The emergence of circular economy: a new framing around prolonging resource productivity

In this article we use Hirsch and Levin’s (1999) notion of ‘umbrella concepts’ as an analytical lens, in order to articulate the valuable catalytic function the circular economy concept could perform in the waste and resource management debate. We realize this goal by anchoring the circular economy concept in this broader debate through a narrative approach. This leads to the insight that while the various resource strategies grouped under circular economy’s banner are not new individually, the concept offers a new framing of these strategies by drawing attention to their capacity of prolonging resource use as well as to the relationship between these strategies. As such, circular economy offers a new perspective on waste and resource management and provides a new cognitive unit and discursive space for debate. We conclude by discussing research opportunities for the IE community relating to the concept’s theoretical development and its implementation. Specifically, we pose that reinvigorating and growing the social science aspects of IE is required for both. After all, it is the wide adoption and collective implementation of an idea that shapes our material future

Management of obstetric anal sphincter injury: a systematic review & national practice survey

BACKGROUND: We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. METHODS: A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. RESULTS: We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ≥ 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). CONCLUSION: An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended

Comorbidity and dementia : a mixed method study on improving healthcare for people with dementia (CoDem)

© Queen’s Printer and Controller of HMSO 2016. This work was produced by Bunn et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UKAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population. To explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population

Evaluating the circular economy for sanitation: Findings from a multi-case approach

Addressing the lack of sanitation globally is a major global challenge with 700 million people still practicing open defecation. Circular Economy (CE) in the context of sanitation focuses on the whole sanitation chain which includes the provision of toilets, the collection of waste, treatment and transformation into sanitation-derived products including fertiliser, fuel and clean water. After a qualitative study from five case studies across India, covering different treatment technologies, waste-derived products, markets and contexts; this research identifies the main barriers and enablers for circular sanitation business models to succeed. A framework assessing the technical and social system changes required to enable circular sanitation models was derived from the case studies. Some of these changes can be achieved with increased enforcement, policies and subsidies for fertilisers, and integration of sanitation with other waste streams to increase its viability. Major changes such as the cultural norms around re-use, demographic shifts and soil depletion would be outside the scope of a single project, policy or planning initiative. The move to CE sanitation may still be desirable from a policy perspective but we argue that shifting to CE models should not be seen as a panacea that can solve the global sanitation crisis. Delivering the public good of safe sanitation services for all, whether circular or not, will continue to be a difficult task

Depression care management for late-life depression in China primary care: Protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late-life depression in primary care settings in Western countries. The primary aim of this project is to implement a depression care management (DCM) intervention, and examine its effectiveness on the depressive symptoms of older patients in Chinese primary care settings.</p> <p>Methods/Design</p> <p>The trial is a multi-site, primary clinic based randomized controlled trial design in Hangzhou, China. Sixteen primary care clinics will be enrolled in and randomly assigned to deliver either DCM or care as usual (CAU) (8 clinics each) to 320 patients (aged ≥ 60 years) with major depression (20/clinic; n = 160 in each treatment condition). In the DCM arm, primary care physicians (PCPs) will prescribe 16 weeks of antidepressant medication according to the treatment guideline protocol. Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes.</p> <p>Discussion</p> <p>This will be the first trial of the effectiveness of a collaborative care intervention aiming to the management of late-life depression in China primary care. If effective, its finding will have relevance to policy makers who wish to scale up DCM treatments for late-life depression in national wide primary care across China.</p> <p>Study Registration</p> <p>The DCM project is registered through the National Institutes of Health sponsored by clinical trials registry and has been assigned the identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01287494">NCT01287494</a></p

Data integration for offshore decommissioning waste management

Offshore decommissioning represents significant business opportunities for oil and gas service companies. However, for owners of offshore assets and regulators, it is a liability because of the associated costs. One way of mitigating decommissioning costs is through the sales and reuse of decommissioned items. To achieve this effectively, reliability assessment of decommissioned items is required. Such an assessment relies on data collected on the various items over the lifecycle of an engineering asset. Considering that offshore platforms have a design life of about 25 years and data management techniques and tools are constantly evolving, data captured about items to be decommissioned will be in varying forms. In addition, considering the many stakeholders involved with a facility over its lifecycle, information representation of the items will have variations. These challenges make data integration difficult. As a result, this research developed a data integration framework that makes use of Semantic Web technologies and ISO 15926 - a standard for process plant data integration - for rapid assessment of decommissioned items. The proposed solution helps in determining the reuse potential of decommissioned items, which can save on cost and benefit the environment