Excess mortality in the Glasgow conurbation: exploring the existence of a Glasgow effect

Introduction There exists a ‘Scottish effect’, a residue of excess mortality that remains for Scotland relative to England and Wales after standardising for age, sex and local area deprivation status. This residue is largest for the most deprived segments of the Scottish population. Most Scottish areas that can be classified as deprived are located in West Central Scotland and, in particular, the City of Glasgow. Therefore the central aim of this thesis is to establish the existence of a similar ‘Glasgow effect’ and identify if the relationship between deprivation and all cause mortality is different in Glasgow to what is in other, comparable cities in the UK. Methods A method to compare the deprivation status of several UK cities was devised using the deprivation score first calculated by Carstairs and Morris. The population of mainland UK was broken into deciles according to the Carstairs score of Scottish postcode sectors and English wards. Deprivation profiles for particular cities were drawn according to the percentage of the local population that lived in each Carstairs decile. Using data from the three censuses since 1981, longitudinal trends in relative deprivation status for each city could be observed. Analysis of death rates in cities was also undertaken. Two methods were used to compare death rates in cities. Indirect standardisation was used to compare death rates adjusting for the categorical variables of age group, sex and Carstairs decile of postcode sector or ward of residence. Negative binomial models of death counts in small areas using local population as the exposure variable were also created; such models allow the calculation of SMRs with adjustment for continuous variables. Covariates used in these models included city of residence, age group, sex, Carstairs z-score and also the z-scores for each of the four variables from which the Carstairs score is comprised (lack of car ownership, low social class, household overcrowding and unemployment). Results The deprivation profiles confirmed that all UK cities have a high proportion of deprived residents, although some cities have far higher proportions than others. Some cities appeared to show relative improvement in deprivation status over time whilst others seemed resistant to change. Glasgow was the most deprived city at all census time points and the Clydeside conurbation was also more deprived than all other conurbations. SMRs calculated by indirect standardisation indicated that many cities have excess mortality compared to the whole of the UK when adjusting for age group and sex only. Three cities, Glasgow, Liverpool and Manchester, had SMRs that were significantly higher than all other cities at every census time point. Adjusting SMRs for Carstairs deprivation decile diminished the magnitude of this excess mortality in most cities. However, adjusting for Carstairs decile did not diminish the excess mortality in Glasgow sufficiently and there remained a significant, unexplained residue of excess mortality in Glasgow. SMRs generated by regression models adjusting for continuous variables were able to reduce the size of the excess mortality in most cities, though the model producing the lowest SMR varied from place to place and from time to time. In Glasgow, a regression model including age group, sex and lack of car ownership as covariates explained most of the excess mortality at all three time points. Discussion and Conclusion The relationship between deprivation (as measured by the Carstairs index) and death rates in Glasgow did appear to be different to other cities, and there seems to be evidence of a Glasgow effect. There are several reasons why this might be the case, including; the Glasgow effect may be apparent rather than real – an artefact of the Carstairs measure of deprivation failing to capture the complex nature of multiple deprivation; The effect may be the result of migration patterns to and from the city; the effect may be the result of historical levels of deprivation; or the effect may result from different behavioural patterns among Glasgow residents compared to residents of other UK cities. In conclusion, the results show that continued efforts by public health professionals, politicians and residents have failed to produce a step change in the city’s relative health status and Glasgow continues to lag some way behind other cities in the UK. The ability of the Carstairs measure to describe multiple deprivation is called into question. Future research should focus on identifying specific causes of mortality that contribute to the Glasgow effect; on qualitative work to identify if there is a distinct set of social norms in deprived neighbourhoods of Glasgow that contribute to unhealthy patterns of behaviour; and on creating a deprivation index that can be used on equivalent units of geographical area in both Scotland and England

Simple basal meningitis in children

Simple Basal Meningitis defines itself as regards its position, though it might be more correct to describe it, as is sometimes done, as Posterior Basic Meningitis, for it is invariably met with at the posterior part of the bases of the brain, at the junction of the cerebellum with the medulla, and in the interpeduncular space. It is named "simple" in contra distinction to the tuberculous variety also affecting the base of the brain.In this thesis, I have included only cases which have been proved either by bacteriological examination to be due to the diplococcus of Still, or where from a clinical evidence, one may conclude that such was the cause. Pneumo- coccal and meningitis secondary to suppurating conditions, I have not included. The cases to be tabulated later have all been culled from the records of the Royal Hospital for Sick Children, Edinburgh, and comprise those that were admitted to that hospital during the years 1900, 1901 and 1902

Methodology for Life Testing of Refractory Metal/Sodium Heat Pipes

The focus of this work was to establish an approach to generate carefully controlled data that can conclusively establish heat pipe operating life with material-fluid combinations capable of extended operation. To accomplish this goal acceleration is required to compress 10 years of operational life into 3 years of laboratory testing through a combination of increased temperature and mass fluence. Specific test series have been identi3ed, based on American Society for Testing and Materials (ASTM) specifications, to investigate long term corrosion rates. The refractory metal selected for demonstration purposes is a Molybdenum-44.5%Rhenium alloy formed by powder metallurgy. The heat pipe makes use of an annular crescent wick design formed by hot isostatic pressing of Molybdenum-Rhenium wire mesh. The heat pipes are filled using vacuum distillation and purity sampling is considered. Testing of these units is round-the-clock with 6-month destructive and non-destructive inspection intervals to identify the onset and level of corrosion. Non-contact techniques are employed for providing power to the evaporator (radio frequency induction heating at I to 5 kW per unit) and calorimetry at the condenser (static gas gap coupled water cooled calorimeter). The planned operating temperature range would extend from 1123 to 1323 K. Accomplishments prior to project cancellation included successful demonstration of the heat pipe wick fabrication technique, establishment of all engineering designs, baselined operational test requirements and procurement/assembly of supporting test hardware systems

Life Test Approach for Refractory Metal/Sodium Heat Pipes

Heat pipe life tests described in the literature have seldom been conducted on a systematic basis. Typically one or more heat pipes are built and tested for an extended period at a single temperature with simple condenser loading. This paper describes an approach to generate carefully controlled data that can conclusively establish heat pipe operating life with material-fluid combinations capable of extended operation. Approximately 10 years of operational life might be compressed into 3 years of laboratory testing through a combination of increased temperature and mass fluence. Two specific test series have been identified and include: investigation of long term corrosion rates based on the guidelines contained in ASTM G-68-80 (using 7 heat pipes); and investigation of corrosion trends in a cross correlation sequence at various temperatures and mass fluences based on a central composite test design (using 9 heat pipes). The heat pipes selected for demonstration purposes are fabricated from a Mo-44.5%Re alloy with a length of 0.3 meters and a diameter of 1.59 cm(to conserve material) with a condenser to evaporator length ratio of approximately 3. The wick is a crescent annular design formed from 400-mesh Mo-Re alloy material hot isostatically pressed to produce a final wick core of 20 microns or less

Fault location and diagnosis in a medium voltage EPR power cable

This paper presents a case study on fault location, characterization and diagnosis in a length of shielded 11 kV medium voltage ethylene-propylene rubber (EPR) power cable. The defect was identified on-site as a low resistance fault occurring between the sheath and the core. A 43 m section was removed for further analysis. The fault resistance was characterized and the location of the defect pinpointed to within a few cm using a combination of time-difference-of-arrival location and infra-red imaging. A combination of X-ray computed tomography, scanning electron microscopy and energy dispersive X-ray spectroscopy were then applied to characterize any abnormalities in the dielectric surrounding the breakdown region. A significant number of high density contaminants were found to be embedded in the dielectric layer, having an average diameter of the order of 100 um, a maximum diameter of 310 um and an average density of 1 particle per 2.28 mm3 . Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to determine the geometry and elemental composition of some initial contaminant samples. It was concluded that contamination of the EPR layer, combined with an observed eccentricity of the cable’s core and sheath resulting in a reduced insulation gap, may have led to an electric field concentration in the region of the defect sufficient to initiate breakdown. Preventative strategies are discussed for similar families of cables, including more stringent dielectric testing requirements at the manufacturing stage and PD monitoring to detect incipient failure

Is native speaker intuition reliable for high-frequency context creation?

This study determined whether native speaker intuition could be relied upon to producecontextual content that mostly fell into what is considered high-frequency vocabulary. Native speakers wrote over 160,000 tokens worth of example sentences for high-frequency multi-word units derived from a corpus. The resulting database was examined to determine whether the content added by the native speakers mostly stayed within the high-frequency realm.Results showed that not only did the vast majority of native speakers\u27 tokens fall into the high-frequency realm, the percentage that fell into the high-frequency realm only dropped by 0.84 percent in comparison to the multi-word units alone despite the large amount of data beingadded. This study highlighted how the intuition of experienced ESL practitioners can be relied upon to produce high-frequency contextual content

Motor pathway degeneration in young ataxia telangiectasia patients: A diffusion tractography study

Background: Our understanding of the effect of ataxia-telangiectasia mutated gene mutations on brain structure and function is limited. In this study, white matter motor pathway integrity was investigated in ataxia telangiectasia patients using diffusion MRI and probabilistic tractography

Experimental results for nulling the effective thermal expansion coefficient of fused silica fibres under a static stress

We have experimentally demonstrated that the effective thermal expansion coefficient of a fused silica fibre can be nulled by placing the fibre under a particular level of stress. Our technique involves heating the fibre and measuring how the fibre length changes with temperature as the stress on the fibre was systematically varied. This nulling of the effective thermal expansion coefficient should allow for the complete elimination of thermoelastic noise and is essential for allowing second generation gravitational wave detectors to reach their target sensitivity. To our knowledge this is the first time that the cancelation of the thermal expansion coefficient with stress has been experimentally observed

Protocols and Structures for Inference: A RESTful API for Machine Learning

Abstract Diversity in machine learning APIs (in both software toolkits and web services), works against realising machine learning's full potential, making it difficult to draw on individual algorithms from different products or to compose multiple algorithms to solve complex tasks. This paper introduces the Protocols and Structures for Inference (PSI) service architecture and specification, which presents inferential entities-relations, attributes, learners and predictors-as RESTful web resources that are accessible via a common but flexible and extensible interface. Resources describe the data they ingest or emit using a variant of the JSON schema language, and the API has mechanisms to support non-JSON data and future extension of service features

Star formation towards the Scutum tangent region and the effects of Galactic environment

By positional matching to the catalogue of Galactic Ring Survey molecular clouds, we have derived distances to 793 Bolocam Galactic Plane Survey (BGPS) sources out of a possible 806 located within the region defined by Galactic longitudes l = 28.5 degr to 31.5 degr and latitudes |b| < 1 degr. This section of the Galactic Plane contains several major features of Galactic structure at different distances, mainly mid-arm sections of the Perseus and Sagittarius spiral arms and the tangent of the Scutum-Centarus arm, which is coincident with the end of the Galactic Long Bar. By utilising the catalogued cloud distances plus new kinematic distance determinations, we are able to separate the dense BGPS clumps into these three main line-of-sight components to look for variations in star-formation properties that might be related to the different Galactic environments. We find no evidence of any difference in either the clump mass function or the average clump formation efficiency (CFE) between these components that might be attributed to environmental effects on scales comparable to Galactic-structure features. Despite having a very high star-formation rate, and containing at least one cloud with a very high CFE, the star formation associated with the Scutum-Centarus tangent does not appear to be in any way abnormal or different to that in the other two spiral-arm sections. Large variations in the CFE are found on the scale of individual clouds, however, which may be due to local triggering agents as opposed to the large-scale Galactic structure.Comment: 11 pages, 8 figures. Accepted for publication in the Monthly Notices of the Royal Astronomical Societ