Quantitative Methods for Integrated Food and Nutrition Security Measurement

Despite the importance of Food and Nutrition Security, great challenges remain to be addressed worldwide to reduce and eradicate hunger and malnutrition. The most recent report on the State of Food Insecurity in the World (2018) stated that, for developing regions taken as a whole, the share of undernourished people in the total population has recently increased in the period 2015-17 to 10.9% compared to its lowest (10.6%) in 2015. Although there has been substantial progress in the last decade, almost 821 million people are still undernourished globally. In part, the inability to tackle the problems relates to the lack of timely and more spatially explicit information to inform decision-making, humanitarian and development initiatives. On the other hand, monitoring progress of policies and actions to combat hunger and malnutrition requires innovative and practical measurements that take into account food and nutrition security (FNS) updated information. The availability of joint measurements for FNS is still low for the great demand of information in this subject. Nonetheless, some efforts have initiated in recent years by researchers and practitioners. Thus, in 2017 the Joint Research Centre (JRC) of the European Commission and the International Food Policy Research Institute (IFPRI) jointly organizing an International Conference on Quantitative Methods for Integrated Food and Nutrition Security Measurements. The conference provided a platform for researchers, academics, professionals and decision makers to define the state of the art for quantitative measurement of food and nutrition security (F&NS). The research work and keynotes presented helped identifying the main practical challenges, innovative methods or modeling techniques, and exploring best practices to scale up multi and cross-sectoral F&NS collaboration and coordination at country, regional and global level. Moreover, in hosting an interdisciplinary forum, the conference offered the opportunity for participants to forge innovative partnerships for the development and promotion of improved methodologies to support evidence-based F&NS policies and decision-making. The conference gathered research work mainly from Africa but also from Asia and included 80 participants from Africa, Asia and Europe. This document summarize the presentations, which included keynotes and research projects, included here according to their order in the program of the conference. Research projects presentations are summarized presenting when possible, their main motivation, methods and results, or else their title and authors for those under publication in scientific journals.JRC.D.5-Food Securit

SALMANTICOR study. Rationale and design of a population-based study to identify structural heart disease abnormalities: a spatial and machine learning analysis

[EN]Introduction: This study aims to obtain data on the prevalence and incidence of structural heart disease in a population setting and, to analyse and present those data on the application of spatial and machine learning methods that, although known to geography and statistics, need to become used for healthcare research and for political commitment to obtain resources and support effective public health programme implementation. Methods and analysis: We will perform a cross-sectional survey of randomly selected residents of Salamanca (Spain). 2400 individuals stratified by age and sex and by place of residence (rural and urban) will be studied. The variables to analyse will be obtained from the clinical history, different surveys including social status, Mediterranean diet, functional capacity, ECG, echocardiogram, VASERA and biochemical as well as genetic analysis. Ethics and dissemination: The study has been approved by the ethical committee of the healthcare community. All study participants will sign an informed consent for participation in the study. The results of this study will allow the understanding of the relationship between the different influencing factors and their relative importance weights in the development of structural heart disease

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Invertebrate communities (Collembola and Acari) in soil cover treatments for mine tailings in a long-term field experiment

Assessment of mine rehabilitation strategies including soil cover treatments rely mainly on soil physico-chemical properties or plant performance indices, while much less is known about the response of biological soil properties. This field study evaluated the response of soil mesofauna (Collembola and Acari) in soil cover treatments (mainly subsoil and subsoil) on mine tailings, with or without organic amendments. The field experiment was conducted in large (1 m3 ) units rehabilitated in 2014, and mesofauna in soil cores was assessed 7 years later. The richness of Collembola and Acari as well as the density of Acari increased with organic amendments. Collembola community composition changed with the addition of soil cover and organic amendments. The density and community composition of Acari were strongly positively associated with organic carbon. The density of Euedaphic Collembola decreased, whereas Hemiedaphic and Epedaphic forms increased with soil cover. The contribution of generalist and metal-tolerant species explained the high density of Euedaphic life forms in tailings. Species-specific traits for Collembola and Acari could play an essential role in explaining the response of populations to treatments, such as affinity for C-enriched habitats, food preferences, and sensitivity to heavy metals. Overall, it is recommended to use a multiple diversity indices approach, to collect data on the density and assemblage of mesofauna species to investigate the response of mesofauna communities to soil cover treatments. Mine tailings rehabilitation strategies should focus on improving the nutrient content of soil covers, since it benefits diversity and density of soil fauna </p

European Alien Species Information Network (EASIN): supporting European policies and scientific research

International audienceThe European Alien Species Information Network (EASIN) was launched in 2012 by the European Commission to facilitate the exploration of existing alien species information and to assist the implementation of European policies on biological invasions. At the core of EASIN, there is an inventory of all known alien and cryptogenic species in Europe (the EASIN Catalogue, herein published), which includes relevant information, such as taxonomic classification, pathways of introduction, year and country of first introduction. Spatial records of species occurrence in Europe are stored in the EASIN geo-databases, integrating data from many data providers and the literature. All this information is publicly available through a widget framework, providing easy to use and flexible tools for searching and mapping. The EASIN datasets have been used for pan-European or regional assessments of pathways and gateways of alien invasions, towards the fulfilment of the related targets of the Convention on Biological Diversity and of European policies. Moreover, in support of the new EU Regulation on the prevention and management of the introduction and spread of invasive alien species in Europe, an Early Warning and Rapid Response System is being developed by EASIN

European Alien Species Information Network (EASIN): supporting European policies and scientific research

The European Alien Species Information Network (EASIN) was launched in 2012 to facilitate the exploration of existing alien species information and to assist the implementation of European policies on biological invasions. At the core of EASIN, there is an inventory of all known alien and cryptogenic species in Europe (the EASIN Catalogue, herein published), which includes information on taxonomic classification, pathways of introduction, year and country of first introduction, and native range in Europe. Spatial records of species occurrence in Europe are stored in the EASIN geo-databases, integrating data from many data providers and the literature. All this information is freely provided to the public through a widget framework, providing easy to use and flexible tools for searching and mapping. The EASIN datasets have been used for pan-European or regional assessments of pathways and gateways of alien invasions, towards the fulfilment of the related targets of the Convention on Biological Diversity and of European policies. Moreover, in support of the new EU Regulation on the prevention and management of the introduction and spread of invasive alien species in Europe, an Early Warning and Rapid Response System is being developed by EASIN.JRC.H.1-Water Resource

Development of a prediction model for postoperative pneumonia A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 degrees C; leucocyte count more than 12 000 mu l(-1). RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO(2) values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)