Liverpool City Council

Clinicians frequently observe that filler deposited at the vermilion border can "track" for a long distance along the lip margin from a single entry point, producing a continuous, sharply defined border line. This behavior suggests an anatomic conduit at the mucocutaneous junction. To identify a reproducible longitudinal structure beneath the vermilion margin (the "vermilion canal") and to characterize the pattern of one-point, linear tracer spread along the vermilion border in the upper and lower lips. Ten adult cadavers underwent dyed gel-filler tracer injection using 1 puncture site per lip (upper and lower). After injection, the lips were examined for macroscopic tracer distribution. Layered dissections and targeted cross-sections were performed to localize the tracer plane and define anatomic boundaries relative to the vermilion margin and orbicularis oris. In 9 of 10 cadavers (90%), tracer propagated as a continuous longitudinal column immediately deep to the vermilion border with limited dispersion into the central lip. Dissection demonstrated a canal-like potential space aligned with the vermilion border, constrained by connective-tissue septa and closely related to the superficial orbicularis oris. The configuration was present in both upper and lower lips in positive specimens. One cadaver showed an indistinct plane with irregular spread. A consistent longitudinal potential space beneath the vermilion margin can facilitate long-segment, linear filler distribution after single-entry injection. The "vermilion canal" concept offers a simple anatomic explanation for border tracking and may support a streamlined, plane-specific approach for creating a crisp vermilion border line while maintaining vigilance for vascular variability.

Purpose Engaging transgender, non-binary and gender-diverse (TNBiGD) individuals in healthcare beyond transition-related care is necessary for improving health outcomes. Because of a lack of legislative protections in the UK, this population faces substantial barriers to accessing healthcare, characterised by negative experiences and discrimination. This study aims to explore the healthcare experiences of TNBiGD individuals in England, focusing on access and engagement within primary and secondary care services. Design/methodology/approach Adopting a participatory research approach, this study involved 17 TNBiGD individuals in England through online focus groups and semi-structured interviews, conducted in three phases. Ethical clearance was obtained, and participants were recruited via snowball sampling from LGBTQIA+ networks. Thematic analysis was used to interpret the data, with a focus on healthcare engagement and barriers to access. Findings Participants highlighted the necessity of equitable healthcare access as a fundamental human right, often hindered by discrimination, restricted access to gender-affirming care and a lack of provider knowledge. Systemic exclusions and identity erasure were identified as major barriers, with participants experiencing misgendering, incorrect use of gender markers and diagnostic overshadowing. Positive healthcare experiences were noted when gender identity was respected and integrated into care. Originality/value This study underscores the significant healthcare barriers faced by TNBiGD individuals in England, highlighting the need for systemic changes to ensure accessible, respectful and inclusive care. Recommendations focus on education, policy changes and further research to address these challenges and improve healthcare outcomes for the transgender and non-binary community [1].

Digital tools, particularly specialised decision support systems (DSSs), can be utilized to assist in the complex process of brownfield redevelopment. Existing brownfield DSSs typically focus on site-specific, late-stage applications, and socioeconomic factors are often overlooked. In this paper, we present a novel DSS aimed at providing support for early-stage, city region-scale brownfield land use planning and redevelopment. The proposed DSS is a prototype WebGIS application that enables land use planners and other brownfield regeneration professionals to examine a region and a set of sites during the initial planning phase for brownfield redevelopment. The DSS includes three bespoke modules comprising: (1) Land Use Potential (residential, commercial, and public open space), (2) risks posed by contamination and geotechnical hazards, (3) data pertinent to brownfield economic viability assessments. We outline a use case for this DSS, developed through comprehensive user-requirements gathering, and subsequently describe the techniques employed to construct the DSS modules and user interface. Finally, we present the results of user testing, wherein case-study stakeholders assessed the DSS. The feedback obtained during user testing aided in the identification of areas for improvement with regard to the functionality, usability, and effectiveness of the DSS in supporting decision-makers. The feedback was utilized to implement iterative improvements to the DSS and to plan future developments for the prototype DSS.

ObjectiveTo evaluate the impact of mobile vaccination units on COVID-19 vaccine uptake of the first dose, the percentage of vaccinated people among the total eligible population. We further investigate whether such an effect differed by deprivation, ethnicity and age.DesignSynthetic control analysis.SettingThe population registered with general practices (GPs) in nine local authority areas in Cheshire and Merseyside in Northwest England, UK.InterventionMobile vaccination units that visited 37 sites on 54 occasions between 12 April 2021 and 28 June 2021. We defined intervention neighbourhoods as having their population weighted centroid located within 1 km of mobile vaccination sites (338 006 individuals). A weighted combination of neighbourhoods that had not received the intervention (1 495 582 individuals) was used to construct a synthetic control group.OutcomeThe weekly number of first-dose vaccines received among people aged 18 years and over as a proportion of the population.ResultsThe introduction of a mobile vaccination unit into a neighbourhood increased the number of first vaccinations conducted in the neighbourhood by 25% (95% CI 21% to 28%) within 3 weeks after the first visit to a neighbourhood, compared with the synthetic control group. Interaction analyses showed smaller or no effect among older age groups, Asian and black ethnic groups, and the most socioeconomically deprived populations.ConclusionsMobile vaccination units are effective interventions for increasing vaccination uptake, at least in the short term. While mobile units can be geographically targeted to reduce inequalities, we found evidence that they may increase inequalities in vaccine uptake within targeted areas, as the intervention was less effective among groups that tended to have lower vaccination uptake. Mobile vaccination units should be used in combination with activities to maximise outreach with black and Asian communities and socioeconomically disadvantaged groups.

Mitochondrial fission and a metabolic switch from oxidative phosphorylation to glycolysis are key features of vascular pathology in pulmonary arterial hypertension (PAH) and are associated with exuberant endothelial proliferation and apoptosis. The underlying mechanisms are poorly understood. We describe the contribution of two intracellular chloride channel proteins, CLIC1 and CLIC4, both highly expressed in PAH and cancer, to mitochondrial dysfunction and energy metabolism in PAH endothelium. Pathological overexpression of CLIC proteins induces mitochondrial fragmentation, inhibits mitochondrial cristae formation, and induces metabolic shift toward glycolysis in human pulmonary artery endothelial cells, consistent with changes observed in patient-derived cells. Interactions of CLIC proteins with structural components of the inner mitochondrial membrane offer mechanistic insights. Endothelial CLIC4 excision and mitofusin 2 supplementation have protective effects in human PAH cells and preclinical PAH. This study is the first to demonstrate the key role of endothelial intracellular chloride channels in the regulation of mitochondrial structure, biogenesis, and metabolic reprogramming in expression of the PAH phenotype.

ObjectiveTo analyse the impact of voluntary rapid testing for SARS-CoV-2 antigen in Liverpool city on covid-19 related hospital admissions.DesignSynthetic control analysis comparing hospital admissions for small areas in the intervention population with a group of control areas weighted to be similar for past covid-19 related hospital admission rates and sociodemographic factors.SettingLiverpool city, UK, 6 November 2020 to 2 January 2021, under the intervention of Covid-SMART (systematic meaningful asymptomatic repeated testing) voluntary, open access supervised self-testing with lateral flow devices, compared with control areas selected from the rest of England.PopulationGeneral population of Liverpool (n=498 042) and a synthetic control population from the rest of England.Main outcome measureWeekly covid-19 related hospital admissions for neighbourhoods in England.ResultsThe introduction of community testing was associated with a 43% (95% confidence interval 29% to 57%) reduction (146 (96 to 192) in total) in covid-19 related hospital admissions in Liverpool compared with the synthetic control population (non-adjacent set of neighbourhoods with aggregate trends in covid-19 hospital admissions similar to Liverpool) for the initial period of intensive testing with military assistance in national lockdown from 6 November to 3 December 2020. A 25% (11% to 35%) reduction (239 (104 to 333) in total) was estimated across the overall intervention period (6 November 2020 to 2 January 2021), involving fewer testing centres, before England’s national roll-out of community testing, after adjusting for regional differences in tiers of covid-19 restrictions from 3 December 2020 to 2 January 2021.ConclusionsThe city-wide pilot of community based asymptomatic testing for SARS-CoV-2 was associated with substantially reduced covid-19 related hospital admissions. Large scale asymptomatic rapid testing for SARS-CoV-2 could help reduce transmission and prevent hospital admissions.

BackgroundAir quality is monitored at a local level in the UK as part of the Local Air Quality Management (LAQM) system. If air quality objectives within an area are not achieved an Air Quality Management Area (AQMA) is declared and action plan developed. The efficacy of this system in reducing air pollution has increasingly come into question, however very little is known about its impact on health or health inequalities. We therefore investigated the effect of declaring an AQMA on emergency hospitalisations for respiratory conditions in the North West Coast region of England, and examined whether the effect differed between more compared to less deprived neighbourhoods.MethodsThis longitudinal controlled ecological study analysed neighbourhoods located within or touching the boundaries of AQMAs declared in the North West Coast region between 2006 and 2016. Each of these intervention neighbourhoods were matched with five control neighbourhoods which had never been located within/touching an AQMA boundary. Difference-in-differences methods were used to compare the change in hospitalisation rates in the intervention neighbourhoods to the change in hospitalisation rates in the matched control neighbourhoods, before and after the declaration of an AQMA.ResultsIn total, 108 intervention neighbourhoods and 540 control neighbourhoods were analysed over the period 2005–2017, giving a total sample size of 8424 neighbourhood-years. Emergency hospitalisations for respiratory conditions decreased in the intervention neighbourhoods by 158 per 100,000 per year [95% CI 90 to 227] after an AQMA was declared relative to the control neighbourhoods. There was a larger decrease in hospitalisation rates following the declaration of an AQMA in more compared to less income deprived neighbourhoods.ConclusionsOur results suggest the LAQM system has contributed to a reduction in emergency hospitalisations for respiratory conditions, and may represent an effective strategy to reduce inequalities in health. These findings highlight the importance of measuring the success of air quality policies not just in terms of air pollution but also in terms of population health.

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.