Water sector resilience in the United Kingdom and Ireland: The COVID-19 challenge

The outbreak of COVID-19 led to restrictions on movements and activities, which presented a serious challenge to the resilience of the water sector. It is essential to understand how successfully water companies responded to this unprecedented event so effective plans can be built for future disruptive events. This study aimed to evaluate how the water sectors in the UK and Ireland were affected from a holistic sustainability and resilience-based perspective. Using pre-COVID data for 18 indicators of company performance and comparing them to the first year of the pandemic, the direction and magnitudes of change varied across companies. Financial indicators were significantly negatively affected, with interest cover ratio, post-tax return on regulated equity, and operating profit, exhibiting the greatest average declines of 21%, 21%, and 18%, respectively, a trend that would be dangerous to provisions and company operations if continued. Despite this, service and environmental indicators improved during the first year of the pandemic, exemplified by unplanned outage, risk of sewer storm flooding, and water quality compliance risk decreasing by a mean average of 37%, 32%, and 27%, respectively. Analysis using the Hicks-Moorsteen Productivity Index concluded that average productivity increased by 35%. The results suggest that the water sector was relatively resilient to the COVID-19 pandemic in terms of services, but adverse effects may have manifested in a deteriorated financial position that could exacerbate future challenges arising from exogenous pressures such as climate change. Specific advice for the UK water sector is to scrutinize non-critical spending, such as shareholder payments, during periods of economic downturn to ensure essential capital projects can be carried out. Although results are temporal and indicator selection sensitive, we recommend that policy, regulation, and corporate culture embrace frameworks that support long-term resilience to since the relative success in response to COVID-19 does not guarantee future success against differing challenges. This study generates a timely yet tentative insight into the diverse performance of the water sector during the pandemic, pertinent to the water industry, regulators, academia, and the public.

Heat recovery and water reuse in micro-distilleries improves eco-efficiency of alcohol production

The number of micro-scale spirit distilleries worldwide has grown considerably over the past decade. With an onus on the distillery sector to reduce its environmental impact, such as carbon emissions, opportunities for increasing energy efficiency need to be implemented. This study explores the potential environmental benefits and financial gains achievable through heat recovery from different process and by-product streams, exemplified for a Scotch whisky distillery, but transferrable to micro-distilleries worldwide. The eco-efficiency methodology is applied, taking into account both climate change and water scarcity impacts as well as economic performance of alcohol production with and without heat recovery. A Life Cycle Assessment, focusing on climate change and water scarcity, is combined with a financial assessment considering investment costs and the present value of the savings over the 20-year service life of the heat recovery system. The proposed heat recovery systems allow carbon emission reductions of 8-23% and water scarcity savings of 13-55% for energy and water provision for 1 L of pure alcohol (LPA). Financial savings are comparatively smaller, at 5-13%, due to discounting of the future savings - but offer a simple payback of the investment costs in under two years. The eco-efficiency of the distillery operations can be improved through all proposed heat recovery configurations, but best results are obtained when heat is recovered from mashing, distillations and by-products altogether. A sensitivity analysis confirmed that the methodology applied here delivers robust results and can help guide other micro-distilleries on whether to invest in heat recovery systems, and/or the heat recovery configuration. Uptake should be enhanced through increased information and planning support, and in cases where the distillery offers insufficient heat and water sinks to use all pre-warmed water, opportunities to link with a heat sink outside the distillery are encouraged. A 10% reduction in heating fuel use through heat recovery has the potential to save 47 kt of CO₂ eq. or £7.4 M per annum in United Kingdom malt whisky production alone, based on current fuel types used and current prices (2021).

Pitfalls in international benchmarking of energy intensity across wastewater treatment utilities

The collection, treatment and disposal of wastewater is estimated to consume more than 2% of the world's electrical energy, whilst some wastewater treatment plants (WWTPs) can account for over 20% of electrical consumption within municipalities. To investigate areas to improve wastewater treatment, international benchmarking on energy (electrical) intensity was conducted with the indicator kWh/m³ and a quality control of secondary treatment or better for ≥95% of treated volume. The core sample included 321 companies from 31 countries, however, to analyse regional differences, 11 countries from an external sample made up of various studies of WWTPs was also used in places. The sample displayed a weak-negative size effect with energy intensity, although Kruskal-Wallace analyses showed there was a significant difference between the size of groups (p-value of 0.015), suggesting that as companies get larger; they consume less electricity per cubic metre of wastewater treated. This relationship was not completely linear, as mid to large companies (10,001-100,000 customers) had the largest average consumption of 0.99 kWh/m³. In the regional analysis, EU states had the largest average kWh/m³ with 1.18, which appeared a result of the higher wastewater effluent standards of the region. This was supported by Denmark being the second largest average consuming country (1.35 kWh/m³), since it has some of strictest effluent standards in the world. Along with energy intensity, the associated greenhouse gas (GHG) emissions were calculated enabling the targeting of regions for improvement in response to climate change. Poland had the highest carbon footprint (0.91 kgCO₂e/m³) arising from an energy intensity of 0.89 kWh/m³; conversely, a clean electricity grid can affectively mitigate wastewater treatment inefficiencies, exemplified by Norway who emit just 0.013 kgCO₂e per cubic meter treated, despite consuming 0.60 kWh/m³. Finally, limitations to available data and the analysis were highlighted from which, it is advised that influent vs. effluent and net energy, as opposed to gross, data be used in future analyses. The large international sample size, energy data with a quality control, GHG analysis, and specific benchmarking recommendations give this study a novelty which could be of use to water industry operators, benchmarking organisations, and regulators.

Spatial behaviour of sheep during the neonatal period: Preliminary study on the influence of shelter

Effective shelter has been demonstrated to reduce neonatal lamb mortality rates during periods of inclement weather. Periods of high wind speed and rainfall have been shown to influence shelter usage; however, it is not yet known how ewe factors such as breed, age and body condition score influence shelter-seeking behaviour. This study, conducted on a working upland farm in the UK, examined impact of artificial shelter on the biological and climatic factors that influence peri-parturient ewe behaviour. Pregnant ewes (n = 147) were randomly allocated between two adjacent fields which were selected for their similarity in size, topography, pasture management, orientation to the prevailing wind and available natural shelter. In one field, three additional artificial shelters were installed to increase the available shelter for ewes, this field was designated the Test field; no additional artificial shelter was provided in the second field which was used as the Control field. Individual ewes were observed every 2 h between 0800 and 1600 for 14 continuous days to monitor their location relative to shelter. Ewe breed (Aberfield and Highlander), age (2-8 years) and body condition score were considered as explanatory variables to explain flock and individual variance in shelter-seeking behaviour and the prevalence of issues which required the intervention of the shepherd, termed 'shepherding problems'. Any ewe observed with dystocia, a dead or poor vigour lamb or who exhibited mismothering behaviour was recorded as a shepherding problem. The prevalence of these shepherding problems which necessitate human intervention represents arguably the most critical limiting factor for the successful management of commercial sheep flocks in outdoor lambing systems. Overall, ewes in the Test field with access to additional artificial shelter experienced fewer shepherding problems than those in the Control field (P < 0.05). A significant breed effect was also observed, with Highlander ewes more likely to seek shelter than Aberfield ewes (P < 0.001), and experiencing significantly fewer shepherding interventions (P < 0.05). These findings demonstrate the substantial and significant benefits to animal welfare and productivity that can be achieved through the provision of shelter in commercial, upland, outdoor lambing systems in the UK.

Aligning efficiency benchmarking with sustainable outcomes in the United Kingdom water sector

The provision of fundamental services by water and sewage companies (WaSCs) requires substantial energy and material inputs. A sustainability assessment of these companies requires a holistic evaluation of both performance and efficiency. The Hicks-Moorsteen productivity index was applied to 12 WaSCs in the United Kingdom (UK) over a 6-year period to benchmark their sustainability, based on eight approaches using different input and output variables for efficiency assessment. The choice of variables had a major influence on the ranking and perceived operational efficiency among WaSCs. Capital expenditure (utilised as part of total expenditure) for example, is an important input for tracking company operations however, potential associated efficiency benefits can lag investment, leading to apparent poor short-term performance following capital expenditure. Furthermore, water supplied and wastewater treated was deemed an unconstructive output from a sustainability perspective since it contradicts efforts to improve sustainability through reduced leakage and consumption per capita. Customer satisfaction and water quality measures are potential suitable alternatives. Despite these limitations, total expenditure and water supplied and wastewater treated were used alongside customer satisfaction and self-generated renewable energy for a holistic sustainability assessment within a small sample. They indicated the UK water sector has improved in productivity by 1.8% on average for 2014-18 and still had room for improvement, as a technical decline was evident for both the best and worst performers. Collectively the sample's production frontier was unchanged but on average companies moved 2.1% closer to it, and further decomposition of productivity revealed this was due to improvements in economies of scale and scope. Careful selection of appropriate input and output variables for efficiency benchmarking across water companies is critical to align with sustainability objectives and to target future investment and regulation within the water sector.

Elevated serum antibody responses to synthetic mycobacterial lipid antigens among UK farmers: an indication of exposure to environmental mycobacteria?

Background: mycobacterial cells contain complex mixtures of mycolic acid esters. These can be used as antigens recognised by antibodies in the serum of individuals with active tuberculosis, caused by Mycobacterium tuberculosis. In high burden populations, a significant number of false positives are observed; possibly these antigens are also recognised by antibodies generated by other mycobacterial infections, particularly ubiquitous 'environmental mycobacteria'. This suggests similar responses may be observed in a low burden TB population, particularly in groups regularly exposed to mycobacteria. Methods: ELISA using single synthetic trehalose mycolates corresponding to major classes in many mycobacteria was used to detect antibodies in serum of individuals with no known mycobacterial infection, comprising farmers, abattoir workers, and rural and urban populations. Results: serum from four Welsh or Scottish cohorts showed lower (with some antigens significantly lower) median responses than those reported for TB negatives from high-burden TB populations, and significantly lower responses than those with active TB. A small fraction, particularly older farmers, showed strong responses. A second study examined BCG vaccinated and non-vaccinated farmers and non-farmers. Farmers gave significantly higher median responses than non-farmers with three of five antigens, while there was no significant difference between vaccinated or non-vaccinated for either farmer or non-farmer groups. Conclusions: this initial study shows that serodiagnosis with mycobacterial lipid antigens can detect antibodies in a population sub-group that is significantly exposed to mycobacteria, in an assay that is not interfered with by vaccination. Given the links between mycobacterial exposure and a range of immune system diseases, further understanding such responses may provide a new opportunity for monitoring public health and directing treatment.

Impact of Sediment Concentration on the Survival of Wastewater-Derived blaCTX-M-15-Producing E. coli, and the Implications for Dispersal into Estuarine Waters

The environmental cycling of antibiotic-resistant bla_CTX-M-15-producing E. coli following release from wastewater treatment plants is a major public health concern. This study aimed to (i) assess the impact of sediment concentrations on the rate of their inactivation following release from human wastewater into freshwater, and (ii) simulate their subsequent dispersal to the nearby coastline during a “worst-case” event where heavy rainfall coincided with high spring tide in the Conwy Estuary, North Wales. Freshwater microcosms of low, medium and high turbidity were inoculated with bla_CTX-M-15-producing E. coli, then exposed to ultraviolet (UV) radiation. Typical regional wintertime exposure to UV was found to be insufficient to eradicate E. coli, and in highly turbid water, many bacteria survived simulated typical regional summertime UV exposure. Modelling results revealed that bla_CTX-M-15-producing E. coli concentrations reduced downstream from the discharge source, with ~30% of the source concentration capable of dispersing through the estuary to the coast, taking ~36 h. Offshore, the concentration simulated at key shellfisheries and bathing water sites ranged from 1.4% to 10% of the upstream input, depending on the distance offshore and tidal regime, persisting in the water column for over a week. Our work indicates that the survival of such organisms post-release into freshwater is extended under typical wintertime conditions, which could ultimately have implications for human health.

Emissions down the drain: Balancing life cycle energy and greenhouse gas savings with resource use for heat recovery from kitchen drains

Although the food service sector is a major user of water, the potential for heat recovery from commercial kitchens' drain water remains largely unexplored. For the first time, we compare the life cycle environmental burdens of producing and installing a heat recovery system with the environmental credits arising from energy savings for a restaurant case study, and for the entire UK food service sector. Life Cycle Assessment was applied to determine the impacts of heat recovery systems made from different materials and comprising a heat exchanger in the shape of a concentric double-walled pipe, pipework and fittings. The design option with the smallest environmental footprint combined a heat exchanger made out of polypropylene-graphite (PP-GR) with polyethylene pipework, exhibiting 80-99% less environmental impact compared with components made out of (35% recycled) copper. Contrasting the environmental impacts of two heat recovery set-ups with energy savings shows that a PP-GR based system pays back all burdens of the seven assessed environmental impact categories, within two years, while payback times for the copper-based system vary depending on the replaced energy source, and can exceed the 10 year operational lifetime of the system. When looking at typical flow-rates in UK food outlets, net environmental savings can be realised across all analysed impact categories above a threshold water consumption of 555 L/day, using current technology. Extrapolation to the UK food service sector indicates annual greenhouse gas emission mitigation potential of about 500 Gg CO₂ equivalent.

Key performance indicators to explain energy & economic efficiency across water utilities, and identifying suitable proxies

Water companies consume up to 8% of global energy demand, at billions of dollars' cost. Benchmarking of performance between utilities can facilitate improvements in efficiency; however, inconsistencies in benchmarking practices may obscure pathways to improvement. The aspiration was to conduct an unbiased efficiency comparison within a sample of 17 water only companies and water and sewerage companies in England and Wales, accounting for exogenous factors, whilst evaluating the accuracy of common proxies. Proxies were tested, and bias-corrected energy and economic efficiency scores with explanatory factors were analysed using a double-bootstrap data envelopment method. Bias correction altered the rankings of two companies for energy efficiency only. Results imply that on average, companies could reduce energy inputs by 91.7%, and economic inputs by 92.3%, which was symptomatic of the companies specialising in drinking water supply considerably out-performing combined water and sewerage companies. As exogenous influences were likely to be a factor in the disparity between the companies, five indicators were evaluated. The results varied but of note were average pumping head height, which displayed a significant negative effect for energy efficiency, and proportion of water passing through the largest four treatment works, that exhibited a significant negative effect on economic efficiency. Within proxy performance, population served for drinking water was an adequate replacement for volume of water produced, with results matching the core variable apart from two companies changing rank in the economic analysis. Conversely, length of water mains performed poorly when replacing capital expenditure, implying companies were on average 12.6% more efficient, resulting in ten companies changing their rank and causing explanatory variables to contradict direction of influence and significance. The findings contribute new insights for benchmarking, including how different types of water companies perform under bias-correcting methods, the degree to which factors affect efficiency and how appropriate some proxies are.

Historical droughts recorded in extended Juniperus procera ring-width chronologies from the Ethiopian Highlands

In the Horn of Africa, little is known about temporal changes in hydroclimate owing to the influence of multiple weather systems, the complex terrain, and the sparse instrumental records. Absolutely dated tree-ring records offer the potential to extend our understanding of climate into the pre-instrumental era, but tree-ring studies in this region, and indeed all of tropical Africa, have been rare largely due to lack of an annual climate cycle that reliably produces annual tree-rings. In this study, 40 cores were obtained from 31 Juniperus procera trees growing in the grounds of Ethiopian Orthodox Tewahedo churches in the Gonder region of Ethiopia. The samples were cross-dated using a re-iterative process involving identifying anatomical features from high-resolution images. The tentative ring-width chronologies were revised after the determination of bomb-peak accelerator mass spectrometry radiocarbon dates. Individual series were significantly correlated to the respective master chronologies (r > 0.55; P < 0.05), and expressed population signal values ranged from 0.55 to 0.92. Historical drought years were successfully traced in the chronologies by pointer year analysis. This study confirms that Juniperus procera growing in areas of unimodal precipitation exhibits annual tree-rings and offers the potential as an indirect measure of past climate.

Economic and environmental efficiency of UK and Ireland water companies: Influence of exogenous factors and rurality

For water companies, benchmarking their performance relative to other companies can be an effective way to identify the scope for efficiency gains to be made through infrastructure investment and operational improvements. However, a key limitation to benchmarking is the confounding effect of exogenous factors, which may not be factored in to benchmarking methodologies. The purpose of this study was to provide an unbiased comparison of efficiency across a sample of water and sewage companies, accounting for important exogenous factors. Bias-corrected economic and environmental efficiency estimates with explanatory factors were evaluated for a sample of 13 water and sewage companies in the UK and Ireland, using a double-bootstrap data envelopment analysis (DEA) approach. Bias correction for economic and environmental efficiency changed the rankings of nine and eight companies, respectively. On average, companies could reduce economic inputs by 19% and carbon outputs by 16% if they performed at the efficiency frontier. Variables explaining efficiency were: source of water, leakage rate, per capita consumption and population density. Population density showed statistical significance with both economic (p-value 0.002) and environmental (p-value 0.001) efficiency. Consequently, a rurality factor was defined for each company's operational area, which was then regressed against normalised water company performance data. More rural water companies spend more per property (R² of 0.633), in part reflecting a larger number of smaller sewage treatment works serving rural populations (R² of 0.823). These findings provide new insight into methods for benchmarking, and factors affecting, water company efficiency, pertinent for both regulators and water companies.

Clinical and laboratory features of seventy-eight UK patients with Good's syndrome (thymoma and hypogammaglobulinaemia)

Good’s syndrome (thymoma and hypogammaglobulinaemia) is a rare secondary immunodeficiency disease, previously reported in the published literature as mainly individual cases or small case series. We use the national UK‐Primary Immune Deficiency (UKPID) registry to identify a large cohort of patients in the UK with this PID to review its clinical course, natural history and prognosis. Clinical information, laboratory data, treatment and outcome were collated and analysed. Seventy‐eight patients with a median age of 64 years, 59% of whom were female, were reviewed. Median age of presentation was 54 years. Absolute B cell numbers and serum immunoglobulins were very low in all patients and all received immunoglobulin replacement therapy. All patients had undergone thymectomy and nine (12%) had thymic carcinoma (four locally invasive and five had disseminated disease) requiring adjuvant radiotherapy and/or chemotherapy. CD4 T cells were significantly lower in these patients with malignant thymoma. Seventy‐four (95%) presented with infections, 35 (45%) had bronchiectasis, seven (9%) chronic sinusitis, but only eight (10%) had serious invasive fungal or viral infections. Patients with AB‐type thymomas were more likely to have bronchiectasis. Twenty (26%) suffered from autoimmune diseases (pure red cell aplasia, hypothyroidism, arthritis, myasthenia gravis, systemic lupus erythematosus, Sjögren’s syndrome). There was no association between thymoma type and autoimmunity. Seven (9%) patients had died. Good’s syndrome is associated with significant morbidity relating to infectious and autoimmune complications. Prospective studies are required to understand why some patients with thymoma develop persistent hypogammaglobulinaemia.

Quantifying the contribution of riparian soils to the provision of ecosystem services

Riparian areas, the interface between land and freshwater ecosystems, are considered to play a pivotal role in the supply of regulating, provisioning, cultural and supporting services. Most previous studies, however, have tended to focus on intensive agricultural systems and only on a single ecosystem function. Here, we present the first study which attempts to assess a wide range of ecological processes involved in the provision of the ecosystem service of water quality regulation across a diverse range of riparian typologies. Specifically, we focus on 1) evaluating the spatial variation in riparian soils properties with respect to distance with the river and soil depth in contrasting habitat types; 2) gaining further insights into the underlying mechanisms of pollutant removal (i.e. pesticide sorption/degradation, denitrification, etc.) by riparian soils; and 3) quantify and evaluate how riparian vegetation across different habitat types contribute to the provision of watercourse shading. All the habitats were present within a single large catchment and included: (i) improved grassland, (ii) unimproved (semi-natural) grassland, (iii) broadleaf woodland, (iv) coniferous woodland, and (iv) mountain, heath and bog. Taking all the data together, the riparian soils could be statistically separated by habitat type, providing evidence that they deliver ecosystem services to differing extents. Overall, however, our findings seem to contradict the general assumption that soils in riparian area are different from neighbouring (non-riparian) areas and that they possess extra functionality in terms of ecosystem service provision. Watercourse shading was highly habitat specific and was maximal in forests (ca. 52% shade cover) in comparison to the other habitat types (7-17%). Our data suggest that the functioning of riparian areas in less intensive agricultural areas, such as those studied here, may be broadly predicted from the surrounding land use, however, further research is required to critically test this across a wider range of ecosystems.

Clinical efficacy of a next-generation sequencing gene panel for primary immunodeficiency diagnostics

Primary immunodeficiencies (PIDs) are rare monogenic inborn errors of immunity that result in impairment of functions of the human immune system. PIDs have a broad phenotype with increased morbidity and mortality, and treatment choices are often complex. With increased accessibility of next-generation sequencing (NGS), the rate of discovery of genetic causes for PID has increased exponentially. Identification of an underlying monogenic diagnosis provides important clinical benefits for patients with the potential to alter treatments, facilitate genetic counselling, and pre-implantation diagnostics. We investigated a NGS PID panel of 242 genes within clinical care across a range of PID phenotypes. We also evaluated Phenomizer to predict causal genes from human phenotype ontology (HPO) terms. Twenty-seven participants were recruited, and a total of 15 reportable variants were identified in 48% (13/27) of the participants. The panel results had implications for treatment in 37% (10/27) of participants. Phenomizer identified the genes harbouring variants from HPO terms in 33% (9/27) of participants. This study shows the clinical efficacy that genetic testing has in the care of PID. However, it also highlights some of the disadvantages of gene panels in the rapidly moving field of PID genomics and current challenges in HPO term assignment for PID.

Association of Surgeons in Training conference: Bournemouth 2017

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. The Association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations. The 2017 Annual Conference in Bournemouth brought together over 700 delegates for a diverse educational weekend with numerous expert guest speakers. With a theme of '#AdvancesIn,' we looked to celebrate cutting edge progress in training, clinical management, medical technology, leadership and entrepreneurialism. These updates were complimented by debates on current training in surgery and an array of focussed parallel sessions. For the first time, delegates were also able to interact with the conference digitally, with the debut of our conference smartphone App. The weekend started with 9 pre-conference courses covering a diverse range of topics including core laparoscopic, vascular, orthopaedics, neurosurgical skills, leadership and global surgery. Over 1000 abstract submissions were received and those successful competed for over 30 awards, representing nearly £4000 in trainee prizes and bursaries. As the only national surgical trainee meeting for all specialties, ASiT continues to grow and we look forward to an even larger and more successful international conference next year in Edinburgh 6-8th April 2018 with the theme of #nurturingexcellence.

IL-10 production by CLL cells is enhanced in the anergic IGHV mutated subset and associates with reduced DNA methylation of the IL10 locus

Chronic lymphocytic leukemias (CLLs) with unmutated (U-CLL) or mutated (M-CLL) IGHV have variable features of immunosuppression, possibly influenced by those CLL cells activated to produce interleukin 10 (IL-10). The two subsets differ in their levels of anergy, defined by low surface immunoglobulin M levels/signaling capacity, and in their DNA methylation profile, particularly variable in M-CLL. We have now found that levels of IL-10 produced by activated CLL cells were highly variable. Levels were higher in M-CLL than in U-CLL and correlated with anergy. DNA methylation analysis of IL10 locus revealed two previously uncharacterized 'variably methylated regions' (CLL-VMRs1/2) in the gene body, but similarly low methylation in the promoter of both U-CLL and M-CLL. CLL-VMR1/2 methylation was lower in M-CLL than in U-CLL and inversely correlated with IL-10 induction. A functional signal transducer and activator of transcription 3 (STAT3) binding site in CLL-VMR2 was confirmed by proximity ligation and luciferase assays, whereas inhibition of SYK-mediated STAT3 activation resulted in suppression of IL10. The data suggest epigenetic control of IL-10 production. Higher tumor load may compensate the reduced IL-10 production in U-CLL, accounting for clinical immunosuppression in both subsets. The observation that SYK inhibition also suppresses IL-10 provides a potential new rationale for therapeutic targeting and immunological rescue by SYK inhibitors in CLL.

Current and Future Environmental Balance of Small-Scale Run-of-River Hydropower

Globally, the hydropower (HP) sector has significant potential to increase its capacity by 2050. This study quantifies the energy and resource demands of small-scale HP projects and presents methods to reduce associated environmental impacts based on potential growth in the sector. The environmental burdens of three (50-650 kW) run-of-river HP projects were calculated using life cycle assessment (LCA). The global warming potential (GWP) for the projects to generate electricity ranged from 5.5-8.9 g CO2 eq/kWh, compared with 403 g CO2 eq/kWh for UK marginal grid electricity. A sensitivity analysis accounted for alternative manufacturing processes, transportation, ecodesign considerations, and extended project lifespan. These findings were extrapolated for technically viable HP sites in Europe, with the potential to generate 7.35 TWh and offset over 2.96 Mt of CO2 from grid electricity per annum. Incorporation of ecodesign could provide resource savings for these HP projects: avoiding 800 000 tonnes of concrete, 10 000 tonnes of steel, and 65 million vehicle miles. Small additional material and energy contributions can double a HP system lifespan, providing 39-47% reductions for all environmental impact categories. In a world of finite resources, this paper highlights the importance of HP as a resource-efficient, renewable energy system.

Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase

This is the first multi-centre retrospective survey from the United Kingdom to evaluate the aetiology and diagnostic performance of tryptase in anaphylaxis during general anaesthesia (GA). Data were collected retrospectively (2005-12) from 161 patients [mean ± standard deviation (s.d.), 50 ± 15 years] referred to four regional UK centres. Receiver operating characteristic curves (ROC) were constructed to assess the utility of tryptase measurements in the diagnosis of immunoglobulin (Ig)E-mediated anaphylaxis and the performance of percentage change from baseline [percentage change (PC)] and absolute tryptase (AT) quantitation. An IgE-mediated cause was identified in 103 patients (64%); neuromuscular blocking agents (NMBA) constituted the leading cause (38%) followed by antibiotics (8%), patent blue dye (6%), chlorhexidine (5%) and other agents (7%). In contrast to previous reports, latex-induced anaphylaxis was rare (0·6%). A non-IgE-mediated cause was attributed in 10 patients (6%) and no cause could be established in 48 cases (30%). Three serial tryptase measurements were available in 34% of patients and a ROC analysis of area under the curve (AUC) showed comparable performance for PC and AT. A ≥ 80% PPV for identifying an IgE-mediated anaphylaxis was achieved with a PC of >141% or an AT of >15·7 mg/l. NMBAs were the leading cause of anaphylaxis, followed by antibiotics, with latex allergy being uncommon. Chlorhexidine and patent blue dye are emerging important health-care-associated allergens that may lead to anaphylaxis. An elevated acute serum tryptase (PC >141%, AT >15·7 mg/l) is highly predictive of IgE-mediated anaphylaxis, and both methods of interpretation are comparable.

Changes in the physicochemical properties and enzymatic activity of waste during bioreduction of pig carcasses

Bioreduction is a novel method for the on-farm storage of fallen stock in a vessel containing water that is heated and aerated, prior to disposal. The combination of a mesophilic temperature and high bacterial population leads to rapid degradation of carcasses due to microbial and enzymatic breakdown of protein material; and ultimately the reduction in volume of waste to be disposed. The system could, however, be improved if more was known about the changes that occur during a bioreduction cycle. Pig carcasses were placed within two commercial-scale bioreduction vessels (BVs) (6.5 m3 capacity) and the changes in physicochemical parameters, enzymatic activity, gas emissions and microbial communities were analysed over 56 days. Analyses showed that each vessel displayed different physicochemical parameters. The microbial communities within both vessels were also distinct, though they converged between days 28 and 42 before again diverging. Of the enzymes assayed, acetylesterases showed the highest activity during initial stages, with a subsequent increase in lipase towards the end. All other enzymes showed little activity in comparison. Despite active aeration of the vessels, conditions were redox-constrained, leading to the emission of gases associated with anaerobic conditions, namely NH3 and H2S. It was concluded that no single parameter governed the biochemical processes and that each BV will have its own unique microbial population and hence rate of decomposition. Further work is needed to increase the rate of bioreduction through bioaugmentation or developing enzyme additives.

Bioreduction of sheep carcasses effectively contains and reduces pathogen levels under operational and simulated breakdown conditions

Options for the storage and disposal of animal carcasses are extremely limited in the EU after the introduction of the EU Animal By-products Regulations (ABPR; EC/1774/2002), leading to animosity within the livestock sector and the call for alternative methods to be validated. Novel storage technologies such as bioreduction may be approved under the ABPR provided that they can be shown to prevent pathogen proliferation. We studied the survival of Enterococcus faecalis, Salmonella spp., E. coli O157 and porcine parvovirus in bioreduction vessels containing sheep carcasses for approximately 4 months. The vessels were operated under two different scenarios: (A) where the water within was aerated and heated to 40 °C, and (B) with no aeration or heating, to simulate vessel failure. Microbial analysis verified that pathogens were contained within the bioreduction vessel and indeed reduced in numbers with time under both scenarios. This study shows that bioreduction can provide an effective and safe on-farm storage system for livestock carcasses prior to ultimate disposal. The findings support a review of the current regulatory framework so that bioreduction is considered for approval for industry use within the EU.

The role of the natural environment in the emergence of antibiotic resistance in gram-negative bacteria

During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.

Defects in lymphocyte subsets and serological memory persist a median of 10 years after high-dose therapy and autologous progenitor cell rescue for malignant lymphoma

The number of survivors having undergone high-dose therapy (HDT) followed by auto-SCT continues to increase, although some of the long-term sequelae remain incompletely understood. The immunological status and quality of life of 37 HDT/auto-SCT survivors with lymphoma in continuous remission of ≥3 years were assessed alongside 14 age-matched controls. At a median follow-up of 10.5 years (range 2.2-20.2) following HDT/auto-SCT, the proportion of CD4(+) cells remained significantly reduced in patients compared with controls (median 43.4% vs 62.5%, respectively; P = < 0.001), predominantly a result of sustained reduction in the naive CD4(+) component (P < 0.001). Naive CD8(+) lymphocytes (P = 0.014) and transitional B cells (P = 0.008) were also significantly reduced, but differences in other lymphocyte subsets were not observed. Uptake of revaccination following HDT/auto-SCT was sporadic; between 11% and 33% of patients had serological titres outside the protective ranges for five of six routinely used vaccines. In the main, patients were found to have a good quality of life, although their EORTC QLQ-C30 questionnaire scores were significantly lower for the physical and social functioning domains compared with controls. Ten years after HDT/auto-SCT immunological deficits persist; to avoid excess risk of preventable disease, serological immunity should be assessed post HDT/auto-SCT followed by appropriate revaccination.

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.