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The growing geographic disconnect between consumption of goods, the extraction and processing of resources, and the environmental impacts associated with production activities makes it crucial to factor global trade into sustainability assessments. Using an empirically validated environmentally extended global trade model, we examine the relationship between two key resources underpinning economies and human well-being—energy and freshwater. A comparison of three energy sectors (petroleum, gas, and electricity) reveals that freshwater consumption associated with gas and electricity production is largely confined within the territorial boundaries where demand originates. This finding contrasts with petroleum, which exhibits a varying ratio of territorial to international freshwater consumption, depending on the origin of demand. For example, although the United States and China have similar demand associated with the petroleum sector, international freshwater consumption is three times higher for the former than the latter. Based on mapping patterns of freshwater consumption associated with energy sectors at subnational scales, our analysis also reveals concordance between pressure on freshwater resources associated with energy production and freshwater scarcity in a number of river basins globally. These energy-driven pressures on freshwater resources in areas distant from the origin of energy demand complicate the design of policy to ensure security of fresh water and energy supply. Although much of the debate around energy is focused on greenhouse gas emissions, our findings highlight the need to consider the full range of consequences of energy production when designing policy.

Septic tank systems (STSs) are widely utilised flowsheets for decentralised wastewater treatment in the UK. With a growing consensus that STSs have a sizeable detrimental impact on the environment, there is a need for rural flowsheets with improved treatment capabilities. This study examines the lifetime cost and carbon emissions of using an enhanced septic tank nature-based solution (EST-NBS) to improve STS compared to a package treatment system (submerged aerated filter (SAF)). The wholelife cost (WLC) of the flowsheets and Scope 2 cradle-to-grave lifetime carbon emissions (LCEs) of the flowsheets were assessed. The EST-NBS flowsheets represent a lower cost improved treatment system than SAFs at population equivalents (PEs) from 5 to 1,000. An STS averages an LCE of over 4,000 kg CO2eq PE−1, with all other considered flowsheets having lower emissions. The EST-NBS flowsheets had lower carbon emissions than SAFs. Even at low populations upgrading from an STS to an EST-NBS is a competitive abatement strategy, with costs of £260 tCO2eq−1 emissions avoided, at 1,000 PE an NBS flowsheet has an abatement cost of –£17 tCO2eq−1. This shows the potential of using NBS flowsheets in rural wastewater treatment providing both a carbon and cost incentive against traditional designs.

Introduction: Congenital anomalies of the kidney and urinary tract (CAKUT) represent a wide range of disorders that result from developmental abnormalities of the kidneys, urinary collecting tract, and lower urinary tract. There has been extensive development in approaches to the management of stones in normal kidneys with the advent of retrograde intra-renal surgeries (RIRS)/ureteroscopies, extracorporeal shock wave lithotripsy (ESWL) percutaneous nephrolithotomy (PCNL), and minimally invasive surgery (laparoscopy/robotics). However, the management of stones in CAKUT is not straightforward and is often challenging for urologists. There are no clear guidelines available to help navigate stone management in such patients. Materials and methods: The aim of this literature review was to focus on stone management in anomalous kidneys. Most common abnormalities were considered. The studies were very heterogeneous with different approaches. The methodology involved evaluating studies looking into individual surgical approaches to the management of stones in these anomalous kidneys as well as looking at different approaches to stone management, in particular renal abnormality. Results: We found RIRS is a feasible approach in most stones with sizes <20 mm and PCNL holds the upper hand in stones more than 20 mm. However, ESWL, laparoscopy, and robotics have their places in managing some of these cases. Conclusion: We concluded that stones in anomalous kidneys can be challenging but can be managed safely. There is no straightforward answer to the right technique but rather the right planning based on the anatomy of the kidney in terms of vascularity and drainage, stone size and density, and expertise available.

The sensing of gravity has emerged as a tool in geophysics applications such as engineering and climate research 1 – 3 , including the monitoring of temporal variations in aquifers 4 and geodesy 5 . However, it is impractical to use gravity cartography to resolve metre-scale underground features because of the long measurement times needed for the removal of vibrational noise 6 . Here we overcome this limitation by realizing a practical quantum gravity gradient sensor. Our design suppresses the effects of micro-seismic and laser noise, thermal and magnetic field variations, and instrument tilt. The instrument achieves a statistical uncertainty of 20 E (1 E = 10 −9  s −2 ) and is used to perform a 0.5-metre-spatial-resolution survey across an 8.5-metre-long line, detecting a 2-metre tunnel with a signal-to-noise ratio of 8. Using a Bayesian inference method, we determine the centre to ±0.19 metres horizontally and the centre depth as (1.89 −0.59/+2.3) metres. The removal of vibrational noise enables improvements in instrument performance to directly translate into reduced measurement time in mapping. The sensor parameters are compatible with applications in mapping aquifers and evaluating impacts on the water table 7 , archaeology 8 – 11 , determination of soil properties 12 and water content 13 , and reducing the risk of unforeseen ground conditions in the construction of critical energy, transport and utilities infrastructure 14 , providing a new window into the underground. A study reports a quantum gravity gradient sensor with a design that eliminates the need for long measurement times, and demonstrates the detection of an underground tunnel in an urban environment.

Septic tank systems (STSs) are widely utilised flowsheets for decentralised wastewater treatment in the UK. With a growing consensus that STSs have a sizeable detrimental impact on the environment, there is a need for rural flowsheets with improved treatment capabilities. This study examines the lifetime cost and carbon emissions of using an enhanced septic tank nature-based solution (EST-NBS) to improve STS compared to a package treatment system (submerged aerated filter (SAF)). The wholelife cost (WLC) of the flowsheets and Scope 2 cradle-to-grave lifetime carbon emissions (LCEs) of the flowsheets were assessed. The EST-NBS flowsheets represent a lower cost improved treatment system than SAFs at population equivalents (PEs) from 5 to 1,000. An STS averages an LCE of over 4,000 kg CO2eq PE−1, with all other considered flowsheets having lower emissions. The EST-NBS flowsheets had lower carbon emissions than SAFs. Even at low populations upgrading from an STS to an EST-NBS is a competitive abatement strategy, with costs of £260 tCO2eq−1 emissions avoided, at 1,000 PE an NBS flowsheet has an abatement cost of –£17 tCO2eq−1. This shows the potential of using NBS flowsheets in rural wastewater treatment providing both a carbon and cost incentive against traditional designs.

Background and objectives Erectile dysfunction (ED) is a multifactorial disease associated with many medical co-morbidities and risk factors commonly encountered in primary care. Initial management includes lifestyle changes and the treatment of any identifiable conditions. Guidelines exist recommending the assessment and management of sufferers with clear indications for referral to secondary care. With the outbreak of COVID-19, non-urgent medical services, including ED, were suspended, creating a significant waiting list for these patients. The aim of this study was to review the management of men in both primary and secondary care who had been referred to a dedicated ED service.  Materials and methods A retrospective review of men referred to secondary care between June 2018 and April 2021 with ED was undertaken, reviewing whether the guidelines published by the National Institute for Health and Care Excellence (NICE) and GP Notebook for the assessment, initial treatment, and referral were followed by the primary care clinician. A secondary aim was to record the outcome of those men after review in a secondary care dedicated ED clinic. Results One hundred and forty-eight men were reviewed in the ED clinic, with 55 men (37.2%) requiring an intervention that was appropriate to have been delivered in primary care. The majority of those (76.3%) were successfully managed with a phosphodiesterase inhibitor. Of those treated in secondary care, almost 60% required a second-line therapy, such as a vacuum device or the administration of alprostadil, with 14 men (15%) necessitating the surgical implantation of a penile prosthesis. Conclusion With a rise in both the prevalence and incidence of ED, primary care physicians have a pivotal role in the screening and initial assessment of patients with ED, with evidence suggesting that a significant proportion can be successfully managed in this setting.

Background As the specialty of Andrology expands it is important to establish the most important studies that have shaped, and continue to shape, current research and clinical practice. Bibliometric analysis involving a citation rank list is an established means by which to identify the published material within a given field that has greatest intellectual influence. This bibliometric analysis sought to identify the 100 most influential manuscripts in Andrology, as well as the key research themes that have shaped contemporary understanding and management of andrological conditions. Methods The Thompson Reuters Web of Science citation indexing database was interrogated using a number of search terms chosen to reflect the full spectrum of andrological practice. Results were ranked according to citation number and further analysed according to subject, first and senior author, journal, year of publication, institution and country of origin. Results The Web of Science search returned a total of 24,128 manuscripts. Citation number of the top 100 articles ranged from 2819 to 218 (median 320). The most cited manuscript (by Feldman et al., The Journal of Urology 1994; 2819 citations) reported the prevalence and risk factors for erectile dysfunction (ED) in the Massachusetts Male Ageing Study. The Journal of Urology published the highest number of manuscripts ( n  = 11), followed by the New England Journal of Medicine ( n  = 10). The most common theme represented within the top 100 manuscripts was erectile dysfunction ( n  = 46), followed jointly by hypogonadism and male factor infertility ( n  = 24 respectively). Conclusion Erectile dysfunction should be considered the most widely researched, published and cited field within andrological practice. This study provides a list of the most influential manuscripts in andrology and serves as a reference of what comprises a ‘highly citable’ paper for both researchers and clinicians.

Background Penile cancer is a rare malignancy usually requiring surgery to achieve oncological control of the primary tumour but often at the expense of functional length. The presenting stage of the primary is a crucial factor in determining the most appropriate surgical procedure. Accurate preoperative staging is essential, and current modalities include clinical and radiological assessment. Clinical staging can, however, be hampered by patient body habitus and unreliable for more advanced T4 tumours, whereas radiological staging allows for more detailed identification of tissue planes and tumour involvement. There is no clear consensus on the preferred imaging technique, although, in the current European Association of Urology penile cancer guidelines, MRI is recommended with the use of ultrasound when MRI is not available. It was recommended that having the penis in an erect state by the administration of intra-cavernosal prostaglandin gave a more detailed picture enabling a greater predictor of corporal involvement. Recent studies have, however, suggested that there may be no such advantage. Methodology A retrospective review was conducted of all patients who underwent surgery for penile cancer comparing the preoperative MRI stage with the final pathological stage between July 2009 and June 2023. In addition to the MRI, patients were given an intra-cavernosal injection of prostaglandin E1 to induce tumescence unless otherwise indicated. All imaging was reported by a single consultant uro-radiologist with surgery undertaken by a single surgeon and pathology reviewed through the supra-regional penile multidisciplinary team. Results A total of 136 penile cancer patients were included in the review. Within this cohort, 98 patients had an MRI without intra-cavernosal prostaglandin and the number who had Ta, T1, T2, T3 and T4 histopathological stages was 3, 31, 45, 18, and 1, respectively. The preoperative MRI stage had a low agreement with the final histological stage for early tumours, with sensitivities and specificity of 35% and 97% for T1 and 56% and 80% for T2, respectively. Sensitivity and specificity increased for cavernosal involvement at 83% and 95%, respectively. In addition, a further 38 patients had an MRI in conjunction with an injection of prostaglandin E1 which failed to show any diagnostic improvement in sensitivity or specificity in the preoperative MRI stage. Conclusions The use of MRI as a preoperative modality for staging penile cancer performs best for identifying tumour involvement of the cavernosal bodies. Performing the MRI with the penis erect with the use of an intra-cavernosal injection did not offer any additional benefit in accurately staging penile cancer.

Why has there been a surge in the application of this green technology? The key difference in using biocatalysis today compared with 10 years ago is that now all the supporting technologies that can make a difference in enzyme development, such as bioinformatics, enzyme evolution and high-throughput screening, allow for an efficient turnaround in process development and enzyme evolution.