Innovative assessment of impacts from industrial activities on the groundwater body quality for improved regional groundwater management

International audienceGroundwater Directive 2006/118/EC (Daughter to Water Framework Directive 2000/60/EC) establishes specific measures in order to prevent and control groundwater pollution. It specifically requires to assess plumes originating from punctual sources such as those due to industrial activities, in order to check if they do not spread and degrade the chemical state of the groundwater bodies. In this context, BRGM (French Geological Survey) supported by the AERMC (Water Agency on the Mediterranean Rhone River basin) has developed an innovative methodologyto assess the impact of industrial activities on the quality of groundwater body. This methodology has been tested and applied on the whole Rhone River basin which covers one quarter of France, five regions and thirty counties. The assessment methodology includes three phases: 1) Inventory of industrial pressures and identification of targeted industrial areas; 2) Assessment of groundwater quality body with respect to industrial contaminants; 3) Assessment of industrial pressures and their impact on the groundwater body. These phases result in technical factsheet on each targeted industrial zone and a proposition for groundwater quality status of each groundwater body of concern. Overall, 57 targeted industrial areas were selected and studied. The assessment of groundwater quality in these zones enabled to identify compounds or groups of compounds causing groundwater degradation. Sixty-five percentage of studied areas were impacted with contaminants (those being by order of importance metals, hydrocarbons, HVOCs and BTEX) originating from around 420 sites. An impact rate (None /local / wide) was attributed for each site / contaminant couple. This " pressure/impact " method enabled to combine industrial data and groundwater data and to give an unprecedented assessment of groundwater quality at the regional scale (contaminated land being mostly managed at the site level in France). It processed numerous groundwater data. The deployment of this innovative methodology at the Mediterranean Rhone River basin scale required a strong engagement with numerous stakeholders (local authorities, regional water agencies, etc.), which in turn fed in the project by providing data and their points of views on the regional-scale project results. The outcomes of this project were used by the AERMC to report groundwater state and quality (with respect to impact from punctual pressures) in compliance with the groundwater directive. The findings enabled to define priority areas where further innovative methodology on regional groundwater body management-encompassing eg multi-sources management, less stringent groundwater objective setting-is currently being developed

Estimating nitrate and pesticide transfer mode within the unsaturated zone of a fluvioglacial aquifer and its implication on spatial and temporal concentration variability

International audienceThe Meyzieu fluvioglacial aquifer of 113 km 2 located at the eastern part of Lyon is intensively exploited and subject to multiple pressures (urban, industrial, agriculture). Nitrate concentrations are quite high while pesticides contamination is low considering the past and today's pressure. A project was initiated in 2011 with the objective of determining the role of the unsaturated zone in the transfer of NO 3 and pesticides from soil to groundwater. Monthly monitoring of major elements, some pesticides, and stable water isotopes is carried out at three sampling points located along the flow lines. Additional information such as hydrogeological functioning, pressure inventory was gathered and additional data from three water sampling campaigns was collected. The temporal variation of NO 3 , metolachlor and metabolites and atrazine and metabolites is quite different at the three monitoring points. At the sampling point located upstream, where the unsaturated zone has a thickness around 40m, the nitrate concentrations are comprised between 20 and 40 mg.l-1 from 2004 to mid-2013. From mid-2013 nitrate concentrations are increasing regularly and are now reaching 70 mg.l-1. This point presents the highest level in atrazine metabolites (DEA) of the area but with concentrations lower than 0.05 µg.l-1 and very low detection of metolachlor or its metabolites. In the centre of the basin, where agriculture pressure is the highest and unsaturated zone of up to 30m in depth, nitrate concentrations are above 50 mg.l-1 with low seasonal variations. Metolachlor is lower than 0.03 µg.l-1 but values of 0,39 µg.l-1 max. of ESA metolachlor (MESA) were reached. Downstream, just before the discharge area, the sampling point shows the lowest and more stable nitrate concentrations (around 40 mg.l-1). The water level in this sector is at less than 20 m deep. Metolachlor have been detected only once while MESA is nearly always detected and can reach 0.24 µg.l-1

Developing a corpus of strategic conversation in The Settlers of Catan

International audienceWe describe a dialogue model and an implemented annotation scheme for a pilot corpus of annotated online chats concerning bargaining negotiations in the game The Settlers of Catan. We will use this model and data to analyze how conversations proceed in the absence of strong forms of cooperativity, where agents have diverging motives. Here we concentrate on the description of our annotation scheme for negotiation dialogues, illustrated with our pilot data, and some perspectives for future research on the issue

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]).Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions.Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997).Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]).Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions.Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997).Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model

Statistical analysis plan for the COMPARE trial: a 3-arm randomised controlled trial comparing the effectiveness of Constraint-induced Aphasia Therapy Plus and Multi-modality Aphasia Therapy to usual care in chronic post-stroke aphasia (COMPARE)

BackgroundWhile high-quality meta-analyses have confirmed the effectiveness of aphasia therapy after stroke, there is limited evidence for the comparative effectiveness of different aphasia interventions. Two commonly used interventions, Constraint-induced Aphasia Therapy Plus (CIAT Plus) and Multi-modality Aphasia Therapy (M-MAT), are hypothesised to rely on diverse underlying neural mechanisms for recovery and may be differentially responsive to aphasia severity. COMPARE is a prospective randomised open-blinded end-point trial designed to determine whether, in people with chronic post-stroke aphasia living in the community, CIAT Plus and M-MAT provide greater therapeutic benefit compared to usual care, are differentially effective according to aphasia severity, and are cost-effective. This paper details the statistical analysis plan for the COMPARE trial developed prior to data analysis.MethodsParticipants (n = 216) are randomised to one of three arms, CIAT Plus, M-MAT or usual care, and undertake therapy with a study trained speech pathologist in groups of three participants stratified by aphasia severity. Therapy occurs for 3 h blocks per day for 10 days across 2 weeks. The primary clinical outcome is aphasia severity as measured by the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ) immediately post intervention. Secondary outcomes include WAB-R-AQ at 12-week follow-up, and functional communication, discourse efficiency, multimodal communication, and health-related quality of life immediately post intervention and at 12-week follow-up.ResultsLinear mixed models (LMMs) will be used to analyse differences between M-MAT and UC, and CIAT-Plus and UC on each outcome measure immediately and at 12 weeks post-intervention. The LMM for WAB-R-AQ will assess the differences in efficacy between M-MAT and CIAT-Plus. All analyses will control for baseline aphasia severity (fixed effect) and for the clustering effect of treatment groups (random effect).DiscussionThis trial will provide relative effectiveness data for two common interventions for people with chronic post-stroke aphasia, and highlight possible differential effects based on aphasia severity. Together with the health economic analysis data, the results will enable more informed personalised prescription for aphasia therapy after stroke.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN 12615000618550 . Registered on 15 June 2016

Statistical analysis plan for the stepped wedge clinical trial Healing Right Way—enhancing rehabilitation services for Aboriginal Australians after brain injury

Background Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. Methods The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL–5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. Discussion The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. Trial registration Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018

Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: A substudy of the very early rehabilitation in SpEech (VERSE) trial

Background: Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. Methods: VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. Results: Two hundred forty-six participants were randomised to Usual Care (n = 81), Usual Care-Plus (n=82), and VERSE (n = 83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. Conclusions: We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. Trial registration: ACTRN 1261300077670