Survival of Escherichia coli in common garden mulches spiked with synthetic greywater.

Reuse of domestic wastewater is increasingly practiced as a means to address global demands on fresh water. Greywater is primarily reused via subsurface irrigation of gardens, where the soil environment is seen to be an integral part of the treatment process. The fate of biological contaminants (i.e. pathogens) in the soil is reasonably well understood, but their persistence and survival in soil cover layers is largely unexplored. This study investigated the ability of Escherichia coli to survive in common soil cover layers. Three garden mulches were investigated: pea straw mulch, a bark-based mulch and a coconut husk mulch. Each mulch was treated with an E. coli solution, a synthetic greywater with E. coli, or a freshwater control. Escherichia coli was applied at 1 × 104  most probable number (MPN) per g dry weight mulch. Subsamples were temporally analysed for E. coli. The bark and coconut husk mulches showed a steady decline in E. coli numbers, while E. coli increased in the pea straw mulch for the duration of the 50 days experiment, peaking at 1·8 × 108  MPN per g dry weight mulch. This study highlighted the importance of selection of a suitable material for covering areas that are subsurface irrigated with greywater. SIGNIFICANCE AND IMPACT OF THE STUDY: Potential for microbial contamination is one of the limiting factors for domestic greywater reuse. Although subsurface irrigation is considered to be one of the lowest risk applications, there is still a possibility of microbes reaching the soil surface if the environmental conditions are not favourable or if soil movement inadvertently exposes the irrigation line. In these circumstances, the soil cover layer may be contaminated by greywater microbes. This study assesses the survival rates of the pathogen indicator organism Escherichia coli in three soil cover materials commonly used worldwide and makes clear recommendations to facilitate the safe reuse of domestic greywater.

Pulmonary nodules and CT screening: the past, present and future.

Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention. This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK.

Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership.

BACKGROUND: Smoking cessation is the key cancer prevention behaviour for smokers; nonetheless, smokers can still benefit from earlier diagnosis of cancer. However, fewer smokers participate in screening despite their increased risk, which may reflect different beliefs about cancer. METHODS: A UK population-representative sample of ⩾50 year-olds (n=6965) was surveyed using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer beliefs (e.g., 'cancer can often be cured'), and four on help-seeking barriers (e.g., 'I would be too embarrassed'). RESULTS: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers on four of six items. For example, 34% agreed 'a cancer diagnosis is a death sentence', compared with 24% of non/former-smokers (P<0.001). More smokers (18%) than non/former-smokers (11%) would not want to know if they had cancer (P<0.01). The only barrier to symptomatic help-seeking differing by smoking status was 'worry about what the doctor might find' (36% vs 28%, P<0.01). Associations were independent of demographics, self-rated health and cancer experience. CONCLUSIONS: Smokers held more pessimistic and avoidant beliefs about cancer, which could deter early-detection behaviour. A better understanding of these beliefs is needed to increase engagement in early diagnosis by this high-risk group.

Recognition of cancer warning signs and anticipated delay in help-seeking in a population sample of adults in the UK.

BACKGROUND: Not recognising a symptom as suspicious is a common reason given by cancer patients for delayed help-seeking; but inevitably this is retrospective. We therefore investigated associations between recognition of warning signs for breast, colorectal and lung cancer and anticipated time to help-seeking for symptoms of each cancer. METHODS: Computer-assisted telephone interviews were conducted with a population-representative sample (N=6965) of UK adults age ≥ 50 years, using the Awareness and Beliefs about Cancer scale. Anticipated time to help-seeking for persistent cough, rectal bleeding and breast changes was categorised as >2 vs ≤ 2 weeks. Recognition of persistent cough, unexplained bleeding and unexplained lump as cancer warning signs was assessed (yes/no). Associations between recognition and help-seeking were examined for each symptom controlling for demographics and perceived ease of health-care access. RESULTS: For each symptom, the odds of waiting for >2 weeks were significantly increased in those who did not recognise the related warning sign: breast changes: OR=2.45, 95% CI 1.47-4.08; rectal bleeding: OR=1.77, 1.36-2.30; persistent cough: OR=1.30, 1.17-1.46, independent of demographics and health-care access. CONCLUSION: Recognition of warning signs was associated with anticipating faster help-seeking for potential symptoms of cancer. Strategies to improve recognition are likely to facilitate earlier diagnosis.

Early Diagnosis and Lung Cancer Screening.

Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.