Childhood growth outcomes 2 years after hypertensive versus normotensive pregnancy: a P4 study.

BACKGROUND: Intrauterine exposure to hypertensive disorders of pregnancy, including gestational hypertension (GH) and preeclampsia (PE), may influence infant growth and have long-term health implications. This study aimed to compare growth outcomes of infants exposed to a normotensive pregnancy (NTP), GH, or PE from birth to 2 years. METHODS: Infants were children of women enroled in the prospective Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTP, GH or PE. Birth, 6-month (age-corrected) and 2-year (age-corrected) weight z-scores, change in weight z-scores, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-scores were calculated to assess infant growth (NTP = 240, GH = 19, PE = 66). RESULTS: Infants exposed to PE compared to NTP or GH had significantly lower birth weight and length z-scores, but there were no differences in growth outcomes at 6 months or 2 years. GH and PE-exposed infants had significantly greater weight z-score gain [95% CI] (PE = 0.93 [0.66-1.18], GH = 1.03 [0.37-1.68], NTP = 0.45 [0.31-0.58], p < 0.01) and rapid weight gain (GH = 63%, PE = 59%, NTP = 42%, p = 0.02) from birth to 2 years, which remained significant for PE-exposed infants after confounder adjustment. CONCLUSION: In this cohort, GH and PE were associated with accelerated infant weight gain that may increase future cardiometabolic disease risk. IMPACT: Preeclampsia exposed infants were smaller at birth, compared with normotensive pregnancy and gestational hypertension exposed infants, but caught up in growth by 2 years of age. Both preeclampsia and gestational hypertension exposed infants had significantly accelerated weight gain from birth to 2 years, which remained significant for preeclampsia exposed infants after adjustment for confounders including small for gestational age. Monitoring of growth patterns in infants born following exposure to a hypertensive disorder of pregnancy may be indicated to prevent accelerated weight gain trajectories and obesity.

Clinical and economic burden of chronic rhinosinusitis with nasal polyposis: A U.S. administrative claims analysis.

Background: Limited data exist on the clinical and economic burden of chronic rhinosinusitis with nasal polyposis (CRSwNP). Objective: To describe patient characteristics, health-care resource utilization (HCRU), and health-care costs among patients with CRSwNP with and without comorbid asthma (primary analysis) and with surgical management of nasal polyps (secondary analysis). Methods: This was a retrospective study of patients diagnosed with CRSwNP conducted using administrative claims data from January 1, 2013, through March 31, 2019. Study outcomes were assessed over a 2-year follow-up. Results were stratified by baseline asthma status (primary analysis) and presented separately for patients with surgically managed CRSwNP (secondary analysis). Results: The primary analysis included 10,999 patients with CRSwNP (2649 with asthma, 8350 without asthma). Patients with versus without asthma had higher medication use, HCRU, and all-cause medical costs (mean ± standard deviation $34,667 ± $42,234 versus $27,122 ± $45,573; p < 0.001) across the full follow-up period. CRSwNP-related medical costs were significantly higher for patients with versus without asthma in year 2 of follow-up. In the surgical management analysis (n = 4943), most categories of medication use and CRSwNP-related HCRU declined from baseline levels during follow-up, and CRSwNP-related pharmacy costs in year 2 were less than half of baseline levels. Conclusion: Patients diagnosed with CRSwNP and asthma had a greater burden of illness than those without asthma. Higher CRSwNP-related medical costs in year 2 of follow-up for patients with asthma may indicate worsening symptoms over time. Among patients with surgically managed CRSwNP, HCRU and costs increased in year 1 of follow-up but decreased below baseline levels in year 2, potentially reflecting improved symptom severity.

Quantifying the benefits of in-time and in-place responses to remediate acute LNAPL release incidents.

Acute large volume spills from storage tanks of petroleum hydrocarbons as light non aqueous phase liquids (LNAPLs) can contaminate soil and groundwater and may have the potential to pose explosive and other risks. In consideration of an acute LNAPL release scenario, we explore the value of a rapid remediation response, and the value of installing remediation infrastructure in close proximity to the spill location, in effecting greater recovery of LNAPL mass from the subsurface. For the first time, a verified three-dimensional multi-phase numerical framework and supercomputing resources was applied to explore the significance of in-time and in-place remediation actions. A sand aquifer, two release volumes and a low viscosity LNAPL were considered in key scenarios. The time of commencement of LNAPL remediation activities and the location of recovery wells were assessed requiring asymmetric computational considerations. The volume of LNAPL released considerably affected the depth of LNAPL penetration below the groundwater table, the radius of the plume over time and the recoverable LNAPL mass. The remediation efficiency was almost linearly correlated with the commencement time, but was a non-linear function of the distance of an extraction well from the spill release point. The ratio of the recovered LNAPL in a well located at the centre of the spill/release compared to a well located 5 m away was more than 3.5, for recovery starting only 7 days after the release. Early commencement of remediation with a recovery well located at the centre of the plume was estimated to recover 190 times more LNAPL mass than a one-month delayed commencement through a well 15 m away from the centre of the LNAPL plume. Optimally, nearly 40% of the initially released LNAPL could be recovered within two months of commencing LNAPL recovery actions.

Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis-associated chronic rhinosinusitis: A randomised pilot trial.

OBJECTIVES: Manuka honey attacks biofilms, which contribute to bacterial persistence in cystic fibrosis sinusitis. The primary objective was to determine feasibility of investigating manuka honey as an irrigation treatment for cystic fibrosis sinusitis and secondarily to assess the treatment's preliminary effectiveness. DESIGN: Prospective, single-blinded (clinician only), randomised, parallel two-arm pilot trial. SETTING: Tertiary rhinology clinic. PARTICIPANTS: Subjects had recalcitrant cystic fibrosis sinusitis and previous sinus surgery. They received manuka honey or saline sinus irrigations twice daily for 30 days. MAIN OUTCOME MEASURES: Main outcomes were recruitment/retention rates and tolerability. Preliminary effectiveness was assessed based on quality-of-life Sinonasal Outcome Test-22 and Lund-Kennedy endoscopic change scores and post-treatment culture negativity. RESULTS: Over 10 months, 13 subjects were enrolled, and 77% (10/13) were included in the analysis. Manuka honey irrigations were well-tolerated. The quality-of-life change score was clinically significant for manuka honey (-9 [-14,-6]) but not saline (-5 [-9,-1]), although the difference was not statistically significant (P = .29). Lund-Kennedy endoscopic change score was significantly better for manuka honey (-3 [-5,-3]) versus saline (0 [0,0]) (P = .006). There was no difference in post-treatment culture negativity between manuka honey (1/5, 20%) and saline (0/5, 0%) (P = 1.00). CONCLUSIONS: Manuka honey irrigations were well tolerated, and retention rates were high. Preliminary data showed that manuka honey achieved a clinically important difference in quality-of-life score and a significantly better endoscopic outcome. Microbiological control was difficult to achieve. A future definitive trial would require multi-institutional recruitment.

Tolerability and effectiveness of povidone-iodine or mupirocin versus saline sinus irrigations for chronic rhinosinusitis.

OBJECTIVES: The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. MATERIALS AND METHODS: This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). RESULTS: Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. CONCLUSIONS: In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.

Biodegradability of legacy crude oil contamination in Gulf War damaged groundwater wells in Northern Kuwait.

During the 1991 Gulf War, oil wells in the oil fields of Kuwait were set aflame and destroyed. This resulted in severe crude oil pollution of the countries only fresh water aquifers. Here, for the first time the natural attenuation and biodegradation of the persisting groundwater contamination was investigated to assess potential processes in the aquifer. Biodegradation experiments were conducted under aerobic and multiple anaerobic conditions using microcosms of the contaminated groundwater from Kuwait. Under the conditions tested, a portion of the total petroleum hydrocarbon (TPH) component was degraded, however there was only a slight change in the bulk concentration of the contaminant measured as dissolved organic carbon (DOC), suggesting the presence of a recalcitrant pollutant. Changes in the associated microbial community composition under different reduction-oxidation conditions were observed and known hydrocarbon degraders identified. The results of this study indicate that lingering contaminant still persists in the groundwater and is recalcitrant to further biodegradation, which presents challenges for future remediation plans.

Biodegradability of polar compounds formed from weathered diesel.

Once released into the environment, petroleum is exposed to biological and physical weathering processes which can lead to the formation and accumulation of highly recalcitrant polar compounds. These polar compounds are often challenging to analyse and can be present as an "unresolved complex mixture" (UCM) in total petroleum hydrocarbon (TPH) analyses and can be mistaken for natural organic matter. Existing research on UCMs comprised of polar compounds is limited, with a majority of the compounds remaining unidentified and their long-term persistence unknown. Here, we investigated the potential biodegradation of these recalcitrant polar compounds isolated from weathered diesel contaminant, and the changes in the microbial community composition associated with the biodegradation process. Microcosms were used to study the biodegradability of the polar compounds under various aerobic and anaerobic conditions and the results compared against the biodegradation of fresh diesel. Under all conditions tested, the majority of the polar UCM contaminant remained recalcitrant to biodegradation. The degradation was limited to the TPH portion of the polar UCM, which represented a minor fraction of the total polar UCM concentration. Changes in microbial community composition were observed under different redox conditions and in the presence of different contaminants. This work furthers the understanding of the biodegradation and long-term recalcitrance of polar compounds formed through weathering at contaminated legacy sites.

Outcomes of Endoscopic Dacryocystorhinostomy in Secondary Acquired Nasolacrimal Duct Obstruction: A Case-Control Study.

INTRODUCTION: Secondary acquired nasolacrimal duct obstruction (SANDO), where the obstruction is caused by a known process, is becoming more commonly treated by endoscopic dacryocystorhinostomy (endoDCR). This study evaluates outcomes of endoDCR for cases of SANDO in comparison to endoDCR outcomes treating primary acquired nasolacrimal duct obstruction (PANDO). METHODS: All patients undergoing endoDCR from 2006 to 2015 at a tertiary referral center were reviewed for etiology of nasolacrimal duct obstruction (NLDO) and success of procedure. Inclusion criteria were preoperative determination of NLDO via probing and irrigation, greater than 60-day follow up with assessment of duct patency via probing and irrigation after silicone tube removal, and postoperative survey for recurrent epiphora. Exclusion criteria were cases treating partial NLDO, patients undergoing concurrent conjunctivodacryocystorhinostomy, and patients lost to follow up or with incomplete records. Preanalysis stratification was performed for the following preexisting conditions: PANDO, granulomatosis with polyangiitis, sarcoidosis, midfacial radiotherapy, radioactive iodine therapy, severe prolonged sinusitis, prior failed DCR, and midface trauma. The primary outcome was postoperative anatomical patency of the nasolacrimal system with resolution of epiphora. Fisher-Freeman-Halton exact tests were performed comparing each SANDO group to the PANDO group with statistical significance set at p < 0.05. RESULTS: Fifty-nine cases of NLDO underwent endoDCR in this series, 21 of which had a diagnosis consistent with SANDO. All patients treated with the aggressive perioperative management protocol the authors describe achieved anatomical patency. Patients with history of radioactive iodine therapy and radiotherapy had statistically worse outcomes compared with patients with PANDO, p = 0.011, p = 0.045, respectively. Stratified groups with increased intranasal sinus inflammation trended toward worse outcomes, but were not statistically different. CONCLUSIONS: EndoDCR is a viable approach for the treatment of SANDO. In patients with history of radiotherapy or radioactive iodine therapy, however, endoDCR demonstrated decreased success rates as compared with patients with PANDO. Modifications of operative and postoperative management based on underlying etiology of NLDO may improve outcomes of endoDCR in SANDO cases. The authors describe an aggressive protocol for perioperative management of patients with pathologic nasal inflammation undergoing endoDCR.

Towards characterizing LNAPL remediation endpoints.

Remediating sites contaminated with light non-aqueous phase liquids (LNAPLs) is a demanding and often prolonged task. It is vital to determine when it is appropriate to cease engineered remedial efforts based on the long-term effectiveness of remediation technology options. For the first time, the long term effectiveness of a range of LNAPL remediation approaches including skimming and vacuum-enhanced skimming each with and without water table drawdown was simulated through a multi-phase and multi-component approach. LNAPL components of gasoline were simulated to show how component changes affect the LNAPL's multi-phase behaviour and to inform the risk profile of the LNAPL. The four remediation approaches along with five types of soils, two states of the LNAPL specific mass and finite and infinite LNAPL plumes resulted in 80 simulation scenarios. Effective conservative mass removal endpoints for all the simulations were determined. As a key driver of risk, the persistence and mass removal of benzene was investigated across the scenarios. The time to effectively achieve a technology endpoint varied from 2 to 6 years. The recovered LNAPL in the liquid phase varied from 5% to 53% of the initial mass. The recovered LNAPL mass as extracted vapour was also quantified. Additional mass loss through induced biodegradation was not determined. Across numerous field conditions and release incidents, graphical outcomes provide conservative (i.e. more prolonged or greater mass recovery potential) LNAPL remediation endpoints for use in discussing the halting or continuance of engineered remedial efforts.

LNAPL transmissivity as a remediation metric in complex sites under water table fluctuations.

Water table fluctuations affect the recoverability of light non-aqueous phase liquid (LNAPL) petroleum hydrocarbons. LNAPL transmissivity (Tn) is being applied as an improved metric for LNAPL recoverability. In this paper, the applicability of Tn as a lagging and leading metric in unconsolidated aquifers under variable water table conditions was investigated. Tn values obtained through baildown testing and recovery data-based methods (skimming) were compared in three areas of a heterogeneous gasoline contaminated site in Western Australia. High-resolution characterisation methods were applied to account for differences in the stratigraphic profile and LNAPL distribution. The results showed a range of Tn from 0 m2/day to 2.13 m2/day, exhibiting a strong spatial and temporal variability. Additionally, observations indicated that Tn reductions may be more affected by the potentiometric surface elevation (Zaw) than by the application of mass recovery technologies. These observations reflected limitations of Tn as a lagging metric and a Remedial Endpoint. On the other hand, the consistency and accuracy of Tn as a leading metric was affected by the subsurface conditions. For instance, the area with a larger vertical LNAPL distribution and higher LNAPL saturations found Tn to be less sensitive to changes in Zaw than the other two areas during the skimming trials. Tn values from baildown and skimming tests were generally in a close agreement (less than a factor of 2 difference), although higher discrepancies (by a factor up to 7.3) were found, probably linked to a preferential migration pathway and Zaw. Under stable Zaw, Tn was found to be a relatively reliable metric. However, variable water table conditions affected Tn and caution should be exercised in such scenarios. Consequently, remediation practitioners, researchers and regulators should account for the nexus between Tn, LNAPL distribution, geological setting and temporal effects for a more efficient and sustainable management of complex contaminated sites.

Endoscopic dacryocystorhinostomy following head and neck radiation therapy.

This article determines the efficacy of endoscopic dacryocystorhinostomy (endoDCR) in patients who have undergone adjuvant external beam radiation therapy (XRT) following head and neck cancer resection. A retrospective chart review was performed on all patients who underwent endoDCR between 2006 and 2014 at a tertiary referral center. Cases were reviewed and selected for the following inclusion criteria: history of adjuvant sinonasal XRT following head and neck cancer resection, preoperative probing and irrigation demonstrating nasolacrimal duct obstruction (NLDO), postoperative probing and irrigation following silicone tube extubation. Exclusion criteria included active dacryocystitis, postoperative follow-up of less than 4 months, presence of epiphora prior to XRT, lack of probing/irrigation at preoperative or postoperative visit, and lid malposition including ectropion, facial palsy, and/or poor tear pump. Six patients (7 eyes) met the selection criteria. EndoDCR was performed at a mean time of 30 months following last radiation treatment (range, 3-71 months). Mitomycin C was used in 4/7 cases. Silicone tube removal occurred between 3-8 months postoperatively. Five out of 6 patients had postoperative sinonasal debridement and nasal saline/corticosteroid irrigation. Five out of 6 patients (83%) had both resolution of epiphora and anatomic patency confirmed by probing and irrigation. Our experience suggests that endoDCR procedures can be effective in patients with NLDO following prior sinonasal XRT for head and neck neoplasms. Postoperative management with sinonasal debridement and combined saline/corticosteroid nasal irrigation may help to improve surgical success in patients with increased post-radiotherapy mucosal inflammation.

Templates for rejection can specify semantic properties of nontargets in natural scenes.

In contrast to standard search templates that specify a target object's expected features, templates for rejection (TFR) may specify features of nontargets, biasing attention away from irrelevant objects. Little is known about TFR, and virtually nothing is known about their role in guiding search across natural scenes. In such scenes, targets and nontargets may not be easily distinguished on the basis of their visual features; it has been claimed that standard search templates may therefore specify target objects' semantic features to guide attention. Here, we ask whether TFR can do so. Noting a limitation of previous procedures used to study standard search templates, we trialed an alternative method to examine semantic templates for nontarget exclusion in natural scene search. We found that when nontargets belonged unpredictably to either of two physically distinct categories, search was less efficient than when targets belonged to one known category. This two-category cost, attributed to inefficient application of search templates, was absent for two physically dissimilar but semantically related categories. Adding a training phase to highlight semantic distinctiveness of two object categories reinstated the two-category cost, precluding stimulus-based accounts of the effect. These patterns were not observed for one-image displays or when observers searched for object categories rather than ignoring them, demonstrating their specificity to TFR, the inadequacy of search-and-destroy models to account for them, and likely basis in attentional guidance. TFR can specify semantic information to guide attention away from nontargets.

Improving VBAC rates: the combined impact of two management strategies.

BACKGROUND: Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section (VBAC). AIMS: To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section. METHODS: Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean (NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period. RESULTS: Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period (P < 0.001). Of those women who desired and attempted a VBAC, the success rate was 64.4%. Regression analysis identified an increased likelihood of attempted vaginal birth where malpresentation was the indication for previous caesarean, while Eastern Asian ethnicity was associated with increased likelihood of choosing repeat caesarean. CONCLUSIONS: A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates.

Advective and diffusive gas phase transport in vadose zones: Importance for defining vapour risks and natural source zone depletion of petroleum hydrocarbons.

Quantifying the interlinked behaviour of the soil microbiome, fluid flow, multi-component transport and partitioning, and biodegradation is key to characterising vapour risks and natural source zone depletion (NSZD) of light non-aqueous phase liquid (LNAPL) petroleum hydrocarbons. Critical to vapour transport and NSZD is transport of gases through the vadose zone (oxygen from the atmosphere, volatile organic compounds (VOCs), methane and carbon dioxide from the zone of LNAPL biodegradation). Volatilisation of VOCs from LNAPL, aerobic biodegradation, methanogenesis and heat production all generate gas pressure changes that may lead to enhanced gas fluxes apart from diffusion. Despite the importance of the gaseous phase dynamics in the vadose zone processes, the relative pressure changes and consequent scales of advective (buoyancy and pressure driven) / diffusive transport is less studied. We use a validated multi-phase multi-component non-isothermal modelling framework to differentiate gas transport mechanisms. We simulate a multicomponent unweathered gasoline LNAPL with high VOC content to maximise the potential for pressure changes due to volatilisation and to enable the joint effects of methanogenesis and shallower aerobic biodegradation of vapours to be assessed, along with heat production. Considering a uniform fine sand profile with LNAPL resident in the water table capillary zone, results suggest that biodegradation plays the key role in gas phase formation and consequent pressure build-up. Results suggest that advection is the main transport mechanism over a thin zone inside the LNAPL/capillary region, where the effective gaseous diffusion is very low. In the bulk of the vadose zone above the LNAPL region, the pressure change is minimal, and gaseous diffusion is dominant. Even for high biodegradation rate cases, pressure build-up due to heat generation (inducing buoyancy effects) is smaller than the contribution of gas formation due to biodegradation. The findings are critical to support broader assumptions of diffusive transport being dominant in vapour transport and NSZD assessments.

The Dynamics of Per- and Polyfluoroalkyl Substances (PFAS) at Interfaces in Porous Media: A Computational Roadmap from Nanoscale Molecular Dynamics Simulation to Macroscale Modeling.

Managing and remediating perfluoroalkyl and polyfluoroalkyl substance (PFAS) contaminated sites remains challenging. The major reasons are the complexity of geological media, partly unknown dynamics of the PFAS in different phases and at fluid-fluid and fluid-solid interfaces, and the presence of cocontaminants such as nonaqueous phase liquids (NAPLs). Critical knowledge gaps exist in understanding the behavior and fate of PFAS in vadose and saturated zones and in other porous media such as concrete and asphalt. The complexity of PFAS-surface interactions warrants the use of advanced characterization and computational tools to understand and quantify nanoscale behavior of the molecules. This can then be upscaled to the microscale to develop a constitutive relationship, in particular to distinguish between surface and bulk diffusion. The dominance of surface diffusion compared to bulk diffusion results in the solutocapillary Marangoni effect, which has not been considered while investigating the fate of PFAS. Without a deep understanding of these phenomena, derivation of constitutive relationships is challenging. The current Darcy scale mass-transfer models use constitutive relationships derived from either experiments or field measurements, which makes their applicability potentially limited. Here we review current efforts and propose a roadmap for developing Darcy scale transport equations for PFAS. We find that this needs to be based on systematic upscaling of both experimental and computational studies from nano- to microscales. We highlight recent efforts to undertake molecular dynamics simulations on problems with similar levels of complexity and explore the feasibility of conducting nanoscale simulations on PFAS dynamics at the interface of fluid pairs.

Long-term outcomes following impedance-controlled radiofrequency ablation for the treatment of chronic rhinitis.

Objective: To assess long-term safety and effectiveness of a multipoint, impedance-controlled, RF ablation device for treatment of chronic rhinitis through 12-month follow-up. Methods: A prospective, multicenter study. Bilateral posterior nasal nerve (PNN) ablation was performed on all participants. Assessments at 6-, 9-, and 12-month visits included Visual Analog Scale Nasal Symptom Score (VAS NSS), reflective Total Nasal Symptom Score (rTNSS), mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini RQLQ), and adverse events. Results: Thirty-six participants were enrolled and 35 completed the 12-month follow-up. All 5 VAS NSS items demonstrated statistically significant improvement (p < .0001) over baseline at all 3 time points. The total rTNSS improved from 7.9 ± 1.8 at baseline to 4.3 ± 2.1 at 6-months, 3.8 ± 2.4 at 9-months, and 4.0 ± 2.1 at 12-months (all p < .0001). At 12-months, 91% (31/35) of participants had achieved the minimum clinically important difference (MCID) of a reduction from baseline of ≥1 point and 80% (28/35) of the participants met the responder criteria of ≥30% reduction from baseline. The total mean mini RQLQ was reduced from 3.0 ± 1.0 at baseline to 1.4 ± 0.8 at 6-months, 1.4 ± 1.0 at 9-months, and 1.3 ± 0.8 at 12-months (all p < .0001). At 12-months, 86% (30/35) of participants achieved the MCID of a reduction from baseline of ≥0.4 points for the mini RQLQ. No related serious adverse events occurred during the study. Conclusions: Impedance-controlled RF ablation of the PNN is safe and resulted in durable, significant improvement in rhinitis symptoms and quality of life through 12-month follow-up. Trial Registration: The study is registered at www.clinicaltrials.gov with the unique identifier of NCT05324397. Level of Evidence: 4.

Efficacy of EDS-FLU for Chronic Rhinosinusitis: Two Randomized Controlled Trials (ReOpen1 and ReOpen2).

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease. No medications are Food and Drug Administration-approved for the most common form, CRS without nasal polyps (also called "chronic sinusitis"). Novel biomechanics of the exhalation delivery system deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard-delivery nasal sprays. OBJECTIVE: Assess EDS-FLU efficacy for CRS (irrespective of nasal polyps). METHODS: Two randomized, EDS-placebo-controlled trials in adults with CRS irrespective of polyps (ReOpen1) or exclusively without polyps (ReOpen2) were conducted at 120 sites in 13 countries. Patients received EDS-FLU 1 or 2 sprays/nostril, or EDS-placebo, twice daily for 24 weeks. Coprimary measures were composite symptom score through week 4 and ethmoid/maxillary sinus percent opacification by computed tomography at week 24. RESULTS: ReOpen1 (N = 332) composite symptom score least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -1.58 and -1.60 versus -0.62 (P < .001, P < .001); ReOpen2 (N = 223), -1.54 and -1.74 versus -0.81 (P = .011, P = .001). In ReOpen1, sinus opacification least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -5.58 and -6.20 versus -1.60 (P = .045, P = .018), and in ReOpen2, -7.00 and -5.14 versus +1.19 (P < .001, P = .009). Acute disease exacerbations were reduced by 56% to 66% with EDS-FLU versus EDS-placebo (P = .001). There were significant, and similar magnitude, symptom reductions in patients using standard-delivery nasal steroid products just before entering the study (P < .001). Adverse events were similar to standard-delivery intranasal steroids. CONCLUSIONS: EDS-FLU is the first nonsurgical treatment demonstrated to reduce symptoms, intrasinus opacification, and exacerbations in replicate randomized clinical trials in CRS, regardless of polyp status.

Reviewing the Bioremediation of Contaminants in Groundwater: Investigations over 40 Years Provide Insights into What's Achievable.

Biodegradation and biotransformation of contaminants in groundwater commonly occurs naturally. However, natural biodegradation rates can be slow leading to elongated contaminant plumes and prolonged risks that demand greater remedial intervention. Enhancement of the biodegradation of contaminants in groundwater can be induced by the addition of amendments to change the geochemical conditions to those that are more favorable for indigenous or added biota. Enhancing biodegradation requires collocation of the contaminant of concern with the 'right' microbial communities under the 'right' geochemical conditions, so that the microbiota thrive and bio-transform, degrade or lock up the contaminant of interest. This is most easily achievable at laboratory or bench scale where mixing is easily performed, and mass transfer limitations are minimized. However, inducing such changes at field scale in aquifers is non-trivial - amendments do not easily mix into groundwater because it is a laminar (non-turbulent) and low-energy flow environment. Bioaugmentation of cultured or genetically modified organisms have also been considered to add to groundwater to enhance contaminant degradation rates. Here we provide an overview of research studies over approximately 40 years that highlight the progression of understanding from natural biodegradation of plumes in groundwater to active bioremediation efforts that have been variably successful at field scale. Investigated contaminants providing insights include petroleum hydrocarbons, chlorinated and brominated hydrocarbons, ammonium, metals, munition compounds, atrazine and per- and polyfluorinated alkyl substances. The redox and electron acceptor/donor conditions that are inducive to biodegradation for a range of contaminants are highlighted. Biodegradation is challenged by the availability of electron donors/acceptors in the core of plumes and on plume fringes. Cases for bioaugmentation are identified. A long history of investigations provides examples of the importance of amendment delivery mechanisms, scale-up from laboratory to field, and field-scale demonstration of the effectiveness of groundwater bioremediation technologies. Advantages and disadvantages of remedial approaches are tabulated. The value and contributions of integrative modelling advances are identified. The literature review and example cases provide a deep understanding of what scale of bioremediation might be achievable for groundwater plumes. Limitations to bioremediation strategies outlined here will help direct future efforts. Addressing the sources of groundwater plumes as well as bioremediation of the plume itself will achieve more effective outcomes. Twelve 'lessons learnt' are synthesized from the review.

Advancing "Autonomous" sensing and prediction of the subsurface environment: a review and exploration of the challenges for soil and groundwater contamination.

Can we hope for autonomous (self-contained in situ) sensing of subsurface soil and groundwater pollutants to satisfy relevant regulatory criteria? Global advances in sensors, communications, digital technologies, and computational capacity offer this potential. Here we review past efforts to advance subsurface investigation techniques and technologies, and computational efforts to create a digital twin (representation) of subsurface processes. In the context of the potential to link measurement and sensing to a digital twin computation platform, we outline five criteria that might make it possible. Significant advances in sensors based on passive measurement devices are proposed. As an example of what might be achievable, using the five criteria, we describe the deployment of online real-time sensors and simulations for a case study of a petroleum site where natural source zone depletion (NSZD) is underway as a potential biodegradation management option, and where a high-quality conceptual site model is available. Multiple sensors targeting parameters (major gases and temperature influenced by soil moisture) relevant to the subsurface NSZD biodegradation processes are shown to offer the potential to map subsurface processes spatially and temporally and provide continuous estimates of degradation rates for management decisions, constrained by a computational platform of the key processes. Current limitations and gaps in technologies and knowledge are highlighted specific to the case study. More generally, additional key advances required to achieve autonomous sensing of subsurface soil and groundwater pollutants are outlined.