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Anorectal manometry (ARM) is the traditional way to assess the physiology of the anus and rectum. However, the catheters used for this procedure can range in diameter from 2.6-10.8 mm and their presence in the anal canal might affect the measurements obtained. Anal Acoustic Reflectometry (AAR) overcomes this potential problem as it is considered a 'catheter-free' technique that uses an ultra-thin catheter of 0.36mm diameter. AAR simultaneously measures the cross-sectional area and pressure of the anal canal using technology that interprets reflected sound waves transmitted through the AAR catheter. AAR has the additional advantage that allows measurement of the pressure at which the anus starts to open called the Opening pressure (Op). More recently a commercially available technique, EndoflipTM has been launched for the measurement of anal canal physiology, but this is not a catheter-free technique. It was the purpose of this research to further evaluate anal function in a variety of situations as well as comparing the different measurement systems described above. After an introductory chapter and another describing methods and materials, Chapter 3 aimed to record, in normal subjects, AAR parameters using the fast-fill inflation technique. Resting AAR parameters significantly correlated with each other. Resting Op and Closing pressure (Cp) correlated with the resting ARM parameter Maximum Resting Pressure (MRP) and AAR Squeeze Op (SqOp) significantly correlated with ARM Maximum Squeeze Pressure (MSP). Chapter 4 investigated whether the degree of stretch caused by the size of catheter placed in the anal canal had any effect on AAR and/or ARM parameters. A study of 9 continent participants, demonstrated that placement of rigid tubes of 6mm and 10mm diameters increased Op by 19.7% and 37% respectively. A large increase in tension was also observed as the size of tube increased and therefore the size of tube used for the assessment of physiology should be taken into consideration when comparing results from different laboratories. Chapter 5 described a further study comparing the "catheter-less" (AAR) with the "catheter-based" (High resolution ARM, Endoflip™) system devices in 20 females with faecal incontinence (FI). The participants found all 3 modalities were of equal acceptability using visual analogue scales. This novel study also compared metrics from the 3 modalities and demonstrated that each technique had at least one parameter (resting or squeeze) that correlated with either symptom severity or, quality of life. This supports the need for further research on the utility of Endoflip™ and AAR. One further aim of this thesis was to investigate the contributions of both the internal anal sphincter (IAS) and the external anal sphincter (EAS) to Op. A study of 19 continent patients (Chapter 6) undergoing general anaesthetic (GA) and neuromuscular (NMB) blockade had AAR performed awake and then during GA+NMB with inclusion of assessment of the rectoanal inhibitory reflex (RAIR). The contribution of the IAS was therefore able to be calculated and was found to be 84.5% with the EAS contributing 15.5% to Op. FI is a common symptom in patients with rectal prolapse (RP). A study of 91 patients (Chapter 7) with RP (grade 1/2 n=34, grade 3/4 n=35, External RP (ERP) n=22) found a highly significant difference in Op (p < 0.001), reducing in a linear fashion, as the severity of prolapse increased. The ability of the anal sphincters to close after being opened, represented by Cp, was significantly lower the more severe the grade of prolapse. SqOp was significantly different between the 3 groups and MRP and MSP were also significantly different. Post-hoc analysis revealed that patients with a grade 3 RP (prolapse above the sphincters) had significantly higher resting and squeeze AAR parameters when compared to grade 4 RP (prolapse progresses through the anal sphincters) and ERP patients (prolapse is visible externally). Patients with grade 3 and grade 4 RP reported the same degree of symptoms and impact on quality of life, however surgery remains reserved for ERP and selected grade 4 RP patients. There was no significant difference in the RAIR values between the 3 groups of prolapse nor when the RAIR value was compared to the continent patients and the incontinent patients with no prolapse radiologically. A pilot study of 5 patients (4 with ERP and 1 with grade 4 RP) who had AAR/ARM performed before and after prolapse surgery reported that resting AAR and ARM parameters were unchanged at shortterm follow up (Chapter 8). However, squeeze function improved which may be the result of restoration of anatomy and the prolapse no longer protruding through the sphincter complex. The RAIR value was also unaffected by prolapse surgery and largely unchanged from the preoperative values (Chapter 9). A better understanding of the intricacies of anorectal physiology should lead to the better management of disorders of anorectal function.

Communication in preservation is key to elevate the momentum of preserving the built environment, historic communities, and cultural landscapes. Effective communication should expand diversity and inclusion of key demographics that have not been sufficiently reached via current or historic outreach methods. Intentional and direct strategies to message specific communities could make an impact on the future success of preservation. This thesis uncovers the trends of current communication practices at historic preservation nonprofits along the East Coast in an effort to evaluate factors that impact methods and evaluation. The purpose of this study is to understand the current methods deployed by nonprofits in their communication programs. The data analyzed includes methods of communication, focus areas, target audiences, resources, and measurement strategies. The goal is to understand if there are organizational implications based on budget, geography, membership, audience focus, and communication resources. A detailed survey of East Coast historic nonprofits provided baseline data to evaluate trends across a variety of factors. Selected follow-up interviews provided context to the survey responses. The results show that organizations with an annual operating budget of over $1 million and the presence of a formal communications role have an impact on an organization’s communication strategy. This research serves as benchmark data for organizations that are looking to institute a communication plan.