Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001

International evidence suggests that there are substantial socio-economic inequalities in the delivery of specialist health services, even in the UK and other high-income countries with publicly funded health systems (Goddard and Smith 2001, Dixon et al. 2003, Van Doorslaer, Koolman and Jones 2004, Van Doorslaer et al. 2000). Studies of total hip replacement in the English NHS have yielded particularly striking examples, given that hip replacement is such a common, effective and longestablished health technology. Administrative data show that people living in deprived areas are less likely to receive hip replacement (Chaturvedi and Ben-Shlomo 1995, Dixon et al. 2004) while survey data suggest they may be more likely to need it (Milner et al. 2004). However, previous studies have not examined change in inequality over time. This paper presents evidence on the change in socio-economic inequality in small area use of elective total hip replacement in the English NHS, comparing 1991 with 2001. This was a period of important large-scale health care reform in England, involving at least two significant reforms that might potentially have influenced socio-economic inequality in health care delivery: (1) the introduction and subsequent abolition of the Conservative “internal market” 1991-7, and (2) the introduction in 1995 of a revised NHS resource allocation formula designed to reduce geographical inequalities in health care delivery. Two datasets, for 1991 and 2001, were assembled from routine NHS data sources: Hospital Episode Statistics (HES) on hospital utilisation in England and the corresponding decennial National Censuses in 1991 and 2001. Both datasets contain information on over 8,000 electoral wards in England (over 95% of the total). To improve comparability, a common geography of frozen 1991 wards was adopted. The Townsend deprivation score was employed as an indicator of socio-economic status. Inequality was analysed in two ways. First, for comparability with previous small area studies of hip replacement, by using simple range measures based on indirectly age-sex standardised utilisation ratios (SURs) by deprivation quintile groups. Second, using concentration indices of deprivationrelated inequality in use based on indirectly age-sex standardised utilisation ratios for each individual small area. Each SUR is the observed use divided by the expected use, if each age and sex group in the study population had the same rates of use as the national population.

Stratigraphic Overview of Palaeogene Tuffs in the Faroe-Shetland Basin, NE Atlantic Margin

Acknowledgements We are very grateful to PGS for generously donating seismic datasets. Seismic interpretation was carried out using IHS Kingdom software, and wells were downloaded from the UK Oil & Gas Common Data Access Welllog interpretation was conducted using Schlumberger Techlog software. D.W. would also like to thank C. Telford for insights regarding the identification of tuffs in ditch cuttings and Total (UK) for material concerning the Vaila Formation. Attendees of VMRC workshops from academia and industry provided important insights into the stratigraphy of the FSB. Finally,D.W.would like to acknowledge the late Robert Knox, without whom our knowledge of North Atlantic explosive volcanism would be considerably poorer. The reviews of P. Reynolds and J. Ólavsdóttir greatly improved the paper. Funding This work is part of D.W.’s PhD research, which is funded by a University of Aberdeen College of Physical Sciences Scholarship.Peer reviewedPostprin

Design of potential antiprotozoal daunorubicin derivatives

Daunorubicin is an antitumour antibiotic which is highly active against the sleeping sickness parasite Trypanosoma rhodesiense in vitro, but which lacks in vivo activity. The object of this work was to modify daunorubicin so as to promote in vivo activity, and to study the mechanism by which daunorubicin is trypanocidal. A series of daunorubicin analogues, and derivatives in which daunorubicin was linked to a macromolecular carrier (known as daunorubicin conjugates) were prepared, and tested against trypanosome infected mice. Only daunorubicin conjugates in which drug was linked to the carrier by glutaraldehyde, were active. Treatment with these conjugates increased the survival time of infected mice from three days to as long as eleven days, and temporarily cleared parasites from the bloodstream of infected animals. Conjugates with other types of linkage were inactive. A fluorescence assay method was developed to measure drug release from conjugates. Investigation revealed that glutaraldehyde linked conjugate released about 20% of bound drug over a 2-3 hour period when incubated in murine plasma. In contrast, inactive conjugates either released bound drug very rapidly, or were stable to drug release. Daunorubicin is known to possess several potentially cytotoxic mechanisms of action, the most important being intercalation into the DNA double hel~x and stimulation of superoxide radical formation. In order to discover the contribution of these mechanisms to trypanocidal activity, the trypanocidal potency of a series of daunorubicin analogues was assessed in vitro. The ability of these analogues to intercalate into DNA and to stimulate lipid peroxidation and oxygen consumption was also assessed. The results were used to explore the relationship between these mechanisms and trypanocidal activity. These studies indicate that ability to bind to DNA is important in conferring trypanocidal activity on this group of antibiotics

Barrier Formation in the Human Fetus is Patterned

We recently demonstrated patterned stratum corneum maturation and skin barrier formation during fetal development in rodents and rabbit. The presence of skin patterning in these mammals led us to predict patterned barrier formation during human infant development. Here we extend our mammalian study and demonstrate patterned stratum corneum development and skin barrier formation in the pre-term human infant. Surprisingly, we show initiation of human barrier regionally as early as 20–24 wk gestational age (22–26 wk menstrual age), bringing barrier formation close to the time of periderm disaggregation. We use the mouse model to show that patterns of periderm disaggregation mirrors barrier formation. Periderm disaggregation follows and recapitulates barrier pattern, suggesting a relationship between the processes. This work reveals regional patterning in skin maturation and barrier formation in the human infant and demonstrates that initiation of human skin barrier formation in utero coincides with the current lower limit of viability of the pre-term infant

Teacher quality, recruitment, and retention: Rapid Evidence Assessment

This rapid evidence assessment identifies areas for future research on teacher quality, recruitment and retention, with the aim of informing the focus of the Education Endowment Foundation’s (EEF’s) future research commissioning on this topic. Given that ensuring access to quality teaching for disadvantaged pupils is expected to be a key mechanism for narrowing the disadvantage gap in attainment, there is a strong rationale for the EEF to build the evidence base on the recruitment and retention of quality teachers. The report set out to scope the field and summarise existing evidence on this topic. The report also identifies gaps in the research; for example, areas that have been researched qualitatively but not investigated experimentally or developed into a testable intervention. The rapid evidence assessment includes two reviews, each summarising a key area of research: - Review 1 focused on measures of (or proxies for) teacher quality commonly used in the literature. - Review 2 focused on strategies for the recruitment, retention and distribution of quality teachers to schools serving disadvantaged communities

SMART Spaces: Spaced Learning Revision Programme - Evaluation Report

SMART Spaces: Spaced Learning Revision Programme (SMART Spaces Revision) aims to raise attainment in GCSE chemistry by improving revision using ‘spaced learning’. Spaced learning involves teachers repeatedly delivering the same content, across multiple sessions, with breaks in between. The programme, developed and delivered by Hallam Teaching School Alliance (HTSA) and Queen’s University Belfast (QUB), trains teachers to deliver six highly structured and manualised chemistry revision lessons for the AQA Combined Science GCSE. Lessons are provided to Year 11 pupils (age 15 to 16) in the three-week period prior to GCSE examinations. Each lesson consists of three 12-minute episodes delivering content separated by two ten-minute spacing activities such as juggling. Lessons are delivered on three separate days, which allows additional spaces of around 24 hours between content repetition. The first three lessons repeatedly cover one half of the curriculum and the second three lessons repeatedly cover the other half. SMART Spaces Revision training involves a lead teacher who supports implementation and chemistry teachers who receive a day of instruction (in twilight sessions). In-school follow-up support and teaching resources are also provided. Resources include PowerPoint slides covering the entire chemistry curriculum content for the AQA Combined Science award together with a manual, an activity pack, and spacing materials. This project was a two-armed, cluster-randomised controlled efficacy trial (c-RCT) with 125 schools from across England: 54 schools were randomly allocated to receive the intervention and 71 acted at the ‘business as usual’ control group; 14,098 pupils from Year 11 taking the AQA Combined Science GCSE took part in the trial. The evaluation tested the impact of the intervention on GCSE chemistry attainment with surveys and interviews with teachers and pupils and observations of training informing the process evaluation. The evaluation was conducted by the IOE at UCL’s Faculty of Education and Society and delivery occurred between April and May 2019

SMART Spaces: Chemistry Teaching - Pilot report

The SMART Spaces Chemistry Teaching programme (SMART Spaces Chemistry Teaching) aims to improve the factual recall of pupils in order to free up lesson time so that teachers can spend more time on pedagogies that embed and extend knowledge—such as practical work and discussion—to improve pupils’ abilities to analyse and evaluate science. This project aimed to see if the programme leads to teachers being able to change the content and practice of their teaching so as to increase time allocated to application and evaluation in chemistry teaching. The programme is a whole-class programme delivered by GCSE science teachers to all pupils undertaking AQA combined award science in Year 10. It is an adapted version of SMART Spaces: Spaced Learning Revision programme (SMART Spaces Revision). SMART Spaces Revision is conducted in the weeks before GCSE examinations whereas the teaching version is conducted during science lessons throughout the year. Delivery is timed to prime pupils in new content and reinforce recall of taught content through ‘spaced learning’. This involves using a scripted presentation to deliver three lots of condensed chemistry content, each lasting 12 minutes, with ten minutes of spacing activity in between. This is repeated in three consecutive lessons, a day apart, termed ‘blocks’, three times across the year. Professional development training is delivered to heads of department and teachers of chemistry by a trainer experienced in the delivery of SMART Spaces. It involves a half-day workshop followed by an in-school coaching visit. Teaching resources are provided, including scripted slides covering the entire GCSE combined science chemistry curriculum, a SMART Spaces manual, and guidelines to develop teaching to maximise the benefit of the additional time created by improved pupil recall. This evaluation was a pilot, which commenced in September 2018 and finished in December 2019. Due to initial delays at start up, during the pilot the project was extended from one academic year to four terms: three in Year 10 and one in Year 11. Some schools were not able to continue with the pilot and new schools were recruited to replace them. This meant that some schools were unable to deliver a fourth block of sessions in the fourth term and some could not complete delivery of three blocks as they started the project later. In total, 12 schools were recruited and undertook training of which nine delivered the intervention. Within these nine, 26 teachers and 714 pupils were involved in the project. The evaluation followed pupils as they moved from Year 10 into Year 11 (ages 14 to16). The evaluation aimed to assess the promise of the intervention according to the theory of change, feasibility, and readiness of the programme for trial. UCL’s Institute of Education undertook the evaluation, which involved a mixed-methods implementation and process evaluation (IPE) using surveys, interviews, and observations with teachers and pupils. The intervention was developed by a team from Queen’s University Belfast (QUB) and Hallam Teaching School Alliance (HTSA). The project was co-funded by the Education Endowment Foundation (EEF) and Wellcome