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Aim: Prior to the kava ban of 2002, the indication for kava ( Piper methysticum ) extracts defined by the German Commission E was "nervous anxiety, tension and restlessness". In 2000, an observational trial was started in Germany with the aim of defining symptoms of these indications best treated with kava extract. The trial was interrupted and archived "unevaluated" in 2001 due to the upcoming safety debate on kava. The data from this study has now been analyzed in order to identify symptoms best treated with kava., Methods: Documentation was available from 156 patients. Twelve typical symptoms of nervous anxiety, tension and restlessness were assessed on a five-item rating scale, together with the therapeutic context, the perceived time of onset of effects and the safety of application., Results: The median duration of treatment was 28 days. All individual symptoms showed significant and clinically relevant improvements. The most effective results were seen for nervous tension and restlessness, with better effects in patients with acute versus chronic complaints. The safety of the treatment was found to be excellent, which included the assessment of laboratory data., Conclusions: Overall, the study confirms the effective and safe short-term use of kava in the Commission E-defined indication of "nervous anxiety, tension and restlessness", especially in other than chronic cases. The clinical use of kava might be translated into context-related phobias according to ICD-10 F40, or to nervous tension (ICD10 R45.0) or restlessness and excitation (ICD-10 R45.1)., Competing Interests: M.S. received honoraria from the pharmaceutical industry for consultancy on kava and grants from the African-Caribbean-Pacific States Organization (ACP) within the European Union (EU) for kava studies in the South Pacific countries of origin of kava. The other authors declare no conflicts of interest., (Thieme. All rights reserved.)

Finding the optimum operational conditions (mainly temperature and stirring) inside the fermenters is crucial in the field of anaerobic digestion. This study was conducted to contribute to the research area of anaerobic digestion process optimization and is an example for other biogas plants to improve efficiency. The research aimed at finding the optimum operational conditions in a large-scale biogas plant located in Lower Saxony, Germany, which started operation in 2011. The optimization activities were performed by operating the fermenters under different operational conditions: the temperature inside the fermenters ranged between 40°C and 43°C, while applying several stirring scenarios. These changes led to an increase in specific electricity yield of 11.7% and a decrease in internal energy consumption of 10.4%. The total internal energy consumption of the biogas plant was in the range of 6.3-7.2% (the average monthly internal energy consumption was 6.7% in 2013 and 6.0% in 2014) from their own production, and 28% of this energy consumption was used by the stirrers before optimization. Therefore, finding the optimum operational conditions leads to high energy harvesting and lower internal energy consumption.