As humanity's marked effects on Earth's natural systems become increasingly apparent, we witness with alarm the impact on health and healthcare delivery. In this review, interrelationships between climate change, kidney health, and peritoneal dialysis (PD) therapies are described, and expansion of duty of care to the environment while maintaining the highest-quality healthcare is explored. Practical, high-yield actions that can be undertaken by patients and providers through the principles of sustainable care are introduced, including medication and single-use plastic consumables optimization, incremental PD, remote health monitoring, innovative PD effluent drainage, waste optimization, and importantly, patient empowerment as partners in sustainability. To ensure sustainable practices are embedded in clinical care, creation of a network of green champions, alignment with low carbon sustainable health systems more broadly, and appropriate uptake of emerging innovations in PD therapy that may be offered through sustainable procurement and regional or point of care dialysate production are crucial.

Purpose This study aims to investigates how social norms influence behavioral intentions and the perceived effectiveness of interventions aimed at promoting sustainable procurement practices, specifically within the context of small and medium-sized enterprises (SMEs) in Ghana’s sachet water industry. Design/methodology/approach A quantitative survey methodology was used, targeting procurement and supply chain personnel within Ghanaian SMEs. Data from 245 respondents were collected and analyzed using structural equation modeling (SEM) to test a conceptual framework linking descriptive norms (DN), injunctive norms (IN) and personal norms (PN) to behavioral intentions and advocacy (BIA), as well as the effectiveness of social norm interventions (ESNI). Findings The results reveal that PN are the strongest predictor of BIA (β = 0.41), outperforming both injunctive (β = 0.27) and DN (β = 0.32). Furthermore, BIA was found to be a central mechanism, significantly mediating the relationship between the norm constructs and the perceived ESNI (β = 0.19). Research limitations/implications While the study identifies individual-level psychological drivers (PN, DN, IN) as central to sustainable procurement intentions, future research could delve deeper into organizational-level factors that may moderate or mediate these relationships. For instance, how does organizational culture influence the internalization of PN? How do leadership styles and top-management support affect the translation of behavioral intentions into actual procurement practices. Practical implications Practically, this suggests that interventions should prioritize strategies that activate PN, supplemented by leveraging DN once initial intentions are formed, to achieve more effective and sustainable supply chain practices, particularly in informal sector SMEs with limited regulatory pressure. Originality/value The study not only highlights the primacy of internalized PN but also demonstrates how the interplay of DN, IN and PN is reshaped by Ghana’s collectivist culture and the informal governance structures typical of SME-dominated sectors. By revealing these context-contingent mechanisms, the research advances norm theory beyond Western, formal-sector assumptions and offers a culturally grounded framework for sustainable procurement in similar Global South settings.

Impact of 3D food printing techniques on waste reduction and personalized nutrition in the digital age: A review

Climate change represents one of the most significant global health threats, with emergency departments (ED) serving as frontline responders to climate-related health emergencies. While EDs are major contributors to healthcare's environmental footprint and critical responders for climate disasters, no comprehensive review has examined sustainability and climate-resilience initiatives specifically implemented in ED settings. We conducted a scoping review examining literature on sustainable and climate-resilient measures in EDs. Comprehensive searches of PubMed, Scopus, and Embase were performed from inception through November 2024, using terms related to EDs combined with sustainability and climate-resilience concepts. Two reviewers independently screened papers, with inclusion criteria requiring ED-specific focus and concrete sustainability or resilience interventions. Seven studies met inclusion criteria, representing diverse geographic contexts. Three addressed sustainability interventions including waste reduction, sustainable procurement, device reprocessing, and renewable energy adoption. Case examples demonstrated co-benefits, such as 31% reduction in ambulance carbon dioxide emissions and $3 million savings from device reprocessing programs. All studies described resilience interventions encompassing disaster preparedness, surge capacity, infrastructure continuity, and clinical protocols. However, significant gaps were identified: Only 13-20% of hospitals in surveyed countries had disaster plans, and no studies documented fully operational climate-smart EDs. Global frameworks were referenced but not operationalized in ED settings. There is a limited body of peer-reviewed studies that describe measures to close the implementation gap between current climate science and operational practices in EDs. Despite extensive policy recommendations and demonstrated benefits, no studies have described any existing programs. Emergency medicine requires translation of conceptual frameworks into measurable interventions, standardized outcome measures, and systematic implementation of climate-smart healthcare practices.

The US health care system significantly contributes to climate change while increasingly facing its adverse consequences. Despite this dual challenge, policy efforts to incentivize carbon reduction and make care delivery climate-resilient remain fragmented. In this article, we identify policy interventions and other strategies that have the potential to accelerate the transition toward low-carbon, climate-smart health care systems. Drawing on academic literature and real-world implementation examples, we present a framework of strategies, highlighting the evidence in support of mechanisms such as green reimbursement models, integration of climate change into health professional education, and sustainable procurement standards. We further examine emerging policy levers, including circular economy practices and mandated carbon accounting. Last, we highlight opportunities for federal and state policy makers, payers, and health system leaders to guide future action. Ensuring that health policies actively support climate mitigation and adaptation is a moral and environmental imperative and a strategic opportunity to improve quality, reduce costs, and advance health equity.

The transition toward low-impact facility management requires robust evidence that environmental optimization does not compromise hygienic reliability. In the professional cleaning sector, sustainability claims are often based on product substitution rather than on integrated performance validation. This study provides a dual-perspective evaluation comparing a conventional cleaning protocol with the Pfe Green system, an eco-designed approach compliant with the Italian Minimum Environmental Criteria (CAM, D.M. 29 January 2021), implemented in a civil building of Renault Italia S.p.A. in Rome. A combined Life Cycle Assessment (LCA) and microbiological evaluation was conducted under real operational conditions to quantify both climate-related and hygienic outcomes. The LCA, performed in accordance with ISO 14040–44 and ISO 14067 standards, demonstrated that the Green protocol achieved an approximately 30% reduction in Global Warming Potential over a 100-year horizon (GWP100), mainly attributable to structural process optimization, including reduced detergent mass, lower laundering temperatures, improved dilution control, and energy-efficient machinery. Microbiological monitoring, conducted according to ISO 14698 and UNI EN ISO 18593, showed that both systems ensured high levels of microbial abatement, with the Green protocol exhibiting slightly higher average reductions in total viable counts (96.1% vs. 94.2%). These findings confirm that lower chemical input and eco-formulated products do not compromise hygienic performance when supported by standardized procedures and microfiber-based mechanical removal. By integrating life-cycle metrics with microbiological validation, this research proposes a replicable assessment model for sustainable cleaning services. The results demonstrate that CAM-aligned green protocols can simultaneously reduce greenhouse gas emissions and maintain hygienic effectiveness, thereby supporting evidence-based sustainable procurement and corporate environmental strategies. The originality of this study lies in the integration of life-cycle environmental assessment with real-world microbiological validation under operational conditions, providing a comprehensive framework for evaluating sustainable cleaning systems beyond product-level substitution.

Background: Sustainable procurement is a crucial pillar of corporate governance and competitiveness, particularly in resource-constrained environments such as Namibia. Regardless of the rising interest in sustainability principles, the bulk of parastatals face difficulties in embedding environmental, social and economic considerations into internal procurement processes. Namibia Corporation (NAMCOR) exemplifies this challenge, where balancing cost efficiency, compliance and sustainability remains a complex task. Objectives: This study aims to highlight and evaluate the key drivers influencing sustainable internal procurement at NAMCOR. Method: An exploratory qualitative approach, interpretivist philosophy and case study design were adopted. Data were collected from 20 participants purposively selected from NAMCOR using semi-structured interview guide. Document analysis was also used to collect data, and thematic analysis was applied during data analysis. Results: The results indicate that leadership commitment, corporate values, compliance with government policies, economic efficiency, employee competence, shareholder influence and supplier collaboration are the key factors of sustainable internal procurement. The adoption of sustainable practices is hampered by misaligned departmental priorities, weak sustainability awareness and inadequate monitoring mechanisms. Conclusion: The study reveals that sustainable internal procurement needs a comprehensive strategy that combines governance, capacity building and digital technology. Stakeholder engagement and policy alignment will stimulate sustainability and organisational performance. Contribution: This research enhances the understanding of sustainable procurement in Namibia. It provides a conceptual framework for adopting sustainability in procurement in the oil and gas industry. It offers practical guidance for corporate leaders who aim to align operational processes with sustainability objectives.

ABSTRACT As climate change intensifies, firms are increasingly expected to extend environmental responsibility across their supply chains. Green procurement, a core element of green supply chain practice, reduces carbon footprints by encouraging firms to source from environmentally superior suppliers. While existing studies have explored the impact of environmental regulation on green procurement, limited research has examined the role of green finance in shaping corporate procurement behaviour. Using panel data on 1,378 Chinese A-share listed firms from 2009 to 2021, this study examines the impact of green finance on firms’ green procurement by employing two-way fixed effects, instrumental variable (IV) methods, and a difference-in-differences (DID) design. The results indicate that green finance significantly promotes firms’ procurement from green suppliers. Mechanism analyses reveal that this effect operates by enhancing environmental awareness and alleviating financing constraints. Heterogeneity analysis shows stronger effects for firms in non-heavily polluting industries and regions with stricter environmental regulation. Furthermore, green procurement significantly improves firms’ green innovation performance. Overall, this study extends research on the economic consequences of green finance to the supply chain context. The findings suggest that policymakers should integrate green procurement criteria into green finance frameworks, and managers should leverage green finance to implement sustainable procurement practices.

This study investigates the key drivers and barriers affecting business-to-business (B2B) buyers’ adoption of green products. Drawing on a conceptual multilevel framework, it examines how access to sustainability information, environmental awareness, and effective green marketing help green procurement decisions. The analysis further highlights the influence of persuasive communication, social norms, and environmental consciousness on strengthening purchase intentions. In contrast, exessive costs, limited product availability, scepticism toward eco-labels, and insufficient information are identified as major obstacles. The findings underscore the dynamic interplay between enabling and inhibiting factors and suggest strategic pathways for businesses to promote sustainable procurement. This research contributes to the sustainability discourse by providing actionable insights for encouraging environmentally responsible purchasing in B2B contexts.

Green Public Procurement (GPP) is increasingly recognized as a vital tool for advancing sustainable development in Africa. This paper compares GPP frameworks in Nigeria, Kenya, and South Africa, focusing on key sectors such as energy, transportation, construction, and ICT. Using survey data from 287 procurement professionals, policymakers, and sustainability officers, the study analyzes the legal, institutional, and operational aspects of GPP across countries. South Africa leads with a mature, well-coordinated system, while Nigeria and Kenya face challenges related to fragmented implementation and weak monitoring. The research highlights the importance of political will, agency collaboration, supplier development, and international support as drivers of successful GPP. The findings offer practical recommendations to harmonize policy and foster sustainable procurement across Africa.

Climate change poses a growing threat to global health, yet healthcare systems contribute substantially to environmental harm through energy use, waste, and greenhouse gas (GHG) emissions. Among hospital departments, Intensive Care Units (ICUs) are among the most resource- and energy-intensive, generating disproportionately high greenhouse gas (GHG) emissions. The aim of this systematic review is to synthesize the literature on the environmental footprint of ICUs and to develop evidence-based strategies for creating sustainable ‘Green ICUs’ in accordance with the PRISMA 2020 guidelines. Peer-reviewed studies published between 2012 and October 2025 were identified through searches of major biomedical databases. Eligible studies examined the impacts of climate change on human health and infectious diseases, the ecological footprint of medical imaging and personal protective equipment, and sustainability interventions relevant to adult intensive care units. The environmental footprint of ICUs ranges from 88 to 178 kg CO2-equivalents per patient per day. High electricity consumption, especially from heating, ventilation, and air-conditioning (HVAC) systems, along with single-use medical supplies and diagnostic imaging, drives this impact. Life-cycle assessments consistently demonstrate that reusable textiles, optimized energy systems, and rationalized diagnostic practices significantly reduce emissions and waste. Educational and behavioral interventions were effective in reducing unnecessary consumable use while maintaining patient safety. A “Green ICU” model integrating energy efficiency, sustainable procurement, waste reduction, and staff education can substantially reduce environmental harm without compromising quality of care.

Purpose The study investigates stakeholder engagement in public procurement of works within tertiary institutions in Ghana, emphasizing its role in advancing environmental sustainability. It aims to determine the present level of stakeholder engagement, assess stakeholders' understanding of environmental sustainability and explore barriers hindering effective engagement. Design/methodology/approach Structured questionnaires were administered to procurement professionals, stakeholders and institutional representatives. Data was analysed using descriptive statistics, one-sample t-test, and mean score ranking to identify patterns, levels and barriers to stakeholder engagement. Findings The results highlight that stakeholder engagement is most prominent at the preparation and planning stage, while later procurement phases, such as tendering and contract implementation, experience reduced participation. Stakeholders demonstrated a generally high understanding of environmental sustainability. However, significant barriers were identified, including difficulty in identifying representatives, lack of clear benefits and financial constraints. These systemic and resource-related challenges limit comprehensive stakeholder involvement across procurement phases. Practical implications The findings emphasize the need for tertiary institutions to adopt comprehensive stakeholder mapping, implement structured engagement frameworks and promote transparency. Tailored training programs and adequate resource allocation are necessary to overcome identified barriers and ensure sustainable procurement practices. Originality/value This study offers new insights into stakeholder engagement in Ghana's tertiary institutions, providing a localized understanding of the interplay between procurement practices and environmental sustainability. It proposes practical strategies to enhance participation and sustainability outcomes, aligning procurement processes with global best practices.

Green procurement has become central to global sustainability efforts, yet its adoption among Small and Medium Enterprises (SMEs) in Ghana remains limited. SMEs constitute over 90% of businesses, employ 80% of the workforce, and contribute about 60% to GDP, making their participation critical to sustainable development. Despite the crucial role fiscal policies play in influencing policy, there appears to be a critical gap in assessing how fiscal tools, particularly tax exemptions, subsidies, and preferential contracting, affect green procurement within the SME sector This study examines the role of tax exemptions, subsidies, and preferential contracting policies on the adoption of green procurement practices in SMEs within the Accra Metropoli. tan Area. Using a quantitative research design, data were collected from 100 SME owners, managers, and procurement officers through structured questionnaires. In order to understand the relationships between the variables, analysis using SPSS regression models was conducted. The results revealed that tax exemptions have the strongest and most significant impact on green procurement adoption, demonstrating their effectiveness as a fiscal incentive. Subsidies showed a positive but marginal effect, while preferential contracting policies, though positive, were statistically insignificant. The findings highlight tax exemptions as the most effective driver of sustainable procurement in Ghana’s SME sector. Policy recommendations include scaling up fiscal incentives, improving subsidy accessibility, and strengthening application of preferential contracting to align SME practices with Ghana’s green economy agenda. Tax based incentives and preferential contracting reforms were among the recommendations proposed. The proposed recommendations may help shape policy on fiscal tools for promoting Green Procurement. It was recommended that future research should employ mixed-methods approaches and longitudinal designs to capture comprehensive insights and assess the sustained impact of policy interventions over time. Moreover, investigating institutional capabilities and direct climate change implications will enhance understanding of green procurement barriers and opportunities, thereby informing more effective and resilient policy development.

This study assesses the institutionalisation of sustainable procurement (SP) practices in South African state-owned enterprises (SOEs), evaluating their alignment with economic, social, and environmental sustainability objectives. It further explores the challenges hindering SP implementation and the variations in adoption across Schedule 2 and Schedule 3 SOEs. We employed a mixed-methods approach based on semi-structured interviews with 51 procurement professionals across 26 SOEs. The quantitative data was analyzed using descriptive and inferential statistical techniques in SPSS while the open data using thematic analysis. The findings indicate that economic sustainability receives the highest emphasis, social sustainability is moderately integrated, and environmental sustainability is the weakest. Notably, Schedule 3 SOEs demonstrate greater adherence to government mandated sustainability policies, while Schedule 2 SOEs prioritize financial autonomy and cost-driven procurement strategies. Governance issues, corruption, and lack of SP training further impede comprehensive sustainability adoption. This study advances the empirical understanding of SP practices in SOEs within a developing economy. It also provides practical recommendations for government policymakers, SOE leadership, and procurement professionals, emphasizing the need for a comprehensive national SP framework, regulatory enforcement, and capacity-building initiatives to enhance SP integration.

Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain-including high implementation costs, limited long-term data, and fragmented regulatory frameworks-integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care.

The rapid expansion of Saudi Arabia's construction sector has intensified environmental press ures, highlighting the urgent need for effective green supply chain management (GSCM) practices. Despite the policy mom entum created by Saudi Vision 2030, limited empirical research explains how GSCM practices influence subcontractors' su stainability performance, particularly from an integrated theoretical and predictive perspective. This study addresses this ga p by integrating institutional theory, the resource-based view (RBV), and the natural resource-based view (NRBV) to examin e the mechanisms through which GSCM practices enhance sustainability performance. Methodologically, the study develop s a hybrid structural equation modelling (SEM)–machine learning (ML) framework, where SEM validates theory-driven caus al relationships and ML improves predictive capability and enables subcontractor sustainability ranking. Using survey data c ollected from construction subcontractors in Saudi Arabia, the SEM results reveal that coercive pressure, information shari ng, sustainable procurement, pollution prevention, and product stewardship significantly influence sustainability performance , while top management support partially mediates these relationships. Complementary ML analysis further identifies the mo st influential GSCM practices driving sustainability outcomes, providing enhanced predictive insights for decision-making. The findings contribute to the literature on sustainable construction supply chains by advancing theoretical integration and met hodological innovation. Practically, the study offers actionable insights for policymakers, contractors, and subcontractors se eking to strengthen sustainability performance in alignment with Saudi Vision 2030 and the Saudi Green Initiative, with broad er implications for emerging economies pursuing sustainable infrastructure development.

The epitome of sustainable public procurement practices aligns with the principles of transparency, integrity, competitiveness, and efficiency, underpinned by the growing adoption of big data analytics capabilities. Big data analytics (BDA) enhances supply chain visibility, operational efficiency, and risk management; however, it has become evident that public supply chains in developing nations require robust digital infrastructure to effectively leverage the potential benefits of BDA. The research objective is to establish the effective role of Big Data Analytics (BDA) in enhancing sustainable public procurement practices (SPPP), aligning with the objectives of the Namibian Procurement Act 2015. The research further evaluates the factors impacting the technological, organisational and environmental context of public procurement principles through data-driven insights on the view of economic constraints and inequalities. The descriptive quantitative research design is rooted in a positivist perspective, focusing on an empirical case study of Namibia to assess the impact of BDA within the Technology-Organisation-Environment (TOE) framework. The research design employs a descriptive case study, enabling the exploration of factorial interrelationships. Diverse perspectives are integrated via stratified sampling, resulting in a sample size of 270 administered for data collection. Inferential statistics, including multivariate analysis, were used to analyse the data. The study revealed enhanced public procurement practices following the enactment of the Public Procurement Act 2015. ICT infrastructure, data quality, and system scalability are pivotal for BDA integration, despite hindrances such as leadership commitment, procurement capacity, procedural complexities, and resource constraints, which impede the shift towards sustainable procurement. These findings culminate in a TOE framework, which suggests that BDA's adoption offers significant strategic value, including improved decision-making, increased efficiency, enhanced transparency, and improved supplier performance in procurement. BDA's strategic effective role/value influences its adoption, leading to the transformation of sustainable public procurement practices in Namibia. This model systematically outlines the impact of BDA adoption on public procurement, showcasing how the TOE factors shape BDA's success in achieving SPPP. This research provides policymakers, public procurement professionals, and technology providers with practical insights to enhance the strategic value of BDA for sustainable procurement. This study contextualises the interplay of TOE factors for BDA adoption in public procurement for developing nations.

National cross-sectional survey. Hospitals delivering orthopaedic and trauma services across all levels of care and ownership categories in Tanzania. Licensed orthopaedic and trauma surgeons practising in Tanzania served as key informants for their respective hospitals. A total of 171 surgeons provided data on 92 unique hospitals nationwide. Primary outcomes included orthopaedic departmental structural capacity, availability of multidisciplinary specialist support, external support mechanisms and in-hospital orthopaedic training activities. A response rate of 77.7% yielded data on 92 hospitals delivering orthopaedic and trauma services nationwide. Structural capacity varied widely, with only 19.6% of hospitals reporting more than 50 orthopaedic beds, 43.5% relying on a single orthopaedic surgeon, and 47.8% operating with one or two functional theatres. Access to specialist support was limited, with vascular trauma surgeons available in 9.8% of hospitals and plastic and reconstructive surgeons in 8.7%. Intensivists were available in 41.3% of facilities and anaesthesiologists in 57.6%, while physiotherapists were present in 90.2% of hospitals but occupational therapists in only 28.3%. External dependence was common, with 41.3% of hospitals relying on donated implants and 29.3% participating in outreach programmes. In-hospital orthopaedic training opportunities were limited, with seminars or workshops available in 25.0% of hospitals. Across domains, higher-tier hospitals demonstrated significantly greater structural capacity and specialist availability. Orthopaedic and trauma services in Tanzania are available across multiple levels of the health system but are characterised by inequitable workforce distribution, limited capacity at lower-tier hospitals and substantial reliance on external assistance. Integrated strategies linking infrastructure development, multidisciplinary workforce expansion, sustainable procurement and decentralised training are essential to strengthen the organisation and resilience of orthopaedic and trauma services nationwide.

In today's business landscape, sustainable supplier selection has gained strategic significance, not only due to ethical responsibilities but also as a key factor in enhancing competitive advantage and managing long-term risks. Stakeholders such as consumers, investors, and regulatory agencies increasingly expect companies to adopt sustainability principles throughout their supply chains. Consequently, integrating environmental, social, and governance (ESG) criteria alongside traditional economic indicators has become essential. This study focuses on a large-scale retail organization’s supplier evaluation process by incorporating sustainability-oriented decision-making criteria. Building on a comprehensive literature review, existing evaluation criteria were revised and expanded to include ESG dimensions, forming a holistic framework of 18 sub-criteria across four primary categories: economic, environmental, social, and governance. To determine the importance of these criteria, the Fermatean Fuzzy SWARA method was applied, and supplier alternatives were prioritized using the Fermatean Fuzzy WASPAS technique. The findings provide actionable insights for practitioners seeking to enhance sustainable procurement practices.

This study aims to identify the key critical factors that MSMEs (Micro, Small, and Medium Enterprises) should focus to be competitive in the market with the introduction of sustainable procurement (SP) process while minimizing capital costs. A framework was developed through a literature review on SP, identifying the most critical factors for MSMEs. Analytical Hierarchy Process (AHP) model was adopted for the data collected from questionaries and discussions with MSME experts and owners. The findings indicates that Information and Technology (IT) (0.49 priority), Supplier relationship (SR) (0.23), Costs (0.18), and Organization Strategic capability (0.08). This finding suggests that MSMEs prioritize IT to ensure SP and best value followed by SR, cost and strategic capabilities for more effective SP. Moreover, this study is unique in its focus on MSMEs at specific Tier-2 city in Tamilnadu, offering insights into the procurement challenges and practices. It highlights the need for continuous improvement in MSME supply chain operations. The research is limited by its regional focus which may limit the generalizability of the findings. Additionally, the purposive sampling(n = 22) which may not represent the broader perspectives. The study provides actionable insights for MSMEs to enhance their operational strategies, which can contribute to job creation and sustainable economic growth. It also offers valuable knowledge for researchers and practitioners preparing for future changes in the sustainable procurement.