Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80&nbsp;MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8\ub10.7(stat)\ub16.7(syst)\u2009\u2009MeV for cosmic rays with an energy of 1&nbsp;EeV arriving perpendicularly to a geomagnetic field of 0.24&nbsp;G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory

Search for photons with energies above 1018eV using the hybrid detector of the Pierre Auger Observatory

A search for ultra-high energy photons with energies above 1EeV is performed using nine years of data collected by the Pierre Auger Observatory in hybrid operation mode. An unprecedented separation power between photon and hadron primaries is achieved by combining measurements of the longitudinal air-shower development with the particle content at ground measured by the fluorescence and surface detectors, respectively. Only three photon candidates at energies 1\u20132EeV are found, which is compatible with the expected hadron induced background. Upper limits on the integral flux of ultra-high energy photons of 0.027, 0.009, 0.008, 0.008 and 0.007 km 122 sr 121 yr 121 are derived at 95% C.L. for energy thresholds of 1, 2, 3, 5 and 10EeV. These limits bound the fractions of photons in the all-particle integral flux below 0.1%, 0.15%, 0.33%, 0.85% and 2.7%. For the first time the photon fraction at EeV energies is constrained at the sub-percent level. The improved limits are below the flux of diffuse photons predicted by some astrophysical scenarios for cosmogenic photon production. The new results rule-out the early top-down models 12 in which ultra-high energy cosmic rays are produced by, e.g., the decay of super-massive particles 12 and challenge the most recent super-heavy dark matter model