Life cycle assessment of animal-based foods and plant-based protein-rich alternatives: an environmental perspective

BACKGROUND

In the European Union proteins for food are largely animal based, consisting of meat and dairy products. Almost all soy but also a larger part of pulses and cereals consumed in the European Union are used for animal nutrition. While livestock is an important source of proteins, it also creates substantial environmental impacts. The food and feed system is closely linked to the planetary and health boundaries and a transformation to healthy diets will require substantial dietary shifts towards healthy foods, such as nuts, fruits, vegetables and legumes.

RESULTS

Extrudated vegetable meat alternatives consisting of protein combined with amaranth or buckwheat flour and a vegetable milk alternative made from lentil proteins were shown to have the potential to generate significantly less environmental impact than their animal-based counterparts in most of the environmental indicators examined, taking into account both functional units (mass and protein content). The underlying field-to-fork life cycle assessment models include several variants for both plant and animal foods. The optimized plant-based foods show a clear potential for improvement in the environmental footprints.

CONCLUSIONS

Development of higher processed and therefore higher performing products is crucial for appealing to potential user groups beyond dedicated vegetarians and vegans and ultimately achieving market expansion. The Protein2Food project showed that prototypes made from European-grown legumes and pseudocereals are a valuable source for high-quality protein foods, and despite being substantially processed they could help reduce the environmental impact of food consumption. © 2021 Society of Chemical Industry.

Aspirin and warfarin therapy in oculoplastic surgery

BACKGROUND/AIMS

There are no nationally agreed guidelines on preoperative management of patients who are on aspirin or warfarin therapy. There is considerable evidence that complication rates in anticoagulated patients are low whereas there are higher rates of thromboembolic complications in those whose therapy is manipulated. This survey aimed to establish oculoplastic specialist and non-specialist ophthalmic surgeons' current management practice of patients before oculoplastic surgery who are taking aspirin or warfarin and to assess the rate of complications in these patients.

METHOD

An anonymous postal questionnaire survey of all ophthalmic consultants and specialist registrars in the Wessex region along with oculoplastic specialists in the Southern region.

RESULTS

The overall response rate was 92%. Preoperative management was influenced both by type of operation and by type of surgeon. A statistically significant higher proportion of surgeons would consider altering warfarin compared with aspirin treatment. For all procedures, non-specialists are unlikely to stop aspirin therapy, and are less likely to stop warfarin before all procedures apart from dacrocystorhinostomy. A significant proportion of surgeons (18%) would allow insufficient time for the coagulation status of the patient to change after altering treatment. A considerable proportion of surgeons (54%) reported that they had seen complications as a result either of stopping or continuing anticoagulation therapy.

CONCLUSIONS

In this survey, at least half the surgeons questioned would consider stopping warfarin before oculoplastic procedures. Over half of all surgeons have seen complications related to aspirin or warfarin, some of which were serious. A suggested approach to minimising patient risk is given.

Familial glaucoma iridogoniodysplasia maps to a 6p25 region implicated in primary congenital glaucoma and iridogoniodysgenesis anomaly

Familial glaucoma iridogoniodysplasia (FGI) is a form of open-angle glaucoma in which developmental anomalies of the iris and irido-corneal angle are associated with a juvenile-onset glaucoma transmitted as an autosomal dominant trait. A single large family with this disorder was examined for genetic linkage to microsatellite markers. A peak LOD score of 11.63 at a recombination fraction of 0 was obtained with marker D6S967 mapping to chromosome 6p25. Haplotype analysis places the disease gene in a 6.4-cM interval between the markers D6S1713 and D6S1600. Two novel clinical appearances extend the phenotypic range and provide evidence of variable expressivity. The chromosome 6p25 region is now implicated in FGI, primary congenital glaucoma, and iridogoniodysgenesis anomaly. This may indicate the presence of a common causative gene or, alternatively, a cluster of genes involved in eye development/function.

Phenotypic heterogeneity may occur in congenital fibrosis of the extraocular muscles

BACKGROUND/AIMS

Congenital fibrosis of the extraocular muscles (CFEOM) is an autosomal dominant, non-progressive disorder characterised by congenital ptosis and external ophthalmoplegia. CFEOM has previously been divided into several clinical entities; general fibrosis syndrome, strabismus fixus, vertical retraction syndrome, and congenital fibrosis of the inferior rectus. The purpose of this study was to identify families with CFEOM in this geographical region in order to perform a study of the clinical presentation of this disorder and to estimate its minimum prevalence in the population.

METHODS

Four families were identified with CFEOM in the Wessex region from whom a full history with a pedigree was obtained. All individuals underwent ophthalmological examination.

RESULTS/CONCLUSION

This study shows that several of the CFEOM entities can be present within one family suggesting that these are variants of the same condition. It is suggested that subclassification is, therefore, not appropriate. The minimum prevalence of this disorder was found to be 1/230,000.

Evaluating Animal-Based Foods and Plant-Based Alternatives Using Multi-Criteria and SWOT Analyses

Global diets have transitioned in recent decades with animal and processed products increasing. Promoting a reversal in these trends towards plant-based diets could reduce the environmental impacts of food systems and reduce the prevalence of non-communicable diseases and malnutrition. In Spain, a reference point for the Mediterranean diet (predominantly plant-source based), plant-based alternatives to traditional animal-based products are receiving increased attention. However, limited focus has been given to the opinions of stakeholder groups on the potential of these novel products. We evaluate the opinions of stakeholders within the Spanish agri-food sector, using multicriteria and SWOT analyses, on traditional and novel food products. Stakeholders involved in the supply chain of food products (producers, processors, and distributors) were critical of novel plant-based foods, highlighting problems with their taste, processing technology, and high prices. These results contrast with the perspectives of policymakers, researchers, environmental NGOs, and consumers who see novel products more positively - healthier, more sustainable, and highly profitable. These results illustrate the more traditional mindset seen in Spanish production systems, contrasting with the rapidly shifting tastes and demands of consumers and the potential legislative orientation of policymakers. This study calls for improved understanding and collaboration between stakeholders to better manage complex choices that affect the future of food systems during their needed transformation.

The House-Brackmann system and assessment of corneal risk in facial nerve palsy

PURPOSE

The House-Brackmann (HB) facial nerve grading system is widely used by ENT/head and neck surgeons, but is perhaps of less value to the ophthalmologist. Our aim was to assess the value of the numeric portion of this system in identifying those patients with facial nerve palsy who are at risk of corneal complications. We also sought to identify other factors that might be predictive of such complications.

METHODS

Forty-two patients (43 palsies) were studied prospectively. The HB grade was recorded together with measurements of levator function, upper lid closure, Bell's phenomenon, lagophthalmos, ectropion, lower lid retraction and corneal sensation. Conjunctival injection and corneal staining were also graded. ROC (receiver operating characteristic) curves were used to assess the value of each parameter as a screening test for corneal complications.

RESULTS

There was no cut-off of HB grade, levator function, Bell's phenomenon, ectropion or lower lid retraction that was sufficiently sensitive and specific to screen for corneal complications. However, on assessing lagophthalmos and upper lid closure, cut-offs with more favourable sensitivities and specificities were identified.

CONCLUSIONS

The numeric portion of the HB grading system is not a useful guide in identifying those patients with facial nerve palsy who are at risk of corneal complications. Measurements of lagophthalmos and upper lid closure, alone or in combination with other tests, may be of more value.

Life cycle assessment of animal-based foods and plant-based protein-rich alternatives: a socio-economic perspective

BACKGROUND

Extensive research shows that replacing animal protein with plant-based protein in the diet would strongly alleviate the environmental impact of the food system. However, much less attention has been given to the socio-economic considerations of dietary transitions. This study analyses the socio-economic performance of innovative legume-based food prototypes, developed in the Protein2Food research project, and conventional animal-based products (chicken meat and dairy milk). We implement a social life cycle assessment (sLCA) to quantify and compare their potential socio-economic impacts along the entire life cycle.

RESULTS

Findings from this analysis show that legume-based prototypes and their respective animal-based counterparts have, overall, a comparable socio-economic performance. Looking at the disaggregated life cycle stages, socio-economic hotspots (points of most negative impacts) were mainly identified at the production stage in legume-based products. Farm-level net margin and profitability are low when compared with their animal equivalents. However, at the processing stage, there are socio-economic gains for plant-based products regarding lower unemployment rates. Finally, at the consumption stage, there are mixed results. Plant-based products show worse protein affordability but better nutritional contents (lower saturated fat and cholesterol) than their animal counterparts.

CONCLUSIONS

To improve socio-economic performance of legume-based foods, greater emphasis should be placed upon developing improved processing technologies and supply chains. This would broaden the supply of sustainable protein-rich food options and make these products more economically attractive. The research illustrates that policies should be targeted to the different stages of the food value chain to optimize the development of innovative plant-based foods. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

The tricot approach: an agile framework for decentralized on-farm testing supported by citizen science. A retrospective

Matching crop varieties to their target use context and user preferences is a challenge faced by many plant breeding programs serving smallholder agriculture. Numerous participatory approaches proposed by CGIAR and other research teams over the last four decades have attempted to capture farmers' priorities/preferences and crop variety field performance in representative growing environments through experimental trials with higher external validity. Yet none have overcome the challenges of scalability, data validity and reliability, and difficulties in capturing socio-economic and environmental heterogeneity. Building on the strengths of these attempts, we developed a new data-generation approach, called triadic comparison of technology options (tricot). Tricot is a decentralized experimental approach supported by crowdsourced citizen science. In this article, we review the development, validation, and evolution of the tricot approach, through our own research results and reviewing the literature in which tricot approaches have been successfully applied. The first results indicated that tricot-aggregated farmer-led assessments contained information with adequate validity and that reliability could be achieved with a large sample. Costs were lower than current participatory approaches. Scaling the tricot approach into a large on-farm testing network successfully registered specific climatic effects of crop variety performance in representative growing environments. Tricot's recent application in plant breeding networks in relation to decision-making has (i) advanced plant breeding lines recognizing socio-economic heterogeneity, and (ii) identified consumers' preferences and market demands, generating alternative breeding design priorities. We review lessons learned from tricot applications that have enabled a large scaling effort, which should lead to stronger decision-making in crop improvement and increased use of improved varieties in smallholder agriculture.

Data-driven approaches can harness crop diversity to address heterogeneous needs for breeding products

This perspective describes the opportunities and challenges of data-driven approaches for crop diversity management (genebanks and breeding) in the context of agricultural research for sustainable development in the Global South. Data-driven approaches build on larger volumes of data and flexible analyses that link different datasets across domains and disciplines. This can lead to more information-rich management of crop diversity, which can address the complex interactions between crop diversity, production environments, and socioeconomic heterogeneity and help to deliver more suitable portfolios of crop diversity to users with highly diverse demands. We describe recent efforts that illustrate the potential of data-driven approaches for crop diversity management. A continued investment in this area should fill remaining gaps and seize opportunities, including i) supporting genebanks to play a more active role in linking with farmers using data-driven approaches; ii) designing low-cost, appropriate technologies for phenotyping; iii) generating more and better gender and socioeconomic data; iv) designing information products to facilitate decision-making; and v) building more capacity in data science. Broad, well-coordinated policies and investments are needed to avoid fragmentation of such capacities and achieve coherence between domains and disciplines so that crop diversity management systems can become more effective in delivering benefits to farmers, consumers, and other users of crop diversity.

Cognitive impairment reversed by cinacalcet administration in primary hyperparathyroidism

Primary hyperparathyroidism (pHPT) is a common endocrine disorder. Often serum calcium is minimally elevated with few symptoms. In elderly patients with multiple co-morbidities, the decision to "watch and wait" is often most clinically appropriate as operative intervention is associated with high peri-operative risk. We present an elderly patient with mild hypercalcemia secondary to primary hyperparathyroidism. The clinical decision was initially to watch and wait. The patient subsequently developed cognitive impairment and was diagnosed with mixed Alzheimer's disease/vascular dementia. She became dependent for all care and housebound. A therapeutic trial of cinacalcet was commenced following a further acute rise in serum calcium. Significant reversal of her functional and cognitive deficit occurred. She was no longer fully dependent. Mini mental state examination (MMSE) improved from 8/30 to 21/30. In vulnerable neural systems, even mild elevation in serum calcium may have a profound effect on cognition and function. We propose a therapeutic trial of cinacalcet in such patients.

Characterizing cassava farmer typologies and their seed sourcing practices to explore opportunities for economically sustainable seed business models in Rwanda

The overdependency on local cassava varieties and informal seed sources by farmers in Rwanda has contributed to the spread of cassava viral diseases. The use of improved planting materials made available through formal seed sources, that assure seed quality, is one way to prevent future disease outbreaks. In order to increase the availability of, and farmers access to, such materials there is increasing interest to develop seed business models. This study aims to understand seed sourcing practices of different farm typologies to inform the development of tailored seed business models. A total of 390 farmers were interviewed and the collected data was analyzed into clusters, resulting in seven farm typologies. Seed sourcing strategies, seed replacement dynamics and purchasing behavior of these typologies were explored via a seed tracing study. We find that more commercial oriented farmers have better access to formal seed sources. Nevertheless, the majority of farmers in all typologies accessed new varieties and quality cassava seed via informal channels. At both formal and informal sources, cash investments in seed were mainly made by the categories of better-off farmers, and were one-time investments to acquire a new variety. Based on farmers current seed sourcing practices, clarifications on the differences between farmers and their willingness-to-pay, the roles of seed degeneration, cost-benefit analysis, value propositions and profit formulas seem important requirements for the further development of viable cassava seed business models. We conclude that tailoring seed business models can have a high potential as it acknowledges differences among farmers, but that careful coordination is needed to ensure that one approach or intervention does not contrast with and/or undermine the others.

Complete infarction of the eye complicating a choroidal malignant melanoma

Infarction of malignant melanoma of the choroid has been previously reported, but infarction of the whole eye in association with infarction of melanoma is a rare event that has not been previously described. We present such a case and discuss the possible pathogenesis.

1231 MANAGING THE DETERIORATING PATIENT IN A REHABILITATION HOSPITAL: THE ROLE OF TREATMENT ESCALATION PLANNING

Introduction

The pandemic has shown how vital patient-centred treatment escalation planning (TEP) is for older people. Locally we have seen inappropriate transfer of dying patients to acute hospitals from rehabilitation units. Mortality review found a lack of useful TEPs in these cases. Baseline data in our rehabilitation hospital showed 54% of patients had a TEP and 16% a decision made about repatriation during acute illness. We aimed to increase the proportion of patients in this setting with a TEP to 80% over six months.

Methods

A multidisciplinary team of doctors, ANPs and senior nurses worked together. We conducted stakeholder engagement to understand the factors that result in transfer of patients and found that completion of TEPs was felt to be an effective way to improve communication out of hours. Our first test of change involved an ANP raising the CPR status and TEP for all new patients at the weekly MDT. We measured the process of what decisions were made once a fortnight. Outcome data on the overall completion of TEPs and repatriation decisions was collected each month.

Results

New decisions were made at each MDT – for example, on one date two new DNACPRs and six new TEPs were completed. Overall TEP completion rate varies however since our first intervention we have seen a sustained increase in the number of TEPs which include consideration of repatriation – from 16% to 60%. Ongoing conversation with doctors in training reveals challenges with ward staff awareness of TEP content and their ability to guide unexpected events out of hours.

Conclusion

Involvement of motivated permanent staff across disciplines has allowed us to ensure escalation plans are being made each week and see a sustained increase.

Climate-related risk modeling of Banana Xanthomonas Wilt (BXW) disease incidence within cropland area of Rwanda

Banana Xanthomonas Wilt (BXW) is the major threat to banana in Rwanda, causing up to 100% yield loss. There are no biological or chemical control measures, and little is known about potential direction and magnitude of its spread, so cultural control efforts are reactive rather than proactive. In this study, we assessed BXW risk under current and projected climate, to guide early warning and control by applying maximum entropy (Maxent) model on 1,022 georeferenced BXW datapoints and 20 environmental variables. We evaluated the variables' significance and mapped potential risk under current and future climates to assess spatial dynamics of the disease distribution. BXW occurrence was reliably predicted (mean validation AUC ranging from 0.79 - 0.85). Precipitation of the coldest quarter, average maximum monthly temperature, annual precipitation, and elevation were strongest predictors, explaining 21.1%, 13%, 12.6%, and 9.4% of the observed incidence variability, respectively, while mean temperature of the coldest quarter has the highest gain in isolation. Further, the most susceptible regions (in western, northern, and southern Rwanda) are characterized by elevation (1,350m - 2,000m), annual precipitation (900mm - 1700mm), and average temperature (14oC - 20oC), among other variables, suggesting that a consistent, rainy, and warm climate is more favorable for BXW spread. Under future climate, the risk is predicted to increase and spread to other regions. We conclude that climate change will likely exacerbate BXW-related losses of banana land area and yield, under temperature and precipitation influence. Findings support evidence-based targeting of extension delivery to farmers and national early warning for timely action.

Leveraging Digital Tools and Crowdsourcing Approaches to Generate High-Frequency Data for Diet Quality Monitoring at Population Scale in Rwanda

Diet quality is a critical determinant of human health and increasingly serves as a key indicator for food system sustainability. However, data on diets are limited, scattered, often project-dependent, and current data collection systems do not support high-frequency or consistent data flows. We piloted in Rwanda a data collection system, powered by the principles of citizen science, to acquire high frequency data on diets. The system was deployed through an unstructured supplementary service data platform, where respondents were invited to answer questions regarding their dietary intake. By combining micro-incentives with a normative nudge, 9,726 responses have been crowdsourced over 8 weeks of data collection. The cost per respondent was < $1 (system set-up, maintenance, and a small payment to respondents), with interactions taking <15 min. Exploratory analyses show that >70% of respondents consume tubers and starchy vegetables, leafy vegetables, fruits, legumes, and wholegrains. Women consumed better quality diets than male respondents, revealing a sex-based disparity in diet quality. Similarly, younger respondents (age ≤ 24 years) consumed the lowest quality diets, which may pose significant risks to their health and mental well-being. Middle-income Rwandans were identified to have consumed the highest quality diets. Long-term tracking of diet quality metrics could help flag populations and locations with high probabilities of nutrition insecurity, in turn guiding relevant interventions to mitigate associated health and social risks.