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Identifying phenotypes in OSA patients with an indication for CPAP treatment using clinical data and experienced symptom severity
No full textBACKGROUND: Although the group of patients with obstructive sleep apnea (OSA) is very heterogeneous, OSA's severity is mainly expressed by an apnea-hypopnea index (AHI), which does not correlate well with the experienced symptom severity. As a first step to develop a more personalized approach for treatment, the purpose of the current study was to create, through cluster analysis, meaningful OSA phenotypes linked to the Patient Reported Apnea Questionnaire (PRAQ).METHODS: Through a survey, new OSA patients indicated for continuous positive airway pressure (CPAP) treatment completed the Epworth Sleepiness Scale (ESS) and the PRAQ to rate their experienced symptom severity. Clinical data, such as the AHI and comorbidity, were assessed from the patient file. Cluster analysis has been performed to derive OSA phenotypes.RESULTS: Based on the AHI, comorbidity and experienced symptom severity data of 151 patients, a two-step cluster analysis revealed five OSA phenotypes: "no comorbidity", "hypertension", "high symptom severity", "low symptom severity" and "unclassified". The five phenotypes mainly differ in the experienced level of fatigue, partner-observed snoring severity and symptoms related to performing regular daily activities.CONCLUSION: Not only the AHI, but also comorbidity and subjective symptoms should be taken into consideration when diagnosing OSA, assessing its severity and in providing a more patient-oriented treatment, including deciding about CPAP treatment. Not the often-used ESS but the modified PRAQ scales provide relevant information to assess experienced symptom severity. In addition, for an improved prognostication, we propose an evaluation of the CPAP treatment effectiveness for the five reported OSA phenotypes.</p
Living Group Climate and Treatment Motivation in Adolescent Girls in Youth Detention - The Importance of Gender Specific Treatment
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Chimeras & other animals:The cultural imagination and conceptualization of human and non-human animals
No full textHow can art and literature help us see non-human animals differently—and rethink what it means to be human? This new issue of Locus explores the cultural representation of human-animal relationships through the lens of the chimera—hybrid beings composed of different animal species—and interspecies metamorphosis. Drawing from diverse disciplines in the humanities, the contributions offer ecocentric perspectives on coexistence between humans and non-human species through image, literary and poetic language, and the acting and dancing body. From singing crickets in a Disney film to early modern representations of the devil as an ambiguous creature, and from pig industry promotional materials to rat-people, and mourning rituals for melting glaciers, this issue reveals how cultural representations shape—and can help reimagine—our relationships with non-human animals.Articles in this issue include:• In our editorial, Winkler and I argue that the arts and literature are essential for expanding the human capacity to empathize with non-human species and for envisioning more eco-centric ways of multispecies coexistence.• Capitain examines the Disney film You, the Human Animal, showing how it presents music as a uniquely human trait—of Western people, to be precise.• Dialeti analyzes early modern theological and legal texts in which the devil, portrayed as a shape-shifting hybrid, blurs boundaries between spirit, human, and non-human animals, thus undermining human exceptionalism. The anxieties it provoked were allayed through witch hunts.• Verduin explores how climate catastrophe prompts changes in established ideas about mourning. Drawing on philosophy and visual art, he reflects on grief over ecological loss and species extinction.• Van Herten & Brouwer analyze how literary representations of rat-people express anxieties over the collapse of human order.• Rinzema & Dekker blend theory and visual art to expose hidden violence in the pig industry. Critiquing the emphasis on “performance” and “growth,” they call attention to the overlooked temporality of animal “waiting” as a way of acknowledging kinship and difference.• Fraipont & Vanasten offer a “zoopoetic” reading of Ramsey Nasr’s poem “zoo mensch zoo dier” (2005), exploring how it confronts unequal power dynamics between humans and non-human animals and experiments with new literary and political forms of representation.<br/
Bayesian Network Analysis of Intervention-Induced Physical Activity Behavior Change:Comparative Modeling Study Across Age, Education, and Activity Impairment Subgroups
No full textBackground:Tailoring intervention content, such as those designed to improve physical activity (PA) behavior, can enhance effectiveness. Previous Bayesian network research showed that it might be relevant to tailor PA interventions based on demographic factors such as gender, revealing differences in determinants’ roles between subpopulations. In order to optimize tailoring, one needs to understand the differences between subpopulations based on different characteristics. Building on this, this study examines age, education level, and PA impairment as key moderators, as these factors might influence PA engagement and intervention responsiveness. Older adults, for example, rely more on habitual behavior, lower-educated individuals may face challenges due to lower health literacy and socioeconomic inequalities, and individuals with PA impairment, defined as functional impairments restricting PA, may face unique barriers to PA. Understanding differences based on these factors is crucial for optimizing interventions and ensuring effectiveness across diverse populations.Objective:This study investigates, by means of Bayesian networks, differences in PA intervention mechanisms of subpopulations based on age, education level, and PA impairment.Methods:Subpopulation-specific subsets from an integrated dataset of 5 studies are analyzed, including demographics, experimental group assignment, and PA and sociocognitive measures at baseline, short term, and long term. The relevant subpopulations are defined based on age, education level, and PA impairment. For each subpopulation, a stable Bayesian network is estimated based on the corresponding subset of data by applying a bootstrap procedure and according to a confidence threshold, relevant paths of the model are visualized in order to find indications regarding subpopulation-specific intervention mechanisms.Results:A comparison of subpopulation-specific models unveils similarities and differences with respect to determinants’ roles in PA behavior change induced by interventions. Similar structures of determinants affect short-term PA, ultimately causing effects in the long term, where intention and habit are directly related to PA for most subpopulations. With respect to age-based differences, the interventions influence PA less via attitude cons and planning for older than younger people. Looking at the level of education, planning and intrinsic motivation are less influential for low-educated participants compared with high- or medium-educated participants, whereas more influence takes place through attitude pros for this low-educated group with respect to maintaining effects in the long term. Looking at PA impairments, apart from the findings that attitude pros and planning are more relevant in the pathway of change for people without impairment, a more interesting insight is that fewer determinants are directly influenced by the intervention within the group with PA impairment.Conclusions:Intervention mechanisms in specific demographic groups have been rarely studied so far. Initial interpretations from the derived subpopulation models in this study unveil subpopulation-specific patterns of behavioral change, which enable better tailoring of intervention content to characteristics of the target population in order to induce or enhance effects