Self-regulation of sex offending, future pathways and the Good Lives Model : applications and problems

Two theoretical developments, the Self-Regulation Model of the Offence and Relapse Process and the Good Lives Model, have recently offered promise in the advancement of sex offender treatment. The present paper represents a preliminary attempt to operationalize these theoretical principles by developing a number of practical treatment procedures. We have employed the method of a life map, which traces personal development from birth and which incorporates long-term future projections. This includes all actions, events, incidents and skills (whether positive or negative), which have led to a sense of self-esteem and the development of personal values. These will include risk factors and criminogenic needs which lead to offending as well as positive experiences and self-resources which can be incorporated into a future Good Lives Pathway. Two case illustrations are presented, which demonstrate the way in which all experiences from the past can be incorporated into alternative future pathways. These pathways will include positive self-resources and protective variables which develop into a non-offending future and negative self-resources with risk variables which develop into an offending future. The cases illustrate the way in which GLM and self-regulation pathways can be combined in a robust practical treatment procedure. Practical difficulties inherent in the procedure are also discussed

Improving accuracy of total knee component cementation: description of a simple technique

<p>Abstract</p> <p>Background</p> <p>Total knee arthroplasty represents a common orthopedic surgical procedure. Achieving proper alignment of its components with the predrilled patellar and tibial peg holes prior to polymerization of the bone cement can be challenging.</p> <p>Technique</p> <p>After establishing the femoral, patellar and tibial bone cuts, the cancellous bone around the tibial keel, as well as the peg holes for the patella and femoral components are marked with methylene blue using a cotton swab stick. If bone cement is then placed onto the cut and marked bone edges, the methylene blue leaches through the bone cement and clearly outlines the tibial keel and predrilled femoral and patellar peg holes. This allows excellent visualization of the bone preparations for each component, ensuring safe and prompt positioning of TKA components while minimizing intraoperative difficulties with component alignment while the cement hardens.</p> <p>Conclusion</p> <p>The presented technical note helps to improve the accuracy and ease of insertion when the components of total knee arthroplasty are impacted to their final position.</p

Bortezomib Augments Natural Killer Cell Targeting of Stem-Like Tumor Cells.

Tumor cells harboring stem-like/cancer stem cell (CSC) properties have been identified and isolated from numerous hematological and solid malignancies. These stem-like tumor cells can persist following conventional cytoreductive therapies, such as chemotherapy and radiotherapy, thereby repopulating the tumor and seeding relapse and/or metastasis. We have previously shown that natural killer (NK) cells preferentially target stem-like tumor cells via non- major histocompatibility complex (MHC) restricted mechanisms. Here, we demonstrated that the proteasome inhibitor, bortezomib, augments NK cell targeting of stem cell-like tumor cells against multiple solid human tumor-derived cancer lines and primary tissue samples. Mechanistically, this was mediated by the upregulation of cell surface NK ligands MHC class I chain-related protein A and B (MICA and MICB) on aldehyde dehydrogenases (ALDH)-positive CSCs. The increased expression of MICA and MICB on CSC targets thereby enhanced NK cell mediated killing in vitro and ex vivo from both human primary tumor and patient-derived xenograft samples. In vivo, the combination of bortezomib and allogeneic NK cell adoptive transfer in immunodeficient mice led to increased elimination of CSCs as well as tumor growth delay of orthotopic glioblastoma tumors. Taken together, our data support the combination bortezomib and NK transfer as a strategy for both CSC targeting and potentially improved outcomes in clinical cancer patients

Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly

BackgroundA recent meta-analysis has suggested that patients aged >65 have worse outcomes with radiocephalic arteriovenous fistulas (RCAVFs) compared with brachiocephalic arteriovenous fistulas (BCAVFs). We hypothesized that outcomes in patients aged ≥80—a rapidly expanding cohort within this elderly group—might be skewing the results, and that age >65 may not be a contraindication to RCAVF formation. This study examined the effect of age group (<65, 65 to 79, ≥80) on functional outcomes (use; primary and secondary functional patency) in RCVAFs and BCAVFs.MethodsWe identified the outcomes of all patients undergoing a first surgical access procedure for a RCAVF or BCVAF between January 1, 2000, and December 31, 2005. We examined the effect of age and other factors including sex, diabetes mellitus, hypertension, late referral (<3 months before dialysis), dialysis before surgical access, preoperative duplex ultrasound imaging, and ethnicity on non-AVF use and primary and secondary functional AVF patency. Logistic regression and Cox proportional hazards regression models were used.ResultsFrom a total of 658 patients, 361 had a RCAVF, and 297 had a BCAVF. Their median age was 68.5 years (interquartile range [IQR], 54.4 to 76.5 years), and 288 (43.8%) were aged <65 years, 274 (41.6%) were 65 to 79, and 96 (14.6%) were ≥80. Age did not influence the site of the first surgical access (P = .874). Only 85.7% of patients actually progressed to hemodialysis, and the RCAVF or BCAVF in 45.7% of those was never used for dialysis. Female sex (hazard ratio [HR], 2.24; 95% confidence interval [CI] 1.387 to 3.643; P = .001) was the only factor associated with an increase risk of RCAVF nonuse, whereas diabetes (HR, 2.095; 95% CI, 1.261 to 3.482; P = .004) was the only factor associated with an increase risk of BCAVF nonuse. The respective primary patency rates at 1 and 2 years for RCAVFs were 46.0% and 27.1% for patients <65, 47.0% and 36.0% for those 65 to 79, and 45.7% and 38.1% for those ≥80. Only female sex (HR, 1.679; 95% CI, 1.261 to 2.236; P = .001) and prior hemodialysis (HR, 1.363; 95% CI, 1.0.29 to 1.804; P = .031) were associated with loss of patency of RCAVFs. The primary functional patency rates for BCAVFs at 1 and 2 years were 39.3% and 31.0% for those <65 years; 53.30% and 37.5% for those 65 to 79, and 46.3% and 42.6% for those ≥80. No factors analyzed were associated with loss of primary functional patency of BCAVFs.ConclusionsAge did not affect usability, primary or secondary patency of either RCAVFs or BCAVFs. Although patient selection is important, even patients ≥80 years who are considered suitable for surgical placement of access should not be denied a RCAVF solely because of age

Hyporheic Exchange and Water Chemistry of Two Arctic Tundra Streams of Contrasting Geomorphology

The North Slope of Alaska’s Brooks Range is underlain by continuous permafrost, but an active layer of thawed sediments develops at the tundra surface and beneath streambeds during the summer, facilitating hyporheic exchange. Our goal was to understand how active layer extent and stream geomorphology influence hyporheic exchange and nutrient chemistry. We studied two arctic tundra streams of contrasting geomorphology: a high-gradient, alluvial stream with riffle-pool sequences and a low-gradient, peat-bottomed stream with large deep pools connected by deep runs. Hyporheic exchange occurred to ~50 cm beneath the alluvial streambed and to only ~15 cm beneath the peat streambed. The thaw bulb was deeper than the hyporheic exchange zone in both stream types. The hyporheic zone was a net source of ammonium and soluble reactive phosphorus in both stream types. The hyporheic zone was a net source of nitrate in the alluvial stream, but a net nitrate sink in the peat stream. The mass flux of nutrients regenerated from the hyporheic zones in these two streams was a small portion of the surface water mass flux. Although small, hyporheic sources of regenerated nutrients help maintain the in-stream nutrient balance. If future warming in the arctic increases the depth of the thaw bulb, it may not increase the vertical extent of hyporheic exchange. The greater impacts on annual contributions of hyporheic regeneration are likely to be due to longer thawed seasons, increased sediment temperatures or changes in geomorphology