BACKGROUND: Sustainable low-carbon health systems are among the United Nations Climate Change Conference (COP27) goals. The literature states that 4.9% of greenhouse gas emissions originate from the health sector.
OBJECTIVE: This study aimed to quantify and visualize trends, citations, key terms and countries of publications about the carbon footprint of intensive care and review their contents.
METHODS: A bibliometric analysis was conducted on 14 articles selected by searching the SCOPUS database using the keywords \'Environmental sustainability\', \'Environmental footprint\', \'Carbon footprint\' and \'Intensive care unit\'. MS Excel was used to create graphs, and VOSviewer was used to perform network analysis. Content analysis methods were used to describe the details in each document.
RESULTS: Most articles on intensive care carbon footprint and environmental sustainability were published in 2023 (n = 7, 47%), with the first publication in 2014. The article \'Environmental sustainability in anaesthesia and critical care\', from the British Journal of Anaesthesia, was the most cited, with 166 citations. The carbon footprinting studies were conducted in the United Kingdom, Australia, United States and the Netherlands.
CONCLUSIONS: Minimizing electricity usage and waste generation (reducing, reusing and recycling more) can reduce the carbon footprint of intensive care. The number of studies on the subject was limited, and although none were specifically about nurses, sustainability and environmental impact are relevant topics for all intensive care staff.
CONCLUSIONS: Nurses and other health care professionals can improve environmental sustainability by better understanding how to reduce the carbon footprint of intensive care units.

While many factors have been studied as potential causes of environmental degradation, the impact of poverty and inequality has been largely overlooked in the research. The Sustainable Development Goals are aligned with the intersection of poverty, inequality, and the environment. In addition, most previous research has used carbon dioxide (CO2) emissions as a surrogate for pollution. These gaps are filled by this study, which uses ecological footprint (a comprehensive measure of pollution) and CO2 emissions to examine the effects of income disparity and poverty on environmental pollution in 13 nations. Dynamic panel Quantile regression methods are used in this study because of their resilience to various econometric problems that can crop up during the estimate process. The empirical results reveal that the whole panel\'s carbon emissions and ecological footprint rise when income disparity and poverty exist. When the panel is subdivided, however, we see that income inequality reduces carbon emissions and environmental footprint for the wealthy but has the opposite effect on the middle class. While high-income households see no impact from poverty on their carbon emissions, middle-income households see an increase in both. Overall, the results of this study suggest that income disparity and poverty are major factors in ecological degradation. Therefore, initiatives to reduce environmental degradation should pay sufficient attention to poverty and inequality to achieve ecological sustainability.

To shift towards low-fossil carbon economies, making more out of residual biomass is increasingly promoted. Yet, it remains unclear if implementing advanced technologies to reuse these streams really achieves net environmental benefits compared to current management practices. By integrating spatially-explicit resource flow analysis, consequential life cycle assessment (LCA), and uncertainty analysis, we propose a single framework to quantify the residual biomass environmental baseline of a territory, and apply it to the case of France. The output is the environmental threshold that a future large-scale territorial bioeconomy strategy should overpass. For France, we estimate the residual biomass baseline to generate 18.4 ± 2.7 MtCO2-eq·y-1 (climate change), 255 ± 35 ktN-eq·y-1 (marine eutrophication), and 12,300 ± 800 disease incidences per year (particulate matter formation). The current use of crop residues and livestock effluents, being essentially a return to arable lands, was found to represent more than 90 % of total environmental impacts and uncertainties, uncovering a need for more certain data. At present, utilizing residual streams as organic fertilizers fulfills over half of France\'s total phosphorus (P) and potassium (K) demands. However, it only meets 6 % of the nitrogen demand, primarily because nitrogen is lost through air and water. This, coupled with the overall territorial diagnosis, led us to revisit the idea of using the current situation (based on 2018 data) as a baseline for future bioeconomy trajectories. We suggest that these should rather be compared to a projected baseline accounting for ongoing basic mitigation efforts, estimated for France at 8.5 MtCO2-eq·y-1.

Enhancing crop diversification in intensive fields has the potential to increase crop yield and reduce environmental footprint. However, these relationships at the landscape scale remained unclear in intensive farming. Addressing this gap, this paper aims to elucidate how crop yield, resources use efficiency (RUE), and environmental footprint (EF) vary with crop diversification levels in the North China Plain. Management practices, including crop pattern, field size, and agronomic inputs, were collected for 421 landscapes of 1 × 1 km subplots using Sentinel-2 and Landsat-8 images and survey. The results showed that, at the landscape scale, energy and fertilizer contributed over 53 %, and 37 % of the carbon footprint, respectively. N fertilizer constituted >98 % of the nitrogen footprint. P fertilizer accounted for over 80 %, while electricity comprised >13 % of the phosphorus footprint. Compared with simplified landscapes, diversified landscapes exhibited several significant features: 1) 56 % reduction of the area ratio of winter wheat-summer maize double crop pattern (WM), 2) a significant decrease in field size, 3) the decreased use of total NPK fertilizers at 32 %, 30 %, and 30 %, respectively, 4) the increased inputs of irrigation water, diesel, electricity, pesticide and labour at 21 %, 19 %, 21 %, 77 %, and 92 %, respectively. Although yield could be reduced at 33 % when transforming simplified landscapes into moderately diversified ones, they increased with the further promotion of crop diversification. Thus, the diversified landscapes could achieve a balance in yield, RUE, and EF to enhance sustainability, whereas simplified landscapes can similarly achieve a balance to benefit productivity. We emphasize the viable potential of diversified landscapes to enhance sustainable agricultural development by optimizing crop composition. This analysis offers pioneering evidence of landscape-scale agronomic and environmental performances of crop diversification.

In many countries, growing deer populations cause environmental, economic, and traffic safety problems. This study sheds light on the potential implications of expanding the consumption of venison from hunted wild deer through deer population management efforts. It focuses on changes in environmental impacts resulting from changes in the demand for livestock meat due to increased consumption of wild venison. We analyzed the demand system between them using the Quadratic Almost Ideal Demand System (QUAIDS) model and scanner data from a grocery store chain in Hokkaido Prefecture, Japan. The results show that wild venison is a substitute good for pork and lamb. By contrast, wild venison is a complementary good for imported and domestic beef. Based on the estimated demand system model, we conducted an environmental footprint analysis to estimate the changes in environmental impacts when venison consumption increased. This shows that the greenhouse gas, water, and land footprints would increase, indicating greater environmental impacts, under a scenario of expanded venison consumption. The results demonstrate that increased venison consumption does not necessarily reduce the net environmental impacts of meat consumption, which depends on the demand system for meat products and the environmental footprint intensities of the respective products.

1. This study evaluated the efficacy of maize differing in particle size in low-density protein diets on performance, the digestive tract and litter characteristics in broilers. Four dietary treatments; control commercial diet with a typical crude protein content 22.50% (CON); CON + 20% maize with particle size 350 µm (M350), crude protein 19.90%; CON + 20% maize with particle size 2600 µm (M2600), crude protein 19.90%); CON + 20% whole maize (WM), crude protein 19.90%, were fed ad libitum to broiler chicks up to 21 d of age.2. No differences in body weight gain, feed intake and FCR were found between the WM and CON. WM increased body weight gain compared to M350 and M2600. M350, M2600 and WM increased (p = 0.004) gizzard relative weight compared with CON on day 14. Both WM and M2600 reduced (p = 0.001) gastric isthmus diameter on d 14 and 21 compared with CON and M350.3. No differences were seen in mucosa for the Lamina propria and the extent of Tunica muscularis of gizzard on d 21 and ileum mucosal depth on d 14 between WM and CON diets. However, WM reduced villus-to-crypt ratio compared with CON on d 21. The M350 reduced (p < 0.05) gizzard digesta particle size compared with CON, M2600 and WM on d 14.4. Both WM and M350 decreased (p < 0.05) nitrogen excretion compared to birds fed CON. Feeding WM increased nitrogen efficiency compared with M350 and M2600 diets, but was similar to birds fed CON. Feeding M350, M2600 or WM decreased (p < 0.05) litter moisture and footpad dermatitis (FPD) scores compared with results from birds fed CON.5. Overall, diluting the protein level in broiler diets with whole maize appeared better than fine or coarse maize in terms of growth performance, digestive tract development, nitrogen excretion and litter parameters. This may lead to economic benefits by reducing grinding costs and dependence on rich protein resources contributing to sustainable meat production and food security.

This study focused on exploring the impact of the digital economy (DE) on energy poverty (EP) across Chinese provinces from 2004 to 2018, motivated by the critical need to understand how technological advancements in the digital sector influence energy accessibility and sustainability. Conducted against the backdrop of global digital transformation, the research aimed to dissect the nuanced ways in which the DE contributes to mitigating EP, employing dynamic panel threshold and indirect effect models to capture both the direct and nuanced, and intermediate effects of digital progress on energy deprivation. Key findings revealed a significant reduction in EP attributed to the advancements in DE, with the most notable improvements observed in Eastern China where strategic energy policies and management practices enhanced the positive impacts of digitalization. The study highlighted the DE\'s role in improving energy access, efficiency, and environmental sustainability, although it also pointed out the potential for regressive effects in areas with lower levels of technological advancement. These findings are of substantial value as they offer empirical evidence of the DE\'s capacity to alleviate EP, underlining the importance of integrating digital strategies into energy policy planning. The research provides critical insights for policymakers, stakeholders in the energy sector, and scholars interested in the synergies between digital innovation and energy security, suggesting that leveraging digital technologies could accelerate efforts towards achieving sustainable energy access and combating energy poverty in China and potentially in other contexts facing similar challenges.

OBJECTIVE: This article aims to estimate the differences in environmental impact (greenhouse gas [GHG] emissions, land use, energy used, acidification and potential eutrophication) after one year of promoting a Mediterranean diet (MD).
METHODS: Baseline and 1-year follow-up data from 5800 participants in the PREDIMED-Plus study were used. Each participant\'s food intake was estimated using validated semi-quantitative food frequency questionnaires, and the adherence to MD using the Dietary Score. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The association between MD adherence and its environmental impact was calculated using adjusted multivariate linear regression models.
RESULTS: After one year of intervention, the kcal/day consumed was significantly reduced (-125,1 kcal/day), adherence to a MD pattern was improved (+0,9) and the environmental impact due to the diet was significantly reduced (GHG: -361 g/CO2-eq; Acidification:-11,5 g SO2-eq; Eutrophication:-4,7 g PO4-eq; Energy use:-842,7 kJ; and Land use:-2,2 m2). Higher adherence to MD (high vs. low) was significantly associated with lower environmental impact both at baseline and one year follow-up. Meat products had the greatest environmental impact in all the factors analysed, both at baseline and at one-year follow-up, in spite of the reduction observed in their consumption.
CONCLUSIONS: A program promoting a MD, after one year of intervention, significantly reduced the environmental impact in all the factors analysed. Meat products had the greatest environmental impact in all the dimensions analysed.

Bundle recommendation aims to generate bundles of associated products that users tend to consume as a whole under certain circumstances. Modeling the bundle utility for users is a non-trivial task, as it requires to account for the potential interdependencies between bundle attributes. To address this challenge, we introduce a new preference-based approach for bundle recommendation exploiting the Choquet integral. This allows us to formalize preferences for coalitions of environmental-related attributes, thus recommending product bundles accounting for synergies among product attributes. An experimental evaluation of a dataset of local food products in Northern Italy shows how the Choquet integral allows the natural formalization of a sensible notion of environmental friendliness and that standard approaches based on weighted sums of attributes end up recommending bundles with lower environmental friendliness even if weights are explicitly learned to maximize it. We further show how preference elicitation strategies can be leveraged to acquire weights of the Choquet integral from user feedback in terms of preferences over candidate bundles, and show how a handful of queries allow to recommend optimal bundles for a diverse set of user prototypes.

China\'s online food delivery (OFD) services consume enormous amounts of disposable plastics. Here, we investigated and modeled the national mass inventories and environmental release of plastics and chemical additives in the plastic. The extra-tree regression identified six key descriptors in determining OFD sales in Chinese cities. Approximately 847 kt of OFD plastic waste was generated in 2021 (per capita 1.10 kg/yr in the megacities and 0.39 kg/yr in other cities). Various additives were extensively detected, with geomean concentrations of 140.96, 4.76, and 0.25 μg/g for ∑8antioxidants, ∑21phthalates, and bisphenol A (BPA), respectively. The estimated mass inventory of these additives in the OFD plastics was 164.7 t, of which 51.1 t was released into the atmosphere via incineration plants and 51.0 t was landfilled. The incineration also released 8.07 t of polycyclic aromatic hydrocarbons and 39.1 kt of particulate matter into the atmosphere. Takeout food may increase the dietary intake of phthalates and BPA by 30% to 50% and raise concerns about considerable exposure to antioxidant transformation products. This study provides profound environmental implications for plastic waste in the Chinese OFD industry. We call for a sustainable circular economy action plan for waste disposal, but mitigating the hazardous substance content and their emissions is urgent.