Simoldes : the impact of additive manufacturing : 3D printing technology

This case study provides an overview of the automobile industry, Simoldes and the emergence of additive manufacturing technology, also known as 3D printing. The goal of this master’s degree dissertation is to conduct a strategic analysis of Simoldes taking into account the implications of incorporating additive manufacturing technology into the company´s value chain. Understanding what advantages additive manufacturing can bring to Simoldes strategy is fundamental. Different management approaches regarding this technology are provided at the end of the case. Should Simoldes not adopt this technology, or should they proactively incorporate additive manufacturing into its manufacturing process? This is the main subject to the discussed on this master’s dissertation thesis. In the teaching notes section, there is a set of questions with a proposed resolution. From this analysis, it is possible to see several benefits that additive manufacturing can bring to Simoldes. Efficiencies in time and costs are the main potential advantages. Incorporation of this technology into Simoldes manufacturing processes is the recommended outcome of this case study.Este caso de estudo mostra uma visão geral da indústria automóvel, da empresa Simoldes e do surgimento da tecnologia de fabricação aditiva, também conhecida como a impressão 3D . O objetivo desta dissertação de mestrado é a da realização de uma análise estratégica da empresa Simoldes tendo em conta as implicações da incorporação da tecnologia de fabricação aditiva na sua cadeia de valor. Entender as vantagens que esta tecnologia pode trazer para a Simoldes é um dos aspectos fundamentais. Diferentes abordagens em relação a esta tecnologia são fornecidos no final do caso. Deverá a Simoldes não adotar essa tecnologia , ou deverá incorporar de forma proactiva a fabricação aditiva nos seus processos de produção ? Este é o principal aspecto a ser discutido nesta dissertação de mestrado. Na secção de notas de ensino , há um conjunto de perguntas com uma proposta de resolução. A partir desta análise , é possível observar vários benefícios que a fabricação aditiva pode trazer para a Simoldes. Ganhos de eficiência no tempo e nos custos são as principais e potenciais vantagens. A incorporação desta tecnologia em processos de fabricação Simoldes é o resultado recomendado deste caso de estudo

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology

BACKGROUND: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. METHODS: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). RESULTS: We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). CONCLUSIONS: The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI..info:eu-repo/semantics/publishedVersio

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy