Google Street View reveals how built environment correlates with risk of cardiovascular disease

EUROPEAN SOCIETY OF CARDIOLOGY

 

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GOOGLE STREET VIEW IMAGES ASSOCIATED WITH HIGHER CARDIOVASCULAR DISEASE

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CREDIT: EUROPEAN HEART JOURNAL

Researchers have used Google Street View to study hundreds of elements of the built environment, including buildings, green spaces, pavements and roads, and how these elements relate to each other and influence coronary artery disease in people living in these neighbourhoods.

Their findings, published in the European Heart Journal [1] today (Thursday), show that these factors can predict 63% of the variation in the risk of coronary heart disease from one area to another.

Coronary heart disease, where a build-up of fatty substances in the coronary arteries interrupts the blood supply to the heart, is one of the most common forms of cardiovascular disease.

Researchers say that using Google Street View can help provide an overview of physical environmental risk factors in the built and natural environments that could help not only in understanding risk factors in these environments, but ultimately help towards building or adapting towns and cities to make them healthier places to live.

The study was led by Prof. Sadeer Al-Kindi and Prof. Sanjay Rajagopalan from University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University, Ohio, USA, and Dr. Zhuo Chen, a post-doctoral fellow in Prof. Rajagopalan’s laboratory.

Prof. Rajagopalan said: “We have always been interested in how the environment, both the built and natural environment, influences cardiovascular disease. Here in America, they say that the zip code is a better predictor of heart disease than even personal measures of health. However, to investigate how the environment influences large populations in multiple cities is no mean task. Hence, we used machine vision-based approaches to assess the links between the built environment and coronary heart disease prevalence in US cities.”

The study included more than half a million Google Street View images of Detroit, Michigan; Kansas City, Missouri; Cleveland, Ohio; Brownsville, Texas; Fremont, California; Bellevue, Washington State; and Denver, Colorado. Researchers also collected data on rates of coronary heart disease according to ‘census tracts’. These are areas smaller than a US zip code that are home to an average of 4,000 people. The researchers used an approach called a convolutional neural network; a type of artificial intelligence that can recognise and analyse patterns in images to make predictions.

The research revealed that features of the built environment visible on Google Street View images could predict 63% of the variation in coronary heart disease between these small regions of US cities.

Prof. Al-Kindi added: “We also used an approach called attention mapping, which highlights some of the important regions in the image, to provide a semi-qualitative interpretation of some of the thousands of features that may be important in coronary heart disease. For instance, features like green space and walkable roads were associated with lower risk, while other features, such as poorly paved roads, were associated with higher risk. However, these findings need further investigation.

“We’ve shown that we can use computer vision approaches to help identify environmental factors influencing cardiovascular risk and this could play a role in guiding heart-healthy urban planning. The fact that we can do this at scale is something that is absolutely unique and important for urban planning.”

“With upcoming challenges including climate change and a shifting demographic, where close to 70% of the world’s population will live in urban environments, there is a compelling need to understand urban environments at scale, using computer vision approaches that can provide exquisite detail at an unparalleled level,” said Prof. Rajagopalan.

In an accompanying editorial, [2] Dr. Rohan Khera from Yale University School of Medicine, USA said: “The association of residential location with outcomes often supersedes that of known biological risk factors. This is often summarised with the expression that a person’s postal code is a bigger determinant of their health than their genetic code. However, our ability to appropriately classify environmental risk factors has relied on population surveys that track wealth, pollution, and community resources.

“The study by Chen and colleagues presents a novel and more comprehensive evaluation of the built environment. This work creatively leverages Google's panoramic street-view imagery that supplements its widely used map application.

“… an AI-enhanced approach to studying the physical environment and its association with cardiovascular health highlights that across our communities, measures of cardiovascular health are strongly encoded in merely the visual appearance of our neighbourhoods. It is critical to use this information wisely, both in defining strategic priorities for identifying vulnerable communities and in redoubling efforts to improve cardiovascular health in communities that need it most.”

Google Street View images associated with lower cardiovascular disease

CREDIT

European Heart Journal

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JOURNAL

European Heart Journal

DOI

10.1093/eurheartj/ehae158 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Built environment features obtained from Google Street View are associated with coronary artery disease prevalence: a deep-learning framework

ARTICLE PUBLICATION DATE

28-Mar-2024

UK

Looking after the NHS workforce must be a top priority, say experts

The future of the NHS depends on having the right staff who feel valued and proud to work in the health service

BMJ

Looking after the NHS workforce is not only an ethical imperative but also a sound investment and must be a top priority, say experts in the third report of The BMJ Commission on the Future of the NHS.

 

From improving basic working conditions to planning for the impact of AI, the authors set out a bold vision to enhance the stewardship of the NHS workforce.

In the most recent (2023) NHS Staff Survey only a quarter (26.4%) of respondents said there were enough staff at their organisation for them to do their job properly, just over a quarter (25.6%) are satisfied with their pay, and only 42% say they are satisfied with the extent to which their organisations value their work.

Against this background, The BMJ Commission brought together leading experts from medicine and healthcare to identify the key challenges and priorities and make recommendations aimed at ensuring that the vision of the NHS is realised.

Today’s recommendations include making workforce stewardship a key priority at all levels, improving workplace conditions, and improving workforce planning.

Calling for a collaboratively designed national framework for NHS employers to improve working environments for all NHS staff, the report identifies the need for much more effective people management, proactively enforced standards relating to antidiscrimination and anti-racism, and better systems for addressing problematic culture and behaviour.

Stressing the importance of operational management to support the effective running of the NHS, it notes the strong evidence from other areas, such as manufacturing, about the contribution of effective management to organisational success and employee wellbeing.

And the report strongly emphasises the need for workforce planning, new technologies, and new roles to be treated as major, novel interventions that require consultation and rigorous design and evaluation.

“The future of the NHS depends on the people who work in it,” write the authors, led by Mary Dixon-Woods from The Healthcare Improvement Studies Institute at the University of Cambridge.

“But at the moment the NHS simply does not have enough staff to deliver on its goals and commitments: it remains under-doctored, under-nursed, and under-managed in comparison with other countries. Staff are routinely exposed to very challenging workplace conditions, yet organisations demonstrate significant weaknesses in addressing the problems – ranging from adequate toilet facilities and water access through to bullying and harassment.

“Quite apart from the ethical imperative to look after the NHS workforce, there are strong arguments that doing so will improve efficiency, productivity, and patient experience and outcomes,” they explain.

“As the largest workforce in Europe, investing in the staff of the NHS is also a sound investment in population health,” the authors add.

They note that some of their recommendations can be managed at organisational level, while others will need to be led from the top of government and the NHS centre. 

However, they conclude: “Much stronger leadership and accountability for people and their development at all levels, from Whitehall downwards, is now needed.”

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JOURNAL

The BMJ

DOI

10.1136/bmj-2024-079474 

ARTICLE TITLE

The future of the NHS depends on its workforce

ARTICLE PUBLICATION DATE

27-Mar-2024

COI STATEMENT

We have read and understood BMJ policy on competing interests and declare: MD-W is currently undertaking evaluative work for the Care Quality Commission. She is an unpaid director and founder of THIS Labs. CS gave oral evidence to the House of Lords Science and Technology Committee Inquiry into Clinical Academics and the NHS. She is employed by the University of Cambridge, is an honorary consultant at Cambridge University Hospitals NHS Foundation Trust, and is director of studies in clinical medicine at Selwyn College, Cambridge. MM is an employee of The BMJ and has acted in various advisory roles for the health service including for the Welsh government. KP has no interests to declare.

 UK

New documents reveal patient safety concerns over strike day cover

Investigation sheds new light on process designed to keep patients safe during industrial action. BMA says it takes concerns around patient safety “incredibly seriously”

BMJ

An investigation published by The BMJ today reveals new details of requests to recall striking junior doctors from picket lines for patient safety reasons. 

Documents show that while most trusts in England did not make such requests, those that did were rejected by the BMA in most cases. Some of these trusts warned of potential harm to patients from cancelling operations at the last minute and short staffing, reports assistant news editor Gareth Iacobucci.

However, the BMA said it takes concerns about patient safety “incredibly seriously” and provided The BMJ with summaries of why requests were turned down.

The union’s chair of council Phil Banfield said, “Throughout industrial action we have engaged thoroughly and in good faith with the derogation process, considering each request carefully to ensure that granting a derogation is necessary and the last and only option.”

He said that poor planning by some trusts had led to some routine care being inappropriately booked in on strike days. In other instances, he said trusts had failed to make sufficient effort to draft in the necessary cover for strike days.

The BMJ sent freedom of information requests to 135 NHS trusts in England and received 90 responses (a 67% response rate) to better understand the performance of derogation - the process designed to keep patients safe during times of industrial action. Derogation allows trusts to ask for staff to be exempt from strikes if they feel patient safety is at risk.

Of the 90 trusts that responded, 83 (92%) did not make any derogation requests. The remaining seven trusts made 27 derogation requests between them, of which 24 (89%) were rejected by the BMA, one (4%) was approved, and two (7%) were withdrawn by the trust. 

Documents reveal that in some cases, trusts that submitted derogation requests were able to find last minute cover to minimise the impact on patients. But in others, surgical procedures for breast cancer, abdominal hysterectomy due to cancer, and hemicolectomy (removal of one side of the colon) were cancelled at the last minute, alongside diagnostic procedures such as endoscopies, hysteroscopies, and biopsies. 

In other cases, trusts identified potentially avoidable harm to patients in critical care and raised concerns around safe staffing, leading some NHS leaders to question whether the process of derogation is meeting its objectives.

Danny Mortimer, chief executive of NHS Employers, said, “The process for requesting derogations during action by junior doctors undoubtedly caused many trusts to decide not to submit requests as there seemed to be almost no circumstances in which the BMA would agree to requests whatever the concerns that were raised.”

Last year, the BMA initially reported that the process was working well. But more recently, relations with NHS England have become increasingly fraught.

 Banfield added, “We continue to be more than willing to work with NHS England on clarity around planning, prioritisation and re-scheduling, and will continue to engage constructively and responsibly with the derogation process, should there be further industrial action. All we ask is that NHS England and trusts do so in the same spirit, which carefully balances the need to prioritise patient safety and allow doctors to exercise their legal right to take industrial action.”

An NHS England spokesperson said, “NHS staff, including junior doctors, have worked incredibly hard to maintain the safest possible level of vital services such as cancer, maternity, and urgent and emergency care on strike days.

“We continue to have active discussions with the BMA to ensure that, in any future periods of action, requests by local clinical leaders for patient safety mitigations are considered quickly and consistently.”

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JOURNAL

The BMJ

DOI

10.1136/bmj.q740 

METHOD OF RESEARCH

News article

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Revealed: hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show

ARTICLE PUBLICATION DATE

28-Mar-2024

 

People experiencing homelessness more likely to develop dementia at younger ages, study finds

Peer-Reviewed Publication

INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES

London, ON, March 27, 2024 – Dementia in unhoused people was 1.9 times greater than the general population, with a higher prevalence for age groups younger than 85 years, according to new research from Lawson Health Research Institute and ICES.

In one of the first population-based studies of its kind and published in The Lancet Public Health, researchers compared dementia prevalence in people experiencing homeless with the general population and people living in low-income neighbourhoods in Ontario, Canada.

“Not only did we find that dementia was more common among unhoused individuals, but the difference was greatest between the ages of 55 to 64 years,” says lead author Dr. Richard Booth, scientist at ICES and Lawson Health Research Institute, and associate professor and Arthur Labatt Family Research Chair in Nursing at Western University.

“There’s a strong link between homelessness and accelerated ageing, which may be one of the reasons people experience an earlier onset of the disease,” says Dr. Booth.

Using a prevalence ratio, the researchers found that within the ages of 55-74 years rates of dementia were 4 to 5 times higher than the general population and 3 to 3.5 times higher than the low-income group. There was a higher dementia prevalence in all age groups younger than 85 years among people experiencing homelessness in both males and females.

Unhoused people were younger on average, less likely to be female, and less likely to live in rural areas compared to the other two groups. They also had higher rates of health conditions associated with dementia, such as head trauma, neurological conditions, HIV, and mental health and substance-use disorders.

After adjusting for factors such as age, sex, residential area, and health conditions, the prevalence ratio for people experiencing homelessness was 1.7 times higher compared to the low-income group, and 1.9 times higher compared to the general population.

“Other research has outlined that the rates of homelessness in older adults are expected to double by 2030, which means that the number of people living with dementia could rise substantially,” says Dr. Booth. “Our findings suggest that unhoused individuals should be screened for dementia at younger ages, rather than waiting until age 65 as many guidelines suggest.”

The researchers also note the complexity of diagnosing dementia in an individual experiencing multiple, chronic health conditions, as cognitive symptoms can overlap. Because of the difficulty in obtaining a medical history and diagnosis in this population, the study could have underestimated the true prevalence of dementia.

“We hope this work serves to enhance the awareness of policy makers and practitioners of the increasing prevalence of dementia among people experiencing homelessness,” says study author Salimah Shariff, staff scientist with the Populations & Public Health Research Program at ICES, associate director of research operations and strategic partnerships at ICES Western, and associate scientist at Lawson. “As housing is a core determinant of health and essential to the sustainment of individuals’ health and wellbeing, access to permanent, supportive housing structures for people experiencing homelessness is also critical in preventing and slowing the progression of dementia in this population.”

This study was funded by the Public Health Agency of Canada.

The study, “Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis” was published in The Lancet Public Health. 
 
Authors: Booth R, Dasgupta M, Forchuk C, Shariff S. 

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario 

ABOUT LAWSON HEALTH RESEARCH INSTITUTE  

Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. 

FOR FURTHER INFORMATION PLEASE CONTACT: 

Misty Pratt 
Senior Communications Associate, ICES 
Misty.Pratt@ices.on.ca 613-882-7065 

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JOURNAL

The Lancet Public Health

DOI

10.1016/S2468-2667(24)00022-7 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis

ARTICLE PUBLICATION DATE

27-Mar-2024

Delirium a ‘strong risk factor’ for dementia among older people

Delirium linked to triple the risk of dementia in older people, findings show

BMJ

Delirium is a strong risk factor for dementia and death among older people, finds the largest study of its kind published by The BMJ today. 

The findings show that, among hospital patients with at least one episode of delirium, the risk of receiving a new dementia diagnosis was three times higher than for patients without delirium and each additional episode of delirium increased that risk by 20%. 

The researchers say their findings support the theory that delirium has a strong independent effect on dementia risk in this clinical population.

Delirium is a sudden change in a person’s usual mental state. Symptoms include agitation, confusion or being unable to stay focused when awake. Delirium is much more common in hospital patients and older people. 

Previous observational studies have suggested an association between delirium and subsequent dementia, but study limitations leave the size and nature of this relationship unclear.

Yet as the global burden of dementia increases, it is of critical importance to confirm the extent to which delirium is a potentially modifiable risk factor.

To try and address these uncertainties, researchers in Australia analysed data from 626,467 patients aged 65 years and older with no dementia diagnosis who were admitted to hospital in New South Wales between January 2009 and December 2014.

Of these patients, 55,211 had at least one recorded episode of delirium and were matched to another 55,211 patients without delirium by age, sex, frailty, reason for being in hospital, length of stay in hospital and length of stay in the intensive care unit.

These 110,422 patients (average age 83; 52% women) were then followed-up for five years to see how many of them were diagnosed with dementia.

Collectively, 58% (63,929) of patients died and 17% (19,117) had a newly reported dementia diagnosis over the follow-up period.

The researchers found that patients with delirium had a 39% higher risk of death and three times the risk of being diagnosed with dementia than patients without delirium.

The relationship between delirium and dementia was stronger in men than women and each additional episode of delirium was associated with a 20% increased risk of developing dementia (a dose-response relationship).

These are observational findings, so cannot establish cause, and the authors acknowledge that hospital data may not be completely accurate. Nor can they rule out the possibility that other unmeasured factors may have affected their results.

However, this was a large, well-designed study with a long follow-up period, and results were similar after further analyses to test the strength of the associations, suggesting that they are robust.

“While our results are consistent with the hypothesis that delirium plays a causative part in dementia, they are not conclusive owing to the fundamental limitations of observational studies in determining causality,” they write. “Nevertheless, the results of this study provide valuable insights because prospective randomised controlled trials are unlikely to be conducted.”

“Delirium is a factor that could triple a person’s risk of dementia. Therefore, delirium prevention and treatment are opportunities to reduce dementia burden globally,” they conclude.

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JOURNAL

The BMJ

DOI

10.1136/bmj-2023-077634 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Delirium and incident dementia in hospital patients in New South Wales, Australia: retrospective cohort study

ARTICLE PUBLICATION DATE

27-Mar-2024

COI STATEMENT

All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from National Health and Medical Research Council: Partnership Centre for Health System Sustainability for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

 

Reclaim ‘wellness’ from the rich and famous, and restore its political radicalism, new book argues

Book Announcement

UNIVERSITY OF CAMBRIDGE

 

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THE FRONT COVER OF JAMES RILEY'S NEW BOOK WELL BEINGS, PUBLISHED BY ICON BOOKS ON 28TH MARCH 2024.

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CREDIT: ICON BOOKS / ANNA MORRISON

A new cultural history of the 1970s wellness industry offers urgent lessons for today. It reveals that in the seventies, wellness was neither narcissistic nor self-indulgent, and nor did its practice involve buying expensive, on-trend luxury products. Instead, wellness emphasised social well-being just as much as it focused on the needs of the individual. Wellness practitioners thought of self-care as a way of empowering people to prioritise their health so that they could also enhance the well-being of those around them.

 

Today’s wellness industry generates trillions of dollars in revenue, but in a new book, Dr James Riley of Cambridge University’s English Faculty, shows that 1970s wellness pioneers imagined something radically different to today’s culture of celebrity endorsements and exclusive health retreats.

“Wellness was never about elite experiences and glossy, high-value products,” says Riley, a Fellow of Girton College, noting that “When we think of wellness today, Gwyneth Paltrow’s Goop and other lifestyle brands might come to mind, along with the oft-cited criticism that they only really offer quackery for the rich.” By contrast, in the 1970s, “wellness was much more practical, accessible and political.”

The word, as it was first proposed in the late-1950s, described a holistic approach to well-being, one that attended equally to the mind (mental health), the body (physical health) and the spirit (one’s sense of purpose in life). The aim was to be more than merely ‘not ill’. Being well, according to the likes of Halbert Dunn and later in the 1970s, John Travis and Don Ardell, meant realising your potential, living with ‘energy to burn’ and putting that energy to work for the wider social good.

Riley’s Well Beings: How the Seventies Lost Its Mind and Taught Us to Find Ourselves, published by Icon Books on 28th March, is the first book to explore the background of the wellness concept in the wider political and cultural context of the 1970s.

“Wellness in the 1970s grew out of changing attitudes to health in the post-war period – the same thinking that gave rise to the NHS,” Riley says. “When coupled with the political activism of the 1960s counterculture and the New Left, what emerged was a proactive, socially oriented approach to physical and mental well-being. This was not about buying a product off the shelf.

“The pursuit of wellness was intended to take time, commitment and effort. It challenged you to think through every facet of your life: your diet, health, psychology, relationships, community engagement and aspirations. The aim was to change your behaviour – for the better – for the long term.”

Riley’s book also makes a case for what the 1970s wellness industry can do for us today.

“We’re often warned about an imminent return to ‘the seventies’, a threat that’s based on the stereotypical image of the decade as one of social decline, urban strife, and industrial discontent. It’s an over-worked comparison that tends to say more about our own social problems, our own contemporary culture of overlapping political, social and economic crises. Rather than fearing the seventies, there’s much we can learn to help us navigate current difficulties.” 

“It was in the 1970s that serious thought was given to stress and overwork to say nothing of such frequently derided ‘events’ as the mid-life crisis and the nervous breakdown. The manifold pressures of modern life - from loneliness to information overload - increasingly came under the microscope and wellness offered the tools to deal with them.”

“Not only are these problems still with us, they’ve got much worse.  To start remedying them, we need to remember what wellness used to mean. The pandemic, for all its horrors, reminded us of the importance of mutual self-care. To deal with the ongoing entanglement of physical and mental health requires more of that conviviality. Being well should be within everyone’s reach, it should not be a privilege afforded to those who have already done well.”

 

Mindfulness versus wellness

At the heart of Riley’s book is an analysis of the ongoing corporate and commercial tussle between ‘mindfulness’ and ‘wellness’.

In 1979 Dr Jon Kabat-Zinn founded the Stress Reduction and Relaxation Programme at the University of Massachusetts Medical Center, where he taught ‘mindfulness-based stress reduction’. For Kabat-Zinn mindfulness meant accepting the inevitable stress that comes with the ‘full catastrophe’ of life and adopting an attitude of serene resilience in the face of it. Stress could be alleviated thanks to a regular meditation routine and small changes made to the working day such as the decision to try a different, more pleasant commute. Little was said about altering the pace of the work causing the stress in the first place.

By contrast, John Travis, a medical doctor who founded the Wellness Resource Center in California’s Marin County in 1975, talked about the health dangers of sedentary, office-based jobs while Don Ardell, author of High Level Wellness (1977), encouraged his readers to become agents of change in the workplace. Both saw work-fixated lifestyles as the problem. Work and work-related stress was thus something to fix, not to endure.     

Ardell argued that because burn-out was becoming increasingly common it was incumbent upon employers to offer paid time off to improve employee well-being. Better to be too well to come to work, reasoned Ardell, than too sick. “We tend to think that flexible hours and remote working are relatively new concepts, particularly in the digital and post-COVID eras,” adds Riley, “but Ardell was calling for this half a century ago.”

Riley argues that the techniques of mindfulness, rather than those of wellness, have proved attractive to contemporary corporate culture because they ultimately help to maintain the status quo. Corporate mindfulness puts the onus on the employee to weather the storm of stress. It says, “there is nothing wrong with the firm, you are the problem, this is the pace, get with it or leave”. 

According to Riley this view is a far-cry from the thinking of seventies wellness advocates like Travis and Ardell who “imagined a health-oriented citizenship, a process of development in which social well-being follows on from the widespread optimistic and goal-oriented pursuit of personal health. It’s that sense of social mission that self-care has lost.”

Riley points out that this self-care mission had a very particular meaning in the 1970s among groups like The Black Panther Party for Self-Defense, which established clinics and ran an ambulance service for black communities in and around Oakland, California. “They were saying you’ve got to look after yourself so you can then look after your community. Such communal effort was vital because the system was seen to be so opposed to Oakland’s needs. One sees the deeply political potency of ‘self-care’ in this context. It meant radical, collective autonomy, not indulgent self-regard.”

The Bad Guru

As well as suggesting positive lessons from the past, Riley is also quick to call out the problems. “The emphasis on self-responsibility in wellness culture could easily turn into a form of patient-blame,” he argues, “the idea that if you’re ill, or rather if you fail to be well, it’s your fault, a view that neglects to consider all kinds of social and economic factors that contribute to ill-health.”

Elsewhere, Riley draws attention to the numerous claims of exploitation and abuse within the wider context of the alternative health systems, new religious movements and ‘therapy cults’ that proliferated in the 1970s.

“It was not always a utopia of free thought. The complex and often unregulated world of New Age groups and alternative health systems could often be a minefield of toxic behaviour, aggressive salesmanship and manipulative mind games. Charismatic and very persuasive human engineers were a common presence in the scene, and one can easily see these anxieties reflected in the various ‘bad gurus’ of the period’s fiction and film.

“There are plenty of voices who say they gained great insights as a result of being pushed to their limits in these situations,” says Riley, “but many others were deeply affected, if not traumatised, by the same experiences.”

 

Self-Experimentation

In addition to exploring the literature of the period, Riley’s research for Well Beings found him trying out many of the therapeutic practices he describes. These included extended sessions in floatation tanks, guided meditation, mindfulness seminars, fire walking, primal screaming in the middle of the countryside, remote healing, yoga, meal replacement and food supplements. 

 

References

J. Riley, Well Beings: How the Seventies Lost Its Mind and Taught Us to Find Ourselves. Published by Icon Books on 28th March 2024. ISBN: 9781785787898.

 

RED SEA

"You Can Hear the Gunfire": The 911 Call Center for Mariners Under Attack

Courtesy Royal Navy

PUBLISHED MAR 27, 2024 8:33 PM BY ROYAL NAVY NEWS

 

 

A Royal Navy-led emergency center has dealt with an ‘unprecedented’ rise in distress calls due to the Red Sea crisis.

The team at the UK Maritime Trade Organisation, based on Portsdown Hill overlooking Portsmouth, has dealt with two or three reports of attacks and incidents daily – compared with monthly – as a result of the wave of attacks on shipping in the southern Red Sea and Gulf of Aden since November.

For the first time the UKMTO opened the doors of its headquarters to shed light on the efforts of its small team – just 18 strong – to help terrified or distressed sailors, guide other vessels to help out (or avoid the area) and work with international shipping companies to keep trade flowing.

The 24/7/365 operations room acts as the 'call center’ for shipping of any nationality in the Gulf, Red Sea and central/northern Indian Ocean.

The UKMTO’s operators – no more than five personnel at any one time – monitor thousands of ships moving across an area ten times the size of the North Sea, as well as a similar size of the Atlantic Ocean focused on the Gulf of Guinea which has suffered piracy and criminal activity, though not to the same extent.

They’ve seen a 475 percent increase in incidents reported by seafarers in the Middle East since attacks began in the autumn, with over 2,500 emails coming into the HQ daily.

Despite the concerted efforts by international warships to protect commercial traffic in the Red Sea and Gulf of Aden and frequent downing of drones and missiles, including by HMS Diamond and Richmond, more than a dozen merchantmen have been hit and one, the bulk carrier Rubymar, sunk by Houthi attacks in recent months.

“There are times when we take a call from very distressed mariners as an attack is taking place – for them it’s a potentially life-changing moment,” said Lieutenant Commander Joanna Black. “You can hear the gunfire, perhaps banging or an explosion – it’s real time and you can see from the look on the team’s faces what is happening. We are rooting for the seafarers and do everything we can for them. We take a great deal of pride in being able to help people in their hour of need – we are the only organization who do what we do.”

Former sailor Darren Longhurst, now a watchkeeper, said the tempo in the operations room “has gone up to 200mph” since the attacks began in mid-November.

“It’s a big adrenaline rush when they call in,” he explained, “but you’re here to calm the master or whichever member of the crew is calling, calm them down as best as you can, and try to assist them in the best possible way you can considering you’re a fair way away from them.”

The team call every vessel registered with the UKMTO – many smaller fishing vessels operating in the same waters are not – within a 20 to 50-mile radius of an incident, either to ask them to assist, or to warn them of the danger.

Trade passing through the Red Sea has dropped by nearly one third as a result of the attacks with liquefied gas carriers in particular avoiding the route due to their flammable cargoes.

The increased traffic taking the longer route to Europe and the Americas sailing down the eastern seaboard of Africa means higher costs and longer waiting times for goods.

It also means ships sail down the Somali coast for around 1,000 miles – a possible lure to pirates and criminal gangs.

“The current focus of industry and military in theatre is on a possible resurgence of Somali-based piracy at extended range – 600 nautical miles – from shore,” Lieutenant Commander Black added. “Although this could have a significant impact on ships, it’s expected that international trade will adapt by re-routing to avoid the danger areas.”

Whether under attack by pirates or Houthi drones, or suffering from a fire or serious injury, seafarers are encouraged to call the UKMTO in an emergency – irrespective of their nationality – and the team will coordinate a response.

Set up in the wake of the September 11 atrocities in 2001, the UKMTO also has a regional center in Dubai – its personnel visit ships in the Gulf, brief crews and discuss the big picture with industry leaders.

“We’ve become the equivalent of an international 999/911 organization for commercial shipping in the region. There is no other organization which does what we do – informing, responding, and reassuring; we’ve become trusted and respected by mariners as the central point of contact for conflict and piracy-related emergencies in the region," said Lieutenant Commander Black.

The opinions expressed herein are the author's and not necessarily those of The Maritime Executive.

Over 19,000 Delta Air Lines Ground Workers Request A Policy Of Neutrality Regarding Unionization

BYALEXANDER MITCHELL

SIMPLY FLYING

PUBLISHED 10 HOURS AGO

The airline's workers are in search of accountability.

Photo: EchoVisuals | Shutterstock


SUMMARY

Delta Air Lines employees seek neutrality in unionization to ensure fair voting opportunities.

Despite Congress's and employees' urges, Delta's CEO's response to neutrality was unsatisfactory.

Delta employees have requested that Congress demand a clear answer from the CEO on remaining neutral in the unionization process.

On March 26, over 16,000 Delta Air Lines employees nationwide demonstrated their support for Congress' recent calls for the airline's management to remain neutral in the staff's unionization efforts. Despite urges from lawmakers and its employees, Delta's responses to the situation have proven unsatisfactory.

Neutrality during the unionization process is critical for ensuring that staff can best decide if a union fits their goals and needs without being influenced by upper-level management like the airline's CEO, Ed Bastian. When responding to Congress, Bastian's failure to acknowledge Delta's alleged interference in the unionization process continues to create concerns.

Photo: Robin Guess | Shutterstock



With Bastian and Delta's c-suite unable to commit to complete neutrality in the unionization process, the carrier's employees are seeking additional action from Congress. According to the airline's staff, it is not important whether individual employees are for or against unionization, but rather that all have a fair opportunity to participate in the voting process to determine whether to unionize.
Broad support

The carrier's employees seek union organization rights from the International Association of Machinists and Aerospace Workers (IAM), a massive multinational trade union with an extensive history of supporting worker's rights since 1888. A selection of Delta employees from across the country published a letter to Congress on 26 March 2024, addressing Bastian's concerning response to lawmaker's initial neutrality request.


Photo: Markus Mainka | Shutterstock

The letter, which included support from Delta employees across 46 different airports, firmly called Bastian to declare Delta's official neutrality in the vote. Specifically, the staff's request was expressed as follows:


"We respectfully request that you demand an answer to your request that Mr. Bastian adopt a policy of neutrality in worker organizing at Delta Air Lines. We need a Yes or No answer."

The employees went further, even suggesting the next steps if Bastian failed to respond to a direct request from Congress for the airline's neutrality. Should the CEO do so, the company's workers would seek a public hearing before Congress on the issue of unionization, one that could be entirely free from management influence.



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A problematic history

Earlier this year, on February 13, a group of 140 members of Congress, including high-profile representatives like New York's Alexandria Ocasio-Cortez, urged Delta to remain neutral because of its problematic history regarding union relations. According to Reuters, members of Congress were quick to indicate that the airline maintained a reputation for deploying union-busting tactics.

Photo: Kevin Hackert | Shutterstock

Such tactics can significantly sway workers away from unionizing, including threatening the termination of employee benefits and distributing anti-union literature. Some lawmakers even indicated that an anti-union website was created, which conveyed the pro-union campaign in a hostile manner.

With this in mind, a request for a neutrality agreement does not seem too much to ask. According to lawmakers, such an agreement would only consist of Delta agreeing not to participate in anti-union pre-election activities. In the eyes of Delta employees, the decision to unionize should be theirs alone.

India's Regulator Delays Pilot Fatigue Rule After Airline Objections

BYGAURAV JOSHI

PUBLISHED 14 HOURS AGO

The previous deadline was June 1, which raised concerns with Indian carriers.

Photo: Media_works | Shutterstock


SUMMARY

Indian airlines can continue using existing pilot duty rules, as DGCA delays the implementation of new regulations.

Proposed changes would have required hiring more pilots or having reduced flights during the summer.

The Indian aviation watchdog had proposed an increased rest period and reduced pilot duty time to address concerns about pilot fatigue.


In a massive relief to Indian airlines, the country’s aviation regulator has delayed the implementation of new flight duty timings for pilots. The issue around pilot fatigue made the authorities revise the number of hours a pilot could fly in India and their rest timings. However, airlines had been worried about meeting the June deadline to implement these changes and were even staring at a reduced summer schedule.
Airlines to continue with existing flight duty rules

India’s aviation regulator, the Directorate General of Civil Aviation (DGCA), has agreed to airlines’ demand to defer the new Flight Duty Time Limitation (FDTL) rules. Indian carriers were initially given until June 1 to implement the revised guidelines - however, given the changes suggested by the regulator under the new rules, airlines would have had to hire many new pilots within a short span of time – a nearly impossible task – or risk cutting flights from the summer schedule.



Photo: WeChitra | Shutterstock

Last month, the Federation of Indian Airlines (FIA), comprising IndiGo, Air India, and SpiceJet, communicated with the DGCA and sought postponement of the new rules by a year. The aviation watchdog finally yielded and has allowed the carriers to continue with the existing regulations for now.

What was proposed by the DGCA?

To keep pilots from experiencing fatigue, the DGCA recently made some significant revisions to their Flight Duty Time Limitations and asked airlines to follow them by June 1.

Photo: Anand Balaji | Shutterstock

It suggested a mandatory weekly rest period for pilots to increase to 48 hours from the current 36 and rewrote the definition of the night period, extending it by an hour from 12 am-5 am to 12 am-6 am. The DGCA also reduced the duty period of pilots to 10 hours and capped the number of landings a pilot could do to two.

Naturally, this did not go down well with Indian airlines, which were looking to increase flight operations during the summer months. They argued that the new rules would require around 25% more pilots, which was difficult to have by June. They also warned that it would result in cutting capacity by around 15-20%.

Pilot fatigue

The DGCA has become more vigilant amid larger conversations regarding pilot fatigue. Last year, pilot fatalities, including two Indian pilots, brought the focus back on grueling pilot schedules and the fatigue that comes with them.

Photo: Luciano de la Rosa | Shutterstock

On August 17, 2023, a 40-year-old IndiGo captain collapsed at Nagpur Airport, right at the boarding gate, just minutes before his scheduled flight to Pune. He was in seemingly good health and had a 27-hour break before duty, according to IndiGo, but died due to cardiac arrest.

Recently, Air India was fined $95,000 for crew rest violations, including inadequate rest before and after long-haul flights. This was done after an audit by the DGCA, in which several violations were found.