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Mass disasters are characterized by a disparity between healthcare demand and supply, which hampers complex therapies like kidney transplantation. Considering the scarcity of publications on previous disasters, we reviewed transplantation practice during the recent coronavirus disease 2019 (COVID-19) pandemic, and dwelled upon this experience to guide transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to saving as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of healthcare resources.

Mass disasters are characterized by a disparity between health care demand and supply, which hampers complex therapies like kidney transplantation. Considering scarcity of publications on previous disasters, we reviewed transplantation practice during the recent COVID-19 pandemic, and dwelled upon this experience for guiding transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to save as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of health care resources.

ZusammenfassungDie Nierenersatztherapie ist neben der Beatmung eines der wichtigsten und am häufigsten angewendeten Organersatzverfahren in der täglichen Praxis in der Intensivmedizin. Im Gegensatz zur Beatmungstherapie sind Qualitätsstandards für die Nierenersatztherapie weniger gut definiert und bekannt. In diesem Positionspapier der Deutschen Interdisziplinären Vereinigung für Intensivmedizin (DIVI) beschreiben wir Qualitätsstandards zur Nierenersatztherapie mit dem Ziel die Behandlungsqualität der Patienten mit einem schweren akuten Nierenversagen zu verbessern.

Item does not contain fulltext Due to the shortage of deceased and genetically- or emotionally-related living donors, living unrelated paid donor (LURpD) kidney transplantation has been considered; however, this practice may result in medical, ethical and social dilemmas, induce organ trading (commodification), and even criminal activities. Commodification also risks undermining public trust in the transplant system and impeding the development of proper altruistic or deceased donor programs by ignoring altruism, volunteerism, and dignity. However, despite many objections by authoritative organizations, black market practices are involved in up to 10% of all transplants worldwide. The authors strongly discourage any payment or rewards for organ donation, and instead urge the governments of all countries to provide adequate and accessible kidney health care. However, it is an undeniable fact that paid-living donor transplantation is increasing despite all objections, disapprovals and regulations. We feel it as our responsibility not to ignore this uncertain and undesirable practice, but rather to underline the necessity for strict rules and prohibitions to minimize unacceptable medical, social and ethical risks as long as it exists. Furthermore, economic profit, be it direct or indirect, must not be the goal of those involved, and the employment of intermediaries must be avoided entirely. Additionally, the donor should be in a position where not donating has no detrimental effect on his/her future in any way (free agency). In our view, every country has the obligation and responsibility to provide adequate kidney health care and to make kidney transplantation accessible to those in need. This provision is key to stop transplant tourism and commercialization of kidney transplantation. The nephrology community has a duty to establish structures that optimize organ availability within strict ethical limits. The legal position of LURpD varies considerably worldwide. Strictly respecting each country's legislation and local values is mandatory to minimize medical and ethical risks and controversies.

ZUSAMMENFASSUNGDas akute Nierenversagen (ANV) stellt ein häufiges Problem bei der Versorgung intensivmedizinischer Patienten dar. Daten aus den USA belegen zudem eine Zunahme der Inzidenz des ANV von 10 % pro Jahr über die letzten 10 Jahre. Die Mortalität des ANV ist dabei unverändert hoch und liegt abhängig vom Stadium und Begleiterkrankungen zwischen 20 und 80 %. Die Indikation für die Einleitung einer akuten Nierenersatztherapie wird auf den Intensivstationen überwiegend von Anästhesisten gestellt. Auf Intensivstationen kleiner Krankenhäuser werden i. d. R. von Anästhesisten kontinuierliche Verfahren eingesetzt, während Internisten mit ambulanter nephrologischer Begleitung häufig intermittierende Hämodialyseverfahren einsetzen. Während es klare Empfehlungen zum Beginn einer Nierenersatztherapie für therapierefraktäre, vital bedrohliche Zustände gibt, ist die Datenlage für andere Situation unsicher. Seit der Publikation von 2 großen Studien ist die Frage der Dosis der Nierenersatztherapie allgemein konsentiert. Es konnte weder ein Überlebensvorteil noch eine Verbesserung der Organfunktion bei einer Steigerung der Dosis von 20–25 ml/kg KG/h beobachtet werden. Die KDIGO-Leitlinien empfehlen den Einsatz der regionalen Zitratantikoagulation, neuere Daten unterstützen auch den Einsatz bei Leberversagen oder Schock. Sollte dieses Verfahren nicht zur Verfügung stehen, sind SOPs für Patienten mit Blutungsrisiko zu entwickeln.

Die Nierenersatztherapie ist neben der Beatmung eines der wichtigsten und am häufigsten angewendeten Organersatzverfahren in der täglichen Praxis in der Intensivmedizin. Im Gegensatz zur Beatmungstherapie sind Qualitätsstandards für die Nierenersatztherapie weniger gut definiert und bekannt. In diesem Positionspapier der Deutschen Interdisziplinären Vereinigung für Intensivmedizin (DIVI) beschreiben wir Qualitätsstandards zur Nierenersatztherapie mit dem Ziel die Behandlungsqualität der Patienten mit einem schweren akuten Nierenversagen zu verbessern.

Was ist neu? Diagnostik Der Einsatz von elektronischen Frühwarnsystemen (electronic alerts) für das akute Nierenversagen (ANV), kombiniert mit der Anwendung von standardisierten Kidney Care Bundles, kann das Outcome der Patienten verbessern. Aktuell gilt es, Wege zu finden, diese in den klinischen Alltag zu implementieren. Prävention/konservative Therapie Eine Volumenersatztherapie soll mit balancierten Lösungen erfolgen. Der Einsatz von 0,9 %iger NaCl-Lösung soll vermieden werden. Eine dringlich indizierte radiologische Diagnostik mit jodhaltigem Kontrastmittel sollte nicht aufgrund einer Nierenfunktionsverschlechterung verzögert oder abgesetzt werden. Die prophylaktischen Maßnahmen hierbei unterscheiden sich nicht von den generellen Maßnahmen bei ANV (Euvolämie erzielen, Nephrotoxine meiden), spezifische Maßnahmen existieren nicht. Eine unkritische Hydrierung nicht hypovolämischer Patienten bietet keine Vorteile und ist mit erhöhtem Risiko für kardiale Dekompensationen und ANV verbunden. Nierenersatztherapie Dosis und Modalität der Nierenersatztherapie sollen an die klinischen Bedürfnisse des Patienten angepasst werden. Die empfohlene Dosis von 20 – 25 ml/kg/h dient als Orientierung. Die weit verbreitete regionale Zitrat-Antikoagulation kann auch sicher für Patienten mit Leberschaden oder Laktatazidose angewendet werden, sofern auf Zeichen einer Zitrat-Akkumulation geachtet wird. Bei Laktatazidose kommt es insbesondere auf die Laktatclearance und weniger auf die Höhe der Laktatwerte bei Therapiebeginn an, wenn das Risiko einer Zitrat-Akkumulation abgeschätzt werden soll.

Georg Simon Ohm's work in the field of electricity led to what is now considered to be the most fundamental law of electrical circuits, Ohm's Law. Much less known is that only months earlier, Ohm had published another law-one that differed significantly from the now accepted one. The latter entailed a logarithmic relation between the length of the conductor and a parameter that Ohm called "loss of force." This paper discusses how Ohm came up with an initial law that he felt compelled to correct a few months later. We analyze Ohm's publication as well as his laboratory notes, relating them to our own laboratory experiences while using the replication method to study his work. We also discuss the conceptual background of Ohm's work. We conclude that he was significantly influenced by French studies in the field of electricity, most notably the ones by Charles Augustin Coulomb.

Background Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that has not been adequately characterized in Sub-Saharan Africa (SSA) despite an increasing use of potentially inciting agents for the treatment of human immunodeficiency virus (HIV) and tuberculosis in the region. Methods A retrospective audit of records of patients with biopsy-proven AIN diagnosed at Groote Schuur Hospital, Cape Town from the 1st of January, 2006, to the 31st of December, 2015. Results 54 patients with biopsy-proven AIN were reviewed. The majority were of black African origin (59.2%), with HIV (42.8%) and HIV-tuberculosis coinfection (30.5%) as the most common comorbidities. Drug-related AIN was seen in 38 (67.9%) patients, with rifampicin as the most often implicated medication. Probable drug-related AIN was seen in 3 (5.4%) patients, infection-related AIN in 8 (14.3%), and unspecified causes in 4 (7.4%). AIN was suspected in 44.6% of patients before biopsy. 18 patients (34%) received hemodialysis, while 19 (35.2%) were treated with corticosteroids. Complete renal recovery at 30 and 90 days was seen in 23 (42.6%) patients and 24 (45.3%) patients, respectively, with the majority seen among those with drug-induced AIN. Six (11.1%) patients died; 4 (10.5%) of the patients were in the drug-related group. There was no correlation between degree of interstitial inflammation and severity of renal failure (p = 0.10). On multivariate logistic regression, drug-related causes of AIN were predictive of complete recovery at day 30 (OR 16.63; 95% CI: 1.71 - 161.6, p = 0.02), and presence of interstitial fibrosis reduced likelihood of recovery (OR 0.03; 95% CI 0.002 - 0.46, p = 0.012). Steroid use did not influence partial recovery (OR 0.59, 95% CI 0.17 - 1.77; p = 0.32) or complete recovery (OR 3.38, 95% CI 0.38 - 30.39, p = 0.28). Conclusions AIN is common in patients with HIV or those on treatment for tuberculosis. Drug-related AIN is often associated with improved outcomes. This is particularly reassuring in the SSA region where the use of potentially-inciting medications is rife from a high burden of HIV and tuberculosis. .

Background: Mortality of critically-ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) in an intensive-care setting continues to remain high. There is still uncertainty as to which factors should guide clinical judgement. Methods: A cohort of 155 patients admitted to an intensive-care unit and necessitating RRT due to AKI were retrospectively analyzed. Demographic and clinical parameters at the time of RRT initiation were retrieved. Multi-and univariate analyses were performed to determine the impact of different risk factors on mortality. Results: The most common causes of AKI were sepsis (39.3%) and cardiac events (32%). The majority of patients were treated by continuous (67.3%), the others by intermittent RRT. After 30 days, 51.0% of patients survived. Nonsurvivors were older (73 vs. 69 years), had a higher APACHEE II score (30.1 +/- 5.6 vs. 26.5 +/- 7.1), and were more likely to be vasopressor dependent, mechanically ventilated, or treated by continuous RRT. Multivariate analysis revealed that higher age, higher APACHEE II score, and lower serum creatinine at baseline were independent predictors for mortality, whereas histories of diabetes mellitus, arterial hypertension, coronary heart disease, or stroke were not. Conclusion: Critically-ill patients with AKI requiring RRT continue to have a high mortality. Age and APACHE II score showed an impact on mortality whereas traditional cardiovascular risk factors did not. Higher BUN and creatinine levels do not have a negative impact on mortality. Our findings support the current practice that RRT initiation should primarily be guided by clinical decision.

This essay discusses educational perspectives in science museums. It places a particular focus on the potential afforded by recent changes in the understanding of science education. Issues raised by the “Nature of Science” approach have gained substantial relevance in the educational discussion during the last decades. These changes are sketched and their potential for educational approaches in science museums is outlined. The “Whole Science” approach and the storytelling approach are discussed in greater detail, especially the way practical experiences are combined with theoretical considerations.

Having students experience historical experiments in the classroom is a powerful tool in teaching about the nature of science. Experiments performed by students support inquiry-based science instruction and have long provided an essential means of producing new scientific knowledge within science itself and throughout its history.

Performative methods are playing an increasingly prominent role in research into historical production processes, materials, bodily knowledge and sensory skills, and in forms of education and public engagement in classrooms and museums. This book offers, for the first time, sustained, interdisciplinary reflections on performative methods, variously known as Reconstruction, Replication and Re-enactment (RRR) practices across the fields of history of science, archaeology, art history, conservation, musicology and anthropology. Each of these fields has distinct histories, approaches, tools and research questions. Researchers in the historical disciplines have used reconstructions to learn about the materials and practices of the past, while anthropologists and ethnographers have more often studied the re-enactments themselves, participating in these performances as engaged observers. In this book, authors bring their experiences of RRR practices within their discipline into conversation with RRR practices in other disciplines, providing a basis for interdisciplinary cross-fertilization.

ObjectivesThe International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to heed this call.SettingA questionnaire was emailed to facilities, where renal replacement therapy is available; to determine type of services available; quality of care and identify clinicians involved.ParticipantsClinicians and administrators involved in the care of patients with acute kidney injury (AKI) completed the questionnaire.ResultsCompleted questionnaires were received from 12 of the 15 SADC countries and Nigeria, covering 48 service providers. The government provided partial funding for dialysis in 41.7% of services. There was no funding for acute dialysis in two countries. Interdisciplinary teams in 72.9% of hospitals covered the intensive care units (ICUs), which included at least one nephrologist in 75%. Only 77% were able to provide dialysis in ICU. Intermittent haemodialysis was the most common modality available (91.7% of facilities), sustained low-efficiency dialysis in 50%, continuous therapies in 35% and peritoneal dialysis in 33.3%. Almost half (47.9%) of the sites were limited to one mode of dialysis and unable to care for severely ill patients. The clinical status was used to initiate and monitor dialysis, with very few sites having clear written standard operating procedures.ConclusionIn the 16 countries surveyed, the majority had limited ability to provide comprehensive dialysis programmes for patients with AKI due to lack of facilities and government funding. Additionally, nephrologists are scarce; modes of dialysis are limited; as is the care for severely ill patients and lack of standard operating procedures. Resources, training and funding need to be made available to create universal coverage of dialysis for AKI. The ISN goal of providing renal replacement therapy to all by 2025 is unlikely to be achieved in SADC and Nigeria.

Background Although citrate dialysate (CiDi) is regarded to be safe, dialysis modalities using higher dialysate volumes, like haemodiafiltration (HDF), may expose patients to higher citrate load and thus increase the risk of complications. We investigated the residual risk of CiDi compared with standard dialysate (StDi) in patients on different dialysis modalities and its effect on dialysis dose. Methods In a multicentre randomized crossover study, 92 dialysis patients (HDF post-dilution: n = 44, HDF pre-dilution: n = 26, haemodialysis: n = 25) were treated for 4 weeks with each dialysate (StDi and CiDi). Hypocalcaemia (ionized calcium ≤0.9 mmol/L), alkalosis (pH ≥7.55), post-treatment bicarbonate ≥32 mmol/L, pre-treatment bicarbonate ≥27 mmol/L, intra-dialytic events (IEs) and adverse events (AEs) between dialysis sessions were investigated as primary end points. The secondary objective was dialysis efficacy, i.e. dose and removal ratios of urea, creatinine, phosphate and β-2-microglobulin. Results Post-dialysis overcorrection of bicarbonate (>32 mmol/L) was less frequent with CiDi (P = 0.008). Other predefined calcium and acid-base disturbances did not vary. There was no significant difference in IE. However, more patients developed AEs such as fatigue, muscle spasms or pain using CiDi (StDi: 41 versus CiDi: 55 patients, P = 0.02), particularly in the first 2 weeks of exposure. Dialysis efficacy was comparable with both dialysates. Conclusions It can be confirmed that CiDi is not associated with the development of severe calcium and acid-base disorders, even when dialysis modalities with higher citrate loads are used. However, a refinement of the CiDi composition to minimize AEs is necessary.

kontinuierliche Hamofiltration (CVVH), die kontinuierliche venovenose Hamo- dialyse (CVVHD) oder die Kombination aus beidem, die kontinuierliche Hamo- diafiltration (CVVHDF), eingesetzt. Diese kontinuierlichen Nierenersatztherapie- verfahren haben vor allem auf chirur- gisch-anasthesiologischen Intensivpfle- gestationen die intermittierende Dialyse fast vollstandig verdrangt. Sie zeichnen sich insbesondere aufgrund ihrer hohe- ren hamodynamischen Stabilitat aus. █ Als zusatzliches Verfahren wird auf der Intensivstation in den letzten Jahren

In this paper, we examine the period that immediately followed the invention of the Leiden jar. Historians of science have developed narrations that emphasize the role of grounding during the process of charging the jar. In this respect, this episode shows significant aspects that can be used to characterize science, scientific knowledge production, and the nature of science. From our own experimentation, we learned that grounding was not necessary in order to produce the effect. These experiences inspired us to go back to primary sources. In doing so, we came to a new understanding of the early period after Kleist’s and Musschenbroek’s initial creation of the effect. From our analysis, we conclude that it is not the grounding which was perceived as a major innovation (as well as a challenge) during this early period of the discussion but the concept of an electrical circuit. This understanding was fundamental in characterizing the Leiden jar as a new device challenging the then current knowledge of experimental practices in the field of electricity.

This paper describes a new approach towards the implementation of history of physics in physics education. Reconstructed historical instruments are given to secondary school students. These students are requested to analyze these devices with the aim of collecting sufficient information in order to build their own working version of this device. Whilst the initial instruments were built according to source information, the students can modify materials, dimensions etc. in order to come up with a device that is their individual representation of the initial device. In working on their own version of the instrument, the students shall be enabled to understand that instruments were built on purpose by skilled craftsmen. Thus, they are enabled to understand that science is not merely done by geniuses, but also skilled workers are crucial to scientific practices. Moreover, through this approach the institution has its own version of the instrument that can be used in future science teaching. In this paper, the approach and its conceptual background will be described; its realization and first experiences will be discussed.

This paper discusses essential elements of the philosophical works of Ludwik Fleck (1896–1961) and their potential interpretation for the teaching and learning of science. In the early twentieth century, Fleck made substantial contributions to understanding the sociological character of the nature of science and explaining the embedding of science in society. His works have several parallels to the later and very popular work, The Structure of Scientific Revolutions, by Thomas S. Kuhn, although Kuhn only indirectly referred to the influence of Fleck on his own theories. Starting from a short review of the life of Ludwik Fleck, his philosophical work and its connections to Kuhn, this paper elaborates upon and illustrates how his theories can be considered for science education in order to provide learners with a better understanding of the nature of scientific endeavor and the bi-directional science-to-society links.

Hintergrund und Fragestellung: Zur Struktur und der Praxis der Versorgung von kritisch kranken Patienten mit akutem Nierenversagen liegen hierzulande bislang keine verlasslichen Daten vor. Patienten und Methodik: Wir fuhrten daher eine detaillierte Umfrage mittels Fragebogen durch. 2265 Intensivstationen wurden 19 Fragen zur Nierenersatztherapie gestellt. Ergebnisse: An der Umfrage beteiligten sich 423 deutsche Intensivstationen. Die meisten der Intensivstationen werden interdisziplinar (47 %) oder von Anasthesisten (30 %) geleitet, wobei deutliche Unterschiede je nach Grose der Klinik bestanden. In kleineren Hausern uberwog die interdisziplinare Leitung. Das Angebot an Nierenersatzverfahren variierte deutlich. Je kleiner das Haus desto weniger Verfahren sind verfugbar. So wurden nur in 35 % der Kliniken mit bis zu 400 Betten intermittierende Dialyseverfahren angeboten. Die Indikation fur die Einleitung einer akuten Nierenersatztherapie wurde auf den Intensivstationen uberwiegend von einem Anasthesisten gestellt (53 %), ein Nephrologe war lediglich auf 22 % aller Intensivstationen involviert. Die Indikationsstellung basiert dabei uberwiegend auf „klinischen Kriterien“, die jedoch unzureichend definiert sind. Folgerung: Unsere Ergebnisse belegen den Bedarf an fachubergreifenden Standards zur Behandlung des akuten Nierenversagens auf deutschen Intensivstationen.

It has long been argued that nature of science (NOS) is an important part of science teaching. In the literature, many different approaches to NOS have been suggested. This article focuses on a storytelling approach, and builds on data from audio recordings from three middle-school (school year 6) classrooms. The three science classes are run by three science teachers who have been introduced to NOS and storytelling during a one-day workshop. These three teachers chose to tell the students a story about Ernest Rutherford. The stories told by the teachers, as well as the whole-class discussions afterwards, are analysed with respect to what NOS aspects were communicated. The results show that many different NOS aspects, such as the tentative nature of scientific models, empirical aspects of the scientific knowledge process, as well as human aspects of science, emerge in the context of the story about Rutherford and his work on the atomic model. The results indicate promising possibilities for storytelling as an approach to NOS teaching.

This issue 2015 Volume 1 and the one that precedes it 2014 Volumes 3 & 4 consist of a number of selected papers that were initially presented at the International Conference for the History of Science in Science Education (ICHSSE). This particular meeting, being the ninth in this series, took place in Flensburg (Germany) in 2012 and was devoted to discuss questions on enabling scientific understanding through historical instruments and experiments in formal and non-formal learning environments. The entire conference series originated from collaboration between Arthur Stinner (University of Manitoba) and Jurgen Teichmann (Deutsches Museum Munich). They established a series of meetings that aimed at familiarizing science teachers with topics from the history of science. This collection of papers in these two volumes are dedicated to the memory of Arthur Stinner, who unexpectedly died in 2014, and honour his large contribution to our common interests as science educators. The Flensburg conference brought together science education researchers with historians of science in order to improve the interdisciplinary discourse of these groups. Consequently, the papers published in this issue can also be characterized by their interdisciplinary approach towards a history-based or historically informed science education. The different approaches towards the topic of the conference is also reflected by the papers in this special issue. The grouping of papers that form the earlier volume involve authors who are concerned to discuss original approaches to science education in which an historical component is important. The authors of the present volume share a focus on the

Aim: We evaluated the influence of C-344T polymorphism of the aldosterone synthase gene, associated with aldosterone levels and the development of arterial hypertension, on focal segmental glomerulosclerosis (FSGS). Methods: We studied 81 patients with primary FSGS followed up for 8.0 ± 12 years. Patients were classified according to their slope of reciprocal serum creatinine into group A (slow progressors, n = 57) and B (fast progressors, n = 24). One hundred healthy volunteers were analysed as controls. The biopsies of n = 50 patients were reviewed and analysed by the same pathologist. C-344T polymorphism was determined by polymerase chain reaction. Results: The allele frequencies differed significantly between patients (C-allele: 0.55, T-allele: 0.45) and controls (C-allele: 0.45, T-allele: 0.55; P

Educational versions of Millikan's oil-drop experiment have frequently been criticized; suggestions for improvement either focus on technical innovations of the setup or on replacing the experiment by other approaches of familiarization, such as computer simulations. In our approach, we have analysed experimental procedures. In doing so, we were able to identify several sources of error and took measures to minimize their influence. At the same time, we attempted to minimize the standard deviation of each individual series of measurements. Our paper describes how we developed criteria which helped to stabilize the data produced in the following series of measurements. The final series of measurements results in data which demonstrate the atomic structure of electricity and enable a demonstration of the elementary charge.

This issue and the one that follows consist of a number of selected papers that were initially presented at the International Conference for the History of Science in Science Education (ICHSSE). This particular meeting, being the ninth in this series, took place in Flensburg (Germany) in 2012 and was devoted to discuss questions on enabling scientific understanding through historical instruments and experiments in formal and non-formal learning environments. The entire conference series originated from collaboration between Arthur Stinner (University of Manitoba) and Jurgen Teichmann (Deutsches Museum Munich). They established a series of meetings that aimed at familiarizing science teachers with topics from the history of science. This collection of papers in these two volumes are dedicated to the memory of Arthur Stinner, who unexpectedly died in 2014, and honour his large contribution to our common interests as science educators. The Flensburg conference brought together science education researchers with historians of science in order to improve the interdisciplinary discourse of these groups. Consequently, the papers published in this issue can also be characterized by their interdisciplinary approach towards a history-based or historically informed science education. The different approaches towards the topic of the conference is also reflected by the papers in this special issue. The first grouping of papers that form the present issue involves authors who are concerned to discuss original approaches to science education in which an historical component is often central. The second grouping which will be published in a following issue share a focus on the educational potential of historical instruments.

Recently, there has been an increasing emphasis in discussions on science education on the potential and advantages of stories and narratives in teaching situations. From this, one might conclude that simply starting to use stories in science classrooms is a good thing, per se. Yet, as I will argue in my paper, things do not appear to be that easy. From my understanding, it is necessary to select the stories to be told in teaching situations with care - and also to reject those stories which are not to be told. With respect to such a selection, different criteria can be employed, depending on the aims of the instructional unit. In doing so, my criteria for selection will be based on an education which does not focus solely on the communication of scientific knowledge but which emphasizes relevant topics from the nature of science for structuring the teaching. With this intention, one can identify constructions of narratives that are misleading with respect to the nature of science and which may lead to an inappropriate understanding of science and scientific practice.

In 1923, R.A. Millikan was awarded the Nobel Prize in Physics for his work on the elementary charge of electricity and on the photoelectric effect. Recently, historical research had a focus on Millikan’s publication practice, as well as on the role of his assistant, Harvey Fletcher. Several studies have raised doubts on whether Millikan can actually be taken as a role model for scientific practice; however, what has not been discussed yet is the question of how the Nobel Committee came to their decision to award Millikan’s work. Based on archival material from the Nobel Committee, this paper discusses the nomination procedure, as well as the evaluation process of Millikan’s work.

Continuous venovenous haemofiltration (CVVH) in the intensive care setting requires anticoagulation to prevent clotting of the extracorporeal circuit. Several protocols avoiding heparin and using regional citrate anticoagulation have been developed to diminish bleeding risks. However, data from randomized trials comparing citrate anticoagulation with systemic heparinization are very limited.One hundred and seventy-four patients on mechanical ventilation, requiring renal replacement therapy for acute renal failure, were included in this prospective randomized multicentre trial comparing regional citrate with systemic heparin. The study was performed at nine different intensive care units at university or academic teaching hospitals. The participants were randomized to either CVVH using regional citrate anticoagulation or CVVH using systemic anticoagulation with unfractionated heparin. The primary outcome was to compare treatment efficacy represented by the patients' acid base status on Day 3 and on each consecutive day. Several parameters of safety and efficacy were analysed as secondary outcomes.Comparison of standard bicarbonate from Day 3 to Day 11 revealed no difference between both treatment modalities. Use of citrate resulted in less systemic anticoagulation, a lower risk of bleeding and a longer haemofilter patency. Episodes of hypercalcaemia, hypocalcaemia and the need for additional bicarbonate infusions occurred more often under citrate. The patients' high mortality was not influenced by the mode of anticoagulation.Citrate may be used as a regional anticoagulant and the only buffering agent in CVVH with adequate treatment efficacy and safety. However, neither citrate nor heparin anticoagulation should be regarded as a therapeutic standard, since there is no advantage of one of these substances with regard to patient mortality.

Millikan's oil-drop experiment is one of the classic experiments from the history of physics. Due to its content (the determination of the elementary charge) it is also among those experiments that are frequently used and discussed in teaching situations. Disappointingly, a review of the educational literature on this experiment reveals that its implementation in teaching situations is not especially successful. Using a collaborative approach, we have attempted to develop an understanding of the difficulties that students encounter with this experiment. In our approach, apart from evaluating students' lab reports, we used questionnaires and semi-structured interviews. Additionally, we have used the historical development of the oil-drop experiment as a resource for restructuring the educational use of the experiment, and we have attempted to develop a more thorough understanding of the experiment through an analysis of the data generated in the experiment and its mathematical treatment. As a result, we suggest a different use of the apparatus that appears to result in less frustration of the students as well as a better understanding of the experiment and its difficulties by the students.

Background There are few anecdotal reports of circulating antineutrophil cytoplasmic autoantibodies (ANCAs) in patients with immunoglobulin A (IgA) nephropathy. Study Design Retrospective case series. Setting & Participants We studied 8 patients with crescentic IgA nephropathy associated with ANCAs against myeloperoxidase (n = 5) and proteinase 3 (n = 3) followed up for 2.4 ± 1.7 years. They were compared with 26 patients with IgA nephropathy with > 10% crescentic glomeruli, but negative for ANCAs. Outcomes We analyzed clinical and histologic features of patients and their response to treatment. Measurements Screening for ANCAs was performed using indirect immunofluorescence, and positive results were verified using enzyme-linked immunosorbent assay. Results All patients with crescentic IgA nephropathy and positive for ANCAs, compared with only one-third of ANCA-negative patients, presented with the clinical syndrome of rapid progressive glomerulonephritis. ANCA-positive patients reached a higher peak serum creatinine level within the first 3 months (4.2 ± 2.2 vs 2.5 ± 1.9 mg/dL; estimated glomerular filtration rate, 19.3 ± 10.2 vs 45.9 ± 30.1 mL/min/1.73 m 2 ). ANCA-positive patients with IgA nephropathy had a higher percentage of crescentic glomeruli (54.3% ± 18%) compared with ANCA-negative patients with crescentic IgA nephropathy (34.5% ± 26%). ANCA-positive patients were treated using cyclophosphamide and corticosteroids. Kidney function improved in all these patients: serum creatinine level decreased from the peak of 4.2 ± 2.2 to 1.7 ± 0.7 mg/dL at the end of follow up (estimated glomerular filtration rate, 19.3 ± 10.2 to 44.6 ± 11.1 mL/min/1.73 m 2 ). In contrast, no significant improvement was achieved in ANCA-negative patients. Conclusion Patients with IgA nephropathy, crescents, and positive for ANCAs represent a clinical entity with a diverse more exaggerated clinical and histologic picture. However, disease in these patients responded well to aggressive immunosuppressive therapy.

OBJECTIVE To determine retrospectively the complications and long-term results of aortocoronary bypass grafting in patients with end-stage renal disease. PATIENTS AND METHODS 65 patients with coronary heart disease (CHD) and on dialysis (54 men, 11 women; average age 56.9 +/- 8.1 years) underwent aortocoronary bypass grafting between 1982 and 1992. Mean duration of dialysis (haemo- or peritoneal) was 41.1 +/- 45.0 (1-215) months. All patients had had haemofiltration treatment in conjunction with the bypass operation. RESULTS Coronary angiography demonstrated triple-vessel disease in 40 patients (62%). Average number of bypasses was 2.8 per patient. Perioperative death rate was 4.6%. 95% of survivors were free of symptoms 6 months postoperatively. Long-term survival rate was 71% after 3 years and 55% after 5 years. CONCLUSION Aortocoronary bypass grafting for CHD in patients with end-stage renal disease can be performed with a low perioperative mortality rate and significantly improves symptoms.