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Abstract Background Reverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes. Methods In this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain. Results The cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p

Background: The purpose of this study was to assess impingement-free internal rotation (IR) in a virtual reverse shoulder arthroplasty simulation using a Statistical Shape Model based on scapula size. Methods: A database of over 10,000 scapulae utilized for preoperative planning for shoulder arthroplasty was analyzed with a Statistical Shape Model to obtain 5 scapula sizes including the mean and 2 standard deviations. For each scapula model, one glenosphere size (33-42 mm) was selected as the best fit based on consensus among 3 shoulder surgeons. Virtual implantation variables included 1) lateral offset (0-12 mm in 2-mm increments), 2) inferior eccentricity (0, 2.5, 5, and 7.5 mm), and 3) posterior eccentricity (0, 2.5, and 5 mm). The neck shaft angle was fixed at 135° with an inlay design humeral prosthesis. IR at the side (IR0) and in abduction (IRABD) were then simulated. Results: Maximum impingement-free IR0 was reached with increasing inferior offset in combination with increasing lateralization. Lateralization was the most important variable in increasing impingement-free IRABD. Maximum IRABD was reached at 4-6 mm of lateralization with smaller scapula (−2 to 0 standard deviation). Increasing lateralization up to 12 mm continues to increase IRABD for larger-sized scapula (+1 to +2 standard deviation). Optimal inferior offset and lateralization to maximize IR did have a small loss of external rotation in neutral abduction. There was no loss of external rotation in 60° of abduction. Conclusion: In a virtual model, the glenosphere position required to maximize IR varied by scapula size. For smaller scapulae, maximum IR0 was reached with a combination of 2.5-mm inferior offset and 0- 4 mm of lateralization. For larger scapulae, maximum IR0 was reached with a combination of 2.5 mm of inferior offset and 4 mm of lateralization. The amount of lateralization required to maximize IRABD also varies by scapula size. Maximum IRABD was reached in smaller scapula with 4-6 mm of lateralization and at least 12 mm of lateralization in larger scapula. These findings may be applied in the clinical decision-making process knowing that impingement-free IR and IRABD can be maximized with combinations of inferior offset and lateralization based on scapula size with minimal effect on external rotation and external rotation in 60° of abduction.

Aims: The liner design is a key determinant of the constraint of a reverse total shoulder arthroplasty (rTSA). The aim of this study was to compare the degree of constraint of rTSA liners between different implant systems. Methods: An implant company’s independent 3D shoulder arthroplasty planning software (mediCAD 3D shoulder v. 7.0, module v. 2.1.84.173.43) was used to determine the jump height of standard and constrained liners of different sizes (radius of curvature) of all available companies. The obtained parameters were used to calculate the stability ratio (degree of constraint) and angle of coverage (degree of glenosphere coverage by liner) of the different systems. Measurements were independently performed by two raters, and intraclass correlation coefficients were calculated to perform a reliability analysis. Additionally, measurements were compared with parameters provided by the companies themselves, when available, to ensure validity of the software-derived measurements. Results: There were variations in jump height between rTSA systems at a given size, resulting in large differences in stability ratio between systems. Standard liners exhibited a stability ratio range from 126% to 214% (mean 158% (SD 23%)) and constrained liners a range from 151% to 479% (mean 245% (SD 76%)). The angle of coverage showed a range from 103° to 130° (mean 115° (SD 7°)) for standard and a range from 113° to 156° (mean 133° (SD 11°)) for constrained liners. Four arthroplasty systems kept the stability ratio of standard liners constant (within 5%) across different sizes, while one system showed slight inconsistencies (within 10%), and ten arthroplasty systems showed large inconsistencies (range 11% to 28%). The stability ratio of constrained liners was consistent across different sizes in two arthroplasty systems and inconsistent in seven systems (range 18% to 106%). Conclusion: Large differences in jump height and resulting degree of constraint of rTSA liners were observed between different implant systems, and in many cases even within the same implant systems. While the immediate clinical effect remains unclear, in theory the degree of constraint of the liner plays an important role for the dislocation and notching risk of a rTSA system. Cite this article: Bone Jt Open 2024;5(10):818–824.

Abstract Background Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration Retrospectively registered.

Aims: Current diagnostic tools are not always able to effectively identify periprosthetic joint infections (PJIs). Recent studies suggest that circulating microRNAs (miRNAs) undergo changes under pathological conditions such as infection. The aim of this study was to analyze miRNA expression in hip arthroplasty PJI patients. Methods: This was a prospective pilot study, including 24 patients divided into three groups, with eight patients each undergoing revision of their hip arthroplasty due to aseptic reasons, and low- and high-grade PJI, respectively. The number of intraoperative samples and the incidence of positive cultures were recorded for each patient. Additionally, venous blood samples and periarticular tissue samples were collected from each patient to determine miRNA expressions between the groups. MiRNA screening was performed by small RNA-sequencing using the miRNA next generation sequencing (NGS) discovery (miND) pipeline. Results: Overall, several miRNAs in plasma and tissue were identified to be progressively deregulated according to ongoing PJI. When comparing the plasma samples, patients with a high-grade infection showed significantly higher expression levels for hsa-miR-21-3p, hsa-miR-1290, and hsa-miR-4488, and lower expression levels for hsa-miR-130a-3p and hsa-miR-451a compared to the aseptic group. Furthermore, the high-grade group showed a significantly higher regulated expression level of hsa-miR-1260a and lower expression levels for hsa-miR-26a-5p, hsa-miR-26b-5p, hsa-miR-148b-5p, hsa-miR-301a-3p, hsa-miR-451a, and hsa-miR-454-3p compared to the low-grade group. No significant differences were found between the low-grade and aseptic groups. When comparing the tissue samples, the high-grade group showed significantly higher expression levels for 23 different miRNAs and lower expression levels for hsa-miR-2110 and hsa-miR-3200-3p compared to the aseptic group. No significant differences were found in miRNA expression between the high- and low-grade groups, as well as between the low-grade and aseptic groups. Conclusion: With this prospective pilot study, we were able to identify a circulating miRNA signature correlating with high-grade PJI compared to aseptic patients undergoing hip arthroplasty revision. Our data contribute to establishing miRNA signatures as potential novel diagnostic and prognostic biomarkers for PJI. Cite this article: Bone Jt Open 2024;5(6):479–488.

Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2–12% of total shoulder instability cases. However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability. This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding. In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI. This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.

Abstract Background The importance of several scapulothoracic muscles, including trapezius and serratus anterior, in maintaining physiological scapula kinematics has been highlighted in the past. However, the relationship between the scapula and the latissimus dorsi muscle remains unclear. Our clinical surgical observation is that the latissimus dorsi does not directly attach but rather runs superficial to the inferior angle of the scapula. Based on this observation, we hypothesise that the latissimus dorsi creates a dynamic track on which the scapula glides under the muscle belly during elevation of the arm, creating the latissimus-scapula overlap (LSO). Methods All consecutive patients who had a whole-body computed tomography scan (CT) in case of polytrauma evaluation between 2018 and 2021, with complete depiction of the scapula and latissimus dorsi muscle, were analysed. 150 shoulders in 90 patients with arms up were matched according to their age (within five years), gender, and affected side with 150 shoulders in 88 patients with arms down. Patients with pathologies of the upper extremities or thorax that potentially could alter LSO measurements were excluded. LSO was calculated as a ratio of the measured area of the latissimus dorsi projection on the scapula and the total scapula area. Results The mean age of the 178 patients (48 females; 13 males) was 60 years. The arms-up group showed a significantly higher LSO than the arms-down group (19.9 ± 6.3% vs. 2.7 ± 2.2%; p

Abstract Background The two major reverse shoulder arthroplasty (RSA) designs are the Grammont design and the lateralized design. Even if the lateralized design is biomechanically favored, the classic Grammont prosthesis continues to be used. Functional and subjective patient scores as well as implant survival described in the literature so far are comparable to the lateralized design. A pure comparison of how the RSA design influences outcome in patients has not yet been determined. The aim of this study was a comparison focused on patients with cuff tear arthropathy (CTA). Methods We analyzed registry data from 696 CTA patients prospectively collected between 2012 and 2020 in two specialized orthopedic centers up to 2 years post-RSA with the same follow-up time points (6,12 24 months). Complete teres minor tears were excluded. Three groups were defined: group 1 (inlay, 155° humeral inclination, 36 + 2 mm eccentric glenosphere (n = 50)), group 2 (inlay, 135° humeral inclination, 36 + 4 mm lateralized glenosphere (n = 141)) and group 3 (onlay, 145° humeral inclination, + 3 mm lateralized base plate, 36 + 2 mm eccentric glenosphere (n = 35)) We compared group differences in clinical outcomes (e.g., active and passive range of motion (ROM), abduction strength, Constant-Murley score (CS)), radiographic evaluations of prosthetic position, scapular anatomy and complications using mixed models adjusted for age and sex. Results The final analysis included 226 patients. The overall adjusted p-value of the CS for all time-points showed no significant difference (p = 0.466). Flexion of group 3 (mean, 155° (SD 13)) was higher than flexion of group 1 (mean, 142° (SD 18) and 2 (mean, 132° (SD 18) (p

Rural architecture, as an integral part of any cultural landscape, reflects the connection between humans and their habitat. The “masi” (farmsteads) of Val Gardena embody this harmony with nature through the use of wood and stone, blending functionality with the surrounding environmental context. These buildings not only symbiotically relate to the terrain, but they also respond to agricultural needs and natural conditions. The construction of “masi” adheres to philosophical principles of order, expressing the “genius loci” of the location. In Val Gardena, two predominant typologies emerge: the “Einhof” and the “Paarhof”, both characterised by the skilful use of natural materials and integration into the landscape. The evolution of “masi” over time reveals functional and organic transformations, showcasing craftsmanship and adaptability to the environment. Wood, a durable and versatile material, is used to form the structural foundation, reflecting a pragmatic approach to design. The interior spaces, such as the kitchen and “stube” (traditional living room), are configured according to functional needs while still maintaining the essence of traditional dwellings. These buildings exhibit an architectural identity oriented towards modernity, offering insights for contemporary architectural language. This essay, accompanied by selected photographs, delves into the peculiarities of Val Gardena’s “masi”, providing a comprehensive analysis of buildings through construction principles, relationships with the landscape, typologies, spatial characteristics, and potential new uses.

Background: Improvements in pain control after shoulder arthroplasty with a reduction in narcotic use continues to be an important postoperative goal. With the increased utilization of stemless anatomic total shoulder arthroplasty (aTSA), it is relevant to compare between stemmed and stemless arthroplasty to assess if there is any association between this implant design change and early postoperative pain. Methods: Patients from a multicenter, prospectively-maintained database who had undergone a stemless aTSA with a minimum of two year clinical follow-up were retrospectively identified. Patients who underwent aTSA with a short stem were identified in the same registry, and matched to the stemless aTSA patients by age, sex and preoperative pain score. The primary study outcome was the Visual Analog Scale pain score. Secondary pain outcomes were the American Shoulder and Elbow Surgeons shoulder pain subscore, Western Ontario Osteoarthritis of the Shoulder physical symptoms subscore, and the Single Assessment Numeric Evaluation score. Finally, the percentage of patients who could sleep on the affected shoulder was assessed for each group. These pain-related clinical outcomes were assessed and compared preoperatively, and postoperatively at 9 weeks, 26 weeks, one year and two years. For all statistical comparisons, P > .05 was considered significant. Results: 124 patients were included in the study; 62 in each group. At 9 weeks after surgery, statistically significantly improved pain control was reported by patients undergoing stemless aTSA, as assessed by the Visual Analog Scale (stemless: 1.5, stemmed: 2.5, P = .001), American Shoulder and Elbow Surgeons pain subscore (stemless: 42.4, stemmed: 37.3, P

With the exponential growth in population and commensurate increased density in urban cities, access to daylight and views to nature is being severely curtailed in buildings. In parallel, increasingly urgent demands to sharply reduce building energy use and associated greenhouse gas emissions are being made to mitigate climate change. There are many challenges and performance tradeoffs associated with the building facade (i.e., daylight and view versus solar and glare control); increased prioritization of health and well-being as a fundamental human requirement could adversely affect building energy-efficiency. Given the current state of knowledge on the effects of daylight and view on health and well-being in buildings, we identify critical needs in research, tools and technologies that if satisfied may enable more effective use of daylight and view in buildings within the constraints of climate change. Lack of knowledge regarding the complex causal mechanisms of window views on human factors is a severely limiting factor in forward progress. Current models and methods to derive bidirectional scattering distribution functions (BSDFs) will need to be modified. Developers of energy-efficient window technologies will need more guidance to shape product development. Advanced window technologies and integrated design can enable attainment of both health and well-being and net zero energy goals, but considerable work will be needed to make such options turnkey and broadly available.

Daylight predictions of architectural spaces depend on good estimates of light transfer through skylights, windows and other fenestration systems. For clear glazing and painted surfaces, parametric transmission and reflection models have proven adequate, but there are many cases where light-scattering, semi-specular shading and daylighting materials defy simple characterization. Something as commonplace as fabric roller shades and venetian blinds may turn daylight prediction into guesswork, and numerous advanced systems on the market tuned specifically to enhance daylight are not sufficiently characterized to distinguish their performance. In this paper, we describe new tools available to handle novel and specialized fabrics, materials, and devices using data-driven modelling of bi-directional scattering distribution functions (BSDFs). These representations are usually tabulated at constant or adjustable angular resolution for efficient point-in-time and annual daylight simulations. We describe a variety of BSDF simulation workflows, including some of the tools and methods that make advanced analysis possible, and highlight some of the current challenges. We conclude with a discussion of future work and how such data might be created and shared worldwide.

Background: Increased coracoclavicular distance due to acute acromioclavicular joint (ACJ) instability is often described as a pseudoelevation of the clavicle due to inferior hanging of the scapula, while the distal clavicle remains in its position. The aim of this study was to analyze whether the elevation of the distal clavicle, depression of the scapula, or both are associated with vertical instability and to evaluate the impact of weighted stress radiographs on the clavicle and scapular position in acute ACJ instabilities. Methods: The cohort consisted of 505 patients (f = 52, m = 453; mean age 46 years) which presented to our emergency department or outpatient clinic and treated in our institution from 2006 to 2019 displaying an acute ACJ injury. The panorama views that displayed at least two vertebraes with their spinous processes were retrospectively evaluated. Two raters assessed the panorama views twice regarding the clavicular and coracoidal angle of both sides in relation to the cervicothoracal spine and the difference in height of both clavicles and coracoids. Results: In our cohort, five types of displacement were distinguished: type A, only clavicle is elevated (N = 46); B, only scapula depressed (N = 36); C, the clavicle elevated and the scapula depressed (N = 67); D, both depressed (N = 133); and E, both elevated (N = 223). 123 patients had non-weighted radiographs and 353 patients stress views with 10 kg of axial load, whereas 29 patients had both radiological modalities. Among these 29 patients, a significant increase in coracoclavicular distance difference, clavicle, and scapula height (P

Bidirectional scattering distribution function (BSDF) data are used in design practice to represent optically complex daylighting and solar control systems in lighting and energy simulation software. Visual comfort assessments (e.g., daylight glare) require accurate determination of luminance and corresponding solid angle of glare sources. For the sun, the necessary resolution of the BSDF causes problems both in terms of data volume and computational effort. With “peak extraction” (PE), we present a new method that simulates the direct solar contribution at its real size and spread, while efficiently using the underlying BSDF data set for the scattered light. PE enables practitioners to evaluate daylight performance metrics for their designs at improved accuracy.

A Bidirectional Scattering Distribution Function (BSDF) describes how light from each incident direction is scattered (reflected and transmitted) by a simple or composite surface, such as a window shade. Compact, tabular BSDFs may be derived via interpolation, discretization and/or compression from goniophotometer measurements. These data-driven BSDFs can represent any measurable distribution to the limits of their tabulated resolution, making them more general than parametric or analytical BSDFs, which are restricted to a particular class of materials. However, tabulated BSDFs present a trade-off between higher sampling loads versus lower directional accuracy during simulation. Low-resolution BSDFs (e.g., Klems basis) may be adequate for calculating solar heat gains but fall short when applied to daylight glare predictions. The tensor-tree representation moderates this trade-off using a variable-resolution basis, providing detail where needed at an acceptable cost. Independently, a peak extraction algorithm isolates direct transmission from any tabular BSDF, enabling high-resolution beam radiation and glare analysis through transmitting systems with a “vision” component. Our data-driven BSDF methods were validated with a pilot study of a fabric shade installed in an outdoor, full-scale office testbed. Comparisons between measurement and simulation were made for vertical illuminance, specular and near-specular transmission, and daylight glare probability. Models based on high resolution BSDF measurements yielded superior results when accounting for anisotropy compared to isotropic models. Models with higher resolution produced more accurate source luminance data than low-resolution models. Further validation work is needed to better characterize generality of observed trends from this pilot study.

A Bidirectional Scattering Distribution Function (BSDF) describes how light from each incident direction is scattered (reflected and transmitted) by a simple or composite surface, such as a window shade. Compact, tabular BSDFs may be derived via interpolation, discretization and/or compression from goniophotometer measurements. These data-driven BSDFs can represent any measurable distribution to the limits of their tabulated resolution, making them more general than parametric or analytical BSDFs, which are restricted to a particular class of materials. However, tabulated BSDFs present a trade-off between higher sampling loads versus lower directional accuracy during simulation. Low-resolution BSDFs (e.g., Klems basis) may be adequate for calculating solar heat gains but fall short when applied to daylight glare predictions. The tensor-tree representation moderates this trade-off using a variable-resolution basis, providing detail where needed at an acceptable cost. Independently, a peak extraction algorithm isolates direct transmission from any tabular BSDF, enabling high-resolution beam radiation and glare analysis through transmitting systems with a “vision” component. Our data-driven BSDF methods were validated with a pilot study of a fabric shade installed in an outdoor, full-scale office testbed. Comparisons between measurement and simulation were made for vertical illuminance, specular and near-specular transmission, and daylight glare probability. Models based on high resolution BSDF measurements yielded superior results when accounting for anisotropy compared to isotropic models. Models with higher resolution produced more accurate source luminance data than low-resolution models. Further validation work is needed to better characterize generality of observed trends from this pilot study.

Abstract Background Scapulothoracic orientation, especially scapular internal rotation (SIR) may influence range of motion in reverse total shoulder arthroplasty (RTSA) and is subjected to body posture. Clinical measurements of SIR rely on apical bony landmarks, which depend on changes in scapulothoracic orientation, while radiographic measurements are often limited by the restricted field of view (FOV) in CT scans. Therefore, the goal of this study was (1) to determine whether the use of CT scans with a limited FOV to measure SIR is reliable and (2) if a clinical measurement could be a valuable alternative. Methods This anatomical study analyzed the whole-body CT scans of 100 shoulders in 50 patients (32 male and 18 female) with a mean age of 61.2 ± 20.1 years (range 18; 91). (1) CT scans were rendered into 3D models and SIR was determined as previously described. Results were compared to measurements taken in 2D CT scans with a limited FOV. (2) Three apical bony landmarks were defined: (the angulus acromii (AA), the midpoint between the AA and the coracoid process tip (C) and the acromioclavicular (AC) joint. The scapular axis was determined connecting the trigonum scapulae with these landmarks and referenced to the glenoid center. The measurements were repeated with 0°, 10°, 20°, 30° and 40° anterior scapular tilt. Results Mean SIR was 44.8° ± 5.9° and 45.6° ± 6.6° in the 3D and 2D model, respectively (p

In the architecture, engineering, and construction industries, the integration of Building Information Modeling (BIM) has become instrumental in shaping the design and commissioning of smart buildings. At the center of this development is the pursuit of more intelligent, efficient, and sustainable built environments. The emergence of smart buildings equipped with advanced sensor networks and automation systems increasingly requires the implementation of Digital Twins (DT) for the direct coupling of BIM methods for integral building planning, commissioning, and operational monitoring. While simulation tools and methods exist in the design phase of developing advanced controls, their mapping to construction or post-construction models is less well developed. Through systematic, keyword-based literature research on publisher-independent databases, this review paper gives a comprehensive overview of the state of the research on BIM integration of building control systems with a primary focus on combined controls for daylight and artificial lighting systems. The review, supported by a bibliometric literature analysis, highlights major development fields in HVAC controls, failure detection, and fire-detection systems, while the integration of daylight and artificial lighting controls in Digital Twins is still at an early stage of development. In addition to already existing reviews in the context of BIM and Digital planning methods, this review particularly intends to build the necessary knowledge base to further motivate research activities to integrate simulation-based control methods in the BIM planning process and to further close the gap between planning, implementation, and commissioning.

The researchers developed a new generation of high-performance façade systems and supporting design and management tools to support industry in meeting California’s greenhouse gas reduction targets, reduce energy consumption, and enable an adaptable response to minimize real-time demands on the electricity grid. The project resulted in five outcomes: (1) The research team developed an R-5, 1-inch thick, triplepane, insulating glass unit with a novel low-conductance aluminum frame. This technology can help significantly reduce residential cooling and heating loads, particularly during the evening. (2) The team developed a prototype of a windowintegrated local ventilation and energy recovery device that provides clean, dry fresh air through the façade with minimal energy requirements. (3) A daylight-redirecting louver system was prototyped to redirect sunlight 15–40 feet from the window. Simulations estimated that lighting energy use could be reduced by 35–54 percent without glare. (4) A control system incorporating physics-based equations and a mathematical solver was prototyped and field tested to demonstrate feasibility. Simulations estimated that total electricity costs could be reduced by 9-28 percent on sunny summer days through adaptive control of operable shading and daylighting components and the thermostat compared to state-of-the-art automatic façade controls in commercial building perimeter zones. (5) Supporting models and tools needed by industry for technology R&D and market transformation activities were validated. Attaining California’s clean energy goals require making a fundamental shift from today’s ad-hoc assemblages of static components to turnkey, intelligent, responsive, integrated building façade systems. These systems offered significant reductions in energy use, peak demand, and operating cost in California.

To successfully understand and shape biodiversity conservation in Alpine grasslands, it is crucial to understand how farmers’ relationship to biodiversity influences their goals and associated practices. We explored how farmers perceive and value biodiversity, how this is related to agricultural and land use practices, and how they view their roles in affecting it. Semi-structured interviews were conducted with 22 farmers in the northern Italian Alps and with 6 experts in the fields of grassland management, agriculture, and environmental conservation in 2020. The farmers’ answers were analyzed using a mental model approach, relational thinking, and the literature on the ‘good farmer’. The experts’ responses were used to discuss and contextualize the farmer’s answers. We found that the farmers’ mental model of biodiversity is associated to different aspects of agricultural management practices and farmers’ roles in mountain agricultural landscapes. Instrumental values of biodiversity are negative and strongly perceived as such by farmers, while relational values associated with biodiversity are positive, but more weakly perceived. These differing perceptions and values seem to be associated with two roles that farmers have, as producers and landscape stewards, and how they value fodder quantity and quality. Most farmers don’t include considerations related to the conservation of biodiversity in their management decisions, and mostly do not envision any changes in biodiversity or management in the future. Effective biodiversity conservation in Alpine grasslands will therefore need to tap into these dual roles and the associated instrumental and relational values of biodiversity for a meaningful dialogue on conservation.

So far, tendon regeneration has mainly been analyzed independent from its adjacent tissues. However, the subacromial bursa in particular appears to influence the local inflammatory milieu in the shoulder. The resolution of local inflammation in the shoulder tissues is essential for tendon regeneration, and specialized pro-resolving mediators (SPMs) play a key role in regulating the resolution of inflammation. Here, we aimed to understand the influence of the bursa on disease-associated processes in neighboring tendon healing. Bursa tissue and bursa-derived cells from patients with intact, moderate and severe rotator cuff disease were investigated for the presence of pro-resolving and inflammatory mediators, as well as their effect on tenocytes and sensitivity to mechanical loading by altering SPM signaling mediators in bursa cells. SPM signal mediators were present in the bursae and altered depending on the severity of rotator cuff disease. SPMs were particularly released from the bursal tissue of patients with rotator cuff disease, and the addition of bursa-released factors to IL-1β-challenged tenocytes improved tenocyte characteristics. In addition, mechanical loading modulated pro-resolving processes in bursa cells. In particular, pathological high loading (8% strain) increased the expression and secretion of SPM signaling mediators. Overall, this study confirms the importance of bursae in regulating inflammatory processes in adjacent rotator cuff tendons.