A roadmap for the future of crowd safety research and practice: Introducing the Swiss Cheese Model of Crowd Safety and the imperative of a Vision Zero target

Crowds can be subject to intrinsic and extrinsic sources of risk, and previous records have shown that, in the absence of adequate safety measures, these sources of risk can jeopardise human lives. To mitigate these risks, we propose that implementation of multiple layers of safety measures for crowds—what we label The Swiss Cheese Model of Crowd Safety—should become the norm for crowd safety practice. Such system incorporates a multitude of safety protection layers including regulations and policymaking, planning and risk assessment, operational control, community preparedness, and incident response. The underlying premise of such model is that when one (or multiple) layer(s) of safety protection fail(s), the other layer(s) can still prevent an accident. In practice, such model requires a more effective implementation of technology, which can enable provision of real-time data, improved communication and coordination, and efficient incident response. Moreover, implementation of this model necessitates more attention to the overlooked role of public education, awareness raising, and promoting crowd safety culture at broad community levels, as one of last lines of defence against catastrophic outcomes for crowds. Widespread safety culture and awareness has the potential to empower individuals with the knowledge and skills that can prevent such outcomes or mitigate their impacts, when all other (exogenous) layers of protection (such as planning and operational control) fail. This requires safety campaigns and development of widespread educational programs. We conclude that, there is no panacea solution to the crowd safety problem, but a holistic multi-layered safety system that utilises active participation of all potential stakeholders can significantly reduce the likelihood of disastrous accidents. At a global level, we need to target a Vision Zero of Crowd Safety, i.e., set a global initiative of bringing deaths and severe injuries in crowded spaces to zero by a set year.fals

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Istanbul, Turkey

Background: Asthma is one of the most important diseases of childhood. The aim of this study was to evaluate the prevalence of asthma symptoms and risk factors affecting asthma.Methods: In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. Asthma prevalence among the children was assessed using the ISAAC protocol.Results: In our study, a total of 10,894 questionnaires were distributed to 13-14 years old children, and of these 9991 questionnaires were suitable for analysis with an overall response rate of 91.7%. The rates of wheeze ever, wheezing in last 12 months and lifetime doctor diagnosed asthma prevalence were 17.4%, 9.0%, and 11.8%, respectively. There were 4746 boys (47.9%) and 5166 girls (52.1%) with M/F ratio of 0.92. Atopic family history, fewer than three siblings living at home, tonsillectomy or adenoidectomy history, consumption of fermented foods, mixed pickles, margarine and meat were found to be associated with an increased asthma risk. Use of paracetamol in the last 12 months, consumption of fruit and animal fats acted as a protective factor against asthma. The Mediterranean-style diet was not associated with the prevalence of asthma.Conclusions: Lifetime doctor diagnosed asthma prevalence was found to be 11.8% in 13-14 year olds. History of tonsillectomy and/or adenoidectomy and consumption of fermented foods, mixed pickles, margarine and meat may increase the symptoms of asthma. Usage of paracetamol and consumption of animal fats may be investigated as a protective factor against asthma. (C) 2013 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved

2-(4-CHLOROPHENYLAZO)-2-METHYL-1,3-INDANDIONE

In the title compound, C16H11ClN2O2, the 2-methyl-1,3-dioxoindan-2-yl and 4-chlorophenyl groups are trans to each other. The five-membered ring of the indandione moiety adopts an envelope conformation. The phenyl and azo groups are not coplanar because of steric hindrance between the lone-pair orbitals on the carbonyl O atom and beta-N atom [C-N=N = 112.4 (3)-degrees]