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Anaerobic digestion can inactivate zoonotic pathogens present in cattle manure, which reduces transmission of these pathogens from farms to humans through the environment. However, the variability of inactivation across farms and over time is unknown because most studies have examined pathogen inactivation under ideal laboratory conditions or have focused on only one or two full‐scale digesters at a time. In contrast, we sampled seven full‐scale digesters treating cattle manure in Wisconsin for 9 mo on a biweekly basis (n = 118 pairs of influent and effluent samples) and used real‐time quantitative polymerase chain reaction to analyze these samples for 19 different microbial genetic markers. Overall, inactivation of pathogens and fecal indicators was highly variable. When aggregated across digester and season, log‐removal values for several representative microorganisms—bovine Bacteroides, Bacteroidales‐like CowM3, and bovine polyomavirus—were 0.78 ± 0.34, 0.70 ± 0.50, and 0.53 ± 0.58, respectively (mean ± SD). These log‐removal values were up to two times lower than expected based on the scientific literature. Thus, our study indicates that full‐scale anaerobic digestion of cattle manure requires optimization with regard to pathogen inactivation. Future studies should focus on identifying the potential causes of this suboptimal performance (e.g., overloading, poor mixing, poor temperature control). Our study also examined the fate of pathogens during manure separation and found that the majority of microbes we detected ended up in the liquid fraction of separated manure. This finding has important implications for the transmission of zoonotic pathogens through the environment to humans. Core Ideas Pathogen inactivation is highly variable among full‐scale anaerobic digesters.Pathogen inactivation by full‐scale digesters on cattle farms needs optimization.Most microbes end up in the liquid fraction during solids separation of manure.

BACKGROUND A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. METHODS A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. RESULTS The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. CONCLUSIONS The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.

Setosphaeria turcica is an important fungal pathogen of maize in the humid mid-altitude and highland environments of East Africa, causing northern corn leaf blight. To conduct a population genetic analysis, a total of 172 S. turcica isolates from four locations in western (Kakamega, Kitale) and central (Embu, Kikuyu) Kenya, collected in 1994 and 1995, were examined with 43 random amplified polymorphic DNA (RAPD) markers. Mating types were also determined. Of the total genetic variation, the greatest portion (70%) was attributed to differences between haplotypes in local populations. Only 26% of the variation was due to differences between regions and 4% to locations within regions. Populations from the two regions clearly differed in their haplotype similarities and had different levels of gene and genotypic diversity. Isolation by distance and divergent selection are likely to be major causes of the differentiation between western and central Kenya. Migration between the two regions was weak. Within regions, population samples from different locations were very similar indicating intense migration. Samples collected early and late in the vegetation period or in consecutive years always showed the same population structure, i.e. little fluctuation occurred during the season. Clones were shown to be conserved over long distances and over years despite sexual recombination and an extremely high genotypic diversity. Zusammenfassung Der Ascomycet Setosphaeria turcica verursacht Northern Corn Leaf Blight, eine in tropischen Hochlandgebieten Ostafrikas bedeutsame Blattkrankheit des Maises. Um die Populationsstruktur zu untersuchen, wurden 172 S. turcica-Isolate, gesammelt 1994 und 1995 an vier Orten in Westkenia (Kakamega und Kitale) und Zentralkenia (Embu, Kikuyu), mit 43 Random Amplified Polymorphic DNA- (RAPD-) Markern sowie auf ihren Geschlechtstyp hin untersucht. Der groste Anteil (70%) der Gesamtvariation war auf Unterschiede zwischen Haplotypen innerhalb lokaler Populationen zuruckzufuhren. Nur 26% der Variation kam durch Unterschiede zwischen Regionen und 4% zwischen Orten innerhalb Regionen zustande. Populationen der beiden Regionen unterschieden sich deutlich hinsichtlich genetischer Ahnlichkeit zwischen ihren Haplotypen sowie hinsichtlich genischer und genotypischer Diversitat. Diese Unterschiede konnen auf Isolation durch raumliche Distanz zuruckgefuhrt werden, auch divergente Selektion spielt vermutlich eine Rolle. Migration zwischen den Regionen konnte auf niedrigem Niveau nachgewiesen werden. Innerhalb der beiden Regionen war Migration intensiv, denn die Populationss-tichproben der zwei Orte unterschieden sich kaum. Die Stichproben aus aufeinanderfolgenden Jahren sowie fruh und spat in der Vegetationsperiode unterschieden sich nicht. Klone konnten trotz sexueller Rekombination und extrem hoher genotypischer Diversitat uber grosere Distanzen und uber Jahre nachgewiesen werden.