Genetic and demographic risk factors affecting HIV-SN in patients receiving ART.
\r\n\t1. Geopolymers chemistry topic describes the chemical reaction models and chemical kinetic of the geopolymerization which occurs after mixing the aluminosilicate raw materials with an alkaline solution.
\r\n\t2. Advanced characterization of geopolymers topic includes innovative technologies applied on geopolymers characterization at the nanoscale level, meant to explain the bond between the reacted and nonreacted particles from the composition.
\r\n\t3. Sustainability with geopolymers topic should provide clear information about the characteristics and applications of the geopolymers which use as raw materials industrial waste. Moreover, environmental impact studies which offer a clear view of the effects produced by geopolymers manufacturing, compared to conventional materials, is included.
\r\n\t4. Geopolymers as functional materials topic will present key aspects in developing geopolymers with tailored properties that increase further the heavy metals adsorption capacity, offering outstanding opportunities for energy-efficient separations and process intensification, in terms of saving energy, reducing capital costs, minimizing environmental impact and maximizing the raw materials exploitation.
\r\n\t5. Reinforced structures topic describe the effects produced by the introduction, in the geopolymers matrix, of different types of reinforcing elements.
Management of HIV patients is now focused on their quality of life as antiretroviral therapy (ART) increases life expectancy. However, with longer lives, a growing number of patients experience a neurological disorder that predominantly affects small fibers. HIV-associated sensory neuropathy (HIV-SN) may arise not only as a result of HIV infection itself but also as a side effect of ART. The clinical pictures triggered by HIV infection or ART are very similar and include neuropathic pain, tingling sensation, and numbness [1, 2, 3]. HIV-SN is one of the most common complications of HIV infection.
\nThe incidence and prevalence of HIV-SN vary widely—perhaps because most studies do not distinguish between neuropathy due to HIV itself and due to ART regimens with different risk profiles. Cross-sectional studies including patients receiving ART identify HIV-SN in 16–50% of HIV patients [4, 5, 6]. ART that includes the non-nucleotide reverse transcriptase inhibitor (NNRTI), stavudine (d4T), is associated with high prevalence of HIV-SN. The prevalence in Melbourne was up to 42%, whereas in Kuala Lumpur and Jakarta, the reported level was lower, 19 and 34%, respectively [7]. Stavudine is no longer in first-line therapy, and the prevalence of HIV-SN is almost halved (14.2%) compared to data from the same clinic in Indonesia when patients received stavudine [8].
\nIn untreated patients, the risk factors for HIV-SN were severe HIV disease marked by low numbers of CD4+ T cells and high viral loads (HIV RNA) in plasma. In the era of ART (including stavudine), the risk factors of HIV-SN included older age, height, <50 CD4+ T cells/mm3, malnutrition, and concurrent diabetes [1, 7, 9, 10]. HIV-SN was also more common in African-Americans [3] and Hispanics [11]. Genetic polymorphisms may alter risk for HIV-SN in Africans [12, 13, 14], Asians [15], and Caucasians [16]. These factors are discussed in more detail here.
\nThere are two forms of HIV-SN—distal symmetrical polyneuropathy in HIV (DSP) and antiretroviral toxic neuropathy (ATN). DSP arises at later stages of HIV infection, while ATN is caused by neurotoxic effects of antiretroviral drugs [10, 17]. These two forms cannot be distinguished clinically, so they are grouped as HIV-SN when seen in patients receiving ART.
\nThe most frequent symptoms of HIV-SN are pain, numbness, and burning sensations. The symptoms can be progressive, predominantly affecting the soles of the feet and may become more severe at night. Physical examination may reveal hyperalgesia and allodynia, with absent physiological reflexes and sensory loss in the distal limb segments, including sensitivity to vibration [1, 9, 10, 11]. Clinical symptoms usually occur first on the lower limbs for several months but may spread upward. Since HIV-SN predominantly affects small nerve fibers, the clinical signs can also manifest as autonomic neuropathy with postural hypotension and urinary dysfunction [18]. Guidelines for the diagnosis and management of HIV-SN are available [e.g.,
Perhaps, the optimal tool to screen HIV-SN is AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Test (ACTG BPNST). This test has been used in many countries including Australia, the USA, India, South Africa, and Indonesia. It is relatively inexpensive, is fairly easy to do, and takes less than 10 minutes to perform but has low sensitivity. A study comparing BPNST to modified Total Neuropathy Scores (mTNS) in HIV patients on ART (including d4T, ddI, ddC) found that the sensitivity of BPNST was 49%, whereas the specificity was high at 88% [17]. Peripheral neuropathy can be diagnosed if there is ≥1 symptom assessed in the BPNST list and one of the following signs: decreased Achilles reflexes or decreased sensibility to vibration when a tuning fork is held on a toe. This definition means that patients with two abnormal signs but no symptoms are not considered to have HIV-SN. This may contribute to variations in the prevalence of peripheral neuropathy in HIV reported in various studies. Some studies consider this intermediate group as asymptomatic peripheral neuropathy with the assumption that they can become symptomatic in time. Ellis et al. defined peripheral neuropathy as a decrease in Achilles tendon reflexes or decreased perception of vibration in both legs. The sensitivity increased by 80% but the specificity decreased to 59% [19].
\nClinically, peripheral neuropathy can also be classified as small- or large-fiber neuropathy. The latter manifests as the loss of joint position and vibration sense and sensory ataxia, whereas small-fiber neuropathy manifests as neuropathic pain, impairment of temperature sensing, and autonomic function. A nerve conduction study (NCS) can include sensory and motor nerve conduction and help in documenting sensory motor deficits that mainly affect large-fiber nerves [20]. As HIV-SN is a predominately small-fiber neuropathy, NCS is often normal [21]. In HIV-SN patients, ATN- and HIV-associated DSP often cannot be distinguished since patients can have both types at same time. However, there are some evidences that ATN primarily impairs small-fiber nerves, whereas HIV-associated neuropathy (DSP) has been linked to large-fiber nerves [22, 23].
\nStimulated skin wrinkling (SSW) test is a method to assess small nerve fiber function using exposure to eutectic mixture of local anesthetic. It has been shown to correlate with intraepidermal nerve fiber density (IENFD) in patients with a sensory neuropathy [24] and has high sensitivity compared to other assessments of small-fiber neuropathy in diabetic patients [25]. Skin wrinkling occurs as a result of vasoconstriction in the glabrous skin, mediated by postganglionic sympathetic fibers [26]. Other assessments that have been used to detect small-fiber neuropathy in HIV-SN patients include quantitative sudomotor axon reflex tests (QSART) [27], quantitative sensory tests (QST) [18], and sympathetic skin responses (SSR) [22, 23].
\nSkin biopsies are the gold standard for the detection of damage to small-diameter sensory nerves, including non-myelinated and myelinated intraepidermal nerve fibers. Lower nerve fiber densities have been demonstrated in patients with HIV-SN [18]. Studies have used several different techniques. The European Federation of Neurological Societies recommended a biopsy of the skin to a depth of 3 mm by using a skin punch biopsy on the distal limbs to calculate the linear density or nerve fibers with a minimum of 50 μm-thick slices, fixed in a 2% solution of paraformaldehyde-lysine-periodate (2% PLP). Immunohistochemical staining techniques recommended are bright-field immunohistochemistry and indirect immunofluorescence [28]. PGP9.5 immunofluorescence allows nerves to be visualized using a confocal microscope [29]. Smaller intraepidermal nerve fiber densities (IENFD) in HIV-SN patients correlated with the clinical and electrophysiological severity [30]. Skin biopsies can also be used to identify cells and mediators that contribute to SN. These are discussed later in this chapter.
\nAnalyses of the risk factor of HIV-SN require that we consider the condition in three distinct eras—(1) pre-ART, (2) the use of combination ART that included stavudine (d4T), and (3) the use of non-neurotoxic ART. In the pre-ART era, the risk factors for developing HIV-SN included HIV disease severity, low CD4+ T-cell counts, high viral load, and older age [31, 32]. In the second era, the risk factors are older age, height, low nadir CD4+ T-cell counts, HIV duration, malnutrition, diabetes mellitus, dyslipidemia, and the use of neurotoxic drugs (usually stavudine; see Table 1; [7, 14, 15, 33, 34]). Stavudine is no longer recommended by the WHO as first-line ART and is now rarely used anywhere in the world, but HIV-SN has not disappeared. The risk factors of HIV-SN in patients on ART without stavudine are almost the same as in the pre-ART era—high plasma viral load and older age [8]. Isoniazid is widely used as therapy for tuberculosis and has been recognized as a risk factor for neuropathy for a long time. It remains weakly associated with HIV-SN even though patients receiving isoniazid are also given B6 supplementation to prevent neuropathy. Protease inhibitor (PI) exposure may be a risk factor of HIV-SN. Lopinavir, indinavir, and ritonavir, but not nelfinavir, were associated with neuropathy in one study [35].
\nDemographic risk factors | \nGenetic risk factors | \n
---|---|
Low nadir CD4+ T-cell count HIV duration Age Height High plasma HIV RNA Diabetes mellitus Malnutrition Neurotoxic drugs \n
| \nRace (more common in African populations) Polymorphisms in \n
| \n
Genetic and demographic risk factors affecting HIV-SN in patients receiving ART.
The risk of HIV-SN cannot be correlated with a single genetic variant, so candidate genes are discussed separately (see Table 1). It is of interest to determine if any aligns with the greater sensitivity of individuals of African descent [13, 14, 36].
\nIn patients receiving stavudine, haplotypic combinations of alleles of single-nucleotide polymorphisms (SNP) spanning the tumor necrosis factor (TNF) block in the central major histocompatibility complex (MHC) associate with variations in the prevalence of HIV-SN, but the associations were different in Africans and Asians [12]. For example, a polymorphism in intron 10 of BAT1 (marking an MHC haplotype associated with several inflammatory disorders) and a polymorphism in the promoter region of the TNFA gene (TNF-1031) were associated with an increased risk of HIV-SN in Caucasians [37]. TNF-1031*2 is associated with an increased risk of HIV-SN in Indonesian HIV-positive patients who receive stavudine [15, 16]. However, in Africans, different SNP alleles were found in linkage disequilibrium with TNF-1031*2, so TNF-1031*2 was not associated with HIV-SN. These findings link HIV-SN with an unknown SNP in the TNF block marked by (but distinct from) TNF-1031. The link between HIV-SN and inflammation was supported by studies linking IL4 genotypes with HIV-SN in Africans receiving stavudine [13].
\nGoullee et al. linked SNP in three genes P2X7R, P2X4R, and CAMKK2 with HIV-SN in African patients treated with stavudine. In a logistic regression model which included demographic analyses, SNP in CAMKK2, and to a lesser extent P2X7R and P2X4R, demonstrated independent associations with HIV-SN (p < 0.0001; R2 = 0.19) [14].
\nThe P2X7R receptor is expressed by microglia and may be involved in neuropathic pain, as its ablation or inhibition in animal models of neuropathy can reduce responses to painful stimuli [38]. Conversely, stimulation of P2X7R will increase the release of pro-inflammatory cytokines such as IL-1β, IL-6, and TNFα [39] as well as pro-inflammatory chemokines such as CXCL2 and CCL3, which have been implicated in neuropathic pain [40, 41].
\nIn animal studies, P2X4R was activated in spinal microglial cells in rats with induced pain [42]. Mice with disrupted P2X4R genes showed reduced pain response in two models of chronic pain (inflammatory and neuropathic) [43]. P2X4R is upregulated after peripheral nerve injury which results in increased activity of mitogen p38 [44]. This process initiates the release of brain-derived neurotropic factor (BDNF). BDNF induces neuronal hyperexcitability through interaction with the TrkB receptor [45, 46].
\nThe CAMKK2 gene encodes calcium-/calmodulin-dependent protein kinase 2 (CaMKK2), which acts as a pervasive second messenger of Ca2+ in many cellular functions such as energy balance, neuronal differentiation, and inflammation [47]. CaMKK2 plays a role in neural plasticity and neurite growth by activating another protein kinase CaMKI [48]. CAMKK2 and P2X4R polymorphisms affect TNFα production in vitro. This suggests a mechanism for their impact on HIV-SN [49]. Hence, polymorphisms in CAMKK2 may affect inflammation or neuronal growth.
\nThe process of mitochondrial toxicity induced by ART is not a simple drug toxicity, but mitochondrial DNA (mtDNA) SNP has a role in developing HIV-SN in patients receiving NRTI. SNP in African mtDNA haplogroup L1c and European haplogroup J is associated with decreased prevalence of HIV-SN compared with all other haplogroups [36]. Moreover, Thai persons belonging to mtDNA haplogroup B were more likely to develop HIV-SN [50].
\nHIV-1 Nef protein may influence iron levels via interactions with the hemochromatosis protein HFE in humans [51]. In an observational prospective study, Kallianpur et al. suggested that disruption of iron homeostasis due to HIV infection might damage neurons and potentially lead to HIV-SN. They presented evidence that the HFE C282Y mutation may be a protective factor in HIV patients using NRTI [52]. They subsequently linked polymorphisms in iron management genes with increased risk (TF, CP, ACO1, BMP6, B2M) and reduced risk (TF, TFRC, BMP6, ACO1, SLC11A2, FXN) of HIV-SN [53].
\nThe pathophysiology of HIV-SN is not completely understood, but there are several promising theories. It remains unclear whether HIV inflicts direct damage in the nerve body of dorsal root ganglia (DRG) or damages nerve fibers; both will lead to the development of distal axonopathies. HIV causes distal axon degeneration, reduction of nerve fiber in DRG, infiltration of inflammation cells, and reduction of the intraepidermal nerve fiber (IENFD) count [2]. As HIV itself cannot directly infect nerve bodies, destruction of neuron in HIV-SN may be caused by neurotoxic agents released by activated macrophage and satellite glial cells (TNF-α, IL-1β, chemokines), viral proteins with neurotoxic properties (gp41, gp120, Tat, Vpr), infection of perineural cells, or combinations of these processes [54, 55, 56, 57, 58]. A study in simian immunodeficiency virus macaque model confirmed that HIV infection activates perineuronal inflammatory cells (including macrophages and lymphocytes) in trigeminal ganglia and DRG during the early stage of infection. In the later stage, neuronal damage becomes evident, and regenerative capacity of small epidermal nerve is impaired [59].
\nHIV infection may cause macrophages to respond to the axonal degeneration (even in mild cases) causing inflammation of the nerves and DRG. Pro-inflammatory mediators were released by Schwann cells at DRG and may accumulate adjacent to peripheral nerves, activate apoptotic pathways and cause damage to the nerves directly or indirectly (reviewed in [55]). The gp120 virus protein may act directly on chemokine receptors expressed on neurons and cause pain [60]. A histopathology study of skin biopsies from HIV-SN patients on ART without stavudine confirmed the presence of inflammatory macrophages and T cells expressing some chemokine receptors (CX3CR1, CCR2, CCR5), along with reduced IENFD [61].
\nHIV protein gp120 is a component of the viral glycoprotein sheath. The entry of the HIV virus into cells requires the interaction of gp120 with CD4 glycoprotein and a chemokine receptor (usually CXCR4 and/or CCR5) which may be expressed on neurons or infiltrating inflammatory cells. Several chemokine receptors, such as CCR2, CCR5, and CXCR4, and CX3CR1 (fractalkine receptor) are located in primary afferent neurons or secondary neurons of the spinal dorsal horn. Chemokines and gp120 can cause pain through direct effects on chemokine receptors expressed by nociceptive neurons [62]. For example, binding of gp120 to CXCR4 receptors increases the release of CCL5, which binds CCR5 and triggers the release of TNFα and other neurotoxic substances. These interactions activate an influx of Ca2+, kinase cascades, and STAT3 signaling leading to the signs and symptoms of HIV-SN. The pathways have been reviewed previously [61, 63].
\nThe pathophysiology of HIV-SN in patients on stavudine may reflect damage to the mitochondria of neurons and axons via damage to mitochondrial DNA (mtDNA) [64]. Inhibition of mtDNA gamma polymerase, mtDNA intercalation, and damage in stress response of mitochondria has been demonstrated in vitro in cultures of T-lymphoblastoid cells [65]. This finding is further supported by differences in haplotypes or SNP in mtDNA in Europeans, Hispanics, and Africans that may contribute to differences in the prevalence of HIV-SN [36, 52, 66, 67].
\nManagement of HIV-SN aims to avoid further nerve damage and minimize the patients’ symptoms especially neuropathic pain. Some studies showed that smoked cannabis is effective and has analgesic value to relieve pain in HIV-SN patients [68, 69]. However, due to legal issues in many countries, the recommendation of smoked cannabis has been controversial. Other pharmacological treatments recommended for neuropathic pain are amitriptyline, pregabalin, and gabapentin [70]. However, these medications were not superior to the placebo in HIV-SN patients [71, 72, 73]. Another option is non-pharmacological treatment such as acupuncture and hypnosis. However, acupuncture was not superior to the placebo to improve pain in HIV patients [74]. A small study showed that hypnosis showed benefit to reduce the pain score in HIV-SN patients [75].
\nDespite the withdrawal of the most toxic drugs from recommended ART regimens, HIV-SN remains a common neurological complication of HIV disease. The risk factors of HIV-SN have changed with changes in ART from the patient’s age and height to the efficacy of ART and the use of protease inhibitors. Genetic polymorphisms that influence pathogenesis of HIV-SN will provide candidate molecules, which may contribute to pathogenesis, but studies of skin biopsies from patients are needed to confirm the roles of the encoded proteins. Animal models may reveal mechanisms for neuropathy and pain by HIV proteins but do not mimic the complexities of HIV disease in patients.
\nThe recent tensions in the globalised world are strongly connected to resources in limited quantities. In this regard, the importance of producing more value using less material and diversifying consumption has been become a driver for developing variety of concepts of circular economy. The chapter is aimed at:
summarising the recent achievements in understanding economic development and circularity of resources presented in these concepts;
identifying understandings how and who will transform linear free market economy into a circular one;
defining a theoretical background to solve the above problems;
approbating its applicability into the practice.
Economic development is a term in which different content is invested. Based on etymology, it means a constant process of transition of the state of the economy from one stage to another more advanced one. In the scientific literature many different classifications of the stages of economic development and respected criteria for their identification take place. Practically none of them discusses circularity as a criterion for belonging to a specific stage. For this study we accept the main characteristic of the recent stage of economy development is that it is a free market one, and that the main challenges before is digitalization and circularity implementation. The latter is the focus of the further analyses.
\nThe basic concept of a circular economy depicts a production and consumption system that relies on the recycling, re-use, repair, remanufacturing, sharing of products, changing the consumption patterns and new business models and systems. Defining circular economy concepts and their problems could be find in academic literature, including contemporary academic reviews, official documents of the European Commission [1], OECD, G-8, etc., and from charities and NGOs, most prominently, the Ellen McArthur Foundation [2].
\nContemporary academic rethinking of the progress within the limits of the planet has contributed to development of different theoretical and methodological dimensions of a concept for circular economy and for a transition from linear to a circular economy [3, 4]. They have concerned also measurement of the change like to redefine growth, focusing on society – wide benefits. The concept of circularity transforms all the elements of the take-make-waste system how to manage resources, how to make and use products, and what is done with the materials afterwards in the process of transforming linear to circular economy. (See: Figure 1).
\nFrom linear to circular economy. Source: [5].
Another dimension of concepts on the circular economy identified is focussed on how materials enter, flow within and (eventually) leave the economy. A visual overview is provided by a material flows diagram (See Figure 2\n1). It shows all raw materials — aggregated as well as grouped by categories of materials — throughout the economy, from their extraction until they become waste.
\nMaterial flows in the economy (EU-28, 2014). Source: [6].
More concretely, the input-side on the left shows that only 0.6 billion of 8 billion tonnes of materials are processed into energy or products annually in the EU originate from recycling. On the output-side, out of the 2.2 billion tonnes of waste that are generated only 0.6 billion tonnes re-enter the system as recycled materials. It means that the rest of the materials, equivalent to 1.5 billion tonnes, is waste. This concept for circular economy points to a significant potential for improvement in particular by increasing the share of materials recycled as secondary raw materials and decreasing the production of waste.
\nIt could be assumed the above two dimensions of concepts for circular economy discuss how resources are used, or have to be used. But they do not characterise who and how will transform the linear free market economy to a circular one. Such answer could be found applying the Hegelian doctrine for economic development.
\nThe most of the recent conflicts are originating from the limited quantities of resources such as water, soil, clean air and ecosystem services which are vital to health and quality of life, but also to the human society as such.
\nIn all of this Hegel appears to be providing a philosophical account of modern economic developments2. He argues the economy, especially through the division of labor, produces fragmentation and diminishment of human life and the state must not only address social problems but also provide the means for the people’s political participation to further the development of social self-consciousness. Regarding to it the state must not only address this phenomenon but also provide the means for the people’s political participation to further the development of social self-consciousness. Such participation could be understood as defining and introducing the objectives and means for economic development. Hegel repeats the need for strong state regulation of the economy, which if left to its own workings is blind to the needs of the social community.
\nSince start of Industrial revolution, the Hegelian doctrine for economic development has become more attractive in the frame of the concept for forth industrial revolution. It is because the notion the free market economy without a state does not contribute to meeting challenges such as diminishing freedom and fragmentation of social community is still correct now-a-days. Today the Hegelian doctrine is attractive also for understanding and approaching the challenges before health and life of human beings, which affect freedom and social community fragmentation also. This doctrine suggests an answer to the question how to avoid the negative effects of traditional linear economy, where raw materials are used to make a product, and after its use any waste (e.g. packaging) is thrown away. Here we are not discussing the level of which a state is able to meet such expectations.
\nIt could be assumed in regard to economic development the Hegel’s theory [7] respects criteria for identification of different stages of this development - the object (goal), the subject (state) and the means for achieving the goals (free market vs., or with state regulation). If this assumption is correct we could conclude the circular economy is a stage of economic development, where circularity of resources is important integral part of the goal of the economic development. The achievement the goal of circularity, understood as minimising the usage of natural resources, minimised or 0 waste needs strong state monitoring and regulation in the frame of a free market economy.
\nMonitoring circular economy is of vital importance for the society. It will be analysed on the case of European union. The monitoring there is based on identification of main areas of appearance of circularity and defining the available indicators to measure them. This approach has allowed monitoring assessment, strategy development and policy making and implementation. As such areas of circularity appearance identified are:
Sustainable resource management;
Societal behaviour;
Business operations.
The content of indicators and interpretation of their contribution to understanding of circular economy is grouped according to the areas of circularity appearance as follow [8]:
\nSUSTAINABLE RESOURCE MANAGEMENT - indicators examining the performance of the EU Member States in transforming their economies toward circularity by lowering resource demands, thereby increasing resource security and lowering pressures on the environment domestically and abroad.
\nSOCIETAL BEHAVIOUR – indicators, reflecting citizen awareness, engagement and participation in the circular economy. Citizen engagement, behaviour change and social norms are integral to the success of a circular economy transition. This means that people participate in new forms of consumption (e.g. sharing, product-service systems, willingness to pay more for durability), re-use (requiring changed mindsets regarding repair and refurbishment), and disposal (separating waste streams and bringing “waste” to remanufacturing/ recycling/ sorting sites).
\nBUSINESS OPERATIONS – indicators, which depict eco-innovation activities toward changing and adapting business models according to the principles of a circular economy. Business activities and their digitalization are the engine behind the circular economy transition. They foster circularity across the life-cycle of material use, beginning with how and what materials are sourced (quality, environmental and health standards). The design stage of business operations is particularly crucial to enabling re-use /re-manufacturing / recycling and raising the durability of goods for keeping within the economy longer. Remanufacturing and recycling are key business operations critical to scaling up the circular economy.
\nThe monitoring and assessment of circularity have become a fundament for developing vast majority of economic development policy measures.
\nThe transition to a more circular economy in Europe is accompanied by implementation of several specific policy measures.
\nIn 2015 the EC adopted an action plan to accelerate Europe’s transition to a circular economy. It was aimed at strengthen global competitiveness, promote sustainable economic growth and create new jobs. This action plan contains 54 measures to “close the loop” of the life cycle of products - from production and consumption to waste management and the market for secondary raw materials. Five priority sectors to accelerate the transition along the value chain are identified: plastics, food waste, critical raw materials, construction and demolition, biomass and bio-based materials.
\nThe strategic documents of today EU institutions include:
A clear resource efficiency agenda;
Roadmap to a resource efficient Europe;
The Circular Economy package;
Amendments to renewable energy policy that seek to address resource issues.
The transition to a circular economy is in the agenda of world fora as well. It was in the focus of discussions during the 2019 Annual Meeting in Davos. The four key priorities emerging for the year ahead identified are as follow:
Leadership is critical;
Leverage the potential of the Fourth Industrial Revolution;
Circular material value chains;
Collaboration is key.
Implementation of the developed visions, strategies and respective policy measures has required developing respective instruments. On the first place they concern defining appropriate indicators.
\nThe literature suggests different methodologies to be applied for collecting and interpreting data for monitoring and assessing policy measures for circular economy. There are a variety of indicators applied now, although most have limitations. There are two most used indicators, predominantly applied by the OECD and G-8, more concretely those:
for resource productivity and
for resource efficiency.
The first indicator is measuring circularity as a ratio between GDP and domestic material consumption, in other words, it is focusing circularity on the resource use.
\nThe second one means using the Earth’s limited resources in a sustainable manner while minimising impacts on the environment. It allows interpreting the level of creating more with less and to deliver greater value with less input. Such indicator is also measured through EU resource efficiency scoreboard [9], as EU eco-innovation index recycling rates [10, 11], through the amount of municipal waste per capita, or amount of waste per GDP output.
\nThe monitoring framework on the circular economy as set up by the European Commission consists of ten indicators, some of which are broken down in sub-indicators, selected in order to capture the main elements of a circular economy. These ten indicators are divided into four thematic areas [8]:
\nProduction and consumption. This area comprises four indicators:
Self-sufficiency of raw materials for production in the EU;
Green public procurement (as an indicator for financing aspects);
Waste generation (as an indicator for consumption aspects);
Food waste.
Waste management. This area comprises two indicators:
Recycling rates (the share of waste which is recycled);
Specific waste streams (packaging waste, bio-waste, e-waste, etc.).
Secondary raw materials. This area comprises two indicators:
Contribution of recycled materials to raw materials demand;
Trade of recyclable raw materials between the EU Member States and with the rest of the world.
Competitiveness and innovation. This area comprises two indicators:
Private investments, jobs and gross value added;
Patents related to recycling and secondary raw materials as a proxy for innovation.
This European monitoring framework aims at measuring progress toward a circular economy in a way that encompasses its various dimensions at all stages of the lifecycle of resources, products and services. In this regard the monitoring framework has a set of the ten indicators (see Table 1), grouped into four stages and aspects of the circular economy: (1) production and consumption, (2) waste management, (3) secondary raw materials and (4) competitiveness and innovation. The logic and structure of this monitoring framework broadly follows the logic and structure of the European circular economy action plan.
\nProduction and consumption | \n|||
---|---|---|---|
1 | \nEU self-sufficiency for raw materials | \nThe circular economy should help to address the supply risks for raw materials, in particular critical raw materials. | \nRaw Materials Initiative; Resource Efficiency Roadmap | \n
2 | \nGreen public procurement\n*\n\n | \nPublic procurement accounts for a large share of consumption and can drive the circular economy. | \nPublic Procurement Strategy; EU support schemes and voluntary criteria for green public procurement | \n
3a-c | \nWaste generation | \nIn a circular economy waste generation is minimised. | \nWaste Framework Directive; directives on specific waste streams; Strategy for Plastics | \n
4 | \nFood waste\n*\n\n | \nDiscarding food has negative environmental, climate and economic impacts. | \nGeneral Food Law Regulation; Waste Framework Directive; various initiatives (e.g. Platform on Food Losses and Food Waste) | \n
Waste management | \n|||
5a-b | \nOverall recycling rates | \nIncreasing recycling is part of the transition to a circular economy. | \nWaste Framework Directive | \n
6a-f | \nRecycling rates for specific waste streams | \nThis reflects the progress in recycling key waste streams. | \nWaste Framework Directive; Landfill Directive; directives on specific waste streams | \n
Secondary raw materials | \n|||
7a-b | \nContribution of recycled materials to raw materials demand | \nIn a circular economy, secondary raw materials are commonly used to make new products. | \nWaste Framework Directive; Eco-design Directive; EU Ecolabel; REACH; initiative on the interface between chemicals, products and waste policies; Strategy for Plastics; quality standards for secondary raw materials | \n
8 | \nTrade in recyclable raw materials | \nTrade in recyclables reflects the importance of the internal market and global participation in the circular economy. | \nInternal Market policy; Waste Shipment Regulation; Trade policy | \n
Competitiveness and innovation | \n|||
9a-c | \nPrivate investments, jobs and gross value added | \nThis reflects the contribution of the circular economy to the creation of jobs and growth. | \nInvestment Plan for Europe; Structural and Investment Funds; InnovFin; Circular Economy Finance Support Platform; Sustainable Finance Strategy; Green Employment Initiative; New Skills Agenda for Europe; Internal Market policy | \n
10 | \nPatents | \nInnovative technologies related to the circular economy boost the EU’s global competitiveness. | \nHorizon 2020 | \n
Indicators on the circular economy included in the monitoring framework.
Indicators under development.
\nSource: [8].
The analyses of data for the ten indicators of the monitoring framework provide a broad picture of increase the circularity of the EU’s economy [8]. The areas of the European economic development where circularity is of importance could be characterised as follow:
\n\nProduction and consumption\n: progress can be observed toward more circular trends in production and consumption e.g. in terms of waste generation; considerable room for narrowing the gap in performance between Member States and across materials. The EU is largely self-sufficient for most non-metallic minerals such as construction materials and industrial minerals; for the EU’s critical raw materials [12] the EU is relying on imports to a large extent, which highlights the need for secure access and diversification of supply3. EU municipal waste4 generation per capita has dropped by 8% between 2006 and 2016 to an average of 480 kg per capita per year; large variations among Member States are observed (between 250 and 750 kg per capita per year)5, and municipal waste generation is still growing in several Member States.
\nIt is positive that the data on total waste generation (including industrial and commercial waste but excluding major mineral waste) per unit of GDP shows a decrease of 11% since 2006. According to Eurostat’s preliminary estimates, EU food waste decreased from 81 to 76 million tonnes (i.e. by around 7%) between 2012 and 2014, equivalent to a drop from 161 to 149 kg per capita.
\n\nWaste management:\n between 2008 and 2016, EU recycling rates for municipal waste increased from 37–46% (See: Figure 3.). Five Member States recycle more than half of their municipal waste, while some countries are approaching the 2030 recycling target of 65% proposed by the Commission, however, five Member States are still below 25%.6\n
\nMunicipal waste treatment, EU (kg per capita). Source: Eurostat.
Between 2008 and 2015, the recycling rates for packaging waste also increased in the EU, from 62–66%; it increased in almost all Member States, and in 2015 almost all Member States had met the 2008 target of 55% (the Commission has proposed a target of 65% by 2025 and 75% by 2030 [12]). For plastic packaging, the average recycling rate in the EU is significantly lower, at 40%, even though there have been improvements in recent years. The recycling of municipal bio-waste in the EU was 79 kg per capita in 2016, an increase of 23% compared to 2007.
\nIn the EU, the level of demand for raw materials exceeds what could be supplied even if all waste were turned into secondary raw materials. Therefore, the supply of primary raw materials will remain necessary. On average, recycled materials only satisfy around 10% of the EU demand for materials, in spite of a steady improvement since 2004. For a number of bulk materials, secondary raw materials satisfy over 30% of total demand for materials (e.g. copper and nickel). The EU is a net exporter of several major recyclable waste streams such as plastics, paper and cardboard, iron and steel, copper, aluminium and nickel. Trade within the EU of plastics, paper and cardboard, copper, aluminium, nickel and precious metals waste increased considerably between 2004 and 2016, allowing economic operators to reap the benefits of the EU internal market for secondary raw materials [13].
\nThe transition to a circular economy is accompanied by an increase of investments, value added and jobs, and stimulates innovation. In 2014, private investments in economic sectors relevant to the circular economy7 are estimated to have been 0.1% of the GDP. There were more than 3.9 million jobs in these sectors, having an increase of 2.3% compared to 2012. The circular economy sectors created value added in 2014 an increase of 6.1% compared to 2012. Significant role for these achievements play EU funding programmes, available to support the transition to a circular economy, such as the European Fund for Strategic Investments, the European Structural and Investment Funds, Horizon 2020 and the LIFE programme. In in January 2017 a Circular Economy Finance Support Platform was launched.
\nFor patents on recycling and secondary raw materials, the data show an increase of 35% between 2000 and 2013. EU patents for glass recycling represent 44% of the world total for such patents, while the EU’s share is 18% for plastics and 23% for paper.
\nConcluding the analysis of the above figures we could assume the transition to a circular economy is taking place in the European Union. For the period 2012–2014 the circular economy sectors created 3.9 mln. Jobs, contributed to the increase of 6.1% value added in 2014 (Euro 141 billion), compared to 2012, attracting private investment of Euro 15 bln. Circular economy is realised as a vital necessity and has become an important part of the strategy and of policy making of the society. Thus it has become an integral part of the goals of economic development.
\nThe chapter provides some arguments for understanding circular economy as a new stage of economic development, where the goal is to meet the challenges of tensions in globalised world, which are strongly connected to resources in limited quantities. The content of the goal is transforming, addressing not only resource productivity and efficiency, but also waste minimization, and many other areas of circularity. The analyses have shown market forces are limited and not strong enough to achieve the new goal of economic development, reflecting the needs of society, vital for its future. It was shown the Hegelian doctrine for economic development provides instruments for understanding and solving new challenges. The new instruments include state regulation and respective monitoring, analysing and drawing conclusions and recommendation, using new indicators, developed for monitoring economic processes and for new economic policies concerning achievement of the new goals of society.
\nThe above notion is argumented on the case of Europe: A new policy for a new stage of economic development focused on circularity on European level has taken place, first achievements are registered. This new policy, in Hegelian tradition, includes A state regulation, aimed at SUSTAYNING economy IN ORDER TO CONTRIBUTE TO ACHIEVING SOCIAL GOALS - preservation of the world’s resources, create local jobs and in this way to generate competitive advantages in globalised economy IN ABILITY TO COOPERATE FOR ACHIEVEMENT BETTER COMMON FUTURE.
\n.
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