Die Finanzierungsbasis der kommunalen Haushalte in Sachsen-Anhalt - Chancengleichheit im Standortwettbewerb?

Die Differenzierung der fiskalischen Handlungsfähigkeit der Kommunen in Sachsen-Anhalt steht im Mittelpunkt der vorliegenden empirisch gestützten Analyse ihrer Finanzierungsbasis für den Zeitraum von 1995 bis 2004. Dabei wird besonders die Differenzierung nach räumlichen Kriterien mittels dreier Raumtypen, den kreisfreien Städten, den Stadtrandkreisen und den ländlichen Kreisen, untersucht. Die Ergebnisse zeigen, dass sich zwar die Finanzierungsbasis der Kommunen in den drei Raumtypen durchaus unterscheidet - die kreisfreien Städte liegen insbesondere aufgrund der allgemeinen Zuweisungen aus dem kommunalen Finanzausgleich innerhalb Sachsen-Anhalts deutlich vor den Kommunen der andern beiden Raumtypen -, die Struktur und die Entwicklung dieser besseren Ausstattung der großen Städte (Oberzentren) hat sich allerdings im Untersuchungszeitraum nicht wesentlich verändert. Von einer besonders gravierenden, zunehmenden Chancenungleichheit von Gruppen von Kommunen im kommunalen Standortwettbewerb aufgrund fehlender Finanzausstattung kann jedoch nicht gesprochen werden, wenn man die Regeln des zu Grunde liegenden horizontalen Finanzausgleichs des Landes Sachsen-Anhalt akzeptiert. Die Kommunen sind daher zunächst angehalten, ihre Ausgangsbedingungen für den interkommunalen Standortwettbewerb durch eigene Anstrengungen im Kommunalhaushalt selbst zu verbessern.This empirically supported analysis of the financing basis of municipal budgets in the period from 1995 to 2004 concentrates primarily on differences in the capacity for fiscal action on the part of local authorities. The study focuses in particular on differentiation according to spatial criteria based on three area types: self-governing cities; counties around the edges of cities; and rural counties. As the results of the study show, there are certainly clear differences among these three area types with regard to the basis for financing municipal budgets: due in particular to the general transfers they receive within the framework of municipal revenue and burden sharing within the state of Saxony-Anhalt, the self-governing cities fare better than the municipalities of the other two area types; very little of any significance changed during the period investigated with regard to the structure and development of the superior infrastructure assets of the major cities (higher-order centres). If one accepts the rules of the underlying system of horizontal financial equalisation in place in Saxony-Anhalt, then there is no evidence of any groups of local authorities being seriously or increasingly disadvantaged in the competition for inward investment due to the lack of financial resources. The onus is therefore initially on local authorities to undertake whatever measures they see fit in respect of their municipal budgets to improve their starting position in the competition among local authorities for inward investment

Der Discounter als Nahversorger - das Beispiel ALDI in Thüringen

Der Strukturwandel im Einzelhandel vom "Tante-Emma-Laden um die Ecke" über den Supermarkt hin zum Discounter hat nicht zu einer gravierenden Verschlechterung der Versorgung der Bevölkerung mit Gütern des täglichen Bedarfs geführt. Der Supermarkt und der Discounter sind die Nahversorger von heute. Die gleichzeitige Erweiterung ihrer Produktpalette mit den wachsenden Angeboten von Markenartikeln, Bio-Produkten und auch langlebigen Konsumgütern hat das Angebot deutlich verbessert. Die räumliche Verteilung der Standorte der Discounter ist, wie die Analyse für alle Landesteile in Thüringen gezeigt hat, durchaus hinreichend. Ihre Erreichbarkeit ist angesichts der gestiegenen Mobilität der Bevölkerung für fast alle Schichten - Ausnahme sind die immobilen Senioren - zumutbar und gegeben. Fasst man diese Ergebnisse zusammen, so kann von einer "Gleichwertigkeitslücke" bei der Versorgung mit Gütern des täglichen Bedarfs, auch für die ländlich-peripheren Regionen, nicht gesprochen werden.The restructuring of retailing from the corner shop, via supermarkets to discount retailers has not seriously impaired the easy availability of the goods people need to meet their day-to-day needs. Supermarkets and discount retailers are today’s local shops. As the variety of goods stocked has increased, with a growing range of branded goods, organic food and also non-food items, the choice to customers has improved dramatically. Moreover, as the study reveals for all sections of the territory of the state of Thuringia, the spatial distribution of the locations occupied by discount retailers is certainly adequate. Given the general increase in mobility across practically all social classes - with the exception of less mobile senior citizens - they can indeed be regarded as generally accessible. Viewed in their totality, the results of the study provide no grounds for claiming “a gap in parity” in respect of the supply of goods to meet everyday needs, even in the case of peripheral rural regions

Thermotropic and structural effects of poly(malic acid) on fully hydrated multilamellar DPPC–water systems

The thermotropic and structural effects of low molecular weight poly(malic acid) (PMLA) on fully hydrated multilamellar dipalmitoylphosphatidylcholine (DPPC)-water systems were investigated using differential scanning calorimetry (DSC), small-angle X-ray scattering (SAXS), and freeze-fracture transmission electron microscopy (FFTEM). Systems of 20 wt% DPPC concentration and 1 and 5 wt% PMLA to lipid ratios were studied. The PMLA derivatives changed the thermal behavior of DPPC significantly and caused a drastic loss in correlation between lamellae in the three characteristic thermotropic states (i.e., in the gel, rippled gel and liquid crystalline phases). In the presence of PBS or NaCl, the perturbation was more moderate. The structural behavior on the atomic level was revealed by FTIR spectroscopy. The molecular interactions between DPPC and PMLA were simulated via modeling its measured infrared spectra, and their peculiar spectral features were interpreted. Through this interpretation, the poly(malic acid) is inferred to attach to the headgroups of the phospholipids through hydrogen bonds between the free hydroxil groups of PMLA and the phosphodiester groups of DPPC

Disease characteristics and clinical outcome over two decades from the Swiss pulmonary hypertension registry

Pulmonary hypertension (PH), especially pulmonary arterial and chronic thromboembolic pulmonary hypertension (PAH/CTEPH), are rare and progressive conditions. Despite recent advances in treatment and prognosis, PH is still associated with impaired quality of life and survival. Long-term PH-registry data provide information on the changing PH-epidemiology and may help to direct resources to patient's needs. This retrospective analysis of the Swiss Pulmonary Hypertension Registry includes patients newly diagnosed with PH (mainly PAH/CTEPH) registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient characteristics (age, body mass index, gender, diagnosis), hemodynamics at baseline, treatment, days of follow-up, and events (death, transplantation, pulmonary endarterectomy, or loss to follow-up) at last visit were analyzed. Patients were stratified into four time periods according to their date of diagnosis. Survival was analyzed overall and separately for PAH/CTEPH and time periods. 1427 PH patients were included (thereof 560 PAH, 383 CTEPH). Over the years, age at baseline (mean ± SD) significantly increased from 59 ± 14 years in 2001–2005 to 66 ± 14 years in 2016–2019 (p < 0.001) while the gender distribution tended toward equality. Mean pulmonary artery pressure and pulmonary vascular resistance significantly decreased over time (from 46 ± 15 to 41 ± 11 mmHg, respectively, 9 ± 5 to 7 ± 4 WU, p < 0.001). Three-year survival substantially increased over consecutive periods from 69% to 91% (for PAH 63%–95%, for CTEPH 86%–93%) and was poorer in PAH than CTEPH independently of time period (p < 0.001). Most patients were treated with mono- or combination therapy and an increasing number of CTEPH underwent pulmonary endarterectomy (40% 2016–2019 vs. 15% 2001–2005). This long-term PH registry reveals that over two decades of observation, newly diagnosed patients are older, less predominantly female, have less impaired hemodynamics and a better survival

Disease characteristics and clinical outcome over two decades from the Swiss pulmonary hypertension registry.

Pulmonary hypertension (PH), especially pulmonary arterial and chronic thromboembolic pulmonary hypertension (PAH/CTEPH), are rare and progressive conditions. Despite recent advances in treatment and prognosis, PH is still associated with impaired quality of life and survival. Long-term PH-registry data provide information on the changing PH-epidemiology and may help to direct resources to patient's needs. This retrospective analysis of the Swiss Pulmonary Hypertension Registry includes patients newly diagnosed with PH (mainly PAH/CTEPH) registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient characteristics (age, body mass index, gender, diagnosis), hemodynamics at baseline, treatment, days of follow-up, and events (death, transplantation, pulmonary endarterectomy, or loss to follow-up) at last visit were analyzed. Patients were stratified into four time periods according to their date of diagnosis. Survival was analyzed overall and separately for PAH/CTEPH and time periods. 1427 PH patients were included (thereof 560 PAH, 383 CTEPH). Over the years, age at baseline (mean ± SD) significantly increased from 59 ± 14 years in 2001-2005 to 66 ± 14 years in 2016-2019 (p < 0.001) while the gender distribution tended toward equality. Mean pulmonary artery pressure and pulmonary vascular resistance significantly decreased over time (from 46 ± 15 to 41 ± 11 mmHg, respectively, 9 ± 5 to 7 ± 4 WU, p < 0.001). Three-year survival substantially increased over consecutive periods from 69% to 91% (for PAH 63%-95%, for CTEPH 86%-93%) and was poorer in PAH than CTEPH independently of time period (p < 0.001). Most patients were treated with mono- or combination therapy and an increasing number of CTEPH underwent pulmonary endarterectomy (40% 2016-2019 vs. 15% 2001-2005). This long-term PH registry reveals that over two decades of observation, newly diagnosed patients are older, less predominantly female, have less impaired hemodynamics and a better survival

Long-term outcome of patients with combined post- and pre-capillary pulmonary hypertension

Aims: Pulmonary hypertension (PH) is a complex clinical condition, and left heart disease is the leading cause. Little is known about the epidemiology and prognosis of combined post- and pre-capillary PH (CpcPH). Methods and results: This retrospective analysis of the Swiss PH Registry included incident patients with CpcPH registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient baseline characteristics [age, sex, mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure (PAWP), pulmonary vascular resistance (PVR), and risk factors, including World Health Organization (WHO)-functional class (FC), 6 min walk distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP), treatment, days of follow-up, and events (death or loss to follow-up) at last visit] were analysed by Kaplan-Meier and Cox regression analyses. Two hundred and thirty-one patients (59.3% women, age 65 ± 12 years, mPAP 48 ± 11 mmHg, PAWP 21 ± 5 mmHg, PVR 7.2 ± 4.8 WU) were included. Survival analyses showed a significantly longer survival for women [hazard ratio (HR) 0.58 (0.38-0.89); P = 0.01] and a higher mortality risk for mPAP > 46 mmHg [HR 1.58 (1.03-2.43); P = 0.04] but no association with age or PVR. Patients stratified to high risk according to four-strata risk assessment had an increased mortality risk compared with patients stratified to low-intermediate risk [HR 2.44 (1.23-4.84); P = 0.01]. A total of 46.8% of CpcPH patients received PH-targeted pharmacotherapy; however, PH-targeted medication was not associated with longer survival. Conclusion: Among patients with CpcPH, women and patients with an mPAP ≤46 mmHg survived longer. Furthermore, risk stratification by using non-invasively assessed risk factors, such as WHO-FC, 6MWD, and NT-proBNP, as proposed for pulmonary arterial hypertension, stratified survival in CpcPH, and might be helpful in the management of these patients

Long-term outcome of patients with combined post- and pre-capillary pulmonary hypertension.

AIMS Pulmonary hypertension (PH) is a complex clinical condition, and left heart disease is the leading cause. Little is known about the epidemiology and prognosis of combined post- and pre-capillary PH (CpcPH). METHODS AND RESULTS This retrospective analysis of the Swiss PH Registry included incident patients with CpcPH registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient baseline characteristics [age, sex, mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure (PAWP), pulmonary vascular resistance (PVR), and risk factors, including World Health Organization (WHO)-functional class (FC), 6 min walk distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP), treatment, days of follow-up, and events (death or loss to follow-up) at last visit] were analysed by Kaplan-Meier and Cox regression analyses. Two hundred and thirty-one patients (59.3% women, age 65 ± 12 years, mPAP 48 ± 11 mmHg, PAWP 21 ± 5 mmHg, PVR 7.2 ± 4.8 WU) were included. Survival analyses showed a significantly longer survival for women [hazard ratio (HR) 0.58 (0.38-0.89); P = 0.01] and a higher mortality risk for mPAP > 46 mmHg [HR 1.58 (1.03-2.43); P = 0.04] but no association with age or PVR. Patients stratified to high risk according to four-strata risk assessment had an increased mortality risk compared with patients stratified to low-intermediate risk [HR 2.44 (1.23-4.84); P = 0.01]. A total of 46.8% of CpcPH patients received PH-targeted pharmacotherapy; however, PH-targeted medication was not associated with longer survival. CONCLUSION Among patients with CpcPH, women and patients with an mPAP ≤46 mmHg survived longer. Furthermore, risk stratification by using non-invasively assessed risk factors, such as WHO-FC, 6MWD, and NT-proBNP, as proposed for pulmonary arterial hypertension, stratified survival in CpcPH, and might be helpful in the management of these patients