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Resumen Antecedentes y objetivo Actualmente existe cierta divergencia entre las principales guias de practica clinica sobre el manejo de los factores de riesgo de la enfermedad arterial periferica (EAP). El objetivo de este proyecto es conocer el manejo de los factores de riesgo de la EAP en la practica clinica y alcanzar un consenso multidisciplinar sobre las estrategias que se tienen que seguir para optimizar su identificacion, tratamiento y seguimiento. Metodologia Consenso multidisciplinar mediante metodologia Delphi. Resultados En la consulta participaron 130 profesionales con amplia experiencia en EAP. Los resultados sugieren que para optimizar el control de los factores de riesgo, los esfuerzos deben dirigirse a: 1) promover la involucramiento y concienciacion de todas las especialidades en la identificacion y el cribado de la enfermedad; 2) garantizar la posibilidad de realizar el indice tobillo-brazo (ITB) en todas las especialidades implicadas; 3) fomentar estrategias de deshabituacion del tabaquismo mediante el uso de farmacos, programas o derivaciones a unidades especializadas; 4) promover el seguimiento de una alimentacion adecuada basada en la dieta mediterranea y la prescripcion de ejercicio diario; 5) concienciar sobre la importancia de alcanzar unos valores de colesterol unido a lipoproteinas de baja densidad (cLDL) inferiores a 70 mg/Dl, especialmente en pacientes sintomaticos, pero tambien en asintomaticos ( Conclusion Las 22 estrategias consensuadas en el presente documento pretenden ayudar a los profesionales a optimizar el manejo multidisciplinar de los factores de riesgo de la EAP.

There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

In multiparty contexts, we know that affective polarization tends to cluster in ideological blocs, although the factors driving this process are still quite unexplored. In this paper, we contribute to filling this gap in the literature by exploring the capacity of ideological identity vis-à-vis issue-based ideology to polarize sentiments towards party voters into two opposing left-right blocs. Specifically, we provide empirical evidence that affective attachments to ideological labels increase the affective distance between ideological blocs to a greater extent than issue extremity and issue consistency. These bipolarizing effects of ideological identity persist even when the identity is inconsistent with issue-based ideology. Additionally, we show that bipolar affective polarization exerts little reverse influence on ideological identity. We support these arguments using an original survey from the TRI-POL project carried out in five multiparty systems: Argentina, Chile, Italy, Portugal and Spain. The research was supported by the Spanish Ministry of Science and Innovation (project reference: PID2019-106867RB-I00/AEI/10.13039/501100011033), the BBVA Foundation (Grants for Scientific Research Teams in Economy and Digital Society 2019) and the European Union-NextGenerationEU / Recovery, Transformation and Resilience Plan / UPF complementary call for requalification - Margarita Salas Grants. Mariano Torcal wants to thank the ICREA-ACADEMIA Intense Research Award for the additional funding.

Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.

Background and objectives Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. Material and methods We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012–2016). Results The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. Conclusions The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.

Resumen: Antecedentes y objetivo: Disponer de datos epidemiológicos y de carga de una enfermedad es crucial para su control y óptima planificación. El objetivo es estimar la carga de la psoriasis en términos epidemiológicos, las comorbilidades asociadas, el uso de recursos sanitarios y la incapacidad laboral. Material y método: Se han analizado los datos de la encuesta de salud de Cataluña (ESCA) del 2016, el registro de morbilidad y utilización de servicios sanitarios de Cataluña (MUSSCAT) del 2016 y los datos recopilados entre el 2012 y el 2016 del sistema integrado de gestión de la incapacidad temporal (IT) del Instituto Catalán de Evaluaciones Médicas. Resultados: La prevalecía de la psoriasis en Cataluña con base en los datos de la ESCA se sitúa en el 1,8%.Los datos del MUSSCAT muestran que el número de casos incidentes se ha mantenido estable en los últimos años. Las comorbilidades más frecuentes en el paciente con psoriasis son la hipertensión arterial (35%) y la diabetes (15%). La estratificación de la población con psoriasis por niveles de riesgo situó al 40% en riesgo moderado-alto. El uso anual de recursos sanitarios de las personas con psoriasis es elevado (8,7 visitas de atención primaria; 2,8 consultas externas; 0,5 de urgencias y hospital de día; 0,2 de salud mental y 6,1 medicamentos).Los procesos de IT asociados con la psoriasis o artropatía psoriásica representaron el 0,04% del total de registros. Conclusiones: La prevalencia de la psoriasis en Cataluña es del 1,8%. La carga de la enfermedad es elevada, tanto en términos de comorbilidades del paciente como en el requerimiento del uso de recursos. Abstract: Background and objectives: Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. Material and methods: We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012–2016). Results: The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%.The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications.Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. Conclusions: The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.

This is an introductory article for a special issue on affective polarisation in Spain. After discussing the concept and its operationalisation in multi-party settings, we offer data on affective polarisation in Spain and Southern Europe from a comparative perspective using the Comparative National Election Project (CNEP) and Comparative Study of Electoral Systems (CSES). In the second part, we pay special attention to the Spanish case, analysing different dimensions of affective polarisation and its evolution overtime, by taking advantage of an extensive number of indicators from the E-DEM panel survey. Finally, we describe its relationship with ideological polarisation and analyse its possible multidimensional nature. We conclude by introducing the rest of contributions of this special issue., This work was supported by the Institució Catalana de Recerca i Estudis Avançats [2019]; Ministerio de Ciencia, Innovación y Universidades [PID2019-106867RB-I00 /AEI/10.13039/ 501100011033; and CSO2016-79772-P]

Simple Summary The additional value of patient-reported symptom monitoring in routine cancer is still under discussion. With this in mind, we have reviewed recent evidence on the benefits of this strategy. The evidence examined illustrates that bringing systematic patient feedback into the oncology consultation provides objective advantages over usual care, such as better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Such care improvements ultimately entail an outstanding survival benefit for advanced cancer patients, an increase in their global quality of life, and eventually, medical cost savings. Monitoring patient-reported symptoms might also have other implications in clinical practice, such as promoting patient disease awareness or enhancing patient–physician communication and relationships. Notwithstanding these advantages, there are still logistical barriers that prevent its widespread implementation—especially in the electronic modality. In addition, the real-world effectiveness and the cost-effectiveness of this strategy are yet to be proven in different settings. Abstract Background: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. Methods: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. Results: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care—mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed that this monitoring approach prevented unplanned emergency room visits and hospital readmissions, leading to a substantial decrease in healthcare usage. Conclusions: There is consistent evidence across the studies that patient-reported symptom monitoring might entail a substantial survival benefit for cancer patients, better HRQoL, and a considerable decrease in healthcare usage. Nonetheless, more studies should be conducted to demonstrate their effectiveness in addition to their cost-effectiveness in clinical practice.

Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave.We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012-2016).The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases.The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.

Introduction To determine patient and rheumatologist preferences for rheumatoid arthritis (RA) treatment attributes in Spain and to evaluate their attitude towards shared decision-making (SDM). Methods Observational, descriptive, exploratory and cross-sectional study based on a discrete choice experiment (DCE). To identify the attributes and their levels, a literature review and two focus groups (patients [P] = 5; rheumatologists [R] = 4) were undertaken. Seven attributes with 2–4 levels were presented in eight scenarios. Attribute utility and relative importance (RI) were assessed using a conditional logit model. Patient preferences for SDM were assessed using an ad hoc questionnaire. Results Ninety rheumatologists [52.2% women; mean years of experience 18.1 (SD: 9.0); seeing an average of 24.4 RA patients/week (SD: 15.3)] and 137 RA patients [mean age: 47.5 years (SD: 10.7); 84.0% women; mean time since diagnosis of RA: 14.2 years (SD: 11.8) and time in treatment: 13.2 years (SD: 11.2), mean HAQ score 1.2 (SD: 0.7)] participated in the study. In terms of RI, rheumatologists and RA patients viewed: time with optimal QoL: R: 23.41%/P: 35.05%; substantial symptom improvement: R: 13.15%/P: 3.62%; time to onset of treatment action: R: 16.24%/P: 13.56%; severe adverse events: R: 10.89%/P: 11.20%; mild adverse events: R: 4.16%/P: 0.91%; mode of administration: R: 25.23%/P: 25.00%; and added cost: R: 6.93%/P: 10.66%. Nearly 73% of RA patients were involved in treatment decision-making to a greater or lesser extent; however, 27.4% did not participate at all. Conclusion Both for rheumatologists and patients, the top three decision-making drivers are time with optimal quality, treatment mode of administration and time to onset of action, although in different ranking order. Patients were willing to be more involved in the treatment decision-making process. Electronic supplementary material The online version of this article (10.1007/s12325-020-01258-5) contains supplementary material, which is available to authorized users.

Transmission configurations in off-road vehicles with multiple driven axles can be a determining factor in the obstacle surmounting capacity and also in the vehicle efficiency. An off-road articulated vehicle with four driven axles, four bogies and two modules has been considered for the global hydrostatic transmission efficiency analysis and for the vehicle functional efficiency analysis. The power flow through the transmission system has been quantified from the combustion engine shaft to each axle of the wheels. It has been done for different the operating conditions and taking into account the wheel–terrain interaction and the transmission configuration, that could lead to a forced slippage of some of the wheels. Results show the influence of the different wheels’ requirements, the transmission configuration limitations and the considered control strategy on the global transmission and vehicle functional efficiencies.

Objectives The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alpha-testing revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients’ decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p

Introduction The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Methods Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. Results A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients’ individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Conclusions Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use The authors are extremely grateful to all study participants who contributed with their time to participate in this research. Sponsorship, publication charges, and the open access charge for this study were funded by Eli Lilly & Co, Madrid (Spain). All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

The quantification of all the forces and moments between a tractor and an implement, when linked through the three-point hitch, is interesting for different purposes, including the optimization of the implement design, the evaluation of the tractor settings or the application in precision agriculture. This work presents the development of a new double frame dynamometer to measure them. The design has been focused in the mechanical optimisation of it while making it easily adaptable to a wide range of tractors and implements. A mathematical model has been developed to determine the forces and the moments at the different couplers between bodies of the tractor-dynamometer-implement system, taking into account the mechanical characteristics of the dynamometer and the inclination of the terrain where the tractor is working. Then the disruptive effect of the dynamometer on the forces acting on the tractor can be evaluated. Resultant longitudinal force between implement and soil is also determined, taking into consideration the inclination of the terrain and the mass of the implement. A prototype of the dynamometer has been built up and some initial field tests have been carried out to validate the design and the functionality of the dynamometer.

The closure of the abdominal wall after making a laparotomy is a major challenge for surgeons, since a significant percentage of closures fail and incisional hernias rise. The suture has to withstand the forces required to close the incision, while not hindering the adequate wound healing progression. Currently, there is no surgical measuring device that could be used to determine the required closing forces, which can be very different depending on the patient. This paper presents a dynamometer to measure the tension forces to be applied while closing a surgical incision, and it simultaneously measures the distance between wound edges. It is a compass-like instrument. A mechanism between the two legs incorporates a load cell, whose signal is read by an electronic device that computes the values of the tension forces between wound edges. An angular position sensor at the pin joint between legs provides the distance between both sides of the incision. Measuring capabilities of the instrument prototype were verified at the laboratory. Thereafter, its functionality was demonstrated in experimental surgery tests. Therefore, the instrument could be very useful in clinical applications, assisting personalized surgical techniques. Ministerio de Ciencia e Innovación (ES) (grant number PI11/01921) for funding this work.

Juan Carlos Torre-Alonso,1 Rubén Queiro,2 Marta Comellas,3 Luís Lizán,3,4 Carles Blanch5 1Rheumatology Department, Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Monte Naranco, Oviedo, Spain; 2Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; 3Outcomes 10, Castellón de la Plana, Spain; 4Medicine Department, Jaime I University, Castellón de la Plana, Spain; 5Health Economics & Market Access, Novartis Pharmaceuticals, Barcelona, Spain Objective: This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA). Patients and methods: We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews) regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence) in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus) were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria. Results: A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients’ HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs) greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that besides efficacy and safety, frequency and route of administration may influence patients’ preferences for BAs. Conclusion: Implementing management programs for SpA patients focuses on the physical, emotional, and social consequences of the disease, in addition to assessing and including patient preferences in the treatment decision-making process, could be crucial to improve patients’ HRQoL and ensure their satisfaction and compliance with treatment. Keywords: spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, patient-reported outcomes, European Union, systematic review

Conventional wheeled vehicles have serious mobility limitations in rough terrain while walking vehicles have inherent drawbacks such as a high number of DOF and actuators, control complexity and low-energy efficiency. Vehicles that passively adapt the position of multiple wheels to maintain contact with the ground can be a good compromise between both conventional wheeled and walking vehicles. One way to increase the number of wheels in contact with the ground is using bogies. However, the kinematics of a multiple axle vehicle moving on irregular terrain is quite complex since every wheel can require different angular speed to avoid slippage. The present work aims to quantify the obstacle surmounting capacity of a four axle, double-bogie vehicle depending on the transmission configuration, since it can provoke the slippage of some of its wheels.Some results are presented corresponding to the vehicle moving on a straight upward slope of different angles and facing variable obstacles in any of its axles.It ...

I Belinchón,1 R Rivera,2 C Blanch,3 M Comellas,4 L Lizán4,5 1Department of Dermatology, Hospital General Universitario de Alicante, Alicante, 2Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, 3Novartis Farmacéutica S.A., Barcelona, 4Outcomes’10, Castellón, Spain; 5Medical Department, University Jaime I, Castellón, Spain Background and objective: Adherence to treatment in patients with psoriasis is often poor. An investigation of patient preferences and satisfaction with treatment may be important, based on the expected correlation with therapy compliance. This paper aims to examine and describe the current literature on patient preferences, satisfaction and adherence to treatment for psoriasis in the European Union (EU).Methods: Electronic searches were conducted using PubMed, ISI Web of Knowledge, Scopus, Spanish databases and Google Scholar. European studies published in English or Spanish between January 1, 2009 and December 31, 2014 regarding patient-reported outcomes in psoriatic patients were included. Studies conducted in non-EU countries, letters to the editor, editorials, experts’ opinions, case studies, congress proceedings, publications that did not differentiate between patients with psoriasis and psoriatic arthritis or studies related to specific treatment were excluded.Results: A total of 1,769 titles were identified, of which 1,636 were excluded as they were duplicates or did not provide any relevant information. After a full-text reading and application of the inclusion/exclusion criteria, 46 publications were included. This paper will describe publications on adherence (n=4), preferences (n=5) and satisfaction with treatment (n=7). Results related to health-related quality of life articles (n=30) have been published elsewhere. Adherence rates are generally low in psoriasis patients regardless of the type of treatment, severity of disease or methods used to measure adherence. Biologic therapy is associated with greater clinical improvement. There is a direct association between physician recommendations, patient preferences and several domains of treatment satisfaction. Conclusion: The results of this review support the conclusion that adherence rates in patients with psoriasis are suboptimal and highlight the need to improve patient compliance and satisfaction with treatment. Patients’ preferences should be taken into account in the treatment decision-making process in order to improve patients’ clinical outcomes by ensuring satisfaction and adherence. Keywords: psoriasis, patient preference, adherence, satisfaction, systematic review, patient-reported outcomes, European Union

There is a large variety of multiple driven axle vehicles. Some of the most common are the 3-axle rigid vehicles and the 4-axle articulated vehicles, which can in some cases have different steering mechanisms, adaptive suspension, etc. This last kind of vehicles usually have very complex transmission configurations. Moreover, the required torques in each of the wheels can be very different, especially when the vehicle is working in rough terrains. The aim of this work is to study and model the driveline of this kind of vehicles, when using a hydrostatic transmission, from the performance and efficiency point of view, by analysing the influence of the operating conditions in the transmission efficiency. A global model is used to quantify the power flow in each of the transmission elements and the overall performance of the entire vehicle driveline, given the operating conditions thereof. A sensitivity analysis has also been done showing the influence of vehicle speed, rolling resistance, terrain slope and hydraulic motors displacement in the overall transmission efficiency. The interest of this work is also to make a contribution to the literature in the field of global modelling of drivelines under variable operating conditions and its application to ATVs. One important aspect is the influence of different actuation requirements that occur in different wheels at the same time. The results show that the overall performance of the transmission is highly dependent on operating conditions, on the selected transmission configuration and on the used components. The authors would like to thank Generalitat de Catalunya for partially funding this work (project 2009-SGR-534). M. Comellas would like to thank Universitat de Lleida for his research fellowship.

To summarize the data published over the last 5 years in the European Union related to the health-related quality of life (HRQoL) of patients with psoriasis and its conditioning factors.International electronic databases and gray literature were searched to identify studies conducted on patient-reported outcomes in patients with psoriasis, published in Europe between January 1, 2009 and December 31, 2013. Bibliographic references were hand-searched. Editorials, letters, commentaries, opinion papers, and studies related to specific treatments were excluded.A total of 46 studies met the inclusion criteria, 27 of them reporting data related to HRQoL or its conditioning factors. The publications reviewed highlighted the substantial negative impact of psoriasis on patients' HRQoL. Most of the studies that analyzed the relationship between HRQoL and sociodemographic characteristics described a relation between gender (female) and age (young patients) and poorer HRQoL. An association between HRQoL impairment and visibility of skin lesions and disease activity and severity was also established. Skin discomfort and pruritus were identified as elements that negatively influenced HRQoL. Use of biological agents had a positive impact on HRQoL and on treatment satisfaction, a better HRQoL being seen in patients treated with systemic therapies and biologics.HRQoL has been broadly addressed in patients with psoriasis in Europe. Several disease- and patient-related factors contributed to its deterioration. Therapeutic measures with proven effectiveness in controlling disease symptoms and reducing PASI should be considered in patients with a severe disease who have a poorer HRQoL.

There is a vast range of off-road multi-axle wheeled vehicle configurations. Some of the most common are the three axle rigid vehicles or the four axle articulated vehicles. However, these types of vehicles have the problem of using very complex transmission configurations. In addition, the requirements in terms of torque in each of the wheels are quite variable and non uniform. This work aims to model and study, from the standpoint of performance and energy efficiency, the driveline of such vehicles. The modelling process for the design and analysis of a hydrostatic transmission aimed at off-road multiple axle vehicles has been conceptually described. Mathematical models for the main components of the transmission and a global model of the driveline have been defined. A specific example study is presented, applying the described procedure. Results show that the overall performance of the transmission is highly dependent on the operating conditions, on the selected configuration and on the used components. The results also show that the actual instantaneous efficiency of each of the components is usually far below their maximum catalogue value. In the case study efficiencies up to 64% have been reached for the overall transmission.

Conventional wheeled vehicles have serious mobility limitations in rough terrain while walking vehicles have inherent drawbacks such as a high number of DOF and actuators, control complexity and low energy efficiency. Vehicles that passively fit the position of multiple wheels to maintain contact with the ground can be a good solution to this problem. The present work aims to comparatively quantify the ability of overcoming obstacles that is achieved by using different configurations of vehicles with bogies. Different configurations of vehicles facing obstacles when climbing along ramps of different longitudinal slope have been modeled. Further analyses have been done in order to investigate the influence of the position of the center of gravity and obstacle traversing speed. Different asymmetrical bogie configurations have also been proposed to further improve the obstacle surmounting capacity of the 4-axle vehicle. The results show a clear improvement in the ability to overcome obstacles when using bogies. Compromise solutions can be found for the obstacle traversing speed and position of the center of gravity. Asymmetrical bogie geometry can provide an improvement in the obstacle surmounting ability, although vehicle application has to be taken into account to find the best solution.

Citrus psorosis virus (CPsV), genus Ophiovirus, causes a bark scaling disease of citrus. CPsV virions are kinked filaments with three negative-stranded RNA molecules (vRNA) and a 48 kDa coat protein. The effect of temperature on symptom expression, virus accumulation and RNA silencing was examined in sweet orange seedlings (Citrus sinensis) graft-inoculated with three different CPsV isolates and grown in a glasshouse at 26/18°C or 32/26°C (day/night). Most plants kept in the cooler glasshouse showed a shock reaction in the first flush with shoot necrosis, and then moderate to intense chlorotic flecking and spotting in young leaves, whereas plants incubated at 32/26°C did not exhibit shoot necrosis, and young leaf symptoms were milder. Virus titre estimated by ELISA and by northern and dot blot hybridization paralleled symptom intensity, with significantly higher virus accumulation in plants incubated at 26/18°C. The amount of CPsV-derived small RNAs (CPsV-sRNAs) slightly increased at 32/26°C, with the ratio of CPsV-sRNA/vRNA being higher at 32/26°C than at 26/18°C. These results suggest that (i) CPsV infection induces RNA silencing in citrus plants, (ii) symptom intensity is associated with virus accumulation, and (iii) temperature increase enhances the RNA silencing response of citrus plants and decreases virus accumulation.

Background: Treatment adherence is one of the key factors for achieving optimal clinical outcomes. In order to assess costs related to adherence to, and persistence and compliance with, disease-modifying therapies (DMTs) in patients with multiple sclerosis (MS), a narrative review of the literature was performed. Satisfaction with and preference for DMTs and their delivery devices were also assessed, as both can have an influence on patients’ adherence and persistence. Methods: Electronic databases (MEDLINE, PubMed, Google Scholar, congress proceedings) were searched to identify publications analyzing MS costs related to adherence, persistence, satisfaction, and preferences for MS treatments. Bibliographic references were hand searched. English or Spanish studies published between January 2007 and January 2013 were selected. Results: A total of 398 titles were identified, of which 12 met the inclusion criteria. Six studies evaluated the impact of adherence, persistence, and compliance on treatment costs; four publications analyzed satisfaction with DMTs; and two assessed treatment preferences based on attributes of the delivery device. Increased adherence and persistence were associated with better clinical outcomes, leading to lower relapse risk (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59–0.85) and a decrease in health care resource use, such as MS-related hospitalizations (OR: 0.63; 95% CI: 0.47–0.83) and emergency department visits (OR: 0.80; 95% CI: 0.60–1.07). This reduction in resource use led to a patient/year total cost reduction (excluding DMT costs) of up to 22%. Conclusion: This review highlights the importance of ensuring adequate adherence in MS patients through treatments and devices better tailored to patients’ needs that could enhance clinical outcomes and reduce MS costs. Understanding the factors underlying satisfaction and compliance with treatment and patients’ preference for certain therapies could help in the development of strategies that can improve adherence.

Dcp from Escherichia coli is a 680 residue cytoplasmic peptidase, which shows a strict dipeptidyl carboxypeptidase activity. Although Dcp had been assigned to the angiotensin I-converting enzymes (ACE) due to blockage by typical ACE inhibitors, it is currently grouped into the M3 family of mono zinc peptidases, which also contains the endopeptidases neurolysin and thimet oligopeptidase (TOP). We have cloned, expressed, purified, and crystallized Dcp in the presence of an octapeptide “inhibitor”, and have determined its 2.0 A crystal structure using MAD methods. The analysis revealed that Dcp consists of two half shell-like subdomains, which enclose an almost closed two-chamber cavity. In this cavity, two dipeptide products presumably generated by Dcp cleavage of the octapeptide bind to the thermolysin-like active site fixed to side-chains, which are provided by both subdomains. In particular, an Arg side-chain backed by a Glu residue, together with two Tyr phenolic groups provide a charged anchor for fixing the C-terminal carboxylate group of the P2′ residue of a bound substrate, explaining the strict dipeptidyl carboxypeptidase specificity of Dcp. Tetrapeptidic substrates are fixed only via their main-chain functions from P2 to P2′, suggesting a broad residue specificity for Dcp. Both subdomains exhibit very similar chain folds as the equivalent but abducted subdomains of neurolysin and TOP. Therefore, this “product-bound” Dcp structure seems to represent the inhibitor/substrate-bound “closed” form of the M3 peptidases, generated from the free “open” substrate-accessible form by a hinge-bending mechanism. A similar mechanism has recently been demonstrated experimentally for ACE2.

Kumamolisin, an extracellular proteinase derived from an acido/thermophilic Bacillus, belongs to the sedolisin family of endopeptidases characterized by a subtilisin-like fold and a Ser-Glu-Asp catalytic triad. In kumamolisin, the Asp82 carboxylate hydrogen bonds to Glu32-Trp129, which might act as a proton sink stabilizing the catalytic residues. The 1.2/1.3 A crystal structures of the Glu32→Ala and Trp129→Ala mutants show that both mutations affect the active-site conformation, causing a 95% activity decrease. In addition, the 1.2 A crystal structure of the Ser278→Ala mutant of pro-kumamolisin was determined. The prodomain exhibits a half-β sandwich core docking to the catalytic domain similarly as the equivalent subtilisin prodomains in their catalytic-domain complexes. This pro-kumamolisin structure displays, for the first time, the uncleaved linker segment running across the active site and connecting the prodomain with the properly folded catalytic domain. The structure strongly points to an initial intramolecular activation cleavage in subtilases, as presumed for pro-subtilisin and pro-furin.