Geological Net Zero and the need for disaggregated accounting for carbon sinks.

Achieving net zero global emissions of carbon dioxide (CO), with declining emissions of other greenhouse gases, is widely expected to halt global warming. CO emissions will continue to drive warming until fully balanced by active anthropogenic CO removals. For practical reasons, however, many greenhouse gas accounting systems allow some "passive" CO uptake, such as enhanced vegetation growth due to CO fertilisation, to be included as removals in the definition of net anthropogenic emissions.

Adjusting 1.5 degree C climate change mitigation pathways in light of adverse new information.

Understanding how 1.5 °C pathways could adjust in light of new adverse information, such as a reduced 1.5 °C carbon budget, or slower-than-expected low-carbon technology deployment, is critical for planning resilient pathways.

High sensitivity of tropical precipitation to local sea surface temperature.

Precipitation and atmospheric circulation are the coupled processes through which tropical ocean surface temperatures drive global weather and climate. Local sea surface warming tends to increase precipitation, but this local control is difficult to disentangle from remote effects of conditions elsewhere. As an example of such a remote effect, El Niño Southern Oscillation (ENSO) events in the equatorial Pacific Ocean alter precipitation across the tropics.

The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols.

Objectives: Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis.

Design: Retrospective health-system database study.

Setting: Multi-center health care system.

The impact of upright radiographs of midshaft clavicle fractures on treatment recommendations.

Clavicle fractures' treatment recommendations are based on displacement. The goal of this paper is to determine upright clavicle radiographs at initial presentation changes timing and method of treatment. Retrospective study in a level 1 trauma center.

Surgery for Unilateral Sacral Fractures: Are the Indications Clear?

Objectives: To evaluate unilateral sacral fractures and compare those treated operatively versus nonoperatively to determine indications for surgery.

Design: Prospective, multicenter, observational study.

Setting: Sixteen trauma centers.

Does Operative Intervention Provide Early Pain Relief for Patients With Unilateral Sacral Fractures and Minimal or No Displacement?

Objectives: To compare pain after operative versus nonoperative pelvic ring injuries with unilateral sacral fractures.

Design: Prospective, multicenter, observational.

Setting: Sixteen trauma centers.

Percutaneous Transiliac-Transsacral Screw Fixation of Sacral Fragility Fractures Improves Pain, Ambulation, and Rate of Disposition to Home.

Objective: To determine whether percutaneous transiliac-transsacral screw fixation improves pain, ambulation, length of stay, and the rate of disposition to home in patients with sacral fragility fractures.

Design: Retrospective cohort study.

Setting: Single academic Level 1 trauma center.

Improving Geriatric Care Processes on Two Medical-Surgical Acute Care Units: A Pilot Study.

The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms.

Advancing national climate change risk assessment to deliver national adaptation plans.

A wide range of climate vulnerability and risk assessments have been implemented using different approaches at different scales, some with a broad multi-sectoral scope and others focused on single risks or sectors. This paper describes the novel approach to vulnerability and risk assessment which was designed and put into practice in the United Kingdom's Second Climate Change Risk Assessment (CCRA2) so as to build upon its earlier assessment (CCRA1). First, we summarize and critique the CCRA1 approach, and second describe the steps taken in the CCRA2 approach in detail, providing examples of how each was applied in practice.

The impact of Earth system feedbacks on carbon budgets and climate response.

A number of studies have examined the size of the allowable global cumulative carbon budget compatible with limiting twenty-first century global average temperature rise to below 2°C and below 1.5°C relative to pre-industrial levels. These estimates of cumulative emissions have a number of uncertainties including those associated with the climate sensitivity and the global carbon cycle.

Ten-Year Incidence of High-Energy Geriatric Trauma at a Level 1 Trauma Center.

Objectives: To examine the characteristics of high-energy geriatric trauma over time.

Design: Retrospective chart review.

Setting: Level 1 trauma center.

Intraoperative Topical Antibiotics for Infection Prophylaxis in Pelvic and Acetabular Surgery.

Objectives: To determine if topical vancomycin and tobramycin powder reduces the incidence of surgical site infection after pelvic ring and acetabulum fracture surgery.

Design: Retrospective cohort study.

Setting: University of Alabama at Birmingham, Academic Level I Trauma Center.

Large differences in regional precipitation change between a first and second 2 K of global warming.

For adaptation and mitigation planning, stakeholders need reliable information about regional precipitation changes under different emissions scenarios and for different time periods. A significant amount of current planning effort assumes that each K of global warming produces roughly the same regional climate change. Here using 25 climate models, we compare precipitation responses with three 2 K intervals of global ensemble mean warming: a fast and a slower route to a first 2 K above pre-industrial levels, and the end-of-century difference between high-emission and mitigation scenarios.

Simple mathematical model of sacroiliac screws safe-zone-Easy to implement by pelvic inlet and outlet views.

Percutaneous sacral screw fixation is the mainstay of posterior pelvic ring fixation. This study quantifies the accuracy of fluoroscopic screw placement using post-operative CT scans and redefines the fluoroscopic safe zone using a mathematical calculation obtained from Inlet and outlet images. The authors hypothesized that a mathematical calculation of screw placement within the ala will improve accuracy of screw placement.

Risk factors for infection after operative fixation of Tibial plateau fractures.

Introduction: Tibial plateau fractures are challenging to treat due to the high incidence of postoperative infections. Treating physicians should be aware of risk factors for postoperative infection in patients who undergo operative fixation.

Patients And Methods: A retrospective review was undertaken to identify all patients with tibial plateau fractures over a 10 year period (2003-2012) who underwent open reduction internal fixation.

Zone 2 sacral fractures managed with partially-threaded screws result in low risk of neurologic injury.

Background: Zone 2 sacral fractures account for 34% of sacral fractures with reported neurological deficit in 21-28% of patients. The purpose of this study was to examine the risk factors for neurological injury in zone 2 sacral fractures. The authors hypothesized that partially thread iliosacral screws did not increase incidence of neurologic injury.

Injury to neurovascular structures with insertion of traction pins around the knee.

Objective: Identify risk to neurovascular structures around the knee with placement of skeletal traction pins.

Methods: Kirchner wires were inserted into cadaveric limbs followed by layer dissecting of each leg. Correlations between weight, height, BMI, and distance were determined after calculating the average distance with deviation between each anatomic structure and the Kirschner wire.

Predicting Reduction in Torsional Strength by Concentric/Eccentric RIA Reaming Normal and Osteoporotic Long Bones (Femurs).

Objectives: Reamer-irrigator-aspirator (RIA) bone graft harvesting human femurs have resulted in spiral fractures. Recommendations/studies on safe RIA diameter are noncomprehensive/inconclusive. Our purpose was to develop an analytical model to predict % reduction in torsional strength after intramedullary oversize reaming (concentric or eccentric) and to test cadaveric femurs with normal-to-osteoporotic bone mineral density to investigate its relationship to femur cross-sectional properties, bone material strength, and torsional strength reduction.

Effect of Retrograde Reaming for Tibiotalocalcaneal Arthrodesis on Subtalar Joint Destruction: A Cadaveric Study.

Recent published data have suggested successful union of subtalar and tibiotalar joints without formal debridement during tibiotalocalcaneal (TTC) fusion procedures. Although previous studies have reported on the importance of the proper guidewire starting point and trajectory to obtain appropriate hindfoot alignment for successful fusion, to our knowledge, no studies have quantified the amount of articular damage to the subtalar joint with retrograde reaming. We hypothesized that reaming would destroy >50% of the posterior facet of the subtalar joint.

Risk of injury to the superior gluteal nerve when using a proximal incision for insertion of a piriformis-entry reamed femoral intramedullary nail: a cadaveric study.

Background: This cadaveric study evaluated the risk of injury to the superior gluteal nerve when a proximal incision site is used for insertion of an antegrade, reamed femoral intramedullary nail into the piriformis fossa. Based on prior anatomical studies, our hypothesis is that the use of a proximal incision site for intramedullary nail insertion will consistently injure the superior gluteal nerve.

Methods: A reamed femoral intramedullary nail was inserted through a piriformis fossa entry site in six pairs of fresh-frozen cadaver femora.

Surgical techniques for complex proximal tibial fractures.

In managing complex proximal tibia fractures, several options are available to the treating surgeon. Closed management with or without external fixation, formal open reduction and internal fixation, and intramedullary nail fixation have been described in the literature. There is a lack of consensus regarding the optimal treatment method for complex bicondylar patterns or proximal metadiaphyseal fractures with or without involvement of the articular surface.