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OBJECTIVE: To examine the association between being born into relative deprivation and hospital costs during childhood. DESIGN: Retrospective cohort study. METHODS: We created a birth cohort using Hospital Episode Statistics for children born in NHS hospitals in 2003/2004. The Index of Multiple Deprivation (IMD) rank at birth was missing from 75% of the baby records, so we linked mother and baby records to obtain the IMD decile from the mother's record. We aggregated and costed each child's hospital inpatient admissions, and outpatient and emergency department (ED) attendances up to 15 years of age. We used 2019/2020 NHS tariffs to assign costs. We constructed an additional cohort, all children born in 2013/2014, to explore any changes over time, comparing the utilisation and costs up to 5 years of age. RESULTS: Our main cohort comprised 567 347 babies born in 2003/2004, of which we could include 91%. Up to the age of 15 years, children born into the most deprived areas used more hospital services than those born in the least deprived, reflected in higher costs of inpatient, outpatient and ED care. The highest costs and greatest differences are in the year following birth. Comparing this with the later cohort (up to age 5 years), the average cost per child increased across all deprivation deciles, but differences between the most and least deprived deciles appeared to narrow slightly. CONCLUSIONS: Healthcare utilisation and costs are consistently higher for children who are born into the most deprived areas compared with the least.

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Wide-awake local anesthesia no tourniquet surgery has been shown to decrease cost and hospital length of stay. The authors studied the use of virtual reality during wide-awake local anesthesia no tourniquet outpatient upper extremity surgery to assess its effect on patient pain, anxiety and fun. Patients undergoing wide-awake local anesthesia no tourniquet surgery were randomized to use (virtual reality) or not use (non-virtual reality) virtual reality during their procedures. Pain, fun, and anxiety were measured with a Likert scale at several time points, as were blood pressure and heart rate. A postoperative questionnaire was used to assess overall satisfaction. Virtual reality patients exhibited lower anxiety scores during injection, during the procedure, and at the end of the procedure. There were no differences in blood pressure, heart rate, or pain scores. Compared with non-virtual reality patients, virtual reality patients' fun scores were higher. Virtual reality patients felt the experience helped them to relax, and they would recommend virtual reality-assisted wide-awake local anesthesia no tourniquet surgery. Among patients with self-reported preexisting anxiety, virtual reality patients had lower pain and anxiety scores during injection of local anesthesia compared with non-virtual reality patients. This study demonstrates that readily available virtual reality hardware and software can provide a virtual reality experience that reduces patient anxiety both during the injection of local anesthesia and during the surgical procedure. (Plast. Reconstr. Surg. 144: 408, 2019.) CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, II.

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To address water scarcity, cities are pursuing options for augmenting groundwater recharge with recycled water. Ozone-based treatment trains comprising ozone and biologically activated carbon potentially offer cost-effective alternatives to membrane-based treatment, the standard process for potable reuse in numerous countries. However, regulations in multiple states effectively limit the extent to which ozone-based treatment alone can produce recycled water for groundwater recharge. To investigate the trade-offs between treatment costs and regulatory constraints, this study presents methods for modeling and optimizing designs for (1) producing recycled water using membrane-based treatment, ozone-based treatment, and hybrid treatment trains comprising ozone-based treatment with a membrane sidestream, and (2) delivering that water to stormwater spreading basins. We present a case study of Los Angeles, CA, to demonstrate the model's application under realistic conditions, including regulations that limit spreading recycled water based on its concentration of total organic carbon and the extent of dilution. While the membrane-based treatment train exhibits economies of scale, we demonstrate how regulatory constraints create a diseconomies of scale effect for hybrid treatment systems because larger scales necessitate a higher proportion of recycled water undergo membrane treatment. Nevertheless, relative to membrane-based treatment, we identify opportunities for ozone-based or hybrid treatment trains to reduce treatment costs and energy use by up to 62% and 59%, respectively, for systems with up to 1 m3/s (23 million gallons per day) mean water recycling rate, potentially lowering the barrier for decentralized water recycling systems. This modeling approach could inform planning and policy regarding recycled water projects for groundwater recharge through spreading basins and, with additional modification, other potable reuse applications.

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Infrastructure systems that use stormwater and recycled water to augment groundwater recharge through spreading basins represent cost-effective opportunities to diversify urban water supplies. However, technical questions remain about how these types of managed aquifer recharge systems should be designed; furthermore, existing planning tools are insufficient for performing robust design comparisons. Addressing this need, we present a model for identifying the best-case design and operation schedule for systems that deliver recycled water to underutilized stormwater spreading basins. Resulting systems are optimal with respect to life cycle costs and water deliveries. Through a case study of Los Angeles, California, we illustrate how delivering recycled water to spreading basins could be optimally implemented. Results illustrate trade-offs between centralized and decentralized configurations. For example, while a centralized Hyperion system could deliver more recycled water to the Hansen Spreading Grounds, this system incurs approximately twice the conveyance cost of a decentralized Tillman system (mean of 44% vs 22% of unit life cycle costs). Compared to existing methods, our model allows for more comprehensive and precise analyses of cost, water volume, and energy trade-offs among different design scenarios. This model can inform decisions about spreading basin operation policies and the development of new water supplies.

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Amelogenesis imperfecta is a hereditary enamel protein disorder affecting deciduous and secondary crown formation. The prevalence ranges from 1:700 to 1:14,000 depending on the population. These teeth may be hypoplastic, hypomineralized, or hypermineralized and are often discolored, sensitive and caries vulnerable. Patients often present with psychosocial issues due to appearance. Primary teeth are often treated with stainless steel crowns while secondary teeth are treated with full coverage esthetic crowns. The presenting preteen male here was fitted with Snap-On Smile? (www.snaponsmile.com). This treatment option provided cosmetic enhancement of the patient's appearance besides stabilization without altering the primary and secondary dentition during adolescent development.

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Child poverty is at the heart of the United Kingdom (UK) government's social policy agenda. Child poverty rose rapidly in the 1980s; the child poverty rate was one of the highest in Europe by 2000. In 1999, the government's objective was to reduce child poverty by 50% by 2004/2005, which it narrowly failed to meet. In 2005/2006, there was an increase in child poverty. An index of child well-being found that the UK was 21st out of the 25 European Union countries. Overall, the UK came in last in the UNICEF well-being index. The government's child poverty strategy has been to manage the economy to maximize employment and to improve in-work incomes. Both have been successful in reducing child poverty. Out-of-work incomes have also been improved, but not enough to lift many children out of poverty. Public expenditure on services, especially health, education and childcare, has also increased; although there are questions about how much of this extra spending has focused on children and child poverty. The comprehensive spending review, reporting later in 2007, is likely to be tight, and it is now unlikely that the government will succeed in its aim of reducing child poverty by 50% by 2010 unless there are radical changes in policy. Constraints on the government's ability to do this include the structural inequalities in British society and public attitudes toward people in poverty.

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There are substantial variations between local authorities in the conception rate of teenagers and the proportion of these that end in abortion. This study builds two deprivation models that explain part of the variation in conceptions and abortions. It then identifies outliers, local authorities with teenage conception and abortion rates that are above or below those predicted by the model. It is suggested that the local authorities with lower than expected conceptions are the ones to look to when seeking to discover how to prevent teenage conceptions and those with higher than expected abortion rates may have abortion services that are more accessible. In general, spatial comparisons of conceptions and abortion should take into account variations in deprivation.

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