Development and validation of risk profiles of West African rural communities facing multiple natural hazards

West Africa has been described as a hotspot of climate change. The reliance on rain-fed agriculture by over 65% of the population means that vulnerability to climatic hazards such as droughts, rainstorms and floods will continue. Yet, the vulnerability and risk levels faced by different rural social-ecological systems (SES) affected by multiple hazards are poorly understood. To fill this gap, this study quantifies risk and vulnerability of rural communities to drought and floods. Risk is assessed using an indicator-based approach. A stepwise methodology is followed that combines participatory approaches with statistical, remote sensing and Geographic Information System techniques to develop community level vulnerability indices in three watersheds (Dano, Burkina Faso; Dassari, Benin; Vea, Ghana). The results show varying levels of risk profiles across the three watersheds. Statistically significant high levels of mean risk in the Dano area of Burkina Faso are found whilst communities in the Dassari area of Benin show low mean risk. The high risk in the Dano area results from, among other factors, underlying high exposure to droughts and rainstorms, longer dry season duration, low caloric intake per capita, and poor local institutions. The study introduces the concept of community impact score (CIS) to validate the indicator-based risk and vulnerability modelling. The CIS measures the cumulative impact of the occurrence of multiple hazards over five years. 65.3% of the variance in observed impact of hazards/CIS was explained by the risk models and communities with high simulated disaster risk generally follow areas with high observed disaster impacts. Results from this study will help disaster managers to better understand disaster risk and develop appropriate, inclusive and well integrated mitigation and adaptation plans at the local level. It fulfills the increasing need to balance global/regional assessments with community level assessments where major decisions against risk are actually taken and implemented

Genetic Testing in Acute and Chronic Pancreatitis

Purpose of review Premature intracellular activation of pancreatic zymogens leads to the initiation of pancreatitis, which in up to 25% leads to chronic tissue destruction, exocrine and endocrine organ failure, and a moderate increased risk of pancreatic cancer development. Whereas in many cases, the trigger of organ damage is identified, diagnostic workup in a significant number of patients does not reveal the underlying etiology of pancreatic inflammation. In these cases, alterations in different pancreatic susceptibility genes have been described to be directly or indirectly involved in disease development. In this review, we want to give an update on the most important pancreatitis risk genes and their impact on clinical diagnostics and risk stratification as well as possible treatment options. Recent findings Genetic testing is not routinely implemented in the diagnostic workup of acute or chronic pancreatitis, as most genetic variations are not considered causative for pancreatitis development but confer increased susceptibility and genetic testing rarely changes disease management. However, in patients with recurrent pancreatitis episodes of unknown etiology after intensive diagnostic work-up, in patients with a family history of pancreatitis, relatives of patients with hereditary pancreatitis, and patients with disease onset at young age, genetic testing and counseling is recommended. Besides well-established susceptibility genes such as PRSS1, SPINK1, CPA1, and CFTR, additional genes such as TRPV6 and rare genetic alterations in established risk genes have been recently identified which significantly contribute to the risk of pancreatitis, involving different molecular mechanisms. Summary When genetic testing is considered, we propose screening at least for PRSS1, SPINK1, CPA1, and CFTR gene variants. The emergence of next-generation sequencing methods could also render larger gene panels possible and clinically meaningful to detect rare variants with high-risk phenotypes. Here we summarize, evaluate, and convey in the form of practical recommendations the current level of knowledge with respect to definition, etiology, and genetic diagnostics of all forms of inherited pancreatitis

Opportunistic, not Optimal Delegation: The Political Origins of Central Bank Independence

Economists have long argued that central banks ran by technocrats have greater independence from the government. But in many countries, politically experienced central bankers are at the helm, including even highly independent central banks. To explain the level of central bank independence awarded, we develop a formal model where nominating politicians screen central bankers for their political ambitions. We show how screening and reelection efforts by the nominating politician changes the level of autonomy associated with different types of candidates. We predict that technocrats are associated with higher levels of independence than nominees with political experience, but as the appointing politician faces tougher reelection, candidates with political experience are associated with higher independence as well. We test our theory using new data from 29 post-communist countries between 1990-2012. We find evidence that the reelection strategy of the nominating politician is an important predictor of the level of central bank independence

Die molekulare Zusammensetzung der extrazellulären Matrix im Lig. coracoacromiale

In dieser Arbeit wurde mit Hilfe histologischer und immunhistochemischer Methoden der Aufbau und die Zusammensetzung der extrazellulären Matrix des Lig. coracoacromiale des Menschen untersucht. Verwendet wurden 9 Präparate aus dem Anatomischen Institut mit einem mittleren Alter von 74,7 Jahren und 6 Proben aus dem Rechtsmedizinischen Institut mit einem mittleren Alter von 27,2 Jahren. Ziel dieser Arbeit war es, eine detaillierte Beschreibung der regionalen molekularen Zusammensetzung der extrazellulären Matrix zu liefern. Dabei wurde das besondere Augenmerk auf die Unterschiede zwischen den beiden Altersgruppen gelegt, um so indirekt auch auf die physiologische Funktion und mechanische Situation des Bandes Rückschlüsse ziehen zu können. An den Anheftungszonen des Bandes an den jeweiligen Knochenvorsprüngen lassen sich in markanter flächiger Ausprägung Chondroitin-6-Sulfat, Kollagen II, Aggrecan und Link Protein als charakteristische Marker von Faserknorpelgewebe nachweisen. Ebenso konnten im Verlauf des Bandes diese für Faserknorpel typischen Proteine in beiden Altersgruppen (etwas abgeschwächt in der jüngeren Gruppe) detektiert werden. In der Annahme, dass das Entstehen von Faserknorpel Ausdruck eines funktionellen Anpassungsprozesses des Gewebes an spezifische mechanische Beanspruchung ist, muss im Hinblick auf die Ergebnisse dieser Arbeit festgestellt werden, dass eine nennenswerte Druckübertragung zwischen Caput humeri und korakoakromialen Bogen stattfindet. Da die Ergebnisse sich in beiden Altersgruppen qualitativ entsprechen, nehmen wir an, dass diese mechanische Situation schon im physiologischen Zustand besteht. Das Auftreten von Fettgewebe an der Unterseite des Bandes und am Rand der Enthesisregion wurde bisher meist als degenerative Veränderung interpretiert. In Anlehnung an Benjamin et al. (2004) vermuten wir, dass das Fettgewebe, zur günstigeren Druckverteilung im Gewebe und als Hüllgewebe für kleine Nervenfasern dient. Insgesamt könnte die beobachtete Konfiguration Ausdruck eines mechanosenorischen Komplexes sein, welcher der Modulation von Muskelreflexen im Schulterbereich dient. Klinische Relevanz gewinnt das Auftreten bestimmter Moleküle im Zusammenhang mit der Manifestation von Erkrankungen aus dem rheumatoiden Formenkreis. Einen wesentlichen Part bei entzündlichen Vorgängen übernehmen Autoimmunprozesse gegen faserknorpelige Bestandteile der extrazellulären Matrix wie Kollagen II, Aggrecan, Link Protein, COMP und CMP. Das Vorkommen dieser Proteine in der extrazellulären Matrix des Lig. coracoacromiale lässt auf einen Mitbefall dieser Struktur bei rheumatischen Erkrankungen schließen