Risk of severe hypoglycemia in sulfonylurea-treated patients from diabetes centers in Germany/Austria: how big is the problem? which patients are at risk?

BACKGROUND We investigated the rate of severe hypoglycemic events and confounding factors in patients with type-2-diabetes treated with sulfonylurea (SU) at specialized diabetes centers, documented in the German/Austrian DPV-Wiss-database. METHODS Data from 29,485 SU-treated patients were analyzed (median[IQR] age 70.8[62.2-77.8]yrs, diabetes-duration 8.2[4.3-12.8]yrs). The primary objective was to estimate the event-rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency.hospitalization). Secondary objectives included exploration of confounding risk-factors through group-comparison and Poisson-regression. RESULTS Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of SU-treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event-rate of severe hypoglycemia [95%CI] was 3.9[3.7-4.2] events/100 patient-years (coma: 1.9[1.8-2.1]; hospitalization: 1.6[1.5-1.8]). Adjusted event-rates by diabetes-treatment were 6.7 (SU + insulin), 4.9 (SU + insulin + other OAD), 3.1 (SU + other OAD), and 3.8 (SU only). Patients with ≥1 severe event were older (p < 0.001) and had longer diabetes-duration (p = 0.020) than patients without severe events. Participation in educational diabetes-programs and indirect measures of insulin-resistance (increased BMI, plasma-triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common (N = 3,113 eGFR ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30-60 mL/min: 4.8; >60 mL/min: 3.9). CONCLUSIONS These real-life data showed a rate of severe hypoglycemia of 3.9/100 patient-years in SU-treated patients from specialized diabetes centers. Higher risk was associated with known risk-factors including lack of diabetes-education, older age, and decreased eGFR, but also with lower BMI and lower triglyceride-levels, suggesting that SU-treatment in those patients should be considered with caution. This article is protected by copyright. All rights reserved.

Na 1 Nachlass Max Horkheimer, 640 - "Simmel and Freudian Philosophy", "Authoritarianism and the Family Today" und "The Chances of Democracy in Germany" (p. IX 18.1-3-IX 19a)

"Simmel and Freudian Philosophy" (GS 5, S. 396-405); 1. Nachruf, verlesen beim Memorial Meeting for Ernst Simmel; datiert: 13.12.1947; veröffentlicht in: International Journal of Psychoanalysis, 29. Jahrgang, 1948, S. 110-113; 2. Abschrift aus Werken und Briefen Siegmund Freuds; Typoskript, 9 Blatt; 3. Freeman, Burriel: 1 Brief mit Unterschirft an Max Horkheimer, Chicago, 10.06.1949; 1 Brief von Max Horkheimer, Los Angeles, 15.06.1949, 2 Blatt; "Authoritarianism and the Family Today" (GS 5, S. 377-395); 1. Aufsatz, datiert 1947, veröffentlicht in: Ruth Nanda Anshen (editor), "The Family: Its Function and Distiny", New York 1949. a) Typsokript, 20 Blatt b) Typoskript mit handschriftlichen Korrekturen, 20 Blatt c) Typoskript mit eigenhändigen Korrekturen, 20 Blatt d)-f) deutsche Fassung mit dem Titel "Autorität und Familie", übersetzt vom Institut für Sozialforschung, 1960; veröffentlicht in : "Erkenntnis und Verantwortung. Festschrift für Theodor Litt", Düsseldorft, 1960 d) Typoskript, 20 Blatt e) Typoskript, 20 Blatt f) Korrekturfahnen aus der Litt- Festschrift, mit dem Titel "Autorität und Familie in der Gegenwart"; 6 Blatt; 2. Schönbach, Peter: 1 Brief mit Unterschrift an Max Horkheier, ohne Ort, 23.06.1960; 1 Blatt; 3. Schönbach, Peter: 1 Brief mit Unterschrift an Friedrich Pollock, ohne Ort, 22.06.1960; 1 Blatt; "The Chances of Democracy in Germany" (GS 12, S. 184-194); 1947 [?] a) Typoskript, 10 Blatt b) Typoskript mit eigenhändigen Korrekturen, 11 Blatt c) Typoskript mit eigenhändigen Korrekturen ,11 Blatt;

Na 1 Nachlass Max Horkheimer, 685 - "Post War Antisemitism in Germany" (p. IX 147.1-6)

Gurland, A.R.L.: "Fight against Antisemitism within the Framwork of Germany's Education for Democracy. Draft Program", 1947. Als Typoskript vervielfältigt, 62 Blatt; Horkheimer, Max: "Momorandum on Post-War Antisemitism in Germany", 31.05.1945. Typoskript, 1 Blatt; Massing, Paul W.; Gurlach, A.R.L.: 2 Briefe mit Unterschrift an Max Horkheimer, ohne Ort, 1944; 1 Brief von Max Horkheimer, ohne Ort, 05.10.1944, 11 Blatt; Massig, Paul W.; Gurlach A.R.L.: "Some Remarks on Leo Löwenthals Memorandum" [September 1944]. Typoskript, 14 Blatt; [Löwenthal, Leo?]: "Post-War Antisemitism in Germany", a) Typoskript, 21 Blatt; b) Typoskript, 29 Blatt; Peck, Georg: "On the Problem of Antisemitism in Post-War Germany", 28.07.1943. Typoskript, 12 Blatt;

Pollen record and dating of a sediment profile from Ahlequellmoor in Germany

A pollen diagram from the Ahlequellmoor in the Solling area shows the history of vegetation and settlement over the last 7,800 years. In the early Atlantic period mixed deciduous forest with mainly Tilia together with Ulmus and Quercus grew in the area. In the late Atlantic period Quercus became most abundant. Fagus spread in the Sub-boreal period at about 2700 B.C. Since ca. 900 B.C. the Solling was covered by beech forests with some oak. In prehistoric times woodland grazing is indicated. Only in Medieval times are two settlements in the vicinity of the Ahlequellmoor reflected in the pollen diagram. The earlier one is dated to about A.D. 750-1020, and may be connected with the former Monastery of Hethis, which is thought to have existed close to the fen from A.D. 815 to 822. The second Medieval settlement dates to the 11th-12th century. The large-scale woodland destruction of late Medieval and modern times is not clearly visible. The silvicultural measures of the last 200 years are reflected by increasing values of spruce and grassland taxa.

Pollen analysis of a sediment profile from Gabelsee in Germany

The article shows that pollen analysis plays an important role in the prediction of potential settlement areas and, furthermore, can offer a crude determination of settlement duration. Especially when the archaeological data fails to offer a possibility of dating, pollen analysis in connection with 14C can importantly broaden the knowledge base. As in the present case, the results of the Archaeo-Prognosis mapping and the pollen analysis of the Gabelsee are compared and, within this vicinity, confirmend. = Der Beitrag zeigt, dass die Pollenanalyse eine wichtige Rolle für die Vorhersage von potenziellen Siedlungsflächen spielen und darüber hinaus eine grobe Berechnung der Siedlungsdauer bieten kann. Insbesondere wenn die archäologische Datenbasis keine genaue Datierung zulässt, ermöglicht die Pollenanalyse in Verbindung mit der 14C-Datierung eine wichtige Erweiterung der Kenntnisse. Im vorliegenden Fall konnten die Ergebnisse der Archäoprognosekarte mit denjenigen der Pollenanalyse des Gabelsees verglichen und für diesen lokalen Raum bestätigt werden.

Rarefied allelic richness of the ground beetle Abax parallelepipedus in Germany

Although genetic diversity is one of the key components of biodiversity, its drivers are still not fully understood. While it is known that genetic diversity is affected both by environmental parameters as well as habitat history, these factors are not often tested together. Therefore, we analyzed 14 microsatellite loci in Abax parallelepipedus, a flightless, forest dwelling ground beetle, from 88 plots in two study regions in Germany. We modeled the effects of historical and environmental variables on allelic richness, and found for one of the regions, the Schorfheide-Chorin, a significant effect of the depth of the litter layer, which is a main component of habitat quality, and of the sampling effort, which serves as an inverse proxy for local population size. For the other region, the Schwäbische Alb, none of the potential drivers showed a significant effect on allelic richness. We conclude that the genetic diversity in our study species is being driven by current local population sizes via environmental variables and not by historical processes in the studied regions. This is also supported by lack of genetic differentiation between local populations sampled from ancient and from recent woodlands. We suggest that the potential effects of former fragmentation and recolonization processes have been mitigated by the large and stable local populations of Abax parallelepipedus in combination with the proximity of the ancient and recent woodlands in the studied landscapes.

Physical properties of four profiles from the Triassic in Germany

The Norian Steinmergel-Keuper (SMK) represents a low-latitude cyclically-bedded playa system of the Mid-German Basin. We investigated a drilling site (core Morsleben) and sections from marginal positions. Dolomite/red mudstone beds form rhythmic alternations that were associated with varying monsoon activity. Hence, low K/Al ratios of dolomite beds suggest increased chemical weathering of the crystalline hinterland and therefore increased monsoonal rainfall. High K/Al ratios in red mudstone beds reflect increased physical weathering of the hinterlands during dryer periods. Dolomite layers reflect the lake stage (maximum monsoon) while red mudstones indicate the dry phase (minimum monsoon) of the playa cycle. We distinguished five major types of cyclic facies alternations, representing specific facies zones in the playa system. We have implemented spectrophotometry as a tool for high-resolution cyclostratigraphy. The dense sampling increment (up to 1 cm) allows for the recognition of all orbital frequencies. Sediment colour profiles reveal striking hierarchical cycles from semi-precession (SP, 99 kyr) over precession (P, 19.8 kyr) and obliquity (O, 36 kyr) to eccentricity (E1-2 109 kyr; E3, 413 kyr). A significant about 2 Myr-signal is attributed to the longer-term eccentricity E4. One monsoonal (precession) cycle includes two carbonate precipitation events. We propose that stratified mudstone and red mudstone are associated with maximum and minimum monsoon during the transition of the solstices in perihelion and aphelion, respectively. The two carbonate precipitation events were most likely created when equinoxes were in perihelion and aphelion, respectively. A sedimentary semi-precession response cycle is a novel finding for the Norian strata. The obliquity signal is attributed to incoming atmospheric moisture from the northeast of the SMK basin. The E4 cycle controls lake-level changes over long times. Apparently, E4 is responsible whether or not a threshold value is crossed. Bundles of 109 kyr and 413 kyr in red mudstones suggest a dry system with reduced monsoonal activity. In contrast, humid periods reveal thick layers of dolomite beds, indicating that during those intervals the monsoonal activity was strong enough to prevent the playa system from drying out completely.

Pollen record from Muggesfelder See and Plussee in Germany

A basaltic tephra layer consisting of brownish-olive glass shards. and about 0.2 mm thick. was found in cores from four lakes in northwest Germany. According to pollen analysis it was deposited during the early Boreal period (corresponding to about 8700 BP). The petrographic properties. the geochemical composition and the age agree with those of the Saksunarvatn tephra. which was first found on the Faroe Islands. The position of the tephra layer in the pollen stratigraphy and in the absolute time-scale is discussed. Procedures for locating the tephra in other cores are suggested.

Diffusion of photovoltaic in Germany: policy vs. consumers

In some countries photovoltaic (PV) technology has already achieved a stage of development at which it can compete with conventional electricity sources. Germany provides a good illustration of this where PV market has reached a mature stage. As a manifest of this, the German government has recently reduced subsidies for households and industry by decreasing the feed in tariff for PV. This development raises fundamental questions: could the PV industry survive? Will consumers be motivated to continue to adopt PV when feed-in tariff diminish? The point of departure for the relevant literature on diffusion of PV has been on the effect of subsidies but little attention has paid to consumer motives when the policy support is scaled down. This paper introduces an in-depth analysis on understanding the consumer motives for adopting photovoltaic applications. Anchored in an extensive exploratory case study on PV consumers and PV system providers, this study aims to provide an encompassing explanation of diffusion of PV by revealing the link between consumer motives and the impact of policy.

Diffusion of photovoltaic in Germany: roles of policy, system suppliers and adopters

In some countries photovoltaic (PV) technology is at a stage of development at which it can compete with conventional electricity sources. A case in point is Germany where PV market has reached a mature stage. As a manifest of this, the German government has recently reduced the feed-in-tariff, which had been the strongest driver of PV diffusion. This development raises a fundamental question: Why would potential adopters be motivated to adopt PV when feed-in tariff diminishes? The point of departure for the literature on diffusion of PV has been on the effect of subsidies but little attention has paid to adopter motives when the policy support is scaled down. This paper presents an in-depth analysis of the adopter motives for photovoltaic applications. Anchored in an extensive exploratory case study we provide an encompassing explanation of roles of policy, adopters and system suppliers on diffusion of PV.

A multi-level analysis of innovation diffusion: The case of solar photovoltaic systems in Germany and the disillusion of grid parity

¿Suministrarán las fuentes de energía renovables toda la energía que el mundo necesita algún día? Algunos argumentan que sí, mientras que otros dicen que no. Sin embargo, en algunas regiones del mundo, la producción de electricidad a través de fuentes de energía renovables ya está en una etapa prometedora de desarrollo en la que su costo de generación de electricidad compite con fuentes de electricidad convencionales, como por ejemplo la paridad de red. Este logro ha sido respaldado por el aumento de la eficiencia de la tecnología, la reducción de los costos de producción y, sobre todo, los años de intervenciones políticas de apoyo financiero. La difusión de los sistemas solares fotovoltaicos (PV) en Alemania es un ejemplo relevante. Alemania no sólo es el país líder en términos de capacidad instalada de sistemas fotovoltaicos (PV) en todo el mundo, sino también uno de los países pioneros donde la paridad de red se ha logrado recientemente. No obstante, podría haber una nube en el horizonte. La tasa de difusión ha comenzado a declinar en muchas regiones. Además, las empresas solares locales – que se sabe son importantes impulsores de la difusión – han comenzado a enfrentar dificultades para manejar sus negocios. Estos acontecimientos plantean algunas preguntas importantes: ¿Es ésta una disminución temporal en la difusión? ¿Los adoptantes continuarán instalando sistemas fotovoltaicos? ¿Qué pasa con los modelos de negocio de las empresas solares locales? Con base en el caso de los sistemas fotovoltaicos en Alemania a través de un análisis multinivel y dos revisiones literarias complementarias, esta tesis doctoral extiende el debate proporcionando riqueza múltiple de datos empíricos en un conocimiento de contexto limitado. El primer análisis se basa en la perspectiva del adoptante, que explora el nivel "micro" y el proceso social que subyace a la adopción de los sistemas fotovoltaicos. El segundo análisis es una perspectiva a nivel de empresa, que explora los modelos de negocio de las empresas y sus roles impulsores en la difusión de los sistemas fotovoltaicos. El tercero análisis es una perspectiva regional, la cual explora el nivel "meso", el proceso social que subyace a la adopción de sistemas fotovoltaicos y sus técnicas de modelado. Los resultados incluyen implicaciones tanto para académicos como políticos, no sólo sobre las innovaciones en energía renovable relativas a la paridad de red, sino también, de manera inductiva, sobre las innovaciones ambientales impulsadas por las políticas que logren la competitividad de costes. ABSTRACT Will renewable energy sources supply all of the world energy needs one day? Some argue yes, while others say no. However, in some regions of the world, the electricity production through renewable energy sources is already at a promising stage of development at which their electricity generation costs compete with conventional electricity sources’, i.e., grid parity. This achievement has been underpinned by the increase of technology efficiency, reduction of production costs and, above all, years of policy interventions of providing financial support. The diffusion of solar photovoltaic (PV) systems in Germany is an important frontrunner case in point. Germany is not only the top country in terms of installed PV systems’ capacity worldwide but also one of the pioneer countries where the grid parity has recently been achieved. However, there might be a cloud on the horizon. The diffusion rate has started to decline in many regions. In addition, local solar firms – which are known to be important drivers of diffusion – have started to face difficulties to run their businesses. These developments raise some important questions: Is this a temporary decline on diffusion? Will adopters continue to install PV systems? What about the business models of the local solar firms? Based on the case of PV systems in Germany through a multi-level analysis and two complementary literature reviews, this PhD Dissertation extends the debate by providing multiple wealth of empirical details in a context-limited knowledge. The first analysis is based on the adopter perspective, which explores the “micro” level and the social process underlying the adoption of PV systems. The second one is a firm-level perspective, which explores the business models of firms and their driving roles in diffusion of PV systems. The third one is a regional perspective, which explores the “meso” level, i.e., the social process underlying the adoption of PV systems and its modeling techniques. The results include implications for both scholars and policymakers, not only about renewable energy innovations at grid parity, but also in an inductive manner, about policy-driven environmental innovations that achieve the cost competiveness.