Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study.

BACKGROUND: Diets with high proportions of foods high in fat, sugar, and/or salt (HFSS) contribute to malnutrition and rising rates of childhood obesity, with effects throughout the life course. Given compelling evidence on the detrimental impact HFSS advertising has on children's diets, the World Health Organization unequivocally supports the adoption of restrictions on HFSS marketing and advertising. In February 2019, the Greater London Authority introduced novel restrictions on HFSS advertising across Transport for London (TfL), one of the most valuable out-of-home advertising estates. In this study, we examined whether and how commercial actors attempted to influence the development of these advertising restrictions. METHODS AND FINDINGS: Using requests under the Freedom of Information Act, we obtained industry responses to the London Food Strategy consultation, correspondence between officials and key industry actors, and information on meetings. We used an existing model of corporate political activity, the Policy Dystopia Model, to systematically analyse arguments and activities used to counter the policy. The majority of food and advertising industry consultation respondents opposed the proposed advertising restrictions, many promoting voluntary approaches instead. Industry actors who supported the policy were predominantly smaller businesses. To oppose the policy, industry respondents deployed a range of strategies. They exaggerated potential costs and underplayed potential benefits of the policy, for instance, warning of negative economic consequences and questioning the evidence underlying the proposal. Despite challenging the evidence for the policy, they offered little evidence in support of their own claims. Commercial actors had significant access to the policy process and officials through the consultation and numerous meetings, yet attempted to increase access, for example, in applying to join the London Child Obesity Taskforce and inviting its members to events. They also employed coalition management, engaging directly and through business associations to amplify their arguments. Some advertising industry actors also raised the potential of legal challenges. The key limitation of this study is that our data focused on industry-policymaker interactions; thus, our findings are unable to present a comprehensive picture of political activity. CONCLUSIONS: In this study, we identified substantial opposition from food and advertising industry actors to the TfL advertising restrictions. We mapped arguments and activities used to oppose the policy, which might help other public authorities anticipate industry efforts to prevent similar restrictions in HFSS advertising. Given the potential consequences of commercial influence in these kinds of policy spaces, public bodies should consider how they engage with industry actors.

"Complete Streets" and Adult Bicyclist Fatalities: Applying G-Computation to Evaluate an Intervention That Affects the Size of a Population at Risk.

"Complete streets" policies require transportation engineers to make provisions for pedestrians, bicyclists, and mass transit users. These policies may make bicycling safer for individual cyclists while increasing the overall number of bicycle fatalities if more people cycle due to improved infrastructure. We merged county-level records of complete streets policies with Fatality Analysis Reporting System counts of cyclist fatalities occurring between January 2000 and December 2015. Because comprehensive county-level estimates of numbers of cyclists were not available, we used bicycle commuter estimates from the American Community Survey and the US Census as a proxy for the cycling population and limited analysis to 183 counties (accounting for over half of the US population) for which cycle commuting estimates were consistently nonzero. We used G-computation to estimate the effect of complete streets policies on overall numbers of cyclist fatalities while also accounting for potential policy effects on the size of the cycling population. Over a period of 16 years, 5,254 cyclists died in these counties, representing 34 fatalities per 100,000 cyclist-years. We estimated that complete streets policies made cycling safer, averting 0.6 fatalities per 100,000 cyclist-years (95% confidence interval: -1.0, -0.3) by encouraging a 2.4% increase in cycling but producing only a 0.7% increase in cyclist fatalities. G-computation is a useful tool for understanding the impact of policy on risk and exposure.

Centralised versus decentralised manufacturing and the delivery of healthcare products: A United Kingdom exemplar.

BACKGROUND: The cell and gene therapy (CGT) field is at a critical juncture. Clinical successes have underpinned the requirement for developing manufacturing capacity suited to patient-specific therapies that can satisfy the eventual demand post-launch. Decentralised or 'redistributed' manufacturing divides manufacturing capacity across geographic regions, promising local, responsive manufacturing, customised to the end user, and is an attractive solution to overcome challenges facing the CGT manufacturing chain. METHODS: A study was undertaken building on previous, so far unpublished, semi-structured interviews with key opinion leaders in advanced therapy research, manufacturing and clinical practice. The qualitative findings were applied to construct a cost of goods model that permitted the cost impact of regional siting to be combined with variable and fixed costs of manufacture of a mesenchymal stromal cell product. RESULTS: Using the United Kingdom as an exemplar, cost disparities between regions were examined. Per patient dose costs of ~£1,800 per 75,000,000 cells were observed. Financial savings from situating the facility outside of London allow 25-41 additional staff or 24-35 extra manufacturing vessels to be employed. Decentralised quality control to mitigate site-to-site variation was examined. Partial decentralisation of quality control was observed to be financially possible and an attractive option for facilitating release 'at risk'. DISCUSSION: There are important challenges that obstruct the easy adoption of decentralised manufacturing that have the potential to undermine the market success of otherwise promising products. By using the United Kingdom as an exemplar, the modelled data provide a framework to inform similar regional policy considerations across other global territories.

[Children exposure to PM10 on the way to school: Regulatory impact of speed regulation under 30km/h]. / Exposition des enfants aux PM10 sur le chemin de l'école : impact d'une réglementation « zone 30 ¼.

BACKGROUND: In Paris, air pollution is now a persistent environmental problem, especially linked to diesel cars in circulation. Exposure of children to air pollution during the journey from home to school, which takes place during peak hours of traffic, is poorly documented. METHODS: The purpose of this work was to identify spaces less exposed to PM10 pollution. We identified spatial recurrences in the relative distribution of air pollution levels using PM10 geolocated measures taken along a fixed circuit, crossing, among others, a speed regulation zone (<30km/h). Measurements were made eight mornings between 8 and 9 a.m., in April and September 2016 in the 14th district of Paris. We obtained a hierarchical classification of spaces in terms of recurrence of relative levels of PM10 concentration. RESULTS: The cartography of the results revealed that the spaces more exposed to high concentrations were found similarly along main roads, side streets and speed regulation<30km/h) zones. These findings suggest speed regulation is insufficient to reduce individual exposure in city streets. CONCLUSION: Elements linked to the functional aspects of the street (commercial/residential) were apparently as important as traffic speed.

Inadequate Accessibility: Why Uber Should Be a Public Accommodation Under the Americans With Disabilities Act.

This Comment will focus on Uber and its obligations under the Americans with Disabilities Act (ADA). While it may seem logical that Uber should adhere to the same ADA regulations as taxis, the relevant ADA provision only applies to private entities that are primarily engaged in the business of transporting people. To avoid these regulations, Uber asserts that it is primarily a technology company, rather than primarily a transportation company. However, the more expansive approach, consistent with the ADA's purpose of eliminating discrimination against persons with disabilities, is to classify Uber's services as public accommodations. While the ADA's public accommodation provision governs physical spaces such as restaurants, shopping centers, and offices, some jurisdictions have recently decided that web-based entities and services are public accommodations. Thus, even if a court were to accept Uber's claim that it is primarily a technology company rather than a transportation company, Uber would still be required to adhere to the ADA's public accommodation provision. This Comment presents and analyzes three rationales for defining Uber as a public accommodation under the ADA: (1) web-based activities are distinct public accommodations, (2) the physical vehicles that Uber operates are places of public accommodation, and (3) Uber is a "travel service" or "other service establishment" as defined in the ADA.

Forest Edge Regrowth Typologies in Southern Sweden-Relationship to Environmental Characteristics and Implications for Management.

After two major storms, the Swedish Transport Administration was granted permission in 2008 to expand the railroad corridor from 10 to 20 m from the rail banks, and to clear the forest edges in the expanded area. In order to evaluate the possibilities for managers to promote and control the species composition of the woody regrowth so that a forest edge with a graded profile develops over time, this study mapped the woody regrowth and environmental variables at 78 random sites along the 610-km railroad between Stockholm and Malmö four growing seasons after the clearing was implemented. Through different clustering approaches, dominant tree species to be controlled and future building block species for management were identified. Using multivariate regression trees, the most decisive environmental variables were identified and used to develop a regrowth typology and to calculate species indicator values. Five regrowth types and ten indicator species were identified along the environmental gradients of soil moisture, soil fertility, and altitude. Six tree species dominated the regrowth across the regrowth types, but clustering showed that if these were controlled by selective thinning, lower tree and shrub species were generally present so they could form the "building blocks" for development of a graded edge. We concluded that selective thinning targeted at controlling a few dominant tree species, here named Functional Species Control, is a simple and easily implemented management concept to promote a wide range of suitable species, because it does not require field staff with specialist taxonomic knowledge.

Qing-Qi Rickshaw : A Boon Or Bane For Public Transportation? A Study Of Road Traffic Injury Patterns Involving Qing-Qi Rickshaws In Karachi Pakistan.

BACKGROUND: The three-wheeler Qing-qi and Compressed Natural Gas (CNG) auto-rickshaws were introduced in Karachi to meet the transportation demand of the growing population. These vehicles have directly or indirectly been implicated in a number of road traffic violations as well as road accidents. This study aims to describe the crash characteristics and injury patterns for Qing-qi rickshaw occupants and other road users hit by Qing-qi rickshaw in Karachi, Pakistan. METHODS: An Observational/ Descriptive study was conducted at Accident & Emergency and Orthopaedic Surgery Department, Jinnah Post Graduate Medical Centre, Karachi Pakistan from July 2014 to June 2015.All patients who came with Qing-qi rickshaw accident in Accident & Emergency (A&E) of JPMC were included. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews. RESULTS: Four hundred and eighty-six rickshaw related injuries were noted in road traffic accidents by Qing-gi rickshaw. Age range was 2-85 (43.5±58.68). 350 injured victims were males and 136 were females. By occupation most victims were laborers and daily wage workers (45%) and students (21%). Overloading of vehicle with more than two passengers was found in (28.5%). The most common cause of injury was collision with a moving vehicle (56%), followed by fall from rickshaw. The most common contributing factor was the overloading of rickshaw and roll over on turning (61%). Injury severity on arrival were mild (49%), moderate were (32%), and severe were (19%). Injuries related to head and neck (26%), face (14%), thorax and abdomen (5%), lower extremity and pelvic girdle (31%) and upper extremity (23%) were observed. CONCLUSIONS: Qing-qi rickshaw injuries are common and these vehicles are vulnerable to road traffic accidents. Occupants and road users are both at risk of injuries.

Identification of Effects of Regulatory Actions on Air Quality in Goods Movement Corridors in California.

Few studies have assessed the impact of regulatory actions on air quality improvement through a comprehensive monitoring effort. In this study, we designed saturation sampling of nitrogen oxides (NOX) for the counties of Los Angeles and Alameda (San Francisco Bay) before (2003-2007) and after (2008-2013) implementation of goods movement actions in California. We further separated the research regions into three location categories, including goods movement corridors (GMCs), nongoods movement corridors (NGMCs), and control areas (CTRLs). Linear mixed models were developed to identify whether reductions in NOX were greater in GMCs than in other areas, after controlling for potential confounding, including weather conditions (e.g., wind speed and temperature) and season of sampling. We also considered factors that might confound the relationship, including traffic and cargo volumes that may have changed due to economic downturn impacts. Compared to the pre-policy period, we found reductions of average pollutant concentrations for nitrogen dioxide (NO2) and NOX in GMCs of 6.4 and 21.7 ppb. The reductions were smaller in NGMCs (5.9 and 16.3 ppb, respectively) and in CTRLs (4.6 and 12.1 ppb, respectively). After controlling for potential confounding from weather conditions, season of sampling, and the economic downturn in 2008, the linear mixed models demonstrated that reductions in NO2 and NOX were significantly greater in GMCs compared to reductions observed in CTRLs; there were no statistically significant differences between NGMCs and CTRLs. These results indicate that policies regulating goods movement are achieving the desired outcome of improving air quality for the state, particularly in goods movement corridors where most disadvantaged communities live.

Health impact assessment of transport policies in Rotterdam: Decrease of total traffic and increase of electric car use.

BACKGROUND: Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. METHOD: Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle kilometers and a share of 50% electric-powered private vehicle kilometers) on particulate matter (PM2.5), elemental carbon (EC) and noise (engine noise and tyre noise) were assessed using Years of Life Lost (YLL) and Years Lived with Disability (YLD). The baseline was 2010 and the end of the assessment 2020. RESULTS: The intervention aimed at reducing traffic is associated with a decreased exposure to noise resulting in a reduction of 21 (confidence interval (CI): 11-129) YLDs due to annoyance and 35 (CI: 20-51) YLDs due to sleep disturbance for the population per year. The effects of 50% electric-powered car use are slightly higher with a reduction of 26 (CI: 13-116) and 41 (CI: 24-60) YLDs, respectively. The two interventions have marginal effects on air pollution, because already implemented traffic policies will reduce PM2.5 and EC by around 40% and 60% respectively, from 2010 to 2020. DISCUSSION: The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well-being, as a necessary step to better understanding consequences of interventions and carefully orienting resources useful to build knowledge to improve public health.

Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities.

BACKGROUND: The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease. METHODS: We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings. RESULTS: Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity. Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities 'green and healthy' goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system. Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information. CONCLUSION: While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.

An Empirical Analysis of Life Jacket Effectiveness in Recreational Boating.

This article gives a measure of life jacket (LJ) effectiveness in U.S. recreational boating. Using the U.S. Coast Guard's Boating Accident Report Database from 2008 to 2011, we find that LJ wear is one of the most important determinants influencing the number of recreational boating fatalities, together with the number of vessels involved, and the type and engine of the vessel(s). We estimate a decrease in the number of deceased per vessel of about 80% when the operator wears their LJs compared to when they do not. The odds of dying are 86% higher than average if the accident involves a canoe or kayak, but 80% lower than average when more than one vessel is involved in the accident and 34% lower than average when the operator involved in the accident has more than 100 hours of boating experience. Interestingly, we find that LJ effectiveness decreases significantly as the length of the boat increases and decreases slightly as water temperature increases. However, it increases slightly as the operator's age increases. We find that between 2008 and 2011, an LJ regulation that requires all operators to wear their LJs-representing a 20% increase in wear rate-would have saved 1,721 (out of 3,047) boaters or 1,234 out of 2,185 drowning victims. The same policy restricted to boats 16-30 feet in length would have saved approximately 778 victims. Finally, we find that such a policy would reduce the percentage of drowning victims compared to other causes of death.

Sanitary Transportation of Human and Animal Food. Final rule.

The Food and Drug Administration (FDA or we) is issuing a final rule to establish requirements for shippers, loaders, carriers by motor vehicle and rail vehicle, and receivers engaged in the transportation of food, including food for animals, to use sanitary transportation practices to ensure the safety of the food they transport. This action is part of our larger effort to focus on prevention of food safety problems throughout the food chain and is part of our implementation of the Sanitary Food Transportation Act of 2005 (2005 SFTA) and the Food Safety Modernization Act of 2011 (FSMA).

Procedures for Handling Retaliation Complaints Under Section 31307 of the Moving Ahead for Progress in the 21st Century Act (MAP-21). Final rule.

On March 16, 2016, the Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor (Department) issued an interim final rule (IFR) that provided procedures for the Department's processing of complaints under the employee protection (retaliation or whistleblower) provisions of Section 31307 of the Moving Ahead for Progress in the 21st Century Act (MAP-21). The IFR established procedures and time frames for the handling of retaliation complaints under MAP-21, including procedures and time frames for employee complaints to OSHA, investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor) and judicial review of the Secretary's final decision. It also set forth the Department's interpretations of the MAP-21 whistleblower provisions on certain matters. This final rule adopts, without change, the IFR.

Americans With Disabilities Act (ADA) Accessibility Guidelines for Transportation Vehicles. Final rule.

The Architectural and Transportation Barriers Compliance Board (Access Board or Board) is issuing a final rule that revises its existing accessibility guidelines for non-rail vehicles--namely, buses, over-the-road buses, and vans--acquired or remanufactured by entities covered by the Americans with Disabilities Act. The revised guidelines ensure that such vehicles are readily accessible to, and usable by, individuals with disabilities. The U.S. Department of Transportation (DOT) is required to revise its accessibility standards for transportation vehicles acquired or remanufactured by entities covered by the Americans with Disabilities Act (ADA) to be consistent with the final rule.

A Comprehensive Look at the FAST Act.

The law mandates that FMCSA provide recognition for motor carriers that make voluntary use of advanced technologies and enhanced driver fitness measures.

Pedestrian injuries-related deaths: a global evaluation.

OBJECTIVE: Pedestrians are vulnerable road users who are at risk of injuries and death on the roads. We aimed to define factors affecting pedestrian injuries-related deaths worldwide and to give recommendations regarding their prevention priorities. METHODS: Data on pedestrian injuries-related deaths for years 2007 and 2010 were retrieved from the WHO global status reports on road safety. These included the country population, gross national income (GNI), number of registered vehicles, estimated pedestrian deaths rate, effectiveness of enforcement of law, and the presence of policies to promote walking or cycling. Correlations between studied variables were done using Spearman rank correlation. General linear models were used to define factors affecting pedestrian injuries-related deaths. RESULTS: The median (range) pedestrian death rates of different countries per 100,000 population significantly decreased in year 2010 compared with year 2007 [3.9 (0-13.5) compared with 4.2 (0-23.6), (p = 0.004, Wilcoxon signed rank test)]. There was a reduction of 8.1% of the global pedestrian death rate between 2007 and 2010. The estimated pedestrian lives saved annually worldwide of a population of 6.8 billion were 23,120 persons. A general linear model has shown that GNI (p = 0.001) and population density (p = 0.01) were the best predictors of pedestrian death rates in 2007, while national legislation (p = 0.03) was the best predictor of pedestrian death rates in 2010. CONCLUSIONS: There is a change in the factors affecting pedestrian mortality worldwide over time. GNI and population density became less significant than national legislation enforcement. Legislation and its enforcement are important to achieve the UN mission of reducing road traffic deaths by 5 million over the next decade.

[Contemporary reforms and optimization of medical examination committees in Russian Railways JSC].

The authors considered problems of restructurization and organization of medical examination committees in Russian Railways JSC, and their interlevel interactions. Detailed specification included documents circulation, order and terms of medical examination. Principles of conclusion on occupational fitness examination are specified. The article covers tasks of further development of occupational medical examination work in trade occupational medicine.

Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation.

OBJECTIVE: To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities. METHODS: We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online. RESULTS: By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p <0.01). Based on these data, an algorithm was developed to guide physician decision-making about reporting patients with MCI or mild dementia to transportation authorities. CONCLUSION: This study supports existing international guidelines that recommend specialized on-road testing when driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving.