Farmers in Nepal lose about a third of their harvested grain due to postharvest handling and storage. This has led to food insecurity and economic losses. Despite the importance of postharvest, the grain storage system in Nepal relies on traditional storage structures like bamboo granaries. The incidence of storage pests is reported up to 100% in these structures. To minimize the storage loss, farmers use different grain protection methods including toxic chemicals. Multiple cases of pesticides-related poisoning and deaths have been caused by misuse and overuse of pesticides. To push safer, chemical-free alternatives like hermetic storage it is important to understand current pest challenges and management practices in Nepal. Adaptation of chemical-free pest management strategies like hermetic storage largely depends upon basic and applied laboratory research findings. Determining the baseline adult mortality under various hypoxia levels and subsequent insect emergence will help determine the effectiveness of a low oxygen environment in controlling <i>Sitophilus oryzae</i> (L.). This would increase our understanding of hermetic storage technology and help improve its application to both farmers and commercial users and serve as a possible substitute to traditional or chemical pest control methods. In chapter one, I report the result of the survey conducted in Nepal to understand i) current post-harvest storage practices and (ii) assessment of the best delivery approach for storage innovations. In chapter 2, I report the result from laboratory experiment conducted to understand the lethality of hypoxia at 5% oxygen level and below against <i>Sitophilus oryzae</i> (L.), which is a major storage pest reported by farmers in Nepal.

La perception est de plus en plus reconnue comme fondamentale à la compréhension du phénotype autistique. La première description de l’autisme, par Kanner en 1947, fait état d’un profil cognitif hétérogène caractérisé par des habiletés exceptionnelles à l’intérieur de domaines spécifiques de la perception (ex., la musique). L’accumulation des observations cliniques sur la présence de particularités perceptives a mené à l’élaboration d’études empiriques permettant d’objectiver des surfonctionnements dans le traitement élémentaire de l’information perceptive dans l’autisme. Parallèlement, des études cognitives suggèrent la présence d’une « intelligence différente » chez les personnes autistes. Celle-ci serait caractérisée par une dissociation entre des performances à différents tests d’intelligence fortement corrélés ensemble chez les personnes typiques. Le potentiel intellectuel des personnes autistes serait sous-estimé lorsque mesuré par l’échelle de Wechsler, plutôt que des mesures d’intelligence fluide comme les Matrices Progressives de Raven. Avec l’appui d’études en imagerie cérébrale, ces résultats suggèrent une relation unique entre la perception et l’intelligence chez cette population clinique. Étant donné l’accumulation de preuves sur 1) la présence d’atypies perceptuelles, 2) le rôle différent de la perception dans l’intelligence et 3) l’importance des comportements répétitifs et intérêts restreints dans le phénotype autistique (DSM-5), le premier volet de cette thèse s’est intéressé à la relation entre les performances perceptives des personnes autistes et celle des personnes ayant un développement typique, au-delà de ce qui est expliqué par l’intelligence. À l’aide de modèles de régression linéaire, les résultats démontrent un profil de covariation spécifique à l’autisme pour les habiletés plurimodales. Contrairement aux personnes ayant un développement typique, ces associations persistent au-delà de ce qui est expliqué par l’intelligence générale ou par l’efficacité générale des systèmes perceptifs. Ce profil de covariation résiduelle propre aux personnes autistes suggère la présence d’un facteur plurimodal spécifique à ce groupe clinique : le facteur « p ». Le deuxième volet de cette thèse s’est intéressé à la prévalence des habiletés exceptionnelles au niveau individuel, la relation les forces perceptives et les talents, ainsi qu’aux facteurs de prédisposition en lien avec le développement d’habiletés exceptionnelles. Les forces perceptives des personnes autistes furent évaluées à l’aide de tâches expérimentales sensibles à la détection de surfonctionnements perceptifs, soit une tâche de discrimination de hauteurs sonores et une version modifiée du sous-test « Blocs » de l’échelle d’intelligence de Wechsler. Les talents furent évalués de manière clinique à l’aide de l’ADI-R (« Autism Diagnostic Interview-Revised »). Les données indiquent que 88.4 % des personnes autistes avec une intelligence dans la normale présentent au moins une habileté exceptionnelle (force perceptive ou talent). Les talents sont rapportés chez 62.5 % des cas et les forces perceptives se retrouvent chez 58 % des cas. La cooccurrence des forces perceptives entre les modalités perceptives est relativement peu fréquente (24 % à 27 %) et la présence d’un talent dans une modalité n’augmente pas les chances de présenter une force perceptive dans une même modalité. Une plus grande intelligence augmente les chances de présenter au moins un talent. En revanche, une intelligence plus faible, mais se situant tout de même dans les limites de la normale, est associée à un profil cognitif plus hétérogène avec des forces perceptives plus fréquentes. En somme, l’intelligence autistique serait caractérisée par un rôle plus important de la perception, indépendamment des surfonctionnements perceptifs. Cette particularité cognitive se manifesterait par la présence d’un facteur plurimodal, « p », spécifique à l’autisme. Théoriquement, le facteur « p » reflèterait des modifications innées (ou « hardwired ») dans l’organisation corticale des microcircuits responsables de l'encodage des dimensions perceptives élémentaires. En revanche, une faible association intermodale entre les forces perceptives suggère que des modifications corticales sont essentielles, mais non suffisantes pour le développement d’habiletés exceptionnelles. Par des processus de plasticité, des modifications corticales auraient des répercussions sur le phénotype autistique en offrant une base plus « fertile » pour le développement d’habiletés exceptionnelles, voire savantes, lorsque la personne autiste serait exposée à des expériences de vie avantageuses. Par ailleurs, les résultats de cette thèse, combinés à la littérature existante sur l’intelligence et l’apprentissage des personnes autistes, nous amènent à réfléchir sur les approches d’évaluation et d’intervention les mieux adaptées au fonctionnement spécifique de cette population clinique. / Perception is increasingly recognized as a fundamental aspect of the autism phenotype. Kanner’s (1947) seminal description of autism highlights a heterogeneous cognitive profile characterized by exceptional skills within specific areas of perception (e.g., music). The accumulation of clinical observation on the presence of perceptual atypicalities led to the elaboration of empirical studies designed to objectify enhanced perceptual functioning in autism. Meanwhile, cognitive studies suggest the presence of a "different intelligence" in autism. Autistic intelligence would be characterized by a dissociation of performance between intelligence tests that are strongly correlated together in typical individuals. Research suggests that using tools posing higher demands on verbal skills, such as Wechsler Intelligence scale rather than measures of fluid intelligence, such as Raven Progressive Matrices, would results in an underestimation of autistics’ intellectual potential. With the support of imaging studies, these results suggest a unique relationship between perception and intelligence in this clinical population. Given the accumulating evidence on 1) the presence of perceptual atypicalities, 2) the different role of perception cognition, and 3) the importance of "repetitive behaviours and restricted interests" in the autistic phenotype (DSM-5), the first part of this thesis is interested in the differential relationship between perceptual performance in autism and controls with typical development, beyond what is explained by intelligence. Using linear regression models, results show a profile of plurimodal covariation specific to autism. Unlike control subjects, this association persists beyond what is explained by general intelligence or the overall effectiveness of perceptual systems. This finding is interpreted as an indication of a specific plurimodal factor in autism: the "p" factor. The second part of this dissertation is interested in the prevalence of exceptional skills, the relationship between perceptual strengths and talents, and the predisposing factors related to the development of exceptional skills. Perceptual strengths were evaluated using experimental tasks sensitive for the detection of enhanced perceptual functioning: a pitch discrimination task and a modified version of Wechsler’s block design test. Talents were evaluated clinically using the Autism Diagnostic Interview-Revised (ADI-R). Results show that 88.4% of people with autism and normal intelligence had at least one exceptional skill (perceptual strengths or talent). Talents were reported in 62.5% of cases and perceptual strengths were found in 58% of cases. The co-occurrence of perceptual strengths across modalities was relatively infrequent (24% to 27%) and the presence of a talent in one modality did not increase the chances of presenting another perceptual strength in the same modality. Greater intelligence increased the chances of presenting at least one talent. In contrast, lower intelligence, still within the normal range, was associated with a more heterogeneous cognitive profile and more frequent perceptual strengths. In sum, autistic intelligence is characterized by a greater role of perception, regardless of enhanced perceptual functioning. This cognitive characteristic is manifested by a specific autism plurimodal factor "p". Theoretically, the factor "p" reflects hardwired alterations in cortical microcircuits organization responsible for the encoding of basic perceptual dimensions. In contrast, weak association between perceptual strengths across modalities suggests that cortical changes would be essential, but not sufficient for the development of exceptional skills. By processes of plasticity, cortical changes would affect the autistic phenotype, offering more "fertile" grounds for the development of exceptional skills. Exceptional skills would develop in autistics exposed to life experiences adapted to their cognitive style. The findings of this dissertation combined with current literature on intelligence and learning lead us to reflect on assessment and intervention approaches most adapted to autistics’ specific cognitive style.

<p>Successful adoption of biofortified orange maize in developing countries requires careful consideration of factors across the chain from farm to fork. This includes consideration of post-harvest storage conditions optimal for the retention of both proviatamin A carotenoids and cooking quality critical to consumers. In these considerations, identification of economical storage methods is critical considering the limitations within specific countries that biofortified maize is being disseminated. To address these points, this dissertation research focused on evaluation of the utility of the Purdue Improved Crop Storage (PICS) bags as a post-harvest storage solution for biofortified maize. The specific focus of this research was to monitor retention of provitamin A and other carotenoids in two biofortified maize genotypes (OPVI and OPVII) as well as storage effect on flour functionality. Finally, a preliminary assessment of the impacts of storage on carotenoid bioaccessibility was completed to begin to translate findings to practice.</p><p>Maize grain from 2016 harvest was stored at ambient conditions for eight months in either PICS bags with or without an O₂ scavenger, (PICS-oxy) and (PICS-noxy), respectively and compared to storage in common polypropylene woven bags (control). After 4 months of storage carotenoid content was significantly higher (p<0.05) in PICS-oxy compared to PICS-noxy and woven bags demonstrating the importance of entrapped oxygen on maize carotenoid degradation. Furthermore, differences in carotenoid stability between maize genotypes were observed with OPVI having higher retention than OPVII. After 8 months, carotenoid retention remained dependent on storage bag and genotype with retention being greater in PICS-oxy and PICS-noxy compared to woven bags. However, final levels after 8 months were more similar between storage methods. Overall, oxygen content and genotype were found to be determining factors in the effectiveness of PICS to mitigate carotenoid degradation during post-harvest storage of maize.</p><p>While reducing the rate of carotenoid degradation during postharvest storage of biofortified maize is important, success of biofortified maize is also dependent on consumer adoption of these grains and their performance in traditional food preparation. Assessment of the rheological and functional properties of these two biofortified maize genotypes as a function of post-harvest storage was completed to assess the impact of post-harvest storage in PICS bags on flour functionality and rheological properties for the two biofortified orange maize genotypes and a control white maize genotype. Flour pasting profiles were assessed initially and at 4 and 8 months. After 8 month storage in woven and PICS bag, OPVI and OPVII produced porridges with similar viscosities to their initial viscosities regardless of postharvest storage type. White maize viscosities progressively decreased with storage and were significantly lower (p<0.05) in woven compared to PICS storage. Sequestration of oxygen (PICS-oxy) had modest but significant effects (p<0.05) on key pasting parameters including peak and final viscosities. These results suggest that oxygen sequestration has a critical effect on final flour functionality. DTT treatment partially restored flour pasting profiles suggesting disulfide linkages may modify pasting profiles of flour. There was also an increase in free ferrulic and <i>p</i>-coumaric acids during storage which may have contributed to observed decreases in porridge viscosities. Evidence of this was found through Raman spectroscopy with spectral intensity at both 478cm^-1 and 2911cm^-1 decreasing with storage suggesting the potential for structural changes induced by storage on starch polymer. While storage in PICS bags does not seem to adversely affect flour functionality it may provide some additional economic benefit resulting from requiring proportionally less flour to achieve similar final viscosities as flour from woven bag stored grains. </p><p>Finally, the effect of postharvest storage on bioaccessibility of carotenoids was explored using experimental wet cooked porridges made from ‘fresh’ and stored grains using an established three stage in-<i>vitro</i> digestion model. Relative carotenoid bioaccessibility (% micellarization) was generally higher in less viscous porridge made from grains stored in woven bags compared to porridge from initial or PICS bags stored grains suggesting that higher viscosity might partly explain lower relative bioaccessibility in porridge from grains stored in PICS bags. Absolute carotenoid bioaccessibility from experimental porridge was dependent on carotenoid species and storage system. Extrapolation of relative bioaccessibility (%) to absolute bioaccessibility (µg/g flour) suggests that fresh grains and their corresponding porridges would provide more absolute bioaccessible carotenoids compared to stored grains despite some improvement in relative accessibility. As such, storage losses remain the main factor impacting total available carotenoids and should continue to be an area of focus for future mitigation. With the potential to minimize post-harvest losses, improve carotenoid retention and provide a product with improved cooking performance, PICS bags do appear to offer a viable storage alternative to improve both food and nutrition security in developing countries.</p><p></p>

Les aspects biologiques ne sont généralement pas considérés lors de la conception des ouvrages de génie civil, malgré que la biocolonisation puisse affecter leur durabilité. Cette thèse s’intéresse à l’encrassement biologique des matériaux cimentaires en eau de rivière. Un essai de biocolonisation phototrophe accélérée, simulant les conditions en rivière a été mis au point et validé. Il a permis l’étude de pâtes cimentaires de différentes formulations. La colonisation a été évaluée par le taux de recouvrement de la surface, estimé par une méthode proposée d’analyse d’images. Une étude de l’influence de la rugosité sur la bioréceptivité du matériau a été réalisée à travers plusieurs paramètres de différentes natures et la densité de pics (paramètre d’espacement) a montré l’influence la plus déterminante. Un modèle a été proposé pour expliquer cette influence et a donné des résultats satisfaisants. Les influences de la porosité et du pH semblent être limitées dans les conditions de l’essai. Enfin, la micro-indentation a été adaptée pour l’évaluation mécanique de la détérioration des pâtes cimentaires sur de faibles épaisseurs. Cette technique pourra être utilisée pour évaluer la biodétérioration. / The biological aspects are generally not considered in the design of civil engineering works, although the biocolonisation may affect their durability. This thesis focuses on biofouling of cementitious materials in river water. A laboratory accelerated test of phototrophic biocolonisation, simulating the river conditions, was developed and validated. It allowed the study of cement pastes of different formulations. Colonization was assessed by the recovery rate of the surface, estimated by a proposed method of image analysis. A study of the roughness influence on the bioreceptivity of the material was conducted through several roughness parameters of different natures, and the peaks density (a spacing parameter) showed the most decisive influence. A model was proposed to explain this influence and gave satisfactory results. The influences of porosity and pH appeared to be limited in the test conditions. Finally, micro-indentation was adapted to the mechanical evaluation of the deterioration of thin layers of cement pastes. This technique may be used to evaluate the biodeterioration.

Les champs électriques pulsés sont largement utilisés dans la recherche, la médecine, l'industrie alimentaire et d'autres procédés biotechnologiques. L'interaction d'une impulsion de 100 µs avec la membrane plasmique et la membrane du réticulum endoplasmique a été évaluée dans deux types cellulaires différents. La perméabilisation des organites cellulaires avec ce type d'impulsions est démontrée expérimentalement pour la première fois. L'utilisation d'une telle impulsion afin de contrôler les oscillations calciques spontanées dans les cellules souches mésenchymateuses humaines issues du tissu adipeux a été évaluée. En créant des pics calciques électro-induits d’amplitudes différentes, l'impulsion peut ou bien induire un pic calcique supplémentaire ou bien inhiber les oscillations spontanées pour quelques dizaines de minutes. Cette inhibition rend possible d’imposer à la cellule des pics d’amplitude et de fréquence désirés. Un essai d’application de l'impulsion 100 µs à des cellules souches subissant une différenciation osseuse a aussi été réalisé. Une impulsion électrique semble retarder la différenciation. Lors d'une différenciation osseuse, plusieurs couches cellulaires ont été observées. La caractérisation de ces couches a donné des résultats qui pourraient aider à obtenir des ostéoblastes matures dans un temps moindre que la normale. L'utilisation des champs électriques pulsés microsecondes, pour perméabiliser la membrane plasmique et les membranes internes des cellules, ainsi que pour moduler les concentrations du calcium intracellulaire, semble donc très intéressante pour étudier le rôle du calcium dans de nombreux processus physiologiques et pour manipuler les dynamiques calciques (oscillations, vagues, pics) dans différents types de cellules. Ainsi, cette technologie simple, facile à appliquer et disponible dans beaucoup de laboratoires serait envisageable pour la modulation et le contrôle de fonctions cellulaires basiques telles que la prolifération, la différenciation et l'apoptose. / Pulsed electric fields are widely used in research, medicine, food industry and other biotechnological processes. The interaction of one 100 µs pulse with the plasma membrane and the endoplasmic reticulum membrane was evaluated in two different cell types. Pulse amplitude ranged between 100 and 3 000 V/cm. Organelles membrane permeabilization using this kind of pulses was experimentally demonstrated for the first time. The use of such a pulse to control the spontaneous calcium oscillations in human-adipose mesenchymal stem cells was also assessed. By creating electro-induced calcium spikes of different amplitudes, the pulse can either add a supplementary spike, or, on the contrary, inhibit the spontaneous oscillations for some tens of minutes. During this inhibition period, the electric pulse-mediated addition of calcium spikes of desired amplitude and frequency is still possible. The delivery of 100 µs pulses to stem cells undergoing osteodifferentiation was also performed. The electric pulse seemed to delay the differentiation. Moreover, during osteogenic differentiation, cells cultures displayed an organization in a few cell layers. The characterization of these layers gave results that may help to obtain mature osteoblast in less time than usual one. The use of the microsecond electric pulses technology to permeabilize the plasma and the internal cell membranes as well as to modulate internal calcium concentrations is therefore interesting to study the role of calcium in many physiological processes and to manipulate the cell calcium dynamics (oscillations, waves, spikes) in different cell types. Doing so, this available, simple and easy to apply technology could be used for the modulation and the control of basic cellular functions such as proliferation, differentiation and apoptosis.

<p>We followed up with about 2,000 smallholder households in Senegal, two years after these households participated in a randomized controlled trial (RCT) aimed at reducing levels of aflatoxins in smallholders’ stored maize. In the initial intervention, treated households were provided with training on proper post-harvest practices, low-cost moisture meters for testing if maize was sufficiently dry to store, plastic tarps for drying maize of the ground, and hermetic (airtight) storage bags to mitigate aflatoxin development in stored maize. Using cross-sectional follow up data on aflatoxins levels and drying and storage practices from 2019 along with baseline demographic data from 2016, we estimate both the longer-term intention-to-treat (ITT) effects and the treatment on the treated (TOT) effects that the four inputs provided on households’ aflatoxins levels in stored maize. The ITT analyses estimate the intervention’s average effect by treatment group, but this may underestimate the true impact for households who complied with recommended post-harvest practices and adopted the recommended technologies. The TOT analyses estimate the local average treatment effects (LATE) of the intervention, that is its impacts on those who were driven by the intervention to follow best practices or use a given technology. Since the decision to follow these practices or adopt a technology was not random, we instrumented the usage decision with the exogenous, random treatment group assignment to get an unbiased estimate. Outside of our main models, we conducted a heterogeneity analysis to test if households with different characteristics benefit differently from the intervention. We interacted each treatment assignment with various household characteristics, including the woman’s level of involvement in the intervention. Additionally, we estimate the cost-effectiveness of providing training and a tarp, according to WHO guidelines for public health interventions. </p>

No description available.

Background Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients. Methods A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study. Results The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37). Conclusions In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.