Competition and habitat availability interact to structure arboreal ant communities across scales of ecological organization.

Understanding how resource limitation and biotic interactions interact across spatial scales is fundamental to explaining the structure of ecological communities. However, empirical studies addressing this issue are often hindered by logistical constraints, especially at local scales. Here, we use a highly tractable arboreal ant study system to explore the interactive effects of resource availability and competition on community structure across three local scales: an individual tree, the nest network created by each colony and the individual ant nest. On individual trees, the ant assemblages are primarily shaped by availability of dead wood, a critical nesting resource. The nest networks within a tree are constrained by the availability of nesting resources but also influenced by the co-occurring species. Within individual nests, the distribution of adult ants is only affected by distance to interspecific competitors. These findings demonstrate that resource limitation exerts the strongest effects on diversity at higher levels of local ecological organization, transitioning to a stronger effect of species interactions at finer scales. Collectively, these results highlight that the process exerting the strongest influence on community structure is highly dependent on the scale at which we examine the community, with shifts occurring even across fine-grained local scales.

Identifying the Role of Elevation, Geography, and Species Identity in Structuring Turtle Ant (Cephalotes Latreille, 1802) Bacterial Communities.

Bacterial communities in animals are often necessary for hosts to survive, particularly for hosts with nutrient-limited diets. The composition, abundance, and richness of these bacterial communities may be shaped by host identity and external ecological factors. The turtle ants (genus Cephalotes) are predominantly herbivorous and known to rely on bacterial communities to enrich their diet. Cephalotes have a broad Neotropical distribution, with high diversity in the South American Cerrado, a geologically and biologically diverse savanna. Using 16S rRNA amplicon sequencing, we examined the bacterial communities of forty-one Cephalotes samples of sixteen different species collected from multiple locations across two sites in the Cerrado (MG, Brazil) and compared the bacterial communities according to elevation, locality, species, and species group, defined by host phylogeny. Beta diversity of bacterial communities differed with respect to all categories but particularly strongly when compared by geographic location, species, and species group. Differences seen in species and species groups can be partially explained by the high abundance of Mesorhizobium in Cephalotes pusillus and Cephalotes depressus species groups, when compared to other clades via the Analysis of Composition of Microbiome (ANCOM). Though the Cephalotes bacterial community is highly conserved, results from this study indicate that multiple external factors can affect and change bacterial community composition and abundance.

Monomicrobial Joint Infection by Leclercia adecarboxylata in an Immunocompetent Patient After Knee Arthroscopy: A Case Report.

CASE: A 54-year-old immunocompetent man presented to the office with severe right knee pain and swelling 27 days after knee arthroscopy. Additional diagnostics identified a monomicrobial infection of the right knee joint by the bacterium Leclercia adecarboxylata, which was later confirmed by repeated aspiration of the joint and culture of the aspirated fluid. CONCLUSION: This case report details a postoperative monomicrobial infection with L. adecarboxylata after a knee arthroscopy in an immunocompetent host. Although infection by this bacterium is rare, this case demonstrates the possibility of L. adecarboxylata infection in the knee joint after orthopaedic surgery.

Distributing Defenses: How Resource Defendability Shapes the Optimal Response to Risk.

AbstractMany organisms divide limited defenses among heterogeneous assets. Plants allocate defensive chemicals among tissues differing in value, cost of defense, and risk of herbivory. Some ant colonies allocate specialized defenders among multiple nests differing in volume, entrance size, and risk of attack. We develop a general mathematical model to determine the optimal strategy for dividing defenses among assets depending on their value, defendability, and risk of attack. We build on plant defense theory by focusing on defendability, which we define as the functional relationship between defensive investment and successful defense. We show that if hard-to-defend assets cost more to defend, as assumed in resource defense theory, the optimal strategy allocates more defenses to those assets, regardless of risk. Inspired by cavity-nesting ants, we also consider the possibility that hard-to-defend assets have a lower chance to be successfully defended, even when defensive investment is high. Under this assumption, the optimal response to elevated risk is to reduce defensive allocation to hard-to-defend assets, a conservative strategy previously observed in turtle ants (Cephalotes). This new perspective on defendability suggests that in systems where assets differ in the chance of successful defense, defensive strategies may evolve to be sensitive to risk in surprising ways.

Informing conservation decisions to target private lands of highest ecological value and risk of loss.

Natural habitats on private lands are potentially important components of national biodiversity conservation strategies, yet they are being rapidly lost to development. Conservation easements and other means of protecting these habitats have expanded in use and will be most effective if they target private lands of highest biodiversity value and risk of loss. We developed a Biodiversity Conservation Priority Index (BCPI) based on ecological value and risk of habitat loss for remaining areas of natural vegetation cover (NVC) in the northwestern United States and addressed two questions: (1) Which remaining NVC on private lands is the highest priority for biodiversity conservation based on ecological value and risk of development? And (2) are conservation easements in NVC placed preferentially in locations of high biodiversity conservation priority? Drawing on the concept of ecological integrity, we integrated five metrics of ecological structure, function, and composition to quantify ecological value of NVC. These included net primary productivity, species richness, ecosystem type representation, imperiled species range rarity, and connectivity among "Greater Wildland Ecosystems." Risk of habitat loss was derived from analysis of biophysical and sociodemographic predictors of NVC loss. Ecological value and risk of loss were combined into the BCPI. We then analyzed spatial patterns of BCPI to identify the NVC highest in biodiversity conservation priority and examined the relationship between BCPI and conservation easement status. We found that BCPI varied spatially across the study area and was highest in western and southern portions of the study area. High BCPI was associated with suburban and rural development, roads, urban proximity, valley bottom landforms, and low intensity of current development. Existing conservation easements were distributed more towards lower BCPI values than unprotected NVC at both the study area and region scales. The BCPI can be used to better inform land use decision making at local, regional, and potentially national scales in order to better achieve biodiversity goals.

The spatial variability of NDVI within a wheat field: Information content and implications for yield and grain protein monitoring.

Wheat is a staple crop that is critical for feeding a hungry and growing planet, but its nutritive value has declined as global temperatures have warmed. The price offered to producers depends not only on yield but also grain protein content (GPC), which are often negatively related at the field scale but can positively covary depending in part on management strategies, emphasizing the need to understand their variability within individual fields. We measured yield and GPC in a winter wheat field in Sun River, Montana, USA, and tested the ability of normalized difference vegetation index (NDVI) measurements from an unoccupied aerial vehicle (UAV) on spatial scales of ~10 cm and from Landsat on spatial scales of 30 m to predict them. Landsat observations were poorly related to yield and GPC measurements. A multiple linear model using information from four (three) UAV flyovers was selected as the most parsimonious and predicted 26% (40%) of the variability in wheat yield (GPC). We sought to understand the optimal spatial scale for interpreting UAV observations given that the ~ 10 cm pixels yielded more than 12 million measurements at far finer resolution than the 12 m scale of the harvester. The variance in NDVI observations was "averaged out" at larger pixel sizes but only ~ 20% of the total variance was averaged out at the spatial scale of the harvester on some measurement dates. Spatial averaging to the scale of the harvester also made little difference in the total information content of NDVI fit using Beta distributions as quantified using the Kullback-Leibler divergence. Radially-averaged power spectra of UAV-measured NDVI revealed relatively steep power-law relationships with exponentially less variance at finer spatial scales. Results suggest that larger pixels can reasonably capture the information content of within-field NDVI, but the 30 m Landsat scale is too coarse to describe some of the key features of the field, which are consistent with topography, historic management practices, and edaphic variability. Future research should seek to determine an 'optimum' spatial scale for NDVI observations that minimizes effort (and therefore cost) while maintaining the ability of producers to make management decisions that positively impact wheat yield and GPC.

Warm and arid regions of the world are hotspots of superorganism complexity.

Biologists have long been fascinated by the processes that give rise to phenotypic complexity of organisms, yet whether there exist geographical hotspots of phenotypic complexity remains poorly explored. Phenotypic complexity can be readily observed in ant colonies, which are superorganisms with morphologically differentiated queen and worker castes analogous to the germline and soma of multicellular organisms. Several ant species have evolved 'worker polymorphism', where workers in a single colony show quantifiable differences in size and head-to-body scaling. Here, we use 256 754 occurrence points from 8990 ant species to investigate the geography of worker polymorphism. We show that arid regions of the world are the hotspots of superorganism complexity. Tropical savannahs and deserts, which are typically species-poor relative to tropical or even temperate forests, harbour the highest densities of polymorphic ants. We discuss the possible adaptive advantages that worker polymorphism provides in arid environments. Our work may provide a window into the environmental conditions that promote the emergence of highly complex phenotypes.

Is the grass always greener? Land surface phenology reveals differences in peak and season-long vegetation productivity responses to climate and management.

Vegetation phenology-the seasonal timing and duration of vegetative phases-is controlled by spatiotemporally variable contributions of climatic and environmental factors plus additional potential influence from human management. We used land surface phenology derived from the Advanced Very High Resolution Radiometer and climate data to examine variability in vegetation productivity and phenological dates from 1989 to 2014 in the U.S. Northwestern Plains, a region with notable spatial heterogeneity in climate, vegetation, and land use. We first analyzed interannual trends in six phenological measures as a baseline. We then demonstrated how including annual-resolution predictors can provide more nuanced insights into measures of phenology between plant communities and across the ecoregion. Across the study area, higher annual precipitation increased both peak and season-long productivity. In contrast, higher mean annual temperatures tended to increase peak productivity but for the majority of the study area decreased season-long productivity. Annual precipitation and temperature had strong explanatory power for productivity-related phenology measures but predicted date-based measures poorly. We found that relationships between climate and phenology varied across the region and among plant communities and that factors such as recovery from disturbance and anthropogenic management also contributed in certain regions. In sum, phenological measures did not respond ubiquitously nor covary in their responses. Nonclimatic dynamics can decouple phenology from climate; therefore, analyses including only interannual trends should not assume climate alone drives patterns. For example, models of areas exhibiting greening or browning should account for climate, anthropogenic influence, and natural disturbances. Investigating multiple aspects of phenology to describe growing-season dynamics provides a richer understanding of spatiotemporal patterns that can be used for predicting ecosystem responses to future climates and land-use change. Such understanding allows for clearer interpretation of results for conservation, wildlife, and land management.

Risk Assessment for the Establishment of Vespa mandarinia (Hymenoptera: Vespidae) in the Pacific Northwest, United States.

The recent introduction of the Asian giant hornet, Vespa mandarinia Smith, in the United States in late 2019 has raised concerns about its establishment in the Pacific Northwest and its potential deleterious effects on honey bees, Apis spp., and their pollination services in the region. Therefore, we conducted a risk assessment of the establishment of V. mandarinia in Washington, Oregon, Montana, and Idaho on a county-by-county basis. Our highly conservative tier-1 qualitative and semiquantitative risk assessment relied on the biological requirements and ecological relationships of V. mandarinia in the environments of the Pacific Northwest. Our risk characterization was based on climate and habitat suitability estimates for V. mandarinia queens to overwinter and colonize nests, density and distribution of apiaries, and locations of major human-mediated introduction pathways that may increase establishment of the hornet in the counties. Our results suggest that 32 counties in the region could be at low risk, 120 at medium risk, and 23 at high risk of establishment. Many of the western counties in the region were estimated to be at the highest risk of establishment mainly because of their suitable climate for queens to overwinter, dense forest biomass for nest colonization, and proximity to major port and freight hubs in the region. By design, our tier-1 risk assessment most likely overestimates the risk of establishment, but considering its negative effects, these counties should be prioritized in ongoing monitoring and eradication efforts of V. mandarinia.

Ecosystem engineering in the arboreal realm: heterogeneity of wood-boring beetle cavities and their use by cavity-nesting ants.

Wood-boring beetle larvae act as ecosystem engineers by creating stem cavities that are used secondarily as nests by many arboreal ant species. Understanding the heterogeneity and distribution of available cavities and their use by ants is therefore key to understanding arboreal ant community assembly and diversity. Our goals were to quantify the abundance and diversity of beetle-produced cavity resources in a tropical canopy, reveal how ants use these resources, and determine which characteristics of the cavity resource contribute to ant use. We dissected branches from six common tree species in the Brazilian Cerrado savanna, measuring cavity characteristics and identifying the occupants. We sampled 2310 individual cavities, 576 of which were used as nests by 25 arboreal ant species. We found significant differences among tree species in the proportion of stem length bored by beetles, the number of cavities per stem length, average entrance-hole size, and the distribution of cavity volumes. The likelihood that a cavity was occupied was greater for cavities with larger entrance-hole sizes and larger volumes. In particular, there was a strong positive correlation between mean head diameters of ant species and the mean entrance-hole diameter of the cavities occupied by those ant species. Wood-boring beetles contribute to the structuring of the Cerrado ant community by differentially attacking the available tree species. In so doing, the beetles provide a wide range of entrance-hole sizes which ant species partition based on their body size, and large volume cavities that ants appear to prefer.

The effects of high-severity fires on the arboreal ant community of a Neotropical savanna.

Fire-suppression is of concern in fire-prone ecosystems because it can result in the loss of endemic species. Suppressing fires also causes a build-up of flammable biomass, increasing the risk of severe fires. Using a Before-After, Control-Impacted design, we assessed the consequences of high-severity fires on Neotropical savanna arboreal ant communities. Over a 9-year period, we sampled the ant fauna of the same trees before and after two severe fires that hit a savanna reserve in Brazil and the trees from an unburned savanna site that served as a temporal control. The ant community associated with the unburned trees was relatively stable, with no significant temporal variation in species richness and only a few species changing in abundance over time. In contrast, we found a strong decline in species richness and marked changes in species composition in the burned trees, with some species becoming more prevalent and many becoming rare or locally extinct. The dissimilarity in species richness and composition was significantly smaller between the two pre-fire surveys than between the pre- and post-fire surveys. Fire-induced changes were much more marked among species with strictly arboreal nesting habits, and therefore more susceptible to the direct effects of fire. The decline of some of the ecologically dominant arboreal ant species may be particularly important, as it opens substantial ecological space for cascading community-wide changes. In particular, severe fires appear to disrupt the typical vertical stratification between the arboreal and ground-dwelling faunas, which might lead to homogenization of the overall ant community.

From foraging trails to transport networks: how the quality-distance trade-off shapes network structure.

Biological systems are typically dependent on transportation networks for the efficient distribution of resources and information. Revealing the decentralized mechanisms underlying the generative process of these networks is key in our global understanding of their functions and is of interest to design, manage and improve human transport systems. Ants are a particularly interesting taxon to address these issues because some species build multi-sink multi-source transport networks analogous to human ones. Here, by combining empirical field data and modelling at several scales of description, we show that pre-existing mechanisms of recruitment with positive feedback involved in foraging can account for the structure of complex ant transport networks. Specifically, we find that emergent group-level properties of these empirical networks, such as robustness, efficiency and cost, can arise from models built on simple individual-level behaviour addressing a quality-distance trade-off by the means of pheromone trails. Our work represents a first step in developing a theory for the generation of effective multi-source multi-sink transport networks based on combining exploration and positive reinforcement of best sources.

Patterns of transaminase elevation in rhabdomyolysis versus acetaminophen toxicity.

BACKGROUND: Transaminase elevations can occur from liver injury or in the setting of rhabdomyolysis. The goal of this study is to evaluate indices that could differentiate acetaminophen toxicity from muscle injury in the setting of transaminase elevations. METHODS: A retrospective chart review of consecutive cases reported to our regional poison center. Patients with transaminase (AST and ALT) elevation were grouped as those with acetaminophen exposure (AT) and those with elevated creatine phosphokinase (CPK) without evidence of acetaminophen exposure (RHB). RESULTS: Of the 345 patients included in the study, elevated AST/ALT levels were attributed to rhabdomyolysis in 168 patients and attributed to acetaminophen toxicity in 177 patients. The median AST: ALT values also differed between groups, with patients in the RHB group had higher median ratios (p < 0.001). Using an AST: ALT value of 2.02 as a diagnostic cutoff produced a specificity of 0.52 (95% CI: 0.37, 0.64) and sensitivity of 0.84 (95% CI: 0.73, 0.94) for acetaminophen detection in the test dataset (N = 104). CONCLUSIONS: Elevated transaminases due to liver injury from acetaminophen ingestion had a different pattern than elevated transaminases due to rhabdomyolysis. Lower AST:ALT ratios were found in acetaminophen cases, however, the specificity using a ratio threshold of ≤1 would be 83%.

A taxonomic study of the Brazilian turtle ants (Formicidae: Myrmicinae: Cephalotes)

ABSTRACT We revise the taxonomy of species of the ant genus Cephalotes occurring in Brazil. Sixty-four species are recognized, distributed in 14 species groups. Five species are described as new: Cephalotes gabicamacho new species, Cephalotes marycorn new species, and Cephalotes monicaulyssea new species (angustus group); Cephalotes liviaprado new species (fiebrigi group); and Cephalotes mariadeandrade new species (pinelii group). The soldier and gyne of C. adolphi (angustus group), and the gyne and male of C. nilpiei (pinelii group) are described for the first time. Cephalotes marginatus is synonymized under C. atratus. The bruchi and the laminatus species groups are synonymized under fiebrigi and pusillus groups, respectively. The new species group manni is proposed, derived from the basalis species group. Distribution maps for each species in Brazil are provided. In addition, we provide an illustrated morphological glossary for the genus and illustrated identification keys for workers and soldiers for species groups and for all Brazilian species.

Revisiting ecological dominance in arboreal ants: how dominant usage of nesting resources shapes community assembly.

Ecologically dominant species can shape the assembly of ecological communities via altering competitive outcomes. Moreover, these effects may be amplified under limited niche differentiation. Nevertheless, the influences of ecological dominance and niche differentiation on assembly are rarely considered together. Here, we provide a novel examination of dominance in a diverse arboreal ant community, defining dominance by the prevalent usage of nesting resources and addressing how it influences community assembly. We first used a series of quantitative observational and experimental studies to address the natural nesting ecology, colony incidence on surveyed trees, and level of dominance over newly available nesting resources by our focal species, Cephalotes pusillus. The experimental studies were then used further to examine whether C. pusillus shapes assembly via an influence on cavity usage by co-occurring species. C. pusillus was confirmed as a dominant user of cavity nesting resources, with highly generalized nesting ecology, occupying about 50% of the trees within the focal system, and accounting for more than a third of new cavity occupation in experiments. Our experiments showed further that the presence of C. pusillus was associated with modest effects on species richness, but significant decreases in cavity-occupation levels and significant shifts in the entrance-size usage by co-occurring species. These results indicate that C. pusillus, as a dominant user of nesting resources, shapes assembly at multiple levels. Broadly, our findings highlight that complex interactions between a dominant species and the resource-usage patterns of other species can underlie species assembly in diverse ecological communities.

Trait evolution is reversible, repeatable, and decoupled in the soldier caste of turtle ants.

The scope of adaptive phenotypic change within a lineage is shaped by how functional traits evolve. Castes are defining functional traits of adaptive phenotypic change in complex insect societies, and caste evolution is expected to be phylogenetically conserved and developmentally constrained at broad phylogenetic scales. Yet how castes evolve at the species level has remained largely unaddressed. Turtle ant soldiers (genus Cephalotes), an iconic example of caste specialization, defend nest entrances by using their elaborately armored heads as living barricades. Across species, soldier morphotype determines entrance specialization and defensive strategy, while head size sets the specific size of defended entrances. Our species-level comparative analyses of morphotype and head size evolution reveal that these key ecomorphological traits are extensively reversible, repeatable, and decoupled within soldiers and between soldier and queen castes. Repeated evolutionary gains and losses of the four morphotypes were reconstructed consistently across multiple analyses. In addition, morphotype did not predict mean head size across the three most common morphotypes, and head size distributions overlapped broadly across all morphotypes. Concordantly, multiple model-fitting approaches suggested that soldier head size evolution is best explained by a process of divergent pulses of change. Finally, while soldier and queen head size were broadly coupled across species, the level of head size disparity between castes was decoupled from both queen head size and soldier morphotype. These findings demonstrate that caste evolution can be highly dynamic at the species level, reshaping our understanding of adaptive morphological change in complex social lineages.

Detection of prey odours underpins dietary specialization in a Neotropical top-predator: How army ants find their ant prey.

Deciphering the mechanisms that underpin dietary specialization and niche partitioning is crucial to understanding the maintenance of biodiversity. New world army ants live in species-rich assemblages throughout the Neotropics and are voracious predators of other arthropods. They are therefore an important and potentially informative group for addressing how diverse predator assemblages partition available prey resources. New World army ants are largely specialist predators of other ants, with each species specializing on different ant genera. However, the mechanisms of prey choice are unknown. In this study, we addressed whether the army ant Eciton hamatum: (a) can detect potential prey odours, (b) can distinguish between odours of prey and non-prey and (c) can differentiate between different types of odours associated with its prey. Using field experiments, we tested the response of army ants to the following four odour treatments: alarm odours, dead ants, live ants and nest material. Each treatment had a unique combination of odour sources and included some movement in two of the treatments (alarm and live ants). Odour treatments were tested for both prey and non-prey ants. These data were used to determine the degree to which E. hamatum are using specific prey stimuli to detect potential prey and direct their foraging. Army ants responded strongly to odours derived from prey ants, which triggered both increased localized recruitment and slowed advancement of the raid as they targeted the odour source. Odours from non-prey ants were largely ignored. Additionally, the army ants had the strongest response to the nest material of their preferred prey, with progressively weaker responses across the live ant, dead ant and alarm odours treatments respectively. This study reveals that the detection of prey odours, and especially the most persistent odours related to the prey's nest, provides a mechanism for dietary specialization in army ants. If ubiquitous across the Neotropical army ants, then this olfaction-based ecological specialization may facilitate patterns of resource partitioning and coexistence in these diverse predator communities.

Correlates and Consequences of Worker Polymorphism in Ants.

Body size is a key life-history trait influencing all aspects of an organism's biology. Ants provide an interesting model for examining body-size variation because of the high degree of worker polymorphism seen in many taxa. We review worker-size variation in ants from the perspective of factors internal and external to the colony that may influence body-size distributions. We also discuss proximate and ultimate causes of size variation and how variation in worker size can promote worker efficiency and colony fitness. Our review focuses on two questions: What is our current understanding of factors influencing worker-size variation? And how does variation in body size benefit the colony? We conclude with recommendations for future work aimed at addressing current limitations and ask, How can we better understand the contribution of worker body-size variation to colony success? And, what research is needed to address gaps in our knowledge?

Co-occurrence patterns in a diverse arboreal ant community are explained more by competition than habitat requirements.

A major goal of community ecology is to identify the patterns of species associations and the processes that shape them. Arboreal ants are extremely diverse and abundant, making them an interesting and valuable group for tackling this issue. Numerous studies have used observational data of species co-occurrence patterns to infer underlying assembly processes, but the complexity of these communities has resulted in few solid conclusions. This study takes advantage of an observational dataset that is unusually well-structured with respect to habitat attributes (tree species, tree sizes, and vegetation structure), to disentangle different factors influencing community organization. In particular, this study assesses the potential role of interspecific competition and habitat selection on the distribution patterns of an arboreal ant community by incorporating habitat attributes into the co-occurrence analyses. These findings are then contrasted against species traits, to explore functional explanations for the identified community patterns. We ran a suite of null models, first accounting only for the species incidence in the community and later incorporating habitat attributes in the null models. We performed analyses with all the species in the community and then with only the most common species using both a matrix-level approach and a pairwise-level approach. The co-occurrence patterns did not differ from randomness in the matrix-level approach accounting for all ant species in the community. However, a segregated pattern was detected for the most common ant species. Moreover, with the pairwise approach, we found a significant number of negative and positive pairs of species associations. Most of the segregated associations appear to be explained by competitive interactions between species, not habitat affiliations. This was supported by comparisons of species traits for significantly associated pairs. These results suggest that competition is the most important influence on the distribution patterns of arboreal ants within the focal community. Habitat attributes, in contrast, showed no significant influence on the matrix-wide results and affected only a few associations. In addition, the segregated pairs shared more biological characteristic in common than the aggregated and random ones.

Medical therapy versus sinus surgery by using balloon sinus dilation technology: A prospective multicenter study.

BACKGROUND: Although previous studies of sinus surgery that used balloon catheter dilation technology for the paranasal sinuses (balloon sinus dilation [BSD]) demonstrated safety and efficacy, data that compare BSD with continued medical management (MM) are lacking. OBJECTIVE: To evaluate the outcomes of sinus surgery when using BSD instruments versus MM for patients with chronic rhinosinusitis for whom MM failed. METHODS: Adult patients with chronic rhinosinusitis for whom a minimum of 3 weeks of oral antibiotics, 4 weeks of daily saline solution therapy, and 4 weeks of daily nasal corticosteroids failed were included. Qualifying participants were allowed to self-select sinus surgery with BSD (either an office or operating room setting) or continued MM. The primary end point was the comparison of change in the Chronic Sinusitis Survey score from baseline to 24 weeks. Secondary end points included comparisons of change for the Rhinosinusitis Disability Index (RSDI) and the Sino-Nasal Outcome Test (SNOT-20). RESULTS: A total of 198 patients were enrolled (146 surgery and 52 MM). Of the patients who chose BSD, 72% (105/146) had their procedures completed in an office setting. Overall, BSD instruments were successful in dilating 97.6% of targeted sinuses (561/575). Patients who chose BSD showed a significantly greater improvement in the Chronic Sinusitis Survey score versus MM (42.0 versus 27.0, p < 0.001). Results from the RSDI and SNOT-20 surveys showed similar improvements for surgery versus MM (RSDI, 36.0 versus 18.1, p < 0.001; SNOT-20, 1.7 versus 1.0, p < 0.002). CONCLUSION: Patients who selected sinus surgery in which BSD instruments were used on the peripheral sinuses demonstrated significantly greater improvements in quality of life compared with those who elected ongoing MM. These results were achieved through office-based procedures with the patient under local anesthesia in the majority of patients.