Rationale and design of BISTRO: a randomized controlled trial to determine whether bioimpedance spectroscopy guided fluid management maintains residual kidney function in incident haemodialysis patients

Background: Preserved residual kidney function (RKF) and normal fluid status are associated with better patient outcomes in incident haemodialysis patients. The objective of this trial is to determine whether using bioimpedance technology in prescribing the optimal post-dialysis weight can reduce the rate of decline of RKF and potentially improve patient outcomes. Methods/Design: 516 patients commencing haemodialysis, aged >18 with RKF of > 3 ml/min/1.73 m2 or a urine volume >500 ml per day or per the shorter inter-dialytic period will be consented and enrolled into a pragmatic, open label, randomized controlled trial. The intervention is incorporation of bioimpedance spectroscopy (BI) determination of normally hydrated weight to set a post-dialysis target weight that limits volume depletion, compared to current standard practice. Clinicians and participants will be blinded to BI measures in the control group and a standardized record capturing management of fluid status will be used in all participants. Primary outcome is preservation of residual kidney function assessed as time to anuria (≤100 ml/day or ≤200 ml urine volume in the short inter-dialytic period). A sample size of 516 was based upon a cumulative incidence of 30% anuria in the control group and 20% in the treatment group and 11% competing risks (death, transplantation) over 10 months, with up to 2 years follow-up. Secondary outcomes include rate of decline in small solute clearance, significant adverse events, hospitalization, loss of vascular access, cardiovascular events and interventions, dialysis efficacy and safety, dialysis-related symptoms and quality of life. Economic evaluation will be carried out to determine the cost-effectiveness of the intervention. Analyses will be adjusted for patient characteristics and dialysis unit practice patterns relevant to fluid management. Discussion: This trial will establish the added value of undertaking BI measures to support clinical management of fluid status and establish the relationship between fluid status and preservation of residual kidney function in incident haemodialysis patients. Trial registration: ISCCTN Number: 11342007, completed 26/04/2016; NIHR Portfolio number: CPMS31766; Sponsor: Keele University Keywords: Fluid status, Body composition, Residual kidney function, Haemodialysis, Bioimpedance, Fluid management, Health economic

The ABC130 barrel module prototyping programme for the ATLAS strip tracker

For the Phase-II Upgrade of the ATLAS Detector, its Inner Detector, consisting of silicon pixel, silicon strip and transition radiation sub-detectors, will be replaced with an all new 100 % silicon tracker, composed of a pixel tracker at inner radii and a strip tracker at outer radii. The future ATLAS strip tracker will include 11,000 silicon sensor modules in the central region (barrel) and 7,000 modules in the forward region (end-caps), which are foreseen to be constructed over a period of 3.5 years. The construction of each module consists of a series of assembly and quality control steps, which were engineered to be identical for all production sites. In order to develop the tooling and procedures for assembly and testing of these modules, two series of major prototyping programs were conducted: an early program using readout chips designed using a 250 nm fabrication process (ABCN-25) and a subsequent program using a follow-up chip set made using 130 nm processing (ABC130 and HCC130 chips). This second generation of readout chips was used for an extensive prototyping program that produced around 100 barrel-type modules and contributed significantly to the development of the final module layout. This paper gives an overview of the components used in ABC130 barrel modules, their assembly procedure and findings resulting from their tests.Comment: 82 pages, 66 figure

Micromechanical Properties of Injection-Molded Starch–Wood Particle Composites

The micromechanical properties of injection molded starch–wood particle composites were investigated as a function of particle content and humidity conditions. The composite materials were characterized by scanning electron microscopy and X-ray diffraction methods. The microhardness of the composites was shown to increase notably with the concentration of the wood particles. In addition,creep behavior under the indenter and temperature dependence were evaluated in terms of the independent contribution of the starch matrix and the wood microparticles to the hardness value. The influence of drying time on the density and weight uptake of the injection-molded composites was highlighted. The results revealed the role of the mechanism of water evaporation, showing that the dependence of water uptake and temperature was greater for the starch–wood composites than for the pure starch sample. Experiments performed during the drying process at 70°C indicated that the wood in the starch composites did not prevent water loss from the samples.Peer reviewe

Verpflichtungszusagen und Art. 101 Abs. 3 AEUV – Verfahren vs. Wohlfahrt

Verpflichtungszusagen sind ein beliebtes Mittel zur Verfahrensbeendigung gegenüber der Kommission. Zumeist werden sie genutzt, um Verstöße gegen Art. 101 und 102 AEUV gänzlich zu beenden. Vereinzelt werden sie aber auch eingesetzt, um die Voraussetzungen für Art. 101 Abs. 3 AEUV herbeizuführen. Diese letzte Möglichkeit wirft indes verschiedene Probleme auf. Hohen materiellen Anforderungen für eine Freistellung stehen relativ niedrige Anforderungen für die Annahme einer Verpflichtungszusage gegenüber. Der Beitrag kommt zu dem Ergebnis, dass das summarische Prüfungsverfahren bei Verpflichtungszusagen nicht geeignet ist, um die Voraussetzungen des Art. 101 Abs. 3 AEUV ausreichend zu überprüfen. Verpflichtungszusagen sollten daher in diesem Kontext nicht genutzt werden

SH-groups on the surface of pancreas cells involved in secretin stimulation and glucose-mediated secretion

A large derivative of p-chloromercuribenzoic acid (PCMB-Dextran T 10, mol. wt approx. 10000) was perfused through an isolated preparation of cat pancreas. It was shown that PCMB-Dextran T 10 inhibited pancreatic fluid and electrolyte secretion by 47%. When glucose in the perfusate was replaced by other substrates, PCMB-Dextran T 10 caused an inhibition of only 26%. Replacement of secretin by dibutyryl cyclic AMP and theophylline led to an inhibition of 15%. When secretin as well as glucose was replaced by its substitutes, no inhibition of secretion could be achieved with PCMB-Dextran T 10. Considering the large molecular size of this mercurial compound it can be concuded that SH-groups on the surface of the pancreatic cells are essential both for the action of secretin and for the glucose-mediated secretion