Trends and Expertise Exchange within Rapid Manufacturing in Europe

Rapid Manufacturing (RM) umfasst den Begriff der direkten und wirtschaftlichen Bauteilherstellung des Serienprodukts aus 3D-Daten. Die Hauptvorteile sind u.a. das Wegfallen von Werkzeugen und eine Designfreiheit in der Produktentwicklung, die noch vor wenigen Jahren undenkbar war. Wenngleich heute eine Vielzahl von Werkstoffen im Kunststoff- und Metallbereich einsetzbar sind, konzentriert sich die Verbreitung des RM allerdings auf besondere Technologie- und Wirtschaftszweige, aufgrund mangelnder Erfahrungswerte, teilweise abweichender Werkstoffeigenschaften, fehlender Standards und ungeeigneter Testmethoden. In der Praxis sind Ingenieure und Techniker stark darauf bedacht, auf etablierte Abläufe und Standards zurückzugreifen. Es ist daher schwer einen geeigneten RM-Prozess aufzubauen, wo wichtige Eingangsgrößen meist unbekannt sind. In diesem Bericht wird beschrieben, welche Informationskanäle es innerhalb Europas zum Thema RM gibt und welche Hochschulen und Forschungszentren Aktivitäten aufweisen. Darüber hinaus werden Anwendungsfelder des RM aufgeführt, die über die bekannten Anwendungsfelder hinaus gehen. Dazu gehören Anwendungen im Bereich der Elektrotechnik, Raumfahrtinstrumentation und der Mode. Obwohl nicht alle Anwendungen des RM in diesem Bericht aufgeführt werden, sind einige Schlüsselinformationen im Bereich innovativer Anwendungen von RM enthalten.

Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization

OBJECTIVES The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. BACKGROUND Since its commercialization in 2007, the number of TAVR procedures has grown exponentially. METHODS The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. RESULTS Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002). CONCLUSIONS The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study

Background Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004–2010, and described subsequent mortality and predictors of these. Methods Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient’s last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient’s death, 1st February 2010 or 6 months after the patient’s last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression. Results Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin’s lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004–2010 in this large observational cohort. Conclusions The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC.