Self-regulation mediates effects of adapted mindfulness-based stress reduction on anxiety among college students.

Objective: Mindfulness-based stress reduction (MBSR) reduces anxiety among undergraduate students; however, there is limited evidence demonstrating mechanistic underpinnings. Theoretical models implicate cognitive self-regulation as a mechanism. This study explored whether an adapted MBSR embedded in a college course reduced anxiety and if self-regulation mediated any intervention effects. Participants: 144 undergraduate students participated in the study; 34 completed a MBSR course and 110 served as a matched control group. Methods: Mindfulness, self-regulation, and anxiety were measured at pre-MBSR, post-MBSR, and 1-month follow-up. Results: Repeated-measure ANOVAs indicated significant effects of MBSR for self-regulation and anxiety. Longitudinal mediation models indicated significant mediation effects of self-regulation on anxiety at post-intervention and 1-month follow-up. Conclusions: MBSR can be implemented within a college course to indirectly affect anxiety mechanistically via self-regulation. Given increasing rates of anxiety in college students and reduced capacity for counseling centers to meet need, MBSR holds promise for future clinical study.

Development of a digital twin of a tablet that mimics a real solid dosage form: Differences in the dissolution profile in conventional mini-USP II and a biorelevant colon model.

The performance of colon-targeted solid dosage forms is commonly assessed using standardised pharmacopeial dissolution apparatuses like the USP II or the miniaturised replica, the mini-USP II. However, these fail to replicate the hydrodynamics and shear stresses in the colonic environment, which is crucial for the tablet's drug release process. In this work, computer simulations are used to create a digital twin of a dissolution apparatus and to develop a method to create a digital twin of a tablet that behaves realistically. These models are used to investigate the drug release profiles and shear rates acting on a tablet at different paddle speeds in the mini-USP II and biorelevant colon models to understand how the mini-USP II can be operated to achieve more realistic (i.e., in vivo) hydrodynamic conditions. The behaviour of the tablet and the motility patterns used in the simulations are derived from experimental and in vivo data, respectively, to obtain profound insights into the tablet's disintegration/drug release processes. We recommend an "on-off" operating mode in the mini-USP II to generate shear rate peaks, which would better reflect the in vivo conditions of the human colon instead of constant paddle speed.

Modelling and simulation of the hydrodynamics and mixing profiles in the human proximal colon using Discrete Multiphysics.

The proximal part of the colon offers opportunities to prolong the absorption window following oral administration of a drug. In this work, we used computer simulations to understand how the hydrodynamics in the proximal colon might affect the release from dosage forms designed to target the colon. For this purpose, we developed and compared three different models: a completely-filled colon, a partially-filled colon and a partially-filled colon with a gaseous phase present (gas-liquid model). The highest velocities of the liquid were found in the completely-filled model, which also shows the best mixing profile, defined by the distribution of tracking particles over time. No significant differences with regard to the mixing and velocity profiles were found between the partially-filled model and the gas-liquid model. The fastest transit time of an undissolved tablet was found in the completely-filled model. The velocities of the liquid in the gas-liquid model are slightly higher along the colon than in the partially-filled model. The filling level has an impact on the exsisting shear forces and shear rates, which are decisive factors in the development of new drugs and formulations.

Eutrophication assessment in the transit area German Bight (North Sea) 2006-2014 - Stagnation and limitations.

The eutrophication status of the German Bight (North Sea) has been assessed the third time since 1998 according to the OSPAR-Comprehensive Procedure between 2006 and 2014. Since the 1980s nutrient discharges and atmospheric nitrogen deposition had declined significantly but chlorophyll a and nutrient concentrations remained above assessment levels inshore and in inner coastal waters, reflecting continuing eutrophication. Recently local river discharges stagnated or increased again and total nitrogen remained above a reduction target of 200 µM. Most nutrients and conversion products were imported by a coastal current, passing the German Bight. Organic matter was trapped in offshore bottom waters in the ancient Elbe valley, causing repeated annual oxygen minima (<6 mg/L) and a classification as Problem Area. Effects of national reduction measures are limited in the transit area German Bight because improvements in open coastal waters require international efforts, based on comprehensive analyses.

Riverine regime shifts through reservoir dams reveal options for ecological management.

Worldwide, dams are a main threat reducing river ecological functioning and biodiversity by severely altering water temperature, flow, and sediment regimes up- and downstream. Sustainable dam management therefore has a key role in achieving ecological targets. Here, we present an analysis of the effects of reservoir dams and resulting regime shifts on community structure and function of lotic macroinvertebrates. Our study derived management options to improve ecological integrity of affected streams. To do this, we contrasted time series data for water temperature (15-min intervals over one year), discharge (daily means over 10 yr), and records of deposited fine sediments against macroinvertebrate samples from pairs of river reaches downstream of dams and of comparable tributaries not affected by dams in the German low mountain range. We observed a decline in the density and diversity of disturbance-sensitive macroinvertebrates (Ephemeroptera, Plecoptera, and Trichoptera) and a correlation between hydrologic metrics and macroinvertebrate deterioration downstream of the dams. Typical "rhithral" (flow-adapted) species changed to "littoral" (flow-avoiding) species below dams, thus indicating a hydrologic regime shift. Increased fine sediment accumulations and deficits of pebbles and small cobbles below dams indicated a severe habitat loss below dams. Additional comparison with undisturbed reference streams allowed us to derive management options that could mitigate the negative impact of hydrologic alterations and accumulations of fine sediments downstream of dams. These options are conditional on the season and in particular address the frequency and duration of low and high flow events.

Origin of the Resistivity Anisotropy in the Nematic Phase of FeSe.

The in-plane resistivity anisotropy is studied in strain-detwinned single crystals of FeSe. In contrast to other iron-based superconductors, FeSe does not develop long-range magnetic order below the tetragonal-to-orthorhombic transition at T_{s}≈90 K. This allows for the disentanglement of the contributions to the resistivity anisotropy due to nematic and magnetic orders. Comparing direct transport and elastoresistivity measurements, we extract the intrinsic resistivity anisotropy of strain-free samples. The anisotropy peaks slightly below T_{s} and decreases to nearly zero on cooling down to the superconducting transition. This behavior is consistent with a scenario in which the in-plane resistivity anisotropy is dominated by inelastic scattering by anisotropic spin fluctuations.

Gender-specific Effects of Treatment with Lifestyle, Metformin or Sulfonylurea on Glycemic Control and Body Weight: A German Multicenter Analysis on 9 108 Patients.

Effects of diabetes treatment are strongly connected to individual factors, but the relevant role of gender has not been addressed so far. This observational study evaluates whether monotherapy with lifestyle, metformin or sulfonylurea has gender-specific effects on glycemic control and/or body weight. Data of 9 108 patients with type 2 diabetes from 129 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database; age 63.1±12.8 years, diabetes duration 5.7±7.4 years, HbA1c 55±17.7 mmol/mol [7.2±1.6%], BMI 30.6±6.1 kg/m(2), 49.3% female patients). Antidiabetic concepts included lifestyle intervention (n=5,787), metformin (n=2,180), sulfonylurea (n=943) or other antidiabetic drugs (n=198), respectively. HbA1c and body weight were compared before and after a stable monotherapeutical period of 0.8±0.4 years. Women had a significantly higher reduction of body weight after treatment with lifestyle (women-0.8±0.1 vs. men-0.2±0.1 kg; p<0.05), metformin (women-1.8±0.2 vs. men-1.2±0.2 kg; p<0.05) or sulfonylurea drugs (women-0.9±0.2 vs. men - 0.1±0.2 kg; p<0.05), whereas men displayed significantly higher HbA1c-reductions after treatment with lifestyle (women-6.9±0.2 mmol/mol [- 0.6±0.02%] vs. men-7.5±0.2 mmol/mol [0.7±0.02%]; p<0.05) and metformin only (women-6.3±0.3 mmol/mol [- 0.6±0.03%] vs. men - 7.4±0.3 mmol/mol [- 0.7±0.03%]; p<0.05). No differences were seen for sulfonylurea monotherapy concerning the HbA1c-reduction (women - 5.6±0.5 mmol/mol [- 0.5±0.05%] vs. men-6.4±0.4 mmol/mol [- 0.6±0.04%]; p=0.196). In summary, antidiabetic treatment concepts might result in gender-specific effects on body weight and HbA1c. Gender might therefore represent another important factor in the context of an individualized treatment management of type 2 diabetes.

Magnetoresistance in two-component systems.

Two-component systems with equal concentrations of electrons and holes exhibit nonsaturating, linear magnetoresistance in classically strong magnetic fields. The effect is predicted to occur in finite-size samples at charge neutrality due to recombination. The phenomenon originates in the excess quasiparticle density developing near the edges of the sample due to the compensated Hall effect. The size of the boundary region is of the order of the electron-hole recombination length that is inversely proportional to the magnetic field. In narrow samples and at strong enough magnetic fields, the boundary region dominates over the bulk leading to linear magnetoresistance. Our results are relevant for two-and three-dimensional semimetals and narrow band semiconductors including most of the topological insulators.

Association of physical activity with glycaemic control and cardiovascular risk profile in 65 666 people with type 2 diabetes from Germany and Austria.

AIMS: To provide representative data from routine diabetes care concerning the physical activity levels of people with type 2 diabetes, and to show the association of activity level with cardio-metabolic risk profile in a gender-specific analysis. METHODS: The anonymized data from 65 666 subjects with type 2 diabetes, who have been receiving treatment in specialized diabetes institutions, were analysed using a large multi-centre database. The population was categorized as physically inactive (PA0), active 1-2 times per week (PA1), active >2 times per week (PA2), and then stratified by age (20-59 and 60-80 years). BMI, glycaemic control (measured by HbA(1c) levels), blood pressure, lipid profile and therapeutic regimen were adjusted for age, gender and diabetes duration. RESULTS: Most subjects were inactive (PA0: 90%; PA1: 6%, PA2: 4%). BMI, HbA(1c) and lipid profiles were better in older subjects and hypertension rates were lower in younger subjects. In both age groups, BMI, HbA(1c) (both P < 0.0001) and triglycerides (P < 0.002) were lower in the most active group PA2 compared with the inactive group PA0. HDL was higher in elderly (P < 0.0001) and pulse pressure (P = 0.03) lower in younger most active subjects only. Insulin therapy was used more frequently by the physically inactive and by older people. CONCLUSIONS: This survey indicates that glycaemic control and cardio-metabolic risk profiles in people with type 2 diabetes are positively related to physical activity. The effects of physical activity were beneficial in younger as well as in older people. The high number of inactive people with diabetes underlines the need to promote physical activity and sport.

Daily insulin doses and injection frequencies of neutral protamine hagedorn (NPH) insulin, insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV-wiss database.

BACKGROUND: We performed a comparative analysis of the use of long-acting insulin (analogues) neutral protamine hagedorn (NPH), detemir (Det) and glargine (Gla), and quantified injection frequencies and daily insulin doses in patients with type 1 and 2 diabetes in daily practice. METHODS: A total number of 51 964 patients from 336 centres in Germany and Austria with type 1 and 2 diabetes with exclusive insulin therapy were retrospectively analysed. RESULTS: A total number of 42.1%/75.9% (type 1/type 2) of patients used NPH, 19.9%/6.7% Det and 38.0%/17.4% Gla, with similar glycaemic control and proportion of severe hypoglycaemia for NPH/Det/Gla in type 1 (Mean HbA(1c) 7.98%/7.98%/8.07%; mean proportion of severe hypoglycaemia 11.06%/11.93%/10.86%) and type 2 diabetes (Mean HbA(1c) 7.61%/7.78%/7.61%; mean proportion of severe hypoglycaemia 5.66%/4.48%/5.03%). In type 1 diabetes, the mean daily injection frequencies of NPH versus Det versus Gla were 1.9 vs 1.8 vs 1.1, and total daily insulin injections were 5.3 vs 5.6 vs 5.0. The adjusted mean daily basal insulin doses were 0.36, 0.39 and 0.31 IU/kg, mean daily total insulin dose was lowest for Gla (0.74 IU/kg), followed by NPH (0.76 IU/kg) and Det (0.81 IU/kg). In type 2 diabetes patients, mean daily injection frequencies were 1.6 for NPH, 1.4 for Det and 1.1 for Gla, total daily insulin injections were 4.0 vs 4.1 vs 3.6. The mean daily basal insulin dosages were 0.30 IU/kg (NPH), 0.33 IU/kg (Det) and 0.29 IU/kg (Gla), mean total insulin doses per day were 0.63 IU/kg (NPH), 0.77 IU/kg (Det) and 0.67 IU/kg (Gla). CONCLUSIONS: In a 'real-world' setting, the injection frequencies and doses of basal and total insulin per day are lowest with the use of insulin glargine compared with NPH-insulin or insulin detemir at similar glycaemic control and rates of severe hypoglycaemia.

Giant magnetodrag in graphene at charge neutrality.

We report experimental data and theoretical analysis of Coulomb drag between two closely positioned graphene monolayers in a weak magnetic field. Close enough to the neutrality point, the coexistence of electrons and holes in each layer leads to a dramatic increase of the drag resistivity. Away from charge neutrality, we observe nonzero Hall drag. The observed phenomena are explained by decoupling of electric and quasiparticle currents which are orthogonal at charge neutrality. The sign of magnetodrag depends on the energy relaxation rate and geometry of the sample.

Coulomb drag in graphene near the Dirac point.

We study Coulomb drag in graphene near the Dirac point, focusing on the regime of interaction-dominated transport. We establish a novel, graphene-specific mechanism of Coulomb drag based on fast interlayer thermalization, inaccessible by standard perturbative approaches. Using the quantum kinetic equation framework, we derive a hydrodynamic description of transport in double-layer graphene in terms of electric and energy currents. In the clean limit the drag becomes temperature independent. In the presence of disorder the drag coefficient at the Dirac point remains nonzero due to higher-order scattering processes and interlayer disorder correlations. At low temperatures (diffusive regime) these contributions manifest themselves in the peak in the drag coefficient centered at the neutrality point with a magnitude that grows with lowering temperature.

Is there a benefit to use calculated percent body fat or age- and gender-adjusted BMI-SDS(LMS) to predict risk factors for cardiovascular disease? A German/Austrian multicenter DPV-Wiss analysis on 42 048 type 2 diabetic patients.

OBJECTIVE: In clinical practice Body Mass Index is generally used to evaluate overweight status in adults. The present multicenter study examines whether Body Mass Index (BMI), age- and gender-adjusted Body Mass Index Standard Deviation Score, or calculated %body fat is a better predictor for cardiovascular disease risk factors, specifically hypertension and dyslipidemia, in a high-risk population. METHODS: Data of 42 048 adult type 2 diabetic patients (median age: 67.1 years) from 161 centers in Germany (n=158) and Austria (n=3) registered in a standardized, prospective, computer-based documentation program, were included in the study. For each patient body weight, height, blood pressure and blood lipids were documented. Spearman correlation analyses as well as multivariable logistic regression models were used to examine the relationship between anthropometric measurements and cardiovascular disease risk factors. RESULTS: Correlation and regression analyses revealed minor, non significant differences between the 3 anthropometric measurements (all p>0.05). In both genders, relationships between anthropometric measurements and hypertension or reduced HDL-cholesterol were nearly identical. Only for increased triglycerides, the relations with the 3 anthropometric measurements were significantly stronger in males than in females (p<0.0001, respectively). With increasing age, associations between anthropometric measurements and hypertension, reduced HDL-cholesterol or increased triglycerides became weaker. Spearman correlation coefficients for total cholesterol and LDL-cholesterol revealed weak associations with the 3 anthropometric measurements. CONCLUSION: Compared to Body Mass Index, age- and gender-adjusted Body Mass Index Standard Deviation Score, or calculation of %body fat, has no further benefit to predict cardiovascular disease risk factors in adult type 2 diabetic patients.

Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120,183 patients from the German/Austrian DPV database.

AIM: To characterize the clinical phenotype of type 2 diabetes mellitus (T2DM) with respect to age, gender, and BMI. METHOD: Anonymized data of 120,183 people with T2DM from the German/Austrian multicenter Diabetes Patienten Verlaufsdokumentation database were analyzed based on chronological age or age at diagnosis (0-19, 20-39, 40-59, 60-79, and ≥80 years). Age, gender, and BMI comparisons with clinical phenotype were made using χ(2) and Kruskal-Wallis tests (SAS V9.2). RESULTS: Of all the patients, 51.3% were male, average age was 67.112.7 years, and average disease duration was 9.99.1 years. More girls than boys were diagnosed during adolescence and more men than women during adulthood (2060 years). No gender differences existed when age at diagnosis was 60 years. Patients were obese on average (BMI: 30.5±6.1 kg/m(2)) and had significantly higher BMI values than German population peers. The BMI gap was widest in the younger age categories and closed with increasing age. Adult women were significantly more obese than men. Obese patients more often had elevated HbA1c (≥7.5%), hypertension or dyslipidemia (irrespective of age), microalbuminuria (adults), or retinopathy (elderly) than nonobese patients. More men than women (20-60 years) had hypertension, dyslipidemia, or microalbuminuria while more women than men (≥60 years) had hypertension or dyslipidemia. CONCLUSION: During puberty, more girls than boys were diagnosed with T2DM while during adulthood males predominated. T2DM manifested at comparatively lower BMI in males, and younger patients were more obese at diagnosis. Age, gender, and BMI were also associated with poor metabolic control and cardiovascular disease comorbidities/complications.

Cardio-metabolic characterisation of patients with coronary heart disease: specific consideration of the 1-h postprandial plasma glucose.

Cardiovascular events and type 2 diabetes are closely correlated. The clinical impact of this knowledge still appears improvable, since patients frequently develop macrovascular diseases directly after, or even before reaching the routine criteria for diabetes. Consideration of the 1-h plasma glucose in the oral glucose tolerance test (OGTT) might allow detecting a high cardiovascular and/or diabetes risk earlier. We performed OGTTs in patients with unknown diabetes after acute coronary syndromes and compared data of patients reaching either a 1-h plasma glucose<140 mg/dl (n=151) or≥200 mg/dl (n=125). Patients with a low or high 1-h plasma glucose differed in BMI 26.2±3.7 vs. 28.1±3.6 kg/m², waist circumference 95.3±10.7 vs. 101.5±11.7 cm, hypertension 59.6 vs. 73.6%, HDL-cholesterol 46.2±13.5 vs. 43.2±13.9 mg/dl, triglycerides 118.6±57.9 vs. 135.9±59.3 mg/dl, cardiac septum/posterior wall thickness 12±2 vs. 13±2 mm, respectively, left atrium diameter 42±6 vs. 45±7 mm, diabetes 1.3 vs. 36.0%, impaired glucose tolerance 6.6 vs. 35.2%; p<0.05, respectively. In summary, a 1-h OGTT plasma glucose≥200 mg/dl suggests a high cardiovascular risk and might help to identify such patients independently of reaching the definition criteria for manifest diabetes.

Multiple complications and frequent severe hypoglycaemia in 'elderly' and 'old' patients with Type 1 diabetes.

AIM: Elderly and old patients with Type 1 diabetes represent a growing population that requires thorough diabetes care. The increasing relevance of this subgroup, however, plays only a minor role in the literature. Here, we describe elderly patients with Type 1 diabetes on the basis of a large multi-centre database in order to point out special features of this population. METHOD: Data of 64609 patients with Type 1 diabetes treated by 350 qualified diabetes treatment centres were assessed and analysed by age group. RESULTS: Compared with the age group ≤ 60 years, patients aged >60 years (n=3610 61-80 years and n=377 >80 years old) were characterized by a longer diabetes duration (27.7 vs. 7.7 years), an almost double risk for severe hypoglycaemia (40.1 vs. 24.3/100 patient-years), a lower level of HbA(1c) [60 vs. 67 mmol/mol (7.6 vs. 8.3%)] and higher percentages of microalbuminuria (34.5 vs. 15.6%), diabetic retinopathy (45.2 vs. 8.3%), myocardial infarction (9.0 vs. 0.4%) or stroke (6.8 vs. 0.3%). Elderly patients used insulin pumps less frequently (12.2 vs. 23.8%), but more often used conventional premixed insulin treatment (10.8 vs. 3.8%). Differences between elderly and younger patient groups were significant, respectively. CONCLUSION: Diabetes care of elderly patients with Type 1 diabetes involves individualized treatment concepts. Increased hypoglycaemia risk and functional impairment attributable to diabetes-associated and/or age-related disorders must be taken into account.

[Endocrine emergencies during pregnancy]. / Endokrine Notfälle in der Schwangerschaft.

Endocrine emergencies during pregnancy can become life-threatening for both mother and fetus. In addition to some pregnancy-linked endocrine disorders, several pre-existing forms of endocrinopathy, such as Grave's disease, type 1 diabetes and adrenal insufficiency might deteriorate acutely during pregnancy. Early diagnosis and management are challenging because the classical symptoms are often modified by pregnancy. Laboratory tests are subject to altered physiological ranges and pharmacological options are limited while therapeutic goals are stricter than in the non-pregnant patient. This article focuses on endocrine emergencies complicating pregnancy.