A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy.

BACKGROUND: Minor ailments are "self-limiting conditions which may be diagnosed and managed without a medical intervention". A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). METHODS: The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists' training, practice change facilitators and patients' educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals' consultation time, medication costs, pharmacists' training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. RESULTS: A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. CONCLUSIONS: Expanding community pharmacists' scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. TRIAL REGISTRATION: ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered

Optimización de modelos en elementos finitos de los maniquíes Hybrid-III percentiles 50% y 95% para su aplicación en transporte ferroviario

En este artículo se presenta la metodología seguida para el desarrollo de los modelos matemáticos de los maniquíes Hybrid-III 50% y 95%, los cuales son capaces de predecir correctamente los criterios de lesión asociados a cada región del cuerpo. Como aplicación práctica de los modelos, se evalúa la seguridad de butacas de tren mediante técnicas de simulación. En primer lugar se han desarrollado los modelos a través de su geometría tridimensional. También han sido asignados los diferentes materiales y propiedades de cada parte de los maniquíes. Posteriormente se ha seguido un proceso de optimización y de mejora que incluye la verificación y validación de los maniquíes virtuales. Dicha validación se realiza a partir de los maniquíes físicos y de los datos experimentales que posee el Laboratorio de Seguridad Pasiva (LSP) del INSIA de la UPM, utilizando los maniquíes en varias configuraciones. Finalmente, se realiza el proceso de optimización de estos modelos virtuales para que representen lo más fielmente posible la realidad, que su comportamiento sea preciso y que el tiempo de cálculo o coste computacional sea el menor posible. Una vez creados los modelos en elementos finitos de ambos maniquíes, se emplean para analizar la seguridad de las butacas de tren mediante la simulación de los ensayos dinámicos que se describen en la norma GM/RT2100. Esta norma exige dos configuraciones de ensayo para evaluar la seguridad de las butacas. La primera configuración sirve para evaluar la resistencia y la integridad estructural de la butaca y sus anclajes mediante el uso de dos maniquíes Hybrid-III 95%. La segunda configuración se utiliza para evaluar la protección que las butacas ofrecen al ocupante mediante el uso de un maniquí Hybrid-III 50% instrumentado. En ambas configuraciones se realizan impactos en sentido de la marcha y en el sentido contrario y se compran los valores registrados en los maniquíes tanto en los ensayos reales como en las simulaciones matemáticas

Fusion of 8He with 206Pb around Coulomb barrier energies

5th International Conference FUSION11The experimental study of the fusion of light neutron-rich nucleus 8He with 206Pb is reported in this work. A fusion stack of 206Pb targets has been used for this study. The most prominent evaporation residue (210Po), which has half-life of 138 days and decays by alpha emission, is populated in the reaction. Radiochemical analysis technique is used to extract the yield of this evaporation residueMinisterio Español de Ciencia e Innovación FPA2007-6307

Contested discourses in social tourism:A relational political economy perspective

Social tourism initiatives often have economic as well as objectives, particularly national schemes such as the Spanish IMSERSO programme, designed to stimulate off-season tourism in mass coastal tourism destinations. Yet, there is little evidence of how such schemes responded to crises or that explores the effects on the tourism industry actors responsible for programme delivery. This article applies a relational political economy approach to assess the contested discourses surrounding the governance of the scheme. We examine the evolution of the IMSERSO programme longitudinally following the global financial crisis and up until the COVID-19 pandemic to assess the relational dynamics at play social tourism governance on destination stakeholders, outlining implications for social tourism policies internationally

Acorn production at the dehesa: influential factors

This paper reviews the state-of-the-knowledge of acorn production in the South-Western Iberian dehesas. In the first part are briefly described the soil and climatic determining factors and phenology of most common trees of genus Quercus at the dehesa (Q. ilex, Q. suber and Q. faginea). In the second part, acorn production estimations are analyzed. Was established a mean acorn yield of 300 to 700 kg/ha; with individual productions of 8-14 kg/tree for Q. ilex, 5-10 kg/tree for Q. suber and 1-11 kg/tree for Q. faginea; with a highly variable production, both between and within years and individual trees. Finally we review the factors affecting acorn production, describing density of trees (estimated in 20-50 trees/ha), masting phenomenon (with cycles of 2-5,5 years and asynchrony between trees), individual cha-racteristics of trees (genetic potential, age, top surface, etc.), tree mass handling (with favourable effect of tilling, moderate pruning and sustainable grazing), meteorological conditions (mainly drought and meteorology during flowering) and sanitary status (Lymantria, Tortrix, Curculio, Cydia, Balaninus and Brenneria).Se revisa el conocimiento sobre la producción de bellota en las dehesas del SW de la Península Ibérica. Primero se analizan los condicionantes edafoclimáticos y la fenología de los principales árboles del género Quercus (Q. ilex, Q. suber y Q. faginea) presentes en las dehesas. A continuación se analiza la producción de bellota, que presentan valores medios de 300 a 700 kg/ha y producciones individuales de 8-14 kg/árbol para Q. ilex, 5-10 kg/árbol para Q. suber y 1-11 kg/árbol para Q. faginea; resultando producciones muy variables entre individuos, tanto intra como interanualmente. Finalmente, se revisan los factores que afectan a la producción de bellota; y entre éstos se describen la densidad de árboles (estimada en 20-50 pies adultos/ha), el fenómeno de la vecería (con ciclos de 2-5,5 años y asincronía entre árboles), las características individuales de los árboles (potencial genético, edad, superficie de copa, etc.), el manejo de la arboleda (con efecto favorable del laboreo, las podas ligeras y el pastoreo sostenible), las condiciones meteorológicas (principalmente sequía y meteorología durante la floración) y el estado sanitario (Lymantria, Tortrix, Curculio, Cydia, Balaninus y Brenneria)

Influence of the effect pigment size on the sparkle detection distance

5 págs.; 5 figs.In an effort to create more dynamic looking automobiles, there is an ever increasing trend among automobile manufacturers towards the use of gonio-apparent coatings in car bodies. These coatings consist of transparent pigments mixed with metallic or interference flakes. The flakes in the coating cause a change in color and brightness of the finish with viewing and illumination direction. This change in appearance accentuates the 3D shading of a car body, making it visually more attractive. Besides this angular dependence on viewing/illumination direction, the metallic finishes also exhibit a visually complex texture. Depending on the properties of the finish and the viewing and illumination conditions, the flakes exhibit a sparkle like texture, while the glossy clear coat may show a rough or smooth surface. As a result of these complex visual attributes, capturing the appearance and finding a perfect color match for an automotive coating is a non trivial task. The main objective of this work is to evaluate the relationship between the special-effect pigments size, and the maximum distance which is detectable the sparkle texture effect. For this, two different sets of samples with different structural features were evaluated in a lighting booth specifically designed for the visual experiment. The booth allows to vary the lighting conditions, the viewing geometry and the distance at which the sample is perceived. The visual experiment was applied to evaluate the high correlation between a structural parameter (i.e. pigment size) and the visual appearance attribute related with texture (sparkle detection distance). Under some fixed environmental conditions, as light intensity, color temperature and geometry of the light source, the sparkle detection distance was evaluated by applying the adjustment psychophysical method for two panel sets (metallic grays and blues), with known pigment sizes and colorimetry, with a small set of observers. The visual results show that a greater the pigment size, a greater the sparkle detection, but with some considerations. In future, we will extend this method, even reinforced applying the statistical design of experiments (DOE), for understanding the relevance and interplay of structural (size, shape, concentration, orientation, etc.), environmental (illuminance level, color rendering, geometry, etc.) and colorimetric (dark vs. light background, chroma, etc.) factors on the sparkle detection distance. © 2015 Society for Imaging Science and Technology.Authors are grateful to EMRP for funding the project “Multidimensional reflectometry for industry”. The EMRP is jointly funded by the EMRP participating countries within EURAMET and the European Union. We would like to thank the Ministry of Economy and Competitiveness for the coordinated project “New developments in visual optics, vision and color technology” (DPI2011-30090-C02). Omar Gómez would also like to thank the Ministry of Economy and Competitiveness for his pre- doctoral fellowship grant (FPI BES-2012-053080).Peer Reviewe

Co-pyrolysis of sewage sludge and manure

The management and valorization of residual organic matter, such as sewage sludge and manure, is gaining interest because of the increasing volume of these residues, their localized generation and the related problems. The anaerobic digestion of mixtures of sewage sludge and manure could be performed due to the similarities between both residues. The purpose of this study is to evaluate the feasibility of the co-pyrolysis of sewage sludge (SS) and digested manure (DM) as a potential management technology for these residues. Pyrolysis of a sewage sludge/manure blend (50:50%) was performed at 525 °C in a stirred batch reactor under N2 atmosphere. The product yields and some characteristics of the product were analyzed and compared to the results obtained in the pyrolysis of pure residues. Potential synergetic and antagonist effects during the co-pyrolysis process were evaluated. Although sewage sludge and manure seem similar in nature, there are differences in their pyrolysis product properties and distribution due to their distinct ash and organic matter composition. For the co-pyrolysis of SS and DM, the product yields did not show noticeable synergistic effects with the exception of the yields of organic compounds, being slightly higher than the predicted average, and the H2 yield, being lower than expected. Co-pyrolysis of SS and DM could be a feasible management alternative for these residues in locations where both residues are generated, since the benefits and the drawbacks of the co-pyrolysis are similar to those of the pyrolysis of each residue

Evidence for a Triaxial Milky Way Dark Matter Halo from the Sagittarius Stellar Tidal Stream

Observations of the lengthy tidal streams produced by the destruction of the Sagittarius dwarf spheroidal (Sgr dSph) are capable of providing strong constraints on the shape of the Galactic gravitational potential. However, previous work, based on modeling different stream properties in axisymmetric Galactic models has yielded conflicting results: while the angular precession of the Sgr leading arm is most consistent with a spherical or slightly oblate halo, the radial velocities of stars in this arm are only reproduced by prolate halo models. We demonstrate that this apparent paradox can be resolved by instead adopting a triaxial potential. Our new Galactic halo model, which simultaneously fits all well-established phase space constraints from the Sgr stream, provides the first conclusive evidence for, and tentative measurement of, triaxiality in an individual dark matter halo. The Milky Way halo within ~ 60 kpc is best characterized by a minor/major axis ratio of the isovelocity contours c/a ~ 0.67, intermediate/major axis ratio b/a ~ 0.83, and triaxiality parameter T ~ 0.56. In this model, the minor axis of the dark halo is coincident with the Galactic X axis connecting the Sun and the Galactic Center to within ~ 15 degrees, while the major axis also lies in the Galactic plane, approximately along the Galactic Y axis.Comment: Accepted for publication in ApJ Letters. 3 figure

Influencia del tamaño de pigmento en la distancia de detección del sparkle

XI Reunión Nacional de Óptica Día de la Luz; Facultad de Ciencias • Universidad de Salamanca 1 - 4 Septiembre, 2015; http://rno11.usal.es/programaSe diseñó un experimento psicofísico para evaluar la influencia del tamaño del pigmento de efecto en la distancia de detección del sparkle. Los resultados mostraron que a mayor tamaño de pigmento, mayor distancia de detección. Además, la correlación visual e instrumental (distancia de detección vs. grado de sparkle (SG)) sigue una relación lineal, sin embargo, no existe una relación lineal con el tamaño de pigmento: la distancia es máxima para un tamaño inferior al tamaño máximo.Peer Reviewe

Long-Term Socio-Ecological Research in the Biosphere Reserve in Mapimi, Mexico: A Multidimensional Participatory Observatory of Rangeland/Pastoral Systems

Since the creation of the UNESCO Biosphere Reserve Mapimi (BRM) in Mexico 45 years ago, pastoralism has undergone a series of transformations. Upon the arrival of the Spaniards, horse breeding flourished until 1900; thereafter extensive cattle production lasted for six decades. Only recently, farmers have adopted alternative management types for organic meat production. National and international efforts to achieve the Sustainable Development Goals (SDGs) require basic, applied, and participatory research efforts. In the socio-ecological pastoral system BRM, first halophytic ecosystems were examined for their ecohydrological role in rangeland productivity. In 1996, a long-term ecological research site was installed to monitor the effects of herbivores on the composition and biodiversity of desert communities. Shortly thereafter, the National Commission of Natural Protected Areas began a rigorous monitoring and conservation program to guarantee both the sustainable management of natural resources and the sustainable development of reserve dwellers. Soon international multisectoral institutions joined Mexican efforts to protect the natural, cultural, and social diversity of the BRM and to strengthen its socio-ecological resilience to climate change and land degradation. Hence, the BRM is currently a space of participatory monitoring and research, with emphasis on the health of this important socio-ecological pastoralist system. It is examined whether institutional programs promoting organic livestock farming are compatible with this desert system and how biological soil crust is developing as a fundamental indicator of soil functioning and the provision of ecosystem services and human wellbeing. The formation of multisectoral partnerships to foster dryland sustainability have led to the foundation of the International Network for Dryland Sustainability; it is currently coordinating a national network of participatory socio-ecological observatories (PSEOs) to promote the SDGs. Mapimi is one of the first PSEOs to promote local governance and social and ecological sustainable development in the drylands of Mexico and world-wide