Showing papers by "Tim Jackson published in 2020"

Ensuring a Post-COVID Economic Agenda Tackles Global Biodiversity Loss

Abstract: The COVID-19 pandemic has caused dramatic and unprecedented impacts on both global health and economies. Many governments are now proposing recovery packages to get back to normal, but the 2019 Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services Global Assessment indicated that business as usual has created widespread ecosystem degradation. Therefore, a post-COVID world needs to tackle the economic drivers that create ecological disruptions. In this perspective, we discuss a number of tools across a range of actors for both short-term stimulus measures and longer-term revamping of global, national, and local economies that take biodiversity into account. These include measures to shift away from activities that damage biodiversity and toward those supporting ecosystem resilience, including through incentives, regulations, fiscal policy, and employment programs. By treating the crisis as an opportunity to reset the global economy, we have a chance to reverse decades of biodiversity and ecosystem losses.

Canadian consensus statement: enhanced recovery after surgery in bariatric surgery.

Abstract: In Canada, bariatric surgery continues to remain the most effective treatment for severe obesity and its comorbidities. As the number of bariatric surgeries continues to grow, the need for consensus guidelines for optimal perioperative care is imperative. In colorectal surgery, enhanced recovery after surgery (ERAS) protocols were created for this purpose. The objective of this review is to develop evidence-based ERAS guidelines for bariatric surgery. A literature search of the MEDLINE database was performed using ERAS-specific search terms. Recently published articles with a focus on randomized controlled trials, systematic reviews, and meta-analyses were included. Quality of evidence and recommendations were evaluated using the GRADE assessment system. Canadian bariatric surgeons from six provinces and ten bariatric centers performed a review of the evidence surrounding ERAS in bariatric surgery and created consensus guidelines for 14 essential ERAS elements. Our main recommendations were (1) to encourage participation in a presurgical weight loss program; (2) to abstain from tobacco and excessive alcohol; (3) low-calorie liquid diet for at least 2 weeks prior to surgery; (4) to avoid preanesthetic anxiolytics and long-acting opioids; (5) unfractionated or low-molecular-weight heparin prior to surgery; (6) antibiotic prophylaxis with cefazolin ± metronidazole; (7) reduced opioids during surgery; (8) surgeon preference regarding intraoperative leak testing; (9) nasogastric intubation needed only for Veress access; (10) to avoid abdominal drains and urinary catheters; (11) to prevent ileus by discontinuing intravenous fluids early; (12) postoperative analgesia with acetaminophen, short-term NSAIDS, and minimal opioids; (13) to resume full fluid diet on first postoperative day; (14) early telephone follow-up with full clinic follow-up at 3–4 weeks. The purpose of addressing these ERAS elements is to develop guidelines that can be implemented and practiced clinically. ERAS is an excellent model that improves surgical efficiency and acts as a common perioperative pathway. In the interim, this multimodal bariatric perioperative guideline serves as a common consensus point for Canadian bariatric surgeons.

Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy.

Abstract: The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample.

Using critical slowing down indicators to understand economic growth rate variability and secular stagnation.

Abstract: This paper utilizes Critical Slowing Down (CSD; instability) indicators developed by statistical physics to analyse economic growth rate variability and secular stagnation in historical GDP data Understanding these phenomena is vital, particularly in advanced economies faced with declining growth rates Two novel indicators - the autocorrelation (AR1) and the variance – are found particularly useful in providing insight into inter-decadal GDP variability over this period These indicators are first applied to the Maddison-Project historical dataset, which includes almost a century of data for some 80 countries and almost two centuries of data for 9 countries They are additionally applied to ~50 years of recent annual data for around 130 countries from the World Bank dataset as well as ~60 years of recent quarterly data for around 20 countries from the OECD dataset Analysis reveals inter-decadal variability in growth cycles (the recession cycle), highlighting periods of large slow growth cycles and periods of small fast growth cycles The most commonly occurring pattern is characterised by an increase in CSD from the 1900s to 1940s, a decline in CSD between the 1930s and the 1970s, then a further increase in CSD from the 1960s to 2010 This pattern is significant in ~70% of the advanced economies CSD indicators may then provide invaluable insights into specific aspects of inter-decadal GDP variability, such as on the nature of the business cycle, secular stagnation and the implicit “restoring forces” of the economy

Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery.

Abstract: Morbid obesity is associated with multiple comorbidities including obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD). It has been suggested that OSA may contribute to NAFLD pathogenesis due to intermittent nocturnal hypoxia. The objective of this study was to assess the apnea-hypopnea index (AHI) and lower minimum oxygen saturation, markers of OSA, in patients undergoing bariatric surgery (BSx) with perioperative liver biopsy to detect NAFLD. This was a single center cross-sectional study of 61 patients undergoing BSx who consented to have a perioperative wedged liver biopsy. Biochemical, clinical, anthropometric variables, and a sleep study test were performed prior to BSx. NAFLD was diagnosed in 49 (80.3%) patients; 12 had normal liver (NL). Those with NAFLD had significantly higher (p < 0.05) AST (42.6 vs 18.1 U/L) and ALT (35.0 vs 22.1 U/L) but similar clinical, anthropometric, and metabolic parameters to NL. There was a higher AHI (32.03 vs 14.35) and significantly lower minimum oxygen saturation (SaO2) (78.87 vs 85.63) in NAFLD compared with NL (p < 0.05). When assessing associations between OSA parameters and liver histology in NAFLD, AHI correlated significantly with lobular inflammation (p < 0.05). In a multivariate analysis, BMI was significantly correlated with lobular inflammation with mean SaO2 nearing significance. These results indicate that in a homogeneous bariatric population sample with similar characteristics, those with NAFLD had higher AHI and lower minimum SaO2 compared with NL. AHI correlated with liver inflammation suggesting a potential role for intermittent nocturnal hypoxia in the pathogenesis and progression of NAFLD.

Unexpected histopathological findings after sleeve gastrectomy.

Abstract: Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG. All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed. All specimens underwent histopathological assessment, while those with findings suspicious for neoplasia or the presence of Helicobacter pylori underwent additional immunohistochemical stainings. Baseline patient characteristics and surgical outcomes were obtained from our internal database. A total of 222 patients underwent LSG during the study period and had their specimens examined histologically. Among them, 22.5% underwent preoperative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%). Abnormal findings warranting a change in postoperative management or follow-up were discovered in 8.6% of specimens and included H. pylori infection, intestinal metaplasia, malignancy, and atrophic gastritis. Only 4.7% of all patients had not undergone preoperative endoscopy and had truly unexpected findings. No significant association was found between abnormal findings and age, sex, or baseline body mass index (BMI). Although a majority of patients had a gastric specimen within normal limits, 8.6% had findings requiring a change in postoperative management. This rate dropped to 4.7% when patients whose diagnoses were known preoperatively were excluded. Our findings suggest that further research is needed to better define the role of preoperative endoscopy to potentially reduce the number of unexpected findings following LSG.

Young people, good life narratives, and sustainable futures: the case of Instagram

Abstract: Young people’s processes of meaning-making in relation to what it means to live well are supported by the shared understandings of the good life that are available in their particular sociocultural and historical contexts. These understandings are tied to questions of environmental impact and social justice, as each ‘good life’ entails different levels of material throughput and some may undermine the ability of others to pursue their chosen ‘good lives’. This paper draws on the insights from an exploration of Instagram posts tagged #goodlife to consider the role of Instagram in the constitution of good life narratives that are available to young people. Using network analysis tools, the researchers analyse the relationships between themes of hashtags appearing on 793 posts tagged #goodlife. The findings from the thematic approach to network analysis are used to support a thematic qualitative exploration of a subsample of 200 of the posts. The paper gives an overview of three good life narratives that can be found on the platform: the good life of the self-made affluent entrepreneur, the good life of the world-traveller, the good life as shared experience. Additionally, it highlights the differing levels of popularity of each narrative on the platform, and considers their respective implications for environmental and social sustainability. The paper then provides a conceptual reading of the platform that enables considerations relating to its place in the creation and maintenance of good life narratives. Conceptualising Instagram as a social conversation, the paper suggests that adequate participation on the platform may require engaging in less sustainable practices. The paper concludes by arguing that while the most popular narratives on the platform are less likely to support sustainable lifestyles, more sustainable understandings of living well are also promoted by users.

Young people and environmental affordances in urban sustainable development: insights into transport and green and public space in seven cities

Abstract: Cities are at the fore of sustainability challenges of the twenty-first century, and many, particularly in Asia and Africa, are predominantly youthful spaces. Understanding young people’s experiences in urban environments is therefore important as we strive to achieve both the Sustainable Development Goals and the Paris Agreement. Two amenities identified in the urban Sustainable Development Goal 11, transport and public and green space, are specifically recognised as applying to youth. Yet, there is little analysis that explicitly considers how youth experience these amenities across the Global North and South, and no current measures for understanding progress in youth experiences of green space and transport. This paper provides a comparative analysis of young people’s experiences with local transport and green space in seven diverse urban communities (Christchurch, New Zealand; Dhaka, Bangladesh; Lambeth/London, UK; Makhanda, South Africa; New Delhi, India; Sao Paulo, Brazil; and Yokohama, Japan). Our study contributes to a growing body of literature that seeks to listen to child and youth perspectives to understand their environmental experiences. We examine the ‘affordances’ young residents aged 12 to 24 years currently associate with green space and transport amenities. Affordances are defined here as the inter-relationships between what a local environment offers young people and their perceptions and actions. Drawing on focus groups and interviews conducted with 332 young people, we identify five affordances young people associate in relation to transport and public space across these diverse urban settings: (1) social inclusion and belonging; (2) autonomy; (3) physical comfort and security; (4) relaxation and reflection; and (5) health and fitness. The paper contributes to growing interdisciplinary research interest in measuring affordances as a way to advance the Sustainable Development Goals in an urban context. In providing a comparative account of young people’s experiences across diverse contexts, our discussion highlights how affordances in relation to transport or public and green space can help understand the multiple interconnections between the well-being of young people and sustainability. In particular, we argue that it is not merely the provision of transport or public and green space that matters, but the nuanced meaning of places and experiences as understood by local communities that needs to be recognised if we are to better support urban youth wellbeing and advance sustainable development goals.

Foreign exchange intervention and financial stability

Abstract: This paper studies the effects of sterilized foreign exchange market intervention in a model with financial frictions and imperfect capital mobility. The central bank operates a managed float regime and issues sterilization bonds that are imperfect substitutes (as a result of economies of scope) to investment loans in bank portfolios. The model is parameterized and used to study the macroeconomic effects of, and policy responses to, capital inflows associated with a transitory shock to world interest rates. The results show that sterilized intervention can be expansionary through a bank portfolio effect and may increase volatility and financial stability risks. Full sterilization is optimal only when the bank portfolio effect is absent. The optimal degree of intervention is more aggressive when the central bank can choose simultaneously the degree of sterilization; in that sense, the instruments are complements. When the central bank's objective function depends on the cost of sterilization, and concerns with that cost are sufficiently high, intervention and sterilization can be substitutes---independently of whether exchange rate and financial stability considerations also matter.

Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy

Abstract: The role of preoperative screening and treatment of Helicobacter pylori (HP) in asymptomatic patients undergoing laparoscopic sleeve gastrectomy (LSG) remains unclear. This study aims to define the preoperative prevalence and management of HP and their effect on postoperative outcomes at our institution. We reviewed the medical records and surgical specimens of all LSG performed at an academic centre in Toronto, ON between 2010 and 2017. Review of our institutional database identified 222 patients that underwent LSG, of which 200 had preoperative HP screening: 18% tested positive and 15% were treated. Seven surgical specimens were HP-positive (3.2%). No association was found between preoperative HP status, treatment or HP-positive specimen and postoperative complications at 1 year. Although preoperative screening and treatment likely reduce the prevalence of HP in LSG specimens, our findings suggest that they may be of limited clinical value in LSG as they have little influence on surgical morbidity.

Ethics in context: essential flexibility in an international photo-elicitation project with children and young people

Abstract: Existing literatures have discussed both ethical issues in visual research with young people, and the problems associated with applying ‘universal’ ethical guidelines across varied cultural contexts. There has been little consideration, however, of specific issues raised in projects where visual research is being conducted with young people simultaneously in multiple national contexts. This paper contributes to knowledge in this area. We reflect on our experiences of planning and conducting the International CYCLES project involving photo elicitation with young people in Bangladesh, Brazil, India, Japan, New Zealand, South Africa and the UK. While some issues such as varying access to technology for taking and sharing photos and diverse cultural sensitivities around the use of photography were anticipated in advance, others were more unexpected. Balancing the need for methods to be appropriate, ethical and feasible within each setting with the desire for sufficient consistency across the project is challenging. We argue that an ‘ethics in context’ approach and an attitude of ‘methodological immaturity’ is critical in international visual research projects with young people.

Review of pathological findings in laparoscopic sleeve gastrectomy specimens performed for morbid obesity.

Abstract: Background Bariatric surgical procedures are employed when there is a failure of lifestyle modification in arresting obesity Laparoscopic sleeve gastrectomy (LSG) is quickly becoming the bariatric surgical procedure of choice LSG results in a gastric remnant that is subject to pathological examination The objective of this paper is to review the literature in regard to histological findings identified in gastric remnants post-LSG and identify the most pertinent histological findings Materials and methods A literature search was performed to identify relevant case series Data gathered from relevant case series then underwent statistical analysis Results The most common histological findings in an LSG specimen were clinically indolent findings such as no pathological abnormalities identified followed by non-specific gastritis A minority of cases demonstrated clinically actionable findings for which Helicobacter pylori represented the majority of these findings Conclusion There is a broad spectrum of pathological findings in LSG specimens, ranging from clinically indolent to clinically actionable The most common histological findings are clinically indolent and only a small portion are of clinical significance and, hence, actionable

Ensuring a Post-COVID Economic Agenda Tackles Global Biodiversity Loss

Abstract: The COVID-19 pandemic has caused dramatic and unprecedented impacts on both global health and economies. Many governments are now proposing recovery packages to get back to normal, but the 2019 Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services Global Assessment indicated that business as usual has created widespread ecosystem degradation. Therefore, a post-COVID world needs to tackle the economic drivers that create ecological disruptions. In this perspective, we discuss a number of tools across a range of actors for both short-term stimulus measures and longer-term revamping of global, national, and local economies that take biodiversity into account. These include measures to shift away from activities that damage biodiversity and toward those supporting ecosystem resilience, including through incentives, regulations, fiscal policy, and employment programs. By treating the crisis as an opportunity to reset the global economy, we have a chance to reverse decades of biodiversity and ecosystem losses.