Selbsthilfeorganisationen für seltene Erkrankungen und Gesundheitsversorgung: Gesundheitspolitische Erwartungen und Selbsthilferealität

Health policy expects self-help associations to make contributions to the improvement of the healthcare sector. The pilot study has explored the degree of reality of these expectations in a sample of five self-help organizations in the field of rare diseases. The study reveals that the expectations are fulfilled only in part. Self-help organizations enrich the healthcare sector with two specific qualities: their members operate with the special competencies of affected people and they have established a long-lasting cooperation with voluntary professionals. They are often a great help to the people contacting them directly, but, for a number of reasons, their supporting measures are reaching only a part of all affected people. The activities in the field of social participation have to cope with a lack of proper activists. They are able to pursue single projects successfully, but they are facing great problems in mastering the whole agenda of social participation

Adoption of digital tools in the context of the COVID-19 pandemic in the Region of the Americas - the Go.Data experience

The COVID-19 pandemic has accelerated the growth of digital health tools. Although a number of different tools exist to support field data collection in the context of outbreak response, they have not been sufficient. This prompted the World Health Organization (WHO) to collaborate with the Global Outbreak Alert and Response Network (GOARN) and GOARN partners to develop a comprehensive system, Go.Data. Go.Data, a digital tool for outbreak response has simplified how countries operationalize and monitor case and contact data. Since the start of the pandemic, WHO and GOARN partners have provided support to Go.Data projects in 65 countries and territories, yet the demand by countries to have documented success cases of Go.Data implementations continues to grow. This viewpoint documents the successful Go.Data implementation frameworks in two countries, Argentina and Guatemala and an academic institution, the University of Texas at Austin

Pig Pancreas Oxygenation at 20°C Increases Islet ATP Generation but Deteriorates Islet Function

Successful pancreas preservation during storage in oxygenated perfluorodecalin (PFD) is mainly related to oxidative ATP generation during storage. Increasing the storage temperature would accelerate this process essential for resuscitation of ischemically damaged pancreatic tissue. The present study aimed at comparing islet isolation outcome from adult pig pancreata preserved in oxygenated PFD by means of a one-layer method during storage on ice or at 20 degrees C. Resected pancreata were intraductally flushed with cold UW solution and promptly processed (n = 6) or stored for 3 h in continuously oxygenated PFD at 4 degrees C (n = 5) or 20 degrees C (n = 7). Prior to digestion-filtration pancreata were intraductally injected with UW supplemented with Serva collagenase NB8 and neutral protease. Islet quality assessment determined viability, glucose stimulation index, mitochondrial activity, intracellular ATP content, and transplant function in diabetic nude mice. Pancreata oxygenated for 3 h at 20 degrees C yielded islet numbers similar to organs oxygenated at 4 degrees C. Compared to a storage temperature of 20 degrees C, preservation at 4 degrees C reduced islet ATP content (p < 0.05) as well as islet viability (p < 0.05). Nevertheless, PFD storage at 20 degrees C decreased insulin response to glucose compared to unstored pancreata (p < 0.05). In contrast to unstored pancreata or cold-stored organs, transplantation of islets isolated after oxygenation at 20 degrees C was characterized by an early loss of transplant function in 50% of recipients (p < 0.05). The present study demonstrates that PFD storage at 20 degrees C enhances islet ATP synthesis within a short period of oxygenation but deteriorates islet function. We conclude that the present data reflect an equilibration between reduced depression of metabolic activity resulting in damage of islets and temperature-stimulated acceleration of ATP synthesis. Future studies are required to adjust the optimum storage temperature for pancreas oxygenation in different species

Wasting disease and static environmental variables drive sea star assemblages in the Northern Gulf of Alaska

Sea stars are ecologically important in rocky intertidal habitats where they can play an apex predator role, completely restructuring communities. The recent sea star die-off throughout the eastern Pacific, known as Sea Star Wasting Disease, has prompted a need to understand spatial and temporal patterns of sea star assemblages and the environmental variables that structure these assemblages. We examined spatial and temporal patterns in sea star assemblages (composition and density) across regions in the northern Gulf of Alaska and assessed the role of seven static environmental variables (distance to freshwater inputs, tidewater glacial presence, exposure to wave action, fetch, beach slope, substrate composition, and tidal range) in influencing sea star assemblage structure before and after sea star declines. Environmental variables correlated with sea star distribution can serve as proxies to environmental stressors, such as desiccation, attachment, and wave action. Intertidal sea star surveys were conducted annually from 2005 to 2018 at five sites in each of four regions that were between 100 and 420 km apart across the northern Gulf of Alaska. In the pre-disease years, assemblages were different among regions, correlated mostly to tidewater glacier presence, fetch, and tidal range. The assemblages after wasting disease were different from those before the event with lower diversity and lower density. In addition to these declines, the disease manifested itself at different times across the northern Gulf of Alaska and did not impact all species uniformly across sites. Post sea star wasting, there was a shift in the environmental variables that correlated with sea star structure, resulting in sea star assemblages being highly correlated with slope, fetch, and tidal range. In essence, sea star wasting disease resulted in a shift in the sea star assemblage that is now correlating with a slightly different combination of environmental variables. Understanding the delicate interplay of environmental variables that influence sea star assemblages could expand knowledge of the habitat preferences and tolerance ranges of important and relatively unstudied species within the northern Gulf of Alaska

Guava (Psidium guajava) Fruit Extract Prepared by Supercritical CO2 Extraction Inhibits Intestinal Glucose Resorption in a Double-Blind, Randomized Clinical Study

Inhibition of intestinal glucose resorption can serve as an effective strategy for the prevention of an increase in blood glucose levels. We have recently shown that various extracts prepared from guava (Psidium guajava) inhibit sodium-dependent glucose cotransporter 1 (SGLT1)- and glucose transporter 2 (GLUT2)-mediated glucose transport in vitro (Caco-2 cells) and in vivo (C57BL/6N mice). However, the efficacy in humans remains to be confirmed. For this purpose, we conducted a parallelized, randomized clinical study with young healthy adults. Thirty-one volunteers performed an oral glucose tolerance test (OGTT) in which the control group received a glucose solution and the intervention group received a glucose solution containing a guava fruit extract prepared by supercritical CO2 extraction. The exact same extract was used for our previous in vitro and in vivo experiments. Blood samples were collected prior to and up to two hours after glucose consumption to quantitate blood glucose and insulin levels. Our results show that, in comparison to the control group, consumption of guava fruit extract resulted in a significantly reduced increase in postprandial glucose response over the basal fasting plasma glucose levels after 30 min (Δ control 2.60 ± 1.09 mmol/L versus Δ intervention 1.96 ± 0.96 mmol/L; p = 0.039) and 90 min (Δ control 0.44 ± 0.74 mmol/L versus Δ intervention −0.18 ± 0.88 mmol/L; p = 0.023). In addition, we observed a slightly reduced, but non-significant insulin secretion (Δ control 353.82 ± 183.31 pmol/L versus Δ intervention 288.43 ± 126.19 pmol/L, p = 0.302). Interestingly, storage time and repeated freeze-thawing operations appeared to negatively influence the efficacy of the applied extract. Several analytical methods (HPLC-MS, GC-MS, and NMR) were applied to identify putative bioactive compounds in the CO2 extract used. We could assign several substances at relevant concentrations including kojic acid (0.33 mg/mL) and 5-hydroxymethylfurfural (2.76 mg/mL). Taken together, this clinical trial and previous in vitro and in vivo experiments confirm the efficacy of our guava fruit extract in inhibiting intestinal glucose resorption, possibly in combination with reduced insulin secretion. Based on these findings, the development of food supplements or functional foods containing this extract appears promising for patients with diabetes and for the prevention of insulin resistance. Trial registration: 415-E/2319/15-2018 (Ethics Commissions of Salzburg)

Prevention of outburst floods from periglacial lakes at Grubengletscher, Valais, Swiss Alps

Flood and debris-flow hazards at Grubengletscher near Saas Balen in the Saas Valley, Valais, Swiss Alps, result from the formation and growth of several lakes at the glacier margin and within the surrounding permafrost. In order to prevent damage related to such hazards, systematic investigations were carried out and practical measures taken. The evolution of the polythermal glacier, the creeping permafrost within the large adjacent rock glacier and the development of the various periglacial lakes were monitored and documented for the last 25 years by photogrammetric analysis of annually flown high-resolution aerial photographs. Seismic refraction, d.c. resistivity and gravimetry soundings were performed together with hydrological tracer experiments to determine the structure and stability of a moraine dam at a proglacial lake. The results indicate a maximum moraine thickness of > 100 m; extremely high porosity and even ground caverns near the surface may have resulted from degradation of sub- and periglacial permafrost following 19th/20thcentury retreat of the partially cold glacier tongue. The safety and retention capacity of the proglacial lake were enhanced by deepening and reinforcing the outlet structure on top of the moraine complex. The water level of an ice-dammed lake was lowered and a thermokarst lake artficially drained