This paper presents a review of currently available data from the literature on the undrained shear strength, bulk density, stickiness and debris content of faecal sludge. Those data have been used to develop two different simulants that replicate the full range of shear strengths and densities reported for faecal sludge. Comprehensive specifications are also presented for the debris or solid waste found in latrines to more closely replicate the challenge of pumping faecal sludge. Finally, a design guide has been produced to capture these results and support quantitative performance testing of desludging pumps. The simulants have already been used as part of the Bill & Melinda Gates Foundation's Faecal Sludge Omni-Ingestor project and by Water for People's SaniHub in developing improved desludging pumps. The wider use of these simulants could accelerate the development of pit emptying technologies and help standardize the quantitative evaluation of their performance.

Small industrial sources collectively release large amounts of pollution, including particulate matter (PM) that contributes to air quality problems in the United States and elsewhere. We study one such type of industrial facility, concrete batch plants, and analyze PM emissions and siting patterns of 131 plants located in Harris County, Texas. We find that concrete batch plants in Harris County are collectively a major pollution source, contributing between 38 and 111 tons of primary PM2.5 emissions (between 26%–76% of PM2.5 from the median Texas oil refinery) and between 109 and 493 tons of primary PM10 emissions (between 64%–290% of PM10 from the median refinery). Estimates from an integrated assessment model suggest that health damages from the PM2.5 emissions alone amount to $29 million annually, reflecting two additional premature deaths per year. We further find that concrete batch plants in Harris County are disproportionately located in census tracts with more low-income, Hispanic, and Black populations, thereby raising important environmental justice questions. On the basis of these findings, we argue that small pollution sources require more air quality monitoring and emissions reporting and that regulatory agencies should consider cumulative environmental and health impacts of these sources as part of the permitting process.

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Aim Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical on-calls. Key areas of concern are assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs. Method Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered, suturing, knot tying, laparoscopic principles, and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training Results Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%. Conclusions All trainees that attended the course displayed marked improvement in their confidence and competence. We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.

Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical oncalls. Key areas of concern are; assessing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs. Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw these presentations to ensure quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered; suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training. Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%. All trainees that attended the course displayed marked improvement in their confidence and competence. We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.