Die verdeckten Verteilungswirkungen des bundesdeutschen Finanzausgleichs

Was sind die Ursachen der aktuellen kommunalen Finanzkrise? Welche Aufkommensverluste stellen sich bei den Gemeinden bei einer Abschaffung der Gewerbesteuer ein? Üblicherweise werden solche Fragen im Rahmen des primären Finanzausgleichs diskutiert, der die aufkommensstärksten Steuern auf Bund, Länder und Gemeinden verteilt. Die indirekten Verteilungswirkungen werden dabei ausgeklammert. Der vorliegende Beitrag erläutert zunächst die zentralen ökonomischen Mechanismen und quantifiziert dann die verdeckten Effekte anhand einiger ausgewählter Maßnahmen der Steuerreform. --

Concept for support and cleavage of brittle crystals

Tröger L, Schütte J, Ostendorf F, Kühnle A, Reichling M. Concept for support and cleavage of brittle crystals. Review of Scientific Instruments. 2009;80(6):063703.We report on sample holders for crystals to be cleaved for the preparation of surfaces with large atomically flat terraces. The concept for mounting sample crystals is based on a vicelike clamping mechanism to securely hold the crystal in position while reducing the risk of fragmentation. Sample holders based on this concept and made of suitable materials allow preparation and cleavage of crystals in the ultrahigh vacuum at high or low temperatures. To cleave the crystal, we employ a scalpel blade mounted on a wobble stick to generate a highly localized stress field initiating the cleavage process. The sample holders are used for experiments of highest resolution scanning force microscopy, however, the concept can be transferred to any other system where cleavage faces of crystals are of interest. Exemplarily, scanning force microscopy results demonstrate that (111) cleavage faces of CaF(2) crystals can be prepared with steps only a few F-Ca-F triple-layers high and atomically flat terraces extending over areas of several mu m(2)

Comparison of Multiscale Imaging Methods for Brain Research

A major challenge in neuroscience is how to study structural alterations in the brain. Even small changes in synaptic composition could have severe outcomes for body functions. Many neuropathological diseases are attributable to disorganization of particular synaptic proteins. Yet, to detect and comprehensively describe and evaluate such often rather subtle deviations from the normal physiological status in a detailed and quantitative manner is very challenging. Here, we have compared side-by-side several commercially available light microscopes for their suitability in visualizing synaptic components in larger parts of the brain at low resolution, at extended resolution as well as at super-resolution. Microscopic technologies included stereo, widefield, deconvolution, confocal, and super-resolution set-ups. We also analyzed the impact of adaptive optics, a motorized objective correction collar and CUDA graphics card technology on imaging quality and acquisition speed. Our observations evaluate a basic set of techniques, which allow for multi-color brain imaging from centimeter to nanometer scales. The comparative multi-modal strategy we established can be used as a guide for researchers to select the most appropriate light microscopy method in addressing specific questions in brain research, and we also give insights into recent developments such as optical aberration corrections

Clear Signature of the (2 x 1) Reconstruction of Calcite (1014)

Schütte J, Rahe P, Tröger L, et al. Clear Signature of the (2 x 1) Reconstruction of Calcite (1014). Langmuir. 2010;26(11):8295-8300.Calcite is a mineral of fundamental importance that plays a crucial role in many fields of research such as biomineralization, biomolecule adsorption, and reactivity as well as industrial and daily life applications. Consequently, the most stable cleavage plane of calcite has been studied extensively using both direct imaging techniques such as atomic force microscopy as well as spectroscopic and diffraction techniques. Several surface structures have been reported for the (10 (1) over bar4) cleavage plane of calcite differing from the simple bulk-truncated structure and an ongoing controversy exists in literature whether the cleavage plane exhibits a (2 x 1) reconstruction or not. We study the (10 (1) over bar4) cleavage plane using high-resolution noncontact atomic force microscopy (NC-AFM) under ultrahigh vacuum conditions and obtain a clear signature of the (2 x) reconstruction. This reconstruction is observed M very narrow tip-surface distance ranges only, explaining why in some experiments the reconstruction has been observed and in others not. Moreover, as all sample preparation is performed in ultrahigh vacuum, the possibility of the (2 x 1) reconstruction being adsorbate-induced appears rather unlikely. Additionally, tip-induced surface changes are ruled out as origin for the observed reconstruction either. In conclusion, our study suggests that the (2 x 1) reconstruction is a true surface property of the (10 (1) over bar4) cleavage plane of calcite

Achieving high effective Q-factors in ultra-high vacuum dynamic force microscopy

Lübbe J, Tröger L, Torbrügge S, et al. Achieving high effective Q-factors in ultra-high vacuum dynamic force microscopy. Measurement Science and Technology. 2010;21(12): 125501.The effective Q-factor of the cantilever is one of the most important figures-of-merit for a non-contact atomic force microscope (NC-AFM) operated in ultra-high vacuum (UHV). We provide a comprehensive discussion of all effects influencing the Q-factor and compare measured Q-factors to results from simulations based on the dimensions of the cantilevers. We introduce a methodology to investigate in detail how the effective Q-factor depends on the fixation technique of the cantilever. Fixation loss is identified as a most important contribution in addition to the hitherto discussed effects and we describe a strategy for avoiding fixation loss and obtaining high effective Q-factors in the force microscope. We demonstrate for room temperature operation, that an optimum fixation yields an effective Q-factor for the NC-AFM measurement in UHV that is equal to the intrinsic value of the cantilever

Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers.

OBJECTIVES To describe potentially avoidable fall-related transfers to the emergency department (ED), and to identify infrastructure, training needs, and resources deemed appropriate for implementation in nursing homes (NHs) to decrease fall-related transfers to EDs. DESIGN A multi-method design, including (1) in-depth case review by an expert panel, (2) structured discussion with NH stakeholders, and (3) appropriateness rating. SETTING AND PARTICIPANTS Fall-related transfers were identified from the prospective reporting of every unplanned hospital transfer occurring within 21 months, collected during the INTERCARE study in 11 Swiss NHs. METHODS Eighty-one fall-related transfers were rated for avoidability by a 2-round expert panel. NH stakeholders were consulted to discuss key implementable resources for NHs to mitigate potentially avoidable fall-related transfers. A questionnaire composed of 21 contextually adapted resources was sent to a larger group of stakeholders, to rate the appropriateness for implementation in NHs. χ2 tests were used to assess whether avoidability was associated with an ED visit and to describe transfers. The RAND/UCLA method for appropriateness was used to determine appropriate resources. RESULTS One of 4 fall-related transfers were rated as potentially avoidable. A positive association was found between an ED visit and a rating of avoidability (χ2 (1, N = 81) = 18.0, P < .001). Fourteen resources, including developing partnerships with outpatient clinics to access imaging services and strengthening geriatric expertise in nursing homes through clinical training and advanced nurse practitioners, were rated as appropriate by NH stakeholders for NH implementation to reduce potentially avoidable fall-related ED transfers. CONCLUSIONS AND IMPLICATIONS Access to diagnostic equipment, geriatric expertise, and clinical training is essential to reduce fall-related potentially avoidable transfers from NHs. Implementing and supporting advanced practice nurses or nurses in extended roles provides NH directors, policymakers, and health care institutions with the possibility of re-engineering resources to limit unnecessary transfers, which are detrimental for resident quality of care and costly for the health system

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/ Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth. Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models. Results: 5954 (76.5%) infants received L. acidophilus/B. infantisprophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82–4.35; p < 0.001) but not in the F group (effect size B = −0.06; 95% CI: −3.05–0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59–0.79; p < 0.001). Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk

PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study

Background: A recently developed haemostatic peptide gel for endoscopic application has been introduced to improve the management of gastrointestinal bleeding. The aim of this pilot study was to evaluate the feasibility, safety, efficacy and indication profiles of PuraStat in a clinical setting. Methods: In this prospective observational multicentre pilot study, patients with acute non-variceal gastrointestinal bleeding (upper and lower) were included. Primary and secondary application of PuraStat was evaluated. Haemoglobin, prothrombin time, platelets and transfusion behaviour were documented before and after haemostasis. The efficacy of PuraStat was assessed during the procedure, at 3 days and 1 week after application. Results: 111 patients with acute gastrointestinal bleeding were recruited into the study. 70 percent (78/111) of the patients had upper gastrointestinal bleeding and 30% (33/111) had lower gastrointestinal bleeding. After primary application of PuraStat, initial haemostatic success was achieved in 94% of patients (74/79, 95% CI 88-99%), and in 75% of the patients when used as a secondary haemostatic product, following failure of established techniques (24/32, 95% CI 59-91%). The therapeutic success rates (absence of rebleeding) after 3 and 7 days were 91% and 87% after primary use, and 87% and 81% in all study patients. Overall rebleeding rate at 30 day follow-up was 16% (18/111). In the 5 patients who finally required surgery (4.5%), PuraStat allowed temporary haemostasis and stabilisation. Conclusions: PuraStat expanded the therapeutic toolbox available for an effective treatment of gastrointestinal bleeding sources. It could be safely applied and administered without complications as a primary or secondary therapy. PuraStat may additionally serve as a bridge to surgery in order to achieve temporary haemostasis in case of refractory severe bleeding, possibly playing a role in preventing immediate emergency surgery

Irinotecan and temozolomide in combination with dasatinib and rapamycin versus irinotecan and temozolomide for patients with relapsed or refractory neuroblastoma (RIST-rNB-2011): a multicentre, open-label, randomised, controlled, phase 2 trial

Background Neuroblastoma is the most common extracranial solid tumour in children. Relapsed or refractory neuroblastoma is associated with a poor outcome. We assessed the combination of irinotecan–temozolomide and dasatinib–rapamycin (RIST) in patients with relapsed or refractory neuroblastoma. Methods The multicentre, open-label, randomised, controlled, phase 2, RIST-rNB-2011 trial recruited from 40 paediatric oncology centres in Germany and Austria. Patients aged 1–25 years with high-risk relapsed (defined as recurrence of all stage IV and MYCN amplification stages, after response to treatment) or refractory (progressive disease during primary treatment) neuroblastoma, with Lansky and Karnofsky performance status at least 50%, were assigned (1:1) to RIST (RIST group) or irinotecan–temozolomide (control group) by block randomisation, stratified by MYCN status. We compared RIST (oral rapamycin [loading 3 mg/m2 on day 1, maintenance 1 mg/m2 on days 2–4] and oral dasatinib [2 mg/kg per day] for 4 days with 3 days off, followed by intravenous irinotecan [50 mg/m2 per day] and oral temozolomide [150 mg/m2 per day] for 5 days with 2 days off; one course each of rapamycin–dasatinib and irinotecan–temozolomide for four cycles over 8 weeks, then two courses of rapamycin–dasatinib followed by one course of irinotecan–temozolomide for 12 weeks) with irinotecan–temozolomide alone (with identical dosing as experimental group). The primary endpoint of progression-free survival was analysed in all eligible patients who received at least one course of therapy. The safety population consisted of all patients who received at least one course of therapy and had at least one post-baseline safety assessment. This trial is registered at ClinicalTrials.gov, NCT01467986, and is closed to accrual. Findings Between Aug 26, 2013, and Sept 21, 2020, 129 patients were randomly assigned to the RIST group (n=63) or control group (n=66). Median age was 5·4 years (IQR 3·7–8·1). 124 patients (78 [63%] male and 46 [37%] female) were included in the efficacy analysis. At a median follow-up of 72 months (IQR 31–88), the median progression-free survival was 11 months (95% CI 7–17) in the RIST group and 5 months (2–8) in the control group (hazard ratio 0·62, one-sided 90% CI 0·81; p=0·019). Median progression-free survival in patients with amplified MYCN (n=48) was 6 months (95% CI 4–24) in the RIST group versus 2 months (2–5) in the control group (HR 0·45 [95% CI 0·24-0·84], p=0·012); median progression-free survival in patients without amplified MYCN (n=76) was 14 months (95% CI 9–7) in the RIST group versus 8 months (4–15) in the control group (HR 0·84 [95% CI 0·51–1·38], p=0·49). The most common grade 3 or worse adverse events were neutropenia (54 [81%] of 67 patients given RIST vs 49 [82%] of 60 patients given control), thrombocytopenia (45 [67%] vs 41 [68%]), and anaemia (39 [58%] vs 38 [63%]). Nine serious treatment-related adverse events were reported (five patients given control and four patients given RIST). There were no treatment-related deaths in the control group and one in the RIST group (multiorgan failure). Interpretation RIST-rNB-2011 demonstrated that targeting of MYCN-amplified relapsed or refractory neuroblastoma with a pathway-directed metronomic combination of a multkinase inhibitor and an mTOR inhibitor can improve progression-free survival and overall survival. This exclusive efficacy in MYCN-amplified, relapsed neuroblastoma warrants further investigation in the first-line setting