Assessing the potential impacts of a revised set of on-farm nutrient and sediment 'basic' control measures for reducing agricultural diffuse pollution across England.

The need for improved abatement of agricultural diffuse water pollution represents cause for concern throughout the world. A critical aspect in the design of on-farm intervention programmes concerns the potential technical cost-effectiveness of packages of control measures. The European Union (EU) Water Framework Directive (WFD) calls for Programmes of Measures (PoMs) to protect freshwater environments and these comprise 'basic' (mandatory) and 'supplementary' (incentivised) options. Recent work has used measure review, elicitation of stakeholder attitudes and a process-based modelling framework to identify a new alternative set of 'basic' agricultural sector control measures for nutrient and sediment abatement across England. Following an initial scientific review of 708 measures, 90 were identified for further consideration at an industry workshop and 63 had industry support. Optimisation modelling was undertaken to identify a shortlist of measures using the Demonstration Test Catchments as sentinel agricultural landscapes. Optimisation selected 12 measures relevant to livestock or arable systems. Model simulations of 95% implementation of these 12 candidate 'basic' measures, in addition to business-as-usual, suggested reductions in the national agricultural nitrate load of 2.5%, whilst corresponding reductions in phosphorus and sediment were 11.9% and 5.6%, respectively. The total cost of applying the candidate 'basic' measures across the whole of England was estimated to be £450 million per annum, which is equivalent to £52 per hectare of agricultural land. This work contributed to a public consultation in 2016.

Benign superior vena cava syndrome due to suppurative mediastinal lymphadenitis: anterior mediastinoscopic management.

The benign superior vena cava syndrome is an uncommon medical emergency. We describe a case of the superior vena cava syndrome caused by suppurative mediastinal lymphadenitis. The organisms isolated from various cultures were group C beta-hemolytic Streptococcus, Fusobacterium species, Corynebacterium species, Eikenella corrodens, and Streptococcus milleri. These anaerobic bacteria are part of the normal flora of the upper respiratory tract and the oral cavity. Anterior mediastinoscopy through the right parasternal approach was used to drain the anterior mediastinal abscess and to establish the etiologic factor.

The status of the trauma coordinator position: a national survey.

The trauma coordinator (TC) position is a vital link in the development and operations of trauma care systems. In 1992 and 1993, the American Trauma Society conducted a national survey of TCs to describe the roles and characteristics of the persons who hold those positions. Of 354 trauma coordinators identified in 46 states, more than three-fourths were employed by large hospitals designated as trauma centers. The typical TC was a woman 26 to 59 years old who held at least a bachelor's degree in nursing. Although new as TCs (mean, 3 years as TCs), the respondents averaged 14 years experience in nursing. Both full-time and part-time TCs worked longer hours than scheduled, often had supervisory responsibilities, and generally were in the nursing administration or the emergency department structure. Most TCs worked with computerized trauma registries that were used routinely in quality of care reviews.

Insertion of Tn916 into Bacillus pumilus plasmid pMGD302 and evidence for plasmid transfer by conjugation.

As part of an effort to develop systems for genetic analysis of strains of Bacillus pumilus which are being used as a microbial hay preservative, we introduced the conjugative Enterococcus faecalis transposon Tn916 into B. pumilus ATCC 1 and two naturally occurring hay isolates of B. pumilus. B. pumilus transconjugants resistant to tetracycline were detected at a frequency of approximately 6.5 x 10(-7) per recipient after filter mating with E. faecalis CG110. Southern hybridization confirmed the insertion of Tn916 into several different sites in the B. pumilus chromosome. Transfer of Tn916 also was observed between strains of B. pumilus in filter matings, and one donor strain transferred tetracycline resistance to recipients in broth matings at high frequency (up to 3.4 x 10(-5) per recipient). Transfer from this donor strain in broth matings was DNase-resistant and was not mediated by culture filtrates. Transconjugants from these broth matings contained derivatives of a cryptic plasmid (pMGD302, approx 60 kb) from the donor strain with Tn916 inserted at various sites. The plasmids containing Tn916 insertions transferred to a B. pumilus recipient strain at frequencies of approx 5 x 10(-6) per recipient. This evidence suggests that pMGD302 can transfer by a process resembling conjugation between strains of B. pumilus.

Evaluation of the insulin jet injector as a potential source of infection.

In recent years jet injection of insulin has been widely used by patients with diabetes mellitus. Jet injectors may become contaminated by bacteria because of repeated use without cleaning; cleansing every 2 weeks is recommended. We investigated the occurrence of bacterial contamination by culturing jet injectors in everyday use by 19 patients with diabetes. Swabs from the interior chambers were cultured on blood agar plates. Only one of 20 cultures yielded bacterial growth, and the organism recovered was a presumed contaminant that could not be identified as any common pathogen. No study patient, nor any of more than 70 patients whom we instructed in jet injection, showed any clinical evidence of infection attributable to jet injector use. Jet injectors are unlikely to become colonized by bacteria or to cause infection in patients using them for insulin administration. The low rate of colonization may be due to the antibacterial preservatives added to commercial preparations of insulin. Additional data based on larger numbers of patients would be useful in further clarifying the risk of infection associated with jet injectors.