Public-Private Partnership: Allheilmittel für die Finanzkrisen der öffentlichen Haushalte oder Risikofaktor?

Public Private Partnership (PPP) findet in Deutschland in den letzten Jahren immer mehr Verbreitung. Die Bandbreite für PPP-Projekte reicht von Bundesfernstraßen bis zu Schulen, Verwaltungsgebäuden, Krankenhäusern, Schwimmbädern etc. Führt dieses Modell zu einer Optimierung von Kosten und Erträgen oder stellt es einen Risikofaktor für den öffentlichen Sektor dar? Gerold Krause-Junk, Universität Hamburg, sieht darin vor allem einen Weg, den Konflikt zwischen "Effizienz- und Verteilungszielen" zu entschärfen: "Die allokative Aufgabe wird dann dem privaten bzw. einem weitgehend nach privatwirtschaftlichem Kalkül handelnden Anbieter überlassen; die Verteilungsaufgabe bleibt beim Staat ..." Für Frank Littwin, Finanzministerium des Landes Nordrhein-Westfalen, sind die PPP-Projekte kein Allheilmittel und auch kein wesentlicher Beitrag zur Haushaltskonsolidierung, sie führen aber zu deutlich mehr Kostentransparenz und befördern wirtschaftliches Handeln. Und nicht zuletzt sind sie ein wichtiges Instrument zur Verwaltungsmodernisierung. Dietrich Budäus und Birgit Grüb, Universität Hamburg, betonen, dass die Wirtschaftlichkeitsbeurteilung bei PPP-Projekten eine Reihe von Problemen aufwirft. Und für Lars P. Feld und Jan Schnellenbach, Universität Heidelberg, hängt die finanzpolitische Sinnhaftigkeit von PPP-Arrangements von den Details der Kooperation ab. Dabei sollte der öffentliche Sektor vor allem die langfristigen Folgekosten seiner Investitionen im Blick haben, wenn er die Zusammenarbeit mit den Privaten sucht.Public Private Partnership, Öffentlicher Sektor, Öffentlicher Haushalt, Finanzmarktkrise, Deutschland

Non‐invasive and tracheostomy invasive ventilation in amyotrophic lateral sclerosis: Utilization and survival rates in a cohort study over 12 years in Germany

Background and purpose: The aim of this study was to investigate utilization rates, treatment pathways and survival prognosis in patients with amyotrophic lateral sclerosis (ALS) undergoing non-invasive (NIV) and tracheostomy invasive ventilation (TIV) in a real-world setting. Methods: A prospective cohort study using a single-centre register of 2702 ALS patients (2007 to 2019) was conducted. Utilization of NIV/TIV and survival data were analysed in three cohorts: (i) non-NIV; (ii) NIV (NIV without subsequent TIV); and (iii) TIV (including TIV preceded by NIV). Results: A total of 1720 patients with available data were identified, 72.0% of whom (n = 1238) did not receive ventilation therapy. NIV was performed in 20.8% of patients (n = 358). TIV was performed in 9.5% of patients (n = 164), encompassing both primary TIV (7.2%, n = 124) and TIV with preceding NIV (2.3%, n = 40). TIV was more often utilized without previous NIV (25.7% vs. 8.3% of all ventilated patients), demonstrating that primary TIV was the prevailing pathway for invasive ventilation. The median (range) survival was significantly longer in the NIV cohort (40.8 [37.2–44.3] months) and the TIV cohort (82.1 [68.7–95.6] months) as compared to the non-NIV cohort (33.6 [31.6–35.7] months). Conclusions: Although NIV represents the standard of care, its utilization rate was low. TIV was mainly started without preceding NIV, suggesting that TIV may not be confined to NIV treatment escalation. However, TIV was pursued in a minority of patients who had previously undergone NIV. The survival benefit observed in the patients with NIV was equal to that reported in a controlled pivotal trial, but the prognosis with TIV is highly variable. The determinants of utilization of NIV/TIV and of survival (bulbar syndrome, availability of ventilation-related home nursing, cultural factors) warrant further investigation

The evolution of the Aristolochia pallida complex (Aristolochiaceae) challenges traditional taxonomy and reflects large-scale glacial refugia in the Mediterranean

The taxonomy of the Mediterranean Aristolochia pallida complex has been under debate since several decades with the following species currently recognized: A. pallida, A. lutea, A. nardiana, A. microstoma, A. merxmuelleri, A. croatica, and A. castellana. These taxa are distributed from Iberia to Turkey. To reconstruct phylogenetic and biogeographic patterns, we employed cpDNA sequence variation using both noncoding (intron and spacer) and protein-coding regions (i.e., trnK intron, matK gene, and trnK-psbA spacer). Our results show that the morphology-based traditional taxonomy was not corroborated by our phylogenetic analyses. Aristolochia pallida, A. lutea, A. nardiana, and A. microstoma were not monophyletic. Instead, strong geographic signals were detected. Two major clades, one exclusively occurring in Greece and a second one of pan-Mediterranean distribution, were found. Several subclades distributed in Greece, NW Turkey, Italy, as well as amphi-Adriatic subclades, and a subgroup of southern France and Spain, were revealed. The distribution areas of these groups are in close vicinity to hypothesized glacial refugia areas in the Mediterranean. According to molecular clock analyses the diversification of this complex started around 3–3.3 my, before the onset of glaciation cycles, and the further evolution of and within major lineages falls into the Pleistocene. Based on these data, we conclude that the Aristolochia pallida alliance survived in different Mediterranean refugia rarely with low, but often with a high potential for range extension, and a high degree of morphological diversity

Decreased HIV diversity after allogeneic stem cell transplantation of an HIV-1 infected patient: a case report

The human immunodeficiency virus type 1 (HIV-1) coreceptor use and viral evolution were analyzed in blood samples from an HIV-1 infected patient undergoing allogeneic stem cell transplantation (SCT). Coreceptor use was predicted in silico from sequence data obtained from the third variable loop region of the viral envelope gene with two software tools. Viral diversity and evolution was evaluated on the same samples by Bayesian inference and maximum likelihood methods. In addition, phenotypic analysis was done by comparison of viral growth in peripheral blood mononuclear cells and in a CCR5 (R5)-deficient T-cell line which was controlled by a reporter assay confirming viral tropism. In silico coreceptor predictions did not match experimental determinations that showed a consistent R5 tropism. Anti-HIV directed antibodies could be detected before and after the SCT. These preexisting antibodies did not prevent viral rebound after the interruption of antiretroviral therapy during the SCT. Eventually, transplantation and readministration of anti-retroviral drugs lead to sustained increase in CD4 counts and decreased viral load to undetectable levels. Unexpectedly, viral diversity decreased after successful SCT. Our data evidence that only R5-tropic virus was found in the patient before and after transplantation. Therefore, blocking CCR5 receptor during stem cell transplantation might have had beneficial effects and this might apply to more patients undergoing allogeneic stem cell transplantation. Furthermore, we revealed a scenario of HIV-1 dynamic different from the commonly described ones. Analysis of viral evolution shows the decrease of viral diversity even during episodes with bursts in viral load

Reframing e-assessment: building professional nursing and academic attributes in a first year nursing course

This paper documents the relationships between pedagogy and e-assessment in two nursing courses offered at the University of Southern Queensland, Australia. The courses are designed to build the academic, numeracy and technological attributes student nurses need if they are to succeed at university and in the nursing profession. The paper first outlines the management systems supporting the two courses and how they intersect with the e-learning and e-assessment components of course design. These pedagogical choices are then reviewed. While there are lessons to be learnt and improvements to be made, preliminary results suggest students and staff are extremely supportive of the courses. The e-assessment is very positively received with students reporting increased confidence and competency in numeracy, as well as IT, academic, research and communication skills

Verteilung der Einkommen 1999-2003: Bericht zur Studie im Auftrag des Bundesministeriums für Gesundheit und Soziale Sicherung

Das Forschungsprojekt analysiert und beschreibt die Entwicklung der personellen Einkommensverteilung insgesamt sowie des Ausmaßes von relativer Einkommensarmut und der Bedeutung von Reichtum zwischen 1998 und 2003. Dazu werden die für die Zeit bis 1998 bereits vorgelegten Verteilungsanalysen fortgeführt, wobei auch die gesamtwirtschaftlichen Rahmenbedingungen und sozialpolitischen Maßnahmen skizziert werden. Darüber hinaus werden die so genannten Laeken-Indikatoren berechnet, die auf eine europäische Vereinbarung von 2001 zur Beschreibung von sozialer Ausgrenzung und Armutstendenzen zurückgehen. Schließlich werden weitere Aspekte von Armut und Reichtum aufgriffen, insbesondere die Kumulation von Problemlagen und Mobilitätsprozesse vertiefend untersucht

Distribution, structure and function of Nordic eelgrass (Zostera marina) ecosystems: implications for coastal management and conservation

This paper focuses on the marine foundation eelgrass species, Zostera marina, along a gradient from the northern Baltic Sea to the north-east Atlantic. This vast region supports a minimum of 1480 km2 eelgrass (maximum >2100 km2), which corresponds to more than four times the previously quantified area of eelgrass in Western Europe. Eelgrass meadows in the low salinity Baltic Sea support the highest diversity (4–6 spp.) of angiosperms overall, but eelgrass productivity is low (<2 g dw m-2 d-1) and meadows are isolated and genetically impoverished. Higher salinity areas support monospecific meadows, with higher productivity (3–10 g dw m-2 d-1) and greater genetic connectivity. The salinity gradient further imposes functional differences in biodiversity and food webs, in particular a decline in number, but increase in biomass of mesograzers in the Baltic. Significant declines in eelgrass depth limits and areal cover are documented, particularly in regions experiencing high human pressure. The failure of eelgrass to re-establish itself in affected areas, despite nutrient reductions and improved water quality, signals complex recovery trajectories and calls for much greater conservation effort to protect existing meadows. The knowledge base for Nordic eelgrass meadows is broad and sufficient to establish monitoring objectives across nine national borders. Nevertheless, ensuring awareness of their vulnerability remains challenging. Given the areal extent of Nordic eelgrass systems and the ecosystem services they provide, it is crucial to further develop incentives for protecting them

New high-resolution age data from the Ediacaran-Cambrian boundary indicate rapid, ecologically driven onset of the Cambrian explosion

The replacement of the late Precambrian Ediacaran biota by morphologically disparate animals at the beginning of the Phanerozoic was a key event in the history of life on Earth, the mechanisms and the timescales of which are not entirely understood. A composite section in Namibia providing biostratigraphic and chemostratigraphic data bracketed by radiometric dating constrains the Ediacaran–Cambrian boundary to 538.6–538.8 Ma, more than 2 Ma younger than previously assumed. The U–Pb-CA-ID TIMS zircon ages demonstrate an ultrashort time frame for the LAD of the Ediacaran biota to the FAD of a complex, burrowing Phanerozoic biota represented by trace fossils to a 410 ka time window of 538.99±0.21 Ma to 538.58±0.19 Ma. The extremely short duration of the faunal transition from Ediacaran to Cambrian biota within less than 410 ka supports models of ecological cascades that followed the evolutionary breakthrough of increased mobility at the beginning of the Phanerozoic