The enhancement of floral biodiversity in small scale constructed wetland treatment systems

Within the U.K. small-scale treatment wetlands are primarily constructed using a monoculture of Phragmites australis. This thesis investigates the potential for enhancing the biodiversity value of these wetlands by the inclusion of appropriate floral species. Extensive literature reviews found that although there was a plethora of data for the design of constructed wetlands, there was a dearth of information on enhancing the biodiversity value of these wetlands. Three potential biodiversity enhancing species were identified which could be beneficial; purple loosestrife Lythrum salicaria, meadowsweet Filipendula ulmaria and water mint Mentha aquatica. A microcosm study was undertaken to investigate the growth of these species, the interactions between them and with Phragmites australis. The two pollutants employed in these studies were nitrogen and salinity. A second parallel system was constructed where competition between the plants was restricted by installing root dividers. The results of the microcosm study identified that selected species survived within all of the nutrient concentrations employed. The roots of the biodiversity enhancing species predominantly stayed within the upper humus layer of the wetland and so would not interfere with the subsurface flow of the wetland or the treatment potential of the Phragmites australis roots. The area coverage of the biodiversity enhancing species combined with the coverage and treatment potential of the Phragmites australis roots show that these species are suitable for growing within a small-scale constructed wetland at the tested nutrient concentrations. Fatalities were present within the salinity concentrations, therefore they can only be utilised at up to a limiting salinity concentration. A field study was subsequently undertaken at operational sites to investigate the addition of biodiversity enhancing species into mature and newly restored reedbeds with mixed results. Following the study, design principle recommendations are made for including biodiversity enhancing species within a small-scale treatment wetland systems within the U.K

Haematuria: from identification to treatment

Haematuria has a prevalence of 0.1% to 2.6%. Potential diagnoses may include infection, kidney stones, trauma, exercise or spurious causes, such as foods, drugs or menstruation, and a tumour. Approximately 20% of patients with haematuria have a urological tumour, with a further 20% found to have a significant underlying pathology. Haematuria is subsequently known as the ‘classic presentation’ of bladder cancer with 70-80% of patients experiencing painless, gross (visible) haematuria. However, in all cases of visible haematuria, a tumour should be suspected until proven otherwise. A patient with visible haematuria requires urgent, stringent investigation, warranting specialist assessment and subsequent selective referral through a series of patient-centred investigations at a haematuria clinic. One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions. Yet despite morbidity and mortality from bladder cancer increasing, the haematuria service has remained largely unchanged for several decades. This paper will discuss the tests and investigations that need to be undertaken in an individual with either visible or non-visible haematuria, and outline the care that is needed to support patients through the investigation process, with special focus on bladder tumour

Erectile dysfunction and its detection in the health care setting: 10 years on

Erectile dysfunction is considered an early indicator of cardiovascular disease. Jackson highlighted the important role that General Practitioners and other health care professionals have in detecting erectile dysfunction and potentially preventing subsequent cardiovascular events.(1) Results from our audit suggest that erectile dysfunction detection remains poor

‘A loose nerve’: Culture(s), Time and Governmentality in the biomedical treatment of Premature Ejaculation in Bangladeshi Muslim men

Introduction: premature ejaculation (PE) is a common sexual dysfunction. Current explanations of PE are homogenised and culture-free. These explanations do not resonate with the local Bangladeshi Muslim male population, who over-represent attendees in the local clinic. Research question: What are the factors that form Bangladeshi Muslim men’s knowledge(s) of premature ejaculation? Design: this is a first level exploratory research project using thematic analysis of semi-structured responses gained during a randomised trial comparing two biomedical interventions followed by a modified behavioural therapy. Foucault’s concept of governmentality was the theoretical foundation of the research. Results: three themes were dominant in explaining PE both in the participant narratives and the published literature. These themes were biomedical, psychological and cultural. Medicine, through disciplinary practices, positions patients in certain spaces through the use of surveillance and panopticism. Participants in the trial both occupied and rebelled against this positioning, creating tensions and contradictions between meanings of PE and clinical practice that are in marked contrast to the recommendations of biomedical literature. Motivation for seeking treatment was changes in ejaculatory recovery, and the main motivator was the man’s partner. There was little or no intimacy in Bangladeshi Muslim men that exacerbated PE. Conclusions: biomedical discourses seek to reduce sexual activity into a time-focussed goal rather than a mutually enjoyable activity. Participants in the research also reduced sexual activity to a time goal, but separated mind from body, possibly due to sexual inexperience and possibly due to cultural pressures. Sex education was minimal or absent, which explains pressures to perform, disengagement from behavioural therapy and demands for pharmacological therapies. This research has discovered new knowledge that leads to an increased understanding of PE in Bangladeshi Muslim men

Erectile dysfunction following retropubic prostatectomy

Prostate cancer is the most common cancer to affect men in the UK. Treatment options depend on the grade of tumour, the patient's co-existing diseases and choice of treatment. One potentially curative option is surgery, specifically a radical retropubic prostatectomy or variation thereof. As a consequence of the surgery, men commonly experience two side-effects: urinary incontinence and erectile dysfunction (ED). This paper outlines the clinical management of ED following surgery and aims to provide an overview of how to assess a man who has developed ED and discuss the various treatment options available, along with the efficacy in terms of recovery of erections

From impediment to innovation: Introducing a residential school within the Human Services Discipline

Recent external program accreditation identified the need for increased face-to-face student engagement within the Human Services core courses. A three-day residential school within the Human Services Case Management course was proposed and accepted. This poster describes how an integrated approach enabled the successful launch of a new residential school within an existing course

Joint keynote presentation – “Erectile dysfunction in Neurological Disorders”

The nature and severity of a man’s neurological condition may have a profound effect on erectile function and this warrants careful consideration in relation to providing supportive treatment options that are effective, safe and acceptable for the individual and his partner. Neurological disorders contribute to erectile dysfunction (ED) in a number of different ways and may occur as a direct result of impairment in the central nervous system, the peripheral nervous system, or a combination of both. Functional loss associated with the condition itself and subsequent damage to CNS structures (including spinal tracts, cerebral cortex, spinal cord or the autonomic nerves), may reduce the capacity to physically experience genital sensation, engage in physical intimacy and achieve erection, normally associated with sexual intercourse. In most neurological disorders, comorbid depression, altered body image, and the prescription of various medicines used to manage symptoms such as pain, spasticity, continence (amongst others) may nefariously contribute to patient’s psychological wellbeing, negatively impact on quality of life and affect relationships. Nurses are ideally placed to assess the relative impact of the neurological condition and the effects of various treatments on erectile function. Proactively addressing patients’ sexuality and making it a natural part of holistic nursing care allows for early detection of any problems that otherwise would go unidentified. Availability of guidelines & information about how to access various treatments for ED may be useful in all neurological care units, so that nurses and other health professionals are adequately equipped to provide appropriate information, reassurance and acceptable treatment interventions. Decisions regarding selection of specific treatments should take into account the preferences and expectations of patient and his partner. As first-line therapy and in the absence of contraindications to their use, conventional treatments such as the phosphodiesterase-5 inhibitors (PDE5Is) have been shown to significantly improve erectile function. Taking into account the patient’s mobility, dexterity and ability to self-administer, other treatments such as intracavernosal injections, medicated urethral system for erection (MUSE) and the use of vacuum constriction devices (VCDs) may be reserved for patients who do not have a response to PDE5Is, or in whom these drugs are poorly tolerated, or contraindicated. Psychosexual counselling may be helpful in cases of erectile dysfunction with psychological needs or relationship difficulties. This talk begins by focusing on the neurobiology of sexual arousal and the biological basis for erectile dysfunction in men with a variety of neurological disorders, including stroke, MS, Parkinson’s disease, Epilepsy, autonomic dysfunction and spinal cord injury (SCI). After considering the range of problems men typically experience with ED secondary to neurological impairment, we will discuss the relative benefits of various treatment options and current guidelines and good clinical practice for management of ED

Cardiovascular disease: The effect of erectile dysfunction on adherence to cardiovascular disease medication

Due to their similar aetiologies, cardiovascular disease (CVD) and erectile dysfunction (ED) are closely linked, with the prevalence of ED being approximately 75% for individuals at high risk of CVD. ED can have a detrimental effect on quality of life not only for the individual but also his sexual partner which in turn impacts upon their intimate relationship. Some CVD medications have been found to have a negative effect on erectile function and therefore act as an influential factor for the cessation of important CVD medication. Low adherence to CVD medication has been linked to increased health costs, hospitalizations and importantly, a higher risk of mortality. Research has shown that men find it difficult to seek medical help in relation to ED which is also compounded by the notion that health care providers do not address sexual issues adequately. Patients' beliefs about CVD medication are modifiable and therefore an opportunity exists not only for health care providers to facilitate discussions in relation to ED and medication adherence but also encompass an opportunity to increase adherence to CVD medication through intervention

Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice

Objectives: This study aimed to define contemporary perioperative management of patients undergoing penile implant surgery in the UK. Methods: All consultant urological surgeons responsible for the insertion of penile prostheses in the UK were invited to complete an online survey comprising of 25 questions relating to surgeon demographics, patient selection, preoperative work-up, intraoperative management and postoperative care. Anonymised responses underwent descriptive statistical analysis, with particular focus on measures employed to reduce the risk of perioperative infection. Results: Of the 34 invited surgeons, 26 (76.5%) responded to the survey. The majority reported undertaking between 10 and 30 cases in 2018 (n=17; 65.4%). A total of 23 (88.5%) respondents reported employing a threshold for diabetic control, although the exact limit varied between surgeons. Most respondents (n=22; 84.6%) reported routinely sampling urine for microscopy, culture and sensitivity. All but one (n=25; 96.2%) reported routinely performing cavernosal washouts, with the most common solution being a mixture of gentamicin and vancomycin (42.3%). All reported routinely giving intravenous antibiotics on induction of anaesthesia, and although there was no clear consensus, most surgeons preferentially used an aminoglycoside in combination with one other agent (including penicillins or teicoplanin). Conclusion: The variation in current perioperative management demonstrates a potential need for the development and introduction of evidence-based guidelines to standardise practice nationwide