Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT.

Background: The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective: The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design: This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting: The trial was set in 17 NHS secondary care hospitals in the UK. Participants: A total of 378 eligible participants aged > 18 years were recruited. Interventions: Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures: The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results: At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations: COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions: Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration: This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.

Septoplasty is an operation to straighten the septum, which is the partition wall between the nostrils inside the nose. Septoplasty can be used as a treatment for people who have a bent septum and symptoms of a blocked nose, such as difficulty sleeping and exercising. Medical management (a saltwater spray to clear the nose followed by a nose steroid spray) is an alternative treatment to septoplasty. The Nasal AIRway Obstruction Study (NAIROS) aimed to find out whether septoplasty or medical management is a better treatment for people with a bent septum and symptoms of a blocked nose. We recruited 378 patients with at least moderately severe nose symptoms from 17 hospitals in England, Scotland and Wales to take part in the NAIROS. Participants were randomly put into one of two groups: septoplasty or medical management. Participants' nose symptoms were measured both when they joined the study and after 6 months, using a questionnaire called the Sino-nasal Outcome Test-22 items. This questionnaire was chosen because patients reported that it included symptoms that were important to them. Other studies have shown that a 9-point change in the Sino-nasal Outcome Test-22 items score is significant. After 6 months, on average, people in the septoplasty group improved by 25 points, whereas people in the medical management group improved by 5 points. We saw improvement after septoplasty among patients with moderate symptoms, and among those with severe symptoms. Most patients who we spoke to after a septoplasty were happy with their treatment, but some would have liked more information about what to expect after their nose surgery. In the short term, septoplasty is more costly than medical management. However, over the longer term, taking into account all the costs and benefits of treatment, suggests that septoplasty would be considered good value for money for the NHS.

Multiplexed experimental strategies for fragment library screening against challenging drug targets using SPR biosensors.

Surface plasmon resonance (SPR) biosensor methods are ideally suited for fragment-based lead discovery.  However, generally applicable experimental procedures and detailed protocols are lacking, especially for structurally or physico-chemically challenging targets or when tool compounds are not available. Success depends on accounting for the features of both the target and the chemical library, purposely designing screening experiments for identification and validation of hits with desired specificity and mode-of-action, and availability of orthogonal methods capable of confirming fragment hits. The range of targets and libraries amenable to an SPR biosensor-based approach for identifying hits is considerably expanded by adopting multiplexed strategies, using multiple complementary surfaces or experimental conditions. Here we illustrate principles and multiplexed approaches for using flow-based SPR biosensor systems for screening fragment libraries of different sizes (90 and 1056 compounds) against a selection of challenging targets. It shows strategies for the identification of fragments interacting with 1) large and structurally dynamic targets, represented by acetyl choline binding protein (AChBP), a Cys-loop receptor ligand gated ion channel homologue, 2) targets in multi protein complexes, represented by lysine demethylase 1 and a corepressor (LSD1/CoREST), 3) structurally variable or unstable targets, represented by farnesyl pyrophosphate synthase (FPPS), 4) targets containing intrinsically disordered regions, represented by protein tyrosine phosphatase 1B  (PTP1B), and 5) aggregation-prone proteins, represented by an engineered form of human tau  (tau K18M). Practical considerations and procedures accounting for the characteristics of the proteins and libraries, and that increase robustness, sensitivity, throughput and versatility are highlighted. The study shows that the challenges for addressing these types of targets is not identification of potentially useful fragments per se, but establishing methods for their validation and evolution into leads.

Response of streamflow and nutrient loads in a small temperate catchment subject to land use change.

The aim of this study was to quantify the effect of land use change (LUC) implemented to meet nutrient load targets for a freshwater lake in New Zealand. We used the Soil and Water Assessment Tool (SWAT) model in combination with a non-parametric statistical test to determine whether afforestation of 15% of a subcatchment area was adequate to meet assigned nutrient load targets. A regional management authority set nutrient load targets of reduction in total nitrogen (TN) by 0.9 t yr-1 and reduction in total phosphorus (TP) by 0.05 t yr-1 to avoid eutrophication in the receiving waters of a freshwater lake. The load reduction was designed to be achieved through 200 ha of LUC from pasture to trees. Analysis of nutrient loads before, during, and following LUC shows that a 15% increase in forest cover decreased the annual flow (7.2%), TP load (33.3%), and TN load (13.1%). As flow and water quality observations were discrete and at irregular intervals, we used a parametric test and the SWAT model as different lines of evidence to demonstrate the effect of afforestation on flow and water quality. Policymakers concerned with decisions about LUC to improve the quality of receiving waters can benefit from applying our findings and using a statistical and numerical modelling framework to evaluate the adequacy of land use change to support improvements in water quality.

Impacts of climate change on nutrient and sediment loads from a subtropical catchment.

Climate change is predicted to significantly alter hydrological cycles across the world, affecting runoff, streamflow, and pollutant loads from diffuse sources. The objectives of this study were to examine the impacts of climate change on streamflow, total nitrogen (TN), total phosphorus (TP), and total suspended sediment (TSS) loads in the subtropical Logan-Albert catchment, Queensland, Australia. We calibrated the Soil Water Assessment Tool (SWAT) against event monitoring data in the Logan and Albert rivers, respectively. Hydrological and water quality effects of an ensemble of 11 dynamically downscaled high-resolution climate models were assessed with SWAT under high (Representative Concentration Pathway 8.5 - RCP8.5) and intermediate (RCP4.5) emission scenarios. Streamflow decreased most in winter and spring and decreased least in summer. This followed the predicted seasonal changes for precipitation, although decreases tended to be amplified due to increasing evaporative loss. TSS, TN, and TP loads showed a similar pattern to streamflow, with the largest decreases predicted for the dry season under RCP8.5 by the 2080s. Annual TSS load decreased by 34.3 and 54.2%, TN load decreased by 29.8 and 30.5%, and TP load by 24.9 and 4.4% for the Logan and Albert sites, respectively. The results of this study indicate that for subtropical river-estuary systems, climate warming may lead to lower streamflow and contaminant loads, reduced flushing, and greater relative importance of point source loads in urbanising catchments.

Phosphorus storage and utilization strategies of two bloom-forming freshwater cyanobacteria.

The inter-relationships between cellular phosphorus (P) storage, dissolved inorganic P (DIP) uptake affinity, alkaline phosphatase activity (APA) and dissolved inorganic nitrogen (DIN) concentrations were studied in two ubiquitous diazotrophic freshwater cyanobacteria, Raphidiopsis raciborskii (six strains) and Chrysosporum ovalisporum (two strains). DIP uptake kinetics were measured using rates of incorporation of the radio-isotope, 33P and APA as a proxy for DOP-ester utilization. The study showed that DIP uptake of individual strains followed Michaelis-Menten kinetics (modified in our study to incorporate cellular P quotas), but differed with DIN and P availability, and between growth stages. High-affinity DIP uptake and APA were activated below a P quota threshold of approximately 0.01 µg P µg-1 C across the species and strains. C. ovalisporum had significantly higher APA and P quotas (per unit C and cell) but lower uptake affinity than R. raciborskii. Demand for DIP by C. ovalisporum increased when N fixation occurred, but typically not for R. raciborskii. Our results indicate that cyanobacterial species and strains differ in their strategies to P limiting conditions, and highlight the interplay between N and P. Physiological adaptations like APA and diazotrophy of cyanobacteria adapting to low DIP and/or DIN conditions may occur simultaneously and drive species dominance in oligotrophic environments.

A slurry approach to identify nutrient critical source areas from subtropical catchment erosion.

Targeting catchment nutrient critical source areas (CSAs) (areas contributing most of the nutrients in a catchment) is an efficient way to prioritize remediation sites for reducing nutrient runoff to waterways. We tested if the soil slurry approach - with particle sizes and sediment concentrations representative of those in streams during high rainfall events - can be used to identify potential CSAs within individual land use types, examine fire impacts, and identify the contribution of leaf litter in topsoil to nutrient export in subtropical catchments. We first confirmed the slurry approach met the prerequisite to identify CSAs with relatively higher nutrient contribution (not absolute load estimation) by comparing the slurry sampling with stream nutrient monitoring data. We validated that: 1) differences in slurry total nitrogen to phosphorus mass ratios from different land uses were consistent with stream monitoring data; and 2) our estimated nutrient export contribution from agricultural land, via the slurry approach, was comparable to that derived from monitoring data. Additionally, we found nutrient concentrations in slurries differed across soil types and management practice within individual land uses, correlating with nutrient concentrations in fine particles. These results indicate the slurry approach can be used to identify potential small-scale CSAs. Slurry results from burnt soils were also comparable to other studies showing increased levels of dissolved nutrient loss and higher nitrogen than phosphorus loss, than non-burnt soils. The slurry method also showed the contribution of leaf litter to slurry nutrient concentrations from topsoil was greater for dissolved nutrients than particulate nutrients, indicating different forms of nutrients need to be considered for impacts of vegetation. Our study reveals that the slurry method can be used to identify potential small-scale CSAs within the same land use from erosion and can account for impacts of vegetation and bushfires, providing timely information to guide catchment restoration actions.

Schindler's legacy: from eutrophic lakes to the phosphorus utilization strategies of cyanobacteria.

David Schindler and his colleagues pioneered studies in the 1970s on the role of phosphorus in stimulating cyanobacterial blooms in North American lakes. Our understanding of the nuances of phosphorus utilization by cyanobacteria has evolved since that time. We review the phosphorus utilization strategies used by cyanobacteria, such as use of organic forms, alternation between passive and active uptake, and luxury storage. While many aspects of physiological responses to phosphorus of cyanobacteria have been measured, our understanding of the critical processes that drive species diversity, adaptation and competition remains limited. We identify persistent critical knowledge gaps, particularly on the adaptation of cyanobacteria to low nutrient concentrations. We propose that traditional discipline-specific studies be adapted and expanded to encompass innovative new methodologies and take advantage of interdisciplinary opportunities among physiologists, molecular biologists, and modellers, to advance our understanding and prediction of toxic cyanobacteria, and ultimately to mitigate the occurrence of blooms.

Methylsulfonylmethane and Sesame Seed Oil Improve Dyslipidemia and Modulate Polyunsaturated Fatty Acid Metabolism in Two Mouse Models of Diabetes.

The objective of this study was to identify alterations in lipids and polyunsaturated fatty acid (PUFA) metabolism in both the streptozotocin (STZ)-induced type 1 diabetic (T1D) mouse and the mutant db/db type 2 diabetic (T2D) mouse to establish a biological signature for the evaluation of natural products with purported lipid-altering activity. Eight-week-old male C57BL/6J mice were randomized to nondiabetic group or STZ-induced diabetic groups (n = 10/group). STZ-induced diabetic mice and 6-week-old male db/db mice (n = 10/group) were randomized to the following groups: (1) diabetic control, no treatment, (2) methylsulfonylmethane (MSM) treatment, (3) sesame seed oil (SSO) treatment, and (4) MSM+SSO combination treatment. Clinical parameters measured included weights, blood glucose, serum lipid panels, and liquid chromatography-tandem mass spectrometry (LC-MS/MS) detection of free fatty acids in serum, liver, brain, and eyes. Blood glucose significantly decreased after 4 weeks of MSM treatment in T1D mice. Serum PUFA levels were significantly reduced in T2D mice compared with control mice. In contrast, treatment with SSO reversed this effect in T2D mice, exhibiting serum PUFA levels comparable to control mice. Serum triglycerides were significantly increased in both diabetic models compared to nondiabetic control, mimicking diabetes in people. High-density lipoprotein (HDL) was significantly increased in T1D receiving MSM+SSO and all T2D treatment groups. A corresponding significant decrease in non-HDL cholesterol was seen in T2D mice in all treatment groups. MSM+SSO treatment's effects on HDL and non-HDL cholesterol and PUFA metabolism could lead to improved clinical outcomes in diabetics by improving the lipid profile.

Herb-Drug Interactions: Worlds Intersect with the Patient at the Center.

This review examines three bodies of literature related to herb-drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb-drug combinations. Interacting herb-drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen's kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb-drug information is needed, including open and respectful discussion with patients.

A thematic analysis of influences on parents' autism intervention decisions.

BACKGROUND: Factors impacting parents' selection of interventions for their child on the autism spectrum need to be understood in order to better support decision-making. The aim of the current study was to explore parent-reported influences on decisions. METHOD: A sample of 14 Australian parents (13 mothers; 1 father) of a child (4-11 years) diagnosed on the autism spectrum were interviewed about their decisions regarding the use of interventions. A thematic analysis was used to identify prominent themes. FINDINGS: A total of three themes, comprising 11 subthemes were identified. The primary themes were: finding interventions; meeting child and family needs; and acceptability and access. CONCLUSION: Parents' responses highlighted influences on decisions to use evidence-based practices (e.g., behavioural therapies and social skills programs), as well as those with limited empirical support (e.g., animal-assisted therapy and dietary intervention). Influences frequently reported in extant research were reported by parents in this study (e.g., recommendations, logistics of access, and children's individual needs) as well as issues that warrant further investigation (e.g., coping with challenges and stress, importance of intervention intensity, and consideration of the whole family).

Trends in water quality in a subtropical Australian river-estuary system: Responses to damming, climate variability and wastewater discharges.

The Logan-Albert estuary in southeast Queensland, Australia, has high biodiversity and supports multiple economic and recreational services. Elevated nutrient and sediment loads have been a longstanding management issue for the estuary. We investigated the spatial and seasonal patterns of nutrients and turbidity along the Logan-Albert estuary and assessed the effects of a recently constructed upstream dam. Nutrient concentrations and turbidity levels were analysed using 15 years of monitoring data from 19 water quality sites throughout the estuary. We hypothesised that the construction of Wyaralong Dam would act as a nutrient and sediment sink which may have positive effects on downstream water quality. Long-term trends of water quality constituents were evaluated using a non-parametric seasonal Mann-Kendall test and the effect of upstream impoundment was assessed with a Before-After Control-Impact (BACI) test. Nutrient concentrations and turbidity levels declined significantly with time in the upper Logan estuary and, to a lesser extent, in the lower Albert estuary. The general improvement of water quality in the upper Logan estuary was attributed to construction of the Wyaralong Dam. Significant decreases in concentrations of total phosphorus (TP) and oxidised nitrogen (NOx-N) along the lower Albert were principally attributed to wetter conditions over the 15-year dataset, which diluted point-source loads from a nearby wastewater treatment plant (WWTP). Our results show that estuarine water quality changes can be highly dynamic with interactions amongst climate and management practices that necessitate long-term monitoring programs with good spatial coverage.

Intra-population strain variation in phosphorus storage strategies of the freshwater cyanobacterium Raphidiopsis raciborskii.

Several cyanobacteria, including diazotrophic Raphidiopsis raciborskii, can form harmful blooms when dissolved inorganic phosphorus concentrations are very low. We hypothesized that R. raciborskii strains would vary in phosphorus (P) allocations to cell growth and storage, providing resilience of populations to continuously low or variable P supplies. We tested this hypothesis using six toxic strains (producing cylindrospermopsins) isolated from a field population using batch monocultures with and without P and dissolved inorganic nitrogen (DIN). Treatments replete with DIN, irrespective of P addition, had similar exponential growth rates for individual strains. P storage capacity varied 4-fold among strains and was significantly higher in DIN-free treatments than in replete treatments. P was stored by all R. raciborskii strains, in preference to allocation to increase growth rates. P stores decreased with increased growth rate across strains, but weeere not related to the time to P starvation in P-free treatments. The storage capacity of R. raciborskii, combined with strategies to efficiently uptake P, means that P controls may not control R. raciborskii populations in the short term. Intra-population strain variation in P storage capacity will need to be reflected in process-based models to predict blooms of R. raciborskii and other cyanobacteria adapted to low-P conditions.

Molecular expression profiles of morphologically defined hippocampal neuron types: Empirical evidence and relational inferences.

Gene and protein expressions are key determinants of cellular function. Neurons are the building blocks of brain circuits, yet the relationship between their molecular identity and the spatial distribution of their dendritic inputs and axonal outputs remains incompletely understood. The open-source knowledge base Hippocampome.org amasses such transcriptomic data from the scientific literature for morphologically defined neuron types in the rodent hippocampal formation: dentate gyrus, CA3, CA2, CA1, subiculum, and entorhinal cortex. Positive, negative, or mixed expression reports were initially obtained from published articles directly connecting molecular evidence to neurons with known axonal and dendritic patterns across hippocampal layers. Here, we supplement this information by collating, formalizing, and leveraging relational expression inferences that link a gene or protein expression or lack thereof to that of another molecule or to an anatomical location. With these additional interpretations, we freely release online a comprehensive human- and machine-readable molecular profile for more than 100 neuron types in Hippocampome.org. Analysis of these data ascertains the ability to distinguish unequivocally most neuron types in each of the major subdivisions of the hippocampus based on currently known biochemical markers. Moreover, grouping neuron types by expression similarity reveals eight superfamilies characterized by a few defining molecules.

Variations in the Distribution of Chl-a and Simulation Using a Multiple Regression Model.

Chlorophyll a (Chl-a) is an important indicator of algal biomass in aquatic ecosystems. In this study, monthly monitoring data for Chl-a concentration were collected between 2005 and 2015 at four stations in Meiliang Bay, a eutrophic bay in Lake Taihu, China. The spatiotemporal distribution of Chl-a in the bay was investigated, and a statistical model to relate the Chl-a concentration to key driving variables was also developed. The monthly Chl-a concentration in Meiliang Bay changed from 2.6 to 330.0 µg/L, and the monthly mean Chl-a concentration over 11 years was found to be higher at sampling site 1, the northernmost site near Liangxihe River, than at the three other sampling sites. The annual mean Chl-a concentration fluctuated greatly over time and exhibited an upward trend at all sites except sampling site 3 in the middle of Meiliang Bay. The Chl-a concentration was positively correlated with total phosphorus (TP; r = 0.57, p < 0.01), dissolved organic matter (DOM; r = 0.73, p < 0.01), pH (r = 0.44, p < 0.01), and water temperature (WT; r = 0.37, p < 0.01), and negatively correlated with nitrate (NO3--N; r = -0.28, p < 0.01), dissolved oxygen (DO; r = -0.12, p < 0.01), and Secchi depth (ln(SD); r = -0.11, p < 0.05). A multiple linear regression model integrating the interactive effects of TP, DOM, WT, and pH on Chl-a concentrations was established (R = 0.80, F = 230.7, p < 0.01) and was found to adequately simulate the spatiotemporal dynamics of the Chl-a concentrations in other regions of Lake Taihu. This model provides lake managers with an alternative for the control of eutrophication and the suppression of aggregations of phytoplankton biomass at the water surface.

"Buckets": Early Observations on the Use of Red and Infrared Light Helmets in Parkinson's Disease Patients.

Background: Parkinson's disease is a well-known neurological disorder with distinct motor signs and non-motor symptoms. Objective: We report on six patients with Parkinson's disease that used in-house built photobiomodulation (PBM) helmets. Methods: We used "buckets" lined with light-emitting diodes (LEDs) of wavelengths across the red to near-infrared range (i.e., 670, 810, and 850 nm; n = 5) or an homemade intranasal LED device (660 nm; n = 1). Progress was assessed by the patients themselves, their spouse, or their attending medical practitioners. Results: We found that 55% of the initial signs and symptoms of the six patients showed overall improvement, whereas 43% stayed the same and only 2% got worse. We also found that PBM did not target a specific sign or symptom, with both motor and nonmotor ones being affected, depending on the patient. Conclusions: In summary, our early observations are the first to note the impact of PBM on patients' signs and symptoms over an extended period, up to 24 months, and lays the groundwork for further development to clinical trial.

Quantifying the Extent of Anthropogenic Eutrophication of Lakes at a National Scale in New Zealand.

Quantifying environmental changes relative to ecosystem reference conditions (baseline or natural states) can inform assessment of anthropogenic impacts and the development of restoration objectives and targets. We developed statistical models to predict current and reference concentrations of total nitrogen (TN) and total phosphorus (TP) in surface waters for a nationally representative sample of ≥1033 New Zealand lakes. The lake-specific nutrient concentrations reflected variation in factors including anthropogenic nutrient loads, hydrology, geology, elevation, climate, and lake and catchment morphology. Changes between reference and current concentrations were expressed to quantify the magnitude of anthropogenic eutrophication. Overall, there was a clear increase in lake trophic status, with the most common trophic status being oligotrophic under a reference state and mesotrophic under current conditions. The magnitude of departure from reference state varied considerably within the sample; however, on average, the mean TN concentration approximately doubled between reference and current states, whereas the mean TP concentration increased approximately 4-fold. This study quantified the extent of water quality degradation across lake types at a national scale, thereby informing ecological restoration objectives and the potential to reduce anthropogenic nutrient loads, while also providing a modeling framework that can be applied to lakes elsewhere.

Combating hypoxia/anoxia at sediment-water interfaces: A preliminary study of oxygen nanobubble modified clay materials.

Combating hypoxia/anoxia is an increasingly common need for restoring natural waters suffering from eutrophication. Oxygen nanobubble modified natural particles were investigated for mitigating hypoxia/anoxia at the sediment-water interface (SWI) in a simulated column experiment. By adding oxygen nanobubble modified zeolites (ONMZ) and local soils (ONMS), the oxygen nanobubble concentrations (105-107 particles/mL) were several orders of magnitude higher in the water than the original water solution (104 particles/mL) within 24 h. In the column experiment, an oxygen-locking surface sediment layer was formed after capping with ONMZ and ONMS particles. The synergy of diffusion of oxygen nanobubbles and retention of oxygen in this layer contributes to both the increase of DO and reversal of hypoxic conditions. The overlying water had significantly higher dissolved oxygen (DO) values (4-7.5 mg/L) over the experimental period of 127 days in ONMZ and ONMS compared with the control systems (around 1 mg/L). Moreover, the oxidation-reduction potential (ORP) was reversed from -200 mV to 180-210 mV and maintained positive values for 89 days in ONMZ systems. In the control systems, ORP was consistently negative and decreased from -200 mV to -350 mV. The total phosphorus (TP) flux from sediment to water across the SWI was negative in the ONMZ and ONMS treated systems, but positive in the control system, indicating the sediment could be switched from TP source to sink. The oxygen-locking capping layer was crucial in preventing oxygen consumption caused by the reduced substances released from the anoxic sediment. The study outlines a potentially promising technology for mitigating sediment anoxia and controlling nutrient release from sediments, which could contribute significantly to addressing eutrophication and ecological restoration.

Modelling interactive effects of multiple disturbances on a coastal lake ecosystem: Implications for management.

Coastal lakes, also known as temporarily open/closed estuaries or intermittently closed and open lakes and lagoons, are common worldwide, are typically sites of high biodiversity and often contain abundant macrophyte populations. Anthropogenic stressors such as increased nutrient and sediment loading have adverse effects on submerged macrophytes, and when closed, the lack of tidal flushing makes coastal lakes highly susceptible to eutrophication. Lake openings to the sea may occur naturally, but many coastal lakes are also opened artificially, often to reduce inundation of surrounding land. Here we used a coupled hydrodynamic-ecological model (DYRESM-CAEDYM), modified to include dynamic feedback between submerged macrophyte biomass and sediment resuspension, to explore the interactive effects of multiple disturbances (openings, eutrophication and climate change) on the dynamics of primary producers in a coastal lake (Waituna Lagoon) in South Island, New Zealand. Our results indicate that with exposure to high external nutrient loads, the frequent disturbances caused by artificial openings prevent sustained dominance by algae (algal biomass averaged 192 g C m-2 with artificial openings compared to 453 g C m-2 with no openings). However, under current nutrient loading, climate change is likely to enhance the effects of eutrophication on the system (algal biomass averaged 227 g C m-2 with climate change compared with 192 g C m-2 for current climate). The model provides a decision-support tool to guide lake management in setting limits for nutrient loads and managing the opening regime, in order to prevent eutrophication and the potential collapse of the macrophyte community.

Black medicine: an observational study of doctors' coffee purchasing patterns at work.

OBJECTIVE: To evaluate doctors' coffee consumption at work and differences between specialties. DESIGN: Single centre retrospective cohort study. SETTING: Large teaching hospital in Switzerland. PARTICIPANTS: 766 qualified doctors (425 men, 341 women) from all medical specialties (201 internal medicine, 76 general surgery, 67 anaesthetics, 54 radiology, 48 orthopaedics, 43 gynaecology, 36 neurology, 23 neurosurgery, 96 other specialties). DATA SOURCE: Staff purchasing history from staff canteens' electronic payment system linked to separate anonymised personal data from the human resource database. MAIN OUTCOME MEASURE: Numbers of coffees purchased per person per year. RESULTS: 84% (644) of doctors purchased coffee at one of the hospital canteens. 70 772 coffees were consumed by doctors in 2014. There was a significant association between specialty and yearly coffee purchasing (F=12.45; P<0.01). On average orthopaedic surgeons purchased the most coffee per person per year (mean 189, SD 136) followed by radiologists (177, SD 191) and general surgeons (167, SD 138). Anaesthetists purchased the least coffee (39, SD 48). Male doctors bought significantly more coffees per person per year (128 (SD 140) v 86 (SD 86), t=-4.66, P<0.01) and twice as many espressos as female doctors (mean 27 (SD 46) v 10 (SD 19), t=-6.54, P<0.01). Hierarchical position was associated with coffee purchasing (F=4.55; P=0.04). Senior consultants (>5 years' experience) bought most coffees per person per year (140, SD 169) and junior doctors and registrars bought fewest (95, SD 85). Propensity of buying rounds also increased with hierarchical position (χ(2)=556.24; P<0.01), with heads of departments buying more rounds than junior doctors (30% v 15%). CONCLUSIONS: Doctors commonly use coffee as a stimulant. Substantial variation exists between specialties. Surgeons drink notably more coffee than physicians, with orthopaedic surgeons consuming the greatest amount in the communal cafeteria setting, though this might reflect social tendencies rather than caffeine dependency. Hierarchical position is positively correlated with coffee consumption and generosity with regard to buying rounds of coffee.