Technology, organisation and productivity performance in services : lessons from Britain and the United States since 1870

This paper documents the comparative productivity performance of the United States and Britain since 1870, showing the importance of developments in services. We identify the transition in market services from customised, low-volume, high-margin business organised on a network basis to standardised, high-volume, low-margin business with hierarchical management, as a key factor. A model of the interaction between technology, organisation and economic performance is then provided, focusing on the transition from networks to hierarchies. Four general lessons are drawn: (1) developments in services must be analysed if the major changes in comparative productivity performance among nations are to be understood fully; (2) different technologies and organisational forms can co-exist efficiently; (3) technological change can cause difficulties of adjustment in technology-using sectors if it is not suited to the social capabilities of the society; (4) reversal of technological trends can lead to reversal of comparative productivity performance

The impact of the COVID-19 pandemic on the delivery of primary percutaneous coronary intervention in STEMI

Objectives: The clinical environment has been forced to adapt to meet the unprecedented challenges posed by the COVID-19 pandemic. Intensive care facilities were expanded in anticipation of the pandemic where the consequences include severe delays in elective procedures. Emergent procedures such as Percutaneous Coronary Intervention (PCI) in acute myocardial infarction (AMI) in which delays in timely delivery have well established adverse prognostic effects must also be explored in the context of changes in procedure and public behaviour associated with the COVID-19 pandemic. The aim for this single centre retrospective cohort study is to determine if door-to-balloon (D2B) times in PCI for ST Elevation Myocardial Infarction (STEMI) during the United Kingdom’s first wave of the COVID-19 pandemic differed from pre-COVID-19 populations. Methods: Data was extracted from our single centre PCI database for all patients that underwent pPCI for STEMI. The reference (Pre-COVID-19) cohort was collected over the period 01-03-2019 to 31-05-2019 and the exposure group (COVID-19) over the period 01-03-2020 to 31-05-2020. Baseline patient characteristics for both populations were extracted. The primary outcome measurement was D2B times. Secondary outcome measurements included: time of symptom onset to call for help, transfer time to first hospital, transfer time from non-PCI to PCI centre, time from call-to-help to PCI centre, time to table and onset of symptoms to balloon time. Categorical and continuous variables were assessed with Chi squared and Mann-Whitney U analysis respectively. Procedural times were calculated and compared in the context of heterogeneity findings. Results: 4 baseline patient characteristics were unbalanced between populations with statistical significance (P<0.05). The pre-covid-19 cohort was more likely to have suffered out of hospital cardiac arrest (OHCA) and had left circumflex disease, whereas the 1st wave cohort were more likely to have been investigated with left ventriculography and be of Afro-Caribbean origin. No statistically significant difference in in-hospital procedural times was found with D2B, C2B, O2B times comparable between groups. Pre-hospital delays were the greatest contributors in missed target times: the 1st wave group had significantly longer delayed time of symptom onset to call for help (Control: 31 mins; IQR [82.5] vs 1st wave: 60 mins; IQR [90.0], P=0.001) and time taken from call for help to arrival at the PCI hospital (control: 72 mins; IQR [23] vs 1st wave: 80 mins; IQR [66.5], P=0.042). Conclusion: Enhanced infection prevention and control procedures considering the COVID-19 pandemic did not impede the delivery of pPCI in our single centre cohort. The public health impact of the pandemic has been demonstrated with times being significantly impacted by patient related delays. The recovery of public engagement in emergency medical services must become the focus for public health initiatives as we emerge from the height of COVID-19 disease burden in the UK.Publisher PDFPeer reviewe

Ad hoc Joint FAO/WHO Expert Consultation on Risk Assessment of Food Allergens Part 1: Review and validation of Codex priority allergen list through risk assessment

The objectives of the meeting is to see whether the published criteria (FAO/WHO, 2000) for assessing additions and exclusions to the list is still current and appropriate. The Expert Committee determined that only foods or ingredients that cause immune-mediated hypersensitivities such as IgE-mediated food allergies and coeliac disease should be included on the list of foods and ingredients included in section 4.2.1.4 of the GSLPF. Thus, it was recommended that foods or ingredients such as lactose, sulphite, and food additives which cause food intolerances rather than immune-mediated responses, should be excluded from this list. The Committee identified prevalence of the immune-mediated hypersensitivity to a specific food, severity (i.e. proportion of severe objective reactions to a food/ingredient such as anaphylaxis), and the potency of food/ingredient (i.e. the amount of the food/ingredient required to cause objective symptoms) as the three key criteria that should be used to establish the priority allergen list. Subgroups of the Expert Committee were established to review the literature on the prevalence, severity and potency of immune-mediated hypersensitivity of each food currently on the GSLPF list (cereals containing gluten and products of these; crustacea and products of these; eggs and egg products; fish and fish products; peanuts, soybeans and products of these; milk and milk products; tree nuts and nut products; ), as well as other foods found on priority allergen lists established in individual countries or regions (e.g. mollusks, mustard, celery, sesame, buckwheat, lupin, and others).Los objetivos de la reunión son ver si los criterios publicados (FAO / OMS, 2000) para evaluar las adiciones y exclusiones a la lista siguen vigentes y son apropiados. El Comité de Expertos determinó que solo los alimentos o ingredientes que causan hipersensibilidades inmunomediadas, como las alergias alimentarias mediadas por IgE y la enfermedad celíaca, deben incluirse en la lista de alimentos e ingredientes incluidos en la sección 4.2.1.4 de la GSLPF. Por lo tanto, se recomendó que se excluyeran de esta lista alimentos o ingredientes como lactosa, sulfito y aditivos alimentarios que causan intolerancias alimentarias en lugar de respuestas inmunomediadas. El Comité identificó la prevalencia de la hipersensibilidad inmunomediada a un alimento específico, la gravedad (es decir, la proporción de reacciones objetivas graves a un alimento / ingrediente como la anafilaxia) y la potencia del alimento / ingrediente (es decir, la cantidad de alimento / ingrediente requerida causar síntomas objetivos) como los tres criterios clave que deben utilizarse para establecer la lista de alérgenos prioritarios. Se establecieron subgrupos del Comité de Expertos para revisar la literatura sobre la prevalencia, severidad y potencia de la hipersensibilidad inmunomediada de cada alimento actualmente en la lista GSLPF (cereales que contienen gluten y productos de estos; crustáceos y productos de estos; huevos y productos de huevo ; pescado y productos de pescado; cacahuetes, soja y productos de estos; leche y productos lácteos; frutos secos y productos de frutos secos;), así como otros alimentos que se encuentran en las listas de alérgenos prioritarios establecidas en países o regiones individuales (por ejemplo, moluscos, mostaza, apio , sésamo, alforfón, altramuz y otros).Instituto de Investigación de Tecnología de AlimentosFil: Baumert, Joseph. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Brooke-Taylor, Simon. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido.Fil: Chen, Hongbing. Nanchang Universidad. Instituto Conjunto de Investigación Chino-Alemán; China.Fil: Crevel, René W.R. René Crevel Consulting Limited; Reino Unido.Fil: Geert Houben. Organización para la Investigación Científica Aplicada TNO; Países Bajos.Fil: Jackson, Lauren. División de Ciencia y Tecnología del Procesamiento de Alimentos. Ingeniería de Procesos de la Administración de Alimentos y Medicamentos de los EE. UU. (FDA); Estados Unidos de América.Fil: Kyriakidis, Symeon. Laboratorio Estatal de Química General (GCSL). Autoridad Independiente de Ingresos Públicos (IAPR); Grecia.Fil: La Vieille, Sébastien. Universidad Laval. Departamento de Ciencias de los Alimentos; Canadá.Fil: Lee, N Alice. Universidad de Nueva Gales del Sur . Escuela de Química e Ingeniería. Ciencia e ingeniería de los alimentos; Australia.Fil: López, María Cristina. Universidad Nacional de San Martín. Ingeniería de Alimentos; Argentina.Fil: Luccioli, Stefano. Administración de Alimentos y Medicamentos de los Estados Unidos. Centro de Seguridad Alimentaria y Nutrición Aplicada; Estados UnidosFil: O’Mahony, Patrick. Universidad College Dublin; Irlanda.Fil: O’Mahony, Patrick. Autoridad de Seguridad Alimentaria de Irlanda; Irlanda.Fil: Polenta, Gustavo Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Tecnología de Alimentos; Argentina.Fil: Polenta, Gustavo Alberto. Instituto de Ciencia y Tecnología de los Sistemas Alimentarios Sustentables (ICyTeSAS) UEDD INTA-CONICET; Argentina.Fil: Pöpping, Bert. Food Consulting Strategically (FOCO); Alemania.Fil: Pöpping, Bert. Comités de Normalización ISO - CEN. Grupo de trabajo CEN Alérgenos Alimentarios (CEN TC 275 WG 12).); Alemania.Fil: Remington, Benjamin C. Remington Consulting Group B.V.; Holanda.Fil: Remington, Benjamin C. Universidad de Nebraska–Lincoln. Programa de Recursos e Investigación de Alergias Alimentarias. Estados UnidosFil: Södergren, Eva. ThermoFisher Scientific; Suecia.Fil: Srikulnath, Sirinrat. Universidad de Kasetsart (UKaset). Instituto de Investigación y Desarrollo de Productos Alimentarios. Centro de Servicio de Aseguramiento de la Calidad de los Alimentos. Unidad de Alérgenos Alimentarios; Tailandia.Fil: Taylor, Stephen L. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Turner, Paul J. Universidad de Sídney; Australia.Fil: Turner, Paul J. Colegio Imperial de Ciencia, Tecnología y Medicina. Alergia e Inmunología Pediátricas; Inglaterra

Risk Assessment of Food Allergens. Part 1: Review and Validation of Codex Alimetarius Priority Allergen list Through Risk Assessment

The labelling of food allergens in pre-packaged foods plays a key role in protecting food allergic individuals, as no preventative clinical treatment is currently available. The list of major foods and ingredients known to cause hypersensitivity was included into the Codex General Standard for the Labelling of Packaged Foods (GSLPF) in 1999. There have been many scientific developments in the understanding of food allergens and their management since the original drafting of the GSLPF. Thus, in response to the request from Codex for scientific advice, including current evidence of consumer understanding of allergens, FAO and WHO convened a series of three expert meetings to provide scientific advice on this subject. The purpose of the first meeting of the Ad hoc Joint FAO/WHO Expert Consultation on Risk Assessment of Food Allergens was to review and validate the Codex priority allergen list through risk assessment. This report focuses on the deliberations and conclusions of this meeting. Resumen: El etiquetado de los alérgenos alimentarios en los alimentos preenvasados ​​juega un papel clave en la protección personas alérgicas a los alimentos, ya que actualmente no se dispone de un tratamiento clínico preventivo. Se incluyó la lista de los principales alimentos e ingredientes que causan hipersensibilidad en la Norma General del Codex para el Etiquetado de Alimentos Envasados ​​(GSLPF) en 1999. Ha habido muchos avances científicos en la comprensión de alérgenos alimentarios y su gestión desde la redacción original de la GSLPF. Por lo tanto, en respuesta a la solicitud del Codex de asesoramiento científico, incluida la actual evidencia de la comprensión del consumidor de los alérgenos, la FAO y la OMS convocaron una serie de tres reuniones de expertos para proporcionar asesoramiento científico sobre este tema. El propósito de la primera reunión de la Consulta Conjunta Especial de Expertos FAO/OMS sobre evaluación de riesgos de los alérgenos alimentarios fue revisar y validar la prioridad del Codex lista de alérgenos a través de la evaluación de riesgos. Este informe se centra en las deliberaciones y conclusiones de esta reunión.Instituto de Investigación de Tecnología de Alimentos (ITA)Fil: Baumert, Joseph. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Brooke-Taylor, Simon. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido.Fil: Che, Huilian. Universidad de Agricultura de China. Facultad de Ciencias de la Alimentación e Ingeniería Nutricional; China.Fil: Chen, Hongbing. Nanchang Universidad. Instituto Conjunto de Investigación Chino-Alemán; China.Fil: Crevel, René W.R. René Crevel Consulting Limited; Reino Unido.Fil: Houben, Geert F. Alergia alimentaria e inmunotoxicología. Científico principal de TNO; Países Bajos.Fil: Jackson, Lauren. Administración de Alimentos y Medicamentos. División de Ciencia y Tecnología del Procesamiento de Alimentos. Ingeniería de Procesos; Estados UnidosFil: Kyriakidis, Symeon. Autoridad Independiente de Ingresos Públicos. Laboratorio Estatal de Química General; Grecia.Fil: La Vieille, Sébastien. Salud Canadá. Dirección de Alimentos; Canadá.Fil: Lee, N Alice. Universidad de Nueva Gales del Sur. Escuela de Química e Ingeniería. Ciencia e ingeniería de los alimentos; Australia.Fil: López, María Cristina. Universidad Nacional de San Martín. Ingeniería de Alimentos; Argentina.Fil: Luccioli, Stefano. Administración de Alimentos y Medicamentos. Centro de Seguridad Alimentaria y Nutrición Aplicada; Estados UnidosFil: O’Mahony, Patrick. Autoridad de Seguridad Alimentaria de Irlanda . Ciencia y Tecnología de los Alimentos; Irlanda.Fil: Polenta, Gustavo Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Tecnología de Alimentos; Argentina.Fil: Pöpping, Bert. Food Consulting Strategically (FOCO); Alemania.Fil: Remington, Benjamin C. Grupo BV. Consultoría Remington; Holanda.Fil: Södergren, Eva. Agencia Sueca de Alimentos. Equipo de Encuestas Dietéticas y Departamento de Nutrición para Beneficio de Riesgo Evaluación; Suecia.Fil: Srikulnath, Sirinrat. Universidad de Kasetsart (UKaset). Instituto de Investigación y Desarrollo de Productos Alimentarios. Centro de Servicio de Aseguramiento de la Calidad de los Alimentos. Unidad de Alérgenos Alimentarios; Tailandia.Fil: Taylor, Stephen L. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Turner, Paul J. Colegio Imperial de Ciencia, Tecnología y Medicina. Alergia e Inmunología Pediátricas; Inglaterra

Ad hoc Joint FAO/WHO Expert Consultation on Risk Assessment of Food Allergens Part 2: Review and establish threshold levels in foods of the priority allergens

The main purpose of this second meeting was to establish threshold levels in foods of the priority allergens. Based on the defined approach, the Expert Committee discussed and agreed on the safety objective, which could be described as “to minimise, to a point where further refinement does not meaningfully reduce health impact, the probability of any clinically relevant objective allergic response, as defined by dose distribution modelling of minimum eliciting doses (MEDs) and supported by data regarding severity of symptoms in the likely range of envisioned Reference Doses (RfD)”. The Committee further identified several important considerations to guide decision-making. These included a clear definition of criteria to be met by quantitative data on which reference doses (RfD) are based, supporting data on health manifestations (severity) at the proposed RfD, quality, quantity, availability and accessibility of data (for priority allergens), as well as how to deal with priority allergens for which information supporting one or more of those considerations was lacking.El objetivo principal de esta segunda reunión fue establecer niveles umbral en los alimentos de los alérgenos prioritarios. Sobre la base del enfoque definido, el Comité de Expertos discutió y acordó el objetivo de seguridad, que podría describirse como “minimizar, hasta un punto en el que un mayor refinamiento no reduzca significativamente el impacto en la salud, la probabilidad de cualquier respuesta alérgica objetiva clínicamente relevante, como definido por el modelo de distribución de dosis de dosis mínimas provocadoras (MED) y respaldado por datos sobre la gravedad de los síntomas en el rango probable de dosis de referencia previstas (RfD) ”. El Comité identificó además varias consideraciones importantes para orientar la toma de decisiones. Estos incluyeron una definición clara de los criterios que deben cumplir los datos cuantitativos en los que se basan las dosis de referencia (RfD), datos de apoyo sobre manifestaciones de salud (gravedad) en la RfD propuesta, calidad, cantidad, disponibilidad y accesibilidad de los datos (para alérgenos prioritarios). , así como cómo tratar los alérgenos prioritarios para los que faltaba información que respaldara una o más de esas consideraciones.Instituto de Investigación de Tecnología de AlimentosFil: Baumert, Joseph. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Brooke-Taylor, Simon. Brooke-Taylor & Co. Consultor australiano de regulación alimentaria y análisis de riesgos (Pty Ltd); Australia.Fil: Crevel, René W.R. René Crevel Consulting Limited; Reino Unido.Fil: Houben, Geert F. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido.Fil: Jackson, Lauren. Administración de Alimentos y Medicamentos de los Estados Unidos. División de Ciencia y Tecnología del Procesamiento de Alimentos. Ingeniería de Procesos; Estados UnidosFil: Kyriakidis, Symeon. Laboratorio Estatal de Química General (GCSL).Autoridad Independiente de Ingresos Públicos (IAPR); Grecia.Fil: La Vieille, Sébastien. Universidad Laval. Departamento de Ciencias de los Alimentos; Canadá.Fil: Lee, N Alice. Universidad de Nueva Gales del Sur. Escuela de Química e Ingeniería. Ciencia e ingeniería de los alimentos; Australia.Fil: López, María Cristina. Universidad Nacional de San Martín. Ingeniería de Alimentos; Argentina.Fil: Luccioli, Stefano. Administración de Alimentos y Medicamentos de los Estados Unidos. Centro de Seguridad Alimentaria y Nutrición Aplicada; Estados UnidosFil: O’Mahony, Patrick. Autoridad de Seguridad Alimentaria de Irlanda; Irlanda.Fil: O’Mahony, Patrick. Universidad College Dublin; Irlanda.Fil: Polenta, Gustavo Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Tecnología de Alimentos; Argentina.Fil: Polenta, Gustavo Alberto. Instituto de Ciencia y Tecnología de los Sistemas Alimentarios Sustentables (ICyTeSAS) UEDD INTA-CONICET; Argentina.Fil: Pöpping, Bert. Food Consulting Strategically (FOCO); Alemania.Fil: Pöpping, Bert. Comités de Normalización ISO - CEN. Grupo de trabajo CEN Alérgenos Alimentarios (CEN TC 275 WG 12).); Alemania.Fil: Remington, Benjamin C. Remington Consulting Group B.V.; Holanda.Fil: Remington, Benjamin C. Universidad de Nebraska–Lincoln. Programa de Recursos e Investigación de Alergias Alimentarias. Estados UnidosFil: Srikulnath, Sirinrat. Universidad de Kasetsart (UKaset). Instituto de Investigación y Desarrollo de Productos Alimentarios. Centro de Servicio de Aseguramiento de la Calidad de los Alimentos. Unidad de Alérgenos Alimentarios; Tailandia.Fil: Taylor, Stephen L. Universidad de Nebraska-Lincoln. Departamento de Ciencia y Tecnología de Alimentos; Estados UnidosFil: Turner, Paul J. Colegio Imperial de Ciencia, Tecnología y Medicina. Alergia e Inmunología Pediátricas; Inglaterra

Diabetes mellitus increases risk of adverse drug reactions and death in hospitalised older people : the SENATOR trial

Purpose: Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, especially in older people. Older people with diabetes mellitus may be at especially high risk of ADRs but this risk has not been well studied. This study aimed to compare severity and type of ADRs in hospitalised, multimorbid older people with and without diabetes and secondly to assess the impact of ADRs on mortality, rehospitalisation and length of stay. Methods: Participants in the SENATOR (Software Engine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons) trial were assessed for 12 common and ‘other’ prevalent and incident adverse drug reactions using a blinded end-point adjudication process. Descriptive analyses, logistic regression and mediation analyses were undertaken. Results: Of 1537 people in the SENATOR trial, 540 (35.1%) had diabetes mellitus (mean age 77.4 ± 7.3 years, 58.5% male). In the total population, 773 prevalent and 828 incident ADRs were reported. Both prevalent and incident symptomatic hypoglycaemia and incident acute kidney injury (AKI) were significantly more common in people with diabetes (p < 0.05). Patients with diabetes had higher all-cause mortality at 12 weeks than those without (9.1% vs 6.3%, p = 0.04). Mediation analysis revealed that mortality was significantly higher (OR = 1.43, Sobel test p = 0.048) in people with diabetes and ADRs causing AKI. Conclusions: Older multimorbid people with diabetes presenting to hospital with acute illness have significantly more ADRs than those without, and a significantly higher mortality that is mediated by medication-associated AKI and poorer renal function.Peer reviewe

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Inspection of Cycleways with DataCycle - Preliminary Results

Irish Transport Research Network (ITRN) 2017, University College Dublin, Ireland, 28-29 August 2017This paper presents the first inspection results using DataCycle, a first maintenance management system for cycleways in Ireland. DataCycle provides a system of inspection and assessment of cycleways, along with an inspection manual. As a first application of DataCycle, the inspection method and assessment is applied to two different cycling routes in Cork, Ireland. The first route is the Passage West to Rochestown cycle route, which has been developed along an old disused rail line and is in an area where cycling and walking for both leisure and commuting is possible. The second route is the Cork City to Ballincollig Cycleway. This is the main cyclist commuter route between Ballincollig and the city centre. It covers a distance of 6.4km. The cycle route is comprised of a segregated roadside cycleway and a shared footpath and cycle route in parts. The assessments compare and contrast these two distinct routes and demonstrates how a Cycleway Management System(CMS) in the form of DataCycle can be beneficial to managing this asset in a targeted manner. The ease of use, ability to align with existing maintenance management systems and the possibility of upscaling the system is highlighted. The results present typical outputs for some of the routes inspected implementing the cycleway management system with suggested intervention options. The work demonstrates how the developed system can be easily implemented for cycleways and encourages the use of such centralised maintenance system for cycleways throughout the country. A substantial inspection database for cycling facilities should allow for implementation of asset management methodologies, including cross-asset management formats