No Threshold Exists for Recommending Revision Surgery in Metal-on-Metal Hip Arthroplasty Patients With Adverse Reactions to Metal Debris: A Retrospective Cohort Study of 346 Revisions

Background Surgeons currently have difficulty when managing metal-on-metal hip arthroplasty (MoMHA) patients with adverse reactions to metal debris (ARMD). This stems from a lack of evidence, which is emphasized by the variability in the recommendations proposed by different worldwide regulatory authorities for considering MoMHA revision surgery. We investigated predictors of poor outcomes following MoMHA revision surgery performed for ARMD to help inform the revision threshold and type of reconstruction. Methods We retrospectively studied 346 MoMHA revisions for ARMD performed at 2 European centers. Preoperative (metal ions/imaging) and intraoperative (findings, components removed/implanted) factors were used to predict poor outcomes. Poor outcomes were postoperative complications (including re-revision), 90-day mortality, and poor Oxford Hip Score. Results Poor outcomes occurred in 38.5%. Shorter time (under 4 years) to revision surgery was the only preoperative predictor of poor outcomes (odds ratio [OR] = 2.12, confidence interval [CI] = 1.00-4.46). Prerevision metal ions and imaging did not influence outcomes. Single-component revisions (vs all-component revisions) increased the risk of poor outcomes (OR = 2.99, CI = 1.50-5.97). Intraoperative modifiable factors reducing the risk of poor outcomes included the posterior approach (OR = 0.22, CI = 0.10-0.49), revision head sizes ≥36 mm (vs <36 mm: OR = 0.37, CI = 0.18-0.77), ceramic-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.30, CI = 0.14-0.66), and metal-on-polyethylene revision bearings (OR vs ceramic-on-ceramic = 0.37, CI = 0.17-0.83). Conclusion No threshold exists for recommending revision in MoMHA patients with ARMD. However postrevision outcomes were surgeon modifiable. Optimal outcomes may be achieved if surgeons use the posterior approach, revise all MoMHA components, and use ≥36 mm ceramic-on-polyethylene or metal-on-polyethylene articulations

The effect of atmospheric nudging on the stratospheric residual circulation in chemistry–climate models

We perform the first multi-model intercomparison of the impact of nudged meteorology on the stratospheric residual circulation using hindcast simulations from the Chemistry–Climate Model Initiative (CCMI). We examine simulations over the period 1980–2009 from seven models in which the meteorological fields are nudged towards a reanalysis dataset and compare these with their equivalent free-running simulations and the reanalyses themselves. We show that for the current implementations, nudging meteorology does not constrain the mean strength of the stratospheric residual circulation and that the inter-model spread is similar, or even larger, than in the free-running simulations. The nudged models generally show slightly stronger upwelling in the tropical lower stratosphere compared to the free-running versions and exhibit marked differences compared to the directly estimated residual circulation from the reanalysis dataset they are nudged towards. Downward control calculations applied to the nudged simulations reveal substantial differences between the climatological lower-stratospheric tropical upward mass flux (TUMF) computed from the modelled wave forcing and that calculated directly from the residual circulation. This explicitly shows that nudging decouples the wave forcing and the residual circulation so that the divergence of the angular momentum flux due to the mean motion is not balanced by eddy motions, as would typically be expected in the time mean. Overall, nudging meteorological fields leads to increased inter-model spread for most of the measures of the mean climatological stratospheric residual circulation assessed in this study. In contrast, the nudged simulations show a high degree of consistency in the inter-annual variability in the TUMF in the lower stratosphere, which is primarily related to the contribution to variability from the resolved wave forcing. The more consistent inter-annual variability in TUMF in the nudged models also compares more closely with the variability found in the reanalyses, particularly in boreal winter. We apply a multiple linear regression (MLR) model to separate the drivers of inter-annual and long-term variations in the simulated TUMF; this explains up to ∼75 % of the variance in TUMF in the nudged simulations. The MLR model reveals a statistically significant positive trend in TUMF for most models over the period 1980–2009. The TUMF trend magnitude is generally larger in the nudged models compared to their free-running counterparts, but the intermodel range of trends doubles from around a factor of 2 to a factor of 4 due to nudging. Furthermore, the nudged models generally do not match the TUMF trends in the reanalysis they are nudged towards for trends over different periods in the interval 1980–2009. Hence, we conclude that nudging does not strongly constrain long-term trends simulated by the chemistry–climate model (CCM) in the residual circulation. Our findings show that while nudged simulations may, by construction, produce accurate temperatures and realistic representations of fast horizontal transport, this is not typically the case for the slower zonal mean vertical transport in the stratosphere. Consequently, caution is required when using nudged simulations to interpret the behaviour of stratospheric tracers that are affected by the residual circulation

Tropospheric jet response to Antarctic ozone depletion: An update with Chemistry-Climate Model Initiative (CCMI) models

The Southern Hemisphere (SH) zonal-mean circulation change in response to Antarctic ozone depletion is re-visited by examining a set of the latest model simulations archived for the Chemistry-Climate Model Initiative (CCMI) project. All models reasonably well reproduce Antarctic ozone depletion in the late 20th century. The related SH-summer circulation changes, such as a poleward intensification of westerly jet and a poleward expansion of the Hadley cell, are also well captured. All experiments exhibit quantitatively the same multi-model mean trend, irrespective of whether the ocean is coupled or prescribed. Results are also quantitatively similar to those derived from the Coupled Model Intercomparison Project phase 5 (CMIP5) high-top model simulations in which the stratospheric ozone is mostly prescribed with monthly- and zonally-averaged values. These results suggest that the ozone-hole-induced SH-summer circulation changes are robust across the models irrespective of the specific chemistry-atmosphere-ocean coupling

Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision: 12,093 replacements from the Australian Joint Registry

BACKGROUND AND PURPOSE: The outcome of modern resurfacing remains to be determined. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) started collection of data on hip resurfacing at a time when modern resurfacing was started in Australia. The rate of resurfacing has been higher in Australia than in many other countries. As a result, the AOANJRR has one of the largest series of resurfacing procedures. This study was undertaken to determine the results of this series and the risk factors associated with revision. PATIENTS AND METHODS: Data from the AOANJRR were used to analyze the survivorship of 12,093 primary resurfacing hip replacements reported to the Joint Replacement Registry between September 1999 and December 2008. This was compared to the results of primary conventional total hip replacement reported during the same period. The Kaplan-Meier method and proportional hazards models were used to determine risk factors such as age, sex, femoral component size, primary diagnosis, and implant design. RESULTS: Female patients had a higher revision rate than males; however, after adjusting for head size, the revision rates were similar. Prostheses with head sizes of less than 50 mm had a higher revision rate than those with head sizes of 50 mm or more. At 8 years, the cumulative per cent revision of hip resurfacing was 5.3 (4.6-6.2), as compared to 4.0 (3.8-4.2) for total hip replacement. However, in osteoarthritis patients aged less than 55 years with head sizes of 50 mm or more, the 7-year cumulative per cent revision for hip resurfacing was 3.0 (2.2-4.2). Also, hips with dysplasia and some implant designs had an increased risk of revision. INTERPRETATION: Risk factors for revision of resurfacing were older patients, smaller femoral head size, patients with developmental dysplasia, and certain implant designs. These results highlight the importance of patient and prosthesis selection in optimizing the outcome of hip resurfacing

Magnetization dynamics of weakly interacting sub-100 nm square artificial spin ices

Artificial Spin Ice (ASI), consisting of a two dimensional array of nanoscale magnetic elements, provides a fascinating opportunity to observe the physics of out-of-equilibrium systems. Initial studies concentrated on the static, frozen state, whilst more recent studies have accessed the out-of-equilibrium dynamic, fluctuating state. This opens up exciting possibilities such as the observation of systems exploring their energy landscape through monopole quasiparticle creation, potentially leading to ASI magnetricity, and to directly observe unconventional phase transitions. In this work we have measured and analysed the magnetic relaxation of thermally active ASI systems by means of SQUID magnetometry. We have investigated the effect of the interaction strength on the magnetization dynamics at different temperatures in the range where the nanomagnets are thermally active. We have observed that they follow an Arrhenius-type Néel-Brown behaviour. An unexpected negative correlation of the average blocking temperature with the interaction strength is also observed, which is supported by Monte Carlo simulations. The magnetization relaxation measurements show faster relaxation for more strongly coupled nanoelements with similar dimensions. The analysis of the stretching exponents obtained from the measurements suggest 1-D chain-like magnetization dynamics. This indicates that the nature of the interactions between nanoelements lowers the dimensionality of the ASI from 2-D to 1-D. Finally, we present a way to quantify the effective interaction energy of a square ASI system, and compare it to the interaction energy computed with micromagnetic simulations

Within-individual phenotypic plasticity in flowers fosters pollination niche shift

Authors thank Raquel Sánchez, Angel Caravante, Isabel Sánchez Almazo, Tatiana López Pérez, Samuel Cantarero, María José Jorquera and Germán Fernández for helping us during several phases of the study and Iván Rodríguez Arós for drawing the insect silhouettes. This research is supported by grants from the Spanish Ministry of Science, Innovation and Universities (CGL2015-71634-P, CGL2015-63827-P, CGL2017-86626-C2-1-P, CGL2017- 86626-C2-2-P, UNGR15-CE-3315, including EU FEDER funds), Junta de Andalucía (P18- FR-3641), Xunta de Galicia (CITACA), BBVA Foundation (PR17_ECO_0021), and a contract grant to C.A. from the former Spanish Ministry of Economy and Competitiveness (RYC-2012-12277). This is a contribution to the Research Unit Modeling Nature, funded by the Consejería de Economía, Conocimiento, Empresas y Universidad, and European Regional Development Fund (ERDF), reference SOMM17/6109/UGR.Phenotypic plasticity, the ability of a genotype of producing different phenotypes when exposed to different environments, may impact ecological interactions. We study here how within-individual plasticity in Moricandia arvensis flowers modifies its pollination niche. During spring, this plant produces large, cross-shaped, UV-reflecting lilac flowers attracting mostly long-tongued large bees. However, unlike most co-occurring species, M. arvensis keeps flowering during the hot, dry summer due to its plasticity in key vegetative traits. Changes in temperature and photoperiod in summer trigger changes in gene expression and the production of small, rounded, UV-absorbing white flowers that attract a different assemblage of generalist pollinators. This shift in pollination niche potentially allows successful reproduction in harsh conditions, facilitating M. arvensis to face anthropogenic perturbations and climate change. Floral phenotypes impact interactions between plants and pollinators. Here, the authors show that Moricandia arvensis displays discrete seasonal plasticity in floral phenotype, with large, lilac flowers attracting long-tongued bees in spring and small, rounded, white flowers attracting generalist pollinators in summer.Spanish Ministry of Science, Innovation and Universities (EU FEDER funds) CGL2015-71634-P CGL2015-63827-P CGL2017-86626-C2-1-P CGL2017-86626-C2-2-P UNGR15-CE-3315Junta de Andalucia P18-FR-3641Xunta de GaliciaBBVA Foundation PR17_ECO_0021Spanish Ministry of Economy and Competitiveness RYC-2012-12277Consejeria de Economia, Conocimiento, Empresas y Universidad SOMM17/6109/UGREuropean Union (EU) SOMM17/6109/UG

A review of bronchiolitis obliterans syndrome and therapeutic strategies

Lung transplantation is an important treatment option for patients with advanced lung disease. Survival rates for lung transplant recipients have improved; however, the major obstacle limiting better survival is bronchiolitis obliterans syndrome (BOS). In the last decade, survival after lung retransplantation has improved for transplant recipients with BOS. This manuscript reviews BOS along with the current therapeutic strategies, including recent outcomes for lung retransplantation

Review of the global models used within the Chemistry-Climate Model Initiative (CCMI)

We present an overview of state-of-the-art chemistry-climate and -transport models that are used within the Chemistry Climate Model Initiative (CCMI). CCMI aims to conduct a detailed evaluation of participating models using process-oriented diagnostics derived from observations in order to gain confidence in the models’ projections of the stratospheric ozone layer, air quality, where applicable global climate change, and the interactions between them. Interpretation of these diagnostics requires detailed knowledge of the radiative, chemical, dynamical, and physical processes incorporated in the models. Also an understanding of the degree to which CCMI recommendations for simulations have been followed is necessary to understand model response to anthropogenic and natural forcing and also to explain inter-model differences. This becomes even more important given the ongoing development and the ever-growing complexity of these models. This paper also provides an overview of the available CCMI simulations with the aim to inform CCMI data users