Fate of pathogens in a simulated bioreduction system for livestock carcasses

The EU Animal By-Products Regulations generated the need for novel methods of storage and disposal of dead livestock. Bioreduction prior to rendering or incineration has been proposed as a practical and potentially cost-effective method; however, its biosecurity characteristics need to be elucidated. To address this, Salmonella enterica (serovars Senftenberg and Poona), Enterococcus faecalis, Campylobacter jejuni, Campylobacter coli and a lux-marked strain of Escherichia coli O157 were inoculated into laboratory-scale bioreduction vessels containing sheep carcass constituents. Numbers of all pathogens and the metabolic activity of E. coli O157 decreased significantly within the liquor waste over time, and only E. faecalis remained detectable after 3months. Only very low numbers of Salmonella spp. and E. faecalis were detected in bioaerosols, and only at initial stages of the trial. These results further indicate that bioreduction represents a suitable method of storing and reducing the volume of livestock carcasses prior to ultimate disposal.

Lettuce cultivar mediates both phyllosphere and rhizosphere activity of Escherichia coli O157:H7

Plant roots and leaves can be colonized by human pathogenic bacteria, and accordingly some of the largest outbreaks of foodborne illness have been associated with salad leaves contaminated by E. coli O157. Integrated disease management strategies often exploit cultivar resistance to provide a level of protection from economically important plant pathogens; however, there is limited evidence of whether the genotype of the plant can also influence the extent of E. coli O157 colonization. To determine cultivar-specific effects on colonization by E. coli O157, we used 12 different cultivars of lettuce inoculated with a chromosomally lux-marked strain of E. coli O157:H7. Lettuce seedlings grown gnotobiotically in vitro did exhibit a differential cultivar-specific response to E. coli O157 colonization, although importantly there was no relationship between metabolic activity (measured as bioluminescence) and cell numbers. Metabolic activity was highest and lowest on the cultivars Vaila-winter gem and Dazzle respectively, and much higher in endophytic and tightly bound cells than in epiphytic and loosely bound cells. The cultivar effect was also evident in the rhizosphere of plants grown in compost, which suggests that cultivar-specific root exudate influences E. coli O157 activity. However, the influence of cultivar in the rhizosphere was the opposite to that in the phyllosphere, and the higher number and activity of E. coli O157 cells in the rhizosphere may be a consequence of them not being able to gain entry to the plant as effectively. If metabolic activity in the phyllosphere corresponds to a more prepared state of infectivity during human consumption, leaf internalization of E. coli O157 may pose more of a public health risk than leaf surface contamination alone.

The relationship between lay and technical views of Escherichia coli O157 risk

Here, we bring together and contrast lay (accessible primarily through social science methodologies) and technical (via risk assessment and epidemiological techniques) views of the risk associated with the Escherichia coli O157 pathogen using two case study areas in the Grampian region of Scotland, and North Wales. Epidemiological risk factors of contact with farm animals, visiting farms or farm fields and having a private water supply were associated with postcode districts of higher than average disease incidence in the human population. However, this was not the case for the epidemiological risk factor of consumption of beef burgers, which was independent of disease incidence in the postcode district of residence. The proportion of the population expressing a high knowledge of E. coli O157 was greatest in high-incidence disease districts compared with low-incidence areas (17% cf. 7%). This supports the hypothesis that in high-disease-incidence areas, residents are regularly exposed to information about the disease through local cases, the media, local social networks, etc. or perhaps that individuals are more likely to be motivated to find out about it. However, no statistically significant difference was found between high- and low-incidence postcode districts in terms of the proportion of the population expressing a high likelihood of personal risk of infection (10% cf. 14%), giving a counterintuitive difference between the technical (epidemiological and quantitative microbiological risk assessment (QMRA)) and the lay assessment of E. coli O157 risk. This suggests that lay evaluations of E. coli O157 risk reflect intuitive and experience-based estimates of the risk rather than probabilistic estimates. A generally strong correspondence was found in terms of the rank order given to potential infection pathways, with environment and foodborne infection routes dominating when comparing public understanding with technical modelling results. Two general conclusions follow from the work. First, that integrative research incorporating both lay and technical views of risk is required in order that informed decisions can be made to handle or treat the risk by the groups concerned (e.g. the public, policy makers/risk managers, etc.). Second, when communicating risk, for example, through education programmes, it is important that this process is two-way with risk managers (e.g. including Food Standards Agency officials and communications team, public health infection control and environmental health officers) both sharing information with the public and stakeholder groups, as well as incorporating public knowledge, values and context (e.g. geographical location) into risk-management decisions.

The environmental and biosecurity characteristics of livestock carcass disposal methods: A review

Livestock mortalities represent a major waste stream within agriculture. Many different methods are used throughout the world to dispose of these mortalities; however within the European Union (EU) disposal options are limited by stringent legislation. The legal disposal options currently available to EU farmers (primarily rendering and incineration) are frequently negatively perceived on both practical and economic grounds. In this review, we assess the potential environment impacts and biosecurity risks associated with each of the main options used for disposal of livestock mortalities in the world and critically evaluate the justification for current EU regulations. Overall, we conclude that while current legislation intends to minimise the potential for on-farm pollution and the spread of infectious diseases (e.g. transmissible spongiform encephalopathies, bacterial pathogens), alternative technologies (e.g. bioreduction, anaerobic digestion) may provide a more cost-effective, practical and biosecure mechanism for carcass disposal as well as having a lower environmental footprint. Further social, environmental and economic research is therefore warranted to assess the holistic benefits of alternative approaches for carcass disposal in Europe, with an aim to provide policy-makers with robust knowledge to make informed decisions on future legislation.

Leaching of bioluminescent Escherichia coli O157:H7 from sheep and cattle faeces during simulated rainstorm events

AIMS

Development of a novel inoculation technique to improve the current methods of determining the leaching of Escherichia coli O157:H7 from faeces.

METHODS AND RESULTS

Ruminant faeces were inoculated with a high [c. 10(7) colony forming units (CFU) g(-1)] or low (c. 10(4) CFU g(-1)) load of a lux-marked strain of E. coli O157:H7 via injection, and subjected to four simulated heavy rainfall events. The population density and metabolic activity of E. coli O157:H7 recovered within the leachate was determined following each simulated rain event and compared with the indigenous E. coli population. The concentration of E. coli O157:H7 in the leachates followed a similar trend to that of nonpathogenic E. coli. Significantly greater densities of generic and pathogenic E. coli were recovered in the leachates generated from sheep faeces compared with cattle faeces. Pathogen metabolic activity was also significantly greater in sheep faeces.

CONCLUSIONS

Our findings show that E. coli O157:H7 may readily leach from ruminant faeces during rain events. The bacterium leaches more freely from sheep faeces than from cattle faeces and displays greater metabolic activity within sheep leachate.

SIGNIFICANCE AND IMPACT OF THE STUDY

A novel inoculation technique was developed that allowed the determination of both population density and cellular activity of E. coli O157:H7 in leachate derived from faeces.

In-vessel bioreduction provides an effective storage and pre-treatment method for livestock carcasses prior to final disposal

The EU Animal By-Products Regulations forbid the burial of livestock carcasses on land. Farmers would benefit from the availability of biosecure and economically viable alternatives for storing and disposing of dead animals. We assessed the efficacy of bioreduction vessels as a mechanism of storing and reducing the volume of fallen livestock prior to ultimate disposal. Two experimental scenarios were tested: (1) a single input of 300 kg of dead sheep with no further inputs for 3 months, and (2) a continuous 'on-farm' addition of dead sheep over 12 months (ca. 2-3t animals vessel(-1)). The trials involved half-filling the vessels with water, addition of the dead sheep with subsequent heating (40 degrees C) and aeration of the liquor. Each trial was repeated three times. Our results showed a complete biodigestion and liquefaction of the animals alongside a significant bioreduction in the volume of the liquid. No pathogens could be detected in either the waste or the gaseous emissions. Calculations showed that bioreduction may offer significant long-term savings for farmers in terms of animal disposal costs. Our findings suggest that bioreduction may offer a practical, biosecure, and cost-effective method of storing fallen livestock prior to disposal via rendering or incineration.

Heat and lime-treatment as effective control methods for E. coli O157:H7 in organic wastes

Land-application of abattoir wastes is economically appealing and may provide an effective means of closing the nutrient cycling loop. This practise is constrained, however, by legislation which necessitates pre-treatment to remove pathogenic micro-organisms prior to land-spreading. Here we investigated whether heat-treatment or lime addition could eliminate Escherichia coli O157:H7 from three contrasting abattoir wastes. We found that treatment at 60 degrees C for 10 min effectively eradicated the organism while treatment for the same length of time at 50 degrees C led to 2-4 log reductions, but not a complete kill. Temperatures of 72 degrees C induced waste solidification rendering its use impractical. The potential for re-growth in heat-treated and untreated wastes was also investigated. Survival was significantly greater in heat-treated wastes, although the difference was less than half a log unit in magnitude. This effect of heat-treatment on pathogen survival appeared to be ameliorated when wastes were mixed with soil. No viable E. coli O157:H7 cells were recovered from any waste after application of lime (CaO) at a rate of 10 gl(-1), even after enrichment. Our results indicate that pasteurisation-style or liming treatments may provide a suitable alternative method for reducing pathogen loads in abattoir wastes, so that they can be applied to land with minimal biological risk.

Survival of Escherichia coli O157:H7 in waters from lakes, rivers, puddles and animal-drinking troughs

Survival of Escherichia coli O157:H7 in surface waters may increase the potential for dissipation of the organism to facilitate cycles of livestock re-infection and lead to human infection. Although previous studies have monitored survival of the organism in a range of surface waters, there is limited information on the influence of physico-chemical characteristics on persistence. Microcosms of four different surface water types (n=31) from the UK were inoculated with E. coli O157:H7 and incubated at 10 degrees C. The water types studied were: lake, puddle, river, and animal-drinking trough waters. Numbers of E. coli O157:H7 declined over time in all waters, although cells were still detected in 45% of non-sterile samples after 2 months. Persistence of E. coli O157:H7 was enhanced by water aeration and by prior sterilisation; however there was no correlation between water chemistry and mean E. coli O157:H7 die-off times or rates in any water type. Survival of the pathogen was better in lake and puddle waters than in river or drinking trough waters. Further studies are needed to establish the key water quality factors that regulate pathogen survival.

Survival of Escherichia coli O157:H7 in the rhizosphere of maize grown in waste-amended soil

AIMS

To assess whether the persistence of Escherichia coli O157:H7 in soil amended with cattle slurry and ovine stomach content waste is affected by the presence of a maize rhizosphere.

METHODS AND RESULTS

Cattle slurry and ovine stomach content waste were inoculated with E. coli O157:H7. Wastes were then applied to soil cores with and without established maize plants. The pathogen survived in soil for over 5 weeks, although at significantly greater numbers in soil receiving stomach content waste in comparison to cattle slurry. Persistence of the pathogen in soil was unaffected by the presence of a rhizosphere.

CONCLUSIONS

Other factors may be more influential in regulating E. coli O157:H7 persistence in waste-amended soil than the presence or absence of a rhizosphere; however, waste type did have significant affect on the survival of E. coli O157:H7 in such soil.

SIGNIFICANCE AND IMPACT OF THE STUDY

Escherichia coli O157:H7 can be present within animal-derived organic wastes that are routinely spread on land. Introduced measures with regards to such waste disposal may decrease exposure to the organism; however, the persistence of E. coli O157:H7 for considerable periods in waste-amended soil may still pose some risk for both human and animal infection. This study has shown that whilst survival of E. coli O157:H7 in waste-amended soil is not significantly affected by the presence or absence of a maize rhizosphere; it may vary significantly with waste type. This may have implications for land and waste management.

AMPA and NMDA receptor regulation of firing activity in 5-HT neurons of the dorsal and median raphe nuclei

The glutamatergic regulation of 5-hydroxytryptamine (5-HT) neuronal activity has not been extensively studied. Here, we used extracellular single unit recording in midbrain slices to examine glutamate receptor mediated effects on 5-HT neuronal activity in the dorsal raphe nucleus (DRN) and the median raphe nucleus (MRN). Alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA; 1 and 3 microm) concentration-dependently increased firing in 5-HT neurons in both the DRN and the MRN. The response to AMPA was blocked by the AMPA receptor antagonist, 6,7-dinitroquinoxaline-2,3(1H-4H)-dione (DNQX; 10 microm) but not the N-methyl-d-aspartate (NMDA) receptor antagonist, 2-amino-5-phosphonopentanoic acid (AP-5; 50 microm). NMDA (10-100 microm) also increased 5-HT neuronal firing in a concentration-dependent manner in both the DRN and MRN; a response that was blocked by AP-5 (50 microm). In some DRN neurons the NMDA response was partially antagonized by DNQX (10 microm) suggesting that NMDA, as well as directly activating 5-HT neurons, evokes local release of glutamate, which indirectly activates AMPA receptors on 5-HT neurons. Responses of DRN 5-HT neurons to AMPA and NMDA were enhanced by the gamma-amino-butyric acid (GABA)(A) receptor antagonist, bicuculline (50 microm), suggesting that both AMPA and NMDA increase local release of GABA. Finally in the DRN the 5-HT(1A) receptor antagonist, WAY100635 (100 nm), failed to enhance the response of 5-HT neurons to AMPA and caused only a small increase in the excitatory response to NMDA suggesting a low degree of tonic activation of 5-HT(1A) autoreceptors even when 5-HT neuronal firing rate is high.

Persistence, dissipation, and activity of Escherichia coli O157:H7 within sand and seawater environments

Runoff from agricultural land into watercourses may transport and deposit animal-derived waste contaminated with Escherichia coli O157:H7 onto beaches, which may in turn lead to human infection. To simulate contamination, freshwater mixed with cattle slurry containing E. coli O157:H7 was added to sand from three recreational beaches. The sand was then maintained in a dry state (nontidal) or subjected to a repeated seawater tidal simulation. The pathogen could still be recovered from all sands by day 5. Although survival of the pathogen did not statistically vary between sands of different origin under nontidal conditions, significant differences in numbers occurred between sands when subject to tidal simulation. In the tidal simulations, a considerable proportion of the E. coli O157:H7 rapidly dissipated from sand into the seawater. In a separate experiment, the activity of bioluminescent (lux-marked) E. coli O157:H7 cells was monitored in various mixtures of contaminated runoff water and seawater over 5 days. Pathogen activity declined with increasing seawater concentration; however, cells remained viable in all treatments over the 5-day period. The addition of nutrients to water rapidly increased pathogen activity in all treatments. Our findings highlight the resilience of E. coli O157:H7 in aquatic and marine environments.

Earthworms as vectors of Escherichia coli O157:H7 in soil and vermicomposts

Survival and movement of Escherichia coli O157:H7 in both soil and vermicompost is of concern with regards to human health. Whilst it is accepted that E. coli O157:H7 can persist for considerable periods in soils, it is not expected to survive thermophilic composting processes. However, the natural behavior of earthworms is increasingly utilized for composting (vermicomposting), and the extent to which earthworms promote the survival and dispersal of the bacterium within such systems is unknown. The faecal material produced by earthworms provides a ready supply of labile organic substrates to surrounding microbes within soil and compost, thus promoting microbial activity. Earthworms can also cause significant movement of organisms through the channels they form. Survival and dispersal of E. coli O157:H7 were monitored in contaminated soil and farmyard manure subjected to earthworm digestion over 21 days. Our findings lead to the conclusion that anecic earthworms such as Lumbricus terrestris may significantly aid vertical movement of E. coli O157 in soil, whereas epigeic earthworms such as Dendrobaena veneta significantly aid lateral movement within compost. Although the presence of earthworms in soil and compost may aid proliferation of E. coli O157 in early stages of contamination, long-term persistence of the pathogen appears to be unaffected.

Persistence of Escherichia coli O157 on farm surfaces under different environmental conditions

AIMS

To compare the persistence of Escherichia coli O157 on a variety of common faecally contaminated farmyard material surfaces (wood and steel) under different moisture and temperature regimes.

METHODS AND RESULTS

Samples of field-conditioned farmyard materials (galvanized steel and wood) were cut into pieces and contaminated with fresh cattle faeces inoculated with nontoxigenic E. coli O157 (strain 3704). Thereafter, they were stored at four different environmental conditions; with temperature (5 and 20 degrees C) and moisture (moist or dry) as variables. Transfer of the pathogen to hands from the surfaces was also evaluated. Escherichia coli O157 numbers declined over time on all surfaces albeit at different rates according to the sample material and environmental conditions. Persistence was greatest on moist wood samples under cooler temperatures with large population numbers remaining after 28 days. Desiccation of surfaces resulted in a more rapid decline in E. coli O157 populations under both temperature regimes. Substantial numbers of colonies may also potentially be transferred to human hands from the surfaces during brief contact.

CONCLUSIONS

When environmental conditions are favourable, E. coli O157 may persist for considerable times on a range of surfaces. However, when exposed to higher temperatures and dehydration, survival is notably decreased. Overall, bacterial persistence was significantly greater on wood samples relative to steel.

SIGNIFICANCE AND IMPACT OF THE STUDY

Escherichia coli O157 is a prevalent pathogen, common in ruminant faeces. Contact with contaminated faeces may lead to human infection, resulting in possible severe illness. Although our study used only one strain of bacteria, our findings indicates that E. coli O157 has the potential to persist for long periods of time on gates, stiles and other farmyard surfaces under a range of environmental conditions. These farmyard surfaces therefore pose a potential infection pathway particularly where there is a high risk of direct human contact (e.g. child petting zoos, open farms).

Women and men managers in pharmacy: gender issues

This paper examines the backgrounds, behaviours, and attitudes of a representative sample of male and female pharmacy managers in Ontario, Canada. It shows that the female managers are younger than their male colleagues, and spend significantly more time on childcare activities. There were no differences between the male and female managers in terms of work commitment and job responsibilities, but the female managers spent more time in direct patient contact, an activity that the qualitative analysis indicated was important to them. Female managers were also more supportive of strategies that would encourage additional patient counseling. For faculty in health administration programs, the results suggest that the importance that females place on the psycho-social aspects of their jobs as managers needs to be recognized and supported in the development and delivery of courses of study.

Identification of novel Tapasin polymorphisms and linkage disequilibrium to MHC class I alleles

Tapasin is a Mr 48,000 glycoprotein and has a specialized role in MHC class I-restricted antigen presentation. It is encoded by a gene which maps centromeric to the MHC class II region of human Chromosome 6 within 200 kb of HLA-DP. There is variable dependence upon tapasin for MHC class I expression among different MHC class I alleles. HLA-B*4402 and to a lesser extent HLA-A1 and B8 are tapasin dependent, whereas HLA-B27, A2 and to a lesser extent B7 and A3 are tapasin independent. We investigated whether tapasin is polymorphic and whether these Tapasin alleles are in linkage with any MHC class I alleles. We identified three new mutations within intron 4, which are in a particular linkage with the previously described exon 4 (G16003C) dimorphism. The intronic mutations are G16146T, G16232A, and T16317A (numbering according to cosmid clone F0811; GenBank accession number Z97184). The allele frequency of Tapasin*01 (G16003) was 0.47 and Tapasin*02 (C16003) was 0.53 in this UK population. Four of the eight possible intronic haplotypes were identified and their cis linkage with the tapasin dimorphism ascertained. Tapasin*01 was associated with all the identified haplotypes, while Tapasin*02 was only associated with the wild-type intronic sequence (GGT). There was no significant linkage (P>0.01) of the Tapasin dimorphism or new Tapasin alleles to any of the MHC class I A, B, or C alleles studied or to the extended A1 B8 DR3 haplotype.

Physician characteristics and the physician-patient relationship. Impact of sex, year of graduation, and specialty

OBJECTIVE

To examine the association of physician sex, medical specialty, and year of graduation from medical school with attitudes and behaviours that define physician-patient relationships. Hypotheses tested are that women physicians, family physicians, and recent graduates spend more time discussing lifestyle and general health issues during patients' first visits; are more likely to report behaviours that are empathetic and that encourage communication with patients; are less likely to view their role as directive and problem-oriented; and are more supportive of patients' rights to information and participation in decision making.

DESIGN

A survey was mailed to a stratified random sample of physicians between February and June 1996.

SETTING

Physician practices in Ontario.

PARTICIPANTS

Of 714 practising Ontario physicians, 405 (57%) responded.

MAIN OUTCOME MEASURES

Proportion of time and actual time spent discussing a patient's lifestyle during a first visit, communication style, attitudes regarding a directive approach to care, and attitudes regarding patients' rights.

RESULTS

Women physicians and family physicians spent significantly more time discussing lifestyle during a first visit. Women, family physicians, and recent graduates were significantly more likely to report an empathetic communication style. Women and recent graduates were significantly less likely to have a directive, problem-oriented approach to care. Family physicians were significantly less supportive of patients' rights than medical and surgical specialists were.

CONCLUSIONS

Physicians in this study reported empathetic communication styles and attitudes that support information sharing and patients' rights.

Gender and income in pharmacy: human capital and gender stratification theories revisited

This is a case study of gender and earnings in pharmacy--a profession characterized by its rapid recruitment of female practitioners. We try to account for disparities in earnings between male and female pharmacists in Ontario with the aid of human capital theory and gender stratification theory. Data is drawn from a random sample of 463 Ontario pharmacists. We find a consistent sex gap in earnings regardless of occupational level of practitioners (i.e. owner, manager or employee) and net of such factors as hours worked, commitment to work, hours devoted to childcare, absences from the labour market, and years since graduation. Instead, the main reason why women in pharmacy earn less than males is because they remain employees throughout their careers. However, we are less successful at identifying the additional factors responsible for the depressed earnings of female practitioners. We discuss our findings in light of the claims of gender stratification and human capital theory.

On high-resolution reciprocal-space mapping with a triple-crystal diffractometer for high-energy X-rays

High-energy X-rav diffraction by means of triple-crystal techniques is a powerful tool for investigating dislocations and strain in bulk materials. Radiation with an energy typically higher than 80 keV combines the advantage of low attenuation with high resolution at large momentum transfers. The triple-crystal diffractometer at the High Energy Beamline of the European Synchrotron Radiation Facility is described. It is shown how the transverse and longitudinal resolution depend on the choice of the crystal reflection, and how the orientation of a reciprocal-lattice distortion in an investigated sample towards the resolution element of the instrument can play an important role. This effect is demonstrated on a single crystal of silicon where a layer of macro pores reveals satellites around the Bragg reflection. The resulting longitudinal distortion can be investigated using the high transverse resolution of the instrument when choosing an appropriate reflection.

Proteolysis during ensilage of forages varying in soluble sugar content

The effect of contrasting concentrations of water-soluble carbohydrates of herbage on silage fermentation and composition was examined using grass with high [250 g/kg of dry matter (DM)] concentrations of water-soluble carbohydrates and grass and clover with low (66 g/kg of DM) concentrations of water-soluble carbohydrates. Herbages were ensiled untreated, after inoculation with lactic acid bacteria, or after treatment with formic acid. Good quality silages were produced from herbage with high concentrations of water-soluble carbohydrates, regardless of treatment, and all pH values were below 3.7 after 90 d of ensilage. However, the silage formed from inoculated herbage had a significantly lower concentration of ammonia N and a significantly higher proportion of residual ribulose-1,5-bisphosphate carboxylase compared with the other two silages. Fast protein liquid chromatography (Pharmacia, Uppsala, Sweden) was used to measure ribulose-1,5-bisphosphate carboxylase, and measurement of true plant protein fractions in herbage and silage showed benefits over traditional measurements such as the measurement of N and ammonia N. Herbages with low concentrations of water-soluble carbohydrates produced inferior quality silages that had lower ribulose-1,5-bisphosphate carboxylase contents and higher ammonia N contents, regardless of treatment; few significant differences were observed among treatments. Under good ensiling conditions, when available water-soluble carbohydrate is adequate, the use of inoculants can improve fermentation characteristics and increase the ribulose-1,5-bisphosphate carboxylase content of silages. However, when the herbage has low concentrations of water-soluble carbohydrates, even in inoculated herbages, lactic acid bacteria may follow a heterofermentative pathway instead of a homofermentative pathway, which can result in a decrease in silage quality and a reduction in intact ribulose-1,5-bisphosphate carboxylase.

Education for navigating "permanent white water:" establishing a bachelors program for Canadian health services managers

A rapidly changing health services environment challenges educators to critically assess what they do, and what they should do, to prepare managers to survive and grow professionally and to contribute to clients, organizations and the health system. In this paper we describe the establishment of an undergraduate degree-completion program in Health Services Management at Ryerson Polytechnic University in Toronto, Canada. In contrast to traditional programs which begin the process of education as the basis for later practice, this program, the first of its kind in a Canadian university, is designed to develop management skills and competencies on an existing base of professional experience and practice; it offers practitioners with 3-year diplomas in a health technology or allied health field the opportunity to complete an undergraduate degree on a part-time basis. Sections of the paper outline the multidisciplinary and multi-stage process of program development which took place outside of traditional departmental lines and involved a partnership of academics and practitioners; and the curriculum design, which integrates knowledge specific to the field of health administration, relevant knowledge from other professional fields, and liberal studies. In a final section we discuss the ongoing development of the program and factors contributing to its success.