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Hazardous alcohol consumption causes approximately 4% of deaths globally, constituting one of the leading risk factors for the burden of the disease worldwide. Alcohol has several health consequences, such as alcohol-associated liver disease, hepatocellular carcinoma, nonliver neoplasms, physical injury, cardiac disease, and psychiatric disorders. Alcohol misuse significantly affects workforce productivity, with elevated direct and indirect economic costs. Due to the high impact of alcohol consumption on the population, public health has led to the development of a range of strategies to reduce its harmful effects. Regulatory public health policies (PHP) for alcohol can exist at the global, regional, international, national, or subnational levels. Effective strategies incorporate a multilevel, multicomponent approach, targeting multiple determinants of drinking and alcohol-related harms. The World Health Organization categorizes the PHP into eight categories: national plan to fight the harmful consequences of alcohol, national license and production and selling control, taxes control and pricing policies, limiting drinking age, restrictions on alcohol access, driving-related alcohol policies, control over advertising and promotion, and government monitoring systems. These policies are supported by evidence from different populations, demonstrating that determinants of alcohol use depend on several factors such as socioeconomic level, age, sex, ethnicity, production, availability, marketing, and others. Although most policies have a significant individual effect, a higher number of PHP are associated with a lower burden of disease due to alcohol. The excessive consequences of alcohol constitute a call for action, and clinicians should advocate for developing and implementing a new PHP on alcohol consumption., (© 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)

The PortaLyzer is a portable homemade device that allows researchers to perform bead-beating steps commonly found in environmental DNA (eDNA) extraction protocols in the field without access to power. This allows researchers to preserve in situ organism abundance by beginning eDNA extraction quickly. The PortaLyzer is composed of a variable speed, battery-powered multi-tool and a vortexer adapter plate. We used the PortaLyzer, in conjunction with the Qiagen DNEasy PowerSoil Pro kit, to successfully field process samples taken from the forelands of the Sólheimajökull and Kvíárjökull glaciers in Iceland, as well as soil samples acquired from a prairie in Indiana. Additionally, we provide evidence that samples held in Buffer CD2 of the DNEasy PowerSoil Pro Kit may be transported to traditional lab spaces and processed up to one month after the initial protocol steps, and still provide an equivalent DNA quality and abundance yield as those processed the same day. These improvements to DNA extraction protocols give researchers more flexibility while sampling, shipping and processing eDNA samples., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008-2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4-23 months, 24-59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24-59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011-2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3-6 days/week 2011-2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1-2 days/week, 2014-2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3-6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1-2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4-23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Previous research suggests that while leisure-time physical activity (LTPA) is beneficial, occupational physical activity (OPA) may be detrimental to health, known as the 'physical activity paradox'. However, the current evidence is primarily based on data from Western countries. We examined the association of OPA with all-cause and cardiovascular disease mortality in working adults in urban China., Methods: This prospective longitudinal study was based on a sample of 142,302 urban working adults aged 30-79 years from the China Kadoorie Biobank study. Self-reported OPA (mainly sedentary, standing occupation, and manual work) was collected at baseline (year 2004-2008) and linked to death registries until 31st December 2016. Multivariable Cox proportional hazards models were used to examine the relationship between OPA and mortality outcomes, with further tests for effect modification by sex, educational attainment and LTPA., Findings: During a median follow-up of 10·2 years, 4,077 deaths occurred, of which cardiovascular disease was the primary cause for 727 deaths. Crude modelling showed that compared with the sedentary workers, manual work was associated with increased risk of all-cause mortality. However, after adjusting for socio-demographic and lifestyle variables, the association was attenuated to null (HR=1·00, 95%CI: 0·93-1·08). In subgroup analysis, higher OPA was associated with lower risk of all-cause mortality in the least educated group (HR=0·84, 95%CI: 0·75-0·95 for manual work, and HR=0·86, 95%CI: 0·75-0·99 for standing occupation), but harmful in the most educated group (HR=1·17, 95%CI: 1·01-1·36) and in those who reported regular LTPA (HR=1·20, 95%CI: 1·01-1·43)., Interpretation: OPA was not associated with mortality risk in the overall sample. However, findings support the 'physical activity paradox' within better educated Chinese workers., Funding: None., Competing Interests: We declare no competing interests., (© 2022 Published by Elsevier Ltd.)

Digitalization of any manufacture industry is a key step in any progress of the production process. The process of digitalization includes both increased use of robotics, automatization solutions and computerization, thereby allowing to reduce costs, to improve efficiency and productivity, and to be flexible to changes. Pharmaceutical Industry (PI) has however been resistant to digitalization, mainly due to fair experience and complexity of the entailed development and manufacture processes. Nevertheless, there is a clear need to digitalize PI as the demand in both traditional and new drugs is constantly growing. Contract Development Manufacture Organizations (CDMOs) have a special digitalizing challenge. Digitalization of PI, and CDMO precisely, should be tightly related to the main aspects of Good Manufacture Practice (GMP), and, to succeed in PI digitalizing requires constant focus on GMP. Close collaboration with constantly changing stakeholders is another important factor which should be in focus during digitalization of CDMO. This paper represents an overview over the main aspects of CDMO digitalization and discusses both the opportunities and challenges of the process, focusing on the practical solutions for successive digital implementation., Competing Interests: None., (© 2021 The Authors.)

India is the second most populous country in the world with a population of nearly 1.3 billion, comprising 20% of the global population. There are an estimated 37.5 million cases of asthma in India, and recent studies have reported a rise in prevalence of allergic rhinitis and asthma. Overall, 40-50% of paediatric asthma cases in India are uncontrolled or severe. Treatment of allergic rhinitis and asthma is sub-optimal in a significant proportion of cases due to multiple factors relating to unaffordability to buy medications, low national gross domestic product, religious beliefs, myths and stigma regarding chronic ailment, illiteracy, lack of allergy specialists, and lack of access to allergen-specific immunotherapy for allergic rhinitis and biologics for severe asthma. High quality allergen extracts for skin tests and adrenaline auto-injectors are currently not available in India. Higher postgraduate specialist training programmes in Allergy and Immunology are also not available. Another major challenge for the vast majority of the Indian population is an unacceptably high level of exposure to particulate matter (PM) 2.5 generated from traffic pollution and use of fossil fuel and biomass fuel and burning of incense sticks and mosquito coils. This review provides an overview of the burden of allergic disorders in India. It appraises current evidence and justifies an urgent need for a strategic multipronged approach to enhance quality of care for allergic disorders. This may include creating an infrastructure for education and training of healthcare professionals and patients and involving regulatory authorities for making essential treatments accessible at subsidised prices. It calls for research into better phenotypic characterisation of allergic disorders, as evidence generated from high income western countries are not directly applicable to India, due to important confounders such as ethnicity, air pollution, high rates of parasitic infestation, and other infections., Competing Interests: MTKs department received educational grant from ALK Abello, MEDA, Thermo Fisher and other companies for annual PracticAllergy course in recent years. MTK received funds from ALK Abello to attend EAACI conference. Other authors have no conflict of interest to declare., (© 2020 Published by Elsevier Inc. on behalf of World Allergy Organization.)

Objective: The use of extracorporeal membrane oxygenation (ECMO) has increased exponentially. Costs and outcomes, however, vary considerably by indication. We sought to elucidate and quantify these differences., Methods: Adult patients supported on ECMO between 2008 and 2016 were analyzed using the Nationwide Inpatient Sample. We divided the study period into an early (2008-2013) and late period (2013-2016). The primary outcome was hospital charges, and the secondary outcomes were mortality, length of stay (LOS), and duration of ECMO support. These were stratified by the 5 most common indications: postcardiotomy shock (PCS), cardiogenic shock (CS), severe acute respiratory failure (SARF), heart (HT), and lung transplantation (LT). Both patient and hospital characteristics were assessed. Charges were adjusted for inflation and analyzed using a generalized linear model with gamma distribution. Pairwise comparison with Bonferroni correction was used to evaluate the cost and multivariate logistic regression to assess the risk of mortality., Results: Data pertaining to 15,829 adult patients were evaluated. Mean age of the entire cohort was 52.8 years, 8895 (56%) were white, and 10,278 (65%) were male. PCS was the predominant indication for ECMO (39%), followed by CS (37%). SARF accounted for 15% and HT and LT accounted for 3.9% and 5.4%, respectively. Mean LOS and duration of ECMO support were 23.4 days and 5.3 days respectively. Mean hospital charges per hospitalization for the entire cohort were USD 731,914 per patient. Charges per patient pertaining to hospitalizations in which ECMO was used in transplant patients were the highest: USD 1,448,931 and USD 1,574,378 ( P  = .99) for HT and LT, respectively. Charges were lower for the other indications: PCS USD 798,909, CS USD 655,099, and SARF USD 824,852. Overall mortality for the entire cohort was 55%. PCS and CS (53% vs 58%, P  = .34) had similar survival, whereas SARF was 45%, LT was 39% and HT 32%. There were no differences in survival in these latter indications (SARF, LT and HT). The cumulative charges (proportion × hospital charges) reveal that PCS and CS (39% and 37%) account for both the majority of charges as well as the greatest mortality. Conversely, SARF and transplantation accounted for the smaller proportion of charges and the lower mortality. Patients undergoing HT had the longest LOS (51.7 days) and duration on ECMO (15.9 days), followed by LT (35.4 and 8.8 days respectively), and patients with SARF (28.6 and 6.6 respectively). LOS and duration of ECMO for those with PCS were 18.7 days and 4.8 days, respectively. Those on ECMO for CS were hospitalized for 19.7 days and spent an average of 3.8 days on ECMO. Mortality decreased, whereas charges increased in the late era., Conclusions: The use of ECMO is associated with high hospital charges and a wide variation in outcomes. Hospitalizations, in which ECMO is used to support patients with cardiogenic shock (PCS and CS), are individually associated with lower LOS and charges. Cumulatively, however, these account for greater charges and greater mortality. Although mortality may be decreasing, overall charges are increasing with time. These variations may influence reimbursement decisions in value-based healthcare., (© 2020 by The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.)