Massive Subcutaneous Emphysema after Hydrogen Peroxide Irrigation of a Penetrating Facial Injury.

We present the case of a child impaled in the face by a meat thermometer who subsequently suffered a significant complication due to the administration of hydrogen peroxide to the wound. The soft tissues of the face rapidly expanded and blanched, the child experienced mental status changes, and imaging revealed massive subcutaneous emphysema, pneumomediastinum, and pneumo-orbit. Herein we review the literature on this rare complication and provide photodocumentation in the hopes that other practitioners, patients, and parents avoid administering hydrogen peroxide into or near any penetrating injury. Laryngoscope, 134:2954-2957, 2024.

The incidence of non-melanoma skin cancer in the UK and the Republic of Ireland: a systematic review.

BACKGROUND: Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) remain the most prevalent malignancies, contributing a higher workload to cancer registries than all cancers combined. The nature of skin cancers in addition to current coding methods employed by registries give a skewed representation of the workload. OBJECTIVES: A comprehensive search examining the incidence of BCC and/or cSCC at a regional or national level in the UK and Ireland was devised. Standardisation methods were grouped to permit comparison, and a bias assessment tool was employed. MATERIALS & METHODS: Sixteen UK and Republic of Ireland epidemiological studies on BCC/cSCC over a 48-year period were compiled, examining incidence, trends and emerging risk factors. RESULTS: Incidence of BCC within the UK is increasing annually by up to 4%, with rates in Wales increasing by up to 6.6% and 1.6% annually for BCC and cSCC, respectively. Inverse relationships are noted between BCC/cSCC and social deprivation. Although the elderly remain the most at risk, the 30-49 age group have illustrated growth rates of approximately 4%. CONCLUSION: This review outlines increasing incidence in the UK with higher rates noted in Wales, the Southeast, West and Central regions. Incidence rates are higher amongst the least socially deprived and an increasing incidence amongst younger age groups was found, however further trend analysis is required. A more comprehensive data collection method within registries is necessary to ensure accurate representation and fluid comparison. Service planning and public awareness campaigns must be implemented to prevent overwhelming future services.

Capturing free-roaming dogs for sterilisation: A multi-site study in Goa, India.

Sterilisation and rabies vaccination programs seek to manage free-roaming domestic dog (Canis familiaris) populations with the aim to reduce inter-species disease transmission and conflicts. As effective, permanent, remotely-administered options are not yet available for sterilisation, and oral vaccination is not yet commonly used; free-roaming dogs are typically captured for these interventions. There is a paucity of information describing how dog capture rates change over time within defined areas following repeated capture efforts. This data is needed to allow efficient dog capture programmes to be developed. Using spatial co-ordinates of dog capture, we characterise where dogs are more likely to be captured in six catch-sterilise-release campaigns, in Goa state, India. Combining capture numbers with population survey data collected in five sites, we document the increasing difficulty of catching entire (non-sterilised) dogs as sterilisation coverage increases and demonstrate how this leads to increased unit costs. Accounting for the extra resources required to capture dogs when sterilisation coverage is high will improve estimation of the resources required to manage free-roaming dog populations and assist in planning the most efficient intervention strategies.

The influence of disordered eating and social media's portrayals of pregnancy on young women's attitudes toward pregnancy.

BACKGROUND: Given the heightened emphasis on physical appearance and the prevalence of social media in young women, they are particularly vulnerable to experiencing negative body image and disordered eating. Therefore, modified social media portrayals of pregnancy could cause young women to have negative attitudes toward a potential pregnancy and subsequently not properly utilize care and resources. The present study examined the influence of disordered eating and modified portrayals of pregnancy on young women's attitudes toward a potential pregnancy and various feelings associated with pregnancy. METHODS: The sample consisted of 154 women aged 18-30, who were given the Eating-Attitudes Test-26, randomly shown either modified or unmodified social media portrayals of pregnancy, then given the Attitudes Toward Potential Pregnancy Scale and the Gestational Weight Gain Psychosocial Risk Assessment Tool. RESULTS: A series of hierarchal regressions revealed that there were no significant main effects or interactions for young women's attitudes toward potential pregnancy. However, women who viewed modified portrayals of pregnancy had higher self-efficacy, and women with higher levels of disordered eating had lower self-efficacy, more positive attitudes toward gestational weight gain, and lower current body image satisfaction. CONCLUSIONS: These results highlight the myriad of different attitudes that young women have toward a potential pregnancy and how these attitudes are influenced by disordered eating and social media. Our findings can be used for educating caregivers and implementing intervention strategies for women.

Young women are more likely to have a negative body image and an unhealthy relationship with food because they are more focused on their physical appearance, especially with the rise of social media. If young women with these struggles see edited representations of pregnancy, they can develop a negative attitude about becoming pregnant in the future. This study examined how unhealthy eating habits and highly edited pictures of pregnant women impact young women's attitudes toward a potential pregnancy. Our participants answered questions designed to see if they possess unhealthy eating thoughts and behaviors, then they were randomly shown either highly edited or not highly edited pictures of pregnant women from social media. Then, they answered questions about their attitude toward a potential pregnancy. We found that women with particularly unhealthy relationships with food were less confident about maintaining healthy eating habits throughout pregnancy. However, we also found that women who viewed the highly edited pictures were more confident about maintaining healthy eating habits throughout pregnancy. We can use these results to educate caregivers and help women get better care.

Community attitudes and perceptions towards free-roaming dogs in Goa, India.

Free-roaming dogs (FRD) represent a large proportion of the canine population in India and are often implicated as a source of conflict with humans. However, objective data on the attitudes and perceptions of local communities toward FRD are lacking. This study collected baseline data from 1141 households in Goa, India, on FRD feeding practices and assessed people's attitudes toward FRD in urban and rural communities. Additionally, respondents identified problems caused by FRD and proposed potential solutions.The study reported that 37% of respondents fed FRD with dog owners and Hindus being the most likely to feed. The majority of respondents agreed FRD were a menace (57%), a nuisance (58%) and scary (60%). Most respondents also agreed FRD were a vulnerable population (59%), that belong in communities (66%) and have a right to live on the streets (53%). Barking was the most commonly reported problem associated with FRD and the preferred solution was to impound FRD in shelters. This study reveals the complex and often misunderstood relationship between local communities and FRD and highlights potential strategies to reduce human-dog conflict.

Emotional intelligence in military medical officers in the Defence Medical Services.

BACKGROUND: Emotional intelligence (EI) is a concept describing an individual's ability to understand, process and act accordingly on others' and one's own emotions. It is a desirable quality for people working in teams and is beneficial to the individual in many ways. It is increasingly recognised that understanding and developing EI are important to working in the healthcare environment. It becomes especially pertinent in the deployed Defence Medical Services (DMS), where clinicians often fulfil a significant leadership role in a small team. METHODS: This study was performed with the aim of exploring the role of EI in military doctors in the UK DMS. EI was measured in a cohort of 64 military doctors by way of a validated self-assessment questionnaire. Results were tested for differences in EI between different services and career stages. RESULTS: The survey had an 83% return rate. There was roughly equal distribution between service, career groups and ages across the study population. There were more men than women. The population showed consistently high EI scores compared with control data. There were no statistical differences in EI scores between services or genders. Foundation doctors showed the highest EI scores and consultants the lowest (6.05 vs 5.3). CONCLUSION: It was demonstrated that military doctors have consistently high EI score, especially at the most junior level. This suggests that traits deemed desirable by the single service selection processes also pertain to high EI without it being specifically measured for. The dangers of having too high EI and the benefits of having a range of EI within a team were discussed. There were limitations of being unable to obtain qualitative data and not including primary healthcare staff. Several recommendations were set out as to how the DMS may use or further investigate EI with regard to training and recruitment.

Contextuality and context-sensitivity in probabilistic models of cognition.

The context-sensitivity of cognition has been demonstrated across a wide range of cognitive functions such as perception, memory, judgement and decision making. A related term, 'contextuality', has appeared from the field of quantum cognition, with mounting empirical evidence demonstrating that cognitive phenomena are sometimes contextual. Contextuality is a subtle notion that influences how we must view the properties of the cognitive phenomenon being studied. This article addresses the questions: What does it mean for a cognitive phenomenon to be contextual? What are the implications of contextuality for probabilistic models of cognition? How does contextuality differ from context-sensitivity? Starting from George Boole's "conditions of possible experience", we argue that a probabilistic model of a cognitive phenomenon is necessarily subject to an assumption of realism. By this we mean that the phenomenon being studied is assumed to have cognitive properties with a definite value independent of observation. In contrast, quantum cognition holds that a cognitive property maybe indeterminate, i.e., its properties do not have well established values prior to observation. We argue that indeterminacy is sufficient for incompatibility between cognitive properties. In turn, incompatibility is necessary for their contextuality. The significance of this argument for cognitive psychology is the following:if a cognitive phenomenon is found to be contextual, then there is reason to believe it may be indeterminate. We illustrate by means of two crowdsourced experiments how context-sensitivity and contextuality of cognitive properties in the form of facial trait judgements can be characterized from empirical data. Finally, we conceptually and formally contrast contextuality with context-sensitivity. We propose that both involve a form of context dependence, with causality being the differentiating factor: the context dependence in context-sensitivity has a causal basis, whereas the context dependence in contextuality is acausal. The resulting implications for probabilistic models of cognition are discussed.

Elimination of human rabies in Goa, India through an integrated One Health approach.

Dog-mediated rabies kills tens of thousands of people each year in India, representing one third of the estimated global rabies burden. Whilst the World Health Organization (WHO), World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030, examples of large-scale dog vaccination programs demonstrating elimination remain limited in Africa and Asia. We describe the development of a data-driven rabies elimination program from 2013 to 2019 in Goa State, India, culminating in human rabies elimination and a 92% reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams to vaccinate over 95,000 dogs at 70% vaccination coverage, and rabies education teams to reach 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention 'very cost-effective' by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India.

Followership: an undervalued concept in effective teams within the military and NHS.

INTRODUCTION: Leadership is accepted as a crucial component of effective working within teams. Followership's contribution to successful performance is increasingly recognised but understudied. This study evaluated followership levels in military doctors at different stages of their careers and made recommendations for how followership concepts can be used to develop the self and better understand the challenges of small team working. METHODS: A self-report study in which Kelley's followership questionnaire was distributed to 64 military doctors in three cohorts. 53 results were assessed using Kelley's followership framework. Subgroup analysis was undertaken to look at differences depending on service, age, gender and career stage. RESULTS: The study demonstrated a predominant exemplary followership style within military doctors. No statistical difference was identified at the 0.05 level in followership by career stage, age, gender or service in the sample group. CONCLUSION: This study gives insight into the attributes of doctors within the Defence Medical Services and laid out a methodology for further cohort evaluations of followership. It made recommendations on the areas of the field that require further research and how followership concepts may be included in further development courses and reporting for military medical personnel.

The impact of force, time, and rotation on the transfer of ammonium nitrate: A reductionist approach to understanding evidence dynamics.

Empirical studies evaluating the conditions under which the transfer of forensic materials occurs can provide contextual information and offer insight into how that material may have been transferred in a given scenario. Here, a reductionist approach was taken to assess the impact of force, time, and rotation on the transfer of an explosive compound. An Instron ElectroPuls E3000 material testing instrument was used to bring porous and non-porous surfaces adulterated with an ammonium nitrate into direct contact with a human skin analogue, controlling for the force of contact, duration of contact, and rotation applied during contact. Quantifiable amounts of ammonium nitrate were recovered from all of the recipient surfaces demonstrating that ammonium nitrate is readily transferred from one surface to another, even when contact occurs for a short duration with a relatively low force. More particulates were transferred from non-porous surfaces onto the human skin analogue, but the amount of ammonium nitrate transferred did not depend upon the force of contact, duration of contact, or the amount of rotation applied. However, when contact occurred and involved rotation, a greater transfer of ammonium nitrate was observed, compared to those contacts occurring without rotation being applied. This approach complements more commonly-used holistic experiments that test multiple interacting variables in a realistic setting by isolating these variables, allowing them to be examined individually. This can be utilised to better understand the individual impact that specific variables have on the transfer of trace evidence in relevant crime reconstruction contexts.

Trace evidence dynamics of cocaine on banknotes: A comparison study of paper and polymer banknotes.

It is well established that a large proportion of paper banknotes in circulation contain traces of cocaine. Being able to discriminate between the innocent transfer of illicit drug particles acquired through everyday interactions with surfaces such as banknotes, as opposed to transfer resulting from criminal activities can provide valuable intelligence that can inform an investigation. With many countries adopting polymer banknotes as legal tender, it is important to consider the transfer of cocaine from these surfaces as well as the retention of these particulates on polymer banknotes for evaluative interpretation in crime reconstruction. This comparison study assessed three contact variables (force, time, and rotation) on the transfer of cocaine particulates from paper and polymer banknotes onto a human skin proxy. The persistence of cocaine particulates was assessed through a realistic scenario which mimicked a cash transaction. Quantifiable amounts of cocaine were transferred onto the human skin proxy across all of the contacts assessed, with a greater transfer observed with contacts involving polymer banknotes and those contacts which involved rotation. Following extensive handling, cocaine persisted on both banknote types, with paper banknotes retaining larger amounts of cocaine than polymer banknotes. These findings show that cocaine can persist on both paper and polymer banknotes for extended periods of time following handling and is therefore available for transfer. This transfer then readily occurs, even when contact is brief and involves relatively small forces. A key distinction between the banknote types was that cocaine particulates are more likely to transfer from polymer banknotes due to the lower retention rate of particulates on this surface. Such insights can aid in evaluating the relevance of illicit drug particles identified on items or persons of interest in crime reconstruction approaches.

Free-roaming dog population dynamics in Ranchi, India.

Rabies causes approximately 20,000 human deaths in India each year. Nearly all of these occur following dog bites. Large-scale, high-coverage dog rabies vaccination campaigns are the cornerstone of rabies elimination strategies in both human and dog populations, although this is particularly challenging to achieve in India as a large proportion of the dog population are free-roaming and unowned. Further, little is known about free-roaming dog ecology in India which makes defining optimum vaccination strategies difficult. In this study, data collected using a mobile phone application during three annual mass vaccination and neutering (surgical sterilisation of both males and females) campaigns of free-roaming dogs in Ranchi, India (during which a total of 43,847 vaccinations, 26,213 neuter surgeries and 28,172 re-sight observations were made) were interrogated, using two novel approaches to estimate the proportion of neutered dogs that were lost from the city (assumed due to mortality or migration) between campaign years. Analysis revealed high losses of neutered dogs each year, ranging from 25.3% (28.2-22.8) to 55.8% (57.0-54.6). We also estimated that the total population declined by 12.58% (9.89-15.03) over the three-year period. This demonstrates that there is a high turnover of free-roaming dogs and that despite neutering a large number of dogs in an annual sterilisation campaign, the decline in population size was modest over a three-year time period. These findings have significant implications for the planning of rabies vaccination campaigns and population management programmes as well as highlighting the need for further research into the demographics of free-roaming, unowned dogs in India.

Utility of Polygenic Risk Scoring to Predict Cognitive Impairment as Measured by Preclinical Alzheimer Cognitive Composite Score.

Background: The utility of Polygenic Risk Scores (PRS) is gaining increasing attention for generating an individual genetic risk profile to predict subsequent likelihood of future onset of Alzheimer's disease (AD), especially those carry two copies of the APOE E3 allele, currently considered at neutral risk in all populations studied. Objectives: To access the performance of PRS in predicting individuals whilst pre-symptomatic or with mild cognitive impairment who are at greatest risk of progression of cognitive impairment due to Alzheimer's Disease from the Alzheimer's Disease Neuroimaging Initiative (ADNI) as measured by the Preclinical Alzheimer Cognitive Composite (PACC) score profile. Design: A longitudinal analysis of data from the ADNI study conducted across over 50 sites in the US and Canada. Setting: Multi-centre genetics study. Participants: 594 subjects either APOE E3 homozygotes or APOE E3/E4 heterozygotes who upon entry to the study were diagnosed as cognitively normal or with mild cognitive impairment. Measurements: Use of genotyping and/or whole genome sequencing data to calculate polygenic risk scores and assess its ability to predict subsequent cognitive decline as measured by PACC over 5 years. Results: Assessing both cognitively normal and mild cognitive impaired subjects using a PRS threshold of greater than 0.6, the high genetic risk participant group declined more than the low risk group over 5 years as measured by PACC score (PACC score reduced by time). Conclusions: Our findings have shown that polygenic risk score provides a promising tool to identify those with higher risk to decline over 5 years regardless of their APOE alleles according to modified PACC profile, especially its ability to identify APOE3/E3 cognitively normal individuals who are at most risk for early cognitive decline. This genotype accounts for approximately 60% of the general population and 35% of the AD population but currently would not be considered at higher risk without access to expensive or invasive biomarker testing.

The Rat Genome Database (RGD) facilitates genomic and phenotypic data integration across multiple species for biomedical research.

Model organism research is essential for discovering the mechanisms of human diseases by defining biologically meaningful gene to disease relationships. The Rat Genome Database (RGD, ( https://rgd.mcw.edu )) is a cross-species knowledgebase and the premier online resource for rat genetic and physiologic data. This rich resource is enhanced by the inclusion and integration of comparative data for human and mouse, as well as other human disease models including chinchilla, dog, bonobo, pig, 13-lined ground squirrel, green monkey, and naked mole-rat. Functional information has been added to records via the assignment of annotations based on sequence similarity to human, rat, and mouse genes. RGD has also imported well-supported cross-species data from external resources. To enable use of these data, RGD has developed a robust infrastructure of standardized ontologies, data formats, and disease- and species-centric portals, complemented with a suite of innovative tools for discovery and analysis. Using examples of single-gene and polygenic human diseases, we illustrate how data from multiple species can help to identify or confirm a gene as involved in a disease and to identify model organisms that can be studied to understand the pathophysiology of a gene or pathway. The ultimate aim of this report is to demonstrate the utility of RGD not only as the core resource for the rat research community but also as a source of bioinformatic tools to support a wider audience, empowering the search for appropriate models for human afflictions.

Timing of reproduction and association with environmental factors in female free-roaming dogs in southern India.

Annual peaks in reproductive activity have been identified in multiple domestic dog populations. However, there is little evidence to describe how these peaks may be associated with environmental factors such as daylength, which plays a well-established role in breeding patterns of seasonally-reproductive species. Data were collected 2016-2020 during 7,743 and 4,681 neuter surgeries on adult female unowned free-roaming dogs in veterinary clinics in Goa and Tamil Nadu respectively. Temperature, precipitation, relative humidity, and daylength data were gathered for time periods preceding the neuter surgery that may have influenced the likelihood of pregnancy (potential influence periods). A multivariable generalised additive model was used to assess the relationship between these factors and pregnancy. The prevalence of pregnancy varied by month in both locations indicating seasonality of reproduction in these groups. The annual pattern was more distinct in Goa with a peak in pregnancies between September and December. In Goa, decreasing daylength was associated with a higher probability of pregnancy (p = 0.040). Decreasing temperature was associated with decreasing probability of pregnancy in the Nilgiris (p = 0.034). Bitches had a median of 6 foetuses, with no evidence of seasonal variation. Environmental factors were associated with patterns of pregnancy in free-roaming dogs, however statistically-significant factors varied by geographical location. Establishing local seasonal patterns of breeding in free-roaming dogs and assessing their relationship with environmental influences is recommended to facilitate effective and efficient population management strategies, which aim to reduce conflict between human and free-roaming dog populations.

Polygenic Risk Scoring is an Effective Approach to Predict Those Individuals Most Likely to Decline Cognitively Due to Alzheimer's Disease.

BACKGROUND: There is a clear need for simple and effective tests to identify individuals who are most likely to develop Alzheimer's Disease (AD) both for the purposes of clinical trial recruitment but also for improved management of patients who may be experiencing early pre-clinical symptoms or who have clinical concerns. OBJECTIVES: To predict individuals at greatest risk of progression of cognitive impairment due to Alzheimer's Disease in individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI) using a polygenic risk scoring algorithm. To compare the performance of a PRS algorithm in predicting cognitive decline against that of using the pTau/Aß1-42 ratio CSF biomarker profile. DESIGN: A longitudinal analysis of data from the Alzheimer's Disease Neuroimaging Initiative study conducted across over 50 sites in the US and Canada. SETTING: Multi-center genetics study. PARTICPANTS: 515 subjects who upon entry to the study were diagnosed as cognitively normal or with mild cognitive impairment. MEASUREMENTS: Use of genotyping and/or whole genome sequencing data to calculate polygenic risk scores and assess ability to predict subsequent cognitive decline as measured by CDR-SB and ADAS-Cog13 over 4 years. RESULTS: The overall performance for predicting those individuals who would decline by at least 15 ADAS-Cog13 points from a baseline mild cognitive impairment in 4 years was 72.8% (CI:67.9-77.7) AUC increasing to 79.1% (CI: 75.6-82.6) when also including cognitively normal participants. Assessing mild cognitive impaired subjects only and using a threshold of greater than 0.6, the high genetic risk participant group declined, on average, by 1.4 points (CDR-SB) more than the low risk group over 4 years. The performance of the PRS algorithm tested was similar to that of the pTau/Aß1-42 ratio CSF biomarker profile in predicting cognitive decline. CONCLUSION: Calculating polygenic risk scores offers a simple and effective way, using DNA extracted from a simple mouth swab, to select mild cognitively impaired patients who are most likely to decline cognitively over the next four years.

Feasibility of using surgical implantation methods for acoustically tagging alewife (Alosa pseudoharengus) with V5 acoustic transmitters.

Anadromous alewives (Alosa pseudoharengus) are abundant in the Canadian Maritimes, where they support lucrative commercial fisheries. Little is known about their coastal movement, and their potential to interact with anthropogenic structures. Acoustic telemetry can provide detailed information on the spatiotemporal distribution and survival of fishes in coastal areas, using information transmitted from tagged fishes and recorded by moored receivers. However, few acoustic telemetry studies have been performed on clupeids as they are extremely sensitive to handling, and are often compromised by surgical tag implantation. This research assesses the feasibility of a surgical tagging protocol using novel High Residency acoustic tags in alewives, and establishes a baseline of short-term tagging effects. Alewives from the Gaspereau River population were tagged between 2018 (n = 29) and 2019 (n = 96) with non-transmitting models of Vemco/Innovasea V5 HR tags. Tagging effects were evaluated based on recovery rate, reflex impairment, and necropsy-based health assessments. Alewives responded well to tagging, with low mortality (3%) and no observed instances of tag shedding 72 hours post-surgery. The use of sutures to close the incision site had no effect on recovery times. Water temperature and spawning condition had the greatest effect on the behavioural response of fish to tagging. Our findings suggest that, with proper handling and smaller acoustic tags, telemetry studies on alewives are feasible.

Sampling of explosive residues: The use of a gelatine-based medium for the recovery of ammonium nitrate.

Forensic scientists must be able to recover traces of any original explosive materials not consumed in the detonation, in a careful controlled manner to aid a crime reconstruction. In current sampling techniques, the collection efficiency of post-blast residue is highly variable and often dependent on the swabbing materials and solvent systems used. To address these method limitations, this study presents a gelatine-based sampling medium and assesses its capabilities for the collection of ammonium nitrate. Common surfaces were spotted with a known concentration of ammonium nitrate, the unset gel applied, allowed to set, and then peeled from the surface. The gel was dissolved, and solid phase extraction employed to isolate the target explosive compound and remove the constituents of the gel. The eluate was concentrated and subsequently analysed and quantified. Overall, the gel formulation was able to collect ammonium nitrate from all of the test surfaces, with recoveries ranging from 0.1% to 61.7%. This study presents a gelatine-based formulation that has the potential to become a valuable asset in the forensic tool kit for the collection of explosive traces. A key attribute of the gel is that it offers an alternative recovery tool to conventional swabbing and solvent extraction methods.

Coronavirus disease 2019 mortality: a multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution.

BACKGROUND: There is emerging evidence about characteristics that may increase the risk of coronavirus disease 2019 (COVID-19) mortality, but they are highly correlated. METHODS: An ecological analysis was used to estimate associations between these variables and age-standardised COVID-19 mortality rates at the local authority level. RESULTS: Ethnicity, population density and overweight/obesity were all found to have strong independent associations with COVID-19 mortality, at the local authority level. DISCUSSION: This analysis provides some preliminary evidence about which variables are independently associated with COVID-19 mortality and suggests that others (deprivation and pollution) are not directly linked. It highlights the importance of multivariate analyses to understand the factors that increase vulnerability to COVID-19.