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ObjectivesThe aim of this analysis is to identify the patterns of social deprivation and childhood mortality; and identify potential points where public health, social and education interventions, or health policy may be best targeted.DesignDecile of deprivation and underlying population distribution was derived using Office for National Statistics data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile.SettingEngland.Participants2688 deaths before 18 years of age reviewed between April 2019 and March 2020.Main outcome measuresThe relationship between deprivation and risk of death; for deaths with, and without modifiable factors.ResultsThere was evidence of increasing mortality risk with increase in deprivation decile, with children in the least deprived areas having a mortality of 13.25 (11.78–14.86) per 100 000 person-years, compared with 31.14 (29.13–33.25) in the most deprived decile (RR 1.08 (95% CI 1.07 to 1.10)); with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (95% CI 1.09 to 1.15)) vs (RR 1.07 (95% CI 1.05 to 1.08)). Deprivation subdomains of employment, adult education, barriers to housing and services, and indoor living environments appeared to be the most important predictors of child mortalityConclusionsThere is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute-community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

Background Life expectancy inequalities in England have increased steadily since the 1980s. Our aim was to investigate how much deaths from different diseases and injuries and at different ages have contributed to this rise to inform policies that aim to reduce health inequalities. Methods We used vital registration data from the Office for National Statistics on population and deaths in England, by underlying cause of death, from 2001 to 2016, stratified by sex, 5-year age group, and decile of the Index of Multiple Deprivation (based on the ranked scores of Lower Super Output Areas in England in 2015). We grouped the 7·65 million deaths by their assigned International Classification of Diseases (10th revision) codes to create categories of public health and clinical relevance. We used a Bayesian hierarchical model to obtain robust estimates of cause-specific death rates by sex, age group, year, and deprivation decile. We calculated life expectancy at birth by decile of deprivation and year using life-table methods. We calculated the contributions of deaths from each disease and injury, in each 5-year age group, to the life expectancy gap between the most deprived and affluent deciles using Arriaga's method. Findings The life expectancy gap between the most affluent and most deprived deciles increased from 6·1 years (95% credible interval 5·9–6·2) in 2001 to 7·9 years (7·7–8·1) in 2016 in females and from 9·0 years (8·8–9·2) to 9·7 years (9·6–9·9) in males. Since 2011, the rise in female life expectancy has stalled in the third, fourth, and fifth most deprived deciles and has reversed in the two most deprived deciles, declining by 0·24 years (0·10–0·37) in the most deprived and 0·16 years (0·02–0·29) in the second-most deprived by 2016. Death rates from every disease and at every age were higher in deprived areas than in affluent ones in 2016. The largest contributors to life expectancy inequalities were deaths in children younger than 5 years (mostly neonatal deaths), respiratory diseases, ischaemic heart disease, and lung and digestive cancers in working ages, and dementias in older ages. From 2001 to 2016, the contributions to inequalities declined for deaths in children younger than 5 years, ischaemic heart disease (for both sexes), and stroke and intentional injuries (for men), but increased for most other causes. Interpretation Recent trends in life expectancy in England have not only resulted in widened inequalities but the most deprived communities are now seeing no life expectancy gain. These inequalities are driven by a diverse group of diseases that can be effectively prevented and treated. Adoption of the principle of proportionate universalism to prevention and health and social care can postpone deaths into older ages for all communities and reduce life expectancy inequalities.

Background Universal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC. Methods We followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not. Results Overall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged

Background: Little is known about the political views of doctors in the United Kingdom, despite their importance in the functioning of the National Health Service. \ud \ud Methods: Survey-based cross-sectional study in which we asked questions about voting behaviour in 2015 and 2017 UK general elections and 2016 referendum on leaving the European Union (Brexit) and questions relating to recent health policies. \ud \ud Results: 1,172 doctors (45.1% women) from 1,295 responded to an online survey. 60.5% described their political views as ‘left-wing’ and 62.2% described themselves as ‘liberal’. 79.4% of respondents voted to remain in the EU in the 2016 referendum compared to 48.1% of voters as a whole (χ2=819.8, p

В роботі описані результати мікробіологічних та імунологічних показників пацієнтів з хворобою Альцгеймера. В работе описаны результаты микробиологических и иммунологических показателей пациентов с болезнью Альцгеймера. The paper describes the results of microbiological and immunological parameters of patients with Alzheimer's disease.

In-situ electrochemical measurements were used to study the sour corrosion of ultra-high strength low alloy carbon steel (UHSLA) in alkaline brines at 200 °C. The solutions were buffered with NaHCO3 / Na2CO3 / NaOH to pH values calculated to be 8.1, 9.8, and 10.8 with the presence of H2S gas at 200 °C. The partial pressure of H2S was equivalent to 10 psi (69 kPa) at 85 °C. According to thermodynamic calculations, the dominant reactive ion changed from HCO3-(aq) to OH-(aq) with a comparable concentration of HS-(aq) as pH increased. Measured polarization resistance values at 200 °C were one to two orders of magnitude lower than those at 85 °C, which corresponded to a drastic increase in corrosion rate. After 60 hours, the corrosion rates (CR) were 0.84 mm y-1, 2.88 mm y-1, and 1.83 mm y-1 from pH 8.1 to 10.8. The CR calculated with commercial software was in reasonable agreement with the experimental CR. Limiting current was observed in the anodic region using linear sweep voltammetry (LSV) but not in the cathodic region. Even with the effect of limiting current, anodic Tafel slopes, ba, were able to be gathered from LSV using a new method derived from the generalized Butler-Volmer equation. The ba values indicated that the anodic reactions followed the Bockris mechanism at pH 8.1 and a two-electron mechanism at pH 9.8 and 10.8. Cathodic Tafel slopes corresponded to a two-electron mechanism in the three conditions. Two layers were observed on the surface at pH 8.1 and 9.8, and the outer layer spalled off in some regions. As the pH increased, the major corrosion products transitioned from pyrrhotite/siderite to magnetite, and the S distribution moved outward from the inner layer.

The Dark Matter Time Projection Chamber (DMTPC) collaboration is developing a low pressure gas TPC for detecting Weakly Interacting Massive Particle (WIMP)-nucleon interactions. Optical readout with CCD cameras allows for the detection of the daily modulation of the direction of the dark matter wind. In order to reach sensitivities required for WIMP detection, the detector needs to minimize backgrounds from electron recoils. This paper demonstrates that a simplified CCD analysis achieves 7.3 × 10[superscript −5] rejection of electron recoils while a charge analysis yields an electron rejection factor of 3.3 × 10[superscript −4] for events with [superscript 241]Am-equivalent ionization energy loss between 40 keV and 200 keV. A combined charge and CCD analysis yields a background-limited upper limit of 1.1 × 10[superscript −5] (90% confidence level) for the rejection of γγ and electron events. Backgrounds from alpha decays from the field cage are eliminated by introducing a veto electrode that surrounds the sensitive region in the TPC. CCD-specific backgrounds are reduced more than two orders of magnitude when requiring a coincidence with the charge readout., United States. Dept. of Energy (Grant DE-FG02-05ER41360), United States. Dept. of Energy. Advanced Detector Research Program (Contract 6916448), Reed Award Program, Ferry Fund, MIT Department of Physics Pappalardo Program (Fellowship), Kavli Institute for Astrophysics and Space Research, MIT Bates Research and Engineering Center, Massachusetts Institute of Technology. Department of Physics