Assessing the impact of COVID-19 on liver cancer management (CERO-19).

BACKGROUND & AIMS: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. METHODS: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). CONCLUSIONS: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. LAY SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes

Groundwater salinization in northwestern Germany: A case of anticipatory governance in the field of climate adaptation?

Groundwater salinization due to sea-level rise is a problem that governance actors in coastal areas of the North Sea region have overseen for a long period. As an ecological problem associated with climate change, it can be severely exacerbated by careless water management. This paper studies governance processes, actor perspectives and responses to groundwater salinization and sea-level rise in the East Frisian and Frisian regions of the German North Sea coast. Due to its low-lying landscape, large areas of land remain below sea-level, making groundwater salinization an urgent concern. Our research questions are: (i) What type of anticipatory governance approach can be found with actors in the study region concerning groundwater salinization and climate adaptation challenges? (ii) How can an alternative anticipatory governance approach promote proactive governance processes addressing the complex problem of groundwater salinization in terms of awareness, preparedness, methods, strategies and policy actions? We conducted semi-structured interviews and workshops between 2017 and 2021, including a group of 15 actors from private and civil society organizations as well as authorities on municipal, inter-municipal and state levels. Our study finds that problem awareness in municipalities and regional governance levels in East Frisia and Frisia is low. Current management of groundwater salinization mainly focuses on technical response measures, while precautionary measures are given low priorities. With regard to governance approaches, our study identifies apparent societal challenges of groundwater salinization at the complex interface between water management, human activities and natural processes, and sustainable ways to manage and protect groundwater resources. However, we found indication for a defensive anticipatory governance approach prioritizing risk management and assessing plausible futures. In participatory processes, we discussed possible technical, non-technical and institutional adaptation options for future implementation. Finally, conclusions will be drawn on how knowledge and awareness building can contribute to change actors perspectives on the overseen problem of groundwater salinization and increase adaptiveness

Earth system governance: A research framework

The Earth System Science Partnership, which unites all major global change research programmes, declared in 2001 an urgent need to develop “strategies for Earth System management”. Yet what such strategies might be, how they could be developed, and how effective, efficient and equitable such strategies would be, remains unspecified. It is apparent that the institutions, organizations and mechanisms by which humans currently govern their relationship with the natural environment and global biochemical systems are not only insufficient—they are also poorly understood. This article presents the science programme of the Earth System Governance Project, a new 10-year global research effort endorsed by the International Human Dimensions Programme on Global Environmental Change (IHDP). It outlines the concept of earth system governance as a challenge for the social sciences, and it elaborates on the interlinked analytical problems and research questions of earth system governance as an object of study. These analytical problems concern the overall architecture of earth system governance, agency beyond the state and of the state, the adaptiveness of governance mechanisms and processes as well as their accountability and legitimacy, and modes of allocation and access in earth system governance. The article also outlines four crosscutting research themes that are crucial for the study of each analytical problem as well as for the integrated understanding of earth system governance: the role of power, knowledge, norms and scale

Emerging Countries and the Convention on Biological Diversity

The Convention on Biological Diversity is a dynamic environmental treaty, which deals with global biodiversity governance according to three objectives: the conservation of biological diversity; its sustainable use; and the equitable sharing of the benefits arising from this use. There is no consensual definition of who “emerging countries” are in the CBD negotiations. This chapter looks at Brazil, India, South Africa and China to compare their power to the one of other key players in global biodiversity governance, i.e. the United States, Switzerland, Canada, and Japan, over the period 1992-2013. Emerging countries are found to share a common negotiating agenda, including benefit sharing and the principle of common but differentiated responsibilities. However, they do not necessarily constitute a very homogeneous group: country coalitions may differ according to the topic, and only individual countries regularly appear on the front scene of the CBD negotiations, in particular Brazil and China

Mutations of RAS/RAF Proto-oncogenes Impair Survival After Cytoreductive Surgery and HIPEC for Peritoneal Metastasis of Colorectal Origin.

Adequate selection of patients with peritoneal metastasis (PM) for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains critical for successful long-term outcomes. Factors reflecting tumor biology are currently poorly represented in the selection process. The prognostic relevance of RAS/RAF mutations in patients with PM remains unclear. Survival data of patients with colorectal PM operated in 6 European tertiary centers were retrospectively collected and predictive factors for survival identified by Cox regression analyses. A simple point-based risk score was developed to allow patient selection and outcome prediction. Data of 524 patients with a median age of 59 years and a median peritoneal cancer index of 7 (interquartile range: 3-12) were collected. A complete resection was possible in 505 patients; overall morbidity and 90-day mortality were 50.9% and 2.1%, respectively. PCI [hazard ratio (HR): 1.08], N1 stage (HR: 2.15), N2 stage (HR: 2.57), G3 stage (HR: 1.80) as well as KRAS (HR: 1.46) and BRAF (HR: 3.97) mutations were found to significantly impair survival after CRS/HIPEC on multivariate analyses. Mutations of RAS/RAF impaired survival independently of targeted treatment against EGFR. Consequently, a simple point-based risk score termed BIOSCOPE (BIOlogical Score of COlorectal PEritoneal metastasis) based on PCI, N-, G-, and RAS/RAF status was developed, which showed good discrimination [development area under the curve (AUC) = 0.72, validation AUC = 0.70], calibration (P = 0.401) and allowed categorization of patients into 4 groups with strongly divergent survival outcomes. RAS/RAF mutations impair survival after CRS/HIPEC. The novel BIOSCOPE score reflects tumor biology, adequately stratifies long-term outcomes, and improves patient assessment and selection