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Across international contexts, people with serious mental illnesses (SMI) experience marked reductions in life expectancy at birth. The intersection of ethnicity and social deprivation on life expectancy in SMI is unclear. The aim of this study was to assess the impact of ethnicity and area-level deprivation on life expectancy at birth in SMI, defined as schizophrenia-spectrum disorders, bipolar disorders and depression, using data from London, UK.
Abridged life tables to calculate life expectancy at birth, in a cohort with clinician-ascribed ICD-10 schizophrenia-spectrum disorders, bipolar disorders or depression, managed in secondary mental healthcare. Life expectancy in the study population with SMI was compared with life expectancy in the general population and with those residing in the most deprived areas in England.
Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Similar reductions were noted for people with depression. Across all diagnoses, life expectancy at birth in people with SMI was lower than the general population residing in the most deprived areas in England.
Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England. This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account.
Precise measurements of basal melting have been made at a series of 14 sites lying within a few kilometres of the grounding line of the Ronne Ice Shelf, Antarctica, where the ice thickness ranges from 1570 to 1940 m. The study was conducted over the course of 1 year and included a detailed survey of the horizontal deformation, as well as phase-sensitive radar measurements of the vertical displacement of both internal reflecting horizons and the ice-shelf base. Results from the surface survey show that the long-term viscous strain rate is modulated at tidal frequencies by (probably) elastic strains of order 10−5 per metre of tidal elevation. The radar measurements show a similar modulation of the long-term thinning/thickening of the ice shelf, with thickness oscillations up to a few centimetres in range. The long-term trends in ice thickness determined at points moving with the ice-shelf flow are consistent with a steady-state thickness profile. Vertical strain rates within the ice shelf were determined from the relative motion of internal reflectors. At two sites the observations were sufficient to discern the effect of tidal bending about a neutral surface 60% of the way down the ice column. Coincident measurements of horizontal and vertical strain imply a Poisson’s ratio of 0.5, and this combined with the asymmetric bending gives rise to the observed oscillations in thickness. At a number of sites the longterm viscous strain rates were found to be a linear function of depth. For an ice shelf this is an unexpected result. It can be attributed to the presence of significant vertical shear stresses set up close to the grounding line where the ice is still adjusting to flotation. Additional vertical motion arising from firn compaction was observed within the upper layers of the ice shelf. The additional motion was consistent with the assumption that firn density is a function only of the time since burial by steady surface accumulation. With both spatial and temporal fluctuations in the vertical strain rate accurately quantified it was possible to estimate the vertical motion of the ice-shelf base in response. Differences between the calculated and observed motion of the basal reflector arise because of basal melting. Derived melt rates at the 14 sites ranged from −0.11 ±0.31 to 2.51 ±0.10 m a−1, with a mean of 0. 85 m a−1 and a standard deviation of 0.69 m a−1, and showed no signs of significant sub-annual temporal variability. There was no obvious global correlation with either ice thickness or distance from the grounding line, although melt rates tended to decrease downstream along each of the flowlines studied. Previous estimates of basal melting in this region have been obtained indirectly from an assumption that the ice shelf is locally in equilibrium and have included a broad range of values. Only those at the lower end of the published range are consistent with the directly measured melt rates reported here.
The ApRES (autonomous phase-sensitive radio-echo sounder) instrument is a robust, lightweight and relatively inexpensive radar that has been designed to allow long-term, unattended monitoring of ice-shelf and ice-sheet thinning. We describe the instrument and demonstrate its capabilities and limitations by presenting results from three trial campaigns conducted in different Antarctic settings. Two campaigns were ice sheet-based – Pine Island Glacier and Dome C – and one was conducted on the Ross Ice Shelf. The ice-shelf site demonstrates the ability of the instrument to collect a time series of basal melt rates; the two grounded ice applications show the potential to recover profiles of vertical strain rate and also demonstrate some of the limitations of the present system.
To assess the general health and activity levels of 4- and 5-year-old children after intervention for congenital cardiac disease.
Health behaviour outcomes were assessed in 91 children who had surgery or catheter intervention for congenital cardiac disease. The children were classified into four groups according to severity. The main parameters of classification were the presence of residual symptoms, frequency of visits to general practitioner or the Accident and Emergency Department, and ability to participate in physical activity according to a calculated “activity score”.
Children had very few residual symptoms after “corrective surgery”. Those with complex congenital cardiac disease post-Fontan-type repair still had symptoms on average 18.2 days per month. Surprisingly, the complex group had fewer days “sick” from non-cardiac causes and had fewer visits to general practitioner or Accident and Emergency Departments. Regression analysis indicates that three variables had significant relevance to the general practitioner or Accident and Emergency visits: complex congenital cardiac disease, fewer visits; Townsend score – more deprivation – more visits; and maternal worry – higher maternal worry score – more visits. Regression analysis indicates that lower activity score is significantly related to complex cardiac disease and higher maternal worry score.
The majority of this group of 4- and 5-year-old children had few residual symptoms and had good exercise tolerance. Maternal worry is a significant factor in influencing both activity levels and frequency of unscheduled health service demands – general practitioner or Accident and Emergency visits.
This article provides a partial test of the rational-technical model and of the patronage model of political mobility in the Soviet Communist Party. Two major hypotheses are examined: 1) the greater the number of patron client ties acquired by regional Party secretaries, the greater the probability of their upward mobility, and 2) the better the economic performance of the regions for which secretaries are responsible, the greater the probability of their upward mobility. Multiple regression analysis indicates only very weak support for these hypotheses for the 1955–1968 period in the RSFSR. Considerably greater support for the hypotheses is found when the following variables are controlled: level of economic development, political regime, and Party cohort. Changes in the level of policy conflict within the central elite are found to account for much of the variation over time in the explanatory power of the two models.
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