Pushing forward the transition to a circular economy by adopting an actor engagement lens

Circular business models (CBMs), such as product-service systems, are rapidly gaining traction in light of a transition to a more circular and sustainable economy. The authors call for a new approach to inform and guide the development and adoption of these CBMs. The main reason is that different actors in the service ecosystems or networks linked to these business models—such as firms, customers, and governmental bodies—may be reluctant to join or even impede the transition to a circular economy. Based upon an abductive analysis of 133 CBM papers with the Motivation-Opportunity-Ability (MOA) framework as organizing structure, the authors theorize about how to achieve “circular economy engagement” ( i.e., an actor’s disposition to embrace CBMs). Specifically, they highlight and illustrate the role of (1) signaling and convincing as motivation-related practices, (2) matching and legitimizing as opportunity-related practices, and (3) supporting and empowering as ability-related practices. The authors provide illustrative cases for each of these practices along with a discussion of the theoretical and practical implications and the remaining challenges—all with the key aim to push the transition to a circular economy forward

Pushing Forward the Transition to a Circular Economy by Adopting an Actor Engagement Lens

Circular business models (CBMs), such as product-service systems, are rapidly gaining traction in light of a transition to a more circular and sustainable economy. The authors call for a new approach to inform and guide the development and adoption of these CBMs. The main reason is that different actors in the service ecosystems or networks linked to these business models—such as firms, customers, and governmental bodies—may be reluctant to join or even impede the transition to a circular economy. Based upon an abductive analysis of 133 CBM papers with the Motivation-Opportunity-Ability (MOA) framework as organizing structure, the authors theorize about how to achieve “circular economy engagement” (i.e., an actor’s disposition to embrace CBMs). Specifically, they highlight and illustrate the role of (1) signaling and convincing as motivation-related practices, (2) matching and legitimizing as opportunity-related practices, and (3) supporting and empowering as ability-related practices. The authors provide illustrative cases for each of these practices along with a discussion of the theoretical and practical implications and the remaining challenges—all with the key aim to push the transition to a circular economy forward

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy