Search

COURLIS is a 1D sedimentology module coupled with MASCARET, 1D hydraulic code of the TELEMAC-MASCARET open source system. The code has been developed for more than 10 years, mainly for suspension sediment transport. Recently, the need of a 1D bedload code has been identified to model the long term evolution of rivers and reservoirs (several decades). New numerical schemes were implemented, some improvements were done in the geometry evolution algorithms. In terms of performance and robustness, the best scheme implemented is a finite volume upwind/downwind scheme. Several solutions are implemented to reduce calculation time. This new version of COURLIS for bedload transport was validated successfully on test-cases (Soni and Newton experiments). A real case has been simulated during an 11 year period. The calculation time is very similar to those obtained with codes tested in the benchmark and the results are in a good agreement with measurements and other code results. COURLIS (suspension and bedload transport) will be released in the next version of the TELEMAC-MASCARET open source system and so, it will be freely available for sedimentology community. Further developments are planned in 2018.

Achieving a sustainable management of sediment fluxes in existing or proposed reservoirs is a challenging but essential requirement for dam operators. Such objective is of utmost importance to avoid sedimentation-related consequences. Numerical modelling is of great interest to understand the flow and sediment dynamics in a reservoir, to simulate the long-term evolution of sediment deposits and to evaluate the efficiency of various management strategies. This paper presents recent case studies, which validate the feasibility and relevancy of such technical option. The progresses obtained on essential stages of the numerical modelling of sediments dynamics in reservoirs are particularly emphasized. Concerning the distribution of deposits, a promising field method based on an optimum combination of direct samplings with acoustic measurements and video auscultations is detailed. Feedbacks are then provided concerning an innovative device deployed in the field for a direct measurement of the settling velocity. Issues about the assessment of calibration parameters are also addressed in this communication. Lab experiments performed on deposits sampled in several reservoirs provide practical guidance to evaluate the erosion parameters of sediments. Finally, several examples of sediment dynamics modelling in reservoirs including both cohesive and non-cohesive sediment are presented.

The upper Rhine River is a highly harnessed and regulated river. EDF (a French electricity company) is in charge of eight dams on the upper Rhine River for producing hydro-electricity. In order to increase the safety and the competitiveness of the installations, but also to reduce their environmental impact, the sediment dynamics in these reservoirs has become a key factor to control and predict. In this study, we focused on the Marckolsheim reservoir, which is located 50 kilometers upstream the city of Strasbourg. Since its construction in 1961, this reservoir has been filled continuously with cohesive sediments, partially contaminated. Two field campaigns were performed in 2015 and 2016 under two different discharge conditions, with the objectives of quantifying the complex velocity fields on this site. The numerical codes TELEMAC-2D and SISYPHE were used to simulate in 2D the hydrodynamic and the suspended sediment transport of the reservoir. A ten kilometers long model was built and calibrated with the measured data of the 2015 and 2016 field campaigns, but also with measurements of sediment parameters that have been done separately. The originality of this model consists in an explicit 3D representation of the dam gates. An algorithm was implemented in TELEMAC in order to adapt the gates position at each time step, in conformity with the real regulation rules followed by the dam operator. By using upstream measured data of discharge and suspended sediment concentration, a four months period was simulated. The comparison of the simulated results with bathymetric surveys shows good agreements if specific properties of sediments related to settling processes are taken into account. Finally, the dynamics of the contaminated sediments was simulated. A 3D spatial distribution of the contaminated sediments in the reservoir was defined at the initial state by using in situ measurements. The fully coupled hydraulic-sediment-pollutant simulation performed over a single flood event gives first interesting highlights on the resuspension conditions of the contaminated sediments.

In response to demographic challenges, primary care need to get familiar with the concept of frailty and the early detection of cognitive impairment. The « Frailty and Alzheimer's disease prevention into primary care » (FAP) project introduced a geriatric evaluation with a nurse in primary care in order to assess older patients. Our work aimed to evaluate the general practitioner's (GPs) opinion involved in FAP project., Methods: This is an observational descriptive study performed in Occitanie region. 26 GPs have involved in this project. The gathering of information was performed through an online survey., Results: GPs estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92% of the surveyed GPs gave a strongly positive or positive opinion regarding the detection of previously unidentified health issues and the improvement of patient care following this evaluation. 42% of the GPs found that the personalized plan of cares is difficult or very difficult to do. 73% of the GPs considered that they have a better knowledge of frailty syndrome and cognitive impairment after the evaluation., Conclusion: GPs feedback was very positive and promising for the future. It could be interesting to develop this geriatric evaluation in primary care into new regions.

Given the current demographic situation, the primary care must consider the frailty concept. The « Frailty and Alzheimer's disease prevention into Primary care » project (FAP) enabled geriatric assessment by a nurse in general practitioner's office to assess older persons. The aim of our study was to evaluate patients' satisfaction after geriatric assessment into primary care., Methods: This is an observational descriptive study performed in the Occitanie area on a population of 268 older patients. Gathering of information was performed through a phone survey., Results: A total of 133 questionnaires were filled in. Average age was 80 (±6) years old and 60% were women. 75.2% (n=100) were frail or pre-frail; 72% (n=89) of participants have been completely satisfied by this assessment; 71% (n=24) have been completely satisfied about their personalized plan of care; 79% (n=89) of them thought the general practitioners' office as the best place for geriatric assessment; 42% (n=52) would have refused the evaluation in the hospital., Discussion: Patient's feedback is very encouraging. They were favorable to the development of the geriatric assessment into primary care and the generalization of the FAP project in other areas. Further studies must be carried out in order to evaluate the medico-economic effect of this care model.

Purpose: Protons Pump Inhibitors (PPIs) are widely used in France. The aim of our study was to determine the rate of exposure to PPIs in old patients and to assess the appropriateness of their prescription according to French guidelines., Methods: We performed a descriptive study from 1st June to 30th August 2016, including all patients admitted in the department of geriatric post emergency of the university hospital of Toulouse with a prescription of PPI. Data concerning age, name of PPI, dose, indication, duration of prescription and the modification of PPI prescription were collected., Results: Among 375 patients admitted during this period, 134 (35.7) were exposed to PPIs with a mean age of 85.9±6.6years. About one third of them were exposed to PPI more than one year (N=49). Prescription was inappropriate for the criteria "dose and indication" and "duration" for respectively 59 (44.0%) and 15 (11.2%) cases. In 50 cases (37.3%), the PPI was renewed, stopped in 69 cases (51.5%) and the dose was reduced for 15 patients (11.2%)., Conclusion: According to our data, the prescription of PPI was no appropriate in about 40% of included patients. A reassessment of their prescription with awareness of patients should be necessary to improve the good utilization of these "popular" drugs and to prevent some serious adverse reactions after long exposure., (Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Older adults can be categorized into three subgroups to better design and develop personalized interventions: the disabled (those needing assistance in the accomplishment of basic activities of daily living), the 'frail' (those presenting limitations and impairments in the absence of disability) and the 'robust' (those without frailty or disability). However, despite evidence linking frailty with a poor outcome, frailty is not implemented clinically in most countries. Since many people are not identified as frail, their treatment is frequently inappropriate in health care settings. Assessing the frail and prefrail older adults can no longer be delayed, we should rather act preventively before the irreversible disabling cascade is in place. Clinical characteristics of frailty such as weakness, low energy, slow walking speed, low physical activity and weight loss underline the links between nutrition and frailty. Physical frailty is also associated with cognitive frailty. We need to better understand cognitive frailty, a syndrome which must be differentiated from Alzheimer's disease. At the Gérontopôle frailty clinics, we have found that almost 40% of the patients referred to our center by their primary care physicians to evaluate frailty had significant weight loss in the past 3 months, 83.9% of patients presented slow gait speed, 53.8% a sedentary lifestyle and 57.7% poor muscle strength. Moreover, 43% had a Mini-Nutritional Assessment less than 23.5 and 9% less than 17, which reflects protein-energy undernutrition. More than 60% had some cognitive impairment associated with physical frailty., (© 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.)

Objective: Weight loss and behavioral disturbances are frequent over the course of Alzheimer's disease (AD) and are risk factors for poor outcome. We investigated the impact of aberrant motor behavior (AMB) on weight changes in older adults with AD. The hypothesis that patients with AMB are more likely to lose weight than patients without AMB was assessed., Methods: A prospective study of 686 patients with moderate AD from the REAL.FR cohort was assessed. The AMB at baseline was defined by the item 10 from the Neuropsychiatric Inventory scale (NPI-10). Patients were classified as "no or light AMB" (NPI-10 < 4), and "significant AMB" (NPI-10 ≥ 4). Weight changes were determined over the 4-year follow-up., Results: The mean weight change over the 4 years was +2.2 ± 0.9 kg in patients with "significant AMB," whereas weight remained stable in patients with "no or light AMB" (p = 0.02)., Conclusion: Older adults with moderate AD and "significant AMB" do gain weight., (Copyright © 2012 John Wiley & Sons, Ltd.)

The prevention of dementias, such as Alzheimer's disease (AD), is a growing public health concern, due to a lack of effective curative treatment options and a rising global prevalence. Various potential risk or preventive factors have been suggested by epidemiological research, including modifiable lifestyle factors such as diet. Current epidemiological data are in favour of a protective role of certain micronutrients (B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish) in the prevention of cognitive decline and dementia/AD. Some factors have been targeted by interventions tested in randomized controlled trials (RCTs), but many of the results are conflicting with observational evidence. Epidemiological analysis of the relations between nutrient consumption and cognitive decline is complex and it is highly unlikely that a single component plays a major role. In addition, since multiple factors across the life course influence brain function in late life, multidomain interventions might be more promising in the prevention of cognitive decline and dementia/AD. Designing such trials remains very challenging for researchers. The main objective of this paper is to review the epidemiologic data linking potential protective factors to cognitive decline or dementia/AD, focusing particularly on the roles of adiposity, caloric restriction, micro (group B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish). Limitations of the current data, divergence with results of interventional prevention studies and challenges for future research are discussed., (© 2013 The Authors. British Journal of Clinical Pharmacology © 2013 The British Pharmacological Society.)

Objective: To describe hospitalizations in a Special Acute Care inpatient Unit for older adults with Alzheimer's disease (AD) and other related disorders., Design: An 11-year observational study of consecutive hospitalizations from 1996 to 2006., Setting: The Alzheimer Special Acute Care inpatient Unit in the Geriatrics Department of the Toulouse University Hospital, France., Participants: A total of 4708 patients with dementia accounting for 6299 consecutive hospitalizations., Measurements: Data regarding admission causes, cognition, physical disability, nutritional assessment, behavioral and psychological symptoms of dementia, and sociodemographics were recorded., Results: Data from 6299 hospitalizations are presented: 4708 (74.7%) hospitalizations accounted for first-time admissions and 1591 (25.3%) were rehospitalizations. Among the first-time admissions, complications of dementia and cognitive diagnosis experienced a significant switch in frequency. Whereas until 2001, the main cause of admission was for a diagnosis (51%), complications became the primary cause from 2003 onward with a significant increasing trend (56%) (P < .001). The most frequent cause of complications was behavioral and psychological symptoms of dementia, with a significant trend for an increased frequency (P < .001). Agitation-aggressiveness represented 60% of behavioral and psychological symptoms of dementia. Between 1996 and 2006, the age of patients at first-time admission gradually increased over time, as did the severity of cognitive impairment and the prevalence of unsatisfactory nutritional status (P for trend < .001 for each variable)., Conclusions: The evolving patient characteristics and the causes of first-time admissions changed over the course of 11 years. Behavioral and psychological symptoms of dementia, especially agitation-aggressiveness, have progressively become the key drivers of Special Acute Care inpatient Unit hospitalizations. These findings suggest that the role, mission, and functioning of the Special Acute Care inpatient Unit within the Alzheimer care system has been modified over time., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)