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Background
Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.
Methods
This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.
Results
With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.
Conclusion
Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.
Melting probes are a proven tool for the exploration of thick ice layers and clean sampling of subglacial water on Earth. Their compact size and ease of operation also make them a key technology for the future exploration of icy moons in our Solar System, most prominently Europa and Enceladus. For both mission planning and hardware engineering, metrics such as efficiency and expected performance in terms of achievable speed, power requirements, and necessary heating power have to be known.
Theoretical studies aim at describing thermal losses on the one hand, while laboratory experiments and field tests allow an empirical investigation of the true performance on the other hand. To investigate the practical value of a performance model for the operational performance in extraterrestrial environments, we first contrast measured data from terrestrial field tests on temperate and polythermal glaciers with results from basic heat loss models and a melt trajectory model. For this purpose, we propose conventions for the determination of two different efficiencies that can be applied to both measured data and models. One definition of efficiency is related to the melting head only, while the other definition considers the melting probe as a whole. We also present methods to combine several sources of heat loss for probes with a circular cross-section, and to translate the geometry of probes with a non-circular cross-section to analyse them in the same way. The models were selected in a way that minimizes the need to make assumptions about unknown parameters of the probe or the ice environment.
The results indicate that currently used models do not yet reliably reproduce the performance of a probe under realistic conditions. Melting velocities and efficiencies are constantly overestimated by 15 to 50 % in the models, but qualitatively agree with the field test data. Hence, losses are observed, that are not yet covered and quantified by the available loss models. We find that the deviation increases with decreasing ice temperature. We suspect that this mismatch is mainly due to the too restrictive idealization of the probe model and the fact that the probe was not operated in an efficiency-optimized manner during the field tests. With respect to space mission engineering, we find that performance and efficiency models must be used with caution in unknown ice environments, as various ice parameters have a significant effect on the melting process. Some of these are difficult to estimate from afar.
Muscle function is compromised by gravitational unloading in space affecting overall musculoskeletal health. Astronauts perform daily exercise programmes to mitigate these effects but knowing which muscles to target would optimise effectiveness. Accurate inflight assessment to inform exercise programmes is critical due to lack of technologies suitable for spaceflight. Changes in mechanical properties indicate muscle health status and can be measured rapidly and non-invasively using novel technology. A hand-held MyotonPRO device enabled monitoring of muscle health for the first time in spaceflight (> 180 days). Greater/maintained stiffness indicated countermeasures were effective. Tissue stiffness was preserved in the majority of muscles (neck, shoulder, back, thigh) but Tibialis Anterior (foot lever muscle) stiffness decreased inflight vs. preflight (p < 0.0001; mean difference 149 N/m) in all 12 crewmembers. The calf muscles showed opposing effects, Gastrocnemius increasing in stiffness Soleus decreasing. Selective stiffness decrements indicate lack of preservation despite daily inflight countermeasures. This calls for more targeted exercises for lower leg muscles with vital roles as ankle joint stabilizers and in gait. Muscle stiffness is a digital biomarker for risk monitoring during future planetary explorations (Moon, Mars), for healthcare management in challenging environments or clinical disorders in people on Earth, to enable effective tailored exercise programmes.
Many important properties of bacterial cellulose (BC), such as moisture absorption capacity, elasticity and tensile strength, largely depend on its structure. This paper presents a study on the effect of the drying method on BC films produced by Medusomyces gisevii using two different procedures: room temperature drying (RT, (24 ± 2 °C, humidity 65 ± 1%, dried until a constant weight was reached) and freeze-drying (FD, treated at − 75 °C for 48 h). BC was synthesized using one of two different carbon sources—either glucose or sucrose. Structural differences in the obtained BC films were evaluated using atomic force microscopy (AFM), scanning electron microscopy (SEM), and X-ray diffraction. Macroscopically, the RT samples appeared semi-transparent and smooth, whereas the FD group exhibited an opaque white color and sponge-like structure. SEM examination showed denser packing of fibrils in FD samples while RT-samples displayed smaller average fiber diameter, lower surface roughness and less porosity. AFM confirmed the SEM observations and showed that the FD material exhibited a more branched structure and a higher surface roughness. The samples cultivated in a glucose-containing nutrient medium, generally displayed a straight and ordered shape of fibrils compared to the sucrose-derived BC, characterized by a rougher and wavier structure. The BC films dried under different conditions showed distinctly different crystallinity degrees, whereas the carbon source in the culture medium was found to have a relatively small effect on the BC crystallinity.
The deformation and damage laws of non-homogeneous irregular structural planes in rocks are the basis for studying the stability of rock engineering. To investigate the damage characteristics of rock containing non-parallel fissures, uniaxial compression tests and numerical simulations were conducted on sandstone specimens containing three non-parallel fissures inclined at 0°, 45° and 90° in this study. The characteristics of crack initiation and crack evolution of fissures with different inclinations were analyzed. A constitutive model for the discontinuous fractures of fissured sandstone was proposed. The results show that the fracture behaviors of fissured sandstone specimens are discontinuous. The stress–strain curves are non-smooth and can be divided into nonlinear crack closure stage, linear elastic stage, plastic stage and brittle failure stage, of which the plastic stage contains discontinuous stress drops. During the uniaxial compression test, the middle or ends of 0° fissures were the first to crack compared to 45° and 90° fissures. The end with small distance between 0° and 45° fissures cracked first, and the end with large distance cracked later. After the final failure, 0° fissures in all specimens were fractured, while 45° and 90° fissures were not necessarily fractured. Numerical simulation results show that the concentration of compressive stress at the tips of 0°, 45° and 90° fissures, as well as the concentration of tensile stress on both sides, decreased with the increase of the inclination angle. A constitutive model for the discontinuous fractures of fissured sandstone specimens was derived by combining the logistic model and damage mechanic theory. This model can well describe the discontinuous drops of stress and agrees well with the whole processes of the stress–strain curves of the fissured sandstone specimens.