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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disabilities (ID) often experience poorer diet quality and lower physical fitness levels as they transition from adolescence to adulthood., Objective: The purpose of this study was to assess the initial feasibility and efficacy of Chef-ID, a 12-week intervention designed to improve cooking skills and physical function in young adults with ID., Methods: Young adults with ID attended weekly group sessions which provided hands-on cooking skills, nutrition education, and exercise. Participants were also asked to attend monthly, virtual, goal setting sessions. Feasibility outcomes included attendance, retention, and safety. Preliminary efficacy outcomes included cooking skills, lower body muscle strength, grip strength, aerobic capacity, and body weight. Paired t-tests were used to assess the differences in cooking skills, strength measures, aerobic capacity, and weight after the 12-week intervention., Results: Study retention was 95 %, attendance exceeded 85 % for all sessions, and no serious adverse events were reported. The number of cooking skills participants could do independently (p = 0.005), the number of cooking skills requiring only a verbal prompt (p = 0.01) and lower body strength (p = 0.004) significantly improved across the 12-week intervention. The number of cooking skills participants had no exposure to (p = 0.01) and weight (p = 0.036) significantly decreased across the intervention. No significant changes were observed for upper body strength or aerobic capacity., Conclusions: The Chef-ID intervention was feasible with desirable initial effects on cooking skill independence, exposure to cooking skills, lower body strength, and weight. The Chef-ID intervention holds promise in enhancing cooking skills and physical function among young adults with ID., Trial Registration Number: Clinicaltrials.gov, NCT05385016., Competing Interests: Conflict of interest Dr. Ptomey received personal fees from Healthy Weight Research Network for Children with ASD and DD, outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Bowel cancer screening using faecal immunochemical testing is provided in the United Kingdom with the aim of reducing mortality from colorectal cancer. However, there are low participant rates among ethnic minorities across the United Kingdom. Faith-placed interventions have the potential to improve screening rates among such populations, but studies examining their effectiveness are scarce., Methods: We delivered a presentation on bowel cancer screening to 204 Muslims in seven mosques in East London (intervention group). All participants completed a questionnaire regarding attitudes, perceptions and knowledge of bowel cancer screening before and after the presentation. Concurrently, we administered the questionnaire to 72 subjects attending a mosque that did not receive the presentation (comparison group)., Results: The intervention group showed a greater willingness to do the test (90% vs. 67%, p < 0.001) and to recommend it to others (96% vs. 74%, p < 0.001), ability to complete the test by themselves (94% vs. 56%, p < 0.001) and confidence in noticing symptoms (78% vs. 32%, p < 0.001) after the presentation compared to before. There was a significant difference between the intervention group post-presentation and the comparison group on intention to do the test (90% vs. 79%, p = 0.02), recommending it to others (96% vs. 83%, p < 0.001), and confidence in their ability to complete the test by themselves (94% vs. 63%, p < 0.001)., Conclusion: A culture-sensitive, faith-placed health education intervention delivered in mosques can substantially improve knowledge of bowel cancer screening and increase the intention to participate in the screening programme., Patient or Public Contribution: The intervention presentation was developed using insights from four public involvement sessions with four to six members representative of the East London Muslim community. The sessions sought attendees' thoughts on appropriate ways to approach the intervention design for their community and asked for their views on the acceptability, appropriateness of messaging, format/design and likely impact of the presentation. Their views were then utilised to improve the presentation., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol., Methods: The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT., Results: In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25., Conclusions: Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management., Competing Interests: Competing interests: ST, AWC, JD, CH, HH and PV are all funded or part-funded through GRAIL as part of the SUMMIT Study. SJ was a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA). SJ is supported by CRUK programme grant EDDCPGM\100002, the Rosetrees Trust, the Roy Castle Lung Cancer foundation, the Garfield Weston Trust and UCLH Charitable Foundation. SJ’s full disclosures are as a Paid Advisory Board member Astra-Zeneca, Bard1 Bioscience, Achilles Therapeutics, Jansen. Assistance for travel to meetings from Astra Zeneca, Takeda, and grant income from GRAIL, Owlstone and share options from Optellum; BARD1 Lifescience. SQ is supported by a Cancer Research UK (CRUK) Population Research Fellowship (C50664/A24460) and Barts Charity (MRC&U0036). AN is part-funded through the UCLH Biomedical Research Centre. AD’s disclosures are personal fees from Boehringer Ingelheim, Roche, Galacto Biotech, Galapagos and Vicore. AH’s disclosures are consulting fees to Evidera and assistance for travel to meetings from GRAIL. JRH’s disclosures are assistance for travel from Astra Zeneca and Boehringer Ingelheim and payment for lectures and presentations from Astra Zeneca, Boehringer Ingelheim, Nutricia and Takeda. There are no disclosures from KG, VB, CL, A-MH, JT and LF., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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., (Copyright © 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Although there is now strong evidence for the efficacy of low-radiation dose computed tomography in reducing lung cancer mortality, the challenge is to establish screening programmes that have the maximum impact on the disease. In screening programmes, participation rates are a major determinant of the success of the programme. Informed uptake, participation, and adherence (to successive screening rounds) determine the overall impact of the intervention by ensuring the maximum number of people at risk of the disease are screened regularly and therefore have the most chance of benefiting. Existing cancer screening programmes have taught us a great deal about methods that improve participation. Although evidence is emerging for the efficacy of some of those methods in lung cancer screening, there is still much work to do in the specific demographic that is most at risk of lung cancer. This demographic, characterised by higher levels of socioeconomic deprivation, may be less willing to engage with healthcare interventions and present a particular challenge in the process of ensuring informed choice. In this article we review the evidence for improving participation and describe the challenges that need to be addressed to ensure the successful implementation of CT screening programmes., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-917). The series “Implementation of CT-based screening of lung cancer” was commissioned by the editorial office without any funding or sponsorship. Dr. DRB reports personal fees from Astra Zeneca, personal fees from Roche, personal fees from MSD, personal fees from BMS, from Johnson and Johnson, outside the submitted work. Dr. KB reports personal fees from Astra Zeneca, outside the submitted work. Dr. SQ reports grants from Cancer Research UK, during the conduct of the study. The authors have no other conflicts of interest to declare., (2021 Translational Lung Cancer Research. All rights reserved.)

Introduction: Lung cancer screening (LCS) by low-dose CT has been shown to improve mortality, but individuals must consider the potential benefits and harms before making an informed decision about taking part. Shared decision-making is required for LCS in USA, though screening-eligible individuals' specific views of these harms, and their preferences for accessing this information, are not well described., Methods: In this qualitative study, we aimed to explore knowledge and perceptions around lung cancer and LCS with a focus on harms. We carried out seven focus groups with screening-eligible individuals, which were divided into current versus former smokers and lower versus higher educational backgrounds; and 16 interviews with health professionals including general practitioners, respiratory physicians, lung cancer nurse specialists and public health consultants. Interviews and focus groups were audio-recorded and transcribed. Data were coded inductively and analysed using the framework method., Results: Fatalistic views about lung cancer as an incurable disease dominated, particularly among current smokers, and participants were often unaware of curative treatment options. Despite this, beliefs that screening is sensible and worthwhile were expressed. Generally participants felt they had the 'right' to an informed decision, though some cautioned against information overload. The potential harms of LCS were poorly understood, particularly overdiagnosis and radiation exposure, but participants were unlikely to be deterred by them. Strong concerns about false-negative results were expressed, while false-positive results and indeterminate nodules were also reported as concerning., Conclusions: These findings demonstrate the need for LCS information materials to highlight information on the benefits of early detection and options for curative treatment, while accurately presenting the possible harms. Information needs are likely to vary between individuals and we recommend simple information materials to be made available to all individuals considering participating in LCS, with signposting to more detailed information for those who require it., Competing Interests: Competing interests: SJ and MR are supported by funding for a large trial of low-dose CT screening, called the ‘SUMMIT Study’ by GRAIL Inc. SQ collaborates on the SUMMIT Study. SJ has received honoraria from Astra Zeneca, BARD1 Bioscience and Achilles Therapeutics for being an Advisory Board Expert and travel to a US conference. SJ receives grant funding from Owlstone for a separate research study and has a family member who has a financial association with Astra Zeneca. MR has received travel funding for a conference from Takeda and an honorarium for planning and speaking at educational meetings from Astra Zeneca. These authors perceive that these disclosures pose no academic conflict for this study., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cancer survival in the UK and Denmark are lower when compared with similar countries with late diagnosis a possible cause. We aimed to study the relationship between barriers to attending a primary care physician (GP) and anticipated time to help seeking (ATHS) with four cancer symptoms in six countries., Methods: A population-based survey measuring cancer awareness and beliefs conducted within the International Cancer Benchmarking Partnership in Australia, Canada, Denmark, Norway, Sweden and UK. Data were collected on perceived barriers to GP consultation (including embarrassment, worry about wasting the doctors' time, fear about what the doctor might find and being too busy) and ATHS for persistent cough, abdominal swelling, rectal bleeding and breast changes. Relationships between perceived barriers and ATHS were investigated using multivariable analysis., Results: Among 19 079 respondents, higher perceived barrier scores were associated with longer ATHS intervals for all symptoms studied (P < 0.01) responders with the highest barrier scores (>10.84) had between two and three times the odds of longer ATHS. ATHS was low in Australia for all symptoms and highest in Denmark for abdominal bloating., Conclusions: Perceived barriers to help-seeking have a role in delaying GP presentation. Early diagnosis campaigns should address emotional and practical barriers that reduce early presentation with potential cancer symptoms., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)