Verkehrswertermittlung von Industrieimmobilien unter besonderer Betrachtung des Bodenwertes

Setting: There exists very little supportive valuation literature for the valuation of industrial properties and the present state of research is capable of improvement. Objective: A critical examination of the procedure for the determination of the market value of industrial properties in accordance with § 194 Building Code will be made on the basis of the relevant valuation literature. Based on using standard valuation practices there should be a ground value derived for an industrial estate. Conclusion: When valuing industrial properties economic use is crucial, therefore the income approach is applied in order to attain the market value of the property. Difficulties which may arise include customary approaches for rent, property management costs and interest rates. Based on a Germany-wide cross-comparison with other automobile-producing properties a plausible range for the derivation of the groundvalue was determined. At the time of submission, the determination of the ground value by the expert Committee was unfinished.

Vertical competition and multi-period interaction : a theoretical and behavioral analysis on the impact of strategic inventories in supply chain management

Otto-von-Guericke-Universtität Magdeburg, Fakultät für Wirtschaftswissenschaft, Univ., Dissertation, 2015

Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery.

International variation in management of screen-detected ductal carcinoma in situ of the breast.

BACKGROUND: Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS: We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS: Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS: Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

Gewisse Patienten profitieren von einem Selfmanagement der oralen Antikoagulation.

Cet article présente les résultats de la revue systématique: Garcia-Alamino JM, Ward AM, Alonso-Coello P, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database of SystematicReviews 2010 Apr 14;(4):CD003839. doi:10.1002/14651858.CD003839.pub2.. PMID: 20393937.

Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC).

An increasing number of patients suffering from cardiovascular disease, especially coronary artery disease (CAD), are treated with aspirin and/or clopidogrel for the prevention of major adverse events. Unfortunately, there are no specific, widely accepted recommendations for the perioperative management of patients receiving antiplatelet therapy. Therefore, members of the Perioperative Haemostasis Group of the Society on Thrombosis and Haemostasis Research (GTH), the Perioperative Coagulation Group of the Austrian Society for Anesthesiology, Reanimation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society of Cardiology (ESC) have created this consensus position paper to provide clear recommendations on the perioperative use of anti-platelet agents (specifically with semi-urgent and urgent surgery), strongly supporting a multidisciplinary approach to optimize the treatment of individual patients with coronary artery disease who need major cardiac and non-cardiac surgery. With planned surgery, drug eluting stents (DES) should not be used unless surgery can be delayed for ≥12 months after DES implantation. If surgery cannot be delayed, surgical revascularisation, bare-metal stents or pure balloon angioplasty should be considered. During ongoing antiplatelet therapy, elective surgery should be delayed for the recommended duration of treatment. In patients with semi-urgent surgery, the decision to prematurely stop one or both antiplatelet agents (at least 5 days pre-operatively) has to be taken after multidisciplinary consultation, evaluating the individual thrombotic and bleeding risk. Urgently needed surgery has to take place under full antiplatelet therapy despite the increased bleeding risk. A multidisciplinary approach for optimal antithrombotic and haemostatic patient management is thus mandatory.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Prevention and management of potential adverse events during transapical aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: Transapical transcatheter aortic valve replacement (TAVR) is a new minimally invasive technique with a known risk of unexpected intra-procedural complications. Nevertheless, the clinical results are good and the limited amount of procedural adverse events confirms the usefulness of a synergistic surgical/anesthesiological management in case of unexpected emergencies. METHODS: A review was made of the authors' four-year database and other available literature to identify major and minor intra-procedural complications occurring during transapical TAVR procedures. All implants were performed under general anesthesia with a balloon-expandable Edwards Sapien stent-valve, and followed international guidelines on indications and techniques. RESULTS: Procedural success rates ranged between 94% and 100%. Life-threatening apical bleeding occurred very rarely (0-5%), and its incidence decreased after the first series of implants. Stent-valve embolization was also rare, with a global incidence ranging from 0-2%, with evidence of improvement after the learning curve. Rates of valve malpositioning ranged from 0% to < 3%, whereas the risk of coronary obstruction ranged from 0% to 3.5%. Aortic root rupture and dissection were dramatic events reported in 0-2% of transapical cases. Stent-valve malfunction was rarely reported (1-2%), whereas the valve-in-valve bailout procedure for malpositioning, malfunctioning or severe paravalvular leak was reported in about 1.0-3.5% of cases. Sudden hemodynamic management and bailout procedures such as valve-in-valve rescue or cannulation for cardiopulmonary bypass were more effective when planned during the preoperative phase. CONCLUSION: Despite attempts to avoid pitfalls, complications during transapical aortic valve procedures still occur. Preoperative strategic planning, including hemodynamic status management, alternative cannulation sites and bailout procedures, are highly recommended, particularly during the learning curve of this technique.

Das GRADE-System: ein internationaler Ansatz zur Vereinheitlichung der Graduierung von Evidenz und Empfehlungen in Leitlinien. [The GRADE System: an international approach to standardize the graduation of evidence and recommendations in guidelines]

Clinical practice guidelines have become an important source of information to support clinicians in the management of individual patients. However, current guideline methods have limitations that include the lack of separating the quality of evidence from the strength of recommendations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group, an international collaboration of guideline developers, methodologists, and clinicians have developed a system that addresses these shortcomings. Core elements include transparent methodology for grading the quality of evidence, the distinction between quality of the evidence and strength of a recommendation, an explicit balancing of benefits and harms of health care interventions, an explicit recognition of the values and preferences that underlie recommendations. The GRADE system has been piloted in various practice settings to ensure that it captures the complexity involved in evidence assessment and grading recommendations while maintaining simplicity and practicality. Many guideline organizations and medical societies have endorsed the system and adopted it for their guideline processes.

Complications of systemic juvenile idiopathic arthritis: risk factors and management recommendations.

Systemic juvenile idiopathic arthritis (SJIA) is an inflammatory condition characterized by fever, lymphadenopathy, arthritis, rash and serositis. Systemic inflammation has been associated with dysregulation of the innate immune system, suggesting that SJIA is an autoinflammatory disorder. IL-1 and IL-6 play a major role in the pathogenesis of SJIA, and treatment with IL-1 and IL-6 inhibitors has shown to be highly effective. However, complications of SJIA, including macrophage activation syndrome, limitations in functional outcome by arthritis and long-term damage from chronic inflammation, continue to be a major issue in SJIA patients' care. Translational research leading to a profound understanding of the cytokine crosstalk in SJIA and the identification of risk factors for SJIA complications will help to improve long-term outcome.

Understanding academics' popular science publishing : institution culture and management style effects

Most universities and higher education systems have formally taken up a third mission, which involves various public outreach and engagement activities. Little is known regarding how higher education institutions' organisations interact with academic's level of public outreach. This article examines to which extent the perceptions academics have of their institutions' culture and management style, as well as some of their own individual and statutory characteristics interact with their level of public outreach. Using the Academic Profession in Europe comparative and quantitative research database, this article focuses on two countries on the extremities of the spectrum - Switzerland and the United Kingdom.

Public Management : Ganzheitliches Know-how zur Sicherstellung eines professionellen Verwaltungsmanagements

Dieses hochwertige Praxishandbuch ermöglicht Personen mit Führungs- und Managementfunktionen in den öffentlichen Verwaltungen des Bundes, der Kantone und der Gemeinden einen raschen Zugang zu allen wichtigen Führungsthemen und enthält praktische Anleitungen zur Bewältigung von Managementproblemen. Über 50 ausgewiesene Fachautoren mit professionellem beruflichen Hintergrund haben die vorliegenden Inhalte entsprechend den heutigen Anforderungen in der öffentlichen Verwaltung erstellt

Das Kontextmarketing im mobilen Customer Relationship Management

Zusammenfassung Mobile Telekommunikationstechnologien verändern den Alltag, ihre Benutzer und die Geschäftswelt. Im Zuge der Mobilität haben die Nutzer von mobilen Übertragungstechnologien ein hohes Kommunikationsbedürfnis in jeglicher Situation entwickelt: Sie wollen überall und jederzeit kommunizieren und informiert sein. Dies ist auch darauf zurückzuführen, dass ein Wandel der Individualisierung – von der Person zur Situation – stattgefunden hat. Im Rahmen der Untersuchung gehen wir auf diese entscheidenden Veränderung ein und analysieren die Potenziale des Kontextmarketing im mobilen Customer Relationship Management anhand der Erringung von Wettbewerbsvorteilen durch Situationsfaktoren. Daneben zeigen wir mögliche Geschäftsmodelle und Wertschöpfungsketten auf. Abgerundet wird die Arbeit durch die Darstellung möglicher personenbezogener, technischer und rechtlicher Restriktionen.

Modellbasiertes Service Level Management verteilter Anwendungssysteme

Zur Senkung von Kosten werden in vielen Unternehmen Dienstleistungen, die nicht zur Kernkompetenz gehören, an externe Dienstleister ausgelagert. Dieser Prozess wird auch als Outsourcing bezeichnet. Die dadurch entstehenden Abhängigkeiten zu den externen Dienstleistern werden mit Hilfe von Service Level Agreements (SLAs) vertraglich geregelt. Die Aufgabe des Service Level Managements (SLM) ist es, die Einhaltung der vertraglich fixierten Dienstgüteparameter zu überwachen bzw. sicherzustellen. Für eine automatische Bearbeitung ist daher eine formale Spezifikation von SLAs notwendig. Da der Markt eine Vielzahl von unterschiedlichen SLM-Werkzeugen hervorgebracht hat, entstehen in der Praxis Probleme durch proprietäre SLA-Formate und fehlende Spezifikationsmethoden. Daraus resultiert eine Werkzeugabhängigkeit und eine limitierte Wiederverwendbarkeit bereits spezifizierter SLAs. In der vorliegenden Arbeit wird ein Ansatz für ein plattformunabhängiges Service Level Management entwickelt. Ziel ist eine Vereinheitlichung der Modellierung, so dass unterschiedliche Managementansätze integriert und eine Trennung zwischen Problem- und Technologiedomäne erreicht wird. Zudem wird durch die Plattformunabhängigkeit eine hohe zeitliche Stabilität erstellter Modelle erreicht. Weiteres Ziel der Arbeit ist, die Wiederverwendbarkeit modellierter SLAs zu gewährleisten und eine prozessorientierte Modellierungsmethodik bereitzustellen. Eine automatisierte Etablierung modellierter SLAs ist für eine praktische Nutzung von entscheidender Relevanz. Zur Erreichung dieser Ziele werden die Prinzipien der Model Driven Architecture (MDA) auf die Problemdomäne des Service Level Managements angewandt. Zentrale Idee der Arbeit ist die Definition von SLA-Mustern, die konfigurationsunabhängige Abstraktionen von Service Level Agreements darstellen. Diese SLA-Muster entsprechen dem Plattformunabhängigen Modell (PIM) der MDA. Durch eine geeignete Modelltransformation wird aus einem SLA-Muster eine SLA-Instanz generiert, die alle notwendigen Konfigurationsinformationen beinhaltet und bereits im Format der Zielplattform vorliegt. Eine SLA-Instanz entspricht damit dem Plattformspezifischen Modell (PSM) der MDA. Die Etablierung der SLA-Instanzen und die daraus resultierende Konfiguration des Managementsystems entspricht dem Plattformspezifischen Code (PSC) der MDA. Nach diesem Schritt ist das Managementsystem in der Lage, die im SLA vereinbarten Dienstgüteparameter eigenständig zu überwachen. Im Rahmen der Arbeit wurde eine UML-Erweiterung definiert, die eine Modellierung von SLA-Mustern mit Hilfe eines UML-Werkzeugs ermöglicht. Hierbei kann die Modellierung rein graphisch als auch unter Einbeziehung der Object Constraint Language (OCL) erfolgen. Für die praktische Realisierung des Ansatzes wurde eine Managementarchitektur entwickelt, die im Rahmen eines Prototypen realisiert wurde. Der Gesamtansatz wurde anhand einer Fallstudie evaluiert.