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BACKGROUND: While the efficacy of digital interventions for the treatment of depression is well established, comprehensive knowledge on how therapeutic changes come about is still limited. This systematic review aimed to provide an overview of research on change mechanisms in digital interventions for depression and meta-analytically evaluate indirect effects of potential mediators. METHODS: The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for randomized controlled trials investigating mediators of digital interventions for adults with depression. Two reviewers independently screened studies for inclusion, assessed study quality and categorized potential mediators. Indirect effects were synthesized with a two-stage structural equation modeling approach (TSSEM). RESULTS: Overall, 25 trials (8110 participants) investigating 84 potential mediators were identified, of which attentional (8â¯%), self-related (6â¯%), biophysiological (6â¯%), affective (5â¯%), socio-cultural (2â¯%) and motivational (1â¯%) variables were the scope of this study. TSSEM revealed significant mediation effects for combined self-related variables (abâ¯=â¯-0.098; 95â¯%-CI: [-0.150, -0.051]), combined biophysiological variables (abâ¯=â¯-0.073; 95â¯%-CI: [-0.119, -0.025]) and mindfulness (abâ¯=â¯-0.042; 95â¯%-CI: [-0.080, -0.015]). Meta-analytical evaluations of the other three domains were not feasible. LIMITATIONS: Methodological shortcomings of the included studies, the considerable heterogeneity and the small number of investigated variables within domains limit the generalizability of the results. CONCLUSION: The findings further the understanding of potential change mechanisms in digital interventions for depression and highlight recommendations for future process research, such as the consideration of temporal precedence and experimental manipulation of potential mediators, as well as the application of network approaches.
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Feature models are frequently used to capture the knowledge about configurable software systems and product lines. However, feature modeling of large-scale systems is challenging as models are needed for diverse purposes. For instance, feature models can be used to reflect the perspectives of product management, technical solution architecture, or product configuration. Furthermore, models are required at different levels of granularity. Although numerous approaches and tools are available, it remains hard to define the purpose, scope, and granularity of feature models. This paper first reports results and experiences of an exploratory case study on developing feature models for two large-scale industrial automation software systems. We report results on the characteristics and modularity of the feature models, including metrics about model dependencies. Based on the findings from the study, we developed FORCE, a modeling language, and tool environment that extends an existing feature modeling approach to support models for different purposes and at multiple levels, including mappings to the code base. We demonstrate the expressiveness and extensibility of our approach by applying it to the well-known Pick and Place Unit example and an injection molding subsystem of an industrial product line. We further show how our approach supports consistency between different feature models. Our results and experiences show that considering the purpose and level of features is useful for modeling large-scale systems and that modeling dependencies between feature models is essential for developing a system-wide perspective.
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The objective of the study was to investigate the first-night treatment success of a nasopharyngeal stent compared to standard nCPAP-titration. This is a case series and a single-center study. Eight participants (n = 8) were selected with untreated obstructive sleep apnea with a prestudy AHI ≥ 10. A newly developed nasopharyngeal stent was tested individually versus standard nCPAP-titration. Cardiorespiratory polysomnography was performed on two consecutive nights (random order: stent, nCPAP). The AHI, the number of obstructive apneas and hypopneas, the mean oxygen saturation, and the minimum oxygen saturation were compared before and after using the nasopharyngeal stent or standard nCPAP. The AHI value before treatment (AHIpre) was 31.1 ± 12.0 (mean ± standard deviation). After inserting the AlaxoStent, the mean AHIstent was 19 ± 12.0 compared to mean AHInCPAP 8.2 ± 11.9 with standard nCPAP-titration. Both nasopharyngeal stenting and nCPAP-titration could reduce the mean number of obstructive apneas by >94 %. Compared to responder rates of classic surgical interventions like uvulopalatopharyngoplasty or multi-level surgery, the nasopharyngeal stent seems to give a comparable responder rate of 50 %. There were no complications associated with the use of the stent and it was well tolerated by all subjects. Nasopharyngeal stenting widens the range of non-invasive mechanical treatment and seems to be an effective mechanical therapeutic alternative to surgery in nCPAP non-compliant patients with OSA. Careful selection of the patient population is a prerequisite of treatment and therefore it should be reserved for individual cases only.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Apnea Obstructiva del Sueño , Stents , Adulto , Investigación sobre la Eficacia Comparativa , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Presión de las Vías Aéreas Positiva Contínua/métodos , Presión de las Vías Aéreas Positiva Contínua/psicología , Diseño de Equipo , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/fisiopatología , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Selección de Paciente , Polisomnografía/métodos , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/fisiopatología , Apnea Obstructiva del Sueño/terapia , Resultado del TratamientoRESUMEN
The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in obstructive sleep apnea (OSA). Target-controlled infusion (TCI) of the sedative propofol was combined with real-time monitoring of the depth of sedation using bispectral analysis. In an observational study 57 patients (mean age 44.8 years, ± SD 10.5; mean apnea hypopnea Index (AHI) 30.8/hr, ± SD 21.6, mean BMI 28.2 kg/m2, ± SD 5.3) underwent cardiorespiratory polysomnography followed by DISE with TCI and bispectral analysis. Sleep was induced solely by the intravenous infusion of propofol with a TCI-pump, with an initial target plasma level of 2.0 µg/ml. Under continuous monitoring of the patient's respiration, state of consciousness and value of the bispectral analysis, the target plasma propofol level was raised in steps of 0.2 µg/ml/2 min until the desired depth of sedation was reached. The mean value of the bispectral analysis at the target depth of sedation was determined and the obstruction patterns during DISE-TCI-bispectral analysis then classified according to the VOTE-system. Subsequently the results were analyzed according to polysomnographic and anthropometric data. The occurrence of multilevel obstruction sites across all degrees of severity of OSA clarifies the need for sleep endoscopy prior to upper airway surgery. The advantage of this technique is the reproducibility of the protocol even for heterogeneous groups of patients. In addition, the gradual controlled and standardized increase of the plasma level of propofol with real-time control of the bispectral index leads to a precisely controllable depth of sedation. The DISE-TCI-bispectral analysis procedure is a step towards a required reproducible protocol of sleep endoscopy - capable of standardization. However it is not yet known whether these observed obstruction patterns also correspond to findings in natural sleep.