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Exposition in der Versorgungspraxis: Zur Frage der Umsetzbarkeit und Prädiktion früher Veränderungen
(2018)
Ziel der vorliegenden Arbeit war die Beantwortung folgender Fragestellungen: 1. Wie wirksam ist ein evidenzbasiertes Expositionsmanuals bei Panikstörung mit Agoraphobie in der Routineversorgung? 2. Was sind mögliche Barrieren und Hindernisse bei der Umsetzung der Exposition? 3. Was sind Prädiktoren früher Veränderungen im Therapieverlauf?
Methode: Im Rahmen einer prospektiven Längsschnittstudie wurden die Daten der vorliegenden Studie mit denen der Multicenter-Studie von Gloster et al. (2011) mittels Effektstärken und Testung auf Äquivalenz verglichen. Grundlage war das Manual von Lang, Helbig-Lang, Westphal, Gloster und Wittchen (2011). Die Patientinnen und Patienten und Therapeutinnen und Therapeuten wurden zu den Hausaufgaben, der Umsetzung im Alltag und der therapeutischen Beziehung befragt. Zusätzlich wurde die wechselseitige Beeinflussung von therapeutischer Allianz und dem Behandlungserfolg im Therapieverlauf untersucht. In Anlehnung an Westra, Marcus und Dozois (2007) wurde getestet, ob bei es Patientinnen und Patienten mit einer hohen Hausaufgaben-Compliance und einer positiven Behandlungserwartung vor Beginn der Therapie zu einer frühen Reduktion der Panik-Symptomatik kommt und ob frühe Veränderungen durch die Compliance und die Behandlungserwartung beeinflusst werden.
Ergebnisse: 1. Die Behandlung war in der Versorgungspraxis nicht weniger effektiv als in der Multicenter-Studie. 2. Die Abbrecherquote lag bei 20.59%. Die meisten Behandelten gaben an, ihre Hausaufgaben wie besprochen erledigt zu haben und schätzten sie nicht übermäßig schwer ein. Die Umsetzbarkeit der Anforderungen im Alltag wurde von den Patientinnen und Patienten sehr hoch eingeschätzt. Die meisten Therapeutinnen und Therapeuten stimmten der Aussage, die Umsetzung der massierten Exposition sei im therapeutischen Alltag nicht praktikabel eher nicht oder gar nicht zu. Je negativer die Einschätzungen der therapeutischen Beziehung durch die Behandelten war, umso höher waren die Panikwerte am Ende der Therapie. Der HAQ-S korrelierte mit dem Outcome zu r = .21, der HAQ-F zu r = .37. 3. Die beiden Mediator-Hypothesen von Westra et al. (2007) konnten nicht bestätigt werden.
Diskussion: Die Behandlung ist in der Routineversorgung wirksam und praktikabel. Die Hausaufgaben scheinen frühe Veränderungen nicht zu prädizieren. In späteren Arbeiten des Forschungsprojektes wird notwendig sein, zudem die differentielle Wirksamkeit des angepassten Manuals zu untersuchen, und zwar mittels drei aktiver Vergleichsgruppen: massierte Exposition versus prolongierte Exposition versus die Kombination beider.
Within aquatic environments sediment water interfaces (SWIs) are the most important areas concerning exchange processes between the water body and the sediment. These spatially restricted regions are characterized by steep biogeochemical gradients that determine the speciation and fate of natural or artificial substances. Apart from biological mediated processes (e.g., burrowing organisms, photosynthesis) the determining exchange processes are diffusion or a colloid-mediated transport. Hence, methods are required enabling to capture the fine scale structures at the boundary layer and to distinguish between the different transport pathways. Regarding emerging substances that will probably reach the aquatic environment engineered nanomaterials (ENMs) are of great concern due to their increased use in many products and applications. Since they are determined based on their size (<100 nm) they include a variety of different materials behaving differently in the environment. Once released, they will inevitable mix with naturally present colloids (< 1 μm) including natural nanomaterials.
With regard to existing methodological gaps concerning the characterization of ENMs (as emerging substances) and the investigation of SWIs (as receiving environmental compartments), the aim of this thesis was to develop, validate and apply suitable analytical tools. The challenges were to i) develop methods that enable a high resolution and low-invasive sampling of sediment pore water. To ii) develop routine-suitable methods for the characterization of metal-based engineered nanoparticles and iii) to adopt and optimize size-fractionation approaches for pore water samples of sediment depth profiles to obtain size-related information on element distributions at SWIs.
Within the first part, an available microprofiling system was combined with a novel micro sampling system equipped with newly developed sample filtration-probes. The system was thoroughly validated and applied to a freshwater sediment proving the applicability for an automatic sampling of sediment pore waters in parallel to microsensor measurements. Thereby, for the first time multi-element information for sediment depth profiles were obtained at a millimeter scale that could directly be related to simultaneously measured sediment parameters.
Due to the expected release of ENMs to the environment the aim was to develop methods that enable the investigation of fate and transport of ENMs at sediment water interfaces. Since standardized approaches are still lacking, methods were developed for the determination of the total mass concentration and the determination of the dissolved fraction of (nano)particle suspensions. Thereby, validated, routine suitable methods were provided enabling for the first time a routine-suitable determination of these two, among the most important properties regarding the analyses of colloidal systems, also urgently needed as a basis for the development of appropriate (future) risk assessments and regulatory frameworks. Based on this methodological basis, approaches were developed enabling to distinguish between dissolved and colloidal fractions of sediment pore waters. This made it possible for the first time to obtain fraction related element information for sediment depth profiles at a millimeter scale, capturing the fine scale structures and distinguishing between diffusion and colloid-mediated transport. In addition to the research oriented parts of this thesis, questions concerning the regulation of ENPs in the case of a release into aquatic systems were addressed in a separate publication (included in the Appendix) discussing the topic against the background of the currently valid German water legislation and the actual state of the research.
Schrift ist in ihrer Besonderheit verkannt, versteht man sie allein als Mittel zur Stillstellung gesprochener Sprache. Phänomene wie Schriftbildlichkeit, Operativität und die Physiognomie des Schriftbildes machen Schrift zu einem Medium. In der Entwicklung und in der Verwendung von Schriftgebrauchsformen in unterschiedlichen Kontexten werden sowohl die Eigenschaften, die Schriftzeichen mit verbalen Zeichen gemeinsam haben, als auch die Potentiale, die sie mit pikturalen Zeichen gemeinsam haben, genutzt. Daher werden in der vorliegenden Arbeit die Funktionalisierungsmöglichkeiten von Schriftgebrauchsformen vor dem Hintergrund der Symboltheorie Nelson Goodmans vorgestellt. Eine an die ästhetische Theorie angelehnte Herangehensweise ermöglicht es, gerade die bildlichen Aspekte von Schriftformen – die bislang in schrifttheoretischen Arbeiten meist als irrelevant ausgeblendet werden – zu berücksichtigen. Es wird ein dynamischer Kompetenzbegriff in Anlehnung an J.G. Schneider entwickelt, der alle Fähigkeiten umfasst, die benötigt werden, um Schriftgebrauchsformen erfolgversprechend verwenden zu können. Zu diesen Fähigkeiten gehören nicht nur grammatische und orthographische Kompetenz, sondern ebenso Geschmack und die Fähigkeit zur Analogiebildung. An Beispielen verschiedener Schriftverwendungen wird gezeigt, wie unterschiedlich Schriftgebrauchsformen eingesetzt werden können. So wird Schrift als Kulturtechnik darstellbar und mithin verdeutlicht, dass die Art und Weise, wie Menschen ihre Kultur, ihre Welt, aber auch ihre spezifische Umgebung und eigene Identität modellieren, von Schriftverwendungen geprägt und verändert wird.
The term “Software Chrestomaty” is defined as a collection of software systems meant to be useful in learning about or gaining insight into software languages, software technologies, software concepts, programming, and software engineering. 101companies software chrestomathy is a community project with the attributes of a Research 2.0 infrastructure for various stakeholders in software languages and technology communities. The core of 101companies combines a semantic wiki and confederated open source repositories. We designed and developed an integrated ontology-based knowledge base about software languages and technologies. The knowledge is created by the community of contributors and supported with a running example and structured documentation. The complete ecosystem is exposed by using Linked Data principles and equipped with the additional metadata about individual artifacts. Within the context of software chrestomathy we explored a new type of software architecture – linguistic architecture that is targeted on the language and technology relationships within a software product and based on the megamodels. Our approach to documentation of the software systems is highly structured and makes use of the concepts of the newly developed megamodeling language MegaL. We “connect” an emerging ontology with the megamodeling artifacts to raise the cognitive value of the linguistic architecture.
Homonegative discrimination such as the denial of leadership qualities and higher salaries concern not only lesbians and gay men but also individuals who were perceived as lesbian or gay (Fasoli et al., 2017). Hence, it is assumed that especially straight people become victims of homonegative discrimination (Plöderl, 2014). The perception of sexual orientation is indeed stereotype-driven (e.g., Cox et al., 2015) but there is a lack of knowledge on how accurate stereotypes are – particularly those referring to speech. Despite a variety of sociophonetic and social psychological research related to sexual orientation and gender, an encompassing understanding is missing on how sexual orientation is expressed and perceived.
The present thesis aims to fill these gaps. The two major aims of the present work are a) the examination of the accuracy of speech stereotypes in the context of sexual orientation and b) the development of a model on how sexual orientation is interpersonally construed. Overall, the present thesis comprises five manuscripts with the following aspects in common: They integratively deal with social psychological and sociophonetic perspectives, share a social identity approach, and primarily center speech instead of facial appearance. Moreover, mostly German and German native speaking participants, respectively, have been investigated.
Manuscript 1 establishes the Traditional Masculinity/Femininity-Scale as a reliable and valid instrument for assessing gender-role self-concept. The invention was necessary because existing scales insufficiently represented the self-ascribed masculinity/femininity yet (e.g., Abele, 2003; Evers & Sieverding, 2014). Manuscripts 2, 3, and 4 address the (in)accuracy of speech stereotypes regarding stereotypic content and suggested within-group homogeneity. This is carried out by the application of different methodological approaches. On the one hand, relevant acoustic parameters of lesbian/gay and straight women and men were averaged for each group. On the other hand, voice morphing was applied in order to create prototypical and naturally sounding voice averages (Kawahara et al., 2008). Lesbians and straight women differed in none, gay and straight men in one of the analyzed acoustic parameters only. In contrast, a fine-grained psychological analysis yielded various evidence for acoustic within-group heterogeneity. In particular, the exclusivity of sexual orientation and gender-role self-concept have been acoustically indexicalized which suggests that speech stereotypes are inaccurate. However, voice averages do carry perceivable sexual orientation information. Hence, speech stereotypes can be considered as exaggerations of tiny kernels of truth. In Manuscript 5, previous literature on the interpersonal construction of sexual orientation is integrated in a model: The Expression and Perception of Sexual Orientation Model (EPSOM). This model postulates an indirect route and describes how sexual orientation information is transmitted from producer to perceiver by proposing three mediating components. Thereby, the model is able to offer an explanation why sexual orientation can be perceived with above-chance but far-away-from-perfect accuracy.
Overall, the present thesis provides meaningful impulses for enhancements of research on social markers of sexual orientation and gender. This thesis offers a model on how sexual orientation is expressed and perceived, shows the benefits of combining sociophonetic and social psychological approaches, and points out the value of applying novel methods and technologies. Beyond that, the present thesis offers useful implications for practice. Speech stereotypes in the context of sexual orientation can be rejected as inaccurate – for example, native German straight men do not nasalize more or less than gay men. Thereby, the present thesis contributes to an erosion of stereotypes and a potential reduction of homonegative discrimination.