Development of an approach to forecast future takeaway outlet growth around schools and population exposure to takeaways in England

Background: Neighbourhood exposure to takeaways can contribute negatively to diet and diet-related health outcomes. Urban planners within local authorities (LAs) in England can modify takeaway exposure through denying planning permission to new outlets in management zones around schools. LAs sometimes refer to these as takeaway “exclusion zones”. Understanding the long-term impacts of this intervention on the takeaway retail environment and health, an important policy question, requires methods to forecast future takeaway growth and subsequent population-level exposure to takeaways. In this paper we describe a novel two-stage method to achieve this. Methods: We used historic data on locations of takeaways and a time-series auto-regressive integrated moving average (ARIMA) model, to forecast numbers of outlets within management zones to 2031, based on historical trends, in six LAs with different urban/rural characteristics across England. Forecast performance was evaluated based on root mean squared error (RMSE) and mean absolute scaled error (MASE) scores in time-series cross-validation. Using travel-to-work data from the 2011 UK census, we then translated these forecasts of the number of takeaways within management zones into population-level exposures across home, work and commuting domains. Results: Our ARIMA models outperformed exponential smoothing equivalents according to RMSE and MASE. The model was able to forecast growth in the count of takeaways up to 2031 across all six LAs, with variable growth rates by RUC (min–max: 39.4-79.3%). Manchester (classified as a non-London urban with major conurbation LA) exhibited the highest forecast growth rate (79.3%, 95% CI 61.6, 96.9) and estimated population-level takeaway exposure within management zones, increasing by 65.5 outlets per capita to 148.2 (95% CI 133.6, 162.7) outlets. Overall, urban (vs. rural) LAs were forecast stronger growth and higher population exposures. Conclusions: Our two-stage forecasting approach provides a novel way to estimate long-term future takeaway growth and population-level takeaway exposure. While Manchester exhibited the strongest growth, all six LAs were forecast marked growth that might be considered a risk to public health. Our methods can be used to model future growth in other types of retail outlets and in other areas

Changes in the number and outcome of takeaway food outlet planning applications in response to adoption of management zones around schools in England: A time series analysis

© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Physical exposure to takeaway food outlets (“takeaways”) is associated with poor diet and excess weight, which are leading causes of excess morbidity and mortality. At the end of 2017, 35 local authorities (LAs) in England had adopted takeaway management zones (or “exclusion zones”), which is an urban planning intervention designed to reduce physical exposure to takeaways around schools. In this nationwide, natural experimental study, we used interrupted time series analyses to estimate the impact of this intervention on changes in the total number of takeaway planning applications received by LAs and the percentage rejected, at both first decision and after any appeal, within management zones, per quarter of calendar year. Changes in these proximal process measures would precede downstream retail and health impacts. We observed an overall decrease in the number of applications received by intervention LAs at 12 months post-intervention (6.3 fewer, 95% CI -0.1, -12.5), and an increase in the percentage of applications that were rejected at first (additional 18.8%, 95% CI 3.7, 33.9) and final (additional 19.6%, 95% CI 4.7, 34.6) decision, the latter taking into account any appeal outcomes. This effect size for the number of planning applications was maintained at 24 months, although it was not statistically significant. We also identified three distinct sub-types of management zone regulations (full, town centre exempt, and time management zones). The changes observed in rejections were most prominent for full management zones (where the regulations are applied irrespective of overlap with town centres), where the percentage of applications rejected was increased by an additional 46.1% at 24 months. Our findings suggest that takeaway management zone policies may have the potential to curb the proliferation of new takeaways near schools and subsequently impact on population health.Peer reviewe

Changes in the number and outcome of takeaway food outlet planning applications in response to adoption of management zones around schools in England: A time series analysis

Physical exposure to takeaway food outlets (“takeaways”) is associated with poor diet and excess weight, which are leading causes of excess morbidity and mortality. At the end of 2017, 35 local authorities (LAs) in England had adopted takeaway management zones (or “exclusion zones”), which is an urban planning intervention designed to reduce physical exposure to takeaways around schools. In this nationwide, natural experimental study, we used interrupted time series analyses to estimate the impact of this intervention on changes in the total number of takeaway planning applications received by LAs and the percentage rejected, at both first decision and after any appeal, within management zones, per quarter of calendar year. Changes in these proximal process measures would precede downstream retail and health impacts. We observed an overall decrease in the number of applications received by intervention LAs at 12 months post-intervention (6.3 fewer, 95% CI -0.1, -12.5), and an increase in the percentage of applications that were rejected at first (additional 18.8%, 95% CI 3.7, 33.9) and final (additional 19.6%, 95% CI 4.7, 34.6) decision, the latter taking into account any appeal outcomes. This effect size for the number of planning applications was maintained at 24 months, although it was not statistically significant. We also identified three distinct sub-types of management zone regulations (full, town centre exempt, and time management zones). The changes observed in rejections were most prominent for full management zones (where the regulations are applied irrespective of overlap with town centres), where the percentage of applications rejected was increased by an additional 46.1% at 24 months. Our findings suggest that takeaway management zone policies may have the potential to curb the proliferation of new takeaways near schools and subsequently impact on population health

Changes in the number of new takeaway food outlets associated with adoption of management zones around schools: A natural experimental evaluation in England

© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/By the end of 2017, 35 local authorities (LAs) across England had adopted takeaway management zones (or “exclusion zones”) around schools as a means to curb proliferation of new takeaways. In this nationwide, natural experimental study, we evaluated the impact of management zones on takeaway retail, including unintended displacement of takeaways to areas immediately beyond management zones, and impacts on chain fast-food outlets. We used uncontrolled interrupted time series analyses to estimate changes from up to six years pre- and post-adoption of takeaway management zones around schools. We evaluated three outcomes: mean number of new takeaways within management zones (and by three identified sub-types: full management, town centre exempt and time management zones); mean number on the periphery of management zones (i.e. within an additional 100 m of the edge of zones); and presence of new chain fast-food outlets within management zones. For 26 LAs, we observed an overall decrease in the number of new takeaways opening within management zones. Six years post-intervention, we observed 0.83 (95% CI -0.30, −1.03) fewer new outlets opening per LA than would have been expected in absence of the intervention, equivalent to an 81.0% (95% CI -29.1, −100) reduction in the number of new outlets. Cumulatively, 12 (54%) fewer new takeaways opened than would have been expected over the six-year post-intervention period. When stratified by policy type, effects were most prominent for full management zones and town centre exempt zones. Estimates of intervention effects on numbers of new takeaways on the periphery of management zones, and on the presence of new chain fast-food outlets within management zones, did not meet statistical significance. Our findings suggest that management zone policies were able to demonstrably curb the proliferation of new takeaways. Modelling studies are required to measure the possible population health impacts associated with this change.Peer reviewe

Efficacy and safety of baricitinib or ravulizumab in adult patients with severe COVID-19 (TACTIC-R): a randomised, parallel-arm, open-label, phase 4 trial

Background From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. Methods TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score. Adult participants (aged ≥18 years) were enrolled from 22 hospitals across the UK. Patients with a risk score indicating a 40% risk of admission to an intensive care unit or death were randomly assigned 1:1:1 to standard of care alone, standard of care with baricitinib, or standard of care with ravulizumab. The composite primary outcome was the time from randomisation to incidence (up to and including day 14) of the first event of death, invasive mechanical ventilation, extracorporeal membrane oxygenation, cardiovascular organ support, or renal failure. The primary interim analysis was triggered when 125 patient datasets were available up to day 14 in each study group and we included in the analysis all participants who were randomly assigned. The trial was registered on ClinicalTrials.gov (NCT04390464). Findings Between May 8, 2020, and May 7, 2021, 417 participants were recruited and randomly assigned to standard of care alone (145 patients), baricitinib (137 patients), or ravulizumab (135 patients). Only 54 (39%) of 137 patients in the baricitinib group received the maximum 14-day course, whereas 132 (98%) of 135 patients in the ravulizumab group received the intended dose. The trial was stopped after the primary interim analysis on grounds of futility. The estimated hazard ratio (HR) for reaching the composite primary endpoint was 1·11 (95% CI 0·62–1·99) for patients on baricitinib compared with standard of care alone, and 1·53 (0·88–2·67) for ravulizumab compared with standard of care alone. 45 serious adverse events (21 deaths) were reported in the standard-of-care group, 57 (24 deaths) in the baricitinib group, and 60 (18 deaths) in the ravulizumab group. Interpretation Neither baricitinib nor ravulizumab, as administered in this study, was effective in reducing disease severity in patients selected for severe COVID-19. Safety was similar between treatments and standard of care. The short period of dosing with baricitinib might explain the discrepancy between our findings and those of other trials. The therapeutic potential of targeting complement C5 activation product C5a, rather than the cleavage of C5, warrants further evaluation

A green and pleasant land? An exploration of the impact associated with planning policy

The consumption of green space land due to urban development has evolved to become a key global concern. Whilst assumed to be a critical component in the control of land change, national planning policies have largely been omitted from analyses. Explorations of the effects associated with the transition between policy frameworks may therefore be considered a crucial element in advancing our understanding of the relationship. This thesis applies novel statistical techniques to analyse the effects attributable to the introduction of the Localism Act 2011 and National Planning Policy Framework, using green space as a primary indicator. An initial analysis of green space loss using exploratory methods and Change Point Detection identified the existence of different structural patterns within the data, associable with the introduction of the revised policy framework. It further challenged extant concepts of the temporal dynamics of policy impact, suggesting evidence of increased land loss within 2 years. Through Interrupted Time Series Analysis using dynamic linear models a policy intervention effect was obtained, which reported the policy to have led to a significant increased loss of green space, based upon both area and as a proportion of rates of residential development, intended to account for the underlying effect of economic drivers. A final element of research evidenced a paradigmatic shift from a policy of urban containment to one permissive of expansion into the proximate rural periphery, using multiple datasets. Rates of green space and ‘brownfield’ development within urban boundaries were shown to have seen minimal effects under the revised framework. However, green space situated outside of said boundary was lost at an average rate 177% greater than under the preceding framework. The research constitutes the first to provide robust empirical evidence that the policy reform impacted upon rates and patterns of land change. In so doing offering new insight with which to augment understanding of the functional dynamics of policy in the regulation of land use

Opportunity for childcare? The impact of government initiatives upon childcare provision

SIGLEAvailable from British Library Document Supply Centre-DSC:m01/27889 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

A multithreaded implementation for TransLucid

We present an implementation of the TransLucid language, in which expressions are evaluated in a dynamic context of arbitrary dimensionality. The basis for this implementation is the TransLucid Virtual Machine (TVM), whose execution supposes a centralised cache storing intermediate computed values and whose individual threads compute the values for (identifier, context) pairs. The TVM is designed so that it is efficiently implementable on a wide variety of physical architectures. © 2008 IEEE

Planning guidance to limit hot food takeaways: Understanding the possible economic impacts

Local and national policymakers are seeking innovative solutions to create healthier food environments around the world. Between 2009 and 2017, 35 local authorities across England (UK) adopted planning guidance designed to limit the proliferation of hot food takeaways near schools. Whilst these policies are intended to improve population health, they are also likely to have economic impacts. Often a decision to introduce such policies comes down to consideration of whether the short-term economic imperatives of allowing new takeaway outlets to open outweighs the potential long-term public health implications and associated economic consequences. These potential negative and positive economic impacts have not previously been clearly described and are summarised here. The aim of this paper is to provide an overview of the potential economic impacts of takeaway management zones. In particular, we present a Causal Loop Diagram (CLD) that outlines the possible economic impacts of takeaway management zones based on researcher knowledge of the interventions and the industry. Potential negative impacts fall across sectors and may include a loss of employment opportunities and reductions in local and national tax receipts, and may impact the economic vitality of local communities. In the longer term, there is the potential for positive impacts such as reductions in healthcare resource utilisation, social care expenditure and sickness-related absence from work. Part of a robust case would a better economic understanding, that would enable local authorities to improve understanding of the trade-offs associated with the policy, such as short-versus long-term, and business-related versus society-related health benefits and costs