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Some CO2-reducing technologies have real-world benefits not captured by regulatory testing methods. This paper documents a two-layer heating, ventilation, and air-conditioning (HVAC) system that facilitates faster engine warmup through strategic increased air recirculation. The performance of this technology was assessed on a 2020 Hyundai Sonata. Empirical performance of the technology was obtained through dynamometer tests at Argonne National Laboratory. Performance of the vehicle across multiple cycles and cell ambient temperatures with the two-layer technology active and inactive indicated fuel consumption reduction in nearly all cases. A thermally sensitive powertrain model, the National Renewable Energy Laboratory’s FASTSim Hot, was calibrated and validated against vehicle testing data. The developed model included the engine, cabin, and HVAC system controls. Validation of component thermal models and engine efficiency ensured accurate thermal dynamics, fuel consumption, and two-layer benefit. The real-world benefit of the two-layer technology was calculated by simulating the validated powertrain model across a representative test matrix comparing performance with and without the two-layer system. Simulation across the test matrix revealed a real-world representative benefit of 0.0835%. Analysis of test matrix results at the regional level revealed the most benefit in cold climates and rural regions. Mean results across cycle length sensitivity simulations revealed a larger real-world benefit of 0.0872%. These benefit values can be considered a more accurate assessment of real-world technology performance. Future work is planned to explore the requisite number of drive cycles to ensure the full technology benefit is captured.

BackgroundThe UK began an ambitious COVID-19 vaccination programme on 8 December 2020. This study describes variation in vaccination uptake by sociodemographic characteristics between December 2020 and August 2021.MethodsUsing population-level administrative records linked to the 2011 Census, we estimated monthly first dose vaccination rates by age group and sociodemographic characteristics among adults aged 18 years or over in England. We also present a tool to display the results interactively.ResultsOur sample included 35 223 466 adults. A lower percentage of males than females were vaccinated in the young and middle age groups (18–59 years) but not in the older age groups. Vaccination rates were highest among individuals of White British and Indian ethnic backgrounds and lowest among Black Africans (aged ≥80 years) and Black Caribbeans (18–79 years). Differences by ethnic group emerged as soon as vaccination roll-out commenced and widened over time. Vaccination rates were also lower among individuals who identified as Muslim, lived in more deprived areas, reported having a disability, did not speak English as their main language, lived in rented housing, belonged to a lower socioeconomic group, and had fewer qualifications.ConclusionWe found inequalities in COVID-19 vaccination uptake rates by sex, ethnicity, religion, area deprivation, disability status, English language proficiency, socioeconomic position and educational attainment, but some of these differences varied by age group. Research is urgently needed to understand why these inequalities exist and how they can be addressed.

ObjectivesTo examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity.DesignA statistical model to estimate increased mortality in population subgroups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous 5 years.SettingInformation on deaths registered in England since 2015 was used, including age, sex, area of residence and cause of death. Ethnicity was obtained from Hospital Episode Statistics records linked to death data.ParticipantsPopulation study of England, including all 569 824 deaths from all causes registered between 21 March 2020 and 26 February 2021.Main outcome measuresExcess mortality in each subgroup over and above the number expected based on trends in mortality in that group over the previous 5 years.ResultsThe gradient in excess mortality by area deprivation was greater in the under 75s (the most deprived areas had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the black and Asian groups, all area deprivation quintiles had significantly larger excesses than white groups in the most deprived quintiles and there were no clear gradients across quintiles. Among the white group, only those in the most deprived quintile had more excess deaths than deaths directly involving COVID-19.ConclusionThe COVID-19 pandemic has widened inequalities in premature mortality by area deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of area deprivation, and the white group the most deprived areas. Statistics limited to deaths directly involving COVID-19 understate the pandemic’s impact on inequalities by area deprivation and ethnic group at younger ages.

BackgroundThe UK began an ambitious COVID-19 vaccination programme on 8th December 2020. This study describes variation in vaccination coverage by sociodemographic characteristics between December 2020 and August 2021.MethodsUsing population-level administrative records linked to the 2011 Census, we estimated monthly first dose vaccination rates by age group and sociodemographic characteristics amongst adults aged 18 years or over in England. We also present a tool to display the results interactively.FindingsOur study population included 35,223,466 adults. A lower percentage of males than females were vaccinated in the young and middle age groups (18-59 years) but not in the older age groups. Vaccination rates were highest among individuals of White British and Indian ethnic backgrounds and lowest among Black Africans (aged ≥80 years) and Black Caribbeans (18-79 years). Differences by ethnic group emerged as soon as vaccination roll-out commenced and widened over time. Vaccination rates were also lower among individuals who identified as Muslim, lived in more deprived areas, reported having a disability, did not speak English as their main language, lived in rented housing, belonged to a lower socio-economic group, and had fewer qualifications.InterpretationWe found inequalities in COVID-19 vaccination rates by sex, ethnicity, religion, area deprivation, disability status, English language proficiency, socio-economic position, and educational attainment, but some of these differences varied by age group. Research is urgently needed to understand why these inequalities exist and how they can be addressed.Research in contextEvidence before this studyWe searched PubMed for publications on sociodemographic inequalities in COVID-19 vaccination coverage. Several studies have reported differences in coverage by characteristics such as ethnicity and religion, however these have focused on older adults and the clinically vulnerable who were initially prioritized for vaccination. There is little evidence on sociodemographic inequalities in vaccination coverage among younger adults and evidence is also lacking on coverage by a wider range of characteristics such as sex, disability status, English language proficiency, socio-economic position, and educational attainment.Added value of this studyThis study provides the first evidence for sociodemographic inequalities in COVID-19 vaccination coverage among the entire adult population in England, using population-level administrative records linked to the 2011 Census. By disaggregating the data by age group, we were able to show that disparities in coverage by some sociodemographic characteristics differed by age group. For example, a lower proportion of males than females were vaccinated in the young and middle age groups (18-59 years) but not in the older age groups, and vaccination rates were lowest among Black Africans in those aged ≥80 years but lowest among Black Caribbeans for all other age groups. Vaccination rates were also lower among individuals who identified as Muslim, lived in more deprived areas, reported having a disability, did not speak English as their main language, lived in rented housing, belonged to a lower socio-economic group, and had fewer qualifications.Implications of all the available evidenceMany of the groups with the lowest rates of COVID-19 vaccination are also the groups that have been disproportionately affected by the pandemic, including severe illness and mortality. Research is urgently needed to understand why these disparities exist and how they can be addressed, for example through public health or community engagement programmes. Since the relationships between sociodemographic characteristics and vaccination coverage may differ by age group, it is important for future research to disaggregate by age group when examining these inequalities.

ObjectivesTo examine the impact of the Covid-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity. DesignA statistical model to estimate increased mortality in population sub-groups during the Covid-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous five years. SettingInformation on deaths registered in England since 2015 was used, including age, sex, area of residence, and cause of death. Ethnicity was obtained from Hospital Episode Statistics (HES) records linked to death registration data. ParticipantsPopulation study of England, including all 569,824 deaths from all causes registered between 21 March 2020 and 26 February 2021. Main outcome measuresExcess mortality in each sub-group over and above the number expected based on trends in mortality in that group over the previous five years. ResultsThe gradient in excess mortality by deprivation was greater in the under 75s (most deprived had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the Black and Asian groups, all deprivation quintiles had significantly larger excesses than the most deprived White group and there were no clear gradients across quintiles. Among the White group, only the most deprived had more excess deaths than deaths directly involving Covid-19. Among the Black group all deprivation quintiles experienced more excess deaths than deaths directly involving Covid-19. ConclusionThe Covid-19 pandemic has widened inequalities in premature mortality by deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of deprivation, and the most deprived White group. Statistics limited to deaths directly involving Covid-19 understate the pandemics impact on inequalities by deprivation and ethnic group at younger ages. Key Messages What is already known on this topicO_LIEstimates of excess mortality for all ages combined for the period March 2020 to February 2021 show a small difference in the relative impact of Covid-19 on excess mortality between the most deprived and the least deprived C_LIO_LIThroughout the pandemic estimates of excess mortality have been greater for ethnic minority groups compared with the white group. C_LI What this study addsO_LIAmong the under 75s the gradient of excess mortality across the deprivation spectrum indicates a stark increase in already established inequalities in premature mortality C_LIO_LIIndependent of deprivation, excess mortality in Black and Asian ethnic groups is much higher than that of the white group, indicating that ethnicity is a determinant of excess mortality, regardless of level of area-based deprivation. C_LI

Thermoelectric generators (TEGs) are being studied and developed for applications in which waste heat, for example, from the exhaust of motor vehicles is converted into usable electricity. TEGs consisting of TE elements integrated with an exhaust heat exchanger require optimization to produce the maximum possible power output. Important optimization parameters include TE element leg length, fill fraction, leg area ratio between n- and p-type legs, and load resistance. A finite difference model was developed to study the interdependencies among these optimization parameters for thermoelectric elements integrated with an exhaust gas heat exchanger. The present study was carried out for TE devices made from n-type Mg 2 Si and p-type MnSi 1.8 based silicides, which are promising TE materials for use at high temperatures associated with some exhaust heat recovery systems. The model uses specified convection boundary conditions instead of specified temperature boundary conditions to duplicate realistic operating conditions for a waste heat recovery system installed in the exhaust of a vehicle. The 1st generation, and an improved 2nd generation TEG module using Mg 2 Si and p-type MnSi 1.8 based silicides were fabricated and tested to compare TE power generation with the numerical model. Important results include parameter values for maximum power output per unit area and the interdependencies among those parameters. Heat transfer through the void areas was neglected in the numerical model. When thermal contact resistance between the TE element and the heat exchangers is considered negligible, the numerical model predicts that any volume of TE material can produce the same power per unit area, given the parameters are accurately optimized. Incorporating the thermal contact resistance, the numerical model predicts that the peak power output is greater for longer TE elements with larger leg areas. The optimization results present strategies to improve the performance of TEG modules used for waste heat recovery systems.

The performance and operating characteristics of a hypothetical thermoelectric generator system designed to extract waste heat from the exhaust of a medium-duty turbocharged diesel engine were modeled. The finite-difference model consisted of two integrated submodels: a heat exchanger model and a thermoelectric device model. The heat exchanger model specified a rectangular cross-sectional geometry with liquid coolant on the cold side, and accounted for the difference between the heat transfer rate from the exhaust and that to the coolant. With the spatial variation of the thermoelectric properties accounted for, the thermoelectric device model calculated the hot-side and cold-side heat flux for the temperature boundary conditions given for the thermoelectric elements, iterating until temperature and heat flux boundary conditions satisfied the convection conditions for both exhaust and coolant, and heat transfer in the thermoelectric device. A downhill simplex method was used to optimize the parameters that affected the electrical power output, including the thermoelectric leg height, thermoelectric n-type to p-type leg area ratio, thermoelectric leg area to void area ratio, load electrical resistance, exhaust duct height, coolant duct height, fin spacing in the exhaust duct, location in the engine exhaust system, and number of flow paths within the constrained package volume. The calculation results showed that the configuration with 32 straight fins was optimal across the 30-cm-wide duct for the case of a single duct with total height of 5.5 cm. In addition, three counterflow parallel ducts or flow paths were found to be an optimum number for the given size constraint of 5.5 cm total height, and parallel ducts with counterflow were a better configuration than serpentine flow. Based on the reported thermoelectric properties of MnSi1.75 and Mg2Si0.5Sn0.5, the maximum net electrical power achieved for the three parallel flow paths in a counterflow arrangement was 1.06 kW for package volume of 16.5 L and exhaust flow enthalpy flux of 122 kW.

Aims To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends. Design and setting Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales. Measurements Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose. Findings From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22–28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6–13%) for methadone only. This difference was significant (P

BACKGROUND: Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates. METHODS: Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993-1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated. RESULTS: There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993-1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas. CONCLUSION: Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression. Language: en

An analytical transport/reaction model was developed to simulate the catalytic performance of ZnO nanowires as a catalyst support. ZnO nanowires were chosen because they have easily characterized, controllable features and a spatially uniform morphology. The analytical model couples convection in the catalyst flow channel with reaction and diffusion in the porous substrate material; it was developed to show that a simple analytical model with physics-based mass transport and empirical kinetics can be used to capture the essential physics involved in catalytic conversion of hydrocarbons. The model was effective at predicting species conversion efficiency over a range of temperature and flow rate. The model clarifies the relationship between advection, bulk diffusion, pore diffusion, and kinetics. The model was used to optimize the geometry of the experimental catalyst for which it predicted that maximum species conversion density for fixed catalyst surface occurred at a channel height of 520 μm.

Objectives To quantify mortality associated with sepsis in the whole population of England. Design Descriptive statistics of multiple cause of death data. Setting England between 2001 and 2010. Participants All people whose death was registered in England between 2001 and 2010 and whose certificate contained a sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code. Data sources Multiple cause of death data extracted from Office for National Statistics mortality database. Statistical methods Age-specific and sex-specific death rates and direct age-standardised death rates. Results In 2010, 5.1% of deaths in England were definitely associated with sepsis. Adding those that may be associated with sepsis increases this figure to 7.7% of all deaths. Only 8.6% of deaths definitely associated with sepsis in 2010 had a sepsis-related condition as the underlying cause of death. 99% of deaths definitely associated with sepsis have one of the three ICD-10 codes—A40, A41 and P36—in at least one position on the death certificate. 7% of deaths definitely associated with sepsis in 2001–2010 did not occur in hospital. Conclusions Sepsis is a major public health problem in England. In attempting to tackle the problem of sepsis, it is not sufficient to rely on hospital-based statistics, or methods of intervention, alone. A robust estimate of the burden of sepsis-associated mortality in England can be made by identifying deaths with one of the three ICD-10 codes in multiple cause of death data. These three codes could be used for future monitoring of the burden of sepsis-associated mortality.

At national level in England and Wales, infant mortality rates fell rapidly from the early 1970s and into the 1980s. Subnational areas have also experienced a reduction in levels of infant mortality. While rates continued to fall to 2006, the rate of reduction has slowed. Although the Government Office Regions Yorkshire and The Humber, the North West and the West Midlands and the Office for National Statistics local authority types Cities and Services and London Cosmopolitan have experienced relatively large absolute reductions in infant mortality, their rates remained high compared with the national average. Within all regions and local authority types, a strong relationship was found between ward level deprivation and infant mortality rates. Nevertheless, levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas. Areas in which the level of deprivation eased have experienced greater than average reductions in levels of infant mortality.

Geographical indicators of mortality provide one of the most important means of assessing the health of populations and are particularly effective in identifying inequalities in health. Geographical mortality indicators have regularly been produced by the Office for National Statistics, but not normally for areas smaller than local authorities. In order to allow variations in mortality within local authorities to be examined, in 2006 ONS published Standardised Mortality Ratios (SMRs) for wards in England and Wales, based on deaths in 1999-2003. For mortality indicators for small populations, based on small numbers of deaths, there is however a risk that results will be unstable, making geographical patterns hard to interpret. To examine whether this problem could be overcome, methods for smoothing SMRs in time and space were considered, with conclusions published in a methodology report in 2007. This article presents results from that work, illustrating the geographical patterns in mortality that emerge following smoothing of the ward-level SMRs.

Alcohol-related mortality for different occupations in England and Wales has long been monitored by the Office for National Statistics and its predecessor organizations. Staff at the General Register Office in the early 1890s sorted half a million paper death records into separate occupational groups, which were in turn classified by cause of death. The results of the consequent analyses, published in 1895, were the first comprehensive assessment of mortality from a range of causes for men in particular occupations (General Register Office, 1895). From the wealth of results, we learn that mortality in publicans from alcoholism was seven times that of all working men, while deaths from liver disease were six and a half times higher. Mortality from alcoholism for workers in agriculture was, conversely, less than a third of that for men in all occupations. Subsequent reports show some consistencies, including that the highest levels of alcohol-related mortality are generally found among those who work in the drinks industry. The last ONS report considered deaths up to 1990 (Drever, 1995), but since then death rates from causes related to alcohol misuse have been rising rapidly. In fact, rates in the UK almost doubled between 1991 and 2005 (Office for National Statistics, 2006). It was therefore timely for ONS to undertake a new analysis of alcohol-related mortality by occupation, the results of which were published in August 2007 (Romeri et al ., 2007). Using the National Statistics definition of alcohol-related mortality (which includes only those causes regarded as being most directly due to alcohol consumption, such as alcoholic liver disease and fibrosis and cirrhosis of the liver), we examined deaths in England and Wales between 2001 and 2005. From the information collected at death registration, we have the occupation of the deceased, …

This article examines trends in suicide by marital status in England and Wales over the period 1982 to 2005. A protective effect of marriage has been observed in a number of previous studies and this article updates figures up to 2005. The article shows that despite changes in marriage patterns over the last 25 years, those who are married still have the lowest risk of suicide, and there has generally been no obvious decline in the difference in suicide rates between those who are married and those who are not.

This article continues a long tradition of examining alcohol-related deaths by occupation in England and Wales. Results are presented for men and women which show those occupations with the highest and lowest indicators of alcohol-related mortality in 2001-05. For both sexes, many of the occupations with the highest alcohol-related mortality were found among those working in the drinks industry, including publicans and bar staff. Low indicators of alcohol-related deaths were found for men who worked as farmers and drivers, and women who worked with children.

Avoidable mortality is a major public health concern but there has been little consensus among researchers on how it should be defined and reported. In this article two definitions of avoidable mortality are considered. These are used to present trends in avoidable deaths in England and Wales from 1993 to 2005, using two statistical indicators of mortality. Analysis of both definitions shows a substantial decline in causes of mortality that are considered amenable to medical intervention over this period. This article discusses which mortality indicator is most appropriate for measuring avoidable deaths, and highlights key issues in developing a National Statistics definition of avoidable mortality.

Alcohol-related deaths in the UK increased substantially between 1991 and 2004, from 4144 to 8221. Overall rates increased in all parts of the UK. There were, however, large differences in rates between countries and regions. This article presents these differences and also looks at patterns of alcohol-related mortality by deprivation within England and Wales. The article considers changes over time for males and females and for different age groups.

The relationship between deprivation and mortality is long established and many studies report higher death rates in more deprived areas. This article examines recent patterns of mortality and deprivation and illustrates these for leading causes of death. Results are considered by age group, sex and region. Mortality rates increased with deprivation for both sexes but the relationship was generally stronger for males. The strongest positive relationships with deprivation were mostly found for smoking-related causes. Those living in the least deprived areas had similar mortality rates, independent of region. There was more geographical variation in mortality for those in the most deprived areas with highest rates generally in the north.

Carstairs scores, first calculated in the 1980s based on data from the 1981 Census, were designed as a summary measure of relative deprivation within small populations. They were based on four indicators from the census which were considered to represent material disadvantage, and have since been widely used to examine the relationship between deprivation and health. This article describes how Carstairs scores were calculated for England and Wales based on data from the 2001 Census and also presents the resulting geographical patterns of deprivation.

Premature mortality is a major public health concern but there has been little consensus among researchers on how it should be defined and reported. In this article four means of measuring early deaths are considered using four different age thresholds to define prematurity. Using these four indicators, trends in premature mortality are reported for England and Wales from 1950 to 2004. All measures show that, however 'premature' is defined, levels of premature mortality have decreased markedly over time. This article discusses which mortality indicator and age threshold would be most appropriate for a measure of premature mortality for use in national mortality statistics for England and Wales.

Almost 6,000 people killed themselves in the UK in 2004. While suicide rates in the UK fell between 1991 and 2004 this decrease did not occur in all areas. Large disparities remain between suicide rates in the countries of the UK, and between regions and local areas. This article also presents inequalities in suicide rates by deprivation, and considers change over time, for men and women, and for different age groups.

EDITOR—Shaw et al argue that any study that does not use the recently released, final revised population estimates will produce erroneous results, citing a paper by one of us (MB), which showed a narrowing of the life expectancy gap in England.1 2 How much do revisions to population estimates influence the conclusions and can this alone account for the apparently different conclusions in the two papers? Bajekal …

To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends.Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales.Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose.From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22-28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6-13%) for methadone only. This difference was significant (P0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29-1.71) for methadone-only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95-1.25) if the weekend was defined as Friday and Saturday.There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.

This article describes the improvements in the way that ONS will be allocating births and deaths data to administrative and health areas in England and Wales, beginning with data for 2001. Births and deaths registered in 2000 are used to examine the differences in area allocations at ward, local authority and health authority levels, which this change will introduce. Differences in the geographical characteristics of births and deaths are also described.

Background. The prescription of antidepressants has increased substantially over the last 10 years. It is therefore timely to examine trends in mortality associated with overdoses of antidepressants and to compare the relative mortality associated with different antidepressants.Methods. Data were derived from a newly developed national database of deaths from overdose and poisoning in England and Wales between 1993 and 1997. Age and sex specific death rates associated with overdose and poisoning with antidepressants were calculated together with numbers of deaths per 100000 prescriptions of individual antidepressants.Results. Twenty per cent (2503) of all deaths from overdose or poisoning were antidepressant related. The number of deaths increased by 18% between 1993 and 1997. Ninety-five per cent of deaths from antidepressants were associated with tricyclic antidepressants, particularly dothiepin and amitriptyline. Tricyclic antidepressants were associated with 5·3 deaths per 100000 prescriptions, 4·4 for monoamine oxidase inhibitors and 0·4 for selective serotonin reuptake inhibitors. Annual death rates were highest in men aged 30–44 years (18·2 per million) and women aged 45–59 years (14·8). Death rates from antidepressants were 2·5 times higher in the most deprived fifth than in the least deprived fifth of enumeration districts.Conclusions. Antidepressants are an important cause of death from poisoning and overdose. SSRIs and newer antidepressants are associated with

The study examines time trends and sociodemographic aspects of drug poisoning deaths in England and Wales.Socio-demographic data from the four drug groups most commonly used in poisoning were extracted, and annual age- and sex-specific mortality rates calculated. Enumeration districts were ranked into five groups on the basis of their Carstairs scores, and the number of deaths in each of the five groups was calculated.There were 15720 deaths from drug poisoning between 1993 and 1998. More deaths occurred in men than in women (10 223 versus 5497). Opiates were the most commonly used drugs in deaths from drug poisoning (32 per cent of deaths); mortality rates increased twofold for these drugs. Males had higher number of deaths from opiate poisoning than females (4523 versus 1221). Highest mortality rates from opiate poisoning (77.4 per million) occurred in men aged 24-35 years. Deaths from drug poisoning were strongly associated with deprivation.There are substantial socio-demographic differences in mortality rates from drug poisoning.

This combination textbook and policy reader allows acknowledged leaders in the formulation of domestic policy to reflect upon certain abiding political disputes in light of the deeper controversy over the meaning of equality and liberty for the American regime. In their disagreements with each other, the authors reveal the fundamental tensions which animate American politics. The first third of the book contains theoretical essays on the nature of the American regime. This lays the foundation for the succeeding eight essays which present controversies over public policy. This volume assists students of American politics in the consideration of the abiding relationship between principle and practice.

On June 19, 1959, the United States Senate refused to confirm Lewis L. Strauss, President Dwight Eisenhower's nominee for the position of Secretary of Commerce. Given the rarity of such rejections, the relative insignificance of the post, and the nominee's distinguished public career, one must conclude that there were other forces at work. This article explores those forces within the context of growing congressional frustration at executive domination, the changing complexion of the Senate's Democratic majority, and the legislative branch's greatly enhanced institutional resources.

On April 6, 1989, members of the United States Senate will meet in special session to commemorate the institution's two hundredth anniversary. A series of projects and publications outlined in 1982 by a special bicentennial advisory panel and carried out by the Senate Historical Office should lay the groundwork for an appropriate commemoration. But beyond that, they should increase the American public's awareness of the Senate's historical role in the functioning of the government and stimulate further study of legislative influence in national policy determination.