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Institute
Background and Objectives
Despite the long-standing consensus on the importance of tumor size, tumor number and carcinoembryonic antigen (CEA) levels as predictors of long-term outcomes among patients with colorectal liver metastases (CRLM), optimal prognostic cut-offs for these variables have not been established.
Methods
Patients who underwent curative-intent resection of CRLM and had available data on at least one of the three variables of interest above were selected from a multi-institutional dataset of patients with known KRAS mutational status. The resulting cohort was randomly split into training and testing datasets and recursive partitioning analysis was employed to determine optimal cut-offs. The concordance probability estimates (CPEs) for these optimal cut offs were calculated and compared to CPEs for the most widely used cut-offs in the surgical literature.
Results
A total of 1643 patients who met eligibility criteria were identified. Following recursive partitioning analysis in the training dataset, the following cut-offs were identified: 2.95 cm for tumor size, 1.5 for tumor number and 6.15 ng/ml for CEA levels. In the entire dataset, the calculated CPEs for the new tumor size (0.52), tumor number (0.56) and CEA (0.53) cut offs exceeded CPEs for other commonly employed cut-offs.
Conclusion
The current study was able to identify optimal cut-offs for the three most commonly employed prognostic factors in CRLM. While the per variable gains in discriminatory power are modest, these novel cut-offs may help produce appreciable increases in prognostic performance when combined in the context of future risk scores.
Background
Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.
Objectives
The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.
Methods
This investigation was part of the European BioCog project (http://www.biocog.eu), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini–Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.
Results
In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749–1.150; ARS [points] OR 0.832; 95% CI 0.564–1.227; ACBS [points] OR 1.045; 95% CI 0.842–1.296).
Conclusion
This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.
Background: In longitudinal studies, observations are made over time. Hence, the single observations at each time point are dependent, making them a repeated measurement. In this work, we explore a different, counterintuitive setting: At each developmental time point, a lethal observation is performed on the pregnant or nursing mother. Therefore, the single time points are independent. Furthermore, the observation in the offspring at each time point is correlated with each other because each litter consists of several (genetically linked) littermates. In addition, the observed time series is short from a statistical perspective as animal ethics prevent killing more mother mice than absolutely necessary, and murine development is short anyway. We solve these challenges by using multiple contrast tests and visualizing the change point by the use of confidence intervals.
Results: We used linear mixed models to model the variability of the mother. The estimates from the linear mixed model are then used in multiple contrast tests.There are a variety of contrasts and intuitively, we would use the Changepoint method. However, it does not deliver satisfying results. Interestingly, we found two other contrasts, both capable of answering different research questions in change point detection: i) Should a single point with change direction be found, or ii) Should the overall progression be determined? The Sequen contrast answers the first, the McDermott the second. Confidence intervals deliver effect estimates for the strength of the potential change point. Therefore, the scientist can define a biologically relevant limit of change depending on the research question.
Conclusion: We present a solution with effect estimates for short independent time series with observations nested at a given time point. Multiple contrast tests produce confidence intervals, which allow determining the position of change points or to visualize the expression course over time. We suggest to use McDermott’s method to determine if there is an overall significant change within the time frame, while Sequen is better in determining specific change points. In addition, we offer a short formula for the estimation of the maximal length of the time series.
Background:
Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol.
Methods:
This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents.
Results:
One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031).
Conclusion:
Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
Background:
Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality.
Methods:
All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression.
Results:
ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent.
Conclusions:
A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
Preoperative medication use and development of postoperative delirium and cognitive dysfunction
(2021)
Postoperative delirium (POD) and postoperative (neuro-)cognitive disorder (POCD) are frequent and serious complications after operations. We aim to investigate the association between pre-operative polypharmacy and potentially inappropriate medications and the development of POD/POCD in elderly patients. This investigation is part of the European BioCog project (www.biocog.eu), a prospective multicenter observational study with elderly surgical patients. Patients with a Mini-Mental State Examination score less than or equal to 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method (for the intensive care unit [ICU]), and a patient chart review. POCD was assessed 3 months after surgery with a neuropsychological test battery. Pre-operative long-term medication was evaluated in terms of polypharmacy (≥5 agents) and potentially inappropriate medication (defined by the PRISCUS and European list of potentially inappropriate medications [EU(7)-PIM] lists), and associations with POD and POCD were analyzed using logistic regression analysis. Eight hundred thirty-seven participants were included for analysis of POD and 562 participants for POCD. Of these, 165 patients (19.7%) fulfilled the criteria of POD and 60 (10.7%) for POCD. After adjusting for confounders, pre-operative polypharmacy and intake of potentially inappropriate medications could not be shown to be associated with the development of POD nor POCD. We found no associations between pre-operative polypharmacy and potentially inappropriate medications and development of POD and POCD. Future studies should focus on the evaluation of drug interactions to determine whether patients benefit from a pre-operative adjustment.
The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.
Objective:
The cervical mucus plugs are enriched with proteins of known immunological functions. We aimed to characterize the anti-HIV-1 activity of the cervical mucus plugs against a panel of different HIV-1 strains in the contexts of cell-free and cell-associated virus.
Design:
A cohort of consenting HIV-1-negative and HIV-1-positive pregnant women in labour was recruited from Mthatha General Hospital in the Eastern Cape province of South Africa, from whom the cervical mucus plugs were collected in 6 M guanidinium chloride with protease inhibitors and transported to our laboratories at −80 °C.
Methods:
Samples were centrifuged to remove insoluble material and dialysed before freeze--drying and subjecting them to the cell viability assays. The antiviral activities of the samples were studied using luminometric reporter assays and flow cytometry. Time-of-addition and BlaM-Vpr virus-cell fusion assays were used to pin-point the antiviral mechanisms of the cervical mucus plugs, before proteomic profiling using liquid chromatography-tandem mass spectrometry.
Results:
The proteinaceous fraction of the cervical mucus plugs exhibited anti-HIV-1 activity with inter-individual variations and some degree of specificity among different HIV-1 strains. Cell-associated HIV-1 was less susceptible to inhibition by the potent samples whenever compared with the cell-free HIV-1. The samples with high antiviral potency exhibited a distinct proteomic profile when compared with the less potent samples.
Conclusion:
The crude cervical mucus plugs exhibit anti-HIV-1 activity, which is defined by a specific proteomic profile.
Background
In DNA methylation analyses like epigenome-wide association studies, effects in differentially methylated CpG sites are assessed. Two kinds of outcomes can be used for statistical analysis: Beta-values and M-values. M-values follow a normal distribution and help to detect differentially methylated CpG sites. As biological effect measures, differences of M-values are more or less meaningless. Beta-values are of more interest since they can be interpreted directly as differences in percentage of DNA methylation at a given CpG site, but they have poor statistical properties. Different frameworks are proposed for reporting estimands in DNA methylation analysis, relying on Beta-values, M-values, or both.
Results
We present and discuss four possible approaches of achieving estimands in DNA methylation analysis. In addition, we present the usage of M-values or Beta-values in the context of bioinformatical pipelines, which often demand a predefined outcome. We show the dependencies between the differences in M-values to differences in Beta-values in two data simulations: a analysis with and without confounder effect. Without present confounder effects, M-values can be used for the statistical analysis and Beta-values statistics for the reporting. If confounder effects exist, we demonstrate the deviations and correct the effects by the intercept method. Finally, we demonstrate the theoretical problem on two large human genome-wide DNA methylation datasets to verify the results.
Conclusions
The usage of M-values in the analysis of DNA methylation data will produce effect estimates, which cannot be biologically interpreted. The parallel usage of Beta-value statistics ignores possible confounder effects and can therefore not be recommended. Hence, if the differences in Beta-values are the focus of the study, the intercept method is recommendable. Hyper- or hypomethylated CpG sites must then be carefully evaluated. If an exploratory analysis of possible CpG sites is the aim of the study, M-values can be used for inference.
Background
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are frequent and serious complications after surgery. We aim to investigate the association between genetic variants in cholinergic candidate genes according to the Kyoto encyclopedia of genes and genomes - pathway: cholinergic neurotransmission with the development of POD or POCD in elderly patients.
Methods
This analysis is part of the European BioCog project (www.biocog.eu), a prospective multicenter observational study with elderly surgical patients. Patients with a Mini-Mental-State-Examination score ≤ 23 points were excluded. POD was assessed up to seven days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. POCD was assessed three months after surgery with a neuropsychological test battery. Genotyping was performed on the Illumina Infinium Global Screening Array. Associations with POD and POCD were analyzed using logistic regression analysis, adjusted for age, comorbidities and duration of anesthesia (for POCD analysis additionally for education). Odds ratios (OR) refer to minor allele counts (0, 1, 2).
Results
745 patients could be included in the POD analysis, and 452 in the POCD analysis. The rate of POD within this group was 20.8% (155 patients), and the rate of POCD was 10.2% (46 patients). In a candidate gene approach three genetic variants of the cholinergic genes CHRM2 and CHRM4 were associated with POD (OR [95% confidence interval], rs8191992: 0.61[0.46; 0.80]; rs8191992: 1.60[1.22; 2.09]; rs2067482: 1.64[1.10; 2.44]). No associations were found for POCD.
Conclusions
We found an association between genetic variants of CHRM2 and CHRM4 and POD. Further studies are needed to investigate whether disturbances in acetylcholine release and synaptic plasticity are involved in the development of POD.
Background
In mucosal barrier interfaces, flexible responses of gene expression to long-term environmental changes allow adaptation and fine-tuning for the balance of host defense and uncontrolled not-resolving inflammation. Epigenetic modifications of the chromatin confer plasticity to the genetic information and give insight into how tissues use the genetic information to adapt to environmental factors. The oral mucosa is particularly exposed to environmental stressors such as a variable microbiota. Likewise, persistent oral inflammation is the most important intrinsic risk factor for the oral inflammatory disease periodontitis and has strong potential to alter DNA-methylation patterns. The aim of the current study was to identify epigenetic changes of the oral masticatory mucosa in response to long-term inflammation that resulted in periodontitis.
Methods and results
Genome-wide CpG methylation of both inflamed and clinically uninflamed solid gingival tissue biopsies of 60 periodontitis cases was analyzed using the Infinium MethylationEPIC BeadChip. We validated and performed cell-type deconvolution for infiltrated immune cells using the EpiDish algorithm. Effect sizes of DMPs in gingival epithelial and fibroblast cells were estimated and adjusted for confounding factors using our recently developed “intercept-method”. In the current EWAS, we identified various genes that showed significantly different methylation between periodontitis-inflamed and uninflamed oral mucosa in periodontitis patients. The strongest differences were observed for genes with roles in wound healing (ROBO2, PTP4A3), cell adhesion (LPXN) and innate immune response (CCL26, DNAJC1, BPI). Enrichment analyses implied a role of epigenetic changes for vesicle trafficking gene sets.
Conclusions
Our results imply specific adaptations of the oral mucosa to a persistent inflammatory environment that involve wound repair, barrier integrity, and innate immune defense.
A comparison study on modeling of clustered and overdispersed count data for multiple comparisons
(2021)
Data collected in various scientific fields are count data. One way to analyze such data is to compare the individual levels of the factor treatment using multiple comparisons. However, the measured individuals are often clustered – e.g. according to litter or rearing. This must be considered when estimating the parameters by a repeated measurement model. In addition, ignoring the overdispersion to which count data is prone leads to an increase of the type one error rate. We carry out simulation studies using several different data settings and compare different multiple contrast tests with parameter estimates from generalized estimation equations and generalized linear mixed models in order to observe coverage and rejection probabilities. We generate overdispersed, clustered count data in small samples as can be observed in many biological settings. We have found that the generalized estimation equations outperform generalized linear mixed models if the variance-sandwich estimator is correctly specified. Furthermore, generalized linear mixed models show problems with the convergence rate under certain data settings, but there are model implementations with lower implications exists. Finally, we use an example of genetic data to demonstrate the application of the multiple contrast test and the problems of ignoring strong overdispersion.
Mountainbiking ist eine stark wachsende Natursportart mit einer hohen Teilnehmerzahl an Downhill- Mountainbikern im nördlichen Harz. Aufgrund der Wegebelastung entstehen soziale Konflikte und ökologische Auswirkungen, weshalb attraktive Strecken entwickelt und umweltschonende Lenkungsmaßnahmen durchgeführt werden müssen. Die Umfrage, die im Zuge dieser Arbeit durchgeführt wurde, ergab, dass die Anforderungen der Mountainbiker naturnahe, schmale und technisch anspruchsvolle Strecken sind. Die Auswirkungen des Mountainbikings betreffen die Tierwelt und sensible Gebiete abseits vorhandener Wege. Für die erfolgreiche Lenkung der Mountainbiker ist Kommunikation zwischen allen Beteiligten in der Landschaftsplanung erforderlich. Es ist auf eine umweltschonende Bauweise, gezielte Streckenführung, klare Beschilderungen, technische Herausforderungen und Wegequalitäten zu achten. Der Ausbau vorhandener Wegeinfrastruktur und aktive Lenkungsmaßnahmen im Harz können zu einer konfliktfreien und umweltfreundlichen Situation des Mountainbikings führen. Zusätzliche Forschungsarbeiten mit konkreten Schwerpunkten einzelner Lenkungskriterien oder ökologischen Auswirkungen können das Management von Mountainbike- Strecken erleichtern.
This qualitative study focuses on assessing the “future readiness” capacity of three Peruvian Higher Education Institutions under the HEInnovate framework. The main question guiding this research is: To what extent can Peruvian universities be considered entrepreneurial and ready
for tackling the Challenges of the Future? The Challenges of the Future are understood as the challenges generated by concepts such as The Future of Work, The Global Skills Gap, Employability and unexpected and destabilizing risks of the environment, such as COVID-19.
Universities were studied based on 4 research sub-questions: 1) How do Peruvian HEIs rate in Entrepreneurial Capacity according to the HEInnovate framework? 2) What are the factors supporting or preventing Peruvian HEIs to accomplish their entrepreneurial potential? 3) What efforts are Peruvian HEIs making for developing 21st century skills, accomplishing Digital Transformation, and enhancing their students Employability? and 4) What measures could Peruvian HEIs take in order to maximize their entrepreneurial and future-proof potential? The research methodology used was mixed, applying first a quantitative assessment, and then
complementing the results with in-depth interviews. After presenting the conclusions, recommendations for policy action and for university management are given.
Die vorliegende Masterarbeit befasst sich mit dem Thema der Darstellung von Vegetation im Kontext des Building Information Modeling (BIM) und hierbei insbesondere mit der Entwicklung eines Datenmodells für ausgewählte Baumarten.
Die Anwendung der BIM-Methode wird in der Landschaftsarchitektur zunehmend gefordert. Zurzeit sind die Integration und die Arbeit mit der BIM-Methode noch mit großen Herausforderungen verbunden. Für die Landschaftsarchitektur fehlen definierte Objekte im internationalen, herstellerneutralen Austauschformat Industry Foundation Classes (IFC). Es fehlen neben den Objekten des Freiraums die Workflows zur Modellierung der Objekte, die beschreibenden Informationen und die Zuordnung zu den Detaillierungsgraden.
Das Ziel der vorliegenden Masterarbeit besteht darin, eine Methode zum Generieren von parametrischen Baummodellen zu entwickeln. Es werden individuelle Baummodelle in der CAD/BIM-Software Autodesk Revit modelliert. Die Baummodelle sollen den Lebenszyklus einer Pflanze abbilden. Das in dieser Arbeit erstellte Baummodell ermöglicht die Abbildung einer Vielzahl von Kronen- und Wurzelformen. Die generierten Baummodelle beinhalten Wachstumsfunktionen mit spezifischen Parametern für die Gesamthöhe, die lichte Stammhöhe, den größten Kronendurchmesser, die Höhe des größten Kronendurchmessers sowie Länge und Tiefe der Wurzel. Zusätzlich zur Geometrie des Modells werden relevante Informationen als konsistenter Parametersatz definiert. Die Informationen können den BIM-Anwendungsfällen zugeordnet werden. Die Parametersätze für das Erscheinungsbild der Modelle und die Informationen zu den Eigenschaften werden über Dynamo gesteuert. Das ermöglicht den direkten Austausch der Modelle und der zugehörigen Informationen.
Ein erläuterndes Video (HAVERLAND 2022) zur Vorgehensweise und den Ergebnissen findet sich unter https://youtu.be/Azx3mPMu3Ng
Was darf man eigentlich noch sagen? - Eine aktuelle Diskussion der Theorie der Schweigespirale
(2021)
Die vorliegende Bachelorarbeit setzt sich mit der Theorie der Schweigespirale nach Elisabeth Noelle-Neumann und ihrem übergeordneten Konzept der öffentlichen Meinungsbildung im Zeitalter des Internets auseinander.
Es wird anhand aktueller Studien zu Schweigespiralprozessen auf Social Networking Sites erörtert, ob die theoretischen Grundannahmen mit Blick auf die Strukturen des modernen Mediensystems heute anders bewertet werden müssen. Die Untersuchungen betrachten jeweils eine Online-Plattform als Medium der computervermittelten Kommunikation und testen, ob die Nutzer:innen dazu tendieren, öffentlich über ihre eigene Meinung zu schweigen. Die kommunikationswissenschaftliche Perspektive der Theorie steht so im Vordergrund: Es wird davon ausgegangen, dass die Merkmale internetbasierter Kommunikation heute einen Einfluss auf die von Noelle-Neumann unterstellte starke Wirkungskraft der Massenmedien nimmt und Schweigespiralprozesse so hemmen könnte.
Die Literaturstudie ergibt jedoch, dass die Mehrheit der betrachteten Untersuchungen auch in Online-Kommunikationsräumen Schweigespiralprozesse feststellen können und die Theorie damit auch weiterhin relevant bleibt. Persönliche Faktoren und das Mediennutzungsverhalten der Individuen werden als wahrscheinlich größere Einflüsse herausgearbeitet und stellen so das Erkenntnisinteresse für weiterführende Studien dar.
Diese Arbeit befasst sich mit Virtueller Realität (VR) und ihrer (möglichen) Integrierung in eine musikalische Komposition. Die zentrale Fragestellung, die dabei verfolgt wird, lautet: Wie kann ein Musikstück, welches Virtuelle Realität verwendet, aussehen bzw. was muss für einen reflektierten Umgang mit Virtueller Realität im Rahmen einer musikalischen Komposition beachtet werden. Hierzu wird ein Kriterienkatalog entwickelt, anhand dessen Michel van der Aa’s VR-Installation Eight (2018–19) analysiert und eine mögliche praktische Umsetzung diskutiert wird.
Hintergrund
Neben der sinkenden Anzahl jüngerer Menschen zeigt der demografische Wandel auch die steigende Anzahl älterer Menschen. Bereits jeder fünfte Deutsche ist über 66 Jahre alt. Bis 2038 wird mit ca. 23 Millionen Menschen über 65 Jahre gerechnet. Die steigende Anzahl von älteren Menschen bedeutet auch eine steigende Anzahl an pflegebedürftigen Menschen. Mit sich verändernden Haushaltskonstellationen kann die Pflege in der Häuslichkeit nicht immer geleistet werden, sodass der Einzug in eine Langzeitpflegeeinrichtung nicht zu umgehen ist. In Pflegeheimen wird die Individualität und Biografie der einzelnen Bewohner nicht immer berücksichtigt, wobei hierdurch das Wohlbefinden gesteigert werden könnte.
Methodisches Vorgehen
Die Grundlage dieser Arbeit bildet ein realer Fall aus der Praxis. Dieser wird mithilfe der hermeneutischen Fallanalyse bearbeitet. Zudem wurde eine systematische Literaturrecherche in den Datenbanken Springerlink und PubMed sowie in der Suchmaschine Scinos der Hoch-schule Osnabrück durchgeführt. Die Forschungsfrage dieser Arbeit lautet: Welche Wohnformen eignen sich für einen betagten multimorbiden Mann aus einem landwirtschaftlichen Kon-text? Das Ziel dieser Arbeit ist die Erarbeitung von geeigneten Wohnformen für den Patienten, welche einen Bezug zu seiner Biografie und somit auch zur Landwirtschaft haben.
Ergebnisse
Die Analyse zeigt, inwieweit Herr Meyer pflegebedürftig ist und weshalb die weitere Versorgung zuhause durch Familienangehörige im weiteren Verlauf nicht mehr gewährleistet werden kann. Des Weiteren konnte die Bedeutung seiner landwirtschaftlichen Biografie für mögliche Wohnformen anhand der Kontinuitätstheorie aufgezeigt werden. Es konnten zwei geeignete Wohnformen für Herrn Meyer, welche sich in Deutschland befinden, identifiziert werden. Die Rahmung dieser Wohnformen bildet der Green Care Ansatz. Das Leben in unmittelbarer Nähe zu einem landwirtschaftlichen Betrieb und den dazugehörigen Tieren würde positive Auswirkungen auf Herrn Meyer haben.
Schlussfolgerungen
Die Berücksichtigung der Biografie älterer Menschen ist bei der Auswahl geeigneter Wohnformen von großer Bedeutung, da dies positive Auswirkungen auf die Zufriedenheit haben kann. Da es in Deutschland bisher erst wenige Wohnmöglichkeiten für ältere Menschen auf land-wirtschaftlichen Betrieben oder Bauernhöfen gibt, besteht hinsichtlich der Einrichtung mehrerer solcher Wohnmöglichkeiten zukünftig Handlungsbedarf.
Die vorliegende Bachelorarbeit thematisiert Strategien, Potentiale und Grenzen aus der zeitgenössischen Theaterlandschaft zur Thematik Flucht. Das zentrale Ziel der Untersuchung war es, innerhalb der Diskussion um Zugang, Repräsentation und Nachhaltigkeit der untersuchten Strategien, das dokumentarische Theaterstück „Die Mittelmeer-Monologe“ (2019, Regie: Michael Ruf) zu analysieren. Inhaltlich werden im genannten Stück vier Lebensgeschichten, basierend auf Interviews, aus dem Kontext Flucht wiedergegeben.
Während die Umsetzung des Stückes mit professionellen Schauspieler*innen als Stellvertreter*innen für die Stimmen geflüchteter Menschen stattfindet, finden sich weitere Strategien im Theater. Die heterogene Zusammenarbeit mit Newcomer*innen, weißen und Schwarzen deutschen Teilnehmer*innen bedarf einer diversen Auseinandersetzung. Aus diesem Grund werden in dieser vorliegenden Untersuchung die Historie Deutschlands als Migrationsgesellschaft bis hin zu aktuellen Fluchtbewegungen sowie der Verhandlung dessen in der zeitgenössischen Theaterlandschaft näher betrachtet. Daraus werden die Kriterien Zugang, Repräsentation und Nachhaltigkeit formuliert, welche in der Zusammenarbeit heterogener Gruppen wichtige Rollen einnehmen, um potenziell ein inklusives Miteinander erschaffen zu können.
In dieser Arbeit werden am Beispiel der ambulanten Wohnbetreuung die Auswirkungen der Wirksamkeitsorientierung dargestellt. Die Wirksamkeit von Leistungen ist im neunten Sozialgesetzbuch verankert, das Leistungen zur „Rehabilitation und Teilhabe von Menschen mit Behinderung“ (§9 SGB IX) mit dem Ziel der gleichberechtigten Teilhabe umfasst. Diese Hilfen unterliegen gleichzeitig dem Wirtschaftlichkeitsgebot (vgl. §123 SGB IX).
Dem Thema wurde sich zum besseren Verständnis zuerst theoretisch genähert, die Erkenntnisse anschließend mit den Ergebnissen einer empirischen Untersuchung verglichen und abschließend vor dem Hintergrund einer aktuellen Forschung diskutiert.
Als Resultat wurden verschiedene Einflussgrößen auf die Wirksamkeit ausgemacht. Obwohl diese Parameter entscheidend dafür sind, ob Hilfen im Sinne des SGB IX als wirksam wahrgenommen werden, sind sie nicht gesetzlich bestimmt und somit auslegbar.
Daher werden nur mögliche Auswirkungen in Form von Chancen und Risiken bestimmt.