Does Higher Cost Inefficiency Imply Higher Profit Inefficiency? - Evidence on Inefficiency and Ownership of German Hospitals

This paper investigates cost and profit efficiency of German hospitals. More specifically, it deals with the question how hospital efficiency varies with ownership, patient structure and other exogenous factors, which are neither inputs nor outputs of the production process. We conduct a Stochastic Frontier Analysis (SFA) on a multifaceted administrative German dataset combined with the balance sheets of 374 hospitals for the years 2002 to 2005.The results indicate that private (for-profit) and (private) non-profit hospitals are on average less cost efficient but more profit efficient than publicly owned hospitals.Hospital efficiency, ownership, stochastic frontier analysis, profit function

Aldosterone signaling and soluble adenylyl cyclase—A nexus for the kidney and vascular endothelium

AbstractThe steroid hormone aldosterone regulates the reabsorption of water and ions in the kidney and plays a central role in blood pressure regulation and homeostasis. In recent years, the vascular endothelium has been established as an important aldosterone target organ with major implications in renal and cardiovascular health and disease. Different lines of evidence suggest that the calcium- and bicarbonate-activated soluble adenylyl cyclase (sAC) is a novel mediator of aldosterone signaling in both the kidney and vascular endothelium. This review summarizes our current understanding of the molecular mechanisms of sAC gene expression regulation in the kidney and vascular endothelium and outlines the potential clinical implications of sAC in chronic kidney disease and cardiovascular disease. This review is part of a special issue entitled: The role of soluble adenylyl cyclase in health and disease. This article is part of a Special Issue entitled: The role of soluble adenylyl cyclase in health and disease

Molekular funktionelle Charakterisierung der 5'-flankierenden Region des humanen Biglykan Gen-Promotors

Das extrazelluläre Matrixprotein Biglykan (BGN) ist an der Pathogenese der Arteriosklerose beteiligt. Dieser Arbeit untersucht die Transkriptionsregulation des humanen BGN Gens. Ein Screening von 57 Individuen mit CVD gefolgt von DNA Subklonierung und Resequenzierung offenbarte drei MolHaps: BGN-MolHap1 [G-578-G-151-G+94], BGN-MolHap2 [G-578-A-151-T+94] und BGN-MolHap3 [A-578-G-151-G+94]. Die Insertion von MolHap2/ 3 führte zur Reduktion der Transkriptionsaktivität (TA). Co-Expressionen, Chromatin Immunprezipitation (ChIP), und EMSA wurden durchgeführt. Der Transkriptionsfaktor (TF) SP1 aktivierte die TA und die physikalische Interaktion von SP1 sowie die Bindung von c-FOS an der Position G+94T wurden nachgewiesen. Der ETS TF PU.1 band das G Allel (G-578A) mit vierfach höherer Affinität verglichen mit dem A Allel. Wir postulieren ein transkriptionelles Modul aus SP1 und dem heteromerischen AP-1 Komplex unter zelltypspezifischer Kontrolle von ETS TF, wie für PU.1 in Monozyten gezeigt. The extracellular matrix protein biglycan (BGN) is involved in the pathogenesis of atherosclerosis. We analyzed the transcriptional regulation of the human BGN gene. Screening of 57 individuals with CVD followed by DNA subcloning and resequencing revealed three molecular haplotypes (MolHaps): BGN-MolHap1 [G-578-G-151-G+94], BGN-MolHap2 [G-578-A-151-T+94] and BGN-MolHap3 [A-578-G-151-G+94]. Introduction of either MolHap2 or MolHap3 resulted in a decrease of transcriptional activity (TA). Co-expression, chromatin immunoprecipitation (ChIP), and EMSA were performed. Transcription factor (TF) SP1 activated TA and physical SP1 interaction was confirmed as well as binding of c-FOS to the 5'-UTR position G+94T. In THP-1 cells, ETS family member PU.1 bound the allele G-578 with higher affinity (4-fold) compared to allele -578A. We propose a transcriptional module of SP1 and heteromeric AP-1 complex under the cell type-specific control of ETS family members as shown for PU.1 in monocytes

Ramped-induced states in a parametrically driven Ginzburg-Landau equation

We introduce a parametrically driven Ginzburg-Landau (GL) model, which admits a gradient representation, and is subcritical in the absence of the parametric drive (PD). In the case when PD acts uniformly in space, this model has a stable kink solution. A nontrivial situation takes places when PD is itself subject to a kink-like spatial modulation, so that it selects real and imaginary constant solutions at +infinity and -infinity. In this situation, we find stationary solutions numerically, and also analytically for a particular case. They seem to be of two different types, viz., a pair of kinks in the real and imaginary components, or the same with an extra kink inserted into each component, but we show that both belong to a single continuous family of solutions. The family is parametrized by the coordinate of a point at which the extra kinks are inserted. Solutions with more than one kink inserted into each component do not exist. Simulations show that the former solution is always stable, and the latter one is, in a certain sense, neutrally stable, as there is a special type of small perturbations that remain virtually constant in time, rather than decaying or growing (they eventually decay, but extremely slowly).Comment: A latex text file and 8 ps files with figures. Physics Letters A, in pres

Pflegeheim Rating Report 2011 - Boom ohne Arbeitskräfte? - Executive Summary

Der Pflegemarkt ist ein Wachstumsmarkt. Die vorliegenden Zahlen aus 2009 bestätigen dies erneut: Insgesamt gab es 2,34 Mill. pflegebedürftige Menschen, davon wurden 749 000 stationär und 555 000 durch ambulante Dienste versorgt, der Rest erhielt Pflegegeld. Das Marktvolumen der ambulanten und stationären Pflegedienste betrug rund 30 Mrd. €. Gegenüber anderen Teilbereichen des Gesundheitsmarkts wächst der Pflegemarkt am stärksten: 1997 betrug der Anteil der Pflege 8,6% des gesamten Gesundheitsmarkts, 2009 bereits 11%. Damit rangierte die Pflege in ihrer Bedeutung an vierter Stelle hinter Krankenhäusern, Arztpraxen sowie Apotheken und Arzneimitteln. Die wirtschaftliche Lage der Pflegeheime ist relativ gut: Ihre durchschnittliche Ausfallwahrscheinlichkeit (Zahlungsunfähigkeit) betrug 2009 1,1%. Sie lag damit niedriger als bei Krankenhäusern und Rehakliniken. 14% der Heime lagen im „roten Bereich“ (d.h. hier gibt es eine erhöhte Insolvenzgefahr), 69% im grünen und 17% dazwischen im gelben Bereich. Ketten schnitten besser ab als Einzelheime, solche mit niedrigen Preisen besser als solche mit hohen. Die Lage der Heime war in den ostdeutschen Bundesländern am besten und in Schleswig-Holstein/Hamburg, Baden-Württemberg und Rheinland-Pfalz/Saarland am schlechtesten. 90% wiesen 2009 aber mindestens einen ausgeglichenen Jahresüberschuss aus, 10% schrieben rote Zahlen. Das durchschnittliche Heim erwirtschaftete 2009 ein EBITDAR (Betriebsergebnis vor Zinsen, Steuern, Abschreibungen, Amortisation und Mieten) von 14% des Umsatzes. Zwischen 2006 und 2009 hat sich die Lage aber leicht verschlechtert. Untersucht wurden 538 Jahresabschlüsse aus den Jahren 2008 und 2009, die insgesamt 1 702 Pflegeheime umfassen. Rückblickend lassen sich folgende spezifischen Trends erkennen: (i) anhaltende Attraktivität des Markts, (ii) zunehmende Professionalisierung, (iii) Ambulantisierung, (iv) Privatisierung, (v) wachsende Personalknappheit, (vi) zunehmende Qualitätstransparenz und (vii) Bürokratisierung.[...]Pflegemarkt; Pflegeheime; ambulante Pflegedienste; stationäre Pflegedienste; Ausfallwahrscheinlichkeit

Krankenhaus Rating Report 2011- Die fetten Jahre sind vorbei - Executive Summary

Im Jahr 2009 befanden sich 12% der Krankenhäuser im „roten Bereich“ mit erhöhter Insolvenzgefahr, 75% lagen im grünen Bereich, die restlichen 13% dazwischen. Die durchschnittliche Ausfallwahrscheinlichkeit betrug 2009 1,2%. Die wirtschaftliche Lage hat sich damit 2009 gegenüber 2008, als 14% der Krankenhäuser im roten und nur 69% im grünen Bereich waren, verbessert. Grundlage für diese Analysen ist eine Stichprobe von 687 Jahresabschlüssen aus 2008, die insgesamt 1 035 Krankenhäuser umfassen, und 366 aus 2009. 2009 erhöhten sich die KHG-Fördermittel erstmals seit 1995 spürbar um 6,5% auf 2,85 Mrd. €. Damit dürfte aber der langfristige Rückgang der Mittel nicht durchbrochen sein. Vielmehr dürfte es sich um eine antizyklische Stabilisierungsmaßnahme als Folge der Finanzkrise gehandelt haben. Legt man einen als notwendig erachteten jährlichen Investitionsbedarf von 10% des Krankenhausumsatzes zugrunde, beläuft sich die seit 1991 kumulierte Investitionslücke auf 30 Mrd. €. Allerdings füllen die Krankenhäuser einen wachsenden Teil dieser Lücke durch Investitionen aus Eigenmitteln, sodass der tatsächliche Investitionsstau nun 14 Mrd. € betragen dürfte. Die sinkende Fördermittelquote bestätigt sich auch in den Krankenhausbilanzen.[...]Krankenhäuser; Ausfallwahrscheinlichkeit; KHG-Fördermittel; Investitionslücke

The Yo-Yo Intermittent Tests: A Systematic Review and Structured Compendium of Test Results

Background: Although Yo-Yo intermittent tests are frequently used in a variety of sports and research studies to determine physical fitness, no structured reference exists for comparison and rating of test results. This systematic review of the most common Yo-Yo tests aimed to provide reference values for test results by statistical aggregation of published data.Methods: A systematic literature search for articles published until August 2017 was performed in MEDLINE, Web of Science, SPORTDiscus and Google Scholar. Original reports on healthy females and males ≥16 years were eligible for the analysis. Sub-maximal test versions and the Yo-Yo Intermittent Recovery Level 1 Children's test (YYIR1C) were not included.Results: 248 studies with 9,440 participants were included in the structured analysis. The Yo-Yo test types most frequently used were the Yo-Yo Intermittent Recovery Level 1 (YYIR1, 57.7%), the Yo-Yo Intermittent Recovery Level 2 (YYIR2, 28.0%), the Yo-Yo Intermittent Endurance Level 2 (YYIE2, 11.4%), and the Yo-Yo Intermittent Endurance Level 1 (YYIE1, 2.9%) test. For each separate test, reference values (global means and percentiles) for sports at different levels and both genders were calculated.Conclusions: Our analysis provides evidence that Yo-Yo intermittent tests reference values differ with respect to the type and level of sport performed.The presented results may be used by practitioners, trainers and athletes to rate Yo-Yo intermittent test performance levels and monitor training effects

Development of a Novel Valve-Controlled Drug-Elutable Microstent for Microinvasive Glaucoma Surgery: In Vitro and Preclinical In Vivo Studies

Purpose: Microinvasive glaucoma surgery (MIGS) has become an important treatment approach for primary open-angle glaucoma, although the safe and long-term effective lowering of intraocular pressure with currently available implants for MIGS is not yet achieved to a satisfactory extent. The study focusses on the development and in vitro and in vivo testing of a novel microstent for MIGS. Methods: A silicone elastomer-based microstent was developed. Implants were manufactured using dip coating, fs-laser cutting, and spray coating. Within the current study no antifibrotic drug was loaded into the device. Sterilized microstents were analyzed in vitro regarding pressure–flow characteristics and biocompatibility. Six New Zealand white rabbits were implanted with a microstent draining the aqueous humor from the anterior chamber into the subconjunctival space. Drainage efficacy was evaluated using oculopressure tonometry as a transient glaucoma model. Noninvasive imaging was performed. Results: Microstents were manufactured successfully and characterized in vitro. Implantation in vivo was successful for four animals with additional device fixation. Without additional fixation, dislocation of microstents was found in two animals. Safe and effective intraocular pressure reduction was observed for the four eyes with correctly implanted microstent during the 6-month trial period. Conclusions: The described microstent represents an innovative treatment approach for MIGS. The incorporation of a selectively antifibrotic drug into the microstent drugelutable coating will be addressed in future investigations. Translational Relevance: The current preclinical study successfully provided proof of concept for our microstent for MIGS which is suitable for safe and effective intraocular pressure reduction and offers promising perspectives for the clinical management of glaucoma

Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry)

BACKGROUND: Chronic kidney disease (CKD) is strongly associated with coronary artery disease (CAD). We established a prospective observational nationwide multicenter registry to evaluate current treatment and outcomes in patients with both CKD and angiographically documented CAD. METHODS: In 32 cardiological centers 3,352 CAD patients with ≥50% stenosis in at least one coronary artery were enrolled and classified according to their estimated glomerular filtration rate and proteinuria into one of five stages of CKD or as a control group. RESULTS: 2,723 (81.2%) consecutively enrolled patients suffered from CKD. Compared to controls, CKD patients had a higher prevalence of diabetes, hypertension, peripheral artery diseases, heart failure, and valvular heart disease (each p<0.001). Myocardial infarctions (p = 0.02), coronary bypass grafting, valve replacements and pacemaker implantations had been recorded more frequently (each p<0.001). With advanced CKD, the number of diseased coronary vessels and the proportion of patients with reduced left ventricular ejection fraction (LVEF) increased significantly (both p<0.001). Percutaneous coronary interventions were performed less frequently (p<0.001) while coronary bypass grafting was recommended more often (p = 0.04) with advanced CKD. With regard to standard drugs in CAD treatment, prescriptions were higher in our registry than in previous reports, but beta-blockers (p = 0.008), and angiotensin-converting-enzyme inhibitors and/or angiotensin-receptor blockers (p<0.001) were given less often in higher CKD stages. In contrast, in the subgroup of patients with moderately to severely reduced LVEF the prescription rates did not differ between CKD stages. In-hospital mortality increased stepwise with each CKD stage (p = 0.02). COMCLUSIONS: In line with other studies comprising CKD cohorts, patients’ morbidity and in-hospital mortality increased with the degree of renal impairment. Although cardiologists’ drug prescription rates in CAD-REF were higher than in previous studies, they were still lower especially in advanced CKD stages compared to cohorts treated by nephrologists

Specific CT 3D rendering of the treatment zone after Irreversible Electroporation (IRE) in a pig liver model: the “Chebyshev Center Concept” to define the maximum treatable tumor size

Background: Size and shape of the treatment zone after Irreversible electroporation (IRE) can be difficult to depict due to the use of multiple applicators with complex spatial configuration. Exact geometrical definition of the treatment zone, however, is mandatory for acute treatment control since incomplete tumor coverage results in limited oncological outcome. In this study, the “Chebyshev Center Concept” was introduced for CT 3d rendering to assess size and position of the maximum treatable tumor at a specific safety margin. Methods: In seven pig livers, three different IRE protocols were applied to create treatment zones of different size and shape: Protocol 1 (n = 5 IREs), Protocol 2 (n = 5 IREs), and Protocol 3 (n = 5 IREs). Contrast-enhanced CT was used to assess the treatment zones. Technique A consisted of a semi-automated software prototype for CT 3d rendering with the “Chebyshev Center Concept” implemented (the “Chebyshev Center” is the center of the largest inscribed sphere within the treatment zone) with automated definition of parameters for size, shape and position. Technique B consisted of standard CT 3d analysis with manual definition of the same parameters but position. Results: For Protocol 1 and 2, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were not significantly different between Technique A and B. For Protocol 3, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were significantly smaller for Technique A compared with Technique B (41.1 ± 13.1 mm versus 53.8 ± 1.1 mm and 39.0 ± 8.4 mm versus 53.8 ± 1.1 mm; p &lt; 0.05 and p &lt; 0.01). For Protocol 1, 2 and 3, sphericity of the treatment zone was significantly larger for Technique A compared with B. Conclusions: Regarding size and shape of the treatment zone after IRE, CT 3d rendering with the “Chebyshev Center Concept” implemented provides significantly different results compared with standard CT 3d analysis. Since the latter overestimates the size of the treatment zone, the “Chebyshev Center Concept” could be used for a more objective acute treatment control