High energy and fertilizer prices are more damaging than food export curtailment from Ukraine and Russia for food prices, health and the environment.

Higher food prices arising from restrictions on exports from Russia or Ukraine have been exacerbated by energy price rises, leading to higher costs for agricultural inputs such as fertilizer. Here, using a scenario modelling approach, we quantify the potential outcomes of increasing agricultural input costs and the curtailment of exports from Russia and Ukraine on human health and the environment. We show that, combined, agricultural inputs costs and food export restrictions could increase food costs by 60-100% in 2023 from 2021 levels, potentially leading to undernourishment of 61-107 million people in 2023 and annual additional deaths of 416,000 to 1.01 million people if the associated dietary patterns are maintained. Furthermore, reduced land use intensification arising from higher input costs would lead to agricultural land expansion and associated carbon and biodiversity loss. The impact of agricultural input costs on food prices is larger than that from curtailment of Russian and Ukrainian exports. Restoring food trade from Ukraine and Russia alone is therefore insufficient to avoid food insecurity problem from higher energy and fertilizer prices. We contend that the immediacy of the food export problems associated with the war diverted attention away from the principal causes of current global food insecurity.

How different COVID-19 recovery paths affect human health, environmental sustainability, and food affordability: a modelling study.

BACKGROUND: The COVID-19 pandemic arrived at a time of faltering global poverty reduction and increasing levels of diet-related diseases, both of which have a strong link to poor outcomes for those with COVID-19. Governments responded to the pandemic by placing unprecedented restrictions on internal and external movements, which have resulted in an economic contraction. In response to the economic shock, G20 governments have committed to providing US$14 trillion stimuli to support economic recovery. We aimed to assess the impact of different COVID-19 recovery paths on human health, environmental sustainability, and food sustainability. METHODS: We used LandSyMM, a global gridded land use change model, to analyse the impact of recovery paths from COVID-19. The paths were illustrated by four scenarios that represent different pandemic severities (including a single or recurrent pandemic) and alternate modes of recovery, including a transition of food demand towards healthier diets that result in changes to the food system: (1) solidarity and celery, (2) nothing new, (3) fries and fragmentation, and (4) best laid plans. For each scenario, we modelled the economic shocks of the pandemic and the impact of policy measures to promote healthier diets in the years after the COVID-19 pandemic, including the supply of and demand for food, environmental outcomes, and human health outcomes. The four scenarios use established future population growth and economic development projections derived from the Shared Socioeconomic Pathways 2. We quantified the outcomes from more societally cooperative pandemic responses that result in reduced trade barriers and improved technological development against less cooperative responses. FINDINGS: Repeated pandemic shocks (the fries and fragmentation and best laid plans scenarios) reduce the ability of the lowest income countries to ensure food security. A post-pandemic recovery that includes dietary transition towards the consumption of less meat and more fruits and vegetables (the solidarity and celery scenario) could prevent 2583 premature deaths per million in 2060, whereas recovery paths that are focused on economic recovery (the fries and fragmentation scenario) could trigger an additional 778 deaths per million in 2060. The transition of dietary preferences towards healthier diets (the solidarity and celery scenario) also reduces nitrogen fertiliser use by 40 million tonnes and irrigation water by 400 km3 compared with no dietary change in 2060 (the nothing new scenario). Finally, the scenario with dietary transition increases the affordability of the average diet. INTERPRETATION: The economic impact of the COVID-19 pandemic is most visible in low-income countries, where a reduction in growth projections makes a greater difference to the affordability of a basic diet. A change in dietary preferences is most impactful in reducing mortality and the burden of disease when income levels are high. At lower income, a transition towards lower meat consumption reduces undernourishment and diet-related mortality. FUNDING: The Global Food Security's Resilience of the UK Food System Programme project, with support from the Biotechnology and Biological Sciences Research Council, Economic and Social Research Council, Natural Environment Research Council, and the Scottish Government.

Cost-effectiveness of indocyanine green angiography in postmastectomy breast reconstruction.

BACKGROUND: Mastectomy skin flap necrosis is a major complication of skin- or nipple-sparing mastectomy. Indocyanine green angiography (ICGA) is a novel technology that can identify flaps at risk of necrosis, but there is paucity of cost-effectiveness data particularly in the Australian context. We evaluated its cost-effectiveness in breast reconstruction surgery. METHODS: Single-institution retrospective study of 295 implant-based breast reconstructions using ICGA compared with 228 reconstructions without ICGA from 2015 to 2020. Costs were calculated using Medicare item numbers and micro-costing analysis. Break-even point analysis determined the number needed to break-even. Cost-utility analysis compared probabilities of ischaemic complications and utility estimates derived from surveys of surgeons to fit into a decision model. RESULTS: There were 295 breast reconstructions using ICGA with a total cost of AU$164,657. The average cost of treating an ischaemic complication was AU$21,375. Use of ICGA reduced the ischaemic complication rate from 14.9% to 8.8%. Ischaemic complications were prevented in 18 breasts resulting in gross cost savings of AU$384,745 and net savings of AU$220,088. Three hundred eighteen cases using ICGA are needed to break-even. The decision model demonstrated a baseline cost difference of AU$1,179, a quality-adjusted life-years (QALY) difference of 1.77, and an incremental cost-utility ratio (ICUR) of AU$656 per QALY favouring ICGA. CONCLUSIONS: Routine use of ICGA during implant-based breast reconstruction is a cost-effective intervention for the reduction of ischaemic complications in the Australian setting. ICGA use was associated with a gain of 1.77 additional years of perfect health at a cost of AU$656 more per year.

A meta-analysis of CD274 (PD-L1) assessment and prognosis in colorectal cancer and its role in predicting response to anti-PD-1 therapy.

BACKGROUND: PD-1 checkpoint inhibitors are novel therapeutic agents in colorectal cancer (CRC). Immunohistochemical staining for CD274 assessment is standardised in upper GI cancer, but not in CRC. METHODS: Methodologies of relevant studies were scrutinized and meta-analysis of survival and CD274/PDCD1 performed. Furthermore, anti-PD-1 therapy clinical trial results in CRC were assessed with particular emphasis on CD274 assessment. RESULTS: 24 studies were included. CD274 on immune cells was associated with good prognosis. CD274 on tumour cells has heterogenous outcomes and does not meet requirements of a prognostic marker. As a marker of response to anti-PD-1 therapy, CD274 assessment is not standardised in CRC. CONCLUSION: CD274 does not appear useful as a prognostic marker. As a marker of response to anti-PD-1 therapy, assessment methodology requires standardisation. As the Combined Positive Score (CPS) is used in upper GI cancer, this seems a logical method to adopt. Thresholds for CRC remain to be determined.

Modelling the perennial energy crop market: the role of spatial diffusion.

Biomass produced from energy crops, such as Miscanthus and short rotation coppice is expected to contribute to renewable energy targets, but the slower than anticipated development of the UK market implies the need for greater understanding of the factors that govern adoption. Here, we apply an agent-based model of the UK perennial energy crop market, including the contingent interaction of supply and demand, to understand the spatial and temporal dynamics of energy crop adoption. Results indicate that perennial energy crop supply will be between six and nine times lower than previously published, because of time lags in adoption arising from a spatial diffusion process. The model simulates time lags of at least 20 years, which is supported empirically by the analogue of oilseed rape adoption in the UK from the 1970s. This implies the need to account for time lags arising from spatial diffusion in evaluating land-use change, climate change (mitigation or adaptation) or the adoption of novel technologies.