Castolin Eutectic (Ireland)

Powder spreading is a crucial step in the powder bed fusion process, which controls the quality of powder bed and consequently affects the quality of printed parts. To date, however, powder spreadability has received very little attention and substantial fundamental work is still needed, largely because of the lack of experimental studies. Therefore, the focus of the present study addresses the influences of powder morphology, spreading velocity and layer thickness on the powder bed topography uniformity. The experiments were conducted with a laser powder bed fusion printer and the powder layers were spread systematically and comprehensively assessed. In summary, it was found that particle sphericity and surface texture dictates the degree of impact that the spreader velocity and the layer thickness exert on the quality of powder bed topography in spread layers. The spreader velocity has substantial influence on powder bed uniformity, such that better uniformity is achieved with low spreading velocities, ≤ 80 mm/s. Powders with a wide particle distribution and containing large number of fine particles (< 25 µm) enabled formation of uniform and dense powder beds, however such powders were found to be more affected by segregation. In addition to these observed effects, for the first time, the major process related challenges to powder spreadability and powder bed quality are reported in this study.

Introduction: Direct oral anticoagulants (DOACs) are increasingly used as alternatives to warfarin for secondary prevention in ischemic stroke patients with atrial fibrillation. Despite demonstrated efficacy in clinical trials, there are few real-world experiences of DOACs vs. warfarin in community practice. Methods: We analyzed ischemic stroke survivors with atrial fibrillation discharged from the Get With The Guidelines Stroke hospitals between 2011-2014 and linked to Medicare claims for longitudinal outcomes through 2015. A propensity score overlap weighting method was used to compare DOACs vs. warfarin. The primary outcomes were major adverse cardiovascular events (MACE) and home time, a patient-centered outcome reflecting desire of “being alive at home, without recurrent stroke, or being hospitalized for complications.” Results: Among 11,662 stroke survivors (median age 80), 4,041 (34.7%) were discharged on DOACs (dabigatran, rivaroxaban, or apixaban) and 7,621 on warfarin. Except for NIHSS (median 4 [IQR 1-9] vs. 5 [2-11]), baseline demographics, medical history, and clinical characteristics were similar between two cohorts. Compared with warfarin, patients discharged on DOACs were less likely to experience MACE (33.95% vs. 40.36% per year, adjusted hazard ratio 0.89, 99% CI 0.83-0.96) and had more days at home (mean 287 vs. 263 days during the first year post discharge, adjusted difference 15.6 days, 99% CI 9.0-22.1) ( Table ). Additionally, there were fewer deaths, all-cause readmissions, cardiovascular readmissions, hemorrhagic strokes, and bleeding hospitalizations in DOAC-treated patients, although no significant differences in fatal bleeding, ischemic stroke readmission, systemic embolism, pneumonia, or sepsis (two negative outcome controls) between the two cohorts. Conclusions: In ischemic stroke survivors with atrial fibrillation, DOACs were associated with improved long-term clinical outcomes compared with warfarin.

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