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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]

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]

Purpose of the research The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. Methods and sample A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m 2 . The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. Key results The main results showed a higher rate of resumption of occupational activities in the intervention group ( p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study ( p = 0.0014), and on their ability to perform family activities ( p = 0.033). The stay in a thermal centre was cost-effective at 12 months. Conclusions Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. [ABSTRACT FROM AUTHOR]

Abstract: Purpose of the research: The French setting, including laws and guidelines, advocates greater involvement of informal caregivers in the care of cancer patients to protect the caregivers from depression, distress, and a decrease in their quality of life. This study aimed to assess the efficacy of a caregiver educational programme by measuring two outcomes: patients' and caregivers' quality of life and caregivers' burden. Methods and sample: A multicentre randomised controlled trial was performed in six oncology wards in French hospitals. Eligible patients had a cancer, a main caregiver, allowed their caregivers' involvement, and received an inclusion agreement by a doctor/psychologist dyad. The experimental group participated in an educational programme performed by nurses to improve their skills in meal support, nursing care, welfare care, or symptom management. The SF36 and the Zarit burden scales were used to measure quality of life and caregivers' burden at the beginning and at the end of the study. Key results: 67 patients were randomised and 33 were included in the experimental group. Evolution scores, which measured the difference between baseline and final scores, showed an improvement in patients' and caregivers' quality of life and an alleviated burden for experimental group caregivers. Conclusions: An educational programme for caregivers encourages the involvement of patients, informal caregivers and health-care providers in a triangular relationship which enhances the quality of life of patients and caregivers alike and decreases caregivers' burden. Care organisation should therefore be rethought as a triangular relationship between patients, caregivers and health-care providers, with nurses as the mainstay. [Copyright &y& Elsevier]

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]

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]

• 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]

Highlights • This study provides new epidemiological data, while highlighting new elements regarding physical activity in osteoarthritis. • Measurement of physical activity level was supplemented by modifiable osteoarthritis risk factors analysis. • The osteoarthritis population appears more affected by these risk factors, and the most severely affected patients are those with less active lifestyles. Abstract Background The effects of physical activity (PA) in disease prevention and therapy have well-known effects on lower-limb osteoarthritis (OA), decreasing pain and improving function. Objective We aimed to describe the level and factors affecting PA practices of people with knee OA. Design Prospective epidemiological study. Setting In all, 548 people with knee OA were interviewed by use of self-administered anonymous questionnaires. Main outcome measurement The main outcome was physical activity level evaluated by the International physical activity questionnaire (IPAQ) (short version). Secondary outcomes included sociodemographic and clinical data, comorbidities, and barriers to and facilitators of practicing regular PA evaluated by 24 specific elements. Results The mean (SD) age of the study population was 67.6 (7.9) years; 73.9% were women and 30.9% had obesity (mean [SD] body mass index [BMI] 28.2 [5.7] kg/m2). Multi-joint OA affected 92% of the population, and 71.6% had comorbidities. The mean (SD) visual analog scale score for pain intensity was 4.5/10 (2.5), which was 51.4% better than the patient acceptable symptom state (PASS). The mean (SD) Western Ontario and McMaster Universities Osteoarthritis Index function score was 36.6/100 (20.7), which was 57.5% better than the PASS. In total, 67% of patients used analgesics, half of them at least once a week. According to the IPAQ, 42.6% of patients reported high, 38.6% moderate, and 18.8% low PA level; the median IPAQ total activity score was 2628 metabolic equivalent of task (MET)-min/week and time spent sitting was 257.1 min/day. Only one third of participants received non-pharmacological treatment corresponding to the latest recommendations. Variables significantly related to inactive or minimally active PA levels were BMI (P = 0.0294), sex (P = 0.0008), and biomedical barriers, related to self-efficacy (P = 0.0118). Conclusions The OA study population was less active, more sedentary, and had more comorbidities and more barriers to PA practice than the overall population. [ABSTRACT FROM AUTHOR]

Highlights • Railway modeling approach for system constraint handling in optimal sizing method. • Handle of operator-imposed criteria: local or sector support, and data assimilation. • Method applied to real railway line of the French railway company in Paris region. • Case study introduced by analyzing real voltage data of two sites over several days. • Energy storage system requirements for future traffic conditions and operator criteria. Abstract In the context of direct-current electrified railway systems, power supply quality issues are a major concern for the railway network operators. Indeed, after signaling systems and track equipment, voltage issues may be the most challenging factor for the capacity of a direct-current railway line. These issues and the high cost of new substations motivate the implementation of wayside energy storage systems to support the system. Since an appropriate sizing methodology is a key step towards an energy storage system implementation in a railway line, in this paper a sizing methodology is presented in detail. As hypothesis, the sizing methodology is defined such that the storage system is able to support the railway line under projected conditions of the rolling stock traffic, along with other technical criteria relevant to the railway operator. A real-time simulation oriented, direct-current railway network modeling approach is proposed and exploited in this sizing methodology. Using this modeling method, the optimal energy storage sizing formulation is described. The objective function to minimize is the trade-off between energy storage capacity and charging power. The proposed sizing method is applied to a real railway line with known power supply quality issues. This case study is introduced by analyzing real voltage measurements on two key sites of the line over several days. Then, the sizing methodology is applied and the results are discussed for the study case, defining the minimal technical requirements to install. The obtained minimal technical requirements for the storage system are considered by the operator to take a cost-effective decision in contrast with the reinforcement of the line with new substations. [ABSTRACT FROM AUTHOR]

Background/Aims: The dysmetabolic iron overload syndrome (DIOS) is a common disorder but its origin remains unclear. Methods: A case-control study was conducted to compare intestinal absorption of iron in 16 men with DIOS (age 53±11 years, serum ferritin 750±372μg/l, hepatic iron 78±25μmol/g) and in 32 age-matched controls with normal body iron stores (16 overweight subjects and 16 lean subjects). Intestinal absorption was calculated as the area under the curve (AUC) of 58Fe administered orally and correlated with plasma hepcidin and with insulin resistance parameters including HOMA. Results: Intestinal iron absorption was lower in DIOS (AUC=22.4±15.9μg/l/h) compared to both overweight controls (AUC=40.5±29.4μg/l/h, p =0.04) and to lean controls (AUC=102.5±113.5μg/l/h, p <0.01). There was an inverse correlation between intestinal iron absorption and plasma hepcidin (r =−0.61, p <0.001), HOMA (r =−0.35, p =0.01) and C reactive protein (r =−0.52, p <0.001). Conclusions: In overweight subjects with normal iron stores, iron absorption is decreased through hepcidin upregulation. In patients with DIOS, this decrease is more pronounced due to an additional effect of iron excess on circulating hepcidin levels. [Copyright &y& Elsevier]

In this paper we developed a phenomenological transient model of bit foundering which accounts for cuttings transport around the bit through time-dependent erosion and deposition terms. By bit foundering we mean the observed effect where Rate of Penetration no longer increases (and potentially decreases) with Weight on Bit. The model is compared against several experimental data sets and a data set from a full-scale drilling test, and is shown to qualitatively replicate the foundering behavior observed in the data. The simple formulation of the bit foundering model makes it attractive for drilling optimization and control applications. • We propose a simple phenomenological model of bit foundering. • The model covers all the three phases of cutting (I through III). • Shown to qualitatively replicate foundering when compared to experiments. • The proposed model is amenable for drilling optimization. [ABSTRACT FROM AUTHOR]

Objective Low back pain is the most prevailing musculoskeletal disorders in developed countries, with lifetime prevalence of 84% in general adult population. In fact physical activity and exercise programs are the key therapeutic long-term strategy for people with this health condition. The latest advances in telecommunication technologies, in particular Smartphones and Connected Devices, as well as an increase in patient expectations for use of new technologies can be very useful in assessing of physical activity within this population. Material/patients and methods The current study aimed to investigate factors that could influence the use of mobile applications in order to increase the adherence to physical activity prescription in low back pain patients. It was designed according COREQ guidelines and compounded 2 groups: patients and therapists. Participants were enrolled in 2 tertiary care hospital (CHU de Clermont-Ferrand and CHU de Montpellier). In both centers, patients followed a 3-week rehabilitation program for chronic low back with health education component. Data collect was held through either individual or focus group interviews that were recorded and transcribed. Results Patients group compounded 18 persons: 12 men, 6 women (mean age 41.9 years; SD ± 6.8). Therapists group had 15 persons: 12 women, 3 men (mean age 34.4 years; SD ± 10.7). According to the study the main factors that have positive impact on the adherence and that are common for all participants are simple user interface, good information quality and low cost of material. Factors that can impair patient's adherence are one's low skills in informatics, therapist's lack of time and particular security considerations. Following components of mobile health application should be tailored according each user preferences: health care provider's feedback, self-monitoring, updates of the training program and social network. Discussion – conclusion The main limit of present study is that participants were interviewed during rehabilitation program and did not have enough autonomy to reveal all potential barriers to their regular physical activity at home. In that respect, study will be completed with a patient's follow-up in real life condition and will be object of future research. The collected data also contributed to development of Smartphone Application eLombactif (Google Play Store). [ABSTRACT FROM AUTHOR]