Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.

A phenomenon called 'piping' often occurs in hydraulics works, involving the formation and evolution of a continuous tunnel between the upstream and the downstream sides. The hole erosion test is commonly used to quantify the rate of piping erosion. However, few attempts have been made to model these tests. From the equations for diphasic flow with diffusion, and the equations of jump with erosion, a piping model is developed. A characteristic time of internal erosion process is proposed. Comparison with experimental data validates our results. To cite this article: S.

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BackgroundThere is an international trend to shorten the postpartum length of stay in hospitals, driven by cost containment, hospital bed availability and a movement toward the ‘demedicalization’ of birth. The aim of this systematic literature review is to determine how early postnatal discharge policies from hospitals could affect health outcomes after vaginal delivery for healthy mothers and term newborns.MethodsA search for systematic reviews, meta-analyses, and primary studies was carried out in OVID MEDLINE, Embase, CINAHL, Econlit and the Cochrane Library (Cochrane Database of Systematic Reviews, DARE and HTA databases). The AMSTAR checklist was used for the quality appraisal of systematic reviews. The quality of the retrieved studies was assessed by the Cochrane Collaboration’s tools. The level of evidence was appraised using the GRADE system.ResultsSeven RCTs and two additional observational studies were found but no comprehensive economic evaluation. Despite variation in the definition of early discharge, the authors of the included studies, concerning early discharge and conventional length of stay, reported no statistical difference in maternal and neonatal morbidity, maternal and neonatal readmission rates, infant mortality, newborn weight gain, neonatal hyperbilirubinemia, or breastfeeding rates. The authors reported conflicting results regarding postpartum depression and competence of mothering, ranging from no difference according to length of stay to better results for early discharge. The level of evidence of the vast majority of outcomes was rated as low to very low.ConclusionsBecause of the lack of robust clinical evidence and full economic evaluations, the current data neither support nor discourage the widespread use of early postpartum discharge. Before implementing an early discharge policy, Western countries with longer length of hospital stay may benefit from testing shorter length of stay in studies with an appropriate design. The issue of cost containment in implementing early discharge and the potential impact on the current and future health of the population exemplifies the need for publicly funded clinical trials in such public health area. Finally, trials testing the range of out-patient interventions supporting early discharge are needed in Western countries which implemented early discharge policies in the past.

Discrete numerical simulations were carried out to reproduce experimental results obtained on loose cohesionless soil samples subjected to triaxial tests. Periodic boundary conditions were adopted and 3D spherical discrete elements were chosen. However, to overcome excessive rolling of such an oversimplified particle's shape, contact rolling resistance was taken into consideration. The influence of both the elastic and the plastic local parameters is discussed. It is shown that the plastic macroscopic behavior of the granular assembly depends only on the plastic parameters at the microscopic scale, and mainly on the plastic rolling moment reflecting the particle's shape. Moreover, a procedure to obtain an initial density, ranging from loose to dense samples, is proposed by adding adhesion at contacts during the preparation phase. Finally, a calibration procedure is proposed to reproduce experimental results and the limitations of the model are discussed.

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International audienceLime treatment is a common technique of improving the workability and geotechnical properties of soils. In this study, the aggregate size effects on the water retention capacity and microstructure of lime-treated soil were investigated. Two soil powders with different maximum aggregate sizes (D max = 0·4 and 5 mm) were prepared and stabilised by 2% lime (by weight of dry soil). Soil samples were prepared by compaction at dry side of optimum water content (w = 17%) with a dry density of 1·65 Mg/m 3. Suction and pore size distribution were determined after different curing periods. The results obtained show that: (a) the treated soil with smaller D max presents relatively smaller modal sizes and lower frequency of macropores (10–330 μm); (b) lime addition effectively improves the soil water retention capacity and decreases both the modal sizes of macro-and micropores gradually over time. Moreover, a higher air entry value and larger water retention capacity were also observed for a smaller D max value, in agreement with the pore size distributions