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Gloster A.T.,TU Dresden | Gloster A.T.,University of Basel | Klotsche J.,Leibnitz Institute | Gerlach A.L.,University of Cologne | And 7 more authors.
Journal of Consulting and Clinical Psychology | Year: 2014

Objective: The mechanisms of action underlying treatment are inadequately understood. This study examined 5 variables implicated in the treatment of panic disorder with agoraphobia (PD/AG): catastrophic agoraphobic cognitions, anxiety about bodily sensations, agoraphobic avoidance, anxiety sensitivity, and psychological flexibility. The relative importance of these process variables was examined across treatment phases: (a) psychoeducation/interoceptive exposure, (b) in situ exposure, and (c) generalization/follow-up. Method: Data came from a randomized controlled trial of cognitive behavioral therapy for PD/AG (n = 301). Outcomes were the Panic and Agoraphobia Scale (Bandelow, 1995) and functioning as measured in the Clinical Global Impression scale (Guy, 1976). The effect of process variables on subsequent change in outcome variables was calculated using bivariate latent difference score modeling. Results: Change in panic symptomatology was preceded by catastrophic appraisal and agoraphobic avoidance across all phases of treatment, by anxiety sensitivity during generalization/follow-up, and by psychological flexibility during exposure in situ. Change in functioning was preceded by agoraphobic avoidance and psychological flexibility across all phases of treatment, by fear of bodily symptoms during generalization/follow-up, and by anxiety sensitivity during exposure. Conclusions: The effects of process variables on outcomes differ across treatment phases and outcomes (i.e., symptomatology vs. functioning). Agoraphobic avoidance and psychological flexibility should be investigated and therapeutically targeted in addition to cognitive variables. (PsycINFO Database Record (c) 2014 APA, all rights reserved). © 2013 American Psychological Association.


Schettler G.,Helmholtz Center Potsdam | Oberhansli H.,Helmholtz Center Potsdam | Oberhansli H.,Leibnitz Institute | Stulina G.,Scientific Information Center Interstate Coordination Water Commission | Djumanov J.H.,REPUBLIC RESOURCES
Journal of Hydrology | Year: 2013

We studied 40 artesian wells (AWs) in the Amu Darya Delta. These wells include high-salinity (~52g/l) and saline (5-24g/l) waters but are mostly low-salinity waters (1.3-2.9g/l). The low-salinity AWs cluster into three types, reflecting the variable mixing of different end member solutes: (residual) brines and solutes deriving from silicate alteration, dissolution of limestone and dissolution of gypsum. The solutes are all undersaturated in calcite and gypsum, contain a substantial cation excess against dissolved inorganic carbon and are characterised by low Ca/SO4 ratios. On the basis of the hydrochemical mass budgets of model cases, we demonstrate that Na-rich Cl-brines (45-48%) and a Na2SO4-brine (30-47%) are the dominant solute components. The solutes derived from aluminium silicate alteration are minor components (7.3-19.4%). Even less important are solutes from limestone or gypsum dissolution (0.05-3.7%). These waters are unlikely to have originated from sediments hosting gypsum. The low-salinity AWs must have acquired their dominant hydrochemical signatures under non-equilibrium conditions between their remote (unknown) seepage areas and their discharge locations. This acquisition may have begun during the early hydrochemical groundwater evolution when meteoric or surface water passed the critical zone under an arid climate regime. Warmer saline AWs (~40°C) hosted in deeper Cretaceous formations contain a high portion of NaCl-rich brine (85%) and some are saturated in gypsum. These waters were derived from fluids rising along faults from pre-Cretaceous strata. The high-salinity and relatively cold AWs discharge close to the retreating Aral Sea south of its western basin. These AWs are suboxic, and Si concentrations are very low. The AW hydrochemical signatures reflect the dissolution of halite and gypsum. We observed positive correlations between temperature, Br, B and Si. The temperature correlation with bromide likely documents the transformation of organically bound Br. The silica concentrations in low-salinity AWs southeast of the Aral Sea (eastern basin) are close to quartz saturation and define a chemical Si-geothermometer. © 2013 Elsevier B.V.


Schettler G.,Helmholtz Center Potsdam | Oberhansli H.,Helmholtz Center Potsdam | Oberhansli H.,Leibnitz Institute | Stulina G.,Scientific Information Center Interstate Coordination Water Commission | And 2 more authors.
Journal of Hydrology | Year: 2013

The Aral Sea, which has been affected by lake level lowering of approximately 25m and a salinity increase from 10 to >100g/l since 1963, represents, along with the Amu Dary Delta a dynamic hydrological system under an arid climate regime. The system receives river water inflow at high seasonal and inter-annual variability from remote alpine source areas. In the Amu Darya Delta, there is a distinct salinity contrast between the low-salinity river water (~1g/l) and the salinity of the unconfined GW (GWunconf: 10-95g/l). The GWunconf levels are predominantly controlled by the seepage of the river water inflow and GW discharge into the shrinking Aral Sea.In June 2009 and August 2009, we sampled water from various sources including surface waters, GWunconf, lake water and soil leachates for chemical analyses. Evaporative enrichment, precipitation/dissolution of gypsum and precipitation of calcite drive the GWunconf to an NaCl(SO4) water type presenting a positive correlation between Na and SO4.We model the hydrochemical evolution of the GWunconf in a box model which considers the capillary rise of near-surface GW, the precipitation of minerals in the unsaturated horizon and the seasonal re-flushing of adhesive residual brines and soluble salts. The model documents a rapid increase in salinity over a few annual cycles. Furthermore, the model simulations demonstrate the importance of the aeolian redistribution of soluble salts on the hydrochemical GW evolution. In a lab experiment, halite, hexahydrite and starkeyite are precipitated during the late stages of evaporative enrichment from a representative local brine.Processes specific to different water compartments plausibly explain the variations of selected element ratios. For example, the precipitation of low-Sr calcite in irrigation canals and natural river branches of the delta lowers Ca/Sr. The dissolution of gypsum in soils (Ca/Sr mole ratio~150) and the possible precipitation of SrSO4 associated with Sr-depletion in adhesive residual brines increases Ca/Sr in seepage and re-increases Ca/Sr in the unconfined GW. Aral Sea water, which receives high-Ca/Sr surface and groundwater inflow, developed due to continued precipitation of high-Ca/Sr calcite the almost lowest Ca/Sr ratio (~25) over time. We observed spatial variations in the GWunconf composition: (i) ammonium levels increase strongly due to interaction with lake sediments rich in organic matter and (ii) distinct increases in levels of nitrate, U, Mo and Se locally reflect oxygenation when GW levels decrease. The Amu Darya Delta acts as a sink for boron (uptake via terrestrial vegetation) and a source for bromide (release by degradation of organically-bound Br). Our results concerning the hydrochemical evolution of the GWunconf and additional data from the Aral Sea constrain the parameter 'GW discharge' in water budget models of the lake and improve the basis for palaeoclimatic interpretations of sediment records from the Aral Sea. © 2013 Elsevier B.V.


Minden K.,Leibnitz Institute | Minden K.,Charite - Medical University of Berlin | Niewerth M.,Leibnitz Institute | Zink A.,Leibnitz Institute | And 5 more authors.
Rheumatology (United Kingdom) | Year: 2012

Objective. To assess the outcome of adult patients with JIA who received etanercept (ETA) during childhood.Methods. JuMBO (Juvenile arthritis MTX/Biologics long-term Observation) is an ongoing prospective cohort study. It follows adult JIA patients who were formerly included in the national JIA biologic register. In JuMBO, clinical status, therapy and the occurrence of adverse events are documented every 6 months by physicians; additionally, patient-derived data are included [e.g. functional capacity and health-related quality of life (HRQoL)]. Here, data from the last available visit of patients were analysed.Results. Until December 2010, 346 patients with a median age of 21 years were included in JuMBO. The majority of them had polyarthritis. Seventy-eight per cent of them were still on DMARDs, 45% on ETA. The disease was inactive in about one in five patients. A restricted functional capacity was reported by 51% of participants and fatigue by 76%. The patients judged their HRQoL to be lower than a reference group from the general population, but only with regard to physical health. HRQoL correlated with the patient's perceived fatigue. Most frequently observed comorbidities in the young adults with JIA were disease related and included uveitis, IBDs and psoriasis. During the observation period, 2.1 severe infections and 1.5 new-onset autoimmune events per 100 patient-years were reported in patients on ETA, respectively.Conclusion. The first data from the JuMBO register indicate an improved long-term outcome of patients with severe JIA treated in the biologic era and an acceptable safety profile of ETA. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.


Enghard P.,Charite - Medical University of Berlin | Rieder C.,Charite - Medical University of Berlin | Kopetschke K.,Charite - Medical University of Berlin | Klocke J.R.,Charite - Medical University of Berlin | And 13 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives Proliferative lupus nephritis (LN) is one of the major concerns in the treatment of systemic lupus erythematosus (SLE). Here we evaluate urinary CD4 T cells as a biomarker of active LN and indicator of treatment response. Methods Urinary CD3CD4 T cells were quantified using flow cytometry in 186 urine samples from 147 patients with SLE. Fourteen patients were monitored as follow-up. Thirty-one patients with other nephropathies and 20 healthy volunteers were included as controls. Results In SLE, urinary CD4 T cell counts ≥800/100 ml were observed exclusively in patients with active LN. Receiver operator characteristic analysis documented clear separation of SLE patients with active and non-active LN (area under the curve 0.9969). All patients with up-todate kidney biopsy results showing proliferative LN had high urinary CD4 T cell numbers. In patients monitored under therapy, normalisation of urinary CD4 T cell counts indicated lower disease activity and better renal function. In contrast, patients with persistence of, or increase in, urinary T cells displayed worse outcomes. Conclusions Urinary CD4 T cells are a highly sensitive and specific marker for detecting proliferative LN in patients with SLE. Furthermore, monitoring urinary CD4 T cells may help to identify treatment responders and treatment failure and enable patient-tailored therapy in the future.

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