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The COVID-19 pandemic is a major shock to society in terms of health and economy that is affecting both UK and global food and nutrition security. It is adding to the 'perfect storm' of threats to society from climate change, biodiversity loss and ecosystem degradation, at a time of considerable change, rising nationalism and breakdown in international collaboration. In the UK, the situation is further complicated due to Brexit. The UK COVID-19 F ood and N utrition S ecurity project, lasting one year, is funded by the Economic and Social Research Council and is assessing the ongoing impact of COVID-19 on the four pillars of food and nutrition security: access, availability, utilisation and stability. It examines the food system, how it is responding, and potential knock on effects on the UK's food and nutrition security, both in terms of the cascading risks from the pandemic and other threats. The study provides an opportunity to place the initial lessons being learnt from the on-going responses to the pandemic in respect of food and nutrition security in the context of other long-term challenges such as climate change and biodiversity loss.

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PURPOSE: For complex oncological procedures, hospital volume affects short and long-term patient outcome. We examined the association of hospital volume and long-term cancer control after radical prostatectomy. MATERIALS AND METHODS: With a cohort study design, we used the Surveillance, Epidemiology and End Results-Medicare linked files to identify a population based sample of men with newly diagnosed prostate cancer treated primarily with radical prostatectomy. Failure of cancer control was defined as the use of postoperative medical or surgical hormone ablation or treatment with radiation therapy more than 6 months after surgery. RESULTS: A total of 12,635 men underwent radical prostatectomy for incident prostate cancer. After adjusting for age, comorbidity, histological grade and clinical stage, the risk of adjuvant therapy was greater among those treated at low (1 to 33 cases) and medium (34 to 61 cases) volume hospitals than at very high (more than 108 cases) volume hospitals (HR 1.25, p <0.001 and HR 1.11, p =0.023 respectively). CONCLUSIONS: Patients treated at lower volume institutions are at increased risk of initiation of subsequent adjuvant therapy with radiation therapy, medical hormone ablation or orchiectomy. Noted differences in cancer control provide additional evidence regarding issues surrounding the debate over surgical volume standards for the surgical treatment of prostate cancer.

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A 64-year-old man with a remote history of left radical nephrectomy presented with a recurrent mass in the renal bed. Computed tomography findings suggested a mass in the bed of the psoas. On laparoscopic exploration, he had metastasis to the tail of the pancreas. We describe our surgical management and the patient's postoperative course.

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PURPOSE: Upper tract urothelial cancer is rare but studies in the 1970s showed that its incidence was increasing. We evaluated national trends of the incidence and survival of upper tract urothelial neoplasms from 1973 to 1996. MATERIAL AND METHODS: We obtained information on upper tract urothelial neoplasms from 1973 to 1996 from the National Cancer Institute Surveillance, Epidemiology and End Results program. To provide a time comparison we evaluated upper tract urothelial cancer from 1973 to 1984 and 1985 to 1996. We also calculated overall disease specific survival stratified by cancer stage, patient race and gender for the study period overall. RESULTS: A total of 9,072 cases of upper tract urothelial cancer were identified in the Surveillance, Epidemiology and End Results program from 1973 to 1996, including 5,379 of the renal pelvis and 3,678 of the ureter. Comparing age adjusted annual incidence rates revealed an increase in ureteral neoplasms from 0.69 to 0.73/100,000 person-years but no change in the incidence of renal pelvic tumors, while the rate of in situ neoplasms increased from 7. 2% to 23.1%. Overall disease specific 5-year survival was significantly different in regard to tumor stage (95.1% in situ, 88. 9% localized, 62.6% regional and 16.5% distant lesions). Disease specific annual mortality was greater in black than in white individuals and in women than in men (7.4% versus 4.9% and 6.1% versus 4.4%, respectively). CONCLUSIONS: There appears to have been a slight increase in the national incidence of ureteral tumors in the last 23 years. Fortunately we also detected a slight improvement in the overall disease specific survival of patients with upper tract neoplasms.

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PURPOSE: The value of radical prostatectomy for patients with prostate cancer depends on low morbidity and mortality. We assessed whether patient outcome is associated with how many of these procedures are performed at hospitals yearly. MATERIALS AND METHODS: Using the Nationwide Inpatient Sample, which is a stratified probability sample of American hospitals, we identified 66,693 men who underwent radical prostatectomy between 1989 and 1995. Cases were categorized into volume groups according to hospital annual rate of radical prostatectomies performed, including low-fewer than 25, medium-25 to 54 and high-greater than 54. We performed multivariate logistic regression to control for patient characteristics when assessing the associations of hospital volume, in-hospital mortality and resource use. RESULTS: Overall adjusted in-hospital mortality after radical prostatectomy was relatively low (0.25%). However, patients at low volume centers were 78% more likely to have in-hospital mortality than those at high volume centers (adjusted odds ratio 1.78, 95% confidence interval 1.7 to 2.6). Overall length of stay decreased at all hospitals between 1989 and 1995. However, average length of stay was longer and total hospital charges were higher at low than at high volume centers (7.3 versus 6.1 days, p<0.0001, and $15,600 versus $13,500, p<0.0001, respectively). CONCLUSIONS: Hospital volumes inversely related to in-hospital mortality, length of stay and total hospital charges after radical prostatectomy. Further study is necessary to examine the association of hospital volume with other important outcomes, including incontinence, impotence and long-term patient survival after radical prostatectomy.

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CONTEXT: The incidence of prostate cancer and rates of radical prostatectomy increased sharply in the Medicare population (men older than 65 years of age) after the introduction of prostate-specific antigen screening in the late 1980s. PRACTICE PATTERN EXAMINED: Trends in age-specific rates of use of radical prostatectomy in U.S. men between 1989 and 1995. DATA SOURCE: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. RESULTS: Overall, rates of radical prostatectomy more than doubled between 1989 and 1992 (from 78 per 100,000 men to 206 per 100,000 men) but decreased by a third between 1992 and 1995 (to 146 per 100,000 men). The pattern in overall radical prostatectomy rates between 1992 and 1995, however, obscures changes that occurred for men in different age groups. Decreases in radical prostatectomy rates were most dramatic in elderly persons, dropping 51% in men 70 to 74 years of age and 71% in men 75 years of age or older. In contrast, rates in younger men continued to increase between 1992 and 1995, rising 42% in men 45 to 49 years of age and 18% in men 50 to 54 years of age. In each age group, trends in surgery rates mirrored trends in cancer detection rates. CONCLUSIONS: Surgical treatment of prostate cancer in older men is decreasing; however, surgery rates are increasing in younger men. These divergent trends reflect the pattern of prostate cancer detection in clinical practice.

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