Extraction and application of lipids from edible insects.

Research on new food sources is a worldwide challenge due to the constant increase in the global population. In this scenario, insects and bug based products have been investigated as feasible food alternatives. They are nutritionally healthy and environmentally sustainable. Eating insects (entomophagy) or utilizing their macronutrients in food formulations can efficiently solve the demand for nutritious food. The benefits of insect-based foods are reported in the literature, mainly because they are viable sources of fat (∼38%) and proteins (∼68%). Fats and oils are recognized as essential nutrients in human nutrition, as they provide a concentrated source of energy and act as structural components of cell membranes and signaling pathways. The high levels of fats/oils of edible insects open the perspective in the food industry to be used as ingredients in the enrichment of several products, such as cookies, biscuits, butter, and margarine, among others, thus contributing to consumer acceptance. Insect fat/oil can be obtained using extraction techniques, such as solvent and supercritical CO2 methods. The method depends on the insect species, fat/oil yield, and process costs. Thus, this review aims to provide current information on the consumption, application, and extraction of edible insect oils.

Savings in CT Net Scan Energy Consumption: Assessment Using Dose Report Metrics and Comparison With Savings in Idle State Energy Consumption.

BACKGROUND. CT scanners' net scan state (i.e., image acquisition period) represents a potential target for energy savings through protocol adjustments. However, gauging CT energy savings is difficult without installing costly energy monitors. OBJECTIVE. The purpose of this article was to assess correlations between CT dose report metrics and energy consumption during the system net scan state and to compare theoretic energy savings from matching percentage reductions in energy consumption during net scan and idle system states. METHODS. Current sensors were installed on a single CT scanner. A phantom was scanned at varying kilovoltage settings and effective tube current-rotation time settings. A retrospective assessment was performed in 32 patients (mean age, 61.2 ± 17.9 [SD] years; 17 men, 15 women) who underwent 32 single-energy noncontrast abdominopelvic CT examinations from September 22, 2021, to September 27, 2021, on the same scanner. Correlations between dose report metrics and net scan energy consumption were assessed in the phantom and clinical scans, and equations were generated to derive net scan energy consumption from DLP. An additional retrospective assessment was performed in 1355 patients (mean age, 59.3 ± 16.9 years; 663 men, 692 women) who underwent 1728 single-energy noncontrast abdominopelvic CT examinations from January 1, 2021, through December 31, 2021, on the same scanner to estimate net scan energy consumption per examination. This information was integrated with literature-derived values to compare estimated annual national energy savings resulting from 20% reductions in net scan and idle state energy consumption. RESULTS. Net scan energy consumption in the phantom scans showed high linear correlation with DLP (R2 = 0.87), and, in the clinical scans, high linear correlation with CTDIvol (R2 = 0.89) and very high linear correlation with DLP (R2 = 0.92). When combining mean DLP in examinations performed in the 1-year interval, an equation relating DLP and net scan energy consumption and literature values estimated that annual national energy savings was 14.9 times greater (40,437,870 kWh/2,704,000 kWh) by targeting the idle state rather than net scan state. CONCLUSION. CT net scan energy savings can be inferred from reductions in dose report metrics. However, targeting net scan energy consumption has modest impact relative to targeting idle state energy consumption. CLINICAL IMPACT. Environmental sustainability efforts should target the idle state energy consumption of CT.

Active Learning-Based Guided Synthesis of Engineered Biochar for CO2 Capture.

Biomass waste-derived engineered biochar for CO2 capture presents a viable route for climate change mitigation and sustainable waste management. However, optimally synthesizing them for enhanced performance is time- and labor-intensive. To address these issues, we devise an active learning strategy to guide and expedite their synthesis with improved CO2 adsorption capacities. Our framework learns from experimental data and recommends optimal synthesis parameters, aiming to maximize the narrow micropore volume of engineered biochar, which exhibits a linear correlation with its CO2 adsorption capacity. We experimentally validate the active learning predictions, and these data are iteratively leveraged for subsequent model training and revalidation, thereby establishing a closed loop. Over three active learning cycles, we synthesized 16 property-specific engineered biochar samples such that the CO2 uptake nearly doubled by the final round. We demonstrate a data-driven workflow to accelerate the development of high-performance engineered biochar with enhanced CO2 uptake and broader applications as a functional material.

Environmental sustainability and gynaecological surgery: Which factors influence behaviour? An interview study.

OBJECTIVE: To assess the various factors that influence environmentally sustainable behaviour in gynaecological surgery and examine the differences between gynaecologists and residents. DESIGN: An interview study. SETTING: Academic and non-academic hospitals in the Netherlands. POPULATION: Gynaecologists (n = 10) and residents (n = 6). METHODS: Thematic analysis of semi-structured interviews to determine the various factors that influence environmentally sustainable behaviour in gynaecological surgery and to examine the differences between gynaecologists and residents. By using the Desmond framework and the COM-B BCW, both organisational and individual factors related to behaviour were considered. MAIN OUTCOME MEASURES: Factors that influence environmentally sustainable behaviour. RESULTS: Awareness is increasing but practical knowledge is insufficient. It is crucial to integrate education on the environmental impact of everyday decisions for residents and gynaecologists. Gynaecologists make their own choices but residents' autonomy is limited. There is the necessity to provide environmentally sustainable surgical equipment without compromising other standards. There is a need for a societal change that encourages safe and open communication about environmental sustainability. To transition to environmentally sustainable practices, leadership, time, collaboration with the industry and supportive regulatory changes are essential. CONCLUSION: This study lays the groundwork for promoting more environmentally sustainable behaviour in gynaecological surgery. The key recommendations, addressing hospital regulations, leadership, policy revisions, collaboration with the industry, guideline development and education, offer practical steps towards a more sustainable healthcare system. Encouraging environmentally sustainable practices should be embraced to enhance the well-being of both our planet and our population, driving us closer to a more environmentally sustainable future in healthcare.

Environmental sustainability in obstetrics and gynaecology: A systematic review.

BACKGROUND: The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES: The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY: The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA: Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS: A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS: The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS: This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.

Environmental impact of the diet of young Portuguese and its relationship with adherence to the Mediterranean Diet.

OBJECTIVE: To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD). METHODS: Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models. RESULTS: Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m2, p = 0.002), potential acidification (57.8 vs. 62.4 g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5 g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9 kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2 g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication. CONCLUSIONS: Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability.

Modelling impacts of a salt and sugar tax on hypothetical intra-category food substitutions, BMI and environmental footprints in the UK population.

PURPOSE: Taxes on unhealthy foods can help improve population health in the United Kingdom (UK), but the health effects of food substitutions resulting from these taxes are often unclear. We investigated the potential impacts of a salt and sugar tax on hypothetical intra-category food substitutions, cost, body-mass index (BMI), and environmental footprints. METHODS: Purchase panel data from Kantar (2017) were used to determine the most popular foods high in salt or sugar within eight 'salt-intensive'/'sugar-intensive' food categories. Within food categories, the most popular lower salt (≤ 1.5 g salt/100 g product) and lower sugar (≤ 22.5 g sugar/100 g product) substitutes were also identified. Hypothetical swaps between high salt/sugar foods and lower salt/sugar substitutes were explored, focusing on changes to cost, caloric intake and BMI, and environmental impacts in the UK population. RESULTS: The suggested intra-category substitutions were largely like-for-like and did not accrue an added overall cost to consumers. The substitutions reduced calorie intake by about 200 kcal/day and lowered the prevalence of overweight and obesity in the UK from approximately 60-65% to about 40-45%. The proposed food substitutions led to a total reduction of -2.7Mt of greenhouse gases, ∼ -500.000 ha of land, -0.5km3 of blue water, -12km3 of scarcity weighted water, ∼ -12.000t of phosphorus, and nearly - 14.000t of sulphur dioxide over one year for the UK population due to reductions in calorie intake. CONCLUSION: Food substitutions following a tax on salt and sugar could lead to significant benefits for health and the environment, without necessarily resulting in major changes to people's expenditure on familiar salty and sugary snacks.

Environmental and economic impact of sustainable anaesthesia interventions: a single-centre retrospective observational study.

BACKGROUND: Anaesthesia contributes substantially to the environmental impact of healthcare. To reduce the ecological footprint of anaesthesia, a set of sustainability interventions was implemented in the University Hospital Zurich, Switzerland. This study evaluates the environmental and economic implications of these interventions. METHODS: This was a single-centre retrospective observational study. We analysed the environmental impact and financial implications of changes in sevoflurane, desflurane, propofol, and plastic consumption over 2 yr (April 2021 to March 2023). The study included pre-implementation, implementation, and post-implementation phases. RESULTS: After implementation of sustainability measures, desflurane use was eliminated, there was a decrease in the consumption of sevoflurane from a median (inter-quartile range) of 25 (14-39) ml per case to 11 (6-22) ml per case (P<0.0001). Propofol consumption increased from 250 (150-721) mg per case to 743 (370-1284) mg per case (P<0.0001). Use of plastics changed: in the first quarter analysed, two or more infusion syringes were used in 62% of cases, compared with 74% of cases in the last quarter (P<0.0001). Two or more infusion lines were used in 58% of cases in the first quarter analysed, compared with 68% of cases in the last quarter (P<0.0001). This resulted in an 81% reduction in overall environmental impact from 3 (0-7) to 1 (0-3) CO2 equivalents in kg per case (P<0.0001). The costs during the final study phase were 11% lower compared with those in the initial phase: from 25 (13-41) to 21 (14-31) CHF (Swiss francs) per case (P<0.0001). CONCLUSIONS: Implementing sustainable anaesthesia interventions can significantly reduce the environmental impact and cost of anaesthesia.

Influence of nitrous oxide added to general anaesthesia on postoperative mortality and morbidity: a systematic review and meta-analysis.

BACKGROUND: Nitrous oxide (N2O) is a common adjuvant to general anaesthesia. It is also a potent greenhouse gas and causes ozone depletion. We sought to quantify the influence of N2O as an adjuvant to general anaesthesia on postoperative patient outcomes. METHODS: We searched Medline, EMBASE, and Cochrane Central for works published from inception to July 6, 2023. RCTs comparing general anaesthesia with or without N2O were included. Risk ratios (RRs) and standardised mean differences (SMDs) were calculated, along with 95% confidence intervals (CIs), using a random-effects model. Outcomes were derived from the Standardised Endpoints for Perioperative Medicine (StEP) outcome set. Primary outcomes were mortality and organ-related morbidity, and secondary outcomes were anaesthetic and surgical morbidity. RESULTS: Of 3305 records, 179 full-text articles were assessed, and 71 RCTs, totalling 22 147 patients, were included in the meta-analysis. Addition of N2O to general anaesthesia did not influence postoperative mortality or most morbidity outcomes. N2O increased the incidence of atelectasis (RR 1.62, 95% CI 1.24 to 2.12) and postoperative nausea and vomiting (RR 1.27, 95% CI 1.15 to 1.40), and decreased intraoperative opioid consumption (SMD -0.19, 95% CI -0.35 to -0.04) and time to extubation (MD -2.17 min, 95% CI -3.32 to -1.03 min). CONCLUSIONS: N2O did not influence postoperative mortality or most morbidity outcomes. Considering the environmental effects of N2O, these findings confirm that current policy recommendations to limit its use do not affect patient safety. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42023443287.

Turning food waste to microbial lipid towards a superb economic and environmental sustainability: An innovative integrated biological route.

With the drastic growth of the economic and population, the global energy requirement is on the rise, and massive human and material resources have been put into the development of alternative and renewable energy sources. Biodiesel has been recognized as a green and sustainable alternative energy, but the raw materials-associated source and cost makes it difficult to achieve large-scale commercial production. Microbial lipids (ML) produced by oleaginous microbes have attracted more and more topics as feedstocks for biodiesel production because of their unique advantages (fast growth cycle, small footprint and so on). However, there are still many problems and challenges ahead towards commercialization of ML-based biodiesel, especially the cost of feedstock for ML production. Food waste (FW) rich in organic matters and nutrients is an excellent and almost zero-cost feedstock for ML production. However, current biological routes of FW-based ML production have some defects, which make it impossible to achieve full industrialization at present. Therefore, this review intends to provide a critical and comprehensive analysis of current biological routes of FW-based ML production with the focus on the challenges and solutions forward. The biological routes towards future FW-based ML production must be able to concurrently achieve economic feasibility and environmental sustainability. On this condition, an innovative integrated biological route for FW-based ML production has thus been put forward, which is also elucidated on its economic and environmental sustainability. Moreover, the prospective advantages, limitations and challenges for future scale-up of FW-based ML production have also been outlined, together with the perspectives and directions forward.

Micropollutant rejection by nanofiltration membranes: A mini review dedicated to the critical factors and modelling prediction.

Nanofiltration (NF) membranes, extensively used in advanced wastewater treatment, have broad application prospects for the removal of emerging trace organic micropollutants (MPs). The treatment performance is affected by several factors, such as the properties of NF membranes, characteristics of target MPs, and operating conditions of the NF system concerning MP rejection. However, quantitative studies on different contributors in this context are limited. To fill the knowledge gap, this study aims to assess critical impact factors controlling MP rejection and develop a feasible model for MP removal prediction. The mini-review firstly summarized membrane pore size, membrane zeta potential, and the normalized molecular size (λ = rs/rp), showeing better individual relationships with MP rejection by NF membranes. The Lindeman-Merenda-Gold model was used to quantitatively assess the relative importance of all summarized impact factors. The results showed that membrane pore size and operating pressure were the high impact factors with the highest relative contribution rates to MP rejection of 32.11% and 25.57%, respectively. Moderate impact factors included membrane zeta potential, solution pH, and molecular radius with relative contribution rates of 10.15%, 8.17%, and 7.83%, respectively. The remaining low impact factors, including MP charge, molecular weight, logKow, pKa and crossflow rate, comprised all the remaining contribution rates of 16.19% through the model calculation. Furthermore, based on the results and data availabilities from references, the machine learning-based random forest regression model was trained with a relatively low root mean squared error and mean absolute error of 12.22% and 6.92%, respectively. The developed model was then successfully applied to predict MPs' rejections by NF membranes. These findings provide valuable insights that can be applied in the future to optimize NF membrane designs, operation, and prediction in terms of removing micropollutants.

A comprehensive review of the environmental benefits of urban green spaces.

This detailed analysis highlights the numerous environmental benefits provided by urban green spaces, emphasizing their critical role in improving urban life quality and advancing sustainable development. The review delves into critical themes such as the impact of urban green spaces on human health, the complex interplay between urban ecology and sustainability, and the evaluation of ecosystem services using a comprehensive review of existing literature. The investigation thoroughly examines various aspects of green infrastructure, shedding light on its contributions to social cohesion, human well-being, and environmental sustainability in general. The analysis summarizes the study's findings and demonstrates the critical role of urban green spaces in urban ecology, which significantly mitigates environmental challenges. The intricate links between these green spaces and human health are thoroughly investigated, with benefits ranging from enhanced mental and physical well-being to comprehensive mental health. Furthermore, the analysis emphasizes how green spaces benefit urban development by increasing property values, boosting tourism, and creating job opportunities. The discussion also considers possible futures, emphasizing the integration of technology, the advancement of natural solutions, and the critical importance of prioritizing health and well-being in the design of urban green spaces. To ensure that urban green spaces are developed and maintained as essential components of resilient and sustainable urban environments, the assessment concludes with practical recommendations for communities, urban planners, and legislators.

Cultivating a sustainable future in the artificial intelligence era: A comprehensive assessment of greenhouse gas emissions and removals in agriculture.

Agriculture is a leading sector in international initiatives to mitigate climate change and promote sustainability. This article exhaustively examines the removals and emissions of greenhouse gases (GHGs) in the agriculture industry. It also investigates an extensive range of GHG sources, including rice cultivation, enteric fermentation in livestock, and synthetic fertilisers and manure management. This research reveals the complex array of obstacles that are faced in the pursuit of reducing emissions and also investigates novel approaches to tackling them. This encompasses the implementation of monitoring systems powered by artificial intelligence, which have the capacity to fundamentally transform initiatives aimed at reducing emissions. Carbon capture technologies, another area investigated in this study, exhibit potential in further reducing GHGs. Sophisticated technologies, such as precision agriculture and the integration of renewable energy sources, can concurrently mitigate emissions and augment agricultural output. Conservation agriculture and agroforestry, among other sustainable agricultural practices, have the potential to facilitate emission reduction and enhance environmental stewardship. The paper emphasises the significance of financial incentives and policy frameworks that are conducive to the adoption of sustainable technologies and practices. This exhaustive evaluation provides a strategic plan for the agriculture industry to become more environmentally conscious and sustainable. Agriculture can significantly contribute to climate change mitigation and the promotion of a sustainable future by adopting a comprehensive approach that incorporates policy changes, technological advancements, and technological innovations.

Nutrient recovery from anaerobic digestate: Fertilizer informatics for circular economy.

This study explores the integration of fertilizer informatics into the circular economy, with a focus on enhancing nutrient recovery from anaerobic digestate. It utilizes advanced algorithms and data analytics to develop new nutrient management strategies essential for sustainable agriculture. This research provides a detailed assessment of current nutrient recovery technologies, evaluating their environmental impact, cost efficiency, and adaptability. Our findings highlight the importance of merging circular economy principles with fertilizer informatics, showcasing the potential for transforming waste into environmentally friendly fertilizers. This approach has significant implications for improving agricultural practices towards sustainability. The methodologies and insights presented are relevant for ongoing research in environmental stewardship and sustainable resource management. This study describes practical solutions and new perspectives, making it a valuable reference for future research.

Sustainability in surgical practice: a collaborative call toward environmental sustainability in operating rooms.

BACKGROUND: The healthcare system plays a pivotal role in environmental sustainability, and the operating room (OR) significantly contributes to its overall carbon footprint. In response to this critical challenge, leading medical societies, government bodies, regulatory agencies, and industry stakeholders are taking measures to address healthcare sustainability and its impact on climate change. Healthcare now represents almost 20% of the US national economy and 8.5% of US carbon emissions. Internationally, healthcare represents 5% of global carbon emissions. US Healthcare is an outlier in both per capita cost, and per capita greenhouse gas emission, with almost twice per capita emissions compared to every other country in the world. METHODS: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES) established the Sustainability in Surgical Practice joint task force in 2023. This collaborative effort aims to actively promote education, mitigation, and innovation, steering surgical practices toward a more sustainable future. RESULTS: Several key initiatives have included a survey of members' knowledge and awareness, a scoping review of terminology, metrics, and initiatives, and deep engagement of key stakeholders. DISCUSSION: This position paper serves as a Call to Action, proposing a series of actions to catalyze and accelerate the surgical sustainability leadership needed to respond effectively to climate change, and to lead the societal transformation towards health that our times demand.

Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults.

Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.

Total Intravenous Anesthesia Is Preferred Over Volatile Agents in Cardiac Surgery.

The choice of maintenance anesthetic during cardiopulmonary bypass has been a subject of ongoing debate. Systematic reviews on the topic have so far failed to demonstrate a difference between volatile agents and total intravenous anesthesia (TIVA) in terms of mortality, myocardial injury, and neurological outcomes. Studies using animal models and noncardiac surgical populations suggest numerous mechanisms whereby TIVA has been associated with more favorable outcomes. However, even if the different anesthetic methods are assumed to equivalent in terms of patient outcomes in the context of cardiac surgery, additional factors, namely variables of occupational exposure and environmental impact, strongly support the preferred use of TIVA.

Health technology assessment and healthcare environmental sustainability: Prioritizing effort and maximizing impact.

The growing global focus on and sense of urgency toward improving healthcare environmental sustainability and moving to low-carbon and resilient healthcare systems is increasingly mirrored in discussions of the role of health technology assessment (HTA). This Perspective considers how HTA can most effectively contribute to these goals and where other policy tools may be more effective in driving sustainability, especially given the highly limited pool of resources available to conduct environmental assessments within HTA. It suggests that HTA might most productively focus on assessing those technologies that have intrinsic characteristics which may cause specific environmental harms or vulnerabilities, while the generic environmental impacts of most other products may be better addressed through other policy and regulatory mechanisms.

Integrated farming with intercropping increases food production while reducing environmental footprint.

Food security has been a significant issue for the livelihood of smallholder family farms in highly populated regions and countries. Industrialized farming in more developed countries has increased global food supply to meet the demand, but the excessive use of synthetic fertilizers and pesticides has negative environmental impacts. Finding sustainable ways to grow more food with a smaller environmental footprint is critical. We developed an integrated cropping system that incorporates four key components: 1) intensified cropping through relay planting or intercropping, 2) within-field strip rotation, 3) soil mulching with available means, such as crop straw, and 4) no-till or reduced tillage. Sixteen field experiments, conducted with a wide range of crop inputs over 12 consecutive years (2006 to 2017), showed that the integrated system with intercropping generates significant synergies-increasing annual crop yields by 15.6 to 49.9% and farm net returns by 39.2% and decreasing the environmental footprint by 17.3%-when compared with traditional monoculture cropping. We conclude that smallholder farmers can achieve the dual goals of growing more food and lowering the environmental footprint by adopting integrated farming systems.

Perspectives of healthcare practitioners on environmental sustainability in healthcare: A qualitative study.

AIM: To explore the perspectives of Kazakhstani healthcare professionals on environmental sustainability in healthcare. DESIGN: An exploratory qualitative design. METHODS: Four focus group discussions (FGDs) on environmental sustainability in healthcare were conducted among healthcare professionals (nurses, physicians, midwives and physical therapists) from June to August 2023 in three cities of Kazakhstan. Each FGD consisted of at least 6 to 11 participants and lasted between 60 and 90 minutes. The collected data were analysed using the thematic analysis. RESULTS: A total of 137 initial codes were identified and further organized into 22 sub-themes based on similarities in codes and meanings, and then 5 significant themes were identified. The five main themes are 'Environmental Sustainability Practices in Healthcare', 'Purposes of Environmental Sustainability in Healthcare', 'Impact of Environmental Sustainability in Healthcare in Patients', 'Challenges in Implementing Environmental Sustainability in Healthcare' and 'The Role of Healthcare Leadership in Improving Environmental Sustainability in Healthcare'. CONCLUSIONS: The findings highlighted the perceptions and practices of healthcare professionals on environmental sustainability's purposes in healthcare, its impacts on patients and its implementation challenges. The study also underscored the critical role of strong and active leadership in ensuring a sustainable implementation of green policies in healthcare facilities and achieving successful results of environmentally conscious healthcare practices. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings provide invaluable information that can be used by policymakers and healthcare organization leaders to create a sustainable healthcare system. Implementing environmental sustainability practices in healthcare should be widespread, intentional, and sustainable, entailing strong leadership and unwavering personal and organizational commitment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: We adhered to relevant EQUATOR guidelines, specifically the Consolidated Criteria for Reporting Qualitative Research.