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Goal and theoretical commentary A number of recent life cycle assessment (LCA) studies have concluded that animal-sourced foods should be restricted—or even avoided—within the human diet due to their relatively high environmental impacts (particularly those from ruminants) compared with other protein-rich foods (mainly protein-rich plant foods). From a nutritional point of view, however, issues such as broad nutrient bioavailability, amino acid balances, digestibility and even non-protein nutrient density (e.g., micronutrients) need to be accounted for before making such recommendations to the global population. This is especially important given the contribution of animal sourced foods to nutrient adequacy in the global South and vulnerable populations of high-income countries (e.g., children, women of reproductive age and elderly). Often, however, LCAs simplify this reality by using ‘protein’ as a functional unit in their models and basing their analyses on generic nutritional requirements. Even if a ‘nutritional functional unit’ (nFU) is utilised, it is unlikely to consider the complexities of amino acid composition and subsequent protein accretion. The discussion herein focuses on nutritional LCA (nLCA), particularly on the usefulness of nFUs such as ‘protein,’ and whether protein quality should be considered when adopting the nutrient as an (n)FU. Further, a novel and informative case study is provided to demonstrate the strengths and weaknesses of protein-quality adjustment. Case study methods To complement current discussions, we present an exploratory virtual experiment to determine how Digestible Indispensable Amino Acid Scores (DIAAS) might play a role in nLCA development by correcting for amino acid quality and digestibility. DIAAS is a scoring mechanism which considers the limiting indispensable amino acids (IAAs) within an IAA balance of a given food (or meal) and provides a percentage contribution relative to recommended daily intakes for IAA and subsequent protein anabolism; for clarity, we focus only on single food items (4 × animal-based products and 4 × plant-based products) in the current case exemplar. Further, we take beef as a sensitivity analysis example (which we particularly recommend when considering IAA complementarity at the meal-level) to elucidate how various cuts of the same intermediary product could affect the interpretation of nLCA results of the end-product(s). Recommendations First, we provide a list of suggestions which are intended to (a) assist with deciding whether protein-quality correction is necessary for a specific research question and (b) acknowledge additional uncertainties by providing mitigating opportunities to avoid misinterpretation (or worse, dis-interpretation) of protein-focused nLCA studies. We conclude that as relevant (primary) data availability from supply chain ‘gatekeepers’ (e.g., international agri-food distributors and processors) becomes more prevalent, detailed consideration of IAA provision of contrasting protein sources needs to be acknowledged—ideally quantitatively with DIAAS being one example—in nLCA studies utilising protein as a nFU. We also contend that future nLCA studies should discuss the complementarity of amino acid balances at the meal-level, as a minimum, rather than the product level when assessing protein metabolic responses of consumers. Additionally, a broader set of nutrients should ideally be included when evaluating “protein-rich foods” which provide nutrients that extend beyond amino acids, which is of particular importance when exploring dietary-level nLCA.

Goede wetenschap. Een cross-disciplinaire studie. Fraude in de wetenschap brengt nogal wat pennen in beweging. Ferm beleid dient oplichterij tegen te gaan en integriteit te bevorderen. Dit zou moeten voorkomen dat individuele wetenschappers, die hun wetenschappelijke moraal niet op orde hebben over de schreef gaan. De stem van wetenschappers zelf ontbreekt echter vaak in deze schermutselingen. Hun stem stond daarom centraal in ons etnografisch onderzoek binnen 5 wetenschappelijke disciplines (wiskunde, chemie, filosofie, antropologie en geneeskunde). We vroegen wat de wetenschappers zelf verstaan onder goede wetenschap. Hoe geven zij vorm hieraan in hun dagelijkse werk, en welke obstakels komen ze tegen om goede wetenschap te realiseren? De uitkomsten van het onderzoek laten zien dat de problemen met wetenschappelijke integriteit niet in de eerste plaats gezocht moeten worden bij individuele wetenschappers, maar in de voorwaarden waaronder zij werken. Het zijn bijvoorbeeld slechte arbeidsomstandigheden en hoge druk vanuit financiers die fraude in de hand werken. Dit project maakt onderdeel uit van het ZonMw programma Bevorderen van verantwoorde onderzoekspraktijken [https://www.zonmw.nl/nl/onderzoek-resultaten/fundamenteel-onderzoek/programmas/programma-detail/bevorderen-van-verantwoorde-onderzoekspraktijken/] Leeshet rapport in de bijgevoegde pdf. Contact: Jeannette Pols – Principal Investigator(a.j.pols@amsterdamumc.nl)

This report is the outcome of a consensus-building project to agree on best practices for environmental and nutritional Life Cycle Assessment (nLCA) methodology, and identify future research needs. The project involved 30 nutritional and environmental LCA researchers from 18 countries. It focused on the assessment of food items (as opposed to meals or diets).Best practice recommendations were developed to address the intended purpose of an LCA study and related modeling approach, choice of an appropriate functional unit, assessment of nutritional value, and reporting nLCA results. An nLCA study should report the quantities of as many essential nutrients as possible and aim to provide information on the nutritional quality and/or health impacts in addition to nutrient quantities. Outstanding issues requiring further research attention include: defining a minimum number of nutrients to be considered in an nLCA study; treatment of nutrients to limit; use of nutrient indexes; further development of Impact Assessment methods; representation of nutritional changes that may occur during subsequent distribution and food preparation in cradle-to-gate nLCA studies; and communication of data uncertainty and variability. More data are required for different regions (particularly developing countries); for the processing, distribution, retail, and consumption life cycle stages; and for food loss and waste. Finally, there is a need to extend nLCA methodology for the assessment of meals and diets, to consider further how to account for the multi-functionality of food in a sustainability framework, and to set nLCA studies within the context of environmental limits.These results provide a robust basis for improving nLCA methodology and applying it to identify solutions that minimize the trade-offs between nourishing populations and safeguarding the environment.

Food systems have become increasingly efficient and technologically advanced in providing food products to meet the needs of the world’s growing population. However, providing healthy diets within environmental limits remains a key sustainability issue as food systems continue to over use increasingly scarce natural resources while making a major contribution to environmental impacts such as climate change, water scarcity and biodiversity loss. At the same time, hundreds of millions of people suffer from chronic hunger or adult obesity, and healthy diets continue to be more expensive than energy- and nutrient-sufficient diets. Many stakeholders are interested in the question of how to assess the environmental impacts of healthy diets, and in exploring solutions for minimizing trade-offs between nourishing populations and safeguarding the environment. Life cycle assessment (LCA) studies have an important role in contributing to solutions because they evaluate the environmental impacts of different practices, products and systems, and they facilitate the exploration of benefits and trade-offs across multiple types of impacts. LCA studies of food items increasingly address nutritional as well as environmental aspects, and this requires consideration of additional methodological aspects. The Food and Agriculture Organization of the United Nations (FAO) initiated a project to identify opportunities for further developing environmental and nutritional LCA methodology and building consensus about best practice, and to propose future research needs. The project involved 30 environmental and nutritional LCA researchers from 18 countries and ran between May and November 2021. The project focused on assessing food items as opposed to raw materials, meals and/or diets, and it is a step towards more comprehensive meal and dietary LCA studies. A key issue concerns the intended purpose of an LCA study. This requires some consideration of the reason for the study, the intended application and the audience. Foods may be consumed for a variety of reasons including for their nutritional value, for enjoyment, and/or as a means of taking part in – or contributing to – socio-cultural functions. This report defines a nutritional LCA (nLCA) study as an LCA study where the provision of nutrient(s) is considered as either the main function or one of the main functions of a food item. nLCA studies should be undertaken by multidisciplinary teams involving nutritional and health scientists as well as environmental scientists. At the outset, the goal and scope of an nLCA study should be carefully defined following the recommendations in this report, including: • Undertake an nLCA when nutrients are and/or nutrition is relevant to the decision-maker and decision context (Chapter 3). • Clearly identify the target audience and the target population for a study because different populations have different nutritional requirements, and this may influence the assessment of nutritional value (Chapter 5). • Report the quantities of as many essential nutrients as possible (Chapters 5 and 6). • Aim to provide information on the nutritional quality and/or health impacts in addition to nutrient quantities (Chapter 5, Chapter 6, Section 7.5.4). • The system boundaries should include all stages of the product life cycle that affect nutritional value. The final processing, storage and/or preparation of food items may have a notable effect on their nutritional value, and this should be taken into consideration (including the potential fortification of foods) (Chapter 5). • Choose a modelling perspective (typically attributional or consequential) based on the relevance to the decision situation (Chapter 4). The functional unit in an nLCA study can be defined in many ways (Chapter 6). These include: a quantity of one or more nutrients, a nutrient density value (calculated using a nutrient index), a quality-corrected quantity of nutrient(s), or another nutritional property (such as energy content). Alternatively, the functional unit could be a serving size. In all cases it should be relevant to the target population and its nutritional requirements. If possible, nutrients not included in the functional unit should be listed and discussed in the LCA report. Figure 5 and Figure 6 provide decision trees for guiding the choice of a functional unit in an nLCA study. When assessing nutrition, consideration should be given to: accounting for nutritional value as well as nutrient quantities (for example, using nutrient indices), separate treatment of nutrients to encourage (e.g. calcium) and of nutrients to limit (e.g. sodium), and assessment of non-nutrients that contribute to nutrition (e.g. dietary fibre) (Chapter 5, Chapter 6). In the impact assessment, research on the potential human health impacts of food items is at an early stage (Section 7.5.4). This report recommends using a nutrition impact category to account for the benefits or impacts of nutrition on human health (Section 8.1.1). Other particularly relevant impact categories to consider in an nLCA of food items include (Chapter 7): climate change, water use, land use, eutrophication (related to fertilizer use), ecotoxicity (related to pesticide use), and other human health impacts (in particular, fine particulates from agricultural activities and indoor use of some stoves, pesticide exposure and residues in food, chemical migration into food from contact materials, persistent organic pollutants and metals that bioconcentrate in foods). Antibiotic resistance is an emerging issue that requires consideration in the context of an LCA of food items (Section 7.7). Additional insights may be gained from integrating elements of the ecosystem services approach into an LCA (Section 7.6). The project led to numerous recommendations about reporting nLCA results. To increase the usefulness of nLCA studies of food items for future meal and dietary studies, the results should be reported using a mass- or volume-based reference flow as well as a nutritional functional unit. The results should identify whether the approach is nutrient-based or whether it also includes nutritional aspects. And the reported result should discuss the limitations of the adopted approach, for example, not accounting for interactions with other food items in a meal or diet (i.e. food matrix and meal effects) (Chapter 5). Some additional outstanding issues were identified in the project that require further attention (Chapter 8): • definition of a minimum number of nutrients to be considered in an nLCA study, and whether this should be based on food groups (Chapter 6); • treatment of nutrients to limit alongside, or separately from, encouraged nutrients (Chapter 6); • use of nutrient indices to assess nutrition (Chapter 6); • nutrition impact category methodology (Section 7.5.4), and further development of impact assessment methods for other impact categories (Chapter 7); • how to represent nutritional changes that could occur during food storage, distribution and preparation if the system boundary for an nLCA study is set at a life cycle stage prior to consumption (Chapter 4); • guidelines for use of an nLCA in different applications, including use of attributional and consequential modelling perspectives (Chapter 4); • representation of data uncertainty and variability in nLCA studies (Chapter 4); and •representative data for different regions (particularly developing countries) for the processing, distribution, retail, and consumption life cycle stages, and for food loss and waste (Chapter 4). Finally, there is a need to extend nLCA methodology for the assessment of meals and diets, to consider further how to account for the multi-functionality of food in a sustainability framework, and to set nLCA studies within the context of environmental limits. In summary, the constructive consensus-building process described in this report led to the identification of key outstanding issues and recommendations for the environmental and nutritional LCA of food items. The results provide a robust basis for future research to improve nLCA methodology and apply it to identify solutions that minimize the trade-offs between nourishing populations and safeguarding the environment

Om verspreiding van COVID-19 te verminderen, is het belangrijk om fysieke afstand te houden en zoveel mogelijk thuis te blijven (thuisisolatie). Maar we weten nog weinig over de gevolgen van die maatregelen op kwetsbare groepen. In deze studie is gesproken met mensen uit deze kwetsbare groepen en hun begeleiders en mantelzorgers over hun ervaringen met thuisisolatie. In dit project zijn de effecten onderzocht van sociale isolatie op kwetsbare groepen in Nederland ten tijde van ‘de lockdown’ periode (van 15 maart 2020 tot 23 mei 2020) en de periode van ‘de versoepeling’ van de maatregelen tot het einde van het onderzoek (de periode na 23 mei 2020-1 juli 2020). Het rapport beschrijft beide periodes tegen het licht van het veranderend overheidsbeleid rond thuisisolatie en aanverwant beleid, zoals afstand houden.

In the Netherlands, individual nursing homes as well as national policies have expressed the aspiration to make the nursing home more homely. In this chapter we discuss three ways in which home and institution emerge in the space of a nursing home. First, we illustrate how access, autonomy and control over space are negotiated. Second, we show how objects associated with the home or the institution are made differentially visible and invisible. Third, we turn to everyday routines to show the attempts to align rhythms of familiarity and rhythms of efficiency. These attempts at home making demonstrate that the institutional character of the nursing home cannot be made altogether invisible: it remains a site with its own logic, where the integration of spheres within its walls requires ongoing reflection, debates and efforts. Home is constantly in flux, and it is hard work to relate the public to the private.

Prevention enthusiasts show great optimism about the potential of health apps to modify peoples’ lifestyles through the tracking and quantification of behaviours and bodily signs. Critical sociologists warn for the disciplining effects of self-tracking. In this paper we use an empirical ethics approach to study the characteristics and strivings of the various types of ‘ethico-psychological subjects’ that emerge in practices of self-quantification by analysing how people and numbers relate in three cases of self-quantification: in prevention discourse, in testimonies from the quantified self (QS) movement and in empirical work we did with people with Diabetes type I and with ‘every day self-trackers’. We show that a free subject that needs support to enact its will is crucial to understand the optimism about prevention. In the QS-movement the concern is with a lack of objective and personalised knowledge about imperceptible processes in the body. These subjects are decentered and multiplied when we trace how numbers in their turn act to make sense of people in our empirical study. We conclude that there are many different types of ethico-psychological subjects in practices of self-tracking that need to be explored in order to establish what good these practices of self-quantification might do.

Kwaliteit van leven staat centraal bij invaliderende aandoeningen waarbij beslissingen over de behandeling en hulpmiddelen verstrekkende gevolgen kunnen hebben. In deze klinische les over een patiënt met ‘locked-in’-syndroom leren we meer over het concept ‘kwaliteit van leven’ en de manier waarop patiënten, familie, artsen en meetinstrumenten daar op verschillende wijze invulling aan kunnen geven. Patiënt, een 57-jarige man, wordt onwel, klaagt over verminderd gezichtsvermogen, verminderde kracht aan rechter arm en been en begint onduidelijk te spreken. Hij was nooit ziek en was zelfstandig ondernemer samen met zijn echtgenote; ze hebben drie volwassen zoons. Hij wordt naar de SEH gebracht, waar de arts dysartrie en een geringe halfzijdige verlamming rechts constateert. De CT-scan toont twee infarcten van oudere datum in de rechter hemisfeer. Het team besluit tot het verrichten van intraveneuze trombolyse met recombinant weefselplasminogeenactivator. De deur-tot-naaldtijd is 22 minuten. Na enige tijd is de uitval verdwenen, waarop behandeling met plaatjesremming (clopidogrel) wordt begonnen ... -- A 57-year-old man developed a locked-in state due to a brain stem stroke. He communicated through eye movements. The team suggested treatment should be discontinued, as there was no perspective of improvement. The family was very upset because they experienced sufficient quality of life. We investigated what 'quality of life' means. The literature shows that severely ill and completely care-dependent patients may experience high quality of life; this is called the disability paradox. Patients and families evaluate quality of life by looking for positive things to live for. Some quality-of-life tests, however, understand quality of life as 'functionality'. Healthy people evaluate the situation of people living with handicaps more negatively than the handicapped themselves do. Practitioners may overlook the instability of patients' evaluations: responses and situations may shift. Quality of life as an outcome in clinical trials may be different for individual patients. These insights may improve communication.