Simulating the density reduction and equity-impact of potential tobacco retail control policies.

Background: Reducing the provision of tobacco is important for decreasing inequalities in smoking and smoking-related harm. Various policies have been proposed to achieve this, but their impacts—particularly on equity—are often unknown. Here, using national-level data, we simulate the impacts of potential policies designed to reduce tobacco outlet density (TOD). Methods: Tobacco retailer locations (n=9030) were geocoded from Scotland’s national register, forming a baseline. Twelve policies were developed in three types: (1) regulating type of retailer selling tobacco, (2) regulating location of tobacco sales, and (3) area-based TOD caps. Density reduction was measured as mean percentage reduction in TOD across data zones and number of retailers nationally. Equity impact was measured using regression-based Relative Index of Inequality (RII) across income deprivation quintiles. Results: Policies restricting tobacco sales to a single outlet type (‘Supermarket’; ‘Liquor store’; ‘Pharmacy’) caused >80% TOD reduction and >90% reduction in the number of tobacco outlets nationally. However, RIIs indicated that two of these policies (‘Liquor store’, ‘Pharmacy’) increased socioeconomic inequalities in TOD. Equity-promoting policies included ‘Minimum spacing’ and exclusion zones around ‘Child spaces’. The only policy to remove statistically significant TOD inequalities was the one deliberately targeted to do so (‘Reduce clusters’). Conclusions: Using spatial simulations, we show that all selected policies reduced provision of tobacco retailing to varying degrees. However, the most ‘successful’ at doing so also increased inequalities. Consequently, policy-makers should consider how the methods by which tobacco retail density is reduced, and success measured, align with policy aims

Using point-of-sale data to examine tobacco pricing across neighbourhoods in Scotland

Objectives: To assess the geographical variation in tobacco price (cigarettes and roll-your-own (RYO) tobacco) in convenience stores across Scotland and how this relates to neighbourhood income deprivation, tobacco retail outlet density and urban/rural status. Methods: Tobacco price data from 124 566 shopping baskets purchased in 274 convenience stores during 1 week in April 2018 were obtained through an electronic point-of-sale system. These data were combined with neighbourhood-level measures of income deprivation, tobacco retail outlet density and urban/rural status. We examined brand price for 12 of the most popular cigarette brands and 3 RYO brands and variations in purchases by price segment; multivariable regression analysis assessed associations between area variables and tobacco price. Results: Most stores sold tobacco in all price segments. The lowest priced subvalue brands were the most popular in all neighbourhoods but were most dominant in shops in more deprived neighbourhoods. When total sales were assessed, overall purchase price varied significantly by neighbourhood income deprivation; packets of 20 cigarettes were 50 pence (5.6%) lower and RYO 34 pence (2.7%) lower among shops in the two highest income deprivation quintiles relative to the lowest. Analysis of individual brands showed that for 3 of the 12 cigarette brands considered, average prices were 12-17 pence lower in more deprived neighbourhoods with the most popular RYO brand 15 pence lower. There was limited evidence of a relationship with tobacco retail outlet density. Conclusion: Across Scottish convenience stores, the purchase price of cigarettes and RYO was lower in more income-deprived neighbourhoods. The lower prices primarily reflect greater sales of cheap brands in these areas, rather than retailers reducing the prices of individual brands

Socioeconomic inequalities in children’s exposure to tobacco retailing based on individual-level GPS data in Scotland

Background: Identifying factors shaping knowledge of and attitudes towards tobacco products in preadolescence is a key component supporting tobacco control policies aimed at preventing smoking initiation. This study quantified exposure to tobacco retailing environments within the individual-level activity spaces of children across a socioeconomic gradient. Methods: One week of global positioning system (GPS) tracking data were collected at 10 s intervals from a nationally representative sample of 10–11-year olds (n=692). Proximity of GPS locations (n=~16 M) to the nearest tobacco retailer (n=9030) was measured and exposure defined when a child came within 10 m of a retailer. Duration, frequency, timing and source of exposure were compared across income deprivation quintiles, along with retail density within children’s home neighbourhoods. Results: On average, children were exposed to tobacco retailing for 22.7 min (95% CI 16.8 to 28.6) per week in 42.7 (35.2–50.1) independent encounters. However, children from the most deprived areas accumulated six times the duration and seven times the frequency of exposure as children from the least deprived areas. Home neighbourhood retail densities were 2.6 times higher in deprived areas, yet the average number of businesses encountered did not differ. Most exposure came from convenience stores (35%) and newsagents (15%), with temporal peaks before and after school hours. Conclusions: By accounting for individual mobility, we showed that children in socially disadvantaged areas accumulate higher levels of exposure to tobacco retailing than expected from disparities in home neighbourhood densities. Reducing tobacco outlet availability, particularly in areas frequently used by children, might be crucial to policies aimed at creating ‘tobacco-free’ generations

Review article: Use of ultrasound in the developing world

As portability and durability improve, bedside, clinician-performed ultrasound is seeing increasing use in rural, underdeveloped parts of the world. Physicians, nurses and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams, and a growing body of literature supports the use of point-of-care ultrasound in developing nations. We review, by region, the existing literature in support of ultrasound use in the developing world and training guidelines currently in use, and highlight indications for emergency ultrasound in the developing world. We suggest future directions for bedside ultrasound use and research to improve diagnostic capacity and patient care in the most remote areas of the globe

The SPECTRUM Consortium : A new UK Prevention Research Partnership consortium focussed on the commercial determinants of health, the prevention of non-communicable diseases, and the reduction of health inequalities

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of 'Unhealthy Commodity Producers' (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM ( S haping Public h Ealth poli Cies To Reduce ineq Ualities and har M) Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium's approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium's ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond

Onset Theory: Pushing the Design Envelope for Textile Composite Structures

Reliably predicting the failure behaviour of fibre reinforced polymer composite materials is a challenging endeavour. Despite decades of work, there is still significant lack of confidence in composite design practices owing to the limitations in generalisable failure prediction frameworks. This has a huge impact on the aerospace industry, where inflated structural weight from enforced design conservatism is felt acutely on the bottom lines of both aircraft manufacturers and aircraft operators. In the aerospace industry, where both structural efficiency and damage tolerance are critical, textile fabrics and unidirectional (UD) laminates are the widely used forms of composite materials. Although they are not as structurally efficient as unidirectional fibre composites (unitape), textile composites have many other inherent advantages, including: handlability, drapability, repairability, bondability and damage tolerance, which make them attractive structural materials. They are also often used in conjunction to create hybrid laminates which are both structurally efficient and damage tolerant. Boeing makes extensive use of both textile fabric and hybrid laminates, for which there is currently no accepted physics-based predictive failure theory. This report discusses the research findings made on the Project ID (LP150100653) in the field of understanding failure in textile fabric laminates using Onset Theory, a multi-scale damage modelling framework proposed by the researchers at The Boeing Company. Novel experimental methodologies and numerical modelling procedures were developed in the due course to explore the meso-mechanical level in the hierarchical framework. Non-destructive material characterisation techniques such as micro X-ray Computed Tomography (microCT) and Neutron Tomography (NT) are utilised in understanding the microstructure, fibre distribution and damage evolution in complex textile and hybrid composites. New material reconstruction algorithms are developed to generate geometric models of the textile architecture. A multi-scale finite element modelling procedure is developed for evaluating the stiffness and strength of textile composites by extending the framework of Strain Invariant Failure Theory (Onset Theory). The improved understanding of composites failure phenomenon thus achieved will help design optimal structures confidently with reduced design safety factors and also develop novel material architectures to suit different applications

The Thummer Mapping Project (ThuMP)

This paper presents the Thummer Mapping Project (ThuMP), an industry partnership project between ThumMotion P/L and The University of Western Sydney (UWS). ThuMP sought to developing mapping strategies for new interfaces for musical expression (NIME), specifically the Thummer™, which provides thirteen simultaneous degrees of freedom. This research presents a new approach to the mapping problem resulting from a primary design research phase and a prototype testing and evaluation phase. In order to establish an underlying design approach for the Thummer™ mapping strategies, a number of interviews were carried out with high-level acoustic instrumental performers, the majority of whom play with the Sydney Symphony Orchestra, Sydney, Australia. Mapping strategies were developed from analysis of these interviews and then evaluated in trial usability testing