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This study aimed to compare the environmental and financial impact of cochlear implantation performed with and without general anaesthesia.
Methods
Two cochlear implant procedures performed on the same day by the same surgical and anaesthetic teams were prospectively evaluated: one under total intravenous anaesthesia with bispectral index monitoring, and one under local anaesthesia with propofol sedation. Anaesthetic drugs, consumables, equipment, electricity use and procedural duration were recorded. Financial costs were estimated using procurement data and national formularies. Carbon dioxide equivalent emissions were calculated using published conversion factors.
Results
Local anaesthesia was associated with lower cost (£59 vs. £179) and lower carbon footprint (2.85 vs. 5.28 kg carbon dioxide equivalent). Procedural duration was similar between pathways (71 vs. 74 minutes).
Conclusion
Cochlear implantation without general anaesthesia may reduce environmental and financial cost without prolonging procedural duration. Anaesthetic pathway selection represents a modifiable determinant of resource use in otological practice.
To examine and synthesise data on the environmental impact of diet in Latin America.
Design:
A systematic review was conducted in April 2024, using Medline, Embase, Web of Science and Scopus databases, and updated in March 2025. We synthesised the evidence on the most reported environmental impact indicators. Meta-analysis was conducted to derive pooled estimates for individual countries of the mean dietary carbon and water footprints per person/per day; crude and energy-standardised (to 8368 kJ (2000 kcal)) values and stratified by dietary assessment method and sociodemographic variables.
Setting:
Latin America.
Participants:
Latin American populations.
Results:
Of the 2766 studies screened, 31 were included. Data on environmental impact of diet were reported for eight Latin American countries, with most coming from Brazil. Dietary water footprint ranged from 2078 in Chile to 3215 L/person/day/8368 kJ in Brazil. Dietary carbon footprint ranged from 2·1 to 7·3 kgCO2-equivalents/person/day/8368 kJ, in Peru and Argentina, respectively. The pooled standardised carbon footprint mean was 4·1 (95 % CI 2·6, 5·5, I2 = 100 %) kgCO2-equivalents/person/day/8368 kJ with no significant differences between dietary assessment method (P = 0·86). A higher carbon footprint was observed in individuals with higher education level and urban residence (P < 0·05).
Conclusion:
The available evidence suggested a wide variation in dietary environmental impact between Latin American countries, but a paucity of studies conducted in countries other than Brazil. Standardised approach to estimate the environmental impact of diet across the region and analytical perspectives in further research would support the development of country-relevant evidence-based public policies for sustainable diets in Latin America.
We surveyed economics and finance professionals on the transition to a low-carbon economy, assessing risks, opportunities and stakeholder responsibilities. Findings reveal that respondents view the transition as an opportunity for the financial sector, with a modest increase in banking risks. Most respondents agreed that governments hold the primary responsibility for climate mitigation policies, with carbon tax as the favoured solution. Additionally, respondents perceived the COVID-19 pandemic to have a neutral or positive impact on the transition, while the Ukraine war to have a strong negative impact. Notably, opinions differ based on environmental consciousness and professional roles, with environmentally conscious individuals expressing more optimism.
The political consequences of climate change have been topics at numerous political science conferences. Contrary to the plurality of discussions at these meetings, it is striking that there is no systematic account of the carbon footprint of political science conferences themselves. Applying a GIS-based approach I estimate the travel induced greenhouse gas emissions of the last six ECPR General Conferences (2013–18). The results show that for the five conferences that took part in Europe the average emissions per attendee were between 0.5–1.3 tons CO2-equivalents. At the 2015 conference in Montreal it were even 1.9–3.4 tons. Compared to estimations based on the latest IPCC reports which call for a reduction of per capita emissions to 2.5 tons by 2030 and even 0.7 tons by 2050 in order to keep on track with the 1.5-degree goal, the travel induced GHG-emissions of ECPR conferences are very high. Yet, further estimations demonstrate that significant emission reductions are possible: by choosing more central conference venues, promoting low-emission landbound means of transportation and introducing online participation for researchers from far away, the carbon footprint could be reduced by 75–90 per cent. The article also gives concrete recommendations how the carbon footprint of conferences could be reduced.
Electrochemical systems are rapidly evolving beyond traditional water electrolysis, including cathodic hydrogen evolution (HER) and anodic oxygen evolution (OER) reactions, to enhance energy efficiency and generate value-added products simultaneously. Cathodic reactions now facilitate multifunctional reductions – ranging from CO2 conversion into oxygenates and hydrocarbons to nitrogen (N2) fixation, and nitrate (NO3−) reduction – by tuning operational parameters. Hybrid co-reduction approaches, such as CO2/nitrile or CO2/nitrate, further enable the synthesis of valuable amines, amides and urea derivatives, among many others. Notably, even in the most advanced electrochemical configurations, the inclusion of the OER – or a functionally equivalent alternative – remains the most convenient oxidation reaction for maintaining charge balance within the cell. As highlighted in recent studies, alternative oxidation reactions (AORs) coupled with cathodic reduction reactions, such as CO2RR, HER, N2RR and NO3RR, are essential for overcoming the limitations of OER. These AORs include oxidation of biomass-derived alcohols and aldehydes, chlorine and water contaminants. In this perspective, we discuss the emerging promise of AORs – with a particular focus on aldehyde electrooxidation – as innovative alternatives to traditional OER. This strategy not only reduces the energy requirements for electrochemical hydrogen production by circumventing the sluggish and energy-intensive OER, but also enables concurrent hydrogen generation at both electrodes. Additionally, integrating AORs into electrolyzer design enables the direct coupling of CO2 reduction at the cathode with high-value chemical transformations at the anode, offering new opportunities for process intensification and enhanced economic viability in the synthesis of sustainable fuels and chemicals.
Agriculture is a major contributor to climate change, and there is an urgent need to reduce greenhouse gas (GHG) emissions from agriculture for mitigation purposes. Modern industrial agriculture has been recognized as a significant source of agricultural GHG emissions, whereas the adoption of regenerative organic agriculture has been proposed as a solution with the potential to reduce GHG emissions from agricultural production. However, there is a lack of on-the-ground studies reporting on the climate impacts of organic agriculture. To remedy this, a carbon footprint (CF) analysis was conducted comparing regionally representative organic and conventional arable cropping systems at Rodale Institute’s Farming Systems Trial in Pennsylvania, USA. Two separate modeling approaches were used to construct CFs for three agricultural systems (two organic and one conventional). The baseline CF analyses used an Intergovernmental Panel on Climate Change Tier 3 model (COMET-Farm) and Tier 2 model (Cool Farm Tool) for comparison purposes. Secondary analyses were conducted on the effects of CO2 emissions from composting manure on CFs. Emission metrics were generally higher (+27%) using the Tier 3 model compared with the Tier 2 model. In the baseline analysis, absolute area-scaled emissions were highest in the conventional system, ranging from 1.25 to 1.72 tons CO2-eq ha−1 yr−1. In comparison, emissions in the organic manure-based system were 25%–37% lower (0.94–1.09 tons CO2-eq ha−1 yr−1), while the organic legume-based system had the lowest emissions, which were 52%–74% lower (0.33–0.83 tons CO2-eq ha−1 yr−1). Yield-scaled emissions of maize in the baseline analyses were highest in the conventional system (0.19–0.26 kg CO2-eq kg−1), followed by the organic manure (0.13–0.16 kg CO2-eq kg−1) and organic legume (0.07–0.17 kg CO2-eq kg−1). Yield-scaled emissions on a feed digestible energy basis were highest in the conventional system (0.014–0.020 kg CO2-eq MJ−1) but were similar between organic manure (0.009–0.010 kg CO2-eq MJ−1) and organic legume (0.006–0.015 kg CO2-eq MJ−1). Including estimates of CO2 emissions due to composting increased emissions for the manure-based organic system substantially (+103%–122%). Our results imply that regenerative organic farming can help mitigate climate change. Future research should focus on more accurately measuring emissions from compost production and other sources of organic fertility, conducting a full life-cycle assessment of these systems, and verifying the results using in-situ field measurements.
Food production represents a complex sustainability challenge, including climate change and freshwater scarcity. In order to promote the incorporation of sustainable prepared protein dishes into the agrifood market, this study aims to assess the environmental performance of three different burgers: a beef burger, a plant-based burger (soy, beans, and rice), and a hybrid burger (50–50 composition) by comparing the water use and the CO2 emissions relative to their nutritional value. The environmental indicators used to perform the current study were the water footprint, the carbon footprint (CF), and their respective nutritional productivity indexes (considering fats, proteins, and carbohydrates). The water needed to produce the beef burger was 1.8 times greater than the quantity needed to produce the hybrid burger, and 21 times greater in the case of the plant-based one. In turn, regarding the CF, the beef burger emitted approximately 2 times more kgCO2e along the supply chain when compared with the hybrid burger, and 13 times more than the plant-based one. However, because the meat burger comes from cattle raised on grasslands, the greenhouse gas emissions are likely lower than those from other, less sustainable forms of beef production. The plant-based burger was, therefore, more sustainable in terms of water use and carbon emissions relative to the nutrition productivity index than the meat and hybrid options.
Traditional diets are culturally accepted and adapted to local environments, but globalisation has shifted towards unhealthy, unsustainable eating habits. This study aims to assess the literature on the effects of traditional, place-based diets on health and sustainability and examines the suitability of common tools used to evaluate them.
Design:
A systematic search was conducted using the PRISMA 2020 guidelines across seven databases (CINAHL, Cochrane Library, MEDLINE, Scopus, Web of Science, PubMed and Google Scholar), and the protocol was registered with PROSPERO (CRD42023445750). The inclusion criteria were traditional place-based diets, studies examining the nutritional, health benefits and sustainability impacts of traditional food consumption, published in English, with no date restriction.
Results:
Eleven studies from Spain, Romania, Portugal, Mexico, Chile, Japan, Uganda and India met the criteria. Assessment tools included carbon footprints (via LCA), nitrogen footprints, NRF9.3, Nutri-Score and EAT-Lancet; some incorporated qualitative methods. Mediterranean, Atlantic and Japanese diets aligned well with health and sustainability, whereas meat-heavy or nutrient-deficient patterns raised concerns. Most studies relied on standardised tools and secondary datasets, with limited use of region-specific environmental data or qualitative insights. Only one intervention study was identified.
Conclusions:
Traditional diets show promise as culturally appropriate models for sustainable and healthy eating. Current tools designed around standardised, reductionist frameworks often fail to capture the complexity of traditional food systems, including local practices, preparation methods and cultural meaning. To better assess traditional diets, future research should develop regionally adapted indicators and integrate quantitative measures with qualitative insights from local communities.
To assess the nutritional composition, adequacy and environmental impact of menus served, consumed and wasted by 11–12-year-old students in public and charter schools in northern Spain.
Design:
A cross-sectional observational study (2017–2018) involving photographing menus before and after consumption, visual portion size estimation using a validated photographic catalogue and food waste assessment via the quarter-waste visual method. Nutritional composition was analysed using food composition databases and greenhouse gas emissions using life cycle assessment data.
Setting:
Ten primary schools (five public and five charter) in northern Spain.
Participants:
1000 school menus for students aged 11–12 years.
Results:
Menus served exceeded energy recommendations (791·5 (sd 176·7) kcal) and were high in fat (39·7 (sd 13·4) g), protein (29·7 (sd 10·0) g) and Na (980·4 (sd 302·2) mg) but low in carbohydrates (74·7 (sd 18·1) g), fibre (8·8 (sd 3·7) g) and several micronutrients. Food waste averaged 140·5 g per menu, mainly vegetables and fruit, leading to nutrient losses, particularly in fibre, vitamins A and C and Fe. The carbon footprint of menus averaged 1·489 kg CO2-eq, primarily from meat and fish, with waste contributing 0·298 kg CO2-eq. Public schools served more nutrient-dense food but had higher waste (public 151·5 (sd 112·3) g v. charter 129·5 (sd 86·3) g, P < 0·001); charter schools served more energy-dense food, with higher Na and fat (P < 0·001).
Conclusions:
Menus showed nutritional imbalances, with excessive energy and Na and insufficient fibre and several micronutrients. Food waste worsened dietary adequacy while increasing environmental impact. Public schools offered more nutrient-rich food but faced greater waste compared with charter schools. Institutional differences suggest the need for tailored strategies to enhance both nutritional quality and sustainability.
The healthcare industry is estimated to contribute 4.4 per cent of global greenhouse gas emissions. This pilot study aimed to investigate the impact of rationalising surgical instruments in tonsillectomy trays on greenhouse gas emissions and costs.
Method
We conducted a prospective observational study over a six-month period. All patients who underwent tonsillectomy were included. The instruments used during the procedure and their frequency of use were counted, with the operating surgeon being unaware of the study.
Results
During the 6-month timeframe, 46 tonsillectomies were performed. From the standard tonsillectomy tray containing 38 pieces, 9 pieces were never used. The removal of unused reusable instruments resulted in an estimated total reduction of 594 g of carbon dioxide equivalents and a saving of €9.63 per operation.
Conclusion
Rationalising the contents of the surgical instrument tray can have a positive environmental impact by reducing greenhouse gas emissions. There are also pecuniary benefits for the National Health Service because of the potential for cost savings.
Technology will play a role in addressing environmental violence. Some common technological aims include: more equitable access to cleaner and safer industrial techniques; wider deployment of pollution safeguards; and the transition of energy infrastructure away from fossil fuels and toward batteries and renewables. Of course, alternative technologies do not address many of the structural and cultural factors involved in generating environmental violence. Shifting from one mechanism to another, or one material to another, entails a shift in economic context, but guarantees nothing about whether this new context will be more equitable, or even ecologically responsible. We propose that, in order for technology deployment to be truly appropriate to the task of reducing environmental violence, economic affluence must be an equally primary factor of concern. In this article, we introduce the “affluence–technology connection” and provide several different contexts and perspectives to support the concept. These include appropriate technology efforts in Ladakh, India, the carbon footprint of alternative transportation technologies, and the true impact of service sector versus industrial sector activities. These lead us to a fairly simple conclusion: Achieving a lower-violence future means seeking appropriate affluence alongside appropriate and sustainable technologies.
Analysing customer loyalty card data is a novel method for assessing nutritional quality and changes in a population’s food consumption. However, prior to its use, the thousands of grocery products available in stores must be reclassified from the retailer’s original hierarchical structure into a structure that is suitable for the use of nutrition and health research. We created LoCard Food Classification (LCFC) and examined how it reflects the nutritional quality of the grocery product groups. Nutritional quality was considered the main criterion guiding the reclassification of the 3574 grocery product groups. Information on the main ingredient of the product group, purpose of use and carbon footprint was also used at the more granular levels of LCFC. The main challenge in the reclassification was a lack of detailed information on the type of products included in each group, and some of the groups included products that have opposite health effects. The final LCFC has four hierarchical levels, and it is openly available online. After reclassification, the product groups were linked with the Finnish food composition database, and the nutrient profile was assessed by calculating the Nutrient-Rich Food Index (NRFI) for each product group. sd in NRFI decreased from 0·21 of the least granular level to 0·08 of the most granular level of LCFC indicating that the most granular level of LCFC has more homogeneous nutritional quality. Studies that apply LCFC to examine loyalty card data with health and environmental outcomes are needed to further demonstrate its validity.
This study aims at comparing two Italian case studies in relation to schoolchildren’s plate waste and its implications, in terms of nutritional loss, economic cost and carbon footprint.
Design:
Plate waste was collected through an aggregate selective weighting method for 39 d.
Setting:
Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved.
Results:
With respect to the served food, in Parma, the plate waste percentage was lower than in Lucca (P < 0·001). Fruit and side dishes were highly wasted, mostly in Lucca (>50 %). The energy loss of the lunch meals accounted for 26 % (Parma) and 36 % (Lucca). Among nutrients, dietary fibre, folate and vitamin C, Ca and K were lost at most (26–45 %). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50 %, Parma; 79 %, Lucca) and nutrients, particularly for fat (85 %, Parma; 89 %, Lucca). Plate waste was responsible for 19 % (Parma) and 28 % (Lucca) of the carbon footprint associated with the food supplied by the catering service, with starchy food being the most important contributor (52 %, Parma; 47 %, Lucca). Overall, the average cost of plate waste was 1·8 €/kg (Parma) and 2·7 €/kg (Lucca), accounting respectively for 4 % and 10 % of the meal full price.
Conclusion:
A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.
Some think a green future is the start of world government with distant administrators telling us what to do and think. But such thinking couldn’t be more wrong. Today, most of our energy is already controlled by distant powers, whether renewable or not, either in uncaring corporate boardrooms or by autocratic state players. If we want more control of our daily lives, smaller-sized, scalable renewable energy allows us to become self-sufficient, letting us make our own decisions about our own needs. With an off-grid power setup, no one can tell me what to do.
Most importantly, no one has to go to war again in my name to secure my energy. Conservation, the circular economy, and the concept of “negawatts” are explained using everyday examples in the house, on the road, and in modern industry. Each watt not consumed is a watt saved. Ways to save energy and money through increased efficiency and changed consumer habits are discussed as is the sharing economy that sees fewer cars needed for personal use. Modern fixes to decrease the rise of greenhouse gases are discussed and the failure of government policy to limit global warming.
The key principles of this text have not changed in this third edition, especially its child agency and rights focus. We continue to argue that children’s voices are integral to implementing ECEfS. The editors and authors remain fundamentally committed to advocating for and profiling the capabilities and rights of young children as active thinkers and doers, who can enact so much in their own contexts to shift ideas and practices towards sustainable solutions. This text is not a response that seeks to shift responsibilities from adults to children, asking next generations to fix what todays adults leave behind. It remains a book of positive thinking and actions showing what early education communities can do when children, educators and parents work together towards living sustainably. The book continues to be about learning and taking action to ‘make a difference’ within the scope of children’s own lives and contexts, and identifying the power of ECEfS as a catalyst for transformative change.
This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil.
Design:
Cross-sectional study.
Setting:
Brazil.
Participants:
We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables.
Results:
Both beef and ultra-processed foods had a significant linear association with carbon and water footprints (P < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint.
Conclusions:
Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.
The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice.
Method
Systematic review of the literature using scientific, healthcare and general interest (public domain) databases.
Results
The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel.
Conclusion
Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.
Mexico is going through an environmental and nutritional crisis related to unsustainable dietary behaviours. Sustainable diets could solve both problems together. This study protocol aims to develop a three-stage, 15-week mHealth randomised controlled trial of a sustainable-psycho-nutritional intervention programme to promote Mexican population adherence to a sustainable diet and to evaluate its effects on health and environmental outcomes. In stage 1, the programme will be designed using the sustainable diets, behaviour change wheel and capability, opportunity, motivation, and behaviour (COM-B) models. A sustainable food guide, recipes, meal plans and a mobile application will be developed. In stage 2, the intervention will be implemented for 7 weeks, and a 7-week follow-up period in a young Mexican adults (18–35 years) sample, randomly divided (1:1 ratio) into a control group (n 50) and an experimental group (n 50), will be divided into two arms at week 8. Outcomes will include health, nutrition, environment, behaviour and nutritional-sustainable knowledge. Additionally, socio-economics and culture will be considered. Thirteen behavioural objectives will be included using successive approaches in online workshops twice a week. The population will be monitored using the mobile application consisting of behavioural change techniques. In stage 3, the effects of the intervention will be assessed using mixed-effects models on dietary intake and quality, nutritional status, physical activity, metabolic biomarkers (serum glucose and lipid profile), gut microbiota composition and dietary water and carbon footprints of the evaluated population. Improvements in health outcomes and a decrease in dietary water and carbon footprints are expected.
This paper presents a novel approach to multi-criteria sustainability performance assessment of horticultural crops. The crops are ranked by the decision-making method ELECTRE IV with environmental, energy and technological criteria. In total eight indicators are taken into consideration and calculated based on primary data collected from over 260 farms in northern Iran. Additionally, Data Envelopment Analysis is used to calculate the technical efficiency and potential for energy saving by different management of the production units. The novel contribution of this study is the comparison of several horticultural products (oranges, kiwis, persimmons and tangerines), when most of the previous studies have focused on one product. Moreover, novel calculations of the carbon footprint are presented for oranges, tangerines and persimmons. This paper also includes the first study on the environmental impact of persimmon fruit's production. The obtained results show that energy efficiency for orange, tangerine, kiwi and persimmon products: 1.1, 0.84, 0.53 and 1.22, respectively. In each hectare of kiwi orchards, the amount of CO2 emissions of 1219 kg and the ecological footprint of 3.21 hectares have been calculated, which is statistically significant compared to orange, tangerine and persimmon. The chemical and fuel inputs have the greatest potential for reducing energy consumption in the studied products. Results of ELECTRE IV showed that kiwi is the most sustainable selection for the studied region followed by orange, persimmon and tangerine, respectively. Kiwi has also relatively low technical efficiency. This means that this product has the greatest potential for a reduction of energy consumption, while maintaining the same amount of crop. It is recommended to include the development of kiwi orchards in the policies of Guilan, but with more careful management of the production inputs.