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n the EU there are longstanding and ongoing pressures towards a tax that is levied on the EU level to substitute for national contributions. We discuss conditions under which such a transition can make sense, starting from what we call a "decentralization theorem of taxation" that is analogous to Oates (1972) famous result that in the absence of spill-over effects and economies of scale decentralized public good provision weakly dominates central provision. We then drop assumptions that turn out to be unnecessary for this results. While spill-over effects of taxation may call for central rules for taxation, as long as spill-over effects do not depend on the intra-regional distribution of the tax burden, decentralized taxation plus tax coordination is found superior to a union-wide tax.
Background. Bile leakage testing may help to detect and reduce the incidence of biliary leakage after hepatic resection. This review was performed to investigate the value of the White-test in identifying intraoperative biliary leakage and avoiding postoperative leakage.
Material and methods. A systematic review and meta-analysis was performed. Two researchers performed literature research. Primary outcome measure was the incidence of post-hepatectomy biliary leakage; secondary outcome measure was the ability of detecting intraoperative biliary leakage with the help of the White-test.
Results. A total of 4 publications (including original data from our center) were included in the analysis. Evidence levels of the included studies had medium quality of 2b (individual cohort studies including low quality randomized controlled trials). Use of the White-test led to a significant reduction of post-operative biliary leakage [OR: 0.3 (95% CI: 0.14, 0.63), p = 0.002] and led to a significant higher intraoperative detection of biliary leakages [OR: 0.03 (95%CI: 0.02, 0.07), p < 0.00001].
Conclusion. Existing evidence implicates the use of the White-test after hepatic resection to identify bile leaks intraoperatively and thus reduce incidence of post-operative biliary leakage. Nonetheless, there is a requirement for a high-quality randomized controlled trial with adequately powered sample-size to confirm findings from the above described studies and further increase evidence in this field.
Second mitochondria-derived activator of caspase (Smac) mimetics are considered as promising anticancer therapeutics that are currently under investigation in early clinical trials. They induce apoptosis by antagonizing inhibitor of apoptosis proteins, which are frequently overexpressed in cancer. We previously reported that Smac mimetics, such as BV6, additionally exert non-apoptotic functions in glioblastoma (GBM) cells by stimulating migration and invasion in a nuclear factor kappa B (NF-κB)-dependent manner. Because NF-κB target genes mediating these effects are largely unknown, we performed whole-genome expression analyses. Here, we identify chemokine (C-C motif) ligand 2 (CCL2) as the top-listed NF-κB-regulated gene being upregulated upon BV6 treatment in GBM cells. BV6-induced upregulation and secretion of CCL2 are required for migration and invasion of GBM cells because knockdown of CCL2 in GBM cells abolishes these effects. Co-culture experiments of GBM cells with non-malignant astroglial cells reveal that BV6-stimulated secretion of CCL2 by GBM cells into the supernatant triggers migration of astroglial cells toward GBM cells because CCL2 knockdown in BV6-treated GBM cells impedes BV6-stimulated migration of astroglial cells. In conclusion, we identify CCL2 as a BV6-induced NF-κB target gene that triggers migration and invasion of GBM cells and exerts paracrine effects on the GBM's microenvironment by stimulating migration of astroglial cells. These findings provide novel insights into the biological functions of Smac mimetics with important implications for the development of Smac mimetics as cancer therapeutics.
Wasserbedarfsprognosen sind für Wasserversorger eine wichtige Entscheidungsgrundlage für zukünftige Maßnahmen in der wirtschaftlichen und technischen Betriebsführung sowie beim Ressourcenmanagement. In den letzten zwei Jahrzehnten sanken in Deutschland die spezifischen Wasserbedarfe aufgrund von Technik- und Verhaltensinnovationen. Für Regionen mit Wirtschafts- und Bevölkerungswachstum ist aber das Zusammenspiel dieser für den zukünftigen Bedarf konträren Entwicklungen von besonderem Interesse. Auch die Metropolregion Hamburg ist von diesen Entwicklungen betroffen.
Im Auftrag des Wasserversorgers HAMBURG WASSER aktualisierte das ISOE (Forschungsschwerpunkt Wasserressourcen und Landnutzung) in Kooperation mit dem ifo Institut München seine mittel- und langfristige Wasserbedarfsprognose aus dem Jahr 2007 für das Versorgungsgebiet des Auftraggebers. In einem innovativen Konzept wurden dafür Forschungsmethoden aus Natur-, Wirtschafts-, Planungs- und Sozialwissenschaften kombiniert. Mit dem gewählten transdisziplinären Forschungsmodus war das Projekt darauf angelegt, im laufenden Forschungsprozess gemeinsam mit den wissenschaftlichen und außerwissenschaftlichen Projektpartnern das Prognosekonzept weiterzuentwickeln. Der vorliegende Studientext basiert auf dem Projektbericht an HAMBURG WASSER und fasst Prognosekonzept, Modellentwicklung, Prognoseergebnissen und Schlussfolgerungen zusammen.
Rain- and floodwater harvesting (RFWH) technologies and water reuse are ideal and generalpurpose technologies to improve water security and to contribute to climate adaptation – in particular for semi-arid regions. These technologies are part of a multi-resources mix within an integrated water resources management (IWRM). They create capacities to buffer water fluctuations and alleviate water scarcity. In this way, they reduce the pressure on existing resources, and can stimulate local economies. However, in order to be sustainable, these technologies need to be adapted to the local context – through suitable design, adapted operation requirements, and a back-up by training users and operators accordingly.
Background: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.
Methods: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.
Results: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.
Conclusions: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.