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The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle-and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

Research is conducted on the study of bacterial adsorption by surfaces with defined and controllable chemistry to investigate chemical and physiochemical factors that may affect adhesion. Results indicate clear correlation between surface chemistry and protein adsorption.

This paper explores the potential for creating online environments for bilingual communities in which minority-language use is supported and actively encouraged. It discusses the language behaviour and attitudes of Welsh–English bilingual users in Pen i Ben, a pilot online community of practice for Head Teachers in Wales. The patterns of language use and the functional roles served by the languages are described. Despite the creation of a bilingual environment and the implementation of specific strategies to encourage Welsh use, the trend indicates increasing use of English. However, it is suggested that a wider set of supporting strategies might be successful in maintaining a truly bilingual online community. [ABSTRACT FROM AUTHOR]

Alkenes react with ozone to produce a distribution of peroxidic compounds that upon thermolysis can produce radicals and these radicals have been used to polymerize vinyl monomers such as MMA, styrene, vinyl acetate and N-vinyl pyrrolidinone. The process can also be carried out in aqueous emulsion. Ozonolysis of the sulfate surfactant, used in emulsion polymerization, also produces species that can be used as a radical initiator. The alkene can also be part of a polymer chain. Ozonolysis/thermolysis produces a macroradical, which can be used to prepare block copolymers. For example, thermolysis following ozonolysis of alkene functional polyisobutene (PIB) produced PIB macroradicals. Styrene was successfully polymerized with these PIB-ozonates and has been shown to be incorporated as an isobutene/styrene block copolymer. However, although MMA could also be polymerized by the PIB-ozonate, the resulting PMMA was found not to be attached to the PIB. [ABSTRACT FROM AUTHOR]

A high proportion of peritoneal cells from untreated mice, after 4-5 days in culture, develop into plaque-forming cells against bromelain-treated mouse red blood cells. The number of plaque-forming cells was increased significantly by exposing the peritoneal cells to ammonium chloride to lyse red blood cells before culture. Conversely, the increase was Significantly inhibited by adding before culture untreated or bromelain-treated sheep or mouse red blood cells. Treated or untreated horse or rat red blood cells did not inhibit the increase. Treating peritoneal cells or subpopulations of peritoneal cells with anti-O serum and complement before culture caused a significant increase in the number of plaque-forming cells against bromelain-treated red blood cells after 3–4 days of culture. Various procedures were used to fractionate peritoneal cells into B-cell enriched and B-cell depleted subpopulations before culture and after culture, to investigate whether some of the plaque-forming cells could be attributed to phagocytic cells. Generally, changes in the number of plaque-forming cells against bromelain-treated mouse red blood cells paralleled changes in B-cells. In some experiments the proportion of plaque-forming cells observed represented up to 85% of the B-cells present. The results suggest that the high level of autoreactivity is due to antibody production by B-cells and that phagocytic cells are not forming spurious plaques. Further, in appears that the autoimmunity is regulated by T-cells and can also be inhibited by mouse RBC. [ABSTRACT FROM AUTHOR]

Subcutaneous and mediastinal emphysema is a rare complication of dental extraction and the use of air turbines has often been implicated. We describe a case which highlights a serious complication of the use of an air rotor for the removal of a right second mandibular molar. [ABSTRACT FROM AUTHOR]

Thrombocytopenia is a rare complication of chlorpropamide therapy. An immunological mechanism is generally held responsible, but has never previously been proved. In the present case the existence of such a mechanism has been established. [ABSTRACT FROM PUBLISHER]

Cryptosporidium parvum is now recognised as being responsible for around 2% of gastroenteritis cases in the immunocompetent population in developed nations, as well as being a significant cause of morbidity in immunocompromised hosts with depressed T-cell function. The resistance of Cryptosporidium oocysts to chlorine-based disinfectants creates particular concerns for drinking water supplies, and numerous outbreaks of cryptosporidiosis have been recorded from both drinking water and recreational water sources in parts of Europe and North America. In Australia, there have been a number of swimming pool-associated outbreaks of cryptosporidiosis, and only one drinking water outbreak from a small private water supply has been documented. Two genotypes of Cryptosporidium parvum have been identified as the major cause of infections in immunocompetent humans. Genotype 1 (or H), appears to infect humans specifically, whereas genotype 2 (or C) may infect humans and a range of other mammals (including cattle, sheep and goats). Species other than C. parvum have been reported to be responsible for up to 20% of infections in immunocompromised hosts, and there is emerging evidence that such species are also responsible for a minority of infections in the immunocompetent human population. We carried out case-control studies of cryptosporidiosis in Melbourne (with high quality source water treated by chlorination only) and Adelaide (with poor quality source water treated by conventional flocculation, sedimentation, filtration and chlorination). The results indicated that drinking tap water was not a significant risk factor for cryptosporidiosis in either city, but that person-to-person transmission and public swimming pools were the main sources of public health risk. Cryptosporidium isolates from participants in the Adelaide case-control study were characterised genetically using single strand conformation polymorphism analysis of the small subunit gene (pSSU; ∼300bp) and second internal transcribed spacer (pITS-2; 230bp) of nuclear ribosomal DNA. Of 26 isolates characterised to date, 15 (58%) were identified as C. parvum genotype 1, 9 (35%) were C. parvum genotype 2 and 2 (7.5%) were C. meleagridis. Neither of the people infected with C. meleagridis had reported any illness or condition affecting the immune system when interviewed for the case-control study. These results support observations from Europe that a small proportion of Cryptosporidium infections in immunocompetent people are caused by species other than C. parvum, in particular C. meleagridis. Acknowledgment: This work was funded by the CRC for Water Quality and Treatment, the Water Services Association of Australia, Melbourne Water Corporation, City West Water Ltd, South East Water Ltd and Yarra Valley Water Ltd. [ABSTRACT FROM AUTHOR]

With two thirds of the global population living in areas affected by water scarcity, wastewater reuse is actively being implemented or explored by many nations. There is a need to better understand the efficacy of recycled water treatment plants (RWTPs) for removal of human opportunistic pathogens and antimicrobial resistant microorganisms. Here, we used a suite of probe-based multiplex and SYBR green real-time PCR assays to monitor enteric opportunistic pathogens (EOPs; Acinetobacter baumannii, Arcobacter butzlieri, Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Legionella spp., Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella Enteritidis, Streptococcus spp.) and antimicrobial resistance genes (ARGs; qnrS, bla SHV , bla TEM , bla GE S , bla KPC , bla IMI , bla SME , bla NDM , bla VIM , bla IMP , bla OXA-48-like , mcr-1 and mcr-3) of key concern from an antimicrobial resistance (AMR), waterborne and foodborne disease perspective. The class 1 integron-integrase gene (intl1) was quantified as a proxy for multi-drug resistance. EOPs, intl1 and ARGs absolute abundance (DNA and RNA) and metabolic activity (RNA) was assessed through three RWTPs with differing treatment trains. Our results indicate that RWTPs produced high quality recycled water for non-potable reuse by removing >95% of EOPs and ARGs, however, subpopulations of EOPs and ARGs survived disinfection and demonstrated potential to become actively growing members of the recycled water and distribution system microbiomes. The persistence of functional intl1 suggests that significant genetic recombination capacity remains in the recycled water, along with the likely presence of multi-drug resistant bacteria. Results provide new insights into the persistence and growth of EOPs, and prevalence and removal of ARGs in recycled water systems. These data will contribute towards the emerging evidence base of AMR risks in recycled water to inform quantitative risk-based policy development regarding water recycling schemes., (Copyright © 2021. Published by Elsevier Ltd.)

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

Small and brief exceedances of chemicals above their guideline values in drinking water are unlikely to cause an appreciable increased risk to human health. As a result, short-term exposure values (STEV) can be derived to help decide whether drinking water can still be supplied to consumers without adverse health risks. In this study, three approaches were applied to calculate and compare STEV for pesticides. The three approaches included basing a STEV on the acute reference dose (ARfD) (Approach 1), removing conventional attribution rates and uncertainty factors from current guideline values (Approach 2) and extrapolating 1 d and 7 d no observed adverse effect levels (NOAEL) from existing toxicity data using a log-linear regression (Approach 3). Despite being very different methods, the three approaches produced comparable STEV generally within an order of magnitude, which often overlapped with other existing short-term exposure values such as short-term no adverse response levels (SNARL) and health advisories (HA). The results show that adjusting the current guideline value using standard extrapolation factors (Approach 2) often produced the most conservative values. Approach 2 was then applied to two other chemical classes, disinfection by-products (DBPs) and cyanotoxins, demonstrating the wider applicability of the approach., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Background: Enterocytozoon bieneusi is one of the commonest microsporidians contributing to human microsporidiosis, and is frequently found in animals in various countries. However, there is limited epidemiological information on this microorganism in Australia. Here, we undertook the first molecular epidemiological study of E. bieneusi in cats and dogs in Victoria., Results: Genomic DNAs were extracted from 514 individual faecal deposits from cats (n = 172) and dogs (n = 342) and then tested using PCR-based sequencing of the internal transcribed spacer (ITS) of nuclear ribosomal DNA. Four distinct genotypes (designated D, PtEb IX, VIC_cat1 and VIC_dog1) of E. bieneusi were identified in 20 of the 514 faecal samples (3.9%). Genotype D is known to have a broad host range (humans and other animals) and has a wide geographical distribution around the world. The identification of this genotype here suggests that companion animals might represent reservoir hosts that are able to transmit E. bieneusi infection to humans in Australia. A phylogenetic analysis of ITS sequence data revealed that the novel genotype VIC_cat1 is related to the known genotype type IV within Group 1, and the new genotype VIC_dog1 is linked to a contentious "Group 3", which includes genotypes reported previously in the published literature to represent Group 2 or 3., Conclusions: A future, large-scale phylogenetic study of all known E. bieneusi genotypes, including VIC_dog1, should aid in clarifying their relationships and assignment to Groups, and in the identification of new genotypes, thus assisting epidemiological investigations.

Two hypothetical scenario exercises were designed and conducted to reflect the increasingly extreme weather-related challenges faced by water utilities as the global climate changes. The first event was based on an extreme flood scenario. The second scenario involved a combination of weather events, including a wild forest fire ('bushfire') followed by runoff due to significant rainfall. For each scenario, a panel of diverse personnel from water utilities and relevant agencies (e.g. health departments) formed a hypothetical water utility and associated regulatory body to manage water quality following the simulated extreme weather event. A larger audience participated by asking questions and contributing key insights. Participants were confronted with unanticipated developments as the simulated scenarios unfolded, introduced by a facilitator. Participants were presented with information that may have challenged their conventional experiences regarding operational procedures in order to identify limitations in current procedures, assumptions, and readily available information. The process worked toward the identification of a list of specific key lessons for each event. At the conclusion of each simulation a facilitated discussion was used to establish key lessons of value to water utilities in preparing them for similar future extreme events., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The Safe Drinking Water Act 2011 was introduced in South Australia to provide clear direction to drinking water providers on how to achieve water safety. The Act requires drinking water providers to register with SA Health and develop a risk management plan (RMP) for their water supply that includes operational and verification monitoring plans and an incident notification and communication protocol. During the first year of operation, 212 drinking water providers registered under the Act, including one major water utility and a range of small to medium sized providers in regional and remote areas of the State. Information was captured on water source(s) used and water treatment. Rainwater was the most frequently reported drinking water source (66%), followed by bore water (13%), on-supply or carting of mains water (13%), mixed source (rainwater with bore water backup) (6%) and surface water (3%). The majority of providers (91%) treated the water supply, 87% used disinfection. During the first year of operation, 16 water quality incidents were formally reported to SA Health. These included both microbial and chemical incidents. Case studies presented highlight how the RMPs are assisting drinking water providers to identify incidents of potential health concern and implement corrective actions.

Among the most widely predicted and accepted consequences of global climate change are increases in both the frequency and severity of a variety of extreme weather events. Such weather events include heavy rainfall and floods, cyclones, droughts, heatwaves, extreme cold, and wildfires, each of which can potentially impact drinking water quality by affecting water catchments, storage reservoirs, the performance of water treatment processes or the integrity of distribution systems. Drinking water guidelines, such as the Australian Drinking Water Guidelines and the World Health Organization Guidelines for Drinking-water Quality, provide guidance for the safe management of drinking water. These documents present principles and strategies for managing risks that may be posed to drinking water quality. While these principles and strategies are applicable to all types of water quality risks, very little specific attention has been paid to the management of extreme weather events. We present a review of recent literature on water quality impacts of extreme weather events and consider practical opportunities for improved guidance for water managers. We conclude that there is a case for an enhanced focus on the management of water quality impacts from extreme weather events in future revisions of water quality guidance documents., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems., Aims: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems., Method: Clinical, work and service use characteristics were collected from social firms' employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively., Results: Predominantly, social firms' employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations., Conclusions: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.

Background: Employment is associated with better quality of life and wellbeing in people with mental illness. Unemployment is associated with greater levels of psychological illness and is viewed as a core part of the social exclusion faced by people with mental illness. Social Firms offer paid employment to people with mental illness but are under-investigated in the UK. The aims of this phase of the Social Firms A Route to Recovery (SoFARR) project were to describe the availability and spread of Social Firms across the UK, to outline the range of opportunities Social Firms offer people with severe mental illness and to understand the extent to which they are employed within these firms., Method: A UK national survey of Social Firms, other social enterprises and supported businesses was completed to understand the extent to which they provide paid employment for the mentally ill. A study-specific questionnaire was developed. It covered two broad areas asking employers about the nature of the Social Firm itself and about the employees with mental illness working there., Results: We obtained returns from 76 Social Firms and social enterprises / supported businesses employing 692 people with mental illness. Forty per cent of Social Firms were in the south of England, 24% in the North and the Midlands, 18% in Scotland and 18% in Wales. Other social enterprises/supported businesses were similarly distributed. Trading activities were confined mainly to manufacturing, service industry, recycling, horticulture and catering. The number of employees with mental illness working in Social Firms and other social enterprises/supported businesses was small (median of 3 and 6.5 respectively). Over 50% employed people with schizophrenia or bipolar disorder, though the greatest proportion of employees with mental illness had depression or anxiety. Over two thirds of Social Firms liaised with mental health services and over a quarter received funding from the NHS or a mental health charity. Most workers with mental illness in Social Firms had been employed for over 2 years., Conclusions: Social Firms have significant potential to be a viable addition to Individual Placement and Support (IPS), supporting recovery orientated services for people with the full range of mental disorders. They are currently an underdeveloped sector in the UK.

We describe a case of brown tumour from primary hyperparathyroidism, which presented with radiolucency in the jaw. It was treated by parathyroidectomy, which resulted in complete resolution of the lytic lesion without any surgery to the jaw. It is important to be aware of endocrine causes of a common radiological sign to avoid unnecessary local surgical intervention., (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives: We examined whether drinking untreated rainwater, a practice that is on the rise in developed countries because of water shortages, contributes to community gastroenteritis incidence., Methods: We conducted a double-blinded, randomized controlled trial in Adelaide, Australia. Sham or active water treatment units were installed, and participants recorded incidences of illness in a health diary for 12 months. The primary outcome was highly credible gastroenteritis (HCG; characterized by a specified number of loose stools or vomiting alone or in combination with abdominal pain or nausea in a 24-hour period), and we used generalized estimating equations to account for correlations between numbers of HCG events for individuals in the same family., Results: Participants reported 769 episodes during the study (0.77 episodes/person/year), with an HCG incidence rate ratio (active vs sham) of 1.05 (95% confidence interval [CI] = 0.82, 1.33). Blinding of the participants was effective (index = 0.65; 95% CI = 0.58, 0.72)., Conclusions: Our results suggest that consumption of untreated rainwater does not contribute appreciably to community gastroenteritis. However, our findings may not be generalizable to susceptible and immunocompromised persons because these groups were specifically excluded from the study.

Background: Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described., Methods: Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed., Results: A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising., Conclusion: The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.

Imprinted polymers are well established as molecular recognition materials but are now being increasingly considered for active biomedical applications such as drug delivery. In this review some highlights of recent research into molecularly imprinted drug delivery and controlled release systems are presented. The key factors controlling recognition and release by imprinted polymer matrices are discussed, the current limiting factors in their properties arising from the synthesis of these materials are considered, and the future prospects for imprinted polymers in drug delivery are outlined.

A range of gene delivery vectors containing the thermoresponsive polymer, poly(N-isopropylacrylamide) (PNIPAm) was evaluated for effects on cell viability, intracellular trafficking and transgene expression in C2C12 mouse muscle cells. Polymers were complexed with plasmid DNA at pH 7.4 and the ability of the resulting particles to transfect cells was assessed via confocal microscopy and protein expression studies in tissue culture. Cell viability assays indicated that these polymers were toxic at high concentrations when not complexed to DNA or at certain polymer:DNA ratios. Poly(ethyleneimine) co-polymers with side-chain grafted PNIPAm were shown to be less toxic than poly(ethyleneimine) alone or PNIPAm-co-(N,N'-dimethylaminoethylmethacrylate) linear co-polymers and the effects were concentration dependent. Confocal micrographs of labeled polymers and DNA indicated rapid cellular entry for all the complexes but expression of Green Fluorescent Protein was achieved only when the branched PEI-PNIPAm co-polymers were used as vectors. The results indicate that design of appropriate co-polymer components and overall polymer architecture can be used to mediate, and perhaps ultimately control, DNA transport and transgene expression.

A series of responsive polymers displaying pH and temperature-mediated phase changes were prepared from N-isopropylacrylamide and omega-carboxylic acid functionalised acrylamides. These polymers were grafted to surfaces and their characteristics probed by atomic force microscopy in aqueous solutions. The effects of pH and temperature induced phase transitions on the short-term adsorption of the bacteria Salmonella typhimurium and Bacillus cereus from pure cultures were assessed. Contact angle studies indicated that pH and temperature-dependent surface properties were exhibited by the graft polymer surfaces. Temperature-dependent surface morphology changes occurred through polymer graft phase transitions as observed in AFM and accompanying changes in adhesion forces underwater were found to correlate with surface properties obtained from contact angle measurements. Adsorption of S. typhimurium and B. cereus was not significantly altered as a function of pH, but attachment of both bacterial strains increased at temperatures above the polymer coil-globule transition indicating the importance of switching surface hydrophobicity in controlling short-term bacterial adsorption.

Three cases of Mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 x 10(4) and 4.5 x 10(3) CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of Mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 x 10(6) CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers.

Poly(N-isopropylacrylamide) (PNIPAm) co-polymers responsive to temperature and pH were prepared with side chain chemistries in order to exhibit phase transitions under physiologically relevant conditions. Fluorescence spectroscopy, gel retardation assays, dynamic light scattering and atomic force microscopy were used to characterize the binding of plasmid DNA to these materials and to control polymers poly(ethyleneimine) (PEI) and poly(ethyleneimine)-octanamide. Complexes of plasmid DNA with thermoresponsive cationic polymers containing PNIPAm displayed variations in gel retardation behaviour above and below polymer phase transition temperatures, with a high molecular weight linear cationic PNIPAm co-polymer forming complexes with reduced affinity above LCST whereas a branched PEI-PNIPAm co-polymer bound with higher affinity above the PNIPAm phase transition. The thermoresponsive polymers also exhibited changes in particle morphology across the same temperature ranges with polymer DNA complexes prepared at N/P ratios of 2:1 generating spherical particles varying in radius between 30-70 nm at 25 degrees C and 60-100 nm at 40-45 degrees C. The transport of DNA within these complexes to cell nuclei was demonstrated to occur within 24 h in tissue culture via confocal microscopy, and low level transfection of mouse muscle cells by a reporter gene encoding green fluorescent protein was achieved with the branched thermoresponsive PEI-PNIPAm conjugate.

A growing list of water contaminants has led to some water suppliers relying primarily on compliance monitoring as a mechanism for managing drinking water quality. While such monitoring is a necessary part of drinking water quality management, experiences with waterborne disease threats and outbreaks have shown that compliance monitoring for numerical limits is not, in itself, sufficient to guarantee the safety and quality of drinking water supplies. To address these issues, the Australian National Health and Medical Research Council (NHMRC) has developed a Framework for Management of Drinking Water Quality (the Framework) for incorporation in the Australian Drinking Water Guidelines, the primary reference on drinking water quality in Australia. The Framework was developed specifically for drinking water supplies and provides a comprehensive and preventive risk management approach from catchment to consumer. It includes holistic guidance on a range of issues considered good practice for system management. The Framework addresses four key areas: Commitment to Drinking Water Quality Management, System Analysis and System Management, Supporting Requirements, and Review. The Framework represents a significantly enhanced approach to the management and regulation of drinking water quality and offers a flexible and proactive means of optimising drinking water quality and protecting public health. Rather than the primary reliance on compliance monitoring, the Framework emphasises prevention, the importance of risk assessment, maintaining the integrity of water supply systems and application of multiple barriers to assure protection of public health. Development of the Framework was undertaken in collaboration with the water industry, regulators and other stakeholder, and will promote a common and unified approach to drinking water quality management throughout Australia. The Framework has attracted international interest.

The role of percutaneous endoscopic gastrostomy (PEG) in patients undergoing resection of head and neck malignancy is well established. The procedure may be performed pre- or post-operatively with intravenous sedation or alternatively under general anaesthesia at the time of tumour resection. There are concerns as to the safety of PEG, particularly when performed under intravenous sedation. Elderly patients with poor general health and those with airway compromise may be at significant risk. We believe that patients with advanced oral malignancy often fall into such groups and, therefore, we routinely perform PEG at the time of resection. The aim of this study was to determine the potential risk factors for PEG insertion in patients with advanced oral malignancy and present our experience with insertion at the time of resection. A retrospective study was undertaken of the risk factors for PEG insertion in 72 consecutive patients with stage IV oral cancer treated between April 1993 and March 2000. Age, sex, tumour site, past medical history, American Society of Anaesthesiologists (ASA) and laryngoscopy grade, as an assessment of potential airway compromise, were recorded. There were 72 patients, 40 males and 32 females, with a mean age of 63 years (27-90). Eighteen patients (25%) scored 3 or 4 on the ASA scores of physical status. Laryngoscopy grades were recorded in 65 patients; of these, 18 (25%) had reduced visualisation of the larynx and in two patients not even the epiglottis could be seen. It is concluded that patients with advanced oral cancer have significant risk factors for PEG placement. However, PEG can be safely performed at the time of ablative surgery and has the advantage of avoiding an additional operative event for the patient.

The dental surgeon can play an important role in the early referral of malignancy of the maxillary sinus, and should be familiar with the signs and symptoms of disease of the paranasal sinuses. Here we report a case of a 71-year-old male patient diagnosed with high-grade B-cell lymphoma of the maxillary sinus that was initially thought to be an odontogenic infection. We discuss the signs and symptoms of lymphomas and malignancy of the maxillary sinus.