Currently the advances in the field of 3D printing are causing a revolution in the (bio-)medical field. With applications ranging from patient-specific anatomical models for surgical preparation to prosthetic limbs and even scaffolds for tissue engineering, the possibilities seem endless. Today, the most widely used method is FDM printing. However, there is still a limited range of biodegradable and biocompatible materials available. Moreover, printed implants like for instance cardiovascular stents require higher resolution than is possible to reach with FDM. High resolution is crucial to avoid e.g. bacterial growth and aid to mechanical strength of the implant. For this reason, it would be interesting to consider stereolithography as alternative to FDM for applications in the (bio-) medical field. Stereolithography uses photopolymerizable resins to make high resolution prints. Because the amount of commercially available resins is limited and hardly biocompatible, here we investigate the possibility of using acrylates and vinylesters in an effort to expand the existing arsenal of biocompatible resins. Mechanical properties are tailorable by varying the crosslink density and by varying the spacer length. To facilitate rapid production of high-resolution prints we use masked SLA (mSLA) as an alternative to conventional SLA. mSLA cures an entire layer at a time and therefore uses less time to complete a print than conventional SLA. Additionally, with mSLA it takes the same time to make 10 prints as it would to make only one. Several formulations were prepared and tested for printability and mechanical strength.
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The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.
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ObjectiveTo compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction.MethodsCost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER).ResultsSome 240 patients were included, and complete follow up was available for 206 patients (ER 111 , SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER.ConclusionER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.
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