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Atopic dermatitis (AD) is a multifactorial inflammatory skin disease and an altered skin microbiota with an increase of Staphylococcus aureus has been reported. However, the role of fungi remains poorly investigated.We aimed to improve the understanding of the fungal skin microbiota, the mycobiota, in AD in relation to the bacterial colonization.Skin swabs of 16 AD patients and 16 healthy controls (HC) from four different skin sites, that is antecubital crease, dorsal neck, glabella and vertex from multiple time points were analysed by DNA sequencing of the internal transcribed spacer region 1 (ITS1) and 16S rRNA gene for fungi and bacteria, respectively.Malassezia spp. were the predominant fungi in all subjects but with a decreased dominance in severe AD patients in favour of non-Malassezia fungi, for example Candida spp. For bacteria, a decrease of Cutibacterium spp. in AD patients in favour of Staphylococcus spp., particularly S. aureus, was observed. Further, both bacterial and fungal community compositions of severe AD patients significantly differed from mild-to-moderate AD patients and HC with the latter two having overall similar microbiota showing some distinctions in bacterial communities.We conclude that severe AD is associated with a pronounced dysbiosis of the microbiota with increased fungal diversity. Potentially infectious agents, for example Staphylococcus and Candida, were increased in severe AD.

Aims Women with long QT syndrome 2 (LQT2) have a particularly high postpartal risk for lethal arrhythmias. We aimed at investigating whether oxytocin and prolactin contribute to this risk by affecting repolarization. Methods and results In female transgenic LQT2 rabbits (HERG-G628S, loss of IKr), hormone effects on QT/action potential duration (APD) were assessed (0.2–200 ng/L). Hormone effects (200 ng/L) on ion currents and cellular APD were determined in transfected cells and LQT2 cardiomyocytes. Hormone effects on ion channels were assessed with qPCR and western blot. Experimental data were incorporated into in silico models to determine the pro-arrhythmic potential. Oxytocin prolonged QTc and steepened QT/RR-slope in vivo and prolonged ex vivo APD75 in LQT2 hearts. Prolactin prolonged APD75 at high concentrations. As underlying mechanisms, we identified an oxytocin- and prolactin-induced acute reduction of IKs-tail and IKs-steady (−25.5%, oxytocin; −13.3%, prolactin, P Conclusions Postpartum hormones oxytocin and prolactin prolong QT/APD in LQT2 by reducing IKs and by increasing Cav1.2 and RyR2 expression/transcription, thereby contributing to the increased postpartal arrhythmic risk in LQT2.

Serology, the detection of B. burgdorferi-specific IgM and IgG serum antibodies, is the most common laboratory test to diagnose cutaneous manifestations of Lyme disease. In a two-tiered approach, an ELISA is used as a screening test. A positive or equivocal ELISA result needs confirmation by a specific immunoblot. The sensitivity of this approach reaches 80-95%. The diagnosis of erythema migrans is based on its typical clinical appearance. Serology is only indicated in atypical cases. In contrast, serology is mandatory in the diagnostic workup of borrelial lymphocytoma and acrodermatitis chronica atrophicans. A positive serology can persist for many years, even after adequate antibiotic treatment. A positive serology is no indication for antibiotic treatment if typical symptoms of Lyme disease are absent.

Es werden beispielhaft je eine virale (Varicella-Zoster-Virus, VZV), eine bakterielle (Lyme-Borreliose) und eine parasitare (Skabies) Infektion in der Schwangerschaft mit ihrer Bedeutung fur Mutter und/oder Kind sowie das jeweilige therapeutische Management dargestellt. VZV-Infektionen fuhren zu sehr unterschiedlichen Szenarien abhangig vom Immunstatus der Mutter und dem Infektionszeitpunkt. Herpes zoster bei einer Schwangeren stellt in der Regel keine Gefahr dar und muss selten therapiert werden. Die VZV-Infektion einer seronegativen Mutter kann jedoch zu schwer verlaufenden Varizellen der Schwangeren und Schadigung des Fetus (kongenitales Varizellensyndrom) bei fruhem Infektionszeitpunkt oder neonatalen Varizellen bei perinataler Infektion fuhren. In diesen Fallen ist eine prompte Therapie mit Aciclovir oder ggf. mit VZV-Immunglobulin obligat. Bei der Lyme-Borreliose kann eine Schadigung des Fetus durch eine effektive antibiotische Therapie verhindert werden. Mittel der Wahl ist Amoxicillin. Doxycyclin ist kontraindiziert. Skabies ist eine wichtige Differenzialdiagnose juckender Dermatosen in der Schwangerschaft und ist topisch mit Permethrin 5% zu behandeln.

Harry Frankfurt has famously criticized the principle of alternate possibilities—the principle that an agent is morally responsible for performing some action only if able to have done otherwise than to perform it—on the grounds that it is possible for an agent to be morally responsible for performing an action that is inevitable for the agent when the reasons for which the agent lacks alternate possibilities are not the reasons for which the agent has acted. I argue that an incompatibilist about determinism and moral responsibility can safely ignore so-called “Frakfurt-style cases” and continue to argue for incompatibilism on the grounds that determinism rules out the ability to do otherwise. My argument relies on a simple—indeed, simplistic—weakening of the principle of alternate possibilities that is explicitly designed to be immune to Frankfurt-style criticism. This alternative to the principle of alternate possibilities is so simplistic that it will no doubt strike many readers as philosophically fallow. I argue that it is not. I argue that the addition of one highly plausible premise allows for the modified principle to be employed in an argument for incompatibilism that begins with the observation that determinism rules out the ability to do otherwise. On the merits of this argument I conclude that deterministic moral responsibility is impossible and that Frankfurt’s criticism of the principle of alternate possibilities—even if successful to that end—may be safely ignored.

For supporting security and reliability of supply KELAG Netz GmbH, TUV Sud AG, the Institute of Power Systems and Power Economics of Aachen University and FGH e.V. developed a certification of control centres and network operation. This paper describes the development process of certification. Furthermore, the main three columns of the requirements of certification process (process management, risk management, requirements on organisation, employees and equipment) are explained and the main benefit of certification for a distribution system operator is illustrated. (4 pages)

We examined the effects of chronic intravenous neutral phosphate administration on systemic acid-base equilibrium and parathyroid function in six normal, NaCl-replete male human subjects under metabolic balance conditions. The subjects received 4.35 mmol of neutral sodium phosphate.kg body wt-1.day-1 intravenously and continuously for 7 days and the same amount of sodium as NaCl during control and recovery. Blood pH increased from 7.388 to 7.411 (P < 0.001) and plasma bicarbonate from 23.5 to 26.0 mmol/l (P < 0.001). Urinary pH increased from 6.58 to 6.79 (P < 0.001). Net acid excretion increased from 59 to 100 mmol/24 h (P < 0.001). Plasma ionized calcium concentration decreased and plasma phosphate concentration increased transiently. Serum intact parathyroid hormone increased from 24 to 62 pg/ml (P < 0.001). Chronic phosphate administration also resulted in a significant increase in renal phosphate clearance (35 to 229 ml/min) and decrease in the fractional excretion of calcium (1.8 to 0.9%). Thus chronic intravenous phosphate administration generates and maintains renal metabolic alkalosis in salt-replete humans and induces hyperparathyroidism. The severity of metabolic alkalosis is mitigated by an apparent increase in effective endogenous acid production as evidenced by the significant increase in steady-state net acid excretion.

Wireless sensor networks (WSNs) consist of wirelessly communicating nodes with an autarkic power supply for each node. Typically, the consumable energy of these nodes is very limited. Energy harvesting systems (EHSs) can be used to extend the lifetime or even enable perpetual operation of the sensor nodes. Applicable energy-aware WSN protocols and applications usually raise the complexity such that rough calculations are not sufficient any more. Simulation-based analysis is needed to cope with the complexity of hardware/software interaction and its implications.This work presents a simulation environment which enables combined simulation and performance evaluation of complete WSNs including the sensor nodes' application software, the energy harvesting enhanced hardware, the wireless network communication, and the environment of the sensor nodes.

Wireless sensor networks (WSNs) are power critical systems, because they are used in application areas without wired infrastructure. Each sensor node needs a dedicated power supply. Today's protocols and applications for WSNs are often power-aware. However, the state-of-charge (SoC) estimation of the energy storage component (e.g. rechargeable battery) influences the decisions of the power-aware software. A measurement error may cause wrong decisions which would reduce the lifetime of the network. This work presents the simulation results of the impact of an SoC measurement error on the network lifetime running a simple and an enhanced power-aware WSN application. A simulation environment written in SystemC-AMS is used, which enables the combined simulation of the sensor node's application software and its hardware. The simulation shows a reduction of the network lifetime of 3.13% caused by an erroneous measurement. However, the enhanced software is able to increase the network lifetime by 1.66%.

Wireless sensor networks (WSNs) suffer from the lack of wired infrastructure. Each node needs its own power supply, e.g. batteries or energy harvesting systems (EHSs). Typically, EHSs can extend the lifetime of a sensor node or even enable perpetual operation. Due to the high variation of harvestable energy of the environment, the design of the EHSs has to be done very carefully. The design process can be enhanced by using simulation of the WSN including energy harvesting. However, a realistic simulation needs accurate data of the harvestable energy of the environment. This paper presents the concept of an on-site characterization instrument for different types of energy harvesting devices. These instruments can be connected like a WSN.

Resource aware sensor grid middleware is subject to optimization of services and performance on one side and has to deal with non-functional requirements and hardware constraints on the other side. Implementing different applications and systems on different types of hardware and architectures demands for sophisticated techniques for modeling and testing. This chapter highlights common misconceptions in design, simulation, test and measurement that need to be overcome or at least be considered for successfully building a system. Rules of thumb are given for how to design sensor grids such that they can easily be simulated and tested. Errors that are to be expected are highlighted. Several practical issues will be discussed using real world examples. A sensor grid utilizing network coding and duty cycling services serves as an example as well as a multi-application middleware and a localization system. The approach shows how to implement performance optimizations and resource awareness with a minimum of negative impact from mutual side effects. This type of view on system development of sensor grids has not been looked at before in detail. Therefore the reader will get valuable insights to state of the art and novel techniques of networking and energy management for sensor grids, power profile optimization, simulation and measurement and on how to translate designs from one stage to another.

Wireless sensor networks (WSNs) are typically used in application areas without wired infrastructure or mobility. Therefore, each sensor node needs its own energy supply unit. Sustainable WSNs are powered by energy harvesting systems (EHSs). These systems harvest and buffer the energy from the environment into rechargeable batteries or double layer capacitors. Due to the fact that the connectivity of the WSN depends on every single sensor node, it is important to know the state-of-charge (SoC) of the buffer to determine the remaining operating time. Therefore, each node has to measure its SoC, calculate the remaining operating time and populate this information through the network. The measurement is usually done by an integrated analog-to-digital converter (ADC) of the microcontroller. Each ADC has a specified error that has to be taken into account at the calculations of the remaining operating time. This work presents the error analysis of the SoC measurement using different energy storage components.

Energy efficiency is very important for mobile devices and wireless sensor networks (WSNs), because the consumable energy is limited. Therefore, the operating time of such devices depends mainly on the capacity of the energy storage component and on the average power consumption of the device. The power consumption depends on the supply voltage and on the activated components of the hardware. This work presents the evaluation of component-aware dynamic voltage scaling (CADVS). This low power technique combines the power-down of unused components and the minimization of the supply voltage. Typically, each component of the hardware (microcontroller, transceiver, sensors) has its own supply voltage range. Therefore, the minimum allowed supply voltage depends on the activated components. However, the activated components and consequently the minimum allowed supply voltage varies over time. CADVS uses voltage converter to adjusts the supply voltage of the hardware to save as much energy as possible. This work presents the evaluation of six different voltage converters. It has been shown that CADVS can be used to save up to 38.7% of the energy compared to a constant voltage supply using the introduced scenario while achieving the same end-user performance.

Wireless sensor network (WSN) motes are resource constrained devices. This is due to optimizations tailoring them towards application-specific and cost-efficient scenarios and setups. Many to most of these optimizations are built upon power aware aspects and dependability measures due to the fact that battery technology still evolves quite slowly and WSN's inherent redundancy is suitable for fault-tolerant schemes. What we do here is implementing a programming paradigm where several applications may be distributed heterogeneously among different subsets of a WSN's motes. Multiple applications can be run side by side on the same mote. This is far more efficient than deploying hardware for each and every application. The Multi-Application Mid-dlewAre (MAMA) layer allows running different TinyOS applications at the same time easily. Concurrent sensor usage and messaging is handled by MAMA. Results from simulation runs, hardware deployments, power profiling and scope measurements show good scalability, only little timing and memory overhead and power efficient properties.

Energy harvesting systems (EHSs) are the key to perpetual operation of electronic devices in application areas with bad infrastructure or mobility. Wireless sensor networks (WSNs) are often used in such areas. Normal WSN nodes are powered by batteries. Therefore, the lifetime is limited and the batteries have to be replaced manually after a certain period of time. This problem can be solved by EHSs. They exploit energy sources of the environment and store the harvested energy in energy buffers. The EHS supplies the electronic device and ensures a continuous operation. WSNs can benefit from these developments, because the lifetime can be enhanced dramatically. However, the EHS have to be adapted to the requirements of the application area and of the supplied device. This enhances the overall efficiency of EHS. To be able to do that, the fundamental mode of operation of an EHS has to be well-understood. We introduce a novel tier model for EHSs. It structures the EHS into tiers with special functions. This enhances the design process of an EHS, because tiers can be adapted to each other and the overall efficiency of can be increased. The tier model is applied to RiverMote, a WSN node for in-river water level monitoring. Each node is supplied by solar cells and the energy is stored in double layer capacitors (DLCs). The hardware of the EHS of RiverMote is divided into the tiers of the model. These tiers are adapted to each other carefully. Although no maximum power point tracker has been implemented, it has been shown that the available power of the solar cell is greater than 80 % of the maximum power point if the energy level of the DLCs is between 42 % and 100 %. This result was only possible by a careful design and an adaption of the tiers.

The article outlines examples of a viral (varicella-zoster virus, VZV), a bacterial (Lyme borreliosis) and a parasitic (scabies) infection in pregnancy with their risk for the mother and/or child as well as their management. VZV infections cause various clinical scenarios depending on the maternal immune status and the time of infection. Herpes zoster usually poses no risk to the pregnant woman and there is no need for antiviral therapy. VZV infection of a seronegative mother, however, may lead to severe varicella in the pregnant woman and to congenital malformations (congenital varicella syndrome) in case of early infection or neonatal varicella in case of perinatal infection. Prompt therapy with acyclovir or administration of VZV immunoglobulin for prophylaxis is mandatory in those patients. In case of Lyme borreliosis of the mother, adequate antibiotic therapy with amoxicillin prevents harm to the fetus. Doxycycline is contraindicated during pregnancy. Scabies represents an important differential diagnosis of pruritic dermatoses in pregnancy and should be treated with permethrin 5% cream.

Wireless sensor network (WSN) motes are devices of small form factor. Tailoring WSNs towards a specific application domain leads to resource constraints due to limited use of hardware and especially bandwidth and energy. Furthermore, system aspects of interaction of different components and services lead to a number of further non-functional constraints and especially timing and memory issues.Though several resources of related work exist that are dealing with localization for WSNs, there are no suitable approaches yet for how to optimize 3D localization accuracy with subject to conserving real-time aspects, memory footprint and power dissipation at the same time. It has also not yet been described how 1D, 2D and 3D errors each relate to one another in experimentation.We present an approach that allows designing, prototyping and improving scalable localization systems for mote-class devices. We implement a localization system on networks of Mica2 motes for which the 3D position accuracy error has been validated to be below 30 cm in real world settings.The paper presents ways to model, simulate, implement and measure the system model, used components' power dissipation and energy balance impact, timing behavior, memory footprint, robustness and accuracy. Statistical means of simulation results' accuracy are compared to real-world measurements' statistics

TinyOS2 (TOS2) is the state of the art operating system for wireless sensor network (WSN) programming. There are a number of testbeds and simulation tools for checking functional correctness and a few integrated development environments (IDEs) that support graphical user interface (GUI) and power profiling of WSN simulation as well. All these systems and environments are tailored towards design optimization of WSNs subject to functional correctness and energy conservation. Unfortunately, all these approaches lack self-contained support for energy harvesting systems (EHSs) which is the state of the art technique for tackling the energy conservation problem. Here, we present the design and implementation of a self-contained X-in-the-loop approach. TOSPIE2 is an Eclipse plug-in that integrates TOS2 installation and compilation support, power profiles and EHS efficiency in simulation and measurement.

The performance of embedded systems often suffers from strict cost/size and power/energy limitations. This is especially important for very small systems that are sold in a high number of items like smart cards and RFID controllers. On one hand, small hardware platforms are developed to minimize cost and power consumption. On the other hand, applications have to fulfill strict performance demands. We introduce a high-level performance optimization for EEPROM-based embedded systems. Writing to persistent memory is known to be very costly in the meaning of time and energy consumption. Our proposal shows how to reduce the number of write operations. We introduce an approach to increase spatial data locality without losing reliability of data that has to be stored persistently.

Wireless sensor network (WSN) nodes have to cope with severe power supply constraints. Energy harvesting system (EHS) technology is used for prolonging network lifetime. Robust operation of such systems heavily relies on accurate models of EHS efficiency and node power dissipation for calculating sustainable operation modes.

Network coding is a suitable mean to come up against the effects of crossing information flows in wireless sensor networks (WSNs) where these areas are heavily impacted in terms of channel bandwidth, message delay and energy balance.

Wireless sensor network (WSN) motes of small form factor are operated in resource-constrained settings. This demands for low-power designs and energy-aware operation, but especially for optimization of costly wireless transmissions.A promising approach is to find network structures where network coding can be applied to optimize energy efficiency of information flows. Schemes exist for global optimization of the load on WSN's resources.Nevertheless, applying them in practical settings is often not feasible due to complex computations and the need for centralized knowledge. The gain from optimization methods fades away for scaled and autonomous operation of WSNs due to control overhead.This paper presents LINDONCS: Localized In-Network Detection Of Network Coding Structures. Communication patterns are adapted autonomously without paying off impact on network scalability. We show how to detect structures and apply network coding to improve network lifetime over state-of-the-art solutions.

Serologic follow-up examinations are frequently performed in patients with erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans (the 3 dermatoborrelioses) to evaluate treatment efficacy. There is, however, substantial proof in the literature that antibody titer development after therapy is unpredictable and variable, and moreover it is largely uncorrelated with the clinical course and mode of antibiotic treatment. For example, persistent positive IgG and/ or IgM antibody titers do not indicate treatment failure. Thus, repeated serologic testing is of very limited value for assessing therapy efficacy, and therefore not recommended in the follow-up of dermatoborrelioses patients. Since cultivation of the etiologic agent, Borrelia burgdorferi sensu lato, and polymerase chain reaction are also inadequate for this purpose, the assessment of patients with cutaneous manifestations of Lyme borreliosis in the follow-up rests primarily on the clinical picture.

Wireless Sensor Network (WSN) nodes are resource- constrained computing devices. Adaptive behavior of autonomously working WSNs tries to maximize the cost efficiency of deployments. This includes maximizing the lifetime through power consumption optimization and recharging energy reservoirs with the use of energy harvesting. The adaptive behavior that leads to efficient resource usage needs information about the WSNs energy balance for decision making. We present a novel platform to measure the harvested, stored and dissipated energy. For being applicable to different environments it allows to attach different energy harvesting devices (EHDs). EHDs do not provide power continuously. Power availability patterns are used to determine how these sources can be used efficiently. Models from harvesting theory try to adapt to it. We implement a model that targets energy neutrality on our platform. It is used to evaluate the model and improve it. Our novel platform can be used to evaluate theories that model different sources. It can utilize and characterize thermoelectric, piezoelectric and magnetic induction generators and solar cells. The measurement platform tracks energy dissipation too. Mote software is implemented to establish communication to the platform. A sample application on top of it shows that the system can be used for software characterization. This paper contributes a novel modular and low-power design for measurement platforms for WSNs. It shows utilization of different energy sources and the ability to supply different mote types. Our work shows how theories for energy harvesting can be evaluated and improved. Our work also contributes to the field of simulation and emulation through online software characterization. The approach improves in accuracy and completeness over the capabilities of offline simulation.

Esophageal myotomy is the standard primary therapy for achalasia. However, reports on long-term results of myotomy have suggested a deterioration of outcome over time with many patients presenting with end stage disease several years after esophagomyotomy. Eight patients who had previously undergone esophagomyotomy for achalasia presented with recurrent or worsening symptoms, and after preoperative evaluation, were treated by esophagectomy via laparotomy and right thoracotomy. The mean age at the time of myotomy was 52 years (range 18 to 62 years), and the mean time until esophagectomy was 12.5 years (range 2 to 18 years) after the initial myotomy. The median time until esophagectomy was performed after myotomy was 14 years. All patients in this series gained weight (mean, 23 pounds; range, 9 to 42 lbs) following esophagectomy, and none of the patients complained of dysphagia at follow-up or developed stricture. There were no major complications (including anastomotic leak) or deaths in this series. Five of the patients have been followed a mean of six years and remain well. Esophagectomy is a safe and appropriate treatment option in the setting of recurrent and end stage achalasia.

The Swiss HIV Cohort Study (SHCS) is a prospective cohort study of HIV-infected adolescents and adults seen at 7 outpatient clinics (Swiss University Hospitals in Basle, Berne, Geneva, Lausanne, Zurich, the St. Gall Cantonal Hospital and the Civico Hospital in Lugano). The SHCS serves as an infrastructure for different research projects and includes about 70% of all patients with advanced disease in Switzerland. From April 1984 to November 1995 3120 HIV-infected patients of the SHCS died. Autopsies were performed in 314 of these patients. The aim of our study is to analyse autopsy findings as well as causes of death in those 314 HIV-infected patients. An HIV-related cause of death was found in 271 (86%) of the patients, 12 patients (4%) died of a drug overdose, and 3 (1%) of the patients committed suicide. 28 (9%) died either from an HIV unrelated or unidentified cause. The five most frequent causes of death were: bacterial pneumonia (52 patients, 17%), Pneumocystis carinii pneumonia (40 patients, 13%), lymphoma (34 patients, 11%), cytomegalovirus infection (33 patients, 11%), and toxoplasmosis (30 patients, 10%). During our study marked progress occurred in treating HIV-infected patients and preventing opportunistic infections. These improvements have further changed the natural course of acquired immunodeficiency syndrome. They are reflected in the falling rate of Pneumocystis carinii pneumonia and toxoplasmosis, as well as an increase in lymphoma as a cause of death over the period of our study.

Wireless sensor network WSN nodes called motes are small wireless embedded devices. They suffer from limitations of their power supplies and available bandwidth as well as in their memory and computational power. As a promising approach, network coding NC provides means of relaxing the combined problem of limited supplies and bandwidth. We present experimentation in modelling, simulation and measurement of a novel approach for robust scalable NC in dynamic environments. It is compared to routing in mesh structured, low data rate WSNs. For keeping it from being purely academic, we discuss the scalable concept's applicability to different applications, systems and topologies. We evaluate its energy conservation capabilities for Mica2 motes and show savings of up to 50%. This paper also highlights trade-offs and solutions that are applicable to other state-of-the-art systems as well.