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

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Plastic, integral to food packaging since the 1950s, has become a global environmental concern due to its contribution to microplastic pollution. Microplastics harm ecosystems, impacting wildlife and human health. Amid increasing focus on sustainability, global initiatives target sustainable production and consumption, but consumers struggle to verify product claims, leading to potential greenwashing, particularly in the food industry. We conducted an experiment focusing on pasta products with varied packaging and labeling attributes. Findings suggest that consumers are willing to pay more for products with both biodegradable packaging and Product Environmental Footprint (PEF) labels, indicating heightened trust and perceived sustainability. Information about microplastics' adverse environmental effects influenced consumer valuation, particularly among females, higher-income individuals, and those with stronger environmental concerns.

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The beer industry stands as a significant player in the global economy, and it is increasingly renowned not only for its diverse flavours, but also for its impact on the environment. Amidst its popularity, the beer sector faces mounting pressure to address environmental concerns, particularly related to packaging. As the world is increasingly embracing sustainability as a guiding principle, the beer industry's approach to packaging has come under scrutiny for its ecological footprint. This study aims to shed some light on the environmental footprint of beer production by applying a life cycle assessment, comparing different types of packaging. This study calculated the product environmental footprint of beer consumed in PET kegs, glass bottles and aluminium cans, and performed three sensitivity analyses on load factors of transport, waste transport distance and recycled content. The results identified draught beer in PET kegs as the most sustainable solution for beer consumption, with a footprint of around 90 % lower than the other types of packaging. However, the analysis showed that the biggest environmental impact is found in the cultivation, packaging and use phases, that account for a contribution of 60 %, 27 % and 11 % respectively. The results of this study highlighted the importance of the load factor in the distribution phase, of recyclability and of the use of secondary raw materials for packaging. This study stands as an original and valuable contribution, offering a comprehensive understanding of the environmental impact of beer packaging and of the beverage industry. Its insights can guide breweries, policymakers, and consumers towards sustainable choices, fostering a positive change within the sector. It also questions the sustainability of circular solutions by comparing recycling and reuse options. This study revealed also that a green supply chain management is key in the transition towards a circular economy and in the decarbonization process.

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

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

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

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

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

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

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Remediation activities, particularly in megasites, may induce substantial secondary environmental impacts that must be addressed for green and sustainable remediation (GSR) practices. Only limited studies are available quantitatively assessing the environmental footprint and environmental benefits of implementing Best Management Practices (BMPs) in megasite remediation. This study used the SiteWise™ tool, a quantitative environmental footprint assessment for scenario simulation and benefit quantification of BMPs, on a contaminated megasite in Hebei Province, China. We observed a considerable environmental footprint and energy from the remediation. Taking the final implementation alternative (Alt 1) as an example, which is characterized by combining multiple remediation techniques, the greenhouse gas (GHG) emissions reached 113,474 t, the energy used was 2,082,841 million metric British thermal units (MMBTU), and other air pollutant emissions (NOx, SOx, and PM10) amounted to 856 t. Further BMP analyses highlighted the benefits of substituting the conventional solidification/stabilization agent with willow woodchip-based biochar, which could reduce GHG emissions by 50,806 t and energy used by 926,648 MMBTU. The overall environmental benefits of implementing all applicable BMPs in the remediation were significant, with a 66.85%, 50.15%, and 56.05% reduction in GHG emissions, energy used, and other air pollutants, respectively. Our study provides insights into quantifying the environmental footprint and exploring emission reduction pathways for contaminated megasite remediation. It also offers a feasible path for quantifying the environmental benefits of BMPs, promoting the development of GSR of contaminated sites.

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

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

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

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Purpose: Healthcare has a large environmental footprint, not least due to the wide use of single-use supplies. Reprocessing of medical devices is a well-established, regulated process, and can reduce its environmental impact. This life cycle assessment (LCA) compares the environmental footprint of a single-use and a reprocessed version of otherwise identical intermittent pneumatic compression (IPC) sleeves. Materials and Methods: The LCA was performed in accordance with the international standard ISO 14044 using the Environmental Footprint 3.0 (EF) method for the assessment. Data were obtained in cooperation with IPC sleeve manufacturers. Where no primary data were available, ecoinvent database records were used. The functional unit is five hospital treatments applying IPC. The robustness of the results was interrogated in sensitivity analyses of the energy mix, the ethylene oxide emissions during reprocessing, and the transport distances. The impact of waste reduction on hospital disposal costs was calculated. Results: The environmental footprint of reprocessed IPC sleeves was found to be reduced in all categories compared to single-use devices, leading to a weighted normalized reduction of 43% across all categories. In a breakdown of the LCA results, reprocessed IPC sleeves were found to reduce the carbon footprint by 40%, with the treatment of five patients with single-use IPC sleeves creating 7 kg CO2eq, compared to 4.2 kg CO2eq from reprocessed sleeves. Waste disposal costs were also reduced by 90%. Conclusion: Reprocessing of IPC sleeves provides an environmental and economic benefit in comparison to single-use devices.

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The sustainable management of landfill leachates remains a matter of important concern in many countries. We used as case study a medium-sized Greek landfill, and we initially investigated the performance of the existing secondary leachate treatment system. The activated sludge process removed chemical oxygen demand (COD), biochemical oxygen demand (BOD), NH4-N, and PO4-P by 55%, 84%, 94%, and 14%, respectively, but the effluents did not meet the legislation requirements for discharge or reuse. Afterwards, different management options of these effluents (co-treatment with sewage in the centralized treatment plant, onsite tertiary treatment with reverse osmosis, granular activated carbon (GAC), ozonation, photo-Fenton, or constructed wetlands) were evaluated regarding their operational costs and environmental footprint. The use of constructed wetlands presented the lower operational cost, energy requirements, and greenhouse gas (GHG) emissions, not exceeding 21.5 kg CO2eq/day. On the other hand, the power consumption and the GHG emissions of the other on-site technologies ranged from 0.37 kWh/m3 and 5.56 kg CO2eq/day (use of GAC) to 39.19 kWh/m3 and 588.6 kg CO2eq/day (use of ozonation), respectively. The co-treatment of the leachates with municipal wastewater required 0.6 kWh/m3 and emitted 30.18 kg CO2eq/day. For achieving zero-discharge of the treated leachates, a system consisting of constructed wetlands and evaporation ponds in series was designed.

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This paper presents a comprehensive study on polyhydroxyalkanoate (PHA) production from sewage sludge. Greenhouse gas (GHG) emissions were monitored for the first time to assess the impact of climate change and environmental sustainability. The pilot plant was composed of a fermenter with a membrane and two biological reactors (namely, selection and accumulation). Results showed that despite a low organic loading rate (namely, 0.06 kg BOD kg SS-1 day-1), a good PHA yield was obtained (namely, 0.37 g PHA/g volatile fatty acids), confirming that sewage sludge can be a suitable feedstock. GHG emissions were 3.85E-04 g CO2eq/g and 32.40 g CO2eq/g, direct and indirect, respectively. Results provided valuable insights in view of finding a trade-off between PHA production and GHG emissions to prove the PHA production process as an effective solution for biosolids disposal at a low carbon footprint.

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Animal proteins have in the past been used in food production due to their functional properties that range from gelation and emulsification to foaming ability and stability. However, animal husbandry has been shown to be a major contributor to global warming and climate change. Consequently, there has been a drive toward the use of alternative proteins, for example, proteins from plant sources which are perceived to be cheaper, healthier, and sustainable. The use of trans and saturated fatty acids in the food industry has been associated with various health issues that include an increased risk of metabolic disorders. This has resulted in an increased search for fat substitutes that are healthier and sustainable. To contribute toward a reduction in the consumption of meats from animal sources and the consumption of trans and saturated fatty acids, the formulation of plant-based meat and fat analogs/substitutes has been carried out. However, there has been a lower acceptance of these meat or fat substitutes which was attributed to their sensorial and textural properties that fail to mimic or resemble real fat or meat. Therefore, this review aims to discuss the advances that have been made when it comes to plant-based meat and fat substitutes. Additionally, consumer perception and acceptance of these products will be reviewed as well as future markets will be discussed and the opportunities and challenges that exist in the formulation of these products will be explored.

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To reduce the current billions of people facing water scarcity, which is a dedicated Sustainable Development Goal (SDG) target, different actions and measures are required. This includes food labelling which accounts for water scarcity, to help consumers make informed choices when purchasing food products. The European Commission is considering the proposal of a "Sustainable food labelling framework" in the last quartal of 2023, within its ambitious Farm to Fork strategy. Implementing such a food label in the EU has a potential reach of 447 million consumers. Most prominent label candidate is its own developed PEF (Product Environmental Footprint), a tool already implemented by some retailers in the EU. However, this paper argues that the category water scarcity in the PEF has two major flaws. First, it does not account for water efficiency of a product, which is essential to solve global water stress. Second, the spatial resolution for water stress is much too coarse. The current PEF tool makes comparisons between products useless and even misleading. Its use might worsen global water scarcity, as it provides producers and consumers the wrong incentives. Urgent revision of the category water stress in the PEF is required. This can be done by using the indicators water stress and water efficiency in a complementary way, as well as using the most detailed spatial resolution science can provide.

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Plant-based foods are increasing in popularity as more and more people are concerned about personal and planetary health. The consumption of plant-based dairy alternatives (PBDAs) has assumed a more significant dietary role in populations shifting to more sustainable eating habits. Plant-based drinks (PBDs) made from soya and other legumes have ample protein levels. PBDs that are appropriately fortified have adequate levels of important vitamins and minerals comparable to dairy milk. For the PBDs examined, the greenhouse gas emissions were diminished by 59-71% per 250 mL, and the land use and eutrophication impact was markedly less than the levels displayed by dairy milk. The water usage for the oat and soya drinks, but not rice drinks, was substantially lower compared to dairy milk. When one substitutes the 250 mL serving of dairy milk allowed within the EAT Lancet Planetary Health Diet for a fortified plant-based drink, we found that the nutritional status is not compromised but the environmental footprint is reduced. Combining a nutrient density score with an environmental index can easily lead to a misclassification of food when the full nutrition profile is not utilized or only a selection of environmental factors is used. Many PBDAs have been categorized as ultra-processed foods (UPFs). Such a classification, with the implied adverse nutritional and health associations, is inconsistent with current findings regarding the nutritional quality of such products and may discourage people from transitioning to a plant-based diet with its health and environmental advantages.

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The rationalization of material flows, together with the utilization of waste raw materials for the production of alternative binders, became a very attractive topic during the last decades. However, the majority of designed materials can be used as a replacement for low-performance products. In this work, the waste materials (brick powder and blast furnace slag) are valorized through geopolymerization to design high-performance material as an alternative to high-performance concrete. Designed mixtures activated by sodium silicate and waste-originated alkali solution are characterized by the meaning of the chemical and mineralogical composition, evolution of hydration heat, and mechanical strength test. To contribute to the understanding of the environmental consequences and potential benefits, the carbon footprint and embodied energy analysis are provided. Obtained results highlight the potential of end-of-life bricks for the design of high-performance composites if mixed together with more reactive precursors. Here, even values over 60 MPa in compressive strength can be achieved with the dominant share of low-amorphous brick powder. The higher crystalline portion of brick powder may lead to the reduction of drying shrinkage and preservation of flexural strength to a greater extent compared to used slag. Performed environmental analysis confirmed the CO2 emission savings; however, the embodied energy analysis revealed a huge impact of using alkaline activators.