Modelling of metal forming processes and multi-physic coupling

http://congress.cimne.com/complas05/admin/Files/FilePaper/p377.pdfInternational audienceThe main physical phenomena which can be coupled with the mechanical computation of metal forming processes are analyzed. Recalling the classical thermal coupling, it is shown that a stronger numerical coupling is necessary when localization of the deformation occurs. Several situations where we have mechanical solid and liquid interactions with thermal coupling are briefly mentioned. A more complete description of electro magnetic and thermal coupling is given in view of induction heating. Finally the case of multi scale coupling for metallurgic microstructure evolution is introduced

Systematic Review of Clinical Trials Assessing the Effectiveness of Ivy Leaf (Hedera Helix) for Acute Upper Respiratory Tract Infections

Introduction. Among nonantibiotic cough remedies, herbal preparations containing extracts from leaves of ivy (Hedera helix) enjoy great popularity. Objective. A systematic review to assess the effectiveness and tolerability of ivy for acute upper respiratory tract infections (URTIs). Methods. We searched for randomized controlled trials (RCTs), nonrandomized controlled clinical trials and observational studies evaluating the efficacy of ivy preparations for acute URTIs. Study quality was assessed by the Jadad score or the EPHPP tool. Results. 10 eligible studies were identified reporting on 17463 subjects. Studies were heterogeneous in design and conduct; 2 were RCTs. Three studies evaluated a combination of ivy and thyme, 7 studies investigated monopreparations of ivy. Only one RCT (n = 360) investigating an ivy/thyme combination used a placebo control and showed statistically significant superiority in reducing the frequency and duration of cough. All other studies lack a placebo control and show serious methodological flaws. They all conclude that ivy extracts are effective for reducing symptoms of URTI. Conclusion. Although all studies report that ivy extracts are effective to reduce symptoms of URTI, there is no convincing evidence due to serious methodological flaws and lack of placebo controls. The combination of ivy and thyme might be more effective but needs confirmation

Competence-based curriculum development for general practice in Germany: a stepwise peer-based approach instead of reinventing the wheel

BACKGROUND: Improving postgraduate medical training is one important step to attract more medical students into general practice. Keeping pace with international developments moving to competence-based curricula for general practice training, the aim of this project was to develop and implement such a curriculum in Germany. METHODS: A five-step, peer-based method was used for the curriculum development process including panel testing and a “test version” of the curriculum for the pilot implementation phase. The CanMEDS framework served as a basis for a new German competence-based curriculum in general practice training. Four curricula from European countries and Canada were reviewed and, following required cultural adaptions, key strengths from these were integrated. For the CanMEDS “medical expertise” element of the curriculum, the WONCA ICPC-2 classification of patient’s “reason for encounters” was also integrated. RESULTS: Altogether, 37 participants were involved in the development process representing 12 different federal states in Germany, and including an expert advisor from Denmark. An official “test version” of the curriculum consisting of three parts: medical expertise, additional competencies and medical procedures was established. A system of self-assessment for trainees was integrated into the curriculum using a traffic light scale. Since March 2012, the curriculum has been made freely available online as a “test version”. In 2014, an evaluation is planned using feedback from users of the test model as a further stage of the implementation process. CONCLUSIONS: The first German competence-based curriculum for general practice training has been developed using a pragmatic peer controlled approach and implementation is being trialed with a “test version” of the curriculum. This model project and its peer-based methodology may support competence-based curriculum development for other medical specialties both inside and outside Germany

Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study

Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18%) received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]). SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services

Effectiveness of Varenicline as an Aid to Smoking Cessation in Primary Care: An Observational Study

Aims: Although varenicline is commonly prescribed in primary care, information on smoking-related comorbidities and the effectiveness of varenicline in this context in Germany is scarce. This study assessed the efficacy and safety of varenicline in a large sample of patients seeking smoking cessation treatment through their general practitioners. The frequency of comorbidities was also evaluated. Methods: This was a 12-week, prospective, observational, non-comparative phase IV trial conducted in Germany. Abstinence rates at week 12 were evaluated by verbal reporting using the nicotine use inventory. Results: Overall, 1,391 subjects were enrolled; 1,177 received study medication and were evaluated for effectiveness and safety. At the end of the study, 71.1% (95% confidence interval 68.5–73.7) of subjects were abstinent. There were a total of 205 all-causality adverse events; 2.2% were classified as serious or severe. There were no fatal adverse events. At inclusion, 66.7% of participants had at least 1 concurrent comorbidity, with chronic obstructive pulmonary disease (35.5%), hypertension (29.6%) and depression (10.4%) being the most commonly reported. Conclusion: These real-world data indicate that varenicline is an effective and well-tolerated smoking cessation treatment when used in the primary care setting including patients with smoking-related comorbidities

Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis

Objective: The assumption that low back pain (LBP) patients suffer from “disuse” as a consequence of high fear-avoidance beliefs is currently under debate. A secondary analysis served to investigate whether fear-avoidance beliefs are associated cross-sectionally and longitudinally with the physical activity level (PAL) in LBP patients

Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Objective: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pai

Continental weathering as a driver of Late Cretaceous cooling : new insights from clay mineralogy of Campanian sediments from the southern Tethyan margin to the Boreal realm

21 pagesInternational audienceNew clay mineralogical analyses have been performed on Campanian sediments from the Tethyan and Boreal realms along a palaeolatitudinal transect from 45° to 20°N (Danish Basin, North Sea, Paris Basin, Mons Basin, Aquitaine Basin, Umbria-Marche Basin and Tunisian Atlas). Significant terrigenous inputs are evidenced by increasing proportions of detrital clay minerals such as illite, kaolinite and chlorite at various levels in the mid- to upper Campanian, while smectitic minerals predominate and represented the background of the Late Cretaceous clay sedimentation. Our new results highlight a distinct latitudinal distribution of clay minerals, with the occurrence of kaolinite in southern sections and an almost total absence of this mineral in northern areas. This latitudinal trend points to an at least partial climatic control on clay mineral sedimentation, with a humid zone developed between 20° and 35°N. The association and co-evolution of illite, chlorite and kaolinite in most sections suggest a reworking of these minerals from basement rocks weathered by hydrolysis, which we link to the formation of relief around the Tethys due to compression associated with incipient Tethyan closure. Diachronism in the occurrence of detrital minerals between sections, with detrital input starting earlier during the Santonian in the south than in the north, highlights the northward progression of the deformation related to the anticlockwise rotation of Africa. Increasing continental weathering and erosion, evidenced by our clay mineralogical data through the Campanian, may have resulted in enhanced CO2 consumption by silicate weathering, thereby contributing to Late Cretaceous climatic cooling