Development of an Environmental Policy for the University of Surrey.

This project, whose aim is expressed in its title of "The Development of an Environmental Policy for the University of Surrey", involved research into the process of integrating environmental management activities into an organisation. At the conceptual level it explored the environmental agenda and various approaches to environmental management. As specific examples it examined two responses to the agenda from within the UK Higher Education sector (University of Surrey) and UK business and industry (Balfour Beatty Major Projects Ltd). The comparison enabled conclusions to be drawn about the most effective method for responding to the demands of the sustainable development agenda through the development and implementation of an environmental policy. At the University of Surrey, the research stimulated the creation of an Environmental Policy Steering Group and three Working Groups explicitly to facilitate a bottom-up approach to the development and implementation of its environmental policy. The early research findings strongly influenced the content and structure of the environmental policy statement that was proposed by these groups and-subsequently approved by appropriate University committees in Spring 1998. In addition, the process undertaken provides further evidence that the success of a bottom-up approach is highly dependent on sufficient top-level support, appropriate institutional arrangements and an appropriate institutional ethos. The research has also involved the development of an environmental procurement policy for Balfour Beatty Major Projects Ltd, which provided an industrial and engineering dimension to the work. Based upon both research and empirical data, a draft environmental procurement policy was proposed for Balfour Beatty Major Projects Ltd. The generic findings from this aspect of the project resulted in the development of a conceptual tri-partite environmental management framework (called "The SMART Approach") and the development of a simple model for an environmental procurement policy. The SMART approach offers guidance for writing the environmental policy statement and assessing its efficacy; presents an approach to establishing environmental impacts; and advocates the involvement of stakeholders to assist with the process of identifying the significance of those impacts. The validity of this model has been demonstrated through its application at the University of Surrey. Exploration of the environmental agenda inevitably focused upon clarifying sustainable development and interpreting the implications for the University of Surrey. The analysis has revealed what can be considered a "lost dimension" to the concept, that of concern for the impoverished and most notably those in the "developing" world. It is argued that institutions in the Higher Education sector can best respond to this agenda by applying the industry concept of "product stewardship" to all activities

Head accelerations during a 1-on-1 rugby tackling drill performed by experienced rugby union players

Rugby Union is a popular sport played by males and females worldwide, from junior to elite levels. The highly physical skill of tackling occurs every few seconds throughout a match and various injuries associated with tackling are relatively common. Of particular interest are head injuries that result in a concussion. Recently, repeated non-injurious head impacts in sport have attracted the attention of researchers interested in brain health. Therefore, this study assessed head movement during repeated rugby tackle drills among experienced Rugby Union players. Experienced male and female participants performed 15 1-on-1 tackles in a motion analysis laboratory to measure the head movements of the ball carrier and tackler during each tackle, using three-dimensional motion capture. The average peak acceleration of the head for ball carriers was 28.9 ± 24.08 g and 36.67 ± 28.91 g for the tacklers. This study found that the type of head impacts common while performing a tackle in Rugby Union are similar to those experienced by soccer players during heading, which has been found to alter brain function that lasts hours after the event. This has important implications for player health and suggests that mitigation strategies should be considered for Rugby Union. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Effectiveness of mouth rinsing versus ingesting pickle juice for alleviating electrically induced cramp in physically active adults

(1) Background: Stimulating oropharyngeal transient receptor potential (TRP) channels in-hibits muscle cramping by triggering a supraspinal reflex to reduce α-motor neuron hyperexcitability. This study investigated whether the longer stimulation of the TRP channels via mouth rinsing with PJ is more effective than drinking PJ at inhibiting an electrically induced muscle cramp (EIMC). Both conditions were compared to the control (water). (2) Methods: The tibial nerves in 11 cramp-prone adults were percutaneously stimulated to elicit an EIMC of the flexor hallucis brevis in three trials that took place one week apart from each other. At cramp onset, the participants received mouth rinsing and expelling PJ (25 mL), ingesting PJ (1 mL·kg−1 body-mass (BM)), or ingesting water (1 mL·kg−1 BM). Cramp onset and offset were induced by electromyography, and the severity of discomfort was recorded using a visual analogue scale (VAS). (3) Results: The median time to cramp cessation as a percentage of water was 82.8 ± 14.63% and 68.6 ± 47.78% for PJ ingestion and PJ mouth rinsing, respectively. These results had large variability, and no statistically significant differences were observed. There were also no differences in perceived cramp discomfort between conditions, despite the hazard ratios for the time taken to reach VAS = 0, which was higher than water (control) for PJ ingestion (22%) and mouth rinsing (35%) (p = 0.66 and 0.51, respectively). (4) Conclusions: The data suggest no difference in cramp duration and perceived discomfort between PJ and water. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Andrew Lavender” is provided in this record*

Delayed prescribing of antibiotics for acute respiratory infections by GP registrars: a qualitative study

Background: Antibiotic prescribing for acute self-limiting respiratory tract infections (ARTIs) in Australia is higher than international benchmarks. Antibiotics have little or no efficacy in these conditions, and unnecessary use contributes to antibiotic resistance. Delayed prescribing has been shown to reduce antibiotic use. GP registrars are at a career-stage when long-term prescribing patterns are being established. Aim: To explore experiences, perceptions and attitudes of GP registrars and supervisors to delayed antibiotic prescribing for ARTIs. Design and setting: A qualitative study of Australian GP registrars and supervisors using a thematic analysis approach. Method: GP registrars and supervisors were recruited across three Australian states/territories, using maximum variation sampling. Telephone interviews explored participants’ experience and perceptions of delayed prescribing of antibiotics in ARTIs. Data collection and analysis were concurrent and iterative. Results: A total of 12 registrars and 10 supervisors were interviewed. Key themes included the use of delayed prescribing as a safety-net in cases of diagnostic uncertainty or when clinical review was logistically difficult. Delayed prescribing was viewed as a method of educating and empowering patients, and building trust and the doctor–patient relationship. Conversely, it was also seen as a loss of control over management decisions. Supervisors, more so than registrars, appreciated the psychosocial complexity of ARTI consultations and the importance of delayed antibiotic prescribing in this context. Conclusion: Better awareness and understanding by GP registrars of the evidence for delayed antibiotic prescription may be a means of reducing antibiotic prescribing. Understanding both registrar and supervisor usage, uncertainties and attitudes should inform educational approaches on this topic

Immediate and delayed antibiotic prescribing strategies used by Australian early-career GP: A cross-sectional analysis

BACKGROUND: Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). AIM: To establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs (specialist GP vocational trainees, also known as GP registrars) for non-pneumonia ARTIs. DESIGN AND SETTING: Cross-sectional analysis of data collected between September 2016 and December 2017 from the Registrar Clinical Encounters in Training cohort (ReCEnT) study, an ongoing cohort study of GP registrars’ in-practice clinical experiences in four Australian states and territories. METHOD: Multinomial logistic regression with outcome antibiotic prescribing (no prescribing, immediate prescribing, and delayed prescribing). RESULTS: Of 7156 new ARTI diagnoses, no antibiotics were prescribed for 4892 (68%); antibiotics were prescribed for immediate use for 1614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%). Delayed prescribing was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI) diagnoses. Delayed prescribing was used for 29% of all prescriptions written. Delayed prescribing and immediate prescribing were associated with markers of clinical concern. Delayed prescribing was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation. CONCLUSION: Australian early-career GPs use no prescribing for ARTIs substantially more than established GPs; however, except where URTIs are concerned, they still prescribe antibiotics in excess of validated benchmarks. Australian early-career GPs may use delayed prescribing more often than European established GPs, and may use it to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. The use of delayed prescribing may enable a transition to an environment of more-rational antibiotic prescribing for ARTIs

A multivariable Mendelian randomization analysis investigating smoking and alcohol consumption in oral and oropharyngeal cancer

The independent effects of smoking and alcohol in head and neck cancer are not clear, given the strong association between these risk factors. Their apparent synergistic effect reported in previous observational studies may also underestimate independent effects. Here we report multivariable Mendelian randomization performed in a two-sample approach using summary data on 6,034 oral/oropharyngeal cases and 6,585 controls from a recent genome-wide association study. Our results demonstrate strong evidence for an independent causal effect of smoking on oral/oropharyngeal cancer (IVW OR 2.6, 95% CI = 1.7, 3.9 per standard deviation increase in lifetime smoking behaviour) and an independent causal effect of alcohol consumption when controlling for smoking (IVW OR 2.1, 95% CI = 1.1, 3.8 per standard deviation increase in drinks consumed per week). This suggests the possibility that the causal effect of alcohol may have been underestimated. However, the extent to which alcohol is modified by smoking requires further investigation

Changing the antibiotic prescribing of general practice registrars: The ChAP study protocol for a prospective controlled study of a multimodal educational intervention

Background: Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis. Methods/design: The intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings. We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training. Discussion: Early-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014)

Stoichiometric constraints on the microbial processing of carbon with soil depth along a riparian hillslope

Soil organic matter (SOM) content is a key indicator of riparian soil functioning and in the provision of ecosystem services such as water retention, flood alleviation, pollutant attenuation and carbon (C) sequestration for climate change mitigation. Here, we studied the importance of microbial biomass and nutrient availability in regulating SOM turnover rates. C stabilisation in soil is expected to vary both vertically, down the soil profile and laterally across the riparian zone. In this study, we evaluated the influence of five factors on C mineralization (Cmin): (i) substrate quantity, (ii) substrate quality, (iii) nutrient (C, N and P) stoichiometry, (iv) soil microbial activity with proximity to the river (2 to 75 m), and (v) as a function of soil depth (0 – 3 m). Substrate quality, quantity and nutrient stoichiometry were evaluated using high and low molecular weight 14C-labelled dissolved organic (DOC) along with different nutrient additions. Differences in soil microbial activity with proximity to the river and soil depth were assessed by comparing initial (immediate) Cmin rates and cumulative C mineralized at the end of the incubation period. Overall, microbial biomass C (MBC), organic matter (OM) and soil moisture content (MC) proved to be the major factors controlling rates of Cmin at depth. Differences in the immediate and medium-term response (42 days) of Cmin suggested that microbial growth increased and carbon use efficiency (CUE) decreased down the soil profile. Inorganic N and/or P availability had little or no effect on Cmin suggesting that microbial community growth and activity is predominantly C limited. Similarly, proximity to the watercourse also had relatively little effect on Cmin. This work challenges current theories suggesting that areas adjacent to watercourse process C differently from upslope areas. In contrast, our results suggest that substrate quality and microbial biomass are more important in regulating C processing rates rather than proximity to a river

Investigating the effect of sexual behaviour on oropharyngeal cancer risk:a methodological assessment of Mendelian randomization

BACKGROUND: Human papilloma virus infection is known to influence oropharyngeal cancer (OPC) risk, likely via sexual transmission. However, sexual behaviour has been correlated with other risk factors including smoking and alcohol, meaning independent effects are difficult to establish. We aimed to evaluate the causal effect of sexual behaviour on the risk of OPC using Mendelian randomization (MR). METHODS: Genetic variants robustly associated with age at first sex (AFS) and the number of sexual partners (NSP) were used to perform both univariable and multivariable MR analyses with summary data on 2641 OPC cases and 6585 controls, obtained from the largest available genome-wide association studies (GWAS). Given the potential for genetic pleiotropy, we performed a number of sensitivity analyses: (i) MR methods to account for horizontal pleiotropy, (ii) MR of sexual behaviours on positive (cervical cancer and seropositivity for Chlamydia trachomatis) and negative control outcomes (lung and oral cancer), (iii) Causal Analysis Using Summary Effect estimates (CAUSE), to account for correlated and uncorrelated horizontal pleiotropic effects, (iv) multivariable MR analysis to account for the effects of smoking, alcohol, risk tolerance and educational attainment. RESULTS: In univariable MR, we found evidence supportive of an effect of both later AFS (IVW OR = 0.4, 95%CI (0.3, 0.7), per standard deviation (SD), p = < 0.001) and increasing NSP (IVW OR = 2.2, 95%CI (1.3, 3.8) per SD, p = < 0.001) on OPC risk. These effects were largely robust to sensitivity analyses accounting for horizontal pleiotropy. However, negative control analysis suggested potential violation of the core MR assumptions and subsequent CAUSE analysis implicated pleiotropy of the genetic instruments used to proxy sexual behaviours. Finally, there was some attenuation of the univariable MR results in the multivariable models (AFS IVW OR = 0.7, 95%CI (0.4, 1.2), p = 0.21; NSP IVW OR = 0.9, 95%CI (0.5 1.7), p = 0.76). CONCLUSIONS: Despite using genetic variants strongly related sexual behaviour traits in large-scale GWAS, we found evidence for correlated pleiotropy. This emphasizes a need for multivariable approaches and the triangulation of evidence when performing MR of complex behavioural traits. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02233-3