Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

The Enfield-Haringey artificial recharge scheme comprises 23 abstraction/recharge boreholes located between Enfield and Haringey in north London. It is a strategic groundwater development aimed at increasing drought yields to meet the 'target level of service' defined by OFWAT for availability of water resources. The hydrogeology of the scheme, revealed by the drilling and testing of 15 new production boreholes is described and its strategic use summarized. The hydrochemistry of the groundwater in the Chalk and Basal Sands aquifer is briefly considered and the likely effects of re-saturation after recharge on the quality of the pumped groundwater is commented on. This and previous studies have led to a better understanding of the aquifer system and the hydraulic relationship between the Basal Sands and the underlying Chalk. Intensive exploitation in the past led to some dewatering but reduction in abstraction since the 1950s has allowed water levels to recover, a process that is continuing. In most of the Enfield-Haringey area the aquifer is still only partially saturated, hence the potential for artificial recharge. The Chalk aquifer has been found to be typically anisotropic and heterogeneous with the upper 30–40 m being productive. Acidization was found to produce significant increases in well yields. Chalk groundwaters are mainly of a calcium bicarbonate type while those of the overlying Basal Sands are dominated by sulphate. Both groundwaters become progressively richer in sodium at the expense of calcium from north to south, in the direction of groundwater flow and towards more deeply confining conditions.

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Groundwater is best described as an open access good: as a common pool resource others cannot be excluded from using and as a finite resource, its consumption leaves less for others to enjoy. In addition to its obvious benefits to humans and animals, it contributes in sustaining the hydro-environment and life on the planet. Scarcity causes groundwater to become an economic good and have an economic value. By and large, economic valuations respond to changes in the quantity and quality of groundwater. They are based on willingness to pay for maintaining its benefits or willingness to accept compensation for giving them up. There have been some 50 published groundwater valuation studies worldwide in the last 30 years, mostly focusing on groundwater quality and contamination. There is sparsity of valuations in Africa and Asia. The results suggest median economic values of 60–160 and mean values of 70–480 US dollars per household per year. Generally, values are higher in the USA followed by Europe, and lowest in Asia. People's income is a major factor affecting values, but this does not mean that they value groundwater less. Economic valuations and cost–benefit analysis are useful in highlighting people's priorities and choice of options. However, economics alone should not dictate actions for protecting groundwater resources from degradation and depletion.

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