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Zusammenfassung Ziel der Studie: Es existieren kaum Publikationen uber das Rehabilitationsergebnis kardiologischer Patienten unter Berucksichtigung eines erhohten medizinischen, pflegerischen und therapeutischen Versorgungsaufwands (Barthel-Index70). Es war Ziel der Studie, die in einem Zeitraum von 2 Jahren aufgenommen Rehabilitanden (n=387) einer gesetzlichen Krankenkasse, aufgeteilt in jeweils eine Gruppe selbstversorgender und versorgungsaufwandiger Patienten, bezuglich ihrer Unterschiede in dem Rehabilitationsergebnis zu uberprufen. Methodik: In Abhangigkeit des Versorgungsaufwandes wurde das Rehabilitationsergebnis sowie Unterschiede im Verlauf hinsichtlich der korperlichen Leistungsfahigkeit, des emotionalen Status und der Aktivitaten des taglichen Lebens, gemessen an Barthelindex, FIM-Index, HADS-Werten, Komplikationen, Funktionsuntersuchungen, Belastungstests, Rehabilitationsdauer und Entlassungsform, gepruft. Ergebnisse: Die in Hinblick auf medizinischen, pflegerischen und therapeutischen Aufwand versorgungsaufwandigen Patienten waren alter, langer im Krankenhaus und in der Rehabilitation, sie hatten mehr Komplikationen und deutlich mehr Begleiterkrankungen. Sie wurden haufiger ins Akutkrankenhaus verlegt. Sie hatten eine hohere Steigerungsrate der Selbstversorgungsindices und eine relevante Steigerung bei den Belastungstests. Schlussfolgerung: Ein hoher Versorgungsaufwand multimorbider kardiologischer Patienten ist keine Kontraindikation gegen eine Rehabilitation, da auch bei dieser Patientengruppe die tragerspezifischen Rehabilitationsziele erreicht wurden. Abstract Introduction: There are hardly any publications about the outcome of cardiac rehabilitation considering patients with an increased need for medical, nursing and therapeutic care. The aim of this study, which consecutively included n=387 statutory health insurance inpatients over a period of 2 years, was to find out differences in outcome in self-care patients (Barthel index>70) as compared to patients with a need for complex care (Barthel index70). Methods: Rehabilitation outcomes concerning physical capacity, emotional status and activities of daily living as measured by Barthel index, FIM index, HADS, clinical complications, exercise test, duration of rehabilitation and form of dismission were analyzed and compared between both groups. Results: The inpatients with a Barthel index 70 at admission were older, had a longer stay in hospital and in rehabilitation, developed more complications and more often suffered from concomitant diseases. They were readmitted to hospital more often. They showed a comparatively higher increase in indices of self-care and a significant increase in physical performance tests. Conclusion: Higher medical care expenses of multimorbid cardiac inpatients are no contraindication against rehabilitation, because even in this group the specific rehabilitation aims of the healthcare payers can be reached.
Galactic cosmic rays reach energies of at least a few petaelectronvolts (of the order of 1015 electronvolts). This implies that our Galaxy contains petaelectronvolt accelerators (‘PeVatrons’), but all proposed models of Galactic cosmic-ray accelerators encounter difficulties at exactly these energies. Dozens of Galactic accelerators capable of accelerating particles to energies of tens of teraelectronvolts (of the order of 1013 electronvolts) were inferred from recent γ-ray observations3. However, none of the currently known accelerators—not even the handful of shell-type supernova remnants commonly believed to supply most Galactic cosmic rays—has shown the characteristic tracers of petaelectronvolt particles, namely, power-law spectra of γ-rays extending without a cut-off or a spectral break to tens of teraelectronvolts4. Here we report deep γ-ray observations with arcminute angular resolution of the region surrounding the Galactic Centre, which show the expected tracer of the presence of petaelectronvolt protons within the central 10 parsecs of the Galaxy. We propose that the supermassive black hole Sagittarius A* is linked to this PeVatron. Sagittarius A* went through active phases in the past, as demonstrated by X-ray outbursts5and an outflow from the Galactic Centre6. Although its current rate of particle acceleration is not sufficient to provide a substantial contribution to Galactic cosmic rays, Sagittarius A* could have plausibly been more active over the last 106–107 years, and therefore should be considered as a viable alternative to supernova remnants as a source of petaelectronvolt Galactic cosmic rays.
The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using gamma-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant gamma-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section <sigma nu >. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach <sigma nu > values of 6 x 10(-26) cm(3) s(-1) in the W+W- channel for a DM particle mass of 1.5 TeV, and 2 x 10(-26) cm(3) s(-1) in the tau(+)tau(-) channel for a 1 TeV mass. For the first time, ground-based gamma-ray observations have reached sufficient sensitivity to probe <sigma nu > values expected from the thermal relic density for TeV DM particles.
A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l = -1.5 degrees, b = 0 degrees and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S. results. No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.