Types Of Outlets Research Articles

Multiplicity and complexity of food environment in China: full-scale field census of food outlets in a typical district.

Community food environment is closely associated with residents' health status, and it has received substantial research attention in recent years. However, such studies are sparse in China. This study aims to reveal the characteristics of food environment in China. A ground-truthing field census of food outlets was conducted in Xi Hu district, Hangzhou. A novel categorizing system was developed to better characterize food outlets in the study area. Geocoding and food environment analysis were performed by Arc-GIS software. A total of 9274 food outlets were identified, of these, 6161 (66.43%) were food service places and 3113 (33.57%) were food stores. Fast-food restaurants (2692) and convenience stores (1764) were the two most numerous outlet types. The density of food outlets was 29.72/km2 and 113.97/10,000 people. Availability of BMI-unhealthy food outlets was four times greater than that of BMI-healthy ones. Further, 41.86% of total food outlets provided food-delivery services; among them, fast-food restaurants were the highest (65.53%) providers. In the urban area, the average density of food outlets was 104/km2. While, it was only 29/km2 in the rural area. Availability of food outlets was excellent in our study area, though it showed regional imbalance. Food environment tends to be obesogenic and high prevalence of food delivery service might increase this trend. Thus, policy makers should guarantee the smooth development of catering industry in China, so as to ensure a balanced nutrition environment.

Type and density of independent takeaway outlets: a geographical mapping study in a low socioeconomic ward, Manchester

ObjectivesThe socioeconomic disparity in childhood and early adult obesity prevalence has been well characterised. Takeaway outlets may cluster in lower socioeconomic areas and their proximity to schools is of concern....

Policies that limit youth access and exposure to tobacco: a scientific neglect of the first stages of the policy process

BackgroundPolicymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets, or banning the display of tobacco products. Many studies have assessed the impact of these policies, while less is known about the preceding policy process. The aim of our review was to assess the available evidence on the preceding process of agenda setting, policy formulation, and policy legitimation.MethodsA systematic literature search was conducted using the PubMed and the Social Sciences Citation Index databases. After selection, 200 international peer-reviewed articles were identified and analyzed. Through a process of close reading, evidence based on scientific enquiry and anecdotal evidence on agenda setting, policy formulation and policy legitimation was abstracted from each article.ResultsScientific evidence on the policy process is scarce for these policies, as most of the evidence found was anecdotal. Only one study provided evidence based on a scientific analysis of data on the agenda setting and legitimation phases of policy processes that led to the adoption of display bans in two Australian jurisdictions.ConclusionThe processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy.

Socio-economic patterning of expenditures on ‘out-of-home’ food and non-alcoholic beverages by product and place of purchase in Britain

While most food is consumed at home, food eaten out-of-home plays an important role in diets and it has been associated with higher energy intake and higher body weight. Beyond prepared meals, there is limited understanding of what foods people buy out-of-home and where they buy them from. This study analyses out-of-home food purchases by food groups and food outlet types, and estimates socio-economic differences in these expenditure patterns. We used a nationally representative product-level dataset of expenditures (n=2,734,987) on foods and non-alcoholic beverages for out-of-home consumption for 9,704 respondents in Great Britain (June 2015-December 2017). Population weighted estimates of per capita weekly expenditures and shares of expenditure were derived for four outlet types and eight food groups. We used linear multi-level modelling to determine differences in expenditure patterns by socio-economic status (SES) characterised via occupational social grade. Out-of-home purchases make up 25-39% of total food and beverage expenditures. Mid- and high-SES respondents spent nearly twice as much (£17.76 and £15.11 weekly), compared to low-SES respondents (£9.69) for out-ofhome food consumption. A third of expenditures across SES (36-37%) were spent in venues other than restaurants or fast-food and takeaway outlets. Meals accounted for 60% of expenditures, but a third was spent on beverages (10-12% non-alcoholic cold beverages, 17-18% hot beverages) and 9-10% on snacks. Mid- and low-SES respondents had a greater share of expenditure in takeaway and fast-food outlets, supermarkets and convenience stores, and on cold non-alcoholic beverages. Overall, low-SES respondents spent less on out-of-home foods but the share of this expenditure across different foods or outlets varied less. While restaurants, fast-food and takeaway outlets were a major source of out-of-home purchases, a significant proportion was spent in other outlets. Policies targeting out-of-home consumption should therefore consider the full range of foods as well as the diversity of places where they are sold.

Disparities in food access around homes and schools for New York City children.

Demographic and income disparities may impact food accessibility. Research has not yet well documented the precise location of healthy and unhealthy food resources around children’s homes and schools. The objective of this study was to examine the food environment around homes and schools for all public school children, stratified by race/ethnicity and poverty status. This cross-sectional study linked data on the exact home and school addresses of a population-based sample of public school children in New York City from 2013 to all corner stores, supermarkets, fast-food restaurants, and wait-service restaurants. Two measures were created around these addresses for all children: 1) distance to the nearest outlet, and 2) count of outlets within 0.25 miles. The total analytic sample included 789,520 K-12 graders. The average age was 11.78 years (SD ± 4.0 years). Black, Hispanic, and Asian students live and attend schools closer to nearly all food outlet types than White students, regardless of poverty status. Among not low-income students, Black, Hispanic, and Asian students were closer from home and school to corner stores and supermarkets, and had more supermarkets around school than White students. The context in which children live matters, and more nuanced data is important for development of appropriate solutions for childhood obesity. Future research should examine disparities in the food environment in other geographies and by other demographic characteristics, and then link these differences to health outcomes like body mass index. These findings can be used to better understand disparities in food access and to help design policies intended to promote healthy eating among children.

Unplanned purchasing of tobacco products: Beyond point of sale display

Tobacco products remain widely available and unplanned purchasing of tobacco has been implicated in cessation relapse. Little is known however about the frequency of consumers' unplanned tobacco purchases or the type of retail outlets where this is more likely to occur. Questions on cigarette purchasing were added to a post-campaign telephone survey for the Make Smoking History Campaign in Western Australia. Respondents (n=200) were aged 25 to 54 years and were either current smokers or had quit in the last 4-5 weeks. Two-thirds of respondents had tried to quit in the past 2 years. Survey responses were analysed to look at place of purchase (the usual and after cessation relapse) and frequency and reasons for unplanned purchases. Supermarkets were the "usual" purchase location for the majority of respondents overall (78%), but the proportion who reported buying cigarettes from a supermarket after taking up smoking again declined substantially (52%), while purchases from convenience stores and service stations increased. Nearly a third (30%) of respondents indicated that they sometimes bought cigarettes unplanned or on impulse, and for 16%, this was at least once a week. Among smokers who have tried to quit but not succeeded, unplanned cigarette purchases are common. There is evidence to suggest that when people resume smoking after a cessation attempt, the cigarette purchase is not necessarily made at their "usual" type of retail outlet. SO WHAT?: The banning of point of sale tobacco display has not eliminated the pervasive availability and retail presence of tobacco, and unplanned purchasing of cigarettes is an impediment to successful smoking cessation. This study adds weight to growing momentum internationally and in Australia to reduce the widespread availability of tobacco products and decrease the barriers to quitting use of a product that kills over half of its consumers.

Deep-sea Kinorhyncha diversity of the polymetallic nodule fields at the Clarion-Clipperton Fracture Zone (CCZ)

Kinorhynch specimens were studied from abyssal sediment samples collected during seven cruises at the Clarion-Clipperton Fracture Zone (Eastern Central Pacific), a vast area that will be mined for polymetallic nodules in a near future. This study is the first in a series focused on kinorhynchs mainly collected at the German zone following requirements of the International Seabed Authority (ISA), who demands identification of fauna associated with nodules previous to the concession of the exploitation license. A total of 18 species were found, of which three new Echinoderidae species are described herein. Cephalorhyncha polunga sp. nov. is easily discriminated from its congeners by the presence of pointed and prominent tergal extensions together with middorsal spines on segments 4–8, ventrolateral tubes on segment 2, lateroventral tubes on segment 5, lateroventral spines on segments 6–9 and midlateral tubes on segment 10; plus subdorsal type 2 glandular cell outlets on segment 2 and midlateral ones on segment 8. Echinoderes shenlong sp. nov. is characterized by middorsal spines on segments 4, 6, 8, lateroventral tubes on segment 5 and lateroventral spines on segments 6–9; glandular cell outlets type 2 are not present. Meristoderes taro sp. nov. is defined by the combination of long middorsal spines on segments 4–8, remarkably increasing in length on posterior segments; short laterodorsal tubes on segment 10, ventrolateral tubes on segment 2 and lateroventral tubes on segment 5, plus lateroventral spines on segments 6–9.

The Rise of a Populist Zeitgeist? A Content Analysis of Populist Media Coverage in Newspapers Published between 1990 and 2017

ABSTRACTIt has been assumed that populism has become mainstream in the Western world, and that the media have substantially contributed to populism’s success and omnipresence in politics and society. To investigate populist elements in media coverage, extant research has mainly focused on election periods, or media populism in specific types of coverage and outlets. In this paper, we investigate if the use of populist elements in general media coverage has increased over time. Focusing on a 28-year period in the Netherlands, we find clear evidence for an increasing presence of people-centric, anti-elitist and right- and left-exclusionist coverage in newspapers. This trend is general, with only limited evidence for cross-outlet differences. Since our analysis was not limited to specific periods, sample frames or topics, our research offers first evidence for an unconditional increase of different elements of populist communication in traditional news coverage. An important implication is that the rise of populist news coverage has made populism more visible to the electorate, potentially setting the agenda for political parties and populist attitudes in public opinion.

Effects of school neighborhood food environments on childhood obesity at multiple scales: a longitudinal kindergarten cohort study in the USA

BackgroundSchool neighborhood food environment is recognized as an important contributor to childhood obesity; however, large-scale and longitudinal studies remain limited. This study aimed to examine this association and its variation across gender and urbanicity at multiple geographic scales.MethodsWe used the US nationally representative Early Childhood Longitudinal Study–Kindergarten cohort data and included 7530 kindergarteners followed up from 1998 to 2007. The Census, road network, and Dun and Bradstreet commercial datasets were used to construct time-varying measurements of 11 types of food outlet within 800-m straight-line and road-network buffer zones of schools and school ZIP codes, including supermarket, convenience store, full-service restaurant, fast-food restaurant, retail bakery, dairy product store, health/dietetic food store, candy store, fruit/vegetable market, meat/fish market, and beverage store. Two-level mixed-effect and cluster-robust logistic regression models were performed to examine the association.ResultsA higher body mass index (BMI) in 2007 was observed among children experiencing an increase of convenience stores in school neighborhoods during 1998–2007 (β = 0.39, p < 0.05), especially among girls (β = 0.50) and urban schoolchildren (β = 0.41), as well as among children with a decrease of dairy product stores (β = 0.39, p < 0.05), especially among boys (β = 1.86) and urban schoolchildren (β = 0.92). The higher obesity risk was associated with the increase of fast-food restaurants in urban schoolchildren (OR = 1.27 [95% CI = 1.02–1.59]) and of convenience stores in girls (OR = 1.41 [95% CI = 1.09–1.82]) and non-urban schoolchildren (OR = 1.60 [95% CI = 1.10–2.33]). The increase of full-service restaurants was related to lower obesity risk in boys (OR = 0.74 [95% CI = 0.57–0.95]). The decrease of dairy product stores was associated with the higher obesity risk (OR = 1.68 [95% CI = 1.07–2.65]), especially boys (OR = 2.92 [95% CI = 1.58–5.40]) and urban schoolchildren (OR = 1.67 [95% CI = 1.07–2.61]). The schoolchildren exposed to the decrease of meat/fish markets showed the lower obesity risk (OR = 0.57 [95% CI = 0.35–0.91]), especially urban schoolchildren (OR = 0.53 [95% CI = 0.32–0.87]). Results from analyses within 800-m straight-line buffer zones of schools were more consistent with our theory-based hypotheses than those from analyses within 800-m road-network buffer zones of schools and school ZIP codes.ConclusionsNational data in the USA suggest that long-term exposure to the food environment around schools could affect childhood obesity risk; this association varied across gender and urbanicity. This study has important public health implications for future school-based dietary intervention design and urban planning.

Distorting the News? The Mechanisms of Partisan Media Bias and Its Effects on News Production

Integrating scholarship from several fields of study, this paper proposes a new model for understanding how partisan bias operates and how to measure its effects. We chart the factors that influence partisan bias over news production within news organizations that are simultaneously constrained and conditioned by factors of market competition, context considerations and journalistic norms. We argue that partisan media bias of a news-story is expressed in the manner that different news outlets cover the same political story within the same timeframe relative to one another. We find that description bias is a key parameter that is intertwined with selection bias mechanisms that highlight and downplay news items according to their content. We illustrate how partisan media coverage occurs in the context of a major political protest in Israel. We employ a dataset consisting of 1556 news products from all major newspapers. We find that partisan bias finds its strongest expression in the types of news products that the news outlets emphasize on their front-page and in the sizing of articles. These mechanisms of partisan bias can be generalized in the study of partisan bias in other types of news outlets.

The evolution of local food environments within established neighbourhoods and new developments in Perth, Western Australia.

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's "Liveable Neighbourhoods Community Design Guidelines" policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.

Exploring University Food Environment and On-Campus Food Purchasing Behaviors, Preferences, and Opinions

Cross-sectional observation of a university food environment and a survey of food purchasing preferences, behaviors, and opinions of students and staff to formulate strategies for interventions. A modified food environment-quality index was used to assess food outlets. A cross-sectional survey with closed (n = 42) and open-ended (n = 2) questions assessing students and staff purchasing, choice determinants, and opinions about the food environment. Six campuses of 1 large urban university. Food outlets (eg, convenience stores, restaurant and café, takeout, vending machines) (n = 57). University students and staff (n = 1,954). The researchers calculated descriptive statistics and Pearson chi-square tests to compare the percentages of healthy and/or unhealthy products in high- vs low-scoring outlets. Kruskal-Wallis H test was used to determine differences in healthiness between outlet types. Pearson chi-square tests were used to examine the influence of gender, and student and staff differences in survey responses. Median food environment-quality index was 79 out of 199 (interquartile range = 7). Six food outlets were categorized as healthy and 2 as unhealthy; the rest were intermediate. Overall, healthy items were less available, accessible, and promoted and cost more than unhealthy items. The majority of respondents in the survey (79%) purchased food and beverages on campus; males consuming them more frequently than did females (P = .001) and students consumed them more frequently than did staff (P = .001). Value for money, healthfulness, and taste determined the choice. Respondents suggested increasing value for money and healthy options. Interventions that improve food availability, accessibility, prices, and promotions through policies are warranted and would be well-received among both university students and staff.

Gen. X and Gen.Y Customer Groups Perception and Preferences Towards Choice of Shopping Malls Using Structural Equation Model (SEM)

In the recent years, the growth, development and expansion of organized retailing has initiated many revolutionary changes in the business environment in Retail Sector and as a result, various types of modern retail outlets had started functioning with most competent and aggressive manner in the country with most effective and efficient business strategies. One among such type of retail format is a shopping mall, wherein a group of retail stores comes under one roof. In Today’s fast growing Indian business environment, shopping malls are most expected to be front-runners towards the growth of organized retail in India. In this paper, the researchers carried out a descriptive study with a major objective focusing on the customer groups of Gen X and Gen Y. The researchers try to find out the perception and preferences among these two Gen X and Gen Y Customer Groups in choosing their preferred shopping mall. Non Probability Sampling Method and Convenience Sampling Technique was adapted in order to collect 200 samples. Samples were collected out of which each 100 samples were divided and collected among Gen X and Gen Y Customer Group keeping as a Base, also the researchers designed a questionnaire and collected primary samples with a structured Interview. Finally, the outcome of the research after employing the Structural Equation Model (SEM) reveals that Gen X and Gen Y Customer Group may look similar in characteristics and but their preferences and perceptions differs in choosing their preferred shopping mall for purchasing their products and services.

A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability.

BackgroundRegular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries.ObjectiveThe objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices.MethodsFourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed.ResultsOne hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1).ConclusionsVirtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy.

Better off without You? How the British Media Portrayed EU Citizens in Brexit News

The United Kingdom is the first country to withdraw its membership from the European Union (EU). Immigration featured high on the Brexit news agenda and EU citizens’ rights to work and live in the United Kingdom are likely to be affected by the country’s exit from the EU. This study analyzes how salient EU citizens were in Brexit news, and investigates whether there was a relationship between the negative portrayal of EU citizens and the type of news outlet. The analysis is based on 19,367 news stories published between June 1, 2015, and June 23, 2016. Automated content analysis was used to determine whether EU citizens were mentioned. The results do not reveal a divide between tabloids and broadsheets, but between national and regional papers. It is only in regional papers from England and Wales that EU citizens were more likely to be mentioned if the tone of a news story was more negative. The findings also suggest that the news media presented the Brexit referendum as a vote about migration in general rather than about intra-EU migration.

Analysing salesmen itinerary with agglomerative hierarchical clustering and vehicle routing algorithm - a case study of a confectionery supplier in Indonesia

The study analysed salesmen itinerary of a confectionery supplier in Indonesia. Channel management and robust product distribution are important elements for confectionery business, since growth heavily depends on healthy product distribution. To support product distribution, optimising salesmen itinerary plays an important role in the firm's sales operation. The study was limited to optimising salesmen schedule for its wholesalers' outlet type, since it contributed to 78% of its revenue. The analyses were carried out using 'cluster first-route second' approach. For clustering the customer nodes, it recommended agglomerative hierarchical clustering (AHC) method. For routing within each customer's cluster, it tested two algorithms, i.e., Clarke-Wright and weighted-serving time-visual approach. The result showed that AHC-weighted-serving-time-visual algorithm was as good as AHC-Clarke-Wright with 2.1% cheaper variable cost. The proposed algorithm was adapted from practical insight and easier to be understood.

Aggravating effects of alcohol outlet types on street robbery and aggravated assault in New York City

ABSTRACTThe present study uses Risk Terrain Modeling (RTM) to analyze how nine different alcohol outlet types differentially influence the likelihood of aggravated assault and street robbery at micro-level places in New York City. Separate models were conducted for each of New York’s five boroughs to account for the differing environmental characteristics across the city. Results suggest that spatial influence of crime risk differed across alcohol outlet types, with off-premise grocery stores having the largest influence on the likelihood of both aggravated assault and street robbery and on-premise bars/taverns having a strong influence only on the likelihood of street robbery. In addition, although certain alcohol outlets affected crime in each borough, the spatial influence of others was more volatile. It is clear not all alcohol outlet types are equally criminogenic across boroughs. Thus, crime reduction efforts should be unique and localized according to the risk associated with outlet types and place.

Quality of medicines in southern Togo: Investigation of antibiotics and of medicines for non-communicable diseases from pharmacies and informal vendors.

Substandard and falsified medicines represent a serious threat for public health and patient safety. Especially in low and middle-income countries, the prevalence of substandard and falsified medicines is reportedly high. However, reliable information on the prevalence of poor-quality medicines is scarce. In this study, 12 essential medicines, including antibiotics, antidiabetics, cardiac drugs and antiasthmatic drugs, were collected from six informal vendors and six licensed pharmacies in the southern part of Togo (regions Maritime and Plateaux). A mystery shopper approach was used in both types of outlets. In total, 64 samples were collected from licensed pharmacies and 30 from informal vendors. Both availability of medicines and prices of medicines were higher in licensed pharmacies than in informal vendors. 92 medicine samples were analyzed by visual examination, followed by chemical analysis for the content and for the dissolution of the active pharmaceutical ingredients according to the respective monographs of the United States Pharmacopoeia. 7 samples (8%) did not comply with the pharmacopoeial specifications, and one sample (1%) showed even extreme deviations. None of the samples was obviously falsified. However, one sample of amoxicillin capsules contained only 47% of the declared content of the active pharmaceutical ingredient, indicating that it may represent amoxicillin capsules 250 mg, rather than 500mg as declared on the label. Medicines stated to originate from Asia (i.e. mainly from India and China) showed a significantly higher proportion (24%) of non-compliant samples than those from Africa and Europe (4%, p = 0.007). High failure rates were observed in medicines both from informal vendors (13%) and from licensed pharmacies (5%), but the difference between both groups was not statistically significant (p = 0.152). The observed high prevalence of substandard medicines requires action from regulatory authorities and health care providers. Testing of selected samples for related substances indicated that inappropriate transport and storage conditions may have been an important cause for substandard quality.

Observation study of water outlet design from a cross-infection/user perspective: time for a radical re-think?

Handwashing is a key barrier to cross-infection performed at a handwash station (HWS). Elbow-operated outlets, if used incorrectly (with hands), become highly touched objects, potentially providing a route for cross-infection. To study how elbow-operated outlets were used by staff in this hospital, whether the correct type of HWS had been installed in the various ward areas according to the Health Building Note (HBN) 00-10 Part C: Sanitary Assemblies (hands-free outlets in clinical, food preparation and laboratory areas), and factors impinging on design/setup which may affect compliance with correct use. Observation of outlet use was performed by mounting a video camera above four HWSs. Review of suitability of outlet was conducted by two of the authors by visiting ward areas and assessing compliance against HBN recommendations. Angle of elbow-operated lever setup was measured using a protractor and water temperature in relation to angle of movement of elbow lever was measured using a calibrated thermocouple. Ninety-two percent of staff used hands to turn on the outlet and 68% used hands to turn the outlet off, potentially re-contaminating their hands. More than 70% of users moved the lever ≤45°. Almost half of elbow levers were set up incorrectly, being flush or within 3.5 cm of the rear panel, making elbow operation extremely difficult. Selection of outlet type according to HBN was most incorrect in the intensive treatment unit but also occurred in the newly built parts of the hospital. Although handwashing is a key barrier to cross-infection, poor selection and incorrect use of outlet undermines its effectiveness. Design and incorrect instalment further compromise the intended means of operation of elbow levers. Of equal concern is that this risk mostly goes unrecognized. There is an opportunity to improve handwashing safety, but it requires engagement across a broad stratum from Government Departments of Health and manufacturers down to the user.

Public health and alcohol licensing policy in local government: an observational study of licensed premises and alcohol-related violence in London, UK

IntroductionCumulative impact zones (CIZs) are a widely used local policy to control alcohol availability in areas deemed saturated. However, there is no academic evidence of their effectiveness, and the harm associated with outlet types remains understudied. Recent alcohol policy has called for a shift towards diversified alcohol availabilitybut quantitative evidence in support of this policy is sparse. We aimed to assess whether a change in licensing policy in a London borough was associated with diversification of alcohol availability and accompanying alcohol-related violence (ARV). MethodUsing 11 years of local licensing data (2005/06–16/17) from the London Borough of Southwark, we measured the availability of alcohol over time by the number of extant alcohol licences (539 in 2016/17) and outlet type (drinking establishments, eateries, takeaways, off-sales, and other). We quantified harm by drawing on law enforcement intelligence that identified the incidence of alcohol-related violence against the person (deemed ARV). We analysed a linked dataset using negative binomial regression to mitigate overdispersion of data, controlling for CIZ and non-CIZ locations. FindingsAcross all three CIZs, implementation of the policy (in 2008 and 2009) was not associated with a change in number of licences issued. Upon disaggregation by outlet type, CIZ implementation was associated with an increase in the number of licences for eateries (incidence rate ratio [IRR] 1·58, 95% CI 1·02–2·52; p=0·04) and takeaways (3·89, 1·32–11·49; p=0·01). There was no effect on the other outlet types. Each licensed takeaway and off-sales was associated with an increase in ARV (1·7%, IRR 1·02, 95% CI 1·004–1·031; p=0·012, and 1·3%, 1·01, 1·003–1·023; p=0·008, respectively), but there was no association with drinking establishments or eateries. The other outlet type was associated with a 2·4% decrease in ARV (IRR 0·98, 95% CI 0·966–0·986; p<0·001). InterpretationAlthough CIZ policies in Southwark have not reduced the number of licences issued, implementation has led to changes in the types of licensed outlets. We propose that takeaways and off-sales are associated with after-hours drinking and congregation. Our findings provide local stakeholders with an evidence-base for continuing to advocate licensing policy that diversifies availability. The use of law enforcement data may be biased towards areas commonly patrolled and might not capture groups who avoid police involvement (eg, gangs). Linking complementary datasets (eg, emergency department, ambulance services) would enrich the picture of alcohol-related harm. FundingNone.