Disclosure of sexual abuse by adolescents treated in a psychiatry department.

OBJECTIVES: The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure. METHODS: This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis. RESULTS: Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%). CONCLUSION: This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

Real-time model predictive and rule-based control with green infrastructures to reduce combined sewer overflows.

The impact of integrating large-scale distribution of green infrastructures (GIs) with different real-time control strategies on combined sewer overflows (CSOs) is assessed for the southern area of the City of Montreal's combined sewer system (Canada). An iterative process involving a synthetic design rainfall event and model predictive control (MPC) of the sewer system is developed to distribute GIs according to cost-efficiency and spatial analysis criteria. The distributed GIs are alternatively integrated with static, rule-based control (RBC) and MPC, for which model simulations are performed for a two-month period. The performance of the three strategies is compared in terms of CSO volume and frequency reductions, fulfillment of the outfall environmental priorities and transfer of runoff capture to CSO volume reduction. A gradual increase in GI implementation levels and an alternative scenario of GIs distribution are also considered to assess the performance of the two real-time control (RTC) strategies. By comparing the scenarios where GIs are uniformly distributed with those where no GIs are implemented and omitting the most extreme rainfall event, average CSO volume reduction is about 65%, 82% and 92%, respectively, for static control, RBC and MPC. Moreover, the scenario integrating GIs with MPC is the only one permitting to avoid almost all CSO events and the fulfilment of the outfall environmental priorities. GIs efficiency performance (the transferability between global runoff capture and CSO volume reduction) is also the highest under MPC, even when considering varying GI implementation levels and spatial distribution schemes.

Screening for domestic violence during pregnancy follow-up: evaluation of an intervention in an antenatal service.

To assess the impact of a brief training for obstetricians and midwives about screening for domestic violence during pregnancy follow-up and to identify barriers to a routine enquiry. A monocentric quasi-experimental study was performed in an obstetrics department in Paris, France. We asked patients during their pregnancy follow-up to complete a survey describing their demographic characteristics. They were also asked if a health professional had screened them for domestic violence during the current pregnancy. Exclusion criteria were refusal and inability to complete the survey alone. Health professionals attended a brief training about domestic violence. The intervention provided general information about domestic violence to alert health professionals (prevalence, risk factors, consequences on women's health, pregnancy, and children) and guidelines on screening and how to deal with women disclosing domestic violence. They also had to complete a survey about their knowledge and practice concerning domestic violence. Two months later, patients consulting for their pregnancy follow-up completed the same survey. Health professionals were not aware of the study's aim throughout its course. The primary outcome was the rate of patients screened for domestic violence during pregnancy follow-up. The secondary outcome was the identification of barriers to a routine enquiry. Four hundred ninety-five patients completed the first survey (control group): 21 patients (4.8%) had been screened for domestic violence. Twenty-one health professionals attended the intervention. Eight (38.1%) stated that they never screened for domestic violence, and 3 (14.3%) stated that they always did. Three hundred ninety-five patients completed the second survey (experimental group): 17 patients (4.3% vs 4.8%, p = 0.53) stated that they had been screened for domestic violence. The main barriers to screening mentioned by health professionals were the presence of the partner, the lack of awareness of the need to screen, uncomfortable feelings, and the difficulty to identify victims. There was no increased screening for domestic violence during pregnancy follow-up after a brief training of obstetricians and midwives. An early training during medical studies or more extensive training for professionals could be more efficient.

A smart predictive framework for system-level stormwater management optimization.

This study presents a global real-time control (RTC) approach for sustainable and adaptive management of stormwater. A network of inter-connected devices are assumed to dynamically generate the required set-points for the system actuators at the remote control center where global optimization algorithms calculate real-time operational decision-making target values. These target values activate the local controllers to manipulate the spatially distributed detention basin's outlets enabling a smart catchment scale optimal control. A real world watershed with four outlets to a nearby watercourse is chosen to test the applicability and efficiency of the proposed dynamic control approach, based on model simulation results. Results show that the proposed autonomous control approach has the ability to enhance the global performance of the stormwater management system in terms of quality and quantity to balance the network flow dynamics and environmental demands, while reducing the potential for erosion of receiving water bodies. Climate change is specifically discussed as a challenge for the designed control framework. Although, the performance criteria are shown to be affected by the increased rainfall intensities compared to actual rainfall scenarios, the proposed methodology still improves the peak flow reduction and detention time of water, at global scale, up to 54% and 14 h respectively under climate change conditions.

Male sexual assaults in the Paris, France area: An observational study over 8 years.

BACKGROUND: Male sexual assaults were long ignored, possibly because of the myth acceptance that a man can only be the perpetrator of sexual assaults. It is increasingly admitted that all males can be victims of rape. We described the characteristics of a series of male adolescent and adult victims of sexual assault who had a forensic medical examination. METHODS: We conducted an observational study over 8 years. RESULTS: We included 98 male patients aged 15 years and older (range 15-66, median 25) at the time of a reported sexual assault. Assailants were known by the victim in 59 cases (60%). Forty-four patients (45%) had physical or mental vulnerability. Anal penetration was reported in 49 cases (50%). Genital examination showed abnormalities compatible with traumatic injuries in 23 cases (24%). Psychological symptoms were found in 81 victims (83%), including shame (39, 40%) and anxiety (38, 39%). Of 98 victims, sperm could be detected in 6 cases (6%) (anal, 4; oral, 1; skin, 1). Male victims were more frequently disabled or vulnerable than female victims examined in the same centre (45% vs. 13%, p<0.001). At the one-month follow-up consultation, psychological symptoms, including sleep disorders and fear, were observed in most patients and the proportions of physical and psychological complaints were similar among male and female victims. CONCLUSION: Male victims of sexual assault experienced high level of psychological trauma and felt more ashamed than women, which suggests that sexual assaults should be considered as severe among men as among women.

Modeling cadmium exchange by an aquatic moss (Fontinalis dalecarlica).

Although aquatic mosses are widely used as metal biomonitors in rivers, there are few effective models to describe metal uptake and loss by these plants. To fill this gap, we exposed the aquatic moss Fontinalis dalecarlica for 28 d to three Cd concentrations (approximately 5-50 nM) in a flow-through laboratory system. Cadmium accumulation by F. dalecarlica was rapid during the first few days of exposure and slowed thereafter but did not reach a steady state within our 1-month long experiment. This lack of a plateau in moss concentrations suggests that, for biomonitoring purposes, the duration of moss exposure should be considered either through a model of the type that we tested or by standardizing the exposure time of mosses transplanted in the field. During the subsequent 22-d elimination phase of our experiment, Cd concentrations in mosses did not return to their initial levels. This result suggests that a two-compartment model is likely to be more effective at describing Cd losses than would a one-compartment alternative. Indeed, predictions of a two-compartment model closely fitted our experimental data, which augurs well for the wider use of this model for other moss species and metals.