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Drug usage in early adolescence (age 14) was related to concurrent and preschool personality characteristics for a sample of 54 girls and 51 boys. The personality concomitants and antecedents of drug use differed somewhat as a function of gender and the drug used. At age 14, for both sexes, the use of marijuana was related to ego undercontrol, while the use of harder drugs reflected an absence of ego-resiliency, with undercontrol also a contributing factor. At ages 3/4, subsequent adolescent drug usage in girls related to both undercontrol and lower ego-resiliency. In boys, adolescent drug usage related strongly, during their nursery school years, to undercontrol and with resiliency having no long-term implications. Early family environment related to adolescent drug usage in girls but not in boys. Drug usage in adolescent girls was related to homes earlier identified as unstructured and laissez-faire, where there was little pressure to achieve. Drug usage related to other substance use and, in boys, to IQ decline from age 11 to age 18. Implications of these results for contemporary views regarding adolescent drug usage are discussed. [ABSTRACT FROM AUTHOR]

Dicoumarol (DIC) modulates the intracellular metabolism of mitomycin C (MC) in vitro, increasing the toxicity of MC to hypoxic EMT6 cells and decreasing its toxicity to aerobic cells. The present experiments assessed whether DIC could be used to increase the therapeutic ratio attainable in vivo when MC was used as an adjunct to radiotherapy. Experiments with transplanted EMT6 tumors in mice showed that DIC increased the toxicity of MC to hypoxic tumor cells and increased the antineoplastic efficacy of regimens combining MC with radiation. DIC did not increase the hematologic toxicity of MC, and pretreatment with DIC plus MC did not augment radiation-induced skin reactions. The increase in antineoplastic effect was therefore obtained without a concomitant increase in normal tissue toxicities, and therapeutic gain was obtained. [ABSTRACT FROM AUTHOR]

Purpose: Much debate exists about the superiority of navigated versus conventional instrumentation for achieving optimal balance and alignment during total knee arthroplasty (TKA). Recent registry data indicate no long-term survivorship benefit for TKAs performed using technology assistance, despite the added resource and financial costs. However, outcome comparisons are confounded by varying surgeon techniques and targets for ideal balance and alignment. This study aimed to investigate alignment or balance outcome differences between navigated and conventionally instrumented TKAs performed using an identical operative sequence and alignment strategy., Methods: Fifty navigated and 50 conventionally instrumented primary TKAs, using an identical inverse kinematic alignment strategy, were included. Navigation equipment was used intraoperatively to 'post-cut' record the conventionally instrumented TKAs. Intraoperative balance, range, and alignment; and post-operative radiographic accuracy for restoration of constitutional alignment were compared., Results: Forty-nine navigated and 49 conventionally instrumented TKAs were compared (n = 2 excluded due to inadequate radiographs). No preoperative demographic or deformity severity differences existed. No intraoperative balance, range or alignment difference existed. Neither technique was more accurate for restoration of constitutional alignment., Conclusion: Whilst large registry data may be confounded by uncaptured variables such as surgeon balancing techniques or surgeon alignment strategy preferences, this study found no alignment or balance differences between navigated versus conventionally instrumented TKA techniques for a surgeon and technique-controlled study. Although the increased resources necessary for technology assistance are not justified by this study, further studies may identify significance using larger samples or comparison of alternative outcomes., Level of Evidence: Level II., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Cervical cancer remains the fourth most frequently diagnosed cancer worldwide, with brachytherapy an important modality of treatment. Patients often rely on YouTube for cancer-related information, yet few studies have evaluated these videos. This study aims to describe and evaluate YouTube videos available to patients relating to cervical cancer brachytherapy. YouTube was searched using pre-defined cervical cancer brachytherapy search terms in January, 2023. Videos were sorted by relevance and the first 50 videos from each search were collected. Duplicates were removed and exclusion criteria applied. Videos were evaluated for general parameters, source information, and content. Descriptive analyses were carried out. 47 unique videos were included in the analysis. Around half of videos were published within 3 years of the search date. Median video length was 4 min and 42 s. Commonly, videos were published in the USA (55%). Two-thirds of videos were aimed towards a patient audience. Overall, the content of 40% of videos related to cervical cancer, 94% related to radiation therapy including brachytherapy, and 51% directly related to the use of brachytherapy in the treatment of cervical cancer. Only 15% of videos overviewed the patient-relevant information of brachytherapy side effects. Some videos (13%) were advertisements and few (4%) contained grossly inaccurate information. Videos collectively presented an overview of the treatments for cervical cancer including brachytherapy, although few included pertinent patient-relevant information and some contained inaccurate information. Overall, this highlights the need for more clear, accurate, and patient education-focused online resources., Competing Interests: Declarations. Ethics Approval: Not applicable. Consent for Publication: Not applicable. Competing Interests: The authors declare they have no competing interest in the preparation or publication of this article., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Purpose: Restricted inverse kinematic alignment (iKA) is a contemporary alignment strategy for total knee arthroplasty (TKA), commonly performed with robotic assistance. While superior clinical results are reported for kinematic-type alignment strategies, registry data indicate no survivorship benefit for navigation or robotic assistance. This study aimed to determine the efficacy of an instrumented, restricted iKA technique for achieving patient-specific alignment., Methods: Seventy-nine patients undergoing 84 TKAs (five bilateral procedures) using an iKA technique were included for preoperative and postoperative lower limb alignment analysis. The mean age was 66.5 (range: 43-82) with 33 male and 51 female patients. Artificial intelligence was employed for radiographic measurements. Alignment profiles were classified using the Coronal Plane Alignment of the Knee (CPAK) system. Preoperative and postoperative alignment profiles were compared with subanalyses for preoperative valgus, neutral and varus profiles., Results: The mean joint-line convergence angle (JLCA) reduced from 2.5° to -0.1° postoperatively. The mean lateral distal femoral angle (LDFA) remained unchanged postoperatively, while the mean medial proximal tibial angle (MPTA) increased by 2.5° (p = 0.001). By preservation of the LDFA and restoration of the MPTA, the mean hip knee ankle angle (HKA) moved through 3.5° varus to 1.2° valgus. The CPAK system was used to visually depict changes in alignment profiles for preoperative valgus, neutral and varus knees; with 63% of patients observing an interval change in classification., Conclusion: Encouraged by the latest evidence supporting both conventional instrumentation and kinematic-type TKA strategies, this study describes how a restricted, conventionally instrumented iKA technique may be utilised to restore constitutional lower limb alignment., Level of Evidence: Level III., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: For primary total knee arthroplasty (TKA), there is an increasing trend towards patient-specific alignment strategies such as kinematic alignment (KA) and inverse kinematic alignment (iKA), which by restoring native joint mechanics may yield higher patient satisfaction rates. Second, the most recent Australian joint registry report describes favourable revision rates for conventionally instrumented TKA compared to technology-assisted techniques such as those using navigation, robotics or custom-cutting blocks. The aim of this technique article is to describe in detail a surgical technique for TKA that: (1) utilises the principles of iKA and (2) uses conventionally instrumented guided resections thereby avoiding the use of navigation, robotics or custom blocks., Methods: A TKA technique is described, whereby inverse kinematic principles are utilised and patient-specific alignment is achieved. Additionally, the patellofemoral compartment of the knee is restored to the native patellofemoral joint line. The sequenced technical note provided may be utilised for cemented or cementless components; cruciate retaining or sacrificing designs and for fixed or rotating platforms., Results: An uncomplicated, robust and reproducible technique for TKA is described., Discussion: Knee arthroplasty surgeons may wish to harness the emerging benefits of both a conventionally instrumented technique and a patient-specific alignment strategy., Level of Evidence: Level V., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. © RSNA, 2024 Supplemental material is available for this article.

Many people living with dementia are 'on the margins', not accessing services and support, despite policy and care advancements. The COVID-19 pandemic exacerbated this, with the closure of face-to-face support during lockdowns in the UK and globally. The aim of the 'Beyond the Margins' project was to develop, implement, and evaluate a face-face programme of support with, by and for people with direct experience of dementia who are on the margins of existing services and support. In March 2020 the project was interrupted by the outbreak of the COVID-19 pandemic and it changed to an online format. The three-phase participatory action research project included 40 people living with dementia, 26 care partners and 31 health and social care practitioners. A seven-week online personal development programme called Getting On with Life (GO) was developed, delivered, and evaluated. This paper focuses on the participatory approaches used to develop and implement the GO programme, and the resulting aspects of its approach to facilitation and content. Key features include the GO Programme's principles of providing a safe and a respectful space, and the programme's values of: Everyone who comes already knows things, can learn things and can teach things; Doing things 'with' each other, rather than 'for' or 'to' each other; Personalised goals-led by the needs of participants rather than an imposed agenda. A key finding was the importance of developing post-diagnostic programmes as a 'sandwich', providing a safe space for learning that is preceded by understanding pathways to access the programme and followed by explicit consideration of the next steps in increasing social engagement.

Introduction: With routine catheterization and low urine output pre-transplant, renal transplant recipients (RTRs) may be at risk of urethral stricture disease post-transplant. The objective of this study was to characterize new urethral stricture disease in males following renal transplant., Methods: A retrospective chart review was carried out on all male RTRs at Vancouver General Hospital who developed urethral strictures from October 2009-2019. Descriptive analyses were conducted on patient characteristics. Comparative analyses against non-stricture RTRs were carried out., Results: Of 636 RTRs, 18 (2.8%) developed a postoperative urethral stricture. Median time from transplant to stricture discovery was 56 days (range 8-618 days). One-third of stricture patients had prior risk factors for stricture formation. Post-transplant, 77.8% presented symptomatically, with 61.1% requiring intervention. Overall graft survival rate was 88.9% among the RTR stricture group; 16.7% experienced acute rejection and 22.2% had delayed graft function (DGF). There was no significant association between developing postoperative urethral stricture and urinary tract infection (Chi-squared [X 2 ]=0.04, p=0.84; odds ratio [OR ] 0.81, 95% confidence interval [CI] 0.1-6.21), DGF (X 2 =0.14, p=0.70; OR 0.8, CI 0.26-2.48), or acute rejection (X 2 =2.02, p=0.14; OR 2.55, CI 0.71-9.12)., Conclusions: De novo post-transplant urethral stricture rates appear to occur at a higher rate than the general population and contribute to patient morbidity. Stricture disease should be considered post-transplantation in patients with voiding dysfunction, even if they don't have prior risk factors. Multicenter studies should be considered to elucidate any relationship between urethral stricture and graft survival.

Cast immobilization remains the standard of care in managing pediatric fractures. Cast complications often result in emergency department visits, office calls and visits, or lasting patient morbidities that burden the healthcare institution from a time and economic standpoint. The purpose of this quality improvement project was to create a multimodal cast care education protocol with an aim of decreasing cast complications over a 6-week period. Qualified patients (0-18) placed in cast immobilization received a quick response (QR) code sticker on their casts linked to a custom cast care website with text, pictures, and video instructions. Incidence of cast complications, complication type, effect(s) on workflow, and patient demographics were recorded. The complication rate declined 7.6%, but it was not statistically significant. Continuous access to clinic-specific cast instructions demonstrates decreased cast complications in pediatric populations, and this approach to patient education can be easily utilized across all medical specialties., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2022 by National Association of Orthopaedic Nurses.)

Phosphorus (P) is essential for plant growth. Arbuscular mycorrhizal fungi (AMF) aid its uptake by acquiring P from sources distant from roots in return for carbon. Little is known about how AMF colonise soil pore-space, and models of AMF-enhanced P-uptake are poorly validated. We used synchrotron X-ray computed tomography to visualize mycorrhizas in soil and synchrotron X-ray fluorescence/X-ray absorption near edge structure (XRF/XANES) elemental mapping for P, sulphur (S) and aluminium (Al) in combination with modelling. We found that AMF inoculation had a suppressive effect on colonisation by other soil fungi and identified differences in structure and growth rate between hyphae of AMF and nonmycorrhizal fungi. Our results showed that AMF co-locate with areas of high P and low Al, and preferentially associate with organic-type P species over Al-rich inorganic P. We discovered that AMF avoid Al-rich areas as a source of P. Sulphur-rich regions were found to be correlated with higher hyphal density and an increased organic-associated P-pool, whilst oxidized S-species were found close to AMF hyphae. Increased S oxidation close to AMF suggested the observed changes were microbiome-related. Our experimentally-validated model led to an estimate of P-uptake by AMF hyphae that is an order of magnitude lower than rates previously estimated - a result with significant implications for the modelling of plant-soil-AMF interactions., (© 2022 The Authors New Phytologist © 2022 New Phytologist Foundation.)

Ex vivo expansion conditions used to generate T cells for immunotherapy are thought to adopt metabolic phenotypes that impede therapeutic efficacy in vivo . The comparison of five different culture media used for clinical T cell expansion revealed unique optima based on different output variables, including proliferation, differentiation, function, activation, and mitochondrial phenotypes. The extent of proliferation and function depended on the culture media rather than stimulation conditions. Moreover, the expanded T cell end products adapted their metabolism when switched to a different media formulation, as shown by glucose and glutamine uptake and patterns of glucose isotope labeling. However, adoption of these metabolic phenotypes was uncoupled to T cell function. Expanded T cell products cultured in ascites from ovarian cancer patients displayed suppressed mitochondrial activity and function irrespective of the ex vivo expansion media. Thus, ex vivo T cell expansion media have profound impacts on metabolism and function., Competing Interests: R.J.D. is a member of the Scientific Advisory Boards of Vida Ventures and Agios Pharmaceuticals and is a founder of Atavistik Biosciences. J.R.C. is an inventor on a patent application for HPLM (PCT/US2017/061,377) assigned to the Whitehead Institute. C.S. is a Principal Scientist at STEMCELL Technologies. J.Y. is a Scientist at STEMCELL Technologies. STEMCELL Technologies provided reagents in kind for the study but were not involved in funding the study, performing experiments, or analyzing the data., (© 2022 The Authors.)

Objectives: This study explores knowledge and utilization of, barriers to, and preferences for harm reduction services among street-involved young adults (YA) in Boston, Massachusetts., Methods: This cross-sectional survey of YA encountered between November and December 2019 by a longstanding outreach program for street-involved YA. We report descriptive statistics on participant-reported substance use, knowledge and utilization of harm reduction strategies, barriers to harm reduction services and treatment, and preferences for harm reduction service delivery., Results: The 52 YA surveyed were on average 21.4 years old; 63.5% were male, and 44.2% were Black. Participants reported high past-week marijuana (80.8%) and alcohol (51.9%) use, and 15.4% endorsed opioid use and using needles to inject drugs in the past six months. Fifteen (28.8%) YA had heard of "harm reduction", and 17.3% reported participating in harm reduction services. The most common barriers to substance use disorder treatment were waitlists and cost. Participants suggested that harm reduction programs offer peer support (59.6%) and provide a variety of services including pre-exposure prophylaxis (42.3%) and sexually transmitted infection testing (61.5%) at flexible times and in different languages, including Spanish (61.5%) and Portuguese (17.3%)., Conclusions: There is need for comprehensive, YA-oriented harm reduction outreach geared toward marginalized YA and developed with YA input to reduce barriers, address gaps in awareness and knowledge of harm reduction, and make programs more relevant and inviting to YA.