The evolution of multipurpose sensors over the last decades has been investigated with the aim of developing innovative devices with applications in several fields of technology, including in the ...food industry. The integration of such sensors in food packaging technology has paved the way for intelligent food packaging. These integrated systems are capable of providing reliable information about the quality of the packed products during their storage period. To accomplish this goal, intelligent packs use a variety of sensors suited for monitoring the quality and safety of food products by recording the evolution of parameters like the quantity of pathogen agents, gases, temperature, humidity and storage period. This technology, when combined with IoT, is able to provide a lot more information than conventional food inspection technologies, which are limited to weight, volume, color and aspect inspection. The original system described in this work relies on a simple but effective method of integrated food monitoring, right at the client home, suitable for user prepared vacuum-packed foods. It builds upon the IoT concept and is able to create a network of interconnected devices. By using this approach, we are able to combine actuators and sensing devices also providing a common operating picture (COP) by sharing information over the platforms. More precisely, our system consists of gas, temperature and humidity sensors, which provide the essential information needed for evaluating the quality of the packed product. This information is transmitted wirelessly to a computer system providing an interface where the user can observe the evolution of the product quality over time.
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships ...between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter‐relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta‐análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, β = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.
This study sought to replicate and extend associations between clinical and demographic features at admission and types of premature treatment termination for adults diagnosed with anorexia nervosa ...(AN) in higher-level-of-care settings. Secondary data analyses examined a study population comprised of adults with AN (N = 565) who were admitted to one of two United States eating disorder treatment centers (April 2015-April 2020) for intensive outpatient, partial hospitalization, residential, or inpatient services. There were no significant differences in the type of non-routine discharge according to level of care. At admission, those with lower BMI were more likely to discharge against medical advice, and those with lower cognitive restraint and elevated binge eating were more likely to discharge against medical advice or by staff-initiated request, respectively. Discharge by parent/patient request was more likely among those who were older or who reported lower baseline desire for muscularity. Overall older age, elevated binge eating, and lower weight, desire for muscularity, and cognitive restraint may be associated with less tolerance/acceptability for AN treatment. Increased understanding of how to better support patients who admit to higher levels of care with these clinical features will contribute to better odds of completion of a full course of treatment.
Inpatient services showed less routine discharges compared to other levels of care
Level of care does not appear to associate with a specific type of discharge
Factors associated with premature discharge include older age and elevated binge eating
Lower weight, desire for muscularity, and restraint associate with premature discharge
Patients who admit with lower restraint and BMI are more likely to discharge against medical advice
With the increase in cardiac PET/CT availability and utilization, the development of a PET/CT-based major adverse cardiovascular events, including death, myocardial infarction (MI), and ...revascularization (MACE-Revasc) risk assessment score is needed. Here we develop a highly predictive PET/CT-based risk score for 90-day and one-year MACE-Revasc.
11,552 patients had a PET/CT from 2015 to 2017 and were studied for the training and development set. PET/CT from 2018 was used to validate the derived scores (n = 5049). Patients were on average 65 years old, half were male, and a quarter had a prior MI or revascularization. Baseline characteristics and PET/CT results were used to derive the MACE-Revasc risk models, resulting in models with 5 and 8 weighted factors. The PET/CT 90-day MACE-Revasc risk score trended toward outperforming ischemic burden alone P = .07 with an area under the curve (AUC) 0.85 vs 0.83. The PET/CT one-year MACE-Revasc score was better than the use of ischemic burden alone (P < .0001, AUC 0.80 vs 0.76). Both PET/CT MACE-Revasc risk scores outperformed risk prediction by cardiologists.
The derived PET/CT 90-day and one-year MACE-Revasc risk scores were highly predictive and outperformed ischemic burden and cardiologist assessment. These scores are easy to calculate, lending to straightforward clinical implementation and should be further tested for clinical usefulness.
在40-70%有缺血症状的患者中, 有创冠状动脉造影检查未发现梗阻性冠状动脉疾病 (INOCA) 。当这一病变组接受冠状动脉功能学检查, 大约三分之二的人有明显的冠状动脉微血管功能障碍 (CMD), 这与不良预后独立相关。CMD有四种不同的表型或亚组, 每种表型都有独特的病理生理机制和对应的不同治疗策略。CMD临床表型包括微血管性心绞痛、血管痉挛性心绞痛、混合型 (微血管和血管痉挛) 和非心脏症状 (重新分类为非INOCA) 。冠状动脉血管运动障碍国际研究组 (COVADIS) 提出了标准化的诊断标准。临床医生和指南对这些疾病的认识也在不断提高。
CorMicA研究提倡 "功能性血管造影 "的概念以指导分层医学治疗。对CMD的检测可以采用侵入性或非侵入性的方式进行。治疗方法大致分为两类: 控制心血管风险和缓解心绞痛症状。患者治疗管理应个体化, 并定期重新评估疗效。基于表型的管理对患者和临床医生来说都是值得努力的, 这与 "精准医学 "以改善预后、症状改善和提高生活质量的概念相一致。在此, 我们对于INOCA患者提出了一种基于表型管理的现代方法。
Loss of control (LOC) eating in youth is a common disordered eating behavior and associated with negative health and psychological sequalae. Family-based treatment (FBT) is an efficacious treatment ...for adolescent anorexia nervosa and bulimia nervosa (BN) but has not been formally evaluated for adolescents with LOC eating. This study is a secondary data analysis from a randomized controlled clinical trial (NCT00879151) testing FBT for 12-18-year-olds with BN. Data were reanalyzed to examine outcomes for LOC eating episodes, regardless of episode size. Abstinence rates, defined as zero LOC eating episodes (objective or subjective binge episodes) in the previous month, were calculated at the end-of-treatment (EOT), 6-month, and 12-month follow-up time points. Among 51 adolescent participants (M + SD: 15.94 + 1.53 y; 92% female; 23.5% Hispanic; 76.5% Caucasian), FBT significantly reduced LOC eating episodes, with 49% achieving LOC eating abstinence at EOT. At 6-month follow-up, 41% achieved LOC eating abstinence. Of those providing 12-month follow-up data, 73% achieved abstinence. This preliminary exploration suggests that FBT may be effective for youth with LOC eating, regardless of episode size. Additional research is needed to replicate these findings and extend treatments with developmental adaptations for younger children with LOC eating.
This paper reports on Magnetospheric Multiscale observations of whistler mode chorus and higher‐frequency electrostatic waves near and within a reconnection diffusion region on 23 November 2016. The ...diffusion region is bounded by crescent‐shaped electron distributions and associated dissipation just upstream of the X‐line and by magnetic field‐aligned currents and electric fields leading to dissipation near the electron stagnation point. Measurements were made southward of the X‐line as determined by southward directed ion and electron jets. We show that electrostatic wave generation is due to magnetosheath electron beams formed by the electron jets as they interact with a cold background plasma and more energetic population of magnetospheric electrons. On the magnetosphere side of the X‐line the electron beams are accompanied by a strong perpendicular electron temperature anisotropy, which is shown to be the source of an observed rising‐tone whistler mode chorus event. We show that the apex of the chorus event and the onset of electrostatic waves coincide with the opening of magnetic field lines at the electron stagnation point.
Key Points
Whistler mode chorus and higher‐frequency electrostatic waves were observed in the vicinity of a reconnection diffusion region at the dayside magnetopause
The location of the Earthward boundary of chorus and electrostatic waves coincides with the opening of magnetic field lines via reconnection
The causes of whistler mode chorus and electrostatic waves are shown to be electron temperature anisotropy and beam‐plasma interactions, respectively
Using a dual-mode STM-AFM microscope operating below 50 mK we measured the local density of states along small normal wires connected at both ends to superconductors with different phases. We observe ...that a uniform minigap can develop in the whole normal wire and in the superconductors near the interfaces. The minigap depends periodically on the phase difference. The quasiclassical theory of superconductivity applied to a simplified 1D model geometry accounts well for the data.
Observations of magnetic reconnection at Earth's magnetopause often display asymmetric structures that are accompanied by strong magnetic field (B) fluctuations and large‐amplitude parallel electric ...fields (E||). The B turbulence is most intense at frequencies above the ion cyclotron frequency and below the lower hybrid frequency. The B fluctuations are consistent with a thin, oscillating current sheet that is corrugated along the electron flow direction (along the X line), which is a type of electromagnetic drift wave. Near the X line, electron flow is primarily due to a Hall electric field, which diverts ion flow in asymmetric reconnection and accompanies the instability. Importantly, the drift waves appear to drive strong parallel currents which, in turn, generate large‐amplitude (~100 mV/m) E|| in the form of nonlinear waves and structures. These observations suggest that turbulence may be common in asymmetric reconnection, penetrate into the electron diffusion region, and possibly influence the magnetic reconnection process.
Key Points
Asymmetric magnetic reconnection at the magnetopause often has strong magnetic field fluctuations and intense parallel electric fields
The magnetic field fluctuations are consistent with a thin, oscillating current sheet that is corrugated along the X line (drift wave)
The drift waves appear to drive strong parallel currents which, in turn, generate large‐amplitude parallel electric fields
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