Understanding the current state of practice in the construction and demolition waste sector through the lenses of circular economy: The Italian recycled materials market for the road construction sector

Construction and demolition waste (CeDw) is mainly produced during the construction, demolition, or renovation activities of civil engineering structures and it accounts for a remarkable amount of the total C&Dw generated, as it is estimated to be around 30%. This proportion differs between countries belonging to different types of economies and tends to be greater in countries with developing economies reaching 74% of total annual production. There is a plethora of applications that C&Dw can be used for under a circular economic model and in this research a focus is being given in the exploitation of C&Dw within the pavement engineering sector, and more specifically, in the utilization of said waste in road earthworks. Circular Economy can act as a steppingstone towards the uptake of C&Dw recycling and exploitation. To understand the state of practice that exists, a market and an implementation analysis have been conducted in Italy. The current applications of C&Dw recycling into road projects were analyzed along with the existing regulations, and local producers. The results projected the various challenges faced by the involved stakeholders, along with the barriers that hinder the wide recycling of C&Dw in road engineering projects. Finally, the proposed national action plans are analyzed and the future potential exploitation of C&Dw is put into context. The future of the specific research is going to involve a full scale, on-site implementation of C&Dw in a defined road segment

A Top-Down Approach Based on the Circularity Potential to Increase the Use of Reclaimed Asphalt

Resource depletion and climate change, amongst others, are increasingly worrying environmental challenges for which the road engineering sector is a major contributor. Globally, viable solutions that comply with the principles of circular economy (CE) are being investigated that can replace conventional asphalt mixtures in a post-fossil fuel society. The use of reclaimed asphalt (RA) is a widely used and well-established method to reduce the environmental and economic impacts of asphalt mixtures while increasing their circularity. However, RA's market supply and demand have not yet been systematically analyzed and established. Moreover, the actual circularity potential and the opportunity of re-circulating RA in a closed-loop model have not yet been methodically defined. To address this, a three-layered framework to quantify and assess the circularity potential (Ω) of RA has been developed. To give stakeholders and legislative bodies a simple method to assess the opportunities available to them to become “more circular”, a novel equation has been formulated. This takes the form of a three-level indicator that considers: technical aspects, the effect of the RA market, and the legislative restrictions. A case study in Germany was structured and undertaken to develop and verify the proposed approach. The results indicate that the available RA is insufficient to cover the needs of asphalt mixture production; even though RA production is significantly lower than the actual need of asphalt mixtures, it is not utilized in its entirety. An impactful step forward is the alteration of the regulations to support the higher utilization of RA in asphalt mixtures, and subsequently, the increased circular opportunity and potential of RA. Thus, Circularity potential (Ω) is a composite indicator that can support stakeholders, designers, and asset managers during the process of decision-making, to follow more circular operational, design, and asphalt pavement management patterns

Where is the History of Political Thought Going?

After the recent publication of a couple of succinct and overarching essays covering the state of the field in the history of political thought (in the English language), Prof. Davide Cadeddu from the University of Milan expressed polemical remarks on some of their content. At the same time, he asked for comments on his own article, inviting the response several of English-speaking scholars (or scholars educated in anglophone cultural context). In response to this challenge, ten colleagues John Dunn (King’s College, University of Cambridge) Humeira Iqtidar (King’s College London) Iain Hampsher-Monk (University of Exeter) Richard Bourke (King’s College, University of Cambridge) Adrian Blau (King’s College London) Alexandra Chadwick (University of Jyväskylä) Duncan Kelly (Jesus College, University of Cambridge) David Leopold (Mansfield College, University of Oxford) Peter Burke (Emmanuel College, University of Cambridge) Richard Whatmore (University of St Andrews) answered with texts of different length and complexity. Depending on each case individually, each scholar was either in agreement or disagreement with the statements previously formulated by him, henceforth eliciting, more or less implicitly, new reflections on the matter at hand

Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial: No Test Is More Equal Than the Others

Background: Previous reports identifying discordance between multiparameter tests at the individual patient level have been largely attributed to methodological shortcomings of multiple in silico studies. Comparisons between tests, when performed using actual diagnostic assays, have been predicted to demonstrate high degrees of concordance. OPTIMA prelim compared predicted risk stratification and subtype classification of different multiparameter tests performed directly on the same population. Methods: Three hundred thirteen women with early breast cancer were randomized to standard (chemotherapy and endocrine therapy) or test-directed (chemotherapy if Oncotype DX recurrence score >25) treatment. Risk stratification was also determined with Prosigna (PAM50), MammaPrint, MammaTyper, NexCourse Breast (IHC4-AQUA), and conventional IHC4 (IHC4). Subtype classification was provided by Blueprint, MammaTyper, and Prosigna. Results: Oncotype DX predicted a higher proportion of tumors as low risk (82.1%, 95% confidence interval [CI] = 77.8% to 86.4%) than were predicted low/intermediate risk using Prosigna (65.5%, 95% CI = 60.1% to 70.9%), IHC4 (72.0%, 95% CI = 66.5% to 77.5%), MammaPrint (61.4%, 95% CI = 55.9% to 66.9%), or NexCourse Breast (61.6%, 95% CI = 55.8% to 67.4%). Strikingly, the five tests showed only modest agreement when dichotomizing results between high vs low/intermediate risk. Only 119 (39.4%) tumors were classified uniformly as either low/intermediate risk or high risk, and 183 (60.6%) were assigned to different risk categories by different tests, although 94 (31.1%) showed agreement between four of five tests. All three subtype tests assigned 59.5% to 62.4% of tumors to luminal A subtype, but only 121 (40.1%) were classified as luminal A by all three tests and only 58 (19.2%) were uniformly assigned as nonluminal A. Discordant subtyping was observed in 123 (40.7%) tumors. Conclusions: Existing evidence on the comparative prognostic information provided by different tests suggests that current multiparameter tests provide broadly equivalent risk information for the population of women with estrogen receptor (ER)–positive breast cancers. However, for the individual patient, tests may provide differing risk categorization and subtype information

OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer

Background: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk in hormone-sensitive HER2-negative node-negative early breast cancer, allowing patients with low risk to safely avoid chemotherapy. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) aims to validate MPA’s as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

The QuinteT Recruitment Intervention supported five randomized trials to recruit to target: a mixed-methods evaluation

ObjectiveTo evaluate the impact of the Quintet Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties, and then implements ‘QRI-actions’ to address these as recruitment proceeds.Study Design and SettingA mixed-methods study, comprising: a) before-and-after comparisons of recruitment rates and numbers of patients approached, and b) qualitative case studies, including documentary analysis and interviews with RCT investigators.ResultsFive UK-based publicly-funded RCTs were included in the evaluation. All recruited to target. RCT2 and RCT5 both received up-front pre-recruitment training before the intervention was applied. RCT2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI-actions in RCTs 1, 3, 4 and 5. Randomization rates significantly improved post-QRI-action in RCTs 1,3, and 4. QRI-actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of, and reportedly changed their practices post QRI-action.ConclusionThere is promising evidence to suggest the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Comparing the Material Circularity Index of the Italian and Spanish motorways: A case study over the Mediterranean basin

Closely following the attempt of the pavement engineering industry to comply with the principles of Circular Economy (CE) while simultaneously promoting its principles, it can be detected that a significant effort is being made towards the minimization of the energy and raw materials usually utilized. In this regard, Reclaimed Asphalt (RA) is a product that exhibits a tremendous exploitation potential. Knowing that by definition CE is restorative [1], regenerative, and aims to keep products, components, and materials at their highest utility and value at all times [2], i.e. it supports the “re-circulation” of materials and energy within the same or alternative product systems and thus the elimination of avoidable wastes [3], RA is the ideal candidate to be recirculated into a closed or even open loop product system and/or approach and thus, ideal material that can re-enter the cycle of asphalt mixture production [4]–[8]. RA can be defined as existing asphalt pavement materials that have been removed during the resurfacing, rehabilitation or reconstruction operations of asphalt pavements and accordingly processed [9]. All of the motorways within the EU member-countries consist of asphalt pavements, which -as anticipatedsuffer from various types of distresses [10]. Maintaining them can be environmentally, economically, and socially intensive. RA recycling and re-use are well-established practices within the road engineering industry with the aim of minimising the environmental and economic impacts asphalt mixtures and move towards more sustainable and circular recycling [10]–[15]. The available annual average quantity of RA within Europe reaches approximately 45.5 Mt; while the average annual utilized RA only 23.2 Mt [16]-[30]. The main techniques with which RA can be utilized are in hot in-plant recycling, hot in-place recycling, full depth reclamation, cold in-plant recycling and cold in-place recycling [11], [31]. The percentage of RA incorporated in road pavements is usually limited between 10% and 30%, despite the advantages that its use might imply, due to legislation limitations and technical issues such as the variability of the RA properties, the lack of complete understanding of the mechanisms taking place during the asphalt mixture production, and uncertainty of the mixture performance [15], [32]. Many studies have concluded that higher use of RA is possible when attention is paid to the mixture design and the RA’s properties so that a consensus between the laboratory mix design and the full-scale realization of the asphalt pavement can be achieved [33]–[39]. In this case study, a comparative analysis between two countries of the Mediterranean basin is performed. The Material Circularity index (MCIMRA) as defined by K. Mantalovas [8], of Italy and Spain in terms of their motorways’ asphalt mixtures are compared for the period 2006-2019. Both countries belong to the Southern region of Europe, have similar GDP, and experience similar climatological conditions. Therefore, these countries were selected for the comparative analysis. Since the Material Circularity Index as tailored and defined by K. Mantalovas corresponds to specific and individual end products the current analysis takes place for surface, binder, and base 3rd Symposium on Circular Economy and Sustainability Chania, Greece 27-29 June, 2022 2 courses separately since these are the typical asphalt layers that constitute the asphalt pavements of the motorways. The necessary data for the completion of the quantitative aspect of the case study were collected from reputable literature sources [5], [8], [28]–[30], [40]. Utilizing the methodological framework developed by K. Mantalovas and G. di Mino, the quantification of the Material Circularity Index for surface, binder, and base courses for the Italian and Spanish motorways became possible for the period 2006-2019, and the results can be seen in Figure 1 Table 1. Product Material Circularity Index per pavement layer per country From the results obtained from this case study we can immediately identify the significant gap between the MCIMRA of the two countries for all the layers. Spain’s MCIMRA for all the layers is on average 44% higher than the equivalent of Italy’s. This could be a projection of a plethora of different circumstances. For instance, in Italy the maximum allowed RA% for surface, binder, and base courses are 20%, 25%, 30% respectively, while in the Spanish regulations asphalt mixtures with RA% up to 50% are allowed and promoted. Moreover, Italy according to data from the European Asphalt Pavement Association (EAPA), recycles 25% of the available RA while Spain reaches the threshold of 72%. Hence, the regulatory context, apparently influences the circularity and sustainability implications of the road engineering industry dictating the maximum circularity thresholds that can be achieved through the limitation of RA use. Although numerous studies by now have proven the functionality, viability, and necessity of RA use, it can still be observed that a lot of countries, regions and/or governments are still not willing to follow the scientifically established facts. For this reason, the authors believe that some key actions must be taken urgently: • Establishment of compulsory and regulated E-o-L strategies for RA prior to its production • Increased budget allocation to the training of stakeholders about CE, and sustainability • Use of material flow tracking along with material passports • Harmonised benchmarking of the mechanical/environmental performances of RA mixtures • Target setting towards the exploitation of all the available RA • Change utilization patters (sharing models, product as service)