Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.

BACKGROUND Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. OBJECTIVES To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response). DATA COLLECTION AND ANALYSIS As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome. MAIN RESULTS We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise. AUTHORS' CONCLUSIONS There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.

Cognitive-Behavioural Analysis System of Psychotherapy (CBASP), a drug, or their combination: differential therapeutics for persistent depressive disorder: a study protocol of an individual participant data network meta-analysis.

INTRODUCTION Despite important advances in psychological and pharmacological treatments of persistent depressive disorders in the past decades, their responses remain typically slow and poor, and differential responses among different modalities of treatments or their combinations are not well understood. Cognitive-Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy that has been specifically designed for chronic depression and has been examined in an increasing number of trials against medications, alone or in combination. When several treatment alternatives are available for a certain condition, network meta-analysis (NMA) provides a powerful tool to examine their relative efficacy by combining all direct and indirect comparisons. Individual participant data (IPD) meta-analysis enables exploration of impacts of individual characteristics that lead to a differentiated approach matching treatments to specific subgroups of patients. METHODS AND ANALYSIS We will search for all randomised controlled trials that compared CBASP, pharmacotherapy or their combination, in the treatment of patients with persistent depressive disorder, in Cochrane CENTRAL, PUBMED, SCOPUS and PsycINFO, supplemented by personal contacts. Individual participant data will be sought from the principal investigators of all the identified trials. Our primary outcomes are depression severity as measured on a continuous observer-rated scale for depression, and dropouts for any reason as a proxy measure of overall treatment acceptability. We will conduct a one-step IPD-NMA to compare CBASP, medications and their combinations, and also carry out a meta-regression to identify their prognostic factors and effect moderators. The model will be fitted in OpenBUGS, using vague priors for all location parameters. For the heterogeneity we will use a half-normal prior on the SD. ETHICS AND DISSEMINATION This study requires no ethical approval. We will publish the findings in a peer-reviewed journal. The study results will contribute to more finely differentiated therapeutics for patients suffering from this chronically disabling disorder. TRIAL REGISTRATION NUMBER CRD42016035886.

The association of area socioeconomic status and cancer screening: A systematic review and multilevel study

Background. The gap between actual and ideal rates of routine cancer screening in the U.S., particularly for colorectal cancer screening (CRCS) (1;2), is responsible for an unnecessary burden of morbidity and mortality, particularly for disadvantaged groups. Knowledge about the effects of individual and area influences is being advanced by a growing body of research that has examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES. The findings from this emerging and heterogeneous research in the cancer screening literature have been mixed. Moreover, multilevel studies in this area have not yet adequately explored the possibility of differential associations by population subgroup, despite some evidence suggesting gender-specific effects. ^ Objectives and methods. This dissertation reports on a systematic review of studies on the association of area SES and cancer screening and a multilevel study of the association between area SES and CRCS. The specific aims of the systematic review are to: (1) describe the study designs, constructs, methods, and measures; (2) describe the association of area SES and cancer screening; and (3) identify neglected areas of research. ^ The empiric study linked a pooled sample of respondents aged ≥50 years without a personal history of colorectal cancer from the 2003 and 2005 California Health Interview Surveys with a comprehensive set of census-tract level area SES measures from the 2000 U.S. Census. Two-level random intercept models were used to test 2 hypotheses: (1) area SES will be associated with adherence to two modalities of CRCS after controlling for individual SES; and (2) gender will moderate the relationship between area socioeconomic status and adherence to both modalities of CRCS. ^ Results. The systematic review identified 19 eligible studies that demonstrated variability in study designs, methods, constructs, and measures. The majority of tested associations were either not statistically significant or significant and in the positive direction, indicating that as area SES increased, the odds of CRCS increased. The multilevel study demonstrated that while multiple aspects of area SES were associated with CRCS after controlling for individual SES, associations differed by screening modality and in the case of endoscopy, they also differed by gender. ^ Conclusions. Conceptual and methodologic heterogeneity and weaknesses in the literature to date limit definitive conclusions about the underlying relationships between area SES and cancer screening. The multilevel study provided partial support for both hypotheses. Future research should continue to explore the role of gender as a moderating influence with the aim of identifying the mechanisms linking area SES and cancer prevention behaviors. ^

Social network size and perceived network sufficiency as predictors of perceived health status

This study focused on the relationship between social network size (number of friends and relatives), perceived sufficiency of the network and self-rated health utilizing data from the National Survey of Personal Health Practices and Consequences, 1979. For men neither perceived sufficiency nor number of relatives were associated with self-rated health status. The number of friends was positively associated with health status. For women perceived network sufficiency was positively and significantly related to health status, independent of network size. The number of friends and relatives was not associated with self-rated health status. The sociodemographic variables accounted for most of the explained variance in health status for both males and females. Social networks may hold different meanings for women and men, and may require qualitative as well as quantitative analysis. There may have been insufficient variance in the major variables to produce meaningful results. ^

LIFE SATISFACTION: A COMPARISON OF RETIRED AND EMPLOYED WOMEN

This research addressed the question of life satisfaction for retired and employed women with long-term employment in a typically female occupational setting. Questions of how women's retirement is related to life satisfaction have been largely neglected because of cultural assumptions about the relative unimportance of the work role in women's lives. It is generally believed that the major source of satisfaction for women is in traditional family roles. Therefore, it follows that retirement from work is not experienced as a loss for women.^ The actual consequences of women's retirement have not been examined systematically. Descriptive data about their lives are inadequate. It is not known what patterns and resources result from a lifetime of work for women.^ The objectives of the study were to test assumptions from role and continuity theory regarding life satisfaction for retired women and women employed late in life and to describe the retirement and work experiences of the women.^ Life satisfaction was measured by the Neugarten, Havighurst and Tobin Life Satisfaction Index. Perceptions of appropriate roles for females and males were assessed through an attitudinal sex-role instrument. A composite index, derived from perceptions of health, social participation, and income at two time periods, measured level of continuity. These indices and demographic information, attitudinal items about work and retirement, and social network data comprised the mailed, self-administered survey and the personal interviews.^ The study population included 91 retired and 53 employed women, 55 years or older with a minimum of 20 years continuous employment, who were enrolled in the pension program of a large retail store.^ The retired women's perceptions of their health and social participation were more positive than the employed women's. Traditional retired women demonstrated higher life satisfaction than nontraditional retired women. Both retired and employed women who perceived continuity in life patterns scored statistically higher on life satisfaction than women who perceived discontinuity. Financial planning was the area of greatest retirement concern for retired and employed women.^

(Tables 1, 2) Permafrost borehole characteristics in the Nordic Area during the IPY 2007-2009

This paper provides a snapshot of the permafrost thermal state in the Nordic area obtained during the International Polar Year (IPY) 2007-2009. Several intensive research campaigns were undertaken within a variety of projects in the Nordic countries to obtain this snapshot. We demonstrate for Scandinavia that both lowland permafrost in palsas and peat plateaus, and large areas of permafrost in the mountains are at temperatures close to 0°C, which makes them sensitive to climatic changes. In Svalbard and northeast Greenland, and also in the highest parts of the mountains in the rest of the Nordic area, the permafrost is somewhat colder, but still only a few degrees below the freezing point. The observations presented from the network of boreholes, more than half of which were established during the IPY, provide an important baseline to assess how future predicted climatic changes may affect the permafrost thermal state in the Nordic area. Time series of active-layer thickness and permafrost temperature conditions in the Nordic area, which are generally only 10 years in length, show generally increasing active-layer depths and rising permafrost temperatures.

Seawater carbonate chemistry and coral (Acropora digitifera and Acropora tenuis) algal infection rate, survival and surface area of plyps during experiments, 2009

Ocean acidification, caused by increased atmospheric carbon dioxide (CO2) concentrations, is currently an important environmental problem. It is therefore necessary to investigate the effects of ocean acidification on all life stages of a wide range of marine organisms. However, few studies have examined the effects of increased CO2 on early life stages of organisms, including corals. Using a range of pH values (pH 7.3, 7.6, and 8.0) in manipulative duplicate aquarium experiments, we have evaluated the effects of increased CO2 on early life stages (larval and polyp stages) of Acropora spp. with the aim of estimating CO2 tolerance thresholds at these stages. Larval survival rates did not differ significantly between the reduced pH and control conditions. In contrast, polyp growth and algal infection rates were significantly decreased at reduced pH levels compared to control conditions. These results suggest that future ocean acidification may lead to reduced primary polyp growth and delayed establishment of symbiosis. Stress exposure experiments using longer experimental time scales and lower levels of CO2 concentrations than those used in this study are needed to establish the threshold of CO2 emissions required to sustain coral reef ecosystems.

Snow height on sea ice and sea ice drift from autonomous measurements from buoy 2013S1, deployed during Antarctic Fast Ice Network 2013 (AFIN 2013)

Snow height was measured by the Snow Depth Buoy 2013S1, an autonomous platform, installed close to Neumayer III Base, Antarctic during Antarctic Fast Ice Network 2013 (AFIN 2013). The resulting time series describes the evolution of snow height as a function of place and time between 2013-02-11 and 2013-04-29 in sample intervals of 1 hour. The Snow Depth Buoy consists of four independent sonar measurements representing the area (approx. 10 m**2) around the buoy. The buoy was installed on the ice shelf. In addition to snow height, geographic position (GPS), barometric pressure, air temperature, and ice surface temperature were measured. Negative values of snow height occur if surface ablation continues into the sea ice. Thus, these measurements describe the position of the sea ice surface relative to the original snow-ice interface. Differences between single sensors indicate small-scale variability of the snow pack around the buoy. The data set has been processed, including the removal of obvious inconsistencies (missing values). Records without any snow height may still be used for sea ice drift analyses. Note: This data set contains only relative changes in snow height, because no initial readings of absolute snow height are available.

Snow height on sea ice and sea ice drift from autonomous measurements from buoy 2014S24, deployed during Antarctic Fast Ice Network 2014 (AFIN 2014)

Snow height was measured by the Snow Depth Buoy 2014S24, an autonomous platform, installed close to Neumayer III Base, Antarctic during Antarctic Fast Ice Network 2014 (AFIN 2014). The resulting time series describes the evolution of snow depth as a function of place and time between 2014-03-07 and 2014-05-16 in sample intervals of 1 hour. The Snow Depth Buoy consists of four independent sonar measurements representing the area (approx. 10 m**2) around the buoy. The buoy was installed on the ice shelf. In addition to snow depth, geographic position (GPS), barometric pressure, air temperature, and ice surface temperature were measured. Negative values of snow depth occur if surface ablation continues into the sea ice. Thus, these measurements describe the position of the sea ice surface relative to the original snow-ice interface. Differences between single sensors indicate small-scale variability of the snow pack around the buoy. The data set has been processed, including the removal of obvious inconsistencies (missing values). Records without any snow depth may still be used for sea ice drift analyses. Note: This data set contains only relative changes in snow depth, because no initial readings of absolute snow depth are available.

La Casa Domínguez. Alejandro de la Sota: Construir - Habitar

La Tesis Doctoral nace con una intensa vocación pedagógica. La hipótesis de trabajo se establece en torno a una cuestión de interés personal, un tema sobre el que se vertebran, desde el comienzo del doctorado, los diferentes cursos y trabajos de investigación: LA CASA DOMÍNGUEZ como paradigma de la dialéctica en la obra de Alejandro de la Sota. La clasificación de la realidad en categorías antagónicas determina un orden conceptual polarizado, una red de filiaciones excluyentes sobre las que Sota construye su personal protocolo operativo: la arquitectura intelectual o popular, experimental o tradicional, universal o local, ligera o pesada, elevada o enterrada, etc. Se propone el abordaje de una cuestión latente en el conjunto de la obra ‘sotiana’, desde la disección y el análisis de una de sus obras más pequeñas: la casa Domínguez. Se trata de una organización sin precedentes, que eleva la estrategia dialéctica al paroxismo: la vivienda se separa en dos estratos independientes, la zona de día, elevada, y la zona de noche, enterrada; cada uno de los estratos establece su propio orden geométrico y constructivo, su propio lenguaje y carácter, su propia identidad e incluso su propio presupuesto. Las relaciones entre interior y exterior se especializan en función de la actividad o el reposo, estableciéndose una compleja red de relaciones, algunas evidentes y otras celosamente veladas, entre los diferentes niveles. La estancia destinada a las tareas activas se proyecta como un objeto de armazón ligero y piel fría; la precisa geometría del cubo delimita la estancia vigilante sobre el paisaje conquistado. La ladera habitada se destina al reposo y se configura como una topografía verde bajo la que se desarrollan los dormitorios en torno a patios, grietas y lucernarios, generando un paisaje propio: la construcción del objeto frente a la construcción del lugar La casa Domínguez constituye uno de los proyectos menos estudiados, y por lo tanto menos celebrados, de la obra de Don Alejandro. Las publicaciones sucesivas reproducen la documentación gráfica junto a la memoria (epopeya) que el propio Sota compone para la publicación del proyecto. Apenas un par de breves textos críticos de Miguel Ángel Baldellou y, recientemente de Moisés Puente, abordan la vivienda como tema monográfico. Sin embargo, la producción de proyecto y obra ocupó a De la Sota un periodo no inferior a diez años, con casi cien planos dibujados para dos versiones de proyecto, la primera de ellas, inédita. El empeño por determinar hasta el último detalle de la ‘pequeña’ obra, conduce a Sota a controlar incluso el mobiliario interior, como hiciera en otras obras ‘importantes’ como el Gobierno Civil de Tarragona, el colegio mayor César Carlos o el edificio de Correos y Telecomunicaciones de León. La complicidad del cliente, mantenida durante casi cuarenta años, habilita el despliegue de una importante colección de recursos y herramientas de proyecto. La elección de la casa Domínguez como tema central de la tesis persigue por lo tanto un triple objetivo: en primer lugar, el abordaje del proyecto como paradigma de la dialéctica ‘sotiana’, analizando la coherencia entre el discurso de carácter heroico y la obra finalmente construida; en segundo lugar, la investigación rigurosa, de corte científico, desde la disección y progresivo desmontaje del objeto arquitectónico; y por último, la reflexión sobre los temas y dispositivos de proyecto que codifican la identificación entre la acción de construir y el hecho de habitar, registrando los aciertos y valorando con actitud crítica aquellos elementos poco coherentes con el orden interno de la propuesta. This doctoral thesis is the fruit of a profound pedagogical vocation. The central hypothesis was inspired by a question of great personal interest, and this interest has, since the very beginning of the doctorate, been the driving force behind all subsequent lines of research and investigation. The “Casa Domínguez” represents a paradigm of the dialectics found in the work of Alejandro de la Sota. The perception of reality as antagonistic categories determines a polarized conceptual order, a network of mutually excluding associations upon which Sota builds his own personal operative protocol: intellectual or popular architecture, experimental or traditional, universal or local, heavy or light, above or below ground, etc. Through the analysis and dissection of the “Casa Domínguez”, one of Sota’s smallest projects, an attempt is made to approach the underlying question posed in “Sotian” work as a whole. This is about organization without precedent, raising the strategic dialectics to levels of paroxysm. The house is divided into two separate levels, the day-time level above ground, and the lower night-time level beneath the surface of the ground. Each level has its own geometrical and stuctural order, its own language and character, its own identity and even has its own construction budget. The interaction between the two areas is centered on the two functions of rest and activity, and this in turn establishes a complex relationship network between both, which is sometimes self-evident, but at other times jealously guarded. The living area designed for daily activity is presented as an object of light structure and delicate skin; the precise geometry of the cube delimiting the ever watchful living area’s domain over the land it has conquered. A green topography is created on the slope below which lies an area adapted for rest and relaxation. Two bedrooms, built around patios, skylights and light crevices, generate an entirely independent environment: the construction of an object as opposed to the creation of a landscape. The “Casa Domínguez” project has been subject to much less scrutiny and examination than Don Alejandro’s other works, and is consequently less well-known. A succession of journals have printed the blueprint document together with a poetic description (epopee), composed by Sota himself, to mark the project’s publication. There has, however, scarcely been more than two brief critical appraisals, those by Miguel Ángel Baldellou and more recently by Moisés Puente, that have regarded the project as a monographic work. The project and works nevertheless occupied no less than ten years of De La Sota’s life, with over a hundred draft drawings for two separate versions of the project, the first of which remains unpublished. The sheer determination to design this “small” work in the most meticulous detail, drove Sota to manage and select its interior furniture, as indeed he had previously done with more “important” works like the Tarragona Civil Government, César Carlos College, or the Post Office telecommunications building in León. Client collaboration, maintained over a period of almost forty years, has facilitated an impressive array of the project’s tools and resources. The choice of “Casa Domínguez” as the central subject matter of this thesis, was made in pursuance of a triple objective: firstly, to approach the project as a paradigm of the “Sotian” dialectic, the analysis of the discourse between the heroic character and the finished building; secondly, a rigorous scientific investigation, and progressive disassembling and dissecting of the architectonic object; and finally, a reflection on aspects of the project and its technology which codify the identification between the action of construction and the reality of living, thus marking its achievements, whilst at the same time subjecting incoherent elements of the proposal’s established order to a critical evaluation.

Influence of Current Pulse Shape on Directly Modulated Systems Performance in Metro Area Optical Networks

Due to the fact that a metro network market is very cost sensitive, direct modulated schemes appear attractive. In this paper a CWDM (Coarse Wavelength Division Multiplexing) system is studied in detail by means of an Optical Communication System Design Software; a detailed study of the modulated current shape (exponential, sine and gaussian) for 2.5 Gb/s CWDM Metropolitan Area Networks is performed to evaluate its tolerance to linear impairments such as signal-to-noise-ratio degradation and dispersion. Point-to-point links are investigated and optimum design parameters are obtained. Through extensive sets of simulation results, it is shown that some of these shape pulses are more tolerant to dispersion when compared with conventional gaussian shape pulses. In order to achieve a low Bit Error Rate (BER), different types of optical transmitters are considered including strongly adiabatic and transient chirp dominated Directly Modulated Lasers (DMLs). We have used fibers with different dispersion characteristics, showing that the system performance depends, strongly, on the chosen DML?fiber couple.

A Light-Weight On-Chip Monitoring Network for Dynamic Adaptation and Calibration

Current nanometer technologies suffer within-die parameter uncertainties, varying workload conditions, aging, and temperature effects that cause a serious reduction on yield and performance. In this scenario, monitoring, calibration, and dynamic adaptation become essential, demanding systems with a collection of multi purpose monitors and exposing the need for light-weight monitoring networks. This paper presents a new monitoring network paradigm able to perform an early prioritization of the information. This is achieved by the introduction of a new hierarchy level, the threshing level. Targeting it, we propose a time-domain signaling scheme over a single-wire that minimizes the network switching activity as well as the routing requirements. To validate our approach, we make a thorough analysis of the architectural trade-offs and expose two complete monitoring systems that suppose an area improvement of 40% and a power reduction of three orders of magnitude compared to previous works.

On-chip Monitoring: A Light-Weight Interconnection Network Approach

Current nanometer technologies are subjected to several adverse effects that seriously impact the yield and performance of integrated circuits. Such is the case of within-die parameters uncertainties, varying workload conditions, aging, temperature, etc. Monitoring, calibration and dynamic adaptation have appeared as promising solutions to these issues and many kinds of monitors have been presented recently. In this scenario, where systems with hundreds of monitors of different types have been proposed, the need for light-weight monitoring networks has become essential. In this work we present a light-weight network architecture based on digitization resource sharing of nodes that require a time-to-digital conversion. Our proposal employs a single wire interface, shared among all the nodes in the network, and quantizes the time domain to perform the access multiplexing and transmit the information. It supposes a 16% improvement in area and power consumption compared to traditional approaches.

The Phase Space as a New Representation of the Dynamical Behaviour of Temperature and Enthalpy in a Reefer monitored with a Multidistributed Sensors Network

The study of temperature gradients in cold stores and containers is a critical issue in the food industry for the quality assurance of products during transport, as well as forminimizing losses. The objective of this work is to develop a new methodology of data analysis based on phase space graphs of temperature and enthalpy, collected by means of multidistributed, low cost and autonomous wireless sensors and loggers. A transoceanic refrigerated transport of lemons in a reefer container ship from Montevideo (Uruguay) to Cartagena (Spain) was monitored with a network of 39 semi-passive TurboTag RFID loggers and 13 i-button loggers. Transport included intermodal transit from transoceanic to short shipping vessels and a truck trip. Data analysis is carried out using qualitative phase diagrams computed on the basis of Takens?Ruelle reconstruction of attractors. Fruit stress is quantified in terms of the phase diagram area which characterizes the cyclic behaviour of temperature. Areas within the enthalpy phase diagram computed for the short sea shipping transport were 5 times higher than those computed for the long sea shipping, with coefficients of variation above 100% for both periods. This new methodology for data analysis highlights the significant heterogeneity of thermohygrometric conditions at different locations in the container.