A typology of circular economy discourses: Navigating the diverse visions of a contested paradigm

The circular economy (CE) has recently become a popular discourse especially in government and corporate sectors. Given the socio-ecological challenges of the Anthropocene, the concept of CE could indeed help the transition to a sustainable, just and resilient future. However, the actual definition, objectives and forms of implementation of the CE are still unclear, inconsistent, and contested. Different actors and sectors are thus articulating circular discourses which align with their interests, and which often do not sufficiently examine the ecological, social and political implications of circularity. In this context, this research asks how to better navigate and analyse the history, complexity and plurality of circularity discourses by conceptually differentiating them in a comprehensive discourse typology. To answer this question a critical literature review has been carried out, which first, examines and reflects on the core challenges, gaps and limitations of the CE concept. Second, this research develops a comprehensive timeline of circularity thinking, which identifies and conceptually classifies 72 different CE-related concepts from the Global North and South (such as Gandhian and steady-state economics, buen vivir, doughnut economics and degrowth). This leads to the development of a typology of circularity discourses, which classifies circularity visions according to their position on fundamental social, technological, political and ecological issues. This research thus seeks to provide a basis for a more inclusive and comprehensive discussion on the topic, which opens the imaginary regarding the many circular futures that can exist and allows for a cross-pollination of ideas, policy options, strategies, practices and solutions

Analysing European Union circular economy policies: words versus actions

Since the publication of the European Union's Circular Economy Action Plan in 2015, this new sustainability paradigm has become a guiding force behind the environmental and economic policies of the Junker Commission. The European Union (EU) has taken a particular approach to circularity, with high expectations to increase competitiveness, promote economic growth and create jobs while reducing environmental impacts and resource dependency. However, the circular economy (CE) is a contested paradigm, for which many competing interpretations exist, each seeking varying degrees of social, ecological and political transformation. Considering the emerging and contested state of the academic literature on CE, the EU's embrace of the concept is a remarkable phenomenon, which remains poorly researched. The aim of this paper is thus to address this research gap by analysing the CE discourse and policies of the Junker Commission (2014-2019) in order to critically discuss their sustainability implications and develop key policy recommendations. To do so, this research uses a combination of qualitative and quantitative research methods. The paper first critically analyses the EU's discourse based on a typology of circularity discourses. It then reviews the complex set of concrete CE policies and actions adopted by the EU and compares them to its discourse. Results show a dichotomy between words and actions, with a discourse that is rather holistic, while policies focus on “end of pipe” solutions and do not address the many socio-ecological implications of a circularity transition. Several actions are thus recommended to tackle the systemic challenges of a circular future from a plural perspective

Efficacy of sacubitril/valsartan relative to a prior decompensation: the PARADIGM-HF trial

Objectives: This study assessed whether the benefit of sacubtril/valsartan therapy varied with clinical stability. Background: Despite the benefit of sacubitril/valsartan therapy shown in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, it has been suggested that switching from an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker should be delayed until occurrence of clinical decompensation. Methods: Outcomes were compared among patients who had prior hospitalization within 3 months of screening (n = 1,611 [19%]), between 3 and 6 months (n = 1,009 [12%]), between 6 and 12 months (n = 886 [11%]), >12 months (n = 1,746 [21%]), or who had never been hospitalized (n = 3,125 [37%]). Results: Twenty percent of patients without prior HF hospitalization experienced a primary endpoint of cardiovascular death or heart failure (HF) hospitalization during the course of the trial. Despite the increased risk associated with more recent hospitalization, the efficacy of sacubitril/valsartan therapy did not differ from that of enalapril according to the occurrence of or time from hospitalization for HF before screening, with respect to the primary endpoint or with respect to cardiovascular or all-cause mortality. Conclusions: Patients with recent HF decompensation requiring hospitalization were more likely to experience cardiovascular death or HF hospitalization than those who had never been hospitalized. Patients who were clinically stable, as shown by a remote HF hospitalization (>3 months prior to screening) or by lack of any prior HF hospitalization, were as likely to benefit from sacubitril/valsartan therapy as more recently hospitalized patients. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255)

Sustainable circular cities? Analysing urban circular economy policies in Amsterdam, Glasgow, and Copenhagen

Cities play a central role in the circular economy (CE) as they are important centres of production and consumption, responsible for 80% of global GDP. European cities are particularly important due to their position of power in the global economy as major markets, and places of industrial and social innovation. Yet urban CE policies and discourses remain poorly researched and understood. This paper addresses this research gap by analysing and comparing the CE policies and discourses in different European cities to draw critical insights and recommendations. It does so by first reviewing academic literature on urban CE policies to develop a new conceptual framework to analyse CE discourses and policies. This framework is then used to analyse and compare the CE policies of three European cities: Glasgow, Amsterdam, and Copenhagen. Results show that technocentric approaches to CE are dominant in the three cities. Moreover, they have very limited social justice policies for a fair distribution of the costs and benefits of a CE transition. Key policy recommendations to address these shortcomings are thus proposed. The insights brought about by this paper are valuable for both practitioners and academics seeking to improve urban CE policies

How circular is your tyre: Experiences with extended producer responsibility from a circular economy perspective

The circular economy (CE) emphasises closing material loops to retain material value. The current practice of tyre recycling in the Netherlands, through a system of extended producer responsibility (EPR), appears an overwhelming success, with claims of 100% recovery. Yet, there is limited critical understanding regarding the system’s circularity, considering alternative value retention options and resource recovery outcomes. This study analyses this Dutch tyre EPR system and reflects on how it can be improved from a systemic CE perspective. It uses a qualitative case study approach, using interviews and a review of policy, legal and EPR reporting documents. This paper assesses the governance of this sector and reflects on the existing system, including its circularity and value retention outcomes. Our analysis reveals seven central issues concerning how the EPR system currently functions, resulting in limited circularity and sustainability outcomes, despite high material recovery levels. To address these issues we recommend the continuous improvement of recovery and sustainability targets beyond a single product life cycle, a more transparent and inclusive governance system, as well as a greater focus on sufficiency strategies, e.g. design for durability and a broader transformation of transport models. This paper adds a practical understanding of the capacity of EPR to contribute to CE

Influence of Sacubitril/Valsartan (LCZ696) on 30-day readmission after heart failure hospitalization

Background: Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization. Objectives: This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril. Methods: We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril. Results: Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations. Conclusions: Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization

Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design

Abstract Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF

Effects of sacubitril/valsartan in the PARADIGM-HF Trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) according to background therapy

Background—In the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan was more effective than the angiotensin-converting enzyme inhibitor enalapril in patients with heart failure and reduced ejection fraction. We examined whether this benefit was consistent irrespective of background therapy. Methods and Results—We examined the effect of study treatment in the following subgroups: diuretics (yes/no), digitalis glycoside (yes/no), mineralocorticoid receptor antagonist (yes/no), and defibrillating device (implanted defibrillating device, yes/no). We also examined the effect of study drug according to β-blocker dose (≥50% and <50% of target dose) and according to whether patients had undergone previous coronary revascularization. We analyzed the primary composite end point of cardiovascular death or heart failure hospitalization, as well as cardiovascular death. Most randomized patients (n=8399) were treated with a diuretic (80%) and β-blocker (93%); 47% of those taking a β-blocker were treated with ≥50% of the recommended dose. In addition, 4671 (56%) were treated with a mineralocorticoid receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a defibrillating device; 2640 (31%) had undergone coronary revascularization. Overall, the sacubitril/valsartan versus enalapril hazard ratio for the primary composite end point was 0.80 (95% confidence interval, 0.73–0.87; P<0.001) and for cardiovascular death was 0.80 (0.71–0.89; P<0.001). The effect of sacubitril/valsartan was consistent across all subgroups examined. The hazard ratio for primary end point ranged from 0.74 to 0.85 and for cardiovascular death ranged from 0.75 to 0.89, with no treatment-by-subgroup interaction. Conclusions—The benefit of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor, was consistent regardless of background therapy and irrespective of previous coronary revascularization or β-blocker dose

Identification of Degraded Land in the Canary Islands; Tests and Reviews

Degraded Land is an area that either by natural causes (fires, floods, storms or volcanic eruptions) or more by direct or indirect causes of human action, has been altered or modified from its natural state. Restoration is an activity that initiates or accelerates the recovery of an ecosystem. It can be defined as the set of actions taken in order to reverse or reduce the damage caused in the territory. In the case of the Canary Islands there is a high possibility for the territory to suffer processes that degrade the environment, given that the islands are very fragile ecosystems. Added to this they are territories isolated from the continent, which complicates the process of restoring them. In this paper, the different types of common degraded areas in the Canary Islands are identified, as well as the proposed solutions for remediation, such as afforestation of agricultural land or landfill closure and restoration