Wastewater-based epidemiology (WBE) seeks to use biological or chemical indicators in sewage to provide information on the overall health of a community. This paper provides an overview of the range of applications of WBE over the past two decades, how it has been used to inform public health responses, and considerations for more integrated approaches to WBE based on a review of the literature. The review finds that WBE has been used extensively around the world for the estimation of consumption patterns of illicit drugs and other substances, but a range of novel applications also exist. As a result of the COVID-19 pandemic, many communities used WBE for the first time as a complementary public health surveillance tool, monitoring trends in SARS-CoV-2 prevalence in large cities, and for micro-surveillance on a more targeted level. WBE may continue to be a useful public health surveillance tool in the future; however, several limitations and challenges exist. Consideration of how information obtained through WBE can be used to inform public health responses is essential to understanding the potential costs and benefits compared with conventional public health surveillance techniques.

The concentrations of 12 pharmaceutical compounds (atenolol, erythromycin, cyclophosphamide, paracetamol, bezafibrate, carbamazepine, ciprofloxacin, caffeine, clarithromycin, lidocaine, sulfamethoxazole and N-acetylsulfamethoxazol (NACS)) were investigated in the influents and effluents of two hospital wastewater treatment plants (HWWTPs) in Saudi Arabia. The majority of the target analytes were detected in the influent samples apart from bezafibrate, cyclophosphamide, and erythromycin. Caffeine and paracetamol were detected in the influent at particularly high concentrations up to 75 and 12 ug/L, respectively. High removal efficiencies of the pharmaceutical compounds were observed in both HWWTPs, with greater than 90 % removal on average. Paracetamol, sulfamethoxazole, NACS, ciprofloxacin, and caffeine were eliminated by between >95 and >99 % on average. Atenolol, carbamazepine, and clarithromycin were eliminated by >86 % on average. Of particular interest were the high removal efficiencies of carbamazepine and antibiotics that were achieved by the HWWTPs; these compounds have been reported to be relatively recalcitrant to biological treatment and are generally only partially removed. Elevated temperatures and high levels of sunlight were considered to be the main factors that enhanced the removal of these compounds.

The Green Deal (GD) was launched in 2013 by the UK Government as a market-led scheme to encourage uptake of energy efficiency measures in the UK and create green sector jobs. The scheme closed in July 2015 after 30 months due to government concerns over low uptake and industry standards but additional factors potentially contributed to its failure such as poor scheme design and lack of understanding of the customer and supply chain journey. We explore the role of key delivery agents of GD services, specifically SMEs, and we use the LoCal-Net project as a case study to examine the use of networks to identify and reduce barriers to SME market engagement. We find that SMEs experienced multiple barriers to interaction with the GD such as lack of access to information, training, and confusion over delivery of the scheme but benefited from interaction with the network to access information, improve understanding of the scheme, increasing networking opportunities and forming new business models and partnerships to reduce risk. The importance of SMEs as delivery agents and their role in the design of market-led schemes such as the GD are discussed with recommendations for improving SME engagement in green sector initiatives.

Purpose Advancements and innovation in engineering design are based on learning from previous failures but students are encouraged to “succeed” first time and hence can avoid learning from failure in practice. The purpose of this paper is to design and evaluate a curriculum to help engineering design students to learn from failure. Design/methodology/approach A new curriculum design provided a case study for evaluating the effects of incorporating learning from failure within a civil engineering course. An analysis of the changes in course output was undertaken in relation to graduate destination data covering 2006 to 2016 and student satisfaction from 2012 to 2017 and a number of challenges and solutions for curriculum designers were identified. Findings The design and delivery of an innovative curriculum, within typical constraints, can provide opportunities for students to develop resilience to failure as an integral part of their learning in order to think creatively and develop novel engineering solutions. The key issues identified were: the selection of appropriate teaching methods, creating an environment for exploratory learning, group and team assessments with competitive elements where practicable and providing students with many different pedagogical approaches to produce a quality learning experience. Originality/value This case study demonstrates how to design and implement an innovative curriculum that can produce positive benefits of learning from failure. This model can be applied to other disciplines such as building surveying and construction management. This approach underpins the development of skills necessary in the educational experience to develop as a professional building pathologist.

Table 1: Characteristics of selected opportunistic pathogens (OPs) of concern in Canada.Legionella spp. Description: Gram-negative bacteria, found in natural water systems and soils, have been detected in most large building water systems and some 10%-30% of home water systems in the United States. Legionella bacteria can be present in water storage containers, pipes, or outlets. Optimal growing conditions: Preference for warm water (e.g., 25-45 °C), high water age, low disinfectant residual, and often associated with biofilms or free-living amoeba (FLA). Routes of transmission: Inhalation or accidental aspiration of aerosolized contaminated water droplets into the lungs from faucets, showerhead, water misters, decorative fountains, hot tubs, cooling towers, etc. Outcome of infection: Legionellosis, includes Legionnaires' disease (LD), a severe pneumonia with a fatality rate of about 10%, and Pontiac fever, a milder flu-like illness. L. pneumophila is the cause of most cases of LD. Groups most at risk: Smokers, over-50s, men, immune-compromised persons, and those with conditions like chronic obstructive pulmonary disease, coronary artery disease, dementia, diabetes, kidney disease, and neurological diseases. Pseudomonas spp. Description: Gram-negative bacteria that can form or join biofilms and colonize plumbing. Found in building water system at point of use areas (e.g., faucets, drains, and showerheads) more often than distribution systems, and can colonize humidifiers, respiratory equipment, swimming pools, hot tubs, and water baths. Optimal growing conditions: Tolerate a range of temperatures (4-42 °C), with an optimum around 37 °C, and reduced virulence below 30 °C; optimal pH around 7.2 and tolerate low dissolved oxygen, low nutrient, and stagnant waters. Grow well in poorly disinfected systems, but also resist disinfectants and can survive in FLA. Routes of transmission: Direct ear and skin contact in swimming pools, hot tubs, and whirlpools; inhalation of aerosols dispersed from faucets, showerhead, etc.; indirect transfer from contaminated devices or fomites. More commonly found in plumbing fixtures than in distribution systems. Outcome of infection: Most infections (80%) associated with P. aeruginosa and P. maltophila range from minor eye, skin, and ear conditions (e.g., swimmer's ear), to bacteremia in immune-compromised individuals or other susceptible patients. A major cause of healthcare-acquired pneumonia, wound infections, and urinary tract infections, and a cause of morbidity and mortality for cystic fibrosis patients. Groups most at risk: Children with cystic fibrosis, hospitalized patients at risk of hospital-acquired pneumonia, newborns, burn patients, patients with invasive devices, and those with underlying pulmonary disease. Nontuberculous mycobacterium (NTM) Description: NTM are a group of more than 190 known species of OP found in natural waters and soil, and building water systems. Includes Mycobacterium avium complex, a group of related bacteria that includes both M. avium and M. intrac...