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Despite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.
A state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.
At 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.
In the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.
Modern nanomaterials contain complexity that spans all three dimensions—from multigate semiconductors to clean energy nanocatalysts to complex block copolymers. For nanoscale characterization, it has been a long-standing goal to observe and quantify the three-dimensional (3D) structure—not just surfaces, but the entire internal volume and the chemical arrangement. Electron tomography estimates the complete 3D structure of nanomaterials from a series of two-dimensional projections taken across many viewing angles. Since its first introduction in 1968, electron tomography has progressed substantially in resolution, dose, and chemical sensitivity. In particular, scanning transmission electron microscope tomography has greatly enhanced the study of 3D nanomaterials by providing quantifiable internal morphology and spectroscopic detection of elements. Combined with recent innovations in computational reconstruction algorithms and 3D visualization tools, scientists can interactively dissect volumetric representations and extract meaningful statistics of specimens. This article highlights the maturing field of electron tomography and the widening scientific applications that utilize 3D structural, chemical, and functional imaging at the nanometer and subnanometer length scales.
Electron microscopy is uniquely suited for atomic-resolution imaging of heterogeneous and complex materials, where composition, physical, and electronic structure need to be analyzed simultaneously. Historically, the technique has demonstrated optimal performance at room temperature, since practical aspects such as vibration, drift, and contamination limit exploration at extreme temperature regimes. Conversely, quantum materials that exhibit exotic physical properties directly tied to the quantum mechanical nature of electrons are best studied (and often only exist) at extremely low temperatures. As a result, emergent phenomena, such as superconductivity, are typically studied using scanning probe-based techniques that can provide exquisite structural and electronic characterization, but are necessarily limited to surfaces. In this article, we focus not on the various methods that have been used to examine quantum materials at extremely low temperatures, but on what could be accomplished in the field of quantum materials if the power of electron microscopy to provide structural analysis at the atomic scale was extended to extremely low temperatures.
Consumption of sugar-sweetened beverages (SSB) by infants and young children are less explored in Asian populations. The Growing Up in Singapore Towards healthy Outcomes cohort study examined associations between SSB intake at 18 months and 5 years of age, with adiposity measures at 6 years of age. We studied Singaporean infants/children with SSB intake assessed by FFQ at 18 months of age (n 555) and 5 years of age (n 767). The median for SSB intakes is 28 (interquartile range 5·5–98) ml at 18 months of age and 111 (interquartile range 57–198) ml at 5 years of age. Association between SSB intake (100 ml/d increments and tertile categories) and adiposity measures (BMI standard deviation scores (sd units), sum of skinfolds (SSF)) and overweight/obesity status were examined using multivariable linear and Poisson regression models, respectively. After adjusting for confounders and additionally for energy intake, SSB intake at age 18 months were not significantly associated with later adiposity measures and overweight/obesity outcomes. In contrast, at age 5 years, SSB intake when modelled as 100 ml/d increments were associated with higher BMI by 0·09 (95 % CI 0·02, 0·16) sd units, higher SSF thickness by 0·68 (95 % CI 0·06, 1·44) mm and increased risk of overweight/obesity by 1·2 (95 % CI 1·07, 1·23) times at age 6 years. Trends were consistent with SSB intake modelled as categorical tertiles. In summary, SSB intake in young childhood is associated with higher risks of adiposity and overweight/obesity. Public health policies working to reduce SSB consumption need to focus on prevention programmes targeted at young children.