NITRATE-CIN Study: Protocol of a Randomized (1:1) Single-Center, UK, Double-Blind Placebo-Controlled Trial Testing the Effect of Inorganic Nitrate on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography for Acute Coronary Syndromes.

BACKGROUND: Contrast-induced nephropathy (CIN), an acute kidney injury resulting from the administration of intravascular iodinated contrast media, is a significant cause of morbidity/mortality following coronary angiographic procedures in high-risk patients. Despite preventative measures intended to mitigate the risk of CIN, there remains a need for novel effective treatments. Evidence suggests that delivery of nitric oxide (NO) through chemical reduction of inorganic nitrate to NO may offer a novel therapeutic strategy to reduce CIN and thus preserve long term renal function. DESIGN: The NITRATE-CIN trial is a single-center, randomized, double-blind placebo-controlled trial, which plans to recruit 640 patients presenting with acute coronary syndromes (ACS) who are at risk of CIN. Patients will be randomized to either inorganic nitrate therapy (capsules containing 12 mmol KNO3) or placebo capsules containing potassium chloride (KCl) daily for 5 days. The primary endpoint is development of CIN using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A key secondary endpoint is renal function over a 3-month follow-up period. Additional secondary endpoints include serum renal biomarkers (e.g. neutrophil gelatinase-associated lipocalin) at 6 h, 48 h and 3 months following administration of contrast. Cost-effectiveness of inorganic nitrate therapy will also be evaluated. SUMMARY: This study is designed to investigate the hypothesis that inorganic nitrate treatment decreases the rate of CIN as part of semi-emergent coronary angiography for ACS. Inorganic nitrate is a simple and easy to administer intervention that may prove useful in prevention of CIN in at-risk patients undergoing coronary angiographic procedures.

Killer-cell immunoglobulin-like receptor assessment algorithms in haemopoietic progenitor cell transplantation: current perspectives and future opportunities.

Natural killer cells preferentially target and kill malignant and virally infected cells. Both these properties present compelling clinical utility in the field of haemopoietic progenitor cell transplantation (HPCT), potentially promoting a graft vs leukaemia effect in the absence of graft vs host disease and protecting against cytomegalovirus activation. Killer Ig-like receptors (KIR) play a central role in the cytotoxic action of natural killer cells, providing opportunity for improving transplantation outcomes by prioritising potential donors with optimal characteristics. Numerous algorithms for assessing KIR gene content as part of HPCT donor selection protocols exist, but no single model has been found to be universally applicable in all transplant centres. This review summarises several of the predominant strategies in KIR assessment algorithms, discussing their basic scientific principles, clinical utility and benefits to post-transplant outcomes. Finally, the review will consider how future donor selection protocols could develop towards unifying the concepts of KIR proteomics and genetics for optimising patient care.

Longitudinal Assessment of the Association Between Pornography Use and Sexual Satisfaction in Adolescence.

Pornography has been theorized to affect sexual satisfaction for decades, yet only two prospective studies, both conducted in the Netherlands, have explored this link among adolescents. Given the unprecedented availability of (online) sexually explicit content and the potential importance of its relationship to sexual satisfaction for young people, we have revisited the association between these variables in a less sexually permissive society. Using a panel sample of 775 female and 514 male Croatian high school students (Mage at baseline = 15.9 years, SD = 0.52) and latent growth curve modeling with six observation points, we did not find a significant association between changes in the frequency of adolescents' pornography use over time and their sexual satisfaction at wave six. The association between the initial levels of pornography use and sexual satisfaction, which, if present, would have indicated a possible relationship during middle adolescence, was also null. These patterns were similar across genders. Possible explanations for the difference between our results and the results of the previous studies are discussed.

Improving Regional Stroke Systems of Care.

PURPOSE OF REVIEW: Acute ischemic stroke (AIS) care is rapidly evolving. This review discusses current diagnostic, therapeutic, and process models that can expedite stroke treatment to achieve best outcomes. RECENT FINDINGS: Use of stent retrievers after selection via advanced imaging is safe and effective, and is an important option for AIS patients with large vessel occlusion (LVO). Significant time delays occur before and during patient transfers, and upon comprehensive stroke center (CSC) arrival, and have deleterious effects on functional outcome. Removing obstacles, enhancing inter-facility communication, and creating acute stroke management processes and protocols are paramount strategies to enhance network efficiency. Inter-departmental CSC collaboration can significantly reduce door-to-treatment times. Streamlined stroke systems of care may result in higher treatment rates and better functional outcomes for AIS patients, simultaneously conserving healthcare dollars. Stroke systems of care should be structured regionally to minimize time to treatment. A proactive approach must be employed; a management plan incorporating stroke team prenotification and parallel processes between departments can save valuable time, maximize brain salvage, and reduce disability from stroke.

Microplastics in the Solent estuarine complex, UK: An initial assessment.

Microplastics are known to be an increasing component found within both marine sediments and the water column. This study carried out an initial assessment of the levels of microplastics present within the Solent estuarine complex, focusing specifically on the water column. A plankton net trawl survey was carried out, with samples analysed using visual observation and Fourier Transform Infrared Spectroscopy (FT-IR). The study identified significant quantities of plastics, ranging in shape, with hot spots found at confluence points within the estuary. Though the FT-IR analysis was inconclusive, the nature of the samples indicates the effect of oceanographic conditions on the prevalent types of microplastics found, which in turn identifies key local sources such as wastewater treatment plants and the plastics industry as being the dominant inputs.

Sharps legislation and assessment of needle protection systems.

Needlestick injuries (NSIs) carry the potential for transmission of serious blood-borne infections and pose a significant risk to patients and healthcare staff. These infections come with an estimated cost of £300 million per year in the UK (Saia et al, 2010). An EU directive mandated in May of 2013 has sought to minimise the risk of NSI though the introduction of needle-protection systems. The authors of this article set out to assess nursing knowledge of this legislation and ascertain which needle-protection systems for low-molecular weight heparin/anti Xa (for subcutaneous administration) were preferred in a large teaching trust. Approximately half of the nurses questioned had some knowledge of the legislation and almost all agreed that there is a need for needle protection systems. All four devices tested meet requirements for the legislation but the preferred devices were the needle protection system for enoxaparin and fondaparinux with a self-sheathing style device after activation.

United States women and pornography through four decades: exposure, attitudes, behaviors, individual differences.

Responding to a call for research on pornography and women's sexuality made by Weinberg, Williams, Kleiner, and Irizarry (2010), this study assessed pornography consumption, predictors, and correlates using nationally representative data gathered from U.S. women between 1973 and 2010 (N = 18,225). Women who were younger, less religious, and non-White were more likely to consume pornography. Women who consumed pornography had more positive attitudes toward extramarital sex, adult premarital sex, and teenage sex. Women who consumed pornography also had more sexual partners in the prior year, prior 5 years, and were more likely to have engaged in extramarital sex and paid sex. Consistent with Wright's (2011a) acquisition, activation, application model of mass media sexual socialization and the theorizing of Linz and Malamuth (1993), liberal-conservative ideology moderated the association between pornography exposure and sexual behavior. Specifically, the positive association between pornography exposure and women's recent sexual behavior was strongest for the most liberal women and weakest for the most conservative women. Cultural commentators and some academics argue that technological advances have resulted in a steady increase in the percentage of individuals who consume pornography. Little support was found for this assertion among U.S. women.

Implementing childhood obesity policy in a new educational environment: the cases of Mississippi and Tennessee.

OBJECTIVES: Our purpose was to investigate the processes involved in, and outcomes of, implementing 3 new state-level, school-oriented childhood obesity policies enacted between 2004 and 2007. METHODS: We followed policy implementation in 8 high schools in Mississippi and Tennessee. We collected data between 2006 and 2009 from interviews with policymakers, administrators, teachers, and students; observations of school-based activities; and documents. RESULTS: Significant barriers to the effective implementation of obesity-related policies emerged. These most notably include a value system that prioritizes performances in standardized tests over physical education (PE) and a varsity sport system that negatively influences opportunities for PE. These and other factors, such as resource constraints and the overloading of school administrators with new policies, mitigate against the implementation of policies designed to promote improvements in student health through PE. CONCLUSIONS: Policies designed to address health and social problems in high-school settings face significant barriers to effective implementation. To have a broad impact, obesity-related policies must be tied to mainstream educational initiatives that both incentivize, and hold accountable, the school-level actors responsible for their implementation.

A hierarchical linear modeling assessment of dual-addiction status and change in sexual compulsivity over time.

This study examined the association between dual-addiction status and sexual compulsivity over time in a sample of self-identified sexually compulsive males. Hierarchical linear modeling was utilized to address the study's research questions. Dually addicted sexually compulsive males exhibited lower rates of sexual compulsivity than their singularly addicted counterparts initially but displayed less precipitous declines in sexual compulsiveness over time. Implications for treatment providers are discussed.

Generation of atomistic models of periodic mesoporous silica by kinetic Monte Carlo simulation of the synthesis of the material.

We have developed a molecular simulation method for the generation of realistic atomic-level models for periodic mesoporous silicas. Using simplified interaction potentials and simplified representations of the templating micelles, the simulation follows the reaction path of the hydrothermal synthesis and calcination of the silica material in a kinetic Monte Carlo (kMC) simulation. The only input to the simulation is the geometry of the micelle and the number of silicic acid monomers at the beginning of the synthesis. We simulated the adsorption properties of the PMS models using Grand Canonical Monte Carlo simulation. With use of MCM-41 materials of different pore sizes as a prototype material, experimental and simulated adsorption isotherms for nitrogen, ethane, and carbon dioxide were compared, showing good agreement between simulation and experiment.

Packing of adsorbed molecules in microporous polymorphs aluminium methylphosphonates alpha and beta.

The adsorption of N2 and CO2 in the microporous aluminium methylphosphonate polymorphs alpha and beta is investigated by adsorption experiments in combination with Monte Carlo (MC) simulations. We find that close steric matching of N2 and polymorph alpha causes a packing transition not observed for the other pairs of adsorbate and adsorbent. This strong effect on adsorption behaviour of small differences in the adsorbent structure and adsorbent-adsorbate interactions suggests that microporous, hybrid inorganic organic materials of this type offer opportunities for highly selective adsorptive separations. The realism of the MC simulations is extraordinarily dependent upon the molecular size parameters used.

Elucidation of the pore structure of SBA-2 using Monte Carlo simulation to interpret experimental data for the adsorption of light hydrocarbons.

We have measured the adsorption of methane and ethane to high pressure on SBA-2, a structured mesoporous silica composed of spheres connected by narrow channels. The experimental data were analyzed by carrying out Monte Carlo simulations of adsorption in pore structure models of different complexity and then adjusting the parameters of the models to match the Monte Carlo results to the experimental data. We found that a model based on single-sized spherical cavities was inadequate and that it is necessary to explicitly account for the interconnecting channels. Further, we found that despite the basic regularity of the SBA-2 structure, it is necessary to allow for a distribution of the sizes of both the cavities and the channels. These size distributions were obtained by fitting the parameters of the model to the experimental adsorption data, revealing detailed structural information not previously known for this material. The channels were found to be 5-15 A in diameter, while the cavities were 40-50 A in diameter. There is some evidence that the distribution of channel sizes leads to a percolation effect whereby the pore structure is not equally accessible to all adsorptives.