-system case study and a diamagnetic levitation device as micro-system one. [ABSTRACT FROM AUTHOR]

With the increasingly high level of electrical system integration, the modeling of both the system behavior and the detailed physics of its elements becomes necessary. VHDL-AMS language allows to describe a range of physical systems, such as electro-magnetic devices, using a unified design approach to simulate a complete system. In addition, the most important constraint in the hierarchical modeling of the design cycle is the difficulty to use the same language or tool for the whole modeling steps and define a single set of tests for each description level. VHDL-AMS can be used as unified language for multilevel modeling, but it cannot support the description of some physical phenomena such local ones. The aim of the paper is to achieve the behavioral and the detailed modeling of multiple energy domains using VHDL-AMS, and their integration in the system environment. It proposes solutions to extend the computation capability of this language, based on computer-aided coupling strategies. [ABSTRACT FROM PUBLISHER]

Automatic differentiation (AD) is introduced as a powerful technique to compute derivatives of functions given in the form of computer programs in high-level programming languages such as FORTRAN, C, or C++. This paper applies AD to compute error-free gradients of electromagnetic device sizing models. Then, the obtained gradients are exploited in optimization to size electromagnetic devices by means of minimizing a cost function with constrained parameters and performances. Often, the electromagnetic devices models have to be described not only by analytical formulas, but also by algorithms. This paper proposes an electromagnetic model of a linear actuator dealing with implicit equations solved by numerical algorithms. The ADOL-C package is considered for automatic differentiation. [ABSTRACT FROM PUBLISHER]

Simulation is ubiquitous in many scientific areas. Applied for dynamic systems usually by employing differential equations, it gives the time evolution of system states. In order to solve such problems, numerical integration algorithms are often required. Automatic differentiation (AD) is introduced as a powerful technique to compute derivatives of functions given in the form of computer programs in a high-level programming language such as FORTRAN, C, or C++. Such technique fits perfectly in combination with gradient-based optimization algorithms, provided that the derivatives are evaluated with no truncation or cancellation error. This paper intends to use AD employed for numerical integration schemes of dynamic systems simulating electromechanical actuators. Then, the resulting derivatives are used for sizing such devices by means of gradient-based constrained optimization. [ABSTRACT FROM AUTHOR]

The paper deals with the design by optimization in pre-sizing step of a drive system that combines a switched capacitor system and a permanent magnet synchronous machine (PMSM). The sizing of the converter and the machine are considered strongly dependent due to the series quasi-resonant topology. The system modelling is based on a semi-analytical approach validated by finite element (FE) simulations. It involves an analytical modelling of the electrical machine and a numerical time solving of the electrical circuit sub-model because of the natural switching events of diodes. The optimization is carried out by SQP (Sequential Quadratic Programming). The model gradients are computed combining mathematical laws, symbolic derivation and automatic differentiation. Finally, trade-offs and gains on the machine power density, the magnet volume and the efficiency are investigated through a Pareto approach. [ABSTRACT FROM AUTHOR]

This paper focuses on experimental and numerical investigations on percussive drilling. An experimental setup, using a single bit button, was developed to carry out dynamic indentation tests on hard rocks under different confining pressures. The influences of multiple factors on the percussive drilling process such as the weight on bit, the confining pressure, and the impact energy have been studied. An experimental campaign consisting of multiple test series was carried out on the Red Bohus granite using a conical insert, under weight on bit of 0–8.64 kN, confining pressures of 0–30 MPa and impact energies of 30–114 J. The drilled rock volumes were measured by a 3D laser scanner. For the numerical part, a virtual laboratory has been developed to explain the experimental observations and to clearly identify the effects on the different fragmentation mechanisms. An empirical law for the drilled volume as function of the three studied factors has been also established. A finite-element-based modeling approach and a contact mechanism were used in the simulations of the dynamic bit–rock interaction process. A damage-viscoplastic model which takes into account the confining pressure and the strain-rate effects as well as the main fracture types in a dynamic indentation: damage in tension and crushing in compression, was used. The investigations showed the following valuable findings: the increase of the weight on bit favors the insert penetration, but it does not influence the chipping process, the increase of the confining pressure reduces the insert penetration and prevents the chips creation, and the increasing of the impact energy leads to deeper craters and more chips. [ABSTRACT FROM AUTHOR]

Background: Few studies have addressed health-related quality of life in community-dwelling individuals aged 80 years and above and very few self-assessment quality of life questionnaires have been formally validated in these populations. This study aimed to validate a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life of people aged 80 years and over. Method: A cross-sectional study of people aged 80 years and over living at home in France was conducted. All subjects recruited were sent a letter explaining the study and requesting their consent to take part. Those who accepted then received the questionnaires, including the LEIPAD, which assesses health-related quality of life in the subjects aged 65 years and above. We assessed its psychometric properties: data completeness, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-scale correlations, reliability and convergent validity with the Medical Outcome Study Short-Form 36 (SF-36). Results: The results obtained from 184 older people (mean age of 83.9 years, standard deviation 3.3) showed very good acceptability (missing data between 1.1% and 11.4% for LEIPAD scales) Factor analysis of the instrument confirmed the multi-dimensional structure in seven independent scales similar to the original version. Good internal consistency (Cronbach’s alpha ranging from 0.68 to 0.87) and strong test-retest reliability of the LEIPAD scales (intraclass correlation coefficients ranging from 0.77 to 0.95) were found. Convergent validity with the SF-36 showed moderate to strong correlations, consistent with the hypotheses stated. Conclusions: The validation of this specific questionnaire will make it possible to investigate individually the health-related quality of life of French older people living at home and will enable French-speaking investigators to contribute to national and international research projects. [ABSTRACT FROM AUTHOR]

Abstract Full-scale drilling experiments (8½ in. bit size) with a high-pressure fluid jet assisted rotary drilling system were performed in hard to drill crystalline rock. Besides the development of novel drill bits and high-pressure components, an existing drilling simulator test bench was adapted to the requirements of the current tests. A total number of seventeen test runs was conducted to enable a comparison of drilling performance between state of the art drilling technique and the innovative jet assisted system. A significant increase in rate of penetration was achieved with the system. Another relevant aspect was the influence of different drilling and jetting fluids on drilling performance. The interaction of the hydraulic and mechanical rock removing processes was researched in detail and led to further conclusions about the rock destruction process. Basic and sophisticated correlations between drilling parameters were examined in order to define the favourable operational parameters for each bit type. Lessons learned during these experiments will directly be integrated in the preparation of later field tests of the enhanced system. [ABSTRACT FROM AUTHOR]

Résumé Objectif La polyarthrite rhumatoïde (PR) est le plus fréquent des rhumatismes inflammatoires systémiques avec des manifestations extra-articulaires à l'origine de comorbidités. Ces comorbidités sont plus fréquentes, plus graves et moins prises en charge que dans la population générale. L'objectif principal de ce travail était d'analyser la pertinence économique d'une consultation infirmière dédiée à la prise en charge des actes de prévention des patients atteints de PR. Méthode L'essai clinique contrôlé randomisé multicentrique COMEDRA qui s'est déroulé de mars 2011 à juin 2012, mesurait l'efficacité d'une consultation infirmière dédiée à la prise en charge des comorbidités des patients atteints de PR à travers 11 procédures de prévention. L'analyse économique était une analyse de type coût–avantage en recherche d'équivalence entre le coût de la consultation infirmière dédiée et le coût des actes de prévention. La consultation infirmière était jugée efficace si son coût était égal ou moindre aux coûts des actes de prévention supplémentaires réalisés qu'elle avait engendrés. Les coûts ont été calculés sur la base des tarifs conventionnés de l'Assurance Maladie. Compte tenu de l'hétérogénéité des coûts des actes de prévention et de la variation de leur fréquence de réalisation, la part contributive de chaque acte de prévention à l'efficacité du programme a été calculée. Résultats L'intervention de l'infirmière a contribué à la réalisation de 747 actes de prévention supplémentaires soit un coût de 30 805,8 euros. En se basant sur l'hypothèse de rentabilité, l'intervention d'une infirmière dédiée à la prévention des comorbidités chez les patients atteints de polyarthrite rhumatoïde est acceptable. Conclusions Une consultation de prise en charge des comorbidités de la polyarthrite rhumatoïde telle que préconisée dans les recommandations, réalisée par une infirmière, est pertinente du point de vue médical et économique en perspective hospitalière. [ABSTRACT FROM AUTHOR]

Objectives: Rheumatoid arthritis (RA) cause major functional, psychological, social and occupational repercussions for patients and has important economic consequences for society. The principal objective of this work was to determine the economic pertinence of a staff nurse specialised in preventive management for these patients.Methods: The COMEDRA multicentre randomised controlled clinical trial, conducted from March 2011 to June 2012, showed the effectiveness of a nurse-led programme dedicated to the management of comorbidities trough the promotion of 11 preventive procedures. A cost-benefit analysis, from a societal perspective and based on direct medical cost, was conducted to assess the equivalence of the cost of the nurse-led programme and the cost of the additional preventive procedures performed, engendered by the programme. The programme was considered effective if its cost was less than or equal to the costs of the additional preventive procedures. The costs were calculated from the approved health insurance charges. From the total costs induced, a contributive share was measured, corresponding to the ratio of the total costs of each type of procedure to the overall total cost.Results: The cost of the intervention was assessed at €16,804.2. This intervention contributed to the performance of 747 additional preventive procedures, at a cost of €30,184.8. This intervention with these patients is financially balanced when at least 37 patients follow the recommendations for every preventive procedure.Conclusions: From the hospital's perspective and from both a medical and economic point of view, a nurse-led programme to manage the comorbidities of RA is useful. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine cutting speed and bottomhole pressure effects on cutting forces acting on PDC cutters during the oil and gas drilling process. A set of single cutter tests was performed in three sedimentary rocks of different permeabilities. Dry tests were carried out at atmospheric pressure and at different cutting speeds. As previously observed in the literature, these tests show that cutting forces increase with the cutting speed, especially the normal component. The same tests were performed at 20 MPa bottomhole pressure. It appears that the cutting speed effect on cutting forces in the medium and low permeability rocks is moderate and weak, respectively. By contrast, rate effects in the highly permeable rock are significant and overcome rate effects observed in dry experiments by an order of magnitude. Interestingly, these observations are similar to those observed in submarine soil ploughing at high hydrostatic pressure. These results are believed to represent an important step into a deeper understanding of the oil and gas drilling process. [ABSTRACT FROM AUTHOR]

A mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. To refine the design of a smartphone application for people with chronic NSLBP using mixed quantitative and qualitative approaches. We used a user-centred design approach involving people with chronic NSLBP and healthcare professionals (HCPs). We used a three-step methodology: developing consensus on the features, content, and design of the app; developing a user interface; and usability testing of the app and assessing users' experience. Transcripts of interviews of users were analyzed by qualitative content analysis. A total of 18 people (aged 45 [23–53] years old) with chronic NSLBP, and 7 HCPs (aged 29.5 [25–55] years old) involved in NSLBP management were interviewed. The overall experience of using the smartphone eLombactif app was initially assessed. Then, with close-ended questions we evaluated users' judgements on the content, its presentation and navigation. Finally, we asked for suggestions: "application content and functionality" and "content presentation" from participants regarding the use and development of the app analyzed by a qualitative methodology. This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. This methodology allows for deepening the knowledge of the needs and expectations of potential users by measuring their user experience. Non-specific low back pain (NSLBP) is a major global public health issue leading to considerable economic cost and is primarily responsible for pain and disability. Mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. [ABSTRACT FROM AUTHOR]

Objectives: The increasing prevalence of chronic diseases in Western countries requires comprehensive care by healthcare professionals and daily management by patients. Some self-management programs are co-constructed with patient associations or patient partners. This study aims to determine whether the absence of a partnership with patient associations and PPs in the development of a self-management program had any effect on its failure or success. Materials and method: A retrospective study of self-management programs submitted for approval to the Regional Health Agency of the Auvergne region, France, between 2011 and 2016 was performed. For each program approved, we investigated whether the programs co-developed had been renewed. Results: Of the 95 programs authorized, 69.5% were renewed. Among the programs co-developed 86.2% were renewed versus 62.1% without patient association or patient partner collaboration (p = 0.0189). Conclusion: The collaboration of patient partners or patient associations in the development of self-management programs is likely to lead to success of the project. Patient partnerships modify the way in which healthcare professionals perceive and experience chronic disease. Our conclusions could prompt policy makers to strongly promote patient partnerships as from the beginning of professional training and make them a prerequisite for the setting-up of self-management programs. [ABSTRACT FROM AUTHOR]

An abstract of the article "Auto-Immune Thrombocytopenia After Measles Mumps Rubella MMR Vaccination: Molecular Mimicry of Measles Virus Phosphoprotein With Platelet GPLLB," by Guy Mong Ky Tran, Laurent Gerbaud and Adrien Caprani is presented.

An abstract of the article "Scorpion Model of Influenza A/H1N1: Hemagglutinin (HA) Contains a Scorpion Toxin, Binding to Voltage-Gated Sodium Na+ Channel: Na+ channel Inhibitors As Therapy," by Guy Mong Ky Tran, Laurent Gerbaud and Adrien Caprani is presented.

This paper deals with the electromagnetic modeling and design aspects of brushless doubly fed reluctance machines (BDFRM). It presents the development and the experimental validation of a semi-analytical model (SAM) used for sizing new machine designs. The SAM is an optimization-oriented model implemented using analytical approaches and a deterministic optimization algorithm to find an optimal machine by solving iteratively an objective function, whereas satisfying several output constraints simultaneously. It is fast and accurate for pre-design stages, premises that are confirmed by both simulation and experimental results. [ABSTRACT FROM AUTHOR]

Background: Deprivation, a process that prevents people to assume their social responsibilities, is a main cause of inequalities in health. Metabolic syndrome has a growing prevalence in France.Objectives: To assess the association between deprivation and the metabolic syndrome and to identify the most relevant waist circumference cut-off point.Methods: A cross-sectional multicentre study was carried out of data extracted from health examination centres of two French areas in 2008. The harmonized definition of the metabolic syndrome contained five criteria with two thresholds for waist circumference. Deprivation was calculated by the Evaluation of Deprivation and Inequalities in Health Examination Centres score (EPICES). Eligible patients were at least 16 years old. The methodology of time to event analysis was used on patients having two criteria to identify the most relevant waist circumference threshold, taking waist circumference as event and computing it as a continuous variable. The median corresponded to the waist circumference threshold for which half of the patients switched from two to three criteria and so metabolic syndrome.Results: Of the 32374 persons included in the study, 39.4% were socially deprived. The prevalence of the metabolic syndrome varied from 16.3% to 22.2% in the overall sample depending on the published waist circumference thresholds chosen. Deprivation was an independent factor associated with the metabolic syndrome. The cut-off point for waist circumference was between 95 and 99 cm for men and 88 and 97 cm for women.Conclusion: Deprivation is associated with a higher prevalence of the metabolic syndrome. The most relevant threshold for waist circumference could be 94 cm for men and 88 cm for women. [ABSTRACT FROM AUTHOR]

Background: Deprivation is associated with inequalities in health care and higher morbidity and mortality. To assess the reliability of a new individual deprivation score, the EPICES score and to analyse the association between the Townsend index, the Carstairs index and the EPICES score and causes of death in one French administrative region. Methods: Eligible patients were 16 years old or more who had come for consultation in Health Examination Centres of the French administrative region of Nord-Pas-de-Calais. An ecological study was performed between 2002 and 2007 in the 392 districts of this administrative region. The EPICES score was compared with the Townsend and the Carstairs indices. These three measurements of deprivation were compared with social characteristics, indicators of morbidity, health-care use and mortality and specific causes of death. The Pearson correlation coefficients were calculated to assess the reliability of the EPICES score. The association between deprivation and mortality was assessed by comparison of the standardized mortality ratio (SMR) between the most and least deprived districts. Results: The EPICES score was strongly correlated with the Townsend and Carstairs indices and with the health indicators measured. SMR increased with deprivation and the higher the deprivation the higher the SMR for all-cause mortality, premature and avoidable deaths and for most specific causes of death. Conclusion: The individual deprivation EPICES score is reliable. Deprivation was related to excess death rate, which clearly indicates that deprivation is a determinant factor that should be considered systematically by health policy makers and health-care providers. [ABSTRACT FROM AUTHOR]

Background: The overall caesarean rate in France has increased from 14.3% in 1994-1996 to 21.0% in 2010. This increased rate is a concern in all developed countries: delivery by caesarean induces both short- and long-term maternal complications, and its use requires careful reflection. The principal objective of this work was to describe the global appropriateness of indications for caesareans among a selected sample of planned caesareans performed within the Auvergne perinatal health network. The secondary objectives were to describe the inappropriate planned caesarean risk according to the maternity unit level and the impact of this medical assessment on the global caesarean rate in this network. Methods: This audit among maternity units belonging to the Auvergne perinatal network in France included women who had a planned caesarean at term, were nulliparous or primiparous, and had a singleton pregnancy in cephalic presentation or a twin pregnancy with twin 1 in cephalic presentation. We used the French guidelines issued from 1998 through 2010 as our benchmark for appropriateness. Result: We analysed 192 cases (100% of the records eligible for the audit). The rate of appropriate caesareans among these planned caesareans was 65.6%. Among the inappropriate caesareans, the rate of "maternal-preference" caesareans was 12.0% and the rate of "provider-preference" caesareans 22.4%. The risk of an inappropriate caesarean did not differ statistically between the level I and level II maternity wards, each compared to the level III hospital. The overall caesarean rate in our entire network decreased from 20.5% to 18.5% (p < 0.001) in the year after the audit. It also decreased in 8 of the network's 10 maternity units, although the difference was statistically significant only in 2. Conclusions: About one third of planned caesareans were inappropriate in our sample and our audit appeared to have some effect on medical practice in the short run. [ABSTRACT FROM AUTHOR]

Introduction: While patient partner are increasingly involved in SM, their experiences following their practices have been little explored. Objective: To understand how patient partners evaluate their activities and roles in SM in Auvergne (France). Methods: A one-month quantitative study was proposed to twenty patient partners in Auvergne. Qualitative data were exploited by thematic categorization, respecting a triangulation of methods and analysis. Results: Eleven patient partners participated in the entire study. A total of 107 categories of lived experience were described, the majority of which had a positive connotation (76.6%). The patient partners mentioned 90 verbatim describing skills and competences necessary for their activities, mainly relational and pedagogical (37%) then intrapersonal (31%). These data were accompanied by the need to discuss their roles and postures and to acquire new skills. Discussion: Patient partners carry out multiple activities and training courses related to SM and have a particular status. This allows them to acquire and mobilize many skills, but also creates a difficulty of recognition and identification with institutions. There is a need for structured, stable, group-based peer exchanges. Conclusion: The patient partners have a salutogenic intellectual curiosity that drives them to train and to develop their activities. However, these impulses and investments must be supported at regional and even national level to ensure their sustainability. [ABSTRACT FROM AUTHOR]

Fuel consumption of a hybrid electrical vehicle (HEV) depends on the driving cycle (i.e. the use of the vehicle), on the powertrain components and on the energy management. The paper proposes an optimal component sizing process taking into account the entire system. An optimal energy management is used in order to minimize the fuel consumption on a driving cycle. This optimization approach of the HEV uses Radial Basis Function models which allow a fast constrained optimization. [ABSTRACT FROM AUTHOR]

A new approach for easy and fast modeling of EMI filter in aircraft application is proposed, in order to be used in an optimization process. A modular description in a user friendly environment allows describing the model and taking into account all the technological parameters of the system, i.e., the control strategy, the inverter model (semiconductors, layout, etc.), the filter, the cables, and the ac machine. The frequency model is automatically built from this description, as well as its gradients according to its inputs. In a second step, by using this model, an optimization of the filter values can be carried out, using various algorithms, to reach the smallest volume. This early design methodology can also be used to investigate the impact of some technological choices of the electrical drive (control strategy or cable characteristics for instance) on the filter volume. [ABSTRACT FROM AUTHOR]

Objective: To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. Design: Population-based cost-effectiveness study. Setting: Auvergne EP registry (France). Patient(s): Women (n = 1,664) registered between 1994 and 2003. Intervention(s): Standard diagnosis and treatment of EP. Main Outcome Measure(s): Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. Result(s): Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. Conclusion(s): Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness. [ABSTRACT FROM AUTHOR]

This paper looks at the collaborative design activity involved in a design experiment of an electromechanical plunger. Much of the coordination was achieved through internet-based communication. As mechanical and electrical researchers involved in the design project, we discuss the information exchanges highlighted by our different professional cultures and relate how these exchanges lead us to propose some methodology to improve the efficiency of virtual meetings. Moreover, we show the need for new communication tools, ones dedicated to specific tasks that are not currently supported, especially shared concept formalization among technical experts. [ABSTRACT FROM AUTHOR]

Introduction: Cancer is defined as a chronic disease, in view of the length of treatment and its repercussions on the life of the child. Therapeutic education could be an essential tool to improve the quality of life of sick children. Objectives: Identify the conceptions of caregivers in pediatric oncohaematology institutions and services on educational actions and the implementation of patient therapeutic education programs. Method: Cross-sectional, multicentre qualitative study based on four semi-structured individual interviews and a focus group. Results: Conceptions of the carers in paediatric oncohaematology establishments and services are based on major themes: conceptions of education linked to care, conceptions of the patient therapeutic education session, conceptions of the specificities linked to paediatrics, conceptions of the resources for setting up a patient therapeutic education programme and conceptions of patient therapeutic education linked to the institution. Discussion: Larger study in order to obtain interviews with all the centres de lutte contre le cancer (CLCC) to better understand the obstacles to the implementation of patient therapeutic education programmes and the actions already in place in order to propose a national strategy to formalise and enhance the actions of the CLCCs. [ABSTRACT FROM AUTHOR]

Patients with Inflammatory Chronic Rheumatic disease have approximately three times more sexual dysfunction than the healthy population. However, health professionals do not dare to discuss the subject with them, largely because they do not feel educated on the subject. To define the educational needs in the sexual health of health professionals involved in patient education and those of patients with Inflammatory Chronic Rheumatic disease. This French multicenter cross-sectional online study included health professionals involved in patient education and patients with Inflammatory Chronic Rheumatic disease. Two surveys were designed to assess, both of them the specific needs. They were filled out anonymously online with a secured server. The influence of professionals and patients' characteristics on their sexual health needs were tested. 57 health professionals and 239 patients answered. 71,6% of the patients reported sexual difficulties and 79,9% had never discussed them with health professionals. To facilitate discussion, the health professionals most often wanted a colleague specialized in sexual health in their team (59,7%) and access to tools (52,6%). The patients' primary expectations were psychological support (65.7%), information (51.9%), and referral to specialists if needed (43.1%). The topics the health professionals and patients considered most useful were adverse effects of treatment and impact of rheumatism on sexuality and body image. 70,2% of the health professionals felt they needed training. This survey demonstrates the need to offer educational training to health professionals designed to enable them to address and discuss sexual health issues and give their patients appropriate advice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the activity of relapsing events (RE) and their mode of presentation in patients with anti-neutrophil cytoplasmic (ANCA)-associated vasculitis (AAV). Methods: Patients diagnosed with AAV between 1990 and 2015 experiencing at least one RE were investigated. The different organ involvements were registered during each RE. Presentation at initial onset (IO) and RE were compared. The Birmingham Vasculitis Activity Score was used to assess the activity. Results: Ninety-nine patients were followed: 54 patients with 96 RE and 45 patients with none. The rate of RE was 53% with a median time of follow-up of 6.8 years. The mean time to first RE was 2.8 years. Thirty patients experienced one single RE, 15 had 2, 5 had 3, 2 had 4, and 2 had, respectively, 7 and 8. Fifty-five percent of RE had the same features as IO. Compared to IO, some clinical manifestations were less present: constitutional symptoms (29% vs 69%), ear-nose-throat (50% vs 76%), lung involvement (59% vs 76%), peripheral neuropathies (14% vs 24%), arthritis (7% vs 27%), kidney (25% vs 41%), and heart (4% vs 20%) (p < 0.001). Skin, eye, and bowel manifestations were not significantly less involved during RE. The mean Birmingham Vasculitis Activity Score at IO was 9.02 and 5.11 at relapse (p < 0.0001). Among the 96 RE, 46% had a new organ involvement compared to IO: none were life-threatening. Conclusion: Global activity of RE in AAV patients is lower than that of IO. Fewer organs are involved in relapses. RE turned out to begin with the same manifestations as IO in most cases. Key Points •First study looking into clinical characteristics of relapses including mostly granulomatosis with polyangiitis. •Around half of patients with AAV seemed to relapse in a similar way compared to the initial diagnosis. •The activity score during relapsing events is less important. [ABSTRACT FROM AUTHOR]

• We confirm the efficacy of spa therapy in knee osteoarthritis (KOA) for pain and disability. • We show for the first time that spa therapy may help increase physical activity in patients with KOA, with limited effect of an additional self-management exercise program. • The benefits of a self-management education program were a significant alleviation of fears and beliefs about KOA and physicians (KOFBeQ) and anxiety (HAD) at 3 months after treatment. The efficacy of spa therapy in osteoarthritis (OA) has ever been demonstrated, with a good level of evidence for pain and disability. The effect of a self-management program with spa therapy on physical activity (PA) level has never been demonstrated. This study aimed to assess, at 3 months, the effectiveness of 5 sessions of a self-management exercise program in patients with knee OA (KOA) who benefit from 18 days of spa therapy and received an information booklet (on proposed physical exercises) on improvement in at least one PA level. This was an interventional, multicentre, quasi-randomized controlled trial with a cluster randomized design (1-month period). People 50 to 75 years old with symptomatic knee OA were included in 3 spa therapy centres in France (Bourbon Lancy, Le Mont Dore, Royat). Both groups received conventional spa therapy sessions during 18 days and an information booklet on the benefits of PA practice for KOA. The intervention group additionally received 5 self-management exercise sessions. The main outcome was improvement in at least one PA level according to the International Physical Activity Questionnaire (IPAQ) short-form categorical score (low to moderate or high, or moderate to high) at 3 months. Secondary outcomes were the evolution of PA (MET-min/week), disability, pain, anxiety, depression, self-efficacy, fears and beliefs concerning KOA, barriers to and facilitators of regular PA practice, consumption of painkillers and adherence to physical exercise program at 3 months. Assessors but not participants or caregivers were blinded. In total, 123 patients were randomized, 54 to the intervention group and 69 to the control group. Considering the main outcome, at 3 months, 37% of patients in the intervention group showed improvement in at least one PA level according to the IPAQ categorical score versus 30.4% in the control group (P = 0.44). In the intervention group, 13 (24.1%) patients showed improvement from low to moderate PA level (vs. 8 [11.6%] in the control group), 2 (3.7%) from low to high (vs. 2 [2.9%]) and 5 (9.3%) from moderate to highvs. 11 [15.9%]). Both intervention and control groups showed increased IPAQ continuous scores (MET-min/week) at 3 months, although not significantly. HAD anxiety and depression scores were significantly reduced in the intervention group (P = 0.001 and P = 0.049, respectively) and the perception of PA was better in the intervention than control group for motivation and barriers scores (P = 0.019 and P = 0.002, respectively). This study showed the lack of impact of a short self-management program on PA level in addition to 18-day spa therapy for KOA, but both intervention and control groups showed improved PA level. [ABSTRACT FROM AUTHOR]

Background: Whiplash-associated disorders have been the subject of much attention in the scientific literature and remain a major public health problem. Objective: Measure the impact of a validated information booklet on the fear-avoidance beliefs of emergency physicians and their approach to management regarding the treatment of whiplash-associated disorders. Methods: A prospective cluster randomized controlled study conducted with a sample of emergency medicine physicians. Fear-avoidance beliefs were measured using The Whiplash Belief Questionnaire (WBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ). We assessed the approach to management based on the prescription of pharmacological and non-pharmacological treatments based on the advice given to patients. The validated information booklet was the French version of The Whiplash Book. A set of questionnaires was sent to participants pre- and post-intervention. The experimental intervention was the provision of The Whiplash Book. The control arm did not receive any training or information. Results: Mean fears and beliefs scores on inclusion were high: WBQ = 19.09 (± 4.06); physical activity FABQ = 11.45 (± 4.73); work FABQ = 13.85 (± 6.70). Improvement in fear-avoidance beliefs scores being greater in the intervention group was further confirmed by the variation in WBQ (-20 [-32; -6] vs. -6 [-16; 9]; p = 0.06), physical activity FABQ (-70 [-86; -50] vs. -15 [-40; 11]; p < 0.001), and work FABQ (-40 [-71; 0] vs. 0 [-31; 50]; p = 0.02). The emergency physicians' initial approach to management was not consistent with current guidelines. Reading the French version of The Whiplash Book could contribute to changing their approach to management in several areas on intra-group analysis. Conclusion: The French version of The Whiplash Book positively influenced fear-avoidance beliefs among emergency physicians. [ABSTRACT FROM AUTHOR]