Evaluating the causal impact of individual alcohol licensing decisions on local health and crime using natural experiments with synthetic controls.

BACKGROUND AND AIMS: Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision-making. We aimed to assess whether alcohol licensing decisions could be evaluated at small spatial scale by using a causal inference framework. DESIGN: Three natural experiments. SETTING AND PARTICIPANTS: Three English local areas of 1000-15 000 people each. INTERVENTION AND COMPARATOR: The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared with synthetic counterfactuals created using Bayesian structural time-series. MEASUREMENTS: Time-series data were obtained on emergency department admissions, ambulance call-outs and alcohol-related crime at the Lower or Middle Super Output geographical aggregation level. FINDINGS: Closure of the nightclub led to temporary 4-month reductions in antisocial behaviour (-18%; 95% credible interval - 37%, -4%), with no change in other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance led to small reductions in drunk and disorderly behaviour (nine of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of two incidents per month. CONCLUSIONS: The impact of local alcohol policy, even at the level of individual premises, can be evaluated using a causal inference framework. Local government actions such as closure or restriction of alcohol venues and alcohol licensing may have a positive impact on health and crime in the immediate surrounding area.

Postexercise cold-water immersion does not attenuate muscle glycogen resynthesis.

PURPOSE: The aim of this study was to test the hypothesis that postexercise cold-water immersion (CWI, via its associated reductions in skeletal muscle blood flow) attenuates muscle glycogen resynthesis during short-term recovery from exhaustive exercise. METHODS: In a repeated-measures design, nine recreationally active men performed an exhaustive glycogen depleting cycling protocol (consisting of intermittent exercise the night before and steady-state exercise on the subsequent morning of the main trial) followed by 10 min of lower-limb CWI (8°C) or remained seated in normal ambient conditions (CONT). Subjects were fed carbohydrate (CHO) at an ingestion rate of 0.6 g·kg body mass at 30 min postexercise and at 1, 2, and 3 h postexercise. RESULTS: Reductions in thigh skin temperature and muscle temperature during postexercise recovery were greater in CWI compared with CONT (P < 0.01). In addition, norepinephrine and blood glucose concentrations were increased and decreased, respectively, during recovery in CWI compared with CONT (P < 0.01). Postexercise muscle glycogen (CONT and CWI postexercise = 76 ± 43 and 77 ± 26 mmol·kg dry weight [dw], respectively; mean ± SD) progressively increased (P < 0.01) during recovery, although rates of resynthesis did not differ (P = 0.719) between conditions (CONT and CWI 4 h postexercise = 160 ± 34 and 157 ± 59 mmol·kg dw, respectively). Total glycogen synthesis during recovery was comparable (CONT and CWI = 83 ± 43 and 79 ± 58 mmol·kg dw, respectively). CONCLUSIONS: Postexercise CWI does not attenuate muscle glycogen resynthesis rates during short-term recovery even when CHO availability is considered suboptimal. Athletes who regularly incorporate CWI as a recovery strategy to alleviate symptoms of exercise-induced muscle damage should therefore not be concerned with potential negative effects of the associated reductions in muscle blood flow on the restoration of muscle glycogen stores.