Pulvinar and pubic cartilage measurements to refine universal ultrasound screening for developmental dysplasia of the hip: Data from 1896 infant hips.

PURPOSE: Screening modalities for Developmental Dysplasia of the Hip (DDH) and indications for treatment of mild forms remain controversial. Ultrasound (US) measurement of the pubofemoral distance (PFD > 6 mm, composed of the pubic cartilage and the pulvinar) can avoid late diagnoses of DDH. A thick pubic cartilage may nevertheless lead to false positives. The purpose of this study was to establish standard measurements of pubic cartilage and pulvinar, through universal US screening, to lower false positive results and thus any overtreatment. METHODS: This is a single-center observational prospective study conducted from December 2016 to January 2018, on infants who underwent universal US screening for DDH. The only inclusion criterion was an adjusted age between 4 and 12 weeks when US was realized. PFD measurement was made using the Couture and Tréguier method. In addition, thicknesses of pubic cartilage and pulvinar were measured on the same US section, in millimeters. RESULTS: Nine hundred and forty-eight patients, representing 1896 hips, were included. The average value of pubic cartilage thickness was 1.25 mm ±â€¯0.58 mm, with an upper threshold of 2.39 mm (+1.96σ). The average value of pulvinar thickness was 2.67 mm ±â€¯0.78 mm, with an upper threshold of 4.20 mm (+1.96σ). We found high inter-observer reproducibility in pubic cartilage measurements. CONCLUSION: Systematic measurements of pubic cartilage and pulvinar may refine therapeutic decision by identifying false positives. Patients with increased PFD due to a thick pubic cartilage >2,39 mm, without an associated pulvinar enlargement (<4,20 mm), could be therefore only monitored and not overtreated.

Modelling of wastewater treatment plants--how far shall we go with sophisticated modelling tools?

Several levels of complexity are available for modelling of wastewater treatment plants. Modelling local effects rely on computational fluid dynamics (CFD) approaches whereas activated sludge models (ASM) represent the global methodology. By applying both modelling approaches to pilot plant and full scale systems, this paper evaluates the value of each method and especially their potential combination. Model structure identification for ASM is discussed based on a full-scale closed loop oxidation ditch modelling. It is illustrated how and for what circumstances information obtained via CFD (computational fluid dynamics) analysis, residence time distribution (RTD) and other experimental means can be used. Furthermore, CFD analysis of the multiphase flow mechanisms is employed to obtain a correct description of the oxygenation capacity of the system studied, including an easy implementation of this information in the classical ASM modelling (e.g. oxygen transfer). The combination of CFD and activated sludge modelling of wastewater treatment processes is applied to three reactor configurations, a perfectly mixed reactor, a pilot scale activated sludge basin (ASB) and a real scale ASB. The application of the biological models to the CFD model is validated against experimentation for the pilot scale ASB and against a classical global ASM model response. A first step in the evaluation of the potential of the combined CFD-ASM model is performed using a full scale oxidation ditch system as testing scenario.

Development and commissioning of decision support tools for sewerage management.

Managing sewerage systems is a highly complex task due to the dynamic nature of the facilities. Their performance strongly depends on the know-how applied by the operators. In order to define optimal operational settings, two decision support tools based on mathematical models have been developed. Moreover, easy-to-use interfaces have been created as well, aiding operators who presumably do not have the necessary skills to use modelling software. The two developed programs simulate the behaviour of both wastewater treatment plants (WWTP) and sewer network systems, respectively. They have essentially the same structure, including raw data management and statistical analysis, a simulation layer using the application programming interface of the applied software and a layer responsible for the representation of the obtained results. Four user modes are provided in the two software including the simulation of historical data using the applied and novel operational settings, as well as modes concerning prediction of possible operation periods and updates. Concerning the WWTP software, it was successfully installed in Nantes (France) in June 2004. Moreover, the one managing sewer networks has been deployed in Saint-Malo (France) in January 2005. This paper presents the structure of the developed software and the first results obtained during the commissioning phase.

Optimisation of a large WWTP thanks to mathematical modelling.

Better controlling and optimising the plant's processes has become a priority for WWTP (Wastewater Treatment Plant) managers. The main objective of this project is to develop a simplified mathematical tool able to reproduce and anticipate the behaviour of the Tougas WWTP (Nantes, France). This tool is aimed to be used directly by the managers of the site. The mathematical WWTP model was created using the software WEST. This paper describes the studied site and the modelling results obtained during the stage of the model calibration and validation. The good simulation results have allowed to show that despite a first very simple description of the WWTP, the model was able to correctly predict the nitrogen composition (ammonia and nitrate) of the effluent and the daily sludge extraction. Then, a second more detailed configuration of the WWTP was implemented. It has allowed to independently study the behaviour of each of four biological trains. Once this first stage will be completely achieved, the remainder of the study will focus on the operational use of a simplified simulator with the purpose of optimising the Tougas WWTP operation.

[Sleep and vigilance in students]. / Sommeil et vigilance des étudiants.

A cross-sectional survey was carried out among students with the higher education system in Paris in November, 1992, during a medical exam carried out during their first year of study. The objective was to better determine the characteristics of sleep, vigilance and prevalence of sleep problems. This survey concerned 3152 students, 52% of them girls. The average age was 20 years +/- 2.38% of students felt they don't sleep sufficiently. Twenty one percent of students maintained that they experience sleep difficulties. Ten percent of students said they are sleepy during the day. Four percent of students take medications for sleeping. 3% of students snore regularly. The practice of a sport, living environment, the duration of daily transportation, remunerated work, and the consumption of stimulants all impact on sleep and/or daytime vigilance.