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The Corona® charged aerosol detector (CAD) is an aerosol-based detector first de-scribed by Dixon and Peterson in 2002. It is capable of detecting compounds inde-pendent from their physico-chemical properties presumed the analyte is sufficiently non-volatile. Consequently, the CAD is often applied to the analysis of substances that do not possess a suitable UV chromophore. Major drawbacks are however, the detector signal is non-linear and depending on the content of organic solvent in the mobile phase.
This thesis tried to explore possible applications of the CAD for pharmaceutical analysis. Therefore, several substances from different compound classes were in-vestigated. Newly developed or existing methods were validated. Thus the perfor-mance of the CAD could be examined. Both assay and impurity determination were evaluated for their compliance with ICH Q2(R1) “Validation of Analytical Proce-dures” and the “Technical Guide for the Elaboration of Monographs”.
In the course of the establishment of reference substances at the EDQM, a generic screening method for the identification of organic and inorganic pharmaceutical counterions was needed. An HPLC-CAD method developed by Zhang et al. was therefore investigated for its suitability for pharmacopoeial purpose. Method valida-tion was performed. It was found that 23 ions could be separated and detected. Iden-tification was achieved via retention time of an authentic standard of the corre-sponding ions. Alternatively, peak assignment was performed by determination of the exact mass using TOF-MS. Ions could be quantified as impurities or for stoichi-ometric purpose.
For the impurity control in topiramate, the performance characterstics of the CAD were compared to that of an ELSD. CAD was superior to ELSD in terms of repeata-bility, sensitivity and linearity. However, impurities could be quantified with satisfac-tory accuracy with both detectors. The application of the ELSD was not feasible due to non-reproducible spike peaks eluting after the principle peak in the chromatogram of the test solution. One of the impurities, topiramate impurity A (diacetonide), gave no or a vastly diminished signal in the ELSD and the CAD, respectively. It is evapo-rated during the detection process due to its relatively high vapor pressure. The re-sponse could be enhanced by a factor of nine via post-column addition of acetoni-trile and a lower nebulizer temperature. As the response of topiramate impurity A was still about thousand-fold lower than the response of all other impurities, its quantification was not feasible. Additionally, the HPLC-CAD was successfully vali-dated as an assay procedure for topiramate.
There seems to be a great potential in the application of the CAD to the analysis of excipients as most compounds do not possess a suitable UV chromophore. Here, a simple and rapid HPLC-CAD method for the determination of polidocanol (PD) was developed. The method was successfully validated as a potential assay procedure for the Ph. Eur. as none is described in either of the two PD monographs. The same method was applied to the determination of the PD release from a pharmaceutical polymer matrix.
A method for the determination of the fatty acid (FA) composition of polysorbate 80 (PS80) was developed and validated. Using the CAD and mass spectrometry, we were able to identify two new FAs in 16 batches from four manufacturers. All batch-es complied with pharmacopoeial specification. Furthermore, the overall composi-tion of the different PS80 species (“fingerprinting”) and the peroxide content were determined. In addition to the chemical characterization, functionality related charac-teristics (FRCs) were determined. Correlations between chemical composition and FRCs were found.
The validation data of the above mentioned methods suggests that the CAD repre-sents a viable detection technique for pharmaceutical analysis. The CAD was suffi-ciently sensitive for non-volatile analytes. Impurity control down to concentrations of 0.05 or 0.03%, as demanded by ICH Q3A (R2), is achievable. However, the response of semi-volatile compounds may be drastically diminished. It could be confirmed that the response of the CAD is linear when the range does not exceed two orders of magnitude. Exceptions may be observed depending on the actual method setup. When the measuring range is sufficiently narrow, quantification can be done using single-point calibration which is common practice in pharmaceutical anlysis. Impuri-ties may also be quantified against a single calibration solution. However, correction factors may be needed and the accuracy is considerably lower compared to an as-say method. If a compound is to be quantified over a large concentration range, log-log transformation of the calibration curve is needed and a decreased accuracy has to be accepted.
While numerous experiments on NFAT were already performed with CD4+ T cells showing defective cytokine release and a reduced T helper cell development, no detailed studies existed for CD8+ T cells. From this point, we wanted to examine the impact of NFATc1 and c2 on the physiological functions of CD8+ T cells in vitro and in vivo. Therefore, we used a murine infection model with the bacteria Listeria monocytogenes and mice in which NFATc1 was specifically depleted in the T cell compartment.
Our first in vitro studies showed a typical NFATc1 and c2 nuclear translocation and changes on mRNA levels upon T cell activation similarly in CD4+ as well as in CD8+ T cells extracted from wild type mice. NFAT nuclear translocation is important for target gene activation and generation of effector functions. Stimulated T cell populations lacking NFATc1 and/or NFATc2 showed a markedly decreased expression of Th1/Tc1 cytokines, as e.g. IL 2 and IFNγ being important for the clearance of intracellular pathogens. From our in vitro model for the generation of allogenically reactive cytotoxic CD8+ T cells, we revealed a decreased killing and lytic granule-release capacity in Nfatc1 inactivated CD8+ T cells whereas NFATc2-/- cytotoxic T cells did not show an altered cytotoxic response compared to wild type cells.
Interestingly, we found lytic granules accumulated and mitochondria not getting translocated to the immunological synapse upon re-stimulation in NFATc1-deficient CD8+ T cells. Together with results showing the CsA insensitivity of the CTL killing/degranulation capacities, we assume that some major cellular processes are affected by NFATc1 which are not directly linked to the TCR-induced signal transduction cascade.
We also showed the importance of NFATc1 in T cells during intracellular infections with the bacteria Listeria monocytogenes in an in vivo mouse model. After five days, only few bacteria were detected in wt mice whereas high amounts of Listeria particles were extracted from livers of Nfatc1fl/fl x Cd4 cre mice. Although the reactivity towards the pathogen was similar in both groups, a decreased cytokine expression in NFATc1-/- CD8+ T cells was observed together with an altered memory cell generation.
Our results show the importance of NFATc1 in CD8+ T cells and give some clue for a possible connection to other basal cellular functions, as e.g. the formation of an immunological synapse.
The role of human Ephrin receptor tyrosine kinase A2 (EphA2) in Chlamydia trachomatis infection
(2015)
Chlamydia trachomatis (Ctr), an obligate intracellular gram negative human pathogen, causes sexually transmitted diseases and acquired blindness in developing countries. The infectious elementary bodies (EB) of Ctr involved in adherence and invasion processes are critical for chlamydial infectivity and subsequent pathogenesis which requires cooperative interaction of several host cell factors. Few receptors have been known for this early event, yet the molecular mechanism of these receptors involvement throughout Ctr infection is not known. Chlamydial inclusion membrane serves as a signaling platform that coordinates Chlamydia-host cell interaction which encouraged me to look for host cell factors that associates with the inclusion membrane, using proteome analysis. The role of these factors in chlamydial replication was analyzed by RNA interference (RNAi) (in collaboration with AG Thomas Meyer). Interestingly, EphrinA2 receptor (EphA2), a cell surface tyrosine kinase receptor, implicated in many cancers, was identified as one of the potential candidates. Due to the presence of EphA2 in the Ctr inclusion proteome data, I investigated the role of EphA2 in Ctr infection. EphA2 was identified as a direct interacting receptor for adherence and entry of C. trachomatis. Pre-incubation of Ctr-EB with recombinant human EphA2, knockdown of EphA2 by siRNA, pretreatment of cells with anti-EphA2 antibodies or the tyrosine kinase inhibitor dasatinib significantly reduced Ctr infection. This marked reduction of Ctr infection was seen with both epithelial and endothelial cells used in this study. Ctr activates EphA2 upon infection and invades the cell together with the activated EphA2 receptor that interacts and activates PI3K survival signal, promoting chlamydial replication. EphA2 upregulation during infection is associated with Ctr inclusion membrane inside the cell and are prevented being translocated to the cell surface. Ephrins are natural ligands for Ephrin receptors that repress the activation of the PI3K/Akt pathway in a process called reverse signaling. Purified Ephrin-A1, a ligand of EphA2, strongly interferes with chlamydial infection and normal development, supporting the central role of these receptors in Chlamydia infection. Overexpression of full length EphA2, but not the mutant form lacking the intracellular cytoplasmic domain, enhanced PI3K activation and Ctr infection. Ctr infection induces EphA2 upregulation and is mediated by activation of ERK signaling pathway. Interfering with EphA2 upregulation sensitizes Ctr-infected cells to apoptosis induced by tumor necrosis factor-alpha (TNF-α) suggesting the importance of intracellular EphA2 signaling.
Collectively, these results revealed the first Ephrin receptor “EphA2” that functions in promoting chlamydial infection. In addition, the engagement of a cell surface receptor at the inclusion membrane is a new mechanism how Chlamydia subverts the host cell and induces apoptosis resistance. By applying the natural ligand Ephrin-A1 and targeting EphA2 offers a promising new approach to interfere with Chlamydia infection. Thus, the work provides the evidence for a host cell surface tyrosine kinase receptor that is exploited for invasion as well as for receptor-mediated intracellular signaling to facilitate the chlamydial replication.
Names of, for instance, children or companies are often chosen very carefully. They should sound and feel good. Therefore, many companies try to choose artificially created names that can easily be pronounced in various languages. A wide range of psychological research has demonstrated that easy processing (high processing fluency) is intrinsically experienced as positive. Due to this positive feeling, easy processing can have profound influences on preferences for names.
Topolinski, Maschmann, Pecher, and Winkielman (2014) have introduced a different mechanism that influences the perception of words. Across several experiments they found that words featuring consonantal inward wanderings (inward words) were preferred over words featuring consonantal outward wanderings (outward words). They argued that this was due to the fact that approach and avoidance motivations are activated by articulating inward and outward words, because the pronunciation resembles approach and avoidance behaviors of swallowing and spitting, respectively. They suggested this close link as an underlying mechanism for the so-called in-out effect, but did not test this assumption directly.
In the current work, I tested an alternative fluency account of the in-out effect. Specifically, I hypothesized that processing fluency might play a critical role instead of motivational states of approach and avoidance being necessarily activated.
In Chapter 1, I introduce the general topic of my dissertation, followed by a detailed introduction of the research area of approach and avoidance motivations in Chapter 2. In Chapter 3, I narrow the topic down to orally induced approach and avoidance motivations, which is the main topic of my dissertation. In Chapter 4, I introduce the research area of ecological influences on psychological processes. This chapter builds the base for the idea that human language might serve as a source of processing fluency in the in-out effect. In the following Chapter 5, I elaborate the research area of processing fluency, for which I examined whether it plays a role in the in-out effect.
After an overview of my empirical work in Chapter 6, the empirical part starts with Study 1a and Study 1b (Chapter 7) that aimed to show that two languages (Eng. & Ger.) in which the in-out effect has originally been found might feature a source of higher processing fluency for inward over outward words. The results showed that higher frequencies of inward dynamics compared to outward dynamics were found in both languages. This can lead to higher pronunciation fluency for inward compared to outward words which might in turn lay the ground for higher preferences found for inward over outward words.
In Chapter 8, the assumption that inward compared to outward dynamics might be more efficient to process was tested directly in experiments that examined objective as well as subjective processing fluency of artificially constructed non-words featuring pure inward or outward dynamics. Studies 2a-4b found an objective as well as subjective processing advantage for inward over outward words.
In Chapter 9, the causal role of objective and subjective pronunciation fluency in the in-out effect was examined. In Study 5 mediational analyses on item-level and across studies were conducted using objective and subjective fluency as possible mediating variables. In Study 6 mediation analyses were conducted with data on subject- and trial-level from a within-subject design. Overall, the data of the item-based, subject-based and trial-based mediation analyses provide rather mixed results. Therefore, an experimental manipulation of fluency was implemented in the last two studies.
In Chapter 10, Study 7 and Study 8 demonstrate that manipulating fluency experimentally does indeed modulate the attitudinal impact of consonantal articulation direction. Articulation ease was induced by letting participants train inward or outward kinematics before the actual evaluation phase. Additionally, the simulation training was intensified in Study 8 in order to examine whether a stronger modulation of the in-out effect could be found. Training outward words led to an attenuation and, after more extensive training, even to a reversal of the in-out effect, whereas training inward words led to an enhancement of the in-out effect. This hints at my overall hypothesis that the explicit preferences of inward and outward words are, at least partially, driven by processing fluency.
Almost all studies of my dissertation, except for one analysis of the item-based mediation study, speak in favor of the hypothesis that inward words compared to outward words are objectively and subjectively easier to articulate. This possibly contributes partially to a higher preference of inward over outward words. The results are discussed in Chapter 11 with respect to processing fluency and to the role of language as an ecological factor. Finally, future research ideas are elaborated.
This investigation deals with the history of the reception of phenomenological philosophy in cognitive science and how this reception has altered and continues to shape the traditional view of cognition inspired by the computer metaphor of mind. The claim will be espoused that cognitive science is not devoid of a philosophical perspective and cognitivism will be characterized precisely as the philosophy behind much work in cognitive science. In conclusion, the irreducibility of philosophical questioning to cognitive science will be defended and reasons will be given as to why it matters to mount such defense.
The pathogenic role of endogenous antibodies in a mouse model for Charcot-Marie-Tooth 1B neuropathy
(2015)
Charcot-Marie-Tooth (CMT) type 1 neuropathies are a genetically heterogeneous group of non-treatable inherited disorders affecting the peripheral nervous system that lead to sensory and motor dysfunction. Secondary low grade inflammation, implicating the innate and adaptive immune system, could previously be identified as a substantial disease modifier in two mouse models for CMT1, CMT1B and 1X, respectively. However, the exact mechanism how the adaptive immune system contributes to disease pathogenesis is not completely understood. Based on observations that the accumulation of endogenous antibodies to myelin components is important for rapid myelin clearance after nerve injury during Wallerian degeneration, a possibly similar mechanism was considered for endogenous antibodies as disease amplifier in mice heterozygously deficient for P0 (P0het), mimicking some typical features of CMT1B.
In this study an increased antibody deposition was detected in the affected peripheral nerves of P0het myelin mutant mice. By crossbreeding P0het mutants with mice specifically lacking B-lymphocytes, and therefore antibodies (JHD-/-), a decline of endoneurial macrophages together with a substantially ameliorated demyelination could be demonstrated in 6-month-old mutant mice. Moreover, reconstitution with murine IgGs reverted the neuropathic phenotype, substantiating that endogenous antibodies are potentially pathogenic at this early stage of disease. Unexpectedly, in 12-months-old P0het mutants, JHD deficiency resulted in disease aggravation accompanied by an increased inflammatory reaction and M2-polarized macrophage response.
These observations suggest that in a mouse model for CMT1B, the lack of endogenous antibodies has a dichotomous effect: ameliorating early macrophage-mediated demyelination, as opposed to increasing inflammatory reactions leading to disease aggravation at older ages.
The present work comprises four studies dealing with the investigation of the auditory event-related potentials (ERP) Mismatch Negativity (MMN), P300, and N400 under different attentional instructions, and with their application in patients with disorders of consciousness (DOC) to assess residual cognitive functioning. In guided interviews (study 1), practitioners working with DOC patients stated their general interest in and an objective need for the complementation of current diagnostic procedures by reliable and valid ERP-based methods. Subsequently, in study 2, simple oddball and semantic paradigms were applied to 19 behaviorally non-responsive DOC patients revealing the presence of at least one ERP in eight patients investigated. In the third and fourth study, specific attentional effects on ERPs were investigated in healthy participants to define optimal instructions and stimulus parameters. In study 3, MMN and N400 amplitudes were assessed in 18 participants, and in study 4, MMN and P300 amplitudes were assessed in 32 participants. Both studies included an ignore task (attention on simultaneous visual stimuli), a passive task, and a focused task and revealed distinct attentional effects on P300 and N400 with largest amplitudes in the focused task, smaller ones in the passive task and no ERP in the ignore task. An MMN was elicited in all tasks, but still, amplitudes differed as a function of task. In addition, study 4 included oddball paradigms comprising several deviants in different dimensions. Higher amplitudes were found in this multifeature paradigm compared to traditional oddball paradigms and larger amplitudes were elicited by deviants highly different from standards. It is concluded that ERPs represent a promising tool to complement clinical assessment of DOC patients. Application of ERP paradigms should include focused instructions, especially when using semantic material. Furthermore, multifeature paradigms have been proven especially useful eliciting large amplitudes and allowing for the investigation of several dimensions of deviants at the same time.
Utility is perhaps the most central concept in modern economic theorizing. However, the behaviorist reduction to Revealed Preference not only removed the psychological content of utility but experimental investigations also exposed numerous anomalies in this theory.
This program of research focused on the psychological processes by which utility judgments are generated. For this purpose, the standard assumption of a homogeneous concept is substituted by the Utilitarian Duality Hypothesis.
In particular, judgments concerning categorical utility (uCat) infer an object's category based on its attributes which may subsequently allow the transfer of evaluative information like feelings or attitudes. In contrast, comparative utility (uCom) depends on the distance to a reference value on a specific dimension of comparison. Importantly, dimensions of comparison are manifold and context dependent.
In a series of experiments, we show that the resulting Dual Utility Model is able to explain several known anomalies in a parsimonious fashion. Moreover, we identify central factors determining the relative weight assigned to both utility components.
Finally, we discuss the implications of the Utilitarian Duality for both, the experimental practice in economics as well as the consequences for economic theorizing. In sum, we propose that the Dual Utility Model can serve as an integrative framework for both the rational model and its anomalies.
Measles, mumps and rubella are viral infectious diseases that may cause severe and devastating complications among affected individuals. The disease burden of all three diseases is high, but could be reduced entirely through successful vaccination strategies. As such, the WHO has established the goal of globally eliminating measles and rubella and concomitantly controlling the frequently co-vaccinated mumps.
In 2010, the WHO European Region member states agreed to strengthen efforts to eliminate measles and rubella from Europe by the end of 2015. As this date draws closer, progress analyses become increasingly relevant. In this systematic literature review, the immunization strategies, vaccination coverages and disease incidences of eleven European nations were assessed and their progress towards disease elimination evaluated.
Successful prevention of the endemic transmission of measles, mumps, or rubella could be achieved in several nations, including Sweden, Croatia, Greece and Spain. Austria, France, Germany, Italy, Poland, Turkey and the United Kingdom of Great Britain and Northern Ireland, though having improved their overall immunization rates, have not yet been able to reach the elimination goals. In Turkey, Italy and Poland, sharp increases in case numbers during recent years are potentially threatening the successful measles, mumps and rubella control in Europe.
Pockets of susceptible population groups that may contribute to the perpetuation of the diseases have been identified. They include infants and young children, adolescents and young adults, adolescent and adult males, recent immigrants and refugees,and traveling ethnic minority groups. Reasons for the increased risk of infection among these groups are manifold and a result of various historic and current vaccination practices, cultural, political and religious differences, as well as individual believes and concerns. Travel and migration of infected individuals to and between the various European nations also play an essential role in the continual transmission of measles, mumps and rubella in Europe. Only an adequate population-wide immunity can prevent the occurrence of major outbreaks due to viral importation. Efforts should therefore be made to immunize all population members able to receive vaccinations and to offer additional immunization opportunities to those susceptible population subgroups that are difficult to reach through routine vaccination programs.
In countries struggling to meet the WHO elimination goals, alternative immunization practices may be necessary. A uniform, European-wide MMR vaccination schedule based on the successful immunization methods of countries that have eliminated measles, mumps and rubella may be an effective tool for improving the overall population-wide immunity and controlling the three diseases. A model for such a schedule was created and includes strategies for reaching population members regardless of age, gender or migratory background. The implementation of uniform immunization recommendations is challenging, but the advantages in terms of improved vaccination, surveillance and disease control methods may be worth at least considering such a strategy in Europe.
Measles, mumps and rubella elimination may be attainable in the WHO European Region. The current epidemiological situation suggests that the goal is unlikely to be reached by the end of 2015, but through continued international efforts and collaboration, effective disease control could be achieved in the near future. In the meantime, improvements in immunization strategies, vaccination coverages, supplementary campaigns as well as disease notification systems and confirmations should be made on a national and international level, so that an adequate population-wide immunity can be established and the disease elimination progresses effectively monitored within the entire European region.
Brain-computer interfaces (BCIs) are devices that translate signals from the brain into control commands for applications. Within the last twenty years, BCI applications have been developed for communication, environmental control, entertainment, and substitution of motor functions. Since BCIs provide muscle independent communication and control of the environment by circumventing motor pathways, they are considered as assistive technologies for persons with neurological and neurodegenerative diseases leading to motor paralysis, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal muscular atrophy and stroke (Kübler, Kotchoubey, Kaiser, Wolpaw, & Birbaumer, 2001). Although most researcher mention persons with severe motor impairment as target group for their BCI systems, most studies include healthy participants and studies including potential BCI end-users are sparse. Thus, there is a substantial lack of studies that investigate whether results obtained in healthy participants can be transferred to patients with neurodegenerative diseases. This clearly shows that BCI research faces a translational gap between intense BCI research and bringing BCI applications to end-users outside the lab (Kübler, Mattia, Rupp, & Tangermann, 2013). Translational studies are needed that investigate whether BCIs can be successfully used by severely disabled end-users and whether those end-users would accept BCIs as assistive devices. Another obvious discrepancy exists between a plethora of short-term studies and a sparse number of long-term studies. BCI research thus also faces a reliability gap (Kübler, Mattia, et al., 2013). Most studies present only one BCI session, however the few studies that include several testing sessions indicate high inter- and intra-individual variance in the end-users’ performance due to non-stationarity of signals. Long-term studies, however, are needed to demonstrate whether a BCI can be reliably used as assistive device over a longer period of time in the daily-life of a person. Therefore there is also a great need for reliability studies.
The purpose of the present thesis was to address these research gaps and to bring BCIs closer to end-users in need, especially into their daily-lives, following a user-centred design (UCD). The UCD was suggested as theoretical framework for bringing BCIs to end-users by Kübler and colleagues (Kübler et al., 2014; Zickler et al., 2011). This approach aims at the close and iterative interaction between BCI developers and end-users with the final goal to develop BCI systems that are accepted as assistive devices by end-users. The UCD focuses on usability, that is, how well a BCI technology matches the purpose and meets the needs and requirements of the targeted end-users and was standardized with the ISO 9241-210.
Within the UCD framework, usability of a device can be defined with regard to its effectiveness, efficiency and satisfaction. These aspects were operationalized by Kübler and colleagues to evaluate BCI-controlled applications. As suggested by Vaughan and colleagues, the number of BCI sessions, the total usage duration and the impact of the BCI on the life of the person can be considered as indicators of usefulness of the BCI in long-term daily-life use (Vaughan, Sellers, & Wolpaw, 2012). These definitions and metrics for usability and usefulness were applied for evaluating BCI applications as assistive devices in controlled settings and independent use. Three different BCI applications were tested and evaluated by in total N=10 end-users: In study 1 a motor-imagery (MI) based BCI for gaming was tested by four end-users with severe motor impairment. In study 2, a hybrid P300 event-related (ERP) based BCI for communication was tested by four severely motor restricted end-users with severe motor impairment. Study 1 and 2 are short-term studies conducted in a controlled-setting. In study 3 a P300-ERP BCI for creative expression was installed for long-term independent use at the homes of two end-users in the locked-in state. Both end-users are artists who had gradually lost the ability to paint after being diagnosed with ALS.
Results reveal that BCI controlled devices are accepted as assistive devices. Main obstacles for daily-life use were the not very aesthetic design of the EEG-cap and electrodes (cap is eye-catching and looks medical), low comfort (cables disturb, immobility, electrodes press against head if lying on a head cushion), complicated and time-consuming adjustment, low efficiency and low effectiveness, and not very high reliability (many influencing factors). While effectiveness and efficiency in the MI based BCI were lower compared to applications using the P300-ERP as input channel, the MI controlled gaming application was nevertheless better accepted by the end-users and end-users would rather like to use it compared to the communication applications. Thus, malfunctioning and errors, low speed, and the EEG cap are rather tolerated in gaming applications, compared to communication devices. Since communication is essential for daily-life, it has to be fast and reliable. BCIs for communication, at the current state of the art, are not considered competitive with other assistive devices, if other devices, such as eye-gaze, are still an option. However BCIs might be an option when controlling an application for entertainment in daily-life, if communication is still available. Results demonstrate that BCI is adopted in daily-life if it matches the end-users needs and requirements. Brain Painting serves as best representative, as it matches the artists’ need for creative expression. Caveats such as uncomfortable cap, dependence on others for set-up, and experienced low control are tolerated and do not prevent BCI use on a daily basis. Also end-users in real need of means for communication, such as persons in the locked-in state with unreliable eye-movement or no means for independent communication, do accept obstacles of the BCI, as it is the last or only solution to communicate or control devices. Thus, these aspects are “no real obstacles” but rather “challenges” that do not prevent end-users to use the BCI in their daily-lives. For instance, one end-user, who uses a BCI in her daily-life, stated: “I don’t care about aesthetic design of EEG cap and electrodes nor amplifier”. Thus, the question is not which system is superior to the other, but which system is best for an individual user with specific symptoms, needs, requirements, existing assistive solutions, support by caregivers/family etc.; it is thereby a question of indication. These factors seem to be better “predictors” for adoption of a BCI in daily-life, than common usability criterions such as effectiveness or efficiency. The face valid measures of daily-life demonstrate that BCI-controlled applications can be used in daily-life for more than 3 years, with high satisfaction for the end-users, without experts being present and despite a decrease in the amplitude of the P300 signal. Brain Painting re-enabled both artists to be creatively active in their home environment and thus improved their feelings of happiness, usefulness, self-esteem, well-being, and consequently quality of life and supports social inclusion. This thesis suggests that BCIs are valuable tools for people in the locked-in state.