When circular economy meets inclusive development: insights from urban recycling and rural water access in Argentina

How is it possible to design and deploy circular economy (CE) strategies oriented to inclusive development? How can non-traditional units of production and consumption (i.e., actual productive actors such as waste picker cooperatives and peasant organizations) be integrated into these strategies? Using data collected as a result of two long-term participatory action research projects carried out with a waste picker cooperative in Buenos Aires and 65 peasant families in Chaco (both located in Argentina) the paper opens the door to a proactive critical debate in terms of how to integrate circular economy principles with the development of technological solutions (artifacts, processes and methods of organization). We show that CE holds great potential, both in terms of its contribution to the generation of new interpretive frameworks and also, in terms of nurturing local and inclusive development strategies when it is integrated with collaborative, bottom-up and innovative dynamics. Based on the idea of working with heterogeneous traditional production units (not only with profit-maximizing firms), it is possible to think of social development avenues for vulnerable populations, where the CE principles build up mechanisms capable of maximizing the transformative potential of the resources (including those understood as waste) presented in actual techno-economic matrices.Fil: Becerra, Lucas Dardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; ArgentinaFil: Carenzo, Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; ArgentinaFil: Juarez, Paula María Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentin

Transformative social innovation for food sovereignty: the disruptive alternative

In the last decade, a new concept has emerged in Europe and the Americas to explain a ‘new’ phenomenon of societal and technological organisation oriented to the resolution of social and environmental issues: social innovation. In certain contexts, social innovators confront dominant institutions in order to achieve their political, economic, and cultural goals. This confrontation has a transformative character. In this sense, transformative social innovation may be defined as ‘changes in social relations, involving new ways of doing, organizing, framing and/or knowing, which challenge, alter, and/or replace established (dominant) institutions in a specific sociomaterial context.’ This framework, developed as a result of the Transformative Social Innovation Theory Project, refers to the ability to design and implement new forms of social interaction that enable people and social groups to carry out strategies and deploy narratives that lead, under certain conditions, to transformative change that engenders modifications in social and/or environmental dynamics. This article presents a conceptual framework to understand transformative social innovation, which is then used to analyse the case of the La Vía Campesina (the International Peasant Movement), focusing on: 1) the strategies employed in terms of a social innovation agent, and 2) the construction of narratives of change oriented to empower peasants and generate a collective identity of the peasantry at a global level. Finally, the article presents closing remarks in order to conceptualise the social innovation capabilities of certain global movements (such as La Vía Campesina) and their achievements related to inclusive sustainable development, where food production and distribution, as well as territorial development, are fundamental.Fil: Juarez, Paula María Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; ArgentinaFil: Trentini, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; ArgentinaFil: Becerra, Lucas Dardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentin

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

“Una película, no una foto”: De la racionalidad tecno-cognitiva lineal a la planificación estratégica de sistemas socio-técnicos para el desarrollo inclusivo sustentable

El artículo analiza críticamente la racionalidad tecno-cognitiva lineal y sus implicancias para el desarrollo inclusivo sustentable. Y en contraposición, presenta un estudio de caso - el plan Agua para el Desarrollo (desarrollada por un grupo de investigadores del Instituto de Estudios sobre la Ciencia y Tecnología, Universidad Nacional de Quilmes)- sobre la planificación y el co-diseño estratégico basado en la noción de Sistemas Tecnológicos Sociales. Finalmente, se generan insumos para comprender los desafíos de estabilizar estrategias de co-diseño de conocimientos, políticas públicas y soluciones tecnológicas que no responden a un "cambio de foto" sino a un proceso continuo y heterogéneo que es llevado a cabo por "sujetos de aprendizaje" que no operan en el vacío y que encuentran resistencias.Fil: Juarez, Paula María Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; ArgentinaFil: Becerra, Lucas Dardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentin

Is there room for a circular economy “from below”? Reflections on privatisation and commoning of circular waste loops in Argentina

The Circular Economy (CE) narrative is spreading at a global scale, addressing different actors and settings, and thus facing new theoretical and empirical challenges. However, CE initiatives in the Global South have tended to extrapolate developed countries’ perspectives, as if the CE provides a global and universal benchmark to converge to. Drawing from a political ecology of waste in Latin America and building on empirical data derived from two case studies of recycling initiatives in Argentina, we focus on how the issue of formalisation of previously informal recyclers could be framed within the CE. Then, we outline two contrasting models, the privatisation of informality on the one hand and the formalisation of commoning on the other. Thus we highlight the extent to which the CE narrative could be used to overlook power relations dynamics, or, to what extent it could be reframed to foster a CE “from below” that could provide a clear path to achieve greater levels of equity and social justice.Fil: Carenzo, Sebastian. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Juarez, Paula María Alejandra. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Becerra, Lucas Dardo. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Instituto de Estudios Sociales de la Ciencia y la Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology