From Rome to Paris: a Call for Strong and Urgent Climate Action

A high-level, international Symposium was held in Rome on 27-29 May to review the realities and risks of climate change, to identify weaknesses in the current negotiating process, to propose policies and measures for rapid and effective climate action and to underline the risks and costs of further delay. The intent is to broaden support for a strong international agreement at the crucial UN Conference on climate, COP 21, which takes place in Paris in November. The Symposium was held on the initiative of President Mikhail Gorbachev, with support of the Italiani Foundation, the European Space Agency and the New Policy Forum. A representative of the Pontifical Council on Justice and Peace attended

Promote flexitarian diets worldwide: Supplementary information to: Governments should unite to curb meat consumption

Marco Springmann and colleagues warn that we must shift to more plant-based ‘flexitarian’ diets if we are to reduce the food system’s projected greenhouse-gas emissions and meet the targets of the 2015 Paris Agreement (Nature 562, 519–525; 2018). We urge countries to work with the United Nations towards a global agreement on food and agriculture that promotes the adoption of such diets, which are more sustainable than meat-based diets and are backed by evidence on healthy eating. Such an agreement would be in line with findings by focus groups in the United States, China, Brazil and the United Kingdom, which indicate that governments should urgently address unsustainable meat consumption (see go.nature.com/2asd1ag). In industrial agriculture, cereals that are edible to humans are fed to animals for conversion into meat and milk. This undermines our food security: rearing livestock is efficient only if the animals convert materials we cannot consume into food we can eat. That means raising them on extensive grasslands, rotating integrated crop-livestock systems and using by-products, unavoidable food waste and crop residues as feed. Feeding animals exclusively on such materials would greatly reduce the availability and hence the consumption of meat and dairy products, as well as the use of water, energy and pesticides — thereby cutting greenhouse-gas emissions

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Interpretation: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. Funding: None