Global impacts of heat and water stress on food production and severe food insecurity.

In contrast to most integrated assessment models, with limited transparency on damage functions and recursive temporal dynamics, we use a unique large-dimensional computational global climate and trade model, GTAP-DynW, to directly project the possible intertemporal impacts of water and heat stress on global food supply and food security to 2050. The GTAP-DynW model uses GTAP production and trade data for 141 countries and regions, with varying water and heat stress baselines, and results are aggregated into 30 countries/regions and 30 commodity sectors. Blue water stress projections are drawn from WRI source material and a GTAP-Water database to incorporate dynamic changes in water resources and their availability in agricultural production and international trade, thus providing a more general measure for severe food insecurity from water and heat stress damages with global warming. Findings are presented for three representative concentration pathways: RCP4.5-SSP2, RCP8.5-SPP2, and RCP8.5-SSP3 (population growth only for SSPs) and project: (a) substantial declines, as measured by GCal, in global food production of some 6%, 10%, and 14% to 2050 and (b) the number of additional people with severe food insecurity by 2050, correspondingly, increases by 556 million, 935 million, and 1.36 billion compared to the 2020 model baseline.

Research priorities for the sustainability of coral-rich western Pacific seascapes.

Nearly a billion people depend on tropical seascapes. The need to ensure sustainable use of these vital areas is recognised, as one of 17 policy commitments made by world leaders, in Sustainable Development Goal (SDG) 14 ('Life below Water') of the United Nations. SDG 14 seeks to secure marine sustainability by 2030. In a time of increasing social-ecological unpredictability and risk, scientists and policymakers working towards SDG 14 in the Asia-Pacific region need to know: (1) How are seascapes changing? (2) What can global society do about these changes? and (3) How can science and society together achieve sustainable seascape futures? Through a horizon scan, we identified nine emerging research priorities that clarify potential research contributions to marine sustainability in locations with high coral reef abundance. They include research on seascape geological and biological evolution and adaptation; elucidating drivers and mechanisms of change; understanding how seascape functions and services are produced, and how people depend on them; costs, benefits, and trade-offs to people in changing seascapes; improving seascape technologies and practices; learning to govern and manage seascapes for all; sustainable use, justice, and human well-being; bridging communities and epistemologies for innovative, equitable, and scale-crossing solutions; and informing resilient seascape futures through modelling and synthesis. Researchers can contribute to the sustainability of tropical seascapes by co-developing transdisciplinary understandings of people and ecosystems, emphasising the importance of equity and justice, and improving knowledge of key cross-scale and cross-level processes, feedbacks, and thresholds.

Epidemiological modelling of the health and economic effects of COVID-19 control in Australia's second wave.

Background: We investigated the public health and economy outcomes of different levels of social distancing to control a 'second wave' outbreak in Australia and identify implications for public health management of COVID-19. Methods: Individual-based and compartment models were used to simulate the effects of different social distancing and detection strategies on Australian COVID-19 infections and the economy from March to July 2020. These models were used to evaluate the effects of different social distancing levels and the early relaxation of suppression measures, in terms of public health and economy outcomes. Results: The models, fitted to observations up to July 2020, yielded projections consistent with subsequent cases and showed that better public health outcomes and lower economy costs occur when social distancing measures are more stringent, implemented earlier and implemented for a sufficiently long duration. Early relaxation of suppression results in worse public health outcomes and higher economy costs. Conclusions: Better public health outcomes (reduced COVID-19 fatalities) are positively associated with lower economy costs and higher levels of social distancing; achieving zero community transmission lowers both public health and economy costs compared to allowing community transmission to continue; and early relaxation of social distancing increases both public health and economy costs.

What vaccination rate(s) minimize total societal costs after 'opening up' to COVID-19? Age-structured SIRM results for the Delta variant in Australia (New South Wales, Victoria and Western Australia).

Using three age-structured, stochastic SIRM models, calibrated to Australian data post July 2021 with community transmission of the Delta variant, we projected possible public health outcomes (daily cases, hospitalisations, ICU beds, ventilators and fatalities) and economy costs for three states: New South Wales (NSW), Victoria (VIC) and Western Australia (WA). NSW and VIC have had on-going community transmission from July 2021 and were in 'lockdown' to suppress transmission. WA did not have on-going community transmission nor was it in lockdown at the model start date (October 11th 2021) but did maintain strict state border controls. We projected the public health outcomes and the economic costs of 'opening up' (relaxation of lockdowns in NSW and VIC or fully opening the state border for WA) at alternative vaccination rates (70%, 80% and 90%), compared peak patient demand for ICU beds and ventilators to staffed state-level bed capacity, and calculated a 'preferred' vaccination rate that minimizes societal costs and that varies by state. We found that the preferred vaccination rate for all states is at least 80% and that the preferred population vaccination rate is increasing with: (1) the effectiveness (infection, hospitalization and fatality) of the vaccine; (2) the lower is the daily lockdown cost; (3) the larger are the public health costs from COVID-19; (4) the higher is the rate of community transmission before opening up; and (5) the less effective are the public health measures after opening up.

Health and economic costs of early and delayed suppression and the unmitigated spread of COVID-19: The case of Australia.

We compare the health and economic costs of early and delayed mandated suppression and the unmitigated spread of 'first-wave' COVID-19 infections in Australia in 2020. Using a fit-for-purpose SIQRM-compartment model for susceptible, infected, quarantined, recovered and mortalities on active cases, that we fitted from recorded data, a value of a statistical life year (VSLY) and an age-adjusted value of statistical life (A-VSL), we find that the economic costs of unmitigated suppression are multiples more than for early mandated suppression. We also find that using an equivalent VSLY welfare loss from fatalities to estimated GDP losses, drawn from survey data and our own estimates of the impact of suppression measures on the economy, means that for early suppression not to be the preferred strategy requires that Australia would have to incur more than 12,500-30,000 deaths, depending on the fatality rate with unmitigated spread, to the economy costs of early mandated suppression. We also find that early rather than delayed mandated suppression imposes much lower economy and health costs and conclude that in high-income countries, like Australia, a 'go early, go hard' strategy to suppress COVID-19 results in the lowest estimated public health and economy costs.

Robust estimates of the true (population) infection rate for COVID-19: a backcasting approach.

Differences in COVID-19 testing and tracing across countries, as well as changes in testing within each country over time, make it difficult to estimate the true (population) infection rate based on the confirmed number of cases obtained through RNA viral testing. We applied a backcasting approach to estimate a distribution for the true (population) cumulative number of infections (infected and recovered) for 15 developed countries. Our sample comprised countries with similar levels of medical care and with populations that have similar age distributions. Monte Carlo methods were used to robustly sample parameter uncertainty. We found a strong and statistically significant negative relationship between the proportion of the population who test positive and the implied true detection rate. Despite an overall improvement in detection rates as the pandemic has progressed, our estimates showed that, as at 31 August 2020, the true number of people to have been infected across our sample of 15 countries was 6.2 (95% CI: 4.3-10.9) times greater than the reported number of cases. In individual countries, the true number of cases exceeded the reported figure by factors that range from 2.6 (95% CI: 1.8-4.5) for South Korea to 17.5 (95% CI: 12.2-30.7) for Italy.

Household adoption of energy and water-efficient appliances: An analysis of attitudes, labelling and complementary green behaviours in selected OECD countries.

Using a household-based data set of more than 12,000 households from 11 OECD countries, we analyse the factors underlying the decision by households to adopt energy-efficient and water-efficient equipment. We evaluate the roles of both attitudes and labelling schemes on the adoption of energy and water-efficient equipment, and also the interaction and complementarity between energy and water conservation behaviours. Our findings show: one, 'green' social norms and favourable attitudes towards the environment are associated with an increased likelihood of households' adoption of energy and water-efficient appliances; two, households' purchase decisions are positively affected by their awareness, understanding, and trust of labelling schemes; and three, there is evidence of complementarity between energy conservation and water conservation behaviours.

Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study.

BACKGROUND: Maintenance anti-tumour necrosis factor-α (anti-TNFα) treatment for Crohn's disease is the standard of care for patients with an inadequate response to corticosteroids and immunomodulators. AIM: To compare the efficacy and safety of infliximab and adalimumab in clinical practice and assess the value of concomitant immunomodulator therapy. METHODS: We performed an observational cohort study in consecutive patients with Crohn's disease qualifying for anti-TNFα treatment in Australia and New Zealand between 2007 and 2011. Demographic and clinical data were prospectively recorded to identify independent factors associated with induction and maintenance of response to infliximab or adalimumab, or to either anti-TNFα therapy. RESULTS: Three hundred and twenty-seven patients (183 infliximab, 144 adalimumab) successfully applied for treatment. Eighty-nine percent responded in all groups and median maintenance of response was similar for the two agents. Concomitant immunomodulator with infliximab, but not adalimumab, demonstrated a significantly longer response overall (P = 0.002), and significantly fewer disease and treatment-related complications (P = 0.017). Corticosteroids at baseline, and/or in the preceding 12 months, were associated with a 9-13 times greater risk of disease flare during maintenance treatment as compared to no corticosteroids (P < 0.0001). Maintenance of response was similar in the anti-TNF naïve and anti-TNF experienced subgroups. CONCLUSIONS: In this large, real-life study, we demonstrate infliximab and adalimumab to have similar response characteristics. However, infliximab requires concomitant immunomodulator to achieve optimal maintenance of response comparable to adalimumab monotherapy. The results of this study will assist clinicians in further optimising patient care in their day-to-day clinical practice.

Environmental offsets, resilience and cost-effective conservation.

Conservation management agencies are faced with acute trade-offs when dealing with disturbance from human activities. We show how agencies can respond to permanent ecosystem disruption by managing for Pimm resilience within a conservation budget using a model calibrated to a metapopulation of a coral reef fish species at Ningaloo Reef, Western Australia. The application is of general interest because it provides a method to manage species susceptible to negative environmental disturbances by optimizing between the number and quality of migration connections in a spatially distributed metapopulation. Given ecological equivalency between the number and quality of migration connections in terms of time to recover from disturbance, our approach allows conservation managers to promote ecological function, under budgetary constraints, by offsetting permanent damage to one ecological function with investment in another.

Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease.

BACKGROUND: Body composition is poorly studied in inflammatory bowel disease (IBD). Sarcopenia describes a loss of muscle mass and strength. AIM: To assess the prevalence of low lean mass (LM), sarcopenia and associated morbidity in an adult IBD cohort. METHODS: Cross-sectional data were gathered on pre-menopausal 18- to 50-year-old patients with IBD. Whole-body dual-energy X-ray absorptiometry, anthropometric assessment and grip strength were performed. Low LM was defined as ≥1 s.d. below the population mean for appendicular skeletal muscle index [ASMI (kg)/height (m)²], and sarcopenia as both ASMI and grip strength ≥1 s.d. below population mean. Multivariate regression analyses were performed. RESULTS: Of 137 participants (median age 31 years, BMI 24.8 kg/m(2) ), 56% were male and 69% had Crohn's disease (CD). Low LM and sarcopenia were observed in 21% and 12% of patients, respectively, and osteopenia/osteoporosis in 38% of patients (mean lumbar spine t-score -0.3 ± s.d. 1.1). Grip strength predicted low LM and sarcopenia better than did body mass index (BMI) (OR 4.8 vs. OR 0.7 for low-LM, P < 0.05 both). Normal BMI was falsely reassuring in 72% and 76% of patients with low ASMI and sarcopenia, respectively. Low LM and sarcopenia (OR = 3.6, P = 0.03; OR = 6.3, P = 0.02; respectively), but not BMI nor fat mass, predicted osteopenia/osteoporosis. CONCLUSIONS: Low lean mass and sarcopenia are common in patients with IBD, and important to recognise as they predict osteopenia/osteoporosis. Grip strength testing should be incorporated into routine clinical practice to detect low lean mass deficits, which may go unrecognised using BMI alone.

Water planning and hydro-climatic change in the Murray-Darling Basin, Australia.

More than a third of humanity lives in regions with less than 1 million liters of fresh water per person per year. Population growth will increase water demand while climate change in arid and semi-arid areas may reduce water availability. The Murray-Darling Basin in Australia is a region where water reform and planning have been used to reduce consumptive extraction to better sustain river ecosystems under climate variability. Using actual data and previously published models that account for climate variability and climate change, the trade-off between water extractions and water essential to the long-term ecological function of river systems is analysed. The findings indicate that better water planning and a more complete understanding of the effects of irrigation on regional climate evapotranspiration could: (1) increase the overall benefits of consumptive and non-consumptive water use; (2) improve riparian environments under climate variability; and (3) be achieved with only small effects on the profits and gross value of food and fiber production.

Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem?

BACKGROUND: Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these. AIMS: To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence. METHODS: Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009-2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease. RESULTS: Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1-61). CONCLUSION: Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.

A chronic care model significantly decreases costs and healthcare utilisation in patients with inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic condition, yet the model of care is often reactive. We sought to examine whether a formal IBD service (IBDS) reduced inpatient healthcare utilisation or lowered costs for inpatient care. MATERIAL AND METHODS: With protocols, routine nurse phone follow-up a help-line, more proactive care was delivered, with many symptoms and concerns dealt with prior to routine presentation. Over two five month periods before (2007/8) and after (2009/10) introducing a formal IBDS two discrete cohorts of admitted IBD patients were identified at a single centre. Each patient was assigned five contemporaneously admitted, age and gender matched controls. Inpatient healthcare utilisation was compared between patients and controls and disease-specific factors amongst the two IBD cohorts. RESULTS: The initial audit captured 102 admitted IBD patients (510 controls, median age 44 years, 57% female); the second audit 95 patients (475 controls, median age 46 years, 45.3% female). In 2009/10, the number of admissions was lower in IBD patients than in controls (mean 1.53+/-1.03 vs. 2.54+/-2.35; p<0.0001). This contrasts with the first audit, where IBD patients had more admissions than controls. Following IBDS introduction, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 (US$15,236.79) vs. US$ 30,467.78 (US$ 53,760.20), p=0.005). In addition, patients known to a specialist gastroenterologist (GE) and the IBD Service tended to have the lowest mean number of admissions (GE and IBDS 1.14 (+/-0.36) vs. no GE/IBDS 1.64 (+/-1.25)). CONCLUSIONS: Healthcare utilisation and disease burden in IBD decreased significantly since introducing an IBDS. These data suggest that proactive management improved outcomes. Contact with a gastroenterologist and IBDS seemed to give best results.

Complementarity of no-take marine reserves and individual transferable catch quotas for managing the line fishery of the great barrier reef.

Changes in the management of the fin fish fishery of the Great Barrier Reef motivated us to investigate the combined effects on economic returns and fish biomass of no-take areas and regulated total allowable catch allocated in the form of individual transferable quotas (such quotas apportion the total allowable catch as fishing rights and permits the buying and selling of these rights among fishers). We built a spatially explicit biological and economic model of the fishery to analyze the trade-offs between maintaining given levels of fish biomass and the net financial returns from fishing under different management regimes. Results of the scenarios we modeled suggested that a decrease in total allowable catch at high levels of harvest either increased net returns or lowered them only slightly, but increased biomass by up to 10% for a wide range of reserve sizes and an increase in the reserve area from none to 16% did not greatly change net returns at any catch level. Thus, catch shares and no-take reserves can be complementary and when these methods are used jointly they promote lower total allowable catches when harvest is relatively high and encourage larger no-take areas when they are small.

Confronting uncertainty and missing values in environmental value transfer as applied to species conservation.

The nonuse (or passive) value of nature is important but time-consuming and costly to quantify with direct surveys. In the absence of estimates of these values, there will likely be less investment in conservation actions that generate substantial nonuse benefits, such as conservation of native species. To help overcome decisions about the allocation of conservation dollars that reflect the lack of estimates of nonuse values, these values can be estimated indirectly by environmental value transfer (EVT). EVT uses existing data or information from a study site such that the estimated monetary value of an environmental good is transferred to another location or policy site. A major challenge in the use of EVT is the uncertainty about the sign and size of the error (i.e., the percentage by which transferred value exceeds the actual value) that results from transferring direct estimates of nonuse values from a study to a policy site, the site where the value is transferred. An EVT is most useful if the decision-making framework does not require highly accurate information and when the conservation decision is constrained by time and financial resources. To account for uncertainty in the decision-making process, a decision heuristic that guides the decision process and illustrates the possible decision branches, can be followed. To account for the uncertainty associated with the transfer of values from one site to another, we developed a risk and simulation approach that uses Monte Carlo simulations to evaluate the net benefits of conservation investments and takes into account different possible distributions of transfer error. This method does not reduce transfer error, but it provides a way to account for the effect of transfer error in conservation decision making. Our risk and simulation approach and decision-based framework on when to use EVT offer better-informed decision making in conservation.

Economics of overexploitation revisited.

About 25% of the world's fisheries are depleted such that their current biomass is lower than the level that would maximize the sustained yield (MSY). By using methods not previously applied in the fisheries conservation context, we show in four disparate fisheries (including the long-lived and slow-growing orange roughy) that the dynamic maximum economic yield (MEY), the biomass that produces the largest discounted economic profits from fishing, exceeds MSY. Thus, although it is theoretically possible that maximizing discounted economic profits may cause stock depletions, our results show there is a win-win: In many fisheries at reasonable discount rates and at current prices and costs, larger fish stocks increase economic profits. An MEY target that exceeds MSY and transfers from higher, future profits to compensate fishers for the transition costs of stock rebuilding would help overcome a key cause of fisheries overexploitation, industry opposition to lower harvests.

Marine reserves with ecological uncertainty.

To help manage the fluctuations inherent in fish populations scientists have argued for both an ecosystem approach to management and the greater use of marine reserves. Support for reserves includes empirical evidence that they can raise the spawning biomass and mean size of exploited populations, increase the abundance of species and, relative to reference sites, raise population density, biomass, fish size and diversity. By contrast, fishers often oppose the establishment and expansion of marine reserves and claim that reserves provide few, if any, economic payoffs. Using a stochastic optimal control model with two forms of ecological uncertainty we demonstrate that reserves create a resilience effect that allows for the population to recover faster, and can also raise the harvest immediately following a negative shock. The tradeoff of a larger reserve is a reduced harvest in the absence of a negative shock such that a reserve will never encompass the entire population if the goal is to maximize the economic returns from harvesting, and fishing is profitable. Under a wide range of parameter values with ecological uncertainty, and in the 'worst case' scenario for a reserve, we show that a marine reserve can increase the economic payoff to fishers even when the harvested population is not initially overexploited, harvesting is economically optimal and the population is persistent. Moreover, we show that the benefits of a reserve cannot be achieved by existing effort or output controls. Our results demonstrate that, in many cases, there is no tradeoff between the economic payoff of fishers and ecological benefits when a reserve is established at equal to, or less than, its optimum size.

Resection of a metastatic sternal carcinoma and reconstruction of the chest wall: a case report.

A large metastatic squamous carcinoma of the anterior chest wall was managed by en-bloc resection of the thoracic wall. The extensive defect resulting from the resection was bridged with Marlex mesh superimposed on an omental flap that served as recipient to partial-thickness skin grafts. This composite reconstruction restored an efficient bellows action to the chest cage, manifested by the lack of anterior flailing and postoperative spirometry values, measured at the bedside, that were 75% of those obtained preoperatively. During the initial postoperative period, however, mechanical ventilatory assistance was required to treat an adult respiratory distress syndrome that together with mild anterior flailing made early extubation impossible.