Patients' Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study.

BACKGROUND: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. OBJECTIVE: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. METHODS: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. RESULTS: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 "paths" through which adherence to telehealth may improve. CONCLUSIONS: Our semiotic square illustrating patients' adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools.

Environmental sustainability assessment of biodegradable bio-based poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from agro-residues: Production and end-of-life scenarios.

In the context of a circular bio-based economy, more public attention has been paid to the environmental sustainability of biodegradable bio-based plastics, particularly plastics produced using emerging biotechnologies, e.g. poly(3-hydroxybutyrate-co-3-hydroxyvalerate) or PHBV. However, this has not been thoroughly investigated in the literature. Therefore, this study aimed to address three aspects regarding the environmental impact of PHBV-based plastic: (i) the potential environmental benefits of scaling up pellet production from pilot to industrial scale and the environmental hotspots at each scale, (ii) the most favourable end-of-life (EOL) scenario for PHBV, and (iii) the environmental performance of PHBV compared to benchmark materials considering both the pellet production and EOL stages. Life cycle assessment (LCA) was implemented using Cumulative Exergy Extraction from the Natural Environment (CEENE) and Environmental Footprint (EF) methods. The results show that, firstly, when upscaling the PHBV pellet production from pilot to industrial scale, a significant environmental benefit can be achieved by reducing electricity and nutrient usage, together with the implementation of better practices such as recycling effluent for diluting feedstock. Moreover, from the circularity perspective, mechanical recycling might be the most favourable EOL scenario for short-life PHBV-based products, using the carbon neutrality approach, as the material remains recycled and hence environmental credits are achieved by substituting recyclates for virgin raw materials. Lastly, PHBV can be environmentally beneficial equal to or even to some extent greater than common bio- and fossil-based plastics produced with well-established technologies. Besides methodological choices, feedstock source and technology specifications (e.g. pure or mixed microbial cultures) were also identified as significant factors contributing to the variations in LCA of (bio)plastics; therefore, transparency in reporting these factors, along with consistency in implementing the methodologies, is crucial for conducting a meaningful comparative LCA.

Effect of the Molecular Structure of Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (P(3HB-3HV)) Produced from Mixed Bacterial Cultures on Its Crystallization and Mechanical Properties.

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (P(3HB-3HV)) copolymer's properties depend on (i) the molar fraction of comonomers, (ii) the overall molar mass, and (ii) the chemical compositional distribution. This work aims at providing a better understanding of the effect of the P(3HB-3HV) molecular structure, produced from mixed cultures and waste feedstock, on copolymer crystallization and tensile properties. Conventional biopolymer characterization methods (differential scanning calorimetry, X-ray diffraction, and polarized optical microscopy) were coupled to both classical one-dimensional (1H and 13C) and advanced two-dimensional (diffusion-ordered spectroscopy (DOSY) and 1H/13C heteronuclear single quantum coherence (HSQC)) nuclear magnetic resonance (NMR) spectroscopy techniques. The obtained results evidenced that (i) a high-quality copolymer could be achieved, even from a waste feedstock; (ii) increasing the 3HV content displayed a positive impact on P(3HB-3HV) mechanical properties only if good interactions between 3HB and 3HV moieties were established; and (iii) the purification process eliminated short-length 3HV-rich chains and promoted homogeneous co-crystallization. Such optimized microstructures enabled the maximal stress and strain at break to be increased by +41.2 and +100%, respectively.

Predictive Microbiology Coupled with Gas (O2 /CO2 ) Transfer in Food/Packaging Systems: How to Develop an Efficient Decision Support Tool for Food Packaging Dimensioning.

Coupling gas transfer with predictive microbiology is essential to rationally design modified atmosphere packaging (MAP) strategies to ensure and guarantee food safety. Nowadays, these strategies are generally empirically built and over-sized since packaging material with high barrier properties is often chosen by default even if such a high level of protection is not systematically required. Protection strategies could be improved using rational sizing based on quantitative analysis and mathematical modeling of mass transfer. This paper aims at reviewing the current knowledge available for developing such a tool and the further research needed. First there is a special focus on oxygen (O2 ) and carbon dioxide (CO2 ) solubility and diffusivity parameters, which are absolutely indispensable to accurately model mass transfer in MAP systems. Next, the current knowledge of the effect of O2 /CO2 on the growth of microorganisms is explored with an emphasis on predictive microbiology. The last part points out the main bottlenecks and further research needed to be carried out in order to develop an efficient MAP modeling tool for food safety coupling O2 /CO2 transfer and predictive microbiology.

Oxygen and Carbon Dioxide Solubility and Diffusivity in Solid Food Matrices: A Review of Past and Current Knowledge.

Oxygen and carbon dioxide solubility and diffusivity are 2 key parameters to understand gas transfer in food matrices. Knowledge of these parameters could help to predict gas concentration in modified atmosphere packaging and, consequently, to predict shelf-life of the product through the development of appropriate mathematical models. The aim of this review is to present the existing methodologies to quantify O2 and CO2 contents in food, especially in solid food matrices which is very challenging. There is a focus on how these methodologies could be used to determine gas transfers kinetics. Data of O2 /CO2 solubilities and diffusivities in food are collected and compared with a specific emphasis on the food characteristics and factors impacting them. An analysis of the current state of knowledge in solid food matrices is carried out to tentatively build a general predictive model of the O2 and CO2 solubility and diffusivity extendable to any kind of food matrix.

CO2 solubility and composition data of food products stored in data warehouse structured by an ontology.

This data paper presents the values of CO2 solubility at different temperatures and main compositional parameters (protein, fat, moisture, sugars and salt content) for food products from different categories: dairy products, fishes and meats. It is the result of an extensive meta-analysis gathering the results of different major papers published on the domain on the period of 1980 to 2021, presenting the composition of 81 different food products corresponding to 362 solubility measures. For each food product, the compositional parameters were either extracted directly from the original source, or extracted from open-source databases. This dataset has also been enriched with measurements made on pure water and oil for comparison purposes. In order to ease the comparison between different sources, data have been semantized and structured by an ontology enriched with domain vocabulary. They are stored in a public repository and can be retrieved through the @Web tool, a user-friendly interface allowing to capitalize and query the data.

Integrating the latest biological advances in the key steps of a food packaging life cycle.

This literature review provides a focus on the potential of integrating the latest scientific and technological advances in the biological field to improve the status of the key steps of a food packaging life cycle: production, usage, post-usage, and long-term fate. A case study of such multi-biological food packaging is demonstrated based on the use of PHAs (polyhydroxyalkanoates) polymer, a microbiologically produced polymer from non-food renewable resources, activated by the use of bioactive components to enhance its usage benefits by reducing food loss and waste, displaying potential for reusability, compostability as post-usage, and finally, being ultimately biodegradable in most common natural conditions to considerably reduce the negative impact that persistent plastics have on the environment. We discuss how designing safe and efficient multi "bio" food packaging implies finding a compromise between sometimes contradictory functional properties. For example, active antimicrobials help preserve food but can hamper the ultimate biodegradation rate of the polymer. This review presents such antagonisms as well as techniques (e.g., coatings, nanoencapsulation) and tools (e.g., release kinetic) that can help design optimized, safe, and efficient active food packaging.

Environmental performance of plastic food packaging: Life cycle assessment extended with costs on marine ecosystem services.

Packaging can play a substantial role in moving towards more sustainable food systems by affecting the amount of food loss and waste. However, the use of plastic packaging gives rise to environmental concerns, such as high energy and fossil resource use, and waste management issues such as marine litter. Alternative biobased biodegradable materials, such as poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) could address some of these issues. For a careful comparison in terms of environmental sustainability between fossil-based, non-biodegradable and alternative plastic food packaging, not only production but also food preservation and end-of-life (EoL) fate must be considered. Life cycle assessment (LCA) can be used to evaluate the environmental performance, but the environmental burden of plastics released into the natural environment is not yet embedded in classical LCA. Therefore, a new indicator is being developed that accounts for the effect of plastic litter on marine ecosystems, one of the main burdens of plastic's EoL fate: lifetime costs on marine ecosystem services. This indicator enables a quantitative assessment and thus addresses a major criticism of plastic packaging LCA. The comprehensive analysis is performed on the case of falafel packaged in PHBV and conventional polypropylene (PP) packaging. Considering the impact per kilogram of packaged falafel consumed, food ingredients make the largest contribution. The LCA results indicate a clear preference for the use of PP trays, both in terms of (1) impact of packaging production and dedicated EoL treatment and (2) packaging-related impacts. This is mainly due to the higher mass and volume of the alternative tray. Nevertheless, since PHBV has limited persistence in the environment compared to PP packaging, the lifetime costs for marine ES are about seven times lower, and this despite its higher mass. Although further refinements are needed, the additional indicator allows for a more balanced evaluation of plastic packaging.

Cascading (3D) reconstruction procedure of composite structures from microtomography data.

Reconstruction of three-dimensional (3D) structure from experimental image acquisition (e.g., from micro computed tomography data) is very useful in composite material science. Composite considered are characterized by a dispersion of particles in a continuous phase. Many properties of the composite (e.g., mass transfer properties) depend on its structural assembly. A reliable prediction of these properties requires to well represent this structure and especially, the region at the vicinity of the dispersed phase. (3D) structure generation must thus permit to (1) simplify the real composite structure observed to make it compatible with further modelling tasks (e.g., meshing constraints in finite elements methods, computation time) and (2) keep enough representativeness of the structure of the specimen to produce reliable numerical predictions. This article describes an innovative, cascading (3D) reconstruction procedure of composite material from microtomography data.•First step of this pipeline is the extraction of relevant structural markers from microtomography images using image analysis.•Second step is the modelling of the distribution of the structural markers selected (statistical laws).•Third and final step is the reconstruction of the (3D) structures based on the pre-determined distribution laws in a RVE (representative volume element) of the composite.

Water Vapor Sorption and Diffusivity in Bio-Based Poly(Ethylene Vanillate)-PEV.

The dynamic and equilibrium water vapor sorption properties of amorphous and highly crystalline poly(ethylene vanillate) (PEV) films were determined via gravimetric analysis, at 20 °C, over a wide range of relative humidity (0-95% RH). At low RH%, the dynamic of the sorption process obeys Fick's law while at higher relative humidity it is characterized by a drift ascribable to non-Fickian relaxations. The non-Fickian relaxations, which are responsible for the incorporation of additional water, are correlated with the upturn of the sorption isotherms and simultaneously the hysteresis recorded between sorption and desorption cycles. The sorption isotherms of amorphous and highly crystalline PEV are arranged in the same concentration range of that of PET proving the similarity of the two polyesters. Water diffusion coefficients, whose determination from individual kinetic sorption/desorption curves required treatment with the Barens-Hopfenberg model, were demonstrated to be ≈ 10× higher for amorphous PEV compared to amorphous PET. Such a difference originates from the enhanced segmental flexibility of PEV chains.

3D Modelling of Mass Transfer into Bio-Composite.

A three-dimensional model structure that allows considering interphase layer around permeable inclusions is developed to predict water vapor permeability in composite materials made of a matrix Poly(3-HydroxyButyrate-co-3-HydroxyValerate) (PHBV) including Wheat Straw Fiber (WSF) particles. About 500 two-phase structures corresponding to composites of different particles volume fractions (5.14-11.4-19.52 % v/v) generated using experimental particles' size distribution have permitted to capture all the variability of the experimental material. These structures have served as a basis to create three-phase structures including interphase zone of altered polymer property surrounding each particle. Finite Element Method (FEM) applied on these structures has permitted to calculate the relative permeability (ratio between composite and neat matrix permeability P/Pm). The numerical results of the two-phase model are consistent with the experimental data for volume fraction lower than 11.4 %v/v but the large upturn of the experimental relative permeability for highest volume fraction is not well represented by the two-phase model. Among hypothesis made to explain model's deviation, the presence of an interphase with its own transfer properties is numerically tested: numerical exploration made with the three-phase model proves that an interphase of 5 µm thick, with diffusivity of Di≥1×10-10 m2·s-1, would explain the large upturn of permeability at high volume fraction.

Shear and Extensional Rheology of Linear and Branched Polybutylene Succinate Blends.

The molecular architecture and rheological behavior of linear and branched polybutylene succinate blends have been investigated using size-exclusion chromatography, small-amplitude oscillatory shear and extensional rheometry, in view of their processing using cast and blown extrusion. Dynamic viscoelastic properties indicate that a higher branched polybutylene succinate amount in the blend increases the relaxation time due to an increased long-chain branching degree. Branched polybutylene succinate exhibits pronounced strain hardening under uniaxial elongation, which is known to improve processability. Under extensional flow, the 50/50 wt % blend exhibits the same behavior as linear polybutylene succinate.

Gas barrier enhancement of uncharged apolar polymeric films by self-assembling stratified nano-composite films.

The gas (O2 and CO2) permeability of an innovative stratified PE-organoclay (LLDPE/OMMT) nano-enabled composite films was studied for the first time and related to the self-assembly process driven by hydrophobic interactions. An 84.4% and a 70% reduction (i.e. a barrier improvement factor of about 6, sufficient for food packaging applications) were observed respectively in the oxygen and carbon dioxide permeability of the 5 bilayers coated film compared to the substrate, while only incorporating 2.4 v/v% of organoclay in the composite and increasing the thickness by 17.7%. Such drastic effect with so low amount of organoclays cannot be achieved by conventional melt blending/exfoliation of the clays into the polymer matrix and is due to a geometrical blocking effect of a brick-wall and compact layer structure of the impermeable clay tactoids. Mathematical prediction of oxygen barrier performance of PE/OMMT films has revealed that 12 bilayers would be necessary to further achieve a barrier improvement factor of 10.

Elaboration and Characterization of Active Films Containing Iron-Montmorillonite Nanocomposites for O2 Scavenging.

Iron particles of sizes between 6 and 20 nm forming aggregates of 57 ± 17 nm were synthesized by chemical reduction of iron precursors on the surface of montmorillonite (MMT). This active MMT-Fe powder was then uniformly distributed in a linear low-density polyethylene (LLDPE) matrix by extrusion at atmospheric conditions, as confirmed by wide-angle X-ray scattering (WAXS), which also detected a partial exfoliation of the nanoclays. Thermogravimetric analysis (TGA) did not detect any significant modification of the degradation temperature between nanocomposites and active nanocomposites. 57Fe Mössbauer spectroscopy evidenced the formation of a majority of iron boride in MMT-Fe as well as in the active film containing it. The LLDPE.Fu15.MMT-Fe3.75 and LLDPE.Fu15.MMT-Fe6.25 films had oxygen-scavenging capacities of 0.031 ± 0.002 and 0.055 ± 0.009 g(O2)/g(Fe), respectively, while the neat powder had an adsorption capacity of 0.122 g(O2)/g(Fe). This result confirms that the fresh film samples were partially oxidized shortly after thermomechanical processing (60% of oxidized species according to Mössbauer spectroscopy). No significant difference in oxygen permeability was observed when MMT-Fe was added. This was related to the relatively small film surface used for measuring the permeability. The reaction-diffusion model proposed here was able to reproduce the observed data of O2 adsorption in an active nanocomposite, which validated the O2 adsorption model previously developed for dried MMT-Fe powder.

Impact of Two-Dimensional Particle Size Distribution on Estimation of Water Vapor Diffusivity in Micrometric Size Cellulose Particles.

This work aims at assessing the impact of two-dimensional particle size distribution (2D-PSD) on the identification of water vapor diffusivity in micrometric size cellulose particles displaying a size aspect ratio lower than 2 and a cylindrical shape. First, different methodologies to obtain the two-dimensional (2D) particle size distribution (diameter versus length) were compared, based on image analysis. Then, experimental sorption kinetics were obtained by using a quartz crystal microbalance (QCM) coupled with a water vapor adsorption system. Diffusivity values were estimated when considering either the 2D-PSD or global descriptors, such as the mean or median diameter and length of particles. Results revealed that the use of an analytical approach when considering the 2D mean-PSD or the median-PSD was the most accurate way to get diffusivity values at the scale of particles in a polydisperse sample of cellulose particles. Following this approach, a water vapor apparent diffusivity of 3.1 × 10-12 ± 2.3 × 10-12 m²·s-1 was found for the considered cellulose sample. Neglecting PSD in diffusivity estimation led to an underestimation of a factor of 2. This procedure could be extended for all the polydisperse samples in order to have an accurate estimation of water vapor diffusivity at the scale of single particles.

The Next Generation of Sustainable Food Packaging to Preserve Our Environment in a Circular Economy Context.

Packaging is an essential element of response to address key challenges of sustainable food consumption on the international scene, which is clearly about minimizing the environmental footprint of packed food. An innovative sustainable packaging aims to address food waste and loss reduction by preserving food quality, as well as food safety issues by preventing food-borne diseases and food chemical contamination. Moreover, it must address the long-term crucial issue of environmentally persistent plastic waste accumulation as well as the saving of oil and food material resources. This paper reviews the major challenges that food packaging must tackle in the near future in order to enter the virtuous loop of circular bio-economy. Some solutions are proposed to address pressing international stakes in terms of food and plastic waste reduction and end-of-life issues of persistent materials. Among potential solutions, production of microbial biodegradable polymers from agro-food waste residues seems a promising route to create an innovative, more resilient, and productive waste-based food packaging economy by decoupling the food packaging industry from fossil feed stocks and permitting nutrients to return to the soil. To respond to the lack of tools and approach to properly design and adapt food packaging to food needs, mathematical simulation, based on modeling of mass transfer and reactions into food/packaging systems are promising tools. The next generation of such modeling and tools should help the food packaging sector to validate usage benefit of new packaging solutions and chose, in a fair and transparent way, the best packaging solution to contribute to the overall decrease of food losses and persistent plastic accumulation.

Assessing the potential of quartz crystal microbalance to estimate water vapor transfer in micrometric size cellulose particles.

This study aims at assessing the use of a quartz crystal microbalance (QCM) coupled with an adsorption system to measure water vapor transfer properties in micrometric size cellulose particles. This apparatus allows measuring successfully water vapor sorption kinetics at successive relative humidity (RH) steps on a dispersion of individual micrometric size cellulose particles (1 µg) with a total acquisition duration of the order of one hour. Apparent diffusivity and water uptake at equilibrium were estimated at each step of RH by considering two different particle geometries in mass transfer modeling, i.e. sphere or finite cylinder, based on the results obtained from image analysis. Water vapor diffusivity values varied from 2.4 × 10-14 m2 s-1 to 4.2 × 10-12 m2 s-1 over the tested RH range (0-80%) whatever the model used. A finite cylinder or spherical geometry could be used equally for diffusivity identification for a particle size aspect ratio lower than 2.

A global visual method for measuring the deterioration of strawberries in MAP.

Evaluating the quality changes of packed strawberries during storage requires multiple, time consuming and costly measurements such as sensorial, chemical and decay identification. In order to efficiently assess the quality of strawberries in Modified Atmosphere Packaging (MAP) while reducing the number of analysis done, we propose to gather the main visual quality changes under one unique, overall measurement. For this end, a protocol associated to a deterioration grid was built to evaluate surface deterioration as a function of time considering color change, texture softening and microorganism development. The developed method has permitted to build the deterioration kinetic of strawberries packed in different conditions (MAP or no MAP). It allows to mimic the quality analysis made by the consumer, at a glance, during purchase. To the best of our knowledge, the presented method is a breakthrough unlike most common usual methods mainly relying on the number of spoiled strawberries. •Global measurement of the deterioration encompassing microorganism development, color change and texture softening.•An annotation grid built to be used as reference for the attribution of the percentage of strawberries' deterioration.•Measurements of a percentage of surface deterioration was found more accurate than counting the number of rotten strawberries.

Consumer perception data and scientific arguments about food packaging functionalities for fresh strawberries.

This data article contains data characterizing consumer perception and scientific arguments about food packaging functionalities for fresh strawberries. These data are associated with the article "Choice of environment-friendly food packagings through argumentation systems and preferences" (see Yun et al., 2018). These data are stored in a public repository structured by an ontology. These data could be retrieved through the @Web tool, user-friendly interface to capitalize and query data (Buche et al., 2013; Guillard et al., 2017). The @Web tool is accessible online at http://pfl.grignon.inra.fr/atWeb/.

Active bio-based food-packaging: Diffusion and release of active substances through and from cellulose nanofiber coating toward food-packaging design.

Cellulose nanofibers (CNFs) were recently investigated for the elaboration of new functional food-packaging materials. Their nanoporous network was especially of interest for controlling the release of active species. Qualitative release studies were conducted, but quantification of the diffusion phenomenon observed when the active species are released from and through CNF coating has not yet been studied. Therefore, this work aims to model CNF-coated paper substrates as controlled release system for food-packaging using release data obtained for two model molecules, namely caffeine and chlorhexidine digluconate. The applied mathematical model - derived from Fickian diffusion - was validated for caffeine only. When the active species chemically interacts with the release device, another model is required as a non-predominantly diffusion-controlled release was observed. From caffeine modeling data, a theoretical active food-packaging material was designed. The use of CNFs as barrier coating was proved to be the ideal material configuration that best meets specifications.