Explore the vast range of titles available.

National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

This text fully documents an outstanding collection of ancient Roman statues acquired by Henry Blundell of Ince Blundell Hall on his Grand Tour visits to Italy in the late eighteenth century.

Since the first prehistoric people started to dig for stone to make implements, rather than pick up loose material, humans have modified the landscape through excavation of rock and soil, generation of waste and creation of artificial ground. In Great Britain over the past 200 years, people have excavated, moved and built up the equivalent of at least six times the volume of Ben Nevis. It is estimated that the worldwide deliberate annual shift of sediment by human activity is 57 000 Mt (million tonnes) and exceeds that of transport by rivers to the oceans (22 000 Mt) almost by a factor of three. Humans sculpt and transform the landscape through the physical modification of the shape and properties of the ground. As such, humans are geological and geomorphological agents and the dominant factor in landscape evolution through settlement and widespread industrialization and urbanization. The most significant impact of this has been since the onset of the Industrial Revolution in the eighteenth century, coincident with increased release of greenhouse gases to the atmosphere. The anthropogenic sedimentological record, therefore, provides a marker on which to characterize the Anthropocene.

Background COVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January–May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response. Methods The study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software. Results There were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services. Conclusion Our findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.

This paper develops the concept of ‘imagined temporalities’ to explore multiple temporal subjectivities, time cultures, ‘myths’, and realities evident in interviews with resettlement workers who were part of the Syrian Vulnerable Persons Resettlement Scheme (VPRS) in Merseyside, United Kingdom (UK). Conducted in 2019, the interviews took place as the triggering of Article 50 signalled the withdrawal of the UK from the European Union (EU). This period of unprecedented social, economic, and political changes formed a crucial backdrop framing our interviewees’ narratives. The views of resettlement workers have been little explored and are employed here to complement the insights provided by work undertaken by others with refugees and asylum seekers. This research provides important insights into their perceptions of the interplay of factors that affect belonging and access to supports for refugees and asylum seekers, revealing wider, largely underreported, concerns.1 These include, their own personal experiences working in support services and system changes, driven by growing socio-political pressures that impact on community-building among refugees during their resettlement. Significantly, debates about “Brexit” and the UK’s political future, as well as heated public discussions of the historical legacies of colonialism which underpin the present treatment of migrants, are reflected in these resettlement workers’ views as well. Subsequently, this paper employs the concept of ‘imagined temporalities’ to explore how support workers understand the treatment of migrants by social and political systems—and their own personal struggles and hopes,—against this wider, divisive post-Brexit backdrop. Overall, the paper underlines the highly politicised space the resettlement workers operate in, where they balance the needs of service users in the midst of constraints imposed by overly rigid time regimes.

Metro mayors heading a combined authority represent the most recent innovation in English devolution. City-region devolution has been a key way in which successive Conservative governments have sought to boost local economic growth against a background of local authority austerity, and now form a part of the Johnson government’s ‘levelling up’ agenda. However, the perspective of voters is often overlooked in these debates. City-region devolution is a top-down innovation, with a focus on city-region economics rather than democratic renewal or engagement, and there is so far very little academic literature on identifying the drivers of public support for mayoral combined authorities. This study draws on survey responses of voters in the Liverpool City Region and explores a number of potential drivers of support for the Liverpool City Region combined authority, including party support, English, British and European identity, left–right and other value positions, and the role of place in driving support. It finds that support for devolution to the Liverpool City Region is driven by whether one lives in the centre or periphery of the city region, support for the Labour Party, left-wing, socially liberal and European identities, as well as being female and older. This paper also lays the groundwork for further research into drivers of public support for city-region devolution in England.

Background To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006. Methods Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n 1171), 1993 (n 2368) 1998 (n 1964) and in 2006 (n 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (CWB). Results Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4 (P < 0.001). Prevalence of CWB increased from 7.8 to 8.0 by 1998, then decreased to 6.7 in 2006 (P 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7 (P 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7 (P 0.001) and maternal asthma from 11.2 to 13.4 (P 0.09). Conclusions An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period. Adapted from the source document.

The port city of Liverpool, England, is home to one of the oldest Black communities in Britain. Its members proudly date their history back at least as far as the nineteenth century, with the global wanderings and eventual settlement of colonial African seamen. Jacqueline Nassy Brown analyzes how this worldly origin story supports an avowedly local Black politic and identity--a theme that becomes a window onto British politics of race, place, and nation, and Liverpool’s own contentious origin story as a gloriously cosmopolitan port of world-historical import that was nonetheless central to British slave trading and imperialism. This ethnography also examines the rise and consequent dilemmas of Black identity. It captures the contradictions of diaspora in postcolonial Liverpool, where African and Afro-Caribbean heritages and transnational linkages with Black America both contribute to and compete with the local as a basis for authentic racial identity. Crisscrossing historical periods, rhetorical modes, and academic genres, the book focuses singularly on \"place,\" enabling its most radical move: its analysis of Black racial politics as enactments of English cultural premises. The insistent focus on English culture implies a further twist. Just as Blacks are racialized through appeals to their assumed Afro-Caribbean and African cultures, so too has Liverpool--an Irish, working-class city whose expansive port faces the world beyond Britain--long been beyond the pale of dominant notions of authentic Englishness. Dropping Anchor, Setting Sail studies \"race\" through clashing constructions of \"Liverpool.\"

Horizontal wells can be utilised for groundwater abstraction in aquifers of limited saturated thickness. One feature that must be considered is the hydraulic head inside the horizontal well, since hydraulic head gradients can be substantial in long wells with relatively small cross-sectional areas. Little experimental evidence is available concerning horizontal wells, but this report describes field data collected for a 300-m long horizontal well in northwest England (UK); the well is curved in plan, in a shallow unconfined aquifer. Conceptual and computational models are presented; they represent regional groundwater flow, convergent groundwater flows towards and into the well, and also hydraulic conditions within the well. Good agreement is achieved between field and modelled values for groundwater heads in the aquifer and for hydraulic heads in the well. The computational model is then used to explore the rates of inflow along the well; the impact on regional groundwater conditions of abstraction from the well is also examined. Finally, a preliminary comparison is made between vertical well points and horizontal wells in shallow aquifers.