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International audience; Sustainable water management is a worldwide challenge for the twenty-first century. It involves replacing traditional management approaches with a new concept, often referred to as sustainable urban water management (SUWM). This paradigm shift means that SUWM systems must include new services, some of which have already emerged. However, no publications have presented the expected SUWM system in terms of the full range of services it would need to include, and no publications have proposed a method for identifying the services the system must provide. This paper proposes a method for identifying these services and presents a generic petal diagram to represent the service functions of the SUWM system. Moreover, this paper presents a new method for defining these services in a specific territory. This method is based on the confrontation between a general representation and the objectives of the stakeholders in a given system in a given territory. The method is illustrated with a full-scale case study on the Doua eco-campus (Lyon University). This method is intended to aid practitioners to manage its system and to transition to SUWM. It is designed to improve the transparency of decision formulation and to involve stakeholders in the process.

Published online: 14 Jan 2014; International audience; In the context of new challenges and emerging needs for transparency regarding users, urban water management is obliged to forge links between different technical fields. This implies managing interfaces between multiple stakeholders on the one hand, and ensuring the adaptability and sustainability of technical infrastructures on the other hand. In a period dominated by public spending cuts, the optimisation and efficiency of the system's infrastructures and the organisation of the stakeholders involved has become important for guaranteeing the continuity of the services provided. From the economic viewpoint, this challenge is related to tracking and reducing costs. Moreover, it also concerns the need to communicate arguments related to service costs to both users and stakeholders. Consequently, the "Eco-EAR" method was developed by adapting Functional Analysis (FA), Activity Based Costing (ABC) and Whole Life Costing (WLC) approaches in view to describing how the direct costs of the sewerage service provided by wastewater utilities are structured. The cost structure is analysed according to the activities and physical flows comprising the primary and secondary functions of an urban water management system. Three goals are targeted: i) to explain the costs of the system to the local authority (owners) and users; ii) to identify the activities that have the greatest impact on costs in order to plan cost reduction actions; and iii) to assess the apportionment of costs per activity and per physical flow, in order to better understand the system by combining both its economic and technical dimensions. The performance indicators proposed by the "Eco-EAR" method could also be used for benchmarking. The method is implemented in a real case study: the sub-system territory around the city of Mulhouse (northeast France) under the responsibility of a water management authority.

Background It is increasingly accepted that patients want information about their proposed treatment, and that provision of such information may alleviate fear and may improve the process of obtaining informed consent. It is not yet clear what form such information should take. Objective Based on differences shown previously between patients receiving standard treatment and those in clinical trials, a system of routine appointments with a chemotherapy nurse at least one day before the patient offered consent to treatment was established for all patients receiving chemotherapy in Leicestershire, at which time patients were given standardised written information regarding outpatient chemotherapy and specific drugs. Method In order to complete the audit cycle, the previous questionnaire study was repeated. Results From 160 questionnaires distributed, 131 complete replies were received. Compared with the previous audit, a significantly higher proportion of patients receiving standard chemotherapy remembered being given written information about chemotherapy from a nurse before starting their treatment and remembered signing a consent form. The significant difference in feelings of involvement in the decision to have chemotherapy between patients receiving standard chemotherapy and those in clinical trials detected in the previous audit was no longer detectable, suggesting the clinical effectiveness of the intervention performed. Conclusion Implementation of nurse-led appointments with provision of standardised information before formal consent being taken should be studied further for its potential to improve patients’ involvement in medical decision making.

Sustainable water management is a global challenge for the 21st century. One key aspect remains protection against urban flooding. The main objective is to ensure or maintain an adequate level of service for all inhabitants. However, level of service is still difficult to assess and the high-risk locations difficult to identify. In this article, we propose a methodology, which (i) allows water managers to measure the service provided by the urban drainage system with regard to protection against urban flooding; and (ii) helps stakeholders to determine effective strategies for improving the service provided. One key aspect of this work is to use a database of sewer flood event records to assess flood risk. Our methodology helps urban water managers to assess the risk of sewer flooding; this approach does not seek to predict flooding but rather to inform decision makers on the current level of risk and on actions which need to be taken to reduce the risk. This work is based on a comprehensive definition of risk, including territorial vulnerability and perceptions of urban water stakeholders. This paper presents the results and the methodological contributions from implementing the methodology on two case studies: the cities of Lyon and Mulhouse.

We describe a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no prior history of multiple myeloma preceding her transplantation. A 72-year-old woman on hemodialysis for 4 years prior to transplantation due to presumed hypertensive nephrosclerosis developed immediate graft dysfunction posttransplantation. The graft biopsy specimens were consistent with myeloma cast nephropathy for which she was treated with plasmapheresis and chemotherapy using bortezomib and dexamethasone. She achieved partial hematologic remission and recovered excellent graft function by 3 months posttransplantation. This is the first report of successful recovery of renal allograft function after development of cast nephropathy.

This study is an analysis of the effects of reducing long tour lengths for unaccompanied first term enlistees. Basic elements of this analysis include considerations associated with various tour lengths; evaluation of impact on combat readiness with emphasis on turbulence, training, indiscipline, time in service, time in command, remaining service at final assignment; evaluation of costs (dollars, PCS moves and Individuals Account), and other nonquantifiable considerations, i.e., morale, job satisfaction, etc.

Data collected during 1984 from an active animal rabies surveillance system and human rabies post-exposure prophylaxis program at the US Naval Hospital, Subic Bay Naval Facility, Philippines revealed that potential rabies exposure, most commonly from dog bites or scratches, was reported for 311 US military and civilian personnel and four Filipino employees working on the facility. Seventy-nine persons (25 per cent) required complete post-exposure prophylaxis. Brain tissue from two captured dogs implicated in attacks was subsequently found to be positive for rabies antigen on fluorescent antibody testing.

Summary A brief resume of the action, uses and side-effects of Mydrilate is given after live years use in this country. It is shown that Mydrilate's main use is as a routine agent in refraction and diagnosis in which it is superior to homatropine and cocaine, but as a pre-operative agent and as a long-term dilator of the pupil it cannot be compared with more conventional agents, such as atropine. The side effects reported have been 23 cases of transient psychosis and one case of nausea and vomiting. Since there have been only 24 such cases reported in all it must be concluded that Mydrilatc is a very safe preparation. The Ophthalmic Optician.