Jesus was the greatest brand of his time. It’s just no one really realized it.
Except (of course), his marketing team who were behind some of his best stunts, like changing water into wine, healing the blind, and the whole thing with feeding the multitude of people with a few loaves of bread. And all this with no media buying whatsoever!
In this video an ad agency imagines what it might’ve been like if Jesus had the slick media executives and creatives that brands have now. Creatives who suggest things like, “it might be beneficial if the Savior walks on water for his next trick”, which he’s naturally a little apprehensive about. But he’s the Lord, he can do anything.
Jesus deliberates this latest stunt and says, “But if I die doing this, you’d better bring me back to life”. After a dramatic pause the marketing team responds, “We can do that!” ….and the rest is history.
3-D PRINTED TITANIUM IMPLANTS THAT PARTICIPATE IN THE HEALING PROCESS
Porous surfaces
In orthopedic implants it is common to create porous surfaces designed to promote ‘osseointegration’ – where a patient’s bone is encouraged to fuse with the metal implant to secure it firmly in place. The implant’s surface is covered with a carefully designed layer of lattice, which has the optimum spacing and strut thickness to enable living bone to grow into it and form a strong, load-bearing bond with the metal device.
Image above – SEM image of the porous surface of an acetabular cup.
So lattices have a number of attractive qualities, although their complexity and delicacy can make them challenging both to design and to manufacture.
Lattice design
Most lattice materials are made up of arrays of slender members that resemble familiar lightweight super-structures such as bridges and building frames, but obviously on a much smaller scale. These complex meso-structures can be produced additively in length scales that vary from microns to millimetres.
Image above – Cubic lattices with various length scales. The minimum producible scale is limited by the smallest strut thickness that can be manufactured on an additive machine, which can be as little as 140 microns on a laser powder-bed fusion machine with a 70 micron laser spot size.
Lattice structures can be regular (such as the cubic lattices shown above) or irregular, and designed to provide either homogeneous or heterogeneous properties. The length scale can vary throughout the lattice volume to tailor its properties – particularly its density and stiffness – in different locations.
Image above – Sectioned femur in which the internal trabeculae form an elegant three-dimensional latticework that mimics the structures seen in natural bones. The length scale and strut thickness vary throughout the lattice volume.
Lattice types
The choice of lattice geometry is critical to effective light-weighting, enabling porous materials that approach the strength of their solid counterparts, yet at far lower densities. Some porous structures such as foams are light, but not all that strong. Their structures are said to be ‘bending-dominated’, so that loads applied to the macro-structure are resisted by bending of the struts in the meso-structure. This makes them compliant and good for energy absorption.
By contrast, lattices that are ‘stretch-dominated’ carry their loads axially along the struts, either in tension or compression. Such structures are characterized by high levels of node connectivity, providing cross-bracing to prevent relative motion of the nodes. These ‘space frame’ meso-structures, like their large-scale architectural equivalents, provide the best strength-to-weight ratio.
Image above – The bending-dominated structure (on the left) is much weaker than the stretch-dominated structure (on the right).
Gyroids
Not all lattice materials comprise simple strut-and-node arrangements. Gyroids are triply periodic structures, built up of small cells of curved ‘minimal’ surfaces that repeat in all directions to form a regular structure. In certain circumstances, these structures can have higher specific strengths than regular diamond lattices. Image from Wikipedia.
Image above – gyroid lattice structures.
Architectured materials
Thanks to the flexibility of additive manufacturing, we can now design and build ‘architectured materials’ in which the meso-structure has been tailored to provide specific mechanical properties.
Image above – Architectured material with heterogeneous properties. Its fibrous structure exhibits, like a composite, different stiffness in different directions.
Hybrid lattice structures
As we have seen above, lattices can be integrated neatly into product designs. They can also be combined with other weight-saving techniques such as topological optimization. The super-structure of the part can be shaped using generative design, with further weight-saving gains achieved by applying a lattice meso-structure onto some of the super-structure.
Image above – An architectural ‘spider’ bracket from titanium combines topological optimization with lattice materials to minimize component mass. ww.youtube.com/watch?v=WMCR6VBSV-E
Image above – cross-section of the spider bracket showing the combination of solid and lattice structures.
Lattice build preparation
A key computational challenge for the additive manufacturing of lattices is how these complex structures are represented and converted into a build file. Most additive components are designed in 3D CAD and then converted into a triangulated surface format (STL). These STL models are then sliced into thin layers from which we compute the laser paths needed to build up the part.
If we take this approach with lattices, especially those with a small length scale, then we quickly run into enormous models and interminable build file preparation. Specialists in lattice design and additive manufacture are looking at ways to simplify the generation and manufacture of such complex geometries through novel representations and custom laser exposure strategies.
Image above – Fine struts in additively manufactured lattices are best built with custom exposure strategies for better mechanical performance and faster build times.
Lattice manufacturing
Manufacturing of fine details requires precise control of the laser energy, as the melting on each layer of the lattice build often comprises thousands of sparsely distributed exposures. There currently is at least one system that features a modulated laser focused down to 70 microns spot size, enabling production of struts and walls as thin as 140 microns.
Image above – A volume of 8,000 cubic cm of architectured material made from Ti6Al4V.
Future challenges
For all their attractions, there remain some barriers to deploying lattices in production parts. A key challenge is to substantiate the suitability of the design for stressed applications, particularly where fatigue is the critical performance attribute. By necessity, lattices contain lots of ‘as built’ surfaces and sharp intersections, which create stress raisers. To balance this out, lattices have a lot of built-in redundancy, and so may not fail catastrophically.
These characteristics make structural parts with load-bearing lattices best suited to applications where the loads are either constant or single, dynamic events. Cyclical load bearing applications look likely to be a little further off.
A related concern is how to validate lattice quality in manufacturing. The complexity and inaccessibility of lattice features makes them hard to inspect. CT scanning offers a solution, albeit a somewhat time-consuming one. The best answer here is likely to be in-process monitoring, so that we can demonstrate that each element of the lattice material has been built correctly.
Summary
Complex lattice structures can deliver exceptional product performance – both in efficiency and functional terms. They are key tools in component light-weighting, and can also boost heat transfer, energy absorption, insulation and joining performance. Careful lattice design can introduce precisely tailored properties into efficient components.
Additive manufacturing is often the only practical way to produce such intricate materials. A great amount of detail needs to be invested in investigating the latest software tools and selection of an AM machine that is optimized for fine detail work.
Dr. Willem Zeegers Pioneer of Total Disc Replacement Passes Away
Dr. Willem Zeegers, a pioneer of total disc replacement (TDR)/artificial disc replacement (ADR), passed away on September 20, 2017 at the age of 72.
Dr. Zeegers is survived by his two daughters, Susan and Heleen, his son, Olivier, his two brothers, Hans and Maarten, as well as his life partner, Branka.
A family memorial service was held on September 25, 2017 prior the cremation at Crematorium Imstenrade, Heerlen, Netherlands.
Born on April 11, 1945 in Maastricht, Netherlands, Willem Zeegers came to devote his life to medicine, becoming an orthopaedic and inventer. He was one of the first surgeons to use STALIF (standalone lumbar fusion).
A longtime friend, Roberto Posavec, M.Econ, says, “His special contribution is definitely in [the] field of TDR/ADR…many surgeons from the U.S. started ADR surgery after watching Willem (for example Texas Back Institute). Willem started with ADR in 1989.”
Recalling Dr. Zeegers’ integrity with a story, Posavec says, “About 25 years ago Willem visited Zagreb, Croatia. He was invited to perform first the lumbar artificial disc replacement (ADR) in Croatia. The event organizer invited politicians, the mayor, and several journalists to cover this story. When Willem arrived, he found that he had been tricked. It was not the patient he was supposed to operate on. This patient did not have clear indications for ADR, so Willem turned around and left the hospital!”
“Willem was a consummate instructor, and unselfishly shared his knowledge and wisdom with physicians from around the globe. In his career he performed over 3,100 implantations of artificial discs. I believe the peak of his career was from 2000-2008 in famous ALPHA KLINIK in Munchen, Germany.
One of Dr. Zeegers’ patients, Robert Giesen, wrote, “Dear Willem, The first time I came for a treatment was in 1986 and you noticed immediately that my back was in bad condition after an operation by another surgeon. You have been working for three years on a solution for my back, before you decided in 1989 to implant two artificial discs. I was the first patient for this kind of operation for you. I will never forget that you sat on my bed, talking to me, explaining the whole operation after you had to cancel it two times. You were so confident that it would be possible, that is was the best solution. That is why I can still walk, even you performed five surgeries after this operation, but it was necessary. You were a great lovely person who really cared about his patients. RIP my friend and thanks for everything you did for me.”
Source:
Orthopedics This Week
Elizabeth Hofheinz, M.P.H., M.Ed.
October 12th, 2017
The majority of the spine market – about 80% – is controlled by companies with annual spine revenue above $100 million.
For 2016, ORTHOWORLD estimated revenue from spinal implants and instrumentation to be $8.8 billion, up 2% vs. 2015. (This figure excludes orthobiologics.) When they published their ORTHOPAEDIC INDUSTRY ANNUAL REPORT® in May, they projected 2017 spine revenue at $9.0 billion – an increase of approximately 2%, supported by increased reimbursement for novel devices, M&A among larger companies, utilization of MIS and surgical assistance technologies, etc.
The U.S. market for spinal implants continued to expand in terms of both market value and procedure volumes in 2016. Despite declines in certain traditional segments, both demographic trends and emerging technologies ensured overall growth. Growth in overall revenues for the traditional, non-miminally invasive spinal implant device market (which includes cervical and thoracolumbar fixation, interbody devices, motion preservation devices, vertebral compression fracture devices, electrical stimulation, and instrumentation) is expected to remain stable throughout the forecast period. The only traditional spine segment exhibiting decline was thoracolumbar fixation, due to decreasing prices and the rising preference for alternative devices.
US (Standard) Spine Device Market – 2013-2023
The market growth of minimally invasive device segments is expected to outpace that of traditional segments. MIS approaches such as lateral lumbar (LLIF) and oblique lumbar (OLIF) interbody fusion are expected to increase their procedure volumes significantly. However, decreasing pricing will somewhat offset the growth seen in market value. Growth of the total minimally invasive device market is expected to slow down over the coming years as the market stabilizes. Overall, the patient base will continue to grow driven by key demographic trends, which in turn strongly incentivizes hospitals and manufacturers alike to develop and update their product lines.
Demographics Spurs Growth in Established Product Segments
In 2017, the demographic of those aged 65 years or more is expected to remain the fastest-growing population in the U.S., increasing more rapidly than the general population. The majority of patients requiring surgical spine treatments fall into this demographic, and this proportion grows further when considering Americans aged 50 years or more. This baby boomer demographic typically leads more active lifestyles than previous generations, and as such is more likely to pursue surgical solutions to spinal issues. This driver is reinforced by another rising demographic: the proportion of the population classified as obese. This condition places strain on the back and can lead to spinal issues, thus increasing the demand for spinal surgical products.
Standard cervical and thoracolumbar fixation devices, as well as standard interbody devices, continue to make up some of the largest product segments in the overall U.S. spinal implant market. The interbody device segment is expected to become the largest by 2023. Of these segments, only the thoracolumbar fixation segment is expected to see a negative compound annual growth rate (CAGR). This is mostly due to the decline in unit sales of single-level degenerative fixation. The cervical fixation market is expected to see strong growth in the posterior fixation segment, resulting from strong unit sales increases of screw/rod products as they continue to displace remaining cable/wire products. Occipitocervical posterior fixation is also expected to see growth in sales volume.
The standard interbody device market has been the most affected by the emergence of new technologies, particularly minimally invasive interbody products and motion preservation. Nevertheless, growth in certain segments is expected to drive overall growth in market value. The market values of the TLIF and CIF market segments, as well as the VBR/corpectomy segment are all expected to see growth, as are interbody procedure volumes for each of these approaches. Furthermore, growth is expected to continue in both the standalone and expandable interbody device segments, with the market value for expandable devices holding a projected CAGR of over 10%. These projections result in a market which makes up for losses in the ALIF and PLIF segments.
Further Cannibalization by Motion Preservation, Minimally Invasive Technologies
The growing patient base in the U.S. has also led to the development of new and sometimes controversial technologies. The motion preservation device market, which includes both artificial discs and dynamic stabilization devices, has continued to remain a major growth segment in 2016. Motion preservation devices are defined by their ability to preserve the spine’s natural motion post-implantation, unlike with traditional interbody devices; both segments are expected to see strong growth into the near future.
Minimally Invasive Device Market – 2013-2023
Minimally invasive technologies are also expected to play an increasing role in spine procedures in the United States. In particular, lateral and oblique approaches (LLIF and OLIF, respectively) have generated growing interest and use by hospitals. Thus, LLIF and OLIF procedure volumes are projected to outpace both standard procedures and minimally invasive PLIF and TLIF counterparts in their cumulative average growth rate for the forecast period ending in 2023.
The LLIF segment of the market has been driven by the popularity of NuVasive’s XLIF® procedure. As popularity grows and more products are released in the coming years, the trend of falling prices is expected to continue generating interest. In 2016, more than ten products were available using this approach. The OLIF segment is comparatively newer, and is designed to access L4-L5 levels effectively without having to flip patients as in ALIF or PLIF approaches. In 2016, OLIF procedure volumes were measured at approximately one-third of the number of LLIF procedures. Nevertheless, this segment is also expected to continue growing, counting Globus Medical, Medtronic, and DePuy Synthes among its largest competitors.
Competitive Landscape is Diverse, but Large Competitors Continue to Expand
The competitive landscape for the U.S. spinal implants industry is characterized by a diversity of sizes and specializations. Large multi-segment competitors such as Medtronic and DePuy Synthes operate side by side with numerous small companies specializing in one or two products. Despite increasing competition, large manufacturers have been able to maintain their leading shares over the past several years for a number of reasons. First, pricing caps and regulatory costs are easier for larger corporations to adapt to, as they will have greater resources to invest in development and consistent supply chains. Second, the larger budgets and supply chains of these companies allows them to more easily acquire potential rivals, invest in emerging technologies, and exercise market power.
Nevertheless, other companies have also managed to gain ground, especially due to a continuing shift in preference for newer techniques. While traditionally many interbody fusion procedures have focused on posterior and anterior approaches, the TLIF, LLIF and OLIF approaches are becoming increasingly popular. NuVasive, which is present in both the minimally invasive and motion preservation device segments, has seen considerable growth in past years by putting a focus on such emerging trends.
Overall, it is expected that the above trends will continue into the foreseeable future. As newer technologies and approaches continue to cannibalize traditional devices, smaller companies which focus their investments accordingly will stand to gain alongside large, established competitors.
Across the medical device industry, the role of a product manager has far-reaching responsibilities within a given organization. Accountability from a product’s conceptualization through the end of its life cycle presents challenges that require a proactive approach to risk and life cycle management.
Product development is the art and science of understanding what to build and why to build it. Part marketer, part engineer, part sales, and part project manager, the product manager must lead engineering, surgeon consultant, regulatory, compliance, finance, and marketing teams from concept through commercialization; navigating patent, FDA and International regulatory compliance, market access, and reimbursement landscapes.
Product managers are responsible for surpassing financial contribution targets through strategic product differentiation and satisfaction of unmet user and clinical needs by increasing procedural efficiency and improving patient outcomes.
Proactive communication is a trait of successful product managers in order to clearly define expectations and create organizational alignment to deliver projects within a designated budget and timeline while ensuring conformity to regulatory, compliance, and company policy / procedure requirements.
Did I mention communication? Here’s a great example demonstrating why communication is vital to successful development of any product.
Product Management Quotes From A Few Well-Know Leaders
“If you are not embarrassed by the first version of your product, you’ve launched too late.” – Reid Hoffman, LinkedIn
“Make every detail perfect and limit the number details to perfect.” – Jack Dorsey, Square
“If you continue to improve a product enough, you’ll eventually ruin it.” – David Pogue, the New York Times
KEY POINT: It’s better to go to market today with an 80% solution, than wait for a 100% solution tomorrow.
Many organizations still struggle to answer this question. While the roles of the project and product manager vary from company to company, there are some unique characteristics that characterize the two.
A lot of project managers look up to program managers and aspire to be in their shoes one day. In order to be able to get to that level, project managers, as well as their organizations, must clearly understand the general responsibilities that are expected from each role. Organizations can then communicate them to their employees, allowing them to train themselves and set goals accordingly.
What is Project Management?
By definition, project management is the application of knowledge, skills, tools and techniques to project activities, to meet project requirements.
The job focus of the project manager is both narrower and deeper than that of the program manager. Project managers are responsible for the project, the project team, and the outcomes the team is working on.
What is a project?
Projects include:
A sequence of tasks
Defined outcomes, and deliverables
Defined beginning, end, schedule, and approach
Planned budgets
Resources specifically allocated to the work
Organized approach
What is Program Management?
The Project Management Institute (PMI) defines program management as:
“A group of related projects managed in a coordinated way to obtain benefits and control not available from managing them individually. Programs may include elements of related work outside scope of the discrete projects in the program.” – PMBOK pg 368
What is a program?
According to Wiki Answers, “ a program is something which delivers a massive piece of functionality. Within this program will be a large number of individual projects each of which will deliver a specific piece of the functionality. When all these projects have delivered, all their pieces will make the big deliverable.”
Programs include:
A single product or deliverable
Many product deliverables
Usually focuses on business objectives and delivering value
Benefit management
Project management vs Program management
Project managers:
Focus on content
Manage projects
Focus on scope, schedules, resources
Perform more technical tasks
Handle risk management
Deal with project requirements
Are responsible for ensuring projects get completed on time, within budget
Program managers:
Focus on context
Manage portfolios
Focus on people, politics and negotiating
Perform more strategic tasks
Handle change management (program and environmental changes)
Deal with business strategies and objectives
Are responsible for maximizing ROI and value delivery
Even though there are many similarities between the project manager and program manager roles, being able to tell what sets them apart can help companies be more productive and deliver better results.
How to Lead When You’re Not In Charge – Pt. 2 of 2
BOTTOM LINE:
Anyone can leverage their influence, even when they lack authority.
KEY TAKEAWAYS:
Everyone is in charge of something—something they are responsible for doing. As a person understands that responsibility, they have the potential to make it better by leveraging whatever influence they have within that responsibility.
1. Leading Yourself
You don’t have to be in charge to take charge.
Take charge of your own development; leading yourself is your responsibility.
If you lead yourself well, you ensure that you’ll always be well led.
2. Choosing Positivity
The greatest thing you can bring to your team is not your education, experience, insight, or ideas. The greatest thing you can bring to your team is the energy of a positive attitude.
Positivity is powerful and adds value.
When leading without authority, these two questions will define your approach:
3. Think Critically
Critical thinkers notice things, question things, and connect things..
You want to think critically without being critical.
4. Reject Passivity
Not being in charge can result in feeling out of control, and when you feel out of control there is a natural drift toward passivity.
Avoid passivity by:
i. Choosing something—find a way to add value.
ii. Planning well—never present a problem without a solution in mind.
iii. Responding to the boss—anticipate what is important to the boss.
QUESTIONS FOR REFLECTION OR TEAM DISCUSSION:
1. In what areas am I being critical rather than thinking critically? What can I do to improve in those areas?
2. In what ways can I overcome the drift toward passivity and take action in my work?
3. What problem/issue is most important to my boss right now? In what ways can I respond to their concerns?
RESOURCES MENTIONED:
1. How To Lead When You’re Not in Charge by Clay Scroggins
How to Lead When You’re Not In Charge – Pt. 1 of 2
BOTTOM LINE:
Anyone can leverage their influence, even when they lack authority.
KEY TAKEAWAYS:
Everyone is in charge of something—something they are responsible for doing. As a person understands that responsibility, they have the potential to make it better by leveraging whatever influence they have within that responsibility.
1. Leading Yourself
You don’t have to be in charge to take charge.
Take charge of your own development; leading yourself is your responsibility.
If you lead yourself well, you ensure that you’ll always be well led.
2. Choosing Positivity
The greatest thing you can bring to your team is not your education, experience, insight, or ideas. The greatest thing you can bring to your team is the energy of a positive attitude.
Positivity is powerful and adds value.
When leading without authority, these two questions will define your approach:
Not helpful: “How can I lead when I don’t have all the authority I need?”
Helpful: “How should I lead with the opportunity I have?”
QUESTIONS FOR REFLECTION OR TEAM DISCUSSION:
1. What am I in charge of, and how can I create an “oasis of excellence” for those areas?
2. How well am I leading myself? In what ways can I better lead myself?
3. How can I improve my attitude toward projects that I have not had a chance to weigh in on, but for which I am responsible?
RESOURCES MENTIONED:
1. How To Lead When You’re Not in Charge by Clay Scroggins
2. The Advantage by Patrick Lencioni
The market growth of minimally invasive device segments is expected to outpace that of traditional segments. MIS approaches such as lateral lumbar (LLIF) and oblique lumbar (OLIF) interbody fusion are expected to increase their procedure volumes significantly. However, decreasing pricing will somewhat offset the growth seen in market value. Growth of the total minimally invasive device market is expected to slow down over the coming years as the market stabilizes. Overall, the patient base will continue to grow driven by key demographic trends, which in turn strongly incentivizes hospitals and manufacturers alike to develop and update their product lines.
Minimally invasive technologies are also expected to play an increasing role in spine procedures in the United States. In particular, lateral and oblique approaches (LLIF and OLIF, respectively) have generated growing interest and use by hospitals. Thus, LLIF and OLIF procedure volumes are projected to outpace both standard procedures and minimally invasive PLIF and TLIF counterparts in their cumulative average growth rate for the forecast period ending in 2023.
