Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Évaluer la durabilité des exploitations agricoles d'un territoire à l'aide d'une méthode multicritère : intégration des impacts environnementaux et des services écosystémiques

The agriculture was profoundly transformed in France after the Second World War in order to recover food sovereignty. The intensification of agriculture through the use of synthetic products and machinery has had repercussions on ecosystems, human health and the economy. In order to better identify ways to limit the negative impacts of agriculture, methods using indicators have been developed to assess the sustainability of farms. In parallel, a lot of work on ecosystem services has emerged to find out how agriculture can rely on the biological processes of agricultural ecosystems to achieve its ecological transition. This thesis aims to provide knowledge on the joint assessment of environmental impacts and ecosystem services by developing a new method for assessing the sustainability of agricultural systems.Firstly, a state of the art of the literature was carried out on 262 methods of environmental sustainability assessment in agriculture and the themes covered by these methods. This synthesis revealed that very few methods organise their indicators in a conceptual framework. Furthermore, so-called predictive indicators are little used and ecosystem service indicators are rarely integrated into these methods.A conceptual framework was then developed for the new sustainability assessment method of agricultural systems, based on the conceptual framework of the MASC 2.0 method and on the EFESE study for the integration of the concept of farmer’s benefit and ecosystem services. This conceptual framework is composed of 22 themes including 7 benefits, 15 environmental impacts, and each theme is characterised by direct or indirect factors. An analytical framework for the joint assessment of environmental impacts and ecosystem services was also proposed. Finally, to implement the conceptual framework, several innovative indicators of environmental impacts and ecosystem services were designed.Lastly, this new method was applied to a case study of 33 arable farms in the Champagne crayeuse (France). The joint assessment of environmental impacts and ecosystem services made it possible to go further in the characterisation of farms than the simple opposition between conventional and organic farming. Indeed, one farm has interesting potential ES levels and low environmental impacts, while being economically efficient. In order to fully assess the sustainability of farms, the work undertaken during this thesis needs to be extended by further developing the economic and social aspects and by integrating dynamic aspects. Similarly, the results need to be confirmed in other pedoclimatic contexts.L’agriculture a été profondément transformée en France après la seconde guerre mondiale afin de retrouver une souveraineté alimentaire. L’intensification de l’agriculture via l’utilisation de produits de synthèse et de machines a eu des répercussions sur les écosystèmes, la santé des Hommes ainsi que sur l’économie. Afin de mieux comprendre comment limiter les impacts négatifs de l’agriculture, des méthodes utilisant des indicateurs ont été développées pour évaluer la durabilité des exploitations agricoles. En parallèle, de nombreux travaux sur les services écosystémiques sont apparus afin de savoir comment l’agriculture peut s’appuyer sur les processus biologiques des écosystèmes agricoles afin de réaliser sa transition écologique. Cette thèse a pour but d’apporter des connaissances sur l’évaluation conjointe des impacts environnementaux et des services écosystémiques en développant une nouvelle méthode d’évaluation de la durabilité des systèmes agricoles.En premier lieu, un état de l’art de la littérature a été réalisé sur 262 méthodes d’évaluation de la durabilité environnementale en milieu agricole et des thèmes traités par ces méthodes. Cette synthèse a mis en évidence que très peu de méthodes organisent leurs indicateurs dans un cadre conceptuel. De plus, les indicateurs dits prédictifs sont peu utilisés et les indicateurs de services écosystémiques sont rarement intégrés dans ces méthodes.Un cadre conceptuel a ensuite été développé pour la nouvelle méthode d’évaluation de la durabilité des exploitations agricoles en se basant sur le cadre conceptuel de la méthode MASC 2.0 et sur l’étude EFESE pour l’intégration du concept d’avantage pour l’agriculteur et des services écosystémiques. Ce cadre conceptuel est composé de 22 thèmes dont 7 avantages, 15 impacts environnementaux et chaque thème est caractérisé par des facteurs directs ou indirects. Un cadre analytique pour l’évaluation conjointe des impacts environnementaux et des services écosystémiques a aussi été proposé. Enfin, pour mettre en oeuvre le cadre conceptuel, plusieurs indicateurs innovants d’impacts environnementaux et de services écosystémiques ont été conçus.Pour finir, cette nouvelle méthode a été appliquée sur un cas d’étude de 33 exploitations en grandes cultures dans la Champagne crayeuse. L’évaluation conjointe des impacts environnementaux et des services écosystémiques a permis d’aller plus loin dans la caractérisation des exploitations que la simple opposition agriculture conventionnelle versus agriculture biologique. En effet, une exploitation a des niveaux de SE potentiels intéressants et de faibles impacts environnementaux, tout en étant performante économiquement. Afin d’évaluer pleinement la durabilité des exploitations agricoles, le travail entrepris durant cette thèse doit être étendu en développant davantage les volets économique et social et en intégrant des aspects dynamiques. De même les résultats sont à confirmer dans d’autres contextes pédoclimatiques

A predictive indicator assessing effect of cropping system and surrounding landscape on biodiversity

Biodiversity is a key component of agricultural ecosystems and belongs to one of the exceeded planetary boundaries. In the quest for innovation to mitigate impact, it is essential to have tools to assess the anthropogenic impact on biodiversity. In this study, we developed a new indicator, I-BIO that aimed to predict the impacts of management practices and the influence of the landscape on overall biodiversity at species group level. I-BIO encompassed four groups: microorganisms, vegetation, invertebrates and vertebrates. This predictive indicator was built using DEXi software that facilitates the design of hierarchical decision trees, based on input variables in the form of qualitative classes, aggregated using utility functions. I-BIO was constructed using data from a long-term platform in Scotland and then applied to two data sets in France and one in Scotland. The results showed that the lowest class is predominant for all branches especially for invertebrates and soil invertebrates. Monte Carlo sampling was used to test for sensitivity. Then, a validation step was carried out to compare I-BIO outputs with real data using data on the four groups from Scottish and French datasets. I-BIO predictions of weed and soil invertebrate abundance conformed to field data. Due to low numbers of samples, validation of microorganisms, flying invertebrates and vertebrates predictions require more data. Future developments of I-BIO will focus on predictions specifically to assess the impact of management on species richness. Avenues for improvement include a better integration of landscape features and the history of agricultural practices as they both have a great influence on biodiversity

RePP'Air - Comprendre les mécanismes de transferts de produits phytosanitaires dans l'air pour une appropriation par la profession agricole.

The RePP'Air project aims to better understand the processes of transfer of plant protection products inthe air through the implementation of a measurement device on 7 sites in France, associated with surveysof agricultural practices on site. After 4 years of study, the RePP'Air project made it possible to betterunderstand the mechanisms influencing the transfers in the air, to sensitize the farmers and farmersorganisations, so that the agricultural sector appropriates this subject and the existing levers of action.Prospects for further work were also identified. The richness of this project also lies in its unprecedentedpartnership between agricultural actors, air actors, agronomic research and vocational schools, which hasenabled progress to be made on this topic of shared interest.Le projet RePP’Air vise à mieux appréhender les processus de transferts de produits phytosanitaires dansl'air via la mise en place d'un réseau de 7 dispositifs de mesures sur des espaces agricoles français,associé à des enquêtes de pratiques agricoles sur chaque site. Après 4 années d’étude, le projetRePP’Air a permis de mieux comprendre les mécanismes influençant les transferts dans l’air, sensibiliserla profession, de façon à ce que le secteur agricole soit d’approprie ce sujet et les leviers d’actionsexistants pour limiter les risques de transfert. Des pistes de travail à approfondir ont également étéidentifiées. La richesse de ce projet réside aussi dans son partenariat inédit entre les acteurs agricoles,les acteurs de l’air, de la recherche agronomique et de l’enseignement agricole qui a permis d’avancersur cette thématique d’intérêts partagé

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease