Factors associated with worse lung function in cystic fibrosis patients with persistent staphylococcus aureus

Background Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads. Methods Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors. Results 195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001). Patients with exacerbations (n = 60), S. aureus small-colony variants (SCVs, n = 84) and co-infection with Stenotrophomonas maltophilia (n = 44) had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103). Patients with SCVs were older (p = 0.0066) and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078). IL-6 levels positively correlated with decreased lung function (p<0.001), S. aureus density in sputa (p = 0.0016), SCVs (p = 0.0209), exacerbations (p = 0.0041) and co-infections with S. maltophilia (p = 0.0195) or A. fumigatus (p = 0.0496). Conclusions In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia

Der Gottesbegriff bei Samuel Hahnemann

Diese Dissertation befasst sich mit dem Gottesbegriff bei Samuel Hahnemann (SH). Um diesen in seinen unterschiedlichen Dimensionen darzustellen, werden SHs Biographie sowie Werk und Briefe unter folgenden Fragestellungen analysiert: wie wird Gott bezeichnet, was ist Gott, welche Eigenschaften werden Gott zugeschrieben (Synonyme und Attribute Gottes) und wie tritt Gott in Beziehung zu Aspekten der dem Menschen wahrnehmbaren Wirklichkeit (Gott-Schöpfung, Gott-Mensch, Gott-Moral, Gott-Arzt/Heilkunde). Besondere Bedeutung kommt dabei der Beziehung zwischen den Begriffen Gott und Homöopathie zu. Neben einer Betrachtung des Problems der Theodizee werden die Begriffe Geist, Wahrheit und Erfahrung in Ihren Bezügen zu SHs Gottesbild analysiert. Dem geht eine Diskussion der Motivationen SHs voraus, sich über Gott in seinen Schriften oder Briefen zu äußern. Abschließend werden Einflüsse wichtiger philosophischer und theologischer Zeitströmungen auf SHs persönlichen Gottesbegriff untersucht