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The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010. We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures. For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4·2 years (95% UI 4·2–4·3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30–34 years, mortality rates have hardly changed (reduction of 3·7%, 95% UI 2·7–4·9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20–54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16–277), cirrhosis (65%, −15 to 107), and drug use disorders (577%, 71–942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21·5% [95 UI 17·2–26·3] of YLDs), and musculoskeletal disorders (30·5% [25·5–35·7]). The leading risk factor in the UK was tobacco (11·8% [10·5–13·3] of DALYs), followed by increased blood pressure (9·0 % [7·5–10·5]), and high body-mass index (8·6% [7·4–9·8]). Diet and physical inactivity accounted for 14·3% (95% UI 12·8–15·9) of UK DALYs in 2010. The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response. Bill & Melinda Gates Foundation.

Household burning of solid fuels in traditional stoves is detrimental to health, the environment and development. A range of improved solid fuel stoves (IS) are available but little is known about successful approaches to dissemination. This qualitative systematic review aimed to identify factors that influence household uptake of IS in low- and middle-income countries. Extensive searches were carried out and studies were screened and extracted using established systematic review methods. Fourteen qualitative studies from Asia, Africa and Latin-America met the inclusion criteria. Thematic synthesis was used to synthesise data and findings are presented under seven framework domains. Findings relate to user and stakeholder perceptions and highlight the importance of cost, good stove design, fuel and time savings, health benefits, being able to cook traditional dishes and cleanliness in relation to uptake. Creating demand, appropriate approaches to business, and community involvement, are also discussed. Achieving and sustaining uptake is complex and requires consideration of a broad range of factors, which operate at household, community, regional and national levels. Initiatives aimed at IS scale up should include quantitative evaluations of effectiveness, supplemented with qualitative studies to assess factors affecting uptake, with an equity focus.

Nearly three billion people in low- and middle-income countries (LMICs) rely on polluting fuels, resulting in millions of avoidable deaths annually. Polluting fuels also emit short-lived climate forcers (SLCFs) and greenhouse gases (GHGs). Liquefied petroleum gas (LPG) and grid-based electricity are scalable alternatives to polluting fuels but have raised climate and health concerns. Here, we compare emissions and climate impacts of a business-as-usual household cooking fuel trajectory to four large-scale transitions to gas and/or grid electricity in 77 LMICs. We account for upstream and end-use emissions from gas and electric cooking, assuming electrical grids evolve according to the 2022 World Energy Outlook’s ‘Stated Policies’ Scenario. We input the emissions into a reduced-complexity climate model to estimate radiative forcing and temperature changes associated with each scenario. We find full transitions to LPG and/or electricity decrease emissions from both well-mixed GHG and SLCFs, resulting in a roughly 5 millikelvin global temperature reduction by 2040. Transitions to LPG and/or electricity also reduce annual emissions of PM 2.5 by over 6 Mt (99%) by 2040, which would substantially lower health risks from household air pollution. Full transitions to LPG or grid electricity in LMICs improve climate impacts over BAU trajectories.

In this study, an experimental and numerical investigation is presented on the effect of thickness and test rate within the pseudo static regime on the tensile properties of Dyneema®HB26 laminates. A detailed experimental presentation on the tensile testing of different thickness is presented and highlights the commonly seen observation that the tensile strength of a laminate reduces as a function of the specimen thickness. To understand these experimental observations, a constitutive material model of the individual macro fibril is developed and applied to modelling the fibre and upscaling to the laminate. The modelling strategy is implemented into ls-dyna and used to perform a parameter study on the specimen geometries used in the experimental study. The model assumes that the fibril strength is a function of the amorphous volume within the fibre and hence fibril. It can be observed that the experimental behaviour can be simulated by modelling the interface between laminate plies and the fibril, and hence fibre failure. The weak interfaces from the fibril to the laminate scale make the testing of fibres and laminates very difficult. Hence, it is proposed that the intrinsic fibril strength should be used as a measure of strength, and the fundamental strength is determined through numerical studies.

Background Household air pollution (HAP) is a recognised risk factor for many diseases, including respiratory diseases, cardiovascular/circulatory disorders, adverse pregnancy outcomes and cataracts. Population exposure to biomass fuels, including wood, varies among countries and from one fuel source to the other. This study aimed to investigate the different sources of HAP in peri-urban and rural communities in Cameroon. Methods A cross-sectional survey was conducted in a representative sample of households from the Dschang Health District (DHD) region. This included 848 homes in which a range of fuels for cooking including biomass (firewood, charcoal, sawdust), kerosene and liquefied petroleum gas (LPG) were used both indoors and outdoors. Results Of the study households, 651 (77%) reported exclusive use of firewood and 141 (17%) reported using more than one source of fuel. Exclusive use of firewood was greater in rural communities (94%) than in peri-urban communities (38%). In peri-urban communities, use of multiple fuels including LPG, wood, sawdust and kerosene, was more common (44.75%). A total of 25.03% of households in both peri-urban and rural communities reported using bottled gas (or liquified petroleum gas (LPG) for cooking. Motivations for choice of fuel included, affordability, availability, rapidity, and cultural factors. Conclusion Wood is the main cooking fuel in both peri-urban and rural communities in the Dschang Health District. Supporting households (especially those with limited resources) to adopt LPG equipment for cooking, and use in a more exclusive way is required to help reduce household air pollution.

The UK Public Health White Paper (2010) acknowledges the widening disparities in health between the rich and poor. Public Health England authorises local authorities to deliver initiatives to improve population health. Such plans require evidence-based information using a validated, uniformly applicable tool. The aim of this study was to assess the feasibility of applying Global Burden of Disease (GBD) methods in Cheshire and Merseyside to (1) describe socioeconomic differences in years of life lost and years lived with disability from elevated body-mass index (BMI), and (2) assess the impact on inequalities of population shifts in BMI distribution. The GBD risk assessment methodology was used, drawing on post-coded sources to link exposure and health outcomes to deprivation. Data on BMI by age and sex were obtained from local surveys. The index of multiple deprivation (IMD) was used to assess social deprivation. Health outcomes, including sequelae, were obtained from hospital episode statistics, national mortality data, and the cancer registry. In a population of around 2 million, 40 000 cases of BMI-related disease and 8000 premature deaths occurred annually, with around 29 000 disability-adjusted life-years (DALYs) per 100 000 people (52% in males). The annual rate of DALYs in the most deprived quintile of the IMD was almost twice that in the least deprived. A shift downwards of 2 units in the BMI distribution led to an annual reduction of 7000 DALYs in the most deprived population, compared with 3500 DALYs in the least deprived. Although subnational application of the GBD methodology was feasible in principle, significant limitations included poor-quality/incomplete BMI and morbidity data. Modelling may improve these, but could be constrained by the requirement for area-based linkage. The methodology can be applied to other geographical-based strata, including administrative units, urban/rural, etc, and can help define locally relevant policy to change risks across these strata. Local capacity building in applying the methodology and interpretation for policy will be required. National Health Services (Primary Care Trusts of Cheshire and Merseyside).

Background Exposure to household air pollution (HAP) from cooking with solid fuels affects 2.8 billion people in developing countries, including children and pregnant women. The aim of this review is to propose intervention estimates for child survival outcomes linked to HAP. Methods Systematic reviews with meta-analysis were conducted for ages 0-59 months, for child pneumonia, adverse pregnancy outcomes, stunting and all-cause mortality. Evidence for each outcome was assessed against Bradford-Hill viewpoints, and GRADE used for certainty about intervention effect size for which all odds ratios (OR) are presented as protective effects. Results Reviews found evidence linking HAP exposure with child ALRI, low birth weight (LBW), stillbirth, preterm birth, stunting and all-cause mortality. Most studies were observational and rated low/very low in GRADE despite strong causal evidence for some outcomes; only one randomised trial was eligible.Intervention effect (OR) estimates of 0.64 (95% CI: 0.55, 0.75) for ALRI, 0.71 (0.65, 0.79) for LBW and 0.66 (0.54, 0.81) for stillbirth are proposed, specific outcomes for which causal evidence was sufficient. Exposure-response evidence suggests this is a conservative estimate for ALRI risk reduction expected with sustained, low exposure. Statistically significant protective ORs were also found for stunting [OR=0.79 (0.70, 0.89)], and in one study of pre-term birth [OR=0.70 (0.54, 0.90)], indicating these outcomes would also likely be reduced. Five studies of all-cause mortality had an OR of 0.79 (0.70, 0.89), but heterogenity precludes a reliable estimate for mortality impact. Although interventions including clean fuels and improved solid fuel stoves are available and can deliver low exposure levels, significant challenges remain in achieving sustained use at scale among low-income households. Conclusions Reducing exposure to HAP could substantially reduce the risk of several child survival outcomes, including fatal pneumonia, and the proposed effects could be achieved by interventions delivering low exposures. Larger impacts are anticipated if WHO air quality guidelines are met. To achieve these benefits, clean fuels should be adopted where possible, and for other households the most effective solid fuel stoves promoted. To strengthen evidence, new studies with thorough exposure assessment are required, along with evaluation of the longer-term acceptance and impacts of interventions.

This paper presents an initial design assessment of a series of novel, cost-effective, and hybrid composite materials for applications involving high velocity impacts. The proposed hybrid panels were designed in order to investigate various physical phenomenon occurring during high velocity impact on compliant laminates from a previous study on Dyneema® and Spectra®. In the first, screening phase of the study twenty different hybrid composite laminates were impacted with 20 mm Fragment Simulating Projectiles at 1 km/s striking velocity. The best performing concepts were put forward to phase II with other hybrid concepts involving shear thickening fluids, commonly used in low velocity impacts. The results indicated that it is possible to design hybrid laminates of similar ballistic performance as the reference Dyneema® laminate, but with lower material costs. The optimal hybrid concept involves a fibre reinforced Polypropylene front and a Dyneema® backing.

[...]it's understandable that surety companies are hesitant to consider a start-up company for a surety program. The best thing a new construction company can do to bolster its profile for surety credit is to assemble a team of advisors, including a surety professional agent, a construction-oriented CPA and a construction-oriented bank representative. Surety underwriters are often confronted with some handwritten numbers on a form from a bank or the surety agent that don't come close to balancing and are obviously incomplete. Securing a formal working capital line of credit with a bank is also helpful for short-term financing; however, due to its short-term nature, it should not be the source of start-up capital for a new company.

Background: Indoor air pollution (IAP) from combustion of biomass fuels represents a global health problem, estimated to cause 1.6 million premature deaths annually. Aims: RESPIRE (Randomised Exposure Study of Pollution Indoors and Respiratory Effects) Guatemala is the first randomised controlled trial ever performed on health effects from solid fuel use. Its goal is to assess the effect of improved stoves (planchas) on exposure and health outcomes in a rural population reliant on wood fuel. Methods: Questions about symptoms were asked at baseline and periodically after the intervention, to an initial group of 504 women (259 randomly assigned to planchas (mean (standard deviation) age 27.4 (7.2) years) and 245 using traditional open fires (28.1 (7.1) years)). Levels of carbon monoxide (CO) in exhaled breath, a biomarker of recent exposure to air pollution from biomass combustion, were measured at each visit. In addition to reducing IAP levels, the plancha may also have a positive health effect by changing the working posture to an upright position. Results: A high prevalence of eye discomfort, headache and backache was found. The odds of having sore eyes and headache were substantially reduced in the plancha group relative to the group using open fires for the follow-up period (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.11 to 0.29 and (OR) 0.63, 95% CI 0.42 to 0.94, respectively). Median CO in breath among women in the intervention trial was significantly lower than controls. Conclusion: In addition to reducing discomfort for women, tangible improvements in symptoms experienced by a substantial proportion of women may help to gain acceptance and wider use of planchas.