Mountainous areas pose a challenge for the out-of-hospital cardiac arrest (OHCA) chain of survival. Survival rates for OHCAs in mountainous areas may differ depending on the location. Increased ...survival has been observed compared to standard location when OHCA occurred on ski slopes. Limited data is available about OHCA in other mountainous areas. The objective was to compare the survival rates with a good neurological outcome of OHCAs occurring on ski slopes (On-S) and off the ski slopes (OffS) compared to other locations (OL).
Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2015 to 2021. The RENAU corresponding to an Emergency Medicine Network between all Emergency Medical Services and hospitals of 3 counties (Isère, Savoie, Haute-Savoie). The primary outcome was survival at 30 days with a Cerebral Performance Category scale (CPC) of 1 or 2 (1: Good Cerebral Performance, 2: Moderate Cerebral Disability).
A total of 9589 OHCAs were included: 213 in the On-S group, 141 in the Off-S group, and 9235 in the OL group. Cardiac etiology was more common in On-S conditions (On-S: 68.9% vs OffS: 51.1% vs OL: 66.7%, p < 0.001), while Off-S cardiac arrests were more often due to traumatic circumstances (OffS: 39.7% vs On-S: 21.7% vs OL: 7.7%, p < 0.001). Automated external defibrillator (AED) use before rescuers' arrival was lower in the Off-S group than in the other two groups (On-S: 15.2% vs OL: 4.5% vs OffS: 3.7%; p < 0.002). The first AED shock was longer in the Off-S group (median time in minutes: OffS: 22.0 (9.5–35.5) vs On-S: 10.0 (3.0–19.5) vs OL: 16.0 (11.0–27.0), p = 0.03). In multivariate analysis, on-slope OHCA remained a positive factor for 30-day survival with a CPC score of 1 or 2 with a 1.96 adjusted odds ratio (95% confidence interval (CI), 1.02–3.75, p = 0.04), whereas off-slope OHCA had an 0.88 adjusted odds ratio (95% CI, 0.28–2.72, p = 0.82).
OHCAs in ski-slopes conditions were associated with an improvement in neurological outcomes at 30 days, whereas off-slopes OHCAs were not. Ski-slopes rescue patrols are efficient in improving outcomes.
The aim of this study was to determine in healthy consultees attending cancer genetics clinics their risk status, their pathways leading to the clinics, their expectations and perception of cancer ...risk. In 1994, the consultees at six French centres completed a questionnaire before their first oncogenetic consultation. The oncogeneticists subsequently filled in a standardised form giving their risk assessment. Among the 206 healthy consultees, 91.3% were women, 92.2% had at least one cancer-affected first-degree relative and 73% had a “cancer family risk” as assessed by the oncogeneticist. Sixty-nine per cent of the consultees were referred to the clinics by a physician, 10.4% by their family and 18.8% on their own initiative: 83.5% of the sample perceived their family risk of cancer as being high and this belief was confirmed in 74.3% of the cases studied by the oncogeneticist. The families of self-referred consultees were less often at risk than those of consultees referred by a physician or by their family (P = 0.012). The majority (78%) expected to be informed about cancer prevention and screening, and this expectation depended on the consultee's level of education (P = 0.001). This study shows that medical pathways are more effective than the media as a means of reaching the members of the general population who are genuinely at risk, and shows that fuller information about prevention needs to be provided at cancer genetic consultations.
The authors report a case of infiltrating non-mucinous neuroendocrine breast tumor of both nesidioid and carcinoid type, exclusively composed of argyrophil cells and showing estrogen receptors. By ...comparing it to those published in literature, they conclude that there are two types of breast tumors with argyrophil cells: one very rare, exclusively composed of neuroendocrine cells, which may present all of the morphological, functional, evolutive aspects and particularly the carcinoid pattern of diffuse endocrine system tumors; the other is more common, composite, reminiscent according to the abundance of their neuroendocrine components, either of the features of diffuse endocrine system tumors, or of those of conventional adenocarcinomas. Their findings help to explain that the combined hormonoreceptive and hormonosecreting nature of these tumors is the particular property of their neuroendocrine cells comparable to that of the pituitary gland. In the composite tumors, these cells are associated in symbiosis with the epithelial glandular cells which are of ectodermal origin. Such an association, also observed in other parts of the body, is not fortuitous but functional and thus could contra-indicate antiestrogen hormonetherapy.
•Different green configurations can be represented by a reservoir cascade model.•The large dissemination of green roof can avoid some flooding issues.•At the basin scale, green roof thickness is not ...a key parameter.•The green roof response depends on initial conditions and rainfall characterization.
At the building scale, the use of green roof has shown a positive impact on urban runoff (decrease and slow-down in peak discharge, decrease in runoff volume). The present work aims to study whether similar effects are possible at the basin scale and what is the minimum spreading of green runoff needed to observe significant impacts. It is particularly focused on the circumstances of such impacts and how they can contribute to storm water management in urban environment. Based on observations on experimental green roofs, a conceptual model has been developed and integrated into the SWMM urban rainfall-runoff model to reproduce the hydrological behaviour of two different types of green roof. It has been combined with a method defining green roofing scenarios by estimating the maximum roof area that can be covered.
This methodology has been applied on a long time series (18years) to the Châtillon urban basin (Haut-de-Seine county, France) frequently affected by urban flooding. For comparison, the same methodology has been applied at the building scale and a complementary analysis has been conducted to study which hydrometeorological variables may affect the magnitude of these hydrological impacts at both scales.
The results show green roofs, when they are widely implemented, can affect urban runoff in terms of peak discharge and volume, and avoid flooding in several cases. Both precipitation – generally accumulated during the whole event- and the initial substrate saturation are likely to have an impact on green roof effects. In this context, the studied green roofs seem useful to mitigate the effects of usual rainfall events but turn out being less helpful for the more severe ones. We conclude that, combined with other infrastructures, green roofs represent an interesting contribution to urban water management in the future.
•The use Blue and Green Infrastructures as stormwater management tools have been assessed.•The Multi-Hydro distributed rainfall-runoff platform has been implemented for this purpose.•A combination of ...B&GI is required to fulfil regulation rules.
Blue and Green Infrastructures (B&GI) are nature-based solutions considered as particularly efficient to reduce the potential impact of new and existing developments with respect to stormwater issues. In order to assess their performance at some large scales compatible with urban projects, adapted distributed rainfall-runoff models are required. The latest advancements of the Multi-Hydro platform have made possible the representation of such B&GI. Applied in a virtual new urban development project located in the Paris region, Multi-Hydro has been used to simulate the impact of B&GI implementation, and their ability to fulfil regulation rules authorizing the connexion to the sewer network. The results show that a combination of several B&GI, if they are widely implemented, could represent an efficient tool to meet regulations at the parcel scale, as they can reduce runoff volume about 90%.
Climate change may have significant consequences for water resources availability and management at the basin scale. This is particularly true for areas already suffering from water stress, such as ...the Mediterranean area. This work focused on studying these impacts in the Llobregat basin supplying the Barcelona region. Several climate projections, adapted to the spatiotemporal resolution of the study, were combined with a daily hydrological model to estimate future water availability. Depending on the scenario and the time period, different assessment indicators such as reliability and resilience showed a future decrease in water resources (up to 40%), with drought periods becoming more frequent. An additional uncertainty analysis showed the high variability of the results (annual water availability ranging from 147 hm
3
/year to 274 hm
3
/year), thus making accurate projections difficult. Finally, the study illustrates how climate change could be taken into account to provide adaptive measures for the future.
Editor M.C. Acreman; Associate editor J. Thompson
To face the consequences of climate change and unsustainable urbanization, green roofs are currently widely implemented in urban environments. Despite their benefits to restore ecosystem services are ...quite well established at the roof scale, green roofs need to be widely and appropriately distributed to perform efficiently at larger scales. However for now, this scale-factor is not considered to guide and conduct green roof implementation policies.
Here we show that a multi-scale analysis based on fractal theory is helpful in providing information for green roof implementation and in assessing the relevance of these policies.
Computed for 9 European cities, green roofs fractal dimensions are sparse, ranging 0.49 to 1.35, and illustrate some different degrees of progress in urban greening. These results demonstrate some significant inconsistencies between political ambition and their in situ realization, and the necessity to better take into account the spatial distribution of green roof implementations in order to optimize their performances.
While the importance of Nature-Based Solutions for climate change adaptation (NBaS) is being increasingly acknowledged, very few studies investigate the status of these solutions in higher education ...syllabi. In an effort to bridge this gap, this study assessed the position of the NBaS notion in French Master's programs.
Based on a survey questionnaire, several interviews and a text mining analysis of the Master's contents, this paper identified, localised and analysed the French Masters that presented links with NBaS related concepts.
This analysis revealed that the notion of NBaS is far from being mastered. This might be caused by a conceptual misunderstanding of definitions. While text mining revealed that the building blocks of the NBaS framework are present, much still needs to be done for connecting them together. A combined analysis of the findings derived from this study led to recommendations to better introduce NBaS in Masters programs in the future.
•The term of Nature-Based (adaptation) Solution is far for being well mastered.•Based on the existing definition, the concept should also be better explained.•Few courses are actually dedicated to climate change and how to adapt to it.•The complexity of the environments across scales has to be taken into account.•NBaS require a transition from silo approaches to multidisciplinary frameworks.
•Green roof designs rely on hydrological behaviour of granular substrates.•Substrate hydraulic properties are closely related to their Grain Size Distribution.•Fractal approximations in size ...distribution models are physically unrealistic.•Pore and Grain size distributions are directly related to each other.•More realistic Multifractal-based models are proposed here.
Hydrological behaviour of granular substrates is of critical interest in Nature-based solutions (NBS) like green roofs. To simulate this behaviour in a physically realistic manner it is indispensable to model the substrate’s hydraulic conductivity (HC) as it determines infiltration rate at various degrees of saturation. Since HC is directly dependent on water content retained by the substrate, it is necessary to physically model this water retention (WR) behaviour too. Capillary water is stored or retained in pore spaces and this water content that can be retained by a substrate under different suction pressures is therefore dependent upon its pore size distribution (PSD). Since pores in any granular media are spaces where grains are absent, their size distribution too is intrinsically related to the substrate’s grain size distribution (GSD) which provides the probability of finding grains smaller than some threshold diameter dg,t. Although earlier studies have attempted to model PSD, WR and HC, they frequently use simplifying mono-fractal approximations, whereas this study proposes a more generalized multifractal-based approach. Furthermore, while it is quite usual to incorporate pore tortuosity through some indirect parameter l in the HC model, a related ink-bottle effect which even though capable of affecting WR behaviour is commonly ignored. Therefore, this paper attempts to address the aforementioned research gaps in modelling GSD, PSD, WR and HC by i) investigating the somewhat overlooked question of similarity in multifractal behaviour between grain size fields and substrate density fields, and consequently suggesting an improved method for estimating universal multifractal (UM) parameters of grain size fields in a more reliable manner from just conventional GSD measurements in order to be directly used in the multifractal GSD model, ii) proposing a new UM-based PSD model, and subsequently using it to obtain a new UM-based WR model with a parameter to directly represent ink-bottle effect - a consequence of the substrate’s pore configuration or arrangement, iii) using this UM-based WR model to suggest a new UM-based HC model without the necessity for a separate pore tortuosity parameter. Finally, the proposed models have been validated by using experimental measurements from 4 different commercially used green roof substrates.
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