Measuring the Economic Impacts of a Circular Economy: an Evaluation of Indicators.

A circular economy (CE) is often seen as a promising way to address pressing environmental challenges, such as climate change, biodiversity loss, and resource depletion. However, the CE concept remains contested, and the implementation of circular strategies (CS) does not automatically improve all dimensions of sustainability. However, assessing the economic impacts of CS implementation is crucial to making the transition from linear to circular value chains. Despite the broad literature on CE indicators, a critical evaluation of economic CE indicators (eCEis) that conduct assessments on a value-chain level is still missing. This study addresses this gap by critically evaluating how capable eCEis are of measuring the economic impacts of implementing CS at the value-chain level. We first identify existing meso eCEis through a literature review, deriving a sample of 13 meso eCEis. We then qualitatively evaluate the eCEis based on criteria synthesised from requirements for CE indicators proposed in the literature. We find that existing meso eCEis only partly fulfil these criteria and consequently have limited capabilities for measuring the economic impacts of the implementation of CS at a value-chain level. The indicators largely satisfy the specific criteria diagnostic and useful, moderately satisfy the criterion practical, and barely satisfy the criteria systemic and transparent. We therefore recommend that future studies on eCEis place a stronger focus on adopting a systemic perspective, discuss their limitations and uncertainties in more detail, and consider combining meso eCEis with the indicators of other dimensions (environmental, social) and levels (micro, macro). Supplementary Information: The online version contains supplementary material available at 10.1007/s43615-022-00190-w.

[Histological changes in intraperitoneal onlay mesh (IPOM) with synthetic and biological meshes. Results of the chronic experiment]. / Gistologicheskie izmeneniya pri intraperitoneal'noi plastike (IPOM) sinteticheskimi i biologicheskimi endoprotezami. Rezul'taty khronicheskogo eksperimenta.

OBJECTIVE: The objective of the study was to analyze histological changes in the site of the meshes FTOREX, FTOREX coated with carboxymethylcellulose, Ventralight ST, Symbotex, REPEREN-16-2 and decellularized porcine peritoneum on the parietal peritoneum of the pig. MATERIAL AND METHODS: At laparoscopy, 6 different meshes were placed intraperitoneally in each of the 3 pigs. After 90 days, the animals were taken out of the experiment. After staining with hematoxylin and eosin, quantitative morphometry and counting the number of vessels and cells in the interstitium in the areas of the mesh and peritoneum were performed. An immunohistochemical study with an antibody to pancytokeratins assessed the state of the initial peritoneum and neoperitoneum. RESULTS: According to morphological characteristics, the meshes were divided into 3 groups: 1) with fluoropolymer coating FTOREX, 2) Ventralight ST and Symbotex, 3) REPEREN and decellularized peritoneum. In group 1, the surface area of the mesh threads was optimal in terms of the arrangement and arrangement of the threads relative to each other. This contributed to the formation of a relatively dense fibrous framework and a place to preserve the underlying peritoneum involved in the formation of the neoperitoneum. Despite the smallest surface area of the threads, in group 3, the greatest fibroblastic reaction was noted. Inflammatory changes were the least pronounced in group 1. They were the greatest in group 3, where there was a pronounced leukocyte reaction, combined with the processes of metaplasia, the development of fibrinoid necrosis, and the progression of the secondary inflammatory process. In group 1, the optimal ratio of newly formed vessels was noted, in group 2 - veins prevailed over arteries, in group 3 - the number of vessels was minimal. Immunohistochemical study showed that in group 1, mesothelial cells covered almost the entire surface of the implant, and there were also areas of preserved basic peritoneum. In group 2, mesothelium also covered most of the surface of the meshes, but the underlying peritoneum was absent. In group 3, on the contrary, a significant number of extended areas not covered with mesothelium were revealed. CONCLUSION: The conducted morphological and morphometric study showed that the most balanced ratio of the components of the newly formed fibrous tissue and blood vessels is observed when using implants with a fluoropolymer coating FTOREX. At the same time, the remaining basic peritoneum actively participated in the formation of the neoperitoneum. The Ventralight ST and Symbotex meshes also contributed to the formation of a full-fledged fibrous tissue and adequate vascular proliferation, however, they prevented the preservation of the underlying peritoneum, which practically excluded its participation in the formation of the neoperitoneum. The REPEREN mesh and decellularized porcine peritoneum led to the least balanced cell and vascular proliferation and the greatest fibroplastic reaction, which could further negatively affect the state of the formed scar.

Sleep disorders and vascular responsiveness in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is the most common systemic autoimmune disease characterized by chronic systemic inflammation. Half of the deaths of patients with RA are due to cardiovascular diseases (CVD), considered to be 1.5 to -2.0-fold that in the general population. Patients with RA also experience poor sleep, which by itself is associated with endothelial dysfunction, CVD events and sudden death. Our aim was to study the mechanistic pathways and the correlations between sleep efficiency and vascular reactivity of patients with RA. METHODS AND RESULTS: A prospective study that evaluated quality of sleep using ACTi Graphs, vascular inflammation and endothelial function of 18 patients with RA. Inflammation was studied by levels of E-selectin, intercellular adhesion molecule 1 (ICAM-1) and NO in serum. Endothelial function was studied using the brachial artery plethysmography method. Eighteen RA patients (aged 57.56 ± 13.55 years; 16 women) with a long-standing active RA: Eight patients had impaired sleep efficiency and 10 had a good sleep efficiency. Those who had an impaired sleep had larger baseline diameters of the brachial artery (0.39 ± 0.08 cm vs. 0.32 ± 0.04 cm; P = 0.02). Negative correlations were found between baseline brachial artery diameter and sleep efficiency (P = 0.01), and with NO level (P = 0.04). Stepwise regression found that brachial artery diameter at baseline and NO level could predict sleep efficiency (r2  = 0.543, P = 0.01). CONCLUSION: Vascular reactivity could predict quality of sleep in patients with RA. Quality of sleep may serve as an independent CVD risk factor in patients with RA.

[Applying HIFU for the obliteration of the veins in the experiment ].

The effect of high-intensity focused ultrasound (HIFU) on venous wall structure was studied in the rabbit model. Special setup was developed for ultrasound generation and vessel targeting. Methods. The essential part of the setup is spherical focusing power irradiator with following characteristics: power supply voltage of 25 V, frequency of 1.9 MHz, ultrasound intensity in the focal spot ~8.7 kW/cm2. Results. Single 15-s exposure of the femoral vein to HIFU resulted in partial desquamation of the endothelium, vacuolization of myocyte cytoplasm, misarrangement and coagulation of collagen fibers. Pulsed HIFU (5 pulses for 5 s each) caused protein coagulation in all layers of venous wall (v. cava posterior) as well as the appearance of the areas of fibrinoid necrosis, severe endothelial desquamation, and intimal detachment. HIFU-induced collagen structural changes in media and adventitia of the vein suggest that HIFU exposure resulted in local temperature increase up to ~60°Ð¡. In some experiments, adjacent to the vein muscles were also exposed to HIFU. In this case, edema of the interstitium and muscle fibers was registered, as well as fragmentation and coagulation of some fibers, altered staining patterns and neutrophil infiltration. These changes could be attributed to the development of acute muscle injury (acute fasciitis). Perivascular adipose tissue also demonstrated edema and lipolysis, red blood cell diapedesis, and leukocyte infiltration. Conclusion. The observations on structural changes in the venous wall after HIFU exposure could lay the ground for future experiments on HIFU - mediated obliteration.

An XY agonadal Oldenburg warmblood horse exhibiting a male phenotype.

In a 1.5-year-old Oldenburg horse, a clitoris-like structure instead of a penis was identified in the prepuce. The external genital organs did not show any abnormalities at visual inspection except that exteriorization of the penis was not possible, not even under general anesthesia. The horse's owner observed a continuous dripping of urine and a tendency to mild colics beginning 2 weeks after birth. Testosterone concentration was 0.01 ng/ml and therefore under the threshold for geldings, and the horse did not respond to the application of gonadotropin-releasing hormone (GnRH). The inner genital consisted of a male urinary tract. Gonads and accessory male glands were missing. Residual structures of a female genital tract were not observed. Abnormalities of the mesentery could be found which might explain the recurrent colics of this horse. A cytogenetic examination revealed a 2n = 64,XY-karyotype and a positive result for the SRY-PCR. This is the first report on an agonadal horse with a male karyotype and a pseudohermaphrodite phenotype.

Predictors of response to Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder: an exploratory study.

OBJECTIVE: Few predictors of treatment outcome or early discontinuation have been identified in persons with borderline personality disorder (BPD). AIM: The aim of the study was to examine the relationship between baseline clinical variables and treatment response and early discontinuation in a randomized controlled trial of System Training for Emotional Predictability and Problem Solving, a new cognitive group treatment. METHOD: Improvement was rated using the Zanarini Rating Scale for BPD, the Clinical Global Impression Scale, the Global Assessment Scale and the Beck Depression Inventory. Subjects were assessed during the 20 week trial and a 1-year follow-up. RESULTS: Higher baseline severity was associated with greater improvement in global functioning and BPD-related symptoms. Higher impulsivity was predictive of early discontinuation. Optimal improvement was associated with attending > or = 15 sessions. CONCLUSION: Subjects likely to improve have the more severe BPD symptoms at baseline, while high levels of impulsivity are associated with early discontinuation.

Counterfeit and substandard antimalarial drugs in Cambodia.

Counterfeit and substandard antimalarial drugs can cause death and contribute to the growing malaria drug resistance problem, particularly in Southeast Asia. Since 2003 in Cambodia the quality of antimalarial drugs both in the public and private health sector is regularly monitored in sentinel sites. We surveyed 34% of all 498 known facilities and drug outlets in four provinces. We collected 451 drug samples; 79% of these were not registered at the Cambodia Department of Drugs and Food (DDF). Twenty-seven percent of the samples failed the thin layer chromatography and disintegration tests; all of them were unregistered products. Immediate action against counterfeit drugs was taken by the National Malaria Control Program (NMCP) and the DDF. They communicated with the Provincial Health Department about the presence of counterfeit antimalarial drugs through alert letters, a manual, annual malaria conferencing and other training occasions. Television campaigns to alert the population about counterfeit drugs were conducted. Moreover, the NMCP has been promoting the use of good quality antimalarial drugs of a blister co-packaged combination of artesunate and mefloquine in public and private sectors. Appropriate strategies need to be developed and implemented by relevant government agencies and stakeholders to strengthen drug quality assurance and control systems in the country.

Synthesis, reactivity, and structure of strictly homologous 18 and 19 valence electron iron nitrosyl complexes.

The 18 and 19 valence electron (VE) nitrosyl complexes [Fe(NO)('pyS4')]BF4 ([1]BF4) and [Fe(NO)('pyS4')] (2) have been synthesized from [Fe('pyS4')]x ('pyS4'(2-) = 2,6-bis(2-mercaptophenylthiomethyl)pyridine(2-)) and either NOBF4 or NO gas. Complex [1]BF4 was also obtained from [Fe(CO)('pyS4')] and NOBF4. The cation [1]+ is reversibly reduced to give 2. Oxidation of 2 by [Cp2Fe]PF6 afforded [Fe(NO)('pyS4')]PF6 ([1]PF6). The molecular structures of [1]PF6 and 2 were determined by X-ray crystallography. They demonstrate that addition of one electron to [1]+ causes a significant elongation of the Fe-donor atom bonds and a bending of the FeNO angle. Density functional calculations show that the unpaired electron in 2 occupies an orbital, which is antibonding with respect to all Fe-ligand interactions. As expected from qualitative Molecular Orbital (MO) theory, it has a large contribution from a pi* type NO orbital. The nu(NO) frequency decreases from 1893 cm(-1) in [1]BF4 to 1648 cm(-1) in 2 (in KBr). The antibonding character of the unpaired electron explains the ready reaction of 2 with excess NO to give [Fe(NO)2('pyS4')] (3), the facile NO/CO exchange of 2 to afford [Fe(CO)('pyS4')], and the easy oxidation of 2 to [1]+.

Differential response of operant self-injury to pharmacologic versus behavioral treatment.

The purpose of this study was to investigate the hypothesis that self-injurious behavior (SIB) maintained by environmental factors will be more effectively treated by behavioral treatments than by haloperidol. Fifteen subjects were enrolled in this study. The efficacy of both haloperidol and a behavioral treatment was assessed. At the onset of treatment, subjects were randomized to receive either haloperidol or a placebo. During each day of treatment, data were collected during sessions with a behavioral treatment and sessions without a behavioral treatment. Behavioral treatment resulted in a statistically significant decrease in SIB, but haloperidol did not. Eighty-three percent of subjects were classified as responders to the behavioral treatment whereas only 25% of the subjects were responders to haloperidol (p = .019). We conclude that individuals with operant SIB are more likely to respond to behavioral treatments than to haloperidol.

Therapy-related changes of CD20+ and CD45RO+ lymphocyte subsets in chronic myeloid leukemia (CML): an immunohistochemical and morphometric study on sequential trephine biopsies of the bone marrow.

Little information exists about the amount of CD45RO+-T- and CD20+-B-lymphocytes in the bone marrow of patients with Philadelphia chromosome-positive chronic myelogenous leukemia (Ph1+-CML) at presentation or regarding corresponding changes during therapy. On the other hand, quantification of this cell compartment seems to be imperative for two reasons: first, the presumed association of immunocompetent lymphocyte subsets in the expansion of the leukemic cell clone; and second, a speculated relationship with the complex generation of myelofibrosis. Therefore, an immunohistological and morphometric study was performed on 219 representative trephine biopsies of the bone marrow derived from 70 patients with repeated examinations during the course of Ph1+-CML. For the identification of the different lymphocyte populations, the monoclonal antibodies UCHL-1 (CD45RO) and L26 (CD20) were applied on formaldehyde-fixed and decalcified specimens. In comparison to a control group and calculated per hematopoietic cells, the CML bone marrow showed about a 50% decrease in the total amount of lymphocytes. Determination of CD45RO+ and CD20+ subsets revealed a significant enhancement during treatment. Because of the different intervals (range, 10 to 25 mo) between first and last biopsy in the various therapeutic groups, results had to be modified by considering dynamic features. This calculation included changes of the lymphocyte subpopulations related to time. Contrasting the CD45RO+ lymphocytes, a relevant increase in the CD20+ subset could be observed after interferon-a treatment or corresponding combination regimens. No significant correlations were found between fiber density at onset (first biopsy) or development of fibrosis and lymphocyte proliferations in the course of CML. Our results are in keeping with the finding that a proper immune response consistent with an increased lymphocyte growth seems to be associated with a regression of the clonally-transformed cell population. Opposed to a repeatedly discussed pathomechanism, we failed to demonstrate any quantitative relationships between the extent of lymphocyte proliferations and occurrence or progression of myelofibrosis.

Improving HIV/AIDS services through palliative care: an HRSA perspective. Health Resources and Services Administration.

There has been a dramatic shift of the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) epidemic into poor, marginalized, and minority communities in the US. At the same time, the availability of new highly active antiretroviral treatments has made it possible for a large number of individuals to live for a much longer time with their disease. A net result is that the US is faced with an increasing number of people who are living with HIV/AIDS and are dependent on publicly supported health care services. In this paper, we review the palliative care efforts of the federal agency, the Health Resources and Services Administration (HRSA), responsible for providing Ryan White CARE Act HIV/AIDS care to medically underserved populations. In addition to supporting traditional hospice care, HRSA's HIV/AIDS Bureau has begun a series of initiatives that apply a broader concept of palliative care to its HIV programs in hospital- and community-based settings. Our interest is not to substitute palliation for access to new HIV therapies, such as highly active antiretroviral treatments, but to ensure that our health delivery systems attend to the alleviation of symptoms and suffering along with the provision of antiretroviral and other necessary treatments. HRSA's HIV/AIDS Bureau is organizing a broader provision of palliative care for its clients and actively contributing to improving care for the disenfranchised internationally.

The bedtime pass: an approach to bedtime crying and leaving the room.

OBJECTIVE: To evaluate a novel intervention for bedtime problems. DESIGN: We used an ABAB withdrawal-type experimental design. SETTING: The intervention was prescribed in an outpatient primary health care context and evaluated in the home setting. PARTICIPANTS: Two normally developing boys aged 3 and 10 years were the primary participants. Twenty parents and 23 practicing pediatricians rated the acceptability of the intervention. INTERVENTION: A bedtime pass, exchangeable for 1 excused departure from the bedroom after bedtime. MAIN OUTCOME MEASURES: For both primary participants, instances of crying and/or coming out from the bedroom after bedtime; for the 20 parents and 23 pediatricians, comparative ratings of acceptability for the pass and 2 other commonly used approaches to bedtime problems (ignoring crying and letting children sleep with their parents). RESULTS: Crying and coming out from the bedroom reduced to zero rates in both children. Pediatricians rated using the pass as significantly more acceptable than letting children sleep with parents and equivalent to ignoring. Parents rated the pass as more acceptable than either alternative. CONCLUSION: The bedtime pass provides pediatricians with a readily usable, potentially effective, and highly acceptable novel intervention for bedtime problems, one of the most common complaints in outpatient pediatrics.

Absence of the fragile X CGG trinucleotide repeat expansion in girls diagnosed with a pervasive developmental disorder.

The purpose of this study was to determine the prevalence of the fragile X (FRAX) CGG trinucleotide expansion in a population of young girls (n = 45) diagnosed with pervasive developmental disorder (PDD). Their mean age was 43.7 months (range, 25 to 132 months). Diagnoses included autistic disorder (n = 20), PDD (n = 23), and Asperger's syndrome (n = 2). Molecular FRAX testing was performed on all patients by using the Southern gene blot technique. Genomic DNA was digested with both EcoRI and EagI, fractionated on agarose gel, and blotted and probed with the radiolabeled StB12.3 FMR-1 probe. None of the subjects were found to have an expansion of CGG in either the 2.8 kb or 5.2 kb fragments. A 95% CI, for the prevalence of the FRAX mutation in female subjects with PDD, has an upper bound of 2.9%. We conclude that the prevalence of FRAX positivity in girls with PDD is lower than previously reported. This raises the question of whether any association between FRAX and PDD in female subjects is specific to PDD or is related rather to the presence of mental retardation.

Hoarding and treatment response in 38 nondepressed subjects with obsessive-compulsive disorder.

OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.

Case study: audio feedforward treatment of selective mutism.

Selective mutism is a relatively rare and difficult-to-treat disorder. Audio feedforward is a potential intervention that involves having the individual with selective mutism listen to audiotapes edited to depict him or her speaking in situations in which he or she is not currently speaking. The successful use of this intervention for three children with selective mutism is reported. The intervention was used in both school and community settings. This intervention has not always proved successful, sometimes because children refused to make the audiotapes.

Behavioral characteristics of children with stool toileting refusal.

OBJECTIVE: To determine if children with stool toileting refusal have more behavior problems than matched children who are toilet trained. DESIGN: Case-control study. SETTING: Suburban private pediatric practice. PARTICIPANTS: Children 30 to 48 months old who had achieved bladder control but refused to defecate on the toilet were identified as cases. Controls were sex- and age-matched children who were fully toilet trained. MEASURES: Total behavior problems were assessed using a semi-structured behavior screening interview with the child's parents. The parents also completed the Child Behavior Checklist for ages 2 to 4 and either the Toddler Temperament Scale (30 to 36 months old) or the Behavioral Style Questionnaire (36 to 48 months old). Child compliance with adult instructions was measured during a room clean-up task. RESULTS: Children with stool toileting refusal were not found to have more behavior problems than the matched children who were toilet trained. There were no differences between the two groups in compliance during the room clean-up task. There was a trend toward children with stool toileting refusal having a more difficult temperament, and these children were reported to have more problems with constipation and painful bowel movements than the controls. CONCLUSIONS: Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.

Preliminary confirmation of the proposed link between reward-dependence traits and norepinephrine.

The tridimensional theory of personality posits that traits belonging to a personality spectrum called 'reward dependence' are determined in part by the neurotransmitter norepinephrine (NE). We hypothesized that urinary levels of the NE metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) would be significantly correlated to the reward dependence score on the Tridimensional Personality Questionnaire (TPQ). Twenty-seven never psychiatrically ill subjects collected urine for MHPG measurements and completed the TPQ. There was a significant correlation between the reward dependence score and the level of MHPG. MHPG levels was not associated with the other two personality dimensions, novelty seeking and harm avoidance. This preliminary study supports the hypothesis that reward-dependence traits are in part determined by NE.