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Prebiotics are considered beneficial to health owing to positive effects upon the gut microbiota (GM). These effects on the GM include stimulating the growth of beneficial species and increasing short chain fatty acid (SCFA) production (1). Accumulating evidence suggests that the putative health benefits associated with seaweed consumption may be, in part, owing to their effects on the GM(2). The red seaweed Palmaria palmata is a source of xylan, a β(1–3) and β(1–4) D-xylose polysaccharide. Given that xylo-oligosaccharides are a recently accepted prebiotic (3), the aim of this investigation was to assess the prebiotic potential of xylan from Palmaria palmata using an in-vitro fermentation gut model. Fibres were subjected to an in-vitro digestion and underwent in-vitro batch culture fermentation (MicroMatrix) over 24 hours. Fermentation vessels were inoculated using a pooled faecal slurry (5% v/v), prepared from six healthy volunteers. Xylan fibre (n = 4) was compared to Cellulose (negative control, n = 8) and Synergy 1 (positive control, n = 8). Changes to GM composition was determined using qPCR (total bacteria, Lactobacilli, and Bifidobacteria), and MiSeq 16S rRNA sequencing. Short chain fatty acid analysis was conducted using gas chromatography-mass spectrometry. The differential abundance of taxa between fermentation substrates was determined using linear discriminant analysis (LDA) effect size (LEfSe). A permutational multivariate analysis of variance (PerMANOVA) was used to determine statistical differences of beta diversity whilst treatment associated differences of short chain fatty acids were determined using an unpaired Mann-Whitney U Test. Xylan altered GM composition at Phylum, Family and Genus taxonomic levels, notably a significant reduction in the Firmicutes/Bacteroides ratio (p = 0.004). Both 16S sequencing data and qPCR analysis revealed a significant increase in Bifidobacteria relative to cellulose, where the effect was comparable to Synergy 1. No significant differences in microbiota diversity were noted for either Xylan or Synergy 1 in comparison to the cellulose control. Xylan was shown to significantly modulate GM activity through increased short chain fatty acid production with increased acetate, propionate and butyrate. The evidence gained from this study suggests that Xylan from Palmaria palmata is a fermentable fibre with potential prebiotic characteristics, and therefore warrants further investigation in humans.
This research was funded under the National Development Plan, through the Food Institutional Research Measure, administered by the Department of Agriculture, Food and the Marine, Ireland (13/F/511) and a Northern Ireland Department of Education and Learning PhD scholarship to Paul Cherry.
Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications.
To define echocardiographic abnormalities in anorexia nervosa through systematic review and meta-analysis.
Two reviewers independently assessed eligibility of publications from Medline, EMBASE and Cochrane Database of Systematic Reviews registries. Studies were included if anorexia nervosa was the primary eating disorder and the main clinical association in described cardiac abnormalities. Data was extracted in duplicate and quality-assessed with a modified Newcastle–Ottawa scale. For continuous outcomes we calculated mean and standardised mean difference (SMD), and corresponding 95% confidence interval. For dichotomous outcomes we calculated proportion and corresponding 95% confidence interval. For qualitative data we summarised the studies.
We identified 23 eligible studies totalling 960 patients, with a mean age of 17 years and mean body mass index of 15.2 kg/m2. Fourteen studies (469 participants) reported data suitable for meta-analysis. Cardiac abnormalities seen in anorexia nervosa compared with healthy controls were reduced left ventricular mass (SMD 1.82, 95% CI 1.32–2.31, P < 0.001), reduced cardiac output (SMD 1.92, 95% CI 1.38–2.45, P < 0.001), increased E/A ratio (SMD −1.10, 95% CI −1.67 to −0.54, P < 0.001), and increased incidence of pericardial effusions (25% of patients, P < 0.01, 95% CI 17–34%, I2 = 80%). Trends toward improvement were seen with weight restoration.
Patients with anorexia nervosa have structural and functional cardiac changes, identifiable with echocardiography. Further work should determine whether echocardiography can help stratify severity and guide safe patient location, management and effectiveness of nutritional rehabilitation.
The origin of this book was our sense of a growing convergence between the leading edge social policy agenda of social investment and the development policy agenda of inclusive growth, especially among international organisations. This sense of convergence has been magnified hugely by the 2015 launch of the UN's 2030 Agenda on Sustainable Development which, as Koehler (2016) observes, was conceptualised as ‘universal, in the sense of being applicable to all countries’ meaning that ‘the decades-old dichotomy of “developed” versus “under-developed” is cast aside’. As our contributed chapters suggest, the impetus for a new ‘universal’ whole world approach to social policy has come very much from the developing countries. There, often stellar growth rates have been accompanied by that explosion of social policy initiatives associated with inclusive growth; while in much of the OECD, the prospects for welfare reform through social investment remain constrained by austerity economics. But in spite of their very different origins and current policy challenges our volume concludes that social investment and inclusive growth do provide two key conceptual stepping stones towards a new universal global social policy framework in the making.
From the outset we observe just how relatively recent and dynamic has been the development of the two policy approaches. As Anton Hemrijck reminds us in Chapter Two, at the turn of the century social investment was little more than a ‘metaphorical’ gesture towards the productive value of social policy while by now it has become a systematic and fundamental rethink of the role of social policy in responding to the new social risks of the 21st century through social investment in human capital ‘stocks’ and ‘flows’, with the ‘buffers’ of social security. It has quite radically refocused policy attention away from a too exclusive emphasis on the role of taxes and transfers in moderating market inequalities to a focus on the role of social investment and services generally in enabling citizens to realise their capabilities amid the various ‘transitions’ encountered across the life course, described by Jon Kvist in Chapter Nine.
Christopher Deeming and Paul Smyth, together with internationally renowned contributors, illustrate how the merging of ‘social investment’ and ‘inclusive growth and development’ agendas, together with the environmental imperative of ‘sustainability’, is forging an important new social policy framework and shaping a new global development agenda.
Over the past two decades, there has been a fundamental reappraisal of the economic value of social policy, coming from a number of different directions. The first is the adoption of the ‘social investment perspective’ (OECD, 1997a: 14) in the advanced economies, as the old post-war welfare states were reformed in an attempt to address the ‘new social risks’ associated with post-industrial society. The social investment perspective in social policy appeared to offer a plausible alternative to neoliberalism and the neoliberal critique of welfare (and the discussions about ‘permanent austerity’ and ‘welfare state retrenchment’ that proliferated during the 1990s and early 2000s). The second major shift was the transition from the so-called ‘Washington Consensus’ towards ‘pro-poor growth’ policies and ‘inclusive growth’ policy frameworks for reducing poverty in developing country contexts in the Global South (with an ‘emphasis on increasing the opportunities for the poor to contribute and benefit from the growth process’, as the World Bank observes, 2008: 7). Third, and related, is the shift in policy perspective at the OECD in response to rapidly rising inequality in the advanced economies (OECD, 2008, 2011a, 2015b), as international organisations and epistemic communities began to diffuse ideas for inclusive growth (OECD, 2013a). Finally, there is the environmental imperative of ‘sustainability’ that is shaping the new global development agenda (Sachs, 2015). Today, we find that socially inclusive models for sustainable growth and development offer policymakers in the Global North (as well as the South) a plausible remedy to address rising social inequality. Although initially quite independent, these intellectual movements and literatures, orientated towards investment and inclusion, have now begun to converge and coalesce and are increasingly seen to contribute towards a single analytical framework and shared policy agenda for human development and flourishing.
In this chapter we consider the emerging global social policy frameworks for inclusive growth and social investment, and draw out the sometimes similar and sometimes quite distinctive insights that these two policy perspectives now bring to our understanding of the relationship between economy and society in the 21st century, and for the future development of global social policy more generally.
As uncertainty in the global economy continues we find there is already underway a new worldwide movement away from the ‘neoliberal’ policy models and frameworks of the late 20th century. Policymakers and epistemic communities are in search of a new understanding of society which has at its core the quest for a better integration of economic development with social and environmental policy, in order to promote what Barack Obama has called ‘shared prosperity’ (White House, 2011) and Christine Lagarde (2014) at the IMF has termed ‘inclusive capitalism’.
Certainly the idea of the social investment welfare state has attracted significant critical attention but the new ideas about inclusive economic growth and development have not been held up to such critical scrutiny within the academic social policy discipline even though the central problem of promoting economic development while reducing inequality is fast becoming the characteristic political desideratum of our time.
We now find a constellation of international organisations like the OECD, the IMF and the World Bank (key actors in the global social policy arena, see Deacon, 2007; Béland and Orenstein, 2013; Kaasch and Martens, 2015) constructing new ‘policy ideas’ (Béland, 2009, 2016) and alternatives for social investment, inclusive growth and sustainable development out of neoliberalism. Global social policy is now being reframed to promote inclusion and cohesion. Rebuilding solidarity across countries and regions continues to be a challenge, however. After the global economic crisis, the shock of Brexit and the rise of ‘populism’ in Europe and the US, with the rhetoric of protectionism and parties on the right promising to stop job competition through migrants and refugees, the politics of any postneoliberal policy settlement has become impossible to predict. Growing inequality, however, presents the major threat to environmental sustainability, to equity and to the world economy, and needs to be tackled now. According to the economist and Nobel laureate Joseph Stiglitz, capitalism does not have to produce inequality (Stiglitz, 2015: 75–6, 105–13, 300–05). With the right policies, it is possible to choose both efficiency and fairness, he argues.
This volume takes stock of the major changes that are already underway in the global policy arena – the neoliberal period having reached its social policy limits.
The notion of building welfare around work poses fresh challenges from a life-course perspective, where the situation of older workers has largely been neglected by policymakers committed to the ‘social investment perspective’ – typically constructed as a policy paradigm for ‘human capital’ development in children and young adults (Esping-Andersen, 2002). This article seeks to re-focus attention on the policy challenges relating to the needs of older workers within the new ‘inclusive growth’ agendas that seek to advance equitable opportunities for all. Social investment policies pose a range of issues and challenges for ageing populations that are discussed and examined in detail in this article. If social investment policy is to succeed in ageing OECD societies, it will mean broadening the investment perspective to include the (neglected) education and training needs of older workers to ensure that everyone can contribute to and share in economic prosperity.
To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS).
Seventy-two consecutive patients with GPTs (greater than 10 cm3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications.
The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829).
Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients.