International variation in outcomes among people with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: insights from the NAVIGATOR Trial

Background: Regional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial. Methods and Results: NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified. Conclusions: Major regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials

Reflexionen über Coaching in der projektbasierten Lehre

Wie kann man Coaches bei der Ausbildung ihrer professionellen Identität unterstützen? Eine mögliche Methode ist die Reflexion von Irritationsmomenten in der projektbasierten Lehre. In diesem Artikel werden die Erfahrungen von vier Coaches mit dieser Methode beschrieben. Drei von ihnen fanden die Methode hilfreich, um ihre eigene Rolle differenzierter zu betrachten und Klarheit über ihre An- und Widersprüche, die Diversität der unterschiedlichen Perspektiven sowie ihre eigene Wirkung zu erhalten. Die Methode erfordert jedoch zeitliche Ressourcen und eine Sensibilisierungsphase zu Beginn, um Irritationsmomente für die Reflexionsarbeit zu nutzen. Insgesamt scheint die Reflexionsmethode geeignet zu sein, um Coaches bei der Ausbildung ihrer professionellen Identität zu unterstützen. (Herausgeber)How can coaches be supported in forming their professional identity? One possible method is the reflection of moments of irritation in project-based teaching. This article describes the experiences of four coaches with this method. Three of them found the method helpful to look at their own role in a more differentiated way and to get clarity about their attachments and contradictions, the diversity of different perspectives, and their own impact. However, the method requires time resources and a sensitization phase at the beginning in order to use moments of irritation for the reflection work. Overall, the reflection method seems to be suitable to support coaches in the formation of their professional identity. (Editor

Influence of fermentable carbohydrates or protein on large intestinal and urinary metabolomic profiles in piglets

It was recently shown that variations in the ratio of dietary fermentable carbohydrates (fCHO) and fermentable protein (fCP) differentially affect large intestinal microbial ecology and the mucosal response. Here we investigated the use of mass spectrometry to profile changes in metabolite composition in colon and urine associated with variation in dietary fCHO and fCP composition and mucosal physiology. Thirty-two weaned pigletswere fed 4 diets in a 2 × 2 factorial design with low fCP and low fCHO, low fCP and high fCHO, high fCP and low fCHO, and high fCP and high fCHO. After 21 to 23 d, all pigs were euthanized and colon digesta and urine metabolite profiles were obtained by mass spectrometry. Analysis of mass spectra by partial least squares approach indicated a clustering of both colonic and urinary profiles for each pig by feeding group. Metabolite identification and annotation using the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathways revealed increased abundance of metabolites associated with arachidonic acid metabolism in colon of pigs fed a high concentration of fCP irrespective of dietary fCHO. Urinary metabolites did not show as clear patterns. Mass spectrometry can effectively differentiate metabolite profiles in colon contents and urine associated with changes in dietary composition. Whether metabolite profiling is an effective tool to identify specific metabolites (biomarkers) or metabolite profiles associated with gut function and integrity needs further elucidation

Behavioural changes to moderate heat load in grazing dairy cows under on-farm conditions

Heat stress poses an increasing risk to welfare, health and productivity of dairy cows, especially for cows on pasture. To apply timely mitigation strategies for grazing cows, simple indicators are needed that signal heat stress. We conducted an exploratory study on the behaviour of grazing dairy cows in relation to the environmental heat load on four commercial dairy farms in Switzerland with herd sizes ranging from 20 to 57 cows. In a scan-sampling procedure standing/lying, feeding/ruminating, low inter-individual distances, proximity to drinker, use of natural shade and insect infestation were observed during 30 days (5–9 days/per farm). Additionally, 10 focal cows per farm were equipped with accelerometers to analyse lying duration and locomotor activity during on average 46 days per farm. On one farm all cows (N = 57) were equipped with GPS devices which were used to calculate inter-individual distances among cows continuously during 69 days. Air temperature and relative humidity were recorded to calculate the temperature-humidity index (THI). For behaviours recorded in direct observations, a principal component analysis was performed for variable reduction. The first three principal components (PC) as well as the variables from automatic measurements were used as outcome variables in mixed effects models with daily maximum THI (THImax), time of day (continuous, in 10 min intervals) and their interaction as explanatory variables. The three PCs could be described as: “feeding and standing”, “proximity to drinker” and “standing in close proximity and seeking shade”. The daily pattern of these PC's differed by THImax (interaction time of day * THImax; all p < 0.01). On days with high THImax compared to days with lower THImax cows were seen more often close to the drinker in the morning, but not in the afternoon when they were observed standing close to each other and in the shade. On days with high THImax, cows also were lying less and increased their locomotor activity towards noon (interaction time of day * THImax; p < 0.001). Data from GPS devices confirmed the findings: On days with high THImax, cows reduced their inter-individual distances over the course of the day, while this was not observed on days with lower THImax (interaction time of day * THImax; p < 0.001). Insect infestation increased with higher THImax. We conclude that a distinct change in daily behavioural patterns, especially a reduction of lying behaviour, an increase in locomotor activity and a decrease in inter-individual distances could be used to monitor heat stress of dairy cows on pasture

Mobile Media Use : Structure and Order - Three Project Reports

In diesem Band werden drei empirische Forschungsprojekte zur Nutzung von mobilen Medien im öffentlichen Raum dokumentiert. Projekt I: "Einsteigen mit Medien. Eine Studie zur Nutzung mobiler Medien im öffentlichen Stadtverkehr am Beispiel der Landeshauptstadt Stuttgart" / Projekt II: "Angst vor der Langeweile? Nutzung mobiler Medien in Wartesituationen" / Projekt III: "Musica Mobilis. Unterwegs mit der schwerelosen Musiksammlung. Eine Studie über die Auswirkungen des mobilen Musikkonsums auf die Wertschätzung von Musik

Structural basis of envelope and phase intrinsic coupling modes in the cerebral cortex

Intrinsic coupling modes (ICMs) can be observed in ongoing brain activity at multiple spatial and temporal scales. Two families of ICMs can be distinguished: phase and envelope ICMs. The principles that shape these ICMs remain partly elusive, in particular their relation to the underlying brain structure. Here we explored structure-function relationships in the ferret brain between ICMs quantified from ongoing brain activity recorded with chronically implanted micro-ECoG arrays and structural connectivity (SC) obtained from high-resolution diffusion MRI tractography. Large-scale computational models were used to explore the ability to predict both types of ICMs. Importantly, all investigations were conducted with ICM measures that are sensitive or insensitive to volume conduction effects. The results show that both types of ICMs are significantly related to SC, except for phase ICMs when using measures removing zero-lag coupling. The correlation between SC and ICMs increases with increasing frequency which is accompanied by reduced delays. Computational models produced results that were highly dependent on the specific parameter settings. The most consistent predictions were derived from measures solely based on SC. Overall, the results demonstrate that patterns of cortical functional coupling as reflected in both phase and envelope ICMs are both related, albeit to different degrees, to the underlying structural connectivity in the cerebral cortex.This work was supported by funding from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - SFB 936 - 178316478 - A1 (C.C.H.), A2 (A.K.E.), and Z3 (C.C.H. and A.M.), SPP1665 - 220176618 - EN533/13-1 (A.K.E.), SPP2041 - 313856816 - HI1286/6-1 (C.C.H.) and EN533/15-1 (A.K.E.), from the European Unions Horizon 2020 Framework Programme for Research and Innovation under Specific Grant Agreements 785907 and 945539 (Human Brain Project SGA2 and SGA3, C.C.H.), and from the 2015 FLAG-ERA Joint Transnational Call for project FIIND - ANR-15-HBPR-0005 (R.T.).Peer reviewe

Healthcare delivery and information provision in bariatric surgery in Germany: qualitative interviews with bariatric surgeons

Background!#!There are several healthcare professionals involved in health information provision regarding bariatric surgery, such as bariatric surgeons, nutritionists, and medical doctors in outpatient settings. Trustworthy health information supports patients in understanding their diagnosis, treatment decisions, and possible prognosis. Therefore, it is necessary to provide health information on bariatric surgery. This study has two distinct objectives. The first is to outline the delivery of healthcare regarding bariatric surgery in Germany. The second is to describe the information provision within healthcare delivery.!##!Methods!#!We conducted 15 semi-structured telephone interviews with bariatric surgeons between April 2018 and February 2019. The interviews were audio recorded and transcribed verbatim. The interview guide consisted of four sections (information about the clinic/surgeon and surgical procedures, preoperative procedure, postoperative procedure, information needs). The transcribed interviews were analyzed using qualitative content analysis supported by MAXQDA software.!##!Results!#!The pre- and postoperative processes differed substantially between clinics. Additionally, every bariatric clinic had its own information provision concept. There were several cost-related issues the surgeons claimed to be relevant for patients, such as nutritional blood tests or postoperative psychotherapy. These issues were often caused by unclearness of responsibility within the medical disciplines involved.!##!Conclusion!#!Healthcare delivery in bariatric surgery in Germany is heterogeneous in terms of pre- and postoperative care. Therefore, preoperative information provision between the clinics differs. The impact of this heterogeneous healthcare delivery and information provision on patients' information needs regarding bariatric surgery should be further investigated among patients and other healthcare professionals involved

The acidic protein rich in leucines Anp32b is an immunomodulator of inflammation in mice

ANP32B belongs to a family of evolutionary conserved acidic nuclear phosphoproteins (ANP32A-H). Family members have been described as multifunctional regulatory proteins and proto-oncogenic factors affecting embryonic development, cell proliferation, apoptosis, and gene expression at various levels. Involvement of ANP32B in multiple processes of cellular life is reflected by the previous finding that systemic gene knockout (KO) of Anp32b leads to embryonic lethality in mice. Here, we demonstrate that a conditional KO of Anp32b is well tolerated in adult animals. However, after immune activation splenocytes isolated from Anp32b KO mice showed a strong commitment towards Th17 immune responses. Therefore, we further analyzed the respective animals in vivo using an experimental autoimmune encephalomyelitis (EAE) model. Interestingly, an exacerbated clinical score was observed in the Anp32b KO mice. This was accompanied by the finding that animal-derived T lymphocytes were in a more activated state, and RNA sequencing analyses revealed hyperactivation of several T lymphocyte-associated immune modulatory pathways, attended by significant upregulation of Tfh cell numbers that altogether might explain the observed strong autoreactive processes. Therefore, Anp32b appears to fulfill a role in regulating adequate adaptive immune responses and, hence, may be involved in dysregulation of pathways leading to autoimmune disorders and/or immune deficiencies