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Purpose: To determine the feasibility of replacing the mid treatment cone beam computed tomography (MT CBCT) image with Intrafraction Imaging (IFI) acquired concurrently during dose delivery in lung Stereotactic Ablative Body Radiation therapy (SABR) patients, and thus improve treatment efficiency. Methods and Materials: A review of departmental imaging data was performed on ten lung SABR patients treated with dual arc volumetric modulated arc therapy (VMAT) on an Elekta Versa HD linear accelerator with XVI imaging software.IFI data was extracted and a database of the translational (TX, TY, TZ) and the rotational (RX, RY, RZ) position errors was created for retrospective comparison, with the values of the MT CBCT for the same patients, treated between March 2021 and March 2022 at our center. The data was evaluated for correlation between the values in all 6° of freedom. Results: The inter-class correlation (ICC) coefficient for Tx was 0.89 (95% CI, 0.80-0.94), Ty was 0.69 (95% CI, 0.49-0.82), Tz was 0.89 (95% CI, 0.82-0.95) in the translational planes, and Rx was 0.79 (95% CI, 0.65-0.88), Ry was 0.79 (95% CI, 0.65-0.88), and Rz was 0.91 (95% CI, 0.84-0.95) in rotational planes.The Bland-Altman (BA) statistics for Tx had a bias of –1.22 × 10−3, with an upper limit of agreement (UOA) of 0.07, and a lower limit of agreement (LOA) of –0.07, for Ty the bias was 0.01 (UOA: 0.18; LOA: –0.16), Tz bias was 2.6 × 10−3(UOA: 0.10; LOA: –0.09), Rx bias was 0.09 (UOA: 0.82; LOA: –0.64), Ry bias was –0.04 (UOA: 1.08; LOA: –1.16) and Rz was –0.03 (UOA: 0.44; LOA: –0.51). Conclusions: The ICC was excellent for Tx, Tz, Rx, y, z, and good for Ty. The data demonstrated promising correlation between IFI and MT CBCT values, and therefore supports the use of IFI for clinical decision making and improving treatment efficiency.

Summary: Food system innovations will be instrumental to achieving multiple Sustainable Development Goals (SDGs). However, major innovation breakthroughs can trigger profound and disruptive changes, leading to simultaneous and interlinked reconfigurations of multiple parts of the global food system. The emergence of new technologies or social solutions, therefore, have very different impact profiles, with favourable consequences for some SDGs and unintended adverse side-effects for others. Stand-alone innovations seldom achieve positive outcomes over multiple sustainability dimensions. Instead, they should be embedded as part of systemic changes that facilitate the implementation of the SDGs. Emerging trade-offs need to be intentionally addressed to achieve true sustainability, particularly those involving social aspects like inequality in its many forms, social justice, and strong institutions, which remain challenging. Trade-offs with undesirable consequences are manageable through the development of well planned transition pathways, careful monitoring of key indicators, and through the implementation of transparent science targets at the local level.

Summary: Background: Current diets are detrimental to both human and planetary health and shifting towards more balanced, predominantly plant-based diets is seen as crucial to improving both. Low fruit and vegetable consumption is itself a major nutritional problem. We aim to better quantify the gap between future fruit and vegetable supply and recommended consumption levels by exploring the interactions between supply and demand in more than 150 countries from 1961 to 2050. Methods: In this global analysis, we use the International Model for Policy Analysis of Agricultural Commodities and Trade, which simulates the global agricultural sector, to explore the role of insufficient production of fruits and vegetables and the effects of food waste and public policy in achieving recommended fruit and vegetable consumption. First, we estimate the average historical (1961–2010) and future (2010–50) national consumption levels needed to meet WHO targets (a minimum target of 400 g/person per day or age-specific recommendations of 330–600 g/person per day) using population pyramids; for future consumption, we use projections from the Shared Socioeconomic Pathways (SSPs), a set of global socioeconomic scenarios characterised by varied assumptions on economic and population growth. We then simulate future fruit and vegetable production and demand to 2050 under three such scenarios (SSP1–3) to assess the potential impacts of economic, demographic, and technological change on consumer and producer behaviour. We then explore the potential effects of food waste applying various waste assumptions (0–33% waste). Finally, we apply two policy analysis frameworks (the NOURISHING framework and the Nuffield ladder) to assess the current state of public policy designed to achieve healthy diets. Findings: Historically, fruit and vegetable availability has consistently been insufficient to supply recommended consumption levels. By 2015, 81 countries representing 55% of the global population had average fruit and vegetable availability above WHO's minimum target. Under more stringent age-specific recommendations, only 40 countries representing 36% of the global population had adequate availability. Although economic growth will help to increase fruit and vegetable availability in the future, particularly in lower-income countries, this alone will be insufficient. Even under the most optimistic socioeconomic scenarios (excluding food waste), many countries fail to achieve sufficient fruit and vegetable availability to meet even the minimum recommended target. Sub-Saharan Africa is a particular region of concern, with projections suggesting, by 2050, between 0·8 and 1·9 billion people could live in countries with average fruit and vegetable availability below 400 g/person per day. Food waste is a serious obstacle that could erode projected gains. Assuming 33% waste and socioeconomic trends similar to historical patterns, the global average availability in 2050 falls below age-specific recommendations, increasing the number of people living in countries with insufficient supply of fruits and vegetables by 1·5 billion compared with a zero waste scenario. Interpretation: Increasing fruit and vegetable consumption is an important component of a shift towards healthier and more sustainable diets. Economic modelling suggests that even under optimistic socioeconomic scenarios future supply will be insufficient to achieve recommended levels in many countries. Consequently, systematic public policy targeting the constraints to producing and consuming fruits and vegetables will be needed. This will require a portfolio of interventions and investments that focus on increasing fruit and vegetable production, developing technologies and practices to reduce waste without increasing the consumer cost, and increasing existing efforts to educate consumers on healthy diets. Funding: The Commonwealth Scientific and Industrial Research Organisation; Climate Change, Agriculture and Food Security (CGIAR) Research Program on Climate Change, Agriculture and Food Security; CGIAR Research Program on Policy, Institutions, and Markets; Bill & Melinda Gates Foundation; and Johns Hopkins University.

Summary: Background: Increasing atmospheric concentrations of carbon dioxide (CO2) affect global nutrition via effects on agricultural productivity and nutrient content of food crops. We combined these effects with economic projections to estimate net changes in nutrient availability between 2010 and 2050. Methods: In this modelling study, we used the International Model for Policy Analysis of Agricultural Commodities and Trade to project per capita availability of protein, iron, and zinc in 2050. We used estimated changes in productivity of individual agricultural commodities to model effects on production, trade, prices, and consumption under moderate and high greenhouse gas emission scenarios. Two independent sources of data, which used different methodologies to determine the effect of increased atmospheric CO2 on different key crops, were combined with the modelled food supply results to estimate future nutrient availability. Findings: Although technological change, market responses, and the effects of CO2 fertilisation on yield are projected to increase global availability of dietary protein, iron, and zinc, these increases are moderated by negative effects of climate change affecting productivity and carbon penalties on nutrient content. The carbon nutrient penalty results in decreases in the global availability of dietary protein of 4·1%, iron of 2·8%, and zinc of 2·5% as calculated using one dataset, and decreases in global availability of dietary protein of 2·9%, iron of 3·9%, and zinc of 3·4% using the other dataset. The combined effects of projected increases in atmospheric CO2 (ie, carbon nutrient penalty, CO2 fertilisation, and climate effects on productivity) will decrease growth in the global availability of nutrients by 19·5% for protein, 14·4% for iron, and 14·6% for zinc relative to expected technology and market gains by 2050. The many countries that currently have high levels of nutrient deficiency would continue to be disproportionately affected. Interpretation: This approach is an improvement in estimating future global food security by simultaneously projecting climate change effects on crop productivity and changes in nutrient content under increased concentrations of CO2, which accounts for a much larger effect on nutrient availability than CO2 fertilisation. Regardless of the scenario used to project future consumption patterns, the net effect of increasing concentrations of atmospheric CO2 will slow progress in decreasing global nutrient deficiencies. Funding: US Environmental Protection Agency, Consultative Group on International Agricultural Research (CIGAR) Research Program on Policies, Institutions and Markets (PIM), and the CGIAR Research Program on Climate Change and Food Security (CCAFS).

Summary: Background: Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives. Methods: In this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25–100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25–100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change. Findings: Following environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10–13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9–11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by