Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty.

BACKGROUND: A cause of groin pain after total hip arthroplasty (THA) is mechanical irritation or impingement of the iliopsoas tendon. The incidence is about 4%. If conservative therapy fails, an arthroscopic release of the iliopsoas tendon can be performed. The aim of the study was to assess the mid-term clinical outcome after arthroscopic release. We hypothesize that good results can be achieved by a minimally invasive endoscopic procedure. METHODS: Using our in-house database, all patients who received an endoscopic release of the iliopsoas tendon due to mechanical irritation after THA were identified. Inclusion criteria were mechanical irritation of the iliopsoas tendon after cementless THA with minimal acetabular component prominence. Exclusion criteria were marked prominence of the acetabular component and groin pain after THA for any other reason. In these patients, the modified Harris Hip Score (mHHS), the pain level using the numerical analogue scale and the UCLA Activity Score were measured. The mean follow-up period was 7 ± 3.8 (2.6-11.7) years. RESULTS: 25 patients were identified in whom an arthroscopic release of the iliopsoas tendon had been performed since 2007. The data of 20 patients were available at follow-up. The gender ratio was 1:1, the average age at the time of arthroscopy was 59 ± 27.7 (52-78) years. The average interval between THA and arthroscopy was 6.3 ± 4.0 (1.7-15) years. The mHHS showed a significant improvement from preoperative 31.2 ± 9.8 (17.6-47.3) to 82.0 ± 9.8 (46.2-100) points (p = 0.001). The pain level on the NAS decreased significantly from 8.5 ± 1.2 (7-10) to 2.5 ± 1.8 (0-6) points (p = 0.001). The activity level based on the UCLA Activity Score raised from 4.0 ± 2.7 (0-7) to 6.5 ± 1.8 (3-9) (p = 0.09). CONCLUSION: Mechanical irritation and impingement of the iliopsoas tendon is an important diagnosis to be considered in persistent groin pain after total hip arthroplasty. In failure of non-operative treatment, good clinical results can be achieved with arthroscopic release and the pain level can be significantly reduced. LEVEL OF EVIDENCE: IV.

[Gluteal insufficiency]. / Gluteale Insuffizienz.

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.

[Surgical refixation of gluteal tendon tears by mini-open double-row technique]. / Knotenlose Doppelreihenrefixation bei Glutealsehnenruptur.

OBJECTIVE: Stable refixation of gluteal tendons at the anatomic footprint by large-area contact by the means of knotless double-row anchor fixation (HipBridge technique). INDICATIONS: Symptomatic tear of gluteus medius and/or gluteus minimus tendon with persisting pain after nonsurgical treatment, or primarily reconstructable mass rupture with gluteal insufficiency, revision surgeries. CONTRAINDICATIONS: Primary nonreconstructable mass ruptures, atrophic or fatty degeneration of gluteal muscles grade Goutallier 4, local infections. SURGICAL TECHNIQUE: Lateral position, longitudinal skin incision over greater trochanter, longitudinal incision of iliotibial band, resection of trochanteric subgluteus maximus bursa, longitudinal splitting of gluteal tendons over tear, debridement and mobilisation of tendons for sufficient distalisation to tendon footprint at anterior and lateral trochanteric facet, debridement of sclerotic greater trochanter, punching and tapping of proximal row, placement of two proximal anchors loaded with nonresorbable suture tape, fan-shaped four times gluteal tendon perforation at myotendinous transition zone, double-V-shape crossing of suture tapes, punching and tapping of distal row, fixation of crossed tapes with two distal knotless suture anchors under mild pretensioning of gluteal tendons, side-to-side tendon suture, vastogluteal and iliotibial band closure, wound closure. POSTOPERATIVE MANAGEMENT: Stage-dependent physiotherapy with partial weight-bearing with 20 kg for 6 weeks, no active abduction, no adduction and no external rotation in flexion for 6 weeks after surgery. From week 7 after surgery, free range of motion, active-assisted abduction and increase in weight-bearing by 15 kg/week. No peak load for 4 months. Thromboembolic prophylaxis until full weight-bearing is reached. RESULTS: Success rates of 80-90% can be expected in cases with no or only minor muscle atrophy.

Integrating groundwater stress in life-cycle assessments - An evaluation of water abstraction.

Understanding groundwater abstraction effects is vital for holistic impact assessments in areas depending on groundwater resources. The objective of our study was to modify the state-of-the-art AWaRe (available water remaining), freshwater impact assessment specifically for use in LCAs in areas dependent on groundwater resources. The new method, called "AGWaRe" (available groundwater remaining), reflects groundwater availability, based on a fraction of available groundwater remaining locally relative to a reference. Furthermore, our method increases spatial resolution beyond 1770 km2 grid cells and adjusts demarcations in order to improve the representation of the heterogeneity of groundwater catchments. The applicability of AGWaRe was demonstrated on three groundwater systems producing 5 million m3 water for the city of Copenhagen, namely Advanced Treatment of Groundwater, Simple Treatment of Groundwater and Infiltration of Reclaimed water. Results were normalised to compare with other effects of supplying water to an average Danish person. The normalised impacts for drinking water for one person ranged between 0.1 and 39 PE (person equivalent) for the three systems, which indicates that effects on groundwater resources differ substantially between systems. A comparative LCA of these groundwater systems shows that other impact categories range between 0 and 1 PE/person. Advanced Treatment of Groundwater generally has the lowest effect, for example <50% of the other groundwater systems in Global Warming Potential. The AGWaRe results indicate that freshwater impacts from Simple Treatment of Groundwater are up to 100 times greater than for Infiltration of Reclaimed water. Furthermore, AGWaRe exposes differences between the groundwater systems that AWaRe cannot evaluate, because one AWaRe cell covers two of the systems in question. These improvements are crucial for groundwater managers looking to include sustainability considerations in their analysis and decision-making.

ASTA - A method for multi-criteria evaluation of water supply technologies to Assess the most SusTainable Alternative for Copenhagen.

Utilities in larger cities have to make complex decisions planning future investments in urban water infrastructure. Changes are driven by physical water stress or political targets for environmental water flows e.g. through the implementation of the European water framework directive. To include these environmental, economic and social sustainability dimensions we introduce a novel multi-criteria assessment method for evaluation of water supply technologies. The method is presented and demonstrated for four alternatives for water supply based on groundwater, rain- & stormwater or seawater developed for augmenting Copenhagen's current groundwater based water supply. To identify the most sustainable technology, we applied rank order distribution weights to a multi-criteria decision analysis to combine the impact assessments of environment, economy and society. The three dimensions were assessed using 1) life-cycle assessment, 2) cost calculations taking operation and maintenance into account and 3) the multi-criteria decision analysis method Analytical hierarchy process. Specialists conducted the life-cycle assessment and cost calculations and the multi-criteria decision analyses were based on a stakeholder workshop gathering stakeholders relevant for the specific case. The workshop reached consensus on three sets of ranked criteria. Each set represented stakeholder perspectives with first priority given to one of the three sustainability dimensions or categories. The workshop reached consensus and when the highest weight was assigned to the environmental dimension of sustainability then the alternative of 'Rain- & stormwater harvesting' was the most sustainable water supply technology; when the highest weight was assigned to the economy or society dimensions then an alternative with 'Groundwater abstraction extended with compensating actions' was considered the most sustainable water supply technology. Across all three sets of ranked weights, the establishment of new well fields is considered the least sustainable alternative.

Higgs physics at the CLIC electron-positron linear collider.

The Compact Linear Collider (CLIC) is an option for a future [Formula: see text] collider operating at centre-of-mass energies up to [Formula: see text], providing sensitivity to a wide range of new physics phenomena and precision physics measurements at the energy frontier. This paper is the first comprehensive presentation of the Higgs physics reach of CLIC operating at three energy stages: [Formula: see text], 1.4 and [Formula: see text]. The initial stage of operation allows the study of Higgs boson production in Higgsstrahlung ([Formula: see text]) and [Formula: see text]-fusion ([Formula: see text]), resulting in precise measurements of the production cross sections, the Higgs total decay width [Formula: see text], and model-independent determinations of the Higgs couplings. Operation at [Formula: see text] provides high-statistics samples of Higgs bosons produced through [Formula: see text]-fusion, enabling tight constraints on the Higgs boson couplings. Studies of the rarer processes [Formula: see text] and [Formula: see text] allow measurements of the top Yukawa coupling and the Higgs boson self-coupling. This paper presents detailed studies of the precision achievable with Higgs measurements at CLIC and describes the interpretation of these measurements in a global fit.

Transition from paediatric to adult care: what makes it easier for parents?

OBJECTIVE: To assess differences between parents of adolescents with chronic illness (CI) going through a self-reported easy or difficult transfer. METHODS: Seventy-two parents of CI youths who had already transferred to adult care were divided according to whether they considered that the transfer had been easy (n = 45) or difficult (n = 27). We performed a bivariate analysis comparing both groups and variables with a significance level < .1 were included in a logistic regression. Results are presented as adjusted odds ratio (aOR). RESULTS: Over one third of parents (27/72) reported a difficult transfer. At the multivariate level, higher socioeconomic status (aOR: 7.74), parents feeling ready for transfer (aOR: 6.54) and a good coordination between teams (aOR: 7.66) were associated with an easy transfer. CONCLUSIONS: An easy transfer for parents is associated with feeling ready and considering that the coordination between teams is good. Health providers should consider these requisites for a successful transfer.

Enhancing dopaminergic signaling and histone acetylation promotes long-term rescue of deficient fear extinction.

Extinction-based exposure therapy is used to treat anxiety- and trauma-related disorders; however, there is the need to improve its limited efficacy in individuals with impaired fear extinction learning and to promote greater protection against return-of-fear phenomena. Here, using 129S1/SvImJ mice, which display impaired fear extinction acquisition and extinction consolidation, we revealed that persistent and context-independent rescue of deficient fear extinction in these mice was associated with enhanced expression of dopamine-related genes, such as dopamine D1 (Drd1a) and -D2 (Drd2) receptor genes in the medial prefrontal cortex (mPFC) and amygdala, but not hippocampus. Moreover, enhanced histone acetylation was observed in the promoter of the extinction-regulated Drd2 gene in the mPFC, revealing a potential gene-regulatory mechanism. Although enhancing histone acetylation, via administering the histone deacetylase (HDAC) inhibitor MS-275, does not induce fear reduction during extinction training, it promoted enduring and context-independent rescue of deficient fear extinction consolidation/retrieval once extinction learning was initiated as shown following a mild conditioning protocol. This was associated with enhanced histone acetylation in neurons of the mPFC and amygdala. Finally, as a proof-of-principle, mimicking enhanced dopaminergic signaling by L-dopa treatment rescued deficient fear extinction and co-administration of MS-275 rendered this effect enduring and context-independent. In summary, current data reveal that combining dopaminergic and epigenetic mechanisms is a promising strategy to improve exposure-based behavior therapy in extinction-impaired individuals by initiating the formation of an enduring and context-independent fear-inhibitory memory.

[Endoprosthetic tumor replacement : Reconstruction of the extensor mechanism and complications]. / Tumorendoprothetik : Rekonstruktion des Streckapparates und Komplikationen.

BACKGROUND: The reconstruction of the extensor mechanism around the knee is an essential part of tumorresection and tumor arthroplasty in orthopaedic oncology for functional rehabilitation of quality of life and daily activities. OBJECTIVES: Operative procedures, treatment options and management of complications with reconstruction of the extensor mechanism after tumor resection around the knee depend on the type of arthroplasty. MATERIALS AND METHODS: Description of the different treatment option for extensor deficiency divided into infra- and suprapatellar modalities. RESULTS: The operative procedure is always an individual decision depending on the size of the tumor and its localisation. The extensor mechanism is reconstructed with autogenic, allogenic or synthetic material in combination with tumor arthroplasty. CONCLUSIONS: Extensor reconstruction (supra-/infrapatellar) is an essential part of tumor resection and tumor arthroplasty around the knee. Often, low functional results and high levels of complications (arthrofibrosis, rerupture extensor mechanism, periprosthetic joint infection) are seen in these highly demanding cases in orthopaedic oncology.

[Gluteal insufficiency: Pathogenesis, Diagnosis and Therapy]. / Gluteale Insuffizienz: Pathogenese, Diagnostik und Therapie.

INTRODUCTION: Gluteal insufficiency is a common and challenging complaint. New concepts in pathobiomechanics and improved clinical understanding of chronic gluteal dysfunction have unmasked gluteus medius (GMed) tears as an underlying cause of enhanced trochanteric pain syndrome (GTPS). These tears are often missed or misdiagnosed as bursitis, but lead to prolonged chronic peritrochanteric pain. Clinic: The clinical signs are often dull pain on the lateral hip aspect, reduced hip abduction strength with positive Trendelenburg testing and a tendency for the leg to external rotation, as the internal rotation strength is reduced. IMAGING: Radiography and ultrasound may be used to confirm the diagnosis, whereas MRI is the modality of choice for imaging. Compensatory hypertrophy of the tensor fascia latae muscle (TFL) and fatty involution (especially of the GMed) are also seen. THERAPY: Conservative treatment regimens for partial thickness tears involve hip joint centering and strengthening of abductor muscles, sparing TFL. Failed conservative treatment and full thickness tears are treated surgically. Partial tears can be addressed endoscopically with suture anchors for tendon footprint reconstruction. Larger tears involving the anterior and/or lateral facets of the tendon or failed conservative treatment are repaired with minimally invasive open reduction techniques. Double row suture anchor techniques provide anatomical tendon footprint reconstruction. Postoperative rehabilitation is prolonged, due to high acting forces in the peritrochanteric region, and needs to be carried out under professional surveillance. CONCLUSION: Reconstruction of gluteal tendon tears is often the only solution in the treatment of chronic hip pain due to gluteal insufficiency. Available data suggest that reduction in pain and restoration of abduction power can be achieved in mid-term follow-up.

[Transition in diabetology]. / Transition en diabétologie.

For patients with type I diabetes, transition from pediatric to adult care is a challenge due to complex treatment requirements and the physical, psychological and social changes of adolescence. Members of the care team must recognize that while these emerging adults need to develop self-management skills, this may conflict at times with the developmentally appropriate desire for increasing autonomy. The role of nursing in coordinating a successful transition is critical for maintaining continuity of patient-centered care that responds to the specific needs of these young adults.

Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†.

BACKGROUND: The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS: Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, ß = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS: With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS: Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER: NCT 00567554, www.clinicaltrials.gov.

[Follow-up and management of children born small for gestational age a endocrine and metabolic aspects]. / Suivi et prise en charge des enfants nés petits pour l'âge gestationnel: aspects endo- crinologiques et métaboliques.

Children born premature and/or small for gestational age (SGA) are at risk of growth and metabolic abnormalities. Catch-up growth occurs usually before the age of 2. In the absence of sufficient catch up growth, growth hormone (GH) treatment should be evaluated under certain conditions. Children who were born premature and/or SGA are at higher risk of insulin resistance and metabolic abnormalities, especially in case of excessive weight gain during the first months of life. Puberty in these children occurs normally or slightly advanced, with no effect on gonadic function or fertility. Each step of the development of premature and/or SGA children present specific risks, which the pediatrician has to follow. If necessary, the pediatric endocrinologist will initiate a specific management.

[Greater trochanteric pain syndrome]. / Peritrochantäre Schmerzsyndrome.

Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases.

Neoadjuvant bevacizumab and anthracycline-taxane-based chemotherapy in 678 triple-negative primary breast cancers; results from the geparquinto study (GBG 44).

BACKGROUND: We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS: Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m(2); q3w) followed by four cycles docetaxel (100 mg/m(2); q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. RESULTS: TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. CONCLUSIONS: The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates.

Life-cycle and freshwater withdrawal impact assessment of water supply technologies.

Four alternative cases for water supply were environmentally evaluated and compared based on the standard environmental impact categories from the life-cycle assessment (LCA) methodology extended with a freshwater withdrawal category (FWI). The cases were designed for Copenhagen, a part of Denmark with high population density and relatively low available water resources. FWI was applied at local groundwater catchments based on data from the national implementation of the EU Water Framework Directive. The base case of the study was the current practice of groundwater abstraction from well fields situated near Copenhagen. The 4 cases studied were: Rain & stormwater harvesting from several blocks in the city; Today's groundwater abstraction with compensating actions applied in the affected freshwater environments to ensure sufficient water flow in water courses; Establishment of well fields further away from the city; And seawater desalination. The standard LCA showed that the Rain & stormwater harvesting case had the lowest overall environmental impact (81.9 µPET/m(3)) followed by the cases relying on groundwater abstraction (123.5-137.8 µPET/m(3)), and that desalination had a relatively small but still important increase in environmental impact (204.8 µPET/m(3)). Rain & stormwater harvesting and desalination had a markedly lower environmental impact compared to the base case, due to the reduced water hardness leading to e.g. a decrease in electricity consumption in households. For a relevant comparison, it is therefore essential to include the effects of water hardness when comparing the environmental impacts of water systems of different hardness. This study also emphasizes the necessity of including freshwater withdrawal respecting the relevant affected geographical scale, i.e. by focusing the assessment on the local groundwater catchments rather than on the regional catchments. Our work shows that freshwater withdrawal methods previously used on a regional level can also be applied to local groundwater catchments and integrated into the standard LCA as an impact category. When standard LCA is extended to include impacts of freshwater withdrawal, rain & stormwater and seawater (0.09-0.18 compared to 11.45-17.16 mPET/m(3)) were the resources resulting in least overall environmental impact.

[Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition]. / Prise en charge des jeunes patients avec endocrinopathies pediatriques chroniques: les défis d'une transition souvent difficile.

The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.

Predictive value of HER2 serum levels in patients treated with lapatinib or trastuzumab -- a translational project in the neoadjuvant GeparQuinto trial.

BACKGROUND: We were able to demonstrate a predictive value of serum HER2 (sHER2) in patients receiving trastuzumab in the neoadjuvant GeparQuattro trial. However, the role of sHER2 in patients receiving neoadjuvant therapy (NT) with lapatinib is still unclear. METHODS: The neoadjuvant GeparQuinto trial compared trastuzumab vs lapatinib in addition to chemotherapy in HER2-positive primary breast cancer patients. The sHER2 levels were measured by enzyme-linked immunosorbant assay in 210 patients, of whom 109 (52%) patients received trastuzumab and 101 (48%) lapatinib at three different time points. RESULTS: Twenty-two percent of patients had elevated baseline sHER2 levels (>15 ng ml⁻¹). A decrease of sHER2 levels (>20%) in the trastuzumab and lapatinib-treated group during NT was seen in 44% and 24% of the patients, an increase of sHER2 levels (>20%) was seen in 6% and 41% of patients, respectively. Higher pre-chemotherapy sHER2 levels were associated with higher pathological complete remission (pCR) rates in the entire study cohort (OR 1.8, 95% CI 1.02-3.2, P=0.043). A decline of sHER2 levels (>20%) during NT was a predictor for pCR in the lapatinib-treated patient group (OR: 11.7, 95% CI 1.3-110, P=0.031). CONCLUSION: Results of this study demonstrate that sHER2 levels change differently during NT depending on the anti-HER2 treatment strategy. Elevated baseline sHER2 levels (>15 ng ml⁻¹) and a decrease of sHER2 levels (>20%) early after therapy initiation are both relevant criteria to predict response to lapatinib-based treatment.

Life cycle assessment of central softening of very hard drinking water.

Many consumers prefer softened water due to convenience issues such as avoidance of removing limescale deposits from household appliances and surfaces, and to reduce consumption of cleaning agents and laundry detergents leading to lower household expenses. Even though central softening of drinking water entailed an increased use of energy, sand and chemicals at the waterworks, the distributed and softened drinking water supported a decrease in consumption of energy and chemical agents in the households along with a prolonged service life of household appliances which heat water. This study used Life Cycle Assessment (LCA) to quantify the environmental impacts of central softening of drinking water considering both the negative effects at the waterworks and the positive effects imposed by the changed water quality in the households. The LCA modeling considered central softening of drinking water from the initial hardness of the region of study (Copenhagen, Denmark) which is 362 mg/L as CaCO(3) to a final hardness as CaCO(3) of 254 (a softening depth of 108) mg/L or 145 (a softening depth of 217) mg/L. Our study showed that the consumer preference can be met together with reducing the impact on the environment and the resource consumption. Environmental impacts decreased by up to 3 mPET (milli Personal Equivalent Targeted) and the break-even point from where central softening becomes environmentally beneficial was reached at a softening depth of only 22 mg/L as CaCO(3). Both energy-related and chemically related environmental impacts were reduced as well as the consumption of resources. Based on scarcity criteria, nickel was identified as the most problematic non-renewable resource in the system, and savings of up to 8 mPR (milli Person Reserve) were found.