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Introduction: Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. Methods: The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. Results: 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15–35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). Conclusions: In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance. [ABSTRACT FROM AUTHOR]

Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs. An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses. The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa. Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures. [ABSTRACT FROM AUTHOR]

Due to the various hazards of using synthetic chemical compounds in pharmaceutics, agriculture, and industry, scientists and researchers do their best to explore and assess new green natural compounds from natural resources with potent activity. The essential oil (EO) from the resin collected from Araucaria heterophylla Salisb. was extracted by the microwave technique and chemically characterized via GC-MS analysis. Furthermore, the extract EO was assessed for its antioxidant and phytotoxic activities. The EO has 33 compounds, mainly terpenes (98.23%), and the major compounds were α-pinene (62.57%), β-pinene (6.60%), germacrene D (5.88%), and β-caryophyllene (3.56%). The extracted EO showed substantial antioxidant activity, where it showed IC50 values of 142.42 and 118.03 mg L−1 for DPPH and ABTS, respectively. On the other hand, the EO revealed considerable phytotoxicity against the weed Chenopodium murale, where the EO showed IC50 values of 304.0, 230.1, and 147.1 mg L−1, for seed germination, seedling shoot growth, and seedling root growth, respectively. Moreover, the EO showed the same pattern of allelopathic inhibition against the weed Sonchus oleraceus, where it showed IC50 values of 295.7, 224.5, and 106.1 mg L−1, for seed germination, seedling shoot growth, and seedling root growth, respectively. The present study showed that the extraction technique affects the constituents of the EO, particularly the quantitative composition. The EO of A. heterophylla resin also revealed considerable antioxidant and phytotoxic activity against weeds. Therefore, it can be considered a promising natural resource that could be integrated into the weed management approach. However, further study is recommended for deep characterization of their authentic compounds and evaluation of their mode of action(s) on a wide spectrum of weeds. [ABSTRACT FROM AUTHOR]

Low-lying coastal cities across the world are vulnerable to the combined impact of rainfall and storm tide. However, existing approaches lack the ability to model the combined effect of these flood mechanisms, especially under climate change and sea level rise (SLR). Thus, to increase flood resilience of coastal cities, modeling techniques to improve the understanding and prediction of the combined effect of these flood hazards are critical. To address this need, this study presents a modeling system for assessing the combined flood impact on coastal cities under selected future climate scenarios that leverages ocean modeling with land surface modeling capable of resolving urban drainage infrastructure within the city. The modeling approach is demonstrated in quantifying the impact of possible future climate scenarios on transportation infrastructure within Norfolk, Virginia, USA. A series of combined storm events are modeled for current (2020) and projected future (2070) climate scenarios. The results show that pluvial flooding causes a larger interruption to the transportation network compared to tidal flooding under current climate conditions. By 2070, however, tidal flooding will be the dominant flooding mechanism with even nuisance flooding expected to happen daily due to SLR. In 2070, nuisance flooding is expected to cause a 4.6% total link close time (TLC), which is more than two times that of a 50-year storm surge (1.8% TLC) in 2020. The coupled flood model was compared with a widely used but physically simplistic bathtub method to assess the difference resulting from the more complex modeling presented in this study. The results show that the bathtub method overestimated the flooded area near the shoreline by 9.5% and 3.1% for a 10-year storm surge event in 2020 and 2070, respectively, but underestimated the flooded area in the inland region by 9.0% and 4.0% for the same events. The findings demonstrate the benefit of sophisticated modeling methods compared to more simplistic bathtub approaches, in climate adaptive planning and policy in coastal communities. [ABSTRACT FROM AUTHOR]

Background: Hand oedema is a common consequence of hand trauma or surgery. There are numerous methods to reduce hand oedema but lack high-quality evidence to support best practice. The primary objective of this pilot trial was to assess study feasibility when comparing treatments for subacute hand oedema after trauma. Methods: A parallel two-arm pilot randomised controlled trial was conducted in the hand therapy department at a regional hospital in Norfolk between October 2017 and July 2018. Patients were eligible if 18 years or over, referred to hand therapy with subacute hand oedema. Randomisation was on a 1:1 basis to treatment as usual (TAU) (compression, elevation and massage) or trial treatment (TT) (kinesiology tape, elevation and massage). One blinded assessor completed all assessments (prior to randomisation, 4 and 12 weeks later). Data on study feasibility, adherence and acceptability of treatments were collected. The primary outcome measure was hand volume (volumetry). Patient-rated severity (0–5 Likert scale), hand health profile of the Patient Evaluation Measure (PEM) and quality of life (EQ-5D-5L) were also recorded. Results: Forty-five patients were screened for eligibility and 26 consented and were randomised with 13 patients in each treatment arm. Twelve participants were lost to follow-up leaving 7 participants in each group included in the analysis. Assessor blinding was maintained in 64% of participants (9/14). Total mean acceptability scores, out of 100, were higher for TAU (87.9) than TT (76.1). Health resource use results showed TT was marginally cheaper (~£2 per patient) than TAU. Individual adherence ranged between 39 and 100%, with higher levels of overall adherence seen in the TAU group. Four participants (28%) reported adverse effects (TT group n = 3, TAU group n = 1). Conclusion: This pilot trial has identified that modifications are required in order to make a full-scale trial feasible. They include a formal assessment of treatment fidelity, research staff assisting with screening and recruitment of participants and multiple blinded assessors at each study site. Whilst not designed as an efficacy trial, it should be acknowledged that the small sample size and high loss to follow-up meant very small numbers were included in the final analysis resulting in wide confidence intervals and therefore low precision in parameter estimates. Trial registration: International Standard Randomised Controlled Trial Number: 94083271. Date of registration 16th August 2017. Trial funding: National Institute for Health Research Trainees Co-ordinating Centre (TCC); Grant Codes: CDRF-2014-05-064 [ABSTRACT FROM AUTHOR]

Poor air quality represents a significant health risk for individuals engaging in recreation activities outdoors in urban parks and trails. This study investigated temporal variability in particulate matter (PM) exposure along an urban waterfront trail. We also used recreation choice frameworks to examine the effects of visitors' perceptions of air quality (AQ) and health benefits on trail use. Average air quality during the collection period was "good" (PM10) to "moderate" (PM2.5). We found that PM density was significantly higher (p < 0.001), though still in the "moderate" range, at 7–9 a.m., 11 a.m.–1 p.m., and 3–5 p.m., and on weekends. Visitors' self-reported perceptions of health outcomes, but not air quality, significantly predicted trail use. Results suggest that these experiential factors may affect recreational choices depending on other factors, such as salience. Further research is merited to determine how experiential factors can be integrated with other theories of motivation to understand recreational decision-making. [ABSTRACT FROM AUTHOR]