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In applied ecophysiological studies related to global warming and water scarcity, the water status of fruit is of increasing importance in the context of fresh food production. In the present work, a fruit water stress index (FWSI) is introduced for close analysis of the relationship between fruit and air temperatures. A sensor system consisting of light detection and ranging (LiDAR) sensor and thermal camera was employed to remotely analyze apple trees (Malus x domestica Borkh. “Gala”) by means of 3D point clouds. After geometric calibration of the sensor system, the temperature values were assigned in the corresponding 3D point cloud to reconstruct a thermal point cloud of the entire canopy. The annotated points belonging to the fruit were segmented, providing annotated fruit point clouds. Such estimated 3D distribution of fruit surface temperature (TEst) was highly correlated to manually recorded reference temperature (r2 = 0.93). As methodological innovation, based on TEst, the fruit water stress index (FWSIEst) was introduced, potentially providing more detailed information on the fruit compared to the crop water stress index of whole canopy obtained from established 2D thermal imaging. FWSIEst showed low error when compared to manual reference data. Considering in total 302 apples, FWSIEst increased during the season. Additional diel measurements on 50 apples, each at 6 measurements per day (in total 600 apples), were performed in the commercial harvest window. FWSIEst calculated with air temperature plus 5 °C appeared as diel hysteresis. Such diurnal changes of FWSIEst and those throughout fruit development provide a new ecophysiological tool aimed at 3D spatiotemporal fruit analysis and particularly more efficient, capturing more samples, insight in the specific requests of crop management.

Abstract Introduction To make efficient use of available resources, decision-makers in healthcare may assess the costs and (health) benefits of health interventions. For interventions aimed at improving mental health capturing the full health benefits is an important challenge. The Mental Health Quality of Life (MHQoL) instrument was recently developed to meet this challenge. Evaluating the pyschometric properties of this instrument in different contexts remains important. Methods A psychometric evaluation of the MHQoL was performed using existing international, cross-sectional data with 7155 respondents from seven European countries (Denmark, France, Germany, Italy, Portugal, The Netherlands, Portugal and the United Kingdom). Reliability was examined by calculating Cronbach’s alpha, a measure of internal consistency of the seven MHQoL dimensions, and by examining the association of the MHQoL sum scores with the MHQoL-VAS scores. Construct validity was examined by calculating Spearman’s rank correlation coefficients between the MHQoL sum scores and EQ-5D index scores, EQ-VAS scores, EQ-5D anxiety/depression dimension scores, ICECAP-A index scores and PHQ-4 sum scores. Results The MHQoL was found to have good internal consistency for all seven countries. The MHQoL sum score and the MHQoL-VAS had a high correlation. Spearman’s rank correlation coefficients were moderate to very high for all outcomes. Conclusion Our results, based on data gathered in seven European countries, suggest that the MHQoL shows favourable psychometrical characteristics. While further validation remains important, the MHQoL may be a useful instrument in measuring mental health-related quality of life in the Western European context.

Abstract Introduction Drug reimbursement decisions are often made based on a price set by the manufacturer. In some cases, this price leads to public and scientific debates about whether its level can be justified in relation to its costs, including those related to research and development (R&D) and manufacturing. Such considerations could enter the decision process in collectively financed health care systems. This paper investigates whether manufacturers’ costs in relation to drug prices, or profit margins, are explicitly mentioned and considered by health technology assessment (HTA) organisations. Method An analysis of reimbursement reports for cancer drugs was performed. All relevant Dutch HTA-reports, published between 2017 and 2019, were selected and matched with HTA-reports from three other jurisdictions (England, Canada, Australia). Information was extracted. Additionally, reimbursement reports for three cases of expensive non-oncolytic orphan drugs prominent in pricing debates in the Netherlands were investigated in depth to examine consideration of profit margins. Results A total of 66 HTA-reports concerning 15 cancer drugs were included. None of these reports contained information on manufacturer’s costs or profit margins. Some reports contained general considerations of the HTA organisation which related prices to manufacturers’ costs: six contained a statement on the lack of price setting transparency, one mentioned recouping R&D costs as a potential argument to justify a high price. For the case studies, 21 HTA-reports were selected. One contained a cost-based price justification provided by the manufacturer. None of the other reports contained information on manufacturer’s costs or profit margins. Six reports contained a discussion about lack of transparency. Reports from two jurisdictions contained invitations to justify high prices by demonstrating high costs. Conclusion Despite the attention given to manufacturers’ costs in relation to price in public debates and in the literature, this issue does not seem to get explicit systematic consideration in the reimbursement reports of expensive drugs.

Abstract Background Valid measures of the well-being of older people are important for the evaluation of health and social care services. The nine-item Well-being of Older People measure (WOOP) was based on a novel framework derived from a recent Q-methodology study, and was developed to capture a comprehensive set of well-being domains relevant to older people, as identified by themselves. This study introduces the WOOP and describes the qualitative assessment of its feasibility and content validity. Methods Between December 2017 and January 2018, a sampling agency retrieved data from 269 adults aged 65 years and older in the Netherlands. Using an online survey, participants were asked to complete the WOOP and to indicate the importance of each item to their well-being. Open-ended questions were used to collect information about participants’ own definition of well-being, their interpretation of the items of the WOOP, and their assessment of the descriptions and response options provided with each item. Data were analysed using inductive content analysis with the software package ATLAS.ti. Results The WOOP closely resembled respondents’ own description of what well-being means to them. The majority of the respondents reported no important well-being aspects to be missing from the WOOP, and indicated all WOOP items to be at least ‘reasonably important’ to their well-being. Many linked the WOOP items to well-being aspects as intended, and only a few had suggestions for improving the items’ descriptions and response options. Conclusions Given these results, all nine items were retained, and no items were added to the measure. Based on respondents’ feedback, minor changes were made to the wording of some descriptions and response options of items. Concluding, the feasibility and content validity of the WOOP seem satisfactory. Further validation of this new measure is required, in different health and social care settings and among subgroups of older people with potentially different views on what constitutes well-being.

Abstract Background We aimed to investigate the acceptability of imperfect health states in relation to age in Hungary and analyse its determinants. Results are contrasted to age-matched actual population health scores and to findings from a previous study in The Netherlands. Methods A cross-sectional online survey was performed. The same survey questions were applied as in a previous study in The Netherlands in order to enable inter-country comparisons. The descriptive system of the EQ-5D-3L health status questionnaire was used to assess the acceptability of moderate and severe health problems at ages from 30 to 80 by 10-year age-groups. Descriptive statistics were performed and linear regression analysis was used to investigate the determinants of acceptability. Results Altogether 9281 (female 32.8%) were involved with mean age 36.0 years and EQ-5D-3L index score of 0.852 (SD 0.177). Acceptability of health problems increased with age, differed per health domain and with severity of the problems. Except for ‘Self-care’, moderate health problems were acceptable by the majority from age 70 and acceptability scores were lower than EQ-5D-3L population norms from that age. The lowest average acceptability age was found in the ‘Anxiety/depression’ and dimension the highest in the ‘Self-care’ dimension. Respondents’ age, current health, and lifestyle were significant determinants (R2: 0.041–0.130). With a few minor exceptions in some health dimensions, acceptability levels and patterns were strikingly similar to the Dutch findings. Conclusion In Hungary, acceptability of health problems increases with age and the majority found severe problems never acceptable. Views on acceptability of health problems seem to be fairly generalizable across European countries with different health and economic indicators.

Abstract Background Health behaviours like smoking, nutrition, alcohol consumption and physical activity (SNAP) are often studied separately, while combinations can be particularly harmful. This study aims to contribute to a better understanding of lifestyle choices by studying the prevalence of (combinations of) unhealthy SNAP behaviours in relation to attitudinal factors (time orientation, risk attitude) and subjective health (self-rated health, life expectancy) among the adult Dutch population. Methods In total 1006 respondents, representative of the Dutch adult population (18–75 years) in terms of sex, age, and education, were drawn from a panel in 2016. They completed an online questionnaire. Groups comparisons and logistic regression analyses (crude and adjusted) were applied to analyse (combinations of) SNAP behaviours in relation to time orientation (using the Consideration of Future Consequences scale comprising Immediate (CFC-I) and Future (CFC-F) scales) and risk attitude (Health-Risk Attitude Scale; HRAS-6), as well as subjective health (visual analogue scale and subjective life expectancy). Results In the analyses, 989 respondents (51% men, average 52 years, 22% low, 48% middle, and 30% high educated) were included. About 8% of respondents engaged in four unhealthy SNAP behaviours and 18% in none. Self-rated health varied from 5.5 to 7.6 in these groups, whilst subjective life expectancy ranged between 73.7 and 85.5 years. Logistic regression analyses, adjusted for socio-demographic variables, showed that smoking, excessive drinking and combining two or more unhealthy SNAP behaviours were significantly associated with CFC-I scores, which increased the odds by 30%, 18% and 19%, respectively. Only physical inactivity was significantly associated with CFC-F scores, which increased the odds by 20%. Three out of the four SNAP behaviours were significantly associated with HRAS-6, which increased the odds between 6% and 12%. An unhealthy diet, excessive drinking, and physical inactivity were significantly associated with SRH, which decreased the odds by 11%. Only smoking was significantly associated with subjective life expectancy, which decreased the odds by 3%. Conclusion Our findings suggest that attitudinal factors and subjective health are relevant in the context of understanding unhealthy SNAP behaviours and their clustering. This emphasizes the relevance of a holistic approach to health prevention rather than focusing on a single unhealthy SNAP behaviour.

Opening and greening are main characteristics of morphogenesis of cotyledons. For revealing interrelationship between metabolism and morphogenesis, metabolic shifts were analyzed in cotyledon of A. membranaceus seedlings with different stages in light and in darkness. Light induced 69 metabolites (MA), related to cotyledon greening; additional 89 metabolites (MB), related to cotyledon opening, were identified by WGCNA. The screening of metabolites shared in both MA and MB obtained 37 specific metabolites (MC) related to both opening and greening. In this context, main changes in MC occurred during A3, the stage in which cotyledons fully opened and greened. Within MC, few sugars, including L-(-)-sorbose, mannose, glucose and its derivatives, markedly decreased, while other sugars, amino acids, and unsaturated fatty acids increased. Most isoflavones and flavonols including ononin, caycosin-7-glucosides, quercetin, genistein, and catechin increased 5.3, 5.5, 13.4, 6.4 and 1.8 times, respectively. Thus, accumulated flavonoids play an important role during this developmental stage.

The capacity of apple trees to produce fruit of a desired diameter, i.e., fruit-bearing capacity (FBC), was investigated by considering the inter-tree variability of leaf area (LA). The LA of 996 trees in a commercial apple orchard was measured by using a terrestrial two-dimensional (2D) light detection and ranging (LiDAR) laser scanner for two consecutive years. The FBC of the trees was simulated in a carbon balance model by utilizing the LiDAR-scanned total LA of the trees, seasonal records of fruit and leaf gas exchanges, fruit growth rates, and weather data. The FBC was compared to the actual fruit size measured in a sorting line on each individual tree. The variance of FBC was similar in both years, whereas each individual tree showed different FBC in both seasons as indicated in the spatially resolved data of FBC. Considering a target mean fruit diameter of 65 mm, FBC ranged from 84 to 168 fruit per tree in 2018 and from 55 to 179 fruit per tree in 2019 depending on the total LA of the trees. The simulated FBC to produce the mean harvest fruit diameter of 65 mm and the actual number of the harvested fruit >65 mm per tree were in good agreement. Fruit quality, indicated by fruit's size and soluble solids content (SSC), showed enhanced percentages of the desired fruit quality according to the seasonally total absorbed photosynthetic energy (TAPE) of the tree per fruit. To achieve a target fruit diameter and reduce the variance in SSC at harvest, the FBC should be considered in crop load management practices. However, achieving this purpose requires annual spatial monitoring of the individual FBC of trees.

Abstract Background Selection of the optimal initial treatment in patients with major depressive disorder (MDD) in need of highly specialized care has the potential to benefit treatment outcomes and cost-effectiveness of treatment strategies. However, to date, there is a paucity of measures that could guide the selection of the initial treatment, in particular to indicate which patients with MDD are in need of highly specialized care. Recognizing this gap, this paper reports on the development and psychometric evaluation of the Decision Tool Unipolar Depression (DTUD), aimed to facilitate the early identification of patients with MDD in need of highly specialized care. Methods The DTUD was developed using a mixed-methods approach, consisting of a systematic review and a concept mapping study. To evaluate the psychometric features of the DTUD, a cross-sectional multicenter study was conducted. A total of 243 patients with MDD were evaluated with the DTUD. Feasibility was operationalized as the time required to complete the DTUD and the content clarity of the DTUD. Inter-rater reliability was evaluated using Krippendorf’s alpha. The Maudsley Staging Method (MSM) and the Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) were administered to assess the convergent validity. A receiver operator characteristic curve was generated to evaluate the criterion validity and establish the optimal cut-off value. Results The mean administration time was 4.49 min (SD = 2.71), and the content of the total DTUD was judged as clear in 94.7% of the evaluations. Inter-rater reliability values ranged from 0.69 to 0.91. Higher scores on the DTUD were associated with higher scores on the MSM (rs = 0.47) and DM-TRD (rs = 0.53). Based on the maximum Youden index (0.494), maximum discrimination was reached at a cut-off score of ≥5 (sensitivity 67%, specificity 83%). Conclusion The DTUD demonstrated to be a tool with solid psychometric properties and, therefore, is a promising measure for the early identification of patients with MDD in need of highly specialized care. Use of the DTUD has the potential to facilitate the selection and initiation of the optimal initial treatment in patients with MDD, which in turn may improve the clinical effectiveness and cost-effectiveness of treatment strategies.

BackgroundEarly identification of patients with an anxiety disorder, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD) in need of highly specialized care could facilitate the selection of the optimal initial treatment in these patients. This paper describes the development and psychometric evaluation of the Decision Tool Anxiety Disorders, OCD and PTSD (DTAOP), which aims to aid clinicians in the early identification of patients with an anxiety disorder, OCD, or PTSD in need of highly specialized mental healthcare.MethodsA systematic literature review and a concept mapping procedure were carried out to inform the development of the DTAOP. To evaluate the psychometric properties of the DTAOP, a cross-sectional study in 454 patients with a DSM-IV-TR anxiety disorder was carried out. Feasibility was evaluated by the completion time and the content clarity of the DTAOP. Inter-rater reliability was assessed in a subsample of 87 patients. Spearman's rank correlation coefficients between the DTAOP and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were computed to examine the convergent validity. Criterion validity was assessed against independent clinical judgments made by clinicians.ResultsThe average time required to complete the eight-item DTAOP was 4.6 min and the total DTAOP was evaluated as clear in the majority (93%) of the evaluations. Krippendorff's alpha estimates ranged from 0.427 to 0.839. Based on the qualitative feedback, item wording and instructions were improved. As hypothesized, the DTAOP correlated negatively with EQ-5D-5L scores. The area under the curve was 0.826 and the cut-off score of ≥4 optimized sensitivity (70%) and specificity (71%).ConclusionsThe DTAOP demonstrated excellent feasibility and good validity, but weak inter-rater reliability. Based on the qualitative feedback and reliability estimates, revisions and refinements of the wording and instructions were made, resulting in the final version of the DTAOP.

BackgroundEarly identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.AimsTo develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups.MethodThe Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.ResultsThe six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value.ConclusionsThe Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.

In cherry production, the assimilate supply to the fruit is a crucial factor for growth and formation of quality parameters. The assimilate supply per fruit is limited by the relative growth capacity of trees, represented by the leaf area to fruit ratio (LA:F). In the present study, the required leaf area per fruit (LAdemand [cm² fruit-1]) of two sweet cherry cultivars, 'Bellise' and 'Regina', was estimated in 2018 and 2019, based on measured and interpolated values of fruit growth and fruit respiration rates. LA demand changed daily with an overall increase during fruit development, showing average values in stage III in 2018 and 2019 of 139 cm² and 175 cm² in 'Bellise', while 199 cm² and 212 cm² were found in 'Regina', respectively. Estimated LA demand for both cultivars was compared with measurements in cherries grown on girdled branches. In both years, estimated values exceeded measured values. In both years, positive correlation between LA:F and fresh mass, soluble solids content, and coloration was observed. The data obtained can be applied to evaluate the tree’s crop load for precise management.t growth and fruit respiration rates. LAdemand changed daily with an overall increase during fruit development, in 2018 and 2019 showing average values in stage III of 226 cm² and 294 cm² in 'Bellise', while 280 cm² and 229 cm² were found in 'Regina', respectively. Estimated LAdemand for both cultivars was validated with measurements in cherries grown on girdled branches. In 2018, estimated values were in the range of the measured values, while in 2019 estimated LAdemand was considerably higher. In both years, positive correlation between LA:F and fresh mass, soluble solids content, and coloration was observed. The data obtained can be applied to evaluate the tree’s crop load for precise management.

Abstract Background Most health valuation studies assume that individuals’ health valuations do not depend on social comparisons. However, there is some evidence that this assumption is not satisfied in practice. This paper tests whether self-rated health by means of a Visual Analogue Scale (VAS) is related to how one perceives the health of one’s contemporaries, while accounting for one’s health as classified by the EQ-5D classification system. Methods In a large sample (n = 1500), representative of the general public, we use a VAS to rate respondents’ own health and their assessment of their contemporaries’ health. In addition, we directly ask them whether they perceive their health to be better, the same, or worse than their contemporaries, and we measure their own health according to the EQ-5D-5 L. Results We find a positive relationship between own health rating and contemporaries’ health rating, after controlling for the respondents’ own health as classified according to the EQ-5D. Furthermore, we observe a discrepancy between relative health vis-à-vis age peers as measured by an ordinal comparison and relative health as measured by a VAS. Finally, respondents, especially women, tended to overestimate the health of other people of their age. Conclusions We provide evidence that people’s own health rating is related to the perception of health of contemporaries. Our results indicate that knowledge about a respondent’s perception of others’ health is useful in explaining health state valuations.

Green-ripe banana fruit are sensitive to chilling injury (CI) and, thus, prone to postharvest quality losses. Early detection of CI facilitates quality maintenance and extends shelf life. CI affects all metabolic levels, with membranes and, consequently, photosynthesis being primary targets. Optical techniques such as chlorophyll a fluorescence analysis (CFA) and spectroscopy are promising tools to evaluate CI effects in photosynthetically active produce. Results obtained on bananas are, however, largely equivocal. This results from the lack of a rigorous evaluation of chilling impacts on the various aspects of photosynthesis. Continuous and modulated CFA and imaging (CFI), and VIS remission spectroscopy (VRS) were concomitantly applied to noninvasively and comprehensively monitor photosynthetically relevant effects of low temperatures (5 °C, 10 °C, 11.5 °C and 13 °C). Detailed analyses of chilling-related variations in photosynthetic activity and photoprotection, and in contents of relevant pigments in green-ripe bananas, helped to better understand the physiological changes occurring during CI, highlighting that distinct CFA and VRS parameters comprehensively reflect various effects of chilling on fruit photosynthesis. They revealed why not all CFA parameters can be applied meaningfully for early detection of chilling effects. This study provides relevant requisites for improving CI monitoring and prediction.

An amendment to this paper has been published and can be accessed via the original article.

In the vegetable processing industry, the application of chlorine dioxide (ClO2) as a disinfectant solved in washing water to eliminate undesirable microorganisms harmful to consumers’ health and the shelf life of produce has been discussed for years. The disinfection efficacy depends on various factors, e.g., the location of microorganisms and the organic load of the washing water. The present study analyzed the sanitation efficacy of various concentrations of water-solved ClO2 (cClO2: 20 and 30 mg L−1) on Escherichia coli (1.1 × 104 cfu mL−1), Salmonella enterica (2.0 × 104 cfu mL−1) and Listeria monocytogenes (1.7 × 105 cfu mL−1) loads, located on the leaf surface of iceberg lettuce assigned for fresh-cut salads. In addition, it examined the potential of ClO2 to prevent the cross-contamination of these microbes in lettuce washing water containing a chemical oxygen demand (COD) content of 350 mg L−1 after practice-relevant washing times of 1 and 2 min. On iceberg leaves, washing with 30 mg L−1 ClO2 pronouncedly (1 log) reduced loads of E. coli and S. enterica, while it only insignificantly (L. monocytogenes, irrespective of the ClO2 concentration used. Although the sanitation efficacy of ClO2 washing was only limited, the addition of ClO2 to the washing water avoided cross-contamination even at high organic loads. Thus, the application of ClO2 to the lettuce washing water can improve product quality and consumer safety.

Hemp currently regains certain importance as fiber, oil and medical crop not least because of its modest requirements of biocides, fertilizer and water. During recent years, crops were exposed to a combination of drought and heat, even in northern Central-Europe. Dynamic responses of photosynthesis and stomatal conductance to these stresses and their persistent effects had been studied, if at all, in controlled environment experiments. Comprehensive field studies on diurnal and long-term net photosynthesis and gas exchange, and yield properties of hemp during a drought prone, high-temperature season in northern Central-Europe are obviously missing. Thus, in whole season field trails, the essential actual physiological (rates of net photosynthesis and transpiration, stomatal conductance, water use efficiencies, ambient and internal CO2 concentrations) and the yield performance of modern high-yielding multi-purpose hemp cultivars, ‘Ivory’ and ‘Santhica 27’, were evaluated under extreme environmental conditions and highly limited soil water supply. This provides comprehensive information on the usability of these cultivars under potential future harsh production conditions. Plants of both cultivars differentially cope with the prevailing climatic and soil water conditions. While ‘Ivory’ plants developed high rates of CO2 gain and established large leaf area per plant in the mid-season, those of ‘Santhica 27’ utilized lower CO2 uptake rates at lower leaf area per plant most time. This and the higher germination success of ‘Santhica 27’ resulted in nearly twice the yield compared to ‘Ivory’. Although stomatal control of CO2 gain was pronounced in both cultivars, higher stomatal limitations in ‘Ivory’ plants resulted in higher overall intrinsic water use efficiency. Cultivation of both hemp cultivars with only basic irrigation during seed germination was successful and without large effects on yield and quality. This was valid even under extremely hot and dry climatic conditions in northern Central Europe.

For fresh-cut salad production, hot-water treatment (HWT) needs optimization in terms of temperature and duration to guarantee a gentle and non-stressing processing to fully retain product quality besides an effective sanitation. One major initial target of heat treatment is photosynthesis, making it a suitable and sensitive marker for HWT effects. Chlorophyll fluorescence imaging (CFI) is a rapid and non-invasive tool to evaluate respective plant responses. Following practical applications in fruit salad production, apples of colored and of green-ripe cultivars (‘Braeburn’, ‘Fuji’, ‘Greenstar’, ‘Granny Smith’), obtained from a local fruit salad producer, were hot-water treated from 44 to 70 °C for 30 to 300 s. One day after HWT and after 7 days of storage at 4 °C, CFI and remission spectroscopy were applied to evaluating temperature effects on photosynthetic activity, on contents of fruit pigments (chlorophylls, anthocyanins), and on various relevant quality parameters of intact apples. In ‘Braeburn’ apples, short-term HWT at 55 °C for 30 to 120 s avoided any heat injuries and quality losses. The samples of the other three cultivars turned out to be less sensitive and may be short-term heat-treated at temperatures of up to 60 °C for the same time. CFI proved to be a rapid, sensitive, and effective tool for process optimization of apples, closely reflecting the cultivar- or batch-specificity of heat effects on produce photosynthesis.

In situ, continuous and real-time monitoring of respiration (R) and respiratory quotient (RQ) are crucial for identifying the optimal conditions for the long-term storage of fresh produce. This study reports the application of a gas sensor (RMS88) and a modular respirometer for in situ real-time monitoring of gas concentrations and respiration rates of strawberries during storage in a lab-scale controlled atmosphere chamber (190 L) and of Pinova apples in a commercial storage facility (170 t). The RMS88 consisted of wireless O2 (0% to 25%) and CO2 sensors (0% to 0.5% and 0% to 5%). The modular respirometer (3.3 L for strawberries and 7.4 L for apples) consisted of a leak-proof arrangement with a water-containing base plate and a glass jar on top. Gas concentrations were continuously recorded by the RMS88 at regular intervals of 1 min for strawberries and 5 min for apples and, in real-time, transferred to a terminal program to calculate respiration rates ( R O 2 and R CO 2 ) and RQ. Respiration measurement was done in cycles of flushing and measurement period. A respiration measurement cycle with a measurement period of 2 h up to 3 h was shown to be useful for strawberries under air at 10 °C. The start of anaerobic respiration of strawberries due to low O2 concentration (1%) could be recorded in real-time. R O 2 and R CO 2 of Pinova apples were recorded every 5 min during storage and mean values of 1.6 and 2.7 mL kg−1 h−1, respectively, were obtained when controlled atmosphere (CA) conditions (2% O2, 1.3% CO2 and 2 °C) were established. The modular respirometer was found to be useful for in situ real-time monitoring of respiration rate during storage of fresh produce and offers great potential to be incorporated into RQ-based dynamic CA storage system.

In practice, fresh-cut fruit and fruit salads are currently stored submerged in sugar syrup (approx. 20%) to prevent browning, to slow down physiological processes and to extend shelf life. To minimize browning and microbial spoilage, slices may also be dipped in a citric acid/ascorbic acid solution for 5 min before storage in sugar syrup. To prevent the use of chemicals in organic production, short-term (30 s) hot-water treatment (sHWT) may be an alternative for gentle sanitation. Currently, profound knowledge on the impact of both sugar solution and sHWT on aroma and physiological properties of immersed fresh-cuts is lacking. Aroma is a very important aspect of fruit quality and generated by a great variety of volatile organic compounds (VOCs). Thus, potential interactive effects of sHWT and sugar syrup storage on quality of fresh-cut apple slices were evaluated, focusing on processing-induced changes in VOCs profiles. Intact ’Braeburn’ apples were sHW-treated at 55 °C and 65 °C for 30 s, sliced, partially treated with a commercial ascorbic/citric acid solution and slices stored in sugar syrup at 4 °C up to 13 days. Volatile emission, respiration and ethylene release were measured on storage days 5, 10 and 13. The impact of sHWT on VOCs was low while immersion and storage in sugar syrup had a much higher influence on aroma. sHWT did not negatively affect aroma quality of products and may replace acid dipping.

In orchards, the variations of fruit quality and its determinants are crucial for resource effective measures. In the present study, a drip-irrigated plum production (Prunus domestica L. “Tophit plus”/Wavit) located in a semi-humid climate was studied. Analysis of the apparent electrical conductivity (ECa) of soil showed spatial patterns of sand lenses in the orchard. Water status of sample trees was measured instantaneously by means of leaf water potential, Ψleaf [MPa], and for all trees by thermal imaging of canopies and calculation of the crop water stress index (CWSI). Methods for determining CWSI were evaluated. A CWSI approach calculating canopy and reference temperatures from the histogram of pixels from each image itself was found to suit the experimental conditions. Soil ECa showed no correlation with specific leaf area ratio and cumulative water use efficiency (WUEc) derived from the crop load. The fruit quality, however, was influenced by physiological drought stress in trees with high crop load and, resulting (too) high WUEc, when fruit driven water demand was not met. As indicated by analysis of variance, neither ECa nor the instantaneous CWSI could be used as predictors of fruit quality, while the interaction of CWSI and WUEc did succeed in indicating significant differences. Consequently, both WUEc and CWSI should be integrated in irrigation scheduling for positive impact on fruit quality.

In recent years, market pressures have reinforced the demand to solve the problem of an increased occurrence of Fusarium head blight (FHB) in cereal production, especially in wheat. The symptoms of this disease are clearly detectable by means of image analysis. This technique can therefore be used to map occurrence and extent of Fusarium infections. From this perspective, a separate harvest in the field can be taken into consideration. Based on the application of chlorophyll fluorescence and hyperspectral imaging, characteristics, requirements and limitations of Fusarium detection on wheat, both in the field and in the laboratory, are discussed. While the modification of spectral signatures due to fungal infection allows its detection by hyperspectral imaging, the decreased physiological activity of tissues resulting from Fusarium impacts provides the base for CFI analyses. In addition, the two methods are compared in view of their usability for the detection of Fusarium, and different approaches for data analysis are presented.

Head blight on wheat, caused by Fusarium spp., is a serious problem for both farmers and food production due to the concomitant production of highly toxic mycotoxins in infected cereals. For selective mycotoxin analyses, information about the on-field status of infestation would be helpful. Early symptom detection directly on ears, together with the corresponding geographic position, would be important for selective harvesting. Hence, the capabilities of various digital imaging methods to detect head blight disease on winter wheat were tested. Time series of images of healthy and artificially Fusarium-infected ears were recorded with a laboratory hyperspectral imaging system (wavelength range: 400 nm to 1,000 nm). Disease-specific spectral signatures were evaluated with an imaging software. Applying the ‘Spectral Angle Mapper’ method, healthy and infected ear tissue could be clearly classified. Simultaneously, chlorophyll fluorescence imaging of healthy and infected ears, and visual rating of the severity of disease was performed. Between six and eleven days after artificial inoculation, photosynthetic efficiency of infected compared to healthy ears decreased. The severity of disease highly correlated with photosynthetic efficiency. Above an infection limit of 5% severity of disease, chlorophyll fluorescence imaging reliably recognised infected ears. With this technique, differentiation of the severity of disease was successful in steps of 10%. Depending on the quality of chosen regions of interests, hyperspectral imaging readily detects head blight 7 d after inoculation up to a severity of disease of 50%. After beginning of ripening, healthy and diseased ears were hardly distinguishable with the evaluated methods.

During recent years, the consumption of prepackaged ready-to-eat salads has strongly increased. To facilitate the production of microbiological safe fresh-cut products, the potential of chlorine dioxide for decontamination of iceberg lettuce during washing and its effects on external and internal quality parameters of the produce were investigated. ClO2 application results in 5 to 6 log reduction of microorganisms in the washing water, depending on its chemical oxygen demand (COD). Colour parameters and vitamin C content of leaves were not affected by chlorine dioxide washing. Therefore, chlorine dioxide is an appropriate sanitizer to minimize human pathogens in lettuce washing water.

ObjectivesTo validate the ICECAP-O capability wellbeing measure's German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.MethodCross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics.ResultsConvergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years).DiscussionThe results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.

BACKGROUND: Increasing attention is being paid to the affordability of medicines in low- and middle-income countries (LICs and MICs) where medicines are often highly priced in relation to income levels. The impoverishing effect of medicine purchases can be estimated by determining pre- and postpayment incomes, which are then compared to a poverty line. Here we estimate the impoverishing effects of four medicines in 16 LICs and MICs using the impoverishment method as a metric of affordability. METHODS AND FINDINGS: Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because of the purchase of medicines. The prices of salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab were obtained from facility-based surveys undertaken using a standard measurement methodology. The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines. CONCLUSIONS: Comparing medicine prices to available income in LICs and MICs shows that medicine purchases by individuals in those countries could lead to the impoverishment of large numbers of people. Action is needed to improve medicine affordability, such as promoting the use of quality assured, low-priced generics, and establishing health insurance systems. Please see later in the article for the Editors' Summary.

BackgroundObesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.Methods and findingsWith a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and "healthy-living" persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.ConclusionsAlthough effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

This study investigated the association of child, caregiver, and caregiving measurements with the quality of life (QoL) in 81 caregivers (mostly parents) of clinically referred children with autism spectrum disorder (ASD). We used the EuroQol five-dimensional (EQ-5D) questionnaire and the care-related QoL questionnaire (CarerQol) to respectively assess health-related QoL and care-related QoL. Health-related QoL was associated with the caregiver's internalizing problems and adaptive coping, explaining 38% of the variance. Parenting stress and adaptive coping were associated with the care-related QoL and explained 60% of the variance. Child variables were not associated with the caregiver's health- and care-related QoL if caregiver and caregiving variables were taken into account. Findings indicate the importance of the caregiver's mental health, coping, and parenting stress in caring for children with ASD.

This study investigated health-related QoL (HRQoL) and care-related quality of life (CarerQol) in clinically referred children with an autism spectrum disorder (ASD), and their primary and secondary caregivers. The EuroQol five-dimensional (EQ-5D) and the CarerQol questionnaires were used to respectively measure health-related QoL and care-related QoL. Primary caregivers reported pain/discomfort (42%) and anxiety/depression (40%). In caring, they mostly experienced problems in the relationship with the child (84%), and in combining care with daily activities (51%). Children with ASD had a relevantly lower QoL. Despite negative effects, almost all caregivers (96%) derived fulfillment from caring for their affected children. HRQoL and CarerQol reports of primary caregivers and children were correlated, both providing useful information to ASD measurement and treatment.