NewSpace and the european space economy

A guide for engineers to better understand space economy. A guide for policy-makers to better understand the space sector. The statement above is probably the best way to sum up the main goal of this work: to connect space engineering and economy in a theoretical approach. The proposal for the thesis is to study the economy of space in Europe and the main challenges for the crucial future decades. This work is intended to give insight into economic strategies in order to enhance the growth of the space sector whilst also detailing the state of space technology in Europe today. This thesis should be useful as a guide for those looking to comprehend the state of space technology in Europe, those interested in creating new companies and those who want to invest in space technology. The broader goal is to focus on solving the fundamental Five Ws with respect to space technology and its socio-economic consequences in Europe. All fundamental questions must be assessed avoiding prior subjective assumptions and/or desired outcomes. Space is experiencing a major shift from concentrated government-lead projects to an ever-increasing volume of commercial activities. This thesis aims to break down the fundamental aspects that are driving the current transformation of space1 while also taking a deep dive into the European space sector, future space economy trends and Europe’s role in the global space sector. In addition, the future of space clusters, space agencies and private-public interactions will be studied. The statement and aim are broad indicators of the contents of the thesis. Before defining specific objectives, some of the topics need defining in a more precise way. Let us make a list of relevant topics to be assessed in the thesis: The emerging NewSpace and Space 4.0 agenda proposed and adopted by ESA require space technologies to be developed coordinating public and private sectors. The rapid increase of private market ecosystems in space in the US and the emerging Indian and Chinese Space markets urge Europe to develop strategies to compete by fostering new private endeavours and stimulating the creation of new markets. Space in Europe may focus on optimizing regional technology clusters paying more attention on regions which could play a larger role in ESA’s industrial policy in the future. Considerations on the creation of new high-tech jobs for social and political concerns would create new opportunities to least developed countries. New financing models or investment communities to effectively catalyse dynamic risk capital investments and additional private investments in the sector. This can be done by studying economic profitability, its relation to specific space technologies and dependency on short/long term growths. A new approach to further linking universities, research institutions, private companies and ESA could be an interesting tool to fully develop student skills and interactions in the real world. An overview of clusters and ecosystems can be key to understand how policy makers can stimulate the growth of the space sector

An efficient technique of texture representation in segmentation-based image coding schemes

In segmentation-based image coding techniques the image to be compressed is first segmented. Then, the information is coded describing the shape and the interior of the regions. A new method to encode the texture obtained in segmentation-based coding schemes is presented. The approach combines 2-D linear prediction and stochastic vector quantization. To encode a texture, a linear predictor is computed first. Next, a codebook following the prediction error model is generated and the prediction error is encoded with VQ. In the decoder, the error image is decoded first and then filtered as a whole, using the prediction filter. Hence, correlation between pixels is not lost from one block to another and a good reproduction quality can be achieved.Peer ReviewedPostprint (published version

Avaluació de l’impacte clínic i econòmic d’una intervenció farmacèutica orientada a disminuir la medicació inadequada en persones majors de 70 anys polimedicades

Introducció L’envelliment de la població s’associa a una major prevalença de malalties cròniques que s’acompanya d’un increment proporcional en el consum de medicaments i a un augment en la polimedicació. Per altre banda, l’increment en la despesa sanitària i concretament en la despesa farmacèutica ha contribuït a posar en perill la sostenibilitat del sistema sanitari. Objectiu Avaluar l’eficàcia, la seguretat i l’impacte econòmic de la intervenció d’un farmacèutic especialista integrat en els equips d’atenció primària orientada a millorar l’adequació del tractament farmacològic prescrit a les persones ancianes polimedicades que viuen a la comunitat. Metodologia S’ha realitzat un assaig clínic aleatoritzat, obert, multicèntric i amb dues branques d’intervenció paral·leles. La població d’estudi inclou ancians de la comunitat no institucionalitzats, de 70 anys o més, que reben 8 o més medicaments, i residents a Mataró o Argentona. La intervenció d’estudi va consistir en la revisió de la medicació dels pacients per part d’un farmacèutic segons criteris àmpliament acceptats. Posteriorment es van presentar les recomanacions al metge responsable de cada pacient i finalment es van acordar els canvis a realitzar. El grup control va seguir la pràctica clínica habitual. Les principals mesures del resultat van ser la proporció de medicaments i de pacients amb canvis realitzats, així com les recomanacions. També s’han registrat el nombre consultes als dispositius assistencials i la mortalitat. Es va considerar un període de seguiment de 12. Conjuntament amb l'assaig clínic s’ha realitzat una anàlisi de cost i s’han valorat els costos entre les dues branques, segons la perspectiva del Servei Català de Salut. S’ha considerat un horitzó temporal d’un any després de la intervenció. Resultats Un total de 503 pacients (252 grup intervenció i 251 grup control) van ser reclutats. Es van avaluar 2.709 medicaments. En el 95,6% dels ancians polimedicats de la comunitat s’ha identificat almenys una medicació potencialment inadequada. Un 26,5% dels medicaments és van considerar potencialment inadequats amb una mitjana de 2,62 recomanacions per pacient. El 80,9% de les recomanacions efectuades pel farmacèutic van ser acceptades pel metge de família i el pacient, de manera que el 21,5% dels medicaments van ser canviats (el 9,2% de les prescripcions es van discontinuar, el 6,9% es va ajustar la dosi, el 3,1% es va substituir i es van iniciar un 2,2% de nous medicaments), amb una mitjana de 2,02 canvis per pacient. Els inhibidors de la bomba de protons i antiàcids (54,1%), les benzodiazepines (33,0%) i els analgèsics (31,2%) van ser els grups de fàrmacs més relacionats amb inadequació. El nombre de medicaments discontinuats, amb ajust de dosi i substituïts va ser superior en el grup intervenció respecte del grup control tant als 3, com als 6 i 12 mesos (p<0,001). No s’ha observat un increment ni en el consum de recursos sanitaris ni en la mortalitat als 12 mesos. Als 6 mesos, el grup intervenció va presentar una major adherència al tractament respecte el valor inicial (p<0,001). La intervenció d’estudi ha sigut responsable d’una reducció del 6,6% de la despesa farmacèutica anual, el que suposa un estalvi de 64,3€ per pacient cada any. S’ha estimat que la incorporació d’un farmacèutic als equips d’atenció primària ha generat un retorn de 2,38 € per euro invertit. Conclusions La intervenció d’un farmacèutic especialista integrat en els equip d’atenció primària i centrat en l’avaluació de l’adequació de la medicació de les persones grans polimedicades és una mesura capaç de millorar la qualitat de la prescripció farmacèutica, de reduir el nombre de medicaments prescrits i de generar uns estalvis en despesa farmacèutica sense que comporti efectes secundaris rellevants ni un increment en la freqüentació dels dispositius assistencials.Introduction Population ageing is associated with a higher prevalence of chronic diseases accompanied by a proportional increase in the consumption of drugs and an increase in polypharmacy. On the other hand, the increase in health expenditure and particularly in pharmaceutical spending has contributed to endangering the sustainability of the health system. Objective To assess the efficacy, safety and economic impact of a pharmacist intervention integrated into primary care teams aimed to improve the drug appropriateness in community-dwelling polymedicated elderly people. Methodology We conducted a randomized, open-label, multicentre, parallel-arm clinical trial. The study population includes non-institutionalized elderly people living in the community, aged 70 years or more, receiving eight or more drugs, and residents in Mataró or Argentona. The study intervention consisted in an evaluation of all drugs prescribed to each patient according to widely accepted criteria conducted by a pharmacist. Recommendations were discussed with patient’s physician in order to come up with a final set of recommendations. Control group continued usual clinical practice. Main outcome measures were the percentage of patients with recommendations and changes as well as number of drugs recommended and changed. Number of healthcare resources and mortality was also registered. 12 months’ follow-up were considered. A cost analysis was performed within clinical trial. Costs were evaluated between the two branches, according to Catalan Health Service perspective. A time horizon of one year was considered. Results A total of 503 patients (252 intervention group and 251 control group) were recruited. 2709 drugs were evaluated. At least one potentially inappropriate medication have been identified in 95.6% of community-dwelling polymedicated elderly people. About 26.5% of prescriptions were rated as potentially inappropriate medication, with an average of 2.62 recommendations per patient. About 80.9% of the recommendations made by the pharmacist were accepted by the physician. This represents a 21.5% of drugs changed (9.2% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription), with an average of 2.02 changes per patient. Proton-pump inhibitor and antacid (54.1%), benzodiazepines (33.0%) and NSAID's and opiates (31.2%) were the groups more related to inadequacy. Total number of drugs discontinued, with dose adjustment or replaced were higher in the intervention group compared to the control group at 3, 6 and 12 months (p <0.001). No increase was observed in health resources consumption or mortality at 12 months. Intervention group presented a greater adherence to treatment compared to baseline at 6 months (p <0.001). Study intervention has been responsible for a reduction of 6.6% of drug expenditure, which represents a savings of € 64.3 per patient per year. It has been estimated that the inclusion of a pharmacist in primary care teams has generated a return of € 2.38 per every euro invested. Conclusions The intervention of a clinical pharmacist integrated into the primary care team assessing drug appropriateness of community-dwelling polymedicated elderly people can improve the quality of prescriptions and reduce the number drugs prescribed and generate savings in pharmaceutical expenditure without significant side effects or involving an increase in the healthcare resources consumption

Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly

Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration—half of them without cough, and 45%, oropharyngeal residue; and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach

Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia

To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). (...

Avaluació de l'impacte clínic i econòmic d'una intervenció farmacèutica orientada a disminuir la medicació inadequada en persones majors de 70 anys polimedicades /

Introducció L'envelliment de la població s'associa a una major prevalença de malalties cròniques que s'acompanya d'un increment proporcional en el consum de medicaments i a un augment en la polimedicació. Per altre banda, l'increment en la despesa sanitària i concretament en la despesa farmacèutica ha contribuït a posar en perill la sostenibilitat del sistema sanitari. Objectiu Avaluar l'eficàcia, la seguretat i l'impacte econòmic de la intervenció d'un farmacèutic especialista integrat en els equips d'atenció primària orientada a millorar l'adequació del tractament farmacològic prescrit a les persones ancianes polimedicades que viuen a la comunitat. Metodologia S'ha realitzat un assaig clínic aleatoritzat, obert, multicèntric i amb dues branques d'intervenció paral·leles. La població d'estudi inclou ancians de la comunitat no institucionalitzats, de 70 anys o més, que reben 8 o més medicaments, i residents a Mataró o Argentona. La intervenció d'estudi va consistir en la revisió de la medicació dels pacients per part d'un farmacèutic segons criteris àmpliament acceptats. Posteriorment es van presentar les recomanacions al metge responsable de cada pacient i finalment es van acordar els canvis a realitzar. El grup control va seguir la pràctica clínica habitual. Les principals mesures del resultat van ser la proporció de medicaments i de pacients amb canvis realitzats, així com les recomanacions. També s'han registrat el nombre consultes als dispositius assistencials i la mortalitat. Es va considerar un període de seguiment de 12. Conjuntament amb l'assaig clínic s'ha realitzat una anàlisi de cost i s'han valorat els costos entre les dues branques, segons la perspectiva del Servei Català de Salut. S'ha considerat un horitzó temporal d'un any després de la intervenció. Resultats Un total de 503 pacients (252 grup intervenció i 251 grup control) van ser reclutats. Es van avaluar 2.709 medicaments. En el 95,6% dels ancians polimedicats de la comunitat s'ha identificat almenys una medicació potencialment inadequada. Un 26,5% dels medicaments és van considerar potencialment inadequats amb una mitjana de 2,62 recomanacions per pacient. El 80,9% de les recomanacions efectuades pel farmacèutic van ser acceptades pel metge de família i el pacient, de manera que el 21,5% dels medicaments van ser canviats (el 9,2% de les prescripcions es van discontinuar, el 6,9% es va ajustar la dosi, el 3,1% es va substituir i es van iniciar un 2,2% de nous medicaments), amb una mitjana de 2,02 canvis per pacient. Els inhibidors de la bomba de protons i antiàcids (54,1%), les benzodiazepines (33,0%) i els analgèsics (31,2%) van ser els grups de fàrmacs més relacionats amb inadequació. El nombre de medicaments discontinuats, amb ajust de dosi i substituïts va ser superior en el grup intervenció respecte del grup control tant als 3, com als 6 i 12 mesos (p 0,001). No s'ha observat un increment ni en el consum de recursos sanitaris ni en la mortalitat als 12 mesos. Als 6 mesos, el grup intervenció va presentar una major adherència al tractament respecte el valor inicial (p 0,001). La intervenció d'estudi ha sigut responsable d'una reducció del 6,6% de la despesa farmacèutica anual, el que suposa un estalvi de 64,3€ per pacient cada any. S'ha estimat que la incorporació d'un farmacèutic als equips d'atenció primària ha generat un retorn de 2,38 € per euro invertit. Conclusions La intervenció d'un farmacèutic especialista integrat en els equip d'atenció primària i centrat en l'avaluació de l'adequació de la medicació de les persones grans polimedicades és una mesura capaç de millorar la qualitat de la prescripció farmacèutica, de reduir el nombre de medicaments prescrits i de generar uns estalvis en despesa farmacèutica sense que comporti efectes secundaris rellevants ni un increment en la freqüentació dels dispositius assistencials.Introduction Population ageing is associated with a higher prevalence of chronic diseases accompanied by a proportional increase in the consumption of drugs and an increase in polypharmacy. On the other hand, the increase in health expenditure and particularly in pharmaceutical spending has contributed to endangering the sustainability of the health system. Objective To assess the efficacy, safety and economic impact of a pharmacist intervention integrated into primary care teams aimed to improve the drug appropriateness in community-dwelling polymedicated elderly people. Methodology We conducted a randomized, open-label, multicentre, parallel-arm clinical trial. The study population includes non-institutionalized elderly people living in the community, aged 70 years or more, receiving eight or more drugs, and residents in Mataró or Argentona. The study intervention consisted in an evaluation of all drugs prescribed to each patient according to widely accepted criteria conducted by a pharmacist. Recommendations were discussed with patient's physician in order to come up with a final set of recommendations. Control group continued usual clinical practice. Main outcome measures were the percentage of patients with recommendations and changes as well as number of drugs recommended and changed. Number of healthcare resources and mortality was also registered. 12 months' follow-up were considered. A cost analysis was performed within clinical trial. Costs were evaluated between the two branches, according to Catalan Health Service perspective. A time horizon of one year was considered. Results A total of 503 patients (252 intervention group and 251 control group) were recruited. 2709 drugs were evaluated. At least one potentially inappropriate medication have been identified in 95.6% of community-dwelling polymedicated elderly people. About 26.5% of prescriptions were rated as potentially inappropriate medication, with an average of 2.62 recommendations per patient. About 80.9% of the recommendations made by the pharmacist were accepted by the physician. This represents a 21.5% of drugs changed (9.2% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription), with an average of 2.02 changes per patient. Proton-pump inhibitor and antacid (54.1%), benzodiazepines (33.0%) and NSAID's and opiates (31.2%) were the groups more related to inadequacy. Total number of drugs discontinued, with dose adjustment or replaced were higher in the intervention group compared to the control group at 3, 6 and 12 months (p 0.001). No increase was observed in health resources consumption or mortality at 12 months. Intervention group presented a greater adherence to treatment compared to baseline at 6 months (p 0.001). Study intervention has been responsible for a reduction of 6.6% of drug expenditure, which represents a savings of € 64.3 per patient per year. It has been estimated that the inclusion of a pharmacist in primary care teams has generated a return of € 2.38 per every euro invested. Conclusions The intervention of a clinical pharmacist integrated into the primary care team assessing drug appropriateness of community-dwelling polymedicated elderly people can improve the quality of prescriptions and reduce the number drugs prescribed and generate savings in pharmaceutical expenditure without significant side effects or involving an increase in the healthcare resources consumption

Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2-59 Months of Age, Spain

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2-59 months who received diagnoses of IPD during January 2012-June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91-23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84-14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary

Effectiveness of the 13-valent pneumococcal conjugate vaccine in preventing invasive pneumococcal disease in children aged 7-59 months. A matched case-control study

Background The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed based on the results of immunogenicity studies and correlates of protection derived from randomized clinical trials of the 7-valent conjugate pneumococcal vaccine. We assessed the vaccination effectiveness (VE) of the PCV13 in preventing invasive pneumococcal disease (IPD) in children aged 7-59 months in a population with suboptimal vaccination coverage of 55%. Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona (Spain) and controls matched by hospital, age, sex, date of hospitalization and underlying disease. Information on the vaccination status was obtained from written medical records. Conditional logistic regression was made to estimate the adjusted VE and 95% confidence intervals (CI). Results 169 cases and 645 controls were included. The overall VE of ≥1 doses of PCV13 in preventing IPD due to vaccine serotypes was 75.8% (95% CI, 54.1-87.2) and 90% (95% CI, 63.9-97.2) when ≥2 doses before 12 months, two doses on or after 12 months or one dose on or after 24 months, were administered. The VE of ≥1 doses was 89% (95% CI, 42.7-97.9) against serotype 1 and 86.0% (95% CI, 51.2-99.7) against serotype 19A. Serotype 3 showed a non-statistically significant effectiveness (25.9%; 95% CI, -65.3 to 66.8). Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7-59 months was good and, except for serotype 3, the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually

Impact of the 13-valent conjugated pneumococcal vaccine on the direct costs of invasive pneumococcal disease requiring hospital admission in children aged < 5 years. A prospective study

The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the effect of pneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimate the direct costs of hospitalized IPD cases. A prospective study was made in children aged <5 years diagnosed with IPD in two high-tech hospitals in Catalonia (Spain) between 2007-2009 (PCV7 period) and 2012-2015 (PCV13 period). Costs were calculated according to 2014 Catalan Health Service rates using diagnostic-related groups. In total, 319 and 154 cases were collected, respectively. Pneumonia had the highest cost (65.7% and 62.0%, respectively), followed by meningitis (25.8% and 26.1%, respectively). During 2007-2015, the costs associated with PCV7 serotypes (Pearson coeffcient (Pc) = 0.79; p = 0.036) and additional PCV13 serotypes (Pc = 0.75; p = 0.05) decreased, but those of other serotypes did not (Pc = 0.23 p = 0.62). The total mean cost of IPD increased in the PCV13 period by 31.4% (¿3016.1 vs. ¿3963.9), mainly due to ICU stay (77.4%; ¿1051.4 vs. ¿1865.6). During the PCV13 period, direct IPD costs decreased due to a reduction in the number of cases, but cases were more severe and had a higher mean cost. During 2015, IPD costs increased due to an increase in the costs associated with non-PCV13 serotypes and serotype 3 and this requires further investigation