Faecal incontinence (FI) is a prevalent complaint in Western populations and causes significant disability. Impaired motor function of the anal canal is a common pathophysiological feature and assessment of sphincteric function with manometry is a routine part of symptom assessment. High-resolution anorectal manometry (HRAM) may provide a more detailed understanding of anorectal function, however its clinical utility has not been established. Aims The principal aims of this thesis were to: (1) Explore existing practices of anorectal manometry (2) Examine current evidence supporting the use of HRAM (3) Develop and validate a protocol for the performance of HRAM (4) Define normal values for traditional measures of sphincteric function using HRAM (5) Develop and validate novel measures of sphincteric function, and explore whether they improve diagnostic accuracy in patients with FI (6) Examine anorectal function over a prolonged period with HRAM to evaluate the phenomenon of anal sampling (referred to in this thesis as transient anal sphincter relaxations [TASRs]) Methods The following methods were used: (1) A worldwide survey of current practices of anorectal manometry (2) A systemic review of the literature (3) Prospective studies (both standard and prolonged) of anal function in healthy volunteers and patients with FI Results The practice of anorectal manometry is markedly variable internationally with no two centres surveyed employing the same methods. Within the 62 centres surveyed, there were 16 combinations of ways in which squeeze data were reported. A review of the literature demonstrated a growing evidence base for the use of HRAM however there is a paucity of data that confirm added benefits of HRAM over conventional manometry. A standardized protocol for HRAM was developed to allow the reporting of traditional measures of anorectal function. Novel measures derived from HRAM were developed which demonstrate increased sensitivity for the detection of impaired sphincteric control in patients with FI (sensitivity of traditional measure [conventional squeeze increment] 36% vs. 59% for the novel HRAM measure [5-second squeeze profile]). Transient anal sphincter relaxations (TASRs) were characterized using HRAM. In health, TASRs are often perceived by the individual as the urge to pass wind (39% of events) and their frequency increases following meal consumption. Conversely in FI, TASRs are a rare occurrence and are generally not perceived (only one patient (1/10 [10%]) with FI reported GI sensations associated with TASR events). Conclusions Anorectal manometry is in need of standardization. Novel measures derived from HRAM may improve diagnostic utility and further exploration of TASR characteristics might give insight into the pathophysiology of FI.

More than 80 per cent of wastewater from human activities is discharged into the rivers or sea without any pollution removal, and the Sustainable Development Goals (SDGs) aim to halve this proportion and increase recycling and reuse globally by 2030. Treatment plants in Sub-Saharan Africa often fail due to lack of operating funds, poor regulation and poor design that does not take into account human factors. The failure of treatment plants can also be put down partly to the funding structures for management, which are often dependent on the disposal tariffs charged. Without sufficient regulation and enforcement, which is often lacking in Sub-Saharan Africa, this often leads to illegal disposal of faecal sludge. Due to the nutrient content and energy potential of wastewater, there is increasing focus on reuse of faecal sludge in ways that can contribute funds for maintenance and incentivise good management of treatment facilities. This research investigates potential designs for the re-use of faecal sludge in small cities in Sub-Saharan Africa to ensure proper treatment. Conducting two case studies using qualitative and quantitative methods, the research looks at the potential for re-use to be scaled up in Sunyani, Ghana and Mzuzu, Malawi, and whether different designs can ensure good management. Building upon the research investigation into how previous designs have failed in case studies, the research also investigates the use of agent-based modelling (ABM) as a modelling approach to explore social and technical aspects of sanitation systems to predict how different designs and management approaches can work. In Sunyani, biogas was the most acceptable option to customers whilst also providing a good business model to fund faecal sludge treatment, either as a decentralised system at public toilets where the fresh sludge is better for biogas production, or centrally at the existing disposal site. The success of biogas as a model that can fund maintenance and ensure good management would depend on the faecal sludge quality of public toilet sludge in the city and the investment level required and how any operating approach would work between the government and private sector. In Mzuzu, two main approaches to faecal sludge re-use exist currently: the implementation of Skyloos as above ground household toilets which provide compost, and a central disposal site from which compost is illegally harvested. At disposal, farmers remove sludge from the ponds and apply it untreated directly onto agricultural land. At times, private sector emptying services do not use the ponds, but also apply untreated sludge to agricultural land. Skyloos were found to have varying levels of success from different Non- Governmental Organisation (NGO) projects, with key sustainability issues being the availability of financing mechanisms, management between landlords and tenants and the trust of and engagement with implementing organisations. Existing approaches to waste management and re-use were found to be inaccessible and not working when implemented for the poorest and people with disabilities. Adopting re-use of faecal sludge in agriculture in Malawi would require improved marketing of sanitation options, financing options for households to incentivize adopting the technology, not targeting to poorest households and people with disabilities, and an improved management model for the treatment site to ensure safe disposal and production of compost. Looking at ABM as a way of modelling faecal sludge treatment systems in Sub- Saharan Africa, two models of different approaches in Mzuzu were developed to look at scaling up Skyloo toilets and managing the treatment plant. Both models demonstrate the potential of ABM to incorporate social and technical aspects into predicting the performance of different designs and approaches. The success and use of modelling depends on the quality of data that can be collected before implementing system approaches. Overall the thesis presents different models of treatment and re-use that can work and contribute to operating and maintenance of systems. It is unlikely that any design system will be so profitable that the treatment and re-use of sludge will be able to ensure good management without regulation, so the success of designs depends on relationships between the government and private sector and households in small cities.

The principal aims of this thesis were to examine whether there were hydraulic links between individual on-site wastewater systems in sandy soils at Salt Ash and the Tilgerry Creek estuary near Port Stephens, New South Wales, and whether the chemical and microbiological contaminants from on-site systems could reach surface and groundwaters, and possibly lead to impacts on estuarine oyster growing waters. The research outcomes are contained within the thesis and in four refereed papers presented at conferences, and which have been subsequently published, or are in press. Copies of each of these papers are contained within the thesis Appendices. The presence of faecal contamination from domestic systems in the estuary, and surface drains in particular, has been confirmed by work contained in this thesis. The potential level of risk to human health from the consumption of contaminated oysters is, however, regarded as very low, although an assessment of health risk using established microbial assessment models has not been undertaken / Doctor of Philosophy (PhD)

Pollution from human and animal faecal waste is a major cause of deteriorating water quality and increased nutrient loads in coastal and inland waterways. Management of this problem depends on knowing which sources of faecal matter are the cause and what is the degree and extent of the pollution. Bacterial indicator organisms have long been the principal method used to test water samples for faecal contamination. However, none of the currently used bacterial indicators on their own are source specific enough to distinguish different sources of faecal matter. The use of faecal sterol biomarkers in conjunction with existing bacterial indicators offers a new way to distinguish sources of faecal contamination. This study investigates the sources of faecal sterols, the relationship of coprostanol to existing bacterial indicators of faecal pollution, the degradation of faecal sterols and the problem of determining the sources of faecal contamination and the distribution of faecal contamination using faecal sterol biomarkers. 5p-Stanols (i.e. faecal sterols) were found to be significant constituents of human, herbivore (i.e. cows, sheep etc.) and pig and cat faeces. Human faeces contained 73 ± 4% coprostanol in relation to the sum of coprostanol and 24-ethylcoprostanol and primary treated effluent contained 86 ± 0.4% coprostanol. Herbivore faeces contained 38 ± 4% coprostanol and 62 ± 4% 24-ethylcoprostanol whereas pig faeces contained 50 � 5% of each compound. Both birds and dogs faeces contained either trace amounts of 5B-stanols or they could not be detected. Notable differences were observed in the abundance of Closthdium perfringens spores between the faeces of birds and domestic pets such as cats and dogs. The above differences were subsequently exploited to distinguish faecal contamination in Lake Tuggerah. An examination of the relationships between coprostanol and bacterial indicator concentrations from several environments revealed that 60 and 400 ng L of coprostanol corresponded to currently defined primary and secondary contact limits for bacteria measured as either thermotolerant coliforms or enterococci in the environment. Four degradation experiments showed faecal sterols and related sterols such as cholesterol decay at similar rates. An induction period was observed in all experiments which meant that simple exponential equations to describe the rate of decay of coprostanol were inadequate; a complimentary log - log transformation of the data was used and the equation: Y = l-Exp(-Exp(time x -0.01 + temp x -0.158 + 3.33)) x 100 was derived where Y equals the predicted percentage of coprostanol remaining over time at a given temperature. In terms of persistence in the environment, Clostridium perfringens spores > coprostanol > enterococci > thermotolerant coliforms. Two field studies were undertaken to highlight the use of faecal sterols. In the Lake Tuggerah study, the results indicated that faecal contamination of receiving waters in the Tuggerah Lakes during rain events was significant, but was not derived from human faecal matter; rather it appears to be principally derived from native birds and, to a lesser extent, domestic pets. In the Derwent Estuary study, based on the distribution of the faecal biomarker coprostanol, the mid estuary and parts of the upper estuary (from Newtown Bay to Taroona), were found to be severely contaminated by sewage. In summary, the use of faecal sterols to trace faecal contamination were found to be an invaluable addition to the tools water managers use to investigate faecal pollution.

Metabolic syndrome is a disease affecting 25% of North America’s population causing strain on the medical systems. With diet and exercise, genetics, environment, and the gut microbiota all being targeted as potential causes of the disease, there is a lack of consensus on the exact aetiology and pathophysiology. With improved methods in bioinformatic sequencing of faecal bacterial DNA in recent years, our research indicates that a dysbiosis in the gut microbiome is both necessary and sufficient in causing immunological changes in the host in order for the development of metabolic syndrome, T1Ds, and T2Ds. Specifically, our data indicates these shifts in microbiota occur prior to the onset of disease, and produce the disease regardless of diet and genetics. The findings in the current study indicate that future research towards manipulating the gut microbiota to prevent disease, as well as using the faecal bacteria as a screening tool should be pursued.

No description available.

Title: The importance of myofeedback rehabilitation in faecal incontinence Introduction: Faecal incontinence is a serious symptom significantly worsening quality of life. Following results of international studies myofeedback has been considered an effective option of conservative treatment of this disease. Despite that it has so far been used at just a few centres in the Czech Republic. Purpose: The main purpose of this thesis was to assess the relevance of myofeedback as part of recovery therapy. Other objectives included assessment of use of a vaginal electrode instead of an anal one and comparison of the result correlations between examination by anal manometry, surface EMG and subjective improvement of continence for the patients. Methods: The research project included 8 females. The objective method of assessment of effects of the treatment involved examination of pelvis bottom muscles with the help of anorectal manometry and surface EMG. Success of the therapy was evaluated through the St Marks incontinence score and by the test population themselves filling out a quality of life questionnaire. Results: In the course of three-month recovery most patients experienced improvement of subjective as well as objective parameters. The results of the study are comparable to results of international...

A avaliação dos níveis de estresse nos animais tem importância tanto na área médica, econômica e de bem-estar, assim estudos vem sendo cada vez mais difundidos neste quesito. Os gatos são animais de companhia que tem progressivamente conquistado espaço no mundo moderno, dessa forma vem sendo mais observados e estudados, demonstrando-se bem mais sociais do que anteriormente se acreditava. Zelar pela qualidade de vida dos mesmos é dever do veterinário, e não somente pela questão médica em si mas também pelo bem-estar, já que se sabe, por exemplo, que condições estressantes podem levar a alterações orgânicas deletérias. A mensuração do cortisol, ou de seus metabólitos, tem sido utilizada para avaliar de forma fisiológica o bem-estar dos animais, tanto domésticos quanto selvagens. As técnicas para tal mensuração também vem sendo aperfeiçoadas, buscando-se assim ensaios mais precisos, seguros e baratos. No presente trabalho pretendemos comparar quantitativamente e qualitativamente dois imunoensaios radioimétrico (radioimunoensaio) e enzimático (enzimaimunoensaio) - utilizando amostras fecais de gatos domiciliados que vivem sozinhos ou em pequenas colônias. Sua importância deve-se ao uso de uma nova técnica, mais barata e segura, porém ainda pouco difundida no nosso país. / Evaluation of stress levels among animals has both medical and welfare importance and studies regarding this matter have been increasingly published. Cats are companion animals achieving a special position within modern societies they have been carefully observed and studied thus demonstrating that they are much more social than previously thought. Taking care of cats´ life quality is a veterinarian duty not only because it constitutes a medical issue per se but also due to its welfare implications: it is well known, for instance, that stressful conditions can lead to deleterious organic diseases. Measurement of cortisol levels (or its metabolites) has been used as a physiological parameter for investigating the welfare of both domestic and wild animals. Laboratory techniques used for such measurements have been under improvement in order to achieve more precise, safe and cheap assays. In the present study we aim at comparing quantitatively two assays radioimmunoassay and enzyme immunoassay by using domestic cats faecal samples (single and in-group housed cats). The relevance of this study lays on the use of a pioneering technique, cheap and safe, besides the establishment of a scientific cooperation with a leading university´s laboratory one of the few existing which deals with faecal hormonal dosages.

Long-term dynamics of lake-water total organic carbon (LW-TOC) concentrations in freshwater lakes provide an important perspective on the recent increases in LW-TOC observed in many of these systems and may assist with the identification of natural and anthropogenic drivers of change. This study examines how LW-TOC in Dragsjön, a lake situated in an area with a long history of anthropogenic land use, has changed in response to natural and anthropogenic perturbations throughout the Holocene. To provide a better understanding of the processes involved, a multi-proxy study was conducted and included multi-element geochemistry (17 major and trace elements), biogenic silica, organic matter (OM) content and composition, and the faecal biomarker “coprostanol”. The direct biomarker for anthropogenic presence, “coprostanol”, and a detailed characterisation of OM composition are for the first time applied for tracing changes in LW-TOC. Natural processes contributed to stable LW-TOC concentrations in Dragsjön for most part of the Holocene. Humans were present in the catchment from AD 100 as indicated by coprostanol, but did not begin to affect LW-TOC until c. AD 1500. In the last 500 years LW-TOC steadily declined from 17 to 10 mg L-1 in response to anthropogenic alterations to the terrestrial biomass balance. The increase in LW-TOC during the last 70 years likely represents a recovery from anthropogenic disturbance rather than a baseline shift in response to any of the number of proposed recent stressors. The faecal biomarker coprostanol and OM composition provided information essential for identifying and characterising the effects of anthropogenic disturbance.

With the current rate of loss of biological diversity worldwide estimated at 100- 1000x the natural background rate, solutions are urgently needed to avoid a catastrophic and irreversible loss of species. Conservation breeding is a tool now widely used to assist in maintaining populations in a safe environment until such time as they can be released back into their natural habitat. The babirusa (Babyrousa celebensis) is a threatened species for which conservation breeding is an integral part of its conservation management. Native to a few Indonesian islands, the babirusa is under threat from habitat destruction and hunting and is estimated to have a wild population of only a few thousand. Conservation breeding was established in 1972 with the translocation of animals from Sulawesi to the Surabaya Zoo in Java, Indonesia. It is thought that 1.2 animals founded what is now a worldwide ex-situ population of around 200 individuals. With concerns mounting regarding likely levels of inbreeding and reduced reproductive success, particularly within the European population, this thesis aimed to utilise a number of techniques to assist the conservation breeding programme. Extensive studbook analysis was used to assess typical reproductive parameters for the babirusa in a captive setting; genetic analysis using microsatellite and mitochondrial DNA markers was used to clarify some aspects of the studbook and to estimate the level of variation within and between populations in different geographical areas; and faecal steroid analysis has been used to shed light on the physiological processes underpinning female reproduction. The combined output from these studies has added to our knowledge of this species and its performance in an ex-situ setting, and has now been used to inform future management of the conservation breeding programme.