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IntroductionVaccines are our best defence against infectious diseases, yet uptake of childhood immunisation programmes has consistently declined in the UK, with growing concerns around socioeconomic inequalities. Liverpool, in particular, demonstrated some of the lowest uptake rates in England since 2019. In response, the Health Equity Liverpool Project (HELP) implemented a hyper-localised community-led initiative between September 2023 and June 2024 to tackle vaccine hesitancy. Activities included outreach events and school-based engagement across nine sites within Liverpool. Despite promising qualitative evidence, the intervention’s impact on childhood vaccine uptake has not yet been quantified. We aim to evaluate the population level impact of the HELP intervention on the uptake of five childhood vaccines (first and second doses of the measles, mumps and rubella vaccine (MMR1, MMR2), 6-in-1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B), pneumococcal conjugate vaccine booster dose (PCV) and rotavirus vaccine) using synthetic control methods.Methods and analysisWe will analyse publicly available quarterly vaccine uptake data (between April 2019 and March 2025) from the Cover of Vaccination Evaluated Rapidly programme for general practices (GPs) in England. The intervention group will be defined as practices located within a 1 km radius of the intervention sites. A synthetic control group will be constructed using non-intervention GPs matched on pre-intervention vaccine uptake, and linked demographic, socioeconomic and healthcare capacity covariates. Primary outcomes are the uptake of MMR1 and MMR2 vaccines. Secondary outcomes include the uptake of 6-in-1, PCV and rotavirus vaccines. Average treatment effects will be estimated as the post-intervention difference in uptake between intervention and synthetic control groups. Sensitivity analyses will examine spillover effects, alternative spatial definitions of exposure, the biasing effect of concurrent interventions and the feasibility of analysis at small area neighbourhood level.Ethics and disseminationThis study will be conducted as part of the ReCITE project, which has received ethical approval from the Liverpool School of Tropical Medicine Research Ethics Committee (Reference: 24–018) and is funded by the UK Arts and Humanities Research Council (Project Number: AH/Z505341/1). Findings will be shared with the project funder and submitted for publication in a peer-reviewed journal.

ObjectivesThe aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.DesignCross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.SettingThree deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).Main outcome measureTypes of foods and beverages sold and/or advertised.ResultsJamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.ConclusionOur study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.

ObjectiveTo determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England.DesignObservational repeated cross-sectional study.SettingEngland (January 2019 to March 2022).ParticipantsWith the approval of NHS England we used individual-level electronic health records from OpenSAFELY, which covered ~40% of general practices in England (mean monthly population size 23.5 million people).Primary and secondary outcome measuresWe estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity and geographical region.ResultsThere were large declines in avoidable hospitalisations during the first national lockdown (March to May 2020). Trends increased post-lockdown but never reached 2019 levels. The exception to these trends was for vaccine-preventable ambulatory care sensitive admissions which remained low throughout 2020–2021. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed across levels of neighbourhood socioeconomic deprivation, Asian ethnicity (compared with white ethnicity) and geographical region (especially in northern regions).ConclusionsWe found no evidence that periods of healthcare disruption from the COVID-19 pandemic resulted in more avoidable hospitalisations. Falling avoidable hospital admissions has coincided with declining inequalities most strongly by level of deprivation, but also for Asian ethnic groups and northern regions of England.

BackgroundReducing avoidable systematic differences in population health requires first understanding which populations are currently disadvantaged. Although the health of coastal communities in England has been of concern for some years, an operationalised definition of ‘coastal’ is lacking. This study aims to use national cancer statistics to define and validate a small area-level definition of ‘coastal’ that could be used to better report cancer-related health inequalities in England.MethodsInformation on the geography and demography of English populations at the Lower Super Output Area (LSOA) level were used to define a suite of candidate coastal variables that considered foreshore proximity, resident population location, rurality and deprivation. Adjusted linear models of LSOA-level statistics of cancer incidence, prevalence and mortality in England (2016 to 2020) were used to identify candidate coastal variable(s) that explained the greatest proportion of variation in cancer outcomes after adjustment.ResultsThe candidate ‘G_25_5’ (LSOA’s designated as ‘coastal’ if 25% or more of postcodes were within 5 km of the coastline) was selected as the candidate that explained the most residual variation in cancer incidence and prevalence after adjustment. This variable would assign 7377 2011 LSOAs as coastal, whose populations summed to 12.3 million people (22% of England’s population, in 2016). This candidate variable was not significantly associated with cancer mortality.ConclusionsThe coastal variable that we identify can explain some of the ‘coastal excess’ in poor cancer outcomes. We propose that this variable is now embedded into health inequalities reporting and adopted as the working definition of ‘coastal’ implicated in NHS England’s ‘Core20PLUS5’ approach for use in cancer data reporting.

BackgroundGastrointestinal (GI) infections affect one in five people in the UK and local authorities play a crucial role in controlling these infections. However, there have been substantial reductions in funding for environmental and regulatory (ER) services that enable GI infectious disease prevention and control via food safety and infection control (FSIC) services. This study investigates how local funding cuts to these services have varied across England to understand the potential consequences of inequalities in GI infections.MethodsWe carried out a longitudinal observational ecological study, using a panel of annual data between 2009/2010 and 2020/2021. Analysis of ER service expenditure and FSIC service expenditure included 312 and 303 local authorities respectively. Generalised estimating equation models were used to estimate the annual per cent change of ER service expenditure between 2009/2010 and 2020/2021 in addition to FSIC expenditure change overall, and as a share of total ER expenditure. Models analysed trends by local authority structure, population density and deprivation level.ResultsER services saw the largest cuts in unitary authorities, declining by 1.9%. London boroughs had the greatest reductions in FSIC expenditure, decreasing by 9.9%. Both ER and FSIC expenditure decreased with increasing population density. Areas of higher deprivation had the largest reduction in expenditure, with ER and FSIC cuts of 2.4% and 22.8%, respectively, compared with a 1.2% and 7.5% reduction in the least deprived areas. The share of ER expenditure spent on FSIC decreased by 13.4% in the most deprived authorities compared with 6.3% in the least deprived areas.ConclusionThe unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to emerging infectious disease threats and to prevent the widening of health inequalities.

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.

Introduction Policies aiming to prevent ill health and reduce health inequalities need to consider the full complexity of health systems, including environmental determinants. A learning health system that incorporates environmental factors needs healthcare, social care and non‐health data linkage at individual and small‐area levels. Our objective was to establish privacy‐preserving household record linkage for England to ensure person‐level data remain secure and private when linked with data from households or the wider environment. Methods A stakeholder workshop with participants from our regional health board, together with the regional data processor, and the national data provider. The workshop discussed the risks and benefits of household linkages. This group then co‐designed actionable dataflows between national and local data controllers and processors. Results A process was defined whereby the Personal Demographics Service, which includes the addresses of all patients of the National Health Service (NHS) in England, was used to match patients to a home identifier, for the time they are recorded as living at that address. Discussions with NHS England resulted in secure and quality‐assured data linkages and a plan to flow these pseudonymised data onwards into regional health boards. Methods were established, including the generation of matching algorithms, transfer processes and information governance approvals. Our collaboration accelerated the development of a new data governance application, facilitating future public health intervention evaluations. Conclusion These activities have established a secure method for protecting the privacy of NHS patients in England, while allowing linkage of wider environmental data. This enables local health systems to learn from their data and improve health by optimizing non‐health factors. Proportionate governance of health and linked non‐health data is practical in England for incorporating key environmental factors into a learning health system.

Few studies have considered dissolution of calcium carbonate in nearshore temperate, mud deposits where sediments are seldom more than 1-3% CaCO $\\sb3$by weight. However, knowledge of the processes that control CaCO $\\sb3$dissolution-preservation in all types of depositional environments are essential to fully understand the global CaCO $\\sb3$cycle. The purpose of this study was to better constrain the role of nearshore-temperate regions in the cycling of biogenic calcium carbonate by studying the seasonal patterns of CaCO $\\sb3$build-up and dissolution in Long Island Sound sediments. Pore water saturation state with respect to calcite and aragonite minerals in Long Island Sound sediments fluctuate from saturated and near saturated conditions during late fall, to undersaturated during winter, before slowly changing to supersaturated conditions during late spring. Higher$\\rm\\Sigma CO\\sb2$production rates during warmer periods cause the$\\rm CO\\sb3\\sp{2-}$concentration to become supersaturated for both calcite and aragonite.$\\rm\\Sigma CO\\sb2$production is controlled by both temperature and substrate availability so that benthic deposition of organic matter produced during the spring bloom accelerates the seasonal progression of pore waters to supersaturation. Undersaturation occurs during winter time when lower rates of$\\rm\\Sigma CO\\sb2$production and oxidation of reduced minerals such as FeS lower$\\rm CO\\sb3\\sp{2-}$below saturation. Large benthic losses of$\\rm Ca\\sp{2+},\\ Mg\\sp{2+},\\ Sr\\sp{2+},$and F $\\sp-$occur when sediments are undersaturated with respect to carbonate minerals over a period of${\\sim}160$days. The prorated annual average flux range of$-0.53$to$-3.3$mmol$\\rm Ca\\sp{2+}\\ m\\sp{-2}\\ d\\sp{-1}\\ (-2.0\\pm 1.02$mmol$\\rm Ca\\sp{2+}\\ m\\sp{-2}\\ d\\sp{-1})$is comparable to or greater than fluxes of$\\rm Ca\\sp{2+}$documented from other nearshore carbonate regions as well as the deep sea, where little if any temporal variability in pore water saturation state occurs. Mass fluxes of$\\rm Ca\\sp{2+}$from this study imply that between${\\sim}31.0$g$\\rm CaCO\\sb3\\ m\\sp{-2}$dissolves during winter in LIS sediments. This translates to a Sound-wide loss during winter of$\\sim 5.6\\times 10\\sp{10}$g$\\rm CaCO\\sb3.$Rapid, significant declines in the total foraminifera assemblage of Elphidium clavatum and Buccella frigida, and the abundance of bivalves Tellina agilis, and perhaps to some extent Nucula annulata, correlate with the winter-time period of calcite/aragonite mineral undersaturation. Declines in the density of individuals can be explained by dissolution of the carbonate tests. Dissolution of some calcareous organisms during winter in LIS suggests one mechanism by which systematic biases exist in the taxonomic and age class composition of the fossil record. What is ultimately preserved as a fossil may not actually represent all ecological groups that existed at the time of burial or reflect their actual abundances while living and/or shortly after death. A laboratory experiment showed that calcite undersaturation resulted in dissolution of previously discarded tests of the foraminifera E. clavatum and B. frigida, and also increased mortality of live individuals approximately 3 times relative to controls. SEM observations of foraminifera support the notion that dissolution was greater in experimental-undersaturated chambers relative to control-saturated chambers. No significant difference was seen between treatments for the bivalves T. agilis or N. annulata. However, dissolution-induced mortality in meiofauna other than foraminifera, such as juvenile bivalves, should not be discounted and deserves future attention.

Photolysis of thermally stable ReH(,5)(PMe(,2)Ph)(,3) results in the dissociation of a phosphine ligand to create a highly reactive, hydrogen-rich unsaturated transient. This transient is scavenged by a number of two electron ligands, L (eg., H(,2), PR(,3)), to form ReH(,5)(PMe(,2)Ph)(,2)L. In the absence of added scavengers dimerization occurs, ultimately forming Re(,2)H(,6)(PMe(,2)Ph)(,5). Photoassisted catalytic hydrogenation of terminal olefins occurs at room temperature under 1 atm H(,2); however, internal olefins form stable hydrido-olefin complexes. Similarly, dienes react with the phototransient to give stable hydrido-((eta)('4)-diene) and hydrido-((eta)('5)-dienyl) complexes. Reaction of the phototransient with 3,3-dimethyl-1-butene produces a species capable of activating the carbon-hydrogen bonds of cyclopentane. Photolysis of ReH(,5)(PMe(,2)Ph)(,3) and 3,3-dimethyl-1-butene in benzene under N(,2) yields the arene complex ((eta)('6)-C(,6)H(,6))Re(PMe(,2)Ph)(,2)(CH(,2)CH(,2)CMe(,3)) and fac-Re(PMe(,2)Ph)(,3)(PMe(,2)C(,6)H(,4))(N(,2)). The photocondensation of monomeric transition metal polyhydrides to dimeric polyhydrides is a general reaction. Photolysis of OsH(,4)(PMe(,2)Ph)(,3) leads to formation of Os(,2)H(,4)(PMe(,2)Ph)(,6), as well as the phosphido-bridged hydride dimer Os(,2)H(,4)(PMe(,2)Ph)(,4)(PMePh)(,2). In solution Os(,2)H(,4)(PMe(,2)Ph)(,6) exists in equilibrium with Os(,2)H(,4)(PMe(,2)Ph)(,5) and PMe(,2)Ph. Acidolysis of Os(,2)H(,4)(PMe(,2)Ph)(,6) leads to the formation of Os(,2)H(,3)(PMe(,2)Ph)(,6)('+). The hydride anion, fac-OsH(,3)(PMe(,2)Ph)(,3), was prepared by reaction of OsH(,4)(PMe(,2)Ph)(,3) with potassium hydride. The polyhydride dimers Re(,2)H(,8)(PMe(,2)Ph)(,4) and Re(,2)H(,6)(PMe(,2)Ph)(,5) react with P(OCH(,2))(,3)CEt to give, respectfully, Re(,2)H(,4)(PMe(,2)Ph)(,4)P(OCH(,2))(,3)CEt(,2) and Re(,2)H(,4)(PMe(,2)Ph)(,5)P(OCH(,2))(,3)CEt. Both of these dimers can be protonated with HBF(,4)(.)Et(,2)O to yield the corresponding Re(,2)H(,5)L(,6)BF(,4) species, in which three hydride ligands bridge the metal-metal triple bond. The X-ray crystal structures of Re(,2)H(,6)(PMe(,2)Ph)(,5), Re(,2)H(,4)(PMe(,2)Ph)(,4)P(OCH(,2))(,3)CEt(,2), Re(,2)H(,5)(PMe(,2)Ph)(,4)P(OCH(,2))(,3)CEt(,2)BF(,4), Re(N(,2))(PMe(,2)Ph)(,3)(PMe(,2)C(,6)H(,4)), Os(,2)H(,4)(PMe(,2)Ph)(,6), Os(,2)H(,3)(PMe(,2)Ph)(,6)Cl, and Os(,2)H(,4)(PMe(,2)Ph)(,4)(PMePh)(,2) are described.

Cells release lipid-bound extracellular vesicles (EVs; exosomes, microvesicles and apoptotic bodies) containing proteins, lipids and RNAs into the circulation. Vesicles mediate intercellular communication between both neighboring and distant cells. There is substantial interest in using EVs as biomarkers for age-related diseases including cancer, and neurodegenerative, metabolic and cardiovascular diseases. The majority of research focuses on identifying differences in EVs when comparing disease states and matched controls. Here, we analyzed circulating plasma EVs in a cross-sectional and longitudinal study in order to address age-related changes in community-dwelling individuals. We found that EV concentration decreases with advancing age. Furthermore, EVs from older individuals were more readily internalized by B cells and increased MHC-II expression on monocytes compared with EVs from younger individuals, indicating that the decreased concentration of EVs with age may be due in part to increased internalization. EVs activated both monocytes and B cells, and activation of B cells by LPS enhanced EV internalization. We also report a relative stability of EV concentration and protein amount in individual subjects over time. Our data provide important information towards establishing a profile of EVs with human age, which will further aid in the development of EV-based diagnostics for aging and age-related diseases.