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.

Present-day vegetation and the Holocene and recent development of Egelsee-Moor, Salzburg province, Austria

This paper describes the present-day vegetation, stratigraphy and developmental history of the mire of Egelsee-Moor (Salzburg, Austria; 45°45′N, 13°8.5′E, 700 m a.s.l., 15 ha in area) since the early Late Glacial on the basis of 4 transects with 14 trial borings across the peatland. We present a vegetation map of the mire, a longitudinal section through the peat body based on six cores showing the peat types, overview macrofossil diagrams of six cores showing the local mire development and two pollen diagrams covering the Late Glacial and Holocene. The chronology of the diagrams depends on biostratigraphic dating for the Late Glacial and early Holocene and radiocarbon dating for the remaining Holocene. The northern part of the mire originated through terrestrialisation of nutrient-rich, mostly inundated fen and the southern part through paludification of wet soils. The very small lake of today was a reservoir until recently for providing water-power for timber rafting (‘Holztrift’). The mire vegetation today is a complex of forested parts (mainly planted Pinus sylvestris and Thuja occidentalis, but also spontaneous Picea abies, Betula pubescens and Frangula alnus), reed-lands (Phragmites) and litter meadows (Molinietum, Schoenetum, etc.). The central part has hummock-hollow complexes with regionally rare species of transitional mires (Drosera anglica, D. intermedia, Lycopodiella inundata, Scorpidium scorpioides, Sphagnum platyphyllum, S. subnitens). The results indicate that some of the mid-Holocene sediments may have been removed by the timber-rafting practices, and that water extraction from the hydrological catchment since 1967 has resulted in a partial shift of transitional mire to ombrotrophic bog. The latter potentially endangers the regionally rare species and was used as an argument to stop further water extraction.

Carl Marx, an Enemy of Jewry ; Karl Marx als Judenfeind

Paul Weisengrün

The Ancestry of Karl Marx

Bernhard Wachstein

The Ancestry of Karl Marx

Bernhard Wachstein

Ms. Ff. Mus. 480 - Am ersten Ostertag : Cantate auf die Geburt des Prinzen Ferdinand 1754

[vom Seibert]. [Poesie: Reinhard]

Anton Hartmann als Karl von Moor, Rollenbild, Hüftbild, in: Friedrich Schiller: Die Räuber

Signatur des Originals: S 36/F04358

Karl Wilhelm Ferdinand Unzelmann, Brustbild, Profil

Signatur des Originals: S 36/G03688

Historisches Tagebuch aller merkwürdigen Begebenheiten, welche sich vor dem Einzuge der kaiserl. französischen Truppen in die k.k. Haupt- und Residenzstadt Wien vom Monat September bis 13. November 1805, während sie diese Hauptstadt im Besitze hatten, vom 13. November 1805 bis 13. Jäner 1806, und nach ihrem Abzuge bis 1. Februar 1806 zugetragen haben

Von Anton Ritter v. Geusau, wiener. Magistrats-Beamten

The glacier inventory of Salzburg, Austria, 2007/2009

A third glacier inventory (GI3) is presented for the province of Salzburg where 173 glaciers are located in the seven mountain ranges: Ankogel (47°4'N, 13°14'E), Glockner, Granatspitz, Sonnblick (Goldberg), Hochkönig, Venediger and Zillertal (47°8'N, 12°7'E). The basis for the new GI3 are orthophotos of 2007 and 2009 and the digital elevation model (DEM) of the southern part of Salzburg. On the basis of former inventories, area- and volume changes have been calculated. The biggest relative loss of glacier area per mountain range was found in the Ankogel range and on Hochkönig as a result of the disrupted structure of their small and thin glaciers. In terms of absolute values, the largest changes took place in the Glockner- and Venediger range with an area loss of -10.1 km**2 and -9.7 km**2 during the period between GI1 (1969) and GI3 (2007/2009), respectively. Volume changes have been calculated for nearly half of the glacier area in Salzburg, where DEMs were available. The Glockner, Granatspitz and Sonnblick mountain ranges showed a volume loss of -0.481 km**3 which corresponds to a mean thickness change of -10.5 m. An extrapolation of these changes to all of the 173 glaciers in Salzburg results in a loss of about 1.04 km**3 between GI1 and GI3 and 0.44 km**3 between GI2 and GI3. Overall annual changes in the province of Salzburg between GI2 and GI3 were higher than between GI1 and GI2 and show likewise changes such as those of Tyrol.

Horizontal profiles of longwave and shortwave radiation components over sea ice near Barrow, Alaska during the 2011 melt

An integrated instrument package for measuring and understanding the surface radiation budget of sea ice is presented, along with results from its first deployment. The setup simultaneously measures broadband fluxes of upwelling and downwelling terrestrial and solar radiation (four components separately), spectral fluxes of incident and reflected solar radiation, and supporting data such as air temperature and humidity, surface temperature, and location (GPS), in addition to photographing the sky and observed surface during each measurement. The instruments are mounted on a small sled, allowing measurements of the radiation budget to be made at many locations in the study area to see the effect of small-scale surface processes on the large-scale radiation budget. Such observations have many applications, from calibration and validation of remote sensing products to improving our understanding of surface processes that affect atmosphere-snow-ice interactions and drive feedbacks, ultimately leading to the potential to improve climate modelling of ice-covered regions of the ocean. The photographs, spectral data, and other observations allow for improved analysis of the broadband data. An example of this is shown by using the observations made during a partly cloudy day, which show erratic variations due to passing clouds, and creating a careful estimate of what the radiation budget along the observed line would have been under uniform sky conditions, clear or overcast. Other data from the setup's first deployment, in June 2011 on fast ice near Point Barrow, Alaska, are also shown; these illustrate the rapid changes of the radiation budget during a cold period that led to refreezing and new snow well into the melt season.