De la vulnérabilité de la parcelle à celle de l'exploitation agricole : un changement d'échelle nécessaire pour l'évaluation économique des projets de gestion des inondations

En France, peu de travaux ont été consacrés à la caractérisation de la vulnérabilité des zones agricoles exposées aux inondations, encore moins à son utilisation dans le cadre d'une évaluation économique de politique de gestion des inondations. Nous proposons dans cet article un modèle conceptuel de la vulnérabilité agricole pouvant servir à une telle évaluation, lorsque les politiques visent à une modification de l'événement physique à l'origine de l'inondation ou à une modification de la vulnérabilité des enjeux exposés à cet événement. / Flood management policies promoted by French government impact agriculture land in two ways. Firstly, they may be designated as potential areas for flood expansion. Secondly, since the 2003 law, local authorities have the right to flood these areas more than those which have been deemed to be more vulnerable (urban areas). Meanwhile, policy-driven appraisals of flood management projects are becoming commonplace in France. This highlights the need to better understand agricultural vulnerability and to develop methods for quantifying it. To introduce our approach, we first present the research conducted by Plan Loire which marks a shift away from existing practices of agriculture vulnerability assessment by considering vulnerability at the farm scale rather than at the plot scale. Based on ex-post flood damage assessment and the results of stakeholders questionnaires in the agricultural sector, forty seven determinants of farm vulnerability to flooding were identified and classified. These determinants were used to draft a guide for farmers. This guide aims to highlight the impacts their farm activities could face in case of flooding and to identify measures to mitigate their vulnerability. At the present, this guide is used along the Rhone River and will be probably used along the Loire River in the future. The current application of these guides to mitigate vulnerability of farms revealed the need for further research which is partly presented here. By focusing on the farming system, we aimed at providing a framework to economically assess agricultural vulnerability to flooding. Firstly, we identified flood effects at the farming system scale including possible interactions with the territorial scale, in order to propose a conceptual model which provides a framework for economic assessment. Finally, we discuss the implications for projects economic appraisal. The provided framework for agricultural vulnerability assessment would enable a selection of most efficient measures to mitigate farm vulnerability using a ratio depending on the agricultural context. It would also help to prioritize projects to reduce vulnerability by economic appraisal at a wider spatial scale such as water basin

Towards an\u2028 EU research and innovation policy agenda for nature-based solutions & re-naturing cities. Final report of the Horizon 2020 expert group on nature-based solutions and re-naturing cities.

1. Nature-based solutions harness the power and sophistication of nature to turn environmental, social and economic challenges into innovation opportunities. They can address a variety of societal challenges in sustainable ways, with the potential to contribute to green growth, 'future-proofing' society, fostering citizen well-being, providing business opportunities and positioning Europe as a leader in world markets. \u2028 2. Nature-based solutions are actions which are inspired by, supported by or copied from nature. They have tremendous potential to be energy and resource-efficient and resilient to change, but to be successful they must be adapted to local conditions. \u2028 3. Many nature-based solutions result in multiple co-benefits for health, the economy, society and the environment, and thus they can represent more efficient and cost-effective solutions than more traditional approaches. \u2028 4. An EU Research & Innovation (R&I) agenda on nature-based solutions will enable Europe to become a world leader both in R&I and in the growing market for nature-based solutions. For this, the evidence base for the effectiveness of nature-based solutions needs to be developed and then used to implement solutions. Both need to be done in conjunction with stakeholders. The potential for transferability and upscaling of solutions also requires further investigation. There is also a need to develop a systemic approach that combines technical, business, finance, governance, regulatory and social innovation. \u2028 5. Four principal goals have been identified that can be addressed by nature-based solutions: �� Enhancing sustainable urbanisation through nature-based solutions can stimulate economic growth as well as improving the environment, making cities more attractive, and enhancing human well-being. \u2028 �� Restoring degraded ecosystems using nature-based solutions can improve the resilience of ecosystems, enabling them to deliver vital ecosystem services and also to meet other societal challenges. \u2028 �� Developing climate change adaptation and mitigation using nature-based solutions can provide more resilient responses and enhance the storage of carbon. \u2028 �� Improving risk management and resilience using nature-based solutions can lead to greater benefits than conventional methods and offer synergies in reducing multiple risks. \u2028 6. Based on the four goals, seven nature-based solutions for R&I actions are recommended to be taken forward by the European Commission and Member States: �� Urban regeneration through nature-based solutions \u2028 �� Nature-based solutions for improving well-being in urban areas \u2028 �� Establishing nature-based solutions for coastal resilience \u2028 �� Multi-functional nature-based watershed management and ecosystem restoration \u2028 �� Nature-based solutions for increasing the sustainability of the use of matter and energy \u2028 �� Nature-based solutions for enhancing the insurance value of ecosystems \u2028 �� Increasing carbon sequestration through nature-based solutions \u2028This report was produced by the Horizon 2020 Expert Group on 'Nature-Based Solutions and Re- Naturing Cities', informed by the findings of an e-consultation and a stakeholder workshop. \u202

Granulocytic Sarcoma in a Nonleukemic Patient: Place of Radiotherapy and Systemic Therapies

Granulocytic sarcoma is a rare extramedullary tumour, which most often occurs in the course of an acute or chronic leukaemia or myeloproliferative disorders. Rarely it is found before peripheral blood or bone marrow evidence of leukemia is present. We report an unusual case of acute paraplegia at first presentation of a spinal epidural granulocytic sarcoma without any haematological disorder. Therapeutic strategies are discussed in the light of the literature

Pancreatic Metastasis from Prostate Cancer

The pancreas is an unusual location for metastases from other primary cancers. Rarely, pancreatic metastases from kidney or colorectal cancers have been reported. However, a variety of other cancers may also spread to the pancreas. We report an exceptional case of pancreatic metastasis from prostate cancer. Differences in management between primary and secondary pancreatic tumors make recognition of metastases to the pancreas an objective of first importance. Knowledge of unusual locations for metastatic spread will reduce diagnostic delay and lead to a timely delivery of an appropriate treatment

Normative Values for Electrochemical Skin Conductances and Impact of Ethnicity on Quantitative Assessment of Sudomotor Function

Background: Sudomotor dysfunction is one of the earliest pathophysiologic abnormalities in diabetes. Sudoscan? (Impeto Medical, Paris, France) was developed as a noninvasive, rapid, and quantitative assessment of sudomotor function and has been shown to be sensitive in the detection of neuropathy. This global collaborative analysis aimed to establish reference values in healthy subjects of different ethnic groups, age, and gender, to define factors potentially affecting results, and to provide standardization of the methodology. Materials and Methods: Data from 1,350 generally healthy study participants who underwent sudomotor function testing were collected and analyzed. The relationship between age, height, weight, gender, glycemic and lipid profiles, ethnicity, and hand and foot electrochemical skin conductance (ESC) was assessed among subgroups of participants. Results: Lower mean hands and feet ESC values were observed in African American, Indian, and Chinese subjects (P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140359/1/dia.2015.0396.pd

La précarité sanitaire vue par les médecins

Maria Melchior et Christophe Adam, copilotes de ce dossier, ont interrogé quatre de leurs collègues médecins. Pratique médicale et difficultés quotidiennes, réflexions personnelles et initiatives « engagées » se mêlent. Chacun livre son témoignage, son ressenti sur ce que rester fidèle au serment d’Hippocrate veut dire dans un contexte de dégradation de l’offre de soins

Lessons from the 2018 drought for management of local water supplies in upland areas : a tracer-based assessment

Funding Information: We would like to acknowledge financial support from the UK Natural Environment Research Council (project NE/P010334/1) via a CASE industrial studentship with Chivas Brothers. David Drummond, Katya Dimitrova-Petrova and Eva Loerke are thanked for assistance with fieldwork, while we acknowledge Dr Aaron Neill for his advice on young water fraction analyses. Trevor Buckley and staff at the Glenlivet Distillery are thanked for on-site assistance and supply of data and abstraction records. We thank Audrey Innes, Dr Bernhard Scheliga, and Dr Ilse Kamerling for their support with the laboratory isotope analysis. Publisher Copyright: © 2020 The Authors. Hydrological Processes published by John Wiley & Sons Ltd. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

The Clinical Variability of Maternally Inherited Diabetes and Deafness Is Associated with the Degree of Heteroplasmy in Blood Leukocytes

Context: Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue. Objective: The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes. Participants: The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A>G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded. Results: A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA1c was also found and remained significant after adjustment for age at molecular sampling and gender. Conclusions: These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD. Heteroplasmy levels are at least one of the determinants of the severity of the phenotype of maternally inherited diabetes and deafness

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

<p>Abstract</p> <p>Background</p> <p>Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.</p> <p>The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome.</p> <p>Methods/Design</p> <p><b>Design</b>: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up.</p> <p><b>Setting</b>: The study will be carried out in the urban primary care setting.</p> <p><b>Study population</b>: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included.</p> <p><b>Measurements</b>: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs.</p> <p>Discussion</p> <p>The results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT01065155</p