COVID-19, antibiotics and One Health: a UK environmental risk assessment

There is growing interest in the role of secondary bacterial and fungal infections as a cause of increased morbidity and mortality in COVID-19 patients,1 with reports of up to 95% of COVID-19 inpatients being prescribed antibiotics.2 Concerns have been raised over the environmental implications of such a large-scale drug administration3 and statements made about the potential impacts of COVID-19-related antibiotic prescription on antimicrobial resistance (AMR) and other toxicological effects on the environment.4 The UK National Strategy aims for a world in which AMR is effectively contained, controlled and mitigated by 2040.5 Taking a ‘One Health’ approach to effective stewardship in settings such as those being experienced in the current pandemic will be key to minimizing the negative impacts of antibiotic use. A large proportion of some drugs (and metabolites) are excreted by patients into wastewater treatment works (WwTW), leading to release of drug residues into effluent-receiving rivers and coastal waters. Environmental concentrations and impacts will be greatest where drugs are used in high volumes, pass through WwTW largely undegraded and are discharged into rivers with limited dilution

Spatial and temporal (annual and decadal) trends of metal(loid) concentrations and loads in an acid mine drainage-affected river

Acid mine drainage (AMD) is a worldwide problem that degrades river systems and is difficult and expensive to remediate. To protect affected catchments, it is vital to understand the behaviour of AMD-related metal(loid) contaminants as a function of space and time. To address this, the sources, loads and transport mechanisms of arsenic (As), copper (Cu), zinc (Zn), iron (Fe) and sulfur (S) in a representative AMD-affected catchment (the Carnon River in Cornwall, UK) were determined over a 12-month sampling period and with 22 years of monitoring data collected by the Environment Agency (England) (EA). The main source of metal(loid)s to the Carnon River was the County Adit which drains AMD from approximately 60 km of underground historical mine workings. Maximum aqueous concentrations of Fe, Cu and Zn occurred immediately downstream of the County Adit confluence with the Carnon River, whereas maximum As and S concentrations occurred further downstream, suggesting the presence of diffuse sources. Discharge and concentration relationships suggested that discharge drove Cu and Zn release, whereas pH and Eh influenced Fe, S, and As mobility. Total loads (represented by unfiltered sample contaminant concentrations) to the coastal zone were high, ranging from 183 to 354 kg/month As, 307–742 kg/month Cu, 189–1960 kg/month Fe, 53,400–125,000 kg/month S and 1280–3320 kg/month Zn. The longevity and increasing amounts of contaminant discharge were confirmed with 22 years of EA monitoring data. This study highlights the complex and multifaceted behaviour of contaminant metal(loid)s within AMD-affected riverine systems and the fact that point and diffuse sources can constitute significant long-term liabilities for such environments

Diagnosis of cancer as an emergency: a critical review of current evidence

Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis

Developing the OECD 106 fate testing protocol for active pharmaceuticals in soil

The ability to determine accurately the fate of APIs in soil is essential for rigorous risk assessment associated with wastewater reuse or biosolid recycling to land, particularly in lower income countries where water and fertiliser is scarce. Four APIs (naproxen, ofloxacin, propranolol and nevirapine) with wide ranging functionality were used as examples in the development of the OECD 106 soil partitioning and/or degradation study, with naproxen used to illustrate applying the full methodology. The data showed key methodological criteria require careful consideration and testing to generate accurate and consistent results. Only glass fibre membranes were suitable for all APIs, without unduly adsorbing APIs to their surface, thus effectively restricting the minimum practical pore size to 0.7 µm. Polypropylene plastic centrifuge tubes were shown to be suitable, with careful determination of recoveries. Direct injection liquid chromatography-mass spectrometry could reliably resolve all 4 APIs down to less than µg L−1 in soil solutions, although allowance for matrix effects via standard additions was required in some cases. Greatest analytical challenges were found for the highest molecular weight API with the greatest affinity for sorption to surfaces (ofloxacin). Key variables that can impact on partitioning such as solution pH and dissolved organic carbon concentrations were shown to vary within tests over time and should be accounted for.</p

Development of a Chemical Source Apportionment Decision Support Framework for Catchment Management

EU legislation, including the Water Framework Directive, has led to the application of increasingly stringent quality standards for a wide range of chemical contaminants in surface waters. This has raised the question of how to determine and to quantify the sources of such substances so that measures can be taken to address breaches of these quality standards using the polluter pays principle. Contaminants enter surface waters via a number of diffuse and point sources. Decision support tools are required to assess the relative magnitudes of these sources and to estimate the impacts of any programmes of measures. This work describes the development and testing of a modeling framework, the Source Apportionment Geographical Information System (SAGIS). The model uses readily available national data sets to estimate contributions of a number of nutrients (nitrogen and phosphorus), metals (copper, zinc, cadmium, lead, mercury, and nickel) and organic chemicals (a phthalate and a number of polynuclear aromatic hydrocarbons) from multiple sector sources. Such a tool has not previously been available on a national scale for such a wide range of chemicals. It is intended to provide a common platform to assist stakeholders in future catchment management