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Настоящий научно-практический комментарий и перевод Уголовного уложения Федеративной Республики Германия не ограничивается собственно трансформацией текста основного уголовного закона Германии на русский язык. Руководствуясь принципами функционального перевода, автор посредством точного и систематического перевода доводит до сведения читателя смысл уголовно-правовых норм. Научно-практический комментарий к Уголовному уложению Германии представляет собой постатейный комментарий, учитывающий как мнение законодателя, так и мнение правоприменительной практики Федерального Верховного суда и высших Земельных судов Германии, а также немецкой юридической доктрины по основным проблемам уголовного права. Необходимое внимание было уделено также дополнительному уголовному праву и уголовно-процессуальным проблемам. Таким образом, задачей настоящего издания является предоставить читателю возможность правильного языкового понимания и юридического толкования уголовно-правовых норм Германии.
Вступительная статья «Введение в уголовное право Германии» содержит общий обзор немецкого уголовного права. Особое внимание уделено развитию и источникам уголовного законодательства, а также доктрине уголовного права ФРГ.
Книга может заинтересовать практиков и правоведов, а также всех, кто в своей профессиональной деятельности или в процессе обучения сталкивается с уголовным правом Германии.
Mehr Schein als Sein
(2021)
In this paper I am concerned with the idiomatic constructions fr. avoir l'air (de) and sp. tener el aire (de). I describe these form-function pairs from a constructionist perspective and analyze them as cases of evidential strategies in French and Spanish.
The incorporation of proteins in artificial materials such as membranes offers great opportunities to avail oneself the miscellaneous qualities of proteins and enzymes perfected by nature over millions of years. One possibility to leverage proteins is the modification with artificial polymers. To obtain such protein-polymer conjugates, either a polymer can be grown from the protein surface (grafting-from) or a pre-synthesized polymer attached to the protein (grafting-to). Both techniques were used to synthesize conjugates of different proteins with thermo-responsive polymers in this thesis.
First, conjugates were analyzed by protein NMR spectroscopy. Typical characterization techniques for conjugates can verify the successful conjugation and give hints on the secondary structure of the protein. However, the 3-dimensional structure, being highly important for the protein function, cannot be probed by standard techniques. NMR spectroscopy is a unique method allowing to follow even small alterations in the protein structure. A mutant of the carbohydrate binding module 3b (CBM3bN126W) was used as model protein and functionalized with poly(N-isopropylacrylamide). Analysis of conjugates prepared by grafting-to or grafting-from revealed a strong impact of conjugation type on protein folding. Whereas conjugates prepared by grafting a pre-formed polymer to the protein resulted in complete preservation of protein folding, grafting the polymer from the protein surface led to (partial) disruption of the protein structure.
Next, conjugates of bovine serum albumin (BSA) as cheap and easily accessible protein were synthesized with PNIPAm and different oligoethylene glycol (meth)acrylates. The obtained protein-polymer conjugates were analyzed by an in-line combination of size exclusion chromatography and multi-angle laser light scattering (SEC-MALS). This technique is particular advantageous to determine molar masses, as no external calibration of the system is needed. Different SEC column materials and operation conditions were tested to evaluate the applicability of this system to determine absolute molar masses and hydrodynamic properties of heterogeneous conjugates prepared by grafting-from and grafting-to. Hydrophobic and non-covalent interactions of conjugates lead to error-prone values not in accordance to expected molar masses based on conversions and extents of modifications.
As alternative to this method, conjugates were analyzed by sedimentation velocity analytical ultracentrifugation (SV-AUC) to gain insights in the hydrodynamic properties and how they change after conjugation. Within a centrifugal field, a sample moves and fractionates according to the mass, density, and shape of its individual components. Conjugates of BSA with PNIPAm were analyzed below and above the cloud point temperature of the thermo-responsive polymer component. It was identified that the polymer characteristics were transferred to the conjugate molecule which than showed a decreased ideality – defined as increased deviation from a perfect sphere model – below and increased ideality above the cloud point temperature. This effect can be attributed to an arrangement of the polymer chain pointing towards the solvent (expanded state) or snuggling around the protein surface depending on the applied temperature.
The last project dealt with the synthesis of ferric hydroxamate uptake protein component A (FhuA)-polymer conjugates as building blocks for novel membrane materials. The shape of FhuA can be described as barrel and removal of a cork domain inside the protein results in a passive channel aimed to be utilized as pores in the membrane system. The polymer matrix surrounding the membrane protein is composed of a thermo-responsive and a UV-crosslinkable part. Therefore, an external trigger for covalent immobilization of these building blocks in the membrane and switchability of the membrane between different states was incorporated. The overall performance of membranes prepared by a drying-mediated self-assembly approach was evaluated by permeability and size exclusion experiments. The obtained membranes displayed an insufficiency in interchain crosslinking and therefore a lack in performance. Furthermore, the aimed switch between a hydrophilic and hydrophobic state of the polymer matrix did not occur. Correspondingly, size exclusion experiments did not result in a retention of analytes larger than the pores defined by the dimension of the used FhuA variant.
Overall, different paths to generate protein-polymer conjugates by either grafting-from or grafting-to the protein surface were presented paving the way to the generation of new hybrid materials. Different analytical methods were utilized to describe the folding and hydrodynamic properties of conjugates providing a deeper insight in the overall characteristics of these seminal building blocks.
Halide perovskites are a class of novel photovoltaic materials that have recently attracted much attention in the photovoltaics research community due to their highly promising optoelectronic properties, including large absorption coefficients and long carrier lifetimes. The charge carrier mobility of halide perovskites is investigated in this thesis by THz spectroscopy, which is a contact-free technique that yields the intra-grain sum mobility of electrons and holes
in a thin film.
The polycrystalline halide perovskite thin films, provided from Potsdam University, show moderate mobilities in the range from 21.5 to 33.5 cm2V-1s-1. It is shown in this work that the room temperature mobility is limited by charge carrier scattering at polar optical phonons. The mobility at low temperature is likely to be limited by scattering at charged and neutral impurities at impurity concentration N=1017-1018 cm-3. Furthermore, it is shown that exciton formation
may decrease the mobility at low temperatures. Scattering at acoustic phonons can be neglected at both low and room temperatures. The analysis of mobility spectra over a broad range of temperatures for perovskites with various cation compounds shows that cations have a minor impact on charge carrier mobility.
The low-dimensional thin films of quasi-2D perovskite with different numbers of [PbI6]4−sheets (n=2-4) alternating with long organic spacer molecules were provided by S. Zhang from Potsdam University. They exhibit mobilities in the range from 3.7 to 8 cm2V-1s-1. A clear
decrease of mobility is observed with decrease in number of metal-halide sheets n, which likely arises from charge carrier confinement within metal-halide layers. Modelling the measured THz mobility with the modified Drude-Smith model yields localization length from 0.9 to 3.7 nm, which agrees well on the thicknesses of the metal-halide layers. Additionally, the mobilities are found to be dependent on the orientation of the layers. The charge carrier dynamics is also
dependent on the number of metal-halide sheets n. For the thin films with n =3-4 the dynamics is similar to the 3D MHPs. However, the thin film with n = 2 shows clearly different dynamics, where the signs of exciton formation are observed within 390 fs timeframe after
photoexcitation.
Also, the charge carrier dynamics of CsPbI3 perovskite nanocrystals was investigated, in particular the effect of post treatments on the charge carrier transport.
In den letzten Jahren erlebte der Rechtspopulismus in Europa einen Aufstieg. Die ‚Alternative für Deutschland‘ (AfD) erhielt bei der deutschen Bundestagswahl 2017 beispielsweise 12,7 % der abgegebenen Stimmen und war darüber hinaus gerade im Osten des Landes erfolgreich. Im Rahmen dieser Arbeit wird vergleichend untersucht, welche sprachlichen Manipulationsstrategien der AfD dazu beitragen und wie sie wirken. Die Arbeit gliedert sich grob in zwei Teile: die Analyse des Sprachgebrauchs der AfD und schließlich der Vergleich mit jenem der Nationalsozialist:innen. Ziel der Arbeit ist es nicht, die AfD als Kopie der NSDAP zu entlarven, sondern ihre sprachlichen Manipulationsstrategien im historischen Kontext ergebnisoffen zu analysieren und so ein tieferes Verständnis dieser zu ermöglichen, um eine Grundlage für die zukünftige Erarbeitung möglicher Gegenstrategien zu schaffen.
Dabei stellt sich die Verwendung von diskriminierenden Sprechakten als wesentlicher Teilaspekt der Strategie heraus. So kann aus den Ergebnissen geschlussfolgert werden, dass die Polarisierung der Gesellschaft in zwei Teile (Ingroup und Outgroup) sowie die damit verbundene Diskriminierung der Outgroup als Ziel des Sprachgebrauchs der AfD bezeichnet werden können. Auf diesem Weg kann eine zunehmende Radikalisierung des Sprachgebrauchs innerhalb der letzten Jahre festgestellt werden.
Im zweiten Teil der Arbeit werden im Vergleich mit den Nationalsozialist:innen zahlreiche Parallelen deutlich: Über gemeinsame Stilmittel wie Metaphorik, Verwendung von Superlativen oder bestimmten Begrifflichkeiten hinaus ist hier vor allem die Diskriminierung eines konkreten Feindbildes sowie die angestrebte Spaltung der Bevölkerung zu nennen. Zugleich gilt es auch, die deutlichen Unterschiede zwischen dem Sprachgebrauch im Nationalsozialismus und jenem der AfD zu akzentuieren, um eine ebenso leichtfertige wie unangemessene Gleichsetzung zu verhindern. Zentral ist hier die Eindeutigkeit des Sprachgebrauchs. Die Vergleiche mit verschiedenen Quellen aus dem Dritten Reich verdeutlichen, dass der Sprachgebrauch im Nationalsozialismus direkter und viel radikaler war. Die AfD ist hingegen oftmals darauf bedacht, ihre Aussagen nur augenscheinlich eindeutig zu formulieren, sich insgesamt aber immer eine Möglichkeit des sprachlichen Zurückruderns offen zu halten. Ein offensichtlicher Grund dürften die unterschiedlichen gesellschaftlichen Bedingungen zu beiden Zeiten sein. Für die AfD ist es heute schwieriger, eine ausreichend große Masse an mindestens unsicheren Menschen zu mobilisieren. Begründet werden kann dies mit einer im Vergleich zur Weimarer Republik über Jahrzehnte hinweg gesetzlich, politisch und gesellschaftlich etablierten und sehr stabilen Demokratie. Deshalb ist die AfD darauf angewiesen, eine mehrdeutige Sprache zu verwenden, die ihnen im Bedarfsfall eine Rechtfertigung und somit einen Weg zurück ermöglicht. Darüber hinaus ermöglicht ihnen ein solcher Sprachgebrauch aber auch, sich einerseits gegenüber den Institutionen der Demokratie (beispielsweise dem Verfassungsschutz) zu rechtfertigen und andererseits insbesondere der konservativen Wählerschaft das Gefühl zu geben, dass sie keine rechtsextreme Partei wählen.
Aus den Ergebnissen der Arbeit lässt sich darüber hinaus die These ableiten, dass eine Veränderung des Sprachgebrauchs allein nicht dazu führt, dass Menschen einer Ideologie folgen. Der historische Vergleich deutet aber darauf hin, dass ein diskriminierender Sprachgebrauch zur Entstehung eines Nährbodens einer solchen Ideologie beitragen kann, wenn der gesellschaftliche und politische Rahmen es zulässt. Diesen Rahmen versucht die AfD Stück für Stück in ihrem Sinne zu verschieben. In den letzten Jahren gelang es ihr zunehmend, den öffentlichen Diskurs zu ihren Gunsten mitzubestimmen und zu verändern. Dafür ist der manipulative Gebrauch von Sprache entscheidend. Durch ihn sind sie in der Lage, die ›gefühlte‹ Wahrheit im Kampf gegen Fakten siegen zu lassen und Diskurse wie die Klima-Debatte oder die Diskussionen um Maßnahmen gegen die Coronapandemie zu beeinflussen.
Die Arbeit macht aber auch deutlich, wie kompliziert das Vorhaben der Polarisierung in einer heterogenen Gesellschaft wie der heutigen deutschen ist. Sogar innerhalb der AfD kommt es immer häufiger zu Uneinigkeiten.
Compound weather events may lead to extreme impacts that can affect many aspects of society including agriculture. Identifying the underlying mechanisms that cause extreme impacts, such as crop failure, is of crucial importance to improve their understanding and forecasting. In this study, we investigate whether key meteorological drivers of extreme impacts can be identified using the least absolute shrinkage and selection operator (LASSO) in a model environment, a method that allows for automated variable selection and is able to handle collinearity between variables. As an example of an extreme impact, we investigate crop failure using annual wheat yield as simulated by the Agricultural Production Systems sIMulator (APSIM) crop model driven by 1600 years of daily weather data from a global climate model (EC-Earth) under present-day conditions for the Northern Hemisphere. We then apply LASSO logistic regression to determine which weather conditions during the growing season lead to crop failure. We obtain good model performance in central Europe and the eastern half of the United States, while crop failure years in regions in Asia and the western half of the United States are less accurately predicted. Model performance correlates strongly with annual mean and variability of crop yields; that is, model performance is highest in regions with relatively large annual crop yield mean and variability. Overall, for nearly all grid points, the inclusion of temperature, precipitation and vapour pressure deficit is key to predict crop failure. In addition, meteorological predictors during all seasons are required for a good prediction. These results illustrate the omnipresence of compounding effects of both meteorological drivers and different periods of the growing season for creating crop failure events. Especially vapour pressure deficit and climate extreme indicators such as diurnal temperature range and the number of frost days are selected by the statistical model as relevant predictors for crop failure at most grid points, underlining their overarching relevance. We conclude that the LASSO regression model is a useful tool to automatically detect compound drivers of extreme impacts and could be applied to other weather impacts such as wildfires or floods. As the detected relationships are of purely correlative nature, more detailed analyses are required to establish the causal structure between drivers and impacts.
The co-occurrence of warm spells and droughts can lead to detrimental socio-economic and ecological impacts, largely surpassing the impacts of either warm spells or droughts alone. We quantify changes in the number of compound warm spells and droughts from 1979 to 2018 in the Mediterranean Basin using the ERA5 data set. We analyse two types of compound events: 1) warm season compound events, which are extreme in absolute terms in the warm season from May to October and 2) year-round deseasonalised compound events, which are extreme in relative terms respective to the time of the year. The number of compound events increases significantly and especially warm spells are increasing strongly – with an annual growth rates of 3.9 (3.5) % for warm season (deseasonalised) compound events and 4.6 (4.4) % for warm spells –, whereas for droughts the change is more ambiguous depending on the applied definition. Therefore, the rise in the number of compound events is primarily driven by temperature changes and not the lack of precipitation. The months July and August show the highest increases in warm season compound events, whereas the highest increases of deseasonalised compound events occur in spring and early summer. This increase in deseasonalised compound events can potentially have a significant impact on the functioning of Mediterranean ecosystems as this is the peak phase of ecosystem productivity and a vital phenophase.
Precipitation forecasting has an important place in everyday life – during the day we may have tens of small talks discussing the likelihood that it will rain this evening or weekend. Should you take an umbrella for a walk? Or should you invite your friends for a barbecue? It will certainly depend on what your weather application shows.
While for years people were guided by the precipitation forecasts issued for a particular region or city several times a day, the widespread availability of weather radars allowed us to obtain forecasts at much higher spatiotemporal resolution of minutes in time and hundreds of meters in space. Hence, radar-based precipitation nowcasting, that is, very-short-range forecasting (typically up to 1–3 h), has become an essential technique, also in various professional application contexts, e.g., early warning, sewage control, or agriculture.
There are two major components comprising a system for precipitation nowcasting: radar-based precipitation estimates, and models to extrapolate that precipitation to the imminent future. While acknowledging the fundamental importance of radar-based precipitation retrieval for precipitation nowcasts, this thesis focuses only on the model development: the establishment of open and competitive benchmark models, the investigation of the potential of deep learning, and the development of procedures for nowcast errors diagnosis and isolation that can guide model development.
The present landscape of computational models for precipitation nowcasting still struggles with the availability of open software implementations that could serve as benchmarks for measuring progress. Focusing on this gap, we have developed and extensively benchmarked a stack of models based on different optical flow algorithms for the tracking step and a set of parsimonious extrapolation procedures based on image warping and advection. We demonstrate that these models provide skillful predictions comparable with or even superior to state-of-the-art operational software. We distribute the corresponding set of models as a software library, rainymotion, which is written in the Python programming language and openly available at GitHub (https://github.com/hydrogo/rainymotion). That way, the library acts as a tool for providing fast, open, and transparent solutions that could serve as a benchmark for further model development and hypothesis testing.
One of the promising directions for model development is to challenge the potential of deep learning – a subfield of machine learning that refers to artificial neural networks with deep architectures, which may consist of many computational layers. Deep learning showed promising results in many fields of computer science, such as image and speech recognition, or natural language processing, where it started to dramatically outperform reference methods.
The high benefit of using "big data" for training is among the main reasons for that. Hence, the emerging interest in deep learning in atmospheric sciences is also caused and concerted with the increasing availability of data – both observational and model-based. The large archives of weather radar data provide a solid basis for investigation of deep learning potential in precipitation nowcasting: one year of national 5-min composites for Germany comprises around 85 billion data points.
To this aim, we present RainNet, a deep convolutional neural network for radar-based precipitation nowcasting. RainNet was trained to predict continuous precipitation intensities at a lead time of 5 min, using several years of quality-controlled weather radar composites provided by the German Weather Service (DWD). That data set covers Germany with a spatial domain of 900 km x 900 km and has a resolution of 1 km in space and 5 min in time. Independent verification experiments were carried out on 11 summer precipitation events from 2016 to 2017. In these experiments, RainNet was applied recursively in order to achieve lead times of up to 1 h. In the verification experiments, trivial Eulerian persistence and a conventional model based on optical flow served as benchmarks. The latter is available in the previously developed rainymotion library.
RainNet significantly outperformed the benchmark models at all lead times up to 60 min for the routine verification metrics mean absolute error (MAE) and critical success index (CSI) at intensity thresholds of 0.125, 1, and 5 mm/h. However, rainymotion turned out to be superior in predicting the exceedance of higher intensity thresholds (here 10 and 15 mm/h). The limited ability of RainNet to predict high rainfall intensities is an undesirable property which we attribute to a high level of spatial smoothing introduced by the model. At a lead time of 5 min, an analysis of power spectral density confirmed a significant loss of spectral power at length scales of 16 km and below.
Obviously, RainNet had learned an optimal level of smoothing to produce a nowcast at 5 min lead time. In that sense, the loss of spectral power at small scales is informative, too, as it reflects the limits of predictability as a function of spatial scale. Beyond the lead time of 5 min, however, the increasing level of smoothing is a mere artifact – an analogue to numerical diffusion – that is not a property of RainNet itself but of its recursive application. In the context of early warning, the smoothing is particularly unfavorable since pronounced features of intense precipitation tend to get lost over longer lead times. Hence, we propose several options to address this issue in prospective research on model development for precipitation nowcasting, including an adjustment of the loss function for model training, model training for longer lead times, and the prediction of threshold exceedance.
The model development together with the verification experiments for both conventional and deep learning model predictions also revealed the need to better understand the source of forecast errors. Understanding the dominant sources of error in specific situations should help in guiding further model improvement. The total error of a precipitation nowcast consists of an error in the predicted location of a precipitation feature and an error in the change of precipitation intensity over lead time. So far, verification measures did not allow to isolate the location error, making it difficult to specifically improve nowcast models with regard to location prediction.
To fill this gap, we introduced a framework to directly quantify the location error. To that end, we detect and track scale-invariant precipitation features (corners) in radar images. We then consider these observed tracks as the true reference in order to evaluate the performance (or, inversely, the error) of any model that aims to predict the future location of a precipitation feature. Hence, the location error of a forecast at any lead time ahead of the forecast time corresponds to the Euclidean distance between the observed and the predicted feature location at the corresponding lead time.
Based on this framework, we carried out a benchmarking case study using one year worth of weather radar composites of the DWD. We evaluated the performance of four extrapolation models, two of which are based on the linear extrapolation of corner motion; and the remaining two are based on the Dense Inverse Search (DIS) method: motion vectors obtained from DIS are used to predict feature locations by linear and Semi-Lagrangian extrapolation.
For all competing models, the mean location error exceeds a distance of 5 km after 60 min, and 10 km after 110 min. At least 25% of all forecasts exceed an error of 5 km after 50 min, and of 10 km after 90 min. Even for the best models in our experiment, at least 5 percent of the forecasts will have a location error of more than 10 km after 45 min. When we relate such errors to application scenarios that are typically suggested for precipitation nowcasting, e.g., early warning, it becomes obvious that location errors matter: the order of magnitude of these errors is about the same as the typical extent of a convective cell. Hence, the uncertainty of precipitation nowcasts at such length scales – just as a result of locational errors – can be substantial already at lead times of less than 1 h. Being able to quantify the location error should hence guide any model development that is targeted towards its minimization. To that aim, we also consider the high potential of using deep learning architectures specific to the assimilation of sequential (track) data.
Last but not least, the thesis demonstrates the benefits of a general movement towards open science for model development in the field of precipitation nowcasting. All the presented models and frameworks are distributed as open repositories, thus enhancing transparency and reproducibility of the methodological approach. Furthermore, they are readily available to be used for further research studies, as well as for practical applications.
Mit 52 Texten versammelt diese Dokumentation sämtliche uns heute bekannten Rezensionen zu Theodor Fontanes „Der Krieg gegen Frankreich 1870–1871“, das in zwei Bänden, bestehend aus insgesamt vier Halbbänden, zwischen März 1873 und September 1876 im Verlag der Königlichen Geheimen Ober-Hofbuchdruckerei (R. v. Decker) erschien. Der Text der Rezensionen wird jeweils nach dem Erstdruck in Zeitungen oder Zeitschriften zeichengetreu konstituiert. Damit wird der Forschung zu Fontanes Darstellung über den Deutsch-Französischen Krieg erstmals eine wichtige rezeptionsgeschichtliche Materialgruppe als Ausgabe zur Verfügung gestellt.
Einleitung
Ältere Patienten mit Herzklappenerkrankungen werden zunehmend häufig mit der kathetergestützten Aortenklappenimplantation (Transcatheter Aortic Valve Implantation, TAVI) oder dem MitraClip®-Verfahren behandelt. In der kardiologischen Rehabilitation nimmt infolgedessen die Patientenpopulation der Hochbetagten stetig zu. Die funktionale Gesundheit dieser Patienten wird durch häufig auftretende, sogenannte geriatrische Syndrome wie Multimorbidität, Mangelernährung, Gebrechlichkeit oder Sturzereignisse beeinflusst. Insbesondere die eingeschränkte Mobilität und Mangelernährung sind wichtige Prädiktoren für die Prognose der Patienten nach TAVI.
Etablierte Verfahren, um die körperliche Leistungsfähigkeit von kardiologischen Rehabilitanden zu beurteilen, sind die Belastungsergometrie und der 6-Minuten-Gehtest. Allerdings ist nahezu die Hälfte der hochbetagten Patienten nicht in der Lage, eine Belastungsergometrie durchzuführen. Bislang erfolgt in der kardiologischen Rehabilitation keine differenzierte Erfassung des funktionellen Status hinsichtlich Mobilität, Kraft und Gleichgewicht, um die geriatrischen Syndrome individuell zu beurteilen. Darüber hinaus werden keine Assessments zur Erfassung des Ernährungsstatus eingesetzt.
Daher war es das Ziel der vorliegenden Arbeit, die Ausprägung des funktionellen und nutritiven Status älterer Patienten anhand geeigneter Assessments in der kardiologischen Rehabilitation zu ermitteln.
Methode
Zwischen Oktober 2018 und Juni 2019 nahmen Patienten im Alter von 75 Jahren oder älter nach TAVI, atrioventrikulärer Intervention mittels MitraClip®-Verfahren (AVI) oder perkutaner Koronarintervention (PCI) an der Studie teil. Zu Beginn der kardiologischen Rehabilitation wurden soziodemografische Daten, echokardiografische Parameter (z. B. links und rechtsventrikuläre Ejektionsfraktion, Herzrhythmus) und Komorbiditäten (z. B. Diabetes mellitus, Niereninsuffizienz, orthopädische Erkrankungen) erhoben, um die Patientenpopulation zu beschreiben. Zusätzlich wurde die Gebrechlichkeit der Rehabilitanden mit dem Index von Stortecky et al., bestehend aus den Komponenten Kognition, Mobilität, Ernährung und Aktivitäten des täglichen Lebens, beurteilt.
Der 6-Minuten-Gehtest diente zur Ermittlung der körperlichen Leistungsfähigkeit der Patienten. Die Mobilität wurde mit Hilfe des Timed-Up-and-Go-Tests, die Ganggeschwindigkeit mit dem Gait Speed Test und die Handkraft mit dem Hand Grip Test erfasst.
Für die Objektivierung des Gleichgewichts wurde eine Kraftmessplatte (uni- und bipedaler Stand mit geöffneten und geschlossenen Augen) erprobt, die bislang bei älteren Rehabilitanden noch nicht eingesetzt wurde.
Der Ernährungsstatus wurde mit dem Mini Nutritional Assessment-Short Form und den ernährungsbezogenen Laborparametern (Hämoglobin, Serumalbumin, Eiweißkonzentration) erfasst.
Die Eignung der Assessments bewerteten wir anhand folgender Kriterien: Durchführbarkeit (bei ≥ 95 % der Patienten durchführbar), Sicherheit (< 95 % Stürze oder andere unerwünschte Ereignisse) und der Pearson-Korrelationen zwischen den funktionellen Tests und dem Goldstandard 6-Minuten-Gehtest sowie den Laborparametern und dem Mini Nutritional Assessment-Short Form.
Ergebnisse
Es wurden 124 Patienten (82 ± 4 Jahre, 48 % Frauen, 5 ± 2 Komorbiditäten, 9 ± 3 Medikamente) nach TAVI (n = 59), AVI (n = 21) und PCI (n = 44) konsekutiv in die Studie eingeschlossen.
Etwa zwei Drittel aller Patienten der Gesamtpopulation waren als gebrechlich zu klassifizieren, bei einer mittleren Punktzahl von 2,9 ± 1,4. Annähernd die Hälfte der Patienten zeigte eine eingeschränkte körperliche Leistungsfähigkeit aufgrund einer reduzierten 6-Minuten-Gehstrecke (48 % < 350 m) sowie eine eingeschränkte Mobilität im Timed-Up-and-Go-Test (55 % > 10 s). Es wurden eine mittlere Gehstrecke von 339 ± 131 m und eine durchschnittliche Zeit im Timed-Up-and-Go-Test von 11,4 ± 6,3 s erzielt. Darüber hinaus wies ein Viertel der Patienten eine eingeschränkte Ganggeschwindigkeit (< 0,8 m/s) auf und etwa 35 % von Ihnen zeigten eine reduzierte Handkraft (Frauen/Männer < 16/27 kg). Im Mittel wurde eine Geschwindigkeit von 1,0 ± 0,2 m/s im Gait Speed Test sowie eine Handkraft von 24 ± 9 kg im Hand Grip Test erreicht. Ein Risiko einer Mangelernährung konnte bei 38 % (< 12 Punkte) der Patienten nachgewiesen werden bei einer mittleren Punktzahl von 11,8 ± 2,2 im Mini Nutritional Assessment-Short Form.
Im Vergleich zwischen den einzelnen Subpopulationen bestanden keine statistisch signifikanten Unterschiede in den Ergebnissen der funktionellen Assessments. Bezüglich des Ernährungsstatus wiesen allerdings die Patienten nach AVI einen statistisch signifikant niedrigeren Punktewert im Mini Nutritional Assessment-Short Form (10,3 ± 3,0 Punkte) auf als die Patienten nach TAVI (12,0 ± 1,8 Punkte) und PCI (12,1 ± 2,1 Punkte), wobei etwa 57 % der Patienten nach AVI, 38 % nach TAVI und 50 % nach PCI ein Risiko einer Mangelernährung zeigten.
Mit Ausnahme der Tests auf der Kraftmessplatte waren alle Assessments durchführbar und sicher. Während 86 % der Patienten den bipedalen Stand mit geschlossenen Augen auf der Kraftmessplatte durchführen konnten und damit nahezu den Grenzwert von 95 % erreichten, war der unipedale Stand mit 12 % an durchführbaren Messungen weit von diesem entfernt.
Der Gait Speed Test (r = 0,79), Timed-Up-and-Go-Test (r = 0,68) und Hand Grip Test (r = 0,33) korrelierten signifikant mit dem 6-Minuten-Gehtest, Hämoglobin (r = 0,20) und Albumin (r = 0,24) korrelierten mit dem Mini Nutritional Assessment-Short Form.
Schlussfolgerung
Über die bestehende Multimorbidität und Multimedikation hinaus wiesen die untersuchten Patienten vor allem eine eingeschränkte Mobilität und ein Risiko einer Mangelernährung auf, wobei die Subpopulation nach AVI besonders betroffen war.
Um den Bedürfnissen hochbetagter Rehabilitanden nach kathetergestützer Intervention gerecht zu werden, ist eine individuelle Behandlung der einzelnen Defizite erforderlich, mit besonderer Berücksichtigung der Komorbiditäten sowie der geriatrischen Kofaktoren. Aufgrund des multidisziplinären Ansatzes erfüllt die kardiologische Rehabilitation bereits die Voraussetzung, hochbetagte Patienten bedarfsgerecht zu behandeln, jedoch mangelt es an Assessments, um die individuellen Defizite der Patienten zu identifizieren
Der Gait Speed Test, der Timed-Up-and-Go-Test und der Hand Grip Test sollten daher in den klinischen Alltag der kardiologischen Rehabilitation implementiert werden, um die körperliche Funktion und Leistungsfähigkeit älterer Patienten detailliert zu beurteilen. In Kombination dieser Assessments mit dem Mini Nutritional Assessment-Short Form können die individuellen funktionellen und nutritiven Bedürfnisse der Patienten während der Rehabilitation erkannt und mit geeigneten Maßnahmen die weitere Ausbildung geriatrischer Syndrome gemindert werden.