Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

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.

A dual channel gas chromatograph for atmospheric analysis of volatile organic compounds including oxygenated and monoterpene compounds.

A dual channel gas chromatograph with flame ionisation detectors has been used extensively for analysis of volatile organic compounds in the atmosphere and forms the basis of two monitoring instruments contributing VOC data to the World Meteorological Organisation - Global Atmosphere Watch network. Recent modifications to the methodology have broadened the scope of the instrument; to incorporate measurements of selected monoterpenes, and achieve improved accuracy in the measurement of oxygenated volatile organic compounds. Analysis of selected monoterpenes has been achieved without any significant loss of resolution of the non-methane hydrocarbons or oxygenated compounds. Quantification of 64 different VOCs of varying functionalities are reported with detection limits in the range 1-5 parts per trillion. Here we present a summary of the instrumental and calibration details for the methodology, which continues to be used on many field projects, along with a discussion of the associated measurement uncertainties.

The first organocatalytic carbonyl-ene reaction: isomerisation-free C-C bond formations catalysed by H-bonding thio-ureas.

Intramolecular carbonyl ene reactions of highly activated enophiles can be catalysed by H-bonding thio-ureas to give tertiary alcohols in high yields without extensive isomerisation side products. An asymmetric variant of this reaction was realised using a chiral thiourea but was limited by low enantioselectivity (up to 33% e.e.) and low turnover frequencies.

Abiotic source of reactive organic halogens in the sub-arctic atmosphere?

Recent theoretical studies indicate that reactive organic iodocarbons such as CH2I2 would be extremely effective agents for tropospheric Arctic ozone depletion and that iodine compounds added to a Br2/BrCl mixture have a significantly greater ozone (and mercury) depletion effect than additional Br2 and BrCl molecules. Here we report the first observations of CH2I2, CH2IBr, and CH2ICl in Arctic air, as well as other reactive halocarbons including CHBr3, during spring at Kuujjuarapik, Hudson Bay. The organoiodine compounds were present atthe highest levels yet reported in air. The occurrence of the halocarbons was associated with northwesterly winds from the frozen bay, and, in the case of CHBr3, was anticorrelated with ozone and total gaseous mercury (TGM), suggesting a link between inorganic and organic halogens. The absence of local leads coupled with the extremely short atmospheric lifetime of CH2I2 indicates that production occurred in the surface of the sea-ice/overlying snowpack over the bay. We propose an abiotic mechanism for the production of polyhalogenated iodo- and bromocarbons, via reaction of HOI and/or HOBr with organic material on the quasi-liquid layer above sea-ice/snowpack, and report laboratory data to support this mechanism. CH2I2, CH2IBr, and other organic iodine compounds may therefore be a ubiquitous component of air above sea ice where they will increase the efficiency of bromine-initiated ozone and mercury depletion.

Solar photolysis of CH2I2, CH2ICl, and CH2IBr in water, saltwater, and seawater.

Ultraviolet-visible absorption spectroscopy and purge-and-trap GC-MS were used to determine the rates and products of the photodissociation of low concentrations of CH2I2, CH2IBr, and CH2ICl in water, saltwater (0.5 M NaCl), and seawater in natural sunlight. Photoproducts of these reactions include iodide (I-) and, in salt- and seawater environments, CH2XCl (where X = Cl, Br, or I). Thus, CH2ICl was produced during CH2I2 photolysis (with a molar yield of 35 +/- 20%), CH2BrCl from CH2IBr photolysis, and CH2Cl2 from CH2ICl photolysis (in lower yields of 6-10%). Formation of these chlorine-atom-substituted products may be via direct reaction of Cl- with either (A) the isopolyhalomethane photoisomer or associated ion pair (e.g., CH2I+-I-) or (B) the initially produced CH2I. photofragment. Estimated quantum yields for photodissociation were 0.62 +/- 0.09, 0.17 +/- 0.03, and 0.26 +/- 0.06 for CH2I2, CH2IBr, and CH2ICl, respectively, in 0.5 M NaCl, with only small differences from these values in water and seawater. The much higher quantum yield of CH2I2 photolysis compared to CH2IBr and CH2ICl photolysis may be explained by the higher yield of the isodiiodomethane photoisomer of CH2I2, resulting in reduced geminate recombination of the initially produced radical photofragments back to the parent molecule. We use a radiative transfer model with measured absorption cross-sections in saltwater to calculate seasonal values of CH2I2, CH2IBr, and CH2ICl photodissociation in surface seawater at midlatitudes (50 degrees N) and show that a significant proportion of CH2ICl in surface seawater may arise from CH2I2 photodecomposition. We also suggest that surface seawater photolysis of CH2I2 over an 8 h period may contribute up to approximately 10% of the surface seawater I- levels, with implications for the increased deposition of O3 to the surface ocean.