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A framework and an associated modeling tool to perform life cycle assessment (LCA) of urban water system, namely the WaLA model, has been recently developed. In this paper, the WaLA model is applied to a real case study: the urban water system of the Paris suburban area, in France. It aims to verify the capacity of the model to provide environmental insights to stakeholder's issues related to future trends influencing the system (e.g., evolution of water demand, increasing water scarcity) or policy responses (e.g., choices of water resources and technologies). This is achieved by evaluating a baseline scenario for 2012 and several forecasting scenarios for 2022 and 2050. The scenarios are designed through the modeling tool WaLA, which is implemented in Simulink/Matlab: it combines components representing the different technologies, users and resources of the UWS. The life cycle inventories of the technologies and users components include water quantity and quality changes, specific operation (electricity, chemicals) and infrastructures data (construction materials). The methods selected for the LCIA are midpoint ILCD, midpoint water deprivation impacts at the sub-river basin scale, and endpoint Impact 2002+. The results of the baseline scenario show that wastewater treatment plants have the highest impacts compared to drinking water production and distribution, as traditionally encountered in LCA of UWS. The results of the forecasting scenarios show important changes in water deprivation impacts due to water management choices or effects of climate change. They also enable to identify tradeoffs with other impact categories and to compare several scenarios. It suggests the capacity of the model to deliver information for decision making about future policies. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study which aims to determine the effectiveness of a multifaceted intervention for venous thromboembolism in elderly post-acute care patients in France. The presence of deep vein thromboembolism was observed in 12.8% of the patients in the preintervention phase versus 7.8% in the postintervention phase. Patients in the postintervention group were more likely to use graduated compression stockings alone or in combination with pharmacologic prophylaxis.

In this article a new characterization model and factors are proposed for the life cycle impact assessment (LCIA) of water consumption on instream freshwater ecosystems. Impact pathways of freshwater consumption leading to ecosystem damage are described and the alteration of instream physical habitat is identified as a critical midpoint for ecosystem quality. The LCIA characterization model aims to assess the change in habitat quantity due to consumptive water use. It is based on statistical, physical habitat simulation for benthic invertebrates, fish species and their size classes, and guilds of fish sharing common habitat preferences. A habitat change potential (HCP) midpoint, mechanistic indicator, is developed and computed on the French river network at the river reach scale (the river segment with variable length between the upstream and downstream nodes in the hydrographic network), for median annual discharges and dry seasons. Aggregated, multi-species HCPs at a river reach are proposed using various aggregation approaches. Subsequently, the characterization factors are spatially aggregated at watershed and sub-watershed scales. HCP is highly correlated with median and low flow discharges, which determine hydraulic characteristics of reaches. Aggregation of individual HCPs at reach scale is driven by the species most sensitive to water consumption. In spatially aggregated HCPs, consistently with their reduced smaller average discharge rate, small stream habitats determine the overall watershed characterization. The study is aimed primarily at life cycle assessment (LCA) practitioners and LCIA modelers. However, since it is the result of a productive cross-fertilization between the ecohydrology and LCA domains, it could be potentially useful for watershed management and risk assessment as well. At the moment, the proposed model is applicable in France. For a broader implementation, the development of global, high resolution river databases or the generalization of the model are needed. Our new factor represents nevertheless an advancement in freshwater ecosystems LCIA laying the basis for new metrics for biodiversity assessment. Image 1 • Mechanistic models to quantify water consumption impact on ecosystems are needed. • Hydraulic habitat change potential is quantified on the French river network. • Habitat sensitivity to water consumption is greater in low flow periods. • Multi-species habitat change potential is driven by a limited number of taxa. • Watershed habitat sensitivity is quantified based on reach scale characterization. [ABSTRACT FROM AUTHOR]

It was the objective of this study to design a clinical prediction score for the diagnosis of upper extremity deep venous thrombosis (UEDVT). A score was built by multivariate logistic regression in a sample of patients hospitalized for suspicion of UEDVT (derivation sample). It was validated in a second sample in the same university hospital, then in a sample from the multicenter OPTIMEV study that included both outpatients and inpatients. In these three samples, UEDVT diagnosis was objectively confirmed by ultrasound. The derivation sample included 140 patients among whom 50 had confirmed UEDVT, the validation sample included 103 patients among whom 46 had UEDVT, and the OPTIMEV sample included 214 patients among whom 65 had UEDVT. The clinical score identified a combination of four items (venous material, localized pain, unilateral pitting edema and other diagnosis as plausible). One point was attributed to each item (positive for the first 3 and negative for the other diagnosis). A score of -1 or 0 characterized low probability patients, a score of 1 identified intermediate probability patients, and a score of 2 or 3 identified patients with high probability. Low probability score identified a prevalence of UEDVT of 12, 9 and 13%, respectively, in the derivation, validation and OPTIMEV samples. High probability score identified a prevalence of UEDVT of 70, 64 and 69% respectively. In conclusion we propose a simple score to calculate clinical probability of UEDVT. This score might be a useful test in clinical trials as well as in clinical practice.

Background: The efficacy of venous thromboembolism prophylaxis has not been established, to our knowledge, in elderly patients hospitalized in subacute care facilities., Objectives: To describe risk factors and physician practices in the prevention of venous thromboembolism and to estimate the prevalence of deep vein thrombosis., Methods: A multicenter cross-sectional study was conducted in the subacute care departments of 36 French hospitals. The study population included 852 inpatients older than 64 years. Systematic ultrasound examination was performed by angiologists., Results: Of the 852 inpatients, 178 (20.9%; 95% confidence interval [CI], 18.2%-23.8%) had 3 or more risk factors other than age, while 144 patients (16.9%; 95% CI, 14.4%-19.6%) had none. The rate of prophylactic anticoagulant treatment was 56.1%, ranging from 20.0% to 86.9%, depending on the department. In multivariate analysis, prophylaxis use was associated with acute immobilization (odds ratio [OR], 4.17; 95% CI, 2.48-7.01), chronic immobilization (OR, 3.19; 95% CI, 2.22-4.60), major surgical procedure (OR, 6.81; 95% CI, 4.26-10.88), and congestive heart failure (OR, 1.65; 95% CI, 1.02-2.67). Prophylaxis use was low in patients who had cancer (OR, 0.49; 95% CI, 0.29-0.84) or myocardial infarction (OR, 0.39; 95% CI, 0.14-1.00). It was not significantly associated with paralytic stroke or history of venous thromboembolism. Deep vein thrombosis was detected in 135 patients (15.8%; 95% CI, 13.4%-18.5%): 50 (5.9%; 95% CI, 4.4%-7.7%) had proximal vein thrombosis and 85 (10.0%; 95% CI, 8.0%-12.2%) had calf vein thrombosis., Conclusions: The prevalence of deep venous thrombosis is high in these patients, despite wide use of prophylaxis. Further prospective studies assessing the clinical benefit of extended duration prophylaxis are needed in elderly patients hospitalized in subacute care settings.