Purpose: To develop a tool to assist the decision-making for selection of Thrombopoyetin Receptor Agonists of adult patients with chronic immune primary thrombocytopenia (PTI). Methods: Stochastic cost-effectiveness analysis with a 6-Health-States Markov model: stable, bleeding type 2, 3 or 4, post-type 4 bleeding and death. Each simulation analyzes a randomly generated scenario that describes patients characteristics, results measured in quality adjusted life years (QALYs) and costs (in €2011). Distributions were obtained from the Spanish data of the European health survey of 2009, the INE estimate of population for 2011 and the 6-months clinical studies for Eltrombopag and Romiplostim. Utility values were obtained from the literature and the costs from Spanish official rates lists. A set of 10.000 random scenarios were generated and the patients evolution of each scenario was simulated during a time horizon of five years (in 2-weeks cycles). National Health System Perspective was used and the annual discount rate was set at 3%. Results: Eltrombopag showed more effectiveness in 9.983 scenarios and there was no difference in 17. In 7.048 scenarios the alternative Eltombopag was dominant. It was cost-effective in another 19 (threshold 30,000 € /AVAC). Conclusions: Eltrombopag was the most cost-effective alternative in 70,67% of the simulated scenarios and its use could produce lower costs to the NHS.

Objetivo: Desarrollar una herramienta de apoyo a la decisión en la selección de agonistas del receptor de trombopoyetina en el tratamiento de pacientes adultos con trombocitopenia inmune primaria crónica (PTI) refractaria. Métodos: Análisis coste-efectividad estocástico con un modelo de Markov de seis estados: estable, sangrado tipo 2, 3 ó 4, postsangrado 4 y muerte. Cada simulación analiza un escenario aleatoriamente generado que describe las características del paciente, los resultados medidos en años de vida ajustados a calidad (AVACs) y los costes (en €2011). Se obtuvieron distribuciones a partir de los datos para España de la Encuesta Europea de Salud de 2009, de la estimación de población para 2011 del INE, de los estudios a 6 meses de Eltrombopag y Romiplostim, de las utilidades obtenidas de la bibliografía y de las tarifas oficiales en España para procesos y actividad. Se generaron 10.000 escenarios aleatorios y se simuló la evolución de los pacientes de cada escenario durante un horizonte temporal de cinco años (ciclos de dos semanas). Perspectiva del Sistema Nacional de Salud (SNS). Tasa de descuento anual del 3% para costes y efectos. Resultados: En 9.983 escenarios Eltrombopag mostró mayor efectividad y en 17 no hubo diferencias. Eltombopag fue la alternativa dominante en 7.048 escenarios y la más coste efectiva en otros 19 (umbral 30.000 €/AVAC). Conclusiones: Eltrombopag es la alternativa más coste-efectiva en el 70,67% de los escenarios simulados, por lo que su uso podría producir menores costes al SNS.

Addition of lactose on whey to produce an alcoholic product by fermentation is optimized in order to maximise final ethanol concentrations and lactose consumption. The effect of the supplementation of the broth with yeast extract, ammonium sulphate, oxygen, protein, peptides and the vitamins nicotinic acid, biotin, pantothenic acid and inositol on aerobic cell growth was also studied. The Crabtree-negative yeast Kluyveromyces marxianus is employed in this study, so oxygen should enhance cell growth and reduce ethanol production. Addition of yeast extract, a source of vitamins, shifts metabolism towards fermentation. The same effect is observed when nicotinic acid and biotin are added to the medium. Individual and mixed effects of the four assayed vitamins are studied, showing that combinations of two or more vitamins diminished cell growth and lactose consumption and increased ethanol production.

Polymeric cation exchange membranes (PEMFC) are used in fuel cell technology. These membranes act as a physical barrier between anode and cathode, but diffusion through the membrane should allow protons to be carried from anode to cathode at a rate sufficient to supply energy requirements. They avoid any direct reaction of oxygen and hydrogen that would diminish fuel cell efficiency. Membranes have to be conditioned before use. This conditioning step changes membrane counterions and modifies their water content, which has an effect on their diffusion coefficients. In order to analyse and quantify the effect of conditioning techniques on membrane performance various experiments with Nafion 117 cation exchange membranes were carried out. Membranes were conditioned using various methods to change the charged cation in the membrane. The reactives used were ultrapure water, nitric acid, hydrochloric acid, hydrogen peroxide, sodium chloride, potassium chloride and ethylene glycol, all at room temperature. Some conditioning methods were carried out using solvents heated to 100 ºC. Water content was indirectly monitored by measuring membrane swelling. Results show that membrane conditioning with strong acids followed by treatment with water increases membrane water content by about 5%. Using high-temperature treatment the water content also increases. Water uptake or release from membranes is analysed in terms of water activity.