ABSTRACT
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in patients with heart failure and reduced ejection fraction (HFrEF). However, MRAs are often underused because of hyperkalemia concerns. OBJECTIVES: The purpose of this study was to assess whether sodium zirconium cyclosilicate (SZC), a nonabsorbed crystal that traps and rapidly lowers potassium, enables MRA use in patients with HFrEF and prevalent hyperkalemia (or at high risk). METHODS: REALIZE-K is a prospective, double-blind, placebo-controlled trial in patients with HFrEF (NYHA functional class II-IV; left ventricular ejection fraction ≤40%), optimal therapy (except MRA), and prevalent hyperkalemia (or at high risk). During the open-label run-in, all participants underwent protocol-mandated spironolactone titration (target: 50 mg daily); those with prevalent (cohort 1) or incident (cohort 2) hyperkalemia during titration started SZC. Participants achieving normokalemia while on spironolactone ≥25 mg daily were randomized to continuing SZC or matching placebo for 6 months. The primary composite endpoint was proportion of participants with optimal response (normokalemia, on spironolactone ≥25 mg daily, no rescue for hyperkalemia [months 1-6]). RESULTS: Of 365 patients (run-in), 202 were randomized. Baseline characteristics included mean age 70 years, prevalent comorbidities (78% estimated glomerular filtration rate <60 mL/min/1.73 m2, 38% atrial fibrillation/flutter), high N-terminal pro B-type natriuretic peptide (median 1,136 pg/mL), and high HFrEF therapy use (64% sacubitril/valsartan, 96% beta-blocker, 42% sodium glucose co-transporter 2 inhibitor). At randomization, 78% were receiving spironolactone 50 mg daily. CONCLUSIONS: REALIZE-K is the first trial to evaluate whether SZC can enable rapid and safe MRA optimization and long-term continuation in patients with HFrEF and prevalent/high risk of hyperkalemia. (Study to Assess Efficacy and Safety of SZC for the Management of High Potassium in Patients with Symptomatic HFrEF Receiving Spironolactone; NCT04676646).
ABSTRACT
The article addresses two recently published books in General Psychology by Niels Engelsted and Jens Mammen. The two approaches offer in their own way solutions to the so-called 'crisis of psychology'. Mammen's new logical foundation for psychology is based on two different properties of the objects we relate to: those characterizing the objects appearances, and those characterizing the objects as unique substances or singulars distributed in time and space - the existence of the objects as opposed to the appearance of the objects. Engelsted makes a journey from Aristotle (384-322 BC) until today's psychology in his quest to identify the domain of psychology. He places the psyche in the natural world as a result of locomotion in the first, most simple animal life. The domain of psychology includes intentionality, mind and consciousness.
ABSTRACT
The physical properties of material largely depend on their crystal structure. Nanowire growth is an important method for attaining metastable crystal structures in III-V semiconductors, giving access to advantageous electronic and surface properties. Antimonides are an exception, as growing metastable wurtzite structure has proven to be challenging. As a result, the properties of these materials remain unknown. One promising means of accessing wurtzite antimonides is to use a wurtzite template to facilitate their growth. Here, a template technique using branched nanowire growth for realizing wurtzite antimonide material is demonstrated. On wurtzite InAs trunks, InAs1-x Sbx branch nanowires at different Sb vapor phase compositions are grown. For comparison, branches on zinc blende nanowire trunks are also grown under identical conditions. Studying the crystal structure and the material composition of the grown branches at different xv shows that the Sb incorporation is higher in zinc blende than in wurtzite. Branches grown on wurtzite trunks are usually correlated with stacking defects in the trunk, leading to the emergence of a zinc blende segment of higher Sb content growing parallel to the wurtzite structure within a branch. However, the average amount of Sb incorporated within the branch is determined by the vapor phase composition.
ABSTRACT
The distribution of ions in a capillary with both pressurized flow and an electric field has been studied. We have earlier reported that the overall concentration of ions increase in a capillary with high electric field and a pressurized flow. Now we describe how the ions are distributed in the capillary both along the capillary length and in the radial direction as a result of the parabolic flow profile. We have combined current measurements with finite element techniques in order to get better understanding of the system. We have found that the concentration of the ions that because of the electric mobility moves towards the flow primarily increases at the beginning of the electric field and close to the capillary wall. In view of the results we have proposed an alterative explanation of earlier published results concerning voltage-induced variation in capacity factors.
