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Food loss and waste (FLW) contribute significantly to the global food system’s economic and environmental burdens, including substantial greenhouse gas (GHG) emissions, resource depletion, and waste management challenges. In alignment with the European Commission’s sustainability objectives and U.N. Sustainable Development Goal 12.3, this study explores the potential energy and environmental footprint savings achievable by halving FLW in Europe by 2030. Using a multiregional input–output model, we estimated the total global energy and environmental footprint savings across all stages of the food supply chain, considering industry-specific FLW rates and proportion weights. The findings reveal substantial environmental savings across Europe, with aggregate savings potentially reaching 51 Mt CO2e (0.09 t CO2e/p), 4,620 Mm3(8 m3/p) of blue water, 106,446 km2(179 m2/p) of cropland, 55,523 km2(93 m2/p) of grassland, and 0.47 EJ (0.54 TJ/p) of energy. The greatest potential for savings was found in Western Europe, specifically in France, Germany, Belgium, and The Netherlands. However, countries with a lower per capita GDP, such as Greece, Croatia, Bulgaria, and Romania, also demonstrate significant per capita savings potential, indicating that wealth does not necessarily correlate with higher environmental savings. Agricultural production emerged as the stage with the highest footprint reduction potential for GHG and resource footprints across Europe, while the foodservice and institutional stages offer the greatest energy-saving potential. Geographical disparities underscore the need for region-specific policies. These results challenge the wealth-sustainability correlation and advocate for adaptable policies that transcend national wealth and accommodate regional disparities, underlining the pivotal roles of the agricultural production and consumption stages in footprint savings.

ObjectiveTo estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections.DesignA nationwide population-based cohort study.SettingAll neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019.PatientsNeonates aged 0–28 days with HSV infection.Main outcome measuresThe main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI.ResultsFifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0–3, 4–7 and 8–14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively.ConclusionsThe incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.

Patients with chronic rheumatic diseases (CRDs), such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), require special attention during the COVID‐19 pandemic as they are considered at risk of severe infections. Our objective was to assess the seroprevalence of SARS–CoV‐2 in patients with SLE and RA and to assess patient behavior, disease‐related symptoms, and mental health. More than 900 participants were included: 405 patients with RA or SLE (CRD patients) and 513 blood donors. All participants had blood SARS–CoV‐2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (Patient Health Questionnaire 9). The CRD patients were further asked about physical activity, adherence to medication, and disease‐related symptoms. CRD patients had a significantly lower seroprevalence of SARS–CoV‐2 antibodies (n = 1 of 365, 0.3%) compared to blood donors (n = 10 of 513, 1.9%; P= 0.03). Almost 60% of patients were unable to exercise as usual, and increased pain and disease activity was experienced by 34% and 24% of patients, respectively. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6.8% of blood donors (P< 0.001). Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS–CoV‐2. However, this mitigation appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side effects and for further studies to investigate the possible long‐term consequences.

Objective.We aimed to investigate (1) whether patients with rheumatic disease (RD) treated with rituximab (RTX) raise a serological response toward the coronavirus disease 2019 (COVID-19) mRNA vaccines, and (2) to elucidate the influence of time since the last RTX dose before vaccination on this response.Methods.We identified and included 201 patients with RDs followed at the outpatient clinic at the Department of Rheumatology, Aarhus University Hospital, who had been treated with RTX in the period 2017–2021 and who had completed their 2-dose vaccination series with a COVID-19 mRNA vaccine. Total antibodies against the SARS-CoV-2 spike protein were measured on all patients and 44 blood donors as reference.Results.We observed a time-dependent increase in antibody response as the interval from the last RTX treatment to vaccination increased. Only 17.3% of patients developed a detectable antibody response after receiving their vaccination ≤ 6 months after their previous RTX treatment. Positive antibody response increased to 66.7% in patients who had RTX 9–12 months before vaccination. All blood donors (100%) had detectable antibodies after vaccination.Conclusion.Patients with RDs treated with RTX have a severely impaired serological response toward COVID-19 mRNA vaccines. Our data suggest that the current recommendations of a 6-month interval between RTX treatment and vaccination should be reevaluated.

Serological assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are needed to support clinical diagnosis and epidemiological investigations. Recently, assays for large-scale detection of total antibodies (Ab), immunoglobulin G (IgG), and IgM against SARS-CoV-2 antigens have been developed, but there are limited data on the diagnostic accuracy of these assays.

ObjectiveTo examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.MethodsThis nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.ResultsThe study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.ConclusionsACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.Trial registration numberEUPAS34887

The biowaste refinery concept has received significant attention in recent years as a sustainable alternative the petroleum refinery, exploiting the biowaste for producing high value bioproducts. However, waste-based biorefineries mainly apply homogeneous waste streams from agriculture and food processing as feedstock. This paper presents the state of the art of mixed-biowaste biorefinery concepts. We identified 20 studies that use the organic fraction of municipal solid waste (OFMSW) as feedstock, producing enzymes, bioplastics, biopesticides and other high value products. Valorisation efficiency (output product per kg OFMSW) and potential revenue by valorising the OFMSW into different products (Euro/ton OFMSW) was analysed for the identified studies. It was found that enzymes have the highest potential revenue followed by biopesticides and bioplastics. Developing biorefineries applying OFMSW as feedstock presents a promising opportunity for moving up the waste hierarch through coupling the waste and production sector in a future circular bioeconomy.

The food provisioning of European cities depends on the global food supply system. However, both economic crises, environmental pressure and climate change effects represent a risk for food chain stability. Urban agriculture (UA) increases the self-sufficiency and resiliency of cities and is able to deliver positive environmental and social benefits. However, its efficacy depends on several variables, including the type of UA and the geographical location of the city. This paper analyses ReFarmers’ pilot farm, a vertical high-yield hydroponic croft located in the urban area of Lyon, France, from a life cycle perspective. The results show that the hydroponic farm performs better than cultivations in heated greenhouses, and similarly to conventional open field farms. Moreover, the source of the electricity input is a determinant factor that, if carbon neutral (e.g. wind energy) allows vertical hydroponic production to outperform the two conventional types of agriculture.

•Consumer utilization and perception of pulses in relation to the climate impact determined using life cycle assessment (LCA) was investigated.•Lentils, kidney beans, and chickpeas were the most popular pulse types, typically consumed at home.•The low environmental impact of pulses was substantiated using LCA with marginal differences between the types and produce in dry or canned form.•Utilization and perception of consumers and objective LCA measures were not correlated.•Consumers might have a misunderstanding of the environmental impact of pulses.

ABSTRACTAntibiotic dosing in septic shock patients poses a challenge for clinicians due to the pharmacokinetic (PK) variability seen in this patient population. Piperacillin-tazobactam is often used for empirical treatment, and initial appropriate dosing is crucial for reducing mortality. Accordingly, we determined the pharmacokinetic profile of piperacillin (4 g) every 8 h, during the third consecutive dosing interval, in 15 patients treated empirically for septic shock. We developed a population pharmacokinetic model to assess empirical dosing and to simulate alternative dosing regimens and modes of administration. Time above the MIC (T>MIC) predicted for each patient was evaluated against clinical breakpoint MIC for Pseudomonas aeruginosa(16 mg/liter). Pharmacokinetic-pharmacodynamic (PK/PD) targets evaluated were 50% fT>4×MIC and 100% fT>MIC. A population PK model was developed using NONMEM, and data were best described by a two-compartment model. Central and intercompartmental clearances were 3.6 liters/h (relative standard error [RSE], 15.7%) and 6.58 liters/h (RSE, 16.4%), respectively, and central and peripheral volumes were 7.3 liters (RSE, 11.8%) and 3.9 liters (RSE, 9.7%), respectively. Piperacillin plasma concentrations varied considerably between patients and were associated with levels of plasma creatinine. Patients with impaired renal function were more likely to achieve predefined PK/PD targets than were patients with preserved or augmented renal function. Simulations of alternative dosing regimens showed that frequent intermittent bolus dosing as well as dosing by extended and continuous infusion increases the probability of attaining therapeutic plasma concentrations. For septic shock patients with preserved or augmented renal function, dose increment or prolonged infusion of the drug needs to be considered. (This study has been registered at ClinicalTrials.gov under registration no. NCT02306928.)

ABSTRACTWhen antimicrobials are used empirically, pathogen MICs equal to clinical breakpoints or epidemiological cutoff values must be considered. This is to ensure that the most resistant pathogen subpopulation is appropriately targeted to prevent emergence of resistance. Accordingly, we determined the pharmacokinetic (PK) profile of moxifloxacin at 400 mg/day in 18 patients treated empirically for community-acquired pneumonia. We developed a population pharmacokinetic model to assess the potential efficacy of moxifloxacin and to simulate the maximal MICs for which recommended pharmacokinetic-pharmacodynamic (PK-PD) estimates are obtained. Moxifloxacin plasma concentrations were determined the day after therapy initiation using ultra-high-performance liquid chromatography. Peak drug concentrations (Cmax) and area under the free drug concentration-time curve from 0 to 24 h (fAUC0–24) values predicted for each patient were evaluated against epidemiological cutoff MIC values for Streptococcus pneumoniae, Haemophilus influenzae, and Legionella pneumophila. PK-PD targets adopted were a Cmax/MIC of ≥12.2 for all pathogens, an fAUC0–24/MIC of >34 for S. pneumoniae, and an fAUC0–24/MIC of >75 for H. influenzaeand L. pneumophila. Individual predicted estimates for Cmax/MIC and fAUC0–24/MIC as well as simulated maximal MICs resulting in target attainment for oral and intravenous administration of the drug were suitable for S. pneumoniaeand H. influenzaebut not for L. pneumophila. These results indicate that caution must be taken when moxifloxacin is used as monotherapy to treat community-acquired pneumonia caused by L. pneumophila. In conclusion, this report reveals key information relevant to the empirical treatment of community-acquired pneumonia while highlighting the robust and flexible nature of this population pharmacokinetic model to predict therapeutic success. (Clinical Trials Registration no. NCT01983839.)

Danish emission values, implied emission factors (IEFs) and activity data (AD) for the national greenhouse gas inventory are assessed according to an updated verification procedure. Focus is on 28 Annex II indicators and 25 identified Key Categories, represented by 29 verification categories covering energy, agriculture, industry and waste. The data are based on the national greenhouse gas inventory for the years 1990 (base year), 2000 and 2010, as reported in 2012, and provided by the United Nations Framework Convention on Climate Change and the European Union. Inter-country comparison and time trend consistency check of Annex II indicators, covering energy and industry, is made for EU15 countries, excluding Italy and Luxembourg. Inter-country comparison and time trend consistency check of IEFs is made for EU15 countries, excluding Luxemburg and including Norway and Switzerland and for some verification steps also including Australia, Canada, Japan, Russian Federation, USA and aggregated values for EU15 and EU27. National and inter-country verification and time trend consistency check of AD are made with data for energy consumption [(Eurostat. (2013). European commission. Retrieved January 9, 2013], agricultural statistics [Eurostat. (2013). European commission. Retrieved January 9, 2013], industrial processes (UN. (2013). United Nations Statistical Yearbook 2010 – fifty fifth issue. New York: United Nations. Retrieved October 12, 2012, from http://unstats.un.org/unsd/syb/default.htm) and waste disposal (OECD. (1997, 2004). Environmental data, compendium 1997 and 2004. Paris: Organisation for Economic Co-operation and Development). Verification in this approach is a combination of qualitative and quantitative assessments and gives lines of evidence of the correctness of the emission inventory.

The methodology and results of Monte Carlo (Tier 2) uncertainty analysis of the Danish Greenhouse Gas (GHG) inventory for base year 1990 and most recent year 2008 are presented. The analysis covers 100% of the total net Danish GHG emissions and removals, excluding LULUCF. Methodological procedures such as random sampling of uncertain parameters and parameter correlation between years are explained. Uncertainties in activity data and emission factors are given for all sectors, Input data are assumed to have log-normal probability distributions, represented by median values and 95% confidence interval uncertainties. The total uncertainty levels for GHG emissions, expressed as 95% confidence intervals, are 4.1 and 5.3% for Tier 1 and Tier 2, respectively. Uncertainties in the trend are 2.4 and 6.9% for Tier 1 and Tier 2, respectively. The most influential sources from the Tier 2 analysis to the total uncertainty are CH4from solid waste disposal on land (4.4%), N2O from leaching (3.0%), N2O from synthetic fertilizer (2.0%), and N2O and CH4from manure management, each with 1.6%. Tier 1 and Tier 2 uncertainties in levels and trends are comparable to seven European countries that have performed a Tier 2 uncertainty analysis.

ABSTRACTA 6-year nationwide study of fungemia in Denmark was performed using data from an active fungemia surveillance program and from laboratory information systems in nonparticipating regions. A total of 2,820 episodes of fungemia were recorded. The incidence increased from 2004 to 2007 (7.7 to 9.6/100,000) and decreased slightly from 2008 to 2009 (8.7 to 8.6/100,000). The highest incidences were seen at the extremes of age (i.e., 11.3 and 37.1/100,000 for those <1 and 70 to 79 years old, respectively). The rate was higher for males than for females (10.1 versus 7.6/100,000, P= 0.003), with the largest difference observed for patients >50 years of age. The species distribution varied significantly by both age and gender. Candidaspecies accounted for 98% of the pathogens, and C. albicanswas predominant, although the proportion decreased (64.4% to 53.2%, P< 0.0001). C. glabrataranked second, and the proportion increased (16.5% to 25.9%, P= 0.003). C. glabratawas more common in adults and females than in children and males, whereas C. tropicaliswas more common in males (P= 0.020). C. kruseiwas a rare isolate (4.1%) except at one university hospital. Acquired resistance to amphotericin and echinocandins was rare. However, resistance to fluconazole (MIC of >4 µg/ml) occurred in C. albicans(7/1,183 [0.6%]), C. dubliniensis(2/65 [3.1%]), C. parapsilosis(5/83 [6.0%]), and C. tropicalis(7/104 [6.7%]). Overall, 70.8% of fungemia isolates were fully fluconazole susceptible, but the proportion decreased (79.7% to 68.9%, P= 0.02). The study confirmed an incidence rate of fungemia in Denmark three times higher than those in other Nordic countries and identified marked differences related to age and gender. Decreased susceptibility to fluconazole was frequent and increasing.

The effect of the water-dispersible tocopherol preparation, Grindox 1032, and the oil-soluble tocopherol preparation, Toco 70, on oxidative stability in fish oil-enriched mayonnaise was examined. The two commercial antioxidant preparations were supplemented in different levels corresponding to 20-280 ppm tocopherol in addition to the 600 ppm present in the oils used for the mayonnaise. The oxidative stability was assessed by sensory analysis, the tendency of formation of free radicals, and concentrations of lipid hydroperoxides and volatile oxidation products. The effect of tocopherol on oxidation depended on the nature and the concentration of the tocopherol preparation employed, and it also depended on the parameters evaluated. Addition of high levels of Grindox 1032 (~140-280 ppm tocopherol) thus decreased the intensity of rancid off-flavor, but increased the formation of fishy off-flavors, the tendency of free radical formation and the concentration of certain volatiles. In contrast, low levels of Grindox 1032 (<70 ppm tocopherol) reduced the concentration of some volatiles, but did not seem to influence the off-flavor profile of the mayonnaise. Toco 70, which was only supplemented in low levels (<40 ppm tocopherol) increased the tendency for free radical formation, changed the profile of volatiles, and did not have a clear effect on the fishy and rancid off-flavor formation. Thus, additional tocopherol did not appear to be an efficient antioxidant in fish oil-enriched mayonnaise, perhaps because it cannot prevent the metal-catalyzed decomposition of peroxides, which we previously suggested to play an important role in mayonnaise.

Abstract:  Electron spin resonance spectroscopy (spin trapping technique) has been used to identify the most important single factor for initiation of lipid oxidation in mayonnaise enriched with fish oil. Low pH increases the formation of radicals during incubation under mildly accelerated conditions at 37  �C as quantified using 12-doxylstearic acid. Sugar, NaCl and potassium sorbate have no effect on radical formation while EDTA (down to 50 μg/g) has an antioxidative effect. Iron bound to phosvitin in egg yolk, inactive at pH∼6, is considered to be exposed to the solvent (the aqueous phase) at low pH and capable of initiating peroxide cleavage reactions when not protected by EDTA in a mixed complex.

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Evaluation of the oxidative stability of food lipids based on the tendency of formation of radicals is shown to be possible using electron spin resonance (ESR) spectroscopy and the spin-trapping technique. Induction time can be determined for mildly accelerated conditions (50°C for lipid fraction from mayonnaise enriched with fish oil), and the length of the induction time decreases during storage and ?-tocopherol depletion. The protection by ethylenediaminetetraacetic acid against initiation of lipid oxidation is also detected in the new assay. For more oxidatively stable lipids (butter, rapeseed oil, dairy spread) the mildly accelerated conditions can be used in the assay, provided that difference in signal height for fixed times replaces determination of induction time. ESR spin trapping provides a sensitive method for evaluating the oxidative stability of food lipids. Detection of radicals in the lipid as an early event in oxidation allows mild conditions to be used, and future experiments should also include sensory evaluation in relation to determination of practical shelf life.

Abstract: Evaluation of the oxidative stability of food lipids based on the tendency of formation of radicals is shown to be possible using electron spin resonance (ESR) spectroscopy and the spin-trapping technique. Induction time can be determined for mildly accelerated conditions (50°C for lipid fraction from mayonnaise enriched with fish oil), and the length of the induction time decreases during storage and γ-tocopherol depletion. The protection by ethylenediaminetetraacetic acid against initiation of lipid oxidation is also detected in the new assay. For more oxidatively stable lipids (butter, rapeseed oil, dairy spread) the mildly accelerated conditions can be used in the assay, provided that difference in signal height for fixed times replaces determination of induction time. ESR spin trapping provides a sensitive method for evaluating the oxidative stability of food lipids. Detection of radicals in the lipid as an early event in oxidation allows mild conditions to be used, and future experiments should also include sensory evaluation in relation to determination of practical shelf life.

Radicals from the flavonoids quercetin, (+)-catechin, (±)-taxifolin and luteolin, and from all-rac-α-tocopherol have been generated electrochemically by one-electron oxidation in deaerated dimethylformamide (DMF), and characterised by electron spin resonance spectroscopy (ESR) after spin-trapping by 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). Simulations of the ESR spectrum based on estimated coupling constants of the spin-trapped quercetin radical, confirmed that this antioxidant radical is oxygen-centered. The complex mixture of radicals, quinoid intermediates and stable two-electron oxidation products, were for each antioxidant allowed to react with each of the four other antioxidants, and the progression of reaction followed by ESR after addition of DMPO, and the product solution further analysed by HPLC. All-rac-α-tocopherol was found to be most efficient in regenerating each of the other antioxidants from their oxidation products with a regeneration index (defined as moles regenerated of the oxidised phenolic antioxidant divided with moles of all-rac-α-tocopherol consumed) of 0.90 ± 0.16 for quercetin, 0.48 ± 0.11 for (+)-catechin, 0.48 ± 0.06 for (±)-taxifolin and 0.50 ± 0.10 for luteolin in equimolar 1.00 mM solution. Quercetin was found to have the highest regeneration index among the flavonoids: 0.88 ± 0.13 for (+)-catechin, 0.41 ± 0.03 for (±)-taxifolin and 0.41 ± 0.02 for luteolin. The antioxidant hierarchy based on the reduction potentials determined by cyclic voltammetry under similar conditions (0.93 V for all-rac-α-tocopherol, 1.07 V for quercetin, 1.15 V for luteolin, 1.16 V for (+)-catechin and 1.20 V for (±)-taxifolin) is compared with the observed over-all regeneration (34% for quercetin, 34% for (+)-catechin, 52% for (±)-taxifolin and 43% for luteolin by all-rac-α-tocopherol).