[Cost-effectiveness analysis of fracture liaison services in Catalonia]

OBJECTIVE

To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service.

METHODS

Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses.

RESULTS

Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case.

CONCLUSIONS

The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

Dermacentor-borne necrosis erythema lymphadenopathy (DEBONEL) due to Rickettsia raoultii in a patient with erythema migrans

Erythema migrans is usually associated with infections/co-infections with Borrelia spp. DEBONEL and other localized diseases caused by Rickettsia spp. following a tick bite usually respond to therapy with doxycycline but possible co-infections with Borrelia spp should be excluded. In this case, PCR in the tick was positive for Rickettsia raoultii.

Detailed Emotional Profile of Secondary Education Students Toward Learning Physics and Chemistry

The present research arises from the need to identify the emotions that K-7 to K-10 students experience toward the learning of Physics and Chemistry, since it is a fact that there is a decrease in the number of students choosing itineraries related to Science. Different blocks of contents have been considered in each subject in order to identify emotions toward each one of them. The considered sample consisted of 149 K-8 students, 152 K-9 students and 130 K-10 students from several middle and high schools in Badajoz (Spain) during the 2014–2015 school year. Students experienced more positive emotions toward the content of Chemistry than toward those of Physics. A decrease was detected in the mean frequency of positive emotions such as joy, fun, and tranquility from K-8 to K-10, as well as an increase in negative emotions such as boredom, anxiety, disgust, fear, nervousness, worry, and sadness. It has also been found that positive emotions toward Chemistry contents are mainly related to teachers’ methods and attitudes, while negative emotions toward Physics contents are related to the exclusive use of the textbook, solving Physics problems, or giving oral presentations of the topics in class.

Exit for success. Gamifying science and technology for university students using escape-room. A preliminary approach

There is a growing tendency to incorporate gamification activities with the aim of improving student's motivation in science, technology, engineering and mathematics (STEM) courses. One of the strategies to apply gamification in the classroom is the use of the escape room. In this work different experiences of escape room in the context of formal university education are analysed. The analysis of students' opinions shows that such activities are well received regardless of background (engineering or education) or gender. The emotions that arise from the experience are mostly positive and the students state that they have developed both specific and transversal competencies. Finally, practical considerations are proposed based on the lessons learned from the developed experiences.

Optimization of the synthesis of a new coagulant from a tannin extract

The current article studies the optimization of a new coagulant agent for water purification and wastewater remediation. Design of experiments is used for optimizing the production of this new tannin-based coagulant by using Acacia mearnsii de Wild tannin extract, NH(4)Cl and formaldehyde. The effectiveness of this product was confirmed on dye-polluted wastewater and surfactant wastewater. This cationic coagulant seems to be sensitive to temperature and tannin-NH(4)Cl ratio (g of ammonium chloride per g of tannin extract). NH(4)Cl ratio was found to be more influent than temperature and no interaction is presented between these two parameters. For each system, an optimum combination NH(4)Cl ratio and temperature was found: 24.9°C and 2 g g(-1) for dye removal and 36.4°C and 1.87 g g(-1) for surfactant elimination. The optimal conditions were merged to produce a combined coagulant that was tested on dye, surfactant, surface river water and municipal wastewater. Predicted levels of remediation were experimentally confirmed.

Paroxysmal extreme pain disorder: a molecular lesion of peripheral neurons

BACKGROUND

a 3-month-old male infant presented, beginning on the second day of life, with paroxysmal painful events that started with tonic contraction of the whole body followed by erythematous harlequin-type color changes.

INVESTIGATIONS

screening of the SCN9A gene, which encodes the voltage-gated sodium channel Na(V)1.7, identified a new mutation, Gly1607Arg, located within the domain IV S4 voltage sensor. Whole-cell patch-clamp analysis demonstrated functional effects of the mutant channel that included impaired inactivation-a hallmark of paroxysmal extreme pain disorder (PEPD).

DIAGNOSIS

the patient was diagnosed as having PEPD, an autosomal dominant disorder characterized by severe rectal pain triggered by defecation or perineal stimulation, usually followed by ocular or submaxillary pain. Erythematous flushing, sometimes in a harlequin pattern, can be a prominent feature of this condition.

MANAGEMENT

treatment with carbamazepine (10 mg/kg/day) for approximately 3 months was ineffective in this case, and the parents made a decision to discontinue the drug. The mother was instructed to avoid painful stimuli that could trigger an episode.

Surface water and wastewater treatment using a new tannin-based coagulant. Pilot plant trials

A new tannin-based coagulant-flocculant (Tanfloc) was tested for water treatment at a pilot plant level. Four types of water sample were treated: surface water (collected from a river), and municipal, textile industry (simulated by a 100 mg L(-1) aqueous solution of an acid dye), and laundry (simulated by a 50 mg L(-1) aqueous solution of an anionic surfactant) wastewaters. The pilot plant process consisted of coagulation, sedimentation, and filtration. The experiments were carried out with an average coagulant dosage of 92.2 mg L(-1) (except in the case of the surface water for which the dosage was 2 mg L(-1)). The efficacy of the water purification was notable in every case: total turbidity removal in the surface water and municipal wastewater, about 95% dye removal in the case of the textile industry wastewater, and about 80% surfactant removal in the laundry wastewater. Filtration improved the removal of suspended solids, both flocs and turbidity, and slightly improved the process as a whole. The efficiency of Tanfloc in these pilot studies was similar to or even better than that obtained in batch trials.

Comparison of single-step and two-step purified coagulants from Moringa oleifera seed for turbidity and DOC removal

The coagulant proteins from Moringa oleifera purified with single-step and two-step ion-exchange processes were used for the coagulation of surface water from Meuse river in The Netherlands. The performances of the two purified coagulants and the crude extract were assessed in terms of turbidity and DOC removal. The results indicated that the optimum dosage of the single-step purified coagulant was more than two times higher compared to the two-step purified coagulant in terms of turbidity removal. And the residual DOC in the two-step purified coagulant was lower than in single-step purified coagulant or crude extract.

Novel tannin-based adsorbent in removing cationic dye (Methylene Blue) from aqueous solution. Kinetics and equilibrium studies

Natural tannin-based adsorbent has been prepared on the basis of the gelification of Quebracho bark extract. The resulting product, Quebracho Tannin Gel (QTG) was tested as cationic dye adsorbent with Methylene Blue (MB). Kinetics of adsorption process were studied out and a period of 15 days was determined for reaching equilibrium. The influences of pH and temperature were evaluated. As pH or temperature raise q capacity of QTG increases. Theoretical modelization of dye-QTG adsorption was carried out by multiparametric adjustment according to Langmuir's hypothesis. Values of the k(l1), k(l2) and activation energies were calculated.

Removal of Alizarin Violet 3R (anthraquinonic dye) from aqueous solutions by natural coagulants

In this paper the ability of two natural products in removing dyes has been tested. After a preliminary screening for dye removal capacity, a tannin-based coagulant called ACQUAPOL C-1 and a vegetal protein extract derived from Moringa oleifera seed have been fully studied. The influence of several parameters such as pH, temperature or initial dye concentration (IDC) have been tested and the behavior of both coagulants has been compared. pH results to be an interesting variable and dye removal decreases as pH increases. This effect is higher in ACQUAPOL C-1 than in M. oleifera seed extract. Temperature seems not to be so affecting parameter, while IDC appears to be a very important variable in q(c) capacity, which is higher as IDC increases. Langmuir isotherm model fits very well in both cases of ACQUAPOL C-1 and M. oleifera seed extract dye removal.

Removal of sodium lauryl sulphate by coagulation/flocculation with Moringa oleifera seed extract

Among other natural flocculant/coagulant agents, Moringa oleifera seed extract ability to remove an anionic surfactant has been evaluated and it has been found to be very interesting. Sodium lauryl sulphate was removed from aqueous solutions up to 80% through coagulation/flocculation process. pH and temperature were found to be not very important factors in removal efficiency. Freundlich (F), Frumkin-Fowler-Guggenheim (FFG) and Gu-Zhu (GZ) models were used to adjust experimental data in a solid-liquid adsorption hypothesis. Last one resulted to be the most accurate one. Several data fit parameters were determined, as Freundlich order, which was found to be 1.66, Flory-Huggins interaction parameter from FFG model, which was found to be 4.87; and limiting Moringa surfactant adsorption capacity from GZ model, which was found to be 2.13 x 10(-3)mol/g.

Improvement of water treatment pilot plant with Moringa oleifera extract as flocculant agent

Moringa oleifera extract is a high-capacity flocculant agent for turbidity removal in surface water treatment. A complete study of a pilot-plant installation has been carried out. Because of flocculent sedimentability of treated water, a residual turbidity occured in the pilot plant (around 30 NTU), which could not be reduced just by a coagulation-flocculation-sedimentation process. Because of this limitation, the pilot plant (excluded filtration) achieved a turbidity removal up to 70%. A slow sand filter was put in as a complement to installation. A clogging process was characterized, according to Carman-Kozeny's hydraulic hypothesis. Kozeny's k parameter was found to be 4.18. Through fouling stages, this k parameter was found to be up to 6.36. The obtained data are relevant for the design of a real filter in a continuous-feeding pilot plant. Slow sand filtration is highly recommended owing to its low cost, easy-handling and low maintenance, so it is a very good complement to Moringa water treatment in developing countries.