SAVE - Strategische Aktivierung und Verzinsung naturschutzfachlicher Ersatzflächen

Die Realisierung von Infrastrukturprojekten verursacht Eingriffe in Natur und Landschaft. Diese sind gemäß Bundesnaturschutzgesetz zu kompensieren. Bislang erfolgt die Planung und Umsetzung von Kompensationsmaßnahmen ausschließlich im Kontext der jeweiligen Projektrealisierung. Ein strategischer und bundesweit einheitlicher Ansatz wurde bislang von der Deutschen Bahn (DB) nicht verfolgt. Der gesamte für die Umsetzung des vordringlichen Bedarfs des Bedarfsplans für die Schienenwege des Bundes entstehende Kompensationsbedarf beträgt rd. 21 000 ha. Da die DB nicht über ausreichende geeignete Flächen verfügt, müssen für die vollständige Deckung dieses Bedarfs auch Flächen Dritter in Anspruch genommen werden. Die Sicherung dieser Flächen sollte, um Spekulationseffekte zu vermeiden, möglichst frühzeitig erfolgen, bevor die Realisierung des Bauprojektes lokal kommuniziert wird. Durch die Bevorratung von Kompensationsmaßnahmen weit vor Baubeginn wird gewährleistet, dass die Akzeptanz der Maßnahmen bereits im Vorfeld bei Behörden bestätigt wird. Durch die sich daraus ergebende Minimierung von Konflikten bei der Flächensicherung sinkt das Risiko für Planungsverzögerungen. Das auf Grund der Knappheit von geeigneten Kompensationsflächen bestehende Realisierungsrisiko durch fehlende Kompensationsmaßnahmen wird ebenfalls verringert. In vielen Bundesländern ist eine Verzinsung der in Ökokonten bevorrateten Ökopunkte gesetzlich geregelt. SAVE dient der Vorbereitung und Durchführung notwendiger Anpassungserfordernisse und ebnet den Weg für die Einführung bzw. den Transfer in das Regelgeschäft bzw. die Linienstruktur

Flächenmanagement bei der DB Netz AG – Nachhaltige Strategie und ganzheitliche Immobilienbetrachtung

Die Anforderungen an den Aufbau einer ganzheitlichen Immobilienbetrachtung und einer damit verbundenen thematischen Vernetzung im Flächenmanagement sind in den vergangenen Jahren drastisch und kontinuierlich gestiegen. Um dieser Herausforderung gerecht zu werden, hat die DB Netz AG eine Flächenmanagement-Strategie entwickelt, welche eine ganzheitliche Betrachtungsweise im Immobilienmanagement ermöglicht. Die Realisierung dieser nachhaltigen Strategie wird mithilfe eines graphischen Tools, der Aktualisierung und Ergänzung bestehender Prozesse sowie der Schaffung definierter Schnittstellen ermöglicht. Bis 2020 soll so ein bundesweit einheitlicher Standard zur Visualisierung aller relevanten Informationen zu Flächenbedarf, -planung und Bestand entstehen. Diese transparente Darstellung der Flächeninformationen ermöglicht eine direkte und verlässliche Kommunikation zwischen Projekten sowie zu Anfragen, Bewirtschaftung und Vertrieb von Bahnflächen

a 1-year follow-up analysis based on German health insurance administrative data from 2008 to 2014

Objectives To describe the use of drug-eluting stents (DESs) in the largest population of statutory health insurance members in Germany, including newly developed bio-resorbable vascular scaffolds (BVSs), and to evaluate 1-year complication rates of DES as compared with bare metal stents (BMSs) in this cohort. Design Routine data analysis of statutory health insurance claims data from the years 2008 to 2014. Setting The German healthcare insurance Allgemeine Ortskrankenkasse covers approximately 30% of the German population and is the largest nationwide provider of statutory healthcare insurance in Germany. Participants and interventions We included all patients with a claims record for a percutaneous coronary intervention (PCI) with either DES or BMS and additionally, from 2013, BVS. Patients with acute myocardial infarction (AMI) were excluded. Main outcome measure: major adverse cerebrovascular and cardiovascular event (MACCE, defined as mortality, AMI, stroke and transient ischaemic attack), bypass surgery, PCI and coronary angiography) at 1 year after the intervention. Results A total of 243 581 PCI cases were included (DES excluding BVS: 143 765; BVS: 1440; BMS: 98 376). The 1-year MACCE rate was 7.42% in the DES subgroup excluding BVS and 11.29% in the BMS subgroup. The adjusted OR for MACCE was 0.72 (95% CI 0.70 to 0.75) in patients with DES excluding BVS as compared with patients with BMS. In the BVS group, the proportion of 1-year MACCE was 5.0%. Conclusion The analyses demonstrate a lower MACCE rate for PCI with DES. BVSs are used in clinical routine in selected cases and seem to provide a high degree of safety, but data are still sparse

Development and validation of risk-adjusted quality indicators for the long-term outcome of acute sepsis care in German hospitals based on health claims data

Background Methods for assessing long-term outcome quality of acute care for sepsis are lacking. We investigated a method for measuring long-term outcome quality based on health claims data in Germany. Materials and methods Analyses were based on data of the largest German health insurer, covering 32% of the population. Cases (aged 15 years and older) with ICD-10-codes for severe sepsis or septic shock according to sepsis-1-definitions hospitalized in 2014 were included. Short-term outcome was assessed by 90-day mortality; long-term outcome was assessed by a composite endpoint defined by 1-year mortality or increased dependency on chronic care. Risk factors were identified by logistic regressions with backward selection. Hierarchical generalized linear models were used to correct for clustering of cases in hospitals. Predictive validity of the models was assessed by internal validation using bootstrap-sampling. Risk-standardized mortality rates (RSMR) were calculated with and without reliability adjustment and their univariate and bivariate distributions were described. Results Among 35,552 included patients, 53.2% died within 90 days after admission; 39.8% of 90-day survivors died within the first year or had an increased dependency on chronic care. Both risk-models showed a sufficient predictive validity regarding discrimination [ AUC = 0.748 (95% CI: 0.742; 0.752) for 90-day mortality; AUC = 0.675 (95% CI: 0.665; 0.685) for the 1-year composite outcome, respectively], calibration (Brier Score of 0.203 and 0.220; calibration slope of 1.094 and 0.978), and explained variance ( R 2 = 0.242 and R 2 = 0.111). Because of a small case-volume per hospital, applying reliability adjustment to the RSMR led to a great decrease in variability across hospitals [from median (1st quartile, 3rd quartile) 54.2% (44.3%, 65.5%) to 53.2% (50.7%, 55.9%) for 90-day mortality; from 39.2% (27.8%, 51.1%) to 39.9% (39.5%, 40.4%) for the 1-year composite endpoint]. There was no substantial correlation between the two endpoints at hospital level (observed rates: ρ = 0, p = 0.99; RSMR: ρ = 0.017, p = 0.56; reliability-adjusted RSMR: ρ = 0.067; p = 0.026). Conclusion Quality assurance and epidemiological surveillance of sepsis care should include indicators of long-term mortality and morbidity. Claims-based risk-adjustment models for quality indicators of acute sepsis care showed satisfactory predictive validity. To increase reliability of measurement, data sources should cover the full population and hospitals need to improve ICD-10-coding of sepsis

Prevalence and Infant Mortality of Major Congenital Malformations Stratified by Birthweight

Background: Low birthweight and major congenital malformations (MCMs) are key causes of infant mortality. Objectives: The aim of this study was to explore the prevalence of MCMs in infants with low and very low birthweight and analyze the impact of MCMs and birthweight on infant mortality. Methods: We determined prevalence and infant mortality of 28 life-threatening MCMs in very-low-birthweight (75% (10,316) had severe congenital heart disease. The prevalence (per 10,000) of any/cardiac MCM was increased in VLBW (286/176) and LBW (244/143), as compared to NBW infants (38/32). Infant mortality rates were significantly higher in infants with an MCM, as opposed to infants without an MCM, in each birthweight group (VLBW 28.5% vs. 11.5%, LBW 16.7% vs. 0.9%, and NBW 8.6% vs. 0.1%). For most MCMs, observed survival rates in VLBW and LBW infants were lower than expected, as calculated from survival rates of VLBW or LBW infants without an MCM, and NBW infants with an MCM. Conclusions: Infants with an MCM are more often born with LBW or VLBW, as opposed to infants without an MCM. Many MCMs carry significant excess mortality when occurring in VLBW or LBW infants

Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

Sepsis survival is associated with adverse outcomes. Knowledge about risk factors for adverse outcomes is lacking. We performed a population-based cohort study of 116,507 survivors of hospital-treated sepsis identified in health claims data of a German health insurance provider. We determined the development and risk factors for long-term adverse events: new dependency on chronic care, chronic dialysis, long-term respiratory support, and 12-month mortality. At-risk patients were defined by absence of these conditions prior to sepsis. Risk factors were identified using simple and multivariable logistic regression analyses. In the first year post-sepsis, 48.9% (56,957) of survivors had one or more adverse outcome, including new dependency on chronic care (31.9%), dialysis (2.8%) or respiratory support (1.6%), and death (30.7%). While pre-existing comorbidities adversely affected all studied outcomes (>4 comorbidities: OR 3.2 for chronic care, OR 4.9 for dialysis, OR 2.7 for respiratory support, OR 4.7 for 12-month mortality), increased age increased the odds for chronic care dependency and 12-month mortality, but not for dialysis or respiratory support. Hospital-acquired and multi-resistant infections were associated with increased risk of chronic care dependency, dialysis, and 12-month mortality. Multi-resistant infections also increased the odds of respiratory support. Urinary or respiratory infections or organ dysfunction increased the odds of new dialysis or respiratory support, respectively. Central nervous system infection and organ dysfunction had the highest OR for chronic care dependency among all infections and organ dysfunctions. Our results imply that patient- and infection-related factors have a differential impact on adverse life changing outcomes after sepsis. There is an urgent need for targeted interventions to reduce the risk

Additive manufacturing of metallic glass from powder in space

Additive manufacturing of metals - and in particular building with laser-based powder bed fusion - is highly flexible and allows high-resolution features and feedstock savings. Meanwhile, though space stations in low Earth orbit are established, a set of visits to the Moon have been performed, and humankind can send out rovers to explore Venus and Mars, none of these milestone missions is equipped with technology to manufacture functional metallic parts or tools in space. In order to advance space exploration to long-term missions beyond low Earth orbit, it will be crucial to develop and employ technology for in-space manufacturing (ISM) and in-situ resource utilisation (ISRU). To use the advantages of laser-based powder bed fusion in these endeavours, the challenge of powder handling in microgravity must be met. Here we present a device capable of building parts using metallic powders in microgravity. This was proven on several sounding rocket flights, on which occasions Zr-based metallic glass parts produced by additive manufacturing in space were built. The findings of this work demonstrate that building parts using powder feedstock, which is more compact to transport into space than wire, is possible in microgravity environments. This thus significantly advances ISRU and ISM and paves the way for future tests in prolonged microgravity settings

Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer?: Evidence from a large German cohort study

Background Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. Methods We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009–2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan–Meier estimator and Cox regression with shared frailty. Results The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85–0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. Conclusion This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care

Challenges in the Technology Development for Additive Manufacturing in Space

Instead of foreseeing and preparing for all possible scenarios of machine failures, accidents, and other challenges arising in space missions, it appears logical to take advantage of the flexibility of additive manufacturing for “in-space manufacturing” (ISM). Manned missions into space rely on complicated equipment, and their safe operation is a great challenge. Bearing in mind the absolute distance for manned missions to the Moon and Mars, the supply of spare parts for the repair and replacement of lost equipment via shipment from Earth would require too much time. With the high flexibility in design and the ability to manufacture ready-to-use components directly from a computer-aided model, additive manufacturing technologies appear to be extremely attractive in this context. Moreover, appropriate technologies are required for the manufacture of building habitats for extended stays of astronauts on the Moon and Mars, as well as material/feedstock. The capacities for sending equipment and material into space are not only very limited and costly, but also raise concerns regarding environmental issues on Earth. Accordingly, not all materials can be sent from Earth, and strategies for the use of in-situ resources, i.e., in-situ resource utilization (ISRU), are being envisioned. For the manufacturing of both complex parts and equipment, as well as for large infrastructure, appropriate technologies for material processing in space need to be developed

MOSAiC goes O2A - Arctic Expedition Data Flow from Observations to Archives

During the largest polar expedition in history starting in September 2019, the German research icebreaker Polarstern spends a whole year drifting with the ice through the Arctic Ocean. The MOSAiC expedition takes the closest look ever at the Arctic even throughout the polar winter to gain fundamental insights and most unique on-site data for a better understanding of global climate change. Hundreds of researchers from 20 countries are involved. Scientists will use the in situ gathered data instantaneously in near-real time modus as well as long afterwards all around the globe taking climate research to a completely new level. Hence, proper data management, sampling strategies beforehand, and monitoring actual data flow as well as processing, analysis and sharing of data during and long after the MOSAiC expedition are the most essential tools for scientific gain and progress. To prepare for that challenge we adapted and integrated the research data management framework O2A “Data flow from Observations to Archives” to the needs of the MOSAiC expedition on board Polarstern as well as on land for data storage and access at the Alfred Wegener Institute Computing and Data Center in Bremerhaven, Germany. Our O2A-framework assembles a modular research infrastructure comprising a collection of tools and services. These components allow researchers to register all necessary sensor metadata beforehand linked to automatized data ingestion and to ensure and monitor data flow as well as to process, analyze, and publish data to turn the most valuable and uniquely gained arctic data into scientific outcomes. The framework further allows for the integration of data obtained with discrete sampling devices into the data flow. These requirements have led us to adapt the generic and cost-effective framework O2A to enable, control, and access the flow of sensor observations to archives in a cloud-like infrastructure on board Polarstern and later on to land based repositories for international availability. Major roadblocks of the MOSAiC-O2A data flow framework are (i) the increasing number and complexity of research platforms, devices, and sensors, (ii) the heterogeneous interdisciplinary driven requirements towards, e. g., satellite data, sensor monitoring, in situ sample collection, quality assessment and control, processing, analysis and visualization, and (iii) the demand for near real time analyses on board as well as on land with limited satellite bandwidth. The key modules of O2A's digital research infrastructure established by AWI are implementing the FAIR principles: SENSORWeb, to register sensor applications and sampling devices and capture controlled meta data before and alongside any measurements in the field Data ingest, allowing researchers to feed data into storage systems and processing pipelines in a prepared and documented way, at best in controlled near real-time data streams Dashboards allowing researchers to find and access data and share and collaborate among partners Workspace enabling researchers to access and use data with research software utilizing a cloud-based virtualized infrastructure that allows researchers to analyze massive amounts of data on the spot Archiving and publishing data via repositories and Digital Object Identifiers (DOI