An Investigation into the environmental impact of off-licensed premises on residential neighbourhoods

In recent times there has been a great deal of concern about levels of anti-social behaviour across the UK. Several reports have investigated the role of alcohol as a potentially important contributor to this problem. Most research has concentrated on public houses and nightclubs. This is in contrast to the view that the off-trade sector is indicated as the source of the current rise in alcohol consumption across the UK over the past 20 years. This research focusing on licensed convenience stores (grocers / newsagents) operating in residential areas and these often provide a broad range of services for the wider community, not just drinkers or the over-18s. The impact of such premises on residents is likely to be continuous and long-lasting, affecting the whole community

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018 [version 3; peer review: 2 approved]

BACKGROUND: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. METHODS: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. RESULTS: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. CONCLUSIONS: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination

The relationship between CM and CO chondrites: Insights from combined analyses of titanium, chromium, and oxygen isotopes in CM, CO, and ungrouped chondrites

A close relationship between CM and CO chondrites has been suggested by previous petrologic and isotopic studies, leading to the suggestion that they may originate from similar precursor materials or even a common parent body. In this study, we evaluate the genetic relationship between CM and CO chondrites using Ti, Cr, and O isotopes. We first provide additional constraints on the ranges of ε50Ti and ε54Cr values of bulk CM and CO chondrites by reporting the isotopic compositions of CM2 chondrites Murchison, Murray, and Aguas Zarcas and the CO3.8 chondrite Isna. We then report the ε50Ti and ε54Cr values for several ungrouped and anomalous carbonaceous chondrites that have been previously reported to exhibit similarities to the CM and CO chondrite groups, including Elephant Moraine (EET) 83226, EET 83355, Grosvenor Mountains (GRO) 95566, MacAlpine Hills (MAC) 87300, MAC 87301, MAC 88107, and Northwest Africa (NWA) 5958, and the oxygen isotope compositions of a subset of these samples. We additionally report the ε50Ti, ε54Cr, and O isotopic compositions of additional ungrouped chondrites LaPaz Ice Field (LAP) 04757, LAP 04773, Lewis Cliff (LEW) 85332, and Coolidge to assess their potential relationships with known carbonaceous and ordinary chondrite groups. LAP 04757 and LAP 04773 exhibit isotopic compositions indicating they are low-FeO ordinary chondrites. The isotopic compositions of Murchison, Murray, Aguas Zarcas, and Isna extend the compositional ranges defined by the CM and CO chondrites in ε50Ti versus ε54Cr space. The majority of the ungrouped carbonaceous chondrites with documented similarities to the CM and/or CO chondrites plot outside the CM and CO group fields in plots of ε50Ti versus ε54Cr,Δ17O versus ε50Ti, and Δ17O versus ε54Cr. Therefore, based on differences in their Ti, Cr, and O-isotopic compositions, we conclude that the CM, CO, and ungrouped carbonaceous chondrites likely represent samples of multiple distinct parent bodies. We also infer that these parent bodies formed from precursor materials that shared similar isotopic compositions, which may indicate formation in regions of the protoplanetary disk that were in close proximity to each other

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.</ns4:p

Petrography, stable isotope compositions, microRaman spectroscopy, and presolar components of Roberts Massif 04133: A reduced CV3 carbonaceous chrondrite

Here, we report the mineralogy, petrography, C-N-O-stable isotope compositions, degree of disorder of organic matter, and abundances of presolar components of the chondrite Roberts Massif (RBT) 04133 using a coordinated, multitechnique approach. The results of this study are inconsistent with its initial classification as a Renazzo-like carbonaceous chondrite, and strongly support RBT 04133 being a brecciated, reduced petrologic type \u3e3.3 Vigarano-like carbonaceous (CV) chondrite. RBT 04133 shows no evidence for aqueous alteration. However, it is mildly thermally altered (up to approximately 440 °C); which is apparent in its whole-rock C and N isotopic compositions, the degree of disorder of C in insoluble organic matter, low presolar grain abundances, minor element compositions of Fe,Ni metal, chromite compositions and morphologies, and the presence of unequilibrated silicates. Sulfides within type I chondrules from RBT 04133 appear to be pre-accretionary (i.e., did not form via aqueous alteration), providing further evidence that some sulfide minerals formed prior to accretion of the CV chondrite parent body. The thin section studied contains two reduced CV3 lithologies, one of which appears to be more thermally metamorphosed, indicating that RBT 04133, like several other CV chondrites, is a breccia and thus experienced impact processing. Linear foliation of chondrules was not observed implying that RBT 04133 did not experience high velocity impacts that could lead to extensive thermal metamorphism. Presolar silicates are still present in RBT 04133, although presolar SiC grain abundances are very low, indicating that the progressive destruction or modification of presolar SiC grains begins before presolar silicate grains are completely unidentifiable

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570