The Influence of Mobile Exergaming on Blood Glucose Control in Adults with Type 2 Diabetes Mellitus

Background: Physical activity plays an important role in type 2 diabetes mellitus (T2DM) prevention and treatment. The hypothesis tested whether a serious mobile exergame (MOBIGAME) designed according to the needs of people suffering from T2DM and those at risk to develop it could have an impact on blood glucose parameters in adults with T2DM. Method: Sixteen participants with T2DM were randomized into an intervention and a control group. Over a period of 24 weeks, the intervention group used the MOBIGAME, and thus benefited from a large range of exercises that improve endurance, balance, strength, flexibility, and from daily physical activity as well as healthy lifestyle promotion. The control group benefited from one lifestyle counseling session that promoted physical activity, an information booklet on the benefits of regular physical activity and recommended exercises comparable to those of the MOBIGAME, and 24 weekly exercise logs. HbA1c, C-peptide, insulin, and blood glucose levels were recorded and HOMA-IR was calculated at the baseline and at the end of the intervention. Results: Fifteen participants completed the 24-week study. Patients in the intervention group significantly improved HbA1c (from 7.1 ± 0.3 % to 6.1 ± 0.3 % (1.0 ± 0.4 %; p = 0.022) while no significant reduction (from 7.5 ± 0.3 to 7.0 ± 0.3 % (0.557 ± 0.48 %; p = 0.256) was found in the control group. Changes in C-peptide, insulin and blood glucose levels as well as in HOMA-IR were not significant. Discussion: The MOBIGAME appears to have a positive impact on blood glucose control in adults with T2DM, but further analysis is necessary

The Clique Problem in Intersection Graphs of Ellipses and Triangles

Intersection graphs of disks and of line segments, respectively, have been well studied, because of both practical applications and theoretically interesting properties of these graphs. Despite partial results, the complexity status of the Clique problem for these two graph classes is still open. Here, we consider the Clique problem for intersection graphs of ellipses, which, in a sense, interpolate between disks and line segments, and show that the problem is APX-hard in that case. Moreover, this holds even if for all ellipses, the ratio of the larger over the smaller radius is some prescribed number. Furthermore, the reduction immediately carries over to intersection graphs of triangles. To our knowledge, this is the first hardness result for the Clique problem in intersection graphs of convex objects with finite description complexity. We also describe a simple approximation algorithm for the case of ellipses for which the ratio of radii is bounde

Unraveling over time

Unraveling, the excessively early matching of future workers to employers, is a pervasive phenomenon in entry-level labor markets that leads to hiring decisions based on severely incomplete information. We provide a model of unraveling in one-to-one matching markets for prestigious positions. Its distinguishing feature is that the market operates over an extended time period during which information about potential matches arrives gradually. We find that unraveling causes potentially thick markets to spread thinly over a long time period. In equilibrium, an employers desirability is correlated neither with the time at which they hire, nor with the expected productivity of their matched worker. Unraveling thus significantly redistributes welfare among employers compared to a pairwise stable match. We study policies that manipulate the availability of information about students and show that they are effective only if they provide a sudden surge in information. Our main application is the market for U.S. federal appellate court clerks, a significant input into the efficiency of the justice system. Consistent with the model, hiring times in our dataset are spread over a period of six months and are uncorrelated with the desirability of a judge as an employer

The Role of Psychological Ownership in Community-based Piped Water Supply Infrastructure in Nepal and India

Psychological ownership, the feeling that something is mine, is a diverse social construct on the individual level with a measurable core dimension of possessiveness. It can be fostered through participative elements in combination with behaviour change interventions. The concept originally stems from the organizational context, where antecedents leading to, and consequences of psychological ownership were vastly researched. Initial evidence of the application of the construct to shared targets such as the environment or common-pool resources, for instance community-based water infrastructure, yielded promising results. However, causal evidence is scarce and a holistic adaptation of the construct, tests of theory-based interventions concerning the routes, validation of the measurement scale, and a systematic investigation of the consequences of psychological ownership are lacking. This dissertation presents findings from two community development programmes in Nepal and India, where psychological ownership for community-based water infrastructure was the subject of the research. Our results are in-line with existing evidence from the organizational context and applications in other domains. First, we found qualitative evidence for the importance of the construct in the specific context of Nepal and India, and we validated the measurement for individual psychological ownership. Second, we found that interventions should be targeting the three routes substantially, e.g. by participatory activities. Community participation can be seen as a means of implementation and therefore needs to be combined with individual-level behaviour change and embedded in institutional interventions to cause greater psychological ownership. Third, the results show that psychological ownership fosters behavioural determinants and organizational citizenship behaviour, but not the functionality of safe water supply infrastructure. This body of work provides various connecting factors for future research. Apart from changes towards an enabling environment, it is important to disentangle complex interaction of stakeholders. There is a need for experts to take care of key infrastructure. In turn, psychological ownership plays an important role in the acceptance, use and sustainability of community-based safe water supply

IgA-Nephropathie: Die häufigste Glomerulonephritis-Form

Zusammenfassung: Die IgA-Nephropathie (IgAN) ist die weltweit häufigste primäre Glomerulopathie. Meist manifestiert sie sich in der Adoleszenz oder im frühen Erwachsenenalter als wiederkehrende Makrohämaturie (oft getriggert durch einen Infekt der oberen Atemwege bzw. starke körperliche Anstrengung) oder als persistierende Mikrohämaturie, milde Proteinurie, arterielle Hypertonie und/oder Niereninsuffizienz. Sie wird häufig zufällig diagnostiziert. Viele Fälle bleiben wahrscheinlich unentdeckt. In Autopsieserien wird häufig IgA in den Glomeruli nachgeweisen [3, 4], wobei es meist Ablagerungen sind ohne dass eine manifeste IgAN bestanden hat. Nahezu 30% der Patienten leiden an einer chronischen, langsam progredienten Niereninsuffizienz. Die hauptsächlichen prognostischen Faktoren für die Progression der Nephropathie sind der Schweregrad der Niereninsuffizienz zum Zeitpunkt der Diagnose, der Grad der Proteinurie und das Vorliegen einer arteriellen Hypertonie. Eine frühe Identifikation des Vorliegens von Risikofaktoren ist entscheidend, da durch gezielte therapeutische Maßnahmen das Fortschreiten der Niereninsuffizienz vermindert werden kann. Die Nierentransplantation ist trotz der Rezidivrate der IgAN (bis zu 40% innerhalb von 5 Jahren) eine gute Therapieoptio

Steroid withdrawal after long-term medication for immunosuppressive therapy in renal transplant patients: adrenal response and clinical implications

Background. Withdrawal of steroids should be attempted after organ transplantation because of their adverse cardiovascular and metabolic effects. However, immunological, haemodynamic and symptomatic complications may occur due to the suppression of endogenous corticoid hormone synthesis under exogenous steroid intake. We have examined the effect of chronic steroid medication on adrenocortical function, and of steroid withdrawal, in immunologically stable renal transplant patients. Methods. Sixty-three patients under long-term prednisone therapy (mean±SD 36±47 months) were assessed regarding basal fasting cortisol concentration and adrenocortical stimulation by the low-dose Synacten test both prior to and after stepwise prednisone withdrawal. Renal graft function (determined as the calculated glomerular filtration rate according to the Cockroft-Gault formula), mean arterial blood pressure and clinical status were evaluated concomitantly. Results. Basal fasting cortisol concentration was clearly suppressed in 14% of patients under long-term steroid medication, and adrenocortical stimulation by the low-dose Synacten test was impaired in 31% after steroid withdrawal. About a third of all patients were symptomatic with fatigue (60%), arthralgias (60%), muscular weakness (20%), loss of appetite (20%), hypotension (15%) or headaches (5%). The incidence of symptoms was much higher in patients with low basal fasting cortisol concentration prior to steroid withdrawal, and after >2 years of steroid medication. Renal graft function, determined as glomerular filtration rate, decreased only slightly overall by ∼5%, and was more pronounced in symptomatic vs asymptomatic patients (−7 vs −2 ml/min, respectively), as was the fall in mean arterial pressure (−10 vs −4.2 mmHg, respectively). Conclusions. Adrenal function is impaired in renal transplant patients receiving long-term steroid medication as part of their immunosuppressive regimen. This may lead to mainly symptomatic complications when steroids are withdrawn. The slight decrease in glomerular filtration rate probably can be ascribed mostly to the effect of steroids on systemic renal haemodynamics. It is recommended to consider cessation of steroid medication within 48 months of therapy, and after determination of basal cortisol to identify patients with potential complication