Verwaltungsökonomische Zusammenarbeit von Finanzverwaltung und Bezirksregierung bei der Flurneuordnung am Beispiel der OFD Rheinland

Die Zusammenarbeit der Finanzverwaltung mit den Bezirksregierungen bei der Flurneuordnung bringt Vorteile für beide Verwaltungen mit sich. Die Reduktion der Kosten beruht zum Teil auf einer Beschleunigung der Verfahren und zum anderen auf geringeren Kosten für die Wertermittlung, da beide Verwaltungen ihr Fachpersonal einsetzen. So stellt in der Regel die Finanzverwaltung die Amtlich Landwirt- schaftlichen Sachverständigen (ALS) und die Ehrenamtlichen Bodenschätzer. Die Bezirks- regierungen ergänzen den Schätzungsausschuss mit den erforderlichen Grabarbeitern und, soweit erforderlich, einem weiteren Vermessungstechniker, der Karten der Flurberei- nigung führt. Ergibt eine Vorprüfung durch die Finanzverwaltung, dass keine flächendeckende Schätzung erforderlich ist, so sind die Einsparungen hinsichtlich Verfahrensdauer und -kosten für die Flurbereinigungsbehörde am höchsten

Risk of myocardial infarction at specific troponin T levels using the parameter predictive value among lookalikes (PAL)

AbstractBackgroundMyocardial infarction is more likely if the heart damage biomarker cardiac troponin T (cTnT) is elevated in a blood sample, indicating that cardiac damage has occurred. No method allows the clinician to estimate the risk of myocardial infarction at a specific cTnT level in a given patient.MethodsPredictive value among lookalikes (PAL) uses pre-test prevalence, sensitivity and specificity at adjacent cTnT limits based on percentiles. PAL is the pre-test prevalence-adjusted probability of disease between two adjacent cTnT limits. If a chest pain patient's cTnT level is between these limits, the risk of myocardial infarction can be estimated.ResultsThe PAL based on percentiles had an acceptable sampling error when using 100 bootstrapped data of 18 different biomarkers from 38,945 authentic lab measurements. A PAL analysis of an emergency room cohort (n=11,020) revealed that the diagnostic precision of a high-sensitive cTnT assay was similar among chest pain patients at different ages. The higher incidence of false positive results due to non-specific increases in cTnT in the high-age group was counterbalanced by a higher pre-test prevalence of myocardial infarction among older patients, a finding that was missed when using a conventional ROC plot analysis.ConclusionsThe PAL was able to calculate the risk of myocardial infarction at specific cTnT levels and could complement decision limits

Assessment of a multi-marker risk score for predicting cause-specific mortality at three years in older patients with heart failure and reduced ejection fraction

Background: Due to increasing co-morbidity associated with aging, heart failure (HF) has become more prevalent and heterogeneous in older individuals, and non-cardiovascular (CV) mortality has increased. Previously, we defined a multi-marker modality that included cystatin C (CysC), troponin T (TnT), and age. Here, we validated this multi-marker risk score by evalu­ating its predictions of all-cause mortality and CV mortality in an independent population of older individuals with HF and reduced ejection fraction (HFrEF). Methods: This prospective cohort study included 124 patients, median age 73 years, that had HFrEF. We determined all-cause mortality and CV mortality at a 3-year follow-up. We com­pared the risk score to the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) for predicting all-cause mortality and CV mortality. Results: High risk scores were associated with both all-cause mortality (HR 4.2, 95% CI 2.2–8.1, p < 0.001) and CV mortality (HR 3.6, 95% CI 1.7–8.0, p = 0.0015). Receiver ope­rating characteristics showed similar efficacy for the risk score and NT-proBNP in predicting all-cause mortality (HR 0.74, 95% CI 0.65–0.81 vs. HR 0.74, 95% CI 0.65–0.81, p = 0.99) and CV mortality (HR 0.68, 95% CI 0.59–0.76 vs. HR 0.67, 95% CI 0.58–0.75, p = 0.95). When the risk score was added to the NT-proBNP, the continuous net reclassification impro­vement was 56% for predicting all-cause mortality (95% CI 18–95%, p = 0.004) and 45% for predicting CV mortality (95% CI 2–89%, p = 0.040). Conclusions: In HFrEF, a risk score that included age, TnT, and CysC showed efficacy similar to the NT-proBNP for predicting all-cause mortality and CV mortality in an older population.

Decreased admissions and hospital costs with a neutral effect on mortality following lowering of the troponin T cutoff point to the 99th percentile

Background: The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources. Methods: Clinical and laboratory data from patients with chest pain or dyspnea at the emergency de¬partment (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient. Results: Following lowering of the hs-cTnT cutoff point fewer ED patients with chest pain or dyspnea as the principal complaint were analyzed with an hs-cTnT sample (81% vs. 72%, p < 0.001). Overall 30-day mortality was unaffected but increased among patients not analyzed with an hs-cTnT sample (5.3% vs. 7.6%, p < 0.001). The MI frequency was unchanged (4.0% vs. 3.9%, p = 0.72) whereas admission rates decreased (51% vs. 45%, p < 0.001) as well as hospital costs. Coronary angiographies were used more frequently (2.8% vs. 3.3%, p = 0.004) but with no corresponding change in coronary interventions. Conclusions: At the participating hospital, lowering of the hs-cTnT cutoff point to the 99th percentile decreased admissions and hospital costs but did not result in any apparent prognostic or treatment benefits for the patients

Spatially differentiated modeling and evaluation of soil water conditions in forest sites of low mountain ranges

The forest hydrological model BROOK 90 was integrated into a GIS framework to calculate and evaluate soil water conditions in forest sites based on climate, topography, soil, and tree species. Model results are visualized in a novel forest site map using indicators for soil drought, soil water excess, and transpiration constraints. Based on knowledge of the number of days in which thresholds of these indicators were exceeded, an evaluation framework for soil water conditions was developed. The model was tested at the Tharandt Forest for an area with varying soil conditions and different tree species. Results can be used to derive and test new forest management strategies. For instance, recommendations for achieving optimum growth based on tree species or stand structure choices can be derived. Further research should focus on relating soil water indices with growth indices.Auf der Basis des forsthydrologischen Modells BROOK 90 wurde ein Modellsystem zur Berechnung und Beurteilung des Standortswasserhaushaltes in Abhängigkeit von Klima, Relief, Boden und Bestockung entwickelt. Implementierte Indikatoren zur Ausschöpfung des Bodenwasservorrates, der Einschränkung der Transpiration und des Auftretens von Staunässe erlauben eine Visualisierung der Modellergebnisse in Form neuartiger Standortskarten. Basierend auf der Kenntnis der Unterschreitungshäufigkeiten von Schwellenwerten dieser Indikatoren wurde ein fünfstufiger Bewertungsrahmen für den Wasserhaushalt aufgestellt. Das Modell wurde im Tharandter Wald für ein Gebiet mit variierenden Böden und unterschiedlicher Bestockung (Buche, Eiche, Fichte und Kiefer) getestet. Die Ergebnisse zeigen, dass diese Vorgehensweise eine differenzierte Informationsgrundlage für die forstliche Planung liefert. Beispielsweise können Entscheidungen zu Baumartenwahl und Bestandesstruktur abgeleitet werden. Forschungsbedarf besteht vor allem in der Verknüpfung der im Modell implementierten Indikatoren des Wasserhaushaltes mit Wachstumsparametern und physiologisch definierten Schwellenwerten

Gradual reset and set characteristics in yttrium oxide based resistive random access memory

This paper addresses the resistive switching behavior in yttrium oxide based resistive random access memory (RRAM) (TiN/yttrium oxide/Pt) devices. We report the coexistence of bipolar and unipolar resistive switching within a single device stack. For bipolar DC operation, the devices show gradual set and reset behavior with resistance ratio up to two orders of magnitude. By using nanosecond regime pulses (20 to 100 ns pulse width) of constant voltage amplitude, this gradual switching behavior could be utilized in tuning the resistance during set and reset spanning up to two orders of magnitude. This demonstrates that yttrium oxide based RRAM devices are alternative candidates for multibit operations and neuromorphic applications

Neutrophil “plucking” on megakaryocytes drives platelet production and boosts cardiovascular disease

Intravascular neutrophils and platelets collaborate in maintaining host integrity, but their interaction can also trigger thrombotic complications. We report here that cooperation between neutrophil and platelet lineages extends to the earliest stages of platelet formation by megakaryocytes in the bone marrow. Using intravital microscopy, we show that neutrophils "plucked" intravascular megakaryocyte extensions, termed proplatelets, to control platelet production. Following CXCR4-CXCL12-dependent migration towards perisinusoidal megakaryocytes, plucking neutrophils actively pulled on proplatelets and triggered myosin light chain and extracellular-signal-regulated kinase activation through reactive oxygen species. By these mechanisms, neutrophils accelerate proplatelet growth and facilitate continuous release of platelets in steady state. Following myocardial infarction, plucking neutrophils drove excessive release of young, reticulated platelets and boosted the risk of recurrent ischemia. Ablation of neutrophil plucking normalized thrombopoiesis and reduced recurrent thrombosis after myocardial infarction and thrombus burden in venous thrombosis. We establish neutrophil plucking as a target to reduce thromboischemic events