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Background: Clinicians are often faced with the decision whether to revise a painful total knee replacement in patients who have chronic vague pain with no apparent explanation. A sensitive metal testing assay called the lymphocyte stimulation test has been used to detect nickel sensitization in patients with orthopedic implants. We hypothesize that nickel sensitization plays a role in the pathology of failed joint arthroplasty in patients with unexplained dissatisfaction.Methods: 32 patients with symptomatic total knee arthroplasty without obvious mechanical findings were tested prior to revision surgery. 19 nickel-sensitized and 13 non-sensitized patients were compared by cell counts of synovium surgical specimens for CD4+ and CD8+ cell lines. Patients were then revised with ceramic-coated implants. Secondary evaluation of functional outcomes, range of motion, and pain relief were assessed.Results: Nickel-sensitive patients showed a statistical increase in CD4+ reactivity compared to CD8+ reactivity. The ratio of CD4+/CD8+ T lymphocytes was 1.28 in nickel-sensitive patients versus 0.76 in the control (p = 0.009). There was no difference in functional scores, clinical scores, or range of motion after revision.Conclusions: This study provides objective data via histological analysis in support of a nickel allergic sensitization in failed arthroplasties where clinical and/or radiographic abnormalities may not be apparent. Biopsy for CD4+/CD8+ cell counts may provide further proof of the existence of nickel sensitization in lymphocyte stimulation test positive patients, and more importantly, may implore the surgeon to consider low nickel implant design in these patients. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are a valuable class of medications for orthopedic surgeons and often play a pivotal role in pain control. However, there are many common stipulations resulting in avoidance of its use in the treatment of musculoskeletal disease. This review summarizes the mechanism of action of NSAIDs as well as provides an overview of commonly used NSAIDs and the differences between them. It provides a concise summary on the osseous effects of NSAIDs with regard to bone healing and heterotopic ossification. Most of all, it serves as a guide or reference for orthopedic providers when counseling patients on the risks and benefits of NSAID use, as it addresses the common stipulations encountered: "It irritates my stomach," "I have a history of bariatric surgery," "I'm already on a blood thinner," "I've had a heart attack," and "I've got kidney problems" and synthesizes both current research and society recommendations regarding safe use and avoidance of NSAIDs. [ABSTRACT FROM AUTHOR]

The Paris Climate Agreement defined an ambition of limiting global warming to 1.5 °C above preindustrial levels. This has triggered research on stringent emission reduction targets and corresponding mitigation pathways across energy economy and societal systems. Driven by methodological considerations, supply side and carbon dioxide removal options feature prominently in the emerging pathway literature, while much less attention has been given to the role of demand-side approaches. This special issue addresses this gap, and aims to broaden and strengthen the knowledge base in this key research and policy area. This editorial paper synthesizes the special issue's contributions horizontally through three shared themes we identify: policy interventions, demand-side measures, and methodological approaches. The review of articles is supplemented by insights from other relevant literature. Overall, our paper underlines that stringent demand-side policy portfolios are required to drive the pace and direction of deep decarbonization pathways and keep the 1.5 °C target within reach. It confirms that insufficient attention has been paid to demand-side measures, which are found to be inextricably linked to supply-side decarbonization and able to complement supply-side measures. The paper also shows that there is an abundance of demand-side measures to limit warming to 1.5 °C, but it warns that not all of these options are "seen" or captured by current quantitative tools or progress indicators, and some remain insufficiently represented in the current policy discourse. Based on the set of papers presented in the special issue, we conclude that demand-side mitigation in line with the 1.5 °C goal is possible; however, it remains enormously challenging and dependent on both innovative technologies and policies, and behavioral change. Limiting warming to 1.5 °C requires, more than ever, a plurality of methods and integrated behavioral and technology approaches to better support policymaking and resulting policy interventions. [ABSTRACT FROM AUTHOR]

Buildings are key in supporting human activities and well-being by providing shelter and other important services to their users. Buildings are, however, also responsible for major energy use and greenhouse gas (GHG) emissions during their life cycle. Improving the quality of services provided by buildings while reaching low energy demand (LED) levels is crucial for climate and sustainability targets. Building sector models have become essential tools for decision support on strategies to reduce energy demand and GHG emissions. Yet current models have significant limitations in their ability to assess the transformations required for LED. We review building sector models ranging from the subnational to the global scale to identify best practices and critical gaps in representing transformations toward LED futures. We focus on three key dimensions of intervention (socio-behavioral, infrastructural, and technological), three megatrends (digitalization, sharing economy, and circular economy), and decent living standards. This review recommends the model developments needed to better assess LED transformations in buildings and support decision-making toward sustainability targets. [ABSTRACT FROM AUTHOR]

The adoption of transportation innovations can be driven by a variety of motivations, including functional, symbolic and societal considerations. We compare these motives regarding consumer choice of electric and shared mobility, using survey data from a sample of Canadian adopters and non-adopters of electric vehicles, car-sharing and shared ride-hailing (n = 529). Our framework includes four perception categories: private-functional (e.g., costs and convenience), private-symbolic (e.g., making good impressions), societal-functional (e.g., protecting the environment) and societal-symbolic (e.g., spreading inspiration). We apply two data analytic approaches, finding that positive private-functional perceptions are consistently associated with adoption across all three innovations, especially convenience and compatibility. Other patterns vary by innovation. Most notably, positive private-symbolic considerations are significantly associated with electric vehicle adoption. Results suggest that while functional considerations are important, symbolic motives can also be important but with more nuance. [ABSTRACT FROM AUTHOR]

Great claims have been made about the benefits of dematerialization in a digital service economy. However, digitalization has historically increased environmental impacts at local and planetary scales, affecting labor markets, resource use, governance, and power relationships. Here we study the past, present, and future of digitalization through the lens of three interdependent elements of the Anthropocene: (a) planetary boundaries and stability, (b) equity within and between countries, and (c) human agency and governance, mediated via (i) increasing resource efficiency, (ii) accelerating consumption and scale effects, (iii) expanding political and economic control, and (iv) deteriorating social cohesion. While direct environmental impacts matter, the indirect and systemic effects of digitalization are more profoundly reshaping the relationship between humans, technosphere and planet. We develop three scenarios: planetary instability, green but inhumane, and deliberate for the good. We conclude with identifying leverage points that shift human–digital–Earth interactions toward sustainability. [ABSTRACT FROM AUTHOR]

Aims: We aimed to evaluate the correlation between preoperative and postoperative resilience scores and postoperative outcomes at minimum 2-year follow-up after arthroscopic rotator cuff repair., Methods: We prospectively enrolled 98 patients who underwent rotator cuff repair. We assessed resilience using the Brief Resilience Scale. Postoperatively, we obtained patient-reported outcomes measures including American Society of Shoulder and Elbow Surgeons scores, Single Assessment Numeric Evaluation, and Patient-Reported Outcome Measurement Information System Global Health-10 at minimum 2-year follow-up. We used Spearman correlation coefficients ( r ) to assess the relationship between variables., Results: Ninety-one of 98 patients (93%) provided follow-up at an average of 32 months. Preoperative Brief Resilience Scale did not show a statistically significant correlation with American Society of Shoulder and Elbow Surgeons ( r  = 0.156; p  = 0.142). However, preoperative Brief Resilience Scale showed statistically significant correlations with Patient-Reported Outcome Measurement Information System Global Health-10 ( r  = 0.290; p  = 0.005) and Single Assessment Numeric Evaluation ( r  = 0.259; p  = 0.014). Postoperative Brief Resilience Scale showed statistically significant correlations with American Society of Shoulder and Elbow Surgeons ( r  = 0.291; p  = 0.005), Single Assessment Numeric Evaluation ( r  = 0.384; p  < 0.001) and Patient-Reported Outcome Measurement Information System Global Health-10 ( r  = 0.515; p  < 0.001)., Discussion: Resilience may be a valuable predictor of patients at risk of having suboptimal outcomes after rotator cuff repair and a target to improve surgical outcomes through non-surgical means., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures., Methods: We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal., Results: The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02-6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6., Conclusion: In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2023 Baylor University Medical Center.)